Opportunity Detail

Questions and Answers

Ohio Resilience through Integrated Systems and Excellence (OhioRISE) Program
Document #:  ODMR20210025


Question:   Item 18. of Attachment B: Letter of Transmittal, 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: Does ODM intend for the applicant, and its affiliates, to only list its litigation?

Answer:   Item 18 of Attachment B: Letter of Transmittal speaks for itself. "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."

Date: 12/4/2020

Inquiry: 82346


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 OhioRISE Plan provider agreement, including the capitation rates, a provider agreement would not be executed with that Applicant.

Date: 12/4/2020

Inquiry: 82345


Question:   Item 17. of Attachment B: Letter of Transmittal, it states " In accordance with Section 5.13, Mandatory Disclosures of Governmental Investigations, a statement that (a) neither the Applicant nor a proposed FDR 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 FDR 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: Similar to Question 18 regarding litigation where there is a 5 year time frame, is there a time period limitation? Is an adverse regulatory or administrative action limited to those instances where a fine, penalty, CAP or sanction is imposed?

Answer:   The scope of this requirement is not limited to actions where a fine, penalty, CAP, or sanction was imposed. See response to inquiry #82260.

Date: 12/4/2020

Inquiry: 82344


Question:   Item 16. of Attachment B: Letter of Transmittal, it states " In accordance with Section 5.12, Mandatory Contract Performance Disclosure, a statement that (a) neither the Applicant nor a proposed FDR has received a formal claim for breach of contract or (b) the Applicant or a proposed FDR 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: Similar to Question 18 regarding litigation where there is a 5 year time frame, is there a time period limitation? Are breach of contract claims limited to those alleged breaches that arise from healthcare services? If limited to health services, is only related to those health services arising from a government contract?

Answer:   See response to inquiry #82338.

Date: 12/4/2020

Inquiry: 82343


Question:   With regard to section 3.4.8.2. Question 13, what types of data, including claims, will the OhioRISE plan have access to: -Will the OhioRISE plan have access to physical health (PH) and behavioral health (BH) medical and pharmacy claims to ensure that we are able to provide comprehensive member care? -Will the OhioRISE plan’s access to SPBM real-time pharmacy claims and prior authorization systems allow access to both BH and PH information for our key staff? -Will the Ohio Rise plan have access to physical health physician-administered drugs (PAD) information/claims/ coverage authorizations we understand that the Ohio Rise program be responsible for BH PAD.

Answer:   The OhioRISE Plan will have access to physical health and behavioral health claims data, including access to physical health physician-administered drugs. It is anticipated that the OMES Systems Integrator will be used to source SPBM pharmacy claims and prior authorization data. Additional specifications regarding pharmacy data will be determined during the readiness period.

Date: 12/4/2020

Inquiry: 82342


Question:   Section 5.13 of the ODMR 2021-0025 Base document, it states "Each Application must indicate whether the Applicant, or any of the Applicant’s proposed FDR(s), have 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: Similar to Question 18 in the Letter of Transmittal Template where there is a 5 year time frame for litigation, is there a time period limitation on government actions?

Answer:   See response to inquiry #82260.

Date: 12/4/2020

Inquiry: 82341


Question:   Page 4 of the "OhioRISE Data Book and Capitation Rate Methodology" narrative discusses that members with behavioral health inpatient hospital stays in CY2019 are included in the data book. Does the data book include all CY2019covered behavioral health experience and enrollment for those members, or only the claims experience and enrollment for the behavioral health inpatient hospital stay and time period after the inpatient stay?

Answer:   Please see Enclosure 1 (Calendar Year 2019 OhioRISE Data Book) that provides all categories of services included in the Data Book.

Date: 12/4/2020

Inquiry: 82340


Question:   Attachment A, Appendix A.1.c.i., page 44: Is the expectation that the OhioRISE plan obtain NCQA accreditation from the actual date of the contract? What NCQA accreditation is required (e.g., Health Plan, Managed Behavioral Healthcare Organization, Population Health Program, Care Management)?

Answer:   The OhioRISE plan must obtain or be in the process of obtaining health plan accreditation from the date of the contract for the OhioRISE Plan's Ohio Medicaid line of business. Please see Table N.2. in Appendix N of the draft provider agreement regarding provisional accreditation status.

Date: 12/4/2020

Inquiry: 82296


Question:   ODM’s posted response to inquiry #81982 indicates that OhioRISE membership is expected to grow gradually, with an approximate enrollment of 50,000 to 60,000 individuals by the end of year one. Does ODM have an expectation of how overall enrollee acuity will change as enrollment increases? For instance, does ODM expect the highest acuity members to enroll initially, with lower acuity members enrolling more gradually?

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: 12/4/2020

Inquiry: 82339


Question:   Section 5.12 of the ODMR 2021-0025 Base document states, "Each Application must disclose whether the Applicant or any proposed FDR 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: Similar to Question 18 in the Letter of Transmittal Template where there is a 5 year time frame for litigation, is there a time period limitation on a breach of contract claims? Are breach of contract claims limited to those alleged breaches that arise from healthcare services? If limited to health services, is only related to those health services arising from a government contract?

Answer:   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. 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: 12/4/2020

Inquiry: 82338


Question:   Attachment A, Baseline Provider Agreement, Article III.D. states, “ODM will consider implementing other risk mitigation techniques for the OhioRISE Program, including but not limited to risk pools for services or populations and Minimum Medical Loss Ratio (MLR) requirements.” Is ODM considering a minimum MLR threshold above the 85% minimum recommended by CMS?

Answer:   See response to inquiry #82335.

Date: 12/4/2020

Inquiry: 82337


Question:   Section 8 Staffing requirements states in part a.i. "The OhioRISE Plan must employ the identified qualified key and organizational staff, sufficient in number, to meet performance and compliance expectations as set forth in this Agreement". . . .part b.i. goes on to say "All OhioRISE Plans key staff must be full time and based (working) in the state of Ohio, unless otherwise indicated in this Agreement. OhioRISE Plans key staff, including staff performing key staff functions on an interim basis, must be approved by ODM." .. . . . Part b.iii. states "key staff must be dedicated to the OhioRISE Plan and may not share roles or responsibilities with an Ohio Medicaid MCO and/or MyCare Ohio Plan unless specifically indicated in the position requirements in this Agreement." Question: The Provider Agreement states that Key Staff must be "employed" and/or "dedicated" to the OhioRISE Plan. In utilizing both terms, it seems ODMs main concern is that the key staff are dedicated solely to OhioRISE. Can Key Staff lay elsewhere within an enterprise structure for the purposes of payment and benefits as long as they are fully dedicated to OhioRISE?

Answer:   In accordance with the provisions of Attachment A Section 8.a. and b., the identified key staff must be in Ohio, dedicated to and employed by the OhioRISE Plan, except where specifically identified positions may be shared between the OhioRISE Plan and an MCO or MyCare Ohio Plan. Key staff may not be employed by another affiliated entity even if the positions are fully dedicated to the OhioRISE program.

Date: 12/4/2020

Inquiry: 82336


Question:   Attachment A, Baseline Provider Agreement, Article III.D. states, “ODM will consider implementing other risk mitigation techniques for the OhioRISE Program, including but not limited to risk pools for services or populations and Minimum Medical Loss Ratio (MLR) requirements. “ Is ODM considering a methodology distinctly different from the minimum MLR methodology as defined by CMS in 42 CFR 438?

Answer:   The structure and parameters for risk sharing arrangements will be established during the rate setting process.

Date: 12/4/2020

Inquiry: 82335


Question:   Attachment A, Baseline Provider Agreement, Article III.C. states, “Capitation rates for the OhioRISE Program are anticipated to include a risk corridor as a shared risk mitigation mechanism.” Can ODM elaborate on the structure of a potential risk corridor, referenced in Article III.C?

Answer:   Please see the risk mitigation section of the Data Book and the response to inquiry #82267.

Date: 12/4/2020

Inquiry: 82334


Question:   Attachment A, Baseline Provider Agreement, Article III.E. states, “ODM may establish financial incentive programs for the OhioRISE Plan based on performance.” Can ODM elaborate on how the possible "financial incentive programs for the OhioRISE Plan based on performance" would work? Upon what metrics would it be based?

Answer:   Please see Attachment A, Appendix J regarding the Quality Withhold or Incentive Program.

Date: 12/4/2020

Inquiry: 82333


Question:   With regard to Attachment A, Introduction, 3.e., can ODM describe what assumptions will be used to develop the expected cost for the enhanced Medicaid services to be offered under the OhioRISE program, including Outpatient SUD services, SUD residential services, and Inpatient Mental Health and SUD services?

Answer:   See response to inquiry #82331.

Date: 12/4/2020

Inquiry: 82332


Question:   With regard to Attachment A, Introduction, 3.e., can ODM describe what assumptions will be used to develop the expected cost for the new Medicaid services to be offered under the OhioRISE program, including Mobile Response and Stabilization Services, Intensive Home Based Treatment, In-state PRTF, and Respite Services?

Answer:   Detailed projected cost information by service is not available at this time. The data and assumptions used to develop cost projections for these services will be considered as part of the capitation rate development process. Please refer to the Data Book for cost information.

Date: 12/4/2020

Inquiry: 82331


Question:   With regard to Section 2.4, can you tell us what proportion of the OhioRISE data book membership and expenses are under the current Medicaid Managed Care program versus Medicaid FFS?

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: 12/4/2020

Inquiry: 82330


Question:   RFA Base 3.4.8.1, Qualifications and Experience (Tab 8) p. 22-23: Thank you for increasing the page limit for Tab 8. Given the complexity and importance of the information system needed to meet the requirements in the Plan Provider Agreement, would ODM consider excluding the information system flowcharts requested in question 6 from the tab page limit? This would allow Applicants to provide sufficient and important detail in the flowcharts to properly illustrate the information system and allow for a complete response to this question.

Answer:   See response to inquiry #82302.

Date: 12/4/2020

Inquiry: 82303


Question:   RFA Base 3.4.8.1, Qualifications and Experience (Tab 8) p. 22-23: Thank you for increasing the page limit for Tab 8. Given the complexity and importance of the information system needed to meet the requirements in the Plan Provider Agreement, would ODM consider excluding the information system flowcharts requested in question 6 from the tab page limit? This would allow Applicants to provide sufficient and important detail in the flowcharts to properly illustrate the information system and allow for a complete response to this question.

Answer:   The entire response, including any flowcharts, count toward the page limits for the section. See response to inquiry #81946.

Date: 12/4/2020

Inquiry: 82302


Question:   3.4.8.2.15 Care Coordination and Collaboration (Tab 9), Pg. 26 The scenario states that “The youth was not previously enrolled in the OhioRISE Plan and is now re-enrolled in OhioRISE due to the PRTF admission.” Can you please clarify if the youth was or was not previously enrolled in the OhioRISE Plan?

Answer:   The language in Section 3.4.8.2.15 of the RFA is amended to read: The youth was not previously enrolled in the OhioRISE Plan and is now enrolled in OhioRISE due to the PRTF admission.

Date: 12/4/2020

Inquiry: 82301


Question:   Attachment A Appendix P, Chart of Deliverables, General, Pg. 277 Sections 1.c and 1.d give ODM the discretion to change the format or timeframe for submission of a deliverable, in addition to requiring new deliverables. To what extent will the OhioRISE Plan be consulted on changes to deliverables and will ODM negotiate an equitable adjustment to the Agreement’s scope and/or compensation for such changes that materially impact the OhioRISE Plan?

Answer:   When amending or renewing the contract, including the contract deliverables, ODM will provide the draft amendment to the OhioRISE plan and enter into a question and answer period. At that time, the OhioRISE plan may provide feedback and ODM will consider changes to the draft language. All adjustments are reviewed by ODM’s actuary for rating impacts.

Date: 12/4/2020

Inquiry: 82300


Question:   Attachment F, Location of Business and Offshore Declaration Form Attachment F, pages 1-2 Attachment F: Location of Business and Offshore Declaration Form asks for the location where state data will be stored, accessed, tested, maintained, or backed-up by Applicant. For security purposes, will ODM allow the Applicant only to disclose the city and state in which a 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: 12/4/2020

Inquiry: 82299


Question:   3.4.8, 3.4.8.1, Responses to Application, Qualifications and Experience (Tab 8), pg.20-23 For the purpose of establishing experience throughout the RFA response, please confirm an Applicant may leverage experience for contracts operated by the Applicant’s parent organization, affiliates, and/or subsidiaries.

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: 12/4/2020

Inquiry: 82298


Question:   Attachment B: Letter of Transmittal Template and Required Forms Attachment B and Forms, Pg. # Throughout RFP Please confirm ODM will accept electronic signatures in lieu of ‘wet’ signatures from Applicants and Subcontractors as you did for other RFPs given the ongoing restrictions / limitations with regard to the COVID-19 pandemic.

Answer:   Yes, ODM will accept electronic signatures.

Date: 12/4/2020

Inquiry: 82297


Question:   Question: In regards to the RFA Base document and the section Qualifications and Experience, will applicant be able to submit letters of support in this section, and if so, do they count against page limits?

Answer:   While the response to the first question in this section (3.4.8.1.1.a. through 3.4.8.1.1.k.) will not be counted toward the page limit for this tab, 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 a 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. See response to inquiry #81965.

Date: 12/4/2020

Inquiry: 82295


Question:   Appendix D of Attachment A the section entitled Care Coordination Tiers on page 145-146, it states, "The OhioRISE Plans care coordination approach must include three tiers: 1. Tier 3 – Intensive Care Coordination using a High Fidelity Wraparound approach for members that have high behavioral health needs 2. Tier 2 – Moderate Care Coordination using a Wraparound informed model for members with more moderate behavioral health needs and 3. Tier 1 – Limited Care Coordination for members who may refuse care coordination or may need lower intensity care coordination than in the Wraparound models." Question: Can ODM share any estimates or assumptions about the percentage or count of members in each tier?

Answer:   Policy criteria for care coordination services will be developed by ODM with stakeholder input. Enrollment estimates will be dependent on the policy criteria developed by ODM.

Date: 12/4/2020

Inquiry: 82294


Question:   Attachment A, Appendix A.2.a., page 36: Will Applicants have inquiry access to ODM’s system and/or the Fiscal Intermediary for eligibility verification?

Answer:   The OhioRISE plan will be able to check eligibility through ODM's PNM Portal, EDI transactions, and the Interactive Voice Response (IVR) system.

Date: 12/4/2020

Inquiry: 82286


Question:   Attachment A, Appendix K.5.b.i., page 233: Will TPL information be contained within the eligibility file?

Answer:   The 834 eligibility file does not contain TPL information. ODM has dedicated interfaces and files that will be used to communicate TPL information to the OhioRISE Plan.

Date: 12/4/2020

Inquiry: 82285


Question:   The Member Identification Section of the Databook states, "Enrollment in the OhioRISE program is anticipated to include children age 20 and under who have previously utilized certain behavioral health services, such as inpatient psychiatric or substance use services. In addition, we anticipate the program will include a cohort of members identified for enrollment through a Child and Adolescent Needs and Strengths (CANS) Assessment process. For the purpose of the data book, we utilized a proxy population of approximately 55,000 Medicaid beneficiaries age 20 and under, identified via the following three-step process, based on conversations with ODM." Question: Are both traditionally Medicaid members and 1915(c) members eligible for OhioRise? Are 1915(c) members eligle for the expanded and enhanced services within OhioRISE?

