STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION REQUEST FOR INFORMATION AHCA RFI 005-14/15 ENROLLMENT BROKER AND RECIPIENT SUPPORT SYSTEM AND SERVICES A. GENERAL INFORMATION 1. Purpose This is a Request for Information (RFI) as defined in Section 287.012(22), Florida Statues, for planning purposes. This RFI is issued by the State of Florida, Agency for Health Care Administration (Agency), to solicit information regarding available providers for the services described herein. A RFI is not a method of procurement. Responses to a RFI are not offers and shall not be accepted by the Agency to form a binding Contract. This RFI and responses to it shall not result in the execution of a Contract with the Agency. By submitting a response to this RFI, a Vendor is not prohibited from responding to any related subsequent solicitation. This RFI may be used for purposes of determining whether or not to competitively procure a commodity or contractual service, determining what solicitation process to use, or researching general, special, and/or technical specifications for a solicitation. The Agency reserves the right to utilize the information gathered through the RFI process to develop a scope of services, which may be incorporated into a Contract using a statutorily approved method of procurement. 2. Background Florida Medicaid provides health coverage to nearly 3.8 million Floridians in all sixtyseven counties, and has enrolled more than 117,000 health care providers. During the 2011 Florida Legislative Session, the Legislature created a new program called Statewide Medicaid Managed Care (SMMC), which changed how some individuals receive health care from the Florida Medicaid program in all sixty-seven counties. SMMC has two (2) components, each serving a different population for Florida Medicaid recipients: Long-term Care (LTC) which is responsible for rendering long-term care, managed care related services to Florida Medicaid recipients who are 18 years and older and meet both medical and financial eligibility requirements and are allowed to enroll into the program. Managed Medical Assistance (MMA) which is responsible for rendering managed care related services to Florida Medicaid recipients who meet financial eligibility requirements and are allowed to enroll into the program. As the Agency is responsible for administering the SMMC program, the Agency has reorganized in structure and methodology with regard to functional and systematic AHCA RFI 005-14/15, Page 1 of 5
operations. This change impacts how the Agency views personnel needs, as well as technological needs. Automated Health Systems (AHS) is the Florida Medicaid enrollment broker for the current Contract and performs choice counseling for the SMMC program. The Agency s Contract with AHS currently expires February 29, 2016, with the option to extend through August 29, 2016, if need is determined. Through the choice counseling, the State offers extensive enrollee education and information about managed care plan choices so Medicaid recipients will fully understand their choices and be able to make an informed selection. The Agency must undertake planning and research related to procurement of a new enrollment broker Contract and enhancements. 3. Agency Project Goals and Schedule The goals of the enrollment broker procurement project are: a. Determine the best solution, including the potential for Federal financial participation under 42 Code of Federal Regulations 433.15 as part of the Medicaid enterprise business model aligned with Medicaid Information Technology Architecture (MITA) framework; b. Improve the scope and quality of data for program management, including detailed information on recipient characteristics and plan choices; c. Expand automated processes, with a focus on communications, workflow and electronic records; d. Expand flexibility for integrating with Agency enterprise initiatives, such as Florida Medicaid Management Information System (MMIS)/Decision Support System (DSS) implementation, consolidation/integration of Agency complaint intake/tracking, etc.; and e. Deploy innovative solutions that allow for efficient and rapid response to ongoing changes to the Medicaid program. 4. Statement of Need The Agency is envisioning seeking an enrollment broker Vendor for development, implementation and operation of a system to address the greater business activities of the Agency with regard to Medicaid recipient support functions for the purpose of administering the SMMC program including the following services: a. Enrollment broker services, including choice counseling and processing managed care enrollment requests, assignments and change processing, in a timely, consistent and coordinated manner; b. Call center, mail fulfillment and field based services with regards to supporting enrollment broker services and other recipient related needs; c. A web-based system for the purpose of documenting and coordinating diverse and complex interactions (e.g. complaints, request for good cause disenrollment AHCA RFI 005-14/15, Page 2 of 5
