5-Attachment C - RFP Specifications.docx

Contents

Introduction The Utah Department of Health and Human Services (the Department) is soliciting proposals to conduct consumer satisfaction surveys for health plan enrollees, dental plan enrollees, and medical home patients between November 1, 2025 and October 31, 2030.

The awardee of this RFP will be expected to use Consumer Assessment of Healthcare Providers and Systems (CAHPS) standards and protocols as designated by the Agency for Healthcare Research and Quality (AHRQ) as well as custom survey design or formats provided by the Department.

This RFP covers surveys of representative samples of Utah residents enrolled in commercial health insurance, Medicaid, CHIP, and dental insurance.

Background The Department maintains an administrative rule which requires certain health plans (referred to as “carriers” in rule and hereinafter in this document) to participate in consumer satisfaction surveys annually and share those results with the Department. Carriers have the option of using the Department’s contractor (the successful respondent of this RFP) or their own contractor. Awardees are required to have the ability to conduct CAHPS surveys for any carriers that choose to use the Department’s contractor, although there is no guarantee that any given carrier will opt to use the awardee of this RFP for their surveys.

The CAHPS “Health Plan” satisfaction survey will be used for all health plan carriers. The CAHPS “Dental Plan Survey” will be used for all dental plan carriers. The Department may also choose a more appropriate CAHPS survey form for certain types of carriers, if one is available.

Scope of Work The awardee of this RFP should anticipate conducting surveys of patients from a variety of carrier types, including (but not limited to):

1. Medicaid contracted health plans or Accountable Care Organizations (ACOs)

2. Prepaid Mental Health Plans (PMHP)

3. Medicaid Dental Plans

4. Home Health Care Consumer Assessment of Healthcare Providers and Systems (H.O.M.E.) Plans

5. CHIP-contracted Health and Dental plans

6. Medicaid Fee for Service Enrollees

7. Commercial managed care organizations

8. Commercial preferred provider organizations

9. Public Employees Health Plan

10. Self-funded Employer Plans

The awardee will be the designated survey contractor for two types of survey projects:

1. Annual CAHPS surveys on the consumers’ satisfaction with their health plans.

2. Ad hoc, small surveys which may be required from time to time.

Description of the Specific Work to be Performed The awardee of this RFP will coordinate with Department staff and carriers’ representatives to administer the surveys.

Under this contract, for each survey to be conducted the awardee of this RFP will:

1. Prepare detailed instructions on how to prepare and submit the sampling frame files and communicate this information to the Department and all participating carriers each year.

2. Contact each carrier to collect relevant information/materials (logos, signature files, etc.).

3. Produce and distribute draft survey materials to each carrier and the Department for approval.

4. Coordinate with department staff to define, and the carriers to collect, appropriate survey sample frames according to NCQA’s guidelines.

5. Review the provided sampling frames to verify their compliance with NCQA guidelines and make corrections as necessary (including, but not limited to: deletion of duplicate numbers, institutional addresses or number, etc.)

6. Draw a representative sample of enrollees from each sampling frame.

7. Conduct survey activities on a representative sample of enrollees from each health plan according to NCQA's Survey Specifications.

8. Provide a preliminary draft of the final report to the Department for approval of the report format before survey completion.

9. Provide final survey data for each participating carrier to the Department in a standardized *.csv file, along with frequency tables, dispositions and response rates, and a summary of all rating questions and composite scores each year for each carrier. Each participating carrier will also be provided with their portion of the above deliverables. Note that this proposal does not include any printed reports, banner tables or statistical analysis to be provided. The Department only requires electronic files.

10. Each key personnel member identified by the awardee of this RFP to work on this project shall have a designated back up. The Department shall be notified within 14 calendar days of any staffing changes made by the awardee of this RFP.

Estimated Scope of the Contract The awardee of this RFP will be the designated survey entity for all Medicaid Department-generated samples. Given that each year, carriers may choose either the state’s contractor or their own, we cannot provide a firm count of the number of surveys or the corresponding sample sizes at this time.

