REQUEST FOR PROPOSAL FOR MEDICARE EXCHANGE RFP … RFP... · REQUEST FOR PROPOSAL FOR MEDICARE...

REQUEST FOR PROPOSAL

FOR MEDICARE EXCHANGE

RFP NO. 13.03

Release Date Friday, March 22, 2013

Proposal Due Date April 29, 2013, 4:00 P.M. PST

At: LACERS 202 W. First St, Suite 500 Los Angeles, CA 90012-4401

All questions must be submitted in writing no later than:

April 12, 2013, 3:00 P.M. PST Any questions concerning the RFP and all answers will also be posted on the LACERS website.

To RFP Administrator Mr. Dan Goto, RFP Administrator LACERS E-mail – [email protected], Phone – (213) 473-7276 FAX – (213) 473-7296

Official RFP Notices/Addendums

To ensure that no firm is provided advantage over another, all requirements are specified in this RFP. Any changes to the requirements will be posted as an addendum to the RFP on the LACERS website: http://www.lacers.org/aboutlacers/request-for-proposals/index.html. Proposers are solely responsible for monitoring this website and adhering to RFP addendums.

Prohibited Communications

From the RFP release date until a contract for these services is fully executed, firms are prohibited from communicating with Board members or staff, other than the RFP Administrator, concerning this RFP or the resulting contract. Any communications could be considered attempts to lobby or market services, and is therefore prohibited by LACERS’ Marketing Cessation Policy. Firms will be disqualified from contract consideration if the prohibition is not honored.

RFP NO.13.03 Medicare Exchange

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TABLE OF CONTENTS Page I. Introduction and Background 4 II. Minimum Qualifications 8 III. Scope of Services 8 A. General Responsibilities 8 B. Program Evaluation and Reports 8 C. Customer Support Services 9 D. Open Enrollment and Communication Services 9 E. Member Satisfaction Survey 10 IV. General Duties 11 V Instructions to Proposers 12 A. Proposal Timeline 12 B. File Naming Conventions 12 C. Basis of Quotation 13 D. Performance Guarantees 14 E. Plans and Rates 14 VI. RFP Process 15 A. Evaluation Process 15 B. Proposer Questions & Restricted Contact with LACERS Personnel 16 C. Proposal Deadline 16 D. Finalist Interviews 17 E. Site Visits 17 F. Contracting Process 17 VII. Questionnaire 18 A. Organization and Account Management 18 B. Implementation 22 C. Exchange Administration 23 D. Member Services 26 E. Available Medical Plans 29 F. Prescription Drug Coverage 30 G. Questions Concerning Your Proposal 30 H. REQUIRED COMPLIANCE DOCUMENTS 31 Appendix A – General Conditions and Compliance Documents Attachment 1 – LACERS’ Marketing Cessation Policy

Attachment 2 – Confidentiality & Non-Disclosure of Member

Information Attachment 3 – Request for Proposal Warranty/Affidavit Attachment 4 – Affirmative Action Plan Attachment 5 – Equal Employment Practice Form Attachment 6 – Bidder Certification CEC Form 50 Attachment 7 – Bidder Certification CEC Form 55


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Attachment 8 – MBE/WBE/OBE Subcontractor List Attachment 9 – Sample LACERS Contract Appendix B – Standard Provisions for City Contracts (Rev. 03/09) Appendix C – Insurance Requirements of Awarded Contractor Appendix D – Spreadsheet Templates Appendix E – LACERS Health Plan Information Attachment 1 – 2013 LACERS Health Benefits Guide Attachment 2 – LACERS Medical Plan Census File


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I. INTRODUCTION AND BACKGROUND Introduction The Los Angeles City Employees’ Retirement System (LACERS) is seeking proposals from qualified organizations with in-depth knowledge and expertise in providing fully-insured Medicare Advantage and Medicare Supplement plans through Medicare Exchanges. We are seeking a Medicare Exchange program for our California members residing outside of our Medicare Advantage HMO network areas as well as for our members residing outside of California. LACERS’ target population for this program consists of our eligible Retired Members, their Survivors (i.e., surviving spouse/domestic partner), and their Dependents. LACERS seeks to partner with vendors who can demonstrate:

