flyer 1 subject: rfp no. 11-10 healthchoices ......e. mentor protégé program (mpp) 44 f. domestic...

COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF PUBLIC WELFARE Division of Procurement

Room 525, Health & Welfare Building

625 Forster Street

PO Box 2675

Harrisburg, PA 17120

Daniel R. Boyd Telephone 717-783-3767

Director Fax 717-787-3560

December 8, 2010

FLYER 1

SUBJECT: RFP NO. 11-10 HealthChoices Physical Health Services for the Southwest

Zone

Dear Prospective Offeror: The attached package represents a formal issuance of materials related to the Commonwealth

of Pennsylvania, Department of Public Welfare Request for Proposal 11-10, HealthChoices

Physical Health Services for the Southwest Zone. The following material is being sent to all entities that were mailed the original RFP package:

Written answers to the questions submitted for the above referenced RFP. The answers serve as the official response from the Office of Medical Assistance Programs, Department of Public Welfare (DPW), to the questions raised by prospective bidders concerning this RFP.

Appendix B, D, H, and K amendments

Amended RFP

Technical amendments

PowerPoint Presentation from the pre-proposal conference

Attendance list from the pre-proposal conference

NO ADDITIONAL QUESTIONS REGARDING RFP 11-10 WILL BE ACCEPTED OR

ANSWERED EITHER VERBALLY OR IN WRITING.

All proposals must be received by January 14, 2011, at or before 2:00 p.m., by the Department of Public Welfare, Division of Procurement, Room 525, Health and Welfare Bldg, 625 Forster Street, Harrisburg, Pennsylvania 17120. Sincerely,

Daniel R. Boyd, Director DPW Division of Procurement

HealthChoices Physical Health Southwest RFP 11-10 1

REQUEST FOR PROPOSALS FOR

HEALTHCHOICES PHYSICAL HEALTH SERVICES

for

Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington

and Westmoreland counties.

ISSUING OFFICE

Commonwealth of Pennsylvania

Department of Public Welfare

Bureau of Financial Operations

Division of Procurement

Room 525 Health and Welfare Building

625 Forster Street


RFP NUMBER

11-10

DATE OF ISSUANCE

10/29/10

HealthChoices Southwest RFP


TABLE OF CONTENTS

HEALTHCHOICES PHYSICAL HEALTH SERVICES for

Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington and

Westmoreland counties.

CALENDAR OF EVENTS 5

PART I: GENERAL INFORMATION 6

I-1 Purpose 6

I-2 Issuing Office 6

I-3 Scope 6

I-4 Problem Statement 6

I-5 Type of Agreement 7

I-6 Rejection of Proposals 8

I-7 Incurring Costs 8

I-8 Preproposal Conference 8

I-9 Questions and Answers 8

I-10 Addenda to the RFP 9

I-11 Response Date 9

I-12 Proposals 9

I-13 Disadvantaged Business Information 10

I-14 Information Concerning Small Businesses in Enterprise Zones 11

I-15 Contractor Partnership Program 12

I-16 Mentor Protégé Program 13

I-17 Economy of Preparation 14

I-18 Alternate Proposals 14

I-19 Discussions for Clarification 14

I-20 Prime Responsibility 14

I-21 Proposal Contents 15

I-22 Best and Final Offers 15

I-23 News Releases 16

I-24 Restriction of Contact 16

I-25 Debriefing Conferences 16

I-26 Issuing Office Participation 16

I-27 Term of Agreement 17

I-28 Offeror’s Representations and Authorizations 17

I-29 Notification of Selection 18

I-30 RFP Protest Procedure 18

I-31 Use of Electronic Versions of this RFP 18

I-32 Liquidated Damages 19


PART II: PROPOSAL REQUIREMENTS 20 II-1 Statement of the Problem 20

II-2 Work Plan-Disadvantaged Business 20

II-3 Prior Experience 20

II-4 Personnel 22

a. Executive Management 23

b. Key Administrative Positions 23

c. Organization 24

d. Staffing Plans 24

e. Subcontracts 25

II-5 Work Statement 25

II-6 Financial Condition 32

II-7 Objections and Additions to Agreement Terms and Conditions 34

II-8 Disadvantaged Business Submittal 35

II-9 Domestic Workforce Utilization Certification 39

II-10 Contractor Partnership Program Submittal 39

II-11 Mentor Protégé Program (MPP) Submittal 40

PART III: CRITERIA FOR SELECTION 42

III-1 Mandatory Responsiveness Requirements 42

III-2 Technical Nonconforming Proposals 42

III-3 Evaluation 42

III-4 Criteria for Selection 42

a. Technical 42

b. Disadvantaged Business Participation 43

c. Enterprise Zone Small Business Participation 43

d. Contractor Partnership Program 44

e. Mentor Protégé Program (MPP) 44

f. Domestic Workforce Utilization 44

PART IV: WORK STATEMENT 45

IV-1 Objectives 45

IV-2 Nature and Scope 45

IV-3 Requirements 45

IV-4. Contract Requirements –Disadvantaged Business & Enterprise Zone 46

IV-5. CPP Reporting Requirements 47

IV-6. Mentor Protégé Program (MPP) 48


RFP APPENDICES

APPENDIX A-DRAFT HEALTHCHOICES AGREEMENT

APPENDIX B-DATA BOOK

APPENDIX C-FORMAT FOR QUESTIONS

APPENDIX D-PROPOSAL COVER SHEET

APPENDIX E-STANDARD TERMS AND CONDITIONS FOR SERVICES

APPENDIX F-DEPARTMENT OF PUBLIC WELFARE ADDENDUM TO STANDARD

TERMS AND CONDITIONS

APPENDIX G-OFFEROR’S MANAGED CARE EXPERIENCE

APPENDIX H-CORPORATE REFERENCE QUESTIONNAIRE

APPENDIX I-EXECUTIVE STAFF AND KEY ADMINISTRATIVE PERSONNEL

CHECKLIST

APPENDIX J-OWNERSHIP STRUCTURE AND RELATED INFORMATION

APPENDIX K-HEDIS REPORTING FORM

APPENDIX L-DOMESTIC WORKFORCE UTILIZATION CERTIFICATION


CALENDAR OF EVENTS

The Commonwealth will make every effort to adhere to the following schedule:

Activity Responsibility Date

Deadline to submit Questions via email to

[email protected] Potential Offerors 11/16/10

Preproposal Conference—Location:

The Pennsylvania Child Welfare Training Program

403 East Winding Hill Road

Mechanicsburg, PA 17055

Phone: (717) 795-9048

DEPARTMENT/

Potential Offerors

11/23/10

12:30 pm

Answers to Potential Offeror questions posted to the

DGS Web site

(http://www.dgsweb.state.pa.us/RTA/Search.aspx) no

later than this date.

DEPARTMENT 12/02/10

Please monitor DGS Web site for all communications

regarding the RFP. Potential Offerors N/A

Sealed proposal must be received by the Issuing Office

at:


Office of Administration

Contract Policy, Management and Procurement


625 Forster Street

Harrisburg, Pennsylvania 17120

Offerors 01/14/2011

mailto:[email protected]

http://www.dgsweb.state.pa.us/RTA/Search.aspx


PART I

GENERAL INFORMATION

I-1. Purpose

This request for proposals (RFP) provides to those interested in submitting proposals

for the subject procurement (Offerors) sufficient information to enable them to prepare

and submit proposals for the Department of Public Welfare’s (Department)

consideration on behalf of the Commonwealth of Pennsylvania (Commonwealth) to

satisfy a need for Managed Care Organizations (MCOs) in the HealthChoices Physical

Health program in the Southwest (SW) Zone.

I-2. Issuing Office

The Bureau of Financial Operations, Division of Procurement (Issuing Office) has

issued this RFP on behalf of the Commonwealth. The sole point of contact in the

Commonwealth for this RFP shall be Cynthia Clea the Project Officer for this RFP.

Please refer all inquiries to the Project Officer.

Cynthia Clea, Director

Division of Program Initiatives, Contract Management & Communications


Bureau of Managed Care Operations

P.O. Box 2675


Phone Number – (717) 772-6300

E-Mail Address – [email protected]

I-3. Scope

This RFP contains instructions governing the requested proposals, including the

requirements for the information and material to be included; a description of the

service to be provided; requirements which Offerors must meet to be eligible for

consideration and general evaluation criteria; and other requirements specific to this

RFP as set forth in the draft HealthChoices Agreement (Appendix A).

I-4. Problem Statement

This RFP has been issued to procure the services of MCOs to operate the

HealthChoices Physical Health program in the SW Zone. As the result of this

procurement, the Department will enter into agreement negotiations with no more than

five MCOs. The Department reserves the right to negotiate with fewer than five MCOs

if the Department determines that doing so is in the best interest of the

Commonwealth. The anticipated composition of the MCO market will heavily

influence this decision. Participation in the HealthChoices SW program will be limited

to Commonwealth-licensed HMOs. MCOs submitting proposals for the HealthChoices



SW program will be required to have operating authority for every county in the

HealthChoices SW Zone no later than three months prior to the implementation

date of 1/1/2012 and will be required to provide a copy of their Certificate of

Authority to the Project Officer

I-5. Type of Agreement

It is proposed that, if the Department enters into an agreement as a result of this RFP, it

will be a full risk, capitated agreement. The Department, in its sole discretion, may

undertake negotiations with Offerors whose proposals, in the judgment of the

Department, show them to be qualified, responsible, and capable of providing the

services.

The Department will pay each MCO, using a schedule of per member per month

(PMPM) capitation rates. The Department may make other types of payments, as

provided by the Agreement. These may include, but are not limited to:

Maternity Care Payments

Home Nursing Risk Sharing Payments

High Cost Risk Pool Payments

The following information is included in Appendix B, Data Book

2010-2011 Rate ranges without allowance for Gross Receipts Tax or Hospital

Assessment

Pre-adjustment 11-12 Data Book

2010-2011 Rates Trend Chart

2010-2011 Admin-profit Load Chart

The Department will provide an initial schedule of rates to those Offerors preliminarily

determined to be qualified to provide services. The Department will afford those

Offerors the opportunity of a meeting to answer questions and concerns about the

development of the initial schedule of rates. The Department will consider

documented evidence from those Offerors demonstrating any potential errors in the

Department’s rate setting methodology. The Department may, at its discretion,

reevaluate the rate setting methodology based on the documented evidence. The

Department will provide a final schedule of rates for each selected Offeror. The final

schedule of rates will be set forth in the final Agreement. The Department shall have

the sole right to make the final rate offer. If the Offeror does not accept the

Department’s final rate offer, the Department may, at its sole discretion, reject the

proposal.

Capitation rates and maternity care rates and any other payments made under the

Agreement year will remain the same as rates for the previous Agreement Year, unless

the Agreement is amended to provide different rates.

The Department may choose to risk-adjust capitation rates. The Department will share

detailed information with the MCO on the risk-adjusted rate methodology. The MCO

will accept capitation rates that are adjusted upward or downward, using rate


adjustment factors computed by the Department, consistent with the risk adjustment

methodology shared by the Department with the MCO.

It is proposed that if an Agreement is entered into as a result of this RFP, capitation

payments will be made monthly; unless specified otherwise in the Agreement, each

capitation payment will be paid one month after the program month, except that the

capitation payment for May of each year will be paid in July. The submission of a

proposal in response to this RFP will constitute acknowledgement and acceptance of

this capitation timing of payments.

I-6. Rejection of Proposals

The Department reserves the right, in its sole and complete discretion, to reject any

proposal received as a result of this RFP or to negotiate separately with competing

Offerors.

I-7. Incurring Costs

The Department is not liable for any costs the Offeror incurs in preparation and

submission of its proposal, in participating in the RFP and Readiness Review process

or in anticipation of award.

I-8. Preproposal Conference

The Department will hold a Preproposal Conference as specified in the Calendar of

Events. The purpose of this conference is to provide opportunity for clarification of

the RFP. Offerors should forward all questions to the RFP Project Officer in

accordance with Section I-10 to ensure adequate time for analysis before the Issuing

Office provides an answer. Offerors may also ask questions at the conference. The

preproposal conference is for information only. Any answers furnished during the

conference will not be official until they have been verified, in writing, by the Issuing

Office. All questions and written answers will be posted on the Department of General

Services’ (DGS) Web site as an addendum to, and shall become part of, this RFP.

Attendance at the Preproposal conference is mandatory.

I-9. Questions and Answers

If an Offeror has any questions regarding this RFP, the Offeror must submit the

questions by email (with the subject line ―RFP 11-10 Question‖) to the Issuing

Officer named in Part I, Section I-2 of the RFP. If the Offeror has questions, they

must be submitted via email no later than the date indicated on the Calendar of

Events. The format for questions shall be submitted to the Project Officer as outlined

in Appendix C. The Offeror shall not attempt to contact the Project Officer by any

other means. The Issuing Office shall post the answers to the questions on the DGS

Web site by the date stated on the Calendar of Events.

All questions and responses as posted on the DGS Web site are considered as an

addendum to, and part of, this RFP in accordance with RFP Part I Section I-10. Each

Offeror shall be responsible to monitor the DGS Web site for new or revised RFP


information. The Department shall not be bound by any verbal information nor shall it

be bound by any written information that is not either contained within the RFP or

formally issued as an addendum by the Issuing Office. The Issuing Office does not

consider questions to be a protest of the specifications or of the solicitation.

I-10. Addenda to the RFP

If the Department deems it necessary to revise any part of this RFP before the proposal

response date, the Issuing Office will post an addendum to the DGS Web site at

http://www.dgsweb.state.pa.us/RTA/Search.aspx. It is the Offeror’s responsibility to

periodically check the website for any new information or addenda to the RFP.

Answers to the questions asked during the Questions & Answers period also will be

posted to the Web site as an addendum to the RFP.

1-11. Response Date

To be considered for selection, hard copies of proposals must arrive at the Issuing

Office on or before the time and date specified in the RFP Calendar of Events. The

Issuing Office will not accept proposals via email or facsimile transmission. Offerors

who send proposals by mail or other delivery service should allow sufficient delivery

time to ensure timely receipt of their proposals. If, due to inclement weather, natural

disaster, or any other cause, the Commonwealth office location to which proposals are

to be returned is closed on the proposal response date, the deadline for submission will

be automatically extended until the next Commonwealth business day on which the

office is open, unless the Issuing Office otherwise notifies Offerors. The hour for

submission of proposals shall remain the same. The Issuing Office will reject

unopened, any late proposals.

I-12. Proposals

1. To be considered, Offerors should submit a complete response to this RFP to the

Issuing Office, using the format provided in Part II, providing seven (7) paper copies

of the Technical Submittal and two (2) paper copies of the Disadvantaged

Business Submittal, two (2) paper copies of the Mentor Protégé Program

Submittal, and two (2) paper copies of the Contractor Partnership Program

Submittal. In addition to the paper copies of the proposal, Offerors shall submit two

complete and exact copies of the entire proposal (Technical, Disadvantaged Business,

and Contractor Partnership Program Submittal, along with all requested documents) on

CD-ROM or Flash drive in Microsoft Office or Microsoft Office-compatible format.

The electronic copy must be a mirror image of the paper copy and any spreadsheets

must be in Microsoft Excel. The Offerors may not lock or protect any cells or tabs.

Offerors should ensure that there is no costing information in the technical submittal.

The CD or Flash drive should clearly identify the Offeror and include the name and

version number of the virus scanning software that was used to scan the CD or Flash

drive before it was submitted. The Offeror shall make no other distribution of its

proposal to any other Offeror or Commonwealth official or Commonwealth consultant.

Each proposal page should be numbered for ease of reference. An official authorized

to bind the Offeror to its provisions must sign the proposal. If the official signs the

Proposal Cover Sheet (Appendix D to this RFP) and the Proposal Cover Sheet is

http://www.dgsweb.state.pa.us/RTA/Search.asp


attached to the Offeror’s proposal, the requirement will be met. For this RFP, the

proposal must remain valid for 120 days or until an agreement is fully executed. If the

Department selects the Offeror’s proposal for award, the contents of the selected

Offeror’s proposal will become, except to the extent the contents are changed through

Best and Final Offers or negotiations, contractual obligations. The information in the

proposal will become a public record upon execution, except as limited by Section 106

(b)(1) of the Commonwealth Procurement Code, 62 Pa. C.S. § 106 (b)(1).

Each Offeror submitting a proposal specifically waives any right to withdraw or

modify it, except that the Offeror may withdraw its proposal by written notice received

at the Issuing Office’s address for proposal delivery prior to the exact hour and date

specified for proposal receipt. An Offeror or its authorized representative may

withdraw its proposal in person prior to the exact hour and date set for proposal

receipt, provided the withdrawing person provides appropriate identification and signs

a receipt for the proposal. An Offeror may modify its submitted proposal prior to the

exact hour and date set for proposal receipt only by submitting a new sealed proposal

or sealed modification which complies with the RFP requirements.

I-13. Disadvantaged Business Information

The Department encourages participation by small disadvantaged businesses as prime

contractors, joint ventures and subcontractors/suppliers and by socially disadvantaged

businesses as prime contractors.

Small Disadvantaged Businesses are small businesses that are owned or controlled by a

majority of persons, not limited to members of minority groups, who have been

deprived of the opportunity to develop and maintain a competitive position in the

economy because of social disadvantages. The term includes:

a) Issuing Office of General Services Bureau of Minority and Women Business

Opportunities (BMWBO)-certified minority business enterprises (MBEs) and

women business enterprises (WBEs) that qualify as small businesses; and

b) United States Small Business Administration-certified small disadvantaged

businesses or 8(a) small disadvantaged business concerns.

c) Businesses that BMCO determines meet the Small Business Administration criteria

for designation as a small disadvantaged business.

