STATE OF NORTH CAROLINA

Transcription

1 STATE OF NORTH CAROLINA Department of Health and Human Services, Division of Medical Assistance Request for Proposal #: 30-DMA Date of Issue: October 5, 2015 Proposal Opening Date: November 2, 2015 At 2:00 PM ET Direct all inquiries concerning this RFP to: Sharon Jordan Contracts Procurement Officer Phone: (919)

2 STATE OF NORTH CAROLINA Request for Proposal # 30-DMA For internal State agency processing, including tabulation of proposals in the Interactive Purchasing System (IPS), please provide your company s Federal Employer Identification Number or alternate identification number (e.g. Social Security Number). Pursuant to North Carolina General Statute (b) this identification number shall not be released to the public. This page will be removed and shredded, or otherwise kept confidential, before the procurement file is made available for public inspection. This page is to be filled out and returned with your proposal. Failure to do so may subject your proposal to rejection. ID Number: Federal ID Number or Social Security Number Vendor Name 2

3 EXECUTION In compliance with this Request for Proposals, and subject to all the conditions herein, the undersigned Vendor offers and agrees to furnish and deliver any or all items upon which prices are bid, at the prices set opposite each item within the time specified herein. By executing this proposal, the undersigned Vendor certifies that this proposal is submitted competitively and without collusion (G.S ), that none of its officers, directors, or owners of an unincorporated business entity has been convicted of any violations of Chapter 78A of the General Statutes, the Securities Act of 1933, or the Securities Exchange Act of 1934 (G.S ), and that it is not an ineligible Vendor as set forth in G.S False certification is a Class I felony. Furthermore by executing this proposal, the undersigned certifies to the best of Vendor s knowledge and belief, that it and its principals are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from covered transactions by any Federal or State department or agency. As required by G.S , the undersigned Vendor certifies that it, and each of its sub-contractors for any Contract awarded as a result of this RFP, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its employees through the federal E-Verify system. G.S and Executive Order 24 (2009) prohibit the offer to, or acceptance by, any State Employee associated with the preparing plans, specifications, estimates for public Contract; or awarding or administering public Contracts; or inspecting or supervising delivery of the public Contract of any gift from anyone with a Contract with the State, or from any person seeking to do business with the State. By execution of any response in this procurement, you attest, for your entire organization and its employees or agents, that you are not aware that any such gift has been offered, accepted, or promised by any employees of your organization. Failure to execute/sign proposal prior to submittal shall render proposal invalid and it WILL BE REJECTED. Late proposals cannot be accepted. Curser VENDOR: STATE OF NORTH CAROLINA Department of Health and Human Services, Division of Medical Assistance Refer ALL Inquiries regarding this RFP to: Sharon Jordan Request for Proposal # 30-DMA Proposals will be publicly opened: Contract Type: Open Market Commodity No. and Description: External Quality Review Services and Evaluation of the State s Quality Strategy Using Agency: Department of Health and Human Services (DHHS), Division of Medical Assistance Requisition No.: STREET ADDRESS: P.O. BOX: ZIP: CITY & STATE & ZIP: TELEPHONE NUMBER: TOLL FREE TEL. NO: PRINCIPAL PLACE OF BUSINESS ADDRESS IF DIFFERENT FROM ABOVE (SEE INSTRUCTIONS TO VENDORS ITEM #10): PRINT NAME & TITLE OF PERSON SIGNING ON BEHALF OF VENDOR: FAX NUMBER: VENDOR S AUTHORIZED SIGNATURE: DATE: Offer valid for at least 60 days from date of proposal opening, unless otherwise stated here: days. After this time, any withdrawal of offer shall be made in writing, effective upon receipt by the agency issuing this RFP. ACCEPTANCE OF PROPOSAL If any or all parts of this proposal are accepted by the State of North Carolina, an authorized representative of the DHHS, Division of Medical Assistance shall affix his/her signature hereto and this document and all provisions of this Request For Proposal along with the Vendor proposal response and the written results of any negotiations shall then constitute the written agreement between the parties. A copy of this acceptance will be forwarded to the successful Vendor(s). FOR STATE USE ONLY: Offer accepted and Contract awarded this day of, 20, as indicated on the attached certification, by. (Authorized Representative of DHHS, Division of Medical Assistance). 3

4 Table of Contents Article Title Page No. 1.0 Purpose and Background General Information Request for proposal Notice to vendors regarding RFP terms and conditions RFP schedule Proposal questions Proposal submittal Proposal contents Definitions, acronyms, and abbreviations Method of award and proposal evaluation process Method of award Confidentiality and prohibited communications during evaluation Proposal evaluation process Evaluation criteria Interpretation of terms and phrases Requirements Contract term Pricing Invoices Payment terms Financial stability Vendor experience References Background checks Personnel Vendor s representations Scope of work 19 4

5 5.1 General Objective Task Project organization Technical approach Acceptance of work Contract administration Contract administrator Post award meetings Dispute resolution Division contract administrators Contract changes 35 Attachments Title Page No. A Instructions to vendors 36 B North Carolina general contract terms and conditions 39 C Cost proposal 43 D Location of workers utilized by vendor 45 E Certification of financial condition 46 F Description of executive order #50 47 G State certifications required by state law 48 H Federal certifications and disclosures 49 I NC business associate addendum 55 J Data protection 58 K 42 CFR qualifications of external review organizations 60 L NC Medicaid waiver performance measures 61 5