Answer:   Yes, any individual that meets the criteria in draft rule OAC 5160-59-02, located in RFA Attachment I, is eligible for OhioRISE services described in Appendix B of the draft provider agreement.

Date: 12/4/2020

Inquiry: 82284


Question:   The Member Identification Section of the Databook states, "Enrollment in the OhioRISE program is anticipated to include children age 20 and under who have previously utilized certain behavioral health services, such as inpatient psychiatric or substance use services. In addition, we anticipate the program will include a cohort of members identified for enrollment through a Child and Adolescent Needs and Strengths (CANS) Assessment process. For the purpose of the data book, we utilized a proxy population of approximately 55,000 Medicaid beneficiaries age 20 and under, identified via the following three-step process, based on conversations with ODM." Question: Will the OhioRISE MCO be required to cover any services retrospectively and does this align to Day 1 methodology used in base Medicaid?

Answer:   Please see proposed draft rule OAC 5160-59-02(C) in Attachment I regarding eligibility and enrollment in OhioRISE. Policy regarding retroactive coverage will be discussed during the readiness period.

Date: 12/4/2020

Inquiry: 82265


Question:   Question: Regarding OhioRISE Databook and Capitation Rate Methodology, the Non-Emergent Transportation (NEMT) rates are listed in the data book as expenditures, how do the rates reflect this expense? Are NEMT services relating to education, food access, employment, social security appointments, and housing searches reflected in the rates?

Answer:   The OhioRISE data book does not include claims experience for NEMT services. The MCOs are to provide all medically necessary non-emergency medical transportation services that are not covered by the county for members enrolled in the OhioRISE Plan 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: 12/1/2020

Inquiry: 82283


Question:   Question: Regarding OhioRISE Databook and Capitation Rate Methodology, for expenses provided in the data book is Non-Emergent Transportation (NEMT) included? Is there an expectation that NEMT services should be charged back to the MCOs covering the members Medical or Pharmacy benefits at 100%?

Answer:   The OhioRISE Databook does not include claims experience for NEMT services. Please refer to Appendix B.2.g. regarding the OhioRISE Plan's responsibilities for non-emergency medical transportation services.

Date: 12/1/2020

Inquiry: 82282


Question:   Question: In regards to Table 3: Behavioral Health Service Package in the OhioRISE Databook and Capitation Rate Methodology, for new and enhanced services, can you please define how "partially reflected" expenditures were reflected in rate development? What categories of service did these expenses represent in the base dataset? What is the total cost of each of these services from the data book? In order to capture services as "fully reflected," will ODM consider information from other States who offer similar benefits to aid in pricing these services?

Answer:   Services that were deemed “partially reflected” in Table 3 of the OhioRISE Databook are those for which the OhioRISE program is expected to feature new or enhanced services. We anticipate utilization of these services will be a blend of new utilization as well as historical utilization of other services included in the OhioRISE Databook. For example, the projected cost associated with the enhanced Intensive Home-Based Treatment benefit may include a combination of historical intensive home-based treatment, reflected in the data book in COS13, plus new utilization not historically observed.

Date: 12/1/2020

Inquiry: 82281


Question:   Question: Regarding the OhioRISE Databook and Capitation Rate Methodology, can you please confirm that the applicable OhioRISE BH costs have been removed for eligible PFK members?

Answer:   Please refer to the OhioRISE Databook Section III. Data Book Development at the first paragraph.

Date: 12/1/2020

Inquiry: 82280


Question:   Attachment A, Appendix F, 4.b.i.1, page 180: This item says, in part: "The OhioRISE Plan must contract with all providers identified by ODM in ODMs provider network management system as eligible to complete the ongoing Child and Adolescent Needs and Strengths (CANS) assessments for continued eligibility for OhioRISE Plan enrollment (CANS providers) except where there are documented instances of quality concerns..." What is the states plan for training and certifying the provider network in the CANS?

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: 12/1/2020

Inquiry: 82275


Question:   In the Administrative Expenses and Risk Margin section of the Data Book, it states "In developing the administrative cost allowances, we will review historical administrative expenses for the existing managed care program along with administrative expenses reported by entities in comparable programs. We will consider the size of the OhioRISE plan and the resulting economies of scale that could be achieved, along with the benefits covered and the demographics of the OhioRISE population." Question: Will there be start-up cost coverage prior to go-live for staff hiring and other related expenditures?

Answer:   Please see RFA section 5.3.

Date: 12/1/2020

Inquiry: 82272


Question:   Attachment A, Appendix K.1.c.vi., page 229: Can ODM provide more detail on Ohio’s Identity and Access Management System and the Innovate Ohio Platform, as well as the need for the OhioRISE plan to integrate with these systems?

Answer:   The Innovate Ohio Platform is a Single Sign-On Identity and Access Management solution that serves all state agencies. The platform supports open source identity service standards to leverage a common framework of services for access management for applications. The OhioRISE plan will be required to integrate with the State’s Identity and Access Management solution to authenticate log ins from State staff, providers, and case managers. More information can be found here: https://innovateohio.gov/wps/portal/gov/innovate/platform/digital-identity

Date: 12/1/2020

Inquiry: 82205


Question:   In the Administrative Expenses and Risk Margin section of the Data Book, it states "In developing the administrative cost allowances, we will review historical administrative expenses for the existing managed care program along with administrative expenses reported by entities in comparable programs. We will consider the size of the OhioRISE plan and the resulting economies of scale that could be achieved, along with the benefits covered and the demographics of the OhioRISE population." Question: Is the anticipated admin rate to be in excess of the current Medicaid rate?

Answer:   Please see response to inquiry #82103.

Date: 11/25/2020

Inquiry: 82273


Question:   In the Administrative Expenses and Risk Margin section of the Data Book, it states "In developing the administrative cost allowances, we will review historical administrative expenses for the existing managed care program along with administrative expenses reported by entities in comparable programs. We will consider the size of the OhioRISE plan and the resulting economies of scale that could be achieved, along with the benefits covered and the demographics of the OhioRISE population." Question: Will all care coordinated services provided through CMEs (e.g. all CM that is not tier one) be a medical expense?

Answer:   See response to inquiry #82269.

Date: 11/25/2020

Inquiry: 82271


Question:   Section 4.i.1.a. of Appendix C of Attachment A states, "1. The OhioRISE Plan shall ensure that child and family-centered care plans for members in all Tiers, are completed, submitted for review, and approved by the OhioRISE Plan according to standards approved by ODM. The QI/UM program is responsible for reviewing and monitoring: a. The timeliness of care plan completion b. Comprehensiveness of the child and family-centered care plans to ensure that all necessary CME and other provider services and supports are incorporated into the child and family-centered plan of care at the needed intensity of service and c. Ensure the plans adhere and support a child and family-centered care planning process consistent with System of Care Principles, and High Fidelity Wraparound practice when that method is used." Question: What is the projected membership by quarter?

Answer:   See response to inquiry #81982.

Date: 11/25/2020

Inquiry: 82270


Question:   Section 1.c. of Attachment A Appendix D states, "i. The OhioRISE Plan must use a tiered care coordination model, varying the intensity of care coordination in a purposeful way that aligns with the strengths and needs of the members enrolled in the OhioRISE Plan. ii. The OhioRISE Plans care coordination approach must include three tiers: 1. Tier 3 – Intensive Care Coordination using a High Fidelity Wraparound approach for members that have high behavioral health needs 2. Tier 2 – Moderate Care Coordination using a Wraparound informed model for members with more moderate behavioral health needs and 3. Tier 1 – Limited Care Coordination for members who may refuse care coordination or may need lower intensity care coordination than in the Wraparound models. iii. The care coordination continuum must be managed by the OhioRISE Plan and must include provider organizations referred to as care management entities (CMEs). The CMEs will be responsible for providing and/or coordinating the provision of intensive and moderate care coordination, community-based services, and other services and supports to improve health outcomes. Tier 2 and Tier 3 care coordination may only be provided by CMEs. iv. OhioRISE Plan-employed care coordinators will provide Tier 1 Limited Care Coordination, the lowest intensity of the three tiers of care coordination. " Question: Could you please describe the process utilized for stratification of Tier 1-3 membership? What case management ratios assumed? Will the State share the non-identified material assumptions used in developing the expenditure and capitation for CM? Will these expenditures be reflected in medical expense or administrative for Tiers 1, 2 and 3?

Answer:   See response to inquiry #82115. Tiers 2 and 3 will be considered medical expenses. Tier 1 will be an administrative expense developed through the rate setting process.

Date: 11/25/2020

Inquiry: 82269


Question:   The Risk Mitigation Section of the Databook states, "As part of the capitation rate development process, ODM will consider implementing various risk mitigation techniques, including but not limited to: Risk Pools Minimum Medical Loss Ratio (MLR) requirements and Risk corridor calculations." Question: What is the anticipated timing when the model for risk corridor will be completed? Will it mirror the risk corridor implemented for the MCOs covering the base Medicaid services?

Answer:   For the first years of the OhioRISE program in particular, we anticipate there will be material uncertainty related to the rate at which members enroll in the program, as well as the relative morbidity of members who enroll in the program versus those who continue to receive behavioral health coverage via the MCOs or FFS. In addition, there may be differences in the nature and cost of services billed to the OhioRISE Plan versus other entities (e.g. MCOs/FFS) relative to what was assumed in this data book and ultimately, the capitation rates. To mitigate these risks, ODM may explore risk-sharing agreements among the OhioRISE Plan, MCOs, and/or FFS.

Date: 11/25/2020

Inquiry: 82267


Question:   Attachment A, Appendix G, 10.g.i, page 203: In the event that ODM chooses to audit, review, investigate, and recover payment from the Plan’s network providers at any time and without notice to the Plan, will the Plan be made aware of the claims audited and recovered so that claims can be appropriately adjusted to reflect the correct final status and to ensure the Plan does not pursue an audit or recovery for the same claims?

Answer:   Yes, ODM will identify any claims it has identified as overpayments from the OhioRISE Plan’s network providers and those claims it has recovered so the OhioRISE Plan does not pursue an audit or recovery for the same claims.

Date: 11/25/2020

Inquiry: 82240


Question:   Attachment A, Appendix G, 10.e.iii, page 202: During a period where the plan is required to “stand down” for suspected fraud, is the plan permitted to take action against the provider in response to any associated quality of care issues or to mitigate potential member harm? Would this require a request for deconfliction?

Answer:   If a stand down is in place, the plan must request deconfliction prior to taking any action against a provider. ODM will work with the OhioRISE Plan to address quality of care issues and mitigate member harm.

Date: 11/25/2020

Inquiry: 82237


Question:   Attachment A, Appendix G, 9.c.ix, page 200: The RFA requires “that at least 3% of total expenditures are subject to a post-payment investigation”. Questions: 1) Can ODM provide its expectation for the scope of this post payment investigation? 2) Does this require the initiation of an audit and/or review of a medical record or does post payment review of claims through algorithms designed to identify outliers and anomalous behavior meet this expectation? 3) If an audit and/or review of medical records is required, please provide the estimated number of claims and estimated total expenditures by year so that we can calculate the estimated number of claims to be audited and the resources needed to meet this requirement.

Answer:   ODM expects that the post-payment review will include audits or reviews of medical records. Please refer to the Data Book for available expenditure information.

Date: 11/25/2020

Inquiry: 82236


Question:   Attachment A, Appendix G, 9.c.vi, page 200: The RFA has a requirement for prepayment review for fraud, waste and abuse, specifically requiring: “A process to manually review all claims for providers placed on prepayment review status as requested by ODM”. Can ODM provide the number of providers and/or claims which required prepayment review at the request of ODM for the last fiscal year?

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: 11/25/2020

Inquiry: 82234


Question:   OhioRISE Library, Data Book, page N/A: On average, 140 of Ohios youth are receiving treatment in out-of-state PRTFs. It is our understanding that these placements are currently funded via a combination of non-Medicaid dollars (for Room and Board charges) and Medicaid dollars (for eligible professional services). Questions: 1) Is this a correct understanding? 2) With PRTF identified as a covered service in OhioRISE, does ODM expect that total costs (combining Room & Board as well as therapeutic services into a single daily charge) would be eligible for Medicaid reimbursement? 3) Where, in the Data Book, would Applicants find where the total cost for these PRTFs are accounted for?

Answer:   PRTF policy and provider criteria, including reimbursement, will be developed by ODM with stakeholder input. PRTF expenditures are not reflected in the OhioRISE data book, and will be considered as a prospective program change in the capitation rate development process.

Date: 11/25/2020

Inquiry: 82226


Question:   General, Security: Does ODM have an IT security questionnaire that must be completed by the OhioRISE plan?

Answer:   The OhioRISE Plan will be required to complete a system security plan that details how it will comply with all applicable security standards and protocols.

Date: 11/25/2020

Inquiry: 82213


Question:   Attachment A, Appendix K.6.a., page 237: Is the requirement for the OhioRISE’s system to accept and transmit real-time transactions met by implementing the real-time HIPAA transactions identified and by participating in Ohio’s two HIEs? If not, please identify additional real-time transactions that Applicants may need to implement.

Answer:   Additional information beyond that included in the RFA and Q&A will be provided during the readiness period. Please see response to inquiry #82118.

Date: 11/25/2020

Inquiry: 82209


Question:   Attachment A, Appendix A.1.g.iii.1.d., page 35: What are the system integration/data exchange requirements related to this system and the OhioRISE program?

Answer:   OhioRISE Plan staff will be provided access to HealthTrack to log in to the system directly.

Date: 11/25/2020

Inquiry: 82187


Question:   Attachment A, Appendix A.c NCQA Accreditation, Pg. 31 In the event the OhioRISE Plan delegates applicable functions to a related entity affiliate, will it be acceptable for the NCQA accreditation to be held by an affiliate instead of the OhioRISE Plan entity?

Answer:   No. The NCQA Health Plan accreditation must be held or in the process of being applied for by the entity contracting with ODM as the OhioRISE Plan.

Date: 11/25/2020

Inquiry: 82127


Question:   Attachment A, Appendix K 1. Health Information System Requirements Pg. 228-242: What kind of Data Exchange is expected between the OhioRISE plan and CMEs/Providers besides the following clinical/EMR integrations? • ADT • C-CDA What is the process and method of integration expected by CMEs and Providers? – Enterprise Service Bus (APIs), Batch files, Message Queues? How are the providers expected to file the CANS Assessments to the OhioRISE Plan? • Through Online form? • Document upload as a Soft copies (PDFs) or • Data through API or file feeds from other source?

Answer:   ODM is in the process of developing the submission requirements for CANS Assessments completed by providers. Regarding system integration, please see response to inquiry #82118.

