AMENDMENT NO 3_RFP S-DASOBO-00010624_Extension QA Responses.docx

AMENDMENT NO. 3 to RFP S-DASOBO-00010624 (“RFP”) | OHA SBM SOLUTION July 26, 2024 The purpose of this Amendment No. 3 (“Amendment”) to the RFP is to announce:

1. Extension of RFP Opening (Due Date for Proposals).

The “Opening” Date (Proposal Due Date) is extended from August 12, 2024, to August 23, 2024, by 5:00 p.m. Pacific Time.

August 23, 2024 By 5:00 p.m.

2. Release of State’s Responses to Questions.

The embedded MS Word document sets out State’s responses to questions posed by prospective Proposers.

The Single Point-of-Contact (SPC) for the procurement remains:

Julie Curry State Procurement Analyst julie.a.curry@das.oregon.gov

(971) 446-8169

Prospective Proposers have until July 31, 2024, by 5:00 PM Pacific Time to submit written concerns or questions via email only to the SPC regarding the content in Amendment 3 to the RFP.

-End of RFP Amendment No. 3- Amendment No. 3 to RFP S-DASOBO-00010624 |OHA SBM Solution Project image1.emf

RFP AMENDMENT SBM RESPONSES TO QUESTIONS FROM PROPOSERS

RFP S-DASOBO-00010624 AMENDMENT 3

RESPONSES TO QUESTIONS SUBMITTED BY Q&A DEADLINE

RFP Reference

Question

Answer

1.

Section 1.1

Introduction

1. The RFP states that “Proposers with the requisite experience and ability to provide one Part may submit a Proposal that includes a proposed contractual relationship between Proposer and a subcontractor or joint Proposer (“Proposer Partner”) for the other Part. In this instance, the prime Proposer and its Proposer Partner(s) must be identified and must provide detailed information on how all aspects of the Services and Solution will be delivered, and how technical, functional, and procedural integration will occur during the life of the project as part of its Proposal.”

2. Please explain the difference between a “proposer and a subcontractor” and a proposer and a joint proposer (“Proposer partner”).

3. Under what circumstances would multiple contracts be awarded? Specifically, if selected, would one contract be awarded to a proposal and subcontractor(s) and two or more contracts be awarded to a proposer and a joint proposer?

4. How will proposals from joint proposers be scored, understanding that each joint proposer would propose a limited scope of services?

“Proposer” is a defined term under ORS 279A.010(1)(x) referring to “a person that submits a proposal in response to a request for proposals.” For purposes of this procurement, a Proposer is the “prime” contractor with the requisite experience, expertise, capabilities and capacity to provide the required Services. A Proposer may augment its staff of employed personnel with one or more “subcontractors” to support Proposer’s delivery of all required Services, i.e., Platform and CAC.

In the alternative, a Proposer capable of delivering one required Service component, e.g., Platform, through its internal staff and any subcontractors, may join ranks with another “Proposer” who is capable of delivering the other required Service component, e.g., CAC, through its internal staff and any subcontractors. These “Joint” Proposers would work together to submit a single Proposal for both required Service components. The single Proposal is scored according to the evaluation and screening criteria and processes published in the RFP and its Amendments, if any.

State has a strong preference for a single contract resulting from a single Proposal for all required Services. However, depending upon circumstances at the end of evaluation and scoring, it may be reasonable to generate two (2) contracts out of a single joint Proposal – one for each joint Proposer in its proposed required Service component. In the alternative, completed scoring results may support selecting two (2) unrelated Proposers, i.e., separate prime contractors each submitting a responsive Proposal, for contract award in their respective required Service component areas.

2.

Section 1.2

Schedule

1. Given the compressed timeline for Q&A and response delivery, would the State consider extension of the submission deadline by two weeks?

2. What is the State’s targeted award date for this opportunity?

1. Yes, State will extend the Opening (Proposal Due Date) but only by 11 Calendar Days to August 23, 2024. See Revised RFP Event Schedule released as part of RFP Amendment 3.

2. State desires to execute a Contract as reasonably soon as possible. Notwithstanding such desire, it is currently too speculative to identify a particular award date. State anticipates at least 2 rounds of competitive evaluation.

3.

Section 2.3.2

Project Overview and Background

The procurement states that “By the end of the project, Oregon will have control over operations, customer service, and service levels of the Solution, similar to Federal-level controls of prior FFM functions.” What does “similar to Federal-level controls” mean? Please explain what operations will remain under the control of the contractor.

Currently, CMS directs activities related to the FFM platform and CAC. It controls, via contractors or other means, the operations, customer service, and service levels of the FFM components. If any changes are requested, CMS decides which changes move forward and which do not.

In this context, the meaning of the word control is meant to parallel the word "agency" more than it is meant to mean direct physical manipulation of the solution.

By becoming an SBM and procuring an SBM technology platform and CAC of its own, Oregon will assume the "control" that CMS currently has over the FFM. "Similar to Federal-level controls" is intended to convey the idea that Oregon will then ultimately have decision control over those aspects of the solution in the way CMS does now, even though many functions may be carried out by contractors and not Oregon staff.

