State Medicaid Data Analytics Oversight Solution

The Pennsylvania Department of Human Services (“Department”), Bureau of Procurement & Contract Management issues this Request for Information (“RFI”) to gather input and information concerning innovative solutions that leverage Medicaid data to improve transparency within Pennsylvania’s Medicaid managed care delivery system and strengthen the Department’s ability to make evidence-based rate-setting decisions.

Specifically, this RFI seeks information regarding innovative analytical methodologies, technologies, and strategies that transform existing Medicaid data into actionable insights by improving visibility into organizational structures, ownership and affiliations, financial and reimbursement flows, utilization patterns, and other factors that influence Medicaid expenditures and future rate-setting methodologies.

The Department is interested in approaches that examine relationships among Managed Care Organizations (“MCO”), county Primary Contractors, affiliated entities, subcontractors, providers, vendors, service brokers, and other entities participating in the Medicaid managed care delivery system.

The Department welcomes both enterprise-wide and targeted solutions applicable across the Medicaid managed care delivery system, as well as approaches focused on service categories experiencing significant utilization or expenditure growth, including, but not limited to, Applied Behavior Analysis (“ABA”), Pharmacy Services, Long-Term Care (“LTC”), and Home and Community-Based Services (“HCBS”).

A respondent may address all or any of the specific questions or topics included in this RFI.

The following provides a suggested structure for a response to this RFI. Please address the following, as relevant:

• Organizational Experience
• Innovative Solutions & Emerging Practices
• Data Analytics & Financial Transparency
• Medical Economics & Priority Service Categories

Responses must be submitted electronically to the following email account with “State Medicaid Data Analytics & Oversight Solutions RFI” in the email subject line: RA-PWRFICOMMENTS@PA.GOV.

The Department is requesting that all responses to this RFI be submitted by **12:00 p.m.** on the due date, **November 13, 2026**.

Please prepare responses simply, providing straightforward and concise language and descriptions. All responses should be produced in 12 point font. Please limit your response to no more than 10 pages, not including the cover letter or attachments. Please refrain from sending marketing materials to the Department.

Please include a cover letter with the following information:

1. An introduction to the respondent’s organization, background, and interest in State Medicaid data analytics and oversight solutions.
2. General information about the respondent and respondent organization, including an address and a point of contact along with a telephone number and an e-mail address.
3. A description of the respondent’s organizational structure, ownership and affiliations, and any actual or potential conflicts of interest arising from relationships with MCOs, Primary Contractors, affiliated entities, subcontractors, providers, vendors, or other entities doing business with state Medicaid programs.

This RFI is issued for information and planning purposes only and does not constitute a solicitation for future business, an offer for procurement, or any other type of current or future procurement action and is only intended to gather information and input.