ESBD_354382_1713386067558_HHS0014046_ RFP pdf.pdf

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 1 of 46 Version 2.10 Revision Date 09/12/2023

Cecile E. Young, Executive Commissioner

Request for Proposals (RFP) for

Actuarial Services and Medicaid Projects

RFP No. HHS0014046

Date of Release: April 17, 2024

Deadline for Submission of Solicitation Responses:

May 16, 2024 by 10:30 a.m. Central Time

NIGP Class/Item Codes:

918-12 Analytical Predictive Studies and Surveys Consulting 920-24 *Data Conversion Service 920-65 *System Requirements Quality Assurance Review 946-00 Financial Services 946-10 Accounting and Billing Services, Including Payroll Services, 3rd Party Reimbursement for Medicare, Medicaid, Private Insurance, etc.

946-12 Actuarial Services 952-77 *Research and Evaluation, Human Services, Including Productivity Audits (*) Automated Information Systems (AIS)

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 2 of 46

Revision Date 09/12/2023

Table of Contents Article I. Introduction, Definitions, and Authority

1.1 Introduction

1.2 Definitions

1.3 Authority

Article II. Scope of Work

2.1 Statement of Work

2.1.1 Actuarial Services

2.1.2 General Contractor Requirements

2.1.3 Required Organizational Qualifications and Experience

2.1.4 Preferred Organizational Experience

2.1.5 Contractor’s Staff Requirements

2.1.6 Contractor’s Staff Qualifications and Experience

2.1.7 Replacement of Key Personnel Requirements

2.1.8 Agency Requirements

2.1.9 Associated Remedies and Liquidated Damages

2.2 Contract Award, Term and Compensation

2.2.1 Contract Award and Execution

2.2.2 Contract Term

2.2.3 Prompt Payment

2.3 Historical Compensation

2.4 Data Use Agreement and Security Privacy Inquiry

2.5 No Guarantee of Volume, Usage, or Compensation

2.6 Governmental Entities

Article III. Administrative Information

3.1 Schedule of Events

3.2 Ambiguity, Conflict, or Discrepancy

3.3 Inquiries

3.3.1 Sole Point of Contact

3.3.2 Prohibited Communication

3.3.3 Exception to Sole Point of Contact

3.3.4 Solicitation Questions

3.4 Pre-Proposal Conference and HSP Training

3.4.1 Attendance

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 3 of 46

Revision Date 09/12/2023

3.4.2 Conference Logistical Information

3.4.3 Questions at Pre-Proposal Conference and HSP Training

3.5 Solicitation Response Composition

3.5.1 General Information

3.5.2 Page Limit and Supporting Documentation

3.5.3 Discrepancies

3.5.4 Exceptions

3.5.5 Assumptions

3.5.6 Binding Offer

3.6 Solicitation Response Submission and Delivery

3.6.1 Deadline

3.6.2 Submission Option

3.6.3 Submission Checklist

3.6.4 Labeling and Delivery for USB Submission and Other Materials

3.6.5 Modifications and Withdrawals

Article IV. Solicitation Response Evaluation and Award Process

4.1 Conformance with State Law

4.2 Best Value Determination

4.2.1 Selection Methodology

4.2.2 Minimum Qualifications

4.2.3 Initial Compliance Screening

4.2.4 Written Solicitation Response Evaluation

4.2.5 Written Response Evaluation Criteria

4.2.6 Advancement Criteria

4.2.7 Best and Final Offer (BAFO)

4.2.8 Final Written Response Score

4.2.9 Summary of Best Value Determination

4.2.10 Questions or Requests for Clarification

Article V. Narrative Proposal

5.1 Narrative Proposal

5.1.1 Executive Summary

5.1.2 Ability to Meet Requirements

5.1.3 Organizational Experience and Qualifications

5.1.4 Key Staff Experience and Qualifications

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 4 of 46

Revision Date 09/12/2023

Article VI. Required Respondent Information

6.1 Company Information

6.1.1 Company Narrative

6.1.2 Company Profile

6.2 Franchise Tax – Right to Transact Business in Texas

6.3 References

6.4 Major Subcontractor Information

6.5 Affirmations and Certifications

6.6 Other Reports

6.6.1 Dun and Bradstreet Reports

6.6.2 Financial Statements and Financial Solvency

6.6.3 Alternate Report

6.7 Corporate Guarantee

6.8 HUB Subcontracting Plan

6.9 Secretary of State Certification

Article VII. Cost Proposal

7.1 Cost Proposal

Article VIII. General Terms and Conditions

8.1 General Conditions

8.1.1 Changes, Modifications, and Cancellation

8.1.2 Offer Period

8.1.3 Costs Incurred

8.1.4 Contract Responsibility

8.1.5 Public Information Act - Respondent Requirements Regarding Disclosure

8.1.6 Contractor Waiver – Intellectual Property

8.1.7 Standards of Conduct for Vendors

8.1.8 Disclosure of Interested Parties

8.2 Insurance

8.2.1 Required Coverage

8.2.2 Alternative Insurability

8.3 Protest

Article IX. List of Exhibits

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 5 of 46

ARTICLE I. INTRODUCTION, DEFINITIONS, AND AUTHORITY

1.1 INTRODUCTION

The State of Texas, through the Texas Health and Human Services Commission (HHSC), seeks to award one Master Contract in accordance with the demonstrated knowledge, skills, and abilities to complete the Scope of Work and activities listed in this Request for Proposals (RFP). HHSC will use this Contract on an “as needed basis.” Contractor is not guaranteed work except as awarded through the Work Order process defined in this RFP.

