Request_for_Proposal_for_Pharmacy_Benefit_Management_and_Claims_Administration_Program.pdf

COUNTY OF ORANGE

COUNTY EXECUTIVE OFFICE - HUMAN RESOURCES

REQUEST FOR PROPOSAL (RFP)

FOR

REQUEST FOR PROPOSAL FOR PHARMACY BENEFIT

MANAGEMENT AND CLAIMS ADMINISTRATION PROGRAM

RFP NO. 017-202407-KA

County of Orange RFP

County Executive Office - Human Resources - Request for Proposal for Pharmacy Benefit Management and Claims

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County of Orange

County Executive Office - Human Resources

Procurement Services

400 W. Civic Center Drive

Santa Ana, CA

92701

SCHEDULE OF ACTIVITIES

Release Project Date January 7, 2025

Question Submission Deadline January 14, 2025, 4:00pm

Question Response Deadline January 21, 2025, 4:00pm

Proposal Submission Deadline February 13, 2025, 4:00pm

Evaluation of Proposals February – March 2025

Respondents Oral Presentations March 27, 2025

Evaluation of Financial Review March – April 2025

Submission for Approval of Final

Contract by the Board of Supervisors

August 12, 2025

**This is a proposed schedule that is subject to change. Any changes to the schedule for the RFP process will be issued to all Respondents via addenda on the County’s online bidding system https://procurement.opengov.com/portal/ocgov **

PROPOSALS MUST BE RECEIVED ON

OR BEFORE

Thursday, February 13, 2025

4:00 pm https://procurement.opengov.com/portal/ocgov

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SECTIONS

SECTION 1. INTRODUCTION AND INSTRUCTIONS TO RESPONDENTS

SECTION 2. WRITTEN PROPOSAL SCORING FORMAT

SECTION 3. PROPOSAL RESPONSE REQUIREMENTS

Attachments:

A - 2025 Sharewell Choice PPO Health Plan Document

B - 2025 Wellwise Non-Medicare Retiree PPO Health Plan Document

C - 2025 Wellwise Medicare Retiree PPO Health Plan Document

D - 2025 Wellwise Choice PPO Health Plan Document

E - 2025 Sharewell Retiree PPO Health Plan Document

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SECTION 1. INTRODUCTION AND INSTRUCTIONS TO RESPONDENTS

1.1 INTRODUCTION

This Request for Proposal (RFP) is being released for a Pharmacy Benefit Management and

Claims Administration Program. This RFP is an opportunity to allow qualified vendors to present proposals that will assist the County of Orange, HRS/Employee Benefits in selecting a contractor that will best meet the needs of the County for a three (3) year contract with two (2) optional one (1) year renewal terms. Services will be according to the Scope of Services stated in

Attachment A of the Model Contract.

Background Information:

The County currently provides a carve-out pharmacy program through OptumRx, as the

Pharmacy Benefits Manager (PBM) for its self-funded PPO (Preferred Provider Organization) health plans administered through Blue Shield of California (Blue Shield). The carve-out pharmacy program is available to members enrolled in the County’s two types of medical plans –

Sharewell and Wellwise. A key differentiator between Wellwise and Sharewell is that Sharewell is a High Deductible Health Plan (HDHP) design, and medical and pharmacy expenses are combined for the deductible and out of pocket maximum. For the Wellwise plans, there are different deductibles and out of pocket maximums for medical and pharmacy benefits. Sharewell and Wellwise are offered to employees, non-Medicare and Medicare retirees, and their dependents. The Wellwise Retiree Medicare PPO pharmacy benefit program is an Employer Group Waiver Plan (EGWP). All Sharewell PPO plans are non-creditable coverage.

Benefits Service Center:

County employees and retirees (Participants) receive benefits information, make all benefit elections, and direct all benefits customer service inquiries to the County of Orange Benefits

Service Center (Benefits Center). These services are provided through Alight Solutions LLC

(Alight). Participants can make their elections on the County of Orange MyOCBenefitsTM website or by calling the Benefits Center toll-free and speaking with a Customer Care

Representative. The Benefits Center is the owner of eligibility on behalf of the County and therefore: 1) maintains and distributes all eligibility and coverage information to vendors for all the County’s benefits programs; 2) provides full customer service for benefits enrollment and eligibility; 3) calculates and provides reports regarding premium billing (ASO fees); 4) submits all data necessary to collect and calculate premiums through payroll and pension files; 5) provides monthly direct billing for employees on leave of absence and retirees not yet on the pension file; 6) administers COBRA when coverage terminates; and 7) provides support for eligibility determination and reporting data for Employer Shared Mandate of the Affordable Care

Act.

Alight manages all calls regarding eligibility and enrollment as follows:

• Responds to questions from Participants and County staff.

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• Serves in a participant advocate role to facilitate inquiries related to eligibility issues with carriers.

• Verifies eligibility, updates vendors when applicable and provides verification of coverage to providers.

