Transcript Vendor Conference Presentation
Kyle L. Janek, M.D., Executive Commissioner
VENDOR CONFERENCE
Actuarial Consulting Services Request for Proposal No. 529-15-0003 January 21, 2014
Welcome
Introductions Steve R. Bailey, Procurement and Contracting Services (PCS) Rachel Butler, Chief Actuary - HHSC Actuarial Analysis Department Sherice Williams, HHSC HUB Coordinator
Jimmy Ramirez, Asst.
General Counsel
Housekeeping Items
HHSC Procurement Roles
PCS- Responsible for procurement activity
Program- Responsible for project scope, requirements, performance, results, contract management and monitoring
HUB- Responsible for HUB activity
Legal- Questions/answers and legal activity
Vendor Conference Overview
Procurement Activities HUB Overview RFP Overview Questions Break Preliminary Responses to Questions Closing
Procurement Activities
Questions and Answers Sole Point of Contact Procurement Schedule Solicitation Access http://www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asp
Solicitation Changes Submission Requirements Proposal Screening and Evaluation Award Information
Procurement Schedule
RFP Release Date January 2, 2014 Vendor Conference January 21, 2014 Respondent Questions Due January 23, 2014 Post Response to Questions (est.) January 28, 2014 Proposals Due ( 2:00 PM Central Time) Deadline for Proposal Withdrawal February 11, 2014 February 11, 2014 Tentative Award Posting (est.) April 1, 2014 Anticipated Contract Start Date September 1, 2014
Historically Underutilized Business (HUB) Requirements Sherice Williams HHSC HUB Coordinator/ Administrator
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I.
Agenda Topics
RFP Section 4.0 Historically Underutilized Business Participation Requirements II. HUB Subcontracting Plan Development and Submission III. HSP Quick Checklist – Handout IV.
HSP Methods – Section 4.6.3.2
V.
HSP Prime Contractor Progress Assessment Report – Section 4.7
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I. Historically Underutilized Business Participation Requirements
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I. RFP Section 4.0 Historically Underutilized Business Participation Requirements
• • • •
HUB Participation Goals – Section 4.3
Potential Subcontracting Opportunities – Section 4.5 Centralized Master Bidders List and HUB Directory – Section 4.5 Vendor Intends to Subcontract – Section 4.6
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I. RFP Section 4.0 Historically Underutilized Business Participation Requirements
(cont.)
• • • •
Minority or Women Trade Organizations – Section 4.6.3.2.04 Self Performance – Section 4.6.3.2.05
HSP Changes After Contract Award – Section 4.7 Reporting and Compliance with the HSP – Section 4.7
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II. HUB Subcontracting Plan (HSP) Development and Submission
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If HSP is inadequate, response will be rejected HUB GOALS Special reminders and instructions HSP Information Page
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III. HSP Quick Checklist
** See Checklist Handout**
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IV. HSP Methods
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METHOD OPTIONS
A Respondent may choose from one of the following methods when completing the HSP:
•
Method I – if 100% of your subcontracting opportunities will be performed using only HUB vendors;
•
Method II – if one or more of the subcontracting opportunities identified will be performed using HUB protégé’s;
•
Method III – if a combination of HUBs and Non-HUBs are used to perform the subcontracting work identified AND the HUB goal identified in the solicitation is met or exceeded;
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METHOD OPTIONS
A Respondent may choose from one of the following methods when completing the HSP (cont.):
•
Method IV – if a combination of HUBs and Non-HUBs are used to perform the subcontracting work identified AND the HUB goal identified in the solicitation is not met or exceeded.
•
Method V - if the Respondent intends to self perform all of the work utilizing their own resources, equipment, employees, and supplies.
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ALL METHODS
For ALL Methods the following steps are required to be completed on the HSP Form:
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Page 1 - Section 1 - Respondent and Requisition Information;
•
Page 2 - Company and Requisition Information
•
Page 2 - Section 2(a) – Subcontracting Intentions
•
Section 4 – Affirmation and Sign
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HSP Information Page Respondent and Requisition Information
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Company Name and Requisition # Subcontracting Intentions: If Yes, Complete Section 2a If No, Complete Section 2b
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Section 4; Affirmation Signature Affirms that Information Provided is True and Correct.
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METHOD I
If all (100%) of your subcontracting opportunities will be performed using only HUB vendors , complete:
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All of the steps in Section 1, 2 , and 4;
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Section 2 b. – List all the portions of work you will subcontract, and indicate the percentage of the contract you expect to award to HUB vendors;
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Section 2 c. – Yes;
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HSP GFE Method A (Attachment A) – Complete this attachment for each subcontracting opportunity.
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Complete Section 2-b; List all the portions of work you will subcontract, and indicate the % of the contract you expect to award to all HUBs.
Complete Section 2-c; Yes if you will be using only HUBs to perform all Subcontracting Opportunities in 2-b .
