T3093 Amend 2 QA Final.docx

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Attached to
T3093 - SHBP and SEHBP Medicare Advantage Plans
Solicitation number
19DPP00265
Issued by
Mercer County, New Jersey

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This document is a bid amendment from the New Jersey Department of the Treasury Division of Purchase and Property regarding Bid Solicitation #19DPP00265 for the State Health Benefits Program (SHBP) and School Employees Health Benefits Program (SEHBP) Medicare Advantage Plans. The bid amendment includes answers to questions, and bidders are directed to refer to the revised bid solicitation document for all additions, deletions, clarifications, and modifications. The bid solicitation is seeking proposals for Medicare Advantage plans for retirees enrolled in the SHBP and SEHBP, with a quote submission due date of July 17, 2018. The State reserves the right to award any or all price lines and to separately procure individual requirements during the blanket purchase order term.

The bid solicitation provides detailed requirements, data files, and specifications for the Medicare Advantage plans, including plan design, claims administration, member services, and reporting. Pricing is to be provided using the State's templates, and the successful vendor(s) must meet all technical and operational requirements. The State does not allow for plan design changes and will not consider proposals from the incumbent Horizon Blue Cross Blue Shield of New Jersey. There are no small business set-aside goals identified, but subcontracting and data security requirements are specified.

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Other files

File Type Posted
T3093 Amend 1.docx DOCX document
Attachment 2 PPO CMS ACCESS Match.xlsx XLSX spreadsheet
T3093 SHBP RFP 6-8-18~1.docx DOCX document
T3093 Offer and Acceptance Page 060818~1.pdf PDF
T3093 Bid Solicitation Checklist 060818.docx DOCX document
Med Adv_Pricing 5718.xlsx XLSX spreadsheet
Attachment 3 Service Area Match.xlsx XLSX spreadsheet
Attachment 4 Statement of Assurances.docx DOCX document
Attachment 1 CMS STAR rating.xlsx XLSX spreadsheet
T3093 SHBP RFP 6-19-18.docx DOCX document
T3093 SHBP RFP 6-29-18.docx DOCX document
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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

SHEILA Y. OLIVER

Lt. Governor

MAURICE A. GRIFFIN

Acting Director https://www.njstart.gov

June 29, 2018

To: All Interested Vendors {Bidders}

Re:Bid Solicitation # 19DPP00265
T3093 State Health Benefits Program and School Employees Health Benefits Program Plans –Medicare Advantage Plans

Quote Submission Due Date: July 17, 2018 (2:00 p.m. Eastern Time)

Bid Amendment #2

The following constitutes Bid Amendment #2 to the above referenced Bid Solicitation:

· This Bid Amendment includes answers to questions; and

· Please note that for all additions, deletions, clarifications and modifications to the Bid Solicitation, please refer to the Revised Bid Solicitation entitled “T3093 Bid Solicitation Revised 062918.

It is the sole responsibility of the Vendor {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 #19DPP00265 T3093 State Health Benefits Program and School Employees Health Benefits Program Plans – Medicare Advantage Plans

Answers to Questions

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

Note: Some of these questions may have been paraphrased in the interest of readability and clarity.

#
Bid Solicitation

Section Reference Question (Bolded) and Answer

1
General
When trying to open a Portable Document Format (PDF) document I am receiving an error message and are unable to access the PDF document.

It is recommended that users utilize Internet Explorer to view PDF documents. 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.

2
Options for bid response
Is it possible for a responding vendor to only respond to a section of the Scope of Work, such as Risk Adjustment?

No, a Vendor {Bidder} must respond to all of the work as outlined in Section 3.0 and must complete and submit all of the price/sheet/schedules per Bid Solicitation Section 4.4.5.2.

3
Excel file “Med Adv Experience & Risk Score Data”
1) Is “CMS revenue” for the carriers before or after sequestration? Is an estimate for final settlement included in the CMS revenue numbers?

· Horizon claims data: The CMS revenue data is before sequestration. An estimate for final settlement is not included in the CMS revenue numbers.

· Aetna claims data: The CMS revenue data is net of sequestration. An estimate for final settlement is not included in the CMS revenue numbers.

2) Is UMDM included in the “Incurred & Paid Claims” for the carriers?

· Horizon claims data: No, UMDM is not included in the “Incurred & Paid Claims” data.

· Aetna medical management expenses such as vendor fees and assessments are included in claims as non-FFS expenses. Many of the medical management resources are bucketed as administrative costs and not included in claims data.

4
Section 1.1 Purpose and Intent (pg 5)
Please provide an example of what could fall into this situation. The State may award any and all price lines. The State, however, reserves the right to separately procure individual requirements that are the subject of the Blanket P.O. during the Blanket P.O. term.

The State cannot provide a response to this question as this determination is made on a case-by-case basis.

5
Section 1.1 Purpose and Intent, Scenarios A, B and C (pg 5-6)
Please provide the current in-force full medical rate (no prescription drug- rx) for the following cohorts: State Group: Horizon $10 PPO MA only plan in-force rate Local Government Group: Horizon $10 PPO MA only plan in-force rate Local Education Current Medicare Supplement Group: Horizon $10 PPO Medicare Supplement plan in-force rate State Group: Horizon $15 PPO MA only plan in-force rate Local Government Group: Horizon $15 PPO MA only plan in-force rate Local Education Current Medicare Supplement Group: Horizon $15 PPO Medicare Supplement plan in-force rate State Group: Aetna $10 PPO MA only plan in-force rate Local Government Group : Aetna $10 PPO MA only plan in-force rate Local Education Current MA Group : Aetna $10 PPO MA only plan in-force rate State Group: Aetna $15 PPO MA only plan in-force rate Local Government Group : Aetna $15 PPO MA only plan in-force rate Local Education Current MA Group : Aetna $15 PPO MA only plan in-force rate State Group: Aetna Legacy HMO plan in-force rate Local Government Group: Aetna Legacy HMO plan in-force rate Local Education Current MA Group: Aetna Legacy HMO in-force rate State Group: Aetna Legacy HMO 15/25 plan in-force rate Local Government Group: Aetna Legacy HMO 15/25 plan in-force rate Local Education Current MA Group: Aetna Legacy HMO 15/25 in-force rate.

