OebbEapRfp_MainRfpDoc_V2~1.pdf

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STATE OF OREGON

COVER PAGE

Oregon Health Authority is issuing this Request For Proposals (RFP) under OregonBuys Bid Number S-44300-00008777 for

EMPLOYEE ASSISTANCE PROGRAM SERVICES

Date of Issue: December 5, 2023

Opening Date and Time: January 26. 2024

Single Point of Contact (SPC) Information:

See RFP Section 4.2

The State of Oregon promotes equal opportunity for all individuals without regard to age, color, disability, marital status, national origin, race, religion or creed, sex or gender, sexual orientation, or veteran status.

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TABLE OF CONTENTS

SECTION 1: GENERAL INFORMATION

1.1 INTRODUCTION

1.2 OEBB DEMOGRAPHICS

1.3 OEBB PROGRAM ADMINISTRATION

SECTION 2: AUTHORITY, DEFINITIONS, AND SCOPE

2.1 AUTHORITY AND METHOD

2.2 DEFINITION OF TERMS

2.3 SCOPE OF WORK / SPECIFICATIONS

SECTION 3: EXPECTATIONS OF Proposers – Minimum Requirements

SECTION 4: SOLICITATION PROCESS

4.1 SCHEDULE

4.2 SINGLE POINT OF CONTACT (SPC)

4.3 PUBLIC NOTICE

4.4 PRE-PROPOSAL CONFERENCE

4.5 QUESTIONS / REQUESTS FOR CLARIFICATIONS

4.6 SOLICITATION PROTESTS

4.7 PROPOSAL DELIVERY OPTIONS

4.8 PROPOSAL MODIFICATION OR WITHDRAWAL

4.9 PROPOSAL DUE

4.10 PUBLIC OPENING

4.11 PROPOSAL REJECTION

4.12 EVALUATION PROCESS

4.13 SCORING / WEIGHTING

4.14 RANKING OF PROPOSERS

4.15 NEXT STEP DETERMINATION

SECTION 5: AWARD AND NEGOTIATION

5.1 AWARD NOTIFICATION PROCESS

5.2 INTENT TO AWARD PROTEST

5.3 APPARENT SUCCESSFUL PROPOSER SUBMISSION REQUIREMENTS

5.4 CONTRACT NEGOTIATION

SECTION 6: ADDITIONAL INFORMATION

6.1 GOVERNING LAWS AND REGULATIONS

6.2 OWNERSHIP/PERMISSION TO USE MATERIALS

6.3 CANCELLATION OF RFP; REJECTION OF PROPOSAL; NO DAMAGES

6.4 COST OF SUBMITTING A PROPOSAL

6.5 RESERVED

6.6 RESERVED

6.7 CHECKLIST DISCLAIMER

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LIST OF ATTACHMENTS

ATTACHMENT A QUESTIONNAIRE AND OTHER RESPONSE ITEMS

ATTACHMENT B FINANCIALS AND PERFORMANCE GUARANTEES

ATTACHMENT C SAMPLE GROUP BENEFITS CONTRACT

ATTACHMENT D DISCLOSURE EXEMPTION AFFIDAVIT

ATTACHMENT E [RESERVED]

ATTACHMENT F PROPOSER CERTIFICATION SHEET: PRIVACY & SECURITY REQUIREMENTS

ATTACHMENT G CERTIFICATION OFFICE FOR BUSINESS INCLUSION AND DIVERSITY (COBID) /

OUTREACH PLAN

ATTACHMENT H RESPONSIBILITY INQUIRY

ATTACHMENT I FINAL SUBMISSION FORM

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SECTION 1: GENERAL INFORMATION

1.1 INTRODUCTION

Oregon has a long history of innovative health reform efforts. Even with this history, Oregon has faced a number of challenges in recent years that are familiar: health care costs that are increasingly unaffordable for individuals, for the state and federal government and businesses; cost growth that far outpaces the growth in state general fund revenue and personal income; and a health care system that rewards volume, not value.

The Oregon Health Authority (OHA) is the largest public purchaser of healthcare services in the state and includes most of the state’s healthcare programs, such as Public Health, the Oregon Health Plan, and Healthy Kids. The Oregon Educators Benefit Board (OEBB) is organizationally located within OHA and purchases healthcare for its Members; however, the Board has its own statutory authority to procure services for certain Benefit Plans, including those within this Request for Proposals (RFP). As the largest public purchaser of healthcare services, OHA is seeking to transform the health care system in Oregon and fundamentally improve how care is paid for and delivered. This transformation process involves focusing on health and preventive care, providing care for everyone, and reducing waste in the health care system to meet three overarching goals: to provide better care, resulting in better health, and at a lower cost This RFP supports this mission.

OEBB expects greater value from its health care partners through a health care delivery system that is accountable for costs and outcomes. By eliminating waste and controlling costs, OEBB will ensure that its Members have the care they need today and in the future.

In addition, OEBB would like to ensure that its Members’ care is coordinated across the continuum and that quality and financial incentives are more aligned throughout the delivery system. When making decisions about its health care partners, OEBB will look for better health outcomes and patient-centered programs with demonstrated success. OEBB believes the coordinated care model is essential for successful potential partners in achieving its goals through this RFP.

To that end, OEBB seeks a best-in-class partner who will deliver high-quality Employee Assistance Program (EAP) services in a manner that is accessible to its diverse membership.

