Q&A Responses.pdf

ATTACHMENT 007

Solicitation No. 5400024117, External Quality Reviews

OFFEROR QUESTIONS

Quest.

Page

Sub Section

RFP Language Question Response n/a General n/a

What is the current contract period of performance and total amount for this work?

Current contract period is from August 8, 2019, until the date the new contractor becomes fully operational pursuant to a contract awarded through the competitive process. The current fiscal year (7/1/22 through 6/30/23) purchase order amount is $700,000.00.

n/a General n/a Does the State have a projected budget or budget range for this project?

No.

2 Page Two **PREFERENCES DO NOT APPLY TO REQUEST FOR

PROPOSALS PER SOUTH CAROLINA

PROCUREMENT CODE SECTION [§11-35-

1524(E)(5)(b)]

Please confirm that, as discussed during the pre-proposal conference call, in-state vendor preference does not apply to this solicitation.

Preferences do not apply to this solicitation.

4 2 Page Two PREFERENCES - ADDRESS AND PHONE OF IN- STATE OFFICE: Please provide the address and phone number for your in-state office in the space provided below.

Please advise how the Offeror should complete the "Preferences - Address and Phone of In-State Office" box if the Offeror does not have an in-state address, e.g., leave blank, insert N/A.

Please see response to question 3.

5 10 &

2.10; 2.15;

2.16; 2.17;

2.19

2.10 CERTIFICATE OF INDEPENDENT PRICE

DETERMINATION (MAY 2008);

2.15 DRUG FREE WORKPLACE CERTIFICATION

(JAN 2004);

2.16 DUTY TO INQUIRE (FEB 2015);

2.17 ETHICS CERTIFICATE (MAY 2008);

2.19 OPEN TRADE REPRESENTATION (JUN 2015)

Is the offeror required to submit any text or signed documents for Sections 2.10, 2.15, 2.16, 2.17, and 2.19 other than a signed proposal?

6 17 2.34(d) If your offer includes any comment over and above the specific information requested in the solicitation, you are to include this information as a separate appendix to your offer.

Should the appendix be included at the end of the technical proposal or uploaded as a separate file?

Refer to Subsection 2.34(d), “you are to include this information as a separate appendix to your offer.”

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RFP Language Question Response

7 17 2.34(d) If your offer includes any comment over and above the specific information requested in the solicitation, you are to include this information as a separate appendix to your offer.

May offerors include resumes in the appendix rather than in Section 3.3.13?

Review Amendment 3, Section 4, Subsection 4.2.1, Section C - Qualifications

8 17 2.36 (b) Steps for On-Line Bidding

1) The link provided on the solicitation’s Cover Page will take you to our web based on-line bidding system, where you will enter and/or upload your offer.

What is the limit on the size of the electronic files that can be uploaded to the on-line bidding system (e.g., 30 MBs)?

If a file exceeds the size limit, can the Offeror send multiple files with its Proposal clearly indicating the order of each in the file name (e.g., Technical Proposal file 1 of 2) to ensure all documents are received?

File attachments larger than 10 MB should be uploaded as separate files.

If a file exceeds the size limit multiple files may be submitted clearly indicating the order of each in the file name.

9 19 3.3 As applicable.

Can SCDHHS please clarify if there are individual deliverables tied to each activity listed in 3.3 or will the results only be presented in the annual technical report?

The deliverables are listed in section 3.3.

Review Amendment 3, Section 3.3, CONTRACTOR

RESPONSIBLITIES/DELIVERABLES

10 19 3.3.2 The Annual Review must include the following activities:

Please clarify whether the term “Annual Review” refers to the evaluation and reporting of the EQR activity results (i.e., in the annual technical report) for activities described in subsection 3.3.2.

The Annual Review requirements are reported in the Final EQR Report for each MCO, Integrated Managed Care Plan and MCC Waiver entity

Review Amendment 3, Section 3, Subsections 3.3.2

11 19 3.3.2.1. Validation of the Performance Improvement Projects (PIP) required by SCDHHS and conducted by the MCO/Integrated Managed Care Plans during the preceding twelve (12) months.

Please confirm that, as discussed during the pre-proposal conference call, there will be two PIPs validated annually for each MCO, Integrated Managed Care Plan, and Medically Complex Children's Waiver entity.

The Contractor is only required to validate PIPs for the MCOs.

Review Amendment 3, Section 3, subsection 3.3.2.4.

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RFP Language Question Response

12 19 3.3.2.2. Validation of the MCO/ Integrated Managed Care Plan’s performance measures reported or calculated by SCDHHS during the preceding twelve (12) months.

How many performance measures are required to be validated per year for each MCO, Integrated Managed Care Plan, and Medically Complex Children's Waiver entity?

The Contractor is only required to validate PMs for the

MCO.

Review Amendment 3, Section 3, subsection 3.3.2 2., and subsection 3.3.2.15.