Current Medicare Advantage premium rates and Medicare Supplement premium equivalent rates (both “medical only”) are public information and can be found in the annual Rate Renewal reports for the SHBP/SEHBP, which can be located at: http://www.state.nj.us/treasury/pensions/rate-renewal.shtml.

6
Section 1.1 B (pg 6)
As it relates to the State’s expectations, does the State expect that the member experience in Medicare Advantage will be the same as the member had in the Medicare Supplemental plans from a medical management standpoint?

Yes, the State expects the experience to be the same.

7
Section 1.2.1 and Plan Design Exhibit (pg 9)
Compression Stockings coverage: Compression Stockings such as Gradient Compression Stockings or Jobst elasticized heavy duty stockings are covered as per Medicare-coverage guidelines under the Prosthetic Devices benefit. Does the State wish additional coverage for non-Medicare covered stockings (e.g., general support hose or elastic stockings)? Should plans apply an annual limit to this type of stocking?

No, the State does not wish to include additional coverage. Annual limits already apply to compression stockings.

8
Section 1.2.1 and Plan Design Exhibit (pg 9)
Horizon Blue Cross Blue Shield of NJ Medicare Advantage plans were found on the State website, but not in the RFP Plan Design Exhibit. Please confirm that the Horizon MA plan designs/pricing are not expected.

Yes, Horizon plan designs/pricing are not expected.

9
Section 1.2.1 and Plan Design Exhibit (pg 9)
Our plan offers standard embedded benefits (e.g., hearing aids). Are we allowed to include these benefits in our plan designs?

No, the State will not allow plan design changes.

10
Section 1.2.2 (pg 10) Open Enrollment
The State does not hold a traditional annual Open Enrollment for Retirees; however, Retirees are permitted to change plans once in a 12 month period. What happens with age-ins turning 65 outside of the annual change period?

As age-ins turn 65 outside of the annual change period, they will be automatically enrolled in their current plan design option. As an example, a State Retiree age-in enrolled in the $10 PPO plan as an Early Retiree would automatically be enrolled in the $10 PPO Medicare Advantage plan when they turn 65. If that State Retiree was enrolled in the 1525 PPO plan as an Early Retiree, they would automatically be enrolled in the 1525 PPO Medicare Supplement Plan when they turn 65. If the plan option that the Early Retiree is enrolled in has both a Medicare Supplement and a Medicare Advantage option (i.e., current Education $10 PPO plan with Medicare Supplement through Horizon and Medicare Advantage through Aetna), the member will be automatically enrolled into the Medicare Advantage plan option.

11
Section 1.2.2 (pg 10)
The Medicare retiree is permitted to switch annually into any SHBP plan design option, including the Medicare Advantage PPO or HMO plans. Will the retirees still maintain the ability to select any plan option offered in 2019?

Yes, retirees will still maintain this ability.

12
1.3.5 Data Files –Mandatory Requirements
Please confirm the Aetna HMO government group does not require a premium development tab to be completed as part of the Med Adv Pricing 5718 document.

Confirmed. The Premium Development tabs are representative of only a sample of the various plan designs, groups, and scenarios. The Premium Development tabs are not required for all scenarios/plans/groups – only those listed within the Pricing document.

13
Section 1.3.5 -Confidential Files
Has the 2.0% sequestration been deducted from the claims and CMS revenue payments?

· Horizon reports and experience data for current MA members are before the 2% reduction for sequestration.

· Aetna reports are net of sequestration. The CMS revenue is on a cash received basis through the date noted on the report.

· The MMR Part D report for Education Medicare Supplement Members, provided by Optum, is before the 2% reduction for sequestration.

14
Section 1.3.5 -Confidential Files
For all of the Medicare Advantage medical claim files, do the paid claims represent all claims or are there any additional claims such as non-FFS claims, vendor fees, provider bonuses, other rider costs, or capitation not included?

· For Horizon claims, the paid claims do not include any of the additional claim items listed in this question.

· Aetna claims are incurred and completed FFS claims along with non-FFS medical expenses (i.e., vendor fees, assessments, pay-for-performance arrangements etc.) and capitations.

15
Section 1.3.5 -Confidential Files
1) Do the RX claims include Part B and Part D?

The Rx claims shown for the current Education Medicare Supplement population are for the self-insured EGWP Part D prescription drug plan that all current Medicare-eligible members are enrolled in. Rx claims do not include Part B drug claims. Note that this Bid Solicitation is requesting medical only quotes and the Rx data was provided for informational purposes only to provide a better picture of the Education Medicare Supplement population.

2) If so, can you isolate Part B claims?

The State can not isolate Part B claims.

16
Section 1.3.5 -Confidential Files
Please provide a census key for the Current MA and Current Med Supp text census files that were provided. Please include DOB, gender and zip code. If this is not possible, please include column headings on the current text files.

Additional documentation was provided to those Vendors {Bidders} who attended the Mandatory Pre-Quote conference pursuant to the Non-Disclosure Agreement signed by all parties in attendance.

