07. Exhibit A-4.docx

EXHIBIT A-4

SUBMISSION REQUIREMENTS AND EVALUATION CRITERIA COMPONENTS (TECHNICAL RESPONSE)

Table of Contents

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

SUBMISSION REQUIREMENTS AND EVALUATION CRITERIA INSTRUCTIONS

Instructions to Respondents for the Completion of Exhibit A-4

All respondents to this solicitation shall utilize Exhibit A-4 for submission of its technical response as specified in Attachment A., Instructions and Special Conditions, Section D., Response Evaluation, Negotiations, and Contract Award, Sub-Section 5., Scored Requirements - Evaluation Criteria, Item a., Technical Response Evaluation. Respondents shall adhere to the instructions below for each Submission Requirement Component (SRC).

The Agency reserves the right to utilize any or all the respondent’s response materials, documents, and information in negotiations.

Completion of Responses

Respondents shall not include website links, embedded links, and/or cross references between SRCs.

Each SRC contains form fields. Population of the form fields with text will allow the form to expand and cross pages. Unless specified in the SRC, there is no character limit. For SRCs with character limits, character counts are inclusive of spaces, but exclude attached tables, charts, exhibits, etc. Text responses must be formatted for 8-1/2’ x 11” paper, single-spaced, and in a size 11 Arial font.

Attachments are acceptable for any SRC response with a form field but must be referenced in the form field for the respective SRC and located behind each respective SRC response. Respondents shall name and label attachments to refer to respective SRCs by SRC identifier number.

Note: In addition to the complete, electronic PDF copy of this Exhibit, the Respondent should submit its response to each SRC in a separate electronic folder that is labeled with the SRC number. The electronic folder for each SRC response should contain the response to the SRC along with all attachments applicable to the SRC.

Agency evaluators will be instructed to evaluate the responses based on the narrative contained in the SRC form fields and the associated attachment(s), if applicable.

The Agency reserves the right to utilize any or all the respondent’s response materials, documents, and information in negotiations.

The SRCs in Exhibit A-4, Submission Requirements and Evaluation Criteria, may not be retyped and/or modified and must be submitted in the original format.

Scoring of the Responses

Each scored SRC includes a description of the Standard Evaluation Criteria Scale and scoring methodology in the Scoring section of the SRC.

FAILURE TO SUBMIT EACH REQUIRED FORM IN ITS ORIGINAL FORMAT MAY RESULT IN REJECTION OF THE RESPONSE.

FAILURE TO SUBMIT AN SRC MAY RESULT IN REJECTION OF THE RESPONSE.

FAILURE TO SUBMIT EACH REQUIRED SRC TEMPLATE IN ITS ORIGINAL FORMAT MAY RESULT IN REJECTION OF THE RESPONSE.

RESPONDENT NAME:

SRC# 1 – Organizational Structure and History - UNSCORED:

The Respondent shall demonstrate its capability to provide the services specified in this ITN by describing its organizational structure and history. At a minimum, the description shall include:

1. The Respondent's organizational structure, ownership, affiliations, and location(s).

2. The Respondent's corporate organizational chart, and a depiction of where the services described in this ITN falls within the organizational structure.

3. Background information on the Respondent’s corporation, the size, and resources, to include:

a. Date established.

b. Ownership (public company, partnership, subsidiary, etc.).

c. Corporation's Federal Employer Identification Number (FEIN) and Florida Corporate Charter Number.

d. Corporation's primary line of business.

e. Total number of employees, including the number of employees located in Florida.

Attachments are limited to:

· An organizational chart of the Respondent; and

· List of its physical location(s).

Response:

Limit your written response to a maximum of 2,000 characters, exclusive of attachments (charts, tables, exhibits, etc.).

SRC# 2 – Proposed Subcontractors - UNSCORED:

The respondent shall list and describe any proposed subcontractors to which it will delegate the provision of services specified in the ITN. At a minimum, the description shall include:

1. The full legal name of the proposed subcontractor.

2. A description of the type of service the subcontractor will provide.

3. Background information on the subcontractor’s corporation, the size, and resources, and years of experience in performing the delegated service(s).

