INVITATION TO NEGOTIATE FOR PARTICIPANT … · PARTICIPANT DOCUMENTATION AND DEPENDENT ELIGIBILITY...
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ITN No.: DMS-10/11-030 Page 1 of 63 INVITATION TO NEGOTIATE FOR PARTICIPANT DOCUMENTATION AND DEPENDENT ELIGIBILITY VERIFICATION SERVICES ITN NO.: DMS-10/11-030 RELEASE: MARCH 17, 2011 Refer ALL Inquiries to Procurement Officer: Lori L. Anderson Departmental Purchasing Department of Management Services 4050 Esplanade Way, Suite 380 Tallahassee, FL 32399-0950 Telephone: (850) 488-0510 Fax: (850) 414-8331 [email protected]
Transcript of INVITATION TO NEGOTIATE FOR PARTICIPANT … · PARTICIPANT DOCUMENTATION AND DEPENDENT ELIGIBILITY...
ITN No.: DMS-10/11-030 Page 1 of 63
INVITATION TO NEGOTIATE
FOR
PARTICIPANT DOCUMENTATION
AND DEPENDENT ELIGIBILITY
VERIFICATION SERVICES
ITN NO.: DMS-10/11-030
RELEASE: MARCH 17, 2011
Refer ALL Inquiries to
Procurement Officer:
Lori L. Anderson
Departmental Purchasing
Department of Management Services
4050 Esplanade Way, Suite 380
Tallahassee, FL 32399-0950
Telephone: (850) 488-0510
Fax: (850) 414-8331
ITN No.: DMS-10/11-030 Page 2 of 63
TABLE OF CONTENTS
SECTION 1 – INTRODUCTORY MATERIALS ........................................................................................ 4
1.01 DEFINITIONS .................................................................................................................................................................... 4 1.02 BACKGROUND ................................................................................................................................................................. 5 1.03 PURPOSE ........................................................................................................................................................................ 10 1.04 TIMELINE ...................................................................................................................................................................... 10
SECTION 2 – SPECIAL INSTRUCTIONS TO RESPONDENTS .......................................................... 11
2.01 AMENDMENTS TO THE SOLICITATION DOCUMENTS .................................................................................................... 11 2.02 QUESTIONS .................................................................................................................................................................... 11 2.03 ALTERNATE REPLIES .................................................................................................................................................... 11 2.04 SPECIAL ACCOMMODATION ......................................................................................................................................... 11 2.05 CONFIDENTIAL, PROPRIETARY OR TRADE SECRET MATERIAL ................................................................................. 11 2.06 CERTIFICATION OF DRUG-FREE WORKPLACE PROGRAM .......................................................................................... 12 2.07 DIVERSITY ..................................................................................................................................................................... 12 2.08 INAPPLICABLE PROVISIONS OF ATTACHMENT B - PUR 1001 GENERAL INSTRUCTIONS FOR RESPONDENTS .......... 12 2.09 PRICING INFORMATION – INITIAL PRICING ................................................................................................................. 12 2.10 RESPONSE SUBMITTAL .................................................................................................................................................. 13 2.11 PASS/FAIL REQUIREMENTS .......................................................................................................................................... 18 2.12 RESPONSE EVALUATION CRITERIA .............................................................................................................................. 19 2.13 NEGOTIATION PROCESS ................................................................................................................................................ 21 2.14 DISCLOSURE OF REPLY CONTENTS .............................................................................................................................. 22 2.15 SUBCONTRACTING ........................................................................................................................................................ 22
SECTION 3 – TECHNICAL SPECIFICATIONS .................................................................................... 24
3.01 SCOPE OF WORK ........................................................................................................................................................... 24 3.02 GENERAL REQUIREMENTS ........................................................................................................................................... 33 3.03 RULES AND REGULATIONS ............................................................................................................................................ 34 3.04 CONFIDENTIALITY –PROTECTED HEALTH INFORMATION, SECURITY PROTOCOL ................................................... 34 3.05 START-UP AND SERVICE IMPLEMENTATION ................................................................................................................ 35 3.06 ADMINISTRATIVE REQUIREMENTS, SPACE, EQUIPMENT & COMMODITIES ............................................................... 35 3.07 CONTRACTOR PERFORMANCE ..................................................................................................................................... 35 3.08 MONITORING METHODOLOGIES .................................................................................................................................. 36 3.09 LIQUIDATED DAMAGES ................................................................................................................................................. 36 3.10 DELIVERABLES .............................................................................................................................................................. 37
SECTION 4 – SPECIAL CONDITIONS ................................................................................................... 38
4.01 COMPLIANCE WITH LAWS ............................................................................................................................................ 38 4.02 INAPPLICABLE PROVISIONS OF ATTACHMENT A - PUR 1000 GENERAL CONTRACT CONDITIONS .......................... 38 4.03 BACKGROUND CHECK .................................................................................................................................................. 38
4.04 WORK LOCATIONS; NO OFF-SHORING OF DATA……………………………………………………………………. 38 4.05 EMPLOYMENT ELIGIBILITY VERIFICATION ................................................................................................................ 38 4.06 CONTRACT MANAGEMENT ........................................................................................................................................... 39 4.06 CONTRACT TERM .......................................................................................................................................................... 40
SECTION 5 – FORMS INSTRUCTION AND INFORMATION ............................................................ 41
ATTACHMENT 1 – RESPONDENT’S CONTACT INFORMATION ................................................................................. 42 ATTACHMENT 2 - CERTIFICATION OF DRUG-FREE WORKPLACE PROGRAM ................................................... 43 ATTACHMENT 3 - NOTICE OF CONFLICT OF INTEREST ............................................................................................ 44 ATTACHMENT 4 - NON-COLLUSION AFFIDAVIT .......................................................................................................... 45 ATTACHMENT 5 - STATEMENT OF NO INVOLVEMENT .............................................................................................. 46 ATTACHMENT 6 – BUSINESS/CORPORATE REFERENCE ........................................................................................... 47 ATTACHMENT 7 – ADDENDUM / AMENDMENT ACKNOWLEDGEMENT FORM ................................................... 48 ATTACHMENT 8 – SUBCONTRACTING ............................................................................................................................ 49 ATTACHMENT 9 – PRICE SHEET – INITIAL TERM ........................................................................................................ 50 ATTACHMENT 10 – PRICE SHEET – ADDITIONAL FEATURES ................................................................................... 51 ATTACHMENT 11 – PASS / FAIL AFFIDAVIT .................................................................................................................... 52
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ATTACHMENT 12 – COMBINED HIPAA BUSINESS ASSOCIATE AGREEMENT, ..................................................... 53 HIPAA SECURITY RULE ADDENDUM, ................................................................................................................ 53 HITECH ACT COMPLIANCE AGREEMENT ....................................................................................................... 53 AND CONFIDENTIALITY AGREEMENT ............................................................................................................. 53 ATTACHMENT 13 - APPLICATION FOR PREFERENCE AS A FLORIDA-BASED COMPANY ................................ 63
INCLUDED AS SEPARATE DOCUMENTS:
ATTACHMENT A – PUR 1000 General Contract Conditions
ATTACHMENT B – PUR 1001 General Instructions to Respondents
APPENDIX A – Eligibility Requirements
APPENDIX B – Appeals
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SECTION 1 – INTRODUCTORY MATERIALS
1.01 Definitions
A. Buyer: The entity that has released this solicitation. The “Buyer” may also be referred to
as Customer as defined in the PUR 1000 if that entity meets the definition of both terms.
B. Contract: Means the legally enforceable agreement, if any, that results from this
solicitation. The parties to the Contract will be the Department of Management Services
(the Department) and the Contractor.
C. Contractor: The Respondent who is awarded a contract as a result of this solicitation.
D. Department: The State of Florida, Department of Management Services, is referred to in
this ITN document as “the Department.”
E. Dependent: The legal spouse, natural child, adopted child, child placed in the home for
the purpose of adoption, foster child, stepchild, child for whom legal guardianship has
been established or for whom temporary custody has been court-ordered, newborn child of
a covered dependent (child must be born while dependent is covered under the plan;
newborn is eligible for up to 18 months as long as dependent remains covered) of a
subscriber.
F. Division: The Division of State Group Insurance, a division within the Department of
Management Services, that administers the State Employees’ Health Insurance Program.
The Division is primarily responsible for overseeing the performance of the Contract.
G. Employer: An entity as described in section 110.123, Florida Statutes, that is authorized
to participate in the State Group Insurance Program to provide benefits for its employees.
Employers may include State of Florida agencies and universities, water management
districts and expressway authorities, among others.
H. Health Maintenance Organization (HMO) Plan: The State group health fully-insured
plans, which are included in the State Group Insurance Program established by section
110.123(3)(b), Florida Statutes, and implemented by Chapter 60P-2, Florida
Administrative Code.
I. HIPAA: Refers to the Administrative Simplification provisions of the Health Insurance
Portability and Accountability Act of 1996 together with the provisions of the Health
Information Technology for Economic and Clinical Health Act (the HITECH Act). The
Contractor shall comply with HIPAA. Such compliance shall be required as outlined in
Attachment 12 – Combined HIPAA Business Associate Agreement, HIPAA Security
Rule Addendum, Health Information Technology For Economic and Clinical Health
(HITECH) Act Compliance Agreement and Confidentiality Agreement, which is
incorporated herein as if fully stated.
J. Preferred Provider Organization (PPO) Plan: The State group health self-insurance
plan, which is included in the State Group Insurance Program established by section
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110.123(3)(b), Florida Statutes, and implemented by Chapter 60P-2, Florida
Administrative Code.
K. Procurement Officer: See Attachment B – PUR 1001 General Instructions to
Respondents for definition.
L. Respondent: See Attachment B – PUR 1001 General Instructions to Respondents for
definition.
M. Response: See Attachment B – PUR 1001 General Instructions to Respondents for
definition.
N. State: The State of Florida and its agencies.
O. State Employees’ Group Health Insurance Program (the Program): The
comprehensive, pretax health and prescription drug plans (PPO and HMO) governed by
Chapter 60P, Florida Administrative Code, and 26 United States Code Section 125,
Cafeteria Plans.
P. Subcontract: An agreement entered into by the Contractor with any other person or
organization that agrees to perform any performance obligation for the Contractor
specifically related to securing or fulfilling the Contractor’s obligations to the Department
under the terms of the Contract resulting from this ITN.
Q. Subscriber: The health insurance plan contract holder, specifically, the employee, retiree,
COBRA participant, or surviving spouse of a deceased subscriber.
R. Timeline: The list of critical dates and actions included in Section 1.04 of this ITN.
S. Vendor Bid System: The State of Florida’s electronic procurement system which
provides access to all bid solicitations.
1.02 Background
The Program
The Division of State Group Insurance (the Division), created within the Department of
Management Services, per section 110.123, Florida Statutes, is the designated entity responsible
for administering the State Employees’ Group Health Insurance Program (the Program). The
Division is authorized to offer a comprehensive package of health insurance programs for state
employees, retirees, COBRA participants, surviving spouses of active state employees and
retirees, and eligible dependents. The benefits of this package are provided in a cost-efficient and
prudent manner, and allow state employees and retirees the option to choose health benefit plans
best suited to their individual needs.
The Program offers health insurance coverage, including hospital, medical and prescription drug
coverage, to state employees and retirees through four (4) types of health plans:
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A. Two (2) statewide self-insured Preferred Provider Organization (State Employees’ PPO)
plans
1. Standard PPO Plan (PPO Standard)
2. Health Investor Health PPO Plan (HIHP), with a Health Savings Account (HSA)
B. Two (2) fully-insured Health Maintenance Organization (HMO) plans
1. Standard HMO Plan
2. Health Investor Health HMO Plan (HIHP), with a Health Savings Account (HSA)
The HIHP option is a variation of the Standard plan with higher deductibles and different
coinsurance levels, but the covered services are the same. Active employees electing participation
in one of the HIHP plans and electing participation in the State-sponsored HSA may receive an
employer contribution into their HSA.
The Department contracts with a Third Party Administrator and a Pharmacy Benefit Manager to
administer the State Employees’ PPO plans and with five (5) HMOs to administer the fully
insured HMO plans.
Human Resource Administrator
The Department currently contracts with a human resource administrator vendor,
NorthgateArinso, to develop and maintain its human resource information system, as well as serve
customers through two service centers. State Group participants may make elections online
through the secure, web-based application, People First, built on SAP ERP 6.0 (ECC 6.0) and
powered by Netweaver 7.0.
NorthgateArinso offers an enterprise-wide suite of human resource services, including, but not
limited to, determining membership eligibility as defined in Chapter 60P, Florida Administrative
Code, and 26 United States Code Section 125, Cafeteria Plans; completing elections via phone or
processing forms; and maintaining accurate dependent eligibility documentation records.
Dependent Documentation
The People First application sends an electronic alert to the user’s homepage and generates a form
letter requesting dependent documentation when a participant registers a dependent. Participants
can either mail or fax documentation to the service center for processing. If the documentation is
acceptable, the service center attaches it to the participant’s record. If it is unacceptable, the
service center notifies the participant. The current process does not require follow-up or
monitoring to determine if documentation is sent. Consequently, dependents may remain covered,
even if documentation proving eligibility is not provided.
Enrolling and Electing Changes
The State Group health insurance plans are pretax cafeteria plans that begin January 1 of each
calendar year. Employees may enroll in coverage within 60 days of their hire date, within 31 days
of a qualifying event (60 for birth or adoption), or during the annual open enrollment held in the
fall. Employees may elect changes in coverage, provided the change is consistent with the event,
within 31 days (60 for birth, adoption or death) of a qualifying event or during the annual open
enrollment period.
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Upon termination, employees may elect within 60 days to continue coverage through COBRA
(federal rules apply) or as a retiree within 31 days, provided they meet the State of Florida
eligibility criteria of a retiree. Retirees may continue coverage, but may not re-enroll after
cancellation.
The surviving spouse of a subscriber may elect coverage within 31 days of the death of the
subscriber, provided the surviving spouse was covered at the time of subscriber’s death. The
surviving spouse may continue coverage, provided s/he does not remarry. The surviving spouse
may also elect coverage for dependents covered at the time of the subscriber’s death.
The State offers a Spouse Program benefit to two married employees of the state. They pay a
reduced premium and are subject to qualifying event rules. Upon divorce, termination or death, the
benefit ends, as the employees no longer meet eligibility requirements for the Spouse Program.
Appeals
Chapter 120, Florida Statutes, defines the appeal process applicable to challenges to decisions
made by the Department regarding the program. For enrollment and eligibility appeals, the State
provides a three-step process:
1. Level I: subscriber appeals decisions to the People First service center for research, review
and response.
2. Level II: if the Level I Appeal is unfavorable to the subscriber, s/he may appeal to the
Division for research, review and response.
3. Administrative Hearing: if the Level II Appeal is unfavorable to the subscriber, s/he may
request an administrative hearing within 21 days of receiving the Level II denial letter sent
via certified mail.
