S000000107 Questions and Answers.pdf

Q # Question Subject Question Response

1 Attachment B - Schedule of Benefits

Attachment B appears to show a high level of the benefits for Actives and Retirees under age 65.

Please provide the full EOC (evidence of coverage) for the Medicare / over age 65 retirees.

See Attachment B: Schedule of Benefits Revised

4.14.22 .

2 Census File Please confirm everyone listed on the census file is enrolled in Medicare. Please confirm if Non- Medicare dependents are included on the census

The census file includes all members with active medicare coverage. Non medicare dependents were not included in the census file.

3 Census Please indicate which members, if any, under age 65 have Medicare Parts A & B as primary?

There are 1,116 people in the census under age 65 who have Medicare Parts A & B as primary.

4 Census Are you able to provide dates of birth for Medicare primary retirees? Dates of birth will not be provided.

5 Contribution Strategy

Will the current contribution strategy remain in place or will the strategy change with the addition of Medicare Advantage? If yes, please explain.

The contribution strategy will be determined based on proposed pricing, final contract details, and other considerations. This will be addressed in more detail during Discussions.

6 Attachment B Please provide the Rx benefit plan design you would like quoted for the ASE and PSE retirees?

See Attachment B: Schedule of Benefits Revised

4.14.22 .

S000000107 Medicare Advantage Prescription Drug Services Questions and Answers

7 Financial Summary

Are Part B Rx claims included in the claims provided? And if so, are they included in the pharmacy or medical claims data? If not included in medical or pharmacy data please provide.

Yes, the Part B Rx claims are included in the medical claims.

8 Financial Summary Thank you for providing the monthly paid claims summary. In reviewing, there appears to be a discrepancy in the medical data provided where the paid amounts are greater than the Medicare Allowed amount. For example, adding ?Plan Paid? plus ?Member Paid? plus ?Medicare Paid?

does not equal ?Medicare Allowed Amount?, and in all cases, with the exception of June 2019 on the ASE population, the paid amount is more than the Medicare allowed. This amount ranges considerably, in excess of up to $93.84. The same applies for the PSE population. Can you explain the reason for the difference or provide a corrected file?

The current Medicare plan is a coordination of benefits plan administered by Blue Cross. Some of the variance is a result of claims that are not covered by Medicare but are covered and allowed under the Plan. The monthly summary was intended to provide additional information to supplement the detailed claims and provide historical information. The State has no additional detail to share.

9 Attachment B

Attachment B includes the SOB for Under 65 retirees. Assuming we should provide a 100% plan to match the existing Medicare Secondary Plan in place today?

See Attachment B: Schedule of Benefits Revised

4.14.22 .

10 Contribution Strategy

For retirees opting-out of the MAPD plan, will they be subject to a higher contribution?

The contribution strategy will be determined based on proposed pricing, final contract details, and other considerations. This will be addressed in more detail during Discussions.

11 Selection Process

For the interview, what types of questions do you anticipate asking? Will the questions be provided in advance? We understand your desire to limit attendance to 1 person, so to ensure we have the best representative available any guidance you can provide here will be extremely valuable.

Questions will be determined by evaluators after reviewing written proposals and will be provided to Prospective Contractors when the interviews are scheduled.

12 Formulary Can we get a copy of the current formulary in excel format with NDC? See Attachment D: Formulary with NDC .

13 Covered Drugs Are there any additional drugs covered on buy-up lists? See Attachment D: Formulary with NDC .

14 Rx Coverage Does your no cost preventative vaccine coverage include both Part B & Part D vaccines? Yes.

15 Rx Coverage

Are there drugs other than statins, bowel prep, and vaccines that are currently covered under ACA that you would expect continued coverage of?

See Attachment D: Formulary with NDC .

16 Plan Administration Please elaborate as to what support EBD is seeking with regards to handling split-family contracts

The State will rely on the Prospective Contractor's expertise in handling split-family contracts. This subject will be addressed during Discussions.

