Title: Kyle L. Janek, M.D., Executive Commissioner
1Kyle L. Janek, M.D., Executive Commissioner
- VENDOR CONFERENCE
- STAR Kids
- Request for Proposal No. 529-13-0071
- July 31, 2014
2- Welcome
- Introductions
- Housekeeping Items
3HHSC Procurement Roles
- PCS Responsible for procurement activity
- Program Responsible for project scope,
requirements, performance, results, contract
management/monitoring - HUB Responsible for HUB Subcontracting Plan
(HSP) requirements and evaluation - Legal Provides legal guidance and advice to the
agency
4Vendor Conference Overview
- Procurement Activities
- RFP Overview
- HUB Overview
- Questions
- Break
- Preliminary Responses to Questions
- Closing Comments
5- Procurement Activities
- Sole Point of Contact -- Section 1.2
- Procurement Schedule -- Section 1.3
- Solicitation Access http//www.hhsc.state.tx.us
/about_hhsc/BusOpp/BO_opportunities.asp - Submission Requirements Section 3.14
- Solicitation Changes
- Proposal Screening and Evaluation
- Award Information
6Sole Point of Contact
- The sole and only permissible point of contact
for inquiries concerning this RFP is Richard
Blincoe. - As a reminder, all communications relating to
this RFP must be directed to the sole point of
contact for this procurement. Failure to comply
with these requirements may result in proposal
disqualification.
7Procurement Schedule
- RFP Release Date
- Vendor Conference
- Respondent Questions Due
- Post Response to Questions (est.)
- Proposals Due (200 P.M. Central Time)
- Deadline for Proposal Withdrawal
- Tentative Award Posting (est.)
- Anticipated Contract Effective Date
- July 18, 2014
- July 31, 2014
- August 5, 2014
- September 16, 2014
- October 30, 2014
- October 30, 2014
- To Be Announced
- September 1, 2015
8Request for Proposals No. 529-13-0071
- RFP Overview
- STAR Kids Overview
- RFP Mission
- Contract Terms
- Eligible Populations
- Scope of Work
- Evaluation Criteria
9STAR Kids Overview
- Senate Bill 7, 83rd Legislature, Regular Session,
2013, directs HHSC to establish a mandatory,
capitated STAR Kids managed care program tailored
to provide Medicaid benefits to children and
young adults with disabilities. - S.B. 7 also calls for the inclusion of the
Medically Dependent Children Program (MDCP) and
requires HHSC to consult with the STAR Kids
Medicaid Managed Care Advisory Committee and
Childrens Policy Council on the establishment
and implementation of the program.
10STAR Kids Overview
- The members that will be served through STAR Kids
have diverse strengths and challenges. As such,
services and supports provided to STAR Kids
members must reflect broad differences in
diagnoses, conditions, prior treatments,
development, environment, age, family dynamics,
and geography. - By working with Members and their families, STAR
Kids MCOs will customize and coordinate acute,
behavioral, and long-term services and supports
(LTSS) through an individualized planning and
service design process. Through comprehensive
service coordination, STAR Kids Members will
receive services and supports tailored to their
individual needs.
11RFP Mission
- The purpose of this procurement is to contract
with multiple Managed Care Organizations (MCOs)
to establish the STAR Kids Medicaid managed care
program. - HHSCs mission for the STAR Kids program is to
enable STAR Kids members to live and thrive in a
setting that maximizes their health, safety, and
overall well-being.
12RFP Mission
- STAR Kids is established with the following
goals - Coordinate care across service arrays
- Improve quality, continuity, and customization of
care - Improve access to care and provide
person-centered Health Homes - Improve ease of program participation for
Members, MCOs, and Providers - Improve Provider collaboration and integration of
different services - Improve Member outcomes to the greatest extent
achievable - Prepare young adults for the transition to
adulthood - Foster program innovation and
- Achieve cost efficiency and cost containment.
13Contract Terms
- HHSC will award one contract per MCO, which will
include all awarded MCO service areas. The
initial contract period will be for three years. - HHSC reserves the right to extend the contract
period, not to exceed a total of eight
operational years. - All STAR Kids MCOs must begin serving members on
the operational start date.
14Eligible Populations
- Children and young adults under age 21 who
receive Social Security Income (SSI) or Home and
Community-based Services (HCBS) Waiver program
services must enroll in STAR Kids. - Children and young adults who reside in an
Intermediate Care Facility for Individuals with
Intellectual Disabilities (ICF/IID) must also
enroll in STAR Kids.
