6300 RFP for TPA.pdf

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STATE OF OREGON

COVER PAGE

OREGON DEPARTMENT OF CORRECTIONS

Is issuing this Request For Proposals (RFP) under OregonBuys Bid Number S-29100-00011086 for

THIRD PARTY ADMINISTRATOR AND PROVIDER NETWORK

SERVICES FOR OFF-SITE HEALTHCARE

Date of Issue: August 13, 2024

Opening Date and Time: October 9, 2024 (the Opening will be done virtually)

Single Point of Contact (SPC): Eric McDowell, Contracts Officer

Address: 3723 Fairview Industrial Drive, Suite 200 City, State, Zip Salem, OR 97302 Phone (971) 375-7783 E-mail: eric.s.mcdowell@doc.oregon.gov

The State of Oregon promotes equal opportunity for all individuals without regard to age, color, disability, marital status, national origin, race, religion or creed, sex or gender, sexual orientation, or veteran status.

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TABLE OF CONTENTS

SECTION 1: GENERAL INFORMATION

1.1 INTRODUCTION

1.2 SCHEDULE

1.3 SINGLE POINT OF CONTACT (SPC)

SECTION 2: AUTHORITY, OVERVIEW, AND SCOPE

2.1 AUTHORITY AND METHOD

2.2 DEFINITION OF TERMS

2.3 OVERVIEW AND PURPOSE

2.4 SCOPE OF WORK

SECTION 3: PROCUREMENT REQUIREMENTS

3.1 MINIMUM QUALIFICATIONS

3.2 MINIMUM SUBMISSION REQUIREMENTS

3.3 PROPOSAL REQUIREMENTS

SECTION 4: SOLICITATION PROCESS

4.1 PUBLIC NOTICE

4.2 PRE-PROPOSAL CONFERENCE

4.3 QUESTIONS / REQUESTS FOR CLARIFICATIONS

4.4 SOLICITATION PROTESTS

4.5 PROPOSAL DELIVERY OPTIONS

4.6 PROPOSAL MODIFICATION OR WITHDRAWAL

4.7 PROPOSAL DUE

4.8 PUBLIC OPENING

4.9 PROPOSAL REJECTION

4.10 EVALUATION PROCESS

4.11 POINT AND SCORE CALCULATIONS

4.12 RANKING OF PROPOSERS

4.13 ADDITIONAL ROUNDS

4.14 SCORING AND RANKING OF PROPOSERS FOR SUBSEQUENT ROUNDS

SECTION 5: AWARD AND NEGOTIATION

5.1 AWARD NOTIFICATION PROCESS

5.2 INTENT TO AWARD PROTEST

5.3 APPARENT SUCCESSFUL PROPOSER SUBMISSION REQUIREMENTS

5.4 CONTRACT NEGOTIATION

SECTION 6: ADDITIONAL INFORMATION

6.1 COMMITMENT TO DIVERSITY, EQUITY, AND INCLUSION

6.2 CERTIFIED FIRM PARTICIPATION

6.3 GOVERNING LAWS AND REGULATIONS

6.4 OWNERSHIP/PERMISSION TO USE MATERIALS

6.5 CANCELLATION OF RFP; REJECTION OF PROPOSAL; NO DAMAGES

6.6 COST OF SUBMITTING A PROPOSAL

6.7 STATEWIDE E-WASTE/RECOVERY PROCEDURE

6.8 RECYCLABLE PRODUCTS

6.9 PRINTING, BINDING, AND STATIONERY WORK

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LIST OF ATTACHMENTS:

ATTACHMENT A: SAMPLE CONTRACT

ATTACHMENT B: DISCLOSURE EXEMPTION AFFIDAVIT

ATTACHMENT C: PROPOSER INFORMATION AND CERTIFICATION SHEET

ATTACHMENT D: RESERVED

ATTACHMENT E: COST PROPOSAL FORM

ATTACHMENT F: COBID CERTIFICATION / OUTREACH PLAN

ATTACHMENT G: RESPONSIBILITY INQUIRY

ATTACHMENT H: TOTAL EXTERNAL COST COMPARISON

ATTACHMENT I: EXTERNAL COST DISTRIBUTION BY LOCATION AND MONTH

ATTACHMENT J: DOC HEALTH REFERRAL OUTSIDE AGENCY

ATTACHMENT K: TECHNOLOGY REQUIREMENTS

ATTACHMENT L: GENERAL INFORMATION QUESTIONNAIRE

ATTACHMENT M: NOTICE OF INTENT TO PARTICIPATE

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SECTION 1: GENERAL INFORMATION

1.1 INTRODUCTION

The State of Oregon, acting by and through the Department of Corrections (“Agency” or “ODOC”), is issuing this Request for Proposals pursuant to Oregon Revised Statutes (“ORS”) 279B.060 for off-site healthcare services for ODOC’s Adult in Custody (“AIC”) population. This Request for Proposals (“RFP”) is issued for the purpose of procuring third-party administration services for all off-site healthcare services for ODOC AICs housed within those correctional institutions identified in Attachment 7, “Designated Institutions,” to Attachment A, “Sample Contract.” The successful Proposer will be responsible for administration of all Off-site healthcare services and a limited amount of related healthcare services provided to AICs On-site at ODOC correctional institutions throughout the State of Oregon (ODOC Institutions). ODOC is solely responsible for the financial and medical decision-making policies related to healthcare services wherever it is provided to AICs under ODOC’s care and control.

It is ODOC’s expectation that a Contract will be executed with the apparent successful Proposer no later than January 1, 2025, and that claims administration services will begin no later than March 1, 2024. The current cost of Services, including cost of AIC healthcare and contractor administrative fees, is approximately $2,500,000 per month.

