The following document includes questions posed by bidder’s in response to Vermont’s Fiscal/Employer Agent RFP. The State continues to research some information. A follow up question and answer document will be provided. Please check the Vermont Bidder’s Registry for further updates.

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Bidder’s Conference

Vermont Fiscal/Employer Agent RFP

Attendance

  • Lisa Neveu - Department of Disabilities Aging and Independent Living (DAIL) F/EA Contract manager
  • Sara Lane -DAIL ASD
  • Andre Courcelle- DAIL ASD
  • Jim Euber- DAIL Business Office
  • Clare McFadden- DAIL DS
  • Adam Poulin- VT Department of Health
  • ACES$ FMS
  • Acumen Fiscal Agent
  • ARIS Solutions
  • FEi Systems
  • GT independence
  • PALCO
  • PCG Public Partnership
  • Premier- FMS

Brief Overview F/EA RFP

The Vermont Agency of Human Services, Department of Disabilities, Aging and Independent Living (DAIL) in conjunction with the Vermont Department of Health, Children with Special Health Needs manage a range of long-term support services in Vermont. Our core Programs include Developmental Disabilities Services, Children’s Personal Care services, the Attendant Services Program, Traumatic Brain Injury services, Choices for Care Long Term Care Medicaid, and the Older Americans Act services.

For more than 2 decades Vermont has been offering participant and surrogate directed programs. Currently there are five participant directed programs which serve approximately 5000 individuals receiving services and more than 14,000 employees.

The state of Vermont is seeking proposals from qualified vendors to act as a Fiscal/Employer Agent (F/EA) which is also known as a Fiscal Intermediary Service Organization [FISO] or Financial Management Service [FMS]).

  • Any prospective vendor must demonstrate the ability to function in Vermont, serving a complicated mix of programs to a relatively small number of participants per program.
  • The vendor will need to recognize that the participant employers or surrogate employers are not employment professionals and will require support, patience, and clear instructions to carry out their responsibilities.
  • The vendor chosen shall be culturally sensitive and emphasize the philosophy of self-direction in all business practices

The scope of work includes but is not limited to:

  • Assisting participating employers to learn and to carry out their responsibilities as employers.
  • Enrolling employers and employees and conducting background checks as needed
  • Accepting and processing timesheets
  • Submitting Medicaid Claims and making payments to employers
  • Compiling with the Department of Labor “Home Care Rule” and the Vermont Earned Sick Time Rules
  • Providing the required tax-related services
  • Ensuring unemployment and workers compensation policies are followed
  • Reporting suspected abuse neglect or exploitation of vulnerable if needed
  • Providing training and payroll related support to employers and employees

In addition, Vermont is not requiring but is inviting vendors to propose:

An Electronic Visit Verification (EVV) solution to meet the requirements of the 21st Century Cures Act and;

Due to the ongoing work by the Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) which has highlighted potential program integrity vulnerabilities in Home and Community Based Services, a secure method by which employees can submit a brief narrative describing the services provided during the time periods indicated on the employee’s timesheet.

SCHEDULE OF SIGNIFICANT DATES

RFP POSTED:Tuesday, July 18, 2017 (additions- 1 week later)

BIDDERS’ QUESTIONS DUE BY: Wednesday, August 9, 2017 -5:00 pm (EST)

POSTING RESPONSES TO

BIDDERS’ QUESTIONS:Tuesday, August 15, 2017

PROPOSALS DUE/ CLOSING DATE: Monday, August 28, 2017 -4:00 pm (EST)

BID OPENING:Tuesday, August 29, 2017 -1:00 PM (EST)

SELECTION NOTIFICATION BY:Monday, September 18, 2017

COMMENCEMENT OF CONTRACT:Friday, December 1, 2017

QUESTIONS

GENERAL

  1. Will the state record and publish who attended the conference both in person and via phoneand if so when will said information be released?

Response: The State will record and publish all known attendees to the conference. This documentation will be provided as part the question and answer summary published online.

