T1619 Bid Amendment 8 02.06.25 Answers to Questions.docx

PHILIP D. MURPHY

Governor State of New Jersey

DEPARTMENT OF THE TREASURY

DIVISION OF PURCHASE AND PROPERTY

PROCUREMENT BUREAU

33 WEST STATE STREET

P. O. BOX 230

TRENTON, NEW JERSEY 08625-0230

ELIZABETH MAHER MUOIO

State Treasurer

TAHESHA L. WAY

Lt. Governor

AMY F. DAVIS, ESQ.

Acting Director https://www.njstart.gov

February 6, 2025

To: All Interested Bidders

Re: Bid Solicitation # 24DPP00958 Bid Solicitation T1619 – Medical Consulting: External Quality Review Organization, DMAHS

Bid Amendment #8

The following constitutes Bid Amendment #8 to the above referenced Bid Solicitation:

· This Bid Amendment includes:

· An extension of the Quote Submission due date from February 12, 2025 to February 26, 2025 (2:00 p.m. Eastern Time); and

· Answers to questions;

· Revisions to the Bid Solicitation; and

· A Revised State-Supplied Price Sheet titled “T1619 REVISED State-Supplied Price Sheet 02-06-2025, and hereafter referred to in this document as the “Revised State-Supplied Price Sheet”, has been added to the Bid Solicitation via the Attachments tab of this Bid Solicitation in NJSTART. Bidders must submit the Revised State-Supplied Price Sheet as part of the Quote.

· Please note that for all additions, deletions, clarifications and modifications to the Bid Solicitation, please refer to the Revised Bid Solicitation titled “T1619 REVISED Bid Solicitation 02-06-2025” and hereafter referred to in this document as the “Revised Bid Solicitation”. The following revisions are included in the Revised Bid Solicitation:

· Section 3.12, Quote Content – revised;

· Section 3.26, State-Supplied Price Sheet Instructions – revised;

· Section 4.2.1, Location – revised;

· Section 4.3.6, MLTSS Performance Measure Development/Validation – revised;

· Section 4.3.7, MLTSS Calculation of Performance Measures – revised;

· Section 4.3.8, FIDE SNP Performance Measure Development/Validation – revised; and

· Section 4.3.18, Validation of Encounter Data – revised.

It is the sole responsibility of the Bidder to be knowledgeable of all of the additions, deletions, clarifications, and modifications to the Bid Solicitation and/or the New Jersey Standard Terms and Conditions relative to this Bid Solicitation as set forth in all Bid Amendments.

All other instructions, terms, and conditions of the Bid Solicitation shall remain the same.

Bid Solicitation #24DPP00958 Bid Solicitation T1619 – Medical Consulting: External Quality Review Organization, DMAHS

Answers to Questions

Where applicable, each question references the appropriate Bid Solicitation section.

Section Reference Question (Bolded) and Answer

Please be advised that all Quotes shall be submitted electronically through NJSTART.

Yes. Prior to the Quote Opening Deadline, a Bidder should review the documents comprising the submitted Quote to ensure that all of the required documents have been completed and attached. Oftentimes a Quote is deemed non-responsive because a Bidder fails to attach a required form or attaches a blank form. To review a submitted a Quote, a Bidder should log into NJSTART and review each document attached to the Quote submission. Instructions on how to review a submitted Quote can be found in the Quick Reference Guide entitled How to Review a Submitted Quote, which is available on the NJSTART Vendor Support Page under Vendor Reference Guides.

It is recommended that users utilize Microsoft Edge to view PDFs. Certain PDF forms cannot be opened in the Chrome or Firefox built in PDF viewers that are enabled by default. If using Chrome or Firefox it is recommended that the file is downloaded instead by clicking the download button in the upper right-hand corner of the browser after an error message is received. An alternative option is to disable the built in PDF viewers in Chrome or Firefox.

As stated in Revised Bid Solicitation Section 2.2, Exceptions to the State of NJ Standard Terms and Conditions (SSTC): “Questions regarding the State of New Jersey Standard Terms and Conditions and exceptions to mandatory requirements MUST be posed during the Electronic Question and Answer period and shall contain the Bidder’s suggested changes and the reason(s) for the suggested change(s).”

Additionally, as stated in Revised Bid Solicitation Section 3.11, Bidder Additional Terms Submitted with the Quote:

“A Bidder may submit additional terms as part of its Quote. Additional terms are Bidder-proposed terms or conditions that do not conflict with the scope of work required in this Bid Solicitation, the terms and conditions of this Bid Solicitation, or the State of New Jersey Standard Terms and Conditions. Bidder proposed terms or conditions that conflict with those contained in the State of New Jersey Standard Terms and Conditions will render a Quote non-responsive. It is incumbent upon the Bidder to identify and remove its conflicting proposed terms and conditions prior to Quote submission.

