DMS-2223-072 HMO ITN.pdf

4050 Esplanade Way Tallahassee, FL 32399-0950

850-488-2786

Ron DeSantis, Governor Pedro Allende, Secretary

INVITATION TO NEGOTIATE

FOR

Third Party Administrative Services for

HMO Health Insurance

ITN NO: DMS-22/23-072

THE STATE OF FLORIDA

DEPARTMENT OF MANAGEMENT SERVICES

Procurement Officer: Greg Hill Departmental Purchasing

Florida Department of Management Services 4050 Esplanade Way, Suite 260

Tallahassee, FL 32399-0950 Email: DMS.Purchasing@dms.fl.gov

Failure to file a protest within the time prescribed in section 120.57(3), F.S. (as altered by section 110.123(3)(d)4, F.S.), or failure to post the bond or other security required by law within the time allowed for filing a bond shall constitute a waiver of proceedings under Chapter 120, F.S.

Any protest concerning this agency decision or intended decision must be timely filed with the Agency Clerk. Protests may be filed by courier, hand delivery, or regular mail at: Department of Management Services, Office of the General Counsel, Attention: Agency Clerk, 4050 Esplanade Way, Suite 160, Tallahassee, Florida 32399-0950. Protests may also be filed by fax at 850-922-6312, or by email at agencyclerk@dms.myflorida.com. It is the filing party's responsibility to meet all filing deadlines.

NOTICE PURSUANT TO SECTION 287.057(25), F.S.

Respondents to this solicitation or persons acting on their behalf may not contact, between the release of the solicitation and the end of the 72-hour period following the agency posting the notice of intended award, excluding Saturdays, Sundays, and state holidays, any employee or officer of the executive or legislative branch concerning any aspect of this solicitation, except in writing to the procurement officer or as provided in the solicitation documents. Violation of this provision may be grounds for rejecting a response.

mailto:DMS.Purchasing@dms.fl.gov mailto:agencyclerk@dms.myflorida.com

ITN No.: DMS-22/23-072 Page 2 of 40 TPA Services for HMO

TABLE OF CONTENTS

SECTION 1. INTRODUCTION

1.1 Solicitation Objective

1.2 Definitions

1.3 Background

1.4 Term

1.5 Questions Being Explored

1.6 Goals of the ITN

1.7 Special Accommodations

1.8 Procurement Officer

1.9 Timeline of Events

1.10 Notice of Intent to Submit a Reply and Data Use Agreement

SECTION 2. SOLICITATION PROCESS

2.1 General Overview

2.2 Questions and Answers

2.3 Addenda to the Solicitation

2.4 Respondent Firm Offer

SECTION 3. GENERAL INSTRUCTIONS

3.1 General Instructions

3.2 Special Instructions

3.3 MFMP Registration and Florida Substitute Form W-9 Process

3.4 Website References

3.5 How to Submit a Reply

3.6 Mandatory Responsiveness Requirements and Minimum Qualifications

3.7 Contents of Reply

3.8 Public Records, Respondent’s Confidential Information, and Redacted Replies

3.9 Subcontracting

SECTION 4. SELECTION METHODOLOGY

4.1 Determination of Replies’ Responsiveness for Evaluation

4.2 Evaluation Process – General Overview

4.3 Evaluation of Attachment B – Technical and Scoring of Attachment C – Network

4.4 Analysis of the Cost Reply

4.5 Other Department Rights for Evaluation

4.6 Negotiations

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4.7 Final Selection and Notice of Intent to Award Contract

SECTION 5. AWARD

5.1 Rights for Award

5.2 Agency Decision

5.3 Other Reserved Rights

5.4 No Contract until Execution

Attachments:

Attachment A – Administrative Requirements Attachment B – Technical Attachment C – Network Attachment D – Cost Attachment E – Draft Contract Attachment F – Privacy, Security, And Confidentiality Business Associate Agreement Attachment G – Benefit Document Attachment H – Data Use Agreement Attachment I – Census File Attachment J – Scrubbed Claims Data

Forms:

Included at the end of this ITN document:

FORM 1 – CONTACT INFORMATION

FORM 2 – NOTICE OF CONFLICT OF INTEREST

FORM 3 – STATEMENT OF NO PRIOR DISQUALIFYING INVOLVEMENT

FORM 4 – SUBCONTRACTING

FORM 5a – MANDATORY RESPONSIVENESS REQUIREMENTS MEDICAL FORM 5b – MANDATORY RESPONSIVENESS REQUIREMENTS RX FORM 6a – MINIMUM QUALIFICATIONS MEDICAL FORM 6b – MINIMUM QUALIFICATIONS Rx

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SECTION 1. INTRODUCTION

1.1 Solicitation Objective

The State of Florida (State), Department of Management Services (Department), Division of State Group Insurance (DSGI), seeks to establish through this Invitation to Negotiate (ITN), a contract (Contract) to one (1) or more Respondents for Health Maintenance Organization (HMO) coverage as further described in the excel workbook titled, Attachment A – Administrative Requirements. The Implementation Date of this Contract will be January 1, 2024.