4.

Section 2.6 pg.2

Section 2.6 of the RFP states: “Agency has a strong preference for a single Contract but will support multiple awards based on the results of Proposal evaluation…” Under what circumstances would the State make multiple awards based on the result of the Proposal evaluation?

See State’s response to Item No. 2.

5.

Section 2.3. & 2.6 pg.2

Section 2.3 indicates that “The Solution must be… comprised of two scopes of service (each a “Part”) as follows…” Section 2.6 of the RFP states: “Agency has a strong preference for a single Contract but will support multiple awards based on the results of Proposal evaluation…” Can a Proposer submit a response to this RFP for only one “Part” of the Solution and still be evaluated for award?

No. Each responsive Proposal must include delivery of all required Services – Platform and CAC.

6.

Section 3.3.2

Experience, Capabilities, and Project Samples

Would projects working in the Federal Marketplace with similar or greater scope be acceptable?

For context, State lists Section 3.3.2 requirements below:

“The Proposal must include a narrative statement that describes how the Proposer has the following experience and capabilities (bold emphasis added below):

1. Proposer must have at least three (3) years of experience configuring and implementing Cloud-based SBM solutions in another state.

2. Proposer must have at least five (5) years of experience working with government entities.

3. Proposer and at least one (1) Key Person must have demonstrable experience working in compliance with ACA rules and regulations related to SBMs.

Project Samples. Proposer shall submit samples of at least one (1) but no more than three (3) SBM projects completed within the last five (5) years that are comparable to the scope of this RFP. The samples provided can be from projects that were completed under a different business entity.”

Each Proposer must determine whether it meets the requirements in this section, and the value such experience may present to members of the Evaluation Committee. State will not give an advisory opinion as to the level of responsiveness in connection with particular experience, especially when the description of such experience is so sparse and at such a high level. For example, did the Federal Marketplace experience involve configuration and implementation activity with particular states? If so, what was the specific nature and duration of such activity?

7.

Section 3.3.3

Scope of Services Response

1. Is the State requesting a full Project Management Plan, Project Implementation Plan, CAC Project Management Plan and CAC Implementation Plan as part of the response to the Scope of Services, or do you simply want to understand how offerors will meet these requirements? Would sample plans used in similar projects be sufficient to meet the requirement?

2. Please confirm if the State is requesting a proposed project management plan and schedule including activities to meet requirements and deadlines which addresses each of the plans included in CAC Implementation Plan, tasks a – h and not providing a detailed plan for each of the plans required in a – h.

3. Should a CAC Manager be key personnel?

4. Please provide a corrected link to System Security Plan. Section 3.3.3.A System Security Plan following the Office of the State Chief Information Officer aka Enterprise Information Services (EIS) Cyber Security Services (CSS) Security Plan Template.

1. This response addresses items 1 and 2. State is requiring satisfaction of all of the elements listed in Section 3.3.3. Through such listed elements State has described its requirement to review and assess for score a Proposer’s detailed implementation strategy in the context of the diverse artifacts listed. The manner in which all such required material is developed and submitted is a matter for Proposer to determine.

The State’s first consideration regarding Proposal submissions is “responsiveness”. Responsiveness means “having the characteristic of substantial compliance in all material respects with applicable solicitation requirements.” For example, did Proposer submit a Project Management Plan seeming to substantially address all PMBOK-compliant knowledge areas relevant to a project comparable to the SBM Solution Project? State’s next consideration is the perceived quality of the submission, which translates to a score, i.e., some percentage of the maximum points possible for an evaluated element.

A redacted example document from a project the Proposer deems comparable to the SBM Solution Project may be responsive but may not score as well as a document created to show how well Proposer understands the needs of the SBM Solution Project in the context of a detailed submission demonstrating Proposer’s approach and methodology to a particular facet of the Project, e.g., project management, implementation, deployment, operational management, and so on.

2. Regarding a Proposer’s Key Personnel, State considers as “key” those persons whose duties and responsibilities, or specialized knowledge, skills, and abilities; are essential to the success of a project or ongoing program. Does Proposer consider a CAC Manager as “key” in the context of such definition?

3. Here is the link to the EIS Cyber Security Services Guidance for State Agencies Web Pages. The Security Plan Template is accessible from that site, as are a number of other guidance documents related to cyber security services:

Enterprise Information Services : Guidance for State Agencies : Cyber Security Services : State of Oregon

8.

Section 3.3.5

In 3.3.5 you state that a proposer shall include a statement detailing any subcontracting firms or individual subcontractors that may be engaged as part of the Proposal to this RFP, with those entities and the Services they will provide clearly identified. Please provide a definition of subcontractors, as opposed to vendors (e.g. hosting provider, printing vendor, etc.) used in the regular course of business.

A subcontractor is a vendor retained by State’s prime contractor, to provide goods or services for which the prime contractor is responsible to State. Such subcontractor has no direct contractual relationship with State. State will hold its prime contractor responsible for subcontractor deficiencies in performance.

