Finalized_Evaluation_Tool.xls
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- Attached to
- Master Agreement AZ|CTR050520
- Contract number
- CTR050520
- Issued by
- Arizona
About this file
This document is an evaluation tool for a state and local contract indefinite delivery vehicle involving the Arizona Department of Child Services (DCS) and multiple healthcare administrative service providers: United Steward Health, MERCY AZ, Complete Health, and others. The evaluation assesses proposals across multiple criteria including information systems, network development, medical management, claims processing, readiness and implementation, experience, and financial stability.
The contract appears to be for comprehensive healthcare services for foster children in Arizona, with a focus on physical and behavioral health management. Pricing is structured on a per-member-per-month (PMPM) basis, with costs ranging from $91.13 to $130.28 in the first year, escalating in subsequent years. MERCY AZ submitted the lowest-cost proposal at $91.13 PMPM in year one, earning 200 cost points, while United Steward Health's proposal was priced at $117.79 PMPM and received 153 points. The contract includes provisions for network development, care coordination, utilization management, claims processing, and transition services for foster children across Arizona, with implementation potentially beginning as early as October 2020.
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ASO Evaluation
| INITIAL EVALUATION | ||||||||||
| Integrated Healthcare Administrative Services Direct Contract Offers | United | Steward Health Choice | MERCY | AZ Complete Health | ||||||
| Total Score | 476.8 | 56.3 | 530.0 | 218.8 | ||||||
| 450 | Method of Approach | 136.3 | 0.0 | 123.8 | 93.8 | |||||
| 50 | Information technology | Exceeds | 50.0 | Unacceptable | 0.0 | Meets | 37.5 | Meets | 37.5 | |
| System to include capabilities, functionality and security features that will support the requirements under the scope of work. | Will develop and implement a fully functional HIPAA/AHCCCS complainant system. Direct access to care management platform and utilization management platform to allow direct visibility. Access is read only. System design will auto assign PCP and support a process of changing providers. System capabilities extensively detailed, by functionality. Date exchange shall be mutually agreed upon. System can capture data elements from multiple systems. Minor edit to system data exchange requirement removing incentive, addition of 75% approval rate of encounters submitted to AHCCCS, no modification to enrollment and capitation transactions or periodic reporting. Reports available as per required reporting. Integrated health records and HIPPA compliant. Revision returned established metrics to identified levels. Did not change access to system. | No information provided on system functionality other than to says the system is largely in place for the areas of reporting. Offeror is recommending customized dashboards for tracking which would be made available to staff. Offering regularly schedule operating review meetings to discuss results and identify issues. Does discuss access for DCS and visibility. Information exchange would be one way, them to us. Unsure if system is HIPPA compliant. Offer indicates system can collect data and calculate metrics. | Offer states advance analytics infrastructure, but provides no details on system functionality or capabilities. Family connect portal collects data from multiple sources to aggregate. which can be accessed by full care team to view. No modifications on RFP scope of work to configuration or entry of prior authorizations. (pg 117). Revisions provides a connection through a secure connection to access records. Also provides ability to enter and receive service authorizations. No modification to RFP scope of work for system data exchange requirements, encounter data reporting, enrollment and capitation transactions or periodic reporting requirements. Minor edits to indicate rate code to track non-Medicaid payments. No indication of calculating or identification of metrics. Unsure if HIPPA compliant. In the care coordination efforts we support what is the right access that will be granted? Unclear. Revision provided detail of CMDP participation in prior authorization guidelines, participation in committees and the read/write access to IT system. | Read access only through portal. Requesting access to CHILDS for key member information to enhance care coordination. Will collaborate for data information sharing in compliance with HIPPA, but no exceptions in the System Data Exchange requirements. No specific details provided about system to understand functionality and capabilities. No metrics identified. Access to system not until go-live date. System not configured to support DCS procedures but to efficiently coordinate services. (pg. 124). Other information compliant with the RFP scope of work. AKA reporting monitoring, screening, and new technologies, primary care provider standards, maternity care, referral management, claims payments systems, encounter data reporting, enrollment and capitation transaction updates and periodic reporting requirements. Revision added collaboration with current HIE provider and collaboration with DCS to operationalize performance measures for IT effectiveness. | ||||||
| 25 | Quality Management | Meets | 18.8 | Unacceptable | 0.0 | Meets | 18.8 | Meets | 18.8 | |
