RFP_31786-00188_Amendment_One.pdf

STATE OF TENNESSEE

DEPARTMENT OF FINANCE & ADMINISTRATION, BENEFITS ADMINISTRATION

REQUEST FOR PROPOSALS #31786-00188

AMENDMENT #ONE FOR EMPLOYEE ASSISTANCE

PROGRAM (EAP) AND BEHAVIORAL HEALTH

ORGANIZATION (BHO) SERVICES

DATE: November 12, 2025

RFP #31786-00188 IS AMENDED AS FOLLOWS:

1. This RFP Schedule of Events updates and confirms scheduled RFP dates. Any event, time, or date containing revised or new text is highlighted.

EVENT

TIME

(central time zone)

DATE

1. RFP Issued October 8, 2025

2. Disability Accommodation Request Deadline 2:00 p.m. October 14, 2025

3. Pre-response Conference 1:00 p.m. October 15, 2025

4. Notice of Intent to Respond Deadline 2:00 p.m. October 16, 2025

5. Written “Questions & Comments” Deadline

NOTE: Submit written questions and comments on Appendix 7.12 the written questions and comments template.

2:00 p.m. October 22, 2025

6. State Response to Written “Questions & Comments”

November 12, 2025

7. Round 2 Written “Questions & Comments” Deadline

NOTE: Respondents may submit no more than five (5) questions to the State in the 2nd round of Written Questions and Comments.

November 19, 2025

8. State Response to Written “Questions & Comments” Round 2

December 12, 2025

9. Response Deadline 2:00 p.m. December 19, 2025

10. State Completion of Technical Response Evaluations

January 29, 2026

11. State Opening & Scoring of Cost Proposals 2:00 p.m. January 30, 2026

12. Negotiations 4:30 p.m. February 9-11, 2026

13. State Notice of Intent to Award Released and RFP Files Opened for Public Inspection

1:00 p.m. February 26, 2026

14. End of Protest Period March 5, 2026

15. State sends contract to Contractor for signature March 6, 2026

16. Contractor Signature Deadline 2:00 p.m. March 13, 2026

2. State responses to questions and comments in the table below amend and clarify this RFP.

Any restatement of RFP text in the Question/Comment column shall NOT be construed as a change in the actual wording of the RFP document.

RFP

SECTION

QUESTION / COMMENT

1.

What are the State’s top member pain points

(e.g., access delays, awareness, engagement)?

We recognize that the rate of behavioral health and substance use care needs is likely higher than our utilization rates. Ensuring communication and engagement of the benefits is key, followed by ensuring members can get appointments with their choice of provider in a timely manner.

2.

What innovations or “next-generation” EAP solutions is the State most interested in (AI, digital therapy, peer programs, etc.)?

The State does not have a particular interest in any specific innovation. The goal is increasing engagement of services and meeting members where they are and through multiple modalities.

3.

Alternate EAP Model: If a bidder proposes an alternate EAP delivery framework – for example, partnering with a specialized EAP provider to deliver the short-term counseling component of the program – what are the State’s expectations for coordination with the existing EAP/BHO setup or incumbent contractor during implementation and operation? In other words, how should the new contractor integrate with or transition from any current EAP services to ensure a seamless experience for employees and consistency with the State’s program requirements?

One of the positive aspects of our current provider network is that the majority if not all of the current EAP providers are also in network BHO providers which allows for seamless continuation of care without member disruption. The State’s expectation is that any subcontracting/partnering with a specialized EAP entity, should include a seamless integration into the behavioral and substance use services. The seamless integration should also be invisible to the member to reduce/eliminate any member confusion regarding access and utilization.

4.

Provider Network Handoffs/Care Continuity:

Can you elaborate on how the State envisions the transition process between short-term EAP counseling and higher-acuity or long-term mental health services? Specifically, does the current model allow for vendor-managed continuity of care through in-network psychiatric or therapy providers beyond the EAP session limit?

One of the positive aspects of our current provider network is that the majority if not all of the current EAP providers are also in network BHO providers which allows for seamless continuation of care without member disruption. This is our expectation and vision under this new contract.

5.

Provider Network Expectations: What minimum access standards (e.g., appointment wait times, virtual availability, or geographic coverage) does the State require for EAP counseling and psychiatric services? For example, are there specific timeliness benchmarks for first appointments or standards for rural and frontier counties within Tennessee?

Access and appointment standards are outlined in the ProForma Contract. Please see Contract Sections: A.8.b., A.9.f., A.9.g., A.9.h., A.9.i., A.13.d. and Attachment B, Performance Guarantees and Liquidated Damages.

6.

Pricing Structure Flexibility: What flexibility is available in the RFP’s pricing model, which is defined on a per-employee-per-month (PEPM) basis? Can bidders propose alternative or innovative pricing arrangements – such as tiered service bundles, outcome-based pricing, or other pricing structures – and if so, how should these options be presented to ensure they are considered within the State’s evaluation?

The State does not agree to pricing flexibility that is not already outlined and permitted under the ProForma Contract terms.

