Opportunity Detail

Questions and Answers

Ohio Medicaid Managed Care Organizations
Document #:  ODMR20210024


Question:   In section 3.4.8.3.17. of the Base Document, it states "Describe the Applicant’s proposed approach to coordinating and collaborating with the SPBM, including but not limited to the areas identified below. For purposes of the response, please assume that the Applicant is not affiliated with the SPBM. a. Clarifying roles and responsibilities b. Communication and coordination and c. Data and information exchange requirements and timeframes.” Question: The Model MCO Provider Agreement, Appendix V, “Coverage and Services,” Section 1. “Basic Benefit Package,” A. “Service Coverage Requirements.”i.4 lists immunizations as the responsibility of the MCO. Please confirm that immunizations will be the responsibility of the MCO to cover through the medical benefit, using MCO-developed utilization management criteria, as this impacts how MCOs responds how it will coordinate with the SPBM.

Answer:   The Model MCO Provider Agreement, Appendix B, "Coverage and Services," Section 1.a.i.4. requires the MCO to cover "[i]mmunizations, following coverage requirements provided by ODM for any newly approved vaccine under the Vaccines for Children (VFC) program[.]" It is not a general requirement for all immunizations.

Date: 11/12/2020

Inquiry: 79776


Question:   In section 3.4.8.3.17. of the Base Document, it states "Describe the Applicant’s proposed approach to coordinating and collaborating with the SPBM, including but not limited to the areas identified below. For purposes of the response, please assume that the Applicant is not affiliated with the SPBM. a. Clarifying roles and responsibilities b. Communication and coordination and c. Data and information exchange requirements and timeframes.” Question: The Model MCO Provider Agreement, Appendix V, “Coverage and Services,” Section 1. “Basic Benefit Package,” A. “Service Coverage Requirements.”i.3 lists physician administered drugs as the responsibility of the MCO. Please confirm that any drugs not currently on the UPDL will be the responsibility of the MCO and covered through the medical benefit, using MCO-developed utilization management criteria, as this impacts how MCOs responds how it will coordinate with the SPBM.

Answer:   The pharmacy benefit administered by the SPBM will include UPDL, vaccines, other medications, and selected durable medical equipment. The MCO's utilization managment criteria under the medical benefit would be subject to the provisions of the Model MCO Provider Agreement.

Date: 11/12/2020

Inquiry: 79775


Question:   Regarding Attachment A Appendix H section 2.a.i. it is stated, "The MCO must meet the alternative payment methodology (APM) target requirements identified in Table H.1 below. APM targets represent the percentage of payments, which include the ODM-required value based initiatives described in this appendix." Question: In reference to Table H.1 APM Target Requirements, do the thresholds set in each year have to be met by end of calendar year 12/31/20 or by the beginning the calendar year 01/01?

Answer:   The measurement year for this requirement is the calendar year. All payments made for services delivered during the measurement year will be evaluated when determining compliance with this requirement.

Date: 11/12/2020

Inquiry: 79543


Question:   In Appendix K.5.b.iii pg. 245, regarding the statement: The MCO must provide updated claims status demonstrating all claims activity on a daily basis to ODM Is the format that ODM visualizes for the above process a daily feed of the unsolicited 277 (277u) claims status response to ODM?

Answer:   The operational details will be finalized during the readiness period.

Date: 11/12/2020

Inquiry: 79724


Question:   In Reference to Section 2.4 of the Base Document as it pertains to the PIHP Services in the rate table to the Managed Care Procurement Data Book and Capitation Rate Methodology document, the Base Document states "ODM will hold an actuarial conference for potential Applicants. While attendance is encouraged, attendance at the conference is not a prerequisite for submitting an Application. The conference will be held virtually at the date and time specified in Section 2.1, Anticipated RFA Schedule. To participate in this conference, potential Applicants must register at https://attendee.gotowebinar.com/register/4009304689454483213. The purpose of the actuarial conference is to discuss the rate setting methodology and the data book. Potential Applicants may ask clarifying questions regarding the rate setting methodology and the data book at the actuarial conference however, ODM’s verbal response to any question at the actuarial conference is preliminary and non-binding. Potential Applicants should submit written questions in accordance with Section 2.5, Question and Answer Period." Question: OhioRISE eligibility is partially determined based on the CANS assessment that will be completed for impacted members. What data proxy was used to determine eligibility from a data perspective knowing that the assessment data is not available?

Answer:   The methodology utilized to identify members enrolled in the OhioRISE program is outlined in pages 3 and 4 of the OhioRISE Data Book and Methodology Report (Data Book). Information related to the individuals who are anticipated to be considered for enrollment in the OhioRISE program via the CANS assessment process is discussed under Step 2 and Step 3 on page 4 of the Data Book. The OhioRISE Data Book can be accessed at https://procure.ohio.gov/proc/viewProcOpps.asp?oppID=22000

Date: 11/12/2020

Inquiry: 81924


Question:   In Reference to Section 2.4 of the Base Document as it pertains to the PIHP Services in the rate table to the Managed Care Procurement Data Book and Capitation Rate Methodology document, the Base Document states "ODM will hold an actuarial conference for potential Applicants. While attendance is encouraged, attendance at the conference is not a prerequisite for submitting an Application. The conference will be held virtually at the date and time specified in Section 2.1, Anticipated RFA Schedule. To participate in this conference, potential Applicants must register at https://attendee.gotowebinar.com/register/4009304689454483213. The purpose of the actuarial conference is to discuss the rate setting methodology and the data book. Potential Applicants may ask clarifying questions regarding the rate setting methodology and the data book at the actuarial conference however, ODM’s verbal response to any question at the actuarial conference is preliminary and non-binding. Potential Applicants should submit written questions in accordance with Section 2.5, Question and Answer Period." Question: We saw the services that were pulled out of the base experience for PIHP based on Appendix C of the data book. It is our understanding that some members that use these services from Appendix C will not be eligible for the OhioRISE program. Is this correct? If so, how were these members identified so that their claims experience remains in the base data for capitation development?

Answer:   We confirm that some members that utilize services listed in Appendix C are not anticipated to enroll in the OhioRISE program. Note that Appendix A provides the service identification logic, whereas Appendix C provides the diagnosis information utilized to identify members potentially eligible for the OhioRISE program. The methodology utilized to identify members enrolled in the OhioRISE program is outlined in pages 3 and 4 of the OhioRISE Data Book and Methodology Report (Data Book). The services identified in Appendix A were included in the Data Book provided in Enclosure 1 only for the members identified as being potentially enrolled in the OhioRISE program. All claims experience for all other members was excluded from the OhioRISE data book development process. The OhioRISE data book can be accessed at https://procure.ohio.gov/proc/viewProcOpps.asp?oppID=22000.

Date: 11/12/2020

Inquiry: 81923


Question:   In Reference to Section 2.4 of the Base Document as it pertains to the PIHP Services in the rate table to the Managed Care Procurement Data Book and Capitation Rate Methodology document, the Base Document states "ODM will hold an actuarial conference for potential Applicants. While attendance is encouraged, attendance at the conference is not a prerequisite for submitting an Application. The conference will be held virtually at the date and time specified in Section 2.1, Anticipated RFA Schedule. To participate in this conference, potential Applicants must register at https://attendee.gotowebinar.com/register/4009304689454483213. The purpose of the actuarial conference is to discuss the rate setting methodology and the data book. Potential Applicants may ask clarifying questions regarding the rate setting methodology and the data book at the actuarial conference however, ODM’s verbal response to any question at the actuarial conference is preliminary and non-binding. Potential Applicants should submit written questions in accordance with Section 2.5, Question and Answer Period." Question: It is our understanding that the estimated enrollment for the OhioRISE program will be in the 50 – 60,000 range by the end of the year. Please provide the estimated member months assumed to be enrolled by Rate Cell in the PIHP for 2022.

Answer:   Estimated calendar year 2022 member month information for the OhioRISE program is not available at this time.

Date: 11/12/2020

Inquiry: 81922


Question:   Medicaid RFP Attachment A Appendix K: Information Systems, Claims, and Data, Section 5.c.i. Page 246. In regards to the following: The MCO must implement claims edits (e.g., Strategic National Implementation Process [SNIP], National Correct Coding Initiative [NCCI]) at the direction of ODM. There is a requirement that managed care plans implement edits mandated by ODM. Also understand in earlier sections that the Fiscal Intermediary will apply the Strategic National Implementation Process (SNIP) edits. Does ODM intend for plans to have discretion in the implementation of claim edits beyond those mandated by ODM and those applied by the Fiscal Intermediary?

Answer:   ODM plans on applying 1-4, and some of 7 SNIP edits. Those will be performed in EDI. FI will not apply any additional SNIP edits. The MCOs will have discretion on the edits they want to perform. The MCO’s edits must align with the business rules identified in the provider agreement and not conflict with ODM policy.

Date: 11/12/2020

Inquiry: 79894


Question:   Medicaid RFP Attachment A Appendix A, Section 2.e.iv.1. Page 39. The MCO must notify ODM within one business day of becoming aware of changes in the members address, phone number, email address, or other relevant contact information. Should MCO send updated contact to ODM or to County ODJFS office? Does the one business day rule apply to recently deceased members or to all members submitting contact changes?

Answer:   The notification must be made to the county department of job and family services (CDJFS) for all members. The operational details will be finalized through collaboration with the MCOs and OJFSDA during the readiness period.

Date: 11/12/2020

Inquiry: 79888


Question:   Medicaid RFP Attachment A Appendix K, Section 1.d.ii. Page 242. The MCO must conduct thorough end-to-end testing for all new program implementations, system upgrades, software updates, and new or revised data requirements. The MCO must provide a description of system changes and a summary of testing results, including any corresponding mitigation plans to ODM for review and approval prior to implementation. We frequently make changes to enhance our member portal and provider directory websites. Are they included in the scope of this requirement? If so, how are "program implementations" and "new or revised data requirements" defined?

Answer:   Program implementations would include changes in program functionality or requirements. New or revised data requirements would be any data element changes to the system either removing data fields or adding data fields.

Date: 11/12/2020

Inquiry: 79886


Question:   Medicaid RFP Attachment A Appendix C: Population Health & Quality 4.c.i.9.e. Page 125. Ensuring the active referral to and follow-up on identified needs related to SDOH such as those outlined above by: Reimbursing network providers for follow-up after referral to confirm that the member received the service (e.g., Unite Us, HIEs). Is this a mandate to reimburse?

Answer:    Yes, MCOs must reimburse network providers for follow-up after referral.

Date: 11/12/2020

Inquiry: 79882


Question:   Medicaid RFP Attachment A Appendix C: Population Health & Quality 4.c.i.9.d. Page 125. In regards to the following: Ensuring the active referral to and follow-up on identified needs related to SDOH such as those outlined above by: Reimbursing SDOH codes (z codes). Is this a mandate to reimburse Z codes if there is a fee schedule?

Answer:    MCOs must reimburse for Z-codes included in the FFS fee schedule and the MCO may reimburse for additional Z-codes at MCO option.

Date: 11/12/2020

Inquiry: 79881


Question:   Medicaid RFP Attachment A Appendix K Section 7.h. Encounter Data Submission Requirements. Page 252. Regarding encounter submissions, the last sentence reads as follows: "ODM reserves the right to direct the MCOs editing and payment." Is this comment related to edits used in the encounters submission process or more broadly to provider claim edits? Can ODM clarify if ODM will accept supplemental data to support encounter submissions?

Answer:   1. ODM reserves the right to direct the MCOs’ editing and payment with regard to either the encounters submission process or provider claim edits or both. This determination may be made based upon many circumstances, including, but not limited to, ODM’s evaluation of encounter submissions provided by the MCOs. 2. Without more information regarding the type and substance of supplemental data referred to in this question, ODM cannot provide a response.

Date: 11/12/2020

Inquiry: 79869


Question:   In regards to the Managed Care Procurement Data Book and Capitation Rate Methodology pg. 4, the single PBM RFP that was released earlier this year stated that the selected single PBM would have a non-risk contract. Reviewing the Data Book and RFA, it appears that MCOs will not be at financial risk for retail pharmacy costs. Can ODM please confirm this understanding?

Answer:   Your assumption is correct.

Date: 11/12/2020

Inquiry: 79849


Question:   Appendix L Section 7 "Reinsurance Requirements" on page 261 of the RFA describes the reinsurance requirements for an MCO. To determine a new bidders reinsurance liability, would the state consider providing either a de-identified list of the large claims above a defined attachment point, a continuance table, or an alternative that will allow us to obtain the required coverage?

Answer:   ODM will work with the chosen applicants during readiness review to determine the appropriate information that would be shared to assist them in pricing reinsurance.

Date: 11/12/2020

Inquiry: 79758


Question:   In regards to Appendix K.c.xiii.Data and Systems Integration pg. 294, we assume that the Single Pharmacy Benefit Manager will be required to allow MCO’s to be provisioned access to the SPBM’s secure portal and (separately) will be required to send to the MCO’s scheduled NCPDP formatted processed pharmacy claims data for purposes of the MCO to meet the requirements in the subsection. Are we correct in this assumption? If we are not correct, please clarify.

Answer:   Yes

Date: 11/12/2020

Inquiry: 79731


Question:   Medicaid RFP Section 1: Introduction and Background 1.2 Background Page 2. In regards to the following: To reduce provider burden and promote consistency across Ohio’s Medicaid managed care program, ODM will centralize claims submission, prior authorization submission, and credentialing and re-credentialing. ODM’s fiscal intermediary (FI) will serve as a single clearinghouse for all medical (non-pharmacy) claims. ODM’s fiscal intermediary will also serve as the single, centralized location for provider submission of prior authorization requests. Under ODM’s centralized credentialing process, providers will submit an application for Medicaid enrollment and credentialing to ODM and will not need to submit credentialing and re-credentialing materials to MCOs. Question: Is ODM centralizing the claim and auth submissions for ALL provider types, inclusive of dental and vision providers? Has ODM defined provider types that will not submit claims through the fiscal intermediary?

Answer:   Claims submission and prior authorization for all medical (non-pharmacy) claims will be submitted via the fiscal intermediary. No provider types have been identified for exclusion from this process.

Date: 11/12/2020

Inquiry: 79873


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: Will each application be scored individually in its entirety, or will the responses to questions be directly compared across applicants?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79868


Question:   In regards to Appendix K.f.iii. Systems Audit, pg. 299, regarding the phrase “cloud hosting provider”, we assume that the two Ohio HIEs are not covered under this phrase for purposes of the MCO ensuring adherence to Fed-RAMP or NIST 800-53 Rev 4. In other words, we assume that it is up to the HIEs to ensure their adherence to these requirements or any other state or federal requirements. Are we correct in our assumption - if we are not correct please clarify.

Answer:   It is up to HIEs to ensure their adherence to these requirements or any other state or federal requirements.

Date: 11/12/2020

Inquiry: 79719


Question:   In regards to Section 3.4.8.3 Question 23 pg. 20 RFA and Attachment A, Appendix F Provider Network 9. Telehealth pg. 187-188, the RFA and Model MCO Provider Agreement do not appear to provide a clear definition of telehealth. Can ODM please clarify?

Answer:   Refer to Ohio Administrative Code Rule 5160-1-18 for the definition of telehealth.

Date: 11/12/2020

Inquiry: 79714


Question:   RFA Section 3.4.6 Required Forms (Tab 5), page 14 In regards to the forms requirements in section 3.4.6, is the expectation that “subcontractors” completing Attachments D, F, G, and H are the list of approved delegates or is there another group ODM is contemplating? Also, is it required that this group complete each of the Attachments D, F, G, and H individually?

Answer:   See responses to inquiries #79467 and 79598.

Date: 11/12/2020

Inquiry: 79706


Question:   The Baseline Provider Agreement, Attachment A, Article VIII states, "When initiated by the MCO, the MCOs written notice of termination of or decision not to renew this Agreement must be received by ODM at least 240 calendar days in advance of the termination or renewal date..." Please confirm that, pursuant to and in accordance with this provision, an MCO has the right to terminate the Baseline Provider Agreement for convenience, upon appropriate notice.

Answer:   Any termination for any reason by the MCO must follow the provisions of Article VIII of the Baseline Provider Agreement, as well as Appendix O. Offerors should note that many obligations under the agreement survive termination of the agreement.

Date: 11/12/2020

Inquiry: 79627


Question:   Section 3.4.8.4.30. of the Base Document states, "Describe the Applicant’s claims audit processes, including but not limited to the following: a. A description of the Applicant’s audit functions, including staffing b. For the most recent three months: i. The number of claims that were adjudicated ii. The percent of adjudicated claims that were auto adjudicated (system-paid versus manually processed) iii. The percent of auto-adjudicated claims that were subject to routine audit functions and iv. The percent of manually processed claims that were subject to routinely audit functions.” Question: For this response, does ODM intend for applicants to respond only with Medicaid data?

Answer:   See response to inquiry #79479.

Date: 11/12/2020

Inquiry: 79781


Question:   Section 3.4.8.4.30. of the Base Document states, "Describe the Applicant’s claims audit processes, including but not limited to the following: a. A description of the Applicant’s audit functions, including staffing b. For the most recent three months: i. The number of claims that were adjudicated ii. The percent of adjudicated claims that were auto adjudicated (system-paid versus manually processed) iii. The percent of auto-adjudicated claims that were subject to routine audit functions and iv. The percent of manually processed claims that were subject to routinely audit functions.” Question: With regard to comparing claims audit data amongst applicants, how does ODM intend to normalize responses to ensure fair comparison? Applicants may have their scores compared against a company in a completely different service area with a different member mix, provider engagement, social determinants of health and program requirements. Also, typically there are different health demographics between Medicaid, commercial, and Medicare Advantage members. Lastly, in each service area, there may be different regulatory requirements that impact, either positively or negatively, an applicant’s response.

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79780


Question:   Section 3.4.8.4.30. of the Base Document states, "Describe the Applicant’s claims audit processes, including but not limited to the following: a. A description of the Applicant’s audit functions, including staffing b. For the most recent three months: i. The number of claims that were adjudicated ii. The percent of adjudicated claims that were auto adjudicated (system-paid versus manually processed) iii. The percent of auto-adjudicated claims that were subject to routine audit functions and iv. The percent of manually processed claims that were subject to routinely audit functions.” Question: How will ODM fairly evaluate responses to this question? Will ODM compare data verse the other applicants to determine points awarded? Alternatively, will the data be evaluated against a baseline or threshold? If a baseline or threshold, can ODM divulge the baseline for the 4 requested data sets?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79779


Question:   In Section 3.4.8.4.29. of the Base Document, it starts "Submit flowcharts and brief narrative descriptions of the Applicant’s information systems to meet the requirements in the Model MCO Provider Agreement, addressing, at a minimum, the functional areas listed below. In addition, describe how these functional areas are integrated and how the Applicant’s system will interface and exchange data with ODM and other entities, including the SPBM, the OhioRISE Plan, and care coordination entities.” And item f. continues: "f. Coordination of benefits (COB) for claims with third party liability (TPL)” Question: The Model MCO Provider Agreement contains conflicting guidance in data utilization requirements for third party liability. Model MCO Provider Agreement, Appendix K, §5 “Claims Adjudication and Payment Processing Requirements” viii. provides that “[t]he MCO must accept and use, and must require its providers to use, third party liability (TPL) data maintained by ODMs fiscal intermediary for the MCOs and providers TPL activities” compared to Model MCO Provider Agreement, Appendix L “Payment and Financial Performance,” §10 “Third Party Liability Requirements,” c. requirement that “[i]n performing its third party liability (TPL) responsibilities, the MCO must use both the MCOs and ODMs TPL information, as specified by ODM.” For clarification, does ODM intend MCO’s to use their own data as well as the fiscal intermediary?

Answer:   The MCO must collect and maintain third party liability (TPL) information and provide that information to the fiscal intermediary. In the event of a difference between the fiscal intermediary's TPL information and the TPL information held by the MCO, the fiscal intermediary's TPL information shall prevail.

Date: 11/12/2020

Inquiry: 79778


Question:   Regarding section 3.4.8.3.21. of the Base Document, it states “Describe the Applicant’s experience managing services for adult members with substance use disorders, including those with chronic, co-occurring, and/or severe substance use disorders. Describe the services, types of providers, and approaches the Applicant will use to effectively manage the care for these members, and evidence these approaches are likely to be successful.” Question: With regard to comparing SUD experience and effectiveness of SUD services amongst applicants, how does ODM intend to normalize scores to ensure fair comparison? Applicants will likely be from different service areas with different member mix, provider engagement, social determinants of health and program requirements. Also, typically there are different health demographics between Medicaid, commercial, and Medicare Advantage members. Lastly, in each service area, there may be different regulatory requirements that impact, either positively or negatively, an applicant’s evaluation, especially for SUD, which recently has recently received more public importance.

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79777


Question:   In regards to section 3.4.8.2.10. of the Base Document, it begins "The Applicant receives a service authorization request from a physician who specializes in bariatric surgery for the coverage of bariatric surgery for an adult member. Respond to the following:" item c. then continues "c. Using the last two years of data related to service authorization requests for bariatric surgery, describe the following: i. The Applicant’s approval rate and ii. For approved service authorization requests, the average number of days between the date of receipt of the service authorization request to the notification to the member and provider of approval.” Question: With regards to comparing 2 years of data regarding service authorization requests for bariatric surgery, amongst applicants, how does ODM intend to normalize responses to ensure proper comparison? Applicants will likely be from different service areas with different member mix, provider engagement, social determinants of health and program requirements. Also, typically there are different health demographics between Medicaid, commercial, and Medicare Advantage members. Lastly, in each service area, there may be different regulatory requirements that impact, either positively or negatively, an applicant’s responses.

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79774


Question:   Regarding section 3.4.8.2.7. of the Base Document, it states "Describe the Applicant’s methods for encouraging members to actively engage in improving their wellness and meeting their health care goals. Provide a specific example of how the Applicant has successfully used similar methods.” Question: With regard to comparing wellness activities and success amongst applicants, how does ODM intend to normalize responses to ensure fair comparison? Applicants will likely be from different service areas with different member mix, provider engagement, social determinants of health and program requirements. Also, typically there are different health demographics between Medicaid, commercial, and Medicare Advantage members. Lastly, in each service area, there may be different regulatory requirements that impact, either positively or negatively, an applicant’s response.

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79773


Question:   Regarding section 3.4.8.2.5. of the Base Document, it states "Describe how the Applicant will identify and address the social determinants of health (SDOH) affecting its membership in the context of the Applicant’s population health management strategy. Include an example of Applicant’s experience and success addressing SDOH to improve population health outcomes.” Question: The RFA inquiry specifically requests an applicant’s experience with SDOH. The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists “experience” as such a criterion. What value will “experience” be given for this response compared to the other two criteria?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79771


Question:   Regarding section 3.4.8.2.5. of the Base Document, it states "Describe how the Applicant will identify and address the social determinants of health (SDOH) affecting its membership in the context of the Applicant’s population health management strategy. Include an example of Applicant’s experience and success addressing SDOH to improve population health outcomes.” Question: With regard to comparing SDOH experience and success amongst applicants, how does ODM intend to normalize scores to ensure fair comparison? Applicants will likely be from different service areas with different member mix, provider engagement, social determinants of health and program requirements. Also, typically there are different health demographics between Medicaid, commercial, and Medicare Advantage members. Lastly, in each service area, there may be different regulatory requirements that impact, either positively or negatively, an applicant’s evaluation, especially for SDOH, which is relatively new to market.

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79769


Question:   Section 3.4.8.1.2. of the Base Document on page 16 states, “Provide, in table format, the Applicant’s audited results for the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures specified below for each of the most recent three years (please identify which three years) for the Applicant’s three largest Medicaid contracts (based on membership). If you are currently contracting with ODM as a managed care plan (MCP) and/or MyCare plan, include your Ohio Medicaid results (MCP and/or MyCare as applicable) as one of the three Medicaid contracts. If you do not have results for three Medicaid contracts, provide results for Medicare (preferred) or commercial contracts, for a total of three contracts. Please identify the applicable contract (state and line of business) for each set of results. If you do not have results for a particular measure or year, please so indicate. If the Applicant does not have HEDIS or CAHPS results, provide results for comparable, alternative performance measures and the methodology for calculating those measures.” Question: With regard to comparing quality scores amongst applicants, how does ODM intend to normalize scores to ensure fair comparison of HEDIS, CAHPS and alternative performance measure scores that are impacted differently for the reasons noted below? MCOs will likely come from completely different service areas with a different member mix, provider engagement, social determinants of health and program requirements. Also, typically there are different health demographics between Medicaid, commercial, and Medicare Advantage members. Lastly, in each service area, there may be different regulatory requirements that impact, either positively or negatively, an applicant’s scores.

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79768


Question:   In Section 3.4.8, Responses to Application Questions (Tab 7), the RFA states responses will be scored per region. Please confirm if each region will be scored individually. If so, will individual regional scores be averaged to create a total Topic Area score in Section 4.3? If individual regional scores will not be averaged, please provide the scoring methodology and how the Topic Area scores in Section 4.3 will be impacted by regional scores.

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79668


Question:   Regarding Section 3.4.7 Financial Capability page 15, it states: "Tab 6 must be labeled “Financial Capability” and must include the Applicant’s Dun & Bradstreet (D&B) ratings, indicating the firm’s financial strength and creditworthiness. These ratings are assigned to most US and Canadian firms by the US firm Dun & Bradstreet (D&B) and are based on a firms worth and composite credit appraisal. The Applicant must also include the Applicant’s D&B credit report, which contains the firms financial statements and credit payment history. If the Applicant is submitting an Application with one or more subcontractors, the Applicant must submit a D&B rating and credit report for each subcontractor." Question: : Regarding Section 3.4.7 Financial Capability page 15, it states “The Applicant must also include the Applicant’s D&B credit report, which contains the firms financial statements and credit payment history. If the Applicant is submitting an Application with one or more subcontractors, the Applicant must submit a D&B rating and credit report for each subcontractor.” In those instances where D&B credit reports do not include financial statements, as D&B credit reports may not have access to financial statements for private companies, will the ratings and whatever is published by D&B with the ratings be sufficient?

Answer:   The applicant may submit any materials that demonstrate it and its subcontractors Financial Capability as identified at Section 3.4.7, up to and including Dun & Bradstreet (D&B) reports.

Date: 11/12/2020

Inquiry: 79644


Question:   In regards to Section 3.4.8, paragraphs 3 and 4, pg. 15: Given that we need to include region specific answers, but are permitted to bid on all regions, allowing the same amount of pages for a single region bidder as you allow for a statewide bidder provides a single region bidder an unfair advantage. Will ODM allow for an additional 10 pages for section 3.4.8.2. Population Health, an additional 10 pages for section 3.4.8.3 Benefits and Service Delivery, and an additional 5 pages for 3.4.8.4 Operational Excellence and Accountability for those respondents that are bidding on more than one region?

Answer:   While ODM took these requirements into account in determining the page limits, ODM will increase the page limits for each section by 10 pages as follows: · The page limit for RFA Section 3.4.8.2, Population Health (Tab 9) is increased from 85 pages to 95 pages. · The page limit for RFA section 3.4.8.3, Benefits & Service Delivery (Tab 10) is increased from 70 pages to 80 pages. · The page limit for RFA section 3.4.8.4, Operational Excellence & Accountability (Tab 11) is increased from 55 to 65 pages.

Date: 11/12/2020

Inquiry: 79554


Question:   RFA Section 5.2 Sensitive Information, page 28 Does RFA Section 5..2 (Sensitive Personal Information) or any other section of the RFA prohibit an applicant from including a personal member success story (authorized by the member signing a HIPAA-valid authorization) in a response to a RFA question? Does any portion of the RFA prohibit an applicant from naming specific providers in response to a posed question?

Answer:   With respect to a member, see the response to inquiry #81920. If the Applicant identifies a provider by name, it must follow the requirements of Ohio Revised Code section 149.45.

Date: 11/12/2020

Inquiry: 81921


Question:   RFA Section 5.2 Sensitive Personal Information, p28 Does RFA Section 5.2 (Sensitive Personal Information) or any other section of the RFA prohibit an applicant from including a personal member success story (backed with a singed release) in a response to a RFA question?

Answer:   The Applicant should de-identify any member success story so that the identity of the member cannot be determined from the information provided.

Date: 11/12/2020

Inquiry: 81920


Question:   Medicaid RFP Section 1.2 Background Page 2. Can you provide information on the provider training plan and training accountability for fiscal intermediary data submissions and processes?

Answer:   The purpose of the Question and Answer process is to enable offerors and interested parties to obtain clarification about the procurement requirements in order to prepare a proposal. This question is not seeking such clarification.

Date: 11/12/2020

Inquiry: 81919


Question:   Medicaid RFP Section 1.2 Background Page 2. Can you provide the scope of information that the fiscal intermediary will provide to the MCOs regarding prior authorization requests?

