Questions and Answers
Ohio Medicaid Consumer Hotline
Document #: JFSR1213078018
Question: Section. 1.2 Background 1.2, p. 2, states the current contract includes health needs assessments. Does this RFP include a Health Needs Assessment or other type of screening surveys? Appendix B references medical and additional assistance screening questions for new enrollees and those changing MCPs. If so, provide detailed requirements. Section 4.4.A.2 The hours of operation are listed as 7am to 8pm, Monday thru Friday and Saturday from 8am to 5pm. The Managed Care Enrollment Center website lists hours as 8am to 8pm, Monday through Friday. Does this RFP expand the current hours of operation for the Enrollment Center hotline? Section 4.4.C Is the contractor responsible for processing re-enrollments? If so, provide details. Section 4.4.C.3 The RFP indicates that managed care enrollment choices will include consideration of scheduled surgeries, treatments, or pregnancies. Is this information obtained from the caller and/or Appendix A Just Cause Exception File? Section 4.4.C.3 Confirm that open enrollment is enrollee-specific based on the date in Appendix A Just Cause Exception File (Open Selection Month) and that OH does not use a single annual time period for Open Enrollment, such as the month of May. Section 4.4.C.4 a. Does the reference to 3.1.C.3 in the 3rd bullet actually refer to section 4.4.C? b. The Enrollment website offers the option for a face-to-face outreach session for enrollment assistance. Does this RFP include that requirement? Section 4.4.C.6 Does the call volume provided in Appendix M include the outbound reminder calls to avoid auto assignment? If not, what is the average monthly outbound call volume? Section 4.4.E Does the vendor use Appendix B to provide all consumer contact data to MITS? Section 4.4.E, 4th bullet.Confirm that these requirements refer to Appendix H. Section 4.4.I.3 a. Does Appendix S provide the number of members to whom a payment invoice must be mailed each month? b. Provide a copy of the invoice template Section 4.4.I.5 a. Provide a copy of the premium non-payment letter b. Provide the average monthly volume of premium non-payment letters that are mailed. Section 4.4.I.7 a. Are there required formats for submitting the required information to ODJFS, including but not limited to refunds? b. If so, provide those details. Section 4.4.L a. Provide a list of each mailing required to be mailed by the vendor, such as EMP, payment invoice, non-payment notice and enrollment reminder/confirmation letter b. Provide a list of each hotline and MCEC-related mailings that is mailed by ODJSF, MITS or other state entity, such as the notice of mandatory selection and enrollment notice (initial and open enrollment. Section 4.4.L.2 a. Confirm that vendor must mail partially completed applications to callers. b. Provide the average monthly volume. Appendix C a. What is the pathway code? b. Item E – what are the ODJFS-determined parameters? Are they included on the AUF file? If not, how are they provided to the contractor? c. Item G references section 2.5.5 (A) (1) of the RFP. That section does not appear to exist. Provide details or alternate location within the RFP. c. Item H references section 2.5.5 (B) (5) of the RFP. That section does not appear to exist. Provide details or alternate location within the RFP. Appendix E MCP Enrollment File – references auto disenrollments and re-enrollments. Are these processed by the contractor or the state? Appendix H Is the premium file from CRISE used to determine which members require payment invoices, non-payment letters and refunds? Appendix N Explain the reason for the significant increase in Premium Invoice mailings in May 2011. Appendix M Explain the reason that call volumes increased in January, February and March 2010. Appendix O Provide the average number of exception/exemption requests processed on a monthly basis.
Answer: Due to field size capacity, the answers to this inquiry can be viewed in the addenda/amendment section as addenda/amendment #2.
Question: Section 4.5 on page 28 indicates that the compensation structure is limited to two fees, yet the cost proposal provides spaces to propose different fees for each year of the contract. Please clarify whether a different price may be proposed for each year or if the fee proposed for phase two must remain the same for the remaining duration of the contract.
Answer: For phase 2 work, the vendor may, at their option, propose different reimbursement rates for each renewal period of the contract, in consideration of possible increases to the vendors’ costs of doing business. The cost proposal form requires that vendors identify in their proposals now what their rates would be for the work for the initial and for all future renewal contracts for the years indicated on the form.
Question: Trade secrets and confidential information must be provided to ODJFS in order to fully respond to its solicitation, and protecting this information from public disclosure is critical to bidders’ success and even survival in this competitive market. The Department is certainly aware that while there are limited companies that provide the services to be included under the Department’s Ohio Medicaid Consumer Hotline contract, competition for these contracts is fierce. Bid contests and requests for proposals are relatively infrequent, and contracts often last for five years or more, intensifying the competition between companies in the field. Although the government bidding process and public contracting necessarily involve a degree of transparency, bidders could not sustain success without preserving their confidentiality of the proprietary and trade secret information. Considering these concerns, would the Department please allow bidders to submit a complete redacted copy of our technical and cost proposals on the bid open date? If so, would the Department please advise bidders on the number of copies and format(s) (i.e., electronic vs. hardcopy) for the submission of redacted proposals?
Answer: No, ODJFS will not accept a redacted copy. Vendors must submit proposals that are free of any proprietary and trade secret information.
Question: Appendix J provides the fees for the state-owned lockbox. The price list indicates they are 2004 prices. Are these the current prices? Please indicate if the lockbox fees in Appendix J are retail or wholesale, and identify the number of premiums collected and processed that is used to make the decision about retail or wholesale.
