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  • The following slides provide an overview of the RFP by reviewing the sections as listed on this slide. Read the sections off of the slide.
  • Transcript

    • 1. Texas Health and Human Services Commission (HHSC ) Medicaid/CHIP Claims Processing and Rebate Administration Financial Audits Request for Proposals # 529-10-0007 Vendor Conference: December 9, 2009 (8:30 – 11:30 AM)
    • 2. <ul><li>Introductions </li></ul><ul><ul><li>Steve Bailey , Enterprise Contract and Procurement Services (ECPS) </li></ul></ul><ul><ul><li>Peggie J. Laser , ECPS Procurement </li></ul></ul><ul><ul><li>Andy Vasquez , Medicaid/CHIP Division – Vendor Drug Program </li></ul></ul><ul><ul><li>Billy Millwee , Medicaid/CHIP Division – Claims Administrator Operations </li></ul></ul><ul><ul><li>Kent Hardin , Office of General Counsel </li></ul></ul><ul><ul><li>Carlos Balderas , HUB Program </li></ul></ul><ul><li>Housekeeping Items </li></ul>Welcome
    • 3. HHSC Procurement Roles <ul><li>ECPS - Responsible for procurement activity. </li></ul><ul><li>Program (Claims Administrator Operations & Vendor Drug Program) - Responsible for project scope, requirements, performance, results, evaluation, and monitoring. </li></ul><ul><li>HUB Program – Responsible for monitoring HUB activity. </li></ul><ul><li>Legal - Questions/Answers re: Legal issues. </li></ul>
    • 4. Vendor Conference Overview <ul><ul><li>1. Procurement Activities </li></ul></ul><ul><ul><li>2. RFP Overview </li></ul></ul><ul><ul><li>3. HUB Items </li></ul></ul><ul><ul><li>4. Question Submittal </li></ul></ul><ul><ul><li>=================== </li></ul></ul><ul><ul><li>Break </li></ul></ul><ul><ul><li>=================== </li></ul></ul><ul><ul><li>5. Preliminary Responses to Questions </li></ul></ul><ul><ul><li>6. Closing Comments </li></ul></ul>
    • 5. <ul><ul><li>Source for questions & answers </li></ul></ul><ul><ul><li>Provides sole HHSC contact : Peggie J. Laser </li></ul></ul><ul><ul><ul><li>Send Peggie any questions (after today), and your completed RFP responses. </li></ul></ul></ul><ul><ul><li>ECPS handles / coordinates : </li></ul></ul><ul><ul><ul><li>Procurement schedule </li></ul></ul></ul><ul><ul><ul><li>Solicitation access ( copy of RFP , etc.) at www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asp </li></ul></ul></ul><ul><ul><ul><li>Submission requirements </li></ul></ul></ul><ul><ul><ul><li>Solicitation changes </li></ul></ul></ul><ul><ul><ul><li>Oversees screening & evaluation </li></ul></ul></ul><ul><ul><ul><li>Award information </li></ul></ul></ul>ECPS Procurement Activities
    • 6. Procurement Schedule <ul><ul><li>RFP Release Date Nov. 25, 2009 </li></ul></ul><ul><ul><li>Vendor Conference Dec. 9, 2009 </li></ul></ul><ul><ul><li>Vendor Questions Due Dec. 10, 2009 </li></ul></ul><ul><ul><li>HHSC Posts Responses Dec. 15, 2009 </li></ul></ul><ul><ul><li>Proposals Due (by 3pm CT ) Jan. 7, 2010 </li></ul></ul><ul><ul><li>Tentative Award Announcement Feb. 19, 2010 </li></ul></ul><ul><ul><li>Anticipated Contract Start Date Mar. 1, 2010 </li></ul></ul><ul><ul><li>Start Date – 1 st Audits (SFY 10) Mar., 2010 </li></ul></ul><ul><ul><li>1 st Key Due Date: Completion of </li></ul></ul><ul><ul><li>SFY 10 Audits Mar. 1, 2011 </li></ul></ul>
    • 7. <ul><ul><li>Background </li></ul></ul><ul><ul><li>Procurement Mission </li></ul></ul><ul><ul><li>Objectives </li></ul></ul><ul><ul><li>Contract Terms </li></ul></ul><ul><ul><li>Vendor Experience Sought </li></ul></ul><ul><ul><li>Scope of Work </li></ul></ul><ul><ul><li>Performance Measures </li></ul></ul>RFP Overview
    • 8. Background <ul><li>Medicaid/CHIP Claims/PCCM Administrator and Pharmacy Rebate Administration Financial Audits </li></ul><ul><ul><li>Medical benefits under this Contract are rendered by enrolled providers under the Traditional Fee-For-Service (FFS) program in some areas and by a Primary Care Case Management (PCCM) model (a non-capitated form of managed care) in other areas. </li></ul></ul><ul><ul><li>Pharmacy benefits are provided through an extensive statewide Vendor Drug Program involving thousands of pharmacies. Additionally, the federal rebate program requires pharmaceutical manufacturers to pay Texas an amount based on volume sales. </li></ul></ul><ul><ul><li>Substantial engagement : This procurement covers auditing the Claims/PCCM Administrator and the Pharmacy Claims and Rebate Administrator contracts. The resulting Contracts will cover 3+ years. </li></ul></ul><ul><ul><li>Types of audits will primarily involve SAS-70 Level II, Retrospective Cost Settlement, and Performance audits. Performance audits will be based on risk assessments performed by the Vendor. </li></ul></ul><ul><ul><li>Opportunity for a knowledgeable audit firm to add/build Medicaid expertise. </li></ul></ul>