Answer:   The FI will pass on all data included in the request from the provider. No data will be removed or added prior to the submission to the MCO.

Date: 11/12/2020

Inquiry: 81918


Question:   Medicaid RFP Attachment A Appendix A, Section 4.c.iii.6 Page 50 In regards to: The MCO must have an after-hours system to route emergent and crisis behavioral health calls directly to Ohio Department of Mental Health and Addiction Services (OMHAS) statewide crisis line outside of the MCOs member services hours of operation. The MCO must collaborate with ODM and OMHAS to ensure OMHAS statewide crisis line will have access to deploy Mobile Response and Stabilization Services (MRSS) providers when necessary. Are MCOs required to send after-hours behavioral health crisis calls to OMHAS or is there any flexibility for MCOs to retain accountability for afterhours crisis calls?

Answer:   OMHAS is developing a statewide approach to behavioral health crisis call lines. MCOs are expected to collaborate with ODM and OMHAS to ensure behavioral health crisis calls are routed consistent with this approach. ODM will provide additional details to MCOs at a later date.

Date: 11/12/2020

Inquiry: 81917


Question:   "Medicaid RFP Attachment A Appendix A, Section 1.e.ii Medicaid RFP Attachment A Appendix A, Section 4.c.iii.1" Pages 34 and 50. In regards to: "1.e.ii: The MCO must have its member and provider call centers for this Agreement located in the state of Ohio 4,c,iii.1: The MCO must ensure member services staff are available nationwide." Please confirm the required location of member and provider call center staff.

Answer:   The call center must be physically located in Ohio, however, a managed care member must be able to reach the call center from anywhere in the country by calling a toll-free number.

Date: 11/12/2020

Inquiry: 81916


Question:   Attachment F: Location of Business and Offshore Declaration Form asks that the Applicant provide the “location where state data will be stored, accessed, tested, maintained, or backed-up by Applicant.” Will ODM allow an Applicant to redact the physical address of its data center for security purposes? Alternatively, will ODM accept that the Applicant only disclose the city and state in which the data center is located in lieu of the street address?

Answer:   In response to Attachment F: Location of Business and Offshore Declaration form, ODM will accept that the Applicant only disclose the city and state in which the data center is located

Date: 11/12/2020

Inquiry: 79926


Question:   In regards to Ohio Medicaid RFP Section 3.4.7 Financial Capability: What is ODM’s guidance if a subcontractor does not have a D&B rating? Will ODM accept other financial and credit ratings in lieu of D&B and if so, can ODM provide acceptable examples? (interim financial statements, etc.)

Answer:   In the event that Dun & Bradstreet (D&B) reports are not available, the applicant may submit any materials that demonstrate it and its subcontractors’ financial strengths, creditworthiness, financial statements, and credit payment history as identified at Section 3.4.7.

Date: 11/12/2020

Inquiry: 79924


Question:   We understand ODM will reduce provider burden and promote consistency with the implementation of a centralized credentialing process that includes enrollment. Given this, will ODM still require each MCO to gather state Medicaid attachments A-D from each provider contractual entity?

Answer:   The purpose of the Question and Answer process is to enable offerors and interested parties to obtain clarification about the procurement requirements in order to prepare a proposal.

Date: 11/12/2020

Inquiry: 79923


Question:   In Attachment A, Appendix K.5.b.iii, pg. 245, the model agreement states “The MCO must provide updated claims status demonstrating all claims activity on a daily basis to ODM.” We assume ODM’s reference to “daily basis” means MCOs must be able to send updated claims status 7 days a week as opposed to 5 days during a standard business week. Can ODM please confirm?

Answer:   Yes. 7 days a week.

Date: 11/12/2020

Inquiry: 79922


Question:   In Attachment A, Appendix K.5.b.v, pg. 245, the model agreement states “the MCO must provide out-of-network providers detailed instructions on claims submission procedures, including information provided by ODM about the role of ODMs fiscal intermediary, within one business day of the earlier of receiving a request from an out-of-network provider or becoming aware that an out-of-network provider has rendered services to a member”. Is ODM’s intent for this requirement to have MCOs notify out-of-network providers for each individual claim submitted within one business day? In other words, would out-of-network providers who submit a high volume of claims receive a large number of notifications (per request) from MCOs in return? Can ODM please clarify these requirements?

Answer:   The intent of this language is to preemptively notify out of network providers how to submit claims either when the provider requests information or when the plan becomes aware of services rendered.

Date: 11/12/2020

Inquiry: 79921


Question:   In Attachment A, Appendix A.4.C.i.5 Member Services telephone System pg. 49, the Model Contract Agreement states “the MCO must have the capability to capture "audio signatures" for any required forms or requests that require the members signature.” Can ODM please provide a definition of “audio signatures” and the intent of their use and capture?

Answer:   An audio signature is a type of electronic signature which captures verbal consent, is attached to or logically associated with a record, and is executed or adopted by a person with the intent to sign the record.

Date: 11/12/2020

Inquiry: 79920


Question:   Can a certified alternative EVV application or another related application serving the homecare ecosystem be added to the electronic visit verification (EVV) devices deployed by the state through a general “app store” download?

Answer:   The purpose of the Question and Answer process is to enable offerors and interested parties to obtain clarification about the procurement requirements in order to prepare a proposal. This question is not seeking such clarification.

Date: 11/12/2020

Inquiry: 79905


Question:   In MCO RFA ODMR-2021-0024__Base, Section 3.4.7, Financial Capability (Tab 6), p. 15. Question: For our subcontractors who don’t subscribe to Dun & Bradstreet, may they provide another type of certification that demonstrates their financial strength and creditworthiness?

Answer:   In the event that Dun & Bradstreet (D&B) reports are not available, the applicant may submit any materials that demonstrate it and its subcontractors’ financial strengths, creditworthiness, financial statements, and credit payment history as identified at Section 3.4.7.

Date: 11/12/2020

Inquiry: 79901


Question:   With population health principles driving the need to gain additional insight, will a MCO have the ability to request and receive a full feed of all member electronic visit verification (EVV) data at regular intervals and free of charge?

Answer:   Yes.

Date: 11/12/2020

Inquiry: 79904


Question:   In MCO RFA ODMR-2021-0024__Base, Section 3.4.7, Financial Capability (Tab 6), p. 15. Question: For our subcontractors who don’t subscribe to Dun & Bradstreet, may they provide another type of certification that demonstrates their financial strength and creditworthiness?

Answer:   In the event that Dun & Bradstreet (D&B) reports are not available, the applicant may submit any materials that demonstrate it and its subcontractors’ financial strengths, creditworthiness, financial statements, and credit payment history as identified at Section 3.4.7.

Date: 11/12/2020

Inquiry: 79900


Question:   In MCO RFA ODMR-2021-0024__Base, Section 3.4.7, Financial Capability (Tab 6), p. 15. Question: For our subcontractors who don’t subscribe to Dun & Bradstreet, may they provide another type of certification that demonstrates their financial strength and creditworthiness?

Answer:   In the event that Dun & Bradstreet (D&B) reports are not available, the applicant may submit any materials that demonstrate it and its subcontractors’ financial strengths, creditworthiness, financial statements, and credit payment history as identified at Section 3.4.7.

Date: 11/12/2020

Inquiry: 79902


Question:   Medicaid RFP Attachment A Appendix F - Provider Network Section 3.b. Page 176. With regards to the following: Written Contracts and Medicaid Addendum. What is ODM’s expectation generally for timing of when plans have to update Medicaid provider contracts when ODM issues a new ODM addendum?

Answer:   If changes are made to the Medicaid Addendum that are substantive in nature, ODM will notify the MCOs and provide a reasonable amount of time for provider contracts to be amended. Any other technical, non-substantive changes to the Medicaid Addendum can be incorporated at a time when the MCO is amending the contract for other purposes, unless otherwise specified by ODM.

Date: 11/12/2020

Inquiry: 79899


Question:   Medicaid RFP Attachment A Appendix F - Provider Network Section 3.b.i. Page 176. In regards to the following: In accordance with 42 CFR 438.206 and OAC rule 5160-26-05, the MCO must enter into written contracts with network providers. if a material notice / opt out process was used, does this meet the criteria established by ODM or is it necessary to have a signed amendment?

Answer:   The notice of material amendment process described in ORC 3963.04 will meet ODM's criteria for contract amendments.

Date: 11/12/2020

Inquiry: 79898


Question:   Medicaid RFP Attachment A Appendix D Care Coordination 2.d.iii. PAge 151. In regards to the following: Health Risk Assessment. Is the state mandating specific data elements for the HRA? If so, is there a specific reference to the data to be used?

Answer:   Appendix D, Section 2.d.iii.1 requires the MCO to complete or ensure CCE completion of an ODM-approved health risk assessment (HRA) for all members. The HRA must be ODM-approved. ODM will establish HRA data submission specifications as part of the readiness process for selected Applicants.

Date: 11/12/2020

Inquiry: 79897


Question:   Medicaid RFP Attachment A Appendix A, Section 7.b.3.ii.3. Page 67. In regards to the following: Member portal must include members EOBs. Will MCO be expected to show claims information for the SPBM and OhioRISE in our member portal or should we expect to link out to a separate portal for claims information?

Answer:   The MCO is expected to present the OhioRISE and SPBM EOB in their member portal for their members.

Date: 11/12/2020

Inquiry: 79896


Question:   Medicaid RFP 3.4.8.3 Benefits and Service Delivery- Q25 Page 20. In regards to the following: "The Applicant’s medical assistance line is contacted after hours by the grandmother of a 17-year-old male member asking about how to get help for her grandson’s escalating odd and threatening behavior. The member’s grandmother reports that the member has not been diagnosed with any physical or psychiatric conditions, and she is fairly confident that the member is not using drugs. She shares that the member has always been a high achiever in school and has a small group of school friends he has grown up with. Within the last six months, the member’s grades have drastically dropped, he has been withdrawing from his friends and family, and has had abnormal sleep patterns. The grandmother’s call was precipitated by escalated behaviors of the member over the course of the day, which included pacing, hand wringing, talking to himself, and just a general sense of increased agitation. The grandmother reported that when she tried to talk to and comfort the member, the member lashed out verbally and pushed her away. The grandmother is very concerned about the member’s wellness and safety, as well as the safety of other family members living in their home. Describe how the Applicant would respond to the immediate needs of this family, as well as follow-up activities and referrals to address the presenting needs of this family." (1) What does ODM mean by "medical assistance line"? Is this the equivalent to the MCOs Member service line, MCO 24/7 Nurse line, or MCO national line? (2) Is it required for the MCO to transfer after hours crisis behavioral health calls directly to the OMHAS statewide crisis line or is it acceptable to transfer the call to the MCOs behavioral health crisis line instead of the statewide crisis line? (3) Are CCEs and CMEs referring to the same entities? In other words, are these terms used interchangeably? (4) What ages do BHCCEs serve?

Answer:   1) “Medical assistance line” as referenced in RFA Section 3.4.8.3, Question 25, means “Medical Advice Line” as described in RFA Attachment A, Model MCO Provider Agreement, Appendix A, Section c.iv. 2) Please refer to inquiry #81917 3) RFA Attachment A, Model MCO Provider Agreement, Definitions and Acronyms defines the terms “Care Coordination Entity (CCE)” and “Care Management Entity (CME)”. 4) ODM has not yet finalized requirements for BHCCEs.

Date: 11/12/2020

Inquiry: 79895


Question:   Medicaid RFP Attachment A Appendix B: Coverage and Services, Section 4.d.1. Page 109. In regards to the following: Pursuant to OAC rule 5160-26-03.1, the MCO must submit information on prior authorization requests as directed by ODM. In situations where the managed care organization requires a prior authorization for CPT codes related to unlisted codes, but ODM does not, is the MCO permitted to be more restrictive than ODM in their policy?

Answer:   Unless otherwise prescribed in the provider agreement, please refer to OAC 5160-26-03 which states "(B) The MCP may place appropriate limits on a service; (1) On the basis of medical necessity for the member's condition or diagnosis;or (2) For the purposes of utilization control, provided the services furnished can be reasonably expected to achieve their purpose as specified in paragraph (A)(1) of this rule" And "Prior authorization is available for services on which an MCP has placed a preidentified limitation to ensure the limitation may be exceeded when medically necessary, unless the MCP's limitation is also a limitation for fee-for-service medicaid coverage.

Date: 11/12/2020

Inquiry: 79893


Question:   Medicaid RFP Attachment A Appendix B: Coverage and Services, Section 4.d.1. Page 109. In regards to the following: Pursuant to OAC rule 5160-26-03.1, the MCO must submit information on prior authorization requests as directed by ODM. Will ODM use HIPAA transactions for the exchange of prior authorization requests, such as the ASC X12N 278 Health Care Service Review Request for Review and Response transactions? Will the transactions be transmitted in real-time?

Answer:   ODM will be using HIPAA transactions for the prior authorization requests, but the details regarding the specific transaction types have yet to be determined.

Date: 11/12/2020

Inquiry: 79890


Question:   Medicaid RFP Section 3: Application Requirement 3.4.8.2.10.a. Page 18. In regards to the following: Provide the Applicant’s coverage policy for bariatric surgery, including exclusion criteria. Would ODM consider making this question exempt from the page limits or modifying the page limits in this section?

Answer:   See response to inquiry #79767

Date: 11/12/2020

Inquiry: 79892


Question:   Medicaid RFP Attachment A Appendix F: Provider Network, Section 23.d. Page 177. Regarding centralized credentialing: Are MCOs required to do any credentialing or readiness reviews for the CCEs?

Answer:   See response to inquiry #79876.

Date: 11/12/2020

Inquiry: 79889


Question:   Medicaid RFP Attachment A Appendix K Information Systems, Claims, and Data Section 10.a. Page 253. The MCO must participate with both of Ohios health information exchanges (HIEs) and be capable of exchanging protected health information, connecting to inpatient and ambulatory electronic health records, connecting to care coordination information technology system records, and supporting secure messaging or electronic querying between providers, patients, and the MCO. This must include but is not be limited to using the HIEs for admission, discharge, and transfer (ADT) data and closing referral loops for social determinants of health (SDOH). Does bidding only on one region remove the obligation to participate with both Ohio HIEs?

Answer:   No, the requirement still applies.

Date: 11/12/2020

Inquiry: 79887


Question:   Medicaid RFP Attachment A Appendix H, Section 1.b.iii.1. Page 216. The MCO must participate in ODM initiatives to design and implement member-accessible comparisons of provider information, including quality, cost, and member experience. What initiatives currently exist to support transparency?

Answer:   On our website currently, ODM posts plan-level comparisons, e.g., the MCP Report Cards, HEDIS & CAHPS results, and the EQRO Technical Report. While ODM has information about provider-level performance through its value-based payment programs, e.g., Comprehensive Primary Care and Episodes Programs, there is not a view for members. ODM plans on designing and implementing member-accessible comparisons using data sources such as these. The expectation is that MCOs participate in the design and implementation of these initiatives.

Date: 11/12/2020

Inquiry: 79885


Question:   Medicaid RFP Attachment A Appendix F, Section 13.a.ii. Page 192. In regards to the following: The MCO must ensure that the information in the MCOs provider directory exactly matches the data in ODMs provider network management system for the MCOs network providers. Can MCO consume provider data directly from ODMs provider network management system? How often should we expect an updated file feed from ODM?

Answer:   The Provider Agreement provides sufficient specificity regarding the expectations of the MCO. The operational details will be finalized during the readiness period.

Date: 11/12/2020

Inquiry: 79884


Question:   Medicaid RFP Attachment A Appendix C: Population Health & Quality 4.e.iii.1.e. Page 128. In regards to: Members who are pregnant or capable of becoming pregnant who reside in a community served by a qualified community hub, as defined in ORC section 5167.173(A)(5), may be recommended to receive HUB pathway services (by a physician, advance practice registered nurse, physician assistant, public health nurse, or another licensed health professional specified by the MCO or ODM). For those members, the MCO at a minimum must provide for the delivery of the following services provided by a certified community health worker or public health nurse, who is employed by, or works under contract with, a qualified community hub: i. Community health worker services or services provided by a public health nurse to promote the members healthy pregnancy and ii. Care coordination performed for the purpose of ensuring that the member is linked to employment and educational/training services, housing, educational services, social services, or medically necessary physical and behavioral health services. What does it mean when it says that the MCO at a minimum must provide for the delivery of services - CHW for pregnancy and care coordination for employment.

Answer:   For MCO members who are pregnant or capable of becoming pregnant, and reside in communities served by a qualified community hub, the MCO must, at least, provide for the delivery of these services. The MCO may also provide additional services beyond CHW services or services provided by a public health nurse to promote healthy pregnancy. The MCO may provide additional linkage services beyond those listed.

Date: 11/12/2020

Inquiry: 79883


Question:   Medicaid RFP Section 3: Application Requirement 3.4.7 Financial Capability. Page 15. In regards to the following: Tab 6 must be labeled “Financial Capability” and must include the Applicant’s Dun & Bradstreet (D&B) ratings, indicating the firm’s financial strength and creditworthiness. These ratings are assigned to most US and Canadian firms by the US firm Dun & Bradstreet (D&B) and are based on a firms worth and composite credit appraisal. The Applicant must also include the Applicant’s D&B credit report, which contains the firms financial statements and credit payment history. If the Applicant is submitting an Application with one or more subcontractors, the Applicant must submit a D&B rating and credit report for each subcontractor. What is ODM’s definition of a subcontractor that would require a D&B rating and credit report?

Answer:   See response to inquiry #79467.

Date: 11/12/2020

Inquiry: 79880


Question:   Medicaid RFP Section 1: Introduction and Background 1.2 Background. Page 2. In regards to the following: To reduce provider burden and promote consistency across Ohio’s Medicaid managed care program, ODM will centralize claims submission, prior authorization submission, and credentialing and re-credentialing. ODM’s fiscal intermediary (FI) will serve as a single clearinghouse for all medical (non-pharmacy) claims. ODM’s fiscal intermediary will also serve as the single, centralized location for provider submission of prior authorization requests. Under ODM’s centralized credentialing process, providers will submit an application for Medicaid enrollment and credentialing to ODM and will not need to submit credentialing and re-credentialing materials to MCOs. Please confirm the FI will only serve as the centralized submission point for claims and authorizations and that it will not involved in the actual processing and/or reviewing of claims and authorizations. Does the Fiscal Intermediary UM/claims/credential/re-credential delegation align with the Medicaid program effective date of 1/5/2022?

Answer:   The fiscal intermediary (FI) is separate from the provider network management module (which will support centralized credentialing). ODM will apply SNIP-level edits 1 through 4 and part of 7 in EDI; the FI will not apply any additional SNIP edits. The provider network management module is scheduled to go live in the spring of 2021, and the FI go-live will align with the services start state under the new MCO agreements (i.e., January 2022).

Date: 11/12/2020

Inquiry: 79879


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: The RFA specifies that “[a] protest based on alleged improprieties in the RFA will be considered by ODM only if the Applicant submitted a question regarding the issue during the Question and Answer Period identified in Section 2.5, Question and Answer Period.” Does this mean that an applicant may only protest based on a question that applicant submitted? Or may an applicant protest based on a question submitted by another applicant?

Answer:   Section 2.12.3 states, "A protest based on alleged improprieties in the RFA will be considered by ODM only if the Applicant submitted a question regarding the issue during the Question and Answer Period identified in Section 2.5, Question and Answer Period."

Date: 11/12/2020

Inquiry: 79877


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: Will certain evaluators be primarily responsible for certain questions or sections of the RFA responses? Or will all evaluators share equal responsibility for evaluating and scoring all areas of the RFA responses?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79875


Question:   Medicaid RFP Attachment A Appendix F Section 3.d. Centralized Credentialing Page 176. Regarding Centralized Credentialing: Will dental and vision providers be required to use the centralized credentialing process? Are there known providers types that will not use the centralized credentialing process? Will ODM credential Care Coordination Entities(CCEs)?

Answer:   The Centers for Medicare and Medicaid Services (CMS) requires credentialing for the following: • Home health agencies • Hospice facilities • Free standing surgical centers • Substance use disorder clinics • End-stage renal disease treatment centers • Substance abuse rehabilitation facilities • Skilled nursing facilities • Hospitals • Community mental health centers • Radiology centers • Residential treatment facilities • All physicians who offer services to an organization’s enrollees, including members of physician groups; and • All other types of health care professionals who provide services to the organization’s enrollees, and who are permitted to practice independently under state law. Credentialing is not dependent on whether an entity is a CCE.

Date: 11/12/2020

Inquiry: 79876


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: Will ODM please identify the members of the Evaluation Committee? Does ODM intend to train the members of the Evaluation Committee regarding the methodology to be used in the evaluation and scoring for the responses to the RFA? Will evaluators be given a set of guidelines and/or scoring rubrics to use in the evaluation and/or scoring of responses to the RFA?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79874


Question:   Medicaid RFP Section 1: Introduction and Background 1.2 Background Page 2. In regards to the following: To reduce provider burden and promote consistency across Ohio’s Medicaid managed care program, ODM will centralize claims submission, prior authorization submission, and credentialing and re-credentialing. ODM’s fiscal intermediary (FI) will serve as a single clearinghouse for all medical (non-pharmacy) claims. ODM’s fiscal intermediary will also serve as the single, centralized location for provider submission of prior authorization requests. Under ODM’s centralized credentialing process, providers will submit an application for Medicaid enrollment and credentialing to ODM and will not need to submit credentialing and re-credentialing materials to MCOs. Question: Is ODM centralizing the claim and auth submissions for ALL provider types, inclusive of dental and vision providers? Has ODM defined provider types that will not submit claims through the fiscal intermediary?

Answer:   Claims submission and prior authorization for all medical (non-pharmacy) claims will be submitted via the fiscal intermediary. No provider types have been identified for exclusion from this process.

Date: 11/12/2020

Inquiry: 79872


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: The RFA states that the evaluators “may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee.” What subject matter experts do the evaluators intend to enlist? On what subjects, does the Evaluation Committee intend to enlist subject matter expertise from non-members of the Evaluation Committee? What will their specific roles be in the evaluation process? Will subject matter experts participate in Evaluation Committee discussion and/or scoring meetings, or will they provide their input in some other format (e.g., written)?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79871


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: Will the Evaluation Committee make its scoring determinations on a consensus basis, or some other model, i.e., individual committee member scoring? If it will not be based on a consensus approach, how will evaluators’ differing opinions be taken into account? Will ODM discount the high and low scores on a given question or for a given criteria in order to prevent outliers from unduly influencing the score?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79870


Question:   Regarding Section 4.4 Phase III: Oral Presentations of the Base Document, it states "All Applicants that meet Phase I: Review of Mandatory Qualifications will be invited to participate in the oral presentation process. Invited Applicants will be notified in writing, including meeting logistics, scope, and format of the presentation no later than one week prior to the Applicant’s oral presentation. The oral presentations will be conducted individually with each invited Applicant. ODM will limit the number of participants and expects participants to include members of the Applicant’s proposed key staff. All participants must be employees of the Applicant consultants may not participate in the oral presentation. ODM is not responsible for any costs incurred by the Applicant related to an oral presentation. The Evaluation Committee will evaluate and score each oral presentation. An Applicant’s oral presentation score will be added to the Applicant’s Phase II score and will be considered during final selection." Section 4.5 Phase IV: Selection of the Base Document goes on to say, "The Applicants with the overall highest point totals will be recommended for selection to the Director of ODM for review, approval, and award. The maximum available points by phase is provided in the table below. Phase Maximum Available Points Mandatory Qualifications Not Applicable (pass/fail) Response to Application Questions 1,000 Oral Presentation 100 Maximum Available Points 1,100" Question: The RFA states that 100 additional points are available based on the oral presentation. How will the 100 points be awarded? What factors will be considered in evaluating the oral presentation?

Answer:   See response to inquiry 79424.

Date: 11/12/2020

Inquiry: 79867


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: The RFA states that for each of the four categories being evaluated (Qualifications & Experience Population Health Benefits & Service Delivery and Operational Excellence & Accountability), the “evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: Method of Approach, Capability and Experience.” How will the evaluators decide which of these three evaluation criteria to apply to a given question? For a question being evaluated against more than one of these evaluation criteria, how will points be allocated across the evaluation criteria? For example, if a question is worth 10 points, and all three evaluation criteria are to be considered, will the 10 points be distributed evenly across the three evaluation criteria, or will some other method of allocating points be used? Will ODM provide applicants with more detail on the point distribution in order to allow applicants to better prepare their responses based on ODM’s priorities, as demonstrated by the weighting ODM gives to certain criteria or questions?

Answer:   See response to inquiry 79424.

Date: 11/12/2020

Inquiry: 79866


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: The RFA states that a total of 180 points are available for “operational excellence and accountability” but does not indicate specifically how those points will be awarded. How will the 180 points for “operational excellence and accountability” be allocated across the application questions relating to operational excellence and accountability? What criteria will be used to guide whether an applicant earns full points for a question in this category, or something less than full points? What criteria or guidance will be used to ensure that scoring in this category is based on objective factors, and not based on subjective preferences? Will ODM provide applicants with more detail on the point distribution in order to allow applications to better prepare their applications based on ODM’s priorities, as demonstrated by the weighting ODM gives to certain criteria or questions?

Answer:   See response to inquiry 79424.

Date: 11/12/2020

Inquiry: 79865


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: The RFA states that a total of 340 points are available for “benefits and service delivery” but does not indicate specifically how those points will be awarded. How will the 340 points for “benefits and service delivery” be allocated across the application questions relating to benefits and service delivery? What criteria will be used to guide whether an applicant earns full points for a question in this category, or something less than full points? What criteria or guidance will be used to ensure that scoring in this category is based on objective factors, and not based on subjective preferences? Will ODM provide applicants with more detail on the point distribution in order to allow applications to better prepare their applications based on ODM’s priorities, as demonstrated by the weighting ODM gives to certain criteria or questions?

Answer:   See response to inquiry 79424.

Date: 11/12/2020

Inquiry: 79864


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: The RFA states that a total of 85 points are available for “qualifications & experience,” but does not indicate specifically how those points will be awarded and whether the experience being evaluated is comparable Medicaid experiences to those to be provided under the RFA. How will the 85 points for “qualifications and experience” be allocated across the application questions relating to qualifications and experience? What criteria will be used to guide whether an applicant earns full points for a question in this category, or something less than full points? What criteria or guidance will be used to ensure that scoring in this category is based on objective factors, and not based on subjective preferences? Will only comparable Medicaid experience be considered in awarding those points? Will ODM provide applicants with more detail on the point distribution in order to allow applications to better respond to the RFA based on ODM’s priorities?

Answer:   See response to inquiry 79424.

Date: 11/12/2020

Inquiry: 79863


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: In performing evaluations, will any preference be given to Ohio-based businesses? Will an applicant earn any additional points in any category for its status as an Ohio-based business or Ohio employer?

Answer:   See response to inquiry 79424.

Date: 11/12/2020

Inquiry: 79861


Question:   In Attachment B, The Letter of Transmittal Template, # 18 states, "In accordance with Section 5.13, Mandatory Disclosure of Governmental Investigations, a statement that (a) neither the Applicant nor a proposed subcontractor has been the subject of an adverse regulatory or administrative governmental action with respect to performance of a government contract or (b) the Applicant or a proposed subcontractor has been the subject of an adverse regulatory or administrative governmental action with respect to such performance. If (b), provide, as an attachment to the Transmittal Letter, a detailed explanation of any such governmental actions." Question: For Ohio, what is considered a "adverse regulatory or administrative governmental action?” Your response to Inquiry 79470 states that it is not limited to instances resulting in corrective action plans or financial penalties, which is understood. However, ODM sends letters with the title of "Notification of Non-Compliance/Remedial Action" which, according to the current definition, make every such letter disclosable. Is this ODMs intent? If not, what is the Ohio threshold for listing a correspondence from ODM?

Answer:   An ‘adverse regulatory or administrative governmental action’ is any final adverse action taken by a regulator or other government agency against the Applicant or proposed subcontractor where the applicant had the opportunity to respond, and the government agency took some negative action against the applicant. This would include litigation by the regulator or government agency against the applicant, contract termination, financial penalties, debarment, licensure action, decertification, or required corrective action. It is not intended to require the disclosure of each non-compliance notice that a state may provide to an applicant.

