STATE OF MICHIGAN



STATE OF MICHIGAN

Department of Management and Budget

Purchasing Operations

Request for Proposal to provide

Administration of Hospital / Medical Health Care Services for MPSERS

RFP # 071I9200205

Attachment # L

Addendum # 04

this Addendum revises and officially supercedes

the terms, conditions, and specifications of the Invitation to Bid, as follows:

Note that the

Proposal Due Date is hereby extended to

THURSDAY, 07/09/2009 @ 3:00 PM

|State’s Answers to |

|Clarifications and Questions |

|submitted by tuesday, 06/18/2009 @ 5:00 PM: |

| | |Clarification | |

|Subject |RFP Citation(s) |-or- |Answer |

| | |Question | |

|(01) |Census |Attachment E, |Please provide a total count of single |No: This information is not readily available for |

| | |MPSERS Census |subscribers, 2 person (subscriber and spouse), |distribution and will not be provided for purposes of |

| | | |single parent with dependents, and full family |this RFP. |

| | | |contracts for the Medicare and Non-Medicare | |

| | | |groups separate from each other. The census | |

| | | |provided in Attachment E does not give enough | |

| | | |detail to price as requested. | |

|(02) |Claims Payment |Attachment B, |Regarding the claims data provided for Non |Claims data is incurred in the month specified.  |

| | |MPSERS Claims Cost & |Medicare PPO, Supplemental, and Medicare |Medicare claims use a run-out period through 9/30/08, |

| | |Enrollment Data |Advantage in Attachment B, are the claims |and non-Medicare claims use a run-out end date |

| | | |incurred or paid, and if it is incurred, what is|of 8/31/08.  |

| | | |the run out period, and if incurred what is the | |

| | | |run out period? |So the final month supplied (June 2008) has 3 months |

| | | | |run-out for Medicare, and 2 months run-out for |

| | | | |non-Medicare. |

|(03) |Confidentiality |§2.036, |The second paragraph of the RFP document states|As stated in RFP §2.036, Freedom of Information, “all |

| | |Freedom of Information |that ALL information submitted is subject to |information in any proposal submitted to the State … is|

| | |(FOIA) |the Freedom of Information Act (FOIA) and that |subject to the provisions of the Michigan Freedom of |

| | | |marking documents as "confidential" or |Information Act, 1976 P A 442, MCL 15.231, et seq (the |

| | |(and) |"proprietary" does not guarantee that those |‘FOIA’).” |

| | | |document s will not be released under the FOIA.| |

| | |§2.100, | | |

| | |Confidentiality | |Following this statute is not discretionary for the |

| | | |The public disclosure of some of the provider |State. |

| | |(and) |discount information requested in Attachments A| |

| | | |(3) and A (4) may be subject to our contracts | |

| | |§2.092 (B) & (C) |with these providers. We understand that this |Pursuant to RFP §2.100, Confidentiality, “‘Confidential|

| | |Security, Breach and |data is required to complete the State’s |Information’ of the State must mean any information |

| | |Notification |evaluation and want to provide you with all |which is retained in confidence by the State (or |

| | | |requested data. |otherwise required to be held in confidence by the |

| | |(and) | |State under applicable federal, state and local laws |

| | | |Some of the state retirement systems we have |and regulations) or which, in the case of tangible |

| | |Introduction |worked with have executed confidentiality |materials provided to Contractor by the State under its|

| | |Statement of Work |agreements and others have asked us to label |performance under this Contract, is marked as |

| | |(pg 15) |the sensitive information as “confidential” and|confidential, proprietary, or with a similar |

| | | |submit additional, redacted copies of our |designation by the State. ‘Confidential Information’ |

| | |(and) |response with the confidential information |excludes any information (including this Contract {or |

| | | |deleted. |any proposal} submitted to the State) that is publicly |

| | |§1.022 (G) (1) & (4) | |available under the Michigan FOIA.” |

| | |HIPPA Compliance |Can the State provide additional guidance on | |

| | | |how best to handle this situation? |Each bidder must follow its own legal council regarding|