• An understanding of the challenges of providing Medicare Advantage and Medicare Supplement plans to those residing outside of our Medicare Advantage HMO coverage areas and outside of the state of California

• An understanding of the challenges of serving LACERS’ population consisting of Retirees who qualify for Medicare Parts A and B, and Retirees who qualify for Medicare Part B but not Part A

• An established track record of providing high-quality service to Medicare Exchange participants

• Effective contracting with medical insurers which balances cost, quality, and minimum provider disruption

• The ability to influence member care purchasing decisions through increased awareness of health management services available from plan vendors as well as the cost-effectiveness of medical care service options

• Consistent, responsive, and professional administrative service backed by verifiable performance measurements

• Understanding of the Patient Protection and Affordable Care Act and its consequences for a Medicare-eligible population

This RFP will be for plan year January 1, 2014 – December 31, 2014 with options to renew for two additional one-year periods. Should an additional two years be desired at the end of the three-year period, approval by the LACERS Board of Administration is required. As a matter of practice, LACERS solicits proposals for medical plan providers every three to five years. Background LACERS is a public pension plan providing retirement benefits, survivor benefits, disability retirement benefits, supplemental annuities, and health insurance benefits to its Retirees and their beneficiaries. Established in 1937, pursuant to the City Charter, and under the management and control of a Board of Administration, LACERS is a defined benefit plan providing retirement-related benefits to approximately 25,400 civilian employees and 16,900 civilian Retirees and beneficiaries of the City of Los Angeles. The LACERS Board has seven members, each serving five-year terms. Working together under the direction of the LACERS Board of Administration and bound by our fiduciary obligation to our members, LACERS strives to provide accurate, timely, reliable and consistent retirement benefits and services. Selected proposers will work with staff to present to the Board or its committees health plan-related updates and reports, as requested.


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The LACERS Board of Administration (Board) is the authorized trustee designated by the City of Los Angeles to oversee the retiree health and welfare program. LACERS’ staff administers the program, which consists of selected health plan carriers, on behalf of its Retired Members and their Dependents. Additionally, LACERS’ staff administers health plan enrollments, conducts an annual Open Enrollment, prepares and distributes program materials and special communications, receives applications for coverage or changes in coverage according to rules developed by the Board, deducts participant health plan premiums from retirement allowances, posts eligibility information to the pension information system, and assists Retirees in accessing LACERS’ program benefits.

For 2013, the health and welfare program includes the following medical plans:

• Anthem Blue Cross HMO, PPO, and Medicare Preferred PPO plans • Kaiser Permanente Traditional HMO and Senior Advantage plans • UnitedHealthcare Medicare Advantage HMO plan • SCAN Health Plan (Medicare Advantage)

All health plans are fully insured. The 2013 LACERS Health Benefits Guide, included in Appendix E, provides an overview of LACERS health plan options and the coverage available, premium costs, and LACERS health benefits. The guide may be found in the Retired Members section of LACERS’ web site at www.LACERS.org. Tier 1 City employees, hired prior to July 1, 2013, can receive a Normal Service Retirement if they meet any of the following criteria:

• Are 55 years of age or older with at least 30 years of City Service; • Are 60 years of age or older with at least 10 years of City Service; or, • Are 70 years of age or older with any amount of City Service.

The City will implement a new tier of retirement benefits, known as Tier 2, for those hired on or after July 1, 2013. Under Tier 2, City employees can receive a Normal Service Retirement if they meet any of the following criteria:

• Are 65 years of age or older with at least 10 years of City Service; or, • Are 70 years of age or older with any amount of City Service.

