rfp-2736-23.pdf

THIS IS ONLY A PDF COPY OF THE RFP DOCUMENT.

BIDDERS MUST RESPOND TO THE ELECTRONIC RFP (eRFP)

LOCATED ON PROPOSALTECH.

TO ACCESS THE eRFP, REGISTER ON PROPOSALTECH AT:

http://www.proposaltech.com/home/app.php/register

State of New Hampshire

REQUEST FOR PROPOSAL

For

MEDICARE ADVANTAGE BENEFIT ADMINISTRATION

RFP # 2736-23

RESPONSE DUE BY:

March 30, 2023 at 2:00 PM Eastern Time (ET)

Department of Administrative Services Division of Risk and Benefits http://www.proposaltech.com/home/app.php/register

TABLE OF CONTENTS

1 Introduction

A. Background B. Objective C. Contract Length & Specifics

2 Bidding Instructions and Conditions

2.1 Proposal Conditions

2.2 Estimated RFP Timetable

2.3-2.7 Evaluation Process

2.8 Bidder Contacts

3 Required Plan Designs, Services and Programs

3.1 Plan Design

3.2 Plan Design Changes

3.3 General Services

3.4 Implementation

4 Technical Questionnaire

4.1 Administrative, Member, & Claim Paying Services

4.2 Data Reporting

4.3 Revenue Maximization

4.4 Enrollment, Implementation, & Communication

4.5 Medical Management & Member Case Management

4.6 Rx Formulary and Clinical Program Management

5 Client References

6 Network Match and Access

6.1 Medical Network Match

6.2 Medical Network Access

6.3 Pharmacy Network Match

6.4 Pharmacy Network Access

7 Performance Guarantees

8 Financial

8.1 Fully Insured Premium Rates

8.2 Financial Questions

8.3 Allowances

9 Appendices – Group Information

State of New Hampshire RFP for Medicare Advantage Benefits #2736-23

1 INTRODUCTION

1.1 This Request for Proposal (“RFP”) is issued by the Department of Administrative Services (DAS), acting through the Division of Risk and Benefits, for a contract for providing Medicare Advantage benefits as described herein.

A. Background The State of New Hampshire (“State”) provides medical and prescription drug benefits to approximately 10,650 Medicare eligible retirees and dependents (“participants”) located throughout the country. Medicare eligible participants are offered medical coverage through a fully insured group Medicare Advantage national passive PPO plan provided by Aetna since January 1, 2021.

The prescription drug benefit is currently carved-out from the medical plan and is a self-funded Part D Employer Group Waiver Plan (EGWP) managed by Express Scripts, Inc. As part of this RFP, the State is exploring the option to carve-in the drugs and provide a fully insured Medicare Advantage Prescription Drug (MAPD) plan.

Medicare participants born on or after January 1, 1949 contribute 10% of the monthly Medicare medical/Rx working rate. Medicare participants born before January 1, 1949 do not contribute to the monthly working rate. The State collects applicable contributions from participants and pays the carrier 100% of the Medicare Advantage premium.

B. Objective The State has two main objectives for this Medicare Advantage RFP:

1. The State seeks to provide high quality, cost-effective benefits to its Medicare participants. The State is soliciting offers on a fully insured, national passive MA PPO plan, with the same benefits for services rendered in or out-of-network. The proposed MA PPO plan should mirror the current benefits design for Medicare-eligible State participants within CMS guidelines. The current benefits are outlined in Section 3 of this RFP document. Bidders are encouraged to identify and offer features or enhancements that provide additional value without adding cost as well as any creative solutions that will achieve the State's goals. Of particular interest are programs that focus on wellness, medical management, member case management services, maximization of CMS funding and minimization of claims cost.

2. As noted in the “background” section, the State is exploring whether to carve-in the drugs and provide a fully insured Medicare Advantage Prescription Drug (MAPD) plan instead of the current plan that includes the fully insured MA medical plan and carved-out self-funded EGWP. The State is not seeking proposals for stand-alone prescription drug plans.

The State requires that Bidders duplicate the current Medicare retiree medical and prescription drug benefit plans due to current State legislative authorization. (See Section 3 for the current Medicare retiree plan designs.) The State must be notified of any deviations from the current program. The State's contract with a vendor requires the Bidder to implement any changes in plan design or coverage to the Medicare Advantage Plan (MA or MAPD) resulting from legislative authorization throughout the term of the contract. The State reserves the right within any contract awarded under this RFP to re-negotiate elements of the contract as required by legislative changes.

C. Contract Length & Specifics The State seeks to contract with a qualified Bidder commencing in July 2023 and ending on December 31, 2026 with the option to extend for up to two additional years as mutually agreed by the parties and approved by the State Governor and Executive Council (G&C). Implementation activities shall commence within seven days of Governor and Executive Council approval but in no event earlier than July 1, 2023. The services outlined in this RFP shall commence on January 1, 2024. Payments for contractual services shall commence January 1, 2024 and shall not be made during the implementation period.

2 BIDDING INSTRUCTIONS AND CONDITIONS

2.1 PROPOSAL CONDITIONS

2.1.1 MANDATORY INSTRUCTIONS FOR BIDDERS

Interested bidders must read the entire RFP, complete all sections of the RFP and submit the required documents in the manner specified in the RFP by the stated proposal submission deadline. Electronic responses must be completed and submitted through ProposalTech. Bidders are responsible for reviewing the most updated information related to this RFP before submitting proposals.

