S000000375 TPA Questions and Answers Final.pdf

QUESTION NUMBER QUESTION SUBJECT QUESTION TEXT ANSWERED BY ANSWER TEXT

1 Procurement Site Is there a file size limit for documents loaded to the procurement site? OSP The file size limit is 450 MB.

2 Procurement Site Can you please confirm if there are any size requirements on the files that can be uploaded?

OSP The file size limit is 450 MB.

3 Procurement Site Are there any file type requirements on the files that can be uploaded, for example can we upload the entire proposal as a zip file?

OSP

Due to the file size limits, it is recommended to upload the claims documents in Excel. Yes, you can upload zip files to ARBuy.

4 1.3 Definition of Terms If there are deviations to the "shall" or "must" statements, will they be considered or must contractors completely agree?

F&F

Shall and must are mandatory requriements. Not meeting these requirements may cause a Prospective Contractor's proposal to be rejected.

5 1.3 Definition of Terms Do the "shall" or "must" statements apply differently if only a portion of the population is awarded?

F&F

Shall and must are mandatory requriements. Not meeting these requirements may cause a Prospective Contractor's proposal to be rejected.

6 1.4 Solicitation Schedule Will an additional round of bidder questions be allowed if the answers to questions asked results in additional clarifications needed?

F&F No.

7 1.4 Solicitation Schedule Given the delay in receiving the census and repricing information, will the TSS

OSP consider granting an extension to the due date?

F&F

No further changes to the tentative solicitation schedule are anticipated.

Section 1.7, Item B.c.iv: Prices must be firm offers for first three years...

Please define how Prospective Contractor should distinguish between the firm pricing for the first 3 years and the remaining 4 years of the 7-year contract, as the formula in column E (tabs 1 and 2) on the Price Sheet only calculates for 7 years.

F&F Please see revised Official Solicitation Price Sheet.

9 2.3.H Minimum Qualifications The Prospective Contractor shall be URAC accredited. Is NCQA accreditation acceptable?

F&F

Where accreditation is required, either URAC or NCQA accreditation will be acceptable.

Please refer to the revised RFP, Section 1.7.B.3.e and Section

2.3.H.

10 General Are there any additional contractors that need to be coordinated with? Such as passing data or integration to other contractors.

F&F

Standard coordination with other contractors (e.g., technology partner, PBM) will be necessary.

11 General What is the current shared savings arrangement and what percentage is charged for any out of network claims spend?

F&F This information is not necessary for responding to the RFP.

12 General

Can you please provide an enrollment report that shows monthly subscribers and members for the last 3 policy years (YTD) and broken out by ASE and their 3 plans, as well as PSE and their 3 plans?

F&F Current plan enrollment breakdowns can be determined from the census data file.

13 Funds Can you please provide any current fund amounts the State receives (i.e. wellness, reporting, communication, audits, etc)?

F&F This information is not necessary for responding to the RFP.

14 Participation On a slice scenario, can a minimum participation requirement be proposed? For example XX% of total eligible or set number of enrolled?

F&F No, this is not acceptable.

15 MWBE

Is there a minimum requirement for MWBE funds to be included, i.e. a % of total fees?

F&F No.

16 MWBE Are there current MWBE funds included? EBD No.

2.6.B Health Insurance

Requirements

1. When you say a la carte, does that mean you want to be able to source solutions from different providers on one platform?

2. Or are you asking for the ability to have the contractor offer different options that you can choose from the services the contractors offering?

F&F

1. No.

2. No. To clarify and in keeping with the applicable section of the

RFP, Prospective Contractors shall provide menu of services from which EBD can select.

18 Current Admin Fees Are current administration fees available? F&F No.

S000000375 Third Party Administrator Questions and Answers

19 2.8 Staffing Requirements Is there a minimum requirement for onsite/in-state staffing beyond the dedicated account manager and healthcare providers?

F&F No.

2.11.F Claim Adjudication

Process

Can additional details be provided for the weekly provider and facility information that will be delivered to EBD?

F&F No.

2.14.A Medical Management

Requirements

Are statistics available on the number of members enrolled in the following services?

a. Case management

b. Disease management

c. Utilizations management

d. Maternity management

e. Wellness program

F&F No.

