Att F Technical Proposal.docx

RFP 26-87847

Healthcare Programs External Quality Review RFP Attachment F - Technical Proposal Response Instructions

Overview:

Request for Proposal (RFP) 26-87847 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 may 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 L Statement of Work:

1. Mandatory EQR Activities (Sections III.a.ii. and III.a.iii. of Attachment L)

2. Additional Required EQR Activities (Section III.a.iv. of Attachment L)

3. Other Scope Requirements (Sections III.a.i.1, III.a.v., III.a.vi., and III.a.vii. of Attachment L)

4. Reports/Deliverables (Sections III.a.ii.1, III.a.viii., and IV.e. of Attachment L)

5. Staffing (Section IV.b. of Attachment L)

6. Project Management/Planning (Sections IV.a.i., IV.a.ii., and VIII. of Attachment L)

Submission Specifications:

Technical proposals have specifications as listed in Section 2.4 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 100 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.iii. Mandatory EQR Activities Overview should have a “III.a.iii.1. Validation of Performance Measures,” section clearly laid out and structured.

Response Structure:

Please review the requirements in Attachment L (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 L 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.

Where applicable, clearly describe your approach to collaboration with the State and the State’s MCOs. Clearly specify processes, approaches, tools, and frameworks proposed to be used in executing the work. In each relevant response area, clearly describe if and how you propose to deploy artificial intelligence (AI) or machine learning (ML) as a clearly marked response element. Any proposed AI/ML use must undergo the State AI Readiness Assessment, follow the AI Policy and Agency AI Systems Standard, and include submitted/approved artifacts prior to implementation.

External Quality Review RFP Technical Proposal Questions

1. Mandatory EQR Activities (Sections III.a.ii. and III.a.iii. of Attachment L) 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 describe in detail your specific experience conducting EQR Activities for Medicaid managed care programs. This description should include:

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

ii. Your proposed strategies to reduce administrative burden for the State and its MCOs.

iii. Your knowledge of EQR as described in federal regulations.

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

c. Please describe in detail your experience conducting Performance Measure Validation as specified in federal regulations. The description should include:

i. Your validation processes for non-standardized performance measures.

ii. Your methodology for validating performance measures where data must be integrated across Medicare and Medicaid secondary crossover claims.

iii. Your knowledge of Medicaid and managed care data systems including claims/encounter data.

d. Please describe in detail your experience conducting Performance Improvement Project (PIP) Validation. The description should include:

i. Your knowledge of quality management and quality improvement strategies.

ii. Your processes for obtaining performance improvement information from MCOs.

iii. Your proposed role in developing tools for MCOs to report quality improvement projects.

iv. Your process/rubric for evaluating performance improvement projects.

v. Any technical assistance you offer to MCOs in the design and implementation of projects.

e. Please describe in detail your experience conducting Compliance Review consistent with federal regulations and with the quality assessment and performance improvement requirements described in federal regulations. This description should include:

i. Your familiarity with the quality assessment and performance improvement requirements described in federal regulations.

ii. Your proposed approach to conducting compliance reviews.

iii. Your approach to Medicare 'Non-Duplication' protocols, including a description of how you will leverage Medicare Advantage audits or Model of Care evaluations to reduce burden on PathWays MCOs, while ensuring Indiana-specific Medicaid elements are still rigorously reviewed.

iv. Your approach to evaluating MCO compliance with Unified Appeals and Grievances regulations. Your response must include detail on how your case file review will verify that the MCO utilized the most beneficiary-favorable timelines and notice languages spanning both Medicare and Medicaid benefits.

v. Your approach to ensuring compliance with federal Model of Care (MOC) requirements, including the validation of integrated Health Risk Assessments (HRAs) and Interdisciplinary Care Team (ICT) composition for the dual-eligible and MLTSS populations.

vi. Your strategy for validating MCO compliance with mandated Care Coordinator caseload ratios and ensuring that care coordination is actively delivered rather than passively logged.

