Failure to notify the Procurement Officer of any conflicts or ambiguities in the Request for Proposal may result in items being resolved in the best interest of the State. Any modification to this RFP as a result of the Pre-Bid Vendor Conference, as well as written answers to written questions, shall be made in writing by official addendum and posted to the Division of Purchases’ web site, http://da.ks.gov/purch/. All vendors are advised that only written communications are binding.
It shall be the responsibility of all participating VENDORs to acquire any and all addenda and additional information as it is made available from the web site cited above. VENDORs need to check the web site periodically for any additional information or instructions.
Reference Forms: VENDORs are advised to pay particular attention to RFP Section 3.2.13. Immediate and timely action is required concerning references.
Expression of Interest Form: VENDORs should submit an Expression of Interest Form at their earliest convenience during the procurement process. Please see RFP Section 3.2.7.1.1, for instructions. The form is found in RFP Section 5.
RFP Definitions: Throughout this RFP the following terms shall be used to designate mandatory and non-mandatory requirements:
MAY, SHOULD, CAN, OPTIONALLY: Denotes desirable, non-mandatory specifications, features, or functions.
MUST, WILL, SHALL: Denotes mandatory specifications, features, or functions; a requirement that must be met without alteration.
Preface
|
High Priority Events and Items
|
1
|
|
Table of Contents
|
3
|
Foreword
|
Request for Proposal (RFP) Organization
|
15
|
RFP Section 1
| RFP PURPOSE, CONTRACTOR(S) DUTIES, BACKGROUND, IMPLEMENTATION AND GENERAL AND ADMINISTRATIVE INFORMATION |
17
|
RFP Section 1.1
|
PURPOSE
|
17
|
RFP Section 1.2
|
CONTRACTOR RESPONSIBILITIES
|
17
|
RFP Section 1.3
|
BACKGROUND
|
19
|
RFP Section 1.3.1
|
SUD Program
|
20
|
RFP Section 1.3.2
|
Mental Health (MH)
|
20
|
RFP Section 1.3.3
|
Current Waivers
|
22
|
RFP Section 1.3.4
|
Enrollment and Assignment Criteria
|
26
|
RFP Section 1.3.5
|
State Agencies and Programs
|
26
|
RFP Section 1.3.6
|
Categories of Eligibility
|
28
|
RFP Section 1.4
|
IMPLEMENTATION
|
29
|
RFP Section 1.5
|
GENERAL AND ADMINISTRATIVE INFORMATION
|
29
|
RFP Section 1.5.1
|
Mandatory Qualifications
|
29
|
RFP Section 1.5.2
|
MCS Procurement Schedule
|
30
|
RFP Section 1.5.3
|
Explanation of MCS Procurement Schedule and Process
|
30
|
RFP Section 1.5.4
|
Disability Accommodation Request
|
31
|
RFP Section 1.5.5
|
CONTRACTORS’ Subcontractors
|
31
|
RFP Section 1.5.6
|
CONTRACTOR’S Proposal
|
31
|
RFP Section 1.5.7
|
Cost of Preparing Proposal
|
32
|
RFP Section 1.5.8
|
Signature of Proposals
|
32
|
RFP Section 1.5.9
|
Modification of Proposals
|
32
|
RFP Section 1.5.10
|
Withdrawal of Proposals
|
32
|
RFP Section 1.5.11
|
Acknowledgment of Amendments (Addenda)
|
32
|
RFP Section 1.5.12
|
Waiver of Minor Irregularities
|
32
|
RFP Section 1.5.13
|
Acceptance or Rejection
|
33
|
RFP Section 1.5.14
|
Proposal Disclosures
|
33
|
RFP Section 1.5.15
|
Disclosure of Proposal Content and Proprietary Information
|
33
|
RFP Section 1.5.16
|
Exceptions
|
34
|
RFP Section 1.5.17
|
Notice of Award
|
34
|
RFP Section 1.5.18
|
Correspondence
|
34
|
