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Kyle L. Janek , M.D., Executive Commissioner PowerPoint Presentation
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Kyle L. Janek , M.D., Executive Commissioner

Kyle L. Janek , M.D., Executive Commissioner

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Kyle L. Janek , M.D., Executive Commissioner

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  1. Kyle L. Janek, M.D., Executive Commissioner VENDOR CONFERENCE STAR Kids Request for Proposal No. 529-13-0071 July 31, 2014

  2. Welcome • Introductions • Housekeeping Items

  3. HHSC Procurement Roles • PCS: Responsible for procurement activity • Program: Responsible for project scope, requirements, performance, results, contract management/monitoring • HUB: Responsible for HUB Subcontracting Plan (HSP) requirements and evaluation • Legal: Provides legal guidance and advice to the agency

  4. Vendor Conference Overview • Procurement Activities • RFP Overview • HUB Overview • Questions • Break • Preliminary Responses to Questions • Closing Comments

  5. Procurement Activities • Sole Point of Contact -- Section 1.2 • Procurement Schedule -- Section 1.3 • Solicitation Access http://www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asp • Submission Requirements – Section 3.14 • Solicitation Changes • Proposal Screening and Evaluation • Award Information

  6. Sole Point of Contact The sole and only permissible point of contact for inquiries concerning this RFP is Richard Blincoe. As a reminder, all communications relating to this RFP must be directed to the sole point of contact for this procurement. Failure to comply with these requirements may result in proposal disqualification.

  7. Procurement Schedule • RFP Release Date • Vendor Conference • Respondent Questions Due • Post Response to Questions (est.) • Proposals Due (2:00 P.M. Central Time) • Deadline for Proposal Withdrawal • Tentative Award Posting (est.) • Anticipated Contract Effective Date July 18, 2014 July 31, 2014 August 5, 2014 September 16, 2014 October 30, 2014 October 30, 2014 To Be Announced September 1, 2015

  8. Request for Proposals No. 529-13-0071 RFP Overview • STAR Kids Overview • RFP Mission • Contract Terms • Eligible Populations • Scope of Work • Evaluation Criteria

  9. STAR Kids Overview • Senate Bill 7, 83rd Legislature, Regular Session, 2013, directs HHSC to establish a mandatory, capitated STAR Kids managed care program tailored to provide Medicaid benefits to children and young adults with disabilities. • S.B. 7 also calls for the inclusion of the Medically Dependent Children Program (MDCP) and requires HHSC to consult with the STAR Kids Medicaid Managed Care Advisory Committee and Children’s Policy Council on the establishment and implementation of the program.

  10. STAR Kids Overview • The members that will be served through STAR Kids have diverse strengths and challenges. As such, services and supports provided to STAR Kids members must reflect broad differences in diagnoses, conditions, prior treatments, development, environment, age, family dynamics, and geography. • By working with Members and their families, STAR Kids MCOs will customize and coordinate acute, behavioral, and long-term services and supports (LTSS) through an individualized planning and service design process. Through comprehensive service coordination, STAR Kids Members will receive services and supports tailored to their individual needs.

  11. RFP Mission • The purpose of this procurement is to contract with multiple Managed Care Organizations (MCOs) to establish the STAR Kids Medicaid managed care program. • HHSC’s mission for the STAR Kids program is to enable STAR Kids members to live and thrive in a setting that maximizes their health, safety, and overall well-being.

  12. RFP Mission STAR Kids is established with the following goals: • Coordinate care across service arrays; • Improve quality, continuity, and customization of care; • Improve access to care and provide person-centered Health Homes; • Improve ease of program participation for Members, MCOs, and Providers; • Improve Provider collaboration and integration of different services; • Improve Member outcomes to the greatest extent achievable; • Prepare young adults for the transition to adulthood; • Foster program innovation; and • Achieve cost efficiency and cost containment.

  13. Contract Terms • HHSC will award one contract per MCO, which will include all awarded MCO service areas. The initial contract period will be for three years. • HHSC reserves the right to extend the contract period, not to exceed a total of eight operational years. • All STAR Kids MCOs must begin serving members on the operational start date.

