Transcript Doing Business with UTEP

Kyle L. Janek, M.D., Executive Commissioner
VENDOR CONFERENCE
STAR Kids
Request for Proposal No. 529-13-0071
July 31, 2014
Welcome
 Introductions
 Housekeeping Items
HHSC Procurement Roles
•
PCS: Responsible for procurement activity
•
Program: Responsible for project scope,
requirements, performance, results, contract
management/monitoring
•
HUB: Responsible for HUB Subcontracting
Plan (HSP) requirements and evaluation
•
Legal: Provides legal guidance and advice to
the agency
Vendor Conference Overview
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Procurement Activities
RFP Overview
HUB Overview
Questions
Break
Preliminary Responses to Questions
Closing Comments
Procurement Activities



Sole Point of Contact -- Section 1.2
Procurement Schedule -- Section 1.3
Solicitation Access
http://www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asp
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


Submission Requirements – Section 3.14
Solicitation Changes
Proposal Screening and Evaluation
Award Information
Sole Point of Contact
The sole and only permissible point of contact for
inquiries concerning this RFP is Richard Blincoe.
As a reminder, all communications relating to this
RFP must be directed to the sole point of contact for
this procurement. Failure to comply with these
requirements may result in proposal disqualification.
Procurement Schedule
RFP Release Date
July 18, 2014
Vendor Conference
July 31, 2014
Respondent Questions Due
August 5, 2014
Post Response to Questions (est.)
September 16, 2014
Proposals Due (2:00 P.M. Central Time)
October 30, 2014
Deadline for Proposal Withdrawal
October 30, 2014
Tentative Award Posting (est.)
To Be Announced
Anticipated Contract Effective
September 1, 2015
Date
Request for Proposals No. 529-13-0071
RFP Overview
 STAR Kids Overview

RFP Mission
 Contract Terms
 Eligible Populations
 Scope of Work
 Evaluation Criteria
STAR Kids Overview
• Senate Bill 7, 83rd Legislature, Regular Session, 2013, directs
HHSC to establish a mandatory, capitated STAR Kids managed
care program tailored to provide Medicaid benefits to children
and young adults with disabilities.
• S.B. 7 also calls for the inclusion of the Medically Dependent
Children Program (MDCP) and requires HHSC to consult with
the STAR Kids Medicaid Managed Care Advisory Committee
and Children’s Policy Council on the establishment and
implementation of the program.
STAR Kids Overview
• The members that will be served through STAR Kids have
diverse strengths and challenges. As such, services and
supports provided to STAR Kids members must reflect broad
differences in diagnoses, conditions, prior treatments,
development, environment, age, family dynamics, and
geography.
• By working with Members and their families, STAR Kids MCOs
will customize and coordinate acute, behavioral, and longterm services and supports (LTSS) through an individualized
planning and service design process. Through comprehensive
service coordination, STAR Kids Members will receive services
and supports tailored to their individual needs.
RFP Mission
• The purpose of this procurement is to contract with multiple
Managed Care Organizations (MCOs) to establish the STAR
Kids Medicaid managed care program.
• HHSC’s mission for the STAR Kids program is to enable STAR
Kids members to live and thrive in a setting that maximizes
their health, safety, and overall well-being.
RFP Mission
STAR Kids is established with the following goals:
• Coordinate care across service arrays;
• Improve quality, continuity, and customization of care;
• Improve access to care and provide person-centered Health Homes;
• Improve ease of program participation for Members, MCOs, and Providers;
• Improve Provider collaboration and integration of different services;
• Improve Member outcomes to the greatest extent achievable;
• Prepare young adults for the transition to adulthood;
• Foster program innovation; and
• Achieve cost efficiency and cost containment.
Contract Terms
• HHSC will award one contract per MCO, which will
include all awarded MCO service areas. The initial
contract period will be for three years.
• HHSC reserves the right to extend the contract
period, not to exceed a total of eight operational
years.
• All STAR Kids MCOs must begin serving members on
the operational start date.
Eligible Populations
• Children and young adults under age 21 who receive Social
Security Income (SSI) or Home and Community-based Services
(HCBS) Waiver program services must enroll in STAR Kids.