| | |(and) | |its current agreements with other providers, with HIPPA|

| | | | |compliance and all third party confidential |

| | |§3.022, | |information, and with all legal obligations concerning |

| | |Step 1 – Technical Proposal| |other confidential information. Proposals will be |

| | |Evaluation Criteria | |evaluated by the State according to the requirements |

| | | | |and criteria expressed Article 3. |

| | |(and) | | |

| | | | |If a bidder fails to fully answer or describe all |

| | |§3.041, | |requested information, then that bidder may be deemed |

| | |Clarifications | |non-responsive. Pursuant to RFP §3.041, |

| | | | | |

| | |(and) | | |

| | | | | |

| | |§3.051, | | |

| | |Complete Proposal | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | |the State may (or may not) ask for clarifications. |

| | | | | |

| | | | |However, a bidder may eliminate a particular column |

| | | | |that asks for the name of a provider, if this assists |

| | | | |with keeping its confidentiality agreements with its |

| | | | |providers - - if the bidder provides the rest of the |

| | | | |information in the same order as it is requested: the|

| | | | |State must be able to discern the information in a |

| | | | |bidder’s response as it is requested in the RFP, in |

| | | | |order to ensure a complete evaluation, and so as to |

| | | | |ensure equity in the evaluation process. |

| | | | | |

| | | | |If a bidder fails to fully answer or describe all |

| | | | |requested information, then that bidder may be deemed |

| | | | |non-responsive. |

|(04) |Confidentiality |Attachments |In regards to the "Hosp_Network_Reimb_NonMA" |Each bidder must follow its own legal council regarding|

| | |A (3) (and) (4), |exhibit that was submitted in the RFP, which |its current agreements with other providers, with HIPPA|

| | |Price Quotation |requests "Total Eligible Charges" and "Total |Compliance and all third party confidential |

| | | |Allowable Expenses" by individual hospital, the|information, and with all legal obligations concerning |

| | | |requested information can be used to calculate |other confidential information. |

| | |§3.022, |the hospital's contractual discount. | |

| | |Step 1 – Technical Proposal| |Proposals will be evaluated by the State according to |

| | |Evaluation Criteria |It is our company policy to not release |the requirements and criteria expressed Article 3: |

| | | |commercial discount information at the facility| |

| | |(and) |level; releasing facility specific discounts |(a) The exact determination regarding the analysis of |

| | | |will compromise the confidential provider |bidder proposals cannot be determined until the Joint |

| | |§3.041, |agreements negotiated with those hospitals. |Evaluation Committee meets, pursuant to State |

| | |Clarifications | |Administrative Guide policy 0510.34, JEC – Pre-Award. |

| | | |(a) What analysis is planned for the exhibit | |

| | |(and) |"Hosp_Network_Reimb_NonMA"? |(b) No: This information is not readily available for|

| | | | |distribution and will not be provided for purposes of |

| | |§3.051, | |this RFP. |

| | |Complete Proposal |(b) Can provider tax identification number be | |

| | | |provided to assure accuracy? |(c) No: If a bidder fails to fully answer or describe|

| | | | |all requested information so that the State is not able|

| | | |(c) If the exhibit "Hosp_Network_Reimb_NonMA" |to complete its evaluation, then that bidder may be |

| | | |has to be completed in the format provided, can|deemed non-responsive. Pursuant to RFP §3.041, |

| | | |bidders provide the "# of Services" and "Total |Clarifications, the State may (or may not) ask for |

| | | |Eligible Charges" at the facility level while |clarifications. |

| | | |providing the "# of Services" and "Total | |

| | | |Eligible Charges" and "Total Allowable Charges"|(d) No: Again, Information must be presented as |

| | | |at an aggregate level?? |requested in order to be completely evaluated, and so |

| | | | |as to ensure equity in the evaluation process. If a |

| | | |(d) Can a bidder provide the State with |bidder fails to fully answer or describe all requested |

| | | |alternate hospital discount information versus |information, then that bidder may be deemed |

| | | |completing the "Hosp_Network_Reimb_NonMA' |non-responsive. Pursuant to RFP §3.041, |

