RFP-2027-DMS-01-MEDIC: Medicaid Medication Risk Reduction Initiative

Request for Proposals
For
Medicaid Medication Risk Reduction Initiative
RFP-2027-DMS-01-MEDIC
Release Date: 9/29/2026

New Hampshire Department of Health and Human Services
Medicaid Medication Risk Reduction Initiative
Table of Contents
Request For Proposal ................................................................................................................... 2
1. Purpose And Overview .......................................................................................................... 2
2. Statement of Work ................................................................................................................. 5
3. Solicitation Response Evaluation ........................................................................................ 10
4. Solicitation Response Process ............................................................................................ 16
5. Solicitation Response Submission Instructions ................................................................... 17
6. Solicitation Response Requirements ................................................................................... 18
7. Additional Terms and Requirements ................................................................................... 18
8. Compliance .......................................................................................................................... 23
9. Appendices to this Solicitation ............................................................................................. 25
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New Hampshire Department of Health and Human Services
Medicaid Medication Risk Reduction Initiative
Request For Proposals
1. Purpose And Overview
1.1 Introduction
The New Hampshire Department of Health and Human Services, Division of Medicaid
Services("Department") is seeking responses to this Request for Proposals
("Solicitation" or "RFP") from qualified Vendors to establish a statewide Medicaid
Medication Risk Reduction Initiative (MMRRI) led by New Hampshire licensed clinical
pharmacists to reduce the prevalence of, and prevent, Medication-Related Problems
("MRPs"), Adverse Drug Events ("ADEs"), polypharmacy, over-prescribing, behavioral
health related medication risks, and opioid related medication risks of New Hampshire
Medicaid beneficiaries.
Qualified Vendors must:
* Possess a minimum of three (3) years' experience with similar work, including
analyzing pharmacy encounter and claims data to conduct comprehensive
medication reviews and issuing medication safety reports;
* Have a technology solution to analyze Medicaid pharmacy encounters and claims
data to create the comprehensive medication list;
* Provide Clinical Pharmacists who have experience in completing comprehensive
medication reviews ("CMR"), advanced medication safety analytics, and creating
MSRs to support, in partnership with, the Medicaid beneficiary provider's clinically
appropriate changes to the Medicaid beneficiary's plan of care;
* Have experience in successfully integrating pharmacy claims and encounter data
into technology solutions with algorithms capable of identifying opportunities to
reduce the prevalence of, and prevent, MRPs, ADEs, polypharmacy, over-
prescribing, behavioral health related medication risks, and opioid related
medication risks. A key competency is to translate pharmacy claims and
encounter data into actionable recommendations the Medicaid beneficiary's
provider and Medicaid Managed Care Organization ("MCO") can take to reduce
the prevalence of, and prevent, MRPs, ADEs, polypharmacy, over-prescribing,
behavioral health related medication risks, and opioid related medication risks;
* Ensure the services and processing of information are based in the United States
and compliant with all applicable privacy, confidentiality and security laws, rules,
and regulations;
* Partner and effectively communicate with medical providers, community
pharmacists, and MCOs to support improved clinical practices and outcomes for
the Medicaid beneficiary;
* Communicate and distribute MSRs to Medicaid beneficiaries and their providers
and MCOs in a format compatible with the provider's or MCO's IT systems (e.g.,
integration into electronic health records systems); and
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New Hampshire Department of Health and Human Services
Medicaid Medication Risk Reduction Initiative
* Close care gaps, help collect medication information, improve medication
adherence, reduce hospital admissions and enable value-based care inclusive of
utilizing modern technologies and clinical recommendations from the Vendor's
Clinical Pharmacists.
The Department anticipates awarding one (1) contract for the services in this
Solicitation. This is a federally funded contract and must follow all applicable federal
requirements, including 2 CFR Part 200 (Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards).
1.2 Key Information
The information listed below is as anticipated by the Department and is subject to
change. Agreements are contingent upon the availability of funds and approval by the
Governor and Executive Council.
1.2.1 Contract Effective Date: 1/1/2027
1.2.2 Contract End Date: 12/31/2029
1.2.3 Renewal Options: The Department may extend the agreement through
September 30, 2031.
1.2.4 Funding for the resulting contract(s) is anticipated to be approximately:
$33,553,391. Vendors are advised this is not a low-cost award; however;
costs will be scored as specified in Section 3.4 below.
1.2.5 Funding Source
The Department anticipates using Federal funds for resulting grant
agreement(s).
