RFA 5611 final~2.pdf

STATE OF OREGON

COVER PAGE

Oregon Health Authority

MARKETPLACE QUALIFIED HEALTH PLANS (QHPs)

REQUEST FOR APPLICATION (RFA)

OREGONBUYS NUMBER S-44300-00005617/OHA‐RFA-5611

Date of Issue: February 01, 2023

Closing Date: March 3, 2023

Single Point of Contact (SPC)

Katie Button

Plan Management and Policy Analyst

Oregon Health Authority

Oregon Health Insurance Marketplace

500 Summer Street NE

Salem, Oregon 97301

Phone: 503.507.2349

E-mail: katie.button2@dhsoha.state.or.us

In compliance with the Americans with Disabilities Act, this document is available in alternate formats. To request an alternate format, please send an e‐mail to dhsalt@state.or.us or call 503.378.3486 (voice) or 503.378.3523 (TTY).

mailto:dhsalt@state.or.us

RFA #5611 Page 2 of 27 OregonBuys #S-44300-00005617

Table of Contents

SECTION 1 – PURPOSE/OVERVIEW

1.1. Introduction

SECTION 2 ‐ MINIMUM QUALIFICATIONS

2.5 QHP/SADP Submission and Certification Requirements: Benefit and Rate Submission Information

SECTION 3 ‐ SCOPE OF WORK

3.1 Expected Carrier Activities

SECTION 4 ‐ RFA PROCESS

4.1 Single Point of Contact (SPC)

4.2 Closing Date for Submittal of Applications

4.3 Questions, Answers, and Addenda

SECTION 5 ‐ APPLICATION REQUIREMENTS

5.1 Application Submittal

SECTION 6 ‐ APPLICATION EVALUATION & CONTRACTOR ENROLLMENT

6.1 Application Evaluation

6.2 Final Selection and Award

6.3 Application Rejection

SECTION 7 ‐ GENERAL INFORMATION

7.1. Changes/Modification and Clarifications

7.2. Reservation of OHA Rights

7.3. Protest of RFA

7.3 Application Modification or Withdrawal

7.4 Cost of Application

7.5 Contractual Obligation

7.6 Contract Documents

QHP/SADP Carrier Attestation Form

Qualified Health Plan RFA Carrier Questionnaire

Applicant Cover Sheet Division of Financial Regulation Plan Submission Timeline

RFA #5611 Page 3 of 27

SECTION 1 – PURPOSE/OVERVIEW

1.1. Introduction

1.2. This is a Request for Application (RFA) from the Oregon Health Authority (OHA)

Health Insurance Marketplace (the Marketplace) to health insurance carriers

(Carriers) wishing to offer Marketplace-certified Qualified Health Plans (QHPs) and/or Stand Alone Dental Plans (SADPs) to Oregonians through the Marketplace on

HealthCare.gov and/or the Marketplace’s Small Employer Program. The

Marketplace requests applications from all Carriers that can meet the requirements of this RFA.

1.3. Unless the Director of OHA finds good cause to accept RFAs from additional

Carriers, this application will be the only opportunity for a Carrier to apply to offer plans through the Marketplace until 2025 for the plan year beginning in 2026.

1.4. The Marketplace issues this RFA under the authority of ORS 741.002(2)(a) and (4) and OAR 945-020-0020. The procedures for this RFA are governed by the Oregon

Department of Justice Model Rules in OAR Chapter 137, Division 147, except as provided in OAR 945-020-0020. The Patient Protection and Affordable Care Act

(P.L. 111-148) as amended by the Health Care and Education Reconciliation Act

(P.L. 111-152), ORS chapter 741, and OAR chapter 945 provide the regulatory framework for the Marketplace certification requirements.

SECTION 2 ‐ MINIMUM QUALIFICATIONS

2.5 QHP/SADP Submission and Certification Requirements: Benefit and Rate Submission Information

2.5.1 Benefit Approval

Carriers will submit plan and form filings with the DFR for each plan they wish to have certified by the Marketplace. DFR will determine the following:

2.5.1.1 The plan provides the essential health benefits that are required by state and federal law and approved by the federal Department of Health and Human Services;

2.5.1.2 The plan meets the actuarial value of the tier ascribed to it; and

2.5.1.3 The plan meets all other insurance regulations as required by state and federal law.

2.5.2 Rate Approval

Carriers will submit their rate filings to DFR for each plan they wish to have certified by the Marketplace. DFR will use its regular rate review process to evaluate and approve/disapprove rates and will provide over the Marketplace with the approved rates. Rates filed for each QHP and SADP must include a single age band of 0-20 for child coverage.