  1. How many F/EAs will be awarded contract?

Response: Currently there is one F/EA for the programs identified. At this time, the State anticipates awarding only one contract.

  1. Who is the incumbent vendor(s)?

Response: ARIS Solutions, Inc.

  1. Pg. 24, Contract, Attachment A, Statement of Work, Can the State provide the proposed Statement of Work for the contract or clarify if the Statement of Work is intended to be the items included in Section 2 of the RFP?

Response: The Statement of Work will be developed based on the Specifications of Work to Be Performed (Section 2 of the RFP) and the vendor’s proposal. Pg. 24, Contract, Attachment A, Statement of Work was provided as a blank template for reference only.

  1. Pg. 25, Contract, Attachment B, Payment Provisions, 6., “The payment schedule for delivered products, or rates for services performed, and any additional reimbursements, are as follows:______” Can the State provide details surrounding the proposed payment schedule?

Response: Attachment B, Payment Provisions, was provided as a sample of the template for reference only. The payment provisions will be negotiated between the selected vendor and the State.

  1. Will the State consider a first payroll start of April 1, 2018, to align with the end of the tax quarter?

Response: The current contract is scheduled to end January 31, 2018.

  1. Does the State require a separate bank account for each program (CPCS, CFC, etc.)?

Response: Yes

  1. What is the difference between a case manager, service coordinator and consultant?

Response: Each program uses different terminology for these roles. Although the roles are similar, they include some variations by program.

  1. Is there a formal communication system/form to communicate with a case manager, service coordinator or consultant?

Response: Yes

ELECTRONIC VISIT VERIFICATION (EVV)

  1. This RFP indicates the State is interested in providers with EVV capability, in addition to FMS expertise. If we are capable of providing both, how would you like to see the pricing differentials detailed within the cost proposal?

Response:The cost of F/EA services should be provided independent of the EVV costs.

  1. Has EVV been negotiated with the Union? If not, what is the anticipated involvement of the union regarding EVV requirement development and implementation of the system? Response: The EVV has not been negotiated with the Union, this is a newer federal requirement.
  1. If there is backlash from the Stakeholders on EVV, will that affect the CBA?

Response:EVV is a federal requirement and if necessary the CBA will be amended.

  1. Can Participants purchase mobile technology solutions for use in EVV through the Goods and Services program?

Response:That has not yet been determined.

  1. The Current Business Environment section specifies a successful EVV solution as "..allowing for last minute scheduling changes.."To what extent does the State intend to employ scheduling for personal care services and home health care services?

Response: The EVV solution proposed must meet the federal requirements as identified in the 21st Century Cures Act. If vendors can offer additional services, the vendor is encouraged to document the additional service options in the proposal.

  1. The State is not requiring vendors bidding on the F/EA contract to provide EVV services. However within the budget proposal, the cost of EVV services and any one-time software development costs related to EVV must be provided as individual budget lines. Does the state anticipate in the future releasing a separate RFP for EVV or amending the awardees contract to include the EVV services they presented in their proposal?

Response: If the vendor is offering an EVV option, then the budget proposal and one-time software costs must be identified within the proposal. If the vendor is not providing an EVV option then EVV budget information is not required. The State has not made a decision regarding the implementation of EVV services in Vermont.

  1. Pg. 2, Section 1, “A successful EVV system will…[be] compatible with accessibility software.” There is a wide range of accessibility software, what degree of compatibility is expected?

Response: The EVV system must meet the requirements of the 21st Century Cures Act as well as the ADA. At a minimum, the system should support popular screen reader software (e.g. JAWS,NVDA), Text Magnification (ZoomText), and Dragon. Forms should also be accessible (e.g. logical tab order, alt-text on fields and images, etc.). Accessibility requirement standards include:

  1. What is the State’s anticipated start date for EVV? Does the state wish to implement prior to the deadline established by the Cures Act?