Assistance Listing Number (ALN): 93.798
Award Name: Rural Health Transformation Program (RHTP)
1.2.6 Match Requirements: N/A
1.2.7 Point of Contact:
Marsha Wade-Mann, Contract Specialist
Marsha.M.WadeMann@dhhs.nh.gov
From the date of release of this solicitation until an award is made and announced
regarding the selection of a Vendor, all communication with personnel employed by
or under contract with the Department regarding this solicitation is prohibited unless
first approved by the Point of Contact listed above. Department employees have
been directed not to hold conferences and/or discussions concerning this solicitation
with any potential contractor during the selection process, unless otherwise
authorized by the Point of Contact. Vendors may be disqualified for violating this
restriction on communications.
Interested Vendors must read this entire Solicitation and submit the required
documents in the specified manner. Vendors are responsible for reviewing the most
updated information related to this Solicitation before submitting responses.
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New Hampshire Department of Health and Human Services
Medicaid Medication Risk Reduction Initiative
1.3 Procurement Timetable
All times are according to Eastern Time. The Department reserves the right to modify
these dates and times at its sole discretion.
1.3.1 Solicitation release date: 9/29/2026
1.3.2 Letter of Intent Submission Deadline (optional) 10/7/2026
1.3.3 Vendor Questions Submission Deadline: 10/7/2026 12:00 Noon
1.3.4 Department responses to questions Published: 10/19/2026
1.3.5 Vendor Solicitation Response Due Date: 10/28/2026 12:00 Noon
1.4 Background
1.4.1 The Centers for Medicare & Medicaid Services ("CMS") has established the
Rural Health Transformation ("RHT") Program, a competitive federal funding
initiative intended to support states and rural communities in strengthening
rural health care delivery and access, improving health outcomes, advancing
prevention and population health strategies, enhancing care coordination and
affordability, and building sustainable rural health system capacity through
targeted investments in infrastructure, workforce, and data/technology-
enabled improvements.
1.4.2 Through Executive Order 2025-06, Governor Kelly Ayotte established the
Governor's Office of New Opportunities and Rural Transformational Health
("GO-NORTH") to deliver the transformational initiatives included in New
Hampshire's CMS approved RHT plan.
1.5 Objective
1.5.1 The objective of the MMRRI is to support a healthier population of New
Hampshire Medicaid beneficiaries by reducing and preventing the harm from
polypharmacy, over prescribing, MRPs, ADEs, opioid medication related risks,
and behavioral health medication related risks.
1.5.2 The selected Vendor must employ or contract with New Hampshire licensed
advanced clinical pharmacists ("Clinical Pharmacists") to create a center of
Clinical Pharmacists who shall conduct comprehensive medication reviews
("CMR") of Medicaid beneficiaries identified as either meeting polypharmacy
or over prescribing criteria or at high-risk of a MRP or ADE, including those
prescribed opioids or behavioral health medications. Contemporaneous to
conducting the CMR the Clinical Pharmacists shall generate a Medication
Safety Report ("MSR") with actionable steps the patient and their medical
provider can take to address the adverse effects of polypharmacy, over-
prescribing, MRPs, ADEs, opioid-related medication risks, or behavioral health
related medication risks.
1.6 Community Pharmacist Obligation. Within 60 days of executing a contract, Vendors
must have an employment or contractual relationship with New Hampshire licensed
pharmacists located in New Hampshire to carry out the comprehensive medication
reviews, create medication safety reports, and coordinate with primary care providers.
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New Hampshire Department of Health and Human Services
Medicaid Medication Risk Reduction Initiative
2. Statement of Work
2.1 Scope of Services - See Appendix A - Scope of Services.
2.2 Mandatory Questions
2.2.1 In response to this Solicitation, Vendor(s) must respond to the Mandatory
Questions below, utilizing Appendix E Technical Responses to Mandatory
Questions. Vendor responses to Mandatory Questions must not exceed a total
of 25 pages, excluding attachments and resumes. Any collaborating
organization must be designated as a subcontractor in solicitation response,
also subject to the terms of Appendix B, P-37 General Provisions and
Standard Exhibits.
Q1 - Describe in detail how your organization will perform the entire scope of services and
achieve all deliverables in Appendix A, Scope of Services, and how your processes will lead to
a healthier NH Medicaid population (including dually eligible beneficiaries) with reduced
polypharmacy, over-prescribing, ADEs, MRPs, opioid medication related risks, and behavioral
health medication related risks. As part of the response, provide a proposed Work Plan
including, but not limited to, all proposed activities and/or deliverables, and measurable
performance goals or indicators. Include a diagram schematic of work processes and flow chart
of activities to fulfil the scope of work.
