Kyle L. Janek, M.D., Executive Commissioner

1
Kyle L. Janek, M.D., Executive Commissioner

• VENDOR CONFERENCE
• STAR Kids
• Request for Proposal No. 529-13-0071
• July 31, 2014

2

• Welcome
• Introductions
• Housekeeping Items

3
HHSC Procurement Roles

• PCS Responsible for procurement activity
• Program Responsible for project scope,
  requirements, performance, results, contract
  management/monitoring
• HUB Responsible for HUB Subcontracting Plan
  (HSP) requirements and evaluation
• Legal Provides legal guidance and advice to the
  agency

4
Vendor Conference Overview

• Procurement Activities
• RFP Overview
• HUB Overview
• Questions
• Break
• Preliminary Responses to Questions
• Closing Comments

5

• Procurement Activities
• Sole Point of Contact -- Section 1.2
• Procurement Schedule -- Section 1.3
• Solicitation Access http//www.hhsc.state.tx.us
  /about_hhsc/BusOpp/BO_opportunities.asp
• Submission Requirements Section 3.14
• Solicitation Changes
• Proposal Screening and Evaluation
• Award Information

6
Sole Point of Contact

• The sole and only permissible point of contact
  for inquiries concerning this RFP is Richard
  Blincoe.
• As a reminder, all communications relating to
  this RFP must be directed to the sole point of
  contact for this procurement. Failure to comply
  with these requirements may result in proposal
  disqualification.

7
Procurement Schedule

• RFP Release Date
  
• Vendor Conference
  
• Respondent Questions Due
• Post Response to Questions (est.)
• Proposals Due (200 P.M. Central Time)
• Deadline for Proposal Withdrawal
  
• Tentative Award Posting (est.)
• Anticipated Contract Effective Date

• July 18, 2014
• July 31, 2014
• August 5, 2014
• September 16, 2014
• October 30, 2014
• October 30, 2014
• To Be Announced
• September 1, 2015

8
Request for Proposals No. 529-13-0071

• RFP Overview
• STAR Kids Overview
• RFP Mission
• Contract Terms
• Eligible Populations
• Scope of Work
• Evaluation Criteria

9
STAR Kids Overview

• Senate Bill 7, 83rd Legislature, Regular Session,
  2013, directs HHSC to establish a mandatory,
  capitated STAR Kids managed care program tailored
  to provide Medicaid benefits to children and
  young adults with disabilities.
• S.B. 7 also calls for the inclusion of the
  Medically Dependent Children Program (MDCP) and
  requires HHSC to consult with the STAR Kids
  Medicaid Managed Care Advisory Committee and
  Childrens Policy Council on the establishment
  and implementation of the program.

10
STAR Kids Overview

• The members that will be served through STAR Kids
  have diverse strengths and challenges. As such,
  services and supports provided to STAR Kids
  members must reflect broad differences in
  diagnoses, conditions, prior treatments,
  development, environment, age, family dynamics,
  and geography.
• By working with Members and their families, STAR
  Kids MCOs will customize and coordinate acute,
  behavioral, and long-term services and supports
  (LTSS) through an individualized planning and
  service design process. Through comprehensive
  service coordination, STAR Kids Members will
  receive services and supports tailored to their
  individual needs.

11
RFP Mission

• The purpose of this procurement is to contract
  with multiple Managed Care Organizations (MCOs)
  to establish the STAR Kids Medicaid managed care
  program.
• HHSCs mission for the STAR Kids program is to
  enable STAR Kids members to live and thrive in a
  setting that maximizes their health, safety, and
  overall well-being.

12
RFP Mission

• STAR Kids is established with the following
  goals
• Coordinate care across service arrays
• Improve quality, continuity, and customization of
  care
• Improve access to care and provide
  person-centered Health Homes
• Improve ease of program participation for
  Members, MCOs, and Providers
• Improve Provider collaboration and integration of
  different services
• Improve Member outcomes to the greatest extent
  achievable
• Prepare young adults for the transition to
  adulthood
• Foster program innovation and
• Achieve cost efficiency and cost containment.

13
Contract Terms

• HHSC will award one contract per MCO, which will
  include all awarded MCO service areas. The
  initial contract period will be for three years.
• HHSC reserves the right to extend the contract
  period, not to exceed a total of eight
  operational years.
• All STAR Kids MCOs must begin serving members on
  the operational start date.

14
Eligible Populations

• Children and young adults under age 21 who
  receive Social Security Income (SSI) or Home and
  Community-based Services (HCBS) Waiver program
  services must enroll in STAR Kids.
• Children and young adults who reside in an
  Intermediate Care Facility for Individuals with
  Intellectual Disabilities (ICF/IID) must also
  enroll in STAR Kids.

