Vendors’ ConferenceJuly 8th, 2013

10:00 AM ET

New York StateMedicaid Administrative Services

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Introduction 10 minutes− Department of Health Introductions− Key MAS Procurement Dates− Designated Contacts− New York Medicaid Program Background

Procurement Overview 15 minutes− Goals and Objectives of the MAS Procurement− Scope of the MAS Procurement− Current and Future MMIS Components− Comparing the MAS Procurement to a Traditional MMIS Procurement− Software Ownership Scenarios in the MAS Procurement− Vendor Preclusions/Restrictions

Contract Overview 10 minutes

− Phases and Timeline− Release of Medicaid System and Operational Components

RFP Review 20 minutes− RFP Structure/Components− MITA Overview− High-level Response Instructions− Elaboration on Key Technical Requirements− Attachment H: Pricing Schedule Key Focus Areas

Evaluation Criteria 5 minutes

Q&A 30 minutes

Today’s Agenda

Introduction

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Speaker Introductions

Facilitator

Subject Matter Experts

Jonathan Halvorson

Deputy DirectorDivision of SystemsOffice of Health Insurance Programs

Christine Hall-FinneyDirectorDivision of SystemsOffice of Health Insurance Programs

Dennis WrightAdministration and Contracts DirectorDivision of SystemsOffice of Health Insurance Programs

Janet ElkindDeputy DirectorDivision of Program Development and ManagementOffice of Health Insurance Programs

Cynthia H. Beaudoin Senior AttorneyNew York State Department of Health Division of Legal Affairs

Joseph ZeccoloFiscal Management Group, Bureau of ContractsDivision of Administration

Jonathan BickDirectorDivision of OHIP OperationsOffice of Health Insurance Programs

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Key MAS Procurement Dates

Item Date

RFP Release Date 06/25/2013

Written Questions Due 4:00 PM ET 07/18/2013

Response to Written Questions on or about 08/16/2013

Proposal Submission Deadline 4:00 PM ET 09/25/2013

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Designated Contacts

Please note that all communication in relation to this procurement, MUST go through the below contacts only

Mr. Joseph ZeccoloNYS Department of HealthFiscal Management Group, Bureau of ContractsPhone: (518) 474-7896Email: jxz02@health.state.ny.us

Contact for all communications attempting to influence this procurement or related to subject matter pertinent to this solicitation

Contacts for communications related to the following subjects:•Debriefings•Negotiation of Contract Terms after Award

Contact for communications related to the following subjects:•Submission of Written Questions•Submission of Written Proposals•Procurement Library Requests

Mr. Dennis WrightNYS Department of HealthOffice of Health Insurance ProgramsDivision of SystemsPhone: (518) 649-4274 (work)E-mail:  dxw07@health.state.ny.us

Mr. Patrick Allen NYS Department of HealthOffice of Health Insurance Programs Division of SystemsPhone: (518) 649-4267E-mail: pwa01@health.state.ny.us

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New York Medicaid Program Background

− Largest Medicaid program in the US− Along with affiliated programs, it provides health care coverage to over five (5) million New

Yorkers− Medicaid Managed Care: 3.3 million, Family Health Plus: 430,000, Child Health Plus: 340,000

− Governor Cuomo established the Medicaid Redesign Team (MRT) in January 2011, to reform the Medicaid system and reduce costs.

− Encompasses a variety of components allowing it to process over 2 million transactions per day in 2012, 1.3 million of which are claims

− Provides application access for the Department, other State agencies, LDSS, and providers− Provides a variety of capabilities such as transaction processing, web-based application for

the State, internet application for provider access, external file transfer, etc.