1.2 Definitions

Capitalized terms used in this ITN and its attachments have the meaning ascribed in this section

1.2. Defined terms in Attachment E, Draft Contract, and section 287.012, F.S., are incorporated herein by reference. In addition to those terms, the following terms have the meanings ascribed below

“Benefits Document” means the document approved by the Florida Legislature in accordance with section 110.123(5), Florida Statutes, describing the scope of coverage, benefits available, limitations, restrictions and exclusions of the plan, and the conditions under which Service Provider will pay claims. The Benefits Document is subject to modification by the Florida Legislature and the Department at any time. The covered and excluded services in the Benefits Document will be equivalent to those set forth in the Benefits Document, together with any additional services expressly approved by the Department. The Benefits Document in effect as of the date of this ITN is included in Attachment G.

“Claim(s)” means an application for payment of, or reimbursement for, health care expenses, including prescription drugs, incurred by Participants, which is filed in accordance with the Benefits Document and the Service Provider’s and/or Department’s requirements.

“Contract” means any binding agreement that results from this ITN, if any, between the Department and a Respondent.

“Covered Services” mean the services that are required to be provided as defined by the Benefits Document.

“Department” means the Florida Department of Management Services or its designee.

“Division” means the Department’s Division of State Group Insurance (DSGI).

“ITN” means Initiation to Negotiate No. DMS-22/23-072, including all attachments and addenda to the Invitation to Negotiate.

“Reply” means the documents submitted by the Respondent in response to this ITN, including any interim revised replies, best and final offers, and other supplemental responses.

“Respondent” means a vendor who submitted a Reply to this ITN.

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“Service Provider” or “Contractor” means the responsive and responsible Respondent(s), awarded a contract, if any, pursuant to this ITN.

“State” means the State of Florida.

“Subscriber”, “Enrollee”, “Member”, “Participants” means the enrolled employee, retiree, surviving spouse, or COBRA participant that is the primary insured, as defined by the Florida Administrative Code

In the event of a conflict between the terms incorporated from Florida Statutes and those contained within these documents, the definitions in these documents control.

1.3 Background

DSGI, created within the Department, pursuant to section 110.123, F.S., has been designated as the entity responsible for administering the State Group Insurance Program (Program). DSGI is authorized to offer a comprehensive package of health insurance plans for state employees, retirees, COBRA participants, surviving spouses of active state employees or retirees, and eligible dependents. These services are being procured in accordance with Chapters 110 and 287, F.S.

The Program currently offers subscribers the following health plan options:

• Standard Preferred Provider Organization (PPO) Plan

• Standard Health Maintenance Organization (HMO) Plan

• High Deductible Health Plan (HDHP) PPO

• High Deductible Health Plan (HDHP) HMO, and

• Medicare Advantage Prescription Drug Plans (MA-PDs)

Of the approximately 168,000 current Program subscribers, forty-seven percent (47%) are enrolled in the PPO Plan, fifty-two percent (52%) are enrolled in the HMO plans and one percent (1%) are enrolled in MA-PDs. Enrollment in the HDHPs is minimal, representing three percent (3.0%) of total enrollment. Benefit and administration costs for fiscal year 2020-21 totaled $2.74 billion and are projected to be $2.90 billion in fiscal year 2021-22. Program costs are trending at approximately nine percent (9.0%) per year.

The State contributes towards active employee premiums. Retirees and COBRA participants are responsible for the full premium, with COBRA participants paying an additional two percent (2%) administrative fee as allowed by federal law.

Currently, DSGI contracts with one Third Party Administrator (TPA) for the self-insured PPO Plans, one fully insured HMO, three self-insured HMOs, and one Pharmacy Benefits Manager (PBM) for the self-insured Prescription Drug Plan. The PPO plans provide worldwide services, the HMO plans offer services based upon county awards from ITN DMS 16/17-018, and the PBM provides nationwide services.

In addition, DSGI contracts with three (3) Medicare Advantage-Prescription Drug Plans (MA-PDs), and each plan offers services to Medicare-eligible retirees of the State. One (1) plan offers statewide MA-PD services, and two (2) plans offer MA-PD services in specific counties.

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The awarded Respondent will not have final decision-making authority over eligibility, coverage benefits, claims, and interpretation of plan documents, as such authority will remain with the Department.

The Plan Year runs from January 1st to December 31st of each calendar year. The State provides two (2) primary enrollment opportunities in addition to qualifying status change events: (i) when a person begins employment with the State, and (ii) annually during open enrollment period. Open enrollment changes are effective January 1st of the year following the open enrollment period. All enrollment activity and eligibility determinations are conducted through the State’s human resource system of record, People First.

To assist with this ITN, the Department has hired Aon (“Consultant”) as the technical and actuarial subject matter expert. The Consultant shall not receive override commissions or any other valuable consideration, in any form, from any issuer, insurance agent, insurance broker, or any involved party when such fee proceeds may be attributable to the award of the Contract with the Department.

Fees earned by the Consultant relating to this procurement will be limited exclusively to those fees paid under the Department-issued purchase order for these services between the Consultant and the Department.

For more information about the Program design and benefits, visit the DSGI website at:

https://www.mybenefits.myflorida.com/health/.

1.4 Term

It is anticipated that the term of the Contract will be three (3) years with up to three (3) optional one

(1) year renewals. The Contract may only be renewed in accordance with section 287.057(14), F.S.

