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Questions - DHS Home

VIEWS: 23 PAGES: 133

									                            Responses to Bidders Questions -
                                         Set 1

  RFP Section 1.2 and 4.1        p. 2 and 41      Purpose of this RFP
    1      Question: For each system or professional component bid under this procurement, please confirm
                     that only one (1) contract will be awarded for each component.
           Response: Yes, only one (1) contract will be awarded for each system or professional services
                     component.
  RFP Section 1.4                 p. 2             Summary of this RFP
    2      Question: Co-location of staff. Must all staff be co-located in Iowa or can the bidder propose co-
                     location of key staff with offsite location of review and other support staff?
           Response: All staff must be co-located. See also response to question # 23.
  RFP Section 1.4, 4.3, and 4.4 p. 2 and 43 to Summary of this RFP
                                    44
     3     Question: The State has been using an older technology solution for a considerable period, and is
                     now proposing to continue this dated system, with modifications, for up to eight (8)
                     additional years. Far more modern systems are available which take advantage of
                     advanced platforms, and table- and rule-driven functionality. Such an architecture results
                     in a system that is dramatically less expensive to modify, and that results in accessibility
                     to data that is nearly real-time, thereby providing a much faster, more cost-effective, and
                     more accurate solution. The proposed new Core MMIS system requirements in the RFP,
                     however, do not allow for the replacement of the current system with advanced
                     technology, and, therefore, seems to be contrary to the stated goal of ―Best of Breed‖.
                     Will the State consider as an alternative, the replacement of the existing Core MMIS with
                     a more advanced solution?

           Response: Not at this time. The State does not have the in-house financial or staff resources to
                     replace the current MMIS system at the present time, and therefore elected to begin by
                     using the current MMIS system with enhancements. Another consideration is the limited
                     implementation schedule the state needs to follow. The POS system may be based on
                     newer technology.
  RFP Section 1.4                p. 3              Summary of this RFP
    4      Question: Please confirm that the state will be responsible for maintaining all hardware/software
                     except MMIS applications on the core MMIS system to the standard required to run the
                     MMIS at ACS' Pittsburgh facility. Please confirm that the state will continue to
                     maintain/upgrade the operating system and all hardware and software on the core MMIS
                     system except for the MMIS applications.
           Response: The State will maintain responsibility for all hardware and the operating system software.
                     The Core MMIS contractor is responsible for the MMIS Application. The state will be
                     responsible for ensuring that the hardware and operating system are appropriate for the
                     MMIS and enhancements.
  RFP Section 1.4; 5.2.1.2.3.3; p. 3, 78, and Summary of this RFP
               and 5.2.2.16          218
    5      Question: Page 3 of the RFP requires the Core MMIS contractor to provide Workflow Process
                     Management (WPM) software, but also states that the I&SS contractor will develop
                     operational logic for WPM. Pages 38 and 41 of the I&SS RFP give the I&SS contractor
                     responsibility for design and testing of WPM. Please clarify the division of



Response to Bidder Questions – Set 1                         February 23, 2004                              1 of 133
                       responsibilities between the Core MMIS contractor and the I&SS contractor with regard
                       to WPM. Will the Core MMIS contractor simply install the software? Section 5.2.1.2.3.3
                       (page 78) specifies WPM requirements as a Core MMIS contractor deliverable during the
                       System Requirements Confirmation Activity. Does the state expect Core MMIS bidders
                       to identify a specific Workflow Process Management System in their proposals, or can the
                       system be identified upon completion of the requirements analysis? Section 5.2.2.16
                       (page 218) states that the Workflow Process Management System will be used to ―report
                       on all contractor activities.‖ Do we correctly understand that this refers only to business
                       operations activities, or is it expected that such activities as system implementation and
                       maintenance will also be included?
           Response: The Core MMIS Contractor will utilize the design provided by the I&SS contractor to
                     install, test, implement and operate the WPM. The Core MMIS contractor will identify the
                     WPM that it will use for the IME. System implementation and maintenance activities will
                     be tracked in a separate system.
  RFP Section 1.4 and 4.1        p. 4 and 41      Summary of this RFP
    6      Question: For each bid component, please provide a list of ―new applications‖ that DHS is
                     anticipating to receive from bidders.
           Response: The State is not necessarily anticipating new applications, but vendors may want to bring
                     tools they use in their operations that are unique to the tasks they will perform.
  RFP Section 1.4 and 7.1          p. RFP Cover Summary of this RFP
                                       letter, 2
                                      and 476
     7     Question: The RFP cover letter and RFP section 1.4 reference the vision of an integrated Iowa
                     Medicaid Enterprise. Section 7.1 requires bidders to submit separate proposals for each
                     of up to 9 components. In order to improve bidders‘ ability to describe an integrated
                     approach to the project, and to reduce the volume of potentially redundant material that
                     the evaluators must review, will the state accept proposals for multiple components
                     consolidated into a single proposal package?
           Response: No. There will be separate evaluation teams who will be reviewing the separate
                     components, so each proposal must be complete and all information needed for the
                     evaluation must be included.
  RFP Section 2.5                p. 8 and 9       Procurement Timetable
    8      Question: Does the State anticipate that all components will begin implementation and operation at
                     the same time? In other words, will the successful Medical Services bidder be required to
                     interface with the current MMIS and POS vendors as well as the awarded MMIS and POS
                     vendors?
           Response: Other than portions of Section 6.7 (see amendment) and the PDL (see RFP MED-04-034),
                     each component contractor will begin the Implementation and Operations Phases
                     simultaneously. The Implementation Phase of the resultant Systems & Professional
                     Services contracts will begin on July 1, 2004. The Operations Phase of the contracts will
                     begin on June 30, 2005. Task M in the Procurement Timetable (Table 1) of Section 2.5 of
                     the RFP has been corrected in Amendment 2 with the correct date of July 1, 2004. All
                     Systems & Professional Services contractors will be responsible, at some level, for
                     interfacing with the current Fiscal Agent (ACS) for the purposes of final file transfers and
                     work in progress. This interfacing will be managed by DHS and the I&SS contractor.

                       6.7 Parts of 6.7 (get from Jim) and PDL are on different schedule.

  RFP Section 2.8              p. 10               Bidders' Questions and Requests for Clarification
    9      Question: May we obtain a list of all the bidders submitting questions for this procurement?



Response to Bidder Questions – Set 1                         February 23, 2004                              2 of 133
           Response: Yes. The following firms submitted questions:

                       AmeriChoice
                       Bull
                       Clifton Gunderson LLP
                       EDS
                       First Health
                       Health Care Excel
                       Heritage Information Systems
                       HMS
                       IFMC
                       MAXIMUS
                       Medstat
                       Myers & Stauffer
                       Noridian
                       PCG
                       PSI
                       Schaller Anderson
                       SXC Health Solutions
                       Unisys
                       UnitedHealthcare
                       White Rabbit Systems (ACS)

  RFP Section 2.8                p. 10            Bidders' Questions and Requests for Clarification
   10      Question: Will the State accept follow-up questions for three business days after the final answers
                     are provided on February 4, 2004?
           Response: Yes. The State will accept follow-up questions only regarding clarification of the
                     responses that are submitted within three business days from publication of the
                     responses. Bidders must identify the question number for which they are requesting
                     clarification. Questions not specifically related to clarification of the responses will not be
                     answered.
  RFP Section 2.12              p. 12.          Bid Proposal Opening
   11      Question: Who are the entities who have submitted Letters of Intent to Bid for each of the
                     components?
           Response: Please refer to the Department‘s web site www.dhs.state.ia.us under the publications section.
  RFP Section 2.27                p. 16             Review for Financial Viability
   12      Question: Please clarify that the ―third-party agency‖ which may participate in a bidder‘s review of
                     financial viability will be a unit of state government. If not, please identify other
                     organization(s) that DHS may use to perform this evaluation function.
           Response: This is a review of the bidder‘s financial viability, not a ―bidder‘s review.‖ The State may
                     engage the assistance of unrelated outside professionals such as university or other
                     entities with required skill sets. No points will be awarded for this review (See RFP Section
                      8.8).
  RFP Section 2.32, 5.1.6.3,       p. 17, 62,       Choice of Law and Forum
              6.1.6.3, 9.19.10,       312, 524,
              and 9.20.6              and 526
    13      Question: Can we assume that agreeing to the requirement that recognizes a DHS Director dispute
                      decision as ―final‖, does not constitute a waiver by the contractor of its remaining rights
                      at law and in equity, as provided for in sections 2.32 and 9.20.6.




Response to Bidder Questions – Set 1                          February 23, 2004                               3 of 133
           Response: The DHS Director's dispute decision is final for purposes of Iowa Code Chapter 17A. This
                     does not constitute a waiver by the Contractor of its rights at law and in equity.
  RFP Section 3.3.1               p. 22            Medicaid Management Information System (MMIS)
   14      Question: Are vendors bidding on the core MMIS component allowed to take over the automated
                     recipient eligibility system (REVS) and the electronic interface for POS transactions
                     (MEVS)?
           Response: For the MEVS that provides voice response (AVRS) to eligibility inquiries, DHS will
                     provide the telephone lines and access to the data. For the MEVS that provides electronic
                      response to eligibility inquiries, DHS will provide the server and access to the data. The
                     Core MMIS contractor will be responsible for the programming relating to updating the
                     these systems with the current eligibility data.
  RFP Section 3.3.1               p. 22              Medicaid Management Information System (MMIS)
   15      Question: If electronic eligibility is available through Pharmacy POS for pharmacy transactions only,
                     how does the current system support acceptance and response to HIPAA-required
                     270/271 transactions?
           Response: The electronic eligibility inquiry, 270/271 transactions, are available to all providers
                     through the MMIS. The POS system does not support the 270/271 transactions, but
                     eligibility data is verified when a pharmacy claim is submitted via the POS system.
  RFP Section 3.3.1             p. 23            Medicaid Management Information System (MMIS)
   16      Question: Will vendors bidding on the core MMIS component be allowed to take over the existing
                     COLD storage technology?
           Response: The State will have a COLD storage type technology available for the vendors to utilize.
  RFP Section 3.3.2             p. 23          Current MMIS Interfaces with Other Systems
   17      Question: What were the approximate 2002 and 2003 dollar amounts for the DHS contract with the
                     Iowa Foundation for Medical Care?
           Response: IFMC dollar amounts: 2002 = $4,508,059 and 2003 = $4,468,013.

                       The only IFMC functions that will be included in the IME contract are the Lock-In
                       functions. See RFP MED-04-034.
  RFP Section 3.3.2             p. 24          Current MMIS Interfaces with Other Systems
   18      Question: What were the approximate 2002 and 2003 dollar amounts for the DHS contract with
                     Health Management Associates?
           Response: Health Mgmt. Systems dollar amounts: 2002 = $1,344,156 and 2003 = $1,128,812
  RFP Section 3.3.3.3            p. 26            State Children's Health Insurance Program (SCHIP)
   19      Question: SCHIP – This paragraph states that the hawk-i program is currently performed by a
                     separate contractor. Please clarify whether SCHIP services will be performed by the
                     contractors selected from this procurement.
           Response: SCHIP is a federal funding source (Title XXI). In Iowa Title XXI funding is used to fund a
                     Medicaid expansion program and the hawk-i program. Medicaid expansion services are
                     included in this RFP, but hawk-i services are not.
  RFP Section 3.4.13.2           p. 38           Health Maintenance Organizations
   20      Question: Are recipients who are enrolled in the fully capitated HMO managed care program
                     disenrolled when private insurance is identified?
           Response: No. Our HMO contracts provide a right of recovery, so TPL information must be provided
                     to the HMOs.




Response to Bidder Questions – Set 1                          February 23, 2004                                 4 of 133
  RFP Section 3.4.16              p. 40            Other Medicaid-Related Contracts
   21      Question: Section 3.4.5 clearly states that the contract with HMS will be discontinued as a result of
                     this procurement. Please clarify which of the "Other Medicaid-related Contracts" in this
                     section will also be discontinued as part of this procurement.
           Response: Lock-In and RetroDUR will be included in the MED-04-034 RFP. Current Fiscal Consultant
                     activities will be discontinued as of July 2005, and the TPL recovery / Estate recovery
                     will be discontinued. LTC facility utilization, quality review, and pre-procedure reviews
                     will stay with the current contractor.
  RFP Section 3.4.16.1          p. 40           Iowa Foundation for Medical Care
   22      Question: What functions does the Iowa Foundation for Medical Care currently provide to the
                     managed health care programs (MediPass and HMOs)?
           Response: The Iowa Foundation for Medical Care provides External Quality Review (EQR) services
                     for MCOs and LSOs (Iowa Plan) on behalf of DHS.
  RFP Section 4.1                p. 41           Procurement Approach to Contractor Service
   23      Question: What level of support may a bidder‘s functional unit in Iowa, as participant in the
                     Medicaid Enterprise, be permitted to have from its other corporate affiliates and yet meet
                     the requirements of being ―capable of standalone operation?‖
           Response: All staff working on the IME project must be located in the Des Moines facility provided
                     by the State. Contractors may call upon corporate resources from time to time to assist in
                     their Iowa responsibilities, but not as part of the regular course of business.
  RFP Section 4.1, paragraph       p. 41            Procurement Approach to Contractor Service
              2
    24      Question: Will State staff or the contractor operate the Core MMIS application software? How will
                      the State address issues where another contractor‘s unique solution requires an interface
                      that was not envisioned? Will the State reimburse the contractor for additional efforts
                      required for the interface?
           Response: All vendor systems must interface with systems residing in the State Data Center.
                     Systems brought by the vendor, other than the Pharmacy POS system, must be loaded on
                     State hardware. The State will provide the hardware and will not reimburse a contractor for
                     operating systems separately from those operated at the State Data Center.
  RFP Section 4.1, paragraph       p. 41            Procurement Approach to Contractor Service
              3
    25      Question: The RFP states that ―Each component must be capable of standalone operation, on either
                      the vendor‘s hardware or at the State Data Center.‖ Are there any circumstances under
                      which the DW/DS would involve hardware not located in the State Data Center?
           Response: No.
  RFP Section 4.3               p. 43            System Integration
   26      Question: By bid component, please provide a listing of ―existing software applications‖ to be taken
                     over by successful bidders and subsequently ―upgraded?‖
           Response: See list of hardware and software in RFP Section 10.12 and the network diagram in
                     Attachment B of these responses.
  RFP Section 4.3 and 5.2.1.1 p. 43 and 73 System Integration
   27      Question: Section 4.3 states that the lead contractor (i.e., the Core MMIS contractor) will have
                     primary responsibility for system integration. Section 5.2.1.1 states that the I&SS
                     contractor will lead the coordination effort, including system integration. Please clarify
                     the respective roles of the Core MMIS contractor and the I&SS contractor with regard to




Response to Bidder Questions – Set 1                         February 23, 2004                             5 of 133
                       system integration. Do we correctly understand that the State will directly manage the
                       I&SS contractor and all IME contractors to ensure that they are meeting their obligations?
           Response: Yes, both will work together to achieve result. Yes, the State will directly manage the I&SS
                     and all IME contractors.
  RFP Section 4.3, paragraph       p. 44           System Integration
              3
    28     Question: When will the I&SS Contractor be selected? When will the selected I&SS Contractor‘s
                     activities commence?
           Response: The I&SS contractor will be selected and the contract will be awarded prior to the bids
                     being submitted for this RFP. The I&SS contractor will begin work on April 01, 2004.
  RFP Section 4.4               p. 44            System Architecture
   29      Question: The RFP states that ―The proposed State server for the Medicaid Data Warehouse /
                     Decision Support application is SQL-based.‖ What does this mean? Is it merely
                     proposed that the DW/DS server be SQL-based or is this a definite fact? Is it possible
                     that a UNIX server running Oracle or DB2 might be used?
           Response: The Data Warehouse/Decision Support application will be Microsoft Sequel server.
  RFP Section 4.5                p. 44          Provisions for HIPAA Compliance
   30      Question: Is the MMIS fully compliant with HIPAA privacy and 278 transaction requirements? If
                     not, what gaps exist?
           Response: The MMIS is compliant except for the HIPAA privacy requirements of amendment or
                     restriction. The Core MMIS is compliant with the 278 transaction requirements. Under the
                     new contract all requests for prior authorization will be submitted to the Medical Services
                     contractor through the MMIS, including requests for pharmacy PAs.
  RFP Section 4.5                p. 44            Provisions for HIPAA Compliance
   31      Question: Please provide the specific HIPAA transactions and claim types that must be supported
                     through the required Provider Billing software solution.
           Response: The software must provide, at a minimum, for the 837 Healthcare Claim Transactions -
                     Institutional, Professional and Dental transaction as well as the 835 Healthcare Claim
                     Payment/Advice transaction. The current WINASAP is HIPAA compliant.
  RFP Section 4.5                p. 44             Provisions for HIPAA Compliance
   32      Question: Please confirm the core MMIS vendor is required to provide only the software related to
                     provider submission of HIPAA compliant transactions. Also confirm that the provider
                     services contractor is to provide the training on that software plus any customer service
                     related to HIPAA.
           Response: The Core MMIS Contractor must provide the WEB portal for submission of claims and
                     claims status inquiry. The Core MMIS contractor must also provide software for claims
                     submission for providers who do not have access to the Internet or do not wish to use
                     the WEB portal. The Provider Services Contractor will provide training on the software
                     and will respond to questions regarding electronic claims submission. However, it is
                     expected that the Core MMIS Contractor will work with the Provider Services Contractor
                     to resolve technical issues related to electronic claims submission.
  RFP Section 4.5                p. 44           Provisions for HIPAA Compliance
   33      Question: Is current MMIS system fully HIPAA compliant for all transactions and code sets? If not
                     please specify which ones and why.
           Response: See answer to question # 98.




Response to Bidder Questions – Set 1                         February 23, 2004                             6 of 133
  RFP Section 4.5                p. 44            Provisions for HIPAA Compliance
   34      Question: The RFP states that the Core MMIS contractor will be required to build a Web portal or
                     connect to the Iowa Portal as part of their solution for allowing providers to submit
                     HIPAA-compliant X12 health care transactions. What is the Iowa Portal? How do
                     providers currently submit X12 transactions? Is a clearinghouse used? Is a translator
                     used? Please describe how providers will submit X12 transactions in the future to the
                     State data center. Who will be responsible for helping providers with their technical
                     questions regarding compliant formats, their file got rejected, etc.?
           Response: The Iowa Portal is the DHS portal that is currently used for access to the provider web
                     site. Currently X12 transactions are submitted using a clearing house and the Mercator
                     translator. The Core MMIS contractor will be required to provide the translator and
                     clearing house functionality, as well as Internet submission of claims and software to
                     replace the current WINASAP. Provider inquiries regarding claim submission will be
                     directed to the Provider Services contractor. The Core MMIS contractor will be required
                     to work with the Provider Services contractor to resolve technical questions about claims
                     submission.

  RFP Section 4.5                p. 44         Provisions for HIPAA Compliance
   35      Question: Are the current MMIS vendor's processes, procedures, and system compliant with
                     HIPAA privacy regulations?
           Response: Yes.
  RFP Section 4.5                p. 44             Provisions for HIPAA Compliance
   36      Question: Please confirm that the state will be responsible for ensuring that the facilities, network,
                     and hardware is compliant with HIPAA security regulations.
           Response: The facilities, network and hardware will be HIPAA compliant.
  RFP Section 4.5                p. 44              Provisions for HIPAA Compliance
   37      Question: Please expand on the requirements of the MMIS contractor to provide a WEB Portal for
                     allowing providers to submit HIPAA-compliant X12 Health Care transactions. Please
                     confirm that this is for a batch file upload/download capability.
           Response: The WEB portal must be capable of accepting single claims for real-time submission (not
                     real-time adjudication) as well as batch file upload/download capability. For the single
                     entry claims the application should provide edits for data content and validity similar to
                     the edits provided in an exam-entry function. For claims submitted through the WEB
                     portal, the system must return an error report if any errors are detected and an
                     acknowledgment of receipt when the claim is accepted by the system. The WEB portal
                     must also accomplish online claims inquiry.
  RFP Section 4.6                p. 45             Schedule
   38      Question: In order to maintain a level playing field for the evaluation of proposed implementation
                     schedules, how will DHS accomplish such evaluation parity in evaluating work plans
                     having proposed timeline alterations, by bid component?
           Response: Considering the 12-month timeframe of the implementation, it is unlikely that proposed
                     timeline alterations will vary significantly from the timeline proposed by the RFP. In its
                     evaluation of the draft project plan for contract phases, DHS will be evaluating how well
                     the bidder‘s work plan and its discussed approach to project management tie together.
                     Reasoning within a bidder‘s approach will present significant background as to why the
                     bidder has proposed an alternative timetable for implementation tasks.

                        The work plans are being required to present the bidders plan to complete the start-up
                        activities within the twelve-month implementation phase. Variations in schedules for these




Response to Bidder Questions – Set 1                           February 23, 2004                             7 of 133
                       activities within the implementation phase will not affect parity. Vendors will need to be
                       on-site as needed to participate in the coordination efforts.
  RFP Section 4.6, Figure 2        p. 46            Schedule
   39      Question: This figure indicates that on 1/1/05 exports of test data to the DW/DS will begin. How
                     does this fit with the statement in Section 5.4 DW/DS Component (page 262, paragraph 2)
                     that ―Prior to the contract awards resulting from this RFP, The Iowa Information
                     Technology Enterprise (ITE) plans to load Medicaid data, beginning with at least five (5)
                     years of historical data, to the current data warehouse.‖
           Response: Figure 2 has been amended to remove the 1/1/05 exports of test data. The MMIS data will
                     be loaded to the data warehouse prior to the contract start date of July 1, 2004.
  RFP Section 4.6, Figure 2       p. 46            Schedule
   40      Question: Figure 2 references a ―parallel test‖ that begins in April, 2005. We could find no reference
                     to such a test elsewhere in the RFP. Is a parallel test required and, if so, what is its
                     purpose?
           Response: DHS will conduct the parallel test for the MMIS prior to the contract start date of the IME.
                      The POS parallel test will be done by the contractor. See amendment to acceptance test
                     tasks for the POS system.
  RFP Section 4.6                 p. 47             Schedule
   41      Question: The RFP states that ―*DW/DS Bidder‘s Note: In the event of data integration delays,
                     DHS reserves the right to negotiate a later DDI start date for the Data Warehouse /
                     Decision Support Component. DHS estimates that the start date can be adjusted up to 3
                     months without jeopardizing the overall implementation timeline.‖ What does this mean?
                     What types of data integration delays are anticipated? The DDI for the DW/DS is
                     proposed to begin 8/15/04 according to Figure 2. What data integration delays would be
                     identified at this stage that might necessitate a DDI start date delay?
           Response: Development of the Data Warehouse/Decision Support component is on schedule for an
                     8/15/04 date. If unforeseen delays occur in the data integration this could include data
                     elements from the Core MMIS system.
  RFP Section 4.7.1.2 and          p. 48           Takeover Task
              4.7.1.3
    42      Question: How should a responsive bidder integrate the takeover task (paragraph 4.7.1.2) and
                      transfer task (paragraph 4.7.1.3) as described by these two paragraphs with the contractor
                      start-up activities included in RFP Section 6.2.1? Should they be included in the
                      development task (paragraph 6.2.1.2) for Professional Services components?
           Response: Yes. For Professional Services components, the takeover task and transfer task
                     responses related to relevant applications should be included in the development task.
  RFP Section 4.7.1.3            p. 48            Transfer Task
   43      Question: Please confirm that the ―live MMIS‖ is intended to remain on the incumbent contractor‘s
                     hardware through 6/30/05.
           Response: Yes, the ―live MMIS‖ will continue to reside on the incumbent Fiscal Agent contractor‘s
                     hardware at least through 6/30/05. In April through June of 2004, an exact replica ―test
                     MMIS‖ will be transferred to the State Data Center.
  RFP Section 4.7.2              p. 49             Operations Phase
   44      Question: During the Operations Phase, how will the State identify and apply appropriate monitoring
                     tools and activities to the contractors‘ respective responsibilities? Will the tools used by
                     the IS&S contractor be carried forward upon the termination of that contract to the
                     Operations Phase? Or does the State anticipate outsourcing these oversight activities at
                     that time? Please clarify.



Response to Bidder Questions – Set 1                          February 23, 2004                              8 of 133
           Response: The I&SS contractor will work with all component contractors during the start-up to
                     develop the monitoring tools and activities. During the first six months of operations, the
                     I&SS contractor will work with DHS and the contractors to monitor the operations using
                     the Workflow Process Management system and will then turn over the tools to DHS to
                     monitor contract activities during the operations phase of the contract.
  RFP Section 5.1.1.1             p. 51          Key Personnel To Be Named
   45      Question: If the bidder submits proposals for multiple components, may key staff be shared between
                      components?
           Response: No. See RFP Section 10.10 Attachment J: Certification of Available Resources for
                     requirements for shared resources.
  RFP Section 5.1.1.1             p. 52           Key Personnel To Be Named
   46      Question: If a contractor bids on more than one component, can the key staff named in one
                     component proposal be named as the key staff bid in another component proposal?
           Response: See question # 45.
  RFP Section 5.1.1.1            p. 52          Key Personnel To Be Named
   47      Question: The RFP states that the named positions for the Systems Components contractors are an
                     Account Manager; Implementation/System Manager and Operations Managers
                     (Minimum of two). What are the duties of the two Operations Managers for the DW/DS
                     contractor?
           Response: The System Manager for operations will be responsible for recommendations for system
                     modifications and the Operations Manager will assist users in developing queries.
  RFP Section 5.1.1.1              p. 53           Key Personnel To Be Named
   48      Question: Five required key personnel (four for ongoing operations) seems excessive for the POS
                     and Data Warehouse system components. Considering the total number of staff for these
                      activities, particularly compared to the Core MMIS system component, would DHS
                     consider reducing the key personnel requirements for these two system components?
           Response: The requirement is for four key personnel positions: two (an account manager and an
                     implementation manager) during the Implementation Phase, and three (an account
                     manager, a systems manager, and an operations manager) during operations. The systems
                     manager for operations may also serve as the implementation manager. No, the
                     Department will not consider reducing the key personnel for the POS and DW/DS
                     components and does not feel that the key personnel requirement is excessive for these
                     components..
  RFP Section 5.1.2 and 6.1.2 p. 56 and 283 Facility Requirements
   49      Question: Are individual vendors responsible for providing file cabinets, in addition to individual
                     workstation printers?
           Response: The State will provide normal office furnishings including file cabinets. If there are any
                     special needs, these should be identified by the bidder in the proposal.
  RFP Section 5.1.2 and 6.1.2 p. 56 and 283 Facility Requirements
   50      Question: Will DHS also provide and be responsible for physical building security?
           Response: Yes.
  RFP Section 5.1.2.1             p. 55            Temporary Offices during Implementation Phase
   51      Question: In order to reduce the cost to the state and to reduce the distractions of moving into and
                     out of temporary space, will the state allow bidders to use existing facilities outside of Des
                      Moines for portions of its development work during the period 7/1/04 through 1/1/05?
           Response: Yes, as long as contractor staff is available for meetings and interaction with other
                     component contractors. Portions of the development work that do not require


Response to Bidder Questions – Set 1                          February 23, 2004                              9 of 133
                       coordination and interaction with other components or DHS may be performed outside of
                       Iowa with the prior approval of the Department.
  RFP Section 5.1.2.1            p. 55            Temporary Offices during Implementation Phase
   52      Question: This paragraph states that cost overruns for temporary offices will not be billable to the
                     State. Pricing Schedule 2 in RFP Attachment K lists temporary office space as a fixed
                     price. Is temporary office space to be bid and billed on a fixed price or cost reimbursement
                      basis?
           Response: Within their total implementation cost, bidders should include a fixed price for temporary
                     office space that encompasses 7/1/04 to 7/1/05. On or about 1/1/05, State staff will be
                     migrated to the permanent IME facility. IME contractor staff will follow. In the event that
                     the contractors have not been migrated into the permanent IME facility by 7/1/05, the
                     State will reimburse contractors for continuing temporary office space expenses upon
                     delivery of a detailed invoice by the contractor.
  RFP Section 5.1.2.1           p. 55            Temporary Offices during Implementation Phase
   53      Question: The requirement to include in the bidder‘s cost proposal the acquisition, furnishing, and
                     maintenance of temporary facilities provides an apparent cost advantage to the
                     incumbent. Will the State‘s evaluation procedures account for this advantage?
           Response: DHS believes that there is a standard cost associated with housing any personnel at an
                     existing or new facility. As such, DHS does not believe the current contractor is
                     advantaged in this procurement.
  RFP Section 5.1.2.2              p. 55 and 56 Permanent Facilities
   54      Question: Who will be responsible for the day-to-day maintenance costs (i.e., up-keep, janitorial,
                     electrical, air conditioning, trash removal, re-cycling) of the State owned facility? Will the
                     State provide 7 x 24 security for the premises? If so, what security will be provided? Who
                      will be responsible for any changes to the floor plan in later years as a result of changes
                     to staff levels that commonly occur during the course of a contract? Will the successful
                     bidders be involved with the State during the process of obtaining permanent space so
                     that all points that could be encompassed in the terms and conditions of the agreement
                     for maintaining the facility are addressed?
           Response: The State will be responsible for the day-to-day maintenance costs for the facility. Yes,
                     the State will provide 7 x 24 security for the premises. Bidder views will be considered, but
                     the State will make the final decisions. The State will be responsible for securing the
                     building. The component contractors should identify any special layout and maintenance
                     needs in their proposals.
  RFP Section 5.1.2.2 and 5.1.5 p. 55 and 58 Permanent Facilities
   55      Question: Please confirm that the maintenance and enhancement responsibilities of the systems
                     contractors are limited to the MMIS, POS, and DW/DS applications, and that State staff
                     will be responsible for maintenance of all hardware, system software, network, and
                     communications infrastructure.
           Response: Yes, the contractors will only be responsible for system maintenance and enhancements
                     to the MMIS and DW/DS applications. The Pharmacy POS contractor will be responsible
                     will be responsible for maintenance of hardware, system software, network, and
                     communications infrastructure for the POS system.
  RFP Section 5.1.2.2.1          p. 55             State Responsibilities
   56      Question: Throughout Section 5 "System Components and Operational Requirements" numerous
                     system-generated high volume publications/reports, such as Remittance and Status
                     Reports, are generated. Please confirm that the state will supply a high volume printing
                     and distribution center for these items. If not, will vendors be responsible for including




Response to Bidder Questions – Set 1                          February 23, 2004                            10 of 133
                       the cost of a printing and distribution center to interface with the MMIS in generation of
                       these reports?
           Response: The State Data Center will print the high volume reports.
  RFP Section 5.1.2.2.1, bullet 3 p. 55             State Responsibilities
    57      Question: Will the State provide all network connections, hubs, routers and other necessary
                      hardware to support the contractor‘s technical infrastructure? If yes, what hardware will
                      be used to establish the environment? If no, at what point will the State expect the
                      contractor to access the State‘s network?
           Response: Contractors will be co-located in a State facility. The State will provide network and
                     infrastructure connectivity.
  RFP Section 5.1.2.2.1, bullet 5 p. 55             State Responsibilities
    58      Question: What commercially available (COTS) software packages and licenses will the State
                      provide for contractor use? Will COTS upgrades be provided during the contract? If so,
                      how often will software releases be provided (i.e. software will be upgraded to agree with
                      the current software release levels)?
           Response: See response to question # 272. DHS will determine when software upgrades will be done.
  RFP Section 5.1.2.2.1            p. 55 and 56 State Responsibilities
   59      Question: Will the State provide at their cost all maintenance support for the equipment listed in this
                      section? What type of maintenance support is being contemplated (on-site response
                     times, etc.) in the event of an outage? In addition to meeting space, will the State provide
                     employee break rooms, on-site storage, off-site storage, staff/employee training labs and
                     other specialized space requirements that is normally included in bidder lease rates and
                     space requirements?
           Response: Yes, the State will provide maintenance for the equipment and will have maintenance
                     contracts on them with standard response time requirements. There will be common areas
                     for the other items identified. However, if there are specialized space needs for the
                     vendors business functions, the bidder should specify these in its proposal.
  RFP Section 5.1.2.3             p. 56             Contingency Plan
   60      Question: Bidders (except the incumbent) will have to take into consideration in their fixed prices the
                      cost risk for the prospect of the State exercising the Contingency Plan referred to in
                     Section 5.1.2.3 where the leassor may require additional cost protection to obligate space
                     for a period that is longer than needed. Will the contractor be reimbursed for the costs
                     related to providing a contingency site if that site is never activated? Will the State
                     exclude bidders costs for temporary space from the price evaluation so that all bidders are
                     evaluated equitably?
           Response: DHS does not believe the current contractor is advantaged in this procurement. As such,
                     DHS will not exclude bidders costs for temporary space from the price evaluation.
                     Contractors are expected to maintain their temporary office space from 7/1/04 to 7/1/05. In
                     the event that the contractor has not moved into the permanent IME facility by 7/1/05,
                     DHS will reimburse the contractor for related leasing costs upon receipt of a detailed
                     invoice from the contractor.
  RFP Section 5.1.3              p. 56             Location of Activities
   61      Question: The RFP states that ―DHS expects all staff directly associated with the provision of
                     contract services to the Iowa Medicaid Enterprise will be located at the Iowa Medicaid
                     Enterprise facilities.‖ What does DHS mean by ―directly associated with‖? If DHS is
                     seeking ―Best of Breed‖ contractors then much valuable expertise and capabilities will not
                      necessarily be located on site. Is DHS interested in ―Best of Breed‖ contractors or simply
                      a ―body shop‖ broker that can provide contract staff?



Response to Bidder Questions – Set 1                          February 23, 2004                             11 of 133
           Response: DHS wants to have the expertise and capability on-site for work on the IME contract.
  RFP Section 5.1.3             p. 56          Location of Activities
   62      Question: Why is the POS system an exception to the on-site staffing requirement?
           Response: The exception was made because the POS system will be off-site. When DHS made the
                     decision to move MMIS to State hardware, it was determined that the preference was to
                     stabilize the MMIS application on State hardware while continuing to allow the POS to
                     reside off State hardware for capacity reasons. Maintenance staff to support the off-site
                     POS system can be off-site. The POS account manager and operations manager must be
                     on-site.
  RFP Section 5.1.3 and 6.1.3 p. 57 and 298 Location of Activities
   63      Question: It is clear that all staff must be located in the Des Moines facility to ensure communication
                      and optimize working relationships. There are some support activities required that are
                     not full time positions and/or require special skill sets. This may include support for
                     proprietary software products that are typically supported from a central location. Is this
                     acceptable?
           Response: All work on the IME contract must be performed on-site at the Des Moines facility, with
                     the exception of the Pharmacy POS component which may include an off-site system.
                     However, the POS account manager and operations manager must be on-site. The
                     systems manager for the POS may be off-site where the systems staff is located as long as
                      the systems manager is available in Des Moines for project meetings.
  RFP Section 5.1.4.2             p. 57            Contractor Responsibilities
   64      Question: Please clarify the division of responsibilities between the Core MMIS contractor and the
                     I&SS contractor for reporting on compliance with performance standards.
           Response: The I&SS will assist in setting up the reporting system and will assist DHS and the
                     vendors in reporting on compliance during the first 6 months of operation. After the first 6
                     months of operation, each vendor will provide appropriate reports from the system and
                     DHS will perform the monitoring.
  RFP Section 5.1.5             p. 58             System Maintenance and Enhancement
   65      Question: Will system maintenance activities be performed at the State‘s cost or at the contractor‘s
                     cost? In addition to the seven items listed in 5.1.5.1, what activities will be considered
                     system maintenance activities?
           Response: System maintenance will be performed as part of the Contractor's fixed price. None.
  RFP Section 5.1.5              p. 58 to 60     System Maintenance and Enhancement
   66      Question: How many enhancement hours does the state anticipate per year? How many FTEs are
                     currently assigned to the ACS maintenance team by position?
           Response: There is no information available on the number of enhancement hours to be anticipated.
                     The current fiscal agent has 1 systems manager and 8 programmer analysts.
  RFP Section 5.1.5.1            p. 58 and 59 System Maintenance
   67      Question: Please confirm that all activities described in 5.1.5.1, except those described in 5.1.5.2
                     (System Enhancement), are currently being performed by the MMIS vendor on the
                     existing MMIS system.
           Response: Not all of these items were specified as maintenance items in the current contract. Under
                     the new contract these will be included in maintenance.
  RFP Section 5.1.5.1.3           p. 59             System Maintenance
   68      Question: Will the state ensure that all data, files, programs, and documentation are current and
                     accurate upon turnover to the new contractor? If not, will the state consider an effort to
                     make these items current and accurate as a system enhancement?



Response to Bidder Questions – Set 1                          February 23, 2004                             12 of 133
           Response: This will be a function of the I&SS contractor. Yes, it is the State‘s intent to ensure the
                     accuracy of the listed items. If not, the effort to make the corrections will be enhancements
                     under RFP Section 5.1.5.
  RFP Section 5.1.5.2            p. 60             System Enhancement
   69      Question: Please confirm that the MMIS Valid Values Booklet will be current and up to date as of
                     June 30, 2004. If not, will the state consider an effort to make it current as a system
                     enhancement?
           Response: Yes, the I&SS contractor will ensure that this is up to date.
  RFP Section 5.1.6              p. 61 to 65     Performance-Based Contracts and Damages for
   70      Question: Please confirm the core MMIS contractor will not be liable for failure to meet performance
                     standards associated with non-MMIS hardware/software application deficiencies.
           Response: True, the new contractor will not be liable for meeting performance standards associated
                     with non-MMIS hardware/software application deficiencies.
  RFP Section 5.1.6.5.1          p. 64           System Availability and Response Time
   71      Question: Please confirm that system availability and response time performance requirements do
                     not apply to components 1 and 3 since the state is supplying the hardware and network
                     for these components.
           Response: Yes.
  RFP Section 5.1.6.5.1.1         p. 64             User Access
   72      Question: The RFP states that the MMIS, POS, automated eligibility verification system and the data
                     warehouse must be available for users 98% of the hours between 7:00 a.m. and 6:00 p.m.
                     Do we correctly assume this only applies to the POS vendor, because the MMIS and data
                     warehouse will reside in the State data center and vendors will have no control over
                     availability? Similarly, would the reports to indicate availability would only apply to POS?
                     This section also states that the MMIS must be available for 95% of the remaining hours
                     between 7:00 PM to 6:00 AM, although the contractor may schedule maintenance during
                     the off hours. The hours between 7:00 PM to 6:00 AM are usually reserved for running
                     adjudication cycles, eligibility updates, etc. and require that the MMIS be unavailable. Is
                     the system counted as ―available‖ if batch update functions are being run during these
                     hours?
           Response: Yes to all questions.
  RFP Section 5.1.6.5.2          p. 65           Timeliness of Check-write File and Provider
   73      Question: Please confirm that no damages will be assessed if failure to provide the check-write file
                     on time is due to system problems beyond the contractor‘s control.
           Response: That is confirmed.
  RFP Section 5.1.8               p. 67           Training
   74      Question: Can training materials, including training manuals and visual aids, be provided
                     electronically?
           Response: Yes.
  RFP Section 5.1.9              p. 67            Documentation
   75      Question: Does DHS expect a full copy of documentation on 24-pound plain white bond paper each
                     time revisions are made, or just the revision pages?
           Response: Just revision pages as long as there is an adequate change control procedure to identify
                     when changes were made and a history of changes.




Response to Bidder Questions – Set 1                         February 23, 2004                            13 of 133
  RFP Section 5.1.9                p. 67           Documentation
   76      Question: Is the state going to provide the hardware and consumable supplies (paper, toner,
                     binders, and high-speed printers) to meet all documentation requirements?
           Response: Yes.
  RFP Section 5.1.9            p. 67         Documentation
   77      Question: Can Web-based documentation be used to meet the requirements?
           Response: Yes, but the costs should be included in the bidders proposal and one printed copy will
                     still need to be produced.
  RFP Section 5.1.9               p. 67           Documentation
   78      Question: To reduce expenses, would the state consider documentation and revisions exclusively in
                     electronic format to meet requirements in 5.1.9?
          Response: No.
  RFP Section 5.1.9            p. 67          Documentation
   79      Question: Can DHS provide a sample of the prescribed format required for documentation changes?

           Response: There is no sample format available. The bidder should identify in the proposal its
                     standards for documentation updates and change control. DHS will review and approve
                     the documentation standards plan presented by the contractor as a deliverable during the
                     Planning Task.
  RFP Section 5.1.9              p. 67           Documentation
   80      Question: Will DHS consider an alternative method of indicating documentation revisions if an
                     electronic documentation tool is used and provided revisions are clearly indicated?
           Response: The vendor may propose an alternative for consideration by DHS as long as it meets the
                     requirements of clearly identifying changes and maintaining version control of both
                     electronic and hardcopy documentation.
  RFP Section 5.1.9.1            p. 68            System Documentation
   81      Question: Please provide the number of copies of operations manuals (and the number of pages),
                     including data entry manuals, screening and coding manuals, and JCL, that have been
                     requested in the past year? Does DHS expect this to increase under the multiple
                     contractor model?
           Response: We expect the contractor to maintain the updated documentation electronically and each
                     component contractor will print the requisite number of hardcopies they need from the
                     electronic files. There will be an electronic library that will contain all documentation, and
                     all vendors will need to provide their documentation to the electronic library.
  RFP Section 5.1.9.3            p. 68          Software Development Documentation
   82      Question: Can we assume the provision of Software Development Documentation would apply only
                     to software developed and paid for under the proposed contract (vs. code developed at
                     private expense)?
           Response: This provision applies to any software that is run by the State Data Center.
  RFP Section 5.1.9.3             p. 68          Software Development Documentation
   83      Question: Please provide the number of copies, media, and size (number of pages or electronic file
                     size) of Software Development Documentation of applications that have been requested
                     in the past year. Does DHS expect this to increase under the multiple contractor model?
           Response: DHS expects all contractors to provide and maintain the specified documentation in
                     accordance with the requirements of RFP Section 5.1.9, that is to provide the
                     documentation in electronic form and provide one hardcopy to DHS. Documentation will
                     reside in the electronic library and additional copies will be generated appropriately.


Response to Bidder Questions – Set 1                          February 23, 2004                            14 of 133
  RFP Section 5.1.9.4             p. 68            Disaster Recovery and Back-Up Planning
   84      Question: Please clarify the responsibilities of the Core MMIS contractor and DHS with regard to
                     disaster recovery. If the MMIS resides on state-owned hardware in the state's data center,
                     does the state have backup procedures and storage facilities in place today that will be
                     maintained after contract award? What is the estimated number of tapes, files, and storage
                      needed to support backup activities?
           Response: The Core MMIS contractor will be responsible for that portion of the disaster recovery
                     plan related to ensuring complete, accurate, and current system documentation and
                     operating procedures, the detailed schedule for backing up critical files, and backup for
                     continuous operation of its contract responsibilities in the event of a disaster. The Core
                     MMIS contractor will need to work with the State ITE to review and revise the state data
                     center backup and recovery plan to ensure that all MMIS activities are included in the
                     plan. The State is responsible for providing the facilities, which includes the tapes, files,
                     and storage necessary to support the backup activities referenced in the backup and
                     recovery plan. See also question # 87.

  RFP Section 5.1.9.4             p. 68              Disaster Recovery and Back-Up Planning
   85      Question: Please confirm that the scope of the core MMIS contractor's responsibilities is to develop
                     the disaster recovery plan but that actual operational activity and equipment associated
                     with that plan is the state's responsibility.
           Response: In the event of a disaster the Core MMIS contractor is responsible for the re-build of the
                     MMIS application. The State is responsible for the recovery of the hardware and other
                     associated software applications.
  RFP Section 5.1.9.4            p. 68             Disaster Recovery and Back-Up Planning
   86      Question: For each of the nine bid components, please specify the required recovery timeframes.
                     Please verify that this section applies only to the MMIS system and not to any
                     operational business continuity requirements.
           Response: All contractors will need to provide a plan, including a business continuity plan for
                     operational functions and the items identified in RFP Section 5.1.9.4 and 6.1.4.4.3. DHS will
                      provide the plan for the MMIS and DW/DS systems. The POS component contractor will
                     need to provide a complete disaster recovery and back-up plan for its system and
                     operation.
  RFP Section 5.1.9.4 and          p. 68-69         Disaster Recovery and Back-Up Planning
              5.2.1.1.1.2,
              bullet 6
    87     Question: Since all operations will take place on state premises, please clarify contractor
                     responsibilities for disaster recovery planning. Who is responsible for identifying backup
                      sites for (a) the MMIS and DW/DS systems that are operating on state hardware and (b)
                     business operations conducted in the state‘s IME location? Who is responsible for
                     development of the detailed recovery plans for (a) system operations and (b) business
                     operations?
           Response: All of these will be State responsibilities for the MMIS and DW/DS components. The
                     Pharmacy POS contractor will be responsible for all of these items for the POS system and
                     operations. As mentioned in the response to Question 86, all contractors will need to
                     provide a plan, including a business continuity plan for operational functions and the
                     items identified in RFP Section 5.1.9.4 and 6.1.4.4.3. DHS will provide the plan for the
                     MMIS and DW/DS systems. The POS component contractor will need to provide a
                     complete disaster recovery and back-up plan for its system and operation.




