Vendor Conference Presentation


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  • These include state schools, ICF/MRs or related conditions, group homes, nursing homes, and general residential operations offering treatment services for children with mental retardation. House Bill 885, Senate Bill 118- p. 7
  • Goal, of course, is to design a long term arrangement, except in cases in which the child’s birth family chooses to have the child returned to his/her home. HHSC contracted in 2002 for a Family-Based Alternative project, and per HHSC recommendations, develops a new RFP every 5 years; thus why we are here!
  • Except in cases where parental rights have been terminated or abridged (and therefore the DFPS caseworker is involved in the process, the matching process involves consent from the birth family. A variety of arrangements can be considered, including: shared parenting (weekend visits by birth parents, for ex.) Adoption of the child may be an option if parental rights have been terminated Due to the unique needs of the child/birth family/support family, it is essential that the training be individualized and tailored to meet these needs for successful permanency to occur. Vendors will need to demonstrate their approach to ensure sufficient numbers of support families are recruited, screened, assessed, trained, and available to provide support family services.
  • One of the main components of this program. Unless the birth family is unable to bring the child back into their home, the need to find an appropriate, permanent support family is essential to establish permanency for a child. One of the key components of this program is to keep children from being reinstitutionalized. That is why the development of relationships is a dynamic effort among birth/support families/natural supports/providers/community-based services.
  • System is intended to be operated in a manner that recognizes that birth parents are a valued and integral part of the process established under the system, and are encouraged to participate in all decisions affecting their children, unless DFPS has terminated parental rights. Defining needs of the child, birth parents, support families/providers that results in successful matches is based on painstaking efforts that develop and nurture relationships among children/birth families to make the outcome successful. Vendors will work with staff from Dept. of Aging and Disability Services, Dept. of Family and Protective Services, mr authorities, permanency planners, institutional and community-based providers, and others to identify children residing in institutions, and their families, who may be in need of, or desirous of, a family-based alternative to residing in an institution.
  • Goal #1: identify and track children currently living in institutional settings and their families in areas which vendors operate; inform parents/guardians about family-based alternatives; provide permanency planning technical assistance to providers; provide quality information materials to families Goal #2- track the number of contacts with providers that are designed to promote, improve, increase and sustain family-based alternatives model. Goal #3-track contacts with stakeholders at state and local level regarding family-based alternatives; identify, analyze and make recommendations about system barriers to HHSC and state agencies. Page 18
  • Vendor Conference Presentation

    1. 1. Texas Health and Human Services Commission (HHSC ) Medicaid Fraud and Abuse Detection System (MFADS) Request for Proposals # 529-07-0164 Vendor Conference November 17, 2008
    2. 2. <ul><li>Welcome </li></ul><ul><li>Introductions </li></ul><ul><ul><li>Katherine Smith, Enterprise Contract and Procurement Services (ECPS) </li></ul></ul><ul><ul><li>Carlos Balderas, HUB Coordinator, Administrative Services Development (ASD) </li></ul></ul><ul><ul><li>David Brown, Assistant General Counsel </li></ul></ul><ul><ul><li>Larry Fisher, Senior Financial Analyst, HHS System Budget and Fiscal Policy </li></ul></ul><ul><ul><li>Genie DeKneef, Director, Technology Analysis, Development & Support, Office of Inspector General (OIG) </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>HUB Items </li></ul></ul><ul><ul><li>RFP Overview </li></ul></ul><ul><ul><li>Questions Submittal </li></ul></ul><ul><ul><li>Break </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, Katherine Smith, ECPS </li></ul></ul><ul><ul><li>Procurement Schedule </li></ul></ul><ul><ul><li>Solicitation Access – </li></ul></ul><ul><ul><li> </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. HUB Subcontracting Plan (HSP) Requirements
    7. 7. 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>
    8. 8. <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
    9. 9. If HSP is inadequate, response will be rejected HSP Information Page
