RFP12 2260P by 1f54pC8

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									                                   STATE OF MONTANA
                               REQUEST FOR PROPOSAL (RFP)

RFP Number:       RFP Title:
12-2260P          ON-SITE EMPLOYEE HEALTH CENTER
     RFP Response Due Date and Time:      Number of Pages:                         Issue Date:
               April 9, 2012              87                                       February 9, 2012
         2:00 p.m., Mountain Time

                             ISSUING AGENCY INFORMATION
Procurement Officer:                              State Procurement Bureau
Penny Moon                                         General Services Division
                                                 Department of Administration
                                                    Phone: (406) 444-2575
       Website: http://vendor.mt.gov/                 Fax: (406) 444-2529
                                                     TTY Users, Dial 711

                                   INSTRUCTIONS TO OFFERORS
Return Sealed Proposal to:
                                                                            Mark Face of
PHYSICAL ADDRESS:                   MAILING ADDRESS:
                                                                            Envelope/Package with:
  State Procurement Bureau              State Procurement Bureau
  General Services Division             General Services Division
                                                                             RFP Number: 12-2260P
  Department of Administration          Department of Administration
  Room 165, Mitchell Building           P.O. Box 200135                      RFP Response Due Date:
  125 North Roberts Street              Helena, MT 59620-0135                April 9, 2012
  Helena, MT 59601-4588
Special Instructions: An optional Pre-Proposal Conference will be conducted on February 23, 2012 at 1:00
p.m. in the Wilderness Room, TRW Building 2nd Floor, 2401 Colonial Drive, Helena, MT. Interested parties
may attend in person or can participate by calling 1-888-387-8686 and enter 1749204 as the Conference ID.

                         OFFERORS MUST COMPLETE THE FOLLOWING
Offeror Name/Address:

                                                                           (Name/Title)


                                                                           (Signature)
                                                     Print name and title and sign in ink. By submitting a
                                                     response to this RFP, offeror acknowledges it understands
                                                     and will comply with the RFP specifications and
                                                     requirements.
Type of Entity (e.g., corporation, LLC, etc.)        Offeror Phone Number:


Offeror E-mail Address:                              Offeror FAX Number:

            OFFERORS MUST RETURN THIS COVER SHEET WITH RFP RESPONSE

                                                                                                      Revised 2/11
                                                                 TABLE OF CONTENTS
                                                                                                                                                                             PAGE
Instructions to Offerors................................................................................................................................... 3
Schedule of Events ......................................................................................................................................... 4
Section 1: Introduction and Instructions ...................................................................................................... 5
          1.1     Introduction ....................................................................................................................................................... 5
          1.2     Purpose ............................................................................................................................................................ 5
          1.3     Contract Period ................................................................................................................................................ 6
          1.4     Single Point of Contact ..................................................................................................................................... 6
          1.5     Required Review .............................................................................................................................................. 6
          1.6     Pre-Proposal Conference ................................................................................................................................. 7
          1.7     General Requirements ..................................................................................................................................... 7
          1.8     Submitting a Proposal ...................................................................................................................................... 8
          1.9     Costs/Ownership of Materials .......................................................................................................................... 9
Section 2: RFP Standard Information.......................................................................................................... 10
          2.1     Authority ......................................................................................................................................................... 10
          2.2     Offeror Competition ........................................................................................................................................ 10
          2.3     Receipt of Proposals and Public Inspection ................................................................................................... 10
          2.4     Classification and Evaluation of Proposals .................................................................................................... 10
          2.5     State's Rights Reserved ................................................................................................................................. 12
Section 3: Scope of Services ....................................................................................................................... 13
          3.1        Plan Administration – Background and Statistics ....................................................................................... 13
          3.2        Services Sought/Scope of Work ................................................................................................................. 14
          3.3        Workplace Health Center Services ............................................................................................................. 14
          3.4        Plan of Operations ...................................................................................................................................... 18
          3.5        Facility Design / Acquisition / Operation ..................................................................................................... 18
          3.6        Reporting ..................................................................................................................................................... 19
          3.7        Case Management Referral ........................................................................................................................ 20
          3.8        Case, Health, ad Disease Management ..................................................................................................... 20
          3.9        Electronic Health Records........................................................................................................................... 21
          3.10       Contractor Responsibilities ......................................................................................................................... 22
          3.11       Performance Standards .............................................................................................................................. 25
Section 4: Offeror Qualifications ................................................................................................................. 26
          4.1     State's Right to Investigate and Reject .......................................................................................................... 26
          4.2     Offeror Qualifications ...................................................................................................................................... 26
Section 5: Cost Proposal ............................................................................................................................. 29
          5.1        Statement of Compliance and Price Sheets ............................................................................................... 29
          5.2        Performance Guarantees ............................................................................................................................ 37
Section 6: Evaluation Process ..................................................................................................................... 38
          6.1     Basis of Evaluation ......................................................................................................................................... 38
          6.2     Evaluation Criteria .......................................................................................................................................... 39
Appendix A - Standard Terms and Conditions (To be Provided at the Pre-Proposal Conference) ......... 41
Appendix B – Contract (To be Provided at the Pre-Proposal Conference)................................................ 42
Appendix C - Client Reference Form ............................................................................................................ 43
Appendix D – Organizational Chart .............................................................................................................. 46
Appendix E – Certificates of Insurance ....................................................................................................... 48
Appendix F – Professional Certifications/Licenses .................................................................................... 49
Appendix G – Financial Information............................................................................................................. 50
Appendix H – Pro Forma ............................................................................................................................... 51
Appendix I – Selected Medications .............................................................................................................. 52
Appendix J - Census and Utilization Information ........................................................................................ 55
Exhibit I – Business Associate Agreement .................................................................................................. 77


                                                                                                RFP12-2260P, On-Site Employee Health Center, Page 2
                                  INSTRUCTIONS TO OFFERORS
It is the responsibility of each offeror to:
   Follow the format required in the RFP when preparing your response. Provide responses in a clear and
   concise manner.
   Provide complete answers/descriptions. Read and answer all questions and requirements. Proposals
   are evaluated based solely on the information and materials provided in your written response.
   Use any forms provided, e.g., cover page, budget form, certification forms, etc.
   Submit your response on time. Note all the dates and times listed in the Schedule of Events and within
   the document. Late proposals are never accepted.

                          The following items MUST be included in the response.
           Failure to include ANY of these items may result in a nonresponsive determination.

    Signed Cover Sheet
    Signed Addenda (if appropriate) in accordance with Section 1.5.3
    Address all mandatory requirements in accordance with Section 1.7.3
    Correctly executed State of Montana "Affidavit for Trade Secret Confidentiality" form, if claiming
     information to be confidential or proprietary in accordance with Section 2.3.1.
    In addition to a detailed response to all requirements within Sections 3.3-3.11, 4.2, 5, and
     Appendices C – I offeror must acknowledge that it has read, understands, and will comply with
     each section/subsection listed below by initialing the line to the left of each. If offeror cannot
     meet a particular requirement, provide a detailed explanation next to that requirement.

              Section 1, Introduction and Instructions
              Section 2, RFP Standard Information
              Section 3.1, Plan Administration – Background and Statistics
              Section 3.2, Services Sought/Scope of Work
              Section 4.1, State's Right to Investigate and Reject
              Section 6, Evaluation Process
              Appendix A, Standard Terms and Conditions
              Appendix B, Contract
              Appendix J, Census and Utilization Information
              Exhibit I, Business Associate Agreement




                                                            RFP12-2260P, On-Site Employee Health Center, Page 3
                                        SCHEDULE OF EVENTS

EVENT                                                                                                     DATE

RFP Issue Date ................................................................................... February 9, 2012

Pre-Proposal Conference ................................................................ February 23, 2012

Deadline for Receipt of Written Questions .................................... February 27, 2012

Deadline for Receipt of Contract Exception Table .............................. March 2, 2011

Deadline for Posting Responses to Written Questions and
  Contract Exception Table to State’s Website ............................... March 19, 2012

RFP Response Due Date .......................................................................... April 9, 2012

Notification of Offeror Interviews .............................................................May 4, 2012

Offeror Interviews (tentatively) ............................................... Week of May 14, 2012*

Intended Date for Contract Award ....................................................... June 15, 2012*

Implementation Begins......................................................................... June 18, 2012*

Clinic Opening Date (tentatively) .................................................December 17, 2012*


*The dates above identified by an asterisk are included for planning purposes. These dates
 are subject to change.




                                                             RFP12-2260P, On-Site Employee Health Center, Page 4
                     SECTION 1: INTRODUCTION AND INSTRUCTIONS

1.1    INTRODUCTION
The STATE OF MONTANA, Department of Administration, Health Care and Benefits Division ("State") is
seeking a contractor to provide an On-Site Employee Health Center. The On-Site Employee Health Center will
provide primary health care, acute and episodic health care, wellness services, health screenings, pharmacy
services, and other services depending on the needs of the State. The On-Site Employee Health Center will be
a health care option for State employees and their dependents. The contractor will not be guaranteed any
specific number of patients. The State Employee Health Benefit Plan may include incentives to use the On-Site
Employee Health Center. However, employees make the final decision about receiving health care services.
The primary goals of the On-Site Employee Health Center are:
    Increase access to primary care services;
    Improve health outcomes for members;
    Improve treatment and compliance for patients with chronic health conditions;
    Provide access to health coaching and care management;
    Reduce costs for the State health plan and plan members;
    Provide health screening services;
    Reduce reliance on emergency room and urgent care;
    Improve employee productivity and reduce absenteeism;
    Point of Integration for health plan services (care management, customer service) with health care
        delivery;
    Develop occupational health capacity and reduce workers’ compensation costs;
    Provide alternative options for retail pharmacy, specialty medications, and infusion services.

A more complete description of the services to be provided is found in Section 3 and additional information
related to census and utilization are included in Appendix J.

Locations and populations served:
    Statewide presence is desired, will likely occur in phases over several years;
    The first location sought is Helena, Montana;
    Community needs will drive the health center services; no one solution will work;
    Health centers could become “regional” serving outlying communities via telemedicine or traveling staff;
    Health centers would be available to employees, legislators, and their dependents;
    Health centers would not be available to members of the general public;
    Statewide approach to health screenings and health risk assessments for employees, retirees,
       legislators, and their dependents.

The State provides health benefits coverage to its employees, retirees, legislators, and their respective
dependents. These benefits are offered to our members through a combination of a Traditional (indemnity)
plan, a dental plan, and managed care plans. Each member must make an annual choice of the medical plan
in which they wish to enroll. A complete description of these benefits can be found at http://benefits.mt.gov.

1.2    PURPOSE
The purpose of this RFP is to:
      1. Solicit competitive proposals to provide the services described;
      2. Describe On-Site Employee Health Center services in detail;
      3. Define clearly all work to be performed under the contract;
      4. Provide mandatory contents for all proposals;
      5. Provide a schedule of milestones for compliance with department objectives; and
      6. Describe the proposal evaluation and selection process.
                                                           RFP12-2260P, On-Site Employee Health Center, Page 5
The State’s objective is to enhance the access to affordable primary medical care, facilitate the continuity of
care, promote wellness programs and preventive care, provide chronic disease management, and offer a time
efficient means for obtaining medical care for its employees and their dependents.

Offerors are encouraged to provide within their technical proposal a recommendation of services that would be
offered in the On-Site Employee Health Center, including at a minimum the above services. If, for any reason,
a service requested by the State is not available, explain in detail why it cannot or should not be provided and
propose any alternative solutions for consideration. We are looking for creative, cost-efficient solutions for the
implementation and management of a successful On-Site Employee Health Center available to eligible state
employees.

1.3    CONTRACT PERIOD
The contract term is for a period of three years and seven months beginning June 15, 2012 and ending
December 31, 2015. The parties may mutually agree to a renewal of this contract in one-year intervals, or any
interval that is advantageous to the State. This contract, including any renewals, may not exceed a total of 10
years, at the State's option.

1.4    SINGLE POINT OF CONTACT
From the date this Request for Proposal (RFP) is issued until an offeror is selected and announced by the
procurement officer, offerors shall not communicate with any state staff regarding this procurement,
except at the direction of Penny Moon, the procurement officer in charge of the solicitation. Any
unauthorized contact may disqualify the offeror from further consideration. Contact information for the single
point of contact is:

                                       Procurement Officer: Penny Moon
                                      Telephone Number: (406) 444-3313
                                         Fax Number: (406) 444-2529
                                        E-mail Address: pmoon@mt.gov

1.5    REQUIRED REVIEW
        1.5.1 Review RFP. Offerors shall carefully review the entire RFP. Offerors shall promptly notify the
procurement officer identified above via e-mail or in writing of any ambiguity, inconsistency, unduly restrictive
specifications, or error that they discover. In this notice, the offeror shall include any terms or requirements
within the RFP that preclude the offeror from responding or add unnecessary cost. Offerors shall provide an
explanation with suggested modifications. The notice must be received by the deadline for receipt of inquiries
set forth in Section 1.5.2. The State will determine any changes to the RFP.

         1.5.2 Form of Questions. Offerors having questions or requiring clarification or interpretation of any
section within this RFP shall address these issues via e-mail or in writing to the procurement officer listed
above on or before February 27, 2012. Offerors are to submit questions using the State’s Vendor RFP
Question and Answer Form available on the OneStop Vendor Information website at:
http://svc.mt.gov/gsd/OneStop/GSDDocuments.aspx or by calling (406) 444-2575. Clear reference to the
section, page, and item in question must be included in the form. Questions received after the deadline may
not be considered.

NOTE: The State will provide the Contract and Standard Terms and Conditions (Appendices A and B) by
February 23, 2012. Exceptions to contract language shall be set forth in detail in the table below. Proposed
contract language changes not submitted in this format may not be considered and may be returned without


                                                             RFP12-2260P, On-Site Employee Health Center, Page 6
review. Contract exceptions must be submitted to the procurement officer listed above on or before March 2,
2012.

                                           Contract Exceptions Table

  Contract
   Section,
                                                              Proposed Alternative or        Effect on Ability to
 Subsection,                           Reasons for
                      Issue                                   Additional Language to         Respond to RFP or
  and Page                          Proposed Change
                                                                Insert into Contract          Perform Contract
   Number




         1.5.3 State's Response. The State will provide a written response by March 19, 2012, to all
questions and contract exceptions received by March 2, 2012. The State's response will be by written
addendum and will be posted on the State's website with the RFP at
http://svc.mt.gov/gsd/OneStop/SolicitationDefault.aspx by the close of business on the date listed. Any other
form of interpretation, correction, or change to this RFP will not be binding upon the State. Offerors shall sign
and return with their RFP response an Acknowledgment of Addendum for any addendum issued.

1.6    PRE-PROPOSAL CONFERENCE
An optional Pre-Proposal Conference will be conducted on February 23, 2012 at 1:00 p.m. in the Wilderness
Room, TRW Building 2nd Floor, 2401 Colonial Drive, Helena, MT. Interested parties may attend in person or
can participate by calling 1-888-387-8686 and enter 1749204 as the Conference ID. Offerors are encouraged
to use this opportunity to ask clarifying questions, obtain a better understanding of the project, and to notify the
State of any ambiguities, inconsistencies, or errors discovered upon examination of this RFP. All responses to
questions during the Pre-Proposal Conference will be oral and in no way binding on the State. Participation in
the Pre-Proposal Conference is optional; however, it is advisable that all interested parties participate.

1.7    GENERAL REQUIREMENTS
       1.7.1 Acceptance of Standard Terms and Conditions/Contract. By submitting a response to this
RFP, offeror accepts the standard terms and conditions and contract set out in Appendices A and B,
respectively. Much of the language included in the standard terms and conditions and contract reflects the
requirements of Montana law.

NOTE: The State will provide the Contract and Standard Terms and Conditions (Appendices A and B) by
February 23, 2012.

Offerors requesting additions or exceptions to the standard terms and conditions or contract terms shall submit
them to the procurement officer listed above by the date specified in Section 1.5.2 and in the table provided. A
request must be accompanied by an explanation why the exception is being sought and what specific effect it
will have on the offeror's ability to respond to the RFP or perform the contract. The State reserves the right to
address nonmaterial requests for exceptions to the standard terms and conditions and contract language with
the highest scoring offeror during contract negotiation.

The State shall identify any revisions to the standard terms and conditions and contract language in a written
addendum issued for this RFP. The addendum will apply to all offerors submitting a response to this RFP. The
State will determine any changes to the standard terms and conditions and/or contract.



                                                              RFP12-2260P, On-Site Employee Health Center, Page 7
       1.7.2 Resulting Contract. This RFP and any addenda, the offeror's RFP response, including any
amendments, a best and final offer (if any), and any clarification question responses shall be incorporated by
reference in any resulting contract.

      1.7.3 Mandatory Requirements. To be eligible for consideration, an offeror must meet all
mandatory requirements as listed in Sections 3.10.8 and 4.2.8. The State will determine whether an offeror's
proposal complies with the requirements. Proposals that fail to meet any mandatory requirements listed in this
RFP will be deemed nonresponsive.

        1.7.4 Understanding of Specifications and Requirements. By submitting a response to this RFP,
offeror acknowledges it understands and shall comply with the RFP specifications and requirements.

        1.7.5 Offeror's Signature. Offeror's proposal must be signed in ink by an individual authorized to
legally bind the offeror. The offeror's signature guarantees that the offer has been established without
collusion. Offeror shall provide proof of authority of the person signing the RFP upon State's request.

       1.7.6 Offer in Effect for 120 Calendar Days. Offeror agrees that it may not modify, withdraw, or
cancel its proposal for a 120-day period following the RFP due date, or receipt of best and final offer, if
required.

1.8    SUBMITTING A PROPOSAL
       1.8.1 Organization of Proposal. Offerors shall organize their proposal into sections that follow the
format of this RFP. Proposals must be bound, and must include tabbed dividers separating each section.
Proposal pages must be consecutively numbered.

All subsections not listed in the "Instructions to Offerors" on page 3 require a response. Restate the
section/subsection number and the text immediately prior to your written response.

Unless specifically requested in the RFP, an offeror making the statement "Refer to our literature…" or "Please
see www…….com" may be deemed nonresponsive or receive point deductions. If making reference to
materials located in another section of the proposal, specific page numbers and sections must be noted. The
evaluator/evaluation committee is not required to search through the proposal or literature to find a
response.

The State encourages offerors to use materials (e.g., paper, dividers, binders, brochures, etc.) that contain
post-consumer recycled content. Offerors are encouraged to print/copy on both sides of each page.

       1.8.2 Failure to Comply with Instructions. Offerors failing to comply with these instructions may be
subject to point deductions. Further, the State may deem a proposal nonresponsive or disqualify it from further
consideration if it does not follow the response format, is difficult to read or understand, or is missing requested
information.

        1.8.3 Multiple Proposals. Offerors may, at their option, submit multiple proposals. Each proposal
shall be evaluated separately.

       1.8.4 Price Sheets. Offerors shall use the RFP Price Sheets found in Section 5. These price sheets
serve as the primary representation of offeror's cost/price. Offeror should include additional information as
necessary to explain the offeror's cost/price.

       1.8.5 Copies Required and Deadline for Receipt of Proposals. Offerors shall submit one original
proposal and two paper copies to the State Procurement Bureau. In addition, offerors shall submit seven
electronic copies of the proposal along with all attachments searchable as a single document, with each
section heading bookmarked, on universal serial bus (USB) flash drive in Microsoft Word or in portable
                                                              RFP12-2260P, On-Site Employee Health Center, Page 8
document format (PDF). At least one electronic copy in Microsoft Word format must be provided upon contract
award. If any confidential materials are included, per the requirements of Section 2.3.1, they must be
submitted on a separate USB flash drive.

EACH PROPOSAL MUST BE SEALED AND LABELED ON THE OUTSIDE OF THE PACKAGE clearly
indicating it is in response to RFP12-2260P. Proposals must be received at the reception desk of the State
Procurement Bureau prior to 2:00 p.m., Mountain Time, April 9, 2012. Offeror is solely responsible for
assuring delivery to the reception desk by the designated time.