7.

Engagement, Utilization & Outcome Metrics:

Can the State provide more detail on which outcome and utilization metrics it prioritizes for vendor performance evaluation (e.g., utilization rate, clinical improvement, member satisfaction, or cost savings)? Additionally, does the State currently use a standard outcomes framework (e.g., Workplace Outcome Suite or PHQ-9 tracking) to assess vendor impact?

The State does not prioritize metrics beyond those outlined as performance guarantees and key performance indicators in the ProForma Contract.

Please see Pro Forma Contract section A.12.h.

8.

Does the prime contractor receive evaluation points or preference for including certified small businesses in their proposal?

No

General Question 9.

Please confirm there are no differences in EAP services the State would like to provide for your fully-insured opt-in population, versus those who are enrolled in your medical plans?

Confirmed. The EAP and Work-Life services outlined in the contract shall be offered to all enrollees regardless of enrollment type.

General Question 10.

Please clarify the session limits you wish to provide for EAP sessions. What is the current session limit by employer group? Do you wish to make any changes to the session limits currently offered?

Please see Pro Forma Contract A.3.a.

The Pro Forma Contract reflects an increase to the current EAP counseling sessions.

General Question 11.

How does the State approach behavioral health cost containment, and how will the State and Aon determine the return on investment and value of your BHO + EAP program?

The State focuses on engagement and utilization over cost containment. However, detailed reporting and quarterly meetings yield opportunities to review, discuss, and outline improvement strategies related to cost containment.

Appendix 7.2 (Network Analysis)

12.

How does the State define provider “availability” in your network analysis? If a provider is in-network and currently practicing, but has no openings for new patients, is that provider considered “available’? To better understand the opportunity to expand network access, is the State open to seeing a report of real-time appointment availability with our network providers?

Appendix 7.2 does not address availability.

Availability is addressed in Pro Forma Contract section A.9.h. The Pro Forma Contract outlines required reports. The State is open to receiving additional reports during the contract term that the Contractor may have available.

The State is not open to receive additional reports during the RFP process.

Appendix 7.7

(EAP + MHSA

Utilization Reports)

13.

Where is outpatient therapy utilization provided by the BHO located in this report? Is it included in the MHSA Summary tab? If so, please confirm we should subtract Residential / Partial / IOP from the overall utilization data to understand the State’s outpatient behavioral utilization for visits not covered by the EAP.

Outpatient behavioral health counseling services are included in the MHSA Summary tab of Appendix 7.7. We do not recommend subtracting data from separate tabs to obtain utilization data. We have added a separate tab related to outpatient behavioral health counseling in a revised Appendix 7.7. The data parameters for the new tab are not the same as the other tabs, but it should provide additional utilization insight.

See amendment item #10 below.

Appendix 7-7 14.

Appendix_7_7_WL_MHSA_Utilization (EAP WL Summary): Rows 21-22 reference 'Take Charge at Work.' Can the State provide additional program and/or service description? General Question

Please see Pro Forma Contract section A.12.j.

Depression and/or Anxiety in the Workplace.

Appendix 7.11 (Manager Referrals Policy)

15.

Does the State request the EAP to provide FFD and SAP evaluations? If so, how do you request these services be included in pricing - as PEPM or fee for service?

Yes. Fitness For Duty and Substance Abuse Professional evaluations are included in EAP and should be included in the PEPM.

1.1 16.

Would a bid for EAP services only be deemed un-scorable, or would State of TN be able to review or separate these 2 services (EAP and

BHO)?

As stated in RFP Attachment 6.1, the Statement of Certifications and Assurances, the Respondent will provide all services as defined in the Scope of the RFP Attachment 6.6., Pro Forma Contract for the total Contract term.

1.12 Plan

Background 17.

How will [REDACTED] know which medical plan the member has selected (BCBS of TN or Cigna)?

Enrollment information will be provided to the Contractor via the 834 file. Please see Appendix 7.8.

Att. 6.4 Reference Questionnaire 18.

Please confirm that the total number of required references is five (5) – two (2) current and three

(3) completed contracts.

Confirmed. Respondents should provide reference questionnaires that represent the following requirements:

• two (2) contracts Respondent currently services that are similar in size and scope to the services required by this RFP; and

• three (3) completed contracts that are similar in size and scope to the services required by this RFP.

References from at least three (3) different individuals are required to satisfy the requirements above, e.g., an individual may provide a reference about a completed project and another reference about a currently serviced account.

Respondents may contact the solicitation coordinator listed in the RFP to confirm if references have been received.

The State will review the first five references received.

Section A.2 19.

Can the state confirm eligibility numbers? There seems to be one 300,000 and another for 430,000.

Enrollment is approximately 300,000 in medical/behavioral health plans.

A.2(b) and A.4(j) 20.

The definition of Account Executive states that it is a designated position, but Section A.4(j) indicates that the Account Executive is a dedicated position. Is this position designated or dedicated?

The Account Executive is a designated position.

