26EHSKWPCMRFR-MassHealth PCA Program PCM Functions RFR

Background
The Executive Office of Health and Human Services (EOHHS) of the Commonwealth of Massachusetts is responsible for administering the state's Medicaid program, known as MassHealth. This program provides a range of health services to eligible individuals. This Request for Responses (RFR) aims to solicit qualified organizations to serve as Personal Care Management (PCM) Agencies that will assist MassHealth Members in managing their Personal Care Attendant (PCA) services. The goal is to enhance the support provided to consumers through effective management of PCA services, particularly in the Northeast and Southeast Regions of Massachusetts.

Work Details
Contractors selected under this RFR will be responsible for providing various PCM functions, including: assessing consumers' abilities to manage PCA services; providing intake and orientation to educate consumers about PCA program rules; conducting evaluations and re-evaluations of consumer needs; submitting prior authorization requests; developing service agreements with consumers; submitting requests for overtime authorization; and providing functional skills training to consumers and their surrogates. Approximately 25,000 consumers were receiving PCA services as of January 2026, with no guarantee of a specific number of consumers for any awarded contractor.

Period of Performance
The contract will be effective from the date of award until June 30, 2029. There are options for EOHHS to extend the contract for up to two additional three-year terms based on satisfactory performance and legislative appropriations.

Place of Performance
The services will be performed primarily in the Northeast and Southeast Regions of Massachusetts.

Bidder Requirements
Bidders must demonstrate experience supporting individuals with physical disabilities, older adults with personal care needs, and children/youth with personal care needs. They must also comply with all submission requirements outlined in the RFR, including providing necessary documentation such as organizational overviews, financial condition statements, security policies, legal actions history, compliance records, cost responses detailing administrative fees per member per month, and references from relevant organizations.