word doc - Texas Health and Human Services Commission

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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.
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