17
Section 1.3.5 Mandatory Pre-Quote Conference; Attachment: Med Advantage Experience and Risk (pg 12-13)
Would it be possible to receive Member Paid and Medicare Allowed amounts in addition to the plan paid data provided?

No.

18
Section 1.3.5 Mandatory Pre-Quote Conference; Attachment: Med Advantage Experience and Risk (pg 12-13)
For the Med Supp plan, can Member Paid, Medicare Allowed, and Medicare Paid also be provided?

No.

19
Section 1.3.5 Mandatory Pre-Quote Conference; Attachment: Med Advantage Experience and Risk (pg 12-13)
Does the data provided include payments (either capitated costs or fee for service claims) for any Non-Medicare covered benefits or Medical Management programs?

· For the Horizon claims data shown, Non-Medicare covered benefits are included (i.e., Acupuncture, Private Duty Nursing and certain Chiropractic benefits, covered per plan rules). The costs associated with Medical Management Programs are not included.

· For the Aetna claims data shown, the data includes expense associated with non-Medicare covered benefits, capitated costs and some medical management expenses. The CMS revenue provided does not include any payment for non-Medicare covered benefits or medical management programs. Additionally, non-Medicare programs are other covered benefits but benefits required by plan rules (i.e., acupuncture, private duty nursing and certain chiropractic benefits).

20
Section 1.3.5 Mandatory Pre-Quote Conference; Attachment: Med Advantage Experience and Risk (pg 12-13)
Would it be possible to get 2017 claims updated with additional runout beyond January 2018? The claims amounts across all plans tail off fairly drastically in the last couple of months of the data provided due to the lack of run out.

No, Vendors {Bidders} have been provided with the most up to date information.

21
Section 1.3.5 Mandatory Pre-Quote Conference; Attachment: Med Advantage Experience and Risk (pg 12-13)
Would it be possible to get 2016 claims so we can get a better view of year over year trends?

No, the majority of members did not participate in Medicare Advantage until plan year 2017.

22
Section 1.3.5 Mandatory Pre-Quote Conference; Attachment: Med Advantage Experience and Risk (pg 12-13)
How have capitation amounts been handled/accounted for the HMO plans?

Capitations are in the claims reported for both PPO and HMO.

23
Section 1.3.5 Mandatory Pre-Quote Conference; Attachment: MMR Report – current MA and MOR Report – current MA:(pg 12-13)
What is the basis for the Risk Scores provided, i.e are they from the most recent MMR file? Has any assumed completion for the final sweep that will happen summer of 2018 been accounted for?

· Horizon MMR files contain risk scores as of a snapshot in time from that given month – December 2017. The risk scores provided in the Experience Data summary are averages for each month from the applicable MMR files. The risk scores do not include an assumed completion for the final sweep.

· Aetna MMR files provide “point-in-time” payment information. The MMRs files do not include an assumed completion for final sweep.

24
Section 1.3.5 Mandatory Pre-Quote Conference (pg 12-13): Questions regarding confidential files received
Please provide updated Current MA Member Census File and Current Med Supp Member Census File that include the missing zip codes for some spouses, and the current plan enrollment for each member listed on census files.

The census data provided is the most accurate available at this time.

25
Section 1.3.5 Mandatory Pre-Quote Conference (pg 12-13)
Question regarding confidential files received: In order to evaluate the extent and details of approved claims outside of the stated EOC coverage (as part of our best practices benefit review), please provide the most recent 24 months of claims data, broken out by plan, and including the following data elements: Unique Member or Subscriber ID (for purposes of identifying unique claimants, not identifying persons), Member DOB, Member Gender, Claim Type Code (Inpatient, Outpatient, Professional), Unique Claim Number (this can be any unique claim # - does not need to match vendor system), Claim Line Number, Plan/ Group ID (or Other Plan Identifier, if Multiple Plan Designs), Plan/ Subgroup ID (if Applicable), Diagnosis Code 1, Diagnosis Code 2, Diagnosis Code 3, Place of Service Code, Service Start Date, Service End Date, Revenue Code, Principal Procedure Code, Procedure Code Modifier, Bill Type Code (Type of Bill, if applicable), Billing Provider Tax ID, Billing Provider Specialty, Billing Provider NPI, Billing Provider Name, Billed Amount, Taxonomy Code, Non-Covered Amount, Copayment Amount, Deductible Amount, Coinsurance Amount, Coordination of Benefits Savings Amount, Paid Amount (If Amount is not available, include an Indicator of "Paid"), Medicare Coverage Indicator, Discounted Covered Amount, Approval or Denial Code, Denial Reason Code.

The State cannot provide this information at this time.

26
Section 1.4.4
Can bidders designate their premium as confidential (i.e. premium would not be considered Price lists/catalogs)?

No.

27
Sections 1.4.11 and 4.4.5.1
Can you confirm that if bidders submit their proposals electronically through NJSTART, they do not need to submit a hard copy?

Confirmed.

28
Section 1.4.5 Announcement of Quote Information (pg 15)
What is the notification of award date?

The notification of award date is the date the Notice of Intent to Award letter, is issued by the Director, is sent to all Vendors {Bidders} indicating the State’s intent to award.

29
Section 2.3 Blanket P.O. Box Specific Definitions/Acronyms (pg 21)
Claim Fiduciary – A named fiduciary having the authority and responsibility to adjudicate Claims in accordance with the provisions of the plan. In the event of a Member appeal for review of a denied Claim, the Claim Fiduciary makes the final determination as to whether the Claim is covered for purposes of compliance with federal law. The SHBP and SEHBP plans also provide that a Member may appeal the review of a denied Claim to the State Health Benefits Commission or School Employees Health Benefits Commission as appropriate. Will there be an exception for MA since CMS has specific rules regarding appeals, who will prevail in the final claim determination regarding the appeal? Conflicts with section 3.1, page 27 All CMS rules and regulations shall govern the administration of the SHBP/SEHBP Medicare Advantage Plans and alert the State as to any processes or aspects of the SHBP/SEHBP that may need to be adjusted to comply with CMS. Would this be considered one of those instances? CMS rules and regulations shall supersede any statement within this Scope of Work that may conflict with CMS rules.

