Apdx_1.AbbrevDefs_DBM_Health_SLEOLA_MDOT_MTA_RFP_2025.8.9.pdf

DBM HEALTH PLAN ADMINISTRATION AND SERVICES; AND

DBM SLEOLA MEDICAL PLAN ADMINISTRATION AND SERVICES; AND

MDOT-MTA REPRESENTED MEDICAL AND VISION PLAN HEALTH BENEFITS

ADMINISTRATION AND SERVICES

SOLICITATION #: F10B6600001 / F10B6600004 / AGY-24-026-SR / BPM051063

RFP Document

RFP for DBM OPSB AND MDOT-MTA ~ Appendix 1. Abbreviations and Definitions Page 1 of 7

Appendix 1. Abbreviations and Definitions

For purposes of this RFP, the following abbreviations or terms have the meanings indicated below:

A. Acceptable Use Policy (AUP) – A written policy documenting constraints and practices to which a user must agree in order to access a private network or the Internet.

B. Access – The ability or the means necessary to read, write, modify, or communicate data/information or otherwise use any information system resource.

C. Active Employees – Employees within the State Personnel Management System, and of the Maryland Department of Transportation, Judiciary and Legislature, including all full and part-time employees and Contractual Employees. Employees of the University of Maryland System are not included under this definition.

D. All-Payer Health Equity Approaches and Development (AHEAD) – As defined by CMS “AHEAD is a state total cost of care (TCOC) model that seeks to drive state and regional health care transformation and multi-payer alignment, with the goal of improving the total health of a state population and lowering costs. Under a TCOC approach, a participating state uses its authority to assume responsibility for managing health care quality and costs across all payers, including Medicare, Medicaid, and private coverage. States also assume responsibility for ensuring health providers in their state deliver high-quality care, improve population health, offer greater care coordination, and promote healthier living for all people participating in the model. The AHEAD Model will provide participating states with funding and other tools to address rising health care costs and improve health outcomes.”

E. Business Day(s) – The official working days of the week to include Monday through Friday. Official working days excluding State Holidays (see definition of “Normal State Business Hours” below).

F. Centers of Excellence – A specialized program or facility within a healthcare institution that provides exceptional care and expertise in a specific medical area or condition, often combining patient care with research and education.

G. COB – Coordination of Benefits.

H. COBRA – Consolidated Omnibus Budget Reconciliation Act.

I. COMAR – Code of Maryland Regulations available on-line at:

http://www.dsd.state.md.us/COMAR/ComarHome.html.

J. Contract – The Contract awarded to the successful Offeror pursuant to this RFP. The Contract will be in the form of Exhibit 2.

K. Contract Administrator – The State’s representative responsible for administrative functions for a procurement contract, including written direction, invoice approval, monitoring for compliance with terms/conditions, the scope of work and deliverables, monitoring MBE/VSBE and Green Purchasing Program compliance, vendor management, compliance and oversight, and achieving completion on time, on budget, and within the scope of the contract.

L. Contract Manager– The State’s DBM OPSB representative responsible for governing the entire lifecycle of a procurement contract to ensure compliance with state laws, regulations, policies, procedures, and best practices. Key duties include contract development and execution, vendor management, risk management, issuing written direction, training and guidance, and continuous http://www.dsd.state.md.us/COMAR/ComarHome.html

MDOT-MTA REPRESENTED MEDICAL AND VISION PLAN HEALTH BENEFITS

ADMINISTRATION AND SERVICES

RFP for DBM OPSB AND MDOT-MTA ~ Appendix 1. Abbreviations and Definitions Page 2 of 7 improvement. The Contract Manager is critical in ensuring fiscal responsibility, legal compliance, and the delivery of high-quality services to meet the needs of Maryland’s state agencies and constituents.

M. Contract Monitor – The State’s MDOT-MTA representative responsible for governing the entire lifecycle of a procurement contract to ensure compliance with state laws, regulations, policies, procedures, and best practices. Key duties include contract development and execution, vendor management, risk management, issuing written direction, training and guidance, and continuous improvement. The Contract Manager is critical in ensuring fiscal responsibility, legal compliance, and the delivery of high-quality services to meet the needs of Maryland’s state agencies and constituents.

