RFP 27-88343 - Att F1 - Technical Proposal Response Template [Add. 1].docx

RFP-27-88343

Indiana Medicaid Managed Care Organizations Attachment F1 - Technical Proposal Instructions

Overview:

Request for Proposal (RFP) 27-88343 is a solicitation issued by the State of Indiana in which organizations are invited to compete amongst other Respondents in a formal evaluation process. Please be aware that the evaluation of your organization’s proposal will be completed by a team of State of Indiana employees and your organization’s score will be reflective of that evaluation. The evaluation of a proposal is based upon the information provided by the Respondent in its proposal submission. Therefore, a competitive proposal will thoroughly address all components of the RFP. The Respondent is expected to provide the complete details of its proposed operations, processes, and staffing for the scope of work detailed in the RFP document and supplemental attachments.

A completed Technical Proposal is a requirement for proposal submission. Failure to complete and submit this form may impact your proposal’s responsiveness.

Respondents must complete and submit Attachment L (AI Technical Proposal Questions) and Attachment M (Infrastructure Overview) as part of their proposal.

Respondents are encouraged to prioritize the quality, relevance and clarity of their responses over page count. Concise, substantive proposals that fully address the requirements without unnecessary narrative or repetition are strongly preferred.

Technical Proposal Components:

The Technical Proposal response should be divided into the following five components:

· Statement of Work Section 1 (Background and Experience)

· References and experience provided in Attachments H1 and H2 will be considered in the evaluation.

· Statement of Work Sections 2 (Administrative Requirements) and 9 (Information Technology Systems)

· Statement of Work Sections 3 (Covered Benefits and Services), 4 (Care Coordination), 5 (Member Services), and 13 (Healthy Indiana Plan Design and Member Eligibility)

· Statement of Work Section 6 (General Provider Network Requirements)

· Statement of Work Sections 7 (Quality Improvement Goals) and 8 (Program Integrity)

Submission Specifications:

Technical proposals are also described in Section 2.4 of the RFP:

· A complete technical proposal, excluding specified attachments, should not exceed 200 300 pages in 10-point Arial font with standard margins.

· Every point made in each section must be addressed in the order given. The same outline numbers must be used in the response.

· Exclusive of specified attachments, it is the State's preference that the technical proposal be submitted as a single document.

· Beyond specified attachments, additional attachments and exhibits may be provided in a separate file if needed. The technical proposal must contain an adequate description of the contents such that it stands on its own and contains enough information to understand any additional separate exhibits or attachments.

· If submitted in PDF format, the files should not be locked.

· It is the responsibility of the Respondent to ensure that no PII (Personally Identifiable Information), PHI (Protected Health Information) and/or anything that can be considered HIPPA-protected information is shared in the response to this RFP.

Response Structure:

Please review the requirements in the RFP carefully and address these accordingly. Describe your relevant experience and explain how you propose to perform the work in its entirety, including but not limited to the specific elements highlighted below. Where applicable, indicate how your proposed offering will address program goals.

Respondents are encouraged to submit inventive proposals for addressing the State’s goals that go beyond the minimum requirements set forth in Attachments K.

For all areas in which subcontractors will be performing a portion of the work, clearly describe their roles and responsibilities, and how you will maintain oversight of the subcontractors’ activities.

Background and Experience References and experience provided in Attachments H1 and H2 will be considered in the evaluation. Please provide an overview of your proposal. Please provide information on:

1. Programs you have initiated in other states that you will adapt for Indiana to help the State meet its goals. Provide and describe examples of achieved health outcomes directly tied to Indiana’s five program quality goals.

2. Examples of how you have worked with other states in a collaborative manner to address changing program needs and priorities.

