NEW MEXICO MEDICAL INSURANCE POOL REQUEST FOR PROPOSALS FOR AN EXECUTIVE DIRECTOR

Transcription

1 NEW MEXICO MEDICAL INSURANCE POOL REQUEST FOR PROPOSALS FOR AN EXECUTIVE DIRECTOR I. INTRODUCTION A. PURPOSE OF THIS REQUEST FOR PROPOSALS The New Mexico Medical Insurance Pool ( NMMIP ) seeks an Executive Director for a period of up to four years. The initial contract will be for one year beginning on January 1, 2017, but the contract may be annually renewed by the NMMIP Board for up to three more years. B. BACKGROUND NMMIP is a non-profit entity created by the New Mexico Legislature in 1987 (Sections 59A-54-1 to 59A NMSA) to offer health care coverage to New Mexico residents who are denied adequate health insurance or are considered uninsurable. All insurers (as defined in the Act) authorized to issue or provide health insurance in New Mexico are members of the Pool. Pool losses (amounts paid for services to insured minus premiums, grants, and other revenue) are covered by Pool members via a periodic assessment, as provided by the Act and the Plan of Operation. The Pool is managed by a Board of Directors ( Board ). The Board selects an administrator for the Pool through competitive bidding, supplemented by a negotiation process, if necessary. The current administrator of the Pool is Blue Cross Blue Shield of New Mexico; the administrator beginning on January 1, 2017 will be Benefits Management, Inc. The Pool currently insures about 2,800 individuals. Over the next four years, the number of insured is expected to decrease to about 1,000 individuals who are denied access to adequate health insurance (by the Exchange or in the private market) and are therefore eligible to purchase insurance from the Pool. The Board has determined that it is in the best interest of NMMIP and its Board to utilize an Executive Director, hired as an independent contractor, to enhance program efficiency, monitor performance and provide financial accountability. The Executive Director is a single person, but the scope and complexity of the tasks assigned to the Executive Director has required that the Executive Director be assisted by additional staff. It is expected that applicants will propose a staff of more than one person, with changes over the four-year period to adjust for the reduction of the number of individuals insured to approximately 1,000 persons. 1

2 C. SCOPE OF WORK The Executive Director will generally be responsible for managing the Pool under the direction of the Board of Directors. Under the guidance of the Board, the Executive Director will have responsibility for program planning, directing and coordinating the Pool and for addressing issues that arise regarding the delivery of health care coverage. This section has two sub-sections. The first describes the duties the Executive Director will be expected to perform. The second identifies 5 critical issues that NMMIP will face during the next four years. Applicants will be asked address both sub-sections in their response to this RFP. 1. Description of Duties A. Develop and Secure Roles for the Pool in the Healthcare System Works closely with the Board to identify individuals that will remain uninsurable or are denied adequate health insurance and leads the development and issuance of coverage for these individuals. Identifies individuals in the Pool who can be adequately covered by other insurance and assists them to smoothly transition to other coverage. Monitors policy-holders use of healthcare resources and recommends to the Board changes that reduce under-, or over- utilization of resources. Assists the Pool to move into roles that capitalize on the experience and expertise of the Pool. Finds ways to cover the losses of the Pool that minimizes the cost to carriers and the State of New Mexico. B. Applicant and Insured Related Responsibilities Serves as navigator for all applicants to, and all individuals insured by, the Pool, either by facilitating their enrollment or continued coverage by the Pool, or by aiming to place the applicant or individual in a public or private insurance plan that provides 1) benefits equal to or better than those offered by the Pool, 2) at the lowest cost to the insured. Promptly responds to all inquiries from applicants, brokers or the public regarding eligibility, benefits and enrollment, including research and coordination of response with the administrator and, as necessary, the Board. Promptly responds to all inquiries from individuals insured by the Pools, including research and coordination of response with the administrator and, as necessary, the Board. Coordinates and participates in broker and agent training and education. Maintains at least one office in New Mexico (although all staff do not have to be based in NM) preferably in Albuquerque to permit policy-holders to receive face-toface support and assistance from Executive Director staff. C. Public and Legislative Liaison Represents the NMMIP and its Board of Directors by direct interaction with the Office of the Superintendent of Insurance, the New Mexico legislature, various departments and organizations in the NM executive branch, insurer and provider groups, consumer organizations, CMS, and federal agencies. Performs requested communication and liaison activities with appropriate state and federal agencies and legislative bodies as directed by the NMMIP Board. 2

3 Represents NMMIP and the Board of Directors to the public, the media, the insurance industry, and other external parties, in accordance with the positions established by the NMMIP Board of Directors. Recommends and coordinates the solicitation and evaluation of a public outreach campaign including applicable media approaches, if needed. Attends appropriate sessions of the New Mexico legislature and its committees. Should the Board choose to retain a lobbyist, works closely with the lobbyist. D. Board Related Responsibilities Ensures complete and accurate implementation of Board policies and decisions, within the framework of state and national policies, rules, and guidelines. Coordinates and manages communication among the NMMIP Board members, the administrator, actuary, attorney, auditor and others. Coordinates and manages communication between the NMMIP Board and outside entities including the Office of the Superintendent of Insurance, the New Mexico Legislature, New Mexico state and federal agencies and public officials and similar pools in other states. Manages and ensures adequate resources are available for assistance to NMMIP Board members in carrying out their responsibilities. Provides information and education to the NMMIP Board regarding current health care issues. Proposes specific strategies, which may include expansion of current programs, that will result in an overall reduction in cost of administering the Pool or providing health care while maintaining a high quality of health care service delivery. Coordinates the work of the Board committees. Coordinates and manages the strategic planning functions of the NMMIP Board. Coordinates and manages all Board meetings and retreats, including securing appropriate locations for meetings, providing for food and beverages as needed, arranging for telephone or other off-site participation in meetings, taking and timely distributing accurate meeting minutes, and all other tasks required to ensure productive Board meetings and retreats. Keeps the Board of Directors informed through regular communications, Board meetings and timely analysis of NMMIP operations. Receives, on behalf of the Board, all requests for an appeal, investigating and gathering necessary documentation regarding such request, making recommendations and/or decisions for resolution as directed by the Board, and corresponding with the member regarding such decision. E. Contracting and Auditing Administers, oversees, and manages the contract between the Board and its administrator for delivery of quality services and cost-effective health care coverage. Administers, oversees and manages all other contracts entered into by the NMMIP Board for delivery of quality and cost-effective services, including preparation of RFPs when needed. Recommends and coordinates the solicitation and evaluation of new contracts to further ensure delivery of quality services and cost-effective health care coverage in accordance with the statutory charge, plan of operation and current strategic plans including, but not limited to, any services provided to similar organizations throughout the U.S. 3