        1.8.6 Facsimile Responses. A facsimile response to an RFP will ONLY be accepted on an
exception basis with prior approval of the procurement officer and only if it is received in its entirety by the
specified deadline. Responses to RFPs received after the deadline will not be considered.

      1.8.7 Late Proposals. Regardless of cause, the State shall not accept late proposals. Such
proposals will automatically be disqualified from consideration. Offeror may request the State return the
proposal at offeror's expense or the State will dispose of the proposal if requested by the offeror. (See
Administrative Rules of Montana (ARM) 2.5.509.)

1.9    COSTS/OWNERSHIP OF MATERIALS
        1.9.1 State Not Responsible for Preparation Costs. Offeror is solely responsible for all costs it
incurs prior to contract execution.

      1.9.2 Ownership of Timely Submitted Materials. The State shall own all materials submitted in
response to this RFP.




                                                              RFP12-2260P, On-Site Employee Health Center, Page 9
                         SECTION 2: RFP STANDARD INFORMATION

2.1    AUTHORITY
The RFP is issued under 18-4-304, Montana Code Annotated (MCA) and ARM 2.5.602. The RFP process is a
procurement option allowing the award to be based on stated evaluation criteria. The RFP states the relative
importance of all evaluation criteria. The State shall use only the evaluation criteria outlined in this RFP.

2.2    OFFEROR COMPETITION
The State encourages free and open competition to obtain quality, cost-effective services and supplies. The
State designs specifications, proposal requests, and conditions to accomplish this objective.

2.3    RECEIPT OF PROPOSALS AND PUBLIC INSPECTION
        2.3.1 Public Information. Subject to exceptions provided by Montana law, all information received in
response to this RFP, including copyrighted material, is public information. Proposals will be made available for
public viewing and copying shortly after the proposal due date and time. The exceptions to this requirement
are: (1) bona fide trade secrets meeting the requirements of the Uniform Trade Secrets Act, Title 30, chapter
14, part 4, MCA, that have been properly marked, separated, and documented; (2) matters involving individual
safety as determined by the State; and (3) other constitutional protections. See 18-4-304, MCA. Typically,
information such as resumes and references are not considered proprietary and confidential. The State
provides a copier for interested parties' use at $0.10 per page. The interested party is responsible for the cost
of copies and to provide personnel to do the copying.

        2.3.2 Procurement Officer Review of Proposals. Upon opening the proposals in response to this
RFP the procurement officer reviews the proposals for information that meets the exceptions in Section 2.3.1,
providing the following conditions have been met:

       ●   Confidential information (including any provided in electronic media) is clearly marked and
           separated from the rest of the proposal;
       ●   The proposal does not contain confidential material in the cost or price section; and
       ●   An affidavit from the offeror's legal counsel attesting to and explaining the validity of the trade secret
           claim as set out in Title 30, chapter 14, part 4, MCA, is attached to each proposal containing trade
           secrets. Counsel must use the State of Montana "Affidavit for Trade Secret Confidentiality" form in
           requesting the trade secret claim. This affidavit form is available on the OneStop Vendor
           Information website at: http://svc.mt.gov/gsd/OneStop/GSDDocuments.aspx or by calling (406)
           444-2575.

Information separated out under this process will be available for review only by the procurement officer, the
evaluator/evaluation committee members, and limited other designees. Offerors shall pay all of its legal costs
and related fees and expenses associated with defending a claim for confidentiality should another party
submit a "right to know" (open records) request.

2.4    CLASSIFICATION AND EVALUATION OF PROPOSALS
          2.4.1 Initial Classification of Proposals as Responsive or Nonresponsive. The State shall
initially classify all proposals as either "responsive" or "nonresponsive" (ARM 2.5.602). The State may deem a
proposal nonresponsive if: (1) any of the required information is not provided; (2) the submitted price is found
to be excessive or inadequate as measured by the RFP criteria; or (3) the proposal does not meet RFP
requirements and specifications. The State may find any proposal to be nonresponsive at any time during the
procurement process. If the State deems a proposal nonresponsive, it will not be considered further.
                                                            RFP12-2260P, On-Site Employee Health Center, Page 10
        2.4.2 Determination of Responsibility. The procurement officer shall determine whether an offeror
has met the standards of responsibility consistent with ARM 2.5.407. An offeror may be determined
nonresponsible at any time during the procurement process if information surfaces that supports a
nonresponsible determination. If an offeror is found nonresponsible, the procurement officer will notify the
offeror by mail. The determination will be made a part of the procurement file.

        2.4.3 Evaluation of Proposals. An evaluator/evaluation committee shall evaluate all responsive
proposals based on stated criteria and recommend award to the highest scoring offeror. The
evaluator/evaluation committee may initiate discussion, negotiation, or a best and final offer. In scoring against
stated criteria, the evaluator/evaluation committee may consider such factors as accepted industry standards
and a comparative evaluation of other proposals in terms of differing price and quality. These scores will be
used to determine the most advantageous offering to the State. If an evaluation committee meets to deliberate
and evaluate the proposals, the public may attend and observe the evaluation committee deliberations.

        2.4.4 Completeness of Proposals. Selection and award will be based on the offeror's proposal and
other items outlined in this RFP. Proposals may not include references to information such as Internet
websites, unless specifically requested. Information or materials presented by offerors outside the formal
response or subsequent discussion, negotiation, or best and final offer, if requested, will not be considered, will
have no bearing on any award, and may result in the offeror being disqualified from further consideration.

        2.4.5 Achieve Minimum Score. Any proposal that fails to achieve 60% of the total available points
for Sections 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.10, 4.2.1, 4.2.3, 4.2.4, 4.2.5, 4.2.6, 4.2.7, or 4.2.8 will be eliminated
from further consideration. A "fail" for any individual evaluation criterion may result in proposal disqualification
at the discretion of the procurement officer.

        2.4.6 Opportunity for Discussion/Negotiation and/or Oral Presentation/Product Demonstration.
After receipt of proposals and prior to the recommendation of award, the procurement officer may initiate
discussions with one or more offerors should clarification or negotiation be necessary. Offerors may also be
required to make an oral presentation and/or product demonstration to clarify their RFP response or to further
define their offer. In either case, offerors should be prepared to send qualified personnel to Helena, Montana,
to discuss technical and contractual aspects of their proposal. Oral presentations and product demonstrations,
if requested, shall be at the offeror's expense. See Section 4.2.9 for description of the oral interview.

         2.4.7 Best and Final Offer. Under Montana law, the procurement officer may request a best and
final offer if additional information is required to make a final decision. The State reserves the right to request a
best and final offer based on price/cost alone. Please note that the State rarely requests a best and final offer
on cost alone.

       2.4.8 Evaluator/Evaluation Committee Recommendation for Contract Award. The evaluator/
evaluation committee shall provide a written recommendation for contract award to the procurement officer that
contains the scores, justification, and rationale for the decision. The procurement officer shall review the
recommendation to ensure its compliance with the RFP process and criteria before concurring with the
evaluator's/evaluation committee's recommendation.

         2.4.9 Request for Documents Notice. Upon concurrence with the evaluator's/evaluation
committee's recommendation, the procurement officer shall request from the highest scoring offeror the
required documents and information, such as insurance documents, contract performance security, an
electronic copy of any requested material (e.g., proposal, response to clarification questions, and/or best and
final offer), and any other necessary documents. Receipt of this request does not constitute a contract and no
work may begin until a contract signed by all parties is in place. The procurement officer shall notify all
other offerors of the State's selection.



                                                             RFP12-2260P, On-Site Employee Health Center, Page 11
        2.4.10 Contract Execution. Upon receipt of all required materials, a contract (Appendix B)
incorporating the standard terms and conditions (Appendix A), as well as the highest scoring offeror's proposal,
will be provided to the highest scoring offeror for signature. The highest scoring offeror will be expected to
accept and agree to all material requirements contained in Appendices A and B of this RFP. If the highest
scoring offeror does not accept all material requirements, the State may move to the next highest scoring
offeror, or cancel the RFP. Work under the contract may begin when the contract is signed by all parties.

2.5    STATE'S RIGHTS RESERVED
While the State has every intention to award a contract resulting from this RFP, issuance of the RFP in no way
constitutes a commitment by the State to award and execute a contract. Upon a determination such actions
would be in its best interest, the State, in its sole discretion, reserves the right to:

       ●   Cancel or terminate this RFP (18-4-307, MCA);
       ●   Reject any or all proposals received in response to this RFP (ARM 2.5.602);
       ●   Waive any undesirable, inconsequential, or inconsistent provisions of this RFP that would not have
           significant impact on any proposal (ARM 2.5.505);
       ●   Not award a contract, if it is in the State's best interest not to proceed with contract execution (ARM
           2.5.602); or
       ●   If awarded, terminate any contract if the State determines adequate state funds are not available
           (18-4-313, MCA).




                                                           RFP12-2260P, On-Site Employee Health Center, Page 12
                                 SECTION 3: SCOPE OF SERVICES
To enable the State to determine the capabilities of an offeror to perform the services specified in the RFP, the
offeror shall respond to the following regarding its ability to meet the State's requirements.

All subsections of Section 3 not listed in the "Instructions to Offerors" on page 3 require a response.
Restate the subsection number and the text immediately prior to your written response.

NOTE: Each item must be thoroughly addressed. Offerors taking exception to any requirements listed
in this section may be found nonresponsive or be subject to point deductions.

3.1    PLAN ADMINISTRATION - BACKGROUND AND STATISTICS
Within the Department of Administration, the Health Care and Benefits Division (HCBD) carries out the Employee
Benefit Plan’s responsibilities. The State is soliciting proposals from qualified Health Services vendors to assist
in the design, operation, and management of On-Site Employee Health Centers for the State. The State
desires to deliver quality acute or episodic health care services, chronic illness management, pharmacy
services, and periodic preventive health care services to employees, dependents, and retirees in a more
convenient, practical, and affordable manner. The On-Site Employee Health Center will be a health care option
for State employees and their dependents.

In accordance with the provisions of Section 2-15-1016, MCA, the State of Montana has established the State
Employee Group Benefits Advisory Council (SEGBAC). The Council provides guidance to the Department in its
statutory responsibilities in accordance with Section 2-18-810, MCA. The State currently provides health benefits
to approximately 12,000 active employees, 3,200 retirees, 80 COBRA enrollees, and their dependents (total
membership of approximately 34,000 lives). Of these lives, approximately 3,350 of the employees, retirees, and
COBRA certificate holders (total membership of approximately 7,400 lives) are currently enrolled in consumer
choice commercial managed care plans offered through a multi-employer, consumer-choice purchasing
cooperative. All Plans are self-insured and self-funded by the State. All benefits are designed by the State and are
subject to change annually.

Please visit http://benefits.mt.gov/publications.mcpx for the summary plan descriptions for the State of Montana’s
Traditional and Managed Care plans.

The contracted HEALTH CENTER VENDOR, (“Contractor”) will work closely with the State’s Health Care and
Benefits Division to design, operate, and effectively manage the On-Site Employee Health Centers for the
State. This will involve communication and coordination with numerous resources in HCBD, including Benefits,
Wellness, and Occupational Health and Safety. Contractor must also be capable of effectively communicating
and coordinating services with the State’s Health Plan administrator(s). The State is very demanding with
respect to quality of services, responsiveness, and accuracy of information.

The State intends to open the first On-Site Employee Health Center in Helena, Montana in December 2012.
The State will work with the selected vendor to evaluate statewide expansion and anticipates the possible
opening of additional On-Site Employee Health Centers during the contract period as the program matures.
The State anticipates it will be responsible for leasing or acquiring office space and medical and pharmacy
equipment.

For additional census and utilization data, please refer to Appendix J.




                                                             RFP12-2260P, On-Site Employee Health Center, Page 13
3.2    SERVICES SOUGHT/SCOPE OF WORK
The State of Montana is seeking On-Site Employee Health Center services to provide primary health care,
acute and episodic health care, wellness services, health screenings, pharmacy services, and other services
depending on the State’s needs.

The primary goals of the On-Site Employee Health Center are to:
    Increase access to primary care services;
    Improve health outcomes for members;
    Improve treatment and compliance for patients with chronic health conditions;
    Provide access to health coaching and care management;
    Reduce costs for the State health plan and plan members;
    Provide health screening services;
    Reduce reliance on emergency room and urgent care;
    Improve employee productivity and reduce absenteeism;
    Point of integration for health plan services (care management, customer service) with health care
       delivery;
    Develop occupational health services and reduce workers’ compensation costs; and
    Provide alternative options for retail pharmacy, specialty medications, and infusion services.

Locations and populations served:
    Statewide presence is desired, will likely occur in phases over several years;
    The first location sought is Helena, Montana;
    Community needs will drive the health center services; no one solution will work;
    Health centers could become “regional” serving outlying communities via telemedicine or traveling staff;
    Health centers would be available to employees, legislators, and their dependents;
    Health centers would not be available to members of the general public; and
    Statewide approach to health screenings and health risk assessments for employees, retirees,
       legislators, and their dependents.

Offerors must propose on all of the components listed. Specific requirements for individual components are
listed below.

Each requirement must have its own response for each component.

3.3    WORKPLACE HEALTH CENTER SERVICES
The offeror must describe their experience/capabilities to provide, at a minimum, the following on-site services
to eligible State employees, legislators, and their dependents:
        Primary Care focused on prevention and wellness with a proactive evidence-based approach;
        Health risk assessments;
        Immunizations and injections;
        New hire physicals (limited scope);
        Patient exams and screenings;
        Prescriptions and pharmaceuticals;
       Coordination with the State of Montana Wellness Program to provide educational, intervention, and
        incentive programs; and
       Lab tests, biometric screenings, and preventive care.




                                                           RFP12-2260P, On-Site Employee Health Center, Page 14
       3.3.1 On-Site Health Center Services. The State intends to develop an On-Site Employee Health
Center in Helena, MT in 2012, and develop other health centers in other cities over several years. Below are
the requirements for the On-Site Employee Health Centers:


            #     Requirement
                  The offeror must provide a detailed description of how primary care services will
            1.
                  be provided in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of how preventive services will
            2.
                  be provided in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of how acute episodic services
            3.
                  will be provided in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of how lab services will be
            4.
                  provided in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of how x-ray and ultrasound
            5.
                  services will be provided in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of how retail, mail order, and
            6.    specialty pharmacy services will be provided in the On-Site Employee Health
                  Center.
                  The offeror must provide a detailed description of how infusion pharmacy
            7.
                  services will be provided in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of how hospital admissions will
            8.
                  be provided and coordinated in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of how it will provide disease and
            9.
                  care management programs in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of how it will provide health
            10.
                  education/promotions in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of how it will provide health risk
            11.   assessments in the On-Site Employee Health Center. The offeror must also
                  describe the tool used to collect health risk assessments.
                  The offeror must provide a detailed description of how it will provide biometrics
            12.   in the On-Site Employee Health Center. The offeror must also describe what
                  tests are included in the Biometric Screening assessment.
                  The offeror must provide a detailed description of how it will provide health
            13.
                  coaching in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of how patient referrals will be
            14.   managed by healthcare providers from the On-Site Employee Health Center for
                  services not available at the center.
                  The offeror must provide a detailed description of how maintenance, cleaning of
            15.   facility, and security will be provided in the On-Site Employee Health Center.
                  Offeror should assume the facility is leased space provided by the State.
                  The offeror must provide a detailed description of how alternative care delivery
            16.   methods will be provided in the On-Site Employee Health Center. This includes
                  mobile services, telemedicine, and similar services.
                  The offeror must provide a detailed description of how general education,
                  marketing, and communication of On-Site Employee Health Center services will
                  be provided including, but not limited to: welcome mailing, targeted mailings,
            17.
                  email, outbound telephone calls, TeleHealth, SMS/text messaging and emerging
                  social networking tools, disease-specific self-care handbook, and ambulatory
                  education program.

                                                          RFP12-2260P, On-Site Employee Health Center, Page 15
           #     Requirement

                 The offeror must outline its approach toward integration and coordination of
           18.   other health resources (either provided by the offeror, the State, or an external
                 vendor).
                 The offeror must provide a detailed description of how it interacts with the
           19.
                 State’s third party administrators.
                 Are you capable of serving as our employees’ medical home as defined by
           20.
                 National Committee of Quality Assurance?
                 The offeror must provide a detailed description of the process for scheduled
           21.   appointments, same day appointments, and walk-ins. Also describe what kind of
                 wait times can be expected.
                 The offeror must provide a detailed description of their workplace-focused
           22.   pharmacy programs that have improved compliance or outcomes and positively
                 impacted cost savings.
                 The offeror must provide a detailed description of how it will ensure pharmacists
           23.
                 are providing adequate service and counseling to patients.
                 The offeror must provide a detailed description of whether its company owns
           24.
                 and operates retail pharmacies. If so, what value could this provide to the State?
                 The offeror must provide a detailed description of how it will develop
           25.   coordinated, collaborative plans with all providers involved on an individual
                 patient basis.
                 The offeror must provide a detailed description of its process to improve quality
           26.
                 of care by monitoring and facilitating appropriateness of care.
                 The offeror must provide a detailed description of how they will facilitate timely
           27.
                 discharges and transfers based on individual needs and required levels of care.
                 The offeror must provide a detailed description of how it will serve as a resource
           28.
                 to members, providers, and the State.
                 The offeror must provide a detailed description of its process to monitor cost-
           29.
                 effective use of resources.
                 The offeror must provide a detailed description of its process to identify high risk
           30.
                 members and engage them in appropriate care.
                 The offeror must provide a detailed description of the on-site health care
           31.
                 services recommended for our employee population.
                 The contractor will not use mailing lists generated as part of this contract for any
                 reason other than the provision of services outlined in this contract. The
                 contractor shall not contact participants or prospective participants for the
           32.
                 purpose of soliciting business unrelated to this contract during the term of this
                 contract or after termination of this contract without full disclosure and approval
                 of the State.

      3.3.2 Optional Services. During the term of this agreement, the services sought from the On-Site
Employee Health Center may be expanded to include other optional services to include the following:


           #     Requirement

                 The offeror must provide a detailed description of how occupational health
           1.
                 services could be provided in the On-Site Employee Health Center.
                 The offeror must provide a detailed description of how routine dental services
           2.
                 could be provided in the On-Site Employee Health Center.

                                                          RFP12-2260P, On-Site Employee Health Center, Page 16
                  The offeror must provide a detailed description of how routine vision services
            3.
                  could be provided in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of how physical and occupational
            4.
                  therapy services could be provided in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of how telemedicine services
            5.
                  could be provided in the On-Site Employee Health Center.
                  The offeror must provide a detailed description of its experience/capabilities
            6.
                  providing treatment for work-related injuries and occupational diseases.

        3.3.3 Statewide Health Screenings and Risk Assessment. In addition, the offeror must describe
its experience/capabilities to provide, at a minimum, the following statewide health screening and health risk
assessment services to eligible State employees:


            #     Requirement

                  The offeror must provide a detailed description of how it will provide health risk
                  assessments in locations without an On-Site Employee Health Center. The
            1.
                  offeror must also include a description of the tool used to collect Biometric and
                  Health Risk assessment information.
                  The offeror must provide a detailed description of how it will provide laboratory
                  services and biometrics in locations without an On-Site Employee Health Center.
            2.
                  The offeror must describe what tests are included in each screening or blood
                  test.
                  The offeror must provide a detailed description of how it will provide a written
                  summary of results and an information brochure. Results provided must include
            3.
                  all health risk assessment results, all biometric testing results, all lab analysis
                  results, and all program related information and feedback summaries.
                  The offeror must provide a detailed description of how it will provide an
            4.    explanation of laboratory values including a written summary of the blood
                  analysis, the results of each blood test, and expected ranges.
                  The offeror must provide a detailed description of how it interacts or will interact
            5.
                  with a third party administrator contracted with the State Employee Health Plan.
                  The offeror must provide a detailed description of how it will refer high risk
            6.
                  patients to disease and care management programs operated by the State.
                  The offeror must provide a detailed description of how it will provide health
            7.
                  education/promotions to high risk patients.
                  The offeror must provide a detailed description of how they will identify and
            8.
                  engage members in appropriate follow-up care.
                  The offeror must provide a detailed description of how it will notify individuals, or
                  their designated contact, within 24 hours or as soon as reasonably possible if
            9.
                  critical laboratory values are identified. Describe how unsuccessful attempts to
                  notify individuals will be documented.
                  The contractor shall: 1) redraw participants’ blood or make arrangements for
                  redraw and/or 2) retest when samples are lost/broken or when results are
            10.   determined by the contractor to be invalid. Documentation of the number of
                  retests done due to 1) broken or lost samples and 2) invalid tests are to be made
                  available as requested.




