Medicare Dual Eligible Special Needs Plan (D-SNP) Request for Proposal

CenCal Health (CCH) will procure a comprehensive consulting partner to support the detailed planning, product development, and product launch of a Medicare Dual Eligible Special Needs Plan (D-SNP) product line offering effective January 1, 2026. The consultant will advise on the Plan’s overall Medicare operating model, inform and support the approach to build/buy/hybrid requisite operational functions, ensure compliance of regulatory filings, provide operational support (P/Ps) and advisement, inform and validate Initial Launch Performance Goals, ensure closure of identified operational gaps and operational readiness for a January 1, 2026 product launch.

The consultant will guide a team of internal staff and leaders across all functional areas to ensure overall Plan readiness (functionality and deliverables jointly defined by CCH and the consultant), inclusive of achieving Initial Launch (Day 1) Performance Goals in the following five (5) key performance areas, as applicable.

  1. Enrollment
  2. Risk Adjustment
  3. Medical Management
  4. Provider Contracting
  5. STARs

This multi-year engagement will start in Q1 2023 and proceed into Q1 2026. The engagement will include a comprehensive workplan and timelines, key milestones for achievement, clear success metrics, and ongoing status updates to a Medicare D-SNP Steering Committee, CCH CEO, Executive Leadership Team and/or the CCH Board of Directors. Additionally, an assessment of overlapping contractual and regulatory requirements between the DHCS 2024 Contract and a D-SNP product is a requested deliverable.

CenCal Health will require that the Consultant provide D-SNP education to the Plan (e.g., D-SNP 101), e-learning development modules based on business areas (e.g., Finance, Claims, Medical Management, Compliance), webinars, and an overall internal communication campaign.

D-SNP RFP Clarification Questions and Answers

Please download full Request for Proposal

dsnp


 D-SNP RFP Clarification Questions and Answers 

 D-SNP RFP Clarification Questions and Answers