State of Washington Office of Insurance Commissioner ...

State of Washington Office of Insurance Commissioner Request for Proposals (RFP) S202110

Project Title

Analysis of Requirement for Hearing Instruments Benefit

Questions Due 11:59pm, June 28, 2021 Proposal Due 11:59pm, July 12, 2021

Emailed proposals will be accepted. Faxed proposals will not.

Estimated period of performance for contract

August 1, 2021? November 15, 2021. The OIC reserves the right to extend the contract for up to six additional months, at the sole discretion of the OIC.

Vendor eligibility

This procurement is open to those vendors that satisfy the minimum qualifications stated herein and that are available for work in Washington State.

Contents of the request for proposals

1. Introduction 2. General Information for Vendors 3. Proposal Contents 4. Evaluation and Award 5. Exhibits

a. Certifications and Assurances b. Contract with General Terms and Conditions

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Table of Contents

1 INTRODUCTION.................................................................................................................................. 2

1.1 Purpose and background .......................................................................................................... 2 1.2 Objectives and scope of work................................................................................................... 2 1.3 Minimum qualifications ............................................................................................................. 4 1.4 Period of performance ............................................................................................................... 4 1.5 Contracting with current or former state employees ............................................................ 5 1.6 Definitions.................................................................................................................................... 5 1.7 ADA............................................................................................................................................... 5 2 GENERAL INFORMATION FOR PROPOSERS ................................................................................... 6

2.1 RFP coordinator .......................................................................................................................... 6 2.2 Estimated schedule of procurement activities........................................................................ 6 2.3 Submission of proposals............................................................................................................ 6 2.4 Proprietary information/public disclosure............................................................................... 7 2.5 Revisions to the RFP ................................................................................................................... 7 2.6 Minority, women-owned, and veteran-owned business participation................................ 8 2.7 Acceptance period...................................................................................................................... 8 2.8 Responsiveness ........................................................................................................................... 8 2.9 Complaint Procedure ................................................................................................................. 8 2.10 Most favorable terms ................................................................................................................. 9 2.11 Contract and general terms & conditions............................................................................... 9 2.12 Costs to propose......................................................................................................................... 9 2.13 No obligation to contract .......................................................................................................... 9 2.14 Rejection of proposals ............................................................................................................... 9 2.15 Commitment of funds.............................................................................................................. 10 2.16 Electronic payment ................................................................................................................... 10 2.17 Insurance coverage................................................................................................................... 10 3 PROPOSAL CONTENTS .................................................................................................................... 12

3.1 Letter of submittal (Mandatory) ............................................................................................. 12 3.2 Technical proposal (Scored) .................................................................................................... 13 3.3 Management proposal (Scored) ............................................................................................. 13 3.4 Cost Proposal (Scored)............................................................................................................. 15 4 EVALUATION AND CONTRACT AWARD ....................................................................................... 16

4.1 Evaluation procedure ............................................................................................................... 16 4.2 Evaluation weighting and scoring .......................................................................................... 16 4.3 Oral presentations may be required ...................................................................................... 16 4.4 Notification to Proposers......................................................................................................... 16 4.5 Debriefing of unsuccessful Proposers.................................................................................... 16 4.6 Protest procedure ..................................................................................................................... 17 5 RFP EXHIBITS ..................................................................................................................................... 19

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1 INTRODUCTION

1.1 Purpose and background

The Office of Insurance Commissioner (OIC) is initiating this Request for Proposals (RFP) to solicit responses from individuals or firms interested in preparing an analysis related to requiring health plans regulated by OIC to include a hearing instruments benefit.

Section 140(7) of the 2021-23 Washington State operating budget (ESSB 5092/Chapter 334, Laws of 2021) directs the Office of the Insurance Commissioner (OIC) to prepare a service utilization, cost, and implementation analysis of requiring coverage for the hearing instruments benefit described in House Bill No. 1047 Requiring Coverage for Hearing Instruments for Children and Adolescents (hearing instruments/children) for children who are 18 years of age or younger, and for children and adults. OIC must contract with one or more consultants to:

1. Obtain projected utilization and cost data from Washington state health carriers for health plans, as defined in Revised Code of Washington (RCW) 48.43.005, to provide an estimate of aggregate statewide utilization and cost impacts of the coverage described in House Bill No. 1047 (hearing instruments/children) separately for children who are 18 years of age 16 or younger and for children and adults, expressed as total annual cost and as a per member per month cost.