Additional details on the scope of the goods or services or both are included in Section 2.4, Scope of Work.

ODOC anticipates the award of one (1) Contract from this RFP. The initial term of the Contract is anticipated to be two (2) years with options to renew up to a cumulative maximum of 10 years.

1.2 SCHEDULE

The table below represents a tentative schedule of events. All times are listed in Pacific Time.

All dates listed are subject to change. N/A denotes that event is not applicable to this RFP.

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Event Date Time

Pre-Proposal Conference August 23, 2024 10:00 AM

Questions / Requests for Clarification Due August 30, 2024 2:00 PM

Answers to Questions / Requests for Clarification Issued (approx.) September 6, 2024

RFP Protest Period Ends

7 calendar days prior to RFP Opening

Opening (Proposal Due) See RFP cover page

Opening of Proposal October 9, 2024 2:00 PM

Presentations, Demonstrations, or Interviews TBD

Issuance of Notice of Intent to Award (approx.) October 30, 2024

Award Protest Period Ends 7 calendar days after Notice of Intent to Award

1.3 SINGLE POINT OF CONTACT (SPC)

The SPC for this RFP is identified on the Cover Page, along with the SPC’s contact information.

Proposer shall direct all communications related to any provision of this RFP to the SPC, whether they are about the technical requirements of this RFP, any contractual requirements, the RFP process, or any other inquiry.

SECTION 2: AUTHORITY, OVERVIEW, AND SCOPE

2.1 AUTHORITY AND METHOD

Agency is issuing this RFP pursuant to its authority under ORS 279A.050 and OAR 125-246- 0170(2).

Agency is using the Competitive Sealed Proposals method, pursuant to ORS 279B.060, OAR 125- 247-0260, and OAR 137-047-0260. Agency may use a combination of the methods for Competitive Sealed Proposals, including optional procedures: a) Competitive Range; b) Discussions and Revised Proposals; c) Revised Rounds of Negotiations; d) Negotiations; e) Best and Final Offers; and f) Multistep Sealed Proposals.

2.2 DEFINITION OF TERMS

For the purposes of this RFP, capitalized words are defined in OAR 125-246-0110 or as specifically defined herein.

2.3 OVERVIEW AND PURPOSE

2.3.1 Agency Overview and Background

The Oregon Department of Corrections was created by the 64th Legislative Assembly in June 1987 and operates under ORS Chapter 423. ODOC has custody of adults sentenced to prison for

DAS Procurement Services, Version 4.4 July 1, 2021 Page 6 of 27 more than 12 months. ODOC houses approximately 12,100 adults in 12 ODOC Institutions throughout the State of Oregon.

2.3.2 Project Overview and Background

ODOC is responsible for the healthcare for all persons housed within ODOC Institutions. State and federal laws, administered through ODOC rules and policies, have established legal obligations to provide healthcare for AICs during incarceration. Each of these individuals has a constitutional guarantee of healthcare equivalent to the community standard.

ODOC, through treating practitioners on its staff and independent contractors, provides AIC healthcare within ODOC Institutions (“On-site” care). ODOC also arranges for, and pays the expenses of, AIC healthcare services delivered at locations other than at the ODOC Institutions (“Off-site” care). The Off-site care includes the range of healthcare services available in the community including, but not limited to, inpatient and outpatient hospital services, diagnostic services, and specialty physician services. Off-site healthcare claims are currently administered by a contractor.

ODOC’s Health Services Division currently employs approximately 500 to 550 personnel and will have the responsibility for administration of the contract resulting from this RFP. The Health Services Division’s administrative offices are located in Salem, Oregon. ODOC’s AIC population, approximately 12,100 individuals currently, is forecast to increase to approximately 12,700 in 2024. To meet this need, capacity of existing ODOC Institutions will be increased.

Current On-Site and Off-Site Healthcare Costs:

ODOC self-insures all healthcare expenses for AICs, regardless of whether such expenses were incurred On-site or Off-site. Each ODOC Institution varies in size and in the healthcare services offered On-site. The type of On-site services for each ODOC Institution is listed below. AICs are transferred within ODOC to try and maximize On-site services, keeping Off-site access to approximately one percent (1%) of overall encounters. For Fiscal Year 2023, DOC had a total of 6,211 claimants with claims totaling approximately $37,873,952. Cost per claimant was approximately $6,100.00. All dollar amounts for Off-site healthcare services described in this RFP reflect amounts paid, including discounts available through the existing contractor. Please reference Attachment H (Total External Cost Comparison) and Attachment I (External Cost Distribution by Location and Month) for additional information regarding ODOC healthcare claims and costs.

Off-Site Healthcare Services:

ODOC requires a full range of Off-site specialty care, subspecialty care, tertiary care, organ transplant services, and ancillary care services. The needed services include, but are not limited to, advanced radiology and imaging procedures such as MRI, CT and Ultrasound; oral surgery and complex dental procedures; neonatal care; and emergency care.

On-Site Healthcare Services:

The successful Proposer will not be responsible for administering or paying the cost of any On-site services obtained directly by ODOC, including prescription services provided by

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ODOC at ODOC’s two on-site pharmacies. The larger ODOC Institutions have full-time primary care physicians who are paid a salary and are available from 8:00 am to 5:00 pm.

Infirmary care is provided at five ODOC Institutions, and these beds are used to provide daily nursing care for AICs who do not require hospitalization but cannot take care of themselves in the general population.

All ODOC Institutions have part-time or full-time nurses available to see AICs on a daily basis.

Some medical specialists come to ODOC Institutions to treat AICs, thereby reducing costs and security risks. ODOC has contracts for On-site care with specialists in the following fields:

surgery, orthopedics, optometry, oral surgery, and infectious diseases. ODOC contracts directly with providers for the purchase and On-site delivery of pharmaceuticals, radiology, and laboratory services.