4 Identifies sources of funds for the Pool, and, if the Board chooses to seek those funds, prepares applications, manages grant activities, and submits required financial and program reports. Develops, in coordination with the administrator, all application forms and routine public information materials regarding the Pool including eligibility, enrollment and benefit summaries. F. Program Evaluation Coordinates member satisfaction survey efforts including follow-up and improvement recommendations. Compares NMMIP financing and operational practices to other states high risk pools. Researches inquiries from the Board regarding program operation. Oversees the assessment process conducted by the Administrator. 2. Critical Issues The Executive Director, during the next four years, must work closely with the Board and Pool members to address at least five significant issues: Transition to a new Pool administrator; Cost to the State: as defined in the Act, Pool members assessments are offset by a tax credit. Until oil and gas tax receipts increase or new revenue is found, NM state revenue will be significantly below amounts received in past years. Elimination of the tax credit has been proposed by the Legislative Finance Committee staff. The Executive Director will need to work on this issue with the Legislature and the Governor. Affordable Care Act changes. Both major party s Presidential candidates have proposed changes in the Affordable Care Act. The Executive Director will need to ensure that the Board understands the impact of proposed changes and reacts quickly and appropriately to opportunities and threats those changes may create in NM. Reducing the number of policy-holders to those individuals who cannot otherwise obtain health insurance. Once the NM Exchange was operational and access to Medicaid was increased, the Board instructed the Executive Director to take steps to decrease the number of individuals insured by the Pool. This effort has been successful the NMMIP once covered approximately 9,800 individuals; it now covers 2,800. The Board has determined that further efforts to reduce the number of policy-holders are needed, and that the number of individuals insured by the NMMIP will likely stabilize at approximately 1,000 persons. But changes in the ACA, or within NM, could reduce that number to zero, or build the number of insured back to the previous maximum of nearly 10,000 individuals. The Executive Director will need to adjust its staff and activities, perhaps with very short notice, in response these possible changes. Universal access to high quality health care at a reasonable cost. As directed by the Board, the Executive Director will be expected to participate in efforts to secure universal access to high quality health care in NM, with special emphasis on access for persons with significant and/or costly health conditions, and for persons who are denied coverage by the Exchange and/or who cannot afford adequate health insurance. 4

5 D. SCOPE OF PROCUREMENT Following award to a successful Offeror, a written contract will be executed between the Offeror and the NMMIP. The contract will begin on January 1, It is the intent of the NMMIP that the contract shall be for an initial term of one year, with an option for up to three one-year renewals or any portion thereof. E. OFFEROR QUALIFICATIONS/CONFLICT OF INTEREST This RFP is open to an Offeror capable of performing the work described in the scope of work (Section I, Paragraph C) and meeting the mandatory specifications in Section IV, Paragraph A, Mandatory Specifications, subject to the following stipulations: Pursuant to the Governmental Conduct Act, NMSA 1978, et. seq., an Offeror will have no direct or indirect interest that conflicts with the performance of services covered under this RFP. If Offeror believes that there is a possible conflict of interest, Offeror should fully discuss the possible conflict in its response to this RfP. Pursuant to NMSA 1978, , , and , through , an Offeror may not provide or offer bribes, gratuities, or kickbacks to applicable state personnel; The burden is on the Offeror to present sufficient assurances to, and as determined by, the NMMIP that the award of the contract to the Offeror shall not create a conflict of interest; and Offerors should fully disclose whether the Offeror is able to perform the work solely or will require the assistance of contractors, sub-contractors, or other staff not directly employed by the Offeror. If contractors, sub-contractors, or other staff not directly employed by the Offeror are needed, the Offeror should include a detailed description of the qualifications of the additional staff, all costs associated with use of additional staff. F. PROCUREMENT MANAGER NMMIP has designated a Procurement Manager who is responsible for the conduct of this procurement whose name, addresses, and telephone number are listed below. Please use this address and for hand deliveries or express mail. John B Arango USPS: PO Box 889 FedEx or UPS: 1452 Highway 313 Algodones, NM Phone: (cell) jarango@nmia.com Any inquiries or requests regarding this procurement should be submitted to the Procurement Manager in writing. Offerors may contact ONLY the Procurement Manager regarding the procurement. Other NMMIP employees, board members or representatives do not have the authority to respond on behalf of the NMMIP. 5

6 G. DEFINITION OF TERMINOLOGY This section contains definitions and abbreviations that are used throughout this procurement document. Close of Business means 5:00 PM Mountain Standard or Mountain Daylight Time, whichever is in effect on the date given. CMS means the Centers for Medicare and Medicaid Services, which is part of the Federal Health and Human Services Department. CCIIO means Center for Consumer Information and Insurance Oversight, which is part of the Federal health and Human Services Department. Contract means a written agreement for the procurement of items of tangible personal property or services. Contractor means a successful Offeror who enters into a binding contract. Day means business day unless otherwise specified. Deliverable means any measurable, tangible, verifiable outcome, result, or item that must be produced to complete a project or part of a project. Determination means the written documentation of a decision by the Procurement Manager including findings of fact supporting a decision. A determination becomes part of the procurement file. Desirable The terms may, can, should, preferably, or prefers identify a desirable or discretionary item or factor (as opposed to mandatory ). Evaluation Committee means a body appointed by the NMMIP Board to perform the evaluation of Offeror proposals. Request for Proposals Committee Report means a document prepared by the Procurement Manager and the Request for Proposals Committee for submission to the NMMIP Board for contract award. It contains all written determinations resulting from the procurement. Finalist is defined as an Offeror who meets all the mandatory specifications of this RFP and whose score on evaluation factors is sufficiently high to merit further consideration by the Request for Proposals Committee. HIPAA means the Health Insurance Portability and Accountability Act. Mandatory The terms must, shall, will, is required, or are required, identify a mandatory item or factor (as opposed to desirable ). Failure to meet a mandatory item or factor will result in the rejection of the Offeror s proposal. Medicaid means the state medical assistance program in New Mexico operated by the Department through the Medical Assistance Division as authorized by the New Mexico Public Assistance Act and in compliance with the federal Social Security Act. Medical Insurance Pool Act [59A-54- NMSA 1978] means the NM statute creating and controlling the operations of the New Mexico Medical Insurance Pool. New Mexico Employee means any resident of the State of New Mexico, performing the majority of their work within the State of New Mexico, for any employer regardless of the location of the employer s office or offices. Offeror is any person, corporation, or partnership who chooses to submit a proposal. PPACA means the Patient Protection and Affordable Care Act. 6

