State Entity RFP Template



0-457200State of GeorgiaState Entity: Georgia Department of Community Health Request for Proposals (“RFP”)Event Name:??Medicaid Medical Coordination Program for the Aged, Blind, and DisabledeRFP (Event) Number: DCH0000099Introduction Purpose Pursuant to the State Purchasing Act (Official Code of Georgia Annotated §§50-5-50 et seq.), this Request for Proposal (“RFP”) is being issued on behalf of the Department of Community Health (DCH) to establish a Contract with a qualified Offeror for the provision of a Medical Coordination Program for eligible Medicaid Members who are aged, blind or disabled (Members).The selected Offeror may use one or more Subcontractors to deliver services throughout Georgia; however, DCH intends to sign only one Contract with the selected Offeror. To qualify for consideration, Offerors must meet the Mandatory Requirements established in RFP Attachment F.Figure 1 provides high-level activities and anticipated dates for implementing the Medical Coordination Program. Figure 1. Key Implementation ActivitiesNo.Key ActivityAnticipated DateConduct DCH and selected Offeror kick-off meetingMay 29, 2014Conduct Implementation and Planning, such as:Deploy communication / education plan Conduct Medical Coordination Program Readiness Review(s)May - October 2014Make “go/no go” decisionOctober 1, 2014Implement Medical Coordination ProgramNovember 3, 2014DCH is in the process of applying for a 1932(a) State Plan Amendment to secure federal authority to implement the Medical Coordination Program. Should federal authority not be received at the time of implementation, DCH will operate in compliance with the Code of Federal Regulations and State Plan allowances until such authority is received. BackgroundThe Department of Community Health (DCH) is the lead agency for Health Care planning, purchasing and oversight in Georgia. The Department’s Division of Medical Assistance is responsible for the administration of Georgia’s Medical Assistance Program (Medicaid), a jointly-funded cooperative venture between the federal government and the State which enables the State to provide medical assistance to low-income, individuals. As the Department’s largest division, Medicaid serves 1.8 million Georgians, and oversees program administration and funding for all Georgia Medicaid services.The objective of this procurement is to obtain the services of a qualified Offeror to provide a Medical Coordination Program for Medicaid Members who are aged, blind and disabled as identified by Members’ Categories of Aid. The successful Offeror is expected to achieve DCH’s healthcare goals and Member health outcomes, serve as an administrative agent of the State, and develop and implement DCH-approved cost-effective Utilization programs. The Department is seeking innovative and value-based solutions to meet these objectives.DCH's goals for this program are as follows:Improve health outcomes for MembersEnsure appropriate Utilization of Health Care resourcesAchieve long-term sustainable savingsThe methods that the selected Offeror shall minimally employ to achieve DCH’s goals include:Provide Person-centered Medical Coordination for all eligible MembersProvide Intensive Medical Coordination services for targeted high-risk, impactable populationsProvide a Medical Home to coordinate and manage care for participants receiving Intensive Medical Coordination servicesProvide Care Coordinators to assist eligible Members with obtaining needed medical services DCH will govern the procurement, development, implementation and operation of the Medical Coordination Program for the State of Georgia. DCH expects the selected Offeror to partner with other State agencies to coordinate the overlay of the proposed Medical Coordination Program with their programs and services. The successful Offeror must coordinate the provision of services with the partner State agencies, where applicable. Below are some of the key State agencies that the selected Offeror must involve in coordination efforts. The Georgia Department of Human Services (DHS) is responsible for delivery of human services throughout the State. The Department serves all Georgia citizens through regulatory inspection, direct service and financial assistance programs. The 8,000 employees manage over 60 programs in all 159 counties. DHS includes three Divisions and seven Offices. The Divisions are: Division of Family and Children Services (DFCS), Division of Child Support Services (DCSS) and Division of Aging Services (DAS).The Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) is responsible for providing treatment and support services to people with mental illnesses and addictive diseases, and support to people with mental retardation and related developmental disabilities. DBHDD serves people of all ages with the most severe and likely to be long-term conditions, including consumers with forensic issues. Services are provided across the State through contracts with 25 community service boards, boards of health and various private Providers, and through State-operated regional hospitals. The Divisions are structured by disability area and are as follows: Division of Mental Health, Division of Developmental Disabilities and Division of Addictive Diseases.The Georgia Department of Public Health (DPH) is the lead agency in preventing disease, injury and disability; promoting health and well-being; and preparing for and responding to disasters from a health perspective. At the State level, DPH functions through numerous divisions, sections, programs and offices. Locally, DPH funds and collaborates with Georgia's 159 county health departments and 18 public health districts. DPH's main functions include: health promotion and disease prevention; maternal and child health; infectious disease and immunization; environmental health; epidemiology; emergency preparedness and response; emergency medical services; pharmacy; nursing; and volunteer Health Care. The Office of Health Equity, Vital Records and the State Public Health Laboratory are within the Department of Public Health.Public Input Process and AnalysesThe procurement for a Medical Coordination Program for eligible Members is the result of extensive public input and program analyses. In August 2011, DCH began an effort to analyze the Medicaid program to identify opportunities to achieve efficiencies and to provide improved outcomes and quality of care for Members. These efforts include a transparent, collaborative process working with stakeholders through focus groups and ongoing taskforces to obtain insights about challenges and opportunities for improvement. Stakeholders with which DCH has collaborated include Medicaid Members, advocates, Providers, legislators and Offerors. DCH formed three task forces that meet regularly to provide input: Provider; Aged, Blind and Disabled; and Children and Families Task Forces. DCH also convened a Mental Health and Substance Abuse Workgroup. Common themes identified by these groups are as follows:Due to the often chronic and serious nature of their health issues, the ABD Population – including individuals in long-term care and disability programs – would significantly benefit from intensive Care Management approaches.Care Coordinators should be used to help all ABD Members obtain timely needed services.A true focus on quality and outcomes is critical to the success of the Medicaid program.A person-centered model with a holistic view of an individual’s needs is essential to quality outcomes.The ABD population is not homogenous in terms of their medical needs. Some Members are aged or have a disability, but they are otherwise healthy. Other Members of the ABD population have high acuity levels and intense medical needs. Due to the often chronic and serious nature of their health issues, the ABD Population – including individuals in long-term care and disability programs – would significantly benefit from intensive Care Management approaches.Member linkages to Patient-Centered Medical Homes are strongly encouraged for those who have the highest level of needs.Improved care coordination for Medicaid/Medicare dually-eligible Members is needed.As part of its review of the Medicaid program, DCH also conducted significant data analyses. In FY2013 the ABD Population represented twenty-nine percent (29%) of Medicaid enrollment, but sixty percent (60%) (or a total cost of $5.2 billion) of Medicaid spending. Findings specific to ABD Populations in conjunction with Stakeholders’ feedback contributed to DCH recognizing the need for improved medical coordination for these Members. (See Offerors’ Library.)In addition to these findings:Georgia is ranked in the top five states in the nation in the use of psychotropic drugs by individuals in nursing homes. In 2012, a telephone outreach effort to thirty (30) nursing homes with the highest rates of inappropriate use of antipsychotics resulted in a thirty-six percent (36%) reduction in use in those homes.The ABD Population has a high proportion of Members with a Behavioral Health diagnosis and/or with various comorbidities so that in general the ABD Population is more costly and high-risk than the traditional Medicaid population. DCH and its sister agencies have various initiatives and programs in place or in development to help address some of the above issues and to move individuals to more community-based care where appropriate. The successful Offeror is expected to have an expert knowledge of the Georgia Health Care landscape.Based on the combined results of public input, primary and secondary research, and Medicaid program analyses, DCH has determined a need for medical coordination options for ABD Populations in the Fee-for-Service delivery system. Program eligibility, including a description of the population to be served is described below.Program Eligibility/Overview of Population to Be Served DCH manages benefits for Members who qualify for an Aged, Blind, or Disabled Medicaid Category of Eligibility, including Adult Medically Needy, through a Fee-for-Service (FFS) delivery system. Currently, this population includes approximately 466,000 Members. With the exception of partial benefit dual eligible Members and those Members enrolled in the Georgia Families program, all other Georgia Medicaid Members will be eligible to receive services through the Medical Coordination Program. Thus, the Medical Coordination Program includes individuals who are dually eligible, enrolled in a Home- and Community-Based Services (HCBS) waiver program or residing in a long-term institutional setting. DCH and its sister agencies will continue to administer State Plan benefits and HCBS waiver programs and to provide related, non-conflicting case management services. Figures 2 and 3 provide enrollment and payment information for individuals who are eligible for the Program. Figure 2. Enrollment and Payments for Members who are Aged, Blind and Disabled, FY2013PopulationsEstimated EnrollmentNet PaymentsFee-for-Service Populations Eligible for Medical Coordination ProgramFFS Only (includes full benefit dual eligibles)251,526$2,160,886,880HCBS Waiver Program Enrollees42,170$1,237,139,912Residing in a Long-Term Care Institution26,776$1,201,659,544Fee-for-Service Populations Excluded From Medical Coordination ProgramPartial Benefit Dual Medicare and Medicaid Members in the following categories: Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB), and Qualifying Individuals 1 (QI1s)146,399$52,683,442Figure 3. Enrollment and Payments for Members who are Aged, Blind and Disabled, FY2012PopulationsEstimated EnrollmentNet PaymentsFee-for-Service Populations Eligible for Medical Coordination ProgramFFS Only (includes full benefit dual eligibles)249,067$2,157,333,292HCBS Waiver Program Enrollees44,104$1,229,024,061Residing in a Long-Term Care Institution25,225$961,492,375Fee-for-Service Populations Excluded From Medical Coordination ProgramPartial Benefit Dual Medicare and Medicaid Members in the following categories: Includes Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB), and Qualifying Individuals 1 (QI1s)138,118$101,525,930Members who are enrolled in Georgia Families, Qualifying Medicare Beneficiaries (QMBs) only, Specified Low-Income Medicare Beneficiary (SLMB) only and Qualifying Individuals 1 (QI1s) only, will be excluded from the Medical Coordination Program. Medicaid benefits will continue to be paid by DCH on a Fee-for-Service basis including those for Home- and Community-Based waiver services. Scope of Work Overview The successful Offeror is expected to conduct Predictive Modeling techniques to risk stratify eligible Members into an appropriate level of intervention. All Members will receive Core Coordination Services to include Member education, call center services and access to a twenty-four (24) hour nurse line. Members with chronic Conditions, Behavioral Health Conditions, co-morbidities or other complex diagnoses deemed “high-risk and impactable” will have the option to receive Intensive Medical Coordination services to include a Health Risk Assessment, establishment of a Health Care Plan, assistance with establishing a Medical Home and interdisciplinary team Care Management. The successful Offeror will provide to DCH for approval its recommendations for what constitutes high-risk and impactable based on its analyses, as well as the criteria and methodology employed to determine these recommendations. The successful Offeror will work with DCH to revise or adopt any changes to these recommendations over time. The successful Offeror is expected to utilize a holistic approach to include the coordination of physical Health Care and Behavioral Health care and to coordinate services with HCBS Waiver Services care managers; caregivers and family members; partner agencies; Providers; and others including federal, State, local and community resources. The focus is to ensure that Members receive the right care, at the right time in the right setting, by the appropriate caregiver. The Offeror will be expected to design and conduct interventions with not only the enrolled Members, but also the Providers who treat those Members. The Offeror will use their analytic capabilities to aggregate Provider Medicaid Member experience and intervene and support those Providers accordingly. For example, identifying and working with Providers who have a high non-compliance rate in clinically accepted standards of care, such as those diabetic patients where HgA1c measures/levels, foot exams, eye exams and LDL levels need improvement. Other responsibilities of the successful Offeror include Provider education; Provider recruitment (to fill gaps in the Medicaid Fee-for-Service network); Utilization Management; Quality Management; and the use of Provider performance-based incentives to improve quality outcomes.Below is a high-level summary of the successful Offeror’s responsibilities. Offerors must refer to RFP Attachment K: Requirements and Scope of Work for detailed scope of services. Under its Contract with DCH, the Offeror will: Provide an implementation Workplan and Member transition planProvide a range of coordination services for all Members, such as:Access to centralized Member Coordination call center servicesAccess to a Care Coordinator for assistance with issues such as