Date: 11/12/2020

Inquiry: 79860


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: Is there a requirement that an applicant demonstrate that any portion of the application will be fulfilled by a minority- or woman-owned business enterprise? Will any points be awarded for demonstrating participation by an MBE or WBE?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79859


Question:   Section 4.3 of the Base Document states, "All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience." Question: In reviewing applications, will the Evaluation Committee reward incumbent applicants with established networks verse a non-Ohio applicant who will be applying/responding hypothetically based on a network it intends to potentially build?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79858


Question:   Section 3.4.8.4.31. of the Base Document on page 23 states, "31. Describe the Applicant’s current and proposed future use and support of electronic health records (EHRs) and health information exchanges (HIEs), including: a. For EHRs: i. How the Applicant will assess whether and how its Medicaid network providers use EHRs ii. The percent of the Applicant’s Medicaid network providers by provider type (institutional, behavioral health, other professionals) that use EHRs iii. The actions the Applicant will take to encourage and facilitate Medicaid providers’ EHR adoption and iv. How and what data the Applicant will integrate from providers’ EHRs." Question: This question asks an applicant to list information regarding its intentions to utilize EHRs and HIEs in its network. How will the Evaluation Committee evaluate an incumbent MCO verse an applicant with no presence, or network, in Ohio? An incumbent will be responding based on its existing network whereas a non-Ohio applicant will be responding hypothetically based on a network it intends to potentially build.

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79857


Question:   Section 3.4.8.3.16 of the Base Document on page 19 states, "Describe the Applicant’s approach (including methodology, timeline, and use of selective contracting) to developing and managing a qualified provider network that meets the requirements of the Model MCO Provider Agreement. Include a narrative describing potential challenges, including network gaps, and how the Applicant would address those challenges." Question: This question asks an applicant to list information regarding its network or proposed network. How will the Evaluation Committee evaluate an incumbent MCO verse an applicant with no presence, or network, in Ohio? An incumbent will be responding based on its existing network whereas a non-Ohio applicant will be responding hypothetically based on a network it intends to potentially build.

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79856


Question:   "Question 16 in Attachment B: Letter of Transmittal requests Applicants to provide “A statement describing any ongoing, active business transactions if the Applicant is in the process of selling or acquiring health care related businesses, and if these transactions are expected to be completed within 12 months from the date of the Application. The Applicant must include this information for the Applicant’s parent organization, affiliates, and subsidiaries, as applicable.” Additionally, Question 21 in Attachment B: Letter of Transmittal requests Applicants to provide “A statement affirming that any and all information in the Application is not confidential and/or trade secret information (as defined in the RFA) and that the Application may be posted in its entirety on the Internet for public viewing.” Given that “ongoing, active business transactions” are held confidential under non-disclosure agreements, letters of intent, or other legally binding agreements, our assumption is that ODM is only asking for an Applicant to disclose ongoing, active health care related business transactions for an Applicant, Applicant’s parent organization, affiliates, and Subsidiaries that have been publicly disclosed? If that assumption is incorrect, can ODM please clarify how an Applicant should respond to Question 16 while also complying with Question 21 in Attachment B: Letter of Transmittal and RFA Section 5.8 Trade Secrets Prohibition: Public Information Disclaimer."

Answer:   If a legally-binding document prohibits Applicant from disclosing particular information in response to Question 16 in Attachment B, Applicant must provide as much information as possible about the business transaction, including but not limited to information that would enable ODM to understand and assess whether the business transaction would create an actual or potential conflicts of interest, whether and how the business transaction would impact ODM’s contract with the Applicant, and whether and how the business transaction would affect ODM’s members and health care in Ohio. In addition, based on the information provided, ODM may seek additional information or clarifications. Section 4.1 of the RFA provides that ODM reserves the right to request clarification from Applicants regarding any information in their Application as it deems necessary at any point in the evaluation process.

Date: 11/12/2020

Inquiry: 79855


Question:   Based on the response to Inquiry #79426, can ODM please confirm that the scope of this request is limited to Medicaid contracts? If not, can ODM please clarify.

Answer:   Section 5.13 of the RFA states that the request is in regard to "any adverse regulatory or administrative governmental action (federal, state, or local) with respect to Applicant’s performance of a government contract." This is not limited to Medicaid contracts.

Date: 11/12/2020

Inquiry: 79854


Question:   Regarding this statement on page 189 of Attachment A: “If ODM determines that the MCOs reimbursement rate or rates for a program, service, or provider type is not sufficient, the MCO, as directed by ODM, must pay, at a minimum, the rate specified by ODM, which will be no more than 100% of the current Medicaid FFS rate.” Please confirm that if ODM does specify a rate floor that there will be an appropriate adjustment to the capitation rates, if needed.

Answer:   We anticipate considering state directed payment arrangements as specified under the CMS requirements provided in the Medicaid Managed Care Rate Development Guide.

Date: 11/12/2020

Inquiry: 79853


Question:   In regards to Attachment A, Appendix A, Auto-Assignment Algorithm, pg. 36, can ODM please provide more guidance on what the upper and lower limits of the auto assignment algorithm will be? At what percent of total enrollment will the limits be set? Will the limits vary by region?

Answer:   See response to inquiry #79657.

Date: 11/12/2020

Inquiry: 79852


Question:   In regards to the Managed Care Procurement Data Book and Capitation Rate Methodology pg. 9 and Section 2: Schedule of Events pg. 5, the Data Book states that rates will be effective 1/1/2022 and the RFA states a Go-live of 1/5/2022. Can ODM please confirm the effective date of the contract?

Answer:   Services under the new managed care organization agreements are scheduled to begin on January 5, 2022, to avoid a transition during the holiday weekend.

Date: 11/12/2020

Inquiry: 79851


Question:   In regards to the Managed Care Procurement Data Book and Capitation Rate Methodology, we understand that COVID-19 has created a lot of uncertainty in rate setting but want to understand Milliman’s approach to setting CY2022 capitation rates. What base data time period will likely be used for the final CY2022 rates?

Answer:   The base data to be utilized for the CY 2022 capitation rates has not been established and will be determined at a later date.

Date: 11/12/2020

Inquiry: 79850


Question:   In regards to the Managed Care Procurement Data Book and Capitation Rate Methodology, how will admin in capitation rates be adjusted with the incorporation of the Single PBM? Generally Rx admin is a lower percent of the Rx claim cost so we would expect the overall admin funding percent to increase. Will that be the case?

Answer:   Administrative load assumptions will be determined during the capitation rate setting process.

Date: 11/12/2020

Inquiry: 79848


Question:   RFA Section 3.4.6 Required Forms (Tab 5), page 14 With centralized credentialing launching in March of 2021, there are a number of credentialing delegates declining to submit the requested subcontractor information for the MCO RFA. Is there a carve out for Credentialing delegates to be excluded from Section 3.4.6 of the RFA requirements?

Answer:   See response to inquiry #79467.

Date: 11/12/2020

Inquiry: 79846


Question:   Inquiry 79555, posted 12/26/2020 states: Question: On page 16 of RFA ODMR20210024, questions one and two of section 3.2.8.1b asks for information about applicants’ Medicaid contracts. Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) exclusively cover Medicaid-eligible enrollees, and in some states, D-SNPs directly cover Medicaid benefits. Please confirm D-SNPs are considered “Medicaid MCO contracts” for purposes of this section." The state answered: "Answer: If the D-SNP does not have an MCO contract with a state, the D-SNP is not considered a “Medicaid MCO contract” for purposes of Question 1 in RFA Section 3.4.8.1 (Qualifications and Experience). If the D-SNP has an MCO contract with a state (e.g., is a fully integrated D-SNP), the MCO contract is a “Medicaid MCO contract.” In one state, we have both a Medicaid managed care contract and a D-SNP that integrates capitated Medicaid benefits. The D-SNP covers Medicaid wrap benefits, including transportation, dental, hearing, vision, durable medical equipment, and over-the-counter medications. For purposes of Questions 1 and 2, please confirm that this D-SNP with integrated Medicaid benefits constitutes a Medicaid MCO contract, regardless of whether it’s a FIDE-SNP.

Answer:   Only plans that are fully integrated D-SNP should be included. Please refer to the response to inquiry #79555.

Date: 11/12/2020

Inquiry: 79842


Question:   In the RFA Base Document, Section 3.4.8.2, Population Health, Q. 10 a., page 18, the question requests the coverage policy for bariatric surgery, including exclusion criteria. Our policy includes an extensive bibliography. Would ODM consider us including it as an appendix without counting it toward the page count?

Answer:   See response to inquiry #79767

Date: 11/12/2020

Inquiry: 79835


Question:   Regarding Section 13.b. of Appendix G of Attachment, on page 214 it states, "The MCO must respond to requests from state or federal authorities within one business day of such request." Question: To facilitate an MCO’s response to ODM, what type of requests from ODM will require a response in one business day? The MCO Provider Agreement, Appendix G13.c. and d. specifies that MCOs have 30 calendar days to respond to ODM inquiries.

Answer:   The response required within one day is to acknowledge receipt of the request. Section 13.c next states that the MCO must produce copies of all data or files requested within 30 calendar days of the request.

Date: 11/12/2020

Inquiry: 79834


Question:   RFA Question 3.4.7 Financial Capability (Tab 6), page 15 In 3.4.7, ODM is requesting the Dun & Bradstreet rating for the Applicant and subcontractors. For Applicants or subcontractors who do not subscribe to this service, what should be used?

Answer:   The applicant may submit any materials that demonstrate it and its subcontractors’ Financial Capability as identified at Section 3.4.7, up to and including Dun & Bradstreet (D&B) reports.

Date: 11/12/2020

Inquiry: 79832


Question:   Requirement 3.4.8.1 Qualifications and Experience states, " 2. Provide, in table format, the Applicant’s audited results for the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures specified below for each of the most recent three years (please identify which three years) for the Applicant’s three largest Medicaid contracts (based on membership). If you are currently contracting with ODM as a managed care plan (MCP) and/or MyCare plan, include your Ohio Medicaid results (MCP and/or MyCare as applicable) as one of the three Medicaid contracts. If you do not have results for three Medicaid contracts, provide results for Medicare (preferred) or commercial contracts, for a total of three contracts. Please identify the applicable contract (state and line of business) for each set of results. If you do not have results for a particular measure or year, please so indicate. If the Applicant does not have HEDIS or CAHPS results, provide results for comparable, alternative performance measures and the methodology for calculating those measures." Please confirm that “largest Medicaid contracts” should be limited to contracts directly between the Applicant and the state Medicaid program, and would not include contracts where the Applicant is a subcontractor.

Answer:   Yes, the "largest Medicaid contracts" referenced in Question 2, RFA Section 3.4.8.1 (Qualifications and Experience), are those contracts directly between the Applicant and the state Medicaid agency and would not include contracts where the Applicant is a subcontractor.

Date: 11/12/2020

Inquiry: 79827


Question:   Attachment A states, "The MCO must contribute 3% of its annual profits to community reinvestment. The MCO must increase the percentage of the MCOs contributions by 1% each subsequent year, for a maximum of 5% of the MCOs annual profits." Please confirm that reference to "percent" of profits only refers to the after-tax profits generated by the MCO pursuant to the Agreement.

Answer:   ODM confirms that RFA Attachment A, Model MCO Provider Agreement, Appendix C, Section 4.g.i.2, “annual profits” refers to net profits of the MCO, meaning after-tax profits.

Date: 11/12/2020

Inquiry: 79826


Question:   Section 3.4.7 Financial Capability states, “If the Applicant is submitting an Application with one or more subcontractors, the Applicant must submit a D&B rating and credit report for each subcontractor.” What information should Applicants provide for small subcontractors that do not have a D&B rating?

Answer:   The applicant may submit any materials that demonstrate it and its subcontractors’ Financial Capability as identified at Section 3.4.7, up to and including Dun & Bradstreet (D&B) reports.

Date: 11/12/2020

Inquiry: 79825


Question:   Attachment B requests "A statement certifying that, as applicable, the Applicant is (a) licensed by the Ohio Department of Insurance (ODI) as a Health Insuring Corporation (HIC), or (b) has submitted an application to be licensed by ODI as a HIC, and provide evidence to support (a) or (b) as applicable." Please confirm that a Certificate of Authority issued by the Ohio Department of Insurance satisfies the requirement for a “license,” as Ohio Department of Insurance does not issue such licenses.

Answer:   Yes, a Certificate of Authority issued by the Ohio Department of Insurance satisfies the requirement for a "license".

Date: 11/12/2020

Inquiry: 79824


Question:   Appendix J states, “ODM will withhold a specified percentage for each applicable state fiscal year (SFY) for use in ODMs Quality Withhold Program. The amount to be withheld for measurement year 2022 will be 3% of the capitation and delivery payments.” Appendix J specifies that the 3% quality withhold will be subject to ODM actuarial approval. Can you provide the quality withhold percentage for the current year for the existing MMC program, and whether or not ODMs actuary has determined any of the withhold amount was not reasonably achievable by MCOs?

Answer:   For measurement years 2020 and 2021, the withhold amount is 3%. The actuaries always consider the Quality Withhold Program when certifying the rates. To date, the actuaries have not determined the withhold amount was not achievable by MCOs.

Date: 11/12/2020

Inquiry: 79821


Question:   Appendix J - Quality Withhold states that, “The measurement year for measures used in the quality indices for the Quality Withhold Program for SFY 2023 is measurement year 2022.” Appendix J seems to indicate that ODM will withhold 3% of capitation and delivery rates beginning in SFY2023, which we understand to run from July 2022 to June 2023. Will ODM withhold a percentage of capitation and delivery rates for the period from January to June 2022?

Answer:   For budgeting purposes, contracts are renewed each fiscal year (July - June). As a result, the Quality Withhold program is aligned with the contract period (July-June). However, to align with national measurement standards, measurement years are on the calendar year. Consequently, the SFY 2023 Quality Withhold Program starts January 2022 and ends December 2022. The withhold period also aligns with the measurement year so, for the SFY 2023 Quality Withhold Program, 3% will be withheld from January - December 2022.

Date: 11/12/2020

Inquiry: 79820


Question:   Requirement 3.4.8.1 Qualifications and Experience states, " 2. Provide, in table format, the Applicant’s audited results for the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures specified below for each of the most recent three years (please identify which three years) for the Applicant’s three largest Medicaid contracts (based on membership). If you are currently contracting with ODM as a managed care plan (MCP) and/or MyCare plan, include your Ohio Medicaid results (MCP and/or MyCare as applicable) as one of the three Medicaid contracts. If you do not have results for three Medicaid contracts, provide results for Medicare (preferred) or commercial contracts, for a total of three contracts. Please identify the applicable contract (state and line of business) for each set of results. If you do not have results for a particular measure or year, please so indicate. If the Applicant does not have HEDIS or CAHPS results, provide results for comparable, alternative performance measures and the methodology for calculating those measures." Please confirm that Applicants should not include health plans acquired within the most recent three years.

Answer:   When responding to question 2 of the RFA Section 3.4.8.1 (Qualifications and Experience), Applicants should not include health plans acquired within the three most recent years

Date: 11/12/2020

Inquiry: 79819


Question:   The requirements in Section 3.4.8 of the RFA Base document state that: “For each question, the Applicant must start on a new page and include both the number of the question and the text of the question and then provide the response.” Question: “Does this mean that any sub questions (items a,b,c,d,e in the example below) must be included with the numbered question before the start of any narrative? Or is it sufficient to only include the number and main question prior to the response, and include the sub questions items (a,b,c,d,e) throughout the response as headings to parts of the response?” Example: 4. Describe the Applicant’s proposed approach to meet the following population health management responsibilities: a. Sources and types of data and information the Applicant will collect and use to inform its population health strategies and initiatives b. Development of criteria and thresholds for risk stratification and how the Applicant will use risk stratification in its population health strategies c. Member outreach and engagement strategies d. Collaboration, coordination, and data sharing with other entities that impact population health as a result of their involvement with the Applicant’s members and e. Evaluation of population health outcomes.

Answer:   The entire question, including any sub-parts, must be included at the top of the page. The sub-parts may be included as headings to parts of the response, but this is not required.

Date: 11/12/2020

Inquiry: 79818


Question:   ODM RFA Attachment A, Medicaid Managed Care Organization Appendix K, 5. Claims Adjudication & Payment Processing Requirements, pages 245-247 Question: Appendix k – Information Systems, Claims, and Data. Section 5.d.i. “When the MCO uses a grouping methodology to pay inpatient and/or outpatient hospital claims, or ambulatory surgery center claims, the MCO is expected to use the same grouper software and inpatient only procedure listing (determined by Medicare, 3M, or other grouping product) that ODM uses to process fee-for-service (FFS) claims.” Is the MCO required to use the same grouper software vendor and product as ODM uses for FFS? Question : Appendix K – Information Systems, Claims, and Data. Section 5.f.iv. “The MCO and any subcontractor that adjudicate claims, must undergo a system and Organizational Control (SOC) 2 Type II or an alternative privacy and security systems audit that is prior approved by ODM” Is it ODM’s expectation that the MCO have completed a SOC 2 Type II prior to 1/1/22? If a MCO adopts the NIST 800-53 or similar control framework that maps to NIST 800-53 and performs a SOC 2 Type II, would the SOC 2 Type II also fulfill the NIST 800-53 audit requirement?

Answer:   Part one: The MCO is expected to use the same product but can obtain the product from any authorized reseller. Part two: The MCO is expected to complete the SOC2 Type II prior to 1/1/2022. Part three: The SOC2 Type II may fulfill the NIST complaince requirement assuming the full crosswalk with the NIST controls are demonstrated in the SOC 2 Type II audit.

Date: 11/12/2020

Inquiry: 79817


Question:   Section 3.4.8.4.32 of the Base Document states, "32. Describe how the Applicant will provide ODM access to the Applicant’s system and data, including any subcontractor’s data." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability, and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79816


Question:   Section 3.4.8.4.31. of the Base Document states, "31. Describe the Applicant’s current and proposed future use and support of electronic health records (EHRs) and health information exchanges (HIEs), including: a. For EHRs: i. How the Applicant will assess whether and how its Medicaid network providers use EHRs ii. The percent of the Applicant’s Medicaid network providers by provider type (institutional, behavioral health, other professionals) that use EHRs iii. The actions the Applicant will take to encourage and facilitate Medicaid providers’ EHR adoption and iv. How and what data the Applicant will integrate from providers’ EHRs. b. For HIEs: i. How the Applicant will work with, participate in, and integrate data with Ohio’s HIEs, including the types of data ii. The percent of the Applicant’s Medicaid network providers that work with HIEs, by facility and professional types of providers and iii. How the Applicant will encourage Medicaid network providers to participate in Ohio’s HIEs to exchange data." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79815


Question:   Section 3.4.8.4.30 of the Base Document states, "30. Describe the Applicant’s claims audit processes, including but not limited to the following: a. A description of the Applicant’s audit functions, including staffing b. For the most recent three months: i. The number of claims that were adjudicated ii. The percent of adjudicated claims that were auto-adjudicated (system-paid versus manually processed) iii. The percent of auto-adjudicated claims that were subject to routine audit functions and iv. The percent of manually processed claims that were subject to routinely audit functions." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79814


Question:   Section 3.4.8.4.29. of the Base Document states, "29. Submit flowcharts and brief narrative descriptions of the Applicant’s information systems to meet the requirements in the Model MCO Provider Agreement, addressing, at a minimum, the functional areas listed below. In addition, describe how these functional areas are integrated and how the Applicant’s system will interface and exchange data with ODM and other entities, including the SPBM, the OhioRISE Plan, and care coordination entities. a. Member eligibility, enrollment, and disenrollment management b. Provider enrollment and network management c. Care coordination system and portal and interface with claims and the provider and member portals d. Claims processing edits, corrections, and adjustments e. Claims payment and prompt payment guidelines f. Coordination of benefits (COB) for claims with third party liability (TPL) g. Encounter submission, including statistics for percent accepted and denied h. Financial management and accounting and i. Any other ancillary systems/databases and their capabilities, such as reporting, grievance and appeals, subcontractor data collection, electronic visit verification (EVV), etc." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79813


Question:   Section 3.4.8.4.28. of the Base Document states, "28. The Applicant receives a call into its member services call center from a caller who wishes to remain anonymous. The caller shares that a provider in the Applicant’s network does not have the appropriate license to deliver the service. Describe the actions the Applicant will take in response to the call, from receipt of the concern through payment recovery." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79812


Question:   Section 3.4.8.4.27. of the Base Document states, "27. Describe the Applicant’s proposed methods and resources for the following program integrity activities under the Model MCO Provider Agreement: a. Areas of focus for Applicant’s program integrity activities b. The Applicant’s resources and how the Applicant will use them to support program integrity efforts and c. The Applicant’s program integrity strategies." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79811


Question:   Section 3.4.8.3.26. of the Base Document states, "26. The Applicant is notified of a new member enrollment – a 50-year-old Hispanic female whose primary language is Spanish. The member was required to change MCOs as a result of a move. Although the relocation of the member was only 20 miles away, her current residence is outside of the regional boundaries served by the previous MCO. The member was auto-assigned to the Applicant. Prior to the reassignment, the member had an MCO Care Manager who was coordinating her complex needs. As part of the transition process, the previous MCO shared information with the Applicant revealing that the member has a long history of depression and borderline personality disorder, with several suicide attempts, high emergency department utilization, and multiple behavioral health inpatient stays. The member intermittently attended individual counseling for short periods of time. Six months prior to the member’s move, the member began receiving individual counseling from a female, bilingual therapist on a weekly basis. As part of the transition process, the Applicant reached out to the assigned MCO Care Manager who shared that prior referrals for individual counseling ended prematurely, with the member “firing” her counselor. The member has made significant progress since her latest referral for counseling – emergency department visits were reduced to just one in the six month timeframe, with no behavioral health inpatient stays. The MCO Care Manager stated the member attributes her improved wellbeing to this particular therapist who the member says “is always there for her” and refers to as “her angel.” The MCO Care Manager indicated that she has become concerned about the dependence of the member on the therapist. The member’s therapist is not in the Applicant’s provider network, and the Applicant has several other similarly skilled therapists in network, though not bilingual. Describe the Applicant’s approach proposed to transition the care of the member to optimize the outcome for the member." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79810


Question:   Section 3.4.8.3.25. of the Base Document states, "25. The Applicant’s medical assistance line is contacted after hours by the grandmother of a 17-year-old male member asking about how to get help for her grandson’s escalating odd and threatening behavior. The member’s grandmother reports that the member has not been diagnosed with any physical or psychiatric conditions, and she is fairly confident that the member is not using drugs. She shares that the member has always been a high achiever in school and has a small group of school friends he has grown up with. Within the last six months, the member’s grades have drastically dropped, he has been withdrawing from his friends and family, and has had abnormal sleep patterns. The grandmother’s call was precipitated by escalated behaviors of the member over the course of the day, which included pacing, hand wringing, talking to himself, and just a general sense of increased agitation. The grandmother reported that when she tried to talk to and comfort the member, the member lashed out verbally and pushed her away. The grandmother is very concerned about the member’s wellness and safety, as well as the safety of other family members living in their home. Describe how the Applicant would respond to the immediate needs of this family, as well as follow-up activities and referrals to address the presenting needs of this family." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79809


Question:   Section 3.4.8.3.24 of the Base Document states, "24. Describe how the Applicant will conduct ongoing monitoring and analysis to ensure Applicant’s compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) requirements in 42 Code of Federal Regulations (CFR) Part 438 Subpart K." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79808


Question:   Section 3.4.8.3.23. of the Base Document states, "23. Describe the Applicant’s proposed approach to offering, promoting, and supporting the appropriate and effective use of telehealth services to increase access and health equity for Ohio Medicaid members. In your response assume a post-pandemic environment where access would be balanced with appropriate utilization management." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79807


Question:   Section 3.4.8.3.22. of the Base Document states, "22. Describe how the Applicant will identify and address inappropriate prescribing practices and member overuse or misuse of pharmacy services. Provide an example of when the Applicant identified and addressed inappropriate prescribing practices, and how it impacted the program." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79806


Question:   Section 3.4.8.3.21. of the Base Document states, "21. Describe the Applicant’s experience managing services for adult members with substance use disorders, including those with chronic, co-occurring, and/or severe substance use disorders. Describe the services, types of providers, and approaches the Applicant will use to effectively manage the care for these members, and evidence these approaches are likely to be successful." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79805


Question:   Section 3.4.8.3.20. of the Base Document states, "20. Describe the Applicant’s proposed strategies to ensure members have timely access to quality dental care and engage members in preventive dental care." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79804


Question:   Section 3.4.8.3.19. of the Base Document states, "19. The availability of timely and reliable transportation is critical for members who need transportation to access services. Describe the Applicant’s proposed approach for the coordination and provision of non-emergency transportation to meet the needs of its members." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79803


Question:   Section 3.4.8.3.18. of the Base Document states, "18. Describe any value-added services the Applicant intends to offer members, including the target population the scope of the benefit, including any limitations the desired outcome of providing the value-added services and how the Applicant will monitor and evaluate the value-added services." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79802


Question:   Section 3.4.8.17. of the Base Document States, "17. Describe the Applicant’s proposed approach to coordinating and collaborating with the SPBM, including but not limited to the areas identified below. For purposes of the response, please assume that the Applicant is not affiliated with the SPBM. a. Clarifying roles and responsibilities b. Communication and coordination and c. Data and information exchange requirements and timeframes." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79801


Question:   Section 3.4.8.3.16. of the Base Document states, "16. Describe the Applicant’s approach (including methodology, timeline, and use of selective contracting) to developing and managing a qualified provider network that meets the requirements of the Model MCO Provider Agreement. Include a narrative describing potential challenges, including network gaps, and how the Applicant would address those challenges." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79800


Question:   Section 3.4.8.2.15. of the Base Document states, "15. Describe the Applicant’s approach for developing its community reinvestment plan." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79799


Question:   Section 3.4.8.2.14 of the Base Document states, "14. Describe how the Applicant will work within communities to engage members and providers on a local level, understand the unique needs and resources within the community, and collaborate to meet the needs of members within those communities." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79798


Question:   Section 3.4.8.2.13 of the Base Document states, "13. Describe the Applicant’s approach to designing and implementing value based care and payment initiatives for Ohio Medicaid members that are in addition to the initiatives specified by ODM (episode based payments, Comprehensive Primary Care [CPC], Behavioral Health Care Coordination [BHCC], Comprehensive Maternity Care [CMC], and Care Innovation and Community Improvement Program [CICIP])." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79797


Question:   Section 3.4.8.2.12. of the Base Document states, "12. Using the following HEDIS measure and result, describe the Applicant’s approach for using quality improvement strategies to address substandard performance. Measure: Comprehensive Diabetes Care – HbA1c Poor Control (>9.0%) Result: 50%" Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79796


Question:   Section 3.4.8.2.11. of the Base Document states, "11. Describe how the Applicant will use grievance, appeal, and service authorization information and data to inform and improve the quality of care and population health for members." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79795


Question:   Section 3.4.8.2.10 of the Base Document states, "10. The Applicant receives a service authorization request from a physician who specializes in bariatric surgery for the coverage of bariatric surgery for an adult member. Respond to the following: a. Provide the Applicant’s coverage policy for bariatric surgery, including exclusion criteria. b. Describe how the Applicant will evaluate the request, associated timeframes, reviewer qualifications, and member and provider communications, from the Applicant’s receipt of the request through rendering an authorization decision in the following two circumstances: i. The service authorization request does not demonstrate that the member meets medical necessity criteria. ii. The service authorization request does not contain sufficient information for the Applicant to make a medical necessity determination. c. Using the last two years of data related to service authorization requests for bariatric surgery, describe the following: i. The Applicant’s approval rate and ii. For approved service authorization requests, the average number of days between the date of receipt of the service authorization request to the notification to the member and provider of approval. " Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79794


Question:   Section 3.4.8.2.9. of the Base Document states, "9. Describe the Applicant’s approach to utilization management that will result in high quality, cost efficient, timely, and effective care consistent and informed decisions and the reduction of unnecessary administrative provider burden." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79793


Question:   Section 3.4.8.2.8. of the Base Document states, "8. Describe the Applicant’s care coordination program, including the design, resources, and monitoring activities in place to facilitate seamless care coordination when multiple care coordination entities may be involved." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79792


Question:   Section 3.4.8.2.7. of the Base Document states, "7. Describe the Applicant’s methods for encouraging members to actively engage in improving their wellness and meeting their health care goals. Provide a specific example of how the Applicant has successfully used similar methods." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability, and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79791


Question:   Section 3.4.8.2.6. of the Base Document states, "6. Describe how the Applicant will use feedback from members, family members, and providers to identify and execute program improvements. Provide a specific example of how the Applicant successfully engaged such stakeholders and used the information to achieve program improvements." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79790


Question:   Section 3.4.8.2.5. of the Base Document states, "5. Describe how the Applicant will identify and address the social determinants of health (SDOH) affecting its membership in the context of the Applicant’s population health management strategy. Include an example of Applicant’s experience and success addressing SDOH to improve population health outcomes." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79789


Question:   Section 3.4.8.2.4. of the Base Document states "4. Describe the Applicant’s proposed approach to meet the following population health management responsibilities: a. Sources and types of data and information the Applicant will collect and use to inform its population health strategies and initiatives b. Development of criteria and thresholds for risk stratification and how the Applicant will use risk stratification in its population health strategies c. Member outreach and engagement strategies d. Collaboration, coordination, and data sharing with other entities that impact population health as a result of their involvement with the Applicant’s members and e. Evaluation of population health outcomes." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79788


Question:   Section 3.4.8.1.3 of the Base Document states, "3. Describe two innovations the Applicant proposes to implement in Ohio, including the timeframe and anticipated impact on Ohio’s Medicaid program." Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79787


Question:   Section 3.4.8.1.2. of the Base Document states, "Provide, in table format, the Applicant’s audited results for the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures specified below for each of the most recent three years (please identify which three years) for the Applicant’s three largest Medicaid contracts (based on membership). If you are currently contracting with ODM as a managed care plan (MCP) and/or MyCare plan, include your Ohio Medicaid results (MCP and/or MyCare as applicable) as one of the three Medicaid contracts. If you do not have results for three Medicaid contracts, provide results for Medicare (preferred) or commercial contracts, for a total of three contracts. Please identify the applicable contract (state and line of business) for each set of results. If you do not have results for a particular measure or year, please so indicate. If the Applicant does not have HEDIS or CAHPS results, provide results for comparable, alternative performance measures and the methodology for calculating those measures. # Measure Source 1 Adult Rating of Health Plan CAHPS 2 Annual Dental Visits HEDIS 3 Childhood Immunization Status (Combo 3) HEDIS 4 Comprehensive Diabetes Care: Blood Pressure Control (<140/90 mm Hg) HEDIS 5 Comprehensive Diabetes Care: HbA1c poor control (>9.0%) HEDIS 6 Follow-up After Hospitalization for Mental Illness, 7-day follow-up, Total HEDIS 7 Medication Management for People with Asthma, 75%, Total HEDIS 8 Prenatal and Postpartum Care: Postpartum Care Visit HEDIS 9 Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics, Total HEDIS 10 Use of Opioids From Multiple Prescribers & Multiple Pharmacies HEDIS" Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79786


Question:   1Section 3.4.8.1 of the Base Document states, "1. Provide, in table format, a list of the Applicant’s current Medicaid MCO contracts that includes the information listed below for each contract. If the Applicant does not have any current Medicaid MCO contracts, please provide the requested information for the Applicant’s most relevant contracts: a. Name of state/state program b. Start and end date c. Average number of member months for the most recent 12 months of the contract (or most recent period if the contract has been in place less than 12 months) d. Covered services (medical, pharmacy, behavioral health, dental, vision, transportation, long term services and supports, and/or other, with an explanation of other) e. Covered populations (families and children, including pregnant women aged, blind, and disabled [ABD] without Medicare ABD with Medicare adult group Childrens Health Insurance Program [CHIP] and/or other, with an explanation of other) f. Role of subcontractors and g. Contact name, email address, and phone number. Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. Which criteria will ODM utilize for this response? How will ODM determine the value given to each of the criteria used to evaluate the response?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79785


Question:   In section 4.3. of the Base Document, it states “All Applications that meet Phase I Mandatory Qualifications will be reviewed by the Evaluation Committee. The Evaluation Committee may use subject matter experts to review responses to specific Application questions and provide feedback for consideration by the Evaluation Committee. The Evaluation Committee will evaluate and assign a score to the responses to the Application questions. The score assigned to a particular response will determine the points given for that response. An Applicant’s Phase II score will be the sum of the points given to each of the Applicant’s responses to the scored Application questions. The questions are grouped into topic areas, and the maximum number of points available for each of the topic areas is as follows: Topic Area Maximum Available Points Qualifications & Experience 85 Population Health 395 Benefits & Service Delivery 340 Operational Excellence & Accountability 180 Total 1,000 The evaluation of the response to each question will focus on one or more of the following evaluation criteria, which are listed in descending order of importance: • Method of Approach • Capability and • Experience. Question: The RFA indicates that the Evaluation Committee will consider “one or more” criteria in scoring each response and lists the following as the criteria: method of approach, capability and experience. How will ODM determine which criteria is utilized for each response? In a number of the RFA questions, the RFA specifically asks for an applicant’s experience (e.g. 3.4.8.1 “Qualifications and Experience,” 3.4.8.2.5, and 3.4.8.3.21), what value will experience be given for each response? Lastly, how will ODM normalize the various applicant experiences will be vastly different based on the various service areas, member mixes, regulatory entities, providers, and products the applicants serve?

