RFP-171-260000002410-2 | Behavioral Health and Substance Use Disorder Benefits Admin
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RFP-171-260000002410-2State & Local
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The State of Michigan, through the Department of Technology, Management and Budget, is soliciting proposals for a hybrid contract to administer behavioral health and substance use disorder benefits for the State Health Plan PPO. This comprehensive administration covers active employees, non-medicare retirees, and medicare supplemental retirees, encompassing a wide range of services including inpatient and residential care, sub-acute detoxification, applied behavioral analysis for autism, and specialized treatments like electroconvulsive therapy. The contract is scheduled to be effective May 1, 2027, and expire December 31, 2031, with the possibility of up to seven additional one-year renewals at the state's discretion.
Awarding will be based on best value, requiring bidders to meet a minimum technical threshold of 80 points. Evaluation factors include price, prior performance with the state, overall economic impact to Michigan, total cost of ownership, and qualified disabled veteran business status. The selected contractor must adhere to strict data security standards, including hosting all data within the continental United States in Tier 3 compliant data centers and maintaining compliance with HIPAA, CMS, and PCI requirements. Performance is subject to state inspection, with a 30-day review period for deliverables and a requirement for monthly infrastructure vulnerability scanning.
General Info
Michigan seeks a contractor to administer behavioral health benefits for State Health Plan.
DOCX, High priority: read this firstcontract-document
HighAI Summary for Hybrid Contract Terms - RFP No. 260000002410: This document outlines the hybrid contract terms between the State of Michigan and a Contractor for RFP No. 260000002410. It establishes an effective date of May 1, 2027, with an expiration date of December 31, 2031, and options for seven additional one-year renewals. The document defines contractor duties, notice procedures, administration roles, performance guarantees, intellectual property rights, and software licensing terms.
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HighAI Summary for RFP 260000002410 - Behavioral Health and Substance Use Disorder Benefits: Request for Proposal (RFP) No. 260000002410 issued by the Michigan Department of Technology, Management and Budget for the administration of Behavioral Health and Substance Use Disorder (BH/SUD) benefits for the State Health Plan PPO. The document outlines the RFP timeline, including a proposal deadline of December 8, 2026, and provides detailed instructions for proposal preparation, submission requirements, and a comprehensive list of required schedules (A through O2) including SOW, pricing, and insurance requirements.
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HighAI Summary for RFP 260000002410 Schedule B - Pricing: This document is Schedule B (Pricing) for State of Michigan RFP No. 260000002410, regarding Behavioral Health and Substance Abuse Benefits for the State Health Plan PPO. It provides a detailed pricing template for a 3-year contract period (2028-2030), including administrative service fees (ASO), claims cost projections, membership assumptions, and specific reimbursement rate tables for telehealth and CPT codes.
DOCX
DOCX, High priority: read this firstspecifications
HighAI Summary for RFP 260000002410 - Schedule C Insurance Requirements: This document outlines the mandatory insurance requirements for contractors bidding on RFP No. 260000002410 for Behavioral Health and Substance Use Disorder Benefits (BH/SUD) for the State Health Plan PPO. It specifies minimum coverage limits for Commercial General Liability, Automobile Liability, Workers Compensation, and Employers Liability insurance, along with requirements for insurer ratings, additional insured endorsements, and proof of insurance submission to DTMB Enterprise Risk Management.
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XLSX, High priority: read this firstspecifications
HighAI Summary for RFP 260000002410 - Schedule F2 Provider Cost & Claims Data FY2025: This document is a pricing and network status schedule (Schedule F2) for RFP 260000002410 regarding Behavioral Health and Substance Abuse Benefits for the State of Michigan Health Plan PPO. It provides a detailed list of active claims paid from 01/01/2025 to 12/31/2025, categorized by service type (Inpatient, Residential, etc.). Bidders are required to provide the 'Allowed amount' based on their 01/01/2028 fee schedule and indicate the 'Network Status' (IC, OC, IX, or OX) for each provider listed.
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XLSX, High priority: read this firstspecifications
HighAI Summary for RFP 260000002410 - Schedule G Section 2 Software Table: A technical data collection template (Schedule G, Section 2) for RFP 260000002410. It requires bidders to provide detailed specifications for proposed software, portals, and SaaS solutions, including user capacity, scalability, AI usage, mobile responsiveness, hosting locations, and data retention/disposal capabilities.
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XLSX, High priority: read this firstspecifications
HighAI Summary for RFP 260000002410 Schedule L - Disruption Analysis: This document is Schedule L (Disruption Analysis) for RFP No. 260000002410 regarding Behavioral Health and Substance Abuse Benefits for the State of Michigan Health Plan PPO. It provides a detailed list of providers utilized by active and retiree members for FY2024 and FY2025. Bidders are required to use specific codes (IC, OC, IX, OX) to indicate the network status of these providers as of January 1, 2028, to analyze potential network disruption.
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XLSX, High priority: read this firstspecifications
HighAI Summary for RFP 260000002410 - Schedule M1 Claims Repricing Active FY2024: This document is Schedule M1 (Claims Repricing Active FY2024) for RFP No. 260000002410 regarding Behavioral Health and Substance Abuse Benefits for the State Health Plan PPO. It provides a detailed bid schedule for claims paid between 01/01/24 and 12/31/24, requiring bidders to provide allowed amounts and network status (IC, OC, IX, OX) based on their 01/01/2028 fee schedules across various service categories including Inpatient, Residential, and Outpatient services.