Response to Bidder Questions – Set 1                          February 23, 2004                             15 of 133
  RFP Section 5.1.10              p. 69           Security and Confidentiality Requirements
   88      Question: According to the National Institute of Standards and Technology, FIPS PUB 41 has been
                     withdrawn. Would the State consider an approach to Privacy that meets all requirements
                     specifically stated in the RFP and also meets all requirements laid out in the HIPAA
                     Privacy rule?
           Response: Yes.
  RFP Section 5.1.10              p. 69             Security and Confidentiality Requirements
   89      Question: The RFP states that the contractor must provide physical site and data security sufficient
                     to safeguard the operation and integrity of the MMIS. What responsibility does the
                     contractor have for physical security at the State data center that houses the MMIS and
                     DW/DS systems? What responsibility does the contractor have for physical security at
                     the IME building? What is the division of responsibility between state and contractor
                     staff for data security in systems running at the State data center?
           Response: Each MMIS component contractor will have responsibility for ensuring that their area of
                     the IME facility remains secure, including following IME-wide physical and data security
                     procedures provided by DHS, ensuring that all staff is trained in the security procedures,
                     and complying with the safeguards identified in Section 5.1.10. DHS retains physical
                     security responsibility for the mainframe system and will implement access security
                     measures. The contractors‘ staff will be responsible to follow all prescribed physical and
                     data access security measures implemented by the state.
  RFP Section 5.1.10 and 6.1.10 p. 69 and 317 Security and Confidentiality Requirements
    90      Question: This question applies to all components of the RFP. On Page 69, Section 5.1.10, Security
                      and Confidentiality Requirements and Page 317, Section 6.1.10, Security and
                      Confidentiality Requirements, state that "The contractor must provide physical site and
                      data security sufficient to safeguard the operation and integrity of the MMIS [and the
                      Iowa Medicaid Enterprise]." Questions: Does the requirement for physical site and data
                      security apply only to the contractor's temporary offices during the implementation
                      phase? Will the Department be responsible for physical site and data security after all
                      contractors move in to the state-provided permanent facilities in January, 2005?
           Response: See question # 89. The contractor will be responsible for physical site and data security
                     for the contractor's temporary office during the implementation phase.
  RFP Section 5.1.11              p. 70           Accounting Requirements
   91      Question: Please clarify that the accounting records may be maintained in the same electronic
                     database or system as the contractor's other financial records as long as the records
                     maintained for this contract are easily identifiable and can be reported on and viewed
                     separately.
           Response: Yes, the accounting records may be maintained in the same electronic database as the
                     contractor's other financial records as long as the records maintained for this contract are
                     identifiable and can be reported and reviewed separately.
  RFP Section 5.1.11 and 5.1.12 p. 70               Accounting Requirements
    92      Question: This section requests that "records be maintained separate and independent of other
                      accounting records of the contractor." Please confirm that bidders will not need to set up
                      separate corporate entities for this contract.
           Response: Bidders will not need to set up separate corporate entities for this contract. See also
                     question # 91.




Response to Bidder Questions – Set 1                          February 23, 2004                                16 of 133
  RFP Section 5.2, 5.2.2.3.4.2, p. 72, 120,          Core MMIS Component
              bullet 60, and       and 217
              Section 5.2.2.15
    93      Question: The RFP states that the Core MMIS contractor will provide and maintain an imaging
                      system. The servers and jukeboxes for these systems need to be in a temperature-
                      controlled environment. Where does the State envision this equipment will be located
                      and will the vendor have 24/7 access to the equipment for maintenance? In addition,
                      software must be installed on the desktop in order to retrieve the images. For
                      licensing/costing purposes, how many users will need this software to retrieve images?
            Response: The bidder should describe the climate control requirements in its proposal. The State will
                      determine where the equipment will be located as part of the development of the IME floor
                      plan. The vendor will have access for maintenance. There will be approximately 250 users.
  RFP Section 5.2.1.1,              p. 73            Planning Task
              paragraph 1
    94      Question: How will contractors be reimbursed for activities directed by the I&SS contractor which
                      are not required by DHS in this contract?
            Response: The ISS contractor will only be directing activities that are required by DHS in the
                      contract. However, in the event that there is a dispute, the dispute will be resolved
                      according to the dispute resolution procedures identified in the RFP.
  RFP Section 5.2.1.1.1         p. 74           Planning Task Activities
   95      Question: What media does the state anticipate using for the twice monthly updates to the Detailed
                     Work Plan?
            Response: Electronic.
  RFP Section 5.2.1.1.1.1        p. 74            State Responsibilities
   96      Question: What is the process for obtaining approval of the project team?
            Response: DHS will review the team proposed by the successful vendor during the proposal
                      evaluation process and the oral presentations. Final review and approval will be done
                      during contract negotiations.
  RFP Section 5.2.1.1.1.2          p. 75           Contractor Responsibilities
   97      Question: Is it acceptable for contractor staff to be initially located at a facility other than the DHS
                     facility as long as the contractor staff are moved to the DHS facility by the start of the
                     Operational Readiness Testing Activities?
            Response: No. DHS will identify the schedule for relocation to the IME facility during the
                      Implementation Phase of the contract.
  RFP Section 5.2.1.1.1.3         p. 74          Deliverables
   98      Question: Is the current MMIS HIPAA compliant? If so, what portion of the system or interfaces
                     does DHS anticipate requiring HIPAA conversion?
            Response: The current MMIS is HIPAA compliant for the transactions finalized as of 10-1-03, except
                      it cannot accept a modifier on the 837 I claim. The solution for compliance includes a
                      clearing house and the Mercator translator. Also the Core MMIS does not process the
                      834 transactions. These are generated by the Title XIX system to the MCOs.
  RFP Section 5.2.1.2.2 and        p. 76 and 189 Enhancements and New Requirements Sub Task
               5.2.2.10.4.1
   99      Question: On page 76 it is stated that the enhancements include ‗reports production and storage in
                      electronic format accessible from the user‘s desktop.‘ On page 189 it is stated that the
                      contractor must ‗Maintain historical file records using COLD Storage capabilities at the
                      State Data Center‘. Is the Core MMIS contractor responsible for purchasing the hardware



Response to Bidder Questions – Set 1                            February 23, 2004                             17 of 133
                       and software for COLD? The servers and jukeboxes for these systems need to be in a
                       temperature-controlled environment. Where does the State envision this equipment will
                       be located and will the vendor have 24/7 access to the equipment for maintenance? In
                       addition, does this mean ALL reports produced by the MMIS need to be accessible from
                       the user‘s desktop. How many generations of the reports must be stored? How many
                       users will need desktop software to access the reports?
           Response: The State will provide the hardware and software for COLD storage type technology. All
                     reports need to be accessible from the user desktop. The State will determine the number
                     of generations and desktop software. The contractor will not be doing maintenance on
                     this system.
  RFP Section 5.2.1.2.3.3,         p. 78            Deliverables
              bullet 1
   100     Question: Does a data model exist today that is to be updated for enhancements or is the data model
                     for the full MMIS to be created from scratch?
           Response: The contractor will need to build the data model.
  RFP Section 5.2.1.2.3.3,         p. 78            Deliverables
              bullet 2
   101     Question: Do entity relationship diagrams (ERD) exist today that are to be updated for
                     enhancements or is the ERD for the full MMIS to be created from scratch?
           Response: The contractor will need to build the ERD.
  RFP Section 5.2.1.2.4           p. 78          System Design Activity
   102     Question: Is the contractor for Component 1 responsible for ensuring only that Component 1 can be
                     certified by CMS, or are they responsible for ensuring that the whole MMIS can be
                     certified?
           Response: With the exception of the POS system, all elements of certification are included in the Core
                     MMIS. Therefore, the contractor for Component 1 (the Core MMIS Contractor) will be
                     responsible for ensuring that the entire MMIS can be certified. This will include working
                     with other component contractors whose functions are included in the certification
                     review.
  RFP Section 5.2.1.2.4.3,         p. 80            Deliverables
              bullet 7
   103     Question: Is the business information model referred to in this requirement the same as the business
                     process model referred to in 5.2.1.2.3.3.2?
           Response: Yes.
  RFP Section 5.2.1.2.4.3,       p. 80 and 227 Deliverables
               bullets 7 and 8,
               and Section
               5.3.1.2.
   104     Question: Please provide further information on what is meant by a ―Business information model‖
                      and ―Information system model‖. What information should these models contain?
           Response: The business information model is a diagram that illustrates the automated and manual
                     functions, including edits and audits for each of the input and processing systems and
                     the interfaces between the automated and manual functions. The information system
                     model is the data model for the system and business processes, including data elements
                     to be captured in each function, their derivation, source, validation, definition, residence,
                     and use.




Response to Bidder Questions – Set 1                          February 23, 2004                             18 of 133
  RFP Section 5.2.1.2.5           p. 80            System Development and Testing Activity
   105     Question: Will the state ensure that resources are available to attend walkthroughs and provide
                     timely approval of the test results?
           Response: At mutually agreeable time frames as identified in the approved Work Plan.
  RFP Section 5.2.1.2.5,           p. 80 and 87      System Development and Testing Activity
              5.2.1.4.1,              to 92
              5.2.1.4.2, and
              5.2.1.4.3
   106     Question: It appears that there are will be at least four different stages to the system testing effort --
                     System/Integration test, Structured system test, Operational Readiness and Operability
                     test, and Pilot test. It appears that each of these stages is intended to test the entire
                     system, so a significant period of elapsed time will be required for each. Does the state
                     require that these tests be conducted consecutively? Will the state accept alternative
                     approaches to testing? For example, could testing stages be combined or overlapped?
                     Since these tests will likely involve multiple contractors, will the State or the I&SS
                     contractor be responsible for the overall testing plan?

           Response: System/Integration testing will be done by the Core MMIS contractor for the
                     enhancements developed by the contractor. The structured system test will be done after
                     all Core MMIS enhancements have been completed. The Operational Readiness and
                     Operability Test is the final stage of acceptance testing and tests all interfaces and
                     operational procedures in addition to the system functionality. These tests cannot be
                     done concurrently. The Pilot Test could be done concurrently with the Operational
                     Readiness and Operability Test if the contractor can show that the Pilot Test will not
                     conflict with the Operational Readiness and Operability Test. Yes, each contractor will
                     contribute to the overall test plan for its areas of responsibility, but the I&SS contractor
                     will be responsible for integrating all of the plans into an overall test plan. These are
                     standard testing requirements and the State expects all tests to be conducted as specified
                     in the RFP.

  RFP Section 5.2.1.2.5.2,         p. 82             Contractor Responsibilities
              bullet 15
   107     Question: Are the quality control procedures specific to the system development and testing
                     activities or the future MMIS operation?
           Response: The quality control procedures apply to both system development and testing activities
                     and to MMIS operations.
  RFP Section 5.2.1.3.2           p. 85           HIPAA Conversion Activity
   108     Question: Does "The Core MMIS contractor, if not the incumbent, will be responsible for bringing a
                     HIPAA compliant "front end" to meet requirements for accepting and processing all ANSI
                      X12 standard transactions, and using HIPAA compliant code sets" mean we are to bring
                     a translator clearinghouse solution?
           Response: Yes. See question # 111.
  RFP Section 5.2.1.3.2         p. 85            HIPAA Conversion Activity
   109     Question: Does the system need to be able to accept and process both HIPAA-compliant and non-
                     HIPAA-compliant transactions concurrently?
           Response: Currently the system accepts both, but we anticipate that by the implementation of the
                     new contracts all transactions will be HIPAA compliant.
  RFP Section 5.2.1.3.2        p. 85         HIPAA Conversion Activity
   110     Question: How is HIPAA compliance achieved today?




Response to Bidder Questions – Set 1                           February 23, 2004                               19 of 133
           Response: Iowa uses a clearinghouse translator front end and back end HIPAA solution, translating
                     the HIPAA formats into the Proprietary format used in the MMIS. The format out of the
                     MMIS is a proprietary format sent back to the translator and translating it into HIPAA
                     compliant transactions to be sent to providers. Also small providers have been given
                     HIPAA compliant software to submit their claims.
  RFP Section 5.2.1.3.2          p. 85            HIPAA Conversion Activity
   111     Question: The RFP states that the Core MMIS contractor will be responsible for bringing a HIPAA
                     compliant ‗front-end‘ to meet requirements for accepting and processing all X12 standard
                     transactions. Please describe this requirement in more detail and describe the current
                     environment.
           Response: Currently the incumbent contractor uses the Mercator translator with a clearing house for
                     processing standard X12 claims transactions. The Core MMIS contractor will need to
                     provide the Mercator translator or another translator and clearing house services for
                     processing of X12 standard transactions.
  RFP Section 5.2.1.3.2.2,         p. 86            Contractor Responsibilities
              bullet 3
   112      Question: Are providers required to submit HIPAA-compliant transactions? If not, what alternatives
                      are available?
           Response: See question # 109.
  RFP Section 5.2.1.4             p. 86             Acceptance Test Task
   113     Question: Will the state provide a full range of test environments for the MMIS?
           Response: Yes.
  RFP Section 5.2.1.4.1.1,         p. 88            State Responsibilities
              bullet 4
   114      Question: To produce a comprehensive test plan that provides accurate completion dates, can DHS
                      provide guidelines to the time required for DHS staff to review and approve test results?
           Response: DHS will review and approve test results within 10 business days from receipt of the test
                     results.
  RFP Section 5.2.1.4.1.3,        p. 89          Deliverables
               bullet 7
   115     Question: Is a current Disaster Recovery Plan available? Is it up-to-date? Has it been tested? What
                      were the test results?
           Response: See response to question # 87 for further information.
  RFP Section 5.2.1.4.2            p. 89            Operational Readiness and Operability Testing
   116 1000 Question: Are the Operational Readiness and Operability Tests intended to be two separate tests or
                      a single testing process verifying the areas listed on page 89 of the RFP?
           Response: This is intended to be a single test that will verify that all systems are ready to begin
                     operations, that all component contractor processes and procedures are in place, and that
                     all system interfaces and telecommunications links are operational.
  RFP Section 5.2.1.4.3           p. 92             Pilot Test Activity
   117     Question: Is it DHS' intent that the pilot test produce "live" payments? In other words will the claims
                     processed and the payments produced by the pilot test system actually result in
                     payments to the provider, or are these providers submitting their claims to both the pilot
                     test system and the actual production MMIS system?
           Response: The intent of the pilot test is to perform a full operational test including producing
                     payments to providers. The claims processed and the payments produced will actually
                     result in payments to the providers. For the pilot test, the selected providers will be



Response to Bidder Questions – Set 1                          February 23, 2004                            20 of 133
                       submitting live claims only through the new IME and will not duplicate the claims in the
                       ACS production system.
  RFP Section 5.2.1.4.3.1,         p. 92           State Responsibilities
              bullet 2
   118     Question: Will DHS mandate provider participation in the Pilot Test?
           Response: The contractor will work with providers and provider associations to solicit volunteers to
                     participate.
  RFP Section 5.2.1.5              p. 93          Implementation Task
   119     Question: The RFP states that the Core MMIS contractor will also take the lead in preparing the
                     MMIS-related components to collectively meet CMS MMIS certification requirements. It
                     also states that the Department will require that the contractor prepare for and participate
                     in the certification of the MMIS. Since this procurement is a takeover of a certified MMIS
                     (with some modifications,) does the system have to be recertified by CMS?
           Response: Yes. CMS has mandated that the system be re-certified. The current system is certified, so
                     the risk is relatively small.
  RFP Section 5.2.2.2.4           p. 100          Contractor Responsibilities
   120     Question: The RFP states in #6 that the contractor must provide online access to the MMIS
                     provider files through terminals and networked personal computers located in the State
                     offices in Des Moines. It also states that the contractor must provide direct connection
                     from the State data center to the DHS LAN. Since the MMIS is located in the State Data
                     Center, and operations will be located on State premises, why is the State not responsible
                     for providing this connectivity?
           Response: The State ITE will be responsible for connectivity.
  RFP Section 5.2.2.2.4, bullet 6 p. 100         Contractor Responsibilities
   121     Question: Does the State currently provide direct connection from the State Data Center to the DHS
                     LAN? If so, will the State continue to provide this connection in the future?
           Response: Yes to both questions.
  RFP Section 5.2.2.3,             p. 106          Claims Processing Function
              Enhancements
              paragraph
   122     Question: In reference to the statement, ―The current claims processing operation produces
                     microfilm copies of all claims and related attachments‖, will the new contractor be required
                      to maintain the current microfilm system?
           Response: No.
  RFP Section 5.2.2.3.4.1 and      p. 108 and 217 Claims Entry and Control
              5.2.2.15
   123     Question: Please clarify the process and responsibilities for imaging. For example, will the Core
                     MMIS vendor be responsible for the imaging of prior authorization requests, provider
                     correspondence, recipient correspondence, returned warrants, etc?
           Response: The Core MMIS Contractor will be responsible for imaging all of the documents identified
                     in the question, as well as claims and claims-related documents and any other work
                     documents used by the IME contractors that are received in the mailroom.
  RFP Section 5.2.2.3.4.2,         p. 118          Claims Adjudication
              bullet 56
   124     Question: Please provide the edits and volumes for claims requiring review by the medical services
                     vendor, if any. #56 indicates that the Core MMIS vendor is responsible for all suspended
                     claims except for those resolved by DHS.


Response to Bidder Questions – Set 1                         February 23, 2004                           21 of 133
           Response: In the month of December 2003 the following edits were reviewed by Medical Review:

                       Edit                                                    Number of Occurrence
                       Procedure requires Medical Review                              6,445
                       Procedure code modified requires Medical Review                3,081
                       There is no Prior Authorization on file                          380
                       Multiple surgeries require review                              2,198
                       Procedure requires manual pricing                              2,111
                       Possible conflict                                                300
                       Special batch                                                    128
                       More than two ultrasounds in 180 days                            978
                       HHA limit exceeded                                               725
                       Diagnosis requires Medical Review                              2,070
                       Surgical procedure code requires medical review                  830
                       Diagnosis code requires Medical Review                           100
                       Diagnosis/age conflict                                            15

  RFP Section 5.2.2.3.4.3        p. 124           Claims Financial and Reporting
   125     Question: The RFP states that currently all providers receiving an electronic RA also get a paper RA
                     and the State expects this procedure to continue. How many providers currently get an
                     electronic RA?
           Response: The State now plans to discontinue paper RAs for providers who receive electronic RAs.
                     Electronic 837 submissions will receive 835 electronic remittance advices.
  RFP Section 5.2.2.3.4.3,       p. 126           Claims Financial and Reporting
               bullet 9
   126     Question: What schedule of check-write and EFT authorization will be utilized during the term of the
                      contract? Will the schedule be more or less often than the current twice monthly cycle?
           Response: DHS anticipates using the twice monthly cycle during the term of the contract.
  RFP Section 5.2.2.3.4.3,        p. 128           Claims Financial and Reporting
              bullet 24
   127     Question: Will DHS allow the contractor to use other electronic storage methods in the place of
                     micro media archives?
           Response: Recommendations can be made by the contractor for State review and approval as long as
                     retrieval requirements are met.
  RFP Section 5.2.2.3.4.4        p. 134          Enhancements to Current Functionality
   128     Question: Regarding the requirement for a process to receive claims history online, how many years
                     of claims history must be available and what type of user interface is required for the
                     claims history to be viewed? What claims history and user interface exist today?
           Response: Currently DHS requests claims histories from the current contractor and receives
                     hardcopy reports of the requested claims history. The enhancement includes developing
                     an online request functionality to be used by DHS and all component contractors who
                     need access to member history with selection parameters, and distribution of the histories
                     in an electronic format. It is anticipated that the COLD storage functionality will be used
                     to provide the electronic access to the reports. All claims history should be available for
                     these member history reports.
  RFP Section 5.2.2.3.4.4        p. 134           Enhancements to Current Functionality
   129     Question: How does the existing MMIS currently receive HIPAA X12 transactions if this is added
                     functionality for the new contract? Are there existing X12 companion guides available?




Response to Bidder Questions – Set 1                         February 23, 2004                            22 of 133
           Response: Currently the MMIS receives a proprietary format from the clearinghouse/translator after
                     receiving the transaction from the provider. Companion guides for the HIPAA
                     transactions are available on the ACS HIPAA website at http://www.acs-gcro.com/
                     Medicaid_Accounts/Iowa_Medicaid/Companion_Guides/companion_guides.htm.
  RFP Section 5.2.2.3.4.4        p. 134          Enhancements to Current Functionality
   130     Question: Please describe the number of years of claims history currently available online.
           Response: Two years.
  RFP Section 5.2.2.3.4.4,         p. 134          Enhancements to Current Functionality
              bullet 4
   131     Question: What is meant by ―provider to submit … inquiries‖? Is this a formatted X12 277 response?
                     Are there additional transactions implied here?
           Response: Enhancements would allow providers to submit the 270 Health Care eligibility benefit
                     inquiry, the 278 health care service review and the 276 health claim status request as well
                     as submitting the 837 Healthcare claims. The Core MMIS contractor is not expected to
                     remediate the legacy MMIS to accept X12 transactions. The combination of the WEB
                     Portal and the Clearinghouse/Translator functionality allows DHS the capability to accept
                     and transmit all X12 transactions.
  RFP Section 5.2.2.3.4.4,        p. 134           Enhancements to Current Functionality
               bullet 5
   132     Question: Does the State currently meet Federal HIPAA requirements for 837 and 835? Do all
                      providers adhere to these formats?
           Response: The System is HIPAA compliant except for certain procedure and Condition codes that
                     DHS has not converted to the standard code sets. Since providers have been allowed a
                     contingency, all providers do not adhere to the HIPAA electronic formats. However,
                     federal regulations allow providers a transition period for compliance and it is the
                     expectation that providers will be compliant prior to June 30, 2005. And providers are
                     allowed to file paper claims as well as telephone inquiries for the claim status and
                     eligibility status.
  RFP Section 5.2.2.3.4.4,         p. 135          Enhancements to Current Functionality
              bullet 7
   133     Question: Is postage to be paid by DHS?
           Response: Yes.
  RFP Section 5.2.2.3.4.4,         p. 135          Enhancements to Current Functionality
              bullet 9
   134     Question: Are the subject bills recycled awaiting eligibility or for other reasons?
           Response: These claims are recycled for eligibility and for services that are on the care plan. In some
                     cases there is a delay in the care plan data being updated by ISIS to the MMIS.
  RFP Section 5.2.2.3.6.1,         p. 138          Enhancements to Current Functionality
              bullet 2
   135     Question: To support accurate assessment of this effort, would DHS provide more detail regarding
                     the required occupancy table (the data to be included in the table, how the table will be
                     updated and who will update it, how the data will be used, etc.)?
           Response: Need the number of beds added to the provider file, and the report would show the
                     Medicaid occupancy rates based on monthly LTC claims.




Response to Bidder Questions – Set 1                          February 23, 2004                           23 of 133
  RFP Section 5.2.2.3.6.1,         p. 138          Enhancements to Current Functionality
              bullet 3
   136     Question: Please explain how payment cycle data is currently being provided to the State
                     accounting system.
           Response: Currently the fiscal agent provides an electronic file of the checks that were written and a
                     hardcopy report of the amounts to be posted to each State account. The DHS accounting
                     unit manually enters the information to the State accounting system.
  RFP Section 5.2.2.3.7.1,         p. 139          Claims Entry and Control
              bullet 8
   137     Question: Does the ten (10) second response time include potential latency due to the State
                     infrastructure (LAN, WAN, desktop, etc.)? If the system is operated on State equipment,
                     how will this performance standard be measured and implemented?
           Response: Any performance standard requiring the ten(10) second response time will account for the
                     State infrastructure. DHS maintains a very reliable infrastructure that has not experienced
                     delays and the uptime averages 99.5%.
  RFP Section 5.2.2.3.7.2,         p. 140           Claims Adjudication
               bullet 3
   138     Question: Does the 100% requirement apply to those claims that have been forwarded to the State or
                       other outside party for policy resolution and other similar issues? If so, how will the
                      State account for delays caused by DHS or other outside parties? Will the State consider
                      modifying this standard to indicate that it does not apply to issues outside of the
                      contractor‘s control?
           Response: The requirement will apply to the time during which the contractor has control of the
                     claims. It is anticipated that the Workflow Process Management system will be able to
                     track the time that each claim or other document is held in each processing step for all
                     contractors. Reports from the WPM should provide this information for tracking
                     performance standards.
  RFP Section 5.2.2.4.4, bullet    p. 147          Contractor Responsibilities
              21
   139     Question: Does this requirement refer to EPSDT claims data? If so, what data does DHS expect to
                     load into the member eligibility file? If not, what data set is being referenced?
           Response: Yes. The IABC system sends over the initial screen date, initial screen code, current
                     screen date and current screen code.
  RFP Section 5.2.2.4.4.1,         p. 147          Enhancements to Current Functionality
              bullet 1
   140     Question: Does the requirement for ―real-time‖ refer to the ability of REVS and POS to supply the
                     information to those utilizing these services immediately after the information is received?
                      Are REVS and POS currently updated in a batch mode? If this is the requirement, how
                     will this data be provided? Is the State requiring the contractor to provide DHS or others
                     relevant parties with the ability to update the operational REVS and POS data stores
                     directly? If these interpretations are inaccurate, please explain what is being required.
           Response: No, the files are updated through a batch process that runs nightly. Data will be provided
                     by the Core MMIS contractor after the nightly eligibility update is run. The POS and
                     MEVS files are updated from the batch process. The contractor will provide the updated
                     data daily after the batch process runs.
  RFP Section 5.2.2.5           p. 151           Reference Function
   141     Question: How are reference file updates currently procured (diagnosis, procedure, NDC, revenue,
                     DRG, APC)?



Response to Bidder Questions – Set 1                         February 23, 2004                             24 of 133
           Response: Updates to the reference files are done manually by fiscal agent staff. Diagnosis and
                     procedure updates are done when ICD-9-CM manuals, CPT manuals and HCPCS manuals
                     are revised. NDC updates are done by First Data Bank; skeletal records are on MMIS;
                     updates are automates. DRG and APG records are manually updated by staff when
                     rebasing/recalibrating occur. Fee updates to the PDD file are normally done via CSR.
                     Routine file maintenance is done by fiscal agent staff on an ongoing basis.
  RFP Section 5.2.2.5.4.4,          p. 156           Data Management
              bullet 2
   142      Question: Is the ICD-10 migration to be accomplished as part of the conversion process?
           Response: CMS has not mandated ICD-10. The contractor will need to update the diagnosis codes as
                     versions are updated.
  RFP Section 5.2.2.5.4.4,       p. 156           Data Management
               bullet 11
   143     Question: Other than those specified, what reimbursement methods must be maintained?
           Response: Refer to RFP Section 3.3.6.3.
  RFP Section 5.2.2.6.4, bullet 8 p. 164             Contractor Responsibilities
   144      Question: The RFP refers to monthly downloads of encounter data for the DW/DS. Is this correct?
                      Claims data is to be downloaded to the DW/DS at each bi-weekly payment cycle. Is there
                      an intentional difference in the timing?
           Response: Yes, this is correct. Claims data is loaded after each payment cycle. Encounter data is
                     received from the HMOs monthly and loaded to the DW/DS.
  RFP Section 5.2.2.6.4, bullet     p. 164           Contractor Responsibilities
              10
   145      Question: Are the HMOs currently submitting data in different formats? If so, how many different
                      formats are utilized? Is the current contractor able to process these different formats?
                      Will the HMOs be required to submit standard, HIPAA compliant, ANSI transactions and
                      code sets in the future? If so, when?
           Response: HMO encounter data is submitted in a proprietary format. It is standard across plans. The
                     Iowa Plan may have a slightly differing version due to the use of non-standard codes, but
                     with HIPAA compliance this may be uniform in the future.
  RFP Section 5.2.2.6.6, bullet 3 p. 165             Outputs
   146      Question: Please define what is meant by ―cleaned‖ encounter data?
           Response: All accepted encounter data should be loaded into the DW/DS system. See question #
                     440.
  RFP Section 5.2.2.8              p. 173           Automated Voice Response System (AVRS)
   147 1012 Question: The RFP states that AVRS ‗is a telephone voice and touch-tone response system
                      maintained by the Core MMIS contractor‘. Does this mean that the Core MMIS
                      contractor is responsible for purchasing the hardware and software for REVS? Will the
                      State will provide the telephone lines for this service as they will need to be tied in with
                      the Provider Services call center? Where does the State envision this hardware will be
                      located?
           Response: The State will provide the hardware and software. The contractor will provide the
                     programming for the updates.
  RFP Section 5.2.2.8.4          p. 174           Contractor Responsibilities
   148     Question: Does the current MMIS AVRS subsystem provide the functionality required in bullet
                     points 1-19 under 5.2.2.8.4 Contractor Responsibilities?




Response to Bidder Questions – Set 1                           February 23, 2004                             25 of 133
           Response: The contractor should plan to assume the current voice and data access to the MEVS
                     system that includes the required functionality. DHS will provide the equipment and the
                     Core MMIS contractor will provide the programming for updating the MEVS database.
  RFP Section 5.2.2.8.4, bullet 6 p. 175           Contractor Responsibilities
   149     Question: Where are toll-free lines required?
           Response: The State will provide the local and toll-free lines for the AVRS functionality.
  RFP Section 5.2.2.8.4, bullet    p. 176          Contractor Responsibilities
              16
   150     Question: Please explain what is meant by the phrase ―a variety of automated telecommunication
                     media‖. How many varieties are in place? Please define and describe each variety in
                     detail.
           Response: Currently MEVS provides access to eligibility data through voice or data connections.
                     See the Provider Services section of the RFP for the additional access modes to be
                     provided in the new IME.
  RFP Section 5.2.2.8.4, bullet    p. 176          Contractor Responsibilities
              19
   151     Question: Please explain what is meant by the phrase ―sufficient communication capabilities‖. Does
                     this refer to the capacity of the system or to the system‘s ability to accommodate various
                     methodologies? If it refers to various methods, please define and describe each method in
                     detail.
           Response: See question # 150.
  RFP Section 5.2.2.9            p. 178         Medically Needy
   152     Question: Please explain how Medically Needy is affected by HIPAA guidelines other than claim
                     submission guidelines.
           Response: Medically Needy was affected by the changing procedure codes for the calculation of
                     spenddown, . It will be affected by the National Provider number as well as privacy and
                     security.
  RFP Section 5.2.2.9.2.2,         p. 179          Interfaces With External Entities
              bullet 1
   153     Question: Please provide the average number of certifications received by the MMIS and the
                     frequency at which they are received.
           Response: The certification period files are received by the fiscal agent daily. Approximately 150 to
                     300 certification periods are received daily.
  RFP Section 5.2.2.9.4, bullet 2 p. 179           Contractor Responsibilities
   154     Question: Please provide the maximum number of certification periods allowed.
           Response: Only 2 certification periods per case can be passed from ABC at one time. However, there
                     is no limit to the total number of certification periods that can be allowed for a case or for
                     a person. The Medically Needy Subsystem (MNSS) can accommodate up to 70
                     certification periods per case number. The oldest certification periods are purged from
                     MNSS when the certification periods exceed 70.
  RFP Section 5.2.2.9.4, bullet 3 p. 180           Contractor Responsibilities
   155     Question: Can non-Medicaid providers submit claims to apply against the spenddown amount?
           Response: Yes, non-Medicaid providers can submit claims through the Income Maintenance worker
                     in the local DHS office. The worker attaches a Medically Needy Transmittal form (470-
                     3630) to the bill; indicates the certification period to apply the bill; and sends it to the
                     fiscal agent. These bills must be manually entered by the fiscal agent.



Response to Bidder Questions – Set 1                          February 23, 2004                            26 of 133
  RFP Section 5.2.2.9.4, bullet 3 p. 180         Contractor Responsibilities
   156     Question: Can recipients submit claims to apply against the spenddown amount?
           Response: Recipients cannot submit claims directly to be applied to the spenddown amount. If the
                     bill is for a covered service, it must be submitted by the provider. If the recipient received
                     services before the certification period or receives non-Medicaid-covered services during
                     the certification period that they want applied to the spenddown, the recipient should
                     have the provider submit a paper claim form to the Income Maintenance worker. The
                     worker will determine whether the bill can be applied to the spenddown, attach a
                     Medically Needy Transmittal form (470-3630), indicates the certification period to apply
                     the bill, and submit it to the fiscal agent. Bills submitted in this way must be manually
                     entered by the fiscal agent.
  RFP Section 5.2.2.9.4, bullet 4 p. 180            Contractor Responsibilities
   157     Question: Please explain how medical expenses are prioritized and whether this a manual or
                     automated function?
           Response: Medical expenses are processed in the following order:

                       • Medicare and other health insurance premiums, deductibles, or coinsurance charges.
                       (Medicare and other health insurance premiums are deducted by the workers in the local
                       DHS office)
                       • An average statewide monthly standard deduction for the cost of medically necessary
                       personal care services provided in a licensed residential care facility.
                       • Medical expenses for necessary medical and remedial services that are recognized under
                       state law but not covered by Medicaid, chronologically by date of submission.
                       • Medical expenses for acupuncture, chronologically by date of submission.
                       • Medical expenses for necessary medical and remedial services that are covered by
                       Medicaid, chronologically by date of submission.

                       The prioritization of medical expenses is an automated function.
  RFP Section 5.2.2.9.4, bullet p. 180            Contractor Responsibilities
               10
   158     Question: Please explain the types of different notifications and the frequency in which they are
                     generated. Are notifications generated by an online or batch process, and is the vendor
                     responsible for the expense of printing and distribution of notifications?
           Response: The Notice of Spenddown Status (NOSS) (form 470-1967) informs the client whether the
                     spenddown obligation is met and the current amount of the spenddown credit. The NOSS
                     is generated biweekly when claims submitted to the MMIS Medically Needy subsystem
                     have been entered into the system or when changes that affect the spenddown
                     calculation are received. The notice is issued in the nightly batch process when
                     spenddown is met.

                       The Eligibility Status Turnaround Document (ESTD) (form 470-1941) informs the worker
                       of each person‘s status for each month of the certification period, and provides the worker
                       with a mechanism to alter or correct data on the Medically Needy subsystem. An ESTD is
                       generated after the MMIS Medically Needy subsystem receives a new case from the
                       ABC system and builds a file. One form is generated for the retroactive period, if any, and
                       one form is generated for the prospective period. A new form is generated when changes
                       have been made to the existing ESTD, and when new certification periods are established
                       through the ABC system.

                       The Bill Status Turnaround Document (BSTD) (form 470-1942) provides the worker with a
                       written history of how expenses were used to meet the client‘s spenddown in a particular
                       certification period. A BSTD is generated biweekly when claims or BSTDs have been



Response to Bidder Questions – Set 1                          February 23, 2004                             27 of 133
                       submitted, and when the spenddown is met. BSTDs are generated for each individual on
                       a case for each certification period.

                       Each of the forms listed above are also generated when a worker submits a Lost Form
                       Request (form 470-0272) to request a replacement form.

                       The notifications are generated by a batch process. DHS will bear the cost of printing and
                       mailing..
  RFP Section 5.2.2.9.4, bullet    p. 180          Contractor Responsibilities
              11
   159     Question: Please explain what media and method is used to notify the provider that the client may be
                     eligible as a Medically Needy client.
           Response: The client is responsible for notifying the providers that he or she is eligible for Medically
                     Needy. Until their spenddown has been met, the client notifies providers of their
                     potential eligibility by showing them their Notice of Decision for Medically Needy (form
                     470-2330) and their Medicaid State ID Numbers form (470-3392). Both of these forms are
                     generated by the local DHS office. Once the spenddown has been met, the worker
                     notifies providers by showing them their Notice of Spenddown Status (form 470-1967) to
                     indicate which bills were used for spenddown, and by showing their Medicaid card for the
                     month. Providers can also call the AVRS phone line to verify whether a client has met
                     their spenddown, and is now eligible.

  RFP Section 5.2.2.9.4.1,         p. 181         Enhancements to Current Functionality
               bullet 1
   160     Question: Please provide further detail about the required information displayed for the member's
                      certification history.
           Response: The recipient‘s State ID number (SID), name, and date of birth will be displayed. All cases
                      for each recipient are displayed along with the county number for each case, the income
                     maintenance worker‘s number, and all the certification periods for each case. Eligibility
                     information for each certification period is shown also (currently on a separate screen
                     accessed by selecting the case number). Recipient eligibility information for each
                     certification period is displayed when a certification period is selected. Information
                     shown includes the spenddown amount, the amount applied to the spenddown, the date
                     the spenddown was met, the Fund Code, the Pregnancy indicator, the program
                     relationship by case number, the certification period, and the recipient state ID number by
                     case number.
  RFP Section 5.2.2.9.4.1,         p. 182          Enhancements to Current Functionality
              bullet 2
   161     Question: Will the recycle of denied claims require claims already applied to spenddown to be rolled-
                     back (unapplied), reprioritized, and reapplied with the previously denied claims? Will this
                     process require additional notifications?
           Response: Claims applied to spenddown would be adjusted in the following circumstances:

                       • When a bill for a Medicaid-covered service incurred during the certification period has
                       been applied to the spenddown, and then a bill for a covered service incurred prior to the
                       certification period is subsequently received.
                       • When a bill for a noncovered Medicaid service is subsequently received with a service
                       date prior to the Medicaid-covered service.
                       • When an unpaid bill for a Medicaid-covered service incurred in the certification period
                       has been applied to spenddown if a paid bill for a covered service incurred in the
                       certification period is subsequently received with a service date prior to the date of the
                       notice of spenddown status.


Response to Bidder Questions – Set 1                         February 23, 2004                             28 of 133
                      Each of these instances would require that a new Notice of Spenddown Status form (470-
                      1967) be generated and sent out. If spenddown has been met and a bill is received with a
                      service date after spenddown has been met, the bill shall not be deducted to meet
                      spenddown. Recycling denied claims will work in the same way.
  RFP Section 5.2.2.10.4,         p. 186           Contractor Responsibilities
              bullet 2
   162     Question: Please provide the number, frequency, size and manpower effort related to special reports
                     requested in the past year.
           Response: Special reports generated last year: Approximately 300 requests for special reports or
                     report changes for approximately 3,250 man hours of effort. It is anticipated that most of
                     the special reports will be generated from the DW/DS system under the new contracts by
                     the users or with help from the DW/DS contractor for more complicated reports.
  RFP Section 5.2.2.10.4,         p. 186           Contractor Responsibilities
              bullet 2
   163     Question: How many ‗special reports‘ are required to be produced on an annual basis?
           Response: See question # 162. The average number of requests per year for special reports is 250.
  RFP Section 5.2.2.10.4,         p. 186           Contractor Responsibilities
              bullet 3
   164     Question: Please describe the state's participation in the process of submitting MSIS data files to
                     CMS. Does the state review and approve summary information before the submission of
                     the files? Does the state participate with CMS and/or the CMS contractors when the
                     quarterly files are rejected because of data anomalies specifically related to Iowa Medicaid
                     rules?
           Response: No to the first question. Yes to the second question.
  RFP Section 5.2.2.10.4,         p. 188           Contractor Responsibilities
              bullet 18
   165     Question: Please provide the number, frequency, size and manpower effort related to special reports
                     requested in the past year. Will this requirement be moved to the data warehouse in the
                     future?
           Response: See question # 162 for the first question. Yes to the second question.
  RFP Section 5.2.2.10.4,         p. 188           Contractor Responsibilities
              bullet 19
   166     Question: What is the current volume of the member claims history and average volume per year?
                     How is this information currently accessed or made available for state access?
           Response: The average number of recipient history requests is 11,000 per year. Currently these are
                     provided as hardcopy reports.
  RFP Section 5.2.2.10.4.1,       p. 189           Contractor Responsibilities
              bullet 1
   167     Question: Please describe the platform and tools being used for COLD storage at the State Data
                     Center. Please include the required frequency of updates to COLD as well as the listing of
                     historical files that should be included.
           Response: Refer to question # 99.
  RFP Section 5.2.2.10.4.1,       p. 189           Enhancements to Current Functionality
              bullet 1
   169     Question: Please detail the historical file records that must be maintained in COLD storage format.
                     What is the total number of records? In what format(s) are they currently maintained?


Response to Bidder Questions – Set 1                         February 23, 2004                           29 of 133
                       Who are the current owners of these records? Any additional information that would
                       quantify this requirement is essential for proper sizing of the effort.
           Response: See question # 99.
   169     Question: Isn‘t this report currently produced to comply with CMS requirements? If not, why not?
                     If so, what is the enhancement related to this requirement?
           Response: Under the current format the 2700 reports are produced by our fiscal agent in ascending
                     chronological order by quarter ending dates starting with the quarter at least two years
                     prior to the quarter for which the report is being submitted. To comply with CMS 64
                     reporting requirements, the reports are produced with line numbers for specific service
                     costs that match the line numbers on the CMS 64.9 reporting forms. To also comply with
                     CMS, the current quarter and all prior quarters are summarized separately by increasing
                     and decreasing public adjustments, increasing and decreasing private adjustments, and
                     by credits. The current quarter also includes a summary for current quarter expenditures.

                       For reporting purposes, the expenditures are summarized to CMS each quarter by line 6 –
                       current quarter expenditures, line 7 – prior period increasing adjustments, and line 10b –
                       prior period decreasing adjustments. The increasing and decreasing prior period
                       adjustments are entered by federal fiscal year. To accomplish this level of data entry, all
                       expenditures from the 2700 report have to be keypunched into an excel spreadsheet to
                       obtain the summaries needed to report current quarter expenditures, and prior period
                       adjustments by federal fiscal years.

                       The enhancement is to include summaries by federal fiscal year for line 6, 7, and 10b
                       reporting requirements. Each of these summaries will include by service line, total
                       computable and federal share for regular FFP, federal only, family planning, and breast
                       and cervical cancer treatment columns.
  RFP Section 5.2.2.10.7,          p. 193           Performance Standards
              bullet 5
   170     Question: Since the contractor does not have the authority to determine the State‘s priorities
                     regarding the loading of data to the State data center servers, will the State modify this
                     standard to indicate the delivery of the reports to the State data center?
           Response: The State and contractor(s) will establish the scheduling priorities so that the contractor
                     is not held responsible for actions of the State that would inhibit the contractors‘ ability
                     to deliver reports.
  RFP Section 5.2.2.11.2.2,        p. 195           Interfaces With External Entities
              bullet 3
   171     Question: Please describe the frequency for the Lock-In contractor to make parameter file updates.
           Response: Currently this depends on changes in Lock-In program Recipient SURS reports given to
                     IFMC at end of quarter when SURS Reports are generated by the system, but the bidder
                     should be prepared to make changes more frequently as needed.
  RFP Section 5.2.2.11.4         p. 195          Contractor Responsibilities
   172     Question: Does the current MMIS SUR subsystem provide the functionality required in bullet
                     points 1-23 under 5.2.2.11.4 Subcontractor Responsibilities?
           Response: See the Detailed System Design for the SURS Subsystem.
  RFP Section 5.2.2.11.4,          p. 195           Contractor Responsibilities
              bullet 1
   173     Question: Please confirm that the edit parameters noted in this requirement pertain only to SUR
                     reporting and not the MMIS.
           Response: Yes.


Response to Bidder Questions – Set 1                          February 23, 2004                             30 of 133
  RFP Section 5.2.2.11.4,          p. 195          Contractor Responsibilities
              bullet 3
   174     Question: Please provide the number, frequency, size and manpower effort related to special reports
                     requested in the past year.
           Response: It is anticipated that under the new contract users will request their own special reports
                     using the query capabilities of the Data Warehouse/Decision Support system. All
                     production reports will be provided electronically using COLD storage technology and
                     users will be able to print the reports or portions of the reports they need in hardcopy.
  RFP Section 5.2.2.11.4,          p. 196          Contractor Responsibilities
              bullet 8
   175     Question: Please clarify whether all case management providers are required to be enrolled as
                     Medicaid providers and submit claims directly to the Core MMIS contractor.
           Response: Any provider who is paid for non-HMO services by Iowa Medicaid needs to be enrolled
                     in Iowa Medicaid and submit claims to the MMIS and/or POS .
  RFP Section 5.2.2.11.4,          p. 196          Contractor Responsibilities
              bullet 11
   176     Question: Please describe the type of data necessary for DHS and its External Quality Review
                     contractor to audit MCO quality. Is this type of data currently being provided by the
                     SURS subsystem?
           Response: The EQRO uses claims files and encounter data. SURS has the same data available.
  RFP Section 5.2.2.11.4,          p. 196          Contractor Responsibilities
              bullet 17
   177     Question: Do the current utilization management reports meet all federal and state requirements?
           Response: Yes.
  RFP Section 5.2.2.11.4.1      p. 197         Enhancements to Current Functionality
   178     Question: How often is DHS expecting that SURS reports will be run?
           Response: This will depend on when parameter changes are made; however, they will be run at a
                     minimum of quarterly but may run more often.
  RFP Section 5.2.2.11.4.1,        p. 197          Enhancements to Current Functionality
              bullet 1
   179     Question: At what interval are the SURS parameters currently run?
           Response: Currently SURS parameters are run quarterly. DHS wants to enhance the functionality to
                     run SURS parameters and reports more frequently.
  RFP Section 5.2.2.11.5          p. 197        Inputs
   180     Question: Please confirm whether pharmacy claims information is also an input for SURS reporting
                     as required in 5.2.2.11.4.
           Response: Yes.
  RFP Section 5.2.2.11.6         p. 198        Outputs
   181     Question: Does the current MMIS SUR subsystem provide the outputs listed in bullet points 1-15
                     under 5.2.2.11.6 Outputs?
           Response: See the Detailed System Design for the SURS Subsystem.
  RFP Section 5.2.2.11.6,          p. 198          Outputs
              bullet 4
   182     Question: Please describe how often the Core MMIS contractor is required to enter updates of new
                     parameters or parameter changes.



Response to Bidder Questions – Set 1                          February 23, 2004                            31 of 133
           Response: Whenever changes are made - monthly at a minimum.
  RFP Section 5.2.2.11.6,           p. 198 and 458 Outputs
              bullet 4 and
              6.6.2.2.4,
              paragraph 1
   183      Question: 5.2.2.11.6, #4 indicates that the Core MMIS vendor is responsible for system input of new
                      parameters or parameter changes. The first paragraph of 6.6.2.2.4 indicates that the SURS
                      vendor "directs the Core MMIS contractor to update or otherwise change the requested
                      report parameters". #1 and #2 of this section indicate that the SURS vendor performs the
                      function of developing and updating the parameters file on the MMIS. Please confirm
                      that the Core MMIS vendor is responsible for system input of new parameters and
                      parameter changes.
           Response: The SURS vendor will identify the parameter changes and additions and will forward
                     these to the Core MMIS contractor for input to the SURS system.
  RFP Section 5.2.2.11.6,           p. 199           Outputs
              bullet 11
   184      Question: Are these reports currently generated by the SURS subsystem?
           Response: See the Detailed System Design for the SURS Subsystem.
  RFP Section 5.2.2.11.6,           p. 199           Outputs
              bullet 13
   185      Question: Please clarify the volume and frequency for this requirement.
           Response: Whenever payments are made to providers, currently twice a month.
  RFP Section 5.2.2.12            p. 201           Third Party Liability (TPL) Function
   186     Question: This section states that the Revenue Collection contractor will perform the activities for
                     the new Iowa Medicaid Enterprise that are currently performed by a supplemental
                     contractor. All of the services performed by the current supplemental contractor were
                     priced using a contingency fee. For the Iowa Medicaid Enterprise, DHS envisions that all
                     recovery activities, except for estate recovery, will be encompassed in the administrative
                     fee established for the Revenue Collection contractor. Can the Revenue Collection
                     contractor propose additional services that could be performed for a contingency fee that
                     would enhance recoveries? Is this approach available as part of ongoing change
                     processes for the Enterprise, where there might be some initiatives identified later that
                     may require additional investment of staff or system resources not included in the original
                     cost proposal?