SIZE

CURRENT MMIS: eMedNY

NYS’S MEDICAID REFORM

INITIATIVES

Procurement Overview

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Goals and Objectives of the MAS Procurement

OBJECTIVES OBJECTIVES

GOALSGOALS

− Solicit proposals for an MAS contractor to provide fiscal agent services and other services for the NYS Medicaid Program in a manner that complies with Centers for Medicare & Medicaid Services (CMS) guidelines and certification requirements for an MMIS

− Replace existing eMedNY functions, except encounter processing− Ensure that the new system will meet CMS certification requirements and comply with

all federal regulations and policy− Take over clinical review and administration functions, including claims processing,

for NYS pharmaceutical programs including the Elderly Pharmaceutical Insurance Coverage (EPIC) Program, the New York Prescription Saver Program (NYPS), and the Preferred Diabetic Supply Program (PDSP)

− Take over administration of MEIPASS incentive program for electronic health record adoption

− Take over prior approval functions from DOH staff

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Pharmacy Benefit Management Prior approval of certain services Specific benefit carve-outs

Member and provider call center Program integrityManaged Care capitation payments

Claims adjudication, payment, and post-payment adjustment

Provider screening, enrollment, and recertification

Provider servicing, communication, and education

Coordination of benefits (private third-party liability, Medicare dual-

eligibles)

Facilitation of Electronic Health Records (EHR) incentive program

Grievance and appeals processes

The prime contractor must provide fiscal agent services and will be responsible for replacement of the current NYS MMIS with a new mechanized claims processing and information retrieval system. Services include, but are not limited to, the following (a full set of required services is provided in Attachment E):

Scope of the MAS Procurement

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Current and Future Components of MMIS

The scope of this procurement does not represent the entire MMIS enterprise Current NYS MMIS is comprised of eMedNY and the Medicaid Data Warehouse (MDW). The MMIS interfaces with the Welfare

Management System (WMS), managed care organizations (MCOs), the managed care enrollment broker, and the state's third-party liability (TPL) contractor to provide MMIS functions

The diagram below provides an overview of the future MMIS environment and interactions with other major NYS systems, delineating the division of high-level responsibilities among the various entities.

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Emphasis on Existing Infrastructure

− Vendors expected to focus on configuring existing infrastructure and platforms for claims processing, customer service, care managerment and other services where possible

− The COTS product(s) delivered by the contractor will be licensed to the Department in accordance with contractor’s or other independent software vendor’s (ISV) standard license agreement, amended if necessary to satisfy Section VI: Contract Requirements

Diverse Vendors

− Procurement open for vendors including but not limited to traditional MMIS vendors, System Integrators, Medicare Administrative Contractors (MACs), Admnistrative Services Organization (ASOs), and commercial and Medicaid managed care organizations (MCOs)

Comparing MAS Procurement to Traditional MMIS Procurement

High-Level Differences

High-Level Similarities

Fiscal Agent Responsibility and State Oversight

− The primary contractor is expected to provide fiscal agent services and other services for the NYS Medicaid Program in a manner that complies with CMS guidelines and MMIS certification requirements as identified in the CMS Medicaid Enterprise Certification Toolkit (MECT)

− The contractor will configure and supplement its existing infrastructure to provide selected health program administration services to NYS, but will not bear health insurance risk for member coverage. Health insurance risk and fiduciary responsibility for member coverage still reside with NYS

− Regardless of whether the Department owns or licenses particular components of the system, it must have access to and oversight of all systems and records procured as part of the MAS procurement to ensure its ability to determine and enforce compliance with requirements of the MAS RFP

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Vendor Preclusions/Restrictions

Primary Contractor

An MCO that provides risk-based capitated Medicaid services in NYS is not eligible to function as the fiscal agent and therefore it cannot submit a proposal as a prime vendor to the RFP, but can serve as a subcontractor

NYS has elected to carve drug rebate responsibilities out in a separate procurement because of the openness of the MAS contract to commercial and Medicaid health plans

Subcontractor

Medicaid MCOs currently providing or intending to provide Medicaid services in NYS can be included as a subcontractor but must be insulated from providing the following services or having exposure to/interaction with the following information:

