S000000390 Managed Care for Workers Compensation REVISION TWO.pdf

STATE OF ARKANSAS

DEPARTMENT OF TRANSFORMATION AND SHARED SERVICES

OFFICE OF STATE PROCUREMENT

501 Woodlane St., Ste. 220

Little Rock, Arkansas 72201-1023

REVISION TWO

REQUEST FOR PROPOSAL

SOLICITATION DOCUMENT

CHANGES TO THIS RFP ARE DISPLAYED IN RED FONT

SOLICITATION INFORMATION

Solicitation Number: S000000390 Solicitation Issued: January 10, 2025

Description: Managed Care for Workers’ Compensation

Department: Arkansas Insurance Department Public Employee Claims Division

SUBMISSION DEADLINE AND DELIVERY OF RESPONSE DOCUMENTS

Proposal Opening Date: February 10 12, 2025 Proposal Opening Time: 2:00 PM 11:00 AM Central Time

Proposal submissions for this Request for Proposal must be submitted through ARBuy, the State’s eProcurement system. It can be accessed at arbuy.arkansas.gov. Proposals received after the submission deadline may be rejected as untimely.

LIVE PROPOSAL OPENING INFORMATION

Teams Meeting Link: Join the meeting now

Meeting ID: 240 335 962 29

Passcode: zn6RW95B

Call in (audio only):

Phone Conference ID:

501.244.3310 or find a local number 395 328 984#

TSS OFFICE OF STATE PROCUREMENT CONTACT INFORMATION

TSS OSP Procurement Specialist:

Julie Robnolt Procurement Specialist’s Direct Phone Number:

501-371-6070

Email Address: julie.robnolt@arkansas.gov TSS OSP’s Main Number: 501-324-9316

TSS OSP Website: transform.ar.gov/procurement/ https://arbuy.arkansas.gov/ https://teams.microsoft.com/l/meetup-join/19%3ameeting_MGY4Y2FlOGMtZTExYi00ZTIwLWI2MGUtZmNhOTIxMzg0ODhk%40thread.v2/0?context=%7b%22Tid%22%3a%225ec1d8f0-cb62-4000-b327-8e63b0547048%22%2c%22Oid%22%3a%22a5e9cf20-c478-4e36-8fed-351f1ae086e2%22%7d https://dialin.teams.microsoft.com/6b6513dc-a034-48d2-8d06-7e711c4ecc0b?id=719036839 mailto:julie.robnolt@arkansas.gov https://www.transform.ar.gov/procurement/

Rev 10/2024

SECTION 1 – GENERAL INFORMATION AND INSTRUCTIONS

1.1 INTRODUCTION

This Request for Proposal (RFP) is issued by the TSS Office of State Procurement (TSS OSP) for the Arkansas Insurance Department (“AID” or “Department”) Public Employee Claims Division (hereafter referred to as “the Division”) to obtain pricing and a contract(s) for Managed Care for Workers’ Compensation.

Contract(s) will be awarded to the Prospective Contractor determined to have submitted the proposal that is the most advantageous to the State. Direct all questions, comments, or concerns regarding this solicitation to the TSS OSP, not the Department.

1.2 TYPE OF CONTRACT

A. As a result of this RFP, TSS OSP intends to award a contract to a single Contractor.

B. The anticipated starting date for any resulting contract is July 1, 2025, except that the actual contract start date may be adjusted unilaterally by the State for up to three (3) calendar months. By submitting a signed proposal in response to the RFP, the Prospective Contractor represents and warrants that it will honor its proposal as being held open as irrevocable for this period.

C. The initial term of any resulting contract will be for two (2) years. Upon mutual agreement by the Contractor and Department, the contract may be renewed by TSS OSP for up to five (5) additional one-year terms or portions thereof, not to exceed a total aggregate contract term of seven (7) consecutive years.

1.3 DEFINITION OF TERMS

A. Unless otherwise defined herein, all terms defined in Arkansas Procurement Law have the same meaning herein.

B. “Business Day” means a week day in which normal business operations are conducted between 8 am and 5 pm, CST, excluding State holidays (listed here: https://www.sos.arkansas.gov/about-the-office/media-center/news/state-holiday-calendar/).

C. “Catastrophic Claim” means a very serious injury which will likely result in extensive permanent disability, long-term medical problems, loss of normal life, and potentially reduced life expectancy.

Examples of catastrophic injuries include traumatic brain injuries, spinal cord injuries, severe burns, and amputations.

D. “Prospective Contractor” means a responsible offeror who submits a proposal in response to this Solicitation.

E. The terms “Request for Proposal,” “RFP,” and “Solicitation” are used synonymously in this document.

F. “Requirement” means a term, condition, provision, deliverable, Specification, or a combination thereof, that is obligated under the Solicitation, resulting contract, or both.

G. “Responsive Proposal” means a proposal submitted in response to this Solicitation that conforms in all material respects to this RFP.

H. “Shall” and “must” mean the imperative and are used to identify Requirements.

I. “Specification” means any technical or purchase description or other description of the physical or functional characteristics, or of the nature, of a commodity or service. “Specification” may include a description of any Requirement for inspecting, testing, or preparing a commodity or service for delivery.

