Texas Health and Human Services Commission (HHSC ) Medicaid / Children with Special Health Care Needs Claims Processing, P...
<ul><li>Welcome </li></ul><ul><li>Introductions </li></ul><ul><ul><li>Lyn Peters, Enterprise Contract and Procurement Serv...
HHSC Procurement Roles <ul><li>ECPS - Responsible for procurement activity </li></ul><ul><li>HUB - Responsible for HUB act...
Vendor Conference Overview <ul><ul><li>Procurement Activities </li></ul></ul><ul><ul><li>RFP Overview </li></ul></ul><ul><...
<ul><li>Procurement Activities </li></ul><ul><ul><li>Questions & Answers  </li></ul></ul><ul><ul><li>Sole Contact, Lyn Pet...
<ul><ul><li>HHSC Point of Contact </li></ul></ul>Lyn Peters, Contract Administrator Enterprise Contract and Procurement Se...
Medicaid / Children with Special Health Care Needs Claims Processing, Primary Care Case Management and Pharmacy Claims and...
<ul><li>RFP Overview </li></ul><ul><ul><li>Background </li></ul></ul><ul><ul><li>Mission </li></ul></ul><ul><ul><li>Scope ...
Background <ul><ul><li>Since 1991, HHSC has overseen and coordinated the planning and delivery of health and human service...
Background <ul><li>Current Contracts </li></ul><ul><li>The current contracts for administering the operations of the Texas...
Background <ul><li>HHSC is seeking a vendor(s) who can: </li></ul><ul><li>1) Take over operations of the current TMMIS, in...
Background <ul><li>•  General Operational Requirements  • Primary Care Case Management (PCCM) Administration </li></ul><ul...
Mission <ul><li>HHSC’s mission for this procurement is to provide quality and necessary health care services to the segmen...
Scope of Work <ul><li>Requirements Overview </li></ul><ul><ul><li>Section 7:  General Contract and Turnover   Requirements...
Scope of Work <ul><ul><ul><li>Requirements Overview  </li></ul></ul></ul><ul><ul><ul><li>Section 8:  Operations Requiremen...
Scope of Work <ul><ul><ul><li>Requirements Overview </li></ul></ul></ul><ul><ul><ul><li>Section 8:  Operations Requirement...
Performance Goals HHSC will monitor the performance of the contract(s) issued under this RFP.  All services and deliverabl...
Compensation <ul><li>The State has chosen to use a “Fixed Price” approach related to the administrative services and a “Fi...
Compensation – Financial Approach <ul><li>The various program types included in the Medicaid/CSHCN Services Program Claims...
Compensation – Financial Approach <ul><li>A Vendor may choose to propose a solution for one or both of the RFP components....
Compensation – Financial Approach <ul><li>The Vendor’s accounting records and procedures are subject to State approval. Ac...
Compensation – Financial Approach <ul><li>A Vendor must keep separate financial records for each of the two (2) component ...
Compensation – Financial Approach <ul><li>A Vendor must provide monthly financial statements depicting the Vendor’s operat...
Compensation – Financial Approach  <ul><li>A Vendor must establish and maintain three (3) bank accounts in a bank located ...
Compensation – Financial Approach <ul><li>The Medicaid/CSHCN Services Program Claims/PCCM Administrator Vendor will receiv...
Compensation – Financial Approach <ul><li>Costs for administrative services provided by the Medicaid/CSHCN Services Progra...
Compensation – Financial Approach <ul><li>HHSC requires that no more than 50% of the administrative fees for the DADS Long...
Compensation – Financial Approach <ul><li>Transition costs to meet the requirements of the RFP will be paid on a fixed fee...
Compensation – Financial Approach <ul><li>Separate transition costs will be proposed, negotiated, and paid for the followi...
Compensation – Financial Approach <ul><li>Payment to the Pharmacy Claims/ Pharmacy Rebate Administrator Vendor for adminis...
Compensation – Financial Approach <ul><li>Transition costs to meet the requirements of the RFP will be paid on a fixed fee...
Compensation – Financial Approach <ul><li>Ownership of all nonexpendable capital items  FUNDED  by the contract resulting ...
Compensation – Financial Approach <ul><li>Administrative fees paid to the Vendor during each Operational Contract Year wil...
Compensation – Financial Approach <ul><li>The total maximum cost of the Services and Deliverables supplied by the Vendor t...
Compensation – Financial Approach <ul><li>Forms substantially similar to those described in the RFP must provide the compo...
Compensation – Financial Approach <ul><li>The potential Vendor must structure its pricing quotation to allow HHSC a method...
Compensation – Financial Approach <ul><li>Transition Pricing Schedules: </li></ul><ul><li>The potential Vendor’s transitio...
