RFP-CMS-2011-0009 Amendment 1.docx

RFP-CMS-2011-0009

Amendment 1

SECTION M – EVALUATION FACTORS FOR AWARD

M.1 EVALUATION METHODOLOGY

(a) In deciding whether to apply for a design contract, states should assess their Level of Readiness with respect to moving forward with a duals demonstration model:

· Low: state has done little or no thinking to date with respect to duals integration;

· Medium: duals are not yet a high priority but the state has done some preliminary analysis/assessment regarding how it might improve the access, quality, beneficiary experience and costs of care for its dual eligibles; or

· High: state has previous experience in developing care interventions targeting the duals and/or has done considerable work to understand the population and identify opportunities for delivery system and/or payment reforms.

The overall goal of the state demonstrations is to identify and validate delivery system and payment integration models that can be rapidly tested and, upon successful demonstration, replicated in other states. As a result, the state design contracts are targeted at states displaying a medium to high level of readiness and that will be able to develop a demonstration model ready for implementation in 2012. CMS and the FCHCO have plans to provide separate technical assistance activities for states early on in the process with the idea that those states may be able to move toward greater integration at a later date.

(b) States will be evaluated based on the degree to which their proposal is consistent with the above goals as well as on their ability to adequately meet the following criteria:

1. Overall Approach to Integrating Care The state demonstrates a thorough understanding of the target population and the current environment through which they receive care. It must also offer a plausible policy rationale for how the proposed approach to integrating care will significantly improve the quality, cost-effectiveness, and experience of care for dual eligible individuals.

2. State Capacity and Infrastructure The state has the necessary personnel and related resources needed to support the design of the integrated demonstration proposal. If there are gaps in the state’s current capacity, the proposal should describe how the state will use funds made available through the design contract to obtain resources/build the capacity within the given timeframe.

3. Analytic Capacity The state has experience analyzing fee-for-service and/or managed care encounter claims data (as applicable). The state has access to both Medicaid and Medicare data or has a plan for obtaining and linking both sets of data in order to conduct duals specific analyses.

4. Stakeholder Engagement The state demonstrates an understanding of or is in the process of assessing its current stakeholder environment (including beneficiaries, advocates, providers, plans, etc.). It also has a plan for engaging such stakeholders during the development of its integrated care demonstration proposal.

5. Timeframe Proposed timeframe is reasonable and consistent with the 2012 implementation objective.

6. Budget Requested amount is reasonable and proposed use of funding is appropriate for undertaking the activities of the contract.

M.2 EVALUATION RATING

The Government will apply the below listed adjectival ratings to the State proposals, based upon the evaluation factors set forth in sections M.1(a) and M.1(b):

1. Outstanding: Proposal exceeds requirements in a way that provides added value to the CMS, has little or no potential for schedule disruption or continuation of positive performance. Normal contractor effort should be able to overcome performance problems.

1. Satisfactory: Proposal demonstrates the potential to meet the requirements of the proposed model. There is some concern of disruption of schedule or degradation of performance. However, special contractor efforts may be able to overcome problems.

1. Marginal: Proposal contains minor deficiencies and/or weaknesses which could have an adverse impact of significant disruption of schedule or degradation of performance.

Note: as stated in FAR 15.304(c)(1) Price or Cost to the Government shall be evaluated in every Source Selection.