This requirement is still applicable as per State regulations regarding Commission appeals (see N.J.A.C. 17:9-1.3).

30
Section 2.3 Blanket P.O. Box Specific Definitions/Acronyms (pg 21)
We propose removing the following language as CMS governs the appeals process: The SHBP and SEHBP plans also provide that a Member may appeal the review of a denied Claim to the State Health Benefits Commission or School Employees Health Benefits Commission as appropriate.

The State will not agree to this proposed change. Per State regulations, an SHBP or SEHBP member has the ability to appeal to their respective Commission regardless of plan.

31
Section 2.3 Blanket PO Specific Definitions (pg 22)
We request to update the definition of EGWP, as it does not include information about Part C, and EGWPs are most often fully insured, not self-funded. Proposed Change: A Centers for Medicare & Medicaid Services (CMS) approved program for employers and unions. Coverage may include Part C and/or Part D. An employer or union may contract directly with CMS or go through a TPA to establish the plan.

This definition has been revised in Bid Solicitation Section 2.3. Please refer to T3093 Bid Solicitation Revised 062918.

32
Section 3.0 (Scope of Work- Page 27 to 46) and 4.4.3.1 (Management Plan)
Are bidders required to provide a direct confirmation and/or response to all the Scope of Service Items, or would it be assume that we are in agreement with all these items if we do not discuss them in response to the Technical Quote (4.4.3)?

Yes.

33
Section 3.1 General Obligations D (pg 27)
This is a fully insured product. Our subcontractor and Provider Agreements are confidential, and we are restricted from sharing those agreements with the State.

Bid Solicitation Section 3.1 has been revised. Please refer to T3093 Bid Solicitation Revised 062918.

34
Section 3.2.2 B Claims Recovery and Subrogation (pg 29-30)
Please confirm this is saying that in the instance of an overpayment that is the result of a carrier error, the carrier cannot recap from the member or non-par provider and must absorb the overpayment.

Yes, if an instance of overpayment is the result of Vendor error, the Vendor cannot recap from the member or provider and must absorb the overpayment.

35
Section 3.2.1 A Claims Recovery and Subrogation (pg 30)
Please define “Cross-Plan Offsetting”.

Please refer to revised Bid Solicitation Section 2.3 for definition.

36
Section 3.2.1 Claims Administration: S (pg 28)
Provide one or more representatives to attend all Commission meetings (generally held bi-monthly) where Claims appeals for the Plan may be heard, including having appropriate medical professionals attend all SHBC and SEHBC meetings when requested by DPB or either Commission. This responsibility shall continue after expiration or termination of the Blanket P.O. for any Claims that may go before the Commissions that were administered or adjudicated by the Vendor {Contractor} during the term of the Blanket P.O Exception: This would not be part of the CMS required appeals process.

This requirement is still applicable per State regulations regarding Commission appeals (see N.J.A.C. 17:9-1.3).

37
Section 3.2.1 Claims Administration: V (pg 29)
Provide medical professionals to serve as witnesses (including participation in witness preparation, discovery and testimony at hearing or trial) in all hearings or trials concerning disputed Claims. This responsibility shall continue after expiration or termination of the contract for any Claims that may be subject to hearing or trial that were administered or adjudicated by the Vendor {Contractor} during the term of the Blanket P.O.; Exception: This would not be part of the CMS required appeals process.

This requirement is still applicable per State regulations regarding Commission appeals (see N.J.A.C. 17:9-1.3).

38
Section 3.3.1 Member Call Center: F (pg 30)
Provide customer service representatives access to tools that allow them to run "test Claims" (to obtain prices) for Members requesting this information; and can this be an estimate of cost and not exact price?

Yes, an estimate of cost is acceptable.

39
Section 3.3.2 Identification Cards: C (pg 30)
Mail ID cards to Members within ten (10) business days of the receipt and processing of a subscriber’s eligibility record or a change warranting the production and release of a new Member Identification Card. One (1) ID card must be sent to each Member; Clarification: CMS requires that ID cards are mailed within seven days of CMS enrollment approval (receipt of the Transaction Reply Report).

Confirmed. This 10 day requirement encompasses any reason for re-issuance of a duplicate card.

40
Section 3.3.3 Website Capabilities (pg 31)
We would like to include the following clarification: Full Website capability functionality is dependent on a 8/1 award date. A post 8/1 award date could result in delays for website readiness.

No, the State will not agree to this proposed change.

Section 3.3.3 Website Capabilities (pg 31)
The Vendor {Contractor} shall provide SHBP/SEHBP Members with 24-hour on-line access to web-based information. On-line capabilities must provide Members the ability to check on the status of Claims and plan cost-sharing status (Is this expected to be real time, how often are you expecting information to be updated on the web?) including but not limited to, deductible and out-of-pocket accumulations.

The Contractor (Vendor) should endeavor to update as close to real time as possible without sacrificing quality. At a minimum, updates should be made at least once every 24 hours.

42
Section 3.6.3 Provider and Facilities Availability Standards: 5 (pg 35)
Certified Midwives are not applicable to Medicare. Request removing this requirement.

This requirement is for Certified Nursing Midwives, as opposed to just Certified Midwives.

