2023HCA27-Dental Authorization Review Services.pdf

REQUEST FOR QUALIFICATIONS AND QUOTATIONS (RFQQ)

RFQQ NO. 2023HCA27

NOTE: If you download this RFQQ from any source other than the Washington Electronic Business Solution (WEBS), you are responsible for registering in WEBS for your organization to receive any RFQQ amendments, including Bidder questions/agency answers. HCA is not responsible for any failure of your organization to register in WEBS or any other repercussions that may result to your organization because of this failure.

PROJECT TITLE: Dental Authorization Review Services

BID DUE DATE: April 3, 2024, by 2 p.m. Pacific Time, Olympia, Washington, USA.

Only e-mailed bids will be accepted.

ESTIMATED TIME PERIOD FOR CONTRACT: July 1, 2024 - June 30, 2026

The Health Care Authority reserves the right to extend the contract for up to an additional four (4) year one (1) year periods at its sole discretion, dependent on mutual agreement of the contract terms by the parties.

BIDDER ELIGIBILITY: This solicitation is open to those Bidders that satisfy the minimum qualifications stated herein and that are available for work in Washington State.

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TABLE OF CONTENTS

1. INTRODUCTION

1.1 DEFINITIONS

1.2 ESTIMATED SCHEDULE OF SOLICITATION ACTIVITIES

1.3 PURPOSE AND OBJECTIVES

1.4 BACKGROUND

1.5 SCOPE OF WORK

1.6 MINIMUM QUALIFICATIONS

1.7 FUNDING

1.8 PERIOD OF PERFORMANCE

1.9 ADA

2. GENERAL INFORMATION FOR BIDDERS

2.1 RFQQ COORDINATOR

......................................................................................................................................................... ERROR! BOOKMARK NOT DEFINED.

2.2 LETTER OF INTENT TO BID

2.3 INTERESTED SUBCONTRACTOR LIST

2.4 BIDDER QUESTIONS PERIOD

2.5 SUBMISSION OF BIDS

2.6 PROPRIETARY INFORMATION / PUBLIC DISCLOSURE

2.7 REVISIONS TO THE RFQQ

2.8 COMPLAINT PROCESS

2.9 RESPONSIVENESS

2.10 MOST FAVORABLE TERMS

2.11 RECEIPT OF INSUFFICIENT NUMBER OF BIDS

2.12 NO OBLIGATION TO CONTRACT

2.13 REJECTION OF BIDS

3. BID CONTENTS AND REQUIREMENTS

3.1 BID CONTENTS OVERVIEW

3.2 BID REQUIREMENTS AND GUIDELINES

3.3 BIDDER PROFILE & SUBMITTAL FORM (MANDATORY)

3.4 DIVERSE BUSINESS INCLUSION PLAN (MANDATORY)

3.5 EXECUTIVE ORDER 18-03 (SCORED)

3.6 REFERENCES (MANDATORY)

3.7 DRAFT CONTRACT (MANDATORY)

3.8 QUALIFICATIONS (SCORED)

3.9 QUOTATION (SCORED)

3.10 WASHINGTON STATE PURCHASING PRIORITIES (SCORED)

4. EVALUATION AND CONTRACT AWARD

4.1 EVALUATION PROCEDURE

4.2 EVALUATION WEIGHTING AND SCORING

4.3 BEST AND FINAL OFFER (BAFO)

4.4 SUBSTANTIALLY EQUIVALENT SCORES

4.5 NOTIFICATION TO BIDDERS

4.6 DEBRIEFING OF UNSUCCESSFUL BIDDERS

4.7 PROTEST PROCEDURE

5. RFQQ EXHIBITS

EXHIBIT A – BIDDER FORMS AND CERTIFICATIONS

EXHIBIT B – DRAFT CONTRACT

EXHIBIT C – QUALIFICATIONS

EXHIBIT D – QUOTATION

EXHIBIT E – WASHINGTON STATE PURCHASING PRIORITIES

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1. INTRODUCTION

1.1 DEFINITIONS

Definitions for the purposes of this RFQQ include:

Apparent Successful Bidder (ASB) – The Bidder selected as the entity to perform the anticipated services under this RFQQ, subject to completion of contract negotiations and execution of a written contract.

Approve – Means to agree or accept a proposed prior authorization.

Apple Health – means an umbrella term or brand name of medical assistance programs (Washington State Medicaid) administered by HCA.

Bid – A formal offer submitted in response to this solicitation. To be responsive, a Bid must include all items outlined in Section 3 (BID CONTENTS AND REQUIREMENTS). Two such items that may be referred to throughout this document are:

1) Quotation – Bidder’s cost as described in Section 3.9 and Exhibit D.

2) Qualifications – Bidder’s qualifications as described in Section 3.8 and Exhibit C.

Bidder – Individual or company interested in the RFQQ that submits a Bid to attain a contract with the Health Care Authority.

Business Day – Monday through Friday, 8:00 a.m. to 5:00 p.m., Pacific Time, except for holidays observed by the state of Washington, unless otherwise specified within the RFQQ.

Client – An individual who is eligible for or receiving services through HCA program(s).

Dental Program Manager – means the individual whose duty is taking a high-level view of the entire program, and strategically guide staff and auxiliary personnel to ensure they are all working effectively toward the dental program’s objective to increase access and utilization of Medicaid/Apple Health dental services.

Deny – Means refusing or not accepting the conditions of a prior authorization.

Health Care Authority or HCA – An executive agency of the state of Washington that is issuing this

RFQQ.