Compensation – Financial Approach <ul><li>The potential Vendor’s operational cost proposal sheets (Appendix A-2) for each ...
Compensation – Financial Approach <ul><li>Instructions for completing each schedule are included in the RFP.  </li></ul><u...
Compensation – Financial Approach <ul><li>The State will be providing prospective Vendors with an electronic version of th...
Compensation – Financial Approach <ul><li>Vendors must separately identify value-added benefits, cost-savings and cost-avo...
15 Minute Break
HUB Subcontracting Plan (HSP) Requirements
Agenda Topics <ul><li>RFP Section 4.0 Historically Underutilized Business  </li></ul><ul><li>Participation Requirements </...
RFP Section 4.0 - Historically Underutilized Business  Participation Requirements <ul><li>HUB Participation Goals </li></u...
If HSP is inadequate, response will be rejected  HUB GOALS
Section 1:  Company  Information Section 2: Subcontracting Intentions:  If Yes: Enter subcontracting opportunities If No: ...
One page for each area subcontracted (listed in Section 2) HSP Information Page
Section 3: List Line # and Subcontracting Opportunity
Section 4: Protégé performing the work  Section 5:  Professional Services  Category
HSP Information Page Section 6(a):  Good Faith Efforts to find/include Texas Certified HUB Vendors
Section 6(b): Contact HUB Trade Organization HSP Information Page
Section 6(c): Written Notification Requirements HSP Information Page
Section 7: List 3 HUBs Contacted for this Subcontracting  Opportunity HSP Information Page Section 8: List Subs Selected (...
Section 8: Reason why HUB was not selected for this Subcontracting Opportunity HSP Information Page
Section 9: Self Performance Explanation Section 10:  Signature Affirms that True and Correct Information is Provided
<ul><li>Required with  </li></ul><ul><li>ALL  Pay Requests </li></ul><ul><li>List  ALL  Sub payments  </li></ul><ul><li>(H...
HSP ASSISTANCE FROM TPASS HUB Subcontracting Plan (HSP) Forms Step-by-step instructions and an audio on “ How to Complete ...
Administrative Services Development HUB Program Office <ul><li>Robert L. Hall, C.P.M. </li></ul><ul><li>Director of Admini...
Submit Questions Lunch Break  Noon - 2:00 p.m. Lonestar Conference Room 1:00 p.m. - 2:00 p.m. Notary Public Available to S...
Questions and Answers <ul><ul><li>Non-binding verbal answers to vendor questions. </li></ul></ul><ul><ul><li>Binding respo...
Closing Comments <ul><li>Office of General Counsel </li></ul><ul><ul><li>Collusion  </li></ul></ul><ul><ul><li>Conflict of...
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  1. 1. Texas Health and Human Services Commission (HHSC ) Medicaid / Children with Special Health Care Needs Claims Processing, Primary Care Case Management and Pharmacy Claims and Rebate Administration Request for Proposals # 529-08-0159 Vendor Conference September 23, 2008
  2. 2. <ul><li>Welcome </li></ul><ul><li>Introductions </li></ul><ul><ul><li>Lyn Peters, Enterprise Contract and Procurement Services (ECPS) </li></ul></ul><ul><ul><li>David Brown, Assistant General Counsel </li></ul></ul><ul><ul><li>Tim Seelig, Deputy Director, Medicaid/CHIP Procurement and Contract Services </li></ul></ul><ul><ul><li>Robert Hall, Director/HUB Coordinator, Administrative Services Development (ASD) </li></ul></ul><ul><ul><li>Larry Fisher, Senior Financial Analyst, </li></ul></ul><ul><ul><li>HHS System Budget and Fiscal Policy </li></ul></ul><ul><li>Housekeeping Items </li></ul>
  3. 3. HHSC Procurement Roles <ul><li>ECPS - Responsible for procurement activity </li></ul><ul><li>HUB - Responsible for HUB activity </li></ul><ul><li>Program - Responsible for project scope, requirements, performance, results, contract management/monitoring </li></ul><ul><li>Legal - Questions/answers and legal activity </li></ul>
  4. 4. Vendor Conference Overview <ul><ul><li>Procurement Activities </li></ul></ul><ul><ul><li>RFP Overview </li></ul></ul><ul><ul><li>Break </li></ul></ul><ul><ul><li>HUB Items </li></ul></ul><ul><ul><li>Questions Submittal </li></ul></ul><ul><ul><li>Lunch </li></ul></ul><ul><ul><li>Notary Public </li></ul></ul><ul><ul><li>Preliminary Responses to Questions </li></ul></ul><ul><ul><li>Closing Comments </li></ul></ul>
  5. 5. <ul><li>Procurement Activities </li></ul><ul><ul><li>Questions & Answers </li></ul></ul><ul><ul><li>Sole Contact, Lyn Peters, ECPS </li></ul></ul><ul><ul><li>Procurement Schedule </li></ul></ul><ul><ul><li>Solicitation Access- http://www.hhsc.state.tx.us/about_hhsc/BusOpp/contracts.asp </li></ul></ul><ul><ul><li>Submission Requirements </li></ul></ul><ul><ul><li>Solicitation Changes </li></ul></ul><ul><ul><li>Screening & Evaluation </li></ul></ul><ul><ul><li>Award Information </li></ul></ul>
  6. 6. <ul><ul><li>HHSC Point of Contact </li></ul></ul>Lyn Peters, Contract Administrator Enterprise Contract and Procurement Services (ECPS) Division 4405 N. Lamar Blvd. Austin, Texas 78756-3422 (512) 206-5504 Fax (512) 206-5475 [email_address] All communications relating to this RFP must be directed to the HHSC contact person. All communications between respondents and other HHSC staff members concerning this RFP are strictly prohibited. Failure to comply with these requirements may result in proposal disqualification.
