Attachment_6_3_Cos_Proposal.xlsx
XLSX spreadsheet 41 KB Posted
- Attached to
- Employee Assistance Program (EAP) and Behavioral Health Organization (BHO) Services - UPDATED
- Solicitation number
- RFP 31786-00188
- Issued by
- Davidson County, Tennessee
About this file
This is a Cost Proposal document for the State of Tennessee's Behavioral Health Organization (BHO) and Employee Assistance Program (EAP) contract opportunity, covering services for state and local government employees, higher education institutions, and their dependents. The contract will run from January 1, 2027 through December 31, 2031, with administrative services only (ASO) fees for behavioral health and EAP services. The solicitation involves a comprehensive evaluation process using Aon as the financial analysis consultant to assess vendor proposals across multiple dimensions including network discounts, claims costs, and administrative fees.
The financial evaluation methodology involves a four-step model that uses baseline claims data, applies vendor-specific network discounts, trends claims costs, and calculates total projected costs. Vendors must submit detailed pricing information for behavioral health ASO fees, EAP ASO fees, and optional fully insured EAP fees across five contract years. The state will allocate 30 points to the financial evaluation, with the lowest total cost vendor receiving maximum points. Key financial assumptions include a 7% facility trend and 8.5% procedure trend, and vendors are required to provide extensive claims and membership data for national and Tennessee-specific commercial book of business to support the evaluation process.
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Instructions & Signature
| COST PROPOSAL & SCORING GUIDE |
| NOTICE: THIS COST PROPOSAL MUST BE COMPLETED EXACTLY AS REQUIRED |
| COST PROPOSAL SCHEDULE— The Cost Proposal, detailed below, shall indicate the proposed price for goods or services defined in the Scope of Services of the RFP Attachment 6.6., Pro Forma Contract and for the entire contract period. The Cost Proposal shall remain valid for at least one hundred twenty (120) days subsequent to the date of the Cost Proposal opening and thereafter in accordance with any contract resulting from this RFP. All monetary amounts shall be in U.S. currency and limited to two (2) places to the right of the decimal point. |
This pricing schedule must be completed in full. Do not skip any cells. If the Respondent fails to detail all cost information for the services proposed as required, the State may determine the proposal to be non-responsive and reject it. Enter numeric figures only. Anything else, including blank cells or any deviated text, will be considered as a zero (0) and will be a cost of zero (0) to the State. The State cannot accept "N/A".
Respondents must complete the required information on the following tabs of this workbook:
� ASO Fees and Claims � National � State of TN
Instructions are included on each tab.
Data submitted on the "National" and "State of TN" tabs will be shared with Aon in order to calculate the projected discounted allowed claims costs. The results of Aon's analysis will be provided to the RFP coordinator who will then add the ASO fees to calculate total costs. The State will convert the total costs into point allocations.
If the sum of the Evaluation Cost on a table equals zero, the Respondent will receive the maximum section score in the table. In this scenario, the State will use one cent (.01) in the formula listed in the table as the 'lowest evaluation cost amount from all proposals" to calculate all other proposals' point allocations
| NOTICE: | The Evaluation Factor associated with each cost item is for evaluation purposes only. The evaluation factors do NOT and should NOT be construed as any type of volume guarantee or minimum purchase quantity. The evaluation factors shall NOT create rights, interests, or claims of entitlement in the Respondent. |
| Notwithstanding the cost items herein, pursuant to the second paragraph of the Pro Forma Contract section C.1. (refer to RFP Attachment 6.6.), “The State is under no obligation to request work from the Contractor in any specific dollar amounts or to request any work at all from the Contractor during any period of this Contract.” | |
| This Cost Proposal must be signed, in the space below, by an individual empowered to bind the Respondent to the provisions of this RFP and any contract awarded pursuant to it. If said individual is not the President or Chief Executive Officer, this document must attach evidence showing the individual’s authority to legally bind the Respondent. | |
| RESPONDENT SIGNATURE: | |
| PRINTED NAME & TITLE: | |
| DATE: |
Financial Analytic Model Financial Evaluation
The State has assigned a total of thirty (30) points to the financial evaluation, which includes the Administrative Services Only (ASO) fees, Opt In EAP Fully Insured fees, and network discounts for providers and facilities.
