addendum-2-rfp-2736-23.pdf

STATE OF NEW HAMPSHIRE

DIVISION OF PROCUREMENT AND SUPPORT SERVICES

BUREAU OF PURCHASE AND PROPERTY

STATE HOUSE ANNEX

25 CAPITOL STREET

CONCORD, NEW HAMPSHIRE 03301-6398

DATE OF CHANGE: 3/17/2023

ADDENDUM # 02 TO BID INVITATION # 2736-23

DATE OF BID CLOSING: 03/30/2023 TIME OF BID CLOSING: 02:00 PM (ET)

FOR: MEDICARE ADVANTAGE BENEFIT ADMINISTRATION

CLARIFICATIONS:

Question 1:

Please clarify whether companies from outside the USA can apply for this?

State Response:

Bidders must meet the requirements indicated in the RFP and as required by the Centers for Medicare and Medicaid Services. For example, Protected Health Information (PHI) is not to be transferred outside of the United States.

Question 2:

Do we need to come over there for in person meetings?

State Response:

Yes.

Question 3:

Can we perform the tasks (related to RFP) outside the USA?

State Response:

See response to Question 1.

Question 4:

Can we submit the proposals via email?

State Response:

No. Bidders must respond to the electronic RFP (eRFP) located on Proposal Tech. To access the eRFP, register on Proposal Tech at: http://www.proposaltech.com/home/app.php/register

Question 5:

Does the State have a requirement or policy to publicly procure or bid the Medicare Advantage contract every 3 years or 5 years?

http://www.proposaltech.com/home/app.php/register

State Response:

The State’s current MA contract expires on December 31, 2023 and is seeking proposals for a three-year contract with an optional extension of up to two years. Contracts of up to five years are the State’s common practice.

Question 6:

Has the State or its retirees experienced any disruption or service issues with the current Medicare Advantage medical vendor in the last 3 years? If so, please explain.

State Response:

The State has not experienced any material disruption or service issues.

Question 7:

Does the State anticipate conducting Finalist meetings? If so, would that meeting be in-person or virtual?

State Response:

Currently, no Finalist meetings are anticipated.

Question 8:

Does the State have dedicated staff today under their current Medicare Advantage Medical and Pharmacy vendor contracts? If so, please identify the positions that are currently dedicated.

State Response:

The requested staffing is indicated in the RFP.

Question 9:

Are the performance guarantees requested in the RFP currently in place with the current Medicare Advantage medical vendor?

State Response:

The requested performance guarantees reflect the State’s desired guarantees and are not intended to be an exact match of the current guarantees.

Question 10:

Please confirm bidders will be able to ask additional clarifying questions based on the March 15, 2023 responses to the March 8, 2023 initial set of questions.

State Response:

See Section 2.1.2. All questions regarding this RFP were to be submitted in writing by the RFP inquiry deadline of March 8, 2023.

Question 11:

2.6, Financial Scoring, Page 11

The RFP requests a three-year financial proposal. How will the State score a five-year financial proposal compared to a three-year proposal?

As indicated in the RFP, the financial score will be based on proposals for the initial three-year contract period from January 1, 2024 to December 31, 2026.

Question 12:

Section 3, Required Plan Design, Services and Programs, 3.1, Plan Design, Appendix – 2023 Medicare Part D EGWP Benefit Overview Please confirm a 30-day supply is acceptable to the State.

State Response:

The State’s current plan design has up to a 31-day supply for the retail 1-month copayment.

However, due to prescribing and dispensing practices, the majority of the State’s retail scripts are filled with a 30-day supply (over 50,000 in the CY 2022 detailed data provided) versus a 31-day supply (about 400 in the data).

Question 13:

Section 3, Required Plan Design, Services and Programs, 3.1, Plan Design

Please confirm how many drug tiers the current ESI PDP plan has.

State Response:

Three tiers.

Question 14:

Section 3, Required Plan Design, Services and Programs, 3.1, Plan Design

Please detail the specialty drug benefit in the current ESI PDP plan.

State Response:

There is not a separate copayment schedule for specialty drugs. The same three tier copayments apply to all drugs.

Question 15:

Section 3, Required Plan Design, Services and Programs, 3.1, Plan Design

Please confirm that the Specialty Rx Copay is $40 for retail, $120 for retail 90, and $80 for mail order.

State Response:

Not confirmed. There is not a separate copayment schedule for specialty drugs. The same three tier copayments apply to all drugs.

Question 16:

3.3, General Services, The State requires a minimum of nine (9) group breakouts for purposes of reporting.

Please provide more detail around the (9) nine breakout groups requested?

The State typically wants reporting for the group as a whole. However, the State has sub-groups that it wants to have the ability to separate for membership reporting for agencies and other groups.

Question 17:

3.3, General Services, The State requires a dedicated toll-free number be made available to enrollees to handle claims or other service issues at no additional cost. The State also requires this same number or separate number be available to retirees to address questions or provide information pre-enrollment.

Is this requirement for the general customer service line provided by the MAPD carrier?

State Response:

If the general customer service line provided by the MAPD carrier is a dedicated number to the State of NH group and accomplishes the other requests in the referenced section, that is acceptable to the State.

Question 18:

3.3, General Services, The State requires that Bidders guarantee adherence to New Hampshire RSA 420-J:8-a regarding prompt pay. The law mandates timeframes for all claims [15 days electronic, 30 days paper claims, overdue (interest payment required if timeframes are not met), denied and pended (inform providers within 15 days (electronic claims) or 30 days (paper claims) and adjudicate with 45 days of receipt of additional].

