MINNESOTA
DEPARTMENT OF HUMAN SERVICES
HEALTH SERVICES AND MEDICAL MANAGEMENT DIVISION
REQUEST FOR PROPOSALS
FOR
A QUALIFIED CONTRACTOR(S) TO
EVALUATE AND REPORT ON THE ADEQUACY OF RATES PAID TO
MINNESOTA HEALTH CARE PROGRAM PROVIDERS
For communication assistance, contact Minnesota Relay Service at 7-1-1 or 1-800-627-3529. If you ask, we will give you this information in another form, such as Braille, large print, or audiotape.
October 13, 2008
TABLE OF CONTENTS
I. INTRODUCTION
A. Purpose of Request
B. Objective of this RFP
C. Background
II. SCOPE OF WORK
A. Overview
B. Tasks/Deliverables
III. PROPOSAL FORMAT
A. Required Proposal Contents
B. Technical Requirements
C. Innovative Concepts (Optional)
D. Required Statements
E. Cost Proposal
IV. RFP PROCESS
A. Responders’ Conference
B. Responders’ Questions
C. Proposal Submission
V. PROPOSAL EVALUATION AND SELECTION
A. Overview of Evaluation Methodology
B. Evaluation Team
C. Evaluation Phases
D. Contract Negotiations and Unsuccessful Responder Notice
VI. REQUIRED CONTRACT TERMS AND CONDITIONS
VII. STATE’S RIGHTS RESERVED
VIII. STATE’S RESPONSIBILITIES
IX. ADDITIONAL REQUIREMENTS
APPENDIX A Responder Information and Declarations
APPENDIX B Exceptions to Terms and Conditions
APPENDIX C Affidavit of Noncollusion
APPENDIX D Trade Secret/Confidential Data Notification
APPENDIX E Location of Service Disclosure and Certification
APPENDIX F Affirmative Action Data Page
APPENDIX G Certification and Restrictions on Lobbying
APPENDIX H Cost Proposal
APPENDIX I State of Minnesota- Immigration Status Certification…………………………….
APPENDIX J Sample State Professional Services Contract
RFP Summary
Important Dates:
RFP Published October 13, 2008
Questions Due October 20, 2008
Responses to Questions October 27, 2008
Proposals Due November 3, 2008
Anticipated Selection of Successful Responder(s) November 10, 2008
Anticipated Start of Contract November 15, 2008
Anticipated End of Contract April 30, 2008
Anticipated Extensions Unknown
Number of Copies: One original, two copies, one electronic on CD
State Contact: Sandy Burge
MN DHS
540 Cedar St.
P.O. Box 64993
St. Paul, MN 55164-0993
Phone: 651-431-3284
Email:
I. INTRODUCTION
A. PURPOSE OF REQUEST
The Minnesota Department of Human Services, through its Health Services and Medical Management Division (State), is seeking Proposals from qualified Responders to evaluate and report on the adequacy of rates paid to Minnesota Health Care Program (MHCP) providers, to ensure access to medical care in the fee-for-service delivery system.
B. OBJECTIVE OF THIS RFP
The objective of this RFP is to contract with a qualified Responder(s) to perform the tasks and services set forth in this RFP. The term of any resulting contract is anticipated to be for six months, from November 1, 2008 until May 31, 2009, with the option for one extension.
The department has estimated that the cost of this contract should not exceed $96,000.00. Price will be a factor in the evaluation of the Proposals. If sent by U.S. mail, Proposals must be received by November 3, 2008. If hand delivered or sent by carrier (e.g. UPS, FedEx, DHL), Proposals must be physically received by 2:30 p.m. Central Daylight Time on that date. This RFP does not obligate the State to award a contract or complete the project, and the State reserves the right to cancel the solicitation if it is considered to be in its best interest. All costs incurred in responding to this RFP will be borne by the Responder.
This RFP provides background information and describes the services desired by the State. It delineates the requirements for this procurement and specifies the contractual conditions required by the State. Although this RFP establishes the basis for Responder Proposals, the detailed obligations and additional measures of performance will be defined in the final negotiated contract.
C. BACKGROUND
The Office of Legislative Auditor (OLA) evaluated and reported in February, 2008, on the “Financial Management of Health Care Programs.” Chapter 3 of that report, “State Payment Rates for Health Care Programs,” concluded that the Legislature and the Department of Human Services (DHS) have not taken sufficient steps to address concerns about the adequacy and equity of Minnesota’s fee-for-service rates. They recommended that:
· DHS should report to the 2009 Legislature on the adequacy of Minnesota’s fee-for-service provider rates. As part of this analysis, DHS should identify service areas or regions of the state in which public program enrollees have had difficulty accessing providers.
