Request for Proposal (RFP) 27-87793 Healthcare Programs Enrollment Broker RFP Attachment F - Technical Proposal Response Instructions

Overview Request for Proposal (RFP) 27-87793 is a solicitation issued by the State of Indiana in which organizations are invited to compete amongst other Respondents in a formal evaluation process. Please be aware that the evaluation of your organization’s proposal will be completed by a team of State of Indiana employees and your organization’s score will be reflective of that evaluation. The evaluation of a proposal is based upon the information provided by the Respondent in its proposal submission. Therefore, a competitive proposal will thoroughly address all components of the RFP. The Respondent is expected to provide the complete details of its proposed operations, processes, and staffing for the statement of work detailed in the RFP document and supplemental attachments.

A completed Technical Proposal is a requirement for proposal submission. Failure to complete and submit this form will impact your proposal’s responsiveness.

Technical Proposal Components:

The Technical Proposal response should be divided into these components, based on the corresponding sections in Attachment K - Statement of Work:

1. Overview (Section I of Attachment K)

2. Objectives of Engagement (Section III.a of Attachment K)

3. Deliverables and Deadlines (Section III.b of Attachment K)

4. Project Management (Sections IV.a.1, IV.a.2, IV.a.3, and IV.a.4 of Attachment K)

5. Quality Improvement, Complaints and Grievances (Sections IV.a.5 and IV.a.6 of Attachment K)

6. Staffing (Sections IV.b and IV.c of Attachment K)

7. Document Management (Section IV.d of Attachment K)

8. Compliance Requirements (Section V of Attachment K)

9. Key Performance Indicators (Section VI of Attachment K)

10. End of Contract Transition and Turnover (Section VII of Attachment K) Submission Specifications:

Technical Proposals have specifications as listed in Section of the RFP Main Document and as provided below:

· It is the State's preference that the Technical Proposal be submitted as a single document. However, if excessive file size is an issue, the State will accept multiple documents. The State prefers not to navigate an excessive number of files during the review process. Technical Proposals greater than 200 pages in length are discouraged.

· The Respondent may respond in the format of their choosing provided their response maintains the order proposed in this template. Diagrams, certificates, graphics, and other exhibits should be referenced within the relevant answer field and included as legible attachments.

· Attachments and exhibits may be provided in a separate file. However, the Technical Proposal must contain an adequate description of the contents. In other words, the Technical Proposal should stand on its own and must contain enough information to understand separate exhibits and attachments.

· If submitted in PDF format, the files should not be locked.

· Technical Proposals should have a table of contents, be continuously paginated, and be separated into the following sections:

· Executive Summary

· Technical Proposal Responses (see below)

· Other attachments

· Please structure your Technical Proposal responses to address the specific subsections in each section of the Statement of Work and cross-reference your responses to the applicable sections. For example, a submission for Section III.a.1 Description of Enrollment Broker Tasks should have a “Section III.a.1 Description of Enrollment Broker” section clearly laid out and structured.

Response Structure:

Please review the requirements in Attachment K Statement of Work carefully and address each section and requirement. Please describe your relevant experience and how your approach incorporates best practices from previous experience. Please explain how you propose to perform the work in its entirety, including but not limited to the specific elements highlighted below. Respondents are cautioned against simply repeating the RFP language within the response as evidence of understanding or capability. While the “what” and “how” of each component is important, the “why” and “with what result” (actual or projected), as well as demonstrated experience and prior work, should illustrate and substantiate the Respondent’s expertise in each area. Please ensure any examples provided are appropriately disguised and do not include Personally Identifiable Information or Protected Health Information.

Respondents are strongly encouraged to submit inventive proposals that go beyond the Statement of Work requirements set forth in Attachment K of this RFP and to demonstrate a depth of understanding of each item discussed. The value added by the Respondent’s proposal should be clearly highlighted for each item addressed and also summarized per the prompts below.

For all areas in which subcontractors will be performing a portion of the work, clearly describe their roles and responsibilities, related qualifications and experience, and how you will maintain oversight of the subcontractors’ activities.

