DETROIT WAYNE MENTAL HEALTH AUTHORITY REQUEST FOR PROPOSALS FOR MANAGERS OF COMPREHENSIVE PROVIDER NETWORK (MCPN) CONTROL # ADDENDUM NO.

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1 DETROIT WAYNE MENTAL HEALTH AUTHORITY REQUEST FOR PROPOSALS FOR MANAGERS OF COMPREHENSIVE PROVIDER NETWORK (MCPN) CONTROL # ADDENDUM NO. 3 ADDENDUM ISSUE DATE: Tuesday, July 22, 2014 This Addendum is being issued prior to the acceptance of Proposals to allow for the following changes, additions, clarifications, and/or answers to questions: MODIFICATIONS AND ADDITIONS: 1) ADD the REVISED CONTRACT TEMPLATE which will be posted on MITN as a separate attachment. QUESTIONS AND ANSWERS: 1. In the previous draft work plan and other communications provided by the Authority, it appeared that substance use disorder prevention services were to be managed through the Managed Care Provider Networks. The new RFP does not specifically discuss the coordination and management of substance use disorder prevention services. Will the Managed Care Provider Networks be responsible for coordinating and managing these services? If they are not responsible for this service, who will be responsible for managing substance use disorder prevention services? See Addendum #2, response to Question Current substance abuse treatment and prevention contracts are through September 30, It appears that the Managed Care Provider Networks will possibly have contract start dates until January 1, Will current substance abuse treatment and prevention contracts be extended through December 30, 2014 or will there be a gap in services? See Addendum #2, response to Question For organization wanting to transition from subcontractor to MCPN: 1. Do they need to stop providing subcontracted services or accepting new subcontracted services until the award Page 1 of 10

2 notification is released? 2. If the organization was awarded a MCPN contract, when would they need to cease all services as a subcontractor? 1. No. 2. On January 1, CONTRACT AWARD, page 4, Item 8 states: All proposals must be for a firm fixed price unless modified. Historically and currently, the MCPN contract price has been on the basis of a not to exceed amount. What is the intent of the Authority with respect to requiring a fixed price? In other words, how is a fixed price to be set by the Proposer without knowledge of the enrollees that will be assigned to the successful Proposer and the pmpm that is assigned to the enrollees? These are general RFP Instructions. For the MCPN RFP, the contracts will continue to be estimated and the amounts are not fixed price and are subject to active enrollment. 5. Section 3, page 13, Board of Director Requirements: If the Proposer is applying to be a I/DD MCPN only, is the Proposer required to add to its board membership a primary or secondary consumer with co-occurring I/DD and SUD? See Addendum #2, responses to Questions 3, 5 and Section 3, page 14, Board of Director Requirements, Item # 6 requires the Proposer to publicly post including website notification, and update no less than annually Certified independent financial audits and 990 forms. If the Proposer post on its website the 990 forms and the Independent Auditor s Report with the Statements of : Financial Position; Activities; Cash Flows and Functional Expenses by Program, do the Notes to Financial Statements also have to be posted on the Proposer s website? Yes. The notes to the financial statements are an integral part of the reporting and must be included on the website. 7. Section 3, page 18, Contract Management of Providers: Is the Proposer required to contract with any and all of the Authority s empanelled providers? Or, will the Proposer be free to select which empanelled providers it will contract with once awarded the MCPN contract? See Addendum #2, responses to Questions 81, 82 and What is the date for the last addendum to be issued? There is no set date for the last addendum to be issued. Please continue to check the MITN website. 9. Page 4, #8: The RFP states that All proposals must be for a firm fixed price unless modified. The basis for establishing a fixed price is unclear. Will the current Milliman funding methodology be utilized? Refer to response to Question #4 in this Addendum. 10. Page 6, #22: What is the basis for Proposer to determine Authority FTEs required? Page 2 of 10