           Response: The State will not consider any change at this time. The State may consider entertaining
                     Contractor proposals during the operational years of the Contract.
  RFP Section 5.2.2.12.1          p. 201           Objectives
   187     Question: Will DHS continue to operate the HIPP program, except for possible identification of
                     recipients for participation and providing historical statistical information to assist in
                     updating the cost-effectiveness algorithm, or will there be additional contractor
                     responsibilities required?
           Response: DHS will continue to operate HIPP.
  RFP Section 5.2.2.12.2          p. 201          Interfaces
   188     Question: Will the TPL subsystem continue to interface with other contractors involved in
                     identification and recovery of member insurance coverage? If so, please identify these.
           Response: The Core MMIS contractor will interface with the Revenue Collection contractor for TPL-
                     related information.




Response to Bidder Questions – Set 1                           February 23, 2004                            32 of 133
  RFP Section 5.2.2.12.4           p. 202         Contractor Responsibilities
              through                 through 205
              5.2.2.12.7
   189     Question: RFP section 5.2.2.12.4 through 5.2.2.12.7 identifies TPL responsibilities of the Core MMIS
                     contractor. Are any of these the responsibility of the Revenue Collections contractor?
           Response: No, these are all system responsibilities of the Core MMIS contractor.
  RFP Section 5.2.2.12.4,          p. 203          Contractor Responsibilities
              bullet 4
   190     Question: Does the contractor have responsibility for follow-up related to the letters that are
                     forwarded to the members? If so, please describe in detail those responsibilities. Must
                     copies of the initial letters be sent to DHS? If so, can this be done electronically? To
                     which organization are the letters returned? How are the returned letters utilized? What is
                     done when an answer is not received? Are follow-up activities required? What activities
                     are required over what period of time?
           Response: The Core MMIS contractor will produce the letters to be mailed to members and maintain
                     copies of the letters via the COLD storage technology. When the letters are returned, the
                     Core MMIS contractor will image the letters and forward them to the Revenue Collection
                     contractor via the Workflow Process Management system. The Revenue Collection
                     contractor will perform all follow-up activities on the letters.
  RFP Section 5.2.2.12.4,          p. 203          Contractor Responsibilities
              bullet 4
   191     Question: Does the current MMIS system automatically generate trauma questionnaires?
           Response: Yes.
  RFP Section 5.2.2.12.4.1,        p. 204          Enhancements to Current Functionality
              bullet 1
   192     Question: Who will be responsible for the verification process related to this enhancement?
           Response: See question # 194.
  RFP Section 5.2.2.12.4.1,      p. 204           Enhancements to Current Functionality
               bullet 1
   193     Question: RFP section 5.2.2.12.4.1 references section 5.2.2.16, Imaging System. What are the
                      imaging requirements for third party coverage information?
           Response: Any hardcopy documents related to member third party coverage, (e.g., responses to
                     trauma letters, notifications of coverage or termination of coverage, etc.) will be imaged
                     and forwarded to the Revenue Collection contractor via the Workfow Process
                     Management system.
  RFP Section 5.2.2.12.4.1,        p. 204          Enhancements to Current Functionality
              bullets 2 and 3
   194     Question: The RFP requires in Items #2 and #3 to add deductible and copay data to the TPL
                     resource file and to utilize deductible and copay data to process balance billing on claims.
                     Please explain how the deductible and copay data would be obtained and then how it
                     would be used to process claims. Medicaid could not accurately maintain deductibles
                     and copays for other insurance based on Medicaid claims data. Some claims applied to
                     deductibles would never be submitted to Medicaid. Medicaid would not be able to
                     accurately determine if a claim would be used to meet a deductible by the other insurance.
                     In addition, in regards to copays, some policies will pay some services at 100% after
                     meeting the deductible and then the other services at a lesser percentage, etc.
           Response: The deductible and co-pay requirements for an insurance policy should be obtained via
                     the insurance verification transaction. As claims are processed that have deductibles or



Response to Bidder Questions – Set 1                         February 23, 2004                            33 of 133
                       co-pays, the Core MMIS system should launch a HIPAA insurance verification
                       transaction to determine if the deductibles and co-pays have been met and process the
                       claim accordingly.
  RFP Section 5.2.2.13.2.2        p. 206           Interfaces With External Entities
   195     Question: Please clarify the interface with providers and the requirement to accept PA requests.
           Response: FAX or paper prior authorization requests will be received and imaged in the mailroom and
                     forwarded via the Workflow Process Management System to the Medical Services
                     contractor for processing. The HIPAA 278 transactions will be received electronically by
                     the Core MMIS, captured and reformatted by the Core MMIS, and forwarded by the
                     Workflow Process Management System to the Medical Services contractor for processing.
  RFP Section 5.2.2.13.4,          p. 209           Contractor Responsibilities
              bullet 8
   196     Question: Please further describe whether the prior authorization decisions are issued by other
                     entities or specifically by DHS.
           Response: PA decisions will be issued by DHS through the Medical Services Contractor.
  RFP Section 5.2.2.13.4,          p. 210           Contractor Responsibilities
              bullet 20
   197     Question: Please explain how a prior authorization will be utilized for claims where the provider will
                     not know of the need for the prior authorization until after the service has been rendered
                     and the claim is received by the contractor for payment.
           Response: The provider manuals identify the services that require prior authorization, and providers
                     are responsible for using the manual to determine if the service requires prior
                     authorization prior to providing the service. If a provider fails to obtain prior
                     authorization, the claim is denied.
  RFP Section 5.2.2.13.4.1,        p. 210           Enhancements to Current Functionality
              bullet 1
   198     Question: What criteria will be utilized to determine if a certification error occurred?
           Response: The MMIS currently produces an error report. The report data will need to be provided in
                     an electronic file for the new contract.
  RFP Section 5.2.2.13.4.1,        p. 210           Enhancements to Current Functionality
              bullet 2
   199     Question: Please confirm that access must be limited to a requesting provider in compliance with
                     HIPAA Privacy requirements. Please describe the type of data to be available to
                     providers.
           Response: Yes to the first question. Providers will have access to data related to their own clients,
                     i.e., client eligibility, claims status, PA status.
  RFP Section 5.2.2.13.4.1,        p. 210           Enhancements to Current Functionality
              bullet 3
   200     Question: Please define the required frequency of reporting.
           Response: This report should be developed as a query that DHS staff can run on request with
                     parameter selection for date ranges, status, and type of PA.
  RFP Section 5.2.2.13.4.1,        p. 211           Enhancements to Current Functionality
              bullet 5
   201     Question: Does this enhancement refer to utilizing ISIS for the source of HCBS Waiver information
                     only as it applies to Prior Authorizations? Will the recipient subsystem utilize Title XIX
                     as the source? How will the differences in source data be reconciled?




Response to Bidder Questions – Set 1                          February 23, 2004                             34 of 133
           Response: Question A: Yes, this is the way the current process works.

                       Question B: The Recipient Subsystem will continue to utilize the TXIX Eligibility
                       Record. Currently during Claims Processing some fields that specifically pertain to
                       Waiver Eligibility are pulled from the TXIX Eligibility Record (in the Recipient
                       Subsystem). Instead these fields should be pulled from the pre-authorized ISIS Service
                       Record sent to the Fiscal Agent because the data is more correct. Some of these fields are
                        as follows: County of Legal Settlement, Waiver Type, etc. ISIS is the source for Waiver
                       Eligibility as well as payments made for all Waiver Services. Waiver Eligibility/Services
                       are spanned eligibility. TXIX eligibility is month by month eligibility.

                       Question C: The contractor will need to develop this process as part of the enhancement.
  RFP Section 5.2.2.14.2.2       p. 213            Interfaces With External Entities
   202     Question: Please describe in detail the nature of ―problems detected during screening.‖
           Response: IA Medicaid uses a modifier in the fee for service system to indicate that there was a
                     problem identified. This issue is also in the EPSDT loop in HIPAA compliant electronic
                     transactions. The EPSDT program is mandated to monitor ongoing service to determine
                     that treatment occurs. There is also a reporting component of the CMS 416.
  RFP Section 5.2.2.14.4,        p. 214          Contractor Responsibilities
               bullet 1
   203     Question: Please provide the frequency and media of this information to be supplied.
           Response: Monthly for all members who are due for screenings or follow-up services based on the
                     EPSDT periodicity schedule. Paper face sheets (notices) to be mailed to members. The
                     average number of screening notices is 650 for the periodic notices, and 1,500 for new
                     eligible notices.
  RFP Section 5.2.2.14.4,          p. 214          Contractor Responsibilities
              bullet 2
   204     Question: Please identify the media method for providing this information and the expected
                     timeframe.
           Response: Email or telephone initial notification is 12 months prior to turning 21 and reminder at 6
                     and 3 months prior to 21. Initial notification for expiring PA at 8 weeks prior to expiration
                     date and 4 week reminder if no PA is received.
  RFP Section 5.2.2.14.4,          p. 214          Contractor Responsibilities
              bullet 4
   205     Question: Please provide more information on this requirement.
           Response: In the course of its processing, the Core MMIS contractor should identify improvements
                     that could be made to the EPSDT system and recommend these changes to DHS. DHS will
                     then review the recommendation and determine whether to implement the change via the
                     CSR process.
  RFP Section 5.2.2.14.4,          p. 214          Contractor Responsibilities
              bullet 8
   206     Question: Please provide the current requirements of information used for monitoring.
           Response: The screens follow the AAP guidelines until age 11 when we still have an every other
                     year requirement instead of an annual visit.
  RFP Section 5.2.2.14.4,          p. 215          Contractor Responsibilities
              bullet 16
   207     Question: Please define the scope of this request.




Response to Bidder Questions – Set 1                         February 23, 2004                            35 of 133
           Response: The scope of this will be defined with the medical services contractor. See RFP MED-04-
                     034 on EPSDT Prevention Promotion.
  RFP Section 5.2.2.15            p. 217           Imaging System
   208     Question: Does the list of documents included in this section represent an accurate listing of all
                     document types that will be scanned? If not, what other documents must be scanned?
                     The list provided in this section is inconsistent with the list given at 5.2.2.3.4.4 (p. 134).
                     For the final list of documents to be scanned will DHS supply the number of documents to
                      be scanned over a specified time period? Will all documents be delivered by the State,
                     I&SS Contractor and other component contractors to the Core MMIS contractor for
                     scanning or will the Core MMIS Contractor be responsible for obtaining the documents
                     from each of these entities?
           Response: Claims and other documents with identifiable data elements in standard formats will be
                     scanned and have data captured by the imaging system prior to entry in the Workflow
                     Process Management (WPM) system. All other hardcopy work documents received in the
                     mailroom will be imaged and identified by the component that will process the information
                     and forwarded via the WPM to the component. All documents will be received by the
                     mailroom. See volumes in Attachment M of the RFP and volume information provided in
                     response to other questions.
  RFP Section 5.2.2.16            p. 218          Workflow Process Management System
   209     Question: How should the contractor price the required Workflow Process Management System,
                     given that the ―State I&SS contractor will work with all of the component contractors
                     during the Start-Up Phase of the contract to identify the workflow process requirements‖?
                     Can this system be removed from the current contract and priced as an enhancement
                     after the requirements have been developed?
           Response: This RFP and RFP MED-04-034 identify the requirements for all component contractors.
                     The Core MMIS bidder should review these to determine the processes that will need to
                     be included in the Workflow Process Management (WPM) system. The intent is for the
                     WPM to manage the workflow for all component contractors. Based on this, the bidder
                     should propose a system that meets all the requirements for the WPM and is robust
                     enough to be able to handle all of the processes. This system will not be removed from
                     the current contract and will be implemented as specified in the RFP.
  RFP Section 5.3.1.3.1,            p. 231          Data Conversion Activity
              Bidder Note
   210      Question: How will the contractor be compensated if the conversion tasks are more complex than
                      described in this section?
           Response: There will be no additional compensation for this task.
  RFP Section 5.3.1.3.1,            p. 231          Data Conversion Activity
              paragraph 1
   211      Question: To accurately size the data conversion effort and to assure that we appropriate the
                      resources necessary, can the Department provide a better indication of the scope and
                      types of ―errors and discrepancies‖ in the current historical data? Is the incumbent
                      vendor required to clean up errors and discrepancies as well? Would the Department
                      consider reducing the amount of history data requiring conversion to two years? POS
                      adjudication processing normally limits historical checks to less than two years. It seems
                      that it would be more appropriate to maintain the five years of data in RFP Component 3 –
                      Data Warehouse/Decision Support and not Component 2 – Pharmacy POS.
           Response: The state has not assessed the quality of the historical data. However, the incumbent
                     vendor is required to do corrective actions and regular quality assurance on errors and
                     discrepancies under the current contract. The new contractor is expected to assume this
                     role. The number of years of historical data will be as stated in the RFP.



Response to Bidder Questions – Set 1                          February 23, 2004                            36 of 133
  RFP Section 5.3.1.3.1,           p. 231           Data Conversion Activity
              paragraph 2
   212     Question: Is the pharmacy historical data to be converted currently maintained by three contractors?
                     If yes, would the Department itemize the three contractors and the files that each
                     contractor would be providing (i.e., the rebate files, the pharmacy claims history files)?
                     Will the vendor for Component 2 (Pharmacy POS) or Component 4 (Medical Services) be
                     responsible for converting the ―active‖ prior authorization records?
           Response: No, the pharmacy historical data is not currently maintained by three contractors. It is
                     maintained by the current Fiscal Agent.
  RFP Section 5.3.1.4.3           p. 239           Pilot Test Activity
   213     Question: Can the State define the scope of the Pilot Test at this time? How many providers and
                     recipients will be included in this test? How many claims will be processed? What is the
                     length of time for the test?
           Response: The Pilot Test must include the number of providers and recipients needed to adequately
                     test all provider types and claim types. The Contractor must be able to show in the Pilot
                     Test results that all functionality has been included in the test. The Contractor is expected
                     to identify in the test plan the number of providers and recipients to be included and how
                     the proposed numbers ensure an adequate test.
  RFP Section 5.3.2.2.4, bullets p. 245             Contractor Responsibilities
               1 and 2
   214     Question: Are pharmacies required to include the ―provider number‖ of the prescribing provider on
                     the submitted POS claim (i.e., is information submitted that can be captured and edited
                     one hundred percent of the time)?
           Response: Yes, but there are 3 dummy numbers for providers to use when they cannot get the
                     prescriber number.
  RFP Section 5.3.2.2.4.1        p. 246           Enhancements to Current Functionality
   215     Question: The RFP states in item #6 ‗if a claim is covered by insurance with a member copay, collect
                     and report the copay and submit the claim for balance billing to the insurance company.‘
                     Pharmacy copays are usually multi-tiered – one copay for a generic drug on the policy
                     formulary; one for a name brand; one for not on the formulary; one for out-of-network,
                     etc. The POS would not be able to accurately determine the correct copay amount.
           Response: See question # 217.
  RFP Section 5.3.2.2.4.1,         p. 246           Enhancements to Current Functionality
              bullet 5
   216     Question: Please clarify what the Department means by this requirement. Can the Department
                     provide an example of the type of edit that would cause strict denial of Medicare Part B
                     eligible recipients or, generally, the intent of this enhancement?
           Response: The system must edit for Medicare Part B coverage and deny the claim if the drug is
                     covered by Medicare.
  RFP Section 5.3.2.2.4.1,         p. 246           Enhancements to Current Functionality
              bullet 6
   217     Question: Is it DHS intent for the bidder to propose a system that can process the POS claim
                     automatically by first, electronically submitting claims for recipients/members with other
                     coverage to their appropriate insurance company for their adjudication and, then second,
                     adjudicating the remaining Medicaid-payable portion? If yes, there are constraints that
                     make this process extremely difficult (i.e., maintaining bin numbers of all insurance
                     companies, the recipient/members‘ insurance identification and program information,
                     unique clinical or prior authorization considerations required by the other carrier, etc.). If



Response to Bidder Questions – Set 1                          February 23, 2004                             37 of 133
                       no, please further explain the requirement so that bidders can give a better estimate of the
                       resources to effectively respond to this enhancement.

           Response: Yes, the intent is for the claim to be billed to the insurance company first and then
                     adjudicated for the Medicaid-payable portion. Since most pharmacies bill insurance
                     companies routinely for non-Medicaid patients, we don‘t anticipate that this should be a
                     problem for pharmacies. The pharmacies will need to get the insurance information from
                     the patient or from Medicaid via the AVRS function.
  RFP Section 5.3.2.2.6, bullet 2 p. 247            Outputs
   218     Question: Does the Department currently ―suspend‖ POS claims? If yes: Under what circumstances
                     and how many claims are suspended monthly? Are suspended claims to be processed
                     by the Component 1 (Core MMIS) vendor or the Component 2 (Pharmacy POS) vendor?
           Response: No, POS claims are adjudicated to payment or denial.
  RFP Section 5.3.2.2.7, bullet 3 p. 248            Performance Standards
   219     Question: As most providers send transactions through 3rd party switch vendors, will DHS modify
                     this requirement to exclude the time that the transaction traverses the 3rd party network?
           Response: No.
  RFP Section 5.3.2.2.7, bullet 6 p. 248            Performance Standards
   220     Question: Does this requirement disallow a bidder from utilizing voice recognition, touch-tone or
                     other automated response system for POS call center activities? Can a bidder meet the
                     requirement by having an automated response system that includes a ―release‖ to an
                     operator, based on the providers‘ request?
           Response: No to the first question. Yes to the second question.
  RFP Section 5.3.2.3.2.2        p. 238          Interfaces With External Entities
   221     Question: Will the First Data Bank Drug File license be held by the Core MMIS vendor, the POS
                     system vendor, or both?
           Response: Currently, the Fiscal Agent holds the First Data Bank Drug File license. Under the new
                     IME structure, DHS is requesting that the POS vendor propose costs associated with
                     acquiring the license under the State‘s name.
  RFP Section 5.3.2.4.4, bullet 8 p. 254            Contractor Responsibilities
   222     Question: Can the subject data be derived from the historical paid claims information? If not, what
                     data does DHS intend for the contractor to utilize?
           Response: Yes.
  RFP Section 5.3.2.4.4.1,         p. 254           Enhancements to Current Functionality
              bullet 2
   223     Question: Please clarify what information DHS expects the contractor to update the database and
                     algorithms with on a monthly basis.
           Response: ProDUR algorithms are updated as needed. The DUR committee meets eight times a year
                     and may review or recommend changes during the meetings.
  RFP Section 5.3.2.4.4.1,        p. 254            Enhancements to Current Functionality
               bullet 3
   224     Question: Please clarify what DHS expects this report to demonstrate. Is DHS expecting the
                      contractor to price all claims to which they are alerted due to ProDUR alerts both as
                      prescribed and as filled? If not, how does DHS expect the cost savings to be generated?
           Response: Yes, all claims should be priced and the report should show the savings generated by the
                     ProDUR alerts.


Response to Bidder Questions – Set 1                          February 23, 2004                              38 of 133
  RFP Section 5.3.2.5.4.2         p. 259           Supplemental Drug Rebates
   225     Question: Does Iowa DHS currently have any supplemental rebate arrangements? If so, are they in
                     the current contractor or in the State's name and would the rebate contracts survive if the
                     State chooses a new Pharmacy Point-of-Sale contractor?
           Response: No.
  RFP Section 5.3.2.5.4.2,         p. 260 and 261 Supplemental Drug Rebates
              bullet 5,
              5.3.2.5.5, bullet
              2, 5.3.2.
   226      Question: These references mention ―CMS‖ drug rebate files, CMS quarterly updates, etc. What
                      role does CMS drug rebate files, etc, currently have with Supplemental Drug Rebates?
                      Does the Department/State currently hold any supplemental rebate contracts?
           Response: No. The State does not currently have any supplemental rebate contracts.
  RFP Section 5.3.2.5.7           p. 261           Performance Standards
   227     Question: The RFP states in item #4 ―Collect at least 90% of the total of accounts receivables
                     outstanding at the beginning of the quarter plus invoices issued during the quarter by the
                      end of the quarter.‖ How do disputes figure into this algorithm? For example, if the
                     accounts receivables outstanding at the beginning of the quarter was $3 million, and
                     invoices issued during the quarter were $1 million (for a total of $4 million), and amount
                     collected by the end of the quarter was $1 million because the other $3 million was in
                     dispute, then what is the real total accounts receivable? After further research and
                     resolution it could be that the $3 million was never owed.

           Response: Items that are documented as in dispute are exempt from the calculation.
  RFP Section 5.4                p. 262            Data Warehouse / Decision Support Component
   228     Question: Would DHS consider DW/DS proposals that include commercial-off-the-shelf healthcare
                     decision support software that would effectively address the DHS decision support
                     business needs listed in the RFP?
           Response: DHS will consider any proposals that address the decision support business needs. The
                     infrastructure design is flexible enough to support either custom development, off-the-
                     shelf software applications, or a combination of both.
  RFP Section 5.4               p. 262           Data Warehouse / Decision Support Component
   229     Question: Would DHS consider DW/DS proposals that would utilize analytical data marts that
                     would reside on a platform other than the Microsoft SQL server?
           Response: Yes. However, all DW/DS platforms will be housed within the DHS/ITE network. The
                     infrastructure design contemplated this potential need. For example, a decision may be
                     made to have a specific data mart on a non-SQL platform (e.g. DB2, Oracle, etc). The
                     source for this data mart would still be the data warehouse database on the SQL 2000
                     server. The use of an alternate platform would require justification detailing the costs,
                     benefits, and ROI for using an alternative platform.
  RFP Section 5.4                 p. 262         Data Warehouse / Decision Support Component
   230     Question: Will the state buy the hardware and software for the new data warehouse?
           Response: ITE currently has the software and hardware necessary to construct the data warehouse.
                     In addition, the State owns business objects and anticipates its use by State employees
                     and Medicaid contractors. Additional software requests will be reviewed by DHS for
                     applicability and overlap of existing capabilities.
  RFP Section 5.4                p. 262          Data Warehouse / Decision Support Component
   231     Question: Is the Enterprise Data Warehouse (EDW) to reside on the state-owned SQL Server
                     database?


Response to Bidder Questions – Set 1                         February 23, 2004                            39 of 133
           Response: Yes. ITE will move data (ETL Process) from the source system(s) to a staging data
                     warehouse database. This data will be on ITE SQL 2000 Server(s) and will be available to
                     the DW/DS contractor to use in constructing the necessary data mart databases for the
                     DW/DS RFP contract requirements. The data marts will be on State owned SQL Server(s),
                      however, the DW/DS contractor will have full control over the SQL 2000 production
                     server configurations. ITE will maintain the hardware, the operating system (Windows
                     2000 or Windows 2003), and the network connectivity.
  RFP Section 5.4              p. 262          Data Warehouse / Decision Support Component
   232     Question: Would DHS consider a decision support solution that would include a UNIX computer
                     platform?
           Response: See response to Question # 229.
  RFP Section 5.4                p. 262           Data Warehouse / Decision Support Component
   233     Question: Since the State ITE will develop and build the Medicaid data warehouse, and not the
                     contractor, what authority will the vendor have to change, modify, redesign, and redeploy
                      the data warehouse and its components, if necessary?
           Response: The State ITE is constructing the data warehouse with semi-structured data. Changes
                     necessary to meet DW/DS contract requirements will be made by ITE working in
                     conjunction with the DW/DS contractor, DHS Staff and Data Source Systems personnel.
                     The DW/DS contractor will have access to the data warehouse, to the staging platform,
                     and will have two areas on the staging platform; A ―scratch‖ area to support development
                     type activities and a Vendor Publication area where the vendor can create scripts to move
                     data out of the data warehouse into production ready data structures. The vendor will
                     have full administrative authority over the data marts including their design, data
                     modification, use of aggregates, and all other items associated with production databases.
  RFP Section 5.4                p. 262          Data Warehouse / Decision Support Component
   234     Question: What is the time frame for adding the MARS and SURS functionality into the data
                     warehouse?
           Response: See question # 240.
  RFP Section 5.4                 p. 262          Data Warehouse / Decision Support Component
   235     Question: What is the estimated total size of the data warehouse after adding 5 years of Medicaid
                     data to the Enterprise data warehouse? What is the anticipated annual growth of this data?
           Response: Initial analysis suggests there is approximately 1 gigabyte of raw data per month
                     contained within the claims data files. The records within the claims files contains a large
                     amount of data per record that is redundant. The total initial size of the data warehouse
                     database prior to pre-aggregation and dimensionalizing is less than 100 gigabytes. The
                     fully deployed size depends on the number of data marts constructed by the DW/DS
                     contractor and the amount of aggregation built into the data marts.
  RFP Section 5.4                p. 262         Data Warehouse / Decision Support Component
   236     Question: Will the Data Marts be housed on separate servers or on the data warehouse hardware?
           Response: The physical structure of the data warehouse environment provides the opportunity for
                     data marts to be staged on hardware necessary to meet specific technical requirements.
                     The infrastructure is designed using HP dual processor blade servers. Each data mart can
                      be housed on a separate server or two or more data marts can be combined on one server.
                     The actual server configuration is dependant on the level of aggregation, the number
                     and types of users per data mart, the frequency of use of the particular data mart, and the
                     size of the data mart(s). Since much of this detail information is unknown at this time,
                     DHS has constructed a flexible infrastructure that will enable dynamic sizing and staging
                     of data mart server(s).




Response to Bidder Questions – Set 1                         February 23, 2004                            40 of 133
  RFP Section 5.4              p. 262           Data Warehouse / Decision Support Component
   237     Question: What is DHS‘s vision of the use of data marts in the decision support function?
           Response: Data marts are the databases that end-users will access. The basic process is to move
                     data from disparate source systems into a data warehouse database. This data warehouse
                     database will be the source data available to the DW/DS contractor. The DW/DS
                     contractor will be responsible in the design, construction, deployment and maintenance of
                     the data marts. The DW/DS Contractor, ITE and select DHS Staff will have access to the
                     Data Warehouse database as necessary. The data marts will be constructed to meet
                     specific end-user business requirements.
  RFP Section 5.4                p. 262            Data Warehouse / Decision Support Component
   238     Question: Can you reiterate that the State is looking for development staff only in its effort to
                     provide replacement functionality to its current STARS DSS system? Additionally, can
                     you confirm that no turnkey deliverable will be the responsibility of the vendor?
           Response: The new DW/DS being created will replace the existing STARS DSS system. The new
                     system will include more functionality than the existing STARS system. The DW/DS
                     contractor will work with State Staff and other IME Contractors and Vendors to create
                     data mart(s) necessary to meet the needs of the Iowa Medicaid Enterprise. The DW/DS
                     contractor will design the data marts and move data from the data warehouse database
                     into the data mart(s).
  RFP Section 5.4             p. 262           Data Warehouse / Decision Support Component
   239     Question: Would DHS consider a decision support solution that would include either an Oracle
                     DBMS or and IBM DB2 DBMS?
           Response: See response to question # 229.
  RFP Section 5.4                 p. 262        Data Warehouse / Decision Support Component
   240     Question: The RFP states ―DHS will at some time during the course of the DW/DS contract
                     transition the MARS and SURS functionality from the Core MMIS component to the
                     DW/DS component.‖ What is the responsibility of the DSS vendor in this endeavor?
           Response: The DSS contractor will assist in the process if and when the State decides to make this
                     change.
  RFP Section 5.4                 p. 262           Data Warehouse / Decision Support Component
   241     Question: Will the state consider a solution that provides two of the four data warehouse
                     operational support personnel from remote locations?
           Response: The Department feels strongly that the success of the Enterprise depends on on-site staff.
  RFP Section 5.4                 p. 262          Data Warehouse / Decision Support Component
   242     Question: Is DHS seeking a DW/DS contractor who will only function as an expert advisor to the
                     State and provide consulting staff labor to attempt to build analytical capabilities using
                     the existing data warehouse platform and tools, or is DHS interested in proposals from
                     vendors who would also be able to provide proven and tested software applications with
                     robust and flexible healthcare decision support capabilities with built-in clinical and
                     healthcare intelligence?
           Response: DHS is seeking a contractor to function as an expert advisor to the State and provide
                     consulting staff labor to build capabilities using the existing data warehouse platform and
                     tools, to recommend additional tools to meet DHS and component contractor needs, and
                     to assist DHS and component contractor staff in building queries. DHS is not looking for
                     a vendor to bring a decision support system.




Response to Bidder Questions – Set 1                         February 23, 2004                            41 of 133
  RFP Section 5.4, paragraph      p. 262           Data Warehouse / Decision Support Component
              2
   243     Question: The RFP states that ―The DW/DS will be deployed through the use of a staging server
                     and database for data integration and cleansing with production data being made
                     available through production data marts (physical databases). The number of data marts
                     along with the size and data contained within each data mart will be determined as part of
                     the business analysis and reporting requirements. ITE will also provide its existing set of
                     decision support tools for access and manipulation of the data.‖ Does DHS want
                     proposals that propose specific, proven approaches to the creation and application of
                     healthcare analytical data marts that would effectively address the analytical and decision
                     support business needs listed in the RFP?

           Response: DHS is open to any proposal that specifically meets the defined business requirements
                     and is cost/beneficial to the State. It is the Vendor's responsibility to demonstrate a
                     proposal meets identified business requirements and is cost/beneficial.
  RFP Section 5.4, paragraph p. 262                 Data Warehouse / Decision Support Component
               2
   244     Question: The RFP states that ―Prior to the contract awards resulting from this RFP, The Iowa
                     Information Technology Enterprise (ITE) plans to load Medicaid data, beginning with at
                     least five (5) years of historical data, to the current data warehouse.‖ We assume that
                     this means that the structure of the data model used to initially load Medicaid data into
                     the data warehouse will not benefit from the DW/DS contractor‘s expertise and one of the
                     contractor‘s tasks will be to subsequently assess whether and how the data model might
                     need to be altered or even totally redone in order to meet DHS‘s decision support
                     requirements. Is this correct? If so, why does DHS want to proceed initially to load the
                     data without the benefit of the DW/DS contractor‘s expertise?

           Response: DHS will proceed on course because the data warehouse will be neutrally structured to
                     support import into expertly designed data marts that are specifically designed by the
                     DW/DS contracting group to meet specified business requirements. The data warehouse
                     is not being designed around any specific decision support business rules or end-user
                     requirements.
  RFP Section 5.4, paragraph      p. 262           Data Warehouse / Decision Support Component
              3
   245     Question: The RFP states that ―DHS will at some time during the course of the DW/DS contract
                     transition the MARS and SURS functionality from the Core MMIS component to the
                     DW/DS component.‖ At what point does DHS anticipate that this might occur? Is DHS
                     thinking about transferring the software code or creating the SURS and MARS
                     capabilities in the DW/DS environment?
           Response: See question # 240. At this point the approach to providing the functionality has not been
                     determined.
  RFP Section 5.4, paragraph      p. 262           Data Warehouse / Decision Support Component
              5
   246     Question: The RFP states that ―The proposed DW/DS system is intended to provide data analysis
                     and decision-making capabilities and access to information, including online access to
                     flexible, user-friendly reporting, analysis, and modeling functions. Iowa will provide front-
                     end query and analysis tools, report writing tools, and tools for data access and
                     modeling.‖ What is meant by ―Iowa will provide‖? Would DHS consider proposals that
                     include contractor-provided front-end query and analysis tools, report writing tools,
                     and/or tools for data access and modeling if they are needed to effectively address the
                     decision support business needs specified in the RFP?




Response to Bidder Questions – Set 1                         February 23, 2004                            42 of 133
           Response: The statement ―Iowa will provide‖ refers to the fact that Iowa will entertain contractor
                     proposals identifying additional 3rd party software that the contractor believes is
                     absolutely required to address the business needs specified by the RFP. Any software
                     has to be approved and licensed by the State. Only for the DW/DS component should
                     the licensing be included in the bidder‘s cost proposal, as a means to properly evaluate
                     the entire proposed solution. Since DHS will ultimately obtain the license for the
                     software, the included software costs will be backed-out of cost proposals for the
                     purposes of contractor payment. DHS will consider alternatives that can be demonstrated
                     to meet stated business requirements and be more cost beneficial than using existing,
                     owned tools.
  RFP Section 5.4                 p. 263          Data Warehouse / Decision Support Component
   247     Question: The RFP states ‗DHS is looking to the DW/DS system to provide capability in data
                     analysis for use in disease management protocols.‘ Does the State expect the DW/DS
                     vendor to propose third party software for disease management profiling to be integrated
                     with the DW/DS? Please explain in more detail.
           Response: No, the vendor is not required to propose third party software for disease management.
                     The Medical Services contractor will be responsible for developing the disease
                     management program. We expect that the Medical Services contractor will utilize data
                     from the Data Warehouse in its analysis and preparation of recommendations for the
                     disease management program. If either vendor has identified software that could be used
                     for disease management, they can recommend purchase of the software for consideration
                     by DHS.
  RFP Section 5.4.1.1.1.3,        p. 266          Deliverables
              bullet 7
   248     Question: The RFP states that ―Tracking data presented back to the Staging database, from that
                     point, ITE would be responsible for tracking data to the underlying source. There will be
                     some overlap at the data mart level.‖ What is meant by overlap at the data mart level?
           Response: The DW/DS contractor may request data be stored in two or more ways (e.g. claims at the
                     line item level and at the claim level) to meet claim inquiries through the DW/DS.
                     Additionally, the DW/DS contractor may want additional data to be made available in the
                     data warehouse to meet specific data presentation requirements. Since the DW/DS
                     contractor is responsible for the design, construction, refresh and maintenance of the
                     DW/DS data mart databases, it is anticipated that the DSS contractor will want to provide
                     input and guidance to ITE in storing data in the data warehouse to enhance the movement
                     of data from the data warehouse to one or more data marts. The construction of data
                     marts is determined by the DW/DS contractor in their business discovery and support
                     processes to the end user. As such, it is anticipated ITE can accommodate the DW/DS
                     contractor by working with the contractor during the data mart design phase.
  RFP Section 5.4.1.2           p. 266        Development Task
   249     Question: How many and what predefined queries and reports does the State expect to be
                     developing?
           Response: The operations staff provided by the DW/DS vendor will work with the DHS and
                     component contractor users to identify and define queries that should be available to run
                     routinely and to assist users in developing queries as needed.
  RFP Section 5.4.1.3.1.1        p. 272          State Responsibilities
   250     Question: Are the state ITE staff members physically creating and running the data conversions for
                     the new data warehouse?
           Response: Yes. The data warehouse database will contain data from the source systems as near
                     identical as possible. Certain business rules will be applied such as validating dates or
                     converting dates from ASCII text to a date format in SQL Server 2000. The purpose of the



Response to Bidder Questions – Set 1                        February 23, 2004                            43 of 133
                        data warehouse is to provide near identical source data in a semi-structured format for
                        import into the data marts that are designed to meet specific end-user requirements.
  RFP Section 5.4.2.4, bullet 9 p. 286             Contractor Responsibilities
   251     Question: The RFP states that a bullet list of 19 DW/DS analytical capabilities is to be provided.
                     These capabilities include such things as ―provide quality of care measurements‖ and
                     provide ―capability to support budget forecasting.‖ Is this simply a list of analytical
                     consulting tasks to be performed by the four full time analysts, or is DHS interested in
                     software, systems and methodologies that would provide State staff with these
                     capabilities? All 19 of the listed capabilities are ones for which proven and commercially
                     available software applications have already been developed. Does DHS desire a system
                     solution here or merely require consulting staff time to answer these types of questions
                     when they arise?

            Response: DHS is looking for a contractor who can recommend commercially available software that
                      can provide the required capabilities or determine how or if existing DHS software
                      provides the functionality. DHS will review the recommendations and make the
                      determination of whether to invest in new software.
  RFP Section 5.4.2.4, bullet 9, p. 286              Contractor Responsibilities
               #1
   252      Question: The RFP requires analytical capabilities for identifying (and presumably evaluating)
                      episodes of care. Is DHS interested in utilizing episodes of care grouping software or
                      methodologies that can provide more comprehensive episode of care analysis, or is DHS
                      only interested in occasional ad hoc identification of particular episodes of care that are
                      manually compiled by contractor analysts?
            Response: See question # 251.
  RFP Section 6.1.1               p. 292           Staffing Requirements
   253     Question: Please clarify that ―contract start date‖ in the context of the second bullet is refers to the
                     ―contract signing date‖ tentatively scheduled for May 28, 2004.
            Response: No, this refers to July 01, 2004.
  RFP Section 6.1.1            p. 292         Staffing Requirements
   254     Question: Where must a proposed IME Account Manager be located when a bidder submits its
                     proposal?
            Response: There is no requirement for the location of the proposed IME Account Manager at the
                      time the bidder submits its proposal.
  RFP Section 6.1.1              p. 292            Staffing Requirements
   255     Question: The RFP lists identical staffing requirements for all Professional Services Components,
                     even though the scope, functions and responsibilities may vary considerably between the
                     different components. For the Provider Cost Audits and Rate Setting Contractor
                     component, would DHS accept a proposal that did not identify the minimum of two key
                     operations manager positions as long as sufficient other staff resources with the requisite
                     skills to meet or exceed all RFP requirements were identified in the proposal, and
                     assurances were provided to secure the operations managers following contract award?
                     Such an approach appears consistent with language at Section 6.1.1 (page 292), wherein
                     the bidder should be in the best position to define the project staffing for the contractor‘s
                     approach.

            Response: Yes. DHS recognizes that one size does not necessarily fit all the professional services
                      contractors. The proposal must identify a project manager and other resources, either
                      systems experts or policy and operations staff to assure the state that the contractor has




Response to Bidder Questions – Set 1                            February 23, 2004                             44 of 133
                        people committed to the bidder that are capable of performing the requirements listed in
                        the RFP.
  RFP Section 6.1.1, Table 4     p. 294           Staffing Requirements
   256     Question: For the Key Personnel listed in this table, what is an acceptable location for their activities
                     on the ―contract signing date?‖ Is it possible for these individuals to be located
                     elsewhere prior to July 1, 2004?
           Response: There is no requirement related to location of key personnel prior to July 1, 2004.
  RFP Section 6.1.1.1             p. 292            Key Personnel To Be Named
   257     Question: What are DHS's expectations as far as the amount of time the contractor's assigned staff
                     are required to spend at the Enterprise office? For managers - Although a manager may
                     be spending 100% of his/her time on the Iowa project, he/she will continue to have non-
                     client responsibilities that will require him/her to be in his/her home office. For staff
                     members - Are staff members expected to do all work associated with the Iowa project at
                     the enterprise office and all other work at his/her home office?
           Response: All staff except POS systems maintenance and Pharmacy Help Desk staff is expected to be
                     on-site in the Iowa IME office when doing IME work. Staff assigned full-time to the
                     project will be expected to be in the IME office on all State workdays with the exception of
                     vacation and approved sick time or personal days.
  RFP Section 6.1.1.1              p. 292          Key Personnel To Be Named
   258     Question: The State is only requiring a few key positions for each component, but when considered
                     in its entirety, the number of key staff far exceeds that of a typical fiscal agent operation.
                     For example, a Provider Relations Manager is typically required, but the provider relations
                     component requires three key positions. Some of the services components are smaller in
                     scope and three key personnel (account manager and two operations managers) seems
                     excessive. Based on both of these examples, would DHS consider reducing the key
                     personnel requirements?
           Response: DHS recognizes that all Professional Services Components will not require the same level
                     of staffing and therefore DHS believes it has accounted for some discretion among these
                     components. The bidder must identify a full time project manager and such other key
                     staff as would be required to support all requirements listed in this RFP. Monitoring of
                     the individual component contractor‘s activities and continued coordination of the IME
                     will require significant effort on behalf of each component‘s account manager. As such,
                     having 2 additional operations managers for the Provider Services component does not
                     seem excessive. The contractor must have an account manager and a designated backup
                     for the account manager. The contractor must have enough staff to meet the performance
                     requirements and enough management staff to appropriately manage and monitor the
                     contractor's activities.
  RFP Section 6.1.1.1             p. 292           Key Personnel To Be Named
   259     Question: Please clarify the distinction between the "Account Manager" and the "Project
                     Manager." Please verify that you anticipate each of the Professional Service Components
                      will have a minimum of a full time Account Manager and two full time Operations
                     Managers during the periods noted on the chart on page 294.
           Response: The terms are synonymous. DHS recognizes that all Professional Services Components
                     will not require the same level of staffing. The bidder must identify a full time project
                     manager and such other key staff as would be required to support all requirements listed
                     in this RFP.
  RFP Section 6.1.1.1             p. 293            Key Personnel To Be Named
   260     Question: Can you provide the period of time (for resumed employees) over which we should
                     calculate "...the percent of time to be dedicated to the Iowa MMIS..."?



Response to Bidder Questions – Set 1                           February 23, 2004                             45 of 133
           Response: Then intent of this question is to determine the status of key employees for the full term
                     of the contract for the component bid. If a key person is proposed to start by July 1, 2004
                     when the contract is effective, the bidder should indicate if the employee is full time, or
                     part time over the course of the contract. For key personnel who are not proposed to work
                     the full duration of the contract, the bidder needs to show start and end dates and the
                     percentage of time devoted to the project during the period when they are part of the
                     project.
  RFP Section 6.1.1.2.4          p. 295           Coverage During Vacations for Sensitive Positions
   261     Question: Please provide a definition of ―sensitive positions‖ as used in the context of this
                     paragraph?
           Response: "Sensitive positions" in this context are defined as mission critical positions.
  RFP Section 6.1.1.3             p. 295         DHS Approval of Key Personnel
   262     Question: Prior to July 1, 2004, when may successful bidders reasonably anticipate receiving DHS‘
                     approval of key personnel as discussed in this paragraph?
           Response: See question # 96.
  RFP Section 6.1.2.1             p. 296           Temporary Offices during Implementation Phase
   263     Question: In reference to the statement, ―All costs associated with the temporary offices should be
                     figured into the bidder‘s Cost Proposal as part of the bidder‘s overall fixed implementation
                     price‖, should the bidder‘s cost proposal include costs for all the items listed in 6.1.2.2.1
                     State Responsibilities pertaining to permanent facilities?
           Response: Yes.
  RFP Section 6.1.2.1            p. 296           Temporary Offices during Implementation Phase
   264     Question: This paragraph states that cost overruns for temporary offices will not be billable to the
                     State. Pricing Schedule 2 in RFP Attachment K lists temporary office space as a fixed
                     price. Is temporary office space to be bid and billed on a fixed price or reimbursement
                     basis?
           Response: Fixed – see question # 263.
  RFP Section 6.1.2.1           p. 296           Temporary Offices during Implementation Phase
   265     Question: Should bidders budget for office supplies, postage, and the like during the transition
                     period when they will be located in temporary quarters?
           Response: Yes.
  RFP Section 6.1.2.1           p. 296            Temporary Offices during Implementation Phase
   266     Question: What about equipment such as mailing machines for notices? Will the bidder budget for
                     these expenses or will the State acquire? What should bidders assume about other types
                     of equipment not specifically mentioned in the RFP?
           Response: All equipment will be provided by the State. If special equipment is needed, the bidder
                     should identify the required equipment in the proposal.
  RFP Section 6.1.2.1           p. 296           Temporary Offices during Implementation Phase
   267     Question: The requirement to include in the bidder‘s cost proposal the acquisition, furnishing, and
                     maintenance of temporary facilities provides an apparent cost advantage to the
                     incumbent. Will the State‘s evaluation procedures account for this advantage?
           Response: See question # 53.
  RFP Section 6.1.2.1            p. 296          Temporary Offices during Implementation Phase
   268     Question: Does there need to be coordination between all of the subcontractors when securing
                     temporary office space?




Response to Bidder Questions – Set 1                          February 23, 2004                            46 of 133
           Response: There will need to be coordination between the contractors during the Implementation
                     Phase prior to the occupation of the IME facility and vendor staff will need to be available
                     and accessible for meetings in Des Moines. Vendors should consider this in selecting
                     temporary offices, but there is no formal requirement for vendors to consult with each
                     other in selecting temporary office space.
  RFP Section 6.1.2.2              p. 296           Permanent Facilities
   269     Question: Please clarify the statement from the Bidders Conference that the permanent co-location
                     facility will be sited within a 5-mile radius of the state capitol building in Des Moines.
           Response: This is the current plan, but it is subject to change.
  RFP Section 6.1.2.2.1          p. 296             State Responsibilities
   270     Question: Indicates that on or about January 1, 2005, DHS expects to have the permanent facilities
                     for Iowa Medicaid Enterprise staff ready to be occupied. This section also lists the
                     resources that will be provided by DHS to vendors at no cost to the vendor. Parking is
                     not included on this list. Will parking be provided for the vendors‘ Iowa Medicaid
                     Enterprise staff at no cost to the vendors?
           Response: Contractor staff will have the same parking privileges as State employees. If the location is
                     one which has no free parking available, both contractors and State employees will need
                     to pay for parking.
  RFP Section 6.1.2.2.1          p. 297           State Responsibilities
   271     Question: What type of telephone system will be provided? Please provide technical and
                     connectivity information regarding the telephone system to be made available by the
                     State to contractors beginning January 1, 2005?
           Response: The State will provide the telephone system. Bidders should identify their requirements
                     for the telephone system in their proposal.
  RFP Section 6.1.2.2.1            p. 297           State Responsibilities
   272     Question: Please provide a list of the ―software licenses for commercially-available packages‖ that
                     the State will be making available to contractors beginning January 1, 2005. Please
                     confirm that bidders should include licensing costs for additional software not included
                     on this list in their cost proposals.
           Response: If the State approves the proposed software, the State will provide the licenses. See
                     Amendment 4 for the change in the date.
                       State Software List:
                       Microsoft Professional Suite
                       SPSS
                       Visual InterDev
                       SQL Enterprise Utility & Analysis Services
                       Macromedia Flash
                       Visio
                       Power Designer
                       Crystal Reports
                       Front Page
                       Paint Shop Pro
                       Visual Basic
                       Business Objects
                       Java/Web Sphere
                       ASP IIS (with graphics enhancement package)
                       For the DW/DS component, bidders will include the cost of licenses in the cost proposal
                       for the purposes of full solution evaluation. However, since the State will actually be




Response to Bidder Questions – Set 1                          February 23, 2004                              47 of 133
                       purchasing the associated third-party licenses, the included cost will be deducted for
                       purposes of payment.
  RFP Section 6.1.2.2.1          p. 297        State Responsibilities
   273     Question: Will portable notebook computers be provided for contractor staff members performing
                     on-site audit work?
           Response: Yes, but these will be shared resources. Not every staff member will have a portable
                     notebook computer.
  RFP Section 6.1.2.3.1           p. 298           Contractor Responsibilities
   274     Question: May bidders propose providing other commercially available software not on the State‘s
                     list of such software for use as part of the Iowa Medicaid Enterprise?
           Response: Yes.
  RFP Section 6.1.2.3.1           p. 298           Contractor Responsibilities
   275     Question: If a contractor wishes to use commercially available software which has not been
                     identified in the RFP as being provided by DHS, how should that be presented in the
                     Technical and Cost Proposals?
           Response: Recommendations for additional software should be identified in the bidder's technical
                     proposal. If the State approves the recommendation, the State will purchase the licenses.
                     These costs should not be included in the bidder's cost proposal.
  RFP Section 6.1.3               p. 298            Onsite and Offsite Expectations
   276     Question: Is it DHS's intent that subcontractors and consultants would also be located in the same
                     common facility? Examples: If a subcontractor's time was not 100 percent dedicated to the
                      Iowa Medicaid Enterprise, could the subcontractor's staff be located off site? Would
                     consultants (e.g., Ph.D. statisticians), who may be used by contractors on an occasional
                     basis, be required to have physical presence at the Medicaid Enterprise premises while
                     providing consultation?
           Response: In general staff of the contractor and any subcontractor, except POS system maintenance
                     and Pharmacy Help Desk staff, engaged in IME work must be located in the IME facility.
                     Consultants who are used from time to time would normally be expected to work on-site
                     when they are doing IME work.
  RFP Section 6.1.3.1             p. 298          Onsite Expectations
   277     Question: Is the contractor expected to assign an administrative staff person to work at the Iowa
                     Medicaid Enterprise who will process our final audit reports?
           Response: Yes.
  RFP Section 6.1.3.1             p. 298           Onsite Expectations
   278     Question: Please clarify your term "directly associated." Does this mean only those who work full
                     time on the project or does it mean anyone who works on the project?
           Response: Anyone other than POS system maintenance and Pharmacy Help Desk staff who is
                     performing Iowa Medicaid work must perform the work on-site at the IME facility.
  RFP Section 6.1.3.1             p. 298           Onsite Expectations
   279     Question: Will it be possible for any, for example, call center staff to be located in another city or
                     state? There may be economies of scale to be achieved by developing some components
                      at locations already providing like services for a similar customer.
           Response: No. All call center staff other than staff for the Pharmacy POS Help Desk must be located
                     in the IME facility. The other exception is to provide coverage outside of normal IME
                     business hours, such as staff to cover night and weekend emergency prior authorization
                     requests.