Contractor will have the expertise, financial resources, and experience necessary to provide quality program development, data management and analysis, actuarial and financial services to support HHSC programs such as the Texas Medicaid program. Texas Medicaid includes directed payment programs, quality-based payment strategies, and managed care delivery systems.

HHSC PCS will administer the procurement process for this Solicitation, which includes RFP publication, handling of communications from vendors, as well as managing the receipt of Solicitation Responses for review and evaluation.

To be considered for award, a Contractor must execute Exhibit A, HHS Solicitation Affirmations Version 2.4 and provide all other required information and documentation as set forth in this Solicitation.

Information regarding HHSC and its programs is available online and can currently be accessed at https:/www.hhs.texas.gov/

1.2 DEFINITIONS

Refer to Exhibit B, Health and Human Services (HHS) Uniform Terms and Conditions – Vendor, Version 3.4, and Exhibit C, Health and Human Services (HHS) Additional Provisions, Version 1.0, for additional definitions.

As used in this Solicitation, unless a different definition is specified or the context clearly indicates otherwise, the following terms and conditions have the meanings assigned below:

“Addendum” means a written clarification or revision to this Solicitation issued by HHSC PCS and posted to the ESBD.

“Advancement Criteria” means the published criteria for Respondent to advance to the next phase of evaluation if multiple evaluation methods are utilized.

https://www.hhs.texas.gov/

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 6 of 46

Revision Date 09/12/2023

“Award Consideration (AC) Documents” means documents Respondent must submit as part of the Solicitation Response to be considered for negotiations or award.

“Business Day(s)” is any day (24-hour period) in which normal business operations are conducted (excludes State holidays and weekends).

“Calendar Day(s)” is each day shown on the calendar beginning at 12:00 Midnight, including Saturdays, Sundays, and holidays.

“Children’s Healthcare Insurance Program” or “CHIP” means the health insurance program authorized and funded pursuant to Title XXI, Social Security Act (42 U.S.C. §§ 1397aa-1397mm) and administered by HHSC.

“Contract Term” means the period of time beginning with the Effective Date of a Contract and ending when the Contract expires in accordance with its terms, or when it has been terminated.

“Contractor” means the party selected to provide the goods or services to the State under this Contract.

“Effective Date” has the same meaning as the definition in Exhibit B, Health and Human Services (HHS) Uniform Terms and Conditions – Vendor, Version 3.4.

“ESBD” means the Electronic State Business Daily, the electronic marketplace where State of Texas bid opportunities over $25,000 are posted. The ESBD may currently be accessed at http://www.txsmartbuy.com/esbd

“Final Written Response Score” refers to the final scoring of the written response as documented in the Solicitation.

“HHSC” means the Health and Human Services Commission.

“HHSC PCS” means Procurement and Contracting Services (PCS), a division of HHSC.

“HUB” means Historically Underutilized Business, as defined by Chapter 2161 of the Texas Government Code.

“HUB Subcontracting Plan” or “HSP” means written documentation regarding the use of subcontractors, which is required to be submitted with all responses to state agency contracts with an expected value of $100,000 or more where the state agency has determined subcontracting opportunities are probable. The HSP subsequently becomes a provision of the awarded Contract and shall be monitored for compliance by the state agency during the term of the Contract.

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 7 of 46

Revision Date 09/12/2023

“Master Contract” means a binding written agreement, issued as a result of a competitive procurement, that establishes an eligible pool of one or more Contractors to render services or deliver goods through the Work Order Process as needs are identified.

“Medicaid” means the medical assistance entitlement program authorized and funded pursuant to Title XIX, Social Security Act (42 U.S.C. §§ 1396 et seq.) and administered by HHSC.

“Respondent” means the individual or entity responding to this Solicitation.

“Solicitation” means this RFP including all exhibits, attachments, forms, and Addenda, if any.

“Solicitation Consideration (SC) Documents” means documents that must be submitted by Respondent with the Solicitation Response in order to be considered for evaluation and cannot be resubmitted or have errors remedied after the submission due date and time in the Schedule of Events has passed.

“Solicitation Response” means all parts of Respondent’s proposal submitted in response to this

RFP.

“State” means the State of Texas and its instrumentalities, including HHSC, and any other state agency, its officers, employees, or authorized agents.

“VPTS” means Vendor Performance Tracking System, as defined under Section 2262.055 of the Texas Government Code and Title 34 of the Texas Administrative Code Part 1, Chapter 20, Subchapter B, Division 2, Rule §20.115 and Subchapter F, Division 2, Rule §20.509.

“Work Authorization” means Contractor agrees to begin work within agreed upon Calendar Day from the date of the approved Work Order.

“Work Order” or “WO” means an order for services placed against an established Master Contract.

“Work Order Request” means an instrument drafted by HHSC used to request offers from an eligible contractor for the completion of specific tasks or the delivery of certain goods.

“Work Order Response” means an offer submitted by a Contractor in an eligible pool describing how the Contractor will accomplish the work for a specific price in response to a Work Order Request.

“Work Order Request-Response Form” means an instrument that contains the WO Request, the WO Response and a work order authorization section in one form, see Exhibit E.

https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2262.htm#2262.055 https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=34&pt=1&ch=20&rl=115 https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=34&pt=1&ch=20&rl=509

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 8 of 46

Revision Date 09/12/2023

1.3 AUTHORITY

HHSC is soliciting the services stated in this Solicitation under of the authority Texas Government Code Title 10, Subtitle D of the Texas Government Code, Section 2155.144 (a), (b-1)(2).