                                                            RFP12-2260P, On-Site Employee Health Center, Page 17
3.4    PLAN OF OPERATIONS
The offeror must describe in detail how it will fulfill each requirement listed.


             #     Requirement

                   The offeror must provide a detailed description of staff recruitment and selection,
             1.
                   including the State’s role (if any).
                   The offeror must provide a detailed description of how it establishes salary and
             2.
                   benefit levels for staff and include measurements for productivity and quality.
                   The offeror must provide a detailed description of its training programs for staff.
             3.
                   Describe training programs available to State staff.
                   The offeror must provide a detailed description of how it establishes staffing
             4.
                   levels for its health centers.
                   Given projected health center utilization, the offeror must outline its
             5.
                   recommended staffing and provide rationale.
                   The offeror must provide a detailed description of how it addresses short and
             6.
                   long term absences for health care practitioners and staff.
                   The offeror must provide a detailed description of its Account Management
             7.    Team – Include names, titles, roles, and responsibilities. Provide an
                   organizational chart outlining structure (Appendix D).
                   The offeror must provide a detailed description of who is responsible for day-to-
             8.    day operations. Describe the process for overseeing and managing the
                   professional staff assigned to the health center.
                   The offeror must provide a detailed description of how its account manager
             9.    shares best practices with the State and advises the State on modification or
                   potential expansion of services.
                   The offeror must provide a detailed description of the process or program for
             10.
                   monitoring client satisfaction. How do you communicate with the State?
                   The offeror must provide a detailed description of how it will credential and
             11.   utilize Montana-licensed pharmacists and staff to provide services under this
                   contract.
                   The offeror must provide a detailed description of how it will credential and
             12.   utilize Montana licensed health care practitioners and staff to provide services
                   under this contract.
                   The offeror must provide a detailed description of how it utilizes current,
             13.
                   evidence-based medicine in the evaluation, treatment, and oversight of patients.
                   The offeror must provide a detailed description of its standard transition plan for
             14.   patients affected by termination of the contract, closure of the health center, loss
                   of health care provider, or any scenario where transition services are required.

3.5    FACILITY DESIGN / ACQUISITION / OPERATION
The offeror must describe in detail how it will fulfill each requirement listed.


             #      Requirement

                    The contractor must assist the State in the design and acquisition of necessary
             1.
                    office space, medical equipment, furniture, and supplies.


                                                              RFP12-2260P, On-Site Employee Health Center, Page 18
            #      Requirement

                   The State desires to be the leaseholder of record. This would mean the
                   contractor is a sub-lessee. Typically, then, the sub-lessee would honor the
            2.     terms of the base lease plus other terms and conditions the State would insist
                   upon. Confirm your agreement with this requirement. If this is not acceptable,
                   provide an alternative for the State’s consideration.
                   The State desires to own all Health Center fixtures, furniture, and medical
            3.     equipment. Confirm your agreement with this requirement. If this is not
                   acceptable, provide an alternative for the State’s consideration.
                   The State desires to obtain best pricing through the contractor for acquisition of
                   all medical supplies, pharmaceuticals, and other supplies. The State reserves
            4.     the right to negotiate other contracts for medical supplies, pharmaceuticals, and
                   other supplies. Confirm your agreement with this requirement. If this is not
                   acceptable, provide an alternative for the State’s consideration.
                   The offeror must provide a detailed description of the safety and security
            5.     standards they will provide for the On-Site Employee Health Center and how
                   those standards comply with all state and federal requirements.
                   The offeror must provide a detailed description of the hours, staffing, and
            6.
                   services available from the On-Site Employee Health Center.
                   The offeror must provide a detailed description of how it will integrate and
                   communicate information with the State ensuring prompt delivery of appropriate
            7.     health care and pharmacy services to qualified members of the State’s self-
                   funded health plan. The description should include specific time frames for the
                   prompt delivery of services.
                   The contractor must provide the day-to-day management of the Health Center
                   during the life of the contract. At a minimum, this would include anticipated
            8.     operating hours of 7:00 AM to 6:00 PM, Monday – Friday. The offeror must
                   describe what, if any, weekend and holiday business hours are available. The
                   Center would be open all regular work week days.

3.6    REPORTING
The offeror must describe in detail how it will provide reporting for all services specified by the State and meet
each requirement listed.


            #     Requirement

                  The offeror must provide a detailed description of its weekly, monthly, quarterly,
            1.    and annual utilization reports. Include copies of actual reports from current
                  customers using de-identified data.
                  The offeror must provide a detailed description of its weekly, monthly, quarterly,
            2.    and annual customer service/complaints reports. Include copies of actual reports
                  from current customers using de-identified data.
                  The offeror must provide a detailed description of the weekly, monthly, quarterly,
            3.    and annual financial reports it can provide to the State. Include copies of actual
                  reports from current customers using de-identified data.
                  The offeror must provide a detailed description of its weekly, monthly, quarterly,
            4.    and annual wellness, health coaching, and health screening reports. Include
                  copies of actual reports from current customers using de-identified data.

                                                            RFP12-2260P, On-Site Employee Health Center, Page 19
            #     Requirement

                  The offeror must provide a detailed description of the wellness, biometric, health
            5.    coaching, and health screening reports it can provide to members. Provide
                  sample reports for each.
                  The offeror must provide a detailed description of its weekly, monthly, quarterly,
            6.    and annual quality assurance reports. Include copies of actual reports from
                  current customers using de-identified data.
                  The contractor must provide the State with a process to produce ad hoc reports.
            7.    Include a detailed description of how the State may access your system to
                  produce its reports.
                  The contractor must provide monthly performance reports to the State. Include
            8.
                  copies of current performance reports used.
                  The contractor must prepare and provide six-month reports to the State
                  including the following information:
                      Overall Health Outcomes Measures
            9.
                      Self-assessment of programs and how well the contractor performed
                         duties
                      Updates on the strategic plan

3.7    CASE MANAGEMENT REFERRAL
The contractor must provide case management referral for all services specified by HCBD and meet each
requirement listed.


            #     Requirement
                  The contractor must support a case management referral process to the State
            1.    for members at risk for ongoing costs/admissions because they are lacking
                  appropriate disease/health management coordination/follow-up.
            2.    The contractor must coordinate with the State and contracted case managers.
                  The contractor must provide data associated with case management triggers to
            3.
                  the data warehouse.

3.8    CASE, HEALTH, AND DISEASE MANAGEMENT
Case management is the coordination of health services.

The selected offeror must either implement the program components as described in this section or propose
other creative solutions that will achieve the same objectives and goals. The offeror must describe in detail
how it will fulfill each requirement listed.


            #     Requirement
                  The contractor must coordinate with health/disease management to refer certain
            1.
                  medical cases for select diseases as determined by the State.
                  The contractor must support a wellness and disease management program that
            2.    sustains or improves the functionality and health status of recipients, measured
                  using consistent output and outcome measures.
                  The contractor must provide care coordination services and create mechanisms
            3.
                  to refer recipients to appropriate medical and social services.

                                                          RFP12-2260P, On-Site Employee Health Center, Page 20
            #     Requirement
                  The contractor and State will collaboratively develop wellness initiatives that
                  address such subjects as annual health checks, immunization schedules,
            4.    appropriate use of emergency rooms, mammograms, and other age appropriate
                  disease related screenings including health checks and specific initiatives to be
                  agreed upon annually with the State.
                  The contractor’s wellness methods will include providing prevention, education,
                  and outreach information to the member population, State personnel, and/or
                  pertinent public health agency personnel through targeted mailings, educational
            5.
                  outreach, group activities, and public awareness campaigns. The contractor will
                  also provide specifically tailored tools to support groups. This will be a
                  collaborative effort between the contractor and the State.
                  The contractor, in collaboration with the State, will target specific members for
            6.
                  outreach and prevention initiatives.
                  The contractor, in collaboration with the State, must promote preventive care for
            7.
                  all eligible members.
                  The contractor, in collaboration with the State, must develop a program to
            8.    promote baseline and periodic health examinations with consistent and
                  professional guidelines including the US Preventive Services Task Force.
                  The contractor must have written policies and procedures describing how
            9.    members are referred to emergency services after business hours and on
                  weekends.
                  The contractor must develop and document a sequence of contact methods
            10.
                  (such as phone, email, physical mailing) to promote a high rate of engagement.
                  The contractor’s case management staff must be familiar with methodologies
            11.
                  and tools utilized in Montana in order to support care coordination.
                  The contractor must work with the State and establish algorithms to determine
                  ways for identifying members who may require behavioral health assessments,
            12.
                  behavioral health case management services, and access to community-based
                  services before a crisis.
                  Define a process for identifying (based on available methods such as prior
            13.   authorization requests and other available information) and responding to
                  members who have indicators suggesting they are in crisis or about to be.
                  Once the contractor becomes aware of a member in crisis, the contractor must
            14.
                  use the process for responding to and assisting the member.
                  The contractor must adhere to the State policies and processes for the provision
            15.
                  of case management services.

3.9    ELECTRONIC HEALTH RECORDS.
The State desires to have the contractor implement and support an electronic health record (EHR). Offeror
shall describe its current system and/or its plan to use an EHR system and how the following requirements will
be met.

            #     Requirement
                  The contractor must support electronic health records for members including a
            1.
                  medical home component.
                  The contractor must use electronic health records to share medical, dental, case
            2.    management, health management, and disease management information, with
                  the State, other providers, the patient, or other authorized entities.

                                                          RFP12-2260P, On-Site Employee Health Center, Page 21
             3.    The EHR must be accessible to the State, providers, and members.
             4.    The contractor’s EHR must support meaningful use criteria.
             5.    The contractor must notify the State in advance of scheduled EHR maintenance.
                   The contractor must effectively coordinate information with the State and the
             6.
                   State’s health plan administrator.
                   The contractor must be able to effectively communicate and coordinate with
             7.    other health care practitioners and staff outside of the State’s On-Site Employee
                   Health Center.
                   The contractor must be able to effectively integrate data and information with the
             8.    State’s data warehouse. The State’s data warehouse is managed by other
                   contractors of the State.
                   The contractor must provide a continuity of care record as part of its electronic
             9.    health record that meets or exceeds all state and federal guidelines for such
                   records.

3.10 CONTRACTOR RESPONSIBILITIES
        3.10.1 On-Site/Off-Site Requirements. The contractor must have a point of contact representative
available during normal business hours (Monday through Friday, 8:00 a.m. to 5:00 p.m. Mountain Time). This
individual must have final decision making authority to adjust and meet all program needs. This person will
have a high-level of interaction with the State of Montana.

       3.10.2 Contractor Relationship to the State and Other Contractors. Contractor staff will have an
ongoing relationship with State staff and other contractor staff that is based on trust, confidentiality, objectivity,
and integrity throughout the contract term. The contractor will be privy to internal policy discussions,
contractual issues, price negotiations, State financial information, and advanced knowledge of legislation. The
contractor must maintain complete confidentiality related to all State projects.

As part of the tasks described in this subsection, the contractor is responsible for the following general contract
requirements. Offerors must describe in detail how they will fulfill each requirement listed.

1. Work cooperatively with key State staff, other State-defined stakeholders, and the staff of other contractors
   as required in the course of the contract period.

2. Identify efficiencies that could be garnered by altering requirements, adapting business processes, or
   making other changes.

3. Maintain complete and detailed records of all project meetings, presentations, performance reporting, risk
   assessment, project planning schedules, and any other interactions related to the project described in this
   RFP, and make such records electronically available to the State on a regular basis throughout the life of
   the contract.

       3.10.3 Project Management. The contractor must provide project management on an ongoing basis
throughout the contract. The multiple deliverables associated with the project management function must be
completed according to the offeror’s proposed work plan, as approved by State staff. The contractor is required
to adhere to the standards described by the Project Management Institute (PMI) in the Project Management
Body of Knowledge (PMBOK). All projects and plans must conform to the industry best practices. Offerors
must propose a detailed approach to project management and communication to be used during the contract.

       3.10.4 Testing. The contractor will test the software and hardware architecture and application to
evaluate accuracy and the systems’ compliance with defined requirements as appropriate. Offerors must
propose a detailed approach to testing to be used during the contract.


                                                              RFP12-2260P, On-Site Employee Health Center, Page 22
        3.10.5 Implementation. Offerors must propose a detailed approach to implementation to be used
during the contract.

       3.10.6 Operations and Maintenance. The contractor will be responsible for operating and
maintaining the On-Site Employee Health Center throughout the contract. Operational support involves all
processes necessary to meet the requirements outlined throughout this RFP. The contractor must perform all
operations maintenance and support as a routine activity. Maintenance and support as a routine activity will be
provided at no additional cost to the State. Offerors must propose a detailed approach to operations and
maintenance to be used during the contract.

         3.10.7 Security, Confidentiality, Auditing. The contractor must provide multiple layers of external
and internal security that provides administrative, physical, and technical means to protect sensitive or
confidential information, supplies, and medications used in performing the responsibilities and duties set forth
in this RFP. The contractor must provide assurance that it has effective internal controls over the operation and
management of the On-Site Employee Health Center and processing of transactions performed under the
resulting contract. Offerors must propose a detailed approach to security, confidentiality, auditing, and HIPAA
compliance to be used during the contract.

The contractor must provide the State, Legislative Auditor, or their authorized agents access to any records
necessary to determine contract compliance. (Section 18-1-118, MCA).

        3.10.8 Ownership of Documents and Work Product. The contractor agrees that all finished or
unfinished documents, data, or reports, prepared by contractor under the contract shall be considered the
State’s property. The contractor must provide all claim information, patient records, and medical records as
defined by the State. Also, upon completion of the services to be performed, or upon termination of the
contract for cause, or for the convenience of the State, all finished or unfinished documents, data, or reports,
prepared by contractor will be turned over to the State. Offerors must provide a specific, signed agreement to
this requirement.

      3.10.9 Technical Environment. The contractor must propose plans detailing which party is
responsible for acquiring computer hardware, computer software, all other health center equipment needed to
complete the scope of work described in this RFP.

        3.10.10 Disaster Recovery. In the event of a system or hardware failure, the system must be
recovered and back online within one business day. In the event of a disaster, the system must be recovered
and back online within 24 hours of the restoration of basic infrastructure. The contractor must maintain an off-
site facility to support disaster recovery. For the purpose of this RFP, a disaster is defined as an event in which
basic infrastructure (i.e. buildings, power, telecommunications, roads) of the local or State community has been
comprised to the extent it interrupts the delivery of the system to the end users. Offerors must propose a
detailed approach to disaster recovery to be used during the contract.

       3.10.11    Staffing Requirements.

                     3.10.11.1 Key Personnel. The contractor shall provide key personnel to perform the
activities called for in this RFP including:

1. A Contract Administrator who will be the primary point of contact for contractor’s performance under the
   contract and who has the authority to make decisions that are binding on the contractor. Contract issues,
   scope of work issues, and other corporate matters may be referred to a higher level of authority than the
   Contract Administrator if the contractor so chooses.

       Preferred Qualifications:
           At least three years of demonstrated effective supervisory experience with a healthcare related
              operation or system;

                                                            RFP12-2260P, On-Site Employee Health Center, Page 23
              At least three years of supervisory experience; and
              Bachelor’s degree from an accredited college or university.

2. An Employee Health Center Manager who will manage the contract on a day-to-day basis under the
   direction of the Contract Administrator. The Employee Health Center Manager or State-approved designee
   must attend employee benefit seminars and online training throughout the state during benefit change
   periods. The Employee Health Center Manager is responsible for day-to-day customer service and case
   management related issues and will act as liaison to the State.

       Preferred Qualifications:
           At least three years of experience with a healthcare related operation or system;
           At least three years of experience with health center operations;
           At least three years of supervisory experience; and
           At least three years of successful customer service experience.

3. Provide a list of names of Montana-licensed medical staff proposed for this contract. Describe all
   qualifications, contractual relationship, length of contract, and other pertinent information. In the absence of
   contracted individuals, provide a description of the qualifications being sought to fulfill the requirements of
   this contract. The State expects all contracted clinical staff to have no licensure and practice restrictions.

                    3.10.11.2 Support Personnel. Support personnel to include, at a minimum, case
managers or health coaches who are licensed and qualified as registered nurses (RNs), social workers, or
related fields in health care. Case managers must be registered nurses with three or more years of health care
related experience, and must be trained in case management, program policies, and member intervention
strategies, and must meet the requirements for nurse licensure in Montana. The behavioral case managers
must have at least three years of experience in behavioral health.

The contractor must assure that all tasks are conducted by the appropriate person (for example, all Central
reviews must be conducted by a licensed RN, APRN, PA, MD, or DO). The contractor must provide staff
qualified/licensed in the areas of the scope of work.

        3.10.12 Subcontractors. If the offeror proposes to use any subcontracts with specialty vendors in
performing the proposed scope of work, the following requirements must be met. Offerors must provide
detailed information about the subcontractor’s qualifications.

1. The subcontractor will report to, and be responsible to, the contractor.

2. The contractor shall provide HCBD with a description of all work to be subcontracted to third parties.

3. The proposal shall provide a description of the nature and duration of the previous relationship of all
   subcontractors and/or third parties with the offeror.

4. The proposal shall provide an explanation of any existing contractual relationships between the offeror and
   subcontractors, or among subcontractors.

5. The highest scoring offeror will be the prime contractor if a contract is awarded and shall be responsible, in
   total, for all work of any subcontractors. All subcontractors, if any, must be listed in the proposal. The State
   reserves the right to approve all subcontractors. The contractor shall be responsible to the State for the
   acts and omissions of all subcontractors or agents of the contractor and of persons directly or indirectly
   employed by such subcontractors, and for the acts and omissions of persons employed directly by the
   contractor. Further, nothing contained within this document or any contract documents created as a result
   of any contract award derived from this RFP shall create any contractual relationships between any
   subcontractor and the State.

                                                            RFP12-2260P, On-Site Employee Health Center, Page 24
6. If any service is not performed in-house by the contractor, the offeror must describe in detail how it will
   subcontract for the desired service.

       3.10.13 State Approval of Staff Replacement. Offerors must propose a detailed approach to staff
replacement to be used during the contract.

1. Personnel whose names and resumes are submitted in the proposal shall not be removed from this
   contract without State’s prior approval. Substitute or additional personnel shall not be used for this contract
   until a resume is received and approved by the State.

2. The State shall have the right to request the removal of any contractor or subcontractor staff member from
   all work on this contract, and the contractor will comply with any such request immediately.

3. The replacement for any staff member who is removed from or leaves the contract for any reason must
   match or exceed the replaced staff member in terms of skill level and experience. Such replacements are
   subject to the State’s approval at the time of the assignment and again 90 days later.

3.11 PERFORMANCE STANDARDS
Offerors must submit recommended performance standards for each section listed above and for the project in its
entirety. Offerors must describe how each service requirement performance standard will be implemented,
managed, and evaluated.




                                                            RFP12-2260P, On-Site Employee Health Center, Page 25
                            SECTION 4: OFFEROR QUALIFICATIONS
All subsections of Section 4 not listed in the "Instructions to Offerors" on page 3 require a response.
Restate the subsection number and the text immediately prior to your written response.