2.5.3 Plan and Rate Data Submission Requirements

2.5.3.1 Carriers will submit plan data and rate data through the System for Electronic

Rate and Form Filing (SERFF). Carriers will submit the following documents:

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2.5.3.1.1 Plan and Benefits Template

2.5.3.1.2 Issuer URL Template

2.5.3.1.3 Prescription Drug Template (QHP only)

2.5.3.1.4 Network Template

2.5.3.1.5 Service Area Template

2.5.3.1.6 Essential Community Providers/Network Adequacy Template

2.5.3.1.7 Rate Data Template

2.5.3.1.8 Rating Business Rules Template

2.5.3.1.9 Statement of Detailed Attestation Responses for SBM Issuers

2.5.3.1.10 Plan ID Crosswalk Template (if applicable)

2.5.3.1.11 Oregon Quality Improvement Strategy Report

2.5.3.1.12 Transparency in Coverage Template

2.5.3.1.13 This list may have additional items after CMS finalizes submission requirements in 2023.

2.5.3.2 Carriers will adhere to filing deadlines set by DFR (Attachment 4).

2.5.3.3 After initial binder submission, and after any changes are made to binders, the Marketplace will transfer plan data to the Federally Facilitated

Marketplace (FFM) via the Health Insurance Oversight System (HIOS).

Carrier will be responsible for reviewing data in HIOS’s Plan Preview function prior to its display on the FFM.

2.5.4 Network Adequacy

2.5.4.1 A Carrier offering a qualified health plan will ensure that the provider network of each qualified health plan meets federal standards that include, but are not limited to the following:

2.5.4.1.1 Includes Essential Community Providers (such as

Federally Qualified Health Centers, Tribal or Indian

Health Centers and Clinics, and other organizations that qualify for special pricing for prescription drug manufacturers),

2.5.4.2 Maintains a network large and diverse enough to provide all services without an unreasonable delay (and includes providers that specialize in mental health and substance abuse services),

2.5.4.3 Is consistent with the network adequacy provisions of section 2702(c) of the Public Health Services Act.

2.5.5 Accreditation

If Carrier is not currently accredited for exchange participation by the National

Committee for Quality Assurance, URAC, or the Accreditation Association for

Ambulatory Health Care, Inc., it will become accredited by July 15, 2024, and will provide the Marketplace a copy of its most recent accreditation survey, together with any survey-related information that the federal Department of

Health and Human Services may require, such as corrective action plans and summaries of findings.

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SECTION 3 ‐ SCOPE OF WORK

3.1 Expected Carrier Activities

The 2024 medical and dental contracts are currently expected be substantially identical to the 2023 contracts, the templates for which are posted at https://orhim.info/resources. Future changes in the legal environment for the

Marketplace may necessitate changes to the contract language.

SECTION 4 ‐ RFA PROCESS

4.1 Single Point of Contact (SPC)

All communications with OHA concerning this RFA must be directed to:

Katie Button, Plan Management Analyst

Oregon Health Authority

Oregon Health Insurance Marketplace

500 Summer Street NE

Salem, Oregon 97301

Phone: 503.507.2349

E‐mail: katie.button2@dhsoha.state.or.us

Any contact regarding this RFA with other State employees or officials may result in inaccurate information and delay of Application processing. Any oral communications will be considered unofficial and non‐binding. The RFA may be viewed at https://oregonbuys.gov/bso/, and https://healthcare.oregon.gov/Pages/resources.aspx Timeline for RFA and

Application Submission is:

RFA Opens: February 01, 2023

RFA Closes: March 03, 2023

4.2 Closing Date for Submittal of Applications

Carriers must submit the required documents via email to katie.button2@dhsoha.state.or.us no later than 5:00 p.m. PST on March 3, 2023. The subject line should be written as follows: “[Carrier Name] RFA Submission.” Each Carrier will receive an email confirming receipt of its submission. Fax, regular mail, and physical deliveries will not be accepted.

Applications received after the closing date and time are late and will not be considered.

Applications will be evaluated by OHA at any time after receipt.