See amendment item #4.

A.2(d) 21.

Propose to insert reopener language:

Notwithstanding the foregoing, the State and Contractor agree that the PEPM rate set forth above shall be subject to adjustment to account for any implementation, administrative and/or programming costs as a result of the following:

a. The initial membership provided by the State and upon which Contractor based its proposal for administrative fees varies from the actual membership on the commencement date of this Agreement by 10% or more resulting in a material impact, directly related to the membership change, to the underlying financial assumptions used to base the payment rates under this Agreement;

b. A change in the membership used to determine the PEPM amount of 10% or more;

The State does not agree to the proposed language.

c. Change in Plan requirements and/or EAP or MHSUD services covered thereunder or to the process for identification of members, including without limitation changes made to address state and/or federal law, rules and/or regulations at any time subsequent to the parties’ agreement to the administrative fees identified above and/or after the initial implementation of this Agreement;

d. Additions or revisions to Plan policies and/or procedures after the initial implementation of this Agreement and which additions or revisions may have an adverse financial or administrative impact to Contractor;

e. To account for changes made by

State to its systems and/or data fees and/or requested electronic reporting and/or systems data interface requirements.

The parties agree to negotiate in good faith in the event that one party requests renegotiation of the fee(s) as provided for herein.

A.2. Definitions, (d.) Admin Fees 22.

The fee for all administrative, clinical, Utilization Management, cost containment solution services paid by the State to the Contractor. It is the only compensation due the Contractor under the contract. The Contractor’s monthly compensation is a function of the contractor’s Administrative Fee multiplied by the number of participating employees per month (“PEPM”).

The Administrative Fee shall constitute all payments due to the Contractor and shall include, but not be limited to, all costs incurred by the Contractor to comply with all state and federal laws including, but not limited to independent dispute resolution fees related to the Consolidated Appropriations Act, 2021.

For models that include clinical services as part of their expenses, will the State make an exception in the Pro Forma contract?

The State does not agree.

A.3 23.

For fully insured EAP-only populations in Local Government, what is the expected volume or agency participation?

Please see Appendix 7.13. As this is a new option for Local Government agencies, the State is unable to estimate the expected volume beyond the eligible but not enrolled counts provided.

A.3 24.

Will the State provide separate rosters or identifiers for EAP-only Members versus those with both EAP and behavioral health?

Yes.

A.7 pg. 62-63 25.

With virtual visits, crisis call line, and the EAP app, please clarify current use volumes and traffic by day, month, year.

For 2024, Virtual visits (EAP + BHO):

Claimants – 14,808; Visits – 100,625

Crisis Call Line – we do not have statistics on crisis calls as they are handled via the standard member call center process and procedures.

There isn’t a specific EAP application.

However, in 2024 the State offered TalkSpace and AbleTo. In 2025, the State offers TalkSpace, Calm, Virtual Behavioral Coaching through AbleTo, and Sober Sidekick. We do not have utilization volumes for these applications separately.

A.8 26.

What is the historical utilization of critical incident response services (CIRs), and are there current agencies requiring frequent engagement?

Please see Appendix 7.7 for CIRS utilization.

Department of Children’s Services has recurring frequent engagement.

A8 27.

Can the State provide a sample or template of the "Take This to Your Behavioral Health Visit" checklist and whether vendors must use this format?

https://www.here4tn.com/content/dam/internal-resources/pdfs/microsite/here4tn/appointment-checklist.pdf

The same format is not required but must be approved by the State prior to use.

A9 28.

For geographic access, will the State accept real-time telehealth network coverage in rural areas to satisfy access standards (e.g., 2 providers within 30 miles)?

The State does not agree.

A.9 29.

Our solution includes suicidality screening for 100% of members, and triage to providers who specialize in treating suicidality. Under this model, is it acceptable to offer sufficient providers specializing in suicidality for Tennessee's member census, and to train those providers in advanced risk management, versus 100% of all network providers.

The State does not agree.

A.5 (d) 30.

We propose the following change to the language:

For matters designated as urgent by the State, the Contractor shall provide a response to the State within four (4) eight

(8) hours during normal business hours.

Change requested to allow for a reasonable response time.

The State does not agree.

A.5(e) 31.

Analyzing legislation to determine the effect on the Plan is a Plan function. We cannot give legal advice but will cooperate in any analysis that is needed. Propose revising the contract as follows:

The Contractor shall cooperate with the State in analyzing the impact of proposed legislation on the operation of the Contract.

The Contractor shall defer to the State’s interpretation of the applicability of proposed legislation to the State Plans.

Additionally, we request a change from forty-eight (48) hours of the State’s request to five (5) business days.

The State does not agree.

https://www.here4tn.com/content/dam/internal-resources/pdfs/microsite/here4tn/appointment-checklist.pdf https://www.here4tn.com/content/dam/internal-resources/pdfs/microsite/here4tn/appointment-checklist.pdf https://www.here4tn.com/content/dam/internal-resources/pdfs/microsite/here4tn/appointment-checklist.pdf

A.5 (g) 32.

