Vendor Fiscal/Employment Agent Financial Management

Vendor Fiscal/Employment Agent Financial Management Services

(FMS)

Request for Proposals (RFP) 04-16

Pre-proposal ConferenceMay 1, 2017

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Introductions

• Michael Hale – Bureau of Provider & Quality Management• Michelle Smith – Bureau of Financial Operations • Karen Kern – Bureau of Financial Operations• Ron Melusky – Bureau of Community Supports• Toni Hoffecker – Bureau of Financial Management and Program

Support

• Other Commonwealth Staff• Attendees

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Agenda

• Introductions

• Ground Rules

• Critical Points

• Project Overview

• Small Diverse Business and Small Business Overview

• Timeline

• Break/Question Submittal

• Questions

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Ground Rules

• Sign in sheets

• Questions may be submitted in writing on the forms provided by theend of this conference.

• The Commonwealth team will determine which questions may bepreliminarily answered.

• Any answers provided are not final until formally issued in writing.

• Any changes to the RFP will be issued as a formal writtenamendment.

• Any communication shall be made through the RFP Project Officer.

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Critical Points

• Offerors may propose on one, or both, of the two lots presented inthis RFP. Each Lot must be submitted as a separate proposal(Technical, Cost, and Small Diverse Business/Small BusinessSubmittals).

• To minimize delays in proposal evaluation and to avoid rejection ofyour proposal, read the RFP carefully and submit a completeproposal, including signature. Follow the proposal format as detailedin Part I of the RFP. Include the appropriate heading descriptions,respond to all requirements and provide any other relevantinformation as an appendix.

• Each proposal must have three separately sealed submittals;Technical, Cost, and Small Diverse Business/Small Business.(Please pay close attention to the number of hardcopy andelectronic submittals required.)

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Critical Points

• Do not include any cost data in the technical portion of your proposal.

• Proposals must be received by 2:00 PM on June 5, 2017.

• An oral presentation with each Offeror may be requested by theDepartment.

• The resulting grant will be for a term of three (3) years, with three (3)additional six (6) month renewal options.

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Evaluation Criteria

• The following criteria will be used in evaluating each proposalsubmitted for each Lot of this RFP.• Technical – 50% (The Offeror’s technical submittal must achieve

a score greater than or equal to 70% of available raw technicalpoints)

• Cost – 30%• Small Diverse Business/Small Business Participation – 20%

• The technical evaluation will be based upon the following criteria, inorder of importance:• Soundness of Approach;• Offeror(s) Qualifications;• Personnel Qualifications; and• Understanding the Problem.

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Project Overview

• As detailed in Part I of RFP 04-16, The Department is seekingGrantees to perform payment-related employer responsibilities onbehalf of participants or their representatives (“individuals”) whoexercise employer or budget authority for their participant directedservices in the Commonwealth’s Medical Assistance (“MA”) Program.

• The Department has structured FMS services into two (2) lots.

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• Aging Waiver

• Attendant Care Waiver

• Independence Waiver

• CommCare Waiver

• OBRA Waiver

• Act 150 Program

Project Overview – Lot 1 - OLTL

OLTL ProgramsLot 1


A selected Offeror will act as the employer agent to the common law employer(“CLE”) (participants receiving waiver services, state-funded programs or managedcare and their representatives) in accordance with Section 3504 of the IRS Code,IRS Revenue Procedure 70-6, IRS Proposed Notice 2003-70 and REG-137036-08, as applicable. In Pennsylvania, the fiscal support services provided by a VF/EAFMS organization include, but are not limited to:

1. Acting as a neutral “bank” for individuals’ public service funds,

2. Providing for payment of qualified Direct Care Workers (“DCWs”), vendors andsmall unlicensed providers in accordance with federal, state and local tax,labor and unemployment insurance laws, as applicable;

3. Preparing and distributing qualified DCWs payroll, including the management offederal and state income tax withholding and employment taxes and localitytaxes;

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Selected Offeror’s(s’) Responsibilities


