ADDENDUM #1 by 87K4dZ

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									                                                                                                  Form CPS.031



                               SOLICITATION ADDENDUM # 2

    DATE:                            6-05-07
    SOLICITATION NO:                 RFP # 529-07-0093
    DATE/TIME DUE:                   6-20-07 4:00 p.m. Central Time


    DESCRIPTION OF THE ADDENDUM:
    This Addendum is issued to provide the following information/clarification:
    Addendum 2, Item No. 1 – Proposal due date:

    RFP Section 1.3, Section 3.14.2 and Addendum #1, The response deadline is extended to Monday,
    June 20, 2007 at 4:00 p.m. Central Time.
    Addendum 2, Item No. 2 – Vendor Questions with HHSC Answers:
    1.      Does HHSC currently have a vendor(s) performing the services that are out for bid in RFP #520-
            07-0093?
            Answer: Yes
    2.      Who is the incumbent contractor?
            Answer: University of Florida, Institute for Child Health Policy (ICHP)
    3.      Were the optional extensions for the current contract exhausted?
            Answer: Yes
    4.      Who are the incumbent subcontractor(s) and what are their roles?
            Answer: None
    5.      What is the contract value for the current base (3-year) contract?
            Answer: The current base contract is $3.2 million.
    6.      Are there any major differences between the upcoming and current scope of work?
            Answer: No
    7.      Please identify the subcontractor(s) to the current EQRO Vendor.
            Answer: See question #4.
    8.      Define the fiscal year start date for HHSC.
            Answer: HHSC fiscal year start date is September 1.
    9.      What are the expectations and/or requirements regarding the EQRO Vendor’s presence in the
            state of Texas? Physical office location must be within the state? In a specific city?
            Answer: Not required to be in Texas or have an office in Austin. EQRO is required to be on-site
            as needed, minimally, monthly.
    10.     Please indicate the number of enrollees in each of the current managed programs in the
            Medicaid and CHIP programs.




            Answer:                                    Attached are the most recent enrollment figures



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    11.     How would HHSC characterize, in terms of satisfaction, its relationship with the current EQRO
            vendor?
            Answer: Very satisfied.
    12.     Of all the EQRO work completed in the past five years, what has been the most valuable to
            HHSC? What has been the least valuable?
            Answer: All work required of and performed by the EQRO is equally valuable to HHSC.
    13.     Has HHSC experienced any challenges, disappointments, etc. over the last contract period? If
            so, please specify.
            Answer: No
    14.     What is the approximate budget for this contract?
            Answer: Not yet determined, however it is not expected to be less than the current contract cost.
    15.     Can the HHSC provide the names of the organizations that submitted Bidders questions?
            Answer: As a courtesy to all vendors and potential subcontractors, attached is the list of
            responders that submitted questions for the RFP.



              Microsoft Word
                 Document

    16.     What is the dollar amount of the proposed contract?
            Answer: See answer to question #14.
    17.     What is the dollar amount of the previous contract?
            Answer: See answer to question #5.
    18.     With the extent of the scope of work for this RFP, and the limited page count, will HHSC consider
            increasing the page limit to 125 pages?
            Answer: No. However, examples of work, templates, and other supporting documentation
            requested by HHSC can be attachments to the proposal and will not count in the page limitation.
    19.     Does this contract require the contractor to have an office in the State of Texas?
            Answer: No. However if other considerations are equal, HHSC will give preference to a vendor
            with a principal place of business in the State of Texas, or a vendor who will manage the contract
            from an office in Texas
    20.     Who is the current prime contractor, and are they utilizing HUB subcontractors in the
            performance of the work? If so, who?
            Answer: See answer to question #2 and #4.
    21.     At the time the answers to questions are posted, will HHSC make available the list of those
            entities that posed questions?
            Answer: See response to question #15
    22.     Because of the 75-page limit, can the report samples and templates be provided as attachments
            to the Business Proposal?
            Answer: Yes. Examples of work, templates, and other supporting documentation requested by
            HHSC can be attachments to the proposal and will not count in the page limitation.
    23.     When does HHSC anticipate making the contract award?
            Answer: Prior to contract start date of October 1, 2007.
    24.     Please provide, if possible, a current list of MCOs participating in each of the Texas Medicaid
            and CHIP managed care programs?
            Answer: See the spreadsheets provided in question #10. This contains all MCOs and
            programs.

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    25.     Section 1.3, Proposals Due noted as June 12, 2007. Section 3.14.2, page 47 notes “copies of
            the proposal…no later than 4:00 PM on June 20, 2007.” Is this in conflict with the originally
            stated due date or is it intended to be an extended due date for the copies of the proposal?
            Please clarify if the electronic copy, signed copy, and six other copies are all due on June 12,
            2007.
            Answer: See Addendum 2, Item No. 1.
    26.     Section 2.1, Go-live Operations SFY 2008 item d. references survey draft methodologies and
            tools submitted but there is no date for submission of survey report. Is there a survey report due
            in fiscal 2008?
            Answer: Appendix A SFY 2008 Expenses Worksheet identifies CAHPS surveys to be priced. In
            prior fiscal years, surveys are conducted between May and July with final reports being due
            approximately 45-60 days later. Actual due dates will be negotiated by HHSC on the final
            business plan with the contracted vendor.
    27.     Section 2.1. - What rate analysis activities is the Vendor responsible for?
            Answer: High level rate analysis-related activities include: financial reporting reconciliation, data
            certification and validation; conducting Prospective Risk Adjustment review, analysis and
            reporting; create and provide risk ratios/table, lag tables, and fiscal year end data sets to HHSC
            for STAR, STAR+PLUS, CHIP, NorthSTAR, and CHIP Dental; analyze 3-year data set and
            develop Texas-specific weights; and conduct clinical risk group (CRP) assignment and chronic
            illness and disability payment system (CDPS) analysis.
    28.     Section 2.1, The Respondent must include a proposed workplan that describes how they will
            meet the timeline, including the milestones and deliverables identified in this section. Since
            there is a 75-page limit, can the Vendor include the workplan as an appendix in Section 6 -
            Appendices?
            Answer: Yes
    29.     Section 2.1, Is the Annual HEDIS Record Review part of a Validation of Performance Measures
            performed by the EQRO?
            Answer: Record review is included in data validation processes and HEDIS performance
            measure analyses.
    30.     Section 2.1, How many performance measures will the EQRO be required to calculate? For non-
            HEDIS measures (if applicable) will file specifications be provided to the EQRO?
            Answer: Please see Chapter 10 in the Uniform Managed Care Manual for the latest dashboard
            for STAR, CHIP, and STAR+PLUS.
            http://www.hhsc.state.tx.us/medicaid/UMCM/default.html
    31.     Section 2.1, What type of data will be available for the calculation of performance measures?
            Answer: The EQRO is required to warehouse all FFS, PCCM, Encounter, Claims, Member, and
            Provider data files to support performance measure calculations.
    32.     Section 2.1, Are the Parallel tests on specific HEDIS measures between old and new EQRO
            vendors to confirm that the new EQRO’s source code creates the same results as the old
            EQRO’s source code?
            Answer: Yes
    33.     Section 2.2, Under Contract Scope, ICM. What is the implementation date for the ICM product in
            Tarrant/Dallas?
            Answer: Not known at this time.
    34.     Section 2.2 - Contract Scope. Can HHSC specify the number of entities to be evaluated for each
            managed care program to be supported by the EQRO?
            Answer: See the spreadsheets provided under question #10 for a current list of all participating
            health plans, programs, and service areas.
    35.     Section 2.2 Texas Access Reform plus Long Term Care appears to be provided to “certain” ABD
            enrollees in specific geographic locations. Can you describe the population in more detail as well
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            as the geographic locations?
            Answer:     Please visit the HHSC website for the latest information on STAR+PLUS.
            http://www.hhsc.state.tx.us/starplus/starplus.htm
    36.     Section 2.2 Is it a correct assumption that Foster Care is currently provided by one MCO that
            provides foster care services to all areas of the State?
            Answer: No. Currently, Foster Care is administered under Medicaid fee-for-service. However,
            this is expected to change during the term of the new contract. See also the answer to question
            #92. #100 and #101.
    37.     Section 2.2 How many contracts does HHSC have for each managed care program? Please
            provide a listing of contractors and their respective counties of operation.
            Answer: That information can be found in the spreadsheets provided under question #10.
    38.     Section 2.2, CHIP Perinate is described on p. 16 and referenced in line 1 of the EQRO Activities
            table on p. 34. There are no other specific references to “Perinate”. Will any of the EQRO tasks
            require CHIP Perinate to be sampled or otherwise studies “separately”?
            Answer: Not at this time.
    39.     Section 2.2, Who is the dental benefit administrator? Will the EQRO contractor perform the
            same scope of review for the dental administrator as for the medical HMOs?
            Answer: Delta Dental. The EQRO contractor will evaluate some aspects of the dental vendor’s
            activities but that is not fully determined outside of the rate analysis activities.
    40.     Section 2.2.2.3—the EQRO Vendor must have clinical evaluation competence or direct access
            to such competence in various medical areas including pediatrics, long-term care, acute care,
            mental health, and dental care. What are the requirements for the medical professionals who
            would provide such competence? Must they be licensed in the state of Texas or may they hold a
            valid license from any state?
            Answer: All professional staff must be currently licensed in the State in which they practice or
            receive their license. Staffs are not required to be license in Texas.
    41.     Section 2.2.3 Can you share the number of Performance Improvement Projects and
            Performance Measures to be validated for each managed care entity on an annual basis?
            Answer: The number of each may change from year to year. The question relates to two
            different areas of business: 1) Performance Improvement Projects (PIPs)– traditionally
            submitted annually to the EQRO; and 2) Performance Measures (contractual and dashboard
            measures).
            Performance Goals replace PIPs under the new MCO contracts that went into effect 9-1-06.
            HHSC establishes Performance Goals annually. The EQRO is expected to support HHSC as
            needed in review of the methodologies and outcomes of each of the Performance Goals.
            Currently all MCOs in STAR, CHIP, and STAR+PLUS will have 3 overarching goals for each
            program. The MCOs must submit and negotiate a minimum of 2 sub-goals for each overarching
            goal. Sub-goals are targeted for a particular service area or can be implemented in all service
            areas for a health plan/program combination. Therefore the number varies from one year to the
            next.
            Performance measures contained in the contract and the performance dashboard are also
            developed annually.
            See Chapter 10 of the Uniform Managed Care Manual.
            http://www.hhsc.state.tx.us/medicaid/UMCM/default.html
    42.     Section 2.2.3, What is the difference between certification and validation of the claims/encounter
            data?
            Answer: Texas uses the CMS protocol for validation, including medical record review. The data
            certification process implemented by the State considers the CMS validation protocol but also
            includes elements defined by the state, such as % data accuracy, % completeness of required
            fields, and % match/comparison for encounter data submitted by a health plan as compared to

