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New York State Medicaid Administrative Services

New York State Medicaid Administrative Services. Vendors’ Conference July 8th, 2013 10:00 AM ET. Introduction 10 minutes Department of Health Introductions Key MAS Procurement Dates Designated Contacts New York Medicaid Program Background

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New York State Medicaid Administrative Services

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  1. New York StateMedicaid Administrative Services Vendors’ Conference July 8th, 2013 10:00 AM ET

  2. Introduction 10 minutes Department of Health Introductions Key MAS Procurement Dates Designated Contacts New York Medicaid Program Background Procurement Overview 15 minutes Goals and Objectives of the MAS Procurement Scope of the MAS Procurement Current and Future MMIS Components Comparing the MAS Procurement to a Traditional MMIS Procurement Software Ownership Scenarios in the MAS Procurement Vendor Preclusions/Restrictions Contract Overview 10 minutes Phases and Timeline Release of Medicaid System and Operational Components RFP Review 20 minutes RFP Structure/Components MITA Overview High-level Response Instructions Elaboration on Key Technical Requirements Attachment H: Pricing Schedule Key Focus Areas Evaluation Criteria 5 minutes Q&A 30 minutes Today’s Agenda

  3. Introduction

  4. Speaker Introductions Facilitator Subject Matter Experts Jonathan Halvorson Deputy Director Division of Systems Office of Health Insurance Programs Janet Elkind Cynthia H. Beaudoin Jonathan Bick Deputy Director Division of Program Development and Management Office of Health Insurance Programs Senior Attorney New York State Department of Health Division of Legal Affairs Director Division of OHIP Operations Office of Health Insurance Programs Joseph Zeccolo Christine Hall-Finney Dennis Wright Fiscal Management Group, Bureau of Contracts Division of Administration Director Division of Systems Office of Health Insurance Programs Administration and Contracts Director Division of Systems Office of Health Insurance Programs

  5. Key MAS Procurement Dates

  6. Designated Contacts Please note that all communication in relation to this procurement, MUST go through the below contacts only Contact for all communications attempting to influence this procurement or related to subject matter pertinent to this solicitation • Contacts for communications related to the following subjects: • Debriefings • Negotiation of Contract Terms after Award Contact for communications related to the following subjects: • Submission of Written Questions • Submission of Written Proposals • Procurement Library Requests Mr. Joseph Zeccolo NYS Department of Health Fiscal Management Group, Bureau of Contracts Phone: (518) 474-7896 Email: jxz02@health.state.ny.us Mr. Dennis Wright NYS Department of Health Office of Health Insurance Programs Division of Systems Phone: (518) 649-4274 (work)E-mail:  dxw07@health.state.ny.us Mr. Patrick Allen NYS Department of Health Office of Health Insurance Programs Division of Systems Phone: (518) 649-4267 E-mail: pwa01@health.state.ny.us

  7. New York Medicaid Program Background • Largest Medicaid program in the US • Along with affiliated programs, it provides health care coverage to over five (5) million New Yorkers • Medicaid Managed Care: 3.3 million, Family Health Plus: 430,000, Child Health Plus: 340,000 SIZE • Encompasses a variety of components allowing it to process over 2 million transactions per day in 2012, 1.3 million of which are claims • Provides application access for the Department, other State agencies, LDSS, and providers • Provides a variety of capabilities such as transaction processing, web-based application for the State, internet application for provider access, external file transfer, etc. CURRENT MMIS: eMedNY NYS’S MEDICAID REFORM INITIATIVES • Governor Cuomo established the Medicaid Redesign Team (MRT) in January 2011, to reform the Medicaid system and reduce costs.

  8. Procurement Overview

  9. Goals and Objectives of the MAS Procurement GOALS • Solicit proposals for an MAS contractor to provide fiscal agent services and other services for the NYS Medicaid Program in a manner that complies with Centers for Medicare & Medicaid Services (CMS) guidelines and certification requirements for an MMIS • Replace existing eMedNY functions, except encounter processing • Ensure that the new system will meet CMS certification requirements and comply with all federal regulations and policy • Take over clinical review and administration functions, including claims processing, for NYS pharmaceutical programs including the Elderly Pharmaceutical Insurance Coverage (EPIC) Program, the New York Prescription Saver Program (NYPS), and the Preferred Diabetic Supply Program (PDSP) • Take over administration of MEIPASS incentive program for electronic health record adoption • Take over prior approval functions from DOH staff OBJECTIVES