It is the intent of the Department that the Respondent provide Level I Appeals services,
including receipt, processing, issuing and documenting Level I determinations. The
Respondent must also provide the Division with support in the Level II process and the
Administrative Hearing process as detailed in Appendix B.
Statistics
A. Enrollment – The charts below present Average Program Enrollment of subscribers for FY
2009-2010:
PPO Plans
Standard HIHP Total
Coverage
Type
Contracts Dependents (1)
Contracts Dependents (2)
Total
Contracts
Total
Dependents
Total
Subscribers
Active
65,786
81,905
821
840
66,607
82,745
149,352
COBRA
594
308
3
-
597
308
905
Retirees < 65
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5,235 1,612 41 17 5,276 1,629 6,905
Medicare I(3)
15,624
-
17
-
15,641
-
15,641
Medicare II(3)
1,811
2,180
5
3
1,816
2,183
3,999
Medicare
III(3)
5,902
5,911
6
6
5,908
5,917
11,825
Total
Enrollment
94,952
91,916
893
866
95,845
92,782
188,627
HMO Plans
Standard HIHP Total
Coverage
Type
Standard Dependents (1)
HIHP Dependents (2)
Total
Contracts
Total
Dependents
Total
Subscribers
Active
73,694
101,320
434
385
74,128
101,705
175,833
COBRA
277
174 -
-
277
174
451
Retirees < 65
2,633
633
4
-
2,637
633
3,270
Medicare I(3)
3,126
-
1
-
3,127
-
3,127
Medicare II(3)
358
435
2
1
360
436
796
Medicare
III(3)
823
830 -
-
823
830
1,653
Total
Enrollment
80,911
103,392
441
386
81,352
103,778
185,130
(1) Based on average dependent count from November 2009 through June 2010.
(2) Based on average HIHP dependent count from July 2010.
(3) Medicare: I = One subscriber eligible for Medicare Parts A and B; II = At least one subscriber is eligible for Medicare
Parts A and B; III = Two subscribers eligible for Medicare Parts A and B.
Total PPO and HMO
Standard HIHP Total
Coverage
Type
Standard Dependents (1)
HIHP Dependents (2)
Total
Contracts
Total
Dependents
Total
Subscribers
Active
139,480
183,225
1,255
1,225
140,735
184,450
325,185
COBRA
871
482
3
-
874
482
1,356
Retirees < 65
7,868
2,245
45
17
7,913
2,262
10,175
Medicare I(3)
18,750
-
18
-
18,768
-
18,768
Medicare II(3)
2,169
2,615
7
4
2,176
2,619
4,795
Medicare
III(3)
6,725
6,741
6
6
6,731
6,747
13,478
Total
Enrollment
175,863
195,308
1,334
1,252
177,197
196,560
373,757
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(1) Based on average dependent count from November 2009 through June 2010.
(2) Based on average HIHP dependent count from July 2010.
(3) Medicare: I = One subscriber eligible for Medicare Parts A and B; II = At least one subscriber is eligible for Medicare
Parts A and B; III = Two subscribers eligible for Medicare Parts A and B.
B. Utilization & Costs – The charts below present medical utilization and costs for FY 2009-
2010:
PPO Plans HMO Plans
Medical Claims
Prescription
Drug Claims
Medical
Claims Prescription
Drug Claims Coverage Type Amount Paid
by State
(In Millions)
Amount Paid
by State
(In Millions)
Coverage Type Estimated
Amount Paid
by HMOs
Estimated
Amount Paid
by HMOs
(In Millions) (In Millions)
Active
Employees $473.5 $143.4
Active
Employees $584.3 $106.7
COBRA
Participants $5.5 $1.9
COBRA
Participants No Data No Data
Retirees < 65 $43.6 $15.9 Retirees < 65 $23.1 $6.7
Medicare $63.8 $91.9 Medicare $28.4 $12.5
Total $586.4 $253.1 Total $635.9 $125.9
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1.03 Purpose
As directed by section 110.12301, Florida Statutes, the Department seeks to competitively procure
a contingency-based contract for participant documentation and dependent eligibility verification
services. The Contractor will audit the dependent membership of the Program to ensure
compliance with eligibility criteria of State Group subscribers when covering dependents under
the plans. The Department also requires the Contractor to collect dependent Social Security
numbers and Medicare eligibility documentation. A description of the required services is
provided in Section 3 – Technical Specifications of this Invitation to Negotiate (ITN).
Pursuant to section 110.12301, Florida Statutes, compensation under the contract may not exceed
historical claim costs for the prior 12 months for the dependent populations disenrolled as a result
of the vendor’s services. The Division may establish up to a three-month grace period and hold
subscribers harmless for past claims of ineligible dependents. The Department shall submit budget
amendments pursuant to Chapter 216 in order to obtain budget authority necessary to expend
funds from the State Employees’ Group Health Self-Insurance Trust Fund for payments to the
vendor as provided in the contract.
1.04 Timeline
Listed below are important dates/times which actions must be taken or completed. If the
Department finds it necessary to update any of the dates/times noted, it will be accomplished by an
addendum to the solicitation. All times listed below are Eastern Standard Time.
DATE TIME
March 17, 2011 Release of Solicitation
March 24, 2011 10:00 a.m. Questions Due
March 29, 2011 Anticipated Date Answers to Questions are posted on the Vendor Bid System
April 11, 2011 3:00 p.m. Replies Due/Opening
April 25, 2011 Anticipated Posting of Notice of Ranking and Intent to
Negotiate
May 2-6, 2011 Anticipated Dates of Negotiations
May 11, 2011 Public Meeting – Recommended Award
May 18, 2011 Anticipated Posting of Intended Award on Vendor Bid System
June 2011 Anticipated Contract Start
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SECTION 2 – SPECIAL INSTRUCTIONS TO RESPONDENTS
This section serves in conjunction with Attachment B - PUR 1001 General Instructions to Respondents.
2.01 Amendments to the Solicitation Documents
The Department shall post amendments to the solicitation documents, including updates to the
timeline in Section 1.04, on the Florida Vendor Bid System (VBS) at www.myflorida.com under
the posted solicitation number. Each Respondent is responsible for monitoring the VBS for new
or changing information. No other Notice of Amendments will be provided.
2.02 Questions
Respondents shall address all questions regarding this solicitation in writing (via e-mail) to the
Procurement Officer, identified on the cover sheet of this solicitation. The Department shall post
answers to questions on VBS as noted in Section 1.04, Timeline. (See PUR 1001 - General
Instructions to Respondents, Section 21. Limitation on Vendor Contact with Agency during
Solicitation Period).
2.03 Alternate Replies
Alternate replies and exceptions to this solicitation are not permitted. If the Respondent has any
issue with the requirements or terms and conditions of this solicitation, such issues shall be
presented to the Department and addressed by the Department during the question and answer
phase of the solicitation. Including alternate replies or exceptions to this solicitation in any
response may result in the response being deemed non-responsive to the solicitation.
2.04 Special Accommodation
Any person requiring a special accommodation at Departmental Purchasing because of a disability
should call Departmental Purchasing at (850) 488-1308 at least five (5) workdays prior to the
scheduled event. If you are hearing or speech impaired, please contact Purchasing by using the
Florida Relay Service at (800) 955-8771 (TDD).
2.05 Confidential, Proprietary or Trade Secret Material
The Department takes its public records responsibilities as provided under chapter 119, Florida
Statutes and Article I, Section 24 of the Florida Constitution, very seriously. If Respondent
considers any portion of the documents, data or records submitted in response to this solicitation
to be confidential, trade secret or otherwise not subject to disclosure pursuant to chapter 119,
Florida Statutes, the Florida Constitution or other authority, Respondent must also simultaneously
provide the Department with a separate redacted copy of its response and briefly describe in
writing the grounds for claiming exemption from the public records law, including the specific
statutory citation for such exemption. This redacted copy shall contain the Department’s
solicitation name, number, and the name of the respondent on the cover, and shall be clearly titled
“Redacted Copy.” Along with the hard copy, one (1) electronic redacted copy is required.
The Redacted Copy shall be provided to the Department at the same time Respondent submits its
response to the solicitation and must only exclude or obliterate those exact portions which are
claimed confidential, proprietary, or trade secret. The Respondent shall be responsible for
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defending its determination that the redacted portions of its response are confidential, trade secret
or otherwise not subject to disclosure. Further, Respondent shall protect, defend, and indemnify
the Department for any and all claims arising from or relating to Respondent’s determination that
the redacted portions of its response are confidential, proprietary, trade secret or otherwise not
subject to disclosure. If Respondent fails to submit a Redacted Copy with its response, the
Department is authorized to produce the entire documents, data or records submitted by
Respondent in answer to a public records request for these records.
2.06 Certification of Drug-Free Workplace Program
The State supports and encourages initiatives to keep the workplaces of Florida’s suppliers and
contractors drug-free. Section 287.087, Florida Statutes, provides that, where identical tie
proposals are received, preference shall be given to a proposal received from a Respondent that
certifies it has implemented a drug-free workforce program. Respondent shall sign and submit the
attached “Certification of Drug-Free Workplace Program” form (Attachment 2) to certify that the
Respondent has a drug-free workplace program. The Contractor shall describe how it will address
the implementation of a drug-free workplace in offering the items of bid.
2.07 Diversity
Florida is a state rich in its diversity and is dedicated to fostering the continued development and
economic growth of minority, women, and/or service-disabled veteran owned businesses.
Participation of a diverse group of vendors doing business with the State is central to our effort.
To this end, it is vital that minority, women, and/or service-disabled veteran owned business
enterprises participate in the State’s procurement process as both prime contractors and
subcontractors under prime contracts. Minority, women, and/or service-disabled veteran owned
businesses are strongly encouraged to submit replies to this solicitation.
2.08 Inapplicable Provisions of Attachment B - PUR 1001 General Instructions for Respondents
The following are not applicable:
A. Section 3. Electronic Submission of Responses
Responses shall be submitted in accordance with Section 2.10 of this solicitation.
B. Section 5. Questions
Questions shall be submitted in accordance with Section 2.02 of this solicitation.
2.09 Pricing Information – Initial Pricing
A. Pricing Methodology
Initial Cost Proposal (Price Sheet) should be submitted consistent with this Section 2.09 and
in such a manner as to offer the most cost effective and innovative solutions the respondent
can offer.
Under the prospective contract, the Contractor will be paid on a contingency fee basis subject
to the following statutory limitation. Pursuant to section 110.12301(2), Florida Statutes,
compensation under the contract may not exceed historical claim costs for the prior 12
months for the dependent populations disenrolled as a result of the vendor’s services. The
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Department shall submit budget amendments pursuant to Chapter 216 in order to obtain
budget authority necessary to expend funds from the State Employees’ Group Health Self-
Insurance Trust Fund for payments to the vendor as provided in the contract.
B. Price Sheet Instruction
The Respondent shall return the Price Sheet (Attachment 9) with its response to this ITN.
The Respondent must provide the following pricing option:
Guaranteed Not-To-Exceed Fee. A fixed amount payable by the Department, subject
to the availability of funding, not-to-exceed 12 months of historical claims costs for
disenrolled dependents.
The Respondent shall print and sign the completed Price Sheet and submit in accordance
with Section 2.10, B.
Respondents should use the question and answer period to recommend an alternative pricing
structure. If an alternative pricing structure is acceptable, the Department will amend the ITN
to accommodate additional pricing scenarios.
2.10 Response Submittal
A. Response Form
Responses should be prepared simply and economically, providing a straightforward, concise
description of the Respondent’s ability to provide the solution sought by the solicitation.
Excessive information distracts readers from focusing on essentials and may operate to a
Respondent’s disadvantage. When responding to specific questions, please reprint each
question in its entirety before the response.
The response shall be limited to a page size of eight and one-half by eleven inches (8½" x
11"), unless otherwise indicated. Type size shall not be less than a 12-point font. The response
should be indexed and all pages sequentially numbered. Bindings and covers will be at the
Respondent’s discretion. Unnecessarily elaborate brochures, artwork, expensive paper and
expensive visual and other presentation aids are neither necessary nor desired. The overall
response must be written in a concise manner, which is conducive to effective evaluation and
product selection.
The Respondent may not apply any conditions to any aspect of the solicitation (see Section
2.03). The only recognized changes to the solicitation prior to the opening will be by written
amendments issued by the Department.
Respondents must submit responses to the Procurement Officer by the date and time
specified in Section 1.04 of the solicitation. The Department shall not consider late
responses.
In response to this ITN, the Respondent shall:
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1. Submit one (1) signed original version of the entire response, with five (5) hardcopies.
2. Submit six (6) searchable electronic copies of the entire response on a CD-ROM (with
large files scanned as several separate .pdf files.). In the event of differences between the
information contained on the CD-ROM and the original written version, the written
version will prevail.
3. If the Respondent believes their response contains information that is confidential, trade
secret, or otherwise not subject to disclosure, submit one (1) redacted copy of the entire
response, along with one (1) electronic redacted (if applicable) copy on a CD-ROM.
See Section 2.05 above. The information contained on the CD-ROM shall be formatted in
such a way that redactions provided on the pages of the electronic document cannot be
removed.
4. Sealed packages to be delivered shall be clearly marked on the outside of the package with
the solicitation number, company name, and the due date and time.
5. Submitted hardcopies contained within the sealed packages shall be clearly marked on the
front cover of both the original and copies, with the Respondent’s company name and
solicitation number.
B. Response Contents
The Response shall be organized with section dividers (Tabs I – V) labeled as follows and
containing the information requested below:
TAB I Respondent’s Contact Information and Attachments
TAB I shall contain a cover letter on the Respondent’s letterhead with contact information and
the name and signature of the representative of the responding organization authorized to
legally obligate the Respondent to provide the Services. The cover letter must state that the
Respondent agrees to provide the services as described in the ITN. Also, TAB I shall include
the following information:
1. Identify Respondent’s business formation (e.g., partnership, corporation), the number of
years in business and the state where the Respondent’s business is legally formed. If
Respondent is a subsidiary or affiliate also provide the name of parent organization.
2. Respondent’s federal tax identification number, as applicable to the legal entity that will be
performing as Primary Contractor under any resultant Contract.
3. Current copy of all required state and federal licenses, permits and registrations, including
but not limited to the face-sheet of the Contractor's current insurance policy coverage as
required in order to provide the services identified in this ITN.
4. Respondent’s web site address where their most recent audited financial statements may be
obtained.
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5. A description of the Respondent's organizational structure, depicting clear lines of
authority.
6. Respondent’s organizational chart outlining the hierarchy of Contractor's staff for the
Contract proposed under this ITN.
7. Respondent’s staff that will be assigned to the Contract proposed under this ITN Including
years of employment with your organization, roles and responsibilities of staff members,
their involvement in responding to this ITN, and role in providing services via the
prospective contract, and any other pertinent information.
