Health Benefits Manager

Project: Health Benefits Manager Ref. #: HSS-24-037 Type: RFP Status: Open Open Date: Mar 14th 2024, 7:00 AM EDT Questions Due Date: Apr 11th 2024, 11:30 PM EDT Close Date: May 10th 2024, 1:00 PM EDT Days Left: 7 Project Description:A. OVERVIEW The Vendor(s) shall provide all equipment, materials, and labor to supplement the State of Delaware’s need for Health Benefits Manager as described herein. The contract will require the Vendor(s) to cooperate with the ordering agency to ensure the State receives the most current state-of-the-art material and/or services. B. BACKGROUND This document is a Request for Proposals for interested vendors to provide a set of services to the Delaware Medicaid and Delaware Healthy Children Program (DHCP) populations through the Diamond State Health Plan (DSHP), and Diamond State Health Plan Plus (DSHP-Plus). The services to be provided by the selected vendor consist of activities to support Members both before and after enrollment in an MCO. These

activities include but are not limited to benefit and program education and non-biased assistance to Members in the choice of an enrollment into managed care organizations (MCOs). These services are to be delivered as an integral part of the Medicaid managed care programs, Diamond State Health Plan, Diamond State Health Plan Plus and Delaware Healthy Children Program. The purpose of this Request for Proposal (RFP) is to solicit bids from qualified organizations to perform services according to the terms and conditions set forth herein. The State of Delaware desires to contract with one (1), independent Health Benefits Manager (HBM) per the attached specifications. This RFP primarily describes the program standards with which the contracting HBM must comply. It also includes information on the policies and procedures that the State will follow in carrying out its program management and oversight responsibilities. Program Oversight The Delaware Department of Health and Social Services (DHSS) is an umbrella agency that is responsible for the administration of most of the State's health-related services. Included in its twelve Divisions is the Division of Medicaid & Medical Assistance (DMMA). The DMMA is officially designated as the administrator of the State's Medicaid and Healthy Children programs. This administrative responsibility is discharged at the operational level through the Managed Care Operations Unit in the Division of Medicaid & Medical Assistance. The Medicaid program is the Title XIX Federal-State health program for certain categorically eligible low-income groups. The Delaware Healthy Children Program is the State’s Title XXI program for low- income children (SCHIP). In addition to State agency oversight, the Center for Medicare and Medicaid Services (CMS) also will monitor Delaware's Medicaid managed care program activities through its Regional office in Philadelphia, Pennsylvania and its central office in Baltimore, Maryland. The Delaware Department of Health and Social Services (DHSS) is the issuing agency for this RFP. Delaware Medicaid Delaware receives on average 54 percent matching funds from the Federal government for this program. In State Fiscal Year (SFY) 2023 (July 2022 to June 2023), total Medicaid expenditures were $3,267,890,354. There were 312,754 average monthly eligibles for SFY 2023. There were 253,471 average monthly eligibles in the Diamond State Health Plan for SFY 2018. Presently, the DMMA State Managed Care program contracts with three Managed Care Organizations (MCOs) to provide services to 229,810 Medicaid and 7,933 Delaware Healthy Children enrollees. The services required under the Diamond State Health Plan program for this proposal shall be provided for one or more MCOs. Delaware Medicaid provides coverage to various populations who meet the Federal Poverty Level (FPL) and other eligibility requirements. Below are the FPL guidelines: • Pregnant women and infants with incomes up to 212% of the FPL • Children age 1 to 5 with incomes up to 142% of the FPL • Children ages 5 to 18 (until the end of the month when the child turns 19) with incomes up to 133% of the FPL • Adults with incomes up to 133% of the FPL Effective 12/20/17, an Amendment was made to the 1115 Waiver to provide Medicaid state plan coverage to former foster care youth under age 26 who were in foster care under the responsibility of another state or tribe when they "aged out" of foster care at age 18 (or such higher age as elected by the other state) and were enrolled in Medicaid at that time. Delaware Medicaid also provides Long Term Services and Supports (LTSS) through both managed Long-Term Care under Diamond State Health Plan Plus and through fee-for-service for the Division of Developmental Disabilities Services (DDDS) waiver. Individuals must qualify both medically and financially to receive LTSS in Delaware. The HBM would be responsible for providing assistance to these groups of individuals as well. The 1915(c) DDDS Lifespan Waiver amendment increases the waiver enrollment limits to include individuals with intellectual and developmental disabilities, autism, and/or Prader-Willi Syndrome who have left school but who do not require a residential support as of the time of enrollment. The individuals that are the target of the waiver expansion typically live in the family home and are currently enrolled in Delaware’s 1115 Diamond State Health Plan (DSHP) Waiver to receive their regular Medicaid State Plan benefits via enrollment with a Managed Care Organization. The population affected by this Demonstration is comprised of individuals who are enrolled in the 1115 DSHP Waiver that qualify to be enrolled in the 1915(c) DDDS Lifespan Waiver on or after July 1, 2017 and are not receiving Residential Habilitation. This population will receive their regular Medicaid State Plan benefits via enrollment with a Managed Care Organization. Individuals who are enrolled in the 1915(c) DDDS Lifespan Waiver and are receiving Residential Habilitation will continue to be carved-out of the 1115 DSHP Waiver and will receive their acute care benefits via fee for service. Members that are currently receiving DSHP Plus LTSS under the 1115 Waiver will be unaffected by this change if they choose to remain enrolled in DSHP Plus. DSHP Plus LTSS members with intellectual and developmental disabilities cannot be concurrently enrolled in the 1115 waiver and the DDDS Lifespan 1915(c) waiver. Individuals must choose the LTSS program that will best meet his or her needs. Individuals will be assisted to make that choice by the MCO case manager and a DDDS Community Navigator. Qualification for the Diamond State Health Plan, Diamond State Health Plan Plus and Delaware Healthy Children’s Program are based on a combination of factors including family composition, income level, insurance status, and medical level of care and pregnancy status, depending on the eligibility group. The specific eligibility groups that will be included in these Plans are described in more detail in Exhibit 3, along with the State's estimate of the size of each group in the target population. C. STATEMENT OF NEEDS The Vendor(s) shall provide all equipment, materials, and labor to supplement the State of Delaware’s need for Health Benefits Manager as described herein. The contract will require the Vendor(s) to cooperate with the ordering agency to ensure the State receives the most current state-of-the-art material and/or services. Important Events:OngoingOpen DateOnline PortalPosting date for the OpportunityMar 14th 2024, 7:00 AM EDTN/AUpcomingClose DateOnline PortalDeadline for SubmissionsMay 10th 2024, 1:00 PM EDTN/AUpcomingEstimated Notification of AwardGSS and BonfireEstimated Notification of AwardJun 30th 2024, 11:59 PM EDT - Jun 30th 2024, 11:59 PM EDTNoPassedQuestions Due DateOnline PortalDeadline to submit QuestionsApr 11th 2024, 11:30 PM EDTN/APassedResponse to QuestionsGSS and BonfireResponse to QuestionsApr 25th 2024, 11:59 PM EDT - Apr 25th 2024, 11:59 PM EDTNo Supporting Documentation:HSS-24-037 - Addendum 1 - QA.docxOtherDocument - Addendum 1 - Q&A for RFP - HSS-24-037 - Health Benefits ManagerRead more...Apr 24th 2024, 2:51 PM EDT - HSS-24-037 - Appendix C – Pricing Form.docxDocumentationAppendix C - Pricing FormMar 1st 2024, 1:17 PM EST - HSS-24-037 - Appendix D - PSA, Appendix E - HIPAA BAA and Appendix F – DTI Agreement,.docxDocumentationAppendix D - PSA, Appendix E - HIPAA BAA and Appendix F - DTI AgreementRead more...Mar 1st 2024, 1:18 PM EST - HSS-24-037 - Business References Form - Attachment 5.docxDocumentationAttachment 5 - Business References FormMar 1st 2024, 1:16 PM EST - HSS-24-037 - Confidential Information Form - Attachment 4.docxDocumentationAttachment 4 - Confidential Information FormMar 1st 2024, 1:15 PM EST - HSS-24-037 - Exceptions Form - Attachment 3.docxDocumentationAttachment 3 - Exceptions FormMar 1st 2024, 1:14 PM EST - HSS-24-037 - Non-Collusion Statement - Attachment 2.docxDocumentationAttachment 2 - Non-Collusion StatementMar 1st 2024, 1:13 PM EST - HSS-24-037 - OSD - Attachment 9.docxDocumentationAttachment 9 - Office of Supplier Diversity (OSD) (if applicable)Read more...Mar 1st 2024, 1:46 PM EST - HSS-24-037 - Subcontractor Information form - Attachment 6.docxDocumentationAttachment 6 - Subcontractor Information Form (if applicable)Read more...Mar 1st 2024, 1:17 PM EST - HSS-24-037 Healthcare Business Manager - Final.docxDocumentationRequest for Proposal documentMar 1st 2024, 1:13 PM EST - Commodity Codes: UNSPSC 8510 Comprehensive health services