1.5 Questions Being Explored

The Department would like to explore the following questions:

a. How does the Department best award enrollment by vendor(s) to provide coverage in every region and leverage the more favorable pricing obtained (ASO fees, discount guarantees, etc.)

as the volume of business awarded to each vendor increases?

b. How can the Department efficiently and effectively provide health care benefits to Members?

c. What combination of fully-insured and self-insured programs are in the best interest of the

State?

d. Is a single vendor or multiple vendor platform in the best interest of the State?

e. How can the Department ensure vendors are committed to and effective at containing claims costs throughout the entire term of the contract?

f. What unique value propositions can vendors offer today or during the term of the contract that are in the best interest of the State?

g. What level of flexibility can vendors offer to implement future changes to the program?

https://www.mybenefits.myflorida.com/health/

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h. What benefit(s), including cost savings, can the State gain through the cross-negotiation of the various DSGI contracts being contemporaneously procured, to achieve best value?

1.6 Goals of the ITN

DSGI is committed to offering health care programs which promote the best value and patient-oriented care. The goal of this ITN is to determine the best value provider of HMO services for state employees, and as follows:

• To establish a Contract promoting the cost-efficient administration of the HMO Program;

• To establish a flexible Contract that provides the ability to effectuate future policy and

Program changes. Future changes may include, but are not limited to, benefit design, moving to a defined contribution structure, and implementing employee wellness initiatives;

• To determine the combination of service levels and pricing terms preferred by the Department and the Respondent that will provide the best overall value for the State in executing the preferred solutions;

• To establish a Contract that ensures competitive prices throughout the entire term, including renewal years of the Contract; and

• To implement and maintain aggressive/effective cost avoidance tactics.

1.7 Special Accommodations

Any person requiring a special accommodation due to a disability should contact the Department’s Americans with Disabilities Act (ADA) Coordinator at (850) 922-7535, or ADA.Coordinator@dms.fl.gov. Requests for accommodation for meetings must be made at least five (5) Business Days prior to the meeting. A person who is hearing or speech impaired can contact the ADA Coordinator by using the Florida Relay Service at (800) 955-8771 (TDD).

1.8 Procurement Officer

The Procurement Officer is the sole point of contact for this procurement. Direct all contact with the Department to the Procurement Officer in writing by email.

Greg Hill Departmental Purchasing Florida Department of Management Services 4050 Esplanade Way, Suite 260 Tallahassee, FL 32399-0950 Email: DMS.Purchasing@dms.fl.gov

***PLACE THE ITN NUMBER IN THE SUBJECT LINE OF ALL EMAILS TO THE

PROCUREMENT OFFICER***

If a Respondent claims that any portion of an email is trade secret under section 812.081, F.S., or otherwise confidential under Florida or Federal Law, the Respondent is to place the word “Confidential” in the subject line. (See also subsection 3.8 of this ITN for more information on confidential information.)

mailto:ADA.Coordinator@dms.fl.gov

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Any such contact by an affiliate, a person with a relevant business relationship with a Respondent, or an existing or prospective subcontractor to a Respondent is assumed to be on behalf of a Respondent unless shown otherwise.

1.9 Timeline of Events

The table below contains the anticipated Timeline of Events for this ITN. The dates and times within the Timeline of Events are subject to change. It is the Respondent’s responsibility to check the Next Gen Vendor Information Portal (VIP) for any changes. The Respondent is responsible for ensuring the Department receives all required documentation by the dates and times (Eastern Time) specified below (or as revised by addenda).

TIMELINE OF EVENTS Event Time (ET) Event Date

ITN posted on the Next Gen VIP August 2, 2022

Vendor deadline to submit to the Procurement Officer via email to DMS.Purchasing@dms.fl.gov Vendor’s Attachment H – Data Use Agreement

4:00 PM August 8, 2022

Deadline to submit questions to the Procurement Officer 4:00 PM August 19, 2022

Department’s anticipated posting of answers to Respondents’ questions on the Next Gen VIP September 8, 2022

Deadline to submit Reply and all required documents to the Procurement Officer 3:00 PM October 10, 2022

Public Opening.

Conference Room 101

Tallahassee, Florida 32399-0950

2:00 PM October 11, 2022

Anticipated Evaluation Phase 10-17-2022 to 11-23-2022

Anticipated Negotiation Phase 12-5-2022 to 5-5-2023

Anticipated Negotiation Team Public Meeting Conference Room 101

Tallahassee, Florida 32399-0950

10:00 AM May 11, 2023

Anticipated date to post Notice of Intent to Award on the Next Gen VIP May 16, 2023 https://vendor.myfloridamarketplace.com/

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1.10 Notice of Intent to Submit a Reply and Data Use Agreement

To be eligible to submit a Reply to this ITN, Respondents must obtain the Attachment I – Census File and Attachment J – Scrubbed Claims Data directly from the Procurement Officer to complete Attachment C – Network and Attachment D – Cost. The Census File contains certain individually identifiable health information and data (“Protected Health Information”).