Small businesses are businesses in the United States that are independently owned, are

not dominant in their field of operation, employ no more than 100 full-time or full-time

equivalent employees and earn less than $20 million in gross annual revenues ($25

million in gross annual revenues for those businesses in the information technology

sales or service business).

Socially disadvantaged businesses are businesses in the United States that BMWBO

determines are owned or controlled by a majority of persons, not limited to members

of minority groups, who are subject to racial or ethnic prejudice or cultural bias, but

which do not qualify as small businesses. In order for a business to qualify as ―socially

disadvantaged,‖ the Offeror must include in its proposal clear and convincing evidence


to establish that the business has personally suffered racial or ethnic prejudice or

cultural bias stemming from the business person’s color, ethnic origin or gender.

Questions regarding this Program can be directed to:

Issuing Office of General Services

Bureau of Minority and Women Business Opportunities

Room 611, North Office Building


Phone: (717) 787-6708

Fax: (717) 772-0021

Email: [email protected]

Website: www.dgs.state.pa.us

A database of BMWBO- -certified minority- and women-owned businesses can be

accessed at http://www.dgsweb.state.pa.us/mbewbe/VendorSearch.aspx. The federal

vendor database can be accessed at http://www.ccr.gov by clicking on Dynamic Small

Business Search (certified companies are so indicated).

I-14. Information Concerning Small Businesses in Enterprise Zones

The Department encourages participation by small businesses, whose primary or

headquarters facility is physically located in areas the Commonwealth has identified as

Designated Enterprise Zones, as prime contractors, joint ventures and

subcontractors/suppliers.

The definition of headquarters includes, but is not limited to, an office or location that

is the administrative center of a business or enterprise where most of the important

functions of the business are conducted or concentrated and location where employees

are conducting the business of the company on a regular and routine basis so as to

contribute to the economic development of the geographical area in which the office or

business is geographically located.

Small businesses are businesses in the United States that are independently owned, are

not dominant in their field of operation, employ no more than 100 full-time or full-time

equivalent employees and earn less than $20 million in gross annual revenues ($25

million in gross annual revenues for those businesses in the information technology

sales or service business).

There is no database or directory of small businesses located in Designated Enterprise

Zones. Information on the location of Designated Enterprise Zones can be obtained by

contacting:

Aldona M. Kartorie

Center for Community Building

PA Issuing Office of Community and Economic Development

4th

Floor, Commonwealth Keystone Building

400 North Street

Harrisburg, PA 17120-0225

Phone: (717) 720-7409

Fax: (717) 787-4088



http://www.dgs.state.pa.us/

http://www.dgsweb.state.pa.us/mbewbe/VendorSearch.aspx

http://www.ccr.gov/



I-15. Contractor Partnership Program (CPP)

a. Overview

The Contractor Partnership Program (CPP) was created by Pennsylvania’s Department

of Public Welfare to create additional employment opportunities within the

Commonwealth. The CPP is designed to leverage the economic resources of the

Department to create jobs for individuals currently receiving TANF cash assistance by

maximizing the recruitment, hiring and retention of those individuals by

Commonwealth contractors, subcontractors and grantees. The CPP utilizes its

partnerships with the local Workforce Investment Agencies (WIAs), County

Assistance Offices (CAOs), service delivery providers and other community action

agencies to advance this goal.

The CPP requires all individuals contracting with the Department to make a

commitment to fill their vacancies and new positions with individuals currently

receiving TANF cash assistance. The CPP will work cooperatively with contractors to

assist in these efforts by coordinating the resources of local service providers to assist

in the identification of qualified individuals for employment opportunities. While the

CPP will provide assistance the Contractor is ultimately responsible for ensuring the

goal is met.

Through CPP, the Department expects not only to increase the employment rate for

individuals receiving TANF cash assistance, but to continue to contribute to the

economic growth of the Commonwealth.

b. Eligibility Requirements

In order for Contractors to receive credit toward meeting the CPP contract

requirements they must hire individuals currently receiving TANF cash assistance

from the Department. This includes but it is not limited to individuals currently

participating in any of the Department’s employment and training programs such as

EARN (Work Support and Career Development), Supported Work, Supported

Engagement, Industry Specific Initiatives, KEYS., as well as, those individuals in self

initiated activities at the CAO. Individuals receiving medical assistance and/or foods

stamps only are not eligible.

For more information about the Contractor Partnership Program please contact:

Contractor Partnership Program

PA Department of Public Welfare

Health & Welfare Building

2nd Floor West

7th

& Forster Streets

Harrisburg PA 17105

Phone: 1-866-840-7214/Fax: (717) 787-4106




I-16 Mentor Protégé Program (MPP)

a. Protégé Program Overview:

The MPP is a key element of the Department of Public Welfare's contracting goal to

mentor and develop skills related to the services identified in this RFP and to assure

that Commonwealth of PA CERTIFIED Minority and Woman Owned Business

Enterprises and Disadvantaged Businesses are provided access to opportunities

generated under this agreement. The MPP has been launched to achieve that objective.

The MPP requires all individuals contracting with DEPARTMENT to make a

commitment to establish a formal Mentor Protégé Program that will further develop

the skills related to the services in this RFP with regard to the capacity and capability

of Commonwealth of PA CERTIFIED Minority and Woman Owned Business

Enterprises and Disadvantaged Businesses. DEPARTMENT is committed to assisting

prime contractors who undertake this important small business growth and

development initiative. Each contractor electing to participate in this program will

identify Commonwealth of PA Certified Minority and woman Owned Business

Enterprises and Disadvantaged Businesses to receive mentorship assistance.

Refer to the Department of General Services for a listing of Commonwealth of PA

CERTIFIED Minority and Woman Owned Business Enterprises and Disadvantaged

Businesses:

Department of General Services

Bureau of Minority and Women Business Opportunities

611 North Office Building

Harrisburg, PA.

Phone: (717) 783-3119.

E-mail: [email protected]

Website: www.dgs.state.pa.us

Contractors are encouraged to seek input and guidance from Department’s Bureau of

Equal Opportunity – Mentor Protégé Plan (DEPARTMENT BEO - MPP) in selecting

participants for mentorship by contacting:

Merry-Grace Majors. Director

Bureau of Equal Opportunity (DEPARTMENT BEO – MPP)

Mentor Protégé Program



Phone: (717) 787-3336


DPW BEO - MPP will also assist contractors who are unable to identify minority or

women owned enterprises or disadvantaged businesses for participation. Contractors

should document their efforts to ensure consideration of Commonwealth of PA

CERTIFIED Minority and Woman Owned Business Enterprise or Disadvantaged

Business protégés prior to the award of any affected contract. While DEPARTMENT


http://www.dgs.state.pa.us/



BEO - MPP will provide assistance, the Offeror is ultimately responsible for ensuring

the goal is met.

b. Eligibility Requirements:

In order for Contractors to receive credit toward meeting the MPP contract

requirements, they must prepare a Mentor Protégé Program Plan for any business that

is Commonwealth of PA CERTIFIED Minority or Woman Owned Business Enterprise

or Disadvantaged Business as defined by the Department of General Services, Bureau

of Minority and Women Owned Business Opportunities.

For more information about the Mentor Protégé Program, you may contact:

Merry-Grace Majors. Director

Bureau of Equal Opportunity (DEPARTMENT BEO – MPP)




Phone: (717) 787-3336


I-17 Economy of Preparation

Offerors should prepare proposals simply and economically, providing a

straightforward and concise description of the Offeror’s ability to meet the

requirements of the RFP and Agreement.

I-18. Alternate Proposals

The Department has identified the basic approach to meeting its requirements,

allowing Offerors to be creative and propose their best solution to meeting these

requirements. The Department will not accept alternate proposals.

I-19. Discussions for Clarification

Offerors may be required to make an oral or written clarification of their proposal to

the Issuing Office to ensure thorough mutual understanding and Offeror

responsiveness to the solicitation requirements. The Project Officer will initiate

requests for clarification.

I-20. Prime Responsibility

The agreement will require the selected Offeror to assume responsibility for all

services offered in its proposal whether it produces them itself or by

subcontract/subagreement. The Department will consider the selected Offeror to be

the sole point of contact with regard to the HealthChoices Agreement.



I-21. Proposal Contents

A. Confidential Information. The Commonwealth is not requesting, and does not

require, confidential proprietary information or trade secrets to be included as part of

Offerors’ submissions in order to evaluate proposals submitted in response to this

RFP. Accordingly, except as provided herein, Offerors should not label proposal

submissions as confidential or proprietary or trade secret protected. Any Offeror who

determines that it must divulge such information as part of its proposal must submit the

signed written statement described in subsection c. below and must additionally

provide a redacted version of its proposal, which removes only the confidential

proprietary information and trade secrets, for required public disclosure purposes.

B. Commonwealth Use. All material submitted with the proposal shall be considered the

property of the Commonwealth of Pennsylvania and may be returned only at the

Issuing Office’s option. The Commonwealth has the right to use any or all ideas not

protected by intellectual property rights that are presented in any proposal regardless of

whether the proposal becomes part of an agreement. Notwithstanding any Offeror

copyright designations contained on proposals, the Commonwealth shall have the right

to make copies and distribute proposals internally and to comply with public record or

other disclosure requirements under the provisions of any Commonwealth or United

States statute or regulation, or rule or order of any court of competent jurisdiction.

C. Public Disclosure. After the award of an agreement pursuant to this RFP, all proposal

submissions are subject to disclosure in response to a request for public records made

under the Pennsylvania Right-to-Know-Law, 65 P.S. § 67.101, et seq. If a proposal

submission contains confidential proprietary information or trade secrets, a signed

written statement to this effect must be provided with the submission in accordance

with 65 P.S. § 67.707(b) for the information to be considered exempt under 65 P.S. §

67.708(b)(11) from public records requests. Financial capability information

submitted in response to Part II, Section II-7 of this RFP is exempt from public records

disclosure under 65 P.S. § 67.708(b)(26).

I-22. Best and Final Offers

The Department reserves the right to conduct discussions with Offerors for the purpose

of obtaining ―best and final offers.‖ To obtain best and final offers from Offerors, the

Department may do one or more of the following:

i. Enter into pre-selection negotiations,

ii. Schedule oral presentations; and

iii. Request revised proposals.

The Department will limit any discussions to responsible Offerors (those that have

submitted responsive proposals and possess the capability to fully perform the

agreement’s requirements in all respects and the integrity and reliability to assure good

faith performance) whose proposals the Department has determined to be reasonably

susceptible of being selected for award. The Criteria for Selection found in Part III,


Section III-4, shall also be used to evaluate the best and final offers. Price reductions

shall have no effect upon the Offeror’s Technical Submittal. Dollar commitments to

Disadvantaged Businesses and Enterprise Zone Small Businesses can be reduced only

in the same percentage as the percent reduction in the total price offered through

negotiations. However, Offerors are encouraged to maintain or increase their

commitment to Disadvantage Business during the best and final offer process and

negotiations.

I-23. News Releases

Offerors shall not issue news releases, Internet postings, advertisements, or any other

public communication pertaining to this Project without prior written approval of the

Department, and then only in coordination with the Department.

I-24. Restriction of Contact

From the issue date of this RFP until the Department selects a proposal for award, the

Project Officer is the sole point of contact concerning this RFP. Any violation of this

condition may be cause for the Department to reject the offending Offeror’s proposal.

If the Department later discovers that the Offeror has engaged in any violations of this

condition, the Department may reject the offending Offeror’s proposal or rescind its

award. Offerors must agree not to distribute any part of their proposals beyond the

Department. An Offeror who shares information contained in its proposal with other

Commonwealth personnel and/or competing Offeror personnel may be disqualified.

I-25. Debriefing Conferences

Offerors whose proposals are not selected will be notified of the name of the selected

Offerors and given the opportunity to be debriefed. The Issuing Office will schedule

the time and location of the debriefing. The debriefing will not compare the Offeror

with other Offerors, other than the position of the Offeror’s proposal in relation to all

other Offeror proposals. An Offeror’s exercise of the opportunity to be debriefed does

not constitute the filing of a protest.

I-26. Issuing Office Participation

Offerors shall provide all services, supplies, facilities and other support necessary to

complete the identified work, except as provided in this Section I-26.

Project monitoring will be the responsibility of the Office of Medical Assistance

Programs and/or other offices, as determined by the Department. The Department will

designate staff to coordinate the project, provide or arrange technical assistance, and

monitor for Readiness Review and compliance with Agreement requirements, as well

as the approved waiver, and program policies and procedures. At its discretion, the

Department may commence monitoring before the effective and/or operational dates of

the Agreement, and before the formal Readiness Review period.

I-27. Term of Agreement


The term of the Agreement will commence on 01/01/2012 and will end after five (5)

years. The Department may, at its discretion, choose to extend the term of the

agreement for one additional period of three (3) years.

.

I-28. Offeror’s Representations and Authorizations

By submitting its proposal, each Offeror understands, represents, and acknowledges

that:

a. The Offeror’s information and representations in the proposal are material and

important, and the Issuing Office may rely upon the contents of the proposal in

awarding the agreement. The Commonwealth shall treat any misstatement,

omission or misrepresentation as fraudulent concealment of the true facts

relating to the Proposal submission, punishable pursuant to 218 Pa. C.S. §

4904.

b. The Offeror has not attempted, nor will it attempt, to induce any firm or person

to refrain from submitting a proposal to this RFP, or to submit any

noncompetitive proposal or other form of complementary proposal.

c. The Offeror makes its proposal in good faith and not pursuant to any agreement

or discussion with, or inducement from, any firm or person to submit a

complementary or other noncompetitive proposal.

d. To the best knowledge of the person signing the proposal for the Offeror, the

Offeror, its affiliates, subsidiaries, officers, directors, and employees are not

currently under investigation by any governmental agency and have not in the

last four (4) years been convicted or found liable for any act prohibited by State

or Federal law in any jurisdiction, involving conspiracy or collusion with

respect to bidding or proposing on any public contract or agreement, or have

been excluded from participating in any federal health care programs, except as

disclosed in its proposal.

e. To the best of the knowledge of the person signing the proposal for the Offeror

and except as the Offeror has otherwise disclosed in its proposal, the Offeror

has no outstanding, delinquent obligations to the Commonwealth including, but

not limited to, any state tax liability not being contested on appeal or other

obligation of the Offeror that is owed to the Commonwealth.

f. The Offeror is not currently under suspension or debarment by the

Commonwealth, or any other state, or the federal government, and if the

Offeror cannot so certify, then it shall submit, along with its proposal, a written

explanation of why it cannot make such certification.

g. The Offeror has not, under separate agreement with the Department, made any

recommendations to the Department concerning the need for the services

described in its proposal or the specifications for the services described in its

proposal.


h. Each Offeror, by submitting its proposal, authorizes all Commonwealth

agencies to release to the Commonwealth information concerning the Offeror’s

Pennsylvania taxes, unemployment compensation and workers’ compensation

liabilities.

i. Until selected Offerors receive a fully executed and approved written

agreement from the Department, there is no legal and valid agreement, in law

or equity, and the Offeror will not begin to perform.

I-29. Notification of Selection

The Issuing Office will notify the selected Offerors in writing of their selection for

negotiation after the Issuing Office has determined, taking into consideration all of the

evaluation factors, the proposals that are the most advantageous to the Issuing Office.

I-30. RFP Protest Procedure

Offerors and prospective Offerors who are aggrieved in connection with the solicitation or

award under this RFP may file a protest with the Department. Any such protest must be in

writing and must comply with the requirements set forth in the Commonwealth

Procurement Code at 62 Pa.C.S. §1711.1. In no event may an Offeror file a protest later

than seven days after the date the notice of award is posted on the DGS website. The date

of filing is the date of receipt of the protest.

Any protest filed in relation to this RFP must be delivered to:




625 Forster Street

Harrisburg, Pennsylvania 17120

Attn: Daniel R. Boyd

Email address: [email protected]

Fax: 717-787-3560

Offerors and prospective Offerors may file a protest electronically or by facsimile but

also must simultaneously send a hard copy of the protest to the address listed above.

I-31. Use of Electronic Versions of this RFP

This RFP is being made available by electronic means. If an Offeror electronically

accepts the RFP, the Offeror acknowledges and accepts full responsibility to insure

that no changes are made to the RFP. In the event of a conflict between a version of

the RFP in the Offeror’s possession and the Issuing Office’s version of the RFP, the

Issuing Office’s version shall govern.

I-32 Liquidated Damages



The selected Offeror agrees that its failure to meet certain contractual requirements as

defined in this section will result in damage to the Department; however, it is

impractical and extremely difficult to establish the actual amount of damage to the

Department. In the event, the selected Offeror fails to meet a contractual requirement

as defined in this section; in addition to any other remedies the Department may have,

the Department may assess the amounts described in the agreement as liquidated and

agreed upon damages.

A. Assessment of Liquidated Damages – the Department, in its sole

discretion, may assess liquidated damages. Liquidated damages shall be paid by

the selected Offeror and collected by the Department by deducting them from the

invoices submitted under the agreement, or any other contract or agreement the

selected Offeror has with the Commonwealth, by collecting them through

performance security, if any, or by billing the selected contractor as a separate

item.

B. Delays – The Department may not assess liquidated damages if the selected

Offeror’s failure to satisfy the contract requirement is caused by the Department

or if the delay arises out of causes beyond the control and without fault or

negligence of the selected contractor, its subcontractors, consultants or agents.

C. Disadvantaged Business Commitment – the selected Offeror must fulfill

its agreed upon commitment to Disadvantaged Business as defined in its final

work plan approved by the Department. The Department may impose liquidated

damages up to the maximum amount set forth in this section for the selected

Offeror’s failure to meet this agreed upon commitment, including the agreed upon

time frames. In the event the selected Offeror fails to meet its agreed upon

commitment, The Department may assess up to the amount of 75% of the amount

of selected Offeror’s Disadvantaged Business commitment.