ARTICLE II. SCOPE OF WORK

2.1 STATEMENT OF WORK

Contractor must demonstrate the knowledge, skills, and abilities to complete the general Scope of Work listed below. Selected Contractor will work on actuarial services associated with, but not limited to, HHSC Medicaid and CHIP Services, Delivery System Quality and Innovation Department. Different types of actuarial services will be performed based on program need. These actuarial services will be identified on a Work Order basis as described in Section 2.1.1.3 (Work Order Process). Each Work Order Request–Response Form, Exhibit E will include a more detailed scope of work, individual requirements including deliverables, schedule of services to be performed, estimated value of services to be performed and best value selection criteria.

2.1.1 Actuarial Services

2.1.1.1 Services for All Work Orders

These services are applicable to all Work Orders under the Contract:

A. Providing actuarial services that meet the standards of Member American Academy of Actuaries (MAAA).

B. Providing complete explanations of all calculations and provide all formulas to HHSC or its Contractors.

C. Providing Deliverables in accordance with the timelines established for each Work Order.

D. Providing expertise of Centers for Medicare & Medicaid Services (CMS) regulations, state directed payment arrangements, quality-based payment strategies, and other related health care initiatives.

E. Participating in meetings with HHSC and other agency staff, HHSC Contractors, legislative committees, provider workgroups, and CMS representatives as needed. Meetings may be face-to-face or virtual and may be scheduled on very short notice.

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 9 of 46

Revision Date 09/12/2023

F. Providing effective presentations on analyses performed as requested by HHSC. These presentations may include, but are not limited to, topics such as rate analyses, research, and other analyses performed by HHSC’s request.

G. Maintaining confidentiality of Medicaid and CHIP recipient data and other information provided by HHSC and/or its Contractors/vendors/providers.

H. Work may involve onsite visits (field work), desk work, and meeting with HHSC staff in Austin, Texas.

I. Non-actuaries must work under the supervision of the principal actuary to perform actuarial work.

2.1.1.2 Additional Services for Work Orders

The services below may be included in Work Orders that fall under this Contract.

A. Performing data management, data analysis, and data visualization for the state directed payment arrangements including, but not limited to:

1. Providing data modeling for use by HHSC, CMS, and stakeholders;

2. Developing tools and templates for data reporting and management;

3. Performing data analyses for annual evaluation and potential annual changes;. and

4. Developing data visualization for stakeholder engagement.

B. Conducting research and develop policy for quality-based payment strategies and other Medicaid-related reform options including:

1. Evaluating and analyzing Texas and nationally identified quality-based payment strategies;

2. Developing options and assess the impact of those options;

3. Developing plans for implementation and measurement of quality-based payment strategies if options are approved by HHSC;

4. Performing periodic assessment/analysis of quality-based payment models to assess implementation of quality-based payment strategies; and

5. Providing subject matter technical assistance to HHSC regarding other strategies for promoting quality and efficiency.

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 10 of 46

Revision Date 09/12/2023

C. Completing stakeholder engagement on directed payment programs, quality-based payment proposals, and other Medicaid-related reform options, including:

1. Facilitating at least five stakeholder events/webinars a year;

2. Developing materials for stakeholder engagement; and

3. Analyzing stakeholder feedback.

D. Providing quality, data management and analysis, actuarial and financial support services and reports not covered under other agency contracts, as needed by HHSC.

2.1.1.3 Work Order Process

Authorized Work Orders include a written Exhibit E, Work Order Request – Response Form accompanied by a PCS issued purchase order. The Work Order Request – Response Form must be signed by both HHSC and the Contractor. Work Orders follow the process below:

HHSC will draft a Work Order Request – Response Form using Exhibit E, Work Order Request

- Response Form.

A. HHSC will email Contractor the draft Work Order Request-Response Form which contains the due date and template for the Work Order Response.

B. Contractor may submit written questions regarding the draft Work Order Request to the point of contact via email: DSQI@hhs.texas.gov. HHSC will respond within five (5) Business Days.

C. Contractor will provide its Work Order Response using the section indicated in the Work Order Request-Response Form. This information may include, but not be limited to, HSP modifications and detailed cost information for each deliverable or task. If applicable, Contractor will include any costs associated with travel required to fulfill the Work Order and/or a proposed project schedule.

D. Contractor will submit the completed Work Order Request - Response Form, including its Work Order Response, to the point of contact and by the due date provided.

E. If approved, HHSC will request Contractor sign the Work Order Request - Response Form and return it within five (5) Business Days.

F. HHSC will subsequently sign the Work Order Request - Response Form.

G. HHSC will forward the authorized Work Order (the fully signed Work Order Request – Response Form and accompanying purchase order) to the Contractor.

mailto:DSQI@hhs.texas.go

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 11 of 46

Revision Date 09/12/2023

H. Each authorized Work Order will be automatically incorporated as an Amendment to the Contract.

2.1.1.4 Minor Work Order Changes

Minor changes to the resulting Work Order are authorized informally without amending the Work Order. The minor changes identified below are permitted, without a formal amendment, under the resulting Work Order.