Answer: The Treasurer of State’s office negotiates the lockbox fees with the bank. Appendix J has been updated in the amendment dated 11/10/2011.
Question: Appendix L and Appendix M. The monthly call volume for the Hotline as expressed in Appendix L is approximately 47,000 calls per month. The information on call volume for the Hotline in Appendix M represents the average monthly volume over the same period to be about 35,000 calls per month. Can the Department please provide guidance on how to reconcile these two substantially different volumes?
Answer: Appendix M is the total number of unduplicated calls received per month. Appendix L is the total calls by type code or subject. Appendix L contains duplicates because a call can have more than one subject.
Question: Section 4.4. Deliverable I, 9, p. 25. What is the typical monthly volume of non-postable payments?
Answer: There is usually only one or two non-postables per month. Most are resolved within 30 days and do not require a refund.
Question: Section 4.4. Deliverable I, 2, p. 24. What is the typical monthly delinquency experience with the current program?
Answer: On average 6% of MBIWD premium cases are delinquent each month.
Question: Section 4.4. Deliverable I, 2. What is the monthly volume of checks returned for insufficient funds?
Answer: There have been 41 returned checks since the program’s inception in April 2008.
Question: P.178, Appendix N. Mail Fulfillment Volumes. Premium invoice volume for May 2011 is listed as 15,041. This is drastically different from all other months. Is there a reason for such high volume of premium invoices during this period?
Answer: This figure should be 1,501.
Question: P.178, Appendix N. Mail Fulfillment Volumes. Premium invoice volume for May 2011 is listed as 15,041. This is drastically different from all other months. Is there a reason for such high volume of premium invoices during this period?
Answer: This figure should be 1,501.
Question: P. 180, Appendix O: Exemption procedures. The Vendor is required to send a letter approving an exemption request. Is the vendor responsible for development + printing of this mailing? Please provide average monthly volume for this type of mailing. P. 31, Section 4.4. Deliverable J. Please confirm that the Vendor is responsible for sending an Exception notification letter. Please provide average monthly volume for this type of mailing? Will ODJFS provide a template of this form? P. 31, Section 4.4. Deliverable K. Please confirm that the Vendor is responsible for sending out a Just Cause notification letter. Will ODJFS provide a template of this form? Please provide average monthly volume for this type of mailing.
Answer: P. 180, Appendix O: Exemption procedures and P. 31, Section 4.4. Deliverable J. - The vendor is responsible for development + printing of this mailing. A sample of the approval and denial exemption letters will be attached to Appendix O. Reference to Appendix O will be placed in 4.4.J.1. and 3. There was a monthly average of approximately 175 exception letters mailed. P. 31, Section 4.4. Deliverable K. - The vendor is responsible for development + printing of this mailing. A sample of the Transition of Membership and Just Cause ABD and CFC letters will be attached to Appendix P. Reference to Appendix P will be placed in 4.4.K.3. There was a monthly average of approximately 30 Transition of Membership and Just Cause letters mailed.
Question: P.41, Section VI, 6.1.C. “The grand total of each technically qualified vendor’s Cost Proposal is divided by that vendor’s final Technical Proposal score. This compares the cost with the quality of the Technical Proposal, which will provide an average cost-per-quality point earned on the Technical Proposal.” (Pg. 41) - According to this clause, receiving a higher score on the technical proposal seem to adversely affect the bidder’s average cost-per-quality point, because higher vendor’s final technical proposal score, greater the denominator will be, and therefore, it will lower the average cost-per-quality. Clarification on this issue will be appreciated.
Answer: The lower the cost-per-quality point, the GREATER the chance of being awarded the contract. This cost-per-quality point method has been used by the state in complex competitive projects for many years to consider vendors’ proposed costs and their quality (as measured through the score criteria) relative to each other. The minimum technical score is set to identify those vendors would be capable of successfully completing the work. Of those vendors that earn at least the minimum acceptable quality score (specified in each RFP), ODJFS seeks the one offering the best value. The lowest priced vendor is not necessarily the ‘winner’ and the highest priced vendor is not necessarily eliminated. One vendor’s low score could potentially be adequately off-set by a very low price; similarly another vendor’s high price could be mitigated by earning a very high technical score.
Question: P.31, Section 4.4.L Mail Fulfillment. Item 2. Assisting Callers. It appears that the vendor needs a capacuty to send applications that are prefilled by CSRs with basic demographic information. Which specific applications would this include? Would there be alternative applications that can be prefilled and printed as well as the application forms provided by ODJFS, or will we need the capacity to prefill the actual application forms? Section 4.4.L Mail Fulfillment. Item 3. Which form types will be provided by ODJFS, and which would be produced by the vendor? This paragraph requires vendors to print cover letters. However, it appears that the vendor would also be responsible for printing individualized information on various letters and invoices, as well as prefilling basic demographic information. Please advise.
Answer: 1. Vendors are required to create an electronic version of Medicaid applications (approved by ODJFS), which at the caller’s request, can be populated with the consumer’s demographic information (names of household members, address, telephone number) and mailed to the consumer. 2. The vendor is responsible for printing individualized application cover letters, premium invoices, and managed care reminder letters informing consumers the MCP chosen for them if they fail to voluntarily select an MCP The Medicaid applications are JFS7200, Request for Cash, Food, and Medical Assistance, JFS2399, Request for Medicaid Home and Community-Based Services (HCBS), JFS7216 Combined Programs Application, JFS7103, Application for Help with Medicare Expenses, and JFS 7211 Medicaid Buy-In for Workers with Disabilities Addendum. Currently, only the 7216 is pre-populated.