Bidder is required to provide a notarized electronic copy of the State of New Hampshire's Transmittal Letter (see Appendix E), signed by a person authorized to bind the company to all commitments made in the RFP response.

Failure to follow these instructions may be grounds for rejection of your RFP response.

2.1.2. RFP INQUIRIES

Any questions regarding how to use ProposalTech should be directed to ProposalTech Support at 877- 211-8316 x84.

All other questions regarding this RFP, including questions related to the form contract P-37 and Business Associate Agreement, must be submitted to Andrew Bennett, the State's point of contact, at Andrew.J.Bennett@das.nh.gov. All questions must be submitted in writing prior to the deadline for Bidder Inquiries and/or Requests for Clarification (March 8, 2023 at 3:00 ET). The questions will be consolidated and/or paraphrased and responded to via a written addendum, or addenda that will be posted on the State's website on or before March 15, 2023. Note that this date is subject to change at the State's discretion. In addition, the bidder inquiry addenda will be visible in ProposalTech.

In response to requested exceptions to the P-37, the State will review requested exceptions and accept, reject or note that it is open to discussion of the proposed exception with the selected Bidder at its sole discretion. Questions about or requested exceptions to the RFP, P-37, and/or any relevant attachments not raised during the inquiry period are waived. Oral statements, representations, clarifications, or modifications concerning the RFP shall not be binding upon the State.

The State may, at its discretion, amend this RFP on its own initiative or in response to issues raised by inquiries as it deems appropriate.

RFP inquiries must be submitted by an individual authorized to commit the organization to provide the services necessary to meet the requirements of this RFP. The Bidder must include complete contact information including the Bidder's name, telephone number, and e-mail address.

Appendix A is a Participating Bidder Agreement (PBA) which must be filled out and emailed to Emily Peters (epeters@segalco.com) to obtain data referred to in Appendix B. A non-disclosure agreement (NDA) with Segal is also required to receive the data in Appendix B. Upon receipt of a Bidder's signed PBA (Appendix A), Segal will check to see if the Bidder has a current Global or Bid-Related NDA on file with Segal. If there is no NDA on file with Segal, an NDA document will be issued to the Bidder for signature.

No data will be issued without first having a signed NDA on file.

Upon receipt of the newly signed NDA, or confirmation of an existing NDA on file, Segal will establish a secure workspace and upload the data files. A system-generated email with instructions for accessing the workspace will be sent to the Bidder's designated data recipient.

2.1.3. ADDENDA

In the event it becomes necessary to add to or revise any part of this RFP prior to the scheduled proposal submittal deadline, the Division of Risk and Benefits shall post any Addenda on ProposalTech and the State's Bidder website. In the event of an addendum/addenda to this RFP, the State, at its sole discretion, may extend the proposal submission deadline, as it deems appropriate. Before submission and periodically prior to the RFP closing, check the ProposalTech platform or the State website for any addenda or other materials that may have been issued affecting the RFP. The website address is:

https://das.nh.gov/purchasing/vendorresources.aspx

2.1.4. BIDDER CERTIFICATIONS

All Bidders must be duly registered as a Bidder authorized to conduct business in the State of New Hampshire. Bidders shall comply with the certifications below at the time of submission and through the term of any resulting contract. Failure to comply shall be grounds for disqualification of proposal and/or the termination of any resultant contract.

o STATE OF NEW HAMPSHIRE VENDOR APPLICATION: Prior to bid award, Bidders must have a completed Bidder Application Package on file with the NH Bureau of Purchase and Property.

See the following website for information on obtaining and filing the required forms (no fee):

https://DAS.NH.Gov/Purchasing o NEW HAMPSHIRE SECRETARY OF STATE REGISTRATION: A bid award, in the form of a contract(s), will ONLY be awarded to a Bidder who is registered to do business AND in good standing with the State of New Hampshire. Please visit the following website to find out more about the requirements for registration with the NH Secretary of State:

https://sos.nh.gov/corporation-division/

2.1.5. PUBLIC DISCLOSURE

The identification of confidential responses has been turned on for this RFP. If you feel that a response to a question contains proprietary/confidential information, click the “Disclosure” tab located underneath the question and check the box for “Exemption from Disclosure.” Provide a reason for the exemption in the text field provided. If you do not provide a reason for exemption, the question will not be considered answered. DO NOT make every response confidential. If you have any questions https://das.nh.gov/purchasing/vendorresources.aspx https://das.nh.gov/Purchasing https://sos.nh.gov/corporation-division/ regarding this process, please contact ProposalTech Support at 877-211-8316 x84. See also the additional Public Disclosure information below.

A. DISCLOSURE OF INFORMATION SUBMITTED IN RESPONSE TO RFP

Information submitted in response to this RFP (including all materials submitted in connection with it, such as attachments, exhibits, addenda, etc.), any resulting contract, and information provided during the contractual relationship may be subject to public disclosure under the State's Right-to-Know law, RSA 91-A.

Confidential, commercial or financial information may be exempt from public disclosure under RSA 91- A:5, IV. If you believe any information submitted in response to this RFP should be kept confidential, you must specifically identify such information for the State by following the redaction designation instructions in ProposalTech. Marking or designating an entire proposal, attachment or section as confidential shall neither be accepted nor honored by the State.

A Bidder that does not believe any information in its proposal to be exempt from disclosure must also provide a letter indicating as such to the Point of Contact indicated herein.