43
Section 3.7.1 Retiree Wellness Program (pg 37) A.
1) Online HAT; What is the Health Assessment Test?

A list of health questions answer by the member, utilized by their health carrier to assess where the member can improve upon areas of their overall health if needed.

2) How are results utilized? We utilize a Health Risk Assessment tool (IVR, Mail or Web) that has been developed over time and is a proven predictor for probability of admission. Results are captured in the clinical system for use by the clinical teams.

Results are utilized in a similar manner.

44
Section 3.7.1 Retiree Wellness Program (pg 37) B
Administering the RWP pledge forms;

1) What is the purpose of this form?

So we know the retiree is aware of the guidelines of the programs, this was established by the original resolution.

2) What are the retirees pledging?

That they will adhere to the guidelines of the retiree wellness program.

45
Section 3.7.1 Retiree Wellness Program (pg 37) B
Tracking the annual Physician Certification form for participating Members;

1) What is the Physician attesting to? 2) What are they certifying?

The Physician is attesting that the information on the form is true and correct.

46
Section 3.7.1 Retiree Wellness Program (pg 37) D
Annual notification of Members who have not met requirements. What requirements? Annual physician visit?

The requirements of the Wellness Program, not just the physician visit, it would include the HAT, as well as other point values that allow the member to reach the total goal of the program.

47
Section 3.7.1 Retiree Wellness Program (pg 37)
Exception: As we have a robust wellness program in place, we wish to propose an exception from the above and request we implement our wellness approach.

The State does not agree to this proposed change.

48
Section 3.10 PPACA Compliance (pg 38)
We will comply to the extent applicable. Exception: The Vendor {Contractor} must ensure compliance (to the extent applicable) with health care reform and with all (applicable) PPACA requirements, including but not limited to, notifications of changes in the regulations to the state and its subscribers.

The State does not agree to this proposed change.

49
3.12 Technical Interface with State (pg 39)
In the event of a transmission or other failure, the Plan Eligibility File may be sent by the State during business hours. On rare occasions when determined necessary by the State in its sole discretion, the Vendor {Contractor} shall accept multiple Plan Eligibility Files in a single day, on a Saturday and/or Sunday, or on a State holiday. Clarification: Files can be sent at any time of the day 7 days per week, but we will only process on business days.

Yes, this clarification is acceptable to the State. Bid Solicitation Section 3.12 has been revised. Please refer to T3093 Bid Solicitation Revised 062918.

50
3.12 Technical Interface with State (pg 39) A
Accept Plan Eligibility File effective dates up to six (6) months into the future; Exception: We can only accept future enrollments up to 90 days in advance per CMS regulations.

Bid Solicitation Section 3.12 A Plan Eligibility File has been revised. Please refer to T3093 Bid Solicitation Revised 062918.

51
3.12 Technical Interface with State (pg 39) C
Send the SCM a Daily Return File before 8:30 am ET on the second business day after the transmission. All errors or omissions must be reported daily to the State; and What kind of return file is the State looking for?

The Return File was included in the CD exhibits (Exhibit E).

52
3.12 Technical Interface with State (pg 40) H
Support retroactive enrollments and terminations of up to one year for Members; Exception: We are unable to support retroactive enrollments and terminations later than 90 days per CMS regulations.

CMS regulations allow for individual requests for retroactive enrollment/termination beyond standard timeframes. The Vendor {Contractor} must be able to support this process.

53
3.12 Technical Interface with State (pg 40) I
Ensure that only DPB-originated eligibility information and changes will be reflected on the Plan records contained in Vendor’s {Contractor’s} files; Clarification: We are required to match CMS records and will report discrepancies between our system and client.

This language means that record changes/updates/deletions should only be processed following receipt of the DPB eligibility file.

54
3.12 Technical Interface with State (pg 40) L
Report to the SCM, within one (1) business day of discovery, all events or conditions adversely affecting the processing of enrollment or Claims;

To the extent that this inquiry is regarding compliance with this section; yes, Vendor {Bidder} must comply with this section. Otherwise there is no question posed.

55
3.12 Technical Interface with State (pg 40) M
Have on-line access for DPB personnel to the Vendor’s {Contractor’s} enrollment system for inquiry and enrollment maintenance; Clarification: We are unable to allow access to our systems due to HIPPA; however, they can add/disenroll on the employer website.

The State will not agree to this proposed change.

56
3.12 Technical Interface with State (pg 40) P
Has a response time not exceeding 2-3 seconds per transaction for inquiry and update access; and Please provide further clarification regarding what transactions this 2-3 second requirement applies to.

This applies to the State’s ability to perform inquiries and edits on the Vendor’s {Contractor’s} enrollment system.

57
3.12 Technical Interface with State (pg 40) Q
Separate levels of access for inquiry and update capabilities. Clarification: We are unable to allow access to our systems due to HIPPA.
58
Section 3.14 Start-Up/Conversion (pg 42) E
Be able to support file transfer in the batch SNA/SDLC environment, using Connect-Direct Secure Plus from IBM Sterling Software. Integration must include real time information system linkages for determination of covered person eligibility and benefits, medical summary, Claims history, and client service history. All systems must assure confidentiality by an incorporated and well-designed security program; and Please provide further clarification on how the vendor should integrate with Connect-Direct Secure Plus.

The State will negotiate Bid Solicitation Section 3.14 E Start/Up and Conversion systems and methods with the awarded Vendor {Contractor} after Blanket P.O. award.

