How is this version of coordinated care going to be different and better than before?
The coordinated care system began in Mississippi in 2011. Now, with a decade of experience, the Division of Medicaid (“DOM”) has had the opportunity to analyze data, consult with experts and stakeholders, and learn from previous experiences to develop a strategy for improving both care to coordinated care Members and value for the state.
For Members
This procurement demands responses that will leverage the experience and innovation of offerors, requiring proposals that meet upgraded requirements that center the care and support of the whole Member. Winning CCOs will have to integrate social determinants of health into their care management systems, working with local and state organizations to ensure that Members are supported both medically and through their community. Winning CCOs will also have to meet improved health literacy standards, utilize Patient-Centered Medical Homes, and ensure that Members have better access to services, whether that is through Care Management, telehealth, or a combination of both.
For Providers
DOM is requiring a higher level of coordination and standardization among CCOs than ever before. Winning CCOs will have to work together, with each other and DOM, to create standardized clinical requirements, performance improvement projects, value-based purchasing strategies, and care management programs. By having standardized methods for each of these service areas, Providers’ administrative burdens will be lower.
For the State
DOM is seeking more value for the State from its CCOs. DOM’s strategy is two-fold. First, investing in supporting health outcomes through preventative care and care management should result in both lower costs and higher quality of life for our Members. Second, DOM is requiring that people holding numerous positions, ranging from executive-level positions to Care Managers, be located in the State, meaning that winning CCOs have to invest not only in Members but in the State’s talented workforce as well.
Why doesn’t Medicaid just run Medicaid services itself instead of using contractors?
Mississippi uses coordinated care for two major reasons: predictability of costs and the opportunity for enhanced services for Members.
Predictable Costs
Coordinated care organizations are paid a set rate per member, called a capitation rate. If the cost for a member’s care exceeds the capitation rate for that member, the managed care organization must bear the extra cost. Because CCOs bear the risk for costs that exceed the capitated rate, the CCOs carry the financial risk for services while the State gets to be able to easily predict what the Medicaid program will cost each year.
Enhanced Services
Coordinated care organization must provide all of the same benefits as Fee-for-Service Medicaid while also providing Care Management services, which are intended to help Members stay on track medically while assessing the Members for any outside influence on their health and referring them to state and local organizations for assistance. Additionally, CCOs usually offer value added benefits, such as cell phones for members and nutrition assistance, free of charge to Members and the State. CCOs also have the option to cover additional services not provided for in Fee-for-Service Medicaid at their own cost if the CCO deems the additional services beneficial to the Member.
What is a RFQ?
An RFQ is a Request for Qualifications. A qualification is the name for the proposal submitted by an Offeror for an RFQ. The Mississippi Public Procurement Review Board, whose rules govern this procurement, defines a Request for Qualifications as follows: “Request for Qualifications means all documents, whether attached or incorporated by reference, utilized for soliciting Qualifications from potential vendors. A Request for Qualifications should contain all evaluation criteria and the weight for scoring each of the criteria. It should outline the intended procurement process and include all information required herein.” DOM’s RFQ for the Coordinated Care Contract contains many questions and requests for Offerors to outline their plans for delivery of services should they be contracted.
DOM also previously used an RFQ for its CHIP contract procurement process in 2018. A copy of the RFQ for this procurement is available at https://medicaid.ms.gov/coordinated-care-procurement/.
How long will it take?
After the procurement is released, the process will take about nine months to finish, depending on how many offerors submit an qualification, which will affect the length of time needed for evaluation. A schedule of the procurement process is provided below. After the Friday, March 4, 2022, submission date, the rest of the dates are estimated due to the inability to precisely predict the number of submissions.
How do you ensure the process is fair?
DOM follows the rules of the Mississippi Public Procurement Review Board (“PPRB”), for the Coordinated Care procurement. As part of these rules, DOM verifies that none of its Evaluation Committee members has any conflict or interest in one CCO winning over another. These are standard practices for DOM and other state agencies for every procurement. To review the PPRB Rules, visit this website:
https://www.dfa.ms.gov/media/9413/pprb-opscr-rules-and-regulations-efficetive-01182020.pdf
How are the winners selected?