  7. 7. Medicaid / Children with Special Health Care Needs Claims Processing, Primary Care Case Management and Pharmacy Claims and Rebate Administration July 10, 2009 Anticipated Contract Start Date July 1, 2009 Tentative Award Announcement November 19, 2008 Deadline for Proposal Withdrawal November 19, 2008 Proposals Due October 17, 2008 HHSC Posts Responses to Vendor Questions September 26, 2008 Vendor Questions Due September 23, 2008 Vendor Conference August 15, 2008 RFP Release Date February 26, 2008 Comments to RFI Due January 25, 2008 RFI Release Date Procurement Schedule
  8. 8. <ul><li>RFP Overview </li></ul><ul><ul><li>Background </li></ul></ul><ul><ul><li>Mission </li></ul></ul><ul><ul><li>Scope of Work </li></ul></ul><ul><ul><li>Performance Goals </li></ul></ul><ul><ul><li>Performance Measures </li></ul></ul><ul><ul><li>Compensation </li></ul></ul>Medicaid / Children with Special Health Care Needs Claims Processing, Primary Care Case Management and Pharmacy Claims and Rebate Administration
  9. 9. Background <ul><ul><li>Since 1991, HHSC has overseen and coordinated the planning and delivery of health and human service programs in Texas. HHSC is established in accordance with Texas Government Code Chapter 531 and is responsible for the oversight of all Texas health and human service agencies (HHS Agencies). HHSC’s chief executive officer is Albert Hawkins, Executive Commissioner of the Health and Human Services Commission. </li></ul></ul>
  10. 10. Background <ul><li>Current Contracts </li></ul><ul><li>The current contracts for administering the operations of the Texas Medicaid Management Information System (TMMIS) are set to terminate in August 2009. The contracts may be extended up to one additional year, expiring no later than August 31, 2010. </li></ul>
  11. 11. Background <ul><li>HHSC is seeking a vendor(s) who can: </li></ul><ul><li>1) Take over operations of the current TMMIS, including the processing of MTP claims; </li></ul><ul><li>2) Manage the Pharmacy Claims and Rebate Administration functions; and </li></ul><ul><li>3) Provide a CHIP PCCM option. </li></ul><ul><li>To accomplish the above, HHSC is seeking vendors who can perform the following business functions: </li></ul>
  12. 12. Background <ul><li>• General Operational Requirements • Primary Care Case Management (PCCM) Administration </li></ul><ul><li>• Integrated Care Management (ICM) • Provider Services </li></ul><ul><li>• Client Services • Call Centers </li></ul><ul><li>• Administrative Cost Containment • Health Care Cost Containment </li></ul><ul><li>• Medical/Dental Policy • Program Policy </li></ul><ul><li>• Prior Authorization (PA) • Fair Hearings </li></ul><ul><li>• Surveillance/Utilization Review (SUR) • Third Party Resources (TPR) </li></ul><ul><li>• Claims Processing • Health Insurance Premium Payments (HIPP) & Insurance </li></ul><ul><li>• Reference Data Maintenance Premium Payment Assistance (IPPA) </li></ul><ul><li>• Financial Management • Recipient Eligibility Maintenance and Eligibility Verification </li></ul><ul><li>• Provider Reimbursement • Management and Administrative Reporting </li></ul><ul><li>• Ad Hoc Reporting • System Maintenance and Modification </li></ul><ul><li>• System Operations, Disaster Recovery, • Long Term Care Online Portal </li></ul><ul><li>and Integrated Test Facility • Long Term Care (LTC) Programs </li></ul><ul><li>• Medical Transportation Program (MTP) • Children with Special Health Care Needs (CSHCN) Services </li></ul><ul><li>• Family Planning (FP) Program </li></ul><ul><li>• County Indigent Health Care Program (CIHCP) • Medically Needy Program (MNP); and </li></ul><ul><li>• Pharmacy Claims and Drug Rebate Administration (PCRA) </li></ul>