3. As a separate attachment, please list any instances in which you or any related holding company, parent company, subsidiary, or intermediary company have been subject to any of the conditions listed below during the past five (5) years for services that relate to those contemplated by this RFP. If any of the following conditions apply, please provide full details of each occurrence. Note that the list and descriptions of these instances/occurrences will not count toward the page limit.

i. Contracts that were terminated for convenience, non-performance, non-allocation of funds, or any other reason for which termination occurred before the completion of the originally contracted term.

ii. Occurrences where the Respondent has either been subject to default or has received notice of default or failure to perform on a contract. Provide full details related to the default or notice of default including the other party’s name and contact information.

iii. Corrective actions, formal complaints or written warnings.

iv. Sanctions, Damages, penalties, or related assessments, or payment withholds not earned. Include the estimated value of each incident with the details of the occurrence.

v. Known litigation, administrative or regulatory proceedings, or similar matters.

4. Please describe specific examples and naming the states where you have saved a state money in a Medicaid administrative and/or assistance endeavor without reduction to quality or care/services being provided to members.

5. As a separate attachment, please provide NCQA health plan ratings for the 2024 Health Plan Rating (Measurement Year 2023), 2025 Health Plan Rating (Measurement Year 2024), and 2026 Health Plan Rating (Measurement Year 2025) for all state Medicaid contracts under which you operated in those years. For each instance, identify the state, health plan name, populations covered (e.g., children, adults, LTSS, etc.), and overall rating. You do not need to separate the ratings by Medicaid program within the state. Note that these health plan ratings reports will not count toward the page limit.

6. In separate and distinct Attachments F2 - Outcomes Measures Response Template, provide audited Reporting Measure results for the Indiana-selected measures for the 2024 Reporting Year (Measurement Year 2023), 2025 Reporting Year (Measurement Year 2024), and 2026 Reporting Year (Measurement Year 2025) for all Medicaid programs you operated in those years. Please complete and submit separate versions of Attachment F2 for each state in which you have operated a Medicaid Managed Care program in the covered years, following the file naming guidance in the file. Note that the Attachment F2 responses will not count toward the page limit.

Administrative Requirements and Information Technology Systems

1. Summarize your proposal as it relates to Statement of Work Sections 2 (Administrative Requirements) and 9 (Information Technology Systems). Please also complete the following table (repeating as many times as is applicable), addressing areas where your proposal exceeds the requirements.: When making these tables, template rows not relevant to the specific response can be removed.

Summary of enhancement beyond Statement of Work requirements:

State(s) where previously implemented successfully:

Indiana Medicaid populations covered by enhancement:

Geographies covered (if not Statewide):

Timeline to implement enhancement (if after 1/1/2029):

Expected improvement to cost efficiency (if applicable):

Expected improvement to quality of care and member outcomes (if applicable):

Expected improvement to member services (if applicable):

Expected improvement to provider services (if applicable):

Note that the Respondent must be able to perform according to established requirements in the RFP and may not condition its proposal on the State’s acceptance of alternative terms.

2. Describe in detail your staffing plan and expected staffing levels, making sure to include all required positions indicated in Section 2 and describe how this plan will enable you to fulfill all Contract requirements and deliver high-quality, operationally efficient services.

3. Indicate the location of the proposed Indiana office from which key staff members will perform their duties and responsibilities. Describe how all staff with decision-making responsibility will be accessible to the State.

4. Provide a comprehensive staffing chart (assuming four awarded contractors, each with approximately equal proportions of members) listing:

i. Each proposed position, distinguished by:

· The prime contractor and each subcontractor (listed by name) that will staff a position.

· Each proposed location (including city, state, and country) in which work will be performed by the prime or subcontractor.

ii. Number of individuals to be staffed per position/contractor/location line.

iii. Number of FTEs per position/contractor/location line.

iv. Note that the staffing chart will not count toward the page limit.

5. As a separate attachment, provide job descriptions for staffing positions proposed in your staffing plan that include the responsibilities and qualifications of each position such as, but not limited to: education, professional credentials, work experience and membership in professional or community associations. Note that these job descriptions will not count toward the page limit.

6. Describe how out-of-State staff will be supervised to ensure compliance with contract requirements and how Indiana-based staff will maintain a full understanding of the operations conducted out-of-State. Clearly indicate which operations you plan to request to be located or conducted out-of-State.

7. Describe how you will ensure you are able to meet staffing needs for members receiving care in home and community settings, including recruiting, training, supporting and retaining staff.

