THIRD PARTY ADMINISTRATOR AND PROVIDER NETWORK SERVICES FOR OFF-

SITE HEALTHCARE

RFP #S-29100-00011086

Q1: For clarification, was Exhibit D, Federal Terms and Conditions, left blank intentionally? (Attachment A, Exhibit)

A1: Yes, this was intentional. This Exhibit is reserved in case Federal funds become available to pay for services and the Federal funds require special terms and conditions.

Q2: Please clarify the degree of background check to be performed? Are there other requirements for secure access to DOC facilities for Contractor staff when said staff is required to enter? (Attachment K, K.2.3)

A2: ODOC runs a background check through the Oregon State Police Law Enforcement Database System for everyone entering an institution.

Q3: In accordance with Attachment L, General Information Questionnaire there are a total of 540 points possible; however, according to the RFP, Section 4.11, Point and Score Calculations, there are a total of 424 points possible for Attachment L. Can you please confirm which one is correct? (Attachment L / RFP Section 4, 4.11 pg 21)

A3: The correct point totals are listed in Attachment L. An amendment will be issued to address this.

Q4: Attachment L, references Medicaid requirements are in Section IIA in the sample contract, but there is no Section IIA. What is the correct section for the Medicaid requirements? (Attachment L, L.3 and L.3.18)

A4: The correct section that identifies Medicaid requirements is in Attachment A, Exhibit A, Section B.1 of the Sample Contract. An amendment will be issued to correct this and some other numbering issues.

Q5: What is required to achieve “provide internet based electronic access to claims data analysis”? (RFP Section 2, 2.4.1 pg 11 & 12)

A5: We expect the successful bidder to have an online portal that gives ODOC access to claims status, including but not limited to payment status.

Q6: What is meant by full access to the online claims system? (RFP Section 2, 2.4.2 pg 12)

A6: We expect the successful bidder to have an online portal that gives ODOC access to claims status, including but not limited to payment status.

Q7: Is the DOC able to download raw information and reproduce Contractor reports or ad hoc reports?

(Attachment A, Exhibit A, Section I pg 43 & 44)

A7: Currently depending on the format the data is in. An Excel or CSV format would be preferred.

Q8: How many FTEs are required to administer the current Medicaid Application Processing function?

Describe the current process. (Attachment A, Exhibit A, Section B.1.a pg 26)

A8: Two.

Q9: The RFP appears to only require Medicaid applications for Inpatient admissions to external hospitals. Is the intent to expand the application process to include all AICs incarcerated either entering the system or releasing? (Attachment A, Exhibit A, Section B.1.a pg 26)

A9: At this time, no. There is ongoing Oregon statute that may make this requirement obsolete, but we are moving forward with the anticipation that Medicaid applications for Inpatient admissions to external hospitals will still be expected under an awarded contract.

Q10: Is the Contractor expected to take on the additional Medicaid application volume for the expanded 1115 waiver process? What is that projected initial workload anticipated to be? (Attachment A, Exhibit A, Section B.1.a pg 26)

A10: This is unknown right now. Our belief is we would focus on the 450-500 new AICs per month entering ODOC’s custody, as well as the inpatient admissions. The 1115 Waiver is scheduled to go live on 1/1/2026.

Q11: Is the Contractor responsible for Medicaid enrollment of inpatient AIC only, or for ALL AICs? If the answer is ALL AICs then what is the expectation of time to enroll the current population? (Attachment A, Exhibit A, Section B.1.a-c pg 26)

A11: As of 9/6/2024 the contractor shall be responsible for Medicaid enrollment of inpatient admissions only. This could change depending on the outcome of the 1115 Waiver.

Q12: What changes are anticipated in the eligibility files based on the 1115 Demonstration Waiver and its impact on Medicaid-eligible AICs? (Attachment A, Exhibit A, Section C.4 pg 28)

A12: The 1115 Waiver allows for Medicaid to pay for most treatment during an AIC’s last 90 days of incarceration. Additional scrutiny of release dates will be required to ensure claims are paid for through Medicaid for eligible AICs.

Q13: Does the DOC have an existing Provider Manual for internal DOC staff? Or is the expectation that the Contractor would develop this as part of the service contract? (Attachment A, Exhibit A, Section D.3.c-d pg 29)

A13: All references to a Provider Manual shall be removed from the requirements of this RFP. A Provider Directory, including the managed care program and its components, shall still be required.