ODOC wishes to obtain certain On-site services through the contract resulting from this RFP when those services are not available within the ODOC health services program. Such services are limited to:

• Services which are the result of continuation of care for an AIC who was treated Off-site; and

• Specialty physician services; services related to On-site clinics for MRI, CAT scans, stress tests, and mammography; and other services as approved in advance in writing by ODOC.

All pre-authorizations and treatment plans will be established and authorized by ODOC. There is a Therapeutic Levels of Care (TLC) Committee for ODOC Institutions located on the east side of the State and a similar committee for those located on the west side. Both committees meet twice each month and review a total of 30 to 40 On-site and Off-site cases per meeting. Both TLC Committees include physicians and a care coordinator LPN or RN who review the chronic On-site and Off-site cases. ODOC resources also include approximately 630 Health Services staff comprised of pharmacists, radiology technicians, physicians, nurses, and other healthcare professionals. Once Off-site care has been approved, an Oregon Department of Corrections Health Referral Outside Agency form (Attachment J) is completed.

One generalization that can be made about the health of individuals in the AIC population is that their physical health is older than their chronological age. AICs are likely to have problems of the musculoskeletal and neurological systems. AICs experience significant problems with dental infection, mental deterioration, and liver problems due to substance abuse. Also, the incidence of various infectious diseases is somewhat higher with this population primarily due to behaviors associated with illicit drug use.

HIV/HEP C – ODOC provides HIV and Hepatitis C education, testing and counseling On-site.

Basic information is provided to all AICs at the time of intake. Special Needs Forms are completed, and cases are managed within the DOC system for the following: Asthma, Diabetes, Epilepsy, HIV, Hypertension, and Lipids and Health Maintenance/Prevention. Complications from methamphetamine use are a significant driver of medical care.

Mental Health Case Management – All AICs are screened at intake for any mental illness or developmental disability. ODOC provides several levels of mental health treatment On-site

DAS Procurement Services, Version 4.4 July 1, 2021 Page 8 of 27 along with individual case management. There are three ODOC Institutions equipped to handle the severely mentally ill On-site.

Pharmacy - There are two ODOC-run pharmacies – one is located in Salem, and one is located in Ontario. Approximately 60% of the AIC population is on some type of prescribed medication.

The most common prescriptions are antibiotics, psychiatric medications, and anti-inflammatory analgesics. Pharmacy services fill over 25,000 prescriptions each month.

Radiology Services - There are seven DOC Institutions providing general radiography services.

The State employs a licensed Radiology Technician who oversees and helps set standards for the radiology program. AICs needing radiology are either transferred to an ODOC Institution with this service or sent Off-site to the nearest contracted hospital or clinic. AICs who need more advanced imaging procedures (e.g. MRI, CT, and Ultrasound) are scheduled at the nearest Off-site contracted hospital or clinic.

Dental – There are 11 DOC Institutions that can provide dental services. AICs housed in those facilities without dental clinics are transported to the nearest ODOC Institution providing dental services. There are approximately 27,000 dental contacts statewide in a calendar year. Oral surgery and complex dental needs are handled as Off-site services.

The Correctional Institutions and On-site Services:

Currently there are 12 ODOC Institutions in the State, and they are listed below. ODOC reserves the right to add or remove ODOC Institutions throughout the term of the awarded Contract.

Additional information about ODOC Institutions may be found at:

http://www.oregon.gov/doc/OPS/PRISON/pages/all_prisons.aspx

Coffee Creek Correctional Facility Address: 24499 SW Grahams Ferry Rd., Wilsonville, OR 97070 Number of AICs: 1,564 Type of On-site services: General medical, women’s healthcare, dental, radiology services, phlebotomy, mental health, HIV/hepatitis counseling, infirmary

Columbia River Correctional Institution Address: 9111 NE Sunderland Ave., Portland, OR 97211 Number of AICs: 553

Type of On-site services: General medical, minor surgery, dental, and radiology services; phlebotomy; and HIV/hepatitis counseling

Deer Ridge Correctional Institution Address: 3920 East Ashwood Road, Madras, OR 97741

Number of AICs: Capacity is 1800, currently housing 650

Type of On-site services: General medical, minor surgery, dental, and radiology services; phlebotomy; and HIV/hepatitis counseling http://www.oregon.gov/doc/OPS/PRISON/pages/all_prisons.aspx

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Eastern Oregon Correctional Institution Address: 2500 Westgate, Pendleton, OR 97801 Number of AICs: 1,659 Type of On-site services: General medical, dental, and radiology services;

phlebotomy; and HIV/hepatitis counseling

Oregon State Correctional Institution Address: 3405 Deer Park Drive, SE, Salem, OR 97310 Number of AICs: 897 Type of On-site services: General medical, minor surgery, dental, orthopedic, and radiology services; phlebotomy; and HIV/hepatitis counseling

Oregon State Penitentiary Address: 2605 State St., Salem, OR 97310 Number of AICs: 2,356 Type of On-site services: General medical, orthopedic, minor surgical, optical, dental, and radiology services; phlebotomy; colonoscopies; HIV/hepatitis counseling; infirmary; and hospice

Powder River Correctional Facility Address: 3600 13th Street, Baker City, OR 97814 Number of AICs: 286 Type of On-site services: General medical and dental services, and HIV/hepatitis counseling