It is unlikely LACERS will have any Tier 2 retirees during the contract period. In addition, Disability Retirees, current spouses/domestic partners of City Retirees, surviving spouses/domestic partners (hereafter referred to as Survivors) of City Retirees, and dependent children and grandchildren also participate in the plans. As a result, the age of the covered population spans a wide range. City Retirees are eligible to receive a medical subsidy paid by the City toward their medical plan premium if they meet all of the following criteria:

• Are receiving a retirement allowance from LACERS; • Are age 55 or older; • Have at least 10 years of Health Service Credit;


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• Are enrolled to the extent eligible in Medicare Parts A and B; and, • Are enrolled in a LACERS-sponsored medical plan or the Medical Premium

Reimbursement Program. The City did not begin paying into Medicare on behalf of active employees until April 1, 1986. Employees hired on or after April 1, 1986 earn credits toward Medicare Hospital Insurance (Part A) coverage. Approximately 10% of LACERS’ retiree population over the age of 65 are not eligible for premium-free Medicare Part A coverage. LACERS’ medical plan participants are required to enroll in Medicare to the extent they are eligible. As a result, all Retirees are required to enroll in Part B upon turning age 65. For those Retirees with Part A coverage, LACERS reimburses the Retiree for the Part B premium. The majority of LACERS Retirees reside within California (approximately 90%). The remaining 10% of LACERS Retirees reside throughout the United States and internationally. Outside of California, Arizona and Nevada are the states with the largest Retiree populations. A recent LACERS electronic census file, for those subscribers and dependents who might take part in a Medicare Exchange, is included in Appendix E as Census.xls. The enrollment by plan, as taken from the census information, is also found in this file. The census file contains records on the 2,165 Retirees and Survivors who are of Medicare age and who reside in areas that are not covered by LACERS Medicare Advantage HMO plans. A small number of Retirees and Survivors (roughly 200) elect to participate in the LACERS Medical Premium Reimbursement Program available to those who reside outside an HMO service area in California, or in other states. LACERS currently offers the following programs to Retirees, Survivors and their eligible Dependents who are enrolled in Medicare:

• HMO plans administered by Kaiser Permanente and Anthem Blue Cross for those Retirees enrolled in only Part B of Medicare

• Medicare Advantage HMO plans administered by Kaiser Permanente, UnitedHealthcare and SCAN Health Plan

• A national PPO plan, administered by Anthem Blue Cross, that coordinates with Medicare for those Retirees with Medicare Part B only

• A national Medicare Advantage PPO plan, administered by Anthem Blue Cross, for Retirees with Medicare Parts A and B

Additional details related to the medical plans include:

• The Anthem Blue Cross Medicare Preferred (PPO) is a Medicare Advantage plan available nation-wide

• SCAN Health Plan’s Medicare Advantage plan is available in California and Maricopa County, Arizona

• UnitedHealthcare Group Medicare Advantage HMO plan is available in California, Arizona and Nevada


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• A Medicare Part B-eligible retiree enrolled in Kaiser Permanente is required to assign their Part B benefit and enroll in Kaiser Permanente Senior Advantage

An annual Open Enrollment period is held October 15 – November 15 of each year. It allows new enrollments (including Retirees and Survivors who opt out of coverage when first given the opportunity), transfers between the various medical plans, and the addition of eligible family members. All Proposers must quote on the basis that there will continue to be an annual open enrollment period. Additional qualifying events for enrolling outside of open enrollment include: retirement from the City, being added to the retirement payroll as an eligible Survivor, turning age 55, qualifying for Medicare (usually at age 65), and moving outside of a HMO health plan service area. Eligible participants have 30 - 60 days from the date of these qualifying events from which to elect coverage. In addition, LACERS is interested in exploring a year-round open enrollment option. Please indicate if this option is available.

Retiree eligibility rules, LACERS premium subsidies, and retiree contributions for calendar year 2013 can be found in the 2013 LACERS Health Benefits Guide.

Should LACERS select a Medicare Exchange provider, the provider will be asked to develop and coordinate a LACERS member satisfaction survey that will involve its program. The Medicare Exchange provider should be responsible for all costs associated with developing this survey. This RFP seeks proposals for Medicare Exchanges. Proposals are invited on the following bases:

• Medicare Exchange for Out-of-Area CA members: assisting LACERS in allowing CA members in out-of-area to use their subsidy dollars to purchase individual In-State Medicare insurance plans

• Medicare Exchange for Out-of-State members: assisting LACERS in allowing non-CA members to use their subsidy dollars to purchase individual Out-of-State Medicare insurance plans

All Proposers submitting bids must address both scenarios above.

