florida healthy kids corporation
DESCRIPTION
Invitation to Negotiate Bidder’s Conference. Florida Healthy Kids Corporation Health Benefits Coverage Underwriting and Services March 22, 2010 – 9:00 a.m. FLORIDA HEALTHY KIDS CORPORATION. Non-profit corporation created in 1990 One of 4 Florida KidCare Program Components - PowerPoint PPT PresentationTRANSCRIPT
FLORIDA HEALTHY KIDS CORPORATION
INVITATION TO NEGOTIATE
BIDDER’S CONFERENCEFlorida Healthy Kids Corporation
Health Benefits Coverage Underwriting and Services
March 22, 2010 – 9:00 a.m.
1
•Non-profit corporation created in 1990•One of 4 Florida KidCare Program Components•Part of Florida’s CHIP\Title XXI Program•Serving children ages 5 through age 18
•This ITN covers only children in the Healthy Kids program
www.healthykids.org
What is the Florida Healthy Kids Corporation?
www.healthykids.org
Scope of Invitation to Negotiate
• To secure a choice of managed care plans in designated counties (Phase I)
• Covers 14 counties with at least 3,000 enrollees
• An overlay with the existing insurer
• Effective January 1, 2011
www.healthykids.org •
Scope of Invitation to Negotiate
• No guarantee of minimum enrollment
– FHKC expects to continue to insure existing enrollment
– Future enrollment based on funding
– Award of contracts based on available funding
– Continuation of incumbent based on contract negotiations; not a rebid of current contracts
www.healthykids.org
Evaluation Process
• Two Step Process– First Step:
• Must offer an insured product• Must meet the minimum benefit specifications• Cannot increase the cost sharing specifications• Cannot change the program’s objectives
– Second Step:• Evaluated consistent with state law• Factors that may be considered under Section III
www.healthykids.org
Evaluation Process
• Personal Interviews– Conducted in Tallahassee– Open Meetings
• Submissions should be complete, organized and concise– Subject to public review after award– FHKC can review and evaluate without further
input or clarification
www.healthykids.org
Calendar
• Subject to Change– Monitor the Healthy Kids Website regularly– Keep contact information up to date
• Key Dates to Remember– Mandatory Letter of Intent: March 26,
2010– Question & Answer Period Ends: April 23,
2010– Proposal Deadline: May 19, 2010 –
12:00 Noon
www.healthykids.org
Single Point of Contact
• Contact only the Issuing Officer – [email protected]– (850) 701-6108
• Contacting any other person is grounds for disqualification
www.healthykids.org
Questions Regarding this ITN
• Must be submitted in writing to Issuing Officer
• Faxed or emailed only – no phone calls
• Accepted through April 23, 2010
• Questions will be posted to web by May 7th
www.healthykids.org
Mandatory Bidder’s Conference - NEW
• Mandatory participation at Bidder’s Conference
– Bids will only be accepted from Bidder’s Conference participants
– Questions answered today will be transcribed and posted
– Answers today are preliminary until posted
www.healthykids.org
Supplemental Information Requests• Written requests will be
considered on a case by case basis– Information will be posted to the web
– Public records can be viewed through appointments
– Proposals, grading tools, materials as part of this ITN are not available until the process has been concluded
www.healthykids.org •
Other Terms
• Amendments to the ITN
• Special Disclosures
• Most Favorable Terms
• Withdrawals
www.healthykids.org
Competitive Negotiation Process
• FHKC may enter negotiations with selected bidders
• FHKC may elect to execute a contract or contracts with a selected bidder or bidders without any further negotiation
• Therefore, proposals should be submitted in complete form
www.healthykids.org •
Limitations
Bidders cannot submit proposals for the same county under multiple plans that are affiliated or linked by shared ownership or controlling interests.