Under the contract, the Department will inform the contractor of the number and size of the surveys to be conducted each year. Respondents must note any capacity limitations on the number or size of surveys to be conducted in their response.

Survey Questionnaires to be Used In even years (2026, 2028, 2030), the focus will be on child surveys. In odd years (2027, 2029), the focus will be on adult surveys. However, the successful awardee of this RFP will conduct child surveys of CHIP enrollees every year.

For CAHPS surveys, the awardee of this RFP should anticipate using the following survey protocols, for pricing purposes. The exact survey protocols to be used will be identified during each year of the contract.

For child surveys: CAHPS 5.1H Child Survey For adult surveys: CAHPS 5.1H Adult Survey Some carriers may wish to ask the respondent to conduct additional surveys outside the scope of this RFP (e.g., CAHPS adult survey in a child year, ECHO survey, etc.) The respondent must have the capacity to incorporate those surveys in this project. It is anticipated that at least two carriers may request additional surveys each year, although this is subject to change and is not guaranteed.

Sample Size and Sampling Methodology For each survey, the respondent will employ the current version of the NCQA-developed sampling and data collection protocols, including de-duplication and over-sampling strategy. Each survey's sample size will follow NCQA's general guideline for the survey year, currently shown in Volume 3: HEDIS 2025 Specifications for Survey Measures.

Maximizing the Response Rate The calculation of survey response rate will follow NCQA's general guideline as shown in Volume 3: HEDIS Specifications for Survey Measures. For example:

· Eligible population: The eligible population for each survey is defined in NCQA's technical specifications. If out-of-state residents or employees of surveying health plans are included in the survey, a flag for each of those fields should be included in the data, so they can easily be identified when conducting analyses.

· Data collection protocols: The contractor shall use a mixed mode of two survey mailings, two reminder postcards, and telephone follow-up calls to conduct the surveys each year.

Custom Questions The Department plans to include at least six custom questions on all CAHPS surveys in all years. Each year, the Department will provide the contractor a list of the custom questions (to be approved by NCQA) which the contractor will include in the survey. Four of the questions will use identical response sets as those found on other CAHPS items. The respondent to this RFP’s cost bid will include the cost for six custom questions. The respondent to this RFP may specify the additional cost for custom questions beyond six as a separate cost if any.

National CAHPS Benchmarking Database (NCBD) The Department wishes to submit data to the NCBD. Respondents must be able to complete this data submission according to NCBD standards and by the required submission deadline.

Additional Needs of the Carriers Some carriers may want to expand their surveys by oversampling or making other NCQA-approved changes to the survey methodology. These changes, as well as any additional charges, will be the sole responsibility of the carrier and the vendor.

Requirements for the Mail Phase of the Survey Survey preparation: The contractor is responsible for ensuring that the survey materials contain the correct logos, signatures, etc., and must receive the approval of each carrier before mailing.

Printing/mailing of survey instruments: The contractor shall be responsible for the printing, mailing and postage of survey instruments (cover letters and questionnaires), envelopes (out-going and postage-paid return envelopes), and reminder postcards. The contractor shall conduct quality control measures to ensure proper matching of cover letters and questionnaires. The contractor shall include representatives of the carriers as artificial respondents of the survey so they can receive a copy of all survey materials.

Spanish questionnaires: The contractor shall prepare a cover letter with English on one side and Spanish on the reverse side. The Spanish side shall list a toll-free number where respondents can call in to request a Spanish version of the survey by mail. On each reminder postcard, a comment box should be included providing the same toll-free number.

Time Frames: The contractor shall follow the time frames specified by the NCQA for the survey.

Requirements for the Telephone Follow-up Interviews Callback Attempts: The contractor will make a minimum of three attempts to call each respondent. A system shall be in place to optimize callback attempts so each applicable phone number is called at different times of the day and different days of the week, to maximize survey response rates. Some carriers may request no calls on Sundays.

Conduct of Interviews: All telephone follow-up calls will be conducted in a central interviewing facility using Computer-Assisted Telephone Interviewing (CATI) software systems.