vii. Your process for auditing Critical Incident Management Systems. Detail how you will use data-mining (e.g., cross-referencing emergency department claims for fractures, sepsis, or decubitus ulcers) to identify under-reported or unmanaged critical incidents within the PathWays program.

f. Please describe in detail your approach to conducting Network Adequacy Validation, including programs or technologies you use or have used to conduct Network Adequacy Validation activities. The description should include:

i. Your familiarity with network adequacy requirements as set forth in federal and Indiana regulations.

ii. Your methodology for validating the capacity and adequacy of Home and Community-Based Services (HCBS) networks (e.g., attendant care, home-delivered meals, adult day services, etc.) where providers travel to the member, including your approach to identifying gaps in services.

iii. Your experience conducting GeoAccess validation and reporting, including the programs or technologies you propose to use to perform geospatial network adequacy analyses.

g. Please describe in detail your experience conducting Secret Shopper surveys as specified in federal regulations. The description should include:

i. Your familiarity with provider directory requirements and appointment wait time requirements under federal regulations.

ii. Your experience evaluating the accuracy of MCO provider directories in accordance with federal regulations.

iii. Your experience conducting provider access and appointment availability surveys in accordance with federal regulations.

iv. Your experience tailoring surveys to to verify provider dual-eligibility, including verifying that listed providers are actively accepting both Medicare and Medicaid, and are accepting new members under the PathWays program?

v. Your approach to performance measure calculation and reporting.

2. Additional Required EQR Activities (Section III.a.iv. of Attachment L) 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.

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

b. Please describe in detail your proposed approach to performing the validation of MCO encounter data. The description should include:

i. Your sampling approach(es) for data validation and analysis activities.

ii. Discussion of any encounter data completeness issues you have identified in other States and how you assisted in resolving these issues.

iii. Your technical approach to validating Medicaid crossover encounter data (where Medicare pays primary and Medicaid pays the cost-sharing balance). This must include a discussion of how you identify and resolve systemic issues regarding the 'lesser-of' payment logic in MCO systems.

c. Please describe in detail your approach to performing focused studies of health care quality. The description should include:

i. Your approach to plan development and data collection.

ii. Your specific experience conducting EQR and/or quality oversight activities for Integrated Care Programs serving dual eligibles, specifically Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs) and Managed Long-Term Services and Supports (MLTSS).

iii. Your specific methodology for evaluating the quality, effectiveness, and fidelity of Person-Centered Service Plans (PCSPs) for MLTSS and dual-eligible populations.

d. Please describe in detail your skills, knowledge and experience with developing Medicaid Quality Rating Systems (QRS). The description should include:

i. Your knowledge of the CMS QRS framework, methodology, and performance measures, including alignment with the qualified health plan QRS under federal regulations.

ii. Examples of any previous work in this area has been conducted within the last five years.

e. Please describe in detail your proposed approach to evaluating and providing recommendations for modifying Indiana Medicaid Quality Strategy based on EQR findings. The description should include:

i. How this approach has demonstrated success in other states.

3. Other Scope Requirements (Sections III.a.i.1, III.a.v., III.a.vi., and III.a.vii. of Attachment L) 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 describe in detail your experience and approach to providing technical assistance, including but not limited to the areas described in Section III.a.i.1. The description should include:

i. How you connect monitoring findings to technical assistance and broader quality improvement, including your ability to assist the State and its MCOs in achieving overall improvements.

ii. Examples of technical assistance that encourage proposing alternative, creative methods for technical assistance activities clearly based on review results, and consider technological tools and best practices from other states operating Medicaid Managed Care programs, applicable research, and current CMS guidance.

c. Please describe in detail your approach to performing the Information Systems Capabilities Assessment (ISCA) activity. The description should include:

i. Assessment finding issues you have identified in other states and how you have assisted the state to resolve these issues.

d. Please describe in detail the contents and scope of the quality improvement education program you offer. The description should include:

i. Your approach to engaging MCOs through workshops, trainings, and ongoing collaboration.