Date: 11/25/2020

Inquiry: 82126


Question:   Attachment A, Appendix K,1.c.v Data and Systems Integration Pg. 229: It is expected that “v. The OhioRISE Plans system must integrate data with all Ohio Medicaid Enterprise System (OMES) modules (e.g., member module, provider module, fiscal intermediary module), through the systems integrator in real-time and batch (based on data currency needs), to support the Ohio Medicaid managed care program.” What are the integration points and method of integration for: • Provider Data and fee schedules: Who/Which system will send this information? Fiscal Intermediary? • Member Eligibility: Who/Which system will send this information? • Claims and AUTH’s from Fiscal Intermediary • All EDI exchanges C-CDA and ADT with providers or CME or Fiscal Intermediary Are there any additional integrations expected? If so, please provide additional information about type of data and method of integration expected.

Answer:   All data will be submitted through the System Integrator which will work with the system of record. The OhioRISE Plan will not have a specific connection to every module. The OhioRISE Plan must be able to support the data exchange requirements outlined in the RFA to communicate with providers, ODM, and managed care plans per Attachment A, Appendix C, 3.d.ii.4-5. Operational details regarding systems integration will be finalized during the readiness period.

Date: 11/25/2020

Inquiry: 82118


Question:   RFA Base 1.2 Background, Pg.6 Please provide additional information about Centers of Excellence: (a) what organizations have been or are likely to be designated COEs and (b) what responsibility, if any, does the OhioRISE Plan have in the selection and oversight of the COEs?

Answer:   The OhioRISE Plan will not be responsible for selection or oversight of Centers of Excellence. For more information, please see the RFA released by the Ohio Department of Mental Health and Addiction Services (MHAS) found here: https://procure.ohio.gov/proc/viewProcOpps.asp?oppID=22038

Date: 11/25/2020

Inquiry: 82107


Question:   Question: Will the State provide the data book and rate methodology PDF in excel?

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: 11/20/2020

Inquiry: 82268


Question:   Question: When will ODM provide the capitation rates for review in consideration of this RFA? Will the State confirm that those rates will have the administration portion of the rate included with sufficient detail to understand the methodology used to build the administration, the type of services being included as administration spend versus medical spend (e.g. surrounding the differences between level of care management required in the base contract)?

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: 11/20/2020

Inquiry: 82266


Question:   The Member Identification Section of the Databook states, "Enrollment in the OhioRISE program is anticipated to include children age 20 and under who have previously utilized certain behavioral health services, such as inpatient psychiatric or substance use services. In addition, we anticipate the program will include a cohort of members identified for enrollment through a Child and Adolescent Needs and Strengths (CANS) Assessment process. For the purpose of the data book, we utilized a proxy population of approximately 55,000 Medicaid beneficiaries age 20 and under, identified via the following three-step process, based on conversations with ODM." Question: Could ODM provide a description of how members that are presumed to be eligible are covered until enrollment into OhioRISE?

Answer:   Please refer to section of Appendix A. Section A.2 regarding eligibility, enrollment, transfers, and enrollment termination.

Date: 11/20/2020

Inquiry: 82264


Question:   Section 3.4.8.2, question 12 states, “Describe the Applicants experience and approach to working with ODM-contracted MCO care coordinators and care coordination entities (CCEs) to coordinate care for children and youth enrolled in the OhioRISE Program who have moderate, acute, or chronic physical health care needs in addition to behavioral health care needs. Please provide information in your response regarding the State or jurisdiction where the work was done, enrollment size and describe similarities in the covered population with the OhioRISE Programs population.” Please confirm that Applicants may respond to this question with both actual current or former ODM-contracted MCOs and CCEs, as well as agencies in other markets that serve in a similar function.

Answer:   ODM confirms that Applicants may respond to this question with both actual current or former ODM-contracted MCOs and CCEs, as well as agencies in other markets that serve in a similar function.

Date: 11/20/2020

Inquiry: 82263


Question:   Section 3.2.1 of RFA provides that applicants must “comply with the page number limits specified in Section 3.5.” However, there is no section 3.5 in the RFA. Please confirm that the page limits are what is outlined in section 3.4.8.1 (30 pages), 3.4.8.2 (70 pages), 3.4.8.3 (25 pages) 3.4.8.4 (40 pages) and 3.4.8.5 (35 pages)?

Answer:   There is no RFA Section 3.5. Please see the response to inquiry #81965 regarding page limits.

Date: 11/20/2020

Inquiry: 82262


Question:   Section 3.4.8.1 states, "Provide a list of the Applicant’s current Medicaid managed care 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, as was expressly permitted in the MCO RFA pursuant to Q&A Inquiry # 79634.

Answer:   Yes, 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: 11/20/2020

Inquiry: 82261


Question:   Transmittal Letter questions #16 and #17 state, "16. In accordance with Section 5.12, Mandatory Contract Performance Disclosure, a statement that (a) neither the Applicant nor a proposed FDR has received a formal claim for breach of contract or (b) the Applicant or a proposed FDR 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. 17. In accordance with Section 5.13, Mandatory Disclosures of Governmental Investigations, a statement that (a) neither the Applicant nor a proposed FDR 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 FDR 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." Please confirm that the lookback period for each of these questions is ten calendar years, which is the maximum record retention requirement for any such records under applicable state or federal record retention law.

Answer:   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. 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.

Date: 11/20/2020

Inquiry: 82260


Question:   In regard to Section 3.4.8.1, page 20, will ODM consider allowing for additional pages for section 3.4.8.1. Qualifications and Experience to accommodate the space needed for the contract information in question 1 and the flowcharts in question 6? Alternatively, please consider allowing the contract information and workflows to be excluded from the page count.

Answer:   Please see response to inquiry #81965 and #81946.

Date: 11/20/2020

Inquiry: 82259


Question:   Section 3.4.7 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 D&B, and are based on a firm’s worth and composite credit appraisal. The Applicant must also include the Applicant’s D&B credit report, which contains the firm’s financial statements and credit payment history. If the Applicant is submitting an Application with one or more first tier, downstream, and related entities (FDRs) as described in the OhioRISE Model Provider Agreement, Appendix A, Section 9, “Subcontractual Relationships and Delegation,” the Applicant must submit a D&B rating and credit report for each FDR." Please confirm that we may omit financial documents in excess of 250 pages from paper RFA submittals and, alternatively, submit them to ODM electronically.

Answer:   ODM will 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: 11/20/2020

Inquiry: 82258


Question:   Section 3.2.1 states, "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, tables, text/callout boxes, and that applicants are allowed to use smaller fonts in those instances. In addition, please confirm subsection headings can be larger than the 12-point font requirement, in alignment with the Ohio MCO RFA.

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. 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. Headings may be larger than 12 point font.

Date: 11/20/2020

Inquiry: 82257


Question:   Regarding the following requirement in Section 3.4.8 Responses to Application pg. 19: “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 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: 11/20/2020

Inquiry: 82256


Question:   Regarding the following requirement in Section 3.4.8 Responses to Application pg. 19: “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 Care Coordination and Collaboration, 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. Also, see response to inquiry #81965.

Date: 11/20/2020

Inquiry: 82255


Question:   Attachment A, Appendix A.4.c.i.5., page 44: What specifically would members be approving via their audio signature? Will it be an automated process or will they add their signature during a call with a live agent? Will the signature be linked to the member or to individual events associated with that member?

Answer:   As stated Attachment A, Appendix A.4.c.i.5., the OhioRISE Plan must have the capability to capture "audio signatures" for any required forms or requests that require a member's signature.

Date: 11/20/2020

Inquiry: 82254


Question:   Attachment A, Appendix A, 8.d.ii. Regional Coordinators, page 85: In Item 1 of this subsection, the list of roles and responsibilities for Regional Coordinators includes developing and executing engagement activities in priority communities. Please clarify how priority communities are or will be identified by the Department.

Answer:   The OhioRISE Plan must identify priority communities. ODM will review and provide feedback during the readiness period.

Date: 11/20/2020

Inquiry: 82232


Question:   OhioRISE Library, Data Book: Please provide patient count data for all levels of care outside of Inpatient. Patients per 1000 will determine staffing levels.

Answer:   Please refer to the member identification section of the Data Book.

Date: 11/20/2020

Inquiry: 82231


Question:   General, Telephony: Will ODM or the OhioRISE plan own and assign the behavioral health toll-free number?

Answer:   Requirements related to toll-free numbers can be found in Appendix A of the RFA.

Date: 11/20/2020

Inquiry: 82217


Question:   General, Telephony: Will the OhioRISE plan’s staff be required to directly access any of ODM’s information systems? If so, will the plan need to install any software/hardware in order to support this? If yes, will ODM provide the additional hardware/software?

Answer:   Any applications or systems the OhioRISE plan would need to access will be web-based and support leading modern web browsers.

Date: 11/20/2020

Inquiry: 82215


Question:   Attachment A, Appendix K.5.b.viii., page 234: How will the OhioRISE plan receive TPL information? If this is a data exchange, please provide details on trading partners, file layouts, and transmission frequency.

Answer:   The OhioRISE plan will receive TPL information electronically. Technical requirements will be specified during the readiness period.

Date: 11/20/2020

Inquiry: 82208


Question:   Attachment A, Appendix K.2.b., page 231: What are the specific needs of the reviewers?

Answer:   The specific needs of the reviewers will be as necessary to conduct the review activities described in Attachment A, Appendix K.2.

Date: 11/20/2020

Inquiry: 82206


Question:   Attachment A, Appendix B.2.e.i., page 100: How will the OhioRISE plan identify lock-in members? Will this information be included on the eligibility file?

Answer:   Yes, this information is transmitted on the 834C and 834F files.

Date: 11/20/2020

Inquiry: 82203


Question:   Attachment A, Appendix A.2.c.ix.1., page 39: Please identify the method by which the OhioRISE plan would receive information on a member prior to their membership effective date.

Answer:   ODM will work with the OhioRISE Plan during the readiness period to develop processes for identifying and communicating information about pending members.

Date: 11/20/2020

Inquiry: 82198


Question:   Attachment A, Appendix A.2.c.iv.3., page 38: Please identify the format of the electronic notifications (i.e., real-time or batch) for changes regarding member circumstance.

Answer:   The operational details for notifications of changes in member circumstance will be finalized through collaboration with the OhioRISE Plan, MCOs, and Ohio Job and Family Services Directors Association (OJFSDA) during the readiness period.

Date: 11/20/2020

Inquiry: 82192


Question:   Attachment A, Appendix A.2.c.iii.3., page 38: Please identify the format of the electronic reconciliation requests (i.e., real-time or batch).

Answer:   Reconciliation requests are currently submitted on excel spreadsheets using templates created by ODM. Requests are submitted via email into a designated mailbox. ODM may change this process in the future.

Date: 11/20/2020

Inquiry: 82190


Question:   Attachment A, Appendix A.2.b.i.-ii., page 36: How will the OhioRISE plan be notified once individuals are enrolled?

Answer:   See response to inquiry #82179.

Date: 11/20/2020

Inquiry: 82189


Question:   Attachment I, Section 4.B.1 & 2, page 9: How will the OhioRISE plan be notified of the eligibility conditions detailed in this section?

Answer:   Attachment I, Section 4.B.1 and 2 include the eligibility requirements associated with inpatient and PRTF admissions and crisis situations. ODM will work with the OhioRISE Plan, Medicaid MCOs, and relevant providers during the readiness period to develop policies and procedures, including notification procedures, to rapidly facilitate enrollment into the OhioRISE Plan when individuals are enrolled under OAC 5160-59-02 (B).

Date: 11/20/2020

Inquiry: 82183


Question:   Attachment I, Section 4.A.3, page 9: How will the OhioRISE plan be notified of an individual’s enrollment in an MCO?

Answer:   See response to inquiry #82179.

Date: 11/20/2020

Inquiry: 82182


Question:   Attachment I, Section 4.A.2, page 9: How will updates to the eligibility data be supplied? (e.g., full refresh, incremental add/change/deletes)? What is the frequency of the eligibility updates (e.g., daily, weekly, monthly)?

Answer:   Eligibility updates will be provided on a daily 834C file that includes incremental add/change/delete transactions. A monthly 834F (full) file that includes the OhioRISE Plan's full roster for the reported month will also be provided.

Date: 11/20/2020

Inquiry: 82181


Question:   Attachment I, Section 4.A.2, page 9: Within the Medicaid file, are there different Medicaid populations identified?

Answer:   Yes, different Medicaid populations will be identified on the Medicaid 834 files and sent to the OhioRISE plan.

Date: 11/20/2020

Inquiry: 82180


Question:   Attachment I, Section 4.A.2, page 9: Please confirm if an 834 will transmit the Medicaid eligible membership.

Answer:   EDI 834C and 834F files will transmit enrollment information to the OhioRISE Plan.

Date: 11/20/2020

Inquiry: 82179


Question:   Base, Section 1.2, Ohio’s Future Medicaid Managed Care Program for Multi-System Youth, page 5: What version of the CANS assessment is being utilized?

Answer:   ODM and other state agency partners are currently working to identify components of the CANS assessment that Ohio will use for OhioRISE eligibility and ongoing care. This work will involve stakeholder input prior to implementation.

Date: 11/20/2020

Inquiry: 82175


Question:   Attachment A, Appendix A.1.g.iii.1.b., page 35: What billing codes are utilized by current mobile crisis response teams (adults or youth)?

Answer:   Currently, mobile response and stabilization service (MRSS) is not a specific Medicaid reimbursable service and therefore does not have a distinct billing code. ODM intends to add this service to the Medicaid State Plan and will identify the necessary procedure code(s) when developing policy for this new service.

Date: 11/20/2020

Inquiry: 82174


Question:   Attachment A, Appendix A.1.g.iii.1.b., page 35: How will mobile crisis teams for youth be accessed under OhioRISE?

Answer:   Additional details regarding the new mobile response and stabilization service will be developed with stakeholder input. It is expected that all members of the OhioRISE plan will have a crisis/safety plan as required in Attachment A, Appendix D.2.d.iii. and iv. The crisis/safety plan will specify when and how an OhioRISE member will access mobile response services.

Date: 11/20/2020

Inquiry: 82173


Question:   Attachment A, Appendix A.1.g.iii.1.b., page 35: Are there currently any mobile crisis teams serving youth in Ohio? If so, how are they dispatched and who currently manages them?

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: 11/20/2020

Inquiry: 82172


Question:   Attachment A, Appendix A.8.c.xvii., page 82: The Chief Compliance Officer may be shared with the MCO or MyCare Plan yet solely dedicated to compliance for OhioRISE. Please clarify if this can be a shared position.

Answer:   Per Appendix A.8.c.xvii.1., the Chief Compliance Officer may be a shared position with an Ohio Medicaid MCO and/or MyCare Ohio Plan. Appendix A.8.c.xvii.2. requires this position to have reporting relationship to the OhioRISE Plan Administrator/CEO/COO and Board of Directors and to be dedicated to ensuring compliance with the OhioRISE agreement for the the portion of their time allocated to this program if it is a shared position. The Chief Compliance Officer should not have other OhioRISE Plan management responsibilities. Applicants are expected to have sufficient staff resources to ensure compliance with all agreement requirements regardless of their choice to share the position.