  13. 13. Mission <ul><li>HHSC’s mission for this procurement is to provide quality and necessary health care services to the segment of the Texas population with health benefits covered by the Texas Medicaid Program, Primary Care Case Management (PCCM), Department of State Health Services Family Planning (DSHS Family Planning), Texas Health Steps Programs (THSteps), the Children with Special Health Care Needs (CSHCN) Services Program and the Vendor Drug Program. </li></ul>
  14. 14. Scope of Work <ul><li>Requirements Overview </li></ul><ul><ul><li>Section 7: General Contract and Turnover Requirements </li></ul></ul><ul><ul><li>Section 8: Operations Requirements </li></ul></ul><ul><ul><ul><li>General Operational Requirements; </li></ul></ul></ul><ul><ul><ul><li>Primary Care Case Management (PCCM) Administration; </li></ul></ul></ul><ul><ul><ul><li>Integrated Care Management; </li></ul></ul></ul><ul><ul><ul><li>Provider Services; </li></ul></ul></ul><ul><ul><ul><li>Client Services; </li></ul></ul></ul><ul><ul><ul><li>Call Centers; </li></ul></ul></ul><ul><ul><ul><li>Administrative Cost Containment; </li></ul></ul></ul><ul><ul><ul><li>Health Care Cost Containment; </li></ul></ul></ul><ul><ul><ul><li>Medical/Dental Policy; </li></ul></ul></ul><ul><ul><ul><li>Program Policy; </li></ul></ul></ul><ul><ul><ul><li>Prior Authorization (PA); </li></ul></ul></ul><ul><ul><ul><li>Fair Hearings; </li></ul></ul></ul>
  15. 15. Scope of Work <ul><ul><ul><li>Requirements Overview </li></ul></ul></ul><ul><ul><ul><li>Section 8: Operations Requirements </li></ul></ul></ul><ul><ul><ul><li>Surveillance and Utilization Review; </li></ul></ul></ul><ul><ul><ul><li>Third Party Resources (TPR); </li></ul></ul></ul><ul><ul><ul><li>Health Insurance Premium Payment (HIPP) System and Insurance Premium Payment Assistance (IPPA); </li></ul></ul></ul><ul><ul><ul><li>Claims Processing; </li></ul></ul></ul><ul><ul><ul><li>Financial Management; </li></ul></ul></ul><ul><ul><ul><li>Provider Reimbursement; </li></ul></ul></ul><ul><ul><ul><li>Management and Administrative Reporting (MAR); </li></ul></ul></ul><ul><ul><ul><li>Ad Hoc Reporting; </li></ul></ul></ul><ul><ul><ul><li>Reference Data Maintenance; </li></ul></ul></ul><ul><ul><ul><li>Recipient Eligibility Maintenance; </li></ul></ul></ul>
  16. 16. Scope of Work <ul><ul><ul><li>Requirements Overview </li></ul></ul></ul><ul><ul><ul><li>Section 8: Operations Requirements </li></ul></ul></ul><ul><ul><ul><li>Eligibility Verification; </li></ul></ul></ul><ul><ul><ul><li>System Maintenance and Modification; </li></ul></ul></ul><ul><ul><ul><li>System Operations, Disaster Recovery, and Integrated Test Facility; </li></ul></ul></ul><ul><ul><ul><li>Long Term Care (LTC) Online Portal; </li></ul></ul></ul><ul><ul><ul><li>Long Term Care (LTC) Programs; </li></ul></ul></ul><ul><ul><ul><li>Children with Special Health Care Needs (CSHCN) Services Program; </li></ul></ul></ul><ul><ul><ul><li>Family Planning (FP); </li></ul></ul></ul><ul><ul><ul><li>County Indigent Health Care Program (CIHCP); </li></ul></ul></ul><ul><ul><ul><li>Medically Needy Program (MNP); </li></ul></ul></ul><ul><ul><ul><li>Medical Transportation Program (MTP); and </li></ul></ul></ul><ul><ul><ul><li>Pharmacy Claims and Drug Rebate Administration (PCRA). </li></ul></ul></ul><ul><ul><ul><li>Section 9: Transition Phase Scope of Work </li></ul></ul></ul>
  17. 17. Performance Goals HHSC will monitor the performance of the contract(s) issued under this RFP. All services and deliverables under the contract shall be provided at an acceptable quality level and in a manner consistent with acceptable industry standards, customs and practices. Failure to produce deliverables in such a manner could result in remedies as outlined in Appendix D.