D. Contractor Partnership Program – The selected Offeror must fulfill it’s

agreed upon commitment to the Contractor Partnership Program as defined in its

final work plan approved by the Department. The Department may impose

liquidated damages up to the maximum amount set forth in this section for the

selected Offeror’s failure to meet this agreed upon commitment, including the

agreed upon time frames. In the event the selected Offeror fails to meet its agreed

upon commitment to the Contractor Partnership Program, the amount assessed

will be a percentage of the value of the agreement and determined prior to

execution of the agreement.


PART II

PROPOSAL REQUIREMENTS

Offerors must submit their proposals in the format, including heading descriptions, outlined

below. To be considered, the proposal must respond to all requirements in this part of the

RFP. Offerors should provide any other information thought to be relevant, but not applicable

to the enumerated categories, as an appendix to the Proposal. Disadvantaged Business cost

data should be kept separate from and not included in the Technical Submittal. Each Proposal

shall consist of the following separately sealed submittals:

a. Technical Submittal, which shall be a response to RFP Part II, Sections II-1

through II-7 and Domestic Workforce Utilization Certification Submittal II-9;

b. Disadvantaged Business Submittal, in response to RFP Part II, Section II-8;

c. Contractor Partnership Program Submittal, in response to RFP Part II, Section

II-10; and

d. Mentor Protégé Program Submittal, in response to the RFP Part II, Section II-

11.

The Department reserves the right to request additional information which, in the

Department’s opinion, is necessary to assure that the Offeror’s competence, number of

qualified employees, business organization, and financial resources are adequate to perform

according to the RFP.

The Department may make investigations as deemed necessary to determine the ability of the

Offeror to perform the Project, and the Offeror shall furnish to the Department all requested

information and data. The Department reserves the right to reject any proposal if the evidence

submitted by, or investigation of, such Offeror fails to satisfy the Department that such Offeror

is properly qualified to carry out the obligations of the RFP and to complete the Project as

specified.

II-1. Statement of the Problem (Limit to 3 pages)

State in succinct terms your understanding of the problem presented or the service

required by this RFP.

II-2. Work Plan – Disadvantaged Business. Provide a work plan for meeting your

proposed Disadvantaged Business commitment, including time frames. Please describe

any mentoring that will be provided to the Disadvantaged Businesses

II-3 Prior Experience. (Limit to 10 pages not including Appendices) Experience shown should be work done by individuals who will be assigned to the SW

Zone as well as that of your company.


a. Corporate Background. The Offeror must describe the corporate history and

relevant experience of the Offeror and any subcontractors. This section must

detail information on the ownership of the company (names and percent of

ownership), the date the company was established, the date the company began

operations, the physical location of the company, and the current size of the

company. The Offeror must provide a corporate organizational chart as part of

this section.

Offerors must identify any current contracting or subcontracting relationship(s)

that may result in a conflict of interest with the requirements of this RFP.

Offerors must also abide by the Department’s conflict of interest standards

identified in Appendix E, Standard Terms and Conditions for Services and

Appendix F, Department of Public Welfare Addendum to Standard Terms and

Conditions.

b. Corporate Experience. The Offeror must describe experience providing

similar services, including the name, address, and telephone number of the

responsible official of the customer, company, or agency who may be

contacted. This section of the proposal must include a description of the

Offeror’s:

i. Qualifications and experience as a fiscal intermediary for MA or other

third party billing systems;

ii. Qualifications and experience with MA managed care systems;

iii. Experience with other Commonwealth agencies;

iv. Experience in relation to Disadvantaged Business program, including

the amounts committed and amounts actually paid to each

Disadvantaged Business during the preceding five (5) years. This

experience is not limited to the Disadvantaged Business program in the

Commonwealth but shall include similar programs in other

jurisdictions.

The Offeror must also submit Appendix G, Offeror’s Managed Care

Experience. If the Offeror has no prior experience as referenced above,

explain what qualifications or past experiences may serve as a substitute.

c. References. The Offeror must provide a list of at least three (3) relevant

contracts within the past three (3) years to serve as corporate references. This

list shall include the following for each reference:

i. Name of contractor

ii Type of contract

iii. Contract description, including type of service provided

iv. Total contract value

v. Contracting officer’s name and telephone number

vi. Role of subcontractor(s) (if any)


vii. Time period in which service was provided

The Offeror must submit Appendix H, Corporate Reference Questionnaire,

directly to the contacts listed. The references should return completed

questionnaires in sealed envelopes to the Offeror. The reference individual should

sign their name over the seal. The Offeror must include these sealed references

with its proposal.

Offers should describe their experience in relation to Disadvantaged Business commitments,

including the amounts committed and amounts actually paid to each Disadvantaged Business.

This experience is not limited to the Disadvantaged Business program in the Commonwealth

but may include similar programs.

II-4. Personnel

The Offeror must submit a description of the MCO's overall organizational structure

and its proposed organizational structure for the operation of the HealthChoices SW

program. The Offeror should demonstrate that all of the requirements of this RFP and

set forth in the draft Agreement are provided for by the MCO.

A selected Offeror may combine functions or split the responsibility for a function

across multiple HealthChoices Zones, unless otherwise indicated, as long as it can

demonstrate that the duties of the function will be carried out. If an Offeror proposes

to combine or split responsibility, its response to this section must clearly indicate

which individuals and offices will be responsible for each duty and function, and

demonstrate that such duties and functions will be effectively performed and

coordinated.

Similarly, a selected Offeror may contract with a third party to perform these

functions, subject to the subcontractor conditions set forth in the draft Agreement. If

an Offeror proposes to engage a subcontractor to perform any of the functions

discussed in this section of the RFP, Offerors may cross-reference and need not

duplicate the descriptions of such subcontractors requested below in Section II-4.e of

this RFP, Subcontracts. Selected contractors are required to keep the Department

informed at all times of the management individual(s) whose duties include each of the

responsibilities outlined in this section.

In addition, the Department is aware that Offerors who do not currently provide

services to recipients in one of the three HealthChoices zones may not currently

employ individuals who are responsible to perform the functions described in this

section. Such Offerors will therefore be unable to provide names or actual résumés as

requested for the positions and functions below, and may instead provide proposed job

descriptions and the related information requested where practical, taking care to

ensure that their responses to the Work Statement in Sections II-5 of this RFP clearly

establish that qualified individuals will be employed, and their names and résumés

provided to the Issuing Office, in time to ensure that all required functions will be

performed.


a. Executive Management (Section V.M of the draft Agreement)

Full time positions for executive management as described in V.M. of the draft

Agreement are understood to mean full time dedicated to the Medicaid

Managed Care Program in Pennsylvania

For the Chief Executive Officer and/or Chief Operations Officer, Chief

Financial Officer, Chief Medical Officer, Pharmacy Director, HealthChoices

Program Manager and the Chief Information Officer provide the following

information:

1. Describe the executive’s role in the organization.

2. During the most recent 36 months, how many months was this position not

filled by an employee permanently assigned to the position? During the most

recent 36 months, how many different people filled this position?

3. Describe the level of effort he/she provides related to each of the major

program areas of contract management, financial management, quality

management, utilization management, data management, recipient services and

provider utilization.

4. Résumés of the executive management personnel already employed by the

organization must be included as an appendix to your proposal.

5. Attach a job description for each management position identified in the MCO

for the proposed organizational structure for the HealthChoices SW program.

6. Specify where these personnel will be physically located during the time they

are engaged to work.

b. Key Administrative Positions (Section V.N of the draft Agreement)

In this section, the Offeror must identify the name and position of the person

authorized to finalize an Agreement with the Department, and the name and

position of the person who will have ultimate responsibility and accountability

for the Agreement should one be entered into.

In addition, for each of the key administrative positions/functions listed below,

provide the following information:

1. Résumés of key administrative personnel already employed by the

organization who will be working on the HealthChoices SW program must

be included as an appendix.

2. Attach a job description that includes minimum education for each staff

position identified in the MCO for the proposed organizational structure for

the HealthChoices SW program.

3. Specify where these personnel will be physically located during the time

they are engaged to work.

Key Administrative Positions/Functions

Quality Management Coordinator

Utilization Management Coordinator


FT Special Needs Unit Coordinator

FT Government Liaison

Maternal Health/EPSDT Coordinator

Member Services Manager

Provider Services Manager

Complaint, Grievance and DEPARTMENT Fair Hearing Coordinator

Claims Administrator

Contract Compliance Officer

Other key personnel identified by Offeror

For ease of reference, Offerors may use the chart in Appendix I, Executive

Staff and Key Administrative Personnel Checklist, to ensure that their response

provides all the documents and information pertaining to the Executive

Management and Key Administrative positions and functions discussed in this

section.

Board Members

The Offeror must describe the role of board members in governance and policy

making and specify the manner in which MA recipients are to be represented in

an advisory and/or decision making capacity for the HealthChoices SW

program. In accordance with Pennsylvania Department of Health regulations,

one-third of the board's membership must be "subscribers" of the MCO.

c. Organization

The Offeror must submit a current or proposed organizational chart so that a

determination can be made as to whether the overall organizational structure

reflects usual and customary business practices consistent with other managed

care programs operating in the Commonwealth. Offerors need not duplicate

but may cross-reference organizational charts provided elsewhere in the

proposal, e.g., Section II-4.d

The Offeror must submit, as an appendix, its organization's Articles of

Incorporation. If it’s Articles of Incorporation does not include all the

information in Appendix J. Ownership Structure and Related Information, this

information must also be provided.

d. Staffing Plans

The Offeror must include a comprehensive statement of its proposed staffing

plan demonstrating how it will provide adequate staffing to address all

requirements found in the RFP and the draft Agreement. Include

comprehensive organizational charts that detail the number of staff and

positions for each existing or proposed Department within the MCO.


e. Subcontracts

Provide a description of each subcontractor with responsibilities related to the

provision of services to recipients (including, but not limited to, the provision

of medical services, recipient services, etc.) and administrative support

including, but not limited to, claims processing along with an organizational

synopsis of services to be provided by each of these subcontractors. Provide a

separate response for each subcontract. (Limit to 2 pages for each subcontract)

Note that, if the subcontractor provides for any financial risks, the

HealthChoices MCO will be required to comply with the subcontracting

requirements set forth in Section XIII of the draft Agreement.

II-5. Work Statement (Soundness of Approach)

Work Statement Questionnaire:

In this section the Offeror will respond to the following questionnaire, taking care to be

as concise as possible in its responses. In responding, the Offeror should repeat each

question and then follow each question with the specific response. Please note that

page limits have been established for the response to each question. While the

Department will take note of an Offeror’s adherence to these limits, they represent only

the maximum permissible length of a response. Offerors are not required to and

should not expand their responses to the maximum length if a question may be fully

answered in fewer pages. All page limits apply to response text only; not to any

additional specifically requested documents, such as HEDIS® reports.

When possible, Offerors currently participating in HealthChoices in the SW Zone

or another zone are encouraged to describe their current practices and to also describe

changes or improvements to their current operations and to use examples from their

HealthChoices line of business when explaining their future plans related to a question.

Offerors new to HealthChoices should provide responses on line(s) of business

deemed to be most relevant. They should also describe how they would adapt their

current line(s) of business to the HealthChoices Program.

Work Statement Questionnaire

Medical Management

1. Describe the management techniques, policies, procedures or initiatives you have in place to

avoid and reduce unnecessary emergency room utilization. Provide HEDIS® data using

Appendix K, HEDIS® Reporting Form. Describe your strategy moving forward to improve

performance in this area. (Limit to six pages)

2. Describe the management techniques, policies, procedures or initiatives you have implemented

to promote health care equity (i.e., reductions in disparity in treatment and outcomes among

disparate races and ethnic groups) for your members. Please provide evidence of success.

Describe your strategy moving forward to improve performance in this area. (Limit to six

pages)



3. Describe the management techniques, policies or initiatives you have in place to promote the

cultural competency (as defined in Section II of the draft Agreement found in Appendix A) of

your network providers. Describe your strategy moving forward to improve performance in

this area. (Limit to four pages)

4. Describe the policies and processes you have in place to assist members with limited English

proficiency (LEP). Please describe LEP policies/procedures from an internal perspective

related to member services, as well as in the provider network at point of service. (Limit to 2

pages)

5. Describe the management techniques, policies, procedures or initiatives you have in place to

effectively and appropriately control avoidable hospitalization and hospital readmissions.

Describe your strategy moving forward to improve performance in this area. (Limit to two

pages)

6. Describe any provider incentive programs that reward quality outcomes, resulting in

improvements in chronic care measures. Provide information on whether the programs were

successful, including what percent of network providers met performance requirements and

received rewards. Describe your strategy moving forward for provider incentive programs.

(Limit to two pages)

7. Describe any member incentive programs you have in place to encourage members to engage

in wellness programs. Provide evidence of the levels of success of the programs, including the

size of the target population, the percentage of target population that received the incentive,

and any associated quality outcome data of the target population.. Describe your strategy

moving forward for member incentive programs. (Limit to four pages)

8. Describe how you encourage provider usage of electronic medical records. (Limit to four

pages)

9. Describe the software you use to identify and track outcomes of members who are being care

managed, including predictive modeling software. (Limit to two pages)

10. Describe policies; procedures and processes you use to identify, stratify, and case manage

pregnant members to ensure that all medically necessary services are provided including

depression and smoking cessation.

Describe all measurable results in terms of clinical outcomes that have resulted from your

prenatal case management activities. Provide HEDIS® data using Appendix K, HEDIS®

Reporting Form. Describe any future quality improvement activities or plans to improve birth

outcomes (Limit to six pages)

11. Describe the policies, procedures and activities or initiatives you use to provide disease

management for members with diabetes, asthma and cardiovascular disease; including:

Identification and outreach to members requiring disease management services.

Stratification (risk levels) and interventions you will implement for each risk level to

provide disease management services for these members.

Facilitation and monitoring of recipient compliance with treatment plans.

Chronic care management programs and how you manage recipients with chronic

conditions.

Chronic care teams / Navigators.

Describe all measurable results in terms of clinical outcomes that have resulted from your

disease management activities. Provide HEDIS® data using Appendix K, HEDIS® Reporting

Form. Describe any future quality improvement activities or plans to improve your disease

management program(s) outcomes. (Limit to six pages)



12. Describe the policies, procedures or initiatives you have in place to develop and maintain a

comprehensive health education program, excluding your disease management program.

Identify specific areas of focus and explain your rationale. Describe your strategy moving

forward to improve in this area. (Limit to four pages)

13. Describe in detail how you use encounter data, trending and other ad hoc internal reports,

HEDIS®, EQR, and CAHPS® to systematically and objectively monitor, measure and evaluate

the quality and appropriateness of care and services provided. (Limit to four pages)

14. Describe the policies, procedures and processes you use to conduct provider profiling that

assess the quality of care delivered by network Primary Care Practitioners (PCPs) and other

acute care providers (such as high volume specialists and hospitals), including how you will:

Identify high volume specialists

Determine which providers will be profiled

Interpret profile results for individual providers, and;

Utilize profile results to conduct provider follow up and education.

(Limit to two pages)

15. Describe data-driven clinical performance improvement projects you have initiated in the past

twenty-four (24) months that have resulted in statistically significant performance

improvement outcomes for a managed care population. Please provide two (2) examples

including supporting data. (Limit to four pages)

16. Describe efforts you have made to assess provider satisfaction during the past year and the

actions taken as a result of your assessment. Please provide your last provider satisfaction

survey and a summary of the results. (Limit to two pages)

17. Describe your plan’s approach to utilization management, including:

Lines of accountability for utilization policies and procedures and for individual medical

necessity determinations;

Data sources and processes to determine which services require prior authorization and

how often these requirements will be re-evaluated;

Process and resources to develop utilization review criteria;

Prior authorization processes for Members requiring services from non-participating

providers or for members who require expedited prior authorization review and

determination due to conditions that threaten the Member’s life or health;

Processes to ensure consistent application of criteria by individual clinical reviewers

(Limit to six pages)

18. Describe policies, procedures and processes that you will use to conduct outreach and follow-

up to ensure that children and adolescents receive all recommended preventive and screening

services, and all medically necessary follow-up treatment. Describe measurable results in

terms of clinical outcomes that have resulted from your childhood and adolescent outreach and

follow-up activities. Provide HEDIS® data using Appendix K, HEDIS® Reporting Form.

Describe any future quality improvement activities or plans to improve the health status for

children and adolescents. (Limit to six pages)

19. Describe the policies, procedures and processes you have in place to address smoking

cessation, particularly smoking cessation for pregnant women. Provide information on whether

the programs are successful. Describe your strategy moving forward to improve performance

in this area. (Limit to two pages)

20. Describe the policies, procedures and processes you have in place to address childhood obesity.

Provide information on whether the programs are successful. Describe your strategy moving

forward to improve performance in this area. (Limit to two pages)



Management to Control Costs

21. Demonstrate how you monitor the performance of your subcontractors to ensure all Agreement

responsibilities are met. Provide sample reports showing any actions taken to improve

performance and ensure positive results. Describe any sanctions or penalties that apply if the

subcontractor fails to perform up to the expectations of your organization. Attach sample

performance monitoring reports. (Limit to two pages)

22. Describe your method and process for capturing third party resource and payment information

from your claims system for use in reporting cost-avoided dollars and provider-reported savings

to the Issuing Office. Explain how you will use such information. Describe the process you use

for retrospective post-payment recoveries of health-related insurance as well as your process for

adjudicating a claim involving an auto accident. (Limit to four pages)

23. During the last 36 months, how many times have you submitted a revised regulatory filing with

a state or federal agency other than DEPARTMENT? List each occurrence and provide a brief

explanation. (Limit to two pages)

24. How will you promote transparency by making information available to recipients regarding the

cost of common inpatient, outpatient and health care provider services and the overall cost or

price of their care? If applicable, describe how you assure transparency for your other lines of

business (e.g., Medicare, commercial programs). (Limit to two pages)

25. Describe any other cost-saving programs/initiatives you have implemented in the last 36 months

and provide information on cost-savings realized related to these programs/initiatives. Please

identify cost-savings plans you have planned, but not implemented. (Limit to four pages)

Coordination of Care

26. Describe the policies, procedures and processes you have in place to ensure access to care and

seamless coordination of care across the continuum of health care services for members with

special needs (including, but not limited to members with complex chronic conditions,

behavioral/physical health dual diagnoses, children in substitute care and medically fragile

children). Describe how you will assist members with special health care needs and chronic

conditions to identify and access community resources that may provide services that the MA

Program does not cover. (Limit to four pages)

27. What are your processes for transitioning and coordinating care for membership (21 years and

under) as they age into adult categories of assistance that may provider less service coverage?