ii. Your approach to the early identification of issues that may be the subject of workshops and training.

iii. How MCO Corrective Action Plans can be used as a basis for identifying workshop and training content.

e. Please describe in detail how you plan to conduct case management services analysis.

f. Please describe in detail your proposed approach to supporting MCO readiness reviews. The description should include:

i. Your development of EQR-related review guide(s) by operational area, and pre-onsite, onsite and post-onsite activities, including the development of findings and recommendations.

ii. How you have successfully collaborated with other contractors in the performance of readiness reviews.

iii. Your specific experience evaluating plan readiness for FIDE SNP or MLTSS market entry, including your evaluation tools for checking an MCO's readiness to administer integrated Medicare/Medicaid benefits from day one.

g. Please describe in detail your proposed approach to applying MCO Corrective Action Plans (CAPs). The description should include:

i. Your approach to monitoring Corrective Action Plans (CAPs), identifying issues, and supporting risk management.

ii. An example and description of how this approach has demonstrated success in another state.

h. Please acknowledge that FSSA may require that the Contractor conduct additional EQR-related projects that it deems necessary to support EQR activities or EQR processes.

i. Confirm your compliance with all applicable Indiana Statewide IT Policies, Procedures & Standards, including security requirements listed in SOW Section VI, and describe your approach to meeting NDA and access control requirements.

4. Reports/Deliverables (Sections III.a.ii.1, III.a.viii., and IV.e. of Attachment L) 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 provide an example MCO-specific Report Card and describe how it aligns with the acceptance criteria specified in SOW Section III.a.ii.1.

c. Please provide an example Findings Report.

d. Please provide an example MCO performance Summary Report.

e. Please provide an example Data Workbook structure.

f. Please describe in detail your skills, knowledge and experience with External Quality Review Annual Technical reports. The description should include:

i. Aspects of the analyses and report production activities that you will conduct.

ii. Your approach to developing visuals and/or dashboards to summarize findings.

iii. A list of example annual technical reports completed over the last five years.

iv. Two annual technical reports completed within the last five years to demonstrate previous work in this area.

g. Please provide the most recent available EQRO annual technical report you have submitted. The report can be included as a standalone PDF file.

h. Please describe in detail your proposed approach to analyzing, synthesizing, and presenting information in a legislative summary report, in a way that ensures the result is concise, clear, and useful for all parties.

i. Please describe in detail your approach to designing, developing, and implementing reports. The description should include:

i. How you approach certifying submitted data and reports.

ii. Your capabilities to produce ad-hoc reports as may be requested by a state client.

5. Staffing (Section IV.b. of Attachment L) 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.

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

b. Please describe in detail all staff positions that are proposed to work under this contract, broken out by Contractor staff and subcontractor staff. The descriptions should include:

i. Position title.

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

iii. Qualifications.

iv. Minimum experience.

c. Please describe in detail your staffing plan for this work. The description should include:

i. A breakdown, by month, for an annual cycle, including positions, number of individual staff (distinguished between Contractor staff and subcontractor staff), and total FTE-equivalent staffing levels (distinguished between Contractor staff and subcontractor staff).

ii. Specific individual names, if available, by position.

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

e. Please describe in detail all training staff must complete, including role-specific and general training.

6. Project Management/Planning (Sections IV.a.i., IV.a.ii., and VIII. of Attachment L) 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 provide a proposed EQR Activity Workplan, including each EQR Activity consistent with Section IV.a.i.

c. Please describe in detail how you would propose transitioning key tasks and responsibilities to the Contactor from the current EQR vendor over the implementation period with minimal impact to project operations. The description should include:

i. An example Implementation Plan from another project.

d. Please describe in detail how you would propose transitioning key tasks and responsibilities from the Contactor to a new EQR vendor with minimal impact to project operations. The description should include:

i. An example of an outgoing Transition Plan from another project.

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