• Verifies coverage dates, provides Participants with carrier/administrator contact information and/or transfers the employee/retiree to carrier if appropriate.

• Assists Participants by taking benefit elections/transaction (Open Enrollment, life events, etc.).

• Advises the County of any employee/retiree benefit issues and/or problems and provides solution where applicable.

• Handles exceptions that require manual processing, as defined in implementation and/or on an ongoing basis.

Blue Shield of CA sends eligiblity information to the current PBM, except for those enrolled in the Wellwise Retiree Medicare health plan option (EGWP). For the EGWP plan, Alight provides electronic eligibility and premium billing files to the PBM. All member enrollment requests must be directed to Alight.

Alight and Blue Shield will work together to resolve discrepancy reports, for all plans, except the

EGWP Plan. It is the responsibility of Contractor to work with Alight to ensure Alight corrects their eligibility records to match CMS’s for the EGWP plan.

The County requires that its selected Contractor(s) be capable of working with Alight and

BlueShield.

Key Laws and Regulations:

The County meets the definition of an applicable large employer (ALE) and therefore is subject to Internal Revenue Code (IRC) Section 4980H, Affordable Care Act (ACA). The Wellwise

Medicare Retiree, Wellwise Non-Medicare Retiree, and Sharewell Retiree health plans are considered to be retiree-only plans and as such are not subject to all provisions of the ACA.

As a governmental entity, the County’s self-insured PPO health plans are not subject to ERISA

(Employment Retirement Income Security Act). The County is required to be compliant with federal mental health parity requirements. Please be aware that the County is in the process of reviewing its current program with regards to the Mental Health Parity and Addiction Equity Act

(MHPAEA). The County will work with the selected Contractor in the event of necessary plan design changes required for compliance. Under HIPAA privacy requirements, the selected

Contractor will be required by the County to follow all privacy guidelines required under the law and comply with all contractual provisions in the Proposed Contract related to HIPAA.

Eligibility:

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The eligibility provisions for County health plans and subsequent pharmacy benefits are:

• All regular and limited-term employees who are regularly scheduled to work 20 hours or more per week are eligible for health benefits on the first day of the month following 30 days from the date of hire.

• All extra-help employees who are regularly scheduled to work 30 hours or more per week are eligible for health benefits on the first day of the month following 60 days from the date of hire.

• Retirees who meet certain conditions, such as eligible to receive an OCERS pension and separated from an eligible bargaining unit, are eligible for a retiree health plan on the first day of the month following retirement.

• Spouses and domestic partners are eligible for coverage.

• Dependent children are eligible for coverage to the end of the calendar month in which they turn 26.

• Dependent children who are permanently disabled before age 26 are eligible for coverage as a dependent child after age 26.

• Additional eligibility provisions may be added to meet the ACA – Employer Shared

Responsibility provisions.

Stop Loss:

The County implemented Stop Loss coverage for the five Wellwise and Sharewell health plans effective January 2024. Stop Loss coverage is currently provided by Voya and the individual stop loss deductible is $1.5 million on a 24/12 contract basis. The current PBM sends Rx data at no cost directly to Voya necessary to support the payment of stop loss claims.

Contract Intent:

The intent of this Contract is to provide complete pharmacy claims administration services, including customer service, for the County’s existing self-insured PPO health plans.

The County’s goal is to find a single Contractor who has demonstrated a history of successfully providing pharmacy claims administration services for public employers of a similar size and complexity as the County of Orange. The desired Contractor will provide our County

Participants with high quality customer service, industry standard technologies and systems, clinical guidance, and best practice methods to ensure accurate administration of claims in accordance with the health plan documents, as well as efficient, effective, and timely claims processing and reporting.

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1.2 PROPOSED TIME SCHEDULE

Date Action

01/07/2025 Release of RFP

01/14/2025

Questions from Offerors to be submitted electronically via OPENGOV, https://procurement.opengov.com RFP #017-202407-KA by 4:00 P.M.

(Pacific Time)

01/21/2025 Issuance of Addendum (Questions and Answers)

02/13/2025 Deadline for Proposals (Closing Date) – On or before 02/13/2025 at

4:00 P.M. (Pacific Time)

February – March 2025 Evaluation of Proposals

03/27/2025 Respondents’ Oral Presentations – The most responsive proposals may be asked to give an in-person oral presentation within five (5) business days of notification.

March – April 2025 Evaluation of Financial Review

08/12/2025 Submission for Approval of Final Contract by the Board of Supervisors

* Please note the County reserves the right to modify the proposed RFP time schedule in its sole and absolute discretion if the County determines a modification is necessary.

1.3 INSTRUCTIONS TO RESPONDENTS AND PROCEDURES FOR SUBMITTAL

By submitting a Proposal, the Respondent represents that it has thoroughly examined and agrees to provide the services required under this RFP as detailed in the Model Contract, Attachment A, and that it is capable of providing the services to achieve the County’s objectives. Respondent must abide by all provisions of the Model Contract unless Respondent notes its objections in its

Proposal. As noted below, if the Respondent cannot abide by any provisions of the Model

Contract, Respondent must make notice of which provisions it cannot comply with in its

Proposal.

