State Health Insurance Information Counseling and Assistance Services RFP.docx

State of Missouri Office of Administration, Division of Purchasing

Request for Proposal (RFP) for State Health Insurance Information, Counseling, and Assistance Services

PROPOSAL DUE NO LATER THAN: October 5, 2026 AT 2:00 PM CENTRAL TIME Proposal response must be submitted electronically through MissouriBUYS, powered by MOVERS, at https://missouribuys.mo.gov.

E-mailed, mailed, courier, or hand-delivered proposal responses will not be accepted.

RFP CONTACT INFORMATION:

BUYER: Mertrell Nickens

PHONE NO.: (573) 751-7656

EMAIL: Mertrell.Nickens@oa.mo.gov See “RFP Questions” in Section 1 for appropriate communications during the procurement process.

DELIVER SUPPLIES/SERVICES FREE ON BOARD (FOB) DESTINATION TO THE FOLLOWING ADDRESS:

Department of Commerce and Insurance 301 W High Street, Room 530 P.O. Box 690 Jefferson City MO 65102

ATTENTION:

1. After reviewing the Request for Proposal (RFP), the vendor must complete and return Exhibit A, Proposal Signature Page and all other necessary exhibits.

2. Due to lead times for obtaining the information needed to complete the various Business Compliance Exhibits herein as explained in the RFP’s Vendor Response Exhibits, vendors are encouraged to IMMEDIATELY begin securing these verifications.

3. The vendor must be registered in MissouriBUYS, powered by MOVERS in a “Prospective” or “Spend Authorized” registration status to submit a proposal. The vendor must achieve “Approved” registration status in MissouriBUYS (WebProcure/Proactis) and “Spend Authorized” registration status in MissouriBUYS, powered by MOVERS to be considered for a contract award. Reference Section 5.

RFP Organization:

RFP Vendor Response Exhibits (Return these exhibits with the proposal)

BUSINESS COMPLIANCE EXHIBITS

Separate Documents: The vendor is advised that the separate documents to this document referenced above provide additional requirements, information, and/or instruction. The separate documents must be downloaded from the Division of Purchasing’s MissouriBUYS, powered by MOVERS, website at: https://missouribuys.mo.gov/. The separate documents are downloadable from the same web page where the solicitation document is downloadable. It shall be the sole responsibility of the vendor to obtain each of the separate documents. The vendor shall not be relieved of any responsibility for performance under the subsequent contract due to the failure of the vendor to obtain a copy of the separate documents.

INTRODUCTION AND BACKGROUND INFORMATION SECTION

Introduction:

Purpose: This document constitutes a request for competitive, sealed proposals for the provision of Medicare and Health Insurance Information, Counseling, and Assistance services as set forth herein for the Department of Commerce and Insurance (hereinafter referred to as “state agency”).

Minimum Experience Qualifications: There are minimum experience qualifications in the RFP (See Section 2.2, Minimum Experience Requirements in Section 2: Scope of Work).

Titles: Titles of paragraphs used herein are for the purpose of facilitating reference only and shall not be construed to infer a contractual construction of language.

Background and Historical Usage Information:

The State Health Insurance Program (SHIP) was created under Section 4360 of the Omnibus Budget Reconciliation Act (OBRA) of 1990 (Public Law 101-508). This section of the law authorized the Centers for Medicare and Medicaid Services (CMS) to make grants to states to establish and maintain health insurance advisory service programs for Medicare beneficiaries. Grant funds were made available to support information, counseling, and assistance activities relating to Medicare, Medicaid, and other related health insurance options such as Medicare supplement insurance, long-term care insurance, managed care options, and other health insurance benefit information. In January 2014, authorized in the Consolidated Appropriations Act of 2014, the SHIP program was transferred from CMS to the Administration for Community Living (ACL). This transfer reflects the existing formal and informal collaborations between the SHIP programs and the networks that ACL serves.

a. The SHIP program is intended for Medicare beneficiaries who prefer or need information, counseling, and enrollment assistance beyond what they are able to receive on their own. The mission is to strengthen the capability of grantees to support a community-based, grassroots network of local SHIP offices that provide personalized counseling, education, and outreach to assist Medicare beneficiaries with their Medicare-related questions. SHIPs give presentations and distribute information to help groups and individuals learn about Medicare benefits, coverage rules, written notices and forms, appeal rights and procedures, and much more. SHIPs provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs answer questions about Medicare and assist people in obtaining coverage through options that include the Original Medicare program, Medicare Advantage (Part C) Plans, Medicare Prescription Drug (Part D) Plans, and programs designed to help people with limited incomes pay for their health care, such as Medicaid, the Medicare Savings Program, and the Low-Income Subsidy. SHIPs also help people compare Medicare Supplemental (medigap) insurance policies and explain how these and other supplemental insurance options – such as insurance plans for retirees – work with Medicare. In addition, SHIPs provide information on long-term care insurance and, when needed, refer beneficiaries to agencies such as the Social Security Administration and local Medicaid offices for additional assistance. Many SHIP counselors are volunteers who are trained and certified to help others navigate the Medicare and health insurance systems for older adults and some people with disabilities.