Please explain how you propose to execute each Section in its entirety, including but not limited to the specific elements highlighted below by Section, and describe all relevant experience. Where applicable, clearly describe your approach to collaboration with the State and the State’s Managed Care Organizations (MCO). Clearly specify processes, approaches, tools, and frameworks proposed be used in executing the work. In each relevant response area, clearly describe how you propose to deploy artificial intelligence (AI) or machine learning as a clearly marked response element.

Enrollment Broker RFP Technical Proposal Questions

1. Overview (Section I of Attachment K) Please provide a list of States to which you currently or in the past have provided similar services (e.g., Medicaid or health-services enrollment broker call centers). In connection with this list, please provide information on:

a. Programs you have initiated in other states that can be replicated in Indiana to help the State meet its goals.

b. Programs you intend to initiate that would be specific to Indiana.

c. Examples of how you have worked with other states in a collaborative manner to address changing program needs and priorities.

d. Any sanctions or formal complaints that you have been subject to.

e. Any corrective actions that you have been subject to.

f. Experience with State and federal compliance.

g. Any lawsuits within the last five (5) years related to similar services you have provided.

2. Objectives of Engagement (Section III.a of Attachment K) Please address these Statement of Work Sections in their entirety. Within your response:

a. If applicable, provide a summary of value-add elements beyond the requirements of the Statement of Work that are fully included in the proposed price. The summary should include:

i. What specific services or capabilities go above and beyond the requirements of the scope.

ii. When each service or capability will be available to the State.

iii. How this service or capability would bring value to the State.

iv. Where this service or capability has been demonstrated before, and the proven results.

b. Please acknowledge your intent to provide plan selection services, and to do so in alignment with the composition of Indiana's managed care programs.

c. Please describe in detail your specific experience conducting enrollment broker services for Medicaid managed care programs. This description should include:

i. Any lessons learned from prior enrollment broker projects and how those experiences will assist you in performing the obligations under this Contract.

ii. Your knowledge of enrollment broker services as described in federal regulations.

iii. Your strategy for keeping apprised of updates or modifications to relevant federal regulations.

d. Please describe in detail your experience and approach pertaining to and approach for operating the Enrollment Broker Helpline number for all four (4) of Indiana’s programs (Healthy Indiana Plan (HIP), Hoosier Healthwise (HHW), Hoosier Care Connect (HCC), Indiana PathWays for Aging. The description should include:

i. Your proposed strategy to provide sufficient “live-voice” access, as defined in the SOW, to members for a minimum of forty-five (45) hours a week Monday through Friday from 8:00 AM to 5:00 PM Eastern Time (ET).

ii. Your proposed strategy to ensure adequate staffing to resolve member inquiries and complaints in a timely manner as per Performance Standards.

iii. Your practices for treating each caller with dignity and respect their right to privacy and confidentiality.

iv. Your capability to provide language translation services and automated telephone options in English and Spanish, and your plan for making these options known to current and potential enrollees.

v. Your proposed strategy for evaluating Helpline adequacy and effectiveness, including daily statistics gathering, call recording, monthly live call monitoring, and regular reporting to the State. Please include example reports if applicable.

vi. Your capability to process warm transfers, as described in the SOW, to and from other Indiana Health Coverage Programs (IHCP) contractors, including three-way (3) calls for priority plan selections.

vii. Your approach to tracking and reporting information collected from the calls into the Contractor database.

viii. Your approach to implementing and maintaining a State-approved Interactive Voice Response (IVR) system.

ix. Your process for verifying and maintaining up-to-date member demographic and eligibility information.

x. How your approach in operating such a Helpline has demonstrable success in other states.

xi. Your plan for disaster recovery if the Call Center were to have a failure.

xii. Your ability to conduct end of call surveys to evaluate caller satisfaction, as described in the SOW.

e. Please describe in detail your experience and approach to providing Managed Care Enrollment Education, including but not limited to the areas described in Section III.a.2.b.1. The description should include:

i. Your approach to educating members with unbiased and neutral information on the managed care programs.