7 Procurement Manager means the person or designee authorized by NMMIP to manage or administer a procurement requiring the evaluation of competitive sealed proposals. Project Manager means the person designated by the NMMIP to manage the contractor work effort. Request for Proposals or RFP means all documents, including those attached or incorporated by reference, used for soliciting proposals. Responsible Offeror means an Offeror who submits a responsive proposal and who has furnished, when required, information and data to prove that his financial resources, production or service facilities, personnel, service reputation and experience are adequate to make satisfactory delivery of the services or items of tangible personal property described in the proposal. Responsive Offer or Responsive Proposal means an offer or proposal which conforms in all material respects to the requirements set forth in the RFP. Material respects of an RFP include, but are not limited to, price, quality, quantity or delivery requirements. State (the State) means the State of New Mexico. Subcontract means a written agreement between a contractor and a third party, or between a subcontractor and another subcontractor, to provide services. 7

8 II. CONDITIONS GOVERNING THE PROCUREMENT This section of the RFP contains the schedule for the procurement, describes the major procurement events, and the conditions governing the procurement. A. SEQUENCE OF EVENTS The Procurement Manager will make every effort to adhere to the following schedule: Action Responsibility Date 1. Issuance of RFP NMMIP 10/27/16 2. Letter of Intent Potential Offerors 11/4/16 3. Deadline to Submit Questions Potential Offerors 11/7/16 4. Response to Written Questions /RFP Amendments Procurement Manager 11/8/16 5. Submission of Proposal Offerors 11/14/16 6. Proposal Evaluation and Selection of Finalists Request for Proposals 11/17/16 Committee 7. Interviews, if determined necessary by the Request for Proposals 11/29/16 Request for Proposals Committee Committee 8. Final Selection by Board of Directors Board of Directors 12/2/16 9. Contract Negotiation Procurement Manager 12/3-12/15/ Contract Effective Date 1/1/17 B. EXPLANATION OF EVENTS The following paragraphs describe the activities listed in the sequence of events shown in Section II: A. 1. Issuance of RFP This RFP is being issued by NMMIP. Potential Offerors may obtain a copy of the RFP from the Procurement Manager. The RFP may also be obtained from the NMMIP website at 8

9 2. Letter of Intent While a Letter of Intent is not mandatory, it is highly recommended that a Letter of Intent be submitted to the Procurement Manager indicating a potential intent to submit a proposal. Potential Offerors who submit a Letter of Intent by will be notified of all questions submitted by any Potential Offeror and answers provided by the NMMIP, as well as any changes made to the RFP. A Letter of Intent may be submitted at any time but is recommended by Nov 4, Deadline to Submit Questions Potential Offerors may submit written questions as to the intent or clarity of this RFP until Nov 7, 2016, 5:00 p.m. Mountain Time. All written questions must be ed to the Procurement Manager (see Section I, Paragraph F). Questions shall be clearly labeled and shall cite the Section(s) in the RFP, or other document that forms the basis of the question. 4. Response to Written Questions/RFP Amendments Written responses to written questions and any RFP amendments will be distributed on or about Nov 8, 2016 to all potential Offerors whose organization name appears on the procurement distribution list. The NMMIP shall make every effort to meet this timeline or provide answers as close to the deadline as possible. 5. Submission of Proposals All offeror proposals must be received for review and evaluation by the Procurement Manager or his Designee by close of business on Friday, Nov 11, 2016, as follows: One copy of the full proposal (including a copy of the signed letter of submission) should be prepared in Adobe Acrobat (.pdf) format and ed to the Procurement Manager no later than 5:00 PM Mountain time on Nov 14, If Offeror has any problem with submission, call the Procurement Manager at the (cell) phone listed in Section I, Paragraph E. The ed proposal may be a single.pdf file, or may be separate files for each required Section (see Section III, Paragraph D for the list of required sections). If a single.pdf file, it should be named (Offeror identifier)(space)(full ED 2017 Proposal), as in Smith Full ED 2017 Proposal. If separate files for each required section, each file should be named (Offeror Identifier)(space)(ED 2017)(space)(section name) as in Smith ED 2017 Desirable Specifications. Receipt of proposals will be acknowledged by . A printed copy of the full proposal including the signed letter of submission should be sent by US Postal Service to the Procurement Manager s PO Box, or by express delivery to the Procurement Manager s street address. The printed proposal must be received by close of business on Wednesday, Nov 16, Proposals received after this deadline will not be accepted. The date and time of receipt will be recorded on each proposal by the Procurement Manager. Proposals submitted by facsimile will not be accepted. 9

10 6. Proposal Evaluation and Selection of Finalists The Request for Proposals Committee will act as the Evaluation Committee for proposals submitted in response to this RFP. The initial evaluation will be completed on or about Nov 17, During this time, the Procurement Manager may initiate discussion with Offerors who submit responsive or potentially responsive proposals for clarifying aspects of the previously submitted proposals. Discussions shall not be initiated by the Offerors. 7. Interviews At the discretion of the Request for Proposals Committee, interviews may be scheduled with one or more Offeror finalist(s). Interviews will take place on or about Nov 29, Final Approval of Selected Finalist The Procurement Manager will present the recommendation of the Evaluation Committee for approval at the regularly scheduled meeting of the NMMIP Board of Directors on Dec 2, Contract Negotiation and Finalization Following approval by the Board of Directors, contract negotiations will commence with the most advantageous Offeror on or about Dec 3, If mutually agreeable terms cannot be reached within the time specified, NMMIP reserves the right to finalize a contract with the next most advantageous Offeror without undertaking a new procurement process or canceling the award. This process of moving to the next most advantageous Offeror without undertaking a new procurement may continue, at the discretion of the NMMIP, until all Offerors on the original list of finalists is exhausted. Contract negotiations are expected to be completed by Dec 17, Contract Award NMMIP will give notice of award of the contract on or about Dec 20, This date is subject to change at the discretion of the NMMIP. This contract shall be awarded to the Offeror whose proposal is most advantageous to the NMMIP, taking into consideration the evaluation factors set forth in the RFP. The most advantageous proposal may or may not have received the most points. C. GENERAL REQUIREMENTS 1. Acceptance of Conditions Governing the Procurement and Other Factors Submission of a proposal constitutes acceptance of the Evaluation Factors contained in Section IV of this RFP. 2. Incurring Cost Any costs incurred by the Offeror in preparation, transmittal, presentation of any proposal or material submitted in response to this RFP shall be borne solely by the Offeror. 3. Prime Contractor Responsibility Any contract that may result from this RFP shall specify that the prime contractor is solely responsible for fulfillment of the contract with the NMMIP. The NMMIP will make contract payments only to the prime contractor. 10

