KYLE L. JANEK, M.D.
EXECUTIVE COMMISSIONER
VENDOR CONFERENCE
STAR+PLUS, Medicaid Rural Service Area Services
Request for Proposal No. 529-13-0042
February 15, 2013 (1:00 PM – 4:00 PM)
Welcome

Introductions





Rick Blincoe, Enterprise Contract & Procurement
Services (ECPS)
Paula Swenson, Program Operations, Medicaid/CHIP
Division
Sherice Williams, HHSC HUB Administrator
Meghan Frkuska, Assistant General Counsel, Office of
General Counsel
Housekeeping Items
Vendor Conference Overview
Procurement Activities

RFP Overview

HUB Overview

Question Submittal
==========================

Break
==========================

Preliminary Responses to Questions

Closing

HHSC Procurement Roles

ECPS - Responsible for procurement activity

Program - Responsible for project scope,
requirements, performance, results, contract
management/monitoring

HUB - Responsible for monitoring HUB
activity

Legal – Questions/answers regarding legal
issues
ECPS Procurement Activities




Sole Point of Contact
Questions & Answers
Procurement Schedule
Solicitation Access
http://www.hhsc.state.tx.us/contract/529130042/anno
uncements.shtml




Submission Requirements
Solicitation Updates
Screening & Evaluation
Award Information
Procurement Schedule













Draft RFP Release Date
Draft RFP Respondent Comments Due
RFP Release Date
Vendor Conference
Respondent Questions Due
Letters Claiming Mandatory Contract Status Due
HHSC Posts Responses to Respondent Questions
Proposals Due
Deadline for Proposal Withdrawal
Respondent Demonstrations/Oral Presentations
Tentative Award Announcement
Anticipated Contract Effective Date
Operational Start Date
October 11, 2012
November 1, 2012
December 12, 2012
February 15, 2013
March 1, 2013
March 29, 2013
April 1, 2013
May 1, 2013
May 1, 2013
(HHSC option)
To be Announced
To be Announced
September 1, 2013
September 1, 2014
RFP Overview
Request for Proposals No. 529-13-0042
RFP Overview
 Mission
 Project Objectives
 Scope of Work
 Performance Measures
STAR+PLUS Expansion

HHSC is expanding the scope of services
and expanding the STAR+PLUS program to
the Medicaid Rural Service Area, making
STAR+PLUS available statewide.

HHSC will select no less than 2 managed
care organizations per Service Area to
provide the STAR+PLUS covered services in
the Medicaid Rural Service Area (MRSA).
Mission Statement
HHSC’s mission is to improve the quality of, and
access to care provided to Members, ensure
continuity of care; increase utilization of Member
benefits; and generate opportunities to contain
program costs. HHSC seeks to accomplish its
mission by contracting for measurable results that :
Integrate acute care and community-based long-term
services and supports.
 Provide continuity of care ; and
 Ensure timely access to quality care.

Mission Objectives
HHSC will prioritize desired outcomes and benefits for the
managed care programs, and will focus its monitoring efforts on
the Managed Care Organization’s (MCO) ability to provide
satisfactory results in the following areas.
 Continuity of Care
 Network adequacy and access to care
 Service Coordination
 Increase Utilization of Member Benefits with an Emphasis
on Medical Check-ups – especially for the children that
volunteer into the STAR+PLUS program.
 Quality
 Timeliness of claim payment
 Timely access to Medically Necessary Behavioral Health
Services
 Delivery of health care to diverse populations
 Provision of a comprehensive disease management program.
Scope of Work


The MCO must comply with all Contract
provisions including all applicable state and
federal laws, rules, regulations, and waivers
Covered Services



The MCO must provide full coverage of Medically
Necessary Covered Acute Services to all Medicaid only
Members in accordance with the requirements of the
Contract
The MCO must also provide Functionally Necessary
Community-based Long-Term Care Services
The MCO may propose Value-added Services
Scope of Work

Covered Community-based Long-Term Care
Services

Day Activity and Health Services (DAHS)