    • 9. Procurement Mission Obtain professional services that will, in a timely manner, help ensure accurate and relevant cost and profit reporting by external contractors who provide Medicaid/CHIP services for HHSC Medicaid/CHIP programs.
    • 10. Objectives <ul><li>Enforce regulatory and contract provisions for Medicaid and CHIP program claims administrator External Entities, as well as, the VDP Rebate program; </li></ul><ul><li>Strengthen HHSC’s oversight of Medicaid and CHIP program components provided by External Entities by performing various audits of high risk areas as well as External Entities reporting to HHSC; </li></ul><ul><li>Ensure External Entities’ costs passed on to HHSC include only program and contract allowable costs; </li></ul><ul><li>Ensure accurate reporting of the administrative components of contracted Medicaid and CHIP program components to enhance effective and efficient management by External Entities, as well as, HHSC oversight staff and leadership; and </li></ul><ul><li>Ensure accurate reporting of the medical benefit components of contracted programs to enhance effective and efficient management by External Entities, as well as, HHSC oversight staff and leadership. </li></ul>
    • 11. Contract Terms <ul><li>Initial contract period: Initial contract period will be for three (3) years. The anticipated Contract start date is March 1, 2010 </li></ul><ul><li>HHSC may extend the term of the contract: </li></ul><ul><ul><li>for one additional year , or as necessary to complete the mission of the procurement </li></ul></ul><ul><ul><li>subject to negotiation between the parties. </li></ul></ul><ul><li>The contract will be on a fixed-fee basis: </li></ul><ul><ul><li>fees tied to specific deliverables (e.g., completion of audits and issuance of final audit reports) </li></ul></ul><ul><ul><li>fixed fees will include all costs ( no per-item reimbursements, with the exception of HHSC pre-approved travel expenses ). </li></ul></ul>
    • 12. Vendor Experience Sought <ul><li>Experience with performing audits of corporations or operating units with revenues in excess of $100 million per year. </li></ul><ul><li>Experience with auditing government contracts . </li></ul><ul><li>Experience with the Federal Acquisition Regulations ( FAR ), Generally Accepted Government Auditing Standards (GAGAS), Generally Accepted Accounting Principles, and other appropriate professional standards. </li></ul><ul><li>Knowledge of Medicaid/CHIP legal requirements including federal privacy laws. </li></ul><ul><li>Experience with auditing related parties, affiliate or External Entity transactions. </li></ul><ul><li>Other related experience. </li></ul>
    • 13. Experience Sought (con’t.) <ul><li>The experience listed above should be manifested in the backgrounds and resumes of the Key Day-to-Day Staff that will handle the majority of the work on the engagement. </li></ul><ul><ul><li>Experience gained by others in the firm, including senior members who will not be primarily engaged in the hands-on day-to-day work of this engagement, will be given less emphasis in the RFP evaluation than that of the day-to-day staff. </li></ul></ul><ul><li>+ Additionally, Vendor firm experience auditing publicly-traded corporations, as well as non-profit firms, would be helpful. </li></ul>
    • 14. Other Vendor Attributes <ul><li>Vendor should have a track record of, and be strongly committed to: </li></ul><ul><ul><li>a high level of responsiveness and availability (by the audit manager and key senior day-to-day contributors) to HHSC’s MCD analysts and hands-on staff; and to </li></ul></ul><ul><ul><li>limiting turnover of Key Day-to-Day Staff. </li></ul></ul><ul><li>The Vendor should be flexible , and ready to take on ad hoc assignments, in a reasonably prompt time frame, and at a reasonable cost. </li></ul>