    10. 10. HSP Information Page HUB GOALS Special reminders and instructions Company Information
    11. 11. If more than 20 subcontracting opportunities, click the link provided to continue adding HSP Information Page Enter subcontracting opportunities Subcontracting Declaration
    12. 12. One page for each area subcontracted (listed on page 1) HSP Information Page
    13. 13. List Line # and Subcontracting Opportunity HSP Information Page
    14. 14. Protégé performing the work HSP Information Page Skip to Sections 8 and 10
    15. 15. Professional Services Category HSP Information Page
    16. 16. Good Faith Efforts to find/include Texas Certified HUB Vendors HSP Information Page
    17. 17. Contact HUB Trade Organization HSP Information Page
    18. 18. Written Notification Requirements HSP Information Page
    19. 19. List 3 HUBs Contacted for this Subcontracting Opportunity HSP Information Page
    20. 20. List Subs Selected (HUBs & Non-HUBs) for this Subcontracting Opportunity HSP Information Page
    21. 21. Reason why HUB was not selected for this Subcontracting Opportunity HSP Information Page
    22. 22. Self Performance Explanation HSP Information Page Signature Affirms that True and Correct Information is Provided
    23. 23. <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”
    24. 24. 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: 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)
    25. 25. 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>
    26. 26. <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 Fraud and Abuse Detection System (MFADS)
    27. 27. Medicaid Fraud and Abuse Detection System (MFADS) <ul><li>Procurement Schedule </li></ul><ul><li>RFP Release Date October 31, 2008 </li></ul><ul><li>Vendor Conference November 17, 2008 </li></ul><ul><li>Vendor Questions Due December 1, 2008 </li></ul><ul><li>Letter of Intent Due December 1, 2008 </li></ul><ul><li>HHSC Posts Responses to Vendor Questions December 12, 2008 </li></ul><ul><li>Proposals Due December 29, 2008 </li></ul><ul><li>Respondent Demonstrations/Oral Presentations February 12, 2009 </li></ul><ul><li>Tentative Award Announcement March 16, 2009 </li></ul><ul><li>Begin Transition to new MFADS Solution May 1, 2009 </li></ul><ul><li>Implementation of new MFADS Solution September 1, 2009 </li></ul>
    28. 28. Background <ul><ul><li>Since 1991, the Texas Health and Human Services Commission (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 Health and Human Services. </li></ul></ul>
    29. 29. Background <ul><li>This RFP is issued pursuant to Section 531.106 of the Texas Government Code. This section requires that HHSC use learning or neural network technology to identify and deter fraud in the Medicaid program and to contract with a private or public entity to develop and implement the technology. </li></ul><ul><li>The current contract will terminate on August 31, 2009. </li></ul>
    30. 30. Mission <ul><li>The mission of HHSC in this procurement is to improve the early detection of fraud, abuse, and waste in the Texas Medicaid program and reduce financial loss to the State of Texas. HHSC will accomplish this mission by contracting with a vendor that is innovative, responsive to the needs of HHSC, the Medicaid program, and taxpayers, and responsible for discrete, measurable results. The contracted vendor will develop, implement, operate, maintain and support an automated information system that employs neural network or learning technology. </li></ul>
    31. 31. Scope of Work <ul><li>The Health and Human Services Commission (HHSC) Office of Inspector General (OIG) is mandated as addressed in Government Code 531.106 to identify and deter fraud, waste and abuse in the Medicaid program. Currently the MFADS and the Surveillance Utilization Review Subsystem (SURS) are two distinct systems. HHSC seeks a highly advanced single solution to meet the requirements and objectives of both these systems. Requirements for the SURS are addressed in the State Medicaid Manual Chapter 11 section 11335. The solution must meet and/or exceed all federal standards and contain, or exceed all functional capabilities required by CMS for certification as a SURS. The federal checklist for the SUR certification requirements can be found at the CMS certification checklists. The single solution must be designed, at a minimum, to do these critical functions: </li></ul><ul><li>Identify and deter suspected fraud, waste and abuse across all recipient and provider types, claims, programs and payment systems; </li></ul><ul><li>Utilize monthly Medicaid data extracts from a variety of sources, to produce and monitor data driven analyses and patterns of suspect behavior; </li></ul><ul><li>Generalize from the previous learning experiences and use this experience to identify new fraud, abuse, or waste schemes as they appear; </li></ul><ul><li>Produce user- friendly reports/tools that increase efficiencies and maximize results; </li></ul><ul><li>Provide continuously improved detection capabilities; </li></ul><ul><li>Be flexible to changing state and federal requirements necessary for maintenance of the integrity and performance of the system. </li></ul>