HIPAA – Means the Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, as amended by the American Recovery and Reinvestment Act of 2009 (“ARRA”), Sec. 13400 – 13424, H.R. 1 (2009) (HITECH Act). HIPAA includes the Privacy, Security, Breach Notification, and Enforcement Rules at 45 C.F.R. Part 160 and Part 164.

Pend – Means to set a claim aside, awaiting additional information or documentation in order to Approve or Deny the request.

Protected Health Information (PHI) – Means information that relates to the provision of health care to an individual; the past, present, or future physical or mental health or condition of an individual; or past, present or future payment for provision of health care to an individual. 45 C.F.R. 160 and 164.

PHI includes demographic information that identifies the individual or about which there is reasonable basis to believe, can be used to identify the individual. 45 C.F.R. 160.103. PHI is information transmitted, maintained, or stored in any form or medium. 45 C.F.R. 164.501. PHI does not include education records covered by the Family Educational Right and Privacy Act, as amended, 20 USC 1232g(a)(4)(b)(iv).

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ProviderOne or P1 – Means the system commonly referred to as the Medicaid Management Information System (MMIS), and is the federally approved system used by the Washington Medicaid program to pay provider claims for goods and services authorized under the State Plan. The MMIS is certified by CMS and is the primary information system used by HCA to pay for health care.

Reject – Means a prior authorization is dismissed at line level due to incompleteness or not meeting criteria.

Request for Qualifications and Quotations (RFQQ) – Formal solicitation document in which a service or need is identified, and firms are invited to provide their qualifications and quotation to provide the services.

Revised Code of Washington (RCW) – The laws of the state of Washington, as enacted by the Legislature. Any references to specific titles, chapters, or sections of the RCW include any substitute, successor, or replacement title, chapter, or section. Pertinent RCW chapters can be accessed at:

http://apps.leg.wa.gov/rcw/.

Subcontractor – A person, partnership, or entity not in the employment of or owned by the Bidder, who would be performing all or part of the services under this RFQQ under a separate contract with or on behalf of the Bidder. The term “Subcontractor” means Subcontractors in any tier.

Washington’s Electronic Business Solution or WEBS – An internet-based bid notification system HCA uses to post competitive solicitations. Individuals and firms interested in state contracting opportunities with the Department of Enterprise Services or any state agency should register for competitive solicitation notices on WEBS. Note: There is no cost to register on WEBS.

1.2 ESTIMATED SCHEDULE OF SOLICITATION ACTIVITIES

Issue Request for Qualifications and Quotations February 21, 2024

Letter of Intent Due March 8, 2024 – 2 p.m.

Bidder Questions Due March 14, 2024 – 2 p.m.

(Pacific)

HCA Answers Posted* March 20, 2024

Interested Subcontractor Responses Due March 22, 2024

Interested Subcontractor List Posted* March 25, 2024

Complaints Due (if applicable) March 27, 2024

Bids Due April 3, 2024 – 2 p.m.

(Pacific)

Evaluate Bids* April 8 – April 17, 2024

Conduct Oral Interviews with Finalists, if required April 23 – April 26, 2024

Announce “Apparent Successful Bidder” via WEBS* May 1, 2024

Debrief Request Deadline (3 Business Days after the ASB announcement)

May 6, 2024 – 4 p.m.

(Pacific) http://apps.leg.wa.gov/rcw/ https://www.des.wa.gov/services/contracting-purchasing/doing-business-state/webs-registration-search-tips

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Negotiate Contract May 7 - June 30, 2024

Begin Contract Work July 1, 2024

*Dates are anticipated and subject to change without an official amendment.

HCA reserves the right in its sole discretion to revise the above schedule at any time.

1.3 PURPOSE AND OBJECTIVES

The Washington State Health Care Authority, hereafter called “HCA,” is initiating this Request for Qualifications and Quotations (RFQQ) to solicit Bids from Washington State licensed dentists interested in conducting dental authorization adjudications for the Apple Health fee for service dental program. The Bidder would also be expected to provide expert testimony at dental hearings, peer to peer meetings, and assist other units within HCA as a subject matter expert as requested.

The federal government, including the Center for Medicare and Medicaid Services (CMS), and the State of Washington all maintain security requirements regarding privacy, data access, and other areas including HIPAA and PHI information. The Contractor is required to comply with the Confidential Information Security Requirements set out in to the sample contract attached to the RFQQ and be able to abide by the appropriate portions of the Washington OCIO Security Standard,141.10 (https://ocio.wa.gov/policies/141-securing-information-technology-assets/14110-securing-information-technology-assets). .

HCA intends to award one contract to provide the services described in this RFQQ.

1.4 BACKGROUND

HCA intends to award one contract to provide the services described in this RFQQ.

HCA receives approximately 1,000 requests each month for approval of Dental services for Apple Health clients.

1.5 SCOPE OF WORK

The Contractor must provide the services, staff, and do all things necessary for or incidental to the performance of work, as set forth below.

1. BACKGROUND

1.1 HCA administers programs that provide health care coverage for nearly 1 in 3 Washington residents as well as community behavioral health services, supports, recovery and prevention efforts for the entire state. HCA is the state’s largest health care purchaser and oversees the Medicaid program (Apple Health), Public Employees Benefits (PEB), School Employees Benefits (SEB), and the COFA Islander Health Care Program. Through these programs, HCA covers nearly 2.6 million lives.