13 20 3.3.2.8. The Contractor shall conduct a thorough review of medical records by specific criteria selected through statistically valid sampling methodology from the identified population. The Quality-of- Care Studies are required by SCDHHS and must be Healthcare Effectiveness Data and Information Set (HEDIS) specific.

Please confirm that, as discussed during the pre-proposal conference call, there will be one Quality of Care study reviewed annually for each MCO, Integrated Care Plan, and Medically Complex Children's Waiver entity.

Review Amendment 3, Section 3, Subsection 3.3.2.11

14 21 3.3.2.9. SCDHHS has established standards for timely access to care and services, considering the urgency of the need for services.

Please confirm that, as discussed during the pre-proposal conference call, there will be one Service Access study conducted annually for each MCO, Integrated Managed Care Plan, and Medically Complex Children's Waiver entity.

Review Amendment 3, Section 3, Subsection 3.3.2.12.

15 21 3.3.2.9. The Contractor shall conduct, annually, a telephone access, or secret shopper study for each health plan…

What is the estimated sample size for the secret shopper telephone surveys per health plan?

Review Amendment 3, Section 4, Subsection 4.2.1 Section B – Technical Approach

16 21 3.3.2.11. Following the Annual Review, the Contractor shall produce a detailed technical report for each MCO and Integrated Managed Care Plan describing, and to include…

Please clarify whether the Contractor is required to produce separate reports, one per health plan/entity, in addition to the comprehensive technical report produced for SCDHHS to meet its CMS reporting requirement.

Review Amendment 3, Section 3, Subsection 3.3.2.14.

Review Amendment 3, Section 3, Subsection 3.3.2.16.

17 21 3.3.2.11. Following the Annual Review, the Contractor shall produce a detailed technical report for each MCO and Integrated Managed Care Plan describing, and to include…

Please confirm that, as discussed during the pre-proposal conference call, a detailed technical report also is required for the Medically Complex Children's Waiver entity.

Review Amendment 3, Section 3, Subsection 3.3.2.16.

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RFP Language Question Response

18 21 3.3.2.11. Following the Annual Review, the Contractor shall produce a detailed technical report for each MCO and Integrated Managed Care Plan describing, and to include…

It appears that all of the performance measures listed in the most recent EQR Technical Report are HEDIS measures which the EQRO indicated it had validated.

Please confirm whether the EQRO Contractor is expected to conduct a HEDIS Compliance Audit of the SCDHHS-selected list of HEDIS measures , or is it expected to review documentation (e.g., the Final Audit Reports, IDSS files, etc.)

from each health plan to validate that the HEDIS measures were audited?

The Contractor is not required to conduct a HEDIS compliance audit.

The Contractor may leverage a completed HEDIS

Roadmap, Final Audit Report, and Interactive Data

Submission System (IDSS) files from a HEDIS compliance audit review when available to complete the Final EQR

Report.

19 22 3.3.2.12. • Validation of Performance Measures (PM) o Annually, each MCO and Integrated

Managed Care Plan must measure and report performance using standard measures specified or required by

SCDHHS.

Please confirm the number of measures (including the number of hybrid measures vs. administrative measures) required to be validated in performance measure validation each year per MCO and Integrated Managed Care Plan.

Review Amendment 3, Section 3, Subsection 3.3.2.15.

The measures are not identified as administrative vs.

hybrid.

20 22 3.3.3 The Contractor shall complete the following:

Validation of PIPs undertaken by the MCO.

Should the activity Validation of PIPs undertaken by the MCO have a corresponding subsection number, like the other mandatory activities in this section (e.g., 3.3.3.1 Validation of PMs, etc.)?

Yes.

Review Amendment 3, Section 3, Subsection 3.3.2.15;

Section 3, Subsection 3.3.3 is deleted in its entirety.

21 23 3.3.4.1. Validation of encounter data reported by an

MCO.

Does SCDHHS anticipate the need for medical record review as an additional verification of encounter data?

If so, please identify any expectations surrounding sampling parameters (e.g., confidence level, margin of error) and anticipated sub-strata.

No.

Review Amendment 3, Section 3, Subsection 3.3.4 is deleted in its entirety.

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RFP Language Question Response

22 23 3.3.4.1. Validation of encounter data reported by an

MCO.

Is the Offeror expected to conform to existing SCDHHS encounter data validation (EDV) frequency and methods or propose an alternate approach?

If the offeror is expected to follow existing EDV protocol, what are the SCDHHS expectations regarding the frequency and scope of the EDV.

This requirement has been removed.

Review Amendment 3, Section 3, Subsection 3.3.4.1. is deleted in its entirety.

23 23 3.3.4.2. Administration of validation of the consumer or provider surveys of quality of care.

The CMS EQR Protocol 6 is titled “Administration or Validation of Quality of Care Surveys”.

Please clarify if the RFP requirement should read “Administration or Validation…” instead of Administration of Validation…”.

Review Amendment 3, Section 3, Subsection 3.3.4.2. is deleted in its entirety.

24 23 3.3.4.2. Administration of validation of the consumer or provider surveys of quality of care.