15Eligible Populations
- Medically Dependent Childrens Program (MDCP)
participants will receive all of their services
through STAR Kids, including long-term services
and supports (LTSS) provided through MDCP. - Children and young adults enrolled in other HCBS
Waiver programs or who receive services through
an ICF/IID will receive Medicaid State Plan
services and service coordination through STAR
Kids, but will separately receive LTSS specific
to their program. - Excluded populations include children in state
conservatorship and individuals under 21 who
reside in nursing facilities.
16Scope of Work
- Covered Services
- The MCO must comply with all contract provisions
including all applicable state and federal laws,
rules, regulations, and waivers. - The MCO must provide full coverage of medically
and functionally necessary covered services to
all members in accordance with contractual
requirements. - The MCO may propose value-added services and
case-by-case added services that compliment the
provision of medically and functionally necessary
covered services.
17Scope of Work
- Access to Care
- The MCO must have network PCPs, behavioral
health, specialty, pharmacy, and home and
community-based providers in sufficient number
and capacity. - Appointments for covered services must be
provided within contractually specified
timeframes. - Members must be provided access to out-of-network
services if medically necessary covered benefits
are not available within the network.
18Scope of Work
- Provider Network
- The MCO must enter into written contracts with
properly credentialed providers. - The MCO must maintain a provider network
sufficient to provide all members with access to
the full range of covered services required under
the contract. - The MCO must enter into contracts with any
willing Significant Traditional Provider (STP)
and develop short and long-term strategies to
increase access to qualified providers. - The MCO will include telemedicine providers in
its network to increase access to care in rural
or underserved areas.
19Scope of Work
- Primary Care Providers (PCPs) and Health Home
- All STAR Kids members must be provided with a
patient and family-centered PCP. - STAR Kids PCPs must coordinate with other
relevant parties to ensure members physical and
behavioral health needs are met. - MCOs must also provide access to a health home
for all members who will benefit from a health
home. - MCOs must develop specific incentives for
providers who meet the requirements for
patient-centered medical homes found in Texas
Government Code 533.0029.
20Scope of Work
- Member Services and Materials
- The MCO must have a member services department to
assist members in obtaining covered services. - Member services must include a member hotline,
nurse hotline, and behavioral health hotline as
well as member education and a member complaints
and appeals process. - Member materials must include a member
identification card, member handbook, provider
directory, welcome letter, and an internet
website. - The MCO must also establish member advisory
groups to identify and address needs and goals of
STAR Kids members.
21Scope of Work
- Clinical and Administrative Advisory Committee
- The MCO must establish Clinical and
Administrative Advisory Committees in each STAR
Kids service area served. - Clinical and Administrative Advisory Committees
must be used to help review and improve clinical
and administrative practices. - Membership in a Clinical and Administrative
Advisory Committee must include the following
provider types PCP, specialty care, behavioral
health, home and community support services,
therapy provider, medical equipment and supplies,
and pharmacy.
22Scope of Work
- Management and Information Systems (MIS)
- The MCO must maintain a MIS to support the
following operational and administrative areas - Enrollment/Eligibility Subsystem
- Provider Subsystem
- Encounter/Claims Processing Subsystem
- Financial Subsystem
- Utilization/Quality Improvement Subsystem
- Reporting Subsystem
- Interface Subsystem
- Third Party Recovery (TPR) Subsystem
23Scope of Work
- Continuity of Care
- The MCO must ensure that the healthcare of newly
enrolled Members is not disrupted, compromised,
or interrupted. - The MCO must ensure new Members have continued
authorization of services for the same amount,
duration, and scope for the shortest period of
one of the following (1) 90 calendar days after
the transition to a new MCO, (2) until the end of
the current prior authorization, or (3) until the
MCO has appropriately evaluated and administered
the STAR Kids Screening and Assessment Process
and issued or denied a new authorization. - The MCO must ensure members receiving
community-based services prior to the operational
start date continue to receive those services for
up to six months after the Operational Start Date.
24Scope of Work
- Service Coordination
- Service coordination provides the Member with
initial and ongoing assistance identifying,
selecting, obtaining, coordinating, and using
covered services and other supports to enhance
the Member's well-being, independence,
integration in the community, and potential for
productivity. - Service coordinators must work with PCPs, network
providers and other resources to help address the
full spectrum of a members needs. - Upon identification of need or member request,
members must be provided with access to a named
service coordinator and comprehensive service
coordination teams.
