Answers to the Questions S2224.xlsx
XLSX spreadsheet 41 KB Posted
- Attached to
- External Quality Review Organization
- Solicitation number
- 40DHHS-S2224
- Issued by
- Clark County, Nevada
About this file
This document is a set of questions and answers related to a Request for Proposals (RFP) for an External Quality Review Organization (EQRO) contract for the State of Nevada Department of Health and Care Financing Policy (DHCFP). The EQRO will be responsible for conducting a variety of activities for Nevada's Medicaid and Children's Health Insurance Program (CHIP) managed care and fee-for-service programs, including performance improvement project validation, HEDIS measure validation, network adequacy validation, readiness reviews, compliance monitoring, and other technical assistance and optional activities. The contract term is for 4 years, from State Fiscal Year (SFY) 2024 through SFY 2027, with the possibility of renewal.
The cost schedule indicates that the EQRO will need to provide pricing for mandatory activities across the 4-year contract term, as well as pricing for optional activities such as consumer/provider surveys, FFS population performance measure calculation, quality studies, quality rating system development, and consulting services for various managed care expansions and initiatives. There is no incumbent EQRO identified, and the funding for this contract will come from Nevada's Medicaid and CHIP programs.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachments for Signature S2224.pdf | ||
| Federal Laws and Authorities~1.pdf | ||
| Proposed Staff Resume~1.docx | DOCX document | |
| Scope of Work 40DHHS-S2224 Revised 12.22.22.docx | DOCX document | |
| Cost Schedule Revised 1.4.23.xlsx | XLSX spreadsheet | |
| Quote Instructions.pdf | ||
| Standard Form Contract.pdf | ||
| Terms and Conditions for Services~1.pdf | ||
| Insurance Schedule S2224.pdf | ||
| RFP 40DHHS-S2224 EQRO External Quality Review Org.docx | DOCX document | |
| Reference Questionnaire~1.docx | DOCX document |
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Bid Q&A for Export Report
| Bid Q&A | |||
| QUESTION_NBR | QUESTION_SUBJECT | QUESTION_TEXT | ANSWER_TEXT |
| 1 | 1.2.3 Calculation of Additional Performance Measures | Can DHCFP please confirm it will require the behavioral health core set instead of the adult core set in order to meet the CMS reporting requirements? | Yes, DHCFP will require the BH and Child core sets to meet the CMS mandatory reporting requirements. |
| 2 | 1.2.3 Calculation of Additional Performance Measures | ​For the core set measures with a hybrid data collection method, does DHCFP anticipate the use of medical records for measure calculation? | Yes, DHCFP anticipates the use of MRR for measure calculation. |
| 3 | 1.2.3 Calculation of Additional Performance Measures | For the core set measures related to immunizations and blood lead screening, is supplemental immunization registry and lead surveillance data available for the FFS population? | Yes, from our Office of Analytics. |
| 4 | 1.2.3 Calculation of Additional Performance Measures | For the core set measures with an electronic health record (EHR) option, does DHCFP anticipate the use of EHR/health information exchange (HIE) data for measure calculation? | No. |
| 5 | 2.8 Vendor Responsibilities | ?The Vendor?s senior staff and other key staff, as identified by the Vendor, shall participate in all meetings scheduled by the DHCFP?The frequency of such meetings may include, at a minimum, monthly teleconferences and/or video conferences in addition to quarterly on-site meetings.? The Cost Schedule includes 4 MCO Quarterly Meetings per year (on-site), 4 DBA Quarterly Meetings per year (on-site). |
| Does DHCFP anticipate the 4 MCO on-site quarterly meetings and 4 DBA on-site quarterly meetings will take place during the same on-site visit? | Yes. | ||
| 6 | 3.3.3 Proposed Staff Resume | The proposed staff resume form states ?A minimum of three (3) references are required.? |
| May the vendor use the same three (3) references on staff resumes that are used to complete the reference questionnaire? | Vendors are encouraged to provide their best response. | ||
| 7 | 7.8.2. Reference Questionnaire | ?Vendors shall provide a minimum of three (3) business references from similar projects performed for private and/or public sector clients within the last five (5) years, see Reference Questionnaire.? |
| May the vendor use current or previous State of Nevada staff as a business reference? | This is allowed, however, depending on the individuals involvemtn with the procurement, they may be required to decline. | ||
| 8 | SOW 1.2.5 | SOW 1.2.5 Conduct studies on quality that focus on a particular aspect of clinical or non-clinical services at a point in time: |