Will the Contractor be required to include the optional activities in its pricing?

If yes, can SCDHHS please clarify what assumptions should be considered for pricing activity 3.3.4.2 Administration of validation of the consumer or provider surveys of quality of care?

1) Will the Contractor be required to administer or validate the surveys?

2) If the Contractor is required to validate surveys, how many surveys will need to be validated?

3) If the Contractor is required to administer surveys:

a. Which survey(s) will be administered?

b. What is the estimated sample size for each survey?

c. What is the mode of administration (e.g., mail, phone, web, mixed)?

d. Which languages will the survey be administered in?

e. Will survey results need to be submitted to any entities (e.g., NCQA, AHRQ CAHPS database)?

Review Amendment 3, Section 3, Subsection 3.3.4.2. is

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RFP Language Question Response

25 23 3.3.4.4. Conducting studies on quality that focus on a particular aspect of clinical or nonclinical services at a point in time.

Section 3.3.2.8 appears to be similar to sections 3.3.4.4 and

3.3.5 (Quality of Care Studies).

Is there a difference in expectations or scope of work of Quality-of-Care activities that would be conducted under each of these three sections, or are they all related?

In Subsection 3.3.2.8, the Contractor is reviewing the Quality of Care Study, and in Subsection 3.3.5 the Contractor is providing assistance with the development of Quality-of-Care Studies.

Review Amendment 3, Section 3, Subsection 3.3.4.4. is deleted in its entirety.

26 24 3.3.11.2. Three (3) annual reporting dates will be established in the Implementation Period and will correspond with each Demonstration Year identified in the State’s three (3)-way agreement with the CMS and each Integrated Managed Care Plan.

Please specify the activities and any deliverable(s) required of the EQRO for subsection 3.3.11.2.

Review Amendment 3, Section 3.3, CONTRACTOR

RESPONSIBLITIES/DELIVERABLES

27 24 3.3.11.3. On an ongoing basis, the Contractor shall perform studies of quality that focus on utilization of Long-Term Services and Supports

(LTSS).

1) How many studies that focus on utilization of Long-Term Services and Supports should be included in the cost proposal?

2) Please clarify “on an ongoing basis” and the required frequency for reporting the study results.

Review Amendment 3, Section 3.3.11.3. is deleted in its entirety.

28 24 3.3.11.5. These reviews shall include, but not be limited to:

• Refining the transitions tools and transition-based quality measures.

• Evaluating staffing competencies in HCBS including self-directed attendant care.

• Assessing network adequacy.

• Evaluating ability to process and pay claims.

• Assessing the ability to perform Level of Care reassessments.

Can SCDHHS please confirm that these activities will only require reviews by the Contractor and that the Integrated Managed Care Plans will be responsible for performing the bulleted activities?

Confirmed.

Review Amendment 3, Section 3, Subsection 3.3.11.5.

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RFP Language Question Response

29 24 3.3.11.5. These reviews shall include, but not be limited to:

• Refining the transitions tools and transition-based quality measures.

• Evaluating staffing competencies in HCBS including self-directed attendant care.

• Assessing network adequacy.

• Evaluating ability to process and pay claims.

• Assessing the ability to perform Level of Care reassessments.

Please confirm that the Contractor is required to conduct two reviews annually for each Integrated Managed Care Plan in each Demonstration Year, for a total of six reviews per year.

Please also confirm the number of Demonstration Years the Offeror should include in its Price-Business proposal.

The Contractor is only required to conduct one (1) review annually for each Integrated Managed Care Plan. Reference to Demonstration Years has been deleted as the Integrated Managed Care Plans do not have any future Demonstration Years.

Review Amendment 3, Section 3, Subsection 3.3.2.

Section 3, Subsection 3.3.11.2. is deleted in its entirety.

30 24 3.3.11.6. The Contractor shall perform annual reviews for each of the Integrated Managed Care Plans which shall include, but not be limited to:

• Validation of encounter data reported by the

Integrated Managed Care Plans.

• Assessing the administration and validation of consumer and/or provider surveys of quality care.

• Review of contract compliance regarding access, structure and operations, and quality of care and services to Members.

A previous requirement, listed in Section 3.3.2., states the Contractor will conduct a comprehensive annual review of each MCO and Integrated Managed Care Plan and lists several activities to be included in the review. Because different annual review activities are listed in 3.3.2 and 3.3.11.6, please clarify the differences, the intent of this section, and the required deliverables, if any.

Review Amendment 3, Section 3, Subsection 3.3.11.6 is

31 24 3.3.11.6. The Contractor shall perform annual reviews for each of the Integrated Managed Care Plans which shall include, but not be limited to:

• Validation of encounter data reported by the

Integrated Managed Care Plans.

• Assessing the administration and validation of consumer and/or provider surveys of quality care.

• Review of contract compliance regarding access, structure and operations, and quality of care and services to Members.

Please confirm that, for the survey activity, the Integrated Managed Care Plans will be responsible for administering the survey and the EQRO will be required to validate the survey results.