Q14: What training is required to be held onsite? Is it to be at each correctional location or in one central location? (Attachment A, Exhibit A, Section D.3.i (pg 31), Section D.3.ii (pg 31), and Section F.2.b (pg 36))

A14: All training, whenever possible, can be held virtually.

Q15: Please clarify what aspects of service delivery are required under Attachment A, E. Service delivery, 2.b? (Attachment A, Exhibit A, Section E.2.b pg 33)

A15: This section refers to the case management of AICs receiving care at offsite provider locations. This management includes, but is not limited to, monitoring, and reporting on care trends of disease states and costs and working with DOC to create measurable targeted outcomes. Ensuring the Contractor’s

Provider Network is adequate to cover each of DOC’s facilities statewide for specialty and emergency/urgent requirements, including an authorization system. To be successful and effective the Contractor must facilitate communication between DOC, themselves, and offsite providers in all medical disciplines that is inclusive of treatment typically involved in patient care.

Q16: What type of accrediting body would be required for CM program? (Attachment A, Exhibit A, Section F.3 pg 36)

A16: Any nationally recognized body would be acceptable.

Q17: The RFP specifies a "desire" for an [OAP] Outside Appointment Predictor system. Is it the expectation that the Contractor will provide this system? (Attachment K, Section K.2.2)

A17: Yes, based on trends and historical data.

Q18: Can you provide further detail on what types of precertification would be handled by DOC vs the Case Management vendor? For example, does the DOC handle all precertification requests completed onsite and would like the potential CM vendor to handle any offsite? (Attachment A, Exhibit A, Section F pg 34-36)

A18: There are no precertification requirements in Attachment A, Exhibit A, Section F pg 34-36. The contractor shall be responsible for all offsite certifications and/or licensures and DOC for onsite.

Q19: How frequently would the DOC like the Contractor to conduct onsite training sessions regarding provider manuals, provider directory, managed care program, etc.? (Attachment A, Exhibit A, Section D.3.D pg 30 and Section F.2.B pg 36)

A19: Initially, weekly until DOC is comfortable with the contractor’s implementation. As needed and for new employees afterwards. This will be clarified in an issued amendment.

Q20: Do the current Contractor’s Case Managers perform hospital visits for inpatient stays lasting over 96 hours? Is there an expectation that the Contractor should bid to include direct hospital visits versus telephonic visits? (Attachment A, Exhibit A E.3.a.ii (P 33)Exhibit A J.2.d.ii (P 46))

A20: Yes, the current Case Managers perform hospital visits for inpatient stays lasting over 96 hours.

These visits can be made in person or telephonically. In cases where adequate information is unable to be collected telephonically it is expected that the Case Manager would conduct in person visits.

Q21: What is the DOC expectation for how they access the Contractor Case Management transaction systems? (Attachment A, Exhibit A F.1.b.ii (P 35))

A21: We can determine how access to a Case Management transaction system is accomplished after contract award. We just need access.

Q22: What is the process for the Contractor to receive the Health Referral Outside Agency form (Attachment J)? Is the expectation that the form (PDF) be associated with the corresponding auth in the Contractor's system? Does the DOC expect to have access to these documents? (RFP Section 2, 2.4.5 (P

13) Attachment J)

A22: All references to the Contractor receiving the Health Referral Outside Agency form shall be removed. This form will be sent directly to the offsite provider.

Q23: How does the current Contractor determine medical necessity for external medical requests (aka prior authorization)? (Attachment A, Exhibit A F.1 (P 35))

A23: Medical necessity is determined by DOC’s TLC order for offsite care.

Q24: Please provide clarification of "Outpatient Concurrent Review" services requested? What is the expectation for services the Contractor will perform versus the TLC or internal DOC staff? (RFP, Section 2

2.4.5 (P 13))

A24: Is expected that the contractor shall monitor and review both inpatient (stay) and outpatient (release) to ensure an appropriate level of care is being accomplished for each patient.

Q25: How much notice is required for each of the four (4) 2-year extension periods? (Attachment A, Section 1 (P 1))

A25: ODOC does not have a set time period for starting the amendment process with the Contractor but try to give as much notice as possible.