  18. 18. Compensation <ul><li>The State has chosen to use a “Fixed Price” approach related to the administrative services and a “Fiscal Agent” approach related to the medical benefit costs / pharmacy benefit costs included in the Contract or Contract(s) resulting from this RFP. Normally, the medical benefit costs for Medicaid recipients enrolled in a Medicaid Managed Care Health Maintenance Organization (HMO) will not be included with the Fiscal Agent medical benefit funds. The pharmacy benefit costs for Medicaid recipients enrolled in a Medicaid HMO will be included with the Fiscal Agent pharmacy benefit funds. </li></ul><ul><li>The RFP is comprised of two specific component service areas for which the Vendor may propose solutions: </li></ul><ul><ul><li>Medicaid/CSHCN Services Program Claims/PCCM Administrator </li></ul></ul><ul><ul><li>Pharmacy Claims/Pharmacy Rebate Administrator. </li></ul></ul>
  19. 19. Compensation – Financial Approach <ul><li>The various program types included in the Medicaid/CSHCN Services Program Claims/PCCM Administrator component service area are as follows: </li></ul><ul><li>(1) Core Title XIX - </li></ul><ul><li>(includes all services not otherwise covered by programs below); </li></ul><ul><li>(2) Children with Special Health Care Needs (CSHCN) Services Program; </li></ul><ul><li>(3) Family Planning (FP) Title V, X, and XX; </li></ul><ul><li>(4) Long Term Care (LTC); and </li></ul><ul><li>(5) Medical Transportation Program (MTP). </li></ul><ul><li>The various program types included in the Pharmacy Claims/Pharmacy Rebate Administrator component service area are as follows: </li></ul><ul><li>(1) Core Title XIX – </li></ul><ul><li>(including pharmacy claims for Medicaid managed care clients); </li></ul><ul><li>(2) Children’s Health Insurance Program (CHIP); </li></ul><ul><li>(3) CSHCN Services Program; and </li></ul><ul><li>(4) Kidney Health Care Program (KHC). </li></ul>
  20. 20. Compensation – Financial Approach <ul><li>A Vendor may choose to propose a solution for one or both of the RFP components. </li></ul><ul><li>A Vendor that proposes solutions for more than one RFP component must submit pricing proposals for each component type separately and a pricing proposal for both components together (3 separate proposals in total). </li></ul>
  21. 21. Compensation – Financial Approach <ul><li>The Vendor’s accounting records and procedures are subject to State approval. Accruals of expenses or liabilities are subject to State review and approval. The State will not recognize as valid costs, any accruals that it deems inappropriate. For example, lease agreement costs beyond the effective date of termination or completion of the Contract, or lease cancellation expenses resulting from termination or completion of the Contract, will not represent valid allowable costs. </li></ul>
  22. 22. Compensation – Financial Approach <ul><li>A Vendor must keep separate financial records for each of the two (2) component service areas administered under the Contract or Contracts resulting from the RFP: </li></ul><ul><li>(1) Medicaid/CSHCN Services Program Claims/PCCM Administrator; and </li></ul><ul><li>(2) Pharmacy Claims / Pharmacy Rebate Administrator. </li></ul><ul><li>A Vendor must keep separate financial records for the following Medicaid/CSHCN Services Program Claims/PCCM Administrator sub-component program types: </li></ul><ul><li>• Core Title XIX; </li></ul><ul><li>• CSHCN Services Program; </li></ul><ul><li>• Family Planning Title V, X, and XX (FP); </li></ul><ul><li>• Long Term Care (DADS-LTC); and </li></ul><ul><li>• Medical Transportation Program (MTP). </li></ul><ul><li>A Vendor must keep separate financial records for the following Pharmacy Claims/Pharmacy Rebate Administrator sub-component program types: </li></ul><ul><li>• Pharmacy Claims Administration; and </li></ul><ul><li>• Pharmacy Rebate Administration. </li></ul>
  23. 23. Compensation – Financial Approach <ul><li>A Vendor must provide monthly financial statements depicting the Vendor’s operation under this Contract or Contracts resulting from this RFP no later than the twenty-fifth (25th) calendar day following the end of the previous month. HHSC reserves the right to request financial information in a format that will allow the State to most efficiently comply with its State and Federal financial reporting requirements. </li></ul><ul><li>A Vendor must provide a monthly report that shows daily cash balances in each of the bank accounts described in this Request for Proposal. </li></ul><ul><li>A Vendor must provide a monthly report that details all of the types of deposits made by the Vendor into each applicable bank account. </li></ul>
