RFP 190000002803 - Questions and Answers.pdf

Version 2 (2/2019)

Bidder Questions & Answers RFP No. 190000002803

HMO Services for Michigan Public School Employees’ Retirement System’s Plans

July 31, 2019

Q # Document and

Section Page

# Bidder Question Answer 1 Schedule J - Benefit

Comparison and Actuarial Attestation

All Is it the intent to have the benefits for 2020 decided by August 7th? In the past we have had until September 1 to provide the benefit changes. August 7th is a big change. Please confirm the intent.

To submit a proposal in response to this RFP, for services beginning 1/1/2020, bidders must include in their proposal benefits that are, at minimum, actuarially equivalent to the benefits as specified in Schedule J – Benefit Comparison and Actuarial Attestation.

The Contract Administrator may propose Benefit Plan adjustments after Contract execution, to be reviewed by the Contractor.

The Plan Sponsor (State) reserves the right, at its sole discretion, to accept or reject any benefit design adjustment.

2 Schedule F - Summary of Benefits - Non- Medicare and Medicare

All The RFP says HMO Services, but the benefit summaries in the RFP are PPO Medicare Advantage and PPO Non- Medicare. Are we supposed to quote/provide HMO versions of the PPO summaries attached? Exact match to benefits as well, or if different improved?

As stated in the Proposal Instructions, Section 1. Proposal Preparation, Schedule F, the PPO Medicare Advantage and PPO non-Medicare benefit summaries are for informational purposes.

Schedule A Statement of Work, Section 1.1.

Services and Deliverables, A. Plan Design, specifies under paragraph 1. “Except as otherwise specified herein, the only benefit requirement is that in-network coverage must be Actuarially Equivalent to or exceed the coverage offered under MPSERS’ self-funded Plan, a description of which is included as Schedule F, Summary of Benefits – Non-Medicare and Medicare (two separate attachments).” For additional pharmacy details, please refer to Schedule M – MPSERS Pharmacy Summary of Benefits (2 attachments- Medicare and Non Medicare)

Schedule M is added to this RFP and included in this amendment.

STATE OF MICHIGAN PROCUREMENT

DTMB, Central Procurement Services

525 W. ALLEGAN ST., LANSING, MICHIGAN 48913

P.O. BOX 300026 LANSING, MI 48909

Document and Section

Page # Bidder Question Answer

3 Schedule F - Summary of Benefits - Non- Medicare

On the non-Medicare benefit summary, it appears Rx coverage is carved out? It is not addressed on the summary.

Pharmacy coverage is not carved out.

Please refer to Schedule A Statement of Work, Scope (page 1) which specifies, “The Contractor must be able to provide and administer both a Non-Medicare and a Medicare product inclusive of pharmacy coverage to Eligible Members who elected enrollment in an HMO and pursuant to the requirements listed herein ”.

Also, please refer to Schedule M- MPSERS Pharmacy Summary of Benefits (2 attachments - Medicare and Non Medicare) -attached to this RFP, which is included for informational purposes.

Schedule M is added to this RFP and included in this amendment.

4 Standard Contract Terms - Schedule L

28 What is the government cloud solution? The State’s private Cloud for VDC (NGDI), and the off-premise VDC solution of Azure Government cloud.

VDC = Virtual Data Center

NGDI= Next Generation Digital Infrastructure

5 Proposal Instructions- Confidential- Treatment-Vendor- Questions- Worksheet.

Question 7, Evaluation Process.

3 Does this item confirm that there will be only one contract award winner or will the contract be awarded to any bidder who meets or exceeds the criteria in Question 7, Evaluation Process?

Multiple award recommendations may be made if there are multiple responsive and responsible Bidders who meet or exceed the criteria stated in Section 7, Evaluation Process. The State reserves the right to award multiple contracts as specified in Section 10. Reservations, k.