Q26: This section seems to be contradictory. “If a conflict arises between any of the provisions in these Contract Documents that cannot be resolved, the provision in the Contract itself or in the exhibit with precedence shall control.” Please clarify which document has precedence. (Attachment A, Section 2 2.9 last paragraph (P 2))

A26: The Contract has precedence over the attachments. The order of precedence is listed in descending order starting with Section 2, subsections 2.1 through 2.9.

Q27: How often, and through what means shall the Agency notify the Contractor of the acceptance of deliverables? (Attachment A, Section 3, 3.2 (P 2))

A27: As often as needed and via email.

Q28: Is the Not-To-Exceed Compensation amount of $160M for the initial 2-year term of the contract?

(Attachment A, Section 4, 4.1 (P 3)?

A28: Yes, with the ability to amend as needed.

Q29: If the $160 million is for the initial 2-year term of the Contract, when will the Contractor be notified of Not to Exceed Compensation for each subsequent 2-year extension period? (Attachment A, Section 4, 4.1 (P 3)

A29: Each extension will be done through an Amendment to extend and add to the Not to Exceed amount. The contractor will be involved in this process.

Q30: Is $160 million Not to Exceed Compensation for TPA administration cost only or does this amount include payments made to the providers? (Attachment A, Section 4, 4.1 (P 3))

A30: The $160 million is the combination of claims paid to the providers and administration of the contract. Monthly Warrants will be issued to the Contractor at the first of each month to cover claims paid on behalf of DOC.

Q31: Cost Proposal requires a Per-AIC rate for all services. How will the DOC provide for relief to Contractor in the event of a significant decrease in AIC population, such as ocurred in the Sars-Cov-2 pandemic? (Attachment E, Part I)

A31: The Per-AIC rate is negotiable, up or down, in the event of significant decreases in the AIC population or substantial change in CPI.

Q32: Cost Proposal Part I Note states that "Travel and any other expenses of the Contractor shall not be paid.". What does this mean in relation to the Per-AIC rate that contractor proposes? (Attachment E, Part I)

A32: DOC does not pay travel for contractors. The contractor’s “Administration Fee” shall include any potential travel needs and requirements. Transportation for AICs, either by ground or air assets, shall be paid through the claims process.

Q33: ADP is stated as 14,500 in the Cost Proposal. What is the actual ADP currently and forecast for the initial 2-year contract period to apply in the cost proposal? (Attachment E, Part I / Part II)

A33: The ADP at the time of creating the RFP was 14,500. It currently sits at approximately 12,048 and we anticipate it fluctuating between 12,000 and 12,300 over the next two years. An amendment will be done to address this.

Q34: What is the minimally sufficient level of detail that must be reported in the cost proposal? Or, is the DOC simply looking for a single Per-AIC rate with no underlying justification? (Attachment E, Part I / Part II)

A34: Part of our decision will be cost. A single Per-AIC rate will suffice for our Admin Fee consideration.

Q35: Can alternative cost proposals allow for pass-through expense elements such as a PPO network access fee? The fee itself being known and fixed for the initial contract period. (Attachment E, Part II)

A35: DOC prefers a single Per-AIC rate.

Q36: Can you please confirm the correct Section in the Sample Contract regarding “additional management information system information and requirements”, as Section IX does not exist?

(Attachment K, Section K.1)

A36: This should be Attachment A, Exhibit A, Section I. An addendum will be issued to address this.

Q37: Please clarify if ODOC’s intent is to only include In-Network Providers with regard to Quality Assurance, but to obtain credentialing packets from both In-Network and Out-of-Network Providers who are often times identified after the fact of services being performed. (Attachment A, Exhibit A, Section G.2 (P 36) & G.6 (P37))

A37: Yes, this is correct.

Q38: Has there been an agreement with OHA for a TPA to handle and obtain information for Medicaid applications? What requirements are necessary to gain access to OHP systems for Medicaid application processing? (N/A, N/A)

A38: There has not been an agreement. OHA has agreed to allow our TPA Contractor to complete and file Medicaid applications on behalf of DOC is necessary.