J. “State” means the State of Arkansas. When the term “State” is used herein to reference any obligation of the State under a contract that results from this Solicitation, that obligation is limited to the Department using such a contract.

https://www.sos.arkansas.gov/about-the-office/media-center/news/state-holiday-calendar/ https://www.sos.arkansas.gov/about-the-office/media-center/news/state-holiday-calendar/

1.4 SOLICITATION SCHEDULE

For informational purposes, TSS OSP is providing a Solicitation Schedule; however, dates listed and noted with an asterisk (*) are anticipated dates only and are subject to change at the discretion of the State. All times are listed in Central Time.

TABLE A: TENTATIVE SOLICITATION SCHEDULE

ACTIVITY DATE

RFP Release to Prospective Contractors January 10, 2025

Deadline for Prospective Contractor Questions January 16, 2025 @ midnight

Answers to Questions Posted to ARBuy* January 21, 2025

Proposal Due Date February 10 12, 2025 @ 2:00 PM

11:00 AM CST

Initial Proposal Evaluation* February 14, 2025

Interviews* February 18-19, 2025

Final Proposal Evaluation* February 19, 2025

Discussions Kick Off Meeting* February 24, 2025

Finalize Discussions* March 7, 2025

Post Anticipation to Award* March 11, 2025

Award Contract* April 2025

1.5 CLARIFICATION OF SOLICITATION

A. Submit questions requesting clarification of information contained in this Solicitation via the

Solicitation posting in ARBuy by the date and time listed in Table A.

1. For each question submitted, Prospective Contractor should reference the specific Solicitation item number to which the question refers, as applicable.

2. Prospective Contractors’ written questions will be consolidated and responded to by the State as deemed appropriate. The State’s consolidated written response is anticipated to be posted to the Solicitation posting in ARBuy by the close of business on the date provided in Table A. If Prospective Contractor questions are unclear or non-substantive in nature, the State may request clarification of a question(s) or decline to answer.

B. The Prospective Contractor should notify the TSS OSP Procurement Specialist of any Requirements that precludes the Prospective Contractor from submitting a Responsive Proposal.

C. Prospective Contractors may contact the TSS OSP Procurement Specialist with non-substantive questions at any time prior to the proposal opening.

D. An oral statement by TSS OSP will not be part of any contract resulting from this Solicitation and may not reasonably be relied on by any Prospective Contractor as an aid to interpretation unless it is reduced to writing and expressly adopted by TSS OSP.

E. Only an addendum written and authorized by the State will modify the Solicitation.

1.6 RESPONSE DOCUMENTS

A. All proposal responses must be submitted through ARBuy, the State’s eProcurement system. The system can be accessed at arbuy.arkansas.gov.

1. Prospective Contractors must be registered in ARBuy to submit proposals responses.

B. Technical Proposal Packet

1. Prospective Contractors shall utilize the Technical Proposal Packet to submit their responses.

https://arbuy.arkansas.gov/

2. The following items are proposal Submission Requirements and must be submitted as part of a Prospective Contractor’s proposal response.

a. Signed Proposal Signature Page; signature may be ink or digital.

b. Technical Proposal response to the Information for Evaluation section included in the Technical Proposal Packet, which must be in the English language.

c. Completed Official Solicitation Price Sheet attached to the Solicitation in ARBuy.

i. Pricing must be proposed in U.S. dollars and cents.

ii. Quantities stated are estimates only and are not guaranteed. Prospective Contractor must submit unit price on the estimated quantity and unit of measure specified.

• The State may order more or less than the estimated quantity on term contracts, and the Contractor shall sell to the Department quantities ordered at no more than the submitted price.

iii. If pricing documents do not allow for accurate pricing, Prospective Contractor should notify the OSP Procurement Specialist at least seventy-two (72) hours before the proposal opening time.

iv. Prices must be firm offers and adjustments may be negotiated at the time of contract renewal.

• A request for a price increase must include supporting documentation demonstrating that the increase in contract price is based on an increased cost to the Contractor and that the proposed pricing is still competitive in the marketplace. The State has the right to approve or deny any request for a price adjustment.

v. Discount from list pricing is not acceptable unless requested elsewhere in the Solicitation.

vi. State or local sales taxes should not be included in the price. Trade discounts should be deducted from the unit price and the net price should be shown in the pricing response.

d. Recommended Options Form

i. The Recommended Options form included in the Technical Proposal Packet allows Prospective Contractors to identify any recommended options or optional service ideas that may benefit the State that were not included in the Requirements and the proposed solution.

e. Copy of Prospective Contractor’s Equal Opportunity Policy

i. Pursuant to Arkansas Code Annotated § 19-11-104, OSP requires a Prospective Contractor bidding on a state contract to submit a copy of the Prospective Contractor’s Equal Opportunity (EO) Policy.

ii. Prospective Contractors not required by law to have an EO Policy must submit a written statement to that effect.

f. Proposed Subcontractors Form (see SRV-1, section 14)

3. The following items, which must be submitted prior to a contract award to the Prospective Contractor, may also be included with the Prospective Contractor’s proposal:

a. EO 98-04: Contract and Grant Disclosure Form (see SRV-1, section 11)

b. Voluntary Product Accessibility Template (VPAT), if applicable

4. Prospective Contractors should not include any other documents or ancillary information, such as a cover letter or promotional/marketing information.

https://transform.ar.gov/procurement/forms-and-reporting/#:~:text=Services%20Contract%20(SRV%2D1)%20Fillable%20Form https://transform.ar.gov/procurement/forms-and-reporting/#:~:text=Services%20Contract%20(SRV%2D1)%20Fillable%20Form https://www.section508.gov/sell/vpat/

C. Redacted copy of the Technical Proposal Packet

1. One (1) redacted (marked Redacted) copy of the Prospective Contractor’s proposal response (see Proprietary Information), if applicable.