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Eligible Populations

• Medically Dependent Childrens Program (MDCP)
  participants will receive all of their services
  through STAR Kids, including long-term services
  and supports (LTSS) provided through MDCP.
• Children and young adults enrolled in other HCBS
  Waiver programs or who receive services through
  an ICF/IID will receive Medicaid State Plan
  services and service coordination through STAR
  Kids, but will separately receive LTSS specific
  to their program.
• Excluded populations include children in state
  conservatorship and individuals under 21 who
  reside in nursing facilities.

16
Scope of Work

• Covered Services
• The MCO must comply with all contract provisions
  including all applicable state and federal laws,
  rules, regulations, and waivers.
• The MCO must provide full coverage of medically
  and functionally necessary covered services to
  all members in accordance with contractual
  requirements.
• The MCO may propose value-added services and
  case-by-case added services that compliment the
  provision of medically and functionally necessary
  covered services.

17
Scope of Work

• Access to Care
• The MCO must have network PCPs, behavioral
  health, specialty, pharmacy, and home and
  community-based providers in sufficient number
  and capacity.
• Appointments for covered services must be
  provided within contractually specified
  timeframes.
• Members must be provided access to out-of-network
  services if medically necessary covered benefits
  are not available within the network.

18
Scope of Work

• Provider Network
• The MCO must enter into written contracts with
  properly credentialed providers.
• The MCO must maintain a provider network
  sufficient to provide all members with access to
  the full range of covered services required under
  the contract.
• The MCO must enter into contracts with any
  willing Significant Traditional Provider (STP)
  and develop short and long-term strategies to
  increase access to qualified providers.
• The MCO will include telemedicine providers in
  its network to increase access to care in rural
  or underserved areas.

19
Scope of Work

• Primary Care Providers (PCPs) and Health Home
• All STAR Kids members must be provided with a
  patient and family-centered PCP.
• STAR Kids PCPs must coordinate with other
  relevant parties to ensure members physical and
  behavioral health needs are met.
• MCOs must also provide access to a health home
  for all members who will benefit from a health
  home.
• MCOs must develop specific incentives for
  providers who meet the requirements for
  patient-centered medical homes found in Texas
  Government Code 533.0029.

20
Scope of Work

• Member Services and Materials
• The MCO must have a member services department to
  assist members in obtaining covered services.
• Member services must include a member hotline,
  nurse hotline, and behavioral health hotline as
  well as member education and a member complaints
  and appeals process.
• Member materials must include a member
  identification card, member handbook, provider
  directory, welcome letter, and an internet
  website.
• The MCO must also establish member advisory
  groups to identify and address needs and goals of
  STAR Kids members.

21
Scope of Work

• Clinical and Administrative Advisory Committee
• The MCO must establish Clinical and
  Administrative Advisory Committees in each STAR
  Kids service area served.
• Clinical and Administrative Advisory Committees
  must be used to help review and improve clinical
  and administrative practices.
• Membership in a Clinical and Administrative
  Advisory Committee must include the following
  provider types PCP, specialty care, behavioral
  health, home and community support services,
  therapy provider, medical equipment and supplies,
  and pharmacy.

22
Scope of Work

• Management and Information Systems (MIS)
• The MCO must maintain a MIS to support the
  following operational and administrative areas
• Enrollment/Eligibility Subsystem
• Provider Subsystem
• Encounter/Claims Processing Subsystem
• Financial Subsystem
• Utilization/Quality Improvement Subsystem
• Reporting Subsystem
• Interface Subsystem
• Third Party Recovery (TPR) Subsystem

23
Scope of Work

• Continuity of Care
• The MCO must ensure that the healthcare of newly
  enrolled Members is not disrupted, compromised,
  or interrupted.
• The MCO must ensure new Members have continued
  authorization of services for the same amount,
  duration, and scope for the shortest period of
  one of the following (1) 90 calendar days after
  the transition to a new MCO, (2) until the end of
  the current prior authorization, or (3) until the
  MCO has appropriately evaluated and administered
  the STAR Kids Screening and Assessment Process
  and issued or denied a new authorization.
• The MCO must ensure members receiving
  community-based services prior to the operational
  start date continue to receive those services for
  up to six months after the Operational Start Date.

