Specifications include, but are not limited to: The Department of Social and Health Services (DSHS) contemplates awarding a sole source contract to Milliman, Inc. to provide actuarial services to set rates for the Program of All-Inclusive Care for the Elderly (PACE) DSHS requires a Contractor to perform the federally required actuary activities in 42 CFR 438.6, associated with setting actuarily sound rates. The actuary prepares the full risk rates for the PACE organization, does required analysis for service area expansions and new contractors, participates in and provides expert knowledge during rate negotiations, prepares the rates letter and necessary documentation and provides the analysis to Center for Medicare and Medicaid Services (CMS) questions required for PACE rate setting and rate changes. Milliman is uniquely qualified to analyse the data and produce the PACE capitated rate. Their actuarial staff have expertise in developing and calculating capitated medical and long-term care rates for PACE programs and managed care models in both WA and throughout the country. They have access to actuarial experts within the field and to other staff who have performed analyses for states with PACE programs. They are also very familiar with the CMS guidelines for the PACE rate calculations. Milliman has expert knowledge in the complex Long Term Support Services (LTSS) delivery system in WA state and has gained that knowledge through years of coordination with DSHS. Milliman is the actuary utilized by the Washington State Medicaid agency, Health Care Authority. Due to the contractual relationship between the Health Care Authority and Milliman, the department has less adminstrative burden to collect necessary medical information for submission to the actuary and the analysis of that data is already done under the Health Care Authority contract, resulting in reduction of duplication of work, alignment across programs and cost savings. Please note: This is a Sole Source Notification.