We propose the following change to the

No less than quarterly, the Contractor shall meet with the State to review and provide information concerning its efforts to develop cost containment mechanisms and improve administrative activities, as well as trends in the provision of benefits. The Contractor shall provide advice, assistance and information to the State regarding applicable existing and proposed Federal and State laws and regulations affecting the Plans. The Contractor shall provide information to the State regarding the administration of the benefit, cost and utilization trends, utilization management, internal procedures for billing and reconciliation of transactions, the provision of behavioral health treatment, fraud and abuse activities, network developments, and other administrative matters. The Contractor shall ensure that the meeting occur in person at the State of Tennessee offices in Nashville, TN, however, at its discretion, the State may request for the meeting to occur remotely.

The change is requested to ensure parties mutually agree. Can JOC meetings be held in person or through other agreed-upon channels?

Does the State have flexibility in meeting venue or does the State require all meetings to be in person?

The State does not agree.

We find that in person meetings at the State offices provide for the best practices of contract management and collaboration.

A.5 (j) 33.

Propose addition of language at end of section:

Unless prior approved In Writing by the State and in compliance with State and Federal law, the Contractor shall not use information gained through this Contract, including but not limited to utilization and pricing information, in marketing or expanding non-State business relationships or for any pecuniary gain.

Change is requested because the language is too broadly worded.

The State does not agree.

A.5(j) 34.

Propose addition of language at end of section:

Notwithstanding the foregoing, Contractor may make general marketing or informational statements based on aggregate, de-identified data and/or performance statistics derived from services provided under the Contract, without the State’s prior written consent, provided that such statements are accurate and presented in a manner that do not identify the State or any confidential State information.

The State does not agree.

A.5(k) 35.

Propose following edit:

The Contractor shall notify the State, within three (3) Business Days of identification, about any situation that appears to materially negatively impact the administration or delivery of the program, The State does not agree.

plan, or benefits, including but not limited to, file and data sharing between contractors.

A.6 (f)

36.

The Contractor shall ensure that the Account Team is available for consultation with the State during the hours of 8:00 a.m. to 4:30 p.m.

Central Time, Monday through Friday, as required to fulfill the scope of services specified in this Contract. The Contractor shall ensure that the Account Executive is available via cell phone and email after hours, including weekends.

Can the State provide clear expectations regarding this requirement and allow discussion between the parties? We have 24/7 customer lines for questions outside normal business hours.

The expectation is that the account team is available to the Benefits Administration program director and assistant director for any urgent issues that may arise after hours. A direct contact on the account team is required to ensure resolution. Members will not be contacting the account team, so this is solely for business purposes.

A.6 (g) 37.

We request the following change to the

The Contractor shall provide a full time Account Executive and Account Manager as members of the Account Team. Unless otherwise directed by the State, the Contractor shall ensure that the Designated Account Executive has at least three (3) years of experience as an Account Executive for an EAP/BHO contract with at least ten thousand (10,000) members. The Contractor shall ensure that the Designated Account Executive has the responsibility and authority to manage the entire range of services specified in this Contract and shall respond promptly to changes in benefit plan design, changes in claims processing procedures, or general administrative problems identified by the State. The Contractor shall ensure that the Dedicated Account Manager has the responsibility and authority to respond promptly to Member, claims, and provider issues or inquiries as identified by the State. Unless otherwise approved by the State, the Contractor shall ensure that the Dedicated Account Manager resides in the greater Nashville, TN area. At a minimum, the Contractor shall ensure that the Account Executive and Account Manager meet in person with the State once a quarter and more often if required by the State. At its discretion, the State may approve the Contractor to participate in such meetings by teleconference.

Can the State provide clear expectations regarding this requirement and allow discussion between the parties? We service many large customers and full-time designated account members are generally not needed. We also request the parties mutually agree to whether the meetings can be conducted via teleconference.

This structure is what the State has found to be most successful in management of this contract. We did change the Account Executive to designated vs. dedicated but feel the Account Manager should also be dedicated due to the volume of agency outreach that is included in the role. The contract does provide the provision of “unless otherwise directed by the State” so this could change during the contract based upon positive performance.

While weekly meetings are held via teleconference the quarterly review meetings will be held in person. We find that in person meetings at the State offices provide for the best practices of contract management and collaboration.

A.6 (l) 38.

Key personnel commitments made in the Contractor’s RFP proposal shall be

The Contractor has control over staffing decisions. However, should the assignment of approved by the State In Writing during implementation and shall not be changed unless requested by the State or prior approved by the State In Writing. The Contractor shall notify the State at least fifteen (15) Business Days in advance, or as soon as the information is available, of proposed changes and shall submit justification, including proposed substitutions, in sufficient detail regarding education and experience equal to previous staff to the State to evaluate the impact upon the Contract. The decision of the State on these matters shall not be subject to appeal.

regarding this requirement and allow further discussion between the parties? We will provide notice of changes, but generally we request control over staffing decisions.

certain personnel not be a fit for the State culture or relationship, the State reserves the right to request a reassignment. Similarly, when making a new assignment the State requests that we review the resume and meet the new assignment to ensure a good fit.