D. Prospective Contractors should not alter language in Solicitation document(s) or Official Solicitation Price Sheet provided by the State.

E. Prospective Contractor’s proposals cannot be altered or amended after the proposal opening except as permitted by law or rule.

F. Prospective Contractors may submit multiple proposals.

SECTION 2 – REQUIREMENTS

2.1 BACKGROUND AND CURRENT ENVIRONMENT

The Division provides managed care services for the workers’ compensation claims filed by public employees. The workers’ compensation claims that will be covered by any resulting contract are:

• All employees of Arkansas State government agencies;

• All employees of the public colleges and universities of the State of Arkansas;

• All employees of the Arkansas county governments with injury dates prior to July 1, 1986;

• All employees of the Arkansas city governments with injury dates prior to July 1, 1986; and

• All employees of the Arkansas public schools K-12 with injury dates prior to July 1, 1994.

The Division receives approximately 2,600 workers’ compensation claims per year. The Division currently has the following number of open claims by category:

• State (agencies, colleges, and universities) 1,569

• City residual claims 11

• County residual claims 7

• School residual claims 34

1,621 Total Claims Open as of 12/4/2024

In fiscal year 2024 (July 1, 2023 – June 30, 2024), the currently contracted vendor processed 13,997 medical bills in review which amounted to 40,344 lines reviewed. The total amount of the billed charges processed through the contract was $15,068,684.11.

2.2 OBJECTIVES AND GOALS

The Department seeks to obtain a contract to provide managed care and medical cost containment services for employees of the State of Arkansas who have workers’ compensation claims. The Division manages these claims. Specific services to be provided include:

• Preferred Provider Organization

• Bill Review/Utilization Review Program

• Precertification of Hospital/Medical Services

• Negotiation of Medical Charges

• Peer Review

• Nurse Care Management

• Medical Payment Pass-Through Option

2.3 PROSPECTIVE CONTRACTOR MINIMUM QUALIFICATIONS

A. The Prospective Contractor shall have a minimum of three (3) years’ experience with occupational injury or disease expertise, or both, to render an informed clinical judgement of the medical appropriateness of the services provided.

B. The Prospective Contractor’s staff shall be licensed, registered, or certified health care professionals in accordance with Arkansas Workers’ Compensation Commission (AWCC) Rule 30 and Rule 33.

Certification must be by the applicable State agency and/or professional organization.

C. The Prospective Contractor, or any subcontractors providing services, shall be certified as a Managed Care Organization (MCO) by the AWCC Medical Cost Containment Division, in accordance with AWCC Rule 30, Section VII and shall maintain its certification for the life of the contract.

https://labor.arkansas.gov/workers-comp/awcc-rules-advisories-medical-fees/awcc-rules/

2.4 ADMINISTRATIVE REQUIREMENTS

A. The Contractor shall provide a Medical Cost Containment program for the public employees of the

State of Arkansas Workers’ Compensation claims managed by the Division.

B. The Contractor shall provide Explanation of Benefits (EOB) data to the Division within ten (10) business days of receipt of a properly submitted bill for importation into the Division’s claims database in a format as determined and approved by the Division. EOBs submitted to the Division more than twenty (20) business days after a properly submitted bill is received will be subject to penalties.

C. The Contractor shall retain all pertinent records, such as Medical Case Manager activities, bill review, and supporting documentation for billing submitted to the Division for five (5) years after final payment is made under any resulting contract.

D. In the event of an audit, litigation, or other action the retained pertinent records must be provided to the auditors, or those subpoenaing the documentation.

E. In the event of an audit or litigation, the documentation must be retained until all issues arising from the action are resolved even if it is beyond five (5) years after final payment has been made.

F. The Contractor shall comply with all applicable rules and regulations of the AWCC, particularly Rules

30, 33, and any subsequent revisions.

G. The Contractor shall follow all lawful and ethical written instructions from the Division in performing services for any resulting contract.

2.5 PREFERRED PROVIDER ORGANIZATION (PPO) REQUIREMENTS

A. The Contractor shall provide Preferred Provider Organization (PPO) discounts for medical services below the AWCC’s Medical Fee Schedule with medical providers, at a minimum, in all counties of the State of Arkansas, in Memphis, Tennessee, and in Texarkana, Texas. Provision of providers in other additional areas is encouraged.

B. The Contractor shall accept any arrangements made by the Division for diagnostic services and physical therapy from other networks available to the Division outside of this contract.

C. The Contractor shall accept any arrangements made by the Division to purchase Durable Medical

Equipment (DME) and prosthetics within a resulting contract or from another provider.

2.6 BILL REVIEW / UTILIZATION REVIEW PROGRAM

A. The Contractor shall provide ongoing and retrospective utilization review of medical bills in compliance with AWCC Rule 30, AWCC Rule 33, and any pertinent Managed Care Organization (MCO) fee schedules, and the Contractor shall make determinations concerning a covered injury or illness through one of the following approaches:

1. Review by licensed, registered, or certified health care professionals

2. The application of criteria developed by licensed, registered, or certified health care professionals

3. A combination of approaches one (1) and two (2) according to the type of covered injury or illness

B. The Contractor shall provide the information for any certifications, registrations, or licenses for the specific personnel performing the services and the specific services the personnel will be providing.