| How will the Offeror handle any required reporting , involve team members or departments, placement of all impacted children and actions through the point of resolution. | Will collaborate with DCS to monitor provider compliance through 12 principles, QM process similar to current DDD model. QM staff to be augmented by BH professionals. Offeror held accountable for all PIPS/CAPS where they are responsible for care. Joint QM committee with DCS. (pg 79) DCS to define PIPS. IF Contractor responsible for care coordination they will develop PIP internally and tell us of the results. Revision Contract will develop and implement PIPs as well. Specified committee membership on credentialing to the DCS Medical Director. Fidelity monitoring modified to indicate Contractor 's joint QM committee will id any PIP or QI efforts. Removes the right of DCS to refuse admission of a provider to the network. Revision restored this right to DCS. Removed DCS from IAD reports Contractor performs all QOC investigations and informs DCS of any and all high profile/high risks QOCs. All responsibility for QM is only limited to where Contractor has care coordination responsibilities. Revision Contract will perform 100% of quality activities and outreach activities. Offer defines stratification of population with assigned responsibilities in each contract year. Performance measure have been modified to be lower than current DCS standards on minimum performance level on well care visits. Moved all Clinical performance measures to be contractor's measure but does not state what that level is. Deleted all operational performance measures. Revision restored operational measures. Clinical measures are all Contractor measures not CMDP measures. Caps ONLY where contractor has care coordination responsibilities. How information, QOC concerns and corrective action plans are address operationalization is questionable. Grievance process segmented. Revisions Contract will manage 100% of the grievance process. Will develop a process to inform DCS of provider monitoring. Collaborative effort to define the operationalization of the system. | Requires the establishment of a new line of business. QM managed by quality management department. Anyone can request an investigation? Does not relate this to the IAD process, but more internally. Quality is measured on a granular level tracked weekly against targets. Does not discuss coordination with CMDP only sharing outcomes. Does state any upheld QOC has a corrective action plan reported monthly to executive team. | Major edits to RFP scope of work to replace DCS with Contactor. Cannot not wholesale strike out DCS with the Contractor. DCS will have to have some interaction and collaboration. Fidelity monitoring modified to indicate Contractor 's QM committee will id any PIP or QI efforts. Unsure of where DCS is in this process. Additional staffing identified, but not in QM process. Offeror is responsible for QM program but has removed DCS from the process. Offeror conducts all QOC initiatives and performance measures. Will provide data and information to DCS. Offeror and DCS share responsibility for performance measures. Participants rather than active direction. Grievance system stating appeal for non delegated services with DCS but they take everything??? (pg. 119) . Does give us the ability to interject at any time during the grievance process. Revisions provides for a BH CFT facilitator to coordinate care and a CFT for a minimum of the first 6 months. If PH is the only need then the PCP becomes the care coordinator. Every placement shall have an assigned point of contact. DCS still invited to participate in the full monitoring process. DCS and Contractor continue to share responsibility and accountability for performance measures. DCS shall have authority to direct, implement and prioritize interventions from QM and PM improvement activities. Contractor will work with DCS to develop specific child welfare HNCM competency expectations. and develop cross training opportunities. Would like to also develop specific oversight strategies. Grievance responsibilities outlined, DCS responsibilities as they relate to fair hearing requests, Contract reports monthly grievance report and handles all investigation and work with regulators. | Provider responsible for Care management, UM, QM/PI, Network development, contracting and credentialing, claims payment, providers grievance and appeal, pharmacy, and provider relations. DCS will have final authority over all UM, CM functions but delegate responsibility to administer and operationalize the clinical management program (UM, CM, Care Coordination) pharmacy management, QM/PI functions, member services, grievance and appeals. Offeror is responsible for QM program, DCS role is to advise and support the implementation of the program. Offeror responsible for identifying PIPs and DCS cannot require or direct monitoring activities. However, metrics is stated as either the AHCCCS or DSC minimum. Revisions changed this to DCS standards. QM committee to review CAPS submitted to AHCCCS with copy to DCS. Interjects AHCCCS into administrative actions and performance issues. Very passive on compliance with scope of work requirements. Minor edits to show collaboration with DCS in behavioral health delivery system, staffing, QM reporting requirements, grievance and appeal system all thought they only handle providers. DCS only responsible for grievance for members and provide guidance and support to all health plan functions. IF they do PA how does DCS handle the grievance? DCS has all final decision making authority. | ||||||
| 25 | Meets | 18.8 | Unacceptable | 0.0 | Meets | 18.8 | Meets | 18.8 | ||
| Describe how the Offeror will perform provider monitoring, oversight and audits | Care management under specialty healthcare needs modified to providing access instead of developing and implementing a shared system (pg. 73). Minor edits to SHCN and BH sections of the scope of work. Fidelity monitoring of the system of care through the joint QM committee. Contractor responsible for monitoring all contract providers and informing DCS of all activities. Offer does not change the requirements of external quality reviews. However, will accommodate any DCS requested or directed monitoring activities. DCS or provider can conduct audits, however any PIPS are only related to areas where contractor has responsibilities. Internal PIPS will be developed and presented to DCS along with findings. Revision DCS, AHCCCS and Contractor all can develop PIPS. DCS cannot request to refuse admission of any provider to the network. Revision restored this right to DCS. Contractor conducts all outreach and quality activates for the entire contracted DCS population, but not responsible for all. Contractor will annually analyze network for needs. Contractor identified trigger points on utilization metrics (pg. 136). Minor edits to primary care standards which comply with the intent of the scope of work .No edits appointment standards or subcontractors | Does not discus regular audits. Specific quality focused measures for reporting performance, but measures unidentified. Current provider network of