Response to Bidder Questions – Set 1                          February 23, 2004                             48 of 133
  RFP Section 6.1.4               p. 298          General Start-Up Activities for Professional Services
   280     Question: Please clarify whether the IS&S contractor selected under RFP No. MED-05-014 will be
                     participating with the IME contractors as part of all activities described in this section.
           Response: Yes. See RFP MED-04-037.
  RFP Section 6.1.4.1.1, bullet 4 p. 299            Planning Task Activities
   281      Question: Does the State currently have a project management system in mind, or is strongly leaning
                      towards one system?
           Response: Microsoft Project 2002 will be used for project management.
  RFP Section 6.1.4.1.2           p. 286           State Responsibilities
   282     Question: Are the State's policies regarding the scope of work within this RFP up to date or are
                     policy revisions expected prior to implementation of any service requested in the RFP? If
                     so, please specify the services that will be affected by policy changes and when these
                     changes will be effective.
           Response: At this time there are no known policy changes, but some may occur during the
                     Implementation Phase.
  RFP Section 6.1.4.1.4, bullet 5 p. 300            Deliverables
   283      Question: Please define the ―Documentation Standards plan‖
           Response: The documentation standards plan specifies the vendor's standards for its documentation
                      (system, operations, and/or procedures), including the format of documents, naming
                     conventions, version control process, etc.
  RFP Section 6.1.4.2.1.2        p. 301           Contractor Responsibilities
   284     Question: Is the incumbent contractor contractually obligated to work with the new contractor? If
                     not, what contingencies are in place to facilitate with the knowledge transfer?
           Response: Yes.
  RFP Section 6.1.4.2.2          p. 301           System Design Activity
   285     Question: Will the contractor be using the existing applications for the Professional Services
                     Components or will the contractor be required to provide new software for each
                     Professional Services System Component?
           Response: Yes, the contractor will be using existing applications. However, bidders may recommend
                     their own software to provide more efficient and cost-effective processing of the work
                     required for their contract. If approved, DHS will purchase the software or the license.

  RFP Section 6.1.4.3.2          p. 306            Pilot Test Activity
   286     Question: If known at this time, please provide a listing of those Professional Services components
                     (and contractors) that will be impacted by this requirement.
           Response: All contractors who utilize elements of the Core MMIS will be involved in the Pilot Test.
  RFP Section 6.1.4.4.3, bullets p. 309             Deliverables
               3 and 4
   287      Question: Please discuss the difference between ―Emergency Back-out Plan‖ versus ―Backup and
                      Recovery Plan.‖
           Response: The emergency back-out plan must be in place prior to the start of operations and will be
                     invoked if the system is not ready to start operations on June 30, 2005. The backup and
                     recovery plan will be in place during operations and would be invoked if there is a disaster
                     that affects the ability of the systems and/or operations to function. Each contractor is
                     responsible for these plans for the work required under their contract.




Response to Bidder Questions – Set 1                         February 23, 2004                              49 of 133
  RFP Section 6.1.5             p. 309         Contract Management
   288     Question: Has the contract management software that will be used been identified and, if so, what is
                     it?
           Response: DHS will provide the project management software that will be used by all component
                     contractors. Final decision of software has not been made.
  RFP Section 6.1.6.1              p. 312           Approach to Performance Standards and Damages
   289     Question: Each Professional Services component task includes a variety of Performance Standards
                     tied to its respective contractor responsibilities. Please discuss and clarify that it would
                     be a reasonable expectation that other performance standards will be developed and
                     negotiated in conjunction with contractors over the term of the contract. Please clarify
                     that such additional or revised performance requirements implemented over the term of
                     the contract would be included under the Change Service Request process described at
                     Section 9.9.
           Response: Yes, the expectation is that other performance standards will be developed and negotiated
                     over the term of the contract and that such standards if implemented as a result of a
                     change in the contract would be included under the Change Service Request Process in
                     Section 9.9.
  RFP Section 6.1.6.2             p. 312          Right to Assess Damages
   290     Question: Please clarify that the Department will only assess damages against the performance bond
                      once the contractor has been given an opportunity to (1) utilize the Dispute Resolution
                     Process For Damages Assessments listed in 6.1.6.3 and/or (2) the contractor has been
                     given opportunity to remit payment.
           Response: The Department may obtain payment of assessed actual damages through one (1) or more
                      claims upon any performance bond furnished by the Contractor after the Contractor has
                     been given the opportunity to utilize the Dispute Resolution Process for Damage
                     Assessments in Section 6.1.6.3 and/or the Contractor has been given the opportunity to
                     remit payment. This response also applies to Section 5.1.6.2.
  RFP Section 6.1.6.3             p. 312            Dispute Resolution Process for Damages Assessment
   291     Question: Please clarify that the director's decision is the final administrative decision and that the
                     director's decision will not prevent the contractor from pursuing the issue in any state or
                     federal court that has jurisdiction
           Response: The Director's decision is final for purposes of Iowa Code Chapter 17A. Please refer to
                     Section 9.20.6 for the appropriate forum.
  RFP Section 6.1.6.4.1           p. 313          Systems Certification
   292     Question: Please clarify the process and criteria that will be used to determine the allocation of FFP
                     reduction damages to the Professional Services Contractor
           Response: If the system is not certified due to acts of commission or omission of the contractor,
                     damages would be assessed proportionate to the fault of the contractor.
  RFP Section 6.1.6.4.2           p. 314          Operations Start Date
   293     Question: Please clarify the process and criteria for determining the allocation of damages to the
                     Professional Services Contractor for a delay in the operations start date.
           Response: The criteria for any of the component contractors is failure to be operational on the
                     scheduled operations start date due to a failure of the contractor to meet the operational
                     requirements of their contract.
  RFP Section 6.1.6.4.2          p. 314            Operations Start Date
   294     Question: This section states that the State will determine the Professional Services contractors‘
                     ability to meet the June 30, 2005 date ―following the conclusion of the MMIS



Response to Bidder Questions – Set 1                           February 23, 2004                             50 of 133
                        implementation.‖ In this context, how is ―conclusion of the MMIS implementation‖
                        defined? How would the state proceed if the new MMIS is implemented but a
                        Professional Services contractor is not ready to use it?
           Response: The conclusion of the MMIS implementation is when the system becomes operational on
                     June 30, 2005. The emergency backout plan would be invoked if necessary.
  RFP Section 6.1.6.4.3            p. 314           Erroneous Payments
   295     Question: Please confirm that it is the State's intent for the professional services vendors at fault to
                     directly initiate overpayment recovery or payment of an underpayment with providers in
                     cases where that vendors performance has resulted in the overpayment or underpayment.
                      If the vendor at fault doesn't routinely have responsibility for recovery or payments, they
                      won't be knowledge in the appropriate processes. The vendor primarily responsible for
                     these activities will also lose control of the process.
           Response: The vendor who is at fault should initiate the recovery or payment. If the vendor does not
                      routinely have responsibility for recovery, they will work with the Revenue Collection
                     contractor and/or the Core MMIS vendor through DHS to initiate the transaction.
  RFP Section 6.1.6.4.3           p. 314            Erroneous Payments
   296     Question: Please clarify the process and criteria that will be used to determine whether the
                     Professional Services Contractor has contributed to an erroneous payment. Please clarify
                     prior to recouping the erroneously paid funds from the Professional Services Contractor
                     that the contractor will be allowed to recoup such amounts through the MMIS.
                     Additionally, please clarify that following payment to the Department, the contractor will
                     be allowed to use the MMIS to recoup monies that are paid to the Department for
                     erroneously paid amounts as well as pursue other available remedies outside of the MMIS.
           Response: If data entered in the MMIS by the contractor was entered erroneously (e.g., a provider
                     rate was entered incorrectly, a manual price was entered incorrectly), the contractor who
                     entered the data will be responsible for the erroneous payment. The contractor will be
                     allowed to recoup such amounts through the MMIS, and if the contractor has made
                     payment to DHS, they will still be able to pursue recoupment through the MMIS or other
                     available means.
  RFP Section 6.1.7               p. 315          Internal Quality Assurance
   297     Question: Please clarify whether the quality improvement measures referred to in this paragraph are
                     in addition to the performance standards included within each service component of this
                     procurement. If so, within what timeframe will such quality improvement measures need
                     to be approved by DHS and subsequently implemented? What other IME contractors or
                     other State agencies will participate in the design and monitoring of these quality
                     measures?
           Response: The quality improvement measures referred to in the paragraph are in addition to the
                     performance standards. The vendor should have a continuous quality improvement
                     program in its operation. The intent is for each vendor to monitor its performance
                     standards through a quality assurance process and to review its operations on a
                     continuing basis to identify improvements that can be made in processes and procedures.
                     These may be triggered by the quality assurance process, but the vendor is expected to
                     be pro-active and identify quality improvements in addition to those identified by the
                     quality assurance process. All IME contractors will participate in the design and
                     monitoring of the quality measures and will provide them to DHS for approval before they
                     are implemented.
  RFP Section 6.1.7.2            p. 315           Contractor Responsibilities
   298     Question: What is the due date for the "Quality Assurance Plan establishing quality assurance
                     procedures"?




Response to Bidder Questions – Set 1                           February 23, 2004                             51 of 133
           Response: The Quality Assurance Plan must be developed and submitted for DHS approval during
                     the Implementation Phase of the contract. Vendors should include the dates for
                     preparation and submission of the plan in the work plan.
  RFP Section 6.1.9                p. 317          Documentation
   299     Question: Please provide a list or copy of the ―standard naming conventions‖ that DHS wishes
                     bidders and contractors to use as part of the Iowa Medicaid Enterprise. If one is not
                     currently available, please provide a timeframe of when such conventions will be available
                     or, if to be developed, an estimated timeframe for DHS approval during the
                     Implementation Phase.
           Response: Standard naming conventions will follow those currently utilized by the core MMIS
                     application. Details of the standard naming conventions will be available once the bidder
                     starts work on the project.
  RFP Section 6.1.10             p. 317            Security and Confidentiality Requirements
   300     Question: We typically use photo nametags with barcode swipe systems for secure entry. Would
                     this be appropriate, and if so, should we include this in our implementation costs? We
                     would recommend all contractors implement this security provision.
           Response: No. This should not be included in the cost proposal. DHS will provide nametags and
                     security provisions.
  RFP Section 6.1.10             p. 318            Security and Confidentiality Requirements
   301     Question: Will the State facility provide "limited access areas" for each of the vendors to secure if
                     vendors are to maintain entry logs for these areas and maintain confidential and critical
                     materials in limited access, secured areas? Please clarify the definition of "limited access
                     areas".
           Response: The facility will provide limited access areas for the whole IME. The configuration of the
                     building will provide for the limited access areas for the whole enterprise.
  RFP Section 6.1.11 and 6.1.12 p. 318 and 319 Accounting Requirements
   302     Question: This section requests that "records be maintained separate and independent of other
                     accounting records of the contractor." Please confirm that bidders will not need to set up
                     separate corporate entities for this contract.
           Response: This is confirmed. See also question # 91.
  RFP Section 6.1.12 and 9.19.4 p. 319 and          Audit Requirements
                                   521.
   303      Question: Section 6.1.12 requires "...an independent audit of their Iowa account annually" while
                      Section 9.19.4, page 521 requires "...a complete financial audit conducted annually...". If
                      an audit of the Iowa Account is the required, are you expecting an audit of the
                      contractor's profit or loss on this contract? If a complete financial audit is required, are
                      you expecting an audit of the contractor's whole organization?
           Response: The audit will consist of those functions related to its work on the Iowa contract.
  RFP Section 6.1.12.2           p. 319           Access to Records
   304     Question: Please confirm that the contractor-provided facilities are only required in instances where
                     audits and inspections are not taking place at the Des Moines facility.
           Response: Yes.
  RFP Section 6.1.13             p. 319            Transfer of Work Responsibilities
   305     Question: By each bid component, please describe the safeguards DHS will put in place with current
                     contractors to require their participation and cooperation with the new contractors for a
                     smooth transfer of work responsibilities during the DDI-Installation Phase.




Response to Bidder Questions – Set 1                          February 23, 2004                             52 of 133
           Response: DHS will ensure the cooperation of current contractors through enforcement of
                     contractual obligations to transfer to the new contractor.
  RFP Section 6.1.13                p. 320, last   Transfer of Work Responsibilities
                                       sentence of
                                        the last
                                       paragraph.
   306      Question: Can any more specific information be provided on how much "unfinished work" each of
                      the Professional Service Components can expect?
           Response: DHS will monitor the current contractors' performance to ensure that performance
                     standards continue to be met during the start-up phase of the new contracts. DHS expects
                      that inventories to be turned over would be equivalent to no more than would be normal
                     at the end of any work day.
  RFP Section 6.2                 p. 321          Medical Services Component
   307     Question: In the introductory paragraph to this Professional Services component, please identify all
                     activities performed by the Iowa Foundation for Medical Care (QIO), the incumbent Fiscal
                     Agent and other organizations.
           Response: Refer to Section 3 of RFP.
  RFP Section 6.2.1              p. 321          Contractor Start-Up Activities
   308     Question: For inclusion in proposed Implementation Phase work plans, please provide an estimated
                     timeframe when the Medical Services contractor may be able to participate in ―training
                     from the systems contractors on using their systems.‖
           Response: See question # 466.
  RFP Section 6.2.1.2            p. 322          Development Task
   309     Question: What is the scope of services provided by the contracted POS pharmacy claims processor?
           Response: See RFP Section 3.
  RFP Section 6.2.1.2            p. 322          Development Task
   310     Question: Who is the State of Iowa currently contracted with to provide POS pharmacy claims
                     processing services?
           Response: Affiliated Computer Services (ACS)
  RFP Section 6.2.1.2           p. 322           Development Task
   311     Question: Does the State of Iowa anticipate any change in the scope of services provided by the
                     POS pharmacy claims processor as a result of this procurement?
           Response: Under the new contract Pharmacy prior authorizations will be processed by the Medical
                     Services contractor. The POS contractor will need to develop a process to access the Core
                     MMIS PA file to verify authorization or develop a file transfer process to obtain the PA
                     data from the Core MMIS.
  RFP Section 6.2.1.2            p. 322         Development Task
   312     Question: When will the Workflow Process Management system be available to assist the
                     contractor in meeting Development Task requirements?
           Response: The Workflow Process Management system will be developed during the Implementation
                     Phase Development Task and will be used during the Operations Phase to monitor and
                     track workflow. During the Implementation Phase, including the Development Task, work
                     will be tracked in a Project Management system using Microsoft Project 2002.
  RFP Section 6.2.1.3             p. 322          Acceptance Test Task
   313     Question: Please clarify the data conversion that is verified during the acceptance test task.



Response to Bidder Questions – Set 1                          February 23, 2004                             53 of 133
           Response: During the Acceptance Test Task, the testing will verify that data transferred from the
                     contractors systems (i.e., Core MMIS and POS) have been transferred and converted to
                     the State Data Center system and the new vendor‘s POS system. It will also test the
                     conversion of MMIS data to the Data Warehouse.
  RFP Section 6.2.1.3            p. 322           Acceptance Test Task
   314     Question: Will connectivity and technical costs by borne by the POS claims processor or should
                     those costs be included in the proposal?
           Response: The POS contractor will pay all connectivity and technical costs. These should be
                     included in the cost proposal.
  RFP Section 6.2.1.4            p. 322          Implementation Task
   315     Question: Will the IS&S contractor be responsible for developing a joint interface plan for all nine
                     contractors and who will coordinate the plan?
           Response: Each contractor will provide the plan for its own component(s). The I&SS contractor will
                     be responsible for the integration of the component plans into a master plan and will
                     coordinate with all component contractors. DHS will provide the interface for all
                     contractors.
  RFP Section 6.2.1.5             p. 322          Operations Task
   316     Question: Will the contractor secured through this procurement have real time or near real time
                     access to claims data?
           Response: Yes.
  RFP Section 6.2.1.5            p. 322         Operations Task
   317     Question: Does the State of Iowa expect 100% of operations described in this request for proposals
                     to occur within the State?
           Response: Other than Pharmacy POS activities, all operations will be performed at the IME facility in
                     Des Moines.
  RFP Section 6.2.2.1           p. 323            General Requirements
   318     Question: Are the medical policies for DHS up to date?
           Response: Yes. The policies can be found in the state administrative rules.
  RFP Section 6.2.2.1             p. 323            General Requirements
   319     Question: The RFP states in the first paragraph ―The contractor will also take the lead in developing
                     analytical tools for quality assessment of service provided through Medicaid.‖ Please
                     explain in more detail.
           Response: The contractor should apply the same standards to Medicaid as one would to a managed
                     care organization and should use those standards as a model.
  RFP Section 6.2.2.2.2          p. 324           Interfaces
   320     Question: Please describe those circumstances where contractor personnel would interface with
                     providers regarding ―decisions on individual claims.‖ What expectation(s) does the State
                     have in regards to the outcomes of discussions with providers regarding ―decisions on
                     individual claims?‖ How will contractor personnel be authorized to use populated claims
                     data in meeting this requirement?
           Response: The contractor may interface with providers to clarify medical policy and medical
                     necessity decisions made by the contractor's staff. Contractor personnel will use the on-
                     line access to claims history when necessary to review the decisions and respond to
                     questions from providers.




Response to Bidder Questions – Set 1                         February 23, 2004                            54 of 133
  RFP Section 6.2.2.2.2.1         p. 324         Interfaces With Other Iowa Medicaid Enterprise
   321     Question: The RFP states ―At the request of DHS, Medical Support staff may update the provider
                     files at the MMIS with any new procedure codes or provider types …‖ Does this mean
                     that the PDD files must be updated?
           Response: The medical support function will review and recommend changes to the procedures,
                     diagnoses, and provider files. The Core MMIS will be responsible for updating the
                     reference files and the Provider Services contractor will be responsible for updating the
                     provider file upon approval of the recommendations by DHS.
  RFP Section 6.2.2.2.4.1.1        p. 324 and 325 General Medical Support
   322      Question: Does the contractor develop a process for submission of recommendations? Please define
                      the frequency of policy implementations-annual or as changes are defined and approved?
           Response: The Contractor will develop process for approval by DHS. Policy implementations are
                     done as changes are defined and approved.
  RFP Section 6.2.2.2.4.1         p. 325          General Medical Support
   323     Question: Is the State expecting consultants to be on-sight staff or may consultants participate from
                     a remote location or another state?
           Response: When consultants are working on the Iowa Medicaid Enterprise, they should be on-site at
                     the IME facility.
  RFP Section 6.2.2.2.4.1        p. 326          General Medical Support
   324     Question: Are the names of the consultants required at time of proposal submission or at time of
                     contract implementation?
           Response: Names of the consultants must be provided at the time of contract execution.
  RFP Section 6.2.2.2.4.1         p. 326           General Medical Support
   325     Question: The RFP states that medical staff support DHS in responding to appeals and requests for
                     exceptions to policy. It further states that medical staff are required to attend appeal
                     hearings, etc. How many appeals does DHS receive in a fiscal year? How many exception
                      to policy requests? How many appeal hearings are there?
           Response: Appeals received in FY 03 was 2,021.

                       Exception to Policy received for calendar year 2003 are:
                        1 for hawk-i
                        439 for HCBS
                        2 for HIPP
                        859 for Medical Coverage
                        49 for Medicaid Eligibility

                       Approximately 826 appeals go to hearing. 97 Department reversed, 285 affirmed, 444
                       modified and the rest were either denied, dismissed, abandoned or withdrawn.

  RFP Section 6.2.2.2.4.1,         p. 325           General Medical Support
              bullet 3
   326      Question: Please describe the scope of the State‘s expectation of the ―technical assistance‖ that
                      may be required from the contractor in responding to program reviews and audits.
           Response: Contractors must fully cooperate with any outside auditors to provide information within
                     their area of work under the contract.




Response to Bidder Questions – Set 1                          February 23, 2004                             55 of 133
  RFP Section 6.2.2.2.4.1,         p. 325           General Medical Support
              bullet 4
   327     Question: Please clarify that support to providers for billing requirements and policy questions are
                     only as it relates to prior authorization requests. Please confirm that general inquiries
                     regarding policy and billing are to be handled by the Provider Relations vendor.
           Response: Medical support staff will prepare the policy clarification and identify the provider groups as
                     needed, and the Provider Services staff will review for format, obtain DHS approval, and
                     arrange for distribution. General inquiries regarding policy and billing will be handled by
                     the Provider Services contractor.
  RFP Section 6.2.2.2.4.1,         p. 325           General Medical Support
              bullet 4
   328     Question: Does a tracking system currently exist, and if so, are we expected to use it or
                     provide/develop our own system?
           Response: The contractor will use the WPM to track contacts.
  RFP Section 6.2.2.2.4.1,         p. 325           General Medical Support
              bullet 5
   329     Question: Where must the medical and social service professionals listed in this requirement be
                     located and licensed? Does DHS anticipate that the contractor will credential each
                     participating medical and social service professional staff or consultant? When must
                     these professionals be available for IME program services, if prior to the June 30, 2005
                     operations date?
           Response: Medical and social service professionals must be licensed in Iowa. The Contractor will be
                     responsible for verifying credentials. These professionals must be available prior to June
                     30, 2005 to get training in the system.
  RFP Section 6.2.2.2.4.1,         p. 325           General Medical Support
              bullet 5
   330     Question: Are these consultants required to have a clinical license from the State of Iowa? If so, can
                     this license be obtained after contract award?
           Response: Yes to both questions.
  RFP Section 6.2.2.2.4.1,         p. 326           General Medical Support
              bullet 5
   331     Question: The last paragraph of #5 indicates that the scope of work for Medical Services
                     consultants includes member utilization review. This seems to be in conflict with Sections
                      3.4.16.1 and Section 5.2.2.11.3 that indicate member utilization review is done by IFMC or
                     the new Lock-In contractor. Please clarify.
           Response: The Medical Services contractor will be responsible for lock-in. See RFP MED-04-034.
  RFP Section 6.2.2.2.4.1,         p. 326           General Medical Support
              bullet 6
   332     Question: In other states it is acceptable for physicians to give testimony at fair hearings and attend
                     meetings via telephonic conference connections. Is this acceptable in Iowa?
           Response: Yes.
  RFP Section 6.2.2.2.4.1,         p. 326           General Medical Support
              bullet 7
   333     Question: What determinations of medical necessity appropriateness are currently performed? How
                     many such reviews are performed monthly? What tools and criteria are used in
                     performing such medical necessity reviews?




Response to Bidder Questions – Set 1                          February 23, 2004                             56 of 133
           Response: Normally, determinations of this nature are performed through the Prior Authorization
                     function. The average number of PAs received per month is 910.
                      The criteria for the majority of PA requests are addressed in the Iowa Administrative Code
                      (IAC) or Medicare Guidelines.
  RFP Section 6.2.2.2.4.1,        p. 326          General Medical Support
              bullet 7
   334     Question: Does the State have an anticipated volume of claims requiring manual review?
           Response: No
  RFP Section 6.2.2.2.4.1,         p. 326         General Medical Support
               bullet 8
   335     Question: Please provide the average monthly volume of claims that require manual pricing by type
                      of service (i.e., DME, MD, etc).
           Response: We do not have the numbers broken down by type of service, however, the total
                     occurrences is 3,081 for the month of December 2003.
  RFP Section 6.2.2.2.4.1,        p. 326          General Medical Support
              bullet 8
   336     Question: Please clarify that it is DHS‘ expectation that the Medical Services contractor will be
                     paying claims in the context of medical necessity reviews? Please provide the rationale
                     for this contractor not forwarding its medical necessity findings to the Core MMIS
                     contractor for final processing. How many claims are currently paid each month in this
                     manner? Is it DHS‘ expectation that the Medical Services contractor will be providing
                     claims processors to accomplish this task? Our concern is that it does not appear
                     appropriate from an internal controls standpoint for the Medical Services contractor to be
                     paying claims in any fashion – please provide a detailed explanation of DHS‘ expectation
                     so that potential bidders may best address this task in their proposals.

           Response: The Contractor will not be paying claims. The Medical Services contractor will be
                     reviewing claims that cannot be priced automatically, such as DME equipment that is
                     tailored to the specific member and other claims that require a medical decision to
                     determine the price. Once the price has been determined, the Medical Services contractor
                     staff will enter the price using the on-line pend resolution process.
  RFP Section 6.2.2.2.4.1,        p. 327          General Medical Support
              bullet 9
   337     Question: How many new outpatient hospital programs have been certified in the past 2 years?
                     Please identify them.
           Response: The number certified in the last two years is 29. They are: Cardiac Rehab 3, Substance
                     Abuse 2, Diabetic Education 16, Eating Disorder 1 and Pulmonary Rehab 7.
  RFP Section 6.2.2.2.4.1,        p. 327          General Medical Support
              bullet 10
   338     Question: Please provide the average monthly volume of claims related to hysterectomies, abortions,
                      sterilization, private duty nursing, personal care and orthodontia that require review and
                     the review purpose (compliance with completed forms vs. clinical).
           Response: These numbers do not represent paid claims. The following numbers represent the
                     number of claims that were reviewed because of these diagnoses: Hysterectomies – 115,
                     Abortions – 209, Sterilizations – 2,025, Private Duty Nursing – insignificant, handled
                     through Prior Authorization process, Orthodontia – insignificant, handled through Prior
                     Authorization process.




Response to Bidder Questions – Set 1                        February 23, 2004                            57 of 133
  RFP Section 6.2.2.2.4.1,         p. 327          General Medical Support
              bullet 15
   339     Question: Please clarify the State‘s expectation that the contractor will be assisting providers with
                     billing procedures as applicable only to medical necessity requirements.
           Response: Yes.
  RFP Section 6.2.2.2.4.1,        p. 327          General Medical Support
               bullet 15
   340     Question: Please clarify when Medical Services will receive and track calls from providers and other
                      stakeholders, compared to those calls received by Provider Relations.
           Response: See RFP MED-04-034.
  RFP Section 6.2.2.2.4.1,         p. 327          General Medical Support
              bullet 15
   341     Question: Does a tracking system currently exist, and if so, are we expected to use it or
                     provide/develop our own system?
           Response: The Workflow Process Management system will be used as the tracking system.
  RFP Section 6.2.2.2.4.1,         p. 327          General Medical Support
              bullet 16
   342     Question: Does that State have an anticipated volume of home health services claims reviews for
                     medical necessity?
           Response: Approximately 10% of claims are reviewed per month. There are 34,000 claims per month.
  RFP Section 6.2.2.2.4.2         p. 327          Preferred Drug List (PDL) Maintenance
   343     Question: Is there a current PDL for Iowa Medicaid?
           Response: No.
  RFP Section 6.2.2.2.4.2,         p. 328          Preferred Drug List (PDL) Maintenance
              bullet 7
   344     Question: Is there a current application to host the information regarding drugs on the PDL for the
                     provider community? The internet is mentioned; does the contractor have to build a site
                     to host this information if one does not already exist?
           Response: See RFP MED-04-034 for these requirements.
  RFP Section 6.2.2.2.4.2,         p. 328          Preferred Drug List (PDL) Maintenance
              bullet 10, #2
   345     Question: Will we be required to develop and host this website, or provide content to another
                     contractor?
           Response: The contractor will provide content for the website to the State.
  RFP Section 6.2.2.2.4.2          p. 328 and 347 Preferred Drug List (PDL) Maintenance
   346     Question: Are there any other requirements for Internet, web-based browser, or client server
                     environments for the Medical Services Component, other than the PDL and P&T
                     Committee requirements (Page 328) and the option to use a Web portal or other means for
                     the ANSI X12 278 transaction (Page 347)?
           Response: No.
  RFP Section 6.2.2.2.4.2,         p. 329          Preferred Drug List (PDL) Maintenance
              bullet 10, #8
   347     Question: Does DHS intend to provide the federal and supplemental rebate information to the
                     Medical Services contractor to accurately calculate the net cost?
           Response: Yes.



Response to Bidder Questions – Set 1                          February 23, 2004                            58 of 133
  RFP Section 6.2.2.3            p. 330           Disease Management
   348     Question: Please provide enrollment data of chronic patients and the ABD population by county to
                     assist bidders in developing their disease management and case management programs.
                     Please include the number of recipients by disease type and costs to provide care for the
                     past 3 years, as known.
           Response: DHS expects the contractor to perform this analysis as part of the contract. See
                     Attachment E to these responses for the disease type and cost information.
  RFP Section 6.2.2.3             p. 330          Disease Management
   349     Question: Is there a current disease management contractor? If so, what is the contractor's name?
           Response: The Department does not currently have a formalized disease management program.
                     However, the Department initiated a pilot program for diabetes management in October of
                     2003 which is expected to be concluded as of September 30, 2004. This is being
                     undertaken by the Iowa Foundation for Medical Care.
  RFP Section 6.2.2.3            p. 330 to 334 Disease Management
   350     Question: Please provide a current list of high-dollar inpatient stays and days per thousand.
           Response: See Attachment D to these responses.
  RFP Section 6.2.2.3            p. 331           Disease Management
   351     Question: Please provide a listing of DHS‘ ―service regions in the state,‖ including a list of the
                     counties included in each service region.
           Response: There are 8 service Areas in Iowa. Each has responsibility for a specific set of counties.
                     They are as follows: Sioux City – Buena Vista, Cherokee, Clay, Dickinson, Emmett, Ida,
                     Kossuth, Lyon, O‘Brien, Osceola, Palo Alto, Plymouth, Sioux, Woodbury. Waterloo –
                     Black Hawk, Bremer, Butler, Cerro Grodo, Chickasaw, Flyod, Franklin, Grundy, Hancock,
                     Mitchell, Winnebago, Worth. Dubuque - Allamakee, Buchanan, Clayton, Clinton,
                     Delaware, Dubuque, Fayette, Howard, Jackson, Winneshiek. Ames – Calhoun, Hamilton,
                     Hardin, Humboldt, Jasper, Marshall, Pocahontas, Poweshiek, Story, Tama, Webster,
                     Wright. Council Bluffs - Audubon, Carroll, Cass, Crawford, Fremont, Greene, Guthrie,
                     Harrison, Mills, Monona, Taylor, Montgomery, Page, Pottawattamie, Sac, Shelby. Des
                     Moines – Adair, Adams, Boone, Clarke, Dallas, Decatur, Lucas, Madison, Marion, Polk,
                     Ringgold, Union, Warren, Wayne. Cedar Rapids – Appanoose, Benton, Davis, Iowa,
                     Jefferson, Johnson, Keokuk, Linn, Mahaska, Jones, Monroe, Van Buren, Wapello,
                     Washington. Davenport - Des Moines, Henry, Lee, Louisa, Muscatine, Scott, Cedar.
  RFP Section 6.2.2.3            p. 331          Disease Management
   352     Question: Please define ―Service Region‖
           Response: See question # 361.
  RFP Section 6.2.2.3 and           p. 331          Disease Management
              6.2.2.3.2
   353      Question: a. Should this initial passage read, non-HMO and MediPASS members, since it is our
                      understanding the disease management program does not apply to HMO members? b If
                      the disease management program does apply to HMO members, please provide details of
                      that relationship.
           Response: HMO enrollees are not enrolled in the diabetes management program. The disease
                     management program does not apply to HMO enrollees.




Response to Bidder Questions – Set 1                          February 23, 2004                             59 of 133
  RFP Section 6.2.2.3.2.2,         p. 332           Interfaces With External Entities
              bullet 2
   354      Question: Who is this ―separate contractor‖ and what role in data analysis will they be performing?
           Response: The interface noted in 6.2.2.3.2 speaks to any "outside contractor" that the medical services
                     contractor may use to analyze data. Bullet 2 speaks to the ability to interface with such a
                     contractor.
  RFP Section 6.2.2.3.4          p. 332           Contractor Responsibilities
   355     Question: Is the bidder required to propose a disease management system?
           Response: The bidder is required to propose a disease management program and bring the tools
                     necessary to implement it.
  RFP Section 6.2.2.3.4          p. 332            Contractor Responsibilities
   356     Question: Once identified, is recipient participation voluntary or mandatory in the pilot program?
           Response: Current activities are voluntary. The department will entertain any suggestion as to how
                     to encourage enrollment and such should be part of the bidder‘s response.
  RFP Section 6.2.2.3.4          p. 332             Contractor Responsibilities
   357     Question: The RFP reference ‗The successful bidder will use current automated tools and apply
                     clinical expertise to identify non-HMO members with chronic diseases …‘. What are the
                     current automated tools?
           Response: The contractor will utilize the Data Warehouse to identify and analyze data to support this
                     function.
  RFP Section 6.2.2.3.4          p. 332           Contractor Responsibilities
   358     Question: What ―current automated tools‖ does Iowa Medicaid use to identify members having
                     chronic diseases? Is it expected that the contractor be taking over the use of these tools
                     in performing disease management tasks as part of the IME? Please explain.
           Response: Claims data may be analyzed to determine which individuals may benefit from disease
                     management programs based on diagnosis and utilization of services. Claims data will be
                     available from the data warehouse to perform the analysis.
  RFP Section 6.2.2.3.4           p. 332            Contractor Responsibilities
   359     Question: What will the relationship be between the Medical Services vendor and the POS system
                     vendor as it relates to the disease management program?
           Response: The Medical Services will obtain pharmacy data from the Core MMIS claims history file
                     and the DW/DS. There will be no direct interface with the POS system.
  RFP Section 6.2.2.3.7, bullet 1 p. 334            Performance Standards
   360      Question: Over what time period is the 10% savings expected to be achieved?
           Response: See question # 361.
  RFP Section 6.2.2.3.7, bullet 1 p. 334           Performance Standards
   361     Question: What baseline year and costs does the State propose for use in measuring the 10 percent
                     reduction in cost of care for the disease management pilots, or are they open to
                     negotiation with the State as the pilots are finalized and approved?
           Response: The Department would look at the full fiscal year immediately prior to initiation of any
                     disease management pilot as a starting point, but DHS is open to negotiation.
  RFP Section 6.2.2.3.7, bullet 3 p. 334            Performance Standards
   362      Question: Can people voluntarily disenroll at any time, for any reason, from the disease management
                      program? If so, it may be somewhat difficult to achieve the 90% target.
           Response: The program is voluntary in nature. See question # 356.


Response to Bidder Questions – Set 1                          February 23, 2004                            60 of 133
  RFP Section 6.2.2.4            p. 334           Retrospective Drug Utilization Review (RetroDUR)
   363     Question: What personnel resources are anticipated to be contributed by the State to RetroDUR
                     activities? What will be their qualifications?
           Response: See 6.2.2.4.3, Pharmacy Consultant participates in the meetings, monitors activities of
                     DUR committee, contractors and approves education letters.
  RFP Section 6.2.2.4.2.2        p. 335            Interfaces With External Entities
   364     Question: What roles do the University of Iowa, the Iowa Pharmaceutical Association and other
                     external entities currently have in existing RetroDUR activities?
           Response: The University of Iowa and the Iowa Pharmaceutical Association staff and operate the
                     RetroDUR committee. They also assist in providing information and input when requested
                      on issues considering cost containment recommendations, identify trends in drugs,
                     studies, special research products.
  RFP Section 6.2.2.4.2.2          p. 335           Interfaces With External Entities
   365     Question: To the extent that the University of Iowa or the Iowa Pharmacists Association is involved,
                      is it the State of Iowa‘s anticipation that the selected vendor will duplicate their work, act
                     as a subcontractor or subcontractee, or provide supplemental support?
           Response: Because the IPA is currently the subcontractor for the administrative services of the DUR
                     project there may be more interaction with this entity currently than would be with a
                     different contractor. With the University of Iowa there is currently assistance from them
                     with special research projects. The vendor will basically have these entities and others
                     available, if they choose, to work collaboratively on projects, which the State would view
                     as beneficial to continue the good relations between the DUR Commission and the
                     pharmacy community as well as other provider groups.
  RFP Section 6.2.2.4.3, bullet 1 p. 336             State Responsibilities

   366      Question: How often does the current DUR Committee meet? And in what locations?
           Response: The committee meets eight times a year in Des Moines, Iowa at Iowa Foundation for
                     Medical Care and the Iowa Pharmacy Association.
  RFP Section 6.2.2.4.4          p. 336           Contractor Responsibilities
   367     Question: The RFP states in item #6 ‗Develop, install and maintain a software program that can
                     support an analysis of prescription patterns by physician, by drug category …‘ Would
                     this requirement be better suited to the Pharmacy Component as the Pharmacy
                     Component contractor will have all the claims data and a programming staff? If not, then
                     must the Medical Services contractor obtain a copy of the pharmacy claims data and hire
                     programming staff to develop a software application that can produce the appropriate
                     reports?
           Response: The Medical Services contractor will be responsible for recommending RetroDUR
                     software to be installed on the State system. See RFP MED-04-034.
  RFP Section 6.2.2.4.4          p. 336           Contractor Responsibilities
   368     Question: The RFP states in item #5 ‗Provide professional pharmacists to staff the DUR committee,
                     as required.‘ How often does the DUR Committee meet? What will be the duties of these
                     pharmacists in regards to the DUR Committee?
           Response: They meet eight times a year. They review medication claims data of recipients to assure
                     appropriate and cost effective use of medications. They review aggregate claims data to
                     identify trends in costs, prescribing patterns, billing patterns and patient overuse.




Response to Bidder Questions – Set 1                           February 23, 2004                             61 of 133
  RFP Section 6.2.2.4.4, bullet 6 p. 336            Contractor Responsibilities
   369      Question: What software programs or packages are currently installed and functioning that support
                      the activities of this requirement? Is it expected that the contractor be taking over the use
                      of these tools in performing RetroDUR tasks as part of the IME? Please explain.

           Response: IFMC and IPA jointly own the software system QA,Inc. currently used for this function.
                     They are hired through the DHS to provide this function. A new contractor would need
                     to develop, install and maintain a software program for this function.
  RFP Section 6.2.2.4.4.5        p. 336        Contractor Responsibilities
   370     Question: How many professional pharmacists are provided for the DUR Committee under the
                     current contract?
           Response: Three Iowa Licensed Pharmacists- one is the project coordinator who is the chairperson
                     for the meetings and two others RPh‘s from IPA staff.
  RFP Section 6.2.2.4.6 and       p. 337            Required Reports
              6.2.2.4.7, bullet 2
   371      Question: In measuring ―program savings‖ of one percent arising from contractor RetroDUR
                      activities, what will be the baseline year(s) and costs for such determinations and
                      reporting?
           Response: See clarification of this requirement in RFP Med-04-034.
  RFP Section 6.2.2.4.7           p. 337           Performance Standards
   372     Question: The RFP states in item #32 ‗Demonstrate annual savings of at least one percent (1%) in
                     total outlays for prescription drugs for the prescriptions included in the RetroDUR
                     universe.‘ Since one of the prime responsibilities of the Medical Services contractor is to
                     prepare DUR intervention letters for targeted medical practitioners and to try and change
                     prescribing patterns, over which they have no control, how can the Contractor be held to
                     a standard of annual savings of 1%?
           Response: See clarification of this requirement in RFP Med-04-034.
  RFP Section 6.2.2.4.7, bullet 2 p. 337            Performance Standards
   373      Question: The performance standard for RetroDUR is demonstrated annual savings of at least 1% in
                      total outlays for prescription drugs included in the RetroDUR universe. Please provide
                      the historical annual savings.
           Response: See clarification of this requirement in RFP MED-04034.
  RFP Section 6.2.2.4.7, bullet 2 p. 337            Performance Standards
   374      Question: a. How is ―one percent (1%) in total outlays for prescription drugs for the prescriptions
                      included in the Retro DUR universe‖ defined? b. Do ―total outlays‖ include state and
                      federal dollars? c. Does ―Retro DUR universe‖ include all outpatient prescriptions or only
                      those medications that are reviewed through the Retro DUR process?
           Response: See clarification of the requirement in RFP MED-04-034.
  RFP Section 6.2.2.5           p. 337          Enhanced Primary Care Case Management
   375     Question: Regarding page 337 of the RFP, please indicate more specifically, which medical services
                     will be managed by the contractor?
           Response: See question # 376.
  RFP Section 6.2.2.5            p. 337          Enhanced Primary Care Case Management
   376     Question: Please describe existing enhanced PCCM activities and identify who performs them.
           Response: The enhanced PCCM program will be a member-oriented program to manage temporary
                     acute conditions and complex combinations of diseases that involve special medical



Response to Bidder Questions – Set 1                           February 23, 2004                             62 of 133
                       needs. The purpose of the enhanced PCCM program is to assist members in getting
                       through the treatment of an episode of care combined with service-oriented assistance to
                       obtain treatment. The contractor will monitor and perform analysis to determine who
                       would benefit from enhanced PCCM and will accept referrals from the member's PCCM.
                       The contractor will then work with the member's PCCM to assist in identifying services
                       and treatment.

  RFP Section 6.2.2.5             p. 337        Enhanced Primary Care Case Management
   377     Question: For the Enhanced PCCM component, is it envisioned that the contractor would be an
                     adjunct to the PMP or would the contractor be involved in "hands on" care management?
           Response: See question # 376.
  RFP Section 6.2.2.5.2.2         p. 338           Interfaces With External Entities
   378     Question: Please clarify that providers statewide also represent external entities with which
                     interfaces may be required.
           Response: Yes, the contractor will interface with providers who can perform the required services.
  RFP Section 6.2.2.5.2.2,         p. 338           Interfaces With External Entities
              bullet 2
   379      Question: Please clarify the case managers identified as an external entity.
           Response: These are the PCCMs. The contractor will work with the PCCM to coordinate the services
                     of other providers.
  RFP Section 6.2.2.5.3         p. 338         State Responsibilities
   380     Question: What guidelines will DHS use to refer recipients for case management to the Medical
                     Services contractor? How many referrals do you anticipate per week?
           Response: The contractor will be responsible for suggesting guidelines and protocols to the
                     Department to identify recipients who would benefit from this type of service. The
                     Department will not be making referrals. Referrals will be made by members' PCCMs. The
                     number of referrals will be dependent upon how the contractor develops the program.
  RFP Section 6.2.2.5.3, bullet 2 p. 338            State Responsibilities
   381      Question: Will the State develop the identification algorithm for referral to case management?
           Response: The contractor will perform analyses and develop the protocols for identifying members
                     who would benefit from the enhanced primary care case management program.
  RFP Section 6.2.2.5.4           p. 339           Contractor Responsibilities
   382     Question: Enhanced PCCM #4 & 5, "Provide professional medical staff to perform case management
                     and... prepare care plans". Is this indicating identification of network physicians to
                     function as case management or expecting the Medical Service Contractor to utilize plan
                     staff to perform these functions?
           Response: The contractor will work with the member's PCCM to assist in identifying services and as
                     part of its analysis will identify providers who can perform the services needed to support
                     the member.
  RFP Section 6.2.2.5.4           p. 339          Contractor Responsibilities
   383     Question: Is the contractor expected to peer review physicians that serve as the primary care
                     providers for members in the PCCM program?
           Response: No.
  RFP Section 6.2.2.5.4          p. 339           Contractor Responsibilities
   384     Question: Does the State have its own assessment tool that the contractor will adopt for peer
                     review, or will the contractor be allowed to develop a tool?