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Responsibilities, (cont’d)4. Verifying prospective DCWs, vendors and small unlicensed provider’s citizenship

and alien status and determining that DCWs, vendors and small unlicensed providers meet the qualifications for the services they are providing as per state requirements;

5. Processing and paying invoices for participant-directed goods and services in accordance with the participant’s person-centered service plan (“ISP”) and spending plan;

6. Processing and submitting claims, receiving MA reimbursements and paying out for services provided by qualified DCWs, vendors and small unlicensed providers in accordance with the participant’s ISP;

7. Processing and submitting monthly claims through PROMISe and receiving MA reimbursements for the fiscal support services that the selected Offeror provides to individuals;


8. Brokering workers’ compensation insurance policies and renewals and payingpremiums for participants who are CLEs;

9. Preparing and distributing financial reports to: CLEs, Administrative Entities(“AEs”), Service Coordinators (“SCs”), Managed Care Organizations(“MCOs”), OLTL, ODP, the Department and the Commonwealth as required;and

10.Providing initial DCW orientation, for Lot 1 only, initial employer skills trainingand on-going skills training to individuals acting as CLEs.

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Responsibilities, (Cont’d)

Requirements Overview – Lot 1 -OLTL

RFP 04-16 outlines specific requirements that Offerors must meet, including but not limited to the below. Offerors must respond to all areas of the work statement and propose how the Offeror will satisfy all requirements. Please reference the RFP for more information:

• Disaster Recovery• Emergency Preparedness• Subcontracting with a Reporting Agent• Performance and Payment Bonds• Compliance with Applicable Regulatory Requirements • Pennsylvania Department of State Registration• Enrollment as a Medical Assistance (Medicaid) Provider • Information Handling in Health Insurance Portability and Accountability Act

(“HIPAA”)• Lobbying Certification and Disclosure of Lobbying Activities

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• Criminal Background Clearances. The selected Offeror must, at its expense, arrange for a criminal background clearances from the Pennsylvania State Police and child abuse clearances per the Child Protective Services Law (CPL) [23 Pa. C.S. Chapter 63].

• Access and Use of Required Systems. The Selected Offeror must be able to access and use:

– The Department’s claims processing and management information system, currently, the Provider Reimbursement and Operations Management Information System (PROMISeTM), the Commonwealth’s claims processing and management information system.

– The Home and Community-Based Services Information System (“HCSIS”), the information system used to maintain all HCBS waiver participants’ records.

– Electronic Eligibility Verification System (“EVS”) is the Department’s system for verifying Medicaid recipient eligibility.

– Additional software packages as applicable.

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Offerors should pay particular attention to the following OLTL requirements:

• Knowledge of OLTL’s CD-PAS Model. The selected Offeror must be aware of and understand the structure of OLTL’s Vendor/Fiscal Employer Agent Consumer-Directed Services Model.

• Conflict Free Requirements. The selected Offeror must be free of any conflict of interest with any providers that render OLTL funded services prior to submitting an offer or at any time in the future.

• Office Requirements. The selected Offeror must establish at least one physical office in the Commonwealth and staff presence in each region. Note: a physical “brick and mortar” office in each OLTL region is not required.

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Project Overview – Lot 2 – ODP

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ODP ProgramsLot 2

• Consolidated Waiver for Individuals with Intellectual Disabilities

• Person/Family Directed Support (“P/FDS”) Waiver

• Adult Autism Waiver

Project Overview – Lot 2 – ODP

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Lot 2 – Office of Developmental Programs

The Office of Developmental Programs (“ODP)” supports Pennsylvanians with developmental disabilities to achieve greater independence, choice and opportunity in their lives through a variety of services that promote community living

ODP administers three Medicaid Home and Community-Based Services (“HCBS”) waiver programs: the Consolidated Waiver, the Person/Family Directed Support (P/FDS) Waiver, and the Adult Autism Waiver.

Project Overview – Lot 2 - ODP

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The Consolidated and P/FDS Waivers offer participants the opportunity to direct their own services through the Vendor Fiscal/Employer Agent (VF/EA) Financial Management Services (“FMS”) model.