Response: The State is looking for a solution to meet the requirements of the 21st Century Cures Act and does not anticipate implementing the system earlier than required.

SECURE DOCUMENTATION SOLUTION

  1. The Current Business Environment section specifies fraud and waste prevention methods as desired capabilities in the solution. Will a solution that already has those featuresdeployed and in operation be scored in a favorable manner compared to proposals offering a future capability?

Response: Vendors are encouraged to document relevant experience.

PROGRAMS

  1. How many participants participate in the self-directed program?

Response:The average number of participants served per payroll:

Choices for Care (CFC) - 852

Attendant Services Program (ASP) -119

Developmental Services (DS) – 1,420

Children’s Personal Care Services (CPCS) - 649

Integrating Family Services Respite (IFSR)- 132

Adult Family Care Respite (AFC)- 4

Moderate Needs Flexible Funds (MNF)- 56

  1. How many individuals are currently enrolled in each self-directed program?

Response:

Choices for Care (CFC)- 852

Attendant Services Program (ASP) -126

Developmental Services (DS) – The State does not have current enrollment data available.

Children’s Personal Care Services(CPCS) - 1186

Integrating Family Services Respite (IFSR)- 366

Adult Family Care (AFC)- 82

Moderate Needs Flexible Funds (MNF)- 435

  1. What services can be self-directed under each program?

Response: The nature of these services are to be self or surrogate directed with the exception of TBI/AFC respite.

  1. What are the average service hours per participant?

Services are developed to meet the needs of the individual, this varies by program and service category. Some individual service budgets are based on the amount of funding rather than a specific number of hours.

  1. What is the average budget allocation?

Budgets are developed to meet the needs of the individual.

  1. What is average monthly Payroll by program?

Response:

Choices for Care - $1.75M

Attendant Services Program $240,000

Developmental Services - $2.5M

Children’s Personal Care Services - $915K

Integrating Family Services Respite- $105k

Adult Family Care Respite- $4k

Moderate Needs Flexible Funds - $1.5k

  1. Page 2, (1) Overview: “Currently there are five participant directed programs, many of which have more than one participant directed option. These programs serve close to 5,000 individuals receiving services, and more than 14,000 employees, with expected annual growth in most programs.” Can the state clarify the breakdown of participants across each program and if possible by region?

Response: Participant enrollment and average participants per payroll information has been provided in prior questions. Currently, the State does notcollect enrollment information by region.

  1. Are there participants enrolled in multiple programs?

Response: Yes, there are a small number of children who are enrolled in Children’s Personal Care Services in addition to another service.

  1. Are designated non-participant employers allowed to represent participants in multiple programs?

Response: Yes, surrogate employers can be employers for participants in multiple programs

  1. Approximately how many employees provide services in more than one program?

Response: This information is not currently available.

BUDGETS

  1. How is the budget and plan of care sent to the FMS?

Response: Most programs provide budget and care plan information electronically.

  1. How often is the budget revised?

Response: Annually or as needed by the participant.

  1. What occurs if a participant over spends his/her budget?

Response: The F/EA system should not pay more than the amount authorized in the budget.

  1. Is there overtime pay built into the budget?

Response: Not for most budgets. Participants may individually request additional funding to cover overtime expense, the State has a process for reviewing and approving these requests.

  1. NOTE: Programs have unique budget timelines and rules, for the following two questions, please refer to the Authorizations and Program Limitations section (2.B.) of the RFP.
  2. If a participant does not spend all of his or her budget in a single month, can the budget “roll over” to a subsequent month?
  3. How are the budgets structured? Does the participant have to utilize a certain number of authorized hours each pay cycle?
  1. “The participant works with an Intermediary Organization to detail how the expenditure of the service allocation/budget will be used.” Is this referring to the Fiscal Intermediary Service Organization or Supportive Intermediary Service Organization?