Interviewer Training: All interviewers will be trained in the basics of standardized survey interviewing techniques, including neutral probing and other aspects of appropriate demeanor. All interviewers who will be working on the survey must be hired and ready to be trained prior to the beginning of data collection for each year.

Bilingual Interviewers: The contractor shall provide bilingual Spanish-speaking interviewers who will conduct telephone survey interviews speaking from Spanish version questionnaires. Bilingual interviewers shall be hired and ready to work at the time of the survey-specific interviewer training session for each year.

Interviewer Supervision: All interviewers will be supervised, and their performance monitored continuously. Supervisory personnel will not conduct telephone interviews while they are supervising interviewers.

Monitoring of Interviews: During the telephone interview period each year, the contractor shall provide a minimum of two remote monitoring opportunities to Department staff.

Status Update: The contractor shall provide weekly status updates in writing to the Department. During data collection periods for each year, weekly response rate updates for each survey shall be included in the status report.

Compliance The contractor will produce the following materials for review.

· In even years, the 2025 CAHPS Health Plan Survey 5.1H Child Questionnaire (without CCC Measure) in English

· In odd years, the most recent adult version of the CAHPS Health Plan Survey in English

· Official cover letter and postcard (in both English and Spanish)

· A copy of the carrier logo and signature block on questionnaire and letters for each carrier (in both English and Spanish)

The contractor will follow collection protocols as defined annually by AHRQ, including but not limited to the following:

· Mixed methodology: a four-wave mail protocol (two questionnaires and two reminder postcards) with telephone follow-up of a minimum of three and a maximum of six telephone attempts.

· Mail: 1st survey packet, reminder postcard, 2nd survey packet, 2nd reminder postcard

· Phone follow-up: 3 phone calls – maximum

· All times are Mountain Time (MT)

· A survey will be assigned the disposition of complete and valid if the respondent appropriately answers the standard questions.

The contractor will provide respondent support through the following methods: toll-free respondent support line in English and Spanish, answered live, 9am – 8pm MT. The contractor will also support alternate language requests.

Upon reasonable request by the Department, the contractor shall allow the Department to perform a review of the facilities, systems, books, records, agreements, policies and procedures relating to the survey to determine the contractor’s compliance. The Department may require the contractor to conduct a risk assessment that addresses administrative, technical, and physical risks, if reasonable and appropriate.

Project Deliverables

1. Project plan and status updates throughout the field period

2. The datasets will be submitted in a comma delimited file, organized as a single record for each member composed of a string of fields containing data values. Weighting of the data is not included. A data file layout with defined labels and values will accompany each dataset.

3. Aggregate dataset to Department; plan-level datasets for each carrier.

4. Out-of-state respondents flagged

5. Banner books or frequencies

· one for each carrier sample

· plan-level frequencies with aggregate score for each plan

· complete disposition results for internal calculations of response rates

· see Data Elements for HEDIS/CAHPS Surveys in the current HEDIS® Volume 3: Specifications for Survey Measures for more details.

6. Overview reports

· one for each carrier sample

· plan-level reports to contain four overall rating questions, composite scores, sample information, and response rates

7. In all data presentations, such as banner books, overview reports, or graphical reports, any results or cells with less than 11 cases will be suppressed and replaced with ‘NA’, per CMS specifications

8. Deliverables are due to the Department no later than July 1st of each survey year

9. Records and scanned images of returned, completed surveys retained for 3 years

Project Timeline Project work will commence on November 1, 2025, and will continue through October 31, 2030. An example of a timeline for one year follows. Each year of administration will follow the same timeline.

Cost Proposal Structure Since the number of participating carriers and total sample size will vary each year, we are asking for the Total Cost Per Survey.

The Total Cost Per Survey should be all-inclusive and include the cost of up to six AHRQ-approved supplemental questions per survey administration. Please review the AHRQ Worksheet M2: Developing Your Budget for an outline of what to include when you create your Total Cost Per Survey estimate.

Evaluation Summary A. Total Cost Per Survey Estimate – Please enter response in U3P posting only.