C. The Contractor shall accept any arrangements made by the Division for other providers to provide Utilization Review/Negotiation services from other networks available to the Division.

D. The Contractor shall determine the accuracy of billing codes.

https://labor.arkansas.gov/workers-comp/awcc-rules-advisories-medical-fees/medical-fee-schedule/

E. The Contractor shall determine if the amount billed for a procedure exceeds the maximum allowable payment under AWCC Rule 30 and the Contractor’s PPO pricing agreement with the provider.

F. If a determination is made that the amount billed for a procedure exceeds the maximum allowable payment, the Contractor shall reduce the bill to the maximum allowable payment for that specific procedure.

G. The Contractor shall apply all PPO discounts applicable to the services that have been provided.

H. The Contractor shall not charge the Division more than $15,000 in PPO access fee charges per individual medical bill.

I. The Contractor shall provide data and images of the original bill, attached medical reviewed bills, and EOB completed and returned to the Division via Electronic Data Interchange (EDI) within ten (10) business days of receipt of properly submitted bills.

J. The Contractor shall minimize the number of mistakes in EOBs. Ten (10) or more mistakes in a month is unacceptable and will be subject to performance damages.

K. Licensed, registered, or certified health care professionals shall be responsible for reconsidering disputed reimbursements, as defined and set forth in AWCC Rule 30, based on documentation submitted by the State or Medical provider for reconsideration of its bill.

1. A written response must be sent to the provider and a copy must be sent to the Division within five (5) thirty (30) business calendar days of receipt of request.

2. If this dispute can’t be resolved or is litigated, the Contractor shall defend its decision, as set forth in AWCC Rules 30 and 33, throughout the appeals process.

L. The Contractor may, at any time, be asked in writing by the Division to review any case records or bill which the Division or any other entity believes may involve over-utilization, inappropriate billing, or patterns of abuse. Should the Contractor receive the request, the Contractor shall follow the process set forth in AWCC Rule 30 Part IV.

M. The Contractor shall notify the Division upon discovery of any over-utilization, inappropriate billing, or pattern of abuse within two (2) business days. Notifications must be made by phone or email.

N. The Contractor shall negotiate bills which meet mutually agreed upon criteria between the Division and the Contractor. The Division will pay an hourly rate equal to the Utilization Review rate for negotiations for bill reduction for providers. In addition to the mutually agreed upon criteria, individual bills must be negotiated when specifically requested or authorized by the following personnel in the Division: Director, Insurance Program Manager, WCC Claims Specialists and Analysts.

2.7 PRE-CERTIFICATION OF HOSPITALIZATION / MEDICAL SERVICES

A. The Contractor shall provide a procedure for requesting pre-certification of hospitalizations and surgeries/procedures in accordance with the AWCC’s Rule 30, Part I, Section S. This procedure must be subject to the Division’s approval.

B. The Contractor shall complete pre-certifications within twenty-four (24) hours of receipt of all records pertaining to the medical care being sought.

C. The Contractor shall invoice, via EDI, all pre-hospitalization certification charges to the Division within thirty (30) days of services being provided.

2.8 PRE-NEGOTIATION FOR SERVICES

A. The Contractor shall provide pre-negotiation services with providers for medical and other services involved in workers’ compensation claims, upon request from the Division.

B. If the Contractor negotiates bills for air ambulance services, the Contractor shall be responsible for paying any negotiated amount in excess of three (3) times the Medicare fee schedule, unless otherwise specifically authorized in writing.

2.9 PEER REVIEW

The Contractor shall provide peer review by a qualified medical provider upon request from the Division.

2.10 MEDICAL CASE MANAGEMENT

A. The Contractor shall provide medical case management services at the specific request of the Division.

B. In accordance with AWCC Rule 30, Section VII, the Contractor’s personnel acting as medical case managers in performing the activities of any resulting contract shall meet at least one (1) of the qualifications of medical case manager:

1. Physician licensed in the Arkansas; or,

2. A Designated Certified Case Manager (CCM) by the Certification of Insurance Rehabilitation Specialists Commission for Case Management Certification; or,

3. Currently licensed Registered Nurse (RN); or,

4. Currently licensed Occupational Health Nurse; or,

5. Currently licensed as a Licensed Practical Nurse (LPN) and have eighteen (18) months supervised clinical experience and six (6) months case management experience.

C. The role of the medical case manager shall be in accordance with the applicable sections of AWCC Rule 33. Claims adjusting will be the sole responsibility of the Division.

D. The medical case manager shall send updates to the Division’s WC Claims Analyst or WC Claims

Specialist handling the claim within twenty-four (24) hours, or the next business day, of all medical appointments and meetings with the injured employee including, but not limited to, the following:

1. Any changes in the injured employee’s work status

2. Any results from medical visits attended by injured employee

3. Any authorizations needed for medical treatment, medication or other services

E. A medical case manager shall begin working on a claim within one (1) business day of receipt of a referral or sooner in emergency conditions involving a Catastrophic Claim.

2.11 INSURANCE REQUIREMENTS

A. The Contractor shall meet the AWCC statutory insurance requirement limits by having commercial general liability insurance, listing the State of Arkansas as an additional insured and having the following coverages prior to any resulting contract and annually by June 1:

1. Bodily injury, including death: Minimum of $1,000,000 per occurrence / $2,000,000 general aggregate.

2. Property damage and personal injury, including coverage for contractual liability: Minimum of $1,000,000 per occurrence / $2,000,000 general aggregate.