4.1    STATE'S RIGHT TO INVESTIGATE AND REJECT
The State may make such investigations as deemed necessary to determine the offeror's ability to perform the
services specified. The State reserves the right to reject a proposal if the information submitted by, or
investigation of, the offeror fails to satisfy the State that the offeror is properly qualified to perform the
obligations of the contract. This includes the State's ability to reject the proposal based on negative references.

4.2    OFFEROR QUALIFICATIONS
To enable the State to determine the capabilities of an offeror to perform the services specified in the RFP, the
offeror shall respond to the following regarding its ability to meet the State's requirements. THE RESPONSE,
"(OFFEROR'S NAME) UNDERSTANDS AND WILL COMPLY," IS NOT APPROPRIATE FOR THIS
SECTION.

NOTE: Each item must be thoroughly addressed. Offerors taking exception to any requirements listed
in this section may be found nonresponsive or be subject to point deductions.

        4.2.1 Client Reference Forms. Offeror shall provide a complete and separate Appendix C, Client
Reference Form, for three references that are using or have used services of the type proposed in this RFP. A
responsible party of the organization for which the services were provided to the client (the offeror’s customer)
must provide the reference information and must sign and date the form. It is the offeror’s responsibility to
ensure that the completed forms are submitted with the proposal by the submission date, for inclusion in the
evaluation process. Any Client Reference Forms that are not received or are not completed, may adversely
affect the offeror’s score in the evaluation process. For those client references who have since terminated
services not related to merger or acquisition activity, must also include the reason for termination. Client
Reference Forms exceeding the specified number will not be considered. The State may contact the client
reference for validation of the information provided in the Client Reference Form and within the proposal. If the
State finds erroneous information, evaluation points may be deducted or the proposal may be rejected.

        4.2.2 Offeror Financial Stability. Offerors shall demonstrate their financial stability to supply, install,
and support the services specified by: (1) providing financial statements, preferably audited, for the three
consecutive years immediately preceding the issuance of this RFP, and (2) providing copies of any quarterly
financial statements that have been prepared since the end of the period reported by your most recent annual
report. This information should be labeled Appendix G.

       4.2.3 Executive Summary. Offeror shall provide an executive summary narrative containing
information that indicates an understanding of the overall need for and purpose of the services as presented in
the RFP. Offerors shall include the following items in the executive summary:
    a. An explanation of the primary nature of your business;
    b. A description of your business philosophy in relation to On-Site Employee Health Centers;
    c. A summary of any and all claims, pending litigation, and judgments that have been entered against
       your organization in the past five years and briefly describe the nature of these actions.
    d. Any pending agreements to merge or sell your firm;
    e. Within the last five years, have you had any defaults on a contract to provide On-Site Employee Health
       Centers? Any litigation regarding such contracts? Cancellation of or failure to be renewed for alleged fault
       on the part of your firm? If any of the above is yes, provide specifics of each; and


                                                            RFP12-2260P, On-Site Employee Health Center, Page 26
   f.   Within the last five years, have you experienced removal or replacement as On-Site Employee Health
        Center contractor of a state or other public entity with 10,000 or more employees? If yes, explain the
        circumstances.

         4.2.4 Company Profile. Offeror shall provide their Legal Name, Physical Address of Corporate
Office or Headquarters, City, State, Zip Code, Telephone Number, Fax Number, and Website address. Offeror
shall specify how long the individual/company submitting the proposal has been in business of performing the
services contemplated under this RFP, under what company name, whether the company is privately or publicly
held, company ownership, whether it is a division of a parent company, and describe the company’s services
and products. The State is particularly interested in On-Site Employee Health Center services as applicable to
this RFP. If your organization is publicly held, include a list of majority shareholders; if privately held, include a
list of minority owners also.

       4.2.5 Organization Capabilities. Offeror shall provide documentation establishing the individual or
company submitting the proposal has the qualifications and experience to provide the services specified in this
RFP, including, at a minimum:
   a. A detailed description of any similar past projects, including the service type and dates the services
       were provided, the clients for whom the services were provided, size, number of employees, and years
       of experience performing services similar to those described within this RFP, preferably with experience
       in governmental programs.
   b. A detailed description of the years of experience in the design, development, implementation, and
       operation of On-Site Employer Health Centers; preferably with experience in multiple On-Site Health
       Centers. Include the total number of clients currently under contract as well as the total number of
       clients currently under contract in Montana.
   c. A detailed description of the total amount of healthcare services billed or otherwise compensated. This
       should also include the total amount of healthcare services billed or otherwise compensated in
       Montana.
   d. A detailed description of the use of evidence-based medicine in the development of employee health
       and care management programs.
   e. A detailed description of methods used to recruit and retain qualified physicians. Include detail of the
       number of physicians recruited, number of physicians leaving employment, and the longevity of the
       physicians’ employment. Include the total number of licensed health care practitioners either employed
       or under contract.
   f. A detailed description of the past experience integrating On-Site Health Center information with health
       plan information. Specifically, describe your experience coordinating with employer based self funded
       medical plans, including high deductible plans. Also, describe your experience integrating patient
       medical record information with health plan claim information.
   g. A detailed description of your experience integrating On-Site Health Center service into the local
       medical community.
   h. A detailed description of your experience working with employees to educate and communicate health
       center services.
   i. A detailed description of your experience providing health screenings and health risk assessments in a
       large geographic area such as the State of Montana.
   j. A detailed description of your ability to report information electronically to the State for all healthcare
       related services.
   k. A detailed description of the software used for practice management, health center administration, and
       patient management. Include the name of the software and the version currently in use.
   l. A detailed description of your relationship with third party administrators, including dates of engagement
       and current status.
   m. Has your company been through recent reorganization or name changes, or do you anticipate any in
       the next 36 months? If yes, describe the nature of the reorganization and list past or future names of
       your company.
   n. List three key points that distinguish your organization from your competitors and make your
       organization uniquely suited to fulfilling the State’s requirements. Include specific examples.

                                                              RFP12-2260P, On-Site Employee Health Center, Page 27
       4.2.6 Resumes. A resume or summary of qualifications, work experience, education, and skills must
be provided for all key personnel, including any subcontractors, who will be performing any aspects of the
contract. Include years of experience providing services similar to those required; education; and certifications
where applicable. Identify what role each person would fulfill in performing work identified in this RFP.

       4.2.7 Innovative and Value Added Services. Offerors must provide descriptions of any innovative
programs or value-added services available and explain the value they would hold for the State. Provide a copy of
your provider incentive program, if available. Clearly state if the cost for these programs is included in the fees
quoted or what the extra costs would be. Offerors should note any other information they believe differentiates
them from their competitors.

        4.2.8 Contractor Qualifications. Offerors must provide detailed information about corporate
qualifications.
   a. The contractor must have successfully demonstrated contractual experience providing On-Site
        Employee Health Center medical and administration services.
   b. The contractor must have successfully demonstrated experience in case management/coordination of
        complex cases, including behavioral case management.
   c. The contractor must adhere to all license and certification requirements to conduct On-Site Employee
        Health Center business in the State of Montana. The State also prefers the contractor to have national
        accreditation, with a commitment to maintaining up-to-date accreditation status throughout the contract.
        The offeror must provide copies of such licensure and accreditation with their response to this
        RFP. These copies should be labeled Appendix F in your response. Also include proof of insurance as
        required in Appendix B (Contract) Section 10, labeled Appendix E in your response.
   d. The contractor’s experience must demonstrate a successful record of savings and benefit to the
        member. Describe the history and outcomes of your experience.

        4.2.9 Oral Interview. Offerors must be prepared to have the key personnel assigned to this project
complete an oral interview in Helena, Montana. Offerors must be prepared to present to SEGBAC based on
the understanding that the Council will not have seen the written RFP responses. The State reserves the right
to (1) have interviews from only the two highest scoring offerors; (2) have interviews from all offerors within
10% of the highest scoring offeror; or (3) have interviews from all offerors who are deemed to have a passing
score prior to the interview process, at the State's discretion.




                                                            RFP12-2260P, On-Site Employee Health Center, Page 28
                                     SECTION 5: COST PROPOSAL
All subsections of Section 5 not listed in the "Instructions to Offerors" on page 3 require a response.
Restate the subsection number and the text immediately prior to your written response.

5.1     STATEMENT OF COMPLIANCE AND PRICE SHEETS
The information requested in Section 5 is being sought to aid in determining the best offer for the State. If any
of this information is considered a trade secret, please refer to Section 2.3.1 for instructions on submitting trade
secret information.
The requested information must be submitted separately for each component.

        5.1.1 Statement of Compliance. Offerors must indicate that they understand and will comply with the
following statement:
            We hereby certify these rates EXCEPT as detailed below and agree to furnish the services
            specified in our proposal at the rate quoted below.
        Authorized Signature:

       5.1.2 Guaranteed Rates. Proposals must include rate guarantees (if any) through the initial term of
the contract. Offerors must propose a cost model that shows actual costs and fees incurred and paid by the
State.
     5.1.2.1 Guaranteed Rates – Helena Health Center and Pharmacy. List rates for the On-Site
Employee Health Center in Helena. Reference Section 3.3.1
Offerors may include pricing for expansion options outside of Helena, identify the community where
services will be offered and include a response for each item below. Reference Section 3.1

A.    Location design, build out, and other start-up costs – Helena Health Center

      Provide a comprehensive list of services and related fees necessary for the initial
      start-up of the On-Site Employee Health Center outlined in this RFP.
      Description of the service        Service fee type     Fee frequency;     Estimated total
                                        (flat fee, hourly    one-time or on-    fee to State
                                        fee, other)          going (state
                                                             frequency if on-
                                                             going)




      Total design, build out, and
      other start-up costs

                                                            RFP12-2260P, On-Site Employee Health Center, Page 29
B.   Equipment and supplies – Helena Health Center

     Provide a comprehensive list of equipment and supplies necessary to initially outfit
     the On-Site Employee Health Center outlined in this RFP.
     Equipment/supply name             Equipment/supply Cost frequency;        Estimated total
                                       type description   one-time or on-      fee to State
                                                          going (state
                                                          frequency if on-
                                                          going)




     Total start-up equipment

C.   Equipment and supplies – Helena Health Center (Pharmacy)

     Provide a comprehensive list of Pharmacy equipment and supplies necessary to
     initially outfit the On-Site Employee Health Center outlined in this RFP.
     Equipment/supply name               Equipment/supply Cost frequency:      Estimated total
                                         type description     one-time or on-  fee to State
                                                              going (state
                                                              frequency if on-
                                                              going)




     Total start-up equipment
     (pharmacy)




                                                          RFP12-2260P, On-Site Employee Health Center, Page 30
D.   Information technology – Helena Health Center, including Pharmacy

     Provide a comprehensive list of all hardware and software necessary to initially
     outfit the On-Site Employee Health Center outlined in this RFP.
     Equipment/supply name              Equipment/supply Cost frequency:       Estimated total
                                        type description    one-time or on-    fee to State
                                                            going (state
                                                            frequency if on-
                                                            going)




     Total start-up information
     technology

E.   Staffing – Helena Health Center

     Provide a list of all anticipated staffing and associated costs to staff the On-Site
     Employee Health Center outlined in this RFP. Include clinical and administrative
     positions.
     Position                              Number of staff     Estimated hours Estimated total
                                                               per week             fee to State




     Total staff costs




                                                           RFP12-2260P, On-Site Employee Health Center, Page 31
F.   Staffing – Helena Health Center - Pharmacy

     Provide a list of all anticipated staffing and associated costs to staff the pharmacy
     outlined in this RFP. Include clinical and administrative positions.
     Position                              Number of staff     Estimated hours Estimated total
                                                               per week             fee to State




     Total staff costs

G.   Prescription Drug Costs – Helena Health Center (Pharmacy)

     Provide a detailed description of the proposed acquisition costs for prescription
     drugs distributed, medical supplies, oxygen services and supplies and durable
     medical equipment (DME) administered by the Pharmacy outlined in this RFP.

     Additionally, provide the actual cost for the selected medications listed in Appendix
     I.

H.   Other Fees – Helena Health Center, including Pharmacy

     Provide a comprehensive list of all other fees, services, and costs associated with
     the on-going operation of the On-Site Employee Health Center outlined in this RFP.
     Description of fee, service, or costs.                  Cost frequency:    Estimated total
                                                             one-time or on-    fee to State
                                                             going (state
                                                             frequency if on-
                                                             going)




     Total other fees and costs

                                                           RFP12-2260P, On-Site Employee Health Center, Page 32
I.   Alternative solutions – Helena Health Center, including Pharmacy

     Provide a comprehensive description of other programs and solutions (including all
     subcontractors) and the associated fees, services, and costs associated with the
     start-up and on-going operation of the On-Site Employee Health Center outlined in
     this RFP.
     Description of alternative fee, service, or costs.    Cost frequency:    Estimated total
                                                           one-time or on-    fee to State
                                                           going (state
                                                           frequency if on-
                                                           going)




     Total alternative fees and costs

       5.1.2.2 Guaranteed Rates – Helena Health Center Optional Services. Reference Section 3.3.2

A.   Equipment and other start-up costs – Helena Health Center optional services

     Provide a comprehensive list of services necessary for the initial start-up of the
     optional services On-Site Employee Health Center outlined in this RFP.
     Description of the equipment or Equipment or          Equipment or           Estimated total
     service                           service fee type    service fee            fee to State
                                       (flat fee, hourly   frequency: one-
                                       fee, other)         time or on-going
                                                           (state frequency
                                                           if on-going)




     Total start-up costs




                                                            RFP12-2260P, On-Site Employee Health Center, Page 33
B.   Staffing – Helena Health Center optional services

     Provide a list of all anticipated staffing and associated costs to staff the optional
     services at the On-Site Employee Health Center outlined in this RFP. Include
     clinical and administrative positions.
     Position                              Number of staff     Estimated hours Estimated total
                                                               per week             fee to State




     Total staff costs

C.   Other Fees – Helena Health Center optional services

     Provide a comprehensive list of all other fees, services, and costs associated with
     the on-going operation of the optional services at the On-Site Employee Health
     Center outlined in this RFP.
     Description of fee, service, or costs.                  Cost frequency:    Estimated total
                                                             one-time or on-    fee to State
                                                             going (state
                                                             frequency if on-
                                                             going)




     Total other fees and costs




                                                           RFP12-2260P, On-Site Employee Health Center, Page 34
D.   Alternative solutions – Helena Health Center optional services

     Provide a comprehensive description of other programs and solutions (including
     subcontractors) and the associated fees, services, and costs associated with the
     start-up and on-going operation of the optional services at the On-Site Employee
     Health Center outlined in this RFP.
     Description of alternative fee, service, or costs.     Cost frequency:    Estimated total
                                                            one-time or on-    fee to State
                                                            going (state
                                                            frequency if on-
                                                            going)




     Total alternative fees and costs

      5.1.2.3 Guaranteed Rates – Statewide Health Screenings and Risk Assessments. Reference
Section 3.3.3

A.   Equipment and other start-up costs – statewide health screenings and risk
     assessments

     Provide a comprehensive list of services necessary for the initial start-up of the
     statewide health screenings and risk assessment services outlined in this RFP.
     Description of the equipment or Equipment or          Equipment or           Estimated total
     service                           service fee type    service fee            fee to State
                                       (flat fee, hourly   frequency: one-
                                       fee, other)         time or on-going
                                                           (state frequency
                                                           if on-going)




     Total start-up costs


                                                            RFP12-2260P, On-Site Employee Health Center, Page 35
B.   Staffing – statewide health screenings and risk assessments

     Provide a list of all anticipated staffing and associated costs to staff the the
     statewide health screenings and risk assessments outlined in this RFP. Include
     clinical and administrative positions.
     Position                              Number of staff     Estimated hours Estimated total
                                                               per week              fee to State




     Total staff costs

C.   Other Fees – statewide health screenings and risk assessments

     Provide a comprehensive list of all other fees, services, and costs associated with
     the on-going operation of the statewide health screenings and risk assessments
     outlined in this RFP.
     Description of fee, service, or costs.                  Cost frequency:    Estimated total
                                                             one-time or on-    fee to State
                                                             going (state
                                                             frequency if on-
                                                             going)




     Total other fees and costs




                                                            RFP12-2260P, On-Site Employee Health Center, Page 36
D.    Alternative solutions – statewide health screenings and risk assessments

      Provide a comprehensive description of other programs and solutions (including
      subcontractors) and the associated fees, services, and costs associated with the
      start-up and on-going operation of the statewide health screenings and risk
      assessments outlined in this RFP.
      Description of alternative fee, service, or costs.     Cost frequency:    Estimated total
                                                             one-time or on-    fee to State
                                                             going (state
                                                             frequency if on-
                                                             going)




      Total alternative fees and costs

        5.1.3 Financial Projections. Proposals must include a comprehensive financial projection for all
aspects of the services outlined in this RFP, from start-up through the initial term, ending December 2015. The
projections should separate initial start-up costs, and include annual estimated costs by calendar year. The
projections should also include a cost benefit analysis of operating an On-Site Employee Health Center to the
traditional costs of paying for these services. All assumptions for the projections must be included. This
information should be labeled Appendix H in your response.

5.2     PERFORMANCE GUARANTEES
Provide a total percentage of the fees you are willing to put at risk for outcomes in each of the following areas:
        __% of the performance standard for payment is based on customer service and customer
          satisfaction;
        __% of the performance standard for payment is based on appointment availability and provider
          stability; and
        __% of the performance standard for payment is based on achieving the estimated cost savings
          outlined in this RFP.

Offerors must propose their best approach to outcomes measurement over the course of the contract in each
of these areas.

The fees may be at risk based on annual progress toward an overall contract goal, or based on specific annual
performance targets.

If performance targets are not met each year, guarantees shall be returned on a proportionate basis. Refunds
payable by the contractor to the State for failure to meet performance guarantees will be calculated based on
an annual audit to be completed within 180 days of each guarantee period. The audit and reconciliation will be
conducted by the State or an independent contractor approved by the State. The State and contractor agree to
use a mutually agreed upon reconciliation methodology to determine if the contractor has fulfilled the
performance guarantees.

                                                            RFP12-2260P, On-Site Employee Health Center, Page 37
                              SECTION 6: EVALUATION PROCESS

6.1    BASIS OF EVALUATION
The evaluation committee will review and evaluate the offers according to the following criteria based on a
total number of 10,000 points. Oral interviews will be worth an additional 1,000 points.

The Workplace Health Center Services; Plan of Operations; Facility Design / Acquisition / Operation;
Reporting; Case Management Referral; Case, Health, and Disease Management; Electronic Health
Records; Contractor Responsibilities; Performance Standards; Client Reference Forms; Executive
Summary; Company Profile; Organizational Capabilities; Resumes; Innovative and Value Added
Services; Contractor Qualifications; Oral Interview; Financial Projections; and Performance Guarantees
portions of the offer will be evaluated based on the following Scoring Guide. The Offeror Financial Stability
portion of the proposal will be evaluated on a pass/fail basis, with any offeror receiving a "fail" eliminated from
further consideration. The Cost Proposal will be evaluated based on the formula set forth below:

Any response that fails to achieve a minimum score per the requirements of Section 2.4.5 will be
eliminated from further consideration. A "fail" for any individual evaluation criterion may result in
proposal disqualification at the discretion of the procurement officer.

                                                SCORING GUIDE

In awarding points to the evaluation criteria, the evaluator/evaluation committee will consider the following
guidelines:

Superior Response (95-100%): A superior response is an exceptional reply that completely and
comprehensively meets all of the requirements of the RFP. In addition, the response may cover areas not
originally addressed within the RFP and/or include additional information and recommendations that would
prove both valuable and beneficial to the agency.

Good Response (75-94%): A good response clearly meets all the requirements of the RFP and
demonstrates in an unambiguous and concise manner a thorough knowledge and understanding of the
project, with no deficiencies noted.

Fair Response (60-74%): A fair response minimally meets most requirements set forth in the RFP. The
offeror demonstrates some ability to comply with guidelines and requirements of the project, but knowledge of
the subject matter is limited.

