da.ks.govda.ks.gov/purch/contracts/default.aspx?getfile=evt... · web viewsection i....

Exhibit 1 – Technical Bid Event # EVT0005594

COBRA RFP (2019, 2020, 2021 Plan Years)

SECTION IRegistration, Event Notice and Acknowledgement of Addenda

The Event Document as posted on the Division of Purchases web site and the acknowledgement of addenda posted for the bid event must be submitted as part of Section I of the Technical proposal.

Vendors may also submit an executive summary not to exceed two pages, explaining why they feel they are the best option for the State Employee Health Plan (SEHP).

The State of Kansas implemented a PeopleSoft Financial Management System (named SMART) in July 2010. In order to submit a response to any bid event, a vendor must be registered in SMART. It is very important for you to register your business with Procurement and Contracts, for the following reasons:

To bid on events, registered bidders must be invited in SMART by the Procurement Officer BEFORE the bid closes.

If invited, registered bidders will be able to receive bid event documents via e-mail. If not invited by the Procurement Officer, registered bidders will still receive notification of bid events

based on their category code registration.

Registration may be accomplished by:

1. Identifying the category codes you would like to be associated with your bidder record. This should be completed prior to completing the bidders registration.

A full list of category codes is available at: http://www.da.ks.gov/purch/SMARTCategoryCodes.xls Note that this is a large file (5mb). It may be beneficial to identify the applicable category codes prior to beginning the registration process. The State uses the UNSPSC category code system which includes over 40,000 codes. For ease of identifying codes that may apply to your business, you may search this document by selecting Ctrl+F on your keyboard, then typing key words that may apply to your business. If you find no results, select a different key word. For example, vehicles are listed under automobiles or cars.

2. Completing the form on the following website (to include the category codes that you have selected) http://www.surveymonkey.com/s/ksbiddersurvey

3. Submitting a completed W-9 Form.E-mail a copy of your signed and dated W-9 Form (with a signature no more than six (6) months old) to [email protected] or fax it to 785-296-7240. Your bidder registration will NOT be processed until we have the W-9 Form. You may download a copy of the current W-9 Form at the IRS website: http://www.irs.gov/pub/irs-pdf/fw9.pdf

Please do not submit another application once you have registered. If you need to make changes to your bidder record (i.e. changes to contact information, address changes, add/delete commodity codes, etc.) please email those changes to [email protected]. Please include your company name and taxpayer identification number to assure that the correct record is updated.

After your application has been processed, you will receive an email confirming that your application has been approved. If you have any questions regarding the bidder application, please call: 785-296-2376

mailto:[email protected]

http://www.irs.gov/pub/irs-pdf/fw9.pdf


http://www.surveymonkey.com/s/ksbiddersurvey

http://www.da.ks.gov/purch/SMARTCategoryCodes.xls



SIGNATURE SHEET

Item: COBRA Administration Services for the State Employee Health PlanClosing Date: 2:00 PM Central Time, February 14, 2018Agency: Kansas State Employees Health Care Commission

Certification of Capabilities:By submission of a bid and the signatures affixed thereto, the bidder certifies all products and services proposed in the bid meet or exceed all requirements of this specification as set forth in the request and that all exceptions are clearly identified.

Conflict of Interest:I hereby certify that I (we) do not have any substantial conflict of interest sufficient to influence the bidding process on this bid. A conflict of substantial interest is one which a reasonable person would think would compromise the open competitive bid process.

Addendums to the RFP: The undersigned acknowledges receipt of the following addenda:

#1( ) #2( ) #3( ) None ( )

Legal Name of Person, Firm or Corporation

Mailing Address City & State Zip

Toll Free Telephone Local Cell: Fax

Tax Number E-Mail

Signature Date

Typed Name Title

In the event the contact for the bidding process is different from above, indicate contact information below.

Bidding Process Contact Name



E-Mail

Back-up Contact Name



E-Mail If awarded a contract and purchase orders are to be directed to an address other than above, indicate mailing address and telephone number below.





E-Mail VENDOR CONTACT INFORMATIONTo facilitate the Request for Proposal (bid event) process, we ask that each Contractor designate a main contact person as well as an alternate contact should the main contact be unavailable. Please complete the following regarding that designated persons. The State has designated contact information listed in this document.

Primary Contact: ____________________________________________

Title: ______________________________________________________

Address: ___________________________________________________

___________________________________________________

Phone Number: ________________ Fax Number: _________________

Email Address: ______________________________________________

Alternate Contact: ___________________________________________

Title: ______________________________________________________

Address: ___________________________________________________

___________________________________________________

Phone Number: ________________ Fax Number: _________________

Email Address: ______________________________________________



TAX CLEARANCEThe Health Care Commission in process of procurement per K. S. A. 75-6504, requests the Director of Purchases to review tax clearance status of all Contractors. Per KSA 75-3740-(c), the Director of Purchases may reject the bid of any bidder who is in arrears on taxes due the State of Kansas. The Division of Purchases will confirm tax status of all potential contractors and subcontractors prior to the release of a purchase order or contract award. The State of Kansas reserves the right to allow a bidder an opportunity to clear tax status within ten (10) calendar days, or to proceed with award to the next lowest responsive bidder, whichever is determined by the Director of Purchases to be in the best interest of the State.

The Secretary of Revenue is authorized to exchange such information with the Director of Purchases as is necessary to determine the bidder’s tax clearance status, notwithstanding any other provision of law prohibiting disclosure of the contents of taxpayer records or information.

Instructions on how to check Tax Clearance Status can be found at the following website: http://www.ksrevenue.org/taxclearance.htm

Information about Tax Registration can be found at the following website: http://www.ksrevenue.org/busregistration.htm

Contact Information: Please provide the attached contact information for use should the State of Kansas need to contact the appropriate officials within your company to discuss your tax clearance / registration status.

CONTRACTORContact Person for Tax Issues:

Company Name: Tax Number:

Mailing Address

City & State Zip Code


E-Mail

SUBCONTRACTOR(S)Contact Person for Tax Issues:

Company Name: Tax Number:

Mailing Address

City & State Zip Code


E-Mail

Additional pages may be added, as required, indicating the same information for multiple subcontractors. All subcontractors must be identified.

http://www.ksrevenue.org/busregistration.htm

http://www.ksrevenue.org/taxclearance.htm



CERTIFICATION REGARDINGIMMIGRATION REFORM & CONTROL

All Contractors are expected to comply with the Immigration and Reform Control Act of 1986 (IRCA), as may be amended from time to time. This Act, with certain limitations, requires the verification of the employment status of all individuals who were hired on or after November 6, 1986, by the Contractor as well as any subcontractor or sub-subcontractor. The usual method of verification is through the Employment Verification (I-9) Form. With the submission of this bid, the Contractor hereby certifies without exception that Contractor has complied with all federal and state laws relating to immigration and reform. Any misrepresentation in this regard or any employment of persons not authorized to work in the United States constitutes a material breach and, at the State’s option, may subject the contract to termination and any applicable damages.

Contractor certifies that, should it be awarded a contract by the State, Contractor will comply with all applicable federal and state laws, standards, orders and regulations affecting a person’s participation and eligibility in any program or activity undertaken by the Contractor pursuant to this contract. Contractor further certifies that it will remain in compliance throughout the term of the contract.

At the State’s request, Contractor is expected to produce to the State any documentation or other such evidence to verify Contractor’s compliance with any provision, duty, certification, or the like under the contract.

Contractor agrees to include this Certification in contracts between itself and any subcontractors in connection with the services performed under this contract.

____________________________________________ ______________________Signature, Title of Contractor date



CERTIFICATION INDIVIDUAL OR COMPANYNOT CURRENTLY ENGAGED IN A BOYCOTT OF ISRAEL

In accordance with HB 2409, 2017 Legislative Session, the State of Kansas shall not enter into a contract with any Individual or Company to acquire or dispose of services, supplies, information technology or construction, unless such Individual or Company submits a written certification that such Individual or Company is not currently engaged in a boycott of Israel.

As an Individual or Contractor entering into a contract with the State of Kansas, it is hereby certified that the Individual or Company listed below is not currently engaged in a boycott of Israel.

____________________________________________ ______________________Signature, Title of Contractor Date

____________________________________________ ________________________Printed

____________________________________________Name of Company



Section IIVendor Qualifications

If you believe that a particular question is not applicable to the services you are bidding, please briefly explain why. If you have described a program/service or other content and it applies to multiple questions, simply refer us to the prior description. Please do not repeat your answers.

2.1.1 Provide a brief history of your organization including: date established; ownership (public, partnership, subsidiary, etc.) nature of business and any additional programs/products offered in addition to audit services.

Answer: 2.1.2 Is your organization part of a national or regional organization? If yes, provide the

corporation’s name and address. Is your company affiliated with any other company? If so, describe these affiliate relationships.Describe how this relationship impacts your operation and delivery of services.

Answer: 2.1.3 List each subcontractor and/or sister corporation performing work on this contract and

the location where the work will be done. Disclose any services under this RFP or your operations that are related to this RFP that are to be provided by workers outside of the United States.

Answer: 2.1.4 If awarded a contract, indicate who within your organization will be assigned

responsibility to manage or service the SEHP account. Provide a brief bio about each person who will be assigned responsibility for the SEHP account including their education and work experience, years with the company and areas of specialization, if any. Include within this team the persons who will be responsible for the data management functions for the SEHP. Confirm that persons to be assigned to implementation and account management will be part of any interview team.

Account Management* Customer Service. Data

Answer: 2.1.5 Describe any staff relocations, computer systems changes/upgrades, program changes

or telephone system changes in process at this time or proposed within the next 12-24 months?

Answer: 2.1.6 If your organization is licensed or registered with the State of Kansas, please provide a

copy of the documentation. Answer:

2.02 EXPERIENCE AND REFERENCES 2.2.1 Provide references from three current large self funded clients you have provided similar

services as those proposed in this RFP. Public sector clients are preferred. . Also preferred would be clients who have worked with the audit teams to be assigned to this account. Information. Response should include:

Company Name Contact Person



Address Office Phone # Mobile Phone # Email Services Provided

Answer:2.2.2 Provide references from three former clients (within last 4 years) to have provided

similar services proposed in this RFP. Public sector clients lives are preferred. Also preferred would be former clients who have worked with the audit teams to be assigned to this account. Information. Response should include:

Company Name Contact Person Address Office Phone # Mobile Phone # Email Services Provided Reason for termination

Answer:

ACKNOWLEDGE AND ACCEPT

I have reviewed the Vendor Qualifications section of the Request for Proposal and acknowledge that the document shall become part of the final contract. I hereby acknowledge and accept all of the provisions, requirements, and conditions stated in this section of Request for Proposal, subject to the modifications, conditions and limitations I have listed below.

_________________________________________________Authorized Signature of Vendor

_________________________________________________Printed Name of Signatory

_________________________________________________ Title

_________________________________________________Date



SECTION IIIDA-146a, Sample Contract, and Business Associate Agreement

Vendors are expected to closely read the DA-146a, sample contract and BAA and provide a binding signature of intent to comply with such terms and conditions. The DA-146 is a required part on all State of Kansas contracts. All Vendors are required to agree to these provisions without modification. Any modifications of the DA-146 will result in the rejection of your bid.

The SEHP is not obligated to negotiate the provisions of the contract or BAA and reserves the right to accept or reject any bid that has made revisions or modifications in the required language. These provisions are a standard part of all State Employee Health Plan contracts. Any requested modifications to the contract or BAA must be submitted in red-line format with the bid response. It is acceptable to use color for this purpose.

Bidders agree by submitting a proposal in response to this RFP, the SEHP will draft the contract, including the HIPAA Confidentiality Agreement or Business Associate Agreement (BAA) as appropriate. Any negotiations regarding the contract and BAA documents will occur prior to the contract award. Once a contract is awarded, the State will draft the contract and the vendor is expected to sign it within 10 business days.