TAB I shall also include the following attachments to this ITN:
ATTACHMENT 1 – Respondent’s Contact Information
ATTACHMENT 2 – Certification of Drug-Free Workplace Program
ATTACHMENT 3 – Notice of Conflict of Interest
ATTACHMENT 4 – Non-Collusion Affidavit
ATTACHMENT 5 – Statement of No Involvement
ATTACHMENT 7 – Addendum/Amendment Acknowledgement Form
ATTACHMENT 11 – Pass/Fail Affidavit (see Section 2.11 for additional instruction)
ATTACHMENT 12 – Combined HIPAA Business Associate Agreement, HIPAA
Security Rule Addendum, HITECH Act Compliance Agreement and Confidentiality
Agreement
ATTACHMENT 13 – Application for Preference as a Florida-Based Company
TAB II Business-Corporate Experience and Ability to Provide Services
Tab II shall contain the following information in the following order, labeled and subdivided
by tabs:
A. Similar Contracts and Services
The Respondent shall:
Demonstrate its experience and qualifications relative to the required services for
completion of a dependent eligibility audit for a large client (the Program had
196,450 dependents as of November 2010);
Provide evidence of the capacity to simultaneously audit up to 200,000 dependents
at any given time; i.e., 10 different clients with 20,000 dependents each or some
combination thereof. It is preferable that at least one of these be a public sector
client.
Identify all dependent audits executed to full completion in the last three (3) years
with public sector clients. For each project identified provide the following
information:
1. Organization name and address
2. Contact name, telephone number, and e-mail address
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3. The percentage of ineligible dependents discovered in proportion to the
covered dependent population
4. Describe how dependents removed during the course of the audit were
identified as ineligible, as opposed to those removed due to legitimate
qualifying events.
5. Identify all relevant similarities or differences to such contracts when
compared to the services sought via this ITN
6. Describe the timetable for each audit and Respondent’s adherence to the
timetable
7. Describe any significant issues that arose and resolution of the issues
8. Indicate whether a grace period was offered to ineligible dependents. If yes,
describe how grace period was implemented and its impact to audit.
B. Business/Corporate References
Using Attachment 6 to this ITN, Respondents shall provide at least three (3)
notarized references from current public sector clients, businesses or government
agencies that the Respondent has provided services of similar scope and size to the
services identified in the ITN. In addition to submitting Attachment 6, for each
reference provided, Respondents shall provide a separate, signed statement from the
entity providing the reference that describes in detail the quality of the services
provided by Respondent and how effective Respondent was in meeting its obligations
under the contract. References shall pertain to current/ongoing contracts or those that
were completed within the last 2 years. References shall not be given by:
1. Current employees of the State of Florida.
2. Persons employed by the Department of Management Services within the past three
(3) years.
3. Persons currently or formerly employed or supervised by the Respondent or its
affiliates.
4. Board members within the Respondent’s organization.
5. Relatives of any of the above.
The Procurement Officer reserves the right to contact the Respondent’s references to
verify the information was actually provided by the reference and the evaluation team
may elect to contact the references to obtain further information regarding the
Respondent’s performance. In addition, the negotiation team reserves the right to use
references other than those provided.
C. Disputes
Respondents shall identify all contract disputes Respondent (including its affiliates,
subcontractors, agents, etc.) has had with any private or public sector client within the
last five (5) years related to contracts under which Respondent has provided participant
documentation and dependent eligibility verification services or similar services sought
via this ITN. The term “contract disputes” means any circumstance involving the
performance or non-performance of a contractual obligation that resulted in: (i)
identification by the contract customer that Respondent was in default of a duty under
the contract; (ii) the issuance of a notice of default or breach; (iii) the institution of any
judicial or quasijudicial action against Respondent as a result of the alleged default or
ITN No.: DMS-10/11-030 Page 17 of 63
defect in performance; or (iv) the assessment of any fines or liquidated damages under
such contracts. Respondents must indicate whether the disputes were resolved and, if
so, explain how they were resolved.
D. Ability to Provide Services
Respondents shall provide a detailed description of the Respondent’s ability to meet
these goals and provide the services sought via this ITN.
Project Management Team: Respondent is required to have a knowledgeable,
accessible and experienced project manager and an experienced team with the
responsibility, integrity and authority to deliver the services required. Respondent must
identify specific personnel and demonstrate their qualifications as applicable to the
requirements listed.
1. Propose a project manager, along with qualifications and a job description,
who:
a. Will serve as the main point of contact with the State for planning,
problem resolution, escalated service, communications and reporting;
b. Will be available full time for the entire term of the project;
c. Will be accessible and able to provide responses in accordance with the
timeliness standards outline in Section 3.01 E., Performance
Guarantees , for the duration of the Contract;
d. Has three (3) years experience serving as a project manager for projects
of similar scope and size that demonstrate his/her qualifications;
e. Shall not be replaced without obtaining written consent from the
Department, which shall not be unreasonably withheld; and
f. Will notify the State of actual or anticipated events that might impact
the delivery of services and present options to minimize or eliminate
the impact of those events.
2. Propose a project team, along with qualifications and job descriptions, that:
a. Must be assigned full time to the Project;
b. Must each have at least one (1) year experience with Respondent’s
company performing projects of similar scope and size; and
c. Must be accessible and sufficiently staffed to provide responses in
accordance with the timeliness standards outlined in Section 3.01 E.,
Performance Guarantees.
3. Provide an organizational chart illustrating the proposed project team and
where they will be located.
If the Respondent plans to utilize subcontractors, Attachment 8 shall be
completed for each proposed subcontractor. Respondent shall also provide the
same information as requested in Tab I (G) for all subcontractors if
subcontractors will be used by Respondent to provide the services.
Respondents shall also include in this TAB a detailed description of the approach
related to the design phase (if applicable); the implementation phase, and the
operations and support phase of the proposed solution. This information shall
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clearly identify all staff functions that will be provided, including, but not limited
to, audit staff, call center staff, and technical staff.
TAB III Technical Proposal
Tab III shall contain responses as described in Section 3 of this ITN in the
following order, labeled and subdivided in the following subtabs:
A. Systems and Technology
B. Documentation, Eligibility Verification and Appeals
C. Call Center
D. Subscriber Communications
E. Project Plan
F. Performance Guarantees
G. Reporting Requirements
H. Benefits to Florida Economy
I. Security Protocol and Controls
TAB IV ATTACHMENT 9 - Price Sheet for Initial Term
Respondent shall complete and submit Attachment 9 - Price Sheet, and include
this attachment in TAB IV of its reply to the ITN. Pricing shall be provided for the
contract period, which shall include appeal support as established by section 28-
106.201 or 28-106.301, Florida Administrative Code; and Chapter 120, Florida
Statutes, once the audit is completed.
TAB V Additional Services
In TAB V of its reply to the ITN, Respondent is invited to provide information
regarding additional capabilities and services that are not specifically addressed in
TABs II – IV of their response but are being offered as part of the proposal.
Respondent shall describe in detail all identified additional features, capabilities, or
services.
Additional pricing terms, if any, for services identified in TAB V – Additional
Services, must be provided separately from the initial term pricing in TAB IV.
Respondent shall complete and submit Attachment 10 – Price Sheet – Additional
Services, and include this attachment in TAB V of its reply to the ITN. Pricing for
additional services will not be scored. Clearly identify in TAB V – Additional
Services if the services are offered without additional cost. Value added services
pricing will not be scored, but may be considered by the ITN negotiation team in
the Department’s overall best-value determination.
2.11 Pass/Fail Requirements
The Respondent shall complete, have notarized and submit Attachment 11 – Pass/Fail Affidavit
requirements, as part of its response certifying that it either meets or exceeds the requirements
below. The Respondent’s Attachment 11 shall be included in Tab I of its response.
ITN No.: DMS-10/11-030 Page 19 of 63
Attachment 11 requires attestation by the Respondent that:
A. Convicted Vendor List
The Respondent has not been disqualified from the public contracting and purchasing
process in accordance with Section 287.133(3) (d), Florida Statutes.
B. Suspended Vendor List
The Respondent has not been removed from the Department’s vendor list pursuant to Rule
60A-1.006, Florida Administrative Code.
C. MyFloridaMarketPlace Registration
As required by Rule 60A-1.030, Florida Administrative Code, Respondents will register in
MyFloridaMarketPlace. Also see Attachment A – PUR 1000 General Contract Conditions.
D. Pursuant to Section 4.02 Compliance with Laws, if Respondent is an out-of-state
corporation Respondent will obtain a Florida Certificate of Authorization from the Florida
Department of State, Division of Corporations, to transact business in the State of Florida.
The Respondent agrees to attain such authorization within seven (7) business days of
notice of award, should the Respondent be awarded. Website: www.sunbiz.org
E. The Respondent has within the last five (5) years successfully completed at least one
participant documentation and dependent eligibility verification service.
F. The Respondent understands and accepts the Pricing Methodology described in Section
2.09, and will be reimbursed on a contingency basis. Compensation under the contract may
not exceed historical claim costs for the prior 12 months for the dependent populations
disenrolled as a result of the vendor’s services.
G. The Respondent will act as the prime contractor to the Department for all services provided
under the prospective contract that results from this ITN.
2.12 Response Evaluation Criteria
The Department will establish an Evaluation Team to review and evaluate responses received on
this solicitation.
The Evaluation (0 - 100 Points) is based on the following criteria:
For the purposes of evaluation, scoring and ranking, responses are divided into four categories.
The following shows the maximum number of points that may be awarded by category.
Category A – Business-Corporate Experience and Ability to Provide Services 20 Points
Category B – Technical Proposal 37 Points
Category C – Price 40 Points
Category D – Florida-Based Business Preference 3 points
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A. Business-Corporate Experience and Ability to Provide Services (0 - 20 Points)
Evaluation of the Respondent’s corporate experience and ability to provide services will be
based upon information contained in the entire response, but primarily on the information
contained in TAB II.
Each subcategory may be awarded up to the following maximum number of points:
Similar Contracts and Services:
Business/Corporate References:
Disputes:
Ability to Provide Services:
5 points
3 points
2 points
10 points
B. Technical Proposal (0 - 37 Points)
Evaluation of the Respondent’s technical proposal will be based upon information contained in
the entire response, but primarily on the information contained in TAB III and TAB V as
applicable.
Based upon the quality, design and workmanship of the technical proposal each subcategory
below may be awarded up to the following maximum number of points:
Systems and Technology:
Document Eligibility Verification and Appeals:
Call Center:
Subscriber Communications:
Project Plan:
Performance Guarantees:
Reporting Requirements:
Security Protocol and Controls:
Pass/Fail
6 points
6 points
6 points
6 points
6 points
4 points
3 points
C. Price (0 - 40 Points)
The Price Sheet – Attachment 9 (TAB IV) shall be submitted as outlined in Section 2.09 and
will be scored as follows:
A total of up to 40 (forty) points will be allocated to the pricing proposed in Attachment 9 -
Price Sheet.
Each additional Respondent will be awarded a percentage of the 40 points relative to the
lowest Guaranteed Not-To-Exceed Fee (Lowest Guaranteed Not-To-Exceed Fee /
Respondents’ Guaranteed Not-To-Exceed Fee x 40 (forty) points = Points Awarded).
D. Florida-Based Business Preference (0 -3 Points)
The Department intends to award the contract to the Respondent that the Department
determines will provide the best value to the State. Additionally, the Department seeks to
promote Florida-based businesses as a result of this ITN. Consequently, Respondents may
complete the Application for Preference as a Florida-based Company in Attachment 13 of this
ITN No.: DMS-10/11-030 Page 21 of 63
ITN and submit it with their Response. Respondents qualifying for the Florida Preference will
receive one (1) point out of the three (3) available points indicated in Section 2.12 above.
All Respondents, including those without a principal place of business in the State of Florida,
are encouraged to provide details regarding how they will commit contractually to maximize
the use of state residents, state products and Florida-based businesses in fulfilling the
contractual duties related to this ITN and a resulting contract. The evaluation team and
negotiation team may, in their best value assessment, provide an additional two (2) points out
of the three (3) available points as part of Tab III, G – Benefits to the Florida Economy.
2.13 Negotiation Process
Using the evaluation criteria specified above, in accordance with section 287.057, Florida Statutes,
the Department will evaluate and rank replies and, at the Department’s sole discretion, proceed to
negotiate with Respondent (s) as follows:
A. The highest ranked Respondent(s) for each service combination will be invited to negotiate a
contract including compensation models. If necessary, the Department shall request
revisions to the approach submitted by the top-rated Respondent(s) until it is satisfied that
the contract will serve the Department’s needs and is determined to be the best value for
the State. The process will continue until a contract is negotiated and executed. The
Department may in its sole discretion, award and enter into contracts with more than one
Respondent, if in the best interest of the State.
A. The Department reserves the right to negotiate with all responsive and responsible
Respondents in each service combination, serially or concurrently, to determine the best-
suited solution. The ranking of replies indicates the perceived overall benefits of the
proposed solution, but the Department retains the discretion to negotiate with other
qualified Respondents as deemed appropriate.
B. Before award, the Department reserves the right to seek clarifications, to request reply
revisions, and to request any information deemed necessary for proper evaluation of
replies. Respondents may be requested to make a presentation, provide additional
references, provide the opportunity for a site visit, etc. The Department reserves the right
to require attendance by particular representatives of the Respondent. Any written
summary of presentations or demonstrations shall include a list of attendees, a copy of the
agenda, and copies of any visuals or handouts, and shall become part of the Respondent’s
reply. Failure to provide requested information may result in rejection of the reply.
C. The focus of the negotiations will be on achieving the solution that provides the best value
to the State.
D. In submitting a reply a Respondent agrees to be bound to the terms and conditions of this
ITN, including the General Conditions (PUR 1000). Offered compensation models should
assume those terms apply, but the Department reserves the right to negotiate different
terms and related price adjustments if the Department determines that it provides the best
value to the State.
The Department reserves the right to reject any and all replies if the Department determines such
action is in the best interest of the State or the Department. The Department reserves the right to
negotiate concurrently or separately with competing Respondents. The Department reserves the
right to accept portions of a competing Respondent’s reply and merge such portions into one
ITN No.: DMS-10/11-030 Page 22 of 63
project, including contracting with the entities offering such portions. The Department reserves
the right to waive minor irregularities in replies.
At the conclusion of negotiations, the Department will request a Best and Final Offer from selected
Respondents.
2.14 Disclosure of Reply Contents
All documentation produced as part of this solicitation shall become a public record of the
Department and may not be removed by the Respondent or its agents. All replies shall become a
public record of the Department and therefore cannot be returned to Respondent. The Department
shall have the right to use any or all ideas or adaptations of the ideas presented in any reply.
Selection or rejection of a reply shall not affect this right. See Section 2.05 regarding confidential,
proprietary, or trade secret material.