11 4. Subcontractors Use of subcontractors must be clearly explained in the proposal, and major subcontractors must be identified by name. The prime contractor shall be wholly responsible for the entire performance whether or not subcontractors are used. 5. Amended Proposals An Offeror may submit an amended proposal before the deadline for receipt of proposals. Such amended proposals must be complete replacements for a previously submitted proposal and must be clearly identified as such in the transmittal letter. NMMIP personnel will not merge, collate, or assemble proposal materials. 6. Offerors' Rights to Withdraw Proposal Offerors will be allowed to withdraw their proposals at any time prior to the deadline for receipt of proposals. The Offeror must submit a written withdrawal request signed by the Offeror's duly authorized representative addressed to the Procurement Manager. 7. Proposal Offer Firm Responses to this RFP, including proposal prices, will be considered firm for ninety (90) days after the due date for receipt of proposals or sixty (60) days after the due date for the receipt of a best and final offer, if one is solicited. 8. Disclosure of Proposal Contents The proposals will, to the extent permitted by applicable law, be kept confidential until a contract is awarded. At that time, all proposals and documents pertaining to the proposals will be open to the public, except for the material that is proprietary or confidential. The Procurement Manager will not disclose or make public any pages of a proposal on which the Offeror has stamped or imprinted proprietary or confidential subject to the following requirements. The price of products offered or the cost of services proposed shall not be designated as proprietary or confidential information Proprietary or confidential data shall be readily separable from the proposal to facilitate eventual public inspection of the non-confidential portion of the proposal. If a request is received for disclosure of data for which an Offeror has made a written request for confidentiality, the Procurement Manager shall examine the Offeror s request and make a written determination that specifies which portions of the proposal should be disclosed. Unless the Offeror takes legal action to prevent the disclosure, the proposal will be so disclosed. The proposal shall be open to public inspection subject to any continuing prohibition on the disclosure of confidential data. 9. No Obligation This procurement in no manner obligates the NMMIP to the use of any proposed professional services until a valid written contract is awarded and approved by the parties. 11

12 10. Termination This RFP may be canceled at any time and any and all proposals may be rejected in whole or in part when the NMMIP determines such action to be in the best interest of the NMMIP. 11. Legal Review The NMMIP requires that all Offerors agree to be bound by the General Requirements contained in this RFP. Any Offeror concerns must be promptly brought to the attention of the Procurement Manager. 12. Governing Law This procurement and any agreement with Offerors that may result shall be governed by the laws of the State of New Mexico. 13. Basis for Proposal Only information supplied by the NMMIP in writing through the Procurement Manager or in this RFP should be used as the basis for the preparation of Offeror proposals. 14. Contract Terms and Conditions The contract between the NMMIP and a contractor will follow the format specified by the NMMIP and contain the terms and conditions set forth in Appendix A, Sample Professional Services Contract. However, the NMMIP reserves the right to negotiate with a successful Offeror provisions in addition to those, or different than those, contained in this RFP or Appendix A. The contents of this RFP, as revised and/or supplemented, and the successful Offeror's proposal will be incorporated into and become part of the contract. 15. Offeror s Objections to Terms and Conditions Should an Offeror object to any of the NMMIP s terms and conditions, as contained in this Section or in Appendix A, that Offeror must propose specific alternative language. The NMMIP may or may not accept the alternative language. General references to the Offeror's terms and conditions or attempts at complete substitutions are not acceptable to the NMMIP and will result in disqualification of the Offeror's proposal. Offerors must provide a brief discussion of the purpose and impact, if any, of each proposed change followed by the specific proposed alternate wording. 16. Offeror s Additional Terms and Conditions Offerors must submit with the proposal a complete set of any additional terms and conditions that they expect to have included in a contract negotiated with the NMMIP. Only terms and conditions that are additional, and agreed to by the NMMIP, as evidenced by inclusion in a duly executed contract, will be included in the contract between the parties. 17. Contract Deviations Any proposed additional terms and conditions, which may be the subject of negotiation, will be discussed only between the NMMIP and the selected Offeror and shall not be deemed an opportunity to amend the Offeror's proposal. 12

13 18. Offeror Qualifications The Request for Proposals Committee may make such investigations as necessary to determine the ability of the Offeror to adhere to the requirements specified within this RFP. The Request for Proposals Committee will reject the proposal of any Offeror who is not a responsible Offeror or fails to submit a responsive offer. 19. Right to Waive Irregularities The Request for Proposals Committee reserves the right to waive irregularities. The Request for Proposals Committee also reserves the right to waive mandatory requirements provided that all of the otherwise responsive proposals fail to meet the same mandatory requirements and/or doing so does not otherwise materially affect the procurement. This right is at the sole discretion of the Request for Proposals Committee. 20. Change in Contractor Representatives The NMMIP reserves the right to require a change in contractor representatives if the assigned representatives are not, in the opinion of the NMMIP, meeting NNMIP s needs adequately. 21. Notice New Mexico criminal statutes impose felony penalties for bribes, gratuities and kickbacks. Offeror will be required to attest to their compliance with these requirements. The NMMIP is subject to the terms of the New Mexico Procurement Code ( Code ), except as otherwise provided in the Medical Insurance Pool Act. 22. NMMIP Rights The NMMIP reserves the right to accept all or a portion of an Offeror's proposal. 23. Right to Publish Throughout the duration of this procurement process and contract term, potential Offerors, Offerors, and contractors must secure from the NMMIP written approval prior to the release of any information that pertains to the potential work or activities covered by this procurement or the subsequent contract. Failure to adhere to this requirement may result in disqualification of the Offeror s proposal or termination of the contract. 24. Confidentiality Any confidential information provided to, or developed by, the contractor in the performance of services under the services agreement resulting from this RFP shall be kept confidential and shall not be published or made available to any third party individual or organization by the contractor without the prior written approval of the NMMIP. 25. Electronic Mail Address Required A large part of the communication regarding this procurement will be conducted by electronic mail ( ). Offeror must have a valid address to receive this correspondence. 26. Use of Electronic Versions of this RFP This RFP is being made available by electronic means. If accepted by such means, the Offeror acknowledges and accepts full responsibility to ensure that no changes are made to the RFP. In the event of conflict between a version of the RFP in the Offeror s possession and the version 13