Should the SEHP be prevented or enjoined from proceeding with the acquisition before or after contract execution by reason of any litigation or other reason beyond the control of SEHP, Vendor shall not be entitled to make or assess claim for damages by reason of said delay.

Note: If no edits are requested to the contract or BAA documents, please return the document marked “no edits required”



State of KansasDepartment of AdministrationDA-146a (Rev. 06-12)

CONTRACTUAL PROVISIONS ATTACHMENT

Important: This form contains mandatory contract provisions and must be attached to or incorporated in all copies of any contractual agreement. If it is attached to the vendor/contractor's standard contract form, then that form must be altered to contain the following provision:

"The Provisions found in Contractual Provisions Attachment (Form DA-146a, Rev. 06-12), which is attached hereto, are hereby incorporated in this contract and made a part thereof."

The parties agree that the following provisions are hereby incorporated into the contract to which it is attached and made a part thereof, said contract being the _____ day of ____________________, 20_____.

1. Terms Herein Controlling Provisions : It is expressly agreed that the terms of each and every provision in this attachment shall prevail and control over the terms of any other conflicting provision in any other document relating to and a part of the contract in which this attachment is incorporated. Any terms that conflict or could be interpreted to conflict with this attachment are nullified.

2. Kansas Law and Venue : This contract shall be subject to, governed by, and construed according to the laws of the State of Kansas, and jurisdiction and venue of any suit in connection with this contract shall reside only in courts located in the State of Kansas.

3. Termination Due To Lack Of Funding Appropriation : If, in the judgment of the Director of Accounts and Reports, Department of Administration, sufficient funds are not appropriated to continue the function performed in this agreement and for the payment of the charges hereunder, State may terminate this agreement at the end of its current fiscal year. State agrees to give written notice of termination to contractor at least 30 days prior to the end of its current fiscal year, and shall give such notice for a greater period prior to the end of such fiscal year as may be provided in this contract, except that such notice shall not be required prior to 90 days before the end of such fiscal year. Contractor shall have the right, at the end of such fiscal year, to take possession of any equipment provided State under the contract. State will pay to the contractor all regular contractual payments incurred through the end of such fiscal year, plus contractual charges incidental to the return of any such equipment. Upon termination of the agreement by State, title to any such equipment shall revert to contractor at the end of the State's current fiscal year. The termination of the contract pursuant to this paragraph shall not cause any penalty to be charged to the agency or the contractor.

4. Disclaimer Of Liability : No provision of this contract will be given effect that attempts to require the State of Kansas or its agencies to defend, hold harmless, or indemnify any contractor or third party for any acts or omissions. The liability of the State of Kansas is defined under the Kansas Tort Claims Act (K.S.A. 75-6101 et seq.).

5. Anti-Discrimination Clause : The contractor agrees: (a) to comply with the Kansas Act Against Discrimination (K.S.A. 44-1001 et seq.) and the Kansas Age Discrimination in Employment Act (K.S.A. 44-



1111 et seq.) and the applicable provisions of the Americans With Disabilities Act (42 U.S.C. 12101 et seq.) (ADA) and to not discriminate against any person because of race, religion, color, sex, disability, national origin or ancestry, or age in the admission or access to, or treatment or employment in, its programs or activities; (b) to include in all solicitations or advertisements for employees, the phrase "equal opportunity employer"; (c) to comply with the reporting requirements set out at K.S.A. 44-1031 and K.S.A. 44-1116; (d) to include those provisions in every subcontract or purchase order so that they are binding upon such subcontractor or vendor; (e) that a failure to comply with the reporting requirements of (c) above or if the contractor is found guilty of any violation of such acts by the Kansas Human Rights Commission, such violation shall constitute a breach of contract and the contract may be cancelled, terminated or suspended, in whole or in part, by the contracting state agency or the Kansas Department of Administration; (f) if it is determined that the contractor has violated applicable provisions of ADA, such violation shall constitute a breach of contract and the contract may be cancelled, terminated or suspended, in whole or in part, by the contracting state agency or the Kansas Department of Administration.

Contractor agrees to comply with all applicable state and federal anti-discrimination laws.

The provisions of this paragraph number 5 (with the exception of those provisions relating to the ADA) are not applicable to a contractor who employs fewer than four employees during the term of such contract or whose contracts with the contracting State agency cumulatively total $5,000 or less during the fiscal year of such agency.

6. Acceptance Of Contract : This contract shall not be considered accepted, approved or otherwise effective until the statutorily required approvals and certifications have been given.

7. Arbitration, Damages, Warranties : Notwithstanding any language to the contrary, no interpretation of this contract shall find that the State or its agencies have agreed to binding arbitration, or the payment of damages or penalties. Further, the State of Kansas and its agencies do not agree to pay attorney fees, costs, or late payment charges beyond those available under the Kansas Prompt Payment Act (K.S.A. 75-6403), and no provision will be given effect that attempts to exclude, modify, disclaim or otherwise attempt to limit any damages available to the State of Kansas or its agencies at law, including but not limited to the implied warranties of merchantability and fitness for a particular purpose.

8. Representative's Authority To Contract : By signing this contract, the representative of the contractor thereby represents that such person is duly authorized by the contractor to execute this contract on behalf of the contractor and that the contractor agrees to be bound by the provisions thereof.

9. Responsibility For Taxes : The State of Kansas and its agencies shall not be responsible for, nor indemnify a contractor for, any federal, state or local taxes which may be imposed or levied upon the subject matter of this contract.

10. Insurance : The State of Kansas and its agencies shall not be required to purchase any insurance against loss or damage to property or any other subject matter relating to this contract, nor shall this contract require them to establish a "self-insurance" fund to protect against any such loss or damage. Subject to the provisions of the Kansas Tort Claims Act (K.S.A. 75-6101 et seq.), the contractor shall bear the risk of any loss or damage to any property in which the contractor holds title.



11. Information : No provision of this contract shall be construed as limiting the Legislative Division of Post Audit from having access to information pursuant to K.S.A. 46-1101 et seq.

12. The Eleventh Amendment : "The Eleventh Amendment is an inherent and incumbent protection with the State of Kansas and need not be reserved, but prudence requires the State to reiterate that nothing related to this contract shall be deemed a waiver of the Eleventh Amendment."

13. Campaign Contributions / Lobbying: Funds provided through a grant award or contract shall not be given or received in exchange for the making of a campaign contribution. No part of the funds provided through this contract shall be used to influence or attempt to influence an officer or employee of any State of Kansas agency or a member of the Legislature regarding any pending legislation or the awarding, extension, continuation, renewal, amendment or modification of any government contract, grant, loan, or cooperative agreement.


The DA146a has been reviewed by me and shall become part of the final contract. I hereby acknowledge and accept all of the provisions, requirements, and conditions stated in this document.

_________________________________________________Authorized Signature of Contractor


_________________________________________________Title

_________________________________________________Date



Redline Copy of the Sample Contract Note: If no edits are requested to this document, please return the document marked “no edits required”

CONTRACT TO PROVIDE______________________________________

FOR THE KANSAS STATE EMPLOYEE HEALTH PLAN FOR2019, 2020, and 2021

THIS CONTRACT is made and entered into this ______ day of _____________, 20_____, by and between the Kansas State Employees Health Care Commission (hereinafter referred to as “HCC”) and _________________________________ (hereinafter referred to as “Contractor”).

WHEREAS, the HCC wishes to provide _________________ for the self-funded Kansas State Employee Health Plan (hereinafter referred to as “Plan”);

WHEREAS, the State Employee Health Plan Staff within the Kansas Department of Health and Environment, Division of Health Care Finance (hereinafter referred to as “SEHP”) has been designated by the HCC to direct the day-to-day operations of the Plan;

WHEREAS, Contractor is a company holding itself out as having expertise in __________________________________ and desires to provide its services and expertise to the HCC; and,

WHEREAS, it has been determined by the HCC that the best interest of the HCC will be served by awarding a contract to Contractor to provide these services.

THEREFORE, in consideration of the mutual agreements contained below, the HCC and Contractor agree as follows:

1. Acceptance: Subject to the terms and conditions of this Contract, the HCC hereby accepts the offer of Contractor as expressed by:

a. Contractor’s Response to Request for Proposal #_______; b. Contractor’s technical proposal; and, c. Contractor’s Response to Request for Proposal #_______ involving pricing, as set forth in

Exhibit A, submitted to the HCC in response to Request for Proposal #_______ (hereinafter referred to as “RFP”).

2. Contract Documents: 1. This Contract consists of the following documents, incorporated herein by direct or indirect

reference and in the following precedential order:a. The DA146a;b. The Business Associate Agreement;c. The terms of this Contract; d. The Addenda to the RFP, if any;e. The RFP, which includes all Exhibits and Attachments; andf. The Contractor’s Technical and Cost Proposal(s), including pricing schedules and

clarifications.

2. In the event of a conflict between or among the terms of the Contract Documents, the term in the Contract Document with the highest precedence will prevail. For example, the DA146a will have the highest precedence in relation to the other listed documents.



3. The documents identified in Section 2.a above constitute the entire agreement between the

parties and supersede all prior oral or written statements or agreements.

3. Term : The term of this Contract shall be 3 years beginning on January 1, ___________ and ending on December 31, ___________.

4. Deliverables: Contractor will provide ___________________ as specified by this Contract and the documents noted in Section 2 above. Pursuant to the RFP and documents noted in Section 2 above, Contractor will:

a. ____________________________________________; b. __________________________________________; c. (as many as needed to describe deliverables);

5. Deliverable Options: Contractor may have provided several options of deliverables to the HCC for services under this Contract in the cost proposal. The HCC reserves the option to select or deselect any of the proposed deliverables contained within the cost proposal during the term of the Contract.

6. Fees: a. For services provided by the Contractor under this Contract, the payment to the Contractor shall

be based on the Contractor’s Best and Final Offer that was presented to and accepted by the HCC and documented by the documents noted in Section 2 of this Contract.

b. The HCC agrees to pay the amount billed by the Contractor that is in conformance with this Contract and fee schedule subject to subsections c and d below.

c. Payment will be made in response to a monthly receipt of an invoice setting forth the total monthly fees and any retroactive adjustments, credits or fees and transmitted by a mutually agreeable method to an address designated by the HCC.

d. Contractor shall also provide the HCC or its delegee, SEHP, the billing data specified by the RFP and/or documents noted in Section 2 of this Contract in a mutually agreeable electronic format. Payment will not be made to the Contractor until the electronic data is submitted in the agreed-upon format to and received by the HCC or its delegee, SEHP.

e. Payment will be made as soon as possible after the receipt of an invoice that meets the requirements of subsections b, c, and d above. The HCC will follow the Kansas Prompt Payment Act (K.S.A. 75-6401 et seq.).

7. Overpayment:

a. HCC assumes that the Contractor shall perform its duties and obligations under this Contract in a timely, careful and reasonable manner.

b. In the event of an overpayment of fees, Contractor shall indemnify the Plan. As used in this Contract, “overpayment” means any amount which has been mistakenly or wrongly paid from the Plan, including duplicate payments, mistaken payments, payments in excess of that actually owed, and any other amount not required to be paid under the terms of the Plan.

c. The HCC and Contractor will cooperate in efforts to recover overpayments when they are as a result of a third-party. Contractor shall not seek legal action against a Plan participant to collect



an overpayment without the HCC’s prior consent.

d. In the case of a dispute on an overpayment between the SEHP and Contractor, there should be an attempt to resolve the dispute by trying to reach an agreement. If the SEHP and Contractor cannot reach agreement, the dispute may be resolved through alternative dispute resolution. The intent is to resolve the dispute at the lowest level possible.

e. Contractor shall not be allowed to collect any overpayment due to its misapplication of the plan’s deductible, co-payment or co-insurance requirements unless it explains the reason for the overpayment in writing to the participant within a reasonable time after the date of service, but not to exceed 15 months after the date of service.

f. The provisions of this section will survive termination of this Contract.