Q39: The RFP refers proposers to Exhibit 1, Sample Contract, Attachment 2, Section B.1) which does not exist. Can you please provide the correct Exhibit, etc.? (RFP, Section 2, 2.4, 2.4.3 (P 12 & 13))

A39: This reference should be Attachment A, Exhibit A, Section B.1. An amendment will be issued to address this.

Q40: The RFP references Attachment A, Exhibit 2, Statement of Work; however, Exhibit 2 does not exist.

Can you please provide the correct reference? (RFP, Section 2, 2.4, 2.4.3 (P 12 & 13))

A40: This reference should be Attachment A, Exhibit A. An amendment will be issued to address this.

Q41: What is meant by, “Proposer will be responsible for understanding the ODOC treatment plan and for tracking all patient care”? (RFP, Section 2, 2.4.5, paragraph 3 (P 13))

A41: The contractor and DOC shall have regular meetings, monthly status updates and daily “Noon Call” to discuss current patients receiving offsite care, to ensure the Contractor understands DOC treatment methodology and procedures. All patient care occurring offsite, and those onsite through service level agreements between a provider and the contractor, shall be tracked by the Contractor. The contractor shall provide updates, metrics, and reports monthly on the tracking of patient care.

Q42: What is meant by “Case monitoring performed by the successful Proposer will include short term and long-term goals including care needs, medical equipment requirements and recommending alternative treatment.", given the Contractor's staff are not treating providers. (RFP, Section 2, 2.4.5, paragraph 3 (P 13))

A42: The contractor’s Case Managers shall be medical professionals who are able to articulate patient care needs and recommendations for continuing or discontinuing treatment plans. They shall be able to communicate reasons for hospital treatment plans to non-medical DOC staff.

Q43: Is the DOC interested in expanding their contract to include prior authorizations for outpatient services? (RFP Section 2, 2.4.5, paragraph 2 (P 13) and Attachment A, Exhibit A, E.2.b (P 33))

A43: In accordance with the Provide Network, the Contractor shall implement an authorization system and maintain an automated authorization file tied to the automated Claims processing, eligibility and Network Provider systems and files to ensure accurate processing of Claims requiring authorization and prior approval.

Q44: Please confirm the correct section for the RFP and Section in the Sample Contract regarding "number of years Proposer, as a company, has been in the business supplying services of the nature described", Scope of Work, RFP Section 3 does not exist. (Attachment L, Section L.4)

A44: The correct reference should be RFP Section 2.4. An amendment will be issued to address this.

Q45: Please confirm the correct section referenced for "(reference Attachment 2, Section V.C of the Sample Contract)" does not exist. (Attachment L, Section L.1.10.b)

A45: The correct reference should be Attachment A, Exhibit A, Section E. An amendment will be issued to address this.

Q46: Please confirm the correct section regarding "proposed Performance Guarantees in Section D.7" (Attachment L, Section L.3.11)

A46: The correct reference should be Section L.7. An amendment will be issued to address this.

Q47: Please confirm the correct section referenced for "Reference Technology Requirements Attachment F, Section F.1." This section does not match. (Attachment L, Section L.3.14)

A47: The correct reference should be Attachment K, Section K.1. An amendment will be issued to address this.

Q48: Please confirm the correct section referenced for "Sample Contract, Attachment A Section ii.A, Medicaid Benefits". This section does not exist. (Attachment L, Section L.3.18)

A48: The correct reference should be Attachment A, Exhibit A, Section B.1. An amendment will be issued to address this.

Q49: Please confirm the correct section referenced for "Performance Guarantees contained in Section X.B of the Sample Contract". This section does not match. (Attachment L, Section L.4.5)

A49: The correct reference should be Attachment A, Exhibit A, Section J.2. An amendment will be issued to address this.

Q50: Please confirm the correct section referenced for "Describe how your proposed case management will meet requirements as described in Section 2.4.5 of this RFP and Section VI of the Sample Contract".

Section VI of the Sample Contract does not exist. (Attachment L, Section L.5)

A50: The correct reference should be Attachment A, Exhibit A, Section F. An amendment will be issued to address this.

Q51: Please confirm the correct section referenced for "Implementation and Transition Plan" Sections VIII.B.21 and X.C.3 of the Sample Contract does not exist. (Attachment L, Section L.6)

A51: The correct reference should be Attachment A, Exhibit A, Section H.2.s and J.3.C. An amendment will be issued to address this.