Santiam Correctional Institution Address: 4005 Aumsville Hwy SE, Salem, OR 97301 Number of AICs: 440 Type of On-site services: General medical and dental services; minor surgery;

phlebotomy; and HIV/hepatitis counseling

Snake River Correctional Institution Address: 777 Stanton Blvd, Ontario, OR 97914 Number of AICs: 3,040 Type of On-site services: General medical, dental, orthopedic, minor surgical, optical, and radiology services; phlebotomy; HIV/hepatitis counseling; and an infirmary

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South Fork Forest Camp Address: 48300 Wilson River Hwy, Tillamook, OR 97141

Number of AICs: 200

Type of On-site services: Limited general medical care

Two Rivers Correctional Institution Address: 82911 Beach Access Road, Umatilla, OR 97882 Number of AICs: 1,812 Type of On-site services: General medical, dental, orthopedic, minor surgical, optical, and radiology services; phlebotomy; HIV/hepatitis counseling; an infirmary;

dialysis; and nephrology

Warner Creek Correctional Facility

Address: 20654 Rabbit Hill Road, Lakeview, OR 97630

Number of AICs: 406

Type of On-site services: General medical services

2.3.3 Purpose

The current contract for third party healthcare administration services is reaching the end of its term, and ODOC is looking to contract with a new provider to deliver the following services:

2.3.3.1 Discounted Provider Network: (See Attachment A – Sample Form of Administrative Services Only Contract (“Sample Contract”), Exhibit A – Statement of Work, Section D). Providers and facilities must be available to all ODOC Institutions at a discount to satisfy ODOC’s constitutional mandate for health care.

2.3.3.2 Medical Case Management: (See Attachment A- Sample Form of Administrative Services Only Contract (“Sample Contract”), Exhibit F). Patients and their care are followed very closely. Case management nurses must work to reduce bed days and allow patients to come home sooner. Nurses must work with ODOC staff towards the smooth transition from offsite care to onsite case management.

2.3.3.3 Medical Claims Processing and Adjudication: (See Attachment A – Sample Form of Administrative Services Only Contract (“Sample Contract”), Exhibit H). Using sophisticated medical industry software, authorized medical claims must be scrutinized and reviewed according to medical coding standards.

2.3.3.4 Information Management and Reporting: (See Attachment A – Sample Form of Administrative Services Only Contract (“Sample Contract”), Exhibit I). Extensive and specific data must be provided

DAS Procurement Services, Version 4.4 July 1, 2021 Page 11 of 27 on a regular and Ad-Hoc basis. This information is very valuable to the ODOC Health Services Team for trend-tracking and decision-making.

2.3.3.5 Medicaid Eligibility: Contractor shall be responsible for working with ODOC and Oregon’s Department of Human Services Aging and People with Disabilities program to coordinate financial and demographic data needed to establish the Medicaid eligibility of all AICs admitted to a medical facility on an inpatient status.

2.4 SCOPE OF WORK

The successful Proposer will be responsible for paying all outside medical and dental providers including, but not limited to: specialists, surgeons, clinics, labs, imaging centers, and hospitals. The successful Proposer will also manage a limited amount of On-Site goods and services as described in Section 2.3.2, Project Overview and Background, On-site Healthcare Services, third paragraph. This responsibility will include tracking of AIC care, obtaining discounts on PPO and non-PPO services, looking for early hospital release opportunities, and providing innovative solutions to help save on global expenses including medical care, transport costs and security detail. Since AICs need transportation and security for all Off-site services, concurrent review and discharge planning should consider ODOC Institution availability. Claims need to be managed from beginning to end. This management involves eligibility determinations (including Medicaid eligibility as further described in Exhibit 1, Sample Contract, Attachment 2, Section B.1), claims payment, partnering with ODOC on utilization management and enforcing ODOC healthcare decisions.

2.4.1 General Requirements: The successful Proposer will be required to:

• Furnish all necessary personnel, materials, facilities and other services to accomplish delivery of Services, except as otherwise expressly provided in this RFP.

• Maintain and expand upon cost-effective provider contracts with a statewide PPO network for Off-site medical care for AICs. The network must include providers on the borders of Idaho and Washington near those ODOC Institutions identified above. The successful Provider shall work to enhance the provider network upon execution of the Contract.

• Be a good steward of plan funds in addition to processing and paying medical claims timely and accurately. Innovative solutions to help the plan save money and manage risk are a high priority.

• Establish reimbursement rates with aggressive provider discounts that are comparable with those in the commercial marketplace.

• Provide internet based electronic access to claims data analysis and information.

• Ensure all claims and administrative charges are billed as agreed.

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• Provide concurrent claims review, cost management and utilization management.

• Accept weekly enrollment data regarding eligibility of AICs.

• Disclose all existing and future subcontracting in furtherance of this Contract to ODOC.

• Provide monthly or quarterly utilization reports as requested by ODOC.

• Provide training to ODOC staff regarding claims software.

2.4.2 Technology Requirements

The successful Proposer shall provide ODOC with web-based electronic access to Proposer’s claims data system. Currently, ODOC has no Electronic Health Record (“EHR”) system. All charts are handwritten, and internal transferring of AICs can create record keeping difficulties. There is an internet feed at each ODOC Institution, and ODOC must have full access to the successful Proposer’s online claims system.

An electronic eligibility file will be sent to the successful Proposer on a weekly basis.

This file will include effective dates and Termination Dates for all AICs. The file will be sent through a secure transmission in a CSV or like kind format.

The successful Proposer’s technology services must maintain compatibility with any new software and hardware acquired by ODOC.

Additional information regarding technology requirements is set forth in Attachment K, Technology Requirements.

2.4.3 Billing Procedures and Reserves

Please refer to Attachment A, Exhibit 2, the Statement of Work.