8. Quality and Innovation: The HCC is interested in quality health care and innovative plan designs and projects. During the course of this Contract, the Contractor agrees to work with the HCC in the development, implementation, and evaluation of quality improvement projects and innovative plan designs or projects as authorized by the HCC. Contractors are encouraged to bring ideas on improving the quality of health care and innovative plan design ideas to the HCC for consideration. The HCC may negotiate with Contractors with regard to any expense related to or resulting from pursuit of these projects.

9. Reports: Contractor will work with the SEHP to develop meaningful management reports, making modifications to report structures and contents as necessary to meet the needs of the HCC and SEHP.

10. Retention of Records: a. Unless the HCC specifies in writing a shorter period of time, the Contractor agrees to preserve

and make available all of its books, documents, papers, records and other evidence involving transactions related to this Contract for a period of five (5) years from the date of the expiration or termination of this Contract.

b. Matters involving litigation shall be kept for one (1) year following the termination of litigation, including all appeals, if the litigation exceeds five (5) years.

c. The Contractor agrees that authorized federal and state representatives, including but not limited to, personnel of the using agency and independent auditors acting on behalf of state and/or federal agencies shall have access to and the right to examine records during the Contract period and during the five (5) year post-Contract period. Delivery of and access to the records shall be at no cost to the HCC.

d. State and/or federal law may require the retention of records for longer periods. In which case Contractor will follow applicable law.

11. Review and Hearings: The Contractor agrees to advise the HCC of the number and type of complaints made known to the Contractor for services provided under this Contract. The HCC has the discretion to require the Contractor to participate in any review, appeal, hearing, or litigation involving issues related to this Contract.



12. Solicitation of Members: The Contractor shall not use the names, home addresses or any other information obtained about participants of this plan for the purpose of offering for sale any property or services which are not directly related to services negotiated in this bid event without the express written consent of the HCC.

13. Performance Standards: Service performance standards set forth in the RFP establish expectations regarding certain areas of the Contract between Contractor and the HCC. These performance standards are designed to assure that all parties involved in providing services know what the standards are and that Contractor will provide guarantees based on these standards. Contractor accepts these standards as agreed upon in the RFP, attached hereto.

14. Acceptance of RFP Terms & Conditions: All proposals are subject to the terms and conditions outlined in the RFP. All responses will be controlled by such terms and conditions and the submission of other terms and conditions, price lists, catalogs, or other documents or exceptions as part of Contractor’s response are waived and have no effect either on the Request for Proposal or this Contract. By submitting an executed response, the Contractor specifically agreed to the conditions set forth in this paragraph.

15. Warranties: Contractor represents and warrants to the HCC that (a) services shall be rendered in a professional manner consistent with standards of professionals in Contractor’s industry; (b) services will be delivered in compliance with all standards and conditions presented by HCC to Contractor; and (c) Contractor is under no obligation or restriction, nor will it assume any obligation or restrictions that would in any way interfere or be inconsistent with the performance of the services.

16. Conflict Resolution: a. Intent: In the event that there is a dispute between the parties to this Contract, the intent of the

parties is to resolve the dispute at the earliest and lowest level possible. The lowest level would be a mutual agreement between the parties resolving the dispute. If the SEHP and Contractor cannot reach agreement, the dispute may be resolved through alternative dispute resolution. A last resort would be litigation in court.

b. HCC authority on deliverables: In the event the parties cannot mutually agree to a resolution of any controversies or claims between the parties regarding the provision of services and completion of deliverables, the HCC, at its sole discretion and judgment, will make the final determination as to whether deliverables have been satisfactorily completed or other services provided in accordance with the Contract.

c. Jurisdiction: i. Should legal proceedings be required between the parties as a result of this Contract,

the jurisdiction for the legal proceeding will be in the State of Kansas. If the venue would be a state court, the legal proceeding would be in the District Court of Shawnee County, Kansas. The United States District Court for the State of Kansas sitting in Topeka, Shawnee County, Kansas, would be the venue for any appropriate federal action or proceeding arising hereunder.



ii. Contractor waives all defenses of lack of personal jurisdiction and forum non conveniens to any legal matters that arise between the parties as a result of this Contract. Process may be served on Contractor in the manner authorized by applicable Kansas law or court rule.

d. Eleventh Amendment: The Eleventh Amendment of the United States Constitution is an inherent and incumbent protection held by the State of Kansas and need not be reserved, but prudence requires the HCC to reiterate that nothing related to this Contract shall be deemed a waiver by the HCC or SEHP of the protections accorded a state entity under the Eleventh Amendment.

17. Employment of Counsel and Resolution of Litigation and Legal Fees:a. In the event of litigation involving the services under this Contract not covered by Section 16

above and where the HCC, SEHP, State of Kansas, or the Contractor are named as a party to the litigation (“Litigation” hereafter), the HCC and Contractor each:

1. Reserve the right to select and retain counsel at its own expense to protect its interests;

2. Will promptly notify the other party to this Contract after learning of the Litigation;

3. Will cooperate fully by providing the other party with all non-confidential relevant information and documents within its control as requested; and

4. Will reasonably assist the other party in the defense of the Litigation.

b. In the event the HCC, the State of Kansas or any of its staff, or Contractor is the sole named defendant in Litigation related to the services provided under this Contract, such party shall have discretion to defend, settle, compromise or otherwise resolve such Litigation consistent with the terms of this Contract and of the SEHP. Such party shall keep the other party informed of the status of the Litigation and any decision to settle, compromise or otherwise resolve the Litigation shall be communicated to and discussed with the other party prior to any such settlement, compromise or other resolution.

c. In the event the HCC, the State of Kansas or any of its staff and Contractor are codefendants in Litigation, the parties will cooperate fully with each other to defend, settle, compromise or otherwise resolve such Litigation consistent with the terms of this Contract and the SEHP.

d. In the event any entity other than the HCC, the State of Kansas, any of its staff or Contractor, is named as a defendant in Litigation, the HCC can elect to defend, settle, compromise or otherwise resolve such Litigation with respect to those other entities consistent with the terms of this Contract and of the SEHP.

e. The provisions of this section will survive termination of this Contract.

18. Conformance with Law: Contractor shall comply with all applicable federal, state and local laws, rules and regulations as they exist or as they may be amended, including those not specifically mentioned in this Contract.

19. Contractor: The Contractor shall be deemed the sole source of contact for the Contract. Contractor shall include all subcontractors, subsidiaries, affiliates, partners and sister corporations, etc. Contractor



is solely responsible for all actions and work performed by other entities involved in performing work under this Contract. All terms, conditions and requirements of the Contract shall apply without qualification to any services and work performed on behalf of the Contractor under this Contract.

20. Kansas Open Records Act: The laws of the State of Kansas require public information be placed in the public domain at the conclusion of the selection process, and be available for examinations by all interested parties. Contractor acknowledges that its response to the RFP under this Contract is considered an open record under the Kansas Open Records Act, K.S.A. 45-215 et seq.

21. Banking: The Contractor shall not open a bank account in the name of the State of Kansas, the HCC, or the Kansas State Employee Health Plan. Any bank account that the Contractor opens for the administration of this program or under this Contract shall be in the name of the Contractor only and solely the responsibility of the Contractor.

22. Duty to Mitigate: The parties to this Contract acknowledge their duty to mitigate damages when appropriate and reasonable.

23. Electronic Accessibility Protocols: The State policy on accessibility standards can be found at: http://oits.ks.gov/kito/itec/Policies/itecitpolicy1210.htm . All web and print based services available to Plan Participants must be handicap accessible and meet the state accessibility policy.

24. Advertising: The Contractor will not use the award of a contract as part of any news release or commercial advertising without the HCC’s prior written permission.

25. Implied Requirements : All products and services not specifically mentioned in the RFP, response and this Contract, but which are necessary to provide the functional capabilities described by the specifications, shall be included.

26. Off-Shore Sourcing: If, during the term of the Contract, the Contractor moves work previously performed in the United States to a location outside of the United States, the Contractor shall immediately notify the HCC in writing, indicating the new location and the percentage of work relocated.

27. Criminal or Civil Offense by Contractor: Any conviction for a criminal or civil offense that indicates a lack of business integrity or business honesty must be disclosed to the HCC. This includes:

a. Conviction of a criminal offense as an incident to obtaining or attempting to obtain a public or private contract or subcontract or in the performance of such contract or subcontract;

b. Conviction under state or federal statutes of embezzlement, theft, forgery, bribery, falsification or destruction of records, or receiving stolen property;

c. Conviction under state or federal antitrust statutes; and

d. Any other offense that reasonably would be expected to affect the ability to function as a State Contractor.

http://oits.ks.gov/kito/itec/Policies/itecitpolicy1210.htm



e. For the purpose of this section, an individual or entity shall be presumed to have control of a company or organization if the individual or entity directly or indirectly, or acting in concert with one or more individuals or entities, owns or controls 25 percent or more of its equity, or otherwise controls its management or policies. Failure to disclose an offense may result in termination of the Contract.

28. Confidentiality and Access : Contractor shall not disclose to any other person, firm, or corporation or entity (other than to the HCC) or use for its own benefit, except as provided in this Contract and the Business Associate Agreement, any data, Protected Health Information (hereinafter referred to as “PHI”) and/or other confidential information it receives from the HCC. Notwithstanding the Business Associate Agreement, such data and information may be disclosed to contract workers, employees, consultants and agents of the Contractor who have a need to know or have access to such data or information in the performance of this Contract and who have executed written agreements with the Contractor obligating them to treat such information in a manner consistent with the terms of this Contract. Contractor shall return any and all data furnished by the HCC promptly at the request of the HCC in whatever form required by the HCC. On the termination of this Contract, Contractor will not use any of such data or any material derived from the data for any purpose and, where so instructed by the HCC, will destroy or render such data or material unreadable. In the event Contractor discloses any of the HCC’s proprietary and/or personal identifiable information, the HCC may immediately terminate the Contract and pursue legal action recourse. The restrictions and obligations contained herein shall continue in perpetuity from the date of this Contract unless the HCC provides a written release to Contractor.

29. Data Ownership: The Contractor understands and agrees that all data provided by the HCC, or by the HCC’s contracted vendors authorized by the HCC, is owned by the HCC and will be used by the Contractor solely for the purposes described in this Contract. All data created in any form as part of this Contract will be the property of the HCC and will be available to the HCC at all times. Upon termination of the Contract, and to the extent feasible, all data associated with this Contract will be transferred to and accepted by the HCC prior to final payment to the Contractor. Under no circumstances will the Contractor share the data with any other entity without the HCC’s prior written authorization.

30. Copyrights: All deliverable items produced pursuant to this Contract that are produced solely and exclusively for the HCC are the exclusive property of the HCC. The Contractor will not assert a claim of copyright or other property interest in such deliverables. The Contractor shall indemnify the HCC against any and all claims for infringement of any copyright or patent occurring in connection with or in any way incidental to or arising out of the occupancy, use, service, operations or performance of work under this Contract.

31. Termination Right:

a. Notwithstanding any other provisions of this Contract, the HCC reserves the right to terminate this Contract at the end of any month by giving thirty (30) days advance notice thereof in writing to Contractor.

b. In the event of termination of this Contract, Contractor will, unless the HCC directs and Contractor otherwise agrees:



1. Complete the pricing of all deliverables incurred prior to the effective date of termination and the HCC shall pay Contractor for all applicable fees in respect to such deliverables priced.

2. Release to the HCC, in a format acceptable to the HCC, all records and files relating to deliverables priced under the SEHP health plan pursuant to this Contract.

c. If Contractor uses any patented, trademarked or copyrighted designs, devices, materials or other property, tangible or intangible in connection with its performance of its obligations under this Contract it shall provide for such use in an approved legal manner by making a proper agreement with the patentee or owner of such trademark or copyright and shall defend and hold the HCC harmless on any claim relating to such items. Contractor also grants the State of Kansas, and its departments, agencies, affiliates, agents, employees and licensees a non-exclusive, royalty-free, non-revocable perpetual license to use and copy for any reason Contractor’s bid and proposal and any other document(s) submitted to the HCC that may be related to this Contract.