2.15 Subcontracting
The Respondent shall be fully responsible for all work performed under the Contract. If the
Respondent plans to utilize subcontractors, the Respondent shall complete the information
requested in Attachment 8 for all proposed subcontractors.
Should the Respondent be awarded and did not identify any subcontractors in the Response, the
Respondent shall submit a written request to the Division’s Contract Manager identified in Section
4.03. The written request shall include, but is not limited to, the following:
A. The name, address and other information identifying the subcontractor;
B. Component / type of services to be performed by the subcontractor;
C. Time of performance of the identified service;
D. How the Respondent plans to monitor the subcontractor’s performance of the identified
services;
E. Certification that the subcontractor has all licenses and/or has satisfied all legal
requirements to provide the services to the Department. Also, Respondent shall certify that
the subcontractor is approved by the Florida Department of State to transact business in the
State of Florida. If the subcontractor is an out-of-state company, it must have a Florida
Certificate of Authority from the Department of State, Division of Corporations, to transact
business in the State of Florida. Website: www.sunbiz.org
F. Certification that the subcontract has the required insurance. The Contractor is solely
responsible for ensuring the subcontractor maintains the insurance as required;
G. A copy of the written subcontract agreement;
H. Acknowledgement from the subcontractor of the Respondent’s contractual obligation to
the Department and that subcontractor agrees to comply with all terms and conditions of
the ITN and resulting contract. This includes, but not limited to, the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) (42 U. S. C. §1320d-1329d-8) and all
applicable regulations promulgated thereunder, Attachment 12 and PUR, 1000 General
Contract Conditions, Section 35. Insurance Requirements; and
I. Certification that the subcontractor will not offshore any component of the project.
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The Department may treat the Contractor’s use of a subcontractor not contained herein and/or
approved by the Department as a breach of this Contract.
The Respondent acknowledges that it shall not be released of its contractual obligation to the
Department as a result of any subcontract.
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ITN No.: DMS-10/11-030 Page 24 of 63
SECTION 3 – TECHNICAL SPECIFICATIONS
3.01 Scope of Work
The Division is seeking Respondents qualified to complete an audit of the eligibility of dependents
enrolled in Program and experienced in providing such services for organizations with enrollment similar
to the Program. The Division is interested in responses that focus on the positive outcomes of a dependent
eligibility verification services process to the state based on disenrollment of ineligible dependents and
that identify probable issues that may arise as a result of the audit.
The proposed audit should ensure that dependents enrolled in the Program meet the guidelines in
Appendix A. The scope of these verification services should include membership records for the plan year
starting on January 1, 2011. The audit should be constructed to allow the Contractor to determine if
dependents enrolled meet the criteria for coverage and have provided the appropriate documentation,
including Social Security Numbers and Medicare cards, if applicable, and contact information. The
Contractor will perform a 100 percent audit of dependents covered by the Program. The initial audit of the
membership records must be completed within six (6) months from receipt of the records from the State
or its human resources administrator. A Level I Appeal and subsequent appeal support period must be
provided by the Contractor at the conclusion of the audit. The scope of work includes those services
identified in the Contractor’s proposal, including those representations made in response to the following
(see, TAB III of the proposal):
A. Systems and Technology
1. Provide an overview of Respondent’s technology platform/system used to perform services, as
well as anticipated integration points (including types and number of interfaces) with the State’s
human resource system, People First. The respondent must coordinate SAP system business
requirements with the Department’s People First team and NorthgateArinso. Any costs associated
with the following must be paid by the Respondent: systems integration with the state’s human
resource system including, but not limited to, implementation of a secure FTP connection between
the Respondent and NorthgateArinso for new interface files and system programming (including
requirements development, design, coding and testing) to load/process the information/images
transmitted.
2. Describe:
a. Client setup process of Respondent’s system;
b. Whether the State can specify the verification documentation requirements for each of its
dependent types;
c. Whether Respondent’s system has a limit to the number of verification documents required for
any dependent type;
d. Respondent’s process for imaging and retaining all verification documentation in digital
format, including file naming conventions, which must include the eight-digit employee ID
number and documentation type;
e. Respondent’s ability to provide the State with all verification documentation images in State
mandated electronic format; and
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f. How the Respondent will identify the dependent if the Social Security number is inaccurate.
3. Describe Respondent’s process to test the transmission of data to/from NorthgateArinso,
including:
a. Capabilities for receiving and transmitting data in a secure and electronic format, on a
mutually agreed upon schedule.
b. Ability to accept/transmit data in a State-defined format.
c. The disaster recovery plan that will be in place for the project.
d. Ability to scan enrollee documentation in a standard format and transmit an indexed file to
NorthgateArinso. Note: the image and indexing files must follow a naming convention to be
defined by NorthgateArinso and approved by the State. At a minimum the format will include
the 8-digit employee ID, date and time of scanning and a reference key for documentation
type.
4. Describe Respondent’s experience with clients who use SAP ERP 6.0 (ECC 6.0), powered by
Netweaver 7.0.
5. Describe the type of server and capacity for storing images.
6. Provide access to a site that can be used to view a demonstration of the Respondent’s online
process, if available.
7. Describe how the State and NorthgateArinso can sample and validate the accuracy of transmitted
documentation in the provider’s core system.
8. Describe means by which subscribers may submit dependent eligibility documentation, how the
documents are processed upon receipt and the length of time required to process each transaction.
B. Documentation, Eligibility Verification and Appeals
1. Provide an overview of your plan to provide the requested participant documentation and
dependent eligibility verification services.
2. Describe how Respondent would implement a grace period (up to three months) and how
requirements under the Patient Protection and Affordable Care Act impact the State’s ability to
recover historical claims paid for ineligible dependents.
3. Describe how Respondent would verify dependent eligibility pursuant to the State’s eligibility
rules, including the proofs Respondent would require to be submitted by the subscriber for each
dependent type (See Appendix A).
4. Describe how Respondent would obtain accurate dependent Social Security numbers.
5. Describe how Respondent would obtain accurate subscriber and dependent Medicare eligibility
information, including HIC numbers.
6. Describe how Respondent would obtain accurate address, phone number and e-mail information.
7. Describe any features to track processing and decision history.
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8. Describe how Respondent will identify and report the dependents removed as a result of
Respondent’s services.
9. Describe the dependent types available in Respondent’s system. What is Respondent’s process for
adding additional types?
10. Describe the process of associating the required verification document(s) necessary to evidence
eligibility for each dependent type.
11. Provide examples of all records used to identify information regarding dependent eligibility.
12. Explain how Respondent would verify that a spouse is the current spouse of a subscriber.
13. Explain how Respondent would verify that a surviving spouse of a deceased subscriber has not
remarried.
14. Describe how the Respondent ensures that all records provided are authentic.
15. Describe the process by which Respondent will communicate to NorthgateArinso and the State the
need to terminate coverage of covered dependents determined to be ineligible.
16. Describe the process by which Respondent will verify ineligible dependents were appropriately
terminated from coverage.
17. Describe the process that would be implemented to reinstate dependents who were terminated
because documentation was not provided on a timely basis and who subsequently were able to
provide documentation. Confirm that acceptable documentation will be reported to
NorthgateArinso and the State in the same format as information received prior to the initial
deadline.
18. Describe how the Respondent shall destroy all verification evidence after completion of services,
as required by the State, and how certification of destruction will be provided to the State.
19. Provide any additional detail not requested elsewhere that is necessary to fully describe your
documentation and eligibility verification proposal.
20. Describe how the Respondent shall comply with appeals that arise from the results of the
verification services described in Appendix B.
C. Call Center
1. Explain how enrollees may contact the Respondent during the audit. Respondent must provide a
toll-free telephone number dedicated to State of Florida, as well as a system with the capacity to
handle call volumes without interruption or dropped calls.
2. The call center must be located in the United States and have an available team designated to the
State account.
3. Provide a toll-free fax number for documentation submittal for subscribers. Faxes must be
received in a secure location.
4. Explain the ability of Respondent’s system(s) to track and provide reports to the State
summarizing all inquiries and complaints, including call type, actions, and resolutions.
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5. Provide the hours and days of the week that the call center would be open and available to receive
calls from subscribers; include holidays.
6. Explain the length and the type of training provided to the representatives. Call center
representatives must be able to respond to questions, complaints, and inquiries including, but not
limited to, dependent eligibility and status of documentation receipt and review.
7. Describe the Respondent’s after-hours services.
8. Describe Respondent’s procedure for escalating complex and/or difficult calls to more
experienced representatives and ultimately supervisory staff.
9. Confirm that Respondent’s staffing level will be sufficient to meet the needs of the State’s
subscribers and provide the number of Full Time Equivalent (FTEs) that will be assigned and the
number of hours to be worked on this project.
10. Respondent shall be expected to monitor the quality of all calls and provide the State with results
of call monitoring. Performance standards for the call center are detailed in Section 3.01 E.,
Performance Guarantees.
11. Provide call center metrics and results for other clients of similar size.
12. Describe how you document calls and access the documentation to resolve customer inquiries or
complaints.
13. Describe how Respondent ensures customer service representatives provide accurate information.
14. Summarize standard call center security protocol that ensures subscriber information is protected
and cannot be made available outside the process of this audit.
15. Provide any additional detail not requested elsewhere that is necessary to fully describe the call
center services that are part of your proposal.
D. Subscriber Communications
The Respondent must develop customized subscriber communications acceptable to the State for the
audit. The Respondent must have the capability to send different communications for different types of
dependents. All communications shall be approved by the Department prior to issue.
1. Describe the Respondent’s standard communication plan, including the number, frequency, timing
and types of communication used in the Respondent’s standard service.
2. Explain the ability of the Respondent’s system to document and retain copies of specific letters
sent to subscribers or dependents.
3. Describe the extent to which communications can be customized for the State.
4. Provide sample mailings included in Respondent’s service, including, but not limited to,
reminder/deadline approaching, initial contact and follow-up communications with subscribers
who do not respond or who provide insufficient documentation, and determinations associated
with Level I Appeals.
5. Confirm that appropriate communication material shall be mailed to each enrollee by First Class
Mail with Address Service Requested.
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6. Communications notifying subscribers of disenrollment of dependents shall be sent via certified
mail and include appeal language pursuant to Chapter 120, Florida Statutes. Describe how
certified mail receipts will be maintained, stored and delivered to the State.
7. Describe how the Respondent handles mail returned as undeliverable.
8. Describe how subscriber is notified of Respondent’s receipt of documentation and subsequent
notification as to status of dependent; i.e., eligible or ineligible.
9. Describe any features of Respondent’s program that minimize participant dissatisfaction with the
process.
10. Describe how implementing a grace period (up to three-months) impacts communications to
subscribers.
11. Describe Respondent’s ability to begin preliminary communications in June 2011.
12. Describe how Respondent will handle communications with university employees who may not be
available during the summer months.
13. Provide any additional detail not requested elsewhere that is necessary to fully describe the
subscriber communication services that are part of the proposal.
E. Project Plan
Project Plan: Respondent must provide a project plan that exhibits a firm commitment that all
requirements will be completed in a timely manner and includes, but is not limited to, the following:
1. Provide a proposed plan for implementing participant documentation and dependent eligibility
verification services that describe preliminary steps that need to be taken prior to the
commencement of the audit and a description/flowchart, including timeframes and
communications, of all major project activities, including what may be required from the State
and/or NorthgateArinso.
2. Provide a project timeline with major milestones and deliverables.
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ITN No.: DMS-10/11-030 Page 29 of 63
F. Performance Guarantees
The Respondent shall complete the last column of this table and submit it in TAB III of the response.
Performance
Indicator
Description of
Proposed
Performance
Guarantee
Performance
Standard
Measurement
Frequency
Percent of
Fees
Respondent is
Willing to Put
at Risk
PG-1 Service Level
Percentage
Shall mean the
number of
subscriber calls
(less abandoned
calls) that are
answered by a
representative
within twenty
(20) seconds of
the call entering
the Contractor’s
queue divided by
the total number
of calls that
entered the
Contractor’s
queue (less
abandoned calls).
Greater than or
equal to 80%
Monthly
PG-2 Forced Disconnect
Percentage
Shall mean the
number of calls
that are prevented
from entering the
Contractor’s
queue divided by
the total number
of calls offered to
the Contractor’s
queue.
Less than or equal
to 1%
Monthly
PG-3 Abandon Rate
Percentage
Shall mean the
number of
inbound calls
from subscribers
that enter the
queue and are not
answered by the
Contractor
divided by the
number of calls
that entered the
Contractor’s
queue.
Less than or equal
to 3%
Monthly
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Performance
Indicator
Description of
Proposed
Performance
Guarantee
Performance
Standard
Measurement
Frequency
Percent of
Fees
Respondent is
Willing to Put
at Risk
PG-4 First Call
Resolution
Percentage
Shall mean the
total calls from
subscribers that
enter the queue
minus the number
of cases opened
by the Contractor
divided by the
total calls that
entered the
Contractor’s
queue.
Greater than or
equal to 95%
Monthly
PG-5 Case Investigation
Resolution
Percentage
Shall mean the
number of cases
that are opened
(when issues are
not resolved on
the first call) by
the Contractor,
resolved and
subscriber
notified of the
resolution by the
Contractor within
five (5) business
days divided by
the number of
cases opened.
Greater than equal
to 98%
Monthly
PG-6 Post Audit
Reinstatements
Shall mean the
number of
documents
verifying
subscriber’s
eligibility
received post
initial audit,
processed and
provided to NGA,
along with
eligibility file,
within two (2)
business days of
receipt by the
Contractor.
Greater than or
equal to 99%
Monthly
ITN No.: DMS-10/11-030 Page 31 of 63
Performance
Indicator
Description of
Proposed
Performance
Guarantee
Performance
Standard
Measurement
Frequency
Percent of
Fees
Respondent is
Willing to Put
at Risk
PG-7 Timeliness of
Deliverables,
Documents and
Reports
Shall mean 100%
of all
deliverables,
documents and
reports shall be
delivered to the
Department or the
Department’s
representative.
Within time
periods specified
below:
A. Weekly:
Four (4) calendar
days following the
end of the
reporting week
B. Monthly:
Ten (10) calendar
days of the end of
the reporting
month
C. Quarterly:
Forty-five (45)
calendar days of
the end of the third
reporting month in
a quarter
D. Ad-Hoc:
Seventy-two (72)
hours of of request
by the Department
Weekly
Monthly
Quarterly
Monthly
PG-8 Accuracy of
Deliverables,
Documents and
Reports
Shall mean all
reports and
deliverables
delivered to the
Department shall
be accurate. (This
standard does not
apply to de
minimus errors
and omissions, as
determined by the
Department.)
100% of all reports
or deliverables
shall be
mathematically
and otherwise
accurate.
Monthly
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Performance
Indicator
Description of
Proposed
Performance
Guarantee
Performance
Standard
Measurement
Frequency
Percent of
Fees
Respondent is
Willing to Put
at Risk
PG-9 Department
Inquiry Response
Timeliness
Shall mean the
project
management team
assigned to the
Department shall
respond to
telephone, email
and other written
inquires from the
Department.