| | | |exhibit? Examples would be releasing average |Clarifications, the State may (or may not) ask for |

| | | |hospital discounts at the MSA or 3 digit zip |clarifications. |

| | | |level. | |

| | | | | |

| | | | | |

| | | | | |

|(05) |Contractor Staff |§1.031, (B) |Can you clarify if the carriers account |No: The carriers account management team will not have|

| | |Contractor Staff, Roles & |management team working with MPSERS would have |access to MPSERS systems. |

| | |Responsibilities, |access to MPSERS systems (eligibility, etc)? | |

| | |Additional Staff | | |

|(06) |Disruption File |Attachment I: |Regarding the Provider Disruption File |No: This information is not readily available for |

| | |Top Providers’ Description |(Attachment I), can we obtain Tax |distribution and will not be provided for purposes of |

| | | |Identification Numbers (TIN) for the providers?|this RFP. |

| | | |This data will assist all bidders in providing | |

| | | |MPSERS with the most accurate provider | |

| | | |disruption analysis. | |

|(07) |Effective Dates |§ 1.011, |Please clarify if the actual effective date of |Yes: claims payments would begin on 01/01/2010, the |

| | |Project Request |coverage should be 1/1/10 while the |proposed contract start date is 10/01/09 to ensure a |

| | | |implementation start date is 10/1/09. |smooth transition if necessary. Implementation |

| | |(and) | |activities, as specified in Requirements in RFP § |

| | | | |1.041, begin in order for the transition from the |

| | |§ 1.041, | |incumbent Contractor to the new Contractor effective |

| | |Contract Implementation | |01/01/2010. |

| | |Management | | |

| | | | | |

| | |(and) | | |

| | | | | |

| | |§ 2.001, | | |

| | |Contract Term | | |

|(08) |Evaluation Criteria |§3.024, |Some bidders responding to this solicitation |Yes: references, past performance, and prior |

| | |Award Recommendation |may be new to State of Michigan contracting.  |experience will be verified as part of the evaluation |

| | | |For those that have no prior dealing or |process. |

| | |(and) |experience with the State, will the evaluation | |

| | | |committee check and validate their references | |

| | |§3.025, |and work quality prior to evaluating and | |

| | |Reservations |assigning points on each factor being reviewed?| |

| | | | | |

| | |(and) | | |

| | | | | |

| | |§3.040, | | |

| | |Possible Additional | | |

| | |Considerations | | |

| | | | | |

| | |(and) | | |

| | | | | |

| | |Article 5, | | |

| | |Required Bidder Information| | |

|(09) |Evaluation Criteria |§3.024, |The Buy Michigan First program is heavily |As indicated in RFP §3.025, Reservations, the “State |

| | |Award Recommendation |promoted across the State as an advantage for |reserves the right to consider total cost of ownership |

| | | |Michigan companies who bid on State contracts. |factors in the final award recommendation,” and further|

| | |(and) |Based on the level of outreach the State |states in §3.023, Step 2 – Price Proposal Evaluation, |

| | | |performs, we assume there is a solid preference|that the “State reserves the right to consider economic|

| | |§3.025, |for companies that choose Michigan for their |impact on the State when evaluating proposal pricing |

| | |Reservations |headquarters and hire thousands of Michigan |(which) includes but is not limited to: job creation, |

| | | |residents.  |job retention, tax revenue implications, and other |

| | |(and) | |economic considerations.” The specific impact and |

| | | |Can the State outline what specific advantage |consideration will be determined by the JEC at the time|

| | |§3.040, |it will give to companies headquartered in |of its committee meeting(s), pursuant to State |

| | |Possible Additional |Michigan?  Will the number of employees who are|Administrative Guide policy 0510.34, JEC – Pre-Award. |

| | |Considerations |Michigan residents be a factor?  Can you please| |

| | | |describe how this RFP will be evaluated to take|The JEC will issue its award recommendation for the |

| | |(and) |into account this program and providing a |responsive and responsible bidder which offers the best|

| | | |preference to Michigan bidders on this RFP? |value to the State of Michigan. |

