RFP PUR-008-24 Addendum 2.doc.pdf

CONTRACT NUMBER ADDENDUM NO. 2

ISSUED BY:

PRINCE GEORGE’S COUNTY PUBLIC

SCHOOLS

OFFICE OF PURCHASING AND SUPPLY

13300 OLD MARLBORO PIKE

ROOM 20

UPPER MARLBORO,

MARYLAND 20772-9983

Date of this Addendum:

January 22, 2024

No. of Pages: 7 (Plus Attachments)

Proposal Submissions:

January 31, 2024

(10:00 AM) EST

RFP No.: PUR-008-24

RFP Issuance Date:

December 19, 2023

TITLE: SELF-INSURED AND FULLY INSURED

MEDICAL PLANS

TO ALL PROSPECTIVE OFFERORS AND OTHER RECIPIENTS OF SOLICITATION DOCUMENTS

This Addendum is hereby made a part of the Contract Document which will be the basis of a

Contract. This Addendum is issued to modify the original Solicitation Documents issued December

19, 2023. Prospective Offerors are requested to attach this Addendum to your Contract Documents.

Receipt of this Addendum must be acknowledged in the Proposal Document (see Appendix A).

Failure to do so may subject the Offerors disqualification.

The Purpose of this Addendum is to Extend the Due Date for Proposals, Provide Modifications and Clarifications to the RFP, as well as to Provide Responses to Questions

Proposals are now due on: January 31, 2024, at 10:00 a.m.

Modifications:

The following Attachments are provided with this addendum:

Medical Plan Summaries for CareFirst and Kaiser

Revised Exhibit 3a, 3b, 3c Repricing File

Revised Appendix G

MBE Administrative Procedures 3325 and Forms

Note: The attachments as referenced above will be will be forwarded via ZendTo to the vendors who submitted a Letter of Interest to Apply.

Clarifications:

1. The Zendto proposal link will be provided no later than January 24, 2024.

2. All proposals are to be submitted electronically via Zendto. Do not upload documents via eMMA.

Vendors shall upload each Volume (Volume I, II, III, IV) as four (4) separate files/uploads via

DeNerika.Johnson, Acting Director | DeNerika.Johnson@pgcps.org

13300 Old Marlboro Pike | Upper Marlboro, MD 20772 | 301-952 6560 mailto:DeNerika.Johnson@pgcps.org

Zendto (do not combine all volumes as one document upload). Hard copy submissions are not required.

3. The correct title for this project is: RFP PUR-008-24 Self Insured and Fully Insured Medical Plans. Please ensure your proposal response reflects this correction.

Questions and Responses:

Item No. Question Response

1 Please provide SPDs for all quoted plans. Plan summaries are attached. See Addendum No. 2.

Given this RFP was released during the holiday week, can you grant a due date extension in order for us to provide the best quote possible? Please see Addendum No. 2.

On page 11 of the RFP there is a reference to envelopes/binders. “BIDDER DELIVERY AND ENVELOPE PACKAGING “Can you clarify what is meant by envelope one and envelope two? Is PGCSD requesting hard copies in addition to the electronic submission?

Please disregard all references to submission of proposals via envelopes. Hard copy submissions are not required.

Submissions via eMMA is not required. All proposal documents are to be submitted via Zendto. See Addendum 2 Clarifications section for additional instructions and clarifications.

In the financial questionnaire, tab PF-1b, it references form PF-6. Can you please provide form PF-6 as it was not included in the RFP documents?

“Performance Guarantees (Complete Proposal Form PF-6) and Attach your full proposed performance guarantee offer”.

Please ignore the reference to Performance Guarantees in the Medical Financial Questionnaire. Performance Guarantees are requested in the Medical Technical Questionnaire (tab TF-5).

There are references to Stop Loss included in the Medical financial questionnaire, rows 43 and 54 on PF – 2a. Is PGCSC requesting a Stop Loss quote?

Request for 3rd Party Stop Loss Interface/Integration Fee (Carve-out) has been deleted.

Please confirm the R&C percentile or % of Medicare Reimbursement on the OON benefits for the medical plans.

Please use your Qualified Payment Amount Methodology as defined by the Center of Medicare and Medicaid Services.

Tab TF-9 and tab TF-10 of the Excel titled, “Exhibit 1- Medical Technical Questionnaire”, provides the following instructions, under headers titled, respectively, “Other Deviations” and “Key Differentiators: “Please complete if you are proposing either Self-Funded Administration or a Staff Model HMO”. These instructions imply that there should be charts in which to insert deviations/differentiators;

however, there is only blank space below these instructions. Please confirm that PGCPS wants all of the RFP’s deviations/differentiators placed in these tabs even though there are no charts to “complete”.

