Proposer:
RFP Section
Evaluator's #
0
8.1
0
Evaluators Score (0 to 10)
RFP Page #59
Weight
Weighted Score
Requirement
Geographic Service Region & Enrollment
RFP Section
8.1.1
Evaluators Score (0 to 10)
Weight
Weighted Score
1
0
Evaluators Comments
RFP Page # 59
Requirement
Include the information provided in Section 6.5
Evaluators Considerations
* Proposer has provided detailed information regarding the program(s) it intends to offer.
* Proposer has provided detailed information regarding the geographic regions it proposes to serve, for each program.
* Financial Projections reflect the proposed program for new and existing identified service regions as described by the proposer.
RFP Section
8.1.2
Weight
Weighted Score
4
0
Evaluators Comments
Evaluators Score (0 to 10)
RFP Page #59
Requirement
8.1.2 The MCO must establish the business case for their minimum enrollment level determination, given its
program offerings and competition within the proposed region, and demonstrate an ability to support varying
fluctuation of enrollment within its financial submission at a cost-effective funding level.
Evaluators Considerations
* Proposer must evidence specific knowledge of enrollment volumes in the regions proposed to serve, within a reasonable level and include discussion of all regions to be served.
* Proposer must evidence working knowledge of historical trends in program enrollment differences across service regions and discuss how those may change, or remain the same,
during the proposed contract period.
* Proposer discusses its enrollment projections in sufficient detail and supports the ability to manage varying enrollment fluctuation.
* Proposer discusses how its proposed enrollment levels allow it to bear the service cost risk associated with the contract.
* Proposer discusses how its proposed enrollment levels allow it to bear the administrative risk associated with the contract.
* Financial Projections reflect reasonable enrollment assumptions based on information available as described by the proposer.
Financial Sustainability and Risk
RFP Section
8.2
RFP Page # 60
RFP Section
8.2.1
RFP Page #60
Requirement
Requirement
Assure that the organization has adequate operating cash to hire staff and contract with providers necessary
to deliver the proposed benefit package (e.g. Family Care or Family Care Partnership).
Weight
Weighted Score
5
0
Evaluators Comments
Evaluators Score (0 to 10)
Evaluators Considerations
* Proposer must discuss its cash position and the overall strength of its cash position, including disclosure of any known weakness or threats.
* The proposing entity must demonstrate it will have a positive unrestricted cash position at the start date of the initial contract period and describe source of funds for required startup
costs.
* Proposer must disclose source of cash for startup and/or operations to support months that will otherwise result in a negative cash balance.
* Financial Projections must reflect positive month end cash position for the three years presented as described by the proposer.
Proposer:
RFP Section
Evaluator's #
0
8.2.2
RFP Page # 60
Requirement
8.2.2. Assure the organization can manage fluctuation in enrollment, timing of capitation payments, other
receipts, and fluctuation in the cost of delivering services in the benefit package based on individual needs of
the enrollees.
0
Evaluators Score (0 to 10)
Weight
Weighted Score
5
0
Evaluators Comments
Evaluators Considerations
* Proposer should discuss the ability to manage fluctuation in enrollment, capitation payments, other receipts, and fluctuation in the cost of delivering services in the benefit package.
* Proposer assumes a capitation rate that is reasonably consistent with historical program averages (e.g., within 1-3%) for the region and program for which it is proposing (i.e., is able to
offer the proposed programs within a cost-effective funding level).
* Proposer does not indicate that the Department must support its operations through an "enhanced" capitation rate.
* Financial Projections reflect performance as described by the proposer.
RFP Section
8.2.3
RFP Page #61
Requirement
8.2.3. Describe the analytical resources used to ensure cost effectiveness and appropriate utilization of
member services and provide examples of analysis used to support decision making.
Weight
Weighted Score
5
0
Evaluators Comments
Evaluators Score (0 to 10)
Evaluators Considerations
* Proposer identifies staffing qualifications, experience and specific skill sets
* Proposer identifies analytical tools used to access, analyze and produce meaningful results to support review and decision making.
* Proposer identifies process for reporting of analysis to support MCO operations and management identification of unit cost and utilization initiatives.
* Proposer includes examples of analysis and reports used to support MCO operations and management decisions.
RFP Section
8.2.4
RFP Page #61
Requirement
8.2.4. Describe organizational entity structure that will conduct program operations and evidence entity is in
good standing with regulatory authorities to include but not limited to Office of the Commissioner of Insurance,
Internal Revenue Service, State Department of Workforce Development, State Department of Revenue or
Department of Labor (e.g. 501(c)(3), long-term care district, private for-profit, HMO organized under
501(c)(4)).