locating Providers or services, coordinating with other service Providers, appointment scheduling and follow-up, and in general, navigating the Health Care system upon request. Care Coordinators will:Help Members who request assistance in locating a Medical Home or other Provider types, and upon request, assist in scheduling appointments with the identified Providers Provide information to and assist Providers and Members with accessing care and coordination of services for MembersEnsure Providers, Members and sister agencies have the information they need to make timely and appropriate decisions, referrals and authorizations to meet Member needs (e.g., information about community resources available to Members and how to connect with these resources)Contact prior Providers from whom the Care Coordinator may need information to identify Members’ service needsEducate Members about their needs and answer Member questionsAccess to a twenty-four (24)-hour nurse hotline Assistance with care coordination and access to primary, preventive, specialty and Crisis care, as neededCoordination with DCH sister agencies and their contractors (Agents) involved in administering services and benefit-specific case management to MembersMember outreach and education that is designed to better coordinate care and improve health outcomesMember Complaints resolution process Conduct initial and ongoing analysis of all eligible Medicaid Members to identify impactable, high-risk or potentially high-risk, or otherwise qualifying individuals who are in need of Intensive Medical Coordination Services, including: Predictive modeling and other data analyses Detailed Health Risk Assessments of Members identified as potentially in need of Intensive Medical Coordination servicesIdentifying, accepting and reviewing ongoing referrals from sources such as Providers, State Agencies and Member self-referral for Intensive Medical Coordination servicesProvide the following activities for Intensive Medical Coordination Participants:Implement a proven approach to engage Intensive Medical Coordination Participants in activities that incorporates outreach and education to Participants or Participants’ Authorized Representatives about the benefits of receiving these services as well as their option to decline servicesProvide services, outreach, education and supports based on Offeror identified and DCH approved stratification levelsUse results of Health Risk Assessments to determine the Intensive Medical Coordination Participant’s stratification level and type of services needed Form inter-disciplinary treatment teams to assist with development and implementation of individual Health Care Plans Assist Intensive Medical Coordination Participants with obtaining services outlined in the Health Care Plan and monitor ongoing progress of the Intensive Medical Coordination ParticipantAssign Medical Homes, which could be a Primary Care Provider (PCP), specialist or a Patient-Centered Medical Home (PCMH) based upon the needs of the Intensive Medical Coordination ParticipantDevelop, implement, and track transition of care plans to support Intensive Medical Coordination Participants’ continued engagement while transitioning between levels of Intensive Care CoordinationDevelop a Primary Care Case Management (PCCM) Network, including the following activities:Conduct outreach and education about the Program and responsibilities of PCCM Network Providers for Providers who have enrolled in the Program as well as those who have not yet enrolled or who may serve Members outside of the program (e.g., HCBS waiver Providers) Recruit for participation in and sign Letters of Agreement with Providers who are willing to participate in the PCCM Network as Medical Home ProvidersEncourage Providers to form PCMHs and incentivize achievement of NCQA PCMH recognition Implement an incentive program to encourage targeted Providers to participate in ongoing efforts to improve quality and health outcomesAssist DCH to identify the primary care and specialist Providers that are most needed, particularly for Intensive Medical Coordination Participants who are receiving Intensive Medical Coordination or Members who are at-risk for needing Intensive Medical Coordination servicesAssist DCH to identify on an ongoing basis Provider network gaps in the Medicaid Fee-for-Service delivery system and gaps in Medicaid programs and/or policies and work with DCH to recruit Providers to improve the overall delivery system (e.g., use results of its ongoing Predictive Modeling and other analyses to identify Providers most needed to meet the needs of all Members with a critical focus on recruiting primary care and specialty Providers to meet the needs of Intensive Medical Coordination Participants receiving Intensive Medical Coordination services)Provide a Quality Management Program, submit customized reporting to DCH that tracks both internal process quality and external Program Quality Management and meet administrative requirements for operating this Program Collaborate with DCH and Providers in Value-Based Purchasing (VBP) initiatives to align incentives and develop initiatives to help achieve the program’s overarching goals Note that DCH has developed a scope of work that is deliberately not highly prescriptive to allow the successful Offeror to use its expertise to develop an innovative program that meets DCH’s program goals. DCH will provide with this RFP Claims-level data with de-identified Member and Provider information to allow Offerors through their proposals to demonstrate their detailed methodologies for conducting Predictive Modeling and other data analyses on an ongoing basis and how they use the findings from those analyses to identify and stratify Members to reach identified goals. Prior to receiving Member Claims information, Offerors must complete Attachment L, Confidentiality/Non-Disclosure Agreement (NDA) and submit it to Marcine Sullivan at msullivan@dch..Offerors must refer to RFP Attachment K: Requirements and Scope of Work for detailed description of the scope of services.Financing and Value-Based PurchasingDCH expects the successful Offeror to establish a program that will achieve substantive improvements in service, access, appropriateness and quality while reducing expenditures over the course of the Contract. As part of this effort, DCH expects a positive fiscal impact. DCH envisions a Value-Based Purchasing (VBP) approach that recognizes and rewards positive financial and health outcomes achieved through this program. To be successful, DCH believes a VBP approach must align payer, Offeror and Provider goals, objectives and incentives. DCH will reimburse the selected Offeror on a Per Member Per Month (PMPM) basis for all Members, regardless of whether the Member is eligible for or is an Intensive Medical Coordination Participant receiving Intensive Medical Coordination services. DCH reserves the right to conduct audits at any point in time. Such audits could result in the successful Offeror being asked to return portions of revenues to reflect any variances determined during the audit. See Section 5, Cost Proposal, for additional information.Additionally, DCH will work with the selected Offeror to establish a VBP approach. Figure 4 provides a graphical description of the DCH Value-Based Purchasing Cycle?. Under a VBP approach DCH and the selected Offeror will collaborate to implement a VBP model, which is an enhanced approach to purchasing and program management that focuses on value over volume. It is part of a cohesive strategy that aligns incentives for Members, Providers, the selected Offeror and the State to achieve the program’s overarching goals. The impact of initiatives is measured in terms of quality of care and savings.Subject to DCH approval, the selected Offeror will develop a payment methodology and incentives for Providers to encourage participation in Value-Based Purchasing. The selected Offeror may also elect to develop a methodology to incorporate Member incentives into the program subject to DCH approval.Figure 4. The Value-Based Purchasing Cycle Offerors’ LibraryA resource library is available electronically for potential Offerors to review material relevant to the RFP. Information on how to obtain access to the electronic resource library will be available via the Additional Resources hyperlink located on the DCH Web Site. The library may be found at: dch.documents/medicaid-medical-coordination. The library includes but is not limited to documents and web access links such as the following:Data Dictionary and Data ExplanationsMedicaid Service RegionsMedicaid Redesign Strategy ReportGeorgia Department of Community Health Aged, Blind, and Disabled ProfilesStakeholder CommentsDepartment of Justice Settlement AgreementIt is the Offeror’s responsibility to review Offerors’ Library materials in addition to other publicly available sources for relevance to this RFP’s Scope of Work. Several data files are included with the RFP to aid in the development of the Offerors’ submissions. Prior to receiving Member Claims information, Offerors must complete Attachment L, Confidentiality/Non-Disclosure Agreement (NDA) and submit it via email to Marcine Sullivan at msullivan@dch...RFP CertificationPursuant to the provisions of the Official Code of Georgia Annotated §50-5-67(a), the State Entity (or DCH) certifies the use of competitive sealed bidding will not be practicable or advantageous to the State of Georgia in completing the acquisition described in this RFP. Overview of the RFP ProcessThe objective of the RFP is to select a qualified Offeror to provide the goods and/or services outlined in this RFP to the State. This RFP process will be conducted to gather and evaluate responses from Offerors for potential award. All qualified Offerors are invited to participate by submitting responses, as further defined below. After evaluating all Offerors’ responses received prior to the closing date of this RFP and following negotiations (if any) and resolution of any Contract exceptions, the preliminary results of the RFP process will be publicly announced, including the names of all participating Offerors and the evaluation results. Subject to the protest process, final Contract Award(s) will be publicly announced thereafter. Schedule of EventsThe schedule of events set out in Figure 5 represents DCH’s best estimate of the schedule that will be followed. However, delays to the procurement process may occur which may necessitate adjustments to the proposed schedule. If a component of this schedule, such as the close date, is delayed, the rest of the schedule may be shifted as appropriate. Any changes to the dates up to the closing date of the RFP will be posted prior to the closing date of this RFP. After the close of the RFP, the State reserves the right to adjust the remainder of the proposed dates, including the dates for evaluation, negotiations, award and the Contract term on an as needed basis with or without notice. Figure 5. Schedule of EventsDescriptionDateTimeRelease of RFPDecember 20, 20134:00 p.m. ESTDeadline (or rolling period) for 1st round of written questions sent via email to the Issuing Officer referenced in Section 1.5. January 7, 20144:00 p.m. ESTResponses to Written QuestionsJanuary 24, 20145:00 p.m. ESTDeadline (or rolling period) for 2nd round of written questions sent via email to the Issuing Officer referenced in Section 1.5.February 4, 20144:00 p.m. ESTResponses to Written QuestionsFebruary 13, 20145:00 p.m. ESTProposals Due/Close Date and TimeFebruary 27, 20144:00 p.m. ESTProposal Evaluation Completed (on or about) FORMTEXT [3] to [4] Weeks after Closing N/ANegotiations Invitation Issued (emailed) (on or about); discretionary process FORMTEXT [3] to [4] Weeks after ClosingTBDNegotiations with Identified Offerors (on or about); discretionary process FORMTEXT [5] to [7] Weeks after ClosingTBDFinal Evaluation (on or about) FORMTEXT [7] to [8] Weeks after ClosingN/AFinalize Contract Terms FORMTEXT [8] to [9] Weeks after ClosingN/ANotice of Intent to Award* [NOIA] (on or about) FORMTEXT [8] to [9] Weeks after ClosingN/ANotice of Award [NOA] (on or about)10 Calendar Days after NOIAN/AOfficial Issuing Officer (Buyer)Debra WhiteDebra.White@doas. Definition of TermsPlease review the following terms:Offeror(s) – companies desiring to do business with the State of Georgia.State Entity – the governmental entity identified in Section 1.1 “Purpose of Procurement” of this eRFP.Any special terms or words which are not identified in this State Entity eRFP Document are identified separately in Attachment B: Definitions of Terms at the end of this eRFP.? Please download, save and carefully review all documents in accordance with the instructions provided in Section 2 “Instructions to Offerors” of this eRFP. Contract TermThe initial term of the Contract shall be from the date of CMS approval of the Contract until the close of the State fiscal year in which CMS grants approval. The State’s fiscal year is from July 1st through June 30th. DCH shall possess 4 one (1) year options to renew, which options shall be exercisable at the sole discretion of DCH. Renewal will be accomplished through the issuance of Notice of Intent to Award Amendment. In the event that the Contract(s) if any, resulting from the award of this eRFP shall terminate or be likely to terminate prior to the making of an award for a new contract for the identified products and/or services, the State may, with the written consent of the awarded Offeror, extend the Contract for such period of time as may be necessary to permit the State’s continued supply of the identified products and/or services. The Contract(s) amended in writing from time to time by mutual consent of the parties. Unless this eRFP states otherwise, the resulting award of the Contract(s) does not guarantee volume or a commitment of funds. The State reserves the right to adjust the initial Contract term prior to Contract Execution based on availability of funds and other factors relevant to the State.Instructions to Offerors By submitting a response to the eRFP, the Offeror is acknowledging that the Offeror: Has read the information and instructionsAgrees to comply with the information and instructions contained hereinGeneral Information and Instructions2.1.1.Team Georgia Marketplace? Registration System DOAS requires all companies and/or individuals interested in conducting business with the State of Georgia to register in the State’s web-based registration system, through Team Georgia Marketplace?. Registration is free and enables the registering company to gain access to certain information, services and/or materials maintained in Team Georgia Marketplace? at no charge to the registering company. All registering companies must agree to be bound by the applicable terms and conditions governing the Offeror’s use of Team Georgia Marketplace?. In the event DOAS elects to offer certain optional or premium services to registered companies on a fee basis, the registered company will be given the opportunity to either accept or reject the service before incurring any costs and still maintain its registration. Companies may register at 2.1.2.Restrictions on Communicating with StaffFrom the issuance date of this RFP until the final award is announced (or the