Submissions which do not conform to these instructions by failing to include redactions and related reasons for redaction, or a letter indicating the proposal does not include any confidential information, or by including redactions which are contrary to these instructions or operative law may be rejected by the State as not conforming to the requirements of the proposal.

Pricing, which includes but is not limited to premium rates and performance guarantees, in your proposal or any subsequently awarded contract shall be subject to public disclosure regardless of whether it is marked as confidential.

Notwithstanding a Bidder's designations, the State is obligated by the Right-to-Know law to conduct an independent analysis of the confidentiality of the information submitted in a proposal. If a request is made to the State by any person or entity to view or receive copies of any portion of your proposal, or if the State otherwise wishes to make your proposal public, the State shall first assess what information it is obligated to release. If you have not provided redactions in your proposal the State will release the proposal in its entirety with only the redactions the State deems necessary (if any). If you have provided redactions in your proposal, the State will notify you that a request has been made or that the State wishes to make your proposal public. The State will indicate what, if any, information it has assessed is confidential and will not be released, and specify the planned release date of the remaining portions of the proposal. To halt the release of information by the State, a Bidder must obtain and provide to the State, prior to the date specified in the notice, a court order valid and enforceable in the State of New Hampshire, at its sole expense, enjoining the release of the requested information.

By submitting a proposal, you acknowledge and agree that:

o The State may disclose any and all portions of the proposal or related materials which are not marked as confidential and/or which have not been specifically explained in the letter to the person identified as the point of contact for this RFP;

o The State is not obligated to comply with your designations regarding confidentiality and must conduct an independent analysis to assess the confidentiality of the information submitted in your proposal; and o The State may, unless otherwise prohibited by court order, release the information on the date specified in the notice described above without any liability to you.

B. ELECTRONIC POSTING OF RFP RESULTS AND RESULTING CONTRACT

Pursuant to RSA 21-G:37, all responses to this RFP shall be considered confidential until the award of a contract. At the time of receipt of proposals, the State will post the number of responses received with no further information. No later than five (5) business days prior to submission of a contract to the Department of Administrative Services, the State will post the name and rank or score of each Bidder.

Pursuant to RSA 91-A and RSA 9-F:1, the Secretary of State will post to the public any document submitted to G&C for approval, including any resulting contract, on its website (https://sos.nh.gov/administration/miscellaneous/governor-executive-council/). By submitting a proposal, Bidder acknowledges and agrees that, in accordance with the above-mentioned statutes and policies, (and regardless of whether any specific request is made to view any document relating to this RFP), any contract resulting from this RFP that is submitted to G&C for approval will be made accessible to the public online.

2.1.6. TERMS OF SUBMISSION

The State assumes no responsibility for understandings or representations made by its officers or employees prior to and in the event of the execution of a contract, unless such understandings or representations are specifically incorporated into this RFP. Verbal discussions pertaining to modifications or clarifications of this RFP shall not be considered part of this RFP unless confirmed in writing. Any information provided by the Bidder verbally shall not be considered part of that Bidder's response. By submitting a proposal, a Bidder agrees that in no event shall the State be either responsible for or held liable for any costs incurred by a Bidder in the preparation of or in connection with the proposal, or for work performed prior to the effective date of a resulting contract. Proposals must be valid until the effective date of any resulting contract.

2.1.7. SUBMISSION FORMAT

Instructions, formats, and approaches for the development of RFP information contained within the RFP are designed to ensure that the submission of data essential to the understanding of the Bidder's response is received in a consistent and comparable format.

Bidder RFP response must be submitted using the ProposalTech platform. Paper submissions, or submissions in any other format, will not be accepted.

Detailed instructions for the completion and submission of your proposal will be found in the electronic RFP (eRFP) on ProposalTech. ProposalTech will be available to assist you with technical aspects of utilizing the system.

All sections must be answered completely and, as outlined in the RFP, using ProposalTech. It is not acceptable to use the term “See Attached” as a response to any of the questions, fee quotation forms, plan or network comparisons. Such a response may jeopardize your chances for consideration.

The State reserves the right to ask Bidders follow‐up clarifying questions through ProposalTech as may be necessary to fully evaluate bidder capabilities.

2.1.8. PROPOSAL SUBMISSION DEADLINE

All RFP submissions must be submitted electronically, using the ProposalTech platform no later than 2:00 PM ET on Thursday, March 30, 2023. A complete RFP submission will include responses to all sections of the RFP, including a complete response to the financial section. Incomplete submissions or submissions received after the date and time specified will be marked as late and will not be considered.

Bidders will be notified if their proposals are compliant by April 7, 2023. Bidders with compliant proposals may participate in the Financial Proposal Confirmation Period (April 10 to 21, 2023). The Financial Proposal Confirmation Period will provide an opportunity for Bidders to consider the CMS Final Rate Announcement (anticipated in early April) in their proposals. During this period, Bidders will be asked to either confirm their initial Financial Proposal or submit an updated Financial Proposal.

Confirmed Financial Proposals must be submitted electronically, using the ProposalTech platform no later than 2:00 PM ET on Friday, April 21, 2023. Submissions received after the date and time specified will be marked as late and will not be considered and the Bidder's response submitted prior to the March 30, 2023 deadline will stand and be deemed the Bidder's “Confirmed Financial Proposal”.