Failed Response (59% or less): A failed response does not meet the requirements set forth in the RFP. The
offeror has not demonstrated sufficient knowledge of the subject matter.




                                                            RFP12-2260P, On-Site Employee Health Center, Page 38
6.2    EVALUATION CRITERIA
           Category                                                   Section of RFP       Point Value

      Workplace Health Center Services                          12% of points for a possible 1,200 points

      On-Site Health Center Services, Optional Services, and            3.3.1, 3.3.2,
1.                                                                                            1,200
      Statewide Health Screenings and Risk Assessments                   and 3.3.3

      Plan of Operations                                        10% of points for a possible 1,000 points

2.    Plan of Operations                                                    3.4               1,000

      Facility Design / Acquisition / Operation                    8% of points for a possible 800 points

 3.   Facility Design / Acquisition / Operation                             3.5                800

      Reporting                                                    3% of points for a possible 300 points

4.    Reporting                                                             3.6                300

      Case Management Referral                                     1% of points for a possible 100 points

5.    Case Management Referral                                              3.7                100

      Case, Health, and Disease Management                         7% of points for a possible 700 points

6.    Case, Health, and Disease Management                                  3.8                700

      Electronic Health Records                                    1% of points for a possible 100 points

7.    Electronic Health Records                                             3.9                100

      Contractor Responsibilities                                  8% of points for a possible 800 points

8.    Contractor Responsibilities                                           3.10               800

      Performance Standards                                        2% of points for a possible 200 points

9.    Performance Standards                                                 3.11               200

      Client Reference Forms                                      1% of points for a possible 100 points

10. Client Reference Forms                                                 4.2.1               100

      Offeror Financial Stability                                                               Pass/Fail

11.   Financial Stability                                                  4.2.2            Pass/Fail

      Executive Summary                                           2% of points for a possible 200 points

12.   Executive Summary                                                    4.2.3               200
                                                        RFP12-2260P, On-Site Employee Health Center, Page 39
          Category                                                        Section of RFP         Point Value

      Company Profile                                                 1% of points for a possible 100 points

13.   Years and Applicability of Experience; Ownership                           4.2.4               100

      Organizational Capabilities                                  10% of points for a possible 1,000 points

14.   Organizational Capabilities                                                4.2.5              1,000

      Resumes                                                         1% of points for a possible 100 points

15.   Staff Qualifications                                                       4.2.6               100

      Innovative and Value Added Services                             2% of points for a possible 200 points

16.   Innovative and Value Added Services                                        4.2.7               200

      Contractor Qualifications                                       3% of points for a possible 300 points

17.   Contractor Qualifications                                                  4.2.8               300

      Cost Proposal                                                 20% of points for a possible 2,000 points

18.   Statement of Compliance                                                    5.1.1             Pass/Fail
19.   Health Center and Pharmacy                                                5.1.2.1             1,000
20.   Health Center Optional Services                                           5.1.2.2              200
21.   Statewide Health Screenings and Risk Assessments                          5.1.2.3              800

  Lowest overall cost receives the maximum allotted points. All other proposals receive a percentage of the
  points available based on their cost relationship to the lowest. Example: Total possible points for cost is 30.
  Offeror A’s cost is $20,000. Offeror B’s cost is $30,000. Offeror A would receive 30 points, Offeror B would
  receive 20 points ($20,000/$30,000) = 67% x 30 points = 20).

       Lowest Responsive Offer Total Cost x Number of available points = Award Points
       This Offeror’s Total Cost

       Financial Projections                                         5% of points for a possible 500 points

22.    Financial Projections                                                    5.1.3               500

       Performance Guarantees                                        3% of points for a possible 300 points

23.    Customer Service and Satisfaction                                         5.2                100
24.    Provider Stability and Appointment Availability                           5.2                100
25.    Achieving Estimated Savings                                               5.2                100

      Oral Interview                                                                              1,000 points

26.    Interview                                                                4.2.9               1,000



                                                           RFP12-2260P, On-Site Employee Health Center, Page 40
                  APPENDIX A: STANDARD TERMS AND CONDITIONS
The Standard Terms and Conditions will be provided at the Pre-Proposal Conference and posted on the
State's website with the RFP at http://svc.mt.gov/gsd/OneStop/SolicitationDefault.aspx by the close of
business on February 23, 2012.




                                                         RFP12-2260P, On-Site Employee Health Center, Page 41
                                    APPENDIX B: CONTRACT

The Contract will be provided at the Pre-Proposal Conference and posted on the State's website with the RFP
at http://svc.mt.gov/gsd/OneStop/SolicitationDefault.aspx by the close of business on February 23, 2012.




                                                        RFP12-2260P, On-Site Employee Health Center, Page 42
                          APPENDIX C: CLIENT REFERENCE FORM
The Offeror is solely responsible for obtaining up to three fully completed reference questionnaires from
clients for whom the offeror has provided services substantially similar to the types proposed in this RFP, and
for including them with their response. To obtain and submit the completed reference questionnaires as
required, follow the process detailed below.

   (1) Customize the standard reference questionnaire by adding the Offeror's name and make exact
duplicates for completion by references.

    (2) Send the customized reference questionnaires to each person chosen to provide a reference along
with a new standard #10 envelope.

   (3) Instruct the person that will provide a reference for the Offeror to:
        (a) Complete the reference questionnaire;
       (b) Sign and date the completed, reference questionnaire;
       (c) Seal the completed, signed, and dated reference questionnaire within the envelope provided;
       (d) Sign his or her name in ink across the sealed portion of the envelope; and
       (e) Return the sealed envelope containing the completed reference questionnaire directly to the
           Offeror.

   (4) Do NOT open the sealed references upon receipt.

   (5) Enclose all sealed reference envelopes within a larger envelope labeled References for RFP # 12-
2260P to be submitted with your response.


NOTES:
   •   The State will not accept late references or references submitted by any means other than that which is
       described above. Each reference questionnaire submitted must be completed as required.
   •   The State will not review more than the three references requested.
   •   These references may be contacted to verify Offeror's ability to perform the contract.
   •   The State reserves the right to use any information or additional references deemed necessary to
       establish the ability of the offeror to perform the conditions of the contract. Negative references may be
       grounds for proposal disqualification.
   •   The State is under no obligation to clarify any reference information.

Client References must be included with the Offeror's response. Responses must be received at the
reception desk of the State Procurement Bureau prior to 2:00 p.m., Mountain Time, April 9, 2012.
References received after this time will not be accepted for consideration. The Offeror may wish to give
each reference a deadline to ensure that the required references are received in time to be included
with the response.




                                                            RFP12-2260P, On-Site Employee Health Center, Page 43
                                        Client Reference Form
                                             Offeror Information
     Company Name (Offeror):                          Name of Project:

     Company (Offeror) Address:



                                             Client Information
     Organization Name (Client):                      Organization Address:

     Person Providing the Reference:                  Title:

     Phone Number:                                    Email address:

     Reference Signature & Date:




The Person Providing the Reference, as identified above, must provide the following information. This person
must be a responsible party of the organization for which the work was performed. This person should have
comprehensive knowledge about the Project and the Company’s (Offeror) role and responsibilities within the
project. Use additional pages to answer the questions and/or provide additional information as necessary.

Your response will be used as part of the Offeror's proposal.

1.       Briefly describe the services provided by the Company identified above.




2.       Rate each of the following concerning this Company’s performance using the ratings from 0-10
         below:
                9 to 10 – Strongly Agree/Very Positive
                 7 to 8 – Agree/Positive
                 5 to 6 – Neutral
                 3 to 4 – Disagree/ Negative
                 0 to 2 – Strongly Disagree/Very Negative

Rating

_____ A.    Did this Company provide the appropriate resources to the project and ensured the project
            deliverables were completed? Please describe.




                                                          RFP12-2260P, On-Site Employee Health Center, Page 44
_____ B.   Was this Company knowledgeable in providing the services? Please comment.




_____ C.   The business relationship with this Company was positive and cooperative, versus negative and
           adversarial. Please describe.




_____ D.   Did this Company provide open, timely communications? Was it responsive to your needs and
           requirements? Please comment.




_____ E.   I would choose to work with this Company again.




                                                        RFP12-2260P, On-Site Employee Health Center, Page 45
                            APPENDIX D: ORGANIZATIONAL CHART

Provide a current Organizational Chart for your organization, including the organizational structure of personnel
anticipated to operate and manage the State’s On-Site Employee Health Center.

Administrative Staff- Health Center

          Name/Staff Type               Staff #         Duties Performed/Function           # Hours Worked
                                                                                               per week




Health Care Practitioners- Health Center

      Name/Medical Licensure            Staff #        Health Care Services/Duties          # Hours Worked
                                                               Performed                       per week




Other Staff- Health Center

          Name/Staff Type               Staff #         Duties Performed/Function           # Hours Worked
                                                                                               per week




                                                           RFP12-2260P, On-Site Employee Health Center, Page 46
Administrative Staff- On-Site Pharmacy

        Name/Staff Type            Staff #       Duties Performed/Function          # Hours Worked
                                                                                       per week




Pharmacist(s)- On-Site Pharmacy

         Name/Licensure            Staff #   Pharmacy Services/Duties Performed     # Hours Worked
                                                                                       per week




Other Staff- On-Site Pharmacy

        Name/Staff Type            Staff #       Duties Performed/Function          # Hours Worked
                                                                                       per week




                                                    RFP12-2260P, On-Site Employee Health Center, Page 47
                       APPENDIX E: CERTIFICATES OF INSURANCE

Certificates of insurance, as outlined in RFP Section 4.2.8, should include the names of the underwriters,
amounts of coverage, policy numbers and the term of the policies.




                                                          RFP12-2260P, On-Site Employee Health Center, Page 48
              APPENDIX F: PROFESSIONAL CERTIFICATIONS/LICENSES
Provide copies of all professional certifications and licenses required to provide the services contemplated
under this RFP, Section 4.2.8. In addition, include all required licensure for health care practitioners and
pharmacists providing services at the On-Site Employee Health Center.

Also include the resumes of all health care practitioners and staff anticipated to operate and manage the On-
Site Employee Health Center. Resumes of all pharmacists and staff are also required.




                                                           RFP12-2260P, On-Site Employee Health Center, Page 49
                           APPENDIX G: FINANCIAL INFORMATION
Providing financial statements, preferably audited, for the three consecutive years immediately preceding the
issuance of this RFP, and provide copies of any quarterly financial statements that have been prepared since
the end of the period reported by your most recent annual report. Reference RFP Section 4.2.2




                                                          RFP12-2260P, On-Site Employee Health Center, Page 50
                                     APPENDIX H: PRO FORMA
Please refer to Section 5.1.3 for description of requirements.




                                                           RFP12-2260P, On-Site Employee Health Center, Page 51
                    APPENDIX I: SELECTED MEDICATIONS

                            LABELNAME                              PRODUCTID     Price
ABILIFY                                                           59148000613
ABILIFY                                                           59148000713
ABILIFY                                                           59148000813
ADVAIR DISKUS                                                     00173069500
ADVAIR DISKUS                                                     00173069600
ADVAIR DISKUS                                                     00173069700
AMLODIPINE BESYLATE                                               68382012316
AVONEX                                                            59627000205
AZITHROMYCIN                                                      00093716956
AZITHROMYCIN                                                      59762311001
AZITHROMYCIN                                                      59762312001
AZITHROMYCIN                                                      59762313001
AZITHROMYCIN                                                      59762314001
COPAXONE                                                          68546031730
CYMBALTA                                                          00002324030
CYMBALTA                                                          00002327004
CYMBALTA                                                          00002327030
ENBREL                                                            58406042534
ENBREL                                                            58406043504
ENBREL                                                            58406044504
ENBREL                                                            58406045504
HUMALOG                                                           00002751001
HUMALOG                                                           00002879959
HUMIRA                                                            00074379902
HUMIRA                                                            00074433902
HYDROCODONE-ACETAMINOPHEN                                         00406036501
HYDROCODONE-ACETAMINOPHEN                                         00406036601
HYDROCODONE-ACETAMINOPHEN                                         00406036701
HYDROCODONE-ACETAMINOPHEN                                         00591085305
HYDROCODONE-ACETAMINOPHEN                                         00591320301
HYDROCODONE-ACETAMINOPHEN                                         00603388728
HYDROCODONE-ACETAMINOPHEN                                         00603388821
HYDROCODONE-ACETAMINOPHEN                                         53746010901
METFORMIN HCL                                                     00093104801
METFORMIN HCL                                                     00093104810
METFORMIN HCL                                                     00093104910
METFORMIN HCL                                                     00093721401
METFORMIN HCL                                                     00093721410
METFORMIN HCL                                                     00781505061
METFORMIN HCL                                                     00781505261

                                        RFP12-2260P, On-Site Employee Health Center, Page 52
                LABELNAME                              PRODUCTID     Price
METFORMIN HCL                                         43547024850
METFORMIN HCL                                         68382002810
METFORMIN HCL                                         68382003010
OMEPRAZOLE                                            00378615001
OMEPRAZOLE                                            00378615010
OMEPRAZOLE                                            00378615093
OMEPRAZOLE                                            00781223310
OMEPRAZOLE                                            00781223331
OMEPRAZOLE                                            55111015810
OMEPRAZOLE                                            62175011832
OMEPRAZOLE                                            62175011837
OMEPRAZOLE                                            62175011843
SIMVASTATIN                                           00093715310
SIMVASTATIN                                           00093715410
SIMVASTATIN                                           00093715498
SIMVASTATIN                                           00093715510
SIMVASTATIN                                           00093715598
SIMVASTATIN                                           00093715610
SIMVASTATIN                                           16714068202
SIMVASTATIN                                           16714068203
SIMVASTATIN                                           16714068301
SIMVASTATIN                                           16714068302
SIMVASTATIN                                           16714068303
SIMVASTATIN                                           16714068402
SIMVASTATIN                                           16714068403
SIMVASTATIN                                           16714068503
SIMVASTATIN                                           16729000515
SIMVASTATIN                                           16729000615
SIMVASTATIN                                           54458093210
SIMVASTATIN                                           65862005230
SIMVASTATIN                                           65862005299
SIMVASTATIN                                           65862005399
SIMVASTATIN                                           65862005499
SIMVASTATIN                                           68180047903
SIMVASTATIN                                           68180048003
SIMVASTATIN                                           68180048102
SIMVASTATIN                                           68180048103
SINGULAIR                                             00006011731
SINGULAIR                                             00006011754
TRACLEER                                              66215010206




                            RFP12-2260P, On-Site Employee Health Center, Page 53
                                 LABELNAME                                       PRODUCTID     Price


                                  Description                                       Code       Price
OXYGEN CONCENTRATOR                                                             E1390
CONT AIRWAY PRESSURE DEVICE                                                     E0601
EXT AMB INFUSN PUMP INSULIN                                                     E0784
HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE                   E0562
NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE         E2402
RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACK-UP RATE      E0471
PORTABLE GASEOUS 02                                                             E0431
RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE    E0470
STATIONARY LIQUID 02                                                            E0439




                                                      RFP12-2260P, On-Site Employee Health Center, Page 54
              APPENDIX J: CENSUS AND UTILIZATION INFORMATION

State of Montana
Enrollment and census data



Summary Enrollment Data for the Fiscal year July 1, 2010 to June 30, 2011

Enrollment by Member Type                  Total Plan   Helena Area
Average # of Non-Medicare Policyholders       13,587          5,076
Average # of Non-Medicare Members             29,920         11,120
Average # of Members per Policyholder            2.20          2.19
Average # of Medicare Policyholders             2,476           790

Other Statistics
Percent Female                                51.80%
Percent Male                                  48.20%
Mean Age                                           37



Census by zip code for all enrollees as of September 2011
                                                  Non-
                                      Medicare   Medicare       Grand
Zip Code     COBRA      Employees     Retirees   Retirees       Total
    04652                                                1              1
    13316                                    1                          1
    16901                                    1                          1
    20001                                                   1           1
    21742                                    1                          1
    22314                                                   1           1
    24210                                    1                          1
    24541                         1                                     1
    27253                                    1                          1
    27519                                    1                          1
    27576                                    1                          1
    28227                                    1                          1
    28468                                    1                          1
    28546                                                   1           1
    30101                                    1                          1
    30132                                    1                          1
    30577                                    1                          1
    33415                                    1                          1
    34481                                    1                          1
    34653                                    1                          1
                                                    RFP12-2260P, On-Site Employee Health Center, Page 55
                                            Non-
                                Medicare   Medicare     Grand
Zip Code    COBRA   Employees   Retirees   Retirees     Total
    36541                                          1            1
    37030                                          1            1
    37075                              1                        1
    38016                   1                                   1
    38583                              1                        1
    42544                              1                        1
    43758                              1                        1
    46038                              1                        1
    46552                              1                        1
    47143                              1                        1
    48015                                          1            1
    49862                              1                        1
    53083                                          1            1
    53590                              1                        1
    55044                                          1            1
    55105                              1                        1
    55124                                          1            1
    55792                              1                        1
    55910                   1                                   1
    56127                              1                        1
    56470                                          1            1
    56601                              1                        1
    57106                              1                        1
    57471                              1                        1
    57702                              1                        1
    57747                                          1            1
    57769                                          1            1
    57783                              1                        1
    58346                                          1            1
    58501                              1                        1
    58504                              1                        1
    58554                              1                        1
    58577                              1                        1
    58601                              1                        1
    58621                              1                        1
    58642                              1                        1
    58730                   1                                   1
    58801                              2                        2
    58838                              1                        1
    59001                   4          1                        5
    59002                   1                                   1

