Kyle L. Janek, M.D., Executive Kyle L. Janek, M.D., Executive CommissionerCommissioner

VENDOR CONFERENCEVENDOR CONFERENCEExternal Quality Review External Quality Review

Organization (EQRO)Organization (EQRO) Request for Proposal No. 529-13-Request for Proposal No. 529-13-

00460046

December 12, 2013December 12, 2013

WelcomeWelcome

IntroductionsIntroductions Elizabeth Ward,Elizabeth Ward, Procurement and Procurement and

Contracting Services (PCS)Contracting Services (PCS) Frank Genco, Quality Manager, HHSC Frank Genco, Quality Manager, HHSC

Medicaid/CHIP DivisionMedicaid/CHIP Division Sherice Williams, HUB Administrator, Sherice Williams, HUB Administrator,

PCSPCS James Ramirez, Asst. General Counsel, James Ramirez, Asst. General Counsel,

and Diana Crumley, Special Counseland Diana Crumley, Special Counsel Housekeeping ItemsHousekeeping Items

HHSC Procurement RolesHHSC Procurement Roles

PCS- Responsible for procurement PCS- Responsible for procurement activityactivity

Program- Responsible for project Program- Responsible for project scope, scope, requirements, performance, requirements, performance,

results, contract results, contract management/monitoringmanagement/monitoring

HUB - HUB -

Legal- Questions/answers and legal Legal- Questions/answers and legal activityactivity

Vendor Conference OverviewVendor Conference Overview

Procurement ActivitiesProcurement Activities RFP OverviewRFP Overview Legal OverviewLegal Overview QuestionsQuestions Break Break Preliminary Responses to Preliminary Responses to

QuestionsQuestions ClosingClosing

Procurement ActivitiesProcurement Activities

Sole Point of Contact -- Section 1.2Sole Point of Contact -- Section 1.2 Procurement Schedule -- Section Procurement Schedule -- Section

1.3 1.3 Solicitation Access Solicitation Access

http://www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asp

Submission Requirements – Section Submission Requirements – Section 3.143.14

Solicitation ChangesSolicitation Changes Proposal Screening and EvaluationProposal Screening and Evaluation Award InformationAward Information

Sole Point of Contact Sole Point of Contact

The sole and only permissible point of The sole and only permissible point of contact for inquiries concerning this RFP contact for inquiries concerning this RFP is Elizabeth Ward.is Elizabeth Ward.

As a reminder, all communications As a reminder, all communications relating to this RFP must be directed to relating to this RFP must be directed to the sole point of contact for this the sole point of contact for this procurement. procurement. Failure to comply with these Failure to comply with these requirements may result in proposal requirements may result in proposal disqualificationdisqualification

Procurement ScheduleProcurement Schedule

RFP Release Date December 3, 2013RFP Release Date December 3, 2013 Vendor Conference December 12, Vendor Conference December 12,

20132013 Respondent Questions Due December 17, Respondent Questions Due December 17,

20132013 Post Response to Questions Post Response to Questions (est.) (est.) December 31, December 31,

20132013 Proposals Due (Proposals Due (2:00 PM Central Time)2:00 PM Central Time) January 16, 2014 January 16, 2014 Deadline for Proposal Withdrawal January 16, 2014Deadline for Proposal Withdrawal January 16, 2014 Tentative Award PostingTentative Award Posting (est.) (est.) May 13, 2014May 13, 2014 Anticipated Contract Start Date December 18, Anticipated Contract Start Date December 18,

20142014

RFP OverviewRFP Overview Mission Mission OverviewOverview ObjectiveObjective Terms of the ContractTerms of the Contract EQRO and Quality Vendor EQRO and Quality Vendor

Responsibilities (Scope of Work)Responsibilities (Scope of Work) Evaluation CriteriaEvaluation Criteria

Request for Proposals No. 529-13-0046Request for Proposals No. 529-13-0046

MissionMission

The mission of HHSC is to maintain The mission of HHSC is to maintain and improve the health and human and improve the health and human services system in Texas and to services system in Texas and to administer its programs in administer its programs in accordance with the highest accordance with the highest standards of customer service and standards of customer service and accountability for the effective use of accountability for the effective use of funds.funds.

OverviewOverview HHSC is soliciting competitive proposals HHSC is soliciting competitive proposals

from qualified organizations to review the from qualified organizations to review the quality of healthcare provided to the clients quality of healthcare provided to the clients enrolled in the Medicaid and CHIP enrolled in the Medicaid and CHIP programs.programs.

