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Kyle L. Janek, M.D., Executive Commissioner

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Title: Kyle L. Janek, M.D., Executive Commissioner


1
Kyle 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

3
HHSC 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

4
Vendor 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

6
Sole 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.

7
Procurement 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

8
Request for Proposals No. 529-13-0071
  • RFP Overview
  • STAR Kids Overview
  • RFP Mission
  • Contract Terms
  • Eligible Populations
  • Scope of Work
  • Evaluation Criteria

9
STAR 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.

10
STAR 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.

11
RFP 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.

12
RFP 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.

13
Contract 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.

14
Eligible 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.

15
Eligible 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.

16
Scope 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.

17
Scope 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.

18
Scope 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.

19
Scope 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.

20
Scope 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.

21
Scope 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.

22
Scope 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

23
Scope 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.

24
Scope 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.

25
Scope 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.

26
Scope 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.

27
Scope 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.

28
Scope 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.

29
Scope 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.

30
Evaluation 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.

31
HUB Subcontracting Plan(HSP) Requirements
32
Historically 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

33
Historically Underutilized Business Participation
  • Historically Underutilized Business
    Participation Requirements

34
Historically 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

35
Historically 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

36
Historically 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.

37
Historically 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.

38
If HSP is inadequate, response will be rejected
HUB GOALS
Special reminders and instructions
HSP Information Page
39
Historically Underutilized Business Participation
  • HSP Quick Checklist
  • See Checklist Handout

40
Historically 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.

41
Historically 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

42
Historically 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.

43
Historically 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.

44
Historically 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.

45
Step by Step
HSP Information Page
Respondent and Requisition Information
46
Company 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
47
Historically 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.

48
Step by Step
Section 4 Affirmation
Signature Affirms that Information Provided
is True and Correct.
49
METHOD 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.

50
Step 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.
51
HSP 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
52
METHOD 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.

53
Step 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.
54
HSP GFE Method B (Attachment B)
Complete Sections B-1 and B-2 only for each
HUB Protégé subcontracting opportunity.
55
HSP GFE Method B (Attachment B)
B-4 List the HUB
Protégé(s) Selected to perform the
subcontracting opportunity
56
METHOD 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.

57
Step 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.
58
Step 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)
60
METHOD 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.

61
Step 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.
62
Step 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.
63
HSP 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
64
HSP GFE Method B (Attachment B)
Written Notification Requirements
List 3 HUBs Contacted for this
Subcontracting Opportunity
65
HSP GFE Method B (Attachment B)
Written Notification To Trade Organizations
66
HSP GFE Method B (Attachment B)
List Trade Organizations Notified with Dates
Sent/Accepted.
67
HSP GFE Method B (Attachment B)
Provide written justification why a HUB was not
selected for this Subcontracting Opportunity
68
METHOD 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,

69
Section 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.
70
iii HUB Subcontracting Opportunity Notification
Form
71
Sample for Respondents Use.
72
III. HSP Prime Contractor Progress Assessment
Report Section 4.2.5.8
73
HSP 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

75
Vendor 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
  • Closing Comments
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