7. Attachment F - Technical Reply.xlsx

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Attached to
RFP No. DMS-2425-312 MAPD
Solicitation number
RFP-12976
Issued by
Leon County, Florida

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Attachment F - Technical Reply is a detailed spreadsheet from the Florida Department of Management Services (DMS) for RFP No. DMS-24/25-312, soliciting Medicare Advantage Prescription Drug (MA-PD) plans for state group insurance. The RFP seeks fully-insured HMO and PPO plans to cover 25,192 Medicare-eligible state retirees, with an anticipated contract implementation date of January 1, 2026. The document provides comprehensive technical reply instructions, requiring respondents to submit a detailed portfolio addressing 64 specific technical questions across nine evaluation categories including business model, implementation, account management, customer service, data interfaces, claims processing, audits, contract termination, and additional plan benefits. The contract will have an initial three-year term from January 1, 2026, to December 31, 2028, with potential renewal for up to three additional years.

The procurement will evaluate proposals using a 40% technical and 60% cost proposal methodology, with vendors required to meet minimum qualifications including current healthcare accreditation, a minimum 3.5 CMS Star Rating, and experience covering at least 80,000 lives. The state plans to award contracts to multiple respondents to ensure coverage across all Florida counties, with an estimated annual contract value of approximately $8,000,000 and monthly premiums not exceeding $430 per member per month. Vendors must provide cost proposals across three coverage tiers with varying out-of-pocket maximums and maintain commercial general liability insurance of $5 million, workers' compensation insurance, and professional indemnity insurance of $5 million. The solicitation requires strict compliance with HIPAA, HITECH Act, and Florida Statutes, with comprehensive data protection and privacy protocols.

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Other files

File Type Posted
13. Attachment L - Business-Assoc-Agreement.pdf PDF
2. Attachment A - Administrative Requirements.pdf PDF
4. Attachment C - Covered Benefits and Services.pdf PDF
9. Attachment H - Data Use Agreement.pdf PDF
12. Attachment K - Draft Contract.pdf PDF
13. Attachment L - Business-Assoc-Agreement.pdf PDF
2. Attachment A - Administrative Requirements.pdf PDF
6. Attachment E - Reporting and Deliverables.pdf PDF
8. Attachment G - Cost Proposal.xlsx XLSX spreadsheet
Addendum No. 1.pdf PDF
2. Revised Attachment A - Administrative Requirements.pdf PDF
DMS-2425-312 Q&A.pdf PDF
13. Attachment L - Business-Assoc-Agreement.pdf PDF
7. Attachment F - Technical Reply.xlsx XLSX spreadsheet
Addendum No. 1.pdf PDF
DMS-2425-312 Q&A.pdf PDF
1. DMS-2425-312_MAPD RFP (1).pdf PDF
11. Attachment J - PUR 7801.docx DOCX document
12. Attachment K - Draft Contract.pdf PDF
7. Attachment F - Technical Reply.xlsx XLSX spreadsheet
1. DMS-2425-312_MAPD RFP (1).pdf PDF
3. Attachment B - Performance Guarantees.pdf PDF
5. Attachment D - Enrollment File Layout and Schedule.pdf PDF
12. Attachment K - Draft Contract.pdf PDF
3. Attachment B - Performance Guarantees.pdf PDF
5. Attachment D - Enrollment File Layout and Schedule.pdf PDF
6. Attachment E - Reporting and Deliverables.pdf PDF
8. Revised Attachment G - Cost Proposal.xlsx XLSX spreadsheet
Addendum No. 1.pdf PDF
Addendum No. 2.pdf PDF
4. Attachment C - Covered Benefits and Services.pdf PDF
8. Revised Attachment G - Cost Proposal.xlsx XLSX spreadsheet
3. Attachment B - Performance Guarantees.pdf PDF
5. Attachment D - Enrollment File Layout and Schedule.pdf PDF
4. Attachment C - Covered Benefits and Services.pdf PDF
7. Attachment F - Technical Reply.xlsx XLSX spreadsheet
9. Attachment H - Data Use Agreement.pdf PDF
1. DMS-2425-312_MAPD RFP (1).pdf PDF
11. Attachment J - PUR 7801.docx DOCX document
2. Revised Attachment A - Administrative Requirements.pdf PDF
3. Attachment B - Performance Guarantees.pdf PDF
5. Attachment D - Enrollment File Layout and Schedule.pdf PDF
Addendum No. 2.pdf PDF
Addendum No. 3.pdf PDF
6. Attachment E - Reporting and Deliverables.pdf PDF
8. Attachment G - Cost Proposal.xlsx XLSX spreadsheet
11. Attachment J - PUR 7801.docx DOCX document
4. Attachment C - Covered Benefits and Services.pdf PDF
9. Attachment H - Data Use Agreement.pdf PDF
1. DMS-2425-312_MAPD RFP (1).pdf PDF
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F1 General Instructions