2.4.4 PPO Network Discounts and Services

The successful Proposer must provide a network of healthcare providers to meet all of ODOC’s Off-site healthcare needs. Off-site healthcare needs include, but are not limited to: a full range of specialty, subspecialty, and tertiary care; organ transplant services; and ancillary care providers. The network must include sufficient numbers and types of healthcare facilities and professional healthcare providers to supply timely and appropriate access to services near AICs housed in all ODOC Institutions. The successful Proposer will be required to expand the network of care to encompass any new ODOC Institutions.

ODOC will reimburse the successful Proposer for healthcare provided by network providers in accordance with the discounted rates negotiated between the successful Proposer and Network healthcare providers (“Reimbursement Schedule”) and the contract resulting from this RFP.

The successful Proposer shall work with providers to maintain all current hospital and specialist contracts statewide and shall be aggressive with ongoing fee

DAS Procurement Services, Version 4.4 July 1, 2021 Page 13 of 27 negotiations for in-network and out-of-network claims. Since most ODOC Institutions are located in rural communities, the successful Proposer shall use best efforts to grow or add physicians to the provider network. In-network hospitals must be within 60 miles of each ODOC Institution. The successful Proposer must be committed to specialist recruitment, customer service assistance for provider triage, and locating specific types of providers for special cases and treatments.

2.4.5 Institution Pre-authorization / Concurrent Review / Utilization / Discharge Planning

ODOC is responsible for the treatment plans for AICs. The ODOC Care Coordinator will be an RN or LPN and will be the designated contact for both emergent and non-emergent services. All outside providers and the successful Proposer must coordinate all questions and medical decisions, including emergency transport and emergency admissions, through the ODOC Care Coordinator.

The successful Proposer will be responsible for understanding the ODOC treatment plan and for tracking all patient care. The successful Proposer will provide inpatient and outpatient concurrent review and utilization management for the entire AIC population. This includes identifying additional services or information needed and reporting back to the ODOC Care Coordinator for approval of new services or revised treatment plans. The successful Proposer will monitor the appropriate level of care, assist in coordination of care, and provide or facilitate discharge planning.

The successful Proposer shall enforce the ODOC treatment plan, ensure timely hospital releases and oversee complex discharge planning. Case monitoring performed by the successful Proposer will include short term and long-term goals including care needs, medical equipment requirements and recommending alternative treatment. Utilization management must be forward looking, managing healthcare cases efficiently and cost effectively.

A “Health Referral Outside Agency Form” (Attachment J) is completed each time an AIC requires Off-site services. The successful Proposer will receive copies of all ODOC Health Referral Forms which shall become part of the successful Proposer’s electronic claims file. Each approved Off-site case involving concurrent review or discharge planning will require special coordination between the ODOC Care Coordinator and the successful Proposer about the approved treatment. The successful Proposer will add this information to the electronic case file. The successful Proposer will have access to the ODOC attending physician when additional information is needed.

SECTION 3: PROCUREMENT REQUIREMENTS

3.1 MINIMUM QUALIFICATIONS

Each Proposer that responds to this solicitation does so solely at the Proposer’s expense. The response (“Proposal”) must clearly address each of the areas identified herein to demonstrate the Proposer’s ability to meet the requirements and provide the Services described. Proposals must address all Proposal and submission requirements set forth in

DAS Procurement Services, Version 4.4 July 1, 2021 Page 14 of 27 this RFP and must describe how the services will be provided. Proposals which merely offer to provide services as stated in this solicitation will be considered non-responsive and will be rejected. Please do not include marketing or promotional materials with or as a part of any Proposal.

3.1.1 Minimum Proposer Requirements

3.1.1.1 Proposals must be received by ODOC no later than the Opening Date and Time specified on the cover page of this RFP.

3.1.1.2 Proposers must currently be in the business of providing services similar in nature to those described in the Scope of Work.

3.1.1.3 Proposers must have a minimum of five (5) years of experience providing services similar in nature to those described in the Scope of Work.

3.1.1.4 The Proposer Information and Certification Sheet, Responsibility Inquiry, and Technology Requirements must be signed by a signatory authorized to legally bind the Proposer.

3.2 MINIMUM SUBMISSION REQUIREMENTS

3.2.1 Proposal Submissions

To be considered for evaluation, a Proposal must contain each of the following elements (further detailed in Proposal Requirements, Section 3.3):

• Executive Summary

• Administrative Proposal

• Technical Proposal

• Disclosure Exemption Affidavit (Attachment B)

• Proposer Information and Certification Sheet (Attachment C)

• Cost Proposal Form (Attachment E)

• COBID Certification / Outreach Plan (Attachment F)

• Responsibility Inquiry (Attachment G)

• Technology Requirements (Attachment K)

• General Information Questionnaire (Attachment L)

• Work Samples

3.2.2 Reserved

3.2.3 Proposal Format and Quantity

Proposals should follow the format and reference the sections listed in the Proposal Requirements section. Responses to each section and subsection should be labeled to indicate the item being addressed.

OregonBuys Electronic Response. ODOC prefers that all Proposals be submitted electronically through OregonBuys. Proposers should follow the procedures outlined in

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Section 4.5, Proposal Delivery Options, for electronic submission.

The Cost Proposal must be submitted as a separate electronic response file.

Proposer shall submit one copy of its Proposal and all other submittal requirements, along with Attachment C - Proposer Information and Certification Sheet bearing the Proposer’s authorized representative’s Signature, in one of the following formats: Adobe Acrobat (pdf), Microsoft Word (docx), or Microsoft Excel (xlsx). If Proposer believes any of its Proposal is exempt from disclosure under Oregon Public Records Law (ORS 192.311 through 192.478), Proposer shall complete and submit the Disclosure Exemption Affidavit (Attachment B) with its Proposal. Proposer shall also mark as “Confidential” in OregonBuys all attachments to its Proposal that Proposer believes are exempt from disclosure.

