2023HCA27-Amendment 2.pdf

Solicitation Amendment Page 1 of 1

Dental Authorization Review Services

RFQQ No. 2023HCA27

Amendment No. 2

Date Issued: 3/19/2024 To: RFQQ Bidders From: Jennifer Burnham, RFQQ Coordinator Purpose: To respond to Bidder Questions.

This amendment hereby modifies and is attached to RFQQ No. 2023HCA27. All other terms, conditions, and specifications remain unchanged.

Response to Bidder Questions attached below.

http://www.hca.wa.gov/

# Section Bidder Questions HCA Answers

1 2.2 I am interested in submitting a Letter of Intent. What details are required in the Letter of Intent?

Please refer to the Request For Qualifications and Quotations (RFQQ) Section 2.2

2 4.2 What significance will the oral evaluations have in making the final Bidder determination?

If HCA chooses to complete oral presentations, the oral presentation will determine the Apparent Successful Bidder.

3 1.3, 1.4, 1.5 I'm a little confused and was wondering if you could help provide clarity on what this role involves?

Please refer to the Request For Qualifications and Quotations (RFQQ) document Section 1.3 Purpose and Objectives, Section

1.4 Background, and Section 1.5 Scope of work.

4 Exhibit B What legal protections do the dental consultants have in this contract? Bidder should fully review Exhibit B, Draft Contract, otherwise HCA cannot provide legal guidance to Bidders.

5 Exhibit B What is the guidance for subcontractors invoicing for their work performed? How will the subcontractors invoice?

Contractors have sole responsibility of managing their subcontractor's invoicing procedures.

Exhibit B sections

4.38, 4.39, 4.40

Is there any language or provision that would allow a dental consultant to terminate the contract prematurely, such as a relatively serious health issue, etc.? I did not see any language whatsoever that would allow the dental consultant to terminate the contract?

Please review RFQQ Exhibit B, Draft Contract, section 4.38, Terminations, for all current contract termination conditions. Please also review section 4.39 and 4.40 for termination procedures and transition obligations.

7 Exhibit B, Attachment 3 Will there be a cost to the dental consultants?

If there is no HCA equipment available the consultants would be responsible to purchase their own equipment. Should the consultant have a sub contractor they would be responsible to pay the subcontractor.

8 Exhibit B, Attachment 3

For advanced complicated prior authorizations, typically involving removable partial prosthetics, or complete dentures, how many of these claims are reviewed within one hour?

The restorative services are not separated out into individual categories (Prosth, OS, perio,etc.). We expect the total for all PAs to be an average of 15 PAs per hour.

9 Exhibit B, Attachment 3 For the last 5 years, what has been the average number of PAs completed per hour?

Please see attached. Hours used in analysis are from invoices submitted by the consultant. Data regarding prior authorization (PA) requests completed is from the agency's Prior Authorization dashboard. PA data only goes back to January 2021 to present date. The data analyzed the most productive consultant (not contract).

10 Exhibit B, Attachment 3

For the last 12 months, what is the monthly average of PAs adjudicated for hygiene/period maintenance services?

The restorative services are not separated out into individual categories (Prosth, OS, perio,etc.). We expect the total for all PAs to be an average of 15 PAs per hour.

11 Exhibit B, Attachment 3 For the last 12 months, what is the monthly average of PAs adjudicated for RPDs?

The restorative services are not separated out into individual categories (Prosth, OS, perio,etc.). We expect the total for all PAs to be an average of 15 PAs per hour.

12 Exhibit B, Attachment 3 For the last 12 months, what is the monthly average of PAs adjudicated for CD’s?

The restorative services are not separated out into individual categories (Prosth, OS, perio,etc.). We expect the total for all PAs to be an average of 15 PAs per hour.

13 Exhibit B, Attachment 3

For the last 12 months, what is the monthly average of PAs adjudicated for restorative dentistry?

The restorative services are not separated out into individual categories (Prosth, OS, perio,etc.). We expect the total for all PAs to be an average of 15 PAs per hour.

14 Exhibit B, Attachment 3

For the last 12 months, what is the monthly average of PAs adjudicated for pediatric dentistry?

The restorative services are not separated out into individual categories (Prosth, OS, perio,etc.). We expect the total for all PAs to be an average of 15 PAs per hour.

15 Exhibit B, Attachment 3

For the last 12 months, what is the monthly average of PAs adjudicated for endodontics?

The restorative services are not separated out into individual categories (Prosth, OS, perio,etc.). We expect the total for all PAs to be an average of 15 PAs per hour.

16 Exhibit B, Attachment 3

For the last 6 months, what is the monthly average of PAs/claims that go to due process hearing? On average, consultants have completed 6 - 7 hearings per month.

17 Exhibit B, Attachment 4

Is the contract as it is drafted negotiables to the number of DC Clarifies that are allowed in a one-month period? Yes

18 Exhibit B, Attachment 4

Along the same lines, how did the Agency arrive at this number (two) per month given the track record of the current dental consultant?

In CY 2023, the most accurate consultant had only 15 DC clarifies, averaging 1.25 DC clarifies per month.