Quotes including Bidder proposed additional terms may be accepted, rejected, or negotiated, in whole or in part, at the State’s sole discretion.

If Bidder intends to propose terms and conditions that conflict with the State of New Jersey Standard Terms and Conditions, those Bidder proposed terms and conditions shall only be considered if submitted and agreed to pursuant to the electronic question and answer procedure. Bidders shall not submit exceptions or modifications as part of the Quote or on the “Terms and Conditions” Tab through NJSTART.”

Yes, there is a 500 MB file size limit. Also, when uploading a file this is based on the file size and internet speed. For example, if you are uploading a 499 MB file with a slow connection, the user may be disconnected from the site before the upload is finished. The Bidder may submit its Quote in as many attachments as it deems necessary, provided that each attachment is accurately labeled so that it is clear to the State which Quote submission requirement(s) the submitted attachment(s) are responding to. Please refer to Revised Bid Solicitation Section 3.0, Quote Submission Requirements, for all Quote submission requirements.

Further, Bidders are strongly encouraged to visit the NJSTART Vendor Support Page, which contains Quick Reference Guides (QRGs), supporting videos, a glossary of NJSTART terms, and helpdesk contact information. Bidders should utilize the QRGs before attempting to submit a Quote through NJSTART. It is the Bidder’s responsibility to ensure that the Quote and attachments have been properly submitted. Inquiries concerning the use of NJSTART may be directed to njstart@treas.nj.gov.

Quote attachments may be submitted either as individual attachments or in a single file.

Please reference Revised Bid Solicitation Section 3.12, Quote Content for additional information.

May the Bidder submit/upload Technical Quote attachments (e.g., resumes, financial statements, etc.) as separate files?

Please see the answer to Question #6.

The RFP indicates that quotes should be organized in the following manner: Forms, Technical Quote, State-Supplied Price Sheet, and State of New Jersey Security Due Diligence Third Party Information Security Questionnaire. Please confirm if Bidders should upload/submit each of the four items as four separate PDF documents.

Please see the answer to Question #6.

The Confidentiality Form states "If Company objects to the disclosure of any portions of the Quote, the Company must advise the Division and must attach a detailed statement clearly identifying those sections of the Quote that Company claims are exempt from disclosure." The second page of the form has limited space for the description of the "Statutory or other legal reason for each requested exemption". Can the Bidder provide the requested information on a separate attachment to allow more room for the responses?

Yes, please reference Revised Bid Solicitation Section 3.13.7, Confidentiality/Commitment to Defend for additional information.

The form instructs Bidders to include a description of Requested Quote Redactions on the form. Should Bidder submit two versions of its response – a redacted version and an unredacted version or will the State remove the information prior to public release/disclosure? If a separate additional redacted version is required, how should Bidder identify the confidential information within its response (e.g., black out text, add the term “Confidential” on the page, etc.)?

The State is not requesting that the Bidder provide a redacted version of its Quote.

In accordance with Revised Bid Solicitation Section, 3.13.7, Confidentiality / Commitment to Defend Form: “The State reserves the right to make the determination as to what to disclose in response to an OPRA request. Any information that the State determines to be exempt from disclosure under OPRA will be redacted.”

A Bidder can organize its Quote in accordance with Revised Bid Solicitation Section 3.12, Quote Content, as long as the Quote submission requirements are met. A Bidder should submit a completed and signed Confidentiality/Commitment to Defend Form with the Quote.

Please reference Revised Bid Solicitation Section 3.13.7, Confidentiality / Commitment to Defend Form for additional information.

The RFP requires “the intended contractor” to submit Affirmative Action documentation. Are Bidders required to submit Affirmative Action documentation (i.e., New Jersey Certificate of Employee Information Report or a Federal Letter of Approval) with their quote, or is this requirement for the awarded contractor?

Affirmative Action documentation is required to be submitted following the State’s issuance of its Notice of Intent to Award and before Contract award.

Please reference Revised Bid Solicitation Section 3.13.10, Affirmative Action for additional information.

The solicitation states that contractors and their named subcontractors are to submit a New Jersey Certificate of Employee Information Report or a Federal Letter of Approval or an Affirmative Action Employee Information Report (AA-302). This requirement appears to pertain to organizations awarded a contract by New Jersey. Since subcontractors will have a contract with the prime, not with the state, please confirm that only the prime bidder is required to submit an affirmative action report/letter with the proposal.