ii. Your ability to accommodate a member's request for in-person or web-based enrollment assistance, in the rare event such a request occurs.

iii. Your approach to conducting telephone interviews for HCC and PathWays for Aging Members, including your approach to scaling staff in response to changes per State's notice and discretion.

iv. Your approach to providing oral interpretation services over the Helpline.

v. Your approach to notifying enrollees that oral interpretation is available for any language and that written information is also available for all member materials.

vi. Your approach to notifying enrollees about how to access interpretation services and written information for all member materials.

vii. Your plan for providing MCE Summary sheets and for directing members to provider lists.

viii. Your capacity to prepare accurate and thorough written responses to various inquiries.

ix. Your plan for responding to ninety-eight percent (98%) of all written provider and recipient correspondence (inquiries) within five (5) business days of receipt of the written correspondence.

f. Please describe in detail your experience and approach to conducting choice counseling, including but not limited to the areas described in Section III.a.2.c. The description should include:

i. Your approach to providing unbiased choice counseling to help members select an MCO and provider.

ii. Your approach to conducting end-of-call satisfaction surveys to evaluate consumer experience, and describe any other proposed methods to effectively educate current and potential managed care members.

g. Please describe in detail your experience and approach to member materials, including but not limited to the areas described in Section III.a.2.d. The description should include:

i. Your approach distributing State-developed member education materials for member education and enrollment facilitation responsibilities.

ii. Your approach submitting the annual list of materials used and anticipated for the Quality Management and Improvement Plan Summary Report.

iii. Your approach to notifying enrollees of language access services and translating member materials into Spanish.

iv. Describe your plan for providing the following:

1. MCO Health Plan Summaries,

2. HIP Annual Health Plan Section Period (Open Enrollment) Postcard or Letter Notification,

3. HCC Welcome Notices, and

4. Indiana Pathways for Aging Notices.

v. The proposed content of your member materials and provide any relevant examples.

h. Please describe in detail your experience and approach to managing member enrollment and disenrollment in managed care programs. The description should include:

i. Your approach to conducting enrollment functions across all four (4) programs (HIP, HHW, HCC, PathWays for Aging), including scripting and tools used to support plan selection.

ii. How you will record a member's MCE selection in your database as well as in MMIS. Your approach to administering Indiana PathWays for Aging enrollment specifically, including D-SNP plan alignment, receipt and use of daily eligibility/age-in files, warm transfers from the Level of Care Assessor (LCAR), and tracking of choice counseling activity.

iii. Your process for administering the American Indian/Alaska Native (AI/AN) opt-in and opt-out process, and the Indiana PathWays hospice opt-in process.

iv. Your approach to processing Presumptive Eligibility enrollments for HHW and HIP.

v. Your process for managing plan changes.

vi. Your approach to administering the annual health plan selection period (open enrollment) across programs.

vii. Your process for reviewing and making determinations on "just cause" plan change requests.

viii. Your plan to manage disenrollments and re-enrollments, including coordination with MMIS-driven and Contractor-managed disenrollment reasons and applicable notification timeframes.

ix. Your approach to data entry and database maintenance, including Medicaid management information system (MMIS) interface capabilities, HIPAA compliance, and referring members to other Indiana Family and Social Services Administration (FSSA) contractors when needed.

x. Please provide any relevant example member materials.

i. Please describe in detail your proposed approach to adhering to all information system requirements. The description should include:

i. Your ability to develop the database required in the SOW that identifies member and provider information in the eight (8) areas listed in Section III.a.4.a of Attachment K.

ii. Your proposed use of a customer relationship management (CRM) system.

iii. Your approach to tracking and managing Right Choices Program restricted members.

iv. Your approach to developing and maintaining the database and information systems required to support all enrollment broker functions.

v. A copy of your information systems security policy.

vi. Your company’s ability to meet all of the State’s information system requirements described in Section III.a.4 of Attachment K.

j. Please describe in detail your proposed approach to start up and transition activities. The description should include:

i. Your plan for managing the incoming transition activities that demonstrates your understanding of the scope and complexity of the incoming transition activities required for the Statement of Work.

ii. Your plan for working with the incumbent vendor during the incoming transition period.

iii. Your proposed project management tool to track and update progress against the transition plan.

iv. Describe your ability to submit documentation for, and ultimately pass, a readiness review.