| Description of the Financial Analytic Model |
| Conceptual Overview |
The State will utilize Aon for the cost proposal evaluation. Aon has established a methodology to evaluate the proposals in an objective manner, to factor in future trends and to calculate the total cost related to the BHO/EAP Program’s (the Program) vendor. This supplement explains how Aon and the State will use the model in its evaluation of each proposal.
| There are four steps in the model: |
| 1. The base data from the existing vendor is used to determine eligible claims under the current program. |
| 2. Each bidder's specific pricing terms are applied to get to the overall allowed claims to the State. |
| 3. The allowed claims are trended to the RFP time period. |
| 4. Aon will send these allowed claims to the RFP coordinator who will then add the ASO fees to calculate total costs. |
Estimating the cost impact
The first step in getting the baseline claims costs is to use the eligible claims data from the existing vendor. Baseline claims are incurred January 2024 to December 2024 and paid by December 2025.
The second step is to calculate the allowed claims by applying each bidder's specific network discount to the baseline eligible claims for in network claims. For the providers that are considered out of network based on the disruption analysis provided in RFP ATTACHMENT 6.2., SECTION D, PART 3, no discount will be applied to the claims.
The third step is to trend the allowed claims to the years 2027 through 2031. Aon will use the following table as the basis for assumptions in trending the utilization:
Table 1 - Trend Assumptions
| Trend | |
| Facility | 7.00% |
| Procedure (EAP and non-EAP) | 8.50% |
The resulting discounted allowed claims costs will be added to the vendor’s proposed ASO fees to determine the total projected cost.
See the "National" and "State of TN" tabs for the required data to be submitted.
| Financial Model Output |
| Aon’s financial analytic model will deliver the following results to the State. Aon will send these claims costs to the RFP coordinator who will then add the ASO fees to calculate total costs. The State will convert the total costs into point allocations. The lowest total cost vendor will receive the maximum points for this section of the cost proposal. |
| Plan Year | Projected Discounted Allowed Claims Amounts | |||
| Vendor #1 | Vendor #2 | Vendor #3 | Vendor #4 |
| 1/1/2027 – 12/31/2027 | $ | $ | $ | $ | ||
| 1/1/2028 – 12/31/2028 | $ | $ | $ | $ | ||
| 1/1/2029 – 12/31/2029 | $ | $ | $ | $ | ||
| 1/1/2030 – 12/31/2030 | $ | $ | $ | $ | ||
| 1/1/2031 – 12/31/2031 | $ | $ | $ | $ | ||
| Total Projected Discounted Allowed Claims* | Sum of Years | |||||
| 2027-2032 | Sum of Years | |||||
| 2027-2032 | Sum of Years | |||||
| 2027-2032 | Sum of Years |
2027-2032
*Total Projected Discounted Allowed Claims is the sum of Employee copays, deductible and coinsurance and claim payments made by the State of Tennessee.
| Time Value of Money |
| We will NOT factor in the time value of money in calculating the 5-year value of the proposal. In other words, we will assume that a dollar in 2031 is the same as a dollar in 2027. |
ASO Fees, FI Fees, and Claims RFP Attachment 6.3
| Table A - BH and EAP ASO Fees |
| 1. Provide Behavioral Health (BH) Administrative Services Only (ASO) PEPM fees for enrolled active State and Higher Education, Local Education, and Local Government employees/retirees (including COBRA) and their enrolled dependents. This should include all costs to deliver all the behavioral health services outlined in the Scope of Services of the RFP Attachment 6.6., Pro Forma Contract, except actual BH claim payments to covered persons. |
The BH ASO fees PEPM multiplied by the actual number of enrolled employees/retirees (or heads of contract), including COBRA, for the billing month will generate the Contractor’s total monthly BH ASO fees payment.