Date: 11/20/2020

Inquiry: 82171


Question:   Attachment A, Appendix K 5.b.vi. Claims Adjudication and Payment Processing Requirements Pg. 233: It is expected that the OhioRISE plan should send claim Status back to Fiscal Intermediary. • Will this be a 276/277 Claim Status Request and Response? • Is the OhioRISE plan expected to send daily claim status reports, in addition to encounters and 276/277?

Answer:   The answer to each question is yes. Per Appendix K 5.b.iii., the OhioRISE Plan must provide updated claims status demonstrating all claims activity on a daily basis to ODM.

Date: 11/20/2020

Inquiry: 82121


Question:   RFA Base 3.4.8.1/Question 3.a. Qualification and Experience, Pg. 21-22 Will all the claims received from the fiscal intermediary be electronic? Please confirm whether there will be any paper claims submitted through the fiscal intermediary and if so, can you please provide estimated volume? Will Providers be sending any Paper Claims? If so, will the Fiscal Intermediary be handling those claims and sending EDI 837 to the OhioRISE Plan?

Answer:   All the claims sent from the fiscal intermediary to the OhioRISE plan will be electronic.

Date: 11/20/2020

Inquiry: 82112


Question:   Attachment A, Appendix K, Exhibit K-1, page 242: What is OAKS, as referenced in the high-level message flow diagram?

Answer:   OAKS is the State’s accounting system. The OhioRISE plan will not have any interaction with OAKS.

Date: 11/19/2020

Inquiry: 82212


Question:   Attachment A, Appendix A.7.c.i.2., page 65: How would the OhioRISE plan know which children were in the custody of each PCSA and/or IV-E Court?

Answer:   The Medicaid 834 eligibility files will indicate which children are in custody and the county of custody.

Date: 11/19/2020

Inquiry: 82202


Question:   Attachment A, Appendix A.4.b.i.4.b., page 43: Will this information be supplied on any incoming eligibility files? How will the OhioRISE plan receive this information from ODM, SPBM, and/or an MCO?

Answer:   ODM and its contractors will supply eligibility files, including 834 files and Consumer Contact Records. The OhioRISE Plan will be responsible for maintaining a database that includes these sources as well as other information specified in the model provider agreement.

Date: 11/19/2020

Inquiry: 82200


Question:   Attachment A, Appendix A.2.c.ix.3., page 39: What is a “Client Contact Record” and how is it provided?

Answer:   The Client Contact Record (CCR) file is a non-EDI flat file generated by Ohio’s managed care enrollment vendor and transmitted to the OhioRISE plan. The file provides supplemental medical information that is not transmitted on the 834 enrollment files. ODM will work with the OhioRISE Plan to establish additional methods of sharing information about individual members.

Date: 11/19/2020

Inquiry: 82199


Question:   Attachment A, Appendix A.2.c.vii.1., page 38: Please identify the format of the electronic notifications (i.e., real-time or batch) for OhioRISE Plan-initiated disenrollment requests.

Answer:   ODM will provide information about these notifications at a later date.

Date: 11/19/2020

Inquiry: 82196


Question:   Attachment A, Appendix A.2.c.vi.1., page 38: Please specify the Ohio Medicaid OhioRISE Plans termination of enrollment requirements.

Answer:   The termination of enrollment requirements can be found in Attachment I under proposed draft rule 5160-59-02. Additional termination requirements will be developed by ODM with stakeholder input.

Date: 11/19/2020

Inquiry: 82195


Question:   Attachment A, Appendix A.2.c.iv.3., page 38: Please identify the format of the electronic notifications (i.e., real-time or batch) for enrollments due to an inpatient behavioral health stay.

Answer:   ODM will provide information about these notifications at a later date.

Date: 11/19/2020

Inquiry: 82193


Question:   Attachment A, Introduction, Section 2.c.ii., page 2: Will providers submit authorization requests to ODM’s Fiscal Intermediary? How will these requests be submitted to the OhioRISE plan?

Answer:   Providers may submit prior authorization requests through the Provider Network Management (PNM) portal or EDI transactions. These will be sent to the OhioRISE Plan by EDI or flat file.

Date: 11/19/2020

Inquiry: 82186


Question:   Attachment A, Introduction, Section 2.c.i., page 2: How will medical claims be transmitted to the OhioRISE plan?

Answer:   These will be sent by EDI or a flat file to the OhioRISE Plan.

Date: 11/19/2020

Inquiry: 82185


Question:   Attachment I, Section 6.B.8, page 18: By what method will the OhioRISE plan communicate authorization status?

Answer:   See response to inquiry #82210.

Date: 11/19/2020

Inquiry: 82184


Question:   Attachment A, Appendix K.8.b.i.-iii., page 240: What type of data will be transmitted from the state’s OMES systems integrator? What are the options for formats and/or transaction types? Would this exchange be in real-time or batch files?

Answer:   Data (e.g., claims, remittance advice, 1099, all EDI transactions, prior authorizations, eligibility, provider, third-party liability, encounters) will be transmitted through the OMES systems integrator. ODM will provide information regarding format and transaction types at a later date. Data will be exchanged both in real-time and in batch files.

Date: 11/19/2020

Inquiry: 82210


Question:   Data book, Section IV, Process Overview Step 5, page 7: Can a range of potential administrative allowances be provided?

Answer:   Administrative expense assumptions will be established during the rate setting process.

Date: 11/19/2020

Inquiry: 82178


Question:   Data book, Section IV, Process Overview Step 4, page 7: Can a range of potential trend adjustments be provided?

Answer:   Prospective trend assumptions will be established during the rate setting process.

Date: 11/19/2020

Inquiry: 82177


Question:   Data book, Section III, Member Stratification, page 4: Please clarify that the SUD cohort is assigned based on the presence of any SUD claim for inpatient or outpatient even if at a lower paid claim amount relative to other behavioral health codes.

Answer:   Members were assigned to the SUD cohort in the event they had at least one claim during the incurred period that had an SUD diagnosis code listed in Appendix C. We confirm that the member was assigned to SUD based on the presence of any claim with an SUD diagnosis, even if total paid expenditures for SUD services were lower than non-SUD services.

Date: 11/19/2020

Inquiry: 82176


Question:   Attachment A, Appendix G.9.c.ix., page 200: Please provided total estimated expenditures for the population for CY19.

Answer:   See response to inquiry #82168.

Date: 11/19/2020

Inquiry: 82170


Question:   Attachment A, Appendix G.9.c.ix., page 200: Please provided total estimated expenditures for the population for CY19.

Answer:   See response to inquiry #82168.

Date: 11/19/2020

Inquiry: 82169


Question:   Attachment A, Appendix G.9.c.ix., page 200: Please provided total estimated expenditures for the population for CY19.

Answer:   Please refer to the Data Book in the bidders library for expenditure information.

Date: 11/19/2020

Inquiry: 82168


Question:   Attachment A, Appendix A.5.b.iii., page 50: Please provide the total admissions by level of care and subsequent number of fair hearing requests and determinations made in CY19.

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: 11/19/2020

Inquiry: 82167


Question:   Item 9 of Section 4.2 of the Base document states, "The Applicant’s response to Attachment E demonstrates that either (a) no actual, potential, or apparent conflict of interest exists, or (b) if such a conflict of interest exists, the Applicant has provided a Mitigation Plan that eliminates or mitigates the actual, potential, or apparent conflict. ODM will, in its sole discretion, determine whether a Mitigation Plan sufficiently and appropriately eliminates or mitigates the actual, potential, or apparent conflict of interest. If the Applicant has a corporate relationship with another entity that is or may become part of Ohio’s managed care system (e.g., an MCO or PBM), then this qualifies as an actual or potential conflict of interest and should be addressed in Attachment E. A sufficient and appropriate Mitigation Plan will be more than aspirations and general principles. Instead, a sufficient and appropriate Mitigation Plan must (a) specifically disclose in detail all actual, potential, or apparent conflicts of interest and (b) provide detailed procedures to eliminate or mitigate the actual, potential, or apparent conflicts of interest. The Mitigation Plan must be submitted with the Applicant’s response to the RFA. The additional instructions in Attachment E must be followed." Question: The RFP Pass/Fail Mandatory Requirements states that ODM has "sole discretion" to determine whether a conflict mitigation plan appropriately mitigates conflicts of interest and requires submission of a mitigation plan. Where an applicant submits a Mitigation Plan, and ODM determines there are areas of potential improvement, will ODM provide feedback or clarifying questions and allow an applicant to submit an updates Mitigation Plan? What criteria will ODM utilize to determine whether a Mitigation Plan appropriately mitigates conflicts?

Answer:   See response to inquiry #82106.

Date: 11/19/2020

Inquiry: 82148


Question:   will this offer be open to small business, Individual Providers working in the behavioral health community?

Answer:   Please review the Mandatory Qualifications under Section 4.2.1 of the RFA.

Date: 11/19/2020

Inquiry: 82142


Question:   My organization JD Dace llc specializes in mentorship for disadvantaged youth of Southwest Ohio. Our goal is to foster a commitment to young people that will promote clean eating, strong interpersonal skills, and reassert a sense of hope for their future. We create opportunities for athletes, entrepreneurs, and leaders to empower disadvantaged youth through mentoring. This opportunity will provide an outlet for parents and young people that promote clean eating and strong interpersonal skills. I would be highly grateful if OhioRise chose to do business with JD Dace llc.

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: 11/19/2020

Inquiry: 82137


Question:   Attachment A 2. Eligibility, Enrollment, Transfers, and Enrollment Termination, Pg. 36 Have procedures and/or a workflow been developed for the process of enrolling members into OhioRISE and if so, can these be provided?

Answer:   Procedures will be provided to the OhioRISE Plan at a later date. See response to inquiry #81982.

Date: 11/19/2020

Inquiry: 82132


Question:   Attachment A, Appendix NTable N-1 Pre-Determined Financial Sanctions Pg. 256-263: When and how will the “To Be Determined” financial sanctions be determined for each of the 61 noncompliance items?

Answer:   See response to inquiry #81979.

Date: 11/19/2020

Inquiry: 82131


Question:   Attachment A, Appendix A.d Model Agreements with MCOs and SPBM, Pg.31 Will ODM please elaborate on its “under ODM’s direction” role in the drafting process of the model written agreements with MCOs? Will ODM be a party to the agreements or otherwise encourage consistency and approve each agreement?

Answer:   ODM will facilitate and actively participate in the dialogue to draft the model agreements. ODM will review the proposed written model agreements prior to execution. The form of the agreements is subject to ODM's approval. ODM will not be a party to the agreements.

Date: 11/19/2020

Inquiry: 82130


Question:   Attachment A, Appendix K 10. Health Information Exchanges Pg. 241: Are there any penalties to either OhioRISE Plan’s CMEs or network providers, if they don’t have the infrastructure to support exchange data with Health Information Exchange?

Answer:   CMEs will need to have the infrastructure to perform CME functions. Per Appendix K, the OhioRISE Plan must provide the necessary technical assistance to CMEs to participate with Ohio’s two HIEs. The OhioRISE Plan must submit to ODM an annual plan to support use of EHRs and HIEs (EHR and HIE Provider Support Plan), including, for example, offering incentives for providers to join an HIE.

Date: 11/19/2020

Inquiry: 82129


Question:   Attachment A, Appendix K 10. Health Information Exchanges Pg. 241: Is there any cost associated in exchanging data with HIEs. Would ODM be bearing the costs on behalf of OhioRISE Plan?

Answer:   There may be costs associated with exchanging data with the HIEs. Outside of the capitation rate setting process, ODM will not directly bear costs, if any, related to exchanging data with HIEs.

Date: 11/19/2020

Inquiry: 82128


Question:   Attachment A, Article X Limitation of Liability, Pg. 25 The model contract does not contain a cap on the OhioRISE Plan’s liability for direct damages. In accordance with standard commercial practices, many state agencies have negotiated and agreed to commercially reasonable limitation of liability provisions. The presence of such a cap would benefit the state of Ohio by encouraging financially responsible and responsive applicants to bid where they might not otherwise out of concern for the open-ended nature of their liability. In light of the foregoing and the TBD nature of the Appendix N financial sanctions, will ODM please amend the model contract to contain a cap on the amount of the OhioRISE Plan’s liability for direct damages (inclusive of liquidated damages and financial sanctions), or otherwise clarify its willingness to negotiate mutually acceptable language that addresses the issue?

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: 11/19/2020

Inquiry: 82125


Question:   Attachment A, Appendix K 5.d Grouping Methodology Pg. 234: Could ODM provide any further detail about the Grouper software used to process fee-for-service (FFS) claims?

Answer:   Currently, for FFS inpatient claims, ODM utilizes 3M Health Information Systems’s All Patient Refined Diagnosis Related Groups version 38. The grouper version is updated annually (October 1st) to coincide with the release of the International Classification of Disease – 10 code sets. For FFS outpatient claims, ODM utilizes 3M Health Information Systems’s Enhanced Ambulatory Patient Groups version 3.14. Typically, the grouper version is updated every 3 to 5 years. However, the CPT/HCPCS code sets in use are updated at least annually to remain HIPAA compliant.

Date: 11/19/2020

Inquiry: 82124


Question:   Attachment A, Appendix K 5.b. Claims Adjudication and Payment Processing Requirements Pg. 233: It is mentioned that “i. The OhioRISE Plan must integrate with the fiscal intermediary for claims, third party liability (TPL), authorizations, and any other types of data or processes as directed by ODM.” What other types of data or processes need to be integrated as directed by ODM? Can ODM provide the method of integration expected?

Answer:   ODM is not able to specify other types of data or processes, nor the method of integration, at this time. ODM will work with the OhioRISE Plan to establish an implementation plan as additional data or processes are identified by ODM.

Date: 11/19/2020

Inquiry: 82123


Question:   Attachment A, Article X Limitation of Liability, Pg. 25 Should the references to “MCO” instead read “OhioRISE Plan” in section A?

Answer:   The references to "MCO" in Attachment A, Article X - Limitation of Liability - Section A should be replaced with "OhioRISE Plan".

Date: 11/19/2020

Inquiry: 82122


Question:   Attachment A, Article VII, D. Records, Documents, Data, and Information, Pg. 21 Will ODM please confirm the right to inspect and audit “any records or documents of the OhioRISE Plan or its subcontractors” is limited to records and documents directly related to the OhioRISE contract?

Answer:   Under Article VII of Attachment A, ODM or its designee has the right to inspect and audit all records, documents, data, or other information produced, used by, or in possession of the OhioRISE plan or its subcontractors under the OhioRISE agreement.

Date: 11/19/2020

Inquiry: 82120


Question:   Attachment A, Appendix K 5.b.vi. Claims Adjudication and Payment Processing Requirements Pg. 233: Could ODM please clarify if the 30 day claim status notification requirement via the fiscal intermediary is a performance guarantee? Please clarify if the requirement is for 100% in 30 days?

Answer:   Appendix K 5.b.vi. applies to all claims. Failure to meet requirements to adjudicate claims to final status and notify providers of the status of submitted claims as specified in Appendix K may be associated with financial sanctions.