    • 15. Scope of Work <ul><li>Perform various audits of Medicaid and CHIP program components as part of HHSC oversight and program accountability requirements. The program components include, but are not limited to, Medicaid and CHIP claims administration for medical and pharmacy services as well as External Entity management of the VDP Rebate programs. </li></ul><ul><li>Types of Audits </li></ul><ul><ul><li>Statement on Auditing Standards (SAS) 70, Level II – Annually for each external entity </li></ul></ul><ul><ul><li>Retrospective Cost Settlement - Annually for each external entity </li></ul></ul><ul><ul><li>Performance Audit </li></ul></ul><ul><ul><ul><li>Performance Risk Assessment - every other year beginning year one </li></ul></ul></ul><ul><ul><ul><li>Performance Audit – every other year, based on recommendations from Risk Assessment </li></ul></ul></ul><ul><ul><li>Accounts Receivable (External Entity and HHSC)– no later than June 1, 2010 [Claims/PCCM Administrator only] </li></ul></ul><ul><ul><li>Pharmacy Rebate Administration – Annually [Pharmacy only] </li></ul></ul><ul><ul><li>Other Types of Audits – HHSC may request compliance exams, agreed upon procedures, and other related work. </li></ul></ul>
    • 16. Scope of Work <ul><li>Additional HHSC Audits/Requests </li></ul><ul><ul><li>Upon request, Contractor should provide additional financial consulting or auditing services (i.e. review of accounting system, banking statements and other related work) of any External Entities providing services to HHSC, and/or the Medicaid or CHIP programs </li></ul></ul><ul><ul><li>This item does not require a bid in the cost proposal and will be resolved through mutual agreement, as needed. HHSC and the auditor will negotiate applicable fees. </li></ul></ul><ul><li>Key Audit Documents </li></ul><ul><ul><li>External Entities may report financial results to HHSC through Financial Statements (including bank statements), when applicable and depending on the audit type. </li></ul></ul><ul><ul><li>Auditor must provide a written opinion that financial reporting by the External Entities are/are not adhering to the terms of the relevant Contract and Federal Acquisition Regulations. </li></ul></ul><ul><ul><li>Auditor must describe specific audit findings and the dollar impact of the findings. </li></ul></ul>
    • 17. Scope of Work <ul><li>Audit Plan Development for Every Audit </li></ul><ul><ul><li>Perform Risk Assessment (Desk Assessment) </li></ul></ul><ul><ul><li>Develop Audit Plan </li></ul></ul><ul><ul><ul><li>Vendor proposes audit methodology for each audit, including sample size, confidence level, and error rate </li></ul></ul></ul><ul><ul><ul><li>Each audit must meet a minimum of 90% confidence level </li></ul></ul></ul><ul><ul><ul><li>Address the estimated population and standard deviation proposed for use in substantive testing and/or validation and estimation of transaction volume and/or amount. </li></ul></ul></ul><ul><ul><ul><li>HHSC approves plan </li></ul></ul></ul><ul><ul><li>Deliverables </li></ul></ul><ul><ul><ul><li>Submit according to schedule in approved plan </li></ul></ul></ul><ul><ul><ul><li>Obtain written approval from HHSC </li></ul></ul></ul><ul><ul><ul><li>Revise deliverables, if requested by HHSC </li></ul></ul></ul>
    • 18. Scope of Work <ul><li>Audit Pricing </li></ul><ul><ul><li>Fixed-dollar bases, with all expenses included </li></ul></ul><ul><ul><li>Tied to specific deliverables </li></ul></ul><ul><ul><li>Comparative vendor pricing will be judged by HHSC’s interpretation of the extended aggregate amount for each vendor. </li></ul></ul><ul><ul><li>20% hold-back for audits in the last fiscal year, payable upon HHSC acceptance of all deliverables </li></ul></ul><ul><li>Audit Payment </li></ul><ul><ul><li>Deliverables may be invoiced upon completion </li></ul></ul><ul><ul><li>To complete audits, Vendor must use contractual elements in the appropriate External Entity contract, including contractually-referenced requirements </li></ul></ul><ul><ul><li>Audits unable to be performed in their entirety (not due to vendor) are subject to non-payment or pro rata payment, as deemed by HHSC. </li></ul></ul>