A.7 (h) 39.

The Contractor shall provide Work-Life services using, at a minimum, the following modalities:

(1) Financial counseling: Telephone, Video/Web conferencing, Secure Chat;

(2) Legal consultation: Telephone, Video/Web conferencing, Secure Chat, and/or in person at the attorney’s office, as selected by the Member;

(3) Personal Legal Documents and Healthcare Directives: Online access to state specific legal documents such as complaint letters, living trusts, bill of sale, wills, power or attorney and estate planning.;

(4) Child/elder care assistance: Telephone, video, Secure Chat;

(5) Supervisor support: Telephone with direct access to Leadership consultants, video, and Secure Chat regarding video and Secure Chat access modalities for Child/elder care assistance and Supervisor support?

If video and secure chat are not available modalities for Child/elder care assistance and Supervisor support, we are open to alternate modalities. For example, the expectation is not that the actual childcare be provided via chat but that the services to connect a Member to childcare could be provided via chat.

A.9(q) 40.

The Contractor shall contract only with providers who are duly licensed to provide applicable Behavioral Health Services and shall require that all providers maintain all licenses and accreditations in existence at the time of selection as a Network Provider in order to continue their status as a Network Provider.

Does this mean [REDACTED] would be required to disenroll a provider that fails to maintain licensure in another state even if such licensure is unnecessary to practice in the State for which they are joining the network, for example?

The State does not fully understand the question. If the Contractor would like to reword the question in Round 2 of the Questions and Answers of the RFP, the State will review and respond.

A.9 (n) 41.

We request a change to the following language:

The contractor shall maintain a record of network voluntary and involuntary changes.

including any additions, deletions, terminations, provider type and reason for the change, in the Contractor’s Behavioral Health Provider Network, including whether a provider is accepting Members as new patients and shall provide a report of said changes upon request by the State. The report shall include behavioral health provider turnover, both the Contractor’s voluntary and involuntary turnover rate by provider type, as provided in Contract Attachment C, Reporting Requirements.

A.9 (p) 42.

Would the State either remove this requirement or allow the opportunity to further negotiate this following section.

For any provider termination, regardless of the type of provider, the Contractor shall provide written notice to the State and Members who received treatment from the provider within the previous six (6) months.

The Contractor shall ensure that the written notice includes the provider’s name and the effective date of the termination and shall offer assistance with finding a new provider, including the option to call the Contractor’s toll-free number or access the provider directory on the Contractor’s website, as well as with transitioning to a new provider.

The Contractor shall mail the notice to Members no less than thirty (30) calendar days prior to the effective date of the termination. The

Contractor shall notify Members upon becoming aware of the provider termination, as soon as possible and within a timeline agreed upon by the State, if the termination date is fewer than thirty (30) days away. For provider terminations impacting twenty-five (25) or more Members, the Contractor shall report compliance in accordance with Contract Attachment D, SLA Scorecard.

The State would consider alternative language that would meet the State’s intent to ensure proper notification to members of any’ disruption of care. Please provide alternative language during Round 2 of the RFP Questions and Answers.

A.9 (w) 43.

We request to either remove the requirement or allow the opportunity to further negotiate this following section as we normally do not provide this reporting. Can we have the opportunity to further discuss alternatives.

The Contractor shall notify the State In Writing, at least thirty (30) days prior to any material adjustments in any Network Provider’s payment terms, including but not limited to provider fee schedules, contract rates, other provider payment arrangements, discounts, rebates, refunds, or credits negotiated with the provider, and the manner in which such adjustments are reasonably likely to affect the cost of claims payments by the State. The Contractor shall ensure that the notice includes the name of the provider, the provider type, the amount of the adjustments, and the projected impact of the adjustments on annual claims payments by the State.

The State does not agree to remove as this is related to compliance with Tennessee state law. The written questions and comments period is the opportunity to provide proposed edits or alternative language for the State’s review and response.

A.11 pg.71

44.

The RFP outlines case management activities but does not define the volume or proportion of members requiring active case management.

In 2024, 1,004 individuals qualified for case management and 112 individuals were enrolled.

We would expect the Contractor to identify and

Please confirm the estimated percentage of members expected to require case management services and the anticipated average case duration.

engage as many individuals as clinically relevant and the case duration should be as long as clinically relevant.

A.14.c 45.

Does the State require a specific rotation methodology for assigning cases among the three independent review organizations, or may we develop our own rotation procedure consistent with impartiality standards?

The State does not require a specific rotation methodology as long as the Contractor’s methodology complies with any applicable state or federal laws.

A.14.f 46.

For the At-Risk Performance Payments tied to appeal timeliness in Section A.14(f), will the State provide specific calculation criteria and corrective action expectations as part of Attachment D (SLA Scorecard)?