Answer:   See response to inquiry #79424.

Date: 11/12/2020

Inquiry: 79784


Question:   Section 3.4.8.4.32. of the Base Document states, “Describe how the Applicant will provide ODM access to the Applicant’s system and data, including any subcontractor’s data.” Question: Is ODM asking for access to subcontractor data via subcontractor systems or is this requirement specific to subcontractor data that has been shared with MCO?

Answer:   If an MCO leverages a contractor to provide services to Medicaid members, then subcontractor data would also be required to be provided to ODM.

Date: 11/12/2020

Inquiry: 79783


Question:   Section 3.4.8.4.32. of the Base Document states, “Describe how the Applicant will provide ODM access to the Applicant’s system and data, including any subcontractor’s data.” Question: The Model MCO Provider Agreement, Appendix K “Information Systems, Claims and Data,” 1.b. references “real time operational data” and “table level access” to data, how are these terms defined? Can the applicant satisfy these requirements by either: 1) transmitting data to ODM in an acceptable format, or 2) placing this data in a repository to which ODM resources are provided access?

Answer:   A replication of appropriate operational tables to support the requirement would be sufficient. Replication would need to be as real time as possible, but no longer than 24 hours. A repository resource would only work if each update included new records, change records, and an indication of adjudication order so that final adjudicated values can be determined.

Date: 11/12/2020

Inquiry: 79782


Question:   Regarding section 3.4.8.2.6. of the Base Document, it states "Describe how the Applicant will use feedback from members, family members, and providers to identify and execute program improvements. Provide a specific example of how the Applicant successfully engaged such stakeholders and used the information to achieve program improvements.” Question: Can ODM define or clarify what is specifically meant by “Program Improvements?” Is ODM referring specifically to the Applicant’s Population Health Management Program, as opposed to the Medicaid program as a whole, and is ODM requesting Applicants to identify population health management improvement opportunities garnered from stakeholder feedback and provide an example of how Applicant used the information to improve its Population Health Management Program?

Answer:   "Program improvement” in Question 6 of RFA Section 3.4.8.2 (Population Health), refers to the Medicaid managed care program as a whole.

Date: 11/12/2020

Inquiry: 79772


Question:   Regarding Attachment A, Appendix I "Quality Measures" starting on page 225, how will the Quality Indices and Measures for the Quality Withhold Program be determined for a new entrant in the first year of operation?

Answer:   The methods for the Quality Withhold Program for measurement year 2022 will likely be applied to the new entrant.

Date: 11/12/2020

Inquiry: 79759


Question:   During the Actuarial Conference, there were a number of non-claims items and adjustments discussed. Please provide details to estimate the value of these items (e.g. Enhanced Maternal Program, the Care Innovation and Community Improvement Program, Pathways Community HUB, and the Health Insuring Corporation Franchise Fee).

Answer:   See reponse to inquiry 79756

Date: 11/12/2020

Inquiry: 79757


Question:   During the Actuarial Conference, Mercer stated that the historical Rate Documents were available on the Ohio Department of Medicaid website. We were able to locate the final historical rates, but we were unable to locate the Rate Documents supporting the historical rates. Can you please make those available in the RFA resource library?

Answer:   Rate documents supporting historical rates have been uploaded in the RFA applicant library.

Date: 11/12/2020

Inquiry: 79756


Question:   Appendix L, Section 7 "Reinsurance Requirements" on page 261 of the RFA describes the reinsurance requirements for an MCO. The Appendix M-Rate Methodology data book does not appear to contain a value for the net reinsurance. Will the state please provide an estimate for this assumption?

Answer:   In recent rate setting activities, the application of net reinsurance adjustments resulted in an increase in base benefit expenses of appropriately 0.1%.

Date: 11/12/2020

Inquiry: 79755


Question:   Section 4.2 of the RFA includes as one Mandatory Qualification the requirement that the Applicant is either licensed by the Ohio Department of Insurance (ODI) as a Health Insuring Corporation (HIC) or has submitted an application to be licensed by ODI as a HIC. Item #14 in the Transmittal Letter requires the Applicant to certify to that effect, and also to provide evidence to support its certification, then gives as examples “a copy of the license or application for a license.” As evidence of an Applicant’s application for a HIC license from ODI, will ODM accept a confirmation of submission from ODI, or must the Applicant include a copy of its entire HIC application (which numbers in the hundreds of pages)?

Answer:   Yes, an Applicant may submit and ODM will accept a confirmation of submission of the HIC license application from ODI, provided that it clearly indicates the Applicant applied for a HIC license.

Date: 11/12/2020

Inquiry: 79753


Question:   Attachment A, Appendix K, Section 1 "Health Information System Requirements" Section 5 "Claims Adjudication and Payment Processing Requirements" starting on page 245 specifies MCO requirements relating to NIST 800-53 Rev 4 (page 246-247), MARS-E 2.0 (page 247) and (SOC) 2 Type II (page 247) report requirements. Would the state consider allowing MCOs to share summarized information regarding our HITRUST report as a proxy for the information requested in Appendix K, given that the HITRUST certification process aligns with the type of certifications requested in Appendix K?

Answer:   The MCOs may use a HITRUST certification as an equivalent to NIST, MARS-E and SOC 2 assuming they provide a crosswalk of the comperable controls and provide the detailed report to ODM.

Date: 11/12/2020

Inquiry: 79752


Question:   Attachment A, page 247, Appendix K, Section 5.g.v states, "The MCO must report systemic errors to ODM within two business days of adjudication or identification, whichever is earlier." If the issue allows the claim to process, it could be multiple days before the issue is identified, causing MCOs to be out of compliance. Can you confirm that this should state that MCOs must notify the state within two business days of identification?

Answer:   MCOs are expected to actively monitor their systems and not wait for reported issues to correct a problem.

Date: 11/12/2020

Inquiry: 79750


Question:   Regarding RFA Section 3.4.8.4 "Operational Excellence & Accountability" question 30.b, please confirm that bidders that do not currently have business in OH should use answer the question with metrics from a substantially similar market outside of the state to provide the state with the most accurate understanding of current performance.

Answer:   See response to inquiry #79479.

Date: 11/12/2020

Inquiry: 79749


Question:   In Appendix B,7,a pg. 161 Can ODM provide a definition for both a “product authorization” and a “service authorization” and how those differ from a prior authorization request?

Answer:   “Product or service authorization” as referenced in of RFA Attachment A, Model MCO Provider Agreement, Appendix B, Section 7.a.i means the MCO approval of coverage of products (e.g., medical equipment and supplies) and services. “Product or service authorization” includes prior authorization, but may include other utilization management authorization requirements, such as concurrent or retrospective authorization. Prior authorization means MCO approval of the coverage of a product or service before the product or service is provided.

Date: 11/12/2020

Inquiry: 79732


Question:   In regards to Appendix K.c.xi. Data and Systems Integration pg. 293 we assume that “name of the member’s care coordinator” refers to the care coordinator of the Member participating in the OhioRISE Plan? (As opposed to the name of the Member’s care coordinator at the MCO). Are we correct in this assumption? If we are not correct, please clarify.

Answer:   The MCO is required to store the name for all care coordinators servicing a member.

Date: 11/12/2020

Inquiry: 79730


Question:   In Appendix k 1C, vi pg. 292 Regarding the statement, “to provide single sign on services for all authorized users.” Question: We assume that it is the responsibility of the MCO to determine who is an authorized user of their systems? Are we correct in our assumption? If not, please clarify.

Answer:   ODM or its delegated authority will determine authorized users for those outside of the MCO. The MCO will determine authorized users for internal staff.

Date: 11/12/2020

Inquiry: 79729


Question:   In Appendix F.13.b.7 pg. 192, With regard to the statement: In accordance with 42 CFR 438.10, the MCOs provider directory must include the following information about each provider: 7. Indication of whether the provider offers telehealth, and if so, when telehealth is available Question: We understand ODM’s requirement to have telehealth information in provider directories, but did ODM mean to cite 42 CFR 438.10 as the underlying regulatory requirement? We cannot find any such telehealth requirement in 42 CFR 438.10. Did ODM mean to cite another regulation? If yes, can ODM specify that regulation?

Answer:   ODM cited 42 CFR 438.10 in Appendix F.13.b of RFA Attachment A, Model MCO Provider Agreement, as the regulatory reference for the federal requirements regarding an MCO’s provider directory. The requirement to include telehealth information in the provider directory is a state, not a federal, requirement.

Date: 11/12/2020

Inquiry: 79728


Question:   In Appendix I A.2 Table I.1 pg. 227, ODM makes a number of references to Population Streams throughout the RFA. We assume that ODM’s Population Streams are: Healthy Children, Women’s Health (Maternal/Infant), BH for Adults, BH for Children, Chronic Conditions, and Healthy Adults. Are we correct in our assumption? If we are not correct, please clarify.

Answer:   See response to inquiry #79541.

Date: 11/12/2020

Inquiry: 79727


Question:   Appendix K.c.v. Data and Systems Integration pg. 241, the RFA makes a number of references to the fiscal intermediary and to the systems integrator, but does not formally define these terms. We assume these two entities are distinct organizations. Are we correct in our assumption? Would ODM be able to supply bidders with a definition of the two terms? For example, is the “systems integrator” responsible for centralized credentialing support and the “fiscal intermediary” solely responsible for claims and prior authorization requests receipt? Does ODM anticipate both organizations to be in place for production use by January 5, 2022?

Answer:   Information concerning the Fiscal Intermediary can be found here: https://managedcare.medicaid.ohio.gov/wps/portal/gov/manc/managed-care/fiscal-intermediary/ Information concerning the system integrator can be found here: https://procure.ohio.gov/proc/viewProcOpps.asp?oppID=13927

Date: 11/12/2020

Inquiry: 79725


Question:   In Appendix F.3.d.vii.1, pg. 177, regarding the sentence: [The MCO must provide to ODM …] 1. The MCOs credentialing and re-credentialing files, including provider demographic information, primary source verification, and results of any site surveys Also, Section 1.2 (page 2 in Section 1 of the RFA) says: Under ODM’s centralized credentialing process, providers will submit an application for Medicaid enrollment and credentialing to ODM and will not need to submit credentialing and re-credentialing materials to MCOs Question: If the MCO is not performing credentialing activities, and if providers will not need to submit credentialing & re-credentialing materials to MCOs, then what does ODM mean by “credentialing and re-credentialing files” in F.3.d.vii.1?

Answer:   Once ODM goes live with the credentialing/recredentialing program as part of the Provider Network Management module, ODM's intention is to complete the credentialing for all ODM approved provider types. Prior to go-live of the Provider Network Management module, ODM intends to integrate the recredentialing dates of existing providers from the MCOs in order to ease the transition of providers.

Date: 11/12/2020

Inquiry: 79723


Question:   In regards to Appendix K.10.a pg. 305, we wish to confirm with ODM that the two HIEs referred to in this subsection are: Clinisync (http://www.clinisync.org/) and The Health Collaborative (https://healthcollab.org/).

Answer:   Correct

Date: 11/12/2020

Inquiry: 79722


Question:   In regards to Appendix K.10.c pg. 305, regarding the requirement as stated in K.10.c: The MCO must require its network hospitals to provide admission, discharge, and transfer (ADT) data to both HIEs. We assume that ODM is requiring this of hospitals in addition to requirements in 42 CFR § 482.24, § 482.61, and § 485.638.

Answer:   This requirement is without regard to the federal requirements cited in the question.

Date: 11/12/2020

Inquiry: 79721


Question:   In Appendix K.f.iv. Systems Audit pg. 298, regarding the System and Organizational Control (SOC) 2 Type II requirement – is ODM mandating this audit to cover the entire contract - or is ODM mandating an annual audit of this type by the MCO?

Answer:   The SOC2 Type II Audits must be completed at implementation and maintained for the entire length of the contract.

Date: 11/12/2020

Inquiry: 79720


Question:   In regards to Appendix K.f.iii. Systems Audit, pg. 299, regarding the phrase “cloud hosting provider”, we assume that the two Ohio HIEs are not covered under this phrase for purposes of the MCO ensuring adherence to Fed-RAMP or NIST 800-53 Rev 4. In other words, we assume that it is up to the HIEs to ensure their adherence to these requirements or any other state or federal requirements. Are we correct in our assumption - if we are not correct please clarify.

Answer:   It is up to HIEs to ensure their adherence to these requirements or any other state or federal requirements

Date: 11/12/2020

Inquiry: 79719


Question:   In regards to Appendix K.5.e.ii Electronic Visit Verification pg. 298, will MCO’s receive Electronic Visit Verification data (for use in review during the claim adjudication process), from the ODM fiscal intermediary – or will this data be received by the EVV vendor?

Answer:   The MCO must work with the EVV vendor to receive this data.

Date: 11/12/2020

Inquiry: 79718


Question:   In regards to Appendix K.5.c.i Edits pg. 298, will ODM’s fiscal intermediary be implementing SNIP edits on claims submitted by MCO providers to the fiscal intermediary? If yes, does ODM have information on what level of SNIP edits will be implemented by the fiscal intermediary? We asked this question because it may be important to have a consistent level of SNIP edits implemented by all MCOs and in coordination with the fiscal intermediary.

Answer:   1-4 and some of 7 SNIP level edits will be performed.

Date: 11/12/2020

Inquiry: 79717


Question:   In regards to Appendix K.4.a.i General pg. 296, regarding the points 1, 2 and 3 (where point 1 is: “Before the MCO may submit production files”), we assume that ODM is requiring that acceptance testing be conducted only under the conditions of points 2 and 3. In other words, ODM is not saying that acceptance testing must be conducted every time an MCO submits production files – but only when points two and/or three are true. Are we correct in our assumption? If we are not correct please clarify.

Answer:   Acceptance testing must occur when a system change is implemented and will be successful and complete when all tests achieve their expected outcome.

Date: 11/12/2020

Inquiry: 79716


Question:   In regards to Appendix D.2d.vii Incident Reporting, pg. 153 regarding the requirements for MCOs to enter incidents, we assume “the Incident Management System” refers to a State system and not the MCO’s internal system. Can ODM please clarify these requirements and define “the Incident Management System”?

Answer:   The Incident Management System is described in Ohio Administrative Code rule 5160-44-05.

Date: 11/12/2020

Inquiry: 79715


Question:   In regards to Section 3.4.8.3 Question 23 pg. 20 RFA and Attachment A, Appendix F Provider Network 9. Telehealth pg. 187-188, the RFA and Model MCO Provider Agreement do not appear to provide a clear definition of telehealth. Can ODM please clarify?

Answer:   Refer to Ohio Administrative Code Rule 5160-1-18 for the definition of telehealth.

Date: 11/12/2020

Inquiry: 79714


Question:   In regards to Attachment A, Appendix K, Information Systems, Claims, & Data 5.b.iii. Claims Adjudication pg. 245, the RFA states “the MCO must provide updated claims status demonstrating all claims activity on a daily basis to ODM.” Can ODM further define what the ‘updated claims status’ will consist of?

Answer:   The Provider Agreement provides sufficient specificity regarding the expectations of the MCO. The operational details will be finalized during the readiness period.

Date: 11/12/2020

Inquiry: 79713


Question:   In regards to Attachment A Appendix F, Provider Network pg. 193, can ODM provide further clarification to how it foresees MCOs and ODM collaborating to ensure the MCO’s internet-based provider directory is updated at the same frequency as ODM’s online provider directory?

Answer:   The Provider Agreement provides sufficient specificity regarding the expectations of the MCO. The operational details will be finalized during the readiness period.

Date: 11/12/2020

Inquiry: 79712


Question:   In regards to Attachment A, Introduction. Ohio Medicaid Managed Care Program pg. 2, has ODM considered tracking EHR and HIE adoption along with credentialing provider to avoid provider having to submit this information to multiple MCOs?

Answer:   The purpose of the Question and Answer process is to enable offerors and interested parties to obtain clarification about the procurement requirements in order to prepare a proposal. This question is not seeking such clarification.

Date: 11/12/2020

Inquiry: 79710


Question:   In regards to Attachment A, Population Health Improvement 9. Strategies pg. 125, could ODM please clarify the meaning of “up to date” regarding community resource lists?

Answer:   We expect that the MCO has taken reasonable measures to ensure the information provided in their Community Resource List is current.

Date: 11/12/2020

Inquiry: 79709


Question:   Section 5 of Attachment A, Model MCO Provider Agreement requires MCOs to have qualified Utilization Management review staff available by phone during standard business hours to process authorization requests for inpatient admissions, or the MCO must have policies and procedures that allow for emergency inpatient admissions with authorization the next business day. Our interpretation of this requirement is that for concurrent service requests, MCOs and providers for not need to use the fiscal intermediary. Please confirm for concurrent reviewers that requests will not go through the fiscal intermediary for initial or continued stay review requests, and address retrospective requests relative to use of the fiscal intermediary.

Answer:   All service authorization requests, whether prior, concurrent, or restrospective, will go through the FI and be passed on to the appropriate MCO.

Date: 11/12/2020

Inquiry: 79708


Question:   RFA Section 3.4.6 Required Forms (Tab 5), page 14 In regards to the forms requirements in section 3.4.6, is the expectation that “subcontractors” completing Attachments D, F, G, and H are the list of approved delegates or is there another group ODM is contemplating? Also, is it required that this group complete each of the Attachments D, F, G, and H individually?

Answer:   See responses to inquiries #79467 and 79598.

Date: 11/12/2020

Inquiry: 79705


Question:   RFA Section 3.4.8.1 Qualification and Experience (Tab 8), Question 2, page 16-17 If an Applicant only has one Medicaid contract in one state (with three years of HEDIS/CAHPS data) but also has Medicare and commercial plans in the same state and other states (with three years of HEDIS/CAHPS data), does ODM want the Applicant to submit the additional HEDIS and CAHPS data for Medicare and commercial for a total of three contracts?

Answer:   In response to Question 2 of RFA Section 3.4.8.1 (Qualifications & Experience) Applicants must submit HEDIS and CAHPS results for a total of three contracts (with Ohio managed care and MyCare contracts counting as a single contract). If an Applicant has Medicare and commercial contracts but only one Medicaid MCO contract, the Applicant must submit HEDIS/CAHPS information for that contract plus two of its largest Medicare contracts (based on membership). If the Applicant only has one Medicare contract, then the Applicant must submit HEDIS/CAHPS information for the Medicaid contract, its Medicare contract, and its largest commercial contract.

Date: 11/12/2020

Inquiry: 79694


Question:   Recognizing that MCOs are not permitted to modify the Model Medicaid Addendum, please confirm that if an MCO’s existing provider agreements for other product lines allow for unilateral amendments (via notification without requiring signature pursuant), that incorporating the Model Medicaid Addendum through that process is permissible so long as we provide 90 days advanced notice for material amendments as outlined by ORC 3963.04.

Answer:   Yes, incorporating the Model Medicaid Addendum in accordance with ORC 3963.04 is acceptable to ODM.

Date: 11/12/2020

Inquiry: 79669


Question:   ODM RFA Attachment A, Medicaid Managed Care Organization Appendix K, 1. Health Information System Requirements, c. Data and Systems Integration, vi, page 241 It would be helpful to understand the scope of all authorized users (i.e., external portal access or does it also mean internal employee access to system and data).

Answer:   All authorized users include staff and users at ODM, Care Coordination Entities (CCEs), Ohio RISE/Case Management Entities (CME), and the Single Pharmacy Benefit Manager (SPBM).

Date: 11/12/2020

Inquiry: 79662


Question:   Attachment A states: “iii. ODM’s auto-assignment algorithm will work in conjunction with Quality Based Assignment percentages where MCOs are awarded a percentage of unassigned enrollees based upon the MCO’s performance relative to other ODM-contracted MCOs.” What sort of reporting or data will ODM require a new MCO that does not yet have Ohio specific performance data or outcomes to provide to facilitate performance comparisons between MCOs for the Quality Based Assignment percentages?

Answer:   The decided approach will be contingent upon how many plans are selected, if any are new, and what regions they are selected for. The approach will be consistent with actuarially sound principles and practices.

Date: 11/12/2020

Inquiry: 79658


Question:   Attachment A, #2 states: “b. ODMs auto-assignment algorithm will account for specified lower and upper limits of MCO member enrollment. “ii. 1. ODM will establish a lower limit of MCO enrollment. Should the MCO fall below the lower limit of MCO member enrollment, auto-assignment will be adjusted to favor the MCO until the MCO meets the lower limit. “2. An upper limit of MCO enrollment will be established based upon the number of ODM-contracted MCOs in each region. Upon reaching the upper limit, ODM will stop the auto-assignment of members to the MCO until the MCOs membership drops below the upper limit.” Has ODM determined what the lower and upper limits of the auto-assignment algorithm will be, and will the limits be different by Region?

Answer:   Upper and lower limits, as well as regional limits, will be dependent on the total number of successful applicants. Until the final number of selected plans is established, ODM will not be able to establish actuarially sound limits. ODM will work closely with our actuaries to determine the limits once the necessary inputs are known.

Date: 11/12/2020

Inquiry: 79657


Question:   Attachment A states: "The MCO must provide additional transportation benefits for members under the age of 21. This medically necessary service cannot be a value-added service or have annual limitations." Please clarify the specific services/coverages that the plans are to provide to satisfy this requirement.

Answer:   RFA Attachment A, Model MCO Provider Agreement, Appendix B, Section 2.q.iv.3 is with regard to OhioRISE and requires the MCO to provide all medically necessary non-emergency medical transportation services for members enrolled in the OhioRISE Plan that are not covered by the county to ensure that children, youth, and their families do not face transportation barriers to receive services. The MCO may not establish numerical limits to non-emergency medical transportation services for OhioRISE members.

Date: 11/12/2020

Inquiry: 79655


Question:   Attachment A states: "The MCO must arrange and provide transportation for members who are enrolled with the OhioRISE Plan in a manner that ensures that children, youth, and their families served by the OhioRISE Plan do not face transportation barriers to receive services regardless of Medicaid payer. The MCO Care Guide Plus is responsible for arranging for transportation, regardless of whether the transportation is covered by the county or MCO." Please clarify the coordination and payment obligations of the MCOs for transportation services received by their members where the trips were covered by the county and/or the member is enrolled in the OhioRISE Plan.

Answer:   The MCO Care Guide Plus is the MCO point of contact for arranging and coordinating transportation services for OhioRISE Plan members and their families, whether the trips are covered by the county or by the MCO. When the county is required to cover transportion services but is unable to engage a provider, the MCO must cover the transportation services for the OhioRISE member.

Date: 11/12/2020

Inquiry: 79654


Question:   Section 3.4.7 of the RFA states, "Tab 6 must be labeled “Financial Capability” and must include the Applicant’s Dun & Bradstreet (D&B) ratings, indicating the firm’s financial strength and creditworthiness. These ratings are assigned to most US and Canadian firms by the US firm Dun & Bradstreet (D&B) and are based on a firms worth and composite credit appraisal. The Applicant must also include the Applicant’s D&B credit report, which contains the firms financial statements and credit payment history. If the Applicant is submitting an Application with one or more subcontractors, the Applicant must submit a D&B rating and credit report for each subcontractor." We were given guidance from Dun & Bradstreet that providing a Business Information Report and/or proprietary D&B Scores and Ratings is not permissible. We were also advised that any pulls of this information would need to occur directly between the requestor and Dun & Bradstreet. Is there an alternate method to meet this requirement in our Application?

Answer:   In the event that an Applicant is legally prohibited from providing a Dun & Bradstreet (D&B) report, the Applicant must submit other materials that demonstrate it and its subcontractors’ financial strengths, creditworthiness, financial statements, and credit payment history as identified at Section 3.4.7. In addition, if an Applicant is legally prohibited from providing only portions of the D&B reports that are responsive to section 3.4.7, then the Applicant must produce the portions of the reports that it is legally permitted to provide.

Date: 11/12/2020

Inquiry: 79651


Question:   Regarding Section 13.b. of Attachment A Appendix G page 214, states "The MCO must respond to requests from state or federal authorities within one business day of such request." Question: CareSource respectfully asks for clarification as to what type of requests where we will have one business day to respond. Depending on the type of request, we may need to collaborate with multiple internal departments, vendors, as well as perform data analytics in order to respond fully. Is this just to acknowledge receipt of ODMs request and then plan a respond date?

Answer:   The response required within one day is to acknowledge receipt of the request. Section 13.c next states that the MCO must produce copies of all data or files requested within 30 calendar days of the request.