19 Exhibit B, Attachment 4 Who has the final determination as to what is considered a DC Clarify? The Dental Program Managers and Clinical Dental Program

Manager.

20 Exhibit B, Attachment 4

And what is meant by, if action is required to be taken? In other words, what and who makes that determination?

The Dental Program Manager and the Clinical Dental Program Manager.

21 Exhibit B, Attachment 4 Will ordinary questions from ASO staff be considered DC Clarifies?

When an auth is missing significant information, it is considered a DC clarify. Meaning a situation where the ASO team cannot complete the client letter without reaching out to the original adjudicator. This will be a new process so of course there will be a grace period.

22 Exhibit B, Attachment 4

Will extraordinary questions (technical dental questions) also be considered DC Clarifies?

No, if the information is too technical with clinical jargon, then it would not be considered a DC clarify. Again, this is more for instances where information is missing or incorrect.

23 Exhibit B, Attachment 4

Will the Dental Program Manager take into account the timing of the post of a DC Clarify so that it is posted for the dental consultant to turn it around in the one (1) day timeframe as listed in the contract?

Yes

24 Exhibit B, Attachment 4 Is this one (1) day turn around requirement negotiable? Yes

25 Exhibit B, Attachment 4

Given the fact that as more and more audits are becoming necessary, and the overall workload has been increasing each year since the COVID outbreak, will the Agency be able to negotiate the contract ceiling of $311,000?

No. The budget for this contract cycle is already set. The Dental Program Manager keeps track of the consultant’s hours and will determine when and if a consultant can participate in an audit.

26 Exhibit B, Attachment 4

Just to be clear, would HCA IT be available to help install and maintain the necessary/required VPN for security and system compatibility reasons?

HCA IT will be available to assist with all programs related to HCA involving assigned HCA equipment. HCA will be available to assist with programs such as VPN and Provider One. HCA is not responsible for tech related to programs not known to HCA.

27 Exhibit B, Attachment 4

If new software becomes available to either party, who determines whether it can or should be installed?

HCA IT security team determines what software is approved for download on HCA equipment.

RFQQ 2023HCA27 - Dental Authorization Review Services

28 Exhibit B, Attachment 4

If updates to P1 or any other state of Washington system is required, would HCA IT be available to help manage the installation/setup so that HCA work may continue, uninterrupted?

Yes

29 Exhibit B, Attachment 4

Will HCA IT be available to help troubleshoot or fix any software issues with regard to P1 and the dental consultants systems?

Yes, HCA will work with the consultants on any software issues on HCA equipment. It will assist with equipment not owned by HCA depending on the program. HCA is not responsible for any software system not approved by HCA.

30 Exhibit B, Attachment 4

The contract goes into detail regarding performance measures, page 40, Section 2, Performance Measures Details. However, other than meeting time, I do not see time allowed for administrative miscellaneous tasks. How much workable time can be billed for general administrative time, for instance, time logging in and out of the computer, rebooting, troubleshooting computer issues? Side note: In general, I have seen 0.5 hours per working day allowed by companies tracking remote employees.

Administrative duties completed in order to meet the deliverable is consider part of the global payment for the negotiated hourly rate.

Refer to the Consultant Hourly Rate Pricing considerations, Exhibit D.

31 Exhibit B, Attachment 4

Will a grace period of 6 months be considered prior to initiating penalties on deficiencies in meeting performance measures? A grace period is negotiable.

32 Exhibit B, Attachment 4

Is there room for negotiation regarding performance measures and how penalties are handled? A grace period is negotiable.

33 Exhibit B, Attachment 4 How are PENDED PAs managed within performance measures? Pended PAs are treated as a new PA and are factored into the hourly average as a stand alone PA.

34 Exhibit B, Attachment 5 What are the security requirements to handle Category 4 data (as described below)?

Please refer to Exhibit B, Attachment 5, specifically definition “Confidential Information” and section 3.4. And the OICO policy found here: https://watech.wa.gov/sites/default/files/2023- 12/141.10_SecuringITAssets_2023_12_Parts_Rescinded.pdf

35 Exhibit B, Attachment 5 What is the criteria for passing a security design review?

All information regarding a security design review requirements can be found here: https://watech.wa.gov/sites/default/files/2023- 09/Risk%2520Assessment%2520Standard__2023_0.pdf

36 Exhibit B, Attachment 5

Does this standard cover computer security/ cybersecurity, specifically against cyber attacks?

OICO policy found here:

https://watech.wa.gov/sites/default/files/2023- 12/141.10_SecuringITAssets_2023_12_Parts_Rescinded.pdf

37 Exhibit B, Attachment 5

What are the specific equipment details (understandable to a lay person) regarding what the minimum laptop and/or desktop configurations are that meet the requirements explained in paragraph 1.6, page 8 of RFQQ and Policy 402-G2 (Information Technology Security Guidelines)?

OICO policy found here:

https://watech.wa.gov/sites/default/files/2023- 12/141.10_SecuringITAssets_2023_12_Parts_Rescinded.pdf

38 Exhibit B, Attachment 5

What are examples of laptops or computers that would meet the requirements explained in paragraph 1.6, page 8 of RFQQ and Policy 402-G2 (Information Technology Security Guidelines)?