  10. Scope of the MAS Procurement The prime contractor must provide fiscal agent services and will be responsible for replacement of the current NYS MMIS with a new mechanized claims processing and information retrieval system. Services include, but are not limited to, the following (a full set of required services is provided in Attachment E): Claims adjudication, payment, and post-payment adjustment Provider servicing, communication, and education Provider screening, enrollment, and recertification Pharmacy Benefit Management Prior approval of certain services Specific benefit carve-outs Member and provider call center Managed Care capitation payments Program integrity Grievance and appeals processes Facilitation of Electronic Health Records (EHR) incentive program Coordination of benefits (private third-party liability, Medicare dual-eligibles)

  11. Current and Future Components of MMIS • The scope of this procurement does not represent the entire MMIS enterprise • Current NYS MMIS is comprised of eMedNY and the Medicaid Data Warehouse (MDW). The MMIS interfaces with the Welfare Management System (WMS), managed care organizations (MCOs), the managed care enrollment broker, and the state's third-party liability (TPL) contractor to provide MMIS functions • The diagram below provides an overview of the future MMIS environment and interactions with other major NYS systems, delineating the division of high-level responsibilities among the various entities.

  12. High-Level Differences High-Level Similarities Emphasis on Existing Infrastructure Diverse Vendors Fiscal Agent Responsibility and State Oversight • Vendors expected to focus on configuring existing infrastructure and platforms for claims processing, customer service, care managerment and other services where possible • The COTS product(s) delivered by the contractor will be licensed to the Department in accordance with contractor’s or other independent software vendor’s (ISV) standard license agreement, amended if necessary to satisfy Section VI: Contract Requirements • Procurement open for vendors including but not limited to traditional MMIS vendors, System Integrators, Medicare Administrative Contractors (MACs), Admnistrative Services Organization (ASOs), and commercial and Medicaid managed care organizations (MCOs) • The primary contractor is expected to provide fiscal agent services and other services for the NYS Medicaid Program in a manner that complies with CMS guidelines and MMIScertification requirements as identified in the CMS Medicaid Enterprise Certification Toolkit (MECT) • The contractor will configure and supplement its existing infrastructure to provide selected health program administration services to NYS, but will not bear health insurance risk for member coverage. Health insurance risk and fiduciary responsibility for member coverage still reside with NYS • Regardless of whether the Department owns or licenses particular components of the system, it must have access to and oversight of all systems and records procured as part of the MAS procurement to ensure its ability to determine and enforce compliance with requirements of the MAS RFP Comparing MAS Procurement to Traditional MMIS Procurement

  13. Vendor Preclusions/Restrictions Primary Contractor Subcontractor • An MCO that provides risk-based capitated Medicaid services in NYS is not eligible to function as the fiscal agent and therefore it cannot submit a proposal as a prime vendor to the RFP, but can serve as a subcontractor • NYS has elected to carve drug rebate responsibilities out in a separate procurement because of the openness of the MAS contract to commercial and Medicaid health plans • Medicaid MCOs currently providing or intending to provide Medicaid services in NYS can be included as a subcontractor but must be insulated from providing the following services or having exposure to/interaction with the following information: • FFS Payments • Maternity kick payment processing • Stop-loss • Capitation payments

  14. Summary of Scenarios Software Ownership Scenarios in the MAS Procurement The ownership rights of the contractor in relation to existing commercially distributed software product(s) as well as conditions on license grant are provided in detail in Section VI: Contract Requirements. The scenarios below help to provide further guidance on ownership:

  15. Contract Schedule Overview

  16. Phases and Timeline The contract will be awarded for five (5) years with the option to renew for three (3) additional one (1) year periods at the sole option of the State. The initial five (5) year period would begin in January 2014 and include all project planning, DDI, operations, certification, and operational enhancement tasks.

  17. RFP Review

  18. RFP Structure/ Components RFP Section I • Provides Procurement Overview including vision, goals and objectives, term of the contract and scope of work summary RFP Section 2 • Provides description of the NYS Medicaid Program and current MMIS environment • Describes ancillary and related MMIS systems and components RFP Section 3 • Includes SOW and guiding principles of the procurement • Describes project personnel requirements, performance and monitoring expectations, including the service level agreements RFP Section 4 • Provides an overview of the proposal requirements • Includes proposal submission instructions, technical and price proposal contents, certifications and the evaluation process RFP Section 5 • Provides an overview of the NYS Administrative requirements • Includes designated contacts for submission of the proposal • Describes department and contractor responsibilities and elaborates on the appendices RFP Section 6 Attachments • Presents the legal provisions that govern the resulting contract. • Standard RFP attachments for NYS and DOH • Attachment E: Vendor Requirements Traceability Matrix (provides technical requirements) • Attachment H: Pricing Schedule (provides a cost template to be filled by the vendor) Note: The RFP and its attachments become part of the final contract