This requirement has been removed.

Review Amendment 3, Section 3, Subsection 3.3.11.6. is

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RFP Language Question Response

32 3.3.11.6. The Contractor shall perform annual reviews for each of the Integrated Managed Care Plans which shall include, but not be limited to:

• Validation of encounter data reported by the

Integrated Managed Care Plans.

• Assessing the administration and validation of consumer and/or provider surveys of quality care.

• Review of contract compliance regarding access, structure and operations, and quality of care and services to Members.

Please clarify whether the on-site review of contract compliance is to be conducted annually or if it may be performed once within each three year period (per 3.3.2.3 and 3.3.2.7).

Review Amendment 3, Section 3, Subsection 3.3.11.6. is deleted in its entirety.

Contractor responsibilities and deliverables identified in section 3.3.2.6 and 3.3.2.10 are conducted annually.

33 24 3.3.11.7. The Contractor shall calculate performance measures for benchmark reporting, on a quarterly basis.

What is the list of performance measures that the Contractor shall calculate quarterly for benchmark reporting?

Review Amendment 3, Section 3, Subsection 3.3.11.7. is deleted in its entirety.

34 27 4.1 You should submit a summary of all insurance policies you have or plan to acquire to comply with the insurance requirements stated herein, if any, including policy types; coverage types;

limits, sub-limits, and deductibles for each policy and coverage type; the carrier’s A.M. Best rating; and whether the policy is written on an occurrence or claims-made basis.

Please specify where in the technical proposal the Offeror should include the summary of insurance policies.

This information may be provided/uploaded as a separate document.

35 27 4.2.1, The Offeror’s proposal shall provide a detailed narrative describing the approach to satisfy the requirements for Key Personnel and Staffing listed in Section 3.

Within Section 2, the fifth bullet includes the instruction to provide a detailed narrative describing the approach to satisfy the requirements for Key Personnel and Staffing listed in Section 3.

Please clarify if a response is required to Section 3 – Qualifications, or if the required elements in Section 3 are to be included in response to Section 2 – Technical Approach.

If a response is required for Section 3 – Qualifications, may the Offeror refer to Section 3 in response to the fifth bullet in Section 2 – Technical Approach?

Review Amendment 3, Section 4, Subsection 4.2.1, Technical Proposal.

The Offeror must provide a response to the information requested in 4.2.1. Technical Proposal, Section A Introductory Documents, Section B Technical Approach, Section C Qualifications.

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36 27 4.2 You shall submit a Technical Proposal and a

Price-Business Proposal of your Offer in separate and distinct documents. Both documents must be uploaded as part of your online submission. In addition to your original

Offer, you are STRONGLY ENCOURAGED to submit a redacted copy of the Technical

Proposal.

Can a redacted copy of the Price-Business Proposal be submitted with the Offer?

If so, should the redacted copy be submitted as a stand-alone document or with the redacted copy of the Technical Proposal?

No

Review Section 2.28, Disclosure of your Bid / Proposal & Submitting Confidential Data, (3) agrees that, notwithstanding any claims or markings otherwise, any prices, commissions, discounts, or other financial figures used to determine the award, as well as the final contract amount, are subject to public disclosure.

37 28 4.2.2 In addition to information requested elsewhere in this solicitation, the Price-Business Proposal must be clearly identified and must include a copy of Page 1 of this solicitation.

The instructions for the Price-Business Proposal require the Offeror to include a copy of Page 1 of this solicitation;

however, Section 2.36 requires online submission of Offers.

Please provide instructions on how the Offeror is to include a copy of Page 1 of the solicitation in the uploaded Price- Business Proposal with its online submission.

Should the Offeror submit a separate PDF attachment of its Price-Business Proposal that includes Page 1 of the solicitation in addition to completing the online Price Proposal?

Review Amendment 3, Section 4, Subsection 4.2.2

38 28 4.2.1 A statement of affirmative action that the Offeror does not discriminate in its employment practices with regards to race, color, religion, age, sex, marital status, political affiliation, national origin, or handicap, except as provided by law.

Is the statement of affirmative action required to be signed separately from the signed technical proposal?

No

39 28 4.2.1 A statement indicating that the Offeror is licensed to do business in South Carolina (include license number) or, that the business licensure is not required.

Is the statement indicating the offeror is licensed in South Carolina required to be signed separately from the signed technical proposal?

No

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40 28 4.2.3 Additionally, the Offeror must submit the following information:

• Minority Participation (DEC 2015): Complete and submit the Minority Participation in See Section 4.3.

• Attachments:

o ATTM 003 CERTIFICATION REGARDING

DEBARMENT SUSPENSION INELIGIBILITY AND

VOLUNTARY EXCLUSION

o ATTM 004 HIPAA BUSINESS ASSOCIATE

AGREEMENT

o ATTM 005 ORGANIZATIONAL CONFLICT OF

INTEREST DISCLOSURE

o ATTM 006 CERTIFICATION FOR CONTRACTS

GRANTS LOANS AND COOPERATIVE

AGREEMENTS

Section 4.2 instructs that two proposals shall be submitted:

Technical and Price-Business.

