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Request for California Healthcare Eligibility, Enrollment, and Retention System Development and Operations Services. Yolanda Richardson, California Health Benefit Exchange Dianne Koelzer, CalHEERS Acting Project Director Overview of Draft Solicitation

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Request for California Healthcare Eligibility, Enrollment, and Retention System Development and Operations Services

Yolanda Richardson, California Health Benefit Exchange

Dianne Koelzer, CalHEERS Acting Project Director

Overview of Draft Solicitation

Health Benefit Exchange Board Presentation

December 20, 2011


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Agenda and

Solicitation Overview

Examples of Inclusion of Stakeholder Input

Draft Solicitation Section Review

What You Will See in Draft Solicitation

Review of Sections

Solicitation Development Timeline

Public Submission of Comments

CalHEERS Draft Solicitation Overview

December 20, 2011


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CalHEERS Partnership and

The California Healthcare Eligibility, Enrollment and Retention System (CalHEERS) project is jointly managed between the California Health Benefit Exchange, the Department of Health Care Services, and the Managed Risk Medical Insurance Board, with the assistance of the Office of Systems Integration. The Exchange will serve as the point of contact for the solicitation.

CalHEERS Draft Solicitation Overview

December 20, 2011


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CalHEERS Solicitation Overview and

  • Seek to assure the information technology system will support the common aspiration of the Exchange, Department of Healthcare Services, and the Managed Risk Medical Insurance Board to have maximum possible enrollment of the eligible individuals in the Exchange, Medi-Cal, and Healthy Families.

  • Listen and learn from partners’ expertise in California and nationally.

  • Build on existing capacity whenever possible.

CalHEERS Draft Solicitation Overview

December 20, 2011


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CalHEERS Solicitation Overview and

Policy and Business Approach to Developing CalHEERS

  • Policy drives IT design

  • Solicitation reflects current policies and includes requirements reflecting policies still under consideration

  • Policies and business approaches will be finalized:

    • Federal regulations forthcoming

    • State policy issues that are specific to the Exchange, Medi-Cal and/or MRMIB in process (e.g., roles and compensation of Assisters, Basic Health Program, employer/employee choice in the SHOP and staffing of a call/service center)

CalHEERS Draft Solicitation Overview

December 20, 2011


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CalHEERS Solicitation Overview and

Service Center Planning Process

CalHEERS Draft Solicitation Overview

December 20, 2011


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Incorporating Input and Building and the Best Possible System

CalHEERS Draft Solicitation Overview

December 20, 2011


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Incorporating Input and Building and the Best Possible System

CalHEERS Draft Solicitation Overview

December 20, 2011


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Incorporating Input and Building and the Best Possible System

CalHEERS Draft Solicitation Overview

December 20, 2011


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Incorporating Input and Building and the Best Possible System

CalHEERS Draft Solicitation Overview

December 20, 2011


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Incorporating Input and Building and the Best Possible System

CalHEERS Draft Solicitation Overview

December 20, 2011


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Incorporating Input and Building and the Best Possible System

CalHEERS Draft Solicitation Overview

December 20, 2011


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Incorporating Input and Building and the Best Possible System

CalHEERS Draft Solicitation Overview

December 20, 2011


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Incorporating Input and Building and the Best Possible System

CalHEERS Draft Solicitation Overview

December 20, 2011


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Incorporating Input and Building and the Best Possible System

CalHEERS Draft Solicitation Overview

December 20, 2011


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CalHEERS Solicitation Overview and

* includes Modified Adjusted Gross Income (MAGI) Medi-Cal, Children’s Health Insurance Program (CHIP), Access for Infants and Mothers (AIM), Advanced Premium Tax Credit (APTC), Cost Sharing Reductions (CSR), if enacted, the Basic Health Program (BHP) based on verified Application data and non-subsidized individual exchange coverage.

CalHEERS Draft Solicitation Overview

December 20, 2011


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CalHEERS Solicitation Overview and

CalHEERS Draft Solicitation Overview

December 20, 2011


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CalHEERS and Solicitation Overview

  • A FIRST DRAFT of:

    • Section 1 – Introduction and Background

    • Section 2 – Solicitation Process and Schedule

    • Section 3 – Vendor Qualifications

    • Section 4 – Vendor Scope of Work

    • Section 5 – Proposal Submission Instructions

    • Section 6 – Evaluation Criteria

    • Appendices

      • Appendix A – Glossary

      • Appendix B – Collaborative Environment and Life Cycle Governance

      • Appendix E – CMS Cloud Computing Standard

      • Appendix F – Gap Analysis Matrices

      • Appendix G – MEDS Functionality

      • Appendix H – CalHEERS Architecture Diagrams and Technical Reference

CalHEERS Draft Solicitation Overview

December 20, 2011


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CalHEERS Solicitation Overview and