Describe your strategy moving forward to improve coordination of care. (Limit to two pages)

28. Describe your plan to create, maintain, and continuously improve collaboration with

HealthChoices Behavioral Health Managed Care Organizations (BH-MCOs) Include a

description of methods you will use to exchange information relevant to ensuring care

coordination using behavioral health utilization data provided by the Department. (Limit to

two pages)

29. Describe the process you will use to coordinate with County Offices of Children, Youth and

Families to ensure that Children in Substitute Care receive necessary services. (Limit to two

pages)

30. Describe your process for care coordination to ensure that members receive adequate in-home

services to divert them from entering long term care facilities. (Limit to two pages)

31. What methods do you use to ensure the quality of care delivered by out-of-network providers?

Describe any potential barriers and the resolution process. (Limit to two pages)



Pharmacy

32. Describe your approach to control pharmacy costs. Describe programs/initiatives that have been

successful at controlling costs. (Limit to 3 pages)

33. Describe policies and procedures you use to determine medications that are included and

excluded from the drug formulary (including the use of generics and over-the-counter

medications) and how those policies and procedures comply with the MA Program’s drug

formulary guidelines. How do you make non-formulary drugs available when medically

necessary? How do you communicate these decisions to members and providers? (Limit to 5

pages)

34. Describe your policies, procedures or processes for conducting both retrospective and

prospective drug utilization review within the MA Program’s Drug Utilization Review

guidelines. Provide evidence of success. Describe your strategy moving forward to improve

performance in this area (Limit to 4 pages)

35. Describe your pharmacy prior authorization process, including the following:

How are prior authorization criteria developed?

How are requests for prior authorization made?

How do providers (pharmacies and prescribers) and recipients learn about the authorization

process and criteria? (Limit to 4 pages)

36. In regard to pharmacy point of sale, explain:

Who adjudicates your pharmacy claims?

How do you ensure adequate oversight and monitoring of the pharmacy claims

processor, including fraud and abuse and encounter data?

Are all outpatient medications processed through pharmacy claims? If not, what other method

of claims processing is used (e.g., professional claim with HCPCs codes?) (Limit to 3 pages)

37. Describe your specialty pharmacy program. Describe your future plans, including plans to

purchase and effectively manage specialty drugs. (Limit to 3 pages)

38. Describe how your pharmacy claim information is coordinated with medical claim data to

provide comprehensive care management. (Limit to 2 pages)

39. Describe how you will use the CMS Drug File to ensure access to all drugs covered under the

MA Program and compliance with data reporting requirements for the Federal Drug Rebate

Program. (Limit to 4 pages)

Management Information Systems

40. Provide a general systems description, including:

A systems diagram that describes each component of the management information system

and all other systems that interface with or support it;

How each component will support the major functional areas of HealthChoices (In-Plan

Services; Coordination of Care; Member Services; Maternity Care Payments; Complaint,

Grievance and Fair Hearings; Pharmacy; Special Needs; Provider Network; Provider

Services; Service Access; Quality Management/Utilization Management (QM/UM); Claims

Payment and Processing, and; Encounter Data Reporting System).

(Limit to 10 pages, including the diagram)

41. Describe any modifications or updates to your Management Information System (MIS) within

the next year that will be necessary to meet the requirements of this Agreement, and your plan

for their completion. (Limit to four pages)



42. What is the current capacity of your MIS/claims processing? Explain your process to readily

expand your MIS/claims processing should the capacity of either be exceeded through

enrollment of program members. (Limit to two pages)

43. Explain your process for ensuring your subcontractors meet the same MIS requirements for

which you are responsible. (Limit to three pages)

44. Describe the capability your management will have to access a database of service information

to create ad hoc reports for both MCO management and the Issuing Office. Include a

description of the system and software, an overview of the data that will be held, and the

resources and the capability you will have to use large amounts of data to create ad hoc reports.

(Limit to five pages and list of monthly, quarterly, annual and ad hoc reports)

45. Describe the capability you will have to access your subcontractor’s information to create ad

hoc reports for subcontractor oversight and for the Issuing Office upon request. (Limit to three

pages)

46. Describe your approach for ensuring complete encounter data is submitted accurately and

timely to the Issuing Office consistent with required formats. (Limit to two pages)

47. The MCO will be required to have a data completeness monitoring program and submit a data

completeness monitoring plan as described in the Agreement. Describe your approach to

providing this data completeness monitoring plan. (Limit to three pages)

48. How will you ensure and verify that providers and subcontractor(s) submit timely, accurate,

complete and required encounter data elements to you for subsequent transmission to the

Issuing Office? How often will you verify the data? (Limit to three pages)

49. How will you manage the non-submission of encounter data by a provider or subcontractor?

Will it result in any assessment of penalties? If so, please describe. (Limit to two pages)

50. Describe in detail your process for utilizing the daily, weekly, and monthly files to manage your

membership. Include the process for resolving discrepancies between your membership data

and the above files. (Limit to four pages)

51. Explain in detail your process for providing membership information to each of your

subcontractors (dental, vision, etc.). Include the subcontractor’s name, their purpose and how

often membership data is submitted. (Limit to three pages)

52. Explain your process for maintaining your provider file with detailed information on each

provider sufficient to support provider payment and also meet the Issuing Office’s reporting and

Encounter Data Requirements. Include how you cross-reference your internal provider ID

number with the PROMISe provider ID and the provider’s NPI number. (Limit to two pages)

53. Explain your processes for ensuring providers are enrolled in MA and have a valid PROMISe

Provider ID number and NPI. Include how you will monitor your subcontractors to ensure their

providers are enrolled in MA and have a valid PROMISe Provider ID number and NPI. (Limit

to two pages)

54. Describe the claims processing systems that will support the Agreement. (Limit to three pages)

55. What is your plan to ensure that claims timeliness standards are met and that providers are paid

timely? (Limit to two pages)

Provider Network Composition and Network Management

56. Describe your organization’s policy to ensure that all licensed health care providers – including

nurses, certified registered nurse practitioners, advanced nurse practitioners, midwives,

physician assistants, dental hygienists, and expanded function dental assistants – can practice to

the fullest extent of their education and training. Provide the percent of your network that

comprises these health care providers. (Limit to two pages)



57. Explain your methodology to ensure that your membership has access to and utilizes both

routine and specialty dental care (e.g., regular cleanings, oral surgery) within each county in the

Zone. Specifically include:

How you provide access for members with special needs and others who may need special

accommodations to receive dental treatment.

Recruitment efforts to increase dental participation

Special arrangements with clinics or dental schools to increase member access to dental

services.

Outreach, education and incentive programs to encourage members to keep dental

appointments and ensure that they receive routine and specialty dental care.

Explain how you ensure that your members have access to dental disease management

programs specifically for members with cardiovascular disease, diabetes and for pregnant

women. (Limit to four pages)

58. Explain your plan to ensure that your provider network meets the network and access

requirements in the draft Agreement. Specifically include:

How you will ensure that your provider Network is ethnically diverse and similar to the

demographic profile of your members within the SW Zone.

Whether and how you will include providers from other lines of business into your SW

Zone network to ensure access (e.g., Medicare, commercial programs).

What method you plan to use on an ongoing basis to assess and ensure that the network

standards outlined in the draft Agreement are maintained for all provider types on an

ongoing basis (e.g., travel requirements, appointment access standards, detection of fraud

and abuse).

Describe your process for continuous improvement in your network over and above

contract compliance.

Describe how you will ensure that appointment access standards are met when members

cannot access care within your provider network and must go to an out-of-network

provider?

Describe how you will collect and record language needs for those recipients with limited

English proficiency and how you ensure all written notices are language appropriate.

Describe how you educate and coordinate interpreter services with your network providers.

(Limit to six pages)

59. How do you intend to use GeoAccess mapping to ensure network adequacy? (Limit to two

pages)

60.. Explain the policy and procedure utilized to insure your provider directories are accurate and up

to date? Please describe how policies are applied to both hard-copy and on-line or electronic

versions. (limit to 3 pages)

61. Explain your plan to manage contracted skilled nursing and home health providers to meet

members’ growing needs for access to home and community based services for medically

complex cases. (Limit to two pages)

62. With regard to shift nursing services; describe the strategies you will follow to insure that the

provision of authorized services is monitored concurrently and not solely in a retrospective

manner. (Limit to two pages)



63. Explain your strategy to address the potential issue of a hospital choosing not to contract with

all MCOs within a county. Past experience has shown that hospitals may competitively bid for

contracts and only contract with a designated number of MCOs. Should your organization be

unable to secure an agreement with a hospital within a county, what strategies will you

undertake to ensure that your members will be able to have access to both primary and specialty

care? If non-participating providers are initially the only way you can guarantee access within a

county, what steps will you take to recruit the providers into your network? (Limit to two

pages)

64. What risk adjustment strategies and/or provider incentives do you employ in PCP contracting to

ensure members with complex medical needs have adequate access to primary care and care

coordination services? How do you measure and assure that these members have adequate

access to care? (Limit to two pages)

65. How do you monitor and evaluate PCP compliance with availability and scheduling

requirements outlined in the draft Agreement? What is your plan to ensure PCP-to-member

ratio requirements are maintained throughout the term of the Agreement? (Limit to two pages)

66. How do you ensure that members have access to medical care for needs that arise after hours

and for urgent, non-emergency situations? How do you monitor providers to ensure that

follow-up is done with the member and the member’s PCP to facilitate transfer of information

from the after hours provider? Describe any incentive programs you have in place to improve

access to care by rewarding providers who provide extended and/or after hours care. (Limit to

two pages)

67. Please explain the availability of your staff in the field to assist providers with billing issues,

authorization requirements or other types of training needs for both new providers and

established providers. (Limit to two pages)

68. Describe the policies and procedures followed in response to the network termination/loss of a

large-scale provider group or health system. Please develop the response taking the following

areas into consideration,

The system utilized for identification and notification of members affected by the

provider loss;

The automated systems and membership supports utilized in assisting affected members

with provider transitions;

Systems and policies utilized in continuity of care for members experiencing provider

transition;

Outcomes experienced in coverage of the membership with existing network resources

following the terminations. (Limit to 5 pages)

II-6. Financial Condition

Offerors must submit information about the financial conditions of the company in this

section. For ease in assembling the proposal, the Offeror should append its financial

documentation rather than including it in the main body of the proposal. The Offeror

must provide the following information:

a. The identity of each entity that owns at least five percent (5%) of the Offeror.


b. For the Offeror and for each entity that owns at least five percent (5%) of the

Offeror:

i) Audited financial statements for the two (2) most recent fiscal years for

which statements are available. The statements must include a balance

sheet, statement of revenue and expense and a statement of cash flow.

Statements must include the auditor’s opinion and the notes to the

financial statements submitted by the auditor to the Offeror. If audited

financial statements are not available, explain why and submit

unaudited financial statements.

ii) Unaudited financial statements for the period between the last month

covered by the audited statements and the month before the proposal is

submitted.

iii) Documentation about available lines of credit, including maximum

credit amount and amount available thirty (30) business days prior to

the submission of the proposal.

iv) The most recent set of quarterly financial statements filed with the

Department of Insurance.

v) State of incorporation.

vi) Type of incorporation, as profit or non-profit.

vii) Bond rating.

viii) A.M. Best rating for life/health.

ix) Standard and Poor rating.

x) Weiss rating.

xi) The Offeror will provide its Risk Based Capital Ratio for the year filed

most recently with the Pennsylvania Insurance Issuing Office.

If any information requested is not applicable or not available, provide an

explanation. Offerors may submit appropriate documentation to support

information provided.

c. Explain how your response provides proof of fiscal soundness. Section VII.A.2. of

the draft Agreement, Equity Requirements, and Section VII.A.3 of the draft

Agreement, Risk Based Capital (RBC).

d. If the Offeror plans to enter into a subcontract at a cost of at least eighty percent of

anticipated Agreement revenues received from the Department, and if the

subcontract provides for financial risk on the part of the subcontractor, provide

items listed in Section II-6.b above, as they relate to the proposed subcontractor.


e. Identify any proposed subcontractor in which the Offeror has five percent (5%) or

more ownership interest.

f. Identify how Offeror satisfies the SAP-Basis equity requirement. Each Offeror

must have SAP-basis equity, as of 01/01/2012 or as of a more recent date, equal

to or greater than the highest amount determined by the following ―three part

test‖:

$10.0 million;

6.0% of revenue earned by the licensed HMO during the most recent four

(4) calendar quarters; or

6.0% of revenue earned by the licensed HMO during the current quarter

multiplied by three (3).

Note: The Department will not permit a successful Offeror to implement a

HealthChoices program in the SW Zone unless it has SAP-basis equity as of the

last day of the second quarter prior to the program implementation date, at least

equal to the amount determined by the formula above. Failure to comply with the

equity requirement, or with the requirement to provide documentation satisfactory

to the Department , may result in rejection of the proposal.

g The Offeror shall explain how it will fund development and start up costs,

including the source of funds. Provide information and documentation to enable

the Department to conclude whether sources have and are committed to providing

the expected funds.

h. List any financial interest in subcontractors the Offeror may have in its

organization, or any financial interests its organization has in proposed

subcontractors. Copies of proposed sub contractual arrangements are to be

included as an appendix. The Department will approve all subcontracts used by

the selected Offeror.

i The Offeror will state whether it has changed its independent actuary or

independent auditor in the last two years. If it has, it must explain why.

II-7. Objections and Additions to Agreement Terms and Conditions

The Offeror will identify which, if any, of the terms and conditions (contained in

Appendices A, E and F) it would like to negotiate and what additional terms and conditions

the Offeror would like to add to the agreement. The Offeror’s failure to make a submission

under this paragraph will result in its waiving its right to do so later, but the Department may

consider late objections and requests for additions if to do so, in the Department’s discretion,

would be in the best interest of the Commonwealth. The Department may, in its sole

discretion, accept or reject any requested changes to the standard contract terms and

conditions. The Offeror shall not request changes to the other provisions of the RFP, nor

shall the Offeror request to completely substitute its own terms and conditions for

Appendices A, E and F. All terms and conditions must appear in one integrated Agreement.


The Issuing Office will not accept references to the Offeror’s, or any other, online guides or

online terms and conditions contained in any proposal.

Regardless of any objections set out in its proposal, the Offeror must submit its proposal on

the basis of the terms and conditions set forth in Appendices A, E and F. The Issuing Office

will reject any proposal that is conditioned on the negotiation of terms and conditions.

II-8. Disadvantaged Business Submittal

A. Disadvantaged Business Information

i) To receive credit for being a Small Disadvantaged Business or a Socially

Disadvantaged Business or for entering into a joint venture agreement with a

Small Disadvantaged Business or for subcontracting with a Small

Disadvantaged Business (including purchasing supplies and/or services through

a purchase agreement), an Offeror must include proof of Disadvantaged

Business qualification in the Disadvantaged Business Submittal of the proposal,

as indicated below:

1. A Small Disadvantaged Businesses certified by BMWBO as an

MBE/WBE must provide a photocopy of their BMWBO certificate.

2. Small Disadvantaged Businesses certified by the U.S. Small Business

Administration pursuant to Section 8(a) of the Small Business Act (15

U.S.C. § 636(a)) as an 8(a) or small disadvantaged business must submit

proof of U.S. Small Business Administration certification. The owners

of such businesses must also submit proof of United States citizenship.

3. Businesses, which assert that they meet the U.S. Small Business

Administration criteria for designation as a small disadvantaged business,

must submit: a) self-certification that the business meets the Small

Business Administration criteria and b) documentary proof to support the

self-certification. The owners of such businesses must also submit proof

of United States citizenship, and provide any relevant small

disadvantaged business certifications by other certifying entities.

4. All businesses claiming Small Disadvantaged Business status, whether as

a result of BMWBO certification, or U.S. Small Business Administration

certification as an 8(a) or self-certification as a U.S. Small Business

Administration small disadvantaged business, must attest to the fact that

the business has no more than 100 full-time or full-time equivalent

employees.

5. All businesses claiming Small Disadvantaged Business status, whether as

a result of BMWBO certification or U.S. Small Business Administration

certification as an 8(a) or self-certification as a U.S. Small Business

Administration small disadvantaged business, must submit proof that

their gross annual revenues are less than $20,000,000 ($25,000,000 for

those businesses in the information technology sales or service business).

This can be accomplished by including a recent tax return or audited

financial statement.


ii) All businesses claiming status as a Socially Disadvantaged Business must

include in the Disadvantaged Business Submittal of the proposal clear and

convincing evidence to establish that the business has personally suffered

racial or ethnic prejudice or cultural bias stemming from the business person’s

color, ethnic origin or gender. The submitted evidence of prejudice or bias

must:

1. Be rooted in treatment that the business person has experienced in

American society, not in other countries.

2. Show prejudice or bias that is chronic and substantial, not fleeting or

insignificant.