HHSC will contract with an EQRO Vendor HHSC will contract with an EQRO Vendor who will perform external quality review who will perform external quality review (EQR) and EQR-related activities, and a (EQR) and EQR-related activities, and a Quality Vendor, who will be responsible for Quality Vendor, who will be responsible for statistical support, evaluation, targeted statistical support, evaluation, targeted analysis, and other quality-related activities.analysis, and other quality-related activities.

OverviewOverview

State Medicaid programs are State Medicaid programs are required to contract with an required to contract with an independent EQRO for the purpose independent EQRO for the purpose of EQR.of EQR.

CHIP Managed Care Organizations CHIP Managed Care Organizations (MCOs) are subject to the same (MCOs) are subject to the same external review process as Medicaid external review process as Medicaid MCOs.MCOs.

OverviewOverview

Sections 1932(c) and 2103(f)(3) of the Sections 1932(c) and 2103(f)(3) of the Social Security Act describe how a Social Security Act describe how a state should develop a quality state should develop a quality assessment and improvement strategy assessment and improvement strategy for its Medicaid and CHIP managed for its Medicaid and CHIP managed care programs.care programs.

Under 42 C.F.R. § 438.356, a state Under 42 C.F.R. § 438.356, a state must contract with an EQRO to must contract with an EQRO to perform external quality review (EQR).perform external quality review (EQR).

OverviewOverview

Each contract with an MCO must Each contract with an MCO must provide for an annual external, provide for an annual external, independent review of the quality independent review of the quality outcomes and the timeliness of, and outcomes and the timeliness of, and access to, the services each MCO is access to, the services each MCO is responsible for under the contract.responsible for under the contract.

OverviewOverview The EQRO The EQRO

Vendor and Vendor and Quality Vendor Quality Vendor will review the will review the following state following state managed care managed care programs.programs.

Children’s Children’s Medicaid Dental Medicaid Dental ServicesServices

CHIP Dental CHIP Dental ServicesServices

CHIPCHIP STARSTAR STAR+PLUSSTAR+PLUS STAR HealthSTAR Health NorthSTARNorthSTAR

ObjectiveObjective

HHSC’s objective in this HHSC’s objective in this procurement is to develop an procurement is to develop an integrated approach to quality integrated approach to quality assessment and improvement that assessment and improvement that leads to measurable quality leads to measurable quality improvement initiatives in all areas improvement initiatives in all areas of managed care contracting and of managed care contracting and service delivery.service delivery.

Terms of the ContractTerms of the Contract HHSC will award one or more HHSC will award one or more

contracts for administrative services.contracts for administrative services.

The initial contract period will be a The initial contract period will be a three-year period.three-year period.

HHSC reserves the option to amend the HHSC reserves the option to amend the term of the contract for up to two one-term of the contract for up to two one-year options, or as necessary to year options, or as necessary to complete the mission of this complete the mission of this procurement.procurement.

EQRO Vendor Scope of WorkEQRO Vendor Scope of Work

EQR means the analysis and EQR means the analysis and evaluation by an EQRO of evaluation by an EQRO of aggregated information on quality, aggregated information on quality, timeliness and access to the timeliness and access to the healthcare services that an MCO or healthcare services that an MCO or PIHP, or its contractors, furnishes to PIHP, or its contractors, furnishes to beneficiaries.beneficiaries.

EQRO Vendor Scope of WorkEQRO Vendor Scope of Work A qualified EQRO must perform an annual A qualified EQRO must perform an annual

EQR for each contracting Medicaid MCO, EQR for each contracting Medicaid MCO, Medicaid PIHP, and CHIP MCO.Medicaid PIHP, and CHIP MCO.

Potential respondents are encouraged to Potential respondents are encouraged to acquaint themselves with the EQRO acquaint themselves with the EQRO federal rules and guidelines.federal rules and guidelines.

The EQRO Vendor will utilize these The EQRO Vendor will utilize these protocols as guidelines.protocols as guidelines.

EQRO Vendor Scope of WorkEQRO Vendor Scope of Work EQRO federal rules and guidelines EQRO federal rules and guidelines

include protocols for conducting include protocols for conducting EQR-related activities including:EQR-related activities including:

Protocols for conducting focus Protocols for conducting focus studies;studies;

Validating performance measures; Validating performance measures; Calculating performance measures;Calculating performance measures; Validating performance improvement Validating performance improvement

projects; andprojects; and Validating encounter data.Validating encounter data.

