QUESTION -Connecticut's Official State Website



SustiNet Model Healthcare Benefit Packages

RFP MCO_0729_011: Questions / Answers

|QUESTION |ANSWER |

|1. Is there an incumbent service provider? |No. There is not an incumbent service provider for the SustiNet Health Partnership's Model |

|If so, who is the current provider and what is the incumbent |Healthcare Benefit Packages. |

|contract value/duration? | |

|2. Is there a not-to-exceed value for the contract resulting |Yes. Currently, the not-to-exceed value for the contract resulting from RFP MCO_0729_011 is |

|from this RFP? |$50,000. |

|3. Is the RFP MCO_0729_011 searching for a system provider for |Currently, the RFP MCO_0729_011 is seeking a consultant or firm to develop initial comprehensive|

|the health insurance exchange which will be established in 2014? |model healthcare benefit packages for the SustiNet Health Plan to be implemented by July 1, |

| |2012. |

|4. Does the scope of services include assisting OHA with issues |No. The scope of services does not include assisting OHA with exchange licensure and/or |

|related to the possible transition to a PPACA exchange and / or |transition at this time. |

|assistance with licensure? | |

|5. Does OHA contemplate engaging a separate firm for marketing |Yes. OHA may contract with another firm to provide a marketing strategy for the SustiNet Health|

|to potential participants during the implementation period of the|Partnership for development and implementation. |

|SustiNet plans? | |

|6. Does the scope of services include assistance with the PPACA |No. SustiNet is not an applicant tor a PPACA consumer assistance grant. |

|grant application for consumer assistance and documentation of | |

|systematic issues?   | |

|7. Do you expect that the SustiNet Model Healthcare Benefit |Yes. The SustiNet Model healthcare Benefit Packages will be risk adjusted. OHA will require a |

|Packages will be risk adjusted? And if so, will OHA require a |public system. |

|public rather than a proprietary system?   | |

|8. How would these new plans accommodate PPACA requirements for |The design of the SustiNet plan has not been completed.   During the design process, the |

|exchanges in terms of: |SustiNet Board will consider whether eligibility functions could be performed through the |

|a. Eligibility |systems currently operated by various state agencies or whether additional functionality will be|

|b. Coverage of individuals and groups |obtained for the SustiNet program.   |

|c. Benefit plan design requirements concerning actuarial value | |

|d. Underwriting requirements regarding age differentials and |The scope of work will include the development of premiums for individuals and families for a |

|geography |set of benefits that is consistent with PPACA, the SustiNet Board’s recommendations, and the |

|e. Consumer protection and education |large Northeast employer standard established in the SustiNet law.  Similarly, consumer |

| |protection and education functions may be included. |

|9. Relating to the information that these will be self-funded |(a) Yes. A Third Party Administrator (TPA) may be hired to administer the SustiNet Health |

|plans, |Plan. |

|a. Will a TPA be hired to administer the plans? | |

|b. What will the risk-bearing entity be? |(b-d) With regard to inquiries (b), (c), and (d), the risk bearing entity (-ies), share of |

|c. How will risk be shared among all parties? |risk(s), and financing mechanism(s) for funding have yet to be determined. |

|d. What financing mechanisms will be used to fund base premium | |

|rates, cover excess risks, and account for and fund experience | |

|gains/losses? | |

|10. Is OHA (or whoever is sponsoring this project) willing to |Yes. The limits of liability are stated in the sample contract provided here. [pic] |

|provide limits on liability to the contractor chosen for this |The limits of liability are the State of Connecticut’s standard language that is not negotiable,|

|project? |as stated in clauses 6(a) (3), 10(f), 16(d), 34(1), 37(a)-(b)-(c)-(d), and 49 of the sample |

| |contract. |

| | |

| | |

|11. Are there limits of liability associated with this work and |Yes. The limits of liability are associated with the services provided, standard state contract|

|if so, what are they? Is this negotiable? |language, and are not negotiable. Please see previous answer. |

| | |

| |The model benefit packages will enable SustiNet to estimate the total cost of services for each |

| |member who might enroll in the program.    |

| | |

| |The state will supply data describing the cost and utilization of health care services by low |

| |income populations with known demographics.  The contractor will be required to develop a cost |

| |model that can accommodate different assumptions about key factors affecting the estimated |

| |premium costs.   The contractor should anticipate multiple scenarios and should identify the key|

| |factors that are subject to adjustment.  Examples of such items could include copayments, |

| |deductibles, co-insurance and out-of-pocket limits; chiropractic services; and tiered |

| |formularies.  The contractor should also provide the functionality to generate alternative |

| |scenarios based on adjustments to fee schedules, utilization rates and patient management |

| |services that will be required whether the contract is managed by a TPA or by an at-risk |

| |entity.   |

| | |

| |The contractor is responsible for ensuring that the requested adjustment factors are accurately |

| |applied to the base data. |

| | |

| | The bidder should clearly state whether the model will be constructed and tested under the |

| |supervision of  a member of the Society of Actuaries (ASA or FSA) with public sector health care|

| |insurance expertise. |

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