25Scope of Work
- Service Coordination
- The MCO must ensure that Service
Coordinator-to-Member ratios are clinically
appropriate and evidence-informed. - The MCO may allow a member to receive service
coordination through an integrated health home if
the individual providing service coordination and
the service coordination structure meet STAR Kids
program requirements. - For members who receive non-capitated HCBS waiver
services, STAR Kids service coordinators must
communicate regularly with the DADS or DSHS staff
members or contractors responsible for overseeing
the members HCBS waiver services.
26Scope of Work
- Individual Service Plan (ISP)
- Each STAR Kids MCO must create and regularly
update a comprehensive person-centered ISP for
each STAR Kids member. - The purpose of the ISP is to articulate
assessment findings, short and long-term goals,
service needs, and member preferences. - The ISP must be used to communicate and help
align expectations between the member, their LAR,
the MCO and key service providers. - The ISP may also be used by the MCO and HHSC to
measure Member outcomes over time.
27Scope of Work
- Adult Transition Planning
- The MCO must help to assure that teenage and
young adult Members receive early and
comprehensive transition planning to help prepare
them for service and benefit changes that will
occur following their 21st birthday. - Each MCO is responsible for conducting ongoing
transition planning starting when the Member
turns 15 years old. - MCO staff must include Transition Specialists
dedicated to counseling and educating Members and
others in their support network about
considerations and resources for transitioning
out of STAR Kids.
28Scope of Work
- STAR Kids Screening and Assessment Requirements
- All STAR Kids MCOs are responsible for conducting
comprehensive, holistic, and evidence-based
service needs assessments for all Members. - A key component of the process is use of the STAR
Kids Screening and Assessment Instrument (SAI). - The STAR Kids SAI encompasses four modules the
Core, the Personal Care Assessment Module (PCAM),
Nursing Care Assessment Module (NCAM), and the
MDCP Module. - All STAR Kids members must receive the Core,
which will indicate if there is need for the
PCAM, NCAM or other screenings or assessments.
29Scope of Work
- Medically Dependent Children Program (MDCP)
- MDCP STAR Kids provides community-based LTSS for
individuals under the age of 21 with complex
medical needs as a cost-effective alternative to
living in a Nursing Facility. - The MCO must provide all covered services
included in the MDCP service array for all MDCP
STAR Kids members. - The MCO will use STAR Kids SAI MDCP Module to
help determine eligibility and an annual cost
limit for each MDCP member. - As a part of the ISP planning process, the MCO
must establish an MDCP plan of care as a part of
the STAR Kids ISP that does not exceed the
Member's cost limit.
30Evaluation Criteria (Section 5.3)
- HHSC will evaluate each proposal using the
following criteria, in descending order of
priority, developed from the best value factors
listed in Section 2 of the RFP. - The extent to which the goods and services meets
HHSCs needs and the needs of the Members for
whom the goods and services are being purchased - Indicators of probable vendor performance
- Effect of the acquisition on agency productivity
and, - Delivery terms.
31HUB Subcontracting Plan(HSP) Requirements
32Historically Underutilized Business
ParticipationAgenda Topics
- RFP Section 4.2.5 Historically Underutilized
Business Participation Requirements - HUB Subcontracting Plan Development and
Submission - HSP Quick Checklist Handout
- HSP Methods
- HUB Subcontracting Notification Form
- III. HSP Prime Contractor Progress Assessment
Report
33Historically Underutilized Business Participation
- Historically Underutilized Business
Participation Requirements
34Historically Underutilized Business Participation
- Historically Underutilized Business
Participation Requirements - HUB Participation Goals Section 4.2.5.3
- Potential Subcontracting Opportunities Section
4.2.5.5 - Centralized master Bidders List and HUB directory
Section 4.2.5.5 - Vendor Intends to Subcontract Section 4.2.5.6
35Historically Underutilized Business Participation
- Historically Underutilized Business
Participation Requirements (cont) - Minority or Women Trade Organizations Section
4.2.5.6.2 - Self Performance Section 4.2.5.7
- HSP Changes After Contract Award Section
4.2.5.8 - Reporting and Compliance with the HSP Section
4.2.5.8
36Historically Underutilized Business Participation
- HUB Subcontracting Plan (HSP)
- Development and Submission
- Note All Respondents must submit a HSP
regardless if its intent is to subcontract or
self perform all the work under the Contract.