Each Respondent must submit its Proposal in strict accordance with all requirements of this RFP and compliance must be stated in the Proposal. Deviations, clarifications and/or exceptions must be clearly identified and listed separately as alternative items for the County’s consideration.

https://procurement.opengov.com/

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1. Proposal Close Date and Time: Proposals are due on or before February 13, 2025, no later than 4:00 P.M. (Pacific Time) and must be uploaded electronically via the County’s Online

Bidding System OPENGOV, https://procurement.opengov.com RFP 017-202407-KA. For assistance on uploading proposals to OPENGOV, please contact the OPENGOV Support Team via email at procurement-support@opengov.com. The County will not accept proposal(s) after the due date and time specified above in 1.2. Proposed Time Schedule.

RE: RFP No. RFP #017-202407-KA for a Pharmacy Benefit Management and Claims

Administration Program

Note: This is a fully electronic Request for Proposals (RFP). Respondents must submit their proposals online via County’s online bidding system. Only electronic proposals will be accepted.

Paper, facsimile and e-mail proposals will NOT be allowed.

HUMAN RESOURCE SERVICES, EMPLOYEE BENEFITS REGULAR BUSINESS

HOURS:

Monday through Friday 8:00 A.M. to 5:00 P.M. (Pacific Time)

COUNTY OFFICES WILL BE CLOSED FOR THE FOLLOWING HOLIDAYS:

Martin Luther King Jr. Day January 20, 2025

Lincoln’s Birthday February 12, 2025

Presidents’ Day February 17, 2025

Memorial Day May 26, 2025

Independence Day July 04, 2025

2. Clarifications: The County has attempted to provide all information available. It is the responsibility of each Respondent to review, evaluate, and, where necessary, request any clarification prior to submission of a Proposal. If any person contemplating submitting a response to this Request for Proposals is in doubt as to the true meaning of any part of the solicitation documents attached hereto or finds discrepancies in or omissions from the specifications, they may submit a written request for clarification/interpretation to the County

Deputy Purchasing Agent (DPA) via the County’s online bidding system under the bid page for this solicitation, via https://procurement.opengov.com RFP #017-202407-KA. For OPENGOV assistance, please contact the OPENGOV Support Team via chat at https://procurement.opengov.com or via email at procurement-support@opengov.com.

3. Addenda: Any interpretation of, or correction to, this RFP will be made only by addendum issued by the Deputy Purchasing Agent or through OPENGOV. It is the Respondent’s responsibility to access the website, https://procurement.opengov.com, throughout the entire process to obtain the most up-to-date information regarding this procurement process. It is the responsibility of each Respondent to periodically check the County’s online bidding system to ensure that they have received and reviewed any and all addenda to this solicitation. The County will not be responsible for any other explanations, corrections to, or interpretations of the documents, including any oral information. If an addendum is issued, proposers must acknowledge the addendum via OpenGov. All questions or requests for interpretations must be https://procurement.opengov.com/ https://procurement.opengov.com/ https://procurement.opengov.com/ mailto:procurement-support@opengov.com

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Administration Program, 017-202407-KA Page 9 of 38 received on January 14, 2025, before 4:00 P.M. (Pacific Time) as specified in the solicitation.

Respondents are not to contact other County personnel with any questions or clarifications concerning this RFP. The DPA will provide all official communication concerning this

RFP. Any County response relevant to this RFP other than through or approved by the DPA is unauthorized and will be considered invalid.

There will be No Pre-Proposal Conference for this RFP. Questions regarding the contents of this Proposal must be submitted electronically (via https://procurement.opengov.com) for RFP

#017-202407-KA on or before January 14, 2025, before 4:00 P.M. (Pacific Time) and directed to the Deputy Purchasing Agent.

4. Validity of Proposals: Proposals must be valid for a period of at least three hundred and sixty-five (365) calendar days from the closing date and time of receipt. No Proposal may be withdrawn after the submission date.

5. Submission Format: Each Respondent must provide: (1) complete electronic copy of their proposal. Proposals shall be formatted in the requested format type (PDF, Excel or Word). All pages must be identified sequentially as listed below. Please try to limit file names to 80 characters or less.

Part 1 – Respondent’s Concurrence/Compliance

Part 2 – Respondent’s Company Profile

Part 3 – Respondent’s Proposal Questionnaire (Excel format)

Proposal Description (PDF format)

Part 4 – Redlined Model Contract, including Attachments A through L, with any additions or deletions shown using “tracked changes” (MS Word Format)

Part 5 – Additional Items:

• Section III, Exhibit 1 – EDD Independent Contractor Reporting

Requirements (PDF format), if not applicable please omit.