6 1.0 PURPOSE AND BACKGROUND The purpose of this Request for Proposal (RFP) is to solicit proposals from Vendors who are willing and able to provide external quality reviews (EQR) of DMA s behavioral health managed care initiative which is administered through Prepaid Inpatient Health Plans (PIHPs) and to evaluate the effectiveness of DMA s quality strategy. The managed care initiative is offered pursuant to a Medicaid Waiver. The Medicaid Waiver was implemented pursuant to Title XIX of the Social Security Act, the Balanced Budget Act of 1997, and Title 42 of the Code of Federal Regulations, and operates under concurrent 1915(b) and 1915(c) waivers. Currently, there are eight PIHPs, or Managed Care Organizations (hereinafter referred to as PIHPs), participating in the Medicaid Waiver covering all 100 counties. The eight PIHPs are: Alliance Behavioral Health, Cardinal Innovations Healthcare Solutions, CenterPoint Human Services, Eastpointe, Partners Behavioral Health Management, Sandhills Center, Smoky Mountain Center and Trillium Health Resources. The total number of participating PIHPs may be reduced by merger during the term of this contract. The Centers for Medicare and Medicaid Services (CMS) amended Parts 433 and 438 of Title 42 of the Code of Federal Regulations on January 24, These regulations, which require States to conduct an EQR, became effective as of March 25, Proposals shall be submitted in accordance with the terms and conditions of this RFP and any addenda issued hereto. 2.0 GENERAL INFORMATION 2.1 REQUEST FOR PROPOSAL DOCUMENT The RFP is comprised of the base RFP document, any attachments, and any addenda released before Contract award. All attachments and addenda released for this RFP in advance of any Contract award are incorporated herein by reference. 2.2 NOTICE TO VENDORS REGARDING RFP TERMS AND CONDITIONS It shall be the Vendor s responsibility to read the Instructions, the State s terms and conditions, all relevant exhibits and attachments, and any other components made a part of this RFP, and comply with all requirements and specifications herein. Vendors also are responsible for obtaining and complying with all Addenda and other changes that may be issued in connection with this RFP. If Vendors have questions, issues, or exceptions regarding any term, condition, or other component within this RFP, those should be submitted as questions as outlined in the instructions of this RFP. If the State determines that any changes will be made as a result of the points raised, then such decisions will be communicated in the form of an RFP addendum. The State may also elect to leave open the possibility for later negotiation of specific components of the Contract that have been addressed during the question and answer period. Other than through this process, the State rejects and will not be required to evaluate or consider any additional or modified terms and conditions submitted with Vendor s proposal. This applies to any language appearing in or attached to the document as part of the Vendor s proposal that purports to vary any terms and conditions or Vendors instructions herein or to render the proposal non-binding or subject to further negotiation. By execution and delivery of this RFP Response, the Vendor agrees that any additional or modified terms and conditions, whether submitted purposely or inadvertently, shall have no force or effect, and will be disregarded. Noncompliance with, or any attempt to alter or delete, this paragraph shall constitute sufficient grounds to reject Vendor s proposal as nonresponsive. Contact with anyone working for or with the State regarding this RFP other than the State Contract Specialist named on the face page of this RFP in the manner specified by this RFP shall constitute grounds for rejection of said Vendor s offer, at the State s election. 2.3 RFP SCHEDULE The table below shows the intended schedule for this RFP. The State will make every effort to adhere to this schedule. 6

7 Event Responsibility Date and Time Issue RFP State October 5, 2015 Submit Written Questions Vendor October 14, 2015 Provide Response to Questions State October 19, 2015 Submit Proposals Vendor November 2, 2015 Contract Award State December 1, 2015 Contract Effective Date State January 1, PROPOSAL QUESTIONS Upon review of the RFP documents, Vendors may have questions to clarify or interpret the RFP in order to submit the best proposal possible. To accommodate the Proposal Questions process, Vendors shall submit any such questions by the above due date. Written questions shall be ed to by the date and time specified above. Vendors should enter RFP # 30-DMA : Questions as the subject for the . Questions submittals should include a reference to the applicable RFP section and be submitted in a format shown below: Reference RFP Section, Page Number Vendor Question Vendor question? Questions received prior to the submission deadline date, the State s response, and any additional terms deemed necessary by the State will be posted in the form of an addendum to the Interactive Purchasing System (IPS), and shall become an Addendum to this RFP. No information, instruction or advice provided orally or informally by any State personnel, whether made in response to a question or otherwise in connection with this RFP, shall be considered authoritative or binding. Vendors shall rely only on written material contained in an Addendum to this RFP. 2.5 PROPOSAL SUBMITTAL Sealed proposals, subject to the conditions made a part hereof and the receipt requirements described below, shall be received at the address indicated in the table below, for furnishing and delivering those items as described herein. [If the mailing address is the same as the physical office address, delete one column of the table and modify the remaining fields as needed] Mailing address for delivery of proposal via US Postal Service PROPOSAL NUMBER: 30-DMA Office of Procurement and Contract Services Mail Service Center 2008 Raleigh, NC Office Address of delivery by any other method (special delivery, overnight, or any other carrier) PROPOSAL NUMBER: 30-DMA Hoey Building (Dix Campus) Office of Procurement and Contract Services 801 Ruggles Drive Raleigh, NC IMPORTANT NOTE: All proposals shall be physically delivered to the office address listed above on or before the proposal deadline in order to be considered timely, regardless of the method of delivery. This is an absolute requirement. All risk of late arrival due to unanticipated delay whether delivered by hand, U.S. Postal Service, courier or other delivery service is entirely on the Vendor. It is the sole responsibility of the Vendor to have the proposal physically in this Office by the specified time and date of opening. The time of delivery will be marked on each proposal when received, and any proposal received after the proposal submission deadline will be rejected. Sealed proposals, subject to 7