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            their self-reported financial data.

    43.     Section 2.2.4 Are all of the managed care plans on the same cycle for the EQR review process?
            Answer: All MCOs within the same program (for example: STAR, CHIP, STAR+PLUS) are on
            the same cycle. Cycles vary somewhat between programs.
    44.     Section 2.2.4, Medical record reviews for Validation of Performance Measures, Encounter Data
            Validation, Focus Studies, and EPSDT (THSteps) Medical Screening Encounter Data Validation
            could vary widely depending on the strata determined appropriate for various studies as well as
            Focus Study topics. Can HHSC recommend a “ball park” number of records the Vendor should
            assume for any or all of these tasks to be abstracted on an annual basis for pricing purposes?
            Answer: Attached is the current base sampling strategy and numbers for managed care health
            plans participating in Medicaid and CHIP for the data validation efforts conducted in Calendar
            Year 2006 on SFY 2005 data. HHSC has not established specific criteria for Focused Studies or
            the proposed EPSDT Medical Screening Encounter Data Validation. The latter two items will be
            negotiated on an individual basis if and when needed.




          For the hybrid Performance Measures (Poor HbA1c Control, LDL controlled, and High Blood
          Pressure controlled), the EQRO follows the record sampling protocols established by HEDIS.
          These can be found in the HEDIS 2006 Technical Specifications readily available from the
          National Committee for Quality Assurance (NCQA).

    45.     Section 2.4—this section states that the EQRO will pay for all reasonable costs incurred by
            HHSC to perform an examination, review or audit of the EQRO Vendor’s books pertinent to the
            EQRO contract. Please provide additional information regarding frequency, associated travel
            costs, etc., associated with these audits or reviews.
            Answer: The most recent audit that the EQRO had to pay for was the EDP SFY 2005
            conducted in 2006. The total cost was $179,334. This dollar amount included all costs incurred
            by the contracted consulting firm performing the audit. Audits conducted against the EQRO
            have historically been on an annual basis.
    46.     Section 2.2.4.1.1—the RFP states: For Medicaid, HHSC has adopted a simplified Quality
            Improvement Plan (QIP) framework. Please explain and provide more detail about that
            framework.
            Answer: The annual summary template for STAR, STAR+PLUS and CHIP is attached. The
            process changed in SFY 2007 because of implementation of new health plans with no prior
            business in Texas. The summary template attached, is currently being reviewed for changes
            that need to be made as a result of the performance-based contracting that went into effect 9-1-
            06. A modified template will be available from HHSC later this year. The MCOs are not
            expected to use this template until April-June 2008 when the reports covering SFY 2007 MCO
            activities are traditionally due. In addition to the annual summary, the EQRO will provide all
            health plans with an Administrative Interview Guide and Questionnaire so that responses can be
            timed to coincide with the receipt of the annual QAPI summaries. Both of these documents are
            reviewed by the EQRO on an annual basis. HHSC and the EQRO determine which health plans
            will require on-site interviews to follow-up on their responses or will be handled via conference
            call. The EQRO is responsible for providing HHSC with annual summary reports on the
            programs’ QAPI activities and Administrative Questionnaires and interview results.




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    47.     Section 2.2.4.1.1 Can you share additional detail regarding the HHSC simplified Quality
            Improvement Plan framework?
            Answer: See question #46.
    48.     Section 2.2.4.1.1, This section refers to 1) a comprehensive quality assurance and 2)
            performance improvement plans. The Deliverables Section 2.2.4.1.6 on p. 29 refers to QIP
            and/or QAPI evaluations. Would activities consistent with the two CMS protocols Monitoring
            Medicaid Managed Care Organizations and Validation of Performance Improvement Projects be
            close approximations of HHSC’s expectations for these tasks?
            Answer: See answer to question #46.
    49.     Section 2.2.4.1.1, requires the EQRO vendor to evaluate the MCO Quality Assurance and
            Performance Improvement Plans. We cannot find where the state has required the EQRO
            vendor to perform monitoring of Medicaid and Managed Care Organizations and Prepaid
            Inpatient Health Plans to determine compliance with Medicaid Managed Care Regulations. Does
            the state perform this task with its state staff? Does the state anticipate forwarding the results to
            the EQRO vendor for incorporation into the External Quality Review Technical Report?
            Answer: See answer to question #46.
    50.     Section 2.2.4.1.2 Do all State-defined Performance Measures included in MCO contracts require
            validation?
            Answer: No
    51.     Section 2.2.4.1.2, Does HHSC require validation of MCO performance measures which are
            independently certified by a HEDIS auditor?
            Answer: Yes. The EQRO is the single entity that produces the official annual HEDIS
            performance measure results used by HHSC. The MCOs are not required to self-report results
            for HEDIS performance indicators.
    52.     Section 2.2.4.1.2, Are the current performance measures all HEDIS measures?
            Answer: No.
    53.     Section 2.2.4.1.2, Are all the MCOs undergoing a HEDIS Compliance Audit or Validation of
            Performance Measures?
            Answer: HHSC does not require the MCOs to undergo HEDIS Compliance Audits. The EQRO
            is responsible to validate HEDIS performance indicators that are contained on the performance
            indicator dashboard.
    54.     Sections 2.2.4.1.2, Does HHSC require the EQRO to perform HEDIS Compliance Audits or
            Validation of Performance Measures?
            Answer: See response to question #53.
    55.     Section 2.2.4.1.2, What is the anticipated number of MCOs participating in the performance
            measure activities for each of the current managed programs supported by the EQRO?
            Answer: Please see the spreadsheets provided in response to questions #10. This carries a
            breakdown of health plans and programs. HHSC expects all health plans contracted for a
            particular program to be measured according to the performance standards and indicators
            previously identified for the program.
    56.     Section 2.2.4.1.2, For deliverables titled “Review of performance based HEDIS and CAHPS
            measures specified for all MCOs within specified programs” and “Results of performance
            measure ranking for MCOs”, please confirm that the requirement is for a Statewide Aggregate
            report.
            Answer: The assumption is not correct. HHSC expects the EQRO to review and provide
            deliverables based on the individual health plan participation in a particular program. The reports
            are to compare individual health plan level of achievement to state standards, state average for
            of all health plans in the program, as well as comparison to national benchmarks and any other
            standards incorporated by HHSC.