  19. MAS MITA 3.0 Business Architecture to Support Functional Requirements MITA Overview • Importance of Attachment E: Vendor Requirements • Developed based on the business needs of NYS, MITA 3.0 and CMS MMIS Certification Requirements • Organized by overarching technical architecture and the MITA 3.0 Business Architecture framework • New Framework MITA 3.0: • Addresses the new legislative requirements outlined in the Health Information Technology for Economic and Clinical Health Act, the Children’s Health Insurance Program Reauthorization Act, and the Patient Protection and Affordable Care Act • Reflects the use of newer technologies such as Service-oriented architecture (SOA)

  20. Response Instructions (High Level) • Detailed response instructions are provided in Section IV of the RFP. • Responses must be received by the Department in Albany, New York no later than the time and date specified in the RFP. • Separate electronic files should be produced for each proposal section as outlined in this RFP and clearly identified through the file name for the section the file represents. • The Department discourages overly lengthy proposals. • Hard and electronic copies should contain identical information. The hard copy is the copy of record.

  21. Elaboration on Key Technical Requirements Vendors are advised to submit proposals that are comprehensive and clearly reflect the technical proposal requirements. This includes, among other proposal requirements, contractor and staff background, understanding of the scope of the project, responsiveness to specifications, a robust SDLC that includes adequate project and schedule controls, adequacy of staffing levels, etc.

  22. Pricing Schedule Attachment H: Pricing Schedule Key Focus Areas Project Planning/ DDI/ Certification (Schedule B) • Provides a summary total of all information entered on the sheets that follow • Reimbursable Postage and Potential Annual Satisfaction Incentive are provided as estimates for budgetary purposes and should not be altered by the bidder Operations Base Fee (Schedule C) • Total Project Planning, DDI, and Certification price MUST be no more than 25% of the proposed Total Price on Tab A: Pricing Schedule. • Milestone based payment during this phase. Operations Adjustment (Schedule D) • Operations price must specify a fixed monthly price to operate the solution for the first contract year and annual price for contract years 2, 3, 4 and 5 • Transaction pricing is used to determine the payment due for allowed types of transactions on a per transaction fee basis if the number of transactions goes over the baseline range specified in the RFP • The baseline range is based on historical data and future projections Systems and Operational Enhancement Payment Staff (Schedule E) • This phase commences with the start of the contract and includes both maintenance and enhancement tasks that must be performed throughout the life of the contract • Any and all system and operational enhancements that are applicable to multiple customers of the contractor will be executed at no additional cost to the State, but unique enhancements will be paid for on a monthly estimate based on a rate card Transition (Schedule F) • Vendors should submit the fixed price for all activities required to support the transition tasks required by this RFP and as detailed in the Transition Plan approved by the Department

  23. Evaluation Criteria

  24. Evaluation Approach Compliance Assessment • The Compliance Assessment will have a pass/fail screening that includes the following requirements: • All vendor proposal materials were submitted to the Procurement Officer on or before 4:00 PM ET 09/25/2013 • Attachment E: Vendor Requirement Traceability Matrix and Attachment H: Pricing Schedules have been completed in the correct format using the spreadsheets provided in the MAS RFP Vendor Technical Proposal (70%) Vendor Price Proposal (30%) The price proposal score will be normalized as follows: C = (A ÷ B) * 30% where: A is the total price of the lowest price proposal; B is the total price of the price proposal being evaluated; and C is the Price Score The technical raw scores will be normalized as follows: N = (A÷B) * 70% where: A is the raw score of the proposal being evaluated; B is the highest technical score; and N is the Technical Score The State will select a contractor using the Best Value award methodology. Best Value is defined in Article XI, Section 163 (1)(j) of the NYS Finance Law as the basis for awarding contracts for services to the vendor which optimizes quality, cost and efficiency, among responsive and responsible vendors.

  25. Evaluation Approach Minority and Women Owned Businesses • For purposes of this solicitation, the Department hereby establishes an overall goal of at least 10% for M/WBE participation. • 5% Minority-owned business • 5% Women-owned business • A contractor that does not propose at least 10% of total contract value expensed to NYS-certified M/WBE firms must document good faith efforts to provide meaningful participation by MWBEs in the performance of the contract. • Directory of certified businesses: http://www.esd.ny.gov/mwbe.html.

  26. ? Q&A

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