specialty health home would need to be expanded. No discussion of oversight other than metrics. | No modifications to the monitoring and oversight of the SHCN and BH sections of the RFP scope of work. Removed DCS from the QM committee and Offeror is responsible for all QOC and PI activities. Unsure where DCS fits in. Offer does not change requirements for external quality reviews. DCS is invited to participate in full monitoring process, and collaborate with offeror to develop monitoring plan as part of QM/PI program. No discussion of action plans. Minor edits to network development to include PH and BH. No modifications to network management, primary care provider standards, appointment standards and subcontracts in the RFP scope of work. Revision states active role in QM committee, Community Based Integrated Committees, participate in workgroups and be a collaborative process. The Contractor leads the process, but DCS has ability to direct, implement and/or prioritized improvement interventions. DCS invited to participate in monitoring process. | Very passive on compliance with scope of work requirements. No discussion of action plans. Revision removed passive language. Flow down requirements, not ensure they being met. Offeror conducts all QOC activities. Information disseminated through provider manual, monthly provider calls and monitor performance compliance with evidence-based clinical practice guidelines. Pg. 79 fidelity monitoring - giving data to AHCCCS instead of us or simultaneously? SOC planning provided to DCS prior to submission to AHCCCS. 2 provider forum added virtual options in case of pandemic. Quarterly meeting with RTC, TFC, and BH home providers. Any more and the department would have to pay the cost. Offeror responsible for identifying PIPs and DCS shall have final review approval and submission of SOC deliverable to AHCCCSS. DCS role in QM is supportive to contractor, and co chair QM/PI committee which retains oversight of QI investigations, peer review, credentialing, and metrics. Collaboration with DCS proactively to enhance fidelity and training for CFT practice, technical assistance and CAPS following audits and care management support to CFT teams. Collaboration in performance metrics and will work with DCS to establish for monitoring. Minor edits to show collaboration with contractor and DCS in specialty health care needs, behavioral health service delivery, quality management and performance improvement, network development, primary care provider standards and subcontractors. All data collection and audits done by contractor and information provided to DCS. | ||||||
| 25 | Meets | 18.8 | Unacceptable | 0.0 | Meets | 18.8 | Meets | 18.8 | ||
| Corporate compliance: Describe the Offerors structure and activities to ensure awareness, detection, investigation and resolution of fraud, waste, and abuse under this scope of work. | Question regarding how many positions 1 person can hold. Revision clarified line of business responsibilities. IT system description details capabilities for data analytics and logic edits to support compliance. No edits the corporate compliance or contract compliance requirements, requirements of compliance for claims payment, medical management and QM and PIP all in line with scope of work. Offeror to work collaborate with DCS to track, document and report on network performance. Data system can track elements of billing practices and identify areas of concern or non-compliance, and has current processes to use Medicaid as the last payor. - added additional compliance metric on loading contracts into system. Response took no exceptions to any required statute, rule or law. | Provider does not talk corporate compliance level. Does discuss metrics per house and internal QOC process is in existence. Coordination with DCS on case level and higher level policies and procedures. QM performance measures established jointly with CMDP. Does not discuss FWA. High level process flow without specific activates. | Staffing on compliance is in line with the RFP scope of work. Question regarding how many positions 1 person can hold. Revision clarified alignment with Medicaid contracts and use of performance metrics to monitor. Additions do we want all these additional people especially the court coordinator - way written doesn’t cover these age groups. Tribal coordinator position is not in CMDP. QM not collaborative but more Offeror responsibility. Revisions clarifies a collaborative effort with participation in workgroups, committees, and the monitoring process. All performance measures are shared measures/responsibilities but the Contractor calculates and monitors. Offer indicates the offeror shall have MM monitoring and reporting, but no details. No modifications to scope of work requirements for claims payment/health information systems or coordination of benefits and third party liability. Pg. 187 removed DCS corporate compliance plan from requirements Revision does not change this. Pg. 191 no check for people convicted of offense against Medicaid, but said will report them. Revision replaces this language. | Response is in compliance with the staffing requirements of the RFP solicitation. Minor edits to reflect collaboration with DCS for compliance to AHCCCS requirements. QM program does state tracking and trending of system performance. Removed agency ability to request and direct monitoring activities. Pg. 102. DCS role in QM is supportive to contractor, and co chair QM/PI committee which retains oversight of QI investigations, peer review, credentialing, and metrics. Performance measures calculated with the assistance with DCS. Minimum perform standards changed from DCS to DCS or AHCCCS. Revisions changed this to DCS standards. Pg. 108 bring in AHCCCS approving cap not DCS. Revision removed modified this to DCS. PIP data to AHCCCS. No changes to scope in compliance, claims payment health information system, or coordination of benefits and third party liability requirements, but no specific detail on how FWA or audits conducted. | ||||||
| 40 | Network Development Management | Meets | 30.0 | Unacceptable | 0.0 | Meets | 30.0 | Unacceptable | 0.0 | |
