AMENDMENT ONE.pdf

SAP

State of South Carolina

Request for Proposal

AMENDMENT ONE

Solicitation:

Date Issued:

Procurement Officer:

Phone:

E-Mail Address:

5400022040 10/11/2021 Lisa Roland Lisa Roland 803-898-0533 rolandld@dhec.sc.gov

DESCRIPTION: Health Insurance Case Management Services USING GOVERNMENTAL UNIT: SC Dept of Health & Environmental Control

The Term "Offer" Means Your "Bid" or "Proposal". Your offer must be submitted in a sealed package. Solicitation Number & Opening Date must appear on package exterior. See "Submitting Your Paper Offer or Modification" provision.

SUBMIT YOUR OFFER ON-LINE AT THE FOLLOWING URL: http://www.procurement.sc.gov

SUBMIT OFFER BY (Opening Date/Time): 10/21/2021 @ 2:30 PM ET (See "Deadline For Submission Of Offer" provision)

QUESTIONS MUST BE RECEIVED BY: Date has passed (See "Questions From Offerors" provision)

CONFERENCE TYPE: Not Applicable

DATE & TIME:

(As appropriate, see "Conferences - Pre-Bid/Proposal" & "Site Visit" provisions)

LOCATION: Not Applicable

AWARD &

AMENDMENTS

Award will be posted on 11/02/2021 The award, this solicitation, any amendments, and any related notices will be posted at the following web address: http://www.procurement.sc.gov

You must submit a signed copy of this form with Your Offer. By signing, You agree to be bound by the terms of the Solicitation. You agree to hold Your Offer open for a minimum of sixty (60) calendar days after the Opening Date. (See "Signing Your Offer" provision.)

NAME OF OFFEROR

(full legal name of business submitting the offer)

Any award issued will be issued to, and the contract will be formed with, the entity identified as the Offeror. The entity named as the offeror must be a single and distinct legal entity. Do not use the name of a branch office or a division of a larger entity if the branch or division is not a separate legal entity, i.e., a separate corporation, partnership, sole proprietorship, etc.

AUTHORIZED SIGNATURE

(Person must be authorized to submit binding offer to contract on behalf of Offeror.)

DATE SIGNED

TITLE

(business title of person signing above)

STATE VENDOR NO.

(Register to Obtain S.C. Vendor No. at www.procurement.sc.gov)

PRINTED NAME

(printed name of person signing above)

STATE OF INCORPORATION

(If you are a corporation, identify the state of incorporation.)

OFFEROR'S TYPE OF ENTITY: (Check one) (See "Signing Your Offer" provision.)

___ Sole Proprietorship ___ Partnership ___ Other_____________________________

___ Corporate entity (not tax-exempt) ___ Corporation (tax-exempt) ___ Government entity (federal, state, or local)

COVER PAGE - PAPER ONLY (MAR. 2015)

http://www.procurement.sc.gov/

AP

SAP

PAGE TWO

(Return Page Two with Your Offer)

HOME OFFICE ADDRESS (Address for offeror's home office / principal place of business)

NOTICE ADDRESS (Address to which all procurement and contract related notices should be sent.) (See "Notice" clause)

Area Code - Number - Extension Facsimile

E-mail Address

PAYMENT ADDRESS (Address to which payments will be sent.)

(See "Payment" clause)

____Payment Address same as Home Office Address ____Payment Address same as Notice Address (check only one)

ORDER ADDRESS (Address to which purchase orders will be sent) (See "Purchase Orders and "Contract Documents" clauses)

____Order Address same as Home Office Address ____Order Address same as Notice Address (check only one)

ACKNOWLEDGMENT OF AMENDMENTS

Offerors acknowledges receipt of amendments by indicating amendment number and its date of issue. (See "Amendments to Solicitation" Provision) Amendment No. Amendment Issue

Date Amendment No. Amendment Issue

Date Amendment No. Amendment Issue

Date Amendment No. Amendment Issue

Date

DISCOUNT FOR

PROMPT PAYMENT

(See "Discount for Prompt

Payment" clause)