2. Assess the impact of federal and state health care nondiscrimination laws on the scope of the benefit described in House Bill No. 1047 (hearing instruments/children).

3. Provide recommendations for distributing state payments to defray the cost of the benefit coverage described in House Bill No. 1047 (hearing instruments/children) for health carriers.

OIC must report the findings of the analysis to the appropriate committees of the legislature by December 15, 2021.

The OIC intends to award one contract to provide the services described in this RFP, but may, at the sole discretion of OIC, award multiple contracts if necessary, to satisfy the requirements of the budget proviso.

1.2 Objectives and scope of work

The contractor selected as a result of this RFP will be responsible for preparing a service utilization, cost,

and implementation analysis of requiring coverage for the hearing instruments benefit described in House Bill No. 1047 (hearing instruments/children) for children who are 18 years of age or younger and for

children and adults. The contractor must: 1. Obtain projected utilization and cost data from Washington state health carriers for health plans, as defined in RCW 48.43.005, to provide an estimate of aggregate statewide utilization and cost impacts of the coverage described in House Bill No. 1047 (hearing instruments/children) separately for children who are 18 years of age or younger and for children and adults, expressed as total projected annual cost for plan years 2023 through 2027 and as a per member per month cost by individual market as defined in RCW 48.43.005, small group market as defined in RCW 48.43.005, the market of large group plans as defined in Washington Administrative Code 284-436520, and by the entire fully-insured market 2. Assess the impact of federal and state health care nondiscrimination laws on the scope of the benefit described in House Bill No. 1047 (hearing instruments/children); and 3. Provide recommendations for distributing state payments to defray the cost of the benefit coverage described in House Bill No. 1047 (hearing instruments/children) for health carriers.

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Responsibilities are detailed below.

1.2.1

Obtain projected utilization and cost data The contractor will be responsible for obtaining projected utilization and cost data from Washington state health carriers for health plans, as defined in RCW 48.43.005, that are necessary to provide an estimate of aggregate statewide utilization and cost impacts of the coverage described in House Bill No. 1047 (hearing instruments/children). The data must be collected separately for children who are 18 years of age 16 or younger, and for children and adults, and be expressed as total annual cost and as a per member per month cost.

OIC will assist the contractor in its initial communication to health carriers related to obtaining necessary projected cost and utilization data. The following licensed health carriers must be included in the data request:

? Premera Blue Cross ? LifeWise Health Plan of Washington ? Regence BlueShield ? Regence BlueCross BlueShield (BCBS) of Oregon ? Asuris Northwest Health ? Kaiser Foundation Health Plan of Washington ? Kaiser Foundation Health Plan of Washington Options ? Kaiser Foundation Health Plan of the Northwest ? Aetna Life Insurance Company ? Coordinated Care Corporation ? Molina HealthCare of Washington ? UnitedHealthCare Insurance Company ? UnitedHealthCare of Washington Incorporated

1.2.2

Estimate of aggregate statewide utilization and cost impacts of the health instrument coverage The contractor will use the data obtained from health carriers, and any other relevant data the contractor may have from other sources, to prepare an estimate of the aggregate statewide utilization and cost impacts of the coverage described in House Bill No. 1047 (hearing instruments/children) separately for children who are 18 years of age or younger, and for children and adults. The estimated costs must be expressed as total projected annual cost for plan years 2023 through 2027, and as a per member per month cost by individual market as defined in RCW 48.43.005, small group market as defined in RCW 48.43.005, the market of large group plans as defined in WAC 284-43-6520, and by the entire fully insured market.

The estimate must be based on an analysis performed in accordance with generally accepted actuarial principles and methodologies and must be conducted by a member of the American Academy of Actuaries.

1.2.3

Assess the impact of federal and state health care nondiscrimination laws on the scope of the benefit described in House Bill No. 1047 RCW 48.43.0128, WAC 284-43-5940, Code of Federal Regultions (CFR) 45 CFR ?156.125, and section 1557 of the Affordable Care Act prohibit discrimination in design of health benefits based upon age. House Bill No. 1047 would require carriers to cover a hearing instruments benefit for

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children up to age 18, but not to adults. WAC 284-43-5940(1) provides that "[i]n reviewing plan design, plan features that attempt to circumvent coverage of medically necessary benefits such as by labeling a benefit as a pediatric service, and thereby excluding adults, or by placing all or most drugs for a specific condition in the highest cost-sharing tier, absent an appropriate reason for the exclusion, are potentially discriminatory." Issuers can be asked to identify an appropriate nondiscriminatory reason that supports their benefit design.