6 Schedule A - Statement of Work, Section 2.1

12 In the Statement of Work document, Section 2.1 Service Level Agreements (sub sections A and B), it states that failure to meet the stated scores will result in financial penalties. HMOs are prohibited by the HMO Act of Michigan’s Insurance Code from putting any portion of underwritten premiums at risk. Please advise how we should handle this.

Section 2. Service Levels is hereby deleted from Schedule A, Statement of Work, per attached Schedule A – Statement of Work – Revised with Redlines 7-31-19.

In addition, Section 48, Service Level Requirements is hereby added to the Standard Contract Terms, per attached Standard Contract Terms – Revised with Redlines 7-31-19.

Bidders should redline the provision if you feel it is violative of an Act and provide an explanation.

Section Page

# Bidder Question Answer 7 Schedule A -

Statement of Work, Section 4.7 Key Personnel

14, In the Statement of Work document, Section 4.7 Key Personnel sub sections 4 (i) and (ii), it states various credits (penalties) for the unauthorized removal or the failure to assign a replacement to shadow Key Personnel. HMOs are prohibited by the HMO Act of Michigan’s Insurance Code from putting any portion of underwritten premiums at risk. Please advise how we should handle this.

Section 4.7 Key Personnel, paragraph

4. is hereby deleted from Schedule A, Statement of Work, per attached Schedule A – Statement of Work – Revised with Redlines 7-31-19.

In addition, Section 15. Key Personnel of the Standard Contract Terms is revised, per attached Standard Contract Terms – Revised with Redlines 7-31-19.

Bidders should redline the provision if you feel it is violative of an Act and provide an explanation.

8 Schedule A statement of work – Section 3 Population

5 Census: Please provide a detailed census, without any specific member identifying information, of all Medicare eligible retirees & Medicare eligible dependents. Members cannot be actively working and must have both Medicare Parts A & B. Include the following at minimum:

Date of Birth (MM/DD/YYYY) Gender Relationship (subscriber or dependent) Residence zip code Current plan or option for each eligible member

To obtain the following information, Bidders must first sign the attached non-disclosure agreement and send it to the Solicitation Manager at cieciwas@michigan.gov. Then the Bidder will receive from the Solicitation Manager via email an encrypted file of population tables with:

Zip Code Date of Birth Gender Medicare / non-Medicare Indicator Relationship

9 Medicare PPO Summary of benefits

2-12

If any benefits changed from the claims experience period to the current benefit period, please indicate what changes were made. If this list is not available, provide the benefit summaries that would correspond with each claims experience period.

HMO Benefit Summaries for 2017, 2018, and 2019 are attached in Schedule N – HMO Benefit Summaries.

Note: HMO 1 and HMO 2 correspond to listings of same on Schedule O – Medical Claims and Net Pay and Schedule P – Pharmacy Claims and Net Pay.

Schedules N, O and P are added to this RFP and included in this amendment.

10 Schedule A, Background –

Financing for MSPERS is funded through public school employer contributions…

1 What is the contribution level of the employer? (percent and dollar amount of premium – if it varies by years of service, please provide average years of service and average employer monthly funding).

Has a cap been placed on the employer contribution?

If so, what is the cap level?

Contributions made to the Michigan Public School Employees’ Retirement System by individual employers (school districts) may vary in accordance with the contribution limits set forth in PA 300.

mailto:cieciwas@michigan.gov

Section

Page # Bidder Question Answer

12 General N/A Please provide incurred monthly medical claims and member counts for the most recent 24 months. If claims are reflective of incurred dates, indicate the “paid through” date split by plan option.

HMO Medical claims paid by month for Medicare and Non Medicare are included in Schedule O- Medical Claims and Net Pay.

13 General N/A Please provide current MA population risk score for medical. Please note the month or time period of the risk score and if it is paid or accrued. If accrued, please note if it includes mid-year or final payments.

The State does not have the requested information, risk scores for the HMO population.

However, the risk score for members enrolled in the MPSERS Master Healthcare Plan (self-funded, PPO) was

0.989 in 2018 (2017 dates of service) on an incurred basis including final adjustments.