| | |Article 5, | | |

| | |Required Bidder Information| | |

|(10) |Evaluation Criteria |Article 1, |In §3.022, Evaluation Criteria, the State |The State will evaluate each individual bidder-proposal|

| | |Statement of Work |outlines numerous factors used to evaluate bid |against the criteria as expressed in Articles 1, 3, and|

| | | |responses.  These include staffing, bidder |5, and specifically following the |

| | |(and) |experience, bidder information, etc.  |joint-evaluation-committee (JEC) process described in |

| | | | |Article 3. |

| | |§3.020, |Will these factors and the weights assigned to | |

| | |Award Process |them be evaluated against a predetermined set | |

| | | |of criteria, or will they each be scored | |

| | |(and) |against other proposals?  | |

| | | | | |

| | |§3.040, | | |

| | |Possible Additional | | |

| | |Considerations | | |

| | | | | |

| | |(and) | | |

| | | | | |

| | |§3.050, | | |

| | |Proposal Details | | |

| | | | | |

| | |(and) | | |

| | | | | |

| | |Article 5, | | |

| | |Required Bidder Information| | |

|(11) |Evaluation Criteria |Article 1, |If bid responses will be scored against a |There is no additional information regarding evaluation|

| | |Statement of Work |predetermined set of criteria, what is the |criteria. Points listed are the maximum for each |

| | | |criteria?  |category or section. |

| | |(and) | | |

| | | |For example, bidders can earn a maximum of 20 |Pursuant to State Administrative Guide Policy 0510.34, |

| | |§3.020, |points for staffing.  The sections referred to |JEC – Pre-Award, determination regarding analysis and |

| | |Award Process |for this line item, §5.013 and §1.031, outlined|evaluation of all bidder proposals, and determination |

| | | |generally what staffing expertise the State is |of a final recommendation(s) are the responsibility of |

| | |(and) |looking for, but does not indicate what |the voting members of Joint Evaluation Committee (JEC).|

| | | |constitutes a perfect score of 20 points.  | |

| | |§3.040, | |The JEC members will individually review each bidder |

| | |Possible Additional |How is it determined that a proposal is a 15 |proposal, and then meet as a group to achieve consensus|

| | |Considerations |versus a 20, or 11 versus 7?  While we used |in determining the evaluation. |

| | | |staffing as an example, we request this | |

| | |(and) |information for all the evaluation factors. |All proposals will be evaluated according to the same |

| | | | |interpretation of the criteria. |

| | |§3.050, | | |

| | |Proposal Details | |The State of Michigan’s Administrative Guide can be |

| | | | |found at: |

| | |(and) | |

| | | | |0.html |

| | |Article 5, | | |

| | |Required Bidder Information| | |

|(12) |Evaluation Criteria – |§3.024, |In Section 4.044, Certification of a Michigan |A business presence is determined by Statute, PA 228, |

| |Michigan Business |Award Recommendation |Business, the solicitation states “…more than a|MCL§§208.1-208.145. |

| | | |nominal filing for the purpose of gaining the | |

| | |(and) |status of a Michigan business, and that it |Further, in RFP § 4.044, Certification of a Michigan |

| | | |indicates a significant business presence in |Business, the bidder must also certify and state |

| | |§3.025, |the state, considering the size of the business|emphatically that it “authorize(s) the Michigan |

| | |Reservations |and the nature of its activities.”  |Department of Treasury to verify that the business has |

| | | | |or has not met the criteria for a Michigan business … |

| | |(and) |The definitions at the beginning of the |and to disclose the verifying information to the |

| | | |solicitation do not define the terms “nominal |procuring agency.” |

| | |§3.040, |filing” or “significant business preference.”  | |

| | |Possible Additional | |The evaluation process would involve the Department of |

| | |Considerations |What does the State consider “significant |Treasury in describing a “significant business |

| | | |business presence” in the State?  What is the |presence” for the Joint Evaluation Committee to |

| | |(and) |process for making this determination?  Who is |consider in making its recommendation. |

| | | |responsible for making this determination?  | |

| | |§4.044, |When will this determination be made in the |The JEC will issue its award recommendation for the |