| Will the data necessary to complete focused study analyses be obtained from the managed care entities (i.e., MCOs, PAHP), from the DHCFP, or through a direct connection to the DHCFP?s data systems? | Depending on the study the data may come directly from managed care organizations, the DBA, or from the Division. | ||
| 9 | SOW 1.3.8.A.2 | SOW 1.3.8.A.2 Healthcare Effectiveness Data and Information Set (HEDIS®) or HEDIS like calculations and audits. |
| Please provide the anticipated measures or number of measures and any sub-populations the vendor will be required to calculate for the FFS population. | We expect to collect 45 measures for Managed Care and are requesting authority to collect the same measures for FFS. | ||
| 10 | SOW 1.3.8.A.3 | SOW 1.3.8.A.3 Encounter data validation and omission studies Cost Schedule |
The cost schedule indicates a cost should be proposed for an encounter data validation each year. Does DCHFP anticipate medical record review will be conducted each year of encounter data validation? The encounter data validation project will not be conducted more frequently than is outlined by federal regulation 42 CFR 438.602 (e).
Medical record review will only be required the year of the project.
11 SOW 1.3.8.A.4 SOW 1.3.8.A.4 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys
a. For the Nevada Medicaid FFS population will both adult and children be surveyed?
b. If children are surveyed, will both the Child Medicaid CAHPS Survey with the Children with Chronic Condition measurement set and Child Medicaid CAHPS Survey without the Children with Chronic Condition measurement set be administered? a. Nevada would like to retain the right to exercise the option to survey both adults and children FFS populations as funding is available.
b. As this is an optional activity, Nevada would complete both surveys if funding is available.
12 SOW 1.4.6 SOW 1.4.6 Qualifications of External Quality Review Organizations states: The vendor must designate a contract manager to work with the assigned DHCFP program specialist or contract monitor(s).
| Does DHCFP anticipate this individual will be 100% dedicated to the contract? | No, but the expectation is the Contract Manager will be available during Nevada's operational hours and can lead expected EQRO projects. | ||
| 13 | SOW 1.6.1 | SOW 1.6.1 Implementation states: ?The vendor shall develop and submit to DHCFP for approval, no later than one month after notification that the vendor has been awarded the Contract, a detailed work plan and timeline for performing the obligations set forth in the Contract for the first contract year.? |
| Will the work plan and timeline be only for mandatory activities described in 1.1.1 ? 1.1.6 or will the work plan include optional activities? Can DHCFP provide anticipated optional activities for the first contract year? | The optional activities do not need to be included in the work plan. | ||
| 14 | Cost Schedule | The cost schedule includes rows for annual consulting for technical assistance tasks 1.3.8.E ? 1.3.8.H, however it does not include a row for 1.3.8.I State Directed Payment. 1.3.8.E is a description of the request for technical assistance from DHCFP and would not require a cost from the vendor. |
| Will DHCFP be providing an updated cost schedule that removes 1.3.8.E and includes 1.3.8.I? | "E" has been removed, and "I" has been added. | |||
| 15 | 7.2. Contract Form | Will DHCFP provide a Word version of the contract form and BAA? | The document is intended to a be PDF to allow no edits. | |
| 16 | 1.2.1 EDV | What are the DHCFP's expectations regarding the frequency of the encounter data validation studies? | Please see answer to question #10. | |
| 17 | 1.2.5 Focused Studies | Can DHCFP please provide confirmation on the anticipated number of focused studies? | The DHCFP has not determined the number of focused studies to be conducted during the contract period. | |
| 18 | 1.2.5 Focused Studies | Can DHCFP please confirm what data sources will be required for the focused studies? Will the studies rely on administrative claims/encounters only, or does DHCFP anticipate requiring medical record review, EHR/HIE data, or registry data? | The study topic will likely determine the data sources. Previous studies have included administrative data, hybrid, and surveys. | |
| 19 | 1.2.5 Focused Studies | Can DHCFP please provide additional details on the deliverable format for the focus studies (e.g., will the deliverable be a formal report with tables/graphics and narrative)? | The requested formats may vary by project. | |
| 20 | 1.3.8 TA and Optional Activities | Re: Scope of Work subsection 1.3.8.A.2: Can DHCFP please provide the number of HEDIS or HEDIS-like measures the vendor may be required to calculate for the FFS population? | We expect to collect up to 45 measures. | |