A. Changes in Contractor’s staff that will participate in traveling, if applicable, so long as the changes do not result in the Contractor’s travel expenditures invoiced for reimbursement exceeding the amount of “Total Projected Travel Expenditures” of this Work Order Response. This minor change is permitted under the following conditions:

1. It must be agreed upon by both parties;

2. It must be in writing, via email correspondence; and

3. It must be documented in the Contract file.

B. Changes in a Deliverable’s timeline/deadline, so long as a Deliverable’s timeline/deadline does not exceed the Work Order End Date of the Work Order Request. This minor change is permitted under the following conditions:

1. It must be agreed upon by both parties;

2. It must be in writing, via email correspondence; and

3. It must be documented in the Contract file.

C. Changes in Contractor’s expenditures for any individual Deliverable, either an increase or a decrease in expenditures, of this Work Order Response, so long as Contractor’s total invoiced expenditures for reimbursement for all Deliverables listed in the Work Order Request does not exceed the “Total Costs for Deliverables” of this Work Order Response.

This minor change does not require:

1. HHSC prior authorization; or

2. Documenting the change within the Contract file.

D. Changes to the HHSC Work Order Request Point of Contact, identified in Exhibit E, Work Order Request-Response Form, Section I, Work Order Request Requirements, B.1. and Contractor’s Point of Contact, identified in Section II, Work Order Response, A.1.

Contractor or HHSC will notify the other Party’s contact, via email, of any changes to its Point of Contact, and the notification email will be documented in the Contract file. This minor change does not require authorization by Contractor or the System Agency.

2.1.1.5 Major Work Order Changes

In the event there are changes to that affect the terms, timeline and/or budget, a request for review and approval must be submitted to HHSC’s assigned Contract Manager identified in the fully executed Work Order. HHSC reserves the right to request a revised, Exhibit E, Work Order

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 12 of 46

Revision Date 09/12/2023

Request-Response Form. All changes must be in writing and signed by the Parties, using a bilateral amendment to the Contract.

2.1.1.6 Work Order Authorization

During the term of any Contract awarded under this Solicitation, HHSC may request Respondent to perform certain tasks expressly authorized under a Work Order Request - Response Form, a sample of which is attached as Exhibit E.

All Work Orders shall be in writing, signed by both parties, and shall include a scope of Services, a list of tasks to be performed by Respondent, a schedule, a list of Deliverables if any, and such other information or special conditions as may be necessary for the Work requested.

2.1.2 General Contractor Requirements

A. Providing actuarial opinions and fiscal impact analysis of changes to proposed programs and/or provider rates upon HHSC’s request.

B. Providing actuarial expertise and data analysis support that include the provision of trend analysis and projections in development of quality-based payment strategies.

C. Supporting and responding to inquiries from HHSC, CMS, and Stakeholders regarding any program development and the related contract with the MCOs. The Contractor will work with HHSC to provide written responses to CMS.

D. Providing Support and Expertise for Specialty Areas.

2.1.3 Required Organizational Qualifications and Experience

Contractor must have sufficient skills, expertise, and qualifications to perform the required Services. These qualifications and experience include, but are not limited to the following:

A. Contractor organization will have a minimum of five (5) years of experience providing Actuarial Standards of Practice in accordance with MAAA. This includes current rules and regulations applicable to government actuarial standards.

B. Contractor must employ a minimum of one (1) actuary who is a MAAA member and a Fellow in the Society of Actuaries (FSA).

C. Contractor organization must have demonstrated knowledge of and/or experience in public sector actuarial standards.

D. Contractor organization must have demonstrated knowledge of and/or experience in healthcare quality measurement.

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 13 of 46

Revision Date 09/12/2023

2.1.4 Preferred Organizational Experience

HHSC prefers a Contractor organization have the specific experiences below:

A. Experience interfacing with MCOs (Manage Care Organizations) that have contracts with Texas, other states, and/or the federal government;

B. Knowledge and experience with state directed payment programs and/or other supplemental payment programs;

C. Knowledge and experience with quality-based payment (as an alternative to fee-for-service payment), including knowledge and experience related to how MCOs reimburse their providers;

D. Knowledge and experience working with large datasets, including healthcare claims data;

and

E. Knowledge and experience with financial and health insurance services.

2.1.5 Contractor’s Staff Requirements

In fulfilling its roles and responsibilities, Contractor will provide sufficient staff to perform tasks as needed and described by each subsequent Work Order. The performance of these tasks has historically been distributed between Senior Actuary; Actuary; Associate Actuary; Senior Data Analyst; Data Analyst; Associate Data Analyst; Senior Policy Analyst; Policy Analyst; Subject Matter Expert (SME); Engagement Director.

A. Contractor shall provide personnel with the following qualifications:

Title Qualifications

Senior Actuary Provide insight surrounding actuarial service development and consultation for State Medicaid and Chip Services. Fellow or Associate member of Society of Actuary completed must have 4-year degree from accredited institution in actuarial science, mathematics, statistics, or another analytical field with five (5) or more years’ experience managing multi stakeholder, data intensive, healthcare and health and human services projects, preferably involving Medicaid.

Actuary 4-year degree from an accredited institution in actuarial science, mathematics, statistics, or another analytical field. Three (3) -five (5) years’ work experience compiling and analyzing statistical data and other information. Ability to explain their

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 14 of 46

Revision Date 09/12/2023 findings and proposals to government officials, shareholders, and clients.

Associate Actuary

Has graduated from an accredited four-year college or university in Actuary and two (2) - four (4) years’ work experience cleaning and analyzing data, running expense analyses.

Senior Data Analyst

Has graduated from an accredited four-year college or university with major course work in Computer Science, Management Information Systems, Actuarial Sciences, Economics, or a related field. Has five (5) or more years’ experience in data analysis, data management, or data visualization.