| | |Michigan Business |evaluation process? |responsive and responsible bidder which offers the best|

| | | | |value to the State of Michigan. |

| | |(and) | | |

| | | | | |

| | |Article 5, | | |

| | |Required Bidder Information| | |

|(13) |Evaluation Criteria – |§5.012 (E), |§5.012 (E) requires bidders to list their 10 |Please disregard the term “life”. |

| |Required Bidder |Prior Experience |largest employer group life accounts for | |

| |Information | |Medicare services and also for non-Medicare | |

| | | |services. Please define the term “group life.” | |

|(14) |Fiduciary |§1.011, |Please confirm the level of fiduciary |MPSERS is a governmental entity and therefore not |

| |Responsibility |Project Request |responsibility that MPSERS will assume under |subject to the federal Employee Retiree Income Security|

| | | |all self-insured funding arrangements. |Act (ERISA). MPSERS obligations are statutory, and if |

| | |(and) | |a contract is entered into then the vendor’s |

| | | | |obligations will be pursuant to the contract. |

| | |§1.012, | | |

| | |Background | | |

|(15) |Fiduciary |§1.011, |Can MPSERS more fully outline how their |It is a true self-insured approach. There is no risk |

| |Responsibility |Project Request |self-insured process currently works? Is it a |sharing between the contractor and the State. |

| | | |true self-insured approach, more of a | |

| | |(and) |“cost-plus” approach and/or is there risk | |

| | | |sharing involved? | |

| | |§1.012, | | |

| | |Background | | |

|(16) |Fiduciary |§1.011, |Can you clarify how the banking works under the|MPSERS currently receives an aggregate amount for |

| |Responsibility |Project Request |current self-insured approach? What types of |claims on a weekly basis; payment is submitted to the |

| | | |charges come through under the claim wire? |vendor by EFT. Charges are for claims paid by the |

| | |(and) | |vendor, on MPSERS behalf, per the Plan Design. |

| | | | | |

| | |§1.012, | | |

| | |Background | | |

|(17) |Fiduciary |§1.011, |Does MPSERS have an imprest balance set up with|No. |

| |Responsibility |Project Request |their bank that is accessed by the current | |

| | | |carrier’s bank as needed to withdraw funds in | |

| | |(and) |order to pay claims? If so, how much is that | |

| | | |imprest balance? | |

| | |§1.012, | | |

| | |Background | | |

|(18) |Fiduciary |§1.011, |Does MPSERS have claim reserves established? If|MSPERS holds claim reserves. However, as a |

| |Responsibility – |Project Request |so, how much? |self-insured plan the State is not required to hold |

| |Solvency | | |reserves at the ERISA levels (as a compared to |

| | |(and) | |fully-funded plan). |

| | | | | |

| | |§1.012, | | |

| | |Background | | |

|(19) |Medical Management |§1.022 (F) (8) |Please provide a description of MPSERS current |"BlueHealthConnection" is the name MPSERS current |

| | |Wellness Program |Wellness program. |Wellness/Care Management programs.  Our current |