In accordance with Revised Bid Solicitation Section 3.13.10, Affirmative Action: “The intended Contractor and its named Subcontractor(s) must submit a copy of a New Jersey Certificate of Employee Information Report, or a copy of Federal Letter of Approval verifying it is operating under a federally approved or sanctioned Affirmative Action program.”

Affirmative Action documentation is required to be submitted before Contract award.

Please reference Revised Bid Solicitation Section 3.13.10, Affirmative Action for additional information.

If Affirmative Action documentation is required with the Bidder’s proposal, would a letter from the US Department of Labor, Office of Federal Contract Compliance Programs (OFCCP) indicating no violations of Executive Order 11246, meet the RFP requirements?

Please see the answer to Question #11 and #12.

Where can the questionnaire be found?

The State of New Jersey Security Due Diligence Third-Party Information Security Questionnaire is located on NJSTART under Bid Solicitation # 24DPP00958 file attachments titled “T1619 State of New Jersey Third Party Information Security Questionnaire 07.18.24”.

The Contract Schedule and Deliverable 4 are essentially the same, however Revised Bid Solicitation Section 3.17, Contract Schedule is a draft, and Deliverable 4 in Revised Bid Solicitation Section 4.3.2.3, Sample Selection Methodology, is a final document.

Please reference Revised Bid Solicitation Sections 3.17, Contract Schedule and 4.3.2.3, Sample Selection Methodology for additional information.

The Division of Medical Assistance and Health Services (DMAHS) has no preference, any example provided should demonstrate the Bidder’s capability to prepare the required Deliverable.

In accordance with Revised Bid Solicitation Section 3.22, Organization Charts: “The Bidder should include an organization chart, with names showing management, supervisory and other key personnel (including Subcontractor management, supervisory, or other key personnel) to be assigned to the Contract. The chart should include the labor category and title of each such individual.”

The Bidder may add additional details to the Organization Chart.

As specified by SSTC Section 5.14, Contract Amendment, the Contract may only be amended by written agreement of the State and the Contractor.

Will Contractors receive a fixed payment for each deliverable, regardless of whether the actual cost for an item is higher or lower?

Yes. In accordance with Revised Bid Solicitation Section 3.26, State-Supplied Price Sheet Instructions: “The Firm Fixed Price provided by the Bidder shall be on a per deliverable basis.”

Also, per Revised Bid Solicitation Section 9.2, Definitions: “Firm Fixed Price – A price that is all-inclusive of direct cost and indirect costs, including, but not limited to, direct labor costs, overhead, fee or profit, clerical support, equipment, materials, supplies, managerial (administrative) support, all documents, reports, forms, travel, reproduction and any other costs.”

“Completing” a Deliverable is a DMAHS approved final deliverable, which depending on the task, may include follow up work on Corrective Action Plans.

The State-Supplied Price Sheet has been revised as part of this Bid Amendment. The question references Price Line #8 on the original State-Supplied Price Sheet, which is now Price Line #16 on the Revised State-Supplied Price Sheet. The answer provided below refers to Price Line #16 on the Revised State-Supplied Price Sheet.

The quantity for Price Line #16 on the Revised State-Supplied Price Sheet refers to the estimated number of Managed Care Organizations (MCOs). There is no guaranteed minimum or maximum volume for the price lines on the Revised State-Supplied Price Sheet.

The Contractor will be paid the corresponding Contract Year Unit Pricing each time it completes Deliverable 16. For example, if Deliverable 16 is completed five (5) times in Contract Year 1, the Contractor will be compensated five (5) times at the Contract Year 1 Unit Pricing cost for Deliverable 16.

Unless specified otherwise, the data provided as part of this Bid Amendment is meant to be informational in nature, and the State makes no representations or guarantee as to such data during any contract term, including any extension(s) thereof.

Please refer to the Revised State-Supplied Price Sheet and the Revised Bid Solicitation Section 3.26, State-Supplied Price Sheet Instructions, as this section has been revised.

The State-Supplied Price Sheet has been revised as part of this Bid Amendment. The question references Price Line #10 on the original State-Supplied Price Sheet, which is now Price Line #19 on the Revised State-Supplied Price Sheet. The answer provided below refers to Price Line #19 on the Revised State-Supplied Price Sheet.

The quantity refers to the estimated number of Managed Care Organizations (MCOs). There is no guaranteed minimum or maximum volume for the price lines on the Revised State-Supplied Price Sheet.