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    57.     Section 2.2.4.1.2, On page, HHSC describes the scope of work as Performance Measures and
            Performance Improvement Goals and Objectives. Does HHSC anticipate the EQRO vendor will
            actually validate performance improvement projects (PIPs) for each MCO, and if so, how many
            PIPs will be validated for each MCO?
            Answer: PIPs are no longer required from the MCOs. Please see response to question #41.
    58.     Section 2.2.4.1.2, How many PIPs are currently being completed by each managed care
            program entity?
            Answer: Please see response to question #41 and #46.
    59.     Section 2.2.4.1.2, What are the specific deliverables associated with the validation of PIPs?
            Answer: PIPs are no longer required from the MCOs. Please see response to questions #41
            and #46.
    60.     Section 2.2.4.1.2, Are the PIPs submitted for validation annually using the CMS protocols as a
            guide?
            Answer: PIPs are no longer required from the MCOs. Please see response to questions #41
            and #46.
    61.     Section 2.2.4.1.2, Is a PIP template for all managed care programs currently be used for all
            submissions?
            Answer: PIPs are no longer required from the MCOs. Please see response to questions #41
            and #46.

    62.     Section 2.2.4.1.3 - ADTP. Is the procurement library available electronically?
            Answer: The Procurement Library is located on the HHSC website.
    63.     Section 2.2.4.1.3 - ADTP. Are hardware and software specifications included in the procurement
            library or, if not, can HHSC provide detailed specifications for hardware and software?
            Answer: HHSC is not specifying hardware and software requirements. It is the responsibility of
            the vendor to provide whatever environment is needed to house all required data, perform
            necessary analytics, report, and fulfill the requirements of this contract. This RFP does not
            include a take over or transfer of the existing EQRP ADTP.
    64.     Section 2.2.4.1.3 Regarding the Analysis and Data Transfer Platform (ADTP), will the new
            vendor be able to build from any existing hardware, software and data currently in place?
            Answer: No.
    65.     Section 2.2.4.1.3 - What is the format for the legacy encounter data and historical 837
            transaction data (from TED) that will be used to populate the ADTP?
            Answer: Please see the attached file layout for the TMHP to ICHP extract for data beginning
            dates of service 9-1-07. Please refer to the ICHP JIP in the procurement library for the file
            layouts for data received by the current EQRO prior to 9-1-07.




    66.     Section 2.2.4.1.3 - Regarding the Texas Medicaid & Healthcare Partner (TED) encounter data,
            what connectivity would the new vendor need? How is the cost reimbursed?
            Answer: The current EQRO connects to all FTP locations and TexMedCentral via a dedicated
            secure T1 line installed and paid for by HHSC.
    67.     Section 2.2.4.1.3 - Will the encounter data from TED data be in HIPAA transaction format?
            Answer: No. See the extract layout in response to Question #65.
    68.     Section 2.2.4.1.3 - What type of data certification is required?
            Answer: State defined in addition to requirements identified by CMS for data validation. That
            information will be provided to the contractor at a later date. See additional information under
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          question #42.


    69.   Section 2.2.4.1.3 - Are there timelines for the disaster recovery plan? How fast must the system
          be operational after a disaster?
          Answer: HHSC expects the EQRO system to be fully operational after a disaster with 5
          business days.
    70.   Section 2.2.4.1.3 - What does “federal-level certification of encounter data” entail, for purposes of
          this contract?
          Answer: See answers to questions #42 and #68.
    71.   Section 2.2.4.1.3 - Will the methods of transmission and data transfer to the contractor be the
          same as is shown in the Joint Interface Plan provided in the procurement library?
          Answer: Not all data will be transferred as shown in the JIP. At the time the new EQRO
          contract is in place, HHSC expects to discontinue direct submission of encounter data from the
          managed care health plans to the EQRO with the TMHP Encounter Data Warehouse being the
          single source for MCO encounter data. Please see the attached document (table) identifying
          changes to current files received by the EQRO and method of transmission.




    72.   Section 2.2.4.1.3 - Is encryption utilized for the data, and, if so, what encryption methodology is
          utilized?
          Answer: Encryption is not needed in the monthly routine data file handling as they are currently
          transmitted via dedicated T1 line access to HHSC servers. Data sets that may be generated on
          request that contain personal health or other protected information are encrypted following CMS
          guidelines. Please use the link below for additional information.
          http://www.cms.hhs.gov/hipaageninfo/01_overview.asp

    73.   Section 2.2.4.1.3, Will the ADTP data extract received from the TMHP Encounter Data (TED)
          warehouse contain the entire 837 record or will it be an abbreviated format as was received by
          the EQRO Vendor prior to TED implementation?
          Answer: Abbreviated format. See response to Question #65.
    74.   Section 2.2.4.1.3, Can HHSC provide reference materials for federal level certification of
          encounter data?
          Answer: See answers to questions #42 and #68.
    75.   Section 2.2.4.1.3, Could you please clarify the relationship between the Texas Medicaid &
          Healthcare Partnership (TMHP) and the EQRO vendor in regards to the Analysis and Data
          Transfer Platform (ADTP)? Does TMHP maintain and house TED? Will TMHP supply data files
          from TED to the EQRO vender or will the EQRO vender have direct access to TED?
          Answer: The EQRO draws data from multiple sources, including TED. TMHP maintains and
          houses TED. TMHP is expected to provide both historical encounter and claims data files and
          new monthly data files produced from the 837 transactions received from the health plans. It is
          not expected that the EQRO will have direct access to TED.
    76.   Section 2.2.4.1.3, It appears that the ADTP will serve as the mechanism to utilize the TMHP
          Encounter Data warehouse (TED). On whose servers will the TED warehouse reside?
          Answer: TED is a product of and the responsibility of TMHP. The EQRO will only receive data
          produced by TMHP from data stored on TED. The EQRO will then load the data on their own
          platform (the ADTP) to use for all EQRO functions.
    77.   Section 2.2.4.1.3, The RFP says that in addition to file received from TED; the EQRO will be
          receiving other data sources (e.g. Medicaid FFS, PCCM, ICM claims, etc.). What will be the
          approximate monthly size of these transfers? What are the State’s standards as to the
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            warehousing of these data? What is the mechanism for transferring these files? Will the State
            require direct access to these stored files?
            Answer: See information provided in response to question # 71.
    78.     Section 2.2.4.1.3, How many users from the State would require access to the ADTP and at the
            same time?
            Answer: No external users are expected for the ADTP.
    79.     Section 2.2.4.1.3, Would the State require 24/7 access to the ADTP?
            Answer: No
    80.     Section 2.2.4.1.3, What are the specific analytic functions required of the ADTP itself?
            Answer: See answer to question #63.
    81.     Section 2.2.4.1.3, What kinds of security would the state require for this connection?
            Answer: Not applicable.
    82.     Section 2.2.4.1.3, How many hours monthly should be allocated to ad hoc analysis of these
            data?
            Answer: Unknown. However the EQRO should expect up to 6 ad hoc requests during any
            contract year as identified in the cost proposals. Time will vary depending on complexity of the
            queries needed. Costs associated with ad hoc report production should be based on the
            vendors experience with previous EQRO work. HHSC expects the vendor to propose a
            maximum expected expenditure for ad hoc reports on an annual basis with each report being
            negotiated as to scope, effort, and actual cost at the time the request is made.
    83.     Section 2.2.4.1.4 For purposes of medical record review, do any of the MCOs use or have an
            Electronic Health Record system?
            Answer: Not applicable to this contract. Standardized review process requires hard copies of
            “documentation” be submitted for validation.
    84.     Section 2.2.4.1.4 Is the expectation for medical chart review to occur in a centralized location, or
            in each facility/provider office?
            Answer: Can be centralized and mailed to the site of choice designated by the EQRO for
            proper control.
    85.     Section 2.2.4.1.4, Have providers contracted with MCOs historically been reimbursed for copying
            and mailing costs for medical records reviews? (Often provider contracts with MCOs require
            them to provide medical record copies and access to medical records without charge.)
            Answer: Yes.
    86.     Section 2.2.4.1.4, Does HHSC have any preferences regarding onsite review of medical records
            vs. copies?
            Answer: Copies are required since this approach is also used to identify potential fraud and
            abuse.
    87.     Section 2.2.4.1.5—what is the anticipated sample size for each of the member surveys, including
            the new surveys that are being incorporated into the scope of work beginning SFY 2009?
            Answer: The member survey sample sizes are expected to be calculated based a statistically
            valid sampling methodology are based on the membership for a specific health plan/program
            combination. Please see the membership and enrollment information previously provided under
            Question #10.
    88.     Section 2.2.4.1.5 - Surveys. Could HHSC please provide a general idea of the number of
            responses expected for each of the surveys specified in the Scope of Work?
            Answer: Please access the most recent Survey reports posted on the HHSC website:
            http://www.hhsc.state.tx.us/about_hhsc/reports/search/search_dateorder.asp