To obtain this file and data, Respondents must submit a fully completed copy of Attachment H

– Data Use Agreement to the Procurement Officer, by email at DMS.Purchasing@dms.fl.gov, by the time and date indicated in section 1.9, Timeline of Events. The Department will not accept any modifications to this form. The Vendor warrants and represents that it intends to submit a Reply to the ITN by submitting a completed Attachment H – Data Use Agreement. A Respondent whose Data Use Agreement is not received by the Procurement Officer on or before the due date indicated in the Timeline of Events section will be deemed non-responsive by the Department.

Upon timely receipt of the fully executed Attachment H – Data Use Agreement, the Department will make the Attachment I – Census File and Attachment J – Scrubbed Claims Data available through a secure download link that will be shared with Vendors who have provided a fully executed Attachment H – Data Use Agreement after the Attachment H submission due date in the Timeline of Events and not prior to that date. The Department will send the download link to the email address provided by the Vendor in Attachment H – Data Use Agreement.

Upon opening the link, the Vendor will be prompted to verify the email address by receiving and entering a verification code in order to access the files in the shared link.

Note: Vendors may need to check spam/junk email folders for the verification code.

The Attachment I – Census File includes information for employees eligible to enroll in health insurance as of March 2022 and provides the following components:

• Date of birth

• Gender

• Home ZIP code

• Plan name (if currently enrolled),

• Plan coverage tier (if currently enrolled)

Vendors that submitted a fully executed Attachment H – Data Use Agreement and received the Attachment I – Census File and Attachment J – Scrubbed Claims Data but fail to submit a Reply to the ITN shall destroy the Attachment I – Census File and Attachment J – Scrubbed Claims Data received from the Procurement Officer, including any copies, by the time Replies are due. At that time, the Vendor shall provide to the Procurement Officer a complete Access List and a certification that the Vendor has complied with this destruction requirement on or before the due date of Replies. (See Attachment H - Data Use Agreement).

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SECTION 2. SOLICITATION PROCESS

2.1 General Overview

The ITN is a method of competitively soliciting contractual services under Chapter 287, F.S. This ITN will be administered through the Next Gen VIP. Vendors interested in submitting a Reply are to comply with all terms and conditions described in this ITN. The Department will hold a public opening of the Replies at the date, time, and location provided in the Timeline of Events.

The ITN process is divided into two (2) phases: the evaluation phase and the negotiation phase.

The evaluation phase involves the evaluation team’s evaluation of Replies in accordance with this ITN. During this phase, the Department's evaluation team will evaluate all Responsive Vendors submitted Attachment B – Technical, and the Consultant will score all Responsive Vendors submitted Attachment C – Network, in accordance with the instructions provided within the ITN to establish a competitive range of Replies reasonably susceptible of award. The Department then selects one (1) or more Respondents within the competitive range with which to commence negotiations.

The negotiation phase involves negotiations by the Department’s Negotiation Team with the selected Respondent or Respondents whose evaluated Replies were determined to be within the competitive range, in accordance with this ITN. During this phase, the Department may request revised Replies and best and final offers (BAFOs) based on the negotiations.

Once negotiations have concluded and BAFO(s) have been received and reviewed, the Department will hold a Negotiation Team public meeting to recommend Contract award(s). The Department intends to post a notice of Intent to Award Contract(s), identifying the Responsive and Responsible Vendor(s) that provide the best value to the State based on the selection criteria set forth in subsection 4.8.2 of the ITN.

Any reservation or listing of reservations of the Department’s rights provided in this ITN is not intended to be exhaustive and shall not be construed to limit the rights of the Department in conducting this procurement.

2.2 Questions and Answers

Respondents will submit all questions during the Question and Answer period in writing to the Procurement Officer via email. Questions submitted by telephone, postal mail, hand delivery, or fax will not be accepted. The deadline for submission of questions is reflected in subsection 1.9, Timeline of Events.

The Department requests that all questions have the ITN number in the subject line of the email.

Questions are requested to be submitted in the following format:

Respondent Name Attachment Tab Question # Question

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Questions will not constitute a formal protest of the specifications of the ITN. Department answers to written questions will be issued by posting to the Next Gen VIP. Verbal answers are not binding.

2.3 Addenda to the Solicitation

The Department reserves the right to modify this ITN by issuing one or more addenda posted on the Next Gen VIP. It is the responsibility of the Respondent to check the Next Gen VIP for information and updates.

2.4 Respondent Firm Offer

The Department may enter into a Contract within three hundred and sixty-five (365) Calendar Days after the date the Notice of Intent to Award is posted, during which period Replies shall remain firm and shall not be withdrawn. If a Contract is not executed within three hundred and sixty-five (365) days, the Replies shall remain firm until either the Contract is executed, or the Department receives from a Respondent written notice that the Reply is withdrawn.

SECTION 3. GENERAL INSTRUCTIONS

3.1 General Instructions

In accordance with Rule 60A-1.002(7), F.A.C., Form PUR 1001, General Instructions to Respondents, is incorporated by reference into this ITN and can be accessed at:

http://www.dms.myflorida.com/business_operations/state_purchasing/documents_forms _references_resources/purchasing_forms

3.2 Special Instructions

The following special instructions modify the general instructions provided in the incorporated PUR 1001. The terms of this ITN control over any conflicting terms of the PUR 1001.

Paragraph eight (8) of the PUR 1001 is inapplicable in its entirety.