  14. Eligible Populations • Children and young adults under age 21 who receive Social Security Income (SSI) or Home and Community-based Services (HCBS) Waiver program services must enroll in STAR Kids. • Children and young adults who reside in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) must also enroll in STAR Kids.

  15. Eligible Populations • Medically Dependent Children’s Program (MDCP) participants will receive all of their services through STAR Kids, including long-term services and supports (LTSS) provided through MDCP. • Children and young adults enrolled in other HCBS Waiver programs or who receive services through an ICF/IID will receive Medicaid State Plan services and service coordination through STAR Kids, but will separately receive LTSS specific to their program. • Excluded populations include children in state conservatorship and individuals under 21 who reside in nursing facilities.

  16. Scope of Work Covered Services • The MCO must comply with all contract provisions including all applicable state and federal laws, rules, regulations, and waivers. • The MCO must provide full coverage of medically and functionally necessary covered services to all members in accordance with contractual requirements. • The MCO may propose value-added services and case-by-case added services that compliment the provision of medically and functionally necessary covered services.

  17. Scope of Work Access to Care • The MCO must have network PCPs, behavioral health, specialty, pharmacy, and home and community-based providers in sufficient number and capacity. • Appointments for covered services must be provided within contractually specified timeframes. • Members must be provided access to out-of-network services if medically necessary covered benefits are not available within the network.

  18. Scope of Work Provider Network • The MCO must enter into written contracts with properly credentialed providers. • The MCO must maintain a provider network sufficient to provide all members with access to the full range of covered services required under the contract. • The MCO must enter into contracts with any willing Significant Traditional Provider (STP) and develop short and long-term strategies to increase access to qualified providers. • The MCO will include telemedicine providers in its network to increase access to care in rural or underserved areas.

  19. Scope of Work Primary Care Providers (PCPs) and Health Home • All STAR Kids members must be provided with a patient and family-centered PCP. • STAR Kids PCPs must coordinate with other relevant parties to ensure member’s physical and behavioral health needs are met. • MCOs must also provide access to a health home for all members who will benefit from a health home. • MCOs must develop specific incentives for providers who meet the requirements for patient-centered medical homes found in Texas Government Code § 533.0029.

  20. Scope of Work Member Services and Materials • The MCO must have a member services department to assist members in obtaining covered services. • Member services must include a member hotline, nurse hotline, and behavioral health hotline as well as member education and a member complaints and appeals process. • Member materials must include a member identification card, member handbook, provider directory, welcome letter, and an internet website. • The MCO must also establish member advisory groups to identify and address needs and goals of STAR Kids members.

  21. Scope of Work Clinical and Administrative Advisory Committee • The MCO must establish Clinical and Administrative Advisory Committees in each STAR Kids service area served. • Clinical and Administrative Advisory Committees must be used to help review and improve clinical and administrative practices. • Membership in a Clinical and Administrative Advisory Committee must include the following provider types: PCP, specialty care, behavioral health, home and community support services, therapy provider, medical equipment and supplies, and pharmacy.

  22. Scope of Work Management and Information Systems (MIS) • The MCO must maintain a MIS to support the following operational and administrative areas: • Enrollment/Eligibility Subsystem • Provider Subsystem • Encounter/Claims Processing Subsystem • Financial Subsystem • Utilization/Quality Improvement Subsystem • Reporting Subsystem • Interface Subsystem • Third Party Recovery (TPR) Subsystem

  23. Scope of Work Continuity of Care • The MCO must ensure that the healthcare of newly enrolled Members is not disrupted, compromised, or interrupted. • The MCO must ensure new Members have continued authorization of services for the same amount, duration, and scope for the shortest period of one of the following: (1) 90 calendar days after the transition to a new MCO, (2) until the end of the current prior authorization, or (3) until the MCO has appropriately evaluated and administered the STAR Kids Screening and Assessment Process and issued or denied a new authorization. • The MCO must ensure members receiving community-based services prior to the operational start date continue to receive those services for up to six months afterthe Operational Start Date.