The Contractor will be paid the corresponding Contract Year Unit Pricing each time it completes Deliverable 19. For example, if Deliverable 19 is completed five (5) times in Contract Year 1, the Contractor will be compensated five (5) times at the Contract Year 1 Unit Pricing cost for Deliverable 19.

Please refer to the Revised State-Supplied Price Sheet and the Revised Bid Solicitation Section 3.26, State-Supplied Price Sheet Instructions, as this section has been revised.

The State-Supplied Price Sheet has been revised as part of this Bid Amendment. The question references Price Line #17 on the original State-Supplied Price Sheet, which is now Price Line #26 on the Revised State-Supplied Price Sheet. The answer provided below refers to Price Line #26 on the Revised State-Supplied Price Sheet.

The quantity represents Deliverable 26. 33 is the estimated annual quantity for the performance of Deliverable 26. The Contractor will be paid the corresponding Contract Year Unit Pricing each time it completes Deliverable 26. For example, if Deliverable 26 is completed 33 times in Contract Year 1, the Contractor will be compensated 33 times at the Contract Year 1 Unit Pricing cost for Deliverable 26.

In accordance with the Revised Bid Solicitation Section 4.3.13, Focused Quality Studies: “Deliverable 26: A complete statistical analysis of each focused quality study, and any other ad hoc studies, in the timeline identified in the Contractor’s approved AWP shall be electronically submitted to DMAHS.”

Please refer to the Revised State-Supplied Price Sheet and the Revised Bid Solicitation Section 3.26, State-Supplied Price Sheet Instructions, as this section has been revised.

Is the price sheet column for Firm Fixed Price for one unit (quantity)?

Yes. In accordance with Revised Bid Solicitation Section 3.26, State-Supplied Price Sheet Instructions: “The Firm Fixed Unit Price provided by the Bidder shall be on a per deliverable basis.”

Note: Each deliverable has a specific quantity. Where the Revised State-Supplied Price Sheet includes an estimated quantity column, Bidders are advised that estimated quantities may vary throughout the Contract term resulting from this Bid Solicitation. There is no guaranteed minimum or maximum volume for the price lines on the Revised State-Supplied Price Sheet.

Unless specified otherwise, the data provided as part of this Bid Amendment is meant to be informational in nature, and the State makes no representations or guarantee as to such data during any contract term, including any extension(s) thereof.

Please refer to the Revised State-Supplied Price Sheet and the Revised Bid Solicitation Section 3.26, State-Supplied Price Sheet Instructions, as this section has been revised.

How is the quantity defined for each line (per MCO, per report, etc.)?

Quantities and their definitions vary based on the Deliverable.

Unless specified otherwise, the data provided as part of this Bid Amendment is meant to be informational in nature, and the State makes no representations or guarantee as to such data during any contract term, including any extension(s) thereof.

Please refer to the Revised State-Supplied Price Sheet and the Revised Bid Solicitation Section 3.26, State-Supplied Price Sheet Instructions, as this section has been revised.

How are deliverables requiring quarterly submissions handled when they are part of a line item that includes other deliverables that may be completed only once a year? For example, for line 9, there are two deliverables included, one of which is conducted four times per year (Deliverable 17) and one of which is conducted once per year (Deliverable 18). How should bidders provide a “per deliverable” price”?

The State-Supplied Price Sheet has been revised as part of this Bid Amendment. The question references Price Line #9 on the original State-Supplied Price Sheet which referenced Deliverable 17 and Deliverable 18, which is now Price Line #17 for Deliverable 17 and Price Line #18 for Deliverable 18 on the Revised State-Supplied Price Sheet.

Each Deliverable now has its own Price Line.

Please refer to the Revised State-Supplied Price Sheet and the Revised Bid Solicitation Section 3.26, State-Supplied Price Sheet Instructions, as this section has been revised.

For line 27, what does the quantity equate to?

The State-Supplied Price Sheet has been revised as part of this Bid Amendment. The question references Price Line #27 on the original State-Supplied Price Sheet, which is now Price Line #39 on the Revised State-Supplied Price Sheet. The answer provided below refers to Price Line #39 on the Revised State-Supplied Price Sheet.

The quantity equates to the estimated number times Deliverable 39 will be completed on an annual basis. The Contractor will be paid the corresponding Contract Year Unit Pricing each time it completes Deliverable 39. For example, if Deliverable 39 is completed ten (10) times in Contract Year 1, the Contractor will be compensated ten (10) times at the Contract Year 1 Unit Pricing cost for Deliverable 39.