    32. 32. Scope of Work <ul><li>The vendor will present a strategy that includes the following: </li></ul><ul><li>Features and detection tools and methods that cover all provider types, claims, and payment systems; </li></ul><ul><li>Detection tools that increase detection by increasing the frequency and rate of identification of suspects; </li></ul><ul><li>Detection tools that greatly reduce the amount of manual, pre-investigative research and analysis currently required; </li></ul><ul><li>Detection tools that increase provider and recipient awareness and education of program regulations and requirements; and </li></ul><ul><li>Detection tools that assist HHSC-OIG in the implementation of necessary policy, procedural, and claims payment/processing changes that are identified as the result of analyzing the data. </li></ul>
    33. 33. Scope of Work <ul><li>The vendor’s solution must also include: </li></ul><ul><li>Targeted Queries (conversion of existing TQs and development of new TQs) </li></ul><ul><li>Online Inquiry Requirements </li></ul><ul><li>Output Requirements/Ad hoc reports </li></ul><ul><li>Record Retention </li></ul><ul><li>Federal Certification </li></ul><ul><li>Case Management component </li></ul><ul><li>Hospital Utilization Review and Nursing Facility Utilization Review components </li></ul><ul><li>Limited Program/Recipient Utilization Control component </li></ul><ul><li>System Operations </li></ul>
    34. 34. Performance Goals <ul><li>HHSC will monitor the performance of the contract issued under this </li></ul><ul><li>RFP. All services and deliverables under the contract shall be provided </li></ul><ul><li>at an acceptable quality level and in a manner consistent with </li></ul><ul><li>acceptable industry standards, custom, and practice. Failure to </li></ul><ul><li>produce deliverables in such a manner could result in remedies as </li></ul><ul><li>outlined in Section 2.3 </li></ul>
    35. 35. Financial Approach <ul><li>The State has chosen to utilize a FIXED PRICE APPROACH to the administrative services included in the Medicaid Fraud and Abuse Detection System Request for Proposal (MFADS RFP). </li></ul><ul><li>The objective of the Financial Approach is to describe the financial components that will enable the State to achieve the Mission Objectives described in Section 1.5 of the RFP. </li></ul>
    36. 36. Financial Approach <ul><li>Allowable and non-allowable direct and indirect costs, wherever applicable to any payments to the successful Vendor, will be governed by the principles set forth in the following regulations and documents (as they may be amended during the term of the contract): </li></ul><ul><li>Title 48 CFR, Chapter 1, Part 31, Contract Cost Principles and Procedures. </li></ul><ul><li>Title 48 CFR, Chapter 1, Part 30, Cost Accounting Standards Administration. </li></ul><ul><li>Title 48 CFR Chapter 99–Cost Accounting Standards. </li></ul>
    37. 37. Financial Approach <ul><li>In addition to costs that are unallowable pursuant to the above accounting principles, the State has deemed some of the allowable costs to be specifically unallowable for the contract resulting from this RFP. The list of additional unallowable costs is included in Section of the RFP. </li></ul>
    38. 38. Financial Approach <ul><li>The Vendor must maintain an accounting system that provides an audit trail containing sufficient financial documentation to allow for the reconciliation of billings, reports, and financial statements with all general ledger accounts and specific business functional areas within the applicable components. </li></ul>
    39. 39. Financial Approach <ul><li>The awarded Vendor must provide authorized governmental representatives of HHSC and the federal government full access to all financial and accounting records related to the performance of the resulting contract, including all requested subcontractor financial and accounting records. </li></ul>
    40. 40. Financial Approach <ul><li>The Vendor must provide quarterly financial statements, including an income statement, depicting the Vendor’s operation under the resulting contract no later than the twentieth calendar day following the end of the previous state fiscal year quarterly period. </li></ul><ul><li>Transition costs to meet the requirements of the RFP will be paid on a fixed fee basis. </li></ul>
    41. 41. Financial Approach <ul><li>Operational costs to meet the requirements of the RFP will also be paid on a fixed fee basis. The Operational fixed fees will be subject to the Retrospective Cost Settlement provisions documented in Section of the RFP. </li></ul><ul><li>Operational and/or Transition costs in excess of the final fixed price amount(s) included in the contract resulting from this RFP will not be paid by the State. </li></ul>