Response:

Limit your written response to a maximum of 20,000 characters.

SRC# 3 – Reimbursement/Payment Structure - UNSCORED:

The Agency anticipates negotiating the pricing structure, although the contract resulting from this solicitation will result in no more than $5,000,000 to $10,000,000 reimbursement made per year for a total contract value of $15,000,000 to $30,000,000. The Agency will be open to different reimbursement mechanisms proposed during negotiations. The Respondent shall utilize Exhibit A-4-a, Unique Count of Providers, along with proposed responses in other SRCs concerning workload and deliverables to develop a proposed payment structure and reimbursement methodology. The proposed payment structure shall be supported by the Cost Proposal required in Attachment A, Instructions and Special Conditions, Section A.1, Instructions, Sub-Section B., Response Preparation and Content, Item 2., Mandatory Response Content, Sub-Item g., Cost Proposal.

Response:

Limit your written response to a maximum of 20,000 characters.

SRC# 4 – Data and Systems - SCORED:

The Respondent will be required to accept data from multiple systems and sources, use this data for analysis purposes and to create separate dashboards for internal use and external publication, and retain a copy of the raw data along with the analysis for a period of at least three (3) years. Routine data analysis shall not override prior data and analysis. The Respondent will also be required to develop, utilize, and maintain a web-based system that allows the Agency to access and view daily progress of secret shopper activities and responses, both in an internal aggregate dashboard as well as individual detailed results. The internal dashboard and detailed data shall also be available for other network metrics.

The Respondent shall demonstrate its planned approach and experience with this type of system request and access sharing. Components of the Respondents approach shall include, but not be limited to:

1. A description of the Respondent’s planned approach and experience with developing and maintaining a web-based system where analysis reports are loaded, access is provided in a secured manner for outside entities like the Agency, and potentially overlapping data is stored and available for retrieval in a clear, concise manner.

2. A description of the Respondent’s planned approach and experience with developing and maintaining internal and external dashboards related to the Managed Care Plans’ provider networks.

3. A description of the Respondent's planned approach and experience in developing and maintaining a system that tracks secret shopper activities and results, in real time, whether completed telephonically or physically onsite.

4. A description of the Respondent’s planned approach and experience in developing and maintaining a system that tracks all compliance and remediation transactions with the Managed Care Plans and the Agency.

5. A description of the Respondent’s planned approach and experience in developing and maintaining a system that receives encounter data, network data, and other types of data for analysis in regard to the Managed Care Plans’ provider network validation.

Response:

Limit your written response to a maximum of 20,000 characters, exclusive of attachments.

Evaluation Criteria:

1. The adequacy of the Respondent’s proposed approach and experience with developing and maintaining a web-based system, where analysis reports are loaded, access is provided in a secured manner for outside entities like the Agency, and potentially overlapping data is stored and available for retrieval in a clear, concise manner.

2. The adequacy of the Respondent’s planned approach and experience with developing and maintaining internal and external dashboards related to the Managed Care Plans’ provider networks.

3. The adequacy of the Respondent’s planned approach and experience in developing and maintaining a system that tracks secret shopper activities and results, in real time, whether completed telephonically or onsite.

4. The adequacy of the Respondent’s planned approach and experience in developing and maintaining a system that tracks all compliance and remediation transactions with the Managed Care Plans and the Agency.

5. The adequacy of the Respondent’s planned approach and experience in developing and maintaining a system that receives encounter data, network data, and other types of data for analysis in regard to the Managed Care Plans’ network adequacy validation.

Score: This section is worth a maximum of 25 points. Each of the above components being worth the maximum points reflected below in the Standard Evaluation Criteria Scale.

Each response will be independently evaluated and awarded points based on the criteria and points scale using the Standard Evaluation Criteria Scale below.