Question: Appendix M, Call Volume. Please provide average talk time and average total call handle time for the most recent available month for both the Hotline and the Enrollment Broker components.
Answer: The Hotline’s average length of call for the month of September 2011 was 4 minutes, 23 seconds. The managed care enrollment center’s average length of call for the month of September 2011 was 5 minutes, 10 seconds.
Question: Appendix M, Call Volume. In order for bidders to ensure staffing that meets the States expectations, please provide peak hours and call volumes for those peak hours for each day of the week (Monday through Saturday).
Answer: MCEC CALLS BY HOUR March 2010-February 2011 Eastern Time 8-9 am 9-10 am 10-11 am 11-12 am 12-1 pm 1-2 pm 2-3 pm 3-4 pm 4-5 pm 5-6 pm 6-7 pm 7-8 pm Annual Total Calls 693,628 33529 54338 95957 102893 95956 89021 75148 61283 40465 26594 12720 5724 Cumulative Percent 5% 8% 14% 15% 14% 13% 10% 8% 6% 4% 2% 1% HOTLINE CALLS BY HOUR – SEPTEMBER 2011 Eastern Time 7-8 am 8-9 am 9-10 am 10-11 am 11-12 am 12-1 pm 1-2 pm 2-3 pm 3-4 pm 4-5 pm 5-6 pm 6-7 pm 7-8 pm Monthly Total 42,231 506 2299 3775 1056 1105 4747 4897 4990 4703 3541 1709 1085 555 Cumulative Percent 1% 5% 9% 11% 11% 11% 12% 12% 11% 8% 4% 3% 1%
Question: RFP Section 4.4.E.1, page 19. Please provide examples of the typical CRIS-E and MITS screens that staff access to address customer questions and complete customer requests. If it is easier for the State to provide all bidders with access to the current training materials or other documents that show these screens, that would be extremely helpful.
Answer: As indicated in 1.3, the vendor is responsible in developing training for vendor staff. The State will offer technical assistance with those vendor staff who will conduct the training. Due to the confidential nature of information and the complexity of CRIS-E and MITS, system training will occur once the contract is awarded. Vendor staff will then be granted access to those screens necessary to perform work related activities. Once this access is granted, vendor staff will then be able to view applicable screens and the specific function of those screens. Train-the-trainer sessions will commence during the transition period beginning on April 1, 2012 and continue as necessary until the contract is fully implemented on October 1, 2012.
Question: Please indicate which years, or if all years, will be included in the evaluation of the cost proposal.
Answer: All years will be included in the consideration of the cost proposals and for the selection of the vendor.
Question: P.25. Deliverable E: IT System. Item 7. Please clarify how the data in the provider directory facilitates the vendor’s requirement to assist consumers in identifying providers that address consumers’ specific health care needs. P. 30. Deliverable J. Managed Care Enrollment Exception Requests. • Should the full array of choice counseling services be provided to those who fall into the "voluntary" category (they may enroll in managed care but are not required to)? • In educating them about their options, does the State have a preference for how the choice of whether to enroll in a MHP should be handled?
Answer: 1. The primary reason consumers select a particular MCP is because the MCP’s provider panel contains the providers the consumer uses. The provider directory referred to in this section is an electronic file that will assist the vendor in developing a comprehensive fee-for-service (FFS) and managed care database to not only assist consumers enrolling in an MCP, but also assist consumers on regular FFS Medicaid in finding a provider that accepts Medicaid. 2. • If the consumer is confident of their desire to not enroll because of a managed care exemption, it is not necessary to provide the full array of choice counseling services. • Creativity is not only acceptable, but encouraged. The State must approve any presentations about options prior to implementation.