A Bidder's disclosure or distribution of proposals other than to the Department of Administrative Services, Bureau of Purchase and Property, or ProposalTech shall be grounds for disqualification. No more than one (1) proposal per respondent shall be submitted.

2.1.9. RFP DELIVERY

This RFP is being conducted electronically using the ProposalTech platform. A Bidder will not be able to submit their proposal until all required sections have been completed in their entirety. ProposalTech provides Bidders with a status of their proposal listed at the top of the page. Once a Bidder submits their proposal, the submission will be confirmed by the status changing to “Posted”. Bidders must submit (or “post”) their proposal by the specified deadlines indicated in Section 2.1.8.

The State shall not be held liable for any costs incurred by the Bidder in preparing or submitting an RFP response.

2.1.10. ADDITIONAL INFORMATION

The State reserves the right to:

o Make a written request for additional information from a Bidder to assist in understanding or clarifying a proposal response.

o Waive minor or immaterial deviations from the RFP requirements, if determined to be in the best interest of the State.

o Omit any planned evaluation step if, in the State's view, the step is not needed.

o Reject any and all proposals, or any part thereof. Note that participating in this RFP process in no way obligates the State to pursue a contract with any of the Bidders participating in the

RFP.

o Make independent investigation in evaluating a proposal.

o Consider available information regarding the Bidder, whether gained from the Bidder's proposal, question and answer conferences, references, or any other source during the evaluation process. This may include, but is not limited to, information from the New Hampshire Department of Insurance, as well as any other state or federal regulatory entity.

2.1.11. RESTRICTION OF CONTACT WITH STATE EMPLOYEES

From the release date of this RFP, all contact with the State regarding this RFP, except the point of contact specifically mentioned in Section 2.1.2 of this RFP, is prohibited. This prohibited contact includes personnel employed by or under contract with the State. Improper contact is grounds for rejection of your response.

2.1.12. CANCELLATION

Notwithstanding any other provision of this RFP, this RFP does not commit the State to award a contract. The State reserves the right, at its sole discretion, to reject any and all proposals, or any portions thereof; to cancel all or any part of this RFP at any time. Cancellation of this RFP, in whole or in part, shall not bar the State from issuing an RFP for the same services or from purchasing the same services through other means.

2.1.13. ETHICAL REQUIREMENTS

From the time this RFP is published until a contract is awarded, no Bidder shall offer or give, directly or indirectly, any gift, expense reimbursement, or honorarium, as defined by RSA 15-B, to any elected official, public official, public employee, constitutional official, or family member of any such official or employee who will or has selected, evaluated, or awarded an RFP, or similar submission. Any Bidder that violates RSA 21-G:38 shall be subject to prosecution for an offense under RSA 640:2. Any Bidder who has been convicted of an offense based on conduct in violation of this section, which has not been annulled, or who is subject to a pending criminal charge for such an offense, shall be disqualified from bidding on the RFP, or similar request for submission and every such Bidder shall be disqualified from bidding on any RFP or similar request for submission issued by any state agency.

2.1.14. SUBCONTRACTING

Contractor may perform certain services hereunder through one or more of its subsidiaries or affiliates.

However, pursuant to Section 12 of the form contract P-37, subcontracting of services shall require prior approval by the State. If Bidder plans to utilize subcontractors for any portion of the Medicare Advantage-related services identified in this RFP, please include the subcontractor information, to include an outline of the services or functions in which Bidder would plan to subcontract, the length of your relationship with the subcontractor, and a brief company profile. A list of these subcontractors shall be attached to the contract with the selected Contractor and shall constitute prior approval by the State (of those subcontractors) consistent with Section 12 of the form contract P-37.

Contractor may, without prior written approval, contract with third-party vendors to provide information technology support services and other ancillary services, which are not Medicare Advantage-related services hereunder, but rather are services that support Contractor's conduct of its business operations.

Contractor shall be accountable for the performance of all subsidiaries, affiliates, partner networks and subcontractors and shall be responsible for all performance guarantee penalties that may result from underperformance of the subsidiary, affiliate and/or subcontractor.

2.1.15. REQUIRED CONTRACT TERMS AND CONDITIONS

a. The form contract P-37 (attached hereto as Appendix F) shall form the basis for any resulting contract. The successful Bidder and the State, following notification of award, shall promptly execute the P-37 contract, as amended by the parties to incorporate the service requirements of this RFP, price conditions established by the Bidder's offer, and any other reasonable administrative practices and services. In no event is a Bidder to submit its own standard contract terms and conditions as a replacement for one or all of the State's terms in response to this RFP.

The terms of this RFP and the selected Bidder's response will be used to form the terms of any resulting contract. References in the P-37 to Exhibits A, B, and C are references to the required structure of any resulting contract (Exhibit A - Special Provisions/Amendments to the P-37, Exhibit B - Scope of Services, and Exhibit C - Payment Terms) and are not references to sections of this RFP.

b. The Business Associate Agreement (attached hereto as Appendix G), is required to comply with the Health Insurance Portability and Accountability Act, Public Law 104-191 and with the Standards for Privacy and Security of Individually Identifiable Health Information, 45 CFR Parts 160 and 164 and those parts of the HITECH Act applicable to business associates, shall be promptly executed by the successful Bidder and the State, following notification of contract award.

c. In addition to the Business Associate Agreement, the Bidder will be required to comply with the Required Protection of Confidential Information and Data Security (attached hereto as Appendix H).

d. State data will not be sold or aggregated for external reporting purposes without first consulting the State.

e. The State intends to incorporate this RFP and the selected Bidder's response into the resulting contract by reference. In the event there is a conflict between the resulting contract and the selected Bidder's response to the RFP the term more favorable to the State shall control.