37Historically Underutilized Business Participation
- HUB Subcontracting Plan (HSP)
- Development and Submission
- Note All Respondents must submit a HSP
regardless if its intent is to subcontract or
self perform all the work under the Contract.
38If HSP is inadequate, response will be rejected
HUB GOALS
Special reminders and instructions
HSP Information Page
39Historically Underutilized Business Participation
- HSP Quick Checklist
- See Checklist Handout
40Historically Underutilized Business Participation
- ii. HSP Methods
- Note
- There are five (5) Method Options to choose from
in order to develop and submit the HSP. - Respondents should indicate their response which
Method Option was selected.
41Historically Underutilized Business Participation
- Method Options
- Respondent may choose from one of the following
methods when completing the HSP - Method I if 100 of your subcontracting
opportunities will be performed using only HUB
vendors - Method II if one or more of the subcontracting
opportunities identified will be performed using
HUB protégés - Method III if a combination of HUBs and
Non-HUBs are used to perform the subcontracting
work identified AND the HUB goal identified in
the solicitation is met or exceeded
42Historically Underutilized Business Participation
- Method Options
- A Respondent may choose from one of the following
methods when completing the HSP (cont.) - Method IV if a combination of HUBs and Non-HUBs
are used to perform the subcontracting work
identified AND the HUB goal identified in the
solicitation is not met or exceeded and - Method V - if the Respondent intends to self
perform all of the work utilizing their own
resources, equipment, employees, and supplies.
43Historically Underutilized Business Participation
- All Methods
- For ALL Methods the following steps are required
to be completed on the HSP Form - Page 1 - Section 1 - Respondent and Requisition
Information. - Page 2 - Company and Requisition Information.
- Page 2 - Section 2(a) Subcontracting
Intentions. - Section 4 Affirmation and Sign.
44Historically Underutilized Business Participation
- All Methods
- For ALL Methods the following steps are required
to be completed on the HSP Form - Page 1 - Section 1 - Respondent and Requisition
Information. - Page 2 - Company and Requisition Information.
- Page 2 - Section 2(a) Subcontracting
Intentions. - Section 4 Affirmation and Sign.
45Step by Step
HSP Information Page
Respondent and Requisition Information
46Company Name and Requisition
Subcontracting Intentions Declaration Check
Yes if you plan to subcontract Check No
if you will not be subcontracting any portion of
the contract
47Historically Underutilized Business Participation
- All Methods
- For ALL Methods the following steps are required
to be completed on the HSP Form - Page 1 - Section 1 - Respondent and Requisition
Information. - Page 2 - Company and Requisition Information.
- Page 2 - Section 2(a) Subcontracting
Intentions. - Section 4 Affirmation and Sign.
48Step by Step
Section 4 Affirmation
Signature Affirms that Information Provided
is True and Correct.
49METHOD I
- If all (100) of your subcontracting
opportunities will be performed using only HUB
vendors, complete - All of the steps in Sections 1, 2, and 4 of the
HSP. - Section 2 b. List all the portions of work you
will subcontract, and indicate the percentage of
the contract you expect to award to HUB vendors. - Section 2 c. Yes.
- HSP GFE Method A (Attachment A) Complete this
attachment for each subcontracting opportunity.
50Step by Step
Complete Section 2-b List all the portions of
work you will subcontract, and indicate the of
the contract you expect to award to all HUBs.
Complete Section 2-c Yes if you will be using
only HUBs to perform all Subcontracting
Opportunities in 2-b.
51HSP GFE Method A (Attachment A)
Complete this attachment (Sections A-1 and A-2)
and List Line and Subcontracting Opportunity.
HUB Subcontractor Selection for this
Subcontracting Opportunity
52METHOD II
- If any of your subcontracting opportunities will
be performed using HUB protégés, complete -
- All of the steps in Section 1, 2 and 4 of the
HSP. - Section 2 b. List all the portions of work you
will subcontract, and indicate the percentage of
the contract you expect to award to HUB vendors. - HSP GFE Method B (Attachment B) Complete
Section B-1, B-2 and B-4 only for each
subcontracting opportunity as applicable.
53Step by Step
Complete Section 2-b List all the portions of
work you will subcontract, and indicate the of
the contract you expect to award to HUB Protégés.
