DMS-2425-312 Q&A.pdf

DMS-24/25-312, Questions and Answers Page 1 of 8 Medicare Advantage and Prescription Drug Plan(s)

REQUEST FOR PROPOSAL NO. DMS-24/25-312

MEDICARE ADVANTAGE AND PRESCRIPTION DRUG PLAN(S)

QUESTIONS AND ANSWERS

Note: All written questions are reproduced in the same format as submitted by the Respondent.

NO.

ATTACHMENT QUESTION ANSWER

1.

General

Can a licensed insurance agency, such as Temple Bookkeeping and Insurance, participate in this RFP as a subcontractor or broker to a MA-PD carrier?

See RFP section 3.8 and Form 6 – Mandatory Responsive Requirements.

2.

General If participating as a subcontractor, should the proposal be submitted by the prime carrier only, or is the subcontractor also required to upload any documents in MFMP/VIP?

See Form 6 - Mandatory Responsive Requirements. The Respondent must certify that it will provide all services contemplated within the RFP and its ability to meet the Minimum Qualifications in accordance with RFP Section 5.

3.

General

Will subcontractors be required to register in MFMP or the Business Network to be eligible for inclusion in a submitted proposal?

See the answer to question 1 and RFP section 3.4.

4.

Attachment H

May a subcontractor also submit Attachment H – Data Use Agreement to obtain access to the Census File for supporting cost analysis?

The deadline to submit Attachment H – Data Use Agreement has passed.

Please refer to RFP section 1.6.

5.

Attachment G

Will brokers or subcontractors be eligible to receive commissions or admin fees for MA- PD enrollments under the awarded plan(s)?

No. Brokers or subcontractors will not be eligible to receive commissions or admin fees.

6.

Attachment G

Should commissions, if applicable, be disclosed or included in the Cost Proposal submitted by the primary carrier?

No. Respondents are to complete Attachment G – Cost Proposal in accordance with the instructions in Attachment G.

7.

Attachment F

May the subcontractor’s qualifications or outreach/marketing capabilities be included in the Technical Proposal (Attachment F) submitted by the carrier?

A subcontractor’s qualifications or outreach/marketing capabilities should not be included separately in the Technical Proposal (Attachment F) submitted by the Respondent.

Submission of the subcontracting form with a Proposal does not guarantee the Department’s approval of the proposed subcontractor.

8.

Attachment F

Will the Department accept samples or résumés from subcontractors as part of the supporting documentation in the Technical Proposal?

Samples or résumés must be provided by the Respondent only.

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ATTACHMENT QUESTION ANSWER

9.

RFP Section 4.4 Will the Department consider multiple carriers for award in overlapping service areas, even if one carrier proposes using a subcontractor and the other does not?

The Department reserves the right to make awards to multiple Respondents in the same geographical area(s).

Please refer to RFP section 4.5.

10.

RFP Section 1.3 Does the Department anticipate expanding MA-PD participation or incentivizing subcontractor-supported outreach in under-enrolled counties?

No. The RFP does not address the expansion of MA-PD participation or the incentivization of subcontractor outreach in under-enrolled counties.

11.

RFP Section 1.3 The fourth paragraph on page 7 states, “Comparable benefits and coverage expectations are outlined in Attachment C:

Covered Benefits and Services.” Please confirm the Department expects that Respondents will propose a plan that matches the current plan designs for the applicable product found in Attachment C. For which Tier shall the current plan design for the applicable product be used within Attachment G?

The Department expects Respondents to propose a plan that matches or closely matches the current plan designs found in Attachment C:

Covered Benefits and Services. The comparable plan design model should be notated in Tier 1.

12.

RFP Section 2.5 In reference to this language: “…No additional documents submitted by a Respondent shall be incorporated in the Contract unless they are specifically identified and approved by the Department.”

What is the process for the Department to review and approve a document to be submitted with our proposal?

Proposals must contain only the documents required by the RFP, in accordance with RFP Section 3.5, Contents of Proposal.

13.

RFP Section 4.4.1

It appears the Department’s intent is to potentially triple the number of MAPD plans offered currently by requiring respondents to administer a plan for each Tier I, II, and III of the respective plan type awarded. Please confirm the Department intends to offer three plans for each awarded MAPD PPO and MAPD HMO contract beginning January 1, 2026. If confirmed, can you please provide context as to why so many plan options will be added by the Department?

If the Department is requiring carriers to administer an MAPD plan for each Tier I, II, and III, how do you intend to map current MAPD plan members into the new plans for 2026?

The Department intends to offer three tiers of premiums for each MAPD PPO and MAPD HMO contract awarded with a contract beginning January 1, 2026. Services and benefits will be the same for each tier. The difference will be the members’ cost share and out of pocket.