Tab TF-9 and TF-10 are to capture “Other Deviations” and “Key Differentiators” that are not mentioned in the charts provided on tab TF-7.

Please confirm the due date and time of the proposal response. The time due on page one differs from page nine. Please see Addendum No. 2.

Is there a tutorial available for the Zendto portal so that we can familiarize ourselves prior to receiving access?

Vendors are to follow the instructions as outlined in the Zendto link to be provided.

Is a hard copy submission required? If yes, please provide instructions for delivery. See Question and Response No. 3.

Indicates it must be signed in blue ink. There is no signature line and submission instructions do not call for hard copy submissions. Please confirm the intent.

Please disregard this request. Hard copy submissions are not required. Proposals signed in blue ink are not required.

There is instruction for tabs TF-3a and TF-3b that indicate ""DO NOT NEED TO PRINT."" Submission instructions suggest that the response will only be submitted electronically.

All proposals are to be submitted electronically via Zendto.

Hard copy submissions are not required.

Please confirm that Prince George's County Public Schools is expecting the full submission to be electronic and not a printed copy. Confirmed

Are there more detailed instructions about the alternate EPO plan that Prince George's County Public Schools is requesting or is it up to the discretion of the carriers?

Vendors are encouraged to propose a fully insured medical and pharmacy benefit that includes the largest provider network available at the disclosed rates. Deductibles, copays, coinsurance, and plan design will be up to the discretion of the carriers.

Please confirm how Prince George's County Public Schools would like sections and forms that are "Not Applicable" to be marked.

Vendors can mark sections and forms that are Not Applicable as N/A.

Does Prince George's County Public Schools plan to issue a Medicare RFP? No

This document contains a "Witness" line for a secondary signature. Are there any requirements or instruction about who can sign as a witness vs. the primary signer?

There are no restrictions on who may be a witness to a signature.

Can you provide information about the Pharmacy Claims?

PGCPS is looking for medical administration bids separate from its pharmacy administration. If you wish to bid on PGCPS’s pharmacy administration, please respond to RFP

PUR-007-24.

P. 11 of the RFP indicates that Volume I - Technical Proposal must include a table of contents with consecutive numbering. Please confirm that consecutive page numbering is necessary given that this proposal is being electronically submitted as multiple files of differing types (Excel, PDF, etc.). Page numbers are not required.

On pages 15, 23, and 30 of the RFP, offerors are instructed to submit Appendices electronically in eMMA. However, other areas of the RFP instruct that the entire proposal is to be submitted via ZendTo.

Please clarify. See Question and Response No. 3.

We request that the Network Name field, which is column CJ in the original source file, be added back to the repricing files.

This information is not required to provide a proposal and is therefore not available for release.

We also request that the HSCRC indicator field, which is column CM in the original source file, be added back to the repricing files.

Please see updated revised repricing file with requested fields in Addendum No. 2.

Please advise if there be an extension to the due date based upon the additional data provided/requested for the census and repricing to allow time for appropriate analysis. Please see Addendum No. 2

24 Please provide SPDs for all quoted plans. See Question and Response No. 1.

Given this RFP was released during the holiday week, can you grant a due date extension in order for us to provide the best quote possible? Please see Question and Response No. 2

On page 11 of the RFP there is a reference to envelopes/binders. “BIDDER DELIVERY AND ENVELOPE PACKAGING “Can you clarify what is meant by envelope one and envelope two? Is PGCSD requesting hard copies in addition to the electronic submission? Please disregard this request.

In the financial questionnaire, tab PF-1b, it references form PF-6. Can you please provide form PF-6 as it was not included in the RFP documents?

“Performance Guarantees (Complete Proposal Form PF-6) and Attach your full proposed performance guarantee offer”.

Please ignore reference to PF-6 in financial questionnaire, performance guarantees are found in technical portion of

RFP.

There are references to Stop Loss included in the Medical financial questionnaire, rows 43 and 54 on PF – 2a. Is PGCSC requesting a Stop Loss quote?

Request for 3rd Party Stop Loss Interface/Integration Fee (Carve-out) has been deleted.

Please confirm the R&C percentile or % of Medicare Reimbursement on the OON benefits for the medical plans. See Question and Response No. 6.

Tab TF-9 and tab TF-10 of the Excel titled, “Exhibit 1- Medical Technical Questionnaire”, provides the following instructions, under headers titled, respectively, “Other Deviations” and “Key Differentiators: “Please complete if you are proposing either Self-Funded Administration or a Staff Model HMO”. These instructions imply that there should be charts in which to insert deviations/differentiators;

however, there is only blank space below these instructions. Please confirm that PGCPS wants all of the RFP’s deviations/differentiators placed in these tabs even though there are no charts to “complete”. See Question and Response No. 7.