Additional details on the scope of services are included in Section 2.3 below.

OEBB anticipates, but does not guarantee, the award of one Contract from this RFP. Proposers shall not interpret anything in this RFP as a guarantee by OEBB that any Proposer will be selected as an Apparent Successful Proposer, or ASP (as such term is defined in Section 2.2 below of this RFP).

OEBB desires, if an ASP is selected, to have any resulting contract negotiated and executed by or closely around June 5, 2024. The initial term of any resulting contract is anticipated to begin on or about the date of Contract execution, and continue through September 30, 2027. That said, the Successful Proposer will not actually begin delivering EAP services to eligible OEBB Members until October 1, 2024, unless otherwise negotiated in the resulting Contract.

Thereafter, OEBB shall have the option, but not the obligation, to extend the term of any resulting Contract for either additional one or multiple 12-month terms. In addition, OEBB reserves the right to amend the Contract for changes in OEBB’s funding, changes to the Scope of Work needed by OEBB that are reasonably related to the then-current Contract and the Scope of Work described in this RFP, changes in applicable law, and Contractor rate changes as permitted in the Sample Group

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Benefits Contract, which is attached to this RFP as Attachment C.

1.2 OEBB DEMOGRAPHICS

OEBB provides various employee benefits to employees of various school district Entities and local government Entities located in Oregon. Many of these Entities have the option of purchasing these benefits either through OEBB or through other sources. More specifically, OEBB currently provides a comprehensive selection of Benefit Plan options to 79% of Oregon’s education-based Entities (93% of K-12 school districts, 46% of charter schools and education service districts, and 100% of community colleges) as well as seven of the state's local governments. OEBB currently provides benefits for almost 150,000 covered lives, including actively employed and retired members and their families. More specifically, as of September 2023, OEBB served a total of 137,669 total covered lives.

The Employee Assistance Program (EAP) OEBB provides is an optional program for all Entities who participate in OEBB’s Benefit Plans. In addition, when an Entity participates in OEBB’s EAP, covered services are available to both Employees of that organization as well as the Eligible Employees’ eligible dependents. Furthermore, 169 of OEBB’s participating Entities currently purchase EAP benefits through OEBB at a per-employee per-month (PEPM) rate covering 71,456 employees. Please note that each Entity self-reports the number of employees they wish to cover and some extend EAP benefits to all employees (including those who are not otherwise benefits-eligible) and some also extend EAP benefits to retirees.

In the 2021-22 Plan Year, OEBB paid its EAP vendor a total of $695,347. As of May 2023, OEBB had paid its EAP vendor a total of $729,796 for the 2022-23 Plan Year. In addition, Proposers should note that OEBB is subject to a 3.4% budgetary growth cap. OEBB’s intent is to manage its overall expenditures within that 3.4% budgetary growth cap by holding each Benefit Plan Contractor responsible for managing its own costs within that budgetary cap, including the future EAP vendor that results from this RFP process.

1.3 OEBB PROGRAM ADMINISTRATION

Background

OEBB was formed by Senate Bill 426 (2007) and charged with purchasing benefits for active employees (and some retirees) of most educational Entities, including public school districts (K-12), education service districts, community colleges and public charter schools in Oregon. Local governments and special districts may also join OEBB under ORS 243.129.

Mercer Health & Benefits (Mercer or Consultant) serves as OEBB’s Consultant. Except where this RFP specifically refers to the Board, any action taken during this RFP (through Contract execution) or in support of this RFP may be taken either by the Board or by the Board’s designees, including OEBB staff and Consultant. Furthermore, Consultant has retained a vendor (Proposal Tech) to provide the Proposal submission website. The vendor is not affiliated with OEBB or the State of Oregon.

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OEBB’s Vision

OEBB strives to work collaboratively with participating Entities, Members, and Benefit Plan Contractors to offer value-added Benefit Plans that support improvement in Members’ health status, hold Benefit Plan Contractors accountable for outcomes, and provide affordable benefits and services.

Key components of OEBB’s vision include:

• Supporting Oregon’s healthcare system transformation efforts promoting better health, better care, and lower costs

• Supporting improvement in Members’ health status through a variety of measurable programs and services

• Offering value-added plans that provide high-quality care and services at an affordable cost to Members

• Administering measurable goals and programs that hold Benefit Plan Contractors accountable for health outcomes

• Encouraging Members to take responsibility for their own health outcomes

• Collaborating with participating Entities, Members, Benefit Plan Contractors, and providers to ensure a synergistic approach to the design and delivery of Benefit Plans and services

• Offering Benefit Plans that are in compliance with all state and federal laws and support participating Educational Entities’ abilities to comply with healthcare-related laws and regulations

SECTION 2: AUTHORITY, DEFINITIONS, AND SCOPE

2.1 AUTHORITY AND METHOD

Request for Proposals (RFP) is being conducted pursuant to Oregon Revised Statutes (ORS) 243.860 – 243.886, which can be found at:

https://www.oregonlegislature.gov/bills_laws/ors/ors243.html

OEBB’s administrative rules are in chapter 111 of the Oregon Administrative Rules (OAR), which can be found at:

https://secure.sos.state.or.us/oard/displayChapterRules.action?selectedChapter=186

Definitions governing this RFP are provided in Section 2.2 of this main RFP document.

In the event that a term included in this RFP is not defined in Section 2.2, Proposers will refer to OEBB’s administrative rules.