| 21 | 1.3.8 TA and Optional Activities | Re: Scope of Work subsection 1.3.8.A.2: Can DHCFP please provide confirmation on the data sources that may be required for the PM calculation activity? Will it utilize administrative FFS claims only, or does DHCFP anticipate requiring medical record review, EHR/HIE data, or registry data? | DHCFP anticipates requiring MRR and possibly registry data depending on the measure specifications. | |
| 22 | 1.3.8 TA and Optional Activities | Re: Scope of Work subsection 1.3.8.B: For the MCOs, does DHCFP anticipate that one Quality Rating System inclusive of both Nevada Check Up and Medicaid beneficiaries will be produced, or does DHCFP anticipate that two Quality Rating Systems will be developed? | Without further guidance provided by CMS, Nevada would like pricing for both Nevada Check Up and Medicaid. | |
| 23 | 1.3.8 TA and Optional Activities | Re: Scope of Work subsection 1.3.8.H: Can DHCFP clarify if the vendor's assistance related to the pay for performance withhold design will include methodology development (which may include testing the methodology on historical data), presenting to stakeholders, and responding to stakeholder feedback? | As this is an optional activity, the specifics have not been decided at this time; however, it would likely include alternative methodolgy designs and responding to stakeholder questions. | |
| 24 | 1.3.8 TA and Optional Activities | Re: Scope of Work subsection 1.3.8.H: Does DHCFP anticipate needing the vendor's assistance with pay for performance withhold calculations and/or creating formal documents to share the pay for performance withhold results with MCOs? Please provide any clarification on the anticipated deliverable for this activity, if the vendor is requested to assist with this activity. | Please see answer to question #23. | |
| 25 | Scope of Work, 1.3.8 Technical Assistance and Optional Activities, page 4 | Where do we budget activity I? I see a place to budget activities A ? H in the Cost Schedule Revised 12.22.22.xlsx, but do not see where we are to budget activity I. | Please see answer to question #14. | |
| 26 | Scope of Work, 1.2.3 Calculation of CMS Child and Adult Core Measures for Medicaid FFS, Page 1 | Will the EQR be responsible for conducting HEDIS audit for each MCO or will the EQR receive HEDIS data from the MCO?s independently contracted HEDIS auditor? | The EQRO will receive the data from the MCOs vendors. | |
| 27 | Scope of Work, 1.2.3 Calculation of CMS Child and Adult Core Measures for Medicaid FFS, page 1 | We will need to access multiple large data sets for this optional activity. Should we include the cost of data ingestion and secure storage in our budget for this item? | Yes. | |
| 28 | Scope of Work, 1.2.3 Calculation of CMS Child and Adult Core Measures for Medicaid FFS, page 1 | The Scope of Work indicates this activity involves producing the CMS Child and Adult Core Measures; 'Cost Schedule Revised 12.22.22.xlsx indicates HEDIS measures. Can you clarify which measure set will be produced with this activity? Will it include all Core Measures, or just the subset that are HEDIS measures? | It will include all BH and Child Core set measures. | |
| 29 | Scope of Work, 1.3.7, page 3 | "1.3.7 Conduct a compliance review evaluating the effectiveness of the quality strategy within the previous 3 years. This review will be broken out in sections to be reviewed annually." It looks like Standard IV was removed or has a typo in the table. Can you please clarify? | This was accidently deleted in 12/22/22 revised scope. It should be: Standard IV—Availability of Services | |
| 30 | Scope of Work, 1.2.2., page 1 | "1.2.2. Administration or validation of consumer or provider surveys of quality of care." Are the surveys included in this task CAHPS surveys? | ||
| If not, can you specify which surveys will be conducted? | Optional activities indentified in section 1.2.2. are further clarified in section 1.3.8. and 1.3.8.4. includes CAHPS surveys. | |||
| 31 | Scope of Work, 1.2.2., page 1 | "1.2.2. Administration or validation of consumer or provider surveys of quality of care" Will the EQR conduct the CAHPS surveys or will the EQR receive the data from the MCO CAHPS vendors? | Nevada does not have a CAHPS vendor to conduct surveys for the FFS delivery program. | |
| 32 | Scope of Work, 1.3.8.A Technical Assistance and Optional Activities, page 3 | The RFP states that the vendor may be required to provide activities such as clinical focused studies, Healthcare Effectiveness Data and Information Set (HEDIS®) or HEDIS like calculations and audits, encounter data validation and omission studies; and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys) for the Nevada Medicaid FFS population. Please confirm whether combined pricing for all activities listed in the RFP is required to be provided for these activities. If yes, please clarify where this pricing should be included on the Cost Schedule template. | Confirmed. |
Row 45-48 Column F-K of Cost Proposal.
