VIEWS: 7 PAGES: 10 POSTED ON: 2/26/2010
ADDENDUM ONE DATE: April 10, 2006 TO: All Vendors FROM: Ruth Gray, Buyer State Purchasing Bureau RE: Questions and Answers for RFP Number 1270Z1 to be opened May 24, 2006 Following are the questions submitted and answers provided for the above mentioned Request For Proposal. The questions and answers are to be considered as part of the Request For Proposal. QUESTIONS ANSWERS 1. Need new census, in excel or text format, The RFP has been amended to include a with DOB, Gender, Zip Codes, Coverage revised Attachment 13. Tier, Health Plan breakout (if more than one plan) 2. Can we get a large claims file? Or are These are the large claims files the State has the 3 claims files (1 from Mutual of received from BCBSNE and Mutual of Omaha. Omaha and 2 from BCBS) all we‟re going No other files are available. to get? 3. Section M, page 30 of the RFP says we Bidder may either save the RFP document in need to photocopy the question, not Word and type the response underneath the retype it. We‟re not sure what that question or may photocopy the questions and means. Can we simply type our type or handwrite the responses underneath response in Word format underneath the the questions. question? 4. If you have a Table of Contents for how Proposal response structure should mirror that you‟d like your binders to be set up of the RFP. please share it with us. QUESTIONS ANSWERS 5. Please describe the process to fund the As indicated on page 40, Section C, Item 2; initial claims. Is Contractor expected to “…The State shall have a minimum of three (3) pay the claims initially and submit a business days to pay contractor after receipt report of claims for reimbursement? and approval of the invoice…”, therefore the contractor will initially be expected to fund the claims. 6. Please confirm that proposals should be Please reference Section II. Procurement sent to State of Nebraska Purchasing Procedures, G. Submission of Proposals for Bureau, Attn: Ruth Gray, 301 Centennial instructions on submitting a proposal Mall South, Mall Level, Lincoln, NE response. 68508. 7. Are the State of Nebraska‟s health plans Since the State‟s health plans are self-insured, considered ERISA plans or exempt from the State is subject to ERISA, but also follow State laws? State statutes regarding health insurance. 8. Employee Census: Is a complete census See answer to question #1. available listing Date of Birth, Gender, Zip code, and dependent enrollment status (i.e. Employee, Employee + 1, Employee + Children, Family, etc.) by vendor (BCBS or Mutual of Omaha) and plan type (PPO, POS, and HMO)? 9. Large Claim Information: The Large Blue Select = HMO product. Claim information from BCBS appears to Blue Choice = POS product. be for two separate plans/groups. What is the difference between these plans/groups? 10. Employee/Employer Contributions: What By statute the employee pays 21% of the are the current employee contribution premium and the State pays 79%. amounts, by vendor (BCBS or Mutual of The RFP has been amended to include Omaha/plan (PPO, POS, HMO)? How Attachment 27 for current health plan will the State determine the "premium premiums. equivalent" for vendors plans in order to set the employer/employee contribution The State‟s contracted actuarial consultant will levels in a self-funded environment? assist in determining the “premium equivalent” for vendor plans self-funded by the State. 11. Blue Select Guide to Health Benefits Provider. (Attachment 6): Page 15- Notification and certification Requirements section states, “If you fail to provide notification of the admission, allowable charges for all covered services associated with that stay may be reduced by 25%.Benefits for all services which are determined to be not medically necessary will be denied. If this is an HMO who will be responsible for the penalty? Provider or Member? Page 2 QUESTIONS ANSWERS 12. PPO Booklet (Attachment 8): Page 31- The State will cover childhood immunizations Deductible section under Exceptions through age six. States Waiver of the Deductible: The Deductible is waived for Covered Services in connection with: services for Childhood Immunization for eligible dependent children through age six. On the Schedule of benefits it states Child immunizations (under age 6). Please confirm if it is under or through age six. 13. Glossary of Terms: Primary Care No. Physician (PCP): Regarding the following sentence: “in a managed care organization, a primary care physician is accountable for the health services of enrollees including referrals, procedures and hospitalization?” Can this be changed from “is accountable” to “may be accountable” since many carriers no longer have gatekeeper requirements? 