On page 12 of the RFP, referring to “TAB C – EXPERIENCE AND CAPABILITIES Offeror shall prepare and present a Technical Proposal in such a way as to provide a straightforward description of response to experience and qualifications, product quality, demonstrated capacity to perform, past performance and references to satisfy the requirements of the RFP.” Can you clarify what information we are to include in this section? Do we include Appendix B in this section in addition to the Volume IV section? Please confirm there should be 1 Appendix B exhibit for EACH reference

Vendors shall provide an overall summarization of their experience and qualifications, product quality, demonstrated capacity to perform, past performance and references to satisfy the requirements of the RFP.

Can you please provide the medical paid claim dollar distribution and/or utilization between Tier 1, 2 and 3?

In the recent 12 month period ending September 2023, the allowed claims distribution for the non-Medicare population was 91%, 2%, and 7% in tier 1, tier 2, and combined tier 3 and OON, respectively.

Please confirm Volume 1 – Technical Proposal Tabs A through D should be provided in one PDF document. Please confirm this is acceptable in order to meet the consecutive numbering requirement. Confirmed

Please confirm we can upload an Excel version of Exhibit 1 in addition to the PDF version. Confirmed

Please confirm Volume IV, in addition to Volumes I-III should be uploaded to Zendto site only, not eMMa. Confirmed

Appendix G appears to apply to a paint supplier/vendor. Based on the services being solicitated as part of this RFP, it is our interpretation that Appendix G does not apply. Please confirm this form is not required and should be omitted from our submission. If not applicable, but required for submission, please advise with bidder instructions.

Please see attached Revised Appendix G. See Addendum No. 2.

Please confirm if bidders can duplicate the “TF-1a” tab if they are responding to the ASO and FI alternative plan? If not, please provide bidder instructions as to how to include both sets of responses.

Yes, that is acceptable. Please describe any differences in the questionnaire.

If PGCPS decides to move forward with implementing the alternative plan design, 01/01/2025:

a. There are two columns for benefits to complete, INN and OON. Should the alternative plan include INN and OON benefit for non-emergency claims?

b. Is PGCPS willing to award the FI alternative plan as a standalone product – meaning not married to the awarded ASO bidder?

c. PF-1C, line 38, references a proposal “form” PF-6.

Please confirm where bidders can locate this form or tab.

PGCPS will consider all qualified proposals submitted in response to this RFP. See responses to the proposed questions below:

a. Please provide the same INN and OON benefit for emergency room claims.

b. PGCPS reserves the right to award this alternative plan to any bidder and would not be tied to ASO award.

c. Please ignore reference to PF-6 form.

What outside vendors, other than pharmacy, will the medical bidder need to accommodate? For example, a third-party enrollment system.

The medical vendor may need to provide data at a minimum to the following vendors:

* Consultant

* Data Warehouse

* External Auditor

Please provide the repricing files with respective tiering indicators for each claim and/or provider? See Question and Response No. 21.

Using the combined RFP repricing files’ billed charges as the denominator, could PGCPS advise what the current percentage of utilization is for each of the 3 tiers? See Question and Response No. 32.

Tab “PF-4” requests bidders to fill out the Tier 1, Tier 2, Tier 3 and OON, in the allotted billed and allowed boxes. Could you please clarify the difference between Tier 3 and OON for the Triple Option Plan?

Tier 3 includes certain Bluecross Blue Shield participating doctors specific to their indemnity network. OON includes providers that have no blue cross affiliation.

This question states, “PGCPS plans to award a contract to this solicitation on or around January 1, 2025….”. Please confirm PGCPS’s estimated date for an award notification.

The estimated award date notification is anticipated to be issued June or July 2024. The start of the benefit period is January 1, 2025.

This question states, “Confirm that you agree to meet PGCPSs file layouts and specifications. We attached file (1g_CF Group Structure The BOE of PG COUNTY).” Please provide the file mentioned within the question.

Group Structure has been provided in Exhibit 10 of the

RFP.

Tab “PF-4” requests bidders to fill out the grid with billed and allowed charges, separated by HSCRC regulated claims and those not. After reviewing the total billed amounts, we are unable to match the amounts pre-filled on the tab with PGCPS’s repricing file. Please provide an amended claims file that include indicators for HSCRC, Non-HSCRC, Professional, and Behavioral. If no, please provide the crosswalk legend that resulted in the total billed claims amounts listed in Tab “PF-4”.

Please see revised pricing file. See Addendum No. 2 attachment.

To provide a FI alternative proposal with 4-tiered rates, please provide an amended census that includes the “assumed 4-tiered enrollment”.