eRFP is officially cancelled, Offerors are not allowed to communicate for any reason with any State staff except through the Issuing Officer named herein, or during the Offerors’ conference (if any), or as defined in this eRFP or as provided by existing work agreement(s). Prohibited communication includes all contact or interaction, including but not limited to telephonic communications, emails, faxes, letters or personal meetings, such as lunch, entertainment or otherwise. The State reserves the right to reject the response of any Offeror violating this provision.Offerors may not discuss any aspect of the RFP or the procurement with any State agency staff in preparation of proposals in response to the RFP. 2.1.3.Submitting QuestionsAll questions concerning this eRFP must be submitted in writing via email to the Issuing Officer identified in Section 1.5 “Issuing Officer” of this RFP. No questions other than written will be accepted. No response other than written will be binding upon the State. All Offerors must submit questions by the deadline identified in the Schedule of Events for submitting questions. Offerors are cautioned that the State may or may not elect to entertain late questions or questions submitted by any other method than as directed by this section. All questions about this eRFP must be submitted in the below pany Name:Date:Question #Section of the RFPQuestion2.1.4.State’s Right to Request Additional Information – Offeror’s ResponsibilityPrior to Contract Award, the State must be assured that the selected Offeror has all of the resources to successfully perform under the Contract. This includes, but is not limited to, adequate number of personnel with required skills, availability of appropriate equipment in sufficient quantity to meet the ongoing needs of the State, financial resources sufficient to complete performance under the Contract and experience in similar endeavors. If, during the evaluation process, the State is unable to assure itself of the Offeror’s ability to perform, if awarded, the State has the option of requesting from the Offeror any information deemed necessary to determine the Offeror’s responsibility. If such information is required, the Offeror will be so notified and will be permitted approximately seven (7) Business Days to submit the information requested. 2.1.5.Failing to Comply with Submission InstructionsResponses received after the identified due date and time or submitted by any other means than those expressly permitted by the RFP will not be considered. Offerors’ responses must be complete in all respects, as required in each section of this RFP. 2.1.6.Rejection of Proposals; State’s Right to Waive Immaterial DeviationThe State reserves the right to reject any or all responses, to waive any irregularity or informality in an Offeror’s response and to accept or reject any item or combination of items, when to do so would be to the advantage of the State of Georgia. It is also within the right of the State to reject responses that do not contain all elements and information requested in this RFP. An Offeror’s response will be rejected if the response contains any defect or irregularity and such defect or irregularity constitutes a material deviation from the RFP requirements, which determination will be made by the State on a case-by-case basis. 2.1.7.State’s Right to Amend and/or Cancel the RFP The State Entity reserves the right to amend this eRFP. Any revisions must be made in writing prior to the eRFP closing date and time. By submitting a response, the Offeror shall be deemed to have accepted all terms and agreed to all requirements of the eRFP (including any revisions/additions made in writing prior to the close of the eRFP whether or not such revision occurred prior to the time the Offeror submitted its response) unless expressly stated otherwise in the Offeror’s response. THEREFORE, EACH OFFEROR IS INDIVIDUALLY RESPONSIBLE FOR REVIEWING THE REVISED eRFP AND MAKING ANY NECESSARY OR APPROPRIATE CHANGES AND/OR ADDITIONS TO THE OFFEROR’S RESPONSE PRIOR TO THE CLOSE OF THE eRFP. Offerors are encouraged to frequently check the eRFP for additional information. Finally, the State Entity reserves the right to cancel this eRFP at any time.2.1.8.Protest Process Offerors should familiarize themselves with the procedures set forth in Chapter 6 of the Georgia Procurement Manual.2.1.9.Costs for Preparing ProposalsEach Offeror’s response should be prepared simply and economically, avoiding the use of elaborate promotional materials beyond those sufficient to provide a complete presentation. The cost for developing the response and participating in the procurement process (including the protest process) is the sole responsibility of the Offeror. The State will not provide reimbursement for such costs.2.1.10.ADA GuidelinesThe State of Georgia adheres to the guidelines set forth in the Americans with Disabilities Act. Offerors should contact the Issuing Officer at least one (1) Business Day in advance if they require special arrangements when attending the Offerors’ Conference (if any). The Georgia Relay Center at 1-800-255-0056 (TDD Only) or 1-800-255-0135 (Voice) will relay messages, in strict confidence, for the speech and hearing impaired.2.1.11.Public Access to Procurement RecordsSolicitation opportunities will be publicly advertised as required by law and the provisions of the Georgia Procurement Manual. The State Purchasing Act delays the release of certain procurement records in the event the public disclosure of those records prior to the State’s public announcements of the results of a solicitation would undermine the public purpose of obtaining the best value for the State such as cost estimates, proposals/bids, evaluation criteria, Offeror evaluations, negotiation documents, offers and counter-offers and certain records revealing preparation for the procurement. The State Purchasing Act requires bids and proposals to be available for public inspection, upon request, within one (1) Business Day of the State’s posting of the Notice of Intent to Award (or the Notice of Award in the event the State does not issue the Notice of Intent to Award). Audited financial statements not otherwise publicly available but required to be submitted as part of the Offeror’s response shall not be subject to public disclosure. DCH (or any other state entity receiving a request) is allowed to assess a reasonable charge to defray the cost of reproducing documents. A State employee should be present during the time of onsite inspection of documents.? PLEASE NOTE: Even though information (financial or other information) submitted by an Offeror may be marked as "confidential", "proprietary", etc., the State will make its own determination regarding what information may or may not be withheld from disclosure.2.1.12.Registered LobbyistsBy submitting a response to this RFP, the Offeror hereby certifies that the Offeror and its lobbyists are in compliance with the Lobbyist Registration Requirements in accordance with the Georgia Procurement Manual.Submittal InstructionsSubmittal Instructions for Team Georgia Marketplace?Listed below are key action items related to this eRFP. The Schedule of Events in Section 1.4 identifies the dates and time for these key action items. This portion of the eRFP provides high-level instructions regarding the process for reviewing the eRFP, preparing a response to the eRFP and submitting a response to the eRFP. Offerors are required to access, print and utilize the training materials identified in Section 2.2.1 of this eRFP to ensure the Offeror successfully submit a response to this eRFP.eRFP ReleasedThe release of the eRFP is formally communicated through the posting of this eRFP as an event in Team Georgia Marketplace? and by a public announcement posted to the Georgia Procurement Registry, which is accessible online as follows: This eRFP is being conducted through Team Georgia Marketplace?, an online, electronic tool, which allows an Offeror to register, logon, select answers and type text in response to questions, and upload any necessary documents. Team Georgia Marketplace? permits an Offeror to build and save a response over time until the Offeror is ready to submit the completed response. Each Offeror interested in competing to win a contract award must complete and submit a response to this eRFP using Team Georgia Marketplace?. Therefore, each Offeror MUST carefully review the instructions and training information from the following link for a comprehensive overview of the functionality of Team Georgia Marketplace?: eRFP ReviewThe eRFP (or “Sourcing Event”) consists of the following: this document, entitled “The State Entity eRFP Document”, and any and all information included in the Sourcing Event, as posted online on Team Georgia Marketplace?, including any and all documents provided by DCH as attachments to the Sourcing Event or links contained within the Sourcing Event or its attached documents.Please carefully review all information contained in the Event, including all documents available as attachments or available through links. Any difficulty accessing the Event or opening provided links or documents should be reported immediately to the Issuing Officer (See Section 1.5) and/or the Help Desk (Section 2.2.8). Attached documents may be found as follows:First, DCH will provide documents at the “header” level of the Event. Please select “View/Add General Comments & Attachments”, which appears at the top of the screen of the Event under the “Event Details” Section. Next, by selecting “View Event Attachments”, the Offeror may open and save all of the available documents. In this location, the Offeror is most likely to find this document (The State Entity eRFP Document) as well as the worksheets referenced in Section 4 “eRFP Proposal Factors”, such as the Mandatory Response Worksheet, the Mandatory Scored Requirements, and the Additional Scored Responses. Please thoroughly review all provided attachments.Second, DCH may also provide documents at the “line detail” level of the Event. Please navigate to “Step 2: Enter Line Bid Responses”, which appears towards the bottom of the screen of the Event. Please access any provided documents as follows:First Method:To the right of each line appearing under Step 2, the Event contains a “Bid” link. By selecting the “Bid” link, the Offeror will navigate to a new page of the Event. On this new page, the Offeror can select “View/Add Question Comments and Attachments” to locate attached documents.Second Method:To the right of each line appearing under Step 2, the Event contains a “Line Comments/Files” icon (appears as a bubble with text). By selecting the “Line Comments/Files” icon, the Offeror will navigate to a new page of the Event.On this new page, the Offeror can locate attached documents.In this location, the Offeror is most likely to find the cost worksheet (if any, as defined by Section 5 “Cost Proposal”) as well as any other documents provided by DCH with respect to the identified line items. Please thoroughly review all provided attachments.2.2.3.Preparing a ResponseWhen preparing a response, the Offeror must consider the following instructions:The Technical Proposal must be structured in the order specified in this RFP and its attached documents and labeled with the corresponding titles given to each section. Answer each question in sufficient detail for evaluation while using good judgment with regard to the length of response Proofread your response and make sure it is accurate and readily understandable.The Cost Proposal must be submitted using the identified Cost Proposal Form.Be sure to complete all attached forms as further described in this RFP. For electronic submission, label any and all files using the corresponding section numbers of the RFP or any other logical name so that the State can easily organize and navigate the Offeror’s response.Uploading FormsOnce the Offeror is ready to upload electronic files (completed forms or worksheets, product sheets, etc.), please following the directions within the eRFP to upload these documents in the proper location. There are three places to upload completed documents:First, the “View/Add General Comments & Attachments” link contains a place for the Offeror to upload all of the documents and worksheets which were provided by DCH under the “View Event Attachments” link. Once the Offeror has completed the Event Attachments, the Offeror can then select “Add New Attachments” to upload the completed documents. The Offeror can upload as many documents as necessary in this section of the Event. Second, the Offeror can also upload documents in response to each question or bid factor which appears on the main page of the Event, which appears below the “View/Add General Comments & Attachments” link of the Event. To the right of each question or bid factor, the Offeror can select the “Add Comments or Attachments” link to either enter a written response or upload an electronic document in response to the question or bid factor. After selecting “Add Comments or Attachments”, the Offeror should select “Upload” under the “Add New Attachments” section to browse and upload an electronic file. Third, the Offeror can also upload documents in the bottom portion of the Event where pricing is requested. After selecting the comment bubble icon, the Event allows the Offeror to select “Upload” in order to include an attachment as part of the Offeror’s response. In the alternative, the Offeror can also select the link “Bid”, which also appears to the right of any line items provided in the “Enter Line Bid Responses” portion of the Event. After selecting the “Bid” link, the Offeror can select “View/Add Question Comments and Attachments” to upload a document.Reviewing the Response Prior to SubmissionEach Offeror is responsible for ensuring all questions have been answered appropriately and that all necessary documents have been uploaded. Prior to final submission of your response, please review the following checklist:Please review and confirm that the Offeror has answered all questions appropriately. Many questions require a “yes” or “no” response. Please ensure that the correct response has been selected.Please review and confirm that the most competitive response has been provided. Please confirm that all necessary files have been uploaded.Please select the “Validate Entries” button under “Event Details” at the top portion of the Event. While the “Validate Entries” feature cannot verify whether the Offeror has attached files, attached the correct files, or entered the correct responses, the “Validate Entries” feature will alert the Offeror if one or more questions in the “Event Questions” section of the Event have not been answered. The “Validate Entries” feature is a useful tool; however, it is no substitute for careful preparation and review by the Offeror. DCH will not consider the Offeror’s use of the “Validate Entries” feature as an excuse for an error committed by the Offeror in the preparation of its response.Submitting the Completed Response/BidOnce the completed response has been reviewed by the Offeror, click the "Submit Bid" button at the top of the page under the “Event Details” section of the Event. Any information entered by an Offeror into Team Georgia Marketplace? but