vendor conference powerpoint presentation

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Vendor Conference: Eligibility Support Services

RFP #529-08-0135 August 14, 2008

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Welcome and Introductions Steve R. Bailey

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ESS RFP Vendor Conference

Welcome

• Introductions– Steve R. Bailey, Manager, Enterprise Contract and

Procurement Services (ECPS)– Sherice Williams-Patty, HUB Coordinator, HHSC

Administrative Services Development– Anne Heiligenstein, Deputy Executive Commissioner

HHSC Office of Social Services – C.J. Brandt, Office of Chief Counsel

• Housekeeping Items

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HHSC Procurement Roles

• ECPS- Responsible for procurement activity

• HUB- Responsible for HUB activity

• Program- Responsible for project scope, requirements, performance, results, contract management/monitoring

• Legal- Questions/answers and legal activity

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Vendor Conference Overview

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

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Procurement Activities

• Questions & Answers • Sole Point of Contact • Procurement Timeline • Accessing Information & Updates • Submission Requirements• Screening & Evaluation• Award & Releasing Information

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HUB Subcontracting Plan(HSP) Requirements Sherice Williams-Patty

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HSP Agenda Topics

• RFP Section 4.0 Historically Underutilized Business RFP Section 4.0 Historically Underutilized Business

Participation RequirementsParticipation Requirements

• HUB Subcontracting Plan for the RFP is requiredHUB Subcontracting Plan for the RFP is required

• Self Performance HSP Self Performance HSP

• HSP Prime Contractor Progress Assessment ReportHSP Prime Contractor Progress Assessment Report

If HSP is inadequate, response will be rejected

Section 1: Company

Information

HUB GOALS

Section 2:

Subcontracting Intentions:

If Yes: Enter subcontracting opportunities

If No: skip to Sections 9 and 10

One page for each area

subcontracted(listed in Section 2)

HSP Information Page

Section 3:List Line # and Subcontracting

Opportunity

Section 4:Protégé

performing the work

Section 5: Professional Services Category


Section 6(a): Good Faith Efforts to find/include Texas Certified HUB Vendors

Section 6(b):Contact HUB

Trade Organization


Section 6(c):Written

Notification Requirements


Section 7:List 3 HUBs

Contacted for this

Subcontracting Opportunity


Section 8:Reason why HUB was not selected for this Subcontracting Opportunity

Section 8:List Subs Selected

(HUBs & Non-HUBs) for this

Subcontracting Opportunity


Section 9:Self Performance

Explanation

Section 10: Signature Affirms that True and Correct Information is Provided

• Required with ALL Pay Requests

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

HSP Prime Contractor Progress Assessment Report

ATTACHMENT “E”

Administrative Services Administrative Services Development HUB Program OfficeDevelopment HUB Program Office Robert L. Hall, C.P.M.Robert L. Hall, C.P.M. Director of Administrative Services DevelopmentDirector of Administrative Services Development

- (512) 424-6596- (512) 424-6596- - [email protected]@hhsc.state.tx.us

Carlos A. BalderasCarlos A. Balderas ASD HUB AdministratorASD HUB Administrator


Sherice Williams-PattySherice Williams-Patty ASD HUB AdministratorASD HUB Administrator


Segundo SanchezSegundo Sanchez ASD Procurement/HUB Team LeadASD Procurement/HUB Team Lead


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HHSC Project Philosophy

Anne Heiligenstein

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HHSC Project Philosophy

HHSC’s fundamental commitment is to contract for results, including:

• defined, measurable, and beneficial outcomes• best value• strong accountability• cooperative relationship with the State• quality approach to client services

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HHSC Mission

HHSC’s mission in this procurement is to:• Procure services that will assist in

modernizing the eligibility system and improve Texans’ access to HHSC programs and

• achieve the highest levels of quality, accuracy, and efficiency in the delivery of eligibility services

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Mission Objectives

The mission objectives are to implement an eligibility process that:

• offers multiple access channels • allows a vendor to support eligibility determination by

skilled workers• allows vendors to perform eligibility determination for

CHIP-only applications and renewals• leverage state investments • uses technology resources available to the state• identify areas for continued performance improvement

and cost effectiveness

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Project Results

As a result of the procurement, the Vendor will:• maximize efficiency and reduce costs in all functions to

support eligibility determination for programs managed by HHSC

• improve the quality of services for programs provided by HHSC

• improve client access provided by HHSC• implement more efficient business processes allowing

