florida healthy kids corporation i nvitation to n egotiate b idder ’ s c onference florida healthy...

FLORIDA HEALTHY KIDS CORPORATION

INVITATION TO NEGOTIATE

BIDDER’S CONFERENCEFlorida Healthy Kids Corporation

Health Benefits Coverage Underwriting and Services

March 22, 2010 – 9:00 a.m.

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•Non-profit corporation created in 1990•One of 4 Florida KidCare Program Components•Part of Florida’s CHIP\Title XXI Program•Serving children ages 5 through age 18

•This ITN covers only children in the Healthy Kids program

www.healthykids.org

What is the Florida Healthy Kids Corporation?

www.healthykids.org

Scope of Invitation to Negotiate

• To secure a choice of managed care plans in designated counties (Phase I)

• Covers 14 counties with at least 3,000 enrollees

• An overlay with the existing insurer

• Effective January 1, 2011

www.healthykids.org •

Scope of Invitation to Negotiate

• No guarantee of minimum enrollment

– FHKC expects to continue to insure existing enrollment

– Future enrollment based on funding

– Award of contracts based on available funding

– Continuation of incumbent based on contract negotiations; not a rebid of current contracts

www.healthykids.org

Evaluation Process

• Two Step Process– First Step:

• Must offer an insured product• Must meet the minimum benefit specifications• Cannot increase the cost sharing specifications• Cannot change the program’s objectives

– Second Step:• Evaluated consistent with state law• Factors that may be considered under Section III

www.healthykids.org

Evaluation Process

• Personal Interviews– Conducted in Tallahassee– Open Meetings

• Submissions should be complete, organized and concise– Subject to public review after award– FHKC can review and evaluate without further

input or clarification

www.healthykids.org

Calendar

• Subject to Change– Monitor the Healthy Kids Website regularly– Keep contact information up to date

• Key Dates to Remember– Mandatory Letter of Intent: March 26,

2010– Question & Answer Period Ends: April 23,

2010– Proposal Deadline: May 19, 2010 –

12:00 Noon

www.healthykids.org

Single Point of Contact

• Contact only the Issuing Officer – lloydj@healthykids.org– (850) 701-6108

• Contacting any other person is grounds for disqualification

www.healthykids.org

Questions Regarding this ITN

• Must be submitted in writing to Issuing Officer

• Faxed or emailed only – no phone calls

• Accepted through April 23, 2010

• Questions will be posted to web by May 7th

www.healthykids.org

Mandatory Bidder’s Conference - NEW

• Mandatory participation at Bidder’s Conference

– Bids will only be accepted from Bidder’s Conference participants

– Questions answered today will be transcribed and posted

– Answers today are preliminary until posted

www.healthykids.org

Supplemental Information Requests• Written requests will be

considered on a case by case basis– Information will be posted to the web

– Public records can be viewed through appointments

– Proposals, grading tools, materials as part of this ITN are not available until the process has been concluded

www.healthykids.org •

Other Terms

• Amendments to the ITN

• Special Disclosures

• Most Favorable Terms

• Withdrawals

www.healthykids.org

Competitive Negotiation Process

• FHKC may enter negotiations with selected bidders

• FHKC may elect to execute a contract or contracts with a selected bidder or bidders without any further negotiation

• Therefore, proposals should be submitted in complete form

www.healthykids.org •

Limitations

Bidders cannot submit proposals for the same county under multiple plans that are affiliated or linked by shared ownership or controlling interests.

www.healthykids.org

Submission Requirements

www.healthykids.org

Submission Requirements

• Volumes must be 3-Ring Notebooks

• Easily flip-able and read-able materials

• WORD, EXCEL and PDF files only

• Clearly marked Tabs and sub-tabs required

www.healthykids.org •

Changes Since Last ITN

• Mandatory Letter of Intent (LOI)Tab B

– Required Letter of Intent by deadline to submit proposal

– Due Friday, March 26, 2010

– LOI is non-binding and can be withdrawn at any time

– Organization, contact information, counties

www.healthykids.org •

Changes Since Last ITN

• Evidence of Regulatory AuthorityTab C

– Evidence of regulatory authority must be in place as of the date the proposal is submitted to FHKC

– Evidence required is based on the model being proposed

www.healthykids.org

Changes Since Last ITN

• Program Management\ConfidentialityTab G-6

– Describe compliance with activities related to Health Information Technology for Economic and Clinical Health Act (HITECH)

www.healthykids.org

Changes Since Last ITN

• Implementation and Transition PlansTab H

– Plans for handling members transitioning from other insurers after January 1, 2011