2.1.16. DEBARMENT

Bidders who are ineligible to bid on proposals issued by the Department of Administrative Services pursuant to the provisions of RSA 21-I:11-c shall not be considered eligible for an award under this RFP.

2.1.17. NON-COLLUSION

The Bidder's signature on a proposal submitted in response to this RFP guarantees that the prices, terms and conditions, and work quoted have been established without collusion with other vendors and without effort to preclude the State from obtaining the best possible competitive Proposal.

2.1.18. PROPERTY OF THE STATE

All material received in response to this RFP shall become the property of the State and will not be returned to the Bidder. Upon contract award, the State reserves the right to use any information presented in any proposal.

2.1.19. CHALLENGES TO IDENTIFICATION OF SELECTED VENDOR

Within five (5) business days of the State's posting of the rank or score on its website, Bidders may, in accordance with RSA 21-G:37, request that the agency review its selection process. The request must be in writing and must specify all points on which the Bidder believes the agency erred in its process and shall contain such argument in support of its position as the Bidder seeks to present. In its request for review, a Bidder shall not submit, and the State will not accept nor consider, any substantive information that was not included in the original proposal. The State will respond to the request within five (5) business days of its receipt.

2.2 ESTIMATED RFP TIMETABLE

2.2.1

Action Due Date (Eastern Time) RFP Released February 24, 2023

Deadline for Bidder Inquiries and/or Requests for Clarification

March 8, 2023 at 3:00 PM ET

Response to Bidder Inquiries and/or Requests for Clarification

No later than March 15, 2023

Proposal Submission Deadline March 30, 2023 at 2:00 PM ET

Bidders Notified of Proposal Compliancy April 7, 2023

Financial Proposal Confirmation Period - Bidders will either confirm their initial Financial Proposal or submit an updated Financial Proposal (this is the Bidders' opportunity to consider the CMS Final Rate Announcement in their proposal) reconsidered

April 10-21, 2023 (period may start prior to April 10, once all

Bidders' compliancy is determined)

Confirmed Financial Proposal Submission Deadline

April 21, 2023 at 2:00 PM ET

Contract Effective Date Upon Governor & Executive Council (G&C) approval (no earlier than July 1, 2023)

Contract Implementation Period G&C Approval through December 31, 2023

TPA Effective Date January 1, 2024

2.3 EVALUATION PROCESS

2.3.1 Segal has been retained by the State to assist in the evaluation of each Bidder's responses for completeness and responsiveness to the RFP and to assist in the review of such responses. The State's designated evaluation team will review and score Bidder responses and select the highest ranking proposal. All proposals will be evaluated in accordance with the State procedures set forth in Steps #1 through #4 below.

The State will conduct an initial screening to verify Bidder compliance with the proposal submission requirements set forth herein. The State may waive or offer a limited opportunity to cure immaterial deviations from the RFP requirements if it is determined to be in the best interest of the State.

2.4 STEP #1: MINIMUM QUALIFICATIONS

Each proposal shall be evaluated initially to determine compliance with the State of New Hampshire’s Minimum Qualifications. Any proposal that fails to meet one (1) or more of the following five (5) qualifications shall be eliminated from further consideration for this contract. Any proposal that meets all of the minimum qualifications shall be further evaluated in accordance with the State’s selection criteria. Therefore, to receive further consideration, a proposal must check “YES” to each of the following questions and, if applicable, comply fully with the “Submission Requirement(s)” for each such qualification.

2.4.1 Does your organization meet CMS's Medicare Advantage coordinated care network adequacy requirement for the State's Medicare-eligible retiree membership (i.e., the 51% rule)?

Submission Requirements: Indicate your percentage of network adequacy with regard to the 51% rule based on the State's Medicare-eligible retiree membership.

Single, Radio group.

1: Yes, 2: No

2.4.2 Is the Bidder able and willing to demonstrate its financial stability?

Submission Requirements: a) Bidder's most recent financial report; b) most recent independent auditor's report; and c) SSAE 16, SAS-70, or equivalent external audit of Bidder's operations. Attach to proposal.

Single, Radio group.

1: Yes, 2: No

2.4.3 Does the Bidder have a minimum of five (5) years of Medicare Advantage medical and prescription drug group experience?

Submission Requirements: Demonstrate such experience by providing the number of years you have provided Medicare Advantage group coverage for medical and prescription drugs.

Single, Radio group.

1: Yes, 2: No

2.4.4 Is the Bidder currently providing Medicare Advantage benefits to at least one (1) group health plan with a minimum of 10,000 lives?

Submission Requirements: Demonstrate such experience by providing the total number of Medicare Advantage clients with at least 10,000 lives.

Single, Radio group.

1: Yes, 2: No

2.4.5 Is the Bidder able to duplicate the current Medicare Retiree medical and prescription drug plan designs for a January 1, 2024 effective date as outlined in Section 3.1?

Submission Requirements: Completion of Requested Plan Designs Form in Appendix C.

Single, Radio group.