2. Provide Employee Assistance Program (EAP) Administrative Services Only (ASO) PEPM fees for EAP services for:
- State and Higher Education active employees/retirees (including COBRA) enrolled in a medical plan and their enrolled dependents;
- State and Higher Education active employees eligible for, but not enrolled in, a medical plan and their eligible dependents;
- Local Education and Local Government employees/retirees (including COBRA) enrolled in a medical plan and their enrolled and/or eligible dependents (if the head of contract is enrolled).
This should include all costs to deliver the EAP services outlined in the Scope of Services of the RFP Attachment 6.6., Pro Forma Contract, except actual EAP claim payments to covered persons.
The EAP ASO fees PEPM multiplied by the actual number of State and Higher Education active employees/retirees (including COBRA) enrolled in a medical plan, State and Higher Education active employees eligible for but not enrolled in a medical plan, as well as Local Education and Local Government employees/retirees (including COBRA) enrolled in a medical plan, for the billing month, will generate the Contractor’s total monthly EAP ASO fees payment.
For reference, the current number of employees/retirees (heads of contract) as well as the total number of members are available in Appendices 7.4, 7.5, and 7.6.
Administrative Services Only (ASO) fees calculations: Respondent shall fill out columns B, C, D, E, and F with the applicable BH and EAP Administrative Services Only (ASO) PEPM fees. The Solicitation Coordinator will sum Columns B, C, D, E,and F (Column G) and multiply it by twelve (12) (Column H) for an Evaluation Cost (Column I). The Solicitation Coordinator will then sum Column I for a total (I10).
| TOTAL FEE PER EMPLOYEE PER MONTH (PEPM) BY CONTRACT PERIOD | State Use Only | |||||||
| 1/1/2027 – 12/31/2027 | 1/1/2028 – 12/31/2028 | 1/1/2029 – 12/31/2029 | 1/1/2030 – 12/31/2030 | 1/1/2031 – 12/31/2031 | SUM (Columns B, C, D, E, and F) | Multiplication | Evaluation Cost |
(SUM x Multiplication)
| BH ASO fees (PEPM) | $ XX.XX | $ XX.XX | $ XX.XX | $ XX.XX | $ XX.XX | PEPM total | 12 | Total (Column G x H ) |
| EAP ASO fees (PEPM) | $ XX.XX | $ XX.XX | $ XX.XX | $ XX.XX | $ XX.XX | PEPM total | 12 | Total (Column G x H ) |
| TOTAL |
| Table B - Opt In EAP Fully Insured Fees |
| 1. Provide Employee Assistance Program (EAP) Fully Insured PEPM fees for EAP services for: |
- Local Education and Local Government agencies who opt to provide Fully Insured EAP services to active employees not enrolled in a medical plan.
This should include all costs to deliver the EAP services outlined in the Scope of Services of the RFP Attachment 6.6., Pro Forma Contract, including actual EAP claim payments to covered employees.
The EAP Fully Insured fees PEPM multiplied by the actual number of participating Local Education and Local Government agencies that opt to provide Fully Insured EAP services to active employees not enrolled in a medical plan, for the billing month, will generate the Contractor’s total monthly EAP Fully Insured fees payment.
For reference, the approximate current number of employees of all Local Education and Local Government agencies that are not enrolled in medical are available in Appendix 7.13.
EAP Fully Insured fees calculations: Respondent shall fill out columns B, C, D, E, and F with the applicable EAP Fully Insured PEPM fees. The Solicitation Coordinator will sum Columns B, C, D, E,and F (Column G) and multiply it by twelve (12) (Column H) for an Evaluation Cost (Column I). The Solicitation Coordinator will then sum Column I for a total (I18).