  24. Scope of Work Service Coordination • Service coordination provides the Member with initial and ongoing assistance identifying, selecting, obtaining, coordinating, and using covered services and other supports to enhance the Member's well-being, independence, integration in the community, and potential for productivity. • Service coordinators must work with PCPs, network providers and other resources to help address the full spectrum of a member’s needs. • Upon identification of need or member request, members must be provided with access to a named service coordinator and comprehensive service coordination teams.

  25. Scope of Work Service Coordination • The MCO must ensure that Service Coordinator-to-Member ratios are clinically appropriate and evidence-informed. • The MCO may allow a member to receive service coordination through an integrated health home if the individual providing service coordination and the service coordination structure meet STAR Kids program requirements. • For members who receive non-capitated HCBS waiver services, STAR Kids service coordinators must communicate regularly with the DADS or DSHS staff members or contractors responsible for overseeing the member’s HCBS waiver services.

  26. Scope of Work Individual Service Plan (ISP) • Each STAR Kids MCO must create and regularly update a comprehensive person-centered ISP for each STAR Kids member. • The purpose of the ISP is to articulate assessment findings, short and long-term goals, service needs, and member preferences. • The ISP must be used to communicate and help align expectations between the member, their LAR, the MCO and key service providers. • The ISP may also be used by the MCO and HHSC to measure Member outcomes over time.

  27. Scope of Work Adult Transition Planning • The MCO must help to assure that teenage and young adult Members receive early and comprehensive transition planning to help prepare them for service and benefit changes that will occur following their 21st birthday. • Each MCO is responsible for conducting ongoing transition planning starting when the Member turns 15 years old. • MCO staff must include Transition Specialists dedicated to counseling and educating Members and others in their support network about considerations and resources for transitioning out of STAR Kids.

  28. Scope of Work STAR Kids Screening and Assessment Requirements • All STAR Kids MCOs are responsible for conducting comprehensive, holistic, and evidence-based service needs assessments for all Members. • A key component of the process is use of the STAR Kids Screening and Assessment Instrument (SAI). • The STAR Kids SAI encompasses four modules: the Core, the Personal Care Assessment Module (PCAM), Nursing Care Assessment Module (NCAM), and the MDCP Module. • All STAR Kids members must receive the Core, which will indicate if there is need for the PCAM, NCAM or other screenings or assessments.

  29. Scope of Work Medically Dependent Children Program (MDCP) • MDCP STAR Kids provides community-based LTSS for individuals under the age of 21 with complex medical needs as a cost-effective alternative to living in a Nursing Facility. • The MCO must provide all covered services included in the MDCP service array for all MDCP STAR Kids members. • The MCO will use STAR Kids SAI MDCP Module to help determine eligibility and an annual cost limit for each MDCP member. • As a part of the ISP planning process, the MCO must establish an MDCP plan of care as a part of the STAR Kids ISP that does not exceed the Member's cost limit.

  30. Evaluation Criteria (Section 5.3) HHSC will evaluate each proposal using the following criteria, in descending order of priority, developed from the best value factors listed in Section 2 of the RFP. • The extent to which the goods and services meets HHSC’s needs and the needs of the Members for whom the goods and services are being purchased; • Indicators of probable vendor performance; • Effect of the acquisition on agency productivity; and, • Delivery terms.

  31. HUB Subcontracting Plan(HSP) Requirements

  32. Historically Underutilized Business ParticipationAgenda Topics • RFP Section 4.2.5 Historically Underutilized Business Participation Requirements • HUB Subcontracting Plan Development and Submission • HSP Quick Checklist – Handout • HSP Methods • HUB Subcontracting Notification Form III. HSP Prime Contractor Progress Assessment Report

  33. Historically Underutilized Business Participation • Historically Underutilized Business Participation Requirements

  34. Historically Underutilized Business Participation • Historically Underutilized Business Participation Requirements • HUB Participation Goals – Section 4.2.5.3 • Potential Subcontracting Opportunities – Section 4.2.5.5 • Centralized master Bidders List and HUB directory – Section 4.2.5.5 • Vendor Intends to Subcontract – Section 4.2.5.6