Telephone and
email: 100%
within one (1)
business day
Written inquiries:
100% within three
(3) business days
Monthly
G. Reporting Requirements
1. Confirm that the Respondent will work with the Department to develop reports including, but not
limited to, the measurement of the Respondent’s efficiency, effectiveness and adherence.
Additionally, the Respondent will be required to provide electronic files, as described in Section
3.01 (A). Reporting and electronic file transmittal will be at intervals mutually agreed upon by the
Department and the Respondent. At a minimum these reports and electronic files must include:
a. Verification Status Summary Report – report must be sortable by employer and include at a
minimum: number of letters mailed, number of responders, numbers of complete
documentation received, number of incomplete documentation received.
b. Call Center statistics, including, but not limited to, number of calls, response time and cases.
c. Management Summary Report – progress and milestones met.
d. Wrap-up Report of Final Eligibility Status Determination Detail– includes, at a minimum,
enrollee information, dependent information and eligibility confirmed/not confirmed, sortable
by employer (e.g., agency, university).
e. Appeals Report – at a minimum, the number of appeals, number approved and number
denied.
f. Searchable file of all imaged eligibility documentation received, including subscriber
correspondence.
g. Performance Guarantee Report – summarizes Respondent’s compliance with all Contract
guarantees.
h. Indexed file (for mass load) of imaged dependent documentation provided to
NorthgateArinso (format to be provided by NorthgateArinso and approved by the State).
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i. File or report to remove ineligible dependents provided to NorthgateArinso (format to be
provided by NorthgateArinso and approved by the State).
2. Provide an overview of the management reporting features of the Respondent’s system.
3. List and explain Respondent’s management reports. Provide samples of Respondent’s
management reports.
4. State whether Respondent’s management reports can be accessed via a website. If possible,
provide the ability to access these reports online with a user name and password with the proposal
submission.
5. Provide an Executive Summary and Final Report that shall include, at a minimum:
a. Objectives of the audit
b. Procedures taken to complete the audit
c. Number of membership records examined by dependent type
d. Audit results
e. Projected financial savings
f. Comparison of audit results to industry standards
g. A description of errors found during the review
h. Recommendations to improve overall administration and membership processing accuracy
i. Recommendations to the State for possible recovery procedures.
6. Confirm that Respondent will provide additional ad hoc reports or information, at no additional
charge, when requested by the Division. Such requests may pertain to Contract compliance or for
information required to respond to inquiries, complaints, appeals, hearings, and other questions
raised by subscribers, dependents or other parties. The Contractor shall submit the report or
information within seventy-two (72) hours after receipt of the request. When time is of the
essence, the Contractor will make every effort to answer the request as soon as possible so the
Division can respond in a timely manner to the authority or party making the request. Data should
be maintained so as to provide a variety of options for queries.
H. Benefits to Florida Economy
1. Explain how Respondent will maximize the use of state residents, products and businesses as
provided for in Section 2.12D to complete the scope of work as defined above. Respondent shall
also complete Attachment 13 and submit in Tab I.
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ITN No.: DMS-10/11-030 Page 34 of 63
I. Security Protocols and Controls
The Respondent must maintain a HIPAA compliant level of security to protect the confidentiality of
enrollee/dependent information on the Respondent’s computer system and in the Respondent’s physical
work environment. (See Attachment A, Part Two, Special Provisions).
3.02 Rules and Regulations
A. The Contractor shall meet all state and federal requirements as applicable to provide
services under the Contract and executing the scope of work. All such laws, rules and
regulations, current and/or as revised, are incorporated herein by reference and made a part
of this ITN and any resulting Contract. The Contractor and the Division shall work
cooperatively to ensure service delivery is in complete compliance with all such
requirements.
B. The Contractor shall comply with s. 627.6131 (18) and (19), Florida Statutes and all
applicable regulations.
C. The Contractor shall comply with the Health Insurance Portability and Accountability Act
of 1996 (HIPAA) (42 U. S. C. §1320d-1329d-8) and all applicable regulations
promulgated thereunder. Such compliance shall be required as outlined in Attachment 12
– Combined HIPAA Business Associate Agreement, HIPAA Security Rule Addendum,
Health Information Technology For Economic and Clinical Health (HITECH) Act
Compliance Agreement and Confidentiality Agreement which is incorporated herein as if
fully stated.
D. The Contractor shall not disclose any protected health information to parties outside the
Division or NorthgateArinso. The Contractor shall adhere to the requirements outlined in
Section 3.04.
E. Prior to the execution of any subcontractor agreements for the performance of any of its
functions under this Contract, the Contractor shall ensure all subcontractor agreements are
approved by the Division’s Contract Manager or designee and contain provisions requiring
the subcontractor to comply with all applicable terms and conditions of the Contract
resulting from this ITN and the Health Insurance Portability and Accountability Act of
1996 (HIPAA) (42 U. S. C. §1320d-8) and all applicable regulations promulgated
thereunder. Such compliance shall be required as outlined in Attachment 12 – Combined
HIPAA Business Associate Agreement, HIPAA Security Rule Addendum, Health
Information Technology For Economic and Clinical Health (HITECH) Act Compliance
Agreement and Confidentiality Agreement which is incorporated herein as if fully stated.
F. The Contractor shall ensure all Contractors’ staff providing services under this ITN
comply with prevailing ethical and professional standards and the rules, procedures, and
regulations mentioned above.
3.03 Confidentiality –Protected Health Information, Security Protocol
A. Subscriber Records
The Contractor will have access to protected health information (PHI) of State of Florida
group health insurance subscribers and their dependents. The Contractor understands that
ITN No.: DMS-10/11-030 Page 35 of 63
the PHI of plan subscribers, their families and dependents is highly confidential and
deserving of protection and privacy. The Contractor shall demonstrate its commitment to
the privacy of PHI with aggressive policies and regularly scheduled employee training.
Such PHI activities shall comply with all state and federal laws regulating the disclosure of
PHI.
B. Use of Data
Data will be used for business purposes only as required by audits and other necessary
business tasks. The Florida Auditor General, other necessary state agencies, and
independent auditing firms hired by either party will be provided data sufficient to carry
out the hired tasks. The Contractor will be notified in advance and all confidentiality and
business associate agreements will be properly executed.
C. Compliance With Confidentiality Laws
The Parties and subcontractors, if any, of the Contractor shall comply with all state and
federal laws regulating the disclosure of PHI.
D. Security Protocol and Controls
Contractor shall maintain adequate security controls of its policies on information
technology (IT) security controls including, but not limited to, conducting adequate
security risk assessments, maintaining comprehensive security policies, identifying
deficiencies in security controls surrounding and within Contractor’s computer systems,
deactivating user accounts, segregating duties, reconciling data, identifying security roles,
etc.
3.04 Start-up and Service Implementation
Respondents must have the capability to implement service delivery upon execution of a contract
with the Department.
3.05 Administrative Requirements, Space, Equipment & Commodities
The Division shall not provide any administrative functions or office support for the Contractor
(e.g., clerical assistance, office supplies, copiers, fax machines, and preparation of documents).
3.06 Contractor Performance
The Division desires to contract with a provider who clearly demonstrates its willingness to be
held accountable for its performance in successfully delivering dependent eligibility verification
services under a resultant contract. Therefore, the Division has developed and will enforce the
standards of section 3.01 E. Performance Guarantees for services performed under the contract.
Any failure by the Contractor to achieve the required level of any Performance Outcomes,
Measures, and Standards identified above shall result in assessment of liquidated damages as
stated in Section 3.09.
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3.07 Monitoring Methodologies
The Division’s Contract Manager and/or designee will monitor the Contractor's service delivery and
monthly Performance Guarantee reports to determine if the Contractor has achieved the required
level of performance for each Performance Outcome and Standards identified in Section 3.01 E.,
Performance Guarantees. The Contractor shall maintain sufficient documentation to substantiate
reported service levels under this contract as well as any records, papers and documents made in
connection with the performance of this contract. The Contractor shall not destroy or make such
records inaccessible without the express written permission of the Division. The Department may
audit the performance and performance reporting. The Division’s authorized representatives or
designees shall have the right, at reasonable times and upon reasonable notice, to examine and copy,
at reasonable expense, the Contractor’s records, systems and files which pertain to the provision and
requirements of this Contract.
Note: The Contractor shall correct all identified non-compliant service delivery issues related to
the Contractor’s failure to meet the Performance Outcomes and Standards identified in Section
3.01 E., Performance Guarantees; however, this shall not negate the fact that a Performance
Guarantee has not been met and that liquidated damages will be imposed in accordance with
Section 3.10, Liquidated Damages For Failure to meet Performance Guarantees.
3.08 Liquidated Damages
By executing the Contract, the Contractor expressly agrees to the imposition of liquidated
damages.
The Department’s Contract Manager will provide written notice to the Contractor of all liquidated
damages assessed, accompanied by detail sufficient for justification of assessment. Within ten (10)
days of receipt of a written notice of demand for damages due, the Contractor shall forward payment
to the Contract Manager. Payment shall be for the appropriate amount and the funds shall be sent
electronically to the Department.
Liquidated Damages for Failure to meet Performance Outcomes and Standards
The Contractor hereby acknowledges and agrees that its performance under the Contract shall
meet the Performance Guarantees set forth in this ITN, particularly in Section 3.01 E.,
Performance Guarantees. If the Contractor fails to meet any Performance Guarantee, the
Department will impose Liquidated Damages identified in TAB III of the Contractor’s proposal.
In addition, The Department will enforce the performance requirements and impose the associated
Liquidated Damages specified below:
A. Electronic Files
In the event the Contractor fails to submit electronic files to NorthgateArinso as described in
Section 3.01F (1) (h) and (i) on a delivery schedule to be mutually agreed upon, liquidated
damages in the amount of ten thousand dollars ($10,000) for each determination of failure plus
an additional one thousand dollars ($1,000) per day until the file is received.
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B. Standard Reports
In the event the Contractor fails to submit to the Division the reports described in Section
3.01F (1) (a) through (g) within the time frames specified in the contract, liquidated damages
in the amount of one thousand dollars ($1,000) for each determination of failure plus an
additional two hundred dollars ($200) per day until the information, data, or report is received,
up to a maximum of twenty-five thousand dollars ($25,000) per occurrence.
C. Documentation to be sent to NorthgateArinso
In the event the Contractor fails to submit accurate documentation, as defined by the State, to
NorthgateArinso as stated in Section 3.09 (A) and (B), liquidated damages in the amount of
one thousand dollars ($1,000.00) for each determination of failure shall be imposed.
3.09 Deliverables
The following services or service tasks are identified as deliverables for the purposes of this ITN:
A. Dependent Eligibility Verification Services as specified herein;
B. Transmittal of eligibility data and documentation to NorthgateArinso;
C. Reports as required in Section 3.01, Reporting Requirements;
D. Compliance with Contract terms and conditions; and
E. Appeals process support.
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ITN No.: DMS-10/11-030 Page 38 of 63
SECTION 4 – SPECIAL CONDITIONS
This section serves in conjunction with Attachment A - PUR 1000 General Contract Conditions.
4.01 Compliance with Laws
The Contractor shall comply with all laws, rules, codes, ordinances, and licensing requirements
that are applicable to the conduct of its business, including those of federal, State, and local
agencies having jurisdiction and authority. By way of non-exhaustive example, Chapter 287 of
the Florida Statutes, and Chapter 60A-1 of the Florida Administrative Code, governs the Contract.
By way of further non-exhaustive example, the Contractor shall comply with Section 247A(e) of
the Immigration and Nationalization Act, the Americans with Disabilities Act, and all prohibitions
against discrimination on the basis of race, religion, sex, creed, national origin, handicap, marital
status, or veteran’s status. Violation of such laws shall be grounds for Contract termination.
4.02 Inapplicable Provisions of Attachment A - PUR 1000 General Contract Conditions
The following are not applicable:
Sections 2, 3, 4, 5, 6, 8, 11, 12, 13, 14 and 39.
4.03 Background Check
The Department will require the Contractor to have an FDLE (Florida Department of Law
Enforcement) Level II background check performed on each individual that will be working in the
Contractor’s facility within fifteen (15) days after execution of the contract. The Contractor may
access the FDLE site themselves to perform this check online. The Contractor is responsible for
payment. The address for the site is: http://www.fdle.state.fl.us/CriminalHistory. If the individual
has not been a resident in Florida for twelve (12) months, then a check should be done from the
individual’s previous residence. Also require a copy of a Photo ID along with a copy of a Social
Security card showing the last 4 numbers of the card holder. These documents and a copy of the
background check must be provided to the Contract Manager for review, which will be forwarded
to the Department of Management Services’ Inspector General’s Office for approval before any
Personnel will be allowed to work under this Contract. The Department reserves the right to reject
any proposed personnel based on background check.
4.04 Work Locations; No Off-shoring of Data
Unless otherwise agreed in writing, Contractor and its subcontractors and agents will not perform
any of the Services outside of the United States, and Contractor will not allow any of the sensitive
or confidential information of the State, subscribers or dependents to be transmitted or accessed
outside of the United States.
A violation of the above will result in immediate and irreparable harm to the Department and will
entitle the Department to a credit of $50,000 per violation, with a cumulative total cap of $500,000
per event. This credit is intended only to cover the Department's internal staffing and
administrative costs as well as the diminished value of Services provided under the Contract, and
will not preclude the Department from recovering other damages it may suffer as a result of such
violation. For purposes of determining the damages due hereunder, a group of violations relating
ITN No.: DMS-10/11-030 Page 39 of 63
to a common set of operative facts (e.g., same location, same time period, same off-shore entity)
shall be treated as a single event.
4.05 Employment Eligibility Verification
Contractor agrees that it will enroll and participate in the Employment Eligibility Verification
Program (“E-Verify Program”) administered by the U.S. Department of Homeland Security
(“DHS”), under the terms provided in the “Memorandum of Understanding” with DHS governing
the program. Contractor further agrees to provide the Department, within thirty (30) days of the
effective date of this Agreement, documentation of such enrollment in the form of a copy of the
“Edit Company Profile” page in E-Verify, which contains proof of enrollment in the E-Verify
Program. (This page can be accessed from the “Edit Company Profile” link on the left navigation
menu of the E-Verify employer’s homepage.
Contractor further agrees that it will require each subcontractor that performs work under this
Agreement to enroll and participate in the E-Verify Program within ninety (90) days of the
effective date of this Agreement or within ninety (90) days of the effective date of the contract
between the Contractor and the subcontractor, whichever is later. The Contractor shall obtain
from the subcontractor(s) a copy of the “Edit Company Profile” screen indicating enrollment in
the E-Verify Program and make such record(s) available to the Department and other authorized
State officials upon request.
