The State of Hawai‘i, through its Medicaid agency, the Department of Human Services (DHS), Med-QUEST Division (MQD), is issuing this Request for Information (RFI) to seek information and comments to better understand options for third-party entities that can provide practice management and administrative support to non-traditional providers who have not historically documented and billed Medicaid for services. These providers may be engaged in housing- and nutrition-related services, pre-release services under the Reentry Program, and other social or community-based services that support Medicaid members’ health and well-being. MQD is exploring whether and how a third-party administrator (TPA) or similar entity (e.g., community care hub, network administrator, or other vendor model) could play two primary roles to support non-traditional providers including: • Capacity building supports to ensure their success as Medicaid providers (e.g., training and education, help desks); and • Core practice management services such as provider enrollment, credentialing and contracting, claims submissions and adjudication, and patient health data systems. Specifically, the purpose of this RFI is to gather information about: • The types of services and operating models that exist in the market today; • How other states and payers have structured TPA-like arrangements for nontraditional Medicaid providers; and • Perspectives on how similar models and supports could be leveraged in Hawai‘i.