Medicare Advantage plans adhere to CMS guidelines regarding prompt pay rules and timelines.

Please confirm the State expects bidders to comply with the CMS prompt pay adherence rules for claims payment over the NH RSA 420-J:8-a.

State Response:

Confirmed.

Question 19:

SONH MA RFP Data File Medical Monthly Data

Please indicate if the MA medical claims include any costs for the following:

• Non-Medicare covered Fee-for-Service Costs (i.e. hearing/vision/wigs) [yes/no]?

• Clinical/Quality/Disease Management Program Costs [yes/no]?

• Fitness/Travel Programs [yes/no]?

• IBNR [yes/no]?

• Part B Rx Claims [yes/no]?

• Non-Medicare covered Fee-for-Service Costs (i.e. hearing/vision/wigs) included

• Clinical/Quality/Disease Management Program Costs not included

• Fitness/Travel Programs not included

• IBNR included

• Part B Rx Claims included

Question 20:

SONH MA RFP Data File Risk Score

The risk score received was for December 2022.

• Does the risk score include Mid-Year Adjustments?

• Does the risk score include an estimate for the Final Adjustments?

Please provide monthly risk scores that match the monthly claims data provided.

Also indicate whether the mid-year and/or final adjustments are included in each month.

State Response:

• Does the risk score include Mid-Year Adjustments? Yes

• Does the risk score include an estimate for the Final Adjustments? The December 2022 risk score does not include the final adjustments and the December 2021 risk score includes the final adjustments.

The 2021 and 2022 monthly risk scores have been added to the RFP data file and will be provide securely to all qualifying Bidders consistent with this RFP’s prior data sharing.

Question 21:

SONH MA RFP Data File Risk Score

Please provide a Jan 2023 risk score which would best align with the census provided.

State Response:

The census represents February 2023. The MMR for February 2023 is being provided securely to all qualifying Bidders consistent with this RFP’s prior data sharing.

Question 22:

SONH MA RFP Data File Risk Score

Consistent with what was provided in the 2021 RFP, please provide a monthly MMR report through Jan 2023. This report should include all data shared through CMS without manipulation.

State Response:

The MMR for February 2023 is being provided securely to all qualifying Bidders consistent with this RFP’s prior data sharing.

Question 23:

SONH MA RFP Data File Drug UM Tab

Is this list for information only, or are there bidder instructions to accompany this list?

This is referenced in Section 3.1 and is informational of the current prescription drug plan.

Question 24:

SONH MA RFP Data File Drug UM Tab

If this is for UM comparison, please supply a list of UM drugs at the NDC level categorized by UM type (PA/ST/QL/etc.)

State Response:

A detailed UM program comparison is not being requested.

Question 25:

SONH MA RFP Pharmacy Claims File Data Dictionary requested

Please provide a data dictionary for pharmacy claims file, values, and headers.

State Response:

SegalRecordID = Record ID BlindedID = Deidentified Member ID Number Pharmacy NPI Number = Pharmacy National Provider Identifier Number DateofService = Date of Service FillNumber = The fill number of a prescription. The initial fill would be “1”, the first refill “2”, etc.

DaySupply = Number of Days Supply MetricQuantity = Metric quantity FormularyStatus = Formulary Status CopayTier = Copay Tier MailRetailInd = Mail or Retail Indicator NDC = National Drug Code DAW = Dispense as Written Code CompoundInd = Compound Drug Indicator ClaimsCounter = Claim or Reverse Claim Indicator

Question 26:

SONH MA RFP Pharmacy Claims File Key requested

Is it possible to get a key that defines the fields on the report?

In order to conduct the formulary analysis, the data team requires definition of at least the following:

• 1 : 282,255 occurrences

• -1 : 1,281 occurrences

• | : 1 occurrence Would values of -1 and the | denote reversals? If so, should those rows be disregarded from the analysis?

Yes, -1 indicates a claim reversal that can be disregarded in the formulary analysis.

Question 27:

SONH MA RFP Pharmacy Claims File

The NDC value for approximately 40 rows in the designated 4-month range = 0. It appears that these are compounds and we can’t confirm Formulary inclusion without NDC detail.

State Response:

Claims with a NDC value of “0” may be omitted from the formulary analysis.

Question 28:

SONH MA RFP Pharmacy Claims File Tier Clarification

The claims data provided with the RFP contains Specialty medications with Tiers 1, 2 or 3 populated. There is no indication of a separate Specialty tier or Specialty cost share.

• Is there a separate tier for Specialty medications with cost shares different from $10/$25/$40 standard copays for non-Specialty?

• Please provide the Specialty Drug Formulary Tiers and corresponding member cost share(s) for each Specialty Tier

State Response:

There is not a separate copayment schedule for specialty drugs. The same three tier copayments apply to all drugs.

Question 29:

Technical Questionnaire 4.1, Administrative, Member & Claim Paying Services, 4.1.2

How does the State define "regions of the state.” How many regions make up the State?

State Response:

The State defines regions geographically. There are five regions.

Question 30:

Technical Questionnaire 4.1, Administrative, Member & Claim Paying Services, 4.1.5

Are the Customer Service Manager and the Member Services Lead two different staff? If yes, please define the roles and responsibilities of each. Further clarify if each role is "dedicated" or "designated" based on the description: Some positions may be dedicated and others may be designated. For the purpose of this RFP, “Dedicated” is defined as the Vendor's staff members who are solely assigned to perform Services in furtherance of this Contract, which means the Vendor does not assign them to work for any other client or customer. “Designated” is defined as the Vendor's staff members who are assigned to perform Services in furtherance of this Contract, but may also be assigned to work for other clients or customers. Indicate which positions are Dedicated vs. Designated.

