Dually-Eligible Medicare, Medicaid Managed Care Contracts

Background
The Idaho Department of Health and Welfare (IDHW), through its Division of Purchasing, is seeking to award contracts to two vendors for the management of its dual eligibility program for individuals who qualify for both Medicare and Medicaid services.
The goal is to enhance service delivery for over 26,000 individuals currently enrolled in the Medicare Medicaid Coordinated Plan (MMCP) and Idaho Medicaid Plus (IMPlus).
The awarded vendors will be responsible for administering both Medicare and Medicaid benefits under MMCP and only Medicaid benefits under IMPlus, ensuring high-quality care and effective care coordination.

Work Details
The contractors must manage the Duals Program, which includes:
1. **Medicare Medicaid Coordinated Plan (MMCP)**: Vendors must administer both Medicare and Medicaid benefits, including behavioral health services, home and community-based services under Idaho’s Aged and Disabled waiver program, State Plan personal care services, and nursing facility care.
Vendors are also responsible for securing CMS approval to operate as a Medicare Advantage carrier in Idaho.

2. **Idaho Medicaid Plus (IMPlus)**: Vendors will administer only Medicaid benefits but must ensure coordination of Medicare benefits received by enrollees.

3. **Care Coordination**: The contractors are required to promote whole-person care by connecting enrollees with community supports.
They must develop metrics to measure health outcomes for individual members and populations.

4. **Implementation Requirements**: Contractors must develop an implementation plan that protects member health, maintains provider relationships, ensures timely claims payment, and provides adequate communication regarding transitions in care.

5. **Reporting**: Monthly reports on staffing status and provider network adequacy must be submitted until 60 days prior to the service start date, after which weekly reports are required.

Period of Performance
The initial term of the contract is four years with the possibility of renewal or extension upon mutual written agreement.
The anticipated total contract term is five years.

Place of Performance
The contract will be performed within the state of Idaho, specifically targeting urban, rural, and remote areas where dual-eligible individuals reside.