The current Active population, when re-mapped to the target 4-tier arrangement as outlined in tab PF-2C are distributed at 48%, 12%, 14%, and 26% into the Self, EE + Spouse, EE + Child(ren), and Family tiers, respectively.

We will not be releasing an amended census at this time.

An amended census is not required to provide a proposal response, as the FI alternative proposal would not be the sole plan offered to PGCPS employees. It would be a third option and no specific enrollments are guaranteed.

If bidders require a non-disclosure agreement (NDA) to be signed due to the proprietary/confidential nature of information within the claims reprice will:

a. PGCPS agree to sign an NDA? If so, who?

b. PGCPS’s consultant, Bolton, agree to sign an NDA? If so, who?

PGCPS will not sign NDAs provided by a vendor. As part of its fiduciary responsibilities, PGCPS will not release confidential information to anyone, with the exception of the PGCPS staff and consultants authorized to work on this project on behalf of PGCPS. In reference to the release of any information requested via a MPIA or FOIA, PGCPS will first obtain written authorization from the vendor prior to release of any proposal information obtained via this project. NDAs are required to be signed between PGCPS and its consultants. The NDAs are designed to protect any proposal information provided by the vendors for this project.

The FI alternative plan includes Rx benefits. Please provide month-by-month Rx claims for the past two years with enrollment.

In the recent 24 month period, the PMPY for the eligible members in terms of paid Rx claims was $212 PMPM and $188 PMPM for periods ending September 2022 and 2023.

These figures are gross of rebates, and would be lower if rebates were accounted for.

Please provide Form 3325 as mentioned in the bidder’s conference. Please see Addendum No. 2 attachment.

Please confirm the anticipated contribution strategy for the requested alternative plan design.

80/20 employer/employee contribution split for employees with more than 8 years of service. 75/25 employee/employer contribution split for employees with 0- 8 years of service.

Please advise if PGCPS will allow bidders to propose multiple alternative plan options and rates. Please provide only one alternative plan option.

Please confirm if the repricing files provided include denied claims.

Confirmed, all claims in the repricing data set were covered claims.

The question asks bidders to confirm if they can provide an OOA plan for the 3rd tier network. Please advise the relationship of an OOA plan with the 3rd tier network benefits. Please disregard this question.

Please advise if the savings is referring to employer or member savings, or both. Please disregard this question.

Can you please clarify what the designations “HSCRC Regulated Claims” and “Non HSCRC Regulated claims” represent on the claim repricing summary exhibit? Can you please also clarify why that is not included in the 2nd chart on the same form?

The Maryland Health Services Cost Review Commission (HSCRC), allows health plan administrators to secure prompt pay / working capital discounts with regulated hospital facilities. The revised repricing file has a new file indicating the HSCRC regulated claims, which will allow you to indicate any prompt pay / working capital discounts you are currently able to provide. We ask that you indicate if you are factoring these discounts in the repricing file.

Can you please provide more detail regarding the intent of the Discount Guarantee as % of the Medicare Fee Schedule? Can you please provide an example of how you would expect a bidder to configure the guarantee?

We are asking bidders to guarantee their aggregate discounts for professional providers as a % of the Medicare Fee schedule. For example, a guarantee would note the allowed amount for professional claims, in the aggregate, would not exceed 95% of the Medicare Fee Schedule.

We noted the submission instruction regarding Prince George's Public Schools desire to have sequential page numbers on responses. Please confirm whether the numbering should restart with each Volume or extend through all Volumes? Please confirm how we should address the Excel Worksheets Exhibit 1/Volume I and Exhibit 2/Volume III? Numbering of the pages is not required.

Prince George's County Public Schools has included an "Administrative Agreement" in the list of requested attachments. Can you please confirm that it is acceptable to provide a "Group Agreement" and an "EOC" for vendors quoting fully insured options only? Yes, that is acceptable.

Please confirm Appendix B should be used to identify current clients that can provide references? Can we use those same current clients (plus termed clients) to address Volume I Exhibit 1 Tab TF-8b?

References provided via Appendix B may also be utilized to satisfy the requirement for Volume I Exhibit 1 Tab TF-8b, provided that the response submitted via Appendix B meets the requirement as detailed in Exhibit 1 Tab TF-8b.

It was confirmed that Medicare plans are in scope for this RFP. How would Prince George's County Public Schools like pricing to be included?

Provide one combined administrative fee for Actives, Non- Medicare eligible retirees, and Medicare eligible retirees.

Can you provide information about the Pharmacy Claims? Specifically, to include Rx Paid Claims by month with associated enrollment. See Question and Response No. 48.

Will this form that is expected to be released with Addendum 2 include a place for us to indicate who our vendors are? Yes