RFP Section 1.5.19
|
Evaluation of Proposals
|
34
|
RFP Section 1.5.20
|
Appearance Before the Procurement Negotiating Committee
(PNC)
|
35
|
RFP Section 1.5.21
|
Negotiated Procurement
|
35
|
RFP Section 1.5.22
|
Competition
|
35
|
RFP Section 1.5.23
|
Accessible Technology
|
35
|
RFP Section 1.5.24
|
News Releases
|
36
|
RFP Section 1.5.25
|
Commercial Advertising
|
36
|
RFP Section 1.5.26
|
Procurement Card (P-Card)
|
36
|
RFP Section 1.5.27
|
Political Subdivisions
|
36
|
RFP Section 2
| SCOPE, APPROACH AND OTHER REQUIREMENTS |
38
|
Section 2.1
|
SCOPE
|
38
|
RFP Section 2.2
|
APPROACH
|
38
|
RFP Section 2.2.1
|
Services Included and Not Included in this CONTRACT
|
38
|
RFP Section 2.2.2
|
Geographic Service Area
|
38
|
RFP Section 2.2.3
|
Functions and Duties of the CONTRACTOR(s)
|
38
|
RFP Section 2.2.4
|
Provider Credentialing and Re-credentialing
|
39
|
RFP Section 2.2.5
|
Contracting with Providers for Cultural Competence, Diversity and Special Needs
|
40
|
RFP Section 2.2.6
|
Children with Special Health Care Needs (CSHCN)
|
41
|
RFP Section 2.2.7
|
Provider Hours of Operation
|
42
|
RFP Section 2.2.8
|
Provider Network
|
42
|
RFP Section 2.2.9
|
Relationship between CONTRACTOR and Network Providers
|
45
|
RFP Section 2.2.10
|
Network Management
|
46
|
RFP Section 2.2.11
|
Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
|
47
|
RFP Section 2.2.12
|
Member Health Risk Assessment:
|
48
|
RFP Section 2.2.13
|
Value-Added Services
|
49
|
RFP Section 2.2.14
|
Health Information Technology and Health Information Exchange (HIT/HIE)
|
51
|
RFP Section 2.2.15
|
General Access Standards
|
55
|
RFP Section 2.2.16
|
Health Literacy and Prevention
|
58
|
RFP Section 2.2.17
|
Member Handbook and Notification
|
59
|
RFP Section 2.2.18
|
Reproduction and Distribution of Materials
|
63
|
RFP Section 2.2.19
|
Choice of Health Professional
|
63
|
RFP Section 2.2.20
|
Medical Transportation
|
63
|
RFP Section 2.2.21
|
Quality Management
|
64
|
RFP Section 2.2.22
|
External Quality Review Organization (EQRO)
|
68
|
RFP Section 2.2.23
|
Grievances and Appeals
|
68
|
RFP Section 2.2.24
|
Clinical and Medical Records
|
69
|
RFP Section 2.2.25
|
Coordination and Continuation of Care
|
70
|
RFP Section 2.2.26
|
Provision of Health Homes
|
74
|
RFP Section 2.2.27
|
Encounter Data and Other Data Requirements
|
75
|
RFP Section 2.2.28
|
Disclosure of Financial Records
|
75
|
RFP Section 2.2.29
|
Appeals to the State for CONTRACTOR Non-payment of Non-participating Providers
|
77
|
RFP Section 2.2.30
|
Program Integrity and Disclosure Requirements
|
77
|
RFP Section 2.2.31
|
Consumer Fraud and Abuse
|
78
|
RFP Section 2.2.32
|
Administrative Lock-In
|
78
|
RFP Section 2.2.33
|
Use of and Safeguarding Data
|
79
|
RFP Section 2.2.34
|
Advance Directives
|
80
|
RFP Section 2.2.35
|
Member Rights and Protection
|
82
|
RFP Section 2.2.36
|
Reproductive Services
|
82
|
RFP Section 2.2.37
|
Information Requirements
|
83
|
RFP Section 2.2.38
|
Timely Claims Payment
|
83
|
RFP Section 2.2.39
|
Members are not Held Liable
|
85
|
RFP Section 2.2.40
|
Utilization Management Activities
|
85
|
RFP Section 2.2.41
|
CONTRACTOR Staffing
|
87
|
RFP Section 2.2.42
|
Customer Service
|
89
|
RFP Section 2.3
|
OTHER REQUIREMENTS
|
91
|
RFP Section 2.3.1
|