STANDARD EVALUATION CRITERIA SCALE

SRC# 5 – Network Analysis and Reporting - SCORED:

The Respondent shall demonstrate its proposed approach and capability to conduct a technical analysis of the metrics for network adequacy as described in Attachment B, Scope of Services. The Respondent shall also demonstrate its experience, understanding, and ability to provide reports of the network analysis results as described in Attachment B, Scope of Services.

The Respondent must include, but is not limited to, the following areas of analysis:

· Provider to member ratio (including both practitioner and facility provider types)

· Provider to member geographic access (aka time and distance) (including both practitioner and facility provider types)

· Accuracy of online and printed directories

· Appointment wait times, including LTC services with Direct Service Workers (DSW)

· Out-of-network utilization rates (specialists and facilities)

· Providers accepting new Medicaid enrollees

· Providers with after hours and weekend hours availability

· Utilization of Single Case Agreements and Letters of Agreement for non-participating network providers

· Additional recommended metrics for analysis

The Respondent shall also describe its experience, understanding, and ability to produce reports related to the above areas of analysis and shall include the method of report presentation such as Excel spreadsheets and dashboards.

The Respondent shall also include its proposed analysis in areas other than network adequacy, such as Staffing, Secret Shopper performance, and Contract Compliance/Remediation dashboards. The Respondent shall submit two samples of created dashboards dealing with any of the items above.

Response:

Limit your written response to a maximum of 20,000 characters, exclusive of attachments (charts, tables, exhibits, etc.).

1. The adequacy of the Respondent’s demonstrated analytical approach and experience for each of the network metrics listed above in terms of how well it relates to the Agency’s Network monitoring business needs, as described in Attachment B, Scope of Services.

2. The sufficiency of the Respondent’s demonstrated frequency of analysis for each of the network metrics above and how well it meets the network requirements of the Agency, as described in Attachment B, Scope of Services.

3. The quality of additional innovative metrics proposed by the Respondent and how well the proposed metrics will meet the network requirements of the Agency, as described in Attachment B, Scope of Services.

4. The quality of the dashboard samples provided by the Respondent and how well the samples demonstrate meeting the goals of the Agency in network monitoring, as described in Attachment B, Scope of Services.

Score: This section is worth a maximum of 20 points. Each of the above components being worth the maximum points reflected below in the Standard Evaluation Criteria Scale.

Each response will be independently evaluated and awarded points based on the criteria and points scale using the Standard Evaluation Criteria Scale below.

STANDARD EVALUATION CRITERIA SCALE

SRC# 6 – Secret Shopper - SCORED:

The Respondent shall demonstrate a detailed proposed approach for validating the accuracy of the Managed Care Plans’ provider network files (e.g., address, phone number, accepting new Medicaid enrollees), online directories, enrollee access to services, and more, through telephonic and physical onsite secret shopper activities, also commonly known as “mystery shoppers” or “simulated patients”. The Respondent shall incorporate all provider types and metrics/requirements of the provider networks as described in Attachment B, Scope of Services and may utilize the data in Exhibit A-4-a, Unique Count of Providers, which lists a snapshot of the number of unique network providers in order to estimate workload. This list does not include atypical providers that may be providing services to Medicaid recipients such as providers of expanded benefits or other special services; however, atypical providers may be included in order to estimate the workload.

Components of the Respondent’s approach shall include, but not be limited to:

1. Proposed sample size, provider type delineation, and frequency of secret shopper activities based upon the number of Medicaid providers enrolled with each Managed Care Plan.

2. Methods of efficiency when the same provider is enrolled with multiple plans.

3. Proposed approach to rural versus urban providers.

4. Proposed approach specifically for providers serving specialty populations.

5. Proposed ratio of telephonic secret shopper activities versus physical onsite secret shopper activities.

6. Proposed approach for the conducting of continuous testing of the provider network databases maintained by each plan.

7. Development of call scripts that simulate real case scenarios.

8. Description of physical onsite secret shopper approach.

9. Development of checklists for both telephonic and physical onsite secret shopper activities.

10. Proposed approach and recommended remedies for validating non-responsive provider locations.

Response:

Limit your written response to a maximum of 20,000 characters, exclusive of attachments (charts, tables, exhibits, etc.).

