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1542332-238125Florida Healthy Kids CorporationINVITATION TO NEGOTIATE 2020-300-01forDental Services and CoverageADDENDUM 1April 20, 2020In accordance with Subsection 3.O of ITN 2020-300-01 for Dental Services and Coverage (“ITN”), Addendum 1 to the ITN is as follows:The Calendar of Events in Subsection 1.F is replaced in its entirety as follows:EventAnticipated DateTime(Eastern)FHKC releases this ITN03/31/2020Respondent deadline to submit questions regarding the ITN via email to the issuing office04/08/20203:00 p.m.FHKC posts answers to Respondents’ questions at deadline to submit Letter of Intent 06/01/20203:00 p.m.Respondent deadline to submit proposal 06/15/20203:00 p.m.Evaluations06/16/2020 through 07/10/2020Negotiations7/20/2020 through08/07/2020Notice of Contract Award – Public MeetingSeptember 2020Effective Date of Services04/01/202112:00 a.m.Item 9 in Subsection 4.D. is hereby deleted in its entirety and replaced as follows:9. Clinical Services. Describe Respondent’s policies and procedures relating to clinical services performed by Providers, including:The utilization controls used to reduce the number of unnecessary services performed;The procedure for handling emergency admission requests, including authorizations; How gaps in care are identified and addressed; Handling requests for second opinions;How reminders are sent to patients and/or dentists to encourage appropriate health actions; andHow children potentially eligible for the Children’s Medical Services Network are identified and referred or directed.Attachment 8: Network Information is replaced in its entirety by Revised Attachment 8: Network Information. FHKC’s answers to Respondents’ questions begin on page 3 of this addendum. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK?Document(e.g., ITN,Proposed Contract)SectionPageNumber QuestionFHKC Response1ITN1. Introduction, D. Procurement Overview, 2. Funding and Enrollment8What is the current funding allocation for insurers providing services under FHKC?? Please break out the allocation by FHK CHIP Plan and FHK Full-Pay Plan.Pursuant to Ch. 2019-115, Laws of Florida, the current legislative funding for dental services is $15.27 PMPM for state fiscal year 2019-20. There is no state or federal allocation for full-pay enrollees. Families are responsible for the entire cost of the full-pay premiums. Please see Attachment 2: FHK Member Demographic Summary for the break-out of full-pay enrollees and subsidized enrollees. 2ITN1. Introduction, D. Procurement Overview8Can FHKC provide a current network directory in Excel and provider fee schedules for the three current insurers?No, FHKC does not have current network directories or provider fee schedules. 3ITN112 of 72The Calendar of Events states the proposal is due on 5/4/2020 at 3:00pm, however, the cover page (page 1) says the proposal is due 5/4/2020 at 10:00am. Can you please clarify the time the proposal is due on 5/4/2020? The proposal is due at 3:00 p.m.4ITN3. General Instructions to RespondentsPage 18Page 18 (FHKC’s Response to Public Records Requests) states that “IF A RESPONDENT FAILS TO SUBMIT A REDACTED COPY OF ANY DOCUMENT OR RECORD, OR PORTIONS THEREOF, FOLLOWING THE INSTRUCTIONS SET FORTH IN THIS ITN, FHKC IS AUTHORIZED TO RELEASE THE DOCUMENT OR RECORD IN RESPONSE TO A PUBLIC RECORDS REQUEST WITHOUT NOTIFYING THE RESPONDENT.” Please confirm that no Respondent materials will be made public while the procurement remains open.Confirmed.5ITN4. Submission requirements, A Overview22With the Governor of Florida issuing an executive "essential services and activities" order and given that the vast majority of states are under similar orders, would FHKC please consider changing the requirement of submitting hard copy proposal documents, and instead allowing bidders to submit their completed proposals via the Secure Partner Connect site? Yes. Respondents may forego providing a hard copy proposal. Responses uploaded to FHKC's Secure Partner Connect site are considered sealed Responses. 6?ITN4. Submission requirements, A Overview22The ITN states: "Proposal text must be blue or black and at least 12 pt. Calibri or Times New Roman font." Is this instruction inclusive of tables/charts, or may we use a smaller font for those?This instruction is inclusive of tables and charts.7ITN4. Submission Requirements, B. Submittal of Proposals 22Will FHKC accept electronic submissions and waive hard copy submittals in light of the current stay-at-home orders?See answer to question 5. 