N. Contractor – The selected Offeror that is awarded a Contract by the State.

O. Contractor Account Executive – The individual assigned by the Contractor (identified as Key Personnel in RFP Section 3.4 and 3.5) to oversee all work performed under the Contract and who is the day-to-day Contract contact.

P. Contractor Account Service Representative – The individuals assigned by the Contractor (identified as Key Personnel in RFP Section 3.4 and Section 3.5) to provide service to EBD.

Q. Contractor Personnel – Employees and agents and subcontractor employees and agents performing work at the direction of the Contractor under the terms of the Contract awarded from this RFP.

R. Contractual Employee – A non-permanent employee of the State of Maryland as described for eligibility purposes in COMAR 17.04.13.03 and .04.

S. Covered Lives – Each individual enrolled in a plan.

T. CPB – Central Payroll Bureau of the State of Maryland.

U. CPT – Current Procedural Terminology.

V. Data Breach – The unauthorized acquisition, use, modification or disclosure of State data, or other Sensitive Data.

W. “DBM OPSB” or “Department” – Department of Budget and Management, Office of Personnel Services and Benefits.

X. Dependent – An eligible person as defined in COMAR 17.04.13.03(A)(9), as amended from time to time.

See https://dsd.maryland.gov/regulations/Pages/17.04.13.03.aspx.

Y. Dependent Child – An eligible person as defined in COMAR 17.04.13.01(B)(3), as amended from time to time.

See https://dsd.maryland.gov/regulations/Pages/17.04.13.01.aspx.

Z. Digital Therapeutics – Digital therapeutics are evidence-based hyper-personalized therapeutic interventions and care pathways to members that are driven by software programs, artificial intelligences, and/or personalized hardware to aid in the prevention, management, and treatment of multiple conditions including, but not limited to, weight loss, diabetes prevention, diabetes, heart disease, maternity, physical therapy, financial, and behavioral health (part of Point Solutions).

https://dsd.maryland.gov/regulations/Pages/17.04.13.03.aspx https://dsd.maryland.gov/regulations/Pages/17.04.13.01.aspx

MDOT-MTA REPRESENTED MEDICAL AND VISION PLAN HEALTH BENEFITS

ADMINISTRATION AND SERVICES

RFP for DBM OPSB AND MDOT-MTA ~ Appendix 1. Abbreviations and Definitions Page 3 of 7

AA. Direct Pay Enrollee – An individual who is billed directly by the Department of Budget and Management for selected benefits, including COBRA Participants, Leave of Absence Participants, Contractual Employees, Part-Time Employees, and certain Retirees.

BB. Disease Management (DM) – An approach to patient care that seeks to limit preventable adverse events by maximizing patient adherence to prescribed treatments and to health-promoting behaviors.

For patients with chronic diseases, the anticipated benefits of disease management include superior clinical outcomes; improved functional capacity and quality of life; lower healthcare costs; reduced need for hospitalization, surgery and other invasive care; and greater access to care.

CC. EBD – Employee Benefits Division of the Department of Budget and Management.

DD. EBD Director – The Director of the Employee Benefits Division of the Department of Budget and Management.

EE. eMMA – eMaryland Marketplace Advantage (see RFP Section 4.2).

FF. Enterprise License Agreement (ELA) – An agreement to license the entire population of an entity (employees, on-site contractors, off-site contractors) accessing a software or service for a specified period of time for a specified value.

GG. EOB – Explanation of Benefits.

HH. EPO – Exclusive Provider Organization with a national network of participating providers.

II. Federal No Surprises Act or No Surprises Act – A federal law that went into effect in January 2022 to provide consumers new protections from surprise medical bills in certain circumstances.

JJ. FMLA – Family Medical Leave Act.

KK. “Functional Area” or “FA” – A contracted set of service requirements outlined within the RFP and subject to award.