1. The adequacy of the Respondent’s proposed approach for sample size delineated by provider type and frequency of secret shopper activities.

2. The adequacy of the Respondent’s proposed approach for performing telephonic secret shopper activities and physical onsite secret shopper activities, demonstrating its ability to evaluate and conduct these activities on a large scale.

3. The adequacy of the Respondent’s proposed approach in incorporating all provider network requirements.

4. The adequacy of the Respondent’s proposed follow-up methods for noted deficiencies and experience with success rates.

5. The quality of additional innovative metrics proposed by the Respondent and how well the proposed metrics will meet the network requirements of the Agency.

Score: This section is worth a maximum of 25 points. Each of the above components being worth the maximum points reflected below in the Standard Evaluation Criteria Scale.

Each response will be independently evaluated and awarded points based on the criteria and points scale using the Standard Evaluation Criteria Scale below.

STANDARD EVALUATION CRITERIA SCALE

SRC# 7 – Compliance/Remedies - SCORED:

Upon identification of network deficiencies through secret shopper and network analysis functions, the Respondent shall demonstrate its planned approach and experience to address all deficiencies with the Managed Care Plans and remediate the deficiencies. Components of the Respondent’s approach shall include but not be limited to:

1. A description of the respondent's process and experience for identifying, engaging, and coordinating a remediation plan to improve compliance.

2. A description of the variety of approaches used that will help monitor network remediation and improve compliance outcomes.

3. A description of the Respondent’s planned approach for communicating with the Agency and Managed Care Plans, including experienced methods of follow up to ensure remediation of the deficiencies.

4. A description of recommended provider incentives for the Managed Care Plans to utilize to reduce the frequency of network deficiencies and non-compliance.

5. A description of any provider incentives that have been proven successful in reducing the frequency of network deficiencies and non-compliance, including documentation that supports the successful metrics.

6. A description of any provider network-related quality improvement projects in which the vendor either created or monitored. The description should include information about the success and experience of the completed quality improvement projects that incorporated a data-driven quality improvement cycle, one of which should be related to reducing the number of Single Case Agreements (SCA).

Response:

Limit your written response to a maximum of 20,000 characters, exclusive of attachments (charts, tables, exhibits, etc.).

1. The adequacy of the Respondent's proposed approach and experience for identifying, engaging, and coordinating a remediation plan to improve compliance.

2. The adequacy of the Respondent’s proposed approach and experience with monitoring network remediation and improving compliance outcomes.

3. The adequacy of the Respondent’s proposed approach for communicating with the Agency and Managed Care Plans, including experienced methods of follow-up to ensure remediation of the deficiencies.

4. The adequacy of the Respondent’s recommended provider incentives for the Managed Care Plans to utilize to reduce the frequency of network deficiencies and non-compliance.

5. The adequacy of any provider incentives that have been proven successful in reducing the frequency of network deficiencies and non-compliance, including the adequacy of the documentation that supports the successful metrics.

6. The adequacy of the completed quality improvement project examples, including the presentation and explanation of the results.

Score: This section is worth a maximum of 30 points. Each of the above components being worth the maximum points reflected below in the Standard Evaluation Criteria Scale.

Each response will be independently evaluated and awarded points based on the criteria and points scale using the Standard Evaluation Criteria Scale below.

STANDARD EVALUATION CRITERIA SCALE

SRC# 8 – Staffing - SCORED:

The Respondent shall describe its proposed baseline staffing solution as described in Attachment B, Scope of Services, Section II., Manner of Service(s) Provision, Sub-Section B., Services Provided by the Vendor, Item 10., Vendor Staffing. The Respondent shall identify its proposed team, including Key Personnel, and describe how its team will implement and support operations during the Contract term. It is the Agency’s expectation that the selected vendor will retain sufficient staff to adequately perform all network activities as described in Attachment B., Scope of Services.

