Third Party Administration of Regional Jail Health Care Services

ISSUE DATE: March 8, 2024 TITLED: Third Party Administration of Regional Jail Health Care Services ISSUING AGENCIES: Albemarle Charlottesville Regional Jail Meherrin River Regional Jail Middle Peninsula Regional Jail Authority New River Valley Regional Jail Northern Neck Regional Jail Northwestern Regional Adult Detention Center Pamunkey Regional Jail Rappahannock Regional Jail Rockbridge Regional Jail Southside Regional Jail Southwest Virginia Regional Jail Authority Western Tidewater Regional Jail INITIAL PERIOD OF CONTRACT: 5 Years SEALED PROPOSALS WILL BE RECEIVED UNTIL: April 26, 2024 5:00 PM EST ALL INQUIRIES SHOULD BE DIRECTED TO: VARJ Executive Director Brandon Monk at admin@varj.org for dissemination to the evaluation committee ALL PROPOSALS SHALL BE MAILED OR HAND DELIVERED TO: Michelle Lewis, Jail Administrator Northern Neck Regional Jail P.O. Box 1090 3908 Richmond Road Warsaw, Virginia 22572 In compliance with this

Request For Proposal and all the conditions imposed herein, the undersigned offers and agrees to furnish the services in accordance with the attached signed proposal or as mutually agreed upon by subsequent negotiation. Name and Address of firm: Date: _____________ By: _____________ Zip: _____________ Title: _______________________ I. PURPOSE: The aforementioned Regional Jail Authorities (and Board) are public bodies that own and operate regional adult correctional facilities in the Commonwealth (“Regional Jails”). They are seeking proposals to secure third party administration of certain health care services for their inmate health care programs for the purpose of obtaining discounts mailto:admin@varj.org 2 from providers, paying claims, coordinating benefits for Medicaid-covered services, quality assurance, and utilization and case management. All defined services must be combined into the proposal, unless otherwise stated herein. This is a joint and cooperative procurement being conducted by the named Regional Jail Authorities (and Board) on behalf of themselves and other public bodies, pursuant to §2.2-4304 of the Code of Virginia. Contracts to more than one successful Offeror may be awarded, and not all participating jails will necessarily enter into contracts pursuant to this RFP. II. BACKGROUND: The Regional Jails provide health care and behavioral health care services (medical, dental, mental health, and substance use disorder treatment) for approximately 5,445 (Appendix B). The Regional Jails provide care through various means, including by not limited to staff providers, contracts with third party providers, and the public sector providers (e.g. community services boards, state mental health facilities, etc.). As used herein, providers are defined to include physicians, nurse practitioners, physician assistants, oral surgeons, dentists, optometrists, hospitals, pharmacies, labs, radiology departments, behavioral health clinicians, and allied health personnel. III. STATEMENT OF NEEDS/SCOPE OF SERVICES: Selected Offerors (“Contractor(s)”) shall meet the requirements of this Section and shall be able provide the Services as set out herein. A. Develop and maintain one or more networks of institutional and professional providers who, by contract, agree to accept discounted charges as payment in full for covered services. The credentialing of providers, maintenance of the network and communications with providers shall be a responsibility of the contractor. The Contractor shall ensure that 1. Providers continue to meet selection and screening criteria. 2. Providers maintain sufficient liability insurance. 3. Provider contracts remain in force. 4. Referral patterns and utilization of services are monitored continually for providers. 5. Provider discounts are secured to reduce costs. 6. State-wide provider access to all Regional Jail inmates. B. The contractor shall provide health claims processing including, but not limited to, the following: 1. Process all claims incurred during the life of the contract. 2. Check that pre-authorization, if required, was obtained. 3. Determine if the services provided were medically necessary. 4. Price the services. 3 5. Determine if the service could be covered by Medicaid pursuant to applicable state and federal regulations for the patient on the date of service and if so, include rational in any denial notice. 6. Generate and mail a check, if required, and an explanation of benefits (EOB) or denial notice. Payments and denial notices must be mailed within five business days of the date on which the claim was initiated. 7. Maintain a history of all claims paid. 8. Provide a monthly report summarizing the amount paid by category of covered service, the amount of services denied due to Medicaid coverage, C. The contractor shall develop and maintain a health care cost containment program. 