3 See Addendum #2, response to Question Page 8, #1 Paragraph 2: Clarification is needed regarding the phrase Covered active beneficiaries by each MCPN with a minimum of 3,000 dependent on number of selected MCPNs and population served. See Addendum #2, response to Question Page 8, #1, The Important Note states Proposers can either bid on DD, MI-SUD, or both. Will DD MCPNs be required to have SUD capability? Yes, see also See Addendum #2, response to Questions 3 and Page 10, #1 What specific activities will be included in the privileging of the panel of Providers? See Addendum #2, Questions 81, 82 and Page 10, #5 What administrative services are going to be funded by the MCPN administrative rates? Is it 4% of services or revenue received? What will the admin percentage be applied to? What benchmarks were used to establish the admin rates? The administrative rate is applied against earned revenues (net of deferred revenue). Please review OMB A-87. Also, refer to Addendum 1, response to Question #3 and Addendum #2, responses to Questions 1, 3, 11 and Page 11 Risk Mgmt. Why are there no upside risk or pay for performance opportunities? Refer to Addendum #2, responses to Question 22 and Page 12, #3D If there are no upside or pay for performance opportunities, how can a Proposer earn a rate of return on the requirement to have $3.5M in unrestricted net assets or fund a line of credit? The unrestricted reserve is the asset of the MCPN and the Authority encourages MCPNs to retain funds in an interest bearing account. Also, refer to Addendum #2, response to Question # Page 14, B #3 What specific activities will be required of the Authority s Centralized Access Center contract and what specific activities will be the responsibility of the MCPNs? See Addendum #2, responses to Questions 1 and Page 14, B #3 How will the Access Center facilitate service on demand for SUD consumers? See Addendum #2, responses to Questions 1 and Page 14, B #3 Will SUD consumers without an MI or DD diagnosis be assigned to an MCPN? Yes, also see Addendum #2, Question Page 15, C UM/QM What will be the MCPN s role in terms of UM and QM? There is currently a very robust UM and QM program in place at the MCPNs. Will this be required in the future? Page 3 of 10

4 While DWMHA will not delegate its UM/QM responsibilities as per the AFP, MCPNs must manage their provider contracts in accordance with DWMHA QAPIP and other indicators. Hence, it is expected that MCPNs will maintain UM and QM activities. 21. Page 15, C UM/QM Will the MCPNs retain the right and responsibility to authorize type, scope and duration of services as they emanate from the IPOS? The majority of the creations of the IPOS-related activities typically occur between the consumer/supports and the case manager/supports coordinator or service provider. Proposers are to describe processes by which service planning, authorization, and start of on-going services, as well utilization management, will occur in a timely and efficient manner, assuring consumers rights are preserved. 22. Page 16, Sec. D, #1B MCPNs are not providers of service. How will they be able to be empanelled by Medicare? MCPNs may choose to provide case management/supports coordination. Whether the proposer is purely administrative or not, MCPNs must ensure that DWMHA is the payer of last resort, and that providers are fully empanelled with private payers. 23. Page 16, Sec. D, #1B How will MCPNs get information regarding private payer rules? That information is usually proprietary. The Authority assumes that the MCPNs shall get information regarding private payor rules when the MCPNs form their relationships with such private payors. 24. Page 16, Sec. D, #1G Currently MCPNs establish fee schedules and do not require Providers to provide cost. How will net cost be reported? The fee schedule, which must be within the rate ranges established by the Authority, should have some correlation to costs incurred for services. 25. Page 16 Managing by funding source require accurate eligibility information. How will the Authority ensure MCPNs are provided accurate and timely eligibility information? While this is primarily the responsibility of the MCPNs and providers. Retro-activity with all states Benefit Programs has always been a complex process and is never completely accurate until several months after the close of the month and year. We will push down coverage information to the MCPNs and the major provider network on a weekly basis. MCPNs should be able to produce a preliminary financial position by funding source from these files that will closely match that of the Authorities for recently passed months. The Authority will take whatever steps necessary to provide the most recent, accurate data on eligibility for Consumers. We will treat the Authority s data as the source of truth for eligibility downstream from our position. This will give us the best chance at reconciling our numbers between the Authority, MCPNs and providers. 26. Page 17, #3 Will the cost settlement process include an opportunity for an MCPN to earn a rate of return on the $3.5M unrestricted reserves? The unrestricted reserve is the asset of the MCPN and the Authority encourages MCPNs to retain funds in an interest bearing account. 27. Page 18, G3 What are the activities related to the privileging of Providers? See Addendum #2, responses to Questions 81, 82 and 100. Page 4 of 10