| | | | |vendor's website contains a collection of information |

| | | | |that our members can use:  drug interaction checker, |

| | | | |medical encyclopedia, health calculators, etc. |

| | | | |  |

| | | | |"Health Coach Hot Line" is a 24/7 number that members |

| | | | |can use to call in to a health coach (most health |

| | | | |coaches are registered nurses) and receive information |

| | | | |which includes:  at-home treatments for minor injuries |

| | | | |and illnesses, education about preventive care, |

| | | | |guidelines for managing chronic conditions, etc.  The |

| | | | |nurses also make outgoing calls to candidates for other|

| | | | |programs:   |

| | | | |  |

| | | | |Case Management is triggered by an admit that signals |

| | | | |that the member may have or be at-risk for a complex or|

| | | | |catastrophic condition.  The trigger generates an |

| | | | |initial call from a health coach, and an info packet |

| | | | |that is sent to the member.  After this, the member can|

| | | | |choose whether or not to participate in the program.  |

| | | | |The program provides these members with assistance, |

| | | | |advocacy and support in accessing care appropriate for |

| | | | |the member's circumstances. |

| | | | |  |

| | | | |Chronic disease management is triggered by claims data |

| | | | |showing member has one of the targeted conditions. The |

| | | | |member receives a call from a health coach, and can |

| | | | |choose whether or not to continue participation. |

| | | | |  |

| | | | |The preference-sensitive condition management program |

| | | | |is similar to the chronic disease management program, |

| | | | |but focuses on conditions where there is not a clear |

| | | | |consensus on the single best treatment approach.  The |

| | | | |program is designed to provide the member information |

| | | | |on the treatment options that are available. |

|(20) |Plan |§ 1.011, |In prior discussions with the State of Michigan|No: as stated in the RFP § 1.011, Project Request, a |

| | |Project Request |purchasing department, we were instructed to |bidder must bid on the entire Plan, not on individual |

| | | |monitor the State RFP website and when the RFP |sub-components of the Plan. |

| | | |for health care administration services was put| |

| | | |out, then submit a response for carving out | |

| | | |benefit administration services for outpatient | |

| | | |physical therapy. Will the State of Michigan | |

| | | |accept and evaluate responses for an outpatient| |

| | | |physical therapy network carve-out model that | |

| | | |represents significant cost savings without | |

| | | |limiting access to medically necessary care? | |

|(21) |Plan Design |Attachments G |Please provide the Outpatient Physical Therapy |Please reference Attachments G3 and G5 for a list of |

| | |(1) to (5), |benefit design for the eligible population |covered services. |

| | |Claims Kit |(i.e., 60 visits maximum combined with OT and | |

| | | |ST). | |

|(22) |Plan Design |Attachments G |Please confirm if the Outpatient Physical |Please reference Attachments G3 and G5 for a list of |

| | |(1) to (5), |Therapy benefit for Medical, Medicare Advantage|covered services. |

| | |Claims Kit |and Medical Supplemental are the same. | |

|(23) |Price Quotation |Attachments A |Please clarify how Bidders are to price the |Yes: costs for non-Medicare spouses and dependents must|

| | |(1) – (7), |pre-65 spouses/dependents of the |be reflected in the pricing area for the non-Medicare |

| | |Price Quotation |Medicare-eligible retirees.  |eligible retirees. |

| | | | | |

| | | |Specifically, since we do not have a breakdown | |

| | | |of spouses/dependents for Medicare vs. | |

| | | |non-Medicare retirees are we to assume that | |

| | | |within the pricing areas for Medicare Advantage| |

| | | |and Medicare Supplemental that we are not to | |

| | | |record any amounts for spouses/dependents and | |

| | | |to reflect their costs in the pricing area for | |

| | | |the non-Medicare-eligible retirees? | |

|(24) |Provider Network |Attachment I, |Regarding Attachment I, Disruption File, in |No: This information is not readily available for |

| | |Top Providers for |addition to a Tax Identification Number, could |distribution and will not be provided for purposes of |

| | |Disruption |the State also provide the service |this RFP. |

| | | |or billing address for all providers listed in | |

| | | |this Attachment? (This information would | |

| | | |greatly assist us in running our disruption | |

| | | |report.) | |

|(25) |Reporting |§1.042 (H) (1), |Where is Appendix I referenced in (1.042) (H) |Yes: it is Attachment I. |

| | |Reports / Data |(1)? Is it the Medical Functional Specs – | |

| | |(and) |Attachment J? | |

| | | | | |

| | |Attachment I, | | |

| | |Top Providers for | | |

| | |Disruption | | |

|(26) |Scope |§1.021, |From the RFP, it appears that only the |Only the self-insured plans are included in this RFP. |

| | |Scope |self-insured (non-HMO) products are part of |Fully insured HMO’s will not be considered in this bid |

| | | |this RFP. Is that correct? Do we have the |process. |

| | | |ability to quote on the fully insured HMO as | |

| | | |well but separately if desired? | |

|(27) |Scope |§1.021, |Since there was a separate RFP for Pharmacy |Prescription drugs covered under MPSERS Prescription |