    • 19. Scope of Work <ul><li>Audit Issues : </li></ul><ul><ul><li>The potential over-statement of costs (and resultant understatement of profitability) in Retrospective Cost Settlement reports submitted to HHSC can lead to the avoidance or reduction of a profit rebate payment back to the state. </li></ul></ul><ul><ul><li>Contractual affiliate relationships can lead to complex audit issues concerning cost reporting. These relationships may involve substantial dollars and can include various administrative services provided by a corporate parent. </li></ul></ul>
    • 20. Performance Measures <ul><li>Performance monitored by HHSC. </li></ul><ul><li>All services and deliverables under the contract shall be provided at an acceptable quality level, and in a manner consistent with acceptable industry standard, custom, and practice. </li></ul><ul><li>See Attachment B: Key Performance Measures and Liquidated Damages. </li></ul>
    • 21. HUB Subcontracting Plan (HSP) Requirements
    • 22. 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>
    • 23. <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>RFP Section 4.0 - Historically Underutilized Business Participation Requirements
    • 24. If HSP is inadequate, response will be rejected HSP Information Page
    • 25. HSP Information Page HUB GOALS Special reminders and instructions Company Information
    • 26. If more than 20 subcontracting opportunities, click the link provided to continue adding HSP Information Page Enter subcontracting opportunities Subcontracting Declaration
    • 27. One page for each area subcontracted (listed on page 1) HSP Information Page
    • 28. List Line # and Subcontracting Opportunity HSP Information Page
    • 29. Protégé performing the work HSP Information Page Skip to Sections 8 and 10
    • 30. Professional Services Category HSP Information Page
    • 31. Good Faith Efforts to find/include Texas Certified HUB Vendors HSP Information Page
    • 32. Contact HUB Trade Organization HSP Information Page
    • 33. Written Notification Requirements HSP Information Page
    • 34. List 3 HUBs Contacted for this Subcontracting Opportunity HSP Information Page
    • 35. List Subs Selected (HUBs & Non-HUBs) for this Subcontracting Opportunity HSP Information Page
    • 36. Reason why HUB was not selected for this Subcontracting Opportunity HSP Information Page
    • 37. Self Performance Explanation HSP Information Page Signature Affirms that True and Correct Information is Provided
    • 38. <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”
    • 39. 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 Comptroller of Public Accounts (CPA) Texas Procurement and Support Services (TPASS) website at: http://www.cpa.state.tx.us/procurement/prog/hub/hub-forms/ HUB Subcontracting Plan Instructional Video Play Windows Media Version (7.7 MB download) Play Quicktime (mp4) version (24 MB download) Play Macromedia Flash version (10.8 MB download) Read Video Transcript (.rtf file) (160 K download)
    • 40. 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>Sharon Addison </li></ul><ul><li>HUB Program/Procurement Services Team Lead </li></ul><ul><li>- (512) 487-3404 </li></ul><ul><li>- [email_address] </li></ul>
    • 41. Texas Health and Human Services Commission (HHSC ) Question Submittal Followed by Break
    • 42. Tentative Responses to Vendor Questions <ul><li>Non-binding verbal answers to vendor questions may be provided here today. </li></ul><ul><li>Reminder: After today, any additional questions, requests for clarification, etc., are due to HHSC, in writing, by December 10, 2009. (Send to Peggie Laser; see below.) </li></ul><ul><li>Vendor Questions/HHSC Responses should be posted by December 15, 2009, on the HHSC Contract Opportunities website at the URL below: http://www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asp </li></ul><ul><li>Sole point of contact for further inquiries concerning this RFP is: </li></ul><ul><ul><li>Peggie J. Laser , Contract Administrator </li></ul></ul><ul><ul><li>Enterprise Contract and Procurement Services </li></ul></ul><ul><ul><li>Texas Health and Human Services Commission </li></ul></ul><ul><ul><li>4405 North Lamar Blvd. </li></ul></ul><ul><ul><li>Austin, Texas 78756 </li></ul></ul><ul><ul><li>Phone (512) 206-5278; fax (512) 206-5475 </li></ul></ul><ul><ul><li>Email [email_address] </li></ul></ul>
    • 43. Closing Comments

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