14. Glossary of Terms: Primary Care No. Physician (PCP): Can the term “generalist” be defined by specific specialties to ensure that all responders are including the same practice types in response calculations? 15. Glossary of Terms: Specialist: No. Regarding the following sentence: “Most managed care plans require members to get a referral from their primary care physician before seeing a specialist.” Can this be changed to “many managed care plans require…” since many carriers no longer have gatekeeper requirements? 16. Glossary of Terms: Specialist: Can the No. definition for the term “specialist” be defined by specific practice types to ensure that all responders are including the same practice types in response calculations? 17. Mandatory Contract Provisions: Item L. The State will not evaluate deviations from the State of Nebraska Personnel Recruitment RFP specifications during the Question and Prohibition: Is it possible to limit this by Answer period. time? Example, within 10 years, „at any time‟ seems really broad. Page 3 QUESTIONS ANSWERS 18. Mandatory Contract Provisions: Item Unit price shall mean the per employee per MM: Changes in Scope/Change Orders: month ASO fee bid by the bidder. Please define “unit price.” 19. Mandatory Contract Provisions: Item The State intends that there will be no OO. Limitation of Liability. Please limitation. elaborate on the intention of this clause. 20. Project Description and Scope of Work: The State does not fully understand the Item E. Subrogation: Please clarify that question and therefore can not provide an the State of Nebraska doesn‟t intend answer. Contractors to be filing suit. 21. Project Description and Scope of Work: Yes. Item I. Administration Transition. Number 2: Can the word “returned” be changed to “provided?” Carriers will be required to maintain records sufficient to satisfy Department of Insurance auditors and other legal responsibilities. 22. Project Description and Scope of Work: The RFP is amended to include Attachment Item K. Administration Provider Network: 28. Bidder must complete this attachment and Number 2.a. For purposes of this return with response for each proposed question, can the question list specific network. provider types to be included in the ratio? . 23. Provider Network: Item K 2 a. - Please Definition of a Primary Care Physician is define Primary Care physicians- What provided on page ix of the “Glossary of specialties are included? Terms”. 24. Provider Network: Item K 3 d. - Please Medical facilities are to include, but not limited define other medical facilities, other than to hospitals, surgical, specialty, rehabilitation acute care? hospitals as well as skilled nursing facilities. 25. Reimbursement: What time-frame 24 months. should be used for the claim detail for the discount and reimbursement data? 26. Reimbursement: Should carriers report Contracted amount. "net" or "contracted rate" discounts and rates? An example would be if the provider's charge is $1000 and the contracted rate is $600 and member coinsurance is $100. Do carriers report the $600 contracted rate which equates to a 40% discount, or do carriers report $500 ($600-$100) or a 50% discount, which is "net" of member liability? Page 4 QUESTIONS ANSWERS 27. We are requesting a complete census. See answer to question #1. The census should include the following employee specific items: (1) year of birth or age, (2) 5-digit zip code, (3) coverage (tier) election, (4) plan election, (5) gender, and (6) active/cobra/retiree status and eligible status. Census should be provided in an Excel format. 28. We are requesting experience The State is not able to obtain this information information including a minimum of two at this time. years of monthly enrollment and claims, on a paid basis, by plan and total. 29. In addition to the experience information, See answer to questions # 28. is information available on draft or check counts, or if unavailable, number of transactions or claim handlings (please included definition of transactions or claim handlings)? Page 5 QUESTIONS ANSWERS 30. On page 10 of the RFP, Section F. The State will not enter into a contract which Contingent Fees, we would like to clarify requires payment of a contingent fee, or is this requirement to make sure we have a reasonably anticipated to result in the payment clear understanding of the State's of a contingent fee of any kind whatsoever. requirements. It would appear the State The State expects any administrative fees for is requiring all administrative fees to be this service to be included in the bidder‟s per charged on a per employee per month employee per month ASO fee. The State is basis? Does that preclude a carrier