• Children and young adults who reside in an Intermediate Care
Facility for Individuals with Intellectual Disabilities (ICF/IID)
must also enroll in STAR Kids.
Eligible Populations
• Medically Dependent Children’s Program (MDCP) participants
will receive all of their services through STAR Kids, including
long-term services and supports (LTSS) provided through
MDCP.
• Children and young adults enrolled in other HCBS Waiver
programs or who receive services through an ICF/IID will
receive Medicaid State Plan services and service coordination
through STAR Kids, but will separately receive LTSS specific to
their program.
• Excluded populations include children in state conservatorship
and individuals under 21 who reside in nursing facilities.
Scope of Work
Covered Services
• The MCO must comply with all contract provisions including all
applicable state and federal laws, rules, regulations, and waivers.
• The MCO must provide full coverage of medically and
functionally necessary covered services to all members in
accordance with contractual requirements.
• The MCO may propose value-added services and case-by-case
added services that compliment the provision of medically and
functionally necessary covered services.
Scope of Work
Access to Care
• The MCO must have network PCPs, behavioral health,
specialty, pharmacy, and home and community-based
providers in sufficient number and capacity.
• Appointments for covered services must be provided within
contractually specified timeframes.
• Members must be provided access to out-of-network services
if medically necessary covered benefits are not available
within the network.
Scope of Work
Provider Network
• The MCO must enter into written contracts with properly
credentialed providers.
• The MCO must maintain a provider network sufficient to
provide all members with access to the full range of covered
services required under the contract.
• The MCO must enter into contracts with any willing
Significant Traditional Provider (STP) and develop short and
long-term strategies to increase access to qualified
providers.
• The MCO will include telemedicine providers in its network
to increase access to care in rural or underserved areas.
Scope of Work
Primary Care Providers (PCPs) and Health Home
• All STAR Kids members must be provided with a patient and
family-centered PCP.
• STAR Kids PCPs must coordinate with other relevant parties to
ensure member’s physical and behavioral health needs are
met.
• MCOs must also provide access to a health home for all
members who will benefit from a health home.
• MCOs must develop specific incentives for providers who
meet the requirements for patient-centered medical homes
found in Texas Government Code § 533.0029.
Scope of Work
Member Services and Materials
• The MCO must have a member services department to
assist members in obtaining covered services.
• Member services must include a member hotline, nurse
hotline, and behavioral health hotline as well as member
education and a member complaints and appeals process.
• Member materials must include a member identification
card, member handbook, provider directory, welcome letter,
and an internet website.
• The MCO must also establish member advisory groups to
identify and address needs and goals of STAR Kids
members.
Scope of Work
Clinical and Administrative Advisory Committee
• The MCO must establish Clinical and Administrative Advisory
Committees in each STAR Kids service area served.
• Clinical and Administrative Advisory Committees must be used
to help review and improve clinical and administrative
practices.
• Membership in a Clinical and Administrative Advisory
Committee must include the following provider types: PCP,
specialty care, behavioral health, home and community
support services, therapy provider, medical equipment and
supplies, and pharmacy.
Scope of Work
Management and Information Systems (MIS)
• The MCO must maintain a MIS to support the following
operational and administrative areas:
• Enrollment/Eligibility Subsystem
• Provider Subsystem
• Encounter/Claims Processing Subsystem
• Financial Subsystem
• Utilization/Quality Improvement Subsystem
• Reporting Subsystem
• Interface Subsystem
• Third Party Recovery (TPR) Subsystem
Scope of Work
Continuity of Care
• The MCO must ensure that the healthcare of newly enrolled Members is
not disrupted, compromised, or interrupted.
• The MCO must ensure new Members have continued authorization of
services for the same amount, duration, and scope for the shortest period
of one of the following: (1) 90 calendar days after the transition to a new
MCO, (2) until the end of the current prior authorization, or (3) until the
MCO has appropriately evaluated and administered the STAR Kids
Screening and Assessment Process and issued or denied a new
authorization.
• The MCO must ensure members receiving community-based services prior
to the operational start date continue to receive those services for up to six
months after the Operational Start Date.
