South Dakota Medicaid PACT (Primary Accountable Care Transformation) Vendor RFP

Summary

The awarded vendor will support South Dakota Medicaid in transforming primary care reimbursement under the Primary Accountable Care Transformation (PACT) model: (1) Reimbursement design — actuarial support to design a population-based alternative payment methodology replacing primary care E&M billing with a monthly Prospective Primary Care Payment, plus methodology for ongoing updates; (2) Provider value-based quality payments — a quality-based payment methodology tied to provider performance on HEDIS or other quality measures, funding yearly value-based payments; (3) Population health and case management tools — a recipient rewards program and investment in case management/population health infrastructure to support the model, plus facilitation of stakeholder engagement meetings. Requested funding: $62,735,000 over five years. This single vendor RFP covers all three facets — reimbursement design, VBQ payments, and population health/case management tooling are described as one integrated scope of work, not separate solicitations.

Eligibility

Vendor/consultant RFP (not a provider grant) — open to qualified actuarial/health-policy consulting organizations able to design and implement a Medicaid alternative payment model.

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