9.

Section 4.5.1 & 4.5.2

RFP Protests

Please provide clarification that "protest," as referenced in section 4.5.2; “Protests to the RFP;” pg.20 of the 49 of the RFP is being used as defined in OAR 137-048-0240?

Yes, but only in the context of subsection (1) of such rule, RFP Protest and Request for Change. The submission deadline for such protest was coterminous with the deadline for submission of questions. However, such protest and request for change may be submitted by the deadline for response to RFP Amendment 3 content. Each subsequent RFP Amendment, if any, will also include a short period for response to content in such amendment.

10.

Section 5.3.4

Pay Equity Certificate

Does the Pay Equity Certificate need to be included along with Att G in the submission? Or should it only be provided if selected for award, as noted in 5.3.4 of the RFP?

No, submission of a current Pay Equity Certificate is not a required Round 1 submission but it is reasonable for a Proposer to include such certificate with its RFP Attachment G, Responsibility Inquiry, submission.

11.

Section 6.2

Certified Small Business Enterprise Plan

Certified Small Business Enterprise Plan link is broken can you update?

The “Plan” is attached to the RFP as its Attachment F. The link to access more information concerning BizOregon’s Certification Office for Business Inclusion and Diversity (COBID) is:

Business Oregon : Certification Office for Business Inclusion and Diversity (COBID) : Certification Office for Business Inclusion and Diversity (COBID) : State of Oregon

12.

RFP Attachment A

Sample Contract & Negotiation

1. Is the State willing to negotiate a reasonable and mutually acceptable limitation of liability with the awarded Contractor?

2. Please clarify whether the vendor is permitted to submit any redlined changes to the Sample Contract in Attachment A with the submission of the proposal.

3. Would the State be willing to negotiate a reasonable Cap to the possible assessment of liquidated damages?

4. Is the proposer required to identify in their proposal submission which sections/items they would like to negotiate upon award?

5. Is the State open to negotiation of Service Level Agreements?

6. Regarding Exhibit B, Service Levels, item 6.2.

a. Is the State willing to work with the successful bidder to define questions for the Customer Satisfaction Survey that are at a discreet enough level to identify the area of satisfaction/dissatisfaction (for example, satisfaction with service received from CAC vs. available QHP choices vs. ease of system use?)

b. Can the State provide the formula for how “CAC: First Call Resolution Rate” will be calculated?

c. Attachment A, Sample Contract, Exhibit B, Section 6.2, Service Level Agreement presents 15 Service Level Metrics. Are you requesting proposers supplement, edit or agree to these SLAs?

d. Just as the State penalizes the Contractor for performance below the standard, will the State please consider granting the Contractor credits for performing above the standard, which credits could then be used to offset any subsequent assessed damages?

e. Will the State please consider aggregately capping any Service Level Agreement damages assessed against the Contractor at 10% of the monthly invoice amount?

f. Will the State please consider adding excused events language into the final contract that protects the Contractor against Service Level Agreement assessments in the following circumstances: (i) when changes in scope, direction, budget, or program funding are made at the request of the State and such changes adversely affect Contractor’s ability to perform in accordance with the Service Level Agreement performance requirements; (ii) when force majeure events occur; (iii) when program processes are changed at the request of the State and such changes adversely affect Contractor’s ability to perform in accordance with the Service Level Agreement performance requirements ; and (iv) when Contractor’s ability to perform is accordance with the Service Level Agreement performance requirements is caused by third-parties under the State’s control?

7. The RFP document states that the anticipated base contract duration is for 7 years plus 5 years with options to renew. How many renewal options will this contract have and for how long will each option be for?

The number designations of the following responses do not directly correspond to number designations for the questions posed. Together, the responses address all posed questions.

1. RFP Section 5.4, Contract Negotiation, makes it clear that with limited exceptions related to law, rule, and jurisdiction, State opens the entire contract, including its diverse exhibits, to reasonable, good faith negotiation with the top ranking Proposer selected for contract award. Accordingly, DAS and OHA will negotiate all items, except those listed below:

a. Choice of law

b. Choice of venue

c. Constitutional requirements

d. Requirements of applicable federal and State law

Service Level Agreements, including exceptions, if any, and the possible capping of liquidated damages for failure to meet service levels, and Contract duration are among the many items that State regards as negotiable.

2. It is not necessary to redline the Sample Contract document for Round 1 submission. State has no interest in starting contract negotiations with all Proposers in Round 1. State is interested in assessing difficulty, if any, in contract negotiations with Competitive Range Proposers in a subsequent round of evaluation. If conducted, such assessment will require submission of a Sample Contract Redline.

3. State has keen interest in Round 1 assessment of Proposer’s offered performance metrics and service level agreements. The Evaluation Committee will assess such submissions in the context of the Service Levels depicted in Contract Exhibit B, Service Level Agreement.