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    89.   Section 2.2.4.15 - Has your previous CAHPS data been submitted to the National CAHPS
          Benchmarking Database?
          Answer: No
    90.   Section 2.2.4.1.5 - How many survey instruments are used to conduct the current survey
          process? Will the selected vendor have access to previously used survey instruments?
          Answer: The number and type of annual surveys have been identified in Appendix A cost
          proposals. Since the survey tools are proprietary to the current contractor, Vendors responding
          to this RFP are expected to have survey tools and processes in place that can be proposed to
          HHSC for modification and implementation.
    91.   Section 2.2.4.1.5 Are current surveys conducted for plans at the county level or on a statewide
          basis? If current surveys are conducted at the county level, does HHSC want to continue this or
          is HHSC open to having surveys conducted on a statewide basis?
          Answer: Statewide, by health plan participating in a specific program.
    92.   Section 2.2.4.1.5 When did enrollment begin in STAR-Foster Care? How many contractors are
          there for this program? What is the enrollment level?
          Answer: The actual start-up date for Foster Care is not yet determined. There is one contractor
          for this line of business and it will serve approximately 38,000 – 40,000 children statewide.
    93.   Section 2.2.4.1.5, STAR/PCCM biennial surveys are stated to begin in SFY 2008 with CHIP
          following in SFY 2009. Section 6.1.3, page 63 provides for costing out CAHPS for CHIP in SFY
          2008.Please clarify which survey will be required in SFY 2008.
          Answer: The clarification is that the CHIP survey is administered in the field sometime in SFY
          2009 but the sample is drawn against member participation with the health plan in the prior fiscal
          year (hence SFY 2008 activity).
    94.   Section 2.2.4.1.5, For the surveys the RFP indicates, "The EQRO Vendor will work cooperatively
          with HHSC to establish a schedule, develop the methodologies and strategies needed to
          implement the above surveys.”          For budget development purposes could you clarify
          requirements as follows:
           a. Anticipated length of non-CAHPS surveys?
           b. Data collection method expectations (mail, phone, combination of mail and phone)?
           c. Sample size expectations?
           d. Do your data files contain reliable indicators for language preference (Spanish)?
           e. Will data analysis be needed at the program level or for each Managed Care Organizations
           (as applicable) with the program?
           f. Historical response rates for these surveys?
          Answer:
           a. Anticipated length of non-CAHPS surveys? No longer than 30-35 minutes.
           b. Data collection method expectations (mail, phone, combination of mail and phone)?
           Computer Assisted Telephone Interviews is the current process accepted by HHSC.
           c. Sample size expectations? Dependent on the member population sizes for each health plan
           and program being surveyed.
           d. Do your data files contain reliable indicators for language preference (Spanish)? The state
           currently only requires English and Spanish.
           e. Will data analysis be needed at the program level or for each Managed Care Organizations
           (as applicable) with the program? Yes
           f. Historical response rates for these surveys? Not applicable because the population to be
           sample may have changed situations. Over sampling is required to reach target population
           numbers.
    95.   Section 2.2.4.1.5, Medicaid CAHPS Surveys administered in SFY 2008 are listed as biennial
          (STAR+PLUS as annual) and CHIP Surveys administered in SFY 2009 as biennial; however,
          Schedule 3-A on p. 63 references CHIP surveys for SFY 2008. Should Schedule 3-A be
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            changed to Medicaid CAHPS? Also, Schedule 3-B on p. 67 lists STAR and STAR+PLUS in SFY
            09 and SFY 11 and CHIP in SFY 10 and SFY 12. Should STAR be SFY 08 and 10,
            STAR+PLUS SFY 09, 10, 11, and 12; and CHIP in SFY 08 and 10? Please clarify.
            Answer: The chart in Section 2.2.4.1.5 Surveys is corrected as listed below. STAR+PLUS
            surveys should be priced for each year of the contract since they are an annual occurrence.

            Medicaid CAHPS Surveys administered in SFY 2009:
                 STAR biennial survey of adult enrollee activity for SFY 2008;
                 STAR biennial survey of child enrollee activity for SFY 2008;
                 PCCM biennial survey of adult enrollee activity for SFY2008;
                 PCCM biennial survey of child enrollees activity for SFY 2008; and
                 STAR+PLUS annual survey of adult enrollee activity for SFY 2008.

            CHIP Surveys administered in SFY 2009 2008:
               CHIP (including Dental) biennial survey for Enrollee activity for SFY2007;
               CHIP (including Dental) biennial survey for Disenrollee activity for SFY 2007; and
               CHIP (including Dental) biennial Caregiver CAHPS survey for member activity for SFY
                2007.


    96.     Section 2.2.4.1.5, Scope of work includes STAR-Foster Care, Integrated Care Management,
            and CHIP – Premium Assistance surveys. These do not appear to be specifically references in
            Schedules 3-A and 3-B. Should they be added or incorporated into existing cells? Please clarify.
            Answer: No. The references to these surveys were for informational purposes only. They are
            not currently in the scope of work expected for the EQRO.
    97.     Section 2.2.4.1.5, Per the description on page 26 (2.2.4.1.5), HHSC requires entities to have
            experience administering surveys in English and Spanish. For the anticipated survey process, is
            a “primary language spoken” field available in the State’s eligibility or demographic data that
            could be used to identify those members requiring a Spanish version of the survey?
            Answer: The current process used by the EQRO does not rely on any specific data field that
            may or may not be populated appropriately since it includes the following:
            Written letters are sent to all potential participants in the sample explaining the purpose of the
            study and requesting their participation. The letter is sent in English and Spanish.
            The follow up telephone surveys conducted include Spanish speaking staff in the event that
            client cannot speak English.
    98.     Section 2.2.4.1.5, Has HHSC, through its EQRO or other contracted activities, administered
            CAHPS surveys to the STAR, PCCM, and STAR+PLUS populations? If so, will the survey
            instruments and previous reports be made available to the EQRO prior to the initiation of the
            survey activities?
            Answer: The current EQRO administers surveys for all operational Medicaid and CHIP
            managed care programs; however, the survey tools they use are proprietary to the EQRO and
            cannot be shared.
    99.     Section 2.2.4.1.5, What is the anticipated number of plans participating in the survey activities for
            each of the current managed programs supported by the EQRO? In other words, how many
            STAR, PCCM, STAR+PLUS, and CHIP plans will be participating in surveys during each
            contract year?
            Answer: See the spreadsheets provided under question #10 for a current list of all participating
            health plans, programs, and service areas.
    100. Section 2.2.4.1.5, For Star-Foster Care, ICM, and CHIP-Premium Assistance, are there multiple
         managed care entities participating in these programs that will need to be evaluated separately
         during the survey administration process? If so, what is the number of entities requiring
         evaluation for each of these programs?

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            Answer: The references to these surveys were for informational purposes only. They are not
            currently in the scope of work expected for the EQRO.

    101. Section 2.2.4.1.5, For the STAR-Foster one-time provider satisfaction survey, what is the
         estimated number of providers that will be eligible for inclusion in the survey?
         Answer: The references to the Foster Care survey is for informational purposes only. It is not
         currently in the scope of work expected for the EQRO.
    102. Section 2.2.4.1.5, Please confirm that the only provider satisfaction survey included in the scope
         of work is the STAR-Foster one-time provider satisfaction survey.
         Answer: This is not an accurate statement. Please see the cost proposal sheets for the
         expected scope of work relating to surveys.
    103. Section 2.2.4.1.6 Can you elaborate more regarding administrative interviews listed under MCO
         QAPI, QIP, and Performance Goals?
         Answer: At a very high level, Administrative Interviews and possible on-site reviews are part of
         the annual QAPI review for all MCOs. The EQRO is responsible for administering a
         comprehensive questionnaire document sent to and completed by the MCOs. The EQRO
         reviews the responses and compares them to the Quality Assurance and Performance
         Improvement annual summaries submitted by the MCOs. The EQRO is expected to conduct on-
         site interviews with the MCOs as needed. Other interviews may be conducted via conference
         calls. During their on-site visits, the EQRO may be requested by HHSC to conduct other reviews
         and gather information relating to processes implemented by the MCO relative to their
         Performance Goals and provide feedback to HHSC.
    104. Section 2.2.4.1.6, Deliverables. There are no weekly reports noted as deliverables, but Section
         2.2.4.2, page 34, and Section 2.2.4.2, page 37, references weekly status/deliverables reports.
         Also there is a reference here to monthly “contract management documentation” without specific
         definition. Are weekly status reports required? Is “contract management documentation” to be
         defined as those items listed for monthly reporting on pages 37 and 38 under “Meeting
         Operational and Financial Contract Requirements?
         Answer: Weekly deliverable report status updates are required and should be priced in with the
         monthly meeting costs. Yes, “contract management documentation” is under “Meeting
         Operational and Financial Contract Requirements”.
    105. Section 2.2.4.1.6 What is the desired format of the reports? If an electronic format is required,
         what format is desired?
         Answer: Format will be dependent on the report being produced. HHSC expects the vendor to
         propose a format, based on prior experience. HHSC and the selected vendor will negotiate the
         final accepted format for each report.
    106. Section 2.2.4.1.6 What is the desired method of providing the reports? For example, is there an
         expectation that the reports will be attached to e-mail, available via secure Web site, or other
         means?
         Answer: Depending on the size of the resulting report, most reports are accepted via e-mail
         unless they contain member or provider-specific sensitive information. Those documents that
         are too large for HHSC to receive are sent on CDs via overnight mail. Member or provider
         sensitive information reports are encrypted and can be sent via email with passwords sent
         separately.