from unable to respond to any hypothetical offering programs that may provide situations. The State will not evaluate savings where fees could be charged on deviations from the RFP specifications during a percent of claims savings basis or on a the Question and Answer period. per claim basis based on number of claims that benefited from the program? Two examples follow: A. If a covered person under the state's plan were to utilize a provider that is outside of the carrier's PPO network, however, where the carrier had an arrangement whereby the state plan could still take advantage of discounts subject to a fee that could be charged on a percent of savings basis, or on a per claim basis, would this be considered a contingent fee? B. If a covered person incurred a claim with a non-participating provider, and a program was used where a professional negotiation service negotiated a claims savings with charges based on a percent of savings, would this be considered a contingent fee? In either example, the state would only incur a charge if a discount of savings were achieved? If these are considered contingent fees by the state, would the state then require that any projected costs related to these types of network access or programs be incorporated into the per employee per month administrative fee? 31. Is the State of Nebraska using a The State does not currently have a contract consultant for this procurement? with an Actuarial Consultant, but a contract is in the process of being awarded. The language in the RFP states that the consultant may “assist the State of Nebraska with the RFP selection process… The assistance will include analysis of the ASO fee, provider discounts and saturation of provider networks statewide”. Page 6 QUESTIONS ANSWERS 32. The State's RFP has allowed bidders to The State has an existing contract with a quote on alternate plans in addition to Pharmacy Benefit Manager through 12/31/07. current plans. One of the options of The current PBM has the ability to administer interest by the State is a High Deductible a HDHP. Health Plan (HDHP) with an HSA. Under an HDHP plan, regulations require that medical and prescription drug claims both be subjected to the deductible under the HDHP plan before any benefits are payable. This requires both the health plan carrier and PBM to accrue medical and prescription drug claims toward the combined HDHP plan deductibles and out-of-pocket maximums. If a carrier has already developed an interface with a PBM to support this requirement, can a carrier bid the HDHP plan option with a packaged medical and prescription drug plan that utilizes the carrier's PBM for those employees who would select the HDHP plan option? 33. The RFP describes 17,000 benefit- The previous census included temporary, eligible, 15,000 subscribed to the State‟s State College, State Patrol employees as well health plans, but the census file contains as employees not enrolled for benefits. The approximately 23,000 listed. How many new census being provided in accordance with subscribers are in each of the State of question #1 will not include these individuals. Nebraska‟s health plans? 34. How many covered lives are in each of See answer to question #1. the State of Nebraska‟s health plans? 35. What are the current incumbent‟s ASO BCBSNE = $34.18 PEPM. fees? Mutual of Omaha HMO = $27.13 PEPM. Mutual of Omaha POS = $27.22 PEPM. Mutual of Omaha PPO = $28.07 PEPM. Mutual of Omaha Outstate HMO and POS = $29.57 PEPM. 36. Call volume. How many calls are The State is not able to obtain this information received by each of the health plans? at this time. 37. Claims volume. How many claims are The State is not able to obtain this information received by each of the health plans? at this time. 38. How many open enrollment meetings are Please reference page 27, Section IV, G. Item held each year and during what time of #7 for information regarding open enrollment year? meetings. Page 7 QUESTIONS ANSWERS 39. Please describe the level of disease The State does not currently have disease management provided by each of the management in place. carriers? 40. Please identify where the Mandatory Proposal response structure should mirror that Contract provisions should be placed in of the RFP. responding to the RFP? In the Technical Proposal under Technical Approach? 41. Please confirm the State will handle The State is responsible for collecting all billing for the health plans. premiums. 42. Page 40. D. Please identify what section Proposal response structure should mirror that the alternative terms and conditions are of the RFP. to be found in a response – under Technical Approach? 