LL. Health Plan – One of the following: a PPO, a self-funded group health plan which includes in-network and out-of-network coverage administered for State employees, retirees and their dependents; a POS, a self-funded group health plan which includes in-network and out-of-network coverage administered for SLEOLA employees and their dependents only; an EPO, a self-funded group health plan which includes in-network coverage only administered for State employees, retirees and their dependents; or an Integrated Health Model (IHM) as defined below.

MM. Health Savings Account (HSA) – A savings account used in conjunction with a high-deductible health insurance plan that allows users to save money tax-free against medical expenses. As defined under § 223 of the Internal Revenue Code.

NN. High-Deductible Health Plan (HDHP) – A plan with a higher deductible than a traditional insurance plan. As defined under § 223 of the Internal Revenue Code.

OO. HIPAA – Health Insurance Portability & Accountability Act and its corresponding regulations, including HITECH.

PP. Information System – A discrete set of information resources organized for the collection, processing, maintenance, use, sharing, dissemination, or disposition of information.

QQ. Information Technology (IT) – All electronic information-processing hardware and software, including: (a) maintenance; (b) telecommunications; and (c) associated consulting services.

https://www.google.com/search?rlz=1C1GCEB_enUS973US973&sxsrf=AB5stBjNVX6Y49Umwb96dwXggDRIy-Qopg:1690300042465&q=tax-free&si=ACFMAn-fuhiZynqzEWN5DhRvBVhtkLl3j1ilv3Zc85uDrhgLI1DnDhlJ9CgswEP7gqmmgx3mYKQZIiCmGQ0YUjk8gB1S9PaGaw%3D%3D&expnd=1

MDOT-MTA REPRESENTED MEDICAL AND VISION PLAN HEALTH BENEFITS

ADMINISTRATION AND SERVICES

RFP for DBM OPSB AND MDOT-MTA ~ Appendix 1. Abbreviations and Definitions Page 4 of 7

RR. Integrated Health – A system of healthcare delivery to enhance care coordination using real-time linkage between PCP, specialists, and healthcare providers. Examples – Health Maintenance Organization (HMO), Patient-Centered Medical Home (PCMH), Accountable Care Organization

(ACO), IHM.

SS. IHM – Integrated Health Model utilizing a regional network of providers

TT. Key Personnel – All Contractor Personnel identified in the solicitation as such that are essential to the work being performed under the Contract. See RFP Section 3.4.4, 3.4.5, 3.5, and 3.6.

UU. LAW – An unpaid leave of absence elected by a permanent employee who is not eligible for State subsidy of benefits during such leave but is eligible to participate in certain benefits provided by the State of Maryland while on the unpaid leave of absence.

VV. Local Time – Time in the Eastern Time Zone as observed by the State of Maryland. Unless otherwise specified, all stated times shall be Local Time, even if not expressly designated as such.

WW. MDOT-MTA – Maryland Department of Transportation, Maryland Transit Administration

(MDOT-MTA).

XX. Medical Plan – A self-funded group health plan which includes a network of medical providers, behavioral health, and vision benefits and is administered on behalf employees and their dependents.

YY. Medical Records Act – The Maryland Confidentiality of Medical Records Act, Annotated Code of Maryland, Health-General Article, Title 4, Subtitle 3.

ZZ. Medicare-Eligible Retiree – The individual who is (a) eligible for Medicare coverage in accordance with the Medicare Rules, (b) not enrolled in a Medicare plan (other than the State’s plan), and (c) eligible to participate in Program benefits.

AAA. Member – An employee, former employee or retiree (including Satellite and Direct Pay) who is eligible to participate in the State of Maryland Benefits Program pursuant to COMAR 17.04.13.03A, as amended from time to time, but does not include the member’s dependents.

BBB. Minority Business Enterprise (MBE) – Any legal entity certified as defined at COMAR 21.01.02.01B(54) which is certified by the Maryland Department of Transportation under COMAR 21.11.03.

CCC. No Pay – Refers to situations in which employees or retirees do not have a sufficient amount in their paycheck or pension allowance to fund benefits deduction(s). Such insufficient balances may be the result of members not having sufficient leave balances or may be due to administrative error.

Members are billed by the State for the insufficient balance and are provided a grace period to pay amount(s) due.