Response to Bidder Questions – Set 1                          February 23, 2004                            63 of 133
           Response: No. The contractor will develop the tool.
  RFP Section 6.2.2.5.4, bullet 7 p. 339           Contractor Responsibilities
   385     Question: Is a 24/7 call center required?
           Response: A 24/7 call center is not required, but an 24/7 emergency on-call function is required.
  RFP Section 6.2.2.5.4, bullet 7 p. 339       Contractor Responsibilities
   386     Question: Case managers from which organization are being referenced in function #7?
           Response: The case managers referred to here are the PCCMs.
  RFP Section 6.2.2.5.4, bullet 7 p. 339           Contractor Responsibilities
   387     Question: Please clarify the case manager referred to in item 7.
           Response: The case manager is the PCCM.
  RFP Section 6.2.2.5.4, bullet 8 p. 339           Contractor Responsibilities
   388     Question: Please elaborate on peer review of case management activities.
           Response: The contractor is expected to do peer review on their own case management activities, i.e.,
                     its enhanced case management work with the PCCMs and support of PCCMSs to provide
                     services.
  RFP Section 6.2.2.5.4, bullet 9 p. 339           Contractor Responsibilities
   389     Question: Will this survey be conducted monthly, annually, or some other period of time? The
                     Required reports section appears to indicate quarterly reporting of satisfaction survey
                     results. Perhaps every 90 days after a member is enrolled into case management?
           Response: See question # 391.
  RFP Section 6.2.2.5.4, bullet 9 p. 339           Contractor Responsibilities
   390     Question: Are there predetermined parameters for performing the member satisfaction survey? (i.e.,
                     random sample, stratified, frequency of survey etc.)
           Response: No. The contractor should prepare a plan for DHS approval.
  RFP Section 6.2.2.5.4, bullet 9 p. 339           Contractor Responsibilities
   391     Question: Is the member survey done of all members periodically, i.e., annually, or is a survey
                     completed at the time of each encounter with the case manager?
           Response: An annual survey of a statistically valid sample is anticipated.
  RFP Section 6.2.2.5.6, bullet 2 p. 339           Required Reports
   392     Question: In comparing ―funding prior to and after receiving case management,‖ what will be the
                     baseline year(s) and costs for such determinations and reporting?
           Response: The vendor should propose a plan for determining these.
  RFP Section 6.2.2.5.7, bullet 3 p. 340           Performance Standards
   393     Question: What kind of errors with case management is the State expecting?
           Response: DHS does not expect errors, but system process and documentation errors could occur
                     and the contractor is required to identify and correct them.
  RFP Section 6.2.2.5.7, bullet 4 p. 340          Performance Standards
   394     Question: Please describe or provide samples and frequency of required reports.
           Response: The vendor should propose a format for these quarterly reports.




Response to Bidder Questions – Set 1                         February 23, 2004                            64 of 133
  RFP Section 6.2.2.6.2.2          p. 341and 342 Interfaces With External Entities
   395     Question: Please clarify the role of the Medical Services component vendor as it relates to providing
                     reports to external entities. This appears to be in conflict with the responsibility of the
                     Core MMIS component vendor.
           Response: The Core MMIS vendor will generate reports to medical services upon request. The
                     Medical Services vendor is responsible for defining need and distribution with DHS
                     approval.
  RFP Section 6.2.2.6.3          p. 342         State Responsibilities
   396     Question: Please describe the EPSDT care coordination activities provided by the Iowa Department
                     of Public Health.
           Response: Informing and Care Coordination services facilitate access to care for Medicaid eligible
                     children. The program emphasizes comprehensive care and collaboration with other
                     providers to assure medical, dental, vision and hearing care, immunizations, lab tests and
                     health education. The program is a proven process designed to support families and
                     facilitate achievement and maintenance of optimal health in children. To accomplish
                     desired results, service providers encourage families to understand and participate in the
                     program by:

                       • Supporting families in making informed health care choices based on needs;
                       • Teaching families to manage care coordination activities;
                       • Assisting families to establish and maintain a medical home;
                       • Encouraging continuity of care;
                       • Decreasing fragmentation and duplication of care; and
                       • Educating families regarding child health to promote positive health beliefs, attitudes and
                        behaviors.

                       Informing: Local Iowa Department of Human Services (IDHS) offices maintain
                       responsibility for informing of newly eligible families with children in foster care and
                       families enrolled in Medically Needy with Spend-down programs. Informing all other
                       newly eligible Medicaid families is the responsibility of the Iowa Department of Public
                       Health (IDPH) designated agencies.

                       Care Coordination: The local IDHS performs activities of care coordination for families on
                       the Medically Needy with Spend-down program and children in foster care. Health
                       Maintenance Organizations (HMOs) are responsible to assure that families covered by
                       them receive EPSDT Care for Kids services. The remainder of Medicaid families eligible
                       for the EPSDT Care for Kids program receives care coordination through the IDPH
                       designated agency.
  RFP Section 6.2.2.6.3          p. 342         State Responsibilities
   397     Question: Will the Iowa Department of Public Health continue to inform new Title XIX eligibles of
                     EPSDT and care coordination activities as part of the IME?
           Response: Yes.
  RFP Section 6.2.2.6.3, bullet 3 p. 342            State Responsibilities
   398     Question: Please clarify the role of the Medical Services component vendor as it relates to providing
                      a report for members who have requested service but for whom there is no indication of
                     service provided. This appears to be in conflict with the responsibility of the Core MMIS
                     component vendor.
           Response: The Core MMIS system needs to produce the report and the Medical Services contractor
                     does the follow-up.




Response to Bidder Questions – Set 1                         February 23, 2004                             65 of 133
  RFP Section 6.2.2.6.4.1,         p. 343           EPSDT Care Coordination
              bullet 3
   399      Question: "Assemble and coordinate the service care planning and interdisciplinary team for the
                      PDN & PCA services provided to the special needs children under EPSDT". Please clarify
                      "assemble and coordinate". Is the state asking for the Medical Service contractor to
                      facilitate the planning and care delivery or actually convene the team and actively
                      participate in the care planning process?
           Response: Schedule and conduct telephone conference calls with families, case managers, providers,
                     and other parties when there are PA requests that have outstanding issues or if the case
                     manager requests a conference in order to understand an issue.
  RFP Section 6.2.2.6.4.1,         p. 343           EPSDT Care Coordination
              bullet 4
   400      Question: What is the current volume of these prior authorizations?
           Response: The current monthly average PA requests received by medical review for Private Duty
                     Nursing and Personal Care is 35.
  RFP Section 6.2.2.6.4.1,         p. 343           EPSDT Care Coordination
              bullet 5
   401      Question: Please provide a listing of Child Health Specialty Clinic (CHSC) locations statewide and a
                      listing of services available.
           Response: Burlington, Carroll, Council Bluffs, Creston, Davenport, Des Moines, Dubuque, Fort
                     Dodge, Iowa City, Mason City, Ottumwa, Sioux City, Spencer, Waterloo. Services
                     include: clinical care and care coordination services.
  RFP Section 6.2.2.6.4.1,         p. 343           EPSDT Care Coordination
              bullet 7
   402      Question: Please define the State‘s expectation regarding ―service facilitation‖ of the service care
                      plan.
           Response: Assisting the case manager in ensuring that PAs and case plans are implemented
                     appropriately with no break in authorized services.
  RFP Section 6.2.2.6.4.2         p. 344            EPSDT Tracking and Reporting
   403     Question: While we understand that all activity, particularly reporting, require coordination between
                     vendors, it is important that the responsibilities are clearly delineated. Please clarify the
                     Medical Services vendor role for defining, developing, requesting, producing, and
                     distributing these reports.
           Response: The MMIS generates reports based on criteria developed by the Medical Services
                     vendor.
  RFP Section 6.2.2.6.4.2,        p. 344           EPSDT Tracking and Reporting
               5.2.2.14 and
               others
   404     Question: In the Professional Services components, there are several requirements for generation of
                      reports to DHS. These requirements appear to be based upon data that is stored in the
                      core MMIS system. For example, section 6.6.2.6.4.2 requires the Professional services
                      contractor to generate EPSDT reports. Section 5.2.2.14 requires the Core MMIS
                      contractor to produce EPSDT reports. Please clarify the division of responsibilities
                      between Professional Services contractors and Systems contractors for reporting that is
                      based upon data stored in the Core MMIS system.
           Response: The professional services contractor will define the reports and set parameters. The Core
                     MMIS will produce the reports.




Response to Bidder Questions – Set 1                          February 23, 2004                             66 of 133
  RFP Section 6.2.2.6.6           p. 344            Required Reports
   405     Question: Please clarify the role of the Medical Services component vendor as it relates to providing
                      these reports. This appears to be in conflict with the responsibility of the Core MMIS
                     component vendor.
           Response: The MMIS generates reports based on criteria developed by the Medical Services
                     vendor.
  RFP Section 6.2.2.6.7           p. 345            Performance Standards
   406     Question: Please clarify the role of the Medical Services component vendor as it relates to the
                     production report performance standards. Reports generated from data in the MMIS are
                     dependent on the performance of the Core MMIS vendor and the data center.
           Response: It is the Medical Services vendor‘s responsibility to have data in the system timely so the
                     MMIS system can generate reports.
  RFP Section 6.2.2.6.7          p. 345            Performance Standards
   407     Question: The RFP states in item #4 ‗Make PA decisions within 5 working days of receiving the
                     completed PA and supporting documentation.‘ What is the performance standard
                     currently or, if none currently exists, what is the average time for approving a PA?
           Response: The performance standard today is 5 working days and is being met.
  RFP Section 6.2.2.7             p. 345           Prior Authorization
   408     Question: Is there a current contractor conducting PA for pharmacy services? If so, what is the
                     name of the contractor?
           Response: Yes, ACS performs pharmacy prior authorization.
  RFP Section 6.2.2.7             p. 345            Prior Authorization
   409     Question: This question applies to the Medical Services Component. Is there an existing Prior
                     Authorization (PA) system, within the MMIS that is being migrated to the Department's
                     data center, that the Medical Services contractor will be expected to utilize, or could
                     utilize? If yes, does this existing PA system cover both pharmacy and non-pharmacy
                     services?
           Response: Yes to both questions.
  RFP Section 6.2.2.7            p. 345           Prior Authorization
   410     Question: Are there state regulations or other specific requirements for the contractor who provides
                     pharmacy prior authorization services, for example URAC certification?
           Response: There are not any state regulations for the contractor who provides pharmacy prior
                     authorization services. The specific contractor requirements for pharmacy prior
                     authorization are included in the RFP MED-04-034.
  RFP Section 6.2.2.7            p. 345            Prior Authorization
   411     Question: Because URAC does not provide pharmacy specific certification, if URAC certification is
                     required, does the state offer any alternatives to URAC certification?
           Response: No certification is required so this is not applicable.
  RFP Section 6.2.2.7.1          p. 331           Objectives
   412     Question: PA requirements #1 states "currently includes..." Does the state anticipate a change in the
                      scope of services requiring PA? If so, please indicate how and what changes are
                     anticipated along with anticipated review volumes.
           Response: The Department is amenable to expanding the services requiring PA based on criteria
                     such as cost and utilization if it can be shown to effectively control services. The
                     contractor should suggest the manner and mechanism by which costs can be controlled
                     and services utilized effectively.



Response to Bidder Questions – Set 1                          February 23, 2004                           67 of 133
  RFP Section 6.2.2.7.2.2         p. 347           Interfaces With External Entities
   413     Question: Is there a current application that is being used to interface with the Providers, ISIS &
                     IFMC? If so, will that application still be there for the contractor to use? Is it HIPAA
                     compliant or does the contractor have to create a new application to perform the services
                     for the Prior Authorizations?
           Response: The application used to transfer data from IFMC is the file transfer protocol (FTP). The
                     data mechanism used to transfer data to ISIS and to the MMIS from ISIS is
                     Connect:Direct. Providers use a wide variety of mechanisms to send and receive
                     information to and from the MMIS: tape, cartridge, via the web, dial up connection, and
                     dedicated lines. The level of care is entered directly to the ISIS system by IFMC for
                     waivers. The level of care for nursing homes is transferred to the Title XIX system via a
                     batch file transfer. These are not HIPAA transactions.
  RFP Section 6.2.2.7.2.2        p. 347           Interfaces With External Entities
   414     Question: Are the external interface partners all HIPAA compliant? Are they currently receiving this
                      information in the 278 format?
           Response: DHS does not believe that the care plan for waiver services and the level of care
                     determination are HIPAA covered transactions because ISIS is an internal Department
                     system interface and IFMC is a business associate entering data directly into the ISIS
                     system.
  RFP Section 6.2.2.7.4          p. 348           Contractor Responsibilities
   415     Question: Services needing PA -Please provide a breakdown of the average monthly other medical
                     prior authorizations in Attachment M by type of service.
           Response: The majority of these are prior authorizations for durable medical equipment and medical
                     supplies. No detail breakdown is available.
  RFP Section 6.2.2.7.4            p. 348          Contractor Responsibilities
   416     Question: Will IFMC continue to conduct PA for selected surgical and inpatient hospital admissions
                      after this contract is awarded, or is this service part of the scope of this RFP?
           Response: IFMC will continue to do pre-procedure reviews for some surgical procedures such as
                     gastric bypass and transplants.
  RFP Section 6.2.2.7.4           p. 349           Contractor Responsibilities
   417     Question: Please clarify whether the ―targeted case management‖ services to be prior authorized by
                     the contractor are for all such procedures not prior authorized by the Iowa Foundation for
                     Medical Care. How does DHS anticipate such coordination between the contractor and
                     the Iowa Foundation for Medical Care to occur?
           Response: Targeted Case Management services for the Mental Retardation and Developmental
                     Disability populations are prior authorized. See RFP MED-04-034.
  RFP Section 6.2.2.7.4          p. 349           Contractor Responsibilities
   418     Question: For each type of service (medical through targeted case management), what is the volume
                     of PA‘s provided historically? Is this volume anticipated to increase? If so, by how
                     much?
           Response: Refer to RFP Section 10.13 (Attachment M, pg 579) for historical volume.
  RFP Section 6.2.2.7.4            p. 349           Contractor Responsibilities
   419     Question: Please clarify that the ―psychological services‖ to be prior authorized by the contractor
                     are for all such procedures not prior authorized by the Iowa Plan contractor (i.e.
                     identification of potential task overlap).
           Response: Psychological services are not prior authorized. See RFP MED-04-034.




Response to Bidder Questions – Set 1                         February 23, 2004                            68 of 133
  RFP Section 6.2.2.7.4           p. 349          Contractor Responsibilities
   420     Question: Please clarify that the ―medical services‖ to be prior authorized by the contractor are for
                     all other medical procedures not prior authorized by the Iowa Foundation for Medical
                     Care. Will the Iowa Foundation for Medical Care be providing its contracted prior
                     authorization services throughout the term of the IME? If not, when is their next contract
                     renewal date.
           Response: All medical services prior authorizations will be done by the Medical Services contractor.
                     See RFP MED-04-034.
  RFP Section 6.2.2.7.4           p. 351             Contractor Responsibilities
   421     Question: a. Will the Medical Services contractor be required to send or receive any other ANSI
                     transaction sets, besides the X12 278? If so, which of the following sets? X12 270/271,
                     Healthcare Eligibility Benefit Inquiry and Response, X12 275, Claims Attachment, X12
                     276/277, Healthcare Claims Status Request and Response, X12 820, Premium Payment,
                     X12 834, HMO Enrollment and Disenrollment, X12 835, Claims Payment and Remittance
                     Advice, X12 837, Healthcare Claim or Encounter b. Are the Pharmacy POS prior
                     authorizations ANSI X12? If not, please specify format. c. Because the MMIS
                     component is required to receive ANSI X12 transaction sets and because business
                     associate agreements will be in place for the Iowa Medicaid Enterprise contractors, can
                     the MMIS component receive ANSI X12 278 transactions on behalf of the Medical
                     Services component and translate the ANSI X12 278 transactions to a simpler, more
                     usable format before sending data on to the Medical Services component systems? Or,
                     alternatively, is it possible for the MMIS component and the Medical Services component
                      to share the ANSI translator software?

           Response: All HIPAA transactions other than pharmacy POS claims transactions would be received
                     and have processing initiated by the Core MMIS contractor. Upon receipt, the Contractor
                     for the MMIS will work out the interfaces necessary to channel transactions to/from
                     other IME contractors. At this stage, they are not HIPAA-covered transactions. HIPAA
                     required transactions appropriately sent by providers to the Contractors which are to
                     receive them must be received in HIPAA format and returned to the providers in HIPAA
                     format.
  RFP Section 6.2.2.7.4.1,         p. 349          Prior Authorization Processing
              bullet 4
   422      Question: For emergency requests, arrange for an on-call professional 24/7. Please define what
                      would constitute an "emergency request" and the scope of services for which this would
                      apply.
           Response: See RFP MED-04-034.
  RFP Section 6.2.2.7.4.1,         p. 349          Prior Authorization Processing
              bullet 9
   423      Question: Please clarify the purpose of sending a copy of the Request for PA form with the Decision
                      Notice. The provider would have a copy of the document and the Decision Notice would
                      provide sufficient information to clearly identify the request and reason for the decision.
           Response: The notice to the member provides information on their appeal rights.
  RFP Section 6.2.2.7.4.1        p. 349          Prior Authorization Processing
   424     Question: The RFP states in item #4 ‗For emergency requests, arrange for an on-call professional to
                     be reached 24 hours per day, 7 days per week through a pager system.‘ An on-call
                     professional would need several items to approve a PA – access to the MMIS files;
                     documentation of the PA request; supporting documentation; and maybe review by a
                     peer consultant. How does the State envision that the on-call professional would get




Response to Bidder Questions – Set 1                         February 23, 2004                            69 of 133
                       access to all of the necessary information? What would constitute an emergency PA
                       under this requirement?
           Response: See RFP MED-04-034.
  RFP Section 6.2.2.7.4.1,         p. 349           Prior Authorization Processing
              bullets 1 and 4
   425      Question: Are any prior authorizations requests received and adjudicated via telephone? How many
                       prior authorizations are anticipated to be received by each media type: paper, facsimile,
                      electronically, and telephone (if applicable)?
           Response: Currently Drug PAs are done by telephone. With RFP MED-04-034 these will be done by
                     fax, mail, and electronically using the HIPAA 278 transaction.
  RFP Section 6.2.2.7.4.1 and      p. 349 and 352 Prior Authorization Processing
              6.2.2.7.4.3
   426      Question: Does the Component 4 (Medical Services) vendor or the Component 2 (Pharmacy POS)
                      vendor provide the prior authorization software and files that are updated by the
                      Component 4 (Medical Services) vendor for pharmacy prior authorizations for the PDL
                      and non-PDL POS pharmacy claims requiring prior authorization?
           Response: The Core MMIS will maintain the prior authorization system that will be used for all PAs.
                     The Pharmacy POS vendor will need to access the PA records directly from the MMIS or
                     will need to develop a batch interface to transfer pharmacy PA data to the POS system.
  RFP Section 6.2.2.7.4.1,         p. 350           Prior Authorization Processing
               bullet 9
   427     Question: For the PA process, the contractor will be required to send notices to members and
                      providers. Should the bidder budget for mailing expenses, or will these costs be covered
                      by the state--postage, stationery, and printing?
           Response: All of these costs will be covered by the State.
  RFP Section 6.2.2.7.4.2        p. 351            Prior Authorization File Maintenance
   428     Question: Will the data set for prior authorization be part of the new MMIS, or will the contractor be
                     responsible for developing a tracking system separate from the MMIS?
           Response: The Core MMIS maintains PA system. Tracking of PAs from receipt through disposition
                     will be done by the Workflow Process Management system.
  RFP Section 6.2.2.7.4.2,         p. 352           Prior Authorization File Maintenance
              bullets 6 and 9
   429      Question: Is the source system of record for Membership and Provider that will feed the PA
                      application, the core MMIS application or the Eligibility & Provider applications of the
                      Professional Services Component?
           Response: The Core MMIS will be the source system.
  RFP Section 6.2.2.7.4.3        p. 352         Prior Authorization for PDL
   430     Question: Please identify Iowa Medicaid‘s current Pharmacy Benefit Manager (PBM).
           Response: Iowa Medicaid does not currently have a PBM.
  RFP Section 6.2.2.8             p. 355          Quality of Care
   431     Question: Please clarify whether these quality of care activities will not be performed for the fee-for-
                     service population. If not, what activities are expected to be performed for quality of care
                     for this population?
           Response: At this time it is only for the programs listed. The bidder may suggest the manner and
                     mechanism by which such quality initiatives may be implemented in the fee for service
                     population.



Response to Bidder Questions – Set 1                          February 23, 2004                            70 of 133
  RFP Section 6.2.2.8.2          p. 355          Interfaces
   432     Question: During the Operations Phase, which IME contractor or external organization will be
                     monitoring and making available HEDIS information for use by the IME? Will this
                     information be from the Iowa Foundation for Medical Care, acting as QIO, under a
                     separate contract? Please clarify.
           Response: The Medical Services contractor will perform this function. See RFP MED-04-034. HEDIS
                     will remain with University of Iowa.
  RFP Section 6.2.2.8.2.1,         p. 356           Interfaces With Other Iowa Medicaid Enterprise
              bullets 1 and 2
   433     Question: Will the interfaces with the internal and external entities require any transactions to be
                     sent in the HIPAA format? The 278-transaction was referenced for the authorization
                     requests; will the feeds into or out of the PA application require any other code sets?
           Response: No, the contractor will utilize MMIS data maintained in the Core MMIS.
  RFP Section 6.2.2.8.2.2,         p. 356           Interfaces With External Entities
               bullet 3
   434     Question: Please clarify whether the ―hawk-i‖ S-CHIP program will also be reviewed under the
                      quality of care activities under this contract.
           Response: The hawk-i program is not part of Medicaid. See question # 19.
  RFP Section 6.2.2.8.4          p. 357           Contractor Responsibilities
   435     Question: Does the State identify any inherent conflicts within the scopes of work for a single
                     contractor to perform the duties and functions of more than one component of the RFP?
           Response: No.
  RFP Section 6.2.2.8.4         p. 357           Contractor Responsibilities
   436     Question: The RFP references in the last bullet in item #1 ‗Providing the phone connection to the
                     HMOs …‘. Please provide additional detail on this requirement.
           Response: Teleconferences are held periodically with each HMO along with this contractor and DHS.
  RFP Section 6.2.2.8.4           p. 357         Contractor Responsibilities
   437     Question: Please clarify the phone connection required to the HMOs.
           Response: See response to question # 436.
  RFP Section 6.2.2.8.4, bullet    p. 357           Contractor Responsibilities
              1, #3
   438     Question: Are the HMO‘s required to ensure provider panel adequacy? It appears that the rest of
                     the section describes more of a monitoring and reporting process for network adequacy.
                     Please comment.
           Response: Yes. The bidder should be prepared to verify the adequacy of the contracted panel
                     members when directed to do so by the Department. Yes, this should be done quarterly
                     for each HMO.
  RFP Section 6.2.2.8.4, bullet    p. 357           Contractor Responsibilities
              1, #5
   439     Question: How frequent are these surveys required? How expansive? If any of these surveys have
                     been conducted in the past, can the (de-identified) results be made public as part of this
                     RFP process?
           Response: Appointment surveys are conducted quarterly for 20 randomly selected MediPASS
                     providers to determine the length of time it would take for recipients to get routine care,
                     physical examination, immunizations, etc. They are not expansive in nature but are




Response to Bidder Questions – Set 1                          February 23, 2004                             71 of 133
                       designed to identify provider who may have issues with providing access for services to
                       Medicaid recipients.
  RFP Section 6.2.2.8.4, bullet p. 357            Contractor Responsibilities
               1, #9
   440     Question: The analysis of encounter data can be a costly and time consuming process. Has the
                     State conducted any encounter data validation studies? If so, can the (de-identified)
                     results be made public as part of this RFP process? If no study has been conducted, we
                     request further elaboration on this potentially very significant contractual requirement.
           Response: Managed Care Organizations are required to submit encounter data on a monthly basis.
                     The contractor should have edits in place that confirm that the ED is technically accurate
                     to within 99%. Every quarter 50 medical records are randomly pulled from providers (with
                     the assistance of the MCOs) and verification is made that the encounter submitted
                     matches that reported through the medical record.
  RFP Section 6.2.2.8.4, bullet    p. 357           Contractor Responsibilities
              1, #11
   441      Question: Please elaborate on the provision of a ―phone connection‖ to the HMOs.
           Response: See question # 436.
  RFP Section 6.2.2.8.4, bullet 2 p. 357            Contractor Responsibilities
   442      Question: If the activities to be performed under this requirement (or any requirement /task) are
                      subject to negotiation subsequent to contract award, then will the contractor‘s Cost
                      Proposal also be re-opened for adjustment to reflect the additional work to be performed?
                      How will the Change Service Request process be utilized in such circumstances?
           Response: The bidder should provide its plan for meeting the requirement in the technical proposal.
                     The cost proposal should reflect the proposed plan.
  RFP Section 6.2.2.8.4.2        p. 357           Contractor Responsibilities
   443     Question: Please provide the frequency for performing utilization review, quality assurance,
                     grievance resolution, data collection, technical analysis, and reporting for the HMOs and
                     MediPASS providers.
           Response: Performance will be continuous with reporting quarterly. See question # 442.
  RFP Section 6.2.2.8.4, bullet 5 p. 358            Contractor Responsibilities
   444      Question: Please define level of participation and scope of "Federal review" activity.
           Response: CMS will periodically review the managed care programs in Iowa. The contractor is
                     expected to support its activities at the time of the review and respond to any questions
                     that might arise. In addition, the contractor will assist the state in the development of
                     responses to any questions that might arise from this or any other federal review.
  RFP Section 6.2.2.8.4.5        p. 358          Contractor Responsibilities
   445     Question: Please provide the frequency for performing these tasks for Iowa Plan participants.
           Response: This section deals with HMOs and MediPASS which are medical managed care services.
                     The Iowa Plan operates slightly differently in that the same level and scope of activities
                     are not necessary. However, the Contractor will be expected to assist the Department in
                     the provision of oversight in the Iowa Plan as follows:

                       Bullet 1:            Ongoing
                       Bullet 2:            Every Other Year
                       Bullet 3:            Quarterly
                       Bullet 4:            Every Other Year
                       Bullet 5:            As directed by DHS, and may me monthly



Response to Bidder Questions – Set 1                          February 23, 2004                            72 of 133
                       Bullet 6:            Unlikely to occur
                       Bullet 7:            Unlikely to occur
                       Bullet 8:            Unlikely to occur
                       Bullet 9:            Unlikely to occur

  RFP Section 6.2.2.8.5           p. 358           Data Sources
   446     Question: Are the other contractors for both the core MMIS and Professional Services Components
                     covered entities under HIPAA? Meaning that data transactions between contractors for
                     the state do not need to follow the HIPAA standards.
           Response: These are business associates, not covered entities, for the purposes of HIPAA.
  RFP Section 6.2.2.9             p. 343            Long Term Care Assessment
   447     Question: This section appears to encompass the federally mandated PASRR Level I screening (42
                     CFR 483.100) in conjunction with a level of care assessment and authorization process. Is
                     this a correct interpretation and if so what assessment tool and software is currently being
                      used to do this?
           Response: It does not include PASARR.
  RFP Section 6.2.2.9             p. 359           Long Term Care Assessment
   448     Question: The second paragraph in the summary indicates "Nurses" will meet.... Is this stating that
                     the state requirement is for a 'nurse' to complete this function? If so, please clarify
                     credentials (RN, LPN) and other requirements.
           Response: Yes – may be an RN or LPN.
  RFP Section 6.2.2.9             p. 359         Long Term Care Assessment
   449     Question: Who is responsible currently for performing the pre-admission screening for long term
                     care services? The second paragraph states: ‗Nurses will meet with the member …‖ How
                      many assessments are done currently per week? How much travel is involved since this
                     is a statewide program?
           Response: The Iowa Foundation for Medical Care completes the level of care determination. The
                     assessments are completed by case managers in the field. Field staff for LTC
                     Assessments are currently located around the State and travel and work from home. This
                     will be acceptable in the new contract and DHS will provide laptops.
  RFP Section 6.2.2.9            p. 359          Long Term Care Assessment
   450     Question: Please provide information regarding the volume of assessments and staffing required in
                     currently performing long-term care assessments.
           Response: Nurses will be required to do the assessments. Approximately 16, 200 nursing facility
                     residents, and approximately 21, 500 other long term care residents that require
                     assessments.
  RFP Section 6.2.2.9          p. 361          Long Term Care Assessment
   451     Question: Based on DHS guidelines, what is the reassessment timeline (i.e., quarterly, annually)?
           Response: The initial pre-admission screening is done to determine eligibility. A second screening is
                     to be completed within 90 days after the initial screening, and then annually unless there
                     is a significant change in the consumer that requires a reassessment prior to the annual
                     one.
  RFP Section 6.2.2.9.2.1 and      p. 360 and 362 Interfaces With Other Iowa Medicaid Enterprise
              6.2.2.9.6
   452      Question: The RFP states ‗The Medical Services contractor interfaces with the Core MMIS for entry
                      of assessment data to the MMIS file.‘ Where is this data entered into the MMIS and
                      what kind of assessment data is entered? In Section 6.2.2.9.6 on page 362 the first
                      sentence references ‗The Medical Services contractor will provide the Pre-Admission



Response to Bidder Questions – Set 1                         February 23, 2004                           73 of 133
                        Screening database to DHS….‖ How is this different than the assessment data entered
                        into the MMIS mentioned above?
           Response: This is a new activity, and is yet to be determined what will be entered. It is expected it
                     will include the assessment information, results of the assessment and the preliminary
                     plan information. It may not be entered into the MMIS system, but rather a subsystem
                     designed by the contractor.
  RFP Section 6.2.2.9.4        p. 361          Contractor Responsibilities
   453     Question: Who develops the assessment/screening tool?
           Response: The Department of Human Services.
  RFP Section 6.2.2.9.4.3        p. 361           Contractor Responsibilities
   454     Question: Provide historical and projected numbers or projected number of LTC clients.
           Response: Approximately 16,200 nursing home residents and other Long Term care consumers is
                     approximately 21,500.
  RFP Section 6.2.2.9.4, bullet 5 p. 361             Contractor Responsibilities
   455      Question: "...authorize preliminary care plan and ..." Please clarify who is responsible for developing
                      the preliminary care plan.
           Response: The contractor will prepare the preliminary plan that identifies the types of services that
                     are needed. The preliminary plan is provided to the case manager who adds the details of
                     the specific services and the providers. This data is then entered in ISIS and transferred to
                      the MMIS through a file transfer.
  RFP Section 6.2.2.9.5, bullet 6 p. 362          Data Sources
   456     Question: This section references software to authorize the preliminary plan. Is it anticipated that
                     the software will include the assessment tool and generate a preliminary plan of care?
                     What is currently being used to do this?
           Response: Today the MDS system is used for Nursing Facilities. The software for the assessment
                     tool and to generate the preliminary plan of care will need to be developed.
  RFP Section 6.2.2.9.5, bullet 6 p. 362             Data Sources
   457      Question: Is there a current application that is being used to facilitate this function that has already
                      been approved by DHS?
           Response: The MDS is currently used for nursing facilities. There are separate assessment tools for
                     the waiver population, but these are prepared manually. The pre-admission screening is a
                     new process. The contractor should propose a tool or propose an approach to the
                     development of the tool.
  RFP Section 6.2.2.9.6          p. 362            Required Reports
   458     Question: Please provide operational, hardware and software information regarding the State‘s
                     current Pre-Admission Screening database. Is it the State‘s expectation that the
                     contractor will be able to take over this existing database?
           Response: The pre-admission screening is a new process. The contractor will need to develop the
                     database.
  RFP Section 6.2.2.9.7          p. 363          Performance Standards
   459     Question: The RFP states in item #5 ‗Enter pre-screening and reassessments requests requiring a
                     peer review into ISIS within 3 business days…‘ What is ISIS? How is this different from
                     entering assessment data into the MMIS; pre-admission screening database, etc.? Please
                     explain in more detail.
           Response: The contractor provides the preliminary service plan with the types of service needed to
                     the case manager. The case manager adds details for the specific services and providers



Response to Bidder Questions – Set 1                            February 23, 2004                              74 of 133
                       and enters the plan into ISIS. ISIS is the Iowa Department of Human Services
                       Individualized Services Information System. The purpose of ISIS is to assist workers in
                       the facility and waiver programs in both processing and tracking requests starting with
                       entry from the Automated Benefits Calculation (ABC) system through approval and
                       denial. Consumer records are tracked in ISIS until that consumer is no longer accessing a
                       facility or waiver program. Specific service plan information is entered by the worker and
                       authorized through ISIS. Any change in the service plan is also authorized through ISIS.
                       Upon individual approval, ISIS provides the Medicaid fiscal agent with service plan
                       information or facility eligibility and authority to make accurate payments to providers of
                       facility or waiver services.

  RFP Section 6.2.2.9.7, bullet 1 p. 363           Performance Standards
   460     Question: This standard is to be met ―within five (5) working days‖ of what event?
           Response: Within 5 working days of receipt of the application.
  RFP Section 6.2.2.10           p. 363            Case Mix Audits
   461     Question: Please identify the current contractor performing case mix audits. How many case mix
                     audits are performed annually statewide?
           Response: The Iowa foundation for Medical Care currently performs 3,500 case mix audits annually.
                     This requirement has been deleted. See RFP MED-04-034.
  RFP Section 6.2.2.10           p. 365          Case Mix Audits
   462     Question: Who is currently responsible for performing case mix audits? How many audits are done
                     annually? Please explain how the Medical Services contractor interfaces with the Provider
                      Cost Audits and Rate setting component for the case mix audit function and the
                     Department of Inspections and Appeals.
           Response: This requirement has been deleted. See RFP MED-04-034.
  RFP Section 6.2.2.10.7      p. 363            Performance Standards
   463     Question: How many certified nursing facilities does the State currently contract with?
           Response: 440.
  RFP Section 6.2.2.10.7          p. 366            Performance Standards
   464     Question: Is the report referenced in item #1 produced by the MMIS? If not, please explain.
           Response: This function has been deleted. See RFP MED-04-034.
  RFP Section 6.2.2.10.7,          p. 366          Performance Standards
              bullet 1
   465     Question: How many certified nursing facilities are there in Iowa, and where are they located?
           Response: 440 throughout Iowa. Refer to DIA web site @ www.DIA.state.ia.us; the health facility
                     section lists all facilities by county.
  RFP Section 6.3.1             p. 368            Contractor Start-Up Activities
   466     Question: When will the user training from the Core MMIS contractor and Data
                     Warehouse/Decision Support Contractor occur?
           Response: The bidder should identify in its proposal work plan when staff needs to be trained. All
                     work plans will be coordinated to set the training schedule. Each contractor will designate
                     a trainer, and the Core MMIS contractor and DW/DS contractors will train the trainers.
                     The individual component contractor trainers will train the component contractor staffs.
  RFP Section 6.3.1.2, bullet 2 p. 369            Development Task
   467     Question: What interface is necessary for the Provider Services Contractor and the Decision
                     Support Vendor? If all of the data is being input into the CORE MMIS what additional
                     data is required to be provided by the Provider Services Contractor?



Response to Bidder Questions – Set 1                          February 23, 2004                            75 of 133
           Response: The Provider Services contractor will utilize the DW/DS for research and analysis to
                     identify provider problems and issues to be addressed in training sessions and to identify
                      providers who need one-on-one training.
  RFP Section 6.3.1.3            p. 369        Acceptance Test Task
   468     Question: How many provider notification letters will the Contractor be required to send out during
                     the acceptance test task?
           Response: Letters will be mailed to all providers. DHS will pay for postage, stationery, printing, and
                     mailing.
  RFP Section 6.3.1.3            p. 370           Acceptance Test Task
   469     Question: Does a provider website currently exist? If not, is the provider service contracted
                     expected to build a website?
           Response: The current contractor and DHS have websites for provider access. The new contractor
                     will add content to the DHS website upon approval of DHS.
  RFP Section 6.3.2.1            p. 371           General Requirements
   470     Question: Is the hardware for this website provided by the state or the contractor? Is this a public
                     web site?
           Response: DHS will provide this. It is a public website.
  RFP Section 6.3.2.2            p. 371           Provider Enrollment
   471     Question: Will the State provide any performance measures in regard to encouraging eligible non-
                     enrolled provider to participate in the Iowa Medicaid program? Are staffing numbers to
                     be included in the proposal to do outreach activities?
           Response: Reduction in waiting time for appointments and absence of waiting lists for covered
                     services will be the performance measures. The contractor will do research to determine
                     where these performance measures need improvement and will plan recruitment efforts
                     around these measures. Yes, the staffing for this should be included in the proposal.
  RFP Section 6.3.2.2             p. 371           Provider Enrollment
   472     Question: The workload statistics chart shows Provider Enrollment receives an average of 678
                     applications per month. Are these new applications? If so, can you provide the number
                     of inquiries for changes, reinstatements, and terminations?
           Response: Provider Enrollment receives 678 new applications per month. The monthly average for
                     changes and termination requests are approximately 352. The number of reinstatements
                     on a monthly average is approximately 5.
  RFP Section 6.3.2.2.1        p. 371             Objectives
   473     Question: How often will this reverification activity need to be completed?
           Response: Need to reverify on a triggering event, e.g. when a provider license expires, certifications
                     expire.
  RFP Section 6.3.2.2.1, bullet 1 p. 371            Objectives
   474      Question: Please clarify what is required to ―certify‖ participating providers. Is this more of a
                      credentialing process whereby the Contractor collects relevant papers from each
                      provider? Also, can the Contractor use secondary or subcontractor data for certification
                      purposes, or must original source data—such as that provided by the provider‘s medical
                      school—be collected?
           Response: See response to question # 475.
  RFP Section 6.3.2.2.1, bullet 1 p. 371            Objectives
   475      Question: What constitutes ―eligibility‖ for a provider?



Response to Bidder Questions – Set 1                          February 23, 2004                            76 of 133
           Response: The provider manual for each provider type specifies the requirements for enrollment into
                     the Medicaid program. This can be found in DHS publications at the following web page:
                     http://www.dhs.state.ia.us/PolicyAnalysis/PolicyManualPages/MedProvider.htm
  RFP Section 6.3.2.2.1 and        p. 371 and 103 Objectives
              5.2.2.2.6
   476     Question: Section 5.2.2.2.6 shows provider data outputs required of the Core MMIS contractor.
                     Please define the frequencies for each of these outputs.
           Response: See the Detailed System Design for the Provider Subsystem for frequency of provider
                     reports from the Core MMIS.
  RFP Section 6.3.2.2.2.1        p. 372           Interfaces With Other Iowa Medicaid Enterprise
   477     Question: Please confirm that the only interfaces required would be between the Provider Services
                     contractor and DHS, Core MMIS contractor and providers and that no other interfaces are
                      involved.
           Response: No, the contractor may interface with other agencies to obtain the information needed to
                     complete the enrollment process.
  RFP Section 6.3.2.2.2.1         p. 372          Interfaces With Other Iowa Medicaid Enterprise
   478     Question: Will the Provider Services contractor be required to make updates via an on line terminal
                     using the interfaces and data described in each of the bullets 1, 2 & 3?
           Response: Yes.
  RFP Section 6.3.2.2.2.1,         p. 372           Interfaces With Other Iowa Medicaid Enterprise
              bullet 1
   479     Question: This requirement alludes to the responsibility to verify continued certification and
                     licensure. Will the CORE MMIS contractor be required to perform this task on a periodic
                     basis, electronically? Or will the Provider Services Contractor be required to manually
                     verify these requirements?
           Response: Provider services will be responsible for all licensure and certification validation. The
                     contractor may work with sources to develop electronic interfaces.
  RFP Section 6.3.2.2.3, bullet 2 p. 372            State Responsibilities
   480     Question: How is provider suspension or termination information provided to the contractor?
           Response: Providers must inform the contractor by mail of termination. The Department will provide
                     notice if legal action has caused license termination or suspension.
  RFP Section 6.3.2.2.3, bullet 4 p. 372            State Responsibilities
   481     Question: Please verify – is ―biannual‖ provider re-verification done 2 x a year or every 2 years?
           Response: Every 2 years.
  RFP Section 6.3.2.2.4        p. 373           Contractor Responsibilities
   482     Question: What percent of provider applications are denied per month and per year?
           Response: An estimate of 12% of provider applications are denied per month and per year.
  RFP Section 6.3.2.2.4         p. 373          Contractor Responsibilities
   483     Question: Does the department provide a block of numbers for provider ID assignment?
           Response: Yes, there are blocks of numbers for provider ID assignment currently. The State needs to
                     determine if it will use the NPI as the provider number or will cross reference to the current
                     numbers.
  RFP Section 6.3.2.2.4          p. 373            Contractor Responsibilities
   484     Question: Does the state validate the licensing requirements of providers not located in Iowa
                     providing service to Iowa Medicaid beneficiaries?



Response to Bidder Questions – Set 1                          February 23, 2004                            77 of 133
           Response: Yes, the contractor will be required to validate the licenses of out-of-state providers..
  RFP Section 6.3.2.2.4          p. 373          Contractor Responsibilities
   485     Question: Will providers be permitted (encouraged) to submit electronic applications instead of a
                     paper application?
           Response: Yes.
  RFP Section 6.3.2.2.4          p. 373          Contractor Responsibilities
   486     Question: Describe the "DHS-directed" enrollment process. Will these be guidelines or will the
                     process include DHS in the actual enrollment workflow?
           Response: DHS provide guidelines that are documented in the Provider Enrollment procedures
                     manual that is approved by DHS. The Provider Services contractor will process enrollment
                      requests according to the approved procedures. The process will not include direct DHS
                     involvement in the enrollment workflow except for specific situations identified in the
                     approved procedures.
  RFP Section 6.3.2.2.4         p. 373          Contractor Responsibilities
   487     Question: Will scanning equipment/system be provided by the Core MMIS contractor?
           Response: The Core MMIS contractor is responsible for providing and installing an Imaging System
                     for the required documents.
  RFP Section 6.3.2.2.4          p. 373          Contractor Responsibilities
   488     Question: Will the Provider Master File be the system of record for all Provider Data? Does the
                     Provider Component Contract update the Provider Master File directly?
           Response: Yes to both questions.
  RFP Section 6.3.2.2.4           p. 373           Contractor Responsibilities
   489     Question: Is there a current application for housing Provider information and the functions
                     associated with Provider Services Component? Will the contractor be required to take
                     over this application and then move to a new application?
           Response: Yes. The contractor will take over this application. There is no plan to develop a new
                     application, nor is the bidder required to bring one.
  RFP Section 6.3.2.2.4           p. 373           Contractor Responsibilities
   490     Question: Will the state provide the provider contractor with a provider file of all licensed providers
                     in the state of Iowa on a periodic basis?
           Response: No, but the contractor may work with the licensing board to develop this interface.
  RFP Section 6.3.2.2.4           p. 373 to 377 Contractor Responsibilities
   491     Question: Several of the requirements in this section are dependent on the Core MMIS: maintaining
                     certain data elements, including (#16 and 17) cross-references, (#19) provider address,
                     group and services provider data, licensure and certification status, (#21) group
                     membership effective dates; allowing inquiry by provider name and provider number; (#23
                     and 26) performing purge functions; and generating certain reports, such as (#25)
                     reporting providers as inactive after 24 months without claim activity; (#22, 33, 35, 36) etc.
                     Please confirm that the MMIS performs these functions or will be enhanced to do so and
                     the provider services vendor is not responsible for maintaining the data is a separate
                     database.

           Response: Yes, the Core MMIS will provide the capability to maintain the data. The Provider
                     Services contractor will not need to maintain a separate database.




Response to Bidder Questions – Set 1                          February 23, 2004                             78 of 133
  RFP Section 6.3.2.2.4, bullets p. 373            Contractor Responsibilities
               1 and 15
   492     Question: Are the Provider numbers addressed in Question 1, the same bank of numbers being
                     addressed in Question 15? Question 15 specifically references a ‗list of available
                     numbers‘, are these provided by DHS?
           Response: Yes, blocks of numbers will be designated for each provider type. These numbers are
                     provided by the Core MMIS.
  RFP Section 6.3.2.2.4, bullet 2 p. 373           Contractor Responsibilities
   493     Question: Have all enrollment applications that require scanning by the current contractor been
                     scanned?
           Response: The current contractor does not scan applications.
  RFP Section 6.3.2.2.4, bullet 2 p. 373 and 374 Contractor Responsibilities
   494     Question: How will electronic applications from the Core MMIS contractor be submitted to the
                     Provider Services contractor?
           Response: This interface will be developed as part of the Workflow Process Management system.
  RFP Section 6.3.2.2.4, bullet 3 p. 374           Contractor Responsibilities
   495     Question: What kind of storage capacity is needed to maintain files? What is the current and
                     projected volume of paper files for Medicaid provider agreements and correspondence?
           Response: There are approximately 75,000 Provider Enrollment paper files with documentation
                     applications, agreements, correspondence, and change requests. DHS is checking on
                     converting old files to electronic media.
  RFP Section 6.3.2.2.4, bullet 3 p. 374           Contractor Responsibilities
   496     Question: If DHS approves contractor's scanning of documents, what standards are used?
           Response: Transactions and standards relating to electronic records are set forth in Iowa Code
                     Chapter 554D.
  RFP Section 6.3.2.2.4, bullet 4 p. 374           Contractor Responsibilities
   497     Question: Please provide the specific communication method and frequency of communication the
                     contractor is required to perform in order to promote provider participation in the
                     Medicaid program.
           Response: The contractor will develop and obtain DHS approval of the plan to promote provider
                     participation. The plan should identify the communication method or methods to be used
                     by the contractor.
  RFP Section 6.3.2.2.4, bullet 4 p. 374           Contractor Responsibilities
   498     Question: What are the state‘s expectations for the promotion of participation in the Iowa Medicaid
                     program by medical providers? What is the current participation rate?
           Response: The Contractor needs to develop a pro-active plan to monitor and anticipate changing
                     needs for coverage and service and provide it to DHS for approval. The plan should focus
                     on those areas where there is not enough coverage for the population in the area. This
                     will be an ongoing process of evaluation and recruitment. The contractor should also
                     track changes in coverage and population to anticipate future needs as the population
                     and service coverages change over time. There are currently approximately 33,000 active
                     providers enrolled in the Iowa Medicaid program.




