1.1 - RFP Information.docx

STATE OF NEVADA

DEPARTMENT OF ADMINISTRATION

Purchasing Division 515 East Musser Street, Suite 300 │ Carson City, NV 89701 Phone: 775-684-0170 │ Fax: 775-684-0188

Request for Proposal: 95PEBP-S1579

For

Third Party Administrator (TPA) for the Public Employees’ Benefits Program (PEBP)

Release Date: April 26, 2021 Deadline for Submission and Opening Date and Time: Wednesday June 2, 2021 @ 2:00 PM PDT

For additional information, please contact:

Gideon Davis, Purchasing Officer 3

Phone: 775-515-5173

Email Address: gkdavis@admin.nv.gov

APPLICABLE REGULATIONS GOVERNING PROCUREMENT

All applicable Nevada Revised Statutes (NRS) and Nevada Administrative Code (NAC) documentation can be found at: www.leg.state.nv.us/law1.cfm.

Prospective vendors are advised to review Nevada’s ethical standards requirements, including but not limited to NRS 281A, NRS 333.800, and NAC 333.155.

PROJECT OVERVIEW

The State of Nevada Purchasing Division on behalf of the Public Employees’ Benefits Program (PEBP) is seeking proposals from qualified vendors to provide Third Party Administrator services.

The State intends to award one contract in conjunction with this RFP, as determined in the best interests of the State.

PEBP shall administer the contract resulting from this RFP. The resulting contract shall be for an initial contract term of six (6) years, anticipated to begin implementation on December 15, 2021, subject to Board of Examiners approval, with an official administrative start date of July 1, 2022 with an option to renew for two (2) additional years, if agreed upon by both parties and in the best interests of the State.

GOALS AND OBJECTIVES

The Public Employees’ Benefits Program (PEBP) is interested in partnering with a Third-Party Administrator who will work with PEBP and other PEBP vendors to assure the continued success of its self-funded program. The objective of this RFP is to acquire a health and dental benefits administrator that will be a strategic partner in providing the Services included in the scope of work identified in this RFP while being able to accommodate the current and possible future plan designs approved by the PEBP Board. Vendors are encouraged to present progressive solutions relating to health plan administration, provider networks and any other enhanced services. PEBP shall administer the contract resulting from this RFP. The contact is subject to PEBP Board approval and no contract is deemed effective until approved by the State of Nevada Board of Examiners.

As part of this RFP, PEBP also requires an Out-Of-State medical network submission. There is also an option to propose an In-State medical Network as well as a National Network. Prior to July 1, 2021, PEBP was utilizing Hometown Health for the In-State Network in Northern Nevada, and Sierra Health Options in Southern Nevada. In the Fall of 2020, the In-State Network went out to bid and was award to Aetna. Those services are set to begin on July 1st, 2021. PEBP currently utilizes Express Scripts for PBM services, though that contract also will be going out to bid later this calendar year for a July 1, 2022 start date.

PEBP will also be going out to bid for HRA/HSA administration, Transparency (currently using Healthcare BlueBook), 2nd Opinion (currently with 2nd MD), and Telemedicine Services (currently with Doctor on Demand) in calendar year 2021 for July 1, 2022 start dates. PEBP would prefer that their new TPA hold these contracts after they are negotiated by PEBP.

ABOUT PEBP

PEBP is governed by a ten-member board, each of whom is appointed by the Governor of Nevada. Details for current eligibility and plan benefit design can be found in the corresponding Master Plan Documents located here: https://pebp.state.nv.us/plans/plan-documents/

PEBP oversees the administration of health insurance benefits available to:

· Full-time state employees

· Certain non-state local government agencies

· Full-time employees of the Nevada State System of Higher Education

· Early retirees who are not yet Medicare eligible; and

· Retirees who are not eligible for premium-free Medicare Part A

The program currently offers medical benefits to its participants (employees, retirees and their dependents) through the following self-funded plans:

· High deductible Consumer Driven Health Plan (CDHP) available globally

· Low deductible plan (LD) available nationwide (this plan is new to PEBP as of 7/1/21, therefore you will not find it on the Enrollment Summary Attachment)

· Exclusive Provider Organization plan (EPO) available regionally

Additionally, PEBP offers a fully insured Health Maintenance Organization (HMO) option available regionally. Plan offerings are subject to change each year.