14 maintained by the NMMIP, the version maintained by the NMMIP shall govern. III. RESPONSE FORMAT AND ORGANIZATION This section describes the format and organization of the Offeror's response. Failure to conform to these specifications may result in the disqualification of the proposal. A. NUMBER OF RESPONSES: Offerors shall submit one (1) proposal. B. NUMBER OF COPIES 1. Offerors shall provide one printed original and one (.pdf format) copy of their proposal to the locations specified in Section I, Paragraph E, on or before the closing date and time for receipt of proposals. See Section II, Paragraph B: 5 for submission details. Each version of the proposal shall be formatted for standard 8 ½ x 11 paper. The printed version shall be placed within a binder with tabs delineating each section. The pages should generally have one-inch margins and font size shall be no smaller than Times New Roman The Offeror shall not distribute its proposal to any entity not specified in this RFP. 3. The printed proposal must be printed on standard 8 ½ x 11 paper (larger paper is permissible for charts, spreadsheets, etc.) and placed within a binder with tabs delineating each section. The pages should generally have one-inch margins and font size shall be no smaller than Times New Roman 12. C. PROPOSAL ORGANIZATION AND ORDERING The proposal must be organized and indexed in the following format and must contain, at a minimum, all listed items in the sequence indicated: Signed Letter of Transmittal Table of Contents Executive Summary (optional) Response to Mandatory Specifications Response to Desirable Specifications Response to NMMIP Terms and Conditions Offeror's Additional Terms and Conditions Completed Cost Response Form Curriculum Vitae Within each section of their proposal, Offerors should address the items in the order in which they appear in this RFP. Do not provide any other material or attachments. If additional information is needed, Offeror(s) will be contacted by the Procurement Manager. 14

15 1. Letter of Transmittal Each proposal must be accompanied by a letter of transmittal. The letter of transmittal MUST: Identify the submitting organization Identify the name, title, telephone (land line and cell), and address of the person(s) authorized by the organization to negotiate and contractually obligate the organization Identify the names, titles, telephone and fax numbers, and addresses of persons to be contacted for clarification Explicitly indicate acceptance of the Conditions Governing the Procurement stated in Section II, Paragraph C: 1. Acknowledge receipt of all amendments to this RFP Be signed by the person authorized to contractually obligate the organization 2. Table of Contents The table of contents must contain a list of all sections of the proposal and the corresponding page numbers. 3. Executive Summary (optional) The executive summary should be no more than two (2) pages and should provide the Request for Proposals Committee with an overview of the technical and business features of the proposal. This material will not be used in the evaluation process but may be used in public notifications regarding the successful Offeror s selection. 4. Response to Mandatory Specifications The Mandatory Specifications may be found in Section IV, Paragraph A of the RfP. This section contains information required in the submission of proposals. Offerors must respond in the form of a thorough narrative to each numbered requirement in the order in which they appear in this section. The Offeror must identify the question being answered in its response to that question. 5. Response to Desirable Specifications The Desirable Specifications may be found in Section IV: B of the RFP. The information contained in this section will be key to the evaluation of proposals. Offerors must respond in the form of a thorough narrative to each numbered specification in the order in which they appear in this section. The Offeror must identify the question being answered in its response to that question. 6. Response to Terms and Conditions The Offeror shall explicitly indicate acceptance of the General Requirements (Section II, Paragraph C) and the Contract terms and conditions as set forth in Exhibit A, Scope of Work of the Sample Professional Services Contract, attached as Appendix A. As provided in Section II, Paragraph C: 15, should the Offeror object to any of the NMMIP s terms and conditions, the Offeror must propose specific alternate language. The Offeror must provide a brief discussion of the purpose and impact, if any, of each proposed change followed by the specific proposed alternate wording. If Offeror has no objections it shall so state in its response to the RFP. 7. Offeror s Additional Terms and Conditions As provided in Section II, Paragraph C: 16, should the Offeror wish to add to any of the NMMIP s terms and conditions, the Offeror must propose specific alternate language. The Offeror 15

16 must provide a brief discussion of the purpose and impact, if any, of each proposed change followed by the specific proposed alternate wording. If Offeror has no additional terms it shall so state in its response to the RFP. IV. SPECIFICATIONS & EVALUATION Unless otherwise specified, Offerors must respond in the form of a thorough narrative to each specification. Narratives should include details as to how Offeror proposes to accomplish each item. A. MANDATORY SPECIFICATIONS Failure to respond to a mandatory specification will result in the disqualification of the proposal as non-responsive. 1. Health Insurance Experience: The Offeror must have at least two staff members (including the Executive Director ) with at least three years health insurance experience. This experience may be: in commercial health insurance (as a manager of, or consultant or counsel to, an insurer, or in a state agency regulating health insurance); or In a high risk pool or in a program offering health care coverage to individuals who are denied adequate health insurance or are considered uninsurable; or in a management position in an Exchange at the state level; or in a management position in a state Medicaid program. 2. Assurances: Offeror must explicitly state that: It will have no conflicts of interest as described in Section I, Paragraph E. Its sub-contractors, if any, will have no conflicts of interest as described in Section I, Paragraph E. All records, files, data bases, and reports associated with this program are, and will remain, the property of the Board and are to be turned over without any cost to any successor Executive Director or to the Board, as directed by the Board; and will provide the Board or its designee with access to all such records during normal business hours. It will maintain at least one office in New Mexico with sufficient staff to be able to provide face-to-face assistance to applicants and support to policyholders. B. DESIREABLE SPECIFICATIONS AND EVALUATION FACTORS Offerors should understand that the Request for Proposals Committee and the Board are seeking an experienced Executive Director, and, in evaluating responses, will pay particular attention to the Offeror s experience as opposed to its paper qualifications. 1. Organization (10 points) Briefly describe the history of your organization, including its tax status. Has your organization or one of its components ever filed for bankruptcy, been the subject of a) a formal complaint by a job applicant or employee, or b) a regulatory action by a local, state or federal agency? If yes, describe the nature of the complaint or action and how the matter was closed. 16