59
Section 4.1 General (pg 47)
After award of the Blanket P.O., if a conflict arises between a Vendor’s {Bidder’s} additional terms included in the Quote and a term or condition of the Bid Solicitation, the term or condition of the Bid Solicitation will prevail Exception: The vendor prefers the executed Contract take precedence over the Proposal, which in turn would take precedence over the RFP. This is significant for the federally-regulated product, since the Contract sets forth the terms and conditions that are required for us to meet the CMS regulatory requirements. We look forward to mutually agreed terms. The negotiated and executed contract shall include all pertinent provisions and exhibits as mutually negotiated by the parties.

The State will negotiate terms within Bid Solicitation Sections 5.9.1, 5.9.1.1 and 5.9.2 and Section 3.14 E (Question #58) after award.

60
Section 4.4.1.3 Subcontractor Utilization Plan (pg 52-53)
1) Is there a Small Business set aside goal for this RFP?

This Bid Solicitation has small business set-aside subcontracting goals. Please refer to revised Bid Solicitation Section 4.4.1.5.

2) If so, what percentage is being requested? What format should be used to document a “good faith effort”?

Please refer to the Subcontractor Utilization Form for specific instructions and information

61
Section 4.4.2.2

Disclosure of Investigations (pg 55-56) This section requires a Vendor to submit a Disclosure of Investigations and Other Actions Involving Bidder Form (the “Form”). Please confirm that, in accordance with the Form’s instructions in the version revised on 8.4.2017, if the Vendor is able to answer “No” to all questions in Part 2 of the Form, there is no requirement to provide detailed descriptions in Part 3 of the Form.

Confirmed.

62
Section 4.4.3.3.4 Contingency Plan (pg 58)
The Vendor {Bidder} shall provide its draft plan to accomplish all work required by this Blanket P.O. The Contingency Plan shall include: A. Disaster Recovery Plan - identifying locations and systems to ensure that they can continue to satisfy RFP requirements within 24 hours, in the event their primary location is rendered unusable. The plan must detail how the Contractor will ensure that the primary location and/or systems destroyed in such a disaster would be made available to meet the 24 hour time frame. The plan is tested. The plan is reviewed and updated annually; B. Backup Plan; and C. Security Plan - identifying key personnel, organization units and alternate sites with telecommunications and computers. The plan is tested. The plan is reviewed and updated annually. The contingency plan should demonstrate to the Evaluation Committee that the Vendor {Bidder} understands the scope of work required for a successful implementation of the system, its operations and maintenance and support. Due to the sensitive nature of the information listed in 4.4.3.3.4, is the vendor permitted to provide a high level summary that demonstrates our ability to meet the RFP requirements? The vendor’s complete business continuity and disaster recovery plans are considered proprietary and confidential.

Yes, the Vendor {Bidder} is permitted to provide a high level summary. However, portions of your plans that are considered proprietary and confidential must be properly marked as they are still subject to the Open Public Records Act (OPRA).

63
Section 4.4.3.3.5 Additional Items (pg 59) A
SSAE No. 16 as well as a report of the actions taken to deal with any weaknesses or deficiencies identified in the SSAE No. 16; Exception: SSAE16/SSAE18 SOC 2 are not applicable to our fully-insured business. Instead, vendor has achieved HITRUST certification. The Health Information Trust Alliance, or HITRUST, in collaboration with healthcare, technology and information security leaders, has established a Common Security Framework (CSF) that can be used by all organizations that create, access, store or exchange sensitive and/or regulated data.

Bid Solicitation Section 4.4.3.3.5 has been revised. Please refer to T3093 Bid Solicitation Revised 062918.

64
Section 4.4.3.3.6 Disclosures (pg 59)
The Vendor {Contractor} shall disclose all: A. Profit sharing agreements; B. Contingent commission agreements; C. Override commission agreements; and D. Other compensation and fee arrangements with all Subcontractors, Providers and/or any other entity providing services to the Vendor {Contractor} or Members covered under this Blanket P.O. wherein the Vendor {Contractor} would receive any monetary amount, credit or other like advantage in connection with any recovery or payment that the Subcontractor, Provider or other entity providing said services to Members may be entitled to Exception: This is a fully insured product. Our subcontractor and Provider Agreements are confidential, and we are restricted from sharing those agreements with the State.

See response to Question #33.

65
Section 5.1 Precedence of Special Contractual Terms and Conditions (pg 64):
Exception: The negotiated and executed contract should include all pertinent provisions, including appropriate provisions from the RFP, and exhibits, as mutually negotiated by the parties. This is significant for the federally-regulated product, since the Contract sets forth the terms and conditions that are required for us to meet the CMS regulatory requirements. We look forward to mutually agreed terms.

See response to Question #59.

66
Section 5.7 Substitution or Addition of Subcontractors (pg 65)
The vendor agrees to this provision in regards to vendors that are providing material or core services, for example, a print vendor for ID cards.

The term “Subcontractor” is defined in Bid Solicitation Section 2.2 and will not be amended.

67
Section 5.8 Ownership of Material (pg 66)
We propose the following clarification: All data, (not claim data), technical information, materials gathered, originated, developed, prepared, used or obtained in the performance of this Blanket P.O., including, but not limited to, all reports, surveys, plans, charts, literature, brochures, mailings, recordings (video and/or audio), pictures, drawings, analyses, graphic representations, software computer programs and accompanying documentation and print-outs, notes and memoranda, written procedures and documents, regardless of the state of completion, which are prepared for or are a result of the services required under this Blanket P.O. shall be and remain the property of the State of New Jersey and shall be delivered to the State of New Jersey upon 30 days’ notice by the State. With respect to software computer programs and/or source codes developed for the State, except those modifications or adaptations made to Vendor’s {Bidder’s/Contractor’s} Background IP as defined below, the work shall be considered “work for hire”, i.e., the State, not the Vendor {Contractor} or Subcontractor, shall have full and complete ownership of all software computer programs and/or source codes developed. To the extent that any of such materials may not, by operation of the law, be a work made for hire in accordance with the terms of this Blanket P.O., Vendor {Contractor} or Subcontractor hereby assigns to the State all right, title and interest in and to any such material, and the State shall have the right to obtain and hold in its own name and copyrights, registrations and any other proprietary rights that may be available.