Contractor further agrees to maintain records of its participation and compliance with the
provisions of the E-Verify Program, including participation by its subcontractors as provided
above, and to make such records available to the Department and other authorized State officials.
Compliance with the terms of this Employment Eligibility Verification provision (including
compliance with the terms of the “Memorandum of Understanding” with DHS) is hereby made an
express condition of this Agreement.
4.06 Contract Management
A. Contract Administrator
The Department employee who is primarily responsible for maintaining this Contract. As of
the effective date, the Contract Administrator shall be as follows:
Lori L. Anderson
Departmental Purchasing
Department of Management Services
4050 Esplanade Way, Ste. 380.9Y
Tallahassee, Florida 32399-0950
Telephone: (850) 488-0510 / Fax: (850) 414-8331
E-mail: [email protected]
The Department may appoint a different Contract Administrator, which shall not constitute an
amendment to the Contract, by sending written notice to Contractor. Any communication to
the Department relating to the Contract shall be addressed to the Contract Administrator.
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B. Contract Manager
The Department shall designate an employee primarily responsible for overseeing the
Respondent’s performance of its duties and obligations pursuant to the terms of this Contract.
The Contract Manager shall be as follows:
Suzetta Furlong
Division of State Group Insurance
Department of Management Services
4050 Esplanade Way, Ste. 215F
Tallahassee, Florida 32399
Telephone: (850) 921-4662
Fax: (850) 488-0252
E-mail: [email protected]
The Department may appoint a different Contract Manager, which shall not constitute an
amendment to the Contract, by sending written notice to Contractor. Any communication to
the Department relating to the Contract shall be addressed to the Contract Manager.
C. Contract Term
The resultant Contract of this solicitation shall begin on the last date signed by either party,
and shall terminate upon completion of all audit and Appeal services as described herein.
However, during the term of the contract, the Department may find it necessary to renew the
contract in increments, complete term, or combination thereof, so as long as the original
renewal price bid is not exceeded. See Rule 60A-1.048 (1)(a), F.A.C. Such a change shall be
accomplished only by an amendment to the contract. Execution of all renewals shall be done
via a contract amendment, and shall remain subject to at least satisfactory performance by the
vendor.
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ITN No.: DMS-10/11-030 Page 41 of 63
SECTION 5 – FORMS INSTRUCTION AND INFORMATION
The following Attachments shall be completed and returned in accordance with Section 2.10, Response
Submittal:
ATTACHMENT 1 – RESPONDENT’S CONTACT INFORMATION
ATTACHMENT 2– CERTIFICATION OF DRUG-FREE WORKPLACE PROGRAM
ATTACHMENT 3– NOTICE OF CONFLICT OF INTEREST
ATTACHMENT 4 – NON-COLLUSION AFFIDAVIT
ATTACHMENT 5 – STATEMENT OF NO INVOLVEMENT
ATTACHMENT 6 – BUSINESS/CORPORATE REFERENCE
ATTACHMENT 7 – ADDENDUM / AMENDMENT ACKNOWLEDGEMENT FORM
ATTACHMENT 8 – SUBCONTRACTING
ATTACHMENT 9 – PRICE SHEET - INITIAL TERM
ATTACHMENT 10 – PRICE SHEET - ADDITIONAL FEATURES
ATTACHMENT 11 – PASS/FAIL AFFIDAVIT
ATTACHMENT 12 – COMBINED HIPAA BUSINESS ASSOCIATE AGREEMENT, HIPAA
SECURITY RULE ADDENDUM, HITECH ACT COMPLIANCE
AGREEMENT AND CONFIDENTIALITY AGREEMENT
ATTACHMENT 13 – APPLICATION FOR PREFERENCE AS A FLORIDA-BASED COMPANY
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ITN No.: DMS-10/11-030 Page 42 of 63
ATTACHMENT 1 – RESPONDENT’S CONTACT INFORMATION
The Respondent shall identify the contact information as described below.
For solicitation purposes, the Respondent’s contact
person shall be:
For contractual purposes, should the Respondent be
awarded, the contact person shall be:
Name
Title
Address
Telephone
Fax
ITN No.: DMS-10/11-030 Page 43 of 63
ATTACHMENT 2 - CERTIFICATION OF DRUG-FREE WORKPLACE PROGRAM
287.087 Preference to businesses with drug-free workplace programs.--Whenever two or more bids, proposals,
or replies that are equal with respect to price, quality, and service are received by the state or by any political
subdivision for the procurement of commodities or contractual services, a bid, proposal, or reply received from a
business that certifies that it has implemented a drug-free workplace program shall be given preference in the award
process. In order to have a drug-free workplace program, a business shall:
(1) Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or
use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against
employees for violations of such prohibition.
(2) Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a
drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the
penalties that may be imposed upon employees for drug abuse violations.
(3) Give each employee engaged in providing the commodities or contractual services that are under bid a copy of
the statement specified in subsection (1).
(4) In the statement specified in subsection (1), notify the employees that, as a condition of working on the
commodities or contractual services that are under bid, the employee will abide by the terms of the statement and
will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of chapter 893
or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no
later than 5 days after such conviction.
(5) Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation
program if such is available in the employee's community by, any employee who is so convicted.
(6) Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.
As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements.
False statements are punishable at law.
Respondent’s Name: ____________________________________
By: _______________________________________________
Authorized Signature Print Name and Title
ITN No.: DMS-10/11-030 Page 44 of 63
ATTACHMENT 3 - NOTICE OF CONFLICT OF INTEREST
Company or Entity Name
For the purpose of participating in the solicitation process and complying with, the provisions of Chapter 112, of
the Florida Statutes, the undersigned corporate officer states as follows:
The persons listed below are corporate officers, directors or agents and are currently employees of the State of
Florida or one of its agencies:
The persons listed below are current State employees who own an interest of ten percent (10%) or more in the
company/entity named above:
Name of Respondent’s Organization Signature of Authorized Representative and Date
Print Name
ITN No.: DMS-10/11-030 Page 45 of 63
ATTACHMENT 4 - NON-COLLUSION AFFIDAVIT
STATE OF
COUNTY OF
I state that I of ,
(Name and Title) (Name of Firm)
am authorized to make this affidavit on behalf of my firm, and its owner, directors, and officers. I am the person
responsible in my firm for the price(s) the amount of this Response, and the preparation of the Response. I state
that:
1. The price(s) and amount(s) of this Response have been arrived at independently and without consultation,
communication or agreement with any other Provider, potential provider, Proposal, or potential Proposal.
2. Neither the price(s) nor the amount(s) of this Response, and neither the approximate price(s) nor
approximate amount of this Response, have been disclosed to any other firm or person who is a Provider,
potential Provider, Proposal, or potential Proposal, and they will not be disclosed before Proposal opening.
3. No attempt has been made or will be made to induce any firm or persons to refrain from submitting a
Response for this contract, or to submit a price(s) higher that the prices in this Response, or to submit any
intentionally high or noncompetitive price(s) or other form of complementary Response.
4. The Response of my firm is made in good faith and not pursuant to any agreement or discussion with, or
inducement from, any firm or person to submit a complementary or other noncompetitive Response.
5. , its affiliates, subsidiaries, officers, director, and employees
(Name of Firm)
are not currently under investigation, by any governmental agency and have not in the last three years been
convicted or found liable for any act prohibited by State or Federal law in any jurisdiction, involving
conspiracy or collusion with respect to Proposal, on any public contract, except as follows:
I state that I and the named firm understand and acknowledge that the above representations are material and
important, and will be relied on by the State of Florida for which this Response is submitted. I understand and my
firm understands that any miss-statement in this affidavit is and shall be treated as fraudulent concealment from the
State of Florida of the true facts relating to the submission of responses for this contract.
Dated this day of 2011.
Name of Organization:
Signed by:
Print Name
being duly sworn deposes and says that the information herein is true and sufficiently complete so as not to be misleading.
Subscribed and sworn before me this day of 2011.
Notary Public:
My Commission Expires:
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ATTACHMENT 5 - STATEMENT OF NO INVOLVEMENT
I, , as an authorized representative of the aforementioned company, certify
that no member of this firm nor any person having any interest in this firm has been involved with the Department
of Management Services to assist it in:
1. Developing this solicitation; or,
2. Performing a feasibility study concerning the scope of work contained in this Invitation to Negotiate.
Name of Respondent’s Organization Signature of Authorized Representative and Date
Print Name
ITN No.: DMS-10/11-030 Page 47 of 63
ATTACHMENT 6 – BUSINESS/CORPORATE REFERENCE This form must be completed by the person giving the reference on the Respondent. For purposes of this form, the Respondent
is the business entity that currently or has previously provided services to your organization, and is submitting a reply to a
solicitation. Upon completion of this form, please return original to Respondent.
This business reference is for (Respondent’s Name):
Name of the person providing the reference:
Title of person providing the reference:
Organization name of person providing the reference:
Telephone number of the person providing the reference:
Please identify your relationship with the Respondent (e.g., subcontractor, customer, etc.).
How many years have you done business with the Respondent? ___________________________________________________________
Please provide dates:_____________________________________________________________________________________________
If a customer, please describe the primary service the Respondent provides your organization.
Did the Respondent act as a primary provider or as a subcontractor?________________________________________________________
Do you have a business, profession, or interest in the Respondent’s organization? If yes, what is that interest?
Have you experienced any contract performance problems with the Respondent’s organization?
Would you conduct business with the Respondent’s organization again?_____________________________________________________
Are there any additional comments you would like to make regarding the Respondent’s organization?
Dated this day of 2011.
Name of Organization:
Signed by:
Print Name
Being duly sworn deposes and says that the information herein is true and sufficiently complete so as not to be misleading.
Subscribed and sworn before me this day of 2011.
Notary Public:
My Commission Expires:
ITN No.: DMS-10/11-030 Page 48 of 63
ATTACHMENT 7 – ADDENDUM / AMENDMENT ACKNOWLEDGEMENT FORM
This acknowledgment form serves to confirm that the Respondent has reviewed, complied and/or accepted all Addendum(s)
/ Amendment(s) to the solicitation posted on the Vendor Bid System (VBS).
Please list all Addendum(s) / Amendment(s) below.
Name of Respondent’s Organization Signature of Authorized Representative and Date
Print Name
ITN No.: DMS-10/11-030 Page 49 of 63
ATTACHMENT 8 – SUBCONTRACTING
The Respondent shall complete the information below on all subcontractors that shall provide services to the
Respondent to meet the requirements of the resultant contract, should the Respondent be awarded. Submission of this
form does not indicate the Department’s approval (see Section 2.15), but provides the Department with information on
proposed subcontractors for review.
Please complete a separate sheet for each subcontractor.
Service:
Company Name:
Contact:
Address:
Telephone:
Fax:
Current Registered as Certified Minority
Business Enterprise (CMBE), Women-
Owned Business (WBE), or Service-
disabled Veteran?
Yes ________ No ___________
Occupational License No:
Acknowledgement from Contractor that
this subcontractor has successfully
complied with the "Subcontractor
Acceptance Process":
Yes ________ No ___________
W-9 verification:
Yes ________ No ___________
In a job description format, describe below the responsibilities and duties of the subcontractor based on the technical
specifications or scope of services outlined in this solicitation.
ITN No.: DMS-10/11-030 Page 50 of 63
ATTACHMENT 9 – PRICE SHEET
By submitting the price sheet, the potential Contractor certifies the following:
This price sheet is signed by an authorized representative of the company.
The cost and availability of all equipment, materials, and supplies associated with performing the services
described herein have been determined and included in the proposed fee.
All labor costs, direct and indirect, have been determined and included in the proposed fee.
The potential Contractor has read and understands the requirements set forth in this ITN and agrees to
them with no exceptions.
The potential Contractor is registered, or agrees to register, in the State of Florida’s e-procurement system
MyFloridaMarketPlace before execution of the prospective contract. SEE PUR 1000, SECTION 14.
Therefore, in compliance with this ITN, and subject to all requirements herein, the undersigned offers and agrees, if
this proposal is accepted within 120 days from the date of the opening, to provide the subject services for a fixed fee
not to exceed:
Guaranteed Not-To-Exceed Fee – A fixed
amount payable by the Department, subject to
the availability of funding, not-to-exceed 12
months of historical claims costs for
disenrolled dependents.
$_________
Company Name:
SPURS Vendor Number:
Contact Name:
Street Address or P.O. Box:
City, State, Zip:
E-mail Address:
Phone Number:
Fax Number:
Federal ID Number:
By:
Authorized Signature
Print Name and Title
Name of Company
Date
THIS PAGE MUST BE SIGNED AND INCLUDED IN YOUR PROPOSAL
ITN No.: DMS-10/11-030 Page 51 of 63
ATTACHMENT 10 – PRICE SHEET – ADDITIONAL SERVICES
NOT SCORED Provide details of additional services in TAB V, including associated fees and summarize additional services and fees
in this Attachment 10.
By submitting the price sheet, the potential Contractor certifies the following:
This price sheet is signed by an authorized representative of the company.
The cost and availability of all equipment, materials, and supplies associated with performing the services
described herein have been determined and included in the proposed fee.
All labor costs, direct and indirect, have been determined and included in the proposed fee.
The potential Contractor has read and understands the requirements set forth in this ITN and agrees to
them with no exceptions.
The potential Contractor is registered, or agree to register, in the State of Florida’s e-procurement system
MyFloridaMarketPlace before execution of the prospective contract. SEE PUR 1000, SECTION 14.
Therefore, in compliance with this ITN, and subject to all requirements herein, the undersigned offers and agrees, if
this proposal is accepted within 120 days from the date of the opening, to provide the subject services for fees not to
exceed:
Service Description
Associated Fee
Company Name:
SPURS Vendor Number:
Contact Name:
Street Address or P.O. Box:
City, State, Zip:
E-mail Address:
Phone Number:
Fax Number:
Federal ID Number:
By:
Authorized Signature
Print Name and Title
Name of Company
Date
THIS PAGE MUST BE SIGNED AND INCLUDED IN YOUR PROPOSAL
ITN No.: DMS-10/11-030 Page 52 of 63
ATTACHMENT 11 – PASS / FAIL AFFIDAVIT
Respondent Name:
Respondent Address:
In accordance with ITN Number DMS 10/11-023, Section 2.1, Pass/Fail Requirements, the undersigned, as an
authorized representative of the above named Respondent, hereby attests that:
A. Convicted Vendor List – The Respondent has not been disqualified from the public contracting and purchasing
process in accordance with Section 287.133(3)(d), Florida Statutes;
B. Suspended Vendor List – The Respondent has not been removed from the Department’s vendor list pursuant to
Rule 60A-1.006, Florida Administrative Code;
C. MyFloridaMarketPlace Registration – As required by Rule 60A-1.030, Florida Administrative Code, Respondents
will register in MyFloridaMarketPlace. Also see Attachment A – PUR 1000 General Contract Conditions;
D. Pursuant to Section 4.02 Compliance with Laws, if Respondent is an out-of-state corporation, Respondent will
obtain a Florida Certificate of Authorization from the Florida Department of State, Division of Corporations, to
transact business in the State of Florida. The Respondent agrees to attain such authorization within seven (7)
business days of notice of reward, should the Respondent be awarded. Website: www.sunbiz.org
E. The Respondent has within the last five (5) years successfully completed at least one dependent eligibility
verification service.