Members will participate in an active enrollment to select the plan and tier they wish to enroll in.

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14.

Attachment A – AR-11 Please clarify timeframe expectations for emergency FDA withdrawal of a medication.

The timeframe expectation is without unreasonable delay and as soon as pertinent information is known.

15.

Attachment A –

AR-37

Subsection a. Renewal Report states, “By May 1, 2028, and annually thereafter if the Contract is renewed pursuant to section

3.1.2 of the Contract, the Contractor shall submit to the Department a rate renewal report prepared and signed by an actuary with a Fellow of the Society of Actuaries (FSA) designation, subject to the Department’s approval, to validate premiums for the renewal term.”

Please confirm the first expected renewal report is due by May 1, 2027.

The first expected renewal report is due by May 1, 2028.

16.

Attachment A –

AR-36

For AR-36, will the Department provide a sample of the PG Report requested or is it the Department’s preference to see the bidders sample PG Report?

Attachment E – Reporting and Deliverables states that the PG Report will be the Department-prescribed format.

17.

Attachment D Please confirm in which field of the enrollment file layout will the plan type Tier be populated for enrollment purposes.

A new field will be created in the Enrollment File for the plan type Tier to be populated for enrollment purposes.

18.

Attachment G-4

– Lines 42 - 59

For services that are either not provided by MAPD plans (i.e. Hospice Care, which is administered by Original Medicare) or for Tiers within the Prescription Drug plan that do not exist (i.e. Tier 5 and Tier 6 on a 4-Tier plan), please confirm if respondents should leave cells blank or populate with N/A.

For fields that the Respondent does not have a dollar amount to list, Respondents should enter $0 for that field. See the revised instructions for completing G-4 Services by Tiers tab in Revised Attachment G – Cost Proposal.

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19.

Attachment G-4

– Column D

Column D for Unit is not able to be edited. For example, the inpatient hospital care for Line 25 is set to per day, which is the benefit for one of the current HMO plans, however, the benefit for the other current HMO plan and the current PPO plan is per admission. How can respondents notate a difference between the prepopulated Unit and the actual coverage unit for a service being quoted?

How will the evaluation of benefits account for the difference between a per day copay and per admission copay within the Average Total Per Tier calculation? For example, a per day copay of $150 on a stay of four days for Inpatient Hospital (Line 25) is an out of pocket of $600 (4 days x $150 copay per day). The same four-day Inpatient Hospital stay on a per admission copay of $100 is an out of pocket of $100, creating a $500 difference between the out of pocket for a member due to plan design differences. This difference in unit of coverage can therefore create a significant difference in the Average Total Per Tier calculation in Line 60 for Columns E, F, and G between respondents.

Line 25 has been added to allow for proposed pricing per admission. See Revised Attachment G – Cost Proposal.

20.

Attachment L In a fully insured relationship, the carrier is considered the covered entity and not a business associate. Please confirm Attachment L, the BAA, is not applicable to a fully insured offering.

The awarded Respondent will be required to execute Attachment L, Privacy, Security, and Confidentiality Business Associate Agreement.

21.

General Please provide incurred monthly medical claims for the most recent 12 to 24 months of data for members and dependents who have Medicare as their primary coverage.

Medical claims are not provided as part of this RFP.

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22.

General Please indicate if the MA medical claims include any costs for each of the following:

• Non-Medicare Covered Fee-for-Service Costs (i.e. private duty nursing, routine vision/dental/hearing/OTC, etc.)

• Clinical/Quality/Disease Management Program Costs

• Fitness/Travel Programs

• IBNR

• Part B Rx Claims

Medical claims were not provided with the RFP.

23.

General Please provide current MA population risk score for both medical and Rx, preferably as monthly averages for the corresponding months of claims data provided. Regarding the provided risk scores, the following information is required:

• Time period (e.g. calendar year average, recent month, etc.)

• Estimated or actual mid-year payment and final reconciliation

The MA population risk score for both medical and RX are not provided as part of this RFP.

24.

General Please provide incurred monthly Rx claims for the most recent 12 to 24 months of data for members and dependents who are Medicare eligible. Rx claims should be provided as allowed costs.

Also, please indicate if the provided pharmacy claims are net of the following:

• Pharmaceutical discount

• Manufacturer Rebates

• Catastrophic Reinsurance

• Member cost share

If the Rx claims are not net paid, indicate what is included in the claims data.

Indicate if the pharmacy data contains any, or all, of the Part B Rx claims

Rx claims for members and dependents who are Medicare eligible are not provided as part of this RFP.

25. General Please confirm bidders may ask clarifying questions once additional data is received Not applicable.

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26.

