Kyle L. Janek, M.D., Executive Commissioner
VENDOR CONFERENCE
Actuarial Consulting Services
Request for Proposal No. 529-15-0003
January 21, 2014
Welcome
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Introductions
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Steve R. Bailey, Procurement and Contracting
Services (PCS)
Rachel Butler, Chief Actuary - HHSC Actuarial
Analysis Department
Sherice Williams, HHSC HUB Coordinator
Jimmy Ramirez, Asst. General 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 and monitoring
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HUB- Responsible for HUB activity
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Legal- Questions/answers and legal activity
Vendor Conference Overview
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Procurement Activities
HUB Overview
RFP Overview
Questions
Break
Preliminary Responses to Questions
Closing
Procurement Activities
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Questions and Answers
Sole Point of Contact
Procurement Schedule
Solicitation Access
http://www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asp
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Solicitation Changes
Submission Requirements
Proposal Screening and Evaluation
Award Information
Procurement Schedule
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RFP Release Date
Vendor Conference
Respondent Questions Due
Post Response to Questions (est.)
Proposals Due (2:00 PM Central Time)
Deadline for Proposal Withdrawal
Tentative Award Posting (est.)
Anticipated Contract Start Date
January 2, 2014
January 21, 2014
January 23, 2014
January 28, 2014
February 11, 2014
February 11, 2014
April 1, 2014
September 1, 2014
Historically Underutilized Business
(HUB) Requirements
Sherice Williams
HHSC HUB Coordinator/ Administrator
7
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 4.6.3.2
V.
HSP Prime Contractor Progress Assessment
Report – Section 4.7
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I. Historically Underutilized
Business Participation
Requirements
9
I. RFP Section 4.0 Historically
Underutilized Business
Participation Requirements
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HUB Participation Goals – Section 4.3
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Potential Subcontracting Opportunities – Section
4.5
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Centralized Master Bidders List and HUB Directory –
Section 4.5
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Vendor Intends to Subcontract – Section 4.6
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I. RFP Section 4.0 Historically
Underutilized Business Participation
Requirements (cont.)
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Minority or Women Trade Organizations – Section
4.6.3.2.04
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Self Performance – Section 4.6.3.2.05
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HSP Changes After Contract Award – Section 4.7
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Reporting and Compliance with the HSP – Section
4.7
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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
13
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;
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METHOD OPTIONS
A Respondent may choose from one of the
following methods when completing the HSP
(cont.):
• 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 on the HSP Form:
• 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 Section 1, 2 , and 4;
• 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 Section 1, 2 and 4;
• 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:
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All of the steps in Section 1, 2, and 4;
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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;
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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:
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All of the steps in Section 1, 2, and 4;
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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;
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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
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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:
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All of the steps in Section 1, 2, and 4;
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Section 3 – Self Performing Justification
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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.
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HUB Subcontracting Opportunity
Notification Form
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Sample for
Respondent’s
Use.
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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
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RFP Overview
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Mission Objectives
 Scope of Work Overview
 Actuarial Personnel
 Performance Measures and Remedies
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Compensation
Mission Objectives
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The Center for Medicaid and Medicare Statistics
requires an external actuary who is a Member of the
American Academy of Actuaries to certify that HHSC’s
HMO capitation rates are actuarially sound.
The external actuary may be used to provide a
second opinion on forecasts and other budgetary
matters.
Actuaries are used for projects involving specialized
analyses and to provide additional resources as
needed.
Scope of Work Overview
1. Provide analysis of program experience to produce
estimates of experience to date and projection of future
experience based on information provided by HHSC and
its Medicaid and CHIP contractors.
2. Contractor must have the ability to maintain
confidentiality of Medicaid recipient information and
other documents provided by HHSC.
3. Perform calculations of managed care capitation rates.
4. Perform cash flow analyses of program expenditures.
Scope of Work Overview (cont.)
5. Provide actuarial opinion and fiscal impact analysis of
proposed program changes.
6. Provide actuarial opinion and fiscal impact analysis for
proposed provider rate methodologies.
7. Must participate in meetings with HHSC and other
agency staff, HHSC contractors, Legislative committees
and CMS representatives as needed. Meetings are faceto-face and may be scheduled on very short notice.
