Kyle L. Janek, M.D., Executive Commissioner
VENDOR CONFERENCE
External Quality Review Organization
(EQRO)
Request for Proposal No. 529-13-0046
December 12, 2013
Welcome
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Introductions
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Elizabeth Ward, Procurement and Contracting
Services (PCS)
Frank Genco, Quality Manager, HHSC
Medicaid/CHIP Division
Sherice Williams, HUB Administrator, PCS
James Ramirez, Asst. General Counsel, and
Diana Crumley, Special Counsel
Housekeeping Items
HHSC Procurement Roles
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PCS- Responsible for procurement activity
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Program- Responsible for project scope,
requirements, performance,
results, contract
management/monitoring
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HUB -
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Legal- Questions/answers and legal activity
Vendor Conference Overview
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Procurement Activities
RFP Overview
Legal Overview
Questions
Break
Preliminary Responses to Questions
Closing
Procurement Activities
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Sole Point of Contact -- Section 1.2
Procurement Schedule -- Section 1.3
Solicitation Access
http://www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asp
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Submission Requirements – Section 3.14
Solicitation Changes
Proposal Screening and Evaluation
Award Information
Sole Point of Contact
The sole and only permissible point of contact for
inquiries concerning this RFP is Elizabeth Ward.
As a reminder, all communications relating to this
RFP must be directed to the sole point of contact for
this procurement. Failure to comply with these
requirements may result in proposal disqualification
Procurement Schedule
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RFP Release Date
December 3, 2013
Vendor Conference
December 12, 2013
Respondent Questions Due
December 17, 2013
Post Response to Questions (est.) December 31, 2013
Proposals Due (2:00 PM Central Time) January 16, 2014
Deadline for Proposal Withdrawal January 16, 2014
Tentative Award Posting (est.)
May 13, 2014
Anticipated Contract Start Date December 18, 2014
Request for Proposals No. 529-13-0046
RFP Overview
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Mission
Overview
Objective
Terms of the Contract
EQRO and Quality Vendor Responsibilities
(Scope of Work)
Evaluation Criteria
Mission
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The mission of HHSC is to maintain and
improve the health and human services system
in Texas and to administer its programs in
accordance with the highest standards of
customer service and accountability for the
effective use of funds.
Overview
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HHSC is soliciting competitive proposals from
qualified organizations to review the quality of
healthcare provided to the clients enrolled in the
Medicaid and CHIP programs.
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HHSC will contract with an EQRO Vendor who will
perform external quality review (EQR) and EQRrelated activities, and a Quality Vendor, who will be
responsible for statistical support, evaluation, targeted
analysis, and other quality-related activities.
Overview
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State Medicaid programs are required to contract
with an independent EQRO for the purpose of
EQR.
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CHIP Managed Care Organizations (MCOs) are
subject to the same external review process as
Medicaid MCOs.
Overview
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Sections 1932(c) and 2103(f)(3) of the Social
Security Act describe how a state should develop
a quality assessment and improvement strategy
for its Medicaid and CHIP managed care
programs.
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Under 42 C.F.R. § 438.356, a state must contract
with an EQRO to perform external quality
review (EQR).
Overview
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Each contract with an MCO must provide for
an annual external, independent review of the
quality outcomes and the timeliness of, and
access to, the services each MCO is responsible
for under the contract.
Overview
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The EQRO Vendor
and Quality Vendor
will review the
following state
managed care
programs.
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Children’s Medicaid
Dental Services
CHIP Dental Services
CHIP
STAR
STAR+PLUS
STAR Health
NorthSTAR
Objective
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HHSC’s objective in this procurement is to
develop an integrated approach to quality
assessment and improvement that leads to
measurable quality improvement initiatives in all
areas of managed care contracting and service
delivery.
Terms of the Contract
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HHSC will award one or more contracts for
administrative services.
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The initial contract period will be a three-year
period.