4. The formula for First Call Resolution Rate will partly depend on how a “First Call” is defined and derived, and how “Resolutions” are defined and captured. The State sees these elements as part of contract negotiations that may vary with how each proposed solution is able to capture these data points and what kinds of calls may be considered exceptions thereto.

For purposes of Proposal submission, State expects Proposer to explain the logic and methodology of its approach to obtaining this metric in the context of its proposed solution.

13.

RFP ATTACHMENT E

Price Proposal

1. Tab 2 Table 1 CAC Cost. CMS data for the federal marketplace shows Oregon as having 145,509 cumulative 2024 OEP Plan Selections. Concerning RFP Attachment E, please describe the reason for the difference between the current enrollees and the assumed 100,000 enrollees included in the Price Sheet. Is the difference related to the OHP Bridge program?

2. Can the State please provide any initiatives or if there are any known reasons why enrollment would increase or decrease over the next two years?

3. Can the State clarify: (1) Whether pricing values should be included in the blank cells for years 8, 9, and 10 in both tabs of the Attachment E, given that the contract is 2 years for solution implementation and 5 years of M&O? (2) Does Year 1 = CY 2025, Year 2 = CY 2026 and so on?

4. Please clarify with an updated Attachment E how vendors will include the requested tiered pricing.

5. Regarding pricing evaluation in subsequent rounds, how will pricing be factored or scored into determining the ultimate awardee? Can the State please publish the methodology for the scoring prior to the submission response due date?

1. The assumed 100,000 enrollees is based on OHP Bridge Program estimates that as many as 55,000 enrollees may migrate to the Bridge Program from Oregon’s Marketplace. There is no baseline data to compare against as the program started in July of 2024.

2. The Bridge Program is the single largest known variable that might decrease overall Marketplace enrollment. There are currently no other known major factors.

3. Contract duration is a negotiable item (see, State’s response to Item No. 12). In the context of continued delivery of certain Services, the resultant Contract(s) may continue beyond ten (10) years. However, requiring binding pricing information beyond ten (10) years is likely to produce sticker shock for the State (too much risk for a Contractor to manage without building in higher cost ceilings). Yes, State requires submission of pricing information for years eight (8) through ten (10).

4. Regard the current RFP Attachment E as a “baseline” template for Proposer’s use in providing all required pricing information. Proposer may modify the attachment to depict additional detail for tiered pricing or discount related to enrollment numbers, e.g., create an additional tab clearly labeled for such purpose.

5. State is not evaluating Round 1 Price Proposals for score. Such Proposal submission is nonetheless critical to the procurement. State will assess submitted pricing information to confirm or correct budget estimations related to the planned procurement and to determine submission requirements, including a different format, for revised Price Proposal submission in a subsequent round(s).

State intends to evaluate future revised Price Proposal submission for score. State will likely follow a hybrid approach in connection with such scoring, i.e., objective assessment through one or more algorithms comparing diverse cost factors including total proposed cost and subjective assessment to verify diverse factors such as:

a. Reasonableness of cost in the context of perceived quality of proposed Services and caliber of proposed personnel,

b. Transparency of cost, i.e., are all costs clearly depicted or is there the specter of hidden cost and related Contract Change Orders that will wreak havoc with Agency’s budget, and

c. Flexibility of proposed cost model permitting State to make intelligent choices regarding initial scope of Services required after Contract execution, if any.

State will release detailed submission requirements for revised Price Proposal submission, if any, through future RFP Amendments.

14.

RFP ATTACHMENT H: Item 18

Auto Enrollment

Requirement 18 asks for an Auto Enrollment opt-in mechanism for enrollees, but marketplaces are legally required to auto reenroll all current enrollees who qualify for a plan. Could we get some clarification on what this requirement is asking for?

The State’s understanding of the Automatic Enrollment and annual redetermination requirements for an SBM are that:

1. Purpose of Requirement 18. The exchange may automatically enroll qualified individuals if it demonstrates good cause. This leaves the mechanisms and justification for auto enrollment to the SBM’s discretion, which requires “active authorization” from a “qualified individual” (i.e., enrollee – see 45 CFR 155.355(l) below).

Requirement 18 speaks to the mechanism by which the enrollee provides that authorization to the SBM to conduct annual eligibility determination for automatic reenrollment (opt-in), which may include the option to authorize for a number of years before requiring another authorization.

2. 45 CFR 155.410(g) Automatic enrollment. “The Exchange may automatically enroll qualified individuals, at such time and in such manner as HHS may specify, and subject to the Exchange demonstrating to HHS that it has good cause to perform such automatic enrollments.”

3. 45 CFR 155.355(l) Annual eligibility determination (and limits on redetermination). “To the extent that a qualified individual has requested an eligibility determination for insurance affordability programs in accordance with § 155.310(b) and the Exchange does not have an active authorization to obtain tax data as a part of the annual redetermination process, the Exchange must redetermine the qualified individual's eligibility only for enrollment in a QHP and notify the enrollee in accordance with the timing described in paragraph (d) of this section. The Exchange may not proceed with a redetermination for insurance affordability programs until such authorization has been obtained or the qualified individual continues his or her request for an eligibility determination for insurance affordability programs in accordance with § 155.310(b).”