b. Upon receipt of the SHIP grant(s), the Missouri Department of Commerce and Insurance (DCI) has agreed to provide insurance consumers with comprehensive Medicare health insurance advocacy. Missouri SHIP is responsible for meeting the needs of Missouri’s Medicare population. Certified counselors assist people locally to help them work through health care issues and understand Medicare options or changes. Missouri SHIP is not affiliated with any insurance company and sells nothing. Working hand-in-hand with local community-based partners, Missouri SHIP provides free, confidential, and unbiased health insurance counseling to Medicare beneficiaries. With the materials produced with grant funds and assistance the counselors provide, people can make the most informed decisions about their health care options. Missouri SHIP counselors provide information, counseling, and assistance to help Medicare beneficiaries understand and access program benefits. The SHIP grant obligates DCI to, at a minimum, assist with and provide the following:

1) Medicare enrollment and eligibility information

2) Preventive service benefits

3) Medigap and other supplemental insurance options

4) Medicare Advantage Plan options, such as HMOs and PPOs

5) Medicare Part D (prescription drug coverage)

6) Medicare appeals

7) Public benefit programs

8) Medicare Saving Programs

9) Information about enrollment in Medicare Low-Income Subsidy programs

10) Medicare enrollment, billing, and general information

11) Suspected waste, fraud, and abuse

c. The State of Missouri has received a grant in the amount of $1,064,861.00 for the Missouri SHIP program for the period of April 1, 2026 through March 31, 2027. In addition, the state agency has received state appropriations of $200,000 in state funds for the Missouri SHIP program for state fiscal year 2027.

The Medicare Beneficiary Outreach and Assistance Program Grant was created under Section 119 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), as amended by the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) Section 3306. MIPPA authorizes ACL/Administration on Aging (AOA) to make grants to states for outreach and assistance service programs for low-income people with Medicare.

a. The MIPPA grant obligates DCI to, at a minimum, perform the following:

1) Locate and assist Medicare beneficiaries eligible for the Low-Income Subsidy program (LIS)

2) Locate and assist Medicare beneficiaries eligible for the Medicare Savings Program (MSP)

3) Assist Medicare beneficiaries with Medicare Part D Prescription Drug choices

4) Provide outreach aimed at preventing disease and promoting wellness

b. The maximum potential balance of the MIPPA grand funds available for the period of September 1, 2025 through August 31, 2026 will be 457,786.00.

The National Council on Aging (NCOA), under a cooperative agreement from the U.S. Administration for Community Living (ACL), provides Benefit Enrollment Centers (BEC) grants to states for person-centered strategies in a coordinated, community-wide approach to find and enroll Medicare beneficiaries—both seniors aged 65+ years and adults living with disabilities—who have limited income and resources to access available benefits.

The BEC grant obligates DCI to, at a minimum, perform the following:

Assist Medicare beneficiaries with enrollment into the Medicare Part D Extra Help Program (or Low-Income Subsidy, LIS)

Assist Medicare beneficiaries with enrollment into the Medicare Savings Program (MSP)

Assist Medicare beneficiaries with enrollment into the Supplemental Nutrition Assistance Program (SNAP)

Assist Medicare beneficiaries with enrollment into the Medicaid Program

The maximum potential balance of the BEC grant funds available for the period of February 1, 2026 through July 31, 2028 will be $200,000.

Current Contract Information:

A current contract exists for the services being obtained via this RFP. A copy of the contract can be viewed and printed from the Division of Purchasing’s Awarded Bid & Contract Document Search System located on the Internet at: https://purch.oa.mo.gov/bidding-contracts/awarded-bid-contract-document-search. In addition, all proposal and evaluation documentation leading to the award of that contract may also be viewed and printed from the Division of Purchasing’s Awarded Bid & Contract Document Search System. Please reference the Bid number RFPS30034901701154 or the contract number CS171154001 when searching for these documents.

State Expenditures: The Missouri Accountability Portal (MAP) located on the Internet at: http://mapyourtaxes.mo.gov/MAP/Expenditures/ provides financial data related to the purchase of the services under the contract. Be sure to read the information provided in the site information and disclaimer links:https://mapyourtaxes.mo.gov/MAP/Help/MapExpendituresHelp.htm and https://mapyourtaxes.mo.gov/MAP/Help/MapExpendituresHelp.htm#disclaimer. Then search by the contract numbers shown above when searching for the financial information.

RFP Questions:

Buyer is Single Point of Contact for Solicitation: Vendors and their agents (including subcontractors, employees, consultants, or anyone else acting on their behalf) must direct all of their questions or comments regarding the RFP, the evaluation, etc., to the buyer indicated on the first page of this RFP. It is preferred that questions be emailed to the buyer.