| 33 | RFP, 2.7.7 2.7. , Page 3 and Scope of Work, 1.3.8.A , page 3 | The RFP states that DHCFP currently contracts with a fiscal agent for FFS claims processing and related functions. The RFP also states that the vendor may be required to provide activities for the Nevada Medicaid FFS population such as clinical focused studies, Healthcare Effectiveness Data and Information Set (HEDIS®) or HEDIS like calculations and audits, encounter data validation and omission studies; and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys). Please confirm: | |
| 1. | Who is the current Fiscal Agent? | ||
| Please confirm whether DHCFP requires annual performance measure validation and encounter data validation of the Fiscal Agent? | Gainwell Technologies. |
Currently DHCFP does not conduct a performance measure calculation with FFS data; however, that is one of the optional activites identified in the RFP that Nevada may elect to have performed as funding is available. This same can be said for encounter data validation of the FFS delivery program.
| 34 | Scope of Work, 1.3.8.C Technical Assistance and Optional Activities, page 3 | The RFP states that the vendor may be required to provide activities such as consulting to DHCFP for ABD performance measures, conduct an Information Systems (IS) Readiness Review on selected ABD MCO Vendors and evaluate implementation of performance measures for the Nevada Medicaid Aged Blind and Disabled population. Please confirm whether combined pricing for all these items should be provided in the row titled ?Quality Activities Related to the ABD Population 1.3.8.(C)" on the Cost Schedule template. | Confirmed. | |
| 35 | Scope of Work, 1.3.8.C Technical Assistance and Optional Activities, page 3 | The RFP states that the vendor may be required to provide activities such as consulting to DHCFP for ABD performance measures, conduct an Information Systems (IS) Readiness Review on selected ABD MCO Vendors and evaluate implementation of performance measures for the Nevada Medicaid Aged Blind and Disabled population. Please confirm: | ||
| 1. | How many MCOs are expected to provide services to the ABD populations? Will the same MCOs that provide Medicaid/Check Up also provide services to the ABD populations? | Four MCO's that were awarded RFP #S1457. |
The same MCO's provide Medicaid/Check Up.
| 36 | Scope of Work, 1.3.8.D Technical Assistance and Optional Activities, page 3 | The RFP states that the vendor may be required to provide activities for the expansion of Managed Care for TANF/CHAP and CHIP populations into the rural counties such as provide consulting for expansion performance measures applicable to the TANF/CHAP and CHIP populations, conduct an Information Systems (IS) Readiness Review on selected expansion MCO Vendor(s), provide technical assistance to the MCOs on the development of performance measures and conduct a HEDIS Compliance Audit or validate the measures using the CMS Validating Performance Measures protocol on the contracted MCOs. Please confirm whether combined pricing for all these items should be provided in the row titled ?Quality Activities Related to Managed Care Expansion into the Rural Counties 1.3.8.(D)? on the Cost Schedule template. | Confirmed. | |
| 37 | Scope of Work, 1.3.8.D Technical Assistance and Optional Activities, Page 3 | The RFP states that the vendor may be required to provide activities for the expansion of Managed Care for TANF/CHAP and CHIP populations into the rural counties such as provide consulting for expansion performance measures applicable to the TANF/CHAP and CHIP populations. Please confirm: | ||
| 1. | How many MCOs are expected to provide these expansion services into the rural counties? | |||
| Will the same MCOs that provide Medicaid/Check Up also provide expansion services into the rural counties? | Four MCO's were awarded RFP #S1457 through December 31, 2025. |
Expanion of services statewide will require legislative funding if approved prior to 2025 the same vendor will be selected to provide those services. New MCO contracts will begin January 1, 2026 and it is unknown how many vendors will be selected at that time.