Should subsection 4.2.3, Additional Documents, be submitted as:

• a separate document, or

• included within the Technical Proposal, or

• included within the Price-Business Proposal?

Review Amendment 3, Section 4, Subsection 4.2.3

41 29 4.3 Entire Minority Participation Form 1) Will minority participation be factored into the Offeror's qualifications?

2) If so, please clarify how minority participation will be evaluated/scored.

42 30 4.4 The redacted copy should (i) reflect the same pagination as the original, (ii) show the empty space from which information was redacted, and (iii) be submitted on magnetic media.

Please clarify how the redacted copy of the technical proposal should be submitted and if submission on magnetic media is required?

If magnetic media submission is required, please provide instructions if the offer will be uploaded into the procurement system.

Magnetic media is not required. Offeror may upload the redacted copy as a separate document electronically.

Review Amendment 3, Section 4, Subsection Section 4.4.

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RFP Language Question Response

43 31 5.1 We may also consider a documented commitment from a satisfactory source that will provide you with a capability.

Please clarify what is meant by "documented commitment from a satisfactory source that will provide you with a capability".

Is this the same as the references that are required under subsection 5.3.2 References?

Review the following from Section 5.1, this does not apply to required references.

(3) Corporate subsidiaries are cautioned that the financial capability of an affiliated or parent company will not be considered in determining financial capability; however, we may elect to consider any security, e.g., letter of credit, performance bond, parent-company corporate guaranty, that you offer to provide. Instructions and forms to help assure acceptability are posted on procurement.sc.gov, link to Standard Clauses & Provisions

44 33 5.3.3 Prior projects and contractual details shall be organized as ordered below…:

May Offerors provide prior projects with contractual details as an appendix rather than within section 5.3.3?

Yes, the appendix should clearly reference applicable Section (5.3.3, Prior Projects and Contracts)

45 58 9 9 ATTACHMENTS TO SOLICITATION For the forms required to be included in the proposal, is the Offeror permitted to place its proposal header and/or footer on the documents or should the Offeror complete and submit the forms as is?

The Offeror may include a header and/or footer for identification of Offeror.

46 4 of

ATTM 004 (a) Term. The Term of this Agreement shall be effective as of ______________and shall terminate on the effective and termination dates of the Contract to which this Agreement is appended, or on the date Covered Entity terminates for cause as authorized in paragraph

(b) of this Section, whichever is sooner.

For Attachment 004, HIPAA Agreement: What effective date should be included in Section E?

The Date will be completed once an Award is made.

47 2 of

ATTM 005 I. INSTRUCTIONS

If a disclosure statement is required, please provide a narrative statement in Part III.

III. DISCLOSURE STATEMENT: (attach additional pages if more space is needed)

(Offeror to provide a concise narrative of any potential conflicts)

For Attachment 005, would SCDHHS please confirm that Section III. Disclosure Statement should be left blank if the Offeror has no identified conflicts of interest?

Yes, you may also indicate that the Offeror has no conflicts of interest. Form must be signed and returned.

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RFP Language Question Response

48 20 3.3.2.6 The Contractor shall perform a desk review of materials and documents submitted by the health plan.

Part of the desk review is a review of the ISCA. Does the EQRO conduct the ISCA?

The Contractor conducts the ISCA as part of the Readiness Review.

See Amendment 3, Section 3, Subsection 3.3.1.3.

See Amendment 3, Section 3, Subsection 3.3.2.9.

49 20 3.3.2.8 The Contractor shall conduct a thorough review of medical records by specific criteria selected through statistically valid sampling methodology from the identified population. The Quality of Care Studies are required by SCDHHS and must be Healthcare Effectiveness Data and Information Set (HEDIS) specific.

Is the EQRO conducting a HEDIS audit? See response to question 18.

50 23 3.3.4.2 Administration of validation of consumer or provider surveys of quality of care.

Please clarify, “Administration of validation”. Does this mean “administration OR validation” or “administration AND validation”?

This requirement has been removed.

Review Amendment 3, Section 3, Subsection 3.3.4 is deleted in its entirety.

51 23 3.3.4.3 Conducting PIPs in addition to those conducted by an MCO and validated by the EQRO.

This indicates that the EQRO may be leading PIPs (in addition to validation of PIPs). Would these be statewide, with individual MCOs?

This requirement has been removed.

Review Amendment 3, Section 3, Section 3.3.4 is

52 25 3.3.13.5 Key Personnel must include at a minimum:

• A full time Physician Consultant

• A full time Contract Manager

Does the requirement for a full-time physician consultant and full-time contract manager mean they work 100% on this contract or that they are a full-time employees of the EQRO?

Review Amendment 3, Section 3, Subsection 3.3.13.5.