    107. Section 2.2.4.1.6 What is the volume of ad hoc reporting requests that the contractor should
         expect to receive per year?
         Answer: Unknown. However, for purposes of pricing, the EQRO should expect up to 6 ad hoc
         requests during any contract year as identified in the cost proposals. Time will vary depending
         on complexity of the queries needed. Costs associated with ad hoc report production should be
         based on the vendors experience with previous EQRO work. HHSC expects the vendor to
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            propose a maximum expected expenditure for ad hoc reports on an annual basis with each
            report being negotiated as to scope, effort, and actual cost at the time the request is made.


    108. Section 2.2.4.1.6 - Deliverables (Ad Hoc Reports). Could HHSC please provide examples of past
         ad hoc report requests or perhaps an indication of the types of reports that may be requested?
         Answer: HHSC will not provide examples as these change based on need. Vendors should
         respond based on their experience with ad hoc reporting.
    109. Section 2.2.4.1.7 - Focused Studies. Since the cost of conducting focused studies can vary
         greatly depending on the subject and methodology, can HHSC provide some guidance on the
         focused study section so that responses can be evaluated between prospective vendors?
         Answer: HHSC expects the vendor to propose a maximum expected expenditure for focused
         studies based on prior experience. This annual budged amount will be considered as each
         focused study request is negotiated as to scope, effort, and actual cost at the time the request is
         made. This will determine the actual number of studies that can be completed.
    110. Section 2.2.4.1.7 - Are specific topics already under consideration for Focused Quality Studies?
         Answer: No

    111. Section 2.2.4.1.7 - What focused studies have been conducted in the past?
         Answer: A response from HHSC is not relevant as previous focused studies are not an
         indicator of what might be needed by HHSC in the future. Please see additional information
         under response to question #109.
    112. Section 2.2.4.1.7, The Focus Studies scope (topic, programs to be included, level of analysis)
         substantially influence the number of medical records that need to be abstracted. For pricing
         purposes, can HHSC recommend an estimated number of records to be abstracted for each
         focus study?
         Answer: See answer to question #109
    113. Section 2.2.4.1.7, Does the state anticipate any major additions or changes to the program (e.g.,
         a new participating MCO) during the course of the contract? The data collection method for
         focused studies may vary according to completeness and availability of data, and the study
         design. Does the state require either of the two focused studies to include medical record
         review? If medical record review is required, will the MCOs conduct the abstraction? If the
         contractor is expected to complete the abstraction for medical record review, will the MCOs be
         responsible for obtaining the medical records?
         Answer: See answer to question #109. Any medical record documentation required for a
         focused study will be at the cost of the EQRO.
    114. Section 2.2.4.1.8 - Annual Encounter Data Certification. Can HHSC provide additional
         information about the nature of certification? For example, has the current vendor calculated a
         score for entities to indicate confidence in the accuracy and completeness of encounter data, or
         some other method?
         Answer: The data certification process implemented by the State considers the CMS validation
         protocol but also includes elements defined by the state, such as % data accuracy, %
         completeness of required fields, and % match/comparison for encounter data submitted by a
         health plan as compared to their self-reported financial data. The current EQRO does calculate a
         health plan’s compliance with the benchmarks established by the State.
    115. Section 2.2.4.1.8, Some states may have different degrees or standards for certification. Does
         the state have specific standards for certification? Can the state provide an example of reports
         for encounter data certification?




            Answer: See the enclosed.

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    116. Section 2.2.4.1.9, Some Medicaid programs have a specific objective when describing validation
         of encounter data. For example, one state Medicaid program just validates billing data for
         newborn deliveries. Is there a specific type of encounter data that the state is interested in
         validating? Can the state provide an example of a report conducted on the validation of
         encounter data?
         Answer: Currently, HHSC’s focus is on validating primary care physician encounter data.
         However, this can vary in the future. Attached is a copy of the table of contents from one of the
         data validation reports produced by the current EQRO. This should give the vendor an idea of
         the current accepted content.




    117. Section 2.2.4.1.11—please confirm: the EQRO vendor will lead one Quality Forum per year?
         Answer: Confirmed.


    118. Section 2.2.4.1.11 - For the one major annual conference, have continuing education credits
         been offered to attendees? And, what is the estimated attendance for this event?
         Answer: HHSC has not associated continuing educational credits to any of our forums. Since
         the MCOs are the targeted audience, the attendance varies for each event. The recent April
         2007 Quality Forum had approximately 90 attendees, inclusive of MCO and State staff.
    119. Section 2.2.4.1.11 - Can you provide some examples of the type and number of quality trainings
         that have occurred in the past on an annual basis?
         Answer: Most recent HHSC-hosted Quality Forum held in April was on value-based purchasing
         (performance-based contracting) and Performance Improvement Goals for the MCOs.
    120. Section 2.2.4.1.11 - Quality Improvement Trainings and Conferences. Could HHSC please
         provide examples of past trainings or conferences that have been lead by the current contractor?
         Answer: See answer to question #119.
    121. Section 2.2.4.1.10, Annual EPSDT (THSteps) Medical Screening Encounter Data Validation is
         described for ‘children in Medicaid.’ Section 6.1.3, page 64, further defines this as for STAR and
         PCCM and also lists a report for “Annual Well-Child Medical Screening Data Validation for CHIP
         Programs. Please confirm the EPSDT Medicaid data validation is for both STAR MCOs and
         PCCM. Also, please confirm deliverable required for data validation for CHIP Well-Child Medical
         Screening.
         Answer: EPSDT is confirmed for Medicaid only. Data validation in these areas is new and the
         requirements are not fully defined, therefore a deliverable is not yet named and will be
         dependent on the outcome of the FREW vs Hawkins settlement.
    122. Section 2.2.4.1.12—please indicate the anticipated frequency of regular contract and status
         meetings or discussions with HHSC. In which city and location will those meetings be held?
         Answer: Monthly, either via conference call or in Austin. Frequency is identified under Monthly
         On-site Meetings in the cost proposals.
    123. Section 2.2.4.1.12—the RFP states that the vendor will provide HHSC with an annual on-site
         MCO visit calendar. Please provide information about the location(s) of each of the MCO sites
         where these on-site visits will occur.
         Answer: HHSC cannot provide the exact locations of the on site visits that will need to occur.
         The on site visits with any particular health plan can be influenced by several factors, including a
         health plan’s response to the Administrative Interview Questionnaire or validation of processes
         or procedures implemented for performance improvement goals. Since the site locations for a
         health plans call center may be different than the site visit for discussions with a CEO, HHSC is
         asking the Responders to build in a projected cost estimate as to the number of staff and travel
         costs based on past experiences.