8. As a separate attachment, submit an implementation plan regarding the Readiness Review. Note that this implementation plan will not count toward the page limit.

9. Review the State’s Information Security Framework at https://www.in.gov/iot/iot-vendor-engagement/ and either confirm that your company conforms to the policy or provide an explanation of the areas for which your company does not conform. Please be advised that Respondents will be required to sign a Non-Disclosure Agreement (NDA) to access the IOT Information Security Framework.

10. Describe your plan for creating, accessing, transmitting, and storing health information data files and records in accordance with the Health Insurance Portability and Accountability Act’s mandates, including National Provider Identification requirements.

11. Describe how you will maintain an IT system with capabilities to perform the data receipt, transmission, integration, management, assessment and system analysis tasks described in the RFP and support provider electronic submission of authorization requests, authorization appeals, claims, claim disputes, and claim appeals.

12. Provide a general IT systems description and an IT systems diagram that describes how each component of your IT systems will support and interface with the major operations functions involved in managing programs.

13. Describe your experience and plan for processing member eligibility and capitation records. Describe how you will address the absence of current contact information, as may be expected to occur in State eligibility files.

14. Describe how you will use and support use of electronic health records, including how you will encourage and facilitate provider EHR adoption.

15. Describe how you will work with, participate in, and integrate data with IHIE, and how you will encourage providers to exchange data.

16. Describe your capability to process and pay provider claims as described in the RFP in compliance with State and Federal regulations.

17. Describe your process for maintaining and updating the configuration within your claims processing system.

18. Describe your plan to monitor claims adjudication accuracy, including correcting claims processing errors and communication with providers.

19. Describe your process for self-auditing claims payment accuracy and timeliness as well as your independent auditing protocols.

20. Describe your plans for coordinating benefits in order to maximize cost avoidance through the utilization of third-party coverage, and your process for identifying, collecting, and reporting third-party liability coverage.

21. Describe how you will use EVV information to ensure appropriate service delivery, including using EVV information to ensure members are receiving necessary services, and actions that will be taken when issues are identified through review of EVV information.

22. Describe your plan to coordinate delivery of Services via Telemedicine, Telehealth, and Telemonitoring, including how you will identify appropriate provider and service types, how you will recruit and support providers, how you will educate and support members accessing these services, and how you will measure success.

23. Describe your approach to complying with CMS Interoperability and Patient Access requirements, including Patient Access APIs, Provider Directory APIs, Payer-to-Payer Data Exchange, Prior Authorization APIs, and integration with State systems and health information exchanges. Include current operational capabilities; states in which these capabilities are currently deployed; member, provider and state user experience considerations; data governance and security controls; performance metrics used to monitor compliance and utilization; and planned enhancements to meet future federal interoperability requirements.

Covered Benefits and Services, Care Coordination, and Member Services

1. Summarize your proposal as it relates to Statement of Work Sections 3 (Covered Benefits and Services), 4 (Care Coordination), 5 (Member Services), and 13 (Healthy Indiana Plan Design and Member Eligibility). Please also complete the following table (repeating as many times as is applicable), addressing areas where your proposal exceeds the requirements.: When making these tables, template rows not relevant to the specific response can be removed.

Summary of enhancement beyond Statement of Work requirements:

State(s) where previously implemented successfully:

Indiana Medicaid populations covered by enhancement:

Geographies covered (if not Statewide):

Timeline to implement enhancement (if after 1/1/2029):

Expected improvement to cost efficiency (if applicable):

Expected improvement to quality of care and member outcomes (if applicable):

Expected improvement to member services (if applicable):

Expected improvement to provider services (if applicable):

Note that the Respondent must be able to perform according to established requirements in the RFP and may not condition its proposal on the State’s acceptance of alternative terms.

2. Describe how you will provide care that addresses the needs of members in an integrated way, with attention to the physical health and chronic disease contributions to behavioral health.

3. Indicate whether you will elect to subcontract with a Pharmacy Benefit Administrator (PBA). If so, whom and what your existing relationship is to the PBA, including ownership and other states where they may be the PBA for your organization.