3. Indicate that the business person’s experience with the racial or

ethnic prejudice or cultural bias has negatively impacted his or her entry

into and/or advancement in the business world.

BMWBO shall determine whether the Offeror has established that a business is

socially disadvantaged by clear and convincing evidence.

iii) In addition to the above verifications, the Offeror must include in the

Disadvantaged Business Submittal of the proposal the following information:

1) Those Small Disadvantaged Businesses submitting a proposal as the

Offeror must include a numerical percentage which represents the total

percentage of the work to be performed by the Offeror and not by

subcontractors and suppliers.

2) Those Small Disadvantaged Businesses submitting a proposal as a part

of a joint venture partnership must include a numerical percentage

which represents the total percentage of the work to be performed by

the Small Disadvantaged Business joint venture partner and not by subcontractors and suppliers or by joint venture partners who are not

Small Disadvantaged Businesses. Offeror must also provide:

a. The amount of capital, if any, each Small Disadvantaged

Business joint venture partner will be expected to provide.

b. A copy of the joint venture agreement signed by all parties.

c. The business name, address, name and telephone number of

the primary contact person for the Small Disadvantaged

Business joint venture partner.

3) All Offerors must include a numerical percentage which represents the

total percentage that the Offeror commits to paying to Small

Disadvantaged Businesses as subcontractors. To support its total

percentage DB subcontractor commitment, Offeror must also include:

a) The dollar amount of each subcontract commitment to a

Small Disadvantaged Business;


b) The name of each Small Disadvantaged Business. The

Offeror will not receive credit for stating that after the

contract is awarded it will find a Small Disadvantaged

Business.

c) The services or supplies each Small Disadvantaged

Business will provide, including the timeframe for

providing the services or supplies.

d) The location where each Small Disadvantaged Business

will perform services.

e) The timeframe for each Small Disadvantaged Business

to provide or deliver the goods or services.

f) A signed subcontract or letter of intent for each Small

Disadvantaged Business. The subcontract or letter of

intent must identify the specific work, goods or services

the Small Disadvantaged Business will perform and how

the work, goods or services relates to the project.

g) The name, address and telephone number of the primary

contact person for each Small Disadvantaged Business.

4) The total percentages and each subcontractor commitment will become

contractual obligations once the contract is fully executed.

5) The name and telephone number of the Offeror’s project (contact)

person for the Small Disadvantaged Business information.

iv) The Offeror is required to submit two copies of its Disadvantaged Business

Submittal. The submittal shall be clearly identified as Disadvantaged Business

information and sealed in its own envelope, separate from the remainder of the

proposal.

v) A Small Disadvantaged Business can be included as a subcontractor with as

many prime contractors as it chooses in separate proposals.

vi) An Offeror that qualifies as a Small Disadvantaged Business and submits a

proposal as a prime contractor is not prohibited from being included as a

subcontractor in separate proposals submitted by other Offerors.

B. Enterprise Zone Small Business Participation.

i) To receive credit for being an Enterprise Zone Small Business or entering

into a joint venture agreement with an Enterprise Zone Small Business or

subcontracting with an Enterprise Zone Small Business, an Offeror must

include the following information in the Disadvantaged Business Submittal

of the proposal:

1) Proof of the location of the business’ headquarters (such as a lease or

deed or Issuing Office of State corporate registration), including a

description of those activities that occur at the site to support the other

businesses in the enterprise zone.


2) Confirmation of the enterprise zone in which it is located (obtained

from the local enterprise zone office).

3) Proof of United States citizenship of the owners of the business.

4) Certification that the business employs 100 or fewer employees.

5) Proof that the business’ gross annual revenues are less than $20,000,000

($25,000,000 for those businesses in the information technology sales

or service business). This can be accomplished by including a recent

tax return or audited financial statement.

6) Documentation of business organization, if applicable, such as articles

of incorporation, partnership agreement or other documents of

organization.

ii) In addition to the above verifications, the Offeror must include in the

Disadvantaged Business Submittal of the proposal the following

information:

1) The name and telephone number of the Offeror’s project (contact) person for the Enterprise Zone Small Business.

2) The business name, address, name and telephone number of the

primary contact person for each Enterprise Zone Small Business

included in the proposal. The Offeror must specify each

Enterprise Zone Small Business to which it is making

commitments. The Offeror will not receive credit for stating

that it will find an Enterprise Zone Small Business after the

contract is awarded or for listing several businesses and stating

that one will be selected later.

3) The specific work, goods or services each Enterprise Zone Small

Business will perform or provide.

4) The estimated dollar value of the contract to each Enterprise

Zone Small Business.

5) Of the estimated dollar value of the contract to each Enterprise

Zone Small Business, the percent of the total value of services or

products purchased or subcontracted that each Enterprise Zone

Small Business will provide.

6) The location where each Enterprise Zone Small Business will

perform these services.

7) The timeframe for each Enterprise Zone Small Business to

provide or deliver the goods or services.


8) The amount of capital, if any, each Enterprise Zone Small

Business will be expected to provide.

9) The form and amount of compensation each Enterprise Zone

Small Business will receive.

10) For a joint venture agreement, a copy of the agreement, signed

by all parties.

11) For a subcontract, a signed subcontract or letter of intent.

iii) The dollar value of the commitment to each Enterprise Zone Small

Business must be included in the same sealed envelope with the

Disadvantaged Business Submittal of the proposal. The following will

become a contractual obligation once the contract is fully executed:

1) The amount of the selected Offeror’s Enterprise Zone Small

Business commitment;

2) The name of each Enterprise Zone Small Business; and

2) The services each Enterprise Zone Small Business will provide,

including the timeframe for performing the services.

II-9. Domestic Workforce Utilization Certification

Complete and sign the Domestic Workforce Utilization Certification contained in Appendix

L of this RFP. Offerors who seek consideration for this criterion must submit in hardcopy the

signed Domestic Workforce Utilization Certification Form in the same sealed envelope with

the Technical Submittal.

.

II-10 Contractor Partnership Program Submittal

The following general information must be included in the Contractor Partnership

Program Submittal of the proposal:

a. Offeror’s name, telephone number and mailing address.

b. County where the Offeror’s headquarters is located if in Pennsylvania.

c. The name, title, telephone number, mailing and email address of the contact

person for the Contractor Partnership Program.

d. Mailing address for all satellite offices located in Pennsylvania including the

county.

e. Type of business entity. (i.e. not for profit, government entity, public

corporation, university etc.)


f. If a subcontractor will provide the primary service of the contract, list the

company name and mailing address for offices located in Pennsylvania

including the county.

g. Type of services being provided.

h. Type of positions needed for this project. Please specify management vs. non-

management positions.

In addition to the above requested information; in order to receive credit for a response

to the Contractor Partnership Program, Offerors must provide a written narrative that

address the following statements and include the information in the Contractor

Partnership Submittal of the proposal. All of the statements listed below pertain to the

hiring of individuals that are currently receiving TANF cash assistance.

1. Identify the anticipated number of employees that will be assigned to this project

including vacancies.

2. Identify the number of management and non management employees.

3. State the number of TANF cash assistance recipients that will be hired. Please

do not include percentages.

4. Describe the strategy that will be employed to identify and recruit individuals

that meet the eligibility requirements for the Contractor Partnership Program.

5. Describe the methods that will be used to retain TANF recipients once they are

employed.

6. Provide a brief explanation of the efforts that will be made to ensure TANF

hiring commitments are met and remain in effect throughout the existence of the

Agreement.

II-11 Mentor Protégé Program (MPP) Submittal.

To receive credit for a response to the MPP, the following information must be included in the

MPP Submittal of the Proposal:

a. Offeror’s name, telephone number and mailing address

b. County where the Offeror’s headquarters is located

c. The name, title, telephone number, mailing and e-mail address of the contact

person for the MPP.

c. Mailing address for all satellite offices located in Pennsylvania including

county.

d. Type of business entity: (i.e. not for profit, government entity, public

corporation, university, etc.)

In addition to the above requested information; in order to receive credit for a response to the

MPP, Offerors must provide a written Mentor Protégé Plan that must include:

(1) The Protégé company's name and address

(2) Protégé company’s contact person, title, telephone number, mailing

and e-mail address


(3) A Mentor Protégé Plan addressing the following areas to include

meeting dates, time frames, goal setting, performance expectations and

outcomes:

(a) Technical Assistance. Assistance in technical areas.

(b) Budget Infrastructure. Assistance pertaining to general

business management or corporate infrastructure, provided by

the Mentor, may include the following:

(1) Organizational planning management: strategic

planning, business planning, legal/risk management,

proposal development

(2) Business development/marketing/sales: market

research, product forecasting, web-based marketing,

e-commerce.

(3) Human Resource management

(4) Financial management

(5) Contract management

(6) Facilities and plant management: security, health

and safety

(7) Any other assistance designed to develop the

capabilities of the Protégé


PART III

CRITERIA FOR SELECTION

III-1. Mandatory Responsiveness Requirements

To be eligible for selection, a proposal must be:

(a) Timely received from an Offeror;

(b) Properly signed by the Offeror.

III-2 Technical Nonconforming Proposals. The Department reserves the right, in its sole

discretion, to waive technical or immaterial nonconformities in an Offeror’s proposal.

III-3 Evaluation. The Department has selected a committee of qualified personnel to

review and evaluate timely submitted proposals. Independent of the committee, BMWBO and

the CPP will evaluate the Disadvantaged Business, Mentor Protégé Program, and CPP

Submittals respectively, and provide the Department with a rating for this component of each

proposal. The Department will notify in writing of its selection for negotiation the responsible

Offerors whose proposals are determined to be the most advantageous to the Commonwealth

as determined by the Department after taking into consideration all of the evaluation factors.

The Department will award an agreement only to an Offeror determined to be responsible in

accordance with the most current version of Commonwealth Management Directive 215.9,

Contractor Responsibility Program.

III-4 Criteria for Selection.

The following criteria will be used in evaluating each proposal. In order for a proposal to be

considered for selection for best and final offers or selection for negotiations, the total score

for the technical submittal of the proposal must be greater than or equal to 70% of the highest

scoring technical submittal.

a. Technical: The Issuing Office has established the weight for the Technical

criterion for this RFP as 80 % of the total points. Evaluation will be based upon

the following in order of importance:

Priority Rank 1 Prior Experience

Priority Rank 2 Work Statement Questionnaire

Priority Rank 3 Financial Condition

Priority Rank 4 Personnel Qualifications

Priority Rank 5 Statement of the Problem


b. Disadvantaged Business Participation BMWBO has established the weight for

the Disadvantaged Business Participation criterion for this RFP as 20 % of the

total points. Evaluation will be based upon the following in order of priority:

Priority Rank 1 Proposals submitted by Small

Disadvantaged Businesses.

Priority Rank 2 Proposals submitted from a joint

venture with a Small

Disadvantaged Business as a joint

venture partner.

Priority Rank 3 Proposals submitted with

subcontracting commitments to

Small Disadvantaged Businesses.

Priority Rank 4 Proposals submitted by Socially

Disadvantaged Businesses.

Each proposal will be rated for its approach to enhancing the utilization of

Small Disadvantaged Businesses and/or Socially Disadvantaged Businesses.

Each approach will be evaluated, with Priority Rank 1 receiving the highest

score and the succeeding options receiving scores in accordance with the

above-listed priority ranking

To the extent that an Offeror qualifies as a Small Disadvantaged Business or a

Socially Disadvantaged Business, the Small Disadvantaged Business or

Socially Disadvantaged Business cannot enter into subcontract arrangements

for more than 40% of the total estimated dollar amount of the agreement. If a

Small Disadvantaged Business or a Socially Disadvantaged Business

subcontracts more than 40% of the total estimated dollar amount of the

agreement to other contractors, the Disadvantaged Business Participation

scoring shall be proportionally lower for that proposal.

c. Enterprise Zone Small Business Participation: In accordance with the

priority ranks listed below, bonus points in addition to the total points for this

RFP, will be given for the Enterprise Zone Small Business Participation

criterion. The maximum bonus points for this criterion is 3% of the total points

for this RFP. The following options will be considered as part of the final

criteria for selection:

Priority Rank 1 Proposals submitted by an

Enterprise Zone Small Business

will receive three percent bonus

for this criterion. Priority Rank 2 Proposals submitted by a joint

venture with an Enterprise Zone

Small Business as a joint venture


partner will receive two percent

bonus for this criterion.

Priority Rank 3 Proposals submitted with a

subcontracting commitment to an

Enterprise Zone Small Business

will receive one percent bonus for

this criterion.

Priority Rank 4 Proposals with no Enterprise Zone

Small Business Utilization shall

receive no points under this

criterion.

To the extent that an Offeror is an Enterprise Zone Small Business, the Offeror

cannot enter into agreement or subcontract arrangements for more than 40% of

the total estimated dollar amount of the agreement in order to qualify as an

Enterprise Zone Small Business for purposes of this RFP.

d. Contractor Partnership Program (CPP) During the evaluation process, CPP

will evaluate each Submittal for its approach in enhancing employment

opportunities for eligible CPP participants. Any points received for the CPP

criterion are bonus points in addition to the total points for this RFP. The

maximum bonus points for this criterion is 5% of the total points for this RFP.

e Mentor Protégé Program (MPP)

During the evaluation process, DPW BEO – MPP will evaluate each Submittal

for its approach to mentoring and developing skills related to the services

identified in this RFP. Any points received for the MPP criterion are bonus

points in addition to the total points for this RFP. The maximum bonus points

for this criterion is 5% of the total technical points for this RFP.

f Domestic Workforce Utilization

Any points received for the Domestic Workforce Utilization criterion are bonus

points in addition to the total points for this RFP. The maximum bonus points

for this criterion is 3% of the total points for this RFP. To the extent permitted

by the laws and treaties of the United States, each proposal will be scored for

its commitment to use domestic workforce in the fulfillment of the agreement.

Maximum consideration will be given to those Offerors who will perform the

contracted direct labor exclusively within the geographical boundaries of the

United States or within the geographical boundaries of a country that is a party

to the World Trade Organization Government Procurement Agreement. Those

who propose to perform a portion of the direct labor outside of the United

States and not within the geographical boundaries of a party to the World Trade

Organization Government Procurement Agreement will receive a

correspondingly smaller score for this criterion. Offerors who seek

consideration for this criterion must submit in hardcopy the signed Domestic

Workforce Utilization Certification Form in the same sealed envelope with the

Technical Submittal. The certification will be included as a contractual

obligation when the agreement is executed.


Part IV

WORK STATEMENT

IV-1. Objectives.

This RFP has been issued to procure the services of MCOs to continue the operation of the

HealthChoices Physical Health program in the SW Zone.

IV-2. Nature and Scope

The HealthChoices Physical Health Program has been operating in the ten-county Southwest

Zone of Pennsylvania since January 1, 1999. The SW Zone includes the counties of

Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington and

Westmoreland. Presently the Department has Agreements with three MCOs to provide

Physical Health services for MA recipients: Gateway Health Plan, Unison Health Plan of

Pennsylvania, Inc., and UPMC for You. There are approximately 299,000 recipients enrolled

in the HealthChoices Southwest Zone. The table below displays enrollment numbers by MCO

and county as of September 1, 2010.

Gateway Health Plan

Unison Health Plan

UPMC for You

Total

Enrollment

Allegheny 59,151 Allegheny 22,066 Allegheny 61,602 142,819

Armstrong 5,026 Armstrong 465 Armstrong 3,322 8,813

Beaver 12,328 Beaver 1,949 Beaver 6,818 21,095

Butler 6,687 Butler 1,499 Butler 5,800 13,986

Fayette 4,274 Fayette 11,787 Fayette 9,652 25,713

Greene 722 Greene 4,216 Greene 1,373 6,311

Indiana 2,583 Indiana 2,154 Indiana 4,334 9,071

Lawrence 7,561 Lawrence 1,602 Lawrence 3,828 12,991

Washington 5,456 Washington 5,645 Washington 10,439 21,540

Westmoreland 12,423 Westmoreland 8,394 Westmoreland 15,942 36,759

TOTAL 116,211 59,777 123,110 299,098

IV-3. Requirements

a. A full description of the requirements for the provision of Physical Health

services for the HealthChoices Program in the SW Zone is set forth in the draft

Agreement (Appendix A). The provisions of this RFP and its Appendices will

become a part of the HealthChoices SW Zone operational Agreement.


b. Emergency Preparedness

To support continuity of operations during an emergency, including a

pandemic, the Commonwealth needs a strategy for maintaining operations for

an extended period of time. One part of this strategy is to ensure that essential

contracts that provide critical business services to the Commonwealth have

planned for such an emergency and put contingencies in place to provide

needed goods and services.

i. Describe how you anticipate such a crisis will impact your operations.

ii. Describe your emergency response continuity of operations plan. Please attach

a copy of your plan, or at a minimum, summarize how your plan addresses the

following aspects of pandemic preparedness:

employee training (describe your organization’s training plan, and how

frequently your plan will be shared with employees)

identified essential business functions and key employees (within your

organization) necessary to carry them out

contingency plans for:

o How your organization will handle staffing issues when a

portion of key employees are incapacitated due to illness.

o How employees in your organization will carry out the essential

functions if contagion control measures prevent them from

coming to the primary workplace.

how your organization will communicate with staff and suppliers when

primary communications systems are overloaded or otherwise fail,

including key contacts, chain of communications (including suppliers),

etc.

how and when your emergency plan will be tested, and if the plan will be

tested by a third-party.