Question: P.29. Deliverable I. Premium and Co-Payment Collection. The proposal must demonstrate that the physical location of the call center will be in the Columbus metropolitan area. • Is it possible for any functionality, specifically lockbox management and premium processing, to be performed outside the Call Center facility in Columbus? P.20, Deliverable A.5 Call Center Operations. A.5 indicates it is acceptable to roll over excess call volume to another call center. • Would ODJFS consider remote based CSRs that are located in Ohio? • Are CSRs located outside Ohio permitted for call overflow? P.20, Deliverable B. Telephone System.Item 1. Can the Department provide an estimate of the number of calls each month that would require a "warm transfer" to MCP services, ODJFS, local CDJFS, or other outside offices? P. 20, Deliverable B. Telephone System. Item 2. This paragraph indicates that the vendor cannot use an interactive voice response system, however, some of the bulleted items listed in the section for the message system (provides information about the website, provides information about the enrollment process, etc.) are functions that are frequently performed by an IVR. • Could ODJFS clarify whether an IVR is allowable to perform the functions listed in this section instead of the automated messaging system? • If use of an IVR can achieve cost savings while preserving consumer satisfaction, will more robust use of an IVR be permitted? Can an IVR be used outside of business hours? P. 21 Deliverable B. Telephone System. Item 7. Are calls routed to a call back queue counted as an abandoned call? P. 21 Deliverable C. Managed Care Enrollment Services. Item 1. • Please identify all of the notices and informational or instructional materials that the vendor is expected to produce. P. 21. Deliverable C. Managed Care Enrollment Services. Item 2. • We understand from C.2 that the State sends information to consumers when they must make enrollment decisions (upon becoming newly eligible and during open enrollment). Please provide additional information about what is sent or provide samples of the material that is sent. Item 3. • For telephone enrollments that we conduct, is the vendor responsible for sending any type of written confirmation of the enrollment and the health plan/PCP choices as well as a consumers right to switch during the first 90 days? Item 5. For mail-based enrollments, is the vendor responsible for sending any type of written confirmation of the enrollment and the health plan/PCP choices as well as a consumers’ right to switch during the first 90 days? Will the vendor have any input into the content of the enrollment forms and notices? P. 20-22. Deliverable C. Managed Care Enrollment Services. 1) What are the vendor responsibilities to perform health plan changes, PCP changes, and disenrollments outside of the 90 day initial period? 2)Please clarify what reminder letters are produced by ODJFS and which are the responsibility of the vendor? 3)How do we verify the status of consumers who are eligible for managed care exceptions? 4)If a consumer moves from a mandatory to a non-mandatory category, how does the consumer know this and how is the vendor notified? In this situation, what are the vendors’ responsibilities? P. 22 Deliverable C. Managed Care Enrollment Services. 4. Enrollment through the Hotline Website. Would it be acceptable to confirm selection with a message that appears on the screen at the time of the transaction? This would be in lieu of an e-mail or phone call. P. 23 Deliverable D. Alternative Inquiries. • Can ODJFS provide monthly volume information on inquiries and correspondence from alternative sources, such as, instant messaging, e-mail, web portal, Contact Tracking Management System (MITS), and written correspondence? Item 2. What are the timeframes for responding to inquiries?
Answer: 1. Premium collection activities do not necessarily have to be performed at the call center location. 2. Approximately 200 per month. 3. Vendors are permitted to use an IVR however, all interactions with consumers is to be done by a customer service representative not an automated system. 4. No. 5. Enrollment by Mail Packet (4.4.C.5.) – Cover letter, information to assist in health care needs (refer to C.3.last bullet), CCR form, return envelope. Reminder letter (4.4.C.7.). Exception Request Letters (4.4.J. and Appendix O) – One letter approving an exception request or one letter not able to verify the request. Just Cause Letters (4.4.K and Appendix P) - An ABD and CFC letter not meeting criteria for a just cause. 6. P. 21. Deliverable C. Managed Care Enrollment Services. Item 2. – Visit the website at http://jfs.ohio.gov/ohp/bmhc/index.stm to view samples of ODJFS generated notices. Item 3. – No. Confirmation is sent by the MCPs in the form of new member packets. Item 5. - No. Confirmation is sent by the MCPs in the form of new member packets. 7. Input from the vendor regarding enrollment forms and notices would be very much appreciated. P. 20-22. Deliverable C. Managed Care Enrollment Services. 1) Changes are only done during the initial 90 days, during open enrollment and for just cause and exemption approvals (refer to 4.4.J. and K.). 2) The only managed care reminder letter produced is referenced in 4.4.C.7. The production of this letter is the responsibility of the vendor. 3) This is explained in more detail in Appendix O. Generally, SSI and Medicare are verified on the state’s CRIS-E and MITS system by the vendor; children in custody (CIC), Title IV-E foster care and adoption assistance are sent by children service agencies (no further verification needed); and Children with Medical Handicaps are verified through the Ohio Department of Health by the vendor. 4) The vendor is responsible for notification of the exemption (non-mandatory category) if the exemption was verified by the vendor. Refer to 4.4.J. and Appendix O. Otherwise, it is the responsibility of the State to notify the consumer. 8. Yes. 9. The approximate volume of alternative inquiries is 100 per month. Currently, inquiries are forwarded from ODJFS via email. The original inquiry may be a phone call, email, or letter. The vendor must respond to the inquiry by phone, email, or letter and communicate the response back to ODJFS via email within five business days unless otherwise noted. Currently, there is no instant messaging or web chat.
Question: P.46, Section 8.8 MBE. Will ODJFS accept WBE-certified firm as part of the MBE requirement for a subcontractor?
Answer: There is no requirement that vendors responding to this RFP either be an MBE or subcontract with one. However, ODJFS always encourages MBEs to participate as prime or sub-contractors. In Ohio, Women-owned Business Enterprises are not Ohio-certified as MBEs (though qualification for EDGE certification could be a possibility).