DOCX
DOCX, High priority: read this firstsow
HighAI Summary for Schedule D - Service Level Agreement for Hybrid Purchases (RFP No. 260000002410): This document is Schedule D, the Service Level Agreement (SLA) for RFP No. 260000002410 regarding Behavioral Health and Substance Use Disorder Benefits for the State Health Plan PPO. It defines critical technical performance metrics, including a 99.98% availability requirement, software response time thresholds (under 2 seconds for 98% of transactions), and protocols for scheduled downtime and service availability reporting.
DOCX
DOCX, High priority: read this firstspecifications
HighAI Summary for Schedule E - Data Security Requirements for Hybrid Purchases (RFP 260000002410): This document outlines the data security and privacy requirements for the Behavioral Health and Substance Use Disorder Benefits (BH/SUD) for State Health Plan PPO under RFP No. 260000002410. It defines critical security standards, including compliance with FedRAMP, FISMA, NIST SP 800-53, and State IT Policies, Standards and Procedures (PSPs). The document specifies contractor responsibilities for protecting State Data, the appointment of a Contractor Security Officer, and requirements for hosting providers and data center standards.
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XLSX, High priority: read this firstspecifications
HighAI Summary for Schedule F3 Provider Cost & Claims Data Retiree FY2024: This document is a pricing schedule (Schedule F3) associated with RFP No. 260000002410 for Behavioral Health and Substance Abuse Benefits for the State of Michigan Health Plan PPO. It requires bidders to provide allowed amounts and network status (IC, OC, IX, OX) for retiree claims paid between 01/01/2024 and 12/31/2024, based on the bidder's fee schedule as of 01/01/2028. The file includes detailed claim data across various service categories including Inpatient, Residential, Day Treatment, Outpatient, and Professional Services.
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XLSX, High priority: read this firstspecifications
HighAI Summary for Schedule F4 Provider Cost & Claims Data Retiree FY2025: This document is a claims repricing schedule (Schedule F4) associated with RFP No. 260000002410 for Behavioral Health and Substance Abuse Benefits for the State of Michigan Health Plan PPO. It provides a structured template for bidders to calculate 'Allowed Amounts' and designate 'Network Status' for retiree claims paid between 01/01/2025 and 12/31/2025, based on the bidder's 01/01/2028 fee schedule. The file includes detailed definitions for service types and network codes, as well as specific claim data for inpatient services.
PDF
PDF, High priority: read this firstspecifications
HighAI Summary for Schedule F - Plan Design and Claim Payment Rules: State Health Plan PPO: This document outlines the plan design and claim payment rules for the State Health Plan PPO Active Employee Plan, specifically focusing on behavioral health and substance use disorder benefits. It details coverage levels, copays, and deductibles for both in-network and out-of-network services, including ABA therapy, inpatient/outpatient care, IOP, and PHP services.
XLSM
XLSM, High priority: read this firstspecifications
HighAI Summary for Schedule H1 GeoAccess Actives Reporting Template: A proprietary Willis Towers Watson (WTW) GeoAccess reporting template used to generate provider access requests for vendors during RFPs or renewals. The document includes instructions for populating client and coverage data (specifically for MPSERS Vision), suggested access standards for various provider types across urban, suburban, and rural areas, and a ZIP code classification reference updated as of February 2020.
XLSM
XLSM, High priority: read this firstspecifications
HighAI Summary for Schedule H2 GeoAccess Retirees Reporting Template: A proprietary Willis Towers Watson (WTW) GeoAccess reporting template used to generate provider network access requests for vendors. The document specifies access standards (provider counts within specific mile radii) for urban, suburban, and rural areas across medical, dental, vision, and mental health services, specifically configured for MPSERS vision coverage.
PDF
PDF, High priority: read this firstspecifications
HighAI Summary for Schedule I HIPAA 834 File Layouts - RFP No. 260000002410: Technical specifications for HIPAA 834 Benefit Enrollment and Maintenance electronic data interchange (EDI) file layouts associated with RFP No. 260000002410. The document defines segment lengths, field identifiers, and data mapping requirements for transaction sets, including control headers, plan sponsor information, and insurer identification.
XLSX
XLSX, High priority: read this firstspecifications
HighAI Summary for Schedule J Service Availability Report - RFP 260000002410: This document is a reporting template (Schedule J) for RFP 260000002410, requiring bidders to provide monthly service availability performance data for offered software. It includes specific requirements for reporting performance percentages, documenting corrective actions for failures below 99.98%, and aligning software listings with Schedule G.
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XLSX, High priority: read this firstspecifications
HighAI Summary for Schedule K Sample Claims Report and Invoice Format (RFP 260000002410): This document provides sample reporting and invoicing templates for RFP No. 260000002410 regarding Behavioral Health and Substance Use Disorder Benefits (BH/SUD). It includes three specific formats: a regular invoicing sample, a quarterly and year-end claims invoice report, and a claim lag report.
XLSX
XLSX, High priority: read this firstspecifications
HighAI Summary for Schedule N SLA Report Format: A Service Level Agreement (SLA) reporting template for Behavioral Health and Substance Use Disorder benefits for the contract period 01/01/2028-12/31/2031. The document defines specific performance metrics (SLAs) regarding eligibility file processing, ID card distribution, claims turnaround, and payment accuracy, including the associated financial credits for non-compliance.
DOCX
DOCX, Low prioritybaa
LowAI Summary for Exhibit 2 to Schedule E HIPAA Business Associate Agreement: A HIPAA Business Associate Agreement (BAA) between the State of Michigan State Health Plan (Covered Entity) and a Contractor (Business Associate). The document outlines the obligations of the Business Associate regarding the protection, use, and disclosure of Protected Health Information (PHI) in compliance with HIPAA Rules and 45 CFR Parts 160 and 164.
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