| | |Scope |coverage a few months ago, can you please |Drug Program are excluded from this RFP; there are no |

| | | |clarify if Pharmacy is also part of this bid? |prescription drug claims payable under the pharmacy |

| | |(and) |If not, do you still want us to answer the |plan in the data provided. |

| | | |pharmacy questions that are part of the RFP? | |

| | |§1.031, | |Contractor is required to work with the State’s Plan |

| | |Contractor Staff Roles & | |Sponsor and the Plan Sponsor's PBM in the management of|

| | |Responsibilities, | |specialty drugs, since specialty medications are often |

| | |Additional Staff | |administered by network providers (and paid through the|

| | | | |Hospital/Medical Plan) to assure that the most |

| | | | |favorable reimbursement arrangement is established for |

| | | | |those medications (in relation to requirement |

| | | | |1.022(F)(7)). |

| | | | | |

| | | | |The State also requires that the Contractor include a |

| | | | |pharmacist on the Account Team, in order to assure that|

| | | | |issues related to prescription drugs that overlap |

| | | | |between the Contractor's responsibilities and the PBM's|

| | | | |responsibilities are appropriately addressed (in |

| | | | |relation to requirement 1.031(B)(2)(c)). |

|(28) |Scope – |Attachment B: |Please confirm that MPSERS wants prescription |Prescription drugs covered under MPSERS Prescription |

| |Prescription Drug |MPSERS Claims Cost |drug coverage excluded from all proposals for |Drug Program are excluded from this RFP; there are no |

| | |and Enrollment Data |the Non-Medicare PPO, Medicare Advantage and |prescription drug claims payable under the pharmacy |

| | | |Medicare Supplement plans. Also, please clarify|plan in the data provided. |

| | | |as to whether prescription drug claims are | |

| | | |excluded or included in all claims data | |

| | | |provided for these three groups. | |

|(29) |Statement of Work – |§1.022 (M) (22), |SLA #22 deals with clinical quality improvement|SLA 22 is not a disease management guarantee and, |

| |Service Level |Performance Guarantees / |for specific disease management, but the |therefore, applies to the Administration Fee. |

| |Agreement |Service Level Agreements – |penalty referenced applies to the total admin | |

| | |Guarantee |fee instead of the disease management program | |

| | | |fee.  Your other SLAs that touch disease | |

| | | |management (19-21) have penalties associated | |

| | | |with the disease management program fee and not| |

| | | |the total admin fee.  Please confirm whether | |

| | | |the penalty applies to the total admin fee or | |

| | | |only the disease management program fee.  | |

|(30) |Statement of Work – |§1.022 (M) (22), |SLA #22 lists quality of care measures for six |The State will work with the Contractor to update the |

| |Service Level |Performance Guarantees / |specific items, many of which are no longer |Clinical Quality Improvement measures to address the |

| |Agreement |Service Level Agreements – |recommended practice for the primary age group |most current published standards by appropriate |

| | |Guarantee |served by MPSERS.  For example, you expect |recognized organizations, throughout the Contractor’s |

| | | |improvement in the percentage of female members|implementation and within the annual work plan. |

| | | |receiving cervical cancer screening tests.  The| |

| | | |American Cancer Society (ACS) recommendations |A bidder must include its recommendations with this |

| | | |suggest stopping cervical cancer screening at |response. |

| | | |age 70 in women who have had three or more | |

| | | |documented, consecutive, technically | |

| | | |satisfactory normal/negative cervical cytology | |

| | | |tests, and who have had no abnormal/positive | |

| | | |cytology tests within the last 10 years. The | |

| | | |USPSTF recommends against routinely screening | |

| | | |women older than age 65 for cervical cancer if | |

| | | |they have had adequate recent screening with | |

| | | |normal Pap smears and are not otherwise at high| |

| | | |risk for cervical cancer.  Will ORS confirm if | |

| | | |they will consider adopting more accepted | |

| | | |clinical quality improvement measures for this | |

| | | |SLA, such as requiring reporting by disease | |

| | | |cluster or against an aggregate set of measure?| |

|(31) |Statement of Work – |§1.022 (M)(5), |SLA #5 is titled Average Speed of Answer, but |For purposes of this RFP, SLA #5 must be answered as |