DDD. Normal State Business Hours – Normal State business hours are 8:00 a.m. – 5:00 p.m. Monday through Friday except State Holidays, which can be found at: www.dbm.maryland.gov – keyword:

State Holidays.

EEE. Notice to Proceed (NTP) – A written notice from the Procurement Officer that work under the Contract, project, Task Order or Work Order (as applicable) is to begin as of a specified date. The NTP Date is the start date of work under the Contract, project, Task Order or Work Order. Additional NTPs may be issued by either the Procurement Officer or the Contract Manager regarding the start date for any service included within this solicitation with a delayed or non-specified implementation date, or if the Department decides to exercise any of the optional services identified in this RFP.

MDOT-MTA REPRESENTED MEDICAL AND VISION PLAN HEALTH BENEFITS

ADMINISTRATION AND SERVICES

RFP for DBM OPSB AND MDOT-MTA ~ Appendix 1. Abbreviations and Definitions Page 5 of 7

FFF. NTP Date – The date specified in a NTP for work on Contract, project, Task Order or Work Order to begin.

GGG. Offeror – An entity that submits a Proposal in response to this RFP.

HHH. Participant – Each individual covered by a plan (Members and Dependents).

III. Part-Time Employee – A permanent employee who works less than fifty percent of the standard workweek and is not eligible for State subsidy of benefits but is eligible to enroll in the State of Maryland Employee and Retiree Health and Welfare Benefits Program.

JJJ. PCP – Primary Care Physician.

LLL. PEPM – Per Employee Per Month; the cost for each employee or retiree on a monthly basis.

MMM. Personal Information (PI) or Personally Identifiable Information (PII) – As defined by statute under the State Government Article, Annotated Code of Maryland, Section 10-1301(c):

(1) “Personal information” means an individual's first name or first initial and last name, personal mark, or unique biometric or genetic print or image, in combination with one or more of the following data elements:

i) a Social Security number;

ii) a driver's license number, state identification card number, or other individual identification number issued by a unit;

iii) a passport number or other identification number issued by the United States government;

iv) an Individual Taxpayer Identification Number; or

v) a financial or other account number, a credit card number, or a debit card number that, in combination with any required security code, access code, or password, would permit access to an individual's account.

(2) “Personal information” does not include a voter registration number.

NNN. PMPM – Per Member Per Month.

OOO. Point Solutions – Carefully evaluated health and well-being solutions in lieu of traditional plan offerings including, but not limited to, concierge customer service, second opinions, and well-being platforms, including digital health and digital therapeutics.

PPP. POS – Point of Service Plan.

QQQ. PPACA – Patient Protection and Affordable Care Act.

RRR. PPO – Preferred Provider Organization having a national network of participating providers

SSS. PPPM – Per Participant Per Month.

TTT. Procurement Officer – As defined in COMAR 21.01.02.01B(67) and prior to the award of any Contract, the sole point of contact in the State for purposes of this solicitation. After a Contract award, the Procurement Officer has responsibilities as detailed in the Contract and is the only State representative who can authorize changes to the Contract (Exhibit 2). The Procurement Officer may be changed at any time by written notice to the Contractor.

UUU. Program – State of Maryland Employee and Retiree Health and Welfare Benefits Program

VVV. Proposal – As appropriate, either or both of the Offeror’s Technical or Financial Proposal.

MDOT-MTA REPRESENTED MEDICAL AND VISION PLAN HEALTH BENEFITS

ADMINISTRATION AND SERVICES

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WWW. Protected Health Information (PHI) – Information that relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual;

or the past, present, or future payment for the provision of health care to an individual; and (i) that identifies the individual; or (ii) with respect to which there is a reasonable basis to believe the information can be used to identify the individual, as the phrase is defined in 45 CFR §160.103 and 164.501.

XXX. Reasonable and Customary (R&C) – A fee for a health service that is within the range of usual fees charged by providers of similar training and experience, for the same service, within the same geographic area.

YYY. Request for Proposals (RFP) – This RFP issued by the Department of Budget and Management, Office of Personnel Services and Benefits (DBM OPSB or Department) and the Maryland Department of Transportation, Maryland Transit Administration (MDOT-MTA), with the Solicitation Number and date of issuance indicated in the Key Information Summary Sheet, including any amendments thereto.