The contractor must provide an assessment of whether there are appropriate nondiscriminatory reasons to limit coverage of hearing instruments to children up to age 18, including relevant clinical or other evidence/research related to the relative impacts of providing hearing instrument coverage to children and to adults.

1.2.4

Provide recommendations for distributing state payments to defray the cost of the benefit coverage described in House Bill No. 1047 for health carriers. 45 CFR ?155.170 relates to benefit requirements in addition to the state designated essential health benefits. States must make payments to defray the cost of additional required benefits provided through qualified health plans, which in Washington state, are offered on the individual market. The payments can be made to health plan enrollees or directly to the qualified health plan issuer on behalf of enrollees. The contractor must provide recommendations for distributing payments to defray the cost of the hearing instrument benefit described in House Bill No. 1047. OIC is interested in mechanisms that other states may have used for distribution of cost defrayal payments related to benefits in addition to the essential health benefits.

1.3 Minimum qualifications

CONTRACTOR minimum qualifications include: ? Licensed to do business in the State of Washington or provide a commitment that it will become licensed in Washington within thirty (30) calendar days of being selected as the Apparent Successful Contractor. ? Demonstrate knowledge of, and prior experience in, the areas of work for which the proposal is being submitted. Proposer must have previously held thirty-six (36) months of responsibilities substantially the same as, or similar to, the Scope of Work in Section 1.2 of this RFP. ? At least three (3) years' experience with health insurance data collection, aggregation, and analysis, including financial analysis, and preparing findings of analyses that inform state health policy development and implementation. ? Experience in health insurance actuarial analysis for public entities, states, or departments of insurance. ? Membership in the American Academy of Actuaries specializing in health insurance of at least one person on the contractor's team to complete the Scope of Work in Section 1.2 of this RFP. o Actuaries will be required to submit, as part of the proposer's proposal, a completed U.S. Qualification Standards Attestation Form from the American Academy of Actuaries (). ? Agree to the Certifications and Assurances set forth in Exhibit A. ? Submit proposals as specified on Section 3, Proposal Contents, of this RFP.

1.4 Period of performance

The period of performance of any contract resulting from this RFP is tentatively scheduled to begin on or about August 1, 2021 and to end on November 15, 2021. The OIC, at its sole discretion, may extend the

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contract once for a period of up to six months; the contract will not exceed a total period of more than twelve months.

1.5 Contracting with current or former state employees

Specific restrictions apply to contracting with current or former state employees pursuant to chapter 42.52 of the Revised Code of Washington. Vendors should familiarize themselves with the requirements prior to submitting a proposal that includes current or former state employees.

1.6 Definitions

Definitions for the purposes of this RFP include:

OIC ? The Office of Insurance Commissioner is the OIC of the state of Washington that is issuing this RFP.

Apparent Successful Contractor ? The individual or company selected as the entity to perform the anticipated services, subject to completion of contract negotiations and execution of a written contract.

Contractor ? Individual or company whose proposal has been accepted by the OIC and is awarded a fully executed, written contract.

Proposal ? A formal offer submitted in response to this solicitation.

Proposer ? Individual, company, of firm that submits a proposal to attain a contract with the OIC.

Request for Proposals (RFP) ? Formal procurement document in which a service or need is identified but no specific method to achieve it has been chosen. The purpose of an RFP is to permit the contractor community to suggest various approaches to meet the need at a given price.

1.7 ADA

The OIC complies with the Americans with Disabilities Act (ADA). Proposers may contact the RFP Coordinator to receive this Request for Proposals in Braille or on tape.

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2 GENERAL INFORMATION FOR PROPOSERS

2.1 RFP coordinator

All communications concerning this RFP must be directed to:

Miranda Matson-Jewett Office of Insurance Commissioner

5000 Capitol Blvd Tumwater, WA 98501

360/725.9604 Contracting@oic.