Part 6 – Attachments requested in Proposal Questionnaire

• Team Biographies and Organizational Chart

• Annual Report

• Service Organization Controls (SOC) Report

It is imperative that all Respondents responding to this RFP comply exactly and completely with the instructions set forth herein. All responses to this RFP shall be word-processed (except where otherwise provided or noted), concise, straightforward, and must fully address each requirement and question. Although not as a substitute for a complete written response, additional material, such as technical documents, may be referenced in any response if the material is included in the same section as additional information.

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Note: Allow sufficient time to upload all required files. OPENGOV will not allow any uploads after the due date and time specified herein, e.g., if Part 1 and 2 uploaded successfully at 3:58:38

P.M. and Part 3 is in progress of being uploaded at 4:00:01 P.M., Part 3 will not upload successfully.

6. Confidential, Proprietary or Trade Secret Information: Proposals are not to be marked as confidential or proprietary and must not constitute or contain confidential, proprietary, or trade secret information. The County may refuse to consider any Proposal so marked.

All Proposals shall become the property of the County. The County reserves the right to make use of any information or ideas in the Proposals submitted. Proposals submitted in response to this RFP may become subject to public disclosure per the requirements of the California Public

Records Act, Government Code Section 6250 et seq. Please be advised that all information and documents submitted to the County by Respondent shall become non-confidential, non-proprietary, non-trade secret, public records without exception and subject to public disclosure by the County at any time without prior notice to Respondent. The County shall not be liable in any way for disclosure of any such records or part thereof related to this RFP or any Proposal, including, but not limited to, evaluations, proposals, or any other information or records. In submitting the information and documents, the Respondent is agreeing to the County’s release of such information and documents in response to a Public Records request without further notice to the Respondent and is agreeing to indemnify and hold harmless the County for release of such information and documents.

Furthermore, all Proposals shall become the exclusive property of the County. The County reserves the right to make use of any information or ideas contained in the Proposals submitted without exception.

By submitting information and documents to the County as part of this RFP, Respondents acknowledge and agree to the terms of this Section 6.

7. Conflict of Interest: Each Respondent shall exercise reasonable care and diligence to avoid submitting a Proposal that could result in a conflict of interest if Respondent were to be selected.

This obligation shall apply to the Respondent, the Respondent’s employees, agents, and relatives, sub-contractors, and third parties associated with accomplishing work and services in Proposal.

In the event Respondent has done work for the County on this Project in the past or has reason to believe that a conflict of interest may exist for Respondent in regard to this Project, Respondent should consult with its legal counsel prior to responding to this RFP. Any Respondent who is found to have an actual conflict of interest may have its Proposal rejected on that ground.

Respondent, its employees and/or consultants may be subject to the provisions of the California

Political Reform Act of 1974 (the “Act”), which (1) requires such persons to disclose any financial interest that may be materially affected by services provided under this Contract, (2) prohibits such persons from making, or participating in making, decisions that could reasonably affect such interest; and (3) may require the filing a Statement of Economic Interest (Form 700).

If subject to the Act, Respondent shall conform to all requirements of the Act. Failure to do so shall constitute a material breach and is grounds for immediate termination of the Contract by

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County. Respondent shall indemnify and hold harmless County for any and all claims for damages resulting from Respondent’s violation of this Section.

8. Qualifications: By submitting a Proposal, the Respondent represents that it thoroughly examined the County’s requirements, is familiar with the services required under this RFP and is qualified and capable of providing the services to achieve the County’s objectives.

9. Compliance: Each Respondent must submit its Proposal in strict accordance with all requirements of this RFP and compliance must be stated in the Proposal. Deviations, clarifications and/or exceptions must be clearly identified as tracked changes in the Model

Contract submitted as part 4 for the County’s consideration as specified in the Proposal Response

Requirements Section, “Statement of Compliance.” The County, in its sole and absolute discretion, may reject a Proposal if it is conditional, incomplete or deviates from the specifications in this RFP.

10. Revisions: County reserves the right to request proposal revisions and hold discussions and negotiations with any Respondent as necessary to serve the best interests of the County. Any

Proposal may be rejected if it is conditional, incomplete or deviates from specifications in this

RFP. The County reserves the right to waive, at its discretion, any procedural irregularity, immaterial defects or other improprieties which the County deems reasonably correctable or otherwise not warranting rejection of the Proposal. Any waiver will not excuse a proponent from full compliance.

11. Expenses: Pre-contractual expenses are not to be included in the Respondent's Cost

Proposal. Pre-contractual expenses are defined as including, but not limited to, expenses incurred by the Respondent in: a) preparing its Proposal in response to this RFP; b) submitting that

Proposal to the County; c) negotiating with the County any matter related to the Respondent’s

Proposal; and d) any other expenses incurred by the Respondent prior to the date of award and execution, if any, of the Contract.

12. Non-Responsiveness: Any Proposal may be construed as non-responsive and ineligible for consideration if it does not comply with the requirements of the RFP. Failure to comply with the technical features and acknowledgment of receipt of addenda are common causes for holding a

Proposal nonresponsive.