IV-4. Contract Requirements—Disadvantaged Business Participation and Enterprise

Zone Small Business Participation. All contracts containing Disadvantaged Business

participation and/or Enterprise Zone Small Business participation must also include a

provision requiring the selected contractor to meet and maintain those commitments made to

Disadvantaged Businesses and/or Enterprise Zone Small Businesses at the time of proposal

submittal or contract negotiation, unless a change in the commitment is approved by the

BMWBO. All contracts containing Disadvantaged Business participation and/or Enterprise

Zone Small Business participation must include a provision requiring Small Disadvantaged

Business subcontractors, Enterprise Zone Small Business subcontractors and Small

Disadvantaged Businesses or Enterprise Zone Small Businesses in a joint venture to perform

at least 50% of the subcontract or Small Disadvantaged Business/Enterprise Zone Small

Business participation portion of the joint venture.

The selected contractor’s commitments to Disadvantaged Businesses and/or Enterprise Zone

Small Businesses made at the time of proposal submittal or contract negotiation shall be

maintained throughout the term of the contract. Any proposed change must be submitted to


BMWBO, which will make a recommendation to the Contracting Officer regarding a course

of action.

If a contract is assigned to another contractor, the new contractor must maintain the

Disadvantaged Business participation and/or Enterprise Zone Small Business participation of

the original contract.

The selected contractor shall complete the Prime Contractor’s Quarterly Utilization Report (or

similar type document containing the same information) and submit it to the contracting

officer of the Issuing Office and BMWBO within 10 workdays at the end of each quarter the

contract is in force. This information will be used to determine the actual dollar amount paid

to Small Disadvantaged Business and/or Enterprise Zone Small Business subcontractors and

suppliers, and Small Disadvantaged Business and/or Enterprise Zone Small Business

participants involved in joint ventures. Also, this information will serve as a record of

fulfillment of the commitment the selected contractor made and for which it received

Disadvantaged Business and Enterprise Zone Small Business points. If there was no activity

during the quarter then the form must be completed by stating ―No activity in this quarter.‖

If the selected contractor fails to meet its Disadvantaged Business commitment as provided in

its agreed upon work plan, the Department may assess liquidated damages as provided in the

contract.

NOTE: EQUAL EMPLOYMENT OPPORTUNITY AND CONTRACT COMPLIANCE

STATEMENTS REFERRING TO COMPANY EQUAL EMPLOYMENT OPPORTUNITY

POLICIES OR PAST CONTRACT COMPLIANCE PRACTICES DO NOT CONSTITUTE

PROOF OF DISADVANTAGED BUSINESSES STATUS OR ENTITLE AN OFFEROR TO

RECEIVE CREDIT FOR DISADVANTAGED BUSINESSES UTILIZATION.

IV-5. CPP Reporting Requirements. The approved hiring commitment will become a

contractual obligation included in the contract. Hiring commitments shall be maintained

throughout the term of the Agreement, including any renewal or extensions. In the event of a

renewal or extension of the original Agreement term and upon request of CPP, the selected

Contractor will submit an updated plan. Any proposed change must be submitted to the

Contractor Partnership Program, which will make a recommendation to the Contracting

Officer regarding course of action. Upon approval of the Department, this updated plan will

become part of the Agreement. If a contract is assigned to another contractor, the new

contractor must maintain the CPP recruiting and hiring plan of the original Agreement. Upon

request of CPP the Contractor will submit a revised plan. Upon approval, this plan will

become a part of the Agreement.

Upon award of the Agreement, the selected Offeror is required to complete and submit the PA

1540 Quarterly Employment Report Form on a quarterly basis to document the number of

TANF cash assistance recipients hired for that quarter. The form must be completed in its’

entirety and forwarded to the Contractor Partnership Program, with a copy sent to the DPW

Contract Monitor, by the fifteenth day of the following month after the quarter ends. If the 15th

falls on a weekend or state holiday the report is due the next business day. The quarters are

based on the Department of Public Welfare’s fiscal year and are as follows:


Quarters Begin Date End Date Reports Due

1 – First July 1 September 30 October 15

2 – Second October 1 December 31 January 15

3 – Third January 1 March 31 April 15

4 – Fourth April 1 June 30 July 15

The selected Offeror, regardless of its contract Effective Date, must submit the PA 1540 based

on the schedule above. If an Agreement begins in the middle of a quarter the information

reported will be based on activity that occurred from the contract Effective Date through the

end of the quarter. If no activity occurred the form must be completed by stating ―No Activity

in this Quarter with the Contractor’s comments. This report must be signed by the entity that

holds the Agreement with the Department of Public Welfare; it may not be signed by a

subcontractor.

The information submitted on this report will be audited for its accuracy and the findings will

be utilized to determine if the selected Offeror is meeting its hiring requirements.

Verification

The Contractor Partnership Program will review the PA 1540 Form for accuracy and

completeness. In addition, the individuals reported on the 1540 Form as TANF cash

assistance recipients will be verified through the Department’s Client Information System

(CIS). The Department will take a statistical sample of all public assistance hires reported to

determine if the selected Offeror will receive credit. The results of the sample will determine

if additional verification measures are needed. If the selected Offeror is found to report

inaccurate information on a consistent basis, it will be reported to the Contracting Officer for

appropriate action.

*Please note that the PA 1540 Form will be mailed to the Contractor after their contract

is executed.

IV-6. Mentor Protégé Program (MPP) Reporting Requirements. The approved Plan

commitment will become a contractual obligation included in the Agreement. Mentor Protégé

Plan commitment shall be maintained throughout the term of the Agreement, including any

renewals or extension of the original Agreement term and upon request of DPW BEO – MPP,

the selected Contractor will submit an updated plan. Any proposal change must be submitted

to the Department of Public Welfare, Bureau of Equal Opportunity, Mentor Protégé Program,

which will make a recommendation to the Contracting Officer regarding course of action.

Upon approval of the Department, this updated plan will become part of the Agreement. If an

Agreement is assigned to another contractor, the new contractor must maintain the Mentor

Protégé Plan commitment. Upon request of DPW BEO – MPP the Contractor will submit a

revised plan. Upon approval this plan will become part of the Agreement.

Upon award of the Agreement the selected Offeror is required to provide a copy of the signed

agreement between the Mentor and the Protégé. The Offeror is required to provide a written

narrative to DPW BEO – MPP on a quarterly basis with an update of the Mentor Protégé

Program Plan with a copy sent to the DPW Contract Monitor, by the fifteenth day of the

following month after the quarter ends. If the 15th

falls on a weekend or state holiday, the


report is due the next business day. The quarters are based on the Department of Public

Welfare’s fiscal year and are as follows:

Quarters Begin Date End Date Reports Due

1 – First July 1 September 30 October 15

2 – Second October 1 December 31 January 15

3 – Third January 1 March 31 April 15

4 – Fourth April 1 June 30 July 15

The selected Offeror, regardless of its contract Effective Date, must submit the written

narrative based on the schedule above. If an Agreement begins in the middle of a quarter the

information reported will be based on activity that occurred from the Agreement Effective

Date through the end of the quarter. If no activity occurred, the written narrative must provide

an explanation. This written narrative must be signed by the entity that holds the Agreement

with the Department of Public Welfare; it MAY NOT be signed by the Protégé.

The information submitted on this report will be audited for its accuracy and the findings will

be utilized to determine if the selected Offeror is meeting its Mentor Protégé Program Plan.

Verification

The Department of Public Welfare, Bureau of Equal Opportunity – Mentor Protégé Plan will

review the written narrative to ensure it is consistent with the Mentor Protégé Program Plan.

In addition, DPW BEO – MPP may contact the Protégé to ensure compliance with Mentor

Protégé Program Plan. The results will determine if additional verification measures are

needed. If the selected Offeror is found to report inaccurate information on a consistent basis,

it will be reported to the Contracting Officer for appropriate action.

Technical Amendments for RFP #11-10

Underlined Text is new, strickthrough text has been deleted

Reference Correction

1. Part II Proposal Requirements Correction to Bullet “a.” Technical Submittal, which should be a

response to RFP Part II, Sections II-1 through II-8 II-7 and

Domestic Workforce Utilization Certification Submittal II-9;

2. Part III-4a. Criteria for Selection

Criteria for Selection, Technical: Should read as follows,

The Issuing Office has established the weight for the Technical

Criterion for this RFP as 80% of the total points. Evaluation will

be based upon the following in order of importance:

Priority Rank 1 Prior Experience

Priority Rank 2 Work Statement Questionnaire

Priority Rank 3 Financial Condition

Priority Rank 4 Personnel Qualifications

Priority Rank 5 Statement of the Problem

3. Appendix B See amended Appendix B (Databook) attached

4. Appendix D See amended Appendix D (Proposal Cover Sheet) attached.

5. Appendix H See amended Appendix H (Corporate Reference Questionnaire)

attached.

APPENDIX D

PROPOSAL COVER SHEET

COMMONWEALTH OF PENNSYLVANIA


Bureau of Financial Operations



625 Forster Street


RFP# 11-10

Enclosed in four separately sealed submittals is the proposal of the Offeror

identified below for the above-referenced RFP:

Offeror Information:

Offeror Name

Offeror Mailing Address

Offeror Website

Offeror Contact Person

Contact Person’s Phone Number

Contact Person’s Facsimile Number

Contact Person’s E-Mail Address

Offeror Federal ID Number

Submittals Enclosed and Separately Sealed:

Technical Submittal

Disadvantaged Business Submittal

Contractor Partnership Program Submittal


Signature

Signature of an official

authorized to bind the Offeror

to the provisions contained in

the Offeror’s proposal:

Printed Name

Title

FAILURE TO COMPLETE, SIGN AND RETURN THIS FORM WITH THE

OFFEROR’S PROPOSAL MAY RESULT IN THE REJECTION OF THE

OFFEROR’S PROPOSAL

APPENDIX H

CORPORATE REFERENCE QUESTIONNAIRE

Proposer Information Reference Information

Proposer____________________ Corporation/Company _________________

Address ____________________ Contact Person ________________________

_____________________________ Telephone Number _____________________

_____________________________

Telephone Number ______________________

Q1. What function does/did the contractor perform for you?

Q2. What is/was the dollar amount of your contract?

Q3. What is/was the time period in which services were provided?

Ratings: Summarize contractor’s performance and circle in the column on the right the number that

corresponds to the performance rating for each rating category. Please use the following rating scale.

0–Unsatisfactory 1-Poor 2–Fair 3–Good 4–Excellent 5–Demonstrated Exceptional Performance

Q4. Rate the contractor’s overall performance. Comments: Rating:

0

1

2

3

4

5

Q5. How would you assess the contractor’s key

personnel?

Comments: Rating:

0

1

(How long did key personnel work on the contract

– did they effectively manage the contract – were

they responsive to technical direction?)

2

3

4

5

Q6. Please rate and comment on the contractor’s

ability to work with your in-house staff.

Comments: Rating:

0

1

2

3

4

5


technical skills and knowledge in providing

managed care or healthcare services.

Comments: Rating:

0

1

2

3

4

5


reasonableness in resolving conflicts or problems.

Comments: Rating:

0

1

2

3

4

5


commitment to customer satisfaction.

Comments: Rating:

0

1

2

3

4

5

Q10. How cooperative was the contractor during

contract negotiations? Please explain your rating.

a. Highly cooperative

b. Moderately cooperative

c. Slightly cooperative

d. Slightly uncooperative

e. Moderately uncooperative

f. Highly uncooperative

g. No opinion

Explanation:

Q11. Would you hire the contractor again for

another project? Please explain your rating.

a. Yes

b. No

Explanation:

Q12. What do you view as the contractor’s

greatest strength?

Comments:

Q13. What do you view as the contractor’s

greatest weakness?

Comments:

Q14. Is there anything you would like to add

concerning the contractor?

Comments:

PRINT NAME: _______________________________

SIGNATURE: ________________________________

TITLE: ______________________________________

DATE: _____________________________________

HealthChoices Physical Health Services for

the Southwest Zone RFP #11-10

Preproposal Conference

11/23/10

Preproposal Conference Purpose

To furnish you with some

of the background leading

to the issuance of this

Request for Proposals;

To emphasize those

requirements of the RFP

we consider especially

important;

To answer your questions

concerning the RFP.

To point out some areas

Offerors have had

problems with in the past;

and

Background

HealthChoices Southwest Zone

SOUTHWEST ZONE ENROLLMENT

Lawrence12,991

Beaver21,095

Washington21,540

Greene6,311

Butler13,986

Allegheny142,819

Fayette25,713

Westmoreland36,759

Armstrong8,813

Indiana9,071

Southwest Zone Growth2008-2010

250,000

275,000

300,000

2008 2009 2010

RFP CRITICAL POINTS

RFP PROBLEM AREAS

MAJOR MILESTONES

Activity Date

1. RFP Released 10/29/10

2. Preproposal Conference 11/23/10

3. Proposals Due 1/14/11

4. Selection of MCOs for Readiness Review March 2011

5. Readiness Review Begins April 2011

6. Department’s Outreach/Mailings to

Medical Assistance recipients

November-

December

2011

7. Proposed Agreement Effective Date 1/1/12

OPERATIONAL INFORMATION

READINESS REVIEW


NO LOCK-IN

• Consumer Choice

– Choice of MCOs

– Choice of providers within MCO

• Freedom To Initiate a Change in MCOs at Any Time

PA Enrollment Serviceshttp://enrollnow.net/PASelfService/home.html


http://enrollnow.net/PASelfService/home.html


Auto-assignment

OPERATIONAL ISSUES

STAFFING

QUESTIONS

Information from today’s

Preproposal Conference

The information from the Preproposal Conference will be posted on the DGS Web site as an addendum to, and shall become part of RFP #10-11:

— Preproposal Conference Presentations — Answers to questions — Technical amendments — Copy of attendance list

Responses to Questions

Conclusion of the Preproposal Conference

Contractor

Partnership Program

PA DEPARTMENT OF PUBLIC WELFARE

1

What is the Contractor Partnership

Program?

The Contractor Partnership Program (CPP) was created by

Pennsylvania’s Department of Public Welfare (DPW) to create

additional employment opportunities within the Commonwealth.

CPP is designed to leverage the economic resources of DPW to

create jobs for individuals currently receiving TANF cash

assistance by maximizing the recruitment, hiring and retention

of those individuals by Commonwealth contractors,

subcontractors and grantees.

2

Who’s required to participate in the

program?

All contractors, vendors, organizations, fiscal

agents, county governments etc. that receive

funding (25,000 or more) from the Department

of Public Welfare (DPW) or a DPW funded

initiative in the form of a contract, grant,

memorandum of understanding or other

contracting vehicle

3

What are the Pre Selection responsibilities

of the Contractors?

Fully answer all questions outlined in the

Contractor Partnership Submittal section of the

this RFP and any applicable BAFO memos

While developing hiring numbers and plans to

be submitted for scoring and approval; look both

company and subcontractor wide for the full

duration of the contract, when evaluating

openings and/or potential openings to be filled. Percentages and ranges are not acceptable

It should be noted that…

In recognition of the difficulties contractors may face in hiring TANF

recipients due to the specific scope of services of some RFPs; CPP

will credit contractors for TANF public assistance hires that are

specific to this RFP, any TANF public assistance hires made in their

respective organization not specific to this RFP, as well as any (non

duplicated) TANF public assistance hires subcontractors make and

maintain on behalf of contractors during the life of this contract.

While DB/MWBs can volunteer to assist contractors in meeting

CPP requirements, Contractors can not require DB/MWBs to hire

qualified TANF recipients as a stipulation to partnership on any

contract that derives from this RFP.

4

5

Where are these people located?

Contractors can partner with the local service delivery

providers in their area; the Workforce Investment Agency

(WIA) or Community Action Agency Program (CAAP)

(Note: Contact CPP to locate an agency within your area)

Contractors can also work with faith based organizations,

host targeted job fairs, post advertisements in newspapers

or the internet

Contractors can post job orders that match “CPP Eligible”

TANF recipients via the Commonwealth Workforce

Development System (CWDS)

6

How do contractors identify that candidates are

qualified?

PA contracts with public and private businesses to provide job skills

recipients of TANF

These Employment and Training sites are located in every county in PA

Sites train on all things job related ranging from GED, ESL, soft skills,

computer skills through in demand trade certifications and associate

degrees

Sites assist TANF recipients with multiple services including but not

limited to; transportation, tools, uniforms and childcare

Sites are monitored by DPW for performance in training curriculum ,

participation, job placement and job retention of placements

Sites have designated CPP contacts to facilitate assisting contractors to

make qualified hires and to meet your CPP requirements

7

Educational Data Systems Incorporated

Keystone Mercy

Ameri Choice

Logisticare

University of Pittsburgh Medical Center

Health Partners

Deloitte

Community Behavioral Health

Multiple County Commissions statewide

What organizations have hired individuals

through the Contractor Partnership Program?

8

What type of positions are typically filled by

CPP applicants?

Outpatient Case

Manager

Customer/Member

Service Representative

Data Entry Clerk

Help Desk Operator

Administrative Assistant

Certified Nursing

Assistants

Receptionist

Janitorial

Call Center Operator

Care Manager

Security

Outreach Coordinator

Home Health Aides

9

What are the reporting requirements for

CPP?

Within 10 days of receiving the notice to proceed, Contractors must register in the Commonwealth Workforce Development System (CWDS). In order to register the selected contractor must provide business, location and contact details by creating an Employer Business Folder for review and approval, within CWDS at HTTPS://WWW.CWDS.State.PA.US.

Contractors are required to complete and submit the PA 1540 Quarterly Employment Report Form on a quarterly basis to document the number of TANF cash assistance recipients hired for that quarter.

The form must be completed in its’ entirety and forwarded to the Contractor Partnership Program by the fifteenth day of the following month after the quarter ends. If the 15th falls on a weekend or state holiday the report is due the next business day.

A copy must also be sent to the DPW Project Officer

10

What are the reporting requirements for

CPP? Cont.

All Contractors, regardless of their contract start date, must submit the PA 1540 based on the calendar quarter. If a contract begins in the middle of a quarter the information reported will be based on activity that occurred from the contract start date through the end of the quarter.