· The Legislature should consider increasing fee-for-service payment rates for certain types of providers, such as primary care physicians.
The OLA report can be found at: http://www.auditor.leg.state.mn.us/ped/pedrep/healthcare.pdf
The fee-for-service rate discussion can be found on pages 49-53 of the report.
Based on the OLA evaluation and report, the Minnesota Legislature required DHS to report to the 2009 Legislature: “…the adequacy of public health care program for fee-for-service rates, including an identification of service areas or geographical regions where enrollees have difficulty accessing providers as the result of inadequate provider payments. This report must
include recommendations to increase rates as needed to eliminate identified access
problems.” Laws of Minnesota 2008, Chapter 364, Section 11, Paragraph (3). The report is due on January 15, 2009.
Minnesota pays for a majority of physician services at the lower of:
· The Provider’s submitted charge; or
· 80% of the 50th percentile of the charges submitted by all providers of this service in 1989.
The base year has not changed since 1992. This payment scheme means that fee-for-service rates are lower than Medicare reimbursement rates.
Another factor influencing whether providers participate in MHCP is Minnesota Law called, concisely, Rule 101. It stems from M.S. §256B.0644, which states that fee-for-service
providers must participate in Medical Assistance, General Assistance Medical Care and MinnesotaCare if they wish to participate as a provider in health insurance programs for state employees, the public employees insurance program, employees of cities, counties, and school districts, the workers’ compensation system, and the Minnesota Comprehensive Health Association. MHCP providers must either be currently accepting new MHCP patients or have a caseload of 20% MHCP clients, or for dentists, of 10% MHCP clients. The statute is fleshed out in Minn. Rules, Parts 9505.5200 – 9505.5249, otherwise known as Rule 101.
DHS’ Health Services and Medical Management Division (HSMM) seeks a vendor to evaluate, analyze and draft a report to be submitted by DHS to the Legislature on whether fee-for-service rates are sufficient to guarantee enrollee access to services.
II. SCOPE OF WORK
A. OVERVIEW
The Minnesota Department of Human Services (DHS) administers Minnesota Health Care Programs (MHCP), comprised of the Medical Assistance, General Assistance Medical Care, and MinnesotaCare health care programs. There are approximately 666,000 persons enrolled in MHCP. Of those approximately 463,000 are enrolled in and receive care from managed care organizations (MCOs). The remaining 203,000 receive their care through the fee-for-service system. For the most part, individuals in the fee-for-service delivery system are those who have a disability. It is important that individuals remaining in the fee-for-service delivery system have adequate access to providers.
The legislation referred to above requires DHS to look at the adequacy of the rates paid to fee-for-service providers, and whether those rates are sufficient to guarantee access to medical services.
All services under this contract shall be performed within the borders of the United States, except as may be otherwise required by the World Trade Organization Government Procurement Agreement of 1996[1]. This includes all storage and processing or information and work performed by subcontractors at all tiers.
B. TASKS/DELIVERABLES
1. Assist the DHS HSMM Division to answer thebasic question: Are fee-for-servicerates sufficient to guarantee enrollee access to services?
2. Research relationship between rates and access, with a primary focus on physician M.D. services.
a. within localities of the state;
b. by broad service type (physician, dental, hospital, etc.);
c. by type of provider (primary care vs. specialty);
d. by type of provider organization (i.e small group practice, large multi specialty group practice, large specialty group practice)
3. Provide an analysis of how physician rates/services compare to non-physician rates/services in order to determine and report provider types who are paid out of proportion to physician M.D.’s. This needs to be completed in order to report to the Legislature by January 15, 2009.
4. Compare other state Medicaid agency rates to Minnesota’s Medicaid rates and access to services within those states. This can be an analysis of all states or an analysis of states most similar to MN. This needs to be completed in order to report to the Legislature by January 15, 2009.
5. Analyze whether cost shifting or shifting of patient care settings are occurring, for example, patient/cost shifting from an entity/departmentthat cannot afford to serve fee-for-service enrollees to an entity/department that can assume the loss of serving fee-for-service enrollees due to the nature of their business or the size of their business. For example, if the primary care department of a large vertically integrated clinic has a highnumber of fee-for-service Medicaid enrollees, rendering the department a financial loss, is that primary care department more likely to refer patients to one of the clinic’s specialty departments that may be able to absorb the loss due totheir overall patient base or their increased revenue from procedural charges.