The Respondent’s proposed baseline staffing solution shall include, but may not be limited to the following:

1. Vendor staff organizational chart that identifies the number of Key Personnel and other staff dedicated to the Enhanced Provider Network Auditing program, by name and position title.

2. Qualifications and experience of the Vendor’s Key Personnel, including resumes with references and job descriptions for each proposed team member. Key Personnel resumes must reflect prior experience as defined in Attachment B, Scope of Services, Section II., Manner of Service(s) Provision, Sub-Section B., Services Provided by the Vendor, Item 10., Vendor Staffing.

3. Staff ratio for all functional areas of the Enhanced Provider Network Auditing program, especially in the area of secret shopper and physical onsite validation activities, based upon the proposed frequency and volume of metrics being validated as described in SRC #6, Secret Shopper. The Respondent shall include proposed number of bilingual or multi-lingual staff in addition to staff with flexible hours to provide secret shopper services for providers indicating after hours or weekend services as required in the Contract.

4. Proposed office/staffing location(s) including proposed plan for staged staffing statewide that will conduct physical onsite validations for providers.

5. Workforce management tool(s) used to assist with operational efficiency of Vendor staffing and scheduling.

6. Staff to supervisor ratio for statewide staff including supervisory plan for teleworking oversight.

7. Capability and approach to onboarding, training, and conducting knowledge management of staff.

8. Plan to mitigate the risk of staff turnover (and potential effect on quality of service and continuity of operations) during the Contract term. The respondent shall provide specific examples from past or current experiences to describe how it has managed similar challenges.

Response:

Limit your written response to a maximum of 20,000 characters, exclusive of attachments (charts, tables, exhibits, etc.).

1. The adequacy of the Respondent’s proposed Key Personnel.

2. The adequacy of the Respondent’s proposed staffing for provider network validation through telephonic and physical onsite secret shopper activities.

3. The adequacy of the Respondent’s proposed staffing location(s).

4. The adequacy of the Respondent’s supervisory plan for teleworking oversight.

5. The adequacy of the Respondent’s approach to staff onboarding, training, and continual knowledge management.

Score: This section is worth a maximum of 25 points. Each of the above components being worth the maximum points reflected below in the Standard Evaluation Criteria Scale.

Each response will be independently evaluated and awarded points based on the criteria and points scale using the Standard Evaluation Criteria Scale below.

STANDARD EVALUATION CRITERIA SCALE

SRC# 9 – Respondent Qualifications - SCORED:

The Respondent shall demonstrate its capability to provide the services specified in Attachment B, Scope of Services, by describing its relevant experience with health care provider networks, qualifications, and length of experience in providing analytical, validation, and remedial services similar in nature to those described in this ITN. The description shall include how these experiences will be applied to the Agency’s goal of increasing and enhancing provider network oversight in the Statewide Medicaid Managed Care program. Details of corporate experience shall include a list of all contracts related to services similar in nature to those described in this ITN within the last five (5) years, and shall include, at a minimum:

1. Relevant experience with designing, developing, implementing, and maintaining information technology and business solutions that include large scale Managed Care Plan provider network submissions, network adequacy analysis, secret shopper call operations and onsite validations, remediation recommendations and tracking, and source data maintenance.

2. Relevant experience with developing and implementing business solutions for confirming the availability for direct service workers (DSW) such as personal care workers, home health aides, and homemaker services in addition to monitoring appointment wait times from service authorization to receipt of services.

3. Capability to work in parallel on multiple projects, with multiple vendors, and maintain timelines.

4. Any relevant experience the Respondent has with coordinating external quality reviews for required federal submissions and reports.

Response:

Limit your written response to a maximum of 30,000 characters, exclusive of attachments (charts, tables, exhibits, etc.).

1. The adequacy of the Respondent’s capability and approach to meet the requirements described in this ITN, based on the relative experience in the performance of current or previous contracts for which it is/was the lead vendor on any projects similar in size, scope, and complexity to the Enhanced Provider Network Auditing program in the past five (5) years.