Q52: Please confirm the correct section referenced for "Performance Measures and Guarantees", Section X.B of the Sample Contract does not exist. (Attachment L, Section L.7)

A52: The correct reference should be Attachment A, Exhibit A, Section J.2. An amendment will be issued to address this.

Q53: Is the opening date September 23 as stated in the OregonBuys posting or October 9 as stated on the title page of the RFP? Cover Page: Opening Date and Time: October 9, 2024 (the Opening will be done virtually) Section 1.2 Schedule: Opening (Proposal Due), See RFP Cover Page, Opening of Proposal – October 9, 2024, 2:00 PM OregonBuys: 9/23/24 2:00 PM (RFPOregonBuys:

https://oregonbuys.gov/bso/external/bidDetail.sdo?docId=S-29100- 00011086&external=true&parentUrl=clo Cover Page (P 1) & Section 1 1.2 (P 5)

A53: This will be corrected in OregonBuys to October 9, 2024.

https://oregonbuys.gov/bso/external/bidDetail.sdo?docId=S-29100-00011086&external=true&parentUrl=clo https://oregonbuys.gov/bso/external/bidDetail.sdo?docId=S-29100-00011086&external=true&parentUrl=clo

Q54: What minimal set of standard claims and utilization statistical reports are required by the contract?

(Attachment A, Exhibit A Section I.4.a (P 44) and Attachment L, Section L.3.17)

A54: Various reports will be required are, but limited to are: Admits Detail for the month with 12 month historical data; Biennium Claims Paid with 12 month historical data; Total Claims paid for the month with 12 month historical data; Clinical Reports based on disease states, inpatient trends, and outpatient trends; Clinical Classification (paid amount by clinical classifications);

Emergency Ambulance (both air and ground) costs; ER Frequent flyers; ER Trends; Financial Report; High Dollar Claimants; IBNR Data; Non-Contracted providers; Outpatient Authorizations; and Self injurious. Ad hoc reports will be required as needed.

Q55: How much of an Admin Fee per AIC per month does the DOC pay currently?

A55: The current PIPM is $8.37

Q56: How many claims per AIC did you have in 2021, 2022, and 2023?

A56: Approximately 31.22, 25.06, and 46.20 claims per unique claimant.

Q57: Can you provide your inpatient days and outpatient visit statistics for 2021 – 2023?

A57: Not currently available.

Q58: Does the DOC pay any fee in addition to the Admin Fee, such as a percentage of savings on the claims?

A58: Not currently.

Q59: The pricing section asks for the cost per AIC per month, but can you elaborate on how you intend to evaluate each proposer’s provider savings (i.e., their network)? Is there a place within the response where you would like to see this expressed? How do you intend to compare the varying network savings responses?

A59: The assumption will be that all proposals shall meet the RFP minimum requirements (provider network capable of meeting the statewide needs of all AICs, claims and authorization portal, reporting requirements, etc.) and therefore the Administrative Fee per AIC per Month shall be utilized to score potential contractors. Alternate cost proposals can be included in Attachment E, Cost Proposal, Part II.

Q60: How many claims are processed annually for those periods? Can you provide the claim counts that match the breakout on Attachment I (e.g., by year by claim type – inpatient, etc.)?

A60: Not currently available.

Q61: Attachments H and I only extend through 2021 and partially through 2022. Can you provide 2022 and 2023, which would be helpful in explaining the large jump in costs from $30M to $37M?

A61: Unfortunately, we cannot get, review, and format the data within the time constraints of this solicitation. The main reason for the jump from $30M to $37M was due to the cost of healthcare increasing and the increase of specialty care needed offsite due to COVID.

Q62: The heading for Attachment I states ‘by month and by location’ but it instead provides by year by claim type. Do you have a breakout of claims and their cost by facility location? By provider?

A62: Not currently available.

Q63: Are providers being paid negotiated rates currently, or are they being paid Medicaid rates?

A63: Negotiated.

Q64: Are payments made to providers as a % of Billed Charges or based on reference prices such as Medicare or Medicaid? If based on a reference price, what % of the reference price is being paid? Could we receive the same ‘by claim type’ breakout as on Schedule I but instead showing the reference price total?

A64: Payments made to providers are a % of Billed Charges.