LACERS reserves the right to award a contract or contracts in whatever configuration best meets its needs, at its sole discretion. These configurations include, for example, awarding the Medicare Exchange contract to a single exchange provider, multiple exchange providers, or not to award a contract at all. If the Proposer submits alternatives and/or substitutions to the terms and conditions, LACERS reserves the right to determine if the alternatives/substitutions are acceptable.

LACERS reserves the right to withdraw this RFP at any time without prior notice and the right to reject any and all responses to this RFP. The rejection of any or all proposals shall not render the LACERS liable for costs or damages. LACERS makes no representation that any contract will be awarded to any Proposer responding to this RFP.


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II. MINIMUM QUALIFICATIONS Firms must clearly demonstrate achievement of the minimum qualifications for their proposals to be considered.

1. The firm, or its parent company, must have been in business for at least five years; 2. The firm offers medical plans from more than a single vendor; and

3. The firm offers medical plans throughout the United States.

III. SCOPE OF SERVICES

Proposers are asked to specify their ability to provide the following services listed below. If a Proposer cannot provide any of the following services, the Proposer must so indicate in their response to this RFP.

A. General Responsibilities

1. Provide access to medical plan coverage to LACERS members who reside in the

state of California or out-of-state (outside California).

2. Accept LACERS’ definitions of eligible Retiree, Survivor, and Dependents. 3. Work collaboratively with LACERS staff, the LACERS Board of Administration, and

LACERS’ Health and Welfare Consultant. 4. Work collaboratively with other LACERS vendors on health plan benefit-related

projects such as a member satisfaction survey.

5. Attend LACERS’ Board meetings as required to present information regarding the Medicare Exchange program.

6. Provide such other services as requested by LACERS, for which the Contractor has

the technical capability and capacity to render, to parties that include but are not limited to LACERS staff, the LACERS Board of Administration, and LACERS Health and Welfare Consultant.

B. Program Evaluation and Reports

1. Meet with LACERS staff at least quarterly to review and evaluate Medicare Exchange administration and customer service issues.

2. Upon LACERS’ request, attend various retiree meetings relating to medical plans. 3. Provide statistical plan reports such as enrollee distribution reports, status reports

and analysis (monthly, periodically, and annually), call volume reports, and other


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reports as needed and requested by LACERS and/or LACERS’ Health and Welfare Consultant.

4. Accept eligibility reporting on a monthly or more frequent basis with a twenty-four

(24) hour upload turnaround time to assure timely eligibility capture. 5. Maintain full and accurate records with respect to all matters and services provided

to LACERS for a minimum of seven (7) years from December 31st of the affected plan year.

6. Maintain compliance with all applicable Health Insurance Portability and

Accountability Act (HIPAA) Privacy and Security Rules as a covered entity. Individuals, organizations, and agencies that meet the definition of a covered entity under HIPAA must comply with the Rules’ requirements to protect the privacy and security of health information and must provide individuals with certain rights with respect to their health information.

7. Inform LACERS staff and LACERS Health and Welfare Consultant of any pending

legislation affecting the administration of the Medicare Exchange or its medical plan offerings. If relevant legislation is enacted, provide LACERS staff and its consultant with a cost analysis and an implementation plan to ensure that the Medicare Exchange and LACERS comply with the new requirements.

C. Customer Support Services

1. Provide financially-based Performance Guarantee(s) to assure a high level of service to LACERS and its Retirees.

2. Provide a dedicated Account Manager, Claims Issue, and Eligibility Contact and agree to change those contacts upon request by LACERS.

3. Perform research and provide responses to technical questions from LACERS staff.

4. Provide training for LACERS staff regarding the Medicare Exchange. 5. Provide administrative services for the Medicare Exchange, including fund

accounting and research and resolution of any issues, complaints, or problems. 6. Investigate and resolve administrative and claims problems. 7. Provide LACERS with a disaster recovery plan within 90 days of executing the

Contract.

D. Open Enrollment and Communication Services

1. Participate in various events related to open enrollment, wellness and other activities/meetings centered upon educating LACERS health plan participants and human resource personnel regarding this benefit.