1.2 In Washington State, we call the Medicaid program “Apple Health.” Apple Health provides health coverage to over 2 million residents – adults and children. Although the majority of Apple Health clients are enrolled in managed care, some clients receive services through the Medicaid fee-for-service (FFS) program, where HCA pays providers directly for each service they provide. Dental and orthodontic services are provided through the FFS program and the contractor will conduct reviews for these services.

https://ocio.wa.gov/policies/141-securing-information-technology-assets/14110-securing-information-technology-assets https://ocio.wa.gov/policies/141-securing-information-technology-assets/14110-securing-information-technology-assets

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1.3 HCA’s Authorization Services Office (ASO) is committed to quality service and partnership with providers to improve clients’ health and well-being. The ASO is responsible for processing prior authorization requests for specific services within an established timeframe to ensure medical necessity as well as cost effectiveness in accordance with privacy and security standards of the Health Insurance Portability and Accountability Act (HIPAA) and other applicable state standards.

2. PURPOSE

2.1 Contractor shall perform timely, consistent high quality utilization review (“UR”) services to establish medical necessity and customize its review process to meet the HCA’s ongoing needs for UR services. Requests for review will come from the HCA’s Authorization Services Office (ASO) and medical necessity determinations for dental services must follow Washington Administrative Code (WAC) 182-501-0165 and WAC 182-535 for Apple Health clients. HCA requires that all reviews receive a recommendation from the Contractor including documentation of the rationale for that recommendation; and in some cases, providing a case specific report, or additional reports; or amendment reports, as applicable, to substantiate those recommendations.

The Contractor must be able to maintain a very high level of customer service with HCA’s participating providers and HCA staff and must be able to manage records consistent with best practices, federal, state and local laws, and all contract requirements.

3. OBJECTIVE AND SCOPE OF WORK

3.1 The Contractor must provide the services, staff, and do all things necessary for or incidental to the performance of work, as set forth below:

3.2 Contractor will attend a meeting on or around July 1, 2024. Per HCA’s discretion this meeting may take place remotely via virtual meeting platform. The finalized meeting date and time will be communicated to Contractor by HCA.

3.3 Contractor will provide all of the equipment, including computers, necessary to perform the work outlined within this section. No reimbursement will be provided except as outlined within Exhibit B, Draft Contract, Section 3.3, Compensation.

3.4 Within five (5) Business Days of receipt from HCA staff:

A. Review initial Client dental services prior to authorization requests and supporting material, such as photographs and x-rays.

B. Evaluate whether or not each initial Client dental service prior to authorization request meets the standard for being Medically Necessary based on criteria referenced in WAC 182-535.

C. Via the Contractor’s access to ProviderOne, document their clinical decision to Approve, Deny, Reject or Pend for submittal of additional supporting material by the Client’s dental provider for each initial dental services prior-authorization request.

D. Upon notification of additional information submitted to support a Pended Prior Authorization (PA) request:

E. Review supporting materials such as photographs, x-rays, and case studies.

F. Evaluate whether or not the supporting materials meet the standards for being Medically Necessary.

G. Via the Contractor’s access to ProviderOne, document their clinical decision to Approve, Deny, Reject or re-Pend for additional supporting material by the Client’s dental provider.

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H. Contractor will notify HCA of their recusal from any work assigned by HCA that is being handled at a facility in which Contractor has a business relationship.

3.5 If necessary, and as requested by HCA, review grievances files by Clients regarding the quality of care provided by enrolled dental providers:

A. Review each grievance and supporting material.

B. Submit written recommendation to HCA staff as to the relative merit of each grievance.

3.6 If necessary, and as requested by HCA, perform peer to peer contact:

A. Discuss complicated client submittals.

B. Discuss decision making process.

3.7 New dental treatments, techniques, modalities, or services:

A. Review based upon evidence-based dental principles within the timeframe as requested by HCA staff.

B. Evaluate as appropriateness for Clients.

3.8 Program policies, procedures, billing instructions, numbered memoranda, bulletins, proposed forms, proposed new or amended regulations, medical determination, or authorization criteria:

A. Review as requested by HCA against criteria and standards as provided by HCA staff.

B. Submit recommendation to HCA staff.

3.9 Meeting attendance is required either in person or via virtual meeting platform on the following schedule:

A. Monthly meetings at the outset of the program will be mutually agreed upon between HCA and all Contractors; and

B. At HCA’s sole discretion, the meeting schedule will be altered to meeting quarterly, instead of monthly.

3.10 Fair hearing attendance is required according to the following criteria:

A. As requested by HCA staff; and

B. As Contractor’s work schedule and availability permits.

3.11 Communications regarding work done under this Contract must be directed to the HCA Contract Manager.

3.12 Work hours and availability:

A. Collaborate with the HCA Dental Program Manager to develop a work schedule.

B. Proactively communicate changes in work schedule to the HCA Dental Program Manager including but not limited to vacations and out of the office.

C. Check work email every day the Contractor is scheduled to work.

D. Review and manage Outlook calendar to ensure that you are attending meetings and fair hearings.

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3.13 Comply with HCA WAC rules and billing guidelines regarding coverage and determining medical necessity.

3.14 In an effort to provide best value and high-quality services, the Contractor and HCA agree to collaborate in order to improve processes and reporting through the term of the Contract.

A. Establish a profile for the Contract and any Subcontractor(s) giving access to the ProviderOne system for the purpose of reviewing prior authorization requests and recording recommendations for clinical decisions.

B. Orient the Contractor and any Subcontractor(s) to ProviderOne.

C. Provide Contractor and any Subcontractor(s) with VPN access and support in order to accomplish tasks described within this Statement of Work.

D. Provide up-to-date online manuals, tutorials, and reference links.

E. Provide calibration workshops on an as needed basis, as determined by HCA.

4. Required Reporting

4.1 In addition to submitting their monthly invoice for payment to the HCA Dental Program Manager, Contractor must submit an accounting of the number of prior authorization requests completed and meetings attended for that month.