State Response:

Customer Service Manager and Member Services Lead are interchangeable.

Question 31:

Technical Questionnaire 4.2, Data Reporting, 4.2.16

Please provide the “Reporting Details and Templates.pdf” referenced in this question.

State Response:

This document has been added to the question.

Question 32:

Technical Questionnaire 4.2, Data Reporting, 4.2.29

Is it an acceptable alternative to provide test claims that adjudicate with the NPI of a retail pharmacy in the test environment?

State Response:

The question referenced does not exist. If this question is referring to Question 4.2.19, this relates to comparing rate development to actual results, not test claims processing.

Question 33:

Technical Questionnaire 4.4, Enrollment, Implementation & Communication, 4.4.42

Please define "providers" and if this includes what carriers send to pharmacies? Is the State wanting to approve communications specific to messaging pertaining to the State's retirees?

State Response:

“Provider” refers to both medical and pharmacies. The State wants to approve communications specific to the administration of its plan. The State is not requesting to review CMS required communications.

Question 34:

Technical Questionnaire 4.6, Rx Formulary and Clinical Program Management, 4.6.4

In order to confirm, we will need:

A complete formulary at the NDC level in Excel format Currently covered “buy-up” or “wrap” drugs at the NDC level in Excel format Currently covered CMS excluded drugs at the NDC level in Excel format

The Specialty Drug list/formulary at the NDC level in Excel format Are the OTCs in the claims file covered products on the Part D plan? If yes, please provide currently covered OTCs at the NDC level in Excel format

State Response:

A complete formulary at the NDC level in Excel format This information is not needed as

Bidders are not being asked to duplicate the current formulary.

Currently covered “buy-up” or “wrap” drugs at the NDC level in Excel format The State’s detailed claims data was provided in this RFP. Non-Part D Drugs with a formulary status of “Y” should indicate “buy-up” or “wrap” drugs. Note that the State does not have a customized program.

Currently covered CMS excluded drugs at the NDC level in Excel format The State’s detailed claims data was provided in this RFP. Note that the State does not have a customized program.

The Specialty Drug list/formulary at the NDC level in Excel format This information is not needed as Bidders are not being asked to duplicate the current formulary.

Are the OTCs in the claims file covered products on the Part D plan? If yes, please provide currently covered OTCs at the NDC level in Excel format Yes, the State’s detailed claims data includes covered OTCs. Note that the State does not have a customized program

Question 35:

4.6, Rx Formulary and Clinical Program Management, 4.6.25

Please provide a formulary list at the NDC level in Excel format for accurate identification of excluded drugs.

State Response:

This question is requesting information related to the formulary you are proposing. This is not related to the current formulary.

Question 36:

Technical Questionnaire 4.6, Rx Formulary and Clinical Program Management, 4.6.26

Please provide a separate list of Specialty NDCs in Excel format for comparison between incumbent specialty list and bidder's covered Specialty medications.

This question is requesting information related to the formulary you are proposing. This is not related to the current formulary.

Question 37:

Technical Questionnaire 4.6, Rx Formulary and Clinical Program Management, 4.6.28

Please provide definition or clarification of “type of impact” as it applies to pharmacy programs.

There is no unique definition for “type of impact”. Explain how each of these programs will affect members, including but not limited to, what the member will be required to do.

Question 38:

Technical Questionnaire 6, Network Access and match, 6.1, Medical Network match, 6.1.2

The "Medical Network Util" tab referenced in this question does not appear to be included in the Network Attachment (Excel) file. Can this please be provided?

State Response:

This is collectively referring to all five (5) of the medical provider utilization tabs in “SONH MA RFP Network Attachment.xlsx” combined. The State is looking for Bidders to indicate their general commitment to recruiting providers.

Question 39:

Technical Questionnaire 7, Performance Guarantees, Average Speed of Answer, Abandonment Rate, Tracking log of Claim Inquiries, Financial Payment Accuracy, Rx Mail Turnaround Time intervention/ no intervention

Please clarify how the penalty is calculated for Performance Guarantee metrics carrying an annual fee at risk that are assessed "...for each percentage point below the threshold". How will a miss of less than one full percentage point be treated? For example, if the Service Level Target is 100%, how will a result of greater than or equal to 99.01% be treated?

State Response:

A miss of less than one full percentage point will be treated the same as a full percentage point.

If the Service Level Target is 100%, a result of 99.01% would be subject to the same penalty as a result of 99.00% to 99.99%.

Question 40:

Technical Questionnaire 7, Performance Guarantees, 7.1 Performance Guarantees: Implementation and Go Live Dates

Vendor's report of 'go-live' readiness would include, claims systems open to pay, timely mailings of member ID cards, and customer service staffed and fully operational. Please confirm this is sufficient for measuring 'go-live' readiness for the initial and annual 'go-live' Performance Guarantees requested.

State Response:

Confirmed.

Question 41:

7, Performance Guarantees, 7.1 Performance Guarantees: Member Services: Average Speed of

Answer (ASA)

As written, the performance guarantee metric and penalty for Average Speed of Answer (ASA) is measured based on percentage rather than the expected measurement in seconds. Should this metric be revised to read as follows:

Annual Fees at Risk = "$10,000 for each percentage point below the threshold for a month, that exceeds the 30 second average, measured separately for IVR and live MSR inbound calls.