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HHSC reserves the option to amend the term of
the contract for up to two one-year options, or
as necessary to complete the mission of this
procurement.
EQRO Vendor Scope of Work
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EQR means the analysis and evaluation by an
EQRO of aggregated information on quality,
timeliness and access to the healthcare services
that an MCO or PIHP, or its contractors,
furnishes to beneficiaries.
EQRO Vendor Scope of Work
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A qualified EQRO must perform an annual EQR for
each contracting Medicaid MCO, Medicaid PIHP, and
CHIP MCO.
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Potential respondents are encouraged to acquaint
themselves with the EQRO federal rules and guidelines.
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The EQRO Vendor will utilize these protocols as
guidelines.
EQRO Vendor Scope of Work
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EQRO federal rules and guidelines include
protocols for conducting EQR-related activities
including:
 Protocols
for conducting focus studies;
 Validating performance measures;
 Calculating performance measures;
 Validating performance improvement projects;
and
 Validating encounter data.
Quality Vendor Scope of Work
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For the purpose of this proposal, the Quality Vendor
will be responsible for statistical support, evaluation,
targeted analysis, and other quality-related activities.
For example:
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Conduct rate-setting data analysis activities;
Conduct annual certification that determines whether MCO and
PIHP encounter data are complete and accurate;
Prepare ad-hoc reports based on administrative data to support
specific assessment/evaluation functions;
Perform ad-hoc data analytics to support state legislation; and
Conduct independent evaluation and analysis for federal grant
initiatives awarded to HHSC.
Evaluation Criteria
HHSC will evaluate each proposal using the
following criteria:
 The quality and reliability of the goods and
services;
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The extent to which the goods and services
meet the agency needs;
Evaluation Criteria
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Indicators of probable performance under the contract
such as past performance, the respondent’s financial
resources, and the respondent’s experience and ability
to provide reliable maintenance agreements;
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The total long-term cost to the agency of acquiring the
vendor’s goods and services; and
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Any other factors relevant to determining the best value
for the agency.
HUB Subcontracting Plan (HSP)
Requirements
Sherice Williams,
Procurement and Contracting Services Division
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Agenda Topics
I. RFP Section 4.0 Historically Underutilized
Business Participation Requirements
II. HUB Subcontracting Plan Development and
Submission
III. HSP Quick Checklist – Handout
IV. HSP Methods – Section 4.6.2
V.
HSP Prime Contractor Progress Assessment
Report – Section 4.8
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I. Historically Underutilized
Business Participation
Requirements
25
I. RFP Section 4.0 Historically Underutilized
Business Participation Requirements
•
HUB Participation Goals – Section 4.3
•
Potential Subcontracting Opportunities –
•
Vendor Intends to Subcontract – Section
•
Centralized Master Bidders List and HUB
Directory – Section 4.5
Section 4.5
4.6.3
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I. RFP Section 4.0 Historically Underutilized
Business Participation Requirements
(cont.)
• Minority or Women Trade Organizations –
Section 4.6.6
•
Self Performance – Section 4.7
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HSP Changes After Contract Award –
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Reporting and Compliance with the HSP –
Section 4.8
Section 4.8
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II.
HUB Subcontracting Plan (HSP)
Development and Submission
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If HSP is
inadequate,
response will be
rejected
HUB GOALS
Special
reminders and
instructions
HSP
Information
Page
29
III. HSP Quick Checklist
** See Checklist Handout**
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IV. HSP Methods
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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;
32
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.
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ALL METHODS
For ALL Methods the following steps are required
to be completed:
• Page 1 - Section 1 - Respondent and Requisition
Information;
• Page 2 - Company and Requisition Information
• Page 2 - Section 2(a) – Subcontracting Intentions
• Section 4 – Affirmation and Sign
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HSP
Information
Page
Respondent and
Requisition
Information
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Company Name and
Requisition #
Subcontracting
Intentions:
If Yes, Complete
Section 2a
If No, Complete
Section 2b
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Section 4;
Affirmation
Signature
Affirms that
Information
Provided is
True and
Correct.