Date: 11/12/2020

Inquiry: 79647


Question:   In regards to item 3 of Attachment F page 2, Name/Location(s) where state data will be stored, accessed, tested, maintained, or backed-up by subcontractor(s): Question: Is the intention of this question to capture delegated vendors/subcontractors who store, access, test, maintain, or back-up a managed care organization’s member PHI?

Answer:   As stated on the face of the Attachment, pursuant to Governor’s Executive Order 2019-12D (https://governor.ohio.gov/wps/portal/gov/governor/media/executive-orders/2019-12d), no public funds shall be spent on services provided offshore. This form serves as a certification of compliance with this policy and required disclosures.

Date: 11/12/2020

Inquiry: 79645


Question:   In regards to Attachment B.11, Letter of Transmittal, pg. 1, can ODM please provide clarification on how to calculate the “Percent of Work to be Completed by the Applicant and each subcontractor” for the upcoming Contract?

Answer:   See response to inquiry #79600.

Date: 11/12/2020

Inquiry: 79637


Question:   Section 19 of Attachment B: Letter of Transmittal Template states, "The Applicant must include requested litigation information for the Applicant, its parent organization, affiliates, and subsidiaries" Please confirm that the requirement to include “requested litigation information for the Applicant, its parent organization, affiliates, and subsidiaries" is limited to litigation involving Medicaid managed care plans.

Answer:   Please refer to the response to inquiry #79585

Date: 11/12/2020

Inquiry: 79636


Question:   Section 2.4: Actuarial Conference for Potential Applicants states, "The purpose of the actuarial conference is to discuss the rate setting methodology and the data book." In addition to the Rate Amendment Summaries already available on ODMs website, can ODM and Milliman provide bidders with the last 3 years of rate books and accompanying Rate Certification materials? This information will help non-incumbent bidders understand factors such as historical trends, historical administrative allowances, and program adjustments.

Answer:   This is currently in the bidders library.

Date: 11/12/2020

Inquiry: 79635


Question:   Section 3.4.8.1 states, "Provide, in table format, a list of the Applicant’s current Medicaid MCO contracts that includes the information listed below for each contract." Please confirm that the use of the word Applicant in the above example, and throughout the RFP generally, permits Applicants to include the experience of Applicants affiliated health plans (each of which share the same ultimate controlling parent).

Answer:   See response to inquiry #79374.

Date: 11/12/2020

Inquiry: 79633


Question:   Section 5.5 Application Offer Firm states, "All Applications submitted in response to this RFA will be considered firm for one hundred eighty (180) calendar days after the deadline for submission of Applications to ODM." Please confirm that, if an MCO determines ODMs reimbursement rates to be either actuarially unsound or unsustainable, that an MCO may withdraw its Application, regardless of the language of Section 5.5.

Answer:   An Applicant may not withdraw its Application after the deadline for submission of Applications. However, if a selected Applicant were not to agree to the terms of the final MCO provider agreement, including the capitation rates, a provider agreement would not be executed with that Applicant.

Date: 11/12/2020

Inquiry: 79632


Question:   Section 5.5 Application Offer Firm states, "All Applications submitted in response to this RFA will be considered firm for one hundred eighty (180) calendar days after the deadline for submission of Applications to ODM." Please confirm that, if an MCO determines ODMs reimbursement rates to be either actuarially unsound or unsustainable, that an MCO may withdraw its Application, regardless of the language of Section 5.5.

Answer:   An Applicant may not withdraw its Application after the deadline for submission of Applications. However, if a selected Applicant were not to agree to the terms of the final MCO provider agreement, including the capitation rates, a provider agreement would not be executed with that Applicant.

Date: 11/12/2020

Inquiry: 79631


Question:   Section 3.4.7 Financial Capability - Tab 6 states that, "Tab 6 must be labeled “Financial Capability” and must include the Applicant’s Dun & Bradstreet (D&B) ratings, indicating the firm’s financial strength and creditworthiness. These ratings are assigned to most US and Canadian firms by the US firm Dun & Bradstreet (D&B) and are based on a firms worth and composite credit appraisal. The Applicant must also include the Applicant’s D&B credit report, which contains the firms financial statements and credit payment history. If the Applicant is submitting an Application with one or more subcontractors, the Applicant must submit a D&B rating and credit report for each subcontractor." Please confirm that we may omit financial documents more than 250 pages from paper RFA submittals and, alternatively, submit them to ODM electronically.

Answer:   ODM would accept a printed and electronic summary of D&B rating and credit report for each applicant and subcontractor and an electronic only detailed D&B rating and credit report for each applicant and subcontractor.

Date: 11/12/2020

Inquiry: 79626


Question:   Paragraphs 17 and 19 on page 2 of Attachment B to the RFA, as well as Section 5.12 on page 30 of the RFA, call for the disclosure of information that may be confidential in nature. Given that Section 5.8 of the RFA prohibits Applicants from including any trade secret information in their Applications and paragraph 21 of Attachment B to the RFA requires Applicants to include a statement affirming that any and all information in the Application is not confidential and/or trade secret information such that the Application may be posted in its entirety on the internet for public viewing, how would ODM like for vendors to treat confidential information required to be submitted in response to Attachment B (17) and (19) and Section 5.12 of the RFA? Would ODM consider allowing Applicants to submit such information on a confidential basis directly to ODM separate from the RFA response and simultaneously provide ODM with a separate redacted copy of the Application appropriate for public posting to the internet, in a manner similar to how Attachment E to the RFA proposes that proprietary subcontractor information be submitted?

Answer:   Section 5.12 on page 30 of the RFA, do not ask for the disclosure of confidential information. If an Applicant is legally precluded from providing responsive information, however, Applicant must provide as much detail as legally permitted and explain the legal basis for withholding information. In so doing, Applicant must also explain Applicant’s role in the legal requirement including, for example, whether Applicant negotiated the agreement under which Applicant is now legally prohibited from providing information.

Date: 11/12/2020

Inquiry: 79624


Question:   Section 3.4.7. Financial Capability (Tab 6) on page 15 of the RFA requires Applicants to submit Dun & Bradstreet (D&B) ratings for the Applicant and for each subcontractor, indicating the firm’s financial strength and creditworthiness. In certain cases, D&B ratings are influenced in a large part by the size of the applying organization, not necessarily its credit status nor financial strength. ER (Employee Range) D&B ratings, for example, apply to certain lines of business that do not lend themselves to classification under the D&B rating system. Instead, these types of businesses are assigned an Employee Range symbol based on the number of people employed. Some of the Applicants’ subcontractors may simply not have a D&B rating because the size of their organization does not warrant it. Would the state consider limiting this requirement to only large subcontractors who perform services related to covered services (i.e. Dental, NEMT, vision subcontractors), or Applicants’ parent companies if they are also listed as subcontractors? Alternatively, please confirm the state will not penalize Applicants for proposing subcontractors who do not yet have a D&B rating?

Answer:   The applicant may submit any materials that demonstrate it and its subcontractors Financial Capability as identified at Section 3.4.7, up to and including Dun & Bradstreet (D&B) reports.

Date: 11/12/2020

Inquiry: 79611


Question:   Regarding Section 2.b. "Auto-Assignment Algorithm, Eligibility, Enrollment, Transfers, and Enrollment Termination" on page 48 of the RFA, could the State provide a specific numerical or percentage minimum and maximum threshold for enrollment in the auto-assignment algorithm? For example, should an incumbent MCO leave a region, would the auto assignment equally distribute those members to new entrant MCOs? Additional guidance on auto assignment will help provide more guidance in the financial feasibility of the opportunity for new applicants.

Answer:   See responses to inquires #79657 and #79658.

Date: 11/12/2020

Inquiry: 79609


Question:   RFA Section 2.3 Pre-Application Conference, page 6 When will the slide deck from the Pre-Application conference call be posted online?

Answer:   Slides have been posted and can be found here: https://managedcare.medicaid.ohio.gov/wps/portal/gov/manc/managed-care/request-for-applications

Date: 11/12/2020

Inquiry: 79601


Question:   In regards to Attachment B.11, Letter of Transmittal, pg. 1, can ODM please provide clarification on how to calculate the “Percent of Work to be Completed by the Applicant and each subcontractor” for the upcoming Contract?

Answer:   For item 11 in RFA Attachment B (Letter of Transmittal), ODM is requesting an estimate of the approximate percent of administrative services that would be provided by the Applicant and each proposed subcontractor. Applicant’s estimate could, as one example, be based on the estimated allocation of administrative costs.

Date: 11/12/2020

Inquiry: 79600


Question:   In regards to Attachment A Appendix C.g Community Reinvestment, pg. 129 and to assist Applicants in providing a detailed and appropriate response to Question 15 in section 3.4.8.2 of the RFA, can ODM provide a definition of community reinvestment and elaborate on what types of investments will be counted towards this?

Answer:   RFA Attachment A, Model MCO Provider Agreement, Appendix C, Section 4.g, Community Reinvestment, provides flexibility in the types of investments that will be counted as community reinvestment, but requires that the funding be used to support the MCO’s population health strategies within the region or regions the MCO serves. MCOs may not use community reinvestment funding to pay for Medicaid covered services.

Date: 11/12/2020

Inquiry: 79567


Question:   In regards to the requirements in Attachment A, Appendix C.4.a Population Health Improvement Strategies, pg. 124, can ODM please provide additional guidance on what types of “Supportive payment structures to promote a system-wide population health management approach” they are looking for?

Answer:   Payment models that are supportive of population health incentivize high quality, cost-effective care. According to the Health Care Payment Learning and Action Network, payers can promote resilient and effective alternative payment models through both short and long term actions that assist in the transition to effective APMS, promote equity in healthcare, account for varying provider needs, and advancing whole-person care.

Date: 11/12/2020

Inquiry: 79559


Question:   On page 15 of RFA ODMR-2021-0024, section 3.4.7 Financial Capability states, "Tab 6 must be labeled “Financial Capability” and must include the Applicant’s Dun & Bradstreet (D&B) ratings, indicating the firm’s financial strength and creditworthiness. These ratings are assigned to most US and Canadian firms by the US firm Dun & Bradstreet (D&B) and are based on a firms worth and composite credit appraisal. The Applicant must also include the Applicant’s D&B credit report, which contains the firms financial statements and credit payment history. If the Applicant is submitting an Application with one or more subcontractors, the Applicant must submit a D&B rating and credit report for each subcontractor." If a subcontractor does not have a D&B Credit Report, will the Applicant remain compliant with an "n/a" response.

Answer:   The applicant may submit any materials that demonstrate it and its subcontractors Financial Capability as identified at Section 3.4.7, up to and including Dun & Bradstreet (D&B) reports.

Date: 11/12/2020

Inquiry: 79550


Question:   RFA Section 2.3 Pre-Application Conference, page 6 When will ODM post the slide deck from the presentation?

Answer:   Slides have been posted and can be found here: https://managedcare.medicaid.ohio.gov/wps/portal/gov/manc/managed-care/request-for-applications

Date: 11/12/2020

Inquiry: 79511


Question:   Please confirm that as noted in the Attachment E instructions, the Applicant must 1) include information for its potential subcontractors in Sections A-C, as an attachment with a table of contents, and 2) Sections D-E and certification apply solely to the Applicant, and 3) only one executed Attachment E form from the Applicant is expected.

Answer:   ODM expects an individual form for the Applicant, as well as an individual form for each of the Applicant’s subcontractors. See response to inquiry #79573

Date: 11/12/2020

Inquiry: 79469


Question:   If a company is not listed with Dun & Bradstreet and therefore does not have a D&B rating, how may the company (the bidder or a proposed subcontractor) otherwise meet the requirements in section 3.4.7 to demonstrate financial strength and creditworthiness?

Answer:   The applicant may submit any materials that demonstrate it and its subcontractors’ Financial Capability as identified at Section 3.4.7, up to and including Dun & Bradstreet (D&B) reports.

Date: 11/12/2020

Inquiry: 79455


Question:   Attachment A, Appendix H - Value Based Payment, Section 2 a., Target Requirements, page 217 Based on the target requirements for CY2022-CY2025 it looks as though the State has separated out small and large providers based on Medicaid members, but doesn’t specify what provider types to which this applies (eg. PCP, PCP/Specialists, or all Provider Types). Please clarify. If intended to be inclusive of non-PCP practices, how does ODM envision non-Primary Care providers (e.g. specialists, BH providers, Hospitals) fitting into this requirement when these provider types do not carry member panels?

Answer:   This requirement applies to all provider types. ODM will designate all providers that do not have members attributed to them as small or large depending on the number of members with visits in a prior measurement year.

Date: 11/12/2020

Inquiry: 79440


Question:   RFA Section 3.4.8.4 Operational Excellence & Accountability (Tab 11), Question 27, page 22 The applicant understands that we can not answer a question with a statement see Question XX that is in same section or in a different topic area/tab. However, since Question 27 has three subparts (a,b and c), can the applicant respond see Question 27 a, if the same responses will be used for b and c?

Answer:   See response to inquiry #79604.

Date: 11/6/2020

Inquiry: 79841


Question:   According to RFA Base document, Section 3.4.8.2 Population Health, Q. 10 a., page 18, the question requests the coverage policy for bariatric surgery, including exclusion criteria. Our coverage policy includes an extensive bibliography. Would ODM consider us including it as an appendix without counting it toward the page count?

Answer:   For purposes of responding to Question 10 in RFA Section 3.4.8.2 (Population Health), the Applicant’s coverage policy for bariatric surgery, including exclusion criteria, will not be counted toward the page limits for Section 3.4.8.2.

Date: 11/6/2020

Inquiry: 79767


Question:   RFA Section 3.2.1 on page 12 states one blank line is required between paragraphs. Can the State confirm that no space is required following headers, between bulleted lines, and between numbered lists?

Answer:   RFA Section 3.2.1 (Paper Copies) requires single spacing within a paragraph and one blank line between paragraphs. Bulleted and numbered lists are considered paragraphs. Therefore, single line spacing is required between bulleted or numbered items in a bulleted or numbered list, and one blank line is required between a bulleted or numbered list and the next paragraph. No blank line is required after headings. See response to inquiry #79529.

Date: 11/6/2020

Inquiry: 79754


Question:   Page 34, 2 e. ii. of Appendix A to the MCO Provider Agreement requires the MCO to have its member and provider call centers for the MCO Provider Agreement located in the state of Ohio. Please confirm that for the purposes of this Provider Agreement, member and provider call centers do not refer to call centers of the Applicant’s subcontractors, for example, its transportation subcontractors.

Answer:   See response to inquiry 79748.

Date: 11/6/2020

Inquiry: 79751


Question:   Page 34 of Attachment A, Section 1 "General Requirements" part e.ii requires that the member and provider call centers for this agreement be located in the state of Ohio. Please confirm this requirement applies to core member and provider call center services, not to 7/24 Medical Advice Line, Behavioral Health Service Line for member crisis calls, nor provider authorizations lines.

Answer:   The requirement applies to the core member and provider call centers and does not extend to the 24/7 Medical Advice Line, Behavioral Health Service Line for members in crisis, nor the prior authorization lines.

Date: 11/6/2020

Inquiry: 79748


Question:   In regards to Section 3.8.4.4 Operational Excellence & Accountability, Question 31 pg. 23 can ODM please define institutional, BH, other professionals and what providers fit into these categories?

Answer:   For purposes of Question 31 in RFA Section 3.4.8.4 (Operational Excellence & Accountability), “institutional” providers are providers that submit institutional claim types (UB-04 or 837-I), such as hospitals and nursing facilities; “professional” providers are providers that submit professional claim types (CMS-1500 or 837-P), such as physicians, non-physician practitioners, laboratories, and medical suppliers; and behavioral health (BH) providers are professional providers that deliver behavioral health services, such as psychiatrists, psychologists, and providers certified by OhioMHAS as a provider of BH services.

Date: 11/6/2020

Inquiry: 79711


Question:   On page 22 of the RFA document, question 29 of section 3.8.4.8 requests the Applicant to "Submit flowcharts and brief narrative descriptions of the Applicant’s information systems to meet the requirements in the Model MCO Provider Agreement, addressing, at a minimum, the functional areas listed below: a. Member eligibility, enrollment, and disenrollment management b. Provider enrollment and network management c. Care coordination system and portal and interface with claims and the provider and member portals d. Claims processing edits, corrections, and adjustments e. Claims payment and prompt payment guidelines f. Coordination of benefits (COB) for claims with third party liability (TPL) g. Encounter submission, including statistics for percent accepted and denied h. Financial management and accounting and i. Any other ancillary systems/databases and their capabilities, such as reporting, grievance and appeals, subcontractor data collection, electronic visit verification (EVV), etc. Are the flowcharts excluded from the page limits for "Operational Excellence & Accountability (Tab 11) (Page limit 55 pages)"?

Answer:   See response to inquiry #79666.

Date: 11/6/2020

Inquiry: 79696


Question:   If ODM intends to reach out to contact individuals listed by an Applicant in response to section 3.4.8.1 Qualifications and Experience (Tab 8), will ODM notify the Applicant if it encounters any issues in reaching or receiving a response from any of the individuals listed, to allow the Applicant to help obtain any information requested by ODM? In several recent procurements in other states, bidders were severely penalized in scoring when the issuing agency was unable to reach one or more contacts after the RFP submission. Some of the contacts retired or left their posts and could not be reached, some intended to respond but missed the deadline due to significant demands of their day-to-day responsibilities, and in few other cases, administrative errors such as issues with a fax or email prevented delivery. These issues can be further exacerbated when several major holidays occur during the evaluation process, as is the case in Ohio. Most importantly, when a reference contact cannot be reached, the issuing agency is unable to receive important information about the bidding MCO’s background and experience, which is needed to fully and effectively evaluate the MCO’s qualifications and experience. Applicants can assist ODM in reaching the contacts listed, should any issues occur.

Answer:   See response to inquiry #79463.

Date: 11/6/2020

Inquiry: 79667


Question:   Regarding RFA Section 3.4.8, please confirm that Exhibits specifically required by the RFA do not count toward the page limits for each section. For example, flow charts requested in question 29 of 3.4.8.4, would not count toward the overall page limit for section 3.4.8.4.

Answer:   The entire response, including any exhibits, count toward the page limits for the section. With respect to Question 29 in RFA Section 3.4.8.4 (Operational Excellence & Accountability), requested flow charts will be counted in the overall page limit for Section 3.4.8.4. See also response to inquiry #79515.

Date: 11/6/2020

Inquiry: 79666


Question:   When will ODM share the Provider Manual template and required model language described in Section 6 (d. i.) on page 58 of Attachment A: Model MCO Provider Agreement?

Answer:   ODM will provide the ODM-developed template and model provider manual language following award during the readiness review period.

Date: 11/6/2020

Inquiry: 79656


Question:   Regarding RFA Section 5.12 on page 30, in the event that an Applicant is subject to legal confidentiality obligations and/or is legally bound not to disclose certain information, as it is currently drafted Section 5.12 of the RFA (as well as the related paragraph 17 on page 2 of Attachment B) may be read as requiring Applicants to provide information that the Applicant would be prohibited by law or legal obligation from disclosing, for example information related to a confidential settlement with a third party. Would ODM consider revising the terms of Section 5.12 and paragraph 17 of Attachment B, or otherwise clarifying that such provisions do not require an Applicant to disclose information that the Applicant is legally prohibited from disclosing?

Answer:   If an Applicant is legally precluded from providing responsive information, Applicant must disclose that it is legally precluded and explain the legal basis for withholding information. In so doing, Applicant must also explain Applicant’s role in the legal requirement including, for example, whether Applicant negotiated the agreement under which Applicant is now legally prohibited from providing information.

Date: 11/6/2020

Inquiry: 79613


Question:   In regards to the requirement below in Attachment A, Appendix F, i. Federally Qualified Health Centers/Rural Health Centers, “1. The MCO must provide expedited payment (within a shorter timeframe than the prompt payment requirements in Appendix L, Payment and Financial Performance) in an amount no less than the rate paid to other providers for the same or a similar service.”, can ODM please clarify the timeframe that MCOs must provide expedited payment?

Answer:   Because FQHCs/RHCs must submit wraparound payments to ODM within three hundred sixty-five days after the date of service, it is imperative that MCOs adhere to the prompt pay timelines outlined in appendix L. The MCO must ensure the claim is paid or denied in enough time to allow the provider to submit the wraparound claim to ODM.

Date: 11/6/2020

Inquiry: 79566


Question:   In regards to Section 3.4.8, pg. 15 paragraph 4, will ODM allow for an additional 5 pages for section 3.4.8.4. Operational Excellence and Accountability to allow for the numerous workflows to be submitted? Alternatively, please consider allowing the workflows to be excluded from the page count.

Answer:   See response to inquiry #79515: While ODM took these requirements into account in determining the page limits, ODM will increase the page limits for each section by 10 pages as follows: · The page limit for RFA Section 3.4.8.2, Population Health (Tab 9) is increased from 85 pages to 95 pages. · The page limit for RFA section 3.4.8.3, Benefits & Service Delivery (Tab 10) is increased from 70 pages to 80 pages. · The page limit for RFA section 3.4.8.4, Operational Excellence & Accountability (Tab 11) is increased from 55 to 65 pages.)

Date: 11/6/2020

Inquiry: 79556


Question:   Will ODM provide more detailed information regarding the process and specifications for the daily reconciliation of the MCOs provider network and ODMs provider network management system?

Answer:   ODM will provide a file extract of all active providers to MCPs that can be used to develop a reconciliation process. Additionally, MCPs will have view access to the Provider Network Management system to verify providers status with Ohio Medicaid before contracting with providers.

Date: 11/6/2020

Inquiry: 79466


Question:   Attachment A, Appendix B - Coverage and Services, 2. Service-Specific Clarifications, k. Substance Use Disorder Treatment, Item i, page 99 RFA Base, Section 3: Application Requirements, 3.4.8.3 Benefits & Service Delivery, Question 21, page 20 Related to substance use disorders, there are two references in the RFA materials to "co-occurring". Please provide ODMs definition of co-occurring. Does ODM define co-occurring as mental health and substance use disorders within the same person or behavioral health and physical health disorders?

Answer:   For purposes of these two references, please consider co-occuring to be inclusive of an individual with a substance use disorder and mental health or an individual with a behavioral health and physical health disorder.

Date: 11/6/2020

Inquiry: 79441


Question:   RFA Base, 3.2.1 Paper Copies, page 12 May 11pt Times New Roman or a smaller font than 12pt Times New Roman be used when restating the question text?

Answer:   Applicants may use 11 point Times New Roman font when restating the question text.

Date: 11/4/2020

Inquiry: 79439


Question:   1. Who are the state’s proposed Care Coordination Entities (CCEs)? 2. Could a certified Pathways Community HUB become a CCE?

Answer:   RFA Attachment A, Model MCO Provider Agreement, Definitions and Acronyms, Definitions, defines a Care Coordination Entity (CCE) as “A local community agency that provides care coordination to a specific population.” RFA Attachment A, Model MCO Provider Agreement, Appendix C, Section 5.a.i provides the following examples of CCEs: Child and Maternal Coordination (CMC) providers, Comprehensive Primary Care (CPC) practices, Behavioral Health Care Coordination (BHCC) entities, as well as conflict‐free case management agencies such as PASSPORT Administrative Agencies, County Boards of Developmental Disabilities, and Ohio Home Care Case Management Agencies.

Date: 11/4/2020

Inquiry: 79450


Question:   On page 176 of Appendix F of the Model MCO Provider Agreement, a reference is made to a provision within 42 CFR 438.207 that the MCO must submit documentation of network capacity at the time the MCO enters into a contract with ODM. Can ODM define the acceptable types of documentation for network adequacy?

Answer:   ODM will require the MCO that enters into a contract to submit their network panels into a system that identifies the provider name, type, specialty, location, and specifics regarding their capacity and availability to members. ODM will complete a review during the readiness process.

Date: 11/4/2020

Inquiry: 79387


Question:   Are the community reinvestment dollars counted as either medical or quality improvement expenses in the minimum medical loss ratio requirement reporting?

Answer:   Yes, as long as the expenditures meet the requirements of 42 CFR 438.8

Date: 11/4/2020

Inquiry: 79610


Question:   RFA Section 3.4.8.4 Operational Excellence & Accountability ( Tab 11) Q27, page 22 We know we are not allowed to refer to other questions in our responses however, are we allowed to refer to subparts within the same question? For example, question 27 has three subparts. Are we permitted to refer to the response to subpart b in the response to subpart c?

Answer:   The response to each question must be complete and independent from other responses; however, the Applicant’s response to a particular question may refer to subparts of the Applicant’s response to that same question.

Date: 11/4/2020

Inquiry: 79604


Question:   On page 5, the RFP indicates a flat fee structure payable at the end of the project. Is TourismOhio open to splitting the fees into two invoices, one of which is issued half way through the project?

Answer:   See response to inquiry #79573. Applicant must complete attachments D, F, G, and H seperately for itself and each of its proposed subcontractors.

Date: 11/4/2020

Inquiry: 79598


Question:   RFA Section 3.4.8.1 Qualifications & Experience, Q2, pages16-17 For the required table for HEDIS and CAHPS measures, does ODM require that the numerator and denominator be included in the table?

Answer:   Yes, include the numerator and denominator in the table.

Date: 11/4/2020

Inquiry: 79596


Question:   In regards to Attachment E Conflict of Interest, pgs. 1-3, can ODM please confirm if the Applicant, as defined in Section 1.6 RFA Glossary of the RFA, should submit a completed COI that includes relevant information for the Applicant and each of its proposed subcontractors? Or is each of the Applicant’s proposed Subcontractors required to fill out sections A. through E. and the Certification section of the COI? If the latter, will ODM consider requiring this form from proposed subcontractors at notification of award, rather than with the RFA response?

Answer:   Applicants must complete the COI for itself and each of its proposed subcontractors. See response to inquiry #79467

Date: 11/4/2020

Inquiry: 79573


Question:   In regards to Attachment E Conflict of Interest A. Description of Corporate and Organizational Structure pg. 1, if an MCP currently operates as a Medicaid and/or MyCare plan in Ohio, can ODM please confirm that it is permissible for the Applicant to submit an organization chart that reflects their current internal structure?

Answer:   For Attachment E Conflict of Interest A. Description of Corporate and Organizational Structure pg. 1, all applicants must follow the instructions in the RFP, specifically: “Applicant must provide: 1. Directors, officers, and partners of the Applicant and any persons with a beneficial ownership of 5% or more in the Applicant; 2. Organizational charts that show the complete corporate organizational structure of the Applicant, to include parent and affiliated organizations, as applicable; 3. Internal organization chart of the entity performing the work; and 4. Narrative explanation of structure/ownership.”

Date: 11/4/2020

Inquiry: 79571


Question:   In regards to the following requirement included in Attachment A, Appendix F, 4. Provider Network Access Requirements, pg. 178: “The MCO must notify ODM within one business day of determining that the MCO is not in compliance with the provider network access requirements specified in this appendix.” Provider adequacy changes on a daily basis due to data updates, change in ownership, etc. To notify ODM each time this occurs would be onerous for both the MCO and ODM. Can ODM please clarify the intent of the notice ODM is seeking – would this be limited to terminations that would result in an adequacy gap? What if we have already have another provider that will close this gap?

Answer:   ODM expects notification within 1 business day when the network provider termination results in a network adequacy deficiency.

Date: 11/4/2020

Inquiry: 79564


Question:   During the 10/8 Actuarial Conference, Milliman stated that the % difference between the encounter and cost report data will typically be 0.5% or less after data adjustment. Milliman also stated in past years the difference has been 0.1-0.3%. We calculate that a difference of 0.1 - 0.5% in the base data is significant as it accounts for a substantial proportion of the risk margin. The threshold for determining materiality may not be consistent between different assumptions within the rate development. For example, on page 13 of the Data Book, Milliman defined program adjustments to be "material" if the impact is greater than 0.1%. Alternately, it appears that Milliman also believes a 0.5% variance in the base data is acceptable. What steps do you plan to take to reduce the remaining variance between the encounter and cost report data after accounting for known data adjustments?

Answer:   ODM has observed data quality concerns in both MCO encounter data and MCO financial cost reports. A variance between MCO financial cost reports and encounter data does not imply a certain level of missing claims. ODM anticipates continued work with all involved parties to review and improve encounter data and cost report submissions in the managed care program.

Date: 11/4/2020

Inquiry: 79561


Question:   Regarding page 16 of the Data Book and Capitation Rate Methodology, can you please confirm if MCOs will receive member level risk scores for the enrolled population?

Answer:   Aggregate risk score information is provided to each MCO; however, member level risk scores are not provided for the enrolled population.

Date: 11/4/2020

Inquiry: 79549


Question:   Regarding page 9 of the Data Book and Capitation Rate Methodology, can you please confirm separate capitation rates will be developed by region and by rate cell? Can you also discuss what smoothing techniques will be used to increase the data credibility for rate cells with limited exposure?

Answer:   Separate capitation rates will be developed by region and rate cell. Smoothing techniques have historically not been applied as the data was determined to be credible for rate setting activities.