B. The Contractor shall provide evidence of the required insurance at the request of and within timeframes specified by the Division.

2.12 IMPLEMENTATION AND TESTING REQUIREMENTS

A. The Prospective Contractor shall provide a proposed Implementation and Testing Plan during the

Discussions phase that must, at minimum, meet all Requirements set forth in this section of the RFP and must include, at minimum, the following:

1. Project Initiation

2. Project Planning

3. Implementation

4. Data Migration

5. Testing

6. Go Live

B. The Contractor shall work with the outgoing Contractor to transition services in a manner that will not negatively impact the current activities of the program.

C. The Contractor shall complete all implementation components to begin services on July 1, 2025.

D. Final Implementation and Testing Plan timelines and details must meet the approval of the Division prior to the award of any resulting contract.

2.13 STAFFING REQUIREMENTS

A. The Prospective Contractor shall provide a Staffing Plan during the Discussions phase. The Staffing Plan must, at minimum, meet the Requirements set forth in this section of the RFP.

B. The Contractor shall include in the Staffing Plan individuals with sufficient relevant expertise and experience to accomplish the Requirements set forth in this RFP.

C. The Division shall have the right to approve or reject proposed staff members prior to the finalization of the Staffing Plan after the award of any resulting contract.

D. The Contractor shall replace key personnel upon request by the Division for justified reasons including, but not limited to, performance, behavior, and security.

E. The Contractor shall maintain sufficient staffing resources to provide timely service for the life of any resulting contract.

F. The Contractor shall replace key personnel or team member with a person having equal or greater qualifications than the person being replaced.

G. At the commencement of any resulting contract and prior to the hiring of staff, including any new or replacement staff, the Contractor shall conduct criminal background checks for all personnel involved in any aspect of the activities and requirements described in this RFP and at the Contractor’s expense.

H. The Division will have the right to refuse personnel based on results of the criminal background checks.

2.14 REPORTING REQUIREMENTS

A. The Contractor shall submit reports to the Division’s contract administrator according to the provisions of AWCC’s Rule 33, Part IX. Contact information for the contract administrator will be provided upon the award of any resulting contract.

B. The Contractor shall submit monthly reports and annual reports by the fifteenth (15th) of the month following the corresponding reporting period. Reports must include, but are not limited to, the following:

1. General report, which must contain the following information:

a. Number of bills reviewed in the month

b. Total amount that the bills were reduced

c. Total cost of review

d. Itemized totals of each different service type charged to the Division

e. Return on investment

2. Medical Case Management report, which must include the following information:

a. List of cases referred to Medical Case Management

b. Costs to date of Medical Case Management for the file

c. Number of cases referred for pre-authorization/certification

d. Listing of all open cases in Medical Case Management as of the reporting date

e. Itemized total costs by service type charged for the month

2.15 ELECTRONIC INVOICING AND PRICING REQUIREMENTS

A. The Contractor shall provide electronic invoicing via EDI as per instructions provided to the Contractor of any resulting award.

B. The Contractor shall calculate the invoices for bill review services by flat rate per bill. PPO access fees must be billed as a percentage of PPO savings.

C. The Contractor shall calculate the invoices for peer review services in the following way:

1. A flat rate will apply for up to fifty (50) pages (even if less than fifty (50) pages).

2. An additional page rate will be applied for each additional page starting at fifty-one (51).

D. The Contractor shall invoice Medical Case Management services at an hourly rate:

1. Time must be billed in ten (10) six (6) minute increments.

2. The Contractor shall round down for under five (5) minutes.

3. The Contractor shall round up for five (5) or more minutes up to ten (10).

E. The Contractor shall invoice Utilization Review (beyond standard bill review) at an hourly rate:

1. Time must be billed in ten (10) six (6) minute increments.

2. The Contractor shall round down for under five (5) minutes.

3. The Contractor shall round up for five (5) or more minutes up to ten (10).

F. The Contractor shall include mileage of up to ten (10) miles roundtrip in the Medical Case Management hourly rate.

1. The State will pay for mileage, per mile, if over ten (10) miles roundtrip.

2. If mileage charges appear to be in excess, the Division will have the final determination for mileage reimbursement charges to the Contractor.

G. The Contractor shall invoice negotiation at an hourly rate.

1. Time must be billed in six (6) minute increments.

2.16 DATA SECURITY

A. The Contractor shall provide a proposed Data Security Plan during the Discussions phase. The Data Security Plan must, at minimum, meet the requirements set forth in this section of the RFP.

B. A Business Associate Agreement (BAA) (Attachment A: BAA) will be negotiated with the Contractor and Division prior to the go-live date to cover additional details of data security not specified in this

RFP.

C. The Contractor’s system must maintain compliance with laws and regulations related to data security.

D. Prior to award of any resulting contract, the Contractor shall provide the name and contact information for an employee who shall serve as the State’s primary security contact and be available to assist the State twenty-four (24) hours per day, seven (7) days per week as a contact in resolving obligations associated with a security breach. The security contact must be able to give a detailed explanation of the breach and the impact of the breach. The security contact must also provide a detailed resolution so that the breach will not be repeated.

E. The Contractor shall notify the State of a security breach as soon as practicable, but no later than four (4) hours after the event is identified and the Contractor becomes aware of it.