The calculation for appeals should be based upon the type of appeal and then subsequently measured by dividing the number of appeal decisions made within the required timeline divided by the number of appeals received.

Corrective action plans are proposed by the Contractor with the expectation that the Contractor correct any administrative issues contributing to missed contract requirements.

If this does not answer the question, please revise the question.

A.14.g 47.

Will the State provide a reporting template or specific data fields for the quarterly appeals report under Section A.14(g), or should can we propose a format consistent with accreditation reporting standards?

The Contractor should propose their preferred format and the State will review, provide feedback, and ultimately approve the final report template.

A.14.i 48.

Can the State clarify what types of “other assistance services or programs” should be listed after the Plan’s customer service department in accordance with Section A.14(i)?

The State doesn’t have any other specific assistance services or programs we expect the

Contractor to list, but if the Contractor’s legal counsel believes there are other such services that would apply to our self-insured non-federal governmental group health plan, those may be listed for our member’s information.

A.14.k 49.

Will the State provide guidance or a preferred format for the appeals process documentation and sample letters required under Section A.14(k), or should [REDACTED] use its standard internal templates?

The State requests the Contractor to provide their standard appeals documents for review.

The State reserves the right to request edits where appropriate.

A.15 50.

Please confirm contract requirements in A.15.

Call Center are specific to member calls.

The requirements are specific to member calls which will include managers, supervisors, agency benefits coordinators, etc. for EAP and Work-Life services as applicable and/or on behalf of a member.

A.15(i) 51.

[REDACTED] utilizes relay services to serve the hearing imparied population. Propose revising the language as follows:

The Contractor shall ensure that its call center is able to serve the hearing impaired population through use of Telephone Device for the Deaf Technology or relay services.

The State has updated language in pro forma contract section A.15.j.

See amendment item #6 below

Section A.15.g 52.

For minimum qualifications of child/elder care consultants, are other equivalent certifications and/or experience be accepted beyond “certified geriatric case manager or licensed behavioral health professional”?

No.

A.16 SOW

53.

Can the State accept a digital card or other alternative methods of delivery in addition to physical ID cards?

Yes. The State agrees that a digital ID card is acceptable only in addition to and not in lieu of a physical ID card.

A.17.a,b,c and d 54.

Can the state accept a digital card or other alternative methods of delivery in addition to physical ID cards?

Yes. The State agrees that a digital ID card is acceptable only in addition to and not in lieu of a physical ID card.

A.18.r 55.

The State requests that members can search the entire provider directory; what expectations or requests does the State have for vendors on

The State is receptive to a curated list of providers based upon member selected search criteria or other member survey data, in addition provider matching services, so that members can access a curated list of recommended providers who are verified to be a good fit?

to a full provider directory being made available to all members.

A.18.t 56.

What SSO capabilities does Here4TN have today and how does this compare to what is requested in the RFP?

This is a new contract requirement.

A.19(h) 57.

[REDACTED] will provide reasonable transition support and proposes to revise this section as follows:

h. Transition of Services at Conclusion of Contract to Other Contractors.

The Contractor shall provide reasonable assistance in transitioning all existing services awarded under this contract to the next awarded contract holder at no additional cost to the State. The Contractor shall provide the State with a written transition plan no later than six (6) months prior to the end of the current Contract.

The State does not agree.

Page 103- A.21.i.1.iii 58.

The RFP states that to Restrict unsuccessful attempts to access system functions to three (3), with a system function that automatically prevents further access attempts and records these occurrences; whereas the TN Enterprise Information Security policy states under Password Management (5.4.3) that User ID's will be revoked after five (5) consecutive attempts to login with an invalid password.

Kindly clarify what the actual count of unsuccessful attempts is before the User ID is revoked.

The Contractor shall restrict unsuccessful attempts to access system functions to three (3). The Contractor is expected to comply with the requirements in Pro Forma Contract Section A.21.i.

A.21 SOW

59.

Who is the State’s eligibility file vendor? The State manages eligibility in house with a customized version of PeopleSoft.

Proforma Contract

Section A.21.d

60.

What specific documents is the RFP referring to in this section?

Upon the State’s request and timeline, the Contractor shall generate a listing of all Members and providers that were sent a particular document, the date and time that the document was generated, and the date and time that it was sent to particular Members or providers or groups thereof. Upon the State’s request and timeline, the Contractor shall generate a sample of a document sent by a Member or provider.

This could include but is not limited to any letters i.e. appeal, authorization, termination, etc., communications, marketing, EOBs, remittance advices, etc.

Section A.21.h 61.

This timeframe may not be feasible given the urgency of some changes and/or our normal quarterly release or agile sprint planning process.

Can we suggest language like “...will make all reasonable efforts to give sufficient notice of major system changes” Or something similar.

Section A.22.j 62.

The requirement references $1k penalty for each business day for each late deliverable and/or milestone leading up to and by go-live.

In another section, the project schedule is required 30 days after contract execution. Can we recommend language such as “...deliverable readiness at go live”, vs each milestone

The State does not agree.