not submitted prior to the submission deadline will not be released to DCH and will not be considered for award. Only after the Offeror selects the “Submit Bid” button, will the response to the eRFP be sent electronically, time stamping the Offeror’s response and sending a confirmation email to the email address of the Offeror. Please note that submission is not instantaneous; therefore, each Offeror must allow ample time for its response to be submitted prior to the deadline. Reviewing, Revising or Canceling a Submitted ResponseAfter the response has been submitted, the Offeror may view and/or revise its response by logging into Team Georgia Marketplace? and selecting the eRFP event number and the “View/Edit” feature for the Offeror’s previous response. Please take note of the following:REVIEW ONLY. In the event the Offeror only wishes to view a submitted response, the Offeror may select “View/Edit”. Once the Offeror has finished viewing the response, the Offeror may simply exit the screen. DO NOT SELECT “Save for Later.” Team Georgia Marketplace? recognizes any response placed in the “Save for Later” status as a work in progress and withdraws the originally submitted bid. As a result, unless the Offeror selects “Submit” prior to the closing date and time, no response will be transmitted to DCH.REVIEW AND REVISE. In the event the Offeror desires to revise a previously submitted response, the Offeror may select “View/Edit” and then revise the response. If the revisions cannot be completed in a single work session, the Offeror should save its progress by selecting “Save for Later.” Once revisions are complete, the Offeror MUST select “Submit” to submit its corrected response. Please permit adequate time to revise and then resubmit the response. Please note submission is not instantaneous and may be affected by several events, such as the Offeror temporarily losing a connection to the Internet.AS EACH OFFEROR IS SOLELY RESPONSIBLE FOR RESUBMITTING ITS RESPONSE PRIOR TO THE eRFP END DATE AND TIME TO ENSURE THE RESPONSE MAY BE CONSIDERED BY DCH, PLEASE USE CAUTION IN DECIDING WHETHER OR NOT TO MAKE REVISIONS. The State will assume no responsibility for an Offeror’s inability to correct errors or otherwise make revisions to the submitted response or the Offeror’s inability to resubmit a response prior to the eRFP end date and time.3.WITHDRAW/CANCEL. In the event the Offeror desires to revise a previously submitted response, the Offeror may select “View/Edit” and then select “Save for Later”. Team Georgia Marketplace? recognizes any response placed in the “Save for Later” status as a work in progress and withdraws the originally submitted bid. As a result, unless the Offeror selects “Submit” prior to the closing date and time, no response will be transmitted to DCH. In the event an Offeror desires to withdraw its response after the closing date and time, the Offeror must submit a request in writing to the Issuing Officer.Help Desk Support For technical questions related to the use of Team Georgia Marketplace?, Offerors have access to phone support through the DOAS Customer Service Help Desk at 404-657-6000, Monday?through Friday 8:00 AM to 5:00 PM excluding State Holidays or any other day State offices are closed such as furlough days or closings in response to inclement weather. Offerors can also email questions to: ProcurementHelp@doas.. “Hard Copy” and Electronic Copies RequiredIn addition to the uploaded Technical and Cost Proposals into Team Georgia Market Place, the Offeror must provide copies of its RFP submission as follows: Technical Proposal: Two (2) hard copies, bound and tabbed, with one (1) marked “Original” with original signatures; and Ten (10) separate electronic copies on thumb drives, with one (1) designated as the original copy.Cost Proposal: Two (2) hard copies, bound and tabbed, with one (1) marked “Original” with original signatures; and Three (3) separate electronic copies on thumb drives, with one (1) designated as the original copy.Technical Proposal and Cost Proposal must be labeled and packaged separately. In the event of a discrepancy/conflict between the TGM electronic submission and the Hard copy version, the TGM electronic version will take precedence. Hard copies and thumb drives must be received within three (3) business days of the closing date of this RFP.Copies should be addressed and mailed or delivered to: Ms. Debra Whitec/o Marcine Sullivan Office of Procurement Services2 Peachtree Street NW, 35th FloorAtlanta, GA 30303 General Business RequirementsThis section contains general business requirements. By submitting a response, the Offeror is certifying its agreement to comply with all of the identified requirements of this section and that all costs for complying with these general business requirements are included in the Offeror’s submitted pricing.3.1.Standard Insurance RequirementsIf awarded a Contract, the Offeror shall procure and maintain insurance which shall protect the Offeror, DCH and the State of Georgia (as an additional insured) from any claims for bodily injury, property damage, or personal injury covered by the indemnification obligations set forth in the Contract attached to this solicitation throughout the duration of the Contract. The Offeror shall procure and maintain the insurance policies described below at the Offeror’s own expense and shall furnish DCH an insurance certificate listing the State of Georgia as certificate holder and as an additional insured. The insurance certificate must document that the Commercial General Liability insurance coverage purchased by the Offeror includes contractual liability coverage applicable to the Contract. In addition, the insurance certificate must provide the following information: the name and address of the insured; name, address, telephone number and signature of the authorized agent; name of the insurance company (authorized to operate in Georgia); a description of coverage in detailed standard terminology (including policy period, policy number, limits of liability, exclusions and endorsements); and an acknowledgment of notice of cancellation to DCH.The Offeror is required to maintain the following insurance coverage’s during the term of the Contract:Workers Compensation Insurance (Occurrence) in the amounts of the statutory limits established by the General Assembly of the State of Georgia (A self-insurer must submit a certificate from the Georgia Board of Workers Compensation stating that?the Offeror qualifies to pay its own workers compensation claims.) In addition,?the Offeror shall require all Subcontractors occupying the premises or performing work under the Contract to obtain an insurance certificate showing proof of Workers Compensation Coverage with the following minimum coverage: Bodily injury by accident - per employee $100,000 Bodily injury by disease - per employee $100,000 Bodily injury by disease – policy limit $500,000Commercial General Liability Policy with the following minimum coverage:Each Occurrence Limit $1,000,000Personal & Advertising Injury Limit $1,000,000General Aggregate Limit$ 3,000,000Products/Completed Ops. Aggregate Limit$ 3,000,000Automobile Liability Combined Single Limit$1,000,000The foregoing policies shall contain a provision that coverage afforded under the policies will not be canceled, or not renewed or allowed to lapse for any reason until at least?thirty (30) Calendar Days prior written notice has been given to DCH. Certificates of Insurance showing such coverage to be in force shall be filed with?DCH prior to commencement of any work under the Contract. The foregoing policies shall be obtained from insurance companies licensed to do business in Georgia and shall be with companies acceptable to DCH, which must have a minimum A.M. Best rating of A-. All such coverage shall remain in full force and effect during the term and any renewal or extension thereof.Within ten (10) Business Days of award, the awarded Offeror must procure the required insurance and provide DCH with two (2) Certificates of Insurance. Certificates must reference the Contract number. The Offeror’s submitted pricing must include the cost of the required insurance. No Contract performance shall occur unless and until the required insurance certificates are provided.3.2.Letter of CreditThe awarded Offeror(s) shall be required to furnish an irrevocable letter of credit to DCH for the faithful performance on the Contract in an amount equal to ten percent (10%) of the annual value of the Contract for each fiscal year for all work that may be undertaken pursuant to the Contract. The letter of credit shall be issued by a FDIC insured financial institution authorized to do business with the State of Georgia; and shall list the State Entity (Georgia Department of Community Health) as the beneficiary. The letter of credit must be submitted to DCH prior to the beginning of any Contract performance by the awarded Offeror. Please refer to eRFP Attachment I: State Contract (Section 18: Irrevocable Letter of Credit) for details surrounding the requirements of the letter of credit.3.3 Proposal CertificationBy responding to this solicitation, the Offeror understands and agrees to the following:That this electronically submitted proposal constitutes an offer, which when accepted in writing by DCH, and subject to the terms and conditions of such acceptance, will constitute a valid and binding Contract between the Offeror and DCH; andThat the Offeror guarantees and certifies that all items included in the Offeror’s response meet or exceed any and all of the solicitation’s identified specifications and requirements except as expressly stated otherwise in the Offeror’s response; andThat the response submitted by the Offeror shall be valid and held open for a period of one hundred and twenty (120) Calendar Days from the final solicitation?closing date and that the Offeror’s offer may be held open for a lengthier period of time subject to the Offeror’s consent; andThat the Offeror’s response is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same materials, supplies, equipment, or services and is in all respects fair and without collusion or fraud. Offeror understands and agrees that collusive bidding is a violation of State and federal law and can result in fines, prison sentences, and civil damage awards; andThat the provisions of the Official Code of Georgia Annotated, Sections 45-10-20 et seq. have not been violated and will not be violated in any respect.4.eRFP Proposal (Bid) FactorsThis section contains the detailed technical requirements and related services for this Sourcing Event. Worksheets found as attachments in the Sourcing Event include the requirements for this solicitation. Offerors are required to download, complete and then upload the Worksheets titled “Offeror General Information”, “Mandatory Response Worksheet” and “Mandatory Scored Requirement Worksheet.” Due to the size and complexity of the solicitation, Offerors must follow the following special instructions for completion of the “Mandatory Scored Requirement Worksheet” The Offeror must download the Mandatory Scored Requirement Worksheet. The document is provided in MS Word as Attachment F to the eRFP. Offerors are to complete the worksheet according to the instructions. All responses must be sequential with the same numbering convention included in the Spreadsheet. If an attachment is provided to support your response, indicate in the question response that there is an attachment. Any attachments must reference the Title of the Major Category, question number, and the question. The completed worksheet and supporting documents should be converted to a PDF file prior to uploading in TGM and downloading to a thumb drive. All requested forms and documents must be submitted electronically via the sourcing tool as an uploaded document to the Offeror’s response. These worksheets together with any and all other documents submitted in response to Section 4 of this eRFP will be considered the Offeror’s technical proposal.DCH has determined that it is best to define its own needs, desired operating objectives, and desired operating environment. DCH will not tailor these needs to fit particular solutions Offerors may have available; rather, Offerors shall propose to meet DCH’s needs as defined in this eRFP. All claims shall be subject to demonstration. Offerors are cautioned that conditional proposals, based upon assumptions, may be deemed non-responsive. 4.1.Technical Proposal IntroductionAll of the items described in this section are service levels and/or terms and conditions that DCH expects to be satisfied by the selected Offeror. Each Offeror must indicate its willingness and ability to satisfy these requirements in the appropriate worksheets. 4.2.Offeror General InformationEach Offeror must complete all of the requested information in the attached file entitled Offeror’s General Information Worksheet.DO NOT INCLUDE ANY COST/PRICING INFORMATION IN YOUR RESPONSE TO THIS WORKSHEET.4.3.Mandatory RequirementsAs specified with each requirement listed in the Mandatory Response Worksheet, the Offeror must indicate whether its proposal meets the individual requirements by marking either a "YES" or "NO" in the response block provided. A Pass/Fail evaluation will be utilized for all mandatory requirements. Ordinarily, to be considered responsive, responsible and eligible for award, all questions identified as mandatory must be marked “YES” to pass. There may be rare instances in which a response of “NO” is the correct and logical response in order to meet the mandatory requirement (e.g. responding “NO” that the Offeror does not possess any conflicts of interest). Otherwise, any mandatory questions marked "NO" will fail the technical requirements and will result in disqualification of the proposal. DO NOT INCLUDE ANY COST/PRICING INFORMATION IN YOUR RESPONSE TO THIS WORKSHEET.4.4.Mandatory Scored ResponseAs specified with each requirement listed in the Mandatory Scored Response Worksheet, the Offeror must indicate whether it will meet the individual requirement (if any) and provide a supporting narrative in the space provided. To be considered responsive, responsible and eligible for award, any and all requirements identified in the Mandatory Scored Response Worksheet must be met. There may be rare instances in which an item within the Mandatory Scored Response Worksheet does not create an individual requirement which must be met, but, instead, merely requires a response. All requirements labeled “Mandatory Scored” must be met by the Offeror. Failure to meet any mandatory scored requirements may result in disqualification of the proposals. The narrative description, along with any required supporting materials, will be evaluated and awarded points in accordance with?Section 6 “Proposal Evaluation, Negotiations and Award” of this eRFP. DO NOT INCLUDE ANY COST INFORMATION IN YOUR RESPONSE TO THIS WORKSHEET.4.5.Additional Scored Responses All items labeled “Additional Scored Responses”?represent?information that?is?requested by DCH. Offerors are encouraged to provide a thorough narrative description in the space provided in the Additional Scored Response Worksheet.? Answers along with any requested supporting materials will be evaluated and awarded points in accordance with?Section 6 “Proposal Evaluation, Negotiations and Award” of this eRFP. DO NOT INCLUDE ANY COST INFORMATION IN YOUR RESPONSE TO THIS WORKSHEET.4.6.Additional InformationAs noted in Section 2.2.2 “eRFP Review”, please access and review all of the attachments provided by DCH within the Event. If supplemental materials are requested by DCH to be submitted by the Offeror as part of the technical proposal, the Offeror should upload these additional materials as noted in Section 2.2.4 “Uploading Forms”. 