1. Maintain a system for reviewing the continuing health care expenditures for services through public and in-house providers. 2. Provide for utilization review, case management, prospective, retrospective and concurrent review of all cases. Provide clinical/financial profiling and feedback state-wide of all regional jail staff and public sector providers. 3. Ongoing audit of bills from medical facilities utilized in the State of Virginia with respect to both the medical necessity and the documentation in the medical record of services for which charges have been made. 4. Provide meaningful clinical/financial reports to each regional jail to meet their budget and administrative needs. D. Medicaid. In addition to the services described above, Contractors are encouraged, but not required, to include in their proposals the management and administration of Medicaid enrollment, claims processing, and Medicaid reentry coordination for Inmates. This may include, but is not limited to: screening incarcerated individuals for potential Medicaid eligibility, providing application assistance for inmates to apply for Medicaid coverage, and coordinating care to ensure that Medicaid medical, mental health, and substance use disorder services are available in the community upon release. Contractors shall at a minimum be required to demonstrate a full understating of Medicaid eligibility and shall ensure that providers are not paid using jail funds for services that are eligible for Medicaid coverage. IV. PROPOSAL PREPARATION AND SUBMISSION REQUIREMENTS: A. GENERAL REQUIREMENTS: 1. RFP Response: In order to be considered for selection, Offerors must 4 submit a complete response to this RFP. One (1) original, five (5) copies of each proposal and a redacted version must be submitted. 2. Proposal Preparation: A. Proposals shall be signed by an authorized representative of the offeror. All information requested must be submitted. Failure to submit all information requested may require prompt submission of missing information and/or giving a lower evaluation of the proposal. Proposals which are substantially incomplete or lack key information may be rejected. Mandatory requirements are those required by law or regulation or are such that they cannot be waived and are not subject to negotiation. B. Proposals should be prepared simply and economically, providing a straightforward, concise description of capabilities to satisfy the requirements of this RFP. Emphasis should be on completeness and clarity of content. C. Ownership of all data, materials and documentation originated and prepared for the regional jails pursuant to this RFP shall belong exclusively to the regional jails and be subject to public inspection in accordance with the Virginia Freedom of Information Act, trade secrets or proprietary information submitted by an offeror shall not be subject to public disclosure if the offeror identifies, in writing, the data or material in accordance with Section 2.2-434 of the Code of Virginia. B. SPECIFIC PROPOSAL REQUIREMENTS: Proposals should be as thorough and possible so that your capabilities to provide the services may be evaluated. Offerors are required to submit the following items as a complete proposal. 1. The return of the RFP cover sheet and all addenda, if any, signed and filled out as required. 2. Complete Contractor Data Sheet, included as an attachment to the RFP, and other specific items or data requested in the RFP. 3. A written narrative statement to include: A. Experience in providing the services described herein. B. Approach to providing the service. 4. Specific plans for providing the proposed services including: A. What, when, and how services will be performed. B. Cost benefit analysis of proposed program defining estimated savings that can be anticipated. 5 C. A statement concerning ability to have statewide network and other facets of the program operational by January 1, 2025. 5. Proposed Pricing: Indicate in the pricing Schedule, Section XI, page 8 of this proposal. 6. A list of Discount rates that the Offeror has secured at each of the hospitals served by the Regional Jails for both inpatient and outpatient services. (see Appendix C for list of Hospitals). V. EVALUATION AND AWARD CRITERIA: A. Evaluation Criteria: Proposals shall be evaluated using the following criteria: 1. Experience in providing the Services. 2. Approach to providing the Services including quality assurance, network access, reporting/administration, Medicaid enrollment and claims administration, and provider discounts. 3. Reference from other clients. 