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HSP GFE Method A (Attachment A) Complete this attachment (Sections A-1 and A-2) and List Line # and Subcontracting Opportunity. HUB Subcontractor Selection for this Subcontracting Opportunity
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METHOD II
If any of your subcontracting opportunities will be performed using HUB protégés , complete:
•
All of the steps in Section 1, 2 and 4;
•
Section 2 b. – List all the portions of work you will subcontract, and indicate the percentage of the contract you expect to award to HUB vendors;
•
HSP GFE Method B (Attachment B) – Complete Section B-1 and Section B-2 only for each subcontracting opportunity as applicable.
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Complete Section 2-b; List all the portions of work you will subcontract, and indicate the % of the contract you expect to award to HUB Protégés .
Skip Sections 2-c and 2-d.
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HSP GFE Method B (Attachment B) Complete Sections B-1; and B-2 only for each HUB Protégé subcontracting opportunity.
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HSP GFE Method B (Attachment B) List the HUB Protégé(s)
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• • • • •
METHOD III
If you are subcontracting with HUBs and Non-HUBs, and the aggregate percentage of subcontracting with HUBs in which the HUB Goal identified in the solicitation is met or exceeded , complete: All of the steps in Section 1, 2, and 4; Section 2 b. – List all the portions of work you will subcontract, and indicate the percentage of the contract you expect to award to HUB vendors and Non HUB vendors; Section 2 c. – No; Section 2 d. – Yes; HSP GFE Method A (Attachment A) – Complete this attachment for each subcontracting opportunity.
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Complete Section 2-b; List all the portions of work you will subcontract, and indicate the % of the contract you expect to award to HUBs and Non-HUBs.
Complete Section 2-c; No to using only HUBs to perform all Subcontracting Opportunities in 2-b.
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Complete Section 2-d; Yes, to the Aggregate % of the contract expected to be subcontracted to HUBs to meet or exceed the HUB goal, which you have a contract agreement in place for five (5) years or less.
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HSP GFE Method A (Attachment A) Complete this attachment (Sections A-1 and A-2) for each subcontracting opportunity. Subcontractor Selection (HUBs and Non-HUBs)
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• • • • •
METHOD IV
If you are subcontracting with HUBs and Non-HUBs, and the aggregate percentage of subcontracting with HUBs, holding an existing contract with HUBs for 5 years or less, does not meet or exceed the HUB Goal identified in the solicitation, complete: All of the steps in Section 1, 2, and 4; Section 2 b. – List all the portions of work you will subcontract, and indicated the percentage of the contract you expect to award to HUB vendors and Non HUB vendors; Section 2 c. – No; Section 2 d. – No; HSP GFE Method B (Attachment B) – Complete this attachment for each subcontracting opportunity.
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Complete Section 2-b; List all the portions of work you will subcontract, and indicated the % of the contract you expect to award to HUBs and Non-HUBs.
Complete Section 2-c; No, to using only HUBs to perform all Subcontracting Opportunities in 2-b.
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Complete Section 2-d; No, to the Aggregate % of the contract expected to be subcontracted to HUBs to meet or exceed the HUB goal, which you have a contract agreement in place for five (5) years or less.
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HSP GFE Method B (Attachment B) Complete Section B-1; and Section B-2 only for each subcontracting opportunity.
Good Faith Efforts to find Texas Certified HUB Vendors
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HSP GFE Method B (Attachment B) Written Notification Requirements List 3 HUBs Contacted for this Subcontracting Opportunity
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HSP GFE Method B (Attachment B) Written Notification To Trade Organizations
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HSP GFE Method B (Attachment B) List Trade Organizations Notified with Dates Sent/Accepted.
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HSP GFE Method B (Attachment B) Provide written justification why a HUB was not selected for this Subcontracting Opportunity
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METHOD V
If you are not subcontracting any portion of the contract and will be fulfilling the entire contract with your own resources (i.e., equipment, supplies, materials, and/or employees) , complete:
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All of the steps in Section 1, 2, and 4;
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Section 3 – Self Performing Justification
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Section 3; Self Performing Justification List the specific page(s)/section(s) of your proposal response, OR in the space provided, which explains how your company will perform the entire contract with its own equipment, supplies, materials and/or employees.
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HUB Subcontracting Opportunity Notification Form
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Sample for Respondent’s Use.
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V. HSP Prime Contractor Progress Assessment Report
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HSP Prime Contractor Progress Assessment Report
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Required with ALL Pay Requests
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List ALL Sub payments (HUBs & Non-HUBs)
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Required even if not subcontracting
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RFP Overview
Mission Objectives
Scope of Work Overview
Actuarial Personnel
Performance Measures and Remedies
Compensation
Mission Objectives
The Center for Medicaid and Medicare Statistics requires an external actuary who is a Member of the American Academy of Actuaries to certify that HHSC’s HMO capitation rates are actuarially sound.
The external actuary may be used to provide a second opinion on forecasts and other budgetary matters.
Actuaries are used for projects involving specialized analyses and to provide additional resources as needed.