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2. Assist LACERS and LACERS’ Health and Welfare Consultant in preparing (open

and special) enrollment and plan documents for use in retiree communications guides or letters.

3. Assist LACERS and LACERS’ Health and Welfare Consultant in drafting communication materials and plan comparison information for Retirees, Survivors, and Dependents.

4. Assist LACERS staff in the planning of a minimum of five (5) annual open enrollment meetings for Retirees. Planning to include at least one annual meeting with LACERS staff regarding current open enrollment meeting information needs.

5. Develop a video or other electronic media, such as a webinar on the Medicare Exchange services for the annual open enrollment efforts.

6. Attend and present Medicare Exchange information (such as medical plan changes for the following calendar year, how to select the best plan for one’s needs, etc) at all annual Open Enrollment seminars for Retirees, Survivors, and Dependents.

7. Assist LACERS with the development of medical plan benefits documents, such as the LACERS Health Benefits Guide.

8. Provide electronically formatted participant communications to be used in LACERS newsletters and flyers.

E. Member Satisfaction Survey

Provide and coordinate a member survey for the LACERS Retirees, Survivors and Dependents to measure and monitor the overall satisfaction with the Medicare Exchange. The survey should conform to the NCQA requirements and be accredited under NCQA standards. All costs involved with the survey should be paid for by the Proposer.


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IV. GENERAL DUTIES The Proposer is expected to perform/handle the following general duties:

1. Treat all LACERS’ information as confidential as defined in the Confidentiality & Non-Disclosure of Member Information Policy. This applies to all data created, gathered, generated, or acquired within the scope of the contract. Sensitive information inclusive of, but not limited to, LACERS members and beneficiaries must be kept confidential in accordance with HIPAA standards. Selected Proposers shall notify LACERS immediately if there are any breaches to the confidentiality of LACERS’ confidential information. The breach of this agreement is subject to cancellation of contract and the selected Proposer being held liable for damages.

2. Maintain confidential any information resulting from this engagement except with written

consent from the General Manager of LACERS or designee, prior to the release of any such information. This includes, but will not be limited to, press releases, research, reports, and any publicity given to the selected Proposer for work provided under the resulting contract. LACERS shall be credited as the sponsoring agency.

3. Refer all requests, reports, and all other communication that use LACERS’ database through the General Manager or appointed designee.

4. Notify LACERS immediately of any anticipated changes in personnel assigned under the

terms of this engagement. The firm shall submit resumes of any proposed replacement personnel, and obtain written approval from LACERS for any change in the personnel assigned to the work.

5. Notify LACERS staff in writing in the event that any conflict of interest or possible conflict

of interest is discovered regarding the provision of these services.

6. Document discussion ideas, issues, and extended services. Share responsibility with LACERS for documenting in writing all ideas and issues raised in discussions and meetings.


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V. INSTRUCTIONS TO PROPOSERS LACERS and its designated representatives will evaluate all proposals submitted according to this RFP. The proposal submitted will be considered to be your organization’s only submission. A. Proposal Timeline

The timeline for the RFP process is as follows: Activity Dates Release RFP March 22 Proposer Question Submission Date April 12 Final Responses to Vendor Questions April 19 Proposals Due April 29 Selection of Finalists May Finalist Interviews May Site Visits, Negotiation of Terms and Costs June – August Award of Business June – August Effective Date January 1, 2014

All questions should be directed exclusively to Mr. Dan Goto at LACERS and must be submitted in writing. Contact with LACERS staff other than Mr. Dan Goto is strictly prohibited during the proposal process.

B. File Naming Conventions

The following document naming conventions must be followed without exception.

Template spreadsheet files For questions requiring an attached Excel file, there will be one Excel file per questionnaire section (e.g., Member Services). Individual questions will be identifiable as individual worksheets within the file. The naming convention for the posted templates is simply:

<Section Name>.xls

When you download the file and populate it with information, you must rename the file by adding your company name and a hyphen separator to the beginning, as shown:

<Vendor Name>-<Section Name>.xls

You may use an abbreviation for your company name. However, you must use exactly the same company name for each and every file. Sections completed by a subcontracting entity must carry the name of the principal bidding entity.