Except as noted herein, vendors and their agents are instructed not to contact any other state employee regarding any of these matters during the solicitation and evaluation process. Inappropriate contacts are grounds for suspension and/or exclusion from specific procurements. Vendors can be sanctioned for unauthorized contact with any evaluator under 1 Code of State Regulation (CSR) 40-1.060(8)(G) and (H) available at http://www.sos.mo.gov/adrules/csr/csr.asp.

0. Service Disabled Veteran Enterprise and Honorably Discharged Veteran Enterprise certification certifications or subcontract questions should be directed to the Office of Equal Opportunity (OEO) at http://oeo.mo.gov.

Vendor is Responsible for Asking Questions About the RFP: It is the vendor’s responsibility to ask questions, request changes or clarifications, or otherwise advise the Division of Purchasing if the vendor believes that any language, specifications, or requirements are: (1) ambiguous, (2) contradictory or arbitrary, (3) violate any state or federal law or regulation, (4) restrict or limit the requirements to a single source, or (5) restrict or limit the vendor’s ability to submit a proposal.

Vendor Question Deadline: Every attempt shall be made to ensure that the vendor receives an adequate and prompt response. However, in order to maintain a fair and equitable procurement process, all vendors will be advised, via the issuance of an amendment to the RFP, of any relevant or pertinent information related to the procurement. All questions and issues should be submitted no later than ten (10) calendar days prior to the proposal closing date and time of the proposals. If not received prior to ten (10) calendar days before the proposal closing date and time, the Division of Purchasing may not be able to fully research and consider the respective questions or issues.

State’s Response to Vendor Questions: Upon the Division of Purchasing’s consideration of questions and issues, if the Division of Purchasing determines that changes are necessary, the resulting changes will be included in a subsequently issued RFP amendment(s); absence of such response indicates that the questions and issues were considered but deemed unnecessary for an RFP amendment. All vendors will be advised of any change to the RFP’s language, specifications, or requirements by a formal amendment to the RFP. There will be no posted written records of the questions/communications (i.e., formal question/answer document).

RFP is State’s Only Official Position: The only official position of the State of Missouri shall be that which is contained in the RFP and any amendments thereto.

Amendments:

If the Division of Purchasing determines that changes to the RFP are necessary, the resulting changes will be included in a subsequently issued RFP amendment(s) prior to the proposal closing date and time.

Glossary of Terms and Acronyms:

Whenever the following terms and acronyms appear in the RFP document or any amendment thereto, the definitions or meanings described below shall apply.

General Glossary, Acronyms, and Abbreviations:

Agency and/or State Agency means the statutory unit of state government in the State of Missouri for which the equipment, supplies, and/or services are being purchased by the Division of Purchasing (Purchasing). The agency is also responsible for payment, unless otherwise specified herein.

Amendment means a written, official modification to a solicitation or contract.

Attachment applies to all documents which are included with an RFP to incorporate any informational data or requirements related to the performance requirements and/or specifications.

Buyer means the procurement staff member of Purchasing.

Code of State Regulation (CSR) contains the current administrative rules of executive agencies of Missouri government. The regulations are arranged by agency rather than by subject.

Contract means a legal and binding agreement between two or more competent parties, for a consideration for the procurement of equipment, supplies, and/or services.

Contractor means a supplier, offeror, person, or organization who is a successful vendor as a result of an RFP and who enters into a contract.

Exhibit applies to forms which are included with an RFP for the vendor to complete and submit with their proposal prior to the specified closing date and time.

May means that a certain feature, component, or action is permissible, but not required.

Must means that a certain feature, component, or action is a mandatory condition.

Party refers to either the State of Missouri or the contractor as an entity that may enter into a contract pursuant to the terms herein.

Pricing Page(s) applies to the form(s) on which the vendor must state the price(s) applicable for the equipment, supplies, and/or services required in the RFP. The pricing pages must be completed and submitted by the vendor with the proposal prior to the specified proposal closing date and time.

Proposal Closing Date and Time and similar expressions mean the exact deadline required by the RFP for the receipt of sealed proposals.

Purchase Order means the authorized document issued by the state agency to the contractor indicating descriptions, quantities, and agreed prices for products and/or services.

Reasonable, Necessary or Proper as used herein shall be interpreted solely by the State of Missouri.

Request for Proposal (RFP) means the solicitation document issued by Purchasing to potential vendors for the purchase of equipment, supplies, and/or services as described in the document. The definition includes the following sections: Introduction and Background Information; Scope of Work; Terms and Conditions (“terms and conditions” and “Terms and Conditions” are used interchangeably throughout the RFP); General Contractual Requirements; and Vendor Submission, Evaluation, and Award Information; and the RFP Vendor Response Exhibits, Attachments, and Amendments of the RFP.

RSMo (Revised Statutes of Missouri) refers to the body of laws enacted by the Legislature which govern the operations of all agencies of the State of Missouri. Chapter 34 of the statutes is the primary chapter governing the operations of Purchasing.

Shall has the same meaning as the word must.

Should means that a certain feature, component and/or action is desirable but not mandatory.