5 28. Page 21 A Will RFP criteria be weighted equally or will there be a point value assigned to each section? Please refer to Modification and Addition section of Addendum 1 for points. 29. Page 26, 5C Clarification is need? This question is vague and may require additional clarification. Regardless, Proposer should estimate the way the administrative costs will be allocated across the seven reportable categories of administration. 30. Do I/DD Proposers need to address under Section 3. C. 1. b) iii, WRAP and WHAM training capacity (Wellness Recovery Action Plan and Whole Health Action Management) in their response to the RFP? It appears that the WRAP and WHAM training pertains to the MI side. No I/DD only Proposers need not address. 31. Section 2 of the RFP discusses Outcomes Management. Is it the intent of the Authority to treat performance indicators as an outcomes measurement? Yes, they will be a part of the outcomes measured. 32. Section 2. 4) G. Scope of Services Contract Management of Providers, Item #2 states: Proposer will assist the Authority on the privileging of providers. How does the Authority intend to use the Proposer in the privileging process? See Addendum #2, responses to Questions 81, 82 and Section 2. 4) G. Item #6 makes reference to protocols for ongoing monitoring of MCPN s provider network. Where/what are the referenced protocols? There are many areas that protocols could exist. They include MDCH administrative rules and performance indicators; MDCH requirements for waivers and benefits; the QAPIP; Medicare and private payer rules; and DWMHA s clinical practice standards and the utilization management manual, which are currently being updated. 34. Section 2. 4) G. Item #12 makes reference to providers fully participating in health care coordination requirements. What are the referenced health care coordination requirements. MDCH has requirements with respect to health care coordination that can be found on its website. Further expectations are developed in the Health Care Integration task force workgroups in collaboration with DWMHA, providers, MCPNs, and managed care entities. 35. Should the Proposer attach to its response to RFP any and all of the Policies and Procedures that it has in place to support its response, or that are referenced in the response? Or, is it sufficient to identify the policies and procedures that are in place that support the response describing how the Proposer will conduct business? The Proposer may do either (list policies or provide copies). 36. Item # 2 of the Due Diligence Questionnaire ask the Proposer to Describe your central management structure, including providing an organizational chart, the functions of key organizational operational components, and key positions. The next sentenced State the assumptions you have used to define these capacities, does not appear to belong in this section. Please clarify what information the Authority is looking for after the Proposer describes its central Page 5 of 10

6 management structure and includes its organizational chart, describes the functions of key organizational operational components and key positions. The sentence referred to is intended to make Proposer s provide justifications for the organizational structure they are proposing to utilize. This information is key when tied into Proposer s explanation of how its proposed administrative structure shall be funded within the confines of the Authority s reduced administrative funding allowances. If, for example, a Proposer is planning to dedicate some of its limited administrative funds to a service for which the Authority is already providing the majority of oversight (e.g., UM), then the dedication of such key positions and funding should be justified. Lastly, Proposer s should state what it perceives or assumes the responsibilities of the Authority and the provider will be in relationship to its management structure in fulfilling the requirements of the RFP. 37. Describe how your organization's system will address the technology requirements of the historical Coordinating Agencies that will shift to the future Proposer? What is meant by technology requirements of the historical Coordinating Agencies. Does the Authority mean the ability to generate TEDs and comply with 42 C.F.R. Part 2? Is use of a central EMR a requirement that needs to be in place by January 1, 2015? 1) Prior to October 1, 2014, SUD services in Wayne County have been managed through MCPN-like entities known as Coordinating Agencies or CAs. This question describes portions of the Systems capabilities required to operate and handle the data of the historical CAs, and the future MCPNs that shall take on the new role of the CAs. The ability to support all of the clinical and administrative requirements of the CAs (plans, Authorizations, Claims payment, Eligibility determination, reporting, etc.) will all need to be uniquely identifiable for the populations previously served by the CAs. 2) All of these operations with the assurance of meeting the requirements of Consumer Privacy and protections under 42 CFR Part-2 and the Michigan Mental Health Code. 3) Yes. 38. Meet all of the SUD data and information system requirements. Please elaborate or share details pertaining to Information system requirements that Proposer s systems should be complying with for SUD data by January 1, See the response to Question #37 of this Addendum. 39. The ability to analyze, integrate and report clinical, financial, utilization, demographic, quality and authorization information. Describe the major components of your organizations analytical environment. Is the Authority including the DCH Performance Indicators with the Outcomes information request or is the Authority intending to ask for Outcomes information aside from the DCH Performance Indicators. The Authority will have outcome expectations including and beyond the DCH Performance Indicators. Page 6 of 10