Qualification Summary Information Each application must include a Qualifications Summary section that adequately describes the following:

A. Data Collection Methods:

1. Strategies for maximizing response rates

2. Sampling methods

3. Respondent selection methods

4. Address standardization

5. Standardization of mailing materials

6. Survey tracking & non-respondent follow-up

7. Acquiring/generating/updating telephone numbers

8. Callback scheduling and assignment methods, including proposed system for handling scheduled callbacks B. Commitment to the Project

1. Promised cooperation and response rates

2. Evidence of established quality control measures for each phase of the project

3. Continuity of work/business schedule during holiday seasons

4. Commitment to five calendar years of data collection and cooperation with the Department

5. Availability of adequate resources to manage and complete the project, noting any capacity limitations and the ability to handle extra surveys requested by carriers

6. Ability of staff members to work remotely with the Department

7. Ability to submit data to NCBD C. Conduct of Interviews

1. An overview of the organization's standard interviewer training procedures

2. Interviewer supervision and monitoring systems D. Qualifications of Staff

1. Describe the contractor's previous experience conducting CAHPS surveys, including response rates for Medicaid and commercial surveys conducted in the past.

2. List the names of staff members who will be assigned to this project and submit resumes for each. For each of the listed staff, the contractor shall identify specific tasks they will be responsible for upon contract award, and whether each staff person has attended NCQA training and when.

3. Evidence that the contractor has adequate resources and staff to conduct all telephone surveys in-house.

E. Timeline

1. A detailed timeline which provides the following items: commencement of project, collection of carrier logos and signatures, collection of sample frame files, mailing phase (including surveys and reminder postcards), phone phase (including beginning and end dates), NCQA submission, draft final report, and final deliverables.

F. References

1. The contractor shall provide three references the Department may contact regarding the quality of services performed or the ability of the respondent to meet the Department’s needs.

G. NCQA Certification

1. The respondent must provide documentation that they and/or their staff have a current NCQA certification for performing CAHPS surveys.

Proposal Response Format All proposals must be organized and tabbed with the labels for the following headlines:

1. RFP Form - The State's Request for Proposal form completed and signed.

2. Executive Summary - The one- or two-page executive summary shall be a brief description of the applicant’s proposal. This summary should highlight the major features of the proposal. It must indicate any requirements that cannot be met by the offeror. The reader should be able to determine the essence of the proposal by reading the executive summary. Proprietary information requests should be identified in this section.

3. Detailed Response & Qualifications Summary - This section should constitute the major portion of the proposal and must contain at least the following information:

- A complete narrative of the applicant’s assessment of the work to be performed, the applicant’s ability and approach, and the resources necessary to fulfill the requirements. This should demonstrate the applicant’s understanding of the desired overall performance expectations. Clearly indicate any options or alternatives proposed.

- A specific point-by-point response, in the order listed, to each requirement listed in the Qualifications Summary section.

RFP Evaluation Criteria

1. Demonstrated ability to meet scope of work (80 points)

a. (50) Sampling methodology is adequately explained and acceptable

b. (50) Resources are sufficient to handle the required volume

c. (50) Quality and reliability of mailing and tracking procedures

d. (50) Quality and reliability of telephone follow-up procedures

e. (50) Strategies to maximize response rates are adequately explained and acceptable

f. (50) Response rates from prior projects

g. (50) Experience conducting CAHPS and/or other large social/behavioral surveys & quality of reference responses

h. (50) Simplicity and readability of the response

i. (50) An overview of the organization's standard interviewer training procedures

j. (50) Interviewer supervision and monitoring systems

k. (50) Evidence that the contractor has adequate resources and staff to conduct all telephone surveys in-house.

2. Staff Qualifications (20 points)

a. (50) Qualifications of guaranteed Utah staff

b. (50) Familiarity and experience working with Utah carriers

3. Ability of RFP applicant to meet timelines (20 points)

a. (100) Provided timeline is adequate, realistic, and meets business needs

4. Cost (250 points)