4.3 Questions, Answers, and Addenda

4.3.1 All communications with the Marketplace concerning this RFA must be directed to the Marketplace Sole Point of Contact (SPC), Katie Button, via email to katie.button2@dhsoha.state.or.us. All communications related to this RFA must be in writing. The Marketplace will provide written answers to all RFA-related questions and will post RFA questions and answers relevant to all carriers on

OregonHealthCare.gov.

4.3.2 Written responses to Carrier questions regarding this RFA are official. Verbal communications are unofficial and non-binding.

4.3.3 Any communications, written or oral, that precede the official posting of this RFA are not official and binding unless reflected in this RFA or an addendum hereto.

mailto:theresa.m.ruddell@dhsoha.state.or.us https://oregonbuys.gov/bso/

RFA #5611 Page 6 of 27

SECTION 5 ‐ APPLICATION REQUIREMENTS

5.1 Application Submittal

Carriers must submit the required documents via email to katie.button2@dhsoha.state.or.us no later than 5:00 p.m. PST on March 3, 2023. The subject line should be written as follows: “[Carrier Name] RFA Submission.” Each Carrier will receive an email confirming receipt of its submission. Fax, regular mail, and physical deliveries will not be accepted.

5.1.1 Carriers currently offering QHPs through the Marketplace and dental carriers must make and submit the Attestations in Attachment 1 and submit the Applicant Cover

Sheet in Attachment 3.

5.1.2 Carriers not currently offering QHPs through the Marketplace must make and submit the Attestations in Attachment 1, complete and submit the Questionnaire in

Attachment 2, and complete and submit the Applicant Cover Sheet in Attachment 3.

LIST OF ATTACHMENTS

Attachment 1 - Attestation Form – attached below Attachment 2 - Questionnaire Form – attached below Attachment 3 - Applicant Cover Sheet – attached below Attachment 4 - Division of Financial Regulation Plan Submission Timeline – attached below

SECTION 6 ‐ APPLICATION EVALUATION & CONTRACTOR

ENROLLMENT

Applications must be complete at the time of submission. OHA will designate an Evaluation

Panel that will meet as necessary after the closing date of this RFA, to conduct a comprehensive and impartial evaluation of the Applications received to determine whether each Applicant meets all qualifications. Applicants whom OHA determines, at its sole discretion, to be qualified to perform Work pursuant to this RFA will have their applications accepted.

6.1 Application Evaluation

Applications may be evaluated by OHA any time after receipt. During the evaluation process, OHA reserves the right to obtain clarification from Applicants regarding their Application materials. Application Evaluation

6.1.1 Pass/Fail Approval of Carriers

After a Carrier submits an application, the Marketplace will evaluate its application and confirm with the Division of Financial Regulation (DFR) within Oregon Department of Consumer and Business Services (DCBS) that the Carrier meets state requirements for licensure and solvency and is in good standing. The Marketplace will then approve or disapprove the application.

6.1.2 The items listed below will be scored on a pass/fail basis.

6.1.2.1 Does the Carrier meet the federal minimum certification requirements?

6.1.2.2 Does the application comply with all application requirements?

6.1.3 The Marketplace will award Contracts to all Carriers for which the Marketplace has approved applications.

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6.1.4 A Carrier must have a Contract with the Marketplace to offer certified QHPs and/or

SADPs through the Marketplace on HealthCare.gov.

6.2 Final Selection and Award

Award will be made to each responsive and responsible Applicant that meets all the requirements of this RFA. All Carriers that submit an application in response to this RFA understand and agree that the Marketplace is not obligated to enter into a Contract with any Carrier and has no financial obligation to any Carrier.

6.3 Application Rejection

OHA may reject an Application if the Applicant fails to substantially comply with all prescribed solicitation procedures and requirements.

SECTION 7 ‐ GENERAL INFORMATION

7.1. Changes/Modification and Clarifications

When appropriate, the Marketplace will issue revisions, substitutions, or clarifications as addenda to this RFA. Changes and modifications to the RFA shall be recognized only if in the form of written addenda issued by the Marketplace and posted on

OregonHealthCare.gov.