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Additional Attachments When submitting documents (either requested or unsolicited) which are not based on a template file provided with the RFP, your files should be named using the following convention, if the attachment is associated with a specific question:

<VendorName>-<Section Name>-<Section Subheading>-<Question #>.<file

extension>

Remember, as noted above, an unsolicited attached file may NOT be provided as a substitute for answering the question fully in the space and manner provided.

Alternatively, if the attachment is not associated with a specific question, the naming should be:

<VendorName>-<Short Title>.<file extension>

Please submit only Microsoft Office documents; other formats cannot be read by all users, and will not be reviewed.

Hard Copy Attachments If the required document is not available in an electronic format, place a copy in a binder under a tab using the same naming convention described above.

C. Basis of Quotation

Any deviations from the requirements or scope of work of this RFP due to operational, contractual or legal limitations must be fully described in your RFP response and in your cover letter. Please be sure that your basic quote includes only those deviations that are absolutely required.

Other Financial and Contract provisions for the proposal include:

Effective date: January 1, 2014 Initial contract term:

12 months

Contract holder: Los Angeles City Employees’ Retirement System

State of contract: California Rate Tiers: All rates must be quoted using the pre-established rate tiers identified in

this RFP. Funding: All programs must be quoted on a fully-insured basis.

Eligibility Provisions:

Duplicate current eligibility provisions


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COBRA: LACERS relies on its current medical vendors to administer COBRA. You

must agree to provide this service. Regulatory Compliance:

You must certify that you are compliant with all federal and state regulations (e.g., HIPAA, PPACA, etc.)

Commissions: None D. Performance Guarantees

LACERS maintains performance standards with its contracted vendors, with portions of the vendor’s compensation at risk for failing to meet these standards. Proposers are expected to include performance guarantees in their proposal, and will be assessed on the strength of the performance standards they are willing to implement. For finalists, negotiations will take place before an award of business to ensure that there is a final understanding of the agreed upon standards.

E. Plans and Rates

Please provide information regarding the plans available through your Medicare Exchange. Please highlight your plan offerings most comparable to the benefits offered through LACERS’ Medicare plans. Census/enrollment information and contributions and current benefits can be found in the following electronic files found in Appendix E:

Census.xls 2013 Health Benefits Guide.pdf

For LACERS’ current plan offerings for those with Medicare Parts A and B, please consult pages 24 and 25 of our 2013 Health Benefits Guide.


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VI. RFP PROCESS LACERS at all times retains ultimate responsibility for the evaluation and award of contract(s) at its sole discretion. Selected and non-selected Proposers will be notified in writing at the conclusion of the process. Selection is contingent on satisfactory completion of appropriate agreements which will be negotiated. LACERS reserves the right to reject any and/or all proposals, to waive any informality in such proposals, to request new proposals, to revise the RFP prior to proposal submission, to withdraw this RFP, to not award the contract, or to not award a portion of the contract at any time. A. Evaluation Process

The selected proposer must successfully pass all the following levels of review:

• Level I. Review of Qualifications, Experience, & References

Proposer must demonstrate its meets the minimum qualifications (see Section II.); must demonstrate a positive record as a responsible contractor; and must have the resources and experience to perform the required services.

• Level II. Administrative Responsiveness Firm’s proposal must demonstrate its responsiveness to the administrative requirements outlined in the RFP. Firm’s ability to adhere to LACERS’ standard contract provisions will also be considered.

• Level IIl. Proposed Services and Compensation (“Proposal”) For the purposes of Level III evaluation, the responsive proposals will be evaluated, ranked, and scored based on the criteria below. Interviews may also be conducted.

Description Maximum Points

Financial Cost and Value – Reasonableness of costs to services and best overall value to LACERS based on the following:

• Ability to deliver the RFP scope of services • Administrative fees • Performance guarantees • Positive contracting history • Reasonableness of cost and value • Firm’s financial position will be used as an indicator of the

ability to provide the requested services over the full term of the contract

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Provider and Plan Selection – The capacity to provide our members with a range of plan carriers and options 25


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Quality and Member Service – Demonstrated ability to deliver high-quality services: The Service rating will be based upon the ability to deliver high-quality customer service to City Retirees and their dependents, including availability of live customer service and claims issue assistance, service hours, and self-service tools. The self-service tools include Web-based tools that help in determining benefit levels, decision support, and member education. LACERS will also assess the strength of the Proposer’s client service orientation, as well as the Proposer’s ability to understand and address LACERS’ unique needs.