Paragraph thirteen (13) and paragraph nineteen (19) of the PUR 1001 are replaced in subsection

5.2 and 3.8 respectively, below. Paragraphs three (3), five (5), seven (7), nine (9), fourteen (14), fifteen (15), and twenty (20) of the PUR 1001 are inapplicable and are replaced as follows:

Section 3. Electronic Submission of Offers Replies shall be submitted in accordance with section 3.5, How to Submit a Reply, of this ITN.

Section 5. Questions Questions shall be submitted in accordance with the section 2.2, Questions and Answers, of this

ITN.

Section 7. Convicted Vendor, Discriminatory Vendor, and Antitrust Violator Vendor Lists.

a. Convicted Vendor List.

Pursuant to section 287.133, F.S., a person or affiliate who has been placed on the Convicted Vendor List following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a https://vendor.myfloridamarketplace.com/ http://www.dms.myflorida.com/business_operations/state_purchasing/documents_forms_references_resources/purchasing_forms http://www.dms.myflorida.com/business_operations/state_purchasing/documents_forms_references_resources/purchasing_forms

ITN No.: DMS-22/23-072 Page 12 of 40 public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in section 287.017, F.S. for CATEGORY TWO for a period of 36 months following the date of being placed on the Convicted Vendor List.

b. Discriminatory Vendor List.

Pursuant to section 287.134, F.S., an entity or affiliate who has been placed on the Discriminatory Vendor List may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity.

c. Antitrust Violator Vendor List.

Pursuant to section 287.137, F.S., a person or an affiliate who has been placed on the Antitrust Violator Vendor List following a conviction or being held civilly liable for an antitrust violation may not submit a bid, proposal, or reply for any new contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply for a new contract with a public entity for the construction or repair of a public building or public work; may not submit a bid, proposal, or reply on new leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a new contract with a public entity;

and may not transact new business with a public entity.

Section 9. Respondent’s Representation and Authorization.

In submitting a Reply, each Respondent understands, represents, and acknowledges the following:

• The Respondent is not currently under suspension or debarment by the State or any other governmental authority.

• The Respondent currently has no delinquent obligations to the State, including a claim by the

State for liquidated damages under any other contract.

• The submission is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive Reply.

• Unless requested by the Department, the Reply, prices, and amounts submitted by a

Respondent at any time during the ITN process have been arrived at independently and without consultation, communication, or agreement with any other Respondent or potential Respondent; the contents of a Reply, the prices, and the amounts, actual or approximate, have not been disclosed to any other Respondent or potential Respondent, and they will not be disclosed before the ITN opening.

• The Respondent has fully informed the Department in writing of all convictions of the firm, its affiliates (as defined in section 287.133(1)(a), F.S.), and all directors, officers, and employees of the firm and its affiliates for violation of state or federal antitrust laws with respect to a public contract for violation of any state or federal law involving fraud, bribery, collusion, conspiracy or material misrepresentation with respect to a public contract. This includes disclosure of the

ITN No.: DMS-22/23-072 Page 13 of 40 names of current employees who were convicted of contract crimes while in the employ of another company.

• Neither the Respondent nor any person associated with it in the capacity of owner, partner, director, officer, principal, investigator, project director, manager, auditor, or position involving the administration of federal funds:

• Is presently indicted or, within the preceding three years, has been convicted or found guilty of, or found civilly liable for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state, or local government transaction or public contract; violation of federal or state antitrust statutes; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; or

• Has within a three-year period preceding this certification had one or more federal, state, or local government contracts terminated for cause or default.

• The Respondent has read and understands the Contract terms and conditions, and the submission is made in conformance with those terms and conditions.

• If an award is made to the Respondent, the Respondent agrees that it intends to be legally bound to the Contract that is negotiated during the ITN process.

• The Respondent has made a diligent inquiry of its employees and agents responsible for preparing, approving, or submitting the Reply, and has been advised by each of them that he or she has not participated in any communication, consultation, discussion, agreement, collusion, act or other conduct inconsistent with any of the statements and representations made in the Reply.

• The Respondent shall indemnify, defend, and hold harmless the Department and its employees against any cost, damage, or expense which may be incurred or be caused by the Respondent’s Reply (including any errors therein).

• All information provided by, and representations made by, the Respondent are material and important and will be relied upon by the Department in awarding a Contract. Any misrepresentation shall be treated as fraudulent concealment from the Department of the true facts relating to submission of the Reply. A misrepresentation may be punishable under law.

• If at any point during the course of the procurement, circumstances change so that any of the above acknowledgements are no longer true, Respondent will notify the Procurement Officer as soon as practicable.

Section 14. Firm Response The Department may make an award within three hundred and sixty-five (365) days after the date of the opening, during which period Replies shall remain firm and shall not be withdrawn. If award is not made within three hundred and sixty-five (365) days, the Reply shall remain firm until the Department enters into a Contract or the Department receives from the Respondent written notice that the Reply is withdrawn.

Section 15. Clarifying Information.

No changes, modifications, or additions to the Replies will be allowed after the Replies have been opened, except as negotiated during the negotiation phase. However, the Department reserves the right to seek clarifications from any Respondent at any time.