If no activity occurred the form must be completed by stating “No Activity in this Quarter with the Contractor’s comments. This report must be signed by the entity that holds the contract with the DPW; it may not be signed by a subcontractor.

(This form will be available to be completed via CWDS in spring 2011.)

The information submitted on this report will be audited for its’ accuracy and the findings will be utilized to determine if the Contractor is meeting its’ hiring requirements as noted in the contract.

11

What are the benefits for hiring via CPP?

Contractor can utilize PA’s vast Employment & Training Network to assist in training, hiring and retention at no cost

Contractors may be eligible for tax credits for hiring individuals receiving cash assistance

It depends on the specific profile of the individual candidate

Information on tax credits can be found at: http://www.dli.state.pa.us (Search for Work Opportunity Tax Credit) or call 1-800-345-2555

http://www.dli.state.pa.us/

12

For Additional Questions and Information

PA Department of Public Welfare

Office of Income Maintenance – BETP

Contractor Partnership Program

Health & Welfare Building

7th & Forster Streets, 2nd Floor West


Phone: 1-866-840-7214





Mentor Protégé Program Submittal

The purpose of the Mentor-Protégé relationship is to enhance the capabilities of the Protégés; and to improve their ability to successfully compete for Commonwealth contracts.

Maximize DPW resources through collaborative partnerships with our contractors

Introduce capacity building support to sustain the growth of small, disadvantaged and minority and women owned enterprises

2

Stimulate the economy through small business job creation

Stimulate the transformation of a small business firm with high potential to a firm of greater capacity, i.e. one able to perform well as a prime contractor/partner and/or a subcontractor.

Generate added value in the contracting process to further support the citizens of the Commonwealth

Who is Qualified to Participate?

Mentors

• Possess favorable financial health and character

• Possess a track record of positive working

relationships with DBs which includes honoring

financial commitments to DBs , reporting

requirements and compliance with other applicable

contract conditions;

• Does not appear on the list of debarred or suspended

contractors;

• Can add value to a Protégé from lessons learned,

practical experience and professional expertise

Protégés -

• Be identified as a DB on the instant contract

• Certified as M/WBE by PA Department of General

Services

• Possess good standing as a M/WBE

• Does not appear on the list of debarred or

suspended contractors

Adopt the Mentor Protégé Program to provide a competitive advantage in your response

Appoint a staff person who will drive this initiative

internally

Mentor and protégé firms enter into a written

agreement that details the protégé’s needs and

the assistance the mentor has committed to provide.

Follow the MPP checklist outlined in the RFP

Offerors should consider development of their selected

DBs/BMWBO certified MBEs and WBEs in the following

areas:◦ Management Expertise & Product / Service Specialization

◦ Financial Management & Business Viability

◦ Capacity-Building Measures / New Emerging Markets & Sales

◦ Product / Service Technical Innovations

◦ Expanded Expertise and Service Capacity

◦ Professional Development & Training

◦ Strategic Business Practices to Sustain Growth

DPW’s Mentor-Protégé Program is designed to be a vehicle for the Protégé to become a valued business partner - an innovator within a relationship that fosters technical progress.

At a minimum, a Mentor Protégé Program Plan should

include the following information:

Name, title, phone number and email address of the

assigned staff person responsible for managing the

Mentor Protégé Program.

Name, contact person, phone number, email address

and commodity or service of selected protégé(s) that will

participate in this program.

Identification of subcontracting opportunities selected for

business mentorship related to this RFP.

Anticipated subcontracting amount for each DB/MWBE

selected.

Detailed outline of mentoring services that will be

provided to further develop the identified protégé

including a timeline and criteria for successful

completion of the mentorship program.

The Mentor and Protégé firms must have a plan that

results in promoting meaningful and sustainable gains to

the Protégé.

Written statement of agreement to provide DPW with

reports and updated information concerning the Mentor

Protégé Program on a quarterly basis.

Merry-Grace Majors

Bureau of Equal Opportunity





Questions and Responses

SW RFP#11-10

N

o.

RFP or

Agreement

Section

Question

Response

1. Appendix A,

Exhibit Z(2) &

Z(3)

Will new plans be provided preferential

auto-assignments as you did for Lehigh

Northeast to enable them to reach a

minimum enrollment threshold?

Beginning with the effective date of the Agreement, the

Department will distribute 100 percent of auto-assignees

equally among PH-MCOs new to the HealthChoices

Program in the SW Zone

This 100 percent enhanced auto-assignment will continue

for a period of three (3) months, or until each of the new

PH-MCOs reaches an auto-assignment threshold to be

determined whichever occurs first.

If after the 3-month enhanced auto-assignment period each

of the new PH-MCOs has NOT received the threshold

number of auto-assignees, the Department will distribute

ninety (90) percent of auto-assignees equally among New

PH-MCOs until each new PH-MCO has received an auto-

assignment threshold. The Department will distribute the

remaining ten (10) percent of auto-assignees among MCOs

that have operated in the SW Zone prior to this

HealthChoices Agreement period via quality-based auto-

assignment

2. General–

HealthChoices

Goals

The draft RFP included goals and

objectives in sections I-5 and IV that

were deleted from the final RFP. Could

the State describe its current

goals/objectives?

To improve access to health care services for Medical

Assistance recipients;

To improve the quality of health care available to

Medical Assistance recipients; and

To maximize opportunities to provide cost-effective

health care

N

o.

RFP or

Agreement

Section

Question

Response

3. General -pdf Several of the Appendixes are required

as part of the proposal submission, such

as Appendix K. They are provided as

pdf. Is it possible to receive these files as

Word or Excel files for completion and

submission?

Yes, Appendix K will be posted on the DGS Website as a

Microsoft Word file.

4. I-4 Please clarify what is meant by ―the

anticipated composition of the MCO

market will heavily influence this

decision‖ on how many MCOs to

negotiate with.

Primarily the size of the MA membership and their

geographic locations within the zone. We are reviewing

historic zone enrollment numbers, combined with

projections for future enrollments, to determine the

coverage patterns for the zone.

5. I-5 Does the Commonwealth anticipate

providing future rate increases to the

health plans operating in Southwest

Pennsylvania?

The Department is required by its HealthChoices Federal

Waiver to offer rates that fall within Actuarial sound ranges.

As the real costs of healthcare and MCO experience are

reviewed, HealthChoices rates are adjusted accordingly.

6. I-5 Does the Department plan to continue to

risk-adjust capitation rates using CDPS?

Yes

7. I-8 Will the Department post a list of

attendees at the Preproposal Conference

on the DGS website?

Yes

8. II For security, is it permissible to encrypt

the CDs containing the complete and

exact copies of the entire proposal?

(Encryption of CDs is standard security

procedure.)

No

9. II The draft RFP specified 12-point font

size for proposal responses. Is this still

the requirement?

Are there specific font/point

size/margins to be used in RFP

responses?

There is no specific font/point size/margins required. 12

point font is preferred. The proposals must be in a font that

can be easily read by the average individual.

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10. II

Also, please clarify that the Technical

Submittal should not include II-8. On

page 20, the Technical Submittal

description (bullet a) suggests that II-8 is

included.

Part II (page 20 of the RFP) lists the

submission types. Section II-8 is listed

twice, under item II.a. as part of the

Technical Submittal and also under item

II.b. that specifies the Disadvantaged

Business Submittal as a separately

sealed submittal. Please confirm that the

Technical Submittal is Part II, Sections

II-1 through II-7 and Section II-9.

This is a typographical error. Bullet ―a.‖ should read

―Technical Submittal, which shall be a response to RFP,

Part II, Sections II-1 through II-7 and Domestic Workforce

Utilization Certification Submittal II-9‖.

II-8 should NOT be included.

11. II-3.b.i Could the State please provide future

clarification regarding a request for the

plan’s ―Qualifications and experience as

a Fiscal Intermediary for MA or other

third party billing systems‖? How does

this apply to the MCO requirements for

this RFP?

Some of the work performed by fiscal intermediaries is

similar to work performed by HealthChoices MCOs; thus,

the Department is requesting related qualifications as an

indication of the Offerors' skills and qualifications to serve

as a HealthChoices MCO

12. II-3.c Please delete the last paragraph on

Disadvantaged Business experienced,

which seems to duplicate the

requirement of II-3.b.iv.

For Part II, Section II-3, experience in

relation to Disadvantaged Business is

asked for twice – in b.iv. under

Corporate Experience and at the end of

Section II-3. Which paragraph is

correct?

No, this is not a duplicate requirement. Section II-3 relates

to the Prior Experience of the Offeror with the exception of

II-3.b.iv. which relates to the DB program

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13. II-4.a The RFP states on page 23 that

executive management positions are

described in V.M of the draft

Agreement. The list in V.M and the list

on page 23 are not the same. Please

clarify which titles should be used in the

proposal response – the position titles on

page 23 or the position titles in Section

V.M of the draft Agreement?

The position titles on page 23 of the RFP should be used in

the proposal response.

14. II.4.a To maximize costs dedicated to medical

services and to allow a new plan to grow

to sufficient size for cost-effectiveness,

can a health plan have the same person

who meets the required qualifications,

have responsibility for more than one

executive position until the plan’s

membership warrants additional

positions.

Generally not. However, this issue can be investigated by

the Readiness team responsible for the selected offeror to

determine if an accommodation of this nature is reasonable.

Final staffing plans will be addressed during the Readiness

Review Period.

15. II-4.c The RFP requires a ―current or proposed

organizational chart.‖ Please clarify the

level of detail to be provided in this

chart. Specifically, should it only include

executive management and key

administrative positions?

The proposed or current organizational chart should include

executive management and all other administrative and line

positions that would be required to operationalize the full

proposal. As the RFP instructs on page 24, ―… must submit

a …proposed organizational chart so that a determination

can be made as to whether the overall organizational

structure reflects usual and customary business practices

consistent with other managed care programs operating in

the Commonwealth..

16. II-5 Does the page limit for the response to

each question include the required

restating of the question?

No

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17. II-5 The terms care management, case

management and care coordination are

used the in the RFP and only case

management is defined in the agreement.

Could the State please provide

definitions or clarifications for the

meaning of care management and care

coordination.

Care management is a process that incorporates case

management and care coordination. Care management,

which involves coordination of care throughout the health

care continuum, provides a whole person approach that

incorporates physical health, behavioral health and life

issues, in attempt to provide education and remove

barriers to enhance the quality of life. Within care

management is the coordination of care, which may include

but is not limited to such things as: arranging transportation,

assisting with scheduling of medical appointments,

assessing medication compliance, providing education

about medications, determining if individual has medical

equipment that is necessary to complete ADL’s and

providing information on resources that may be available in

the community. Care management is dependent on the

individual and their unique lifestyle circumstances. Because

of this, care management is defined by the needs of the

individual.

18. II-5 It states all page limits apply to response

text only and not to any additional

specifically requested documents. May

specific results beyond the specifically

requested HEDIS results or evidence of

success be included as an attachment

when necessary to support outcomes or

success statements? Can offerors provide

sample documents that help illustrate a

response such as member materials, risk

stratification documents, etc?

Yes

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19. II-5, #11 Please provide additional information

and a definition of the ―navigators‖

added to chronic care teams.

The term ―Navigator‖ is used in a number of different ways

in health care. They can be individuals employed by the

plan or a provider in the network and they typically work to

ensure coordination of care for members with complex

needs. The interventions are usually face-to-face and

include assistance with navigating complex needs due to

multiple chronic medical or behavioral health conditions. In

addition, they can help identify linkages around social

issues such as handicapped accessible housing, employment

or community support groups. Navigators have a working

knowledge of both healthcare and community resources. In

some models, the Navigators are para-professional staff and

also may perform functions such as interpreting for non-

English speaking patients or peer support for patients and

families. In other cases, they may be licensed professionals

such as CRNPs, RNs, psychologists, or social workers. The

professional level Navigators do some limited clinical

intervention when required as well as helping to develop

comprehensive treatment plans and consulting with other

practitioners in the healthcare systems such as primary care

providers or specialists. Navigators also may work on-site

at inpatient facilities or emergency departments to assist

members’ transition appropriately and effectively to

community based care.

20. II-5, #25 The Offeror is asked to provide two

examples of performance improvement

project including supporting data. Can

the examples and supporting data be

provided as attaching?

Yes

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21. II-5, #27 What aid categories are included in the

children in transition to adult care?

Please confirm that for Page 28,

Question 27, the end of the question

should read ―…that may provide less

service coverage?‖ instead of ―…that

may provider less service coverage?‖

In the majority of situations, the consumers are in categories

of assistance J (SSI) &/or PH 95 (Categorically Needy

Child w/Special Needs) These categories are not all

inclusive, but merely examples. The MCOs are responsible

to assist in the transition for any member that requires it

regardless of category of assistance.

Yes.

22. II--5 Please provide more information on the

Department's expectations for MCOs’

use of the CMS Drug Product Data File.

Current information on the

HealthChoices website indicates that ―it

is supplied for your reference and can be

used as an aid in making business

decisions.‖ Are MCOs to describe how

they will comply with the reporting

requirements for the Federal Drug

Rebate Program, or is the second part of

the question only related to the CMS

Drug Product Data File in relation to

rebate requirements?

The Department provides its managed care contractors with

the CMS Drug Product Data File in order to ensure that

MCOs:

1. Comply with the reporting requirements for the

Federal Drug Rebate Program

2. Provide MCO enrollees access to non-formulary

drugs that are covered under the MA Program when

medically necessary

3. Ensure that drugs covered by the MCO on its

formulary are covered under the MA Program and

have valid NDCs

The MCO should describe how it will use the CMS Drug

Product Data File to comply with those requirements.

23. II-5, #60 Please provide additional clarification on

what the State means by ―shift nursing

services‖. This is not defined in the

glossary of the draft agreement.

The Department is referring to home-based skilled nursing

and home health aid services in this item. ―Shift Nursing‖

is commonly used in the HealthChoices Program—denoting

that these services are often based on timed shifts of

services provided within the 24hour daily period.

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24. II-5, #63 Does the State have any regulations or

requirements for providers to accept the

Medicaid fee schedules even if they

choose to not become a plan provider?

DPW does not make requirements in non-emergent

situations. MA MCOs generally negotiate rates for required

services with non-par providers. MA-Fee for Service can be

the base rate for negotiations of payment. In emergency

situations, consistent with the provisions of 42 U.S.C.

1396u-2(b)(2)(D), the MA-MCO must limit the amount to

be paid to Non-participating Providers of Emergency

Services to no more than the amount that would have been

paid for such services under the Department’s Fee-for-

Service Program. [See HealthChoices Agreement/Section

V./A.#9 ]

25. II-6.b.ii In the case the respondent unaudited

annual 2010 financial statements

referenced by this section of the RFP

will not be available for distribution on

January 14th

2011 due to SEC

regulations, would the state accept

submission of the prior quarter’s

(September 30, 2010) unaudited

financial statements for the appropriate

entities as a substitute?

Yes

26. II-8 Will the State consider ―start-up costs‖

that are allocated to a Disadvantaged

Business part of the response for Year 1?

These start-up costs would occur in 2011

in preparation for the contract start date

of 01/01/12.

Yes, BMWBO will allow credit for startup costs, but please

note: that Prime Contractors are responsible for all costs

incurred to the DB subcontractors if for some reason the

contract is canceled or not awarded.

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27. II-8 Please clarify what form of documentary

proof that will be deemed acceptable to

support the self-certification of small

disadvantaged businesses which assert

that they meet the U.S. Small Business

Administration criteria for designation.

The RFP requires that businesses, which assert that they

meet the U.S. Small Business Administration criteria for

designation as a small disadvantaged business, must

submit:

a) Self-certification that the business meets the Small

Business Administration criteria

b) Documentary proof to support the self-certification

c) Proof of United States citizenship

d) Any relevant small disadvantaged business

certifications by other certifying entities

e) Attestation that the business has no more than 100 full-

time or full-time equivalent employees

f) Proof that their gross annual revenues are less than

$20,000,000 ($25,000,000 for those businesses in the

information technology sales or service business). A Tax

Return.

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28. II-8 Please specify if the type of relevant

small disadvantaged business

certifications by other certifying entities

is evaluated and accepted at the state or

national level. (e.g.- National Minority

Supplier Development Council, Inc.

(NMSDC), Women's Business

Enterprise National Council (WBENC),

National Association of Women's

Business Owners (NAWBO), etc.)

No, the small disadvantaged business certifications by

other certifying entities listed are not evaluated or accepted

for the DB program, but for companies that are currently

certified with the PA Unified Certification Program (PA

UCP), the National Minority Supplier Development

Council (NMSDC), or the Women's Business Enterprise

National Council (WBENC) and are a PA based company

we have an abbreviated certification application when

applying for certification as a Minority or Women Business

Enterprise.

29. III-4 It appears the RFP intended to include

text after the sentence ―Evaluation will

be based upon the following in order of

priority:‖ Could the State provide the

missing text.

What are ―the following in order of

importance‖ evaluation criteria? They

are not provided like they are with b.

Disadvantaged Business and c.

Enterprise Zone.

A Technical Amendment will be posted on the DGS

Website.

III-4 a. Criteria for Selection, Technical: Should read as

follows, ―The Issuing Office has established the weight

for the Technical Criterion for this RFP as 80% of the

total points. Evaluation will be based upon the

following in order of importance:

1. Prior Experience

2. Work Statement Questionnaire

3. Financial Condition

4. Personnel Qualifications

5. Statement of Problem

30. IV-3.b. Emergency Preparedness, when is the

bidder expected to address subsections i.

and ii.? As part of Technical Submittal

or at a later date?

As part of the Technical Submittal and as part of Readiness

Review.