$100,000 annual maximum.”?

State Response:

Yes.

Question 42:

Technical Questionnaire 7, Performance Guarantees, 7.1 Performance Guarantees: Account Management Satisfaction:

Annual Score Card

Is the State’s intent to discuss/negotiate the alignment of the Service Level Target to correspond with the mutually agreed upon Scorecard? If not, please explain.

State Response:

Yes.

Question 43:

Technical Questionnaire 7, Performance Guarantees, 7.1 Performance Guarantees: Claims Processing: Claims Processing:

Accurately Implement Benefits or Program Changes, including mandated CMS updates of service codes, fee schedules, etc.

Regarding Claims Processing Accurately Implement Benefits or Program Changes, including mandated CMS updates of service codes, fee schedules, etc., please clarify how this metric should be measured. Should it measure internal claims audit results or the State staff/member complaints?

State Response:

The intent is to have both play a role in determining whether 100% of the changes were implemented accurately.

Question 44:

7, Performance Guarantees, 7.1 Performance Guarantees: Claims Processing: Claims Processing:

Accurately Implement State required benefit plan changes that have the potential to create member disruption and provider payment issues

Regarding Claims Processing: Accurately Implement State required benefit plan changes that have the potential to create member disruption and provider payment issues, please clarify how this metric should be measured.

If 100% of these changes are not implemented accurately and claims/cost shares are not processed correctly, the “Annual Fees at Risk” will apply.

Question 45:

Technical Questionnaire 7, Performance Guarantees, 7.1 Performance Guarantees: Financial Payment Accuracy

The Annual Fees at Risk column indicates “$25,000 for each percentage point above the threshold, measured on a monthly basis.” Should this state “…below the threshold…”?

State Response:

Yes, this should read, “$25,000 for each percentage point below the threshold, measured on a monthly basis.”

Question 46:

SONH RFP Financial Attachment Weight Loss Tab

Is the intent that we provide a list of the medications included in our weight loss buy-up list or is there a separate list we are expected to match?

If there is an expectation to match, please provide current list of covered weight loss drugs at the NDC level in Excel format.

State Response:

The intent is that Bidders describe any weight loss program buy-up coverage options and the associated premium.

Question 47:

Appendix C, Medicare Retiree Prescription Drug Plan Design

Please provide preferred Diabetic Supply manufacturers.

The State does not have preferred diabetic supply manufacturers.

Question 48:

Are there any Specialty medications allowed/dispensed/shipped in greater than 30-day supply?

State Response:

Yes, some drugs are packaged in greater than 30-day supply so they have to be dispensed that way.

Question 49:

To ensure there are no deviations to the current coverage, the following are needed for thorough comparison:

A complete formulary at the NDC level in Excel format Currently covered “buy-up” drugs at the NDC level in Excel format Currently covered CMS excluded drugs at the NDC level in Excel format The Specialty Drug list/formulary at the NDC level in Excel format

State Response:

See response to Question 34.

Question 50:

Appendix F: Form P-37 Section 8. Event of Default/Remedies, 8.2.1

CMS requires Contractors to notify members in advance of a plan’s termination. Please confirm the State will accept the following language change to allow for this notification:

8.2.1 give the Contractor a written notice specifying the Event of Default and requiring it to be remedied within, in the absence of a greater or lesser specification of time, thirty (30) calendar days from the date of the notice; and if the Event of Default is not timely cured, terminate this Agreement, effective two (2) thirty (30) calendar days after giving the Contractor notice of termination.

State Response:

Agreed.

Question 51:

Appendix F: Form P-37 Section 12 Assignment/Delegation/Subcontracts, 12.1

12.1 Contractor shall provide the State written notice at least fifteen (15) calendar days before any proposed assignment, delegation, or other transfer of any interest in this Agreement. No such assignment, delegation, or other transfer shall be effective without the written consent of the State.”

Regarding Section 12.1, Is the intent of this language to obligate the carrier to notify the State such that the State can terminate a contract rather than having the contract assigned?

State Response:

The State must know the entity with which it is contracting at all times. Should the State have reason not to contract with the assignee, transferee, etc., termination may be in order.

Question 52:

Appendix G Appendix G-Business Associate Agreement

In a fully insured arrangement, the MA carrier is the covered entity and not a Business Associate.

Please confirm the BAA will apply only to RFP activities. If not, will the state consider a different agreement with HIPAA and HITECH language included?

If a BAA is required, please confirm carriers can submit suggested redlines with their proposal.

State Response:

The State is willing to discuss applicable HIPAA and HITECH language (as opposed to a BAA) with the selected bidder.

Question 53:

Please advise the expected dates for finalist notifications and/or presentations, as applicable.

State Response:

Currently, the State is not planning on finalist presentations.

Question 54:

As part of the 2024 Advance Notice released by CMS on February 1st, 2023, a significant change to the Part C risk score model was proposed. This proposal is facing large pushback from the industry and Medicare Advantage member advocacy groups. To ensure a consistent premium build up across bidders for the initial RFP submission, can the State of New Hampshire confirm how or when bidders should assume this change occur (e.g., implemented in full in 2024, delayed beyond the quoted time periods within the RFP)?

State Response:

Bidders' initial RFP financial submissions should be based on their expectation of the impact of any CMS changes. The Financial Proposal Confirmation Period is included in the process to give Bidders the opportunity to reflect the CMS Final Rate Announcement.