| Offerors short, intermediate and long term approaches to address system service needs in a timely and accessible manner in their network. In particular, how will this be done for specialty services. This should include what is available in the network now versus what needs to be built. | Offeror serves 65,000 foster children in 12 states Medicaid programs. Response indicates a statewide network of providers that extend beyond AZ borders into adjacent states with 59,000 providers. Offeror continually analyze network gaps and recruit to close identified gaps. No indicated of assessment to date for DCS purposes. Revision assessment provided was for DDD network Dec 2019. Provided the process to address network gap if identified. Will work with DCS to confirm network meets needs. States coverage for both PH and BH at go live, Pharmacy year 2. Offer outlines year 2 and forward for Pharmacy. Will use single case agreements when necessary. Contract edits to required services indicated contractor responsibilities for care coordination and utilization management. Complies with the annual network adequacy analysis. No future planning or collaborative statements. Provider covers all services as described and network development in line with RFP scope of work. Revision states development of the program to be a collaborative effort to ensure needs of the DCS are met. | New line of business required leveraging the current network of health homes and supplement with BCBS network of providers. No discussion of adequacy or how adequacy would be determined. Doe intend to cover BH, PH and Dental. Unsure of specialty services available in the network. Most health homes in Northern Arizona, but offices will be in Phoenix. Will provide transition services for a year. No discussion of surveys, appointment standards or the use of QY outcomes to improve network. | Current network of over 20,000 providers of all types of services to support required scope of work. Transition of care is 180 day after go live for both BH and PH. Revision has aligned continuity of care to 12 months. Go Live date 10/1/2020 or to be determined at a later date. Provider covers all services as described in the RFP scope of work. Minor edits to Network Development to incorporate PH and no edits to the scope of work for Network Management. Assessment based on review of barriers, timeliness and resources. Proactive plan bases on metric assessment to attempt to increase providers to meet needs. Pg. 185 community reinvestment is over 6% = .024% back into the community vs. investing into a specific bunch of individuals for prevention. If profit is over 4% state gets it. Revision specifies development of a CMDP reinvestment plan. No specific long term strategy but annual assessment and review of activity to create annual plan. Pg 163 Medicaid members, however must include Medicaid and non-Medicaid patients. Issue with pregnancy terminations Pg 162. Revision indicated compliance with DCS requirements on this. No specific BH/TFC/Health Home information. BAFO describes assessment, monitoring, and efforts to increase providers in BH/TFC and health homes. | Responsibilities under offer include care management, UM, QM/PI, Network Development Contracting and Credentialing, Claims Payment, Provider grievance and appeal, Pharmacy and Provider relations. Offer states access to a comprehensive network of providers serving the entire state creating an integrated network covering both PH and BH. However, pg. 50 indicates a need to develop a network to specifically cover the services described in the scope or work. No specifics on their network. Some minor edits to indicate a collaborative effort with DCS. Revision made offer a collaborative effort between Offeror and DCS. Original go live date or one to be negotiated. Very passive on compliance with scope of work requirements. Revision removed passive language. Will verify there is a sufficient number of providers (pg. 128). (Pg. 130) if we want more than they network they currently have we would have to fund the incentive to grow the network. No discussion or indication of adequacy of the current network vs. what the needs of the population. No specific plans outlined to define how to approach a long term strategy. Offer states contractor will develop a plan to assure adequacy and sufficiency, and update annually. No language rearding BHRFs. Revision indicated Network "Development plan last year for southern and central regions, against AHCCCS ACOM 449 policy indicates no gaps in adequacy. Predecessor, Cenpatico and Well Care identified potential gap in northern region and none is central region. Does indicated additional services will need to be developed to meet DCS needs. | ||||||
| 30 | Meets | 22.5 | Unacceptable | 0.0 | Meets | 22.5 | Below | 7.5 | ||
| Offeror' s assessment of its current network capacity to meet the requirements under this scope of work and how the Offeror will develop and maintain a statewide network of physical, behavioral and specialty health care providers to meet the requirements under the scope of work. | Continual analysis of network. Offer stratifies population for management and accountability. Operationalizing this stratification is unclear. Revision removed stratification process in relation to responsibility but leaves the stratification for care management. Contract responsible for 100% of care management. Will work with Department on identifying High Needs cases and develop criteria for prior auths. Contractor retains care coordination and UM, including prior auth, concurrent and retrospective review for those children Offeror is responsible for. Offeror has a current established network that they feel is sufficient to provide services requested. Revision had BH services oversight by an AZ licensed clinician experienced with AZ Vision, Twelve Principles for Children's BH Service Delivery. Chart in overview provides limited detail around specialized health homes, TFC, BHIF or doing work in this space. Detail provided is not sufficient to determine the composition of the network around specialized health homes or doing work in this space. Network assessment was Dec 2019 for DDD network. No gaps for found under that demographic. Contract has outlined the process for assessing network if a gap is found. No edits to the transition activities, network development, primary care standards, appointment standards or federally qualified health centers and rural clinics. | Provider identified use of existing