4. Price. B. AWARD: Selection shall be made of two or more Offerors deemed to be fully qualified and best suited among those submitting proposals on the basis of the evaluation factors included in the Request For Proposals, including price. Negotiations shall be conducted with the Offerors so selected. Price shall be considered, but need not be the sole determining factor. After negotiations have been conducted with each Offeror so selected, an Offeror or Offerors shall be selected which have made the best proposal(s) and those Offeror(s) shall be awarded the contract based on the needs of the constituent facilities included. This Request for Proposal may be canceled at any time prior to an award. Should it be determined in writing that only one offeror is clearly more highly qualified than others under consideration, a contract may be negotiated and awarded to those offeror(s). The award document will be a contract incorporating by reference all the requirements, terms and conditions of this solicitation and the Contractor’s proposal as negotiated. Each constituent facility reserves the right to accept or reject the selected offeror(s) and/or enter into an agreement with the offeror(s) that they deem best meets the needs of their facility. VI. REPORTING AND DELIVERY REQUIREMENTS: A. GENERAL REPORTING REQUIREMENTS: 1. The proposal shall contain sample monthly/annual reports proposed by 6 the offeror which cover all of the standards of performance and critical workload items for the program. 2. Annual Report: The contractor shall deliver a comprehensive annual report of operations for each fiscal year ended June 30 within sixty days of the fiscal year end. The report shall contain appropriate statistical data and a narrative evaluation of the program and suggestions for improvements. 3. Medical Surgical Plan Reports: The contractor shall suggest specific formats and attach examples. VII. PRE-PROPOSAL CONFERENCE: A non-mandatory pre-proposal conference will be held at 1:30pm on March 26, 2024 at the Hilton Virginia Beach Oceanfront, 3001 Atlantic Ave. Virginia Beach, VA 23451. In lieu of attendance at the pre bid conference you may email admin@varj.org. The purpose of this conference is to allow Offerors an opportunity to present questions and obtain clarification relative to any facet of this solicitation. VIII. GENERAL TERMS AND CONDITIONS: A. APPLICABLE LAWS AND COURTS: This solicitation and any resulting contract shall be governed in all aspects by the laws of the Commonwealth of Virginia and any litigation with respect thereto shall be brought in the courts of the Commonwealth. The contractor shall comply with applicable federal, state, and local laws and regulations. B. ANTI-DISCRIMINATION: By submitting their proposals Offerors certify that they will conform to the provisions of the Federal Civil Act of 1964, as amended, as well as the Virginia Fair Employment Act of 1975, as amended, where applicable, the Virginians with Disabilities Act, the Americans With Disabilities Act and Section 11-51 of the Virginia Public Procurement Act. C. ETHICS IN PUBLIC CONTRACTING: By Submitting their proposals, Offerors certify that their proposals are made without collusion or fraud and that they have not offered or received any kickbacks or inducements from any other offeror, supplier, manufacturer or subcontractor in connection with their proposal and that they have not conferred on any public employee having official responsibility for this procurement transaction any payment, loan, subscription, advance, deposit of money, services or anything of more than nominal value, present or promised unless consideration of substantially equal or greater value was exchanged. D. QUALIFICATIONS OF OFFERORS: The Regional Jails may make such reasonable investigations as deemed proper and necessary to determine the ability of the offeror to perform the work and the Offeror shall furnish to the Regional Jails all such information and data for this purpose as may be requested. The Regional Jails reserve the right to inspect the Offeror’s physical facilities prior to award to satisfy questions regarding to Offeror’s capabilities. The Regional Jails further reserves the right to reject any proposal if evidence submitted by, or investigations of, such Offeror is not properly qualified to carry out the obligations of the contract and to complete the work contemplated therein. mailto:admin@varj.org 7 IX. SPECIAL TERMS AND CONDITIONS: A. CANCELLATION OF CONTRACT: The Regional Jails reserve the right to cancel and terminate any resulting contract, in part or in whole, without penalty, upon sixty days written notice to the Contractor. Any contract cancellation notice shall not relieve the contractor of the obligation to deliver and/or perform on all outstanding orders issued prior to the effective date of cancellation. B. RENEWAL OF CONTRACT: This contract may be renewed individually by any of the Regional Jail Authorities (Boards) for a period of four successive one year periods under the general terms and conditions of the original contract. Price increases may be negotiated only at the time of renewal. Written notice of a Regional Jail’s intention to renew shall be given approximately 90 days prior to the expiration date of the contract period. If such notice is