Please reference Revised Bid Solicitation Section 4.3.21, Validation of Network Adequacy for additional information.

Unless specified otherwise, the data provided as part of this Bid Amendment is meant to be informational in nature, and the State makes no representations or guarantee as to such data during any contract term, including any extension(s) thereof.

Please refer to the Revised State-Supplied Price Sheet and the Revised Bid Solicitation Section 3.26, State-Supplied Price Sheet Instructions, as this section has been revised.

How should bidders provide a “per deliverable” price for the following lines?

a. In line 7, the quantity is 5. Deliverable 11 includes four reports per MCO. Deliverable 12 includes one report. Deliverables 13 and 14 include one report per MCO and one statewide report. Deliverable 15 includes only an activity.

b. In line 19, the quantity is 15. Each of the three deliverables includes six components (one report for each MCO and a statewide summary).

c. In line 20, the quantity is 5, but there are six components to the deliverable (one report for each MCO and one statewide summary).

d. In line 22, the quantity is 1, but there are five reports, one for each MCO.

Answer A: The State-Supplied Price Sheet has been revised as part of this Bid Amendment. The question references Price Line #7 on the original State-Supplied Price Sheet, which is now Price Lines #11 through 15 on the Revised State-Supplied Price Sheet. The answer provided below refers to Price Lines #11 through 15 on the Revised State-Supplied Price Sheet.

Answer B: The State-Supplied Price Sheet has been revised as part of this Bid Amendment. The question references Price Line #19 on the original State-Supplied Price Sheet, which is now Price Lines #28 through 30 on the Revised State-Supplied Price Sheet. The answer provided below refers to Price Lines #28 through 30 on the Revised State-Supplied Price Sheet.

Answer C: The State supplied Price sheet has been revised as part of this Bid Amendment. The question references Price Line #20 on the original State-Supplied Price Sheet, which is now price line #31 on the Revised State-Supplied Price Sheet. The answer provided below refers to Price line #31 on the Revised State Supplied Price Sheet.

Answer D: The State supplied Price sheet has been revised as part of this Bid Amendment. The question references Price Line #22 on the original State-Supplied Price Sheet, which is now price line #33 on the Revised State-Supplied Price Sheet. The answer provided below refers to Price line #33 on the Revised State Supplied Price Sheet.

Please refer to the Revised State-Supplied Price Sheet and the Revised Bid Solicitation Section 3.26, State-Supplied Price Sheet Instructions, as this section has been revised.

In accordance with the Revised Bid Solicitation Section 3.26, State Supplied Price Sheet Instructions: “The Revised State-Supplied Price Sheet contains 40 price line items. The Bidder must submit a Firm Fixed Unit Price for all 40 price lines in order to be considered for award. The Bidder must submit a Firm Fixed Unit Price for each year (Year 1, Year 2, Year 3, and Year 4) for each price line. The Firm Fixed Unit Price provided by the Bidder shall be on a per deliverable basis.”

The Contractor will be paid the corresponding Contract Year Unit Pricing each time it completes a Deliverable. For example, if a Deliverable is completed five (5) times in Contract Year 1, the Contractor will be compensated five (5) times at the Contract Year 1 Unit Pricing cost for that Deliverable.

The State supplied Price sheet has been revised as part of this Bid Amendment. The question references Price Line #3, Price Line #4, and Price line #19 on the original State-Supplied Price Sheet, which is now price line #5, #6, #7, #8, #28, #29, and #30 respectively on the Revised State-Supplied Price Sheet. The answer provided below refers to Price line #5, #6, #7, #8, #28, #29, and #30 on the Revised State Supplied Price Sheet.

Please refer to the Revised State-Supplied Price Sheet and the Revised Bid Solicitation Section 3.26, State-Supplied Price Sheet Instructions, as this section has been revised.

In accordance with the Revised Bid Solicitation Section 3.26, State Supplied Price Sheet Instructions: “The Revised State-Supplied Price Sheet contains 40 price line items. The Bidder must submit a Firm Fixed Unit Price for all 40 price lines in order to be considered for award. The Bidder must submit a Firm Fixed Unit Price for each year (Year 1, Year 2, Year 3, and Year 4) for each price line. The Firm Fixed Unit Price provided by the Bidder shall be on a per deliverable basis.”

The Contractor will be paid the corresponding Contract Year Unit Pricing each time it completes a Deliverable. For example, if a Deliverable is completed five (5) times in Contract Year 1, the Contractor will be compensated five (5) times at the Contract Year 1 Unit Pricing cost for that Deliverable.