Q2 - Describe your organization's prior experience for a similar project.
Q3 - Describe your organization's experience and knowledge regarding the development and
deployment of algorithms and technology solutions to identify polypharmacy, over-prescribing,
risks of ADEs, risks of MRPs, opioid medication related risks, and behavioral health medication
related risks to support the Clinical Pharmacists to conduct the CMR, interpret the outputs of the
algorithms for detecting opportunities to address polypharmacy, over-prescribing, ADEs and
MRPs and provide actionable recommendations in the MSR to be taken by the Medicaid
beneficiary's medical provider.
Q4 - Describe your organization's experience delivering key insights to medical providers to
positively influence their prescribing to patients, as well as delivering key information to MCOs,
including knowledge of provider prescribing behavior change and understanding of how
incentives are most effective for medical provider engagement; exchange of medication claims
data from pharmacy benefit managers, MCOs, and health insurance companies, and integrating
MSRs into medical provider and MCO technology systems and workflows to promote the
efficient and streamlined use of MSRs to reduce polypharmacy, over-prescribing, ADEs, MRPs,
opioid medication related risks, and behavioral health medication related risks.
Q5 - Complete Appendix F - Staff List. Describe your organization's personnel's ability and
capacity to perform the entire scope of services, as outlined in Appendix A of this Solicitation,
and include:
* The number of personnel and whether they are employed or contracted, and the time
commitment in full-time equivalency (FTE).
* Description of qualifications, curriculum vitae/resumes, and/or credentials for key
personnel referenced in Appendix F, Staffing List.
* Any specialized staff training completed relevant to providing services in this solicitation.
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New Hampshire Department of Health and Human Services
Medicaid Medication Risk Reduction Initiative
* A plan outlining which key personnel will be responsible for each required activity and/or
deliverable; and a schedule and timeline for completion of required activities and
deliverables
* Any subcontractor roles, as specified in Appendix A.
Q6 - Provide evidence that your proposed solution will guarantee a positive return on
investment, no later than the end of Contract Year 3, for the Medicaid Managed Care program
in the form of a reduction in total cost of care on a per member/per month (PMPM) basis.
Response must include the estimated PMPM savings in each Contract Year through expiration
of the Contract, including:
* A clear definition of the PMPM metric you will use (e.g., total cost of care, allowed vs.
paid, included/excluded services, carve-outs, risk adjustment, and member-month
methodology).
* The guaranteed minimum PMPM reduction (in dollars and percent) and the timeframe
for achieving it, including any ramp-up assumptions.
* The contractual mechanism to enforce the guarantee, including financial at-risk terms
(e.g., liquidated damages in an amount equivalent to 10% of the yearly contract value,
fee at risk) if the PMPM reduction is not achieved.
* An explanation of the causal pathway by which your solution reduces PMPM, including
key drivers (e.g., utilization, total drug costs, avoidable ED/inpatient, pharmacy, etc.) and
implementation dependencies.
* Supporting evidence from comparable managed care implementations (or the closest
available), including:
o Client/payer name and state (or a redacted description if required);
o Baseline vs. post-implementation PMPM results;
o Population characteristics and program design;
o Evaluation approach (e.g., pre/post with controls, difference-in-differences,
actuarial validation); and
o Independent validation (audits, actuarial certifications, or third-party evaluations).
* Measurement and reconciliation method (data sources, timing, reporting cadence,
attribution methodology, and dispute resolution).
* An actuarial attestation from an independent actuary that the guaranteed minimum
PMPM reduction is actuarially reasonable.
Q7 - Describe how your organization will partner pharmacists with the patient's medical
provider to support the clinical decision-making process of the patient's medical provider to
reduce polypharmacy, over-prescribing, MRPs, ADEs, and the medication risks associated with
opioid and behavioral health medication prescribing. Include examples and references of prior
successful experience.
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New Hampshire Department of Health and Human Services
Medicaid Medication Risk Reduction Initiative
Q8 - Describe your organization's experience in (i) successfully engaging with patients to
complete a CMR; and (ii) communicating MSRs to patients in a patient friendly/accessible
communication.
2.3 Finance
2.3.1 Funding is anticipated to be available for the resulting contract as follows:
Anticipated Timeframes by RHTP Budget Anticipated Funding
Period Amount
RHTP Budget Period 1: G&C Approval - 09/30/27 $5,000,000
RHTP Budget Period 2: 10/1/27- 09/30/28 $4,545,391
RHTP Budget Period 3: 10/1/28 - 09/30/29 $9,504,000
RHTP Budget Period 4: 10/1/29 - 09/30/30 $9,504,000
RHTP Budget Period 5: 10/1/30 - 09/30/31 $5,000,000
Total $33,553,391
2.3.2 Payment will be made based on the completion of each deliverable as
specified in Appendix G - Deliverables Cost Sheet.