2.15.D Case Management

Requirements

What are the expectations of the contractor to manage, set up or schedule administration of IV therapy?

F&F

The Contractor is expected to manage and coordinate the care for members, including IV therapy.

23 2.15.G Case Management:

The Contractor shall monitor compliance protocols for specific disease states as determined by EBD (for example, compliance with Hepatitis B protocols).

Question - Would the selected contractor be monitoring these protocols to ensure physicians are following or monitoring facilities? Are these national compliance protocols or state level protocols?

F&F

Yes, the Contractor is expected to monitor physician compliance with protocols.

National compliance protocols should be applied unless there is a superceding state-level protocol.

24 2.15.O Case Management:

The Contractor shall coordinate prescription drugs administered with J-codes, and/or in a provider setting, and Behavioral Health Services.

Question - What other contractors would we be asked to coordinate with? The member or contractor? What type of coordination is being requested?

F&F Coordination means working together with all of our partners to provide a seamless customer service experience.

2.18.C Maternity Management

Services

The Contractor shall maintain capacity for the following minimum prenatal visit schedule:

1. Weekly appointments from weeks 4-28 of gestation

2. Bi-weekly appointments from weeks 28-36

3. Weekly appointments from week 36 through delivery

4. Accommodation for additional visits as medically necessary.

Question - Is this request around provider visits or capacity for telephonic maternity management consults by nurses?

F&F This requirement is with respect to provider visits.

26 2.20.B Nurse Line Services Are statistics available on the number of members utilizing the 24/7/365 toll free nurse line?

EBD Please refer to Attachment D Nurse Line Utilization.

27 2.20 Nurse Line Services

1. When you say a la carte, does that mean you want to be able to source solutions from different providers on one platform?

2. Or are you asking for the ability to have the contractor offer different options that you can choose from the services the contractors offering?

F&F

1. No.

2. No. To clarify and in keeping with the applicable section of the

RFP, Prospective Contractor shall provide menu of services from which EBD can select.

2.22.C Implementation and

Testing Requirements

Can additional details be provided on what technical updates and changes that must be completed no later than August 1, 2025?

F&F

It is EBD's intention to be able to test the successful Contractor(s)' implementation and service components to allow for open enrollment in the fall of 2025 and for a successful effective date of

January 1, 2026.

2.23 Operations and Security

Requirements

Will the State of Arkansas agree to allow the contractor to use our own information security policies? While the bidder's policies differ from the State of Arkansas, bidder's policies have complimentary scope and controls in place and fully meet

State of Arkansas' intent of ensuring the security of the State of Arkansas' data and the availability of our services. The Contractor will partner with the State of

Arkansas, including providing discussions with our information security professionals to identify mutually satisfactory approaches, support our claim that our policy is able to ensure the State of Arkansas' sensitive data is secure. Bidder must manage to our own policies as we support many different customers

(including federal, state, local government, higher education, K-12 and private clients) in our multi-tenant environment using a "common support" approach using a single industry standard security policy across the enterprise.

F&F

If the Contractor's information security policies are deemed by OSP and EBD to meet or exceed the State and Arkansas' requirements, then that would be acceptable.

30 Large Claims

Are large claims reports available for the same period as the monthly claims report, preferably by policy period (2022, 2023, 2024)? This would show individuals with total large claim amount, diagnosis and service date, if available.

F&F

Additional information will not be provided at this time. High-cost claimants can be identified through analysis of the claim repricing files.

31 Claims Experience Can you please provide monthly claims for the last 3 policy years (YTD) and broken out by ASE and their 3 plans, as well as PSE and their 3 plans F&F

Detailed claim files with monthly claims during 2023 have already been made available.

2.30 EBD's Responsibilities and

Roles

Please describe the current clinical and customer service programs. Are the resources dedicated or designated? Is it a high-touch clinical model? Please provide a listing of programs included.

EBD This information will not be provided.

2.30 EBD's Responsibilities and

Roles How many dedicated resources (employees) administer the plan currently? F&F Approximately 35.

