Written Questions and Answers Medicare Advantage UK-1871-19 Closing Date: 7/27/2018 Today s Date: 7/23/2018 No. Question Answer 1. Will data be provided to complete the provider disruption form (Form D)? If so, when can we expect this data? Not at this time due to Passive PPO 2. Can you please provide current equivalent rates Not applicable, Please provide most (full funding rates) for the in-force Medicare Supplement plan? competitive rate for MA 3. Please confirm that the plan design grid provided (UK-1871-19) are benefits requested. Please confirm that we should match these benefits as is and as stated and not to assume any Medicare Coordination of Benefits assumptions. Please do assume Medicare Coordination in that the benefits shown are for the Med Sup plus Part A and B. Match as closely as possible 4. 5. 6. 7. 8. Page 49 of the RFP, Section 7.2 Optional Services, F Coalition Strategy : Beyond UK, is there another KY Public Sector entity seriously considering joining this Coalition for 1/1/2019? What type of growth is anticipated for the Coalition? For instance, what is a realistic projection of membership in the Coalition by 1/1/2020? Would you provide the same level of census and claims data provided here for UK, of another KY Public Sector entity seriously considering the Coalition for 2019 or 2020? How much administrative autonomy would be needed for each Coalition entity? Which administrative functions would be shared amongst Coalition entities? Page 25 Evaluation Criteria Process Please explain the difference between primary and secondary scoring criteria listed. Because of timing 1-1-19 will not be applicable however there is intention for other large and small MA plans to join. This is priority for other public sector entities This number could fluctuate greatly do to the possible groups that are interested to join. Assume 5-10K in the first year. Year 2-3 could range 30 50K depending on the groups Not at this time Assume full autonomy See page 25, paragraphs 2 & 3 of Section 5.0. Written Questions and Answers Page 1 of 7
9. Page 36 Scope of Services In section 7.1, question 6-g, there is a reference to TRS. Please clarify if UK requesting 2 dedicated resources for this account? UK is not requesting 2 dedicated resources 10. 11. 12. 13. 14. 15. Pages 37, 45, 46 Scope of Services There are several references to TRS on pages 37 (question 6-g), 45 (D-11, E-5) and 46 (question E- 19). Is that reference TRS intended to be UK? If not, please provide clarification. Pages 49-50 Optional Services Section 7.2 contains several references to a potential MAPD option. We understand this is MA-only opportunity. We also understand today that UK operates the Know Your Rx coalition (carved-out) administered by Express Scripts. Please provide some information about UK s vision for an integrated MAPD plan for UK or the coalition. Page 51 Financial Offer Summary Item 1 states Please confirm that you have completed the sheet labeled MA Proposed Rates for a fullyinsured MA only plan. Please provide this attachment as we are unable to locate the document. Page 55 Financial Offer Summary, Data Reporting Please provide additional detail around the term Pharmacy Profiling. Page 70 Form D Please confirm when bidders will receive the data from the incumbent carrier to complete a provider disruption. Attachment A Plan Design Exhibit The Plan Design exhibit (Attachment A) indicates that Routine Vision and Hearing services are the only non-medicare services to be covered. The provided schedule of benefits states that the current plan covers Routine Chiropractic care, TMJ, and Oral Surgery, in addition to hearing and vision. Please confirm the currently covered services. Also, is it UK s intent to match all benefits as closely as possible? Do not consider TRS at this time The MAPD would be for smaller Public Sector Groups groups that might not be included in the Know Your Rx Coaltion. This would probably be a small percentage of the groups. Please include the financial offer i9n a separate addendum labeled Financial offer. We do not need this information At this time because of the Passive PPO this will not be required. We reserve the right to request this information prior to finalist presentations It is UK s intent to match all benefits as closely as possible 16. Census Please provide a census with Zip codes, gender, and date of birth listed for all Look for new census Friday 7-20-18 Written Questions and Answers Page 2 of 7
members, not limited to subscribers. The current census lacks a gender field. ease clarify the methodology behind the Coordination of Benefits using the three examples below. The requested plan design indicates that the benefit might coordinate based upon Example #3, however, the claims data provided indicates that the coordination is likely based upon Example #1 or # 2. Specifically, we ask the question because we would have expected the claims to be materially lower if the coordination was based upon Example #3. Example 1 The plan pays like example 1 -Medicare Pays 80% -Plan will pay remaining amount up to allowed amount and up to percentage listed on summary. In this simple scenario, the plan would pay the remaining 20% coinsurance and the member would be responsible for no out of pocket costs. 17. Example 2 -Medicare Pays 80% -Plan will pay based on remaining amount after Medicare pays (20%). Plan will then pay the percentage that is listed on the summary and apply it to the remaining amount. In this scenario, the plan would pay 80% of the remaining 20% of the charge. This would result in the member being responsible for a 4% coinsurance after both Medicare and the plan have paid. Example 3 -Medicare Pays 80% -Plan will only make payment if the amount paid by Medicare is less than what the plan would have paid if it were primary. In this scenario, the plan would have paid 80%, but because Medicare had already paid the 80%, the plan will pay nothing. Written Questions and Answers Page 3 of 7
