Texas Health and Human Services Commission HHSC

1
Texas Health and Human Services Commission (HHSC)

• Medicaid Eligibility and Health Information (EHI)
  Project
• Request for Proposals 529-08-0128
• Vendor Conference January 28, 2009

2

• Welcome
• Introductions
• Billy Millwee, Medicaid/CHIP Deputy Director of
  Contract Administrative Operations
• Elizabeth Ward, Enterprise Contract and
  Procurement Services (ECPS)
• Noel Villarreal, EHI Director
• Larry Fisher, Senior Financial Analyst,
• HHS System Budget and Fiscal Policy
• Carlos Balderas, HUB Administrator,
  Administrative Services Development (ASD)
• Chester Beattie, HHSC Assistant General Counsel
• Housekeeping Items

3
Opening Remarks

• Billy Millwee, HHSC Deputy Director
  Medicaid/CHIP,
• Claims Administrator Operations

4
HHSC Procurement Roles

• ECPS - Responsible for procurement activity
• HUB - Responsible for Historically Underutilized
  Business (HUB) activity
• Program - Responsible for project scope,
  requirements, performance, results, contract
  management/monitoring
• Legal - Questions/answers and legal activity

5
Vendor Conference Overview

• Procurement Activities
• RFP Overview
• Financial Approach
• HUB Requirements
• Vendor Questions Submittal
• Break
• Preliminary Responses to Questions
• Closing Comments

6

• Procurement Activities
• Sole Contact, Elizabeth Ward, ECPS
• Procurement Schedule
• Solicitation Access- http//www.hhsc.state.tx.us/
  about_hhsc/BusOpp/contracts.asp
• Submission Requirements
• Solicitation Changes (Addendums)
• Screening Evaluation
• Award Information

7
HHSC Point of Contact
Elizabeth Ward, Contract Administrator Enterprise
Contract and Procurement Services (ECPS)
Division 4405 N. Lamar Blvd. Austin, Texas
78756-3422 [phone] Fax (512)
206-4540 Elizabeth.ward_at_hhsc.state.tx.us All
communications relating to this RFP must be
directed to the HHSC contact person. All
communications between respondents and other HHSC
staff members concerning this RFP are strictly
prohibited. Failure to comply with these
requirements may result in proposal
disqualification.
8
Medicaid Eligibility and Health Information
Project
9
(No Transcript)
10
RFP Overview

• Background
• Mission
• Scope of Work
• Transition Plan
• Turn-over Period
• Performance Measures

11
Background

• Current Environment
• HHSC mails approximately 2.7 million paper Med ID
  letters each month
• Over 1 million letters are returned annually
• Requires full-time staff to process
• Current tools and processes support relatively
  static data model
• Lives of the clients are dynamic, and so is the
  data
• Access to data is limited

12
Background Pilots
January 2004
December 2005
December 2006
Medicaid Pilot Voluntary Phase
MAC Phase I Mandatory Phase
MAC Phase II Sustained operations

• Medicaid Integrity Pilot (MIP)
• 4 Vendor Solutions, being tested in separate
  counties
• Voluntary participation by providers and clients
• Medicaid Access Card (MAC) Phase I
• Using a single vendor solution, chosen as most
  effective solution from previous phase
• 300 MAC terminals deployed
• 3 counties Cameron (FFS), Hidalgo (FFS) and
  Travis (MC)
• Mandatory participation for clients and providers
• Approximately 1500 MAC terminals deployed
• MAC Phase II sustained operations
• Sustained operations for participating clients
  and providers
• Lights on operations during planning for
  statewide implementation

13
Background

• Change in Direction
• While finger imaging was a primary element of the
  previous pilot, the statewide implementation of
  the EHI system will not include the use of smart
  cards or biometrics for client authentication.
• Will use magnetic stripe cards
• Will not include finger image biometrics
• This change will provide a cost effective means
  for modernizing HHSC methods for client
  identification and offers new tools and process
  improvements for Medicaid clients and providers.