All deliverables and milestones are outlined in the Pro Forma Contract and are not negotiable.

Any questions or discovery should be addressed during the RFP Q&A periods. The project schedule should be provided in the RFP and the final is due 30 days after contract throughout the implementation.

If we have to agree to each milestone, we would like to include language that is in effect once “we have a mutually agreed plan, post joint discovery”? We would also like to see the elimination of milestones if the State is the cause of the delay.

execution to allow for any additional clarifications. The State is reasonable in assessing performance guarantees if delays are beyond the Contractor’s control or are due to the State or other State Contractors.

State of TN_31786- 00188_EAP_BHO_Prof orma Contract

63.

Request to remove this requirement.

Unless otherwise agreed upon by the State In Writing, the Contractor shall provide at least one

(1) State employee with access and update capability to the Contractor’s enrollment system no later than one month prior to Go-Live. The Contractor shall provide appropriate training and system documentation to State employees as requested by the State. The Contractor shall ensure that additional or replacement users are added at any time at the State’s request. The Contractor shall ensure that access to the Contractor’s enrollment update system includes the ability to do real-time updates to the Contractor’s enrollment records and that State access is limited to only enrollment data.

We do not permit external access to our proprietary systems. To maintain data security and system integrity, all updates and changes are managed through data exchanges and internally by authorized [REDACTED] personnel. We are committed to ensuring that the State receives timely and accurate enrollment information through established reporting and data exchange processes, which provide the necessary visibility without direct system access.

As noted in the Pro Forma Contract language, “Unless otherwise agreed upon by the State In Writing,..”, the State may agree to an alternative process to ensure real-time and accurate enrollment updates if the Contractor is unable to grant access to their enrollment system.

A.24, A.25

pg. 109 64.

The RFP describes FWA responsibilities but does not specify investigation volumes or required audit frequency. Please clarify typical FWA case volumes, expected volumes, audit frequencies, and reporting timeframes to the state.

The Pro forma Contract states that the Contractor shall have and implement its own procedures and processes. The State cannot provide volume estimates.

A. 25 65.

[REDACTED] requests reasonable audit parameters due to the time and expense incurred by both parties in regard to audits.

Please see below language that [REDACTED] requests be added to this section:

State shall audit a subject area only once annually unless an initial audit identifies a potential concern with Contractor’s Services.

Parties shall bear their own expenses of the audit. Any such audits or reviews shall be allowed upon reasonable advance notice during regular business hours and shall be subject to all applicable laws and regulations concerning the privacy and/or confidentiality of such data or records. Following a written request for an audit, the parties will cooperate in good faith to agree upon the time, place, and scope of any such audits, examinations, or reviews.

The State does not agree.

A. 25(h) 66.

We would like to propose the following changes:

The Contractor shall fund the following audits which shall be conducted by a qualified organization or representative chosen by the State and the scope of the audit shall be defined by the State:

(1) A pre-implementation audit to review, at a minimum, whether the Contractor’s adjudication system is configured according to the State’s benefit design;

(2) An operational audit focusing on, at a minimum, staffing, customer service capabilities, Contractor audit programs, and claims administration; and

(3) Any follow-up audits if significant deficiencies, as determined by the State, are noted.

[REDACTED] requests the State be responsible for its own expenses related to audits.

A.25(j) 67.

[REDACTED] will only pay undisputed amounts to the State. Disagreements should be subject to dispute resolution. Proposed revisions are below.

If the outcome of the audit results in an undisputed amount due to the State, the Contractor shall pay the amount due within (30) thirty days of final audit report notification from the State. Any undisputed amount due the State which is not paid within (30) thirty days of the final audit report shall be deducted from the total amount due from the fees due to the Contractor pursuant to Contract Section C.3 until the full amount due is paid. If the Contractor disagrees with a finding resulting in a payment to the State, the State will review the Contractor’s comments, and the parties shall work in good faith to resolve the dispute.

A.26 68.

The State and its TPA are responsible for ensuring mental health parity compliance.

Propose revising this Section to reflect that [REDACTED] as Contractor will support the State by sharing MH/SUD NQTL narrative and data and working in a collaborative manner with the State and its TPA to meet their compliance obligations.

The State does not agree.

A.26(e) 69.

The Plan is responsible for ensuring that it meets all state and federal requirements.

Propose striking this language.

The Contractor will be responsible for ensuring that all benefits and programs offered by the State and administered by the Contractor meet all current and future requirements of the PPACA and shall advise the State on all such benefits and programs, including benefit design, cost sharing structure, and appeals of all levels.

The Contractor shall ensure that the Administrative Fees in Contract Section C.3 include all possible work to ensure that the State and the Contractor are compliant with the

PPACA.

The State does not agree.

A.26(f) 70.

[REDACTED] should not be responsible for The State does not agree.

fines incurred by the Plan for non-compliance.

Suggest striking this language.

Any fines for non-compliance related to services provided by the Contractor under this Contract will be the Contractor’s sole responsibility.