Request for Proposal for the State of Florida, Department of Management Services
DMS-24/25-312, Medicare Advantage Prescription Drug Plan(s)

Technical Reply Instructions

Instructions:

In a separate PDF document, Respondents shall provide a Portfolio responding to each of the Technical Questions listed in Tab F2 in accordance with section 3.5 (Content of Proposal) of the RFP document.

Respondents shall for each Technical Question also complete Tab F2 of this Attachment F by identifying in column D the Portfolio page number that corresponds to the applicable Technical Question listed on tab F2 Technical Questions. Respondents should also insert their business entity name in cell A4.

Responses should be written in at least 11-point type using Calibri, Arial, or Times New Roman font.

Failure to submit a reply to any portion of the Technical Proposal shall negatively impact the Respondent’s evaluation score.

This section will be scored pursuant to subsection 4.3 (Evaluation of the Proposal) of this RFP.

Evaluators may not consider the Cost Reply in evaluating the Respondent's Reply.

&G &"-,Bold"Attachment F - Technical Reply

F1: GENERAL INSTRUCTIONS

RFP No.: DMS-24/25-312 Medicare Advantage Prescription Drug Plan &P of &N

F2 Technical Questions

Request for Proposal (RFP) DMS-24/25-312 for the State of Florida, Florida Department of Management Services (Department)
Medicare Advantage Prescription Drug Plan(s)
Technical Reply
Respondent Name:
The Respondent shall respond to each of the Technical Questions listed herein and describe, in detail, its proposed plan for meeting all requirements identified Attachment A, Administrative Requirements. Responses must clearly identify how the Respondent meets or exceeds each of the requirements. All requested information must be submitted per section 3.5 of the RFP document and tab F1 General Instructions of this Excel workbook. Failure to provide a response to any question will result in the respondent receiving a zero (0) score for that question.
Technical QuestionsPortfolio Page NumberMaximum Raw Points PossibleRaw Points Awarded by EvaluatorWeight
(Raw Score multiplied by X)Maximum Weighted Points PossibleTotal Weighted Points Awarded by Evaluator
I.Business Model
1Describe the distinguishing characteristics of the Respondent’s business model, health management programs, network management strategies, and other key operational functions that differentiate the Respondent from competitors.5201000
2Describe the Respondent’s experience in administering Medicare Advantage Prescription Drug (MA-PD) plan benefits, highlighting relevant expertise and demonstrated performance.
3Describe the Respondent’s provider network development model and contracting strategy, with a focus on quality, access, and sustainability.
4Describe the Respondent’s strategies for managing prescription drug utilization to ensure safe, effective, and cost-efficient use of medications covered under Medicare.
5Describe how your organization ensures timely, compliant notifications and reporting for both standard and emergency formulary changes, including required notice content, stakeholder communication, and documentation.
6Describe how your organization manages care and utilization review, including pre-certification, prior authorization, care reviews, member programs, and automated systems to support efficient, high-quality, and compliant care.
7Describe how your organization manages Medicare Risk Adjustment to ensure accurate revenue and long-term program success.
II.Implementation
8Furnish a comprehensive Final Implementation Plan that clearly showcases the Respondent's capability to fulfill the State's requirements, ensuring a fully operational program by January 1, 2026. The finalized Implementation Plan should be presented to the Department for approval within ten (10) Business Days from the Effective Date of the Contract. This plan is expected to encompass a detailed outline of specific implementation tasks and transition protocols, accompanied by a timeline indicating the initiation and completion dates for each task, in alignment with the milestones outlined in AR-1.5201000
9Specify the pivotal dates that must be adhered to in order to achieve the implementation deadline of January 1, 2026. This should encompass the processes slated for review, the steps to be executed—encompassing but not limited to system testing—the necessary transition data to be acquired from the incumbent, and the timelines for the development of Plan documents.
10Furnish an organizational chart outlining the names, titles, areas of expertise, functions, and reporting relationships of key individuals tasked with implementing and providing continuous servicing for the State's account.
11Outline the responsibilities of the Implementation Manager, specifying the percentage of time allocated to implement this Contract for the State in comparison to duties and time dedicated to other clients.
12Describe any major transition issues Respondent reasonably anticipates during implementation and how it proposes to mitigate the impact of those potential issues.
III.Account Management and Support Services
13Specify the Account Manager(s) who will assume the primary responsibility for planning, overseeing, and executing account management services for the State in the event that the Respondent secures a Contract under this RFP, and indicate the percentage of this person's time dedicated to the resulting contract from this RFP.5201000
14Illustrate the online capabilities that the Department will possess, including features such as on-demand reporting.
15Provide an in-depth explanation of the Respondent's ad-hoc reporting capabilities and elucidate the Respondent’s capacity to generate and furnish ad-hoc reports to the Department at no additional cost, complying with required formats and timeframes.