53 22 3.3.2.12 Validation of Performance Measures (PM) The EQRO is required by CMS to evaluate the accuracy of the PM and determine the extent the MCO or Integrated Managed Care Plan followed specifications established by SCDHHS for the calculation of each measure.

How many measures would the EQRO be expected to validate for the MCO?

See response to question 19.

54 22 3.3.2.12 Validation of Performance Measures (PM) The EQRO is required by CMS to evaluate the accuracy of the PM and determine the extent the MCO or Integrated Managed Care Plan followed specifications established by SCDHHS for the calculation of each measure.

How many measures would the EQRO be expected to validate for the Integrated Managed Care Plan?

Page

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RFP Language Question Response

55 23 3.3.4 EQR Optional Activity Optional activities SCDHHS may require the Contractor to use to gather information about the performance of MCOs include:

The optional activities mention activities SCDHHS may require the Contractor to use.

Should these activities be included in the pricing?

If so, should this cost be included in each contract year and optional years?

This requirement has been removed.

Review Amendment 3, Section 3, Subsection 3.3.4 is deleted in its entirety.

56 24 3.3.11.4 The Contractor shall conduct two (2) reviews of each Integrated Managed Care Plan during the Demonstration Year related to Home and Community-Based Services (HCBS) benchmark transitions.

Which year is considered the Demonstration Year? Reference to Demonstration Years has been deleted as the Integrated Managed Care Plans do not have any future Demonstration Years.

Review Amendment 3, Section 3, Subsection 3.3.11.4 is

57 24 3.3.11.7 The Contractor shall calculate performance measures for benchmark reporting, on a quarterly basis.

Please provide the performance measures the Integrated Managed Care Plans are reporting.

Review Amendment 3, Subsection 3.3.11.7 is deleted in its entirety.

58 24 3.3.11.7 The Contractor shall calculate performance measures for benchmark reporting, on a quarterly basis.

Please clarify, are the Integrated Managed Care Plans reporting performance measures to SCDHHS on a quarterly basis? How does this relate to benchmarking?

This requirement has been removed.

Review Amendment 3, Subsection 3.3.11.7 is deleted in its entirety.

59 28 4.2.2 Offeror must submit ATTM 007 PRICE-BUSINESS

PROPOSAL.

Section 9.1 on Page 58 lists ATTM 007 as the QUESTIONS TEMPLATE. Can SCDHHS please clarify what offers need to submit as part of requirement 4.2.2?

Review Amendment 3, Section 4, Subsection 4.2.2

60 28 4.1 Your offer should include all other information and documents requested in this part and in Sections 2. INSTRUCTIONS TO OFFERORS -- B.

SPECIAL INSTRUCTIONS; 3 SCOPE OF

WORK/SPECIFICATIONS; 5. QUALIFICATIONS; 8.

BIDDING SCHEDULE / PRICE PROPOSAL; and any appropriate attachments addressed in Section 9

ATTACHMENTS TO SOLICITATIONS.

Section 5. QUALIFICATIONS overlaps with the requirements for “Section 3 – Qualifications” under 4.2.1. Can SCDHHS please clarify if offerors need to provide responses to both sections?

Review Amendment 3, Section 4 and Section 5.

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61 19 3.3.2.3 Annual Reviews:

The Contractor shall conduct a comprehensive annual review to evaluate each MCO’s and Integrated Managed Care Plan’s compliance with the federal regulations contained in 42 CFR 438.354, SCDHHS managed care policies, and contractual requirements. The Contractor must also review the entity who manages the Medically Complex Children’s Waiver (MCC).

Analyzing a review conducted within the previous three (3) years to determine the MCO’s compliance with the requirements of 42 CFR 438.354

42 CFR 438.354 references “Qualifications of External Quality” whereas 42 CFR 438.358 references “Activities related to external quality review”. Can SCDHHS please confirm the correct regulation is 42 CFR 438.358?

Confirming 42 CFR 438.358 is the correct regulation relating to activities of EQRO.

62 21 3.3.2.9 Service Access Studies- Targeted review and evaluation of the MCO and Integrated Managed Care Plan’s performance on availability and accessibility shall focus on:

Emergency Room Service and Utilization

Please clarify how a provider phone call would gather information regarding ER visit and utilization access?

Review Amendment 3, Section 3, Subsection 3.3.2.12.

Emergency Room Service and Utilization is deleted in its entirety

63 9 2.1 Additional Definitions: KEY PERSONNEL means the Account Manager, Implementation Manager, Technical Coordinator, and Operations Manager, required to be identified by name in Contractor’s Offer, any approved successor to such named individuals and any other individual and his/her approved successor designated in Contractor’s Offer as Key Personnel.

In section 3.3.13.5 Lists Key Personnel as a Full Time Physician Consultant and a Full Time Contract Manager. Can SCDHHS please confirm the Physician Consultant and the Contract Manager positions are the only required Key Personnel?

Yes.

Review Amendment 3, Section 2, Subsection 2.2

Review Amendment 3, Section 4, Subsection 4.2.1, Section B – Technical Proposal

64 25 3.3.13.5 Key Personnel Can the SCDHHS please clarify if the Physician Consultant is considered a 1099 consultant or a W2 employee?