7.2. Reservation of OHA Rights

The Marketplace reserves all rights regarding this RFA, including, without limitation, the right to:

Amend or cancel this RFA without liability if it is in the best interest of the Marketplace or the people of Oregon to do so;

7.2.1 Reject all applications received by reason of this RFA upon finding that it is in the best interest of the Marketplace or the people of Oregon to do so;

7.2.2 Waive any minor informality;

7.2.3 Seek and obtain clarification of an application from an applicant;

7.2.4 Amend or extend the term of any Contract that is issued as a result of this RFA; or

7.2.5 Reject any application upon finding that to accept the application may impair the integrity of the procurement process or that rejecting the application is in the best interest of the Marketplace or the people of Oregon.

7.3. Protest of RFA

Subject to OAR 137-047-0730, any prospective Carrier may submit a written protest of the procurement process or this RFA no later than February 23, 2023. A Carrier must submit any written protest to the procurement process or this RFA to the SPC at katie.m.button@oregon.gov and shall contain the following:

7.3.1. Sufficient information to identify the solicitation that is the subject of the protest;

7.3.2 The grounds that demonstrate how the procurement process is contrary to law or how the solicitation document is unnecessarily restrictive, is legally flawed, or improperly specifies a brand name;

7.3.3. Evidence or supporting documentation that supports the grounds on which the protest is based;

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7.3.4 The relief sought; and

7.3.5. A statement of the desired changes to the procurement process or the RFA that the will remedy the conditions upon which the Carrier based its protest.

7.3.6 Release of Information

After the application deadline and prior to a decision to grant an award or a decision to not grant an award, no person, including an applicant, is entitled to any information related to the consideration of an application or an applicant’s award status.

Notwithstanding, the Marketplace may share any information contained in an application with the Division of Financial Regulation (DFR), CMS, or persons involved in the review and evaluation of the application at the request of the Marketplace.

7.3.7. Protest of Application Selection

The SPC will notify every Carrier of its application selection status. A Carrier has seven calendar days after the date of the notice of application selection status to submit a written protest to the Marketplace. A protest under this paragraph must meet the requirements of ORS 279B.410 to be considered. The Marketplace will not consider any protests that are received after this deadline.

7.3 Application Modification or Withdrawal

7.4.1 Modifications: A Carrier may modify its application in writing prior to the date that applications are due. A Carrier must submit any modification to its application to the

SPC to katie.button2@dhsoha.state.or.us.

7.4.2 Withdrawals: A Carrier may withdraw its application by written notice, signed by an authorized representative of the Carrier, sent to the SPC to katie.button2@dhsoha.state.or.us.

7.4.3 Notification of Application Evaluation Decision

7.4.4 Applicants will be notified in writing of the evaluation decision regarding their application.

7.4.5 After the application has been evaluated and the Carrier notified of the outcome, the

Marketplace’s RFA file is subject to public disclosure in accordance with OAR 137-

047-0630, and the Oregon Public Records Law (ORS 192.311–192.478).

7.4.6 All Applications are considered public information once they have been opened.

However, copies of Applications will not be released until the evaluation process has been completely closed. Any person may request copies of public information, in writing to the Single Point of Contact listed in Section 4.1 of this RFA. A fee per page copied will be assessed and payment must be made before copies will be released. If any part of an application is considered a trade secret, the Applicant must clearly designate that portion as confidential to obtain protection, if any, from disclosure. See Oregon Revised Statutes 192.501(2) and 646.461 to 646.475.

7.4 Cost of Application

All costs incurred in preparing and submitting an Application in response to this RFA will be the responsibility of the Applicant and will not be reimbursed by OHA.

7.5 Contractual Obligation

mailto:katie.m.button@oregon.gov

RFA #5611 Page 9 of 27

Applicants submitting an Application in response to this RFA understand and agree that OHA is not obligated thereby to enter into an Agreement with any Applicant and, further, has absolutely no financial obligation to any Applicant or Contractor.

7.6 Contract Documents

The 2024 medical and dental contracts are currently expected be substantially identical to the 2023 contracts, the templates for which are posted at https://orhim.info/resources.

Future changes in the legal environment for the Marketplace may necessitate changes to the contract language.

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Attachment 1

Oregon Health Insurance Marketplace 500 Summer Street NE E-56, Salem, OR 97301 | 855-268-3767 (toll-free)

QHP/SADP Carrier Attestation Form

Instructions

For each attestation below, carrier will check “yes,” or “no.” Please explain each “no” answer.

If desired, documents may be uploaded in lieu of a written explanation. Include the document title in the explanation text field. Clearly label each document to indicate the corresponding question.