15.

RFP ATTACHMENT H: Item 20

SHOP Calculator

The requirement states: "The Solution must have Small Business Health Options Program (SHOP) functionality required by 45 CFR, part 155, subpart H, including an estimating tool for plans with costs based on a tiered-composite rating model. (https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-B/part-155)". The following are SHOP functions required by 45 CFR 155 Subpart H and are assumed to be currently operated by the State: (1) Employer Eligibility Application processing, related communications, and reporting, and (2) Employer Appeals processing, related communications, and reporting.

Can the State confirm if the vendor is expected to operate these functions? If yes, please provide the requirements for vendors to evaluate.

No, such functionality is not required. However, if the SBM Solution includes such functionality, Proposer should so declare and describe the functionality.

16.

RFP ATTACHMENT H: Item 20-21

SHOP Calculator and SHOP Plan Display

Baseline Enrollment 1.6

1. How many Oregonians - both employees/employer groups are currently enrolled using the healthcare.gov SHOP solution?

2. How many carriers with small group plans participate currently?

3. What is your projection of small group enrollment and carrier participation at go-live and throughout the contract term?

4. How many groups use the existing group premium quoting functionality annually?

1. Oregon averages about 100 groups and 1,000 covered lives in SHOP plans.

2. Oregon has three (3) carriers currently participating.

3. Oregon does not project significant increases in either carrier participation or enrollments, but it’s possible other carriers may wish to participate in future years.

4. The calculator averages 300 total visitors per year. There is no current capability to determine which visitors are employers.

17.

RFP ATTACHMENT H: Item 20-21

SHOP Calculator and SHOP Plan Display

Baseline Enrollment 1.8

1. For small group/employer coverage affordability tool, can offerors leverage the existing functionality as it exists at:

https://or-affordabilityestimator.checkbookhealth.org/#/ and https://healthcare.oregon.gov/marketplace/employers/pages/shop-calculator-2024.aspx ?

2. If so, would the State prefer the offeror to assume the existing contract (or portion thereof) and at what annual costs?

3. If the State's preference is for offerors to provide an alternative solution, are there any shortcomings of the small group/employer coverage affordability tool currently in use the state would like the offerors to take into consideration?

1. The State expects the new SBM Solution to address these functions.

a. The affordability estimator is not related to SHOP.

b. State intends to move away from the OregonHealthcare.Gov SHOP calculator. It currently operates in a proprietary, in-house database application that another state agency owns and controls. OHA’s agreement with that agency does not prevent such agency from decommissioning its system – a decision and related timing beyond OHA’s control.

2. For the reasons asserted in Response 1.a and 1.b, above, an assumption of the “existing contract” is not feasible.

3. Any shortcomings identified with the SHOP calculator are more the consequence of Oregon's tiered-composite premium rating methodology for SHOP than the calculator itself. State is open to assessment of any innovations Proposer may have to make such calculator easier to navigate for a small employer.

18.

RFP ATTACHMENT H: Item 20-21

SHOP Calculator and SHOP Plan Display

The SHOP functionality, including small group premium calculator, has proven to be both costly to set up and maintain, and of limited value in most states due to lack of interest from small groups. As such, the SHOP functionality (including a small group premium calculator) has been removed and replaced with (1) basic site re-directing small groups interested in coverage to carrier sites, and with (2) ICHRA/QSEHRA functionality, mirroring the FFM.

1. Would the State be open to such an approach by offerors as an alternative to requirements #20 and #21?

2. Does OHA intend for SHOP Plan Display to be available to users in both anonymous Window Shopping and Logged-in “post-application” sessions?

3. Does OHA intend for SHOP Plan Display to include similar features as the plan comparison tool described in Items 12 and 13?

4. Can OHA provide any projections of the number of employers, employees, and/or total covered lives that will participate in the SHOP program?

5. Can OHA provide more information on the options employers will have when participating in SHOP?

6. Will employers have the choice to offer a single plan or multiple plans to their employees?

7. If multiple plans, can the employer choose to offer all plans, all plans within a single-tier, all plans offered by a single-carrier, or other combinations?

8. If offering multiple plans, will the employer's contribution to each employee (within a given tier of coverage) be based on a calculated composite premium of a single reference plan?

1. The State desires a direct enrollment model, but a SHOP premium calculator such as the one accessible at:

https://healthcare.oregon.gov/marketplace/employers/pages/shop-calculator-2024.aspx is still a requirement for an SBM with a SHOP program (45 CFR 155, Part H - 155.706(b)(11)). Otherwise, “redirects” to direct enrollment resources tracks with the current model in use, and the State is not opposed to continuing with this model. However, State will assess other proposed approaches that may offer more options to SHOP customers.

2. To the extent that solutions are capable of a SHOP plan display, the State expects that such display will at least be available in an anonymous “Window Shopping” experience. The State expects to maintain a direct enrollment process for SHOP but will assess proposed Solutions that include automated SHOP functionality.