Quality Vendor Scope of Quality Vendor Scope of WorkWork

For the purpose of this proposal, the Quality For the purpose of this proposal, the Quality Vendor will be responsible for statistical Vendor will be responsible for statistical support, evaluation, targeted analysis, and support, evaluation, targeted analysis, and other quality-related activities.other quality-related activities.

For example: For example: Conduct rate-setting data analysis activities;Conduct rate-setting data analysis activities; Conduct annual certification that determines whether Conduct annual certification that determines whether

MCO and PIHP encounter data are complete and MCO and PIHP encounter data are complete and accurate;accurate;

Prepare ad-hoc reports based on administrative data to Prepare ad-hoc reports based on administrative data to support specific assessment/evaluation functions;support specific assessment/evaluation functions;

Perform ad-hoc data analytics to support state legislation; Perform ad-hoc data analytics to support state legislation; and and

Conduct independent evaluation and analysis for federal Conduct independent evaluation and analysis for federal grant initiatives awarded to HHSC. grant initiatives awarded to HHSC.

Evaluation CriteriaEvaluation Criteria

HHSC will evaluate each proposal HHSC will evaluate each proposal using the following criteria:using the following criteria:The quality and reliability of the The quality and reliability of the goods and services;goods and services;

The extent to which the goods and The extent to which the goods and services meet the agency needs;services meet the agency needs;

Evaluation CriteriaEvaluation Criteria Indicators of probable performance under Indicators of probable performance under

the contract such as past performance, the the contract such as past performance, the respondent’s financial resources, and the respondent’s financial resources, and the respondent’s experience and ability to respondent’s experience and ability to provide reliable maintenance agreements;provide reliable maintenance agreements;

The total long-term cost to the agency of The total long-term cost to the agency of acquiring the vendor’s goods and services; acquiring the vendor’s goods and services; andand

Any other factors relevant to determining Any other factors relevant to determining

the best value for the agency.the best value for the agency.

HUB Subcontracting Plan (HSP) HUB Subcontracting Plan (HSP) RequirementsRequirements

Sherice Williams, Sherice Williams, Procurement and Contracting Services DivisionProcurement and Contracting Services Division

2323

Agenda TopicsAgenda Topics

I.I. RFP Section 4.0 Historically Underutilized RFP Section 4.0 Historically Underutilized

Business Participation Requirements Business Participation Requirements

II.II. HUB Subcontracting Plan Development HUB Subcontracting Plan Development

and Submissionand Submission

III.III. HSP Quick Checklist – HSP Quick Checklist – Handout Handout

IV.IV. HSP Methods – HSP Methods – Section 4.6.2 Section 4.6.2

V.V. HSP Prime Contractor Progress HSP Prime Contractor Progress

Assessment Report – Assessment Report – Section 4.8 Section 4.8 2424

I.I. Historically Underutilized Historically Underutilized

Business Participation Business Participation

RequirementsRequirements

2525

• HUB Participation Goals – HUB Participation Goals – Section 4.3Section 4.3

• Potential Subcontracting Potential Subcontracting Opportunities – Opportunities – Section 4.5 Section 4.5

• Vendor Intends to Subcontract – Vendor Intends to Subcontract – Section 4.6.3 Section 4.6.3

• Centralized Master Bidders List and Centralized Master Bidders List and HUB Directory – HUB Directory – Section 4.5 Section 4.5

I.I. RFP Section 4.0 Historically RFP Section 4.0 Historically

Underutilized Business Participation Underutilized Business Participation

RequirementsRequirements

2626

• Minority or Women Trade Minority or Women Trade Organizations – Organizations – Section 4.6.6 Section 4.6.6

• Self Performance – Self Performance – Section 4.7Section 4.7

• HSP Changes After Contract Award – HSP Changes After Contract Award – Section 4.8 Section 4.8

• Reporting and Compliance with the Reporting and Compliance with the HSP – HSP – Section 4.8Section 4.8

I.I. RFP Section 4.0 Historically RFP Section 4.0 Historically

Underutilized Business Participation Underutilized Business Participation

Requirements (cont.)Requirements (cont.)