13. Joint Venture: Where two or more Respondents desire to submit a single Proposal in response to this solicitation, they must do so on a prime/subcontractor basis rather than as a joint venture. The County intends to contract with a single firm that may subcontract with multiple firms (team) but not with multiple firms doing business as a joint venture.

14. Lobbyist: County does not require and neither encourages nor discourages the use of lobbyists or other consultants for the purpose of securing business.

15. D-U-N-S Number: The County requires a valid D-U-N-S number prior to Contract Award.

If needed, your company may obtain one at no cost at www.dnb.com. If you are unable to provide/obtain a D-U-N-S number, please indicate so in your proposal/bid submission response.

https://www.dnb.com/

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16. UEI Number: The County requires a valid UEI number prior to Contract Award. Your company must obtain one at no cost at www.usfcr.com. If you are unable to provide/obtain a

UEI number, please indicate so in your proposal submission response.

17. Presentations/Demonstrations: After the Close Date, evaluation and Proposal clarification will commence. Respondents who submit Proposals most responsive to the County’s requirements in this RFP, and therefore receive the highest score in the evaluation process, may be invited to give a presentation/demonstration of their Proposal to County staff. This presentation/demonstration will be provided to the County at no cost to the County.

Invited Respondent(s) should be prepared to make their oral presentation/demonstrations virtually within five (5) business days after notification and be prepared to discuss all aspects of the Proposal in detail, including technical questions regarding the Proposal. Invited

Respondent(s) shall not be allowed to alter or amend the Proposal through the use of the virtual presentation/demonstration process. Invited Respondent(s) who cannot attend the in-person presentation/demonstration scheduled as requested may be subject to elimination from the selection process at the County’s sole and absolute discretion.

18. County Rights: The County reserves the right to negotiate modifications with any

Respondent as necessary to serve the best interests of the County. Any Proposal may be rejected as non-responsive if it is conditional, incomplete or deviates from specifications in this

RFP. The County reserves the right to waive, at its discretion, any procedural irregularity, immaterial defects or other improprieties which the County deems reasonably correctable or otherwise not warranting rejection of the Proposal. No such waiver will excuse a proponent from full compliance.

19. Notice: The County reserves the right to: a) negotiate the final Contract with any

Respondent(s) as necessary to serve the best interests of the County; b) withdraw this RFP, in whole or in part, at any time without prior notice; c) award its total requirements to one

Respondent or to apportion those requirements among two or more Respondents as the County may deem to be in its best interests; d) reject any Proposal if it is conditional, incomplete or deviates from the specification in this RFP and/or e) request Best and Final Offer from any

Respondent determined to be within the competitive range.

The County makes no representations that any Contract will be awarded to any Respondent responding to this RFP. Moreover, the County may decide to forego negotiations with the

Respondent and accept the Proposal submitted; therefore, the Proposal submitted should contain the Respondent’s most favorable terms and conditions.

1.4 EVALUATION PROCESS AND CRITERIA

Proposals will be evaluated on the basis of the response to all requirements in this RFP. The

County shall use the following criteria in its evaluations and comparisons of Respondent(s). No inference is to be drawn concerning relative importance of criteria based on the order presented.

Contract award shall be made to the responsible Respondent(s) whose proposal is most advantageous to the County, taking into consideration the applicable evaluation criteria set forth https://www.usfcr.com/

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Administration Program, 017-202407-KA Page 13 of 38 below. Please note, however, that the listing of fees as an evaluation criterion does not require the County to select the Respondent(s) with the lowest fee proposal.

Proposals will be evaluated on the basis of responsiveness to the questions and requirements in this RFP by an evaluation panel.

Proposals will be competitively evaluated on the basis of the following criteria listed in random sequence not in the order of importance:

• Administrative Capability: Ability of Respondent to demonstrate administrative competence for both commercial and EGWP in areas such as implementation, customer service, claim system capability, data, reporting and systems, including capabilities for eligibility and accumulation of deductibles and out of pocket maximum.

• Cost: Total projected program cost (Claims cost with rebates, administrative fees, guaranteed network discounts, and additional costs).

• Financial: Respondents will be evaluated on the Proposed financial aspects of proposal to County.

• Implementation/Transition: Implementation project planning, support provided, and experience transitioning from current PBM.

• Member Services: Member services operations, training, and support available for both commercial and EGWP participants.

• Network: Retail network management and disruption

• Performance Guarantees: Ability to duplicate or enhance proposed performance guarantees, including County’s Account Management Scorecard and Reporting.

• Program Design: For both commercial and EGWP, utilization and formulary management, formulary composition and disruption, clinical program, and appeals management. Respondents shall demonstrate competence to provide claims processing, retail, home delivery pharmacy, Specialty pharmacy, and Rebate services for the commercial programs and EGWP in accordance with CMS requirements for County’s

EGWP Eligible Participants.

