Hawaii releases Medicaid Managed Care RFP

The Hawaii Department of Human Services (DHS) released its QUEST Integration Medicaid Managed Care RFP last week. According to the Request for Proposals, DHS plans to contract with four health plans to provide service for Medicaid and CHIP members in Hawaii. All four will serve members in Oahu, and two will operate statewide.

The health plans chosen will provide medical, behavioral health, and long-term services and supports.

 

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Also detailed in the RFP is Hawaii’s intent to implement the Hawaii ‘Ohana Nui Project Expansion (HOPE) program – a program focused on investing in primary care and prevention. The HOPE program also aims to improve outcomes for individuals with special health care needs, reform and align payment to providers, and support community-driven initiatives to improve population health.

The RFP places an emphasis on several initiatives aimed at improving care coordination and delivery. The five initiatives include:

a) Advancing Primary Care;

b) Supporting team-based care;

c) Implementing Prevention and Health Promotion;

d) Implementing the Stepped Care Approach; and

e) Addressing Social Determinants of Health (SDOH).

“The integration of these five (5) initiatives results in a focus on proactive identification of need, early intervention and treatment, and access to the most appropriate level of care across the continuum,” reads the RFP.

DHS will score all proposals received on several evaluation categories including “Approach to Care Delivery and Coordination,” “Covered Benefits and Services,” “Information Systems and Information Technology,” and “Program Integrity.”

The two statewide plans will be awarded to the plans with the highest scoring technical proposals.

Proposals are due November 8, 2019. Awards will be made January 6, 2020, with implementation set to being July 1, 2020.

Links to the full 638-page RFP and its appendices are available here.