5. Performance Measures

5.1 HCA reserves the right to place penalties on Contractor’s monthly invoice based on the table provided in Exhibit B, Draft Contract, Attachment 4, Performance Measures.

1.6 MINIMUM QUALIFICATIONS

The following are the minimum qualifications for Bidders:

A. Licensed to do business in the state of Washington or provide a commitment that it will become licensed in Washington within 30 calendar days of being selected as the Apparent Successful Bidder.

B. Bidder must have at least 5 years’ experience as a practicing clinical dentist.

C. Experience with Washington State Medicaid dental programs.

D. Must hold a valid Washington State dental license.

E. Familiar with insurance adjudication/processes.

F. Must cannot have in the last ten (10) years

a. Any license, certificate, registration or other privilege to practice a health care profession denied, revoked, suspended, or restricted by any state, federal, or foreign authority.

b. Ever surrendered a credential like those listed above in section in connection with or to avoid action by a state, federal, or foreign authority.

G. The ability to enter utilization review decisions into an electronic records system.

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H. The ability to collaborate with HCA and the dental program concerning final determination of prior authorization.

I. The ability to calibrate with other consultants and program staff.

J. Must be able to meet and pass all security requirements to handle Category 4 data in accordance with the Washington State Office of the Chief Information Officer (OCIO) Standard 141.10. The OCIO website can be found at https://watech.wa.gov/policies/securing-information-technology-assets Criteria for passing a security design review are included within the Standard. Associated language will be included in any Data Sharing Agreement (DSA), and Business Associate Agreement (BAA). Experience with Washington state Medicaid dental programs.

Failure to meet these Minimum Qualifications will result in a proposal being found non-responsive and eliminated for consideration.

1.7 FUNDING

HCA has budgeted an amount not to exceed Three Hundred Eleven Thousand One Hundred and Twenty Dollars ($311,120.00) for this two-year contract. Bids in excess of $311,120.00 will be considered non-responsive and will not be evaluated.

Any contract awarded as a result of this solicitation is contingent upon the availability of funding.

1.8 PERIOD OF PERFORMANCE

The period of performance of any contract resulting from this RFQQ is tentatively scheduled to begin on or about July 1, 2024, and to end on June 30, 2026. Amendments extending the period of performance, if any, will be at the sole discretion of HCA.

HCA reserves the right to extend the contract for up to four (4) one (1) year amendment periods.

1.9 ADA

HCA complies with the Americans with Disabilities Act (ADA). Bidders may contact the RFQQ Coordinator to receive written information in another format (e.g., large print, audio, accessible electronic formats, and other formats).

https://watech.wa.gov/policies/securing-information-technology-assets https://watech.wa.gov/policies/securing-information-technology-assets

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2. GENERAL INFORMATION FOR BIDDERS

2.1 RFQQ COORDINATOR

The RFQQ Coordinator is the sole point of contact in HCA for this solicitation. All communication between the Bidder and HCA upon release of this RFQQ must be with the RFQQ Coordinator, as follows:

Name Funmi Omolade

E-Mail Address HCAProcurements@hca.wa.gov

Any other communication will be considered unofficial and non-binding on HCA. Bidders are to rely on written statements issued by the RFQQ Coordinator. Communication directed to parties other than the RFQQ Coordinator may result in disqualification of the Bidder.

2.2 LETTER OF INTENT TO BID

To be eligible to submit a Bid, a Bidder must submit a Letter of Intent to Bid. The Letter of Intent to Bid must be emailed to the RFQQ Coordinator, listed in Section 2.1, and must be received by the RFQQ Coordinator no later than the date and time stated in the Solicitation Schedule, Section 1.2.

The subject line of the email must include the following: 2023HCA24 – Letter of Intent to Bid – [Your entity’s name].

The Letter of Intent to Bid may be attached to the email as a separate document, in Word or PDF, or the information may be contained in the body of the email.

Information in the Letter of Intent to Bid should be placed in the following order:

A. Bidder’s Organization Name;

B. Bidder’s authorized representative for this RFQQ (who must be named the authorized representative identified in the Bidder’s Bid);

C. Title of authorized representative;

D. Address, telephone number, and email address;

E. Statement of intent to bid; and

F. A statement of how the Bidder meets ALL the minimum requirements specified in Section 1.6 of this RFQQ.

HCA may use the Letters of Intent to Bid as a pre-screening to determine whether Minimum Qualifications are met.

2.3 INTERESTED SUBCONTRACTOR LIST

HCA supports and encourages contracts and subcontracts with small, diverse, and veteran-owned businesses. To support participation in this process, the RFQQ Coordinator will add a list of Interested Subcontractors to the RFQQ. The RFQQ Coordinator will prepare the List based on the timely and complete submission of specific information requested in this section. The purpose of the mailto:HCAProcurements@hca.wa.gov

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List is to communicate to prime bidders the capabilities of interested subcontractors who can perform components of this RFQQ’s Scope of Work.

A. Interested Subcontractor Instructions

i. Failure to follow the instructions in this Section may prevent your information from being included in the List.

ii. An interested party must complete the below table to submit their firm name, contact information, and the summary of their capabilities as they relate to this RFQQ’s Scope of Work. Submissions are limited to what is requested in the table below and capability summaries must be two paragraphs or less.

iii. The RFQQ Coordinator will only include the information requested below. Do not submit marketing materials.

iv. Submissions must be emailed to the RFQQ Coordinator, with the subject line “RFP # Interested Subcontractor List – [Interested Subcontractor Name]” by the date specified in Section 1.2 (ESTIMATED SCHEDULE OF SOLICITATION ACTIVITIES).

v. All material submitted for the Interested Subcontractor List becomes a public record.