3. To the extent that a proposed Solution offers a dynamic SHOP plan display, similar features to requirements 12 and 13 are desired. State is aware that there are several variables that may differ in nature between an individual and SHOP plan shopping and selection experience that Agency would need to address. Accordingly, State does not have a singular, specific vision for such display and desires to review and assess alternative Proposer approaches to address SBM SHOP implementation challenges.

4. Oregon averages about 100 groups with about 1,000 total covered lives in SHOP plans. Agency does not expect significant increases to either of those numbers.

5. Oregon has always applied a direct enrollment SHOP model, and Agency’s plan is to continue such practice. Agency must:

a. Display plans to employers, similar to anonymous browse,

b. Provide a premium calculator that displays the employer’s portion of the premium, and

c. Provide employers with information on how to apply for participation.

Agency must also have the capability to connect to its agent locator tool from the employer section of the site.

The SHOP participation application will likely continue to be an MS Word document emailed directly to Agency, but if Proposer’s Solution has employer application capabilities, Proposer may so declare and describe.

6. This response addresses matters raised in questions 6 and 7. Employers can offer as many plans from as many carriers and as many tiers as they choose.

7. This response addresses matters raised in question 8. Oregon uses tiered composite rating. The employer’s portion is a percentage of the total premium for the enrolled group members.

19.

RFP ATTACHMENT H: Items 29 to 31; 60; and 70 to 81

The referenced requirements in order are:

"The Solution should provide tools to facilitate data reconciliation between the exchange and carriers"

"The Solution should provide the capability to sort and filter data discrepancies between the exchange and carriers"

"The Solution should provide the capability to suppress certain discrepancies from being triggered"

"The Solution should provide access to all communication history to authorized users."

"The Solution must provide a configurable Interactive Voice Response (IVR) system."

"The Solution's IVR should provide the capability to authenticate caller identity as needed for automated processes."

"The Solution should provide application status lookups for authenticated callers."

"The Solution should provide configurable hold messages to callers in queue."

"The Solution should provide expected wait time while callers are in queue."

"The Solution should provide the capability for consumers to request and schedule a return call."

"The Solution's IVR should provide the capability to route the caller to appropriately trained staff based on menu selection and/or application status."

"The Solution should provide the capability for consumers to hold their place in the queue."

"The Solution should provide the ability to auto-dial lists of consumers who have provided auto-dial consent."

"The Solution should provide the ability to route callers to other phone numbers when appropriate (Medicaid, Carriers etc.)."

"The Solution must conduct customer satisfaction surveys at a configurable cadence on an opt-in basis."

Will the State confirm if the vendor is expected to provide services for the above solution capabilities?

Yes, State so confirms.

20.

RFP ATTACHMENT H: Item 34

Additional Data Services

Requirement makes reference to "the capability to connect to other state or commercial data sources".

Are there any specific commercial / state systems and data sources that Offerors are expected to integrate with as part of the initial implementation? Please provide a list of data sources that offerors should consider in scope and should incorporate in their cost proposals.

No, not at this time. However, since changes to laws and rules may occur in the future with timing requirements beyond Agency’s control, Proposer must address the adaptability and configurability of its proposed Solution regarding the Solution’s general capacity to efficiently address potential future EDI. Some potential examples include:

1. Alternatives to the current Equifax connection that now charges state SBM and Medicaid programs for verification services.

2. Connections to other commercial income or identity verification solutions.

3. Connections to other state agencies to tie in referral information, e.g., with the Oregon Department of Revenue or Department of Motor Vehicles.

Agency reiterates that there are no current or pending agreements for these kinds of connections, they are just examples of partnerships Agency may pursue.

21.

RFP ATTACHMENT H: Item 39

Other Healthcare.gov Integration/Migration

Please describe what is meant by "CAC" data in the following requirement: The Solution must provide migration for potential additional Healthcare.gov data that would support Agent/ Broker information and CAC data. Does CAC in this context mean Certified Application Counselor?

No. The acronym “CAC” is consistently used as a short-term reference to “Customer Assistance Center”.

This part of the requirement acknowledges that migrated customer data from the FFM may also include additional data from a separate CRM or ticketing system used by the CAC. Such data might include trouble tickets for complex case issues or other CRM data that may not be stored as part of the customer record in the primary FFM enrollment system.

22.

RFP ATTACHMENT H: Item 60

Call Center Requirements

The requirement states: “The Solution must provide help and education regarding health plans, eligibility, application assistance, etc, for Marketplace users (Primaries, Assisters, Carriers, Agents, etc) through telephone, internet Chat, and E-mail.”

1. Will the State define what “help and education” means in “application assistance” in terms of direct vendor responsibilities?

2. Will the State define if “provide help and education” means the CAC must intake applications and/or perform and run eligibility on applications over the following potential channels: telephone, internet chat, e-mail?