14
Mission

• Replace the paper Med ID form
• Improve access and quality of information
  available to providers beyond what is available
  on the printed paper form
• Provide more on-demand information and
  self-service capability to clients
• Provide multiple channels for access to
  information (i.e. call centers, web, interfaces)

15
Scope of Work

• Replace the current paper MedIDs with new
  permanent plastic Medicaid Identification cards
  for all Medicaid clients.
• Supply participating Medicaid providers with
  automation options.
• Provide training and support.
• Operate the EHI host system with interfaces to
  the eligibility systems and other information
  resources.
• Create and maintain user portals.
• Operation of a Help Desk.
• Electronic Health Records (EHR).

16
Scope Functions

• In summary, the Vendor must provide the following
  high-level functions
• Card Services
• Provider Services
• Client Services
• Host Processing Services
• Help Desk Services
• User Portals
• Electronic Health Records
• General

17
Scope of Work

• Client Access to Information
• Near real time data
• Client Portal
• Eligibility information
• Rudimentary EHR
• Medicaid program information
• Aggregate information

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Scope of Work EHR

• Electronic Health Records (EHR)
• Multiple terminal configurations
• Provider Portal
• Aggregate information
• Interfaces for future data sources

19
Transition Plan

• HHSC requires that the transition and start-up
  period be limited and that the EHI be System
  Ready by December 29, 2009. System Ready
  includes all design, development, testing and
  certification be complete, such that card
  issuance and operations may begin.
• HHSC understands that some of the scheduled
  activities (e.g. User Acceptance Testing, System
  Ready Review) may involve significant state
  resources. As such, vendors must provide
  detailed assumptions on what state resources will
  be required.
• The Implementation Plan must describe the
  Vendors plan for implementing their solution,
  and describe how the transfer of functions,
  facilities, and processes will transition from
  the current contractor to the incoming Vendor.

20
Turn-over Period

• At the end of the Contract, the Vendor will
  transfer ownership and possession of all
  hardware, software, data purchased or developed
  under the EHI Contract and any other materials or
  property deemed to be a product of the project to
  HHSC, or a new vendor as directed by HHSC, within
  the timelines specified by HHSC.
• The Vendor will be responsible for all costs
  related to transferring these assets to HHSC or
  HHSCs designee. All transferred data must be
  compliant with HIPAA requirements.
• In the case of provider automation equipment,
  Vendor will transfer ownership and possession to
  the applicable procuring provider or entity.

21
Performance Measures

• HHSC will monitor the performance of the EHI
  Contract issued under this RFP. All services and
  deliverables under the EHI Contract shall be
  provided at an acceptable quality level and in a
  manner consistent with acceptable industry
  standard, custom, and practice.
• If the Vendor fails to meet the contract
  requirements, HHSC will assess liquidated damages
  (LD) as specified per incident.

22
Financial Approachand Pricing Overview

• Larry Fisher, Senior Financial Analyst,
• HHS System Budget and Fiscal Policy

23
Financial Approach

• The State has chosen to utilize a FIXED PRICE
  APPROACH to the administrative services included
  in the Medicaid Eligibility and Health
  Information Services Request for Proposal (EHI
  RFP).
• The objective of the Financial Approach is to
  describe the financial components that will
  enable the State to achieve the Mission
  Objectives described in Section 1.5 of the RFP.

24
Financial Approach

• Allowable and non-allowable direct and indirect
  costs, wherever applicable to any payments to the
  successful Vendor, will be governed by the
  principles set forth in the following regulations
  and documents (as they may be amended during the
  term of the contract)
• Title 48 CFR, Chapter 1, Part 31, Contract Cost
  Principles and Procedures.
• Title 48 CFR, Chapter 1, Part 30, Cost Accounting
  Standards Administration.
• Title 48 CFR Chapter 99Cost Accounting
  Standards.

25
Financial Approach

• In addition to costs that are unallowable
  pursuant to the above accounting principles, the
  State has deemed some of the allowable costs to
  be specifically unallowable for the contract
  resulting from this RFP. The list of additional
  unallowable costs is included in Section 2.3.3.1
  of the RFP.

26
Financial Approach

• The Vendor must maintain an accounting system
  that provides an audit trail containing
  sufficient financial documentation to allow for
  the reconciliation of billings, reports, and
  financial statements with all general ledger
  accounts and specific business functional areas
  within the applicable components.