    42. 42. Financial Approach <ul><li>Separate Fixed administrative fees will be proposed for each 12 – month operational period of a resulting contract (and any applicable operational period less than 12 months). </li></ul><ul><li>All fees will be paid to the Vendor retrospectively. </li></ul>
    43. 43. Financial Approach <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 any administrative service fee (profit). </li></ul><ul><li>A complete listing of expenditures designated as Pass-Through Items are documents at Section of the RFP. </li></ul>
    44. 44. Financial Approach <ul><li>Administrative fees paid to the Vendor during each Operational Contract Year will consist of: </li></ul><ul><ul><li>(i) the Fixed Administrative Fees; </li></ul></ul><ul><ul><li>(ii) the Variable Administrative Fees; </li></ul></ul><ul><ul><li>(iii) the Administrative Fees for the Additional Periodic Activities; and </li></ul></ul><ul><ul><li>(iv) the Administrative Fees for the 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>
    45. 45. 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><li>(a) the Vendor’s Fees (Fee Ceiling) or </li></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>
    46. 46. Financial Approach <ul><li>On a quarterly basis, the state and the Vendor will reconcile the amounts disbursed to the Vendor with the Vendor’s allowable costs plus the allowable administrative service fee. </li></ul><ul><li>Additional details related to the Retrospective Cost Settlement provision included in the RFP are located in Section </li></ul>
    47. 47. Pricing Overview <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 MFADS 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, and </li></ul></ul><ul><ul><li>Attachment A, Appendix A-3 contains the formal Price Summary Sheets. </li></ul></ul>
    48. 48. Pricing Overview <ul><li>The prospective 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. </li></ul>
    49. 49. Pricing Overview <ul><li>Transition Pricing Schedules </li></ul><ul><li>The prospective Vendor’s transitional cost proposal sheets must include the “Key Milestones” the Vendor must accomplish during the Transitional period (Appendix A-1). Key Milestones are listed in Section of the RFP. </li></ul>
    50. 50. Pricing Overview <ul><li>The prospective Vendor’s operational cost proposal sheets must be delineated by the primary business functional areas (“functional area”) for the Operational period(s) (Attachment A, Appendix A-2) also listed in Section of the RFP. </li></ul>
    51. 51. Pricing Overview <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>
    52. 52. Pricing Overview <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><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>
    53. 53. Pricing Overview <ul><li>Price Summary Sheet 1 shows the fixed administrative fees for the transitional period by Key Milestone. The total fixed fees by Key Milestone on this sheet must be consistent with the detailed Transitional Pricing Schedules in Appendix A-1. </li></ul>
    54. 54. Pricing Overview <ul><li>Price Summary Sheet 2 shows the fixed administrative fees for each operational period. The total fixed fees for each 12 month operational period (or portion thereof) must be consistent with the more detailed Operational Pricing Schedules in Appendix A-2. </li></ul>
    55. 55. Pricing Overview <ul><li>Price Summary Sheet 3 shows the all-inclusive hourly labor rates and the proposed fixed annual inflator used to show costs associated with additional non-recurring and/or periodic activities to be performed by the Vendor by different types of service categories. </li></ul><ul><li>The maximum fees associated with additional non-recurring and/or periodic activities to be performed by the Vendor will be based on explicit fixed prices proposed for Vendor inputs and the actual number of hours worked on the specific modification by the Vendor’s staff and/or the staff of a Vendor’s subcontractor. </li></ul>
    56. 56. Pricing Overview <ul><li>The prospective Vendor must submit a Financial Operations Plan that shows how the Vendor will fulfill all financial requirements contained in the contract resulting from this RFP. </li></ul>
    57. 57. Pricing Overview <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>
    58. 58. Texas Health and Human Services Commission (HHSC ) Questions Submittal Followed by Break
    59. 59. Medicaid Fraud and Abuse Detection System (MFADS) <ul><ul><li>Non-binding verbal answers to vendor questions are provided. </li></ul></ul><ul><ul><li>Binding responses are posted on the procurement website by December 12, 2008. </li></ul></ul>
    60. 60. 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>