43. The RFP states the proposed network Yes. must be accepted by an organization such as NCQA, JCAHO, etc. Is URAC accreditation acceptable? 44. Pertaining to the Request for CPT Code The State does not fully understand the Allowances, should allowances be question and therefore can not provide an separated by professional and technical answer. components? 45. Since there is currently more than one Although the State will not accept tiered ASO vendor being offered to the state fees based on enrollment, the State would employees, will you reconsider allowing allow for tiered ASO fees based on the plan tiered pricing on the ASO fees? design. For example, a different ASO fee would be allowed for an HMO plan than for a PPO plan. 46. Please verify if the State will allow us to See answer to question #45. offer tiered ASO fees or not based on enrolled membership. 47. Please provide the current carriers ASO See answer to question 35. The State does and stop loss fees. not currently have stop loss coverage. 48. Please confirm that all fees should be Yes, Per Employee Per Month. submitted as a Per Employee Per Month fee, not a percent of savings or a contingency fee basis. Also, if there are Yes. additional fees, for example reporting, this should be listed in the "other" category at the bottom of attachments 23, 24, 25, and 26 with the PEPM fee listed out as well for 2007, 2008, and 2009. Page 8 QUESTIONS ANSWERS 49. What are the current administrative fees Please see answer to question #35 being charged to the State to administer their health plan? 50. The State indicated in the RFP that The State did revisit this subject and the bidders could not impose, and the State language will remain as written in the RFP would not accept, enrollment guarantees document. (minimum or maximum) or fees based on the number of enrollees in a plan(s). Inclusion of this type of caveat would be cause for rejection of all or that portion of the bid. However, during the pre- proposal meeting attended last week, the State did mention during the meeting that this question could be submitted again to revisit this issue. So will the State accept enrollment guarantees (minimum or maximum) or fees based on the number of enrollees in a plan(s)? 51. Employee Census: A complete census is Please see answer to question #1. requested to include date of birth, gender, dependent status, and location (zip code) for each individual. Many carriers use this demographic information and geographic information to develop specific stop loss rates. 52. Current Vendor Enrollment: Can you Please see answer to question #34. please provide us the current year and prior year monthly enrollment broken out by each vendor and plan? 53. Employer Contributions: What are the Please see answer to question #10. current employer premium amounts for BCBS and Mutual of Omaha by plan, PPO, POS, HMO? 54. Employee Contributions: What are the Please see answer to question #10. current employee premium amounts for BCBS and Mutual of Omaha by plan, PPO, POS, HMO? 55. Funding Mechanism: What is the current The State does not fully understand the funding mechanism (insured, ASO, etc.) question and therefore can not provide an for the current coverage‟s? What are the answer. current rates/fees applicable to the current coverage‟s? Are any other fees applicable (vendor, report, % of savings, network access, etc.)? Page 9 QUESTIONS ANSWERS 56. Contract Award: Item A5 (last paragraph) Yes. on page 23 indicates the State may award the contract to multiple bidders. Clarification is requested regarding multiple awards by coverage (PPO, POS, HMO, etc.) may be made or whether there could be for example, multiple awards within each coverage such that multiple bidders would be awarded administration of PPO coverage, POS coverage, HMO coverage, etc. 57. Networks: We need clarification on the See answer to question #33. census. Census (attachment 13) has a total of 23,109 lives. RFP says there are 17,000 eligible employees. 58. Networks: RFP states that proposed Yes. network must be accredited by an organization such as NCQA, JCAHO, etc. Will a network without accreditation be disqualified? 59. Utilization Review: Questionnaire - Can See answer to question #3. we type the questions into the document in Word format? 60. Stop Loss: Can a census with coverage See answer to question #1. tiers be provided? (EO, ES, EC, and EF) 61. Stop Loss: Are large claim reports The State is not able to obtain this information available for 2003, 2004, and 2006 (to at this time. date)? 62. Stop Loss: Monthly Enrollments by Plan The State is not able to obtain this information for 2003-2005? at this time. 63. Pricing: Will the State accept tier pricing No. by lives? Page 10
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