  24. 24. Compensation – Financial Approach <ul><li>A Vendor must establish and maintain three (3) bank accounts in a bank located within the State of Texas. The accounts are identified as follows: </li></ul><ul><li>(1) Core Title XIX Medical Benefits Disbursement Account, </li></ul><ul><li>(2) Core Title XIX Refund Account, and </li></ul><ul><li>(3) CSHCN Services Program Medical Benefits Disbursement Account. </li></ul>
  25. 25. Compensation – Financial Approach <ul><li>The Medicaid/CSHCN Services Program Claims/PCCM Administrator Vendor will receive funds weekly from the State to pay medical benefit claims the Vendor has determined are ready for payment. The Vendor will receive payments monthly as compensation for the applicable administrative services required in the RFP. </li></ul>
  26. 26. Compensation – Financial Approach <ul><li>Costs for administrative services provided by the Medicaid/CSHCN Services Program Claims/PCCM Administrator Vendor will be based on fixed fee (s) and variable fee formulas for two (2) of the program types. The costs for administrative services for three (3) program types will be based on fixed fee (s) only. </li></ul>
  27. 27. Compensation – Financial Approach <ul><li>HHSC requires that no more than 50% of the administrative fees for the DADS Long Term Care services will be paid utilizing fixed fees and a minimum of 50% of the administrative fees for the DADS Long Term Care services will be paid utilizing variable fees. HHSC reserves the right to determine the final percentage of fixed fees and variable fees in the contract for the DADS Long Term Care services. </li></ul><ul><li>HHSC requires that no more than 65% of the administrative fees for the Core Title XIX services will be paid utilizing fixed fees and a minimum of 35% of the administrative fees for the Core Title XIX services will be paid utilizing variable fees. HHSC reserves the right to determine the final percentage of fixed fees and variable fees in the contract for the Core Title XIX services. </li></ul>
  28. 28. Compensation – Financial Approach <ul><li>Transition costs to meet the requirements of the RFP will be paid on a fixed fee basis. Transition costs in excess of the final fixed price amount(s) included in the Contract(s) will not be paid by the State. Any expenses incurred by a vendor after the commencement of the operational phase of the contract(s) to complete transition activities or correct any defects from the Transition Phase must not be recorded as an operational expense and will not be considered an allowable expense for the Retrospective Cost Settlement provision of the Contract. </li></ul>
  29. 29. Compensation – Financial Approach <ul><li>Separate transition costs will be proposed, negotiated, and paid for the following program types of the Medicaid/CSHCN Services Program Claims/PCCM Administrator component service area: </li></ul><ul><li>• Core Title XIX services; </li></ul><ul><li>• CSHCN Services Program services; </li></ul><ul><li>• Family Planning Title V, X, and XX services; </li></ul><ul><li>• Long Term Care Program services; </li></ul><ul><li>• Medical Transportation Program services; and </li></ul><ul><li>• Children’s Health Insurance Program (CHIP) – for </li></ul><ul><li> CHIP PCCM option. </li></ul>
  30. 30. Compensation – Financial Approach <ul><li>Payment to the Pharmacy Claims/ Pharmacy Rebate Administrator Vendor for administrative services will be based on a fixed administrative fee basis. </li></ul><ul><li>Separate fixed administrative fees will be paid for: </li></ul><ul><li>• Pharmacy Claims Administration; and </li></ul><ul><li>• Pharmacy Rebate Administration. </li></ul>
  31. 31. Compensation – Financial Approach <ul><li>Transition costs to meet the requirements of the RFP will be paid on a fixed fee basis. Transition costs in excess of the final fixed price amount(s) included in the Contract will not be paid by the State. </li></ul><ul><li>Transition costs will be proposed to allow the Pharmacy Claims/Pharmacy Rebate Administrator Vendor to assume the responsibilities of the RFP effective no later than September 1, 2010. </li></ul><ul><li>Transition costs will not be paid as an element of operational administrative costs. Transition costs will be paid to the Vendor retrospectively. </li></ul>
