Managed Care Organization (MCO)

Background
The State of Nevada's Department of Health and Human Services, specifically the Division of Health Care Financing and Policy (DHCFP), is seeking proposals from qualified vendors to provide risk-based capitated Managed Care Organization (MCO) services.

These services are designed to support the Social Security Act Title XIX (Medicaid) and Title XXI (Children’s Health Insurance Program, CHIP) medical assistance programs. The DHCFP collaborates with the Centers for Medicare & Medicaid Services (CMS) to ensure quality medical care for low-income individuals and families.

The goal of this contract is to expand managed care services into rural regions of Nevada starting January 1, 2026, thereby increasing access to healthcare for approximately 75,000 additional individuals.

Work Details
Vendors will be required to provide comprehensive MCO services that include but are not limited to:
- Covering all medically necessary services as defined under Medicaid and CHIP.
- Implementing care management strategies that enhance member access to healthcare.
- Establishing provider networks that ensure adequate access to care across urban and rural areas.
- Offering additional benefits unique to managed care, such as member services and behavioral health support.
- Participating in the State Designated Health Insurance Exchange within two years if not already involved.
- Achieving NCQA accreditation within one year of contract implementation unless an extension is granted based on good faith efforts.

The contract will cover three geographic service areas: Urban Clark, Urban Washoe, and Rural Service Areas.

Period of Performance
The contract period is from January 1, 2026, to December 31, 2030, with a possibility of a two-year extension subject to approval by the Board of Examiners.

Place of Performance
The services will be performed throughout the State of Nevada, including all counties in urban, rural, and frontier regions.