8ITN4. A.22In sections that require responses, must the bidder include the instructions for each section along with the questions?Respondent is not required to copy and paste the instructions for each section along with the questions. 9ITN4.C23-24Section 4.C of the ITN requires that respondents submit two hard-copy proposals, in addition to electronic copies. Considering safety concerns regarding the COVID-19 public health emergency, will FHKC consider waiving the hard copy submission requirements and accept proposals via the secure electronic upload to the portal?See answer to question 5. 10ITN4.C; 4.D, Tab C-524, 30Page 30 of the ITN (Tab C, Tab 5) requires that respondents provide at least three references. Section 4.C (bullet: Tab C-5) states that the reference form should be "completed for five references, each within the last two years." Please clarify how many references are required for submission. Three references are required. 11ITN4.C and 4.D24-25Page 24 lists “Attachment 5: Certification Regarding Lobbying” as a requirement of Tab A, however page 25 does not list this attachment under Tab A. Please confirm that Tab A, subitem 5, should be “Attachment 5” and “A copy of Respondent’s Letter of Intent” should become subitem 6.Confirmed.12ITN4.D, Tab B26For minimum qualifications, items 4 and 5, the required label for the submission of proof for these items appears to be one number off (3 and 4, instead of 4 and 5, respectively). Please confirm if these labels can be updated in the response.Confirmed. The attachment for minimum qualification #4 should be labeled "[Company Name] Minimum Qualification 4" and the attachment for minimum qualification #5 should be labeled "[Company Name] Minimum Qualification 5."13ITN426 of 72Tab B, Minimum Qualifications, question 4 states to submit proof of registration or certification labeled as “[Company Name] Minimum Qualification 3” when it is question 4. Should the Respondent still submit per the instructions in the ITN with titling the document “[Company Name] Minimum Qualification 3”?See answer to question 12.14ITN426 of 72Tab B, Minimum Qualifications, question 5 states to submit proof of accreditation as “[Company Name] Minimum Qualification 4” when it is question 5. Should the Respondent still submit per the instructions in the ITN with titling the document “[Company Name] Minimum Qualification 4”?See answer to question 12.15?ITN4. Submission requirements, Tab C-1, question 227The ITN states we must: "List other clients of Respondent for whom Respondent has provided insured dental benefits and member services for Medicaid, CHIP, or similar programs within the last five years." No. Respondents are not required to list all clients served within the last five years. Respondent must provide its client list within the page limit. Some bidders may have extensive client lists, while others may only have a few. Would FHKC consider permitting this information be included as an attachment that would not count against the page limit for this section?16ITN4.D, Tab C-1, #1128Tab C-1, Question 11, requires respondents to "provide the most recent security risk assessment conducted by an independent third party." Please confirm that this assessment is excluded from the 10 single-sided page limit for Tab C-1 (Corporate Profile). This assessment alone is lengthy and exceeds the page limit. Confirmed. The assessment is excluded from the 10-page limit for Tab C-1.17?ITN4. Submission requirements, Tab C-1, question 1128The ITN states: "Provide the most recent security risk assessment conducted by an independent third party. Acceptable security risk assessments must include the dates of the assessment; the standards assessed, such as those from the National Institute of Standards and Technology; findings; and any corrective actions taken or scheduled. If Respondent has not undergone such a security risk assessment, Respondent should indicate as such and describe any plans for conducting such an assessment." See answer to question 16.Can FHKC please confirm the most recent risk assessment document is excluded from the 10 limit page count for this section? 18ITN4.D, Tab D34Please confirm that if respondent chooses to include supporting attachments, that these attachments would be exempt from the 100 page limit.?Bullet #4 on page 34 of the ITN identifies the attachments that do not count toward the page limit.19ITN4.D, Tab D, Item 636For item 6, Security Compliance, please confirm that there is only one sub-item (a).?Confirmed.20?ITN4: Tab D: Technical Information, subsection 9.b Clinical Services37The ITN states: "Describe Respondent’s clinical services, including: b. The procedure for handling emergency admission requests." Please see item 2 in Addendum 1 to the ITN.Should bidders interpret this to mean "what is the process for emergency dental authorizations?" If not, please advise what information FHKC is seeking as it relates to "emergency admissions." 