New York State
Medicaid Administrative Services
Vendors’ Conference
July 8th, 2013
10:00 AM ET
Today’s Agenda
Introduction
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10 minutes
Department of Health Introductions
Key MAS Procurement Dates
Designated Contacts
New York Medicaid Program Background
Procurement Overview
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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
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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
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Introduction
Speaker Introductions
Facilitator
Jonathan Halvorson
Deputy Director
Division of Systems
Office of Health Insurance Programs
Subject Matter Experts
Cynthia H. Beaudoin
Senior Attorney
New York State Department of Health
Division of Legal Affairs
Christine Hall-Finney
Director
Division of Systems
Office of Health Insurance Programs
Jonathan Bick
Director
Division of OHIP Operations
Office of Health Insurance Programs
Dennis Wright
Administration and Contracts Director
Division of Systems
Office of Health Insurance Programs
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Janet Elkind
Deputy Director
Division of Program Development and
Management
Office of Health Insurance Programs
Joseph Zeccolo
Fiscal Management Group,
Bureau of Contracts
Division of Administration
Key MAS Procurement Dates
Item
Date
RFP Release Date
06/25/2013
Written Questions Due
4:00 PM ET 07/18/2013
Response to Written Questions
on or about 08/16/2013
Proposal Submission Deadline
4:00 PM ET 09/25/2013
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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
Mr. Joseph Zeccolo
NYS Department of Health
Fiscal Management Group,
Bureau of Contracts
Phone: (518) 474-7896
Email: [email protected]
Contacts for
communications related to
the following subjects:
Contact for
communications related to
the following subjects:
• Debriefings
• Negotiation of Contract Terms
after Award
• Submission of Written Questions
• Submission of Written Proposals
• Procurement Library Requests
Mr. Dennis Wright
NYS Department of Health
Office of Health Insurance Programs
Division of Systems
Phone: (518) 649-4274 (work)
E-mail: [email protected]
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Mr. Patrick Allen
NYS Department of Health
Office of Health Insurance Programs
Division of Systems
Phone: (518) 649-4267
E-mail: [email protected]
New York Medicaid Program Background
SIZE
CURRENT MMIS:
eMedNY
NYS’S MEDICAID
REFORM
INITIATIVES
− 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
− 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.
− Governor Cuomo established the Medicaid Redesign Team (MRT) in January 2011, to
reform the Medicaid system and reduce costs.
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Procurement
Overview
Goals and Objectives of the MAS Procurement
GOALS
OBJECTIVES
− 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
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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
Pharmacy Benefit Management
Specific benefit carve-outs
Member and provider call center
Managed Care capitation payments
Coordination of benefits (private
third-party liability, Medicare dualeligibles)
Grievance and appeals
processes
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Provider screening, enrollment, and
recertification
Prior approval of certain services
Program integrity
Facilitation of Electronic Health
Records (EHR) incentive program
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 thirdparty 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.
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Comparing MAS Procurement to Traditional MMIS Procurement
High-Level Differences
Diverse Vendors
Emphasis on Existing Infrastructure
− 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)
− 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
High-Level Similarities
Fiscal Agent Responsibility and State Oversight
− 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 MMIS certification 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
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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
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Software Ownership Scenarios in the MAS Procurement
Summary of Scenarios
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:
Scenario
Description
Key Points
Scenario
1
Traditional MMIS vendor with
existing Fiscal Agent/MMIS clients
that transfers their custom
developed core solution to NYS
• Core solution was federally funded and
NYS-specific enhancements would be
federally funded
• Ownership of the system and the
enhancements would remain in the public
domain
Scenario
2
Non-traditional vendor (e.g., Health
Plan) with existing internally
developed claims processing
solution that will be leveraged for
NYS
• Vendor to define what is its proprietary
core solution
• Core package license is funded 75/25
Federal Financial Participation (FFP)
• Modifications/enhancements to
core/package for NYS funded at 90/10
FFP
• Enhancements for NYS that are federally
funded at any level become part of the
public domain
• The State can purchase, lease, or rent the
core/package solution upon
end/termination of contract for use by
successor Fiscal Agent
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Traditional MMIS vendor with a
COTS solution for claims processing
that will be configured for NYS
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Contract Schedule
Overview
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.
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RFP Review
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
− Presents the legal provisions that govern the resulting contract.
Attachments
− 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
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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)
MAS MITA 3.0 Business Architecture to Support Functional
Requirements
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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.
Electronic Submission
Original
Copies
Technical Proposal
5 Secure Flash Drives or Secure
CDs/DVDs with the following contents:
• 1 copy in Adobe PDF;
• 1 copy in MS Word 2007; and
• 1 copy of all project plans in MS Project
2007
3 Original Hard Copy
30 Hard Copies
Price Proposal
6 Secure Flash Drives or Secure
CDs/DVDs with the following contents:
1 copy in Adobe PDF (complete);
1 MS Office copy consisting of:
• Narrative in MS Word 2007 as needed;
and
• Attachment H Worksheets in MS Excel
2007
3 Original Hard Copy
6 Hard Copies
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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.
SECTION TITLE
Technical Architecture
Business Relationship Management
Care Management
Contractor Management
Eligibility and Enrollment
Management
Financial Management
Member Management
Operations Management
Performance Management
Plan Management
Provider Management
Service Level Agreements
Vendor Qualification and Experience
Organization and Staffing
Total
SECTION WEIGHT
10%
7.5%
5%
5%
5%
10%
7.5%
10%
5%
10%
7.5%
7.5%
5%
5%
100%
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Attachment H: Pricing Schedule Key Focus Areas
Pricing Schedule
− 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
Project Planning/ DDI/
Certification (Schedule B)
− 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 Base Fee
(Schedule C)
− 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
Operations Adjustment
(Schedule D)
Systems and Operational
Enhancement Payment Staff
(Schedule E)
Transition
(Schedule F)
− 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
− 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
− 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
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Evaluation Criteria
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%)
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
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 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.
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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.
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Q&A