All members may receive medically and
functionally necessary Day Activity and Health
Services
Personal Assistance Services (PAS)

All members may receive medically and
functionally necessary Personal Assistance Services
Scope of Work


HCBS STAR+PLUS Waiver

STAR+PLUS provides access to an enriched
array of services for who would otherwise qualify
for nursing facility care. SSI members have
access without an interest list

STAR+PLUS Services Areas still maintain an
interest list for 217-Like Group Non-Member
applicants
The MCO is responsible for tracking end
dates of the Individual Service Plans and
initiating the annual review
Scope of Work

Service Coordination



Service Coordinators are responsible for
assessing member needs, formulating an
individualized plan of care, coordinating and
authorizing acute and long-term care, and
making referrals to community organizations
The Service Coordinator must actively work
with the Member’s primary and specialty care
Providers in order to integrate care
Minimum requirements are set for categories of
members, based upon acuity, functional needs,
and/or other needs. These requirements
include a minimum number of contacts, types
of contacts, and credentials of Service
Coordination staff.
Scope of Work

Improvements!

8.1.4.8.3 Advanced Payments


8.1.4.10 Provider Advisory Groups


MCOs are required to develop a process by which
providers may request advanced payments for authorized
services that have not yet been delivered.
The MCO must establish and conduct quarterly meetings
with Network Providers in each service area in which it
operates. Membership in the Provider Advisory Group(s)
must include, at a minimum, acute care, communitybased LTSS, and pharmacy providers.
8.1.5.10 Member Advisory Groups

The MCO must establish and conduct quarterly meetings
with Members in each service area in which it
operates. Membership in the Member Advisory Group(s)
must include, at least three Members attending each
meeting and allow for member advocates to participate.
Scope of Work

Assessment Instruments

The MCO must use functional instruments to
assess Members including:
The DADS Consumer Needs Assessment
Questionnaire and Task/Hour Guide, Form 2060
 The Texas Medicaid Personal Care Assessment
Form (PCAF) for assessment of children under the
age of 21
 The Community Medical Necessity and Level of
Care (MN/LOC) Assessment Instrument


The HMO must also complete the Individual
Service Plan (ISP), Form 3671, for each Member
receiving HCBS STAR+PLUS Waiver services.
Scope of Work

Access to Care

The MCO must have network PCPs and
Specialty Providers in sufficient numbers and
capacity

Appointments for Covered Services must be
provided within the specified timeframes

The MCO is required to regularly verify that
Covered Services are available and accessible to
Members in compliance of required standards
Scope of Work

Provider Network

The MCO must enter into written contracts with
properly credentialed Providers

The MCO must maintain a Provider Network
sufficient to provide all Members with access to
the full range of Covered Services required
under the Contract

Providers must be furnished with a Provider
Manual, materials, training, and a toll-free
Provider Hotline
Scope of Work

Member Services

The MCO must have a Member Services
Department to assist Members in obtaining
Covered Services

Member Services must include Member
Hotline, Nurseline, Member Education, and a
Member Complaints and Appeals process

Member Materials must include a Member
Identification Card, Member Handbook,
Provider Directory, and Internet Website
Scope of Work

Marketing and Prohibited Practices

MCOs must adhere to the Marketing Policies
and Procedures in the Contract and the HHSC
Uniform Managed Care Manual

All Marketing Policies and Procedures are
applicable to the MCO, its Agents,
Subcontractors and Providers

Marketing representatives are required to
complete orientation and training
Scope of Work

Management Information System (MIS)
Requirements

The MCO must maintain a MIS to handle the
following operational and administrative areas:
 Enrollment/Eligibility Subsystem
 Provider Subsystem
 Encounter/Claims Processing Subsystem
 Financial Subsystem
 Utilization/Quality Improvement Subsystem
 Reporting Subsystem
 Interface Subsystem
 Third Party Recovery (TPR) Subsystem
Scope of Work