Bid Solicitation Section 5.8 has been revised. Please refer to “T3093 Bid Solicitation Revised 062918”.

68
5.9.1 Data Confidentiality
Our employees are required to complete an annual business conduct and integrity training in which confidentially is addressed. They must also attest that they have reviewed and comply with our training and Code of Conduct, therefore we cannot require every employee to sign a confidentiality agreement specific to one customer.

This practice is acceptable to the State. The Vendor {Contractor} shall provide proof of conduct and integrity training procedures to the State upon request.

69
5.9.1 Data Accuracy
Would this alternative be acceptable to the State: Given the number of subcontractors we have and the number of customers we serve we cannot require our subcontractors to sign agreements directly with customers. Aetna is responsible for the acts of our subcontractors therefore any agreement we sign would cover their actions. We can provide a list of tier 1 vendors no more frequently than monthly. If there are customers specific to NJ Medicare only, we may be arrange for specific processes but would need to be mutually agreed upon by the vendor(s).
70
Section 5.9.1 Data Confidentiality (pg 67); 5.9.4 Security Plan (pg 71-72)
The State reserves the right to obtain, or require the Vendor {Contractor} to obtain, criminal history background checks from the New Jersey State Police for all Vendor {Contractor} and project staff (to protect the State of New Jersey from losses resulting from Vendor {Contractor} employee theft, fraud or dishonesty). If the State exercises this right, the results of the background check(s) must be made available to the State for consideration before the employee is assigned to work on the State’s project. Prospective employees with positive criminal backgrounds for cyber-crimes will not be approved to work on State Projects. Refer to the National Institute of Standards and Technology (NIST) Special Publication (SP) 800-12, An Introduction to Computer Security: The NIST Handbook, Section 10.1.3, Filling the Position – Screening and Selecting. Clarification: The vendor completes a 50 state (included New Jersey) criminal background check. The vendor will provide an attestation to confirm background check results. Upon request, background checks can be renewed.
71
5.9.1.1 Vendor's (Contractor's) Confidential Information (pg 67) F
In addition, in the event Vendor {Contractor} receives a request for State Confidential Information pursuant to a court order, subpoena, or other operation of law, Vendor {Contractor} shall, if permitted by law, provide the State with as much notice, in writing, as is reasonably practicable and Vendor’s {Contractor’s} intended response to such order of law that such a request has been made. The State shall take any action it deems appropriate to protect its documents and/or information; and Exception: We request removing the following language: and Vendor’s {Contractor’s} intended response to such order of law that such a request has been made.
72
Section 5.9.2 Data Security Standards A. (pg 68)
Clarification: The vendor requests the State notify if any change is made to their policies.

Please refer to Question #59.

73
5.9.2.b Data Security Standards
We can agree to notify the State within 2 business days of when it has been confirmed that the State’s personally identifiable information has been impacted requiring notification.
74
5.9.2.b Data Security Standards (Data Storage)
Given the nature of our business and the number of customers we serve we cannot agree to approval of the State for the system topology or use of portable media. Aetna has a portable device policy in place that requires encryption on all devices. A limited number of employees have access to, and must request approval, to use USB devices and other portable media. Currently not all data at rest in encrypted. Aetna has a multi-layer approach to protecting data. This includes components, among others, related to physical security, Privileged User Monitoring (PUM), Access controls and multiple layers of encryption. Aetna has implemented SAN Storage encryption, email encryption, external transmission encryption, internal transmission encryption, hard drive encryption, removable media encryption and data field level encryption. Aetna continues to roll out these encryption capabilities based upon levels of risk.

No, the State will not agree to this proposed change. Sensitive data must be encrypted in transit and at rest.

75
Section 5.9.2 Data Security Standards (pg 68) Data Re-Use
We propose the following additional language: No State data of any kind must be transmitted, exchanged or otherwise passed to other Vendors {Contractors} or interested parties except or on a case-by-case basis as specifically agreed to in writing by the State Contract Manager.

Please refer to Question #59.

76
5.9.4. aa
Our employees are required to complete an annual business conduct and integrity training in which confidentially is addressed. They must also attest that they have reviewed and comply with our training, therefore we cannot require every employee to sign a confidentiality agreement specific to one customer. Aetna performs its own robust background checks and cannot be subject to customer specific requirements.

See response to Question #68.

77
5.9.4.y and aa
Would the State accept this wording: Given the nature of our business and the number of customers we serve we cannot agree to approval of the State in the event of a system change. Given the number of subcontractors we have and the number of customers we serve we cannot require our subcontractors to sign agreements directly with customers. Aetna is responsible for the acts of our subcontractors therefore any agreement we sign would cover their actions. We can provide a list of tier 1 vendors no more frequently than monthly. If there are customers specific to NJ Medicare only, we may be arrange for specific processes but would need to be mutually agreed upon by the vendor(s).
78
Section 5.17.1 Indemnification; 4.1.1a Limitation of Liability (pg 78)
We request the following language be added to this requirement. The Vendor’s {Contractor’s} obligation to indemnify the State of New Jersey and its employees from and against any claim, demand, loss, damage, or expense relating to bodily injury or the death of any person or damage to real property or tangible personal property, incurred from the work or materials supplied by the Vendor {Contractor} under this Blanket P.O. caused by (gross) negligence or willful misconduct of the Vendor {Contractor}. (Network providers/health care professionals are not our agent, therefore we will not indemnify the employer group for any acts or omissions of network provider/health care professionals).