2.31 Employee Assistance

Program Requirements Who is the current vendor? F&F Lucet.

2.31 Employee Assistance

Program Requirements What visit model is in place today? F&F

Three (3) initial phone visits per household member per life event and then additional in-person or telephonic as needed. Additional mental health resources are generally available.

2.31 Employee Assistance

Program Requirements What is the current PMPM for the EAP? F&F This information is not necessary for responding to the RFP.

2.31 Employee Assistance

Program Requirements

Will you want a work life quote as well? Do you have one today and is the work life

PMPM included in the overall EAP PMPM rate or is it charged separately?

F&F No.

2.31 Employee Assistance

Program Requirements

How many training/critical incident hours are included in the program today and are you being charged an hourly rate or are they baked into the current PMPM?

F&F Critical incident hours are currently charged on an hourly rate basis.

2.31 Employee Assistance

Program Requirements Please send us the most recent annual report. F&F This information will not be provided.

2.31 Employee Assistance

Program Requirements Are 1st responders included in the population? F&F No.

2.31 Employee Assistance

Program Requirements

Are there any onsite EAP resources being provided by the current vendor? If so, are they full time and what is their role?

F&F No.

2.31 Employee Assistance

Program Requirements

Are there any state employed EAP management resources in place today, if so how many and what is their role?

F&F

There are currently no state-employed EAP resources. EAP services are currently provided by a Contractor.

43 EAP Utilization Can we please receive 12 months of EAP utilization experience? EBD Please refer to Attachment E EAP Utilization Report 2024.

44 Current EAP Coaching Benefits Can you please clarify what the credentials of these coaches are? EBD

EBD does not have credential information on all of the coaches on the current contract. Prospective Contractors should propose resources with credentials and qualifications standard for the field of service they will be providing.

45 Current EAP Coaching Benefits Can you please briefly describe what coaching services, programs, etc., are available?

EBD Please refer to Attachment F Introduction to EAP.

46 Section 2.31.O

The Contractor shall meet with an AR Employee in extreme crisis (harmful to self or others on an emergency basis.) Can you please confirm if this is telephonic or face to face?

F&F The mode of interface with an employee in extreme crisis should be situation-specific to best address the crisis.

47 Section 2.31.T

The Contractor shall notify EBD of any changes to the Statewide Network coverage within 1 business day of the change. Can you please confirm if this means if a provider gets added and/or terminated?

F&F Confirmed.

48 RFP EAP

We provide a 3 year flat rate guarantee and subsequent renewals will be based on our organization's standard renewal analysis, is the State opposed to this?

OSP

The State will negotiate annual increases for renewal years as outlined in Section 1.7.B.2.c.iv in the RFP.

49 2.31 Is EAP pricing required in the Official Solicitation Price Sheet if the prospective vendor opts to not quote an EAP solution?

OSP

The EAP program is a mandatory optional. Proposals that do not include the EAP program will be rejected. See Section 2.31.A of the

RFP.

50 2.34 Performance Standards Are performance guarantees being requested and if so does the State have any specifics they are requesting?

F&F

Current Performance Standards are attached to this Q&A document as an example. Performance standards will be negotiated during the Discussions phase.

Please see Attachment G Performance Standards Examples.

Section 3.1, Item C.1:

Prospective Contractors shall attend the interview as scheduled

Please confirm that a finalist presentation by the prospective contractor will be included in the interview.

OSP

Interview agendas will be provided to qualifying Prospective

Contractors after the State has completed evaluation of the written technical responses. More information on the interview process can be found in Section 3.5.D in the RFP.

Official Solicitation Price Sheet

Tab # 1 Major Components Would PEPM be acceptable in place of Per Member Per Month (PMPM)? F&F No, fees must be on a PMPM basis.

Official Solicitation Price Sheet -

Tabs #1 & #2

Please clarify the time period for which the percentage of membership awarded should be applied in columns G-K (tabs 1 and 2) on the Price Sheet, (e.g., first 3 years).

F&F See revised Official Solicitation Price Sheet.

Official Solicitation Price Sheet -

Tabs #3

Please confirm that the provider discounts reported on tab 3 of the Price Sheet should be for 2022 and projected for 2023, and not for 2024 and projected for

2025, as stated on the pre-bidder's call.