| |Service Level |Performance Guarantees / |the standard requests 95% of calls answered |directed. |

| |Agreement |Service Level Agreements, |within 30 seconds.  A service level of 95% of | |

| | |Customer Service Call – |calls answered within 30 seconds or less | |

| | |Average Speed |requires an Average Speed of Answer (ASA) of | |

| | | |less than 5 seconds.  Staffing for this level | |

| | | |of service is extremely expensive and | |

| | | |maintaining that service level at all times is | |

| | | |unlikely, so the costs for this level of | |

| | | |service and the risk of paying substantial | |

| | | |penalties must be built into the fees charged | |

| | | |to the State.  | |

| | | | | |

| | | |We think you may have intended to specify a | |

| | | |standard of 95% of calls in an average of 30 | |

| | | |seconds or less.  Please confirm whether our | |

| | | |assumption is correct.  (We offered this same | |

| | | |point of clarity in the Prescription Benefit | |

| | | |Management solicitation, and our assumption was| |

| | | |confirmed in that case.) | |

|(32) |Statement of Work – |§1.022 (M), |Will performance standards be applied, if |Yes: All SLA’s apply. The State would modify the |

| |Service Level |Performance Guarantees / |MPSERS chooses an insured arrangement? |penalty language so that it would apply to only the |

| |Agreement |Service Level Agreements | |administrative fee portion of the premium rates. |

|(33) |Subcontractors |§1.031 (C), |With regard to subcontractors, are bidders |Bidders must include a complete description of all |

| | |Contractor – Staff, Roles |required to disclose companies whose products |proposed subcontractors (and describe the roles and |

| | |and Responsibilities, |we have purchased or only those providing |responsibilities) that will directly affect or |

| | |Subcontractors |direct service to prospective members? For |contribute to its ability to provide the services in |

| | | |example, we use a health assessment from a |the RFP. |

| | |(and) |subcontractor, but the subcontractor will not | |

| | | |“service” the member. | |

| | |§2.044, | | |

| | |Subcontracting | | |

| | | | | |

| | |(and) | | |

| | | | | |

| | |§ 2.070, | | |

| | |Subcontracting by | | |

| | |Contractor | | |

| | | | | |

| | |(and) | | |

| | | | | |

| | |§4.036, | | |

| | |Use of Other Sources as | | |

| | |Subcontractors | | |

| | | | | |

| | |(and) | | |

| | | | | |

| | |§5.013 (C), | | |

| | |Subcontractors | | |

|(34) |Subcontractors |§1.031 (C), |How do we obtain written consent from the |A bidder must include a description of all proposed |

| | |Contractor – Staff, Roles, |Department of Management and Budget, Purchasing|subcontractors (and roles and responsibilities) that |

| | |and Responsibilities, |Operations for subcontractor approval (2.072)? |will directly affect or contribute to its ability to |

| | |Subcontractors | |provide the services described. |

| | | | | |

| | |(and) | |With each fiscal year, the awarded-Contractor is |

| | | | |required to submit a work plan, and include an update |

| | |§1.041, | |for its staff roles and responsibilities; this will be |

| | |Contract Implementation | |conveyed to DMB via the ORS. |

| | |Management Plan | | |

| | | | |This requirement to include an updated description of |

| | |(and) | |staff roles and responsibilities in the annual work |

| | | | |plan is indicated in RFP §1.041 (D) (1). |

| | |§2.044, | | |

| | |Subcontracting | | |

| | | | | |

| | |(and) | | |

| | | | | |

| | |§ 2.070, | | |

| | |Subcontracting by | | |

| | |Contractor | | |

| | | | | |

| | |(and) | | |

| | | | | |

| | |§4.036, | | |

| | |Use of Other Sources as | | |

| | |Subcontractors | | |

| | | | | |

| | |(and) | | |

| | | | | |

| | |§5.013 (C), | | |

| | |Subcontractors | | |

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