2.2 DEFINITION OF TERMS

Unless otherwise noted directly below or elsewhere throughout this RFP, capitalized terms shall have the meanings provided in OAR 111-005-0020 and 111-010-0015. If the preceding OARs do not include the relevant definition(s), capitalized terms shall then have the meaning provided in OAR 137-046-0110.

https://www.oregonlegislature.gov/bills_laws/ors/ors243.html

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Addenda means any amendments, clarifications, or changes to the terms of the RFP as posted on OregonBuys and ProposalTech’s Prposal Submission Website.

Administrative Overpayments mean payments that exceed the benefit amount payable under the Benefit Plan design resulting from a Provider billing error, retroactive or inaccurate eligibility information, coordination of benefits, third-party liability, Medicare disputes, missing information, or similar circumstances.

Affiliate of a Proposer means all affiliates, assignees, subsidiaries, parent companies, successors and transferees, and persons under common control with the person; any officers, directors, partners, agents and employees of such person; and all others acting or appearing to act on their behalf or in concert with them.

Affiliated Company means an “affiliate” as defined in ORS 732.548 (insurance holding company registration statute).

ASP means Apparent Successful Proposer, which refers to the organization selected as the ASP to this RFP but who has not yet successfully negotiated and executed a Contract with

OEBB.

Benefits Claim means a claim of a Member for benefits.

Benefit Plan includes, but is not limited to, insurance or other benefits, including:

(i) Medical (including non-integrated health reimbursement arrangements, or HRAs);

(ii) Dental;

(iii) Vision;

(iv) Life, disability, and accidental death;

(v) Long term care;

(vi) Employee Assistance Program;

(vii) HRAs as defined by OAR 111-010-0015(22);

(viii) Supplemental medical, dental, and vision coverages;

(ix) Any other remedial care recognized by state law, and related services and supplies; and,

(x) Self-insurance programs managed by the Board.

Board means either the governing board of OEBB or, collectively, its staff, depending upon context.

Broker means a person who is under, or is expected to, or has responded to, a Procurement to be under, a contract as a consultant, broker, agent, representative, or other person responsible for evaluating insurance services.

Client means an Eligible Employee, Qualified Dependent, or participating Entity (as context requires) either actively receiving services from Contractor or an Employee or Qualified Dependent eligible to receive services from Contractor through their respective agency’s participation in the program.

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Confidential Member Information or Confidential Information means information that contains personally identifiable health information about a Member. More specifically, it means any and all information of any form obtained by Contractor or its employees, subcontractors, or agents in the performance of this Contract, including OEBB data, as well as any reports or other documents or items (including data aggregations) that result from the use of OEBB information and data that are relied upon to produce the reports or other documentation or items, are deemed to be confidential information of OEBB (“Confidential Information”). Confidential Information does not to include information that (i) is or becomes (other than by disclosure by Contract) publicly known; (ii) is furnished by OEBB to others without restrictions similar to those imposed by this Contract; (iii) is rightfully in Contractor’s possession without the obligation of nondisclosure prior to the time of its disclosure under this Contract; (iv) is obtained from a source other than OEBB without the obligation of confidentiality, (v) is disclosed with the written consent of OEBB, or; (vi) is independently developed by employees, agents or subcontractors of Contractor who can be shown to have had no access to the Confidential Information.

Consultant has the meaning described in OAR 111-005-0020. For purposes of this RFP, OEBB has retained Mercer Health & Benefits as its Consultant.

Contract or Group Benefits Contract are synonymous with “Contract” and mean the contracts that result from this RFP process. The terms Contract, Groups Benefits Contract, and Agreement may be used interchangeably.

Contractor means the party providing EAP services to Clients and Entities under the future Group Benefits Contract.

Contractor Intellectual Property means any intellectual property owned by Contractor and developed independently from the Work.

Contractor Proprietary Information means any information marked or designated in writing by Contractor as “confidential” prior to initial disclosure, or information disclosed orally that is confirmed in writing as “confidential” within 10 (ten) calendar days of disclosure.

EAP means Employee Assistance Program.

EDI means Electronic Data Interchange, as defined under HIPAA.

Effective Date means the date that Contracts awarded under this RFP will begin, which is when they are fully executed by the parties and after they receive all necessary approvals from the State of Oregon, including legal sufficiency approval from the Oregon Department of Justice.

Eligible Employee or Employee means an employee of an Entity who is actively working or on paid or unpaid leave that is recognized by federal or state law, and:

(a) Is employed in a half time or greater position or is in a job-sharing position; or

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(b) Meets the definition of an eligible employee under a separate OEBB rule or under a collective bargaining agreement or documented district policy in effect on January 31, 2008; or

(c) Is an employee of a community college who is covered under a collectively bargained contract and has worked a class load of between 25 percent and 49 percent for a minimum period of two years and is expected to continue to work a class load of at least 25 percent.

Entity means an educational entity, local government, or special district eligible to participate in OEBB’s Benefit Plans under ORS 243.860 – 243.886.

ERISA means the Employee Retirement Income Security Act.

HIPDB means Healthcare Integrity and Protection Data Bank.

Insurance Services includes but is not limited to the services of an insurance company, reinsurer, dental care service contractor, dental services manager, third-party administrator, insurance broker, insurance agent, risk manager, utilization review organization, consultant, Benefits Claims payment processor, or any other employee benefits management company or contractor.