1: Yes, 2: No

2.5 STEP #2: TECHNICAL SCORING

Technical Score = 50 total points with MA (medical only) or 60 total points with MAPD (medical and prescription drug)

2.5.1 The Bidder's response to information requested in Sections 4, 6, and 7 of the RFP will be evaluated based on the extent to which the Bidder documents conformance with specifications, as well as the completeness, soundness, and creativity of the Bidder's response, all as evaluated by the State.

The State will evaluate proposals based on technical criteria, including:

• Questionnaire Score - the extent to which the Bidder demonstrates its ability and experience in the categories indicated in the chart below in Section 2.7. (Section 4)

• Network Match and Access Score - the extent to which the Bidder's MA/MAPD network provides adequate access for the State's membership and utilization. (Section 6)

• Performance Guarantees Score - the extent to which the Bidder demonstrates a willingness to agree to the requested performance guarantees and the proposed dollar amount at risk. (Section 7)

2.6 STEP #3: FINANCIAL SCORING

Financial Score = 50 points with MA (medical only) or 60 points with MAPD (medical and prescription drug)

2.6.1 Financial Score - Section 8

The Bidders' Confirmed Financial Proposals (see Section 2.1.8) will be scored based on the total projected costs (TPC) as determined by the State for the three-year period from January 1, 2024 to December 31, 2026. Where a Bidder submits an updated Financial Proposal, the initial Financial Proposal will be disregarded. For the MA (medical only) Plan, the lowest cost proposal will receive 100% of the 50 points allocated for the Financial Score. For the MAPD (medical and prescription drug) Plan, the lowest cost proposal will receive 100% of the 60 points allocated for the Financial Score. All other financial proposals will be scored on a sliding scale where the bidder's score will be reduced by 2 points for every percentage point it is higher than the lowest cost proposal. As the scale is sliding, scores will be adjusted for partial percentage differences.

The following exhibit, using the MA (medical only) Plan scoring as an example, illustrates how the financial score will be calculated from the 50 points available:

Formula Example, where:

Lowest Bid TPC = $1,000 and Bidder TPC = $1,025

A Cost Difference = (Bidder's TPC / Lowest Bid TPC) - 1 ($1,025 / $1,000) - 1 = 0.025 B Convert Decimal to

Percent Value = A x 100 0.025 x 100 = 2.5

C 2 Point Reduction per Percentage Higher

= 2 x B 2 x 2.5 = 5.0

Bidder's TPC Score = 50 - C 50 - 5.0 = 45.0

2.7 STEP #4: CONTRACT AWARD

2.7.1 As summarized in the chart below for the MA (medical only) Plan option, each bidder's technical score (as outlined in Step #2 above) based on the sections that apply to the MA (medical only) Plan will be combined with their financial score based on their MA (medical only) Plan proposal (as outlined in Step #3 above) to determine the highest scoring bidder for the MA (medical only) Plan set of proposals.

As summarized in the chart below for the MAPD (medical and prescription drug) Plan option, each bidder's technical score (as outlined in Step #2 above) based on the sections that apply to the MAPD (medical and prescription drug) Plan will be combined with their financial score based on their MAPD (medical and prescription drug) Plan proposal (as outlined in Step #3 above) to determine the highest scoring bidder for the MAPD (medical and prescription drug) Plan set of proposals.

The State reserves the right to select a winning bidder from either the MA Plan or MAPD Plan set of proposals.

During the evaluation of the proposals, the State will determine if it is in the State's best interest to continue with the current arrangement that includes the fully insured MA (medical only) Plan and the carved-out self-funded EGWP or to change to an integrated medical and prescription drug fully insured MAPD Plan. The award shall be made to the qualified bidder meeting the criteria established in this RFP and receiving the highest combined score of either the MA Plan or the MAPD Plan proposals.

If the State decides to award a contract as a result of this RFP process, formal and final selection of the Bidder, is contingent upon the successful negotiation and the proper execution of all contract documents (acceptable to the State), approval of the Governor and Executive Council, and continued appropriation of funding for the contract. If the State is unable to reach agreement with the selected Bidder, the State may, at its sole discretion and at any time and without liability to the Bidder, immediately terminate such contract discussions with the Bidder and undertake discussion with the Bidder submitting the next highest ranked proposal, and so

on. The State reserves the right to reject any or all proposals or any part thereof, cancel this RFP, or solicit new proposals under a new procurement process.

MA

(Medical Only)

MAPD

(Medical &

Prescription Drugs)

Criteria Points Points Section(s)

QUESTIONNAIRE 30 37

Administrative, Member, & Claim Paying Services

9 9 4.1

Data Reporting & Revenue Maximization 6 6 4.2 and 4.3 Enrollment, Implementation, & Communication 9 9 4.4 Medical Management & Member Case Management

6 6 4.5

Rx Formulary and Clinical Program Management N/A 7 4.6

NETWORK MATCH AND ACCESS 15 18 6

PERFORMANCE GUARANTEES 5 5 7

FINANCIAL 50 60 8

TOTAL POINTS 100 120

2.8 BIDDER CONTACTS

2.8.1 Designate the individual(s) responsible for representing your company during the RFP process and day-to-day service if awarded the contract.

RFP Process Day-to-Day Service Representative Name 5 words. 5 words.

Title 5 words. 5 words.

Phone 5 words. 5 words.

Email 5 words. 5 words.

3 REQUIRED PLAN DESIGNS, SERVICES AND PROGRAMS

3.1 Plan Design

Due to required legislative authorization, the State requires Bidders to duplicate the Medicare retiree plan design.