not given, the contract shall become a month to month contract until either terminated as provided herein, or renewed in writing for an additional term. C. INDEMNIFICATION: Contractor agrees to indemnify, defend and hold harmless the Regional Jails, its officers, agents, and employees from any claims, damages and actions of any kind or nature, whether at law or in equity, arising from or caused by the use of any materials, goods, or equipment of any kind or nature furnished by the Contractor; any services of any kind or nature furnished by the Contractor, provided that such liability is not attributable to the sole negligence of the using agency or to failure of the using agency to use the material, goods, or equipment in the manner already and permanently described by the Contractor on materials, goods, or equipment delivered. D. SUBCONTRACTS: No portion of the work shall be subcontracted without prior written consent of the Regional Jails. X. METHOD OF PAYMENT: The offeror shall be paid on a monthly by each Regional Jail upon submission of a valid invoice to the applicable Regional Jail for services rendered the previous month. XI. PRICING SCHEDULE: The offeror agrees to provide the services in compliance with the Statement of Needs and the terms and conditions of this Request for Proposal at the rates quoted below: Firm fixed cost for full administration program including all labor, supplies, materials, or any other costs associated with providing the required services during the initial twelve month contract period. Price $______________________ XII. ATTACHMENTS: Appendix A Contractor Data Sheet Appendix B Regional Jail Population Summary 8 Appendix C List of Hospitals used by Regional Jails 9 APPENDIX A RFP CONTRACTOR DATA SHEET (To Be Completed By Offeror) 1. QUALIFICATIONS OF OFFEROR: The Offeror must have the capability and capacity in all respects to fully satisfy all of the contractual requirements. 2. YEARS IN BUSINESS: Indicate the length of time you have been in business providing this type of service. __________ Years __________ Months 3. REFERENCES: Provide below a listing of at least four recent references for whom you have provided the type(s) of requirement coverage by the Statement of Needs section of the solicitation. Include the date the services were rendered and the name, address, and telephone number of the person(s) whom we have your permission to contact. CLIENT ADDRESS CONTACT/PHONE # ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 10 APPENDIX B RFP REGIONAL JAIL POPULATION SUMMARY Albemarle Charlottesville Regional Jail 260 Meherrin River Regional Jail 238 Middle Peninsula Regional Jail Authority 130 New River Valley Regional Jail 625 Northern Neck Regional Jail 250 Northwestern Regional Adult Detention Center 600 Pamunkey Regional Jail 425 Rappahannock Regional Jail 1183 Rockbridge Regional Jail 56 Southside Regional Jail 180 Southwest Virginia Regional Jail Authority 1736 Western Tidewater Regional Jail 753 11 APPENDIX C RFP LIST OF HOSPITALS USED BY VIRGINIA REGIONAL JAILS Allegheny Community Hospital Augusta Health Bedford Memorial Hospital Bon Secours Haborview Bon Secours Memorial Regional Medical Center Bon Secours Richmond Community Hospital Bon Secours St. Francis Hospital Bon Secours St. Mary's Hospital Buchanan General Hospital Carilion New River Valley Medical Center Carillion Roanoke CarillionTazewell Community Hospital Centra Southside Community Hospital Chippenham Hospital Clinch Valley Medical Center Community Memorial Health Center Culpeper Memorial Hospital Dickenson County Hospital Fairfax Hospital Halifax Regional Hospital Health South Hospital Henrico Doctors' Hospital John Randolph Hospital Johnston Memorial Hospital Johnston-Willis Hospital Lee Community Hospital Lewis Gale Blacksburg Lewis Gale Montgomery Hospital Lewis Gale Pulaski Lonesome Pine Hospital Lynchburg General Hospital Martha Jefferson Hospital Mary Immaculate Hospital Mary View Medical Center Mary Washington Hospital Memorial Regional Medical Center Norfolk Community Hospital Norton Community Hospital Obici Sentara Hospital Prince William Hospital Portsmouth General Potomac Hospital Rappahannock General Hospital Riverside Tappahannock Hospital 12 Riverside Regional Medical Center Riverside Walter Reed Hospital Roanoke Hospital Russell County Hospital Sentara Belleharbour Sentara Hampton General Hospital Sentara Obici Hospital Sentara Rockingham Memorial Sentara Norfolk General Smyth County Community Hospital Southampton Memorial Hospital Southside Community Hospital Southern Virginia Regional Medical Center Southside Regional Medical Center Spotsylvania Regional Medical Center Stafford Hospital (Medicorp) Stonewall Jackson Hospital UVA Hospital VCU/ CMH South Hill, Virginia VCU Medical Center (formerly MCV) Virginia Baptist Hospital Williamsburg Community Hospital Winchester Medical Center Wythe Community Hospital Winchester Medical Center