14 General N/A Do the MA medical claims include any costs for Non-Medicare Covered Services, Clinical, Quality, Disease Management or Fitness Programs? If not, can you please provide the estimated costs of these programs that were charged by the current carrier?

Yes.

The State does not have further information regarding the cost of specific programs implemented by an

HMO.

15 General N/A Please provide incurred monthly Rx claims for the most recent 24 months for Medicare eligible subscribers & dependents including either monthly member count or PMPM. Are the drug claims net of Pharma discount, Rebates, reinsurance, member cost share and LIS? If not, please provide these amounts separately.

HMO Pharmacy claims paid by month for Medicare are included in Schedule P- Pharmacy Claims and Net Pay.

16 General N/A Are there any Non-Part D drugs or lifestyle drugs covered on the current Part D plan?

No.

However, there is no restriction should an HMO choose to do so.

17 Statement of Work

– Section A Plan Design – 4

2 Please confirm if the non-Medicare HMO may be self-funded.

No.

18 General N/A Please confirm the Pharmacy plan design and type that the HMO Medicare and Non Medicare retirees are on.

Each HMO is eligible to create their own plan design, as long as it is actuarially equivalent to the plan design of the MPSERS Master Healthcare Plan, as specified in Schedule F Summary of Benefits – Non-Medical and Medicare and Schedule J – Benefit Comparison and Actuarial Attestation.

19 Medicare PPO Hearing Aid Section

Please confirm if bidders must use TruHearing or may provide an equivalent benefit using another provider.

Bidders are not required to use TruHearing.

Section

Page # Bidder Question Answer

20 Schedule C, Mandatory Requirements Form, 4.

1 May bidders offer an MA PPO option in order to provide comprehensive benefits to members when they temporality reside outside the service area?

No.

21 Schedule J - Benefit Comparison and Actuarial Attestation

Is it your intent for diagnostic lab, pathology and x-ray to apply 10% coinsurance after deductible?

The benefit details of the Bidder’s proposed plan are at the Bidder’s discretion. The requirement is that overall the plan be actuarially equivalent to the benefits listed in Schedule J - Benefit Comparison and Actuarial Attestation (and further detailed in Schedules F- PPO Summary of Benefits and M-MPSERS Pharmacy Summary of Benefits).

22 Schedule J - Benefit Comparison and Actuarial Attestation

Is it your intent for Private Duty Nursing to be covered like all other outpatient services?

The benefit details of the Bidder’s proposed plan are at the Bidder’s discretion. The requirement is that the plan be actuarially equivalent to the benefits listed in Schedule J - Benefit Comparison and Actuarial Attestation (and further detailed in Schedules F- PPO Summary of Benefits and M- MPSERS Pharmacy Summary of Benefits).

23 Schedule A – Statement of Work,

1.1 Services and

Deliverables, A.

Plan Design. 6.

2 Regarding Schedule A Statement of Work, Requirements 1.1, Item A.6: With an HMO, there is ER and UC coverage only when a member is travelling outside the service area. Must an HMO carrier provide an HMO Point of Service plan, or is the HMO plan OK?

The specific plan the Bidder proposes is at the Bidder’s discretion.

As specified in Schedule A Statement of Work, 1.1. Services and deliverables, A. Plan Design, 6 “Where a Member’s primary residence remains in Michigan, the Contractor must provide comprehensive benefits to members when they travel outside of the service area.” Benefits should not be limited to only ER and UC.

24 Schedule A – Statement of Work

Regarding Schedule A Statement of Work, Requirements 1.1, Item A.1:

Please reaffirm that the goal of quoting an HMO plan is it match the State plan, offer an actuarially equivalent plan, or offer a benefit that is better than the State plan.

The HMO plan must be, at minimum actuarially equivalent to the MPSERS Master Healthcare Plan.

HMO offerings are made in addition to, not in competition with the MPSERS Master Healthcare Plan.