Medicaid Administrative Claiming Support

The Department of Health, Executive Office on Aging in Hawaii is seeking a contractor to provide comprehensive technical, administrative, and operational support for the state’s Medicaid Administrative Claiming program, with a primary focus on operating and maintaining a federally compliant Random Moment Sampling system. The contractor will be responsible for developing and calculating quarterly Medicaid claims, delivering training and technical assistance to participating agencies including Area Agencies on Aging and Aging and Disability Resource Centers, and ensuring all activities align with federal Medicaid guidelines and state laws under Hawaii Administrative Rules Chapters 3-123 and 3-126, as well as Generally Accepted Accounting Principles. The contract is structured as a cost-reimbursement agreement with a total estimated value of $350,000 over an initial two-year term, potentially extendable by mutual agreement for up to four additional years, and requires the contractor to maintain audit-ready documentation, rigorous data security protocols, and full compliance with state tax and labor regulations. The evaluation of proposals will be based on a best-value trade-off approach, weighing technical merit at 90 points and cost at 10 points, with emphasis on organizational experience in Medicaid Administrative Claiming and RMS systems, a detailed understanding of program requirements, a viable work plan with clear milestones, qualified staffing, and sound financial justification. Offerors must submit electronic proposals via the Hawaii State eProcurement System (HIePRO) by the August 10, 2026 deadline and provide certifications for tax clearance, business registration, labor law compliance, and HCE status, while also disclosing any pending litigation. Key contractual obligations include strict confidentiality of personal health information, adherence to ethics rules prohibiting campaign contributions, restrictions on subcontracting without state approval, mandatory retention of records under HRS §487R, and immediate reporting of data breaches. The contractor must also comply with state and federal audit requirements, maintain financial accountability under Chapter 37 of the Hawaii Revised Statutes, and ensure all personnel meet licensing and accreditation standards, with all performance subject to state-led inspections and final acceptance determinations.