F. Any data located on servers must be physically and virtually secure from any unauthorized access using the strictest of accepted principles adhering to the International Information Systems Security Certification Consortium ((ISC)2) body of knowledge.

G. Third parties or personnel from the Contractor that are not directly involved with the activities of any resulting contract shall not be allowed information relating to statistics or demographics of the State of Arkansas. Only staff with a need to know shall have access to such data.

H. Any time a hard drive is removed from use within the scope of any resulting contract, the Contractor shall erase, destroy, and render unrecoverable all data and certify, in writing, that these actions have been completed within thirty (30) days of the termination of any resulting agreement or within seven

(7) days of the request by the State, whichever comes first. At a minimum, a “Clear” media sanitization must be performed according to the standards enumerated by the National Institute of Standards, Guidelines for Media Sanitization, SP800-88, Appendix A – see http://csrc.nist.gov/.

http://csrc.nist.gov/

I. The Contractor’s system (software and hardware) must not store any personally identifiable Arkansas citizen’s information for any time longer than required by Arkansas State law and the requirements of this RFP.

J. The Contractor shall ensure that all logs are encrypted using AES-256.

K. The Contractor shall utilize a Secure File Transfer Protocol (SFTP) as defined by the Division.

L. The Contractor shall ensure that all data being transmitted is encrypted and all stored data is encrypted at rest. Encrypting must be done with AES-256.

M. All data associated with the activities of any resulting contract must not be stored or accessed from outside the continental United States.

2.17 MEDICAL PASS-THROUGH OPTION

A. If the medical pass-through payment option is selected, on a weekly or bi-weekly basis the Division will total the amount of all payments approved on the following Monday or Tuesday and send ACH payment(s) in that amount along with a listing of all approved EOBs to the Contractor. The Contractor shall pay the medical providers for the approved payments and send the corresponding EOBs to the providers.

B. The Contractor shall pay all pass-through payments to providers for which the Division has paid the

Contractor within five (5) business days as set forth in AWCC’s Rule 30.

C. If the bill(s) is not paid by the Contractor within five (5) business days of receipt of the funds, and a penalty for late payment is assessed due to this delay, the Contractor shall pay the penalty assessed by the AWCC.

D. If the Contractor has agreements with payees allowing a longer time to pay which removes the risk of the Division being assessed late payment penalties, then the five (5) day late payment penalty provision will not apply.

E. If the five (5) day timeframe is not met and a dispute arises between the Contractor and a payee, and a late payment penalty is assessed, the Contractor shall be responsible for payment of the late payment penalty assessed by the AWCC.

2.18 DATA OWNERSHIP AND CONTRACT TRANSITION

A. The State shall retain sole ownership, right, title, and interest to all data collected and stored by the Contractor under a resulting contract, excluding intellectual property and exclusions governed by applicable State and Federal laws.

B. At the end of the contract data retention period and after confirmed transfer of 100% of the State-owned data, deliverables, and products the Contractor has created, developed, produced, and managed while performing the services outlined in this RFP back to the State or their designee, the Contractor shall destroy all copies of the State-owned data the Contractor possesses.

C. The Contractor shall ensure all data received as part of any resulting contract is used solely for the purpose of this contract and not shared, reused, or disseminated to any other party or entity without the express written consent of the Division designated representative or as otherwise required under applicable State and Federal laws.

D. Upon termination or expiration, should any subsequent contract for this or similar services be awarded to a provider other than the Contractor, the Contractor shall, to the greatest extent possible and reasonable, cooperate with the Division in initiating a smooth and orderly transition to the next Contractor.

2.19 PERFORMANCE STANDARDS

A. State law requires that qualifying contracts for services include Performance Standards for measuring the overall quality of services that a Contractor shall provide.

B. The State may be open to negotiations of Performance Standards prior to contract award, prior to the commencement of services, or at times throughout the contract duration.

C. Performance Standards shall not be amended unless they are agreed to in writing and signed by the parties.

D. Failure to meet the minimum Performance Standards as specified will result in the assessment of damages.

E. In the event a Performance Standard is not met, the Contractor will have the opportunity to defend or respond to the insufficiency. The State has the right to waive damages if it determines there were extenuating factors beyond the control of the Contractor that hindered the performance of services. In these instances, the State has final determination of the performance acceptability.

F. Should any compensation be owed to the Department due to the assessment of damages, Contractor shall follow the direction of the Department regarding the required compensation process.

Performance Standards

Criteria Acceptable Performance Damages

Administration

Provide to the Division properly submitted bills to be reviewed and EOB(s) within twenty (20) business calendar days of receipt. Bills/EOBs received after twenty

(20) business days of receipt will be considered “late.” (Section 2.4.B)

The Contractor shall pay $20.00 per bill/EOB above ten (10) bills/EOBs that are not received within twenty (20) business days of receipt.

Failure of this performance standard for three (3) months in a row, may result in the Contractor being declared in breach of contract.

Bill Review/Utilization Review

Ten (10) mistakes or less in EOBs made by the Contractor in a monthly period.

(Section 2.6.J)

The Contractor shall pay $10.00 per bill containing a mistake if there are more than ten (10) mistakes in EOBs.

The Contractor shall pay any additional costs due to mistakes or shall reimburse those costs to the Division if the payment(s) have been made.

The Contractor shall pay any penalties for late submission.

Failure of this performance standard for three (3) months in a row, may result in the Contractor being declared in breach of contract.