Any other communication will be considered unofficial and non-binding on the OIC. Proposers are to rely on written statements issued by the RFP Coordinator. Communication directed to parties other than the RFP Coordinator may result in disqualification of the proposer.

2.2 Estimated schedule of procurement activities

Issue Request for Proposals Question & answer period

Issue last addendum to RFP Proposals due

Evaluate proposals (Optional) Oral Interviews Announce `Apparent Successful Contractor' Hold debriefing conferences (if requested) Begin contract negotiations

June 18, 2021 June 18, 2021 - June 28, 2021, 11:59pm July 2, 2021 July 12, 2021 11:59 pm July 13, 2021 ? July 19, 2021 July 21, 2021 ? July 22, 2021 July 23, 2021 July 21, 2021 ? August 1, 2021 July 23, 2021

The OIC reserves the right to revise the above schedule.

2.3 Submission of proposals

The OIC will ONLY accept electronic submissions of the Proposal. Note: If your attachment exceeds 30 MB, please contact the RFP coordinator for an alternate means of electronic submittal.

ELECTRONIC PROPOSALS: The proposal must be received by the RFP Coordinator no later than 11:59pm Pacific Time on July 12, 2021.

Proposals are to be submitted electronically and should be sent as attachments in an email to Miranda Matson-Jewett, the RFP Coordinator, at the email address listed in Section 2.1. Attachments to email should be in Microsoft Word, Excel, or PDF. Zipped files can be received by the OIC and can be used for submission of proposals. The cover submittal letter and the Certifications and Assurances form must have an electronic signature of the individual within the organization authorized to bind the proposer to the

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offer. An electronic signature is defined as an electronic identifier, created by a computer, attached, affixed to, or logically associated with an electronic record executed, or adopted by a person with the intention of using it to have the same force and effect as the use of a manual signature. Digital, facsimile, and scanned signatures will be considered electronic signature. The OIC does not assume responsibility for problems with proposer's email. If the OIC's email is not working, appropriate allowances will be made.

Proposals may not be transmitted using facsimile transmission.

Proposers should allow sufficient time to ensure timely receipt of the proposal by the RFP Coordinator. Late proposals will not be accepted and will be automatically disqualified from further consideration, unless the OIC's email is found to be at fault. All proposals and any accompanying documentation become the property of the OIC and will not be returned.

2.4 Proprietary information/public disclosure

Proposals submitted in response to this competitive procurement shall become the property of the OIC. All proposals received shall remain confidential until the apparent successful contractor, if any, resulting from this RFP is announced by the OIC; thereafter, the proposals shall be deemed public records as defined in Chapter 42.56 of the Revised Code of Washington (RCW).

Any information in the proposal that the proposer desires to claim as proprietary and exempt from disclosure under the provisions of Chapter 42.56 RCW must be clearly designated. The information must be clearly identified and the exemption from disclosure upon which the proposer is making the claim must be cited. Each page containing the information claimed to be exempt from disclosure must be clearly identified by the words "Proprietary Information" printed on the lower right-hand corner of the page. Marking the entire proposal exempt from disclosure or as Proprietary Information will not be honored.

If a public records request is made for the information that the proposer has marked as "Proprietary Information," the OIC will notify the proposer of the request and of the date that the records will be released to the requester unless the proposer obtains a court order enjoining that disclosure. If the proposer fails to obtain the court order enjoining disclosure, the OIC will release the requested information on the date specified. If a proposer obtains a court order from a court of competent jurisdiction enjoining disclosure pursuant to Chapter 42.56 RCW, the OIC shall maintain the confidentiality of the proposer's information per the court order.

A charge will be made for copying and shipping, as outlined in chapter 42.56 RCW. No fee shall be charged for inspection of contract files, but twenty-four (24) hours' notice to the RFP Coordinator is required. All requests for information should be directed to the RFP Coordinator.

2.5 Revisions to the RFP

If it becomes necessary to revise any part of this RFP, addenda will be published in WEBS and on insurance.. For this purpose, the published questions and answers and any other pertinent information will be provided as an addendum to the RFP and will be placed on the website and in WEBS.

If you downloaded this RFP from the OIC's website as listed above, you are responsible for checking the website to ensure you receive any amendments or questions and answers. Proposers are encouraged to download solicitations using WEBS to ensure notification of amendments.

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