Date: 11/4/2020

Inquiry: 79548


Question:   RFA Section 3.4.8.2 Population Health (Tab 9), page 17 The applicant would like to confirm with ODM that page limit, 85 pages, is the maximum for answering all 12 questions under this section not per individual question.

Answer:   See response to inquiry #79515.

Date: 11/4/2020

Inquiry: 79539


Question:   Regarding the page limits requirements in Section "3.4.8 Response to Applications Questions (Tab7)" on page 15 of the Base document, the requirement states that "For each question, the Applicant must start on a new page and include both the number of the question and the text of the question and then provide the response. All pages for a topic area/tab must be numbered sequentially and include the topic area name and total number of pages for the topic area." Question: Will the state reconsider the page limits in light of the requirements to: 1. Restate all questions on the page (some of which include tables), 2. Restate new questions on a new page (this could result in the loss of ½ a page per question) and 3. Prohibition of referencing other sections of the response within an answer, 4. Requirement to discuss regional variances could add additional length. In light of these limitations/substantive narrative requests, would the state agree to increase page limits?

Answer:   While ODM took these requirements into account in determining the page limits, ODM will increase the page limits for each section by 10 pages as follows: · The page limit for RFA Section 3.4.8.2, Population Health (Tab 9) is increased from 85 pages to 95 pages. · The page limit for RFA section 3.4.8.3, Benefits & Service Delivery (Tab 10) is increased from 70 pages to 80 pages. · The page limit for RFA section 3.4.8.4, Operational Excellence & Accountability (Tab 11) is increased from 55 to 65 pages.

Date: 11/4/2020

Inquiry: 79515


Question:   How do we get an application for the OHIO RISE? Thank you, Lynn

Answer:   The purpose of the Question and Answer process is to enable Offerors and interested parties to obtain clarification about the procurement requirements in order to prepare a proposal. This question is not asking for clarification but instead is asking about a separate procurement opportunity.

Date: 10/29/2020

Inquiry: 79643


Question:   Section 3.4.8.1 states, "Provide, in table format, a list of the Applicant’s current Medicaid MCO contracts that includes the information listed below for each contract." Please confirm that Applicants may include in their experience narrative examples that Applicants or Applicants’ affiliates have administering non-owned plans, so long as Applicants clearly identify plans that are non-owned plans as such.

Answer:   In response to Question #1 in RFA Section 3.4.8 (Qualifications & Experience), the Applicant may include information on contracts held by the Applicant or by the Applicant’s parent, subsidiary, or affiliate. If the Applicant includes information on contracts held by the Applicant’s parent, subsidiary, or affiliate, the Applicant must identify the name of the parent, subsidiary, or affiliate and the nature of the corporate relationship. See response to inquiry #79374 regarding including experience by the Applicant’s corporate family in response to any other questions. Additionally, the Applicant may include information on contracts administered by the Applicant or the Applicant’s parent, subsidiary or affiliate but held by non-owned plans. However, the Applicant must include the following in the table (either in the body of a table or as a footnote): (a) the name of the entity administrating the non-owned plan; (b) if the entity administering the non-owned plan is not the Applicant, the Applicant’s corporate relationship with the entity administering the non-owned plan; (c) the name of the non-owned plan; (d) the relationship between the entity administering the non-owned plan and the non-owned plan; and (e) the key functions conducted by the entity administering the non-owned plan. If the Applicant includes experience from non-owned plans in response to any other questions, the Applicant must include information on (a) through (e) in its response.

Date: 10/29/2020

Inquiry: 79634


Question:   Section 5.13 Mandatory Disclosures of Governmental Investigations states, "Each Application must indicate whether the Applicant, or any of the Applicant’s proposed subcontractor(s), has been the subject of any adverse regulatory or administrative governmental action (federal, state, or local) with respect to Applicant’s performance of a government contract." Please confirm that Applicants and proposed subcontractors need only disclose adverse regulatory or administrative governmental actions from the last three calendar years.

Answer:   No. See response to inquiry #79426.

Date: 10/29/2020

Inquiry: 79630


Question:   Section 5.12 Mandatory Contract Performance Disclosure states, "Each Application must disclose whether the Applicant or any proposed subcontractor has received a formal claim for breach of contract. For purposes of this disclosure, “formal claims” means any claims for breach that have been filed as a lawsuit in any court, submitted for arbitration (whether voluntary or involuntary, binding or not), or assigned to mediation." Please confirm that Applicants and proposed subcontractors need only disclose formal claims for breach of contract that have occurred in the last three calendar years.

Answer:   No. See response to inquiry #79425.

Date: 10/29/2020

Inquiry: 79628


Question:   Section 5.12 Mandatory Contract Performance Disclosure states, "Each Application must disclose whether the Applicant or any proposed subcontractor has received a formal claim for breach of contract. For purposes of this disclosure, “formal claims” means any claims for breach that have been filed as a lawsuit in any court, submitted for arbitration (whether voluntary or involuntary, binding or not), or assigned to mediation." Please confirm that Applicants and proposed subcontractors need only disclose formal claims for breach of contract that have occurred in the last three calendar years.

Answer:   No. See response to inquiry #79425.

Date: 10/29/2020

Inquiry: 79629


Question:   Regarding section 2.c.i. of Attachment A Appendix A page 37, it states, "Members under the age of 21 may be eligible for OhioRISE and enrolled in the OhioRISE Plan. Members enrolled in the OhioRISE Plan when turning 21 years of age will remain eligible and enrolled until the end of the month in which the member turns 21 years of age. The OhioRISE Plan is designed to provide comprehensive, coordinated behavioral health care for children with serious or complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems. Members enrolled in the OhioRISE Plan will remain enrolled in the MCO for services not provided by the OhioRISE Plan. The MCO must cover and provide services for OhioRISE enrolled members as specified in Appendix B, Coverage and Services." Question: What is the definition of "factors" that will lead to a child being defined as “at-risk for becoming involved in multiple systems”?

Answer:   Additional information regarding eligibility for the OhioRISE plan is available through the separate OhioRISE RFA.

Date: 10/29/2020

Inquiry: 79590


Question:   Regarding Section 2.c.i. "Ohio Medicaid Managed Care Program" on page 2 of Attachment A, the requirement states, "ODMs fiscal intermediary will serve as a single clearinghouse for all medical (non-pharmacy) claims. All Medicaid claims will be submitted to ODMs fiscal intermediary, and the fiscal intermediary will apply specified Strategic National Implementation Process (SNIP) level edits and send the claim to responsible MCO for claims processing and payment." Additionally, regarding section 7.a.i. Service Authorization on page 110 of Attachment A Appendix B, the requirement states, "the MCO must cooperate with ODM to develop processes and systems necessary to allow providers to submit requests for product or service authorization, and for the MCO to accept and respond to authorization requests from providers through secure electronic transmission and exchanges with ODMs fiscal intermediary. The MCO must require its providers to comply with service authorization submission requirements through ODMs fiscal intermediary as determined by ODM." Question: As plans currently utilize direct payment and prior auth processes with providers and providers are benefitting from these relationships with plans through faster turnaround times, increased transparency, minimization of operational burdens and administrative complexities: Will providers be allowed to submit claims and prior authorizations directly to the plan or will providers be required to use the fiscal intermediary on a mandatory bases for all claims and prior authorizations submissions?

Answer:   As quoted in the question, providers will not be allowed to submit claims and prior authorizations directly to the managed care organization; the use of the fiscal intermediary is mandatory.

Date: 10/29/2020

Inquiry: 79589


Question:   Regarding the section Letter of Transmittal Template in Attachment B Item 17 on page 2 states, " In accordance with Section 5.12, Mandatory Contract Performance Disclosure, a statement that (a) neither the Applicant nor a proposed subcontractor has received a formal claim for breach of contract or (b) the Applicant or a proposed subcontractor has received a formal claim for breach of contract. If (b), provide, as an attachment to the Transmittal Letter, a detailed explanation of any claims." Question: In reference to the Letter of Transmittal Template item 17, is breach of contract claims limited to disputes arising from services contracted to the managed care organization pursuant to the Ohio Department of Medicaid Ohio Medical Assistance Provider Agreement for Managed Care Plan? Further, similar to Question 19 in the Letter of Transmittal Template where there is a 5 year time frame for litigation, is there a time period limitation for breach of contract claims? Do subcontractors also include providers? Is the requested breach of contract claims limited to Ohio?

Answer:   See response to inquiry #79425.

Date: 10/29/2020

Inquiry: 79588


Question:   In reference to the Instructions to Applicant in Attachment E at the top of page 1, it states to "Complete this form for the Applicant and each subcontractor, and provide all of the following information contained herein (A. through E., plus the Certification) with your Application and update during performance under the provider agreement, as required. Because all of the information to be submitted cannot be contained within this form, provide a table of contents with your submission(s). Please ensure that you follow this outline format in your submission(s), and include the appropriate sections (A. through E., and Certification) and page numbers for ease of reference." Question: In reference to these instructions, when referring to "subcontractor," is this limited to FDRs as defined in Section 56 of the Ohio Department of Medicaid Ohio Medical Assistance Provider Agreement for Managed Care Plan? Further, where an existing managed care organization has already submitted a Conflict of Interest form for a particular subcontractor as part of the FDR process, does ODM intend for the managed care organization to submit another Conflict of Interest Form for the same subcontractor as part of the RFA submission?

Answer:   See response to inquriy #79467. Additionally, the MCO must submit a Conflict of Interest Form for the same contractor as part of the RFA submission.

Date: 10/29/2020

Inquiry: 79586


Question:   Regarding the section Letter of Transmittal Template in Attachment B Item 19 on pages 2-3, it states, "A statement of whether there is any pending or recent (within the past five years) litigation against the Applicant where the amount in controversy or the damages sought or awarded is $1 million or more. This includes but is not limited to litigation involving the failure to provide timely, adequate, or quality health care services. If there is pending or recent litigation against the Applicant, the Applicant must describe the litigation and the damages being sought or awarded and the extent to which an adverse judgment is/would be covered by insurance or reserves set aside for that purpose. The Applicant must include an opinion of counsel as to the degree of risk presented by any pending litigation and whether the pending or recent litigation will impair the Applicant’s performance under the provider agreement. If there has been a judgment against the Applicant, the Applicant must provide the details of the judgment and an opinion of counsel as to the degree of risk presented by the judgment and whether the judgment will affect the Applicant’s solvency and/or impair the Applicant’s ability to perform under the provider agreement. If applicable, the Applicant must include any Securities Exchange Commission (SEC) filings discussing any pending or recent litigation. The Applicant must include requested litigation information for the Applicant, its parent organization, affiliates, and subsidiaries. This information may be included as an attachment to the transmittal letter." Question: In reference to the Letter of Transmittal Template item 19, with regard to pending or recent litigation, is this limited to pending or recent litigation being considered in an Ohio state or federal court? Is litigation limited to disputes arising from services contracted to the managed care organization pursuant to the Ohio Department of Medicaid Ohio Medical Assistance Provider Agreement for Managed Care Plan?

Answer:   No, the geographic scope of this requirement is not limited to Ohio. It includes any US state or territory. This requirement pertains to contracts with both governmental and non-governmental entities. This requirement pertains to contracts related to providing or administering health care services, including Medicaid, Medicare, and commercial health insurance and both insured and self-funded plans.

Date: 10/29/2020

Inquiry: 79585


Question:   Regarding the section Letter of Transmittal Template in Attachment B Item 18 on page 2 states, "In accordance with Section 5.13, Mandatory Disclosure of Governmental Investigations, a statement that (a) neither the Applicant nor a proposed subcontractor has been the subject of an adverse regulatory or administrative governmental action with respect to performance of a government contract or (b) the Applicant or a proposed subcontractor has been the subject of an adverse regulatory or administrative governmental action with respect to such performance. If (b), provide, as an attachment to the Transmittal Letter, a detailed explanation of any such governmental actions." Question: In referring to "subcontractor" in the Letter of Transmittal Template item 18, is this limited to FDRs as defined in Section 56 of the Ohio Department of Medicaid Ohio Medical Assistance Provider Agreement for Managed Care Plan? Further, similar to Question 19 regarding litigation where there is a 5 year time frame, is there a time period limitation? Are the requested governmental actions limited to Ohio? Is an adverse regulatory or administrative action limited to those instances where a fine, penalty, or sanction is imposed?

Answer:   For purposes of responding to the RFA, subcontractor means first-tier entities, related entities, and downstream entities, as defined in RFA Attachment A, Model MCO provider agreement, performing administrative services. Administrative services include care management, marketing, utilization management, quality improvement, enrollment, disenrollment, membership functions, claims administration, provider network management, and coordination of benefits. The Applicant must disclose any governmental actions against the Applicant (including the Applicant’s parent company, affiliates, or subsidiaries) or subcontractor, arising after January 1, 2005. The scope of this requirement is not limited to Ohio. It includes any United States state or territory. The scope of this requirement is not limited to actions where a fine, penalty, or sanction was imposed.

Date: 10/29/2020

Inquiry: 79584


Question:   Regarding the section Letter of Transmittal Template in Attachment B Item 12 on pages 1-2 states, "If the Applicant proposes to use subcontractors, provide, as an attachment to the transmittal letter, a letter from each proposed subcontractor, signed by a person authorized to legally bind the subcontractor, indicating the following: a. Subcontractor’s legal status, federal tax ID number, and principal business address b. Name, phone number, and email address of a person who is authorized to legally bind the subcontractor to contractual obligations c. A description of the work the subcontractor will do d. A commitment to do the work, if the Applicant is selected e. Subcontractor qualifications for the proposed work the subcontractor will do and f. A statement that the subcontractor has read and understands the RFA, the nature of the work, and the requirements of the RFA." Question: In referring to "subcontractor" in the Letter of Transmittal Template item 12, is this limited to FDRs as defined in Section 56 of the Ohio Department of Medicaid Ohio Medical Assistance Provider Agreement for Managed Care Plan?

Answer:   See response to inquiry #79467.

Date: 10/29/2020

Inquiry: 79583


Question:   Regarding Section 5.12 "Mandatory Contract Performance Disclosure" pages 30-31 of the Base document, it states, "Each Application must disclose whether the Applicant or any proposed subcontractor has received a formal claim for breach of contract. For purposes of this disclosure, “formal claims” means any claims for breach that have been filed as a lawsuit in any court, submitted for arbitration (whether voluntary or involuntary, binding or not), or assigned to mediation. If any such claims are disclosed, the Applicant must fully explain the details of those claims, including the allegations regarding all alleged breaches, any written or legal action resulting from those allegations, and the results of any litigation, arbitration, or mediation regarding those claims, including terms of any settlement. While disclosure of any formal claims in response to this section will not automatically disqualify an Applicant from consideration, at the sole discretion of ODM, such claims and a review of the background details may result in a rejection of the Applicant’s Application. ODM will make this decision based on its determination of the seriousness of the claims, the potential impact of the alleged behavior that led to the claims could have on the Applicant’s performance of the work, the outcome, judgment, or resolution of the claim, and the best interests of ODM." Question: In reference to Section 5.12 of the Base document, is breach of contract claims limited to disputes arising from services contracted to the managed care organization pursuant to the Ohio Department of Medicaid Ohio Medical Assistance Provider Agreement for Managed Care Plan? Further, similar to Question 19 in the Letter of Transmittal Template where there is a 5 year time frame for litigation, is there a time period limitation for breach of contract claims? Do subcontractors also include providers? Is the requested breach of contract claims limited to Ohio?

Answer:   See response to inquiry #79425.

Date: 10/29/2020

Inquiry: 79582


Question:   Regarding Section 5.13 "Mandatory Disclosures of Governmental Investigations" on page 31 of the Base document, it states, "each Application must indicate whether the Applicant, or any of the Applicant’s proposed subcontractor(s), has been the subject of any adverse regulatory or administrative governmental action (federal, state, or local) with respect to Applicant’s performance of a government contract. If any such instances are disclosed, Applicant must fully explain, in detail, the nature of the governmental action, the allegations that led to the governmental action, and the results of the governmental action, including any legal action that was taken against Applicant by the governmental agency. While disclosure of any governmental action in response to this Section will not automatically disqualify an Applicant from consideration, such governmental action and a review of the background details and outcome, judgment, or resolution of the action may result in a rejection of the Applicant’s Application at the sole discretion of ODM." Question: In reference to "subcontractor" in section 5.13 of the Base document, is this limited to FDRs as defined in Section 56 of the Ohio Department of Medicaid Ohio Medical Assistance Provider Agreement for Managed Care Plan? Further, similar to Question 19 in the Letter of Transmittal Template where there is a 5 year time frame for litigation, is there a time period limitation on any adverse regulatory or administrative governmental action? Are government actions limited to actions arising from services contracted to the managed care organization pursuant to the Ohio Department of Medicaid Ohio Medical Assistance Provider Agreement for Managed Care Plan? Are the requested governmental actions limited to Ohio? Is an adverse regulatory or administrative action limited to those instances where a fine, penalty, or sanction is imposed?

Answer:   For purposes of responding to the RFA, subcontractor means first-tier entities, related entities, and downstream entities, as defined in RFA Attachment A, Model MCO provider agreement, performing administrative services. Administrative services include care management, marketing, utilization management, quality improvement, enrollment, disenrollment, membership functions, claims administration, provider network management, and coordination of benefits. The Applicant must disclose any governmental actions against the Applicant (including the Applicant’s parent company, affiliates, or subsidiaries) or subcontractor, arising after January 1, 2005. The scope of this requirement is not limited to Ohio nor to the Ohio Department of Medicaid Ohio Medical Assistance Provider Agreement for Managed Care Plan. It includes any United States state or territory. The scope of this requirement is not limited to actions where a fine, penalty, or sanction was imposed.

Date: 10/29/2020

Inquiry: 79581


Question:   In regards to the requirements in Attachment A, Appendix H, 4.C Comprehensive Primary Care (CPC) Practice Requirements, pg. 219, In order to move practices to a risk model, will ODM support downside risk by allowing practices to opt out of CPC?

Answer:   ODM is continually evaluating and updating the CPC and CPC for Kids programs. ODM plans to continue working with provider and payer partners to make improvements that optimize clinical outcomes and evolve financing mechanisms.

Date: 10/29/2020

Inquiry: 79579


Question:   In regards to Attachment A, Appendix H Table H.1 APM Target Requirements, pg. 217: With the high uptake of large practices and systems (above 150 Medicaid members) participating in the Comprehensive Primary Care (CPC) program, does ODM anticipate also adding a downside/risk component to the program? This may impact a MCO’s ability to meet the new APM LAN requirements as outlined in the draft Provider Agreement.

Answer:   ODM is continually evaluating and updating the CPC and CPC for Kids programs. ODM plans to continue working with provider and payer partners to make improvements that optimize clinical outcomes and evolve financing mechanisms.

Date: 10/29/2020

Inquiry: 79578


Question:   In regards to Attachment A Appendix A.9.e.ii.3 pg.89, the MCOs are to notify ODM and submit a corrective action plan (CAP) to ODM if at any time the FDR is found to be in noncompliance with the MCOs delegated contractual obligations. As this data is reviewed on a frequent basis, what is the expectation on the frequency of the CAPs and are there any parameters around the noncompliance (i.e. below 98%, etc.)?

Answer:   The MCO must notify and submit a corrective action plan (CAP) to ODM when the MCO determines that a First Tier, Downstream, and Related Entity (FDR) is out of compliance with the MCO’s contractual requirements for a delegated function. The frequency of reporting is dependent upon the frequency in which the MCO identifies non-compliance. ODM will hold the MCO responsible for meeting all contractual obligations and performance thresholds under its MCO Provider Agreement with ODM, regardless of delegation. The MCO Provider Agreement does not specify a compliance threshold or percentage to define the level of FDR or MCO noncompliance warranting a CAP. Guidance related to the types and levels of noncompliance and ODM’s approach to noncompliance is provided in RFA Attachment A, Model MCO Provider Agreement, Appendix N, Compliance Actions.

Date: 10/29/2020

Inquiry: 79574


Question:   In regards to the Subcontractor definition included in Attachment A, Definitions and Acronyms, Pg. 15 Subcontractor: “As defined in OAC rule 5160-26-01, any party that has entered into a subcontract to perform a specific part of the obligations specified under the MCOs provider agreement with ODM.” Please confirm that for the purposes of this RFA, subcontractor refers to the Applicant’s First Tier entities and Related entities involved in the delivery of care for covered services under the contract.

Answer:   See response to inquiry #79467.

Date: 10/29/2020

Inquiry: 79572


Question:   In regards to the requirements in Attachment A, Appendix F, F. Sole Source Contracting pg. 178, can ODM please confirm if they will allow grandfathering of sole source contracts or will ODM require approval for existing sole source contracts?

Answer:   ODM will require approval for existing sole source contracts.

Date: 10/29/2020

Inquiry: 79565


Question:   In regards to the following requirement included in Attachment A, Appendix F, 3. Provider Contracting b.v., pg. 177, “Upon ODMs request, the MCO must disclose to ODM all financial and other terms that apply between the MCO and any network provider.” Can ODM please confirm that this financial data will remain confidential and will not be disclosed to the public?

Answer:   See Article VII of the baseline Provider Agreement in Attachment A.

Date: 10/29/2020

Inquiry: 79563


Question:   In regards to the following requirement included in Attachment A, Appendix F, 3. Provider Contracting b.iii., pg. 176, “The MCO must submit network provider contract templates to ODM for review prior to executing contracts using the applicable template.” Can ODM please clarify if this applies to Value-Based Contracts?

Answer:   If the Applicant has templates for different types of value-based contracts, then those templates would need to be submitted to ODM for review prior to executing contracts using the applicable template. See also response to inquiry #79468

Date: 10/29/2020

Inquiry: 79562


Question:   In regards to the following requirement included in Attachment A, Appendix F, 3. Provider Contracting b.iii., pg. 176, “The MCO must submit network provider contract templates to ODM for review prior to executing contracts using the applicable template.” Can ODM please clarify if this requirement would apply to a current MCO if they are awarded to continue to participate in the Ohio Medicaid Managed Care Program? If yes, will those templates need to be submitted to ODM for review, or will this only apply to templates for new contracts?

Answer:   If a current MCO is awarded to continue participation, it must submit the templates it intends to use for new contracts. For existing contracts, the MCO must incorporate any changes required by ODM.

Date: 10/29/2020

Inquiry: 79560


Question:   Please confirm Applicants need only include subcontractor information for parties with which they have/will have an FDR agreement as defined in Section 9(a)(ii) and 9(a)(vi)(5) of Appendix A of the Model MCO Provider Agreement.

Answer:   See response to inquiry #79467.

Date: 10/29/2020

Inquiry: 79546


Question:   Regarding Attachment A Appendix C section 3.a.ii. on page 122, it is stated: "The MCO must incorporate ODM-provided, structured guidance for identifying the population streams as described in ODMs Quality Strategy, located on ODMs website, into the MCOs Population Health Strategy as required by ODM." Question: The six population streams indicated in section 3.a.i. (women (maternal and infants), children with behavioral health conditions, adults with behavioral health conditions, healthy adults, healthy children, and members with chronic conditions) of Appendix C page 122 and referred to in section 3.a.ii. do not align with the five population streams identified on page 55 with ODMs Quality Strategy located on ODMs website which are women, chronic conditions, behavioral health, healthy children & adults Please clarify.

Answer:   ODM’s Quality Strategy is currently in use by ODM and is subject to review and revision for the future program (reference the “Read Me” file in the RFA Resource Library for ODM Medicaid MCO RFA, Folder Number 4). ODM’s Quality Strategy will be updated to reflect the population streams in RFA Attachment A, Model MCO Provider Agreement, Appendix C, Section 3.a.ii. The population streams reflected in RFA Attachment A, Model MCO Provider Agreement, Appendix C, Section 3.a.ii were chosen to place emphasis on the differing needs of children and adults, requiring separate population streams for these subpopulations. This separation also aligns with ODM’s implementation of OhioRISE (Resilience through Integrated Systems and Excellence), a specialized program that will offer enhanced care coordination and behavioral health services for children with complex behavioral health and multi-system needs. More information about OhioRISE can be found at https://managedcare.medicaid.ohio.gov/wps/portal/gov/manc/managed-care/ohiorise/ohiorise.

Date: 10/29/2020

Inquiry: 79542


Question:   In regards to Attachment A Appendix C section 3.a.i. on page 122, it is stated: "The MCO must stratify populations within its membership to drive the MCO population health management approach, prioritization of initiatives, and resource allocation and to optimize health outcomes. The MCOs assigned population stream must align with ODM identified population streams, which are currently: women (maternal and infants), children with behavioral health conditions, adults with behavioral health conditions, healthy adults, healthy children, and members with chronic conditions." Question: The population streams identified in this section do not align exactly with the population streams identified as described on page 55, the quality strategy identifies five population streams: women, chronic conditions, behavioral health, healthy children & adults in the ODMs Quality Strategy located on ODMs website. Attachment A Appendix C Population Health and Quality in section 3.a.i on page 122 lists six population streams (women (maternal and infants), children with behavioral health conditions, adults with behavioral health conditions, healthy adults, healthy children, and members with chronic conditions). Please clarify.

Answer:   ODM’s Quality Strategy is currently in use by ODM and is subject to review and revision for the future program (reference the “Read Me” file in the RFA Resource Library for ODM Medicaid MCO RFA, Folder Number 4). ODM’s Quality Strategy will be updated to reflect the population streams in RFA Attachment A, Model MCO Provider Agreement, Appendix C, Section 3.a.i. The population streams reflected in RFA Attachment A, Model MCO Provider Agreement, Appendix C, Section 3.a.i were chosen to place emphasis on the differing needs of children and adults, requiring separate population streams for these subpopulations. This separation also aligns with ODM’s implementation of OhioRISE (Resilience through Integrated Systems and Excellence), a specialized program that will offer enhanced care coordination and behavioral health services for children with complex behavioral health and multi-system needs. More information about OhioRISE can be found at https://managedcare.medicaid.ohio.gov/wps/portal/gov/manc/managed-care/ohiorise/ohiorise.

Date: 10/29/2020

Inquiry: 79541


Question:   It is stated in the requirements for the Letter of Transmittal Template item 11 on page 1 of Attachment B the following: “Whether the Applicant proposes to use subcontractors in the performance of this provider agreement. If the Applicant proposes to use subcontractors, provide the name of each subcontractor and the general scope of work to be performed by the subcontractor, and the approximate percent of work to be completed by the Applicant and each subcontractor." Question: In referring to "subcontractor," is this limited to FDRs as defined in Section 56 of the Ohio Department of Medicaid Ohio Medical Assistance Provider Agreement for Managed Care Plan?

Answer:   See response to inquiry #79467.

Date: 10/29/2020

Inquiry: 79519


Question:   Regarding the page limits requirements in Section "3.4.8 Response to Applications Questions (Tab7)" on page 15 of the Base document, the requirement states that "For each question, the Applicant must start on a new page and include both the number of the question and the text of the question and then provide the response. All pages for a topic area/tab must be numbered sequentially and include the topic area name and total number of pages for the topic area." Question: Can we submit letters of support in the Qualifications and Experience section?

Answer:   While there is no page limit for the response to questions in RFA Section 3.4.8.1, Qualifications and Experience, the general instructions in RFA Section 3.4.8, Response to Application Questions, apply to these responses. This includes providing a concise response to each question. ODM does not consider letters of support to be concise response to any of the questions in RFA Section 3.4.8.1 (or any other section); therefore, Applicants should not include letters of support in that (or any other) section. Any letters of support will not be considered.

Date: 10/29/2020

Inquiry: 79516


Question:   Regarding Section 3.4.8.1 in the Base document, question 2, on page 16, the requirement states: "Provide, In table format, the Applicant’s audited results for the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures specified below for each of the most recent three years (please identify which three years) for the Applicant’s three largest Medicaid contracts (based on membership). If you are currently contracting with ODM as a managed care plan (MCP) and/or MyCare plan, include your Ohio Medicaid results (MCP and/or MyCare as applicable) as one of the three Medicaid contracts. If you do not have results for three Medicaid contracts, provide results for Medicare (preferred) or commercial contracts, for a total of three contracts. Please identify the applicable contract (state and line of business) for each set of results. If you do not have results for a particular measure or year, please so indicate. If the Applicant does not have HEDIS or CAHPS results, provide results for comparable, alternative performance measures and the methodology for calculating those measures." Question: If an MCO currently serves OH Medicaid and OH MyCare, does the MCO have to submit results for both of those products and then one additional Medicaid markets results?

Answer:   RFA Section 3.4.8.1, Question 2 requires that if an Applicant is currently contracted with ODM as a Managed Care Plan (MCP) and/or a MyCare Plan, the Applicant must submit results from the Applicant’s Ohio Medicaid contracts (MCP and/or MyCare as applicable) and that will count as one of the three largest Medicaid contracts based upon membership. Therefore, the Applicant would be required to submit results for two additional contracts.