B. Posting Date

Complete and timely submissions will be compiled and posted in alphabetical order by interested subcontractor name. HCA anticipates the List will be posted as an RFP amendment on the Interested Subcontractor List Posted date identified in Section 1.2 (ESTIMATED SCHEDULE OF SOLICITATION ACTIVITIES). Late submissions will not be posted.

C. Information Provided As-Is

The Interested Subcontractor List is provided as an opportunity to support participation in this RFQQ. HCA provides this information as a courtesy with no warranties or representations as to any party and no guarantee of a subcontract. The Interested Subcontractor List shall not be construed as an endorsement by the state of Washington or HCA. The interested party is responsible for the completeness and accuracy of their submission.

2.4 BIDDER QUESTIONS PERIOD

Bidders are provided an opportunity to ask questions during the bidder question period which starts on the date of the RFQQ posting and concludes on the Questions Due date specified in Section 1.2

(ESTIMATED SCHEDULE OF SOLICITATION ACTIVITIES).

Interested Subcontractor Name

Contact Name Contact Address, Phone Number, and Email Address

Summary of your capabilities as it relates to the Scope of Work

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A. Questions regarding the RFQQ will only be accepted in writing, sent by email to the RFQQ Coordinator. The Bidder must use the following email subject line when submitting questions:

“RFQQ 2023HCA24 Question(s) – [Bidder Name]” to ensure timely receipt.

B. HCA anticipates it will post answers to the questions in WEBS as an RFQQ amendment on the Answers Posted date specified in Section 1.2 (ESTIMATED SCHEDULE OF

SOLICITATION ACTIVITIES).

C. HCA is under no obligation to respond to any questions received after the Questions Due date but may do so at its discretion.

2.5 SUBMISSION OF BIDS

Bids must be received by the RFQQ Coordinator no later than the Bid Due deadline in Section 1.2 (ESTIMATED SCHEDULE OF SOLICITATION ACTIVITIES). Bids must be submitted electronically as an attachment to an e-mail to the RFQQ Coordinator at the e-mail address listed in Section 2.1, and meet the following requirements:

A. Attachments to e-mail must be in Microsoft Word format or PDF except for the Exhibit D, Quotation, which must be in Excel format.

B. The Quotation must be submitted as a separate attachment.

C. Zipped files cannot be received by HCA and cannot be used for submission of Bids.

D. The forms and certifications that require authorized signature (as designated in section 3.1, BID CONTENTS OVERVIEW) must have a signature of the individual within the organization authorized to bind the Bidder to the offer.

E. HCA does not assume responsibility for problems with Bidder’s e-mail. If HCA e-mail is not working, appropriate allowances will be made.

Bidders should allow sufficient time to ensure timely receipt of the bid by the RFQQ Coordinator. Late bids will not be accepted and will be automatically disqualified from further consideration, unless HCA e-mail is found to be at fault or HCA deems a grace period is in the best interest of the State. All bids and any accompanying documentation become the property of HCA and will not be returned.

2.6 PROPRIETARY INFORMATION / PUBLIC DISCLOSURE

Bids submitted in response to this RFQQ will become the property of HCA. All bids received will remain confidential until the Apparent Successful Bidder is announced; thereafter, the bids will be deemed public records as defined in chapter 42.56 of the Revised Code of Washington (RCW).

Any information in the bid that the Bidder desires to claim as proprietary and exempt from disclosure under chapter 42.56 RCW, or other state or federal law that provides for the nondisclosure of a document, must be clearly designated. Each page claimed to be exempt from disclosure must be clearly identified and must reference either: (1) the specific basis claimed under 42.56 RCW, or (2) a statement of why the information is designated propriety. Each page containing the information claimed to be exempt from disclosure must be clearly identified by the words “Proprietary Information” printed on the lower right-hand corner of the page. Marking the entire bid exempt from disclosure or as Proprietary Information will not be honored.

If a public records request is made for the information that the Bidder has marked as “Proprietary Information,” HCA will notify the Bidder of the request and of the date that the records will be released to the requester unless the Bidder obtains a court order enjoining that disclosure. If the Bidder fails to

HCA RFQQ No. 2023HCA27 Page 12 of 31 obtain the court order enjoining disclosure, HCA will release the requested information on the date specified. If a Bidder obtains a court order from a court of competent jurisdiction enjoining disclosure pursuant to chapter 42.56 RCW, or other state or federal law that provides for nondisclosure, HCA will maintain the confidentiality of the Bidder’s information per the court order.

A charge will be made for copying and shipping, as outlined in RCW 42.56. No fee will be charged for inspection of contract files, but 24 hours’ notice to the RFQQ Coordinator is required. All requests for information should be directed to the RFQQ Coordinator.

The submission of any public records request to HCA pertaining in any way to this RFQQ will not affect the solicitation schedule, as outlined in Section 1.2, unless HCA, in its sole discretion, determines that altering the schedule would be in HCA’s best interests.

2.7 REVISIONS TO THE RFQQ

If HCA determines in its sole discretion that it is necessary to revise any part of this RFQQ, then HCA will publish addenda on WEBS. For this purpose, the published questions and answers and any other pertinent information will be provided as an addendum to the RFQQ and will be published on WEBS.

HCA also reserves the right to cancel or to reissue the RFQQ in whole or in part, prior to execution of a contract.

2.8 COMPLAINT PROCESS

The complaint process allows potential Bidders to focus on the solicitation requirements and evaluation process and raise issues early enough in the process to allow HCA to correct a problem before bids are submitted. The complaint period starts on the date of the RFQQ posting and concludes on the Complaints Due date identified in Section 1.2 (ESTIMATED SCHEDULE OF

SOLICITATION ACTIVITIES).

