RFP 27-88864

Pharmacy Benefits Administrator (PBA) Services Attachment F – Technical Proposal Instructions

Overview:

Request for Proposal (RFP) 27-88864 is a solicitation issued by the State of Indiana in which qualified organizations are invited to compete for a contract among 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, among other things, thoroughly address all components of the Statement of Work (SOW). 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.

Technical Proposal Components:

RFP 27-88864 Attachment K - SoW has multiple sections. Each section requiring a response corresponds with a prompt below. A Respondent’s Technical Proposal must address each of the prompts below, in order in a separate, written document.

A properly completed Technical Proposal is a requirement for proposal submission. Failure to complete and submit a concise Technical Proposal may impact your proposal’s evaluation.

Submission Specifications:

· The Technical Proposal should be limited to 200 pages, including any embedded graphics or charts.

· Attachments and exhibits may be provided in a separate file which will not count towards the page limit; 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 the gist of the separate exhibits and attachments. Any requested draft plans, resumes or charts may be attached and referenced in the Technical Proposal.

· It is the State's preference that the technical proposal components be submitted as single documents, however if the excessive file size is an issue the state will accept multiple documents. The State prefers to not navigate an excessive number of files during the review process.

Response Structure:

Please review the requirements in Attachment K - SoW carefully and address each section and requirement as prompted below. 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 are proposed to perform 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.

Clearly specify processes, approaches, tools, and frameworks proposed to be used in executing the work. Reference relevant industry standards and best practices in the response. In each relevant response area, clearly describe if and how you propose to deploy artificial intelligence (AI) or machine learning as a clearly marked response element.

TECHNICAL PROPOSAL SECTION A – Technology and Project Management In this Section, the Respondent should respond to Section III.A.4 of the Statement of Work.

Please explain how you propose to execute the described duties in their entirety, including but not limited to the specific elements outlined in sections III.A.4.1 through III.A.4.13 of the SOW. Please describe all the relevant experience you have in this regard. Please structure your response to address the specific sections in Section III.A.4 and cross reference your response to the applicable section (e.g., have a “III.A.4.9 Training” section in your Technical Proposal).

In the preparation of this Section A, please address the following questions/requests:

· 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:

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

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

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

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

· Explain how any aspect(s) of your proposal would be changed if the State elected to adopt either of the alternative scenarios (“Single PBA” or “Carve Out”) addressed in RFP Section III.A.11.3.3

· Provide a draft or sample plan regarding how you would manage the transition of this project from the incumbent Contractor, if applicable

· Provide a draft or sample Data Conversion Plan (as contemplated by Section III.A.4.6), if applicable

· Provide a proposed Training Plan or a substantive description of your contemplated Training Plan

· Provide a proposed Infrastructure Plan or a substantive description of your contemplated Infrastructure Plan

· Provide a proposed Business Continuity and Disaster Recovery Plan or a substantive description of your contemplated Business Continuity and Disaster Recovery Plan

· Provide a proposed plan for how you will adhere to the State’s Privacy and Security standards

· Provide detail on your proposed cost containment strategy

· Provide your proposed office location in adherence with the requirements of Section III.A.4.11.1

· Identify all components, systems, modules, test scenarios, and scenarios you propose to leverage or reuse from existing implementations, and explain how your solution incorporates such partnerships or existing solutions

· Clearly indicate if the requested system configurations will impact the solution’s ability to receive standard patches and upgrades as part of future routine maintenance and operations

· Disclose any prior Medicaid sanctions, audits, or Corrective Action Plans with Indiana or other states that you have been subjected to.

TECHNICAL PROPOSAL SECTION B – Function Requirements In this Section, the Respondent should respond to Section III.A.5 of the Statement of Work.

Please explain how you propose to execute the described duties in their entirety, including but not limited to the specific elements outlined in sections III.A.5.1 through III.A.5.9 of the SOW. Please describe all the relevant experience you have in this regard. Please structure your response to address the specific sections in Section III.A.5 and cross reference your response to the applicable section (e.g., have a “III.A.5.3 Communication Management” section in your Technical Proposal).

In the preparation of this Section B, please address the following questions/requests:

· 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:

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

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

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

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

· Explain how any aspect(s) of your proposal would be changed if the State elected to adopt either of the alternative scenarios (“Single PBA” or “Carve Out”) addressed in RFP Section III.A.11.3.3

· Provide a substantive overview of each function required by this section

TECHNICAL PROPOSAL SECTION C – Drug Claims Processing In this Section, the Respondent should respond to Section III.A.6 of the Statement of Work.