  32. 32. Compensation – Financial Approach <ul><li>Ownership of all nonexpendable capital items FUNDED by the contract resulting from this RFP will pass to the State at the expiration of the contract. </li></ul><ul><li>Actual expenditures for Pass-Through Items made on the State’s behalf will be paid without allocation of any indirect charges (general & administrative expenses, overhead, etc.) or profit. </li></ul><ul><li>A complete listing of expenditures designated as Pass-Through Items is documented at Section 6.8.3.2 of the RFP. </li></ul>
  33. 33. Compensation – Financial Approach <ul><li>Administrative fees paid to the Vendor during each Operational Contract Year will consist of: </li></ul><ul><ul><li>Fixed Administrative Fees </li></ul></ul><ul><ul><li>Variable Administrative Fees </li></ul></ul><ul><ul><li>Administrative Fees for the Additional Periodic Activities </li></ul></ul><ul><ul><li>Administrative Fees for Additional Recurring Activities </li></ul></ul><ul><li>The sum of the four Fee components will be referred to as the “Fee Ceiling” . </li></ul>
  34. 34. Compensation – Financial Approach <ul><li>The total maximum cost of the Services and Deliverables supplied by the Vendor to HHSC during each Operational Contract Year will not exceed the lesser of </li></ul><ul><ul><li>(a) the Vendor’s Fees (Fee Ceiling) or </li></ul></ul><ul><ul><li>(b) the sum of the Allowable Costs incurred by the Vendor plus the allowable administrative service fee during the subject Operational Contract Year. </li></ul></ul>
  35. 35. Compensation – Financial Approach <ul><li>Forms substantially similar to those described in the RFP must provide the component costs of the Firm Fixed Prices quoted for providing the services and deliverables set forth in the RFP. </li></ul><ul><ul><li>Attachment A, Appendix A-1 contains Transitional Pricing Schedules </li></ul></ul><ul><ul><li>Attachment A, Appendix A-2 contains Operational Pricing Schedules </li></ul></ul><ul><ul><li>Attachment A, Appendix A-3 contains formal Price Summary Sheets </li></ul></ul>
  36. 36. Compensation – Financial Approach <ul><li>The potential Vendor must structure its pricing quotation to allow HHSC a method to map the proposed costs for the cost proposal submitted back to the Vendor’s Detailed Work Plan for the initial term of the Contract. </li></ul><ul><li>The Vendor must provide separate Transitional Costs through the proposed transition period. </li></ul><ul><li>The Vendor must provide the required projected monthly costs for the entire operations period. </li></ul><ul><li>The pricing quotations for each specific component must agree with the Firm Fixed Prices proposed by the Vendor (Fixed and Variable Prices). </li></ul>
  37. 37. Compensation – Financial Approach <ul><li>Transition Pricing Schedules: </li></ul><ul><li>The potential Vendor’s transitional cost proposal sheets for this RFP must identify the proposed “Key Milestones” the Vendor will accomplish during the Transitional period (Appendix A-1). </li></ul><ul><li>The State is requesting each prospective Vendor to identify the “Key Milestones” the Vendor believes would be pertinent and appropriate as a Key Milestone during the Transition period. </li></ul><ul><li>The State reserves the option to add, delete and/or modify Key Milestones included in the Vendor’s transitional cost proposal sheets. </li></ul>
  38. 38. Compensation – Financial Approach <ul><li>The potential Vendor’s operational cost proposal sheets (Appendix A-2) for each of the operational components must be delineated by the primary business functions (functional areas) documented in the RFP for each component. </li></ul>
  39. 39. Compensation – Financial Approach <ul><li>Instructions for completing each schedule are included in the RFP. </li></ul><ul><li>Summary forms should be supported by the detailed information contained on monthly schedules. </li></ul><ul><li>Amounts shown on the monthly schedules must agree with the cumulative amounts shown on the summary forms. </li></ul><ul><li>In addition to paper copies of the Vendor’s Cost Proposal and Price Summary sheets, Vendors must submit electronic versions in an MS Excel format. </li></ul>
  40. 40. Compensation – Financial Approach <ul><li>The State will be providing prospective Vendors with an electronic version of the required Cost Proposal and Price Summary sheets in an MS Excel format on or before October 6, 2008 (when answers to questions are posted to the website). The file will posted in the procurement library. </li></ul><ul><li>Any electronic version of the pricing forms must contain any and all formulas used to calculate pricing information contained on the forms and include any and all links to other worksheets / forms included in the Vendor’s Cost Proposal. </li></ul>