Functions and Duties of the State
|
91
|
RFP Section 2.3.2
|
Cooperation with Other Agencies
|
92
|
RFP Section 2.3.3
|
Enrollment, Marketing and Disenrollment
|
93
|
RFP Section 2.3.4
|
Reports and Audits
|
98
|
RFP Section 2.3.5
|
Post-Pay Recovery {Third Party Liability (TPL)} and Coordination of Benefits
|
103
|
RFP Section 2.3.6
|
Payment
|
103
|
RFP Section 2.3.7
|
Facilities and Equipment
|
108
|
RFP Section 3
|
PROPOSAL RESPONSE
|
111
|
RFP Section 3
|
SUBMISSION REQUIREMENTS, TECHNICAL PROPOSAL, COST PROPOSAL, AND DELIVERABLES
|
111
|
RFP Section 3.1
|
SUBMISSION REQUIREMENTS
|
111
|
RFP Section 3.1.1
|
Proposal Submission Media
|
111
|
RFP Section 3.1.2
|
Submission Information
|
111
|
RFP Section 3.1.3
|
Proposal / RFP Response Instructions
|
112
|
RFP Section 3.2
|
TECHNICAL PROPOSAL
|
112
|
RFP Section 3.2.1
|
Technical Proposal Title Page
|
112
|
RFP Section 3.2.2
|
Technical Proposal Tab A – Transmittal Letter
|
113
|
RFP Section 3.2.3
|
Technical Proposal Tab B – RFP Addenda
|
114
|
RFP Section 3.2.4
|
Technical Proposal Tab C – Table of Contents
|
114
|
RFP Section 3.2.5
|
Technical Proposal Tab D – Executive Summary
|
114
|
RFP Section 3.2.6
|
Technical Proposal Tab E – Corporate Qualifications and Experience
|
114
|
RFP Section 3.2.7
|
Technical Proposal Tab F – Administrative Requirements
|
115
|
RFP Section 3.2.8
|
Technical Proposal Tab G – Corporate Information
|
116
|
RFP Section 3.2.9
|
Technical Proposal Tab H – Vendor Response to Section 2.1 SCOPE
|
117
|
RFP Section 3.2.10
|
Technical Proposal Tab I – Vendor Response to Section 2.2 APPROACH
|
117
|
RFP Section 3.2.11
|
Technical Proposal Tab J – Vendor Response to Section 2.3 OTHER REQUIREMENTS
|
117
|
RFP Section 3.2.13
|
Technical Proposal Tab K – References
|
117
|
RFP Section 3.2.14
|
Technical Proposal Tab L – VENDOR Assumptions
|
118
|
RFP Section 3.2.15
|
Technical Proposal Tab M - Exceptions
|
118
|
RFP Section 3.3
|
COST PROPOSAL
|
119
|
RFP Section 3.3.1
|
Cost Proposal Title Page
|
119
|
RFP Section 3.3.2
|
Cost Proposal Tab A – Table of Contents
|
120
|
RFP Section 3.3.4
|
Cost Proposal Tab B – Administrative Requirements
|
120
|
RFP Section 3.3.5
|
Cost Proposal Tab C – Percentage Discount from the Lowest Cost Estimate Rate
|
120
|
RFP Section 3.3.6
|
Cost Proposal Tab D – VENDOR Cost Assumptions
|
120
|
RFP Section 3.4
|
DELIVERABLES
|
120
|
RFP Section 3.4.1
|
Detailed Implementation Time Line
|
120
|
RFP Section 3.4.2
|
Detailed Network Development Plan
|
120
|
RFP Section 3.4.3
|
Turnover Plan
|
120
|
RFP Section 3.4.4
|
Staffing Contingency Plan
|
121
|
RFP Section 3.4.5
|
Performance Bond
|
121
|
RFP Section 3.4.6
|
Other Deliverables
|
121
|
RFP Section 4
|
CONTRACT TERMS AND CONDITIONS
|
122
|
RFP Section 4.1
|
ACCEPTANCE
|
122
|
RFP Section 4.1.1
|
Terms and Conditions
|
122
|
RFP Section 4.1.1.1
|
Contract Documents
|
122
|
RFP Section 4.1.1.2
|
Contract
|
122
|
RFP Section 4.1.1.3
|
Contract Formation
|
122
|
RFP Section 4.1.1.4
|
Notices
|
123
|
RFP Section 4.1.1.5
|
Termination for Cause
|
123
|
RFP Section 4.1.1.6
|
Termination for Convenience
|
123
|
RFP Section 4.1.1.7
|
Debarment of State Contractors
|
124
|
RFP Section 4.1.1.8
|
Rights and Remedies
|
124
|
RFP Section 4.1.1.9
|
Force Majeure
|
124
|
RFP Section 4.1.1.10
|
Waiver
|