ZZZ. Retiree – For purposes of Program benefits, retired employees who qualify for benefits in accordance with COMAR 17.04.13.04A(7) or .04A(08).

AAAA. Satellite Account Employee and Retiree – An employee or retired employee of a political subdivision, agency, commission, or organization that is permitted by Maryland law to participate in the Program.

BBBB. Security Incident – A violation or imminent threat of violation of computer security policies, Security Measures, acceptable use policies, or standard security practices. “Imminent threat of violation” is a situation in which the organization has a factual basis for believing that a specific incident is about to occur.

CCCC. Security or Security Measures – The technology, policy and procedures that a) protects and b) controls access to networks, systems, and data.

DDDD. Sensitive Data – Means PII or PHI. It also means other proprietary or confidential data as defined by the State, including but not limited to “personal information” under Md. Code Ann., Commercial Law § 14-3501(e) and Md. Code Ann., St. Govt. § 10-1301(c) and information not subject to disclosure under the Public Information Act, Title 4 of the General Provisions Article;

and information about an individual that (1) can be used to distinguish or trace an individual‘s identity, such as name, social security number, date and place of birth, mother‘s maiden name, or biometric records, or (2) is linked or linkable to an individual, such as medical, educational, financial, and employment information.

EEEE. SPS – State Personnel System.

FFFF. Spouse – An individual who is joined in marriage to an employee or retired employee, provided that such marriage is performed in a jurisdiction permitting such marriage.

GGGG. State – The State of Maryland, including the agency that is issuing this solicitation and executing the awarded contract.

HHHH. System Documentation – Those materials necessary to wholly reproduce and fully operate the most current deployed version of the Solution in a manner equivalent to the original solution including, but not limited to:

1) Source Code: This includes source code created by the Contractor or subcontractor(s) and source code that is leveraged or extended by the Contractor for use in the Contract;

MDOT-MTA REPRESENTED MEDICAL AND VISION PLAN HEALTH BENEFITS

ADMINISTRATION AND SERVICES

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2) All associated rules, reports, forms, templates, scripts, data dictionaries and database functionality;

3) All associated configuration file details needed to duplicate the run time environment as deployed in the current deployed version of the system;

4) All associated design details, flow charts, algorithms, processes, formulas, pseudo-code, procedures, instructions, help files, programmer’s notes, and other documentation;

5) A complete list of Third Party, open source, or commercial software components and detailed configuration notes for each component necessary to reproduce the system (e.g., operating system, relational database, and rules engine software);

6) All associated user instructions and/or training materials for business users and technical staff, including maintenance manuals, administrative guides and user how-to guides; and

7) Operating procedures.

IIII. Technical Safeguards – The technology and the policy and procedures for its use that protect State Data and control access to it.

JJJJ. TIN – Tax Identification Number.

KKKK. Total Proposal Price – The Offeror’s total price for goods and services in response to this solicitation, included in Appendix 2 – Financial Proposal Form.

LLLL. TPA – Third Party Administrator.

MMMM. Transparency in Coverage Rule – Released by the Department of Health and Human Services, this rule requires most group health plans and health insurance issues in the group and individual market to disclose price and cost-sharing information to participants, beneficiaries, and enrollees.

NNNN. TTY/TDD – A telephone-text device used by hearing impaired individuals whereby they communicate via telephone connected to a keyboard and screen.

OOOO. Use – With respect to individually identifiable health information, the sharing, employment, application, utilization, examination, or analysis of such information within an entity that maintains such information.

PPPP. USM – University System of Maryland.

QQQQ. Utilization Review (UR) – Evaluation of the necessity, quality, effectiveness, or efficiency of medical services, procedures and facilities.

RRRR. Veteran-owned Small Business Enterprise (VSBE) – A business that is verified by the Center for Verification and Evaluation (CVE) of the United States Department of Veterans Affairs as a veteran-owned small business. See Code of Maryland Regulations (COMAR) 21.11.14.