The Proposer Information and Certification Sheet (Attachment C) must bear the Proposer’s authorized representative’s Signature.

Other Electronic Media Response

Proposer may submit its Proposal via email to the dedicated mailbox listed below. Faxed submissions or hard copies will NOT be accepted.

ODOC will only accept electronic Proposals compatible with MS Office applications and .pdf files. Do not submit .zip, .exe. or .com files. Proposals in excess of 10 megabytes must be incrementally submitted. When submitting the Proposal in multiple e-mails, sequentially number the e-mail submittals.

The Cost Proposal must be included in the e-mail as a separate file.

The Proposal e-mail subject or reference line must include the RFP Number and Title, as follows:

Proposal for RFP #S-29100-00011086, THIRD PARTY ADMINISTRATOR AND

PROVIDER NETWORK SERVICES FOR OFF-SITE HEALTHCARE

Failure to clearly identify the Proposal as directed in the subject line may cause misrouting of the Proposal and late delivery, resulting in disqualification.

Dedicated mailbox – submit Proposals to (not case sensitive):

doc.contractproposals@doc.oregon.gov

3.2.4 Authorized Representative

Failure of Proposer’s authorized representative to sign the Proposal may result in rejection of the Proposal by Agency.

3.3 PROPOSAL REQUIREMENTS

Proposals must address each of the items listed in this section and all other requirements set forth in this RFP. Proposers shall describe the Goods to be provided or the Services to be mailto:doc.contractproposals@doc.oregon.gov

DAS Procurement Services, Version 4.4 July 1, 2021 Page 16 of 27 performed or both. A Proposal that merely offers to provide the goods or services as stated in this RFP may be considered non-Responsive and will not be considered further.

Proposals should not include extensive artwork, unusual printing, or other materials not essential to the utility and clarity of the Proposal. Do not include marketing or advertising materials in the Proposal, unless requested. Proposals should be straightforward and address the requirements of this RFP. Proposals containing unsolicited marketing or advertising material may receive a lower evaluation score if required information is difficult to locate.

3.3.1 Proposer Information and Certification Sheet

Proposer shall complete and submit the Proposer Information and Certification Sheet (Attachment C).

Failure to demonstrate compliance with Oregon Tax Laws and sign the Proposer Information and Certification Sheet may result in a finding of non-Responsibility.

3.3.2 References

References shall be made available upon request.

3.3.3 Cost Proposal

The cost proposal shall include a fixed fee per AIC per month. The cost proposal shall be submitted separately from the rest of the Proposal.

3.3.4 Key Persons and their Resumes

See Attachment L, Section L.1.10 for details.

3.3.5 Project Implementation Plan

Briefly describe how Proposer would perform the services in the context of the Scope of Work. Provide a comprehensive management plan that the Proposer intends to follow.

Illustrate how the plan will serve to coordinate and accomplish the Work.

SECTION 4: SOLICITATION PROCESS

4.1PUBLIC NOTICE

The RFP and its attachments are published in the State of Oregon’s electronic procurement system, OregonBuys, at https://oregonbuys.gov/. Documents will not be mailed to prospective Proposers.

Modifications, if any, to this RFP will be made by written Amendment(s) published in OregonBuys. Prospective Proposers are solely responsible for checking OregonBuys to determine whether or not any Amendment(s) have been issued. Amendment(s) are incorporated into this RFP by this reference.

4.2 PRE-PROPOSAL CONFERENCE

A Pre-Proposal conference will be held at the date and time listed in Section 1.2, Schedule.

https://oregonbuys.gov/

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Prospective Proposers’ participation in this conference is highly encouraged but is not mandatory.

The purpose of the Pre-Proposal conference is to:

• Provide an additional description of the project;

• Explain the RFP process; and

• Answer any questions Proposers may have related to the project or the process.

Statements made at the Pre-Proposal conference are not binding upon Agency. Proposers may be asked to submit questions in Writing.

Interested parties may participate in the Pre-Proposal Conference by:

The Pre-Proposal Conference will be held remotely using Microsoft Teams. Please complete Attachment M. Notice of Intent to Participate, and return it if you plan on attending the Pre- Proposal Conference. An invitation will be emailed to the address(es) on the Notice of Intent to Participate.

4.3 QUESTIONS / REQUESTS FOR CLARIFICATIONS

All inquiries, whether relating to the RFP process, administration, deadline or method of award, or to the intent or technical aspects of the RFP must:

• Be delivered to the SPC via email;

• Reference the OregonBuys bid number in the subject line;

• Identify Proposer’s name and contact information;

• Refer to the specific area of the RFP being questioned (i.e., page, section and paragraph number); and

• Be received by the due date and time for Questions/Requests for Clarification identified in

Section 1.2, Schedule.

4.4 SOLICITATION PROTESTS

4.4.1 Protests to RFP

Prospective Proposer may submit a Written protest of anything contained in this RFP, including but not limited to, the RFP process, Specifications, Scope of Work, and the Sample Contract. This is prospective Proposer’s only opportunity to protest the provisions of the RFP, except that Proposer may protest as provided below.

4.4.2 Protests to Amendment(s)

Prospective Proposer may submit a Written protest of anything contained in an Amendment. Protests to an Amendment, if issued, must be submitted by 5:00 p.m. Pacific Time on the second Business Day following the issuance of the Amendment or the date/time specified in the Amendment, or the protest will not be considered. Protests of matters not added or modified by the Amendment will not be considered.