Date: 10/29/2020

Inquiry: 79514


Question:   Requirement 3.2.1,Paper Copies, states that applications "Be printed in font size 12 point Times New Roman (smaller font is permissible for charts, diagrams, graphics, and similar visuals)" In addition to charts, diagrams, graphics, and similar visuals, please confirm that the 12-point font requirement does not apply to headers, footers, and tables, and that applicants are allowed to use smaller fonts in those instances.

Answer:   The 12-point Times New Roman font requirement does apply to tables. Applicants may not use a smaller font in tables. The text in the header and footer may be smaller than 12 point Times New Roman as needed to fit within the one-inch margins.

Date: 10/26/2020

Inquiry: 79625


Question:   Appendix F, Section 3.d.iii prohibits an MCO from requesting “any additional credentialing or re-credentialing information from an ODM enrolled provider.” Knowing there will be a centralized credentialing vendor, will ODM collaborate with MCOs regarding what information the centralized credentialing process will collect? MCOs need information for business administration purposes beyond what may be captured as part of standardized credentialing forms, such as additional provider demographic data, information required for claims payment, and information related to providers’ experience, training, and expertise treating complex behavioral health and other conditions. This information informs Provider Directories, helps members to select providers with specific experience, and assists in our care management process, among other things. Although this information may not affect ODM’s credentialing determination, it is often necessary, and less burdensome on providers, for MCOs to capture it as part of the provider application processes.

Answer:   Per NCQA CR standards, ODM will collect for credentialing purposes the following – demographics, licensure, DEA information, board certification, training/education, CAQH data, work history, malpractice claims history, history of Medicare/Medicaid sanctions, malpractice insurance information, hospital privileges, OIG/SAM data. The MCOs are allowed to collect additional data for contracting, provided that it has not already been collected by ODM. ODM intends for PNM to serve as the source of truth for all of the credentialing data mentioned above.

Date: 10/26/2020

Inquiry: 79612


Question:   Where is the “Guidance Document for Managed Care Plan Submission for Trial Member Level Incentive Programs” located on the Ohio Managed Medicaid Care Organizations procurement site?

Answer:   The Guidance Document for Managed Care Plan Submission for Trial Member Level Incentive Programs has been placed in folder #3 of the MCO RFA Resource Library folder.

Date: 10/26/2020

Inquiry: 79603


Question:   Regarding Attachment F Location of Business and Offshore Declaration Form question 4 asks for the "Location where services to be performed will be changed or shifted by Applicant." Question: What qualifies as a service for this response? Is the intention of the question to determine whether an applicant is moving its offices or whether it will subcontract portions of its services outside of Ohio? What is meant by "changed or shifted?"

Answer:   Any service or deliverable provided under the agreement resulting from this Request for Applications qualifies as a service for this response. Offerors should provide locations that services will be provided or where Medicaid data will be located. The purpose of this question is to determine if any of the services or data will be moved outside of the United States during the life of the agreement.

Date: 10/26/2020

Inquiry: 79587


Question:   In regards to the requirements included in Attachment A, Appendix B Member Cost Sharing pg. 106 can ODM please confirm if they intend to allow and/or support copays for non-emergent ED visits?

Answer:   ODM allows member co-payments under OAC rule 5160-26-12. There is no current intent to amend or rescind the rule.

Date: 10/26/2020

Inquiry: 79558


Question:   In regards to the requirements included in Attachment A, Appendix B. 11.3 Prior Authorizations for Transplant Evaluations (Pre-Transplants) pg. 100, can ODM please confirm if the MCO would be able to direct members to a specific facility instead of the Consortium?

Answer:   No, the MCO would not be able to direct members to a facility without the consortium. The expectation would be the MCO would work with the consortium to obtain a transplant evaluation by a hospital approved by the consortium as an evaluation center. https://www.osotc.org/resources/policy-and-general-indications/

Date: 10/26/2020

Inquiry: 79557


Question:   On page 16 of RFA ODMR20210024, questions one and two of section 3.2.8.1basks for information about applicants’ Medicaid contracts. Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) exclusively cover Medicaid-eligible enrollees, and in some states, D-SNPs directly cover Medicaid benefits. Please confirm D-SNPs are considered “Medicaid MCO contracts” for purposes of this section.

Answer:   If the D-SNP does not have an MCO contract with a state, the D-SNP is not considered a “Medicaid MCO contract” for purposes of Question 1 in RFA Section 3.4.8.1 (Qualifications and Experience). If the D-SNP has an MCO contract with a state (e.g., is a fully integrated D-SNP), the MCO contract is a “Medicaid MCO contract.”

Date: 10/26/2020

Inquiry: 79555


Question:   3.4.83 Benefits & Service Delivery #18, page 20 Would it be acceptable to list each MCP proposed value-added service in a grid format describing scope of the benefit, target population, limitations, desired outcomes and monitoring monitoring/evaluation using the required 12 point font size? Also, please define or clarify what is meant by limitations.

Answer:   Yes, it would be acceptable for an Applicant to provide its response to Question 18 in RFA Section 3.4.8.3 (Benefits & Service Delivery) in a grid format using 12 point Times New Roman. The reference to “limitations” in Question 18 refers to any quantitative (e.g., visit limit, dollar limit) or non-quantitative (e.g., prior authorization, coverage exclusions) limitation that applies to a proposed value-added service.

Date: 10/26/2020

Inquiry: 79553


Question:   RFA Sections 3.2.1 "Application Format Requirements" on page 12 and 3.4.8 "Responses to Application Questions" on page 15 reference page limits specified in "Section 3.5, Application Questions." There does not appear to be a Section 3.5 in the RFA. Please confirm the sections in which page limits are referred to are 3.4.8.1-3.4.8.4 "Responses to Application Questions" on pages 15-24. Please also confirm there should not be a Section 3.5 in the RFA.

Answer:   There is no RFA Section 3.5. The reference in item #7 in RFA Section 3.2.1 (Paper Copies) to “Section 3.5, Application Questions” should be “Section 3.4.8, Response to Application Questions (Tab 7).”

Date: 10/26/2020

Inquiry: 79532


Question:   In the MCO RFA Resource Library, File 03 Guidance for Managed Care Plan Submission for Trial Member Level Incentive prg, does not contain any files. Does ODM plan to upload a file(s) to folder 03 within the MCO RFA Resource Library?

Answer:   The Guidance Document for Managed Care Plan Submission for Trial Member Level Incentive Programs has been placed in folder #3 of the MCO RFA Resource Library folder.

Date: 10/26/2020

Inquiry: 79530


Question:   Regarding Section 3.2.1, Application Format Requirements, page 12: 1. For ease of review, will ODM allow headings larger than 12 pt font? 2. Does the format requirement of ""One blank line between paragraphs"" imply there should be a space after Response Headings and the paragraph that follows?

Answer:   1. Yes, headings may be larger than 12 point font. 2. The requirement to have one blank line between paragraphs applies to narrative text. It does not apply to headings.

Date: 10/26/2020

Inquiry: 79529


Question:   Regarding Appendix F, Section 3.d. ""Centralized Credentialing"" part (iii) on page 177 of Attachment A, please confirm that ODM’s centralized credentialing vendor will collect providers’ Disclosure of Ownership (DOO) documentation, as part of the centralized credentialing process in order to minimize provider administrative burden of having to provide this same form to multiple MCOs.

Answer:   ODM currently collects disclosure information for providers and will continue to do so in the PNM module at time of initial enrollment and revalidation. The CVO does not collect ownership documentation as part of credentialing.

Date: 10/26/2020

Inquiry: 79528


Question:   Appendix F, Section 3.d. "Centralized Credentialing" part (iii) on page 177 of Attachment A prohibits an MCO from requesting “any additional credentialing or re-credentialing information from an ODM enrolled provider.” However, Section 3.d.vii of the same section outlines MCO responsibilities for updating ODM regarding changes to provider information, including provider demographic information. Will ODM clarify specifically what information MCOs will and will not be allowed to collect from providers? MCOs need information for business administration purposes beyond what may be captured as part of standardized credentialing forms, such as additional provider demographic data, information required for claims payment, and information related to providers’ experience, training, and expertise treating complex behavioral health and other conditions. This information informs Provider Directories, helps members to select providers with specific experience, and assists in our care management process, among other things. Although this information may not affect ODM’s credentialing determination, it is often necessary, and less burdensome on providers, for MCOs to capture it as part of the provider application processes. Will MCOs be permitted to collect this information separately, or will ODM’s centralized credentialing vendor collect this information?

Answer:   Per NCQA Credentialing standards, ODM will collect for credentialing purposes the following – demographics, licensure, DEA information, board certification, training/education, CAQH data, work history, malpractice claims history, history of Medicare/Medicaid sanctions, malpractice insurance information, hospital privileges, OIG/SAM data. The MCOs will be allowed to collect additional data for initial and ongoing contracting and network management, provided that the information has not already been collected by ODM and is not used by the MCO for credentialing or re-credentialing. ODM intends for PNM to serve as the source of truth for credentialing status and all of the credentialing-related data mentioned above.

Date: 10/26/2020

Inquiry: 79527


Question:   Regarding Section 3.4.8.1 in the Base document, question 1 on page 16, the requirement states: "Provide, in table format, a list of the Applicant’s current Medicaid MCO contracts that includes the information listed below for each contract. If the Applicant does not have any current Medicaid MCO contracts, please provide the requested information for the Applicant’s most relevant contracts: "and part g. specifically states "Contact name, email address, and phone number." Question: In reference to part g, the contact name, email address and phone number should be the contact at the state who oversees the Medicaid contract for that state, do you agree?

Answer:   RFA Section 3.4.8.1, Question 1 subpart g requires the Applicant to provide the name of a contact and contact information for each of the contracts the Applicant references in their response to Question 1. When providing the contact name and information for a current Medicaid MCO contract, the Applicant may identify the individual at the state who oversees the Medicaid MCO contract.

Date: 10/26/2020

Inquiry: 79520


Question:   Can ODM please confirm if there were any files included in “Folder 03-Guidance for Managed Care Plan Submission for Trial Member Level Incentive prg” of the MCO RFA Resource library?

Answer:   The Guidance Document for Managed Care Plan Submission for Trial Member Level Incentive Programs has been placed in folder #3 of the MCO RFA Resource Library folder.

Date: 10/26/2020

Inquiry: 79499


Question:   In regards to the APM Target Requirements included in Attachment A Table H.1 pg. 217, can ODM please confirm the HCP LAN Level for all ODM-required value based initiatives (Episodes, CPC, BHCC, CMC, CICIP)?

Answer:   Episodes = 3B CPC = 3A BHCC = TBD CMC = 3A once fully implemented CICIP = 3B

Date: 10/26/2020

Inquiry: 79498


Question:   In 3.4.8.1, Qualifications and Experience, is the Adult Rating of Health Plan measure specified referring to Adult Rating of Health Plan results for numerator 8+9+10?

Answer:   Yes.

Date: 10/26/2020

Inquiry: 79485


Question:   In regards to the following statement in section 3.4.8.1.2 Qualifications and Experience pg. 16: “If you are currently contracting with ODM as a managed care plan (MCP) and/or MyCare plan, include your Ohio Medicaid results (MCP and/or MyCare as applicable) as one of the three Medicaid contracts.” Can ODM please confirm if Applicants currently contracting with ODM as both an MCP and MyCare Plan should submit the Standard NCQA HEDIS Submission (includes both Medicaid-only and MyCare MMP members) or the “Special Project” HEDIS Submission (limited to Medicaid-only members)?

Answer:   For Applicants in this situation, submit both the Standard HEDIS Submission and the “Special Project” HEDIS Submission for one of the three Medicaid contracts.

Date: 10/26/2020

Inquiry: 79458


Question:   Regarding the following statement in Section 1.4 Regions pg.3: “ODM intends to make multiple awards per region. Successful Applicants are not guaranteed awards in all regions for which an Application was submitted. ODM will make the final decision regarding the number of awards per region based upon what is most advantageous to the State, but anticipates no more than five Applicants per region.” Will ODM please provide the regional scoring criteria that will be used to decide what is most advantageous to the state?

Answer:   RFA Section 3.4.8, Responses to Application Questions states, “Responses will be scored per region.” The evaluation and selection process and the evaluation criteria for the RFA are described in RFA Section 4, Evaluation and Selection. No additional scoring detail will be provided to potential Applicants.

Date: 10/23/2020

Inquiry: 79497


Question:   RFA Section 3.4.6 Required Forms (Tab 5), page 14 As for sub-contractors, we presume the intention is that this process is completed for any vendor determined to be an FDR, correct?

Answer:   See response to inquiry #79467.

Date: 10/23/2020

Inquiry: 79490


Question:   May Applicants and/or Subcontractors limit their disclosure of adverse regulatory or administrative governmental actions in response to Section 5.13 to matters that were finalized within three years of the date of application. If not, are there any time limitations or materiality thresholds for disclosures in response to Section 5.13?

Answer:   See answer to inquiry #79426.

Date: 10/23/2020

Inquiry: 79488


Question:   May Applicants and/or Subcontractors limit their disclosure of formal claims for breach of contract in response to Section 5.12 to matters that (1) were filed within three years of the date of application, and (2) seeking an amount greater than $100,000? If not, are there any time limitations or materiality thresholds for disclosures in response to Section 5.12?

Answer:   See response to inquiry #79425. Applicants and/or subcontractors must identify claims for breach of contract filed on or after January 1, 2010, seeking an amount greater than $100,000.00.

Date: 10/23/2020

Inquiry: 79487


Question:   For 3.4.8.4 Operational Excellence & Accountability, Q30.b, please confirm that Applicants who are currently contracting with ODM as a managed care plan (MCP) and/or MyCare plan, should include their Ohio Medicaid claims statistics. Please confirm Applicants who are not currently contracting with ODM should provide claims statistics for their largest Medicaid contract (based on Membership).

Answer:   For RFA Section 3.4.8.4, Operational Excellence & Accountability, Q30.b, Applicants who are currently contracting with ODM as a managed care plan (MCP) must provide claims statistics for that contract. Applicants who are currently only contracted with ODM as a MyCare plan must provide claims statistics for that contract. Applicants currently not contracted with ODM as either a MCP or MyCare plan must provide claim statistics for their largest Medicaid contract based on membership. If the Applicant does not have a Medicaid contract, the Applicant must provide claims statistics for the Applicant’s largest Medicare (preferred) or commercial contract based on membership. Applicants must identify the applicable contract (state and line of business) for the reported claims statistics.

Date: 10/23/2020

Inquiry: 79479


Question:   For 3.4.8.2 Population Health, Q10.c, please confirm that Applicants who are currently contracting with ODM as a managed care plan (MCP) and/or MyCare plan, should include their Ohio Medicaid results. Please confirm Applicants who are not currently contracting with ODM should provide results for their largest Medicaid contract (based on Membership).

Answer:   In responding to RFA Section 3.4.8.2, Question 10.c, Applicants currently contracted with ODM as a managed care plan (MCP) must provide data from their Ohio Medicaid MCP results. Applicants currently only contracted with ODM as a MyCare plan must provide data from their Ohio Medicaid MyCare plan results. Applicants not currently contracted with ODM as either an MCP or MyCare plan must provide data from the Applicant’s largest Medicaid contract based on membership. If the Applicant does not have Medicaid contracts, the Applicant must provide results from a Medicare (preferred) or commercial contract.

Date: 10/23/2020

Inquiry: 79478


Question:   Please confirm that Applicants should use the same time period “within the past five years” from Attachment B Transmittal Letter Question #19 when responding to Sections 5.12 and 5.13, and the associated Attachment B: Transmittal Letter Questions #17 and 18.

Answer:   No. See responses to inquries #79425 and #79426.

Date: 10/23/2020

Inquiry: 79471


Question:   Please confirm that adverse regulatory or administrative government actions are instances that warranted issuance of a formal request for corrective action plan or levying a financial penalty.

Answer:   Adverse regulatory or administrative government actions are not limited to instances where a formal request for a corrective action plan or a financial penalty were imposed.

Date: 10/23/2020

Inquiry: 79470


Question:   Attachment A, Section 35.b.iii on page 177 states, "The MCO must submit network provider contract templates to ODM for review prior to executing contracts using the applicable template.”  Can the MCO offer the contracts to the Providers for contracting prior to obtaining ODMs approval of the template?

Answer:   Yes, the MCO may offer contracts to providers prior to obtaining ODM’s approval. However, if any changes are required by ODM, the MCO must incorporate those changes in any executed contracts. This clarification applies only during the procurement.

Date: 10/23/2020

Inquiry: 79468


Question:   The RFA defines a subcontractor as any party, that has entered into a subcontract to perform a specific part of the obligations specified under the MCO’s provider agreement with ODM, and appears to include downstream entities that contract with Applicant’s first-tier subcontractors, second-tier subcontractors. Throughout the RFA there are various references to including information about the functions provided by subcontractors and about disclosures from subcontractors in sections: 3.4.7, 3.4.8. 5.12, 5.13, and Attachments B, E and F. Please confirm that for the purposes of the references in the RFA, ODM is requiring MCOs to disclose information regarding first-tier subcontractors that provide obligations under the MCO provider agreement with ODM at this time. As an example, an MCO’s first-tier non-emergency transportation subcontractor, in addition to maintaining its own fleet of vehicles, may also enter into contractual agreements with small companies for provision of services covered by the first-tier subcontractor’s agreement with the Applicant MCO for certain service areas or locales. These additional second tier subcontractors may not be known at the time of RFA submission, and the extent and nature of services sought to be disclosed would already be encompassed by disclosure of the MCO’s first-tier vendor for those services.

Answer:   For purposes of responding to the RFA, the Applicant must disclose information about all subcontractors known to it at the time of submitting the application. For this purpose, subcontractor means first-tier entities, related entities, and downstream entities, as defined in RFA Attachment A, Model MCO provider agreement, performing administrative services. Administrative services include care management, marketing, utilization management, quality improvement, enrollment, disenrollment, membership functions, claims administration, provider network management, and coordination of benefits.

Date: 10/23/2020

Inquiry: 79467


Question:   Requirement 18 of Attachment B, Transmittal Letter, requires the following information, " In accordance with Section 5.13, Mandatory Disclosure of Governmental Investigations, a statement that (a) neither the Applicant nor a proposed subcontractor has been the subject of an adverse regulatory or administrative governmental action with respect to performance of a government contract or (b) the Applicant or a proposed subcontractor has been the subject of an adverse regulatory or administrative governmental action with respect to such performance. If (b), provide, as an attachment to the Transmittal Letter, a detailed explanation of any such governmental actions. 1. Please provide the look-back period ODM is requesting for the "Mandatory Disclosure of Governmental Investigations" requirement? 2. Is the geographic scope of this requirement limited to the state of Ohio?

Answer:   1. The Applicant must disclose any governmental actions against the Applicant (including the Applicant’s parent company, affiliates, or subsidiaries) or subcontractor, arising after January 1, 2005. 2. No, the geographic scope of this requirement is not limited to Ohio. It includes any US state or territory.

Date: 10/23/2020

Inquiry: 79426


Question:   Requirement 17 of Attachment B, Transmittal Letter ,requires the following information, " In accordance with Section 5.12, Mandatory Contract Performance Disclosure, a statement that (a) neither the Applicant nor a proposed subcontractor has received a formal claim for breach of contract or (b) the Applicant or a proposed subcontractor has received a formal claim for breach of contract. If (b), provide, as an attachment to the Transmittal Letter, a detailed explanation of any claims. 1. Please provide the look-back period ODM is requesting for the "Contract Performance Disclosure" requirement"? 2. Is the geographic scope of this requirement limited to the state of Ohio? 3. Is this limited to contracts with government entities or does it pertain to all contracts? 4. Please confirm the "Contract Performance Disclosure" pertains to administering a health plan or related to the insurance sector.

Answer:   1. The Applicant must disclose any claims against the Applicant (including the Applicant’s parent company, affiliates, or subsidiaries) or subcontractor, for any claim arising on or after January 1, 2010, seeking an amount greater than $100,000.00. 2. No, the geographic scope of this requirement is not limited to Ohio. It includes any US state or territory. 3. This requirement pertains to contracts with both governmental and non-governmental entities. 4. This requirement pertains to contracts related to providing or administering health care services, including Medicaid, Medicare, and commercial health insurance and both insured and self-funded plans.

Date: 10/23/2020

Inquiry: 79425


Question:   RFA Section 3.4.8.1 Qualifications and Experience (Tab 8) Page 16 As some Applicants may be new market entrants, or existing domestic health insurance corporations with no current Medicaid contracts, for the purpose of establishing experience throughout the RFA response, please confirm that as noted in the 2012 RFA’s Q&A #29, “the answers and information provided for the RFA must solely relate to the operational experience of the applying health insurance corporation or its corporate family.” In other words, that experience for contracts operated by the Applicant’s corporate family can be leveraged.

Answer:   Yes, an Applicant may leverage experience for contracts operated by the Applicant’s parent organization, affiliates, and/or subsidiaries. However, if the Applicant relies upon the experience of the Applicant’s parent organization, affiliates, and/or subsidiaries, the Applicant must identify the parent organization, affiliate, or subsidiary and must, as part of the Applicant's response: (1) detail the experience attributed to that parent organization, affiliate, or subsidiary; and (2) identify the nature of the corporate relationship it has with the entity on whose experience it is relying.

Date: 10/23/2020

Inquiry: 79374


Question:   In RFA #ODMR-2021-0024, section 3.4.8.1, question 2 on pages 19-20 of the PDF requests HEDIS and CAHPS measures for the three largest Medicaid contracts. Population health and HEDIS data vary significantly between states due to many factors related to local health dynamics. Please confirm that the scoring methodology will account for state variation in order to avoid inequitable bias against MCOs for serving Medicaid members in states with especially challenging population health issues.

Answer:   RFA Section 4.3, Phase II: Review of Responses to Application Questions, sets forth the process for evaluating and assigning points to the response for each question and the maximum available points for each topic area. No additional scoring detail will be provided to potential Applicants.

Date: 10/21/2020

Inquiry: 79424


Question:   Where an applicant intends to subcontract certain services, but is currently evaluating and procuring new subcontractors to ensure the best quality and experience for Ohio members, and value for our State partners, how does the applicant address the need to submit the required subcontractor information and forms to be compliant with the subcontractor requirements within the RFA throughout Section 3.4?

Answer:   Except as further provided below regarding responses to RFA Section 3.4.8, Responses to Application Questions, Applicants must submit subcontractor information for subcontractors that have signed a letter of intent or have otherwise agreed in writing to perform services if the Applicant is awarded a provider agreement pursuant to this RFA. In its responses to questions in RFA Section 3.4.8, Responses to Application Questions, if the Applicant intends to use a subcontractor, regardless of whether the subcontractor has agreed in writing to be a subcontractor, the Applicant must indicate that it intends to use a subcontractor, the role of the subcontractor, and how the Applicant will ensure the subcontractor’s effectiveness. If the subcontractor has agreed in writing to be a subcontractor, then the Applicant must also identify the subcontractor in the response and provide the subcontractor information required in other parts of RFA Section 3.4.8. Note that any agreements with a subcontractor are subject to the requirements in RFA Attachment A, Model MCO Provider Agreement, including Appendix A, Section 9, Subcontractual Relationships and Delegation.

Date: 10/21/2020

Inquiry: 79456


Question:   In regards to section 3.4.8.1.2 Qualifications and Experience pg. 16: The RFA allows bidders that are non-incumbents, or lack three comparable Medicaid contracts to submit commercial HEDIS and CAHPS scores: “If you do not have results for three Medicaid contracts, provide results for Medicare (preferred) or commercial contracts, for a total of three contracts.” In many cases, populations served by Medicaid and Medicare plans have different challenges and patterns of care than populations enrolled in commercial health plans. As a result, it can be difficult to adequately compare health plan experience and performance. For example, commercial health plan performance on HEDIS and CAHPS measures is often higher than Medicaid health plan performance. These and other issues may limit ODMs ability to accurately determine a bidders future success in Ohio’s Medicaid Managed Care Program. We encourage ODM to require that bidders only submit HEDIS and Quality scores from contracts that serve populations similar to those covered by Ohio’s Medicaid Managed Care Program (e.g. Medicaid/Medicare). If ODM accepts the submission of results of Medicare contracts, we recommend ODM require potential Applicants submit results from Dual Eligible Special Needs Plans (DSNPs) Medicare contracts. This will ensure a more equitable and valid comparison for ODM, and provide greater predictive reliability for future performance. Additionally, if ODM accepts submission of results of Medicare and/or Commercial contracts, can ODM provide the scoring methodology which will indicate that Medicaid contracts receive preferential points.

Answer:   RFA Section 4.3, Phase II: Review of Responses to Application Questions, sets forth the process for evaluating and assigning points to the response for each question and the maximum available points for each topic area. No additional scoring detail will be provided to potential Applicants.

Date: 10/21/2020

Inquiry: 79459


Question:   If ODM intends to reach out to contact individuals listed by an Applicant in response to section 3.4.8.1 Qualifications and Experience (Tab 8), will ODM notify the Applicant if it encounters any issues in reaching or receiving a response from any of the individuals listed, to allow the Applicant to help obtain any information requested by ODM?

Answer:   ODM will take the suggestion under advisement and will apply the same approach to all Applicants.

Date: 10/21/2020

Inquiry: 79463


Question:   In Attachment A, Appendix E, Section 30, part b., on page 164, it states, "Marketing representatives must be trained and duly licensed by the Ohio Department of Insurance (ODI)…" Please confirm the marketing representatives noted in this section are purely sales-focused positions (i.e. commissioned positions).

Answer:   RFA Attachment A, Model MCO Provider Agreement, Appendix E, Section 1.b.i.3 requires marketing representatives to be trained and duly licensed by the Ohio Department of Insurance (ODI). ODI training and licensing requirements apply to the Applicant’s marketing representatives who are subject to ORC section 3905.02.

Date: 10/21/2020

Inquiry: 79465


Question:   In regards to the following statement in Section 2.12.6 Protest Procedure pg. 10: “If a protest consists of more than 25 pages, a CD-ROM must be provided in addition to a hard copy” Will ODM confirm if Applicants may submit a protest that consists of more than 25 pages on a USB?

Answer:   Yes, Applicants may submit a protest that consists of more than 25 pages on a USB.

Date: 10/21/2020

Inquiry: 79501


Question:   In regards to the following statement included in Section 3.4.8.1.2 Qualifications and Experience pg. 16: “Provide, in table format, the Applicant’s audited results for the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures specified below for each of the most recent three years (please identify which three years) for the Applicant’s three largest Medicaid contracts (based on membership).” Certain states administer their own CAHPS surveys and due to COVID have not released the results of their 2019 Adult and Child CHAPS survey. Additionally, under certain Medicaid contracts, MCOs are only required to perform Adult and Child CAHPS surveys in alternating years. Can ODM please confirm that submission of CAHPS from the three most recent reporting years available (non-consecutive years 2013, 2015, and 2017) is permissible? If this is not permissible, can an Applicant submit CAHPS from their next largest Medicaid contract?

Answer:   See response to inquiry #79460.

Date: 10/21/2020

Inquiry: 79638


Question:   RFA Section 3.4.8 Response to Application Questions (Tab 7), p 15 For page numbering, does ODM want the entire applications to be start with page 1 and end with the last page number? Or does ODM want each Tab/section (i.e., Qualifications & Experience (Tab 8), Population Health (Tab 9), etc ) to begin with page 1 and end with the last page number? Instead of just having one page 1, there would be multiple page number 1s.

Answer:   Each topic area/tab should be paginated separately (i.e., beginning with page 1). All pages for a topic area/tab must be numbered sequentially and include the topic area name and total number of pages for the topic area.

Date: 10/21/2020

Inquiry: 79641


Question:   Sections 17 and 18 of Attachment B Transmittal Letter state: 17) "In accordance with Section 5.12, Mandatory Contract Performance Disclosure, a statement that (a) neither the Applicant nor a proposed subcontractor has received a formal claim for breach of contract or (b) the Applicant or a proposed subcontractor has received a formal claim for breach of contract. If (b), provide, as an attachment to the Transmittal Letter, a detailed explanation of any claims." 18) "In accordance with Section 5.13, Mandatory Disclosure of Governmental Investigations, a statement that (a) neither the Applicant nor a proposed subcontractor has been the subject of an adverse regulatory or administrative governmental action with respect to performance of a government contract or (b) the Applicant or a proposed subcontractor has been the subject of an adverse regulatory or administrative governmental action with respect to such performance. If (b), provide, as an attachment to the Transmittal Letter, a detailed explanation of any such governmental actions. " RFA Sections 5.12 and 5.13, taken along with the Transmittal Letter, imply that Applicants should only provide responses to RFA Sections 5.12 and 5.13 in the Transmittal Letter, and not in the body of the RFA itself. Please confirm that Applicants should only provide responses to RFA Sections 5.12 and 5.13 in the Transmittal Letter, as instructed, as opposed to both in the body of the RFA response and in in the Transmittal Letter.