Requests for reconsideration of EOBs processed by the Contractor within five

The Contractor shall pay any penalties for late submission.

(5) thirty (30) business calendar days of receipt. (Section 2.6.K.1)

The Contractor shall pay $10.00 per bill containing a mistake if there are more than ten (10) mistakes in EOBs.

The Contractor shall pay any additional costs due to mistakes or shall reimburse those costs to the Division if the payment(s) have been made.

Failure of this performance standard for three (3) months in a row, may result in the Contractor being declared in breach of contract.

Written Instructions

Following all written instructions provided by the Division or having a reasonable explanation why the instructions were not followed. (Section 2.4.HG)

The Contractor shall pay any additional costs that are incurred from not following all written instructions provided by the Division.

Failure of this performance standard for three (3) months in a row, may result in the Contractor being declared in breach of contract.

Medical Case Management

Keeping Division personnel handling a claim informed about any change in an employee’s work status within twenty-four

(24) hours or one (1) business day of learning of the change. (Section 2.10.D.1)

Poor performance of Medical Case Management services shall result in twenty percent (20%) reduction of the bill(s) for Medical Case Management for the claim in the month in which the poor performance occurred.

Failure of this performance standard for three (3) months in a row, may result in the Contractor being declared in breach of contract.

Keeping Division personnel handling a claim informed of results in medical visits attended within twenty-four (24) hours or one (1) business day of the visit. (Section 2.10.D.2)

Poor performance of Medical Case Management services shall result in twenty percent (20%) reduction of the bill(s) for Medical Case Management for the claim in the month in which the poor performance occurred.

Failure of this performance standard for three (3) months in a row, may result in the Contractor being declared in breach of contract.

Notifying Division personnel handling a claim of any authorization needed for

Poor performance of Medical Case Management services shall medical treatment, medications, or other services within twenty-four (24) hours or one (1) business day of receiving information about the need for the authorization. (Section 2.10.D.3) result in twenty percent (20%) reduction of the bill(s) for Medical Case Management for the claim in the month in which the poor performance occurred.

Failure of this performance standard for three (3) months in a row, may result in the Contractor being declared in breach of contract.

Beginning work within one (1) business day of receipt of a referral or sooner in emergency conditions involving a catastrophic claim. (Section 2.10.E)

Poor performance of Medical Case Management services shall result in twenty percent (20%) reduction of the bill(s) for Medical Case Management for the claim in the month in which the poor performance occurred.

Failure of this performance standard for three (3) months in a row, may result in the Contractor being declared in breach of contract.

SECTION 3 – SELECTION

3.1 SELECTION PROCESS

A. TSS OSP will review each Technical Proposal Packet to verify Submission Requirements have been met. Technical Proposal Packets that do not meet Submission Requirements will be rejected and will not be evaluated.

1. The State may conduct cost checks based on the cost submitted by each Prospective Contractor on the completed pricing response.

a. Prospective Contractors submitting Responsive Proposals with a proposed cost that falls twenty-five percent (25%) or more from the average submitted cost may be asked to justify their submitted cost.

b. Should TSS OSP request clarification and/or additional information regarding cost, Prospective Contractors shall provide clarification and/or additional information as specified by the request.

B. A Department-appointed Evaluation Committee will evaluate and score Responsive Proposals.

Evaluation will be based on Prospective Contractor’s response to the Information for Evaluation section included in the Technical Proposal Packet and the pricing submitted by the Prospective Contractor.

1. Cost information will be provided to the members of the Evaluation Committee (Evaluators) to allow them to determine which proposal(s) is the most advantageous to the State.

2. Evaluators will individually review and evaluate proposals and complete an Individual Score Worksheet for each proposal. Individual scoring for each Evaluation Criteria will be based on the scoring description in Table B: Scoring Table.

TABLE B: SCORING TABLE

SCORE DESCRIPTION

The response provides metrics clearly establishing that the Prospective Contractor is reliable and capable of fully performing the required services.

The response provides metrics suggesting that the Prospective Contractor’s level of performance may be acceptable, but it does not clearly establish that the Prospective Contractor is reliable and capable of fully performing the required services.

The response provides metrics clearly establishing that the Prospective Contractor is unreliable and incapable of fully performing the required services.

3. After initial individual evaluations are complete, the Evaluators will meet to discuss their individual scores. At the initial consensus meeting, each Evaluator will be afforded an opportunity to discuss his or her score for each evaluation criteria.

4. After Evaluators have had an opportunity to discuss their individual scores with the committee, the Evaluators will be given the opportunity to change their initial individual scores, if they feel that is appropriate.

5. The final individual scores of the Evaluators will be recorded on the Consensus Scoresheets and averaged to determine the group or consensus score and rank for each proposal.

6. Other agencies, consultants, and experts may also examine documents at the discretion of the Department.

C. Prospective Contractors submitting Responsive Proposals will be contacted by TSS OSP to schedule an interview.

1. Prospective Contractors shall attend the interview as scheduled by TSS OSP.

2. Evaluators will complete an Individual Score Worksheet for each interview. Evaluation will be based on Prospective Contractor’s responses to questions presented during the interview Individual scoring for each interview will be based on the Scoring Descriptions in 3.1.B.1.

3. During a final consensus meeting, after all interviews are complete, Evaluators will have the opportunity to discuss the interviews and change their individual interview scores on the Consensus Scoresheet, if they feel that is appropriate.

a. The final individual scores of the Evaluators will be recorded on the Consensus Scoresheets and averaged to determine the group or consensus score and rank for each proposal.