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Failure to supply the information or documentation as requested may result in the Reply being deemed non-responsive.

Section 20. Protests Any protest concerning this ITN shall be made in accordance with section 120.57(3), F.S., as modified by section 110.123(3)(d)4, F.S. and Rule Chapter 28-110, F.A.C. Any communication not in accordance with these sections or the ITN, including questions to the Procurement Officer, shall not constitute a formal protest.

3.3 MFMP Registration and Florida Substitute Form W-9 Process

The awarded Respondent, if any, must register in MFMP prior to Contract execution. For additional information, please visit: https://vendor.myfloridamarketplace.com

The awarded Respondent, if any, will be required to pay the required MFMP transaction fee(s) as specified in Section 14 of the PUR 1000, unless an exemption has been requested and approved in accordance with Rule 60A-1.031, F.A.C.

The awarded Respondent, if any, must complete a Florida Substitute Form W-9 prior to Contract execution. The Internal Revenue Service receives and validates the information provided on the Florida Substitute Form W-9. For instructions on how to complete the Florida Substitute Form W- 9, please visit: https://flvendor.myfloridacfo.com/.

3.4 Website References

Do not incorporate or reference dynamic links that are external to the Reply documents. If the Respondent deems it necessary to provide website references, provide screen shots in lieu of weblinks. References to dynamic links (Universal Resource Locators) will not be considered as part of the Respondent’s Reply.

3.5 How to Submit a Reply

The Respondent must submit the sealed Reply in accordance with the following submission requirements:

3.5.1. One (1) unredacted, bound hard copy of the entire Reply (containing Tabs 1, 2, 3, 4, and 5).

3.5.2. One (1) unredacted electronic copy of the entire Reply (containing separate folders for Tabs 1, 2, 3, 4 and 5) on a CD or USB flash drive. All CDs or thumb drives should be labeled with the Respondent’s name and the ITN number.

3.5.3. One (1) REDACTED electronic copy of the entire Reply (containing separate folders for Tabs 1, 2, 3, 4 and 5) in accordance with section 3.7 of this ITN, if applicable (may be provided on the same CD or USB used for 3.5.2.). On the cover of the redacted copy, the Respondent is to provide its name and the ITN name and number and clearly title it, “Redacted Copy.”

https://flvendor.myfloridacfo.com/

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3.5.4 Sealed Replies should be clearly marked on the outside of the package with the ITN number, Respondent name, and Procurement Officer name.

3.5.5 Submit Replies to the Procurement Officer: 1) by the due date and time listed in subsection 1.9, Timeline of Events; and 2) at the address listed in subsection 1.8, Procurement Officer. The Respondent is responsible for ensuring its Reply is delivered at the proper time and to the proper place.

All electronic documents should be searchable to the fullest extent practicable. Paper and electronic copies of Replies are to consist of identical information. In the event of a conflict, the electronic version will control.

Replies that are not timely submitted shall be deemed nonresponsive.

3.6 Mandatory Responsiveness Requirements and Minimum Qualifications

The Department will not evaluate Replies that do not include completed Forms 5a, 5b, 6a, and 6b, as applicable, in accordance with the instructions contained within this ITN. Respondents not submitting a Reply for the HMO Pharmacy Carve-In option are not required to submit Forms 5b and 6b.

The Department reserves the right to waive any minor irregularity, technicality, or omission if the Department determines that doing so will serve the best interest of the State.

At any time during the ITN process, the Department may require the Respondent to submit documentation to demonstrate that it meets these mandatory responsiveness requirements and minimum qualifications. If the Respondent cannot produce sufficient documentation to demonstrate that it meets these mandatory responsiveness requirements and minimum qualifications, the Respondent will be deemed non-responsive.

3.7 Contents of Reply

The following sections of a Respondent’s Reply should be submitted in accordance with section 3.5, How to Submit a Reply, of this ITN:

The Respondent’s Reply may not contain any conditions or exceptions to any aspect of the solicitation and any such conditions or exceptions will not be considered in evaluating the Respondent’s Reply. In Attachments A, B, and D, a Respondent is requested, in submitting a Reply to this ITN, to acknowledge certain Department created terms and elsewhere to provide explanations in response to such terms contained in Attachments A, B, and D. In the event a Respondent selects “no” in the “Respondent Acceptance” or “Respondent Acknowledgement” columns or indicates in an “Explanation” column that Respondent cannot adhere to the Department created terms, such responses will not be used in the Department’s determination of whether a Respondent is Responsive and Responsible but instead will be used to determine if such terms need to be further negotiated in the event the Respondent is invited to negotiations. The Respondent, however, should assume that the Department will not agree to any caveats, exceptions, conditions, or deviations to such Department created terms contained in Attachments A, B, and D and should therefore base its pricing on the assumption that the terms will apply as-written during any resultant contract term. The only recognized changes to this ITN prior to the

ITN No.: DMS-22/23-072 Page 16 of 40 opening will be by written amendments issued by the Department. Please note that while completing Attachments A, B, C, and D, the portions of a response exceeding the 400-character limit will not be evaluated. Please refer to the instructions within each of these Attachments at the top of each tab.