10 Calendar Days (%) 20 Calendar Days (%) 30 Calendar Days (%) _____Calendar Days (%)

PREFERENCES - A NOTICE TO VENDORS (SEP. 2009): On June 16, 2009, the South Carolina General Assembly rewrote the law governing preferences available to in-state vendors, vendors using in-state subcontractors, and vendors selling in-state or US end products. This law appears in Section 11-35-1524 of the South Carolina Code of Laws. A summary of the new preferences is available at www.procurement.sc.gov/preferences . ALL THE PREFERENCES MUST BE CLAIMED AND ARE APPLIED BY LINE ITEM, REGARDLESS OF WHETHER AWARD IS MADE BY

ITEM OR LOT. VENDORS ARE CAUTIONED TO CAREFULLY REVIEW THE STATUTE BEFORE

CLAIMING ANY PREFERENCES. THE REQUIREMENTS TO QUALIFY HAVE CHANGED. IF YOU

REQUEST A PREFERENCE, YOU ARE CERTIFYING THAT YOUR OFFER QUALIFIES FOR THE

PREFERENCE YOU'VE CLAIMED. IMPROPERLY REQUESTING A PREFERENCE CAN HAVE SERIOUS

CONSEQUENCES. [11-35-1524(E)(4)&(6)]

PREFERENCES - ADDRESS AND PHONE OF IN-STATE OFFICE: Please provide the address and phone number for your in-state office in the space provided below. An in-state office is necessary to claim either the Resident Vendor Preference (11-35-1524(C)(1)(i)&(ii)) or the Resident Contractor Preference (11-35-1524(C)(1)(iii)). Accordingly, you must provide this information to qualify for the preference. An in-state office is not required, but can be beneficial, if you are claiming the Resident Subcontractor Preference (11-35-1524(D)).

Preferences do not apply to Request for Proposals per the South Carolina Consolidated Procurement Code Section

11-35-1524, Part (E)(5)(b).

____In-State Office Address same as Home Office Address ____In-State Office Address same as Notice Address (check only one) PAGE TWO (SEP 2009) End of PAGE TWO http://www.procurement.sc.gov/preferences

AMENDMENT ONE

Solicitation No. 5400022040

DESCRIPTION: Health Insurance Case Management Services

AMENDMENTS TO SOLICITATION (JAN 2004)

(a) The Solicitation may be amended at any time prior to opening. All actual and prospective Offerors should monitor the following web site for the issuance of Amendments: www.procurement.sc.gov (b) Offerors shall acknowledge receipt of any amendment to this solicitation (1) by signing and returning the amendment, (2) by identifying the amendment number and date in the space provided for this purpose on Page Two, (3) by letter, or (4) by submitting a bid that indicates in some way that the bidder received the amendment. (c) If this solicitation is amended, then all terms and conditions which are not modified remain unchanged. [02-2A005-1]

QUESTIONS FROM OFFERORS – AMENDMENT (JUN 2017)

This solicitation is amended as provided herein, information or changes resulting from questions will be shown in a question–and-answer format. All questions received have been reprinted below. The “State’s Response” should be read without reference to the questions. The questions are included solely to provide a cross-reference to the potential offeror that submitted the question. Questions do not form a part of the contract; the “State’s Response” does. Any restatement of part or all of existing provision of the solicitation in an answer does not modify the original provision except as follows:

underlined text is added to the original provision. Stricken text is deleted. [02-2A097-1]

The following prospective offeror questions and agency responses are hereby incorporated into the solicitation.

Vendor Question 1: We understand that section “Certificate of Independent Price Determination” on page 10 of the Request for Proposal states that all prices in the offer must be arrived at independently.

However, in setting the budget, does the SC Department of Health and Environmental Control have a maximum allowed budget for the sickle cell and hemophilia programs? If so, can the Department share such budget amounts with Offerors?

State’s Response: The maximum allowed budget for Hemophilia is $500,000. The maximum allowed budget for Sickle Cell is $150,000. Both amounts are per year.

Vendor Question 2: On page 24, the Solicitation states that Offerors must submit a written response to the Service Provider Security Assessment Questionnaire, which should be attached to the Solicitation.