Data Analyst Has graduated from an accredited four-year college or university with major course work in Computer Science, Management Information Systems, Actuarial Sciences, Economics, or a related field. Has two (2) - four (4) years’ experience in data analysis, data management, or data visualization.

Associate Data Analyst

Has major course work in Computer Science, Management Information Systems, Actuarial Sciences, Economics, or a related field from an accredited four-year college or university

Senior Policy Analyst

Have a graduate degree or Ph.D. from accredited institution in fields of economic, public policy, political science and or degree related to a specific area of expertise. With five (5) years’ work experience working as policy analyst and expertise related to government healthcare.

Policy Analyst Have a 4-year degree from accredited institution in fields of economic, public policy, political science and or degree related to a specific area of expertise. With two (2) - four (4) years’ work experience working as policy analyst with expertise related to government healthcare.

Subject Matter Expert (SME)

Graduate degree or Ph.D. an accredited institution and five (5) or more years of work experience performing actuarial, economic, and/or health services research using health and human services data.

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 15 of 46

Revision Date 09/12/2023

Engagement Director

4-year degree from accredited institution in business management, business administration or relevant field. At least five (5) years of experience in project management or client relations. Comprehensive familiarity with industry standards and best practices, identify efficient processes and techniques to achieve the desired results of the clients following their budget limitations and timetables.

B. Contractor will provide personnel resources necessary to perform the services, unless specifically stated as the responsibility of HHSC.

2.1.6 Contractor’s Staff Qualifications and Experience

A. Preference for principal actuaries:

1. HHS prefers contractor to employ more than one senior actuary with required qualification specified in Section 2.1.3 (Required Organizational Qualifications and Experience, B.); and

2. Principal actuaries shall have experience in rendering opinions on Medicaid and CHIP managed care delivery systems.

B. Preferences for non-principal actuaries assisting with work orders:

1. Knowledge and experience developing useable data collection tools and complex financial, statistical, and actuarial models.

2. Technical skills and knowledge in the following areas:

a. Actuarial services;

b. Statistics ;

c. Data analysis ;

d. Data management ;

e. Microsoft (MS) Excel ;

f. MS Project ;

g. MS PowerPoint ;

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 16 of 46

Revision Date 09/12/2023

h. Healthcare Quality Measurement; and

i. Healthcare Quality Improvement.

2.1.7 Replacement of Key Personnel Requirements

After a Work Order is awarded to a Contractor, Contractor shall not remove any staff member from its work team until the Work Order has been completed. In the event a staff member leaves employment, or the Contractor determines a change of a staff member is required, or HHSC requests the replacement of a staff member, the Contractor shall ensure that HHSC:

A. Receives two (2) Business Days’ notice prior to removal of any staff member; and

B. Has the right to review the qualifications/credentials of the proposed new staff member and approve the proposed new team member.

2.1.8 Agency Requirements

To ensure that the Contractor can fulfill each authorized Work Order, HHSC shall:

A. Provide access, remote and physical, to necessary documentation, and/or personnel, as outlined in the Work Order Request-Response Form, Exhibit E; and

B. Provide at least one point of contact for the Contractor.

2.1.9 Associated Remedies and Liquidated Damages

2.1.9.1 General

Section 2261.101 of the Texas Government Code requires that all Contracts contain a remedies schedule, a graduated sanction schedule, or both. In accordance with that statutory requirement, sanctions and remedies will apply for the incidents specified in this section. This RFP will refer to the sanctions and remedies as “Sanctions.” In compliance with Section 2261.101, HHSC reserves the right, in its sole discretion, to include in each Work Order Request a schedule of liquidated damages in addition to those stated in this section.

2.1.9.2 Waiver for Good Cause

Liquidated damages, sanctions, and other remedies may be waived for good cause shown at the discretion of HHSC. Contractors shall not be liable for any failure or delay in the performance of this Contract for the period that such failure or delay is beyond reasonable control of the Contractor.

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 17 of 46

Revision Date 09/12/2023

2.1.9.3 Performance Measures

HHSC will monitor the performance of the Contract issued pursuant to this RFP. All Services and Deliverables under the Contract shall be provided at an acceptable quality level and in a manner consistent with acceptable industry standard, custom, and practice. HHSC Deliverables are invoiced by the Contractor upon completion and specifically paid for by HHSC. In the event Contractor fails to timely meet the performance measures enumerated below, it will be difficult if not impossible for HHSC to determine the actual damage to HHSC. As such, a reasonable estimate of HHSC’s projected financial loss and damage from Contractor’s failure to timely meet performance measures may be assessed against the Contractor as liquidated damages. The performance measures and liquidated damages are indicated in the table below.

Item No. Performance Measure Liquidated Damages

PMAR-01 Contractor must complete requested Deliverables/tasks within the negotiated timeframes and by the due date for each Project as indicated in the issued Work Order or as otherwise agreed upon by the Parties.

The State may assess $500 per Business Day for each day the requested Services are not timely submitted, are inaccurate, or incomplete.

PMAR-02 Contractor must provide sound analysis for actuarial and fiscal impact pertaining to program changes, proposed provider rate methodologies, and special projects.

The State may assess $500 per Business Day for each day the actuarial opinions are not timely submitted, are inaccurate, or incomplete.

2.2 CONTRACT AWARD, TERM AND COMPENSATION

2.2.1 Contract Award and Execution

HHSC intends to award one Contract as a result of this Solicitation. Any award is contingent upon approval of the HHSC executive commissioner or their designee.