Response to Bidder Questions – Set 1                        February 23, 2004                               79 of 133
  RFP Section 6.3.2.2.4, bullet 4 p. 374           Contractor Responsibilities
   499     Question: As a contractor for a state agency, will the provider relations vendor have access to all
                     licensed medical personnel records in the state to expedite the licensure and certification
                     validation?
           Response: Being a contractor for a State agency does not give the vendor any rights not available to
                     the general public.
  RFP Section 6.3.2.2.4, bullet 9 p. 374           Contractor Responsibilities
   500     Question: In what form (paper, e-mail, electronic) will the provider termination information be
                     submitted to the contractor?
           Response: On the provider enrollment application there are currently questions regarding sanctions
                     by health care programs. Also provider enrollment checks OIG provider exclusions which
                     is an electronic file. When DHS becomes aware of a provider being terminated, DHS sends
                     a letter to provider enrollment.
  RFP Section 6.3.2.2.4, bullet    p. 374          Contractor Responsibilities
              10
   501     Question: Can you provide the average number of telephone inquiries received in Provider
                     Enrollment?
           Response: The estimated average monthly number of telephone inquiries is 730.
  RFP Section 6.3.2.2.4, bullet p. 374          Contractor Responsibilities
               10
   502     Question: What is the current number of provider inquiries and what is the nature of them?
           Response: The average number of Provider Services inquiries (phone and written) received in a
                     month is roughly 29,000. Inquiries cover the following major areas:

                       Eligibility – nursing facility, HMO, MediPASS
                       Requests for DHS on retro eligibility, date of death, timely filing
                       Requests for provider enrollment applications
                       Third Party Liability (TPL) changes, deletions and additions
                       Questions on claims
                       Questions on adjustments
                       Requests for copies of remittance advice
                       Requests to stop payment on checks or additional questions for the business department
                       Questions on cost reports worked by the Audit Department
                       Questions and/or requests for training materials or bulletins
                       Questions on Medical Review decision
                       Questions on Medicaid Policy
                       Requests for referrals to Medical Review for payment
                       Exceptions to Policy
                       Questions on procedure codes
                       Questions in HIPAA
                       Questions on reimbursement
                       Questions on Information Bulletins
                       Questions on updates to the provider manuals or policy
  RFP Section 6.3.2.2.4, bullet    p. 374          Contractor Responsibilities
              11
   503     Question: What is the contractor required to do after providers with multiple practice locations are
                     identified?
           Response: Multiple practice locations are added to the provider file and cross-referenced to the
                     provider number.



Response to Bidder Questions – Set 1                         February 23, 2004                             80 of 133
  RFP Section 6.3.2.2.4, bullet   p. 374           Contractor Responsibilities
              11
   504     Question: Will providers be required to submit all service locations and update that information as
                     necessary?
           Response: Each service location should be recorded separately and addressed individually.
  RFP Section 6.3.2.2.4, bullet p. 374 and 375 Contractor Responsibilities
               12
   505     Question: What are the average monthly volumes for each of these provider enrollment statuses?
           Response: The average monthly volumes for each provider enrollment status (if available) are as
                     follows:

                      1. Application pending - 200 to 400 (estimate)
                      2. Enrolled for all programs - 58,000 total provider enrolled (estimate)
                      3. Enrolled for special program (e.g. waiver) - 4,812 total providers enrolled (estimate)
                      4. Preferred provider arrangement - Not applicable
                      5. Enrollment suspended - None
                      6. Designated as on review - Not available
                      7. Terminate status codes, such as voluntary or involuntary - 31,302 total providers in
                      terminated status
                      8. Enrolled as a serving provider only - 13,000 total provider (estimate)

  RFP Section 6.3.2.2.4, bullet   p. 375           Contractor Responsibilities
              13
   506     Question: The workflow process management system will provide "some" of the data to track
                     provider enrollment activities. Is the remaining activity tracked in the MMIS or is the
                     provider services vendor expected to provide a separate tracking database?
           Response: The tracking of the enrollment process will be done by the Workflow Process
                     Management (WPM) system. The data provided on applications will be tracked in the
                     Core MMIS. The Provider Services contractor will need to define the information needed
                     in the WPM and will not need to provide a separate tracking database.
  RFP Section 6.3.2.2.4, bullet   p. 375           Contractor Responsibilities
              13
   507     Question: Any specifications on the report requests and frequency of those reports and requests?
           Response: The contractor will propose the reports needed to meet this requirement. These will be set
                     up as routine on-request reports. Identify when things change, if there are no changes, no
                      report is needed.
  RFP Section 6.3.2.2.4, bullet   p. 375           Contractor Responsibilities
              17
   508     Question: Is it possible for a single provider to be a member of multiple groups and have different
                     provider numbers? Is this separate from or in addition to the provider website? Is this
                     publicly available information or accessible only by state staff?
           Response: Yes to the first question. Provider ID numbers are not available on the website, nor are
                     they public information.
  RFP Section 6.3.2.2.4, bullet   p. 375           Contractor Responsibilities
              21
   509     Question: Will the Contractor be required to perform any Capitation Payment processing? Will the
                     core MMIS application do this?
           Response: The Core MMIS will perform capitation payment processing.



Response to Bidder Questions – Set 1                         February 23, 2004                            81 of 133
  RFP Section 6.3.2.2.4, bullet p. 376            Contractor Responsibilities
               25
   510     Question: The RFP states that the contractor is responsible for identifying and contacting inactive
                     providers. Is the first contact made by phone? Mail? How many respond to the first
                     contact? Is the follow-up notice by mail or by phone? How many follow-up notices are
                     currently done?
           Response: A letter is available for use in periodically contacting inactive providers. Some providers
                     are identified as inactive because of returned mail. If there is a forwarding address listed
                     by the post office, mail is sent to that address. If this address also fails, the provider file is
                     set to a special incorrect address termination status. About 400 provider numbers were
                     set with this code in 2003.
                       Data is not maintained on the percentage or number of responses (e.g., first versus second
                       contact).

  RFP Section 6.3.2.2.4, bullet     p. 376           Contractor Responsibilities
              28
   511     Question: Will DHS provide a storage area and file cabinets for provider records?
           Response: Yes.
  RFP Section 6.3.2.2.4, bullet     p. 376           Contractor Responsibilities
              31
   512     Question: Can credentialing be verified electronically through other sources, such as the State
                     Medicaid Licensing Board Web site?
           Response: It is acceptable to use electronic verification if such sources exist.
  RFP Section 6.3.2.2.4, bullet     p. 376           Contractor Responsibilities
              33
   513     Question: Please clarify what is meant by ―DRG and APG coverage indicators and hospital-specific
                     factors.‖
           Response: Inpatient hospital services are reimbursed using DRG's and (most) outpatient hospital
                     services are reimbursed using APG's. The inpatient reimbursement system can consist of
                     base, capital, direct medical education, indirect medical education, and disproportionate
                     share rates. The outpatient reimbursement system can consist of base and direct medical
                     education rates. These rates are dollar values. These dollar values vary among all Iowa-
                     based and Omaha, NE-based hospitals, therefore, they are provider-specific. (All other
                     out-of-State hospitals are assigned the Iowa statewide average rates.) The provider
                     records for general med/surg hospitals should carry at least five (5) date-specific
                     segments of the dollar values of these base, capital, direct medical education, indirect
                     medical education, and disproportionate share rates.

  RFP Section 6.3.2.2.4, bullet     p. 376           Contractor Responsibilities
              34
   514     Question: Does the contractor receive all information regarding Provider sanctions and convictions
                     from DHS? Does the current MMIS system have a series of edits during enrollment to
                     ensure these providers are not enrolled?
           Response: DHS informs the contractor of sanctioned providers. The contractor also utilizes the OIG
                     databank of excluded providers, and provider enrollment verifies credentials with
                     licensing boards. The contractor will also check the CMS website for sanctions.
  RFP Section 6.3.2.2.4, bullet p. 377             Contractor Responsibilities
               36
   515     Question: Is this a function of the Core MMIS? If so, is there a reason why the Contractor‘s system
                     is also required to perform this functionality?


Response to Bidder Questions – Set 1                            February 23, 2004                              82 of 133
           Response: The Core MMIS will provide the system functionality. The Provider Services contractor
                     will update the data on the Provider file.
  RFP Section 6.3.2.2.4, bullet     p. 377           Contractor Responsibilities
              37
   516      Question: Does the contractor receive all information regarding providers dis-enrolled from
                      Medicaid or Medicare from DHS? Does the current MMIS system have a series of edits
                      during enrollment to ensure these providers are not enrolled?
           Response: DHS is one source, see answer to question # 514. Provider status is placed on the
                     provider file if the provider is enrolled in Medicaid; however no edits are in the system to
                     automatically identify sanctioned providers.
  RFP Section 6.3.2.2.4.1        p. 377         Enhancements to Current Functionality
   517     Question: Will the enhancements to current functionality cause a move from the current application?
           Response: No.
  RFP Section 6.3.2.2.4.1         p. 377            Enhancements to Current Functionality
   518     Question: Is the entry into the State‘s ISIS application manual or automated?
           Response: This is an online application.
  RFP Section 6.3.2.2.4.1        p. 377           Enhancements to Current Functionality
   519     Question: Can the current application support the enhancements being requested?
           Response: The current application or the data warehouse can be used to support the enhancements.
                     The contractor will need to determine how to develop the enhancements.
  RFP Section 6.3.2.2.4.1,          p. 377           Enhancements to Current Functionality
              bullet 1
   520      Question: Will the state maintain the data exchange site or will this be the responsibility of the
                      provider contractor?
           Response: DHS will maintain the website. The contractor will provide content for inclusion on the
                     website.
  RFP Section 6.3.2.2.4.1,          p. 377           Enhancements to Current Functionality
              bullet 1
   521      Question: Is it the State's intent that the contractor would electronically interface with the CORE
                      MMIS or would they be required to enter this data manually from the form into the
                      MMIS? If the State is expecting the functionality to interface with the Web application,
                      will this development be done by the CORE contractor?
           Response: The contractor will electronically interface with the Core MMIS and the Workflow Process
                     Management system. The Core MMIS contractor will determine how to handle
                     applications downloaded from the web to capture an image of the document and move it
                     into the workflow.
  RFP Section 6.3.2.2.4.1,         p. 377           Enhancements to Current Functionality
               bullet 1
   522     Question: Based on the requirement to receive and process electronic applications, is there a
                      process designed to provide a method that allows the Provider Services Contractor to
                      ensure that all of the requirements are met before their addition to the provider file? Is
                      there a pending queue that provides for this review of the data in the MMIS or is it
                      expected that the electronic interface will communicate with the provider to ensure all of
                      the data is submitted and correct?
           Response: Currently this is done manually.




Response to Bidder Questions – Set 1                           February 23, 2004                             83 of 133
  RFP Section 6.3.2.2.4.1,         p. 377           Enhancements to Current Functionality
              bullet 3
   523      Question: Please explain the state‘s expectations related to the 25% sample Quality Assurance audit
                      of HCBS waiver provider applications.
           Response: To determine: 1) if provider continues to meet Medicaid requirements and 2) if the
                     provider wants to continue to be an enrolled Iowa Medicaid provider. The contractor
                     contacts the provider requesting information on the provider's eligibility to continue as a
                     Medicaid provider. If the provider returns the information, they are continued as an active
                     provider. If the provider does not respond or cannot provide the required documentation,
                     the provider is terminated.
  RFP Section 6.3.2.2.4.1,         p. 377           Enhancements to Current Functionality
              bullet 3
   524      Question: Describe the Quality Assurance process for waiver provider applications.
           Response: Letters are sent to enrolled HCBS providers who are not Medicare certified asking for
                     documentation that is current and meets the criteria in the Iowa Administrative Code. The
                     provider documentation is compared to the requirements defined in the Iowa
                     Administrative Code to assure that the provider meets current requirements. If the
                     provider does not meet current requirements, notice is sent to the provider stating why
                     they do not meet and defines the current enrollment/certification requirements. The
                     provider may either terminate their enrollment in the program or provide documentation
                     that complies. For providers who do not respond to this request, contacts are made to
                     again request the information by a specific date. If no response is received, a termination
                     process is implemented.

  RFP Section 6.3.2.2.6         p. 378            Required Reports
   525     Question: RFP Section 6.3.2.2.6 references required reports. Does the MMIS system generate denial
                     and approval letters, additional information letters, etc? Or must the contractor use other
                     means to generate those notices?
           Response: No, see question # 526.
  RFP Section 6.3.2.2.6, bullet 1 p. 378            Required Reports
   526      Question: Is the expectation of the state that the Provider Services Contractor will produce these
                      letters independent of the CORE MMIS?
           Response: Yes.
  RFP Section 6.3.2.2.6, bullet 1 p. 378            Required Reports
   527     Question: Can the department provide historical statistics for the following: Approval and denial
                     letters, Letters for request of additional information, Recertification or license renewal
                     notices,
           Response: Historical statistics for the following:

                       1. Approval and denial letters: Approximately 50 - 100 applications each month would
                       result in some sort of approval or denial letter.
                       2. Letters for request of additional information: Approximately 2,765 letters for request of
                       additional information are sent each month
                       3. Recertification or license renewal notices: Not applicable.
  RFP Section 6.3.2.2.7, bullet 2 p. 379            Performance Standards
   528      Question: For those providers where the State plays a part in the enrollment process; i.e., waiver
                      providers, would the 5 business days for processing enrollment applications begin after
                      State approval?




Response to Bidder Questions – Set 1                            February 23, 2004                          84 of 133
           Response: The 5 days begins upon receipt of the approved application from DHS. The contractor
                     updates the provider file with the information provided by the State.
  RFP Section 6.3.2.2.7, bullet 6 p. 379            Performance Standards
   529      Question: How will the State monitor for accuracy or is that up to the contractor to specify?
           Response: The contractor should include this monitoring in its quality assurance plan.
  RFP Section 6.3.2.2.7, bullet 6 p. 379            Performance Standards
   530      Question: How is online update accuracy currently measured?
           Response: The current contractor has a quality assurance team that samples and measures this. The
                     bidder should include its plan to ensure accuracy in its proposal.
  RFP Section 6.3.2.3           p. 381          Provider Inquiry/Provider Relations
   531     Question: The monthly average hotline calls for Provider Services is 49,983. Can you provide the
                     monthly average of Provider Services written, faxed or e-mailed inquires received?
           Response: The average monthly received by fax or mail are 1,185.
  RFP Section 6.3.2.3            p. 381          Provider Inquiry/Provider Relations
   532     Question: What is the average talk time to handle a provider hotline call?
           Response: The average length of a provider hotline call is 186 seconds.
  RFP Section 6.3.2.3.4          p. 381           Contractor Responsibilities
   533     Question: Please identify the call management system that DHS will provide. This will allow the
                     vendor to understand the tools available to manage the call center.
           Response: Vendors should identify their needs in the proposal.
  RFP Section 6.3.2.3.4          p. 381          Contractor Responsibilities
   534     Question: What are the average monthly call volumes of the provider call center for the past year?
                     Please break down by type of call (e.g., billing inquiries, program questions, eligibility
                     questions, claims submission issues, etc.).
           Response: ACS does not have in place a mechanism to accurately count the breakdown of monthly
                     calls into the provider call center.
  RFP Section 6.3.2.3.4          p. 381          Contractor Responsibilities
   535     Question: Is the Provider Services Contractor required to supply the telephone lines?
           Response: No.
  RFP Section 6.3.2.3.4, bullet 3 p. 381            Contractor Responsibilities
   536      Question: Will the State provide training on the automatic call tender answering system and the
                      reports available from the system? Page 296, 6.1.2.2.1 states the state has the
                      responsibility for ―network infrastructure and network connections.‖ Is the required
                      online access to MMIS different from the network connectivity provided by the state?
           Response: Yes to the first question. No to the last question.
  RFP Section 6.3.2.3.4.5        p. 381         Contractor Responsibilities
   537     Question: Please provide the number of incoming lines and the size of queues.
           Response: See question # 546.
  RFP Section 6.3.2.3.4.5         p. 381          Contractor Responsibilities
   538     Question: Clarify that the Workflow Process Management System mentioned in item #5 is used for
                     correspondence tracking. Is this also the Workflow Process Management System used
                     for enrollment application tracking and workflow?
           Response: Yes to both questions.




Response to Bidder Questions – Set 1                          February 23, 2004                             85 of 133
  RFP Section 6.3.2.3.4.1       p. 382           Enhancements to Current Functionality
   539     Question: Have there been previous provider satisfaction surveys conducted? If so, what are the
                     outcomes for the past year?
           Response: No, this is a new requirement.
  RFP Section 6.3.2.3.4.1,        p. 382           Enhancements to Current Functionality
              bullet 1
   540     Question: What are the expectations of the State regarding this quarterly provider analysis?
                     (Completion rate--percent of non-respondents, sample methodology, sample size and data
                      collection methods)
           Response: The contractor must propose its methodology.
  RFP Section 6.3.2.3.6, bullet 2 p. 382           Required Reports
   541     Question: Statistical reports: Please provide more detail on what the State expects and the
                     frequency for reporting.
           Response: The contractor will recommend the format and content for DHS approval.
  RFP Section 6.3.2.3.7           p. 383          Performance Standards
   542     Question: Please clarify the algorithm and provide an example.
           Response: The algorithm with a 30-second threshold will be applied as shown in the following
                     example:

                       T = 20,000 (Total Calls)
                       A = 5,000 (Calls answered after 29 seconds)
                       B = 3,000 (Calls abandoned after 29 seconds)

                       SL = (20,000 - (5,000 + 3,000) ÷ 20,000) * 100 = 60%

  RFP Section 6.3.2.3.7, bullet 1 p. 383           Performance Standards
   543     Question: Please describe the Iowa Department of Human Services (DHS)‘s expectations regarding
                     connectivity to the Core MMIS to ensure the Contractor has access to sufficient data to
                     meet this performance standard. What is the expected volume?
           Response: All component contractors will have access to Medicaid data via the network provided by
                     DHS. The volume will be dependent on the number of providers who are having billing
                     problems.
  RFP Section 6.3.2.3.7, bullet 2 p. 383           Performance Standards
   544     Question: Please explain, in more detail, what is meant by an 80 percent service level for incoming
                     calls and the calculation used to determine this.
           Response: 80 % of incoming calls must be answered in less than 30 seconds. See question # 681 for
                     an example of how the algorithm will be applied.
  RFP Section 6.3.2.3.7, bullet 2 p. 383           Performance Standards
   545     Question: Please clarify whether calls abandoned in less than 30 seconds are counted as answered
                     or abandoned?
           Response: These calls are not counted as either answered or abandoned.
  RFP Section 6.3.2.3.7.2         p. 383            Performance Standards
   546     Question: Is there any type of call routing associated with incoming calls - how many established
                     queues (type and number)?




Response to Bidder Questions – Set 1                        February 23, 2004                            86 of 133
             Response: The State will provide the telephone system including call routing functionality. The
                       bidder needs to identify in its proposal the type and number of queues needed to maintain
                        a service level of 80%
  RFP Section 6.3.2.4.4         p. 385            Contractor Responsibilities
   547     Question: Does the ―current provider list‖ have to be real-time, or can there be a day lapse?
             Response: These reports can be generated from the MMIS or through queries against the Data
                       Warehouse. The information on the MMIS will be real time and the information on the
                       Data Warehouse will be updated after each payment cycle.
  RFP Section 6.3.2.4.4, bullet 2 p. 385         Contractor Responsibilities
   548     Question: What is the current media and software package used for provider manuals?
             Response: Provider manuals are prepared in Microsoft Word and published on the website in PDF
                       format.
  RFP Section 6.3.2.4.4, bullet 2 p. 385             Contractor Responsibilities
   549       Question: Is there a scheduled publication release of newsletters and bulletins?
             Response: Please refer to 6.3.2.4.4, page 386, number 7.
  RFP Section 6.3.2.4.4, bullet 3 p. 386             Contractor Responsibilities

   550       Question: How frequently does DHS anticipate revisions to the provider manuals being necessary?
             Response: As needed. Frequency varies with legislative changes and other policy changes.
  RFP Section 6.3.2.4.4, bullet      p. 386          Contractor Responsibilities
              11
   551       Question: Will the state require prior approval from the contractor for emergency requests?
             Response: Refer to last sentence of bullet 11 in section 6.3.2.4.4 page 386.
  RFP Section 6.3.2.4.4, bullet      p. 386          Contractor Responsibilities
              13
   552 325   Question: Is this a report that is currently produced by the MMIS or is the provider services vendor
                       expected to produce it from the data warehouse?
             Response: Yes this is currently produced by the DW/DS and will need to be developed in the new
                       data warehouse.
  RFP Section 6.3.2.4.4.1         p. 387           Enhancements to Current Functionality
   553     Question: Is there a current website that houses Provider Services information? If so, can the
                     contractor take over this site and make the necessary changes to be in compliance with
                     this request? Is the incumbent contractor under any contractual obligation to work with
                     the new contractor?
             Response: There is currently a web site hosted by DHS. The contractor will provide content and
                       changes to current content to the existing website. The current contractor's turnover
                       responsibilities include working with the new contractor where appropriate.
  RFP Section 6.3.2.4.4.1        p. 387           Enhancements to Current Functionality
   554     Question: RFP Section 6.3.2.4.4.1 references enhancements to current functionality. Does the
                     information disseminated via the web site (provider publications, provider manuals) need
                     to be protected against unauthorized access? In other words, does this task include the
                     requirement that providers must log into the Web site to obtain access to its contents?
             Response: Provider publications are public information.
  RFP Section 6.3.2.4.4.1        p. 387          Enhancements to Current Functionality
   555     Question: What is the required frequency of updates to the provider manual?



Response to Bidder Questions – Set 1                           February 23, 2004                           87 of 133
           Response: The frequency varies, they needed to be updated as needed.
  RFP Section 6.3.2.4.4.1,        p. 387          Enhancements to Current Functionality
               bullet 3
   556     Question: Does the state intend to send targeted e-mails only to those providers who provide their
                      e-mail address on enrollment? What is the current size of the Medicaid e-mail database?
           Response: Contractor must allow for capturing email addresses as part of enrollment. Currently, a
                     provider database of email addresses is not available.
  RFP Section 6.3.2.4.4.1,         p. 387           Enhancements to Current Functionality
              bullet 4
   557      Question: Could this functionality be met by granting limited database query capability? Please
                      clarify what is expected with this function?
           Response: No.
  RFP Section 6.3.2.5             p. 388         Provider Training
   558     Question: Will this training be mandatory for participating providers?
           Response: Provider training is not mandatory for providers.
  RFP Section 6.3.2.5         p. 388            Provider Training
   559     Question: How many face-to-face training were conducted during the last year?
           Response: During calendar year 2003, face-to-face individual provider training was conducted 102
                     times. This includes ASAP software installations.
  RFP Section 6.3.2.5.4          p. 390           Contractor Responsibilities
   560     Question: How many providers attend training in the eight assigned areas? How long does a
                     training normally last? Is the training done in a State office or in a location chosen by the
                     Contractor?
           Response: Annual provider training sessions are not currently being conducted. However, during 2003
                     there were 20 training sessions for provider associations, special requests and HIPAA
                     outreach. In addition 23 training sessions were conducted for individual provider (e.g. a
                     hospital requesting training for 10 billing staff)..
  RFP Section 6.3.2.5.4           p. 390           Contractor Responsibilities
   561     Question: In addition to the eight services areas identified, are there other areas where provider
                     trainings have been conducted in the past year?
           Response: The eight service areas encompass the entire State of Iowa. There has been no out-of-
                     state provider training.
  RFP Section 6.3.2.5.4, bullet 2 p. 390            Contractor Responsibilities
   562      Question: What is the current level of problems in billing for all providers?
           Response: Many provider issues remain the same on an ongoing basis: understanding Medicaid
                     policies that deviate from traditional ―insurance companies‖, claim denial reasons, TPL
                     billing procedures and eligibility issues. However, at the present time, a number of
                     providers are struggling with HIPAA-related issues such as procedure code conversion
                     from local codes to standard codes and use of new software. Electronic billers have a
                     number of billing issues that relate to their software vendors and to the understanding of
                     new fields that were not utilized in the past for Medicaid billing.
  RFP Section 6.3.2.5.4         p. 391          Contractor Responsibilities
   563     Question: How often does DHS staff request training? How long do these trainings normally last?
                     Are they done at the DHS office?




Response to Bidder Questions – Set 1                          February 23, 2004                            88 of 133
           Response: The only training has been on the system. DHS may want provider training to be
                     available to DHS staff or to assist DHS staff in resolving provider problems. This will be
                     an occasional thing when needed.
  RFP Section 6.3.2.5.4        p. 391          Contractor Responsibilities
   564     Question: How many individual provider training sessions is the Contractor expected to offer?
           Response: The contractor should develop a plan and propose the number of sessions.
  RFP Section 6.3.2.5.4           p. 391        Contractor Responsibilities
   565     Question: How often does policy specific training occur? How long do these training sessions
                     usually last? How many people attend these type of trainings?
           Response: Policy specific training is done on an as needed basis.
  RFP Section 6.3.2.5.4, bullet 7 p. 391            Contractor Responsibilities
   566      Question: This section specifies that training must be provided ―on site.‖ Does this mean that
                      provider trainings must be conducted at various providers‘ offices in the eight service
                      areas, or in one specific location for each service area?
           Response: Training must be provided in one specific location for each service area.
  RFP Section 6.3.2.5.4, bullet 7 p. 391            Contractor Responsibilities

   567      Question: What is the State‘s expectation of the number of special statewide policy-specific training
                      sessions that would need to be conducted during the course of the contract?
           Response: This training will be conducted as needed when policy changes are made. At this time the
                     State cannot anticipate the number of training sessions that would be needed.
  RFP Section 6.3.2.5.4, bullet    p. 391           Contractor Responsibilities
              10
   568      Question: Please provide the approximate volume of individual trips to Provider facilities for training.
           Response: See question # 559.
  RFP Section 6.3.2.5.4, bullet    p. 391           Contractor Responsibilities
              11
   569      Question: Will the State pay for report format and content changes of the training reports?
           Response: No.
  RFP Section 6.3.2.5.7, bullet 2 p. 392            Performance Standards
   570      Question: Would DHS be open to having reports regarding provider training sessions submitted on
                      a more regular schedule, such as weekly, bi-monthly, or monthly?
           Response: Yes.
  RFP Section 6.3.2.6             p. 393 to 396 Managed Care Function
   571     Question: Please clarify if licensure and credentialing activities are included in the Managed Care
                     function.
           Response: DHS will determine if an HMO is properly licensed but the contractor may be a part of the
                     DHS' decision in allowing expansion based on the availability of contracted providers
                     within any county. Credentialing of specific provider panel members is under the purview
                     of the HMO.
  RFP Section 6.3.2.6.1, bullet 5 p. 393            Objectives
   572      Question: Further explain what all of the appropriate geographic locations for expansion are. Are
                      there expectations of expansion by the State in certain geographical locations?




Response to Bidder Questions – Set 1                          February 23, 2004                            89 of 133
           Response: Medical managed care is mature in Iowa. There are only 6 counties at this time that do not
                     have medical managed care. The contractor is expected to assist in recruitment of
                     MediPass providers in these counties as well as existing managed care counties. HMOs
                     will be encouraged to provide services in additional counties.
  RFP Section 6.3.2.6.2.2        p. 394           Interfaces With External Entities
   573     Question: Are individuals or groups of providers that take on risk considered MCOs? Does DHS
                     expect the Contractor to recruit such organizations into the Iowa Medicaid program?
           Response: No, they are not. The Department expects the contractor to assist with recruitment of
                     HMOs into the program whenever possible.
  RFP Section 6.3.2.6.4        p. 394           Contractor Responsibilities
   574     Question: What percent of medical providers statewide are Medicaid providers?
           Response: This information is not available.
  RFP Section 6.3.2.6.4        p. 394           Contractor Responsibilities
   575     Question: What percent of all Medicaid providers are members of MediPASS?
           Response: There are 1658 MediPASS providers.
  RFP Section 6.3.2.6.4, bullet 1 p. 394           Contractor Responsibilities

   576     Question: Please provide a list of all MCOs currently participating in the Iowa Medicaid program and
                     their coverage areas.
           Response: John Deere Health Plan – Clayton, Jackson, Delaware, Dubuque, Scott and Muscatine –
                     Coventry Health Plan Of Iowa – Butler, Black Hawk. Iowa Health Solutions – Benton,
                     Boone, Buchanan, Calhoun, Clayton, Clinton, Dallas, Dubuque, Hamilton, Hardin,
                     Jackson, Lee, Linn, Lucas, Madison, Mahaska, Marion, Marshall ,Muscatine, Polk, Scott,
                     Story, Tama, Van Buren, Warren.
  RFP Section 6.3.2.6.4.2        p. 394            Contractor Responsibilities
   577     Question: Please describe the type of technical support expected in the requirement to "assist DHS
                     in the education and technical support to HMOs."
           Response: QA analysis and performance, grievance recording and reporting, provider panel
                     sufficiency. The vendor should present its plan for these activities for DHS approval.
  RFP Section 6.3.2.6.4.2        p. 394           Contractor Responsibilities
   578     Question: Please describe the scope of the requirement to identify and recruit additional HMOs in
                     more detail. Would the State be responsible for the solicitation of competitive bids from
                     potential HMO contractors?
           Response: There is no competitive bid process. The contractor will assist with describing the
                     program and enrolling the HMO as a provider for counties where a certificate of authority
                     has been issued and the Department has determined that a sufficient panel exists. The
                     contractor will assist with the determination of sufficiency of the provider panel.
  RFP Section 6.3.2.6.4         p. 395         Contractor Responsibilities
   579     Question: Can the Department provide historical statistics for the following items:

                       ● Number of calls received on the Provider Managed Care Hotline
                       ● Duration of the calls received
                       ● Number and length of surveys performed
                       ● Number of solicitation letters sent to providers for participation in MHCAC
           Response: The MHC provider line answered 11,847 calls for the last twelve months. The average
                     time per call is 2 – 5 minutes. Surveys – 20 providers per month randomly selected. No
                     solicitation letters have been sent.


Response to Bidder Questions – Set 1                         February 23, 2004                           90 of 133
  RFP Section 6.3.2.6.4, bullet 3 p. 395           Contractor Responsibilities
   580     Question: Are statistical reports regarding participation, provider enrollment, and capacity available
                     through the MMIS or is the provider services vendor expected to produce these through
                     the data warehouse or a separate database maintained by the provider services vendor?
           Response: To the extent that data regarding enrollment of recipients or participation of providers in
                     managed care is contained in the core MMIS and/or data warehouse, the contractor for
                     provider services will be expected to pull data from appropriate sources to produce the
                     required reports. If such data are not available from those sources, the contractor would
                     be expected to maintain a database with such information and provide it to the
                     Department upon request or as specified for routine report generation.
  RFP Section 6.3.2.6.4, bullet    p. 395          Contractor Responsibilities
              3#8
   581     Question: Are there specific types of reports the State is requesting? If so, how many reports is the
                     State requesting?
           Response: A quarterly formal report will be required listing each county, the number of MediPASS
                     providers and the number of openings for patients. The contractor should assess the
                     viability of continued MediPASS operations based on available service providers.
                     Additionally the contractor should be independently identifying any areas where
                     additional recruitment activities need to be undertaken.
  RFP Section 6.3.2.6.4, bullet p. 395            Contractor Responsibilities
               3, #9
   582     Question: Please explain further the appointment surveys, the number of attempts to contact, data
                     required in the surveys, and who is responsible for designing?
           Response: Every month 20 MediPASS providers will be selected at random. The vendor should
                     propose a tool but the Department expects each provider contacted to reply to a series of
                     questions regarding appointment availability for routine, urgent and preventive care,
                     including immunizations for children.
  RFP Section 6.3.2.6.4, bullet    p. 395          Contractor Responsibilities
              3, #11
   583     Question: If sent electronically, do HIPAA file format requirements apply?
           Response: If the Department decides to send the monthly enrollment roster electronically to each
                     MediPASS provider, HIPAA formats would apply.
  RFP Section 6.3.2.6.4.4         p. 395        Contractor Responsibilities
   584     Question: Is the Provider Managed Care Hotline a part of the telephone inquiry function - 1-800 lines
                      and call tracking?
           Response: Yes.
  RFP Section 6.3.2.6.4, bullet    p. 396          Contractor Responsibilities
              5, #2
   585     Question: Who incurs the costs of the meetings including materials and location of the meetings?
           Response: All meetings would be held in the permanent IME facilities. DHS will be responsible for
                     these costs.
  RFP Section 6.3.2.6.7          p. 396           Performance Standards
   586     Question: What was the provider participation in MediPASS for the base year? This statistic does
                     not appear to be in the bidder's library.
           Response: See question # 575.




Response to Bidder Questions – Set 1                         February 23, 2004                             91 of 133
  RFP Section 6.3.2.6.7         p. 396           Performance Standards
   587     Question: The performance standard for managed care is increasing provider participation by 5%
                     each year. What is the current participation percentage?
           Response: See question # 575.
  RFP Section 6.3.2.6.7          p. 396           Performance Standards
   588     Question: Is there some percent of provider participation the state would consider the goal met even
                      though participation did not increase by 5%?
           Response: No.
  RFP Section 6.4.1.2 and          p. 398 and 400 Development Task
              6.4.2.2.1
   589     Question: Please clarify the difference between ―not need to design a formal tracking system for
                     enrollments‖ and ―maintain Enrollment/Eligibility data, eliminating duplicate member
                     records by ensuring non-overlapping enrollments?‖.
           Response: It is anticipated that the Workflow Process Management system will be used to track
                     enrollment activities. The Core MMIS edits enrollments to ensure that there are no
                     overlapping segments.
  RFP Section 6.4.2.1             p. 399          General Requirements
   590     Question: Please clarify what it means to ensure ―that federal requirements for managed health care
                     contracting HMOs and MediPASS are met‖?
           Response: All components required by the balanced budget act of 1997 as they pertain to managed
                     care and rules that became effective August 14, 2003. There are significant issues that
                     must be addressed and the bidder is encouraged to review them. See question # 742.
  RFP Section 6.4.2.1              p. 399           General Requirements
   591     Question: The General Requirements for the Member Services contractor include, ―ensuring that
                     Federal requirements for managed health care contracting (HMO and MediPASS) are
                     met.‖ Will the Member Services contractor perform direct oversight of the MediPASS
                     program administrator‘s regulatory compliance? Does the State perceive this as a conflict
                     of interest if a single contractor performs these components (Medical Services and
                     Member Services)?
           Response: All components required by the balanced budget act of 1997 as they pertain to managed
                     care and rules that became effective August 14, 2003. There are significant issues that
                     must be addressed and the bidder is encouraged to review them. The contractor will be
                     the MediPASS program administrator. Member Services will only do enrollment broker;
                     medical services support will only deal with medical decisions.
  RFP Section 6.4.2.2            p. 399 to 404 MHC Enrollment Broker
   592     Question: Should the bidder propose a member enrollment system that is separate from the
                     Automated Benefits Calculation system, the Title XIX system, and the Core MMIS
                     system? Or will these systems allow the bidder to perform all of the MHC enrollment tasks
                     described in Section 6.4.2.2?
           Response: The Core MMIS system has an enrollment component that will be utilized by the Member
                     Services contractor.
  RFP Section 6.4.2.2         p. 400        MHC Enrollment Broker
   593     Question: How many days do members have to choose a different provider?
           Response: At least 10 days for the initial selection. More is granted depending upon when the
                     enrollment is created. After the initial letter of enrollment the 90-day rule takes effect. See
                     response to question # 609.




Response to Bidder Questions – Set 1                          February 23, 2004                            92 of 133
  RFP Section 6.4.2.2            p. 400        MHC Enrollment Broker
   594     Question: Can the Department provide statistics on the number of enrollment packets that were sent
                     to members? How many letters are sent to inform the client they can switch providers
                     after six months?
           Response: The number of MHC enrollment packets that were sent to potential enrollees in MHC by
                     month for the calendar year 2003 were: January 8,577, February 7,736, March 7,388, April
                     8,354, May 6,457, June 8,213, July 12,506, August 20,879, September 7,901, October
                     10,023, November 7,170 and December 7,906. DHS will bear the costs of mailing.

                       There were 87,452 letters sent to persons enrolled in MHC programs pursuant to the
                       impending end of the client‘s EPP.
  RFP Section 6.4.2.2          p. 400         MHC Enrollment Broker
   595     Question: Does the MHC enrollment broker assign a PCP for force or choice enrollments, if the
                     member does not make a PCP choice?
           Response: Yes, in the MediPASS program. The PCP is assigned by the HMO when the enrollment,
                     whether by default or selection, is to the HMO.
  RFP Section 6.4.2.2             p. 400           MHC Enrollment Broker
   596     Question: The section states that the Title XIX system will send a daily update and monthly full file
                     electronically to notify the Core MMIS of individuals to be enrolled in medical managed
                     health care, who will then make a tentative assignment to an HMO or MediPASS provider.
                     The Core MMIS will then notify the Member Services contractor of these eligibles and
                     the tentative provider assignments. Will the communication between the core MMIS and
                     the Member Services contractor also occur through electronic file communication? Can
                     the State elaborate on the size and format of the file that the Core MMIS will send daily
                     and monthly to the Member Services contractor?
           Response: Yes. The intent is for the Workflow Process Management system to automatically queue
                     the enrollments to the Member Services contractor. The size and file format will be
                     determined during the DDI phase of the contract.
  RFP Section 6.4.2.2            p. 400        MHC Enrollment Broker
   597     Question: How many enrollments are processed by phone? By mail? By email? By fax? How many
                     are done in person?
           Response: 10,619 case enrollment forms were received by mail. 23,215 case enrollments were made
                     by phone. Enrollments are not performed in person except that a worker at the local DHS
                     office may provide a potential enrollee with the appropriate documents that can then be
                     mailed to the enrollment broker. There are no e-mail or fax enrollments.
  RFP Section 6.4.2.2            p. 400         MHC Enrollment Broker
   598     Question: When a beneficiary voluntarily changes plan enrollment, how does the six month lock-in
                     period apply, if at all?
           Response: After the first 90 days of enrollment (starting from the date the first letter of assignment is
                     sent) the recipient may change at any time but the effective date will be the first day of the
                     next month, providing the choice was made in time to be entered before the system cutoff
                     dates. After the first 90 days, the recipient may not change without good cause until the
                     end of 6 months.
  RFP Section 6.4.2.2            p. 401         MHC Enrollment Broker
   599     Question: What is the average monthly receipts for the member enrollments, disenrollments, and
                     changes?
           Response: 5,000 monthly average, including enrollments, disenrollments, and changes.




Response to Bidder Questions – Set 1                          February 23, 2004                              93 of 133
  RFP Section 6.4.2.2.1, bullet 2 p. 400           Objectives

   600     Question: Does ―MHC‖ in ―Notify MHC and Core MMIS of new or changed enrollment data‖ refer
                     to the MHC contractors?
           Response: Yes.
  RFP Section 6.4.2.2.4         p. 401          Contractor Responsibilities
   601     Question: Does the MMIS system provide a facility for generating the enrollment letter and/or any
                     other components of the enrollment packet?
           Response: DHS will inform the contractor of the need for enrollment. The contractor will need to
                     generate appropriate notifications and information.
  RFP Section 6.4.2.2.4, bullet 1 p. 401           Contractor Responsibilities
   602     Question: Define ―demographic change notices.‖
           Response: Any change in demographic information such as address, phone, etc.
  RFP Section 6.4.2.2.4, bullet 1 p. 401           Contractor Responsibilities
   603     Question: How many member address changes occurred, on average, each month, for the past year?
           Response: Demographic updates received include all types of updates, not specific just to address
                     changes. Therefore, the information is not available. We do not track address changes
                     that would be in the same county of residence. An example of recipient county changes
                     for December is 1,375.
  RFP Section 6.4.2.2.4, bullet 3 p. 402           Contractor Responsibilities
   604     Question: Is the contractor responsible for printing costs, mail production costs, and postage?
           Response: DHS will be responsible for all printing, mailing, and postage costs.
  RFP Section 6.4.2.2.4, bullet 3 p. 402           Contractor Responsibilities
   605     Question: What is the average number of enrollment packets mailed per month and per year?
           Response: 2001 – 7,155 per month
                     2002 – 7,671 per month
                     2003 – 9,426 per month
  RFP Section 6.4.2.2.4, bullet 4 p. 402           Contractor Responsibilities
   606     Question: What HMO materials are included in the enrollment packet? Are these materials provided
                     by the HMOs? Is the contractor responsible for printing these materials? Storage?
           Response: The individual HMO promotional brochure and the provider listing for the county of
                     residence are included in the enrollment packet. These materials are provided by the HMO
                      and stored by the contractor.
  RFP Section 6.4.2.2.4, bullet 4 p. 402           Contractor Responsibilities
   607     Question: ―Your Choice Booklet‖ – is this booklet designed and printed by the Department or the
                     contractor?
           Response: The booklet is designed by the contractor, approved and printed by the Department.
  RFP Section 6.4.2.2.4, bullet 4 p. 402        Contractor Responsibilities
   608     Question: Can the enrollment form be pre-printed with required member information (e.g., name,
                     DOB, Medicaid ID)?
           Response: Yes, but any additional cost associated with this would be borne by the contractor. The
                     vendor must propose changes for DHS approval.




Response to Bidder Questions – Set 1                         February 23, 2004                               94 of 133
  RFP Section 6.4.2.2.4, bullet 5 p. 402            Contractor Responsibilities

   609     Question: What is the average number of letters per month and per year mailed to members who
                     have been in managed care for 6 months? Are there other materials mailed with this letter?
           Response: There are 150,000 enrollees in HMO and MediPASS in any given month. Each will receive
                     two letters per year after the first six months. This is a form letter that notifies the member
                     how to change the primary care provider, if necessary. No other materials are mailed with
                     the letter.
  RFP Section 6.4.2.2.4, bullet    p. 402           Contractor Responsibilities
              6, #1
   610     Question: Please provide average monthly call volumes for the Member Managed Care Hotline for
                     the past year, by type of call and average call times.
           Response: 6,500 average calls per month. Average call time is 6 minutes.
  RFP Section 6.4.2.2.4, bullet    p. 402           Contractor Responsibilities
              6, #5
   611     Question: Please describe in further detail the type of reports (specifications) the State is expecting.
           Response: These are monthly reports of MediPASS provider changes of enrollment restrictions,
                     disenrollments requested, and the volume of changes from or to any specific provider.
  RFP Section 6.4.2.2.4, bullet    p. 402           Contractor Responsibilities
              6, #7
   612     Question: What is the average monthly number of Medicaid individuals who regained eligibility
                     within 90 days and had to be reinstated over the past year?
           Response: In 7/02 - reinstatements for 5/02, 6/02, and 7/02 ------------3599
                     In 8/02 - reinstatements for 6/02, 7/02, and 8/02------------ 3088
                     In 9/02 - reinstatements for 7/02, 8/02, and 9/02 ----------- 3049
                     In 10/02 - reinstatements for 8/02, 9/02, and 10/02--------- 3811
                     In 11/02 - reinstatements for 9/02, 10/02, and 11/02 ------ 3110
                     In 12/02 - reinstatements for 10/02, 11/02, and 12/02 ---- 4013
                     In 1/03 - reinstatements for 11/02, 12/02, and 1/03 -------- 3435
                     In 2/03 - reinstatements for 12/02, 1/03, and 2/03 --------- 3390
                     In 3/03 - reinstatements for 1/03, 2/03, and 3/03 ----------- 3245
                     In 4/03 - reinstatements for 2/03, 3/03, and 4/03 ----------- 3368
                     In 5/03 - reinstatements for 3/03, 4/03, and 5/03 ---------- 3455
                     In 6/03- reinstatements for 4/03, 5/03, and 6/03 ----------- 3641

                                     tot ----- 41204/12 mo = 3434 avg/mo

  RFP Section 6.4.2.2.4, bullet p. 402         Contractor Responsibilities
               6, #7
   613     Question: Does the Core MMIS vendor identify these individuals and the last provider on record?
                     Is this a manual process?
           Response: Whoever enters the enrollment selection should have this data available.
  RFP Section 6.4.2.2.4, bullet    p. 402           Contractor Responsibilities
              6, #8
   614     Question: In what format is the Lock-In data provided from IFMC and how frequently will the
                     contractor receive the data?
           Response: IFMC provides lock-in data monthly via hardcopy correspondence. See RFP MED-04-034.
                     This is being automated. CSR is in development.



Response to Bidder Questions – Set 1                          February 23, 2004                              95 of 133
  RFP Section 6.4.2.2.4, bullet   p. 403           Contractor Responsibilities
              6, #8
   615     Question: Please define ―IFMC.‖
           Response: Iowa Foundation for Medical Care.
  RFP Section 6.4.2.2.4, bullet 8 p. 403           Contractor Responsibilities
   616     Question: Is there a required time to remove ineligible members? Does a timely notice required?
           Response: Timely notice does not apply since there is not a change in benefits. However, any
                     recipient who is actually ineligible for benefits does take up a slot which could be used by
                     another eligible recipient. Therefore, it is expected that the contractor will remove
                     ineligible recipients in accordance with department policy at least every quarter and more
                     frequently if possible. However, no recipient may be removed from the history file of
                     managed health care because the default enrollment if that person becomes eligible at a
                     later date must go to the last medical managed care provider with whom the individual was
                     enrolled.

  RFP Section 6.4.2.2.4, bullet 9 p. 403           Contractor Responsibilities
   617     Question: Does the State anticipate any major changes to MCO providers in the next contract year?
                     What has been the history of such MCO provider changes in the past two years?
           Response: One HMO has dropped 20 of 25 counties. Another has added counties and the
                     Department anticipates adding counties in the future. Other than this, type of activity, no
                     significant changes are anticipated.
  RFP Section 6.4.2.2.5, bullet 1 p. 403           Data Sources
   618     Question: Will the file from MMIS be in a proprietary format or in the HIPAA 834 format?
           Response: This file will be in MMIS proprietary format. Since the component contractors are
                     business associates, HIPAA requirements do not apply to these transactions.
  RFP Section 6.4.2.2.6, bullet 4 p. 404           Required Reports
   619     Question: Please provide more detail about daily, monthly, quarterly and annual file updates for DHS
                     and MHC Providers.
           Response: The contractor should be able to provide an electronic file that notes current enrollments
                     into MediPASS and HMOs.
  RFP Section 6.4.2.2.7, bullet 2 p. 404           Performance Standards
   620     Question: How and on what frequency will the State monitor accuracy level?
           Response: The Department expects to look at required reports as they are available and will monitor
                     accuracy on a monthly basis, as necessary.
  RFP Section 6.4.2.2.7, bullet 2 p. 404           Performance Standards
   621     Question: Please explain in more detail on what the 98% accuracy rate for all enrollment assignments
                     in HMO and MediPASS participation is based.
           Response: Enrollment assignment of 98% does not need further explanation. Enrollments should be
                     accurate based on enrollee selections and defaults.
  RFP Section 6.4.2.2.7, bullet 3 p. 404           Performance Standards
   622     Question: Will the state accept access to query capability for these reports in an approved format as
                     a method of meeting the timeliness standards?
           Response: Reports described in the RFP must be available as directed.
  RFP Section 6.4.2.3            p. 404           Member Inquiry / Member Relations
   623     Question: What is the estimated call volume for member inquiry monthly and annually?