Please review the attached plan design documents and complete the “Requested Plan Designs Form” located in Appendix C. If no deviations are provided on this form, it will be assumed that your organization can administer the current plan designs exactly as written in the following attached documents.

Medical Plan

• 2023 Aetna Summary of Benefits - link below https://www.das.nh.gov/documents/rmu/retiree/benefits/Aetna-Summary-of-Benefits-2023.pdf

• 2023 Aetna Evidence of Coverage (EOC) Benefits Booklet - link below https://www.das.nh.gov/documents/rmu/retiree/benefits/Aetna-Evidence-of-Coverage-EOC-Benefits- Booklet-2023.pdf

• Diabetic Supplies Benefits - link below https://www.das.nh.gov/documents/rmu/retiree/benefits/Aetna-Overview-of-Diabetic-Supplies- Benefits.pdf

• Enhanced clinical care support - provides concierge-type support to members receiving acute and post-acute care

Prescription Drug Plan

• 2023 Medicare Part D EGWP Benefit Overview - link below https://www.das.nh.gov/documents/rmu/retiree/benefits/Medicare-Part-D-EGWP-Benefit-Overview- 2023.pdf

• 2023 Express Scripts Medicare PDP Evidence of Coverage Booklet - link below https://www.das.nh.gov/documents/rmu/retiree/benefits/EGWP-Evidence-of-Coverage-2023.pdf

• Current utilization management programs (see Appendix B)

3.2 Plan Design Changes

As indicated in the attached plan design summary documents, the member is responsible for an annual deductible. This deductible is based on the prior year's Medicare Part B deductible. The State of NH plan's deductible for the last three years and this year (i.e., 2023) are illustrated below:

Calendar Year State of NH Deductible

2020 $185 2021 $198 2022 $203 2023 $226

As CMS announced the 2023 Medicare Part B deductible early enough to provide the State adequate time to communicate to its plan participants, the State Plan's implemented deductible for 2023 matches the Medicare Part B deductible of $226. In other words, the State did not implement the prior year's Medicare Part B deductible (i.e., $233 for 2022) consistent with past practice.

https://www.das.nh.gov/documents/rmu/retiree/benefits/Aetna-Summary-of-Benefits-2023.pdf https://www.das.nh.gov/documents/rmu/retiree/benefits/Aetna-Evidence-of-Coverage-EOC-Benefits-Booklet-2023.pdf https://www.das.nh.gov/documents/rmu/retiree/benefits/Aetna-Evidence-of-Coverage-EOC-Benefits-Booklet-2023.pdf https://www.das.nh.gov/documents/rmu/retiree/benefits/Aetna-Overview-of-Diabetic-Supplies-Benefits.pdf https://www.das.nh.gov/documents/rmu/retiree/benefits/Aetna-Overview-of-Diabetic-Supplies-Benefits.pdf https://www.das.nh.gov/documents/rmu/retiree/benefits/Medicare-Part-D-EGWP-Benefit-Overview-2023.pdf https://www.das.nh.gov/documents/rmu/retiree/benefits/Medicare-Part-D-EGWP-Benefit-Overview-2023.pdf https://www.das.nh.gov/documents/rmu/retiree/benefits/EGWP-Evidence-of-Coverage-2023.pdf

Other than the deductible changes noted above, there have not been other plan design changes in the last several years.

3.3 General Services

To be eligible to receive a score for the Technical Questionnaire in Section 4, Bidders are required to provide the minimum services indicated below at no additional cost.

Indicate the name and address of the legal entity providing any of the services below, if different that the bidding entity. If any of these services are offered by another legal entity (e.g., subcontractor, partner provider network), the State expects that the awarded Bidder will be responsible for all the other entities' actions in the operation of services provided to the State.

• The Bidder will provide:

o Member Services o Claims Adjudication o Data Reporting o Member Enrollment and Eligibility Maintenance o Revenue Maximization o Medical Management o Member Case Management Services o Network Access and Network Management - Medical and Pharmacy (if applicable) o Provider Advocacy and Assistance with Claims Issues o Medicare Advantage Administrative Assistance o Effective Member Communications o Patient and Family/Caretaker Education and Assistance o Rx Formulary and Clinical Program Management (if applicable)

• The State requires you provide dedicated staff in the following specialties:

o Implementation Manager o Medical Clinical Manager o Pharmacy Clinical Manager (if applicable) o Account Executive o Member Case Management Director o Finance/Billing Manager o Customer Service Manager

• The State requires the assignment of a designated Account Executive that shall be accountable to the State for proactive management of all aspects of the Bidder's performance to the State and its members. The Account Executive shall remain constant, within the Contractor's control, for at least the first 18 months of the contact period. The Contractor shall not change assignment of the Account Executive without written notice provided to the State with a minimum of fourteen (14) days prior to such change. The State reserves the right to request assignment of a new Account Executive and the Contractor shall make such change within 30 days of receipt of written notice from the State.

• The State requires that Bidder agree to accept invoice payments via Electronic Funds Transfer.

• The State requires that Bidders guarantee adherence to New Hampshire RSA 420-J:8-a regarding prompt pay. The law mandates timeframes for all claims [15 days electronic, 30 days paper claims, overdue (interest payment required if timeframes are not met), denied and pended (inform providers within 15 days (electronic claims) or 30 days (paper claims) and adjudicate with 45 days of receipt of additional].

