By OPEN MINDS Circle
On December 1, 2022, the Oklahoma Health Care Authority (OHCA) reissued a request for proposals (RFP 8070000052) to implement Medicaid managed care for a program to be called SoonerSelect and the SoonerSelect Children’s Specialty Program for youth involved with the foster care and/or juvenile justice systems. The contractors will be responsible for medical, behavioral, and pharmacy coverage. All health plans will be required to provide SoonerSelect members with the same health care services currently offered by SoonerCare (the state’s Medicaid program) but may offer extra benefits to help improve the health of its members.
The state intends to award contracts to at least three entities, one of which could be a provider organization-led entity (PLE). Proposals from managed care organizations (MCOs) and PLEs are due by February 8, 2023. Contract implementation is scheduled for October 1, 2023, and the contracts are expected to run through June 30, 2024, followed by five, one-year options. The aggregate contract value has not been disclosed.
Oklahoma currently does not have a fully capitated, risk-based Medicaid managed care program. Most of the state’s 1.3 million beneficiaries are enrolled in SoonerCare Choice, a Primary Care Case Management (PCCM) program in which each member has a medical home. As of July 1, 2021, Oklahoma became a Medicaid expansion state. The state’s other programs include SoonerCare Traditional (Medicaid fee-for-service), SoonerPlan (a limited benefit family planning program), and Insure Oklahoma (a premium assistance program for low-income people whose employers offer health insurance). After the coronavirus disease 2019 (COVID-19) public health emergency ends, OHCA anticipates that its Medicaid enrollment will drop.
One of the awarded SoonerSelect plan contractors will be selected for a separate contract for the SoonerSelect Children’s Specialty Program. The specialty program will enroll children in foster care, former foster children up to 25 years of age, juvenile justice-involved children, and children receiving adoption assistance. Currently, there are nearly 34,000 children in these groups. This contract will start at the same time as the main SoonerSelect contracts, running from October 1, 2023, through June 30, 2024, with five one-year renewal options.
The proposals will be evaluated on 13 topics, with a maximum of 1,550 points. PLE bidders would need to provide proof that a majority of their ownership is held by Oklahoma Medicaid provider organizations, or the majority of the governing body is composed of individuals who have experience serving Medicaid members and are licensed medical professionals. PLEs would also be able to bid on urban regions if the PLE agrees to develop statewide readiness within a timeframe set by the OHCA. If no PLEs meet OHCA standards, Oklahoma can choose not to award a PLE. The PLE proposals will receive a bonus of 50 points.
|
Oklahoma Medicaid Managed Care RFP: Technical Proposal Evaluation Areas & Maximum Points | |
|
Evaluation Area |
Points Possible |
| Executive Summary |
25 |
| Organizational Structure |
250 |
| Operations Plan |
180 |
| Provider Network and Services |
210 |
| Covered Benefits |
100 |
| Enrollee Services |
120 |
| American Indian/Alaska Native Health |
50 |
| Quality Improvement |
100 |
| Population Health |
120 |
| Value-Based Payment |
80 |
| Case Studies |
120 |
| Compliance |
75 |
| Information Technology |
120 |
| Total Technical Proposal Points Available |
1550 |
In 2020, the state legislature had enacted a law directing OHCA to implement Medicaid managed care, and on October 15, 2020, OHCA released an RFP for SoonerSelect MCOs. It announced awards in January 2021, and the contracts were slated to go live in October 2021 with Blue Cross and Blue Shield of Oklahoma, Oklahoma Complete Health, Humana Healthy Horizons, and UnitedHealthcare. However, in June 2021, the contracts were canceled after the Oklahoma Supreme Court ruled that the procurement was invalid because OHCA lacked the authority to award the contracts until May 27, 2021, when the legislation went into effect.
For more information about the RFP, contact: Richard Williams, Procurement Contact Point, Oklahoma Office of Management and Enterprise Services, 5005 North Lincoln, Suite 300, Oklahoma City, Oklahoma 73105; 405-522-1040; Email: richard.williams@omes.ok.gov; Website: https://oklahoma.gov/omes/services/purchasing/solicitations/8070000052.html
For more information about the Oklahoma Medicaid program, contact: Melissa Richey, Chief of Communications, Oklahoma Health Care Authority, 4345 North Lincoln Boulevard, Oklahoma City, Oklahoma 73105; 405-605-9805; Email: Melissa.Richey@okhca.org; Website: https://www.okhca.org/