16A notification regarding open enrollment should be sent to all potential Subscribers before the commencement of open enrollment for the initial year of the Contract. Please furnish a sample of the announcement package.
17After the initial enrollment, what communication materials will a Participant receive, such as a welcome package? Please provide samples of these communication materials.
18In the event that it becomes evident a group would benefit from additional education concerning Plan benefits, detail the procedures the Respondent has in place to achieve this objective.
19Outline how the Respondent intends to adhere to Americans with Disabilities Act requirements, ensuring the provision of materials and other communications in alternative formats.
20Describe your approach to developing, submitting, and executing Corrective Action Plans as requested by the Department.
21Describe your process for developing, submitting, and distributing plan materials in compliance with AR-8.
22Explain how you will ensure timely mailing of enrollment materials within four business days, as stated in AR-9.
23Describe how you will meet ID card issuance standards under AR-10, including formatting, compliance, and security.
24Detail your strategy for participating in annual Open Enrollment Benefit Fairs per AR-7.
25Explain the strategy for delivering materials in languages aside from English.
IV.Customer Service
26Detail the Respondent’s customer service call center, providing information on the call center's location serving Members, operating hours, the quantity of representatives, or the representative-to-Members ratio designated for the State’s account, and outline the security protocols implemented for both the customer service call center and its representatives.5502500
27Elaborate on the communication capabilities of the Respondent's customer service call center beyond telephone calls, encompassing areas such as online chat, email, and other modalities.
28Detail the multi-lingual capabilities of the Respondent's customer service call center and elucidate on the mechanisms through which this support is facilitated, whether through language lines or dedicated multilingual call center representatives.
29Outline the Respondent's process for tracking and managing routine customer service calls, including the reporting procedures in place.
30Detail the Respondent's capacity to furnish recorded calls to the customer service unit in electronic format to the Department within 24 hours of a request, without incurring any additional costs.
31Explain the procedures in place for handling after-hours and weekend calls.
32Furnish examples of system-generated reports from the Respondent that monitor and gauge call center statistics, encompassing metrics like average speed to answer, abandonment rate, average length of call, average hold time, Interactive Voice Response (IVR) self-service interactions, and reasons for calls. It is essential that the reports presented by the Respondent mirror those that can be provided to the Department if a Contract is awarded under this RFP.
33Utilizing insights from the Respondent's book of business, industry trends, and the provided Census File, pinpoint up to two underinsured demographics. Elaborate on the Respondent's strategy concerning these demographics.
34Outline the functionalities of the Respondent's website and smartphone application(s), such as customer service and chat.
35Describe the value-added programs, cost-saving benefits, and supplemental services the Respondent offers to Medicare Advantage plan participants.
36Describe the Respondent’s clinical service capabilities and approach to delivering high-quality, coordinated care to Medicare-eligible Members.
37Detail the services accessible to Participants through the Respondent's website, specifying the extent of functionality. Additionally, highlight any compatibility concerns with widely used web browsers.
V.Data and Interface
38What is the duration for which the Respondent retains records?5502500
39Explain the procedures that the Respondent adheres to when a Participant is terminated due to omission.
40Detail the Respondent's capability to receive eligibility files outside the usual timeframe, such as a file sent to rectify an error impacting multiple employees.
41Provide a comprehensive overview of the Respondent's online reporting capabilities. Is it possible to customize reports and reporting schedules?
42What contingency plans does the Respondent have in place for the continuity of operations concerning its Medicare Advantage Prescription Drug Plan(s)?
43What standard protocol does the Respondent have in place to ensure the continuous operation of services during a natural disaster or other unplanned or planned events that may affect service delivery?
44In the event of a disaster or any unforeseen circumstance, where is the location of the Respondent's backup system hosting?
45Is there a remote location available for the Respondent in case its primary operating location becomes unavailable?
46On average, what is the timeframe for the Respondent to activate a remote location and achieve full functionality for Participants?
47Does the Respondent have a telework policy? If yes, please explain the policy, and elaborate on how and when this policy would be activated, particularly if it is reserved for specific circumstances.
48Detail the process employed by the Respondent to test system backups, encompassing both hardware and software, including disaster recovery procedures.
VI.Claims Processing
49Explain the duration for which claims history is retained.5502500
50For the Respondent's portfolio, outline the typical timeframe from the receipt of all necessary information/documentation to the payment of a claim.
51Detail the security protocols implemented by the Respondent to guarantee accurate issuance of benefits to the intended recipients.