Question 55:

CMS announced they will be changing the Part D risk score model for 2025 to account for the Inflation Reduction act changes in that year. This will have a material impact on the direct subsidy received which is expected to grow significantly due to various program changes. Can the State of New Hampshire confirm how they are comparing financial quotes in 2025 and beyond that are subject to this variability?

Bidders are expected to provide fully insured quotes as directed in the RFP.

Question 56:

RFP 2736-23 – Section 2.1.5 – Public Disclosure

Will the State please clarify this excerpt from Section A – “Pricing, which includes but is not limited to premium rates and performance guarantees, in your proposal or any subsequently awarded contract shall be subject to public disclosure regardless of whether it is marked as confidential.”

Will all data provided in the in the “SONH RFP Financial Attachment.xlsx” be released, or will bidders be able to mark some elements as confidential?

State Response:

Total projected costs, premium rates and performance guarantees are subject to release. Rate development detail provided in the attachment if marked confidential will be reviewed separately by the State.

Question 57:

RFP 2736-23 – Section 3.1 – Plan Design

Will the State please provide the current and/or renewal rates for this plan?

State Response:

The current MA (medical only) premium rate is $0.

Question 58:

RFP 2736-23 – Section 4.2 – Data Reporting, Q.4.2.16

Can the State please provide the “Reporting Details and Templates.pdf” referenced in the question?

State Response:

This document has been added to the question.

Question 59:

RFP2736-23 – Section 7 – Performance Guarantees

Implementation and Go Live Dates Is it acceptable to base ID Card timeliness performance guarantees on date mailed rather than “in hand” or “received”?

State Response:

Yes, date mailed is acceptable. ID cards should be mailed no later than 10 business days before the beginning of the calendar year.

Question 60:

RFP2736-23 – Section 7 – Performance Guarantees

For Performance Guarantees that are assessed quarterly, please confirm if the maximum penalty shown is annual.

State Response:

Confirmed.

Question 61:

RFP2736-23 – Section 7 – Performance Guarantees

Claims Processing Please clarify that these Claims Processing Performance Guarantees would apply to different scenarios (i.e. both PGs would not apply to the same issue).

Claims Processing: Accurately Implement Benefits or Program Changes, including mandated CMS updates of service codes, fee schedules, etc.

Claims Processing: Accurately Implement State required benefit plan changes that have the potential to create member disruption and provider payment issues.

These apply to different scenarios.

Question 62:

SONH MA RFP Network Attachment

Will the State please provide supplemental utilization information to include the total claims, allowed amount, and number of unique members of each provider shown on all tabs of this spreadsheet?

State Response:

This information is not being provided.

Question 63:

SONH MA RFP Data File – Census

Will the State please add the actual DOB to the census file? The current file includes age only.

State Response:

Bidders can calculate the estimated date of birth using age and the census as of date of February 2.

Question 64:

SONH MA RFP Data File - Medical Monthly Data

Are the medical claims on an allowed or paid basis (i.e. after the member deductible impact)?

Medical claims are plan paid amounts and do not include member deductible.

Question 65:

SONH MA RFP Data File - Medical Monthly Data

Do the medical claims provided include non-benefit expenses such as Quality Improvement costs?

State Response:

Medical claims do not reflect quality improvement costs.

Question 66:

SONH MA RFP Data File - Medical Monthly Data

Has the 2022 medical claim data been adjusted for sequestration?

State Response:

Claims are net of sequestration.

Question 67:

SONH MA RFP Data File - Medical Monthly Data

Do the risk scores provided include mid-year and/or all final payments?

State Response:

See response to Question 20.

Question 68:

SONH MA RFP Data File - Medical Monthly Data

Do the claims and risk scores include ESRD members? Can you confirm the number of ESRD members in 2021, 2022, and current?

State Response:

The claims and risk scores include ESRD members. There were 30 ESRD members as of December 2021 and 32 ESRD members as of December 2022.

Question 69:

SONH MA RFP Data File – Rx Monthly Data tab

Do the 2022 monthly member counts from the Medical Monthly Data tab coincide with the 2022 months on the Rx Monthly Data tab?

State Response:

The State plan only offers combined medical and prescription drug coverage to its participants, so the monthly counts reported by both coverage should be comparable.

Question 70:

SONH MA RFP Data File – Rx Monthly Data tab

Is the monthly Rx experience for 2021 available? If yes, can the State please provide?

State Response:

No. The provided detailed prescription drug claims data for 2022 is more than adequate to provide a response to this RFP.

Question 71:

RFP2736-23 – Appendix F: P-37 Form Contract

6. Compliance by Contractor with Laws and Regulations/Equal Employment Opportunity

6.4 We request the addition of “subject to the requirements and limitations of HIPAA” as shown.

The Contractor agrees to permit the State or United States access to any of the Contractor’s books, records, and accounts, subject to the requirements and limitations of HIPAA, for the purpose of ascertaining compliance with this Agreement and all rules, regulations and orders, and pertaining to the covenants, terms and conditions of this Agreement.

Agreed.

Question 72:

RFP2736-23 - Appendix F: P-37 Form Contract

9. Termination

9.1 We request sixty (60) days’ written notice to allow compliance with CMS regulations regarding timely notice to members of termination.

State Response:

Agreed.

Question 73:

RFP2736-23 - Appendix F: P-37 Form Contract

10. Property Ownership

10.2 We request the addition of “subject to applicable record retention laws” as shown:

All data and any Property which has been received from the State, or purchased with funds provided for that purpose under this Agreement, shall be the property of the State, and shall be returned to the State upon demand or upon termination of this Agreement for any reason, subject to applicable record retention laws.