21ITN437 of 72In regards to question 12(c), alternate delivery systems performed by licensed or qualified dental professionals are typically referred to as "teledentistry." For purposes of this ITN, is the intent of the term “telehealth” to reflect services of teledentistry as provided by licensed dental professionals, as opposed to telehealth, which does include dentists, but more commonly is used for those providing medical services that are typically performed in a medical setting?The term "telehealth" as used in question 12.c. includes teledentistry and is used within the context of the provisions of the Draft Contract, including Covered Benefits.22ITN4.D.15 (Quality Protocols) 38-39AHRQ does not have a CAHPS survey specific to the Medicaid and CHIP population. Would FHKC consider accepting an alternative source of member satisfaction scores in lieu of CAHPS results?Respondents may provide alternate member satisfaction scores in lieu of CAHPS results. 23ITN439 of 72Question 16(a) on the Call Center asks how rollover calls are handled. Can you please clarify how you define rollover call?When the call volume at the primary call center site exceeds the site’s ability to handle calls, the calls roll over to another site.24ITN541 of 72For Section 5, Rate Submission, what membership weight per region should be used by a Respondent in developing its blended PMPM rate for all regions? Should the Respondent assume 50% of the membership in each region? Respondent is responsible for projecting membership weight per region when developing its bid. Respondent is not guaranteed any specific percentage of membership or mix of subsidized and full-pay enrollees. See pages 5 and 9 of the ITN and attachment 2: FHK Member Demographic Summary for information that may be helpful in developing this aspect of the response. 25ITN541 of 72For Section 5, Rate Submission, is FHK expecting separate pricing for the FHK CHIP members and FHK Full-pay Plan members or should the pricing for both be blended together? Respondent must provide blended pricing for CHIP and full-pay enrollees. 26ITN6 (Network Access)42Requirement states: “Respondent must submit the access rate by county for each provider type (pediatric dentist, general dentist, and orthodontists) by time and distance and urban and rural measurements.” However, the actual spreadsheet template only requires that we complete a listing of provider name, NPI, address, telephone, and specialty. There is no template where we complete access rates. Please clarify. Respondents should submit the information required in Attachment 8: Network Information. FHKC's consultant, Qsource, will calculate access rates for each Respondent. 27ITN642 of 72The first paragraph mentions that Respondent must submit the access rate by county for each provider type by time and distance and urban and rural measurements. What template should Respondent use for this report?See answer to question 26.28ITN642 of 72The first paragraph mentions that Respondent must submit the access rate by county for each provider type by time and distance and urban and rural measurements. What access standards should Respondent use for this report?See answer to question 26.29ITN642 of 72Section 6 and Attachment 8 only mention pediatric dentists, general dentists, and orthodontists. However, the incumbents are required to report routinely on other dental specialties such as oral surgeons. Please confirm that Section 6 and Attachment 8 only apply to pediatric dentists, general dentists, and oral surgeons. Confirmed.30ITN7. Evaluation of ProposalsPage 43-45Will FHKC please provide a breakdown of scoring criteria and weight assigned to each section of the technical proposal?Refer to Section 7.A. of the ITN.31??Attachment 1 – Draft ContractSection 1.6, Definitions16Please confirm that the definition of Subcontract does not include contracts for ancillary services where Vendor (or Respondent) is fulfilling the obligations under the FHKC Contract. Not confirmed. The entities cited as examples in this question are Subcontractors under the draft contract.For example, if Vendor (Respondent) contracts with an exclusion screening platform, but Vendor (Respondent) is responsible for determining and acting on excluded