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    124. Section 2.2.4.1.12 Given the need for close communication with HHSC, MCOs, and
         stakeholders can some “meetings” be conducted telephonically, or will it require the physical
         presence of the vendor?
         Answer: Yes, some meetings can be conference calls.
    125. Section 2.2.4.1.12 Is it required that the vendor maintain an office in the State of Texas?
         Answer: No. However if other considerations are equal, HHSC will give preference to a vendor
         with a principal place of business in the State of Texas, or a vendor who will manage the contract
         from an office in Texas.
    126. Section 2.2.4.1.12 - Are telephonic meetings sometimes acceptable as compared to on-site
         meetings?
         Answer: Yes.
    127. Section 2.2.4.1.12 - How many meetings does HHSC anticipate that the vendor will participate in
         every year?
         Answer: Please see the cost proposal sheets that further define the number of meetings.
    128. Section 2.2.4.1.12 - From past experience, is there an approximate number of Stakeholder
         Trainings that have occurred over a year period?
         Answer: Trainings are typically scheduled to be done in conjunction with the on-site monthly
         meeting presence of the EQRO.
    129. Section 2.2.4.2, List of Deliverables: The first two sentences relate to the work plan and Vendor
         updates on progress toward the planned work. The third sentence begins with “A detailed
         monthly…” but then appears to be describing a technical report rather than reporting regarding
         EQRO achievement of deliverables and work plan tasks. The remainder of the section also
         clearly describes what is to be included in a technical report following EQRO evaluation and
         analysis. Was some language referring to monthly reporting of deliverables status omitted from
         this section? Is there any requirement for monthly technical reporting that meets the detailed
         outline provided or is that detailed description actually a description of technical report
         requirements for EQRO evaluative reports?
         Answer: this is referencing the monthly data quality/log reports.
    130. Section 2.2.4.2, Task 13—states that EQRO will conduct analysis on MCO QAPI, QIP, and
         Administrative Interview questionnaire results and conduct MCO Site Reviews. Please provide
         information about the Administrative Interview questionnaire.
         Answer: At a very high level, Administrative Interviews and possible on-site reviews are part of
         the annual QAPI review for all MCOs. The EQRO is responsible for administering a
         comprehensive questionnaire document sent to and completed by the MCOs. The EQRO
         reviews the responses and compares them to the Quality Assurance and Performance
         Improvement annual summaries submitted by the MCOs. The EQRO is expected to conduct on-
         site interviews with the MCOs as needed. Other interviews may be conducted via conference
         calls. During their on-site visits, the EQRO may be requested by HHSC to conduct other reviews
         and gather information relating to processes implemented by the MCO relative to their
         Performance Goals and provide feedback to HHSC.
    131. Section 2.2.4.2, List of Deliverables, Item 20. Is there a previous EDP Audit report available?
         Answer: An EDP Audit Report may be available through a formal Open Records Request
         submitted to HHSC.
    132. Section 2.2.4.2, The last full sentence of the first paragraph reads, “A detailed monthly technical
         report …” The description that follows is typical of an annual technical report (as opposed to
         monthly). Did HHSC intend this report to be annual?
         Answer: See response to question #129.
    133. Section 2.2.4.2, Deliverable #6b is risk ratios tables, for what are the risk ratios being computed?
         Answer: Rate setting purposes.


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    134. Section 2.2.4.2, In 2.2.4.2 List of Deliverables states that the EQRO vendor will submit “a
         detailed monthly technical report that describes the manner in which the data was collected,
         analysis conducted, results aggregated, and conclusions drawn as to the quality, timeliness, and
         access to the care furnished by the MCOs is required…” The BBA requires this report to be
         provided on an annual basis, not monthly. Is the state’s intention to require this monthly and if so
         what data does the state envision the report will encompass as the RFP tasks will be completed
         over a period of a year rather than monthly.
         Answer: See response to question #129.
    135. Section 2.2.4.2, What type of connectivity is required between the EQRO vendor and DSHS and
         ACS? What is the expected size and format of the data files?
         Answer: None. Access has historically been through URL, FTP, and specific login and
         passwords. The current EQRO connects to all FTP locations via a dedicated secure T1 line
         installed and paid for by HHSC. Please access the link provided under question #72 for
         additional information.
    136. Section 2.6—please explain the acronym TDI.
         Answer: Texas Department of Insurance

    137. Section 2.8—the first sentence states “the EQRO Vendor must provide a Turnover Plan …to
         either HHSC.” It seems that words are missing at the end of the sentence.
         Answer: The sentence should read as:
          Twelve (12) months after the start of the contract the EQRO Vendor must provide a Turnover
          Plan covering the turnover of the records and information to HHSC.
    138. Section 2.9 What exactly does “All transferred data must be compliant with HIPAA” imply?
         Answer: Any data exchange or transfer of data must be compliant with HIPAA regulations
         relative to the HIPAA privacy rules, including, but not limited to data security for Personal Health
         Information (PHI) and electronic transmission of PHI, member and provider data, data format,
         and data encryption. Please access the link provided under question #72 for additional
         information.
    139. Section 3.2—please clarify the following sentence: Respondent who submitted questions
         contact information will be posted on the HHSC website. Must each potential respondent who
         submits questions provide contact information? If so, what information? And will that
         information be posted at the time the questions and HHSC responses are posted on the
         website?
         Answer: See response to #15.
    140. Section 3.12—this section states that subcontractors providing services under the contract shall
         meet the same requirements and level of experience as required of the Respondent. It seems
         unlikely that subcontractors will meet the same requirements for level of experience that is
         required of the prime contractor. Please clarify.
         Answer: Subcontractors are required to give their experience in the area in which they are
         being subcontracted, along with resumes and financial capacity as the respondent is required in
         Section 3.15.12 Section 2 – Corporate Background and Experience.
    141. Section 3.14—all proposals must be no more than 75 pages total, excluding required forms and
         resumes. Does the current financial statement plus two years of audited financial reports count
         toward this total?
         Answer: No. The current financial statement plus two years of audited financial reports is not
         included in the 75 page limit.
    142. Section 3.14.2, The proposal due date listed in this section is June 20, 2007 4:00 p.m. CST
         while Section 1.3 - Procurement Schedule lists the due date as June 12, 2007. Please confirm
         the due date and time.
         Answer: See Addendum 2, Item No. 1.
     143. Section 3.14.3, Additional Requirements for proposal submission include a limit of “75 pages,
          excluding required forms and resumes.” Throughout the RFP several ‘Respondent Response’
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            sections ask for inclusion of sample reports or examples of research and analysis. Are the
            requested samples and examples included in the 75 page maximum for the proposal or are they
            in addition?
            Answer: No. Examples of work, templates, and other supporting documentation requested by
            HHSC can be attachments to the proposal and will not count in the page limitation.
    144. Section 3.15.1, Are Appendices (i.e. financial statements, etc.) included in the 75-page limit?
         Answer: No. See response to question #143.
    145. Section 3.15.1.2, section 2, #1—the section states that if the proposal includes the use of
         subcontractors, the Respondent must include a similar description of each subcontractor’s
         corporate background and experience. Does this mean that each subcontractor must provide at
         least three references from projects performed within the last five years?
         Answer: Yes.
    146. Section 3.15.1.2, section 2, #2—is there a specific manner or format by which the Respondent
         will indicate the commitment of key personnel who are not currently employees of the
         Respondent? Are letters of commitment necessary? If so, do they count toward the 75 page
         limitation?
         Answer: Letters of commitments are necessary. They will not count toward the 75 page limit.
    147. Section 3.15.1.2, asks for “resumes of all proposed key personnel” to be included in the
         Respondent’s proposal. Is it acceptable to include current management and implementation
         staff resumes in addition to job descriptions for proposed EQRO staff positions to be recruited
         upon notice of contract award?
         Answer: Yes
    148. Section 3.15.1.2, HHSC reserves the right to require the Respondent to procure one or more
         performance, fidelity, payment or other bond, if during the term of the contract, HHSC in its sole
         discretion determines that there is a business need for such requirement. If the Vendor needs to
         procure a bond, what dollar value would be associated with the bond (e.g., $50,000, $100,000,
         etc.)?
         Answer: The size of the bond will be determined according to the business needs.
    149. Section 3.15.1.3 states: Describe the Respondent’s proposed processes and methodologies for
         providing all components of the Mission Results/Scope of Work described in Article 2, including
         the Respondent’s approach to meeting the Project Schedule. Several sections within Article 2
         do not appear to require a response, such as Section 2.2 Scope of Work as well as Sections 2.6
         – 2.12. How should the Vendor reply to these sections?
         Answer:       Responders are expected to consider all contract requirements, activities,
         deliverables, timeframes (including transition, implementation, and operational start dates) as
         well as the timelines for the expected deliverables and provide a project plan that would give
         HHSC confidence that expectations can be achieved by the Responder.
    150. Section 3.15.1.6, The RFP states, “Respondents are not required to submit appendices to the
         Business Proposal.” Where should the resumes be placed, i.e., within Section 2, at the end of
         Section 2, or in the Appendices?
         Answer: Resumes may be placed at the end of Section 2.
    151. Section 3.15.1.8, - What is the contract number the State would like Bidders to list on the non-
         disclosure form?
         Answer: List the number 529-07-0093 on the non-disclosure form.

    152. Section 3.15.1.8, For the Child Support Certification form, please clarify if the State requires the
         names and Social Security number for each member of the project team or the official
         representative of the organization?
         Answer: In accordance with Section 231.006, the names and social security numbers of the
         individuals identified in the contract, bid, or application, or of each person with a minimum 25%
         ownership interest in the respondent organization.

