RFA ENROLLMENT ASSISTANCE PROGRAM (EAP) SERVICES FOR THE HEALTHCHOICES PROGRAM Questions & Answers

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Erin Summers
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1 General What are the top challenges experienced by DHS that the Department would like to solve with this procurement? The RFA describes the general and specific objectives of this procurement in Section IV Work Statement. General Please provide the current contractor s staffing model, including FTEs by position. The current staffing levels are not relevant to submitting a proposal for this RFP. The Applicant should propose adequate staffing so it can meet the requirements and accomplish the tasks described in the RFA. The current agreement can be accessed on the Treasury website General Are there any new requirements included in the RFA that are not a currently a responsibility of the incumbent? Offerors should submit applications based on this RFA. General Please confirm that the Applicant s price is to include costs for postage. Yes, the Applicant s price is to include costs for postage. General Please describe in detail any responsibilities related to an MA Consumer s anniversary date or annual open enrollment in general. Please include any potential mailings in this discussion. There is not an anniversary date or an annual open enrollment. MA consumers have the option to change their plan at any time. 6 General Do MA Consumers have the option of submitting paper enrollment forms? If so, please provide the number of paper enrollments processed by month for Yes. Refer to the information contained in the document provided with this Addendum. 1

2 General Do MA Consumers currently have the option to submit an enrollment online? If so, please indicate the approximate date this option became available and provide the number of on-line enrollments processed per month for Yes. Refer to the information contained in the document provided with this Addendum. I-12 Application Please confirm pdf is a Microsoft compatible format. PDF is a Microsoft compatible format. I-23 Term of Agreement Would DHS please provide an estimate of the Effective Date? The estimated effective date is May 1, II-4.A Corporate Background Please provide the names of the EQRO and the EQRO subcontractors so Applicants may verify there is no conflict of interest. The EQRO is IPRO. Subcontractors are: Innovative Business Concepts (IBC) Medisys Aqurate Health Data Management Dasher II-10 Cost Submittal, Appendix M From May to June, there was an increase of 150,000 members. Is this increase due to Medicaid expansion? Yes, this is most likely attributed to MA expansion. II-10 Cost Submittal, Appendix M Is this increase in membership expected to continue? MA eligibility is expected to continue to grow due to MA expansion. To date, there are 477,078 newly eligible individuals in HealthChoices receiving the new Adult benefit package. 2

3 II-10 Cost Submittal, Appendix M If the increase in membership is expected to continue, is the population expected to reach the 2,200,000 reflected in the cost proposal by Go-Live? If not, please revise the cost proposal to reflect the expected membership at Go-Live. The population is still estimated to reach 2,200,000 by implementation. As of September 8, 2015, the total MA population is 2,635,294 with 2,082,733 being enrolled in Physical Health Managed Care. Please note the cost submittal contains an estimate of the MA population and may increase or decrease based on the actual number (See RFA Part II, Section II-10). II-10 Cost Submittal Please provide the number of cases (households) associated with each number of members. The number of households is not relevant to submitting a response to this RFA. All mailings are to individual consumers rather than the household. II-10 Cost Submittal What is the current number of members? As of September 8, 2015, the total MA population is 2,635,294 with 2,082,733 being enrolled in Physical Health Managed Care. II-1.B Specific What is the current auto-assignment rate? 29.85%. II-1.B Specific Would DHS please provide the number of field enrollments processed by zone by month for 2015? Refer to the information contained in the document provided with this Addendum. 3

4 IV-3.A.3 Compliance Please address the apparent inconsistency between the second and third paragraphs. The second paragraph indicates that monthly fluctuations related to open enrollment activities do not constitute a significant change for amendment purposes. However, the third paragraph indicates that increases in volumes due to open enrollment activities may result in an amendment. The third paragraph is meant to address significant changes in enrollment for events such as a new line of business, such as with the implementation of Healthy PA. IV-4.G.5.a Pre Enrollment Packets Please provide the number of pre-enrollment packets mailed per month for If possible, please separate those associated with expansion activities. Refer to the information contained in the document provided with this Addendum. IV-4.G.5.a Pre Enrollment Packets Please provide the number of post-enrollment packets mailed per month for If possible, please separate those associated with expansion activities. Refer to the information contained in the document provided with this Addendum. IV-4.G.5.a Pre Enrollment Packets Do both auto-assigned MA Consumers and voluntarily enrolled individuals receive a post enrollment packet? In other words, does every MA Consumer receive an enrollment packet? Yes. All members regardless of whether they make a choice or are auto-assigned receive an enrollment packet. IV-4.G.6 HealthChoices Notices Please provide the number of each of these notices mailed by month for If possible, please separate those associated with expansion activities. Refer to the information contained in the document provided with this Addendum. IV-4.G.6 HealthChoices Notices How is the Grantee notified of MA Consumers who lose and regain eligibility? DHS sends a weekly enrollment/disenrollment file to the enrollment broker. 4