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Administration Support and Account Management and Service Team – Ability to provide excellent administration support, and proactive and highly responsive account management services. The level of applicable administrative support services will be considered (billing and eligibility, contracts, enrollment, and firm’s business operation, etc.). The Account Management and Service Team evaluation will be based on the quality, quantity, and experience of staff assigned to the City account necessary to deliver the services outlined in the scope of services. Ability to provide electronic files as part of the Patient Protection and Affordable Care Act (PPACA).

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Total 100

• Level IV. Final Approval by the Board The proposer that demonstrates to be the most qualified to provide the required services at the best overall value to LACERS, as determined by the evaluation panel, will be recommended for contract award to the LACERS’ Board of Administration (Board). The Board at its sole discretion makes the final award determination.

B. Proposer Questions

Please direct all questions by e-mail to the RFP administrator identified on the RFP cover page. Questions from all proposers, and LACERS’ answers will be posted on the LACERS website.

C. Proposal Deadline

All RFP responses are due at LACERS by the date and time indicated on the cover of this RFP. All requested documents must arrive at LACERS by the due date and time indicated on the cover page to be considered. The complete proposal package shall be


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placed in a sealed envelope or box with the following label: REQUEST FOR PROPOSAL FOR LACERS MEDICARE EXCHANGE Number of Copies: Please provide: one spiral-bound original; seven hard copies; one non-bound reproducible copy, and one electronic copy on a CD or flash drive in Microsoft Word Format as submitted and any charts or exhibits as indicated in the File Naming Conventions section of this RFP. Plainly identify the respective documents. Note: Proposers selected to make presentations to the evaluation committee may be asked for between five and ten additional copies of their responses. LACERS staff will provide further instructions to these Proposers before they make their presentations.

D. Finalist Interviews

All proposals deemed timely and responsive will be reviewed, evaluated and a short list of the most qualified Proposer(s) will be developed. An evaluation panel consisting of a committee of LACERS staff members will interview the qualified Proposer(s) on the short list. This will be your opportunity to present your proposal in person, to engage in an interactive dialogue and to answer questions. The meeting will be in Los Angeles, and the meeting time would be approximately three hours.

E. Site Visits

At its discretion, LACERS may conduct site visits with selected Proposers to address any and potentially all aspects of operations affecting administration of its plan. This could include customer service, provider network management, and other administrative operations.

F. Contracting Process

After the completion of the interview process, LACERS will rank the short listed Proposers and negotiate a contract with the highest ranked, qualified Proposer. (See sample form of contract, Appendix A, Attachment 9.) If a contract for any reason cannot be successfully negotiated with the first ranked firm, LACERS may choose to negotiate with the next most qualified firm. The final terms and conditions will be determined during contract negotiations following the selection process. Upon satisfactory negotiation, LACERS Management will return to the Board of Administration with a recommendation to award the contract. No contract shall be final until approved by the Board of Administration.


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VII. QUESTIONNAIRE Answer each question contained in this Questionnaire. Each question of the RFP shall be repeated in its entirety before the answers. Proposer must respond to each question contained in the questionnaire. If a question does not apply to Proposer, please write in “not applicable” and state the reasons why the question does not apply.

A. Organization and Account Management

Proposal Summary

1. Indicate your legal business name, address, telephone number, and legal entity type (individual, limited liability partnership, corporation, etc.).

2. Please summarize your proposed Medicare Exchange products/services for LACERS members both in California (excluding areas where LACERS offers Medicare Advantage HMO coverage) and outside of California. In your summary, please explain why you are qualified for LACERS particular circumstances and principal reasons you should be selected.

3. Indicate the person(s) authorized to represent the proposer in negotiations with LACERS

with respect to the RFP and subsequently awarded contract including contact names, titles telephone and fax numbers and e-mail addresses.