• Qualifications and Experience: General bid requirements, experience with public sector clients, account management, and service support.

• Responsiveness to the RFP: Respondents will be evaluated on the extent to which they can accept the existing contract provisions (Minimal revisions to the Model Contract).

Proposals deemed to meet all minimum RFP requirements will be scored based on established criteria, which will be assigned points that measure the responsiveness to each identified

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Administration Program, 017-202407-KA Page 14 of 38 criterion. The total number of points earned will be tallied for each Proposal, and the Proposals will be rank ordered, based upon the Respondent(s) submitted written materials.

Following the initial evaluation process, the highest-ranking Respondent(s) (if deemed necessary by the Evaluation Panel) may be required to complete an additional questionnaire regarding more specific processes and capabilities, as well as provide additional pricing information. In addition, Respondent’s may be required to provide an on-site interview or clarification as it relates to the requested and/or proposed services.

Respondents who submit Proposals most responsive to the County’s requirements will be asked to give an oral presentation of their Proposal to the Evaluation Panel. Selected Respondents should be prepared to make their oral presentation within five (5) business days after notification and be prepared to discuss all aspects of their Proposal in detail, including technical questions regarding the Proposal. Respondents shall not be allowed to alter or amend its Proposal through the use of the presentation process.

Respondents should remain prepared for the County to ascertain whether the Respondent is able to comply with the County’s Cybersecurity needs before a Contract is awarded to any

Respondent. This may include a review of a Respondent’s Cybersecurity operations by the

County’s Evaluation Panel, Human Resource Services, and/or Information Technology

Department. Respondents may be required to provide additional information as requested.

Award of final contract is subject to review and approval of Respondent’s cybersecurity policies and practices.

1.5 SELECTION/AWARD PROCESS

Upon the completion of the evaluation process, the Evaluation Committee will make a recommendation for award to the DPA. Contract award shall be made to the responsible

Respondent whose proposal is most advantageous to the County. Final award determination shall be subject to reference checks and past performance and may be subject to approval(s) by the

County Board of Supervisors. In addition, County reserves the right to verify and validate any information prior to the Contract Award and during the entire term of the Contract.

The Model Contract contained here in this RFP is the Contract proposed for execution. It may be modified to incorporate negotiated items and other pertinent terms and conditions set forth in this

RFP, including special conditions and requirements and those added by addendum, necessary attachments, and to reflect Respondent’s Proposal and qualifications. Any additional exceptions to the terms and conditions made by any Respondent after submission of its Proposal may result in its elimination from further consideration.

Negotiations may or may not be conducted with the finalist(s); therefore, the Proposal submitted should contain Respondent(s) most favorable terms and conditions, since the selection and award may be made without further discussion or need for clarification. Exceptions to the terms and conditions of the proposed Contract or the statements regarding Respondent’s inability to comply with any of the provisions thereof are to be declared in the response to the RFP in the Section below titled: "Proposal Response Requirements" subsection titled: “Statement of Compliance”.

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Any additional exceptions to the terms and conditions made by any Respondent(s) after submission of its proposal may result in elimination from further consideration.

If a satisfactory Contract cannot be negotiated in a timely manner, County, in its sole discretion, may terminate negotiations with the selected Respondent and begin negotiations with the next

Respondent.

1.6 PROTEST PROCEDURES

Any actual or prospective Respondent, who alleges a grievance in the solicitation or award of the

Contract may submit a protest to the Deputy Purchasing Agent. All protests shall be type written on the protester’s letterhead and submitted in accordance with the provisions stated herein.

1. Procedure

All protests shall be typed under the protester’s letterhead and submitted in accordance with the provisions stated herein. All protests shall include at a minimum the following information:

• The name, address and telephone number of the protestor;

• The signature of the protestor or protestor’s authorized representative;

• The solicitation number;

• A detailed statement of the legal and/or factual grounds of the protest;

• The form of relief requested.

2. Protest of Bid/Proposal Specifications

All protests related to bid or proposal specifications must be submitted to the Deputy Purchasing

Agent no later than five (5) business days prior to the close of the proposal. Protests received after the five (5) business day deadline will not be considered by the County.

In the event the protest of specifications is denied, and the protester wishes to continue in the solicitation process, they must still submit a bid prior to the close of the solicitation in accordance with the bid/proposal submittal procedures provided in the bid/proposal.

3. Protest of Award of Contract

In protests related to the award of a Contract, the protest must be submitted no later than five (5) business days after the notice of the proposed contract award is provided by the Deputy

Purchasing Agent. Protest relating to a proposed contract award which is received after the five

(5) business day deadline will not be considered by the County.

4. Protest Process

In the event of a timely protest, the County shall not proceed with the solicitation or award of the contract until the Deputy Purchasing Agent, the County Purchasing Agent or the Procurement

Appeals Board renders a decision on the protest.