If, for any reason, a final Contract cannot be executed with a Contractor selected for award within 60 Calendar Days of HHSC determination to seek to contract with that Respondent, HHSC may negotiate a Contract with the next highest-scoring Respondent or may withdraw, modify, or partially award this Solicitation.

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 18 of 46

Revision Date 09/12/2023

2.2.2 Contract Term

The initial term of any Contract resulting from this Solicitation will be three (3) years. HHSC, at its sole option, may extend any Contract awarded pursuant to this Solicitation for up to two (2) additional years.

Notwithstanding the limitation in the preceding paragraph and with at 30 Calendar Days advance written notice to Contractor, at the end of the initial term or any extension period, HHSC at its sole discretion, may extend the Contract as necessary to ensure continuity of service, for purposes of transition, or as otherwise determined by HHSC to serve the best interest of the State for up to 12 months, in one-month intervals, at the then-current contract rate or rates (if applicable) as modified during the Contract Term.

Individual Work Orders, if applicable, issued during the term of a resulting Contract may survive the termination or expiration of this Contract and may be extended for the purpose of completing any authorized Work.

2.2.3 Prompt Payment

All payments to a Contractor by HHSC, any payments by a Contractor to any Subcontractor, and any payments by a Subcontractor to any other person or entity that provides goods or services under this contract shall be made in compliance with Chapter 2251 of the Texas Government Code and Title 34 of the Texas Administrative Code Part 1, Chapter 20, Subchapter F, Division 1, Section 20.487.

2.2.3.1 Compensation Method

Compensation for Work Orders associated with this procurement will be made upon acceptance of deliverables. Compensation will be based on either a lump sum or fixed fee payment structure or time and materials, fully loaded hourly rates, with a not to exceed amount. Contractor’s Authorized Work Order pricing may not exceed established rates identified in its Master Contract.

2.2.3.2 Reimbursement

System Agency will reimburse Contractor for successfully completing each Deliverable in the resulting Work Order. Contractor may invoice upon its completion of each individual Deliverable and does not need to wait until all Deliverables under the resulting Work Order are completed and accepted by System Agency before invoicing for reimbursement. Successful completion of Work Order Deliverables will be determined by HHSC. HHSC will not reimburse for a Deliverable in excess of the Total Cost for of Deliverables as identified in Exhibit E, Work Order Request-Response Form, Section II, Work Order Response, B.1. The amount that Contractor seeks for reimbursement for completion of an individual Deliverable may be over or under the projected expenditures for that Deliverable, as indicated in Exhibit E, Work Order Request-Response Form, Section II, Work Order Response B.1. The cumulative reimbursement

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 19 of 46

Revision Date 09/12/2023 for all Deliverables in the resulting Work Order must not exceed the Total Cost for Deliverables as indicated in Exhibit E, Work Order Request-Response Form, Section II, Work Order Response B. The hourly rates for each staff position listed in Exhibit E, Work Order Request- Response Form, Section II, Work Order Response B.1., may not exceed established rates identified in the Contractor’s Solicitation Response, and as incorporated into Contractor’s Contract.

HHSC will also reimburse Contractor for any travel expenditures indicated in each authorized Work Order, as applicable, upon successfully completing each deliverable associated with such travel expenditures. HHSC will reimburse no more than the State travel rates for allowable travel expenditures established by the Texas Comptroller of Public Accounts (see https://fmx.cpa.texas.gov/fmx/travel/textravel/rates/current.php). Contractor must use the State travel rates in effect at the time the travel expenditures are incurred. Any projected travel expenditures not invoiced by Contractor cannot be used for Deliverables expenditures. HHSC will not reimburse for travel expenditures in excess of the Total Projected Travel Expenditures as identified in Exhibit E, Work Order Request-Response Form, Section II, Work Order Response, B.2.

Reimbursement for all Work Orders issued under this Contract shall not exceed the Contract’s not to exceed amount. Likewise, reimbursement for all Deliverables expenditures and travel expenditures under this Work Order must not exceed the amount identified in the resulting Work Order, which is the combination of the “Total Projected Travel Expenditures,” as identified in Exhibit E, Work Order Request-Response Form ,Section II, Work Order Response B.2., as applicable, and the Total Costs for Deliverables as identified in in Exhibit E, Work Order Request-Response Form, Section II, Work Order Response B.1. Additionally, HHSC will not reimburse Contractor any amount in excess of an approved purchase order resulting from an accepted Work Order.

2.3 HISTORICAL COMPENSATION

Historical compensation under Contracts with similar scope and size to this Solicitation has been approximately $1 million per fiscal year. Notwithstanding Section 2.3 (Historical Compensation), HHSC reserves the right to adjust any projected amount based on state funding during the term of a resulting Contract.

Total compensation for any one or for all cumulative Work Orders under a Contract resulting from this Solicitation shall not exceed $15,000,000 for the total contract term. Notwithstanding the preceding, HHSC reserves the right to increase this amount should additional state or federal funding become available during the term of a resulting Contract, including any extensions.

2.4 DATA USE AGREEMENT AND SECURITY PRIVACY INQUIRY

By entering into a Contract with HHSC as a result of this Solicitation, Respondent agrees to be bound by the terms of the HHS Data Use Agreement, v 8.5, attached as Exhibit D.

https://fmx.cpa.texas.gov/fmx/travel/textravel/rates/current.php

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 20 of 46

Revision Date 09/12/2023

Respondents must complete and return with their Solicitation Response Exhibit D-1, Texas HHS System-Data Use Agreement-Attachment 2, Security and Privacy Inquiry (SPI), Version 2.1.