32. Independent Contractor : Both Contractor and the HCC, in the performance of this Contract, are and shall be acting in an individual capacity and not as agents, employees, partners, joint ventures or associates of one another. The employees or agents of one party shall not be deemed or construed to be the employees or agents of the other party for any purpose whatsoever except the Contractor's employees shall be deemed agents of the State of Kansas for the purpose of maintaining confidentiality of private or confidential data, software and equipment maintained by the HCC.

33. Indemnification: The Contractor will hold and save the State, its officers, agents, and employees acting within the scope of their employment, harmless from liability of any kind, including all claims and losses accruing or resulting to any other person, firm, or corporation furnishing or supplying work, services, materials, or supplies in connection with the performance of this Contract, and from any and all claims and losses accruing or resulting to any person, firm or corporation that may be injured or damaged by the Contractor in the performance of this Contract. The Contractor acknowledges that any liability of the State’s agents or employees while acting within the scope of their employment is covered by the Kansas Tort Claims Act, K.S.A. 75-6101 et seq.

34. Accounts Receivable Set-Off Program: If, during the course of this Contract the Contractor is found to owe a debt to the State of Kansas, agency payments to the Contractor may be intercepted / setoff by the State of Kansas. Notice of the setoff action will be provided to the Contractor. Pursuant to K.S.A. 75-6201 et seq., Contractor shall have the opportunity to challenge the validity of the debt. If the debt is undisputed, the Contractor shall credit the account of the agency making the payment in an amount equal to the funds intercepted. K.S.A. 75-6201 et seq. allows the Director of Accounts and Reports to setoff funds the State of Kansas owes Contractors against debts owed by the Contractors to the State of Kansas. Payments setoff in this manner constitute lawful payment for services or goods received. The Contractor benefits fully from the payment because its obligation to the State is reduced by the amount subject to setoff.

35. Liability: Subject to the limitations set forth below, Contractor shall assume full responsibility for damage, including mitigation expenses, security breaches, or misuse of all State and Contractor property, including any private or confidential data, software and equipment maintained by Contractor



and any equipment, supplies, accessories, software or parts furnished by Contractor while such property is in Contractor’s care. Contractor shall also assume full responsibility for compliance with the standards for security of privacy of confidential records, data, software, software code, or equipment used or maintained by the Contractor, as set forth in federal and State statutes which mandate implementation of strict measures to ensure physical and electronic security of the same.

36. Hold Harmless : Contractor shall save, hold harmless and indemnify the HCC against any and all liability, claims for injury to, or death of any persons and for loss or damage to any property and for infringement of any copyright or patent occurring in connection with or in any way incidental to or arising out of Contractor’s performance under the terms of this Contract.

37. Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, guarantees, and warranties contained herein will survive the Contract expiration or termination date unless specifically provided otherwise herein, or unless superseded by applicable federal or State statutes of limitation.

38. Waiver : In the event of breach of this Contract, or any provision hereof, failure of the HCC to exercise any of its rights or remedies under the Contract shall not be construed as a waiver of any such provision of the Contract breached or as acquiescence in the breach. The remedies herein reserved shall be cumulative and in addition to any other remedies at law or in equity.

39. Legislative Requests: Contractor will provide support to the HCC in responding to information requests and fiscal notes or impact statements needed by the Legislature. Responses shall be given within two (2) business days.

40. Audits and Access to Records: The HCC reserves the right to conduct annual, or more frequently if needed audits of Contractor’s records and files related to the performance or cost of this Contract. The Contractor will make available to the HCC any person, record or file deemed necessary by the HCC to validate either performance or cost. The Legislative Division of Post Audit will have access to persons and records as a result of all contracts or grants entered into by State agencies or political subdivisions. There will be no fee from the Contractor to complete such audits. All third-party auditors will enter into a confidentiality agreement reasonably acceptable to Contractor and permitted under the Kansas Open Records Act.

41. Beneficiaries: Except as herein specifically provided otherwise, this Contract will inure to the benefit of and be binding upon the parties hereto and their respective successors. It is expressly understood and agreed that the enforcement of the terms and conditions of this Contract, and all rights of action relating to such enforcement, will be strictly reserved to the HCC and the named Contractor. Nothing contained in this document will give or allow any claim or right of action whatsoever by any other third person. It is the express intention of the HCC and Contractor that any such person or entity, other than the HCC or the Contractor, receiving services or benefits under this Contract will be deemed an incidental beneficiary only.

42. Amendment: This Contract shall be amended only by the written agreement of the parties. No alteration or variation of the terms and conditions of this Contract shall be valid unless made in writing



and signed by the parties. Every amendment shall specify the date on which its provisions shall be effective.

43. Option to Renew: The HCC shall have the option, by mutual written agreement of the HCC and Contractor, to renew this Contract in such a manner mutually agreed upon, in writing, by the parties.

44. Joint Drafting: No provision of this Contract shall be construed more harshly or unfavorably against any party hereto regardless of which party drafted the provision or for whose benefit the provision was included.

45. Captions: The captions or heading in this Contract are for reference only and do not define, describe, extend or limit the scope or intent of this Contract.

46. Validity and Waiver: The invalidity in whole or in part of any provision of this Contract shall not affect the validity of other provisions. A waiver of a breach of any provision or performance guaranty of this Contract shall not constitute a waiver of any subsequent breach of that provision or a breach of any other provision of this Contract. The failure of the HCC to enforce at any time or from time to time any provision of this Contract shall not be construed as a waiver thereof.

47. Force Majeure: Contractor or the HCC shall be excused from performance under this Contract for any period that Contractor or the HCC is prevented from performing any services, in whole or part, as a result of an act or event not within the reasonable control of the party prevented from performing.

48. Travel Expenses: Contractor will be responsible for all expenses, including travel mileage, meals, lodging and other travel expenses incurred in the performance of this Contract.

49. Notices: The notice addresses of the parties are as follows:

HCC:Director of the State Employee Health Plan900 SW Jackson St., Ste. 900-NTopeka, KS 66612

Contractor:(Name of Contractor) ___________________________(Address of Contractor) ___________________________

___________________________

50. Transition Assistance : In the event of Contract termination or expiration, Contractor shall provide all reasonable and necessary assistance to the State to allow for a functional transition to another vendor.

51. Signatures: Signatures herein shall serve to bind the parties to this Contract. The parties represent and warrant that they have read and thoroughly understand the terms and conditions and they are represented by counsel and the terms and conditions of the RFP and Contract have been fully explained to them by counsel. This Contract shall be binding on any person or entity that is a successor or purchaser of Contractor.

SIGNATURES ON NEXT PAGE



CONTRACTOR - (Name of Contractor)

By: ____________________________________ Date: ______________________

Printed Name: ____________________________

Title: ____________________________________

KANSAS STATE EMPLOYEES HEALTH CARE COMMISSION

By: _____________________________________ Date: ______________________

(Printed Name) _______

(Title)____________________________



BUSINESS ASSOCIATE AGREEMENT

THIS AGREEMENT is made and entered into by and between the Kansas Department of Health and Environment (hereinafter referred to as “KDHE”) and ------------------------------------------------------------- (hereinafter referred to as “Business Associate”).

Notwithstanding Section V of this Business Associate Agreement (hereinafter referred to as “BAA”), the term of this BAA shall run concurrently with the Underlying Contract between the parties and shall have the same effective date and termination date as the Underlying Contract.

RECITALSThe Parties to this BAA have a relationship whereby KDHE may provide the Business Associate access to Protected Health Information (hereinafter referred to as “PHI”), which may include electronic Protected Health Information, that Business Associate will use to fulfill its contractual obligations to KDHE.

KDHE and Business Associate acknowledge that each party has certain obligations under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), as amended, including those provisions of the American Recovery and Reinvestment Act of 2009 (“ARRA”), specifically the Health Information Technology for Economic and Clinical Health Act (“HITECH”), and the statutes implementing regulations to maintain the privacy and security of PHI, and the parties intend this BAA to satisfy those obligations including, without limitation, the requirements of 45 CFR 164.504(e).

KDHE, with its three divisions, self-identifies as a Hybrid Entity under HIPAA with the Division of Health Care Finance containing Covered Entity functions. Therefore, a Business Associate would not be permitted to use or disclose health information in ways that KDHE could not. This protection continues as long as the data is in the hands of Business Associate. Business Associate acknowledges that for the purposes of this BAA, Business Associate is a “business associate” as that term is defined in 45 CFR § 160.103, and therefore the requirements of HIPAA apply to Business Associate in the same manner that they apply to KDHE pursuant to 42 USC § 17931(a).

NOW THEREFORE, in consideration of the mutual promises below and other good and valuable consideration the parties agree as follows:

I. DEFINITIONSa) “Administrative Safeguards” shall mean the administrative actions, policies and procedures to

manage the selection, development, implementation and maintenance of security measures to protect PHI and to manage the conduct of Business Associate’s workforce in relation to the protection of that PHI.

b) “Breach” shall mean any disclosure which compromises an individual’s protected health information (PHI) in a way that creates risk of harm to the individual.

c) “Business Associate” shall have the same meaning as the term “Business Associate” as defined in 45 CFR 160.103.

d) “Data Aggregation Services” shall mean, with respect to PHI created or received by Business Associate in its capacity as a Business Associate of KDHE, the combining of such PHI by the Business Associate with the PHI received by the Business Associate in its capacity as a business associate of another covered entity, to permit data analyses that relate to the health care operations of the respective covered entities, as defined in 45 CFR § 164.501 and as such term may be amended from time to time in this cited regulation.



e) “Designated Record Set” shall mean a group of records maintained by or for KDHE that consists of the following: (a) medical records and billing records about Individuals maintained by or for a health care provider; (b) enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or (c) records used in whole or in part, by or for KDHE to make decisions about Individuals. For these purposes, the term “record” means any item, collection, or group of information that includes PHI and is maintained, collected, used, or disseminated by or for KDHE.

f) “Disclosure” shall mean the release, transfer, provision of, access to, or divulging in any other manner of PHI outside the entity holding the information.

g) “HIPAA” shall mean the Health Insurance Portability and Accountability Act of 1996, the implementation regulations promulgated thereunder by the U.S. Department of Health and Human Services, the HITECH (as defined below) and any future regulations promulgated thereunder, all as may be amended from time to time.

h) “Individual” shall have the same meaning as the term “individual” as defined in 45 CFR 160.103, and any amendments thereto, and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

i) “Physical Safeguards” shall mean the physical measures, policies and procedures to protect KDHE’s electronic information systems and related buildings and equipment from natural and environmental hazards and unauthorized intrusion.

j) “Privacy Rule” shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR Part 160 and Part 164.

k) “Protected Health Information” shall have the same meaning as the term “protected health information,” as defined in 45 CFR 160.103 and any amendments thereto, limited to the information created or received by Business Associate from or on behalf of KDHE.

l) “Required by Law” shall have the same meaning as the term “required by law” in 45 CFR 164.103.

m) “Secretary” shall mean the Secretary of the United States Department of Health and Human Services or his/her designee.

n) “Security Incident” shall mean the attempted or successful unauthorized access, use, disclosure, modification or destruction of information or interference with system operations in an information system.

o) “Security Rule” shall mean the Standards for Security of Electronic Protected Health Information at 45 CFR Parts 160, 162 and 164.

p) “Technical Safeguards” shall mean the technology and the policy and procedures for its use that protect PHI and control access to it.

q) “Underlying Contract” means any written contract for services between KDHE and Business Associate.

r) “Use” shall mean, with respect to PHI, the sharing, employment, application, utilization, examination, or analysis of such information within any entity that maintains such information.



s) Capitalized terms used, but not otherwise defined, in this BAA shall have the same meaning ascribed to them in HIPAA, the Privacy Rule, the Security Rule, or HITECH or any future regulations promulgated or guidance issued by the Secretary.

II. OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATEa) Use and Disclosure . Business Associate agrees to not use or disclose PHI other than as permitted

or required by this BAA or as Required by Law.

b) Safeguards to be in Place . Business Associate agrees to use appropriate safeguards to prevent the use or disclosure of PHI other than as provided for by this BAA. Additionally, Business Associate shall implement Administrative, Physical and Technical Safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of the PHI that it creates, receives, maintains or transmits on behalf of KDHE as required by the Security Rule.

c) HIPAA Training . Business Associate agrees to ensure all members of its workforce, including subcontractor workforce members, that will or potentially will provide services pursuant to the Underlying Contract will be appropriately trained on the requirements of HIPAA.

d) Duty to Mitigate . Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of PHI by Business Associate in violation of the requirements of this BAA or the Privacy Rule and to communicate in writing, such procedures to KDHE.

e) Business Associate’s Agents and Subcontractors . Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides PHI received from, or created or received by Business Associate on behalf of KDHE agrees, in writing in the form of a Business Associate Agreement, to the same restrictions and conditions that apply through this BAA to Business Associate with respect to such information, including implementation of reasonable and appropriate safeguards to protect PHI. Business Associate agrees that it is directly liable for any actions of its subcontractors that result in a violation of this Agreement. Business Associate also agrees to make available to KDHE any contracts or agreements Business Associate has with any subcontractors to whom Business Associate provides PHI under this BAA. Business Associate may redact proprietary and financial information from said contracts before providing them to KDHE.

f) Duty to Provide Access . To the extent Business Associate has PHI in a Designated Record Set, Business Associate agrees to provide access, at the request of KDHE, to the PHI in the Designated Record Set to KDHE or, as directed by KDHE, to the Individual, in order to meet the requirements under 45 CFR 164.524. Any denial by Business Associate of access to PHI shall be the responsibility of, and sufficiently addressed by, Business Associate, including, but not limited to, resolution of all appeals and/or complaints arising therefrom.

g) Amendment of PHI . Business Associate agrees to make any amendment(s) to PHI in its possession contained in a Designated Record Set that KDHE directs or agrees to pursuant to 45 CFR 164.526 at the request of KDHE or an Individual, and within a reasonable time and manner.

h) Duty to Make Internal Practices Available . Business Associate agrees to make its internal practices, books and records, including policies and procedures relating to the use and disclosure of PHI, and any PHI received from, or created or received by Business Associate on behalf of KDHE, available to the Secretary, in a time and manner designated by the Secretary, for purposes of the Secretary determining KDHE’s compliance with the Privacy Rule.



i) Documenting Disclosures/Accounting . Business Associate agrees to document any disclosures of PHI and information in its possession related to such disclosures as would be required for KDHE to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 CFR 164.528. Business Associate agrees to provide to KDHE information collected in accordance with Section II(f) of this BAA, to permit KDHE to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 CFR 164.528.

j) Reporting Breaches and Security Incidents to KDHE . In addition to the duty to mitigate under Section II(d), Business Associate agrees to report to KDHE any use or disclosure which compromises PHI and creates risk of harm including any Security Incident of which it becomes aware, as soon as practicable but no longer than five (5) business days after the discovery of such event(s). Notice to KDHE shall consist of notifying the KDHE Privacy Officer by phone or email of the occurrence of an unauthorized use, disclosure or security incident.

k) Notification of Breach . Business Associate shall notify Covered Entity within three (3) business days after it, or any of its employees, subcontractors, or agents, reasonably suspects that a breach of unsecured PHI as defined by 45 CFR 164.402 may have occurred, irrespective of any occurrence or non-occurrence of harm. Notice to KDHE shall consist of notifying the KDHE Privacy Officer by phone or email of the occurrence of a Breach or suspected occurrence of a Breach. Business Associate shall exercise reasonable diligence to become aware of whether a breach of unsecured PHI may have occurred and, except as stated to the contrary in this Section, shall otherwise comply with 45 CFR 164.410 in making the required notification to Covered Entity. Business Associate shall cooperate with Covered Entity in the determination as to whether a breach of unsecured PHI has occurred and whether notification to affected individuals of the breach of unsecured PHI is required by 45 CFR 164.400 et seq., including continuously providing the Covered Entity with additional information related to the suspected breach as it becomes available. In the event that Covered Entity informs Business Associate that (i) Covered Entity has determined that the affected individuals must be notified because a breach of unsecured PHI has occurred and (ii) Business Associate is in the best position to notify the affected individuals of such breach, Business Associate shall immediately provide the required notice (1) within the time frame defined by 45 CFR 164.404(b), (2) in a form and containing such information reasonably requested by Covered Entity, (3) containing the content specified in 45 CFR 164.404(c), and (4) using the method(s) prescribed by 45 CFR 164.404(d). In addition, in the event that Covered Entity indicates to Business Associate that Covered Entity will make the required notification, Business Associate shall promptly take all other actions reasonably requested by Covered Entity related to the obligation to provide a notification of a breach of unsecured PHI under 45 CFR 164.400 et seq. Business Associate shall indemnify and hold Covered Entity harmless from all liability, costs, expenses, claims or other damages that Covered Entity, its related corporations, or any of its or their directors, officers, agents, or employees, may sustain as a result of Business Associate’s breach, or Business Associate’s subcontractor’s or agent’s breach, of its obligations under this Agreement.

III. PERMITTED USES AND DISCLOSURES BY BUSINESS ASSOCIATEa) General Use and Disclosure Provisions . Except as otherwise limited in this Agreement, Business

Associate may use or disclose PHI on behalf of, or to provide services to, Covered Entity for the purposes set forth in III(b), if such use or disclosure of PHI would not violate the Privacy Rule if done by Covered Entity.

b) Specific Use and Disclosure Provisions .



1. Business Associate may use and disclose PHI to perform services for Covered Entity, including specific services, as set out in the Underlying Contract, and any additional services necessary to carry out those specific services in the Underlying Contract.

2. Business Associate may use PHI in its possession for the proper management and administration of Business Associate and to carry out the legal responsibilities of Business Associate.

Business Associate may disclose PHI in its possession for the proper management and administration of Business Associate, provided that disclosures are Required by Law.

Business Associate may only de-identify PHI in its possession obtained from Covered Entity with Covered Entity’s prior written consent, in accordance with all de-identification requirements of the Privacy Rule.

3. Business Associate may use PHI to report violations of law to appropriate federal and state authorities, consistent with 45 CFR 164.502(j)(1). Covered Entity shall be furnished with a copy of all correspondence sent by Business Associate to a federal or state authority.

4. Except as otherwise limited in this Agreement, Business Associate may use PHI to provide Data Aggregation Services to Covered Entity.

5. Any use or disclosure of PHI by Business Associate shall be in accordance with the minimum necessary policies and procedures of Covered Entity and the regulations and guidance issued by the Secretary on what constitutes the minimum necessary for Business Associate to perform its obligations to Covered Entity under this Agreement and the Underlying Contract.

IV. OBLIGATIONS OF COVERED ENTITYa) Covered Entity shall notify Business Associate of any limitation(s) in its Notice of Privacy

Practices of Covered Entity in accordance with 45 CFR 164.520, to the extent that such limitation(s) may affect Business Associate’s use or disclosure of PHI.

b) Covered Entity shall notify Business Associate in a timely manner of any changes in, or revocation of, permission by an Individual to use or disclose PHI to the extent that such change may affect Business Associate’s permitted or required use or disclosure of PHI.

c) Covered Entity shall notify Business Associate in a timely manner of any restriction to the use and/or disclosure of PHI, which the Covered Entity has agreed to in accordance with 45 CFR 164.522, to the extent that such restriction may affect Business Associate’s use or disclosure of PHI.

d) Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under the Privacy Rule if done by Covered Entity.

V. TERMINATIONa) Term. The term of this Agreement shall run concurrently with the Underlying Contract with

Covered Entity and shall terminate upon termination of the Underlying Contract and when all of the PHI provided by Covered Entity to Business Associate, or created or received by Business Associate on behalf of Covered Entity, is destroyed or returned to Covered Entity, or, if it is



infeasible to return or destroy the PHI, protections are extended to such information, in accordance with the termination provisions of Section V(c)(2).

b) Termination for Cause. Upon either party’s knowledge of a material breach by the other party, such party shall either:

1. Provide an opportunity for the breaching party to cure the breach, end the violation, or terminate this Agreement if the breaching party does not cure the breach or end the violation within five (5) business days;

2. Immediately terminate the Agreement if the breaching party has breached a material term of this Agreement and cure is not possible; or

3. If neither termination nor cure is feasible, the non-breaching party shall report the violation to the Secretary.

c) Effect of Termination.

1. Except as provided in paragraph V(c)(2) of this Agreement, upon termination of this Agreement, for any reason, Business Associate shall return or destroy all PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. This provision shall apply to PHI that is in the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of the PHI.

2. In the event that Business Associate determines that returning or destroying the PHI is infeasible, Business Associate shall provide to Covered Entity notification in writing of the conditions that make return or destruction infeasible. Upon verification that return or destruction of PHI is infeasible, Business Associate shall extend the protections of this Agreement to such PHI and limit further uses and disclosures of such PHI to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such PHI. If it is infeasible for Business Associate to obtain from a subcontractor or agent, any PHI in the possession of the subcontractor or agent, Business Associate must provide a written explanation to Covered Entity and require the subcontractors and agents to agree to extend any and all protections, limitations and restrictions contained in this Agreement to the subcontractors’ and/or agents’ use and/or disclosure of any PHI retained after the termination of this Agreement, and to limit any further uses and/or disclosures to the purposes that make the return or destruction of the PHI infeasible.

d) Judicial or Administrative Proceedings. Notwithstanding any other provision herein, Covered Entity may terminate the applicable Underlying Contract, effective immediately, upon a finding or stipulation in any criminal, administrative or civil proceeding in which the Business Associate is a named party that Business Associate violated any applicable standard or requirement of the Privacy Rule or the Security Rule or any other applicable laws related to the security or privacy of PHI, relating to the Underlying Contract.

VI. MISCELLANEOUS

a) Regulatory References . A reference in this Agreement to a section in the Privacy Rule or Security Rule means the section as in effect or as amended and for which compliance is required.



b) Amendment . No change, amendment, or modification of this Agreement shall be valid unless set forth in writing and agreed to by both parties, except as set forth in Section VI(l) below.

c) Indemnification . Business Associate shall indemnify Covered Entity for any and all claims, inquiries, costs or damages, including but not limited to any monetary penalties, that Covered Entity incurs arising from a violation by Business Associate, or a subcontractor or agent of Business Associate, of its obligations hereunder.

d) Survival. The respective obligations of Business Associate under this Agreement shall survive the termination of this Agreement.

e) Interpretation . Any ambiguity or inconsistency in this Agreement shall be resolved in favor of a meaning that permits Covered Entity to comply with the Privacy Rule, the Security Rule, and the HITECH sections contained within ARRA.

f) No Third-Party Beneficiaries . Nothing express or implied in this Agreement is intended to confer, nor shall anything herein confer, upon any person other than Covered Entity and its respective successors or assigns, any rights, remedies, obligations or liabilities whatsoever.

g) Notices . Any notices to be given to either party under this Agreement shall be made in writing and delivered via e-mail at the address(es) given below:

Business Associate: General Counsel –

Privacy Officer –

Covered Entity: Brian M. Vazquez – [email protected]

h) Headings . The section headings are for convenience only and shall not be construed to define, modify, expand, or limit the terms and provisions of this Agreement.

i) Governing Law and Venue . This Agreement shall be governed by, and interpreted in accordance with, the internal laws of the State of Kansas, without giving effect to its conflict of law provisions.

j) Binding Effect . This Agreement shall be binding upon, and shall inure to the benefit of, the parties hereto and their respective permitted successors and assigns.

k) Effect on Underlying Contract . If any portion of this Agreement is inconsistent with the terms of the Underlying Contract, the terms of this Agreement shall prevail. Except as set forth above, the remaining provisions of the Underlying Contract are ratified in their entirety.

l) Modification . The parties acknowledge that state and federal laws relating to electronic data security and privacy are rapidly evolving and that amendment of this Agreement may be required to ensure compliance with such developments. The parties specifically agree to take such action as may be necessary to implement the standards and requirements of HIPAA and other applicable state and federal laws relating to the security or confidentiality of PHI as determined solely by Covered Entity.