State collectively referring to the state government and/or the agencies thereof.

Supplier has the same meaning as the word, vendor.

Vendor means the supplier, offeror, person, or organization that responds to an RFP by submitting a proposal with prices to provide the equipment, supplies, and/or services as required in the RFP document.

State Agency Glossary, Acronyms and Abbreviations:

a. SHIP refers to the State Health Insurance Program.

b. OBRA refers to Omnibus Budget Reconciliation Act.

c. CMS refers to Centers for Medicare and Medicaid Services.

d. ACL refers to Administration for Community Living.

e. Part C refers to Original Medicare Program and Medicare Advantage Plans.

f. Part D refers to Medicare Prescription Drug Plans.

g. Medigap refers to Medicare Supplemental Insurance Policies.

h. MIPPA refers to Medicare Improvements for Patients and Providers Act of 2008.

i. BEC refers to Benefits Enrollment Centers.

j. AOA refers to Administration on Aging.

k. MSP refers to Medicare Savings Program.

l. LIS refers to Low-Income Subsidy Program.

m. HMO refers to Health Maintenance Organization.

n. PPO refers to Preferred Provider Organization.

o. CTM refers to Compliant Tracking Module.

p. MARx refers to Medicare Advantage Prescription Drug.

q. VRPM refers to Volunteer Risk and Program Management.

r. MORx refers to Missouri Rx Plan.

Accuracy of Background Information:

Although an attempt has been made to provide accurate and up-to-date information, the State of Missouri does not warrant or represent that the background information provided herein reflects all relationships or existing conditions related to this RFP.

****END OF INTRODUCTION AND BACKGROUND INFORMATION SECTION****

SCOPE OF WORK SECTION

General Requirements:

The contractor shall provide state health insurance information, counseling, and assistance services (hereinafter referred to as Missouri SHIP program services) for the Department of Commerce and Insurance in accordance with the provisions and requirements stated herein and to the sole satisfaction of the state agency.

The contractor shall partner with community-based programs throughout the state to provide Missouri SHIP program services. The contractor shall have one (1) central authority and statewide supervisory structure for the Missouri SHIP program. The contractor shall create a statewide supervisory structure to which all Missouri SHIP program personnel report. The contractor shall identify one (1) main point of contact. Additionally, the contractor shall recruit and train volunteers to provide Missouri SHIP counseling services.

a. The contractor shall ensure a minimum of 200 trained Missouri SHIP counseling volunteers, appropriately distributed across the state, to ensure Missouri SHIP program services are available to all Medicare beneficiaries. If the number of Missouri SHIP counseling volunteers falls below the minimum, the contractor shall immediately submit a plan to the state agency to meet the minimum.

The contractor shall perform all Missouri SHIP program services in accordance with the provisions and requirements stated herein, to the sole satisfaction of the state agency, and in accordance with State Health Insurance Assistance Program (SHIP) created under Section 4360 of the Omnibus Budget Reconciliation Act of 1990 (Public Law 101-508) and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). The contractor must also comply with all obligations imposed upon the state agency, as outlined below:

a. Health and Human Services Grants Policy Statement (HHS GPS) (https://www.hhs.gov/grants-contracts/grants/grants-policies-regulations/index.html).

b. All applicable statutory and regulatory requirements, including 2 CFR Part 200, apart from any coverage in the HHS GPS.

The contractor shall cooperate with the SHIP National Technical Assistance Center or other Administration for Community Living (ACL) designated entity in cataloging and sharing SHIP publications, resources, and training materials.

The contractor shall implement the ACL SHIP data system security procedures required by ACL that are designed to secure and protect the confidentiality of data submitted into the ACL database, including:

a. Regularly confirming the status of SHIP users who access the database, and utilizing any other procedures that may be required to maintain a secure system. All passwords and password changes must comply with ACL security requirements.

b. Submitting programmatic data using the ACL SHIP Data System on a monthly basis.

c. Following processes required by ACL regarding the use and management of 1-800-medicare Unique IDs, the Complaint Tracking Module (CTM), and the Medicare Advantage Prescription Drug (MARx) System. The contractor shall maintain the required trainings and certifications necessary to remain active in each system.

d. Implementing ACL’s Volunteer Risk and Program Management (VRPM) policies and procedures statewide.

e. Participating in ACL’s Beneficiary Satisfaction Survey Project.

The contractor shall assure full and equal accessibility of Missouri SHIP services to all categories of Medicare beneficiaries including the aged, disabled, and end-stage renal disease patients. The contractor must provide Missouri SHIP services without discrimination on the basis of race, color, national origin, disability, age, sex, or income. The contractor must make reasonable efforts to accommodate Medicare beneficiaries with existing barriers that limit their access to information (e.g., language, visual, hearing, or speech impairments, physical accessibility, literacy, and location).