| TOTAL FEE PER EMPLOYEE PER MONTH (PEPM) BY CONTRACT PERIOD | State Use Only | |||||||
| 1/1/2027 – 12/31/2027 | 1/1/2028 – 12/31/2028 | 1/1/2029 – 12/31/2029 | 1/1/2030 – 12/31/2030 | 1/1/2031 – 12/31/2031 | SUM (Columns B, C, D, E, and F) | Multiplication | Evaluation Cost |
(SUM x Multiplication)
| EAP Fully Insured fees (PEPM) | $ XX.XX | $ XX.XX | $ XX.XX | $ XX.XX | $ XX.XX | PEPM total | 12 | Total (Column G x H ) |
| TOTAL | ||||||||
| Table C - Claims | ||||||||
| Respondents must complete the required information on the "National" and "State of TN" tabs of this workbook. This information will be submitted to the State’s actuarial and benefits consultant, Aon. Aon will then supply the State with a Total Projected Discounted Allowed Claims Amount for years 2027-2031 for each Respondent to this RFP based on their analysis (refer to the Financial Analytic Model tab). | ||||||||
| State Use Only | ||||||||
| 1/1/2027 – 12/31/2027 | 1/1/2028 – 12/31/2028 | 1/1/2029 – 12/31/2029 | 1/1/2030 – 12/31/2030 | 1/1/2031 – 12/31/2031 | SUM (Columns B, C, D, E, and F) | |||
| Total Projected Discounted Allowed Claims Amounts | To be populated with Aon Results | To be populated with Aon Results | To be populated with Aon Results | To be populated with Aon Results | To be populated with Aon Results | Projected Discounted Allowed Claims Total | ||
| Total Cost Score | ||||||||
| STATE USE ONLY |
The Solicitation Coordinator shall sum the totals from Tables A and B above to calculate the Total Cost Score.
Calculations shall result in numbers rounded to two decimal places.
| Table A Score - BH and EAP ASO Fees | |
| Table B Score - Opt In EAP Fully Insured Fees | |
| Table C Score - Claims | |
| Total Cost Score | 0.00 |
| The Solicitation Coordinator will use the Total Cost Score shown above and use the formula below to calculate the Cost Proposal Score. Numbers rounded to two (2) places to the right of the decimal point will be standard for calculations. | |
| Lowest Total Cost Score from all proposals |
Total Cost Score being evaluated x 30 (maximum section score)
= COST PROPOSAL SCORE:
State Use – Solicitation Coordinator Signature, Printed Name & Date:
Data Definitions
DATA DEFINITIONS
Provide the following pricing data, which will allow the State to benchmark Respondents’ overall total costs against one another. This applies to the "National" and "State of TN" tabs included in this workbook.
| Source of Data Requested |
| Include all claims incurred (service dates) on an in-network basis from January 1, 2024 through December 31, 2024 paid through December 31, 2025. Summarize the data as shown in the "National" and "State of TN" tabs. Do not provide individual claims records. Include all claims for your entire book-of-business (in-network) with National data (National tab) and member home ZIP codes in Tennessee (State of TN tab). |
| Financial Data Definitions |
| Eligible Claims — Billed Charges less any amount determined to be ineligible under the terms of the plan. |
| Allowed Claims — The total amount paid to the provider including any member copays, coinsurance, or other cost sharing. |
| Data Inclusions |
| (1) Group commercial block of business only (do not include Medicare, Medicaid, etc.); |
| (2) Only in-network claims should be included (In-network claims are defined as claims paid according to the in-network benefit level using contracted providers); |
| (3) Claims paid through rental networks if they are normally part of the product offerings; |
| (4) All claims, regardless of dollar amount (do not exclude high dollar claims); and |
| (5) All EAP counseling claims. |
| Data Exclusions |
| (1) Client-specific networks that are not generally available to other clients; |
| (2) Services/encounters that are capitated; |
| (3) Outpatient prescription drugs; |
| (4) Claims for people equal to and over age 65 and Medicare eligible, where age is defined as difference between birth date and service date; and |
| (5) Claims where carrier is the secondary payer. |
| Book of Business Definitions |
| Average Monthly Membership - Average number of enrolled members per month. |
| Average Monthly Contracts in Force - Average number of contracts in place with employers, plan sponsors, and clients per month. |
| Data Delivery |
| Data should be provided in Excel format, using this workbook as a basis for your submission's format and following all instructions contained in this workbook and relevant instructions included in the main body of the RFP. |
National Financial Information - National
1. To illustrate the impact of network contracts for professional services, provide the total allowed claims for January 1, 2024 to December 31, 2024 compared against the total eligible claims for the key procedure codes for your network for the national commercial book of business.