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    153. Section 3.15.1.8, For the Child Support Certification form, can Bidder’s provide other data
         instead of the Social Security number?
         Answer: No, however see response to #152.
    154. Section 4.6.2—per the RFP, Respondents must provide written notice to potential HUB
         subcontractors “prior to submitting proposals.” The HUB Subcontracting Plan (HSP) form states
         in Section 6c. that the Respondent must provide notice of its subcontracting opportunity to a
         minority or women trade organization or development center no less than five (5) working days
         prior to the submission of its response to the contracting agency. In five days prior to submission
         of its proposal, it is unlikely that the Respondent will receive responses, evaluate those
         responses, document the selection in Section 8 of the HSP form, and include the subcontractor
         in its cost proposal. May the Respondent issue its written notice to potential HUB certified
         subcontractors five days prior to its proposal submission? Please explain the process and timing
         requirements.
         Answer: All Respondents must make a good faith effort to develop and submit a completed
         HSP with its RFP response in accordance with Section 4 of the RFP and Section 6A-C of the
         HSP. Supporting documentation must be submitted with the HSP to assist in making a
         conclusive determination regarding the Respondent's good faith effort compliance. Incomplete
         HSPs will be rejected as a material failure to comply with the advertised specifications.
    155. Section 5 The RFP indicates that “HHSC will more favorably evaluate proposals that offer no or
         few exceptions, reservations, or limitations to the terms and conditions of the RFP, including
         HHSC’s UTC.” Please confirm that HHSC is willing to negotiate some terms and conditions of
         the RFP.
         Answer: HHSC reserves the right but is not required to negotiate RFP terms and conditions.
    156. Section 6.13, Schedule 3-A – Operations Expenses Worksheet. This does not include a weekly
         requirement for reporting on contract status and achievement of deliverables. Will the weekly
         reports be required? If so, is it appropriate to add itemized costing for this reporting in this
         schedule?
         Answer: A weekly deliverable status report is required and should be priced in with the monthly
         meeting costs. Separate routine weekly contract reports are not required.
    157. Section 6.1.2, Footnotes for superscripts 4, 5, and 6 are missing.              Please provide these
         references.
         Answer: Section 6 was replaced with Addendum 1.
    158. Section 6.1.3, The cells for number of units and frequency for Monthly Conference Call
         Meetings: agenda/minutes are blank. Should the Vendor assume a unit of 1 and a frequency of
         7 for pricing?
         Answer: Section 6 was replaced with Addendum 1.
    159. Appendix A, If the Unit is one and the frequency is 12, is the unit cost for one or for 12, i.e., if the
         contractor is doing monthly data loads, is the unit cost for one month or for the twelve month
         period?
         Answer: Unit is 1 month, with total cost being for all 12 months in the contract year.
    160. Appendix B – Performance Measures (page 70-71), under 2.2.4.1.5 Surveys, it states “The
         EQRO Vendor will conduct…annual Consumer Assessment of Healthcare Providers and
         Systems (CAHPS), EPSDT Member surveys, and MCO and Provider Spot Checks.” The EPSDT
         Member surveys and MCO and Provider Spot Checks do not appear to be defined in the
         Surveys section of the RFP (2.2.4.1.5). Please define the scope of the “EPSDT Member
         surveys” and “MCO and Provider Spot Checks” and confirm their inclusion in the proposed EQR
         scope of work.
         Answer: Please see the attached spot checks documents currently in use by HHSC. The
         EPSDT surveys are not defined, pending the results of the FREW vs Hawkins court decree.
         HHSC may simply append existing member surveys to include EPSDT-related questions.



5/27/2012                                        18
                                                                                                  Form CPS.031




    161. Appendix A, Since appropriate pricing for each deliverable requires an understanding of the work
         connected to the deliverable, we attempted a crosswalk between the deliverables in the cost
         proposal worksheets to the EQRO activities. There is not a direct correlation between the
         itemized deliverables listed in Schedule 3-A, 3-B to the EQRO Activities Table on p. 34 – 38
         of the RFP and to the EQRO Scope of Work described on pages 20 - 33 of the RFP. Please
         clarify the relationship of each deliverable listed in Appendix A with the Deliverables Schedule on
         pages 34-38 and the Mission Results/Scope of Work (Article 2). Please see Attachment A for
         examples.
         Answer: See HHSC’s response in columns 1 and 2 in the Table Below:
                                                 Attachment A
          The attached table shows the deliverables that appear to be correlated across the three sources;
          we were unable to determine correlations that seemed reasonable to us for many deliverables
          and are reluctant to make incorrect assumptions. Could HHSC please correct and complete the
          attached table or by another means provide clarification regarding which activities correspond to
          which deliverables?
    Cross Reference to
    EQRO Activities Table p. 34 - Cross Reference to                        Schedule 3-A
    38                                 EQRO Scope of Work p. 20 - 33        Itemized Deliverables
                                                                            Monthly data loads and
                                       2.2.4.1.3 Analysis and Data          maintenance of ADTP
    1.a                                Transfer Platform (ADTP)             Report
                                                                            Monthly data log reports:
                                                                            STAR MCOs (14);
                                                                            STAR+PLUS MCOs (4);
                                                                            Foster Care MCO (1), CHIP
                                       2.2.4.1.3 Analysis and Data          (17), CHIP Dental (1), CHIP
    1.b                                Transfer Platform (ADTP)             EPO (1)
                                       2.2.4.1.3 Analysis and Data          Monthly data file transfers:
    2.a, 2.b, 3.a, 3.b                 Transfer Platform (ADTP)             DSHS (1); ACS (1)

                                      2.2.4.1.6 Deliverables; 2.2.4.1.12
                                      Meetings with HHSC, MCOs, and         Monthly On Site Meetings:
    17.a, 17.b - split                Stakeholders                          agenda/minutes
                                      2.2.4.1.6 Deliverables; 2.2.4.1.12
                                      Meetings with HHSC, MCOs, and         Monthly Conference Call
    17.a, 17.b - split                Stakeholders                          Meetings: agenda/minutes
                                                                            Monthly Contract Reports
                                                                            and Invoices: HUB,
    17.a, 17.b - split, 18.b          2.2.4.1.6 Deliverables                Deliverables Log, Invoice
                                                                            Quarterly data log report for
                                                                            NorthSTAR program

                                                                            (Note: NorthSTAR data files
                                                                            are currently received by the
                                                                            EQRO directly from DSHS on
                                                                            a quarterly basis. This may
                                                                            change to Monthly file receipt
                                      2.2.4.1.3 Analysis and Data           from TMHP by the time the
    1.b                               Transfer Platform (ADTP)              contract is in place.)
                                      2.2.4.1.2 Performance Measures        Quarterly MCO Comparison
                                      and Performance Improvement           Quality of Care Reports:
                                      Goals and Objectives; and             STAR (1, includes Foster
     7.b                              2.2.4.1.6 Deliverables: Quarterly     Care); STAR+PLUS (1); CHIP
5/27/2012                                      19
                                                                              Form CPS.031

                                                        (1, includes EPO), CHIP
                                                        Dental (1)
                  2.2.4.1.2 Performance Measures        Quarterly State-wide HMO to
                  and Performance Improvement           FFS Comparison Quality of
                  Goals and Objectives; and             Care Reports: STAR/PCCM
     7.b          2.2.4.1.6 Deliverables: Quarterly     (1), STAR+PLUS/ICM (1)
                                                        Quarterly MCO Financial
                                                        Performance Reports: STAR
                  2.2.4.1.2 Performance Measures        (1, includes Foster Care);
                  and Performance Improvement           STAR+PLUS (1); CHIP (1,
                  Goals and Objectives; and             includes EPO), CHIP Dental
     7.b          2.2.4.1.6 Deliverables: Quarterly     (1)
                                                        Quarterly State-wide HMO to
                  2.2.4.1.2 Performance Measures        FFS Financial Performance
                  and Performance Improvement           Comparison Reports:
                  Goals and Objectives; and             STAR/PCCM (1),
     7.b          2.2.4.1.6 Deliverables: Quarterly     STAR+PLUS/ICM
                                                        Quarterly Individual MCO
                                                        Reports: STAR MCOs (14);
                  2.2.4.1.2 Performance Measures        STAR+PLUS MCOs (4);
                  and Performance Improvement           Foster Care MCO (1); CHIP
                  Goals and Objectives; and             (17); CHIP Dental (1); CHIP
     7.b          2.2.4.1.6 Deliverables: Quarterly     EPO (1)
                                                        Quarterly Contract Reports
    17.d, 17.e    2.2.4.1.6 Deliverables                (status and financial reporting)
                  2.2.4.1.2 Performance Measures        Quarterly Review and
                  and Performance Improvement           Report of all MCO
                  Goals and Objectives; and             Performance Improvement
     7.b          2.2.4.1.6 Deliverables: Quarterly     Goals
                                                        Annual CAHPS Survey
                                                        Reports for SFY 2008:
                                                        (includes developing and
                                                        finalizing all instruments,
                                                        sampling plans,
                                                        questionnaires, and producing
                                                        final reports) CHIP (3 enrollee,
    11.a, 11.b    2.2.4.1.5 Surveys                     disenrollee, caregiver)
                  2.2.4.1.2 Performance Measures
                  and Performance Improvement
                  Goals and Objectives; and
                  2.2.4.1.6 Deliverables