• It is the State's standard to exchange data with its vendors using the State of New Hampshire's Secure File Exchange Server. You will be required to retrieve enrollment and eligibility data, as well as other related data, from this server. In addition, you will be required to use this method for sending data files to the State.

• The State requires that the Bidder work with the State's eligibility systems. The State utilizes a comprehensive HR/Benefits Administration software to manage the State Plan's eligibility.

• The State requires a minimum of nine (9) group breakouts for purposes of reporting.

• The State requires the State's staff have online access to information and services via the Internet or through CRT interface.

• The State requires Bidder to host Education sessions, open to retirees and guests, as requested by the

State. These sessions are provided at no additional cost to the State.

• The State requires a dedicated toll-free number be made available to enrollees to handle claims or other service issues at no additional cost. The State also requires this same number or separate number be available to retirees to address questions or provide information pre-enrollment.

• The State requires Bidder to provide member support services for selecting and/or locating network providers. This includes both an on-line provider directory as well as direct telephonic customer service inquiries.

3.4 Implementation

Implementation activities shall commence within seven days of Governor and Executive Council (G&C) approval but in no event earlier than July 1, 2023.

The Bidder shall provide an implementation plan in its bid and identify its implementation team members, as well as the State resources required for the implementation. No later than one week after Governor & Executive Council approval, the Bidder shall submit a detailed implementation plan subject to the State's approval that will include but not be limited to the following:

• Key implementation team member(s), including their contact information

• Development of eligibility and enrollment interface between Bidder and State system

• Transition requirements with the incumbent vendors

• Data and timing requirements from current vendors to ensure transition of care and prior-authorization data is appropriately transferred

• Staff assigned to attend and present at the October 2023 Open Enrollment/educational sessions and annual support thereafter

• Development of a Comprehensive Communication plan with defined targeted audiences to include but not be limited to DAS, retirees, state agencies, providers and other plan participants. Include examples of proposed retiree communications newsletters, posters, etc.

• Design and review of plan documents including plan summaries and benefit booklets.

• Testing of Rx data transfer from the State's Pharmacy Benefits Manager (PBM), if applicable

• Delivery of benefit program information and ID cards, prior to 1/1/2024, to plan participants

• Access to the Bidder's online client and member portals as directed by the State

• Notification letters to members and their prescribing physicians of drug formulary changes or other changes where there is a negative impact on the member at no additional fee.

The project plan shall be updated thereafter as the State and Bidder mutually agree. Implementation activities shall be conducted in close collaboration and with the approval of the DAS.

4 TECHNICAL QUESTIONNAIRE

(See Technical Questionnaire Scoring in Section 2.5, Step #2)

The State requires a response to the following questions:

4.1 Administrative, Member, & Claim Paying Services

“Administrative, Member, & Claim Paying Services” Score = 9 points The “Administrative, Member, & Claim Paying Services” technical score shall be scored in consideration of:

• the completeness of responses to the questions in Section 4.1 in the Technical Questionnaire

• the degree to which responses are judged by the State to indicate that the Bidder would provide high quality member services, including:

o trained customer service staff with State Plan specific knowledge o maximizing hours of customer service operation o assurance of member satisfaction

• the degree to which responses are judged by the State to indicate that the Bidder would provide high quality account services, including:

o flexibility with the State in regards to payment options o optimum account service hours of operation o claims payment practices (e.g., coordination of benefits, appeals processes) o quality assurance and auditing o claims and appeals o compliance with federal rules

4.1.1 Confirm that all Member Service Representatives (MSR), clinical staff and other applicable team members are appropriately licensed or certified in the state in which they are employed.

Single, Radio group.

1: Confirmed, 2: Not confirmed, explain: [ 500 words ]

4.1.2 Confirm that your organization will host statewide educational/implementation sessions for the State's Medicare-eligible retirees and Medicare-eligible dependents of retirees between the effective date of the contract and January 1, 2024. These meetings will be held in all regions of the state on mutually agreeable dates and you will prepare and mail the communications announcing these sessions.

Single, Radio group.

1: Confirmed, 2: Not confirmed, explain: [ 500 words ]

4.1.3 Confirm you agree to, at a minimum, quarterly calls to review aggregate member or Plan service issues and that you will allow the State to review these service quality issues to the resolution endpoint.

Single, Radio group.

1: Confirmed, 2: Not confirmed, explain: [ 500 words ]

4.1.4 Confirm that you agree to a minimum of one annual meeting with appropriate executives to discuss services regarding enrollment and member issues.

Single, Radio group.

1: Confirmed, 2: Not confirmed, explain: [ 500 words ]

4.1.5 Confirm that you will designate a dedicated member services lead for direct contact by the State team to escalate/resolve day to day individual member issues, with established channel(s) for communication.

Single, Radio group.

1: Confirmed, 2: Not confirmed, explain: [ 500 words ]

4.1.6 Provide the following information regarding the proposed account team:

Name of Team Member

Years of Relevant Experience

Number of Assigned Accounts

Location

Account Executive 10 words. Decimal. Integer. 10 words.

Operations Manager 10 words. Decimal. Integer. 10 words.

Implementation Manager 10 words. Decimal. Integer. 10 words.

Member Services Lead 10 words. Decimal. Integer. 10 words.

Member Case Management Director

10 words. Decimal. Integer. 10 words.

4.1.7 Identify the key Account Management team you propose to work on this account and provide an organization chart, including names and titles, of management and key personnel that will be responsible for account management.