Unless otherwise specified herein, the contractor shall provide all office space, material, labor, facilities, equipment, and supplies necessary to perform the services required herein and for the contractor’s personnel.

a. The contractor shall understand and agree that the procurement of equipment is the responsibility of the contractor and shall be made in accordance with any provisions of the applicable Federal or State guidelines. All property so procured shall be used, managed, and disposed of as set forth in 45 CFR Subtitle A (10-1-89 Edition) and any other applicable state or federal law.

The contractor shall work with the state agency, the Department of Health and Senior Services (DHSS), Department of Social Services (DSS), Department of Mental Health (DMH), other appropriate state agencies, and ACL to coordinate outreach, education, and all other SHIP and MIPPA required services. The contractor must also work with community-based programs to coordinate outreach, education, and all other SHIP and MIPPA required services.

Preferred Use Contract: The contractor shall provide the services on an as needed, if needed basis. The State of Missouri does not guarantee any usage of the contract whatsoever. The contractor shall understand and agree that the contract shall be construed as a preferred use contract but shall not be construed as an exclusive arrangement. Preferred use means that any state agency needing the services should use the established contract unless it is determined to be in the best interest of the State of Missouri for a state agency, at its own discretion, to obtain alternate services elsewhere.

Minimum Experience Requirements:

The contractor must meet or exceed the following minimum experience requirements at the time of proposal submission and for the duration of the contract:

a. The contractor shall maintain the required training and certifications necessary to remain active in each data system.

b. The contractor shall have a minimum of five (5) years of experience working with ACL.

c. The contractor shall have a minimum of five (5) years of experience providing community and outreach services regarding Medicare options.

Personnel Qualifications:

Leadership Personnel: The contractor’s leadership personnel shall include a Statewide Program Director to administer and perform the contract requirements:

a. Statewide Program Director: The contractor shall designate a Statewide Program Director who shall serve as the contractor’s contact person and shall be the liaison between the contractor and the state agency. By no later than five (5) state business days after authorization by the state agency to proceed with services, the contractor shall provide the state agency with the name, address, email address, and telephone number of the contractor’s Statewide Program Director. The contractor’s Statewide Program Director shall (1) oversee all services being provided, (2) assume responsibility and liability for services performed per the contract, and (3) serve as the primary point of contact with the state agency. The contractor’s Statewide Program Director:

Shall have a minimum of five (5) years of experience in non-profit health organizational management.

Shall have a minimum of one (1) year of experience with grants management. It is highly desirable the Statewide Program Director have a minimum of five (5) years of experience with grants management.

Shall have a minimum of one (1) year of experience with program management. It is highly desirable the Statewide Program Director have a minimum of five (5) years of experience with program management.

Should have a minimum of five (5) years of experience with outreach and partnerships.

Should have a minimum of five (5) years of experience with training and management of counselors.

Should have a minimum of five (5) years of experience with customer service.

Should have a minimum of five (5) years of experience with quality assurance.

Should hold a bachelor’s degree in a field related to the scope of the RFP.

The contractor’s working team shall include the following personnel to administer and perform the contract requirements:

a. Program Trainer: The contractor’s Program Trainer:

Should have a minimum of two (2) years of experience working with non-profit health organizations.

Should have a minimum of two (2) years of experience with training and management of counselors.

Should have a minimum of two (2) years of experience with customer service.

b. Regional Liaisons: The contractor’s Regional Liaison:

0. Should have a minimum of two (2) years of experience working with non-profit health organizations.

Should have a minimum of two (2) years of experience with training and management of counselors.

Should have a minimum of two (2) years of experience with customer service.

c. Volunteer and Outreach Specialists: The contractor’s Volunteer and Outreach Specialists:

0. Should have a minimum of one (1) year of experience working with non-profit health organizations.

Should have a minimum of one (1) year of experience with volunteer recruitment.

d. Community-Based Program Counselors: The contractor’s Community-Based Program Counselors:

0. Should have a minimum of one (1) year of experience working with non-profit health organizations.

Should have a minimum of one (1) year of experience with customer service.

e. Customer Service Representatives: The contractor’s Customer Service Representatives:

0. Should have a minimum of one (1) year of experience working with non-profit health organizations.

Should have a minimum of one (1) year of experience with customer service.

Should have a minimum of one (1) year of experience with quality assurance.

The contractor shall understand and agree that the state agency reserves the right to request any of the contractor’s personnel assigned to provide the services be removed without just cause. The contractor shall understand and agree that the state agency will allow the contractor a reasonable time to find a replacement. The state agency shall approve all replacement personnel. The state agency reserves the right to require background checks and non-disclosure agreements (NDA) of selected contractor personnel, at the contractor’s expense.

Contractor’s Personnel Requirements:

The contractor’s Missouri SHIP program personnel shall include, at a minimum, a Statewide Program Director, Program Trainer(s), Regional Liaisons, Volunteer and Outreach Specialist, and counseling personnel. The contractor shall also provide a sufficient number of Customer Service Representatives to adequately staff the contractor’s toll-free hotline and provide support to the contractor’s Missouri SHIP website.