General If bidders cannot agree to a request in the RFP or contract, please clarify how bidders should provide an exception to the Department. For example, but not limited to, a CMS rule, requirement, or a Federal regulation or law that contradicts the Department’s requirement.

A Respondent’s Proposal 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 Proposal.

27.

General Please confirm any reference to subcontractor only applies to subcontractors hired in direct support of this contract.

Refer to definition in Attachment K, Draft Contract, Section 1.27.

28.

Attachment G Please confirm the Department will accept additional rate sheet documentation to support responses related to Attachment G – Cost Proposal.

The Department will not accept additional rate sheet documentation related to Revised Attachment G – Cost Proposal.

29.

Attachment F -

Please clarify if the intent of this question is to assure members can access medications in the event of an emergency. The plan itself may not be impacted by an emergency - for example a natural disaster/hurricane.

Question 42 is to determine the Respondent’s plan for continuity of operations if the Respondent is negatively impacted by an event such as a cyber attach or pandemic.

30.

Attachment A –

AR-1

AR-1 references the Final Implementation Plan submitted for “question (6) of Attachment F: Technical Proposal”, however this question appears to apply to Care and Utilization Review. Please clarify the location for the proposed Final Implementation Plan.

Refer to Revised Attachment A, Administrative Requirements, AR-1.

31.

Attachment A – AR-23 and AR-

AR-23 and AR-24 reference Attachment F as the “Privacy, Security, and Confidentiality Business Associate Agreement.” Please confirm Attachment F is the Technical Reply and Attachment L is the Privacy, Security, and Confidentiality Business Associate Agreement being referenced.

Refer to Revised Attachment A, Administrative Requirements, AR-23 and AR-24.

32.

Attachment A – AR-11 (b) Attachment B – 12 (b)

Please confirm that these sections only apply to FDA Class 1 drug recalls (reasonable possibility that the use or exposure will cause serious adverse health consequences or death).

The notice requirements apply to a wider range of formulary changes than just FDA Class 1 drug recalls, such as changes like moving a drug to a less preferred tier or removing it from the formulary (not due to recall).

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33.

Attachment G-4 The cells in the "Unit" column of the attachment are protected. How do we denote that the response is "Per Admission" or "Per Day" by tier, for tiers I, II, III?

For example, a $1000 Per Admission copayment in Column E (Tier I) vs. a $20 copayment Per Day in Column F (Tier II), vs.

a $5 copayment Per Day in Column G (Tier III).

The units in Attachment G-4 cannot be changed.

34.

Attachment G-4 The cells for tiers I, II, and III in Column E, F, G will only accept a numeric value. How do we denote the number of days for a benefit that has a copayment Per Day?

For example, a $20 copayment Per Day (days 1-10) vs. a $5 copayment Per Day (days 1-20).

The cells for Tier I, II, and III in Column E, F, and G of Attachment G-4 must be in numeric value. Using the example provided, notate $20 in the columns.

35.

Attachment G-4 RFP Section 4.3.3.3

The average copayment calculated using the spreadsheet in "G-4 Services by Tiers" (Columns E, F, G,) would be higher when a Per Admission copayment is more than a copayment Per Day.

For example a $500 Per Admission copayment in Column E (Tier I) calculates an average of $250 in the "average total per tier" and $83.33 in the Average of Tiers I,II, III cell vs a $200 copayment Per Day which results in an average of $100 and $33.33 in the Average of Tiers I, II, III cell (Column E, row 62).

Please confirm that the results calculated in the "Average of Tiers I, II, III" cell (Column E, row 62) that differ based on Per Admission vs.

Per Day, is the average amount used in the formula for section 4.3.3.3 Services and Benefits Evaluation.

Column E, Row 62 will be an average of Column E, F, and G, Row 60 combined and divided by three (3).

36.

Attachment G-4 Attachment G-3

In Exhibit G-3 (HMO Coverage) respondents will indicate counties for which they will offer a proposed plan.

As an HMO, please confirm that no services outside of the counties proposed would need to be provided other than emergency and urgent care services.

Respondents will not be required to provide services outside of the counties proposed aside from emergency services.

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37.

Attachment G-1 The instructions ask respondents to closely resemble the current benchmark plan offered by the programs. The benchmark plan includes supplemental benefits. For example, routine dental coverage and hearing aids. As such, how do we include supplemental benefits in Attachment G-4?

Refer to RFP section 3.5.6. Tab 6 – Additional Information (Optional).

38.

Attachment G-1 Attachment G-4

The instructions indicate that a dollar amount must be entered in every yellow highlighted cell in Columns E, F, and G. How do you respond for a tier 4 and 5 medical dug that does not have coverage for a 60 or 90-day fill?

Respondents should enter $0 for that field. See the revised instructions for completing G-4 Services by Tiers tab in Revised Attachment G – Cost Proposal.

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