In the event that a federal or state law, statute, regulation, regulatory interpretation or court/agency determination materially affects this Agreement, as is solely determined by Covered Entity, the parties agree to negotiate in good faith any necessary or appropriate




revisions to this Agreement. If the parties are unable to reach an agreement concerning such revisions within the earlier of sixty (60) days after the date of notice seeking negotiations or the effective date of the change in law or regulation, or if the change in law or regulation is effective immediately, the Covered Entity, in its sole discretion, may unilaterally amend this Agreement to comply with the change in law upon written notice to Business Associate.

VII. OBLIGATIONS OF BUSINESS ASSOCIATE PURSUANT TO HITECHa) Access to PHI in an Electronic Format . If Business Associate uses or maintains PHI in an

Electronic Health Record, Business Associate must provide access to such information in an electronic format if so requested by an Individual. Any fee that Business Associate may charge for such electronic copy shall not be greater than Business Associate’s labor costs in responding to the request. If an Individual makes a direct request to Business Associate for access to a copy of PHI, Business Associate will promptly inform the Covered Entity in writing of such request.

b) Prohibition on Marketing Activities . Business Associate shall not engage in any marketing activities or communications with any individual unless such marketing activities or communications are allowed by the terms of the Underlying Contract and are made in accordance with HITECH or any future regulations promulgated thereunder. Notwithstanding the foregoing, any payment for marketing activities should be in accordance with HITECH or any future regulations promulgated thereunder.

c) Application of the Security Rule to Business Associate . Business Associate shall abide by the provisions of the Security Rule and use all appropriate safeguards to prevent use or disclosure of PHI other than as provided for by this Agreement. Without limiting the generality of the foregoing sentence, Business Associate shall:

(i) Adopt written policies and procedures to implement the same administrative, physical, and technical safeguards required of the Covered Entity; and

(ii) Abide by the most current guidance on the most effective and appropriate technical safeguards as issued by the Secretary.

If Business Associate violates the Security Rule, it acknowledges that it is directly subject to civil and criminal penalties.

VIII. ADDITIONAL OBLIGATIONS OF BUSINESS ASSOCIATE Business Associate shall not receive any remuneration, directly or indirectly, in exchange for any PHI, unless so allowed by the terms of the Underlying Contract and in accordance with HITECH and any future regulations promulgated thereunder.

IX. ENFORCEMENT Business Associate acknowledges that, in the event it, or its subcontractor or agent, violates any applicable provision of the Security Rule or any term of this Agreement that would constitute a violation of the Privacy Rule, Business Associate will be subject to and will be directly liable for any and all civil and criminal penalties that may result from such violation.

IN WITNESS WHEREOF, the parties have executed this Agreement as of the date last noted below and for a term specified by Section V(a) above.



On behalf of:

KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT

By: _______________________________________ Date: _______________________Secretary and State Health OfficerKansas Department of Health and Environment

BUSINESS ASSOCIATE - (Name of Contractor)

By: __________________________________________ Date: _______________________

Printed Name: ____________________________

Title: _____________________________________



Section IVScope of Work

Purpose of ProjectThe State Employee Health Plan (SEHP) on behalf of the Kansas State Employees Health Care Commission (Commission) seeks an administrator for COBRA continuation benefits, record keeping, reporting and premium collection in accordance with Federal law and regulations. The SEHP will maintain membership within the SEHP’s Membership Administration Portal (MAP) and transmit membership files to the selected vendor for COBRA administration.

BackgroundHealth Care Commission: The five-member Kansas State Employees Health Care Commission (Commission) was established in 1984 under K.S.A. 75-6501, et seq. for the purpose of developing, implementing and administering the State health care benefit program and a wellness program called HealthQuest. The Commission is assisted by the State Employee Health Plan (SEHP). The Commission designates, by rules and regulations, those persons who are qualified to participate in the State health care benefit program, including active and retired public officers, employees and their dependents.

Other Public Entities: In 1999 the Commission established administrative procedures and eligibility requirements to allow for inclusion of Unified School Districts, Community Colleges, Technical Colleges and Vocational Technical Schools into the State plan. Beginning in 2000, the Commission established administrative procedures and eligibility requirements to allow for inclusion of Cities, Counties, Rural Water Districts, Extension Councils and certain other public entities. These entities are referred to as Non-State Employer (NSE) groups

Currently there are approximately 172 groups and 7,275 members in the NSE groups. However, this segment is experiencing growth and we anticipate these numbers to increase within the next two years.

Census: Current enrollment by health plan is provided in Exhibit 4A.

Medical Plans: There are currently five health plan options available to active employees. Plan A, Plan C, Plan J, Plan Q, and Plan N are administered by Aetna and Blue Cross Blue Shield of Kansas. Current Benefit Descriptions and Schedules of Benefits are located on the web at www.kdheks.gov/hcf/sehp/default.htm All active employee medical plans are self-funded.

Prescription Drugs: All members participating in Plan A, Plan C, Plan J, Plan Q, and Plan N medical coverage are automatically enrolled in the self-funded prescription drug coverage. Currently, membership and administrative services are provided by Caremark.

Dental Plan: All active members participating in medical coverage have the option of enrolling in dental coverage for themselves and their dependents. However, individuals may not participate in dental coverage unless enrolled in a medical plan. Currently there is one (1) self-insured option administered by Delta Dental Plan of Kansas.

Vision: This is a voluntary plan offered to participants who may enroll regardless of their choice for medical coverage. Vision coverage is currently insured by Surency Vision.Additional Voluntary Plans for hospital indemnity, critical illness and accidental injury are offered from Metropolitan Life.

Waiting Periods: The plan has a thirty day waiting period for newly hired employees.

Plan Year: The plan year runs from January 1 through December 31 of any calendar year. Coverage for all except Vision and VPS is monthly and ends on the last day of employment. For active State of Kansas employees, payroll deductions are taken semi-monthly.



Open Enrollment: Open enrollment for the active State of Kansas and NSE members is traditionally conducted October 1 through October 31 each year and consists of a series of statewide employee meetings and webinars conducted by SEHP staff, agency personnel officers and representatives from the insurance carriers, Third party administrators, and other contracting parties. Open Enrollment for COBRA members is October 1 through October 31 each year. Direct bill Open Enrollment is October 16 to November 15 each year. . All members make their open enrollment elections through the MAP system.

Continuation Options: The Commission offers former employees the opportunity to continue participation in the group health insurance program in the following ways:

COBRA: The Commission offers an extension of Group Health Insurance coverage in accordance with COBRA, Consolidated Omnibus Budget Regulation Act of 1986, provided they meet one of the qualifying events. Program membership has been outsourced to a Third Party Administrator.

Direct Bill: The Commission Plan allows retirees, former elected state officials and persons on approved leave without pay to participate.

Required ServicesIn this section the SEHP is outlining the services being requested in this RFP. You do not need to accept each item. You do need to highlight in Redline any item or service which you will not able to provide. You may use color to designate your exceptions to the requested services.

4.1 The State Employee Health Plan is seeking a contractor to manage the following functions:

4.1.1 Prepare and mail all initial COBRA notice for benefits eligible employees and dependents directly to the member’s home address

4.1.2 Prepare and mail COBRA Qualifying Event offer letters with customized coverage options to eligible member’s home address

4.1.3 Timely twice weekly submissions of online initial COBRA elections and mid-year qualifying event elections made by qualified COBRA members

4.1.4 Process election data and transmit data to the SEHP MAP system.

4.1.5 Image and retain COBRA and HIPAA documentation in electronic archival system compatible with State requirements

4.1.6 Invoice and collect COBRA premiums accurately and timely for remittance to the SEHP

4.1.7 Provide past due premium notifications to COBRA members

4.1.8 Provide COBRA eligibility information to Vendors

4.1.9 Disburse premium to appropriate sources

4.1.10 Provide expiration of COBRA rights notifications (for expiration of eligibility and failure to pay premiums)

4.1.11 Communicate rate/plan changes to COBRA members

4.1.12 Provide Medicare notices, Conversion letters, provide HIPAA Certificates of Creditable Coverage for loss of COBRA coverage

4.1.13 Provide online access to account information for COBRA members

4.1.14 Provide online access to account and membership information to SEHP staff

4.1.15 Provide Toll-free customer service, 24-hour IVR services



4.1.16 Coordination of Open Enrollment activities, communication and mailings to COBRA members (to be determined by the State annually) each September through October

4.1.17 Notification to the SEHP of member changes no later than the first Wednesday of December preceding the new Plan year.

4.1.18 Complete record keeping for COBRA processes and transactions

4.1.19 Assist with training for SEHP staff and Human Resource and Benefit Officers

4.1.20 Customer service and support for COBRA members

4.1.21 Specifications: The following are desired specifications for the services related to the SEHP COBRA Administration system. They should be considered guidelines and not absolutes. The SEHP is interested in obtaining an efficient solution that requires minimal customization and wants to limit changes to current internal processes to obtain that result. The SEHP plans to maintain its membership administration on its own MAP platform. However, contractor must provide enough information/description in the response to section V that the SEHP can evaluate its system’s capabilities. Since this is not intended to be an inclusive list, the Vendor is responsible for detailing other system/product capabilities that it considers important features of the system or product offered.

4.2 Membership Eligibility Files and Rate Tables: 4.2.1 Initial implementation: Accept SEHP electronic membership eligibility information in

a format defined and designated by the SEHP. Contractor will create a database and/or membership system or other storage capability for subsequent updating of member eligibility and COBRA notification requirements. Vendor agrees to accept changes to these file layouts if the SEHP deems a change is necessary.

4.2.2 Post Implementation: Following the initial implementation, Vendor must be able to accept electronic membership eligibility file updates a minimum of twice weekly (per SEHP business rules and in SEHP designated format) containing new enrollments, terminations, personal data changes, and mid-year and Open Enrollment election changes. These files will include retroactive and future dated changes therefore Vendor will need to be able to handle these transactions. Vendor agrees to accept changes to these file layouts if the SEHP deems a change is necessary.

4.2.3 A full membership eligibility file is sent quarterly by SEHP. Contractor shall NOT load this file. Contractor will compare files to their membership system and provide an enrollment mismatch report to the SEHP within ten (10) business days of receiving the full file. Vendor agrees to accept changes to these file layouts if the SEHP deems a change is necessary.

4.2.4 Any electronic file transmittal to or from the SEHP must be encrypted in SEHP format, placed on the SEHP secure website for pick up and include FTP protocols.

4.2.5 Rate tables will be provided by the SEHP to the Vendor in a format defined and designated by SEHP. Rate tables will be used along with membership eligibility files to determine appropriate billing.

4.2.6 Rates will be effective dated so retroactive changes can be billed appropriately.

4.2.7 The Vendor will accept, load and test rate table changes a minimum of 2 times each year within appropriate deadlines to meet timely billing requirements. New rates are typically effective July 1 and January 1.



4.2.8 Yearly plan design changes for Open Enrollment, including plan codes, rate identifiers, benefit programs, department changes, rates and other items as requested by the SEHP must be accepted and ready for implementation by deadline specified by the SEHP.

4.2.9 New Non-State Employer group department codes will be added throughout the year. The Vendor must be able to accept these department additions at any time.

4.2.10 The SEHP will make all determinations with regard to eligibility to participate in the health plan. The Vendor shall work quickly and efficiently to resolve all eligibility issues with the SEHP staff.

4.2.11 The SEHP and the Vendor must agree on the eligibility file layout. Any requests to modify this layout must be approved by the SEHP. The standard 834 layout is preferred but the SEHP will work with the Vendor to establish the eligibility file layout to be used.

4.2.12 Vendor must be able to accept eligibility information on daily change files or daily full files in the agreed upon layout.

