Third Party Administrator Services

The Vendor is required to provide third-party administrator (TPA) to operational support of the tiered rate structure (TRS) – wraparound immediate needs (WIN) program
- Financial management
•    A core function of the TPA will be to facilitate the transfer and tracking of those funds on a county-specific basis.
•    Analyze county data to estimate the number of eligible youth per tier by county and make those funds available to the TPA for disbursement.
•    The TPA will create 58 individual county subaccounts to hold funds and track all in-flows and outflows.
•    County placing agencies will have direct, self-service visibility into their subaccount balances, pending transactions, and historical activity to support local oversight, reconciliation, and court-related inquiries. 
•    Cares that will replace child welfare services and case management system beginning in October 2026 will serve as the source of truth for the tiered rate level for WIN eligible youth.
•    The TPA will provide reports and reconciliations and make available online dashboards to department and county placing agencies that show in fund expenditures and balances.
•    The TPA could use this data to verify that the funds went to a WIN provider for eligible services and calculate the funds owed to each county.
- Reporting
•    Identifying any data the TPA will receive other than financial data. 
•    The TPA should have the ability to store data securely and in compliance with all applicable state and federal privacy laws. 
•    The TPA will have the ability to use the data to create analytics that inform financial tracking and reconciliation. 
•    The department anticipates the TPA will create service delivery summaries at the individual, provider, county and state levels, assuming claims or other data with that level of information is available.
- Dashboards
•    The TPA will be expected to provide WIN program data dashboards and quarterly reports to the state and county partners that summarize program expenditures. 
•    Using other data provided, the TPA may also be utilized to support other quality improvement initiatives and to collaborate with external evaluators
- TPA support for continuous quality improvement and technical assistance
•    County will continue to conduct network oversight and quality monitoring processes, as under current policy. 
•    The center will monitor fidelity to aligned high fidelity wraparound (HFW) standards work with providers to support them achieving and maintaining medical fidelity designation. 
•    The departments will determine together the quality measures for youth receiving HFW including foster care youth. 
•    The TPA may be asked to support providers with technical assistance related to the medical program, such as site certification, contracting and claiming.