PEBP offers dental coverage as part of the basic benefit package for participants all plans (including the fully insured HMO and retirees who receive coverage through the Medicare Exchange). PEBP recently re-awarded the Dental Network contract to Diversified Dental Services and would like their chosen TPA to administer dental claims through this network.

For a summary of the amount of claims that were paid on PEBP’s behalf in the past 24 months by their current TPA, HealthScope Benefits, please see Attachment 1.5.

For an enrollment summary of PEBPs membership, please see Attachment 1.6. Note PEBP is currently transitioning away from Morneau Shepell’s enrollment system to Benefitfocus on July 1, 2021.

GENERAL INFORMATION

Attachments to be Read – Not to be Returned (unless redlining 1.2-1.4, which is strongly discouraged)

1.2 Standard Form Contract

1.3 Insurance Schedule

1.4 Sample Business Associate Agreement

1.5 Paid Claims Summary 201901-202012

1.6 Enrollment Summary 202104

Attachments to be Completed, Acknowledged and Returned - Submission Checklist can be found within TPA RFP Spreadsheet

2.1 Intent to Bid

2.2 TPA RFP Spreadsheet

2.3 References - Confidential Spreadsheet

Network Access and Provider Disruption (instructions found within TPA RFP Spreadsheet)

TIMELINE AND SUBMISSION INFORMATION

RFP Timeline (times listed are all Pacific)

Via Zoom https://zoom.us/j/99101408155 Intent to Bid Form 2.1 Due to Purchasing Division No later than 2:00pm on 5/14/2021 Responses to Questions not answered on the Conference be posted to NevadaEPro (if applicable)

Conference Call Answering Written Questions and Verbal Follow-Up Questions

Written questions are to be submitted by 5/5/21 using the Q&A in on the Bid in NevadaEPro.

Assigned Company Identification Letter for the call Prior to the call on 5/11/21 and after submitting your written questions, your company will receive a randomly assigned letter from Gideon Davis that the State will use to reference you on the call. For example, you will be known on the call as “Company C”. We suggest that even if you do not have any questions to submit in advance, that you consider submitting a question or emailing Gideon Davis in the Purchasing Division at gkdavis@admin.nv.gov letting him know that your company will be attending the call and that you would like to be assigned a company identifier for the call.

Call Logistics

Personally De-Identify - In order to promote anonymity, please consider logging in to the Zoom meeting using only your initials or some other identifier like the last 3 digits of your phone number – we strongly encourage you to complete this task as you are logging in rather than relying on State staff do it for you after the call begins. If you miss this step or are unsure how to do this for yourself, State staff will work to de-identify you during the first 5-10 minutes of the call. You may also want to consider dialing in 5 minutes or so early in order to allow State staff more time to assist you on de-identification.

The call will start with State staff verbally responding to the written questions submitted in advance and will share those questions on the screen.

1st Round - We will then ask “Company A” if they have any verbal questions, these can pertain to written questions and verbal answers that were provided at the start of the call, or they could be new questions or clarifying questions. State staff will do their best to answer questions during the call. When “Company A” has no further questions, we will move to “Company B”, then C, and so on.

If you didn’t submit any written questions and forgot or did not to request a company code in advance of the call, we will open it up to all callers after we have exhausted our known Company callers, for example, if we preassigned Companies A-G, after G is finished, we will allow for all callers who were not assigned a letter to ask questions at that time.

2nd Round - we will then go back through the Company list, one at a time, for any follow up questions or questions that were sparked during the first round.

At the end of the 2nd round, we will once again open it up at the end for any unidentified callers, though we strongly encourage you to get an assigned letter prior to the call.

Please note, some live question answers may need to be taken away and if so, those answers will be provided in writing and posted via amendment to the Bid in NevadaEPro within 7 days of the call.

Proposal Submission Requirements

Pursuant to NRS 333.313, vendors must respond via NevadaEPro to be considered.

Vendors shall create a Quote in NevadaEPro, on the ‘Attachments Tab’ of their quote, the documents listed Section 3.2 shall be uploaded.

Refer to Instructions for Vendors Responding to a Bid in the Important Links section on the front page of NevadaEPro for instructions on how to submit a Quote using NevadaEPro.

Vendors’ electronic Quote must be in Submitted status in NevadaEPro prior to the deadline for opening to have proposed.