4.2.13 Vendor must be able to retrieve all files from the SEHP secure FTP server daily. Files will be placed on the SFTP server by 11:00 AM Central Time every weekday unless Vendor is otherwise notified of a schedule change. Vendor must notify SEHP staff within twenty-four (24) hours if information on the file received is incomplete or unreadable. Vendor will provide eligibility load reports to the SEHP staff within twenty-four (24) hours of file processing.

4.2.14 Vendor is responsible for establishing, maintaining and accurately updating eligibility records. Vendor agrees to process enrollment additions, changes and deletions within two (2) business days of the release date of the file. Eligibility files sent correctly by the SEHP staff but not processed correctly by the Vendor will be retroactively corrected back to the original effective date, even if the correction occurs more than sixty (60) days following the date of the original changes. Vendor will provide eligibility load reports to the SEHP staff within twenty-four (24) hours of file processing.

4.2.15 If regularly receiving change files, Vendor shall receive a periodic full file eligibility file for the comparison purposes. Currently the full eligibility file is provided monthly. SEHP may change the delivery schedule of the full file with notice to the Vendor. Vendor shall compare the full file with their eligibility records and provide the SEHP with a mismatch and reconciliation reports within ten (10) business days of receipt of file. Incomplete or unreadable information must be reported to the SEHP within twenty-four (24) hours. Once this report has been reviewed by SEHP Membership staff, the vendor may be directed to modify, terminate or add members as need to bring the eligibility in to alignment.

4.2.16 Vendor shall notify SEHP of any enrolled persons who, to the knowledge of the Vendor, do not appear to meet the eligibility criteria set forth by the SEHP. SEHP will research and make final determination on eligibility.

4.2.17 Reporting and Eligibility tracking for the SEHP is on the following membership divisions:

State of Kansas Non State Entities

4.3 COBRA Administration:



4.3.1 Administer COBRA in accordance with Federal Law and regulations from initial notification through termination. .

4.3.2 SEHP will send Vendor the COBRA qualifying events at a minimum of twice weekly via electronic file using the SEHP membership system, business rules and change reason codes.

4.3.3 Vendor will update membership eligibility files and contact employees to provide COBRA notification. Upon election, Vendor will coordinate eligibility and changes with the SEHP. The SEHP will transfer eligibility to plan carriers. Those members who continue enrollment through COBRA will pay their monthly premium through the Vendor (see billing and accounting section below).

4.3.4 Conduct Open Enrollment activities, to be determined by the SEHP, annually and notify the SEHP of membership changes in a timely manner.

4.4 Billing Accounting and Reconciliation:4.4.1 Establish COBRA capability to pay premiums to Vendor on monthly basis through

invoice, bank draft, or other remittance approved by SEHP.

4.4.2 Vendor shall create a monthly electronic file to send to a financial institution specified by the SEHP. This file will contain member, premium and account information for those members paying by ACH in a given month.

4.4.3 Provide monthly reimbursement with summary statement to the SEHP of total collected premium for previous month. Summary will indicate enrolled members, by program (State, employee, Non State employer group or Direct Bill) coverage tier, employer/organization identified, carrier and coverage period (to include adjustments).

4.4.4 Vendor shall accurately post and process all payments received within three (3) business days of receipt.

4.4.5 Vendor shall process refund checks for refunds approved by the SEHP within seven (7) business days of approval.

4.4.6 Vendor will not accept incomplete enrollments or under payments that are under billed amount by more than 10% of the premium due or $50.

4.4.7 Vendor will send insufficient payment notices (those not more than 10% of premium due or $50 whichever is less) as soon as one is received.

4.5 Customer Service:4.5.1 Make initial contact with continuation eligible enrollees through written, email and

telephonic notice. All determination for coverage, effective and termination dates will be made according to the SEHP administrative guidelines and policies.

4.5.2 Provide timely and knowledgeable responses to members. Demonstrate working knowledge of SEHP options and policies; communicate premium costs to members; refer members to SEHP for contract issues concerning coverage.

4.5.3 Vendor must maintain a toll-free customer service line that will be available from 8:00 am until 5:00 pm Central Time Monday through Friday, except of legal holidays.

4.5.4 All member appeals must be submitted to SEHP in writing within three (3 business



day for SEHP review and final approval.

4.6 Service to SEHP Membership Team:4.6.1 Multiple ways for the SEHP Membership Team to contact the Vendor, telephone, fax,

email and website.

4.6.2 Vendor shall notify SEHP of holiday schedules each year by February 1. Vendor shall notify the SEHP in advance of the customer service center scheduled closing if possible. If closing is due to a natural disaster or weather, vendor will notify the SEHP as soon as possible.

4.6.3 Vendor shall notify SEHP of any disruption in customer service center availability or toll-free access regardless of the reason for disruption, as soon as the problem is identified.

4.6.4 Vendor shall maintain online scanned/imaged documentation of all member activity and invoices and make this information available to the SEHP Membership Team.

4.6.5 In the event of contract termination, Vendor will return all files, images and documentation in the format defined and designated by the SEHP to the SEHP at no additional cost.

4.6.6 The Vendor agrees to identify orientation, communications and training needs for the SEHP. The Vendor agrees to provide training on the Vendor’s system and any additional training as required and requested by the State at no cost to the State.

4.7 Reporting:4.7.1 Weekly:

Processing report indicating member data that was rejected when loading each of the weekly eligibility change files.

Report of all COBRA notifications sent by type.

COBRA change report listing all updates in COBRA membership including clear change reasons for the previous week.

Report of refunds sent to SEHP for approval prior to disbursement of funds.

4.7.1 Monthly:

Monthly SEHP Fee Invoice:

Summary of all administrative fees broken down by COBRA program including all fees, number of members by program, and description of all activity fees shall be sent by email on the vendors letterhead to the SEHP by no later than the 10 th

business day of the month following.

Monthly SEHP Premium Statement:

Summary of payments received broken down by COBRA member including member’s name, ID number, date of payment, amount paid, refunds adjustments and paid through date shall be sent by email on in Excel to the SEHP by no later than the 10th business day of the month following.

Listing of all COBRA members and amount(s) due (including past due balances)



Monthly report on customer service activity to include number of calls, average speed to answer, abandonment rate and other measures required of the performance guarantees.

4.7.2 Quarterly:

Performance standard reports shall be submitted to the SEHP quarterly except for call statistics which shall be submitted monthly as stated above.

Quarterly full file compare report indicating discrepancies between the SEHP full file and the vendor’s membership system

4.7.3 Vendor shall provide any reports that may be necessary to maintain membership and operations of the SEHP account.

4.7.4 Vendor shall provide any documents or data obtained by the Vendor on behalf of the State and make these available to the State upon request at no additional fee.


The Scope of Work of the Request for Proposal has been reviewed by me and shall become part of the final contract. I hereby acknowledge and accept all of the provisions, requirements, and conditions stated in this section of Request for Proposal, subject to the modifications, conditions and limitations I have listed below.

_________________________________________________Authorized Signature of Vendor


_________________________________________________ Title

_________________________________________________Date



SECTION V

Questions

Please do not repeat your answers. If you have described a program/service or other content and it applies to multiple questions, simply refer us to the prior description.

5.1 Implementation and Transition5.1.1 Provide a proposed implementation plan that includes both a project overview

and details on specific tasks, timeliness and responsibilities. Clearly delineate the tasks you expect the State to perform and the information you expect the State to provide. At a minimum, address the following:

Training Key Staff Testing of eligibility files and eligibility logic Date to begin receiving eligibility files Training of Customer Service representatives

Answer:5.1.2 If the implementation coordinator and on-going account manager will be two

different people, describe how they work together during the process and the procedures for transfer of responsibility.

Answer:5.1.3 If selected as a finalist, will the implementation coordinator and designated

account management team be part of the team present for the interview? Why or why not.

Answer:5.1.4 Discuss planned procedures and schedule to have the Customer Service unit in

place and trained to receive Open Enrollment calls by mid-September prior to the start of the open enrollment.

Answer:5.1.5 State what records (including the participant and data processing documents)

would, in fact, belong to the State upon contract termination. In what format will the data be returned to the State?

Answer:

5.2 Customer Service5.2.1 Will you provide a dedicated customer representative to the State? If so, where

will this unit be located and what are the hours of operation? Will this account be the only client served by this dedicated unit? Where will this unit be located?

Answer:5.2.2 Describe the training provided to members of the Customer Service Unit(s). How

is performance monitored? Can the State assist in the training of the dedicated unit?

Answer:



5.2.3 Describe how you will communicate to the members. Please attach sample communication materials you have produced for your clients. Are the costs of these communication materials included in your regular fees? If not, what is the additional cost? Are customized communications available? What is the cost?

Answer:5.2.4 Describe the appeals procedures and time frames that a member would follow.Answer:5.2.5 Provide samples of any consumer education materials available and when they

are used.Answer:5.2.6 What are your normal customer service hours? The State requires a minimum of

Customer Service access from 8:00am to 5:00pm Central time, Monday through Friday. Will you be able to meet this minimum?

Answer:5.2.7 Do Customer Service representatives have online access to real-time premium

billing process information?Answer:5.2.8 What is the policy and procedure for ‘escalated’ calls – those referred to a

supervisor or manager?Answer:5.2.9 What is the average time to answer the telephone? What is the average time a

person waits in queue to speak to a representative?Answer:5.2.10 Do you use an automated phone system? If yes, does the menu or options

include talking to a ‘real person’ or CSR?Answer:5.2.11 What types of reports are provided to the State relative to customer service

performance? How are these calls tracked and reported to the State? Provide samples.

Answer:5.2.12 Provide samples of educational materials regarding COBRA information you will

make available to members. To what extent will the State be able to personalize this material? How will educational materials be distributed?

Answer:5.2.13 As requested by our employees, the State has adopted certain language

standards for our plan documents to ensure that words are spelled and used the same way with the same meaning. Describe the procedures you have in place to accommodate these language standards within your communications.

Answer:5.2.14 Please share a copy of the survey instrument(s). If surveys are not currently

conducted, when do you anticipate beginning this type of project?Answer:

5.3 Eligibility/Membership Processing5.3.1 Are you able to administer electronic eligibility transfers?Answer:5.3.2 Have you reviewed the file layout attached and comment on your ability to

administer the file as presented?



Answer:5.3.3 Do you have the capability for SEHP staff to access your premium billing and

eligibility system through a secure on-line system? Answer:5.3.4 Will you agree to follow the State’s guidelines for eligibility and reinstatement of

coverage? How will eligibility be verified? Answer:5.3.5 Can your system process eligibility files with multiple transaction rows for one

participant?Answer:5.3.6 Supply a copy of a load report for an eligibility file including items that ‘erred off’Answer:5.3.7 What is your experience with assisting clients in a transition to your system and

testing files and procedures prior to full implementation of the new system?Answer:5.3.8 What types of back-up systems will your company have in place through the

transition process and for how long will these parallel or back-up systems remain activated?

Answer:

5.4 Systems Backup and Disaster Recovery5.4.1 Describe mechanisms in place for systems backup? Do these procedures vary by

system (i.e. membership versus customer service inquiries)?Answer:5.4.2 How do you maintain service and benefits for members and providers when a

natural disaster occurs in the area of your primary operations?Answer:

5.5 Web Access5.5.1 Does your plan have established standards for web access? Please describe in

detail.Answer:5.5.2 Describe in detail your internet capabilities for:

Member inquiry capabilities Employer inquiry capabilities Future plans/timeframes for enhancements.

Answer:



5.5.3 How do you maintain a secure environment for communicating and transacting business with each audience (members, SEHP)?

Answer:5.5.4 Do you have the capability and willingness to create a personalized web

experience (content and transactions), at no additional cost, for the State of Kansas?

Answer:5.5.5 Is internet and web communication a two-way street? Can members send

questions and inquiries to Customer Service via secure web or internet?Answer:5.5.6 Provide a sample website you proposed to use for the SEHP population.