8 the conditions made a part hereof, will be received at the address indicated in the table in this Section, for furnishing and delivering the commodity as described herein. Note that the U.S. Postal Service generally does not deliver mail to specified street address but to the State s Mail Service Center. Vendors are cautioned that proposals sent via U.S. Mail, including Express Mail, may not be delivered by the Mail Service Center to the agency s purchasing office on the due date in time to meet the proposal deadline. All Vendors are urged to take the possibility of delay into account when submitting a proposal. Attempts to submit a proposal via facsimile (FAX) machine, telephone or electronic means, including but not limited to , in response to this RFP shall NOT be accepted. a) Submit two (2) signed, original executed proposal responses, five (5) of photocopies, two (2) un-redacted electronic copies on CD, DVD or flash drive and two (2) redacted electronic (Proprietary and Confidential Information Excluded) copies on CD, DVD or flash drive of your proposal simultaneously to the address identified in the table above. b) Submit your proposal in a sealed package. Clearly mark each package with: (1) Vendor name; (2) the RFP number; and (3) the due date. Address the package(s) for delivery as shown in the table above. If Vendor is submitting more than one (1) proposal, each proposal shall be submitted in separate sealed envelopes and marked accordingly. For delivery purposes, separate sealed envelopes from a single Vendor may be included in the same outer package. Proposals are subject to rejection unless submitted with the information above included on the outside of the sealed proposal package. c) The electronic copies of your proposal must be provided on separate read-only CD s, DVD s or flash drives. The files on the discs shall NOT be password protected, shall be in.pdf or.xls format, and shall be capable of being copied to other media including readable in Microsoft Word and/or Microsoft Excel. Disc One must contain unredacted copies of the Technical and Cost Proposals including any proprietary information and have the following label affixed to the disc: 1) Vendor name; (2) the RFP number; (3) the due date; and (4) the words Disc One Technical and Cost Proposal Non-Redacted. Disc Two must contain redacted copies of the Technical and Cost Proposals from which the Vendor s confidential and proprietary information has been deleted in accordance with the provisions of Attachment A, Paragraph 11 of the Instructions to Vendors. DHHS, Division of Medical Assistance, in responding to public records requests, will release the information on this disc. It is the sole responsibility of the Vendor to ensure that this disc complies with the requirements of A, Paragraph 11 of the Instructions to Vendors. The following label must be affixed to the disc: (1) Vendor name; (2) the RFP number; (3) the due date; and (4) the words Disc Two Technical and Cost Proposal Redacted Copy. 2.6 PROPOSAL CONTENTS Vendors shall populate all attachments of this RFP that require the Vendor to provide information and include an authorized signature where requested. Vendor RFP responses shall include the following items and those attachments should be arranged in the following order: a) Cover Letter b) Title Page: Include the company name, address, phone number and authorized representative along with the Proposal Number. c) Completed and signed version of EXECUTION PAGES, and signed receipt pages of any addenda released in conjunction with this RFP d) Table of Contents e) The Vendor s name and principal place of business. f) The Vendor s legal status; i.e. whether the Vendor is an individual, a corporation, a general partnership, a limited partnership, a joint venture or some other legal entity. g) The state in which the Vendor is incorporated or organized. h) A brief overview of the Vendor s history. i) A brief overview of all services provided by the Vendor 8