The State will not agree to this proposed change. See response to question #82 below.

79
Section 5.20.1 Financial Accounting (pg 79);
We request to include the following CMS language in the Terms and Conditions: Uniform Premium Requirements: Group may determine how much of Member’s Plan Beneficiary Premium Group will subsidize, subject to the following conditions in determining the Plan Beneficiary Premium subsidy: a. Group can subsidize different amounts for different classes of Members in the Plan provided such classes are reasonable and based on objective business criteria, such as years of service, date of retirement, business location, job category, and nature of compensation (e.g., salaried v. hourly); and b. Group cannot vary the Plan Beneficiary Premium subsidy for individuals within a given class of Members.
80
Standard Terms and Conditions Sections 3.2 and 3.3 (pg 92-93)
Public Works Contractor Registration Act and Additional Affirmative Action Requirements: We request removal of these sections as the Act is not applicable to the vendor.
81
Standard Terms and Conditions Sections 3.4 Building Services and 3.5
The Worker and Community Right to Know Act (pg 94): These sections should be removed as the vendor is not providing these services and/or goods to the State.
82
Standard Terms and Conditions Section 4.1 Indemnification (pg 95)
We request the following additional language to this requirement: Network providers/health care professionals are not our agents; therefore we will not indemnify the State for any acts or omissions of network providers/health care professionals.

The Vendor {Contractor} is not in a contractor/subcontractor relationship with the doctors or other health care providers and, as such, the Vendor {Contractor} will not have to indemnify the State for a claim arising out of a doctor or health care providers actions or inactions.

83
Standard Terms and Conditions Section 5.7 Termination of Contract (pg 97)
We request the additional termination rights be included in the terms and conditions: .02 6.02.01 This Agreement shall terminate, in whole or in part as the case may be, for one or more of the following events and notices of termination shall be sent by United within 90 (ninety) days of the effective date of termination, or as otherwise required by CMS. a. termination or non-renewal of vendor’s contract with CMS; b. termination or non-renewal with respect to a Service Area or a portion of a Service Area in which Member resides, as applicable. c. if vendor no longer issues the Plan or any group health benefit plans within the applicable market, as permitted by law; d. if Group fails to abide by and enforce the conditions of Enrollment set forth in this Agreement; e. if Group no longer meets vendor's minimum contribution or participation requirements; f. non-renewal of this Agreement by vendor at the end of the then current term. g. in the event of a filing by or against the Group of a petition for relief under the Federal Bankruptcy Code, h. any jurisdiction prohibits a party from administering the Plan under the terms of this Agreement, or imposes a penalty on the Plan, Group or Vendor and such penalty is based on the services specified in this Agreement. In this situation, the party may immediately discontinue the Agreement’s application in such jurisdiction. Notice must be given to the other party when reasonably practical. The Agreement will continue to apply in all other jurisdictions.
84
Standard Terms and Conditions Section 5.7 Termination of Contract (pg 97): (continued) 6.02.02
Termination for Nonpayment of Plan Beneficiary Premium. Vendor may terminate this Agreement in the event Group or its designee, or Member fails to remit Plan Beneficiary Premium in full by the Due Date to vendor by giving written notice of termination of this Agreement to Group. Nonpayment of Plan Beneficiary Premium includes, but is not limited to, payments returned due to non-sufficient funds and post-dated checks. Such notice shall specify that payment of all unpaid Plan Beneficiary Premium must be received by vendor within fifteen (15) calendar days of the date of issuance of the notice, and that if payment is not received within the fifteen (15) day period, no further notice shall be given, and coverage for all Members enrolled in this Plan shall automatically be terminated effective at the end of the month for which Plan Beneficiary Premium has been actually received by vendor, subject to compliance with notice requirements.
85
Standard Terms and Conditions Section 5.11 Performance Guarantee Contractor (pg 98)
The section should be deleted; not applicable to vendor's services.
86
Standard Terms and Conditions Section 5.12 Delivery Requirements (pg 99)
The section should be deleted; not applicable to vendor's services.

The State will not agree to this proposed change.

87
Standard Terms and Conditions Section 6.3 Payment to Vendors (pg) 100 D
The contractor shall provide, on a monthly and cumulative basis, a breakdown in accordance with the budget submitted, of all monies paid to any small business, minority or woman-owned subcontractor(s). This breakdown shall be sent to the Chief of Operations, Division of Revenue, P.O. Box 628, Trenton, NJ 08646. Will the State accept this report on a quarterly basis w/a breakout of cost/payment by month?

Section 6.3 of the State of New Jersey Standard Terms and Conditions has been revised. Please refer to T3093 Bid Solicitation Revised 062918.

88
Standard Terms and Conditions Section 6.3.C (pg 101)
Please remove as not applicable to our services.
89
Standard Terms and Conditions Sections 7.2, 7.3, 7.4 (pg 103-105)
These sections should be deleted. As they don't apply to our services.

Mandatory Pre-Quote Conference Attendees:

Company Name
Contact Person
Phone #
Email
Aetna
Michael North
215-775-0309
NorthMS@aetna.com
Aetna
Kim Ward
201-572-2735
WardK5@aetna.com
Aetna
Kevin Fenton
860-275-6488
FentonK1@aetna.com
Humana
Cindy C. Walsh
610-567-3082
cwalsh3@humana.com
Horizon BCBSNJ
David Perry
973-466-8518
dave_perry@horizonblue.com
UnitedHealthcare
John Thompson
770-200-6802
John_c_thopson@uhc.com
UnitedHealthcare
Valerie Duncan
952-406-2177

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