Date: 11/19/2020

Inquiry: 82119


Question:   Attachment A, Appendix K Claims Flow Pg. 228-230: In the Claims workflow, should the OhioRISE plan have any direct integration with OAKS?

Answer:   There will be no integration with OAKS.

Date: 11/19/2020

Inquiry: 82117


Question:   Attachment A, Appendix D, d.iii. Assessments Pg. 156: Please clarify the term “independent evaluator.” Is an independent evaluator external to the OhioRISE Plan and not part of the OhioRISE network? Is the evaluator paid directly by ODM?

Answer:   The independent evaluator is external to the OhioRISE plan and will be an individual practitioner or organization (including CMEs) that will meet the network requirements set forth in Appendix F.4.b.i of Attachment A. The OhioRISE Plan is responsible for the cost of CANS assessment for all enrolled members. Prior to OhioRISE enrollment, payment for CANS assessments will be made by the child's managed care plan or the fee for service program, as applicable.

Date: 11/19/2020

Inquiry: 82116


Question:   Attachment A, Appendix D c.iii Care Coordination Caseloads v. Contacts Pg.151 & 157: Has the criteria that determines the Tier assignment been determined and have guidelines for caseloads or contacts by Tier been finalized? If so, can that information be made available to potential Applicants? Could ODM provide estimates of expected enrollment by care coordination Tier?

Answer:   Intensive care coordination (Tier 3) will require a care coordinator to child and family ratio consistent with a High Fidelity Wraparound Approach. Moderate care coordination (Tier 2) will be delivered by providers of ICC and will be less intensive than ICC. Policy and provider criteria for Tier 3 and Tier 2 care coordination will be developed by ODM with stakeholder input. Limited care coordination (Tier 1) provided by the OhioRISE plan must have caseload standards consistent with the staffing ratios proposed in the program description required in Appendix D. Tiered enrollment estimates cannot be provided at this time.

Date: 11/19/2020

Inquiry: 82115


Question:   RFA Base 3.4.8.1/Question 3 Qualification and Experience, Pg. 21-22 Can ODM provide anticipated yearly or monthly Behavioral Health claim volume information?

Answer:   Claim volume information can be accessed in the OhioRISE Data Book found here https://procure.ohio.gov/proc/viewProcOpps.asp?oppID=22000. Note that this claim volume is based on a proxy population and partially represented services that will be covered by the OhioRISE Plan.

Date: 11/19/2020

Inquiry: 82114


Question:   Attachment A, Appendix A, General Requirements c.i. Secure Provider Portal, Pg. 64-65: Could ODM please clarify if the providers are expected to use two Provider Portals Provider Portal as part of with Fiscal Intermediary (Referred in Exhibit K.1 Claims Flow) and the “Secured Provider Portal” created by the OhioRISE plan?

Answer:   There will be two portals that providers will use, the Provider Network Management (PNM) portal and the provider portal maintained by the OhioRISE plan. The first, the PNM portal, will be used for claims and prior authorization submissions. The second provider portal will be maintained by the OhioRISE plan per Appendix A, A.7.c.

Date: 11/19/2020

Inquiry: 82113


Question:   RFA Base 2.1 Anticipated RFA Schedule, Pg. 9 We understand ODM’s goal is to receive Applications as soon as possible. However, this is a complex RFA with a short timeframe to respond, which may put some potential Applicants at a competitive disadvantage. ODM has committed to answering questions up to one week prior to the submission deadline, which allows potential Applicants very little time to finalize their submissions. Will ODM consider granting a modest extension of at least two weeks, to facilitate higher quality Applications that are in the best interest of the state?

Answer:   See response to inquiry #81972.

Date: 11/19/2020

Inquiry: 82111


Question:   Appendix A, 3.b. Data Security Agreement with Board of Pharmacy, Page 40: Is it possible to receive the Ohios Board of Pharmacy data security agreement to determine if additional resources or technologies are needed to fulfill this agreement?

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: 11/19/2020

Inquiry: 82110


Question:   RFA Base 2.1 Anticipated RFA Schedule Pg. 9 Will potential Applicants have an opportunity to ask additional questions or request clarifications after ODM posts its written responses to submitted questions or in response to any RFA amendments?

Answer:   The deadline for submitting questions is 8:00 a.m. ET on November 21, 2020. Under section 4.1 of the RFA, 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: 11/19/2020

Inquiry: 82109


Question:   RFA Base 1.5 Introduction and Background / Request for Application Resource Library, Pg. 7 Can ODM please provide the estimated monthly enrollment estimates for each of the initial 24 months of the program?

Answer:   See response to inquiry #81982.

Date: 11/19/2020

Inquiry: 82108


Question:   OhioRISE Library, Databook, Managed Care Efficiencies, page 11: Please provide a range of managed care efficiencies which Milliman anticipates will be included in the rates.

Answer:   Managed care efficiency adjustments, if applicable, will be developed as a component of the capitation rate setting process.

Date: 11/19/2020

Inquiry: 82104


Question:   OhioRISE Library Databook, Risk Mitigation, page 12: Given the significant uncertainty of initial enrollment levels and the cost of add-on services, please provide some additional information on the percentage level of risk corridors being considered. Since the uncertainty affects both medical costs and administrative costs, will the risk sharing be based on actual net margin as opposed to just medical costs?

Answer:   ODM will consider administrative and services costs uncertainties, along with the structure and parameters for risk sharing arrangements, associated with implementing the new OhioRISE plan in the rate setting process.

Date: 11/19/2020

Inquiry: 82103


Question:   OhioRISE Library, Databok, Covered Populations, pages 3-4: Given the uncertainty on enrollment levels, will Milliman consider an administrative load which is a combination of fixed costs (regardless of membership) and variable costs (PMPM) versus a traditional PMPM or percentage of premium approach?

Answer:   Administrative cost assumptions will be determined during the capitation rate setting process. Uncertainties will be considered during this process.

Date: 11/19/2020

Inquiry: 82102


Question:   OhioRISE Library, Databook, page 5: Please provide a high-level estimate of the new and enhanced services to give bidders an estimated range for the total program spend beyond the $573.77 PMPM and the $350 million included in the Databook. Milliman notes that these will be a “material portion of the projected expenditures” and therefore are an important consideration for bidders.

Answer:   Detailed cost estimates for new and enhanced services are not available at this time. Preliminary analyses suggest that these services will represent a material portion of total program expenditures. The final capitated rates will consider the costs for services not yet included within the preliminary data book. In recognition of this uncertainty, ODM is exploring various risk mitigation techniques as discussed within the OhioRISE Data Book and Rate Methodology.

Date: 11/19/2020

Inquiry: 82101


Question:   OhioRISE Library Data book, page 4: What was the basis for assuming 45,400 eligible enrollees through the CANS process? Please provide some total cost sensitivity around this assumption – that is, if 5,000, 10,000, 25,000, 50,000, 75,000, etc. are actually enrolled using same ordering of members from most to least costly.

Answer:   ODM currently estimates OhioRISE enrollment to be approximately 55,000 individuals. See the "member identification" section of the OhioRISE data book for information regarding factors that were considered when identifying the proxy population. As noted in the OhioRISE data book, there is material uncertainty related to the enrollment levels in the OhioRISE program, particular in the first year. We anticipate that per member per month (PMPM) costs of the OhioRISE population will be sensitive to changes in the enrolled population. In recognition of this uncertainty, ODM is exploring various risk mitigation techniques as discussed within the OhioRISE Data Book and Rate Methodology.

Date: 11/19/2020

Inquiry: 82100


Question:   Item 9 of Section 4.2 of the Base document states, "The Applicant’s response to Attachment E demonstrates that either (a) no actual, potential, or apparent conflict of interest exists, or (b) if such a conflict of interest exists, the Applicant has provided a Mitigation Plan that eliminates or mitigates the actual, potential, or apparent conflict. ODM will, in its sole discretion, determine whether a Mitigation Plan sufficiently and appropriately eliminates or mitigates the actual, potential, or apparent conflict of interest. If the Applicant has a corporate relationship with another entity that is or may become part of Ohio’s managed care system (e.g., an MCO or PBM), then this qualifies as an actual or potential conflict of interest and should be addressed in Attachment E. A sufficient and appropriate Mitigation Plan will be more than aspirations and general principles. Instead, a sufficient and appropriate Mitigation Plan must (a) specifically disclose in detail all actual, potential, or apparent conflicts of interest and (b) provide detailed procedures to eliminate or mitigate the actual, potential, or apparent conflicts of interest. The Mitigation Plan must be submitted with the Applicant’s response to the RFA. The additional instructions in Attachment E must be followed." Question: The RFP Pass/Fail Mandatory Requirements states that ODM has "sole discretion" to determine whether a conflict mitigation plan appropriately mitigates conflicts of interest and requires submission of a mitigation plan. Where an applicant submits a Mitigation Plan, and ODM determines there are areas of potential improvement, will ODM provide feedback or clarifying questions and allow an applicant to submit an updates Mitigation Plan? What criteria will ODM utilize to determine whether a Mitigation Plan appropriately mitigates conflicts?

Answer:   Attachment E regarding Conflicts of Interests, including any mitigation plans, is a Mandatory Qualification per section 4.2.  ODM reserves the right to reject any response, in whole or in part, for any reason, including when a response is not in compliance with the RFA requirements.  Any mitigation plan must provide the information specified in Attachment E, section B.4, and should include sufficient information to enable ODM to understand and assess whether an actual or potential conflict of interest would be appropriately mitigated.  In addition, based on the information provided, ODM may seek further 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: 11/19/2020

Inquiry: 82016


Question:   Attachment A, Appendix A, 6.a Provider Services, page 51: Please clarify what is meant by having the capability to capture "audio signatures" for any required forms or requests from providers.

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: 11/16/2020

Inquiry: 82105


Question:   RFA Base 3.4.8.1, Qualifications and Experience (Tab 8) p. 22-23: Given the complexity of the information system needed to meet the requirements in the Plan Provider Agreement, would ODM consider excluding the information system flowcharts requested in question 6 from the 30 page limit? This would allow Applicants to provide sufficient and important detail in the flowcharts and allow for responses to the other qualification and experience questions in Tab 8.

Answer:   See response to inquiry #81965. The page limit for RFA Section 3.4.8.1. Qualifications and Experience (Tab 8) is increased from 30 to 40 pages. The response to the first question in this section (3.4.8.1.1.a. through 3.4.8.1.1.k.) will not be counted toward the page limit for this tab.

Date: 11/16/2020

Inquiry: 82095


Question:   Section 4.5 of the Base document states, "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: 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 #82015.

Date: 11/16/2020

Inquiry: 82079


Question:   Item 32 of section 3.4.8.5 of the Base document states, "The Ohio Department of Jobs and Family Services, as a requirement of the Family First Prevention Services Act, will be ensuring children and youth who are at risk for entering custody will have access to Multi-Systemic Therapy (MST). This is an existing Medicaid service, but may require additional providers to offer this service to members enrolled in the OhioRISE Plan. Describe the Applicant’s experience with working with state child-serving agencies and discuss how the Applicant will work with the relevant Ohio state agencies, providers, CMEs, and COE(s) to develop additional capacity for delivering this service and how the Applicant will work with the COE(s) to ensure the service is provided consistent with clinical guidelines. Describe specific activities and strategies the Applicant will use to support providers to deliver this service." Question: With regard to comparing experience with regard to working with child-serving agencies, 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.

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82078


Question:   Item 32 of section 3.4.8.5 of the Base document states, "The Ohio Department of Jobs and Family Services, as a requirement of the Family First Prevention Services Act, will be ensuring children and youth who are at risk for entering custody will have access to Multi-Systemic Therapy (MST). This is an existing Medicaid service, but may require additional providers to offer this service to members enrolled in the OhioRISE Plan. Describe the Applicant’s experience with working with state child-serving agencies and discuss how the Applicant will work with the relevant Ohio state agencies, providers, CMEs, and COE(s) to develop additional capacity for delivering this service and how the Applicant will work with the COE(s) to ensure the service is provided consistent with clinical guidelines. Describe specific activities and strategies the Applicant will use to support providers to deliver this service." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82077


Question:   Item 31 of section 3.4.8.5 of the Base document asks to "Describe the Applicant’s proposed approach to offering, promoting, and supporting the appropriate and effective systemic use of telehealth services to increase access and health equity for OhioRISE members. In your response, assume a post-pandemic environment where access would be balanced with appropriate utilization management." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82076


Question:   Item 30 of section 3.4.8.5 of the Base document asks to " Describe any value-added services the Applicant intends to offer its members, including: a. How the value-added services align with the goals of the OhioRISE Program b. The scope of the benefit, including any limitations c. The desired outcome of providing the value added services and d. How the Applicant will monitor and evaluate the value added services." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82075


Question:   Item 29 of section 3.4.8.5 of the Base document states " A CME and COE has asked the Applicant for assistance with obtaining data and information that will: 1) be used to support the CME to perform care coordination responsibilities and 2) inform the Child and Family Teams’ (CFTs’) assessments and development of the child and family-centered care plans. Describe the data and information sources the Applicant would target to assist the CME, the process for obtaining the information, the format the Applicant would use to provide the information to the CME, and how the Applicant would collaborate with the COE to assist the CME and CFTs to use this information when developing the child and family-centered plans." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82074


Question:   Item 28 of section 3.4.8.5 of the Base document asks to “Describe what resources and methods (including data analytics) the Applicant will use for adhering to network adequacy standards (i.e., access and availability) set forth in Appendix F to ensure member access to care." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82073


Question:   Item 27 of section 3.4.8.5 of the Base document asks to “Describe the Applicant’s experience with and approach (including methodology, timeline, and use of selective contracting) to developing and managing a qualified provider network that meets the requirements of the OhioRISE Plan Provider Agreement. Include a narrative describing the approach the Applicant will use to support network providers to deliver new and enhanced services offered by the OhioRISE Plan, the staffing and information that the Applicant will use to identify and address potential challenges, including network gaps. Please provide information in your response regarding the State or jurisdiction where the work was done and describe similarities in the covered services between the referenced experience and the covered services for the OhioRISE Program’s population." 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 #82015.