Question: 1.3, p. 4 of 47 What is the average length of calls for each of the hotline and enrollment broker? 2.1, p. 6 of 47 What does the three asterisks (***) refer to? 2.3, p. 11 of 47 If all other requirements are meant for the Project Manager, would ODJFS consider a non-bachelor’s degree as acceptable? 4.4, Deliverable A, p. 15 of 47 What languages are required for interpretive services and written information? 4.4, Deliverable C.4, p. 17 of 47 That percent of selection confirmation is from an email response vs a phone call? 4.4, Deliverable C. 5, p. 18 of 47 Please confirm that EMPs to potential enrollees must be done within 24 hours of requests to the hotline? 4.4, Deliverable D.1, p. 19 of 47 What is the nature of these inquiries? 4.4, Deliverable E.5, p. 20 of 47 Is the cross-referencing with case information or CRIS-E or the MITS recipient subsystem done through a manual look-up or real-time interface? 4.4, Deliverable G.3. p. 22 of 47 Are penalties assessed for the first 2 failures? 4.4, Deliverable L.1, p. 27 of 47 What is the purpose of the “applications?” 4.4, Deliverable M.1, p. 28 of 47 What is the function of the”consumer and provider forum registration?” 4.5, p. 29 of 47 How are significant changes related to Medicaid expansion under the Affordable Care Act handled with respect to “no additional fees or costs of any sort will be paid under this contract?” 6.1.C, p. 36 of 47 Please confirm that the grand total is the dollar amount of the Cost Proposal divided by the Technical Proposal score. 8.6.B p. 41 of 47 Where in the proposal should bidders reflect the annotated model contract. Attachment A, Article IV.D Please indicate how this requirement relates to performance issues.
Answer: 1. The Hotline’s average length of call is 4 minutes, 16 seconds. The managed care enrollment center’s average length of call is 5 minutes, 45 seconds. 2. This has been corrected. Please view amendments dates 11/10/2011. 3. A bachelor’s degree for the project manager is not one of the mandatory vendor qualifications. The project manager’s education will be scored according to the scale on the Technical Score sheet. 4. The vendor must be able to assist callers regardless of the language spoken. Currently, printed information is not translated. 5. All enrollments through the web is immediately followed up by an e-mail confirmation. Phone calls are only made if the confirmation comes back undeliverable and the frequency is negligible. 6. The EMPs must be sent within 24 hours of the request, but the intent of this time frame is one business day so a request made on Friday may be sent on Monday. 7. The inquires are very similar to the type of questions received through the call center, i.e., the application process, application status, general Medicaid information, explanation of Medicaid Spend-down, etc. 8. The case information in CRIS-E and MITS is real-time. 9. Yes 10. Applications for Medicaid programs, JFS 7200 Request for Cash, Food, and Medical Assistance (English, Spanish, and Somali), JFS 7103 Application for Help with Medicare Expenses (English and Spanish), and JFS 7216 Combined Programs Application (English and Spanish). 11. ODJFS occasionally hosts forums for which individuals must register for dates and times. 12. The effect of the Affordable Care Act on Ohio Medicaid and this contract have not been determined. 13. This question is unclear as there are both grand totals of the technical score and of the cost proposal. As stated in Section 6.1, C, a vendor’s grand total from the cost proposal form is divided by the vendor’s technical proposal score. 14. The model contract is provided for reference only to indicate the general composition of the contract for the project. As stated in Section 8.6, vendors should review it, but should not return it with their proposals UNLESS they would request changes to certain items or language in the contract. If so, the annotated contract should be included in the vendor’s proposal, Tab 1. All requested changes are subject to ODJFS approval. 15. Attachment A is required as it carries information that is required to identify the vendor and to determine the vendor’s compliance with certain requirements in order to be eligible to be awarded a state government contract (e.g., compliance with certain Governor’s Executive Orders, no debarment issues, etc.).
Question: P.32 of the RFP states the following: "The information above is a summary of the duties and responsibilities that would be contractually required of the selected vendor. In order to receive consideration for contract award, all aspects of the requirements described in this section must be addressed in Tab 2 of the vendors technical proposal." The requirement is to respond to the SOW in Tab 2 however, Tab 3 is actually called Scope of Work and Specifications of Deliverables. Please advise which Tab vendors should be using for this requirement.
Answer: This citation will be corrected.
Question: Section 4.4 Deliverable I, page 25, Co-Payments. Will the Department entertain contract amendments if it puts a co-payment program in place? Should vendors incorporate pricing for this unknown into their base price?
Answer: Please Amendment #1 dated 11/10/2011 for changes to this deliverable. Also, ODJFS only considers increasing a contractor's compensation as a result of increased work volume or additional work responsibilities. Any such changes must be handled through a formal contract amendment, including Controlling Board approval when necessary.
Question: Appendix P Provide the average number of transition of membership and just cause requests are processed on a monthly basis. Appendix R and T a. Appear to be the same document. Confirm or explain the difference. b. How does the vendor use the data in these Appendices?
Answer: 1. Approximately 100 per month. 2. Appendix T will be removed.
Question: 4.4 Specifications of Deliverables, Deliverable A: Call Center Operations, Item 3 Would a financial penalty apply for days during which the call center may not be operational due to a facility-related emergency, such as a building fire? 4.4 Specifications of Deliverables, Deliverable D: Alternative Inquiries, Item 1 The requirements for alternative sources of inquiries and correspondence mention instant messaging and web chat. Are there established avenues for these types of interface through the State’s systems, or will the contractor have to establish such avenues as part of this contract?
Answer: 1. Deliverable B.,6, states, the vendor must present a detailed summary or outline of their disaster recovery plan that demonstrates how calls will be handled in the event of a disaster, power outage, phone line problem, computer virus, staff shortage, etc. ODJFS will specific call center closures on a case-by-case basis. 2. The contractor is responsible for developing instant messaging and web chat.
Question: P.29, Section 4.4 Deliverable I.Premium and Co-Payment Collection. 1. How many new cases each month that must pay a premium for the Medicaid for the Working Disabled? 2. Does the daily enrollment file from CRIS-E include some type of marker that identifies which members are required to pay a premium? If so, what is the marker/code used? 3. Are enrollments processed regardless of the status of the premium payment?