Insurance Services Contractor means a company or person which is currently, or is responding to a Procurement to become, under contract with or otherwise furnishing Insurance Services to the State of Oregon.

IRS means Internal Revenue Service.

Legal Claim means any claim, suit, action, or proceeding between OEBB (or any other agency or department of the State of Oregon) and Contractor that arises from or relates to the future Contract.

Member means, and includes, the following:

(i) “Eligible employee” as defined by OAR 111-010-0015(17);

(ii) “Child” as defined by OAR 111-010-0015(7);

(iii) “Eligible Domestic partner” as defined by OAR 111-010-0015(15);

(iv) “Spouse” as defined OAR 111-010-0015(34);

(v) “Eligible Early Retiree” as defined by OAR 111-010-0015(18); and

(vi) “Dependent” as defined by OAR 111-010-0015(13).

Network means a Provider who has entered into or is governed by contractual arrangements with Contractor or a Contractor Affiliate or subcontractor, under which they agree to provide health care services to Members and to accept negotiated fees for such services under at least one of the Benefit Plans.

Network Provider means a Provider who participates in a Contractor Network for at least one of the Benefit Plans.

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Noncompetitive Response means bidding, proposing, or otherwise responding to a Procurement, which response (as a result of actions of or circumstances that are created in whole or part by a Proposer or its Affiliates):

(i) is not bona fide;

(ii) favors the incumbent Insurance Services Contractor;

(iii) restricts or allocates opportunities to sell Insurance Services to the State of

Oregon;

(iv) is rigged, steered to a particular Insurance Services Contractor to avoid fee disclosures or for other reasons not specified in the Procurement, based on target premiums or fixed prices or chosen by the State of Oregon under false pretenses;

(v) has a backup quote or protective quote, a so-called ‘B Quote’ not based on underwriting analysis, false or inflated quotes, or quotes that were deliberately inferior in order to manipulate market pricing or to present the quotes of Insurance Services Contractor or the Broker’s negotiating powers in a more favorable light;

(vi) is collusive, fictitious or otherwise noncompetitive; or,

(vii) induces or causes the State of Oregon to purchase Insurance Services at prices higher than it would have paid, or on terms less favorable than would have been available, in a competitive market.

OAR means Oregon Administrative Rule(s).

OHA means the Oregon Health Authority. OEBB is located within the OHA.

OregonBuys means the State of Oregon website where procurement documents, including documents from this RFP, are publicly posted. OEBB will post official RFP documents on OregonBuys as well as instruct Proposal Tech to do the same in their Proposal submission site.

ORS means the Oregon Revised Statutes.

OEBB means the State of Oregon, acting by and through its Oregon Educators Benefit Board.

Open Enrollment (“OE”) means the period when Eligible Employees select Benefit Plan options for the upcoming Plan Year. OEBB’s OE period takes place annually between August 15 and September 15.

PHI means Protected Health Information, as defined under HIPAA.

Plan Year means October 1 through September 30.

Procurement means the action of obtaining goods or services under a public contract.

Proposal means a competitive document, binding on the Proposer and submitted in response to this RFP.

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Proposal Submission Website refers to the website hosted by Proposal Tech where this RFP will be administered.

Proposer means an organization that submits a proposal responsive to this RFP and by the RFP’s stated timeline.

Provider means a health care practitioner or facility that is validly licensed by the appropriate state agency to diagnose or treat health care conditions, and is providing services within the scope of that license.

Qualified Dependent means a spouse, domestic partner, or dependent child, each as defined in OEBB’s administrative rules.

Recent Retiree means an employee of a participating Entity, who has retired within the last 30 calendar days.

Successful Proposer means the organization that is selected as this RFP’s ASP and who successfully negotiates and executes a Contract with OEBB.

Third Party Intellectual Property means any intellectual property owned by parties other than OEBB or Contractor.

Vendor means a person who is under a contract with the State of Oregon for Insurance Services.

Work means the deliverables to be completed and services to be provided under the Contract resulting from this RFP.

Work Product means every invention, discovery, work of authorship, trade secret or other tangible or intangible item and all intellectual property rights therein that Contractor is required to deliver to OEBB pursuant to the Work.

2.3 SCOPE OF WORK / SPECIFICATIONS

Please refer to Attachment C, Sample Group Benefits Contract.

SECTION 3: EXPECTATIONS OF PROPOSERS – MINIMUM REQUIREMENTS

In addition to the required submissions described below, Proposals must meet the following requirements to be considered for award:

• EAP services must be made available to employees not enrolled in a medical plan;

• EAP services must be made available to an employee’s applicable dependents (i.e.

spouse and children);

• EAP services must also be made available to members of employee’s household who are not dependents (i.e. parent); and,

• EAP services must be made available at both a physical location and virtually.

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In order to be considered under this RFP, Proposers must submit a complete and responsive Proposal that responds to all applicable questions and submits all required documents as further described in this RFP. One purpose of Attachment I, Final Submission Form, is to provide a submission checklist to Proposers that includes a list of the RFP requirements in one place.

Like other required submissions under this RFP, Proposers will confirm their compliance with the Mandatory Minimum Requirements provided in Attachment I, Final Submission Form, by completing Part A of the Final Submission Form on the Proposal submission website at: www.proposaltech.com. Specific instructions for completing this required checklist can also be found on the Proposal submission website.