www.healthykids.org
Submission Requirements
www.healthykids.org
Submission Requirements
• Volumes must be 3-Ring Notebooks
• Easily flip-able and read-able materials
• WORD, EXCEL and PDF files only
• Clearly marked Tabs and sub-tabs required
www.healthykids.org •
Changes Since Last ITN
• Mandatory Letter of Intent (LOI)Tab B
– Required Letter of Intent by deadline to submit proposal
– Due Friday, March 26, 2010
– LOI is non-binding and can be withdrawn at any time
– Organization, contact information, counties
www.healthykids.org •
Changes Since Last ITN
• Evidence of Regulatory AuthorityTab C
– Evidence of regulatory authority must be in place as of the date the proposal is submitted to FHKC
– Evidence required is based on the model being proposed
www.healthykids.org
Changes Since Last ITN
• Program Management\ConfidentialityTab G-6
– Describe compliance with activities related to Health Information Technology for Economic and Clinical Health Act (HITECH)
www.healthykids.org
Changes Since Last ITN
• Implementation and Transition PlansTab H
– Plans for handling members transitioning from other insurers after January 1, 2011
– Transition plan goes through September 30, 2011
www.healthykids.org •
Reporting Requirements
• Existing Insurers: Current Compliance status
• Non-Incumbent: – Must initiate testing phase prior to Personal
Interview with at least one (1) exchange to move on in process
– Must complete testing process to continue evaluation process or may be disqualified
– Completion determined by date of Purchasing & Oversight Committee meeting (final grades)
– Bidder’s sole responsibility to complete
www.healthykids.org
Standard Contract\Contract Amendment• Existing Insurers will be asked to
execute an amendment if awarded additional counties
• New Insurers will execute the final contract
• Revisions not generally acceptedMust affirmatively accept contractPoints deducted for substantive
changes
www.healthykids.org
Contract\Contract Amendment
• Current contract template provided for reference with most recent changes highlighted
• New provisions recently identified by federal CMS
• Updated template with required revisions will be posted by April 5th
www.healthykids.org
Provider Networks – Volume II
• Must be provided EXACTLY as prescribed
• Information only for counties covered by LOI unless Enrollees may access services in those counties AND meets access standards
• Required Summary Sheets (NEW)
www.healthykids.org •
Changes Since Last ITN
• Provider Listings NEW
– List only those providers already under contract
– If the provider must still complete contracting, their rows must be shaded
– FHKC may request evidence of such contracts
www.healthykids.org
Changes Since Last ITN
• Summary Sheets Tab A & Appendix
– Summary Sheet found in Appendix should be first page in Tab A followed by EXCEL listing of providers
– GEO ACCESS map of board certified only providers mapped to Enrollees required
www.healthykids.org
Changes Since Last ITN
• Specialists Tab B & Appendix– Summary Sheet found in Appendix listing
Specialists should be first page in Tab B followed by EXCEL listing of providers
– Providers for the county being bid should be first followed by any other providers available within neighboring counties meeting contract standards
– Within the county listing, the next sort order should be alphabetical by the specialty and then alphabetical by provider last name
www.healthykids.org
Changes Since Last ITN
• Affiliated Entities Tab I
– New Tab
– Response required
– Affirmative response if does not apply
www.healthykids.org
Volume III – Rate Proposals
• Three presentation options provided• Single combined rate for 14 counties• Single rate for any group of counties• Individual county rates
• Special Optional response for a statewide proposal
www.healthykids.org •
Other New Provisions Since Last ITNEffective July 1, 2009: • Permits children income and clinically eligible
children for CMS to opt-out of CMS into Healthy Kids.
Effective October 1, 2009:• Managed Care Protections Policy– 90 day free look policy for all new Enrollees– Good cause exceptions after lock-in occurs– 90 day choice period after implementation for
all existing Enrollees in new choice counties
www.healthykids.org
Delivery of Services – Background Information• Standards for delivery of services • Access (Primary Care, Specialty, Hospital,
BH\SA)• Appointment• Credentialing
• Board certified primary care physicians only• Pediatricians and family practice
• Calculations used adequacy provided
www.healthykids.org •
Appendix Documents
• Word versions of these will be posted to the website
• Current FHKC Insurers may use FHKC as one of the three required references
• Summary sheets for designated Tabs are required
www.healthykids.org
Specialty Care Provider Summary Sheets• Only those providers that see the
majority of Enrollees within the Healthy Kids age range (5-18) should be listed.
• Example:• A Specialist only sees those over
age 16 – should not be included on summary sheet; can be included on the EXCEL provider listing behind the summary sheet
• Ok, if sees children over age 10
www.healthykids.org
Premium Rate Proposal Form
• Premium Rate Proposal Form
–Only those rates that are presented on the required form will be considered
www.healthykids.org •
Supplemental Information
• Utilization Data–Will be posted to the website in EXCEL– Notation regarding change in plans
• Data Layouts and Submission Guidelines
www.healthykids.org
Question and Answer Period
Question and Answer Period
Break
www.healthykids.org
Final Words
• Any conflict between today’s presentation and the ITN, the ITN provision controls
• Today’s verbal responses are preliminary. Final written responses will be posted to the Healthy Kids’ website – www.healthykids.org
• Contact Only the Issuing Officer
www.healthykids.org •
Issuing Officer Contact Information
Jennifer Kiser LloydChief External Affairs Officer
[email protected](850) 701-6108 – Phone ; (850) 224-0615 –
Fax
661 E. Jefferson Street2nd Floor, Florida Bar AnnexTallahassee, Florida 32301