17 Eligibility Requirements

Confirm if contractor shall update eligibility data within 24 business hours from receipt of data

Confirmed. This is a minimum Requirement under a resulting contract.

18 Solicitation Terms and Conditions

The RFP mentions agreeing to Terms and Conditions, and has a link for the Solicitation Terms and Conditions document on the State's website. Are we to review the Solicitation Terms and Conditions document and provide any deviations/redline?

Yes. Exceptions should be specified on the Exceptions Form in the Technical Proposal Packet .

19 Solicitation Terms and Conditions

If there any deviations to the Solicitation Terms and Conditions document, should those be listed on the Exceptions Form?

Yes.

20 RX Data File

File ARK_MAPD_RFP_Rx_File received appears to only include retail claims. Are there any mail order claims? If so, please provide an updated RX Claims File.

Yes, 0.3% of the claims are mail order and they are included in the file.

21 Section 2.22 of RFP

- PGs

Section 2.22 refers to Performance standards, are there defined requests or should our standard PGs be included?

Performance Standards will be negotiated during Discussions.

22 Section 2.20 of RFP

- Rx Bonus Drug List o The RFP refers to a bonus drug list and additional drug coverage (2.20.F: The Contractor shall propose supplemental coverage that wraps around the basic Medicare Part D benefits and are not covered under Part D (i.e., bonus drug list).) Can you please provide the data required for this and what the bonus drug list is? Should we include the expanded rider w. $0 ACA drugs?

See Attachment D: Formulary with NDC . Additional details on bonus drug lists will be discussed in Discussions.

23 Section 2.2 - Opt Back In o RFP shows members can opt back in (2.2: If a member beneficiary opts out of the MA-PD PPO Plan, he/she may elect to opt back into the group Medicare Primary plan.) Can members opt back in to the original plan at any point in the year or only during open enrollment?

EBD anticipates members will only be allowed to opt back in during Open Enrollment. However, this limitation will be dependent upon the Prospective Contractor's experience and expertise and any applicable regulations.

24 Onsite FTEs o RFP requests 2 onsite FTEs (2.8.B: The Contractor shall provide two (2) full-time, dedicated employees to work onsite at the EBD office in Little Rock to serve as member service representatives.) If this doesn?t get approved, will they still consider [vendor]?

The two (2) full-time, dedicated employees working onsite at the EBD office in Little Rock is a minimum Requirement under a resulting contract.

Section 2.7.6 - Members with Part B Only

Are there any members with Part B coverage only? (2.7.6: Members with Part B coverage only) No.

Section 2.5.H - Readiness Assessment

The RFP refers to a readiness assessment (2.5.H: The Contractor shall complete and bear the cost of readiness assessments to the satisfaction of EBD.) What does this refer to?

The readiness assessment is a review conducted by EBD staff to ensure the Contractor's operational readiness. Readiness review will include verification (by EBD or its agent) that EBD's benefits have been properly loaded into the Contractor's claims processing system. EBD will provide the Contractor with a summary of findings as well as areas requiring corrective action.

27 Geo Access Report Are you looking for a GeoAccess Report? Not as part of the Prospective Contractor's proposal submission.

28 Final Submission Are we able to upload everything as 1 zip file?

Submission documents can be uploaded as one file or as individual files as attachments to the Prospective Contractor's response.

29 Is there a limit to total size of files to be uploaded?

No, but there is a page limit to the Information for Evaluation response documents (see Technical Proposal Packet).

30 Services Contract Form - Section 7b

The RFP includes a Services Contract form, which includes various sections that require completion. However, Section 7(b) of the ?Solicitation Terms and Conditions? states: ?Do not alter any language in any solicitation document provided by the State.?

What is the State?s expectations with regard to the Services Contract form? Specifically, should bidders complete the Services Contract form?