Response to Bidder Questions – Set 1                         February 23, 2004                            96 of 133
           Response: Currently the Member Hotline is only used for Members receiving a bill or being denied
                     service, the following numbers of call are considered ―actual Hotline calls and
                     inappropriate calls‖ combined.. The average number of calls made to the Member Hotline
                      per month are 1,038. The average number of calls made to the Member Hotline per year
                     are 12,456.
  RFP Section 6.4.2.3            p. 406           Member Inquiry / Member Relations
   624     Question: Contractor responsibility #4 under Member Inquiry/Member Relations states, ―For the
                     two court-ordered circumstances, send a letter to the member with the information
                     required to support a potential appeal.‖ What are the two court-ordered circumstances?
           Response: See 6.4.2.3.4 The two bullets in the first paragraph are the two court ordered instances.
  RFP Section 6.4.2.3            p. 406            Member Inquiry / Member Relations
   625     Question: Please provide historical statistics for the following items:

                       ● Number of member hotline calls received
                       ● Length of calls received
                       ● Number of inquiries that are completed during the first call
                       ● Number of inquiries that are received by mail, fax and email
                       ● Average length of an ―open ticket‖
           Response: Currently the Member Hotline is only used for Members that are receiving a bill or being
                     denied service. The number of ―actual‖ Hotline calls received calendar year 2003 is 3,760 .
                     The average length of a Hotline call is 186 seconds. Currently, the inquiry is not
                     completed during the phone call. The number of inquiries received by mail, fax or email is
                     not recorded, an estimate would be 25 per month. Currently, the Department has 30 days
                     to respond in writing to a Member Hotline inquiry.
  RFP Section 6.4.2.3.1, bullet 1 p. 405           Objectives
   626     Question: Are the REVS/MEVS Inquiry volume listed on the Attachment M the volume of inquiries
                     referred to in the objective 1 listed under 6.4.2.3.1? If so, can you provide a breakdown of
                     the types of inquires that are received?
           Response: The MEVS inquiry volume is the total inquiries received via the MEVS functions. No
                     further breakdown is available.
  RFP Section 6.4.2.3.4          p. 406        Contractor Responsibilities
   627     Question: How many telephone calls do you project will be received through the Managed Care and
                     fee-for-service hotline?
           Response: Managed Care can be extrapolated from the statistics in attachment M. Fee-for-service is
                     an enhancement and therefore no figures are available.
  RFP Section 6.4.2.3.4, bullet 2 p. 406           Contractor Responsibilities
   628      Question: Please clarify if the State telecommunications network will have the capability to record
                      incoming calls or if the equipment will need to be provided and integrated into the
                      network by the Member Services vendor.
           Response: DHS will provide equipment that provides records of incoming calls.
  RFP Section 6.4.2.3.4, bullet 4 p. 406           Contractor Responsibilities
   629      Question: What are the ―two court-ordered circumstances‖ referenced here? What volume of
                      inquiries do they represent?
           Response: They are the two bullets in Section 6.4.2.3.4. The volume is approximately 4,000 per year.




Response to Bidder Questions – Set 1                         February 23, 2004                            97 of 133
  RFP Section 6.4.2.3.4, bullet 4 p. 406            Contractor Responsibilities
   630     Question: Please define ―the 2 court-ordered circumstances.‖
           Response: See 6.4.2.3.4
  RFP Section 6.4.2.3.4, bullet    p. 407           Contractor Responsibilities
              9, #5
   631     Question: Please explain what is involved in answering questions about ―Accounts
                     Payable/Receivable.‖
           Response: These would include questions on claims payment or claims that had not been paid.
  RFP Section 6.4.2.3.4, bullet    p. 408           Contractor Responsibilities
              11
   632     Question: It is not clear if the State or contractor is responsible for providing front-end options to
                     assist non-English speaking members and a TDD. Please specify.
           Response: The State is responsible for providing these.
  RFP Section 6.4.2.3.4, bullet p. 408          Contractor Responsibilities
               11
   633     Question: What are the primary languages spoken by Medicaid clients?
           Response: 96% of Iowa Medicaid members profess to English proficiency as their primary language.
                     The majority of the non-English speaking clients have Spanish as their primary language.
                     There is an occasional need for translation to Eastern European and Southeast Asian
                     languages.
  RFP Section 6.4.2.3.7, bullet 1 p. 408            Performance Standards
   634     Question: Please clarify if the ability to store inquiry records will be a function of the State
                     telecommunications network or if that capability will need to be provided and integrated
                     into the system by the Member Services vendor.
           Response: This will be a function of the State network and/or the Workflow Process Management
                     system.
  RFP Section 6.4.2.3.7, bullet 1 p. 408            Performance Standards
   635     Question: In what format (e.g., electronic, paper) will the contractor forward the inquiry to DHS
                     within 48 hours?
           Response: The contractor should forward the inquiry electronically through the Workflow Process
                     Management system.
  RFP Section 6.4.2.3.7, bullet 3 p. 409            Performance Standards
   636     Question: Please define service level. Is a service level of 80% equivalent to an abandonment rate of
                     20%? (abandonment rate is the % calls abandoned after 30 seconds).
           Response: See question # 542.
  RFP Section 6.4.2.4.1, bullet 2 p. 409            Objectives
   637     Question: Approximately to how many other websites will the contractor provide links?
           Response: The contractor will need to identify these.
  RFP Section 6.4.2.4.4         p. 411           Contractor Responsibilities
   638     Question: How often do vendors need to provide member education regarding program policy,
                     compliance, and provider selection for new enrollees.
           Response: Sending publications will be a relatively small volume of mailings to help in response to
                     member inquiries. The IM workers provide the publications to the members when they are
                     enrolled and when the IM worker receives an inquiry.



Response to Bidder Questions – Set 1                          February 23, 2004                              98 of 133
  RFP Section 6.4.2.4.4, bullet 5 p. 411            Contractor Responsibilities
   639      Question: Please provide average monthly volumes mailed to members over the past year for each
                      publication listed.
           Response: This information is not currently available.
  RFP Section 6.4.2.4.4, bullet 8 p. 412           Contractor Responsibilities
   640     Question: Please clarify what is required of the contractor to ―publish a Provider Directory for use
                     by members‖? Is it required they be distributed to anyone but members?
           Response: The contractor will develop a report using the Data Warehouse query tools. They may be
                     distributed to members and providers.
  RFP Section 6.4.2.4.4, bullet 8 p. 412            Contractor Responsibilities
   641      Question: How many hardcopy provider directories are published quarterly? Are they mailed to
                      members? Please provide average monthly volumes for each for the past year.
           Response: This is an enhancement, not previously done. The contractor should recommend
                     software to do this function.
  RFP Section 6.4.2.5            p. 414         Member Complaints
   642     Question: How many utilization reviews and grievance resolutions are completed by the current
                     Contractor in an average month? How much time does the current Contractor spend on
                     each issue?
           Response: This is an enhancement.
  RFP Section 6.4.2.5.2.2,          p. 414          Interfaces With External Entities
              bullet 3
   643      Question: Please define ―ISIS.‖
           Response: Individualized Service Information System.
  RFP Section 6.4.2.6            p. 416         Member Quality Assurance
   644     Question: Will the Member Services contractor perform satisfaction surveys across the entire
                     Medicaid population, including those in managed care plans, or only those in fee for
                     service or MediPASS? Can the State estimate the number of individuals in the survey
                     population?
           Response: Yes to the first question. The contractor will prepare the survey plan including the number
                     of individuals to be surveyed and the algorithm for selecting survey participants to DHS
                     for review and approval.
  RFP Section 6.4.2.6.4, bullet 7 p. 418            Contractor Responsibilities
   645      Question: Please explain further the expected performance standards, including the frequency they
                      will be monitored.
           Response: See 6.4.2.6.4, bullet 9 and Section 6.4.2.6.7.
  RFP Section 6.4.2.6.4, bullet     p. 418          Contractor Responsibilities
              9, #1
   646      Question: Who is responsible for training staff on MARS recipient reports?
           Response: The contractor will designate a trainer for its component. The Core MMIS contractor will
                     train the trainer, and the trainer will train component contractor staff.
  RFP Section 6.5                p. 421            Revenue Collection Component
   647     Question: Please provide collection statistics for the last three years for the following, and where
                     applicable, differentiate the collection by the State or Fiscal Agent staff and by the
                     supplemental TPL contractor:




Response to Bidder Questions – Set 1                          February 23, 2004                             99 of 133
                       ● Third Party Liability (specify collections from Medicare, CHAMPUS/TRICARE and
                       Commercial Insurance, and how many new insurance updates do the Fiscal Agent and the
                       supplemental TPL contractor update to the MMIS monthly)
                       ● Estate Recovery
                       ● Lien Recovery
                       ● Provider Overpayments
                       ● Interface with DAS (Tax Offsets)
                       ● Miller Trust and Special Needs Trust Recovery

           Response: Where statistics are available, see Attachment M, the last four years.
  RFP Section 6.5.2.2             p. 424         Third Party Liability
   648     Question: Is the Revenue Collection contractor responsible for identifying insurance for recipients
                     enrolled in the HMO managed care program, or for TPL recoveries for this population?
           Response: See question # 20
  RFP Section 6.5.2.2.4          p. 426          Contractor Responsibilities
   649     Question: What is the number of insurance verifications from claims or SIQ forms currently done on
                     a monthly basis?
           Response: An average of 1357 per month.
  RFP Section 6.5.2.2.4           p. 426           Contractor Responsibilities
   650     Question: Can, or will, the system cost avoid by type of service and procedure code to calculate the
                     balance Medicaid payment due using the deductible and co-payment amounts that the
                     contractor is required to verify and enter? For example, a doctor visit with a $15 deducible.
           Response: See RFP Section 5.2.2.12.4.1.
  RFP Section 6.5.2.2.4          p. 426        Contractor Responsibilities
   651     Question: Will the MMIS contractor be responsible for generating and printing the claims for TPL
                     recovery billings?
           Response: The Revenue Collection contractor will be responsible for triggering activities to generate
                     the claims and the Core MMIS will produce and send the transaction to the insurer. DHS
                     would like to use the HIPAA transaction to send these claims.
  RFP Section 6.5.2.2.4         p. 426           Contractor Responsibilities
   652     Question: Who is responsible for reviewing, maintaining and updating the TPL cost avoidance
                     matrix?
           Response: The Core MMIS contractor will be responsible for maintaining and updating the cost
                     avoidance matrix.
  RFP Section 6.5.2.2.4         p. 426          Contractor Responsibilities
   653     Question: Who will pay the cost for mailing the recovery claims and for postage?
           Response: DHS will pay the cost for mailing and postage.
  RFP Section 6.5.2.2.4         p. 426           Contractor Responsibilities
   654     Question: Must the Revenue Collection contractor maintain a separate file of 60 months of historical
                     TPL information, separate from the MMIS?
           Response: No. This will be maintained in the MMIS.
  RFP Section 6.5.2.2.4          p. 426         Contractor Responsibilities
   655     Question: Does, or will, the MMIS TPL cost avoidance system maintain prior billed amounts so that
                     the system will know when the deductible has been met and appropriately cost avoid one
                     service but not the next?
           Response: No. See question # 194.




Response to Bidder Questions – Set 1                         February 23, 2004                          100 of 133
  RFP Section 6.5.2.2.4, bullet 1 p. 426            Contractor Responsibilities
   656      Question: Will the contractor individually verify these policies with the insurer or employer?
           Response: Yes, the contractor will verify these policies. It is anticipated that the contractor would
                     use the HIPAA insurance inquiry transaction for these verifications.
  RFP Section 6.5.2.2.4.1         p. 427           Enhancements to Current Functionality
   657     Question: RFP section 6.5.2.2.4.1 requires the Revenue Collection contractor to obtain deductible
                     and co-pay data for member insurance policies and maintain this data on the TPL resource
                      file. What are the exact deductible and co-pay requirements by type of service and by
                     policy that the contractor must verify and maintain? For example, for some services such
                     as drugs, lab services or x-rays there could be up to 50 different deductible and co-pay
                     amounts for various services. How many deductible and co-pay amounts will the cost
                     avoidance system accommodate for use in the Medicaid benefit calculation?
           Response: HIPAA provides for electronic queries on third party insurance to obtain this data. The
                     enhancement in RFP Section 5.2.2.12.4.1 should take this into account in the design of the
                     enhancement.
  RFP Section 6.5.2.2.7          p. 429           Performance Standards
   658     Question: Please provide the historical percentage increase for third party insurance collections and
                     cost avoidance.
           Response: TPL Amount Collected
                     FY 01 to FY 02 40.6%
                     FY 02 to FY 03  4.1%

                       TPL Amount Cost Avoided
                       FY 01 to FY 02 18%
                       FY 02 to FY 03 .004%
  RFP Section 6.5.2.3            p. 429          Estate Recovery
   659     Question: What is the proportion of Iowa Medicaid recipients who are identified as belonging to an
                     American Indian Tribe (AI), and that would have resources exempt from estate recovery?
           Response: This information is not available, but Iowa has a very small population of American Indian
                     Medicaid members.
  RFP Section 6.5.2.3            p. 429         Estate Recovery
   660     Question: What is the current number of FI and supplemental TPL contractor staff performing Estate
                      Recovery activities?
           Response: Five.
  RFP Section 6.5.2.3         p. 429          Estate Recovery
   661     Question: How many undue hardship estate recovery cases are identified annually?
           Response: 25 to 30 cases are identified annually.
  RFP Section 6.5.2.4         p. 441          Lien Recovery
   662     Question: How many casualty cases were opened per year over the past five years?
           Response: Approximately 2,000 per year over the last 5 years.
  RFP Section 6.5.2.4           p. 441           Lien Recovery
   663     Question: What were the total recoveries per year over the past five years (SFY 1999, 2000, 2001,
                     2002, and 2003)?
           Response: SFY 1999 & 2000 are not available
                     SFY 01 - $6,392,113.64




Response to Bidder Questions – Set 1                           February 23, 2004                           101 of 133
                        SFY 02 - $8,896,468.63
                        SFY 03 - $9,536,124.69
  RFP Section 6.5.2.4          p. 441           Lien Recovery
   664     Question: How many liens were filed in the last five years, by year?
           Response: Approximately 2,000 per year over the last 5 years.
  RFP Section 6.5.2.4             p. 441         Lien Recovery
   665     Question: Will the trauma code editing be run by the MMIS contractor?
           Response: Yes.
  RFP Section 6.5.2.4         p. 441           Lien Recovery
   666     Question: How many cases are currently in open status?
           Response: Currently there are 1,539 open Lien Recovery cases.
  RFP Section 6.5.2.4            p. 441         Lien Recovery
   667     Question: Will the Revenue Collection contractor be expected to provide its own legal expertise and
                     counsel for lien cases?
           Response: No, legal counsel will be provided by the Iowa Attorney General.
  RFP Section 6.5.2.4           p. 441            Lien Recovery
   668     Question: Does the current contractor produce Trauma Code Mailers? How often? How many are
                     sent monthly/quarterly/annually?
           Response: Yes, these are produced by the MMIS. The Trauma Code Mailers are produced monthly.
                     1,200 sent monthly, 3,600 sent quarterly and 14,400 sent annually. DHS will cover the cost
                     of mailing.
  RFP Section 6.5.2.4           p. 441           Lien Recovery
   669     Question: What were the total legal expenses incurred over the past five years?
          Response: The Iowa Attorney General provides legal counsel. No expense data is available.
  RFP Section 6.5.2.4              p. 441          Lien Recovery
   670     Question: If the state is named as a party in a casualty/tort case, does the contractor represent the
                     State, or does the contractor refer such cases to the Attorney General's office?
           Response: The contractor refers these cases to the Iowa Attorney General.
  RFP Section 6.5.2.4            p. 441          Lien Recovery
   671     Question: Are DHS Medicaid managed care contractors responsible for their own casualty
                     recoveries on encounter data or is the contractor responsible for recovery of the
                     encounter claims?
           Response: TPL is recovered by the HMOs. See question # 20
  RFP Section 6.5.2.4         p. 441           Lien Recovery
   672     Question: How many cases required legal action the past five years, by year?
           Response: Approximately 5 per year.
  RFP Section 6.5.2.4            p. 441             Lien Recovery
   673     Question: What is the cost of filing a lien in Iowa?
           Response: Iowa Code section 602.8105 identifies the fees for filing statutory liens and other services.
                     Pursuant to Iowa Code section 70A.5, fees payable by the state do not need to be paid in
                     advance.
  RFP Section 6.5.2.4         p. 441         Lien Recovery
   674     Question: How many DHS and contractor staff currently perform casualty functions?
           Response: 2 full time staff members currently perform casualty functions for Lien Recovery.



Response to Bidder Questions – Set 1                           February 23, 2004                           102 of 133
  RFP Section 6.5.2.4.6, 1        p. 443          Required Reports
   675     Question: Please clarify the TPL vendor's responsibility as it relates to reporting the monthly
                     potential trauma or accident claims. Is this report produced in the MMIS or is the TPL
                     vendor expected to produce this from the data warehouse?
           Response: This report is produced by the Core MMIS.
  RFP Section 6.5.2.5          p. 443         Provider Overpayment
   676     Question: Approximately how many refund checks are received and processed each month?
           Response: Reflected below, for provider overpayments, the numbers of refund checks received and
                     processed for each month of calendar year 2003:

                       January               335
                       February               291
                       March               1,744
                       April               2,425
                       May                 3,098
                       June                2,333
                       July                3,147
                       August              3,138
                       September           2,274
                       October             2,367
                       November            2,021
                       December            2,655.

                       These volumes include refunds from providers and TPL recovery checks.
  RFP Section 6.5.2.5          p. 443        Provider Overpayment
   677     Question: Approximately how many upper payment limit payments are being processed each
                     month?
           Response: During calendar year 2003, 20 UPL payments were processed:
                     January    = 1
                     April      = 1
                     July       = 1
                     September = 16
                     October    = 1
  RFP Section 6.5.2.5            p. 443          Provider Overpayment
   678     Question: Please describe in more detail the activities being performed by DHS and its contractors.
           Response: See RFP sections 3.4.5 and 3.4.16.4.
  RFP Section 6.5.2.5 and          p. 443 and       Provider Overpayment
              6.7.2.2.4 13            468.
   679     Question: Can you clarify the distinction between these two overpayment/credit balance contract
                     requirements for the two different Professional Service Components?
           Response: The reference in Section 6.5.2.5 is to provider overpayments not due to cost settlement.
                     The reference in Section 6.7.2.2.4 is to cost settlement.
  RFP Section 6.5.2.6            p. 447          Interface With DAS (Tax Offset)
   680     Question: Please describe in more detail the activities being performed by DHS and its contractors.
           Response: The following steps are taken for Tax Offset:
                     1. ACS receives a list of providers from the Iowa Department of Revenue and Finance
                     (IDRF) that owe money for taxes
                     2. ACS makes an entry in the provider's file in the MMIS to reflect the amount owed



Response to Bidder Questions – Set 1                        February 23, 2004                          103 of 133
                       3. This in effect places a lien on that provider's Medicaid payments
                       4. Money owed that provider is then sent to the IDRF
                       5. Once the provider's obligation to IDRF has been met, the provider file in the MMIS is
                       then returned to its original format showing no balance owing IDRF.

  RFP Section 6.5.2.6          p. 447         Interface With DAS (Tax Offset)
   681     Question: Approximately how many liens are recovered each month?
           Response: The number of Liens recovered each month for CY 2003:

                       January     22
                       February    25
                       March       26
                       April       30
                       May         30
                       June        22
                       July        27
                       August      26
                       September   28
                       October     36
                       November    21
                       December    32
  RFP Section 6.5.2.6         p. 447          Interface With DAS (Tax Offset)
   682     Question: How much was recovered for the past five years, by year?
           Response: The amount of money recovered for the past 5 years (by year) from Tax Liens:

                       CY 2003 $288,320.48
                       CY 2002 $311,328.86
                       CY 2001 $397,411.44
                       CY 2000 not available
                       CY 1999 not available
  RFP Section 6.5.2.6             p. 447           Interface With DAS (Tax Offset)
   683     Question: Will the contractor or DHS be responsible for courier, mail, postage, and delivery costs
                     incurred by the contractor's Des Moines-based staff associated with deliveries/mailings
                     to third parties such as healthcare providers, health insurers, members, and attorneys?
           Response: The Core MMIS contractor will provide the courier. DHS will be responsible for the
                     mailing and postage costs.
  RFP Section 6.5.2.6          p. 447         Interface With DAS (Tax Offset)
   684     Question: Approximately how many liens are processed each month?
           Response: The number of Liens processed each month for calendar year 2003:

                       January     140
                       February    229
                       March       145
                       April       215
                       May         189
                       June        168
                       July        180
                       August      186
                       September   145
                       October     215




Response to Bidder Questions – Set 1                         February 23, 2004                          104 of 133
                       November 155
                       December 109
  RFP Section 6.6                p. 453          SURS Analysis and Provider Audits Component
   656     Question: Please describe in more detail the SURS and provider audit activities currently being
                     performed by DHS and its contractors. What were the total recovery savings for the past
                     five years?
           Response: The Contractor is responsible for selection of providers for review, reviewing
                     selected providers claims, clinical records, fiscal records, services from other providers on
                     same date of service, identifying claim problems, establishing overpayments and
                     collections, appeals etc. All activities associated with ensuring providers participating in
                     Medicaid follow all policies and rules of the Medicaid program. An average of $500,000 to
                     a $1,000,000.00 is identified each year. See also question # 687.

  RFP Section 6.6.2.2            p. 455         SURS Analysis and Provider Audits
   686     Question: Does the current MMIS system capture all MCO encounter data in a comprehensive,
                     cohesive, and comparable (from MCO to MCO) methodology?
           Response: See question # 440.
  RFP Section 6.6.2.2.7, bullet 2 p. 461            Performance Standards
   687     Question: Please provide the historical figures for SURS recoveries. What percent of the annual
                     program budget has been recovered or reduced?
           Response: The recoveries for the last five State fiscal years are:

                       1999   $178,482
                       2000   $343,308
                       2001   $265,939
                       2002   $286,840
                       2003   $231,426
  RFP Section 6.7.1.4             p. 464, last     Implementation Task
                                     paragraph.
   688     Question: How many historical audit and rate files will be required to have data extracted? Will this
                     be an entire cost report or rate profile? Can this data be obtained electronically? How
                     many years of historical data is the contractor required to maintain?
           Response: Since the Provider Cost Audits and Rate Setting contractor will be determining rates for
                     providers as listed in 6.7.2.1 General Requirements, the potential is for data to be extracted
                     for all actively enrolled Iowa Medicaid providers of these provider types. Historical rate
                     data will be available from the MMIS, but entire (hard copy) cost reports will also be
                     required to be kept for hospitals that have hospital-specific rates calculated for them, plus
                     all Iowa-based nursing facilities, ICFs/MR, RCF‘s, home health agencies, PMIC‘s, rural
                     health clinics, rehabilitation agencies, federally qualified health centers, case management
                     providers, psychiatric (mental) hospitals, and adult rehabilitation option providers. The
                     rate data for drugs subject to SMAC pricing will be available from the MMIS. Even
                     though Medicare has not specified a time limit for retention of cost reports (currently
                     indefinite), the Department will require the Provider Cost Audits and Rate Setting
                     contractor to retain cost reports for all providers for a minimum of ten years.
  RFP Section 6.7.2.1          p. 464           General Requirements
   689     Question: Would you elaborate on the contractor's requirement of collecting overpayments?
           Response: In the case of cost settlements or adjustments that result in a provider overpayment, the
                     Provider Cost Audits and Rate Setting contractor will be responsible for notifying the
                     provider of the result of the settlement or adjustment. That initial notification should
                     include the amount of the overpayment and should provide an address to where the



Response to Bidder Questions – Set 1                          February 23, 2004                           105 of 133
                        overpayment is to be mailed. The Revenue Collection Contractor is to be notified of the
                        overpayment and is ultimately responsible for the collection.
  RFP Section 6.7.2.1             p. 464            General Requirements
   690     Question: General Requirements, identifies the provider types that the contractor will be required to
                     determine reimbursement rates. For each provider type, can the department indicate the
                     basis for setting the rate (e.g., costs, fee basis, cost w/settlement, etc.), provide the total
                     number of Medicaid providers, the total number of rates set during state fiscal year 2003
                     and the number of rates expected to be set during each contract year?
            Response: All reimbursement policy for all Medicaid providers can be found in the administrative
                      rules relating to Medicaid providers or Medicaid provider manuals at:
                      www.dhs.state.ia.us/PolicyAnalysis.html. Rates can be set semi-annually, annually,
                      biannually, triennially, or at greater frequencies, depending on the frequency with which
                      the department‘s policy requires rates to be set. Also, rate changes can be made more
                      than once per year if the state Legislature provides inflation increases (or decreases)
                      during a fiscal year. So, the number of rates that can be expected to be set during each
                      contract year cannot be specifically determined. The total number of Medicaid providers,
                      by provider type, can be found in the response to question # 814.

                        Total number of rates set during state fiscal year 2003 = 4,844
                        The number of rates expected to be set during each contract year does not vary
                        significantly from year to year, therefore, a contractor could expect to set approximately
                        4,844 rates.
  RFP Section 6.7.2.1            p. 464           General Requirements
   691     Question: General Requirements, identifies the provider types that the contractor will be required to
                     perform cost audits on, if necessary. For each provider type, can the department indicate
                     the total number of desk and field audits performed during state fiscal year 2003 and the
                     department‘s expectation for the number of desk and field audits to be performed during
                     each contract year?
            Response: Desk Audits:
                      General hospitals = 138                            Outpatient rehab agencies = 23
                      State mental health institutes = 4                 Home health agencies = 255
                      Rural health clinics = 205                         Federally qualified health centers = 14
                      Targeted case management agencies = 69             Adult rehab option agencies = 149
                      Psychiatric medical inst. for children = 21        IMMT & special respite waiver svcs = 130
                      Nursing facilities = 440                           RCF‘s = 228
                      ICF/MR facilities = 176                            HCBS providers = 464

                        Field Audits: 36 (total of all provider types found in Section 6.7)
                        The number of desk and field audits does not vary significantly from year to year, except
                        during hospital rebasing years. (Hospitals rebase every 3 years; next rebasing during CY
                        2005) The number of desk reviews would increase by approximately 125 during those
                        years. (See Section 6.7.2.3 for further information on hospital rebasing.) On-site (field)
                        audits are conducted each year on approximately 15 percent of NF‘s and ICFs/MR.
  RFP Section 6.7.2.2            p. 465           Rate Setting, Cost Settlements, and Cost Audits
   692     Question: Rate Setting, Cost Settlements, and Cost Audits, requires the contractor to ―… perform
                     on-site audits and arrange for specialty program audits aimed at provider rate setting and
                     program compliance.‖ Can the department elaborate on what types and the quantity of
                     ―specialty program audits‖ it anticipates during the contract period?
            Response: The Provider Cost Audits and Rate Setting contractor is responsible to ―26. Conduct
                      analysis and assist DHS in the development of new reimbursement methodologies for
                      institutional or other cost-based providers.‖ (Section 6.7.2.2.4) Specialty program audits



Response to Bidder Questions – Set 1                           February 23, 2004                            106 of 133
                      would be performed in carrying out this requirement. Currently, the department is
                      anticipating making changes to the home health agency reimbursement system during
                      state fiscal year 2005. This is the only known reimbursement system change, at this time
                      that will require a specialty program audit.
  RFP Section 6.7.2.2.3, bullet 1 p. 466          State Responsibilities
   693     Question: What were the approximate 2002 and 2003 dollar amounts for the DHS contract with
                     Milliman USA?
           Response: Total expenditures: SFY 2002 = $28,993 SFY 2003 = $243,978
  RFP Section 6.7.2.2.3, bullet 2 p. 467          State Responsibilities
   694     Question: What were the approximate 2002 and 2003 dollar amounts for the DHS contract with
                     Myers and Stauffer?
           Response: The Department has several contracts with Myers and Stauffer. The contract amounts
                     were as follows:

                      MED-01-408: (NF) FY 2002 = $662,820; FY 2003 = $333,176
                      MED-02-066: (Hospital) FY 2002 = $248,734; FY 2003 = $164,640
                      MED-02-148: (SMAC) FY 2002 = N/A; FY 2003 = $692,168
  RFP Section 6.7.2.2.3, bullet 2 p. 467          State Responsibilities
   695     Question: How much longer does the current contract with Myers and Stauffer have to run? Will
                     those duties be absorbed by the Provider Cost Audits and Rate Setting Contractor when
                     the current contract expires?
           Response: The Department has more than one contract with Myers and Stauffer and the contract
                     terms are different for each contract as follows:

                      MED-01-408: (Technical assistance for nursing facility case mix reimbursement
                      implementation and nursing facility IGT) June 1, 2001 through June 30, 2002, with two (2)
                      one-year renewal options

                      MED-02-066: (Reimbursement methodology for non-state, government-owned or operated
                      hospitals and performing upper payment limit tests) December 5, 2001 through June 30,
                      2002, with three (3) one-year renewal options

                      MED-02-148: (Maintain and operate a State Maximum Allowable Cost (SMAC) program)
                      July 1, 2002 through June 30, 2004

                      Section 6.7 has recently been amended to include work being performed by Myers and
                      Stauffer under these contracts.

  RFP Section 6.7.2.2.3, bullet 3 p. 467          State Responsibilities
   696     Question: What were the approximate 2002 and 2003 dollar amounts for the DHS contract with Ryun,
                     Givens, Wenthe, and Co.?
           Response: FY 2002 = $184,205; FY 2003 = $194,584
  RFP Section 6.7.2.2.4           p. 467          Contractor Responsibilities
   697     Question: In reference to the contractor making recommendations on filing of cost reports, is DHS
                     requesting recommendations on the actual procedures currently in place to file cost
                     reports or is DHS requesting recommendations on the cost report itself?
           Response: Both.




Response to Bidder Questions – Set 1                        February 23, 2004                          107 of 133
  RFP Section 6.7.2.2.4, bullet 7 p. 468           Contractor Responsibilities

   698     Question: How many provider audits, annual cost settlements, and rate determination functions will
                     be required to be performed for each of the health care entities listed in this section?
           Response: Provider audits – see response to question # 691
                     Rate Determinations – see response to question # 690
                     Cost Settlements – 1,319 made during state fiscal year 2003 (587 tentative and 732 final
                     settlements)
                     These numbers do not vary significantly from year to year, unless as noted.
  RFP Section 6.7.2.2.4, bullet 8 p. 468          Contractor Responsibilities
   699     Question: Please define "in-depth review"?
           Response: An in-depth review consists of more extensive testing of revenue and expense accounts,
                     statistics used to allocate costs, and an examination of expense vouchers from the
                     provider‘s records. (Versus an initial (desk) review of filed cost reports which is performed
                     to ensure the accuracy of the Medicaid data used as the basis for the Medicaid
                     settlement and/or rate determination and to ensure the mathematical accuracy of both the
                     provider‘s submitted cost report and the resulting settlement and/or rate determination.)
                     An in-depth review is performed if the provider is a Medicaid-only provider or the
                     provider‘s Medicare utilization is so low that the Medicare intermediary did not require a
                     complete Medicare desk review.

  RFP Section 6.7.2.2.4, bullet 9 p. 468           Contractor Responsibilities
   700     Question: How is it determined if a provider's cost report will be field audited? Are there certain
                     criteria that must be met? Are all providers audited within a certain time frame? Will the
                     contractor make the determination or will DHS? If the contractor recommends a field audit
                     and approval is required by DHS, what is the process? Is there a minimum number of
                     field audits that will be required annually?
           Response: Selection of on-site (field) audits for provider types under Section 6.7 will be based on
                     criteria developed by the Contractor and approved by the Department.
  RFP Section 6.7.2.2.4, bullet 9 p. 468           Contractor Responsibilities
   701     Question: Please define your term "audit" relative to the auditing standards promulgated by the
                     American Institute of Certified Public Accountants and the General Accounting Office.
           Response: For purposes of the RFP, this response defines the term ―audit‖ as it relates to the work
                     that will be required for the Provider Cost Audits and Rate Setting contractor to perform.
                     Three ―types‖ of audits are required:
                     1. Desk Review – a review performed to ensure the accuracy of the Medicaid data used as
                     the basis for the Medicaid settlement and/or rate determination and to ensure the
                     mathematical accuracy of both the provider‘s submitted cost report and the resulting
                     settlement and/or rate determination.

                       2. Full-Scope Desk Review – a more extensive testing (versus the Desk Review) of revenue
                       and expense accounts, statistics used to allocate costs, and an examination of expense
                       vouchers from the provider‘s records.

                       3. Field Audits - a more extensive, on-site, testing (versus the Desk Review) of revenue
                       and expense accounts, statistics used to allocate costs, and an examination of expense
                       vouchers from the provider‘s records.




Response to Bidder Questions – Set 1                         February 23, 2004                           108 of 133
  RFP Section 6.7.2.2.4, bullet 9 p. 468            Contractor Responsibilities
   702     Question: Contractor Responsibilities, item 9, requires the contractor to perform on-site audits, as
                     required. Does the department require these audits be performed in accordance with
                     established professional standards (e.g., GAAP, GAAS, etc.) that would enable the
                     auditor to express an opinion on the fairness of the presentation of financial information?
           Response: Section 6.7.2.1 is to be amended to include the statement, ―Audits shall be sufficiently
                     detailed to enable the Contractor to express an opinion on total costs and statistical data
                     provided by the cost report.‖ Additionally, state administrative rules at 441 – 81.14(1)a
                     (regarding nursing facilities) state that the nursing facility audit is to be performed using
                     generally accepted auditing procedures.
  RFP Section 6.7.2.2.4, bullet 9 p. 468            Contractor Responsibilities
   703     Question: The RFP states in this section that Medicaid generally follows Medicare reimbursement
                     methodology and therefore the Medicare audit will suffice. Based on or work for CMS,
                     most Medicare cost reports are settled without audit. If Iowa wants a system that insures
                     that reimbursement is applied on a consistent basis and that all non-patient care costs
                     have be eliminated, additional procedures should be applied beyond reliance on the
                     Medicare cost settlement. Is it permissible in our proposal to include these additional
                     procedures?
           Response: Bidders may include any recommendations for improving the current system in their
                     proposals. The bidder‘s cost proposal should identify all costs associated with system
                     improvements.
  RFP Section 6.7.2.2.4, bullet    p. 468           Contractor Responsibilities
              13
   704     Question: Contractor Responsibilities, item 13, requires the contractor to perform credit balance
                     audits. How many credit balance audits does the department anticipate per year?
           Response: Approximately 400 – 500.
  RFP Section 6.7.2.2.4, bullet    p. 468           Contractor Responsibilities
              13
   705     Question: Are credit balance audits to be performed for all provider types? Are credit balance audits
                     currently being performed and, if so, by whom? If not, how many years back is the
                     Provider Cost Audits and Rate Setting Contract required to audit? Are the credit balance
                     audits performed separately from the cost report audits? Are any type of patient co-
                     payment or patient fund account audits performed in conjunction with the credit balance
                     audits?
           Response: ACS, the Medicaid fiscal agent, is currently performing credit balance audits for all in-
                     state hospitals and their related provider entities (i.e. hospital-based home health agency).
                     In order to accomplish this, ACS requests quarterly Medicaid Credit Balance Reports
                     from all Iowa hospitals. These reports reflect specific information for each Medicaid claim
                     that results in a credit balance on a patient account after payments from all sources
                     (including patient co-payments) have been applied. Credit balance audits are performed
                     separately from the cost report audits. Patient co-payment and patient fund account
                     audits are not performed in conjunction with the credit balance audits.
  RFP Section 6.7.2.2.4, bullet    p. 468           Contractor Responsibilities
              14.
   706     Question: What is the frequency of provider appeals?
           Response: Relatively infrequent. See response to question # 708.




Response to Bidder Questions – Set 1                          February 23, 2004                            109 of 133
  RFP Section 6.7.2.2.4, bullet p. 469          Contractor Responsibilities
               18
   707     Question: From what source is the Provider Cost Audit and Rate Setting Contractor to "make
                     tentative payment"?
           Response: Tentative payments are made to providers when their reimbursement includes a cost
                     settlement provision. Providers who receive payments as settlements based on their costs
                     are paid using interim or tentative rates. These rates are determined based on their cost-
                     to-charge ratios and on claims history. The sources used to determine their cost-to-charge
                     ratios will be the provider‘s cost reports, which are obtained from the Medicare fiscal
                     intermediary or from the provider directly. Provider charge and claims data is obtained
                     from the Core MMIS contractor.
  RFP Section 6.7.2.2.4, bullet    p. 469          Contractor Responsibilities
              20
   708     Question: Contractor Responsibilities, item 20, requires the contractor to provide documentation and
                      participate in hearings in the event of an appeal of the audited cost reports. How many
                     audited cost reports were appealed during state fiscal year 2003? How many appeal
                     hearings were held during state fiscal year 2003?
           Response: Number of audited cost reports appealed during state fiscal year 2003: Home Health
                     Agencies = 3; Rehabilitation Agencies = 1
                     Number of appeal hearings held during state fiscal year 2003 = 3
  RFP Section 6.7.2.2.4, bullet    p. 469          Contractor Responsibilities
              26
   709     Question: Contractor Responsibilities, item 26, requires the contractor to conduct analysis and
                     assist DHS in the development of new reimbursement methodologies for institutional or
                     other cost-based providers. Does DHS anticipate that the contractor will also assist in
                     drafting administrative rules, state plan amendments, and change orders for the MMIS?
           Response: Yes.
  RFP Section 6.7.2.2.7, bullet 2 p. 470           Performance Standards
   710     Question: Is the 5% sample to be a statistically valid sample or is a judgmental sample adequate?
           Response: This is to be a statistically valid 5% sample.
  RFP Section 6.7.2.3            p. 470           Rebasing and DRG and APG Recalibration
   711     Question: Does DHS intend to make any changes in the payment methodology for either the IP or
                     the OP system, for example, the methodology used to calculate the direct and indirect
                     medical education component of the rate? If so, have changes in policies been discussed
                     and written in regulations/SPA?
           Response: There are no current plans to make changes in the payment methodology for inpatient and
                     outpatient services.
  RFP Section 6.7.2.3.1          p. 471          Objectives
   712     Question: Do you update the version of the groupers on an annual basis or only every three years
                     when you rebase and recalibrate? What versions of the DRG grouper and the APG
                     grouper are you currently using?
           Response: The Department began using DRG grouper version 20 effective October 1, 2002. This
                     version will remain in effect until September 30, 2005. Mapper software is being used to
                     accommodate annual CMS updates to the system.

                       Version 04.1 of the APG software is currently being used. 3M Health Information Systems
                       updates the APG grouper when changes are made to national HCPCS or CPT codes. 3M
                       provides the department with the updated grouper software.



Response to Bidder Questions – Set 1                         February 23, 2004                         110 of 133
  RFP Section 6.7.2.3.3         p. 471           State Responsibilities
   713     Question: Is DHS or the contractor responsible for obtaining new versions of the DRG and APG
                     groupers?
           Response: The Department is responsible for obtaining new versions of the DRG and APG groupers.
  RFP Section 6.7.2.3.4          p. 472            Contractor Responsibilities
   714     Question: Contractor Responsibilities, states that the contractor is required to recalibrate the
                     weights for APGs and DRGs every three (3) years, or as specified by DHS. When were
                     the weights last recalibrated and how frequent does the department expect to recalibrate
                     the weights in the future?
           Response: The weights were recalibrated during calendar year 2002, with an effective date of 10/1/02.
                     Unless the Department changes its policy, the requirement will be to recalibrate the
                     weights every three years per IAC 79.1(5)k(2) and 79.1(16)j(2).
  RFP Section 6.7.2.3.4           p. 472            Contractor Responsibilities
   715     Question: Contractor Responsibilities, requires the contractor to calculate disproportionate share
                     rates. Is the contractor also required to determine disproportionate share eligibility?
           Response: Yes.
  RFP Section 6.7.2.3.4         p. 472            Contractor Responsibilities
   716     Question: Contractor Responsibilities, requires the contractor to maintain and operate the APG-
                     based prospective payment system. Has the department considered adopting the
                     Medicare APC system in the future?
           Response: No, the Department has not considered implementing a new outpatient hospital payment
                     system, in particular the Medicare APC system, but the Department is always willing to
                     entertain any suggestions or recommendations to do so.
  RFP Section 6.7.2.3.7          p. 473           Performance Standards
   717     Question: How will the state determine that a 95% accuracy rate has been maintained for each of the
                     following: 1) apportioning costs to Medicaid for each hospital submitting Form CMS
                     2552; 2) calculation of hospital case-mix indices, inpatient base, capital cost, direct and
                     indirect medical education, and disproportionate share rates and outpatient base and
                     direct medical education rates; 3) calculation of DRG and APG weights when determined
                     using Iowa Medicaid paid claims data or when determined based on other negotiated or
                     manually calculated means?
           Response: The contractor should have an internal quality assurance function as specified in RFP
                     Section 6.1.7 and DHS internal auditors will sample for this to verify the accuracy rate.
  RFP Section 7.1, bullet 3      p. 475          Instructions
   718     Question: Can the complete Financial Information portion of the proposal be declared
                     "confidential"?
           Response: Yes. However, a bidder cannot designate the entire proposal as confidential. Please refer
                     to Section 2.22 for an explanation of the Department's response to a request for
                     information that a bidder has identified as confidential.
  RFP Section 7.1, bullet 5      p. 476         Instructions
   719     Question: Should the bidder submit both the Technical and Cost Proposals on each CD-Rom or
                     should the Technical Proposal be submitted on CD-Rom and the Cost Proposal submitted
                     on the second CD-Rom?
           Response: As stated in the RFP, the bidder shall submit 2 CD-Roms, each containing 1 full version of
                     the Technical and Cost Proposals and 1 sanitized version (if applicable) of the Technical
                     and Cost Proposals. Therefore, all these materials will be present on each of the two CD-
                     Roms.



Response to Bidder Questions – Set 1                         February 23, 2004                           111 of 133
  RFP Section 7.2.2               p. 479          Transmittal Letter (Tab 2)
   720     Question: According to the requirements of the transmittal letter, ―any subcontractor proposed is
                     also licensed to do work in Iowa.‖ Is it acceptable to the State for the subcontractor‘s
                     license to do business in Iowa to be in process?
           Response: Yes. However, the process must be completed and the subcontractor must be licensed to
                     work in Iowa by the contract start date.
  RFP Section 7.2.2, bullet 4     p. 479          Transmittal Letter (Tab 2)
   721     Question: Please clarify when a prime contractor must be registered to do business in Iowa, at time
                     of: bid submission, contract award or contract execution.
           Response: The contractor must be registered to do business in Iowa at contract execution. If the
                     bidder is not registered at the time of proposal submission, the bidder must provide
                     evidence in the proposal that it has applied for registration.
  RFP Section 7.2.2, last          p. 480          Transmittal Letter (Tab 2)
              sentence
   722      Question: Is "Transmittal Letters should be numbered..." referring to page numbers?
           Response: Yes. The Transmittal Letter should have page numbers that are in sequence between the
                     relevant pages of Tabs 1 and 3.
  RFP Section 7.2.7 and 7.2.8 p. 482               General Requirements (Tab 7)
   723     Question: Please clarify that bidders‘ responses to General Start-Up requirements should be
                     presented only under Tab 7. As currently written, the RFP appears to want this
                     discussion to be included under both Tabs 7 and 8.
           Response: The response to all General Requirements should be presented under Tab 7. The use of
                     the word ―general‖ in the phrase ―general project Start-Up requirements‖ in Section 7.2.8
                     is merely an associated adjective and Tab 8 should have all related Start-Up requirements
                     for that IME component.
  RFP Section 7.2.8              p. 482           Start-Up Activities (Tab 8)
   724     Question: As section 6.1.4 describes General Start-Up Activities for Professional Services
                     Contractors, should the corresponding proposal response be included in Tab 8?
           Response: Yes, the General Start-Up Activities of Section 6.1.4 should be included in Tab 8 of the
                     Technical Proposal and not as part of the General Requirements Tab.
  RFP Section 7.2.9               p. 482           Operational Requirements (Tab 9)
   725     Question: As per the illustration provided in this RFP paragraph, please clarify that an opening
                     Introduction section is permitted under Tab 9.
           Response: Yes, an opening Introduction section in permitted under Tab 9.
  RFP Section 7.2.11             p. 485           Corporate Organization, Experience, and
   726     Question: Please define "partnership relationship with the community".
           Response: This requirement refers to relationships within the State of Iowa.
  RFP Section 7.2.11              p. 485          Corporate Organization, Experience, and
   727     Question: The last bullet under Corporate Organization, Experience, and Qualifications asks the
                     bidder to, ―describe other contracts or projects currently undertaken by the bidder.‖ On
                     page 489, section 7.4, Company Financials Content, the third bullet has the same language
                     and requirements. Can the State specify the information about ―other contracts‖ that it is
                     looking for in these responses? How should this response differ from the response to
                     the seventh bullet under 7.2.11, which stipulates, ―Identify other projects in which the
                     bidder is currently providing services similar to the services described in this RFP…‖




Response to Bidder Questions – Set 1                         February 23, 2004                           112 of 133
           Response: While the material for these two sections will be similar, DHS expects that the material
                     provided for Section 7.4 will be an abbreviated version of the material provided for Section
                     7.2.11. The intent for the receipt of ―descriptions of other contracts or projects currently
                     undertaken by the bidder‖ is for the DHS evaluation to consider how the IME project fits
                     within the overall landscape of a bidder‘s related operations. For bidders where the IME
                     Systems & Professional Services contract would be the responsibility of a single business
                     unit within a much larger global corporate entity, please provide only descriptions of
                     contracts or projects related to that corporate business unit.