18. 19. 20. 21. 22. Can you please confirm that the census provided in Attachment B includes all the Medicare eligible members enrolled in the University of Kentucky s Medicare Carve out Classic plan with BCBS? The census provided shows 3,361 rows and Attachment D shows 3,771 members enrolled as of May 2018. Can you please either provide a new census that is member based, provide a tier indicator on the original census provided to duplicate for Medicare eligible membership or can you please provide an explanation for the discrepancy in lives? Are members leaving the plan and seeking coverage elsewhere, etc? Can you please provide a gender indicator for each row provided in Attachment B Census? Page 45, question E.5. says, TRS Currently covers members that are eligible for Part B Medicare Coverage Only. If the University of Kentucky has members who are eligible for Medicare Part B only and would be eligible to enroll in the Medicate Advantage PPO being offered, can you please provide an indicator on the census that delineates which members are eligible for Medicare Part-B only? Are the Medicare Part-B only member s claims/enrollment data included in Attachment D? If so can you please provide a break-out between secondary paid claims and membership for members eligible for Medicare part s A&B and Medicare Part-B only? On page 51 in the RFP, question number 1 references a sheet labeled MA Proposed Rates. If the sheet was already included with the RFP attachments, please clarify where it is located. If it was not included with the RFP attachments, can you please provide the MA Proposed Rates sheet so we can fill out and comply with the RFP requirements? What is the current coordination method? a. For the Medicare eligible retirees, please confirm the current coordination of benefits New census will be available 7-20- 18. Please use the number on the new census. Included in new census TRS is not included in the RFP except as a possible coalition member in the future. Please see answer to question 12 above. We are not disclosing current Med Sup rates Please see answer to question 16 above Written Questions and Answers Page 4 of 7
23. 24. 25. methodology with Medicare that is used; COB (coordination of benefits, retiree comes out whole), MOB (maintenance of benefits, also called Carve-out and Non-duplication) or Government Exclusion (also called Medicare exclusion) basis: 1) COB Coordination of benefits/ retiree comes out whole - Calculates what the plan would have paid as sole provider and adds what Medicare pays. If the total is more than 100% of the bill, the plan pays only enough to total 100%. The retiree often pays no deductible or coinsurance. 2) MOB - maintenance of benefits or also called Carve-out and Non-duplication - Calculates the plan s payment as if there were no Medicare coverage, applies the deductibles, coinsurance and other plan limits and pays the remaining amount minus what Medicare pays. 3) Government Exclusion (also called Medicare exclusion) - Determines the total expenses covered under the plan, reduces them by Medicare benefits and then applies the deductibles, coinsurance and other plan limits. Please confirm that the intent of the RFP is to eliminate the current S.I. BCBS Medicare Carveout Classic plan and offer the national passive PPO Group Medicare Advantage Plan in its place. Question 8.1 reads, Please complete and attach Section 7.1 to provide support for your firm fixed price bid. Please confirm that section 7.1 is already provided in the RFP starting on page 35 and there is not a separate attachment needed to comply with RFP requirements. Page 7 of the RFP reads, The coalition will be open to new membership in the first plan year and Can you please clarify what you mean by open to new membership? Does this mean That is correct Please see answer to question 12 and 21 above We anticipate that new groups coming into the coalition would be underwritten to protect the integrity of other groups but we would like Written Questions and Answers Page 5 of 7
26. 27. 28. 29. 30. 31. anyone who joins the coalition will have access to the quoted MA plan at the same rate/rate caps quoted for UK? Please specify. Please confirm someone with binding authority can sign the proposal form. Please confirm that we should be sending our proposals to the following address. If the package is delivered to the front desk prior to the deadline, will it get sent to room 322 on time? We want to ensure that the package will arrive prior to the deadline. UNIVERSITY OF KENTUCKY PURCHASING DIVISION 411 LIMESTONE ROOM 322 PETERSON SERVICE BLDG. LEXINGTON, KY 40506-0005 Please advise which portions of the RFP documents are considered financial so we know exactly what to separate from technical. We assume that the rates are the only financial information but would like you to confirm. We as an Offeror can accept electronic data interface (EDI) or paper applications for enrollment but per CMS guidelines we cannot accept both. Please confirm which method of enrollment UK utilizes. There is reference to provider disruption and PGs around Network Access. Will a current provider file be provided? Section 8.4 Additional Financial Commitment - In addition to the financial offers, please propose a financial commitment to assist the University. Options may include a signing bonus, scholarships, internships, committee to hire University Graduates or a (%) percentage rebate. With this RFP being for a fully insured Medicare Advantage product regulated by the Centers for Medicare and Medicaid Services (CMS), legal has concerns regarding this request and how it would be perceived from a legal perspective (antikickbacks). Please confirm the bidder s response to not include a financial commitment will not specific interpretations of how this might be adapted. Yes, that is correct. The street address and room number are correct. If a service (such as UPS, Fed EX, etc.) is used, a confirmation signature is usually required. The Financial is everything from Section 8.0 of the RFP. For 2019 enrollment will be Paper however UK has plans to move to electronic in near future. Please see answer to question 14 Please disregard this request due to limitations from CMS. An incorrect template was used from a current non-hospital R.F.P. Written Questions and Answers Page 6 of 7
impact rating or ability to secure the contract. If UK has reviewed the anti-kickback guidance around federally regulated programs and the ability to offer additional financial commitments, can that guidance be shared? Written Questions and Answers Page 7 of 7