MO HealthNet Managed Care Program

The State of Missouri, through the Office of Administration and the Department of Social Services, is soliciting proposals under solicitation number STATE 0000000463SL for the MO HealthNet Managed Care Program. The objective is to establish a managed care medical service delivery system that improves healthcare access and quality for eligible populations while controlling costs. The program consists of a General Plan and a Specialty Plan, with the Specialty Plan award being contingent upon the vendor being one of the three highest-scoring General Plan proposals. The initial contract period lasts one year from the effective date, with the state maintaining the option to renew for four additional one-year periods. The contract utilizes a risk-based, capitated payment model with firm and fixed pricing. Evaluation is based on a weighted point system focusing on technical proposals, organizational experience, team qualifications, and methodology, alongside preferences for minority-owned, women-owned, and service-disabled veteran enterprises. Awardees must comply with rigorous federal and state requirements, including HIPAA and HITECH regulations via a Business Associate Agreement, the Anti-Discrimination Against Israel Act, and federal funds requirements such as the Byrd Anti-Lobbying Amendment. Key deliverables include the management of specific health program areas, periodic quality and utilization reporting, and the maintenance of NCQA or URAC accreditation. Performance is monitored through Quality Assessment and Improvement programs, with strict reporting mandates for critical incidents.