CalHEERS Draft Solicitation Overview

December 20, 2011

  • A FIRST DRAFT of:

    • Attachments

      • Attachment 1 – Vendor Notice of Intent to Respond

      • Attachment 2 – Confidentiality Form

      • Attachment 3 – Requirements

      • Attachment 4 – Certification Checklist

      • Attachment 5 – Corporate Experience Matrix

      • Attachment 6 – Key Personnel Experience Matrix

      • Attachment 7 – Client Reference Form

      • Attachment 8 – Resume Form

      • Attachment 9 – Cost Schedules

      • Attachments 10 – Comment Matrix

      • Attachments 11 - 19 – Other Administrative Forms

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CalHEERS and Solicitation Overview

CalHEERS Draft Solicitation Overview

December 20, 2011

  • There are [placeholders] for:

    • Text and requirements that are still in progress

    • Decisions that are under discussion

    • Final graphics/organization charts to be provided/completed

  • Metrics and Estimated Service Volume Tables are under Development

    • Show the type of information to be provided

    • Anticipated to be completed before final solicitation is released

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Section 1 - Information and Background and

CalHEERS Draft Solicitation Overview

December 20, 2011

  • Purpose of the Solicitation of Proposal

  • Project Background

  • Business Need

    • Future Vision

    • Current Environment

    • Gap Analysis

  • Solicitation Instructions

  • Interpretive Conventions

  • General Vendor and Contract Information and Scope

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Section 2 – Solicitation Process and Schedule and

CalHEERS Draft Solicitation Overview

December 20, 2011

Identifies Single Point of Contact

Procurement Process and Schedule

Submitting Vendor Questions

Security and Confidentiality

The Exchange Terms and Conditions Pertaining to the Solicitation Process

22


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Section 3-Vendor Qualifications and

CalHEERS Draft Solicitation Overview

December 20, 2011

Minimum Vendor Qualifications

Vendor Key Staff Qualifications

23


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Section 4 – Vendor Scope of Work and

CalHEERS Draft Solicitation Overview

December 20, 2011

  • Overview

  • Business/Functional Scope

  • Technical Scope

  • Project Management Scope

  • System Development and Implementation Services

  • Deliverables

  • Operations and Maintenance Support

  • Alternative Approach

24


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Section 5 – Proposal Submission Instructions and

CalHEERS Draft Solicitation Overview

December 20, 2011

Proposal Submission

Subcontractor Agreements

Proposing Realistically

Proposal Organization and Format

Proposal Content Requirements

Proposal Submission Instructions

25


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Section 6 – Evaluation Criteria and

CalHEERS Draft Solicitation Overview

December 20, 2011

  • Proposal Evaluation and Selection

  • Evaluation Team

  • Evaluation Process

  • Proposal Scoring Methodology and Evaluation Criteria

    • Corporate Qualifications

    • Project Management and Staffing

    • Business Proposals

    • Technical Proposals

    • Cost Proposals

  • Best and Final Offer (BAFO)

  • Vendor Selection and Notification

26


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Section 6 – Evaluation Criteria and

CalHEERS Draft Solicitation Overview

December 20, 2011


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Project Funding and Value and

  • The solicitation does not include an estimated cost.

  • The solicitation makes clear the funding of contracted services will partially come from the Level I Grant and the not yet submitted or approved, Level II Grant and from program partners.

  • The solicitation asks the vendor to take advantage of systems developed by other states or the federal government that can be used to provide the required services.

  • The solicitation also requires the vendor to share the technologies developed at no cost to other states or the federal government.

CalHEERS Draft Solicitation Overview

December 20, 2011


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CalHEERS Solicitation Development Timeline and

CalHEERS Draft Solicitation Overview

December 20, 2011


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Commenting on the Draft Solicitation and

CalHEERS Draft Solicitation Overview

December 20, 2011

  • Draft solicitation will be posted today at www.hbex.ca.gov under the Solicitations tab

  • Use the Solicitation Comment Matrix at www.hbex.ca.gov under the Solicitations tab

  • Follow instructions on first tab for entering comments and submit comments to [email protected]

  • Combine Comments – One set of comments per organization

  • All comments are welcome and must be submitted by

    December 30, 2011 by 5:00pm

  • All comments will be thoroughly reviewed by the CalHEERS partnership


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