7 40. On Page 8 of the RFP, under "Important Note". If a Proposer provided MI/SUD services, do those services need to include SED (as referenced on page 13 "MI/SED/SUD") Yes. Also, see Addendum #2, response to Question Are all Proposers expected to provide early intervention/prevention services, or will there only be one MCPN that provides these services? No, see Addendum #2, response to Question When must all key staff at the Proposer and subcontractor have to be in place? January 1, Can 2 organizations partner to be the Proposer? For the proposal, can the organizations apply as co-applicants? Must a legal entity be formed prior to submission? Or can a MOU be in place to form upon award? 1) Yes. The organizations must have some draft or finalized governing documentation (e.g., Articles of Incorporation/Organization, Bylaws/Operating Agreement, Joint Venture Agreement) in place identifying proposed ownership/partnership interest. Furthermore, the organization must provide information related to prior working relationships. All partnering organizations must meet the minimum qualification and the conflict of interest provisions of the RFP. 2) NO, they cannot apply as co-applicant. 3) No the organization entity does not need to be formed prior to submission. However, the entity must be in place when the contract is executed (if awarded). 4) Yes. However, the organizations must have some draft or finalized governing documentation (e.g., Articles of Incorporation/Organization, Bylaws/Operating Agreement, Joint Venture Agreement) in place identifying proposed ownership/partnership interest. All partnering organizations must meet the minimum qualification and the conflict of interest provisions of the RFP. 44. Can an MCPN who provides case management, complete the intake as well? Are charges for case management and intake then allowable costs, above administrative cost allowances? Case management is separate from intake. The MCPN is not to conduct the intake. Case management is a direct service, hence, not a part of the administrative cost. 45. What does sufficient provider capacity mean? Can you clarify? Does this mean breadth of services available? And/or Quantity of Consumers actively receiving services? Based on the number of active enrollees, and the medically necessary services as identified in their IPOS or MTP, the MCPN must ensure that there is enough provider capacity for its consumers to access these services in a timely fashion. 46. Section 1. Operations Due Diligence; Items g, h, and i page 23 of the RFP. Should information about staff at the Administrative level be included? Page 7 of 10

8 Yes. 47. Please Clarify: Will the Authority provide rates to MCPN for specific services, or will the Authority negotiate rates by provider, or does MCPN negotiate rates by provider? The Authority will establish rate corridors, as well as criteria for exceptions, working in collaboration with MCPNs and providers. The MCPNs then negotiate rates with providers within these rate ranges. 48. Reference is made in the RFP to family support specialist. Is this a position? If so, is the position like a peer support specialist who is a family member who works with families? If family support specialist is not a position that the Proposer is expected to have, please explain the meaning of the phrase. Family support specialist services are delivered in a number of ways, including family peers, or persons who have lived experience as a family member of a person in service. This service is often delivered at the provider level, though many managed care entities provide this service as well. 49. Part II (A): General Statement of Work A. What does [RESERVED] mean? It s used in the following sections: 2.7: General Fund page : Systems Transformation page : Employment of Persons with Lived Experiences- page : Behavioral Health Best Practice Task Force- page : Special Programs- page : Withholds for Insufficiency of Quarterly Claims page : Savings and Investment page 64 The Draft MCPN Agreement (as revised) is provided as an example of the contract upon which the Authority shall enter into negotiations with the winning bidders of this RFP. During such negotiations, a successful bidder shall not be permitted to demand re-negotiation of those sections which such Proposer did not take exception to in its RFP response. A section labeled RESERVED in the Draft MCPN Agreement means that no draft language has yet been developed by the Authority, for one of many reasons. Accordingly, such sections, if and when they are developed, will be open for negotiation between the parties. 50. Part II (B): Substance Abuse Disorder Services A. The scope of work and relevant contractual provisions are pending and not included in this section. Page 66. No question was asked, however, the Authority assumes the Proposer is asking whether it shall be held to such RESERVED language sections in the Draft MCPN Agreement. Please see Addendum #3, response to Question 49, above. 51. Appendices A-I are not included. Page 8 of 10