5 IV-4.H.1 MA Consumer Enrollments, PCP Selections and Plan Transfers Is the process to assign an MA Consumer a PH-MCO when the CAO worker completes an online eligibility determination currently in-place? IV-4.H.1 MA Consumer Enrollments, PCP Selections and Plan Transfers If this process is currently in place, when was it implemented? Yes. Yes. This process has been in place since the HealthChoices program was implemented in IV-5.A Performance Measures SLA Assessments Please discuss the voluntary enrollment rate calculation as impacted by those individuals that are pre-assigned to a plan and, having no desire to choose a different plan, do not contact the enrollment broker. Voluntary enrollment calculations are calculated based on the total enrollments in that given month. IV-5.A Performance Measures SLA Assessments What is the current Contractor s HealthChoices Plan PH-MCO voluntary choice rate for new enrollments? 60.15% IV-5.A Performance Measures SLA Assessments What is the current Contractor s HealthChoices Primary Care Provider (PCP) voluntary selection rate for newly determined eligible MA Consumers who selected a HealthChoices PH-MCO and PCP? 95.51% IV-6.Reports Would the Department please provide a copy of a recent monthly report generated for the program? Refer to the information contained in the document provided with this Addendum. 5

6 30 Appendix K Cost Submittal Please indicate if the average monthly call volume of 50,000 and average call time 6.4 minutes includes IVR answered calls for both statistics? No, it does not include IVR answered calls Appendix P Calls Report Please clarify the difference between IVR incoming calls and Calls Received? IVR incoming calls are the calls that come into the interactive voice response system. Calls received are those calls that enter the queue. Appendix P Calls Report Is calls received synonymous with calls answered by a live agent? No. Calls received are those calls that enter a queue. Appendix P Calls Report Is the average talk time calculated only based on live answer calls or is this calculation impacted by IVR calls? If IVR calls are included in the calculation, would the Department separately provide the length of live answer calls? Yes. Average talk time is only applicable to live answer calls. II-3 It is our understanding that a GANTT chart is to be provided with our response to the Work Plan requirement. Should Applicants include a GANTT Chart within the response to section IV-4 Tasks, or can it be attached as an Appendix to the RFA response. Either approach is acceptable. II.5, A.4-5 Must job descriptions for the Implementation Team be included in addition to EAP project staff? Yes, unless they are Key Personnel; then a resume is required. 6

7 Part II The instructions in Part II of the RFA, specifically in Part II-3 Work Plan, indicate that Applicants should use the task descriptions in Part IV of the RFA as a reference point for responding to the required tasks. They also indicate that Applicants should respond to Part IV, Section IV-5 Service Level Agreements. Will the Department please clarify if Applicants are required to respond to all of section IV, or only Sections IV-4 Tasks and IV-5 Service Level Agreements? For example, are Applicants required to respond to IV-1 Objectives, IV-2 Nature and Scope of the Project, IV-3 General Requirements, IV-6 Reports and Project Control, and IV-7 Small Diverse Business Participation Requirements? Part II-3 Work Plan should address all tasks and requirements for the Project as set forth in RFA Part IV. Further, Applicants must respond to all sections of the RFA as outlined in RFA Part II. For example, an Offeror should not include its response to IV-7 Small Diverse Business in its Part II-3 Work Plan response. IV-4.A What is the current Go-Live Date? The Department anticipates that the Effective Date of the agreement will be May 1, 2016 and that the selected Offeror will start providing services to MA consumers on August 1, 2016 after the readiness review completion. IV-4 D.1.c The RFA states The selected Applicant s telecommunication capabilities shall include: Contractor automated data files. Please clarify what is meant by Contractor automated data files with regard to the telecommunications system. Data should be readily available from the telecommunications system and provided in an automated fashion. IV-4, E.5 Will the Department provide clarification on procedure item b Process for coordinating MA Consumer eligibility with the PH-MCOs? The vendor does not control eligibility. Pending weekly enrollment files are sent from the Enrollment Broker to the plans. The selected Offeror must coordinate with the MCOs regarding the information exchanged and outreach activities to consumers. 7