2727

II. HUB Subcontracting Plan HUB Subcontracting Plan (HSP) Development and (HSP) Development and

SubmissionSubmission

2828

If HSP is inadequate, response will be rejected

HUB GOALS

Special reminders and instructions

HSP Information

Page2929

III.III. HSP Quick ChecklistHSP Quick Checklist

** See Checklist Handout**** See Checklist Handout**

3030

IV.IV. HSP MethodsHSP Methods

3131

METHOD OPTIONS

A Respondent may choose from one of the following methods when completing the HSP:

•Method I – if 100% of your subcontracting opportunities will be performed using only HUB vendors;

•Method II – if one or more of the subcontracting opportunities identified will be performed using HUB protégé’s;

•Method III – if a combination of HUBs and Non-HUBs are used to perform the subcontracting work identified AND the HUB goal identified in the solicitation is met or exceeded;

3232

METHOD OPTIONS

A Respondent may choose from one of the following methods when completing the HSP ………(continued)

•Method IV – if a combination of HUBs and Non-HUBs are used to perform the subcontracting work identified AND the HUB goal identified in the solicitation is not met or exceeded.

•Method V - if the Respondent intends to self perform all of the work utilizing their own resources, equipment, employees, and supplies.

3333

ALL METHODS

For ALL Methods the following steps are required to be completed:

•Page 1 - Section 1 - Respondent and Page 1 - Section 1 - Respondent and Requisition Information; Requisition Information;

•Page 2 - Company and Requisition Page 2 - Company and Requisition Information Information

•Page 2 - Section 2(a) – Subcontracting Page 2 - Section 2(a) – Subcontracting Intentions Intentions

•Section 4 – Affirmation and SignSection 4 – Affirmation and Sign

3434

Respondent and Requisition Information

HSP Information Page

3535

Company Name and Requisition #

SubcontractingIntentions:

If Yes, Complete Section 2a

If No, Complete Section 2b

3636

Section 4; Affirmation

Signature Affirms that Information Provided isTrue and Correct.

3737

METHOD I

If all (100%) of your subcontracting opportunities will be performed using only HUB vendors, complete:

•All of the steps in Slide 14All of the steps in Slide 14

•Section 2 b. – List all the portions of work you Section 2 b. – List all the portions of work you will subcontract, and indicate the percentage will subcontract, and indicate the percentage of the contract you expect to award to HUB of the contract you expect to award to HUB vendors;vendors;

•Section 2 c. – Yes; Section 2 c. – Yes;

•HSP GFE Method A (Attachment A) – Complete HSP GFE Method A (Attachment A) – Complete this attachment for each subcontracting this attachment for each subcontracting opportunity. opportunity.

3838

Complete Section 2-c; Yes if you will be using only HUBs to perform all Subcontracting Opportunities in 2-b.

Complete Section 2-b; List all the portions of work you will subcontract, and indicate the % of the contract you expect to award to all HUBs.

3939

Complete this attachment (Sections A-1 and A-2) and List Line # and Subcontracting Opportunity.

HSP GFE Method A (Attachment A)

HUB Subcontractor Selection for this Subcontracting Opportunity

4040

METHOD II

If any of your subcontracting opportunities will be performed using HUB protégés, complete:

•All of the steps in Slide 14All of the steps in Slide 14

•Section 2 b. – List all the portions of work Section 2 b. – List all the portions of work you will subcontract, and indicate the you will subcontract, and indicate the percentage of the contract you expect to percentage of the contract you expect to award to HUB vendors;award to HUB vendors;

•HSP GFE Method B (Attachment B) – HSP GFE Method B (Attachment B) – Complete Section B-1 and Section B-2 only Complete Section B-1 and Section B-2 only for each subcontracting opportunity as for each subcontracting opportunity as applicable. applicable.

4141

Skip Sections 2-c and 2-d.

Complete Section 2-b; List all the portions of work you will subcontract, and indicate the % of the contract you expect to award to HUB Protégés.

4242

HSP GFE Method B (Attachment B)

Complete Sections B-1; and

B-2 only for each HUB Protégé subcontracting opportunity.

4343

4444

List the HUB Protégé(s)

HSP GFE Method B

(Attachment B)

METHOD III

If you are subcontracting with HUBs and Non-HUBs, and the aggregate percentage of subcontracting with HUBs in which the HUB Goal identified in the solicitation is met or exceeded , complete:

• All of the steps in Slide 14All of the steps in Slide 14

• Section 2 b. – List all the portions of work you will subcontract, Section 2 b. – List all the portions of work you will subcontract, and and indicate the percentage of the contract you expect to award to indicate the percentage of the contract you expect to award to HUB HUB vendors and Non HUB vendors;vendors and Non HUB vendors;

• Section 2 c. – No;Section 2 c. – No;

• Section 2 d. – Yes; Section 2 d. – Yes;

• HSP GFE Method A (Attachment A) – Complete this attachment HSP GFE Method A (Attachment A) – Complete this attachment for each for each subcontracting opportunity.subcontracting opportunity.