HHSC to reduce processing times for applications for program benefits and reduce staff workloads

• identify areas for continued performance process improvement and cost effectiveness

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Scope of Work

Shaun Barker

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Eligibility Support Services RFP - Scope of Work

• Call Center Operations• Inquiry Management• Image Association• Data Collection and Other Case Actions• CHIP Eligibility Determination and Related Services• Complaint and Dispute Handling• Appeals, Requests for Reviews, and Fair Hearings• Call Monitoring and Case Data Accuracy• Training and Quality Management

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Scope of Work:State Responsibilities

Under the Eligibility Support Services RFP the State will:

• Determine eligibility for all HHSC programs including eligibility for CHIP clients with associated cases

• Assess missing Information and manage correspondence with client

• Collect data for applications and redeterminations

• Perform data broker look-ups – except for CHIP (vendor does data broker look ups for CHIP)

• Certify and issue benefits

• Process requests for appeals and hear appeals

• Provide assistance in eligibility offices and centers

• Perform CHIP reviews

• Resolve complaints

• Issue expedited benefits

• Provide technologies and assets

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State Technology

• HHSC’s technology will support the eligibility determination process • Vendor staff will use HHSC technology, including the State

Portal to perform the functions under this RFP• The State Portal (STP) is used to access:

• Inquiry • Case comments entry • Scheduler • Application Registration • TLM task creation & routing to the state • Alerts processing • Image association (thru content manager)

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State Technology

• Accepting client applications via call center– Clients may apply for benefits over the phone through the

vendor Customer Care Center staff

– Vendor staff will use the Self Service Portal available via the Internet at www.yourtexasbenefits.com to enter the applicant’s information for further processing

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CHIP Eligibility Determination

Elisa J. Garza

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Vendor Responsibilities• Use HHSC technologies to determine eligibility for CHIP

applications and renewals that do not include other HHSC benefit programs. (CHIP-only)

• Obtain the necessary information to make an eligibility determination for Children’s Medical Assistance (CMA), and route to the HHSC.

• Route applications to HHSC when other HHSC Programs are included. (CHIP-plus)

• Identify and route CHIP Requests for Review (RFR) to HHSC staff.

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CHIP-only Application ProcessingUse HHSC technologies to:• Review all incoming applications• Perform inquiry and link the document to the appropriate

application or case • Perform Third Party Verification inquiry and document

the results • Send a letter to request any missing information• Determine eligibility for CHIP (CHIP,SKIP, and CHIP

perinatal) programs, and notify the family of the outcome• Route the application and supporting documentation to a

state worker if the family is potentially eligible for Medicaid

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CHIP-plus Application ProcessingUse HHSC Technologies to:

• Review all incoming applications

• Perform inquiry, link the document to the appropriate application or case, and create a case if unable to link

• Create a task to route the application to HHSC staff

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Transition and Operations

Leslie DeHay

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Transition Phase

The primary objectives of the Transition Phase are to:

• Ensure a smooth transition and implementation of business operations and systems

• Perform readiness assessment thoroughly and timely for implementation

• Establish strong Vendor accountability controls

• Ensure cost effectiveness

• Mitigate risk to clients and HHSC

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Facilities and Assets

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Customer Care Centers

Customer Care Center & Processing Center Locations

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Customer Care Centers –Assets and Technology

Four Customer Care Center facilities:Asset/ Equipment Area Future

Technology

Server Hardware and Software HHSC

Applications Development Software HHSC

Desktop PC - Non EB Northrop Grumman

Desktop PC - Application Developer Northrop Grumman

Telephony

Telephony and Network Hardware and Software

DIR

Desktop Telephone Equipment and Accessories - Non EB

HHSC

FacilitiesLeasehold Improvements RFP Vendor

Furniture and Fixtures RFP Vendor

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Midland Customer Care Center

• Document Processing Center (DPS Vendor) Staff

• Image Assembly Staff• ES and CHIP Call Center for Client Access Staff • HHSC Texas Works, MEPD, Women’s Health

Program, and Call Escalation Staff• HHSC Vendor Operations Oversight Staff• Office of Family Services Quality Assurance