                                             RFP12-2260P, On-Site Employee Health Center, Page 56
                                               Non-
                                  Medicare    Medicare     Grand
Zip Code    COBRA     Employees   Retirees    Retirees     Total
    59003                     5           2                       7
    59006                     2           1           1           4
    59010                     2                                   2
    59011                    26          4            6          36
    59014                    10          1                       11
    59015                     3                                   3
    59016                     4                       1           5
    59018                     3                       1           4
    59019                    16          6            2          24
    59022                     2                                   2
    59024                     5                                   5
    59025                     3                                   3
    59026                     2                                   2
    59027                     2          1                        3
    59029                     1                                   1
    59030                     3                       1           4
    59032                     6          1            2           9
    59034           1        27          8            3          39
    59035                                             1           1
    59036                    10          2            1          13
    59037                     7                                   7
    59038                     7          4                       11
    59041                    12          4            2          18
    59043                     3          1                        4
    59044                    56          3            2          61
    59046                     3          1                        4
    59047                    56         12            7          75
    59050                     5                                   5
    59052                                1            1           2
    59053                     1          1                        2
    59054                     3                                   3
    59057                     4                                   4
    59058                     1                                   1
    59062                                1                        1
    59063                    10          2                       12
    59064                     3                                   3
    59065                     1                                   1
    59066                     2                                   2
    59067                     1                                   1
    59068                    18          4            3          25
    59069                     6                                   6
                                                RFP12-2260P, On-Site Employee Health Center, Page 57
                                                 Non-
                                    Medicare    Medicare     Grand
Zip Code    COBRA       Employees   Retirees    Retirees     Total
    59070                       8           1           1          10
    59072                      31          10           2          43
    59074                       4           3           1           8
    59075                       1                                   1
    59079                      11          2            1          14
    59082                                  1                        1
    59083                                  1                        1
    59086                       7          1                        8
    59087                       2          2                        4
    59088                       7          1                        8
    59101           1         146         25           8         180
    59102           3         261         77          14         355
    59103                       9                                   9
    59104                       6          2                        8
    59105                     189         33          12         234
    59106                      64          6           2           72
    59107                       7          1                        8
    59108                       2          2            1           5
    59201                      61         10            5          76
    59211                       2                                   2
    59212                                               1           1
    59214                       3                                   3
    59215                       7          5                       12
    59218                       6          5            1          12
    59219                                  1                        1
    59221           1           2          1                        4
    59222                       2                                   2
    59223                      11          2                       13
    59225                       1                       1           2
    59226                       2                                   2
    59230                      69         14            1          84
    59241                       2          1                        3
    59243           1                      1                        2
    59248                      14          1            3          18
    59250                       2                                   2
    59254                      17          6            2          25
    59255                       4                       1           5
    59256                                  1                        1
    59259                       1                                   1
    59261                       1                                   1
    59262                       2          2                        4
                                                  RFP12-2260P, On-Site Employee Health Center, Page 58
                                                 Non-
                                    Medicare    Medicare     Grand
Zip Code    COBRA       Employees   Retirees    Retirees     Total
    59263                       7           5                      12
    59270           2          36           7           3          48
    59275                       1                                   1
    59301                     269         65          19         353
    59311                       1                                   1
    59312                       1                                   1
    59313                      12          8                       20
    59314                       1                                   1
    59317                      13          5            3          21
    59323                      11                                  11
    59324                       1          1            1           3
    59326                       3                                   3
    59327                      18          7            2          27
    59330                     105         41            7        153
    59336                       2                                   2
    59337                       9          2            1          12
    59338                       3                                   3
    59339                       1                                   1
    59344                       2                                   2
    59349           1           6          4                       11
    59351                       1          1                        2
    59353                       7          4           2           13
    59401                      94         13           2         109
    59403                      14                      2           16
    59404           1         224         54          11         290
    59405           1         196         43           8         248
    59406                       3          1                        4
    59410                       5          7            1          13
    59411                       5                                   5
    59412                      15          4            1          20
    59414                      12          3            1          16
    59416                       3                                   3
    59417                      15          1                       16
    59418                       2          1                        3
    59420                       2          2                        4
    59421                      31          3            1          35
    59422                      17         10                       27
    59425                      38         10                       48
    59427                      28          6                       34
    59430                       3                                   3
    59432                       4          2            1           7
                                                  RFP12-2260P, On-Site Employee Health Center, Page 59
                                                 Non-
                                    Medicare    Medicare     Grand
Zip Code    COBRA       Employees   Retirees    Retirees     Total
    59433                       8           2                      10
    59434                       5                       1           6
    59436                      10          5            1          16
    59440                       1          1                        2
    59442                      14          5            1          20
    59443                       7                                   7
    59448                       1                                   1
    59450                       3                                   3
    59451                       3          2                        5
    59452                       5                                   5
    59454                       1                                   1
    59456                                  1                        1
    59457           1         196         49            8        254
    59460                                  1                        1
    59463                       6          3                        9
    59464                       8                                   8
    59465                       1                                   1
    59467                       1                                   1
    59468                       3                                   3
    59469                       2                                   2
    59471                       3          1                        4
    59472                       4                       1           5
    59474                      25         11            2          38
    59477                       1          1            1           3
    59479                       9          1                       10
    59480                       5          1                        6
    59482                       5          1            1           7
    59483                       5          1            1           7
    59484                                  1                        1
    59485                       8          1                        9
    59486                       7                                   7
    59487                       8          3                       11
    59501           2          99         20            9        130
    59520                       3          2            1           6
    59521                       2                                   2
    59522                       5          4            2          11
    59523                      21          7            2          30
    59524                                  1                        1
    59526                       4          2                        6
    59538           1          16          8            3          28
    59540                       1                                   1
                                                  RFP12-2260P, On-Site Employee Health Center, Page 60
                                                 Non-
                                    Medicare    Medicare     Grand
Zip Code    COBRA       Employees   Retirees    Retirees     Total
    59547                       3           1                       4
    59601           3        2395         443        161         3002
    59602           5        1616         156         88         1865
    59604           2         108          22          7          139
    59620                       5           5          1           11
    59624                      66           8          6           80
    59631                      23           2          3           28
    59632                     195          20         12          227
    59633                      14                      1           15
    59634           1         395         41          21          458
    59635           1         579         55          35          670
    59636                       4                                   4
    59638                      40          6            2          48
    59639                      16          5                       21
    59640                       2          1                        3
    59642                                  1                        1
    59643                       6                                   6
    59644           1         104         15            5         125
    59645                      12          8            2          22
    59647                      20          2                       22
    59648                      22                                  22
    59701           2         581         90          33          706
    59702                      21          2                       23
    59703                       5          2                        7
    59710                                              1            1
    59711                     543        116          35          694
    59713                       9          2           1           12
    59714                      86         14           6          106
    59715           1          97         46           9          153
    59717                       1                                   1
    59718                     113         25            5         143
    59719                       3                                   3
    59720                       1                      1            2
    59721                       3          2           1            6
    59722           2         399         63          15          479
    59724                       2                                   2
    59725                      82         25            6         113
    59727                       4                                   4
    59728                       9          4            2          15
    59729                      15          6                       21
    59730                       6          1                        7
                                                  RFP12-2260P, On-Site Employee Health Center, Page 61
                                                Non-
                                    Medicare   Medicare     Grand
Zip Code    COBRA       Employees   Retirees   Retirees     Total
    59731                       9                                  9
    59732                       2                      1           3
    59733                       3                      1           4
    59735                       3          2           2           7
    59736                       2                                  2
    59739                       4          3                       7
    59740                       4                                  4
    59741                      16          2           1          19
    59743                       1                      1           2
    59747                       3                                  3
    59748                      10                      1          11
    59749                      15          5           1          21
    59750                       5          2           1           8
    59751                       4                      1           5
    59752                      18          3           6          27
    59754                       8          4                      12
    59755                       5                      1           6
    59756                      24          2                      26
    59758                       8          3                      11
    59759                      40          9           3          52
    59761                       3          3           1           7
    59762                                  1                       1
    59771                       4          3           2           9
    59772                       7          1                       8
    59801                     148         31           3         182
    59802           5          99         12           4         120
    59803           1          97         19           8         125
    59804                      46         10           2          58
    59806                      11          1                      12
    59807           1           9          3                      13
    59808           1         121         18           8         148
    59820                       6          5           1          12
    59821                      15          1           1          17
    59823                      16          3                      19
    59824                       4          2                       6
    59825                      14          2           1          17
    59826                       6                      1           7
    59827                       1                                  1
    59828                      24          5                      29
    59829                       7          1                       8
    59830                       1                                  1
                                                 RFP12-2260P, On-Site Employee Health Center, Page 62
                                               Non-
                                  Medicare    Medicare     Grand
Zip Code    COBRA     Employees   Retirees    Retirees     Total
    59831           1         1           2                       4
    59832                    12           4                      16
    59833                    31           2           2          35
    59834                    22           1                      23
    59837                     7           1                       8
    59840                    58          21           1          80
    59842                     2           2                       4
    59843                     2                                   2
    59845                     1          2                        3
    59846                    10                                  10
    59847                    45          6                       51
    59848                     1                                   1
    59851                     5                                   5
    59853                     5                                   5
    59854                     1                       1           2
    59855                     1                                   1
    59856                     1                                   1
    59858                    11          7            1          19
    59859                    17          3            1          21
    59860                    61         18            3          82
    59864                    19          6            1          26
    59865                     4          5            1          10
    59866                    11          3                       14
    59867                     2                                   2
    59868                    11          5            2          18
    59870                    46          2            4          52
    59871                     3                                   3
    59872                    24          5            2          31
    59873                    25          3                       28
    59874                     4          2                        6
    59875                     8                                   8
    59901                   272         65          24          361
    59903                    14          1           2           17
    59904                    11          3                       14
    59910                     4          1                        5
    59911                    35         12            5          52
    59912                   136         21            4         161
    59913                     8                                   8
    59914                     2                                   2
    59915                                1                        1
    59916                     2                                   2
                                                RFP12-2260P, On-Site Employee Health Center, Page 63
                                               Non-
                                  Medicare    Medicare     Grand
Zip Code    COBRA     Employees   Retirees    Retirees     Total
    59917                    14           3                      17
    59918                     2                                   2
    59919                     8                                   8
    59920                    17                       1          18
    59922                     5          4            2          11
    59923                    69         13            4          86
    59925           1         5          2                        8
    59926                     5                                   5
    59927                     2                                   2
    59930                     1                                   1
    59931                     1          2                        3
    59932                    17                                  17
    59934                     3                                   3
    59935                     8          2                       10
    59936                     4          1            3           8
    59937                    61          8            4          73
    61764                                1                        1
    63376                                1                        1
    64012                                1                        1
    65251                                1                        1
    67218                                1                        1
    67844                                1                        1
    69361                                1                        1
    71037                                1                        1
    72519                                             1           1
    74112                                1                        1
    74135           1                                             1
    75075                                1                        1
    75088                                1                        1
    75135                                1                        1
    77082                                1                        1
    77399                                1                        1
    78414                                             1           1
    78501                                1                        1
    80004                                1                        1
    80033                                1                        1
    80107                                1                        1
    80132                                1                        1
    80517                                1                        1
    80918                                1                        1
    81321                                1                        1
                                                RFP12-2260P, On-Site Employee Health Center, Page 64
                                                 Non-
                                    Medicare    Medicare     Grand
Zip Code    COBRA       Employees   Retirees    Retirees     Total
    81401                                   1                        1
    82003                                               1            1
    82401                                  1                         1
    82414                                  1                         1
    82801                                  1                         1
    83202                                  1                         1
    83210                                  1                         1
    83301                                               1            1
    83316                                  1                         1
    83318                                               1            1
    83324                                  1                         1
    83401                                  1                         1
    83402                                  1                         1
    83501                       1          2                         3
    83606                                  1                         1
    83624                                  1                         1
    83638                                  1                         1
    83646                                  1                         1
    83647                                  1                         1
    83704                                  1            1            2
    83709                                  1                         1
    83714                                  1                         1
    83811                                  1                         1
    83814                                  5                         5
    83815                                  1            1            2
    83849                                  1                         1
    83855                                  1                         1
    83861                                  1                         1
    84004                                  1                         1
    84029                                  1                         1
    84043                                  1                         1
    84062                                  1                         1
    84103                                  1                         1
    84663                                  1                         1
    84780                                               1            1
    85023                                  1                         1
    85027                                  1                         1
    85028                                  1                         1
    85122                                  1                         1
    85140           1                                                1
    85248                                  1                         1
                                                  RFP12-2260P, On-Site Employee Health Center, Page 65
                                                 Non-
                                    Medicare    Medicare     Grand
Zip Code    COBRA       Employees   Retirees    Retirees     Total
    85249                                   1                        1
    85253                                   2                        2
    85282                                               1            1
    85294                                  1                         1
    85351                                  2                         2
    85364                                  1                         1
    85365                                  1                         1
    85367                                  1                         1
    85374                                  1                         1
    85375                                  2                         2
    85387                                  1                         1
    85390                                               1            1
    85544                                  1                         1
    85635                                  1                         1
    85658                                  1                         1
    85704           1                                                1
    85718                                  1                         1
    85743                                  1                         1
    85746                                  1                         1
    85752                                  1                         1
    85901                                               1            1
    86406                                               1            1
    86442                                  1                         1
    87108                                  1                         1
    87112                                  1                         1
    87505                       1                                    1
    89024                                  1                         1
    89434                       1                                    1
    89705                                  1                         1
    92057                                  1                         1
    93022                                               1            1
    93446                                  1                         1
    93535                                  1                         1
    93704                                  1                         1
    94114                                  1                         1
    95521                                  1                         1
    95621                                  1                         1
    95993                                  1                         1
    96520                                               1            1
    96740                                               1            1
    96761                                  1                         1
                                                  RFP12-2260P, On-Site Employee Health Center, Page 66
                                            Non-
                                Medicare   Medicare     Grand
Zip Code    COBRA   Employees   Retirees   Retirees     Total
    97007                                          1            1
    97128                              1                        1
    97136                                          1            1
    97370                                          1            1
    97392                              1                        1
    97405                                          2            2
    97408                                          1            1
    97415                              1                        1
    97478                              1                        1
    97479                              1                        1
    97801                              1                        1
    97850                              1                        1
    98005                              1                        1
    98022                              1                        1
    98026                              1                        1
    98056                              1                        1
    98108                   1                                   1
    98118                              1                        1
    98155                              1                        1
    98201                                          1            1
    98226                   1                                   1
    98233                              2                        2
    98277                              1                        1
    98282                              1                        1
    98292                              1                        1
    98310                              1                        1
    98365                              1                        1
    98368                                          1            1
    98382                              4                        4
    98443                              1                        1
    98550                              1                        1
    98664                              1                        1
    98665                              1                        1
    98671                              1                        1
    98682                              1                        1
    98908                              1                        1
    99016                              1                        1
    99019                              2                        2
    99030                              1                        1
    99156                              1                        1
    99205                              1                        1
                                             RFP12-2260P, On-Site Employee Health Center, Page 67
                                                          Non-
                                         Medicare        Medicare       Grand
Zip Code      COBRA        Employees     Retirees        Retirees       Total
    99208                                        3                              3
    99212                                        1                              1
    99217                                        2                              2
    99324                                                        1              1
    99338                                           1                           1
    99352                                           1                           1
    99362                                           1                           1
    99403                                           1                           1
    99518                                           1                           1
    99603                                           1                           1
Grand
Total                 47        12621             2496        808        15972



State of Montana
Total Utilization, excluding Medicare enrollees
Fiscal Year July 1, 2010 to June 30, 2011



Medical & Rx Services                     Total Plan          Helena
Admits/1,000                                    64.0             59.4
Days/1,000                                     248.9            224.0
Average Length of Stay (Days)                    3.9              3.8
Office Visits/1000                           2,548.1          2,500.2
Outpatient Visits/1000                       1,648.2          1,646.1
ER Visits/1000                                 180.3            166.3
Prescriptions/1,000                        11,062.5          10,296.1




                                                           RFP12-2260P, On-Site Employee Health Center, Page 68
State of Montana
Total Spending, excluding Medicare enrollees
Fiscal Year July 1, 2010 to June 30, 2011



Medical & Rx Claims Paid Per Period                             Total Plan             Helena
Total Medical & Rx Claims Paid                                $100,633,246        $39,809,677
Total Medical Claims Paid                                      $82,976,546        $33,107,585
Total Rx Claims Paid                                           $17,656,700         $6,702,092

Medical & Rx Claims Paid Per Employee Per Period                 Total Plan            Helena
Total Medical & Rx Claims Paid Per Employee                         $7,373             $7,843
Medical Claims Paid Per Employee                                    $6,079             $6,522
Rx Claims Paid Per Employee                                         $1,294             $1,320

Medical & Rx Claims Paid PEPM                                    Total Plan            Helena
Total Medical & Rx Claims Paid PEPM                                    $614              $654
Medical Claims Paid PEPM                                               $507              $544
Rx Claims Paid PEPM                                                    $108              $110




Member Out-of-Pocket Cost-Sharing (Allowed - Paid)               Total Plan            Helena
Member Out-of-Pocket Cost-Share - Medical                              $942              $715
Member Out-of-Pocket Cost-Share Percentage - Medical                   25%               19%
Member Out-of-Pocket Cost-Share - Rx                                   $190              $172
Member Out-of-Pocket Cost-Share Percentage - Rx                        24%               22%




% of spending by category                                        Total Plan            Helena
Inpatient Facility                                                     24%               27%
Inpatient Professional                                                  4%                 3%
Outpatient Other                                                       31%               30%
Outpatient Professional                                                24%               23%
Pharmacy                                                               17%               17%




                                                       RFP12-2260P, On-Site Employee Health Center, Page 69
State of Montana
Helena Area outpatient utilization, excludes all retirees
Fiscal Year July 1, 2010 to June 30, 2011

               Category                                            Number of          Paid amount        Amount
                                                                       units                             per unit
               Office visits                                           34,492         $2,954,979.56        $85.67
               Laboratory services (Excluding                          38,535          $806,992.51         $20.94
               Venipuncture)
               Radiology                                               18,704         $2,180,841.23       $116.60
               Venipuncture                                             7,226            $20,324.32         $2.81
               Flu shots (Med Data)                                     1,235            $14,594.15        $11.82
               Flu shots (Med Data) - Associated Office                   401            $34,567.97        $86.20
               Visit
               Flu shots (Rx Data)                                        195            $1,269.04          $6.51
               Immunizations                                            6,575          $272,811.99         $41.49
  Primary      Immunizations - Associated Office Visit                  1,163           $93,404.30         $80.31
   Care
               Allergy shots                                            4,610           $50,983.97         $11.06
               Allergy shots - Associated Office Visit                    323           $28,278.53         $87.55
               EKG Total                                                1,538           $47,739.36         $31.04
               EKG - No Modifier                                        1,413           $44,035.31         $31.16
               EKG - Mod. 26 (Professional Component)                       1               $85.87         $85.87
               EKG - Mod. 76 (Repeat Procedure by Same                     20              $331.82         $16.59
               Physician)
               EKG - Mod. 77 (Repeat Procedure by                               1           $74.38         $74.38
               Another Physician)
               EKG - Mod. TC (Technical Component)                        102            $3,211.98         $31.49
               Injections                                                   5            $2,765.14        $553.03
               Physical therapy                                        21,951          $492,748.80         $22.45

Urgent and     ER Visits without admission                                655          $221,978.37        $338.90
 ER care       Urgent Care Visits                                       2,391          $120,123.47         $50.24



               Category                      Number of        Number of             Paid amount       Amount per
                                             patients         units (scripts)                         unit
               Retail Pharmacy                      10,922            97,751        $2,610,047.04     $    26.70
Pharmacy
               Mail Order Pharmacy                   2,132            12,607        $1,375,987.02     $   109.14
               Specialty pharmacy                      478             1,913        $2,481,932.30     $ 1,297.40
               Infusion drugs                        1,436             2,904        $3,032,097.15     $ 1,044.11




                                                            RFP12-2260P, On-Site Employee Health Center, Page 70
              Category                  Number of
                                        patients
  Disease     Diabetes                            494
and Health
              High Cholesterol                  1,374
Status Data
              High Blood Pressure               1,289
              BMI >30                             834

              Category                  Number of
                                        patients
 Members      Policyholders                       672
 with No
              Spouses                             313
  Claims
              Children                            914
              Total                             1,899




                                    RFP12-2260P, On-Site Employee Health Center, Page 71
State of Montana
Total wellness visits for health screenings
Fiscal Year July 1, 2010 to June 30, 2011


City                           Total
Anaconda                         131
Big Timber                        25
Billings                         561
Boulder                           92
Bozeman                          233
Broadus                           14
Butte                            249
Columbia Falls                   112
Cut Bank                          13
Deer Lodge                       293
Dillon                            53
Eureka                            15
Glasgow                           84
Glendive                         108
Great Falls                      413
Hamilton                          91
Havre                            109
Helena                         4,177
Kalispell                        290
Laurel                            41
Lewistown                        120
Libby                             89
Livingston                        49
Miles City                       203
Missoula                         494
Polson                            86
Shelby                            76
Sidney                            33
Warm Springs                     138
Whitefish                         47
Wolf Point                        58
Grand Total                    8,497




                                              RFP12-2260P, On-Site Employee Health Center, Page 72
State of Montana
Worker Comp Medical Claims, all enrollees
Fiscal Year July 1, 2010 to June 30, 2011

                               Number
                               of
Employee City                  Claimants    Medical Paid
ANACONDA                              85    $    158,261
ARLEE                                  1    $       3,074
ASHLAND                                1    $         182
AVON                                   1    $           -
BABB                                   1    $         396
BASIN                                  7    $       1,319
BELGRADE                               4    $      20,105
BELT                                   1    $       2,749
BIG SANDY                              1    $       1,648
BIG TIMBER                             2    $       7,236
BIGFORK                                2    $      27,560
BILLINGS                              53    $    111,904
BLACK EAGLE                            2    $         856
BONNER                                 1    $         230
BOULDER                               57    $      77,116
BOULDER CITY                           1    $       1,640
BOZEMAN                               12    $       9,611
BROADUS                                1    $         248
BROWNING                               2    $       3,470
BUTTE                                 73    $      89,848
CASCADE                                1    $       3,706
CHESTER                                2    $       5,784
CHINOOK                                3    $       2,112
CHOTEAU                                1    $           -
CLANCY                                13    $      11,749
COLUMBIA FALLS                        17    $      45,764
COLUMBUS                               2    $         792
CONDON                                 2    $       1,003
CONRAD                                 3    $      14,687
CORAM                                  3    $      26,065
CORVALLIS                              3    $         113
CULBERTSON                             1    $      19,371
CUSTER                                 1    $         797
CUT BANK                               4    $       7,886
DAYTON                                 1    $       6,238
DEER LODGE                            46    $    121,480
DEERLODGE                              1    $         688
DENTON                                 1    $           -
DILLON                                13    $      66,707
DRUMMOND                               1    $         267