By completing Attachment I, Final Submission Form, Proposers will also indicate that they have submitted all other required responses and documents. More specifically, Part A requires Proposers to not only agree to a number of statements and certifications, but also confirm that they have fully responded to the RFP by completing or submitting the following:

• All applicable responses to items included in Attachments A and B, including submitting supporting or supplemental documents or information where required;

• All applicable responses to items included in Attachment C, Sample Group Benefits Contract, including confirming acceptance of all terms or provisions that are deemed non-negotiable under this RFP1;

• All applicable responses to items included in Attachment F, Proposer Certification Sheet: Privacy and Security Requirements;

• All applicable responses to items included in Attachment G, Certification Office for Business Inclusion and Diversity (COBID) Outreach Plan;

• All applicable responses to items included in Attachment H, Responsibility Inquiry; and, By completing Attachment I, Final Submission Form, Proposers will also agree to follow the process for declaring portions of their Proposal as exempt from disclosure under Oregon’s Public Records Law, even though the process will occur after Proposals are submitted. Proposers will declare disclosure exemptions by submitting a completed Attachment D, Disclosure Exemption Affidavit, along with its claimed exemptions, by the date described in the Section 4.1. Please note that this submission is a requirement and failure to submit Attachment D, along with the claimed disclosure exemptions, may be grounds for disqualification. Please also note that OEBB, or its Consultant, will provide

1 This RFP requires Proposers to indicate which terms and conditions, or other Contract provisions, they would like to negotiate in the event they are selected as an ASP and must also provide alternative language or a clear explanation of how they would like to change the term or provision if they indicate that they would like to negotiate. If a Proposer does not indicate that it would like to negotiate a specific term or provision and does not provide alternative language or a clear explanation, the Proposer will lose the right to negotiate that term or condition upon being selected as an ASP. Furthermore, if a Proposer does not wish to negotiate any terms or conditions, it must indicate so.

http://www.proposaltech.com/

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By completing Attachment I, Final Submission Form, Proposers will also agree to a number of representations and warranties described in Part B, such as agreeing that Proposer prepared its response to this RFP independently from all other Proposers, unless otherwise permitted by this RFP concerning subcontractors and collaborators, and without collusion, fraud, or other dishonesty.

In addition, Attachment I, Final Submission Form, also requires Proposers to complete Part C, which contains a number of state-required certifications.

Last, some responses to this RFP may be limited to a certain number of words. Such limitations will be described in Proposal Tech and will be considered requirements to this RFP.

OEBB requires Proposals to be complete and comply with all RFP specifications. Any missing information could disqualify a Proposal. Unless a Proposer notes to the contrary, OEBB will assume the Proposer’s Proposal conforms to the specifications of this RFP in every way.

SECTION 4: SOLICITATION PROCESS

4.1 SCHEDULE

The table below represents a tentative schedule of events. Unless otherwise noted, all Events will be due by 5:00 pm Pacific Time. All dates listed are subject to change. N/A denotes that event is not applicable to this RFP.

Event Date Time

Pre-Proposal Conference December 14, 2023 TBD

Questions / Requests for Clarification Due December 28, 2023

Answers to Questions / Requests for Clarification Issued (approx.) January 10, 2024

RFP Protest Period Ends January 17, 2024

Opening (Proposal Due) See RFP cover page

Attachment D and Disclosure Exemptions February 20, 2024

Presentations, Demonstrations, or Interviews (If needed)

March 18-22, 2024

Issuance of Notice of Intent to Award (approx.) March 29, 2024

Award Protest Period Ends April 5, 2024

Expected start date for resulting contract See Section 1.1

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4.2 SINGLE POINT OF CONTACT (SPC)

Any and all questions from Proposers about this RFP, including questions relating to contractual requirements, clarification of specific information requested, the procurement process, or any other aspect of the project or needed services, shall be directed as follows:

• All technical questions related to the Proposal submission website or how to submit responses shall be directed to the appropriate customer support team at Proposal Tech at: support@proposaltech.com or via telephone at 877-211-8316 ext. 84 ;

• All other related assistance or questions related to this RFP should be submitted via the Proposal submission website (www.proposaltech.com) using the “Ask Question” feature located on the left-hand menu under “Help.2”

4.3 PUBLIC NOTICE

The RFP and attachments are published in the State of Oregon’s electronic procurement system OregonBuys at https://oregonbuys.gov/ as a courtesy to prospective Proposers. This RFP will be administered, however, through the Proposal submission website hosted by Proposal Tech:

www.proposaltech.com. Documents will not be mailed to prospective Proposers.

Modifications, if any, to this RFP will be made by written Amendment(s) published in OregonBuys and also posted to the Proposal submission website. Prospective Proposer is solely responsible for checking OregonBuys and the Proposal submission website to determine whether or not any Amendment(s) have been issued. Amendment(s) are incorporated into the RFP by this reference.

4.4 PRE-PROPOSAL CONFERENCE

A Pre-Proposal conference will be held for this RFP according to the schedule in Section 4.1.

4.5 QUESTIONS / REQUESTS FOR CLARIFICATIONS

All inquiries, whether relating to the RFP process, administration, deadline, or method of award, or to the intent or technical aspects of the RFP must:

(i) Be delivered consistent with Section 4.2,

(ii) Reference the OregonBuys bid number,

(iii) Identify Proposer’s name and contact information,

(iv) Refer to the specific area of the RFP being questioned (i.e. page, section and paragraph number), and

(v) Be received by the due date and time for Questions/Requests for Clarification identified in the Schedule in Section 4.1 above.