Answer:   See response to inquiry #79454. Applicants must respond to RFA Sections 5.12 and 5.13 as part of the Transmittal Letter, which is Tab 2. See items 17 and 18 in RFA Attachment B, Letter of Transmittal Template.

Date: 10/20/2020

Inquiry: 79640


Question:   The RFA does not specify where to include 5.12 Mandatory Contract Performance Disclosure and 5.13 Mandatory Disclosures of Governmental Investigations in the response. May bidders include this content after section 3.4.8 Tab 7 Responses to Application Questions in the Response?

Answer:   Applicants must respond to RFA Sections 5.12 and 5.13 as part of the Transmittal Letter, which is Tab 2. See items 17 and 18 in RFA Attachment B, Letter of Transmittal Template.

Date: 10/20/2020

Inquiry: 79454


Question:   Section 6: Attachments pg. 32 Can ODM please confirm that they will accept electronic signatures in lieu of ‘wet’ signatures from Applicants and Subcontractors for all required forms listed below due to the ongoing restrictions/limitations in some states with regard to the COVID-19 pandemic? • Attachment B: Letter of Transmittal • Attachment E: Conflict of Interest • Attachment F: Location of Business and Offshore Declaration Form • Attachment G: Affidavit of Non-Collusion • Attachment H: Certification of Compliance with Special Conditions

Answer:   Yes, ODM will accept electronic signatures.

Date: 10/20/2020

Inquiry: 79639


Question:   Will ODM please provide additional details regarding the composition of the Evaluation Committee referenced in Section 4.3 on page 26 of the RFA? For example, please clarify if each evaluator on the Evaluation Committee will review and score the same question across all Applicants and across all regions? Or will different evaluators score different Applicants on the same question?

Answer:   Section 2.5 of the RFA provides, "The purpose of the Question and Answer process is to enable potential Applicants to obtain clarification about the RFA requirements in order to prepare an Application. ODM may choose not to answer questions that are submitted for reasons other than to obtain clarifications regarding the RFA requirements." This question does not seek clarification of an RFA requirement.

Date: 10/20/2020

Inquiry: 79608


Question:   In regards to Section 2: Schedule of Events 2.10 Oral Presentations pg. 9, can ODM please provide additional clarification as to what type of demonstration (e.g. system demonstrations, example reports, etc.) may be required during the Oral Presentations?

Answer:   See response to inquiry #79510. The oral presentation will be conducted via video conference. All participants will be introduced during the oral presentation. ODM participants will include members of the Evaluation Committee. As provided in Section 4.4 of the RFA, additional information about the meeting logistics, scope, and format will be provided to invited Applicants no later than one week prior to the Applicant’s oral presentation. ODM will provide the topics for the oral presentation.

Date: 10/20/2020

Inquiry: 79570


Question:   In regards to the requirements in Attachment A, Appendix K, l.i. Notice to Providers, pg. 250, Can ODM please clarify if these changes include national coding updates, standard code changes, etc., or is this related to Health Plan specific changes?

Answer:   The requirement applies to "any new edits or systems changes related to claims adjudication or payments processing" without limitation, as stated in the referenced requirement.

Date: 10/20/2020

Inquiry: 79569


Question:   On page 125 of Attachment A, requirement 4.c.9.e mentions Unite Us". Is there a preference for MCOs to contract with this SDoH partner?

Answer:   As was indicated in the RFA, Unite Us is only an example. ODM is not indicating a preference for it or any particular vendor; rather, this requirement indicates the applicant must demonstrate the ability to ensure active referrals and follow-up after referral to confirm members received services related to SDOH. ODM does not endorse this vendor or prefer any vendor over another. The reference to Unite Us will be removed from the final managed care provider agreement.

Date: 10/20/2020

Inquiry: 79547


Question:   RFA Section 3.2.2 Electronic Copy, page 12 For the submission of the electronic copy of the Application, can the CD-ROM or USB flash drive contain folders for each required tab (per Section 3.3 Application Organization) or does expect one PDF document that begins with the Title Page and concludes with the last page number in Tab 11?

Answer:   The entire Application must be converted into one single .pdf document and provided on a CD-ROM or USB flash drive. If the Application’s size necessitates more than a single .pdf document to contain the entire Application, Applicants must use the fewest separate .pdf documents possible. The .pdf document must contain a printable copy of the Application that complies with the requirements of Section 3.2.1, Paper Copies.

Date: 10/20/2020

Inquiry: 79533


Question:   Regarding Section 3.2.1, Application Format Requirements, page 12, for ease of review, will the state permit the Applicant to submit workflows on 11x17 fold out paper?

Answer:   Except as otherwise provided in ODM's response to a question (see, e.g., response to inquiry #79475), Applicant's response must be on 8.5" x 11" paper.

Date: 10/20/2020

Inquiry: 79531


Question:   RFA Section 3.4.1 Title Page, page 13 Does the title page have to follow the formatting requirements (i.e., 12 point Times News Roman, margins, header, etc) described in section 3.2.1 Paper Copies?

Answer:   No, the title page does not have to follow the formatting requirements.

Date: 10/20/2020

Inquiry: 79526


Question:   RFA Section 3.4.2 Table of Contents (Tab 1), page 14 The instructions state that table of contents must be linked to appropriate pages in the Application. Is ODM defining link as a hyperlink or that the page numbers listed in the Table of Contents must line up with the tabs?

Answer:   For purposes of the requirement in RFA Section 3.4.2, Table of Contents, that the table of contents “be linked to appropriate pages in the Application,” ODM means the table of contents must have hyperlinks so that the reader can click on the table of contents and navigate directly to that page. The page number in the table of contents should be the same as the page number of the linked page.

Date: 10/20/2020

Inquiry: 79525


Question:   We understand that Ohio uses centralized credentialing to help reduce administrative burdens for Medicaid doctors and other providers. Does Ohio currently recruit and own its Medicaid networks? If yes, for what disciplines (e.g., dental)?

Answer:   ODM currently has a network for its fee-for-service program, and all providers contracted with the current managed care or MyCare Ohio plans must be enrolled with ODM. Item #11 in the RFA Resource Library includes information on providers enrolled with ODM.

Date: 10/20/2020

Inquiry: 79522


Question:   It is stated in Section 2.14 page 11 of the Base document the following: " As provided in Appendix A, Section 1.c of Attachment A, Model MCO Provider Agreement, the Contractor must demonstrate to ODM’s satisfaction that it is able to meet the requirements of the MCO provider agreement prior to providing services to members. ODM will not assign members nor make payment to a Contractor until ODM has determined that the Contractor is able to meet the requirements of the MCO provider agreement." Question: Should the reference to section 1.c be changed to Section 1.d page 33 of Attachment A?

Answer:   Yes, the reference in RFA Section 2.14 to Section 1.c of Appendix A of Attachment A, Model MCO Provider Agreement, should be to Section 1.d of Appendix A of Attachment A.

Date: 10/20/2020

Inquiry: 79518


Question:   Regarding Section 3.4.8.2, question #13, on page 19, the requirement states "Describe the Applicant’s approach to designing and implementing value based care and payment initiatives for Ohio Medicaid members that are in addition the initiatives specified by ODM (episode based payments, Comprehensive Primary Care [CPC], Behavioral Health Care Coordination [BHCC], Comprehensive Maternity Care [CMC] and Care Innovation and Community Improvement Program [CICIP])." Question: Should the word "members" in this question be changed to providers?

Answer:   The word “members” in RFA Section 3.4.8.2, Question 13 will not be changed to “providers.” Although payments are made to providers, the use of the word “members” denotes that the goal of value-based care and payment initiatives is to improve member care and outcomes.

Date: 10/20/2020

Inquiry: 79517


Question:   RFA Section 4.4 Phase III: Oral Presentation, page 27 For the presentation, it was mentioned during the Pre-Application conference call that this would occur remotely. Will this be audio or live video? Who will be participating from ODM? How much time will be allocated for the presentation? Will ODM provider the topics or will the Plans?

Answer:   The oral presentation will be conducted via video conference. All participants will be introduced during the oral presentation. ODM participants will include members of the Evaluation Committee. As provided in Section 4.4 of the RFA, additional information about the meeting logistics, scope, and format will be provided to invited Applicants no later than one week prior to the Applicant’s oral presentation. ODM will provide the topics for the oral presentation.

Date: 10/20/2020

Inquiry: 79510


Question:   RFA Section 3.4.8.4 Operational Excellence & Accountability, Question 30 (b), page 23 For using the most recent three months of claims data, is this based on received dates or paid dates? Is ODM requesting the number of claims adjudicated for payment, payment/denial or payment/denial/pended? Does auto adjudicated mean first pass rate? For Question 30(b)(iii), does ODM mean internal quality checks? For Question 30(b)(iv), does ODM mean the percent of totaled processed per person by day, month, or year? The Plan doesn’t base audit functions on a percentage of claims but on a number per month. Would ODM accept the number over percentages?

Answer:   Regarding Question 30.b in RFA section 3.4.8 (Operational Excellence & Accountability): · The “most recent three months” is based on all claims paid or denied within that timeframe. · ODM is requesting the number of claims adjudicated for payment or denial. Pended claims should not be included in the requested statistics for b.i through b.iv. · “Auto-adjudicated,” aka system-paid or systematically paid claims, indicates claims that are adjudicated without manual or analyst intervention. · In b.iii and b.iv “audit” refers to claims audits, not quality checks. All MCOs must have claims audit functions that routinely pull and examine the results of daily paid or denied claims. · In b.iii and b.iv ODM is requesting the percent of auto-adjudicated claims (in b.iii) and the percent of manually processed claims (in b.iv) that are routinely audited. If the Applicant audits based on number, not percent, of claims, the Applicant can calculate the percent based on the number of claims audited divided by the total number of claims adjudicated (separately for auto-adjudicated and for manually processed claims).

Date: 10/20/2020

Inquiry: 79504


Question:   Regarding 3.4 Submission Requirements pg. 13 -15: Can ODM please confirm that the narrative text instructions listed in sections 3.4.1 thru 3.4.8 are for informational purposes only and does not need to be repeated in the Applicant’s submission?

Answer:   Correct. Only the text of each question (see questions in RFA sections 3.4.8.1 through 3.4.8.4) must be included in the Applicant’s submission. The text in RFA sections 3.4.1 thru 3.4.8 does not need to be repeated in the Applicant's submission.

Date: 10/20/2020

Inquiry: 79503


Question:   In regards to the following statement in Attachment A Appendix D Care Coordination 2.e.i.3 pg. 154: “The MCOs Care Management Portal must be available to members, ODM, the SPBM, CCEs, and/or OhioRISE Plan/CMEs, subject to access controls and requirements necessary to comply with state and federal privacy requirements.” Can ODM please confirm that the MCO’s Care Management Portal is the same as the MCO’s Care Coordination Portal?

Answer:   ODM confirms that the reference to the “MCO’s Care Management Portal” in RFA Attachment A, Model MCO Provider Agreement, Appendix D, Section 2.e.i.3 is the same as the MCO’s Care Coordination Portal.

Date: 10/20/2020

Inquiry: 79502


Question:   In regards to Section 3.2.1 Paper Copies, pg. 12, would ODM consider allowing certain exhibits (workflows, organizational charts) to be submitted as an attachment on paper larger than 8.5” x 11”?

Answer:   Except as otherwise provided in ODM’s response to a question (see, e.g., response to inquiry #79475), Applicant’s response must be on 8.5” x 11’’ paper.

Date: 10/20/2020

Inquiry: 79500


Question:   Regarding the following requirement in 3.2.1 Paper Copies pg. 12: “Include a header and/or footer on every page that includes: name of Applicant, RFA title and number, and the page number” Will ODM allow the text required in the header and footer to be smaller than 12 point Times New Roman?

Answer:   The text in the header and footer may be smaller than 12 point Times New Roman as needed to fit within the one-inch margins.

Date: 10/20/2020

Inquiry: 79496


Question:   Regarding the following requirement in Section 3.4.8 Responses to Application pg. 15: “For each question, the Applicant must start on a new page and include both the number of the question and the text of the question and then provide the response.” Due to the limited number of pages available for Applicants to respond to each section, would ODM consider allowing each section (i.e., 3.4.8.1 Qualifications and Experience, 3.4.8.2 Population Health, etc.) to start on a new page rather than each question? If no, can ODM confirm that any blank space between questions does not count toward the total page limit per section?

Answer:   ODM is not revising the requirement that the response to each question start on a new page. ODM will count each page, regardless of blank space, as a page.

Date: 10/20/2020

Inquiry: 79495


Question:   Regarding the following requirement in Section 3.4.8 Responses to Application pg. 15: “For each question, the Applicant must start on a new page and include both the number of the question and the text of the question and then provide the response.” Can ODM please confirm if the question text will count towards the page limits of each section. If yes, would ODM consider allowing the question text to be smaller than 12 point Times New Roman font?

Answer:   Applicants may use 11 point Times New Roman font when restating the question text.

Date: 10/20/2020

Inquiry: 79494


Question:   Regarding the following requirement in Section 3.2.1 Paper Copies pg.12: “4. Be printed in font size 12 point Times New Roman (smaller font is permissible for charts, diagrams, graphics, and similar visuals)” Our assumption is that smaller font is permissible for tables as well. Can ODM please confirm?

Answer:   Smaller font is not permitted for tables. All tables must be in 12 point Times New Roman.

Date: 10/20/2020

Inquiry: 79493


Question:   Please confirm that Question 4 on Attachment F of the RFA should only be completed if Applicant and/or Subcontractor intends to change or shift the location identified on Attachment F as the location where services will be performed.

Answer:   Question 4 in RFA Attachment F (Location of Business and Offshore Declaration Form) is only applicable if the Applicant and/or subcontractor intends to change or shift the location identified in response to questions 1, 2, and/or 3. If the Applicant and subcontractor do not intend to change or shift the locations identified in questions 1, 2, or 3, the Applicant should complete question 4 by stating “Not applicable.”

Date: 10/20/2020

Inquiry: 79489


Question:   Section 3.4.8.1 Qualifications and Experience. Please confirm that "the Applicants audited results for the Healthcare Effectiveness Data and Information Set (HEDIS)" are the audited results reported in the plans HEDIS Final Audit Report (FAR).

Answer:   RFA Section 3.4.8.1, Question 2 states, “Provide, in table format, the Applicant’s audited results…” The term “audited results” means the Applicant’s final audited results from the Applicant’s final audit report.

Date: 10/20/2020

Inquiry: 79480


Question:   Please confirm ODM will allow Applicants to use a smaller font size, such as, 9 pt Times New Roman, for the number of the question and the text of the question.

Answer:   Applicants may use 11 point Times New Roman font when restating the question text.

Date: 10/20/2020

Inquiry: 79477


Question:   The RFA states, "For each question, the Applicant must start on a new page and include both the number of the question and the text of the question and then provide the response." Please confirm the text of the question does not count toward the page limit.

Answer:   The text of the question does count towards the page limit. ODM considered the text of the question in determining the page limits.

Date: 10/20/2020

Inquiry: 79476


Question:   In Applicants response to Q29, to ensure ease of understanding and improve readability, please confirm that ODM will allow the use of 11”x17” paper for the flowchart of Applicants information systems and integration points.

Answer:   In response to Q29 in RFA Section 3.4.8.4 (Operational Excellence & Accountability), Applicants may use 11” x 17” paper for the required flowcharts.

Date: 10/20/2020

Inquiry: 79475


Question:   To improve readability in charts, diagrams, graphics, tables, and callouts, please confirm ODM will allow Applicants to use a san serif font (like Arial).

Answer:   While a smaller font is permissible for charts, diagrams, and graphics, a smaller font is not permitted for tables or callouts. All tables and callouts must be in 12 point Times New Roman.

Date: 10/20/2020

Inquiry: 79474


Question:   Section 3.4.8 of the RFA states ""The response to each Application question must be complete and independent from information or responses provided elsewhere in the Application. The Evaluation Committee will not follow references to other sections (emphasis added) of the Application or review information not included as part of a response."" Based on discussion at the bidder’s conference, please clarify whether the Evaluation Committee will not follow references to other questions in the same section as well as other sections (e.g., Qualifications and Experience, Population Health, etc.), or whether it is acceptable to include references to other questions within the same section in order to avoid repetition?

Answer:   The Evaluation Committee will not follow references to other questions, including references to questions within the same section/topic area/tab.

Date: 10/20/2020

Inquiry: 79473


Question:   Regarding Appendix F, #16, will ODM release a data file listing current Ohio Medicaid enrolled providers with relevant demographic (names, address, provider type, specialty, group affiliation), identifier information (NPI), and Medicaid utilization volume (units and/or $ paid) for bidders to use for network development and targeting ODM-enrolled providers?

Answer:   Item #11 in the RFA Resource Library includes information on current ODM enrolled providers. ODM will provide additional information after award.

Date: 10/20/2020

Inquiry: 79472


Question:   Attachment A, Appendix A, Section 7.b.i., page 58, states, "The MCO must have the administrative capacity to offer feedback to individual providers on its adherence to evidence-based practice guidelines..." Please confirm the correct language is “their adherence,” meaning the providers, not the MCO.

Answer:   The word “its” in this requirement means the individual provider’s adherence.

Date: 10/20/2020

Inquiry: 79464


Question:   In regards to the following statement in Section 3.4.8.1.2 Qualifications and Experience pg. 16: “If you do not have results for a particular measure or year, please so indicate.” Can ODM please provide further detail how an applicant would indicate that a particular measure from one of our three largest Medicaid contracts (based on membership) does not have results for a particular measure for three consecutive years?

Answer:   RFA Section 3.4.8.1, Question 2 requires Applicants to provide responses in table format. Applicants who do not have results for a particular measure or year must indicate that in the table.

Date: 10/20/2020

Inquiry: 79462


Question:   In regards to the following statement in Section 3.4.8.1.2 Qualifications and Experience pg. 16: “Provide, in table format, the Applicant’s audited results for the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures specified below for each of the most recent three years (please identify which three years) for the Applicant’s three largest Medicaid contracts (based on membership).” If an MCO holds multiple Medicaid contract in one state, can ODM confirm that they are looking for largest Medicaid membership by contract or largest Medicaid membership by State?

Answer:   RFA Section 3.4.8.1, Question 2 requires the Applicant to submit audited results for the Applicant’s three largest Medicaid contracts based on membership. The size of the membership is based upon membership by contract.

Date: 10/20/2020

Inquiry: 79461


Question:   In regards to the following statement included in Section 3.4.8.1.2 Qualifications and Experience pg. 16: “Provide, in table format, the Applicant’s audited results for the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures specified below for each of the most recent three years (please identify which three years) for the Applicant’s three largest Medicaid contracts (based on membership).” Under certain Medicaid contracts, MCOs are required to perform Adult and Child CAHPS surveys in alternating years and therefore would not have Adult survey results for consecutive years. Can ODM please confirm that submission of CAHPS from the three most recent reporting years available (non-consecutive) is permissible?

Answer:   In the circumstance in which the Applicant’s contract does not require CAHPS survey submission annually, the Applicant must submit the three most recent, consecutive CAHPS measure submissions. In the example provided, this means the three most recent reporting years (i.e., those performed on alternating years).

Date: 10/20/2020

Inquiry: 79460


Question:   If an Applicant does not currently possess an Ohio tax ID number, may the Applicant wait to obtain an OH tax ID number until after that Applicant is selected by the Evaluation Committee?

Answer:   An Applicant is not required to have an Ohio taxpayer identification number to submit an Application. However, an Applicant must have an Ohio taxpayer identification number in order to contract with ODM. If the Applicant does not have an Ohio taxpayer identification number, it should indicate that in its response to item #6 of RFA Attachment B, Letter of Transmittal Template, and indicate the Applicant’s intent to obtain an Ohio taxpayer identification number prior to contracting with ODM.

Date: 10/20/2020

Inquiry: 79457


Question:   RFA Section 3.4.8.1 Qualifications & Experience Q2, page 16-17 Are the 10 listed HEDIS and CAHPs scores, the only HEDIS and CAHPS measures that ODM is requesting?

Answer:   RFA Section 3.4.8.1, Question 2 requires the Applicant to provide the Applicant’s audited results for the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) for the 10 listed measures. ODM is not requesting any additional measures.

Date: 10/20/2020

Inquiry: 79444


Question:   RFA Base, 3.2.1 Paper Copies, page 12 May 11pt Times New Roman or a smaller font than 12pt Times New Roman be used when restating the question text?

Answer:   Applicants may use 11 point Times New Roman font when restating the question text.

Date: 10/20/2020

Inquiry: 79438


Question:   I submitted the following on Oct 9 but did not receive an automatic reply confirming that the inquiry has been received. RFA Section 2.3 - Pre-Application Conference, page 6 During this conference call, Jim Tassie asked participants to send a list of names of people who participated in this conference call but not did not say where to send this list. thank you,

Answer:   The list may be sent to either or both of the following email addresses: ODM_Procurement@medicaid.ohio.gov or mcprocurement@medicaid.ohio.gov.

Date: 10/15/2020

Inquiry: 79486


Question:   3.1 Number of Applications Attachment B: Letter of Transmittal Template. Please confirm ODM will accept electronic signatures in lieu of ‘wet’ signatures from Applicants and Subcontractors as you did for the SPBM RFP given the ongoing restrictions / limitations in some states with regard to the COVID-19 pandemic.

Answer:   Yes, ODM will accept electronic signatures.

Date: 10/15/2020

Inquiry: 79481


Question:   During the Pre-Applicant conference held on Oct. 8 from 9 a.m. to 11 a.m., ODM asked that MCOs provide ODM with contact information for all participants. Which email address should the MCO submit participant names to, ODM_Procurement@medicaid.ohio.gov or mcprocurement@medicaid.ohio.gov?

Answer:   The list may be sent to either or both of the following email addresses: ODM_Procurement@medicaid.ohio.gov or mcprocurement@medicaid.ohio.gov.

Date: 10/15/2020

Inquiry: 79445


Question:   Section 2.3 Pre-Application Conference, page 6 During yesterday’s Pre-Application Conference call, Jim Tassie asked participants to send a list of names who registered/participated in the call but there wasn’t any direction on where to send this information.

Answer:   The list may be sent to either or both of the following email addresses: ODM_Procurement@medicaid.ohio.gov or mcprocurement@medicaid.ohio.gov.

Date: 10/15/2020

Inquiry: 79442


Question:   Hello-- Thank you for the opportunity to review and ask questions about this RFA. OHA has the following questions: 1) On page 247 of the RFA, Table F.3. it references Hospital System and General Hospital. How are the terms “Hospital System” and “General Hospital” defined? 2) Provider network/network adequacy a) How will ODM monitor network adequacy and ensure that a payer has sufficient network adequacy? b) Which provider types are must haves, if any, in order for a payer to submit a credible bid? 3) Behavioral Health Care Coordination Entities (BHCCE) a) Is this a new provider type under the RFA? b) Would existing providers keep their current provider type, or be transitioned into this one? c) What requirements would providers under the BHCCE status have to meet? 4) Provider Network Management System a) Would this include providers certified by OMHAS? b) Would this be external facing? Thank you in advance for your assistance, Quyen Weaver

Answer:   1. We define hospital system as a hospital that functions as a part of a large health care system. A general hospital may be academic or community-based entities. They are general in the sense that they admit all types of medical and surgical cases, and they concentrate on patients with acute illnesses and needing short-term care. A hospital can be a general hospital and a part of a hospital system.2a. The purpose of the Question and Answer process is to enable offerors and interested parties to obtain clarification about the procurement requirements in order to prepare a proposal. This question is not seeking such clarification. Offerors should refer to appendix F and appendix N of the MCO provider agreement. 2b. Offerors should use their best judgment in responding to the RFA. 3. ODM has not yet finalized requirements for BHCCEs.4. The Provider Network Management (PNM) module will replace the current MITS provider system, including the provider enrollment application process. OMHAS certified providers seeking to be a Medicaid provider will do so in the PNM module.

Date: 10/15/2020

Inquiry: 79384


Question:   RFA Section 3.4.8.1 Qualifications and Experience (Tab 8) Page 16 Section 3.4.8.1. requests Applicants to provide "in table format" a list of the Applicants current Medicaid MCO contracts." Because, as provided in section 4.3., "the evaluation of the response to each question will focus on one or more of the following … Method of Approach, Capability and Experience", please confirm whether or not Applicants, in addition to the table, are also permitted to submit a narrative summarizing and highlighting their approach, capability and experience.

Answer:   Section 3.4.8.1 specifically requires the Applicant to respond in table format. The Applicant should not include a narrative in response to, or in addition to the table required by, that section.

Date: 10/15/2020

Inquiry: 79375


Question:   Section 3.1.8.3, Benefits & Services Delivery Page 20, Q #25 The scenario describes the teenager as living with his grandmother, but does not indicate if grandmother has legal custody of the child. Can you clarify if grandmother does have legal custody of the teenager?

Answer:   ODM intentionally omitted information regarding custody/guardianship. The Applicant’s response should include how the Applicant would assess for custody/guardianship and the Applicant’s assumption about custody/guardianship.

Date: 10/13/2020

Inquiry: 79391


Question:   Section 3.1.8.3, Benefits & Services Delivery Page 21, Q # 26 paragraph 3. The sentence reads “As part of the transition process, the Applicant reached out to the assigned MCO Care Manager who shared that prior referrals for individual counseling ended prematurely, with the member “firing” her counselor.” Previously in the scenario the MCO the woman left was referred to as the “previous MCO” and the Applicant is noted to have been auto-assigned this member and is currently managing her transition. In the application sentence quoted, please confirm that the “assigned MCO Care Manager” is meant to represent the previous MCO Care Manager who worked with the member prior to her reassignment to the Applicant MCO.

Answer:   Yes, the “assigned MCO Care Manager” in the 2nd sentence of the 3rd paragraph is referring to the member’s Care Manager at the previous/disenrolling MCO.

Date: 10/13/2020

Inquiry: 79392


Question:   RFA Section 4.4 Phase III: Oral Presentations Page 27 Section 4.4 indicates all Oral Presentation participants must be employees of the Applicant. As a new market entrant that is continuing to build out its on-the-ground staff dedicated to the Ohio Medicaid contract, please confirm the list of Orals Presentation participants can include key staff from the Applicant’s parent company and/or affiliates owned by the MCO’s parent company who will either be dedicated to the Ohio Medicaid contract, or who can speak to the experience and capabilities leveraged by the Applicant.

Answer:   Yes, oral presentation participants may include employees of the Applicant's parent organization, affiliates, and/or subsidiaries. All participants must be employees; consultants may not participate in the oral presentation.

Date: 10/13/2020

Inquiry: 79377


Question:   RFA Section 4.3 Phase II: Review of Responses to Application Questions Page 26 Will ODM provide the available points and/or weight for questions or subsections within each topic area provided in the table in Section 4.3?

Answer:   No.

Date: 10/13/2020

Inquiry: 79376


Question:   RFA Section 3.4.8 Responses to Application Questions (Tab 7) Page 15 If the Applicant will use a subcontractor to fulfill any part of the response, the RFA requires that in responding to a question the Applicant must provide the name of the subcontractor and explain how the subcontractor’s performance will be no less effective than if done by the Applicant. Most managed care organizations rely on parent or affiliate organizations for certain administrative functions that benefit from economies of scale. These services are typically seamless within the overarching organizational structure of the MCO. For the ease of review, and to avoid repetitive statements throughout the RFA response, please confirm these services provided by parent or affiliate organizations of the Applicant are exempt from this requirement. As an alternative, in the interest of full transparency while avoiding repetitive responses in each individual question regarding the activities of parent company and affiliates in standard administrative services that are essentially seamless to members, would ODM consider a response in each tab that fully lays out the applicable services performed by affiliates and parent company?

Answer:   The Applicant must list the services provided by a parent or affliate organization, and the name of the parent or affiliate organization, as they are relevant to the Applicant's response to each question. The response to each Application question must be complete and independent from information or responses provided elsewhere in the Application. The Evaluation Committee will not follow references to other sections of the Application or review information not included as part of a response.

Date: 10/13/2020

Inquiry: 79373


Question:   I’m a dentist with multiple dental offices with over 40,000 patients. I was wondering if I qualify for this OhioRise and the new MCO program. Thanks! -Dr. Warsame

Answer:   The new managed care organization contracts will not affect the requirements to be a dental provider in the Medicaid program. MCOs will continue to be required to maintain a minimum number of dental providers in their panel.

Date: 10/5/2020

Inquiry: 79360


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Inquiry period ended:  10/30/2020 8:00:00 AM