1. “Help and education” relative to application assistance means assisting anyone contacting the SBM via the CAC with all aspects of the application process, e.g., filling out an application, clarification of needed content in specific application fields, connecting the customer with in-person application assistance, etc. State presumes that most of this assistance will come from the CAC portion of the Solution. The more precise parameters of direct Contractor responsibilities in this area may be a consequence of contract negotiations.

2. The State anticipates that Proposer will present its capabilities in the context of required Round 1 Proposal submissions and subsequent round submissions, e.g., Solution Demonstration. One expected component of “provide help and education” is the ability for CAC staff to process applications over the telephone from start to finish, including eligibility determination.

State understands that providing such assistance via email, and especially chat, presents a different set of IT security challenges. Nonetheless, State desires to consider and assess a proposed Solution’s capability to “provide help and education” through any additional means such as internet chat and email.

23.

RFP ATTACHMENT H: Item 63

Issues, Escalations, Complaints, and Appeals

The requirement states: “The Solution must provide staff and processes to resolve issues, escalations, complaints, manual reviews, and provide assistance with appeals.”

Will the State define what “Provide assistance with appeals” means in terms of direct vendor responsibilities?

State acknowledges that the appeals process is very specific with a higher degree of rigor and legal compliance standards than other customer interaction processes. “Assistance with appeals” in this context means providing information regarding the appeals process, such as:

1. How a customer can begin an appeal,

2. Connecting the customer to the appeals team or providing contact information for such team,

3. Communicating a high-level overview of the process, and

4. Potentially providing a general status update if available in the customer record.

24.

RFP ATTACHMENT H: Item 75

CRM Data Availability

Will State users require access to the CRM? If so, can you please provide the estimated number of users requiring access. Please also describe the type of access that these users will require, i.e., read-only access, limited access for workflows or full access

Yes. Some users will need read-only access to the CRM. Others may need different levels of limited access for workflows up to full access, e.g., State user’s responsible for handling customer interactions may need the degree of access appropriate to update customer records. Agency does not have a current user count.

25.

RFP ATTACHMENT H: Item 82

Print Shop

The requirement states: "The Solution must generate correspondence including notices and marketing materials".

1. Can the State confirm if the vendor is expected to provide services to design various notices templates and marketing materials?

2. Can the State confirm if the vendor is expected to also conduct the physical printing of notices and marketing materials?

1. The State anticipates handling notice template and marketing material design at this time. Proposals may include optional pricing for these services for State’s consideration.

2. Proposer selected for Contract Award will be responsible for the physical printing of notices and marketing materials that are created for correspondence.

26.

RFP ATTACHMENT H: Item 85

Mailroom

1. Will the State be responsible for the postage for outbound mail?

2. If the Contractor is responsible for the postage, will it be treated as passthrough?

Yes, State expects to pay for postage for outbound mail. The manner of such payment depends on how charges are incurred and billed. State has not prescribed the exact mechanism for postage process, charges, invoicing, and reconciliation and is interested in assessing available options and recommendations depicted in Proposal submissions. In connection with such activity, State values efficiency/lowest number of mid-process handoffs.

27.

RFP ATTACHMENT H: Item 88

Languages

The requirement states: "The Solution must support public-facing notifications/communications that are ADA (Americans with Disabilities Act of 1990) and WCAG 2.2 (or current) compliant in multiple languages based on user preferences. Preferred languages include, but are not limited to, the following: English, Spanish, Simplified Chinese, Traditional Chinese, Arabic, Russian, Somali, and Vietnamese."

Will State specify if "public-facing notifications/communications" would also include technical components of the CAC, such as the IVR system and Chatbot?

The expectation for accessibility and language requirements is that they apply primarily to more static information presentation such as website information. For systems that are expected to respond to variable input like Chatbots, i.e., computer programs simulating human conversations, and IVR with speech recognition, State will review and assess the presented capabilities of such programs to become fluent in all required languages.

28.

General

Background Checks

Please provide the fee charged to the Contractor for the State-conducted background check.

The State-conducted background check will only apply to a limited number of staff with direct access to State systems. Agency does not usually pass the costs for these checks back to the Contractor.

29.

General

Budget

What is the annual budget for this project? Is it broken out by scope, e.g., Part One (Platform) and Part Two (CAC & Mailroom Services)?

Senate Bill 972 (2023) requires OHA to transition from an SBM-FP to a state-based eligibility and enrollment platform and call center for operation and administration of Oregon’s health insurance exchange. The State therefore anticipates having an available budget to procure a robust Solution that satisfies the stated SBM Project objectives, fulfills both Parts of the scope, and meets all applicable requirements. The content in submitted Price Proposals will facilitate State’s confirmation or correction of any estimated budget for the Project and ongoing Solution operation.

30.

General

Call Center Remote Work

Please confirm the call center agents can work remotely in a Work-from-Home model.

State does not currently impose any restrictions regarding individual call center agent location and expects some work-from-home in most modern CAC models, as long as the working arrangement is compliant with applicable privacy and IT security requirements.

31.