2. The adequacy of the Respondent's relevant experience with developing and implementing business solutions for confirming the availability for direct service workers (DSW) such as personal care workers, home health aides, and homemaker services in addition to monitoring appointment wait times from service authorization to receipt of services.

3. The adequacy of the Respondent’s experience and demonstrated capability to work in parallel with other vendors and maintain timelines while effectively working as a single, distributed team to meet State and federal requirements.

4. The adequacy of the Respondent's relevant experience with coordinating external quality reviews for required federal submissions and reports.

Score: This section is worth a maximum of 20 points. Each of the above components being worth the maximum points reflected below in the Standard Evaluation Criteria Scale.

Each response will be independently evaluated and awarded points based on the criteria and points scale using the Standard Evaluation Criteria Scale below.

STANDARD EVALUATION CRITERIA SCALE

SRC# 10 – Compliance History - SCORED:

The Respondent shall list and describe any imposed actions levied against the Respondent, its affiliates, its subsidiaries, its parent company, the affiliates and subsidiaries of its parent company, its affiliate’s subsidiaries, and subcontractors (handling subcontracts related to consultant services when the subcontracts are for $250,000.00 or more annually), within the five (5) years preceding the date of its response to this ITN. This shall include those actions imposed by a state or federal entity in relation to a contract under which the Respondent provided data analysis and/or operational services or government services contracts (fines, penalties, sanctions, and Corrective Action Plans (CAPs)).

The respondent shall provide all the following information:

· Fines and penalties - The respondent shall disclose whether any monetary amounts were charged to it due to non-compliance.

· Sanctions - The respondent shall disclose whether any monetary or non-monetary penalty was imposed upon it.

· CAPs - The respondent shall disclose whether it developed any written plan of action to correct cited deficiencies in compliance with federal or state regulations, rules, or policies.

· Contract Terminations - The respondent shall disclose, for the past five (5) years (since November 2019), whether it:

· Voluntarily terminated a contract, in whole or in part, under which data analysis and/or operational services or government services were provided.

· Had a contract partially or fully terminated before the contract end date (with or without cause).

· Withdrew from a contracted service area of data analysis and/or operational services or government services contract.

Response:

Respondent shall use Exhibit A-4-b, Compliance History Template, to provide its Compliance History response.

1. The extent to which the respondent or parent or subsidiary or affiliates had any fines and penalties charged to it due to non-compliance.

2. The extent to which the respondent or parent or subsidiary or affiliates had any sanctions imposed upon it.

3. The extent to which the respondent or parent or subsidiary or affiliates had any CAPS to correct cited deficiencies.

4. The extent to which the respondent or parent or subsidiary or affiliates had contract terminations within the last five years.

Score: This section is worth a maximum of 20 points. Each of the above components being worth a maximum of 5 points each.

Each response will be independently evaluated and awarded points based on the criteria and points listed below.

1. Number of fines and penalties

0 = 5 Points 1 or more = 0 Points

2. Number of sanctions

0 = 5 Points 1 or more = 0 Points

3. Number of CAPs

0 = 5 Points 1 or more = 0 Points

4. Number of contracts terminated

0 = 5 Points 1 or more = 0 Points

SRC# 11 – Additional Dashboards - UNSCORED:

The Agency is also interested in the creation of additional external dashboards, particularly in the area of home health private duty nursing (PDN) services for children, with the possibility of future services being added. This PDN dashboard would be created to show by Managed Care Plan and home health agency, the number of hours authorized versus the number of actual hours provided with a break down by reason of why any hours were missed and the resultant percentages, as verified using electronic visit verification (EVV) technology. The Respondent shall demonstrate its proposed approach and capability to conduct a technical analysis for this topic and creation of the requested dashboard to be discussed further in negotiations.

Response:

Limit your written response to a maximum of 20,000 characters, exclusive of attachments (charts, tables, exhibits, etc.).

AHCA ITN 002-24/25, Attachment A, Exhibit A-4, Page 53 of 53