Evaluators Considerations
Weight
Weighted Score
5
0
Evaluators Comments
Evaluators Score (0 to 10)
*Proposer identifies legal entity structure such as 501(c)(3) or Long Term Care District.
*Proposer identifies the planned entity and structure required to operate the proposed program such as an HMO under 501(c)(4) for Family Care Partnership.
*Proposer provides a statement regarding investigations, findings or corrective action by other regulatory authorities.
* Financial Projections reflect the required entity type to operate the proposed program as described by the proposer.
Proposer:
RFP Section
Evaluator's #
0
8.2.5
RFP Page # 61
Requirement
8.2.5. Assure that the organization has a reasonable expectation of ongoing solvency, and satisfies capital
requirements as required by the DHS-MCO Contract and/or regulatory requirements of the OCI. (See
http://dhs.wisconsin.gov/LTCare/StateFedReqs/FC-RC-CMO-Contracts.htm).
0
Evaluators Score (0 to 10)
Weight
Weighted Score
10
0
Evaluators Comments
Evaluators Considerations
* Proposer must demonstrate how, specifically, contractual requirements pertaining to capitalization will be met.
* Proposer's financial projections must be based on realistic assumptions and demonstrate that losses are not budgeted, or planned, over any extended period of time.
* Evidence of WI HMO licensure and an attestation of "good standing" status with the WI OCI must be provided for proposals to operate the Family Care Partnership program.
* For an unlicensed proposer that intends to offer Family Care Partnership, specific evidence must be provided that such licensure will be obtained prior to the start date of the entity's
proposed start date.
* If there are specific threats to the organization's "expectation of ongoing solvency," the proposer will specifically identify those, address them, and provide overwhelming evidence that it
can address those threats without relying on "enhanced" funding from the Department or jeopardizing the continuity of care provided to current/potential members.
* Financial Projections reflect solvency and ability to meet contractual and/or statutory requirements as described by the proposer.
RFP Section
8.2.6
RFP Page #62
Requirement
8.2.6.Demonstrate the strength of the organization's financial position and ability to support proposed
operations of both the proposing entity, as well as the consolidated entity, if such a relationship exists.
Evaluators Considerations
* Provide a copy of the most recent audited financial statements
* Provide the most recent interim financial statements
* Statements demonstrate the financial position described by the proposer
RFP Section
8.3
RFP Page #62
Requirement
All Proposers must submit a three-year financial projections starting with the anticipated initial contract date to
include all operations of the organization (see BP financial projections template). The submission will project
that, if awarded a managed long-term care contract, the Proposer will be financially stable throughout the
three-year period and describe projected financial performance with sufficient detail to identify key
assumptions, cost drivers, business infrastructure, strategies to operate an efficient and cost effective Family
Care program model consistent with responses to requirements in sections 8.1 and 8.2. Omission of the
financial projections may result in rejection of a proposal.
Detailed historical data regarding the population to be served is available from the Department. These data
can be requested by contacting Jessica A Harlan at DHSProcurement@wi.gov. Currently operating MCOs
already have access to these data. Requestors will be required to enter into a data use agreement prior to
receiving the data extract. Available historical data includes detailed cost information for individuals not yet
enrolled in the program as well as comprehensive service, cost, and functional assessment records for current
enrollees in a de-identified format.
Summary information on enrollment by target group and service cost by category and region for existing
regions is available through the annual Family Care and Family Care Partnership rate reports on the
Department website: http://www.dhs.wisconsin.gov/ltcare/StateFedReqs/CapitationRates.htm.
Evaluators Considerations
Weight
Weighted Score
5
0
Evaluators Comments
Evaluators Score (0 to 10)
Proposer:
RFP Section
Evaluator's #
0
8.3.1
RFP Page #63
0
Weight
Weighted Score
4
0
Evaluators Comments
Evaluators Score (0 to 10)
Requirement
8.3.1. Three Year Financial Projections
The proposer's three-year submission projects financial stability, based on a set of "comprehensive and
globally reasonable" assumptions.
Evaluators Considerations
* Use the DHS Financial Projections template (Reference Appendix 2) to provide the 3 year financial projections.
* Submissions must include completed projections with required worksheets described in the DHS Financial Projections template and within each worksheet with notes detailing major
budget assumptions and additional information to support a complete understanding of the proposal.