Staff

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Athens Customer Care Center

ES and CHIP Call Center for Client Access Staff HHSC Texas Works and MEPD Staff HHSC Vendor Operations Oversight Staff Office of Family Services Quality Assurance

Staff Document Processing Center DRC

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San Antonio Processing Center

• Image Assembly Staff• Application Support Staff• HHSC Texas Works, MEPD, and Call Escalation

Staff• HHSC Women’s Health Program Staff• HHSC Vendor Operations Oversight Staff• Office of Family Services Quality Assurance

Staff

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Austin Customer Care Center

• CHIP Operations Staff• Enrollment Broker Operations Staff• THSteps Operations Staff• HHSC Texas Works and MEPD Staff• HHSC CHIP and Managed Care Operations

Oversight Staff• OFS Quality Assurance Staff• HHSC Vendor Operations Management Staff• HHSC IV&V Vendor Staff• DIR Systems Support Staff

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Financial Approach

Larry Fisher

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Financial Approach

• The State has chosen to utilize a FIXED PRICE APPROACH to the administrative services.

• The Vendor must maintain separate financial records for each of the two components administered under the contract resulting from this RFP:

(1) Eligibility Support Services

(2) Children’s Health Insurance Program (CHIP) Services

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Financial Approach

• The Vendor must maintain, document, and submit operations cost data in accordance with HHSC requirements and federal manuals and directives.

• Documentation must support and differentiate between component operational costs for services provided by the Vendor and include the reimbursable federal matching rates for each applicable program or sub-program.

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Financial Approach

• The Vendor must provide monthly financial statements, including, but not limited to an income statement, depicting the Vendor’s operation under the resulting contract no later than the twentieth calendar day following the end of the previous month.

• Costs for administrative services provided by the Vendor for the Eligibility Support Services components will be based on a fixed fee plus variable fee formulas.

• The specific business components applicable for this RFP are:

(1) Eligibility Support Services

(2) Children’s Health Insurance Program (CHIP) Services

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Financial Approach

• The State anticipates that no more than 50% of the administrative fees for the Eligibility Support Services / CHIP Services will be paid on a fixed fee basis and a minimum of 50% of the administrative fees for the Eligibility Support Services / CHIP Services will be paid utilizing variable fees.

• Transition costs to meet the requirements of the RFP will be paid on a fixed fee basis. Transition costs in excess of the final fixed price amount(s) included in the contract resulting from this RFP will not be paid by the State. Separate transition costs will be proposed, negotiated, and paid for: • Eligibility Support Services• CHIP Services

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Financial Approach

• Separate fixed and variable administrative fees will be proposed for the first 12 –month operational period of a resulting contract for each component type. For subsequent contract years (12-month operational periods), the fixed and variable administrative fees will be determined by the application of a fixed annual inflator proposed by a Vendor and subject to approval and acceptance by HHSC.

• The Eligibility Support Services component includes variable administrative fees based on the following activities:• Number of “Image Application Only” transactions completed and

processed correctly”• Number of “TIERS Alerts” completed and processed correctly• Number of “ESS Changes” completed and processed correctly

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Financial Approach

• The CHIP Services component includes variable administrative fees based on the following activities:• Number of “CHIP Applications” completed and processed

correctly• Number of “CHIP Renewals” completed and processed correctly• Number of “CHIP Changes” completed and processed correctly

• The Eligibility Support Services / CHIP Services variable payments will be based on the number of activities listed above that are appropriate for the respective components and are completed and processed correctly. Any activity or multiple activities that must be reprocessed due to Vendor error(s) will not be considered an appropriate activity or activities for payment of additional variable payment(s).

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Financial Approach

• Ownership of all nonexpendable capital items FUNDED by the contract will pass to the State at the expiration of the contract.

• Actual expenditures for Pass-Through Items made on the State’s behalf will be paid without allocation of any indirect charges (general & administrative expenses, overhead, etc.) or profit.

• Expenditures designated as Pass-Through Items are listed in Section 2.2.10.8.2 of the RFP.

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Financial Approach

• Administrative fees paid to the Vendor during each Operational Contract Year will consist of: • Fixed Administrative Fees • Variable Administrative Fees • Administrative Fees for the Additional Periodic Activities• Administrative Fees for Additional Recurring Activities

• The sum of the four Fee components will be referred to as the “Fee Ceiling”.