Skip Sections 2-c and 2-d.
54HSP GFE Method B (Attachment B)
Complete Sections B-1 and B-2 only for each
HUB Protégé subcontracting opportunity.
55HSP GFE Method B (Attachment B)
B-4 List the HUB
Protégé(s) Selected to perform the
subcontracting opportunity
56METHOD III
- If you are subcontracting with HUBs and Non-HUBs,
and the aggregate percentage of subcontracting
with HUBs in which the HUB Goal identified in the
solicitation is met or exceeded , complete - All of the steps in Section 1, 2, and 4 of the
HSP. - Section 2 b. List all the portions of work you
will subcontract, and indicate the percentage of
the contract you expect to award to HUB vendors
and Non HUB vendors. - Section 2 c. No.
- Section 2 d. Yes.
- HSP GFE Method A (Attachment A) Complete this
attachment for each subcontracting opportunity.
57Step by Step
Complete Section 2-b List all the portions of
work you will subcontract, and indicated the of
the contract you expect to award to HUBs and
Non-HUBs.
Complete Section 2-c No, to using only HUBs to
perform all Subcontracting Opportunities in 2-b.
58Step by Step
Complete Section 2-d No, to the Aggregate of
the contract expected to be subcontracted to HUBs
to meet or exceed the HUB goal, which you have a
contract agreement in place for five (5) years or
less.
59 HSP GFE Method A (Attachment A)
Complete this attachment (Sections A-1 and A-2)
for each subcontracting opportunity.
Subcontractor Selection (HUBs and Non-HUBs)
60METHOD IV
- If you are subcontracting with HUBs and Non-HUBs,
and the aggregate percentage of subcontracting
with HUBs, holding an existing contract with HUBs
for 5 years or less, does not meet or exceed the
HUB Goal identified in the solicitation,
complete - All of the steps in Section 1, 2, and 4 of the
HSP - Section 2 b. List all the portions of work you
will subcontract, and indicated the percentage
of the contract you expect to award to HUB
vendors and Non HUB vendors - Section 2 c. No
- Section 2 d. No
- HSP GFE Method B (Attachment B) Complete this
attachment for each subcontracting opportunity.
61Step by Step
Complete Section 2-b List all the portions of
work you will subcontract, and indicated the of
the contract you expect to award to HUBs and
Non-HUBs.
Complete Section 2-c No, to using only HUBs to
perform all Subcontracting Opportunities in 2-b.
62Step by Step
Complete Section 2-d No, to the Aggregate of
the contract expected to be subcontracted to HUBs
to meet or exceed the HUB goal, which you have a
contract agreement in place for five (5) years or
less.
63HSP GFE Method B (Attachment B)
Complete Section B-1 and Section B-2 only
for each subcontracting opportunity.
Good Faith Efforts to find Texas Certified HUB
Vendors
64HSP GFE Method B (Attachment B)
Written Notification Requirements
List 3 HUBs Contacted for this
Subcontracting Opportunity
65HSP GFE Method B (Attachment B)
Written Notification To Trade Organizations
66HSP GFE Method B (Attachment B)
List Trade Organizations Notified with Dates
Sent/Accepted.
67HSP GFE Method B (Attachment B)
Provide written justification why a HUB was not
selected for this Subcontracting Opportunity
68METHOD V
- If you are not subcontracting any portion of the
contract and will be fulfilling the entire
contract with your own resources (i.e.,
equipment, supplies, materials, and/or
employees), complete - All of the steps in Section 1, 2, and 4 of the
HSP. - Section 3 Self Performing Justification,
-
69Section 3 Self Performing Justification
List the specific page(s)/section(s) of your
proposal response, OR in the space provided,
which explains how your company will perform the
entire contract with its own equipment, supplies,
materials and/or employees.
70iii HUB Subcontracting Opportunity Notification
Form
71Sample for Respondents Use.
72III. HSP Prime Contractor Progress Assessment
Report Section 4.2.5.8
73HSP Prime Contractor Progress Assessment Report
- Required with
- ALL Pay Requests
- List ALL Sub
- payments
- (HUBs Non-HUBs)
- Required even if
- not subcontracting
74- Questions Submittal
- Followed by Break
75Vendor Question/Response
- Verbal answers to vendor questions will be
provided to the extent practicable. - Responses are not binding until the final written
responses are posted on the HHSC website.
76