Answer: 1. The number of new premium cases fluctuates each month. Some cases are terminated, new cares are added, and others are reinstated. The net increase is generally between 10 and 50. 2. Appendix H. Premium File Layouts, is the file layouts to and from CRISE for premiums. It only contains Medicaid Buy-In for Workers with Disabilities (MBIWD) cases that owe a premium. 3. MBIWD cases are fee-for-service and are not eligible to be enrolled in a managed care plan. The vendor is to continue billing and sending invoices regardless of the payment status until a termination is receive in the daily premium file.
Question: 4.4.E.1, page 19: Will the ODJFS train Contractor staff on CRIS-E, MITS, Medicare Buy-In System, and any other systems ODJFS deems necessary for operation of the Hotline? If yes, please indicate the duration of the training and the maximum number of staff that ODJFS can accommodate in each class for each system. If no, will the ODJFS provide the materials for the Contractor to train its own staff?
Answer: ODJFS will provide train-the-trainer sessions for ODJFS systems during the transition period. Specifics about the duration of training, number of employees, time, or location will be determined when the training is scheduled. ODJFS will provide any training materials that the agency has available. The contractor is responsible for developing its own training program to train the employees throughout the contract.
Question: Deliverable K, page 31: Can the ODJFS department support SFTP (FTP over SSH) for secure data transfer? Is the ODJFS hosting this environment, or is this a service requirement that the vendor needs to provide?
Answer: Yes, ODJFS supports and currently uses SFTP for this contract.
Question: Deliverable E, page 23: Can the ODJFS provide information about the software package suite, including software version, which vendors must be compliant with?
Answer: MicroSoft Office, Groupwise and SFTP at this point.
Question: Section 4.4 Deliverable I, page 24, states that “The addition of such programs may increase the number of premiums to be collected significantly.” Can the Department give some guidance on how big an increase this would be and when it would happen? Would the Department allow a contract amendment to accommodate this and other such unknowns?
Answer: There is no planned expansion of premium programs at this time. If ODJFS develops or expands premium programs, ODJFS may negotiate an amendment to the contract.
Question: Section 4.4 Deliverable E.4, page 20. What is the format that the contractor must use to transmit the daily file of consumer contact data to MITS? The format in Appendix B does not appear to have an appropriate spot for this kind of data. Is the required data described in 4.4.E.5?
Answer: Refer to Appendix E referenced in Section 4.4 Deliverable E.4, 5th bullet on page 20 for enrollment data to MITS. Section 4.4 Deliverable E.4, 6th bullet on page 20 reflects consumer contact data to MITS which is the same data that is submitted to the MCPs and follows the consumer contact record file format (Appendix B).
Question: Section 4.4 Deliverable E.1, page 19. What types of access will be available to the vendor for communication with ODJFS’s mainframe system? Will they be nightly batch jobs, real-time service calls, look-up only, edit? Please provide this information for each of the systems listed. • CRIS-E • MITS • Medicare Buy-In • Any other systems ODJFS deems necessary If communications currently occur through interfaces, please provide the layouts and description of fields. Is the reference to the Medicare Buy-In system a typo that should read Medicaid Buy-in program?
Answer: • CRISE – Real-time read only access, interfaces are nightly batches for the premium indicator file layout from the Hotline to CRISE and nightly batches for the premium file layout from CRISE to Hotline (Deliverable I. Premium and Co-payment Collection and Appendix H. Premium File Layouts). • MITS – Real-time access with managed care subsystem update capability, read only for all other subsystem access. Daily interfaces for consumer eligibility file (Appendix D. Hotline MCP Eligibility and Demographics) to the Hotline from MITS, managed care plan enrollment data (Appendix E. Hotline MCP Enrollment to MITS) from the Hotline to MITS, and consumer contact record data from the Hotline to MITS (Appendix B. Managed Care CCR Format). • Medicare Buy-In – Real-time read only access to Medicare Premium Assistance Program information. It is not a typo for Medicaid Buy-In. Once the contract is awarded, the vendor will work with the Office of Information Services to establish interfaces and any access issues. • MCP brochures and directories: Provider directories average 8.5” x 11”. Packets average 4.5 lbs. The number of provider directories and solicitation brochures directly reflect the number of MCPs within a given region for each program (ABD vs. CFC). There are generally three MCPs per region, but can go as little as two MCPs. Each packet would contain a minimum of two provider directories, but no more than three provider directories. The MCPs are responsible for printing and shipping to the vendor. The vendor is responsible for assembly and mailing costs. • CCR form: The CCR form can be viewed on the MCEC website (available in the Program Resource Library (section 2.4 of the RFP). http://ohiomcec.com. The vendor is responsible for design, printing and mailing costs.
Question: Section 4.4 Deliverable C.6, page 18. This requirement speaks to ODJFS-generated notice of mandatory enrollment and reminder letters. This appears to be in conflict with the requirement under 4.4.C.7 that says the Hotline mails the reminder letter to the consumer. Are these the same letter? Are there other ODJFS notices that will be mailed by ODJFS that will have the return address of the Hotline/Enrollment center that the vendor must process? If yes, what is the volume and nature of these?