17 List all other clients, contracts and/or projects that will be in force in 2017 or later, and briefly describe the role your organization carries out for each client, contract or project. Identify the clients (with contact information) that NMMIP may contact to obtain information about your organization s effectiveness. How many staff do you currently employ? How many of these staff will be assigned to the NMMIP Executive Director if you are the successful bidder? List all current offices in New Mexico city, physical address, number of current staff (number full-time, number part-time). Which office or offices will be used by the Executive Director? Which offices will be able to offer face-to-face assistance or support to policy-holders? Describe the facilities, methods of communication, and office equipment that will be available for use by the Executive Director in each office. If you do not have an office in New Mexico, briefly describe where the office(s) will be located, what staff will be assigned to this (these) office(s), and show the date when the office(s) will be fully operational. Describe how NMMIP information and records will be safeguarded. In particular, describe how any policy-holders health information will be protected. Describe steps the organization has and will take to protect itself and its clients from hacking or from other electronic intrusions. 2. Scope of Work: General (10 points) Name the person who will be the Executive Director (the person to be considered the Pool s Executive Director). Attach a copy of this person s curriculum vitae at the end of your application. Here, briefly describe why you believe this person has the experience to be the Executive Director. Name the second person who has the required three years of health insurance experience. Attach a copy of this person s curriculum vitae at the end of your application. Here, briefly describe why you believe this person has the experience to be a key member of the Executive Director s staff. Assume that the number of policy-holders in 2017 will be an average of 2500 individuals. Using this number, and the need to address the critical issues (Section I, Paragraph C:2), list the positions that you believe will be needed to perform the duties of the Executive Director (Section I, Paragraph C:1), and briefly describe the tasks that will be assigned to each position. For each position, indicate whether you use will use current staff or will hire new staff. If hiring, when will each position be filled? For key positions that will be filled by existing staff, name the person that will fill that position and attach his or her curriculum vitae at the end of your application. Now assume that the number of policy-holders has stabilized at Provide the same information requested in the previous paragraph. 3. Scope of Work: Description of Duties (Section I, Paragraph C:1) (20 points) For each subsection (A, B, C, etc.) briefly describe your organization s experience (and/or your proposed staff s experience) in carrying out each of the duties listed. What the RFP Committee wants to know is whether your organization has the experience to address each of the principal tasks (develop and secure roles of the Pool in the health care system, etc.). 4. Scope of Work: Critical Issues (Section I, Paragraph C:2) (20 points) For each bullet, describe what experience your organization or staff have had with these or similar issues. Describe what your organization will do to help the Board address each issue. 17

18 5. Other (0 Points) If you propose to use a sub-contractor to carry out any of the duties in the Description of Duties : a) justify the use of a sub-contractor rather than staff; b) name the organization or person you will use; c) briefly describe that organization s or person s experience, and attach his or her curriculum vitae at the end of your application. Relations with the NM Legislature and executive branch agencies. Unless you have already done so, describe here any limitations or special arrangements that will be required to carry out the tasks of informing and working with the Legislature and executive branch agencies. 6. Cost (30 points) A. The 2017 budget adopted the Board at its October, 2016 meeting projects an average of 2500 policy-holders in Prepare a one-year line item budget for the Executive Director as follows: Personnel: List each staff position (including support staff), starting with the Executive Director. Show the percent of time devoted to this project (100%=fulltime). Show the annual salary or wages to be paid for each position. Multiply the salary by the percent time to determine annual cost for each position. Add to determine total personnel cost. Benefits: List each employee benefit to be provided (and indicate which staff will receive that benefit, if all staff do not receive the same benefits); after each benefit, show the cost of that benefit as a percentage of total personnel costs. Add percentages to determine the total cost of benefits as a percent of personnel costs. Multiply by the total personnel cost amount to determine total benefits costs. Contractors: list each contract. If it has not been explained in the description of sub-contractors, above, explain each contractor s duties here. Show the cost for each contractor separately, and then add to determine total contractor cost. All other costs: List each major other cost (space, travel, communications, supplies and materials, etc.); briefly explain what is included in that item, and show the cost. Add to determine total other costs. Overhead: Explain how overhead is calculated, and the amount requested. Total: Add all cost categories to show the total cost. B. Now assume that the number of policy-holders has stabilized at 1000 policy-holders. Prepare a cost estimate using the guidelines above. C. Method of payment. Propose how you will be paid. In the past, the Pool has used the following methods: 1) per policy-holder, per month; 2) same, but transition to a different amount when the number of policy-holders increases or decreases; 3) same, but moving to a flat fee when the number of policy-holders reaches a certain number; 4) flat fee payable in 12 monthly increments. Applicants may choose any of these methods, or propose something else. (Note that the Section 2. Compensation in the model contract (Appendix A) will be modified to conform to the payment method agreed to by NMMIP and the successful Offeror). 7. References (10 points). Attach letters of reference from three other organizations that your organization is working with, or has worked with. Please inform each of them that they may be contacted by the Procurement Manager if additional information is needed. 18