27
Financial Approach

• The awarded Vendor must provide authorized
  governmental representatives of HHSC and the
  federal government full access to all financial
  and accounting records related to the performance
  of the resulting contract, including all
  requested Primary subcontractor financial and
  accounting records.

28
Financial Approach

• The Vendor must provide monthly financial
  statements, including an income statement,
  depicting the Vendors operations under the
  resulting contract no later than the twentieth
  calendar day following the end of the reporting
  month.

29
Financial Approach

• Transition costs to meet the requirements of the
  RFP will be paid on a fixed fee basis. Each Key
  Milestone will be paid on a separate fixed fee
  basis.
• Transition costs will be proposed to allow the
  Vendor to assume the responsibilities of each Key
  Milestone effective with the operational start
  date applicable to the specific Key Milestone.

30
Financial Approach

• Operational costs to meet the requirements of the
  RFP will also be paid utilizing both fixed fee
  and variable fee formulas.
• HHSC requires that no more than 50 of the
  administrative fees for the EHI services will be
  paid utilizing fixed fees and a minimum of 50 of
  the administrative fees for the EHI services will
  be paid utilizing variable fees. HHSC reserves
  the right to determine the final percentage of
  fixed fees and variable fees in the contract for
  the EHI services.

31
Financial Approach

• The Operational fixed and variable fees will be
  subject to the Retrospective Cost Settlement
  provisions documented in Section 2.3.6.7(c) of
  the RFP.
• Operational and/or Transition costs in excess of
  the final fixed price amount(s) included in the
  contract resulting from this RFP will not be paid
  by the State.

32
Financial Approach

• Separate Fixed administrative fees will be
  proposed for each 12 month operational period
  of a resulting contract (and any applicable
  operational period less than 12 months).
• All fees will be paid to the Vendor
  retrospectively.

33
Financial Approach

• Separate Variable administrative fees will be
  proposed for the initial 12 month operational
  period. For subsequent operational contract
  years, the variable administrative fees will be
  determined by the application of a fixed annual
  inflator / deflator proposed by the Vendor.
• EHI Variable fees will be paid for the following
• Enrolled EHI Clients,
• Issued EHI Cards, and
• Active EHI Providers.

34
Financial Approach

• Ownership of all nonexpendable capital items
  funded by the contract resulting from this RFP
  will pass to the State at the expiration of the
  contract.
• The provisions related to Ownership of Capital
  Items at Expiration of the Contract are
  documented in Section 2.3.6.7(a) of the RFP.

35
Financial Approach

• Actual expenditures for Pass-Through Items made
  on the States behalf will be paid without
  allocation of any indirect charges (general
  administrative expenses, overhead, etc.) or any
  administrative service fee (profit).
• A complete listing of expenditures designated as
  Pass-Through Items are documented in Section
  2.3.6.7(b) of the RFP.

36
Financial Approach

• Administrative fees paid to the Vendor during
  each Operational Contract Year will consist of
• - (i) the Fixed Administrative Fees
• - (ii) the Variable Administrative Fees
• - (iii) the Administrative Fees for the
  Additional Periodic Activities and
• - (iv) the Administrative Fees for the
  Additional Recurring Activities.
• The sum of the four Fee components will be
  referred to as the Fee Ceiling.

37
Financial Approach

• The total maximum cost of the Services and
  Deliverables supplied by the Vendor to HHSC
  during each Operational Contract Year will not
  exceed the lesser of
• (a) the Vendors Fees (Fee Ceiling) or
• (b) the sum of the Allowable Costs incurred by
  the Vendor plus the allowable administrative
  service fee during the subject Operational
  Contract Year.

38
Financial Approach

• On a monthly basis, the state and the Vendor will
  reconcile the amounts disbursed to the Vendor
  with the Vendors allowable costs plus the
  allowable administrative service fee.
• Additional details related to the Retrospective
  Cost Settlement provision included in the RFP are
  located in Section 2.3.6.7(c).

39
Pricing Overview

• Forms substantially similar to those described in
  the RFP must provide the component costs of the
  Firm Fixed Prices quoted for providing the
  services and deliverables set forth in the EHI
  RFP.
• - Attachment A, Appendix A-1 contains
  Transitional Pricing Schedules,
• - Attachment A, Appendix A-2 contains
  Operational Pricing Schedules,

40
Pricing Overview

• - Attachment A, Appendix A-3 contains the formal
  Price Summary Sheets.
• - Attachment A, Appendix A-4 contains Provider
  Automation Pricing Sheets, and
• - Attachment A, Appendix A-5 contains the DIR
  DCS Components Pricing Sheets.