In the VF/EA FMS model, the participant or his or her surrogate is the “Employer” of qualified direct support professionals, and is responsible to fulfill functions including but not limited to recruiting, hiring scheduling, supervising, and dismissing direct support professionals.

Participants or surrogates functioning as employers in the VF/EA FMS model are called Common-Law Employers (“CLE”). Direct support professionals in the VF/EA FMS model are called Support Service Workers (SSW).

There are approximately 780 individuals using the ODP VF/EA FMS model.


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ODP seeks to procure a Financial Management Services agent to fulfill responsibilities such as:

• Qualifying and paying SSWs;

• Withholding, filing, and paying federal employment taxes, state income taxes, and workers compensation for SSWs on behalf of the participant/surrogate, and

• Providing employers with informational materials for enrollment of the employer and the workers into the VF/EA FMS model.

Additional information on tasks will be presented shortly.


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ODP’s operations are separated into four regions. Of the 780 VF/EA FMS participants: • 42% are served in the Central Region• 11% in the Northeast Region• 39% in the Southeast Region, and • 9% in the Western Region.

Requirements Overview – Lot 2 - ODP

RFP 04-16 outlines specific requirements that Offerors must meet, includingbut not limited to the below. Offerors must respond to all areas of the workstatement and propose how the Offeror will satisfy all requirements.

• Disaster Recovery• Emergency Preparedness• Subcontracting with a Reporting Agent• Performance and Payment Bonds• Compliance with Applicable Regulatory Requirements• Pennsylvania Department of State Registration• Enrollment as a Medical Assistance (Medicaid) Provider• Information Handling in Health Insurance Portability and Accountability Act

(“HIPAA”)• Lobbying Certification and Disclosure of Lobbying Activities

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Requirements of Note – Lot 2 -ODP

Offerors should pay particular attention to the following ODP requirements:

• Knowledge of ODP’s PDS Model. The selected Offeror must be aware of and understand the structure of ODP’s Vendor/Fiscal Employer Agent Participant-Directed Services Model.

• Conflict Free Requirements. The selected Offeror must be free of any conflict of interest with any providers that render ODP-funded services prior to submitting an offer or at any time in the future.

• Office Requirements. The selected Offeror must establish at least one physical office in the Commonwealth and staff presence in each region. Note: a physical “brick and mortar” office in each ODP region is not required.

• Criminal Background Clearances. The selected Offeror must, at its expense,arrange for a criminal background clearances from the Pennsylvania State Policeand child abuse clearances per the Child Protective Services Law (“CPSL”) [23 Pa.C.S. Chapter 63].

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Requirements of Note – Lot 2 - ODP

• Assess and Use of Required Systems. The Selected Offeror must be able to access and use:

o The Department’s claims processing and management information system, currently, the Provider Reimbursement and Operations Management Information System (PROMISeTM), the Commonwealth’s claims processing and management information system.

o The Home and Community-Based Services Information System (“HCSIS”), the information system used to maintain waiver participants’ records specific to the Consolidated, P/FDS, and Adult Autism waivers.

o Electronic Eligibility Verification System (“EVS”) is the Department’s system for verifying Medicaid recipient eligibility.

o Additional software packages as applicable.

• Current, Comprehensive, Pennsylvania-specific VF/EA FMS Organization Procedures Manual. The selected Offeror must prepare and maintain a Pennsylvania-specific VF/EA FMS Organization Procedures Manual (“Manual”). This Manual must include procedures and internal controls for all VF/EA FMS organization tasks and requirements outlined in the RFP.

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Tasks Overview – Lot 2 - ODP

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The RFP specifies specific Offeror tasks, including but not limited to the below. Please reference the RFP for more information:

• Billing for Services Rendered. The selected Offeror must determine and incorporate all ODP program rules and requirements for payroll and invoice payment.

• Managing Public Funds. The selected Offeror must establish and maintain an accounting and information system for receiving and disbursing MA funds and for tracking all transactions and balances.

• Receive Federal and State Authority to Act as a VF/EA FMS Organization

• Providing Customer Service. The selected Offeror must implement customer service policies and procedures that reflect the principals of ODP.