124
|
RFP Section 4.1.1.11
|
Independent Contractor
|
124
|
RFP Section 4.1.1.12
|
Staff Qualifications
|
125
|
RFP Section 4.1.1.13
|
Subcontractors
|
125
|
RFP Section 4.1.1.14
|
Proof of Insurance
|
125
|
RFP Section 4.1.1.15
|
Conflict of Interest
|
125
|
RFP Section 4.1.1.16
|
Confidentiality
|
125
|
RFP Section 4.1.1.17
|
Nondiscrimination and Workplace Safety
|
126
|
RFP Section 4.1.1.18
|
Environmental Protection
|
126
|
RFP Section 4.1.1.19
|
Hold Harmless
|
126
|
RFP Section 4.1.1.20
|
Care of State Property
|
126
|
RFP Section 4.1.1.21
|
Prohibition of Gratuities
|
126
|
RFP Section 4.1.1.22
|
Retention of Records
|
126
|
RFP Section 4.1.1.23
|
Antitrust
|
127
|
RFP Section 4.1.1.24
|
Modification
|
127
|
RFP Section 4.1.1.25
|
Assignment
|
127
|
RFP Section 4.1.1.26
|
Third Party Beneficiaries
|
127
|
RFP Section 4.1.1.27
|
Captions
|
127
|
RFP Section 4.1.1.28
|
Severability
|
127
|
RFP Section 4.1.1.29
|
Governing Law
|
128
|
RFP Section 4.1.1.30
|
Jurisdiction
|
128
|
RFP Section 4.1.1.31
|
Mandatory Provisions
|
128
|
RFP Section 4.1.1.32
|
Integration
|
128
|
RFP Section 4.1.1.33
|
Criminal or Civil Offense
|
128
|
RFP Section 4.1.1.34
|
Injunctions
|
128
|
RFP Section 4.1.1.35
|
Statutes
|
129
|
RFP Section 4.1.1.36
|
Federal, State and Local Taxes
|
129
|
RFP Section 4.1.1.37
|
Accounts Receivable Set-Off Program
|
129
|
RFP Section 4.1.1.38
|
Definitions
|
129
|
RFP Section 4.1.1.39
|
HIPAA Confidentiality
|
129
|
RFP Section 4.1.1.40
|
Off-Shore/Foreign Sourcing of Services
|
133
|
RFP Section 4.1.1.41
|
Immigration and Reform Control Acct of 1986 (IRCA)
|
133
|
RFP Section 4.1.1.42
|
Worker Misclassification
|
134
|
RFP Section 4.1.1.43
|
Mandatory Provisions
|
134
|
RFP Section 4.1.1.44
|
Payment
|
134
|
RFP Section 4.1.1.45
|
Performance Guaranty Bond
|
134
|
RFP Section 4.1.1.46
|
Equipment
|
135
|
RFP Section 4.1.1.47
|
Implied Requirements
|
135
|
RFP Section 4.1.1.48
|
Warranty
|
135
|
RFP Section 4.1.1.49
|
Acceptance
|
135
|
RFP Section 4.1.1.50
|
Ownership
|
135
|
RFP Section 4.1.1.51
|
Data
|
135
|
RFP Section 4.1.1.52
|
Submission of the Bid
|
136
|
RFP Section 4.1.1.53
|
VENDOR Contracts
|
136
|
RFP Section 4.1.1.54
|
Transition Assistance
|
136
|
RFP Section 4.1.1.55
|
Award
|
136
|
RFP Section 4.1.1.56
|
Termination for Unavailability of Funds
|
136
|
RFP Section 4.1.1.57
|
Termination Obligations of Contractor and the State of Kansas
|
136
|
RFP Section 4.1.1.58
|
Payment Retainage
|
137
|
RFP Section 4.1.1.59
|
Survival of Terms
|
137
|
RFP Section 4.1.1.60
|
Legal Authority
|
137
|
RFP Section 4.1.1.61
|
Contractual Limitations
|
137
|
RFP Section 4.1.1.62
|
Disputes
|
140
|
RFP Section 4.1.1.63
|
Administrative Review
|
140
|
RFP Section 4.1.1.64
|
Suspension of New Enrollment
|
141
|
RFP Section 4.1.1.65
|
Withholding of Capitation Payment
|
141
|
RFP Section 4.1.1.66
|
Liquidated Damages – Failure to Meet Performance Requirements
|
141
|
RFP Section 4.1.1.67
|
Federal Financial Participation
|
142
|
RFP Section 4.1.1.68
|
Other Contracts by the Contractor and the State
|
143
|
RFP Section 4.1.1.69
|
Assignments and Mergers
|
147
|
RFP Section 4.1.1.70
|
Continuation of Coverage
|
147
|
RFP Section 4.1.1.71
|
Temporary Management Provisions
|
147
|
RFP Section 4.1.1.72
|
Other Contract Provisions