2.5 NO GUARANTEE OF VOLUME, USAGE, OR COMPENSATION

HHSC makes no guarantee of volume, usage, or total compensation to be paid to any Respondent under any awarded Contract, if any, resulting from this Solicitation. Any awarded Contract is subject to appropriations and the continuing availability of funds.

HHSC reserves the right to cancel, make partial award, or decline to award a Contract under this Solicitation at any time at its sole discretion.

2.6 GOVERNMENTAL ENTITIES

If Contractor is responding to this Solicitation in its capacity as a governmental entity, certain terms and conditions found in this Solicitation, including all exhibits and attachments, may not be applicable. Furthermore, to the extent permitted by law, if a Solicitation Response is received from a governmental entity, HHSC reserves the right to enter into an interagency or interlocal agreement with the governmental entity.

ARTICLE III. ADMINISTRATIVE INFORMATION

3.1 SCHEDULE OF EVENTS

EVENT DATE/TIME

Solicitation Posting Date to ESBD (Date of Release)

April 17, 2024

Pre-proposal Conference and HSP Training Attendance is Optional

April 23, 2024 at 10:00 a.m. Central Time

Deadline for Submitting Questions or Requests for Clarification

April 24, 2024 by 10:00 a.m. Central Time

Tentative Date Responses to Questions or Requests for Clarification Posted on ESBD

April 30, 2024

Deadline for Courtesy HSP Review Optional

May 2, 2024 by 2:00 p.m. Central Time

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 21 of 46

Revision Date 09/12/2023

Deadline for Submission of Solicitation Responses NOTE: Responses must be RECEIVED by HHSC by the deadline.

May 16, 2024 by 10:30 a.m. Central Time

Evaluation Period May 2024

Anticipated Notice of Award August 2024

Anticipated Contract Start Date September 2024

Contractors must submit their Solicitation Responses to HHSC in accordance with the due date and time indicated in this Schedule of Events or as changed via an Addendum posted to the ESBD.

NOTE: All dates are tentative and HHSC reserves the right to modify these dates at any time. At the sole discretion of HHSC, events listed in the Schedule of Events are subject to scheduling changes and cancellation. Scheduling changes or cancellation determinations made prior to the Deadline for Submission of Solicitation Responses will be published by posting an Addendum to the ESBD. After the Deadline for Submission of Solicitation Responses , if there are delays that significantly impact the anticipated award date, HHSC, at its sole discretion, may post updates regarding the anticipated award date to the Procurement Forecast on the HHS Procurement Opportunities web page. Each Respondent is responsible for checking the ESBD and Procurement Forecast for updates.

By submitting a Solicitation Response, contractors represent and warrants that any individual submitting the Solicitation Response and any related documents on behalf of the Respondent is authorized to do so and to bind the Respondent under any Contract that may result from this Solicitation.

3.2 AMBIGUITY, CONFLICT, OR DISCREPANCY

Contractors must notify the Sole Point of Contact (Section 3.3.1) of any ambiguity, conflict, discrepancy, exclusionary specification, omission, or other error in the Solicitation in the manner and by the deadline described in Section 3.3.4 (Solicitation Questions).

Contractors submits a Solicitation Response at its own risk.

If Contractor fails to properly and timely notify the Sole Point of Contact (Section 3.3.1) of any ambiguity, conflict, discrepancy, exclusionary specification, omission, or other error in the Solicitation, Contractor, whether awarded a Contract or not:

A. Waives any claim of error or ambiguity in the Solicitation and any resulting Contract;

B. Must not contest the interpretation by HHSC of such provision(s); and https://hhs.texas.gov/doing-business-hhs/contracting-hhs/procurement-opportunities https://hhs.texas.gov/doing-business-hhs/contracting-hhs/procurement-opportunities https://hhs.texas.gov/doing-business-hhs/contracting-hhs/procurement-opportunities

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 22 of 46

Revision Date 09/12/2023

C. Is not entitled to additional compensation, relief, or time by reason of ambiguity, conflict, discrepancy, exclusionary specification, omission, or other error or its later correction.

3.3 INQUIRIES

3.3.1 Sole Point of Contact

All requests, questions, or other communication about this Solicitation shall be made in writing to HHSC PCS, addressed to the person listed below (Sole Point of Contact). Additionally, a phone number is provided for purposes such as instructing a potential Respondent through an IT system or website referenced in this Solicitation. Communications via telephone are not binding.

The Sole Point of Contact will authorize a secondary Sole Point of Contact in the event of their absence and, in such an event, will include the contact information for the secondary Sole Point of Contact in their automatic reply out-of-office e-mail message. Respondents seeking to contact the Sole Point of Contact should do so via e-mail in order to receive updated contact information.

Name Ron Hurley CTCM CTCD

Title PCS Purchaser

Address Procurement and Contracting Services Building 1100 W 49th St. MC: 2020 Austin, TX 78756

Phone 512-406-2598

Email Ron.Hurley@hhs.texas.gov

See also, Section 3.3.3 (Exception to Sole Point of Contact) below.

3.3.2 Prohibited Communication

Except as provided in Section 3.3.1 (Sole Point of Contact) and Section 3.3.3 (Exception to Sole Point of Contact), potential Contractors are prohibited from any communication with HHSC regarding the Solicitation. HHSC or, its representative(s), and partners will not answer any questions or otherwise discuss the contents of this Solicitation with any potential Contractor or its representative(s). Attempts to ask questions by phone or in person will not be allowed or recognized as valid. Contractors shall rely only on written statements issued by or through HHSC designated staff as provided by Section 3.3 (Inquiries). This restriction does not preclude discussions between affected parties for the purposes of conducting business unrelated to this Solicitation. Failure to comply with these restrictions may result in disqualification of Contractor's Solicitation Response.