parties, the contract with the exclusion screening platform is not a Subcontract for purposes of the FHKC Contract. Similarly, if Vendor (Respondent) contracts with a CVO to conduct provider primary source verification, but Vendor (Respondent) is solely responsible for all aspects of Credentialing, the CVO is not a Subcontractor for purposes of the FHKC Contract.In both examples, the Vendor (Respondent) is performing/fulfilling obligations under the Contract, and the contracted entities are providing ancillary services only Subcontractor: any individual or entity, including an independent contractor, that has an agreement with Insurer to perform or fulfill any of the obligations of Insurer under this Contract. The term “Subcontractor” includes Vendor’s subsidiaries and affiliates. A network Provider is not a Subcontractor by virtue of the network Provider agreement with Insurer.32Attachment 1 Draft Contract3: Insurer Organization Administration, requirement 3.1730We respectfully request clarification with respect to the background screening requirements of Contract Section 3.17. As Section 435.04, F.S., is cited, it appears that this section of the Contract is drafted to be aligned with the Florida Statutes. The relevant Florida Statute, however, states that “All employees required by law to be screened pursuant to this section must undergo security background investigations as a condition of employment . . .” Thus, the statute is intentionally limited to employees that are already “required by law” to submit to level 2 screening. The federal regulation concerning screening levels based on risk levels for Medicaid providers, 42 CFR § 455.450, is also quite limited. Even though the regulation is specifically directed toward “providers” as opposed to employees of insurers or benefits providers, it may be relevant, as it is the source of the requirements for “high categorical risk” or level 2 background screening, which includes a criminal background check and fingerprinting. As such, we respectfully request guidance on the necessity for level 2 background screening of “each of [Insurer’s] employees, Subcontractor personnel, independent contractors, leased employees, volunteers, licensees, or other persons (hereinafter referred to as “Person” or “Persons”) who directly or indirectly perform Services under the Contract, regardless of whether the Person has direct or indirect Access to Data or perform Services under the Contract.” Is it possible to limit this screening requirement to managing principals and executives of Insurer?The draft contract clearly identifies those persons who are required to undergo the level 2 screening. 33Proposed Contract22.683Can FHK please provide some insight on what it is looking for Respondents to offer as Value-add Services? Can FHK please provide some examples? No specific information about Value-add Services for the dental contracts will be provided. FHKC is able to provide examples of Value-add Services proposed in the most recent health plan ITN, which include non-emergency transportation services, CVS ExtraCare Health cards, water safety or swim lessons, and hypoallergenic bedding for enrollees with asthma. 34Attachment 1 Draft Contract24: Access to Care, requirement 24.5.193The requirement states: "Insurer shall participate in the Event Notification System (ENS) of the Florida Health Information Exchange." In our experience serving 800,000 child Florida Medicaid enrollees, we are only experience a notification rate of 0.0025% each month. Would FHKC consider making this an optional requirement? Alternatively, Since the ENS system has a subscription fee, and the health plans already get this data, can FHK require that the health plans share this data with the dental plans vs having the dental plans subscribe to the ENS service?This will be determined during negotiations. 35?Attachment 1 Draft Contract24: Access to Care, requirement 24.3 93Requirement states: "Insurer shall ensure all network Providers have an active Medicaid ID."This may be discussed during negotiations; however, for purposes of submitting network information in Revised Attachment 8, submit all network Providers regardless of Medicaid ID status.See Revised Attachment 8: Network Information. Approximately 8-10% of our network only takes CHIP, and not Medicaid. Would FHKC consider revising this language, or could FHKC please provide further explanation on the need for CHIP only providers to possess a Medicaid ID?36Attachment 1 Draft Contract24: Access to Care, requirement 24.9.1 96Please define what specialists will be considered under the "specialist" category, and is it an accumulated metric, or individual for each specialty type within? The specialist category is an aggregate category of dental specialists and is inclusive of all dental specialists other than orthodontists and pediatric dentists. 