Statewide Program Director: The contractor’s Statewide Program Director’s duties shall include, but are not limited to:

a. Serving as the contractor’s main point of contact for the state agency.

b. Grants Management

1) Annually, assisting the state agency with grant application(s) to ACL;

2) Ensuring that the SHIP and MIPPA Grant Terms and Conditions are met and all required documents, as specified in the SHIP and MIPPA grants, are submitted to ACL;

3) Supporting the state agency in ensuring compliance with the SHIP and MIPPA Grants Terms and Conditions; and

4) Managing the use of contract funds and development of an annual budget for the Missouri SHIP program.

c. Program Management:

1) Managing the contractor’s program personnel, including the local coordinators of the community-based partners, in order to manage and supervise the day-to-day operations of the Missouri SHIP Program;

2) Maintaining ongoing communication with the contractor’s program in order to stay abreast of all Missouri SHIP program activities, including those provided by the community-based partners, and report on such activities as directed by AOA;

3) Managing the Missouri SHIP program’s interaction with the ACL-mandated SHIP tracking and reporting system to ensure that (1) required data is submitted in a timely manner, (2) data is utilized to monitor state and local performance, and (3) the Missouri SHIP program is managed to fulfill AOA-established performance measure goals and other objectives;

4) Attending the SHIP New Director Training during the first year of the contract. In the event a new Statewide Program Director is appointed during the term of the contract, the new Statewide Program Director must attend the SHIP New Director Training during the first year of appointment. The Statewide Program Director must also attend the annual SHIP Director’s Conference and attend, or appoint someone to attend, the annual AOA-sponsored MIPPA conference;

5) Advising the state agency SHIP Planner on a monthly basis concerning Missouri SHIP program activities during the month; and

6) On a timely basis, sharing all information that is provided directly to the contractor by ACL with the state agency.

d. Outreach and Partnerships:

1) Assessing state and local community-based partners’ networks serving the Medicare population to help fill gaps in services and outreach throughout the state to targeted populations;

2) Developing and implementing outreach strategies;

3) Managing the community-based partners to help conduct outreach to Medicare beneficiaries and deliver personalized Medicare counseling;

4) Collaborating with other state agencies to develop coherent strategies to expand outreach and Missouri SHIP program services;

5) Developing working relationships with each key federal and state program sponsor, including, but not limited to, AOA, the regional or state office of ACL, Social Security Administration (SSA), Missouri Family Support Division, Division of Senior and Disability (DSDS), and the MO HealthNet Division. The development of these relationships shall ensure timely and accurate information sharing concerning Missouri SHIP program services;

6) Collaborating and cooperating with ACL Regional Office (RO) staff and other SHIP programs in the ACL established service region;

7) Leading public relations with community-based partners and the media to raise awareness of Medicare issues;

8) Developing and delivering presentations for outreach and counseling; and

9) Designing and implementing publicity campaigns.

e. Training and Management of Counselors:

1) Developing, managing, and sustaining a base of counselors. The contractor must partner with community-based partners to provide Missouri SHIP counseling services;

2) Ensuring that the counselors have no conflict of interest, as identified elsewhere herein, or other interest that would pose a conflict with their Missouri SHIP program responsibilities;

3) Ensuring that local coordinators of the community-based partners and the counselors have access to and are trained on the web-based tools necessary for Missouri SHIP program services, such as, but not limited to, Medicare.gov, Medicare Plan Finder, and hospital compare (www.Medicare.gov);

4) Developing and implementing a training program to ensure that all Missouri SHIP counselors, including the contractor’s counseling personnel, volunteer counselors, and counselors from community-based partners, are appropriately trained in operating procedures, as outlined below, and when appropriate, Medicare counseling information:

i. General volunteer training shall be twenty-four (24) hours in length. Training shall include, at a minimum, the topics listed herein. Training methods may include classroom, Internet, satellite, mentoring, self-study, conferencing, videotape, teleconferencing, videoconferencing, and other applicable methods.

ii. At the completion of training, a volunteer shall be prepared to provide counseling on the topics listed below. The Statewide Program Director shall determine the degree of training for each of the following topics:

· Medicare – eligibility, enrollment, fraud and abuse, claims, appeals, and coordination of benefits;

· Medicare Health Plans – original Medicare vs. Medicare health plan, enrollment, disenrollment, eligibility, plan feature/comparisons, non-renewal/plan changes, appeals/grievances, and marketing issues;

· Medicare Part D – plans/benefits, enrollment, disenrollment, premiums, claims, appeals/grievances, and marketing issues;

· Medicare Supplement – standard plans/plan benefits, Medicare select, pre-standardized plans, open enrollment, guaranteed renewability, pre-existing conditions, guarantee issue policies, guarantee issue protections, crossover/automatic file, premiums, claims filing, appeals, and state-specific laws and regulations.

iii. The contractor shall provide counselors with at least twelve (12) hours of continuing education training annually, covering new developments as well as reviewing basic concepts.

iv. The contractor shall obtain at least two (2) references for each prospective volunteer from a certified counselor, other agency, community-based partners, or church leader.

v. The contractor shall obtain a criminal background check on all prospective volunteers prior to the volunteer attending any training. The Statewide Program Director or the community-based partner shall submit the criminal background check form to the appropriate entity conducting the criminal background check for review.

vi. Training of new volunteers shall include written materials, which the contractor shall develop and obtain state agency approval for, establishing guidelines for objective, unbiased counseling.

vii. The contractor shall administer a certification exam to Missouri SHIP counselors who complete the initial training.

viii. The contractor shall provide annual recertification of counselors after their completion of a continuing education self-directed evaluation or test from the AOA online testing and certification program (www.shiptacenter.org).