Fraud and Abuse



The MCO is subject to all state and federal laws
and regulations relating to Fraud, Abuse, and
Waste
The MCO must cooperate with HHSC and any
state or federal agency charged with the duty of
identifying, investigating, sanctioning, or
prosecuting suspected Fraud, Abuse, and Waste
The MCO must submit a written Fraud and
Abuse compliance plan to the Office of
Inspector General (OIG) for approval each year
Scope of Work

Reporting Requirements

The MCO must provide all information as
required under the Contract and the Uniform
Managed Care Manual (UMCM)

Required reports with a description of the
format, content, file layout, and submission
deadlines are included in the UMCM

HHSC may require additional reports as
necessary
Scope of Work

Continuity of Care and Out-of-Network
Providers

The MCO must ensure that the care of newly
enrolled Members is not disrupted

Members must be provided access to Out-ofNetwork services if necessary and covered
benefits are not available within the Network

The MCO is required to ensure continued
authorization of Community-based Long Term
Care Services at the time of implementation
Scope of Work

Medicaid Significant Traditional Providers

The MCO must seek participation in its
Network from all Medicaid Significant
Traditional Providers (STPs) defined by HHSC

The HHSC website includes a list of Medicaid
STPs by Service Area (see addendum 2 dated
January 30, 2013)
Points of Interest