9 j) The details of: (1) Any criminal convictions of any of the Vendors or any of their officers, directors, employees, agents or subcontractors of which the Vendors have knowledge or a statement that there are none; (2) Any criminal investigations pending against of any of the Vendors or any of their officers, directors, employees, agents or subcontractors of which the Vendors have knowledge or a statement that there are none; (3) Any regulatory sanctions levied against any of the Vendors or any of their officers, directors, employees, agents or subcontractors by any state or federal regulatory agencies within the past three years of which the Vendors have knowledge or a statement that there are none. As used herein, the term regulatory sanctions includes the revocation or suspension of any license or certification, the levying of any monetary penalties or fines, and the issuance of any written warnings; (4) Any regulatory investigations pending against of any of the Vendors or any of their officers, directors, employees, agents or subcontractors by any state or federal regulatory agencies of which the Vendors have knowledge or a statement that there are none. Note: The Department may reject a proposal solely on the basis of this information. k) A statement of whether any of the Vendor s directors, partners, proprietors, officers or employees or any of the proposed project staff are related to any DHHS employees. If such relationships exist, identify the related individuals, describe their relationships, and identify their respective employers and positions. l) The Vendor s Assurance that the Vendor and the proposed Vendor staff are not excluded from participation by Medicaid or the Office of the Inspector General of the United States Department of Health and Human Services. m) A certification that none of the regulations cited in RFP Section 5.3 (1) would bar it from performing any of the duties of an independent EQRO for DMA as of the date that the Vendor filed its proposal; and the Vendor shall refrain for the life of this contract from entering into any contractual relationships that would violate those regulations. n) Documentation that the Vendor has the qualifications specified in RFP Section 4.6, above. o) A description of the Vendor s experience providing the services described in the Scope of Work (SOW), within the last five years, including: (1) The beginning and ending dates of the contracts; (2) The services provided under those contracts; (3) The total number of Vendor employees assigned to service each contract; (4) Whether any of those contracts were extended or renewed at the end of their initial terms; (5) Whether any of those contracts were terminated early for cause by either party to the contract; (6) The lessons learned from each of those contracts; and (7) The name, address, and telephone number of at least one manager in each client organization who is personally familiar with the Vendor s performance under the contract. p) A written description of the Vendor s understanding of the objective of this RFP. q) A written description of the Vendor s approach to the work described in the RFP r) Documentation of the Vendor s ability to perform the services described in the RFP. s) Work plans, timelines and schedule for all deliverables along with implementation and transition plans described in the RFP section 5.3. t) A discussion of problems foreseen by the Vendor and the Vendor s proposed solutions to these problems. 9

10 u) A description of how the Vendor will staff the project, including the name, resume and qualifications of each of the proposed team members (including subcontractors), and at least three (3) references for each. v) An Organization Chart showing the employees who will provide services under this contract and the chain of command and supervision of those employees. w) Documentation that the Vendor s proposed Project Manager has the experience required by RFP Section 4.6. x) Documentation that at least one member of the Vendor s proposed staff has the experience required by RFP Section 4.6 y) Identify the Vendor staff, if any, that must be relocated to North Carolina and indicate how long it will take them to relocate. z) The name and contact information of the Vendor s proposed Contract Administrator aa) ATTACHMENT A: INSTRUCTIONS TO VENDORS bb) ATTACHMENT B: NORTH CAROLINA GENERAL CONTRACT TERMS AND CONDITIONS cc) ATTACHMENT C: COST PROPOSAL dd) Completed and signed version of ATTACHMENT D: LOCATION OF WORKERS UTILIZED BY VENDOR ee) Completed and signed version of ATTACHMENT E: CERTIFICATION OF FINANCIAL CONDITION ff) Completed and signed version of ATTACHMENT F: DESCRIPTION OF EXECUTIVE ORDER #50 gg) Completed and signed version of ATTACHMENT G: CERTIFICATIONS REQUIRED BY STATE LAW hh) Completed and signed version of ATTACHMENT H: FEDERAL CERTIFICATIONS AND DISCLOSURES ii) Completed and signed version of ATTACHMENT I: N.C. BUSINESS ASSOCIATE ADDENDUM jj) ATTACHMENT J: DATA PROTECTION kk) ATTACHMENT K: 42 CFR QUALIFICATIONS OF EXTERNAL REVIEW ORGANIZATIONS ll) ATTACHMENT L: N.C. MEDICAID WAIVER PERFORMANCE MEASURES If the Vendor submits additional attachments in its proposal, those attachments should follow the attachments listed above and should be lettered consecutively thereafter. 2.7 DEFINITIONS, ACRONYMS, AND ABBREVIATIONS a) BAFO: Best and Final Offer, submitted by a vendor to alter its initial offer, made in response to a request by the issuing agency. b) CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS): The agency within the Federal Department of Health and Human Services that has primary responsibility for the overall administration and coordination of the Medicare and Medicaid programs. CMS was formerly known as the Health Care Financing Administration. c) CLEAN CLAIM: A claim that can be processed without obtaining additional information from the provider of the service or from a third party. It includes a claim with errors originating in the PIHP s claims system but does not include a claim from a provider who is under investigation by a governmental agency for fraud or abuse or a claim under review for medical necessity. d) CODE OF FEDERAL REGULATIONS (CFR): The Code of Federal Regulations (CFR) is the codified form of the regulations published in the Federal Register by the executive agencies of the Federal Government. e) CONTRACT LEAD: Representative of the DHHS, Division of Medical Assistance who corresponds with potential Vendors in order to identify and contract with that Vendor providing the greatest benefit to the State. f) DHHS or DEPARTMENT: The NC Department of Health and Human Services g) DMA or DIVISION: Division of Medical Assistance h) EXTERNAL QUALITY REVIEW (EQR): The analysis and evaluation, by an EQRO, of aggregated information on quality, timeliness, and access to the health care services that a PIHP/MCO, or their subcontractors, furnish to Medicaid recipients. i) EXTERNAL QUALITY REVIEW ORGANIZATION (EQRO): An entity that meets federal competence and independence criteria for the performance of the EQR and EQR-related activities. 42 C.F.R. Part 438, Subpart E. 10