4. Describe any experience you have with a pharmacy carve-out or Single Pharmacy Benefit Administrator model under managed care. Describe how you would adapt to each of these models if implemented in Indiana. Describe the prospective savings or other benefits each model may be expected to provide.

5. Describe how you will identify and address inappropriate prescribing practices and member overuse or misuse of pharmacy services.

6. Describe your strategies to reduce inappropriate use of the emergency room and to address members who frequently utilize emergency services.

7. Describe your strategy to facilitate the identification of members in need of behavioral health services by physical health providers.

8. Describe the processes you propose for crisis intervention.

9. Describe your policies and procedures to facilitate the reciprocal exchange of health information between physical and behavioral health providers treating the member.

10. Explain how you will coordinate with hospital discharge planners and case managers for members who are hospitalized for a behavioral health condition and require continuity of care.

11. Describe your plan to manage the delivery of MRO, 1915(i), and CCBHC services.

12. Describe the engagement you will have with HCBS and LTSS providers in Indiana.

13. Describe how you will provide opportunities for members receiving LTSS to have access to the benefits of community living, to achieve person-centered goals, and to live and work in the setting of their choice. Provide examples.

14. Describe how you will use person-centered and trauma-informed planning to identify and develop appropriate supports and training for both informal caregivers / legally authorized representatives and members.

15. Describe your plan to ensure members have timely access to quality dental care and engage members in preventive dental care.

16. Describe your plan to provide accessible and high-quality non-emergency medical transportation services to members. If you plan to use a broker, please name the broker and describe your experience with them in the State of Indiana specifically and other locations. Describe your evaluation plan for the Broker's network and ongoing compliance with contract requirements.

17. Describe your plan and process for providing continuity of care for members transitioning across, in, and out of the programs, and between MCOs. How will you track and reintegrate members that may leave coverage and then reenter the program?

18. Describe any proposed enhanced services benefits to be offered that will enhance the general health and well-being of your members, including programs that address preventive health, chronic conditions, risk factors, or personal responsibility. Describe the benefits you intend to offer members, including the target population, the scope of the benefit (including any limitations), the desired outcome, and how you will monitor and evaluate the utilization and measured outcome of each enhanced benefit.

19. Describe your plan to manage services for members with substance use disorders. Describe the services, types of providers, and approaches you will use to manage the care for these members.

20. Describe how you will design programs specifically for foster children and high-risk youth, including the unique services and interventions that are needed for this population.

21. Describe your approach to population health. How will you deploy local leaders to design a program that is specific to Indiana Medicaid needs, and the cycle you will use to assess the efficacy of your population health efforts and make ongoing updates.

22. As a separate attachment, provide a draft Care Coordination Program Plan (CCPP) that you would propose for Indiana Medicaid, addressing the entirety of the populations and services covered. The CCPP must identify specific interventions for special populations, including, Pregnant Women/Infants, MRO, Wards/Fosters and Medically Frail. Note that this CCPP will not count toward the page limit referenced in the Submission Specifications, but it should not exceed 100 pages in 10-point Arial font with standard margins. The CCPP should address at a minimum C.22.i – xix.

22.i. 23. Describe yYour stratification methodology for placing members in Health Management, Care Management, Complex Case Management and the Right Choices Program.

22.ii. 24. Describe tThe disease states and conditions that you expect to target within each level of service, why each was selected, and intervention strategies for addressing each.

22.iii. 25. Describe yYour strategies to identify members who become pregnant and your approach to enrollment in care coordination.

22.iv. 27. Describe yYour process for conducting member assessments including initial screenings and comprehensive health assessments.

22.v. 28. Describe tThe methods you will use to maximize contacts with members in order to complete the initial screening requirements and comprehensive health assessments.

22.vi. 29. Describe hHow you will reduce member burden and prevent the duplication of assessment components between the CHAT, Medicare Advantage assessments, LTSS-specific assessments, and nursing facility assessments, while still ensuring that members are assessed comprehensively according to their needs.

22.vii. 30. Describe in detail hHow person-centered care plans will be developed for each member, and the plan for reviewing and reassessing the care plan.

22.viii. 31. Describe hHow you will ensure that members have an informed understanding of the contents of their care plan and are able to request explanations of or updates to the care plan.