FFS Payments Maternity kick payment processing Stop-loss Capitation payments

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Software Ownership Scenarios in the MAS Procurement

The ownership rights of the contractor in relation to existing commercially distributed software product(s) as well as conditions on license grant are provided in detail in Section VI: Contract Requirements. The scenarios below help to provide further guidance on ownership:

Scenario Description Key Points

Scenario 1

Traditional MMIS vendor with existing Fiscal Agent/MMIS clients that transfers their custom developed core solution to NYS

• Core solution was federally funded and NYS-specific enhancements would be federally funded

• Ownership of the system and the enhancements would remain in the public domain

Scenario 2

Non-traditional vendor (e.g., Health Plan) with existing internally developed claims processing solution that will be leveraged for NYS - or – Traditional MMIS vendor with a COTS solution for claims processing that will be configured for NYS

• Vendor to define what is its proprietary core solution

• Core package license is funded 75/25 Federal Financial Participation (FFP)

• Modifications/enhancements to core/package for NYS funded at 90/10 FFP

• Enhancements for NYS that are federally funded at any level become part of the public domain

• The State can purchase, lease, or rent the core/package solution upon end/termination of contract for use by successor Fiscal Agent

Summary of Scenarios

Contract Schedule Overview

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Phases and Timeline

The contract will be awarded for five (5) years with the option to renew for three (3) additional one (1) year periods at the sole option of the State. The initial five (5) year period would begin in January 2014 and include all project planning, DDI, operations, certification, and operational enhancement tasks.

RFP Review

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RFP Section I

RFP Section 2

RFP Section 3

RFP Section 4

RFP Section 5

Attachments

− Provides Procurement Overview including vision, goals and objectives, term of the contract and scope of work summary

− Provides description of the NYS Medicaid Program and current MMIS environment− Describes ancillary and related MMIS systems and components

− Includes SOW and guiding principles of the procurement− Describes project personnel requirements, performance and monitoring expectations, including

the service level agreements

− Provides an overview of the proposal requirements− Includes proposal submission instructions, technical and price proposal contents, certifications

and the evaluation process

− Provides an overview of the NYS Administrative requirements− Includes designated contacts for submission of the proposal− Describes department and contractor responsibilities and elaborates on the appendices

− Standard RFP attachments for NYS and DOH− Attachment E: Vendor Requirements Traceability Matrix (provides technical requirements)− Attachment H: Pricing Schedule (provides a cost template to be filled by the vendor)

RFP Structure/ Components

Note: The RFP and its attachments become part of the final contract

RFP Section 6 − Presents the legal provisions that govern the resulting contract.

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MITA Overview

Importance of Attachment E: Vendor RequirementsDeveloped based on the business needs of NYS, MITA 3.0 and CMS MMIS Certification RequirementsOrganized by overarching technical architecture and the MITA 3.0 Business Architecture framework

New Framework MITA 3.0:Addresses the new legislative requirements outlined in the Health Information Technology for Economic and Clinical Health Act, the Children’s Health Insurance Program Reauthorization Act, and the Patient Protection and Affordable Care ActReflects the use of newer technologies such as Service-oriented architecture (SOA)

MAS MITA 3.0 Business Architecture to Support Functional Requirements

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• Detailed response instructions are provided in Section IV of the RFP.• Responses must be received by the Department in Albany, New York no later than the time and date specified in the RFP.• Separate electronic files should be produced for each proposal section as outlined in this RFP and clearly identified through the

file name for the section the file represents.• The Department discourages overly lengthy proposals. • Hard and electronic copies should contain identical information. The hard copy is the copy of record.