Response: The Supportive Intermediary Service Organization (currently Transition II)

  1. “The State, or for DS the provider agency or Supportive Intermediary Service Organization (ISO), will provide timely, correct and updated information for eligible individuals and changes in authorized services such as terminations, changes in plans of care, etc.” How often will the state provide updates on eligibilities and in what format will this information be communicated?

Response: The vendor is provided notification at time of enrollment and when changes occur. The communication format is dependent on program:

Choices for Care - Electronic

Attendant Services Program - Electronic

Developmental Services – Electronic

Children’s Personal Care Services - Paper

Integrating Family Services Respite- Electronic

Adult Family Care Respite- Paper

Moderate Needs Flexible Funds - Paper

GOODS AND SERVICES

  1. What is the volume of Goods and Services invoices, per pay period, per waiver? What is the total expenditure amount on Goods and Services, per pay period, per waiver?

Response: The State does not have access to this information at this time. The State estimates Goods and Services represent less than 10% of the payments processed.

  1. Does Goods and Services include Assistive Technology?

Response: Assistive Technology is included in Goods and Services for some programs including: Choices for Care, Developmental Services, Children’s Personal Care Services, and Moderate Needs Flexible Funds.

  1. On page 2, please explain what is meant by a “cash payment to participant.”

Currently a participant may be preapproved to receive a small amount in cash. This is to purchase goods or services that are not amenable to billing or vouchers such as cab rides or the neighbor who shovels the sidewalk.

  1. “Make payments for goods, services and in cash when requested by a participating employer and as allowed under state policies and procedures and program guidelines.”Are any current payments being made by cash? What record policy would be in place for cash payments? Can the State cite the referenced policies, procedures, and program guidelines surrounding the requirement to provide payment in cash upon participant request?

Response: Cash payments are made in the Choices for Care program see the Choices for Care High/Highest Program Manual- Flexible Choices Section

  1. “The F/EA shall also make miscellaneous payments for non-payment goods and services (e.g. health club memberships, yard and home maintenance, cab rides, etc.), pay all employment-related taxes for participating employers and employees, and make direct cash payments to participants as directed by the State. “Can the state clarify the process for direct cash payments? Is this done via direct deposit, cash card, check or actual cash?

Response: “Cash” payments can be made by the F/EA by check.

FAMILY DIRECT HI-TECH NURSES

  1. When the F/EA submits a bill to Vermont Medicaid Fiscal Agent (currently DXC) for Hi-Tech nurses, does the DXC send the payment directly to the nurse?

Response: The payment is not made by the F/EA. The F/EA acts only as a payroll service by submitting the timesheet to DXC. The number of individuals in this program is currently less than 12. DXC makes the payment directly to the nurse.

  1. What is format does the time sheet for Family Direct Hi Tech Nurses?

Response: The format is provided by DXC.

  1. Please elaborate on the statement that “the vendor does not produce checks?”

Response: The checks are provided by DXC directly to the provider.

  1. What paperwork is completed for nurses?

Response: The F/EA submits timesheets/claims to DXC.

PATIENT SHARE

  1. Is there a deductible/cost share option?

Response: Yes, for Choices for Care and TBI(called “Patient Share”)

  1. “Vendor must demonstrate that the software used by the vendor can accommodate all program needs and that the vendor has the capacity to modify the software if/when needs change. This includes, but is not limited to the management and processing of:…(4) patient share” What percentage of program participants currently have a patient share? What is the State’s process for managing those who do not pay their identified patient share?

Response: Approximately17% of CFC and TBI participants have a patient share. Within the Choices for Care High/Highest manual it states, “Nonpayment of patient share by the individual or legal representative may lead to the termination of services.”

  1. Is there an option for patient share to be deducted directly from the budget at the start of each calendar month, or through a deduction from the employee’s net wages?

Response: No

BACKGROUND CHECKS

  1. Are the background checks paid for from the participant’s budget or by the F/EA?

Response: By F/EA and the F/EA is paid for background checks though the administrative fees or in some cases by the provider agency.