2013 Legislative session includes many bills that
may affect this RFP and current MCO contracts.

8.1.45 Nursing Facility Services

HHSC reserves the right to amend the scope of the
Contract to include Nursing Facility (NF) services
for Medicaid Members. If NF services are added to
the scope of the Contract, HHSC will provide
advance written notice and conduct appropriate
Readiness Review.
HUB Subcontracting Plan
(HSP) Requirements
Agenda Topics
• RFP Section 4.0 Historically Underutilized Business
Participation Requirement
• HUB Subcontracting Plan Development and
Submission
 HSP Quick Checklist
 HSP Methods
• HSP Prime Contractor Progress Assessment Report
RFP Section 4.0 Historically Underutilized
Business Participation Requirements
● HUB Participation Goals
● Potential Subcontracting Opportunities
● Vendor Intends to Subcontract
● Centralized Master Bidders List and HUB Directory
RFP Section 4.0 Historically Underutilized
Business Participation Requirements
● Minority or Women Trade Organizations
● Self Performance
● HSP Changes After Contract Award
● Reporting and Compliance with the HSP
HUB Participation Requirements
HUB Subcontracting Plan (HSP)
Development and Submission
If HSP is
inadequate,
response will be
rejected
HUB GOALS
Special
reminders and
instructions
HSP
Information
Page
HUB Participation
Requirements
HSP Quick Checklist
HUB Participation
Requirements
HSP Methods
METHOD I
If all (100%) of your subcontracting opportunities will be
performed using only HUB vendors, complete:
•
Section 1 - Respondent and Requisition Information;
•
Section 2 a. – Yes, I will be subcontracting portions of the contract;
•
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;
•
Section 4 – Affirmation; and,
•
HSP GFE Method A (Attachment A) – Complete this attachment for
each subcontracting opportunity.
HSP
Information
Page
Respondent and
Requisition
Information
Company Name
and Requisition #
Subcontracting
Intentions:
Complete Section
2-a; Yes, I will be
subcontracting
portions of the
contract.
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.
Section 4;
Affirmation
Signature
Affirms that
Information
Provided is
True and
Correct.
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
Reminders: Notice
to subcontractors
and HHSC.
METHOD II
If any of your subcontracting opportunities will be
performed using HUB protégés, complete:
•
Section 1 - Respondent and Requisition Information;
•
Section 2 a. – Yes, I will be subcontracting portions of the contract;
•
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 4 – Affirmation; and,
•
HSP GFE Method B (Attachment B) – Complete Section B-1 and Section
B-2 only for each subcontracting opportunity as applicable.
HSP
Information
Page
Respondent and
Requisition
Information
Company Name
and Requisition #
Subcontracting
Intentions:
Complete Section
2-a; Yes, I will be
subcontracting
portions of the
contract.
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.
Section 4;
Affirmation
Signature
Affirms that
Information
Provided is
True and
Correct.
HSP GFE Method B
(Attachment B)
Complete
Sections B-1; and
B-2 only for each
HUB Protégé
subcontracting
opportunity.
HSP GFE Method B
(Attachment B)
List the
HUB Protégé(s)
METHOD III
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, which
meets or exceeds the HUB Goal identified in the solicitation,
complete:
•
Section 1 - Respondent and Requisition Information;
•
Section 2 a. – Yes, I will be subcontracting portions of the contract;
•
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;
•
Section 4 – Affirmation; and,
•
HSP GFE Method A (Attachment A) – Complete this attachment for each
subcontracting opportunity.
HSP
Information
Page
Respondent and
Requisition
Information
Company Name
and Requisition #
Subcontracting
Intentions:
Complete Section
2-a; Yes, I will be
subcontracting
portions of the
contract.
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.
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.
Section 4;
Affirmation
Signature
Affirms that
Information
Provided is
True and
Correct.
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)
Reminders: Notice
to subcontractors
and HHSC.
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:
•
Section 1 - Respondent and Requisition Information;
•
Section 2 a. – Yes, I will be subcontracting portions of the contract;
•
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;
•
Section 4 – Affirmation; and,
•
HSP GFE Method B (Attachment B) – Complete this attachment for each
subcontracting opportunity/
HSP
Information
Page
Respondent and
Requisition
Information
Company Name
and Requisition #
Subcontracting
Intentions:
Complete Section
2-a; Yes, I will be
subcontracting
portions of the
contract.
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.
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.
Section 4;
Affirmation
Signature
Affirms that
Information
Provided is
True and
Correct.
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
HSP GFE Method B
(Attachment B)
Written
Notification
Requirements
List 3 HUBs
Contacted
for this
Subcontracting
Opportunity
HSP GFE Method B
(Attachment B)
Written
Notification To
Trade
Organizations
HSP GFE Method B
(Attachment B)
List Trade
Organizations
Notified with
Dates
Sent/Accepted.
HSP GFE Method B
(Attachment B)
Provide written
justification why a
HUB was not
selected for this
Subcontracting
Opportunity
Reminders: Notice
to subcontractors
and HHSC.
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:
•
Section 1 – Respondent and Requisition Information;
•
Section 2 a. – No, I will not be subcontracting any portion of the
contract, and I will be fulfilling the entire contract with my own
resources;
•
Section 3 – Self Performing Justification; and,
•
Section 4 – Affirmation
HSP
Information
Page
Respondent and
Requisition
Information
Company Name
and Requisition #
Subcontracting
Intentions:
Complete Section
2-a; No, I will not
be subcontracting
any portion of the
contract.
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.
Section 4;
Affirmation
Signature
Affirms that
Information
Provided is
True and
Correct.
HSP ASSISTANCE FROM CPA
HUB Subcontracting Plan (HSP) Forms
How to Complete an HSP:
Step-by-step instructions and an audio on “How to Complete an HSP ” is
located on the Texas Comptroller of Public Account’s (CPA’s) website at:
(TO BE UPDATED)
HUB Participation Requirements
HUB Subcontracting Opportunity
Notification Form
Sample for
Respondent’s
Use.
Texas Health and Human Services Commission
Question Submittal
Followed by Break
Responses to
Vendor Questions
 HHSC may provide non-binding verbal answers to vendor
questions. Verbal responses are non-binding, however, the
binding, written addendum will be posted on the HHSC web
site.
 Additional questions must be submitted in writing to the
HHSC Sole Point of Contact (see RFP Section 1.2) by the date
noted in the procurement schedule (see RFP Section 1.3).
 HHSC Responses are tentatively scheduled to post by the date
noted in the procurement schedule (see RFP Section 1.3) on
the HHSC website located at the URL below:
http://www.hhsc.state.tx.us/contract/529130042/announcements.shtml
Texas Health and Human Services Commission
Closing Comments