6. Survey of providers/enrollees: survey a sample of providers and enrollees, rural and metro, to understand any current stress providers and enrollees find in access (short of de-enrollment) due to the existing rate structure. Our information now is anecdotal, based on calls to our ombudsman office. The survey may be subcontracted, but information about the subcontractor must be included in the RFP.
7. Draft report
III. PROPOSAL FORMAT
Proposals must conform to all instructions, conditions, and requirements included in the RFP. Responders are expected to examine all documentation and other requirements. Failure to observe the terms and conditions in completion of the Proposal are at the Responder’s risk and may, at the discretion of the State, result in disqualification of the Proposal for nonresponsiveness. Acceptable Proposals must offer all services identified in Section II - Scope of Work and agree to the contract conditions specified throughout the RFP.
A. REQUIRED PROPOSAL CONTENTS
Responses to this RFP must consist of all of the following components (See following sections for more detail on each component).
1. Table of Contents
2. Technical Requirements
a. Statement of Understanding
b. Proposed Work Plan
c. Relevant Responder Experience/Resumes of Lead Responder Staff
3. Required Statements
a. Responder Information and Declarations
b. Exceptions to Terms and Conditions
c. Affidavit of Noncollusion
d. Trade Secret/Confidential Data Notification
e. Location of Service Disclosure and Certification
f. Proof of Targeted Group Small Business/Economically Disadvantaged
Small Business Certification
g. Affirmative Action Data Page
h. Certification and Restriction on Lobbying
i. State of Minnesota-Immigration Status Certification
5. Appendix (If Applicable)
Any additional information thought to be relevant, but not applicable to the prescribed format, may be included in the Appendix of your Proposal.
6. Cost Proposal
B. TECHNICAL REQUIREMENTS PROPOSAL
The following will be considered minimum requirements of the Technical part of the Proposal. Emphasis should be on completeness and clarity of content.
1. Statement of Understanding
This component of the Proposal should demonstrate the Responder's understanding of the services requested in this RFP, the nature of the contract, and any problems anticipated in accomplishing the work. Specifically, the Proposal should demonstrate the Responder's familiarity with the project elements, a summary of its solution(s) to the problems presented and knowledge of the requested services and/or deliverables.
2. Proposed Work Plan
The Responder should provide a description of the deliverables to be provided along with a detailed work plan that identifies how the major tasks are to be accomplished. The work plan should provide sufficient information to be used as a scheduling and managing tool. The work plan should show the Responder’s overall design of the project in response to achieving the deliverables as defined in this RFP. Responder should include proposed staffing for the project. Responder should include its risk assessment/management plan.
3. Relevant Responder Experience, Resumes of Lead Responder Staff
The Responder should demonstrate the length, depth, and applicability of prior experience in providing the requested services. This component of the Proposal must include previous experiences that will demonstrate the Responder's ability to deliver the services requested in this RFP. Responder may identify entities for which it has supplied similar services to those requested in the RFP, if any. If such organizations are identified, Responder should include each identified organization’s name and address, and the name, title and telephone number of a contact of each organization. Responder should also provide a narrative description of the actual services provided to the organization(s). Describe what role, if any, staff proposed for this project had in the referenced service. Letters of reference may be included.
The Responder should also demonstrate the skill and experience of proposed lead staff. At a minimum, resumes must be provided for employees who would be assigned lead responsibilities on this Project. Resumes should describe the education, professional affiliations, and other relevant background of the lead staff to be assigned to this project. No change in the Successful Responder’s personnel assigned to this project will be permitted without the prior approval of the State Program Manager.
C. INNOVATIVE CONCEPTS
The detailed needs and requirements for Responders in this RFP are not intended to limit the Responder’s creativity in preparing a Proposal. Responders may submit innovative ideas, new concepts, partnership arrangements, and optional features in response to this RFP. However, Responder must still address the needs and requirements stated in this RFP. Submitting only a different idea instead of addressing the needs and requirements stated in the RFP will result in the Responder’s Proposal being found nonresponsive and receiving no further consideration.
Any additional innovative concept submitted by a Responder will only be reviewed after the required needs stated in the RFP have been addressed. The State will review such additional features to determine whether or not, in the State’s sole discretion, the features enhance the rest of the Responder’s Proposal. If, at the State’s sole discretion, it is determined that the additional innovative concepts would enhance the rest of the Responder’s Proposal, the State may award bonus points to the Responder’s Proposal in accordance with the evaluation process of this RFP.