5) Maintaining a current list of active Missouri SHIP counselors on the SHIP website (https://shiptacenter.org);

6) Providing privacy training to the contractor’s personnel and Missouri SHIP counselors;

7) Issuing and managing the AOA SHIP Unique JD system (www.shiptacenter.org), which provides counselors with access to participating Medicare Plans in order to obtain personalized Medicare beneficiary information; and

8) Updating Missouri’s profile as needed, and maintaining up-to-date counseling locations, including locations at community-based partners, on https://shiptacenter.org.

f. Customer Service

1) Implementing AOA state and local call protocols (www.shiptacenter.org) to respond to Medicare beneficiary and caregiver inquiries; and

2) Monitoring and maintaining high levels of Medicare beneficiary satisfaction and service quality in counseling and public education.

g. Quality Assurance

1) Developing and ensuring adequate quality assurance measures related to providing personalized counseling and assistance to Medicare beneficiaries are in place for all counseling locations and regions as defined by the contractor.

Program Trainer: The contractor’s Program Trainer(s)’ duties shall include, but are not limited to:

a. Developing training plans and providing continuing education training to contractor personnel, community-based partners, and volunteer counselors. The contractor’s Program Trainer(s) should encourage community-based partners responsible for the administration of other health insurance programs to participate in the initial and follow-up training;

b. Assisting the Statewide Program Director in the Missouri SHIP training planning and development to ensure that the training needs of the counselors are met;

c. Identifying, locating, and/or coordinating presenters for Missouri SHIP program service training components;

d. Coordinating and/or participating in outreach activities;

e. Using the ACL, AOA SHIP, MIPPA training materials to train, or using the ACL/AOA SHIP/MIPPA training materials as a resource in the development of training material for the Missouri SHIP counselors;

f. Submitting reports, evaluating training effectiveness, and making recommendations regarding training effectiveness to the Statewide Program Director;

g. Making recommendations to the Statewide Program Director regarding initial certification and recertification of Missouri SHIP counselors;

h. Working with AOA and others as appropriate to utilize the ACL/AOA online testing and certification programs (www.missouricalim.org);

i. Attending the annual ACL-sponsored National Medicare Training Program (NMTP) targeted for the SHIP program; and

j. When requested by the state agency, assisting in developing and presenting NMTP programs locally in Missouri.

Regional Liaison: The contractor’s Regional Liaison’s duties shall include, but are not limited to:

a. Providing ongoing support, as needed, to the community-based partners, specifically within the Regional Liaison’s region, but also throughout the state;

b. Assisting the Statewide Program Director in the planning and development of the Missouri SHIP program to ensure the needs of the Missouri SHIP counselors and Medicare beneficiaries within the region are met;

c. Training or assisting the Program Trainer(s) with the initial and follow-up training requirements for the Missouri SHIP counselors in the Regional Liaison’s region.

d. Identifying and implementing methods for improving recruitment of community-based partners and volunteers and outreach within the region;

e. Coordinating and/or participating in outreach activities;

f. Providing presentations regarding the Missouri SHIP program to groups and organizations within the Regional Liaison’s region;

g. Evaluating the effectiveness and making recommendations for improvement to the Missouri SHIP program activities to the Statewide Program Director;

h. Submitting monthly status reports to the Statewide Program Director regarding regional Missouri SHIP program activities; and

i. Meeting twice a year with the contractor’s Missouri SHIP program personnel, volunteer counselors, and community-based partners in the Regional Liaison’s region to review activities and information.

Volunteer and Outreach Specialist(s): The contractor’s Volunteer and Outreach Specialists’ duties shall include, but are not limited to:

a. Volunteer Responsibilities

Maintaining a potential volunteer database, training hours, and other relevant volunteer information;

Sending volunteer packets to potential volunteers and distributing information internally on potential volunteers;

Coordinating volunteer recruitment activities and initial training dates, announcements, and distribution; and

Assisting with annual certification.

b. Outreach Responsibilities

1) Handling Missouri SHIP program promotion;

2) Developing and coordinating outreach activities;

3) Seeking, arranging, designing, and coordinating educational presentations and events on Medicare for the contractor’s personnel, counselors, community-based partners, state agency staff, and volunteers working with the Regional Liaison. This may include coordination of press releases and posters;

4) Leading open enrollment planning;

5) Maintaining a database of outreach events;

6) Maintaining information on the Missouri SHIP website of outreach events;

7) Keeping up with current Medicare regulations, policies, and changes with assigned programs;

8) Contributing articles to publications; and

9) Tracking outreach performance measures and completing internal quality control for outreach activities.

c. Counseling Responsibilities

1) Following up on internal quality assurance methods with Medicare beneficiaries and caregivers;

2) Sharing problems and successes with the contractor’s personnel; and

3) Providing other counseling as needed.

d. Other Duties and Responsibilities

1) Assisting with compiling reports for the state agency, AOA, and internal purposes as required; and

2) Assisting in planning and development to ensure Missouri SHIP program needs are met.