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Upon receipt of a timely protest, the Deputy Purchasing Agent will within ten (10) business days of the receipt of the protest, issue a decision in writing which shall state the reasons for the actions taken.

The County may, after providing written justification to be included in the procurement file, make the determination that an immediate award of the Contract is necessary to protect the substantial interests of the County. The award of a Contract shall in no way compromise the protester’s right to the protest procedures outlined herein.

If the protester disagrees with the decision of the Deputy Purchasing Agent, the protestor may submit a written notice to the Office of the County Purchasing Agent requesting an appeal to the

Procurement Appeals Board, in accordance with the process stated below.

5. Appeal Process

If the protester wishes to appeal the decision of the Deputy Purchasing Agent, the protester must submit, within three (3) business days from receipt of the Deputy Purchasing Agent’s decision, a written appeal to the Office of the County Purchasing Agent.

Written appeals must be sent by mail to the address below with a courtesy copy by email;

County of Orange/County Executive Office

County Procurement Office

400 W. Civic Center Drive, 5th Floor

Santa Ana, CA 92701

Attn: County Procurement Officer

CPOAppeals@ocgov.com

Within fifteen (15) business days, the County Purchasing Agent will review all materials in connection with the grievance, assess the merits of the protest and provide a written determination that shall contain his or her decision on whether the protest shall be forwarded to the Procurement Appeals Board.

The decision of the County Purchasing Agent on whether to allow the appeal to go forward will be final and there shall be no right to any administrative appeals of this decision.

1.7 EDD INDEPENDENT CONTRACTOR REPORTING REQUIREMENTS

Effective January 1, 2001, the County is required to file federal Form 1099-Misc for services received from a “service provider” to whom the County pays $600 or more or with whom the

County enters into a contract for $600 or more within a single calendar year. The purpose of this reporting requirement is to increase child support collection by helping to locate parents who are delinquent in their child support obligations.

The term “service provider” is defined in California Unemployment Insurance Code Section

1088.8, subparagraph B.2 as “an individual who is not an employee of the service recipient for

California purposes and who received compensation or executes a contract for services performed for that service recipient within or without the state.” The term is further defined by

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The reporting requirement does not apply to corporations, general partnerships, limited liability partnerships, and limited liability companies.

Additional information on this reporting requirement can be found at the California Employment

Development Department web site located at http://www.edd.ca.gov/Payroll_Taxes/FAQ_-

_California_Independent_Contractor_Reporting.htm.

1.8 COUNTY OF ORANGE LOCAL SMALL BUSINESS (OCLSB) AND DISABLED

VETERAN BUSINESS ENTERPRISE (DVBE) PREFERENCE POLICIES

A. OCLSB: Effective January 1, 2020, the Orange County Board of Supervisors adopted the

OCLSB Preference policy. Implementation of the OCLSB Preference policy supports local businesses, the local economy and the development of the County’s tax base.

To be certified as a Local Small Business by the County of Orange, a business shall meet

(1) and (2) below:

1. Local Business requirements:

a. Maintains their principal center of operations (i.e. headquarters) within Orange

County, and;

b. Has:

i. a business address located in the County of Orange that is not a post office box, or

ii. a valid business license or certificate of occupancy issued by the County of

Orange or by an Orange County city, or other documentation acceptable to the

County of Orange.

2. Small Business Requirements:

a. Must be certified as a Small Business by the State of California Department of

General Services (DGS); and,

b. DGS Small Business requirements must be valid at the time of bid/proposal submittal.

B. DVBE: Effective January 1, 2021, County of Orange Board of Supervisors adopted the

DVBE Preference policy. The DVBE Preference policy supports local business opportunity, economy and the development of the County’s tax base, and in addition recognizes the service and sacrifice given by the men and women of our Armed Forces.

http://www.edd.ca.gov/Payroll_Taxes/FAQ_-_California_Independent_Contractor_Reporting.htm http://www.edd.ca.gov/Payroll_Taxes/FAQ_-_California_Independent_Contractor_Reporting.htm

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To be certified as a Disabled Veteran Business Enterprise by the County of Orange, a business shall meet (1) and (2) below:

1. Must be certified as a DVBE by the State of California Department of General

Services (DGS); and,

2. DGS DVBE requirements must be valid at the time of bid/proposal submittal.

1.9 COUNTY OF ORANGE CAMPAIGN CONTRIBUTION DISCLOSURE (LEVINE

ACT)

The Campaign Contribution Disclosure Form, must be completed by applicants for, or persons who are the subject of, any proceeding involving a license, permit, or other entitlement for use, including most contracts and franchises, pending before the Board of Supervisors (“Board”) of the County of Orange or any of its affiliated agencies.