4.6 SOLICITATION PROTESTS

4.6.1 Protests to RFP

2 Note: All communications sent via this route will automatically be forwarded to OEBB staff managing the RFP.

https://oregonbuys.gov/

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Prospective Proposers may submit a written protest of anything contained in this RFP, including but not limited to, the RFP process, Specifications, Scope of Work, and the proposed Sample Contract. This is prospective Proposer’s only opportunity to protest the provisions of the RFP, except that Proposer may protest Amendment(s) as provided below and Proposer may take exception to the terms and provisions of the Sample Group Benefits Contract as allowed by or described in Attachment C and Section 5.4 below.

4.6.2 Protests to Amendment(s)

Prospective Proposer may submit a written protest of anything contained in an Amendment.

Protests to an Amendment, if issued, must be submitted by 5:00 p.m. Pacific Time on the second Business Day following the issuance of the Amendment or the date/time specified in the Amendment, or they will not be considered. Protests of matters not added or modified by the Amendment will not be considered.

4.6.3 Requirements for Protests

All protests must:

(i) Be delivered consistent with Section 4.2,

(ii) Reference the OregonBuys bid number,

(iii) Identify prospective Proposer’s name and contact information,

(iv) Be sent by an authorized representative,

(v) State the reason for the protest, including:

o the grounds that demonstrate how the Procurement process is contrary to law, unnecessarily restrictive, legally flawed, or improperly specifies a brand name;

and o evidence or documentation that supports the grounds on which the protest is based, and

(vi) State the proposed changes to the RFP provisions or other relief sought.

Protests to the RFP must be received by the due date and time identified in the Schedule.

Protests to an Amendment must be received by the due date identified in the Amendment.

4.7 PROPOSAL DELIVERY OPTIONS

Proposer is solely responsible for ensuring its Proposal is submitted in accordance with the RFP requirements before Opening. OEBB is not responsible for any delays in mail or by common carriers or by transmission errors or delays, or for any mis-delivery for any reason.

A Proposal submitted by any means not authorized below will be rejected. The following delivery options are permitted for this RFP:

Delivery through Proposal Submission Website ONLY

Proposers must submit all required RFP materials and responses through the Proposal Submission Website (www.proposaltech.com) unless otherwise specifically allowed by this

RFP.

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4.8 PROPOSAL MODIFICATION OR WITHDRAWAL

If a Proposer wishes to make modifications to a submitted Proposal, the Proposer must make such modification through the Proposal Submission Website before Proposals are due, unless OEBB specifically grants an exception to a Proposer to modify a portion of their Proposal after the submission deadline.

If a Proposer wishes to withdraw a submitted Proposal, it must do so through the Proposal Submission Website and should also provide a written confirmation to the SPC of their intent to withdraw.

4.9 PROPOSAL DUE

A Proposal (including all required submittal items) must be successfully submitted to the Proposal Submission Website on or before Opening, which is identified on the Cover Page and in the Schedule set forth in Section 4.1 above.

A Proposal received after Opening is considered LATE and will NOT be accepted for evaluation.

A late Proposal will be returned to the Proposer or otherwise destroyed.

4.10 PUBLIC OPENING

A public Opening will be held on the date and time listed in the Schedule set forth in Section 4.1 and in the manner stated on the Cover Page. Only the name of the Proposer will be read at the Opening, no other information will be made available at that time. Proposals received will not be available for inspection until after the evaluation process has been completed and the notice of Intent to Award is issued pursuant to OAR 111-005-0040

4.11 PROPOSAL REJECTION

OEBB may reject a Proposal for, but not limited to, any of the following reasons:

• For good cause and deem it as non-responsive upon written finding that it is in the best interest of Eligible Employees, Dependents, Eligible Domestic Partners, and Eligible Early Retirees to do so or acceptance of the Proposal may impair the integrity of the RFP process.

• Proposer fails to substantially comply with all prescribed RFP procedures and requirements, including but not limited to the requirement that Proposer’s authorized representative sign the Proposal.

• Proposer has liquidated and delinquent debt owed to the State or any department or agency of the State.

• Proposer has been debarred as set forth in ORS 279B.130.

• Proposer is found non-responsible as described in OAR 111-005-0055.

• Proposer makes any contact regarding this RFP with State representatives such as State employees or officials other than the SPC or persons authorized by the SPC, or inappropriate contact with the SPC.

• Proposer attempts to influence a member of the Evaluation Committee.

• Proposal is conditioned on OEBB’s acceptance of any other terms and conditions or rights to negotiate any alternative terms and conditions that are not reasonably related to those expressly authorized for negotiation in the RFP or Amendment(s).

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4.12 EVALUATION PROCESS

4.12.1 Responsiveness and Responsibility Determination

4.12.1.1 Responsiveness determination

A Proposal received prior to Opening will be reviewed to determine if it is Responsive to all RFP requirements including compliance with Section 3 (Expectations of Proposers – Minimum requirements) and this Section 4 (Solicitation Process). If the Proposal is unclear, the SPC may request clarification from Proposer. However, clarifications may not be used to rehabilitate a non-Responsive proposal. If the SPC finds the Proposal non- Responsive, the Proposal may be rejected; however, OEBB may waive mistakes in accordance with OAR 111-005-0050.