41
Pricing Overview

• The prospective Vendor must structure its pricing
  quotation to allow HHSC a method to map the
  proposed costs for the cost proposal submitted
  back to the Vendors Detailed Work Plan for the
  initial term of the Contract.
• The Vendor must provide separate Transitional
  Costs through the proposed transition period.
• The Vendor must provide the required projected
  monthly costs for the entire operations period.
• The pricing quotations for each specific
  component must agree with the Firm Fixed Prices
  proposed by the Vendor.

42
Pricing Overview

• Transition Pricing Schedules
• The prospective Vendors transitional cost
  proposal sheets must include the Key Milestones
  the Vendor must accomplish during the
  Transitional period (Appendix A-1). Key
  Milestones are listed in Section 3.15.3.3 of the
  RFP.

43
Pricing Overview

• The prospective Vendors operational cost
  proposal sheets must be delineated by the primary
  business functional areas (functional area) for
  the Operational period(s) (Attachment A, Appendix
  A-2) also listed in Section 3.15.3.3 of the RFP.

44
Pricing Overview

• Instructions for completing each schedule are
  included in the RFP.
• Summary forms should be supported by the detailed
  information contained on monthly schedules.
• Amounts shown on the monthly schedules must agree
  with the cumulative amounts shown on the summary
  forms.

45
Pricing Overview

• In addition to paper copies of the Vendors Cost
  Proposal and Price Summary sheets, Vendors must
  submit electronic versions in an MS Excel format.
  
• Any electronic version of the pricing forms must
  contain any and all formulas used to calculate
  pricing information contained on the forms and
  include any and all links to other worksheets /
  forms included in the Vendors Cost Proposal.

46
Pricing Overview

• Price Summary Sheet 1 shows the fixed
  administrative fees for the transitional period
  by Key Milestone. The total fixed fees by Key
  Milestone on this sheet must be consistent with
  the detailed Transitional Pricing Schedules in
  Appendix A-1.

47
Pricing Overview

• Price Summary Sheet 2 shows the fixed
  administrative fees for each operational period.
• The total fixed and variable fees for each 12
  month operational period (or portion thereof)
  must be consistent with the more detailed
  Operational Pricing Schedules in Appendix A-2.

48
Pricing Overview

• Price Summary Sheet 3 shows the variable
  administrative fees for the first 12 month
  operational period by the specific type of
  variable activities requested by the state. The
  variable administrative fees for subsequent 12
  month operational periods (or portion thereof)
  will be determined by the application of the
  fixed annual price inflator / deflator proposed
  by Vendor. The fixed annual price inflator /
  deflator will be calculated utilizing four
  decimal places ( 0.xxxx ).

49
Pricing Overview

• Price Summary Sheet 4 shows the all-inclusive
  hourly labor rates and the proposed fixed annual
  inflator used to show costs associated with
  additional non-recurring and/or periodic
  activities to be performed by the Vendor by
  different types of service categories.

50
Pricing Overview

• The maximum fees associated with additional
  non-recurring and/or periodic activities to be
  performed by the Vendor will be based on explicit
  fixed prices proposed for Vendor inputs and the
  actual number of hours worked on the specific
  modification by the Vendors staff and/or the
  staff of a Vendors subcontractor.

51
Pricing Overview

• Appendix A - 4, Provider Automation Pricing Sheet
  shows the proposed Provider Automation Pricing
  contracted directly between the Vendor and
  participating providers. Applicable costs will
  be paid by participating providers. The Provider
  Automation Pricing will be a factor in the
  overall cost evaluation .

52
Pricing Overview

• Appendix A - 5, DIR DCS Components Pricing
  provides a description and associated pricing
  related to DIR DCS components. Schedule 1 must
  be completed with all the applicable DIR DCS
  components included in the Vendors solution.
  The component pricing must be obtained from and
  approved by DIR DCS. Schedule 2 may be
  completed as an option as discussed in Section
  3.15.2.4.