Please explain how you propose to execute the described duties in their entirety, including but not limited to the specific elements outlined in sections III.A.6.1 through III.A.6.5 of the SOW. Please describe all the relevant experience you have in this regard. Please structure your response to address the specific sections in Section III.A.6 and cross reference your response to the applicable section (e.g., have a “III.A.6.3 Pharmacy Claims Payment” section in your Technical Proposal).

In the preparation of this Section C, please address the following questions/requests:

· 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:

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

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

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

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

· Explain how any aspect(s) of your proposal would be changed if the State elected to adopt either of the alternative scenarios (“Single PBA” or “Carve Out”) addressed in RFP Section III.A.11.3.3

· Provide a comprehensive overview of the claims processing and payment function and any associated systems

· Provide a description of Respondent’s experience and proposed policies and procedures related to third-party liability

· Provide a description of Respondent’s accounting standards and its compliance with Section III.A.6.4

· Provide the proposed methodology for calculating Cost Avoidance Savings contemplated by Section III.A.6.5

TECHNICAL PROPOSAL SECTION D – Pharmacy Services In this Section, the Respondent should respond to Section III.A.7 of the Statement of Work.

Please explain how you propose to execute the described duties in their entirety, including but not limited to the specific elements outlined in sections III.A.7.1 through III.A.7.6 of the SOW. Please describe all the relevant experience you have in this regard. Please structure your response to address the specific sections in Section III.A.7 and cross reference your response to the applicable section (e.g., have a “III.A.7.2 Rebates – Medical Supply Items” section in your Technical Proposal).

In the preparation of this Section D, please address the following questions/requests:

· 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:

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

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

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

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

· Explain how any aspect(s) of your proposal would be changed if the State elected to adopt either of the alternative scenarios (“Single PBA” or “Carve Out”) addressed in RFP Section III.A.11.3.3

· Provide a description of experience you have working with bodies similar to those named in Section III.A.7 (e.g. the DUR Board)

· Provide a comprehensive overview of your rebate methodology, including past successes. Please ensure (in this overview and throughout the proposal) that there is a clear and consistent distinction drawn between rebates for diabetic supply items (or other medical supply items, as applicable) and drug rebates.

· Provide a description of your reporting support capabilities

TECHNICAL PROPOSAL SECTION E – Pharmacy Audits In this Section, the Respondent should respond to Section III.A.8 of the Statement of Work.

Please explain how you propose to execute the described duties in their entirety, including but not limited to the specific elements outlined in sections III.A.8.1 through III.A.8.8 of the SOW. Please describe all the relevant experience you have in this regard. Please structure your response to address the specific sections in Section III.A.8 and cross reference your response to the applicable section (e.g., have a “III.A.8.2 Desk Audit” section in your Technical Proposal).

In the preparation of this Section E, please address the following questions/requests:

· 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:

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

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

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

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

· Explain how any aspect(s) of your proposal would be changed if the State elected to adopt either of the alternative scenarios (“Single PBA” or “Carve Out”) addressed in RFP Section III.A.11.3.3

· Provide a comprehensive overview of your audit methodology and strategy, including a detailed discussion of how the audit program shall coordinate with the State and its audit vendor(s) (including the method of coordination and anticipated follow-up), identify candidates for audit, the appeal process, how provider communication is managed, and how recoupment is handled

TECHNICAL PROPOSAL SECTION F – Rate Setting In this Section, the Respondent should respond to Section III.A.9 of the Statement of Work.

Please explain how you propose to execute the described duties in their entirety, including but not limited to the specific elements outlined in sections III.A.9.1 through III.A.9.2 of the SOW. Please describe all the relevant experience you have in this regard. Please structure your response to address the specific sections in Section III.A.9 and cross reference your response to the applicable section (e.g., have a “III.A.9.2 MAC Rates for covered OTC Drugs, Pharmacy Supplements, Drug Related Medical Supplies, and Specified Non-Drug Pharmacy Products” section in your Technical Proposal).

In the preparation of this Section F, please address the following questions/requests:

· 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:

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

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

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

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

· Explain how any aspect(s) of your proposal would be changed if the State elected to adopt either of the alternative scenarios (“Single PBA” or “Carve Out”) addressed in RFP Section III.A.11.3.3

· Provide a description of your experience and proposed plan to perform all rate setting activities contemplated by Section III.A.9

TECHNICAL PROPOSAL SECTION G – Management Reporting and Other Responsibilities In this Section, the Respondent should respond to Section III.A.10 of the Statement of Work.