There are five stages to DOM’s CCO Procurement.
Stage 1: Development
DOM goes through an internal process that take 18 months to two years to prepare for the CCO procurement. This cycle, DOM researched practices in other states, looked a data from current Mississippi CCOs, sought insight from internal subject matter experts, and solicited input from external stakeholders, resulting in the RFQ and Draft Contract. The two documents act as one, with CCOs having to refer to each in making their proposals.
State 2: Release
DOM will release the RFQ on Friday, December 10, 2022, on DOM’s Dedicated Coordinated Care Procurement website, https://medicaid.ms.gov/coordinated-care-procurement/. Qualifications must be submitted by 2:00 p.m. on Friday, March 4, 2022, to be considered.
Stage 3: Vetting
After the submission deadline, the DOM Office of Procurement reads every qualification to ensure that it meets the requirements of the RFQ and is in compliance with the PPRB Rules.
Stage 4: Evaluation
The DOM Evaluation Committee scores the qualifications using the same scoring scale and rules for evaluation of each proposal.
Stage 5: Award
The Evaluation Committee submits its scores to the Office of Procurement, recommending the highest-scoring plans to receive award. The Office of Procurement checks the tallies of the scores, ensuring that they have been calculated correctly. The recommended awardees are then submitted to the Executive Director for approval. The Executive Director approves the awardees, and then DOM submits the awardees to PPRB for approval. Once PPRB approves the awardees, DOM can execute a contract for services with each of them.
Why aren’t winners selected based on the lowest bid?
The Coordinated Care procurement does not evaluate monetary bids because no monetary bids are made. An actuarial firm determines the capitation rate, a rate paid per Member, for each Member Category. DOM pays all winning offerors receive the same Capitated Rate per Member, with CCOs with more members receiving more total funds. Because the cost of the contract is already pre-determined, DOM is able to focus on finding offerors that will submit the best proposals that will bring the most quality to DOM, our Members, and the State.
Who chooses the winners?
The Evaluation Committee scores all offers that are deemed responsive. The Office of Procurement verifies the scores, submitting the top scores to the Executive Director for review. CCOs with the highest scores will be chosen unless a CCO with a winning score is disqualified.
How many winners will be selected?
No more than three CCOs will be selected. DOM may choose as few as two. The number selected will be based on recommendations from an actuarial firm regarding the number of plans needed to both comply with federal requirements and best serve Members and the State.
Will there be a protest?
DOM cannot predict if a protest will occur. However, many other states often receive protests from plans that are not chosen. Protests usually revolve around the process used by the State Medicaid agency to choose winning plans and/or any perceived conflicts the State Medicaid agency that may have affected the process. DOM has taken numerous steps to ensure that its selections will stand if protested by ensuring that its process is fair and the Evaluation Committee is prepared and trained.
What impact will combining MSCAN and MSCHIP on same contract have?
There are two reasons that DOM has chosen to combine these contracts: relief of administrative burden and the ability to get more competitive bids.
Jointly procuring and administrating the programs relieves administrative burden, both for providers and the State, and it allows oversight to be consolidated for ease and clarity. Winning CCOs will be expected to deliver services and handle requirements for both programs, administrating them together. Some of the services and requirements are different between programs, and winning CCOs must be able to be attentive of those differences and administrate the programs accordingly.
Additionally, combining the CHIP and MSCAN populations for joint administration will make the contract more attractive for offerors, hopefully increasing the number and quality of bids for both populations, especially for CHIP. The current CHIP contract covers 1/10th of the number of Members that the current CCO contracts do (about 45,000 in CHIP versus about 400,000 in MSCAN). Because the CHIP contract is not worth as much total money, it is difficult to get competitive bids due to the investment a CCO must make in the state to deliver services. By combining the two, CHIP Members can benefit from the competitiveness of the higher value MSCAN Contract.