General

Call Center Location and Hours of Operation

1. Is it a requirement that the call center be physically located in Oregon?

2. What are the expected hours of operation for the call center?

1. There are no current requirements that the call center be physically located in Oregon, only that it be physically located within the United States.

2. CAC hours of operation will be determined depending on proposed pricing and operation hours options. At minimum, hours of CAC operations must be from 8 a.m. to 5 p.m. Pacific Time, with expanded hours during the annual Open Enrollment period.

32.

General

Current Call Volumes

1. Can you provide what the current call patterns, e.g., average call volume by hour?

2. What is the breakdown of inbound/outbound calls? How will the agency be notified of outbound call requirements?

3. Does the State have any information or special circumstances that might influence the anticipated volumes for, inbound calls, outbound calls, campaign related calls and associated handle times or mailroom volumes? (for both OEP and non OEP).

4. Does the State intend to be involved in the process to determine caseload and call volume forecasts?

1. The State unfortunately does not have this information at this level of detail from CMS.

2. See State’s response in Item 32.1.

3. The State does not have any information or awareness of special circumstances that would impact the listed variables for plan year 2027 forward. The Bridge Health Program commences operations in 2024. State anticipates having baseline information on the impact of the Bridge Health Program on overall Marketplace enrollment before plan year 2027.

4. Yes.

33.

General

Chat and Chatbots

Currently is live chat offered? Are chatbots in use?

No.

34.

General

Current FTE Headcount

Do you have the number of FTE's that are currently servicing the Oregon business?

Oregon currently has 20 Marketplace FTEs, augmented by other OHA staff for shared services such as facilities and budget analysis. The State anticipates the need for more staff to support the additional SBM functions.

35.

General

Current Performance Metrics

Is it possible to receive a copy of the current performance metrics for the services provided today?

No. The current performance metrics for FFM services provided to the State have not been made available to Oregon.

36.

General

Counselor Certifications

Are counselors required to be certified for Oregon Health Plan and/or ACA-Marketplace certified?

Yes, those assisting (counseling) consumers with OHP or SBM applications in a professional capacity must be part of a non-profit community organization and certified with that program.

Organizations certified by the SBM are called Community Partners by the program and must have at least one certified staff individual to remain a community partner. Only certified individuals may assist with SBM applications.

37.

General

Current HealthCare.Gov Operations

Currently, it is our understanding that the following are functions operated by HealthCare.gov for Oregon, and as you transition to an SBM, the State will be responsible for handling: (1) Agent Certification Training; (2) Complaint Escalation & Triage (e.g., complaints related to issuer premiums, Medicaid services, etc.).

Will the State confirm if the vendor is expected to complete these services? If yes, please provide requirements?

The details of training and handling of complaints generally is expected to be discussed and determined between the State and the Vendor. On these specific points:

1. Training and certification of SBM partners (agents, navigators/ community organizations, etc.) is expected to be led and handled by SBM staff, with the desire to see any parts of the proposed solution that may address recordkeeping and current certification status for those partners as users of the solution.

2. Complaint escalation and triage will be a series of processes.

38.

General

45 CFR 155 Requirements

1. 45 CFR 155 allows for an SBM to choose whether to use federal services including HealthCare.gov for handling specific administrative functions such as employer appeals (155.555) and exemptions (155.625).

Does the State plan to operate these functions? If yes, please provide the requirements for vendors to evaluate.

2. 45 CFR § 155.405(a) requires that each Exchange must provide applications in a manner that is accessible to applicants, including through an internet website, by telephone, and in person, as well as through a paper application. We did not see a requirement in the RFP for development of a paper application.

Will State confirm if the vendor is expected to develop the paper application? If yes, please provide requirements related to the design and development of this form, including language translation requirements?

3. 45 CFR 155.520 states that the Exchange and the appeals entity must accept appeal requests by telephone, by mail, in person, if the Exchange or the appeals entity, as applicable, is capable of receiving in-person appeal requests, and via the Internet. We did not see a requirement in the RFP for development of an appeals request form.

Will State confirm if the vendor is expected to develop a form to intake consumer appeals via all required methods? If yes, please provide requirements related to the design and development of this form, including language translation requirements?

1. Yes, but State has an interest in reviewing proposed solutions that include such functionality.

2. State will likely develop any such paper application form but has not yet determined the exact steps in process and form creation. Proposal submissions will help inform such determination. There will be associated processes that the CAC solution must also handle, e.g., intake, discrepancy reconciliation, follow-up, etc.

To the extent that a paper form is developed, Agency will have it translated into the supported languages.

3. In the same manner as the paper application, the State is planning to offer a paper appeals option to the extent that it is required but has not yet determined the exact steps in process and form creation. See response in Item 38.2 for the remainder of State’s response to question 38.3.

39.

General

Financial Assistance

Can the state advise the proportion of enrollees anticipated to be eligible for financial assistance (APTC/CSR).

As of July 2024, approximately 81% of enrollees receive APTCs and 27% receive CSRs.

40.

General

Inbound Document Processing

1. Can the State please elaborate on the processing of inbound documents.