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

1. Kyle L. Janek, M.D., Executive Commissioner VENDOR CONFERENCE External Quality Review Organization (EQRO) Request for Proposal No. 529-13-0046 December 12, 2013

2. Welcome • Introductions • Elizabeth Ward,Procurement and Contracting Services (PCS) • Frank Genco, Quality Manager, HHSC Medicaid/CHIP Division • Sherice Williams, HUB Administrator, PCS • James Ramirez, Asst. General Counsel, and Diana Crumley, Special Counsel • Housekeeping Items

3. HHSC Procurement Roles • PCS- Responsible for procurement activity • Program- Responsible for project scope, requirements, performance, results, contract management/monitoring • HUB - • Legal- Questions/answers and legal activity

4. Vendor Conference Overview • Procurement Activities • RFP Overview • Legal Overview • Questions • Break • Preliminary Responses to Questions • Closing

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

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

7. Procurement Schedule • RFP Release Date December 3, 2013 • Vendor Conference December 12, 2013 • Respondent Questions Due December 17, 2013 • Post Response to Questions (est.) December 31, 2013 • Proposals Due (2:00 PM Central Time) January 16, 2014 • Deadline for Proposal Withdrawal January 16, 2014 • Tentative Award Posting (est.) May 13, 2014 • Anticipated Contract Start Date December 18, 2014

8. Request for Proposals No. 529-13-0046 RFP Overview • Mission • Overview • Objective • Terms of the Contract • EQRO and Quality Vendor Responsibilities (Scope of Work) • Evaluation Criteria

9. Mission • The mission of HHSC is to maintain and improve the health and human services system in Texas and to administer its programs in accordance with the highest standards of customer service and accountability for the effective use of funds.

10. Overview • HHSC is soliciting competitive proposals from qualified organizations to review the quality of healthcare provided to the clients enrolled in the Medicaid and CHIP programs. • HHSC will contract with an EQRO Vendor who will perform external quality review (EQR) and EQR-related activities, and a Quality Vendor, who will be responsible for statistical support, evaluation, targeted analysis, and other quality-related activities.

11. Overview • State Medicaid programs are required to contract with an independent EQRO for the purpose of EQR. • CHIP Managed Care Organizations (MCOs) are subject to the same external review process as Medicaid MCOs.

12. Overview • Sections 1932(c) and 2103(f)(3) of the Social Security Act describe how a state should develop a quality assessment and improvement strategy for its Medicaid and CHIP managed care programs. • Under 42 C.F.R. § 438.356, a state must contract with an EQRO to perform external quality review (EQR).

13. Overview • Each contract with an MCO must provide for an annual external, independent review of the quality outcomes and the timeliness of, and access to, the services each MCO is responsible for under the contract.

14. Overview • Children’s Medicaid Dental Services • CHIP Dental Services • CHIP • STAR • STAR+PLUS • STAR Health • NorthSTAR • The EQRO Vendor and Quality Vendor will review the following state managed care programs.

15. Objective • HHSC’s objective in this procurement is to develop an integrated approach to quality assessment and improvement that leads to measurable quality improvement initiatives in all areas of managed care contracting and service delivery.

16. Terms of the Contract • HHSC will award one or more contracts for administrative services. • The initial contract period will be a three-year period. • HHSC reserves the option to amend the term of the contract for up to two one-year options, or as necessary to complete the mission of this procurement.

17. EQRO Vendor Scope of Work • EQR means the analysis and evaluation by an EQRO of aggregated information on quality, timeliness and access to the healthcare services that an MCO or PIHP, or its contractors, furnishes to beneficiaries.

18. EQRO Vendor Scope of Work • A qualified EQRO must perform an annual EQR for each contracting Medicaid MCO, Medicaid PIHP, and CHIP MCO. • Potential respondents are encouraged to acquaint themselves with the EQRO federal rules and guidelines. • The EQRO Vendor will utilize these protocols as guidelines.

19. EQRO Vendor Scope of Work • EQRO federal rules and guidelines include protocols for conducting EQR-related activities including: • Protocols for conducting focus studies; • Validating performance measures; • Calculating performance measures; • Validating performance improvement projects; and • Validating encounter data.

20. Quality Vendor Scope of Work • For the purpose of this proposal, the Quality Vendor will be responsible for statistical support, evaluation, targeted analysis, and other quality-related activities. • For example: • Conduct rate-setting data analysis activities; • Conduct annual certification that determines whether MCO and PIHP encounter data are complete and accurate; • Prepare ad-hoc reports based on administrative data to support specific assessment/evaluation functions; • Perform ad-hoc data analytics to support state legislation; and • Conduct independent evaluation and analysis for federal grant initiatives awarded to HHSC.

21. Evaluation Criteria HHSC will evaluate each proposal using the following criteria: • The quality and reliability of the goods and services; • The extent to which the goods and services meet the agency needs;

22. Evaluation Criteria • Indicators of probable performance under the contract such as past performance, the respondent’s financial resources, and the respondent’s experience and ability to provide reliable maintenance agreements; • The total long-term cost to the agency of acquiring the vendor’s goods and services; and • Any other factors relevant to determining the best value for the agency.