Scope of Work Overview
1. Provide analysis of program experience to produce estimates of experience to date and projection of future experience based on information provided by HHSC and its Medicaid and CHIP contractors.
2. Contractor must have the ability to maintain confidentiality of Medicaid recipient information and other documents provided by HHSC.
3. Perform calculations of managed care capitation rates.
4. Perform cash flow analyses of program expenditures.
Scope of Work Overview
(cont.)
5. Provide actuarial opinion and fiscal impact analysis of proposed program changes.
6. Provide actuarial opinion and fiscal impact analysis for proposed provider rate methodologies.
7. Must participate in meetings with HHSC and other agency staff, HHSC contractors, Legislative committees and CMS representatives as needed. Meetings are face to-face and may be scheduled on very short notice.
8. Provide approximately 3,500 or more hours of actuarial services per year. (HHSC does not guarantee any specific number of hours of work under the RFP or any resulting contract. The amount is an estimated yearly total).
Scope of Work Overview
(cont.)
9. Provide within one-week, or longer if approved by HHSC, a subcontract for actuarial expertise in specialty areas. Examples of recent HHSC needs in specialty areas include Medical Transportation, Texas Medicaid Wellness Program, Medicare Advantage Plan, prescription drug formulary management, nursing facility contracting, and risk adjustment. Subcontractor selection will be subject to HHSC approval. HHSC may elect at any time to separately procure services for specialty areas even if there is a subcontract in place. 10. Expertise and knowledge of Center for Medicare and Medicaid Services regulations for determining rates including Medicaid capitation rates.
11. Provide complete explanations of all calculations and provide all formulas to HHSC or its contractors.
Scope of Work Overview
(cont.)
12. Provide effective presentations on analyses performed as requested.
13. Request for work on legislative fiscal notes must be completed within timeframe negotiated with HHSC.
14. May assist as a subject matter expert in HHSC’s preparation of Requests for Proposals or other solicitations, evaluation of solicitations and contract negotiations. 15. Perform special actuarial projects as assigned.
Actuarial Personnel
1. The principle actuary must be a Fellow in the Society of Actuaries (FSA) and a Member of the American Academy of Actuaries (MAAA) with proven experience with a Medicaid and/or CHIP program.
2. One actuary must be both FSA and MAAA and have proven experience with a Medicaid and/or CHIP program.
3. Two other actuaries must be either FSA or MAAA with at least a working knowledge of a Medicaid and/or CHIP program.
Actuarial Personnel (cont.)
4. Non-actuaries must work under the supervision of the principle actuary in performing the actuarial work.
5. At least one actuary must be available either in person or by phone within two hours every Monday through Friday when the State legislature is not in session to discuss actuarial matters and work on pressing issues.
6. At least one actuary must be available in person within one hour, 24 hours a day, seven days a week during a State Legislative Session to discuss and testify on actuarial matters and work on pressing issues.
Performance Measures and Remedies
HHSC will monitor contract performance All services and deliverables under the contract shall be provided at an acceptable quality level and in a manner consistent with acceptable industry standard, custom, and practice.
Assist HHSC Actuarial Analysis with development of the Annual Managed Care Capitation Rates due July 15 th of each year
Performance Measures and Remedies (cont.)
Requested services must be completed within the negotiated timeframes for each project. May assess $500 per business day for each day the Services are not submitted timely. If the information is received timely, but is inaccurate or incomplete, may assess $200 per business day until accurate or complete information is received.
Provide sound analysis for actuarial opinions and fiscal impact pertaining to program changes, proposed provider rate methodologies and special projects. May assess $500 per business day for each day the actuarial opinions are not submitted timely. If the information is received timely, but is inaccurate or incomplete, may assess $200 per business day until accurate or complete information is received.
Performance Measures and Remedies (cont.) Provide at least one actuary who is available in person within two (2) hours upon request to discuss actuarial matters and work on pressing issues upon HHSC's request. May assess $800 for each occurrence in which the Vendor does not meet this request.
Provide at least one actuary who is available in person within one (1) hour seven days a week during a Legislative Session to discuss and testify on actuarial matters and work on pressing issues. May assess $1,000 for each occurrence in which the Vendor does not meet this requirement.
Compensation
Attachment 1 includes the format for submitting cost proposals. Costs must be based on an hourly rate per skill set and must be all inclusive. HHSC will reimburse vendor for reasonable travel that HHSC has pre-approved according to State reimbursement rates. Cost Proposals must be based on the Scope of Work described in the RFP. This section should include any business, economic, legal, programmatic, or practical assumptions that underlie the Cost Proposal.
Separately identify value-added benefits, cost-savings and cost avoidance methods and measures, and the effect of such methods on the Cost Proposal and Scope of Work.
Texas Health and Human Services Commission
Questions Submittal Followed by Break
Vendor Question/Response
Verbal answers to vendor questions will be provided to the extent practicable.
Responses are not binding until the final written addendum is posted on the HHSC website. HHSC estimates the addendum will post by January 28, 2014.
Texas Health and Human Services Commission