4. Should the State receive only one (1) Responsive Proposal, the State may forgo the interview portion of the evaluation if the proposal has received the Maximum Weighted Score Possible for the Experience, Solution, and Risk subsections.

a. In this scenario, the proposal would automatically receive the maximum weighted score possible for the interview subsection.

D. Should the State request clarification and/or additional information Prospective Contractors’ responses, Prospective Contractors shall provide clarification and/or additional information as specified by the State.

E. TSS OSP will submit responses and pricing received from the interviewed Perspective Contractors, along with the Evaluation Committee’s recommendation to the Department for review and approval to move into Discussions.

3.2 TECHNICAL PROPOSAL SCORE

A. The Information for Evaluation section has been divided into subsections.

1. Each subsection has been assigned a maximum point value of ten (10) points. The total point value for each subsection is reflected in the table below as the Maximum Raw Points Possible.

2. The Department has assigned Weighted Percentages to each subsection according to its significance.

INFORMATION FOR EVALUATION

SUBSECTIONS

MAXIMUM

RAW

POINTS

POSSIBLE

SUBSECTION’S

WEIGHTED

PERCENTAGE

* MAXIMUM

WEIGHTED

SCORE

POSSIBLE

Experience 10 30% 210

Solution 10 40% 280

Risk 10 10% 70

Interview 10 20% 140

Total Technical Score 40 100% 700

*Subsection’s Percentage Weight x Total Technical Maximum Weighted Score = Maximum Weighted Score Possible for the subsection.

B. The proposal’s weighted score for each subsection will be determined using the following formula:

(A/B)*C =D

A = Actual Raw Points received for subsection in evaluation

B = Maximum Raw Points possible for subsection

C = Maximum Weighted Score possible for subsection

D = Weighted Score received for subsection

C. The proposal’s weighted scores for subsections will be added to determine the Total Technical Score for the proposal.

3.3 COST SCORE

A. When scores are applied to pricing, the maximum amount of cost points will be given to the proposal with the lowest one (1) year grand total as shown in Table One (1) on the completed Official Solicitation Price Sheet. (See Grand Total Score for maximum points possible for cost score.)

B. The amount of cost points given to the remaining proposals will be allocated by using the following formula:

(A/B)*C =D

A = Lowest estimated cost

B = Second (third, fourth, etc.) lowest estimated cost

C = Maximum Points for lowest estimated cost

D = Total price points received

3.4 GRAND TOTAL SCORE

The Technical Score and Cost Score will be added together to determine the Grand Total Score for the proposal. The State may move forward to Discussions with the Prospective Contractor determined reasonably susceptible of being selected for award.

MAXIMUM

POINTS

POSSIBLE

Technical Proposal 700

Cost 300

Maximum Possible Grand Total Score 1,000

3.5 EXPLANATION OF THE SUBSECTIONS OF THE TECHNICAL PROPOSAL

A. Experience

1. The Experience subsection included in the Technical Proposal Packet allows Prospective Contractors to differentiate themselves based on their experience, technical capability, and understanding of the State’s specific needs.

2. Prospective Contractors should identify expertise in the form of a claim and provide relevant experience to support each claim.

3. Prospective Contractors should use verifiable metrics (number of accounts, size of accounts, years of experience, customer satisfaction ratings) to support each claim.

B. Solution

1. The Solution subsection included in the Technical Proposal Packet allows Prospective Contractors to differentiate themselves based on their proposed solution and/or approach to solve the State’s specific needs.

2. Prospective Contractors should provide a high-level overview of the Prospective Contractor’s proposed solution and/or approach to services using the Requirements outlined in the RFP.

3. Proposed solutions should be non-technical and include the Prospective Contractor’s recommendations for meeting the objectives and Requirements of the RFP.

4. Additional service options and recommendations above and beyond those included in proposed solution should be included in the Recommended Options Form.

C. Risk

1. The Risk subsection included in the Technical Proposal Packet allows Prospective Contractors to identify and prioritize major risks that they reasonably foresee could potentially prevent or impair the Prospective Contractor’s delivery of the solution as offered in the proposal or to otherwise fail to meet the State’s desired outcome, specifications, and performance standards, and how they will mitigate, manage, and/or minimize each risk listed.

a. Prospective Contractors should include sources, causes, or actions that are both within and beyond the control of the Prospective Contractors that they reasonably foresee may cause cost increases, delays, amendments, or dissatisfaction to the State.

b. Risks should be described in simple, clear, and non-technical terms.

c. Prospective Contractor should explain how the Prospective Contractor will mitigate, manage, and/or minimize each risk listed.

i. The Documented Performance cell should include details such as how many times any identified risk was previously mitigated and the impact on the Prospective Contractor’s performance in terms of time, cost, and client satisfaction.

D. Interview

1. The Interview will allow Prospective Contractors to further demonstrate their experience in providing the services outlined in the RFP.

a. Each Prospective Contractor meeting the Submission Requirements will be contacted by TSS OSP to schedule an interview. Prospective Contractors shall attend the interview as scheduled by TSS OSP.

b. Prospective Contractors shall identify one (1) Project Lead at the time of interview confirmation who shall attend the interview as part of the evaluation process.

c. The Evaluation Committee will interview the Prospective Contractor’s identified Project Lead using a pre-determined set of interview questions.