State Response:

The State agrees to the following addition: “subject to, but not to exceed, applicable record retention laws”.

Question 74:

RFP2736-23 - Appendix H: Required Protection of Confidential Information and Data Security

As the carrier assumes the risk in a fully insured arrangement, does the State believe Appendix H would still be applicable? Since this is fully insured, we recommend the removal of this exhibit from the fully insured agreement.

State Response:

The State is willing to discuss with the highest scoring bidder.

Question 75:

Section 2.0 Bidding Instructions and Conditions – Item 2.1.5A:

Please confirm that you do not want us to provide a redacted copy of our proposal submission, we just need to mark anything we deem confidential as confidential and proprietary with our reasoning as to why it is so marked?

Confirmed.

Question 76:

Section 4.2 Data Reporting – Question 4.2.16:

It asks that we that we will provide data reporting based on the examples included in the “Reporting Details and Templates.pdf” however the referenced PDF was not provided. Please provide.

State Response:

This document has been added to the question.

Question 77:

Section 7. Performance Guarantees, Question 7.1 Items Rx Mail Turnaround – Prescriptions not requiring intervention and Rx Mail Turnaround – Prescriptions requiring intervention:

Please confirm if this is strictly Rx Mail Turnaround or if (Turnaround Time - Clean Claims Guarantee and Turnaround Time - Clean Claims Requiring Intervention Performance Guarantees are more what you are looking for.

State Response:

These are mail Rx performance guarantees.

Question 78:

Section 7. Performance Guarantees, Question 7.1 Item Average Speed of Answer (ASA):

Would the State consider adjusting the language of ASA performance guarantee to reflect the customer service industry standard, which is to use the average of all calls answered within 30 seconds, in lieu of 100% of all calls answered within 30 seconds? This calculation would better align with typical staffing and reporting around the ASA metric.

State Response:

These reflect the State’s requested performance guarantees. Bidders have the opportunity to propose alternatives in their proposals.

Question 79:

SONH MA RFP Pharmacy Claims file:

Please clarify what the field “Fill Number” means?

State Response:

The fill number of a prescription. The initial fill would be “1”, the first refill “2”, etc.

Question 80:

When will bidders be required to submit revisions/provisions and exhibits to be incorporated into P-37?

See Section 2.1.2. All questions regarding this RFP, including questions related to the form contract P-37, were to be submitted in writing by the RFP inquiry deadline of March 8, 2023.

Question 81:

EGWP-Evidence-of-Coverage-2023 PDF and Medicare-Part-D-EGWP-Benefit-Overview-2023

PDF:

The EOC makes multiple references to a preferred pharmacy network, however, the Benefit Overview document does not define a member cost sharing differential between standard and preferred pharmacies. Our assumption is the language in the EOC is generic content, and there is no preferred pharmacy network in place currently. To ensure we properly match the current benefits, please confirm if there is, or is not a preferred pharmacy network in place currently.

State Response:

There is no preferred pharmacy network with different member cost sharing.

Question 82:

Please provide full year Risk Adjustment Factor (RAF) scores for 2021 and 2022.

State Response:

See response to Question 20.

Question 83:

Please provide Medical Allowed and Medical Claims Paid by month for 2021 and 2022.

Plan paid amounts are provided. The only member cost sharing is the Part B deductible.

Question 84:

In the current, claims data received can you explain what “Incurred and Completed Claims” means? Does it include the cost of riders, disease management and capitation costs?

State Response:

The claims data includes the cost of riders and capitation costs but does not include disease management costs.

Question 85:

In the current, claims data received, does 2022 have any IBNR in it?

State Response:

Yes.

Question 86:

Section 3.3 - General Services / Bullet Point #7: The State requires that the Bidder work with the

State's eligibility systems. The State utilizes a comprehensive HR/Benefits Administration software to manage the State Plan's eligibility.

Please confirm which HR/Benefits Administration software the State uses.

State Response:

The State uses Infor ERP.

Question 87:

4.2.16: Confirm that you will provide the data reporting in the examples included in the “Reporting Details and Templates.pdf” when requested by the State.

The "Reporting Details and Templates.pdf" document was not provided as an attachment in ProposalTech. Can you confirm when the document will be provided?

State Response:

This document has been added to the question.

Question 88:

2.1.15 REQUIRED CONTRACT TERMS AND CONDITIONS

a. The form contract P-37 (attached hereto as Appendix F) shall form the basis for any resulting contract. The successful Bidder and the State, following notification of award, shall promptly execute the P-37 contract, as amended by the parties to incorporate the service requirements of this RFP, price conditions established by the Bidder's offer, and any other reasonable administrative practices and services. In no event is a Bidder to submit its own standard contract terms and conditions as a replacement for one or all of the State's terms in response to this RFP.

The terms of this RFP and the selected Bidder's response will be used to form the terms of any resulting contract. References in the P-37 to Exhibits A, B, and C are references to the required structure of any resulting contract (Exhibit A - Special Provisions/Amendments to the P-37, Exhibit B - Scope of Services, and Exhibit C - Payment Terms) and are not references to sections of this

RFP.

b. The Business Associate Agreement (attached hereto as Appendix G), is required to comply with the Health Insurance Portability and Accountability Act, Public Law 104-191 and with the Standards for Privacy and Security of Individually Identifiable Health Information, 45 CFR Parts 160 and 164 and those parts of the HITECH Act applicable to business associates, shall be promptly executed by the successful Bidder and the State, following notification of contract award.

c. In addition to the Business Associate Agreement, the Bidder will be required to comply with the Required Protection of Confidential Information and Data Security (attached hereto as Appendix H).

d. State data will not be sold or aggregated for external reporting purposes without first consulting the State.

e. The State intends to incorporate this RFP and the selected Bidder's response into the resulting contract by reference. In the event there is a conflict between the resulting contract and the selected Bidder's response to the RFP the term more favorable to the State shall control.