                                                     RFP12-2260P, On-Site Employee Health Center, Page 73
                   Number
                   of
Employee City      Claimants   Medical Paid
DUPUYER                    1   $      12,121
E HELENA                   2   $       8,595
EAST HELENA               23   $      48,045
ELLENSBURG                 1   $      19,308
ELLISTON                   1   $       1,090
EMIGRANT                   1   $         628
FLORENCE                   5   $       3,733
FORSYTH                    1   $       1,807
FORT PECK                  1   $       2,859
FRENCHTOWN                 1   $       1,304
GALLATIN GATEWAY           1   $      10,536
GARRISON                   1   $         586
GILBERT                    1   $           -
GLASGOW                    6   $       4,850
GLENDIVE                   8   $      39,530
GOLD CREEK                 1   $       1,456
GRASS RANGE                1   $           -
GREAT F                    1   $         556
GREAT FALLS               39   $    105,997
GREENOUGH                  1   $         198
HAMILTON                   3   $       5,202
HARDIN                     1   $         267
HARLEM                     2   $       7,246
HARLOWTON                  1   $         974
HAVRE                      6   $      15,430
HELENA                   160   $    226,231
HOBSON                     1   $         276
HUNGRY HORSE               3   $      11,049
HUNTLEY                    1   $         110
HUSON                      3   $         728
HYSHAM                     1   $         592
JACKSON                    1   $       6,040
JEFFERSON CITY             3   $       2,243
KALISPELL                 26   $      64,478
KEVIN                      1   $       1,355
KILA                       4   $       2,528
LAKESIDE                   1   $       1,391
LAME DEER                  2   $         236
LAUREL                     6   $       5,153
LAVINA                     1   $           -
LEWISTORE                  1   $         287
LEWISTOWN                 39   $      87,112
LIBBY                      8   $      17,517
LINCOLN                    2   $       4,467
LIVINGSTON                 3   $      25,385

                                        RFP12-2260P, On-Site Employee Health Center, Page 74
                        Number
                        of
Employee City           Claimants   Medical Paid
LOLO                            5   $       2,527
MALTA                           2   $           -
MANHATTAN                       2   $       2,380
MERIDIAN                        2   $       3,942
MILES CITY                     40   $      32,334
MISSOULA                       33   $    102,620
MOLT                            1   $         345
NASHUA                          1   $       6,655
PABLO                           1   $           -
PETOSKEY                        1   $       1,029
PHILIPSBURG                     2   $      12,785
PLAINS                          4   $      10,396
PLENTYWOOD                      3   $         245
POLSON                          5   $      26,816
PRYOR                           2   $       5,132
RED LODGE                       2   $       1,472
REED POINT                      1   $         180
ROBERTS                         2   $         837
RONAN                           3   $         438
ROUNDUP                         2   $         438
SAINT REGIS                     2   $         588
SCOBEY                          1   $       1,299
SEELEY LAKE                     5   $       6,933
SHELBY                          3   $         355
SHEPHERD                        4   $       1,622
SHERIDAN                        2   $       7,271
SIDNEY                          2   $         229
ST REGIS                        1   $           -
STEVENSVILLE                    3   $       7,632
STOCKETT                        1   $         567
SUPERIOR                        3   $       7,792
THOMPSON FALLS                  3   $       6,417
THREE FORKS                     4   $      20,270
TOWNSEND                        5   $       8,627
TREGO                           1   $         350
TROUT CREEK                     1   $          90
TROY                            2   $      16,194
VAUGHN                          1   $         844
VICTOR                          1   $         294
VIRGINIA CITY                   1   $         409
VOLBORG                         1   $         333
WARM SPRINGS                    3   $      30,883
WEST YELLOWSTONE                1   $      61,925
WHITE SULPHUR SPRINGS           2   $       2,923
WHITEFISH                       7   $       5,690

                                             RFP12-2260P, On-Site Employee Health Center, Page 75
                Number
                of
Employee City   Claimants   Medical Paid
WHITEHALL               4   $       8,660
WINSTON                 2   $         547
WISDOM                  1   $         765
WOLF CREEK              1   $      30,938
WOLF POINT              6   $      10,894
WORDEN                  1   $         171
Grand Total           993   $ 2,054,241




                                     RFP12-2260P, On-Site Employee Health Center, Page 76
                      EXHIBIT I: BUSINESS ASSOCIATE AGREEMENT

                               Business Associate Agreement

         This Business Associate Agreement (“Agreement”) is effective ____________, 2011 and made by and
between the State of Montana, Department of Administration, Health Care and Benefits Division (“the State”),
and ________________________ (“Business Associate”), (collectively, the “Parties”). Terms appearing below
in the Recitals section with initial upper case letters shall have the respective meanings assigned to them in
this introductory paragraph or in Section 1.02 of this Agreement, as applicable.

                                                 RECITALS:

       WHEREAS, Business Associate is concurrently entering into a Contract with the State to provide
Services to or on behalf of the State;

      WHEREAS, the Parties acknowledge and agree that in providing Services to or on behalf of the State,
Business Associate will create, receive, use or disclose Protected Health Information;

        WHEREAS, the Parties intend to enter into this Agreement to address the requirements of HIPAA,
HITECH, the Privacy Rule, and the Security Rule as they apply to “business associates”, including the
establishment of permitted and required uses and disclosures (and appropriate limitations and conditions on
such uses and disclosures) of Protected Health Information by Business Associate that is created or received
in the course of performing Services on behalf of the State; and

       WHEREAS, the objective of this Agreement is to provide the State with reasonable assurances that
Business Associate will appropriately safeguard the Protected Health Information that it creates or receives in
the course of providing Services to the State;

       NOW, THEREFORE, in connection with Business Associate’s creation, receipt, use or disclosure of
Protected Health Information and in consideration for the mutual promises contained herein, and for other good
and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties hereby
agree as follows:

                                                 ARTICLE I
                                                 Definitions

1.01   General Definitions. All terms appearing in this Agreement with initial upper case letters that are not
       otherwise defined in this Agreement shall have the same meaning as that provided for the respective
       terms in 45 C.F.R. §§ 160.103, 164.103, 164.304 and 164.501.

1.02   Specific Definitions. For purposes of this Agreement, the following terms shall have the indicated
       meanings whenever the term appears with initial upper case letters in this Agreement:

       (a)     “Business Associate” shall have the same meaning as the term in 45 C.F.R. § 160.103 and
               shall mean ______________________ for purposes of this Agreement. Any reference to
               Business Associate in this Agreement includes Business Associate’s employees, agents,
               officers, subcontractors, third party contractors, volunteers, or directors.

       (b)     “Breach” shall mean the acquisition, access, use or disclosure of Protected Health Information
               in a manner not permitted by HIPAA which compromises the security or privacy of the Protected

                                                           RFP12-2260P, On-Site Employee Health Center, Page 77
      Health Information unless such acquisition, access, use or disclosure is otherwise excluded
      under 45 C.F.R. § 164.402. For this purpose, Protected Health Information is “compromised” to
      the extent that the action poses a significant risk of financial, reputational or other harm to the
      Individual.

(c)   “Covered Entity” shall have the same meaning as the term in 45 C.F.R. § 160.103 and shall
      mean the State of Montana, Department of Administration, Health Care & Benefits Division for
      the purposes of this agreement.

(d)   “Data Aggregation” shall mean, with respect to Protected Health Information created or
      received by the Business Associate in its capacity as the Business Associate of the State, the
      combining of such Protected Health Information by the Business Associate with Protected Health
      Information received by the Business Associate in its capacity as business associate of another
      covered entity, to permit data analyses that relate to the health care operations of the respective
      entities.

(e)   “Designated Record Set” shall mean a group of records maintained by or for the State within
      the meaning of 45 C.F.R. § 164.501 that consists of: (i) the enrollment, payment, claims
      adjudication, and case or medical management record systems maintained by or for a health
      plan; or (ii) records that are used, in whole or in part, by or for the State to make decisions about
      Individuals.

      For purposes of this Section 1.02(e), the term “record” means any item, collection or grouping of
      information that includes Protected Health Information and is maintained, collected, used or
      disseminated by or for the State.

(f)   “HHS-Approved Technology” shall mean, with respect to data in motion, the encryption
      guidelines in Federal Information Processing Standard 140-2. For data at rest, HHS-Approved
      Technology shall mean the encryption guidelines in National Institutes of Standards and
      Technology (NIST) Special Publication 800-111. With respect to the destruction of data
      containing Protected Health Information, an HHS-Approved Technology requires the destruction
      of the media on which the Protected Health Information is stored such that, for paper, film or
      other hard copy media, destruction requires shredding or otherwise destroying the media so that
      Protected Health Information cannot be read or reconstructed; for electronic media, destruction
      requires that the data be cleared, purged or destroyed consistent with NIST Special Publication
      800-88 such that the information cannot be retrieved. HHS-Approved Technology may be
      updated from time to time based on guidance from the Secretary of HHS.

(g)   “HIPAA” shall mean the Health Insurance Portability and Accountability Act of 1996, Pub. L.
      104-191.

(h)   “HITECH” shall mean the Health Information Technology for Economic and Central Health Act,
      Pub. L. 111-5.

(i)   “Individual” shall have the same meaning as the term “individual” in 45 C.F.R. § 160.103, and
      shall include a person who qualifies as a personal representative in accordance with 45 C.F.R.
      § 164.502(g).

(j)   “Minimum Necessary” means the least amount of PHI necessary to accomplish the purpose for
      which the PHI is needed.

(k)   “Privacy Rule” shall mean the Standards for Privacy of Individually Identifiable Health
      Information at 45 C.F.R. Part 160 and Part 164, Subparts A and E.


                                                   RFP12-2260P, On-Site Employee Health Center, Page 78
       (l)    “Protected Health Information (PHI)” shall mean individually identifiable health information that
              is transmitted by electronic media (within the meaning of 45 C.F.R. § 160.103), maintained in
              electronic media, or maintained or transmitted in any form or medium including, without
              limitation, all information (including demographic, medical, and financial information), data,
              documentation, and materials that are created or received by Business Associate from or on
              behalf of the State in connection with the performance of Services, and relates to:

                  (A) The past, present or future physical or mental health or condition of an Individual;
                  (B) The provision of health care to an Individual; or
                  (C) The past, present or future payment for the provision of health care to an Individual;

              and that identifies or could reasonably be used to identify an Individual and shall otherwise have
              the meaning given to such term under the Privacy Rule including, but not limited to, 45 C.F.R. §
              160.103. Protected Health Information does not include health information that has been de-
              identified in accordance with the standards for de-identification provided for in the Privacy Rule
              including, but not limited to, 45 C.F.R. § 164.514.

       (m)    “Required By Law” shall have the same meaning as the term “required by law” in 45 C.F.R. §
              164.103.

       (n)    “Secretary” shall mean the Secretary of the United States Department of Health and Human
              Services (“HHS”) or his designee.

       (o)    “Secured Protected Health Information” shall mean Protected Health Information to the extent
              that the information is protected by using an HHS-Approved Technology identified by HHS for
              rendering Protected Health Information unusable, unreadable or indecipherable to unauthorized
              individuals.

       (p)    “Security Rule” shall mean the Security Standards at 45 C.F.R. Part 160, Part 162, and Part 164.

       (q)    “Services” shall mean the functions, activities or services to be provided to the State under the
              terms of a Contract for On-Site Employee Health Center Services between the State and
              Business Associate.

       (r)    “Unsecured Protected Health Information” shall mean Protected Health Information that is not
              rendered unusable, unreadable or indecipherable to unauthorized individuals through the use of an
              HHS-Approved Technology.

                                              ARTICLE II
                            Obligations and Activities of Business Associate

2.01   Non-Disclosure of Protected Health Information. Business Associate shall not use or disclose
       Protected Health Information other than as permitted or required by this Agreement or the Contract or as
       Required By Law.

2.02   Safeguards. Business Associate agrees to use appropriate safeguards to prevent use or disclosure of
       Protected Health Information other than as provided for by this Agreement or the Privacy Rule.
       Business Associate agrees to implement administrative, physical, and technical safeguards, along with
       policies and procedures, that reasonably and appropriately protect the confidentiality, integrity, and
       availability of the electronic Protected Health Information that it creates, receives, maintains or transmits
       on behalf of the State and to utilize Secured Protected Health Information in connection with the
       performance of Services under this Agreement.


                                                            RFP12-2260P, On-Site Employee Health Center, Page 79
2.03   Mitigation. Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is
       known to Business Associate relating to a use or disclosure of Protected Health Information by Business
       Associate in violation of the requirements of this Agreement or the Contract.

2.04   Reporting of Violations. Subject to Section 2.05, Business Associate agrees to report to the State any
       use or disclosure of Protected Health Information not provided for by this Agreement or the Contract
       within thirty (30) days of such disclosure or Business Associate’s knowledge of such disclosure.
       Business Associate agrees to report to the State any security incident (within the meaning of 45 C.F.R. §
       164.304) of which Business Associate becomes aware.

2.05   Breach of Unsecured Protected Health Information. To the extent that the Business Associate
       knows or has reason to know that there has been a Breach or suspected Breach of Unsecured
       Protected Health Information, the Business Associate is required to identify the Individual whose
       Unsecured Protected Health Information has been acquired, accessed, used or disclosed and to notify
       the State of such Breach without reasonable delay, but no later than five (5) days after discovery of the
       Breach. Upon discovering the Breach, the Business Associate is required to (a) identify the entity to
       which the information was impermissibly disclosed, (b) determine whether or not the entity is subject to
       the HIPAA and the Privacy Rule, (c) identify the type and amount of Protected Health Information
       disclosed, (d) determine whether the disclosure poses a significant risk of financial, reputational, or other
       harm to the Individual, and (e) if the improperly disclosed Unsecured Protected Health Information is
       returned, determine if the information was returned before being accessed for an improper purpose.

2.06   Notice of a Breach of Unsecured Protected Health Information. In the event of a Breach involving
       Unsecured Protected Health Information, the Business Associate, with the prior written approval of the
       State, will notify the affected Individuals without unreasonable delay, but no later than sixty (60) days
       after discovery of the Breach (“notice date”). The notice will include (a) a brief description of the
       incident, (b) the date the Breach occurred, (c) the date the Breach was discovered, (d) the type of
       Protected Health Information involved, (e) steps the Individual should take to protect him/herself from
       potential harm resulting from the Breach, (f) a brief description of steps the State has taken to
       investigate, mitigate losses and protect against further Breaches, and (g) contact information for
       Individuals to ask questions, including a toll-free number, e-mail address, website or postal address. To
       the extent that the Breach involves more than 500 residents of a single state or jurisdiction, the Business
       Associate shall provide to the State, no later than the notice date, the information necessary for the
       State to prepare the notice to media outlets as set forth in 45 C.F.R. § 164.406. To the extent that the
       Breach involves 500 or more Individuals, the Business Associate shall provide to the State, no later than
       the notice date, the information necessary for the State to prepare the notice to the Secretary of HHS, as
       set forth in 45 C.F.R. § 164.408. To the extent that the Breach involves less than 500 Individuals, the
       Business Associate shall maintain a log of such Breaches and provide such log to the State for
       submission to HHS. The Breach log shall be provided by Business Associate to the State on an annual
       basis, not later than sixty (60) days after the end of the calendar year.

2.07   Audits. Business Associate shall permit the State to audit Business Associate’s compliance with the
       Privacy Rule, Security Rule and this Agreement upon reasonable prior notice and in a reasonable
       manner. The State shall pay for any such audits.

2.08   Agents and Contractors. Business Associate agrees to ensure that any of Business Associate’s
       agents, including any subcontractors, to whom it provides Protected Health Information received from, or
       created or received by Business Associate on behalf of the State, agrees to the same restrictions and
       conditions that apply through this Agreement to Business Associate with respect to such information.
       Business Associate also agrees to ensure that any Business Associate employee or agent, including
       any subcontractor to whom it provides Protected Health Information received from, or created or
       received by Business Associate on behalf of the State agrees to implement reasonable and appropriate
       safeguards to protect such Protected Health Information. Business Associate and the State agree that
       the Business Associate is not the agent of the State at any time under this Agreement.

                                                           RFP12-2260P, On-Site Employee Health Center, Page 80
2.09   Sanctions. Business Associate agrees to apply appropriate sanctions against any Business Associate
       employee or agent, including a subcontractor, with access to Individuals’ Protected Health Information
       who fails to comply with the State’s, or the Business Associate’s health information privacy policies and
       procedures.

2.10   Amendment of Protected Health Information. Business Associate agrees to make appropriate
       amendments to Protected Health Information in a Designated Record Set that either the State or an
       Individual requests pursuant to procedures established under 45 C.F.R. § 164.526. To the extent
       Business Associate is requested by an Individual to amend his or her Protected Health Information,
       Business Associate shall communicate its approval or denial of such request to the Individual pursuant
       to procedures to be mutually agreed upon in advance by the Parties.

2.11   Disclosure of Internal Practices, Books, and Records. Business Associate agrees to make internal
       practices, books, and records (including policies and procedures) relating to the use and disclosure of
       Protected Health Information received from, or created or received by Business Associate on behalf of
       the State, available to the State or, at the request of the State, to the Secretary, in a time and manner
       requested by the State or designated by the Secretary, for purposes of the Secretary determining the
       State’s compliance with the Privacy Rule.

2.12   Access to Protected Health Information. To the extent that either the State or an Individual requests
       to inspect or obtain a copy of Protected Health Information (as provided for in 45 C.F.R. § 164.524) that
       may be in the possession or control of the Business Associate or its agents or subcontractors, or that
       exists in a Designated Record Set, Business Associate shall respond in the time and manner requested
       by the State or, as directed by the State, to an Individual, provided that compliance with the request
       would not result in a violation of HIPAA or the Privacy Rule.

2.13   Documentation of Disclosures. Business Associate agrees to document disclosures of Protected
       Health Information and information related to such disclosures as would be required for the State to
       respond to a request by an Individual for an accounting of disclosures of Protected Health Information in
       accordance with 45 C.F.R. § 164.528. At a minimum, such documentation shall include: (i) the date of
       each disclosure; (ii) the name of the entity or person who received Protected Health Information and, if
       known, the address of the entity or person; (iii) a brief description of the Protected Health Information
       disclosed; (iv) the disclosures of Protected Health Information that occurred during the six-year period
       prior to the date of the request for an accounting (or any shorter period of time requested by the
       Individual) and that are otherwise subject to the accounting requirement in 45 C.F.R. § 164.528; (v) a
       brief statement of the purpose of the disclosure that reasonably informs the Individual of the basis for the
       disclosure or, if applicable, in lieu of such a statement, a copy of the Individual’s authorization and a
       copy of the written request for disclosure.

2.14   Accounting for Disclosures. Business Associate agrees to provide to the State or an Individual, in a
       time and manner mutually determined by the Parties, information collected in accordance with
       Section 2.11 of this Agreement so as to permit the State to respond to a request by an Individual for an
       accounting of disclosures of Protected Health Information in accordance with 45 C.F.R. § 164.528,
       provided, however, that to the extent that the State uses or maintains an electronic health record with
       respect to Protected Health Information, Business Associate shall provide such accounting to the
       Individual (or, upon the request of the State, to the State for delivery to the Individual) of the disclosures
       required for the three-year period immediately preceding the date on which the accounting is requested.
       The accounting of disclosures through electronic health records shall not be required earlier than the
       earliest applicable date established by the Secretary of HHS.