F. The Respondent understands and accepts the Pricing Methodology described in Section 2.09 A. The Contractor
will be paid on a contingency fee basis subject to the statutory limitation. Pursuant to s. 110.12301(2), Florida
Statutes, compensation under the contract may not exceed historical claim costs for the prior 12 months for the
dependent populations disenrolled as a result of the vendor’s services. The Department shall submit budget
amendments pursuant to Chapter 216 in order to obtain budget authority necessary to expend funds from the State
Employees’ Group Health Self-Insurance Trust Fund for payments to the vendor as provided in the contract.
G. The Respondent shall be responsible for all Level I Appeal activities and subsequent requests for information from
the Department throughout the appeal process as described in Section 3.01 of this ITN.
H. The Respondent will act as the prime contractor to the Department for all services provided under the prospective
contract that results from this ITN.
Dated this day of 2011.
Name of Organization:
Signed by:
Print Name
Being duly sworn deposes and says that the information herein is true and sufficiently complete so as
not to be misleading.
Subscribed and sworn before me this day of 2011.
Notary Public:
My Commission Expires:
ITN No.: DMS-10/11-030 Page 53 of 63
ATTACHMENT 12 – COMBINED HIPAA BUSINESS ASSOCIATE AGREEMENT,
HIPAA SECURITY RULE ADDENDUM,
HITECH ACT COMPLIANCE AGREEMENT
AND CONFIDENTIALITY AGREEMENT
This Business Associate has been selected by competitive procurement to conduct participant documentation
and dependent eligibility verification services. A defined description of services is provided in the Contract,
Section 3 – Technical Specifications of this Invitation To Negotiate (ITN), wherein the Business Associate is
referred to as the Contractor.
The parties have entered into this Agreement for the purpose of satisfying the Health Information
Technology For Economic and Clinical Health Act (the HITECH Act, as enacted in Pub. L . No. 111-05
H.R., 111th
Cong. (2009), Title XIII.), as well as the confidentiality requirements contained in section
110.123 (9), Florida Statutes.
The Parties: The Florida Department of Management Services, Division of State Group Insurance (the
“Covered Entity”), with its principal offices located at 4050 Esplanade Way, Suite 215, Tallahassee, Fl
32399-0950, and
____________________, a________ corporation, with its principal place of business at
__________________________________ (the “Business Associate”).
Term: This Agreement shall be effective as of 2011, and shall terminate on
2011.
1.0 Definitions
Terms used but not otherwise defined in this Agreement shall have the same meaning as those terms in 45
CFR 160.103 and 164.501, and in the HITECH Act, Subtitle D.
“Agency” means the Department of Management Services, an executive agency of the State of Florida, and
its Division of State Group Insurance with a place of business at 4050 Esplanade Way, Suite 215,
Tallahassee, FL 32399-0950.
“Contract Provider” or “Contract Providers” mean the third party administrator of the State of Florida
Pharmacy program and any other entity for which the Covered Entity requires audit services as prescribed
in the Contract, including section 1.03 of the Contract.
"Covered Entity" means the State of Florida’s Division of State Group Insurance.
“Individual” has the same meaning as the term “individual” in 45 CFR 164.501 and shall include a person
who qualifies as a personal representative in accordance with 45 CFR 164.502(g).
“Parties” mean collectively the Agency and the Contract Provider. A “party” means either the Agency or the
Contract Provider.
“Plan” means the insurance coverages offered through the Covered Entity, as authorized in section 110.123,
Florida Statutes.
ITN No.: DMS-10/11-030 Page 54 of 63
“Privacy Rule” means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR
part 160 and part 164, subparts A and E.
“Protected Health Information” is defined in HIPAA at 45 CFR 160.103, and as used in this Agreement also
refers to the term “Protected Health Information,” as defined in the HITECT Act.
“Secretary” means the Secretary of the U.S. Department of Health and Human Services or designee.
“Security Incident” means any event resulting in computer systems, networks, or data being viewed,
manipulated, damaged, destroyed or made inaccessible by an unauthorized activity. See National Institute of
Standards and Technology (NIST) Special Publication 800-61, "Computer Security Incident Handling
Guide,” for more information.
“Third Party Administrator” means BlueCross Blue Shield of Florida, Inc.
Part I – Privacy Provisions
2.0 Obligations and Activities of Contract Provider
(a) Contract Provider agrees to not use or further disclose Protected Health Information other than as
permitted or required by Sections 3.0, 5.0 and 6.0 of this Agreement, or as required by applicable federal or
laws of the state of Florida.
(b) Contract Provider agrees to use appropriate safeguards to prevent use or disclosure of the Protected
Health Information other than as provided for by this Agreement.
(c) Contract Provider agrees to mitigate, to the extent practicable, any harmful effect that is known to
Contract Provider of a use or disclosure of Protected Health Information by Contract Provider in violation of
the requirements of this Agreement.
(d) Contract Provider agrees to report to Covered Entity any use or disclosure of the Protected Health
Information not provided for by this Agreement of which it becomes aware.
(e) Contract Provider agrees to ensure that any agent, including a subcontractor, to whom it provides
Protected Health Information received from, or created or received by Contract Provider on behalf of
Covered Entity, agrees to the same restrictions and conditions that apply through this Agreement to Contract
Provider with respect to such information.
(f) Contract Provider agrees to provide access, at the request of Covered Entity or an Individual, and in a
prompt and reasonable manner consistent with the HIPAA regulations, to Protected Health Information in a
designated record set, to the Covered Entity or directly to an Individual in order to meet the requirements
under 45 CFR 164.524.
(g) Contract Provider agrees to make any Amendment(s) to Protected Health Information in a designated
record set that the Covered Entity or an Individual directs or agrees to pursuant to 45 CFR 164.526, in a
prompt and reasonable manner consistent with the HIPAA regulations.
(h) Contract Provider agrees to make its internal practices, books, and records, including policies and
procedures and Protected Health Information, relating to the use and disclosure of Protected Health
Information received from, or created or received by Contract Provider on behalf of Covered Entity available
to the Covered Entity, or at the request of the Covered Entity, to the Secretary in a time and manner
ITN No.: DMS-10/11-030 Page 55 of 63
designated by the Covered Entity or the Secretary, for purposes of the Secretary determining Covered
Entity's compliance with the Privacy Rule.
(i) Contract Provider agrees to document disclosures of Protected Health Information and information
related to such disclosures as would be required for Covered Entity to respond to a request by an Individual
for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.
(j) Contract Provider agrees to provide to Covered Entity or an Individual an accounting of disclosures
of Protected Health Information in accordance with 45 CFR 164.528, in a prompt and reasonable manner
consistent with the HIPAA regulations.
(k) Contract Provider certifies that it is in compliance with all applicable provisions of HIPAA standards
for electronic transactions and code sets, also known as the Electronic Data Interchange (EDI) Standards, at
45 CFR Part 162; and the Annual Guidance as issued by the Secretary pursuant to the HITECH Act, sec.
13401.Contract Provider further agrees to ensure that any agent, including a subcontractor, that conducts
standard transactions on its behalf, will comply with the EDI Standards and the Annual Guidance.
(l) Contract Provider agrees to determine the Minimum Necessary type and amount of PHI required to
perform its services and will comply with 45 CFR 164.502(b) and 514(d).
3.0 Permitted or Required Uses and Disclosures by Contract Provider General Use and Disclosure.
(a) Except as expressly permitted in writing by DMS/ DSGI, Contract Provider shall not divulge, disclose,
or communicate protected health information to any third party for any purpose not in conformity with this
Contract without prior written approval from the Covered Entity.
(b) Except as otherwise limited in this Agreement, Contract Provider may use Protected Health
Information to provide data aggregation services to Covered Entity as permitted by 45 CFR
164.504(e)(2)(i)(B).
(c) Contract Provider may use Protected Health Information to report violations of law to appropriate
Federal and State authorities, consistent with 45 CFR 164.502(j) (1).
4.0. Obligations of Covered Entity to Inform Contract Provider of Covered Entity’s Privacy Practices, and
any Authorization or Restrictions.
(a) Covered Entity shall provide Contract Provider with the notice of privacy practices that Covered
Entity produces in accordance with 45 CFR 164.520, as well as any changes to such notice.
(b) Covered Entity shall provide Contract Provider with any changes in, or revocation of, Authorization
by Individual or his or her personal representative to use or disclose Protected Health Information, if such
changes affect Contract Provider's uses or disclosures of Protected Health Information.
(c) Covered Entity shall notify Contract Provider of any restriction to the use or disclosure of Protected
Health Information that Covered Entity has agreed to in accordance with 45 CFR 164.522, if such changes
affect Contract Provider's uses or disclosures of Protected Health Information
5.0 Permissible Requests by Covered Entity
Covered Entity shall not request Contract Provider to use or disclose Protected Health Information in any
manner that would not be permissible under HIPAA, the Privacy Rule, and the HITECH Act and of the laws
of the State of Florida, if done by Covered Entity.
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6.0 Termination
(a) Protected Health Information. Prior to the termination of this Agreement, the Contract Provider shall
destroy or return to the Covered Entity all of the Protected Health Information provided by Covered Entity to
Contract Provider, or created or received by Contract Provider on behalf of Covered Entity. If it is infeasible
or impossible to return or destroy Protected Health Information, the Contract Provider shall immediately
inform the Covered Entity of that and the parties shall cooperate in securing the destruction of Protected
Health Information, or its return to the Covered Entity. Pending the destruction or return of the Protected
Health Information to the Covered Entity, protections are extended to such information, in accordance with
the termination provisions in this Section.
(b) Termination for Cause. Without limiting any other termination rights the parties may have, upon
Covered Entity's knowledge of a material breach by Contract Provider of a provision under this Agreement,
Covered Entity shall provide an opportunity for Contract Provider to cure the breach or end the violation. If
the Agreement of Contract Provider does not cure the breach or end the violation within the time specified
by Covered Entity, the Covered Entity shall have the right to immediately terminate the Agreement. If
neither termination nor cure is feasible, Covered Entity shall report the violation to the Secretary.
(c) Effect of Termination. Within sixty (60) days after termination of the Agreement for any reason, or
within such other time period as mutually agreed upon in writing by the parties, Contract Provider shall
return to Covered Entity or destroy all Protected Health Information maintained by Contract Provider in any
form and shall retain no copies thereof. Contract Provider also shall recover, and shall return or destroy with
such time period, any Protected Health Information in the possession of its subcontractors or agents. Within
fifteen (15) days after termination of the Agreement for any reason, Contract Provider shall notify Covered
Entity in writing as to whether Contract Provider elects to return or destroy such Protected Health
Information, or otherwise as set forth in this Section 7.0(c). If Contract Provider elects to destroy such
Protected Health Information, it shall certify to Covered Entity in writing when and that such Protected
Health Information has been destroyed. If any subcontractors or agents of the Contract Provider elect to
destroy the Protected Health Information, Contract Provider will require such subcontractors or agents to
certify to Contract Provider and to Covered Entity in writing when such Protected Health Information has
been destroyed. If it is not feasible for Contract Provider to return or destroy any of said Protected Health
Information, Contract Provider shall notify Covered Entity in writing that Contract Provider has determined
that it is not feasible to return or destroy the Protected Health Information and the specific reasons for such
determination. Contract Provider further agrees to extend any and all protections, limitations, and
restrictions set forth in this Agreement to Contract Provider’s use or disclosure of any Protected Health
Information retained after the termination of this Agreement, and to limit any further uses or disclosures to
the purposes that make the return or destruction of the Protected Health Information not feasible. If not
feasible for Contract Provider to obtain, from a subcontractor or agent, any Protected Health Information in
the possession of the subcontractor or agent, Contract Provider shall provide a written explanation to
Covered Entity and require the subcontractors and agents to agree to extend any and all protections,
limitations, and restrictions set forth in this Agreement to the subcontractors’ or agents’ uses or disclosures
of any Protected Health Information retained after the termination of this Agreement, and to limit any further
uses or disclosures to the purposes that make the return or destruction of the Protected Health Information
not feasible.
ITN No.: DMS-10/11-030 Page 57 of 63
Part II – Security Addendum
7.0 Security
WHEREAS, Contract Provider and the Agency agree to also address herein the applicable
requirements of the Security Rule, codified at 45 Code of Federal Regulations (“C.F.R.”) Part 164, Subparts
A and C, issued pursuant to the Administrative Simplification provisions of Title II, Subtitle F of the Health
Insurance Portability and Accountability Act of 1996 (“HIPAA-AS”), so that the Covered Entity may meet
compliance obligations under HIPAA-AS, the parties agree:
(a) Security of Electronic Protected Health Information. Contract Provider will develop, implement,
maintain, and use administrative, technical, and physical safeguards that reasonably and appropriately protect
the confidentiality, integrity, and availability of Electronic Protected Health Information (as defined in 45
C.F.R. § 160.103) that Contract Provider creates, receives, maintains, or transmits on behalf of the Plans
consistent with the Security Rule.
(b) Reporting Security Incidents. Contract Provider will report to the Plans any incident of which
Contract Provider becomes aware that is (1) a successful unauthorized access, use or disclosure of the Plans’
Electronic Protected Health Information; or (2) a successful major (a) modification or destruction of the
Plans’ Electronic Protected Health Information or (b) interference with system operations in an information
system containing the Plans’ Electronic Protected Health Information. Upon the Plans’ request, Contract
Provider will report any incident of which Contract Provider becomes aware that is a successful minor (a)
modification or destruction of the Plans’ Electronic Protected Health Information or (b) interference with
system operations in an information system containing the Plans’ Electronic Protected Health Information.
Part III -HITECH REPORTING REQUIREMENTS
8.0 HITECH
I n the event of any inconsistency or conflict between Part II and Part III, the more stringent provision shall
apply.
(a) Applicability of HITECH and HIPAA Privacy Rule and Security Rule Provisions. Title XIII of
the American Recovery and Reinvestment Act of 2009 (ARRA), also known as the Health Information
Technology Economic and Clinical Health (HITECH) Act, requires a Contract Provider that contracts with
the Agency, a HIPAA covered entity, to comply with the provisions of the HIPAA Privacy and Security
Rules (45 C.F.R. 160 and 164).
(b). Reporting. The Contract Provider shall make a good faith effort to identify any use or disclosure of
protected health information not provided for in this Contract.