Answer: The mandatory enrollment notices are generated and mailed by ODJFS. The reminder notices are generated and mailed by the Hotline. There are open enrollment notices generated and mailed by ODJFS to all existing assistance groups enrolled in managed care. These notices do not have the Hotline’s return address listed. Undelivered open enrollment notices are returned to the county departments of job and family services. Visit the website at http://jfs.ohio.gov/ohp/bmhc/index.stm to view samples of ODJFS generated notices.
Question: Section 4.4 Deliverable C.5, page 18. Can the Department please provide information about the following items that are to be included in the Enrollment by Mail Packet? Will the Department please confirm who is responsible for printing and who is responsible for mailing costs associated with these? • Medicaid consumer guides: Please provide a sample copy and/or the weight and size of the brochure. Please confirm the Department is responsible for printing the brochure and that the vendor is responsible for the costs of putting it into the packet and mailing it. • MCP brochures and directories: Please provide the weight, dimensions, and number of brochures and directories put in each packet for each region. Please confirm that MCPs are responsible for printing brochures and directories and shipping those to the vendor’s fulfillment facility, and that the vendor is responsible for assembly and mailing costs. • CCR form: Please provide a copy of this form and confirm the vendor is responsible for printing and mailing costs.
Answer: The consumer guide is 5.5” x 8.5” pamphlet. The ABD guide is 10 pages and the CFC guide in 8 pages. ODJFS is responsible for printing the consumer guide and the Hotline is responsible for including it in the enrollment by mail packets.
Question: Section 4.4 Deliverable C.5, page 18. The requirement states that the vendor “must provide EMPs to potential enrollees within 24 hours of the request.” Please confirm that the vendor must mail the EMP no later than 24 hours or one business day after the request. Please confirm that requests made on Friday can be fulfilled by mailing on Monday.
Answer: The EMPs must be sent within 24 hours of the request, but the intent of this time frame is one business day so a request made on Friday may be sent on Monday.
Question: Section 4.4 Deliverable C.3, page 17. The last bullet in this section describes a variety of things that counselors must assist enrollees with, including special care needs, scheduled surgeries, treatments, and pregnancies. Does the Department have a current list of required questions that the vendor is required to ask of each member? If yes, will the Department please provide that list?
Answer: Section 4.4 Deliverable C.3, page 17 is the current list of required questions. More details regarding the possible information contained in these questions can be found in pages 16, 17, and 18 of the Consumer Contact (CCR) file format (Appendix B).
Question: Appendix B, pages 16-21 contains a number of categories of information that must be passed to the MCO. Will the Department please elaborate on the following: 1. Items related to screening: screenstatus medscrnresult othmedscrn nonmedscrnresult ssot svtrt srvtrtdatesrvtrtdoc. Is the vendor required to provide these to the MCO? If yes, is it on all members or just on a subset identified by CRIS-E that a screening is needed? If it is not required on all members, can the Department provide information of the number of cases where this typically takes place? Does this information need to be collected on new enrollments as well as transfers? 2. Items related to other medical insurance: opolicyiname opolicyinum. Is this information provided through the MMIS system to the vendor? Is this information the vendor is required to collect from the members? 3. Items related to emergency contact erclastname ercfirstname ercrship erchacode erchphone ercbacod ercbphone. Is the vendor required to collect this information on all members in managed care? 4. Provider directory request. Are all provider directories provided by the MCPs? Is the vendor required to send some directories?
Answer: 1. As indicated in the Consumer Contact (CCR) file format (Appendix B), this information is conditional upon either an initial voluntary enrollment or a voluntary enrollment change. This means the information can only be obtained from the consumer. The number of screenings directly corresponds to the voluntary enrollment/enrollment change rate which is available by accessing http://jfs.ohio.gov/ohp/bmhc/index.stm. This information along with other reports is available in the Program Resource Library in section 2.4 of the RFP. 2 and 3. As indicated in the Consumer Contact (CCR) file format, medical insurance and emergency contact information is optional and is only available from consumers who request to enroll or change their MCP. 4. MCPs are required to send provider directories. The Hotline is only required to send provider directories for enrollment by mail requests.
Question: Section 3.1.G-H, page 10, and Section 3.3.A.5, page 11. The combination of these three requirements means that a vendor or partnership of vendors must have a qualified manager already in their employment for a year who can relocate to the Columbus area. This combination of requirements significantly disadvantages vendors who don’t already have significant health-related call centers in Columbus. Will the Department consider eliminating or modifying the requirement that the manager currently be the vendor’s employee?
Answer: It is important to have an onsite project manager and equally important that this manager is familiar with the vendors operations. It is not necessary for the project manager to initially be located in the Columbus metropolitan area, but it is required that they permanently relocate once the contract is fully implemented on October 1, 2012.
Question: Section 4.4 Deliverable J.2, page 26. How many PCSAs should the vendor expect to receive electronic lists from for enrolling, disenrolling, or preventing MCP enrollment? Will these lists all use the same format?
Answer: This number will greatly vary. There was an average of 400 per month over the last 6 months. There is a standard Excel spreadsheet that is used, but because there are 88 counties in Ohio, requests can vary such as e-mails and phone calls.
Question: Section 4.4 Deliverable E.10, page 21. Are workers with disabilities the only group of people in Medicaid buy-in that is subject to premiums?
Answer: The Medicaid Buy-In for Workers with Disabilities (MBIWD) program is currently the only Medicaid program that requires some consumers pay a premium.