4545

Complete Section 2-c; No to using only HUBs to perform all Subcontracting Opportunities in 2-b.

Complete Section 2-b; List all the portions of work you will subcontract, and indicate the % of the contract you expect to award to HUBs and Non-HUBs.

4646

Complete Section 2-d; Yes, to the Aggregate % of the contract expected to be subcontracted to HUBs to meet or exceed the HUB goal, which you have a contract agreement in place for five (5) years or less.

4747

Complete this attachment (Sections A-1 and A-2) for each subcontracting opportunity.

HSP GFE Method A (Attachment A)

Subcontractor Selection (HUBs and Non-HUBs)

4848

METHOD IV

If you are subcontracting with HUBs and Non-HUBs, and the aggregate percentage of subcontracting with HUBs, holding an existing contract with HUBs for 5 years or less, does not meet or exceed the HUB Goal identified in the solicitation, complete:

• All of the steps in Slide 14All of the steps in Slide 14

• Section 2 b. – List all the portions of work you will subcontract, and indicated the percentage of the contract you expect to award to HUB vendors and Non HUB vendors;

• Section 2 c. – No;

• Section 2 d. – No;

• HSP GFE Method B (Attachment B) – Complete this attachment for each subcontracting opportunity.

4949

Complete Section 2-c; No, to using only HUBs to perform all Subcontracting Opportunities in 2-b.

Complete Section 2-b; List all the portions of workyou will subcontract, and indicated the % of the contract you expect to award to HUBs and Non-HUBs.

5050

Complete Section 2-d; No, to the Aggregate % of the contract expected to be subcontracted to HUBs to meet or exceed the HUB goal, which you have a contract agreement in place for five (5) years or less. 5151

HSP GFE Method B (Attachment B)

Complete Section B-1; and

Section B-2 only for each subcontracting opportunity.

Good Faith Efforts to find Texas Certified HUB Vendors

5252

HSP GFE Method B (Attachment B)

Written Notification Requirements

List 3 HUBs Contacted for this Subcontracting Opportunity

5353

HSP GFE Method B (Attachment B)

Written Notification To Trade Organizations

5454

HSP GFE Method B (Attachment B)

List Trade Organizations Notified with Dates Sent/Accepted.

5555

Provide written justification why a HUB was not selected for this Subcontracting Opportunity

HSP GFE Method B (Attachment B)

5656

METHOD V

If you are not subcontracting any portion of the contract and will be fulfilling the entire contract with your own resources (i.e., equipment, supplies, materials, and/or employees), complete:

• All of the steps in Slide 14All of the steps in Slide 14 •Section 3 – Self Performing Justification; and,

5757

List the specific page(s)/section(s) of your proposal response, OR in the space provided, which explains how your company will perform the entire contract with its own equipment, supplies, materials and/or employees.

Section 3; Self Performing Justification

5858

HUB Subcontracting HUB Subcontracting Opportunity Opportunity

Notification FormNotification Form

5959

METHOD I

Subcontractor notification when/if selected

6060

Sample for Respondent’s Use.

6161

V.V. HSP Prime Contractor HSP Prime Contractor Progress Assessment Progress Assessment

ReportReport

6262

6363

• Required with ALL Pay Requests

• Required even if not subcontracting

• List ALL Sub payments

(HUBs & Non-HUBs)

HSP Prime Contractor Progress

Assessment Report

Texas Health and Human Services Texas Health and Human Services CommissionCommission

Questions SubmittalQuestions Submittal

Followed by BreakFollowed by Break

Vendor Question/ResponseVendor Question/Response

Verbal answers to vendor questions Verbal answers to vendor questions will be provided to the extent will be provided to the extent practicable.practicable.

Responses are not binding until the Responses are not binding until the final written addendum is posted on final written addendum is posted on the HHSC website. HHSC estimates the HHSC website. HHSC estimates the addendum will post by December the addendum will post by December 31, 2013.31, 2013.

Closing CommentsClosing Comments

Texas Health and Human Services Texas Health and Human Services CommissionCommission