Date: 11/16/2020

Inquiry: 82072


Question:   Item 27 of section 3.4.8.5 of the Base document asks to “Describe the Applicant’s experience with and approach (including methodology, timeline, and use of selective contracting) to developing and managing a qualified provider network that meets the requirements of the OhioRISE Plan Provider Agreement. Include a narrative describing the approach the Applicant will use to support network providers to deliver new and enhanced services offered by the OhioRISE Plan, the staffing and information that the Applicant will use to identify and address potential challenges, including network gaps. Please provide information in your response regarding the State or jurisdiction where the work was done and describe similarities in the covered services between the referenced experience and the covered services for the OhioRISE Program’s population." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82071


Question:   Item 26 of section 3.4.8.4 of the Base document asks to “Describe the Applicant’s experience and approach to ensuring that child and family-centered care plans for all members in all tiers are completed, submitted for review, coordinated with service authorization, and approved by the OhioRISE Plan. Please provide information in your response regarding the State or jurisdiction where the work was done, enrollment size and describe similarities in the covered population with the OhioRISE Program’s population. Include how the Applicant will monitor to ensure high performance, including: a. Ensure the timeliness of care plan completion b. Confirm the comprehensiveness of the child and family-centered care plans to ensure that all necessary CME and other provider services and supports are incorporated into the child and family-centered plan of care at the needed intensity of service c. Ensure the plans adhere to and support a child and family-centered care planning process that is consistent with System of Care Principles and High Fidelity Wraparound practice and d. Incorporate lessons learned from Applicant’s prior experience with similar processes. " Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82070


Question:   Item 26 of section 3.4.8.4 of the Base document asks to “Describe the Applicant’s experience and approach to ensuring that child and family-centered care plans for all members in all tiers are completed, submitted for review, coordinated with service authorization, and approved by the OhioRISE Plan. Please provide information in your response regarding the State or jurisdiction where the work was done, enrollment size and describe similarities in the covered population with the OhioRISE Program’s population. Include how the Applicant will monitor to ensure high performance, including: a. Ensure the timeliness of care plan completion b. Confirm the comprehensiveness of the child and family-centered care plans to ensure that all necessary CME and other provider services and supports are incorporated into the child and family-centered plan of care at the needed intensity of service c. Ensure the plans adhere to and support a child and family-centered care planning process that is consistent with System of Care Principles and High Fidelity Wraparound practice and d. Incorporate lessons learned from Applicant’s prior experience with similar processes." Question: With regard to comparing experience with regard to child and family-centered plans, 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.

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82069


Question:   Item 25 of section 3.4.8.4 of the Base document asks to “Describe how the Applicant will use its experience and resources to design and implement value based care and payment initiatives that support the objectives of the OhioRISE Program and enhance care and outcomes for its members. Please provide information in your response regarding the experience, the State or jurisdiction where the work was done and describe similarities in the covered population with the OhioRISE Program’s population." Question: With regard to comparing experience with regard to value-based care, 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.

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82068


Question:   Item 25 of section 3.4.8.4 of the Base document asks to “Describe how the Applicant will use its experience and resources to design and implement value based care and payment initiatives that support the objectives of the OhioRISE Program and enhance care and outcomes for its members. Please provide information in your response regarding the experience, the State or jurisdiction where the work was done and describe similarities in the covered population with the OhioRISE Program’s population." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82067


Question:   Item 24 of section 3.4.8.4 of the Base document asks to “Describe the Applicant’s proposed uses of CANS data to support and achieve the goals of the OhioRISE Program. Include in your response how the Applicant will make care coordination tier assignments, child and family-centered care plan review and feedback, and outcomes measurement." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82066


Question:   Item 23 of section 3.4.8.4 of the Base document asks to " Describe the Applicant’s system-wide experience collaborating with entities external to the Applicant (e.g., CMEs, other MCOs) to meet performance measures similar to those in Appendix I, Table I.3. Include in your response how the Applicant will develop and implement CME requirements to support the measures in Appendix I, Table I.3, and specific strategies and methods to require and oversee CME performance related to the following measures: a. Well child and well care adolescent visits b. Dental visits and c. Graduation rates." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82065


Question:   Item 23 of section 3.4.8.4 of the Base document asks to " Describe the Applicant’s system-wide experience collaborating with entities external to the Applicant (e.g., CMEs, other MCOs) to meet performance measures similar to those in Appendix I, Table I.3. Include in your response how the Applicant will develop and implement CME requirements to support the measures in Appendix I, Table I.3, and specific strategies and methods to require and oversee CME performance related to the following measures: a. Well child and well care adolescent visits b. Dental visits and c. Graduation rates." Question: With regard to comparing experience with regard to collaborating with external entities, 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.

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82064


Question:   Item 22 of section 3.4.8.4 of the Base document states " For each of the referenced measures below from Appendix I of the OhioRISE Plan Provider Agreement, describe the Applicant’s experience with similar measures, how the Applicant will collect and analyze member-level and aggregate data related to these measures, and the Applicant’s approach for using quality improvement strategies to address substandard performance. a. Table I.1 – OhioRISE Plan Performance Measure: Foster Care Placement Disruptions Due to Behavioral Health: Rate of children who had an unplanned change in foster care placement due to a behavioral health issue per 1,000 eligible beneficiaries for each quarter of the state fiscal year and annual aggregate. b. Table I.2 – Measures, which the OhioRISE Plan must report to MCOs and collaborate on improvement: Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics, Total." Question: With regard to comparing experience with regard to measures similar to Appendix I of the OhioRise Plan Provider Agreement, 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.

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82063


Question:   Item 22 of section 3.4.8.4 of the Base document states " For each of the referenced measures below from Appendix I of the OhioRISE Plan Provider Agreement, describe the Applicant’s experience with similar measures, how the Applicant will collect and analyze member-level and aggregate data related to these measures, and the Applicant’s approach for using quality improvement strategies to address substandard performance. a. Table I.1 – OhioRISE Plan Performance Measure: Foster Care Placement Disruptions Due to Behavioral Health: Rate of children who had an unplanned change in foster care placement due to a behavioral health issue per 1,000 eligible beneficiaries for each quarter of the state fiscal year and annual aggregate. b. Table I.2 – Measures, which the OhioRISE Plan must report to MCOs and collaborate on improvement: Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics, Total." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82062


Question:   Item21 of section 3.4.8.3 of the Base document asks to "Describe the Applicant’s approach for developing its community reinvestment plan, including the Applicant’s strategy for using community reinvestment funding to improve health outcomes of OhioRISE members in local communities." Question: In reviewing approaches to community reinvestment plans, will the Evaluation Committee reward incumbent applicants with established plans verse a non-Ohio applicant who will be applying/responding hypothetically?

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82061


Question:   Item21 of section 3.4.8.3 of the Base document asks to "Describe the Applicant’s approach for developing its community reinvestment plan, including the Applicant’s strategy for using community reinvestment funding to improve health outcomes of OhioRISE members in local communities." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82060


Question:   Item 20 of section 3.4.8.3 of the Base document asks to "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 how the Applicant has systemically addressed SDOH to improve the population health outcomes of its members who are similar to population in the OhioRISE Program. Please provide information in your example regarding the State or jurisdiction where the work was done, enrollment size and describe similarities in the covered population with the OhioRISE Program’s population. " Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82059


Question:   Item 20 of section 3.4.8.3 of the Base document asks to "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 how the Applicant has systemically addressed SDOH to improve the population health outcomes of its members who are similar to population in the OhioRISE Program. Please provide information in your example regarding the State or jurisdiction where the work was done, enrollment size and describe similarities in the covered population with the OhioRISE Program’s population. " 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 #82015.

Date: 11/16/2020

Inquiry: 82058


Question:   Item 19 of section 3.4.8.3 of the Base document asks to "Describe the Applicant’s approach to identifying the members in the OhioRISE Program who may be at higher risk for health disparities and the Applicant’s approach for achieving health equity for OhioRISE members." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82057


Question:   Item 18 of section 3.4.8.3 of the Base document asks to "Describe the Applicant’s resources and approach to developing and implementing a population health approach for high-risk children and youth with behavioral health conditions who will be enrolled in the OhioRISE Plan, including how the Applicant will work with ODM, the MCOs, and the SPBM to develop cross-cutting population health and quality improvement initiatives for this population, which include the following activities: a. The development and implementation of population health strategies b. The collection, analysis, and reporting of quality measures c. The identification and resolution of service system and clinical issues and d. The development and implementation of strategic initiatives and other quality improvement activities. Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82056


Question:   Item 17 of section 3.4.8.2 of the Base document states ," The Applicant receives a referral from the MCO of a three year old, multiracial girl, who was screened by her primary care provider (PCP) for behavioral health issues after being suspended from her pre-school program for uncontrollable tantrums and aggression toward other children and teachers. The PCP referred the child and her mother to an outpatient mental health therapist. The family lives in a rural part of the state with few behavioral health resources. The outpatient therapist has seen the mother and her daughter twice. The mother is young, age 19, single, and feels overwhelmed trying to cope with her child’s behavior. The therapist thinks the mother may be using drugs, but the therapist does not feel equipped to conduct a substance use screen. She also is concerned the child may need psychotropic medication. a. Describe how the Applicant would coordinate with the MCO, the PCP, providers, and other state or local agencies to ensure the mother and child receive appropriate early intervention services b. Describe how the Applicant will provide consultation to the MCO, PCP, and other providers that are involved in this child’s care and c. Describe the implications of this scenario for helping the MCO to meet population health goals related to child behavioral health and maternal and child health." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82055


Question:   Item 16 of section 3.4.8.2 of the Base document states, “The Applicant just received the enrollment of a 10-year old, white girl, who is also served by a local BDD. The member has been diagnosed with autism, anxiety, diabetes, and has uncontrollable tantrums and aggression toward other children and teachers. At the time of OhioRISE enrollment, the child is receiving Intensive Behavioral Support Services in an ICF/DD with the goal of discharging to home. Currently, the member has been prescribed several anti-psychotic and other psychotropic medications. Prior to her admission into the ICF/DD, the member was receiving Targeted Case Management (TCM) through the local BDD and receiving applied behavioral analysis through her MCO. Describe how the Applicant would coordinate with the member/family, local BDD, ICF/DD provider, TCM providers, and other state or local agencies to develop the discharge plan for this member and family." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82054


Question:   Item 15 of section 3.4.8.2 of the Base document states, "The OhioRISE Plan is notified of an admission to an out-of-state PRTF of a 14-year-old African American youth. The youth was not previously enrolled in the OhioRISE Plan and is now re-enrolled in OhioRISE due to the PRTF admission. The admission into the PRTF was court-ordered and recommended by the PCSA. The child was placed in foster care at age 10, after experiencing physical and emotional abuse from his stepfather and neglect on the part of his mother, who was living in extreme poverty in a neighborhood plagued by violence. The youth has a history of multiple placements in residential treatment centers and group homes, authorized and paid for by the PCSAs, where he has received various types of antipsychotic medications. When not in residential settings, the youth lives with his aunt in a kinship placement, after experiencing multiple foster care placements. His aunt is a recent immigrant and is non-English speaking. His aunt wants to keep him at home but is unable to manage his behavioral health challenges, which include extreme anger, aggressive behaviors, and possible substance use. She also worries about his influence over her younger 11-year-old son. The 14-year old has had some involvement with the juvenile justice system and has had repeated trouble at school, which he often skips. Describe how the Applicant would approach this situation, including ensuring that the PRTF order is clinically appropriate, coordinating with the child welfare system and the court, responding to the needs of the member and his family, and ongoing coordination and oversight of his care." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82053


Question:   Item 14 of section 3.4.8.2 of the Base document asks to " Describe the Applicant’s systemic approach to, experience with, and capacity to coordinate with key state and local child and youth-serving systems that the OhioRISE member population may be involved with, including: a. Coordination with the courts and correctional systems for court-involved youth and young adults (such as the Ohio Juvenile Courts and the Ohio Department of Youth Services (DYS), as well as the Ohio Department of Rehabilitation and Correction) b. Coordination with state and local child welfare agencies to support permanency goals and prevent placement disruption for children and youth with behavioral health challenges (such as the Ohio Department of Jobs and Family Services and local PCSAs) c. Coordination with state agencies (such as the Ohio Department of Youth Services) and local juvenile justice systems to support diversion or transition from detention for youth with behavioral health challenges d. Coordination with the state agencies (such as the Ohio Department of Developmental Disabilities and county Boards of Developmental Disabilities [BDD]) or similar county/regional entities to serve children and youth with intellectual and developmental disabilities and children and youth with autism with co-occurring behavioral health conditions e. Coordinating with the state agencies (such as the Ohio Office of Child and Family First and local Children and Family First Councils) that enhance services for children, youth, and families f. Coordination with early intervention systems for the 0–3 population (such as early intervention services provided by local BDD) g. Coordination with the Ohio Department of Education and local school systems h. Coordination with ODM specifically regarding the Ohio Home Care waiver i. Coordination with state, county, and regional agencies (such as the Ohio Department of Mental Health and Addiction Services, Alcohol, Drug Addiction and Mental Health Services Boards and local behavioral health providers) to serve youth with co-occurring mental health and SUD challenges and j. Coordination with in-state and out-of-state and local systems serving OhioRISE transition-age youth, aged 18–21 (such as behavioral health, vocational rehabilitation, housing, and employment services). " Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82052


Question:   Item 14 of section 3.4.8.2 of the Base document asks to " Describe the Applicant’s systemic approach to, experience with, and capacity to coordinate with key state and local child and youth-serving systems that the OhioRISE member population may be involved with, including: a. Coordination with the courts and correctional systems for court-involved youth and young adults (such as the Ohio Juvenile Courts and the Ohio Department of Youth Services (DYS), as well as the Ohio Department of Rehabilitation and Correction) b. Coordination with state and local child welfare agencies to support permanency goals and prevent placement disruption for children and youth with behavioral health challenges (such as the Ohio Department of Jobs and Family Services and local PCSAs) c. Coordination with state agencies (such as the Ohio Department of Youth Services) and local juvenile justice systems to support diversion or transition from detention for youth with behavioral health challenges d. Coordination with the state agencies (such as the Ohio Department of Developmental Disabilities and county Boards of Developmental Disabilities [BDD]) or similar county/regional entities to serve children and youth with intellectual and developmental disabilities and children and youth with autism with co-occurring behavioral health conditions e. Coordinating with the state agencies (such as the Ohio Office of Child and Family First and local Children and Family First Councils) that enhance services for children, youth, and families f. Coordination with early intervention systems for the 0–3 population (such as early intervention services provided by local BDD) g. Coordination with the Ohio Department of Education and local school systems h. Coordination with ODM specifically regarding the Ohio Home Care waiver i. Coordination with state, county, and regional agencies (such as the Ohio Department of Mental Health and Addiction Services, Alcohol, Drug Addiction and Mental Health Services Boards and local behavioral health providers) to serve youth with co-occurring mental health and SUD challenges and j. Coordination with in-state and out-of-state and local systems serving OhioRISE transition-age youth, aged 18–21 (such as behavioral health, vocational rehabilitation, housing, and employment services). " Question: With regard to comparing experience in applicants experience with, and capacity to coordinate with key state and local child and youth-serving systems, 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.

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82051


Question:   Item 13 of section 3.4.8.2 of the Base document asks to "Describe the Applicant’s programmatic experience with and approach to coordinating with an external pharmacy benefit manager to ensure appropriate oversight and use of medications, with particular attention to psychotropic medications for a member population similar to the population in the OhioRISE Program, including staffing and data management capacity to identify and address outlier psychotropic medication utilization among members." Question: With regard to comparing experience in applicants working with external PBMS, 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.