3. Deliverables and Deadlines (Section III.b of Attachment K)

a. If applicable, provide a summary of value-add elements beyond the requirements of the Statement of Work that are fully included in the proposed price. The summary should include:

i. What specific services or capabilities go above and beyond the requirements of the scope.

ii. When each service or capability will be available to the State.

iii. How this service or capability would bring value to the State.

iv. Where this service or capability has been demonstrated before, and the proven results.

b. Please describe in detail your proposed approach to meeting all Performance Standards for Report Submissions. The description should include:

i. Your plan for developing, maintaining, and updating a comprehensive Reporting Manual, as described in the SOW, on an ongoing basis.

ii. Your ability to meet the report submission requirements for the following documents:

1. Monthly Status Report

2. Monthly Program Data

3. Monthly Usage Volume Report

4. Indiana Pathways for Aging Reports

5. Annual Report & Workplan

6. Quality Management and Improvement Work Plan

7. Quality Management and Improvement Progress Report

8. Business Continuity Disaster Recovery Plan

9. Health Equity Report

iii. Your abilities to meet the report submission requirements for the weekly operations reports on the Indiana Pathways for Aging program.

iv. Your capabilities to produce any additional reports as may be requested by the State.

v. Please provide any relevant example reports.

4. Project Management (Sections IV.a.1, IV.a.2, IV.a.3, and IV.a.4 of Attachment K)

a. If applicable, provide a summary of value-add elements beyond the requirements of the Statement of Work that are fully included in the proposed price. The summary should include:

i. What specific services or capabilities go above and beyond the requirements of the scope.

ii. When each service or capability will be available to the State.

iii. How this service or capability would bring value to the State.

iv. Where this service or capability has been demonstrated before, and the proven results.

b. Please describe in detail your proposed approach to policy oversight. The description should include:

i. Your approach to developing, maintaining, and annually reviewing written policies and procedures across all functional areas, incorporating revised State policies and procedures.

ii. Your approach to producing an administrative plan detailing resources, staffing, and organizational structure for contract functions.

iii. Your approach to incorporating revised policies and procedures, as appropriate, into the revisions of all materials such as the member letters and brochures.

c. Please describe in detail your proposed approach to administrative plan development and execution. The description should include:

i. Your approach to producing an administrative plan, per the SOW, detailing resources, staffing, and organizational structure for contract functions.

ii. Your process for notifying and filling key position vacancies.

d. Please describe your ability to attend and actively participate in virtual and in-person meetings as requested by the State.

e. Please describe in detail your approach to staff training and call script maintenance. The description should include:

i. Your approach to developing and delivering a comprehensive training program to your staff including: program orientation and updates, cultural sensitivity, program policies and procedures, relevant information regarding all Health Plans available to potential enrollees and other topics as requested by the State.

ii. Your process for submitting training materials to the State for review and approval.

iii. Your process for reviewing and updating call scripts on an ongoing basis.

iv. Please acknowledge the need to conduct training on enrollment broker functions to State staff upon request.

5. Quality Improvement, Complaints and Grievances (Sections IV.a.5 and IV.a.6 of Attachment K) Please address this Statement of Work Section in its entirety. Within your response:

a. If applicable, provide a summary of value-add elements beyond the requirements of the Statement of Work that are fully included in the proposed price. The summary should include:

i. What specific services or capabilities go above and beyond the requirements of the scope.

ii. When each service or capability will be available to the State.

iii. How this service or capability would bring value to the State.

b. Please describe in detail your approach to quality management. The description should include:

i. How you plan to ensure Health Equity and Cultural Competency in the delivery of contracted services.

ii. Your approach to developing and implementing an ongoing Quality Management and Improvement Program (QMIP) that addressed and supports the Program Quality Goals as a core component.

c. Please describe in detail your approach to resolving each of the three (3) grievances detailed in Section IV.a.6, including receiving, tracking, reporting, and related policies and procedures.