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METHOD I
If all (100%) of your subcontracting
opportunities will be performed using only HUB
vendors, complete:
• All of the steps in Slide 14
• Section 2 b. – List all the portions of work you will
subcontract, and indicate the percentage of the
contract you expect to award to HUB vendors;
• Section 2 c. – Yes;
• HSP GFE Method A (Attachment A) – Complete
this attachment for each subcontracting
opportunity.
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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.
Complete Section
2-c; Yes if you will
be using only HUBs
to perform all
Subcontracting
Opportunities in 2-b.
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HSP GFE Method A
(Attachment A)
Complete this
attachment
(Sections A-1 and
A-2) and List Line #
and Subcontracting
Opportunity.
HUB Subcontractor
Selection for this
Subcontracting
Opportunity
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METHOD II
If any of your subcontracting opportunities
will be performed using HUB protégés,
complete:
• All of the steps in Slide 14
• Section 2 b. – List all the portions of work you
will subcontract, and indicate the percentage of
the contract you expect to award to HUB
vendors;
• HSP GFE Method B (Attachment B) – Complete
Section B-1 and Section B-2 only for each
subcontracting opportunity as applicable.
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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.
Skip Sections
2-c and 2-d.
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HSP GFE Method B
(Attachment B)
Complete
Sections B-1; and
B-2 only for each
HUB Protégé
subcontracting
opportunity.
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HSP GFE Method B
(Attachment B)
List the
HUB Protégé(s)
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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 14
•
Section 2 b. – List all the portions of work you will subcontract, and
indicate the percentage of the contract you expect to award to HUB
vendors and Non HUB vendors;
•
Section 2 c. – No;
•
Section 2 d. – Yes;
•
HSP GFE Method A (Attachment A) – Complete this attachment for each
subcontracting opportunity.
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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.
Complete Section
2-c; No to using only
HUBs to perform all
Subcontracting
Opportunities in 2-b.
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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.
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HSP GFE Method A
(Attachment A)
Complete this
attachment
(Sections A-1 and
A-2) for each
subcontracting
opportunity.
Subcontractor
Selection (HUBs and
Non-HUBs)
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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 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.
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Complete Section
2-b; List all the
portions of work
you will subcontract,
and indicated the %
of the contract you
expect to award to
HUBs and Non-HUBs.
Complete Section
2-c; No, to using
only HUBs to
perform all
Subcontracting
Opportunities in 2-b.
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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.
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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
52
HSP GFE Method B
(Attachment B)
Written
Notification
Requirements
List 3 HUBs
Contacted
for this
Subcontracting
Opportunity
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HSP GFE Method B
(Attachment B)
Written
Notification To
Trade
Organizations
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HSP GFE Method B
(Attachment B)
List Trade
Organizations
Notified with
Dates
Sent/Accepted.
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HSP GFE Method B
(Attachment B)
Provide written
justification why a
HUB was not
selected for this
Subcontracting
Opportunity
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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 14
Section 3 – Self Performing Justification; and,
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Section 3; Self
Performing
Justification
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.
58
HUB Subcontracting Opportunity
Notification Form
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METHOD I
Subcontractor notification when/if selected
60
Sample for
Respondent’s
Use.
61
V. HSP Prime Contractor
Progress Assessment Report
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HSP Prime
Contractor
Progress
Assessment
Report
• Required with
ALL Pay Requests
• List ALL Sub
payments
(HUBs & Non-HUBs)
• Required even if
not subcontracting
63
Texas Health and Human Services Commission
Questions Submittal
Followed by Break
Vendor Question/Response
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Verbal answers to vendor questions will be
provided to the extent practicable.
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Responses are not binding until the final
written addendum is posted on the HHSC
website. HHSC estimates the addendum
will post by December 31, 2013.
Texas Health and Human Services Commission
Closing Comments