2.3.3 The selected Vendor must submit an invoice for each completed deliverable
using a form satisfactory to the Department to initiate and request payment in
accordance with the terms of the resulting contract.
2.3.4 The selected Vendor's indirect costs and administrative costs must not exceed
4% of the selected Vendor's total funding under this Contract, inclusive of any
subcontractors, subrecipients or sub-awardees of the selected Vendor. The
selected Vendor must track all administrative costs and indirect costs under
this Agreement and report such costs to NH-DMS. Administrative costs and
indirect costs are defined as set forth in 2 CFR Part 200 Uniform
Administrative Requirements, Costs Principles, Audit Requirements for
Federal Awards, and CMS RHT program guidance.
2.3.5 The selected Vendor agrees and covenants that the funds will be used solely
for an allowable purpose as set forth in the resulting Agreement and as
allowed under the CMS Rural Health Transformation Program as authorized
by the One Big Beautiful Bill Act (Section 71401 of Public Law 119-21). The
selected Vendor must ensure no funds under the resulting Agreement are
used for costs that are unallowable, including but not limited to the following:
2.3.5.1 New construction, including supplanting funding for in-process or
planned construction projects or directing funding towards new
construction builds, which is unallowable.
2.3.5.2 Replacing payment for clinical services that could be reimbursed by
insurance, including public and private payers. Payments to clinical
services are not allowed if it would duplicate billable services and/or
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New Hampshire Department of Health and Human Services
Medicaid Medication Risk Reduction Initiative
attempt to change payment amounts of existing fee schedules. If
the selected Vendor plans to fund direct health care services, the
selected Vendor must provide a written justification to NH-DMS
detailing why such services are not already reimbursable, how the
payment will fill a gap in care coverage (such as uncompensated
care or services not covered by insurance), how such payment will
transform the current care delivery model, and receive NH-DMS
prior approval.
2.3.5.3 Pre-contract effective date costs.
2.3.5.4 Meeting any matching requirements for any other federal funds or
local entities.
2.3.5.5 Services, equipment, or supports that are the legal responsibility of
another party under federal, State, or tribal law.
2.3.5.6 Goods or services not applicable to the scope of this Agreement.
2.3.5.7 Supplanting, or duplicating, existing State, local or private funding of
infrastructure or services.
2.3.5.8 The cost of independent research and development, including the
selected Vendor's proportionate share of indirect costs, see 2 CFR
300.477.
2.3.5.9 Purchase of covered telecommunications and video surveillance
equipment (see 2 CFR 200.216) as well as financial assistance to
households for installation and monthly broadband internet costs.
2.3.5.10 Meals, unless in limited circumstances such as (i) subject and
patients under study; (ii) where specifically approved as part of the
project; (iii) as part of a per diem or subsistence allowance provided
in conjunction with allowable travel. For community based
meetings, food allowance is an allowable cost.
2.3.5.11 Activities prohibited under 2 CFR 200.450 and the HHS Grants
Policy Statement, including, but not limited to: (i) payments related
to any activity designed to influence the enactment of legislation,
appropriations, regulation, administrative action, or executive order
proposed or pending before the Congress or any State government,
State legislature, local legislature or legislative body, including but
not limited to paying the salary or expenses of any grant Recipient
or agent acting for such Recipient for such activity; and (ii) lobbying,
but the selected Vendor can lobby at its own expense if the
selected Vendor can segregate federal funds from other financial
resources used for lobbying to the extent allowed under State law.
2.3.5.12 Replacement of HITECH certified electronic health records (EHR)
systems.
2.3.5.13 Clinician salaries or wage supports for facilities that subject
clinicians to non-compete contractual limitations. This applies only
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New Hampshire Department of Health and Human Services
Medicaid Medication Risk Reduction Initiative
to salaries and wages funded by RHTP through an approved
initiative described in the State's approved application.
2.3.5.14 Recruiting or retaining clinical workforce to rural areas, without a
commitment to serve rural communities for a minimum of five years
in accordance with CMS RHT program guidance.
2.3.5.15 SSA 2105(c), paragraphs (1), (7), and (9) apply as funding
limitations. These limitations are related to general limitations,
limitations on payment for abortions, and citizenship documentation
requirements for payments made with respect to an individual.
2.3.5.16 Any other use of funds deemed impermissible by CMS.
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