2.15   Facilitate the Exercise of Privacy Rights. Business Associate agrees to establish procedures that
       allow Individuals to exercise their rights under the Privacy Rule, including the right to (i) inspect and
       obtain copies of records and documents within the possession or control of the Business Associate that

                                                            RFP12-2260P, On-Site Employee Health Center, Page 81
       contain the Individual’s Protected Health Information; (ii) request amendments to their Protected Health
       Information; (iii) receive an accounting of disclosures of their Protected Health Information by Business
       Associate; (iv) request restrictions on the use or disclosure of Protected Health Information; and
       (v) receive communications regarding Protected Health Information at alternative locations or by
       alternative means. Business Associate agrees that, to the extent that an Individual requests restrictions
       with respect to the disclosure of Protected Health Information, and such restrictions relate to disclosure
       to the State for purposes of carrying out payment or health care operations (but not treatment), and the
       Protected Health Information pertains solely to a health care item or service for which the health care
       provider involved has been paid out of pocket in full, such restriction shall be followed.

2.16   No Waiver of Rights. The State and Business Associate shall not require Individuals to waive their
       health information privacy rights as a condition for treatment, payment, enrollment or eligibility for
       benefits.

2.17   Responses to Subpoenas. In the event that Business Associate receives a subpoena, discovery
       request or other lawful process, with or without an order from a court or administrative tribunal, arising
       out of or in connection with the State or this Agreement including, but not limited to, any use or
       disclosure of Protected Health Information or any failure in Business Associate’s health data security
       measures, Business Associate shall fully comply with the notice and protective action obligations set
       forth in 45 C.F.R. § 164.512(e) in accordance with Business Associate’s standard policy and procedures
       regarding subpoenas, discovery requests, and other lawful processes which shall be communicated to
       the State upon request.

2.18   Electronic Transactions. To the extent required under HIPAA (including the Standards for Electronic
       Transactions at 45 C.F.R. Parts 160 and 162), Business Associate agrees to use or conduct, in whole or
       part, standard transactions and utilize code sets or identifiers under the Privacy Rule for or on behalf of
       the State as detailed under the Privacy Rule or HIPAA (including the Standards for Electronic
       Transactions at 45 C.F.R. Parts 160 and 162). Business Associate shall also require any subcontractor
       or agent to also comply with such electronic transaction requirements under HIPAA (including the
       Standards for Electronic Transactions at 45 C.F.R. Parts 160 and 162).

2.19   Security Standards. Business Associate acknowledges that it may need to issue and change
       procedures from time to time to improve electronic data and file security, and agrees that such
       measures shall be at least as stringent as may be required by the Privacy Rule or the Security Rule, as
       applicable. Notwithstanding the foregoing, Business Associate agrees and acknowledges that it shall at
       all times use an HHS- Approved Technology for all Protected Health Information that is in motion, stored
       or to be destroyed.

2.20   Disclosures to Designated Plan Sponsor Representatives. The State shall identify for Business
       Associate, in writing, certain the employees of the State who are authorized to discuss Protected Health
       Information with Business Associate in connection with an Individual’s claim for benefits from the State.
       To the extent that Business Associate is contacted by any such designated representative in connection
       with an Individual’s claim for benefits from the State, Business Associate shall treat such inquiry as
       relating to “treatment, payment or healthcare operations” within the meaning of the Privacy Rule and
       shall provide the information permitted under such Privacy Rule.

2.21   Notice of Privacy Practices. The State shall prepare and distribute a notice of privacy practices as
       required by the Privacy Rule. If Business Associate maintains a web site on behalf of the State that
       provides information about the State’s participant services or benefits, Business Associate shall make
       the notice of privacy practices available electronically through the web site and shall make certain that
       the notice of privacy practices is prominently posted on the web site.

2.22   Insurance. Business Associate shall maintain insurance as required by the Contract and appropriate and
       adequate insurance coverage for Business Associate’s obligations pursuant to this Agreement.

                                                           RFP12-2260P, On-Site Employee Health Center, Page 82
2.23   Ownership. The parties agree that the PHI is, and shall remain, the property of the State.

2.24   Minimum Necessary Standard. Business Associate shall apply the HIPAA minimum necessary
       standard to any use or disclosure of PHI necessary to achieve the purposes of the contract and this
       Agreement.

2.25   Representation and Warranty of Business Associate. Business Associate represents and warrants
       that, at all times during the term of the Contract and this Agreement and at such other times as may be
       indicated, Business Associate: (i) is duly organized or incorporated and validly existing under the laws of
       the jurisdiction of its organization; (ii) has all requisite powers, licenses, and permits; (iii) has undertaken
       all actions and has fulfilled all conditions to use, disclose, or receive PHI and to enter into, perform under
       and comply with its obligations under this Agreement and the contract; (iv) shall comply with, and as
       applicable, shall require its directors, officers, and employees to comply with, applicable federal, state,
       and local laws and State’s policies, procedures, and notice of privacy practices; (v) is not and has not
       ever been excluded, barred, or otherwise ineligible from participation in any government health care
       benefits program, including but not limited to Medicare, Medicaid, CHAMPUS, or Tricare; (vi) has not
       ever received, and if applicable has taken appropriate steps to ensure that its directors, officers and
       employees have ever received, a Criminal Conviction, as defined below, relating to health care; and (vii)
       shall comply with, and, as applicable, shall require its directors, officers and employees to comply with,
       its duties and obligations pursuant to this Agreement and the contract, which duties and responsibilities
       shall survive the termination of this contract for any reason. For purposes of this Agreement, “Criminal
       Conviction” shall mean (a) a judgment of conviction has been entered against the entity or individual by
       a federal, state or local court, regardless of whether an appeal is pending or the judgment of conviction
       or other record relating to criminal conduct has been expunged; (b) a finding of guilt against the
       individual or entity that has been accepted by a federal, state or local court; (c) a plea of guilty or nolo
       contendere by the individual or entity that has been accepted by a federal, state or local court; or (d) the
       entering into participation in a first offender, deferred adjudication or other arrangement or program
       where judgment of conviction has been withheld. If any of the above representations or warranties is no
       longer accurate, Business Associate shall immediately inform the State.

                                               ARTICLE III
                         Permitted Uses and Disclosures by Business Associate

3.01   General Uses and Disclosures. Except as otherwise limited by this Agreement, Business Associate
       agrees to create, receive, use or disclose Protected Health Information only in a manner that is
       consistent with this Agreement, the Privacy Rule and the Security Rule, and only in connection with
       providing Services to the State, provided that such creation, receipt, use or disclosure would not violate
       the Privacy Rule or Security Rule if done by the State, or the minimum necessary policies and
       procedures of the State.

3.02   Use and Disclosure for Treatment, Payment and Health Care Operations. In providing Services,
       Business Associate shall be permitted to use and disclose Protected Health Information for purposes of
       “treatment, payment and health care operations” in accordance with the Privacy Rule, including, but not
       limited to, using or disclosing Protected Health Information (i) to investigate, pay, audit and otherwise
       administer and facilitate the payment of health plan claims; (ii) to enroll or disenroll participants and
       beneficiaries in and/or confirm or deny participant and beneficiary eligibility for participation in the State;
       and (iii) to coordinate the payment of benefits from the State when a participant or beneficiary is enrolled
       in another health plan which provides similar benefits, provided, however, that any communication by
       Business Associate that is about a product or service and that encourages recipients of the
       communication to purchase or use the product or service shall not be considered a health care
       operation for purposes of 45 C.F.R. Part 164, subpart E, unless the communication is made in
       accordance with 45 C.F.R. § 164.501 and is approved in writing by the State.

                                                             RFP12-2260P, On-Site Employee Health Center, Page 83
3.03   Use and Disclosure for Public Health, Health Oversight and Law Enforcement Purposes. In
       providing Services, Business Associate shall be permitted to use and disclose Protected Health
       Information, in accordance with the Privacy Rule, (i) to provide needed information to government
       agencies engaged in public health, health oversight, law enforcement, and otherwise as Required by
       Law; and (ii) to report violations of law to appropriate Federal and State authorities, consistent with
       45 C.F.R. § 164.502(j)(1).

3.04   Use for Management and Administration of Business Associate. Except as otherwise limited in this
       Agreement, Business Associate may use Protected Health Information for the proper management and
       administration of the Business Associate (defined as those uses arising in the ordinary course of its
       business and as is customary in its industry) or to carry out the legal responsibilities of the Business
       Associate. Any such use shall be in accordance with the uses and disclosures permitted by the Privacy
       Rule.

3.05   Disclosure for Management and Administration of Business Associate. Except as otherwise
       limited in this Agreement, Business Associate may disclose Protected Health Information for the proper
       management and administration of the Business Associate provided that the disclosures are Required
       by Law, or Business Associate (i) obtains the prior written approval of the State for such use or
       disclosure, and (ii) obtains reasonable assurances from the person to whom the information is to be
       disclosed that (A) the information shall remain confidential, (B) the information shall be used or further
       disclosed only as Required by Law or for the purpose for which it was disclosed to the person, and
       (C) the person shall notify the Business Associate of any instances of which it is aware in which the
       confidentiality of the information has been breached.

3.06   Use for Data Aggregation Services. Except as otherwise limited in this Agreement, Business
       Associate may use Protected Health Information to provide Data Aggregation services relating to the
       health care operations of the State as permitted by 45 C.F.R. § 164.504(e)(2)(i)(B).

3.07   Prohibition on Sale of Electronic Health Records or Protected Health Information. Effective with
       respect to exchanges occurring after the date that is six (6) months after issuance of final regulations,
       and except as provided in this Agreement or otherwise excepted under HITECH, Business Associate
       shall not directly or indirectly receive remuneration in exchange for any Protected Health Information of
       an Individual unless the State or Business Associate has received a valid authorization (within the
       meaning of 45 C.F.R. § 164.508) that includes a specification that the Protected Health Information can
       be further exchanged for remuneration by the entity receiving the Protected Health Information of that
       Individual.

                                                  ARTICLE IV
                                             Obligations of the State

4.01   Obligations to Notify Business Associate.

       (a)    Limitations in Notice of Privacy Practices. The State shall notify Business Associate of any
              limitations in the State’s notice of privacy practices provided in accordance with the requirements
              of 45 C.F.R. § 164.520, to the extent such limitations may affect Business Associate’s use or
              disclosure of Protected Health Information.

       (b)    Changes in Permission by Individual for Use of Disclosure. The State shall notify Business
              Associate of any changes in, or revocation of, permission by an Individual to use or disclose
              Protected Health Information, if and to the extent that such changes affect Business Associate’s
              use or disclosure of Protected Health Information.

       (c)    Agreements to Restrict Use or Disclosure. The State shall notify Business Associate of any
              restrictions on the use or disclosure of Protected Health Information or a request for confidential
                                                           RFP12-2260P, On-Site Employee Health Center, Page 84
              communication that the State has agreed to pursuant to and in accordance with the requirements
              of 45 C.F.R. § 164.522, or shall direct Individuals to make any such request directly to Business
              Associate if and to the extent that such restriction or request may affect Business Associate’s
              use or disclosure of Protected Health Information.

4.02   Permissible Requests by the State. The State shall not request Business Associate to use or disclose
       Protected Health Information in any manner that would not be permissible under the Privacy Rule or
       Security Rule if done by the State, except that the State may request that Business Associate perform
       Data Aggregation services pursuant to the provisions of Section 3.06 of this Agreement.

                                                    ARTICLE V
                                               Term and Termination

5.01   Term. This Agreement shall terminate when all of the Protected Health Information provided by the
       State to Business Associate, or created or received by Business Associate on behalf of the State, is
       destroyed or returned to the State or, if it is infeasible to return or destroy Protected Health Information,
       protections shall be extended to such information, in accordance with the termination provisions in this
       Article V.

5.02   Termination for Cause. Upon the State’s knowledge of a material breach of this Agreement by
       Business Associate, the State shall either (i) provide an opportunity for Business Associate to cure the
       breach or end the violation, and terminate this Agreement if Business Associate does not cure the
       breach or end the violation within the time agreed to by the Parties; or (ii) immediately terminate this
       Agreement if a cure is not possible. If neither termination nor cure is feasible, the State shall report the
       violation to the Secretary.

5.03   Effect of Termination.

       (a)    Return or Destruction of Protected Health Information. Except as provided in
              Section 5.03(b) of this Agreement, upon termination of this Agreement for any reason, Business
              Associate shall return or destroy (in accordance with the HHS-Approved Technology) all
              Protected Health Information received from the State, or created or received by Business
              Associate on behalf of the State. This provision shall apply to Protected Health Information that is
              in the possession of subcontractors or agents of Business Associate. Business Associate shall
              retain no copies of the Protected Health Information.

       (b)    Extension of Protections for Retained Protected Health Information. In the event that
              Business Associate determines that returning or destroying the Protected Health Information is
              infeasible, Business Associate shall provide to the State notification of the conditions that make
              return or destruction infeasible. Upon mutual agreement of the Parties that return or destruction
              of Protected Health Information is infeasible, Business Associate shall extend the protections of
              this Agreement to such Protected Health Information and limit further uses and disclosures of
              such Protected Health Information to those purposes that make the return or destruction
              infeasible, for so long as Business Associate maintains such Protected Health Information. The
              obligations of the Business Associate under this Agreement shall survive termination of this
              Agreement with respect to that Protected Health Information that Business Associate is unable to
              return or destroy.

                                                     ARTICLE VI
                                                    Miscellaneous

6.01   Regulatory References. A reference in this Agreement to a section in the Privacy Rule or the Security
       Rule means the section in the respective regulations, as amended and in effect at the relevant time.

                                                            RFP12-2260P, On-Site Employee Health Center, Page 85
6.02   Amendment. The Parties agree to take such action as is necessary to amend this Agreement from
       time to time in order for the State to comply with the requirements of the Privacy Rule, the Security Rule,
       HIPAA, and HITECH. All references to “C.F.R.” are to the Code of Federal Regulations as amended
       and in effect at the relevant time.

6.03   Survival. The respective rights and obligations of Business Associate under this Agreement shall
       survive the termination of this Agreement.

6.04   Interpretation. The parties specifically incorporate the provisions of this Agreement in the Contract,
       and this Agreement shall be deemed an integral part of the Contract. Except where the Agreement
       conflicts with the Contract, all other terms and conditions of the Contract remain unchanged. The
       parties agree that, if an inconsistency exists between the Contract and this Agreement, the provisions of
       this Agreement will control. Any ambiguity in this Agreement, or in determining controlling provisions,
       shall be resolved in favor of an interpretation that permits the State to comply with HIPAA and other
       federal, state and local laws and that provides the greatest privacy and security protections for PHI. In
       the event of an inconsistency between the provisions of this Agreement and mandatory provisions of
       HIPAA, as amended, HIPAA shall control. Where provisions of this Agreement are different from those
       under HIPAA, but are nonetheless permitted by HIPAA, the provisions of this Agreement shall control.

6.05   Complete Integration. This Agreement constitutes the entire agreement between the Parties with
       respect to HIPAA,HITECH, the Privacy Rule, and the Security Rule, and supersedes all prior
       negotiations, discussions, representations or proposals, whether oral or written, unless expressly
       incorporated herein, related to the subject matter of the Agreement. Unless expressly provided
       otherwise herein, this Agreement may not be modified unless in writing signed by the duly authorized
       representatives of the Parties.

6.06   Severability A declaration by any court, or any other binding legal source, that any provision of the
       contract is illegal and void shall not affect the legality and enforceability of any other provision of the
       contract, unless the provisions are mutually dependent.

6.07   No Third-Party Beneficiaries. Except as expressly provided for in the Privacy Rule, the Security Rule,
       and the Agreement, there are no third-party beneficiaries to this Agreement. Business Associate’s
       obligations, unless expressly noted herein, are only to the State.

6.08   Successors and Assigns. Business Associate shall not assign, transfer or subcontract any portion of
       the Agreement without the State’s express written consent, as required by section 18-4-141, MCA. This
       Agreement shall inure to the benefit of and be binding upon the successors and assigns of the State and
       Business Associate. This Agreement shall automatically be assigned to any entity to which the
       Agreement is properly assigned.

6.09   Confidentiality. Except as otherwise provided for in the Privacy Rule, the Security Rule, or this
       Agreement, no Party shall disclose the terms of this Agreement to any third party without the remaining
       Party’s written consent.

6.10   Counterparts. This Agreement may be executed in two or more counterparts, each of which may be
       deemed an original.

6.11   Applicable Laws. Business Associate represents and warrants that it shall comply with all applicable
       laws and regulatory requirements in the performance of this Agreement. The Parties agree to enter into
       good faith discussions aimed at amending this Agreement from time to time to comply with the
       requirements of HIPAA, the Privacy Rule, the Standards for Electronic Transactions at 45 C.F.R.
       Parts 160 and 162, the Security Rule, and related regulations and technical pronouncements, provided,
       however, that Business Associate shall also be responsible for complying with any state privacy or data

                                                             RFP12-2260P, On-Site Employee Health Center, Page 86
         security rules that are not contrary (within the meaning of 45 C.F.R. § 160.202) to HIPAA, the Privacy
         Rule, the Security Rule and related regulations and technical pronouncements and, to the extent
         applicable, that are more stringent (within the meaning of 45 C.F.R. §§ 160.202 and 160.203(b)) than a
         standard, requirement or implementation specification adopted under 45 C.F.R. Part 164.

6.12     Governing Law, Venue and Attorney Fees. This Agreement is governed by the laws of Montana. Any
         litigation concerning this Agreement must be brought in the First Judicial District in and for the County of
         Lewis and Clark, State of Montana, pursuant to Mont. Code Ann. § 18-4-401. Each party shall pay its
         own costs and attorney fees.

6.13     Applicability to Separate Covered Entities. If, and to the extent that, this Agreement applies to two or
         more separate “covered entities” (as defined in the Privacy Rule), the provisions of this Agreement
         regarding the permitted and required uses and disclosures (and limitations and conditions on such uses
         and disclosures) of Protected Health Information shall apply separately and independently to each such
         “covered entity”, except to the extent otherwise agreed to by the Parties.

6.14     Indemnification. Business Associate will indemnify, hold harmless and defend the State from and
         against any and all claims, losses, liabilities, costs and other expenses incurred as a result of, or arising
         directly or indirectly out of or in connection with: (i) any misrepresentation, breach of warranty or non-
         fulfillment of any undertaking on the part of Business Associate under this Agreement; and (ii) any
         claims, demands, awards, judgments, actions and proceedings made by any person or organization
         arising out of or in any way connected with Business Associate’s performance under this Agreement.

6.15     Assistance in Litigation or Administrative Proceedings. Business Associate shall make itself, and
         any subcontractor, employee or agent assisting Business Associate, available to the State, at no
         expense to the State, to testify as witnesses, or otherwise provide support, in the event of litigation or
         administrative proceedings being commenced against the State based on a claimed violation of HIPAA
         or other laws relating to confidentiality, privacy or security of PHI, except where Business Associate or
         such other person is named an adverse party.

6.16     Waiver. No change, waiver or discharge of any liability or obligation under this Agreement on any one
         or more occasions shall be deemed a waiver of performance of any continuing or other obligation, or
         shall prohibit enforcement of any obligation, on any other occasion.


IN WITNESS WHEREOF, the Parties have caused this Agreement to be executed by their duly authorized
representatives.

THE PARTIES ACKNOWLEDGE THAT THEY HAVE READ THIS AGREEMENT, UNDERSTAND IT, AND
AGREE TO BE BOUND BY ITS TERMS.

STATE OF MONTANA, DEPARTMENT                                   BUSINESS ASSOCIATE
OF ADMINISTRATION, HEALTH CARE                                 ________________________________
AND BENEFITS DIVISION                                          ________________________________


By:      _______________________________                               By:      __________________________


Name: _______________________________                                  Name: __________________________

Title:   _______________________________                               Title:   __________________________

Date: _______________________________                                  Date: __________________________

                                                              RFP12-2260P, On-Site Employee Health Center, Page 87

								
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