Scope of Work
Service Coordination
• Service coordination provides the Member with initial and
ongoing assistance identifying, selecting, obtaining,
coordinating, and using covered services and other supports to
enhance the Member's well-being, independence, integration
in the community, and potential for productivity.
• Service coordinators must work with PCPs, network providers
and other resources to help address the full spectrum of a
member’s needs.
• Upon identification of need or member request, members
must be provided with access to a named service coordinator
and comprehensive service coordination teams.
Scope of Work
Service Coordination
• The MCO must ensure that Service Coordinator-to-Member
ratios are clinically appropriate and evidence-informed.
• The MCO may allow a member to receive service coordination
through an integrated health home if the individual providing
service coordination and the service coordination structure
meet STAR Kids program requirements.
• For members who receive non-capitated HCBS waiver
services, STAR Kids service coordinators must communicate
regularly with the DADS or DSHS staff members or
contractors responsible for overseeing the member’s HCBS
waiver services.
Scope of Work
Individual Service Plan (ISP)
• Each STAR Kids MCO must create and regularly update a
comprehensive person-centered ISP for each STAR Kids
member.
• The purpose of the ISP is to articulate assessment findings,
short and long-term goals, service needs, and member
preferences.
• The ISP must be used to communicate and help align
expectations between the member, their LAR, the MCO and
key service providers.
• The ISP may also be used by the MCO and HHSC to measure
Member outcomes over time.
Scope of Work
Adult Transition Planning
• The MCO must help to assure that teenage and young adult
Members receive early and comprehensive transition planning
to help prepare them for service and benefit changes that will
occur following their 21st birthday.
• Each MCO is responsible for conducting ongoing transition
planning starting when the Member turns 15 years old.
• MCO staff must include Transition Specialists dedicated to
counseling and educating Members and others in their support
network about considerations and resources for transitioning
out of STAR Kids.
Scope of Work
STAR Kids Screening and Assessment Requirements
• All STAR Kids MCOs are responsible for conducting
comprehensive, holistic, and evidence-based service needs
assessments for all Members.
• A key component of the process is use of the STAR Kids
Screening and Assessment Instrument (SAI).
• The STAR Kids SAI encompasses four modules: the Core, the
Personal Care Assessment Module (PCAM), Nursing Care
Assessment Module (NCAM), and the MDCP Module.
• All STAR Kids members must receive the Core, which will
indicate if there is need for the PCAM, NCAM or other
screenings or assessments.
Scope of Work
Medically Dependent Children Program (MDCP)
• MDCP STAR Kids provides community-based LTSS for
individuals under the age of 21 with complex medical needs as
a cost-effective alternative to living in a Nursing Facility.
• The MCO must provide all covered services included in the
MDCP service array for all MDCP STAR Kids members.
• The MCO will use STAR Kids SAI MDCP Module to help
determine eligibility and an annual cost limit for each MDCP
member.
• As a part of the ISP planning process, the MCO must establish
an MDCP plan of care as a part of the STAR Kids ISP that does
not exceed the Member's cost limit.
Evaluation Criteria (Section 5.3)
HHSC will evaluate each proposal using the following
criteria, in descending order of priority, developed
from the best value factors listed in Section 2 of the
RFP.
• The extent to which the goods and services meets
HHSC’s needs and the needs of the Members for
whom the goods and services are being purchased;
• Indicators of probable vendor performance;
• Effect of the acquisition on agency productivity; and,
• Delivery terms.
HUB Subcontracting Plan
(HSP) Requirements
Historically Underutilized Business Participation
Agenda Topics
I.
RFP Section 4.2.5 Historically Underutilized Business
Participation Requirements
II.
HUB Subcontracting Plan Development and Submission
III.
i.
HSP Quick Checklist – Handout
ii.
HSP Methods
iii.
HUB Subcontracting Notification Form
HSP Prime Contractor Progress Assessment Report
Historically Underutilized Business Participation
I. Historically Underutilized Business
Participation Requirements
Historically Underutilized Business Participation
I. Historically Underutilized Business
Participation Requirements
HUB Participation Goals – Section 4.2.5.3
Potential Subcontracting Opportunities – Section
4.2.5.5
Centralized master Bidders List and HUB directory –
Section 4.2.5.5
Vendor Intends to Subcontract – Section 4.2.5.6
Historically Underutilized Business Participation
I. Historically Underutilized Business
Participation Requirements (cont)
Minority or Women Trade Organizations – Section
4.2.5.6.2
Self Performance – Section 4.2.5.7
HSP Changes After Contract Award – Section 4.2.5.8
Reporting and Compliance with the HSP – Section
4.2.5.8
Historically Underutilized Business Participation
II.
