Care Management Organization Procurement for Georgia Families and Georgia Families 360 Programs

Bid Opportunities with State Purchasing Division

The State Purchasing Division (SPD) has issued a Request for Proposal (RFP) on behalf of the Department of Community Health (DCH) to establish a contract with up to four (4) qualified Care Management Organizations (CMOs) for the provision of services and benefits for Georgia Families, the State’s managed care program for Medicaid, PeachCare for Kids® members and Planning for Healthy Babies (P4HB) participants. PeachCare for Kids® is the State Children’s Health Insurance Program (CHIP), and the P4HB program is Georgia’s Section 1115 Family Planning Waiver program. The State also intends to contract with one (1) of the selected Georgia Families CMOs for the provision of services and benefits for the State’s Medicaid managed care program, Georgia Families 360°, for children, youth and young adults in Foster Care or receiving Adoption Assistance, and select youth involved with the Department of Juvenile Justice. The successful Suppliers are expected to achieve DCH’s health care goals and Member health outcomes.

The Department is seeking competitive responses from Suppliers who can provide innovative and value-based solutions to meet these objectives. For the procurement announcement, please visit the following link: https://ssl.doas.state.ga.us/PRSapp/PublicBidNotice?bid_op=154190041900-DCH0000100.

All questions regarding the RFP must be directed to the SPD Issuing Officer, Ms. Dana Harris at [email protected]

The following Supplier's Library is provided to assist Suppliers in preparing responses to the RFP.

  1. Download this pdf file. Medicaid Service Regions 
  2. Download this pdf file. CMO Procurement Suggestions
  3. Download this pdf file. Amerigroup Contract Revision Recommendations  
  4. Download this pdf file. Bright Futures Program  
  5. Download this pdf file. Recommendations for Preventive Pediatric Health Care
  6. Download this pdf file. Georgia Quality Strategy
  7. Download this pdf file. 2014 External Quality Review Annual Report
  8. Download this pdf file. Georgia Department of Public Health Billing Resources Manual
  9. Download this pdf file. Georgia Public Health Services for Medicaid Members
  10. Download this pdf file. Georgia Dental Association Comments
  11. Download this pdf file. Georgia Occupational Therapy Association, Georgia Speech Language - Hearing Association and Physical Therapy Association of Georgia – Georgia Families Procurement Comments
  12. Download this pdf file. 2014 NCQA Health Plan Accreditation Requirements
  13. Download this pdf file. DCH Fraud and Abuse Monitoring Analysis
  14. Download this pdf file. DCH Medicaid Primary Care Accessibility Analysis  
  15. Download this xls file. Readiness Review Tool
  16. Download this pdf file. GAMMIS 5010 Encounter 837D Companion Guide v2
  17. Download this pdf file. GAMMIS 5010 Encounter 837I Companion Guide v2.3
  18. Download this pdf file. GAMMIS 5010 Encounter 837P Companion Guide v2.3
  19. Download this xls file. Rebate Vendor Data Feeds and Interface Capabilities
  20. Download this pdf file. Georgia Rate Certification Planning for Healthy Babies FY13 and FY14
  21. Download this pdf file. Georgia Rate Certification Planning for Healthy Babies FY15
  22. Download this pdf file. Georgia Families 360° Rate Certification March 2014 – June 2015
  23. Download this pdf file. Georgia Families 360° Rate Certification CY14
  24. Download this pdf file. Georgia Families Rate Certification FY14
  25. Download this pdf file. Georgia Families Rate Certification FY15
  26. Download this pdf file. 2014 CMO Medical Loss Ratio Summary

The Suppliers’ Library has been updated with the following documents:

  1. Download this xls file. Provider Listing Report Template   -- Posted 03/19/2015
  2. Download this xls file. Telemedicine Expenses CY13 and CY14  -- Posted 03/19/2015
  3. Download this pdf file. Attachment K  Georgia Families Contract Attachment I  -- Posted 03/19/2015
  4. Download this pdf file. Attachment K  Georgia Families 360 Contract Attachment J  -- Posted 03/19/2015
  5. Download this xls file. 2014 CMO Medical Loss Ratio Summary Revised  -- Posted 03/19/2015
  6. Download this pdf file. NICU Supplemental Payment Submission Process  -- Posted 03/19/2015
  7. Download this pdf file. Obstetrical Delivery Payment Submission Process  -- Posted 03/19/2015
  8. Download this pdf file. GAMMIS 5010 834 Companion Guide v2.4  -- Posted 03/19/2015
  9. Download this pdf file. GAMMIS 5010 820 Companion Guide v2.3  -- Posted 03/19/2015
  10. Download this xls file. Excel version GA Certification P4HB FY13-14-05232014  -- Posted 03/19/2015
  11. Download this xls file. Excel version GA Certification P4HB FY15-05232014  -- Posted 03/19/2015
  12. Download this xls file. Excel version GF 360 Rate Certification 03032014 06302015  -- Posted 03/19/2015
  13. Download this xls file. Excel version GF 360 DCH GA Certification CY14-092713-Final  -- Posted 03/19/2015
  14. Download this xls file. Excel version GF Rate Certification FY14-06182014-Procurement  -- Posted 03/19/2015
  15. Download this xls file. Excel version GF Rate Certification FY15-09242014-Procurement  -- Posted 03/19/2015

The Suppliers’ Library has been updated with the following document:

  1. Download this xls file. Sample Data Dictionary Data Model  -- Posted 04/06/2015

The Suppliers’ Library has been updated with the following documents:

  1. Download this xls file. FY15 Ga Families and Georgia Families 360 Final Exhibit   -- Posted 04/20/2015
  2. Download this xls file. Provider Listing Report Template Revised 4-20 -- Posted 04/20/2015

The library also includes but is not limited to web access links such as the following:  

  1. Vaccines for Children Program Resources: http://dph.georgia.gov/vaccines-children-program

  2. Planning for Healthy Babies Resources: http://dch.georgia.gov/planning-healthy-babies

  3. Georgia Medicaid State Plan: http://dch.georgia.gov/medicaid-state-plan

  4. Medicaid Redesign Strategy Report: https://dch.georgia.gov/medicaid-chip-redesign

  5. NCQA Patient Centered Medical Home Resources: http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.aspx

It is the Supplier’s responsibility to review Supplier's Library materials in addition to other publicly available sources for relevance to this RFP’s Scope of Work.