The TPA RFP Spreadsheet and References Confidential Spreadsheet shall be attached in Excel format.

Only the References Confidential Spreadsheet can be flagged as confidential in NevadaEPro.

PROPOSAL EVALUATION AND AWARD PROCESS

Proposal Evaluation Process

Proposals shall be consistently evaluated and scored in accordance with NRS 333.335 based upon the following criteria.

Presentations / Proposals

Following the evaluation and scoring process specified above, the State may require vendors to make a presentation of their proposal to the evaluation committee or other State staff, as applicable.

The State, at its option, may limit participation in vendor presentations to those vendors who score high enough to remain viable relative to other scores in the points available from the first five criteria.

Following the presentations, the combined initial submission and presentation scores will become the final score for a vendor’s proposal.

The State reserves the right to forego vendor presentations and select vendor(s) based on the written proposals submitted.

Pursuant to NRS 333.3354, the State of Nevada awards a five percent (5%) preference to Nevada-based businesses.

Nevada-Based business is defined in NRS 333.3352(1).

The term ‘principal place of business’ has the meaning outlined by the United States Supreme Court in Hertz Corp v. Friend, 559 U.S. 77 (2010), typically meaning a company’s corporate headquarters.

To claim this preference a vendor must indicate it on their vendor account and submitted Quote in NevadaEPro.

This preference cannot be combined with any other preference, granted for the award of a contract using federal funds, or granted for the award of a contract procured on a multi-state basis.

Pursuant to NAC 333.155, the sole contact shall be the Purchasing Division as specified on Page 1 of this RFP. Failure to observe this restriction may result in disqualification.

Proposals shall be kept confidential until a contract is awarded.

The evaluation committee is an independent committee comprised of a majority of State officers or employees established to evaluate and score proposals submitted in response to the RFP pursuant to NRS 333.335.

The evaluation committee may solicit information from any available source concerning any aspect of a proposal and seek and review any other information deemed pertinent to the evaluation process.

Each vendor shall include in its proposal a complete disclosure of any alleged significant prior or ongoing contract failures, contract breaches, any civil or criminal litigation or investigations pending which involves the vendor or in which the vendor has been judged guilty or liable.

Failure to comply with the terms of this provision may disqualify any proposal.

The State reserves the right to reject any proposal based upon the vendor’s prior history with the State or with any other party, which documents, without limitation, unsatisfactory performance, adversarial or contentious demeanor, significant failure(s) to meet contract milestones or other contractual failures. Refer generally to NRS 333.335.

Clarification discussions may, at the State’s sole option, be conducted with vendors who submit proposals determined to be acceptable and competitive per NAC 333.165.

Vendors shall be accorded fair and equal treatment with respect to any opportunity for discussion and/or written revisions of proposals.

Such revisions may be permitted after submissions and prior to award for the purpose of obtaining best and final offers.

In conducting discussions, there shall be no disclosure of any information derived from proposals submitted by competing vendors.

Any modifications made to the original proposal during the best and final negotiations shall be included as part of the contract.

Letter of Intent (LOI)

A Letter of Intent (LOI) shall be issued in accordance with NAC 333.170 notifying vendors of the State’s intent to award a contract to a vendor, pending successful negotiations.

Negotiations shall be confidential and not subject to disclosure to competing vendors unless and until an agreement is reached.

All information remains confidential until the issuance of the formal Notice of Award (NOA).

If contract negotiations cannot be concluded successfully, the State upon written notice to all vendors may negotiate a contract with the next highest scoring vendor or withdraw the RFP.

Notification of Award (NOA)

A Notification of Award (NOA) shall be issued in accordance with NAC 333.170.

Vendors shall be notified that a contract has been successfully negotiated, executed, and is awaiting approval of the Board of Examiners (BOE).

Any award is contingent upon the successful negotiation of final contract terms and upon approval of the BOE, when required.

Any non-confidential information becomes available upon written request.

Any unsuccessful vendor may file an appeal in strict compliance with NRS 333.370 and NAC Chapter 333.

Contract Effective Date

PEBP Board approves all contracts prior to final submission to the Board of Examiners.

Pursuant to NRS 333.700, any contract resulting from this RFP shall not be effective unless and until approved by the Nevada State Board of Examiners.

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