Suggested Deviation:

a: Consistent with the instructions in RFP 2.1.15 Required Contract Terms and Conditions of the RFP, should Bidder be awarded the business, Bidder will provide the State with revisions/provisions it proposes to incorporate into P-37 relating to service requirements of the RFP, price conditions established by our offer, and other reasonable administrative practices and services after receipt of notice from the State of such award.

b: Bidder is proposing to use the current Appendix B, Plan Sponsor Letter Agreement (PSLA) because under a fully insured arrangement, Bidder is the Covered Entity, and no business associate agreement is required between Bidder as the Covered Entity and the fully insured plan sponsor. Bidder is required to comply with the HIPAA privacy rules because it is a Covered Entity, not because it is a business associate.

c. We are proposing to use the current agreed upon, Appendix D -REQUIRED PROTECTION OF

CONFIDENTIAL INFORMATION AND DATA SECURITY.

State Response:

See Section 2.1.2. All questions regarding this RFP, including questions related to the form contract P-37 and the Required Protection of Confidential Information and Data Security, were to be submitted in writing by the RFP inquiry deadline of March 8, 2023. Questions about or requested exceptions to the P-37 and/or any relevant attachments, including the Required Protection of Confidential Information and Data Security, are waived.

Consistent with Section 2.1.15, the terms of this RFP and the selected Bidder’s response will be used to form the terms of any resulting contract. Service requirements, price conditions and any other reasonable administrative practices and services will be included in Exhibits B and C to the P-37.

The State is willing to discuss applicable HIPAA and HITECH language (as opposed to a BAA) with the selected bidder.

The State is willing to discuss the required protection of confidential information and data security appendix with the highest scoring bidder.

Question 89:

4. CONDITIONAL NATURE OF AGREEMENT.

Notwithstanding any provision of this Agreement to the contrary, all obligations of the State hereunder, including, without limitation, the continuance of payments hereunder, are contingent upon the availability and continued appropriation of funds. In no event shall the State be liable for any payments hereunder in excess of such available appropriated funds. In the event of a reduction or termination of appropriated funds by any state or federal legislative or executive action that reduces, eliminates or otherwise modifies the appropriation or availability of funding for this Agreement and the Scope for Services provided in EXHIBIT B, in whole or in part, the State shall have the right to withhold payment until such funds become available, if ever, and shall have the right to reduce or terminate the Services under this Agreement immediately upon giving the Contractor notice of such reduction or termination. The State shall not be required to transfer funds from any other account or source to the Account identified in block

1.6 in the event funds in that Account are reduced or unavailable.

Suggested Deviation:

We are proposing to use the current contract language in Section 4.

State Response:

The State is willing to add a provision to the Section 4 language in the RFP providing that notice of reduction or termination shall be provided to Contractor as soon as practicable after the Department of Administrative Services becomes aware of such reduction or termination of appropriated funds.

Question 90:

6. COMPLIANCE BY CONTRACTOR WITH LAWS AND REGULATIONS/ EQUAL EMPLOYMENT

OPPORTUNITY.

6.4. The Contractor agrees to permit the State or United States access to any of the Contractor’s books, records and accounts for the purpose of ascertaining compliance with this Agreement and all rules, regulations and orders pertaining to the covenants, terms and conditions of this Agreement.

Suggested Deviation:

We are proposing to use the current contract language in Section 6.3.

State Response:

The State is willing to add a reference to books, records and accounts “relating to the Services provided under this Agreement” to Section 6.4.

Question 91:

8. EVENT OF DEFAULT/REMEDIES.

8.2.1 give the Contractor a written notice specifying the Event of Default and requiring it to be remedied within, in the absence of a greater or lesser specification of time, thirty (30) calendar days from the date of the notice; and if the Event of Default is not timely cured, terminate this Agreement, effective two (2) calendar days after giving the Contractor notice of termination;

Suggested Deviation:

We are proposing to use the current contract language in Section 8.2.1.

State Response:

See response to Question 50.

Question 92:

10. PROPERTY OWNERSHIP/DISCLOSURE.

10.2 All data and any Property which has been received from the State, or purchased with funds provided for that purpose under this Agreement, shall be the property of the State, and shall be returned to the State upon demand or upon termination of this Agreement for any reason.

10.3 Disclosure of data, information and other records shall be governed by N.H. RSA chapter 91- A and/or other applicable law. Disclosure requires prior written approval of the State.

Suggested Deviation:

We are proposing to use the current contract language in Sections 10.2 and 10.3.

State Response:

The State does not agree.

Question 93:

12. ASSIGNMENT/DELEGATION/SUBCONTRACTS.

12.2 Contractor shall provide the State written notice at least fifteen

(15) calendar days before any proposed assignment, delegation, or other transfer of any interest in this Agreement. No such assignment, delegation, or other transfer shall be effective without the written consent of the State.

12.3 None of the Services shall be subcontracted by the Contractor without prior written notice and consent of the State. .