– Transition plan goes through September 30, 2011

www.healthykids.org •

Reporting Requirements

• Existing Insurers: Current Compliance status

• Non-Incumbent: – Must initiate testing phase prior to Personal

Interview with at least one (1) exchange to move on in process

– Must complete testing process to continue evaluation process or may be disqualified

– Completion determined by date of Purchasing & Oversight Committee meeting (final grades)

– Bidder’s sole responsibility to complete

www.healthykids.org

Standard Contract\Contract Amendment• Existing Insurers will be asked to

execute an amendment if awarded additional counties

• New Insurers will execute the final contract

• Revisions not generally acceptedMust affirmatively accept contractPoints deducted for substantive

changes

www.healthykids.org

Contract\Contract Amendment

• Current contract template provided for reference with most recent changes highlighted

• New provisions recently identified by federal CMS

• Updated template with required revisions will be posted by April 5th

www.healthykids.org

Provider Networks – Volume II

• Must be provided EXACTLY as prescribed

• Information only for counties covered by LOI unless Enrollees may access services in those counties AND meets access standards

• Required Summary Sheets (NEW)

www.healthykids.org •

Changes Since Last ITN

• Provider Listings NEW

– List only those providers already under contract

– If the provider must still complete contracting, their rows must be shaded

– FHKC may request evidence of such contracts

www.healthykids.org

Changes Since Last ITN

• Summary Sheets Tab A & Appendix

– Summary Sheet found in Appendix should be first page in Tab A followed by EXCEL listing of providers

– GEO ACCESS map of board certified only providers mapped to Enrollees required

www.healthykids.org

Changes Since Last ITN

• Specialists Tab B & Appendix– Summary Sheet found in Appendix listing

Specialists should be first page in Tab B followed by EXCEL listing of providers

– Providers for the county being bid should be first followed by any other providers available within neighboring counties meeting contract standards

– Within the county listing, the next sort order should be alphabetical by the specialty and then alphabetical by provider last name

www.healthykids.org

Changes Since Last ITN

• Affiliated Entities Tab I

– New Tab

– Response required

– Affirmative response if does not apply

www.healthykids.org

Volume III – Rate Proposals

• Three presentation options provided• Single combined rate for 14 counties• Single rate for any group of counties• Individual county rates

• Special Optional response for a statewide proposal

www.healthykids.org •

Other New Provisions Since Last ITNEffective July 1, 2009: • Permits children income and clinically eligible

children for CMS to opt-out of CMS into Healthy Kids.

Effective October 1, 2009:• Managed Care Protections Policy– 90 day free look policy for all new Enrollees– Good cause exceptions after lock-in occurs– 90 day choice period after implementation for

all existing Enrollees in new choice counties

www.healthykids.org

Delivery of Services – Background Information• Standards for delivery of services • Access (Primary Care, Specialty, Hospital,

BH\SA)• Appointment• Credentialing

• Board certified primary care physicians only• Pediatricians and family practice

• Calculations used adequacy provided

www.healthykids.org •

Appendix Documents

• Word versions of these will be posted to the website

• Current FHKC Insurers may use FHKC as one of the three required references

• Summary sheets for designated Tabs are required

www.healthykids.org

Specialty Care Provider Summary Sheets• Only those providers that see the

majority of Enrollees within the Healthy Kids age range (5-18) should be listed.

• Example:• A Specialist only sees those over

age 16 – should not be included on summary sheet; can be included on the EXCEL provider listing behind the summary sheet

• Ok, if sees children over age 10

www.healthykids.org

Premium Rate Proposal Form

• Premium Rate Proposal Form

–Only those rates that are presented on the required form will be considered

www.healthykids.org •

Supplemental Information

• Utilization Data–Will be posted to the website in EXCEL– Notation regarding change in plans

• Data Layouts and Submission Guidelines

www.healthykids.org

Question and Answer Period

Question and Answer Period

Break

www.healthykids.org

Final Words

• Any conflict between today’s presentation and the ITN, the ITN provision controls

• Today’s verbal responses are preliminary. Final written responses will be posted to the Healthy Kids’ website – www.healthykids.org

• Contact Only the Issuing Officer

www.healthykids.org •

Issuing Officer Contact Information

Jennifer Kiser LloydChief External Affairs Officer

lloydj@healthykids.org(850) 701-6108 – Phone ; (850) 224-0615 –

Fax

661 E. Jefferson Street2nd Floor, Florida Bar AnnexTallahassee, Florida 32301