19 C. EVALUATION POINT SUMMARY The following is a summary of evaluation factors with point value assigned to each. These, along with the general requirements, will be used in the evaluation of Offeror proposals. FACTOR MANDATORY SPECIFICATIONS Health Insurance Experience Assurances MAXIMUM POINTS AVAILABLE Pass/fail Pass/fail DESIRABLE SPECIFICATIONS Organization 10 Scope of Work: General 10 Scope of Work: Duties 20 Scope of Work: Critical Issues 20 Cost 30 References 10 TOTAL 100 D. EVALUATION PROCESS The evaluation process will follow the steps listed below: 1. All Offeror proposals will be reviewed for compliance with the mandatory requirements stated within the RFP. Proposals deemed non-responsive will be eliminated from further consideration. 2. The Procurement Manager may contact the Offeror for clarification of the response as specified in Section II, Paragraph B: The Request for Proposals Committee may use other sources of information to perform the evaluation as specified in Section II, Paragraph C: Responsive proposals will be evaluated on the factors that have been assigned a point value. The responsible Offerors with the higher scores will be selected as finalist Offerors based upon the proposals submitted. 5. Finalist Offerors who are asked or choose to submit revised proposals for the purpose of obtaining best and final offers will have their points recalculated accordingly. 6. The responsible Offeror whose proposal is most advantageous to the NMMIP, taking into consideration the evaluation factors, will be recommended for contract award as specified in Section II, Paragraph B: 8. Please note, however, that a serious deficiency in the response to any one factor may be grounds for rejection regardless of overall score. 7. The NMMIP Board will select in final Offeror and authorize a member of the Board to begin negotiations with the final Offeror as discussed in Section II, Paragraphs B: 8 and The contract will be awarded per Section II, Paragraph B:

20 APPENDIX A Contract Terms and Conditions NEW MEXICO MEDICAL INSURANCE POOL Sample PROFESSIONAL SERVICES CONTRACT This Professional Services Contract (PSC) is made and entered into by and between the New Mexico Medical Insurance Pool, hereinafter referred to as the "NMMIP", and NAME OF CONTRACTOR, hereinafter referred to as the "Contractor", and is effective as of the date set forth below. IT IS MUTUALLY AGREED BETWEEN THE PARTIES: 1. Scope of Work A. The Contractor shall provide legal work and services normally performed by in-house counsel of a corporation, as requested by the Board and including, but not limited to: advice and counsel as to the NMMIP Act, New Mexico Insurance Code, New Mexico Procurement Code, the Patient Protection and Affordable Care Act (PPACA), the Health Insurance Portability and Accountability Act (HIP AA), Medicare statutes and regulations, assistance and advocacy in NMM IP dealings with the Centers for Medicare & Medicaid Services ("CMS"), Center for Consumer Information and Insurance Oversight ("CCIIO") and other state and federal agencies. Required legal service includes attendance at all NMMIP Board and relevant Committee meetings, representing the NMMIP's interest in federal and state lawsuits, audits and evaluations, procurement and contract negotiations and any legal matters regarding the NMMIP operations. 2. Compensation A. The NMMIP shall pay to the Contractor in full payment for services satisfactorily performed rat the rate of _dollars($ ) per hour (OR BASED UPON DELIVERABLES, MILESTONES, BUDGET, ETC.] such compensation not to exceed (AMOUNT), including gross receipts tax. This amount is a maximum and not a guarantee that the work assigned to be performed by the Contractor under this PSC shall equal the amount stated herein. The New Mexico gross receipts tax levied on the amounts payable under this PSC shall be paid by the Contractor. The parties do not intend for the Contractor to continue to provide services without compensation when the total compensation amount is reached. The Contractor is responsible for notifying the NMMIP when the services provided under this PSC reach the total compensation amount. In no event will the Contractor be paid for services provided in excess of the total compensation amount without this PSC being amended in writing prior to those services in excess of the total compensation amount being provided. B. The Contractor must submit a statement accounting for all services performed and expenses incurred. If the NMMIP finds that the services are not acceptable, within thirty (30) days after the date of receipt of written notice from the Contractor that payment is 17

21 requested, it shall provide the Contractor a letter of exception explaining the defect or objection to the services, and outlining steps the Contractor may take to provide remedial action. Upon certification by the NMMIP that the services have been received and accepted, payment shall be tendered to the Contractor within thirty (30) days after the date of acceptance. If payment is made by mail, the payment shall be deemed tendered on the date it is postmarked. However, the NMMIP shall not incur late charges, interest, or penalties for failure to make payment within the time specified herein. 3. Term This PSC shall be for an initial two-year term, commencing on January 1, 2017 and terminating on December 31, 2018 unless terminated pursuant to Paragraph 4 (Tennination). This PSC may be renewed for two additional one-year periods. 4. Termination A. Termination. This PSC may be terminated by either of the parties hereto upon written notice delivered to the other pa1iy at least thirty (30) days prior to the intended date of tennination. Except as otherwise allowed or provided under this PSC, the NMMIP' s sole liability upon such termination shall be to pay for acceptable work performed prior to the Contractor's receipt of the notice of termination, if the NMMIP is the terminating party, or the Contractor's sending of the notice of termination, if the Contractor is the terminating party; provided however, that a notice of termination shall not nullify or otherwise affect either party's liability for pre- termination defaults under or breaches of this PSC. The Contractor shall submit an invoice for such work within thirty (30) days of receiving or sending the notice of tennination. B. Te1mination for Cause. Notwithstanding the foregoing, this PSC may be terminated immediately for cause upon written notice to the Contractor. Cause includes, but is not limited to: 1. Contractor furnishes any statement or representation in connection with this PSC which is materially false or deceptive; or 11. Contractor fails to perform to the NMMIP's reasonable satisfaction any material requirement of the PSC or violates any specific provisions of the PSC; or m. The NMMIP determines that satisfactory performance of the PSC is substantially endangered or that unsatisfactory performance or a default is reasonably foreseeable; or 1v. Contractor ceases to be a licensed New Mexico attorney; or v. Contractor becomes unable to perform the services contracted for; or v1. Contractor or any of its officers, employees or agents is indicted for fraud, embezzlement or other crime due to misuse of funds. THIS PROVISION IS NOT EXCLUSIVE AND DOES NOT WAIVE NMMIP OTHER LEGAL RIGHTS AND REMEDIES CAUSED BY THE CONTRACTOR'S DEFAULT/BREACH OF THIS PSC. 18