5.Cost Proposal5.1.Cost ProposalEach Offeror is required to submit a cost proposal as part of its response. The cost proposal will be evaluated and scored in accordance with Section 6 “Proposal Evaluation, Negotiations and Award” of this eRFP. By submitting a response, the Offeror agrees that it has read, understood, and will abide by the following instructions/rules:The submitted cost proposal must include all costs of performing pursuant to the resulting Contract; andIn the event there is a discrepancy between (1) the Offeror’s pricing as quoted on the eRFP’s provided cost worksheet and (2) the Offeror’s pricing as quoted by the Offeror in one or more additional documents, the former shall govern; and The prices quoted and listed in the cost proposal shall be firm throughout the term of the resulting Contract, unless otherwise noted in the eRFP or Contract.5.2.Cost Structure and Additional InstructionsDCH’s intent is to structure the cost format in order to facilitate comparison among all Offerors and foster competition to obtain the best market pricing. Consequently, DCH requires that each Offeror’s cost be in the format outlined below. Additional alternative cost structures will not be considered. Each Offeror is cautioned that failure to comply with the instructions listed below, submission of an incomplete offer, or submission of an offer in a different format than the one requested may result in the rejection of the Offeror’s proposal.Enter all information directly into the cost sheet(s). Enter numbers on each cost sheet in “number” (two-place decimal), not “currency” or other format unless otherwise stated. That is, omit dollar signs, commas, and any other non-essential symbols (e.g., $7.90 should be entered as 7.90). Prices must be in US Dollars. Enter “n/a” to indicate not available or “0” if there is no charge. Cells left blank will be interpreted as “no offer”.Download the cost proposal worksheet, complete the worksheet, and then upload by following the instructions in the third bullet of Section 2.2.4 “Uploading Forms” of this eRFP.General Description of Cost StructureThe selected Offeror will receive a Per Member Per Month (PMPM) rate for all Members enrolled in the Medical Coordination Program. The PMPM rate will be comprised of three (3) components:Core PMPM rate for providing Core Coordination Services, as described in Section B of Attachment K: Requirements and Scope of Work;2. Add-on Intensive Medical Coordination PMPM rate to cover expenses for a percentage of Members as defined by DCH for the Period who should be receiving Intensive Medical Coordination services. This percentage is 10% in Period 1 and will change in subsequent periods as determined by DCH; and3. Add-on Case Management Fees PMPM rate to pay a Case Management Fee to Medical Home Providers for a percentage of Members as defined by DCH for the Period who should be receiving Intensive Medical Coordination services (this is the same percentage as in 2 above).The Offeror will bid on the PMPM rate for Periods 1-3 in the Cost Proposal using the assumptions provided below and in the Cost Proposal worksheet. The Offeror should bid the PMPM rate in the three (3) components described above as shown in the Cost Proposal worksheet.The Cost Proposal worksheet does not request a bid related to costs prior to the Medical Coordination Program launch date. DCH will not pay any start up, planning or implementation costs for services prior to the launch date of the Program which is estimated to be November 3, 2014. DCH will require a minimum percentage of Intensive Medical Coordination Participants receiving services in each period as described below:Period 1 – November 3, 2014 through June 30, 2015:DCH expects that the selected Offeror will have on average ten percent (10%) of Members participating in Intensive Medical Coordination (called the Period 1 percentage) in Period 1. DCH expects the selected Offeror will make Case Management Fees for Medical Home Providers for Intensive Medical Coordination Participants receiving Intensive Medical Coordination services and actively enrolled in a Medical Home in Period 1. At the end of Period 1, DCH or its Agent will evaluate the population receiving Intensive Medical Coordination to determine:If Intensive Medical Coordination Participants in the population should be classified as a population who needs Intensive Medical Coordination services; andIf Intensive Medical Coordination Participants in the population were enrolled in a Medical Home; andIf Intensive Medical Coordination Participants in the population are actively participating in the program.If upon audit DCH determines that Intensive Medical Coordination Participants do not meet the three (3) criteria described above, the selected Offeror may be asked to return a portion of the Administrative Fee Payments they received to reflect the variance between the Period 1 percentage and the actual percentage.DCH reserves the right to audit the program at any time during the Contract and make adjustments to the Administrative Fee Payments if the above standards are not met. Such audits will also address Contractor staffing levels, Case Management Fees paid to Medical Home Providers and Provider incentives.Period 2 – State Fiscal Year 2016 (July 1, 2015 through June 30, 2016)At the end of Period 1, DCH will determine an appropriate level of Intensive Medical Coordination participation for Period 2 and reset the Administrative Fee to reflect the new percentage (called the Period 2 percentage). This number will be determined three (3) months before the end of Period 1 based on experience during the period and discussions with the Offeror.The Period 2 Administrative Fee will be developed from three components as follows:Second year Core PMPM rate proposed by the Offeror for providing Core Coordination Services, as described in Section B of Attachment K: Requirements and Scope of Work.Second year add-on Intensive Medical Coordination PMPM rate proposed by the Offeror to cover expenses for services provided to Intensive Medical Coordination Participants. This rate will be developed assuming the Period 2 percentage of Intensive Medical Coordination participation that DCH determines is appropriate for Period 2.Second year add-on Case Management Fees PMPM rate to pay a Case Management Fee to Medical Home Providers for services provided by the Offeror to Intensive Medical Coordination Participants. This rate will be developed assuming the Period 2 percentage of Intensive Medical Coordination participation that DCH determines is appropriate for Period 2.The total PMPM rate for Period 2 will be developed using the Period 2 percentage of Members determined by DCH. At the end of Period 2 of the Contract period, DCH or its Agent will evaluate the population receiving Intensive Medical Coordination during the Period to determine:If the Intensive Medical Coordination Participants in the population should be classified as a population who needs Intensive Medical Coordination;If the Intensive Medical Coordination Participants in the population were enrolled in a Medical Home; and,If the Intensive Medical Coordination Participants in the population are actively participating in the program.If upon audit DCH determines that Intensive Medical Coordination Participants do not meet the three (3) criteria described above, the selected Offeror may be asked to return a portion of the revenue they received to reflect the variance between the Period 2 percentage and the actual percentage.DCH reserves the right to audit the program at any time during the Contract and make adjustments to the PMPM if the above standards are not met. Such audits will also address Contractor staffing levels, Case Management Fees paid to Medical Home Providers and Provider incentives.Period 3 – State Fiscal Year 2017 (July 1, 2016 through June 30, 2017)At the end of Period 2, DCH will determine an appropriate level of Intensive Medical Coordination participation for Period 3 and reset the Administrative Fee to reflect the new percentage (called the Period 3 percentage). This number will be determined three (3) months before the end of Period 2 based on experience during the period and discussions with the Offeror.Period 3 Administrative Fee development will mirror the Period 2 PMPM rate development using the PMPM amounts the selected Offeror quoted for Period 3 and using the Period 3 percentage.Subsequent PeriodsFor Periods after Period 3, DCH will determine an appropriate level of Intensive Medical Coordination participation for subsequent Periods and reset the Administrative Fee to reflect the new percentage. This number will be determined three (3) months before the end of each Period based on experience during the period and discussions with the selected Offeror. Additionally, changes to the PMPM components will be negotiated with the selected Offeror before the beginning of each Period.5.3.Offeror PMPM Rate Development and Assumptions for Cost ProposalsOfferors should use the following assumptions when developing their Cost Proposals:Bid Core Coordination Services, as described in Section B of Attachment K: Requirements and Scope of Work for all Members. Bid an add-on Intensive Medical Coordination PMPM rate to cover expenses for services for Intensive Medical Coordination Participants provided by the Offeror.Bid an add-on Case Management Fees PMPM rate to pay a Case Management Fee to Medical Home Providers for services provided by the Offeror for Intensive Medical Coordination Participants.Assume ten percent (10%) of the population will receive Intensive Medical Coordination services and be enrolled in Medical Homes for each Period 1 through 3 in the PMPM rate development for Steps 2 and 3 above. The ten percent (10%) is an average of ten percent (10%) of Member months over the period. For example, if Period 1 is eight (8) months and there are 321,000 Members on average over eight (8) months that would be 2,568,000 (321,000 x 8) Member months. Ten percent (10%) of 2,568,000 would be 256,800 Member months of participation in Intensive Medical Coordination services and enrollment in Medical Homes over the course of the eight (8) months. This may look like the chart below.Bid an incremental add-on PMPM rate for Intensive Medical Coordination and for Case Management Fees for Medical Home payments to Providers who have Intensive Medical Coordination Participants.? This incremental add-on PMPM rate should reflect the additional cost if the Offeror has an additional one percent (1%) of the population receiving Intensive Medical Coordination services over and above the mandatory ten percent (10%).This amount will be used to adjust the PMPM rate in the following instances:DCH and the Offeror determine that the percentage of Members who can receive Intensive Medical Coordination services in Period 1 is higher than ten percent (10%) on average.DCH resets the percentage of Members who can receive Intensive Medical Coordination services in Period 2 and forward to a percentage other than ten percent (10%).This amount is additive to the original PMPM rate for the ten percent (10%) level. For example, if the Offeror’s PMPM rate at the ten percent (10%) level is $9.00 and the one percent (1%) additional PMPM rate is $0.50, then the PMPM rate for an eleven percent (11%) level is $9.50 ($9.00 + $0.50).Offerors must bid separate PMPM rates for Periods 1-3 as shown in the Cost Proposal worksheet worksheets – labeled Period 1 Pricing, Period 2 Pricing and Period 3 Pricing – using these assumptions. The PMPM rates quoted are fixed firm rates and will apply throughout the term of the resulting Contract. In these same worksheets, the Offerors should also complete the sections on staffing levels for each Period.Offerors must also complete the Cost Proposal Narrative to describe the assumptions used by the Offeror to develop costs for Period 1 and project expected salaries and other costs forward to Periods 2 and 3. In addition to the Period 1 through Period 3 bidding worksheets – labeled Period 1 Pricing, Period 2 Pricing and Period 3 Pricing, the Cost Proposal Workbook includes three other worksheets – one for each period – for the Offeror to complete using their own assumptions around the number of Intensive Medical Coordination Participants receiving Intensive Medical Coordination services and enrolled in Medical Homes. These spreadsheets are labeled Period 1 Offeror's % Assumption, Period 2 Offeror’s % Assumption, and Period 3 Offeror's % Assumption. The responses in these spreadsheets will be informational only for DCH and will not be scored in the Cost Proposal evaluation.6.Proposal Evaluation, Negotiations and AwardAll timely proposals will be evaluated in accordance with the following steps. The objective of the evaluation process is to identify the proposal which represents the best value to DCH based on a combination of technical and cost factors. Based on the results of the initial evaluation, DCH may or may not elect to negotiate technical and/or cost factors as further described in the eRFP. In the event negotiations of the technical and/or cost factors occur, the revised proposals will be reevaluated in accordance with the provisions of Section 6.4 “Scoring Criteria” of this eRFP. Once the evaluation process has been completed (and any negotiations DCH desires to conduct have occurred), the apparent successful Offeror(s) will be required to enter into discussions with DCH to resolve any exceptions to DCH’s Contract. DCH will announce the results of the eRFP as described further in Section 6.9 “Public Award Announcement” of this eRFP.6.1.Administrative/Preliminary ReviewFirst, the proposals will be reviewed by the Issuing Officer to determine the proposal’s compliance with the following requirements:1.Proposal was submitted by deadline in accordance with Section 22.Proposal is complete and contains all required documents 3.Technical Proposal does not include any pricing from the Cost Proposal6.2.Evaluating Proposal Factors (Section 4)If the Offeror’s proposal passes the Administrative/Preliminary Review, the Offeror’s responses to Section 4 “eRFP Proposal Factors” will be submitted to the Evaluation Team for evaluation.6.2.1.Review of Mandatory and Mandatory Scored QuestionsThe Evaluation Team will review each proposal in detail to determine its compliance with mandatory eRFP requirements. Responses to both “Mandatory” and “Mandatory Scored” Questions will be evaluated on a pass/fail basis. If a proposal fails to meet a mandatory and/or mandatory scored eRFP requirement, DCH will determine if the deviation is material. A material deviation will be cause for rejection of the proposal. An immaterial deviation will be processed as if no deviation had occurred. All proposals which meet the requirements of the “Mandatory” and “Mandatory Scored” Questions are considered “Responsive Proposals” at this point in time and will be scored in accordance with the point allocation in Section 6.4 “Scoring Criteria” of this eRFP.6.2.2.Review of Additional Scored Information QuestionsFor all proposals determined to be “Responsive Proposals”, the Evaluation Team will review and score the responses to the Additional Scored Information (if any) in accordance with the point allocation in Section 6.4 “Scoring Criteria” of this eRFP. The Offeror will receive a total technical score at the conclusion of the evaluation of the eRFP Proposal Factors.6.3.Evaluating Cost Proposal and Total Combined ScoreThe cost proposals will be reviewed and scored in accordance with Section 6.4 “Scoring Criteria.” To expedite the evaluation process, DCH reserves the right to analyze the cost proposals independently, but at the same time the Evaluation Team is analyzing the technical proposals, provided neither the cost proposals nor the cost analysis is disclosed to the Evaluation Team until the Evaluation Team completes its initial evaluation and scoring of the eRFP Proposal Factors.??6.3.1.Cost ScoringDCH will utilize total cost of ownership (TCO) based on the estimated Total Costs for three (3) Contract Periods (Period PMPM Rates multiplied times 321,000 members multiplied times the months in each Period) ?to determine the most competitive cost proposal. The cost proposal may be scored on an overall basis or at the category/subcategory/line level (as applicable) relative to other proposals. The Offeror deemed to have the most competitive cost proposal overall, as determined by DCH, will receive the maximum weighted score for the cost criteria. In the alternative, in the event the cost proposal is scored at the category, subcategory or line level, DCH may assign the maximum score per category/subcategory/line for the most competitive proposal at that level. Other proposals will receive a percentage of the weighted score based on the percentage differential between the most competitive cost proposal and the specific proposal in question. Scoring for Core and Intensive Medical Coordination services will be adjusted using a modifier to account for the staffing ratios included in the Cost Proposal for the proposed staff identified for Care Coordination and Care Management, Quality Management and Intensive Medical Coordination. The appropriateness of Case Management Fees for Medical Home payment levels also will be considered in the scoring process.Georgia Enterprises for Products and Services (GEPS)In the event the issuing officer has received a response from GEPS, the issuing officer must factor in a price preference of eight (8%) for purposes of cost evaluation. The price preference of 8% has been approved by DOAS in accordance with the State Use Law set forth at O.C.G.A. 50-5-135 et seq., which is intended to create opportunities for disabled persons employed by community-based rehabilitation programs and training centers that are certified by the State Use Council. To implement the price preference, the issuing officer must lower GEPS’ price by eight (8%) when comparing GEPS’ price with any other supplier’s response. However, in the event GEPS wins the contract award, GEPS must be paid at its actual bid price.6.4.Scoring CriteriaThe evaluation is comprised of the following:CategoryCriteriaPointsCost1. Cost of proposed products and/or services 300 pointsTechnical/Proposal Factors2. "Mandatory" RequirementsPass/FailTechnical/Proposal Factors3. "Mandatory Scored" and/or “Additional Scored” Responses700 pointsTotalN/A1000 points6.5.Georgia Based Business/Reciprocal Preference Law O.C.G.A. §50-5-60(b)For the purposes of evaluation only, Offerors resident in the State of Georgia will be granted the same preference over Offerors resident in another state in the same manner, on the same basis, and to the same extent that preference is granted in awarding bids for the same goods or services by such other state to Offerors resident therein over Offerors resident in the State of Georgia. NOTE: For the purposes of this law, the definition of a resident Offeror is an Offeror who is domiciled in the State of Georgia. 6.6.Negotiations of Proposals and/or Cost FactorsDOAS possesses discretionary authority to conduct one or more rounds of negotiations of technical proposal and/or cost factors as permitted by Georgia law and DOAS’ established procurement policy. This section of the eRFP describes DOAS’ process for utilizing its discretionary negotiation authority as defined by O.C.G.A. Section 50-5-67(a)(6). No state entity is permitted to conduct negotiations of proposal and/or cost factors without DOAS’ supervision unless DOAS has expressly authorized the state entity to conduct negotiations on its own. Although this section addresses DOAS’ right to negotiate in accordance with O.C.G.A. §50-5-67(a)(6), DOAS/State Entity reserves the right to conduct any other negotiations authorized by law. The objective of negotiations is to obtain the Offeror’s best terms. PLEASE NOTE: NEGOTIATIONS ARE DISCRETIONARY; THEREFORE, DCH URGES THE OFFEROR (1) TO SUBMIT ITS BEST RESPONSE AND (2) NOT TO ASSUME THE OFFEROR WILL BE GRANTED AN OPPORTUNITY TO NEGOTIATE.6.6.1.Overview of NegotiationsAfter the Evaluation Team has scored the Offerors’ proposals, DCH may elect to enter into one or more rounds of negotiations with all responsive and responsible Offerors or only those Offerors identified by the Evaluation Team as being in the competitive range. The competitive range will not be selected arbitrarily and those Offerors included in the competitive range must have highly scored proposals. After each round of negotiations (if any), the Offeror will submit revisions to its proposal factors and/or cost proposal, which revisions will be scored by the Evaluation Team in accordance with the same criteria used to evaluate the initial responses from the Offerors. Offerors may be removed from further participation in the negotiation process in the event the Evaluation Team determines the Offeror cannot be considered responsive and responsible or based on the competitive range as defined in Section 6.6.3 “Competitive Range.”DCH reserves the right to proceed to award without further discussions after receipt of the initial proposals, in which case, negotiations and Proposal Revisions will not be required. 6.6.2.Negotiation InstructionsListed below are the key action items related to negotiations. The State’s Negotiation Committee may consist of the State’s Evaluation Committee or may be comprised of different people. However, evaluation of proposals or revised proposals shall be completed only by the State’s Evaluation Committee.1.Negotiation Invitation: Those Offerors identified by the Evaluation Committee to negotiate will be notified and invited to attend negotiations. Offerors will be notified in writing: (i) the general purpose and scope of the negotiations; (ii) the anticipated schedule for the negotiations; and (iii) the procedures to be followed for negotiations.2.Confirmation of Attendance: Offerors who have been invited to participate in negotiations must confirm attendance.3.Negotiations Round(s): One or more rounds of negotiations may be conducted with those Offerors identified by the State’s Evaluation Team.6.6.petitive RangeIf DCH elects to negotiate pursuant to Section 6.6, DCH may either (1) elect to negotiate with all responsive and responsible Offerors, (2) limit negotiations to those Offerors identified within the competitive range, or (3) limit negotiations to the number of Offerors with whom DCH may reasonably negotiate as defined below. In the event DCH elects to limit negotiations to those Offerors identified within the competitive range, DCH will identify the competitive range by (1) ranking Offerors’ proposals from highest to lowest based on each Offeror’s Total Combined Score and (2) then looking for breaks in the scores such that natural groupings of similar scores may be identified. In the event DCH determines the number of responsive and responsible Offerors is so great that DCH cannot reasonably conduct negotiations (which determination shall be solely at DCH’s discretion and shall be conclusive), DCH may elect to limit negotiations to the top three (3) ranked Offerors as determined by the Total Combined Score.6.6.4.Negotiation Round CompletionAs part of each round of negotiation, DCH may or may not engage in verbal discussions with the Offerors. However, whether or not DCH engages in verbal discussions, any revisions the Offeror elects to make to its response must be submitted in writing via email by the end date and time identified by the Issuing Officer. All revisions received by the due date and time will be evaluated and re-scored by the Evaluation Team in accordance with the same criteria used to evaluate the initial responses from the Offerors. Revisions which are not received prior to the due date and time cannot be considered; however, any Offeror failing to submit timely revisions will not be disqualified from consideration for award based on its final proposal as accepted by DCH.6.7.Selection and AwardThe responsive and responsible Offeror receiving the highest Total Combined Score and with whom DCH is able to reach agreement as to Contract terms will be selected for award.6.8.Site Visits and Oral PresentationsDCH reserves the right to conduct site visits or to invite Offerors to present their proposal factors/technical solutions to the Evaluation Team. Cost proposals and related cost information must not be discussed during the oral presentation of the Offeror’s technical solution. Nothing in this section shall prohibit the Negotiation Team from discussing both proposal factors and cost information during the negotiation process defined by Section 6.6 “Negotiations of Proposals and/or Cost Factors”.6.9.Public Award AnnouncementThe preliminary results of the evaluation will be announced through the public posting of a Notice of Intent to Award (in the event the value of the Contract(s) is estimated to be $100,000 or more in the first year) to the Georgia Procurement Registry. The Notice of Intent to Award (“NOIA”) is not notice of an actual Contract Award; instead, the NOIA is notice of DCH’s expected Contract Award(s) pending resolution of the protest process. The NOIA (if any) will identify the apparent successful Offeror(s), unsuccessful Offeror(s), and the reasons why any unsuccessful Offerors were not selected for Contract Award. NO OFFEROR SHOULD ASSUME PERSONAL NOTICE OF THE NOTICE OF INTENT TO AWARD (“NOIA”) WILL BE PROVIDED BY DCH. INSTEAD, ALL OFFERORS SHOULD FREQUENTLY CHECK THE GEORGIA PROCUREMENT REGISTRY FOR NOTICE OF THE NOIA. The Notice of Award (“NOA”) is DCH’s public notice of actual Contract Award(s). The NOA will be publicly posted to the Georgia Procurement Registry.7.Contract Terms and ConditionsThe Contract that DCH expects to award as a result of this eRFP will be based upon the eRFP, the successful Offeror’s final response as accepted by DCH and the Contract terms and conditions, which terms and conditions can be downloaded from the Sourcing Event. The “successful Offeror’s final response as accepted by DCH” shall mean: the final cost and technical proposals submitted by the awarded Offeror and any subsequent revisions to the awarded Offeror’s cost and technical proposals and the Contract terms and conditions due to negotiations, written clarifications or changes made in accordance with the provisions of the eRFP, and any other terms deemed necessary by DCH, except that no objection or amendment by the Offeror to the eRFP requirements or the Contract terms and conditions shall be incorporated by reference into the Contract unless DCH has explicitly accepted the Offeror’s objection or amendment in writing. Please review the DCH’s Contract terms and conditions prior to submitting a response to this eRFP. Offerors should plan on the Contract terms and conditions contained in this eRFP being included in any award as a result of this eRFP. Therefore, all costs associated with complying with these requirements should be included in any pricing quoted by the Offerors. The Contract terms and conditions may be supplemented or revised before Contract Execution and are provided to enable Offerors to better evaluate the costs associated with the eRFP and the potential resulting Contract. Exception to Contract By submitting a proposal, each Offeror acknowledges its acceptance of the eRFP specifications and the Contract terms and conditions without change except as otherwise expressly stated in the submitted proposal. If an Offeror takes exception to a Contract provision, the Offeror must state the reason for the exception and state the specific Contract language it proposes to include in place of the provision.? Any exceptions to the Contract must be uploaded and submitted as an attachment to the Offeror’s response. Proposed exceptions must not conflict with or attempt to preempt mandatory requirements specified in the eRFP. In the event the Offeror is selected for potential award, the Offeror will be required to enter into discussions with DCH to resolve any contractual differences before an award is made. These discussions are to be finalized and all exceptions resolved within the period of time identified in the schedule of events. Failure to resolve any contractual issues will lead to rejection of the Offeror. DCH reserves the right to proceed to discussions with the next best ranked Offeror.DCH reserves the right to modify the Contract to be consistent with the apparent successful offer, and to negotiate other modifications with the apparent successful Offeror. Exceptions that materially change the terms or the requirements of the eRFP may be deemed non-responsive by DCH, in its sole discretion, and rejected. Contract exceptions which grant the Offeror an impermissible competitive advantage, as determined by DCH, in its sole discretion, will be rejected. If there is any question whether a particular Contract exception would be permissible, the Offeror is strongly encouraged to inquire via written question submitted to the Issuing Officer prior to the deadline for submitting written questions as defined by the Schedule of Events.8. List of eRFP AttachmentsThe following documents make up this eRFP. Please see Section 2.2.2 “eRFP Review” for instructions about how to access the following documents. Any difficulty locating or accessing the following documents should be immediately reported to the Issuing Officer.State Entity eRFP (this document)Term Definitions from Section 1.6 “Definition of Terms” of this eRFP Offeror’s General Information Worksheet from Section 4.2 of this eRFPSPD-SP054 Immigration and Security FormMandatory Response Worksheet from Section 4.3 of this eRFPMandatory Scored Response Worksheet from Section 4.4 of this eRFPAdditional Scored Response Worksheet from Section 4.5 of this eRFPCost Worksheet from Section 5 “Cost Proposal” of this eRFPDCH Contract from Section 7 “Contract Terms and Conditions” of this eRFPDCH Liquidated Damages, Exhibit 6 to the ContractDCH Performance Guarantees and Liquidated Damages Attachment to the ContractScope of Work Non-Disclosure AgreementATTACHMENT BDefinitions of TermsABD Population: Members who receive Medicaid services