11 j) FINANCIAL RELATIONSHIP: A direct or indirect ownership or investment interest (including an option or nonvested interest) in any entity. This direct or indirect interest may be in the form of equity, debt, or other means and includes any indirect ownership or investment interest no matter how many levels removed from direct interest; or a compensation arrangement with an entity. k) FLAGRANT QUALITY OF CARE ISSUE: An issue, circumstance, or occurrence that places a recipient s health, safety, or wellbeing in immediate jeopardy. l) MANDATORY ACTIVITIES: Activities which must be performed to comply with federal EQR requirements. m) MCO: Managed Care Organization n) OPTIONAL ACTIVITIES: Certain activities which are optional to produce data for EQR. o) PLAN-LEVEL: A description of a specific organizational level at which work will be performed. For example, a Plan- Level data analysis involves the analysis of data from a single PIHP, or Plan, rather than the analysis of data from all eight PIHPs. p) PREPAID INPATIENT HEALTH PLAN (PIHP): [A]n entity that -- (1) Provides medical services to enrollees under contract with the State agency, and on the basis of prepaid capitation payments, or other payment arrangements that do not use State plan payment rates; (2) Provides, arranges for, or otherwise has responsibility for the provision of any inpatient hospital or institutional services for its enrollees; and (3) Does not have a comprehensive risk contract. 42 C.F.R q) QUALIFIED PROPOSAL: A responsive proposal submitted by a responsible Vendor. r) QUALITY: As it pertains to external quality review, means the degree to which a PIHP/MCO increases the likelihood of desired health outcomes of its enrollees through its structural and operational characteristics and through the provision of health services that are consistent with current professional knowledge. s) RFP: Request for Proposal t) STATE: The State of North Carolina, including any of its sub-units recognized under North Carolina law. u) STATE AGENCY: Any of the more than 400 sub-units within the executive branch of the State, including its departments, boards, commissions of higher education and other institutions. v) VALIDATION: The review of information, data, and procedures to determine the extent to which they are accurate, reliable, free from bias, and in accord with standards for data collection and analysis. w) VENDOR: Supplier, bidder, proposer, company, firm, corporation, partnership, individual or other entity submitting a response to a Request for Proposal. 3.0 METHOD OF AWARD AND PROPOSAL EVALUATION PROCESS 3.1 METHOD OF AWARD All qualified proposals will be evaluated and awards will be based on the criteria identified below as applied to each proposal. Pursuant to G.S , all qualified proposals will be evaluated and awards will be made to Vendors meeting the RFP requirements and achieve the highest and best final evaluation, as described below. While the intent of this RFP is to award a Contract(s) to a single Vendor, the State reserves the right to make separate awards to different Vendors for one or more line items, to not award one or more line items or to cancel this RFP in its entirety without awarding a Contract, if it is considered to be most advantageous to the State to do so. The status of a Vendor s e-procurement Services account(s) shall be considered a relevant factor in determining whether to approve the award of a contract under this RFP. Any Vendor with an E-Procurement Services account that is in arrears by 91 days or more at the time of proposal opening may, at the State s discretion, be disqualified from further evaluation or consideration. The State reserves the right to waive any minor informality or technicality in proposals received. 11

12 3.2 CONFIDENTIALITY AND PROHIBITED COMMUNICATIONS DURING EVALUATION During the evaluation period from the date proposals are opened through the date the contract is awarded each Vendor submitting a proposal (including its representatives, sub-contractors and/or suppliers) is prohibited from having any communications with any person inside or outside the using agency, issuing agency, other government agency office, or body (including the purchaser named above, department secretary, agency head, members of the general assembly and/or governor s office), or private entity, if the communication refers to the content of Vendor s proposal or qualifications, the contents of another Vendor s proposal, another Vendor s qualifications or ability to perform the contract, and/or the transmittal of any other communication of information that could be reasonably considered to have the effect of directly or indirectly influencing the evaluation of proposals and/or the award of the contract. A Vendor not in compliance with this provision shall be disqualified from contract award, unless it is determined in the State s discretion that the communication was harmless, that it was made without intent to influence and that the best interest of the state would not be served by the disqualification. A Vendor s proposal may be disqualified if its sub-contractor and supplier engage in any of the foregoing communications during the time that the procurement is active (i.e., the issuance date of the procurement to the date of contract award). Only those discussions, communications or transmittals of information authorized or initiated by the issuing agency for this RFP or general inquiries directed to the purchaser regarding requirements of the RFP (prior to proposal submission) or the status of the contract award (after submission) are excepted from this provision. 3.3 PROPOSAL EVALUATION PROCESS The State shall review all Vendor responses to this RFP to confirm that they meet the specifications and requirements of the RFP. The State reserves the right to waive any minor informality or technicality in proposals received. The State will conduct a One-Step evaluation of Proposals: Proposals will be received from each responsive Vendor in a sealed envelope or package. All proposals must be received by the issuing agency not later than the date and time specified on the cover sheet of this RFP. At that date and time the package containing the proposals from each responding firm will be opened publicly and the name of the Vendor and total cost offered will be announced. Interested parties are cautioned that these costs and their components are subject to further evaluation for completeness and correctness and therefore may not be an exact indicator of a Vendor s pricing position. At their option, the evaluators may request oral presentations or discussion with any or all Vendors for the purpose of clarification or to amplify the materials presented in any part of the proposal. Vendors are cautioned, however, that the evaluators are not required to request presentations or other clarification and often do not; therefore, all proposals should be complete and reflect the most favorable terms available from the Vendor. Proposals will generally be evaluated according to completeness, content, and experience with similar projects, ability of the Vendor and its staff, and cost. Specific evaluation criteria are listed in 3.4 EVALUATION CRITERIA, below. Vendors are cautioned that this is a request for offers, not an offer or request to contract, and the State reserves the unqualified right to reject any and all offers at any time if such rejection is deemed to be in the best interest of the State. The State reserves the right to reject all original offers and request one or more of the Vendors submitting proposals within a competitive range to submit a best and final offer (BAFO), based on discussions and negotiations with the State, if the initial responses to the RFP have been evaluated and determined to be unsatisfactory. Upon completion of the evaluation process, the State will make Award(s) based on the evaluation and post the award(s) to IPS under the RFP number for this solicitation. Award of a Contract to one Vendor does not mean that the other proposals lacked merit, but that, all factors considered, the selected proposal was deemed most advantageous and represented the best value to the State. 12