8. Provide approximately 3,500 or more hours of actuarial
services per year. (HHSC does not guarantee any
specific number of hours of work under the RFP or any
resulting contract. The amount is an estimated yearly
total).
Scope of Work Overview (cont.)
9. Provide within one-week, or longer if approved by HHSC,
a subcontract for actuarial expertise in specialty areas.
Examples of recent HHSC needs in specialty areas
include Medical Transportation, Texas Medicaid Wellness
Program, Medicare Advantage Plan, prescription drug
formulary management, nursing facility contracting, and
risk adjustment. Subcontractor selection will be subject
to HHSC approval. HHSC may elect at any time to
separately procure services for specialty areas even if
there is a subcontract in place.
10. Expertise and knowledge of Center for Medicare and
Medicaid Services regulations for determining rates
including Medicaid capitation rates.
11. Provide complete explanations of all calculations and
provide all formulas to HHSC or its contractors.
Scope of Work Overview (cont.)
12. Provide effective presentations on analyses performed
as requested.
13. Request for work on legislative fiscal notes must be
completed within timeframe negotiated with HHSC.
14. May assist as a subject matter expert in HHSC’s
preparation of Requests for Proposals or other
solicitations, evaluation of solicitations and contract
negotiations.
15. Perform special actuarial projects as assigned.
Actuarial Personnel
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1. The principle actuary must be a Fellow in the Society
of Actuaries (FSA) and a Member of the American
Academy of Actuaries (MAAA) with proven experience
with a Medicaid and/or CHIP program.
2. One actuary must be both FSA and MAAA and have
proven experience with a Medicaid and/or CHIP
program.
3. Two other actuaries must be either FSA or MAAA with
at least a working knowledge of a Medicaid and/or CHIP
program.
Actuarial Personnel (cont.)
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4. Non-actuaries must work under the supervision of the
principle actuary in performing the actuarial work.
5. At least one actuary must be available either in person
or by phone within two hours every Monday through
Friday when the State legislature is not in session to
discuss actuarial matters and work on pressing issues.
6. At least one actuary must be available in person
within one hour, 24 hours a day, seven days a week
during a State Legislative Session to discuss and testify
on actuarial matters and work on pressing issues.
Performance Measures and Remedies
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HHSC will monitor contract performance
All services and deliverables under the contract shall be
provided at an acceptable quality level and in a manner
consistent with acceptable industry standard, custom,
and practice.
Assist HHSC Actuarial Analysis with development of the
Annual Managed Care Capitation Rates due July 15th of
each year
Performance Measures and Remedies (cont.)
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Requested services must be completed within the negotiated
timeframes for each project. May assess $500 per business day for
each day the Services are not submitted timely. If the information is
received timely, but is inaccurate or incomplete, may assess $200
per business day until accurate or complete information is received.
Provide sound analysis for actuarial opinions and fiscal impact
pertaining to program changes, proposed provider rate
methodologies and special projects. May assess $500 per business
day for each day the actuarial opinions are not submitted timely. If
the information is received timely, but is inaccurate or incomplete,
may assess $200 per business day until accurate or complete
information is received.
Performance Measures and Remedies (cont.)
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Provide at least one actuary who is available in person within two
(2) hours upon request to discuss actuarial matters and work on
pressing issues upon HHSC's request. May assess $800 for each
occurrence in which the Vendor does not meet this request.
Provide at least one actuary who is available in person within one
(1) hour seven days a week during a Legislative Session to discuss
and testify on actuarial matters and work on pressing issues. May
assess $1,000 for each occurrence in which the Vendor does not
meet this requirement.
Compensation
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Attachment 1 includes the format for submitting cost proposals.
Costs must be based on an hourly rate per skill set and must be all
inclusive. HHSC will reimburse vendor for reasonable travel that
HHSC has pre-approved according to State reimbursement rates.
Cost Proposals must be based on the Scope of Work described in
the RFP. This section should include any business, economic, legal,
programmatic, or practical assumptions that underlie the Cost
Proposal.
Separately identify value-added benefits, cost-savings and costavoidance methods and measures, and the effect of such methods
on the Cost Proposal and Scope of Work.
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 January 28, 2014.
Texas Health and Human Services Commission
Closing Comments