However, the referenced questionnaire is not attached. Can the Department share the questionnaire for response?

http://www.procurement.sc.gov/

State’s Response: This clause was inadvertently included and should be disregarded.

Vendor Question 3: How many children are currently in DHEC’s Children & Youth with Special Health Care Needs (CYSHCN) Program?

State’s Response: This program does not only serve Children and Youth with Special Health Care Needs. It also serves adults over the age of 18 who do not have any other form of insurance coverage.

This number is fluid and can vary based on qualifying events or other circumstances.

Vendor Question 4: Project the number of individuals for the period 01/01/2022 thru 12/31/2024 by indicating how the population will grow by quarter from 01/01/2022 thru 12/31/2024.

State’s Response: Please clarify what is being requested. The population will not grow by quarter.

Insurance coverage would only be provided during open enrollment or in the event of a qualifying event.

The number of individuals approved for the program would not exceed the maximum allowed for the budget.

Vendor Question 5: Project the age ranges of the population to be managed to ensure the staffing requirements.

State’s Response: 18 and over. This program is for adults only.

Vendor Question 6: Provide numbers in support of the program populations (covered lives) to project staffing requirements.

State’s Response: Not enough information was given to provide an answer to this question.

Vendor Question 7: Would the selected insurer and their plans function in a subcontractor role?

State’s Response: No.

Vendor Question 8: RFP discussed insurer case management, please define case management as a definition and the staff credentials required.

State’s Response:

For insurance case management:

1. Accept referrals from DHEC and make contact with the client within 24 hours of receipt of the referral and obtain all necessary information.

2. Contact the client by phone, explain the enrollment and approval process and provide direct contact information if the client requires assistance.

3. Provide the client with a representative to provide prompt access to information and assistance throughout the enrollment and approval process.

4. Work directly with the client to determine insurance options, review plans and assist with their application if needed.

5. Triage the client to direct them to additional assistance available or needed.

6. Follow up with client at the minimum of 7, 14, 21, and 30 days to obtain the needed information and/or as the vendor’s policy states for when the client is referred.

7. Follow up may be in the form of written letters, phone calls, or electronic contact as approved by the client.

8. Monitor client information and documentation.

9. Monitor client and assure expenses do not exceed the annual cap for premium assistance and approved out of pocket expenses (Hemophilia: $15,000 max annual premium assistance, $10,000 max out of pocket assistance. Sickle Cell: $7,500 max annual premium assistance, $8,000 max out of pocket assistance.)

No credentials are required.

Vendor Question 9: As accredited case management requires assessments, patient education and care plans for each covered life, does DHEC require all the aforementioned Case Management elements as components of the program.

Vendor Question 10: Does DHEC expect a monthly case summary with anticipated costs for the next month included like stop loss reporting?

State’s Response: DHEC requires a quarterly report showing activity for the 3 months covered in that quarter. The report should include, but shall not be limited to, the cost/benefit and number of clients serviced, number of referrals applied, applications pending, applications approved, names of any clients no longer receiving services along with the reason, and premiums paid per client.

Vendor Question 11: Does DHEC expect to approve the insurer and plans prior to contracting for access to plan enrollment?

State’s Response: Yes. DHEC requires the summary page of the selected insurance plan to be submitted for review. DHEC reviews the annual premium and maximum out of pocket for the selected insurance plan to ensure it does not exceed the maximum allotted amounts per individual.

Vendor Question 12: Is all case management currently handled by DHEC?

Vendor Question 13: Or is there a current vendor for these services?

State’s Response: Yes.

Vendor Question 14: Would Prior Authorizations come through and be approved by the vendor?

State’s Response: If a prior authorization is required by the insurer, then yes, it would need to be approved by the vendor. If there is a question regarding if the requested service is a covered service and reimbursable by SC DHEC, then program staff may be consulted to provide additional guidance.

Vendor Question 15: Is there an overlap between MCCW and DHEC kids?

Vendor Question 16: Will the vendor take on any enrollment responsibilities?

State’s Response: Yes. Only for enrolling the client into the vendor’s program. DHEC enrolls clients into the CYSHCN program. Vendor will only assist the client with insurance choices but cannot enroll the client into the insurance plan.

END OF AMENDMENT ONE