Also, are bidders permitted to revise the terms of the Services Contract, if needed, to be consistent with federal laws and regulations applicable to the Medicare Advantage program?

The Services Contract referenced in the RFP will be the final contract document and will require signature by the State and the selected Contractor. Prospective Contractors should not complete the Services Contract as a submission document.

Prospective Contractors should submit applicable exceptions to the Services Contract on the Exceptions Form (see the Technical Proposal Packet ).

31 Pharmacy Question Can you please provide a detailed pharmacy plan design for the ASE group. We did not see one attached with the RFP and need it to quote.

See Attachment B: Schedule of Benefits Revised

4.14.22 .

32 Pharmacy Question - Enrollment

Can you please provide membership by month, from 7/2020 ? 12/2021, for the members in the ASE group that enroll in the pharmacy plan? Per the RFP documents it seems that members have ability to elect medical only or medical paired with Rx.

As of 4/1/22, there are 208 Medicare-eligible members that elected medical and waived the pharmacy plan.

33 Pharmacy Question - Risk Score

Can you please provide the plan year 2021 part D risk score?

The current ASE pharmacy plan is not a Part D plan.

As a result, risk scores are not available.

34 Pharmacy Only

CMS does not allow Medicare eligible members to simultaneously enroll in a group Medicare Advantage plan and individual market Rx. They must either have group MAPD or IVL MAPD.

Since the ASP members will not be able to elect group MA with IVL Rx as they can with SI medical plans today, would you like us propose a group plan either matching the existing Rx group plan or a plan similar to the plans available on the individual market? If so, should we assume that members will pay full cost of that plan Rx plan?

Otherwise members will be removed from one of the plans by CMS (group or IVL) and lose access to medical or Rx coverage.

Please propose one MA-PD plan for both PSE and ASE retirees using the current medical benefits and the current ASE Rx benefits. If a Medicare-eligible retiree elects a separate pharmacy plan, the retiree will not be eligible for the MA-PD.

35 RFP Section 2.7.C.6 Does State of AR intend for Prospective Contractor to cover Members with Part B only coverage under the MAPD plan?

All members of the Plan are currently covered under Part A. Membership in the MA-PD will require coverage under Parts A and B.

36 Final Submission Process

Does each final proposal document need to be uploaded individually vs. a zip file? See Question 28.

37 Formulary Disruption

The RFP states: ?A. During Discussions, the Prospective Contractor shall provide a MA-PD PPO Formulary and Clinical Program Management and Disruption Plan that must address, at minimum, each of the Requirements in this subsection and formulary details, including drug exclusions, therapeutic alternatives, and specialty formulary proposed. 1. Prospective Contractors shall submit a detailed formulary disruption report with their proposal response.

The disruption report will not be assigned a score but is required for submission.?

Please clarify if the detailed formulary disruption report is to be submitted during discussion or with the Technical Proposal Packet.

If it is to be submitted with the Technical Proposal Packet, please confirm in which section is should be placed.

The detailed disruption report must be submitted with the Prospective Contractor's response. It can be submitted as a separate file or attachment, and must not be included in the Experience, Solution, or Risk sections of the response.

38 Extension

Given some of the data elements requested in order to quote and the need to clarify Rx plan strategy, would the state consider offering an extension?

No.

39 Extension

Given some of the data elements requested in order to quote and the need to clarify Rx plan strategy, would the state consider offering an extension?

No.

40 Eligibility members losing Part B coverage, will the State allow for a grace period prior to terming the member?s MAPD plan and prohibiting re-enrollment?

Yes, EBD allows for a grace period for members that lose Part B coverage as a result of a disability (assuming they have Part A). EBD plans to explore this issue and understand the process behind it during Discussions.

41 Final Submission Process

How do we submit the final proposal documents within ARBuy?

Prospective Contractor response must be uploaded as an attachment (as a single file or as multiple files) to the Prospective Contractor's response in ARBuy.

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