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31. IV-4 Please provide clarification in regards to

the reporting requirements on page #47

as they relate to Disadvantaged Business

Participation and Enterprise Zone Small

Business Participation. Will the Prime

Contractors Quarterly Utilization

Reports submission be based on the

calendar year (CY) or the fiscal year

(FY)?

It will be based on either a calendar year or fiscal year

depending when the contract is fully executed.

32. Appendix A Will the appendices listed be provided

before or after the proposal submission?

No. Appendices listed in the draft Agreement will be

provided to selected Offerors only.

33. Appendix A

Agreement

I.B.2

A website is referenced for information

on bulletins and information. Non-

incumbent plans are not able to access

this site. Can all potential bidders be

given access to the website or have the

materials provided in a bidder’s library.

The site is

http://healthchoices.dpw.state.pa.us/.

The Department circulated applications for bidder access at

the proposer’s conference. Applications must be completed

prior to entities being granted access to the websites. If you

did not receive an application, and still wish to gain access,

please contact the project officer for this RFP.

34. Appendix A

Agreement

V

Will the State be providing prior claims

data on new members?

The Department will provide six months of claims or

encounter data for new members--if that information is

available on file. This will include members that move from

MCO to MCO, or from one MA program to another.

http://healthchoices.dpw.state.pa.us/

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35. Appendix

A

Agreement

V.A.16.a

The draft HealthChoices agreement states: The

PH-MCO must arrange for and provide services

to persons with AIDS or symptomatic HIV the

same as those provided under the Department’s

AIDS Waiver Program. Individuals enrolled in

the Department’s AIDS Waiver Program who

would not otherwise be eligible for MA, are

included in HealthChoices. The PH-MCO must

track these Members in accordance with federal

reporting requirements.

Please clarify the following:

Will the Department determine eligibility

for waiver services? If not, is the MCO

responsible for eligibility determination and

will the Department be providing additional

information on the eligibility determination

process?

Is there a waiting list for the AIDS Waiver

Program? If so, will the Department

maintain the waiting list and notify the

MCO when a slot is available for the

HealthChoices member?

If there is a waiting list, may the MCO offer

supplemental services or downward

substitution of services to persons who

would otherwise be enrolled into the waiver

in order to maintain them in the community

and avoid institutionalization?

Regarding the statement ―Individuals enrolled in

the Department’s AIDS Waiver Program who

would not otherwise be eligible for MA, are

included in HealthChoices‖. Is the Department

referring to the special income level for waiver

recipients or is there another meaning to this

statement?

The Commonwealth determines eligibility for all Waiver

programs. There is currently no ―waiting list‖ for the Aids Waiver Program

in Pennsylvania. PH-MCO can always offer benefits in excess of MA obligations

to better manage the care of various individuals.

Yes, Income levels are viewed differently for Aids Waiver

recipients.

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36. Appendix A

Agreement

V.B.2.e.

The RFP states that if the member is

currently receiving a requested service

and the PH-MCO decides to deny the

prior auth request, written notice of the

denial must be mailed to the Member at

least 10 days prior to the effective date

of the denial for continued services.

Does this 10-day rule apply to both

inpatient and outpatient?

This primarily applies to outpatient services; there would be

limited instances where it would apply to inpatient services.

37. Appendix A

Agreement

V.F.3.a

Will new plans entering the State be able

to use billboards, radio spots and other

marketing activities to let potential

members know they are a new plan in

the area?

Exhibit X of the draft Agreement (Appendix A of the RFP)

contains the HealthChoices PH-MCO guidelines for

advertising, sponsorships and outreach.

38. Appendix A

Agreement

V.F.4

What are the current language

preference trends and the current

prevalent languages in the Southwest

region?

Contracted MCOs must place mandatory tag lines on all

required member information in the following languages

other than English:

a. Spanish

b. Vietnamese

c. Cambodian

d. Russian

e. Chinese: Cantonese & Mandarin

These are the most numerous alternatives spoken statewide.

Alternative language material in ANY language or viable

alternative (i.e. Braille or audio) must be provided by MA-

MCOs when necessary through member request or DPW

directive.

In addition to the 5 most prevalent statewide language

alternatives, the SW Zone also sees a number of Polish,

Laotian and Amharic speakers

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39. Appendix A

Agreement

V.T.S

A website is referenced for information

on all the required reports. Non-

incumbent plans are not able to access

this site. Can all potential bidders be

given access to the website or have the

materials provided in a bidder’s library.

The site is

http://dpwintra.dpw.state.pa.us/healthcho

ices/custom/program/reprog/qmum/qmu

m.asp.

The Department circulated applications for access at the

preproposal conference. Applications must be completed

prior to entities being granted access to the websites. If you

did not receive an application, and still wish to gain access,

please contact the project officer for this RFP.

40. Appendix A,

Exhibit B(1)

P4P

Are the benchmarks for the twelve (12)

quality indicators specific to NCQA

HEDIS Medicaid Benchmarks, please

clarify.

Incremental Performance Improvements

- Will you be applying a "test for

statistical significance" related to

improvement in performance in addition

to incremental improvement calculation?

For the MCO Pay for Performance

Program, Benchmark Performance, if the

HEDIS rate is below the 50th percentile,

is the 25% offset only against the 1% of

the Maximum Program Payout?

Yes, quality indicators are compared to HEDIS Medicaid

benchmarks issued by NCQA.

No, incremental performance is based on percentage

point increase from previous year’s performance.

Yes, the 25% offset represents 25% of the maximum

potential payment for the measure within the Benchmark

component of the Program.

http://dpwintra.dpw.state.pa.us/healthchoices/custom/program/reprog/qmum/qmum.asp



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41. Appendix A,

Exhibit Z(2) &

Z(3)

Will there be consideration to new

MCO's for a committed # of auto-

assignments prior to the quality-based

methodology?

How will auto-assignments be

determined? Will quality-based auto-

assignment be suspended if new MCOs

enter the SW Zone?

Beginning with the effective date of the Agreement, the

Department will distribute 100 percent of auto-assignees

equally among PH-MCOs new to the HealthChoices

Program in the SW Zone

This 100 percent enhanced auto-assignment will continue

for a period of three (3) months, or until each of the new

PH-MCOs reaches an auto-assignment threshold to be

determined whichever occurs first.

If after the 3-month enhanced auto-assignment period each

of the new PH-MCOs has NOT received the threshold

number of auto-assignees, the Department will distribute

ninety (90) percent of auto-assignees equally among New

PH-MCOs until each new PH-MCO has received an auto-

assignment threshold. The Department will distribute the

remaining ten (10) percent of auto-assignees among MCOs

that have operated in the SW Zone prior to this

HealthChoices Agreement period via quality-based auto-

assignment

42. Appendix A

Exhibit DD(1)

Draft Exhibit DD(1) includes the

statement that at least one member of the

Second Level Grievance Committee will

be an MCO member; however, this has

not been the case for several years. This

statement conflicts with Exhibit

GG.C.2.c. that specifies that one

member of the Second Level Grievance

Committee be a non-employee. Please

clarify that the final version of Exhibit

DD(1) will be corrected and that Exhibit

GG is unchanged.

Yes—You are correct and the Agreement Amendments

have been revised in accordance with your inquiry.

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43. Appendix B The current full-year 2011 rates are

based on 2008 data and are effective

from July 2010 to June 2011. It appears

that the next set of rates will be based on

2009 data and would presumably be

effective from July 2011 – June 2012.

The RFP has an effective date of January

1, 2012, how does the timing of the rates

match with the contract start date?

The initial rates would be for the Jan-June 2012 time period,

and therefore be based on CY 2009 data

44. Appendix B Can the State share the average rate

increase for the Southwest region for the

past 3 rate cycles (July 2008, 2009,

2010)? If this is not possible, could the

Commonwealth provide pricing trends

used for the three periods?

The average SW increase for each agreement period is

shown below:

10-11: 3.5%

09-10: 2.2%

08-09: 0.3%

07-08: 4.4%

06-07: 6.8%

45. Appendix B Will there be more information provided

in the future rate development than was

shared with the past rate development?

Only PMPM costs are shown.

Will the State share utilization

and unit cost information?

Several efficiency adjustments

were made to the current full-

year 2011 rates. Can the State

provide additional detail

describing how these adjustments

were calculated and the

magnitude of each adjustment?

Yes. A Technical Amendment will be posted to include all

of the data sheets in the data book.

46. Appendix B In the past, were the rate ranges Mercer

developed by Mercer provided to the

MCOs in the high or low range

developed?

DPW provides contracted MA MCOs with actuarially

sound rate ranges. The ranges, as developed, are not

characterized as ―low‖ or ―high‖ by DPW. During

negotiations, MA-MCOs can make the determination

whether the offered rates are within acceptable boundaries

of the range necessary to meet their business models.

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47. Appendix B The unadjusted 2009 experience in the

RFP is for Alleghany county only. When

will the combined experience for the

other 9 counties be made available?

A Technical Amendment will be posted on the DGS

website.

Prior to posting of the technical amendment, the 2011-2012

data books can be accessed on the DPW website on the

following page:

http://www.dpw.state.pa.us/provider/healthcaremedicalassis

tance/managedcareinformation/index.htm

48. Appendix B It is stated that the ―Department will

provide an initial schedule of rates to

those Offerors preliminarily determined

to be qualified to provide services. Does

this mean we won’t get rate information

before we have to submit the RFP?

The Department has supplied significant rate information

with the RFP posting and Website. DPW does not plan to

release any further material prior to the offer submission

date.

49. Appendix B Can the State share the data used to set

the rate ranges for full-year 2012 in

Excel format?

No, the document will not be shared in Excel format.

50. Appendix B Can the State share the detailed

derivation of full-year 2012 rates from

the base data?

No

51. Appendix B Can the State provide more details on

the high cost risk pool (HCRP) such as:

Details regarding the methodology

used to re-price claims, as they are

high cost of these claims, most of

them will be a percent of billed

charges.

Will money from the pool be

distributed on a regular basis or at

the end of the policy period with a

sufficient run-out period?

What happens if the pool is under-

funded or over-funded by the end of

the policy period?

DPW reprices at the amount DPW’s FFS program would

pay. DPW plans to convert from DRGs to APR-DRGs

effective July 1, 2010.

Yes, the risk pool funding is distributed quarterly, based on

adjusted MCO experience from the previous 12 months.

Mercer prices the risk pools to cover 80% of costs in excess

to $80,000 per person per year. There is no subsequent

adjustment

http://www.dpw.state.pa.us/provider/healthcaremedicalassistance/managedcareinformation/index.htm

http://www.dpw.state.pa.us/provider/healthcaremedicalassistance/managedcareinformation/index.htm

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52. Appendix B Can the State provide more information

on the CDPS methodology and how it is

impacted by the high cost risk pool?

Mercer has adjusted the CDPS weights to account for the

limits on risk attributable to the HCRPs. CDPS is

documented on the web site of the University of California

at San Diego.

53. Appendix B References are made to Exhibits C-1 –

C-3 and D-1 – D-3. However only C-1 is

included. Can the State provide the

missing exhibits?

Yes. A Technical Amendment will be posted to the DGS

Website

54. Appendix D Please revise Appendix D per the RFP

section II to state ―four separately sealed

submittals‖ and delete the ―Cost

Submittal‖ item.

Appendix D, Cover Sheet includes a box

labeled ―Cost Submittal.‖ As there is no

Cost Submittal portion of this RFP,

should all responders insert ―N/A‖?

A Technical Amendment will be posted to the DGS

Website

Appendix D, Cover Sheet, will be revised. There is no Cost

Submittal with this procurement.

55. Appendix H It appears the top part of the Appendix H

format is misaligned. Under ―Proper

Information,‖ we assume you want the

name of our Pennsylvania entity, its

address and contact telephone number.

Under ―Reference Information‖, for

―Corporation/Company‖, we assume you

want our entity name in the state

providing the reference, and then the

―Contact Person‖ and telephone number

from the agency providing the

reference?

Appendix H will be re-formatted and posted to the DGS

Web site.

56. Appendix A;

Appendices

Are all Appendices currently available,

specifically Appendix 3b and 3f or will

these be available by November 30,

2010?

No, the Appendices are not available now and will not be

available by November 30, 2010.

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57. Misc.-Rates How is the state handling the new rates -

APR/DRG and tax assessment with the

new MCO's in the Southwest who

currently do not have contracts with

providers. Will all inpatient providers

get the 34% increase in rates for

effective date of July 1? Will this

increase be calculated in the capitation

rates to MCOs?

DPW plans to increase FFS inpatient rates by an average of

34%, effective July 1, 2010. This is subject to CMS

approval. Proposed increases vary greatly by hospital.

Any new MCOs will be phased into the additional hospital

payments when practical. All amounts will be included in

HealthChoices capitation rates for this

58. Misc. If a health plan is participating in a

HealthChoices zone currently, will the

contract for the SW be handled

separately or is it considered one

contract?

It will be handled separately.

59. Provider

Networks

How are size and capacity of Provider

Networks being assessed? Past RFPs

included a Provider Network Reporting

Form, which is not included in this RFP.

The size and capacity of Provider Networks will be assessed

during the Readiness Review Process.

The Department will be evaluating the Offeror’s response to

the Provider Network Composition and Network

Management questions in the RFP, Section II-5, and

Workstatement Questionnaire.

60. Appendix A,

Exhibit Z(2) &

Z(3)

When will the auto assignment threshold

be determined?

The auto assignment threshold will be determined after the

selection of Offerors.

61. Misc.-Staffing Can an MCO share full-time required

staff across zones if they participate in

HealthChoices elsewhere?

Final staffing decisions will be addressed during the

Readiness Review Period.

N

o.

RFP or

Agreement

Section

Question

Response

62. CPP Contractor Partnership—Is the number

of hired employees separate from other

zones of HealthChoices where the MCO

participates?

Yes, the number of hired employees is separate from the other

zones of HealthChoices where MCO’s participate. Each

individual contract will have its own specific CPP Hiring

requirement. Contractors are responsible to identify which

specific contract CPP hires are to be credited. Please note that CPP hiring requirements Offerors may have on

active (executed) contracts are taken into consideration during

scoring, but do not exempt Offerors from submitting CPP hiring

plans and numbers to be reviewed and scored on this RFP.

63. Provider

Networks

Do we need LOI/LOA’s with providers

to show commitment, or are contracted

networks required by August.

Offerors are permitted to submit LOI/LOA with providers

if they believe it will strengthen their responses on provider

network development and maintenance. However, selected

MCOs must have DPW approved provider contracts in

place, as well as Pennsylvania Department of Health

operating authority, no later than three (3) month prior to

the effective date of their HealthChoices Agreement.

64. P4P For the MCO Pay for Performance

Program, Benchmark Performance, if the

HEDIS rate is below the 50th

percentile,

is the 25% offset only against the 1% of

the Maximum Program Payout?

Please refer to the answers provided in question #43

65. RFP Contact Should Disadvantaged

Businesses/Maximizing

Participation/Contractor Partnership

Program specific questions be sent

directly to the specified contact for each

program; or sent to project officer Ms.

Cindy Clea?

These questions must be sent to the RFP Project Officer.

N

o.

RFP or

Agreement

Section

Question

Response

66. Staffing Please clarify is Executive Management

(full-time) positions are 100% dedicated

to the PA Medicaid Program vs.

Voluntary Contract and each

HealthChoices contract. Will one

management structure across these

contracts suffice?

Final staffing decisions will be addressed during the

Readiness Review Period.

67. Proposal

Submission

There is conflicting guidance regarding

the number of submittals an Offeror

must provide:

Section II, page #20 specifies

that four (4) separately sealed

submittals are required

(Technical, Disadvantaged

Business, Contractor Partnership

Program, and Mentor Protégé

Program)

Appendix D, Cover Letter of the

RFP, notates three (3) separately

sealed submittals enclosed;

however, there are five (5)

submittals listed (Technical,

Disadvantaged Business,

Contractor Partnership Program,

Mentor Protégé Program, and

cost Submittal)

The mailing labels in front of

RFP indicate five (5) submittals

(Technical, Disadvantaged

Business, Contractor Partnership

Program, Mentor Protégé

Program, and cost Submittal)

A Technical Amendment will be posted to the DGS

Website

Appendix D, Cover Sheet, will be revised.

There is no Cost Submittal with this procurement.

N

o.

RFP or

Agreement

Section

Question

Response

68. DB Does DPW require a threshold

percentage for the Disadvantaged

Business commitment? Is there a

minimum commitment?

The Commonwealth does not have a required percentage for

the DB commitment.

69. Provider

Networks

How will the Department evaluate

networks? There did not appear to be a

requirement for Geo Access Reports.

Will the Department place a higher value

to signed contracts vs. Letters of Intent,

or will they be scored equally? Please

advise how network information should

be included in the response.

The size and capacity of Provider Networks will be assessed

during the Readiness Review Process.

The Department will be evaluating the Offeror’s response to

the Provider Network Composition and Network

Management questions in the RFP, Section II-5,

Workstatement Questionnaire.

70. DB Section II-8.A.iii. 3) asks the Offeror to

include a percentage for which the

Offeror will commit to spend with Small

Disadvantaged Businesses as

subcontractors. Please clarify whether

the percentage should reflect the

commitment as a percentage of the total

contract revenue or as a percentage of

the revenue available for administrative

services to support the contract?

Percentage of the total contract.

71. RFP

Appendix D

The proposal cover sheet includes a

check-box for the inclusion of a ―Cost

Submittal.‖ However, the RFP does not

include a request for a cost submittal.

Please confirm that the Department is

not requesting a ―Cost Submittal‖.

Correct, the Department is not requesting a Cost Submittal.

72. RFP

Appendix K

Will Appendix K-HEDIS Reporting

Form (and other appendices/documents)

be provided in Word or Excel for ease of

completion?

Yes, Appendix K will be posted on the DGS Website as a

Microsoft Word file.

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