Please define “centrally located.” Can this requirement be met by availability of staff for onsite meetings, or is there a mileage requirement?

The requirement can be met by availability of staff for onsite meetings.

Please refer to Revised Bid Solicitation Section 4.2.1, Location, as this section has been revised.

Is it mandatory to have a physical presence for the biweekly meetings, or is it permissible to attend these meetings remotely via Zoom at the discretion of the client?

In accordance with the Revised Bid Solicitation Section 4.2.2 (B), Operations: “The Contractor shall: Be available onsite at the DMAHS office for biweekly meetings with DMAHS. Some meetings may be conducted via conference call or video conference with the approval of DMAHS. Additional meetings may be scheduled at the discretion of the State on an as-needed basis.”

Is it acceptable to send one person onsite while other team members attend remotely via Zoom for the biweekly meetings?

It may not be necessary for all team members to attend the biweekly meeting onsite however, all team members must be available to attend onsite meetings as necessary.

Please see the answer to Question #31.

How much review time does DMAHS require for report/deliverable review prior to finalizing documents/reports.

Review time may vary according to the quality, size, and complexity of the Deliverable.

Is it required for the Medical Director to possess a current license specifically from the state of New Jersey, or is it acceptable to have a valid medical license from any state?

Yes, a current New Jersey license is required.

In accordance with the Revised Bid Solicitation Section 4.3.2.1, Medical Review Plan: “A Medical Director, with a current New Jersey license, must lead the design and provide medical oversight for all medical reviews.”

Please confirm that a separate sample is required for each population, for each MCO.

The sample selection varies depending on the Deliverable.

In section 4.3.4, “Development of additional Performance Measure(s) and specifications upon request” is mentioned. Please provide the total number of performance measures the contractor will be required to develop each contract year.

Currently there are two (2) New Jersey State Specific Performance Measures. Please note that this is subject to change based on State requirements.

Unless specified otherwise, the data provided as part of this Bid Amendment is meant to be informational in nature, and the State makes no representations or guarantee as to such data during any contract term, including any extension(s) thereof.

Please provide the total number of Core Medicaid performance measures that the contractor will be required to validate each contract year.

This will be determined by the annual Centers for Medicare and Medicaid Services (CMS) requirements.

Regarding Sections 4.3.4 and 4.3.5, does DMAHS have a preferred format for the Contractor to provide feedback on Annual Work Plans and CAPs submitted by the MCOs for any measures found below a benchmark identified by CMS or the State?

The format used would be agreed upon between the State and the Contractor.

Please provide the total number of FIDE performance measures that the contractor will be required to validate each contract year.

Similar to Core Medicaid this will be determined by the annual CMS requirements. Please see the answer to Question #37

Please confirm whether this will be one aggregate quarterly report representing all MCO’s in each of four quarters (for four reports per year), or these are meant to be MCO-specific reports and therefore this should be five MCO-specific reports in each of four quarters

There shall be a total of one (1) consolidated MCO report per quarter, resulting in four (4) reports annually. This encompasses 20 reviews/validations per year, as represented by the Quantity for this Deliverable on the Revised State-Supplied Price Sheet.

The Contractor will be paid the corresponding Contract Year Unit Pricing each time it completes Deliverable 11. For example, if Deliverable 11 is completed 20 times in Contract Year 1, the Contractor will be compensated 20 times at the Contract Year 1 Unit Pricing cost for Deliverable 11.

In accordance with the Revised Bid Solicitation Section 4.3.6, MLTSS Performance Measure Development/Validation: “There shall be a total of one (1) consolidated MCO report per quarter, resulting in a total of four (4) reports annually. The report will encompass review/validation data from all five (5) MCOs.”

In section 4.3.6, “Development of MLTSS State specific Performance Measure(s) upon request” is mentioned. Please provide the total number of performance measures the contractor will be required to develop each contract year.

The number of Performance Measures are dependent on CMS and program requirements.

Please provide the total number of MLTSS performance measures that the contractor will be required to validate each contract year.

The number of Performance Measures are dependent on CMS and program requirements.

Based off the current Nursing Facility (NF) transition program, short term NF stays are not applicable. Please confirm that DMAHS intends for this to be a separate NF transition incentive program to capture NF stays less than 60 calendar days to ensure compliance with MCO engagement of CM resources to avoid an unnecessary NF LTC admission.

No, DMAHS does not intend for this to be a separate NF transition incentive program.