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82050


Question:   Item 13 of section 3.4.8.2 of the Base document asks to "Describe the Applicant’s programmatic experience with and approach to coordinating with an external pharmacy benefit manager to ensure appropriate oversight and use of medications, with particular attention to psychotropic medications for a member population similar to the population in the OhioRISE Program, including staffing and data management capacity to identify and address outlier psychotropic medication utilization among members." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82049


Question:   Item 12 of section 3.4.8.2 of the Base document asks to “Describe the Applicants experience and approach to working with ODM-contracted MCO care coordinators and care coordination entities (CCEs) to coordinate care for children and youth enrolled in the OhioRISE Program who have moderate, acute, or chronic physical health care needs in addition to behavioral health care needs. Please provide information in your response regarding the State or jurisdiction where the work was done, enrollment size and describe similarities in the covered population with the OhioRISE Program’s population. " Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82048


Question:   Item 12 of section 3.4.8.2 of the Base document asks to “Describe the Applicants experience and approach to working with ODM-contracted MCO care coordinators and care coordination entities (CCEs) to coordinate care for children and youth enrolled in the OhioRISE Program who have moderate, acute, or chronic physical health care needs in addition to behavioral health care needs. Please provide information in your response regarding the State or jurisdiction where the work was done, enrollment size and describe similarities in the covered population with the OhioRISE Program’s population. " Question: With regard to comparing experience in applicants outreach efforts to members, 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.

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82047


Question:   Item 11 of section 3.4.8.2 of the Base document asks to “Describe how the Applicant will conduct outreach and engage members and their families into the OhioRISE care coordination program. Include the Applicant’s internal capacity and community partnerships the Applicant will use to engage members and families. Provide examples of effective systemic outreach and engagement strategies from the Applicant’s experience with similar programs. Please provide information in your response regarding the State or jurisdiction where the work was done and describe similarities in the covered population with the OhioRISE Program’s population. In the response, specifically address the Applicant’s approach for: a. Members assigned to the Applicant’s care coordination staff b. Members assigned to CMEs for care coordination and c. Members and families that may be difficult to engage." Question: With regard to comparing experience in applicants outreach efforts to members, 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.

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82046


Question:   Item 10 of section 3.4.8.2 of the Base document asks to "Describe the Applicant’s experience with and approach to performing care coordination for members with low intensity care coordination needs, similar to the Tier 1 Limited Care Coordination requirements set forth in the OhioRISE Plan Provider Agreement, including Tier 1 staffing ratios and types of staff." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82045


Question:   Item 9 of section 3.4.8.2 of the Base document asks to "Describe the Applicant’s system-wide experience with and approach to developing, working with, and supporting specialized care coordination programs similar to CMEs, which provide care coordination for a member population similar to the OhioRISE population. Please provide information in your response regarding experience, the State or jurisdiction where the work was done, enrollment size and describe similarities in the covered population with the OhioRISE Program’s population. In addition, describe the Applicant’s staffing and data management capabilities to support the CMEs." Question: With regard to comparing experience in applicants supporting specialized care programs similar to CMEs, 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.

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82044


Question:   Item 9 of section 3.4.8.2 of the Base document asks to "Describe the Applicant’s system-wide experience with and approach to developing, working with, and supporting specialized care coordination programs similar to CMEs, which provide care coordination for a member population similar to the OhioRISE population. Please provide information in your response regarding experience, the State or jurisdiction where the work was done, enrollment size and describe similarities in the covered population with the OhioRISE Program’s population. In addition, describe the Applicant’s staffing and data management capabilities to support the CMEs." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82043


Question:   Item 8 of Section 3.4.8.2 of the Base Document asks to "Describe the Applicant’s experience with and approach to the development and implementation of a high performing care coordination program built on Systems of Care principles and a Wraparound Approach. Include in the description the Applicant’s experience with an approach to using a tiered care coordination model, which varies the intensity of care coordination to align with the strengths and needs of the members. Describe the tools that will be used to inform decisions regarding assignment of care coordination tiers." Question: With regard to comparing experience in applicants development and implementation of a high performing care coordination program, 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.

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82042


Question:   Item 8 of Section 3.4.8.2 of the Base Document asks to "Describe the Applicant’s experience with and approach to the development and implementation of a high performing care coordination program built on Systems of Care principles and a Wraparound Approach. Include in the description the Applicant’s experience with an approach to using a tiered care coordination model, which varies the intensity of care coordination to align with the strengths and needs of the members. Describe the tools that will be used to inform decisions regarding assignment of care coordination tiers." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82041


Question:   Item 7 of section 3.4.8.1 of the Base document asks to “Describe the Applicant’s current use and support of Electronic Health Records (EHRs) and Health Information Exchanges (HIEs) and strategies to expand Applicant, CME, and provider use of EHRs and HIEs. In your response, include how the Applicant will integrate EHRs and HIEs into administrative and clinical functions (e.g., care coordination, utilization management, and population health)." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82040


Question:   In item 5 of section 3.4.8.1 of the Base document, it asks to "Describe the following related to meeting program integrity requirements under the OhioRISE Plan Provider Agreement: a. The Applicant’s strategy and approach for meeting program integrity requirements b. The Applicant’s resources and how the Applicant will use them to support its program integrity efforts and c. The Applicant’s experience and outcomes from program integrity activities performed under other contracts with populations, services, providers, and FDRs similar to those in the OhioRISE Plan Provider Agreement." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82039


Question:   In item 4 of section 3.4.8.1 of the Base document, it asks to "Describe two system-wide examples the Applicant has successfully used in administering managed care programs similar to the OhioRISE Program and how the Applicant will implement innovations to benefit OhioRISE members and their families. Include both programmatic and financial strategies used to partner with providers in the description of these innovations. Please provide information in your response regarding the State or jurisdiction where the work was done and describe similarities in the covered population with the OhioRISE Program’s population. Include the implementation timeframe and anticipated impact on the OhioRISE Program." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82038


Question:   In item 3 of section 3.4.8.1 of the Base document, it asks to "Describe the Applicant’s claims payment and encounter submission experience and capabilities for similar programs and the methods the Applicant will use to ensure claims payment and encounter requirements in the OhioRISE Plan Provider Agreement will be met. In your response, include a description of how the Applicant will: a. Work with the Applicant’s providers regarding claims, payments, and related issue resolution, including integration with ODM’s Fiscal Intermediary and b. Adhere to federally qualified health centers/rural health clinics (FQHCs/RHCs) reimbursement requirements and accurate incorporation of associated encounters." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82037


Question:   Regarding item 2 of section 3.4.8.1 of the Base document, it states "Based upon the Applicant’s experience managing populations and services similar to those covered under the OhioRISE Program, provide examples of the Applicant’s accomplishments in achieving optimal outcomes for the population(s) and how they achieved those outcomes for its enrolled population(s). Describe how the Applicant will use its experience to achieve the program goals set forth in the OhioRISE Plan Provider Agreement." Question: The RFA inquiry specifically requests an applicant’s experience with managing populations similar to the OhioRISE Program. 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 #82015.

Date: 11/16/2020

Inquiry: 82036


Question:   Regarding item 1 of section 3.4.8.1 of the Base document, it states "1. Provide a list of the Applicant’s current Medicaid managed care contracts that includes the information listed below for each contract. If the Applicant does not have any current Medicaid managed care 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. Managed care type (full-service MCO, prepaid ambulatory health plan, prepaid inpatient health plan, other) d. Primary contractor or FDR and, if an FDR, name of primary contractor with the State e. 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) by age group – birth through age 20 and age 21 and over f. Covered services (medical, pharmacy, behavioral health, transportation, long-term services and supports, and services and supports provided through Intermediate Care Facility and Developmental Disabilities [ICF/DD] and home and community-based services waivers) g. Method of payment (risk-based and/or administrative services) h. Covered populations similar to those covered by the OhioRISE Program (e.g., Title IV-E Foster Care families and children Aged, Blind, and Disabled and Children’s Health Insurance Program) i. For populations in 1.h above, provide the length of time (in months) the populations are or were covered in the contract, and whether the contract required the Applicant to work with provider-based intensive care coordination entities similar to the role of CMEs envisioned for the OhioRISE Program. j. Covered populations and behavioral health services similar to those included in the OhioRISE Plan Provider Agreement for multi-system children and youth specifically including children and youth involved in the child welfare and criminal and juvenile justice systems as well as children and youth with developmental/intellectual disabilities, serious emotional disturbances, and substance use/opioid use disorders and k. List and roles of FDRs for the following functions: i. Care coordination ii. Marketing iii. Utilization management iv. Quality improvement v. Enrollment vi. Disenrollment vii. Claims administration viii. Provider network management and ix. Coordination of benefits" Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82035


Question:   Item 2 of section 3.4.8.1 of the Base Document states, "Based upon the Applicant’s experience managing populations and services similar to those covered under the OhioRISE Program, provide examples of the Applicant’s accomplishments in achieving optimal outcomes for the population(s) and how they achieved those outcomes for its enrolled population(s). Describe how the Applicant will use its experience to achieve the program goals set forth in the OhioRISE Plan Provider Agreement." Question: For this 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 #82015.

Date: 11/16/2020

Inquiry: 82034


Question:   Item 2 of section 3.4.8.1 of the Base document states, "Based upon the Applicant’s experience managing populations and services similar to those covered under the OhioRISE Program, provide examples of the Applicant’s accomplishments in achieving optimal outcomes for the population(s) and how they achieved those outcomes for its enrolled population(s). Describe how the Applicant will use its experience to achieve the program goals set forth in the OhioRISE Plan Provider Agreement." Question: With regard to comparing experience in managing populations similar to the OhioRISE Program and success in same, 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.

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82033


Question:   Item 7 of section 3.4.8.1 of the Base document states, "Describe the Applicant’s current use and support of Electronic Health Records (EHRs) and Health Information Exchanges (HIEs) and strategies to expand Applicant, CME, and provider use of EHRs and HIEs. In your response, include how the Applicant will integrate EHRs and HIEs into administrative and clinical functions (e.g., care coordination, utilization management, and population health)." 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 applicants with experience in Ohio verse an applicant with no presence, or network, in Ohio? Applicants with Ohio experience 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 #82015.

Date: 11/16/2020

Inquiry: 82032


Question:   Section 3.4.8.5 item 27 states, "Describe the Applicant’s experience with and approach (including methodology, timeline, and use of selective contracting) to developing and managing a qualified provider network that meets the requirements of the OhioRISE Plan Provider Agreement. Include a narrative describing the approach the Applicant will use to support network providers to deliver new and enhanced services offered by the OhioRISE Plan, the staffing and information that the Applicant will use to identify and address potential challenges, including network gaps. Please provide information in your response regarding the State or jurisdiction where the work was done and describe similarities in the covered services between the referenced experience and the covered services for the OhioRISE Program’s population." 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 #82015.

Date: 11/16/2020

Inquiry: 82031


Question:   Regarding item 3 of section 2.12 of the Base document, it 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." 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: 11/16/2020

Inquiry: 82030


Question:   Regarding section 4.3 of the base document, it states "All Applications that meet Phase I: Review of 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 and Experience 160 Care Coordination and Collaboration 335 Population Health 140 Quality 185 Benefits and Service Delivery 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 · Experience and · Capability." 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 #82015.

Date: 11/16/2020

Inquiry: 82029


Question:   Regarding section 4.3 of the base document, it states "All Applications that meet Phase I: Review of 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 and Experience 160 Care Coordination and Collaboration 335 Population Health 140 Quality 185 Benefits and Service Delivery 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 · Experience and · Capability." 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 #82015.

Date: 11/16/2020

Inquiry: 82028


Question:   Section 4.5 of the Base document states, "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: Will each application be scored based on individual responses or in its entirety, or will the responses to questions be directly compared across applicants?

Answer:   See response to inquiry #82015.

Date: 11/16/2020

Inquiry: 82027


Question:   Section 4.5 of the Base document states, "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 #82015.

Date: 11/16/2020

Inquiry: 82026


Question:   Regarding section 4.3 of the base document, it states "All Applications that meet Phase I: Review of 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 and Experience 160 Care Coordination and Collaboration 335 Population Health 140 Quality 185 Benefits and Service Delivery 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 · Experience and · Capability." Question: The RFA states that for each of the four categories being evaluated (Qualifications & Experience Care Coordination and Collaboration Population Health Quality Benefits and Service Delivery), 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, Experience and Capability.” 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 #82015.

Date: 11/16/2020

Inquiry: 82025


Question:   Regarding section 4.3 of the base document, it states "All Applications that meet Phase I: Review of 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 and Experience 160 Care Coordination and Collaboration 335 Population Health 140 Quality 185 Benefits and Service Delivery 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 · Experience and · Capability." Question: The RFA states that a total of 185 points are available for “quality” but does not indicate specifically how those points will be awarded. How will the 185 points for “quality” 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 #82015.

Date: 11/16/2020

Inquiry: 82024


Question:   Regarding section 4.3 of the base document, it states "All Applications that meet Phase I: Review of 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 and Experience 160 Care Coordination and Collaboration 335 Population Health 140 Quality 185 Benefits and Service Delivery 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 · Experience and · Capability." Question: The RFA states that a total of 140 points are available for “population health” but does not indicate specifically how those points will be awarded. How will the 140 points for “population health” 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 #82015.

Date: 11/16/2020

Inquiry: 82023


Question:   Regarding section 4.3 of the base document, it states "All Applications that meet Phase I: Review of 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 and Experience 160 Care Coordination and Collaboration 335 Population Health 140 Quality 185 Benefits and Service Delivery 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 · Experience and · Capability." Question: The RFA states that a total of 335 points are available for “care coordination and collaboration” but does not indicate specifically how those points will be awarded. How will the 335 points for “care coordination and collaboration” 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 #82015.

Date: 11/16/2020

Inquiry: 82022


Question:   Regarding section 4.3 of the base document, it states "All Applications that meet Phase I: Review of 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 and Experience 160 Care Coordination and Collaboration 335 Population Health 140 Quality 185 Benefits and Service Delivery 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 · Experience and · Capability." Question: The RFA states that a total of 180 points are available for “benefits and service delivery” but does not indicate specifically how those points will be awarded. How will the 180 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 #82015.

Date: 11/16/2020

Inquiry: 82021


Question:   Regarding section 4.3 of the base document, it states "All Applications that meet Phase I: Review of 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 and Experience 160 Care Coordination and Collaboration 335 Population Health 140 Quality 185 Benefits and Service Delivery 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 · Experience and · Capability." Question: The RFA states that a total of 160 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 160 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 #82015.

Date: 11/16/2020

Inquiry: 82020


Question:   Regarding section 4.3 of the base document, it states "All Applications that meet Phase I: Review of 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 and Experience 160 Care Coordination and Collaboration 335 Population Health 140 Quality 185 Benefits and Service Delivery 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 · Experience and · Capability." 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 #82015.

Date: 11/16/2020

Inquiry: 82019


Question:   Regarding section 4.3 of the base document, it states "All Applications that meet Phase I: Review of 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 and Experience 160 Care Coordination and Collaboration 335 Population Health 140 Quality 185 Benefits and Service Delivery 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 · Experience and · Capability." 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 #82015.

Date: 11/16/2020

Inquiry: 82018


Question:   Regarding section 4.3 of the base document, it states "All Applications that meet Phase I: Review of 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." 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 #82015.