24
Scope of Work

• Service Coordination
• Service coordination provides the Member with
  initial and ongoing assistance identifying,
  selecting, obtaining, coordinating, and using
  covered services and other supports to enhance
  the Member's well-being, independence,
  integration in the community, and potential for
  productivity.
• Service coordinators must work with PCPs, network
  providers and other resources to help address the
  full spectrum of a members needs.
• Upon identification of need or member request,
  members must be provided with access to a named
  service coordinator and comprehensive service
  coordination teams.

25
Scope of Work

• Service Coordination
• The MCO must ensure that Service
  Coordinator-to-Member ratios are clinically
  appropriate and evidence-informed.
• The MCO may allow a member to receive service
  coordination through an integrated health home if
  the individual providing service coordination and
  the service coordination structure meet STAR Kids
  program requirements.
• For members who receive non-capitated HCBS waiver
  services, STAR Kids service coordinators must
  communicate regularly with the DADS or DSHS staff
  members or contractors responsible for overseeing
  the members HCBS waiver services.

26
Scope of Work

• Individual Service Plan (ISP)
• Each STAR Kids MCO must create and regularly
  update a comprehensive person-centered ISP for
  each STAR Kids member.
• The purpose of the ISP is to articulate
  assessment findings, short and long-term goals,
  service needs, and member preferences.
• The ISP must be used to communicate and help
  align expectations between the member, their LAR,
  the MCO and key service providers.
• The ISP may also be used by the MCO and HHSC to
  measure Member outcomes over time.

27
Scope of Work

• Adult Transition Planning
• The MCO must help to assure that teenage and
  young adult Members receive early and
  comprehensive transition planning to help prepare
  them for service and benefit changes that will
  occur following their 21st birthday.
• Each MCO is responsible for conducting ongoing
  transition planning starting when the Member
  turns 15 years old.
• MCO staff must include Transition Specialists
  dedicated to counseling and educating Members and
  others in their support network about
  considerations and resources for transitioning
  out of STAR Kids.

28
Scope of Work

• STAR Kids Screening and Assessment Requirements
• All STAR Kids MCOs are responsible for conducting
  comprehensive, holistic, and evidence-based
  service needs assessments for all Members.
• A key component of the process is use of the STAR
  Kids Screening and Assessment Instrument (SAI).
• The STAR Kids SAI encompasses four modules the
  Core, the Personal Care Assessment Module (PCAM),
  Nursing Care Assessment Module (NCAM), and the
  MDCP Module.
• All STAR Kids members must receive the Core,
  which will indicate if there is need for the
  PCAM, NCAM or other screenings or assessments.

29
Scope of Work

• Medically Dependent Children Program (MDCP)
• MDCP STAR Kids provides community-based LTSS for
  individuals under the age of 21 with complex
  medical needs as a cost-effective alternative to
  living in a Nursing Facility.
• The MCO must provide all covered services
  included in the MDCP service array for all MDCP
  STAR Kids members.
• The MCO will use STAR Kids SAI MDCP Module to
  help determine eligibility and an annual cost
  limit for each MDCP member.
• As a part of the ISP planning process, the MCO
  must establish an MDCP plan of care as a part of
  the STAR Kids ISP that does not exceed the
  Member's cost limit.

30
Evaluation Criteria (Section 5.3)

• HHSC will evaluate each proposal using the
  following criteria, in descending order of
  priority, developed from the best value factors
  listed in Section 2 of the RFP.
• The extent to which the goods and services meets
  HHSCs needs and the needs of the Members for
  whom the goods and services are being purchased
• Indicators of probable vendor performance
• Effect of the acquisition on agency productivity
  and,
• Delivery terms.

31
HUB Subcontracting Plan(HSP) Requirements
32
Historically Underutilized Business
ParticipationAgenda Topics

• RFP Section 4.2.5 Historically Underutilized
  Business Participation Requirements
• HUB Subcontracting Plan Development and
  Submission
• HSP Quick Checklist Handout
• HSP Methods
• HUB Subcontracting Notification Form
• III. HSP Prime Contractor Progress Assessment
  Report

33
Historically Underutilized Business Participation

• Historically Underutilized Business
  Participation Requirements

34
Historically Underutilized Business Participation

• Historically Underutilized Business
  Participation Requirements
• HUB Participation Goals Section 4.2.5.3
• Potential Subcontracting Opportunities Section
  4.2.5.5
• Centralized master Bidders List and HUB directory
  Section 4.2.5.5
• Vendor Intends to Subcontract Section 4.2.5.6

35
Historically Underutilized Business Participation

• Historically Underutilized Business
  Participation Requirements (cont)
• Minority or Women Trade Organizations Section
  4.2.5.6.2
• Self Performance Section 4.2.5.7
• HSP Changes After Contract Award Section
  4.2.5.8
• Reporting and Compliance with the HSP Section
  4.2.5.8

36
Historically Underutilized Business Participation

• HUB Subcontracting Plan (HSP)
• Development and Submission
• Note All Respondents must submit a HSP
  regardless if its intent is to subcontract or
  self perform all the work under the Contract.