as a result of being aged, blind or disabled.Abandoned Call Rate: Percentage of calls received by the call center but the caller elects a valid option and is either not permitted access to that option or disconnects from the system prior to a live agent answering the call.Adverse Action: A termination, suspension, or reduction of Medicaid eligibility or a previously authorized covered service. Agent: An entity that contracts with the State of Georgia to perform administrative functions, including but not limited to: fiscal Behavioral Health activities; outreach, eligibility, and Enrollment activities; Systems and technical support; etc.Administrative Fee: The fixed monthly amount, including the VBP withhold, that the Contractor may receive from DCH for each Member enrolled in the Medical Coordination Program. The Administrative Fee will be comprised of three (3) components:Core Per Member Per Month (PMPM) rate for providing Core Coordination Services, as described in the RFP Section B of Attachment K: Requirements and Scope of Work;Add-on Intensive Medical Coordination PMPM rate to cover expenses for a percentage of Intensive Medical Coordination Participants as defined by DCH for the Period. This percentage is 10% in Period 1 and will change in subsequent periods as determined by DCH; andAdd-on Medical Home PMPM rate to pay a Case Management Fee to Medical Home providers for a percentage of Intensive Medical Coordination Participants as defined by DCH for the Period (this is the same percentage as in 2 above).Administrative Fee Payment: A payment, fixed in advance as the Member Administrative Fee Payment, less the VBP withhold, that DCH makes to Contractor on a Per Member Per Month (PMPM) basis for each Member enrolled in the Medical Coordination Program. Payments are contingent upon the availability of appropriated funds.Authorized Representative: A person authorized by the Member in writing to make health-related decisions on behalf of a Member, including, but not limited to decisions to receive Intensive Medical Coordination services, filing Complaints with the Offeror, and choice of a Medical Home. The Authorized Representative is either the Parent or Legal Guardian for a child.? For an adult this person is either the legal guardian (guardianship action), Health Care or other person who has power of attorney, or another signed HIPAA compliant document indicating who can make decisions on behalf of the Member.Automatic Assignment (or Auto-Assignment): The assignment of a Member who does not make a voluntary selection to a Medical Home chosen by the Offeror, pursuant to the provisions of this Contract.Behavioral Health: Includes mental health and substance abuse. Behavioral Health Crisis: An intensive behavioral, emotional or psychiatric situation that exceeds an individual’s current resources and coping mechanisms which, if left untreated, could result in an emergency situation.Behavioral Health Services: Services that are necessary to diagnose, correct or diminish the adverse effects of a psychiatric or substance use disorder.Blocked Call Rate: Percentage of calls that cannot be connected immediately because no circuit is available at the time the call arrives or the telephone system is programmed to block calls from entering the queue when the queue backs up beyond a defined threshold.Business Days: Monday through Friday typically from 9 A.M. to 5 P.M. excluding State holidays.Calendar Days: All seven (7) days of the Week. Care Coordination Services: A set of Member-centered, goal-oriented, culturally relevant, and logical steps that assure that a Member receives needed services in a supportive, effective, efficient, timely, and cost-effective manner. Services include assessment, evaluation, planning, linkage, support and advocacy to assist individuals in gaining access to needed medical, social, educational or other services.Care Coordinator: An Offeror staff person with responsibility for assisting any Member eligible to receive services through the Medical Coordination Program with obtaining needed medical services.Care Management: Services provided to Members by other entities or through other programs, such as Home-and Community-Based Waiver Programs, and with which the Offeror must coordinate when providing Intensive Medical Coordination services.Case Management Fee: An enhanced monthly fee paid to Medical Homes in the Contractor’s network that have Member assignments and a Letter of Agreement with the Contractor.Category of Eligibility: A group of people covered by Medicaid when it meets defined requirements.? Requirements may include age; being pregnant, disabled, blind, or aged; meeting income and asset requirements and being a U.S. citizen or a qualified alien. ?Non-qualified aliens or undocumented immigrants may be eligible for emergency assistance only.? Centers for Medicare & Medicaid Services (CMS): The agency within the U.S. Department of Health and Human Services with responsibility for the Medicare, Medicaid and the Children’s Health Insurance Program.Claim: A bill for services, a line item of services, or all services for one recipient within a bill.Clinician: Unless otherwise designated by DCH, a person who is licensed to practice independently in the State of plaint: An expression of dissatisfaction about any matter other than an Adverse Action. This includes but is not limited to issues regarding the quality of care or services provided, aspects of interpersonal relationships such as rudeness of a Provider or employee or failure to respect the individual’s rights.Condition: A disease, illness, injury, disorder, of biological, cognitive, or psychological basis for which evaluation, monitoring and/or treatment are indicated. Contract: The written agreement between the State and the Contractor; comprised of the Contract, any addenda, appendices, attachments, or amendments thereto.Contract Award: The date upon which DCH issues the Apparent Successful Offeror Letters.Contract Execution: The date upon which all parties have signed the Contract.Contractor: The Offeror that contracts hereunder with the State to administer the Medical Coordination Program.Core Coordination Services: All services available to Members through the Medical Coordination Program with the exception of services specific to individuals receiving Intensive Medical Coordination Services. Corrective Action Plan (CAP): The detailed written plan required by DCH to correct or resolve a deficiency or event, which may result in the assessment of a liquidated damage or sanction against the Contractor. To ensure that corrective actions are effective, the systematic investigation of the failure incidence is pivotal in identifying the corrective actions undertaken.Covered Services: Those Medically Necessary Health Care services provided to Members.Crisis: A Condition of instability/danger or dramatic emotional or circumstantial upheaval in a person’s life requiring action or change.Cultural Competency: A set of interpersonal skills that allow individuals to increase their understanding, appreciation, acceptance, and respect for cultural differences and similarities within, among and between groups and the sensitivity to know how these differences influence relationships with Members. This requires a willingness and ability to draw on community-based values, traditions and customs, to devise strategies to better meet culturally diverse Member needs, and to work with knowledgeable persons of and from the community in developing focused interactions, communications, and other supports.Deliverable: A document, manual or report submitted to DCH by the Contractor to fulfill requirements of this Contract.Department of Behavioral Health and Developmental Disabilities (DBHDD): The Georgia State agency that provides treatment and support services to people with mental illnesses and addictive diseases, and support to people with mental retardation and related developmental disabilities. DBHDD serves people of all ages with the most severe and likely to be long-term Conditions, including consumers with forensic issues.Department of Community Health (DCH): The agency in the State of Georgia responsible for oversight and administration of the Medicaid program, the PeachCare for Kids? program, and the State Health Benefit Plan (SHBP).Disease Management: A system of coordinated Health Care interventions and communications for populations with Conditions in which patient self-care efforts are significant.? Disease management supports the whole person, focusing on all Conditions and co-morbidities, and not just one disease.? Patients are active in managing their Conditions.? ?Discharge Planning: Activities that facilitate a patient's movement from one Health Care setting to another or to home. Discharge planning is a multi-disciplinary process, involving the patient and his or her family, physicians, nurses, social workers and possibly other Health Care professionals. The process begins on admission and is aimed at enhancing continuity of care.Effective Date: The date this Contract is executed by the DCH Commissioner.Enrollee: See Member.Fee-for-Service (FFS): A method of reimbursement based on payment for specific services rendered to a Member.Georgia Health Information Network, Inc. (GaHIN): The 501(c)(3) non-profit organization licensed to do business in the State of Georgia for the mobilization of healthcare information electronically across organizations to facilitate regional information exchange within the State.GaHIN Member: Any entity or organization that meets the requirements for participation in the GaHIN Network.GaHIN Member Affiliates: Those persons who have been authorized by a GaHIN Member to access health data through the GaHIN and in a manner defined by such GaHIN Member, in compliance with the terms and conditions of the GaHIN Member agreement and applicable law. Member Affiliates may include, but are not limited to, Health Care organizations such as hospitals and clinics, Health Care Providers and employees, contractors, or agents of a Member.? GaHIN Network: The network operated by GaHIN that allows for the exchange of health data between and among GaHIN Members and GaHIN Member Affiliates. Health Care: Care, services, or supplies related to the health of an individual. Health Care includes, but is not limited to, the following: (i) Preventive, diagnostic, therapeutic, rehabilitative, maintenance, or palliative care, and counseling, service, assessment, or procedure with respect to the physical or mental Condition, or functional status, of an individual or that affects the structure or function of the body; and (ii) Sale or dispensing of a drug, device, equipment, or other item in accordance with a prescription.Health Care Plan: A Member-centric care treatment plan, development for which is based on the Health Risk Assessment, and which reflects the Member’s Health Care needs. It must include appropriate medical, behavioral and social services and be consistent with the Medical Home’s clinical treatment plan and medical diagnoses, reflect the principles of person-centered and self-directed care and be culturally sensitive. The Health Care Plan shall incorporate, to the greatest extent possible, the Member’s unique perspective and own words about how he/she views his/her Recovery, experience, challenges, strengths, resources and needs in each of the domains included in the assessment process. The Member, and/or the Member’s legal guardian and the Member’s PCP must be actively involved in the development, of and revisions, to the Health Care Plan. For planning related to an Intensive Medical Coordination Participant, the Member’s or the family’s Peer Supporter(s) may also be involved at the Member’s request.Health Information Technology: Hardware, software, integrated technologies or related licenses, intellectual property, upgrades, or packaged solutions sold as services that are designed for our support the use of Health Care entities or patients for the electronic creation, maintenance, access, or exchange of health information. Source is ARRA - H.R.1 -115 Sec. 3000 (5)Health Insurance Portability and Accountability Act (HIPAA): A federal law, as well as the regulations promulgated pursuant to the federal law, that includes requirements to protect the privacy of individually identified health information in any format, including written or printed, oral and electronic, to protect the security of individually identified health information in electronic format, to prescribe methods and formats for exchange of electronic medical information, and to uniformly identify Providers. When referenced in this Contract it includes all related rules, regulations and procedures. Health Information Technology for Economic and Clinical Health Act (HITECH Act) Title IV: The legislation establishes a transparent and open process for the development of standards that will allow for the nationwide electronic exchange of information between doctors, hospitals, patients, health plans, the government and others by the end of 2009. It establishes a voluntary certification process for Health Information Technology products. The National Institute of Standards and Technology will provide for the testing of such products to determine if they meet the national standards that allow for the secure electronic exchange and use of health information.Health Professional Shortage Area (HPSA): An area designated by the United States Department of Health and Human Services’ Health Resources and Services Administration (HRSA) as being underserved in primary medical care, dental or mental health Providers. These areas can be geographic, demographic or institutional in nature. A care area can be found using the following website: Risk Assessment: A more detailed assessment for those Members who have been deemed to potentially qualify to receive Intensive Medical Coordination services. The Health Risk Assessment is used to collect information on a Member’s health status that includes, but is not limited to Member demographics, personal and family medical history, and lifestyle. The assessment will be used to determine Member’s needs for Intensive Medical Coordination, Disease Management, Behavioral Health Services and/or other health or community services. The Health Risk assessment is the initial step in developing a Health Care Plan.Home- and Community-Based Services (HCBS): Includes all services included in a Home and Community Based Waiver Program. Georgia HCBS programs include the Independent Care Waiver Program, the Community Based Alternatives for Youth (CBAY) Program, the New Options Waiver (NOW) Program, the Elderly and Disabled Waiver Program, and the Comprehensive Supports Waiver Program (COMP). Contractor is not required to provide Home and Community Based Services, but must provide all other Medicaid State Plan services required under this Contract for any Member enrolled in an HCBS waiver program.Individual Service Plans (ISP): The Individual Service Plan (plan of care) identifies the Home- and Community-based waiver services as well as other services and supports that a person needs in order to live successfully in the community and, therefore, avoid institutionalization. In accordance with 42 CFR §441.301 (b)(1)(i), all waiver services must be furnished