22.ix. 33. Describe yYour plan for using person-centered and trauma-informed planning to develop service plans for LTSS.

22.x. 35. Describe hHow you will support members in leading their own service planning process, including reviewing and exploring options, identifying who is at the individual’s service plan meetings, and dictating how the meeting is conducted in adherence with the HCBS Settings Rule.

22.xi. 37. Describe hHow you will address periods of transition between care settings.

22.xii. 38. Describe yYour plan for reintegrating individuals back into the home and community from a skilled nursing facility setting.

22.xiii. 39. Describe yYour caseload for the various roles in your care management team.

22.xiv. 40. Describe yYour plan for ongoing person-centered practices training and your plan for assessing Care Coordinator and other Care Coordination team members’ competence and mastery of person-centered practices.

22.xv. 41. Describe hHow the interdisciplinary care team will be engaged in care coordination efforts.

22.xvi. 43. Describe hHow you will approach operating a Dual Eligible Special Needs Plan (D-SNP) as part of the PathWays program and how you will coordinate care for members who are dually eligible for Medicaid and Medicare.

22.xvii. 44. Describe yYour outreach strategies and capacity, including the use of community health workers, to locate members who would benefit from Health Management or Care Management.

22.xviii. 45. Describe yYour plans for using technology in areas of the State and for eligible populations with limited internet and cell-based service availability to ensure consistent and efficient care planning, service provision, and related documentation as well as a high level of consumer satisfaction.

22.xix. 46. Describe yYour plans to provide outreach to members in rural areas where medical and behavioral health services may be less available than in more urban areas.

23. 26. Describe examples of the evidence-based, data-driven supplemental questions you would propose to add to the Health Needs Screening (HNS) to further refine stratification to an appropriate level of coordination.

24. 32. As a separate attachment, submit a proposed care plan for each stratification level and indicate which interventions and approaches would be used. This should be in substantially the same form as would be provided to the member and their interdisciplinary care team. Describe successful interventions and approaches used to gain maximum benefit for each care coordination stratification level. Note that the proposed care plans will not count toward the page limit.

25. 33. Describe how the service plan is used in the service coordinator’s daily activities, maintained, and updated for different resources (including community-based supports and non-paid supports).

26. 34. Describe how you use person-centered and trauma-informed planning for all of the different resources, including community-based supports and non-paid supports, that a person needs to live a full life. How do you use resources to create a holistic plan?

27. 36. As a separate attachment, submit a proposed service plan. Sample service plans should be submitted with the RFP response in substantially the same form as would be provided to the member and their interdisciplinary care team. Note that service plans are not subject to the page limit.

28. 42. Describe how you will ensure members eligible for Medicare are appropriately enrolled.

29. 47. Describe in detail your plans to assist members in the eligibility redetermination process.

48. Describe any value-added services you intend to offer members, including the target population, the scope of the benefit (including any limitations), the desired outcome, and how you will monitor and evaluate the value-added services.

30. 49. Describe your experience administering Applied Behavior Analysis (ABA) services for Medicaid members with autism spectrum disorder. Include your clinical review and authorization processes, qualifications of reviewers, provider engagement strategies, oversight and auditing activities used to promote consistency in decisions and methods for monitoring access, utilization, and member outcomes. Provide examples of performances measures and outcomes achieved in other Medicaid programs.

31. 50. Scenario – Provider Network Termination and Continuity of Care. Respond to the following scenario:

You determine that a contracted provider organization serving a significant number of members will be terminated from your network. The termination is not for cause. The provider serves members who have active authorizations and established treatment relationships. Using a real-life example, describe how you:

i. Evaluated the potential impact of the proposed termination on affected members prior to finalizing the termination decision;

ii. Assessed both network adequacy AND provider capacity to determine whether participating providers could absorb affected members and continue services within clinically appropriate timeframes;

iii. Identified members at greatest risk for disruption of care;

iv. Collaborated with the provider, the state, affected members, caregivers, care coordinators, and receiving providers to develop and implement a transition plan;

v. Communicated with affected members regarding the termination;

vi. Maintained continuity of care, including circumstances under which you authorized or reimbursed out-of-network services on a temporary basis;

vii. Monitored member access, appointment availability, out-of-network service utilization, grievances, and appeals, or other indicators of care disruption throughout the transition period; and

viii. Measured the success of the network management decision, including performance metrics, reporting to state partners, and what corrective actions you implemented if access or continuity of care concerns were identified.