8 40 RFA ENROLLMENT ASSISTANCE PROGRAM (EAP) SERVICES FOR THE HEALTHCHOICES PROGRAM IV-4, L.1.b Please clarify if it is acceptable for sample training materials to be included as an attachment to our Technical Submittal. Yes. 41 Cost Submittal Will the Department please provide the formula that will be used for cost scoring? 1- (B-A) x C = D A A the lowest Applicant s cost. B the Applicant s cost being scored. C the maximum number of cost points available. D Applicant s cost score (points). Note: If the formula results in a negative number (which will occur when the Applicant s cost is more than twice the lowest cost), zero points shall be assigned. 42 Appendix K Which estimate is the appropriate estimate for the number of Medicaid members, Appendix K, which shows 2,200,000 members per month, or the estimate on page 18 of 1,700,000 members per month? Page 18 has the physical health enrollment numbers prior to the MA expansion. As of September 8, 2015, the total MA population is 2,635,294 with 2,082,733 being enrolled in Physical Health Managed Care. The estimate of 2,200,000 for the Physical Health HealthChoices population is still expected by 8/1/ Appendix K Which estimate is the appropriate estimate for the average call handle time, Appendix K, which shows 6.4 minutes, or the average handle time shown in Appendix P of 6.22 minutes? Appendix K was updated to indicate a 6.22 minute estimate for the average call handle time. Refer to the Revised Appendix K provided with this Addendum. 8

9 Does the appropriate average handle time estimate (either in Appendix K of 6.4 or in Appendix P of 6.22) include a wrap time? No. This is actual handle time. Please clarify the estimated number of consumers bidders should assume Refer to the answer to Q.42. in their proposals. Appendix K (cost form) indicates 2.2 million members; however, pg 18 indicates 1.7 million. Please clarify the estimated call handle time and monthly call volume bidders should assume. Appendix K indicates 6.4 minutes and 50,000 calls; however, Appendix P indicates 6.22 minutes and 34,586 calls. Refer to the answer to Q.43. Is there an annual mailing for open enrollment? No. No open enrollment period exists. A consumer can choose at any time and change plan selections at any time. Is open enrollment anniversary driven or is it statewide during a standard Refer to the answer to Q. 47. period? Is the successful Applicant responsible for enrollments for the dual eligible population? If so, how many dual eligible members are included in the population, and when are services expected to begin? If so, will a change order/amendment be processed or are Applicants to incorporate prices in their cost proposal? No, the selected Applicant is not responsible for dual eligibles. What services/options are currently provided through the IVR? When consumers call the enrollment broker, they are given the options of Enrolling; Change a plan; Select a PCP; MCO Contact Information; and Start Date information. 9

10 Is the successful Applicant responsible for enrollments for the LTSS No. population? If so, how many LTSS members are included in the population, and are Applicants to incorporate prices into their costs? Section 2.a.v.) on page 33 of the RFA states that the applicants proposed MIS must have the capability to support interactive functions and screens for selected applicant staff to use to assist in providing choice counseling Could DHS provide copies of screen shots for the screens and functions currently used to meet this requirement? Alternatively, could the DHS provide prospective vendors some form of limited access (e.g. test environment) to the current system to allow for review of the functionality? No screen shots or access will be provided. The MIS system currently being used to support this work is proprietary to the current vendor. Please see the RFA for a list of requirements for MIS functionality. We have some advanced enrollment functionality that is not included within the scope of the RFA that we would like to include in our proposal. However, we do not want our cost or technical score adversely affected by the inclusion of additional functionality (and potential cost). Is DHS interested in advanced functionality not currently included in the scope of the RFA? May a vendor include advanced functionality as an option that would be priced separately? Would the cost of such optional functionality be excluded from the cost scoring for proposal evaluation purposes? Refer to Section I-15 Alternate Applications of the RFA. The Department will not accept alternate applications. However, if an offeror decides to include additional functionality in its proposal, it will have to include the costs of this functionality in its cost submittal. The Department cannot separately evaluate the costs of this additional functionality. Is there an opportunity to participate in the Pre-proposal conference via telephone? Remote participation to the Pre- Application Conference is not an option; please refer to the Calendar of Events and Section I-8 of the RFA. Further, your question was submitted after the conference was conducted. 10

COMMUNITY HEALTH CHOICES AND THE NEW FEDERAL MANAGED CARE RULES

COMMUNITY HEALTH CHOICES AND THE NEW FEDERAL MANAGED CARE RULES 24 th Annual Health Law Institute Pennsylvania Bar Institute March 14, 2018 Doris M. Leisch Kevin E. Hancock Edward G. Cherry Community HealthChoices