Carrier must respond to all attestations.

Carrier Agrees to Work Collaboratively with the Marketplace in Key Areas

1. Carrier will perform the following functions related to the Oregon Health Insurance Marketplace and the Centers for Medicare and Medicaid Services:

• Consumer dispute resolution

• Plan data submission and display

• System integration with the Federally Facilitated Marketplace

• Member communications regarding exchange issues and instructions

❏ Yes ❏ No

If you checked “no,” explain below (1,000 character limit):

Federal Minimum Certification Requirements

As a condition of participation in the exchange, health insurance carriers must agree to comply with the federal minimum certification requirements. These requirements are taken from the Patient Protection and Affordable Care

Act (ACA) and the related federal regulations promulgated by the United States Department of Health and Human

Services (HHS) in 45 CFR, Parts 155 and 156. This section highlights some of the major requirements. It is not intended to be a complete list of federal certification requirements.

Licensure and Solvency

2. Carrier will be licensed and in good standing to offer health or dental insurance coverage or both in Oregon.

❏ Yes ❏ No

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Fees and Assessments

6. Carrier will pay administrative charges to the Oregon Health Insurance Marketplace under Oregon Administrative Rules Chapter 945, Division 30.

❏ Yes ❏ No

If you checked “no,” explain below (1,000 character limit):

Plan Offerings

7. Carrier will offer through the Oregon Health Insurance Marketplace at least one standardized QHP in the Bronze, Silver, and Gold coverage levels. Dental carriers, select NA.

❏ Yes ❏ No ❏ NA

If you checked “no,” explain below (1,000 character limit):

8. Child-only plans. Carrier will include rates for ages 0-20 on all plans to accommodate the ACA’s child-only plan requirement.

❏ Yes ❏ No

If you checked “no,” explain below (1,000 character limit):

Cost-Sharing Reductions

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9. The ACA (§1402) requires carriers to reduce the cost-sharing levels in Silver-level QHPs sold to individuals with household incomes less than 250 percent of the federal poverty level. Carrier will offer cost-sharing reductions plans as required by §156.420 and then by reducing other forms of cost sharing. Dental carriers, select NA.

❏ Yes ❏ No ❏ NA

If you checked “no,” explain below (1,000 character limit):

Enrollment Management

The carrier will:

10. Enroll a qualified individual who is determined to be eligible by the Federally Facilitated Marketplace (FFM) for the plan for which the qualified individual has applied during the annual open enrollment periods described in

§155.410(b) and (f), and abide by the effective dates of coverage established by the Oregon Health Insurance

Marketplace, the Federally Facilitated Marketplace (FFM), and state and federal law.

❏ Yes ❏ No

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11. Enroll a qualified individual who is determined to be eligible by the Federally Facilitated Marketplace (FFM) for the plan for which the qualified individual has applied during special enrollment periods described in

§155.420(d) and abide by the effective dates of coverage established by the Oregon Health Insurance Marketplace, the FFM, and state and federal law.

❏ Yes ❏ No

If you checked “no,” explain below (1,000 character limit):

Risk Adjustment

12. Carrier will comply with the requirements of the federal risk adjustment program. Dental carriers, select NA.

❏ Yes ❏ No ❏ NA

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Small Employer Product Line Standards

Enrollment Timeline and Process

Carriers offering a small employer plan through the exchange will:

13. Provide new enrollees with an enrollment packet. ❏ Yes ❏ No

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14. Report on SHOP enrollment as requested. ❏ Yes ❏ No

15. Enroll all qualified employees consistent with the plan year of the applicable employer. ❏ Yes ❏ No

If you checked “no,” explain below (1,000 character limit):

Network Adequacy

Carrier will ensure that the provider network of each of its plans is available to all enrollees and meets the following standards:

16. Includes essential community providers in accordance with §156.235. ❏ Yes ❏ No

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17. Maintains a network that is sufficient in number and types of providers to ensure that all services will be accessible without unreasonable delay.

❏ Yes ❏ No

If you checked “no,” explain below (1,000 character limit):

18. Is consistent with the network adequacy provisions of 45 CFR§156.230, ORS 743.B.505 and OAR 836-053-

0300 to 836-053-0350.