Throughout these Attachments, various supplemental documents have been requested to be provided with the Respondent’s Reply. Please review Attachment A – Administrative Requirements, tab Read Me First, for a complete list of supplemental documents requested for this ITN. Please include these supplemental documents as an attachment to Tab 2, Tab 3 Technical Reply or Tab 4 Cost Reply, where applicable, labeled with the applicable file name as listed in Attachment A - Administrative Requirements, tab Read Me First. A Respondent submitting a Reply without an HMO Pharmacy Carve-In option is not required to complete forms or portions of Attachments A, B, C, or D that relate to providing an HMO Pharmacy Carve-In option.

Tab 1 Completed Forms

FORM 1 – CONTACT INFORMATION

FORM 2 – NOTICE OF CONFLICT OF INTEREST

FORM 3 – STATEMENT OF NO PRIOR DISQUALIFYING INVOLVEMENT

FORM 4 – SUBCONTRACTING

FORM 5a – MANDATORY RESPONSIVENESS REQUIREMENTS MEDICAL FORM 5b – MANDATORY RESPONSIVENESS REQUIREMENTS RX (if applicable) FORM 6a – MINIMUM QUALIFICATIONS MEDICAL FORM 6b – MINIMUM QUALIFICATIONS Rx (if applicable)

Note: All forms requiring signature may be completed by the Respondent using either electronic or wet-ink signature.

Tab 2 Completed Attachment A - Administrative Requirements and the supplemental documents requested

ADMINISTRATIVE REQUIREMENTS (as applicable)

• ASO, No Rx

• Insured, No Rx

• ASO, Rx

• Insured, Rx

PERFORMANCE GUARANTEES (as applicable)

• ASO, No Rx

• Insured, No Rx

• ASO, Rx

• Insured, Rx

Respondent should also include any supplemental documents requested within Attachment A – Administrative Requirements as a separate folder in Tab 2. These supplemental documents should be submitted in PDF format and labeled with the applicable file name.

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Tab 3 Completed Technical Reply that includes Attachment B – Technical, Attachment C - Network and the supplemental documents requested.

Respondent’s entire Technical Reply will consist of both Attachment B – Technical and Attachment C – Network and the applicable supplemental documents requested.

Respondent should complete each portion and respond to all parts of each question or request for information in Attachment B - Technical and Attachment C – Network in accordance with the instructions set forth therein. Respondent should submit the final versions of its Technical Reply (Attachment B – Technical and Attachment C– Network) in excel files. Respondent should keep Attachment B – Technical and Attachment C – Network excel files separate. Respondent must also include any supplemental documents requested within Attachment B – Technical and Attachment C – Network as a separate folder in Tab 3. These supplemental documents should be submitted in PDF format, unless otherwise indicated in the Read Me First tab in Attachment A – Administrative Requirements, and labeled with the applicable file name.

Tab 4 Completed Cost Reply that includes Attachment D – Cost and the supplemental documents requested

Attachment D -- Cost must be completed in accordance with the instructions included in the Reply. Respondent must submit the final version of the Cost Reply in excel format.

Respondent must include any supplemental documents requested within Attachment D – Cost as a separate folder in Tab 4. These supplemental documents should be submitted in PDF format, unless otherwise indicated in the Read Me First tab in Attachment A – Administrative Requirements, and labeled with the applicable file name.

Tab 5 Letter of Bondability

A letter signed on or after the advertisement date of this ITN from a surety company or bonding agent authorized to do business in the State and written on company letterhead indicating the Respondent’s ability to obtain a performance bond or irrevocable letter of credit in an amount of not less than $40 million.

3.8 Public Records, Respondent’s Confidential Information, and Redacted Replies

The following replaces section 19 of the PUR 1001 Form, General Instructions to Respondents:

Article 1, section 24, Florida Constitution, guarantees every person access to all public records, and section 119.011, F.S., provides a broad definition of “public record.” As such, the entirety of the Replies are public records and are subject to disclosure unless exempt from disclosure by law.

If the Respondent considers any portion of its Reply to be Confidential Information, the Respondent is to mark the document as “confidential” and simultaneously provide the Department with a separate, redacted copy of its Reply. For each portion redacted, the Respondent is to briefly describe in writing the grounds for claiming exemption, including the specific statutory citation for such exemption. On the cover of the redacted copy, the Respondent is to provide its name and the ITN name and number and clearly title it, “Redacted Copy.” Only portions of material that the Respondent claims are Confidential Information are to be redacted.

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If the Respondent is invited to negotiations, it will also be incumbent upon the Respondent to identify, in real-time, portions of the Respondent’s negotiation sessions which include references to materials and/or information Respondent claims are Confidential Information.

In accordance with section 119.0701, F.S., Replies are exempt from production in response to public records requests until such time as the Department provides notice of an intended decision or until 30 days after opening the final Replies, whichever is earlier. After that time, the Department will provide the redacted copy, if any, in response to a public records request.

In the event of a request for public records pursuant to Chapter 119, F.S., the Florida Constitution, or other authority, to which documents that are marked as “confidential” are responsive, the Department will provide the redacted copy to the requestor. If a requestor asserts a right to the redacted Confidential Information, the Department will notify the Respondent such an assertion has been made. It is the Respondent’s responsibility to take the appropriate legal action to assert that the information in question is exempt from disclosure under Chapter 119, F.S., or other applicable law.