4.12.1.2 Responsibility Determination

OEBB will determine if an Apparent Successful Proposer is Responsible prior to award and execution of the Contract. Selected Proposer shall submit a signed Responsibility Inquiry form (Attachment H) at the time all other submission documents are due per the Schedule in Section 4.1.

At any time prior to award, OEBB may reject a Proposer found to be not Responsible.

4.12.2 Evaluation Criteria

Not all responses submitted in a Proposal in response to the questionnaire items in Attachments A and B will be scored. Rather, some items will be used for informational purposes, such as to inform OEBB of potential contract negotiation issues if that specific Proposer is selected.

Items that are scored will be scored on a 5-point scale.

The evaluation criteria for this 5-point scale will be as follows:

Points Criteria

5 Excellent - Considered best in class

4 Above Average - Meets desired capabilities with some best in class features

3 Average - Meets desired capabilities, but does not exceed expectations in a few critical areas

2 Below Average - Does not meet capabilities desired, but does have a few positive components

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1 Unsatisfactory - Fails to meet most, if not all, desired capabilities

Each Proposal meeting all Responsiveness requirements will be independently evaluated by members of an Evaluation Committee. Evaluation Committee members may change and OEBB may have additional or fewer evaluators for optional rounds of competition.

The SPC may request further clarification to assist the Evaluation Committee in gaining additional understanding of a Proposal. A response to a clarification request may only clarify or explain portions of the already submitted Proposal and may not contain new information not included in the original Proposal.

4.12.3 FINANCIAL AND PERFORMANCE GUARANTEES EVALUATION

Financial proposals will be scored based on the submitted all-inclusive Per Employee Per Month (PEPM) fee and weighted as described in 4.13. An all-inclusive PEPM that reflects all fees and services included in this proposal is required considering OEBB is structured as an annual opt-in at the Entity level.

Performance guarantee proposals will be scored based on the percent of PEPM fees placed at risk and the level of acceptance of performance guarantees as originally stated without modification.

This RFP includes no preferential scoring or evaluations. If OEBB receives Proposals identical in price, fitness, availability, and quality and chooses to award a Contract, OEBB shall award the Contract in accordance with the procedures outlined in OAR 111-005-0040.

4.13 SCORING / WEIGHTING

Proposals will be scored as follows using the following overall component weights:

Component Weight

Questionnaire (Responses to Attachment A) 60%

Financials and Performance Guarantees (Responses to Attachment B) 20%

Finalist Interviews and References 20%

Total 100%

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Responses to the Questionnaire component (Attachment A) will be scored using the following section weights:

Section Weight

Access and Network Quality 45%

Clinical Process, Outcomes, and Effectiveness 15%

Member Experience and Programming 15%

Equity and Inclusion 10%

Account Management, Implementation, and Company Key Information

10%

Organizational Training and Support 5%

Total 100%

Responses to the Financials and Performance Guarantees component (Attachment B) will be scored using the following section weights:

Section Weight

Financials 80%

Performance Guarantees 20%

Total 100%

The Finalist Interviews and references component will be scored using the following section weights:

Section Weight

Finalist Interview 90%

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References 10%

Total 100%

The SPC or designee will total scores among the evaluators and then average scores for each section described above so each Proposer has a single score expressed as a single percentage for each section listed. These section scores will be weighted as indicated above and summed across sections to obtain a component score for each Proposer.

4.14 RANKING OF PROPOSERS

After compiling each Proposer’s score, including any applicable preference, the SPC or designee will determine the rank of each Proposal, with the highest score receiving the highest rank, and successive rank order determined by the next highest score.

Upon conclusion of scoring the first round, OEBB may, in OEBB’s sole discretion, determine an ASP with no additional rounds of competition or may decide to conduct a second round of competition.

4.15 NEXT STEP DETERMINATION

4.15.1 Second Round of Competition

If OEBB, in its sole discretion, decides to invite top ranking Proposers to finalist interviews (the second round of competition, the ranking for this purpose will be based on combining the Questionnaire and Financials and Performance Guarantees component scores to achieve an interim total score for each Proposer.

OEBB may elect to conduct interviews via teleconference or virtual meetings. Further details will be included with Notice of Competitive Range. Finalists invited to be interviewed in a 2nd round of competition, if any is held, will be determined using the competitive range determination described in Section 4.15.3 below.

Selected finalists will go through interviews, undergo reference checks, and receive follow-up questions that will be scored by evaluators. Like the earlier scoring process, average scores will be calculated so each finalist has a single score for each section. These section scores will be weighted and summed across sections to calculate a finalist interview and references component score for each finalist.

The final total score for each finalist will be calculated by combining the three component scores for each finalist using the weights listed.

If OEBB holds finalist interviews (second round of competition) it is anticipated that a Successful Proposer will be identified at the end of such round. However, upon completion of the second round, OEBB may, in its sole discretion, hold additional rounds of competition. If it does, OEBB will again rank and advance Proposers in accordance with Section 4.15.2 below of this RFP.

Furthermore, OEBB anticipates that if a second round of competition is held, it may be scored. If

OregonBuys Bid Number S-44300-00008777 Page 21 of 26 scored, the second round of competition may be worth up to half the weight attributed to the first round of competition for the Finalist Interview section (in this case, the second round of competition may be worth up to 45%, which is half of the 90% attributed to this section).

4.15.2 Additional Rounds of Competition.

OEBB may choose, in its sole discretion, to conduct additional round(s) of competition.