❏ Yes ❏ No

If you checked “no,” explain below (1,000 character limit):

Submission Information

Carriers must submit the attestation and questionnaire responses via email to katie.button2@dhsoha.state.or.us no later than 5 p.m. PST on March 3, 2023. Please make sure the email subject line reads: [CARRIER NAME] RFA

Submission. The attestation must be complete and include complete responses. Fax, regular mail, and physical deliveries will NOT be accepted. You will receive an email confirming your submission.

By submitting this attestation, I certify that the information contained herein is true and correct to the best of my knowledge.

Name and title of the person submitting this attestation:

For: Date:

(Company name)

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Attachment 2

Oregon Health Insurance Marketplace 500 Summer Street NE E-56, Salem, OR 97301 | 855-268-3767 (toll-free)

Qualified Health Plan RFA Carrier Questionnaire

Instructions

This questionnaire identifies the Patient Protection and Affordable Care Act (ACA) requirements that a carrier must meet before a contract is finalized between the Oregon Health Insurance Marketplace and the carrier. Please respond to each question and explain how you will meet the requirements.

If the space allotted does not allow for complete answers, please add additional pages or documentation. Include the document title in the explanation text field. Documents must be clearly labeled to indicate the corresponding question.

Transparency

Transparency — ORS §741.001(3): “Empower Oregonians by giving them the information and tools they need to make health insurance choices that meet their needs and values.”

The Oregon Health Insurance Marketplace seeks to empower Oregonians by providing the information and tools customers need to make good choices and be informed about their coverage.

RFA #5611 Page 19 of 27

1. In the space provided below, please describe how you provide enrollees with timely information about plan benefits and cost sharing, provider networks, changes to the foregoing, and the steps necessary for a member to locate this information on your website.

Health Equity

The Oregon Health Authority is working to eliminate health inequities by 2030. As part of that work, OHA has established the following definition of health equity:

Oregon will have established a health system that creates health equity when all people can reach their full health potential and well-being and are not disadvantaged by their race, ethnicity, language, disability, age, gender, gender identity, sexual orientation, social class, intersections among these communities or identities, or other socially determined circumstances. Achieving health equity requires the ongoing collaboration of all regions and sectors of the state, including Tribal governments to address:

• The equitable distribution or redistribution of resources and power; and

• Recognizing, reconciling and rectifying historical and contemporary injustices.

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2. How do you communicate important information to your members about your health benefit plans and company policies in a culturally and linguistically appropriate manner?

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Quality — ORS §741.001(4): “Improve health care quality and public health, mitigate health disparities linked to race, ethnicity, primary language and similar factors…”

In addition to the Quality Improvement Strategies required in 45 CFR §156.1130, the Oregon Health Insurance Marketplace is working to align with quality initiatives in place or in progress with the Oregon Health Authority.

3. Some individual or small group market commercial plans may have quality incentive or value-based payment strategies that are also in place in coverage offered through the Oregon Health Plan (OHP), the Public

Employees Benefit Board (PEBB), and/or the Oregon Educators Benefit Board (OEBB). If you currently include, or plan to include, any of these quality incentive or value-based payment strategies in your individual or small group market commercial plans, please provide the following information for each strategy you include or plan to include in these plans:

■ Name of the strategy or initiative and effective date

■ Describe how the strategy has performed in OHP, PEBB, and/or OEBB – explain the annual change in per-member cost and/or quality scores for the program’s success metrics

■ If currently implemented in individual or small group commercial plans, describe how the strategy has performed – identify the plans/networks and scope of providers that participate in the quality incentive or value-based program, and explain the annual change in per-member cost and/or quality scores for the program’s success metrics

■ If not currently implemented in individual or small group commercial plans, describe how the strategy is expected to perform – explain the program’s success metrics and the targeted change in those metrics

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4. If you previously included quality incentive or value-based payment strategies from OHP, PEBB, and/or

OEBB in your individual and small group commercial plans, but have discontinued those strategies in your commercial plans, please provide the following information for applicable strategies:

■ Name of the strategy or initiative, and effective and termination dates

■ Describe how the strategy has performed in OHP, PEBB, and/or OEBB – explain the annual change in per member cost and/or quality scores for the program’s success metrics

■ Describe how the strategy performed or failed to perform in your individual and small group commercial plans - explain the annual change in per member cost and/or quality scores for the program’s success metrics

■ Any other information that provides the rationale for discontinuing the use of the strategy in your commercial plans

If you have not discontinued any of the strategies described here, please put N/A.