F&F Correct, actual 2022 discounts and projected to 2023.

55 Official Solicitation Price Sheet Can more details be provided on the how the calculation of actual full year 2022 weights on tab #3, provider discounts?

F&F

These five (5) percentages should sum to 100% and represent the breakdown of total eligible charges during 2022.

56 Pricing Sheet

On the Official Solicitation Price Sheet for Medical, is the PMPM fee illustrative based on an assumed average contract size (acs) of xxx and will billing on a PEPM basis be acceptable? If not acceptable, can all fees be billed through the client's bank account?

F&F Fees must be on a PMPM basis. Banking and billing arrangements will be discussed during the Discussions phases.

57 Benefit Maximums

After reviewing the benefits it looks as though there are some benefits that have dollar maximums that are not allowed due to the essential health benefits mandates. Would the State like to select a different EHB state to apply the dollar maximums to their benefits or would the state like to follow the State of Arkansas

EHB and exclude dollar maximums?

F&F Assume the plans are administered as described in the SPDs and benefit summaries.

SPD and Summary of Benefits for Premium and Classic Plan

In the Summary plan description on the premium and classic plan the deductibles and out of pockets are showing separate cost share amounts for state employees

vs. school employees but on the benefit summary of benefits and the ASE

Summary it does not show the cost shares broken out. Can you please confirm if there should be separate deductibles and out of pockets for state employees and school employees?

F&F

Currently, there are different deductibles and out-of-pocket maximums for the Premium, Classic, and Basic plans for ASE and

PSE employees.

59 Pricing Sheet -EAP Rates Can the pricing be on a PEPM basis because we assume membership based on a factor determined by our actuarial analysis?

F&F Fees must be on a PMPM basis.

60 Claim Repricing Files

Does EBD expect a repriced amount on every claim line in all files? Can a case rate be applied to one claim line on a single claim and with other claim lines on that claim record priced at $0?

F&F Yes. But a case rate is acceptable where appropriate. It must be clear which claim lines apply to each claim number.

61 Repricing Files Can you please confirm if a line-by-line repricing is requested or if a summary will suffice?

F&F

Line-by-line responses are required. If a case rate applies, then refer to response to Question.

62 Repricing

If a line-by-line repricing is being requested, Will the State sign an NDA in order to release the confidential information. If the state will sign how should we send over the NDA?

OSP

No. Prospective Contractors may provide a redacted copy of their response documents.

Please refer to Section 4.5, Proprietary Information, of the RFP.

63 Repricing

If the state will not sign an NDA for release of our confidential information. Can the state please explain how they will keep our information confidential in the event there is a of a FOIA request?

OSP Please refer to Section 4.5, Proprietary Information, of the RFP.

64 Repricing

If the state will not sign an NDA for release of our confidential information. Can the state please explain how our confidential information data will be protected and not released to any third party?

OSP Please refer to Section 4.5, Proprietary Informtion, of the RFP.

65 Repricing

In order to do a claim repricing we will need Eligible or billed charges on the repricing files; can you please confirm if the "Charges" column is either Eligible or

Billed? If not, please provide an updated file that includes this information

F&F Charges reflects eligible billed amounts before provider discounts are applied.

66 Census Can you please provide a census that includes all eligible employees and waivers? F&F There are approximately 144,000 members enrolled in the program.

Refer to the census data provided for details.

67 Census Can you please confirm what the Primary plan is on the census under the Plan

Option column? I do not see a plan labeled Primary.

F&F

The Primary plan benefits are the same as the Premium plan, but coordinated with Medicare.

68 Claims Files

After reviewing the claims file there were a couple of vital fields missing. Could you send an updated file that includes eligible or billed dollars instead of covered amount? The covered amount will skew the results because it is after the discount is applied. Also, the file did not contain provider zip code information which verifies specific location for an accurate result.

F&F

Charges reflects eligible billed amounts before provider discounts are applied. In Prospective Contractors' responses, apply your discount to calculate your Allowed Amount entry.

There is no additonal provider data that will be provided.