HUB Subcontracting Plan (HSP)
Development and Submission
• Note: All Respondents must submit a HSP regardless
if its intent is to subcontract or self perform all the
work under the Contract.
Historically Underutilized Business Participation
II.
HUB Subcontracting Plan (HSP)
Development and Submission
• Note: All Respondents must submit a HSP regardless
if its intent is to subcontract or self perform all the
work under the Contract.
38
If HSP is
inadequate,
response will be
rejected
HUB GOALS
Special
reminders and
instructions
HSP
Information
Page
Historically Underutilized Business Participation
i.
HSP Quick Checklist
** See Checklist Handout**
Historically Underutilized Business Participation
ii. HSP Methods
Note:
There are five (5) Method Options to choose from in order to
develop and submit the HSP.
Respondent’s should indicate their response which Method
Option was selected.
Historically Underutilized Business Participation
Method Options
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;
Historically Underutilized Business Participation
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; and
• Method V - if the Respondent intends to self perform all of
the work utilizing their own resources, equipment,
employees, and supplies.
Historically Underutilized Business Participation
All Methods
For ALL Methods the following steps are required to be
completed on the HSP Form:
• 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.
Historically Underutilized Business Participation
All Methods
For ALL Methods the following steps are required to be
completed on the HSP Form:
• 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.
45
Step by Step
HSP
Information
Page
Respondent and
Requisition
Information
46
Company Name
and Requisition #
Subcontracting
Intentions:
Declaration:
Check – “Yes”
if you plan to
subcontract
Check – “No”
if you will not be
subcontracting
any portion of the
contract
Historically Underutilized Business Participation
All Methods
For ALL Methods the following steps are required to be
completed on the HSP Form:
• 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.
48
Step by Step
Section 4;
Affirmation
Signature
Affirms that
Information
Provided is
True and
Correct.
49
METHOD I
If all (100%) of your subcontracting
opportunities will be performed using only HUB
vendors, complete:
• All of the steps in Sections 1, 2, and 4 of the HSP.
• 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.
• Section 2 c. – Yes.
• HSP GFE Method A (Attachment A) – Complete this
attachment for each subcontracting opportunity.
50
Step by Step
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.
51
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
52
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 of the HSP.
• 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,
B-2 and B-4 only for each subcontracting opportunity as
applicable.
53
Step by Step
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.
54
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)
B-4
List the
HUB Protégé(s)
Selected to perform the
subcontracting opportunity
METHOD III
56
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 of the HSP.
•
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.
57
Step by Step
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.
58
Step by Step
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.
59
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)
METHOD IV
60
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 of the HSP;
•
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.
61
Step by Step
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.
62
Step by Step
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.
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
63
HSP GFE Method B
(Attachment B)
Written
Notification
Requirements
List 3 HUBs
Contacted
for this
Subcontracting
Opportunity
64
HSP GFE Method B
(Attachment B)
Written
Notification
To Trade
Organizations
65
HSP GFE Method B
(Attachment B)
List Trade
Organizations
Notified with
Dates
Sent/Accepted.
66
HSP GFE Method B
(Attachment B)
Provide written
justification why
a HUB was not
selected for this
Subcontracting
Opportunity
67
68
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:
•
All of the steps in Section 1, 2, and 4 of the HSP.
•
Section 3 – Self Performing Justification,
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.
69
70
iii HUB Subcontracting Opportunity
Notification Form
71
Sample for
Respondent’s
Use.
72
III. HSP Prime Contractor Progress
Assessment Report
Section 4.2.5.8
73
HSP Prime
Contractor
Progress
Assessment
Report
• Required with
ALL Pay Requests
• List ALL Sub
payments
(HUBs & Non-HUBs)
• Required even if
not subcontracting
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 responses are posted on the HHSC
website.
Closing Comments