health home network in Northern Arizona but no stated plan on how to increase that statewide. BCBS network to supplement for PH and other BH services. No discussion of how to approach single case needs. No discussion of Centers of Excellence. Current BCBS network does have out of state availability | Offeror has a robust network of providers, pharmacies, and facilities of every available provider type in every county in Arizona. Offeror will support continuity of care for BH and PH services for 180 days after go live. Offeror clear on responsibility for transition activities, scope of service, behavioral health service delivery and medical based school claiming. Annual network and development plan. No true details on providers in network supporting statewide, more being good about where they are. No outreach to rural areas. Basically took all the new performance measures and dropped them. Pg. 206 mentions DCS sanctions out. Confused about the inmate issue on page 174. Network assessments done quarterly, identified needs in birth to 5 and initiated efforts to add providers in this category and has added comprehensive BH homes. Monitoring rural providers. Assess network adequacy daily. Corrected sanctions to administrative actions. Performance measure are collaborative between DCS and Contractor. | Offer indicates a statewide network. No information to validate that the current network meets the needs or is adequate. Revision indicated Network "Development plan last year for southern and central regions, against AHCCCS ACOM 449 policy indicates no gaps in adequacy. Predecessor, Cenpatico and Well Care identified potential gap in northern region and none is central region. Does indicated additional services will need to be developed to meet DCS needs. Offer does leave in tact the 12 month transition period for non participating providers. Offer makes minor edits to required services to show collaboration with DCS. Very passive on compliance with scope of work requirements. Passive language removed. Concern with requirement to ensure providers appointment availability. This is a federal requirement. Revision clarifies the way standards are verified through mystery shopper calls, random sampling of providers, surveys of care managers and caregivers. Out of compliance receive technical assistance and collaborate with DCS to identify strategies to address providers who fail to comply. | ||||||
| 30 | Meets | 22.5 | Unacceptable | 0.0 | Meets | 22.5 | Meets | 22.5 | ||
| Describe how the Offeror will work with DCS/CMDP and the Offeror' s network provider(s) to ensure that they are able to best meet the needs of the member(s). | Offer understands and is aware of trauma. Response states Offeror will work closely with DCS to confirm network meets the needs of those to be serviced. Provider indicated a current AHCCCS report as the vehicle to analyze network for sufficiency. 44 BHHS in 15 counties currently services Complete Care and DDD members. Continuous monitoring to identify any gaps. 5 of 7 recent assessment showed no network pages in BHH. Response offers a process/system to share access to health records and plans. No edits to transition activities in scope of work. Offer shortens transition time from 12 months to 6 months. Data analysis and notifications in compliance with RFP scope of work and Jacob's law. Unknown if the report detail includes TAY, TFC or the additional support systems. | Offeror does provide for access and review of potential denials of service. View of quality metric dashboards. Will collaborate with DCS on case level, policy and procedure level, prior authorizations and Offeror does discuss transitionary services and other populations unique to DCS. Current network demonstrates understanding of the potential for trauma. | Offeror understands and is aware of trauma. Largest contracted provider for BH services to 8,000 kids in foster dare. Has youth advisory council. Supports crisis specialist and behavior coaches to be assigned to group homes to support, train and work with youth and staff. Seek statewide provider and community input for implementation. Meet the requirements of the scope of work. No discussion on developing additional providers, basically will continue to analyze to develop. Annual network development plan. Revision indicated a network analysis quarterly using AHCCCS reporting requirements and grievance system. Additional efforts to contract with providers in rural settings. Looking to identify additional providers in Birth to 5 as well. | Offer reflects and awareness and understanding of trauma. Offer will developed transition activities consistent with DCS policies. Minor edits to scope of work to indicated collaborative effort with DCS. Transition time frame of 12 months retained. No specific detail with TAY, TFC or transitioning between levels of care. Revision identified 4 types of transitional activities providing a high level process flow in a couple of bullet points for each type of transition identified. Offer does discuss assessing members needs. No information to validate the current network meets the needs or is adequate. Does indicated additional services will need to be developed to meet DCS needs. (Pg. 130) if we want more than they network they currently have we would have to fund the incentive to grow the network. | ||||||
| 50 | Medical Management | Meets | 37.5 | Meets | 37.5 | Meets | 37.5 | Meets | 37.5 | |