53
Pricing Overview

• The prospective Vendor must submit a Financial
  Operations Plan that shows how the Vendor will
  fulfill all financial requirements contained in
  the contract resulting from this RFP.

54
Pricing Overview

• The cost proposal should include any business,
  economic, legal, programmatic, or practical
  assumptions that underlie the Cost Proposal. HHSC
  reserves the right to accept or reject any
  assumptions.

55
HUB Subcontracting Plan(HSP) RequirementsCarlo
s Balderas, HUB Administrator, Administrative
Services Development
56
Agenda Topics

• RFP Section 4.0 Historically Underutilized
  Business
• Participation Requirements
• HUB Subcontracting Plan for the RFP is required
• Self Performance HSP
• HSP Prime Contractor Progress Assessment Report

57
RFP Section 4.0 - Historically Underutilized
Business Participation Requirements

• HUB Participation Goals
• Potential Subcontracting Opportunities
• Vendor Intends to Subcontract
• Minority or Women Trade Organizations
• Self Performance
• HSP Changes After Contract Award
• Reporting and Compliance with the HSP

58
If HSP is inadequate, response will be rejected
HSP Information Page
59
HUB GOALS
Special reminders and instructions
Company Information
HSP Information Page
60
HSP Information Page
Subcontracting Declaration
Enter subcontracting opportunities
If more than 20 subcontracting opportunities,
click the link provided to continue adding
61
One page for each area subcontracted (listed on
page 1)
HSP Information Page
62
List Line and Subcontracting Opportunity
HSP Information Page
63
HSP Information Page
Protégé performing the work
Skip to Sections 8 and 10
64
HSP Information Page
Professional Services Category
65
HSP Information Page
Good Faith Efforts to find/include Texas
Certified HUB Vendors
66
HSP Information Page
Contact HUB Trade Organization
67
HSP Information Page
Written Notification Requirements
68
HSP Information Page
List 3 HUBs Contacted for this
Subcontracting Opportunity
69
HSP Information Page
List Subs Selected (HUBs Non-HUBs) for this
Subcontracting Opportunity
70
HSP Information Page
Reason why HUB was not selected for this
Subcontracting Opportunity
71
Self Performance Explanation
Signature Affirms that True and Correct
Information is Provided
HSP Information Page
72
HSP Prime Contractor Progress Assessment Report
ATTACHMENT E

• Required with
• ALL Pay Requests

• List ALL Sub payments
• (HUBs Non-HUBs)

73
HSP ASSISTANCE FROM TPASS
HUB Subcontracting Plan (HSP) Forms Step-by-step
instructions and an audio on How to Complete an
HSP is located on the Comptroller of Public
Accounts (CPA) Texas
Procurement and Support Services (TPASS) website
at http//www.cpa.state.tx.us/procurement/prog/
hub/hub-forms/ HUB Subcontracting Plan
Instructional Video Play Windows Media Version
(7.7 MB download) Play Quicktime (mp4) version
(24 MB download) Play Macromedia Flash version
(10.8 MB download) Read Video Transcript (.rtf
file) (160 K download)
74
Administrative Services Development HUB Program
Office

• Robert L. Hall, C.P.M.
• Director of Administrative Services
  Development
• - [phone]
• - robert.hall_at_hhsc.state.tx.us
• Carlos A. Balderas
• ASD HUB Administrator
• - [phone]
• - carlos.balderas_at_hhsc.state.tx.us
• Sherice Williams-Patty
• ASD HUB Administrator
• - [phone]
• - sherice.williams-patty_at_hhsc.state.tx.us
• Segundo Sanchez
• ASD Procurement/HUB Team Lead
• - [phone]
• - segundo.sanchez_at_hhsc.state.tx.us

75
Chester Beattie,Office of General Counsel

• Collusion
• Conflict of Interest
• Permissible Contacts

76
Texas Health and Human Services Commission

• Questions Submittal
• Followed by Break

77
Preliminary Responses to Questions

• Questions and Answers
• Non-binding verbal answers to vendor questions
• Binding responses will be posted on the
  procurement website by February 13, 2009

78

• Closing Comments
• by Elizabeth Ward, ECPS