| National Commercial Book of Business | |||
| Procedure Code | Procedure Code Description | Total Eligible Claims | Total Allowed Claims |
| 90791 | Psychiatric diagnostic evaluation without medical services | ||
| 90792 | Psychiatric diagnostic evaluation with medical services | ||
| 90833 | Psychotherapy, 30 minutes | ||
| 90834 | Psychotherapy, 45 minutes | ||
| 90837 | Psychotherapy, 60 minutes | ||
| 90847 | Family Psychotherapy | ||
| 90868 | Transcranial magnetic stimulation (TMS) | ||
| 97151 | Behavior identification assessment | ||
| 97153 | Adaptive Behavior Treatment by Protocol | ||
| 97155 | Adaptive Behavior Treatment with Protocol Modification | ||
| 99213 | Established Patient, Low Complexity | ||
| 99214 | Established Patient, Moderate Complexity | ||
| 99215 | Established Patient, High Complexity | ||
| H0020 | Alcohol and/or drug services; methadone administration and/or service | ||
| H0047 | Alcohol and/or other drug abuse services, not otherwise specified |
2. To illustrate the impact of network contracts for facility services, provide the total allowed claims for January 1, 2024 to December 31, 2024 compared against the total eligible claims for your network for the national commercial book of business.
| National Commercial Book of Business | ||
| Facility | Total Eligible Claims | Total Allowed Claims |
| Acute Inpatient facility | ||
| Residential facility | ||
| Other facility (include partial hospitalization, intensive outpatient, and halfway house/recovery home treatment centers) |
3. To illustrate total utilization and participation, provide the following national membership statistics.
| National Commercial Book of Business | |
| Average Monthly Membership | Average Monthly Contracts in Force |
State of TN Financial Information - Tennessee
1. To illustrate the impact of network contracts for professional services, provide the total allowed claims for January 1, 2024 to December 31, 2024 compared against the total eligible claims for the key procedure codes for your network for commercial members with a home ZIP code in the State of Tennessee.
| National Commercial Book of Business | |||
| Procedure Code | Procedure Code Description | Total Eligible Claims | Total Allowed Claims |
| 90791 | Psychiatric diagnostic evaluation without medical services | ||
| 90792 | Psychiatric diagnostic evaluation with medical services | ||
| 90833 | Psychotherapy, 30 minutes | ||
| 90834 | Psychotherapy, 45 minutes | ||
| 90837 | Psychotherapy, 60 minutes | ||
| 90847 | Family Psychotherapy | ||
| 90868 | Transcranial magnetic stimulation (TMS) | ||
| 97151 | Behavior identification assessment | ||
| 97153 | Adaptive Behavior Treatment by Protocol | ||
| 97155 | Adaptive Behavior Treatment with Protocol Modification | ||
| 99213 | Established Patient, Low Complexity | ||
| 99214 | Established Patient, Moderate Complexity | ||
| 99215 | Established Patient, High Complexity | ||
| H0020 | Alcohol and/or drug services; methadone administration and/or service | ||
| H0047 | Alcohol and/or other drug abuse services, not otherwise specified |
2. To illustrate the impact of network contracts for facility services, provide the total allowed claims for January 1, 2024 to December 31, 2024 compared against the total eligible claims for your network for commercial members with a home ZIP code in the State of Tennessee.
| National Commercial Book of Business | ||
| Facility | Total Eligible Claims | Total Allowed Claims |
| Acute Inpatient facility | ||
| Residential facility | ||
| Other facility (include partial hospitalization, intensive outpatient, and halfway house/recovery home treatment centers) |
3. To illustrate the relative utilization and participation, provide the following membership statistics for the State of Tennessee.
| National Commercial Book of Business | |
| Average Monthly Membership | Average Monthly Contracts in Force |
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