Review Amendment 3, Section 3, Subsection 3.3.13.5.

65 19 3.3.2.2 Validation of the MCO/ Integrated Managed Care Plan’s performance measures reported or calculated by SCDHHS during the preceding twelve (12) months.

1) How many performance measures will the contractor be required to validate?

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66 19 3.3.2.2 Validation of the MCO/ Integrated Managed Care Plan’s performance measures reported or calculated by SCDHHS during the preceding twelve (12) months.

2) Can SCDHHS please provide list of the performance measures the MCOs and the Integrated Managed Care Plans are reporting?

67 19 3.3.2.2 Validation of the MCO/ Integrated Managed Care Plan’s performance measures reported or calculated by SCDHHS during the preceding twelve (12) months.

3) Can SCDHHS please provide a list of the performance measures SCDHHS is calculating?

68 20-

3.3.2.8 SCDHHS selected Quality of Care studies may

require qualified surveyors to:

• Collect aggregate data pertaining to the populations from which the sample medical records and administrative data will be selected.

Abstract data from selected medical records and claims data as required by SCDHHS

Can SCDHHS please define “qualified surveyors?” Review Amendment 3, Section 3, Subsection 3.3.2.11.

69 19 3.3.2.1 Validation of the Performance Improvement Projects (PIP) required by SCDHHS and conducted by the MCO/Integrated Managed Care Plans during the preceding twelve (12) months.

1) How many PIPs is the contractor expected to validate for the MCOs?

See response to question 11.

70 19 3.3.2.1 Validation of the Performance Improvement Projects (PIP) required by SCDHHS and conducted by the MCO/Integrated Managed Care Plans during the preceding twelve (12) months.

2) How many PIPS is the contractor expected to validate for the Integrated Managed Care Plans?

See response to question 11.

71 23 3.3.6 Workshops and Training Classes

Contractor shall conduct workshops and training classes for MCO staff regarding abstraction of data for the quality of care studies and other features of the annual Quality Assurance (QA) evaluation

Can SCDHHS please define what the “annual Quality Assurance Evaluation” is?

This requirement has been removed.

Review Amendment 3, Section 3, Subsection 3.3.6. is deleted in it entirety

72 24 3.3.11.7 Integrated Managed Care Plans

The Contractor shall calculate performance measures for benchmark reporting, on a quarterly basis.

Can SCDHHS please confirm which performance measures they would like contractors to calculate?

This requirement has been removed.

Review Amendment 3, Section 3, Subsection 3.3.11.7. is deleted in its entirety

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73 19 3.3.2 Annual Reviews

3.3.2.3 Analyzing a review conducted within the

previous three (3) years to determine the MCO’s compliance with the requirements of 42 CFR 438.354.

Can SCDHHS please clarify which review type they request to be analyzed from the last three years?

Final reports are available on the SCDHHS website to analyze the reviews conducted within the previous three years. The reports can be found here.

Review Amendment 3, Section 3, Subsection 3.3.2.5.

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3.3.1 Readiness Reviews: The Contractor shall conduct

a readiness review to assess the new health plan’s readiness to provide health care services to Medicaid members.

Please confirm whether readiness reviews are required every year for the duration of the contract

Readiness Reviews are only required when new MCOs and Integrated Managed Plans are entering the market.

The Contractor will be notified when a Readiness Review is required.

Review Amendment 3, Section 3, Subsection 3.3.1

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3.3.1 Readiness Reviews: The Contractor shall conduct

a readiness review to assess the new health plan’s readiness to provide health care services to Medicaid members.

Please confirm whether Readiness reviews are required for the five (5) MCOs, three (3) Integrated Managed Care Plans and the Medically Complex Children (MCC) Waiver plan

See response to question 74

76 57 of

8.1 Price Proposal: Readiness Reviews The pricing template list the quantity as 5 for readiness reviews. Please confirm offerors need to perform one (1) readiness review activity during the contract period for each of the five (5) MCOs.

See response to question 74

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3.3.2.8 Quality of Care Studies Please confirm whether the Quality of Care Studies will be required annually for the five (5) MCOs, three (3) Integrated Managed Care Plans and the Medically Complex Children (MCC) Waiver plan

Review Amendment 3, Section 3, Subsection 3.3.2.11.

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3.3.2.10 Medical Record Survey: The Contractor shall

conduct a validation survey of the MCOs denial of services.

Please confirm whether the Medical Record Survey will be required annually for the five (5) MCOs, three (3) Integrated Managed Care Plans and the Medically Complex Children

Review Amendment 3, Section 3, Subsection 3.3.2.13.

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3.3.2.10 Medical Record Survey: The Contractor shall

conduct a validation survey of the MCOs denial of services.