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Financial Approach

• The total maximum cost of the Services and Deliverables supplied by the Vendor to HHSC during each Operational Contract Year will not exceed the lesser of (a) the Vendor’s Fees (Fee Ceiling) or

(b) the sum of the Allowable Costs incurred by the Vendor plus the allowable administrative service fee during the subject Operational Contract Year.

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Pricing Overview

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Pricing Overview

Forms substantially similar to those described in the RFP must provide the component costs of the Firm Fixed Prices quoted for providing the services and deliverables set forth in the RFP.

• Attachment A, Appendix A-1 contains Transitional Pricing Schedules

• Attachment A, Appendix A-2 contains Operational Pricing Schedules

• Attachment A, Appendix A-3 contains the formal Price Summary Sheets

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Pricing Overview

• The potential Vendor must structure its pricing quotation to allow HHSC a method to map the proposed costs for the cost proposal submitted back to the Vendor’s Detailed Work Plan for the initial term of the Contract.

Transition Pricing Schedules:• The potential Vendor’s transitional cost proposal sheets

for the Eligibility Support Services Component and the CHIP Services Component must identify the proposed “Key Milestones” the Vendor will accomplish during the Transitional period (Appendix A-1).

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Pricing Overview

• The State is requesting each prospective Vendor to identify the “Key Milestones” the Vendor believes would be pertinent and appropriate as a Key Milestone during the Transition period.

• The State reserves the option to add, delete and/or modify Key Milestones included in the Vendor’s transitional cost proposal sheets.

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Pricing Overview

• The potential Vendor’s operational cost proposal sheets (Appendix A-2) for the ESS and CHIP operational components must be delineated by the primary business functions (functional areas) documented in the RFP.

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Pricing Overview

• Instructions for completing each schedule are included in the RFP.

• In addition to paper copies of the Vendor’s Cost Proposal and Price Summary sheets, Vendors must submit electronic versions in an MS Excel format.

• The State will be providing prospective Vendors with an electronic version of the required Cost Proposal and Price Summary sheets in an MS Excel format on September 3, 2008. The file will be posted in the procurement library.

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Pricing Overview

• Costs for administrative services provided by the Vendor for the Eligibility Support Services components will be based on a fixed fee plus variable fee formulas.

• The specific business components applicable for this RFP are:

• Eligibility Support Services

• Children’s Health Insurance Program (CHIP) Services

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Pricing Overview

• Price Summary Sheet 1 shows the fixed administrative fees for the transitional period by Key Milestone applicable for each component.

• Price Summary Sheet 2 shows the fixed administrative fees for the first 12 months of the operational period for each component and the fixed annual inflator proposed by the Vendor.

• Price Summary Sheet 3 shows the variable administrative fees for the ESS component for the first 12 month operational period (Operational Contract Year 1), by the specific types of variable activities requested by the State and the fixed annual inflator proposed by the Vendor.

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Pricing Overview

• Price Summary Sheet 4 shows the variable administrative fees for the CHIP Services component for the first 12 month operational period (Operational Contract Year 1), by the specific types of variable activities requested by the State and the fixed annual inflator proposed by the Vendor.

• Price Summary Sheet 5 shows the all-inclusive hourly labor rates and the proposed fixed annual inflator used to show costs associated with additional non-recurring and/or periodic activities to be performed by the Vendor by different types of service categories.

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Pricing Overview

• The maximum fees associated with additional non-recurring and/or periodic activities to be performed by the Vendor will be based on explicit fixed prices proposed for Vendor inputs and the actual number of hours worked on the specific modification by the Vendor’s staff and/or the staff of a Vendor’s subcontractor.

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Pricing Overview

• The cost proposal should include any business, economic, legal, programmatic, or practical assumptions that underlie the Cost Proposal. HHSC reserves the right to accept or reject any assumptions.

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Legal Considerations

C. J. Brandt

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Elements of the Contract:

Offer and Acceptance

• HHSC may accept proposal without negotiating

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Elements of the Contract, continued:

• RFP

• Proposal

• Any Required Documents

• Any Negotiated Terms

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Contract Remedies:

• Legal Remedies– Damages

• Equitable Remedies– Injunctive Relief

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Contract Remedies, continued:

Damages

• Actual, Direct, Indirect, Consequential, etc.

– Liquidated Damages

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Conflicts of Interest

• Revolving Door

• Organizational Conflicts

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Questions and Answers

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End of Presentation