Specialty Managed Care Plan

The Nevada Health Authority has issued Request for Proposals (RFP) 41NHA-S3536 seeking qualified vendors to deliver a Specialty Managed Care Plan (SMCP) focused on children and youth with complex behavioral health needs across the state of Nevada. This risk-based, capitated managed care contract aims to integrate comprehensive physical health, behavioral health, and pharmacy Medicaid services statewide, improving access and care coordination for this vulnerable population. The contract term is anticipated to be five years with the possibility of a two-year extension. Proposals must be submitted by January 6, 2026, through the Nevada ePro portal, adhering to strict format and page limits. Vendor submissions will be evaluated using weighted technical criteria emphasizing Care Management (25%), Provider Network (25%), Overall Experience (20%), Complex Case Scenarios (20%), and Service Delivery (10%), with a pass/fail assessment of financial and certification information. The scope of work requires the successful contractor to provide culturally competent, family-centered behavioral health services to prevent institutionalization and improve care coordination. Contractors must meet numerous regulatory requirements including compliance with Medicaid managed care regulations (42 CFR 438), Nevada state laws, and National Committee for Quality Assurance (NCQA) accreditation by January 2028. Key contract attachments define geographic service areas, reporting requirements, member material definitions, and planned Medicaid policy updates, reflecting ongoing expansion and refinement of covered services such as Behavioral Health Training Clinics, Assertive Community Treatment, and Coordinated Specialty Care. The contract mandates appointment of dedicated Key Personnel—including a CEO, Specialty Plan Program Director with managed care experience serving children with trauma, CFO, and CIO—who must be full-time and exclusive to this contract. Vendors must maintain appropriate commercial insurance, obtain a Nevada certificate of authority, and comply with strict data privacy and business continuity obligations per HIPAA and state statutes. Confidentiality of proprietary information and prohibition on lobbying activities using contract funds are strictly enforced. While pricing details (Attachment J) are not publicly included, vendors may request this information via designated contacts. The contract is structured as an independent contractor agreement with comprehensive terms governing performance, inspection, acceptance, and invoicing, requiring uniform reporting and quality assurance practices to ensure effective service delivery and compliance throughout its term.