RFP Section
8.3.2
RFP Page #63
Weight
Weighted Score
4
0
Evaluators Comments
Evaluators Score (0 to 10)
Requirement
8.3.2. Target population historical trends and projections
The proposer's enrollment assumptions are reasonable, compared to identified benchmarks such as the
Department's projections if provided, existing program experience, actuarial rate reports, and company trends,
as relevant.
Evaluators Considerations
* Use the Regional enrollment worksheets within the DHS Financial Projections template to describe enrollment by target group and level of care to project your enrollment and growth
model.
* Describe how the projected target group mix to be enrolled was identified and describe the implications of this enrollment pattern on your program planning and fiscal projections.
* Include a description of the data source for the base data that underpin the enrollment projections, along with the actual base data. For organizations without a program enrollment
history that are relying on the historical data extract provided by the Department, or summary enrollment information published in the annual Family Care and Family Care Partnership rate
reports on the Department website, describe any additional steps taken to validate the reliability of projections for the proposed region.
* Include assumptions regarding program enrollment (Family Care, Family Care Partnership, IRIS) and market share.
* Document trend assumptions for each enrollment group that is assumed to have a different rate of growth (e.g., target groups, level of care, and for Partnership: MA-only enrollees, dual
Medicaid-Medicare eligible enrollees, etc.). Include an explanation of major changes, trends, and/or unusual changes in enrollment.
RFP Section
8.3.3
RFP Page #64
Weight
Weighted Score
4
0
Evaluators Comments
Evaluators Score (0 to 10)
Requirement
8.3.3. Capitation and other revenue assumptions
The proposer's capitation, and other revenue assumptions, are reasonable compared to identified
benchmarks such as the Department's projections if provided, existing program experience, current regional
rates, and company trends, as relevant.
Evaluators Considerations
* Use the Regional Rev Exp worksheets within the DHS Financial Projections template to provide:
o DHS Medicaid capitation
o Medicare capitation if Family Care Partnership proposal
o Member collections for cost share, room and board, spend down or other third party
* Use the Rev Exp Multi-year worksheet within the DHS Financial Projections template to provide other revenue assumptions.
* Describe basis for assumptions and projections if they are inconsistent with other benchmarks or program experience.
Proposer:
RFP Section
Evaluator's #
0
8.3.4
RFP Page #64
Requirement
8.3.4. Costs associated with each major service area in the benefit package
The proposer's service costs, by target group, are reasonable compared to identified benchmarks such as the
Department's projections if provided, existing program experience, actuarial rate reports, and company trends,
as relevant.
Evaluators Considerations
0
Weight
Weighted Score
4
0
Evaluators Comments
Evaluators Score (0 to 10)
* Use the Regional Rev Exp worksheets within the DHS Financial Projections template to estimate the costs associated with each major service area in the benefit package, by target
group. These projections should reflect the MCO’s best estimate of cost growth in future years, taking into account historical cost and utilization data and best practices, as well as
alternative service delivery models.
* Describe whether services are purchased or provided, historical utilization trends, historical unit rate trends, and discuss the basis of the projections for both utilization and unit rates.
* Describe how the PMPM costs for those service categories have changed over time and how they are projected to change (increases and decreases). Describe service cost
assumptions against existing experience and planned service delivery model. If the implementation of specific business strategies are key to achieving changes, the strategies should be
identified.
* Projections by service line should rely on program experience where possible. Discuss reasons for deviations from that experience (reasonable sources for this information include: 1)
actuarial rate report for managed LTC programs, 2) the historical data that has been provided to MCOs and can be requested from DHS, and 3) an organization’s own experience with
markets or providers).
RFP Section
8.3.5
RFP Page #65
Requirement
8.3.5. Costs associated with care management
The program's projected care management expenses are reasonable compared to identified benchmarks
such as such as existing program experience, actuarial rate reports, and company trends, as relevant.
Weight
Weighted Score
4
0
Evaluators Comments
Evaluators Score (0 to 10)
The proposer's administrative allocation to care management, and the development of a unit rate for care
management, are reasonable, if the proposal includes an internal care management staffing model.
Evaluators Considerations
* Use the CM worksheet within the DHS Financial Projections template to provide the internal care management rate calculations and include in narrative form the methodology for
establishing each rate.
* Utilization assumptions should be detailed and discussed and describe prior experience of providing or contracting for this service and include discussion of historical trends.