37
Historically Underutilized Business Participation

• HUB Subcontracting Plan (HSP)
• Development and Submission
• Note All Respondents must submit a HSP
  regardless if its intent is to subcontract or
  self perform all the work under the Contract.

38
If HSP is inadequate, response will be rejected
HUB GOALS
Special reminders and instructions
HSP Information Page
39
Historically Underutilized Business Participation

• HSP Quick Checklist
• See Checklist Handout

40
Historically Underutilized Business Participation

• ii. HSP Methods
• Note
• There are five (5) Method Options to choose from
  in order to develop and submit the HSP.
• Respondents should indicate their response which
  Method Option was selected.

41
Historically Underutilized Business Participation

• Method Options
• Respondent may choose from one of the following
  methods when completing the HSP
• Method I if 100 of your subcontracting
  opportunities will be performed using only HUB
  vendors
• Method II if one or more of the subcontracting
  opportunities identified will be performed using
  HUB protégés
• Method III if a combination of HUBs and
  Non-HUBs are used to perform the subcontracting
  work identified AND the HUB goal identified in
  the solicitation is met or exceeded

42
Historically Underutilized Business Participation

• Method Options
• A Respondent may choose from one of the following
  methods when completing the HSP (cont.)
• Method IV if a combination of HUBs and Non-HUBs
  are used to perform the subcontracting work
  identified AND the HUB goal identified in the
  solicitation is not met or exceeded and
• Method V - if the Respondent intends to self
  perform all of the work utilizing their own
  resources, equipment, employees, and supplies.

43
Historically Underutilized Business Participation

• All Methods
• For ALL Methods the following steps are required
  to be completed on the HSP Form
• Page 1 - Section 1 - Respondent and Requisition
  Information.
• Page 2 - Company and Requisition Information.
• Page 2 - Section 2(a) Subcontracting
  Intentions.
• Section 4 Affirmation and Sign.

44
Historically Underutilized Business Participation

• All Methods
• For ALL Methods the following steps are required
  to be completed on the HSP Form
• Page 1 - Section 1 - Respondent and Requisition
  Information.
• Page 2 - Company and Requisition Information.
• Page 2 - Section 2(a) Subcontracting
  Intentions.
• Section 4 Affirmation and Sign.

45
Step by Step
HSP Information Page
Respondent and Requisition Information
46
Company Name and Requisition
Subcontracting Intentions Declaration Check
Yes if you plan to subcontract Check No
if you will not be subcontracting any portion of
the contract
47
Historically Underutilized Business Participation

• All Methods
• For ALL Methods the following steps are required
  to be completed on the HSP Form
• Page 1 - Section 1 - Respondent and Requisition
  Information.
• Page 2 - Company and Requisition Information.
• Page 2 - Section 2(a) Subcontracting
  Intentions.
• Section 4 Affirmation and Sign.

48
Step by Step
Section 4 Affirmation
Signature Affirms that Information Provided
is True and Correct.
49
METHOD I

• If all (100) of your subcontracting
  opportunities will be performed using only HUB
  vendors, complete
• All of the steps in Sections 1, 2, and 4 of the
  HSP.
• Section 2 b. List all the portions of work you
  will subcontract, and indicate the percentage of
  the contract you expect to award to HUB vendors.
• Section 2 c. Yes.
• HSP GFE Method A (Attachment A) Complete this
  attachment for each subcontracting opportunity.

50
Step by Step
Complete Section 2-b List all the portions of
work you will subcontract, and indicate the of
the contract you expect to award to all HUBs.
Complete Section 2-c Yes if you will be using
only HUBs to perform all Subcontracting
Opportunities in 2-b.
51
HSP GFE Method A (Attachment A)
Complete this attachment (Sections A-1 and A-2)
and List Line and Subcontracting Opportunity.
HUB Subcontractor Selection for this
Subcontracting Opportunity
52
METHOD II

• If any of your subcontracting opportunities will
  be performed using HUB protégés, complete
• All of the steps in Section 1, 2 and 4 of the
  HSP.
• Section 2 b. List all the portions of work you
  will subcontract, and indicate the percentage of
  the contract you expect to award to HUB vendors.
• HSP GFE Method B (Attachment B) Complete
  Section B-1, B-2 and B-4 only for each
  subcontracting opportunity as applicable.