32. 51. While managed care for individuals with intellectual and developmental disabilities (IDD) is currently excluded from the existing scope, the State recognizes the opportunity for innovative approaches to improve care delivery for this population. The State is interested in exploring potential managed care models aimed at enhancing coordination and quality of care for the IDD population within the State.

As a separate attachment:

i. Describe strategies, care models, and practices that you have implemented in other states that have been successful and could improve the coordination and quality of care for individuals with IDD in Indiana.

ii. Include any innovative strategies for care coordination among providers of HCBS and State Plan services, approaches to enhancing communication with families and caregivers, and mechanisms to ensure quality of care and positive health outcomes.

iii. Provide an outline of how the proposed models could be practically implemented, including timelines, resource requirements, and key performance indicators for success.

iv. Describe your overall strategy for addressing Social Determinants of Health (SDOH) for members with disabilities, including how you identify and prioritize SDOH needs across different disability populations and age groups (e.g., physical, intellectual/developmental, sensory, behavioral health).

v. Explain how your proposed care model integrates medical, behavioral, and LTSS to address whole-person needs, including SDOH.

vi. Describe the tools and methods you would use to screen members with disabilities for SDOH needs, including how you would ensure tools are accessible (e.g., plain language, alternative formats, assistive technology-friendly).

vii. Explain how you would use administrative, clinical, and community data to identify members at risk for poor outcomes related to SDOH, and include any predictive analytics, Care Management triggers, or equity-focused stratification methods.

viii. Describe how you would approach person-centered care planning that incorporates SDOH, including how care coordinators assess and address housing stability, transportation, food access, employment, and social connection.

ix. Explain how you would train care coordinators and other staff to work effectively with individuals with disabilities, including those with communication barriers or complex medical or behavioral support needs.

x. Describe how you would develop and maintain an accessible, disability-competent provider network specific to the IDD population, including how you would incorporate community-based organizations, Centers for Independent Living, and disability advocacy groups into your service model.

xi. Explain how you would coordinate non-medical supports, such as home modifications, employment services, peer supports, and transportation, through community partnerships.

xii. Describe how you would approach ensuring physical, digital, and communication accessibility for the IDD population across all member-facing services, including websites, apps, printed materials, call centers, and care coordination.

xiii. Describe your plan to ensure that the IDD population has access to community supports such as peer support programs.

xiv. Describe how you would collect and use member experience data from individuals with disabilities of all ages to improve SDOH-related interventions, including approaches for accessible surveys, focus groups, and grievance processes.

xv. Provide examples of innovative SDOH initiatives you have implemented for people with disabilities in other markets or programs, and describe the outcomes achieved.

xvi. Describe performance metrics, quality improvement strategies, and reporting methods you would use to demonstrate impact on SDOH and health equity for members with disabilities.

xvii. Note that this response element will not count toward the page limit.

General Provider Network Requirements

1. Summarize your proposal as it relates to Statement of Work Section 6 (General Provider Network Requirements). Please also complete the following table (repeating as many times as is applicable), addressing areas where your proposal exceeds the requirements.: When making these tables, template rows not relevant to the specific response can be removed.

Summary of enhancement beyond Statement of Work requirements:

State(s) where previously implemented successfully:

Indiana Medicaid populations covered by enhancement:

Geographies covered (if not Statewide):

Timeline to implement enhancement (if after 1/1/2029):

Expected improvement to cost efficiency (if applicable):

Expected improvement to quality of care and member outcomes (if applicable):

Expected improvement to member services (if applicable):

Expected improvement to provider services (if applicable):

Note that the Respondent must be able to perform according to established requirements in the RFP and may not condition its proposal on the State’s acceptance of alternative terms.