Q65: Page 4 of the RFP mentions that services will begin no later than March 1, 2024. Should that read March 1, 2025? There are multiple references to 2021 on the solicitation – was this solicitation originally posted in 2022 and then retracted? If so, why?

A65: This should read March 1, 2025. This was a typo and has not been solicited since 2016. ODOC started drafting this solicitation in 2021 and that is why there are references to 2021. An amendment will be issued to address this.

Q66: Page 6 mentions that for FY 2023, DOC had a total of 6,211 claimants with claims totaling approximately $37,873,952. How many claims were represented in those totals?

A66: 148,347

Q67: Is the DOC willing to indemnify the Contractor and/or the provider for services provided on-site?

A67: The standard state indemnification language is located in Attachment A, Section 11. This section is not part of what DOC is open to negotiating per Section 5.4.1 of the RFP.

Q68: Can you expand on the current process for determining Medicaid eligibility as referenced in section 2.3.3.5 on page 11? Is the Contractor responsible for the actual enrollment of the individual into Medicaid, or just “coordinating financial and demographic data needed to establish the Medicaid eligibility”?

A68: The Contractor shall be responsible for coordinating financial and demographic data needed to establish the Medicaid eligibility by coordinating with DOC and Oregon OHA’s Medicaid application process.

Q69: Can you expand on what functionality the DOC is looking for in reference to “Provide internet based electronic access to claims data analysis and information” as mentioned on page 11? Does the DOC want to see status of claims, or does the DOC want the ability to modify claim information? How many people within the DOC would need access to the claims system?

A69: DOC needs access to the status of each claim. Currently, viewing the status is within the same portal as the entering prior authorizations. Approximately 15-20 DOC staff could have access.

Q70: What format is the weekly enrollment data provided in? Can you provide a template that will identify the format and what column headers are included?

A70: An amendment will be issued that will add the template as an additional Attachment.

Q71: Does ODOC anticipate any of the contractor’s staff to be onsite at a DOC facility?

A71: No. Unless they want to attend the daily or monthly meetings in person.

Q72: What is meant in Sections 2.3.2 and 2.4 when it asks that the contractor manage onsite goods?

A72: This reference shall be removed. An amendment shall be issued to address this.

Q73: Section 2.4.3 refers to Attachment A Exhibit 2 and while Attachment A has an Exhibit A (the SOW), it does not appear to have an Exhibit 2. Can you tell us where we should look?

A73: This reference should be Attachment A, Exhibit A, Section B.1. An amendment will be issued to address this.

Q74: Section 2.4.5 mentions concurrent Review and Utilization/Discharge Planning. How is information currently being shared with the Case Managers that are responsible for those services? Does the Case Manager have access to the EMR at the facilities?

A74: DOC does not currently have an EMR. We are hoping to go live with our EMR within the next 6-10 months. Case managers shall coordinate review and discharge planning with the local provider.

Q75: Page 50 requires that the contractor maintain a system in compliance with the CASB. The reporting listed all seems to fall under ‘regular’ FASB / GAAP. Could you provide a specific example or report that is CASB specific that you require?

A75: We are now using GAAP. An amendment shall be issued to address this.

Q76: Attachment A page 34 asks that two Oregon nurses be onsite at inpatient facilities. Is there any expectation that they be based out of a DOC facility or have to visit a DOC facility? Can they work remotely?

A76: They would not be based out of a DOC facility, or have to visit a DOC facility. Offsite providers would be considered inpatient facilities.

Q77: Attachment E indicates that the AIC could approach 14,500. Is this based on a general growth rate assumption or specific changes (e.g., another facility, etc.)?

A77: DOC’s population was approximately 14,500 AICs when the RFP document was created. It is now approximately 12,048. An amendment will be issued to reflect this.

Q78: Can you provide the current contract and the prior RFP?

A78: Per Section 4.3, all prior procurement processes prior to this RFP are not available through the Q&A process. Please see OregonBuys for the current contract (search for 291-6060-16). For the previous RFP, that is available through a public records request. The public records request process can be found here: Department of Corrections : Public Record Requests : Research and Information Requests : State of Oregon https://www.oregon.gov/doc/research-and-requests/pages/public-records.aspx https://www.oregon.gov/doc/research-and-requests/pages/public-records.aspx

Q79: Can you provide the annual summary from the existing incumbent for 2020, 2021, and 2023?