6. Staffing (Sections IV.b and IV.c of Attachment K) Please address this Statement of Work Section in its entirety. Within your response:

a. If applicable, provide a summary of value-add elements beyond the requirements of the Statement of Work that are fully included in the proposed price. The summary should include:

i. What specific services or capabilities go above and beyond the requirements of the scope.

ii. When each service or capability will be available to the State.

iii. How this service or capability would bring value to the State.

b. Please describe in detail all key staff positions that are proposed to work under this contract The descriptions should include:

i. Position title

ii. Functional title, role, and responsibilities (including subcontractor oversight, where applicable)

iii. Qualifications

iv. Minimum experience

v. Resume

vi. Three (3) professional references for each key staff member

c. Please describe in detail how you will maintain sufficient staffing for executive management, technical support services, and customer services.

d. Please acknowledge the need to obtain background checks for personnel as required and to remove or reassign staff at the State's request.

e. Please describe your expected subcontractors and the services they will provide, and how they will help you to provide the services required in this contract.

f. Please provide an organization chart for the staff that are proposed to work under this contract.

g. Please acknowledge the need for compliance with 42 CFR 438.230 and all subcontracting requirements detailed under Section IV.c.2.

7. Document Management (Section IV.d of Attachment K) Please address these Statement of Work Sections in their entirety. Within your response:

a. If applicable, provide a summary of value-add elements beyond the requirements of the Statement of Work that are fully included in the proposed price. The summary should include:

i. What specific services or capabilities go above and beyond the requirements of the scope.

ii. When each service or capability will be available to the State.

iii. How this service or capability would bring value to the State.

b. Please describe in detail your approach to submitting and maintaining documents in the State's electronic project library, including formatting, naming conventions, and version control.

c. Please describe in detail your approach to maintaining up-to-date documentation and submitting updates to the State as required.

8. Compliance Requirements (Section VI of Attachment K) Please address these Statement of Work Sections in their entirety. Within your response:

a. Please acknowledge your obligation to comply with any Independent Verification & Validation (IV&V) oversight or other verification and validation methods required by the State, and to provide all requested information and documentation in connection with such efforts.

b. Please acknowledge your obligation to comply with all applicable State and Federal laws and regulations.

9. Key Performance Indicators & Performance Standards (Section VI of Attachment K and Attachment N Performance Exhibit) Please address these Statement of Work Sections in their entirety. Within your response:

a. If applicable, provide a summary of value-add elements beyond the requirements of the Statement of Work that are fully included in the proposed price. The summary should include:

i. What specific services or capabilities go above and beyond the requirements of the scope.

ii. When each service or capability will be available to the State.

iii. How this service or capability would bring value to the State.

b. Please describe in detail your proposed approach to adhering to the following performance standards as detailed in the Scope of Work and Attachment N - Performance Standards:

i. Helpline Performance Standards.

ii. Member Education Performance Standards.

iii. Report Submissions Performance Standards.

iv. Staff Turnover Rate

c. Please acknowledge your obligation to monitor Helplines for fraud prevention, data gathering and quality improvement of services to members and providers.

d. Please acknowledge your obligation to comply with the requirements in Attachment N - Performance Exhibit

10. End of Contract Transition and Turnover (Section VII of Attachment K)

a. Please describe in detail your approach to the end of contract transition and turnover. The description should include:

i. How you will maintain continuation of services up to and including 11:59 PM ET on the termination date of the Contract or end date of the Contract in the event of a non-renewal or non-extension.

ii. How you will develop a transition plan that demonstrates an understanding of the scope and complexity of the outgoing transition activity.

iii. How you will maintain all communications and State access to data records through the transition.

iv. How you will maintain communication with the succeeding contractor and State as it pertains to the requirements.

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