2. Describe in detail your plans to develop and maintain a comprehensive network to provide services to members, including goals and tasks that will need to be achieved and/or completed to develop a comprehensive network.

3. Please describe your approach to evaluating and monitoring network adequacy. Please describe your experience with monitoring such as is required in this procurement.

4. Describe how you plan to monitor medical and behavioral health care standards to evaluate access to care and quality of services provided to members.

5. Describe your plans to monitor utilization in rural and urban areas to assure equality of service access and availability.

6. Describe how you will encourage out-of-network providers to enroll in the Indiana Health Coverage Programs.

7. Describe how you will onboard newly contracted providers and provide ongoing education to existing providers within your network.

8. Describe the communication channels you will utilize to assist providers with resolving claim, authorization, enrollment, and eligibility issues. Please include your provider relations staff roles and locations relative to your providers.

9. Describe how you would work with the State to utilize a centralized enrollment and credentialing system and your experience in other states with centralized credentialing systems. Please include recommendations for the State in implementing a centralized credentialing system.

Quality Improvement Goals and Program Integrity

1. Summarize your proposal as it relates to Statement of Work Sections 7 (Quality Improvement Goals) and 8 (Program Integrity). Please also complete the following table (repeating as many times as is applicable), addressing areas where your proposal exceeds the requirements.: When making these tables, template rows not relevant to the specific response can be removed.

Summary of enhancement beyond Statement of Work requirements:

State(s) where previously implemented successfully:

Indiana Medicaid populations covered by enhancement:

Geographies covered (if not Statewide):

Timeline to implement enhancement (if after 1/1/2029):

Expected improvement to cost efficiency (if applicable):

Expected improvement to quality of care and member outcomes (if applicable):

Expected improvement to member services (if applicable):

Expected improvement to provider services (if applicable):

Note that the Respondent must be able to perform according to established requirements in the RFP and may not condition its proposal on the State’s acceptance of alternative terms.

2. Describe your Quality Management and Improvement Program, including how you will monitor, evaluate, and take effective action to identify and address any needed improvements in the quality of care delivered to members.

3. Describe how you will support providers in providing high-quality, cost-efficient, timely, and effective care, including streamlining the authorization of services.

4. Describe how you will use clinical decision support tools and evidence-based practice guidelines to support high-quality care, and incentivize providers to use those tools.

5. Describe Value-Based Payment (VBP) models you propose to implement, including for HCBS and LTSS providers. Describe successes you have had with implementing VBP models in other states, including the results and outcomes that were achieved.

6. Describe your experience with sub-capitation programs and how you might implement similar programs in Indiana.

7. Describe your proposed provider incentive program and methodology for incentivizing providers.

8. In the event that the State no longer requires MCOs to follow minimum fee schedules, please describe how this would impact your provider reimbursement and incentive program.

9. Describe your proposed member incentive programs and how they will encourage appropriate utilization of health services and healthy behaviors.

10. Describe your approach to utilization management and how your process reduces unnecessary provider burden.

11. Describe how you will audit and ensure that authorizations are successfully loaded into your claims processing system to enable appropriate claims payment.

12. Describe practices you will use to streamline authorizing HCBS/LTSS services and connecting a member’s service plan authorized services to your claims system.

13. Describe how you plan to monitor medical and behavioral health care standards to evaluate providers regarding their practice patterns.

14. Describe your process for identifying and reducing rates of potentially preventable healthcare utilization, including inpatient readmissions and non-emergent emergency department visits. Describe the strategies you will implement to reduce potentially preventable healthcare utilization, including how you will use data to identify improvement opportunities, and how you will engage providers to take appropriate actions.

15. Describe your procedures for identifying, avoiding, tracking, and reporting suspected fraud and abuse to the State, while maintaining quality. Include your processes for investigating suspected fraud or abuse identified using Electronic Visit Verification (EVV) information.

16. Describe in your opinion what the three largest threats are to ensuring program integrity in Indiana’s Medicaid Program and how you will combat.

17. Describe a past real scenario from start to completion of a successful complex provider fraud investigation. Include origination of the lead, investigation steps taken, and general outcome. No actual provider names or PHI should be included in this scenario.

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