Additional rounds of competition may consist of, but will not be limited to:

(i) Interviews

(ii) Presentations/Demonstrations/Additional Submittal Items

(iii) Discussions and submittal of revised Proposals

(iv) Serial or simultaneous negotiations

(v) Best and Final Offers

If additional rounds are conducted, OEBB will rank Proposers at the conclusion of each subsequent round and advance the Proposers in accordance with Section 4.15.3 below of this RFP.

If OEBB holds additional rounds of competition, it reserves the right to establish additional weights for those additional rounds of competition, with the weights added to the cumulative total from previous rounds. In addition, OEBB may determine an ASP at any time after the first round of competition during the solicitation process.

4.15.3 Competitive Range Determination for Additional Rounds of Competition

If OEBB, in its sole discretion, determines that one or more additional rounds of competition is necessary, it will select a Competitive Range to identify the Proposers that will be invited to participate in a subsequent round. The Competitive Range may include all, or at OEBB’s sole discretion, some (based primarily on a natural break in the distribution of scores), of the Proposers from a previous round. OEBB will post a notice in OregonBuys of its Competitive Range Determination and provide details about the process and schedule for the subsequent round.

4.15.4 Competitive Range Protest

Proposers excluded from any round of competition may submit a Written protest of Competitive Range. Protests must:

(i) Be delivered consistent with Section 4.2,

(ii) Reference the OregonBuys bid number,

(iii) Identify Proposer’s name and contact information,

(iv) Be sent by an authorized representative,

(v) State the reason for the protest, and

(vi) Be received within 7 calendar days after issuance of the Notice of the

Competitive Range unless a different due date and time is specified in such notice.

OEBB will address all protests within a reasonable time and will issue a Written decision to the respective Proposer. Protests that do not include the required information will not be

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SECTION 5: AWARD AND NEGOTIATION

5.1 AWARD NOTIFICATION PROCESS

5.1.1 Award Consideration

OEBB, if it awards a Contract, will award it to the highest ranking Responsive, Responsible Proposer based upon the scoring methodology and process described in Section 4 with the following exception: If the total final scores are within 3 percentage points for more than one Proposer, OEBB may at its discretion select the Proposer with the lower total final score, should that Proposer have higher scores in both Access and Network Quality as well as Clinical Process, Outcomes, and Effectiveness.

Specific questions in these areas include, but are not limited to, the following:

• Average wait time to in-person and virtual appointments

• Use of clinically validated measures in both intake and outcomes

• Demonstration of provider concordance through diverse provider network and provider search/filtering options

• Leading practice risk protocols in place to address high-risk members seeking services

OEBB may award less than the full Scope of Work described in this RFP.

5.1.2 Intent to Award Notice

OEBB will notify all Proposers in Writing that it intends to award a Contract to the selected Proposer subject to successful negotiation of any negotiable provisions.

5.2 INTENT TO AWARD PROTEST

5.2.1 Protest Submission

An Affected Proposer shall have 7 calendar days from the date of the Intent to Award notice to file a Written protest.

A Proposer is an Affected Proposer only if the Proposer would be eligible for Contract award in the event the protest was successful and is protesting for one or more of the following reasons:

• All higher ranked Proposals are non-Responsive.

• OEBB has failed to conduct an evaluation of Proposals in accordance with the criteria or process described in the RFP.

• OEBB abused its discretion in rejecting the protestor’s Proposal as non-

Responsive.

• OEBB’s evaluation of Proposal or determination of award otherwise violates

ORS Chapter 243 or Chapter 111 of the Oregon Administrative Rules. .

If OEBB receives only one Proposal, it may dispense with the evaluation process and Intent

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5.2.1.1 Protest Requirements

Protests must:

• Be delivered consistent with Section 4.2;

• Reference the OregonBuys bid number ;

• Identify Proposer’s name and contact information;

• Be signed by an authorized representative of Proposer;

• Specify the grounds for the protest; and

• Be received within 7 calendar days of the Intent to Award notice.

5.2.2 Response to Protest

OEBB will address all timely submitted protests within a reasonable time and will issue a Written decision to the respective Proposer. Protests that do not include the required information will not be considered by OEBB.

5.3 APPARENT SUCCESSFUL PROPOSER SUBMISSION REQUIREMENTS

Proposer who is selected for a Contract Award under this RFP will be required to submit additional information and comply with the following:

5.3.1 Insurance

Prior to award, Proposer shall secure and demonstrate to OEBB proof of insurance as required in this RFP. Insurance Requirements are found in Attachment C.

5.3.2 Taxpayer Identification Number

Proposer shall provide its Taxpayer Identification Number (TIN) and backup withholding status on a completed W-9 form when requested by OEBB or when the backup withholding status or any other relevant information of Proposer has changed since the last submitted W-9 form, if any.

5.3.3 Business Registry

If selected for award, Proposer shall be duly authorized by the State of Oregon to transact business in the State of Oregon before executing the Contract. Visit http://sos.oregon.gov/business/pages/register.aspx for Oregon Business Registry information.

5.3.4 Responsibility Inquiry

Proposer shall be required to complete and submit Attachment H — Responsibility Inquiry, when all other submission documents are due as identified in Section 4.1.

5.4 CONTRACT NEGOTIATION

5.4.1 Negotiation

http://sos.oregon.gov/business/pages/regis…