If the Department becomes subject to a demand for discovery or disclosure of documents that are marked as “confidential” in a legal proceeding, the Department will give the Respondent notice of the demand or request. It will be the Respondent’s responsibility to take the appropriate legal action in response to the demand and to defend its claims of confidentiality. If the Respondent fails to take appropriate and timely action to protect the materials it has designated as Confidential Information, the Department will provide the unredacted materials to the requester.

By submitting a Reply, the Respondent agrees to protect, defend, and indemnify the Department for all claims arising from or relating to the Respondent’s determination that the redacted portions of its Reply are Confidential Information. If a Respondent fails to submit a redacted copy in accordance with this section, of information it claims is Confidential Information, the Department is authorized to produce the entire material submitted to the Department in response to a public records request for, or demand for discovery or disclosure of, these records.

For the avoidance of doubt, the term “Reply” is inclusive of revised Replies and BAFOs.

3.9 Subcontracting

The awarded Respondent will be fully responsible for all work performed under the Contract. If the awarded Respondent wishes to use subcontractors other than those properly and specifically identified in the subcontracting form submitted with the Reply, the awarded Respondent must follow the approval process specified in the Contract. Submission of the subcontracting form with a Reply does not guarantee the Department’s approval of the proposed subcontractor.

SECTION 4. SELECTION METHODOLOGY

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4.1 Determination of Replies’ Responsiveness for Evaluation

The Department will determine which Respondents are Responsive and Responsible, and which have submitted a Responsive Reply that meets the requirements of this ITN. The Department will perform the initial responsiveness check. Replies found to be nonresponsive will not be evaluated.

Responsive Replies will be evaluated as described in section 4.

The Department reserves the right to act upon information discovered after the initial responsiveness check impacting the responsibility or responsiveness of the Respondent or the responsiveness of a Reply.

4.2 Evaluation Process – General Overview

The Department will appoint an Evaluation Team for the evaluation and scoring of the Responsive Replies for the evaluation phase. This ITN will be supported by the Department’s Consultant, who will provide information and technical assistance.

For each Reply that is deemed Responsive, each evaluator will be provided a copy of a Respondent’s Attachment B – Technical and the applicable supplemental documents.

The evaluators will each independently evaluate from Tab 3 the Attachment B – Technical and the applicable supplemental documents from each Responsive Reply using the assessment scale in section 4.3 against all areas for evaluation as described in section 4.3. and subsection 4.3.1 These sections demonstrate how the areas for evaluation will be scored, and the relative weights given to the scored sections.

The Consultant will independently review from Tab 3 the Attachment C – Network and the applicable supplemental documents from each Responsive Reply and provide the Department with a summary of the Network responses. The Consultant will also rank each Responsive Respondent’s Attachment C – Network and the applicable supplemental documents, which will be assessed points as described in section 4.3.1. The Consultant will provide the ranking and scoring results and a summary of Respondent’s Attachment C – Network responses to the Department. A Respondent Reply which includes both HMO broad and HMO narrow networks in Attachment C – Network will receive two separate scores for the Respondent’s Attachment C – Network Reply.

The Procurement Officer will combine the evaluator’s weighted scores from Attachment B – Technical with the score(s) from the Consultant’s analysis of Attachment C – Network to create a Respondent’s final technical score(s), which will be used by the Department to establish a competitive range of Replies reasonably susceptible of award. For a Respondent Reply which includes both HMO broad and HMO narrow networks in Attachment C – Network, the Reply will have two separate final technical scores – (1) a combination of the evaluator’s weighted scores from Attachment B – Technical with the HMO broad network score from the Consultant’s analysis of Respondent’s Attachment C – Network HMO broad network information; and (2) a combination of the evaluator’s weighted scores from Attachment B – Technical with the HMO narrow network score from the Consultant’s analysis of Attachment C – Network HMO narrow network information.

Please note, for Respondents submitting a Reply for the HMO Pharmacy Carve-In option, the Pharmacy portion of Responsive Replies in Attachment B – Technical will be removed from a Respondent’s Reply by the Procurement Officer and will not be provided to the Evaluation Team for review. A Respondent’s HMO Pharmacy Carve-In option will only be considered by the

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Negotiation Team if the Respondent is selected to negotiate with the Department in the negotiation process. See subsection 4.6.1 for information on the negotiation phase of the ITN.

The Tab 4, Attachment D - Cost submitted by Respondents will be analyzed by the Consultant in accordance with section 4.4 and will not be scored for purposes of evaluation or provided to the Evaluation Team for consideration.

4.3 Evaluation of Attachment B – Technical and Scoring of Attachment C – Network The evaluators will independently review and evaluate Attachment B – Technical from Tab 3 and the applicable supplemental documents for each Responsive Reply, and the Consultant will rank and score Attachment C – Network. Using the assessment scale below, the evaluators will assign a rating of zero (0) to five (5) based on the quality of each response within a Reply to Attachment B – Technical. Evaluators will assign whole numbers and will not use decimals.

In determining the quality of a Reply for Attachment B – Technical, the evaluators will use the following guiding questions:

• How well does the Reply demonstrate the Respondent’s ability to provide the services requested?

• How well does the Reply…