C.5 71.

Can we further discuss this requirement as SLA’s are on an annual basis as it relates to payments.

There is not a question or proposed language for the State to review. Please revise and submit a question or proposed alternative language for the State to review and respond during Round 2 of Questions and Answers of the RFP.

C.10 Invoice Requirements 72.

To the extent there are applicable sales taxes, we would request the State to be responsible for those taxes if the State is responsible for them under Tennessee state law.

The State does not agree as the State is exempt from sales tax and can provide a tax exemption certificate.

D.5 73.

To the extent there are multi-year pricing commitments, Will there be an opportunity to negotiate this section to align with those commitments.

In addition, the right to terminate without cause should be mutual. Propose revising the language as follows:

Termination for Convenience. Either party The State may terminate this Contract for convenience without cause and for any reason.

The terminating party The State shall give the other party Contractor at least ninety (90) thirty

(30) days written notice before the termination date. The Contractor shall be entitled to compensation for all conforming goods delivered and accepted by the State or for satisfactory, authorized services completed as of the termination date. In no event shall the State be liable to the Contractor for compensation for any goods neither requested nor accepted by the State or for any services neither requested by the State nor satisfactorily performed by the Contractor. In no event shall the party’s the State’s exercise of its right to terminate this Contract for convenience relieve the other party Contractor of any liability to the State for any damages or claims arising under this Contract.

Any additional questions, comments, objections, and redlines should be submitted by the Round 2 Written Questions and Comments listed on the RFP Schedule of Events, Section

2.1. Please note that In Round 2 of Questions

and Comments, Respondents are limited to five

(5) questions and/or comments, which include suggested redlines. There will be no negotiations after the contract award.

The State does not agree with any of the revisions.

D.6 74.

[REDACTED] would request this section to be mutual and allow for a 30-day cure period. Both parties should have the right to terminate for cause. Propose revising the language as follows:

Termination for Cause. If a party the Contractor fails to properly perform its obligations under this Contract in a timely or proper manner, or if the party the Contractor materially violates any terms of this Contract (“Breach Condition”), the non-breaching party the State shall have the right to immediately terminate the Contract. and withhold payments in excess of compensation for completed services or provided goods.

Notwithstanding the above, the breaching party the Contractor shall not be relieved of liability to the non-breaching party State for damages

The State does not agree to any of the revisions.

sustained by virtue of any Breach Condition and the non-breaching party State may seek other remedies allowed at law or in equity for breach of this Contract.

D.7 75.

[REDACTED] is agreeable to an approval process, but we would request additional details due to the operational impact on [REDACTED].

Please see below for sample language:

After Contractor provides prior written notice of a new material subcontractor (which does not include providers or coaches contracted to provide clinical and coaching services), State will have fifteen (15) business days after receiving notice of any new material subcontractor to respond. In the event State reasonably objects to the engagement of any new material subcontractor, Contractor and State shall work together in good faith to agree on a reasonable solution regarding the engagement of the new material subcontractor with respect to State which may include termination of certain Services or termination of this Agreement without penalty.

The State does not agree

D.17 76.

How is “Maximum Liability” defined? How much is the State’s Maximum Liability?

The maximum liability for this contract will be determined through the best evaluated cost proposal and estimated cost associated with this service and will be the responsibility of the State.

D.18 77.

We would like to propose the following changes:

Limitation of Contractor’s Liability. The Contractor’s liability for all claims arising under this Contract shall be limited to an amount equal to one times the total Paid Claims, as defined in Contract Section A.2., that have processed throughout the one year of contract performance immediately preceding the breach.

If the breach occurs in the first year of the contract, the calculation will be based on processed claims from the beginning of contract performance until the date of the breach, prorated to equal one year PROVIDED THAT in no event shall this Section limit the liability of the Contractor for: (i) intellectual property or any Contractor indemnity obligations for infringement for third-party intellectual property rights; (ii) any claims covered by any specific provision in the Contract providing for liquidated damages; or (iii) any claims for intentional torts, criminal acts, or fraudulent conduct, or acts or omissions that result in personal injuries or death.

The limitations of liability now reflects customary market standards and form the basis for how [REDACTED] prices its services, as well as [REDACTED]’s view for how the parties should allocate and share the risks associated with contracting.

The State does not agree with any of the

D.19 78.

Each party should be responsible for its own legal fees related to enforcing the contract.

Propose revising the language as follows:

Hold Harmless. The Contractor agrees to indemnify and hold harmless the State of Tennessee as well as its officers, agents, and employees from and against any and all third party claims, liabilities, losses, and causes of action which may arise, accrue, or result to any person, firm, corporation, or other entity which may be injured or damaged as a result of Contractor's (a) gross negligence or willful misconduct in performing Services; (b) material violation of applicable laws; or (c) infringement of intellectual property rights related to the Services. Contractor may, at its sole option and expense: (i) procure for State the right to continue using the Services under the terms of this Agreement; or (ii) replace or modify the Services to be non-infringing.