Date: 11/16/2020

Inquiry: 82017


Question:   In Section 4.1 of the Base document on page 32, it states "Applicants should not assume the individuals involved in the evaluation process are familiar with any current or past work activities with ODM." 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:   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: 11/16/2020

Inquiry: 82015


Question:   Attachment A, Appendix F, 4.b.i.1 Child and Adolescent Needs and Strengths Providers, page 180: Appendix states that "The OhioRISE Plan will not be responsible for completing the initial CANS assessment for initial OhioRISE Plan eligibility." Please provide further clarity regarding who the responsible entities will be for completing the initial CANS assessment and determining initial eligibility.

Answer:   Designated providers will conduct CANS assessments for the purpose of eligibility determinations.

Date: 11/16/2020

Inquiry: 82006


Question:   Will the list of attendees (or attendee organizations) of the Pre-Application Conference be made available to the public? And if so, where will it be accessible?

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: 11/16/2020

Inquiry: 82002


Question:   RFA Section 4.2, Phase I: Review of Mandatory Qualifications #6, page 33: With regard to the Mandatory Qualification requiring the Applicant and OhioRISE plan to be licensed by the Ohio Department of Insurance (ODI) as a Health Insuring Corporation (HIC), would an existing certificate of authority under Ohio Revised Code Chapter 3911.01 Life, Accident & Annuities be sufficient in lieu of being licensed by ODI as a HIC? If not, will ODM amend the RFA to allow submission of an HIC application after contract award? This may encourage otherwise qualified applicants to consider submitting a proposal without expending the administrative time and expense of submitting an HIC application for a license which may not be necessary for the applicant to maintain absent the contract award.

Answer:   A certificate of authority in life, accident & annuities under ORC 3911.01 is not sufficient in lieu of HIC licensure. If an applicant is not licensed by the Ohio Department of Insurance (ODI) as a HIC, an applicant must have an application pending with ODI pursuant to Section 4.2 of the RFA.

Date: 11/16/2020

Inquiry: 82000


Question:   Attachment A, Section N/A, page N/A: Does ODM intend to designate Family and Youth Peer Support as billable Medicaid services?

Answer:   Substance use disorder peer recovery support is a covered benefit per OAC 5160-27-02. ODM is considering various strategies for incorporating additional Family and Youth Peer Supports in the OhioRISE program.

Date: 11/16/2020

Inquiry: 81988


Question:   Attachment I, 4. 5160-59-02 OhioRISE: Eligibility And Enrollment, page 9: 2 questions related to subsection (A): 1. Can the State confirm that eligibility determined by two different scenarios? a. Scenario 1: child meets criteria (A)(1) through (A)(4) b. Scenario 2: child meets criteria (A)(1) through (A)(3), and also meets one criteria from (B)(1) through (B)(3) 2. Does the CANS referenced in criterion (A)(4) drive eligibility? Does the CANS translate to voluntary enrollment (since enrollment through Scenario 1 is mandatory)? Are the providers conducting the CANS assessments?

Answer:   1. Yes, eligibility is determined by the two scenarios outlined in the question. 2. To receive the services covered by OhioRISE, enrollment in the OhioRISE plan is mandatory for members who meet paragraph (A) or (B) of draft OAC 5160-59-02. The CANS assessment is one component required when determining eligibility according to paragraph (A) of draft OAC 5160-59-02. Members who meet paragraph (B) of draft OAC 5160-59-02 will not require a CANS assessment at the time of eligibility determination. Yes, designated providers will conduct CANS assessments for the purpose of eligibility determinations.

Date: 11/16/2020

Inquiry: 81983


Question:   Appendix A (General Requirements 2.a), page 36: How will members will be enrolled in the OhioRISE Plan? Can ODM provide an estimate, by month, of how many members will be eligible for enrollment in the first year of the program? Will members be identified as eligible in advance of the OhioRISE Plan’s go-live?

Answer:   Individuals will be enrolled upon determination of eligibility pursuant to OAC 5160-59-02. ODM anticipates a gradual enrollment with additional members being added monthly. ODM estimates an approximate enrollment of 50,000 - 60,000 individuals by the end of year one.

Date: 11/16/2020

Inquiry: 81982


Question:   Appendix A (General Requirements 1.f.ii), page 33: Do clinical staff (UM and care coordination staff) located in Ohio need to also be licensed in the state of Ohio?

Answer:   License requirements are detailed in paragraph 8 of Appendix A. Utilization managment and care coordination staff requiring a license must be licensed in Ohio.

Date: 11/16/2020

Inquiry: 81981


Question:   Appendix A (General Requirements 1.f.i), page 33: Regarding the Applicant’s administrative office, how large of a private on-site space does ODM require to perform onsite reviews, audits, and other administrative oversight activities?

Answer:   On-site space must be sufficient for ODM to perform on-site reviews, audits, or other oversight activities. The space may be dependent on the review team and could be an office or a conference room for ODM use while on site.

Date: 11/16/2020

Inquiry: 81980


Question:   Appendix N (Table N.1), page 256: No information is provided regarding financial sanctions. Will ODM be providing financial sanctions by item during the RFA process, or will these items be discussed/negotiated further during contract negotiations with the selected Applicant?

Answer:   The financial sanction amounts will not be provided during the RFA process. As stated in the RFA, the financial sanction amounts are "to be determined." These amounts will not be negotiated. Note, however, that ODM will take into consideration the number of enrollees of the OhioRISE plan in determining the financial sanction amounts.

Date: 11/16/2020

Inquiry: 81979


Question:   Section 3.2.2, page 16: Can Applicants opt to submit the required electronic version of the proposal as an email attachment rather than a shipped CD or flash drive?

Answer:   Email attachments are not permitted. Also see response 81973.

Date: 11/16/2020

Inquiry: 81975


Question:   Section 3.1, page 16: If Applicants are permitted to email their proposals, should the emails be sent to ODM_Procurement@medicaid.ohio.gov? Are there file size limitations for this email address?

Answer:   ODM does not accept email submissions. See response to 81973.

Date: 11/16/2020

Inquiry: 81974


Question:   Section 3.1, page 16: The OhioRISE RFA specifies that Applicants must submit five paper copies of their Application. Because of the COVID-19 pandemic, such a production is considered hazardous per state and federal instructions. Therefore, can Applicants submit responses electronically by email without paper copies?

Answer:   Electronic submissions are not permitted. Applicants should implement social distancing and infection control procedures when paper copies are created and thereafter submitted. Please allow adequate time for dropping off materials because social distancing procedures will be in place.

Date: 11/16/2020

Inquiry: 81973


Question:   Appendix B (1.a.i.15), page 98: Is there a list of ODM-approved goods and services that can be provided with flexible funding?

Answer:   ODM has not yet finalized guidance related to customized goods and services.

Date: 11/16/2020

Inquiry: 81978


Question:   Appendix B (1.a.i.14), page 98: Which drugs for the treatment of mental health and substance use disorders must be reviewed/approved by the OhioRISE Plan?

Answer:   ODM has not yet finalized the list of physician-administered drugs for the treatment of mental health and substance use disorders that will be covered by the OhioRISE plan.

Date: 11/16/2020

Inquiry: 81977


Question:   Section 3.4.7, page 19: In lieu of providing a D&B rating and credit report, can Applicant’s submit audited financial statements, 10-K and quarterly 10-Q financial statements, and/or credit ratings from other reporting agencies such as AM Best, Standard & Poor’s, Moody’s, etc.?

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

Date: 11/16/2020

Inquiry: 81976


Question:   Section 2.1, page 9: Due to the alarming spike in COVID-19 cases across the U.S, would ODM be amendable to extending the submission deadline?

Answer:   ODM will not be extending the deadline at this time.

Date: 11/16/2020

Inquiry: 81972


Question:   Section 3, 3.4.8 Responses to Application Questions, page 19: The RFA states that each application question must begin on a new page please confirm that this means each main question (numbered) and not individual sub-questions (lettered).

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: 11/16/2020

Inquiry: 81971


Question:   RFA Section 3.4.8.1 Qualifications and Experience (Tab 8), Page 20-21: In light of the level of detail requested in the contracts list and the number of questions in Tab 8, can the list of the Applicant’s current Medicaid managed care contracts requested in item 1 be excluded from the 30 page limit?

Answer:   See response to 81965. The page limit for RFA Section 3.4.8.1. Qualifications and Experience (Tab 8) is increased from 30 to 40 pages. The response to the first question in this section (3.4.8.1.1.a. through 3.4.8.1.1.k.) will not be counted toward the page limit for this tab.

Date: 11/16/2020

Inquiry: 81966


Question:   RFA Section 3.4.8 Responses to Application Questions (Tab 7), page 19: Given the page limits assigned per topic area/ tab, would ODM consider removing the direction to start each question on a new page?

Answer:   ODM is not revising the requirement that the response to each question start on a new page. However, while ODM took these requirements into account in determining the page limits, ODM will increase the page limits for each section as follows: The page limit for RFA Section 3.4.8.1. Qualifications and Experience (Tab 8) is increased from 30 to 40 pages. The response to the first question in this section (3.4.8.1.1.a. through 3.4.8.1.1.k.) will not be counted toward the page limit for this tab. The page limit for RFA Section 3.4.8.2, Care Coordination and Collaboration (Tab 9) is increased from 70 pages to 80 pages. The page limit for RFA section 3.4.8.3, Population Health Delivery (Tab 10) is increased from 25 pages to 35 pages. The page limit for RFA section 3.4.8.4, Quality (Tab 11) is increased from 40 to 50 pages. The page limit for RFA section 3.4.8.5, Benefits and Service Delivery (Tab 12) is increased from 35 to 45 pages. Please note, 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.

Date: 11/16/2020

Inquiry: 81965


Question:   Section 1, 1.2 Background, page 5: Text near the bottom of this page states: “A Network of Regionally Located CMEs that will serve as the locus of accountability for children and youth with complex challenges and their families who are involved in navigating multiple state systems. The OhioRISE Plan will select CMEs with demonstrated expertise providing ICC using High-Fidelity Wraparound and with sufficient capacity to serve OhioRISE Plan members.” Please provide clarity around the “selection” of the CMEs will the Plan be responsible for identifying the CMEs or will ODM identify the potential CMEs for selection?

Answer:   Appendix D.1.d requires submission of a care coordination program description for ODM review and approval. The program description requirements include the process the successful Applicant will use to select and contract with CMEs. Additional CME policy and provider criteria will be developed by ODM with stakeholder input.

Date: 11/16/2020

Inquiry: 81960


Question:   Section 3, 3.4.8.5 Benefits and Service Delivery, page 29: Question 27 includes the following language: “Describe the Applicant’s experience with and approach (including methodology, timeline, and use of selective contracting) to developing and managing a qualified provider network that meets the requirements of the OhioRISE Plan Provider Agreement. Include a narrative describing the approach the Applicant will use to support network providers to deliver new and enhanced services offered by the OhioRISE Plan, the staffing and information that the Applicant will use to identify and address potential challenges, including network gaps. Please provide information in your response regarding the State or jurisdiction where the work was done and describe similarities in the covered services between the referenced experience and the covered services for the OhioRISE Program’s population.” Questions: 1) Please provide clarity regarding the definition of selective contracting and enhanced services. Is selective contracting specific to PRTFs, as mentioned in Appendix F? 2) Are there specific criteria by which ODM expects Applicants to make selective contracting decisions? Or are those criteria to be determined by the selected OhioRISE Plan? 3) Does the phrase "enhanced services" refer to any specific services beyond meeting the network requirements outlined in Attachment A and related appendices? 4) Is ODM looking for the OhioRISE Plan to propose and develop new services not already identified as covered services in the RFA or is ODM looking for the Plan to propose and provide enhancements to existing covered services as defined in the RFA?

Answer:   Response to 1) ODM anticipates that the OhioRISE Plan will develop a selective contracting approach initially for PRTFs and Intensive and Moderate Care Coordination provided by Care Management Entities. ODM may identify other services that may be subject to selective contracting through the period of time covered by the Agreement. Response to 2) The OhioRISE Plan will be responsible for ensuring that the network of providers of services that already exist in the state plan and the new services listed in the provider agreement is sufficient to handle the demand for services as well as ensuring high quality providers are trained and ready. Policy and provider criteria will be developed by ODM with stakeholder input. Response to 3) The OhioRISE plan will be responsible for the services identified in Attachment A, Appendix B.1.a, which include new services and existing Medicaid covered services that ODM may enhance over the next year. Response to 4) At this time, ODM is not requiring the OhioRISE Plan to propose any additional services beyond what is in the Provider Agreement in Attachment A, B.1.a., unless those additional services would be considered value-added as described in Attachment A, Appendix B.3. ODM may develop new services during the period of time covered by the Agreement as set forth in Attachment A, B.1.a. i. 16.

Date: 11/16/2020

Inquiry: 81959


Question:   Section 2, 2.8 Submission of Application, page 12. The State requests what we use a delivery company capable of hand-delivering our Application directly to ODMs security desk and obtaining a time/date stamp. Two questions, please: 1) Can the State confirm that FedEx or UPS (with delivery signature required) is an acceptable form of hand delivery? 2) Can the State confirm that FedEx or UPS delivers directly to the security desk?

Answer:   1. Private delivery companies such as FedEx or UPS are acceptable forms of hand delivery. Applicants are strongly encouraged to use a delivery company capable of obtaining a date and time stamp. Regardless of hand delivery or delivery by a private delivery company, Applications must be received by ODM by the date and time specified in Section 2.1, Anticipated RFA Schedule. 2.The security desk has received deliveries from FedEx and UPS.

Date: 11/6/2020

Inquiry: 81949


Question:   Section 3, 3.4.8.2 Care Coordination and Collaboration, page 24. Please clarify Question 12. It requests that we provide our experience and approach to working with ODM-contracted MCO care coordinators and CCEs, and then, later in the same requirement, we are asked to provide information regarding the State or jurisdiction where the work was done. Please confirm that, if the Applicant will be a new Plan in the state, information only on the Applicants experience and approach with similar staff/entities in other states is sufficient for this response.

Answer:   If an Applicant does not have experience working with ODM-contracted MCO care coordinators and CCEs, the Applicant must share information regarding the Applicant's experience and approach in other states or jurisdictions.

Date: 11/6/2020

Inquiry: 81948


Question:   Section 4, 4.4 Phase III: Oral Presentations, page 34. The first paragraph of this section states “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…” As a new Plan in Ohio, key staff will not be hired until the contract is awarded will the State permit the participation in oral presentations of current leaders in similar roles who would be involved in the program from a national support perspective, in lieu of key staff?”

Answer:   Yes, oral presentation participants may include current staff who are involved in the program from a national perspective. All participants must be employees; consultants may not participate in the oral presentation.

Date: 11/6/2020

Inquiry: 81947


Question:   Section 3, 3.4.8.1 Qualifications and Experience, page 22. Question 6 requires the submission of flowcharts. Please confirm that the flowcharts requested in this requirement can be provided on 11" x 17" paper, if needed.

Answer:   In response to Question 6 in RFA Section 3.4.8.1 (Qualifications and Experience), Applicants may use 11" x 17" paper for the required flowcharts.

Date: 11/5/2020

Inquiry: 81946


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Inquiry period ended:  11/21/2020 8:00:00 AM