13 3.4 EVALUATION CRITERIA All qualified proposals will be evaluated and award made based on the following criteria considered, to result in an award most advantageous to the State: Vendor shall respond to all of the items outlined in the Deliverables section of the Scope of Work. The Vendor will be scored on the content, quality, and completeness of the responses for each deliverables and to how well each deliverable addresses the following core factors. a) Overall approach and methods that will be used to accomplish the deliverables and the scope of work, including what is unique, creative or innovative about the proposed approaches and/or methods to meet the deliverable b) Utilization of the protocol for the specific activity along with identification and in-depth information for each specific tasks/activities and functions that will be performed in the order that they are likely to occur. c) Comprehensiveness of work plans, schedules, timelines, implementation and transition plans. Timelines are clear and include reasonable representation of all outlined activities as well as indicate who will have the primary responsibility for performing each major task/activity/function including the name and position title of all key personnel, subcontractors, or consultants that will perform the work to meet the deliverable. Note: The RFP task order has prioritized the activities based on the state's needs. The Evaluation Committee will score the proposals using the scoring system shown in the following scoring table. The highest score that can be awarded to any proposal is 5700 points. Technical (4050 Maximum Points) Proposal Deliverable Scoring total for each Deliverable Compliance with Medicaid MCO Federal and State regulations 200 Administrative Interviews 200 Validation of Performance Measures 200 Validation of Encounter Data 200 Validation of Performance Improvement Projects: 200 Annual Individual Reports. 150 Annual Program Report: 150 Information Systems Capabilities Assessment 200 Program Integrity Reviews and Ad Hoc Reports 200 Consumer Satisfaction Surveys 200 Provider Satisfaction Surveys 200 Evaluation of the State s Quality Strategy 150 Semi-Annual Audit 200 HEDIS and other Quality Measures Reports 100 Annual Technical Report 150 Follow-up Report:

14 Quality Forums 150 Annual summary report from each quality forum 150 Quality of Care Reports 150 Monthly Progress Reports 100 Annual Summary Report 150 Other Areas of Evaluation Transition and Implementation Plans 100 Vendor Qualifications 400 Technical Proposal Subtotal 4050 Cost Proposal 1650 Total Possible Score 5700 Cost (1650 Maximum Points) The State will determine the proposal with the lowest total annual cost by normalizing the scores as follows: The proposal with the lowest cost will receive a score of All other competing proposals will be assigned a portion of the maximum score using the formula: 1650 x the cost of the lowest cost proposal the cost of the cost proposal being evaluated PERFORMANCE OUTSIDE THE UNITED STATES Vendor shall complete ATTACHMENT D: LOCATION OF WORKERS UTILIZED BY VENDOR. In addition to any other evaluation criteria identified in this RFP, the State may, for purposes of evaluating proposed or actual contract performance outside of the United States, also consider how that performance may affect the following factors to ensure that any award will be in the best interest of the State: Total cost to the State Level of quality provided by the Vendor Process and performance capability across multiple jurisdictions Protection of the State s information and intellectual property Availability of pertinent skills Ability to understand the State s business requirements and internal operational culture Particular risk factors such as the security of the State s information technology Relations with citizens and employees Contract enforcement jurisdictional issues 3.5 INTERPRETATION OF TERMS AND PHRASES This Request for Proposal serves two functions: (1) to advise potential Vendors of the parameters of the solution being sought by the Department; and (2) to provide (together with other specified documents) the terms of the Contract resulting from this procurement. As such, all terms in the Request for Proposal shall be enforceable as contract terms in accordance with the General Terms and Conditions. The use of phrases such as shall, must, and requirements are intended to create enforceable contract conditions. In determining whether proposals should be evaluated or rejected, the Department will take 14