In accordance with Revised Bid Solicitation Section 4.3.6, MLTSS Performance Measure Development / Validation : “The Contractor shall be responsible for the review and validation of DMAHS approved transition incentives where the Nursing Facility (NF) stay is less than 60 calendar days to ensure that MCO Care Management resources were appropriately engaged to avoid unnecessary NF admissions.”

Regarding Sections 4.3.6 and 4.3.8, please provide the anticipated number of measures for development and validation.

The number of Performance Measures are dependent on CMS and program requirements for Revised Bid Solicitation Section 4.3.6, MLTSS Performance Measure Development / Validation and Section 4.3.8, FIDE SNP Performance Measure Development / Validation.

Regarding Sections 4.3.6 and 4.3.8, please confirm if DMAHS anticipates requesting annual updates to specifications and reporting guidance.

Yes, DMAHS anticipates annual review of source code, interviews with MCOs to review code changes, and review of code and reports.

Please reference Revised Bid Solicitation Section 4.3.6, MLTSS Performance Measure Development / Validation and Section 4.3.8, FIDE SNP Performance Measure Development / Validation for additional information.

Regarding Sections 4.3.6 and 4.3.8, does DMAHS have a preferred format for the Contractor to provide feedback on CAPs submitted by the MCOs?

DMAHS prefers Excel format.

What are the anticipated data sources necessary for performance measure calculation (e.g., claims/encounter data, electronic health records, medical records, case management)?

Anticipated data sources are intended to derive from the Managed Long Term Services and Support (MLTSS) Home and Community Based Services (HCBS) and Nursing Facility (NF) / Special Care Nursing Facility (SCNF) Care management audits as outlined under Revised Bid Solicitation Section 4.3.15 MLTSS / Care Management (CM) Deliverables 29 and 30.

What is the anticipated timeframe (e.g., July of each year, monthly) for providing data for measure calculations to the Contractor?

Anticipated timeframe is annually, during MLTSS, HCBS, and NF/SCNF Care management audits as outlined under Revised Bid Solicitation Section 4.3.15 MLTSS / Care Management (CM) Deliverables 29 and 30.

What is the anticipated number of measures for calculation?

The number of Performance Measures are dependent on CMS and program requirements.

Please provide the total number of MLTSS performance measures that the contractor will be required to calculate each contract year.

Please see the answer to Question #49.

4.3.7 includes the following language: “Each MCO is required to submit a CAP within 20 business days of receipt of the final Audit results, for any elements found “Not Met” during the respective calculation of Performance Measures.” Please clarify if “Not Met” refers to the MCOs not meeting the state-established performance standards.

“Not Met” refers to the MCOs not meeting the State-established performance standards.

In Section 4.3.8, NJ asks the bidder to outline its processes for “FIDE SNP PERFORMANCE MEASURE DEVELOPMENT/VALIDATION.” The current contractor validates PMs for a portion of the FIDE population as a part of its MLTSS PM validation processes—essentially validating PMs for FIDE members who have an MLTSS benefit. Please confirm that DMAHS wants the bidder to validate PMs for FIDE in this way.

The Contractor will be requested to validate Performance Measures for a portion of the Fully Integrated Dual Eligible Special Needs Plans (FIDE SNP) population as part of the MLTSS Performance Measures Validation.

In section 4.3.8, “Development of FIDE SNP State Specific Performance Measure(s) upon request” is mentioned. Please provide the total number of performance measures the contractor will be required to develop each contract year.

The number of performance measures will be based on CMS requirements.

Please confirm whether this will be one aggregate quarterly report representing all MCO’s in each of four quarters (for four reports per year), or these are meant to be MCO-specific reports and therefore this should be five MCO-specific reports in each of four quarters.

Bid Solicitation Section 4.3.8, FIDE SNP Performance Measure Development / Validation has been revised.

In accordance with the Revised Bid Solicitation Section 4.3.8, FIDE SNP Performance Measure Development / Validation: “There shall be a total of five (5) individual MCO quarterly reports, resulting in a total of 20 reports annually.”

The Contractor will be paid the corresponding Contract Year Unit Pricing each time it completes Deliverable 17. For example, if Deliverable 17 is completed 20 times in Contract Year 1, the Contractor will be compensated 20 times at the Contract Year 1 Unit Pricing cost for Deliverable 17.

What are the anticipated data sources necessary for performance measure calculation (e.g., claims/encounter data, electronic health records, medical records, case management)?

The data sources will depend on the CMS requirements as well as the annual assessment which is based on the contract with the MCOs. Depending on the variable claims\encounter data or medical records that will be used.