  35. Historically Underutilized Business Participation • Historically Underutilized Business Participation Requirements (cont) • Minority or Women Trade Organizations – Section 4.2.5.6.2 • Self Performance – Section 4.2.5.7 • HSP Changes After Contract Award – Section 4.2.5.8 • Reporting and Compliance with the HSP – Section 4.2.5.8

  36. Historically Underutilized Business Participation • HUB Subcontracting Plan (HSP) Development and Submission • Note: All Respondents must submit a HSP regardless if its intent is to subcontract or self perform all the work under the Contract.

  37. Historically Underutilized Business Participation • HUB Subcontracting Plan (HSP) Development and Submission • Note: All Respondents must submit a HSP regardless if its intent is to subcontract or self perform all the work under the Contract.

  38. If HSP is inadequate, response will be rejected HUB GOALS Special reminders and instructions HSP Information Page

  39. Historically Underutilized Business Participation • HSP Quick Checklist ** See Checklist Handout**

  40. Historically Underutilized Business Participation ii. HSP Methods Note: • There are five (5) Method Options to choose from in order to develop and submit the HSP. • Respondent’s should indicate their response which Method Option was selected.

  41. Historically Underutilized Business Participation Method Options Respondent may choose from one of the following methods when completing the HSP: • Method I – if 100% of your subcontracting opportunities will be performed using only HUB vendors; • Method II – if one or more of the subcontracting opportunities identified will be performed using HUB protégé’s; • Method III – if a combination of HUBs and Non-HUBs are used to perform the subcontracting work identified AND the HUB goal identified in the solicitation is met or exceeded;

  42. Historically Underutilized Business Participation Method Options A Respondent may choose from one of the following methods when completing the HSP (cont.): • Method IV – if a combination of HUBs and Non-HUBs are used to perform the subcontracting work identified AND the HUB goal identified in the solicitation is not met or exceeded; and • Method V - if the Respondent intends to self perform all of the work utilizing their own resources, equipment, employees, and supplies.

  43. Historically Underutilized Business Participation All Methods For ALL Methods the following steps are required to be completed on the HSP Form: • Page 1 - Section 1 - Respondent and Requisition Information. • Page 2 - Company and Requisition Information. • Page 2 - Section 2(a) – Subcontracting Intentions. • Section 4 – Affirmation and Sign.

  44. Historically Underutilized Business Participation All Methods For ALL Methods the following steps are required to be completed on the HSP Form: • Page 1 - Section 1 - Respondent and Requisition Information. • Page 2 - Company and Requisition Information. • Page 2 - Section 2(a) – Subcontracting Intentions. • Section 4 – Affirmation and Sign.

  45. Step by Step HSP Information Page Respondent and Requisition Information

  46. Company Name and Requisition # Subcontracting Intentions: Declaration: Check – “Yes” if you plan to subcontract Check – “No” if you will not be subcontracting any portion of the contract

  47. Historically Underutilized Business Participation All Methods For ALL Methods the following steps are required to be completed on the HSP Form: • Page 1 - Section 1 - Respondent and Requisition Information. • Page 2 - Company and Requisition Information. • Page 2 - Section 2(a) – Subcontracting Intentions. • Section 4 – Affirmation and Sign.

  48. Step by Step Section 4; Affirmation Signature Affirms that Information Provided is True and Correct.

  49. METHOD I • If all (100%) of your subcontracting opportunities will be performed using only HUB vendors, complete: • All of the steps in Sections 1, 2, and 4 of the HSP. • Section 2 b. – List all the portions of work you will subcontract, and indicate the percentage of the contract you expect to award to HUB vendors. • Section 2 c. – Yes. • HSP GFE Method A (Attachment A) – Complete this attachment for each subcontracting opportunity.

  50. Step by Step Complete Section 2-b;List all the portions of work you will subcontract, and indicate the % of the contract you expect to award to all HUBs. Complete Section 2-c; Yes if you will be using only HUBs to perform all SubcontractingOpportunities in 2-b.