| Offeror describe Medical Management model (inclusive of utilization management - prior authorization and concurrent review) | Provided for a stratification of the population. How to operationalize the one point of contact while DCS manages a small portion and they manage the rest. How do you split grievance process are still unclear. When to stratify, how do they flux, need to take a point in time to make determination. How do providers know how to do this. DCS would need separate system. Revision removed stratification process in relation to responsibility but leaves the stratification for care management. One system with DCS having view capabilities, ability to jointly developed authorization criteria. Contract handles 100% of UM/MM. Offeror has authority over pregnancy terminations which is a problem for DCS. Revision removed this and returned authority to DCS. DCS can review prior authorizations and view records but no active participation in authorizations. No information on 2nd level review or approval. Offer is compliant with scope of work for staffing, added categories of DCS liaison and Care Navigators. Revision outlines process for CFT training, oversight and recommends a facilitator model. | Offer offers to develop policies and procedures with DCS on this issue. Mgmt. team has 2 components concurrent and retrospective review. Retro focused on review of medical necessity for high dollar claims. Prior auth decisions can be mad accessible to CMDP for final review. Concurrent is focuses on discharge planning to ensure the child an family post discharge needs are in place. High level, no specific process flow. | DCS final authority on BH higher level of care. No discussion of secondary review or development of criteria for pa. MM through the portal with read only access. Offeror has added additional positions to key personnel. Contractor taking lead role in care management, UM, and prior auth, but DCS shares responsibility and accountability for performance measures. No details in shared responsibility and management approach, just stated that care management and care coordination by design shall be a shared responsibility. May be a stratification approach of Nigh Need/High Cost but no details. Where can we add value is missing from offer. Revision highlights collaborative nature of prior auth and performance monitoring. Revision outlined DCS' involvement in the development of prior auth review process, guidelines, hierarchy, which auths will require 2nd level review and collaborative effort to process map the flow. DCS will participate in develop prior auth criteria ,is a voting committee member for approving guidelines on prior auth, and DCS determines what services require second level review. While Contract takes lead on MM, DCS is integral to the development of measures, development of guidelines and assistance in the training of CFTS. Pregnancy termination is an issue. Revision states DCS has prior auth on pregnancy terms and will support the DCS process. | UM and MM and Pharmacy are Offerors responsibilities. Provided portal to allow for viewing what they did. Offer states DCS will have final authority. Revision added retrospective review of pharmacy denials. Did not have a specific process for the involvement of DCS in prior auth and/or concurrent review. Revision provides minimal process flow and identifies co-locating staff to assist this process. Pregnancy termination is an issue. Revision corrected this issue. Minor edits to scope of work to reflect more current state and compliance with the staffing outlined in the solicitation. Offer retains UM/MM but DCS has grievance process. Revision delegates operationalization of functions to Offeror. DCS only responsible for grievance for members and provide guidance and support to all health plan functions. | ||||||
| 50 | Fiscal Responsibility | Meets | 37.5 | Unacceptable | 0.0 | Meets | 37.5 | Meets | 37.5 | |
| Describe the strategies the Offeror will employee to help manage overall DCS/CMDP program costs, while ensuring DCS/CMDP members have timely access to quality services and supports. | Response and MM IT system has built in checks and controls for audit. Response is in line with RFP scope on third party liability and claims payment. Provided a PMPM cost with added significate upside for administration. Risk assessment of costs not associated with service delivery needs to be assessed. Revision aligned risk to standard process. No need for 2 systems. DCS collaboratively developing prior auth criteria minimizing risk. Reinvestment in network and program at specified level. No statement of program to manage costs but shall collaborate on VBP initiatives. Offer complies with the requirements of AHCCCS audits and scope standards. No edits to third party liability scope of work or corporate compliance on FWA. If contractor has favorable claim outcome other than errors in payment contractor keeps the money. | No discussion of FWA processes or detailed VBP initiatives. No discussion as Medicaid as last payor and third party liability issues. No discussion of financial management other than the stated administrative fee during initial term of contract. Offer does state will extend transitionary services through 1 year. | Integrated system has demonstrated effective cost-control processes, while improving member care and reducing OOH or OOschool timeframes. Response complies with the scope of work. No details on how to contain costs. Offeror uses a plan, do, study, act process. Response complies with scope requirements for coordination of benefits and third party liability, but corporate compliance will only be consistent with DCS policy. No edits to value based purchasing requirements. Revision provides additional information on process flow including exception validation on record loading, provides information on claims adjudication to be compliant with Federal regulations, edits for completeness and accuracy, checks for duplication, recovery a joint effort with DCS, and compliance with Federal and DCS direction. | No specific details on system of capabilities to control cost or identify FWA. Revision identified cost containment as responsibility of Offeror. (Pg. 130) if we want more than they network they currently have we would have to fund the incentive to grow the network. Very passive on compliance with scope of work requirements. Revision removed passive language. Modification to a fixed 2 year fee then review. Unsure if paying in advance or arrears. Revision clarified payment in advance. Performance based payments based on percentage of capitate rate, used to incentivize performance. However, proposed performance metrics include one Offeror is not responsible for. Revision modified this to collaborative effort to establish performance metrics. Offer states responsible for cost-containment but no details. Response is compliant with scope of work for coordination of benefits and third party liability and value based purchasing. | ||||||
| 50 | Claims/Encounters/Payments | Meets | 37.5 | Unacceptable | 0.0 | Meets | 37.5 | Below | 12.5 | |