(c) To Covered Entity. The Contract Provider will report to the Covered Entity, within ten (10)
business days of discovery, any use or disclosure of protected health information not provided for in this
Contract of which the Contract Provider is aware. The Contract Provider will report to the Covered Entity,
within twenty-four (24) hours of discovery, any security incident of which the Contract Provider is aware. A
violation of this paragraph shall be a material violation of this Contract. Such notice shall include the
identification of each individual whose unsecured protected health information has been, or is reasonably
believed by the Contract Provider to have been, accessed, acquired, or disclosed during such breach.
(d) To Individuals. In the case of a breach of protected health information discovered by the Contract
Provider, the Contract Provider shall first notify the Covered Entity of the pertinent details of the breach and
upon prior approval of the Covered Entity shall notify each individual whose unsecured protected health
ITN No.: DMS-10/11-030 Page 58 of 63
information has been, or is reasonably believed by the Contract Provider to have been, accessed, acquired or
disclosed as a result of such breach. Such notification shall be in writing by first-class mail to the individual
(or the next of kin if the individual is deceased) at the last known address of the individual or next of kin,
respectively, or, if specified as a preference by the individual, by electronic mail. Where there is
insufficient, or out-of-date contract information (including a phone number, email address, or any other form
of appropriate communication) that precludes written (or, if specifically requested, electronic) notification to
the individual, a substitute form of notice shall be provided, including, in the case that there are 10 or more
individuals for which there is insufficient or out-of-date contact information, a conspicuous posting on the
Web site of the covered entity involved or notice in major print of broadcast media, including major media
in the geographic areas where the individuals affected by the breach likely reside. In any case deemed by
the Contract Provider to require urgency because of possible imminent misuse of unsecured protected health
information, the Contract Provider may also provide information to individuals by telephone or other means,
as appropriate.
(e) To Media. In the case of a breach of protected health information discovered by the Contract
Provider where the unsecured protected health information of more than 500 persons is reasonably believed
to have been, accessed, acquired, or disclosed, after prior approval by the Covered Entity, the Contract
Provider shall provide notice to prominent media outlets serving the State or relevant portion of the State
involved.
(f) To Secretary of Health and Human Services. The Contract Provider shall cooperate with the
Covered Entity to provide notice to the Secretary of Health and Human Services of unsecured protected
health information that has been acquired or disclosed in a breach. If the breach was with respect to 500 or
more individuals, such notice must be provided immediately. If the breach was with respect to less than 500
individuals, the Contract Provider may maintain a log of such breach occurring and annually submit such log
to the Covered Entity so that it may satisfy its obligation to notify the Secretary of Health and Human
Services documenting such breaches occurring in the year involved.
(g) Content of Notices. All notices required under this Attachment shall include the content set forth
Section 13402(f), Title XIII of the American Recovery and Reinvestment Act of 2009, except that references
therein to a “covered entity” shall be read as references to the Contract Provider.
(h) Financial Responsibility. The Contract Provider shall be responsible for all costs related to the
notices required under this Attachment.
(i) Mitigation. Contract Provider shall mitigate, to the extent practicable, any harmful effect that is
known to the Contract Provider of a use or disclosure of protected health information in violation of this
Attachment.
Part IV - Confidentiality
5.0 Subpoenas
In addition to the HIPAA privacy requirements, Business Associate agrees to observe the confidentiality
requirements of section 110.123 (9), Florida Statutes. In general, the referenced statute provides that patient
medical records and medical claims records of state employees, former state employees, and their covered
dependents are confidential and exempt from the provisions of section 119.07 (1), Florida Statutes, known as
the public records law of the State of Florida. Any person who willfully, knowingly, and without
authorization discloses or takes data, programs, or supporting documentation, including those residing or
existing internal and external to the DMS/DSGI computer system, commits an offense in violation of section
815.04, Florida Statutes.
ITN No.: DMS-10/11-030 Page 59 of 63
(a) Confidentiality requirements protect more than unlawful disclosure of documents. The confidentiality
requirements protect the disclosure of all records and information of DMS/DSGI, in whatever form,
including the copying or verbally relaying of confidential information.
(b) Receipt of a Subpoena. If Business Associate is served with subpoena requiring the production of
DMS/DSGI records or information, Business Associate shall immediately contact the Department of
Management Services, Office of the General Counsel, (850) 487-1082.
(c) A subpoena (c) A subpoena is an official summons issued by a court or an administrative tribunal, which requires the
recipient to do one or more of the following:
i. Appear at a deposition to give sworn testimony, and may also require that certain records be brought to
be examined as evidence.
ii. Appear at a hearing or trial to give evidence as a witness, and may also require that certain records be
brought to be examined as evidence.
iii. Furnish certain records for examination, by mail or by hand-delivery.
(d) Employees and Agents. Business Associate acknowledges that the confidentiality requirements
herein apply to all its employees, agents and representatives. Business Associate assumes responsibility and
liability for any damages or claims, including state and federal administrative proceedings and sanctions,
against DMS/DSGI, including costs and attorneys' fees, resulting from the breach by Business Associate of
the confidentiality requirements of this Agreement.
(e) Employees and Agents. Business Associate acknowledges that the confidentiality requirements
herein apply to all its employees, agents and representatives. Business Associate assumes responsibility and
liability for any damages or claims, including state and federal administrative proceedings and sanctions,
against DMS/DSGI, including costs and attorneys' fees, resulting from the breach by Business Associate of
the confidentiality requirements of this Agreement.
Part V Confidentiality
6.0 Audit
(a) Confidential Information. The Covered Entity has requested that the TPA or Contract Providers
disclose to the Business Associate certain documents, statistical information and other information that the
TPA or Contract Providers have determined to be commercially valuable, confidential, proprietary, or other
trade secret (“Proprietary Information”) and also materials which may contain confidential health
information as defined under 45 C.F.R. Part 160 (“Confidential Health Information”), shall collectively
referred to in this Part V as “Confidential Information.” The term “Confidential Information” shall not
include information: (i) generally available to the public prior to or during the time of the Services through
authorized disclosure; or (ii) obtained from a third party.
(b) Confidential Information disclosed to the Business Associate by the TPA or Contract Providers in
connection with the services rendered under the Contract, shall be used by the Business Associate only as
permitted by this Agreement.
(c) Systems Access. If The TPA or Contract Providers grant Business Associate the right to access the
benefit administration systems (“Systems”) that the TPA or Contract Providers make available to facilitate
the transfer of Confidential Information, the following conditions apply. The Systems, and any
documentation with respect to the Systems, shall be treated as Proprietary Information as defined in this Part
ITN No.: DMS-10/11-030 Page 60 of 63
V of the Agreement and subject to the same confidentiality restrictions contained herein. This right is
nonexclusive and nontransferable, and all rights, title and interest in the Systems remain the property of the
TPA or Contract Providers. Business Associate shall not share, lease or otherwise transfer its right to access
and use the Systems to any other person or entity.
(d) In accessing and using the Systems, Business Associate shall use commercially reasonable security
measures, including measures to protect: (a) the confidentiality of user identification and passwords and (b)
data accessed through the Systems from unauthorized access or damage, including damage by computer
viruses. Business Associate also agrees to comply with security measures of which it is notified. Business
Associate will notify the TPA or Contract Provider immediately if : (a) any breach of the security
procedures is suspected or has occurred; and/or (b) an employee no longer needs Systems access due to
termination of employment, or otherwise, so that the TPA or Contract Provider may deactivate the
employee’s identification number or password.
(e) The TPA and Contract Providers reserve the right to terminate the Business Associate’ s Systems
access at any time. System Access will automatically terminate on the date Business Associate’s business
relationship with Covered Entity ends. Upon termination of Systems access, Business Associate will cease
all use of the Systems.
(f) Electronic Transmission. If Business Associate receives Confidential Information from the TPA or
Contract Provider via electronic means such as FTP transmission, Business Associate shall use reasonable
physical and software-based security measures, commonly used in the electronic data interchange field, to
protect Confidential Information sent to, or received from, the TPA or Contract Providers. Business
Associate shall implement and comply with, and shall not attempt to circumvent or bypass, the TPA’s or
Contract Providers’ security procedures for the use of the electronic method of Confidential Information
transmission. Business Associate shall notify the TPA or Contract Provider immediately if Business
Associate is aware of any breach of the security procedures, such as unauthorized use, or if Business
Associate suspects such a breach. The TPA and Contract Providers reserve the right to terminate electronic
transmission immediately on the date the TPA or Contract Providers reasonably determine that Business
Associate has breached, or allowed a breach of, this provision of the Confidentiality Agreement. The TPA
and Contract Provider also reserve the right to change or upgrade its method of Confidential Information
transmission with reasonable notice to Business Associate.
(g) Permitted Uses. Business Associate: (a) shall not use (deemed to include, but not be limited to,
using, exploiting, duplicating, recreating, modifying, decompiling, disassembling, reverse engineering,
translating, creating derivative works, adding to a Business Associate database, or disclosing Confidential
Information to another person or permitting any other person to do so) Confidential Information except for
purposes of the Services; (b) shall limit use of Confidential Information only to its authorized employees
(deemed to include employees as well as individuals who are agents or independent contractors of Business
Associate) who have a need to know for purposes of the Services and who have been advised of the
existence and terms of this Confidentiality Agreement and the obligations of confidentiality herein; (c) shall
comply with all applicable laws and regulations governing the use and disclosure of information (d) shall use
and require its employees to use, at least the same degree of care to protect the Confidential Information as is
used with Business Associate’s own proprietary and confidential information; and (e) may release
Confidential Information in response to a subpoena or other legal process to disclose Confidential
Information, after giving the TPA or Contract Providers reasonable prior notice of such disclosure.
ITN No.: DMS-10/11-030 Page 61 of 63
(h) Breach. If during the course of the Services it is discovered that this Confidentiality Agreement has
been breached by Business Associate then all Confidential Information shall be relinquished to The TPA or
Contract Provider upon demand.
(i) Indemnification. Unauthorized use of Confidential Information by Business Associate is a material
breach of this Confidentiality Agreement, which the TPA and Contract Providers may maintain will result in
irreparable harm to the TPA or Contract Providers for which the payment of money damages is inadequate.
Business Associate agree to indemnify and hold harmless the TPA or Contract Providers with respect to any
claims and any damages caused by Business Associate’ breach of this Confidentiality Agreement and/or
resulting from Business Associate’ Systems access, if such access has been granted.
Part VI
9.0 Miscellaneous
Regulatory References. A reference in this Agreement to a section in the Privacy Rule, the Security Rule or the
HITECH Act means the section as in effect or as amended, and for which compliance is required.
Amendment. Upon the enactment of any law or regulation affecting the use or disclosure of Protected Health
Information, Standard Transactions, the security of Health Information, or other aspects of HIPAA-AS or the
HITECH Act applicable or the publication of any decision of a court of the United States or any state relating to
any such law or the publication of any interpretive policy or opinion of any governmental agency charged with the
enforcement of any such law or regulation, either party may, by written notice to the other party, amend this
Agreement in such manner as such party determines necessary to comply with such law or regulation. If the other
party disagrees with such Amendment, it shall so notify the first party in writing within thirty (30) days of the
notice. If the parties are unable to agree on an Amendment within thirty (30) days thereafter, then either of the
parties may terminate the Agreement on thirty (30) days written notice to the other party.
Survival. The requirements as to the treatment of all Confidential Information, Confidential Health Information
and Protected Health Information hereunder shall survive the termination of this Agreement. The requirement to
treat all Proprietary Information as Confidential Information under this Confidentiality Agreement shall remain in
full force and effect so long as any Proprietary Information remains commercially valuable, confidential,
proprietary and/or trade secret, but in no event less than a period of three (3) years from the date of the Services.
Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a meaning that permits Covered
Entity to comply with the Privacy Rule and the confidentiality requirements of this Agreement.
No third party beneficiary. Nothing expressed or implied in this Agreement is intended to confer, nor shall
anything herein confer, upon any person other than the parties and the TPA and Contract Providers and the
respective successors or assignees of the parties, any rights, remedies, obligations, or liabilities whatsoever.
Governing Law and Venue. This Agreement shall be governed by and construed in accordance with the laws of
the state of Florida to the extent not preempted by the Privacy Rules or other applicable federal law. The venue of
any proceedings shall be the appropriate federal or state court or administrative tribunal in Leon County, Florida.
Indemnification and performance guarantees. Business Associate shall indemnify, defend, and save
harmless the State of Florida and Individuals covered by the Plans for any financial loss as a result of claims
brought by third parties and which are caused by the failure of Business Associate, its officers, directors or agents
to comply with the terms of this Agreement.
ITN No.: DMS-10/11-030 Page 62 of 63
Assignment. Business Associate shall not assign either its obligations or benefits under this Agreement without
the expressed written consent of the Covered Entity, which shall be at the sole discretion of the Covered Entity.
Given the nature of this Agreement, neither subcontracting nor assignment by the Contract Provider is anticipated
and the use of those terms herein does not indicate that permission to assign or subcontract has been granted.
Counterparts: This Agreement may be executed in any number of counterparts, which together shall be
deemed one original, and delivery of copies of signatures or facsimile signatures shall be deemed of equal
force as delivery of original signatures.
General: (i) This Agreement is the entire understanding between the parties as to the subject matter hereof.
(ii) This Agreement binds the parties and their respective successors, assigns, agents, employers, subsidiaries
and affiliates. (iii) No modification to this Agreement shall be binding upon the parties unless evidenced in
writing signed by the party against whom enforcement is sought. (iv) Headings in this Agreement shall not
be used to interpret or construe its provisions. (v) The alleged invalidity of any term shall not affect the
validity of any other terms.
The parties have caused their authorized representatives to execute this Agreement.
For the Agency: For the Business Associate:
Department of Management Services
By: By:
Michelle Robleto, Director (Print Name and Title)
Division of State Group Insurance
Date: Date:
Approved as to form and legality:
Office of the General Counsel
Date:
ITN No.: DMS-10/11-030 Page 63 of 63
ATTACHMENT 13
APPLICATION FOR PREFERENCE AS A FLORIDA-BASED COMPANY
Chapter 2010-151, Laws of Florida, Section 49, grants a preference in certain procurements to Respondents
whose principal place of business is in the State of Florida. To receive this preference the undersigned
Respondent hereby certifies and agrees as follows:
A. Respondent currently maintains its principal place of business in the State of Florida. The
term “principal place of business” is defined as a company’s “nerve center” as discussed in
Hertz Corp. vs. Friend, 130 S.Ct 1181 (2010). [Under the “nerve center” test, a company is
deemed to have ONLY ONE principal place of business.]
B. Respondent has no current plans to move its principal place of business out of the State of
Florida.
C. Respondent agrees to maximize the use of state of Florida residents, state of Florida products,
and other Florida-based businesses in fulfilling its duties under the prospective contract. This
requirement shall not be construed in any way to infringe on any right of a non-Florida
resident to work for the Respondent on the prospective contract.
RESPONDENT’S NAME: ________________________________________________
By:________________________________________ Date:____________________________
Name/Title: _____________________________________