A79: DOC does not currently require an annual summary and we do not have the numbers for the years requested.

Q80: Will the DOC be housing only Oregon residents or also residents from other states?

A80: DOC houses AICs from other states.

Q81: Can you confirm that the border hospitals participate in Oregon Medicaid as well as the other applicable state’s Medicaid program (WA/ID)?

A81: This is an unknown at this time.

Q82: Is the DOC willing to negotiate the terms and conditions of the sample contract? Will it render a response non-responsive if vendors submit suggested changes to the terms and conditions?

A82: Per Section 5.4.1 of the RFP, the Terms and Conditions that DOC will negotiate will be methods of payment, term of contract, and pricing.

Q83: Page 28 Sec D 1 b - Can you clarify the number of expected users/concurrent users accessing the "Claims data analysis information" and also confirm this is intended to be a web portal for claims reporting?

A83: We have between 10 and 25 individuals who might have access to the Claims portal. Yes, this shall be a web portal.

Q84: Page 38 Sec H 2 i - Is it acceptable that the ICN identify the claim based on date of receipt and not date of service?

A84: As long as both date of service and date of receipt is available for reporting and sorting.

Q85: Page 39 Sec H 2 f iii - Can you elaborate on this requirement, what supplemental attachments and mailing does this reference?

A85: Any documentation required by the provider to complete the claim.

Q86: Page 40 Sec H 2 l i - While authorizations can be an integral part of claims adjudication, authorizations are typically provided by those responsible for generating and approving an authorization for services not the servicing provider, can you clarify this requirement?

A86: Currently, authorizations are entered into the Contractor’s Claims system, which then generates an authorization number for the provider. Our intent is to continue this practice.

Q87: On page 6 RFP, complex dental procedures is a requested service. Can you give an example of a complete dental procedure as compared to oral surgery?

A87: DOC has been short-staffed with full time dentists for several years. It has been our experience that creating single-case agreements and full contracts for dental services has been our best option. These services are not limited to just oral surgeries but some routine care like simple extractions and root canals when the service is not available in the institution.

Q88: On page 7 RFP, “ODOC wishes to obtain certain On-site services through the contract resulting from this RFP when those services are not available within the ODOC health services program. Such services are limited to:

• Services which are the result of continuation of care for an AIC who was treated Off-site; and

• Specialty physician services; services related to On-site clinics for MRI, CAT scans, stress tests, and mammography; and other services as approved in advance in writing by ODOC.

Are you requesting on site specialty physician services, MRI, CAT scans, stress tests and mammography, etc. or services FROM these services be provided off-site?

A88: We are requiring the Contractor have the ability to enter into single-case agreements and full contracts when services are not able to be provided on-site and a provider is willing to come inside the institution. Transporting AICs is costly and has an inherent risk to the AIC, staff, and the community.

Q89: On page 11 of the RFP and page 26 of the contract. Can you describe the Medicaid eligibility services now? How many staff cover this service. Where are they located? Are any calls made remotely?

A89: DOC’s Medicaid staff (2) coordinate interviews and application completion between Oregon’s OHA and the AIC. Both Medicaid Specialists are stationed in Salem, and do work remotely.

Q90: Section 2.4.5 Utilization Management of the RFP. How many staff and and what levels (RN, LPN, etc) support the inpatient and outpatient concurrent review and UM program? Where are they located?

Are any calls made remotely? (Understanding the contract pg 33, requires a minimum of 2 Oregon-based nursing staff.

A90: We currently have two RNs, our TLC which consists of several MDs, and approximately six other health professionals and support staff who oversee the inpatient and outpatient concurrent review— these positions are made up of contractors and DOC staff.

Q91: Does the claimants in Attachment H refer to lives? If so, can you share how many claims per month are currently processed?

A91: The claimants refer to individual AICs. Currently, approximately 2,000—2,500 claims are processed per month.

Q92: Can you share any information on the cost model to maintain current staff for concurrent review nurses and staff managers as well as Medicaid eligibility staff?

A92: DOC is a taxpayer funded state agency with a limited number of available positions and biennial budget. We have permanent Medicaid Specialist positions built into our biennial budget and the concurrent review nurses and staff managers provide this service as additional duties.