Managed Care Organization (MCO) for the Delivery of Managed Long-Term Care in GSR 3

The Wisconsin Department of Health Services (DHS), Division of Medicaid Services, through its Bureau of Procurement and Contracting, has issued a Request for Proposal (RFP S-1772 DMS-26) for Managed Care Organizations (MCOs) seeking certification to deliver managed long-term care under the Family Care and Family Care Partnership Programs within Geographic Service Region 3 (GSR 3) of Wisconsin. The purpose of the contract is to provide comprehensive managed long-term care services, including care management, eligibility determinations, quality management, and provider network oversight according to state and federal standards. The procurement is focused on ensuring program sustainability through sound financial planning, operational capacity, and regulatory compliance, with a contract start date projected for January 1, 2027. Proposals must include detailed financial projections, operational plans, and demonstrate fiscal stability and solvency meeting the Wisconsin Office of the Commissioner of Insurance (OCI) standards for HMOs or analogous solvency requirements for non-HMO entities. Vendors may propose alternate contract language but must generally accept standard state contract terms, submitting exceptions for consideration. Evaluation of proposals emphasizes a weighted scoring system prioritizing Program Requirements (64%), followed by Fiscal Requirements (31%), and Vendor Qualifications (5%), alongside minimum mandatory pass/fail criteria. The award will be based on the highest overall score using a trade-off process, potentially involving Best and Final Offers to determine best value. Vendors must submit responses compliant with Wisconsin statutes, DHS administrative rules, and Centers for Medicare and Medicaid Services (CMS) guidelines. The RFP outlines the necessity for organizational descriptions, financial statements, conflict-of-interest mitigation, and examples of prior managed care performance. Deliverables include completed financial projection templates and comprehensive narratives detailing operational approaches and enrollment assumptions. Submission requirements enforce a maximum 300-page limit, strict formatting rules, and the use of a digital procurement portal by the January 16, 2026 deadline. No physical goods packaging, shipping, or military standards apply, as this contract pertains solely to healthcare service delivery within approved geographic and network parameters.