A. The contractor shall provide DHS with statistical and actuarial services and consulting services in support of the development, implementation, and evaluation of various Medicaid projects. Areas of work include but are not limited to: 1. Budgeting and fiscal impacts analysis. 2. General analysis tasks. 3. Rate reviews and recommendations 4. Waiver rate and budget development B. Projects scheduling may be on the following basis: 1. A regular, recurring basis, such as an annually. 2. 3. An ad hoc or “as needed” basis. DHS will provide as much advance notice, planning, and collaboration as possible to the contractor, and the contractor shall meet all requirements and deadlines of the agreed-upon projects. C. The exact scope of these projects will be identified through a specific request from DHS as needs arise. D. Because some projects may require elements which are not known at this time, the requirements for a project may extend beyond those provided in this RFP. E. The currently required project is the PASSE Rate Development. 1.The contractor shall develop actuarially sound capitated and shared savings rates and quality incentive payments for services and populations provided under the PASSE based on claims data including without limitation Medicaid and other claims data. 2.PASSE rate development is typically undertaken on an annual basis. F. Actuarial Analyses for Existing Populations and Programs In addition to actuarially sound rate development, any additional actuarial analyses for existing populations and programs are covered under this task. 1.Consistent with the actuarial analyses tasks above, develop actuarially sound rates for various models for delivering Medicaid programs and services including without limitation: • A Provider-Led Arkansas Shared Savings Entity (PASSE) with multi-tiered managed care rules, • The Arkansas Patient-Centered Medical Home Program (PCMH), • Program of All-Inclusive Care for the Elderly (PACE), • Non-Emergency Transportation (NET) for Medicaid beneficiaries, • The Arkansas Health and Opportunity for Me (ARHOME) program, and • The Tax Equity and Fiscal Responsibility Act (TEFRA) program. 2. In addition to actuarially sound rate development, this task will include: • Analyses surrounding utilization and unit cost trends, • Incurred but not reported claims calculations, • Impacts of programmatic changes, • Efficiency adjustments, • Development of nonmedical expenditures including administration, • Medical management and profit, risk, and contingency margins, • Review and analysis of legislative estimates, • Other actuarial analyses impacting rate development. 3. Actuarial services around 1915(b) and (c) Waiver amendment work shall include without limitation: • Assistance with CMS communications, • Development of budget neutrality and cost effectiveness figures, • Guidance on waiver concepts and terms, and • Assistance with the completion of cost effectiveness and budget neutrality portions of the Waiver applications, • Any other needed actuarial consulting with regard to 1915(b) and (c) waivers.
