Pennsylvania eMarketplace #RFI CHC 2026

RFI for Statewide Community HealthChoices Managed Care Organizations and Quality Incentive Programs

The Pennsylvania Department of Human Services is seeking input from industry stakeholders to inform the upcoming re-procurement of Community HealthChoices Managed Care Organizations (CHC-MCOs) statewide. - Government Buyer: - Pennsylvania Department of Human Services (DHS), including the Program Integrity Division (PID) - Products/Services Requested: - Comprehensive managed care services for Medicaid and long-term services and supports (LTSS) populations - Nursing Facility Quality Incentive Program based on six CMS quality metrics (rehospitalization, pressure ulcers, falls, vaccinations, antipsychotic use) - Extensive reporting and monitoring services, including encounter data, financial viability, fraud detection, provider network updates, and compliance with federal/state regulations - Provider termination notification and management, including 90-day advance notice, work plans, participant notifications, and continuity of care for up to 60 days post-termination - OEMs and Vendors: - No specific OEMs or vendors are named at this RFI stage; the opportunity is open to all qualified managed care organizations - Unique or Notable Requirements: - Strict financial solvency and equity standards for MCOs - Value-based payment strategies and quality incentive programs for nursing facilities - Robust participant protections, including grievance and complaint procedures - Comprehensive and timely reporting obligations with potential sanctions for noncompliance - Detailed requirements for provider network management, including advance notice and continuity of care provisions - Place of Performance: - Statewide across Pennsylvania, with activities involving the Pennsylvania HealthChoices Extranet and oversight by DHS offices

Description

This Request for Information (RFI) seeks input and information to assist the Department of Human Services with the current Community HealthChoices (CHC) agreement. The purpose is to gather suggestions for the anticipated re-procurement of the CHC Managed Care Organizations (CHC-MCOs). The solicitation covers service and materials related to the CHC program statewide in Pennsylvania. No contracts or awards exist for this solicitation as it is an information-gathering RFI.

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