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5. Do you currently include any value-based payment strategies in your provider networks not described above? If so, please list and describe each strategy, including the plans in which it is employed, and the effective date. Explain the annual change in per-member cost and/or quality scores for each program’s success metrics. If you do not use any value-based contracting strategies in your provider networks, please indicate why.

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Access – ORS §741.001(4): “…ensure access to affordable, equitable, and high-quality health care throughout the State.”

6. Are there communities within your geographic service area that heavily rely on essential community providers and would benefit from expanded contracts with such providers? Do you currently include essential community providers in your health benefit plan networks? If not, how and when do you plan to contract with them in the future?

7. Please describe your referral process and prior authorization process when an Indian Health Service or

Tribal 638 facility is not a participating provider in your network. What is your payment structure with IHS or tribal clinics when members receive services there?

Submission Information

Carriers must submit the attestation and questionnaire responses via email to katie.button2@dhsoha.state.or.us no later than 5 p.m. PST on March 3, 2023. Please make sure the email subject line reads: [CARRIER NAME] RFA Submission. The questionnaire must be complete and include complete responses. Fax, regular mail, and physical deliveries will NOT be accepted. You will receive an email confirming your submission.

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By submitting this questionnaire, I certify that the information contained herein is true and correct to the best of my knowledge.

Name and title of the person submitting this questionnaire:

For: Date:

(Company name)

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Attachment 3

Applicant Cover Sheet

Carrier Information

Carrier legal entity name (per Oregon Certificate of Authority):

Carrier Assumed Business Name in Oregon (if different):

Form of legal entity (business corporation, nonprofit corporation, etc.):

Oregon Certificate of Authority number as □ health care service contractor, or □ health insurance company

NAIC Company Code Number:

State of domicile:

Primary Contact Person: Title:

Address:

City, State, Zip:

Telephone: Fax:

E-mail Address:

Name and title of the person(s) authorized to represent the Carrier and sign any Contract that may result:

Name: Title:

By signing this page and submitting an Application, the Authorized Representative certifies that the following statements are true and will remain true throughout the RFA process and contractual period:

1. Statements contained in this Application are true and, so far as is relevant to the Application, complete. Carrier accepts as a condition of the Contract, the obligation to comply with applicable state and federal requirements, policies, standards, and regulations. No attempt has been made or will be made by the Carrier to induce any other person or organization to submit or not submit an Application.

2. Carrier does not discriminate in its employment practices with regard to race, creed, age, religious affiliation, sex, disability, sexual orientation or national origin, nor has Carrier or will Carrier discriminate against a subcontractor in the awarding of a subcontract because the subcontractor is a minority, women or emerging small business enterprise certified under ORS 200.055.

3. Information included in this Application shall remain valid until a Contract is approved.

4. The undersigned recognizes that this is a public document and will become open to public inspection

5. Carrier confirms that it has followed the instructions provided and has identified any deviations from specifications within its response. Carrier affirms that it had the opportunity to ask questions about the RFA and to seek clarification when it deemed clarification was necessary.

6. Carrier acknowledges receipt of all addenda issued under this RFA.

7. If Carrier is awarded a Contract as a result of this RFA, Carrier is expected to sign, and will be bound by, the

Contract described in this RFA. Carrier agrees to the statement of work, except to the extent Carrier has timely requested a change or clarification or filed a protest in accordance with the RFA.

Signature: Title: Date:

RFA #5611 Page 27 of 27

Division of Financial Regulation

Product Regulation Insurance

P.O. Box 14480

Salem, Oregon 97309-0405

503-947-7980

Date: January 19, 2023

To: All issuers selling health benefit and pediatric dental plans Re: Draft 2023 filing deadlines

Based on the Center for Medicaid and Medicare Services’ (CMS) deadline for final plan data submission for 2024 plans, the Division of Financial Regulation (DFR) has prepared the following draft timeline for submission of 2024 form, rate, and binder filings. The filing deadlines apply to health benefit plans and exchange certified pediatric dental plans offered on-exchange and off-exchange. Dental products that will not be exchange certified are not required to follow this timeline.

DFR is providing these preliminary deadlines for planning purposes, but issuers are advised that we are still awaiting final federal due dates for 2024 plans. We will respond and adjust to changes in federal due dates as necessary.

All due dates are 2023, unless noted.

01.19.23 ver 1.0