OICO policy found here:

https://watech.wa.gov/sites/default/files/2023- 12/141.10_SecuringITAssets_2023_12_Parts_Rescinded.pdf

39 Exhibit B, Attachment 5 What type, if any, of computer and/or IT support will be provided by HCA?

Yes, HCA will work with the consultants on any software issues on HCA equipment. It will assist with equipment not owned by HCA depending on the program. HCA is not responsible for any software system not approved by HCA.

40 Exhibit B, Attachment 5 What type, if any, of VPN support will be provided by HCA? HCA tech support will be available for any VPN issues.

41 Exhibit B, Attachment 5 What type, if any, of computer software support and updates will be provided by HCA?

Yes, HCA will work with the consultants on any software issues on HCA equipment. It will assist with equipment not owned by HCA depending on the program. HCA is not responsible for any software system not approved by HCA.

42 Exhibit B, Attachment 5 What type, if any, of cyber security support will be provided by HCA?

OICO policy found here:

https://watech.wa.gov/sites/default/files/2023- 12/141.10_SecuringITAssets_2023_12_Parts_Rescinded.pdf

43 Exhibit B, section 3.1.8

On page 10 of the proposed contract, in Section 3, Special Terms and Conditions, the LAST performance expectations is listed as (3.1.8) Provision of high-quality services.

Could this provision be defined or explained so it is clear what HCA's expectations are for high-quality services.

High quality services is better expanded upon in the Attachment 3, Statement of Work and Attachment, 4 Performance Guarantees.

44 Exhibit B, section 4.8

Given that there is not any language as mentioned in question 3, would the Agency be amenable to negotiating for such a clause to be added?

If the Bidder would like to propose alternative termination conditions or make any other request to change the Draft Contract, they are welcome to provide those exceptions per RFQQ, section 3.7, Draft Contract, and Exhibit A, Bidder Forms and Certifications, section 4. HCA will review requested exceptions and accept or reject the same at its sole discretion.

45 Exhibit B, section 4.8

If allowed, how will exceptions or amendments to the proposed contract be handled or addressed?

HCA will review requested exceptions and accept or reject the same at its sole discretion.

46 Exhibit B, section 4.8 Are Bidders able to make amendment requests to the proposed contract?

If the Bidder would like to propose requests to change the Draft Contract, they are welcome to provide those exceptions per RFQQ, section 3.7, Draft Contract, and Exhibit A, Bidder Forms and Certifications, section 4. HCA will review requested exceptions and accept or reject the same at its sole discretion.

47 Exhibit C Could the last 10 years of contract hourly invoice rates be provided? In the last three years, there has been a surge in inflation and I am curious if HCA is capturing this rise in inflation in their current contract hourly rates.

HCA cannot provide the hourly rates of other contracts. Bidder is welcome to submit a public record request for current contract documents.

https://watech.wa.gov/sites/default/files/2023-09/Risk%2520Assessment%2520Standard__2023_0.pdf https://watech.wa.gov/sites/default/files/2023-09/Risk%2520Assessment%2520Standard__2023_0.pdf https://watech.wa.gov/sites/default/files/2023-09/Risk%2520Assessment%2520Standard__2023_0.pdf

Month PA hours PAs completed Average Cases Per Hour January 31.5 472 14.98 February 49.25 763 15.49 March 72.1 1314 18.22 April 71 1219 17.17 May 57 1238 21.72 June 86.25 1593 18.47 Total 367.1 6599

Average 69.70 2121.00

Cases per hour 17.98

Month PA hours PAs completed Average Cases Per Hour July 65 1287 19.80 August 45 955 21.22 September 51.5 778 15.11 October 37.5 692 18.45 November 28.5 497 17.44 December 40.8 528 12.94 January 38.5 713 18.52 February 36.25 654 18.04 March 38.6 880 22.80 April 43 794 18.47 May 39.75 790 19.87 June 39.5 761 19.27 Total 503.9 9329

Average 42.22 778.91

Cases per hour 18.51

Month PA hours PAs completed Average Cases Per Hour July 52.25 619 11.85 August 54.75 978 17.86 September 54 853 15.80 October 45.75 1014 22.16 November 39.5 870 22.03 December 49.75 1253 25.19 January 41.25 894 21.67 February 42.75 839 19.63

Fiscal Year 2021

Fiscal Year 2022

Fiscal Year 2023

March 57.5 1178 20.49 April 49.25 872 17.71 May 60.55 1010 16.68 June 41 808 19.71 Total 588.3 11188

Average 49.03 932.33

Cases per hour 19.02

Month PA hours PAs completed Average Cases Per Hour July 56.75 1105 19.47 August 58.25 995 17.08 September 48.5 997 20.56 October 46.75 819 17.52 November 59 1093 18.53 December 74.5 1059 14.21 January 50.25 1182 23.52 February 60.75 1050 17.28 Total 454.75 8300

Average 56.84 1037.50

Cases per hour 18.25

Fiscal Year 2024