                  (Note: 2.2.4.1.6 Deliverables is at   Annual Spot Checks
                  a “high level”, not the granular      Reports: STAR MCOs (14);
                  complete list of all deliverables     STAR+PLUS MCOs (4);
                  expected. To identify all             Foster Care MCO (1); CHIP
                  deliverables, Responders must         (17); CHIP Dental (1); CHIP
    14.c          refer to the cost detail sheets.)     EPO (1)
                  2.2.4.1.2 Performance Measures        Annual Administrative
                  and Performance Improvement           CSHCN State-Wide Analysis
                  Goals and Objectives; and             Report for STAR and CHIP
     7.b          2.2.4.1.6 Deliverables: Quarterly     MCOs
                   2.2.4.1.2 Performance Measures       Annual Quality of Care
                  and Performance Improvement           Report: (includes costs
                  Goals and Objectives; and             associated with sampling,
                  2.2.4.1.6 Deliverables                obtaining and reviewing
                                                        medical record request for
    7.c and 8.b   (Note: 2.2.4.1.6 Deliverables is at   HEDIS hybrid measures for all

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                                                                                    Form CPS.031

                          a “high level”, not the granular      STAR (1, including Foster
                          complete list of all deliverables     Care), STAR+PLUS (1), CHIP
                          expected. To identify all             (1, including EPO), CHIP
                          deliverables, Responders must         Dental (1), and NorthSTAR (1)
                          refer to the cost detail sheets.)
                           2.2.4.1.2 Performance Measures
                          and Performance Improvement           Annual State-Wide Quality
                          Goals and Objectives; and             of Care Report: (includes
                          2.2.4.1.6 Deliverables                costs associated with
                                                                sampling, obtaining and
                          (Note: 2.2.4.1.6 Deliverables is at   reviewing medical record
                          a “high level”, not the granular      request for HEDIS hybrid
                          complete list of all deliverables     measures for all Medicaid
                          expected. To identify all             STAR/PCCM (1),
                          deliverables, Responders must         STAR+PLUS/ICM compare
     7.c and 8.b          refer to the cost detail sheets.)     (1)
                           2.2.4.1.2 Performance Measures
                          and Performance Improvement
                          Goals and Objectives; and
                          2.2.4.1.6 Deliverables

                          (Note: 2.2.4.1.6 Deliverables is at   Annual MCO Performance
                          a “high level”, not the granular      Ranking Reports: (includes
                          complete list of all deliverables     establishing annual ranking
                          expected. To identify all             criteria and methodology for
                          deliverables, Responders must         STAR, STAR+PLUS, and
     7.c and 8.b          refer to the cost detail sheets.)     CHIP (including EPO).
                                                                Annual MCO Encounter
                                                                Data Validation Report:
                                                                (includes generating samples
                                                                medical record requests,
                                                                postage, reimbursement to
                                                                provides for records, and
                                                                reviews for all STAR,
                          2.2.4.1.9 Annual Encounter Data       STAR+PLUS, and CHIP
     4.a, 4.b, 4.c, 4.d   Validation                            MCOs)
                          2.2.4.1.9 Annual Encounter Data
                          Validation and 2.2.4.1.10 Annual
                          EPSDT (THSteps) Medical
                          Screening Encounter Data
                          Validation

                          (Note: This effort is to be priced    Annual EPSDT Medical
                          and is subject to negotiation and     Screening Data Validation
                          possible deletion from the final      Report for Medicaid (STAR
     4.a, 4.b, 4.c, 4.d   contract.)                            and PCCM)
                          2.2.4.1.9 Annual Encounter Data
                          Validation

                          (Note: This effort is to be priced
                          and is subject to negotiation and     Annual Well-Child Medical
                          possible deletion from the final      Screening Data Validation
     4.a, 4.b, 4.c, 4.d   contract.)                            for CHIP programs
                                                                Annual SFY 2007 Data
                                                                Certification Reports for
                                                                STAR (1, includes Foster
                                                                Care), STAR+PLUS (1),
                          2.2.4.1.8 Annual Encounter Data       NorthSTAR(1), CHIP (1,
     5.a, 5.b, 5.c        Certification                         includes EPO), CHIP Dental
5/27/2012                          21
                                                                              Form CPS.031

                                                          (1)
                                                          Annual SFY 2007 Rate
                                                          Analysis Lag Tables STAR
                                                          (includes Foster Care);
                                                          STAR+PLUS, CHIP (includes
                        2.2.4.1.8 Annual Encounter Data   EPO), CHIP Dental, and
    6.c                 Certification                     NorthSTAR)
                                                          Annual SFY 2007 Rate
                        2.2.4.1.8 Annual Encounter Data   Analysis Risk Ratio Tables
    6.b                 Certification                     (STAR, STAR+PLUS, CHIP)
                                                          Annual SFY 2007 Rate
                                                          Analysis Data Files (STAR,
                        2.2.4.1.8 Annual Encounter Data   STAR+PLUS, CHIP, CHIP
    6.d                 Certification                     Dental, and NorthSTAR

                        2.2.4.1.1 Evaluation of MCO
                        Quality Assurance and             Annual QIP/QAPI Reports for
                        Performance Improvement Plans,    each MCO, STAR (includes
                        and 2.2.4.1.6 Deliverables –      Foster Care), CHIP (includes
     13.c               Annual                            EPO); and STAR+PLUS

                        2.2.4.1.1 Evaluation of MCO       Annual Program – Level
                        Quality Assurance and             QIP/QAPI Summary Report
                        Performance Improvement Plans,    by Program (STAR,
                        and 2.2.4.1.6 Deliverables –      STAR+PLUS, and CHIP
     13.c               Annual                            (includes EPO), CHIP Dental

                        2.2.4.1.1 Evaluation of MCO
                        Quality Assurance and
                        Performance Improvement Plans,    Annual Administrative
                        and 2.2.4.1.6 Deliverables –      Interview Questionnaire
     13.a               Annual                            Tool for all programs

                        2.2.4.1.1 Evaluation of MCO
                        Quality Assurance and             Annual Administrative
                        Performance Improvement Plans,    Interview On-Site Interviews
                        and 2.2.4.1.6 Deliverables –      with MCOs selected by
     13.a, 13.b, 13.c   Annual                            HHSC
                                                          Annual Administrative
                                                          Interview Matrix/Report
                                                           For all STAR (includes Foster
                                                          Care), CHIP (includes EPO),
                        2.2.4.1.1 Evaluation of MCO       CHIP Dental, STAR+PLUS,
                        Quality Assurance and             and NorthSTAR (a total of 20
                        Performance Improvement Plans,    health plans covering multiple
                        and 2.2.4.1.6 Deliverables –      lines of business for each
     13.c               Annual                            health plan)
                                                          Annual MCO Review of
                                                          Performance Improvement
                        2.2.4.1.2 Performance Measures    Goals and Quality Forum all
                        and Performance Improvement       health plans and all lines of
    13.a, 13.b, 13.c    Goals and Objectives              business
                                                          Annual Focused Studies on
    12.a, 12.b          2.2.4.1.7 Focused Studies         HHSC-specified Topics
                                                          Annual Contract Financial
    18.e                2.2.4.1.6 Deliverables            Report
                                                          Annual EQRO Summary of
    18.f                2.2.4.1.6 Deliverables            Activities Report
    18.f                2.2.4.1.6 Deliverables            Annual Independent EDP
5/27/2012                       22
                                                                                         Form CPS.031

                                                                     Audit Report
    18.f                            2.2.4.1.6 Deliverables           Annual Business Plan
                                                                     Ad Hoc reports based on
                                                                     administrative data –
    16.b                            2.2.4.1.6 Deliverables           approximately 6 per year.

Failure to acknowledge receipt of this addendum may result in offer rejection. Offerors may
acknowledge receipt of this addendum by one of the following methods:

1. Sign and return this addendum to HHSC with the solicitation response; or
2. Acknowledge receipt of this addendum on the face of the offer, or;
3. If response has already been submitted by respondent, respondent may acknowledge receipt of
   this addendum prior to solicitation due date and time by signing and faxing to:

Steve Bailey                        512-206-4653              512-206-5475
Attn:                                Phone:                   Fax:

Authorized Signature:                                             Date:                  _____
Printed or Typed Name of Authorized Signature:______________________________________
Business Entity Name:                                        _______________________________




5/27/2012                                  23

								
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