• Processing and Distributing Qualified SSWs Payroll and Related Taxes and Insurances

• Processing a Common Law Employer’s Disenrollment from a VF/EA FMS Organization

• Performing End-of-Year Tax and Other Activities

• Establishing and Maintaining Files and Documentation

• Procure and Manage Worker’s Compensation Insurance

Tasks of Note – Lot 2 - ODP

Offerors should pay particular attention to the following ODP tasks:

• Readiness Review. Prior to rendering VF/EA FMS services, theselected Offeror shall participate in the VF/EA FMS OrganizationReadiness Review (“Readiness Review”) process, to be conducted byODP. The selected Offeror will not be permitted to provide VF/EA servicesif it does not show acceptable evidence of readiness relative to eachrequirement during the Readiness Review and detailed descriptions of howit will comply with the VF/EA FMS requirements. Additionally, as a part ofthe Readiness Review, ODP may conduct an onsite visit on a date to bedetermined by ODP. The VF/EA FMS Organization Readiness Review isnot a paid task.

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Tasks of Note (Continued)

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• Providing Customer Service. The selected Offeror must implementcustomer service policies and procedures that reflect the principals ofODP as outlined in the RFP.

• Coordinating and Communicating with Supports CoordinationOrganizations, Administrative Entities and ODP. A SupportsCoordination Organization (“SCO”) supports ODP in coordinatingservices and provides supports for people with intellectual disabilitiesand their families. An Administrative Entity (“AE”) is a county/joinderor non-governmental entity with an agreement or contract with theDepartment to perform operational and administrative functionsdelegated by the Department, related to the Department's approvedConsolidated and P/FDS Waivers. The selected Offeror mustcoordinate its activities and communicate effectively with SCOs, AEs,and ODP staff.

Tasks of Note – Lot 2 -ODP

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• Providing Common Law Employer Orientation and CLE SkillsTraining. The selected Offeror must develop and provide a CLEorientation process that uses a standard curriculum and materials thatare pre-approved by ODP.

• Enrolling Individuals with the selected Offeror as the CommonLaw Employer. The selected Offeror must prepare and receive ODPapproval of a Common Law Employer Enrollment Packet thatincludes all of the materials described in the RFP, and process theapplicable materials accordingly.

• Enrolling Qualified SSWs and Vendors. The selected Offeror mustverify that SSWs and Vendors are qualified, and enroll qualifiedSSWs and Vendors, as described in the RFP.

Tasks of Note – Lot 2 - ODP

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• Processing and Tracking Payments for Vendor-Delivered Participant-Directed Goods and Services and Mileage Reimbursement. The selectedOfferor must receive, verify, process and pay all invoices from vendorsproviding outcome-based participant-directed goods and services (e.g.assistive technology, specialized supplies, etc.) in accordance with theparticipant’s authorized ISP and complete and process all required taxdocuments.

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Bureau of Diversity, Inclusion and Small Business Opportunities

Request for Proposal(RFP) : Format and Template

RFP Small Diverse (SDB) and Small Business(SB) Components:

Part I: General Information

– SDB/SB Eligibility and Program Information

Part II: Criteria For Selection

Part III: Technical Submittal

Part IV: Cost Submittal

Part V: Small Diverse And Small Business Participation Submittal

– Contractual obligations resulting from SDB/SB Submittal

Appendix J: Small Diverse Business and Small Business SubmittalAppendix K : Small Diverse and Small Business Letter of Intent

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What do I need to know – Part I?

Program designed to encourage participation of Small Diverse (SDB) and Small Businesses (SB) in state contracting

A small business is a business in the United States which is independently owned, not dominant in its field of operation, employs no more than 100 full-time or full-time equivalent employees, and earns less than $7 million in gross annual revenues for building design, $20 million in gross annual revenues for sales and services and $25 million in gross annual revenues for those businesses in the information technology sales or service business.

A Small Diverse Business is a DGS-verified minority-owned business, woman-owned business, veteran-owned business, service-disabled veteran-owned business, LGBT owned or disability-owned business enterprise.

What do I need to do –Part I?