| Describe the Offeror' s claims adjudication process for Medicaid and state-funded services for both participating and non-participating providers. | Offer has minor edits to claims payment section of scope of work but added additional sections detailing system overview and requirements. Response does not edit the requirements of key personnel in claims and encounter area but did for Information System Administrator. Offer has deleted all operational performance measure for claim and encounters. Claims system has a metric of 90% contract load within 30 days of credentialing. and 90% of contracts loaded with out error. 75% of encounters submitted will reach approval status by AHCCCS. No other metrics identified. Revision restored metrics as identified in the scope, clinical measures are changed to Contractor measures not DCS measures. Operational measures are as stated. Offer complies with the intent of the RFP scope of work. System description indicates checks and balances in the process. Has an established payment processing and claims system compliant with AHCCCS codes and payment structure. DCS has read access to system for review. System is HIPPA compliant. | Offer does not provide details of claims processing or system support. Offer does identify which area of organization would be responsible. No specific metric for claims processing or encounter data provided. | Portal will provide transparency and provide data necessary for DCS to monitor system. No edits or changes to the job responsibilities in key personnel overseeing claims processing. No changes to the performance measures outlined in the RFP scope of work for claims and encounter measures. Response is complaint with the requirements of the scope of work or claims payment/health information system and system data exchange. Assign rate code to member to track. No specific details on how system supports this or identified metrics on this. Revision provided process flow of IT system showing claims process, validation checks, adjudication and grievance flow. Identified current process metrics. | Offer is compliant to the staffing requirements outlined in the solicitation but edited to reflect current system and responsibilities for the information system administrator. (pg. 90) Offer is does not state any conflicts with the requirements in the scope of work but provides no discussion on how system will work to ensure rate and claims payment. Revision makes no changes. | ||||||
| 75 | Readiness and Implementation plan | Meets | 56.3 | Unacceptable | 0.0 | Meets | 56.3 | Below | 18.8 | |
| Describe the Offeror' s implementation plan to demonstrate readiness and implementation of the scope of work responsibilities. | Implementation as early as 10/1/2020 but will negotiate. Implementation of PH and BH at same time, pharmacy year 2. Changed transition to 6 months from 1 year. Modified contractor contracting timeline to provider a shorter timeframe. This puts pressure on the system to testing and uploading. Response with minor edits in compliant with the intent of the scope of work. Revision provides supporting information for the 6 month transition. | Offer does not clearly define an implementation strategy or timeline. Identifies key staff and overall responsibility but indicates all staff will need to be hired. Staff indicated is less than RFP scope but does cover major areas of responsibilities. | Implementation as early as 10/1/2020, but will negotiate. Modifications to the term proposed. Proposing statewide provider and community forums prior to implementation and a creation of an implementation advisory committee. Will use prior experience with AHCCCCS and DD to implementation, experience in transitioning over 1 million members. Wil provide a fully articulated transition plan, a transition coordinator and regulate updates. Edits to scope of work include identifying contractor responsibilities, implementation of PH and BH at same time, changed transition over a year to 180 days for current services. Pg. 47 after 180 days pursuant to contractor policies. No true go live date identified, but they did allow for flexibility. Readiness review compliant with RFP scope of work requirements. Revision made continuity of care to 12 months for all providers including non-participating/non-contracted vendors. | Minor edits to indicate collaboration with DCS for transition and support. Offer request the development of a readiness review plan with shorter timeframes then outline in scope. Timelines subject to mutual agreement. Concern with short timeframes to allow for adequate testing of system and data exchange. No flex time to validate the process. Revision removed the shorter timeframes and re-instated timeframes as outlined in the solicitation. Access to their system not allowed to go live date. BAFO made no changes | ||||||
| 350 | Experience and Capacity | 187.5 | 56.3 | 206.3 | 125.0 | |||||
| 125 | Information System Capacity | Meets | 93.8 | Unacceptable | 0.0 | Meets | 93.8 | Below | 31.3 | |
| Describe Offeror' s information technology system(s), to include system capabilities, functionality and security features, that will support the requirements of the scope of work. | Utilities of the system are more than qualified. Access to system is read and view only. No discussion on collaborating with DCS on authorization criteria. Revision clarifies the process for a collaboration on developing prior authorization criteria and second level review. Concerns on stratification allowing for prior authorization for children in our care, do we need to operate an additional system to manage our responsibilities. Revision removed stratification of responsibility. Adjustment capability of the system is a concern. To effectively manage care offer direct access to platform and um platform to allow visibility. Some confusion on summary for pending denials. | Offer does not outline system capacity. States metrics available to populate dashboards and names systems functions would be processed in. Offer calls out at least 2 different systems of use MED MC and QNXT for claims processing and QliksSnese for analytics. Systems are in place. No discussion of modifications needed. DCS would have access to review/ | No description of system and how it will support the requirements of the scope. However, no edits to scope of work for purpose and applicability, claims payment and health information system, data exchange requirements, encounter data reporting, enrollment and capitation transaction or periodic reporting. Revision provided information on system, process flows, current metrics, grievance and adjudication of claims. | No information provided to define how the existing system meets the scope of work to support the scope of work. Minor edits to purpose and applicability to indicate responsibilities of DCS and offeror. No edits to scope of work for claims payment and health information system, data exchange requirements, encounter data reporting, enrollment and capitation transaction or periodic reporting. BAFO made no changes. | ||||||