38 Attachments for Signature S2224 Do Subcontractors only need to fill out the first 4 pages of this PDF file (e.g., the Vendor Information Response) or do they also need to fill out the other forms (e.g., Vendor Certifications, Confidentiality and Certification of Indemnification, Certification Regarding Lobbying, and Business Associate Addendum)? Subcontractors only need to fill out the first 4 pages, "Vendor Information Response".
Microsoft_Excel_Worksheet.xlsx Sheet1
RFP# 40DHHS-S2224 Vendor's Name:
Mandatory Activities: SFY 2024-2027
Bid amounts need to reflect 4 MCOs and 1 DBAs.
Activity RFP or Scope of Work Section MCO Title XIX MCO Title XXI DBA Title XIX DBA Title XXI TOTAL
Performance Improvement Project Validation 1.1.1 2024 $0.00
1.3.3 2025 $0.00
2026 $0.00
2027 $0.00
HEDIS Performance Measure Validation 1.1.2 2024 $0.00
1.3.1 2025 $0.00
1.3.2 2026 $0.00
2027 $0.00
Network Adequacy Validation 1.1.4 2024 $0.00
1.3.4 2025 $0.00
2026 $0.00
2027 $0.00
Readiness Reviews FY26: 4 MCOs FY27: 1 PAHPs 1.1.5 2026 $0.00
2027 $0.00
| Independent Assessment of one PAHP | ||
| 1.1.6 | 2025 | $0.00 |
2027 $0.00
| Independent Evaluation of 1115 waivers | ||
| 1.1.7. | 2024 | $0.00 |
2025 $0.00
2026 $0.00
2027 $0.00
Compliance Monitor of MCOs and PAHP 1.1.3 2024 $0.00
1.3.7 2025 $0.00
2026 $0.00
2027 $0.00
Validation of the Quality Assessment and Performance Improvement Strategy 1.3.5 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Production of a Detailed Annual Technical Report 1.3.6 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Vendor Responsibilities: Meetings: 4 MCO Quarterly Meetings per year (on-site), 4 DBA Quarterly Meetings per year (on-site), and monthly DHCFP teleconference calls for managed care (12 months) and the dental benefits administrator (12 months) programs. (RFP section) 2.8 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Encounter Data Validation 1.2.1 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Technical Assistance- Fee For Service population activities 1.3.8 (A) 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Optional Activities: State Fiscal Year 2023-2026
Activity Scoep of Work Attachment SFY MCO Title XIX MCO Title XXI DBA Title XIX DBA Title XXI Total:
Consumer and/or Provider Surveys of Quality of Care 1.2.2 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
HEDIS Performance Measure Calculation in addition to those required of MCOs and PAHP(s) 1.2.3 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Administration of Performance Improvement Projects in Addition of PIPs conducted by MCO and PAHP. 1.2.4 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Quality Studies related to clinical and non-clinical services 1.2.5 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Assist with establishing a Quality Rating System 1.2.6 2024 $0.00
1.3.8 (B) 2025 $0.00
2026 $0.00
2027 $0.00
Quality Activities Related to the ABD Population 1.3.8 (C) 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Quality Activities Related to Managed Care Expansion into the Rural Counties 1.3.8 (D) 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Consulting 1.3.8 (F) 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Consulting 1.3.8 (G) 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Consulting 1.3.8 (H) 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Consulting 1.3.8 (I) 2024 $0.00
2025 $0.00
2026 $0.00
2027 $0.00
Total SFY Costs
2024 2025 2026 2027
$0.00 $0.00 $0.00 $0.00
Total Contract Costs :
$0.00 image1.emf
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