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4.4.3 Requirements for Protests

All protests must:

• Be delivered to the SPC via email;

• Reference the OregonBuys bid number;

• Identify prospective Proposer’s name and contact information;

• Be sent by an authorized representative;

• State the reason for the protest, including:

o the grounds that demonstrate how the Procurement Process is contrary to law, unnecessarily restrictive, legally flawed, or improperly specifies a brand name;

and o evidence or documentation that supports the grounds on which the protest is based; and

• State the proposed changes to the RFP provisions or other relief sought.

Protests to this RFP must be received by the due date and time identified in Section 1.2, Schedule.

4.5 PROPOSAL DELIVERY OPTIONS

Proposer is solely responsible for ensuring its Proposal is received by the SPC in accordance with the RFP requirements before Opening. ODOC is not responsible for any delays in mail or by common carriers or by transmission errors or delays, or for any mis-delivery for any reason.

A Proposal submitted by any means not authorized below will be rejected. The following delivery options are permitted for this RFP:

Delivery through OregonBuys

Proposal submission should be electronically through OregonBuys at: OregonBuys.gov

Detailed instructions on how to submit a Proposal can be found at OregonBuys Vendor Formal Solicitation Response.pdf

Alternative Delivery Option: Delivery through Email

A Proposal may be submitted through email and must be clearly identified in the subject line. It must be sent to the attention of the SPC at the address listed below:

doc.contractproposals@doc.state.or.us

4.6 PROPOSAL MODIFICATION OR WITHDRAWAL

If a Proposer wishes to make modifications to a submitted Proposal, the Proposer must submit its modification by one of the authorized methods listed in Section 4.5, Proposal Delivery Options. Any modification must include a statement that the modification amends and supersedes the prior Proposal. To be effective the modification must include the OregonBuys bid number and be submitted to the SPC prior to Opening.

https://www.oregon.gov/das/ORBuys/Documents/OregonBuys%20Vendor%20Formal%20Solicitation%20Response.pdf https://www.oregon.gov/das/ORBuys/Documents/OregonBuys%20Vendor%20Formal%20Solicitation%20Response.pdf mailto:doc.contractproposals@doc.state.or.us

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If a Proposer wishes to withdraw a submitted Proposal, it must submit a Written notice signed by an authorized representative of its intent to withdraw to the SPC via email prior to Opening in accordance with OAR 125-247-0440. To be effective the notice must include the OregonBuys bid number.

4.7 PROPOSAL DUE

A Proposal (including all required submittal items) must be received by the SPC on or before Opening. All Proposal modifications or withdrawals must also be received prior to Opening.

A Proposal received after Opening is considered LATE and will NOT be accepted for evaluation.

A late Proposal will be returned to the Proposer or destroyed.

4.8 PUBLIC OPENING

A public Opening will be held on the date and time listed in the Schedule set forth in Section 1.2 and in the manner stated on the Cover Page. Only the name of the Proposer will be read at the Opening; no other information will be made available at that time. Proposals received will not be available for inspection until after the evaluation process has been completed and the notice of Intent to Award is issued pursuant to OAR 125-247-0630.

4.9 PROPOSAL REJECTION

Agency may reject a Proposal for any of the following reasons:

• Proposer fails to substantially comply with all prescribed RFP procedures and requirements including, but not limited to, the requirement that Proposer’s authorized representative sign the Proposal.

• Proposer has liquidated and delinquent debt owed to the State or to any department or agency of the State.

• Proposer fails to meet the responsibility requirements of ORS 279B.110.

• Proposer makes any contact regarding this RFP with State representatives such as State employees or officials other than the SPC or persons authorized by the SPC, or makes inappropriate contact with the SPC.

• Proposer attempts to influence a member of the Evaluation Committee.

• Proposal is conditioned on Agency’s acceptance of any other terms and conditions or rights to negotiate any alternative terms and conditions that are not reasonably related to those expressly authorized for negotiation in this RFP or any Amendment(s).

4.10 EVALUATION PROCESS

4.10.1 Responsiveness and Responsibility Determination

4.10.1.1 Responsiveness determination

A Proposal received prior to Opening will be reviewed to determine if it is Responsive to all RFP requirements including compliance with Section 3.1, Minimum Qualifications, and Section 3.2, Minimum Submission Requirements. If the Proposal is unclear, the SPC may request clarification from Proposer. However, clarifications may not be used to rehabilitate a non-Responsive proposal. If the SPC finds the Proposal non-Responsive, DAS Procurement Services, Version 4.4 July 1, 2021 Page 20 of 27 the Proposal may be rejected; however, Agency may waive minor informalities in accordance with OAR 125-247-0470.

4.10.1.2 Responsibility Determination

Agency will determine if an apparent successful Proposer is Responsible prior to award and execution of the Contract. Proposers shall submit a signed Responsibility Inquiry form (Attachment G) with Proposal.

At any time prior to award, Agency may reject a Proposal from a Proposer found to be not Responsible.

4.10.2 Evaluation Criteria

Each Proposal meeting all Responsiveness requirements will be independently evaluated by members of an Evaluation Committee. Evaluation Committee members may change, and Agency may have additional or fewer evaluators for optional rounds of competition. Evaluators will assign a score for each evaluation criterion listed below in this Section 4.10.2 up to the maximum points available as specified in Section 4.11, Point and Score Calculations.

Agency may request further clarification to assist the Evaluation Committee in gaining additional understanding of a Proposal. A response to a clarification request may only clarify or explain portions of the already submitted Proposal and may not contain new information not included in the original Proposal.

