Questions and Answers Regarding the CHIP Quality Monitor RFP 1. How many total CHIP Health Plans and how many of each type (HMO, PPBP, other) would HHSC anticipate being awarded contracts to enroll or treat CHIP beneficiaries? ANSWER: The evaluation of proposals is underway. HMO finalists will be announced November 10, 1999. 2. On page 8 of the RFP, B. Overview of Administrative Services Procurement, the third paragraph reads, "The quality monitoring contractor must adhere to any file transfer protocols established by the administrative services contractor." Will HHSC require standardization of file transfer protocols among the contracted HMOs, PPBPs, the dental claims administrator and others (as applicable)? ANSWER: File transfer protocols will be negotiated between the administrative contractor, the quality monitor contractor and the health plans. 3. On page 9 of the RFP, C. Overview of Health Plan Procurement, the fourth paragraph reads, "There is some likelihood that HHSC will purchase non-managed care services for CHIP." What are examples of non-managed care services H HSC might purchase? If this occurs, will the non-managed care providers be required to electronically transmit data to the quality-monitoring contractor or will this process entail a non-electronic (manual) submission? ANSWER: Indemnity insurance and direct contracts with providers are two examples of non-managed care coverage that HHSC may purchase. Whatever products are selected, the contracted entities will be expected to submit claims data to the quality monitor electronically. 4. From page 18 of the RFP, Proposal Deliverables: "information system capacity," What criteria will HHSC use to determine whether the quality monitoring contract proposer's data warehousing and data processing capacities meet or exceed capacity requirements of the CHIP Quality contract? What data management capacity does HHSC envision as being required to meet the quality-monitoring requirement? ANSWER: See the answer to Question 19 below. 5. On page 24 of the RFP, under c. Data Collection, the first paragraph reads, "All health plans in the Children's Health Insurance Program are required to report encounters or claims in a standardized format." What is this format or where is it available? ANSWER: Standards for formatting claims and encounter data are emerging in the health care industry in light of the federal government’s Electronic Data Interchange initiative. HHSC expects that CHIP contractors will arrive at a standard that is mutually agreeable to all parties and meets expected federal requirements. 6. Relating to page 24 of the RFP, under c. Data Collection, fourth bullet, which of the "Texas selected measures" from HEDIS 3.0 will not be required to be produced due to non-applicability to the population served by the CHIP program? ANSWER: HHSC intends to focus on pediatric HEDIS measures. 7. What will be the record layout of a CHIP quality beneficiary enrollment record that will be available to the quality-monitoring contractor? ANSWER: The precise layout has not been determined. Data elements are described in the HMO RFP. 8. Will HHSC give preference to any particular information management architecture/design? If so, what architecture/design is preferred? ANSWER: No particular design is favored. 9. Is there a rollout schedule (by geographic areas) or will all CHIPs go on-line at the same time statewide? ANSWER: CHIP will be rolled out statewide on May 1, 2000. 10. Will there be a standardized format that HMOs and PPBPs will utilize to submit utilization and quality improvement data to the quality monitoring contractor? ANSWER: Yes. The format will be developed collaboratively between HHSC, the quality monitor and the health plans. 11. Will the CHIP contract with the HMOs and PPBPs contain a delivery schedule for information to be submitted to the quality monitoring contractor or will the quality monitoring contractor be required to coordinate receipt of deliverables directly with the HMOs and PPBPs? ANSWER: The CHIP contracts with participating health plans will include schedules for data delivery to the quality monitor. 12. What data will providers of non-managed care services for CHIP be required to submit to the quality monitoring contractor? ANSWER: Everything but HEDIS. 13. RFP states that HHSC may purchase non-managed care services for CHIP and that the proposer should be prepared to monitor quality beyond the managed care framework of health care delivery. Please clarify the types and setting of nonmanaged care services to be purchased. ANSWER: Please refer to Question 3 above. 14. Will encounter data be subject to edits by the administrative contractor? Can the quality monitoring contractor receive a listing of those edits? ANSWER: Data edits and the entity performing them will be identified in conjunction with the health plans. 15. Does HHSC have a confidence interval recommendation in order to determine the sample size for encounter data validation? ANSWER: HEDIS data specifications contain sample size requirements. Other data must be validated using generally accepted principles of statistical sampling. 16. Medical Records Review. The RFP describes requirements for both onsite and central site medical record abstracting. Please clarify the expected number/frequency of visits to clinical sites of care and community based sites of care within each contracted health plan. The RFP states the number of HMO medical record reviews will vary with each health plan depending on the number of enrollees. Does HHSC expect a different number in the sample for HMOs of difference sizes or would a statistically valid number of randomly selected cases meet this requirement? The medical record review requirements for PPBPs state that the methodology for determining the number of medical record reviews to be performed must be specified in the proposer’s proposal. Would it be acceptable for this review to be performed at the contractor site instead of onsite review at physician offices? ANSWER: (1) HHSC expects that site visits will occur no more often than annually. (2) The number of medical records sampled must be statiscally valid to a 90 or 95% confidence level. Therefore, numbers sampled will vary by enrollment and other factors. (3) Medical record reviews for PPBPs and other plans will be done with a minimum of interference to provider’s practices. 17. Does HHSC have a recommendation related to the number of medical records to be reviewed by the contractor for the random sample, aside from beneficiary complaints? ANSWER: No. HHSC expects to defer to the judgment of the quality monitor. 18. Monitoring of Specific Operational Components. Please specify the expected frequency of site visits for individual provider facilities and at health plan offices. ANSWER: HHSC anticipates that these visits will occur annually. 19. System Requirements. Acknowledging that “The formats and file transfer protocols will be collaboratively determined after the execution of a contract,” can HHSC provide more specificity on system requirements (e.g., storage requirements and period for on-line retention)? ANSWER: A system should have, at a minimum, sufficient capacity to store claims or encounter data for at least 450,000 persons for a period of at least three years. HHSC will look to the recommendations of proposers regarding the technical specifications for such a system. 20. It is stated that “Any contractor must have sufficient staff to manually input data (e.g., the surveys), to perform the required analysis, and to write the required reports.” Will the bidder be required to design the entry system (e.g., screens, edits) for the survey? ANSWER: The enrollee survey HHSC intends to use, CAHPS has entry and editing software. A provider survey has not been selected. The quality monitor may have to design data entry screens for this instrument. 21. This section mentions that proposers should submit two annual budgets outlining anticipated start-up and recurring costs and that the budgets should encompass the first two years for the contract. Clarification is requested on the statement “two annual budgets.” Does this mean a budget for year 1 and a budget for year 2 (both of which may include start-up and recurring costs)? Or does it mean a separate budget for start-up costs and a separate budget for recurring costs (both covering the first two years)? Also, are start-up costs to be factored into the monthly fee computation or will such costs be paid separately? ANSWER: The two annual budgets should each include start-up and recurring costs. Start-up costs will be paid separately. 22. [The work plan and budget] section mentions that proposers are required to submit two monthly fees for quality monitoring services . . . one for HMO coverage and one for non-HMO coverage. In order to compute such monthly fees, it is requested that HHSC provide bidders with the number (names and locations) of entities of each type be used for proposal purposes. Such information would help to ensure more comparable fee bids for the evaluation process. ANSWER: HHSC will not be able to provide this information until the conclusion of the health plan evaluation process.