IMPORTANT NOTICE

Government Code section 84308 (also known as the “Levine Act”) contains requirements that are summarized generally as follows:

A. If you are an applicant for, or the subject of, any proceeding involving a license, permit, or other entitlement for use, you are prohibited from making a campaign contribution of more than $250 to any member of the Board of Supervisors or other County official who may participate in your proceeding. This prohibition begins on the date your application is filed or the proceeding is otherwise initiated, and the prohibition ends 12 months after a final decision is rendered by the Board of Supervisors or other County officer. In addition, no Board member or other County official who may participate in your proceeding alternate may solicit or accept a campaign contribution of more than $250 from you during this period.

B. These prohibitions also apply to your agents, and, if you are a closely held corporation, to your majority shareholder as well. These prohibitions also apply to your subcontractor(s), joint venturer(s), and partner(s) in this proceeding. Also included are parent companies and subsidiary companies directed and controlled by you, and political action committees directed and controlled by you.

C. You must file the attached disclosure form and disclose whether you or your agent(s) have in the aggregate contributed more than $250 to any Board member or other County officer who may participate in your proceeding during the 12-month period preceding the filing of the application or the initiation of the proceeding.

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D. If you or your agent have in the aggregate contributed more than $250 to any individual

Board member or other County officer who may participate in your proceeding during the 12 months preceding the decision on the application or proceeding, that Board member or other County officer must disqualify himself or herself from the decision.

However, disqualification is not required if the Board member or other County official returns the campaign contribution within 30 days from the time the member or official knows, or should have known, about both the contribution and the fact that you are a party in the proceeding. The Campaign Contribution Disclosure Form should be completed and filed with your application or proposal, or with the first written document you file or submit after the proceeding commences.

1. A proceeding involving “a license, permit, or other entitlement for use” includes all business, professional, trade and land use licenses and permits, and all other entitlements for use, including all entitlements for land use, all contracts (other than competitively bid, labor or personal employment contracts), and all franchises.

2. Your “agent” is someone who represents you in connection with a proceeding involving a license, permit or other entitlement for use. If an individual acting as an agent is also acting in his or her capacity as an employee or member of a law, architectural, engineering, consulting firm, or similar business entity, both the business entity and the individual are “agents.”

3. To determine whether a campaign contribution of more than $250 has been made by you, campaign contributions made by you within the preceding 12 months must be aggregated with those made by your agent within the preceding 12 months or the period of the agency relationship, whichever is shorter. Contributions made by your majority shareholder (if a closely held corporation), your subcontractor(s), your joint venturer(s), and your partner(s) in this proceeding must also be included as part of the aggregation. Campaign contributions made to different Board of Supervisors members or other County officer who may participate in your proceeding are not aggregated.

A list of the Board of Supervisors members and other County officials can be found in The

Levine Act: County of Orange Campaign Contribution Disclosure form. This notice summarizes the major requirements of Government Code section 84308 of the Political Reform Act and

California Code of Regulations, Title 2 sections 18438.1-18438.8.

SECTION 2. WRITTEN PROPOSAL SCORING FORMAT

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2.1 PHASE 1: WRITTEN PROPOSALS

No. Evaluation Criteria Scoring Method Weight (Points)

1. Administrative Capability

Ability of Respondent to demonstrate administrative competence for both commercial and EGWP in areas such as implementation, customer service, claim system capability, data, reporting and systems, including capabilities for eligibility and accumulation of deductibles and out of pocket maximum.

N/A N/A

2. Financials

Respondents will be evaluated on the Proposed financial aspects of proposal to County.

N/A N/A

3. Implementation/Transition

Implementation project planning, support provided, and experience transitioning from current PBM.

N/A N/A

4. Member Services

Member services operations, training, and support available for both commercial and

EGWP participants.

N/A N/A

5. Network

Retail network management and disruption

N/A N/A

6. Performance Guarantees

Ability to duplicate or enhanced proposed performance guarantees, including County’s

Account Management Scorecard and

Reporting.

N/A N/A

7. Program Design

For both commercial and EGWP, utilization and formulary management, formulary composition and disruption, clinical program, and appeals management. Respondents shall demonstrate competence to provide claims processing, retail, home delivery pharmacy, Specialty pharmacy, and Rebate services for commercial and EGWP in accordance with

CMS requirements for County’s EGWP

Eligible Participants.

N/A N/A

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8. Qualifications and Experience

General bid requirements, experience with public sector clients, account management, and service support.

N/A N/A

9. Responsiveness to the RFP

Respondents will be evaluated on the extent to which they can accept the existing contract provisions (Minimal revisions to the Model

Contract).

2.2 PHASE 2: PRESENTATION / INTERVIEW

No. Evaluation Criteria Scoring Method Weight (Points)

1. Administrative Capability

Ability of Respondent to demonstrate administrative competence for both commercial and EGWP in areas such as implementation, customer service, claim system capability, data, reporting and systems, including capabilities for eligibility and accumulation of deductibles and out of pocket maximum.

N/A N/A

2. Financials

Respondents will be evaluated on the Proposed financial aspects of proposal to County.

N/A N/A

3. Implementation/Transition

Implementation project planning, support provided, and experience transitioning from current PBM.

N/A N/A

4.