9 No question was asked, however, the Authority assumes the Proposer is asking whether it shall be held to such RESERVED language sections in the Draft MCPN Agreement. Please see Addendum #3, response to Question 49, above. However, to the extent that appendices are Authority specific policies, procedures and/or standards, or are otherwise MDCH requirements which the Authority cannot control, and are thus not contractual terms which can be negotiated, successful Proposers shall be expected to comply with such policies and procedures without chance for negotiation of their terms. 52. The referenced MDCH Contract Attachments are not included Please see Addendum #2, response to question # A. The "Business Information Questionnaire" presupposes that the Proposer may be an LLC, Joint Venture, Partnership, or even an Individual. These types of entities/persons do not have a Board of Directors. However, the "Scope of Services" on Page 13 of 35 of the RFP contains "Board of Directors Requirements." Additionally, the "Minimum Qualifications" section on pages of the RFP makes reference to the Proposer "changing its corporate structure." Is the Authority implying that any entity/person that is not a corporation with a board of directors must change its structure to be a corporation (for profit or nonprofit) and have a board of directors in order to respond to the RFP? May a Proposer who is not a corporation establish an advisory board to comply with the Board of Directors Requirements? B. An LLC, Joint Venture, and Partnership are not formed by "articles of incorporation" and usually do not have bylaws. If a newly formed Proposer need not be a corporation (for profit or nonprofit) (see Question 1.a.), would the Proposer simply need to provide copies of the draft/final organizational documents to comply with the "Experience & Qualifications" 2.(h) (Page 23 of 35)? A. All forms of entity authorized to do business in the State of Michigan shall be acceptable Proposers. The Authority does not believe that it would be possible for an Individual to be a successful proposer, as such individual would not be able to fulfill the Board of Directors requirements described. The term Board of Directors is used here as a stand-in reference to the governing board or membership of an entity. In essence, whatever group has voting control over the dayto-day business operations and policy decisions of the Proposing entity (for example, the membership or managers of an LLC, or the partners in a Partnership or Joint Venture). A Proposer may not establish an advisory board to comply with Board of Directors requirements, unless such advisory board is given the power to make voting decisions on behalf of the business; in which case such advisory board would also become subject to the conflict of interest requirements outlined in the RFP. The Authority is willing to consider a variety of governmental arrangements among bidding entities, however, as noted in previous addenda, such arrangements will be scrutinized by the Authority to make certain that they are in compliance with the RFP s conflict of interests standards. Any attempts to circumvent the conflict of interest provisions of the RFP through creative entity formation shall not be viewed favorably. B. Yes. A Proposer entity should submit whatever governing documents apply. Page 9 of 10

10 54. A. If the Proposer is an LLC, a Joint Venture, or a Partnership that has been in existence less than five years, but one or more of its members/partners has a minimum of five years of experience in providing or managing behavioral health and/or developmental disability services, will the Proposer be qualified under the Minimum Qualification F. (page 13 of 35)? B. If the Proposer is an LLC, a Joint Venture, or a Partnership that does not have at least $3.5 million in unrestricted net assets, but one or more of its members/partners does, will the Proposer be qualified under the Minimum Qualification D. (page 12 of 35)? C. If the Proposer is an LLC, a Joint Venture, or a Partnership that has been in existence less than five years, and does not have audited financial statements for the last three fiscal years, should the member(s)/partner(s) provide its/their audited financial statements for the last three fiscal years to comply with "General Submittal Requirement" 3.(b) (page 21 of 35)? D. If the Proposer is a newly formed LLC, Joint Venture, or Partnership, and does not have three examples of how the CCP has benefited the Proposer organization, but its member(s)/partner(s) does, should the member(s)/partner(s) provide its/their examples to comply with "Submittal Requirements Specific to Evaluation Criteria" 1.(b) (page 22 of 35)? E. If the Proposer is a newly formed LLC, Joint Venture, or Partnership and is not accredited, but one or more of its members/partners is accredited, may the Proposer rely on the member's/partner's accreditation to comply with the "Experience & Qualifications" 2.(f) (page 23 of 35)? A. Yes. See Modification and Addition #3, from Addendum #2. B. In the situation described, Proposer would be expected to obtain a line of credit from a bank or other respected financial institution, however, the Proposer s members/partners may serve as the guarantor(s) on such financing. C. Yes. See Modification and Addition #3, from Addendum #2. D. Yes. See Modification and Addition #3, from Addendum #2. E. No. As stated in the RFP, If the Proposer is a recently formed organization, please describe intent and actions to achieve accreditation from NCQA or CARF within two years. Page 10 of 10

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