| 75 | Experience and Capacity with DCS/CMDP Population | Meets | 56.3 | Meets | 56.3 | Exceeds | 75.0 | Meets | 56.3 | |
| Describe the Offerors experience including the number of years of experience in the industry, number of contracts, number of government contracts, history and capability in providing the services described in the scope of work. | Offer has other state experience, but some experience with CRS and DDD which crosses DCS population. However this is not a complete mirror of services required under this contract. Other states 65,000 across 12 other states. Current ACC contractor. | Meets - Offer has current experiences with health home model and covers 20,000 members in 8 counties of the state, mainly central and northern Arizona. Interaction and coordination with the Northern Arizona RBH Institute indicates experience in this industry and AHCCCS contract indicated direct experience with this population. | Current behavioral health provider for over 8,000 in foster care. Experience in the Medicaid program since 1985. Has provided training for DCS and caregivers in Navigating Behavioral health. Contracted with AHCCCS for Complete Care, ALTCS, DDD and RBHA services. Identification of additional staff in support of directly related activities indicate and understanding of the systematic need. | Experience in this industry, AHCCCS contracts. 14 years serving AZ Behavioral health needs. Not statewide. However sister organization allows access to the network providing statewide coverage. Current ACC contractor. | ||||||
| 25 | Meets | 18.8 | Unacceptable | 0.0 | Meets | 18.8 | Meets | 18.8 | ||
| Describe any disciplinary or adverse actions or other administrative action taken by any jurisdiction or person against the Offeror, any related entity, or one of its officers, members o principals, within the last five (5) years before the submittal. | No information provided BAFO provided a list of adverse actions over the last 5 years. All but 2 corrective actions plans or fines were paid or addressed and closed. 2 active issues are on hold. Report by line of business, either long term care or medicated. Many were encounter non-compliance. | No information provided on current organizational position, liability or potential legal parameters. | No information provided BAFO provided list of adverse actions over the last 5 years. All sanctions were paid, notice of cures addressed or withdrawn, compliance letters complied with. Report by entity/type of line of business (e.g. ALTCS, RHBA, DDD) | No information provided BAFO provided list of administrative actions over the past 5 years. Some remediation not indicated. Unclear if sanctions paid and corrective action plans closed. Many were encounter data. | ||||||
| 25 | Personnel | Meets | 18.8 | Unacceptable | 0.0 | Meets | 18.8 | Meets | 18.8 | |
| Provide an overview of the organizational structure including a list of all Key Personnel that will be dedicated, total or in part, to any resultant contract. | No org structure. No key personnel identified. Request individuals be able to fulfill key staff positions with same individual. Added positions for Member service Managers, DCS liaison and Care Navigators. Revision clarified same person in multiple roles, stated DCS approval will be sought. BAFO provided organizational structure identifying key personnel, their functional area and the positions with more than 1 reporting responsibility. No names identified. | Offer provides list of key personnel to meet the scope of work, but this is a much smaller team than expected. All areas are covered but at a higher level. Job responsibilities listed are aggregated within areas and specific scope of work key personnel will be on "teams" of the key personnel listed in the response. Qualifications are minimally listed and Key personnel would need to be hired. | No org structure. No key personnel identified. Additional staffing listed. Description of job requirements are consistent with industry processes, but unsure of need. Struck out clause for removal of contract employees. (pg. 252). Request individuals be able to fulfill key staff positions with same individual. Revision identified why one person may fill more than one roll. BAFO provided a functional organizational chart. Chart identified key personnel and hierarchical reporting structure. Additional staff positions have been identified. Modification of removal of employees acceptable. | No org structure. No key personnel identified. BAFO provides overview of overall structure via org chart. Showing key personnel and functional areas of key personnel per DCS function tied to scope of work. No indication of dedicated time. | ||||||
| 20 | Meets | 15.0 | Unacceptable | 0.0 | Meets | 15.0 | Meets | 15.0 | ||
| Provide an organizational chart displaying all of the Key Personnel and interrelationships as it pertains to the proposed services. | No org chart BAFO provided org chart identifying hierarchical structure, reporting flow and organizational infrastructure. Key personnel positions identified, but not the person. Identified those positions holding more than 1 position and indicates the staff may also report to or hold responsibilities in other parts of the organization. | Org Chart not provided | No org chart BAFO provides Org Chart and functional lines of reporting. Identification of key personnel to reporting structure provided. | No org chart BAFO provided an overall key organizational chart showing key positions and personnel. Chart indicates interrelationships with the organization. Functional area charts specific to DCS functions also provided. | ||||||
| 30 | Meets | 22.5 | Unacceptable | 0.0 | Meets | 22.5 | Meets | 22.5 |
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