37Benefit ScheduleAttachment A1 – 4 Codes D9222, D9223, D9239, D9243, D9248Are the above codes covered by the health plan when the services are provided by an MD or cRNA?The dental plan's responsibility for the listed service codes when such services are provided by an MD or cRNA is dependent on the place of service. The health plans are responsible for such services when taking place in an inpatient setting, outpatient hospital setting, or ambulatory surgical center. The dental plan may contract with and pay for services provided by any health care practitioner, including dental care practitioners, acting within the scope of their license, and providing covered services within the scope of the Florida Healthy Kids benefit schedule. 38?Attachment A Benefit ScheduleRestorative Services section 3Requirement states: “Anesthesia is covered for restorative services only when not billed separately."Anesthesia is part of the restorative fee and should not be billed separately. Sedation is an adjunctive service that is not typically considered to be a routine component of restorative services. Can you please clarify this requirement? Does it mean local anesthesia is part of the restorative fee and cannot be billed or reimbursed separately? Or does it mean if a member has restorative services under sedation, the sedation services are not covered if billed separately? 39Attachment A Benefit ScheduleLimitations sectionAll Are the limitations per service or per group of services? For example, if a member is allowed one screening per 181 days, 1 assessment per 181 days – providers could do both (when in reality it should be one of either a screening or assessment per 181 days).? Covered services must be medically necessary. If one screening and one assessment within the same 181 days is not medically necessary, the plan should not cover the second service. If one assessment and one screening are both medically necessary, then both would be covered. 40Attachment B BAA All All To what extent is the BAA?subject to negotiation???FHKC is unable to answer this question. The BAA is subject to negotiation. 41Attachment C Performance GuaranteesPG-6: Enrollment Files 4Please clarify the calculation methodology, which states: "For purposes of determining compliance with this PG and for determining any financial consequences, Insurer shall report the number of days to process one hundred percent (100%) of enrollment files percentage of enrollment files."The instruction should read "Insurer shall report the number of days to process one hundred percent (100%) of enrollment files." Attachment 1: Draft Contract will be revised to reflect this change42Attachment 9 Ownership and Control InterestN/AN/APlease confirm if Respondents are to complete all three sheets for BOTH the Respondent AND its subcontractors, or are Respondents to complete sheet 1 (Ownership and Control) and sheet 3 (Managing employees) for the Respondent and only sheet 2 (Subcontractors) for its subcontractors.Respondents must complete the entirety of Attachment 9: Ownership and Control Interest for the Respondent and its Subcontractors. 43All documents requiring signaturesAll applicable sectionsAll corresponding page numbersFor portions of the ITN that require signatures, will digital (electronic) signatures be accepted?Electronic signatures that comply with Florida law are acceptable. Further, FHKC waives all notary requirements in the ITN. 44Attachment 10 – FHK Databook Narrative3.2 – Financial Data Limitations6Given the information provided in this section, will FHKC issue a revised Attachment 10 – FHK Databook?No.To the extent this Addendum 1 conflicts with any previous written or oral ITN specifications, instructions, or information provided by FHKC, this Addendum 1 shall control.REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANKAny party that has standing to challenge an FHKC Intended Decision must file a written notice of intent to protest, formal written protest, and any required bond or other security as set forth in Appendix B of the Invitation to Negotiate. Failure to timely file a notice of intent to protest, formal written protest, or any required bond or other security shall constitute a waiver of proceedings. ................
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