Please confirm whether the Medical Record Survey will include an analysis and review of denied claims data from the five (5) MCOs, three (3) Integrated Managed Care Plans and the Medically Complex Children (MCC) Waiver plan

Confirming Yes. Medical Record survey review is conducted yearly during the EQR for each MCO, MCC waiver entity, and Integrated Managed Care plan.

Review Amendment 3, Section 3, Subsection 3.3.2.13.

https://msp.scdhhs.gov/managedcare/site-page/eqr-reports

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80 22 of

3.3.2.12 Annual Validation Projects:

Validation of Performance Measures (PM)

Please confirm:

1. How many measures will be required to be validated for the five (5) MCOs, three (3) Integrated Managed Care Plans and the Medically Complex Children (MCC) Waiver plan

2. Please confirm whether the measures required to be validated will be only NCQA HEDIS measures for the five (5) MCOs, three (3) Integrated Managed Care Plans and the Medically Complex Children (MCC) Waiver plan

3. Please confirm whether the measures required for validation will include any state specific or CMS Adult and Child Core Set non-HEDIS measures for the five

(5) MCOs, three (3) Integrated Managed Care Plans and the Medically Complex Children (MCC) Waiver plan

Please confirm whether the measures required for validation will include any special measures for the three (3) Integrated Managed Care Plans and the Medically Complex Children

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3.3.4.1 EQR Optional Activities: Validation of encounter

data reported by an MCO.

Please confirm whether encounter data validation will be required for the five (5) MCOs, three (3) Integrated Managed Care Plans and the Medically Complex Children (MCC) Waiver plan

This requirement has been removed.

Review Amendment 3, Subsection 3.3.4. is deleted in its entirety

82 23 of

3.3.4.1 EQR Optional Activities: Validation of encounter

data reported by an MCO.

• Please confirm whether pricing should be provided for encounter data validation.

If yes, please provide guidance on how the pricing should be provided since the current budget template does not have a spot for optional activities.

This requirement has been removed.

Review Amendment 3, Subsection 3.3.4. is deleted in its entirety

83 23 of

3.3.4.1 EQR Optional Activities: Validation of encounter

data reported by an MCO.

Please confirm whether encounter data validation would be required annually.

This requirement has been removed.

Review Amendment 3, Subsection 3.3.4. is deleted in its entirety.

84 56 of

8.1 Price Proposal Please confirm whether the training pricing is for the five (5) MCOs, three (3) Integrated Managed Care Plans and the Medically Complex Children (MCC) Waiver plan

This requirement has been removed.

Review Amendment 3, Section 3, Subsection 3.3.6 is

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85 24 of

3.3.11.2 Three (3) annual reporting dates will be

established in the Implementation Period and will correspond with each Demonstration Year identified in the State’s three (3)-way agreement with the CMS and each Integrated Managed Care Plan.

Please confirm whether the timing of the validation of performance measures activity for the three Integrated Managed Care Plans will be different than the timing of when PMV will be conducted for the five (5) MCOs and the Medically Complex Children (MCC) Waiver plan.

The three (3) annual reporting dates will be established in the Implementation Period.

Review Amendment 3, Section 3, Subsection 3.3.11.2.

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3.3.11.6 The Contractor shall perform annual reviews for

each of the Integrated Managed Care Plans which shall include, but not be limited to: Validation of encounter data reported by the Integrated Managed Care Plans.

Please confirm that validation of encounter data is not an optional activity for the three (3) Integrated Managed Care Plans and that it will be required annually.

This requirement has been removed.

Review Amendment 3, Section 3, Subsection 3.3.11.6. is deleted in its entirety

87 24 of

3.3.11.6 The Contractor shall perform annual reviews for

each of the Integrated Managed Care Plans which shall include, but not be limited to: Validation of encounter data reported by the Integrated Managed Care Plans.

Please confirm that pricing for the validation of encounter data should be included for the three (3) Integrated Managed Care Plans for YR 1-2 and the three option years.

This requirement has been removed.

Review Amendment 3, Section 3, Subsection 3.3.11.6. is deleted in its entirety

88 22 of

Please confirm whether SCDHHS would permit leveraging the completed HEDIS Roadmap, Final Audit report and IDSS files from the five (5) MCOs, three (3) Integrated Managed Care Plans and the Medically Complex Children (MCC) Waiver plan’s HEDIS compliance audit review when available.

Yes, the Contractor may leverage a completed HEDIS Roadmap, Final Audit Report and IDSS files from a HEDIS compliance audit review when available.

89 22 of

Please confirm whether SCDHHS requires that the bidder conduct HEDIS Compliance Audits following the NCQA timeline for the five (5) MCOs, three (3) Integrated Managed Care Plans and the Medically Complex Children (MCC) Waiver plan.

See response to question 18.

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Please confirm whether SCDHHS requires that five (5) MCOs, three (3) Integrated Managed Care Plans and the Medically Complex Children (MCC) Waiver plan undergo independent HEDIS Compliance audits each year following the NCQA timeline.

This is not relevant to this Solicitation.

91 22 of

Please confirm if onsite can be conducted virtually for the PMV activity.