12.4. The State is entitled to copies of all subcontracts and assignment agreements and shall not be bound by any provisions contained in a subcontract or an assignment agreement to which it is not a party.

Suggested Deviation:

We are proposing to use the current contract language in Section 12.3.

State Response:

The State is willing to discuss amendments to Section 12.3 of the P-37 with the selected bidder that are consistent with Section 2.1.14 of the RFP regarding subcontracting.

Question 94:

13. INDEMNIFICATION. The Contractor shall indemnify, defend, and hold harmless the State, its officers, and employees from and against all actions, claims, damages, demands, judgments, fines, liabilities, losses, and other expenses, including, without limitation, reasonable attorneys’ fees, arising out of or relating to this Agreement directly or indirectly arising from death, personal injury, property damage, intellectual property infringement, or other claims asserted against the State, its officers, or employees caused by the acts or omissions of negligence, reckless or willful misconduct, or fraud by the Contractor, its employees, agents, or subcontractors. The State shall not be liable for any costs incurred by the Contractor arising under this paragraph 13.

Notwithstanding the foregoing, nothing herein contained shall be deemed to constitute a waiver of the State’s sovereign immunity, which immunity is hereby reserved to the State. This covenant in paragraph 13 shall survive the termination of this Agreement.

Suggested Deviation:

We are proposing to use the current contract language in Section 13.

State Response:

No.

Question 95:

6. COMPLIANCE BY CONTRACTOR WITH LAWS AND REGULATIONS/EQUAL EMPLOYMENT

OPPORTUNITY.

6.4. The Contractor agrees to permit the State or United States access to any of the Contractor’s books, records and accounts for the purpose of ascertaining compliance with this Agreement and all rules, regulations and orders pertaining to the covenants, terms and conditions of this Agreement.

Suggested Deviation:

We do not generally allow audits under a fully insured plan that are broad in scope. We will negotiate appropriate audit rights upon award of the business.

State Response:

The State is willing to discuss the scope of this provision with the selected Bidder.

Question 96:

10. PROPERTY OWNERSHIP/DISCLOSURE.

10.2 All data and any Property which has been received from the State, or purchased with funds provided for that purpose under this Agreement, shall be the property of the State, and shall be returned to the State upon demand or upon termination of this Agreement for any reason.

Suggested Deviation:

We do not anticipate creating works or inventions on behalf of a specific customer. Our services are universally provided to our entire book of business, and not created through a means that would pass title or ownership to any one customer.

We can confirm that you would own your eligibility data. However, under Federal Laws and guidance, data (such as claims data) maintained by a fully insured carrier is not the property of the customer. We maintain and may disclose such data pursuant to federal and state laws, including but not limited to HIPAA Security Privacy Rules (45 C.F.R. Section 164, et. Seq.), Medicare regulations and guidance from CMS.

State Response:

No response required.

Question 97:

12. ASSIGNMENT/DELEGATION/SUBCONTRACTS.

12.3 None of the Services shall be subcontracted by the Contractor without prior written notice and consent of the State.

Suggested Deviation:

We need discretion in the utilization of subcontractors and our affiliates, as it deems appropriate.

We can’t agree to let one customer have veto power over its choices because the subcontractors we use are used across its entire book of business.

State Response:

The State is willing to discuss amendments to Section 12.3 of the P-37 with the selected bidder that are consistent with Section 2.1.14 of the RFP regarding subcontracting.

Question 98:

12. ASSIGNMENT/DELEGATION/SUBCONTRACTS.

12.4 The State is entitled to copies of all subcontracts and assignment agreements and shall not be bound by any provisions contained in a subcontract or an assignment agreement to which it is not a party.

Suggested Deviation:

These documents are confidential and proprietary. They will not be provided.

State Response:

The State is willing to discuss the proprietary nature of any such agreements with the selected Bidder, and to amend Section 12.4 to address such concerns.

Question 99:

Appendix G – Business Associate Agreement

Suggested Deviation:

We are the covered entity, as defined pursuant to HIPAA, administering the fully-insured Medicare plan. We are not the Business Associate. Therefore, it is not appropriate for us to enter into a BAA. However, we will agree to Appendix G but only as it pertains to PHI sent directly from the State to us. All other PHI/PII created and maintained by us is our PHI/PI.

State Response:

The State is willing to discuss applicable HIPAA and HITECH language (as opposed to a BAA) with the selected bidder.

Question 100:

8. Covered Entity’s Responsibilities

a. Covered Entity shall be responsible for the preparation of its Notice of Privacy Practices (“NPP”). To facilitate this preparation, upon Covered Entity’s request, Business Associate will provide Covered Entity with its NPP that Covered Entity may use as the basis for its own NPP.

Covered Entity will be solely responsible for the review and approval of the content of its NPP, including whether its content accurately reflects Covered Entity’s privacy policies and practices, as well as its compliance with the requirements of 45 C.F.R. § 164.520. Unless advance written approval is obtained from Business Associate, Covered Entity shall not create any NPP that imposes obligations on Business Associate that are in addition to or that are inconsistent with the HIPAA Rules.

Suggested Deviation:

We cannot agree to any NPP other than its own. It is used across our entire book of business and is not open to revision. We are unable to allow the State to use our NPP.

State Response:

The State is willing to forego approval of the NPP.

Question 101:

Appendix H – Required protection of Confidential Information and Data Security

2. Contractor Responsibilities Only the confidential information that the State provides directly to us (e.g., information for enrollment purposes) is the State’s information.