|
147
|
RFP Section 4.1.1.73
|
Compliance with State and Federal Anti-discrimination Laws
|
148
|
RFP Section 4.1.1.74
|
Environmental Protection Laws
|
149
|
RFP Section 4.1.1.75
|
Compliance with Applicable Law
|
150
|
RFP Section 4.1.1.76
|
Use of Federal Funds
|
150
|
Section 4 – Terms and Conditions
|
Signature Page
|
150
|
RFP Section 5
|
FORMS
|
151
|
RFP Section 5
|
Expression of Interest Form
|
152
|
RFP Section 5
|
Signature Sheet
|
153
|
RFP Section 5
|
Supplier Diversity Survey Form
|
154
|
RFP Section 5
|
Tax Clearance Instructions
|
157
|
RFP Section 5
|
Certification Regarding Immigration Reform & Control
|
158
|
RFP Section 5
|
KanCare Medicaid and CHIP Managed Care Services Reference Questionnaire
|
160
|
RFP Section 5
|
Disclosure Agreement
|
163
|
ATTACHMENTS
|
Attachment A
|
Contractual Provisions Attachment (DA-146a)
|
|
Attachment B
|
American Academy of Pediatrics Recommendations for Pediatric Health Care
|
|
Attachment C
|
Definitions & Acronyms
|
|
Attachment D
|
Grievance & Appeals
|
|
Attachment E
|
Advisory Committee on Immunization Practices Immunization Schedule
|
|
Attachment F
|
Services Covered
|
|
Attachment G
|
Liquidated Damages
|
|
Attachment H
|
Reports
|
|
Attachment I
|
Health Home Model
|
|
Attachment J
|
State Quality Strategy
|
|
Attachment K
|
Encounter Data & Other Data Requirements
|
|
Attachment L
|
Program Integrity and Disclosure Requirements
|
|
EXHIBITS
|
Exhibit 1-1
|
Kansas Medical Eligibility
|
|
Exhibit 1-2
|
Application for Medical Coverage
|
|
Exhibit 1-3
|
MC Enrollment 09-2011
|
|
Exhibit 2-1
|
Medicaid Fee-for-Service Schedule
|
|
Exhibit 2-2
|
FY 11 T-XIX Certification and XIX and XXI Rate Ranges
|
|
Exhibit 2-3
|
FY12 T-XIX Certification and Rate Ranges
|
|
Exhibit 2-4
|
FY12 T-XXI Certification and Rate Ranges
|
|
Exhibit 2-5
|
CMHC Screening Reimbursement Methodology
|
|
Exhibit 2-6
|
MH Screening Rate
|
|
Exhibit 2-7
|
MH Concurrent Review Cost Model
|
|
Exhibit 2-8
|
Payment Integrity Report
|
|
Exhibit 2-9
|
HW MCO Reporting Template
|
|
Exhibit 3-1
|
KS CDDO Locations
|
|
Exhibit 3-2
|
KNI Admissions Policy
|
|
Exhibit 4-1
|
AAPS Integrated Data System
|
|
Exhibit 5-1
|
KDOA Field Service Manual
|
|
Exhibit 5-2
|
NOMS Requirements for Admission and Discharge
|
|
Exhibit 5-3
|
SUD Screening Instrument
|
|
Exhibit 6-1
|
MH Screening for Continued Stay NFMH
|
|
Exhibit 6-2
|
Screens for Continued Stay Long Form NFMH
|
|
Exhibit 6-3
|
Screens for Continued Stay Short Form NFMH
|
|
Exhibit 6-4
|
MH Managed Care Reports
|
|
Exhibit 6-5
|
HCBS-MRDD Handbook
|
|
Exhibit 6-6
|
FE Waiver
|
|
Exhibit 6-7
|
MH Screening Form
|
|
Exhibit 6-8
|
Request for Exception to Age 18 Criteria SED
|
|
Exhibit 6-9
|
Request for Exception to CCBL Criteria SED
|
|
Exhibit 6-10
|
Current Evidence Supporting Member’s Need for Level of Care in State MH Hospital SED
|
|
Exhibit 6-11
|
Notification of HCBS or Working Healthy Services SED
|
|
Exhibit 6-12
|
HCBS-SED Waiver Initial Clinical Eligibility
|
|
Exhibit 6-13
|
HCBS Autism Waiver Eligibility
|
|
Exhibit 6-14
|
Autism Waiver Services
|
|
Exhibit 6-15
|
HCBS PD Waiver Eligibility
|
|
Exhibit 6-16
|
HCBS TBI Waiver Eligibility
|
|
Exhibit 6-17
|
TA Waiver ACIL Manual
|
|
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