Describe the features available.Answer:5.5.7 Has your website been tested for ADA compliance? List all equipment on which

your web application is tested.Answer:

5.6 HIPAA Section 5.6.1 Please confirm your compliance with HIPAA privacy and security rules for data

transferred to outside parties. If you cannot confirm, please explain below.Answer:


This section of the Request for Proposal has been reviewed by me and shall become part of the final contract by reference. I hereby acknowledge and accept responsibility for the accuracy of all responses, requirements, and conditions stated in this section of Request for Proposal, subject to the modifications, conditions and limitations I have listed below.

Authorized Signature of Vendor

Printed Name of Signatory

Title

Date



SECTION VIPERFORMANCE STANDARDS, GUARANTEES, LIQUIDATED DAMAGES

LIQUIDATED DAMAGES – Failure to meet Performance RequirementsThe purpose of liquidated damages is to ensure adherence to the performance requirements in the contract. No punitive intention is inherent. It is agreed by the State and the Vendor that, in the event of a failure to meet the performance requirements listed below, damage shall be sustained by the State, and that it is and shall be impractical and extremely difficult to ascertain and determine the actual damages which the State shall sustain in the event of, and by reason of, such failure; and it is therefore agreed that the Vendor shall pay the State for such failures at the sole discretion of the State according to the following:

Damages assessments are linked to performance of system implementation or operational responsibilities. Where an assessment is defined as an ‘up to “$,$$$” amount, the dollar value shall be set at the discretion of the State.

For all self reported metrics, Vendor will include a check for liquidated damages as specified, with the report due for the metric. Written notification of each failure to meet a performance requirement that is measured by the SEHP shall be given to the Vendor prior to assessing liquidated damages. The Vendor shall have five (5) business days from the date of receipt of written notification of a failure to perform to specifications to cure the failure. However, additional days can be approved by the SEHP Contract Manager if deemed necessary. If the failure is not resolved within this warning/cure period, liquidated damages may be imposed retroactively to the date of failure to perform. Late reports will incur additional liquidated damages to the state. Liquidated damage amounts will double for each five (5) business days that a report is delayed. The imposition of liquidated damages is not in lieu of any other remedy available to the State.

If the State of Kansas elects to not exercise a damage clause in a particular instance, this decision shall not be construed as a waiver of the State’s rights to pursue future assessment of that performance requirement and associated damages.

6.1 PERFORMANCE GUARANTEES: The following requirements are areas where the Vendor will guarantee performance for each plan offered. Failure to meet the required standards will result in the liquidated damages. Prompt resolution of problems or issues is expected but will not reduce or eliminate any liquidated damages imposed due to failure to meet the performance standards outlined below.

Liquidated Damages may be enforced by reducing the administrative fees or other amounts owed to the Vendor. Some items will require the Vendor to supply a recommendation. Proposal must include Vendor recommendations regarding liquidated damage amounts for each incident with an annual maximum for each performance standard for discussion during negotiations.

If there are other performance standards that your company has in place with other clients, please provide the language and guarantees that are used.

Service Performance Standards Timing Liquidated Damages6.1.1 Reliability and Integrity of Data: Vendor is

responsible to accurately load all membership eligibility files into their system. Vendor guarantees 95% accuracy of membership eligibility file loads.

Measured weekly.

Reported quarterly

$1,000 per file

6.1.2 COBRA Compliance: Vendor will assume responsibility for any financial penalties assessed for

Penalty assessed for non-compliance



Service Performance Standards Timing Liquidated DamagesCOBRA non-compliance activities which have been contracted to the Vendor.

6.1.3 Customer Service for the State of Kansas Plan:(a) Telephone response time: Ninety (90) percent

of all calls answered within thirty (30) seconds. The amount of time that elapses between the times a call is received into a customer service queue to the time the phone is answered by a Customer Service Representative (CSR).

(b) Call abandonment rate: Less than two (2) percent of calls abandoned. Percentage of calls that are not answered by administrator (caller hangs up before answer). Calculated as the number of calls that are not answered, divided by the number of calls received.

(c) First call resolution rate: Ninety-five (95) percent of calls are handled to conclusion on first call. Percentage of calls that are completed on first call. Measured by the number of calls that are completed without need for referral or follow-up actions, divided by the total number of calls received.

(d) Open Call Resolution Turn-around-time: One hundred (100%) of calls that require follow-up or research beyond a four (four) business day standard will be resolved within ten (10) business days after the initial call. The percentage of calls that are resolved during this additional period will be measured as the number of calls that are resolved during this additional period, divided by the total number of calls unresolved at the beginning of this additional period. “Resolution” will be defined as completion of specific customer service actions necessary to address the issues raised by the member. The starting point for measurement of resolution time will be the time when complete identification information about the issue is received by Vendor, including member identification and any other information that can only be obtained from the member or SEHP (e.g. mailing address). Resolution time will not include time required for such follow-up activities as time elapsed for calls that need to be re-cured, time required for the member or SEHP to provide additional information, etc. For a call to be included in this measure, SEHP or the member must provide the necessary information for follow-up, which will include a statement of the member issue to be resolved and at least two of the eligibility criteria. These

$2,500 per calendar quarter






Service Performance Standards Timing Liquidated Damagescriteria include but may not be limited to the member name (as presented in the eligibility file), the correct member ID number and a valid phone number.

(e) Customer Service Quality: Ninety-nine (99) percent of calls handled in a professional manner, based on audited telephone inquiries – live monitoring or taped calls.

(f) E-mail response: One hundred (100) percent of emails responded to within five (5) business days

(g) Written Inquiry Response: Ninety-eight (98) percent of all written inquiries and faxes responded to within five (5) business days of receipt

(h) Written Inquiry Response: One hundred (100) percent of all written inquiries and faxes responded to within ten (10) business days of receipt

(i) Call Center Access: Toll-free telephone access to customer service center available between 8:00 a.m. and 5:00 p.m., Central Time, Monday through Friday, except for legal holidays

(j) Notice of Holiday Schedule: Vendor shall notify SEHP of holiday schedules annually by February 1.

(k) Notice of Service Disruption: Vendor shall notify SEHP of any disruption in customer service center availability or toll free access regardless of reason for disruption, as soon as the problem is identified. Failure to notify SEHP of the problem will result in liquidated damages.

(l)


$2,500 per calendar quarter$2,500 per calendar quarter



$1,000 per incident

$1,000 per incident


6.1.4 Service to SEHP Membership Team:(a) One hundred (100) percent of calls returned by

account service representative by 5:00 p.m. on the next business day.

(b) One hundred (100) percent of issues received by phone call or email resolved within three (3) business days of receipt.

(c) Respond to one hundred (100) percent of written inquiries sent by fax within five (5) business days.

(d) Respond to one hundred (100) percent of written inquiries received by mail within seven (7) business days.

$150 per incident

$150 per incident

$150 per incident

$150 per incident

6.1.5 Member Inquiries:If a member has a premium billing issue or other issue with the Vendor that they have made a good faith effort

$1,000 per incident



Service Performance Standards Timing Liquidated Damagesto resolve with the Vendor and are unable to resolve the matter, the Vendor will be assessed liquidated damages of $1,000 for each instance where the staff of SEHP becomes involved in the investigation and/or resolution of the problem and finds that error lies on the part of the Vendor. This provision shall only apply if the member has previously contacted the Vendor and the Vendor has had the opportunity to address the problem.

6.1.6 Implementation:(a) Membership Eligibility File testing protocols

completed by October 1. (b) Customer service center with trained

representatives and toll free number must be open for members to call by September 15.

(c)

$2,000 per incident

$5,000

6.1.7 Website Availability: The website structure, pages and content shall be updated with the appropriate Open Enrollment plan and rate changes and available no later than September 1, and continuously thereafter. In the event of downtime, the Vendor shall immediately notify the SEHP of the expected duration of the downtime and post a notice on the website, if possible. The Vendor will notify the Contract Manager in SEHP of any substantial changes being made to the website prior to implementation.

$500 per incident

6.1.8 Money Owed to the State of Kansas: Money owed to the State of Kansas shall be paid within thirty (30) calendar days from notification of Liquidated damages or monies owed. Vendor has thirty (30) calendar days to document any dispute of amounts owed. Amounts owed that are not received within thirty (30) calendar days will be subject to liquidated damages of $25 per day until paid. After thirty (30) days, SEHP may collect owed funds by deducting the amounts from the administrative fees or other payments made to the Vendor.

$25 per day will be added until payment is received by SEHP

6.1.9 Approval of Materials: All materials must be pre-approved by SEHP prior to distribution to members of the State of Kansas Health Plan.

$2,000 per incident

6.1.10 Solicitation of Members: The Vendor shall not use the names, home addresses or any other information obtained about members of this plan for the purpose of offering for sale any property or services that is not directly related to the services negotiated in this RFP without the express written consent of the State

$5,000 per member solicited



Service Performance Standards Timing Liquidated DamagesEmployee Health Benefit Plan staff.

6.1.11 Member Billing Timeliness and Accuracy: Vendor will guarantee timeliness and accuracy of monthly member invoices/bills. Vendor will send accurate individual monthly invoices to all members enrolled in this payment method by the 15th of the month prior to the month of coverage.

Measured weekly.

Reported quarterly

$2,500 per billing cycle

6.1.12 Monthly SEHP Fee Invoice & Monthly SEHP Premium Statement Vendor will provide complete and accurate monthly fee invoices and premium statements to be received by the SEHP by the tenth (10th) business day of the month following month being billed.

$1,000 per incident

6.1.13 COBRA Rates: The Vendor will accept, guarantee to load accurately and test rate table changes a minimum of 2 times each year within appropriate deadlines to meet timely billing requirements. New rates are typically effective July 1 and January 1.

Annual plan design updates and changes for Open Enrollment, including plan codes, rate identifiers, benefit programs, department changes, rates and other items as requested by the SEHP must be accepted and ready for implementation by deadline specified by the SEHP.

New Non-State department codes will be added throughout the year. The Vendor must be able to accept these department additions at any time. Vendor will guarantee accuracy of the loading of these department codes

$1,000 per incident

$1,000 per incident

$1,000 per incident

6.1.14 Legislative Requests: Vendor will provide support to the Commission and SEHP staff in responding to information requests made by the Legislature. Responses to Legislative Requests are due to the SEHP staff within two (2) business days.

$500 per incident

6.1.15 Daily Eligibility File: The Vendor agrees to process enrollment additions, changes, and deletions correctly within two (2) business days of the generation date of the file. Vendor must notify SEHP within twenty-four (24) hours if information received is incomplete or unreadable.

Additions, changes, and deletions sent correctly by the

$1,000 per incident



Service Performance Standards Timing Liquidated DamagesSEHP but not processed correctly by the Vendor will be retroactively corrected back to original date, even if correction occurs more than sixty (60) days following date of the membership change.

6.1.16 Comparison Eligibility File: SEHP will periodically send a full eligibility file on a predetermined schedule, This schedule may change based on SEHP needs with notice to the vendor. Currently monthly by the second Thursday of the month.

Vendor shall not load this file. Vendor will compare files to their membership database and provide an enrollment mismatch report to the SEHP within ten (10) business days of the creation date of the full file.

SEHP will respond with information to make corrections in Vendor’s membership system. Vendor will make needed corrections within ten (10) business days of receipt of information. Premium and claims adjustments will be made by the Vendor and reported to the SEHP. Incomplete or unreadable information must be reported to the SEHP within twenty-four (24) hours.

$1,000 per mismatch report not received.

$1,000 per correction not completed within the timeframe

6.2 Reporting Due Dates: Annual reports are due to SEHP by February 1 of each year. Quarterly reports are due fifteen (15) business days after the end of the quarter to be reported. Monthly reports are due ten (10) business days after the end of the month to be reported.


The Performance Guarantee and Liquidated Damages section of the Request for Proposal has been reviewed by me. I hereby acknowledge and accept all of the provisions, requirements, and conditions stated in this section of Request for Proposal, subject to the modifications, conditions and limitations I have listed below.

Authorized Signature of Vendor

Printed Name of Signatory

Title



Date