52 Explain the procedures and processes involved in managing pended claims.

VII.Audits
53Is there an internal audit team within the Respondent's organization?5502500
54How often does the Respondent's internal audit staff conduct audits of the claims processing function?
55Does the Respondent's organization engage an external auditor?
56How often does the external auditor conduct audits of the claims processing function?
57How are audit findings communicated internally within the Respondent's organization, and to whom are these results conveyed?
58What percentage of claims undergo auditing?
59What is the Respondent’s standard audit size in terms of volume and percentage of claims?
60Provide a detailed description of all tests conducted on samples of claims.
61Outline the procedures undertaken by the Respondent to address any deficiencies identified during the audit process.
62Detail the audit trail and processes employed by the Respondent to track claims through the entire adjudication process.
VIII.Contract Termination or Experation
63Are you able to process and adjudicate Run-Out Claims and provide all related claim services, including data file transmissions and audit support, for up to sixteen (16) months following contract termination?510500
IX.Additional Plan Benefits
64Describe any additional benefits included in the premium that are not part of standard covered services (e.g., dental, vision, wellness, OTC allowances). Include any limitations or eligibility requirements.510500
Maximum Raw Points PossibleTotal Raw Points Awarded by EvaluatorMaximum Weighted Points PossibleTotal Weighted Points Awarded by Evaluator
Evaluation Total:45014000

&G &"-,Bold"Attachment F - Technical Reply F2: Technical Questions

RFP No.: DMS-24/25-312 Attachment F - Technical Reply &P of &N image1.png

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