15 into consideration the degree to which Vendors have proposed or failed to propose solutions that will satisfy the Department s needs as described in the Request for Proposal. Except as specifically stated in the Request for Proposal, no one requirement shall automatically disqualify a Vendor from consideration. However, failure to comply with any single requirement may result in the Department exercising its discretion to reject a proposal in its entirety. 4.0 REQUIREMENTS This Section lists the requirements related to this RFP. By submitting a proposal the Vendor agrees to meet all stated requirements in this Section as well as any other specifications, requirements and terms and conditions stated in this RFP. If a Vendor is unclear about a requirement or specification or believes a change to a requirement would allow for the State to receive a better proposal, the Vendor is urged and cautioned to submit these items in the form of a question during the question and answer period in accordance with Section CONTRACT TERM The Contract shall have an initial term of two (2) years, beginning on the date the Contract is executed by the State (the Effective Date ). The Vendor shall begin work under the Contract within 30 business days of the Effective Date. At the end of the Contract s current term, the State shall have the option, in its sole discretion, to renew the Contract on the same terms and conditions for one additional one-year term. The State will give the Vendor written notice of its intent whether to exercise the option no later than one hundred and twenty (120) days before the end of the Contract s current term. In addition, the State reserves the right to extend a contract term for a period of up to 180 days in 90-day-or-less increments. 4.2 PRICING Proposal price shall constitute the total cost to the Division for complete performance in accordance with the requirements and specifications herein, including all applicable expenses such as administrative and other similar fees. Vendor shall not invoice for any amounts not specifically allowed for in this RFP. The Vendor shall use the Cost Table found in ATTACHMENT C: COST PROPOSAL to create the Cost Proposal. The Vendor shall not use any other tables or forms, nor modify the contents of any of the shaded cells in the Cost Table. All costs quoted in your Cost Proposal must be firm and fixed for the duration of the contract, which could last as long as three years if the State exercises its option for one additional year. 4.3 INVOICES a) The Vendor must submit one monthly invoice within fifteen (15) calendar days following the end of each month in which work was performed. b) Invoices must be submitted to the following address: NC Department of Health & Human Services Division of Medical Assistance Attention: Gregory Sligh 2501 Mail Service Center Raleigh, NC c) Invoices must be submitted to the Contract Lead in hard copy on the Contractor s official letterhead stationery and must be identified by a unique invoice number. All invoice backup reports and spreadsheets must be provided in electronic format. d) Invoices must bear the correct contract number and purchase order number to ensure prompt payment. The Vendor s failure to include the correct purchase order number may cause delay in payment. e) Invoices must itemize the deliverables for which payment is sought, the invoice date, the period of time covered, the amount of fees due to the Vendor and the original signature of the Vendor s project manager. 4.4 PAYMENT TERMS a) This is a deliverables-based contract, not a time-and-materials contract. The Division will pay the Vendor the firm, fixed price specified in ATTACHMENT C: COST PROPOSAL for each deliverable. 15

16 b) The Vendor will be paid net thirty (30) calendar days after the Vendor s invoice received and the Division has approved all deliverables covered by the invoice and after the Division s Contract Administrator has approved the Vendor s invoice. c) If DMA rejects a deliverable, DMA will give the Vendor a written explanation for the rejection and a written description of the changes that must be made to the deliverable. d) The Vendor shall then have ten business days to correct and resubmit the deliverable to DMA. e) This cycle of submission, review, rejection, revision, and resubmission shall be repeated until DMA accepts the deliverable. f) If DMA does not accept the deliverable the third time it is submitted to DMA for acceptance, the Vendor s compensation for the deliverable shall be reduced by 2% every day thereafter until an acceptable deliverable is submitted to DMA. Example: If DMA notifies the Vendor for a third time that a deliverable is not acceptable; the Vendor resubmits the deliverable to DMA five days later; and DMA accepts the deliverable three days after it receives the fourth iteration of the deliverable, the Vendor s compensation for the deliverable shall be reduced by 10% (2% x 5 days). Note: The calculation of a reduction in compensation shall exclude the time a deliverable is under review by DMA. g) If the Vendor s deliverables are repeatedly late or defective, DMA may terminate the contract pursuant to the provisions of RFP Sections 9.13 or 9.14 or invoke any other remedy available at law or equity. 4.5 FINANCIAL STABILITY Each Vendor shall certify it is financially stable by completing the ATTACHMENT E: CERTIFICATION OF FINANCIAL CONDITION. The State is requiring this certification to minimize potential issues from Contracting with a Vendor that is financially unstable. From the date of the Certification to the expiration of the Contract, the Vendor shall notify the State within thirty (30) days of any occurrence or condition that materially alters the truth of any statement made in this Certification. 4.6 VENDOR EXPERIENCE a) The Vendor must be an External Quality Review Organization (EQRO) as described in 42 CFR A copy of the regulation is attached to this RFP as ATTACHMENT K. b) The Vendor must have: 1) Five years experience performing EQR activities, as described in 42 CFR and ; 2) Five years experience with data management and analysis; and 3) Five years experience with statistical methodologies, techniques and procedures in support of quality improvement. c) Vendor Personnel: The Vendor shall provide at a minimum, the following personnel for EQR. The personnel must be in place at within 90 days of contract award. The staff must have the knowledge and experience required by 42 C.F.R (b)(1). The Vendor s staff must include: 1) A full-time Project Manager with five years of management experience and a minimum of five years of experience in offsite and onsite EQR activities who shall oversee all EQR activities and function as a liaison with DMA. The Project Manager shall have a Degree in Behavioral Health or Social Science and shall have experience in each of the following areas: i. Medicaid recipients, policies, data systems and processes; ii. Managed care delivery systems, organizations, and financing; iii. Quality assessment and improvement methods; and iv. Research design and methodology, including statistical analysis. 2) A full-time Contract Manager with the experience and knowledge required by 42 C.F.R (b)(1): 16