  RFP Section 7.2.11              p. 485         Corporate Organization, Experience, and
   728     Question: Page 485 requests description of partnership relationships with the community. Would
                     this apply to communities in other states as well as in Iowa?
           Response: See also question # 726. This requirement refers to relationships within the State of Iowa.
  RFP Section 7.2.11              p. 485           Corporate Organization, Experience, and
   729     Question: In the instructions for responding to General Requirements, bidders are instructed to
                     ―explain their approach to all General Requirements…‖ The General Requirements
                     sections (5.1 and 6.1) include Contractor as well as State responsibilities. Is the bidder
                     expected to prepare a response for the State responsibilities? If so, will a statement such
                     as, ―The bidder understands that these will be the State‘s responsibilities‖ suffice for
                     these requirements?
           Response: In response to Contractor Responsibilities, bidders should discuss their approach toward
                     cooperation and interface with the State on its activities in order to accomplish the overall
                     goal of the function described.
  RFP Section 7.2.11, bullet 4 p. 485          Corporate Organization, Experience, and
   730     Question: We have over 150 owners, do you really want a list of all of them?
           Response: Yes.
  RFP Section 7.2.11.2           p. 487          Letters of Reference
   731     Question: The RFP requests Letters of Reference from previous clients. May a bidder provide
                     Letters of Reference from existing clients?
           Response: Yes, a bidder can provide Letters of Reference from existing or previous clients.
  RFP Section 7.3.2              p. 489          Bid Proposal Security (Tab 2)
   732     Question: Will the Bid Proposal Securities be returned to the successful bidder when the
                     Performance bond referred to in Section 9.13.1 on page 515 is delivered to DHS?
           Response: Essentially, these are intended to be nearly simultaneous actions. Performance Bonds are
                     delivered to DHS by successful bidders upon execution of contracts. Bid Proposal
                     Securities will be returned to the successful bidders upon execution of contracts and the
                     subsequent approval of contracts by CMS, which may take slightly longer.
  RFP Section 7.3.3              p. 489           Pricing Schedules (Tab 3)
   733     Question: There does not appear to be any place for the bidder's signature in the Cost Proposal.
                     Should the signature be included in a transmittal letter with the Cost Proposal?
           Response: In Tab 12 of the Technical Proposal, the Proposal Certification form (Attachment I) that is
                     signed by the bidder and the Firm Bid Proposal Terms guarantee collectively bind the
                     bidder to the cost presented by the accompanying pricing schedules of the Cost
                     Proposal.
  RFP Section 7.4                 p. 489         Company Financials Content
   734     Question: Please clarify whether a Table of Contents is required for bidders‘ Company Financial
                     Information submissions.




Response to Bidder Questions – Set 1                          February 23, 2004                           113 of 133
           Response: The Table of Contents for the Cost Proposal shall identify the Cost Proposal page number
                     on which Company Financials Content begins. DHS understands that some of these
                     materials (e.g., audited financial statements or financial references) may indeed be
                     photocopies of originals that are inserted into the Cost Proposal. For the Cost Proposal,
                     DHS is asking that pages be numbered sequentially wherever possible and referenced
                     appropriately in the Table of Contents.
  RFP Section 7.4               p. 489           Company Financials Content
   735     Question: What specific information is to be included in the five year business plan?
           Response: DHS wants to understand how this contract will fit into the business of the company over
                      the term of the contract, including available resources. The state wants to be assured that
                     it will not be at risk due to upsizing or downsizing of the company and that the company
                     can sustain the business commitment to the State over the next 5 years.
  RFP Section 7.4                 p. 489          Company Financials Content
   736     Question: As a certified public accounting firm, we do not have audited financial statements as
                     requested in Section 7.4, Company Financials Content. Will internally-prepared financial
                     statements be sufficient to meet this requirement?
           Response: Yes
  RFP Section 7.4, bullet 1      p. 489          Company Financials Content
   737     Question: Certified Public Accounting firms do not receive audited financial statements. Does this
                     prevent them from bidding?
           Response: No. Internally prepared financial statements will be sufficient to meet this requirement.
  RFP Section 7.4, bullet 3      p. 489          Company Financials Content
   738     Question: Please elaborate on the need for ―other contracts‖ – the list will be quite exhaustive.
           Response: The intent for the receipt of ―descriptions of other contracts or projects currently
                     undertaken by the bidder‖ is for the DHS evaluation to consider how the IME project fits
                     within the overall landscape of a bidder‘s related operations. For bidders where the IME
                     Systems & Professional Services contract would be the responsibility of a single business
                      unit within a much larger global corporate entity, please provide only descriptions of
                     contracts or projects related to that corporate business unit.
  RFP Section 7.4, bullet 7       p. 490          Company Financials Content
   739     Question: Our five-year business plan includes many activities and plans unrelated to this potential
                     contract. It is extremely confidential and we are reluctant to include the complete
                     document. Can this requirement be satisfied in any other way?
           Response: See response to questions # 735 and # 740.
  RFP Section 7.4, bullet 7        p. 490           Company Financials Content
   740     Question: This bullet reads that bidder‘s are to provide their ―company‘s five-year business plan
                     that would include the award of the State‘s contract as part of the work plan.‖ Please
                     specify the content of the required business plan. What work plan is the State referring to
                      in this bullet? Is the State assuming that the award of a contract will materially affect the
                     successful company‘s five-year business plan? In the event the company‘s business
                     plan is not materially affected, must the bidder submit a business plan?
           Response: See response to question # 735. Yes, we assume the award would affect the company's
                     business plan. All bidders must submit a business plan.
  RFP Section 8.5                 p. 497          Scoring of Bidder Cost Proposals
   741     Question: Will the State consider establishing a level evaluation point for all bidders for DDI prices
                     since the current Fiscal Agent will have a significant advantage over its competition for
                     these costs?



Response to Bidder Questions – Set 1                           February 23, 2004                           114 of 133
            Response: DHS does not believe the current contractor is advantaged in this procurement.
  RFP Section 9.4                 p. 502 to 504 Term of the Contracts
   742     Question: Please clarify dates. For example, the Implementation Phase end dates are June 29th – why
                      not June 30th to incorporate a full year? Each year of the Operations Phase begins on
                     June 30th – the end of the month?
            Response: The dates are correct as stated. For CMS certification, the system must be operational in
                      the quarter prior to the quarter for which the State requests certification. DHS will be
                      requesting certification back to July 1, 2005, so the system must be operational prior to
                      July 1, 2005.
  RFP Section 9.5.2              p. 505           No Increase in Charges
   743     Question: The RFP states that no increases in charges during the term of the contract are permitted.
                     Can we assume this means no price increases over those stated in the Cost Proposal
                     prices provided, including the Option Year and Turnover pricing provided?
            Response: For the option years, DHS will negotiate with the contractor prior to exercising the option
                      if DHS determines that it is in the best interest of the State to renew for the option year.
                      The Turnover costs are to be included in the contractor's bid price.
  RFP Section 9.13.1              p. 515            Performance Bond
   744     Question: If the contractor's price varies from the first operations year to the final operations year, to
                      which year would the state apply the 20 percent performance bond provision?
            Response: In the event that a bidder‘s operations price is variable across the base contract years, the
                      Performance Bond should include an amount equal to the average (i.e., the arithmetic
                      mean) operations price for all base contract years and option years.
  RFP Section 9.13.1            p. 515           Performance Bond
   745     Question: Does the amount of the performance bond covering the implementation period have to be
                     continued during the operations period? The first sentence in this section includes an
                     "and" which indicates the implementation period bond is added to the operations period
                     bond.
            Response: See question # 746.
  RFP Section 9.13.1             p. 515            Performance Bond
   746     Question: Please confirm that the state of Iowa intends to release the portion of the performance
                     bond associated with the implementation phase of the contract when this phase is
                     completed and the first year of operations has started.
            Response: Yes, the performance bond for the implementation phase will be released and the
                      performance bond for the operations phase will go into effect upon approval of the
                      Department to begin operations.
  RFP Section 9.15.1              p. 516            Rights in Data
   747     Question: If commercial software is used (―furnished‖) to carry out the requirements of this contract,
                      rights, other than licensing rights to use this software only for the purposes of this
                     contract, are not normally available for the required assignment of rights set forth in this
                     section? Can the stated licensing requirements be considered only to apply to software
                     developed and paid for under the proposed contract (vs. code developed at private
                     expense)?
            Response: Section 9.15.1 applies to data, records, and reports. It does not apply to software used.
  RFP Section 9.16.1             p. 517            Operating Systems, Applications Software and
   748     Question: Many large commercial operating and application packages are only provided on an
                     annual fee basis (in addition to annual maintenance requirements), and not available on a
                     perpetual basis, although licenses can typically be acquired with an assignability



Response to Bidder Questions – Set 1                           February 23, 2004                            115 of 133
                       provision. Will an assignability provision for commercially available software suffice to
                       meet this requirement?
           Response: Yes.
  RFP Section 9.16.1             p. 517          Operating Systems, Applications Software and
   749     Question: Most commercial and application software developers will not provide source code, even
                     on an escrow basis. Will this commercial prohibition provide a basis for an exception to
                     this requirement?
           Response: Yes.
  RFP Section 9.16.1             p. 517           Operating Systems, Applications Software and
   750     Question: Most commercial software developer licenses do not allow reproduction or duplication
                     (beyond that needed for legitimate backup purposes), and also do not allow modifications
                     (without breaching the license agreements). Will any such commercial prohibitions,
                     when present, provide a basis for an exception to this requirement?
           Response: Yes.
  RFP Section 9.16.1              p. 517           Operating Systems, Applications Software and
   751     Question: If the contractor uses licensed software, approved by the Department, will the contractor
                     be required to pay the fees associated with the license during the contract period or will
                     the Department absorb that cost directly?
           Response: The Department will absorb the costs.
  RFP Section 9.16.1             p. 517           Operating Systems, Applications Software and
   752     Question: Can the stated licensing and source code requirements be considered only to apply to
                     software developed and paid for under the proposed contract (vs. code developed at
                     private expense)?
           Response: Yes.
  RFP Section 9.16.2            p. 519            Right to Reproduce Documentation
   753     Question: Can we assume this requirement applies only to software developed and paid for under
                     the proposed contract (vs. code developed at private expense)?
           Response: Yes.
  RFP Section 9.17.3              p. 519          Compatibility Warranty
   754     Question: This question also applies to all components of the RFP. On Page 519, Section 9.17.3, the
                     Compatibility Warranty states that "The Contractor represents and warrants that the
                     system and software which is developed and delivered under the Contract shall perform
                     as a system with hardware or software currently owned or used by the Department." The
                     RFP's Attachment L (Existing State System Architecture, Hardware, and Software)
                     describes the hardware and software currently in place at the Department's data center.
                     Does the Compatibility Warranty mean, for example, that any application program source
                     code that a contractor develops must be written in one of the programming languages
                     listed in Attachment L? Or can a contractor propose additional programming languages
                     and software tools for the Department to install at their data center (both platforms: the
                     Enterprise Network and the ITE Mainframe Environment)? Please clarify the meaning of
                     the Compatibility Warranty.

           Response: The Department is open to reasonable suggestions about programming languages and
                     software tools that are technically and fiscally feasible. The Department is requiring the
                     Contractor to represent and warrant that the system and software developed and
                     delivered by the Contractor is compatible with the Department's system and software in
                     that it will accurately process, transfer, and sequence data, or otherwise interact with the
                     Department's system and software when performing the contract services.




Response to Bidder Questions – Set 1                          February 23, 2004                            116 of 133
                       Note: With the exception of the Pharmacy POS system and the Decision Support system,
                       no additional software is needed to perform the required functions. The State will allow
                       vendors to propose software tools to help meet performance standards.

  RFP Section 9.17.3             p. 519           Compatibility Warranty
   755     Question: Does this mean, for example, any application program source code the Medical Services
                     contractor develops to run in a mainframe environment must be written in one of the
                     mainframe programming languages listed in Attachment L? Can the Medical Services
                     contractor propose other programming languages? Please clarify the meaning of the
                     Compatibility Warranty.
           Response: See question # 754.
  RFP Section 9.17.4              p. 519          Remedies
   756     Question: Please clarify that the words "at no cost to the Department" in this paragraph means at no
                     additional cost to the department and that the contractor will be allowed to consider such
                     costs when calculating the fixed price bid to the Department.
           Response: It means that the non-compliant software will be repaired or replaced by the Contractor at
                     no cost to the Department and the Contractor may consider such costs when calculating
                     the fixed bid price. Please note that Sections 9.17.1, 9.17.2, and 9.17.3 will be amended so
                     that only the "anti-use" warranty will survive termination of the Contract.
  RFP Section 9.17.5             p. 520           Intellectual Property Rights Warranty
   757     Question: A contract cannot normally warrant ownership (vs. licensing rights) to commercial
                     software. Can the stated licensing requirements be considered only to apply to software
                     developed and paid for under the proposed contract (vs. code developed at private
                     expense)?
           Response: No. The requirement is for the contractor to warrant that it has secured licenses for
                     commercial software.
  RFP Section 9.18.2              p. 520           Other Department Contractors
   758     Question: If losses are sustained by the Contractor, or damages are assessed by the State on the
                     Contractor, because of acts of omission or commission by the State, it would seem
                     equitable to make any such dispute subject to the Disputes clause (RFP 9.19.10, page
                     523). Can this provision be added?
           Response: Section 9.18.2 addresses damages to the Contractor from a third party contractor, not
                     damages that may be assessed against the Contractor by the Department. The dispute
                     resolution process for disputes between the parties about the assessment of damages is
                     addressed in Sections 5.1.6.3 and 6.1.6.3.
  RFP Section 9.19.1           p. 521          Meetings with Department
   759     Question: Meetings with Department: What is the frequency of the meetings with the Department?
           Response: As requested – frequency will vary. The Account Manager could be expected to meet as
                     often as daily on regular business days to ensure coordination of efforts.
  RFP Section 9.19.4              p. 521          Annual Independent Examinations
   760     Question: Please clarify that the words "at their own expense" in this paragraph does not preclude
                     pricing the annual independent examinations into the fixed price bid to the Department
           Response: This Section does not preclude pricing the annual independent examinations into the fixed
                     price bid.
  RFP Section 9.19.7              p. 522          Approval
   761     Question: For the purpose of developing the bidder's work plan, please specify the number of days
                     the state will have to approve contractor deliverables.




Response to Bidder Questions – Set 1                         February 23, 2004                           117 of 133
           Response: Generally DHS will review and approve deliverables within 10 business days. If the size or
                     volume of deliverables prevents the 10-day turnaround, DHS will negotiate with the
                     contractor for a mutually agreeable time frame.
  RFP Section 9.19.10             p. 523            Contract Disputes and Appeals
   762     Question: Please clarify that the director's or administrative law judge's decision is the final
                     administrative decision and that the director's or administrative law judge's decision will
                     not prevent the contractor from pursuing the issue in any state or federal court that has
                     jurisdiction
           Response: The decision of the Director is final for purposes of Iowa Code Chapter 17A. Please refer
                     to Section 9.20.6 for the appropriate Iowa forum.
  RFP Section 10.2.6              p. 538          Other Documents
   763     Question: The list includes ―Mercator Mapping.‖ Does this mean that Mercator‘s ANSI translator
                     software package is part of the MMIS that will reside at the State‘s data center?


           Response: No. The Core MMIS contractor will need to provide translator software.
  RFP Section 10.4, item 28       p. 542             Attachment D: Bid Proposal Mandatory
   764     Question: Are the "Company Financials" listed here the same as the Company Financials described
                      in Section 7.4? Is it the intent of the DHS that Company Financials be listed in both the
                      Cost Proposal and Company Financials parts of the proposal?
           Response: Yes, the ―Company Financials‖ referenced in #28 of the Bid Proposal Mandatory
                     Requirements Checklist is the same material described in Section 7.4? The Company
                     Financials section IS PART OF THE COST PROPOSAL.
  RFP Section 10.6               p. 552          Attachment F: Authorization to Release Information
   765     Question: Do you realize this form would enable a third party to maliciously lie about a bidder and
                     the bidder would have no recourse against that third party? Can the last sentence be
                     modified to make an exception for slander or libel by a third party?
           Response: The Department will not modify the last sentence in the Authorization to Release
                     Information.
  RFP Section 10.11                p. 562           Attachment K: Pricing Schedules for Cost Proposal
   766     Question: After reviewing the cost proposal and pricing described under sections 7.2, 7.3, 8.5, and
                     9.5.1, it is duly noted that only the Estate recovery work under the Revenue Collections
                     component is contingency fee-based. If after completing the pricing components as
                     specified by the bidder's Pricing Schedule, will alternative pricing suggestions, especially
                     those that prove to be more cost-effective to the State of Iowa, be accepted for this
                     component? Justification for alternate pricing structure: Payment on a contingency fee
                     promotes the continued and necessary outreach by a vendor to continually increase all
                     portions of the Revenue Collections recoveries, just as it does for Estate Recovery. The
                     outreach for these other portions (TPL, Lien, Provider Overpayment, Interface with DAS,
                     Miller and Special Needs Trust) includes obtain new carrier eligibility data, provider
                     relations, attorney and bar association relations, and outreach to suppliers when
                     applicable.
           Response: See question # 186.
  RFP Section 10.11                p. 563         Attachment K: Pricing Schedules for Cost Proposal
                                      through 565
   767      Question: Attachment K: Pricing Schedules for Cost Proposal, Summary Pricing Schedule 1a, 1b and
                      1c, describes item #1 as ―DDI Bid Price.‖ What does ―DDI‖ stand for?




Response to Bidder Questions – Set 1                          February 23, 2004                           118 of 133
           Response: As provided in the Glossary, DDI refers to the Design, Development, & Implementation
                     Phase of the contract. Bidders should provide their Implementation Phase cost in this
                     section of the Pricing Schedules.
  RFP Section 10.11.2            p. 566           Pricing Schedule 2 - Pricing Detail of DDI Costs
   768     Question: Since the bidder will be paid per deliverable during the Implementation Phase, please
                     define the specific deliverables that will be used in the payment structure.
           Response: The deliverables are identified in RFP Sections 5.2.1, 5.3.1, 5.4.1, 6.1.4, and 6.3.1.3.
  RFP Section 10.11.2,             p. 566           Pricing Schedule 2 - Pricing Detail of DDI Costs
              paragraph 2
   769      Question: Does Paragraph 2 mean that the Pricing Schedule 2 submitted for each component should
                      only contain the total price for all deliverables within the component (broken down per the
                       line item in the Pricing Schedule) and that the prices for each deliverable within the
                      component will be part of the overall contract negotiation?
           Response: During contract negotiation, vendors will propose ―per deliverable‖ prices for all required
                     DDI deliverables. The total of all of these deliverables will be equal to the Grand Total
                     Implementation (or DDI) Cost presented in Pricing Schedules 1 and 2. Pricing Schedule 2
                     essentially affords DHS an alternative view of the pricing methodology behind the total
                     implementation cost, showing how the cost of all relevant deliverables is distributed
                     among various line item expenses (e.g., Salaries and Benefits, Temporary Office Space,
                     etc.).
  RFP Section 10.11.2 and          p. 566 to 567    Pricing Schedule 2 - Pricing Detail of DDI Costs
              10.11.3                 and 568 to
                                      571
   770      Question: For each Professional Services component, please provide a detailed listing of the specific
                       services requested under each task that support the contractor responsibilities listed.
                      This will assist bidders in preparing their respective Cost Proposals (Pricing Schedules 2
                      and 3) and assist the State in the evaluation process by providing for greater
                      comparability of the services and prices offered.
           Response: The services are identified in Section 6 of the RFP.
  RFP Section 10.11.2              p. 568 to 571 Pricing Schedule 2 - Pricing Detail of DDI Costs
   771     Question: Please clarify that the line items present in the schedule are only examples and that each
                     line is to include all associated vendor cost markups.
           Response: In Pricing Schedule 2, the line items presented are some standard line items categories.
                     Bidders are expected, at the least, to roll up all associated DDI (Implementation Phase)
                     costs into these categories. However, bidders are free to show an itemized breakdown of
                     any or all line items (e.g., Travel) into its subparts (e.g., lodging, airfare, ground
                     transportation, and meals) as a means to provide greater detail to DHS. If greater detail is
                     shown, however, please be sure to still roll up costs into the main categories provided
                     (e.g., Salaries & Benefits, Temporary Office Space, Travel, Administrative Overhead, etc.).
                     The overall format of the Pricing Schedule (3 columns for Item #, Line Item Description,
                     and Fixed Price) must remain the same as the template. Since the ―Grand Total‖ presented
                     at the bottom of Pricing Schedule 2 is equal to the total DDI bid price present in Pricing
                     Schedule 1, the various line items of Pricing Schedule 2 should include any associated
                     vendor cost markups.
  RFP Section 10.11.2            p. 568 to 571 Pricing Schedule 2 - Pricing Detail of DDI Costs
   772     Question: Because the contract is a Firm Fixed Price contract, it is unclear why the state is
                     requesting details surrounding each line item if the evaluation criteria is focused solely on
                      total NPV. Please clarify the intent of this schedule.




Response to Bidder Questions – Set 1                          February 23, 2004                           119 of 133
           Response: The State is basing evaluation of Cost Proposals upon the total Implementation Phase
                     fixed price, NPV of Fixed Price for Operational Phase Contract Years, CSR Blended
                     Consulting Rate, and Estate Recovery Contingency Fee Percentage (Revenue Collection
                     component only). The supplemental information, however, provides DHS with a
                     sufficient level of detail regarding the reasoning behind the bidders‘ pricing methodology.
  RFP Section 10.11.3            p. 568           Pricing Schedules 3a, 3b, and 3c - Breakdown of
   773     Question: RFP section 10.11.3 states that Pricing Schedule 4c is to be used for the Revenue
                     Collection component. However, section 10.11.4 provides no Schedule 4c. Please clarify.
           Response: The applicable Pricing Schedule for the Revenue Collection component is Pricing
                     Schedule 3c.
  RFP Section 10.11.3           p. 568 to 571 Pricing Schedules 3a, 3b, and 3c - Breakdown of
   774     Question: On Cost Proposal Schedule 3, please provide a comprehensive listing of the ―Other
                     Expenses‖ that can be used in completing these forms. This would provide the State with
                     greater comparability of expense line items from the Cost Proposals received.
           Response: Examples of ―Other Expenses‖ that could be itemized further in the Pricing Schedules may
                     include items such as: business licenses or regulatory fees paid to various agencies and
                     any legal or professional fees associated with the IME contract. While not required,
                     please note that bidders are free to show an itemized breakdown of any or all line items
                     (e.g., Travel) into its subparts (e.g., lodging, airfare, ground transportation, and meals) as
                     a means to provide greater detail to DHS. If greater detail is shown, however, please be
                     sure to roll up costs into the main categories provided (e.g., Salaries & Benefits, Travel,
                     Administrative Overhead, etc.). The overall format of the Pricing Schedule (columns for
                     Item #, Line Item Description, and Fixed Price in Each Base Contract Year, and Total) must
                     remain the same as the template.
  RFP Section 10.12             p. 574          Attachment L: Existing State System Architecture,
   775     Question: Will the Department consider additional software tools that are not listed on the inventory
                     in Attachment L?
           Response: Yes.
  RFP Section 10.12              p. 578           Attachment L: Existing State System Architecture,
   776     Question: The RFP lists the following current data warehouse query tools: Business Objects, ASP
                     pages on an IIS server with custom programming, Direct query through Query Analyzer,
                     Any ODBC software can be supported, SPSS. These are all generic query tools that lack
                     any imbedded healthcare or Medicaid specific intelligence. There are no built-in
                     healthcare performance measures or clinical classification methodologies that are now
                     considered to be essential for effective healthcare analytical decision support. Would
                     DHS consider proposals that include software or clinical classification methodologies that
                     would support complex analysis for Medicaid business functions, such as disease
                     management analysis for improving quality of care and cost containment?
           Response: Yes. The contractor will provide recommendation for DHS approval.
  RFP Section 10.13           p. 579          Attachment M: Iowa Medicaid Workload Statistics
   777     Question: How many US Post Office boxes does the current Fiscal Agent have for receiving mail?
           Response: Two, one for claims, one for all other correspondence.
  RFP Section 10.13             p. 579           Attachment M: Iowa Medicaid Workload Statistics
   778     Question: Are postage costs a pass-through cost to the State or are they to be included in the fixed
                     price?
           Response: Postage costs will be paid by the State and should not be included in the fixed price.




Response to Bidder Questions – Set 1                          February 23, 2004                          120 of 133
  RFP Section 10.13              p. 579           Attachment M: Iowa Medicaid Workload Statistics
   779     Question: What is the average percentage of claims that are pended during the course of a payment
                     cycle? Please provide this information for paper and electronic claims.
           Response: 14.5% of claims are pended (suspended) during the course of a payment cycle.
  RFP Section 10.13              p. 579           Attachment M: Iowa Medicaid Workload Statistics
   780     Question: Does the current Fiscal Agent return any claims to providers because they cannot be
                     processed (commonly called Returns to Provider)? Please provide the volumes of claims
                     returned to providers by the current Fiscal Agent in an average week?
           Response: An average of 990 RTP envelopes are mailed out each week, the exact amount of claims
                     RTD‘d can vary as a provider could have 1 or 10 in an envelope. An estimate of this
                     works out to be roughly 1,200 claims per week are returned because they cannot be
                     processed.
  RFP Section 10.13               p. 579           Attachment M: Iowa Medicaid Workload Statistics
   781     Question: Please provide bidders the average number of adjustment claims and voided claims,
                     separately, that the current Fiscal Agent receives and processes in an average week.
           Response: An average of 5,432 adjusted claim and voided claim transactions are processed each
                     week.
  RFP Section 10.13              p. 579          Attachment M: Iowa Medicaid Workload Statistics
   782     Question: The table indicates average monthly provider enrollment for SFY2002 as 52,208 and
                     SFY2003 as 46,579. Do these figures indicate the number of providers who have billed in
                     these SFYs or the total number of enrolled providers in the system? If the response is the
                     total number of enrolled providers, please provide the number of billing providers for
                     these periods. Does the State want to recertify every enrolled provider on Attachment M
                     on a bi-annual basis?
           Response: Enrolled providers. The number of billing providers is not available. Yes.
  RFP Section 10.13             p. 579           Attachment M: Iowa Medicaid Workload Statistics
   783     Question: Workload statistics were provided for 1999-2003. What is the projected growth for 2004
                     and beyond?
           Response: The bidder should develop projections for 2004 and beyond based on the workload
                     statistics provided for 1999-2003. Other than the potential reduction in Pharmacy claims
                     volume identified in the amendment regarding Medicare pharmacy coverage, the
                     Department does not anticipate any other significant changes from the trends shown in
                     the 1999-2003 statistics.
  RFP Section General            p.                General
   784     Question: Will the State provide a listing of the services that the existing Fiscal Agent is currently
                     providing that are not located or performed in the local Des Moines, Iowa site? For
                     example, where is POS, electronic claim submission, data entry, etc. performed and how
                     many staff provide the services? Does the existing Fiscal Agent outsource any work to
                     subcontractors or to other groups within their Corporation?
           Response: The current fiscal agent utilizes its facilities and staff in Pittsburgh, Atlanta, and
                     Tallahassee for portions of the contract and currently does outsource some work.
  RFP Section General            p.              General
   785     Question: Would the State provide a listing of all proprietary components of the existing MMIS,
                     POS and other processes (i.e. imaging, call center, etc). that must be replaced by the
                     successful bidder?
           Response: At this point the State has identified 3 proprietary utilities. The State will be responsible
                     for replacing these or obtaining licenses to use them.



Response to Bidder Questions – Set 1                           February 23, 2004                              121 of 133
  RFP Section General             p.               General
   786     Question: Will the State provide for a follow-up Question and Answer period to clarify, for example,
                     the State‘s responses to bidders questions, information contained in the Bidders Library,
                     etc.
           Response: See response to question # 10.
  RFP Section General            p.               General
   787     Question: What is the average call length?
           Response: 186 seconds.
  RFP Section General            p.              General
   788     Question: What is the total number of enrollees in MediPASS? Attachment M, 10.13 lists the
                     average monthly enrollment in MediPASS for FY 03 as 68,477, section 3.4.13.1 states there
                      are approximately 95,000 enrollees.
           Response: See response to question # 788.
  RFP Section General            p.              General
   789     Question: What is the total number of enrollees in HMOs? Attachment M, 10.13 lists the average
                     monthly enrollment in HMO Managed care for FY 03 as 60,968, section 3.4.13.2 states
                     there are 50,000 enrollees.
           Response: SFY 04 saw an HMO leave a number of counties which left enrollees with the MediPASS
                     program. The FY 03 number is correct. In December, 2003 the HMO enrollees were at
                     approximately 52,000.
  RFP Section General            p.               General
   790     Question: What is the total number of enrollees in the Iowa Plan? Attachment M, 10.13 lists the
                     average monthly enrollment in the Iowa Plan for FY 03 as 236,893, section 3.4.13.3 states
                     there are 230,000 enrollees.
           Response: This will vary according to Medicaid eligibility. This number is approximate and changes
                     in proportion to Medicaid eligibility.
  RFP Section General             p.              General
   791     Question: Enrollment into MediPASS and HMOs is limited to TANF members only. Is the
                     Department considering expanding managed health care to AND recipients, disabled
                     adults, persons over 65, or persons whose Medicaid benefit package is limited?
           Response: Not at this time. However, the Department reserves the right to alter the enrollment at its
                     discretion. Enrollment includes TANF and adults, but not disabled or persons over 65.
                     Almost all full Medicaid members are enrolled in the LSO.
  RFP Section General         p.              General
   792     Question: How many newborns are enrolled in MHC programs monthly?
           Response: Newborns for HMO enrollment are:

                       January     377
                       February    359
                       March       354
                       April       333
                       May         364
                       June        346
                       July        286
                       August      377
                       September   250
                       October     291




Response to Bidder Questions – Set 1                         February 23, 2004                          122 of 133
                       November 284
                       December 293

  RFP Section General            p.                General
   793     Question: Please confirm that the state is providing telephones, call management/reporting/workflow
                     management, network infrastructure and connectivity, PCs and network printers. Is the
                     state providing any other equipment related to the Provider Services or Member Services
                     components of this RFP?
           Response: Yes to the first question. The list of other equipment to be provided is in RFP section 6.1.2.
  RFP Section General            p.              General
   794     Question: Will regularly scheduled meetings occur among involved vendors to ensure coordination
                     during the planning, takeover, transition, transfer, implementation, and operation phases
                     of all components? If so, who is responsible for scheduling and recording minutes for
                     these meetings?
           Response: Yes, the Department will be responsible for calling meetings. I&SS will prepare minutes
                     during implementation; at the conclusion of the I&SS contract DHS will prepare minutes.
  RFP Section General          p.                 General
   795     Question: What percent of clients currently/annually have ―force‖ enrollments?
           Response: See question # 815.
  RFP Section General            p.            General
   796     Question: What is the budgeted amount for each component of this enterprise?
           Response: This information is not available.
  RFP Section General            p.              General
   797     Question: What is the total budgeted amount for this enterprise?
           Response: The total amount budgeted for the implementation phase is $1.8 million state dollars. This
                     includes all implementation costs: the transfer of the MMIS system to state hardware, the
                     development of the data warehouse on state hardware, facility start-up costs, and
                     contractor costs. The budgeted amount for the operations phase is not available.
  RFP Section General             p.               General
   798     Question: Is there any additional distribution or segmentation of call volume information?
           Response: No.
  RFP Section General           p.               General
   799     Question: Over what period of time are the performance metrics measured for each segment of this
                     proposal?
           Response: Performance metrics will be measured and reported on a monthly report card.
  RFP Section General            p.              General
   800     Question: Do all business services providers have to reside in Iowa?
           Response: All business services providers doing work on the IME must perform the work at the IME
                     facility. They do not necessarily have to reside in Iowa, but they must be working in the
                     Iowa facility during regular State business hours.
  RFP Section General           p.                 General
   801     Question: With regard to certification as a Women-Owned Business Enterprise, does the State of
                     Iowa recognize WBE certification from other states?
           Response: The bidder is not required to be a Women-Owner Business Enterprise and points are not
                     awarded on this basis. For additional information, please refer to Iowa Code section 12.43,
                     which discusses focused small businesses owned and operated by women or minorities.



Response to Bidder Questions – Set 1                         February 23, 2004                           123 of 133
  RFP Section General             p.               General
   802     Question: Is there a current budget for the call centers? If so, is it possible to get a copy?
            Response: Not available.
  RFP Section General         p.               General
   803     Question: How many providers currently participate in the Iowa Medicaid program?
            Response: FY 2003 most current – See attachment M.
  RFP Section General            p.               General
   804     Question: Please confirm that the price for all RFP Sections entitled "Enhancements to Current
                     Functionality" should be included in the bidder's fixed price bid.
            Response: Yes, the price for all identified enhancements should be included in the bidder's fixed price.
  RFP Section General            p.               General
   805     Question: Since there will be necessary coordination between the successful bidder for RFP#: MED-
                     04-014 and this procurement, will the State provide a list of the organizations who bid on
                     RFP#: MED-04-037? Is RFP#: MED-04-037 still on track to be awarded and implemented
                     in February of 2004?
            Response: A list of bidders is available on the State website. We are on track for a April 01, 2004
                      implementation.
  RFP Section General             p.               General
   806     Question: Is the current contract a fixed price contract?
            Response: Yes. The contract is a fixed price per claim and a fixed price for managed care per member
                      per month.
  RFP Section General            p.             General
   807     Question: From the language in the RFP, it appears there could be two implementations for
                     professional services components--one under the current MMIS and a second under a
                     new or enhanced MMIS. How will a bidder know how to plan and budget for these
                     without knowing timing or scope of changes to anticipate?
            Response: There will be only one implementation. Except for the PDL implementation identified in
                      RFP MED-04-034 and portions of the Provider Audit and Rate Setting function identified
                      in the amendment to Section 6.7, all components will be implemented at the same time.
  RFP Section General            p.               General
   808     Question: What is the total volume of claims processed?
            Response: Please refer to 10.13 Attachment M.
  RFP Section General            p.            General
   809     Question: What is the total TANF population?
            Response: Please note that persons on TANF are not always on Medicaid. Medicaid is ―delinked‖
                      from TANF.

                                       TANF Cases        TANF Eligibles
                        Jul 03           19,898             44,691
                        Aug 03           20,087             45,026
                        Sep 03           20,089             44,855
                        Oct 03           20,018             44,833
                        Nov 03           19,905             44,430
                        Dec 03           19,929            44,219




Response to Bidder Questions – Set 1                           February 23, 2004                            124 of 133
  RFP Section General            p.               General
   810     Question: What is the total number of providers, by type (e.g., primary care providers, ancillary
                     providers, specialty care providers, hospitals, etc.)?
           Response: Providers enrolled in Iowa Medicaid by provider type as of December 31, 2003:
                     1. General Hospital                      705
                     2. Physician M D                     23,392
                     3. Physician DO                        2,826
                     4. Dentist                             1,514
                     5. Podiatrist                            282
                     6. Optometrist                           813
                     7. Optician                               51
                     8. Pharmacy                            1,395
                     9. Home Health Agency                    205
                     10. Independent Lab                      108
                     11. Ambulance                            376
                     12. Medical Supplies                     512
                     13. Rural Health Clinic                  143
                     14. Clinic                                34
                     15. Physical Therapist                   164
                     16. Chiropractor                         947
                     17. Audiologist                           84
                     18. Skilled Nursing Facility             122
                     19. Rehab Agency                          42
                     20. Intermediate Care Facility           453
                     21. Community MH                          38
                     22. Family Planning                       23
                     23. Residential Care Facility            203
                     24. Health Maintenance Organ             100
                     25. ICF MR State                           2
                     26. Mental Hospital                        7
                     27. Community Based ICF/MR               134
                     28. Para Professional                      0
                     29. Psychologist                          98
                     30. Screening Center                      28
                     31. Hearing Aid Dealer                    58
                     32. Tape Intermediary                     19
                     33. Orthopedic Shoe Dealer                18
                     34. Maternal Health Center                29
                     35. Ambulatory Surgical Center            34
                     36. Genetic Counselor                      0
                     37. Certified Nurse Midwife               34
                     38. Birthing Center                        2
                     39. Area Education Agency                 14
                     40. Psych Medical Inst Children           24
                     41. MEP Case Manager                      64
                     42. Adult Rehab                          207
                     43. CRNA                                 948
                     44. Hospice                               75
                     45. Prepaid Health Plan                    0
                     46. HIPP                                   4
                     47. Clinical Social Worker                89
                     48. Federal Qual Health Center            28
                     49. Nurse Practitioner                   245
                     50. Therapeutic Treatment Service        298
                     51. Nursing Facility – Mental Ill          2



Response to Bidder Questions – Set 1                         February 23, 2004                           125 of 133
                       52. Mental Health Substance Abuse Plan 1
                       53. County Relief                         0
                       54. Lead Inspection Agencies             18
                       55. Local Education Agency              106
                       56. Early Access Service Coordinator     25
                       57. Indian Health Service                 0
                       58. Medically Needy Only              3,381
                       59. Non Provider Mail Only               80
                       60. RCF Guardian                      8,852
                       61. Lienholder                           11
                       62. Waiver                            4,719
                       TOTAL                                54,186
  RFP Section General             p.               General
   811     Question: Is there a default standard? (Was it 20% or less?)
           Response: Insufficient context is delivered in this question to provide a response.
  RFP Section General             p.                General
   812     Question: What is the State‘s intention regarding CMS‘ new Medicaid Information Technology
                     Architecture (MITA)? Will the new contractors be required to comply with these MITA
                     requirements when they become effective? Please describe contractor‘s responsibility for
                     achieving and maintaining MITA compliance, particularly as pertains to retaining MMIS
                     certification. Also, if federal certification for the Iowa MMIS is lost due to contractor
                     fault, what is the contractor liability? If multiple contractors are at fault for loss of
                     certification, how will liability be apportioned?
           Response: If and when MITA is required, the contractor will need to compliant.
  RFP Section General             p.                General
   813     Question: Please describe all litigation between the State of Iowa and any of its various Medicaid
                     fiscal agent contractors.
           Response: There is no litigation between the State of Iowa and any of its Medicaid fiscal agent
                     contractors.
  RFP Section General             p.             General
   814     Question: Will the state please make available any information in the bidder's library in electronic
                     format, and accessible through the Iowa DHS Web site?
           Response: The provider manuals are available through the Department‘s web site.
  RFP Section General            p.             General
   815     Question: What is the percentage of Managed Care enrollees who have ―forced enrollments‖ and
                     those who have ―choice enrollments‖ each month for the past year?
           Response: Quarter Ending 3-31-03          Default:   25,133   Changes: 9,300
                     Quarter Ending 6-30-03          Default:   29,761   Changes: 10,973
                     Quarter Ending 9-30-03          Default:   31,393   Changes: 14,102
                     Quarter Ending 12-31-03         Default    45,380   Changes: 18,729
  RFP Section General            p.              General
   816     Question: Please provide Medicaid enrollment for each month of the past year, by program (fee-for-
                     service, Managed Care, etc.)
           Response: See spreadsheet in Attachment A of the responses for medical managed care enrollment.
                     Approximately 93% of all eligibles will be enrolled into the Iowa Plan. Total eligibles is
                     noted in the spreadsheet and includes those who are eligible for fee-for-service payment
                     and not enrolled in any managed care plan.




Response to Bidder Questions – Set 1                            February 23, 2004                        126 of 133
  RFP Section General            p.             General
   817     Question: Will the impending RFP for the Preferred Drug List impact the Medicaid Enterprise RFP?
                     If so, how?
           Response: See RFP MED-04-034.
  RFP Section General            p.              General
   818     Question: What is the total number of providers, by program (e.g., fee-for-service, managed care,
                     home-based community services, etc.)?
           Response: For managed care, there are 3 HMOs, 1 LSO, and 1,450 MediPASS providers. See question
                     # 810 for list of providers by provider type.




Response to Bidder Questions – Set 1                        February 23, 2004                          127 of 133
                   ATTACHMENT A: IOWA MEDICAID ENROLLMENT


     Month             HMO         MediPASS    Total MHC       Eligibiles   % MHC
     Jan-03           61,293          68,565      129,858       258,009     50.33%
    Feb-03            61,568          68,572      130,140       260,448     49.97%
    Mar-03            62,428          70,134      132,562       262,361     50.53%
    Apr-03            63,407          71,402      134,809       264,652     50.94%
    May-03            64,055          72,459      136,514       266,531     51.22%
     Jun-03           64,734          73,477      138,211       266,737     51.82%
      Jul-03          64,457          72,638      137,095       267,998     51.16%
    Aug-03            63,395          73,830      137,225       269,110     50.99%
    Sep-03            41,683          83,771      125,454       270,923     46.31%
    Oct-03            51,083          95,038      146,121       273,454     53.44%
    Nov-03            51,917          95,458      147,375       272,869     54.01%
    Dec-03            53,031          96,918      149,949       275,252     54.48%




Response to Bidder Questions – Set 1                February 23, 2004                128 of 133
                   ATTACHMENT B: 2001 DHS Enterprise Network (8) NOIP




Response to Bidder Questions – Set 1          February 23, 2004         129 of 133
                       ATTACHMENT C: Project Plan for Transfer of MMIS




Initial Planning Phase - Milestone I
         Develop project scope - Define project
         Finalize project milestones/dates
         Complete project work plan
         Establish project tracking/reporting plan
         Establish communication plan

Preparation/set up - Milestone II
       Batch processing
       Review and document program source library
       Build test plan
       Online processing
       Build test plan
       Build CICS Test region
       Data file load
       Program update tracking

Load Core MMIS subsystems to SDC - Milestone III
      Part I. Initial load steps
      Part II. Batch processing by subsystem
      Part III. Online Processing

Test/Verification of Core MMIS Subsystems - Milestone IV
       Complete system test for each subsystem following test plan
       Document results of system test
       Verify results of system test
       Sign off on completion of system test

Reload/refresh/clean up/finalize - Milestone V
       NOTE: This will be an ongoing process throughout the project.
       Refresh/reload source files from ACS
       Move source members to test pds library
       Re-compile all updated members
       Track source changes from ACS and update
       Reload or refresh data files




Response to Bidder Questions – Set 1                 February 23, 2004   130 of 133
                     ATTACHMENT D: High Dollar Inpatient Days and Stays


                             Rank           Payment          Covered Days
                                        1      $704,569.74             123
                                        2      $513,237.22             229
                                        3      $483,100.55              60
                                        4      $436,437.76             218
                                        5      $430,304.20             555
                                        6      $419,809.20             154
                                        7      $415,206.63             539
                                        8      $401,171.88             504
                                        9      $383,294.10             261
                                       10      $362,063.88             591
                                       11      $353,376.05             172
                                       12      $348,040.00             616
                                       13      $339,288.00             579
                                       14      $336,827.16             123
                                       15      $335,020.65             298
                                       16      $330,182.68             533
                                       17      $316,982.83             305
                                       18      $316,097.46             281
                                       19      $310,297.76             264
                                       20      $304,124.22             115
                                       21      $289,613.22             133
                                       22      $286,054.81             157
                                       23      $284,019.74             153
                                       24      $275,805.50             109
                                       25      $270.012.84             185
                                       26      $258,972.81              38
                                       27      $258,063.12             216
                                       28      $256,917.58             175
                                       29      $251,609.18             130
                                       30      $246,042.58             169
                                       31      $244,023.27              59
                                       32      $243,888.78             139
                                       33      $242,728.21             235
                                       34      $240,981.15              99
                                       35      $233,850.00             396
                                       36      $226,396.65             146
                                       37      $225,424.14             294
                                       38      $220,425.40             517
                                       39      $213,570.66             132
                                       40      $211,365.04             189
                                       41      $211,050.00             603
                                       42      $208,759.87             151
                                       43      $208,511.86              86
                                       44      $207,471.23             273
                                       45      $206,752.30              98
                                       46      $202,887.87             117
                                       47      $202,300.00             578
                                       48      $201,281.89             139
                                       49      $200,211.58             120



Response to Bidder Questions – Set 1                February 23, 2004        131 of 133
                             Rank        Payment           Covered Days
                                   50       $199,650.58              115
                                   51       $198,916.37               67
                                   52       $196,438.10               86
                                   53       $196,067.77              143
                                   54       $194,904.75               90
                                   55       $194,513.92              166
                                   56       $189,927.04              166
                                   57       $189,666.66               66
                                   58       $187,625.98              153
                                   59       $185,486.99              389
                                   60       $184,342.09               72
                                   61       $183,314.58              161
                                   62       $180,512.10              136
                                   63       $180,396.36              153
                                   64       $190,394.35              166
                                   65       $179,334.20              695
                                   66       $178,990.64              110
                                   67       $177,296.44              319
                                   68       $175,960.63               87
                                   69       $175,200.00              292
                                   70       $174,972.21              175
                                   71       $174,321.44               55
                                   72       $172,917.54               55
                                   73       $169,871.59              171
                                   74       $169,381.51               72
                                   75       $167,770.71              117
                                   76       $165,799.99              137
                                   77       $164,483.02              145
                                   78       $164,021.63              148
                                   79       $163,087.57               97
                                   80       $162,389.58              162
                                   81       $161,887.68              132
                                   82       $159,801.96               97
                                   83       $158,424.37              103
                                   84       $156,650.00              482
                                   85       $155,542.32               88
                                   86       $155,350.00              478
                                   87       $155,269.21               92
                                   88       $154,873.76              131
                                   89       $154,551.82               60
                                   90       $154,467.27              552
                                   91       $153,450.00              284
                                   92       $151,420.37              149
                                   93       $150,841.38              119
                                   94       $149,614.74               41
                                   95       $149,500.00              460
                                   96       $148,919.74              107
                                   97       $148,758.40              153
                                   98       $145,598.90               57
                                   99       $145,483.88               82
                                  100       $145,345.26              114
                           Grand Total    $23,302,130.50          21,103



Response to Bidder Questions – Set 1             February 23, 2004         132 of 133
                        ATTACHMENT E: Asthma, Diabetes, CHF, and COPD
                             Payments and Unique Recipient Counts


                                        Feb 2001 – Jan 2002
                                       Unique Recipients           Payments
             Asthma                                9,447               $3,830,423.92
             Diabetes                             11,533              $10,917,724.42
             CHF                                     119                $143,409.35
             COPD                                  9,415               $8,429,785.57

             Total                               27,548               $23,321,343.26

                                        Feb 2002 – Jan 2003
             Asthma                              10,703                $3,259,688.49
             Diabetes                            11,909               $11,668,723.29
             CHF                                    136                 $141,989.00
             COPD                                10,280                $8,582,854.26

             Total                               29,905               $23,653,255.04

                                        Feb 2003 – Jan 2004
                                       Unique Recipients           Payments
             Asthma                               11,997               $3,640,256.42
             Diabetes                             12,982              $13,383,967.01
             CHF                                      83                  $95,291.62
             COPD                                 11,294               $8,805,001.54

             Total                               32,906               $25,924,516.54

                                            Grand Total
                                       Unique Recipients           Payments
             Asthma                               23,412              $10,730,368.83
             Diabetes                             20,326              $35,970,414.75
             CHF                                     245                $380,689.97
             COPD                                 23,813              $25,817,641.29

             Total                               59,004               $72,899,114.84




Response to Bidder Questions – Set 1                       February 23, 2004           133 of 133

								
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