What is the anticipated timeframe (e.g., July of each year, monthly) for providing data for measure calculations to the Bidder?

Data will be provided annually at the end of State fiscal year (June 30th) each year. However, there may be data sources that are outlined during the calendar year.

What is the anticipated number of measures for calculation?

This is dependent on CMS requirements.

Please provide the total number of FIDE performance measures that the contractor will be required to calculate each contract year.

The number of performance measures will be based on CMS requirements.

4.3.9 includes the following language: “Each MCO is required to submit a CAP within 20 business days of receipt of the final Audit results, for any elements found “Not Met” during the respective calculation of Performance Measures.” Please clarify if “Not Met” refers to the MCOs not meeting the state-established performance standards.

“Not Met” refers to the MCOs not meeting the State established performance standards.

The Bidder understands that the MCOs submit PIPs to the Contractor for review in April and August of each year. Please confirm that one submission is a progress review, and one submission is for the annual validation required by CMS.

Yes, April is a progress update and August is an annual validation.

Please confirm that the reports produced by the Contractor are MCO-specific reports that include information for all PIPs submitted by the MCO and validated by the Contractor, and not PIP-specific reports.

Yes, the reports produced by the Contractor are MCO specific reports.

4.3.17 states “…a written study design with proposed unit cost budget to conduct each of the studies shall be electronically submitted for DMAHS’ approval.” However, this activity is included in the Price Sheet under price line #17. Given the Bidder is required to submit a unit cost budget for each quality study, please advise how price line #17 should be populated.

The State-Supplied Price Sheet has been revised as part of this Bid Amendment. The question references Price Line #17 on the original State-Supplied Price Sheet, which is now Price Line #26 on the Revised State-Supplied Price Sheet. The answer provided below refers to Price Line #26 on the Revised State-Supplied Price Sheet.

The Price Line should be populated per unit. There are 33 units allocated for Focused Quality Studies. A study design may be proposed utilizing multiple units as necessary.

The Firm Fixed Unit Price provided by the Bidder shall be all the requirements mentioned in Deliverable 26.

The Contractor will be paid the corresponding Contract Year Unit Pricing each time it completes Deliverable 26. For example, if Deliverable 26 is completed 33 times in Contract Year 1, the Contractor will be compensated 33 times at the Contract Year 1 Unit Pricing cost for Deliverable 26.

How are cases for individual case review identified and referred to the Contractor?

Cases may be identified during External Quality Review Organization (EQRO) work activities and by various offices/leadership within DMAHS.

b. If random sampling will be required, is there a specific service line/setting reviews should focus on?

Random Sampling is not required for Individual Case Reviews.

Please confirm that the annual total sample size for the Individual Case Reviews of quality of care concerns is 100 as depicted on the State-Supplied Price Sheet.

This is an estimated annual quantity. Total individual case reviews vary and may be up to 100.

Unless specified otherwise, the data provided as part of this Bid Amendment is meant to be informational in nature, and the State makes no representations or guarantee as to such data during any contract term, including any extension(s) thereof.

The Contractor will be paid the corresponding Contract Year Unit Pricing each time it completes Deliverable 32. For example, if Deliverable 32 is completed 100 times in Contract Year 1, the Contractor will be compensated 100 times at the Contract Year 1 Unit Pricing cost for Deliverable 32.

Please confirm when the most recent validation of encounter data was performed.

The most recent validation of encounter data was performed in 2017.

DMAHS has no frequency expectation; Validation of Encounter Data will occur when warranted.

Please see the answer to Question #67.

DMAHS has no frequency expectation; medical record review will occur when warranted.

Please confirm if survey administration will include a mail-only methodology, mail and Internet methodology, or a mail, Internet, and phone methodology for the CAHPS member experience survey for the CHIP population.

Survey administration must be conducted per National Committee for Quality Assurance (NCQA) specifications. DMAHS will approve survey methodology.

Please reference Revised Bid Solicitation Section 4.3.19, Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey-Core Medicaid for additional information.

Please confirm in which languages the CAHPS member experience survey for the CHIP population will be administered.

In accordance with Revised Bid Solicitation Section 4.3.19, Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey-Core Medicaid administration of the CAHPS survey for the CHIP population must follow the NCQA and Healthcare Effectiveness Data and Information Set (HEDIS) protocols.

Please confirm if DMAHS intends to add supplemental questions to the CAHPS member experience survey for the CHIP population. If so, how many supplemental questions will be added?

Currently, there are five…