  41. 41. Compensation – Financial Approach <ul><li>Vendors must separately identify value-added benefits, cost-savings and cost-avoidance methods and measures, and the effect of such methods on the Cost Proposal and Scope of Work. </li></ul><ul><li>The cost proposal should include any business, economic, legal, programmatic, or practical assumptions that underlie the Cost Proposal. HHSC reserves the right to accept or reject any assumptions. </li></ul>
  42. 42. 15 Minute Break
  43. 43. HUB Subcontracting Plan (HSP) Requirements
  44. 44. Agenda Topics <ul><li>RFP Section 4.0 Historically Underutilized Business </li></ul><ul><li>Participation Requirements </li></ul><ul><li>HUB Subcontracting Plan for the RFP is required </li></ul><ul><li>Self Performance HSP </li></ul><ul><li>HSP Prime Contractor Progress Assessment Report </li></ul>
  45. 45. RFP Section 4.0 - Historically Underutilized Business Participation Requirements <ul><li>HUB Participation Goals </li></ul><ul><li>Potential Subcontracting Opportunities </li></ul><ul><li>Vendor Intends to Subcontract </li></ul><ul><li>Minority or Women Trade Organizations </li></ul><ul><li>Self Performance </li></ul><ul><li>HSP Changes After Contract Award </li></ul><ul><li>Reporting and Compliance with the HSP </li></ul>
  46. 46. If HSP is inadequate, response will be rejected HUB GOALS
  47. 47. Section 1: Company Information Section 2: Subcontracting Intentions: If Yes: Enter subcontracting opportunities If No: skip to Sections 9 and 10 Special Language
  48. 48. One page for each area subcontracted (listed in Section 2) HSP Information Page
  49. 49. Section 3: List Line # and Subcontracting Opportunity
  50. 50. Section 4: Protégé performing the work Section 5: Professional Services Category
  51. 51. HSP Information Page Section 6(a): Good Faith Efforts to find/include Texas Certified HUB Vendors
  52. 52. Section 6(b): Contact HUB Trade Organization HSP Information Page
  53. 53. Section 6(c): Written Notification Requirements HSP Information Page
  54. 54. Section 7: List 3 HUBs Contacted for this Subcontracting Opportunity HSP Information Page Section 8: List Subs Selected (HUBs & Non-HUBs) for this Subcontracting Opportunity
  55. 55. Section 8: Reason why HUB was not selected for this Subcontracting Opportunity HSP Information Page
  56. 56. Section 9: Self Performance Explanation Section 10: Signature Affirms that True and Correct Information is Provided
  57. 57. <ul><li>Required with </li></ul><ul><li>ALL Pay Requests </li></ul><ul><li>List ALL Sub payments </li></ul><ul><li>(HUBs & Non-HUBs) </li></ul>HSP Prime Contractor Progress Assessment Report ATTACHMENT “E”
  58. 58. HSP ASSISTANCE FROM TPASS HUB Subcontracting Plan (HSP) Forms Step-by-step instructions and an audio on “ How to Complete an HSP ” is located on the Texas Building and Procurement Commission’s (TBPC’s) website at: http://www.cpa.state.tx.us/procurement/prog/hub/hub-forms/HUBSubcontractingPlan.pdf How to Complete an HSP Play Windows Media Version (7.7 MB) Play QuickTime (mp4) version (24 MB) Play Macromedia Flash version (10.8 MB) Read Video Transcript (.rtf file, 160K)
  59. 59. Administrative Services Development HUB Program Office <ul><li>Robert L. Hall, C.P.M. </li></ul><ul><li>Director of Administrative Services Development </li></ul><ul><li>- (512) 424-6596 </li></ul><ul><li>- [email_address] </li></ul><ul><li>Carlos A. Balderas </li></ul><ul><li>ASD HUB Administrator </li></ul><ul><li>- (512) 424-6896 </li></ul><ul><li>- [email_address] </li></ul><ul><li>Sherice Williams-Patty </li></ul><ul><li>ASD HUB Administrator </li></ul><ul><li>- (512) 424-6903 </li></ul><ul><li>- [email_address] </li></ul><ul><li>Segundo Sanchez </li></ul><ul><li>ASD Procurement/HUB Team Lead </li></ul><ul><li>- (512) 424-6896 </li></ul><ul><li>- [email_address] </li></ul>
  60. 60. Submit Questions Lunch Break Noon - 2:00 p.m. Lonestar Conference Room 1:00 p.m. - 2:00 p.m. Notary Public Available to Sign Non-Disclosure Statements. 2:00 p.m. – 3:00 p.m. Non-Binding Answers to Vendor Q uestions.
  61. 61. Questions and Answers <ul><ul><li>Non-binding verbal answers to vendor questions. </li></ul></ul><ul><ul><li>Binding responses will be posted on the procurement website by October 17, 2008. </li></ul></ul><ul><ul><li>http://www.hhsc.state.tx.us/about_hhsc/BusOpp/contracts.asp </li></ul></ul>
  62. 62. Closing Comments <ul><li>Office of General Counsel </li></ul><ul><ul><li>Collusion </li></ul></ul><ul><ul><li>Conflict of Interest </li></ul></ul><ul><ul><li>Permissible contacts </li></ul></ul>

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