Please explain how you propose to execute the described duties in their entirety, including but not limited to the specific elements outlined in sections III.A.10.1 through III.A.10.2 of the SOW. Please describe all the relevant experience you have in this regard. Please structure your response to address the specific sections in Section III.A.10 and cross reference your response to the applicable section (e.g., have a “III.A.10.2 Contractor Requirements” section in your Technical Proposal).

In the preparation of this Section G, please address the following questions/requests:

· 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:

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

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

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

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

· Explain how any aspect(s) of your proposal would be changed if the State elected to adopt either of the alternative scenarios (“Single PBA” or “Carve Out”) addressed in RFP Section III.A.11.3.3

TECHNICAL PROPOSAL SECTION H– “Specialty Pharmacy” Services; E-Prescribing and Health Information Technology; Pharmacy Providers Billing HCPCS-Coded Services In this Section, the Respondent should respond to Section III.A.11 of the Statement of Work.

Please explain how you propose to execute the described duties in their entirety, including but not limited to the specific elements outlined in sections III.A.11.1 through III.A.11.3 of the SOW. Please describe all the relevant experience you have in this regard. Please structure your response to address the specific sections in Section III.A.11 and cross reference your response to the applicable section (e.g., have a “III.A.11.2 Pharmacy Providers Billing HCPCS-Coded Services” section in your Technical Proposal).

In the preparation of this Section H, please address the following questions/requests:

· 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:

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

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

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

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

· Explain how any aspect(s) of your proposal would be changed if the State elected to adopt either of the alternative scenarios (“Single PBA” or “Carve Out”) addressed in RFP Section III.A.11.3.3

· Regarding Section III.A.11.1, please discuss any preliminary recommendations regarding the State’s “as is” e-prescribing environment and how it could and/or should be chanted to align with industry best practices

· Regarding Section III.A.11.2.1, please describe your proposed approach towards receiving and processing Physician Administered Drug (PAD) claims, should the State elect to implement a PAD processing program

· Regarding Section III.A.11.3.1, please describe your proposed approach to enacting a prescription refill synchronization program, should the State elect to implement such services

· Regarding Section III.A.11.3.2, please describe your proposed approach to enacting a Medication Therapy Management program, should the State elect to implement such services

TECHNICAL PROPOSAL SECTION I – Key Persons and Other Project Staff In this Section, the Respondent should respond to Sections IV.b and IV.c of the Statement of Work.

Please explain how you propose to execute the described duties in their entirety, including but not limited to the specific elements outlined in sections IV.b through IV.c of the SOW. Please describe all the relevant experience you have in this regard. Please structure your response to address the specific sections in Sections IV.b and IV.c and cross reference your response to the applicable section (e.g., have a “IV.b.13 Human Resource Management”).

In the preparation of this Section I, please address the following questions/requests:

· 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:

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

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

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

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

· 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:

· Position title.

· Functional title.

· Role and contribution to specific functional requirements and deliverables.

· Other responsibilities (including subcontractor oversight, where applicable).

· Minimum qualifications.

· Minimum experience.

· Please describe in detail your staffing plan for this work. The description should include a breakdown, by staff position, of:

· Number of individual staff members (distinguished between Contractor staff and subcontractor staff).

· Total FTE-equivalent staffing levels (distinguished between Contractor staff and subcontractor staff).

· Provide proposed candidates for all Key Personnel positions listed in Section IV.b as well as any proposed candidates for the Other Personnel listed in Section IV.c. For each candidate please provide a CV or resume.

· Explain how any aspect(s) of your proposal would be changed if the State elected to adopt either of the alternative scenarios (“Single PBA” or “Carve Out”) addressed in RFP Section III.A.11.3.3

TECHNICAL PROPOSAL SECTION J – Status Updates and Reporting In this Section, the Respondent should respond to Section IV.e of the Statement of Work.

Please explain how you propose to execute the described duties in their entirety, including but not limited to the specific elements outlined in section IV.e of the SOW. Please describe all the relevant experience you have in this regard. Please structure your response to address the specific sections in Section IV.e and cross reference your response to the applicable section (e.g., have a “IV.e.17 Pharmacy Program Information Management”).

In the preparation of this Section J, please address the following questions/requests:

· 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:

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

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

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

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

· Explain how any aspect(s) of your proposal would be changed if the State elected to adopt either of the alternative scenarios (“Single PBA” or “Carve Out”) addressed in RFP Section III.A.11.3.3

· Provide a description of how you propose to periodically improve the Business and Quality Assurance Plan, as well as any other efforts for ongoing or continuous process improvements.

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