17 3) At least one member of the Vendor s staff must have a minimum of five years experience monitoring contracts, and preferably experience with managed care contracts management and monitoring. 4) An IT or Claims Manager with a minimum of 10 years of experience with claims processing/database design/encounter data processing and implementation in a managed care environment. 5) A Program Integrity Manager with a minimum of 10 years of experience with Program Integrity and Monitoring in a managed care environment. 6) A Quality Manager with a Master s Degree in a Social Sciences or Clinical field with a minimum of 10 years of experience with program evaluation, survey design and analysis, statistical analysis and performance measurement. 7) A Finance Manager with a Bachelor s Degree in accounting, business administration, finance, or related discipline; or equivalent combination of training or experience. Must have completed 12 credit hours of accounting coursework and five years of professional accounting experience. 8) One Ph.D. level Psychologist with a minimum of 10 years of post-degree experience. 9) One clinician with a Master s degree or equivalent and a minimum of 10 years of post-degree experience in providing direct care to persons with a Mental Health diagnosis. 10) One clinician with a Master s degree or equivalent and a minimum of 10 years of post-degree experience in providing direct care to persons with a Substance Abuse diagnosis. 11) One clinician with a Master s degree or equivalent and a minimum of 10 years of post-degree experience in providing direct care to persons with intellectual and developmental delays. 4.7 REFERENCES Each Bidder shall provide the names of and contact information for at least three (3) client references who are familiar with the Bidder s performance on contracts for services of similar size and scope. The State shall contact these references to determine whether the services provided were substantially similar in scope to those proposed herein and whether the Vendor s performance was satisfactory. Such information shall be considered in the evaluation of the Vendor s proposal. COMPANY NAME CONTACT NAME TELEPHONE NUMBER 4.8 BACKGROUND CHECKS Vendor and its personnel are required to provide or undergo background checks prior to beginning work with the State. As part of Vendor background the details below must be provided to the State: (1) Any criminal felony conviction, or conviction of any crime involving moral turpitude, including, but not limited to fraud, misappropriation or deception, of Vendor, its officers or directors, or any of its employees or other personnel to provide services on this project, of which Vendor has knowledge or a statement that it is aware of none; (2) Any criminal investigation for any offense involving moral turpitude, including, but not limited to fraud, misappropriation, falsification or deception pending against Vendor of which it has knowledge or a statement it is aware of none; 17

18 (3) Any regulatory sanctions levied against Vendor or any of its officers, directors or its professional employees expected to provide services on this project by any state or federal regulatory agencies within the past three years or a statement that there are none. As used herein, the term regulatory sanctions includes the revocation or suspension of any license or certification, the levying of any monetary penalties or fines, and the issuance of any written warnings; (4) Any regulatory investigations pending against Vendor or any of its officers, directors or its professional employees expected to provide services on this project by any state or federal regulatory agencies of which Vendor has knowledge or a statement that there are none. (5) Any civil litigation, arbitration, proceeding, or judgments pending against Vendor during the three (3) years preceding submission of its proposal herein or a statement that there are none. Vendor s responses to these requests shall be considered to be continuing representations, and Vendor s failure to notify the State within thirty (30) days of any criminal litigation, investigation or proceeding involving Vendor or its then current officers, directors or persons providing services under this contract during its term shall constitute a material breach of contract. The provisions of this paragraph shall also apply to any subcontractor utilized by Vendor to perform services under this contract. 4.9 PERSONNEL Vendor shall not substitute key personnel assigned to the performance of this Contract without prior written approval by the Contract Lead. Vendor shall notify the Contract Lead of any desired substitution, including the name(s) and references of Vendor s recommended substitute personnel. The State will approve or disapprove the requested substitution in a timely manner. The State may, in its sole discretion, terminate the services of any person providing services under this Contract. Upon such termination, the State may request acceptable substitute personnel or terminate the contract services provided by such personnel VENDOR S REPRESENTATIONS a) Vendor warrants that qualified personnel will provide services under this Contract in a professional manner. Professional manner means that the personnel performing the services will possess the skill and competence consistent with the prevailing business standards in the industry. Vendor agrees that it will not enter any agreement with a third party that might abridge any rights of the State under this Contract. Vendor will serve as the prime Vendor under this Contract, and Vendor shall be legally responsible for the performance and payment of any subcontractor(s) that may be approved by the State. Names of any third party Vendors or subcontractors of Vendor may appear for purposes of convenience in Contract documents; and shall not limit Vendor s obligations hereunder. b) If any services, deliverables, functions, or responsibilities not specifically described in this Contract are required for Vendor s proper performance, provision and delivery of the service and deliverables under this Contract, or are an inherent part of or necessary sub-task included within such service, they will be deemed to be implied by and included within the scope of the contract to the same extent and in the same manner as if specifically described in the contract. Unless otherwise expressly provided herein, Vendor will furnish all of its own necessary management, supervision, labor, facilities, furniture, computer and telecommunications equipment, software, supplies and materials necessary for the Vendor to provide and deliver the Services and Deliverables. c) Vendor warrants that it has the financial capacity to perform and to continue to perform its obligations under the contract; that Vendor has no constructive or actual knowledge of an actual or potential legal proceeding being brought against Vendor that could materially adversely affect its performance of this Contract; and that entering into this Contract is not prohibited by any contract, or order by any court of competent jurisdiction. 18