* Provide care manager ratios and include the rationale and cost-benefit analyses to support the investment in the assumed care manager ratios (e.g., different ratios for member
subgroups such as those with mental health issues).
* Provide a description of the cost allocation method for allocation of shared administrative/overhead costs to care management.
* This section should provide a complete understanding of the resources supporting the proposed care management model.
Proposer:
RFP Section
Evaluator's #
0
8.3.6
RFP Page #66
Requirement
8.3.6. Rates for other internally provided services
MCOs are required to pay at or below the Medicaid rate for services that are included in the Wisconsin
Medicaid fee for service program. Medicaid fee schedule:
https://www.forwardhealth.wi.gov/WIPortal/Max%20Fee%20Home/tabid/77/Default.aspx.
MCOs determine the rates paid for the home and community based services included in the benefit package.
0
Weight
Weighted Score
0.5
0
Evaluators Comments
Evaluators Score (1 or 10)
Evaluators Considerations
* Provide the proposed rate(s) for all internally provided services (e.g., other than care management) and the methodology for establishing each rate, or otherwise indicate where
Department staff may obtain that information (e.g., MA fee schedule).
RFP Section
8.3.7
RFP Page #66
Requirement
8.3.7. Administrative Expenses
The program's projected administrative expenses are reasonable compared to identified benchmarks such as
existing program experience, actuarial rate reports, and company trends, as relevant.
Evaluators Considerations
Weight
Weighted Score
3
0
Evaluators Comments
Evaluators Score (0 to 10)
* Use the Administrative Expense worksheet within the DHS Financial Projections template to support administrative expenses and program allocation of the organization.
* Describe cost allocation method and cost drivers for allocation of overhead to the proposed program if operating other programs or share administrative overhead services with related
entities.
RFP Section
8.3.8
RFP Page #66
Evaluators Score (0 to 10)
Weight
0.5
Weighted Score
0
Requirement
8.3.8. Other non-operating revenues and expenses
The proposer's projected non-operating revenues and expenses are reasonable.
Evaluators Considerations
* Use the Rev Exp Multi-Year worksheet within the DHS Financial Projections template to provide projections.
* Provide description for material items
RFP Section
8.3.9
RFP Page #67
Requirement
8.3.9. Balance Sheet
The balance sheet demonstrates a healthy organization, financially, with positive working capital, positive
equity and full satisfaction of Family Care permitted MCO capital and solvency requirements or describes
satisfaction of the OCI HMO requirements for compulsory surplus and Risk Based Capital (RBC).
Weight
Weighted Score
6
0
Evaluators Comments
Evaluators Score (0 to 10)
Evaluators Considerations
* Use the Bal Sheet Multi-Year worksheet within the DHS Financial Projections template to provide balance sheet projections.
* Provide narrative to support balance sheet presentation and highlight unusual items related to the proposed program or other anticipated business needs/experience.
Proposer:
RFP Section
Evaluator's #
0
8.3.10
RFP Page #67
0
Weight
Weighted Score
4
0
Evaluators Comments
Evaluators Score (0 to 10)
Requirement
8.3.10. Cash Flows
The cash flows demonstrate the ability to support operations and result in a positive month -end cash position
throughout the 3-year projections.
Evaluators Considerations
* Use the Cash Flows worksheet within the DHS Financial Projections template to provide monthly projected cash inflows and outflows.
* Describe cash resources in place to support operations during June of each year when the capitation is paid in July. (e.g. line of credit).
RFP Section
8.3.11
RFP Page #67
Requirement
8.3.11. Capacity for financial solvency and stability and ability to assume risk
Family Care programs must demonstrate how the organization will achieve and maintain full financial stability
based on realistic assumptions of capitation rates supported by the DHS funding model as explained in the
annual rate report.
Weight
Weighted Score
6
0
Evaluators Comments
Evaluators Score (0 to 10)
The assumptions, and their basis, are clearly presented and described.
Family Care Permitted program’s Capital and Solvency Requirements are calculated within the DHS Financial
Projections template.
A Proposal to operate the program under an HMO model satisfies, or provides evidence of ability to satisfy,
the OCI requirements at the start of the contract.
Evaluators Considerations
* Proposals for Family Care Permitted program projects satisfaction of all requirements at the start of the proposed contract.
* Proposals for Family Care Partnership must provide evidence of HMO Licensure and meeting the OCI requirements relating to financial solvency and stability.