53
Step by Step
Complete Section 2-b List all the portions of
work you will subcontract, and indicate the of
the contract you expect to award to HUB Protégés.
Skip Sections 2-c and 2-d.
54
HSP GFE Method B (Attachment B)
Complete Sections B-1 and B-2 only for each
HUB Protégé subcontracting opportunity.
55
HSP GFE Method B (Attachment B)
B-4 List the HUB
Protégé(s) Selected to perform the
subcontracting opportunity
56
METHOD III

• If you are subcontracting with HUBs and Non-HUBs,
  and the aggregate percentage of subcontracting
  with HUBs in which the HUB Goal identified in the
  solicitation is met or exceeded , complete
• All of the steps in Section 1, 2, and 4 of the
  HSP.
• Section 2 b. List all the portions of work you
  will subcontract, and indicate the percentage of
  the contract you expect to award to HUB vendors
  and Non HUB vendors.
• Section 2 c. No.
• Section 2 d. Yes.
• HSP GFE Method A (Attachment A) Complete this
  attachment for each subcontracting opportunity.

57
Step by Step
Complete Section 2-b List all the portions of
work you will subcontract, and indicated the of
the contract you expect to award to HUBs and
Non-HUBs.
Complete Section 2-c No, to using only HUBs to
perform all Subcontracting Opportunities in 2-b.
58
Step by Step
Complete Section 2-d No, to the Aggregate of
the contract expected to be subcontracted to HUBs
to meet or exceed the HUB goal, which you have a
contract agreement in place for five (5) years or
less.
59
HSP GFE Method A (Attachment A)
Complete this attachment (Sections A-1 and A-2)
for each subcontracting opportunity.
Subcontractor Selection (HUBs and Non-HUBs)
60
METHOD IV

• If you are subcontracting with HUBs and Non-HUBs,
  and the aggregate percentage of subcontracting
  with HUBs, holding an existing contract with HUBs
  for 5 years or less, does not meet or exceed the
  HUB Goal identified in the solicitation,
  complete
• All of the steps in Section 1, 2, and 4 of the
  HSP
• Section 2 b. List all the portions of work you
  will subcontract, and indicated the percentage
  of the contract you expect to award to HUB
  vendors and Non HUB vendors
• Section 2 c. No
• Section 2 d. No
• HSP GFE Method B (Attachment B) Complete this
  attachment for each subcontracting opportunity.

61
Step by Step
Complete Section 2-b List all the portions of
work you will subcontract, and indicated the of
the contract you expect to award to HUBs and
Non-HUBs.
Complete Section 2-c No, to using only HUBs to
perform all Subcontracting Opportunities in 2-b.
62
Step by Step
Complete Section 2-d No, to the Aggregate of
the contract expected to be subcontracted to HUBs
to meet or exceed the HUB goal, which you have a
contract agreement in place for five (5) years or
less.
63
HSP GFE Method B (Attachment B)
Complete Section B-1 and Section B-2 only
for each subcontracting opportunity.
Good Faith Efforts to find Texas Certified HUB
Vendors
64
HSP GFE Method B (Attachment B)
Written Notification Requirements
List 3 HUBs Contacted for this
Subcontracting Opportunity
65
HSP GFE Method B (Attachment B)
Written Notification To Trade Organizations
66
HSP GFE Method B (Attachment B)
List Trade Organizations Notified with Dates
Sent/Accepted.
67
HSP GFE Method B (Attachment B)
Provide written justification why a HUB was not
selected for this Subcontracting Opportunity
68
METHOD V

• If you are not subcontracting any portion of the
  contract and will be fulfilling the entire
  contract with your own resources (i.e.,
  equipment, supplies, materials, and/or
  employees), complete
• All of the steps in Section 1, 2, and 4 of the
  HSP.
• Section 3 Self Performing Justification,

69
Section 3 Self Performing Justification
List the specific page(s)/section(s) of your
proposal response, OR in the space provided,
which explains how your company will perform the
entire contract with its own equipment, supplies,
materials and/or employees.
70
iii HUB Subcontracting Opportunity Notification
Form
71
Sample for Respondents Use.
72
III. HSP Prime Contractor Progress Assessment
Report Section 4.2.5.8
73
HSP Prime Contractor Progress Assessment Report

• Required with
• ALL Pay Requests

• List ALL Sub
• payments
• (HUBs Non-HUBs)

• Required even if
• not subcontracting

74

• Questions Submittal
• Followed by Break

75
Vendor Question/Response

• Verbal answers to vendor questions will be
  provided to the extent practicable.
• Responses are not binding until the final written
  responses are posted on the HHSC website.

76

• Closing Comments