3.3.3 Exception to Sole Point of Contact

Exceptions to Section 3.3.1(Sole Point of Contact) are as follows:

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 23 of 46

Revision Date 09/12/2023

A. Contractors with questions relating to the HUB Subcontracting Plan are permitted to direct those questions to the HUB coordinator at Cheryl.Bradley@hhs.texas.gov.

B. Where it is expressly directed by the Sole Point of Contact that another designated HHSC representative may speak to the Contractor, such as during Contract negotiations. Contractors are required to ensure that communications have been authorized by the Sole Point of Contact before engaging in such communication. Failure to comply with this requirement may result in the disqualification of a Contractor’s Solicitation Response.

3.3.4 Solicitation Questions

HHSC will allow written questions and requests for clarification regarding this Solicitation.

Questions must be submitted by e-mail to the Sole Point of Contact (Section 3.3.1) by the deadline established in Section 3.1 (Schedule of Events). Responses to questions or other written requests for clarification will be consolidated and posted to the ESBD and will not be provided individually to requestors.

HHSC reserves the right to amend answers previously posted, prior to the Deadline for Submission of Solicitation Responses Section 3.1 (Schedule of Events). Amended answers will be posted on the ESBD. It is the Respondent's responsibility to check the ESBD. HHSC also reserves the right to provide a single consolidated response to all similar questions at the agency’s sole discretion.

A. All questions and requests for clarification must include the following information:

1. Solicitation number;

2. Solicitation package reference (page number, section, and exhibit or attachment, if applicable;

3. Question topic (e.g., “Schedule of Events,” or “Exhibit F, Cost Proposal”); and

4. Question for HHSC.

B. Requestors contact information below must be included in the body of the e-mail and submitted with the question(s):

1. Company name;

2. Company representative name;

3. Phone number; and

4. E-Mail address.

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 24 of 46

Revision Date 09/12/2023

Questions or requests for clarification received after the deadline in Section 3.1 (Schedule of Events), may be reviewed by HHSC but may not be answered. Only answers to questions submitted to the Sole Point of Contact in writing, in accordance with this section, are binding.

3.4 PRE-PROPOSAL CONFERENCE AND HSP TRAINING

3.4.1 Attendance

HHSC PCS will conduct a Pre-proposal Conference and HSP Training via webinar. Attendance is optional but highly recommended as the pre-proposal conference will include the training on the proper completion of the HSP. See Section 6.8 (HUB Subcontracting Plan).

Attendees to virtual Pre-proposal Conference and HSP Training are required to send an email to the Sole Point of Contact (Section 3.3.1), advising of participation in the Pre-proposal Conference and HSP Training. Attendees must provide their name, phone number, and name of the company they are representing regardless of whether the Pre-proposal Conference and HSP Training is in-person or virtual.

3.4.2 Conference Logistical Information

HHSC PCS will hold the Pre-proposal Conference and HSP Training via webinar on the date and time set out in Section 3.1 (Schedule of Events).

People with disabilities who wish to attend the meeting and require auxiliary aids or services should contact the Sole Point of Contact identified in Section 3.3.1 (Sole Point of Contact), at least 72 hours before the meeting in order to have reasonable accommodations made by HHSC.

Participants must register for the webinar conference prior to the event using the following link:

https://attendee.gotowebinar.com/register/2118531742901907034

3.4.3 Questions at Pre-Proposal Conference and HSP Training

A. Reference Section 3.3.4 (Solicitation Questions) for the required format and information to be provided for submission of questions and requests for clarification.

B. During the conference, HHSC may provide responses to questions and requests for clarification, but only written responses posted by HHSC PCS as an Addendum to the Solicitation on the ESBD will be considered an official, binding update to the Solicitation.

C. HHSC reserves the right to amend, prior to the Deadline for Submission of Solicitation Responses, answers previously posted. Amended answers will be posted on the ESBD.

Notification of posting will be in accordance with Section 3.1 (Schedule of Events).

https://attendee.gotowebinar.com/register/2118531742901907034

PCS 550 HHS RFP/RFO RFP No. HHS0014046 Page 25 of 46

Revision Date 09/12/2023

D. Conversations with HHSC program area staff before or after the Pre-proposal Conference and HSP Training are prohibited.

3.5 SOLICITATION RESPONSE COMPOSITION

3.5.1 General Information

Failure to submit all required Solicitation Response documents in the required format(s) may result in disqualification of the Solicitation Response without further consideration, see Section 3.6.3, Submission Checklist. Contractor shall prepare a Solicitation Response that clearly and concisely represents its qualifications and capabilities. Expensive bindings, colored displays, promotional materials, etc. are not necessary or desired. Respondent should focus on the instructions and requirements of the Solicitation.

3.5.2 Page Limit and Supporting Documentation

The narrative proposal should not exceed 20 pages, not including resumes or CVs, and should be formatted for 8 ½" x 11" paper with 1-inch margins and typed in Times New Roman, 12-point font. If complete responses cannot be provided without referencing supporting documentation, such documentation must be provided with the Solicitation Response, with specific reference made to the file, page, section, and/or paragraph where the supporting information can be found.

3.5.3 Discrepancies

In the event of any…