A. Potential Bidders may submit a complaint to HCA based on any of the following:

i. The RFQQ unnecessarily restricts competition;

ii. The RFQQ evaluation or scoring process is unfair or unclear; or

iii. The RFQQ requirements are inadequate or insufficient to prepare a response.

B. For a complaint to be considered, it must be received by HCA by 5:00 pm PT on the Complaints Due date identified in Section 1.2. The complaint must:

i. Be in writing;

ii. Be sent to the RFQQ Coordinator, or designee;

iii. Clearly articulate the basis for the complaint; and

iv. Include a proposed remedy.

C. HCA will address any complaint as follows:

i. The RFQQ Coordinator, or designee will respond to the complaint in writing.

ii. The response to the complaint and any changes to the RFQQ will be posted on

WEBS.

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iii. The Director of HCA will be notified of all complaints and will be provided a copy of HCA’s response.

Complaints may not be raised again during a protest and HCA’s action or inaction in response to a complaint will be final. There is no appeal process.

2.9 RESPONSIVENESS

The RFQQ Coordinator will review all bids to determine compliance with administrative requirements and instructions specified in this RFQQ. A Bidder’s failure to comply with any part of the RFQQ may result in rejection of the bid as non-responsive.

HCA also reserves the right at its sole discretion to waive minor administrative irregularities.

2.10 MOST FAVORABLE TERMS

HCA reserves the right to make an award without further discussion of the bid submitted. Therefore, the bid should be submitted initially on the most favorable terms which the Bidder can propose. HCA reserves the right to contact a Bidder for clarification of its bid.

The ASB should be prepared to accept this RFQQ for incorporation into a contract resulting from this RFQQ. The contract resulting from this RFQQ will incorporate some, or all, of the Bidder’s bid. The bid will become a part of the official solicitation file on this matter without obligation to HCA.

2.11 RECEIPT OF INSUFFICIENT NUMBER OF BIDS

If HCA receives only one responsive bid as a result of this RFQQ, HCA reserves the right to either: 1) directly negotiate and contract with the Bidder; or 2) not award any contract at all. HCA may continue to have the Bidder complete the entire RFQQ. HCA is under no obligation to tell the Bidder if it is the only Bidder.

2.12 NO OBLIGATION TO CONTRACT

This RFQQ does not obligate HCA to enter into any contract for services specified herein.

2.13 REJECTION OF BIDS

HCA reserves the right, at its sole discretion, to reject any and all bids received without penalty and not to issue any contract as a result of this RFQQ.

2.14 SUBCONTRACTOR PARTICIPATION MONITORING AND REPORTING

Pursuant to Executive Order 22-01, Equity in Public Contracting (dated 01/07/2022), Bidders using Subcontractors for any part of this work will be subject to the requirements of this section if awarded a contract as a result of this solicitation.

Once a contract is awarded through the solicitation process, the awarded Contractor is obligated to complete a new vendor registration in Access Equity. Access Equity (B2Gnow) is a secure business diversity management system available online at https://omwbe.diversitycompliance.com/.

Confidential Information (e.g., Tax ID, etc.) will not be published in Access Equity. Contractors that have previously registered with B2Gnow for any public entity, must verify and ensure that Access Equity contains their most up-to-date registration information. Contractors can navigate online to

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Access Equity at https://omwbe.diversitycompliance.com/ or through a direct link on the Office of Minority and Women’s Business Enterprises (OMWBE) website at: https://omwbe.wa.gov/.

During the contract term, the Contractor will report monthly payments to all relevant Subcontractors in Access Equity. Monthly reporting information includes total dollar payments made to relevant Subcontractors, payment dates, and any additional information required to verify payment to Subcontractors. The Contractor will enter this payment information into Access Equity, and the Subcontractors will verify this payment information in the system. This requirement applies to both Contractors and Subcontractors. Online training is available through Access Equity.

https://omwbe.diversitycompliance.com/ https://omwbe.wa.gov/

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3. BID CONTENTS AND REQUIREMENTS

3.1 BID CONTENTS OVERVIEW

Bids must be submitted per the instructions in Sections 2.6 (SUBMISSION OF BIDS) and 3.2 (BID REQUIREMENTS AND GUIDELINES) in the order noted below.

A. Bidder Forms and Certifications (Exhibit A)

All the following are included in Exhibit A:

i. Bidder Profile & Submittal Form* (Section 3.3 and Exhibit A, Section A)

ii. Diverse Business Inclusion Plan (Section 3.4 and Exhibit A, Section B)

iii. Executive Order 18-03 Worker’s Rights* (Section 3.5 and Exhibit A, Section E)

iv. References (Section 3.6 and Exhibit A, Section D)

B. Draft Contract (Section 3.7 and Exhibit B)

C. Qualifications (Section 3.8 and Exhibit C)

D. Quotation (Section 3.9 and Exhibit D)

E. Washinton State Purchasing Priorities (Section 3.10 and Exhibit E)

*Authorized signature required

3.2 BID REQUIREMENTS AND GUIDELINES

Bids must comply with the requirements or restrictions listed below. Failure to do so may result in the disqualification of the Bidder’s Bid:

A. State the Bidder’s full legal name on the first or cover page of the Bid.

B. Bids must provide information in the same order as presented in this RFQQ and with the same headings. Title and number each item in the same way it appears in the RFQQ. Each question must be restated prior to the Bidder’s response.

C. All items listed in Section 3.1 (BID CONTENTS OVERVIEW) must be included as part of the Bid for the Bid to be considered responsive; however, only the following items will be scored during the evaluation process: Executive Order 18-03 Worker’s Rights, Qualifications, and Quotation.