23. HUB Subcontracting Plan (HSP) Requirements Sherice Williams, Procurement and Contracting Services Division

24. Agenda Topics RFP Section 4.0 Historically Underutilized Business Participation Requirements HUB Subcontracting Plan Development and Submission HSP Quick Checklist – Handout HSP Methods – Section 4.6.2 HSP Prime Contractor Progress Assessment Report – Section 4.8

25. Historically Underutilized Business Participation Requirements

26. RFP Section 4.0 Historically Underutilized Business Participation Requirements • HUB Participation Goals– Section 4.3 • Potential Subcontracting Opportunities – Section 4.5 • Vendor Intends to Subcontract – Section 4.6.3 • Centralized Master Bidders List and HUB Directory – Section 4.5

27. RFP Section 4.0 Historically Underutilized Business Participation Requirements (cont.) • Minority or Women Trade Organizations – Section 4.6.6 • Self Performance – Section 4.7 • HSP Changes After Contract Award– Section 4.8 • Reporting and Compliance with the HSP – Section 4.8

28. HUB Subcontracting Plan (HSP) Development and Submission

29. If HSP is inadequate, response will be rejected HUB GOALS Special reminders and instructions HSP Information Page

30. HSP Quick Checklist ** See Checklist Handout**

31. HSP Methods

32. METHOD OPTIONS A Respondent may choose from one of the following methods when completing the HSP: • Method I – if 100% of your subcontracting opportunities will be performed using only HUB vendors; • Method II – if one or more of the subcontracting opportunities identified will be performed using HUB protégé’s; • Method III – if a combination of HUBs and Non-HUBs are used to perform the subcontracting work identified AND the HUB goal identified in the solicitation is met or exceeded;

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

34. ALL METHODS For ALL Methods the following steps are required to be completed: • Page 1 - Section 1 - Respondent and Requisition Information; • Page 2 - Company and Requisition Information • Page 2 - Section 2(a)– Subcontracting Intentions • Section 4 – Affirmation and Sign

35. HSP Information Page Respondent and Requisition Information

36. Company Name and Requisition # Subcontracting Intentions: If Yes, Complete Section 2a If No, Complete Section 2b

37. Section 4; Affirmation Signature Affirms that Information Provided is True and Correct.

38. METHOD I If all (100%) of your subcontracting opportunities will be performed using only HUB vendors, complete: • All of the steps in Slide 14 • Section 2 b. – List all the portions of work you will subcontract, and indicate the percentage of the contract you expect to award to HUB vendors; • Section 2 c. – Yes; • HSP GFE Method A (Attachment A) – Complete this attachment for each subcontracting opportunity.

39. Complete Section 2-b;List all the portions of work you will subcontract, and indicate the % of the contract you expect to award to all HUBs. Complete Section 2-c; Yes if you will be using only HUBs to perform all SubcontractingOpportunities in 2-b.

40. HSP GFE Method A (Attachment A) Complete this attachment (Sections A-1 and A-2) and List Line # and Subcontracting Opportunity. HUB Subcontractor Selection for this Subcontracting Opportunity

41. METHOD II If any of your subcontracting opportunities will be performed using HUB protégés, complete: • All of the steps in Slide 14 • Section 2 b. – List all the portions of work you will subcontract, and indicate the percentage of the contract you expect to award to HUB vendors; • HSP GFE Method B (Attachment B) – Complete Section B-1 and Section B-2 only for each subcontracting opportunity as applicable.

42. Complete Section 2-b;List all the portions of work you will subcontract, and indicate the % of the contract you expect to award to HUB Protégés. Skip Sections 2-c and 2-d.

43. HSP GFE Method B (Attachment B) Complete Sections B-1; and B-2 only for each HUB Protégé subcontracting opportunity.

44. HSP GFE Method B (Attachment B) List the HUB Protégé(s)

45. METHOD III If you are subcontracting with HUBs and Non-HUBs, and the aggregate percentage of subcontracting with HUBs in which the HUB Goal identified in the solicitation is met or exceeded , complete: • All of the steps in Slide 14 • Section 2 b. – List all the portions of work you will subcontract, and indicate the percentage of the contract you expect to award to HUB vendors and Non HUB vendors; • Section 2 c. – No; • Section 2 d. – Yes; • HSP GFE Method A (Attachment A) – Complete this attachment for each subcontracting opportunity.

46. Complete Section 2-b;List all the portions of work you will subcontract, and indicate the % of the contract you expect to award to HUBs and Non-HUBs. Complete Section 2-c; No to using only HUBs to perform all SubcontractingOpportunities in 2-b.

47. Complete Section 2-d; Yes, to the Aggregate % of the contract expected to be subcontracted to HUBs to meet or exceed the HUB goal, which you have a contract agreement in place for five (5) years or less.

48. HSP GFE Method A (Attachment A) Complete this attachment (Sections A-1 and A-2) for each subcontracting opportunity. Subcontractor Selection (HUBs and Non-HUBs)

49. METHOD IV If you are subcontracting with HUBs and Non-HUBs, and the aggregate percentage of subcontracting with HUBs, holding an existing contract with HUBs for 5 years or less,does not meet or exceed the HUB Goal identified in the solicitation, complete: • All of the steps in Slide 14 • Section 2 b. – List all the portions of work you will subcontract, and indicated the percentage of the contract you expect to award to HUB vendors and Non HUB vendors; • Section 2 c. – No; • Section 2 d. – No; • HSP GFE Method B (Attachment B) – Complete this attachment for each subcontracting opportunity.

50. Complete Section 2-b;List all the portions of work you will subcontract, and indicated the % of the contract you expect to award to HUBs and Non-HUBs. Complete Section 2-c; No, to using only HUBs to perform all SubcontractingOpportunities in 2-b.