pursuant to a written service plan that is developed for each waiver participant. The service plan must reflect the full range of a participant’s service needs and include both the Medicaid and non-Medicaid services along with informal supports that are necessary to address those needs. The service plan commits the State to provide the Medicaid services and supports that are specified in the plan.Immediately: Within twenty-four (24) rmation: (i.) Structured Data: Data that adhere to specific properties and validation criteria that is stored as fields in database records. Structured queries can be created and run against structured data, where specific data can be used as criteria for querying a larger data set; (ii.) Document: Information that does not meet the definition of structured data includes text, files, spreadsheets, electronic messages and images of forms and pictures.Intensive Medical Coordination (IMC): Specialized Care Coordination services provided to Members who have significant physical health and/or Behavioral Health or psychosocial needs that are not being adequately or effectively addressed. Criteria for IMC may include, but are not limited to, Members with an unstable chronic Condition or Behavioral Health Condition, more than one chronic Condition with or without co-occurring Behavioral Health Conditions; developmental delays; acute Conditions at risk of resulting in adverse long term outcomes, such as some pregnancies or severe trauma; or chaotic social or living circumstances. Specialized Care Coordination provided by an Intensive Medical Coordinator includes, but is not limited to, conducting person-centered assessment(s) of needed services and supports, assembling a wraparound team consisting of interdisciplinary professionals, the Member and his/her representatives to address the Member’s unique needs and develop a person-centered plan of care, identifying and brokering community-based medical and social services for unserved needs, coordinating new services with existing services/Providers, engaging the Member in self-healthcare, and providing assistance and encouragement to sustain engagement. These services are based upon the services outlined in 42 CFR 440.169 and 441.18 referencing Case Management and Targeted Case Management.Intensive Medical Coordination (IMC) Participant: An eligible Medicaid Member who is aged, blind or disabled and receiving Intensive Medical Coordination services. Intensive Medical Coordination Participants have a Medical Home.Intensive Medical Coordinator: An independently licensed Clinician employed by the Offeror who is responsible for managing and coordinating the care of Intensive Medical Coordination Participants.Mandated Reporters: People in professions who have regular contact with vulnerable people such as children, disabled persons and senior citizens and are therefore legally required to report (or cause a report to be made) when abuse, neglect or exploitation is observed or are suspected. The specific professionals are typically named in state law. Georgia identified mandated reporters in the OCGA for adults and children §§ 30-5-1, et seq. and 19-7-5(c)(1) which include, but are not limited to: Physicians licensed to practice medicines, interns or residents; dentists; psychologists; chiropractors; podiatrists; pharmacists; physical therapists; occupational therapists; licensed professionals and counselors; nursing personnel; social work personnel; day care personnel; employees of a public or private agency engaged in professional health-related services; and law enforcement personnel.Measurable: Applies to a Contractor objective and means the ability to determine definitively whether or not the objective has been met, or whether progress has been made toward a positive outcome.Medicaid: The joint federal/State program of medical assistance established by Title XIX of the Social Security Act, which in Georgia is administered by DCH.Medicaid Eligible: An individual eligible to receive services under the Medicaid Program but not necessarily enrolled in the Medicaid Program.Medicaid Management Information System (MMIS): Computerized system used for the processing, collecting, analysis, and reporting of Information needed to support Medicaid and Children’s Health Insurance Program functions. The MMIS consists of all required subsystems as specified in the State Medicaid Manuals.Medical Home: Provider to which Intensive Medical Coordination Participants are assigned for provision of Primary Care Services and coordination of other service needs. Primary Care Providers, as well as alternative Provider types such as specialists and Patient Center Medical Homes may serve as a Medical Home.Medically Necessary Services: Based upon generally accepted medical practices in light of Conditions at the time of treatment, Medically Necessary services are those that are:Appropriate and consistent with the diagnosis of the treating Provider and the omission of which could adversely affect the eligible Member’s medical ConditionCompatible with the standards of acceptable medical practice in the communityProvided in a safe, appropriate, and cost-effective setting given the nature of the diagnosis and the severity of the symptomsNot provided solely for the convenience of the Member or the convenience of the Health Care Provider or hospitalNot primarily custodial care unless custodial care is a covered service or benefit under the Member’s evidence of coverageThere must be no other effective and more conservative or substantially less costly treatment, service and setting availableMedication Therapy Management (MTM): A group of patient-center services provided by pharmacists involving the assessment and evaluation of the patient’s complete medication therapy regimen, pharmacotherapy consults and collaboration with physicians and other healthcare professionals to optimize medication use in accordance with evidence based guidelines. Pharmacists providing MTM services actively engage patients and caregivers in the identification, prevention and resolution of medication-related problems.Member: Aged, blind or disabled individual enrolled in Medicaid, served through the Fee-for-Service delivery system, and eligible to receive services through the Medical Coordination Program.National Committee for Quality Assurance (NCQA): An organization that sets standards, and evaluates and accredits health plans and other managed care organizations.Optional Services: Additional services proposed by the Vendor as potential methods for improving health outcomes and decreasing costs. The Contractor must receive prior approval from DCH before implementing and providing any Optional Services for Members. Vendors proposing Optional Services should refer to Section 7 of Attachment K: Requirements and Scope of Work.Patient-Centered Medical Home (PCMH): Georgia recognizes Providers as PCMHs if they have received NCQA PCMH recognition. A Patient-Centered Medical Home is a Health Care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient's family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. The Provider is required to provide this coordination and is encouraged to improve practice infrastructure in order to qualify as a Medical Home.PeachCare for Kids?: The State of Georgia’s Children’s Health Insurance Program established pursuant to Title XXI of the Social Security Act, as amended.Peer Supporter: A person with a disability who has learned life strategies, how to be a self-advocate, and how to live independently and has acquired the skills to help others do the same. A Peer Supporter differs from a counselor or an advocate in that a Peer Supporter does not tell his/her peers how to live their life. Rather, a Peer Supporter offers the benefit of his/her own experiences, passing along the encouragement and support needed for others to construct their own advocacy and life strategies to bring about desired goals.Per Member Per Month (PMPM): A unit of measure.Person-centered Medical Coordination: Care Coordination services that focus on the person and not only on the person's disease, illness or Condition. In a person-centered system, behaviors and symptoms are understood after first learning about how the person experiences his or her situation. This requires an understanding of the person's life circumstances and preferences, combined with up-to-date evidence-based knowledge about individualized medical treatment.Predictive Modeling: A process by which the Offeror identifies current or prospective high-cost, high-risk, impactable Members and uses this data to improve Member health and quality of care while managing costs.Preventive Action Plan (PAP): A detailed plan focusing on the systematic investigation of discrepancies (failures and/or deviations) in an attempt to prevent their recurrence. To ensure that preventive actions are effective, the systematic investigation of the failure incidence is pivotal in identifying the preventive actions undertaken.Primary Care Case Management (PCCM): A model of Health Care delivery where Members choose or are assigned a Medical Home that is responsible for coordinating the Member’s care and is paid a monthly Case Management Fee in addition to Fee-for-Service payment for providing medical services. Primary Care Provider (PCP): A licensed medical doctor (MD) or doctor of osteopathy (DO) or certain other licensed medical practitioner who, within the scope of practice and in accordance with State certification/licensure requirements, standards, and practices, is responsible for providing all required Primary Care services to Members. A PCP shall include general/family practitioners, pediatricians, internists, physician’s assistants, CNMs, NP-Cs, or Behavioral Health Providers depending on the most acute needs of the Member and provided that the practitioner is able and willing to carry out all PCP responsibilities in accordance with Contract provisions and licensure requirements.Primary Care Services: All Health Care services and laboratory services, including periodic examinations, preventive Health Care and counseling, immunizations, diagnosis and treatment of illness or injury, coordination of overall medical care, record maintenance, and initiation of referrals to specialty Providers described in this Contract, and for maintaining continuity of patient care. Prior Authorization: The process for approving Covered Services prior to the delivery of the service or initiation of the plan of care based on a determination as to whether the requested service is Medically Necessary. DCH will conduct Prior Authorization for Fee-for-Service services rendered.Provider: Any physician, hospital, facility, or other Health Care Professional who is licensed or otherwise authorized to provide Health Care services in the State or jurisdiction in which they are furnished.Provider Complaint: A written expression by a Provider, which indicates dissatisfaction or dispute with the Offeror’s policies, procedures or any aspect of an Offeror’s administrative functions. Quality Management (QM): The process of reviewing, measuring and continually improving the processes and outcomes of care delivered. Quality Management refers to a comprehensive program of quality and cost measurement, quality improvement and quality assurance activities responsive to the Department’s objectives.Recovery: A process of restoring or developing a positive and meaningful sense of identity apart from one's Condition and then rebuilding one's life despite, or within the limitations imposed by that Condition.Remedy: The State’s means to enforce the terms of the Contract through performance guarantees and other actions.Risk Stratification: The process of assigning Members to a risk category based on their diagnosis and the severity, duration, chronicity, impactability and other factors related to their Condition such as the availability of a social support network. Risk stratification enables the Offeror to determine the type, duration and intensity of Medical Coordination services to provide to the Member. The Offeror uses Predictive Modeling, Claims data, Health Risk Assessments and other data analysis tools to assign risk categories.Service Area: A geographic area comprised of those counties where the Contractor is responsible for providing adequate access to Medical Coordination Services and PCCM Providers.State: The State of Georgia.Subcontractor: Any third party who has a written contract with the Offeror to perform a specified part of the Offeror’s obligations under this Contract.Telecommunication Device for the Deaf (TDD): Special telephony devices with keyboard attachments for use by individuals with hearing impairments who are unable to use conventional phones.Transitional Medical Coordination: A person-centered, interdisciplinary process to plan for and facilitate preparation for discharge of Members from inpatient acute care and chronic disease hospital care.Unscheduled System Unavailability: Loss of systems functions caused by the failure of systems and telecommunications technologies within or outside the Contractor’s span of control.Utilization: The rate patterns of service usage or types of service occurring within a specified time.Utilization Management (UM): The prospective, retrospective or concurrent assessment of the medical necessity of the allocation of Health Care resources and services given, or proposed to be given, to an individual within the State of Georgia. DCH will conduct Utilization Management.Value-Based Purchasing (VBP): An enhanced approach to purchasing and program management that focuses on value over volume. It is part of a comprehensive strategy that aligns incentives for ABD Members, Providers, the Offeror and the State to achieve the program’s overarching goals. Week: The traditional seven-day Week, Sunday through Saturday.Working Days: Monday through Friday but shall not include Saturdays, Sundays, or State and Federal Holidays.Workplan: The document that outlines the specific components of the work and the time frame within which the Offeror will perform this work.Work Week:The traditional Work Week, Monday through Friday.ACRONYMSABD – Aged, Blind, and Disabled ADA – American’s with Disabilities ActAVR – Automated Voice ResponseCAP – Corrective Action PlanCDC – Centers for Disease ControlCFR – Code of Federal RegulationsCMS – Centers for Medicare & Medicaid ServicesCSB – Community Service BoardDBHDD – Department of Behavioral Health and Developmental DisabilitiesDCH – Department of Community Health DME – Durable Medical EquipmentFFS – Fee-for-ServiceGaHIN – Georgia Health Information NetworkHIPAA – Health Insurance Portability and Accountability ActIDEA – Individuals with Disabilities Education ActLEP – Limited English ProficiencyIMC- Intensive Medical CoordinationMMIS – Medicaid Management Information SystemMTM – Medication Therapy ManagementNCQA – National Committee for Quality AssurancePAP - Preventive Action PlanPCCM – Primary Care Case ManagementPCMH – Patient Centered Medical HomePCP – Primary Care ProviderPMPM – Per Member Per MonthPT – Physical Therapist/Physical TherapySSA – Social Security ActTDD – Telecommunication Device for the DeafTTY – Teletypewriter VBP – Value-Based Purchasing ................
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