Question: Section 4.4 Deliverable E.5, page 20. Is the vendor expected to look separately at the CRIS-E or MITS systems for the cross-reference information? Can that information be contained in the vendor system based on a regular update schedule?
Answer: The vendor may look at CRISE or MITS for real time data to cross-reference a caller’s identity, name, case number or social security number, address, and phone number. However, the vendor may be required to look at either or both systems to address a caller’s issue appropriately.
Question: Section 4.4 Deliverable D.2, page 19. What are the timeframes required for responding to alternative sources of inquiry?
Answer: Legislative inquiries, questions from consumers to their legislator, governor, or ODJFS Director must be responded to within five working days unless otherwise instructed by ODJFS. Web chat and instant messaging are not a part of the current contract but should be a part of the vendor proposals.
Question: Section 4.4 Deliverable E.2, page 20, and Appendix C. What are the logic steps and data sources in the assignment approach used on the AUF that vendors will be required to duplicate in the event an assignment is not listed on the AUF? What is the frequency of such occurrences?
Answer: This is called discretionary assignments. ODJFS provides a list to the Hotline of all MCPs currently able to receive an assignment within the applicable region and county. ODJFS develops this list based on MCP membership thresholds and MCP provider panel capacities. The Hotline then assigns consumers to MCPs permitted to accept discretionary assignments in a round robin manner.
Question: Section 4.4 Deliverable D.1, page 19. How will messaging be received from the Medicaid Information Technology system and what are the typical types of inquires from this source?
Answer: Currently, ODJFS forwards inquiries by email and all follow up by the vendor is made by email. Inquires are about the application process, application status, general Medicaid information, explanation of Medicaid Spend-down, etc.
Question: Section 4.4 Deliverable C.6, page 18. What happens to members who are not able to receive a notice because their mail has been returned? Do they remain in fee-for-service? What other responsibilities does the vendor have toward members whose mail is undeliverable?
Answer: As delineated in Section 4.4 Deliverable C.6, page 18, the vendor must attempt to obtain a current address either, by phone call if possible or by researching CRIS-E or MITS. If the vendor is successful, the noticed is re-mailed. If the vendor in unsuccessful, the consumer remains on regular Medicaid (fee-for-service).
Question: Section 4.4 Deliverable C.6, page 18. What is the current rate of undeliverable mail for notices of mandatory enrollment and reminder letters?
Answer: Approximately 800 per month.
Question: Section 4.4 Deliverable C.4, third bullet, page 17. Please provide clarification on the reference to Section 3.1.C.3. Section 3.1.C of the RFP does not appear to correspond to this requirement there is no Section 3.1.C.3.
Answer: This should reference 4.4.C.3.
Question: Section 4.4 Deliverable A.9, page 15. Must the vendor access the CRIS-E system directly or can it use information within its own system that comes from CRIS-E?
Answer: The vendor must access CRIS-E directly.
Question: Section 4.2, page 14. What is the current proportion of calls to the Hotline from Medicaid providers, prospective providers, and county departments of job and family services? What is the current average talk time and wrap-up time associated with those calls?
Answer: On average, the Hotline currently receives 3,400 per month from providers. Vendors can offer solutions to mitigate this issue by, for example, establishing a provider queue that directs providers to the Provider Services call center. Calls from caseworkers and county departments of job and family services are negligible.
Question: Deliverable E. Information Technology System, page 23. Can the ODJFS provide additional information regarding the CRIS-E system? Is this a web interface system, thin client Citrix platform, or mainframe system?
Answer: CRIS-E is a mainframe system.
Question: Would a center located within a 30 mile radius of downtown Columbus be considered?
Answer: A 30 mile radius of downtown Columbus is outside the Columbus metropolitan area and would not be considered as a realistic location for the Hotline call center.
Question: Attachment D, Cost Proposal Form, appears to missing from the RFP. Please confirm.
Answer: Attachments C and D have been added to RFP posting.
Question: Attachment C Technical Proposal Score Sheet, and Attachment D Cost Proposal Form: These documents were not included in the RFP. Will the State please post them to the website? Bidders will appreciate having these files in Excel rather than PDF, in order to facilitate completing these forms.
Answer: Attachments C and D have been added to RFP posting.
Question: Attachments C and D (Evaluation Criteria and Cost Form) seem to be missing from the RFP. Please advise.
Answer: The cost proposal form and score sheet with be added to the PDF by October 14, 2011.
Question: Attachment A, Section II, Location of Business Form and Attachment A, Section III, Declaration Regarding Material Assistance: These forms were not included in the RFP. Will the State please post them on the website?
Answer: The missing pages of Attachment A, Location of Business Form and Declaration Regarding Material Assistance, have been added to the RFP posting.
Question: Please send the RFP
Answer: The RFP can be found at the following link: http://procure.ohio.gov/PDF/1052011115517DAS8018.pdf
Question: Is this a similar RFP that was posted earlier?
Answer: Yes, but the due date of November 24, 2011 (Thanksgiving Day)was revised to Monday, November 28, 2011 by 3:00 P.M.
Question: Will the State be open on November 24, the bid deadline, which is also Thanksgiving Day, to receive proposal packages? Will the State please list any other days around Thanksgiving that it will be closed?
Answer: Due to an administrative error, the due date of November 24, 2011 (Thanksgiving Day) has been changed to 3:00 P.M. Monday, November 28, 2011. The PDF file has been updated listing the revised date throughout the RFP.
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