4.10.2.1 Technology Requirements and Proposer Capabilities, see Attachment K for more details

• Access and Technology Abilities

• Security and Integrity of Data

• Compatibility

4.10.2.2 General Information Questionnaire, see Attachment L for more details

• Company Background, Key Personnel, and Experience

• Claims Administration

• Provider Network

• Case Management

• Implementation and Transition Plan

• Performance Measures and Guarantees

4.10.3 PRICE EVALUATION

The SPC will conduct the price evaluation. The SPC will award a price score to each Price Proposal based upon the percentage of the proposed price as compared to the lowest Proposer’s price using the following formula:

lowest price of all Proposers X price points possible = price score price being scored

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4.10.4 PREFERENCES

4.10.4.1 Oregon Supplies and Services

Agency prefers Oregon goods and services, and for evaluation purposes, per ORS 279A.128, Agency shall subtract 10% from the price for any Proposer proposing all Goods fabricated or processed or all Services performed entirely in Oregon before calculating the price score.

4.10.4.2 Reciprocal Preference

For evaluation purposes per OAR 125-246-0310, Agency shall add a percentage increase to each out-of-state Proposer's Proposal price that is equal to the percentage preference, if any, given to a Resident Proposer in the Proposer's state.

4.10.4.3 Recycled Materials

Agency will give preference to Goods manufactured from Recycled Materials if each of the conditions specified in ORS 279A.125 (2) exists following any adjustments made to the price of the Goods according to any applicable reciprocal preference.

4.10.4.4 Tiebreakers

If Agency receives Proposals identical in price, fitness, availability, and quality and chooses to award a Contract, Agency shall award the Contract in accordance with the procedures outlined in OAR 137-046-0300.

4.11 POINT AND SCORE CALCULATIONS

Points are the total possible for each section as listed in the table below.

Price points are calculated as stated in Section 4.10.3, Price Evaluation.

4.12 RANKING OF PROPOSERS

The SPC will average the scores for each Proposal in a given round of competition (calculated by totaling the points awarded by each Evaluation Committee member and dividing by the number of members). The SPC will combine the average score for each Proposal with Proposer’s price score.

After any applicable preference has been applied, the SPC will determine the rank of each Proposal, with the highest score receiving the highest rank, and successive rank order determined by the next highest score.

TOTAL POINTS POSSIBLE : 624

POINTS POSSIBLE 524

4.10.2.1 Technology Requirements and Proposer Capabilities, Attachment K

4.10.2.2 General Information Questionnaire, Attachment L 424

4.10.3 PRICE POINTS POSSIBLE 100

https://www.naspo.org/reciprocity1

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Agency may, in Agency’s sole discretion, determine an apparent successful Proposer with no additional rounds of competition. If additional rounds are conducted, Agency will rank advancing Proposers at the conclusion of each subsequent round and may determine an apparent successful Proposer at any time during the solicitation process.

NEXT STEP DETERMINATION

At the conclusion of a round of competition, Agency may choose to conduct additional round(s) of competition if in the best interest of the State. Additional rounds of competition may consist of, but will not be limited to:

• Interviews

• Presentations/Demonstrations/Additional Submittal Items

• Discussions and submittal of revised Proposals

• Serial or simultaneous negotiations

• Best and Final Offers

4.12.1 Competitive Range Determination

If Agency, in its sole discretion, determines that one or more additional rounds of competition is necessary, it will select a Competitive Range to indicate the Proposers that will be invited to participate in a subsequent round. The Competitive Range may include all, or, at Agency’s sole discretion, some (based primarily on a natural break in the distribution of scores), of the Proposers from a previous round. Agency will post a notice in OregonBuys of its Competitive Range Determination and provide details about the process and schedule for the subsequent round.

4.12.2 Competitive Range Protest

Proposers excluded from a round may submit a Written protest of the Competitive Range.

Protests must:

• Be emailed to the SPC;

• Reference the OregonBuys bid number ;

• Identify Proposer’s name and contact information;

• Be sent by an authorized representative;

• State the reason for the protest; and

• Be received within 7 calendar days after issuance of the Notice of the Competitive Range unless a different due date and time is specified in such notice.

Agency will address all protests within a reasonable time and will issue a Written decision to the respective Proposer. Protests that do not include the required information may not be considered by Agency.

4.13 ADDITIONAL ROUNDS

If the Agency determines that it is in the best interest of the State to conduct additional rounds of competition, then the details of the additional rounds will be provided in the Notice of Competitive Range.

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4.14 SCORING AND RANKING OF PROPOSERS FOR SUBSEQUENT ROUNDS

If Agency conducts two or more rounds of competition, the rounds will be scored independently. Once the ranking from a previous round is complete and a Competitive Range has been determined, Proposers participating in a subsequent round will compete on an equal basis – scores from the previous round will be set aside and will not carry over. The Proposer with the highest score from the final round will receive the highest final ranking.

SECTION 5: AWARD AND NEGOTIATION

5.1 AWARD NOTIFICATION PROCESS

5.1.1 Award Consideration

Agency, if it awards a Contract, will award a Contract to the highest ranking Responsible Proposer(s) based upon the scoring methodology and process described in Section 4.

Agency may award less than the full Scope of Work described in this RFP.

5.1.2 Intent to Award Notice

Agency will notify all Proposers in Writing that Agency intends to award a Contract to the selected Proposer(s) subject to successful negotiation of any negotiable provisions.

5.2 INTENT TO AWARD PROTEST

5.2.1 Protest Submission

An Affected Proposer shall have 7 calendar days from the date of the Intent to Award notice to file a Written protest.

A Proposer is an Affected Proposer only if the Proposer would be eligible for Contract award in the event the protest was successful and is protesting for one or more of the following reasons as specified in ORS 279B.410:

• All higher ranked Proposals are non-Responsive.

• Agency has failed to conduct an evaluation of Proposals in accordance with the criteria or process described in the RFP.

• Agency abused its discretion in rejecting…