22 C. Termination Management. Immediately upon receipt by either the NMMIP or the Contractor of notice of termination of this PSC, the Contractor shall: 1) not incur any further obligations for salaries, services or any other expenditure of funds under this PSC without written approval of the NMMIP; 2) comply with all directives issued by the NMMIP in the notice of termination as to the performance of work under this PSC; and 3) take such action as the NMMlP shall direct for the protection, preservation, retention or transfer of all property titled to the NMMIP and records generated under this PSC. Any nonexpendable personal property or equipment provided to or purchased by the Contractor with contract funds shall become property of the NMMIP upon termination and shall be submitted to the NMMIP as soon as practicable. 5. Status of Contractor The Contractor and its agents and employees are independent contractors performing professional services for the NMMIP and are not employees of NMMIP. The Contractor and its agents and employees shall not accrue leave, retirement, insurance, bonding, use of state vehicles, or any other benefits afforded to employees of the NMMIP as a result of this PSC. The Contractor acknowledges that all sums received hereunder are rep01table by the Contractor for tax purposes, including without limitation, self-employment and business income tax. The Contractor agrees not to purport to bind NM MI P unless the Contractor has express written authority to do so, and then only within the strict limits of that authority. 6. Assignment The Contractor shall not assign or transfer any interest in this PSC or assign any claims for money due or to become due under this PSC without the prior written approval of the NMMIP. 7. Subcontracting The Contractor shall not subcontract any portion of the services to be performed under this PSC without the prior written approval of the NMMIP. 8. Release Final payment of the amounts due under this PSC shall operate as a release of the NMMIP, its officers and employees from all liabilities, claims and obligations whatsoever arising from or under this PSC. 9. Confidentiality Any confidential information provided to or developed by the Contractor in the performance of this PSC shall be kept confidential and shall not be made available to any individual or organization by the Contractor without the prior written approval of the NMMIP. 19

23 10. Conflict of Interest; Governmental Conduct Act The Contractor warrants that it presently has no interest and shall not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance or services required under the PSC. The Contractor certifies that the requirements of the Governmental Conduct Act, Sections through , NMSA 1978, regarding contracting with a public officer or state employee or former state employee have been followed. 11. Amendment A. This PSC shall not be altered, changed or amended except by instrument in writing executed by the parties hereto and all other required signatories. B. If the NMMIP proposes an amendment to the PSC to unilaterally reduce funding due to budget or other considerations, the Contractor shall, within thirty (30) days of receipt of the proposed Amendment, have the option to terminate the PSC, pursuant to the termination provisions contained herein, or to agree to the reduced funding. 12. Merger This PSC incorporates all the agreements, covenants and understandings between the parties hereto concerning the subject matter hereof, and all such covenants, agreements and understandings have been merged into this written PSC. No prior agreement or understanding, oral or otherwise, of the parties or their agents shall be valid or enforceable unless embodied in this PSC. 13. Penalties for violation of law The Procurement Code, Sections through , NMSA 1978, imposes civil and criminal penalties for its violation. In addition, the New Mexico criminal statutes impose felony penalties for illegal bribes, gratuities and kickbacks. 14. Equal Opportunity Compliance In addition to the provisions concerning non-discrimination set forth in Section 29, Non Discrimination, the Contractor agrees to abide by all federal and state laws and rules and regulations, and executive orders of the Governor of the State of New Mexico, pertaining to equal employment opportunity. In accordance with all such laws of the State of New Mexico, the Contractor assures that no person in the United States shall, on the grounds of race, religion, color, national origin, ancestry, sex, age, physical or mental handicap, or serious medical condition, spousal affiliation, sexual orientation or gender identity, be excluded from employment with or participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity performed under this PSC. If the Contractor is found not to be in compliance with these requirements during the life of this PSC, the Contractor agrees to take appropriate steps to correct these deficiencies. 20

24 15. Applicable Law The laws of the State of New Mexico shall govern this PSC, without giving effect to its choice of law provisions. Venue shall be proper only in a New Mexico court of competent jurisdiction. By execution of this PSC, the Contractor acknowledges and agrees to the jurisdiction of the courts of the State of New Mexico over any and all lawsuits arising under or out ofany term of this PSC. 16. Records The Contractor shall maintain a complete file of records, documents, communications and other materials, including time and expenditure records, pertaining to the delivery of services under this PSC. All files shall be maintained by the Contractor for a period of three years from the final payment of services under this PSC. In the event of tennination for cause, or otherwise, all files held by the Contractor relating to this PSC shall be forwarded to the NMMIP upon request. The records shall be subject to inspection by the NMMIP. The NMMIP shall have the right to audit billings both before and after payment. Payment under this PSC shall not foreclose the right of the NMMIP to recover excessive or illegal payments. 17. Indemnification The Contractor shall defend, indemnify and hold harmless the NMMIP from all actions, proceeding, claims, demands, costs, damages, attorneys' fees and all other liabilities and expenses of any kind from any source which may arise out of the performance of this PSC, caused by the negligent act or failure to act of the Contractor, its officers, employees, servants, subcontractors or agents, or if caused by the actions of any client of the Contractor resulting in injury or damage to persons or property during the time when the Contractor or any officer, agent, employee, servant or subcontractor thereof has or is performing services pursuant to this PSC. In the event that any action, suit or proceeding related to the services performed by the Contractor or any officer, agent, employee, servant or subcontractor under this PSC is brought against the Contractor, the Contractor shall, as soon as practicable but no later than two (2) days after it receives notice thereof, notify the legal counsel of the NMMIP by certified mail. 18. Invalid Term or Condition If any term or condition of this PSC shall be held invalid or unenforceable, the remainder of this PSC shall not be affected and shall be valid and enforceable. 19. Enforcement of PSC A party's failure to require strict performance of any provision of this PSC shall not waive or diminish that party's right thereafter to demand strict compliance with that or any other provision. No waiver by a party of any of its rights under this PSC shall be effective unless express and in writing, and no effective waiver by a party of any of its rights shall be effective to waive any other rights. 21

25 20. Notices Any notice required to be given to either party by this PSC shall be in writing and shall be delivered in person, by courier service or by U.S. mail, either first class or ce1tified, return receipt requested, postage prepaid, as follows: To the NMMIP: Deborah Armstrong, Executive Director New Mexico Medical Insurance Pool P.O. Box 6726 Santa Fe, NM E. Palace Ave, Suite 0 Santa Fe, NM dannstrong@nmmip.org To the Contractor: Name ofcontract"or Street/PO Box Address, City, State Zip code address 21. Authority If the Contractor is other than a natural person, the individual(s) signing this PSC on behalf of the Contractor represents and warrants that he or she has the power and authority to bind the Contractor, and that no further action, resolution, or approval from the Contractor is necessary to enter into a binding contract. IN WITNESS WHEREOF, parties have executed this Contract By: NMMMIP Date:. By: Contractor Date: NM Tax ID Number 22