D. Page limits stated in this RFQQ are determined by counting single sides of the response. HCA has no obligation to read, consider, or score any material exceeding the stated page limits. There will be no grounds for protest if critical information is on the pages exceeding the specified page limit that is not reviewed.

E. Bidders are liable for all errors or omissions contained in their Bids. Bidders will not be allowed to alter Bid documents after the deadline for Bid submission. HCA is not liable for any errors in Bids.

HCA is under no obligation to consider any supplemental materials submitted that were not requested.

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3.3 BIDDER PROFILE & SUBMITTAL FORM (MANDATORY)

Exhibit A, Bidder Forms and Certifications, Section A, Bidder Profile & Submittal Form must be completed in its entirety and signed and dated by a person authorized to legally bind the Bidder to a contractual relationship (e.g., the President or Executive Director if a corporation, the managing partner if a partnership, or the proprietor if a sole proprietorship).

3.4 DIVERSE BUSINESS INCLUSION PLAN (MANDATORY)

Exhibit A, Bidder Forms and Certifications, Section B, Diverse Business Inclusion Plan must be completed in its entirety. In accordance with legislative findings and policies set forth in RCW 39.19 the state of Washington encourages participation in all contracts by firms certified by the Office of Minority and Women’s Business Enterprises (OMWBE), set forth in RCW 43.60A.200 for firms certified by the Washington State Department of Veterans Affairs, and set forth in RCW 39.26.005 for firms that are Washington Small Businesses.

Participation may be either on a direct basis or on a Subcontractor basis. However, no preference on the basis of participation is included in the evaluation of Diverse Business Inclusion Plans submitted, and no minimum level of minority- and women-owned business enterprise, Washington Small Business, or Washington State certified Veteran Business participation is required as a condition for receiving an award.

Any affirmative action requirements set forth in any federal governmental regulations included or referenced in the contract documents will apply.

3.5 EXECUTIVE ORDER 18-03 (SCORED)

Bidder must review Exhibit A, Bidder Forms and Certifications, Section C and respond as to whether the Bidder requires its employees, as a condition of employment, to sign or agree to mandatory individual arbitration clauses and class or collective action waivers.

3.6 REFERENCES (MANDATORY)

Provide three business references for the Bidder using the reference forms provided in Exhibit A, Bidder Forms and Certifications, Section D, References. References must be independent of the Bidder’s and Subcontractor’s company corporation (e.g., non-Bidder owned, in whole or in part, or managed, in whole or in part) and be for work similar to the scope of work contained herein. Complete all boxes of the reference form for each reference, including a description of the services provided, the timeframe in which services were provided, and the Bidder’s team members who provided the services. By submitting a bid in response to this solicitation, the Bidder and team members grant permission to HCA to contact these references and others, who from HCA’s perspective, may have pertinent information. HCA may or may not, at HCA’s discretion, contact references.

3.7 DRAFT CONTRACT (MANDATORY)

The ASB will be expected to enter into a contract which is substantially the same as the sample contract and its general terms and conditions attached as Exhibit B. HCA will not accept any draft contracts prepared by any Bidder. The Bidder must be prepared to agree to all terms of the attached Exhibit B, Draft Contract, as presented or the Bid may be rejected. If Bidder has exceptions to the terms and conditions, they must include with their Bid a copy of the Draft Contract with redline edits/comments documenting the changes they propose to be made if selected as ASB. If the Bidder fails to identify an objection to any particular term or condition, the term or condition will be deemed agreed to by the Bidder. HCA will review requested exceptions and accept or reject the same at its sole discretion.

If, after the announcement of the ASB, and after a reasonable period of time, the ASB and HCA cannot reach agreement on acceptable terms for the Contract, the HCA may cancel the selection and Award the Contract to the next most qualified Bidder.

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3.8 QUALIFICATIONS (SCORED)

Exhibit C, Qualifications must be completed in its entirety in accordance with the page limits identified within the Exhibit (See Section 3.2(E)). Bidder should respond using Exhibit C as its template, to ensure compliance with the formatting requirements outlined in Section 3.2(B).

3.9 QUOTATION (SCORED)

The maximum cost proposed for this contract must be Three Hundred Eleven Thousand One Hundred and Twenty Dollars ($311,120.00) for duration of two-year contract or less to be considered responsive to this

RFQQ.

The evaluation process is designed to award this solicitation not necessarily to the Bidder of least cost, but rather to the Bidder whose bid best meets the requirements of this RFQQ. However, Bidders are encouraged to submit bids which are consistent with state government efforts to conserve state resources.

A. Identification of Costs

i. Bidder will complete Exhibit D, Quotation, to provide their proposed hourly rate. All hourly rates provided by Bidders are to be not-to-exceed (NTE) rates. The resulting ASB(s) will be required to honor their Proposal’s NTE rates during contract negotiations. Bidder should consider all pricing consideration in their hourly rate this should include, at minimum, staff costs, estimates for any applicable sales and use taxes (see 3.A(ii) below), and any expenses necessary to accomplish the tasks and to produce the deliverables under the contract.

ii. ASB(s) will be required to collect Washington state sales and use taxes from HCA, as applicable, and for remittance of payment to the Washington State Department of Revenue (DOR). Bidders must identify any expenses to which Washington State sales and use taxes apply in the Quotation and include an estimated amount for such taxes (based on the current tax rate(s)). HCA understands these amounts may fluctuate as tax rates fluctuate. If a tax isn’t specifically identified, HCA will assume it is included in the costs identified.

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B. Quotation

Bidder will complete Exhibit D to provide their quotation. Bidder may review the table provided below* as a guide to develop their hourly rate.