• Consider subcontracting opportunities available for small diverse and small businesses

• Search the DGS database of SDBs and SBs and identify SDB/SB business partners for opportunities and inclusion

• Complete and submit two (2) SDB/SB Participation Submittal Forms in separately sealed envelope (1 original and 1 copy) and corresponding Letters of Intent

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How do I find SDBs and SBs?

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To search all DGS-verified SDBs and DGS-certified SBs, visit the DGS website at:

https://www.dgs.internet.state.pa.us/SBPI/AlphaResults.aspx

https://www.dgs.internet.state.pa.us/SBPI/AlphaResults.aspx

SDB / SB Participation Submittal

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SDB / SB Letter of Intent

What do I need to know – Part II?Raw score will be calculated by crediting commitments to SDBs at 67% of total available points and adding commitments to SBs at 33% of total available points.

SDB/SB Raw Score =TOTAL POINTS (2/3 x SDB% + 1/3 x SB% + 1/3 x SDB%)

Simplified to: 200 (SDB% + (SB% x 1/3))

• SDBs are already qualified as a SBs, therefore SDB Proposers are eligible to receive 100% of the SDB/SB points

• Proposers who indicate subcontracting commitments to SDB/SBs will be credited in accordance with percentages proposed

• Proposer submitting the highest scoring SDB/SB Participation Submittal will receive all available points, with other Proposers’ raw scores adjusted pro rata

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How is the SDB/SB Submittal Scored?

Scoring Examples:

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What do I need to know – Part V?

• Contract commitments made to SDBs/SBs become contractual obligations upon contract execution

• Selected Proposer must submit a final, executed subcontract for each SDB/SB named within 30 days of contract execution

– SDB/SB subcontractors must perform 50% of the work subcontracted to them– If subcontract cannot be achieved, Selected Proposer must notify BDISBO

• Individual percent commitments cannot be altered without written approval from BDISBO

• All SDB/SB commitments must be maintained if the contract is assigned to another prime contractor.

• Selected Proposer must complete quarterly utilization reporting, tracking progress in meeting commitments

• Selected Proposer must contact BDISBO if circumstances arise that may affect the ability to comply with contract commitments

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What’s New?

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• Consideration for and inclusion of Small Businesses as prime contractors and subcontractors in addition to Small Diverse Businesses in scoring

• Simple, consistent template form for SDB/SB submittal supported by executed Letters of Intent

• DGS issued SDB/SB certificate not required with submittal

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Contact InformationBureau of Diversity, Inclusion and Small

Business Opportunities (BDISBO)Telephone: (717) 783-3119

Audrey Smith, Procurement LiaisonE-Mail: [email protected]

Curtis Burwell, Procurement ComplianceE-Mail: [email protected]

mailto:[email protected]


Timeline

Project Timeline

• April 21, 2017 – RFP 04-16 is issued

• May 1, 2017 – Pre-proposal Conference

• May 5, 2017 - Questions due to the Department in writing

• May 15, 2017 - Answers to Potential Offerors’ questions will beposted to the Department of General Services (DGS) website

• June 5, 2017– Due date for proposals

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Break/Question Submittal

Break & Question Submittal

Questions may be submitted in writing on the forms provided during this break or at the end of the conference.

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Questions

• To date, four (4) written questions have been submitted by email.

• You may submit additional questions today on the forms provided.

• A preliminary response may be provided to any questions submitted.

• We will not answer any question not provided in writing.

• No answer is official until it is answered in writing and posted to theDGS website as an addendum to the RFP.

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RFP #04-16

This concludes the pre-proposal conference.

Answers to all questions posed will be posted to the DGS website at

http://www.emarketplace.state.pa.us/Search.aspx

by close of business May 15, 2017.

No further questions will be entertained or answered.

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Project Officer

Michelle E. SmithDepartment of Human ServicesBureau of Financial OperationsHealth & Welfare Bldg., Rm 402

Harrisburg, PA 17120Telephone No: (717)787-9200


Any contact with the Department concerning this RFP must be through the RFP Project Officer.

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Documents

Vendor Fiscal/Employment Agent Financial Management