Response Instructions (High Level)

Electronic Submission Original Copies

Technical Proposal 5 Secure Flash Drives or Secure CDs/DVDs with the following contents:•1 copy in Adobe PDF; •1 copy in MS Word 2007; and •1 copy of all project plans in MS Project 2007

3 Original Hard Copy 30 Hard Copies

Price Proposal 6 Secure Flash Drives or Secure CDs/DVDs with the following contents:1 copy in Adobe PDF (complete); 1 MS Office copy consisting of: •Narrative in MS Word 2007 as needed; and •Attachment H Worksheets in MS Excel 2007

3 Original Hard Copy 6 Hard Copies

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Elaboration on Key Technical Requirements

Vendors are advised to submit proposals that are comprehensive and clearly reflect the technical proposal requirements. This includes, among other proposal requirements, contractor and staff background, understanding of the scope of the project, responsiveness to specifications, a robust SDLC that includes adequate project and schedule controls, adequacy of staffing levels, etc.

SECTION TITLESECTION WEIGHT

Technical Architecture 10%Business Relationship Management 7.5%Care Management 5%Contractor Management 5%Eligibility and Enrollment Management

5%

Financial Management 10%Member Management 7.5%Operations Management 10%Performance Management 5%Plan Management 10%Provider Management 7.5%Service Level Agreements 7.5%Vendor Qualification and Experience 5%Organization and Staffing 5%Total 100%

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Attachment H: Pricing Schedule Key Focus Areas

− Total Project Planning, DDI, and Certification price MUST be no more than 25% of the proposed Total Price on Tab A: Pricing Schedule.

− Milestone based payment during this phase.

− Operations price must specify a fixed monthly price to operate the solution for the first contract year and annual price for contract years 2, 3, 4 and 5

− Transaction pricing is used to determine the payment due for allowed types of transactions on a per transaction fee basis if the number of transactions goes over the baseline range specified in the RFP

− The baseline range is based on historical data and future projections

− This phase commences with the start of the contract and includes both maintenance and enhancement tasks that must be performed throughout the life of the contract

− Any and all system and operational enhancements that are applicable to multiple customers of the contractor will be executed at no additional cost to the State, but unique enhancements will be paid for on a monthly estimate based on a rate card

− Vendors should submit the fixed price for all activities required to support the transition tasks required by this RFP and as detailed in the Transition Plan approved by the Department

− Provides a summary total of all information entered on the sheets that follow− Reimbursable Postage and Potential Annual Satisfaction Incentive are provided as

estimates for budgetary purposes and should not be altered by the bidder

Evaluation Criteria

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Vendor Technical Proposal (70%)

Compliance Assessment

The Compliance Assessment will have a pass/fail screening that includes the following requirements:All vendor proposal materials were submitted to the Procurement Officer on or before 4:00 PM ET 09/25/2013Attachment E: Vendor Requirement Traceability Matrix and Attachment H: Pricing Schedules have been completed in the correct format using the spreadsheets provided in the MAS RFP

The technical raw scores will be normalized as follows: N = (A÷B) * 70% where: A is the raw score of the proposal being evaluated; B is the highest technical score; and N is the Technical Score

Evaluation Approach

Vendor Price Proposal (30%)

The price proposal score will be normalized as follows: C = (A ÷ B) * 30% where: A is the total price of the lowest price proposal;B is the total price of the price proposal being evaluated; andC is the Price Score

The State will select a contractor using the Best Value award methodology. Best Value is defined in Article XI, Section 163 (1)(j) of the NYS Finance Law as the basis for awarding contracts for services to the vendor which

optimizes quality, cost and efficiency, among responsive and responsible vendors.

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Evaluation Approach

Minority and Women Owned Businesses

For purposes of this solicitation, the Department hereby establishes an overall goal of at least 10% for M/WBE participation.

5% Minority-owned business 5% Women-owned business

A contractor that does not propose at least 10% of total contract value expensed to NYS-certified M/WBE firms must document good faith efforts to provide meaningful participation by MWBEs in the performance of the contract.

Directory of certified businesses: http://www.esd.ny.gov/mwbe.html.

?Q&A