Duty Duty description Average Percentage of time dedicated to duty type

Prior Authorization Adjudications

• Review prior authorization requests with supporting documentation submitted by providers

• Clinical information

• Photographs

• Radiographs

• Chart notes

• Determine medical necessity based on criteria per WAC 182-535 and 182-501-0165.

70%

Meeting Attendance

• Attend and participate in prehearing meetings administrative hearings. This includes:

• Re-reviewing authorization request from providers.

• Discuss with assigned

HCA legal representative.

• Review, complete and sign written declaration that is created and formatted by legal.

• Attend and participate in meetings internal and/or external stakeholders.

20%

Review and Assist

• Audit reviews

• Other tasks requiring a Subject Matter

Expert (SME) when assigned by HCA Dental Program Managers

10%

*This data is for informational purposes only, there is no monthly or overall guarantee of hours that should be assumed. Billable duty volumes and Prior Authorization forms may change per HCA’s discretion.

3.10 WASHINGTON STATE PURCHASING PRIORITIES (SCORED)

Exhibit E, Washington State Purchasing Priorities must be completed and returned by Bidder. Bidders should check the applicable box(es) indicating which, if any, of the identified certifications are applicable to the Bidders’ business. Definitions for listed certifications can be found at: Department of Enterprise Services (DES) (wa.gov).

https://des.wa.gov/sell/how-work-state/tips-small-diverse-and-veteran-owned-businesses

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4. EVALUATION AND CONTRACT AWARD

4.1 EVALUATION PROCEDURE

Responsive Bids will be evaluated strictly in accordance with the requirements stated in this RFQQ and any addenda issued. The evaluation of bids will be accomplished by an evaluation team, to be designated by HCA, which will determine the ranking of the bids. Evaluation teams could be comprised of internal (HCA) and external individuals. Evaluations will only be based upon information provided in the Bidder’s Bid.

A. All bids received by the stated deadline in Section 1.2 (ESTIMATED SCHEDULE OF SOLICITATION ACTIVITIES) will be reviewed by the RFQQ Coordinator to ensure that they contain all of the required information requested in the RFQQ. Only responsive bids that meet the requirements will be evaluated by the evaluation team. Any Bidder who does not meet the stated qualifications or any bid that does not contain all the required information will be rejected as non-responsive.

B. HCA may, at its sole discretion, waive minor administrative irregularities.

C. The RFQQ Coordinator may, at their sole discretion, contact the Bidder for clarification of any portion of the Bidder’s Bid. Bidders should take every precaution to ensure that all answers are clear, complete, and directly address the specific requirement.

D. Responsive Qualifications will be reviewed and scored by an evaluation team using the weighted scoring system described in Section 4.2 (EVALUATION WEIGHTING AND SCORING). Qualifications will be evaluated strictly in accordance with the requirements set forth in this RFQQ and any addenda issued.

E. The evaluation of the Executive Order 18-03, Quotation, and the Washington State Purchasing Priorities will be completed by the RFQQ Coordinator.

F. HCA, at its sole discretion, may elect to select finalists for an oral presentation.

G. HCA reserves the right to award the contract to the Bidder whose bid is deemed to be in the best interest of HCA and the state of Washington.

4.2 EVALUATION WEIGHTING AND SCORING

Bidders’ final scores will be based on the following scored items: Executive Order 18-03, Qualifications, Quotations, Washington State Purchasing Priorities, and Oral Presentations.

A. Executive Order 18-03

Pursuant to RCW 39.26.160(3) and consistent with Executive Order 18-03 – Supporting Workers’ Rights to Effectively Address Workplace Violations (dated June 12, 2018), HCA will evaluate bids for best value and provide a preference in the amount 40 points to any Bidder who certifies, pursuant to the certification included in Exhibit A, Bidder Forms and Certifications, Section C, that their firm does NOT require its employees, as a condition of employment, to sign or agree to mandatory individual arbitration clauses or class or collective action waiver. Bidders that do require their employees, as a condition of employment, to sign or agree to mandatory individual arbitration clauses or class or collective action waiver will not be disqualified from evaluation of this RFQQ, however they will receive 0 out of 40 points for this section.

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B. Scoring of Qualifications

Each question in Exhibit C, Qualifications has been assigned a weight. Points will be assigned to each question based upon the average of all evaluation team members scores for the question (0-10) multiplied by the weight indicated below. Individual question scores will then be combined to result in the Bidder’s total weighted score. Any point calculations that result in decimal points will be rounded to the nearest whole number. The weight and maximum points for each question are as outlined in the following Evaluation Table:

Evaluation Table Section Title Weight Maximum Points

Experience 12 120 Key contractor Staffing (subcontractors) 10 100 Internal controls 8 80 Schedule 14 140

Capability 16 160

Qualifications Maximum Points 600

C. Scoring Rubric for Written Response

Evaluators will score the sections outlined in the Evaluation Table above using the following (0-10) scoring rubric:

Scoring Rubric

Score Description Scoring Criteria 10 Far Exceeds Requirements The Bidder has provided an innovative, detailed, and thorough response to the requirement, and clearly demonstrates a high level of experience with, or understanding of the requirement.

7 Exceeds Requirements The Bidder has demonstrated an above-average capability, approach, or solution and has provided a complete description of the capability, approach, or solution.

5 Meets Requirements The Bidder has an acceptable capability of solution to meet this criterion and has described its approach in sufficient detail to be considered “as substantially meeting the requirements”.

3 Below Requirements The Bidder has established some capability to perform the requirement but descriptions regarding their approach are not sufficient to demonstrate the Bidder will be fully able to meet the requirements.

1 Substantially Below…