Customer Service Representatives: The contractor’s Customer Service Representatives’ duties shall include, but are not limited to:

a. Answering calls to the contractor’s toll-free hotline for the Missouri SHIP program;

b. Providing support to the contractor’s Missouri SHIP website;

c. Gathering initial information from Medicare beneficiaries’ callers and referring the call to the appropriate Missouri SHIP program personnel or a local coordinator at a community-based partner;

d. Entering data into the ACL-mandated SHIP tracking and reporting system regarding the Medicare beneficiary’s caller, the assistance provided, and the outreach/media events;

e. Attending appropriate trainings to enhance skills and Missouri SHIP program service knowledge;

f. Assisting with the Missouri SHIP program progress reports for ACL and the state agency; and

g. Opening, logging, sorting, time-stamping, and distributing mail.

In addition to contractor personnel serving as counselors, the contractor must utilize community-based programs to serve as counselors. The contractor should also utilize volunteers as counselors when possible.

The contractor shall recruit, train, and certify that the Missouri SHIP counselors are qualified to provide advice to Missouri citizens in accordance with the SHIP and MIPPA grant requirements and the provisions and requirements herein.

The contractor shall maintain a risk management program for the recruitment and retention of counselors, including, but not limited to, applications, background checks, reference checks, and signed confidentiality statements.

The contractor shall train the counselors as recruitment needs require, and training updates for counselors shall be offered on a quarterly basis and as program changes require.

The contractor shall provide counselors who complete the initial training session with an identification card as evidence of certification.

The contractor shall also schedule and provide initial and follow-up Missouri SHIP training as needed to the state agency Consumer Services staff handling Missouri SHIP counseling telephone calls.

The Missouri SHIP counselors shall not have a conflict of interest or the appearance of conflict of interest in compliance with the requirements stated elsewhere herein.

Prior to providing counseling services, the contractor must screen potential counselors to ensure they have the capacity to work with seniors, minorities, caregivers, and persons with disabilities. The contractor shall provide training to counselors to sensitize them to the special needs of these groups.

The contractor should utilize SHIP/MIPPA and Partnership for Health Insurance Counseling materials developed by ACL and available through the SHIP resource center at www.shiptacenter.org and through ACL at http://www.cms.gov/home/outreacheducation.asp as guidance in managing, operating, and training counselors. The ACL, AOA, SHIP, and MIPPA materials will be revised as required by changes in insurance programs.

The contractor shall establish and maintain counselor status records.

The contractor shall understand and agree that the contractor’s Missouri SHIP program personnel may be monitored by the state agency SHIP Planner. The contractor shall understand and agree that such monitoring may include, but not be limited to, on-site visits and review of work to determine if records have been kept and if services have been provided in an acceptable manner and in accordance with the requirements of the grants and contracts.

The contractor’s personnel shall attend meetings, seminars, and conferences appropriate to enhance their Missouri SHIP program service knowledge. The contractor shall disseminate information to all Missouri SHIP counselors and community-based partners through the weekly updates, special mailings as appropriate, initial and follow-up Missouri SHIP training sessions, and bi-annual contacts with community-based partners.

Performance Requirements:

For each Performance Measure listed in Attachment 1, Performance Measure Goals and Objectives, the contractor shall meet or exceed the Performance Measure Goals and Objectives. The contractor shall maintain an annual overall rating of average or better on the Likert Scale, Attachment 2.

a. The contractor shall understand and agree that ACL/AOA may identify additional Performance Measure Goals and Objectives and/or obligations due to changing ACL/AOA SHIP/MIPPA requirements. The contractor shall meet or exceed any such additional Performance Measure Goals and Objectives and/or obligations. As additional Performance Measure Goals and Objectives and/or obligations are identified and received from ACL/AOA, the Division of Purchasing shall notify the contractor of the additional Performance Measure Goals and Objectives and/or obligations by means of a formal contract amendment. Beyond the new Performance Measure Goals and Objectives and/or obligations added by ACL/AOA, other new Performance Measure Goals and Objectives and/or obligations may be added to the contract upon contract amendment issued by the Division of Purchasing.

b. The contractor should establish county or regional goals using data provided in Attachment 3, Medicare Enrollment by County, to ensure statewide access to Missouri SHIP program services.

The contractor shall provide a computer tracking system capable of providing information to the state agency regarding both the SHIP and…