and/or Medicaid Fair Hearings) between the Agency, recipients and other stakeholders; d. Systems access for State recipient support personnel, to include scheduling and field activity tracking and assignment, with development and provision of ongoing State user training and support for the system; e. Tracking, storing and reporting activity captured in the system, including, but not limited to call and complaint intake and resolution; f. Use of managed care network submissions, received either directly or indirectly, from plans for choice counseling as well as evaluation, reporting and network adequacy; g. Flexible and user driven reporting capabilities and/or integration of data with enterprise Data Warehouse/DSS solutions; and h. Enhanced data exchange with State and Federal agencies integrated web functionality for Agency stakeholders and the general public. B. RFI RESPONSE INSTRUCTIONS Respondents to this RFI are asked to be thorough, but concise. The RFI response must include the following: 1. Thorough description of the respondent s organizational capacity and its business experience as it relates to the services outlined in this RFI. 2. A statement of interest in or knowledge of the services outlined in this RFI, including a high level outline of any specific product, concept, technology or approach that would pertain to the information sought through this RFI. 3. A budget narrative estimating the implementation and operational costs for the services outlined in this RFI. 4. Projected project staffing which includes anticipated and/or known risks for implementation of the project, including an implementation schedule for the development of a system as described. 5. Contact Information On the cover page of the response submission, the respondent must include the following contact information: a. Project tile; b. Respondent Name; c. Address; d. Contact Phone Numbers (Voice, Mobile), E-Mail Address; and e. Web Site Address, if applicable. AHCA RFI 005-14/15, Page 3 of 5
C. PROPRIETARY INFORMATION Any portion of the submitted response which is asserted to be exempt from disclosure under Chapter 119, Florida Statutes, shall be clearly marked exempt, confidential, or trade secret (as applicable) and shall also contain the statutory basis for such claim on every page containing such exempt information. Pages containing trade secrets shall be marked trade secret as defined in Section 812.081, Florida Statutes. Failure to segregate and identify such portions shall constitute a waiver of any claimed exemption and the Agency will provide such records in response to public records requests without notifying the respondent. Designating material simply as proprietary will not necessarily protect it from disclosure under Chapter 119, Florida Statutes. An entire response should not be considered trade secret. D. RESPONSE SUBMISSION Respondents to this RFI shall submit one (1) electronic copy of its response. The response shall not exceed one hundred (100), single-sided, pages in length. The electronic format shall be submitted on CD-ROM. The software used to produce the electronic files must be Microsoft Word 97 and/or Excel 97 or newer. The electronic files must be logically named. The respondent shall also submit one (1) electronic redacted copy of the response suitable for release to the public. Any confidential or trade secret information covered under Section 812.081, Florida Statutes, should be either redacted or completely removed. The redacted response shall be marked as the redacted copy and contain a transmittal letter authorizing release of the redacted version of the response in the event the Agency receives a public records request. Responses to this RFI shall be provided no later than 5:00 PM, Eastern Standard Time, April 08, 2015. Responses shall be submitted to: Agency for Health Care Administration Procurement Office Attn: Jennifer Barrett 2727 Mahan Drive, MS 15 Tallahassee, FL 32308 procurement@ahca.myflorida.com After the Agency has received all responses to this RFI, the Agency, in its sole discretion, shall determine if a meeting with respondents is necessary to clarify the information received. In the event that the Agency decides to hold a meeting, the respondent(s) will be notified via email. E. VENDOR COSTS Vendors are responsible for all costs associated with preparing a response to this RFI. The State of Florida, Agency for Health Care Administration, will not be responsible for any Vendor costs associated with preparing a response to this RFI. AHCA RFI 005-14/15, Page 4 of 5
F. QUESTIONS Questions concerning this RFI should be submitted in writing via email to procurement@ahca.myflorida.com. All responses to questions received will be made, in writing, directly to the sender. G. AGENCY FOR HEALTH CARE ADMINISTRATION WEBSITE Additional information about the Florida Agency for Health Care Administration can be found on the Agency s website at: http://ahca.myflorida.com/ REMAINDER OF PAGE INTENTIONALLY LEFT BLANK AHCA RFI 005-14/15, Page 5 of 5