4. Provide a brief history of the firm and the year the firm was founded 5. List all the major services provided by your firm. 6. Indicate the location of your headquarters and subsidiaries, if any. 7. Indicate the number of personnel (full-time, part-time, and seasonal) at each firm location. 8. Provide an organizational chart of parent/subsidiary relationships. 9. Are ownership changes planned or anticipated at this time? 10. What do you consider to be your firm’s specialties, strengths, and limitations? 11. Provide an organizational chart of the management team of the firm. 12. Provide a biography/profile/resume for each key manager/officer/principal of the firm. 13. Describe the turnover in key professional personnel in each of the last five years. Indicate

the number of people lost in the following areas: (a) account managers (b) key technical personnel.

14. What incentives are provided to attract and retain top quality employees at your firm?


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15. Has any officer or principal of your organization been involved in litigation relating to health plan insurance activities? If so, provide a brief explanation and indicate the current status of the proceedings.

16. Describe the services of your organization that distinguish your firm from your competitors.

Convincingly and briefly explain why your firm is the most qualified for this engagement. 17. How many organizations does your firm provide Medicare Exchange services for? 18. How many of the organizations referenced in question 17 are public employee retirement

systems? 19. How many Medicare Exchange accounts have been added in the last five years? 20. How many Medicare Exchange accounts were lost in the last five years? What was the

reason(s) for each account lost? 21. Describe your plans for managing the future growth of your firm in terms of the total

number of accounts that will be accepted, plans for additions to professional staff, and approximate timing in relation to anticipated growth in the number of accounts.

22. Briefly summarize your philosophy relating to the firm’s relationship with Boards, Staff,

Council, etc. 23. Please indicate your experience with major disruption(s) of your business and how they

impacted your clients. Please provide a copy of your Business Continuity Plan (BCP). If you do not have a formal BCP, indicate what contingencies has your firm made to address potential disruptions to client services in the event of a natural or man-made disaster, or pandemic.

24. Describe any efforts you have to outreach to government certified minority-owned,

woman-owned, or other- business enterprises. 25. Please summarize your proposed products/services and explain why your organization is

a match for LACERS’ particular circumstances, and the reasons your organization should be selected over your competitors.

Organizational Background 26. Please describe the organization of your company including relationships with any parent

companies, subsidiaries, etc. Indicate which entities will administer each of the services requested in this RFP.

27. Does your organization have ownership interest in, or management contracts with, any

provider of medical, mental health, disease/care management, or pharmaceutical services?


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Operations 28. Are there any recent or anticipated changes in your organizational structure (such as key

personnel, consolidation of operations, new service centers, etc.) that would directly impact LACERS? If yes, detail (include project plan and timetable) how these transitions will be handled, and the effect on LACERS members participating in your Medicare Exchange. Also, please provide the rationale for these changes.

29. Does your organization anticipate any changes (either replacement or enhancements) in

its claim, member services, utilization management, or other key systems between 2013-2015 that could impact LACERS? If yes, when will this take place and how will the transition be handled? Please fully describe the proposed changes and your transition and implementation plan.

30. Discuss any technological improvements your organization has planned for 2013-2015

(e.g., Internet related services, online eligibility, etc.) and the effect on participating members.

Membership and References 31. Please indicate the total members participating in your Medicare Exchange as of January

2013.

32. Please list five of your largest public sector clients as well as any clients located in California or with significant populations in California.

33. Please provide five of your largest clients that have terminated your services within the last

two years (include the number of covered lives). Financial History 34. Provide your organization’s most recent ratings by the following organizations.

Rating Organization Rating AM Best

S&P Weiss

Moody’s

35. Is your organization publicly traded, privately held or other (please describe)? If publicly traded, please refer to Organization and Account Management.xls found in Appendix D and provide the information in the attached table for the last twelve (12) quarters.

36. If your organization is not-for-profit, indicate your net profit/losses over the past 3 years. If

not applicable respond with N/A. 37. Please refer to Organization and Account Management.xls found in Appendix D and

provide us with your fiscal year-end financials in the attached table.


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Compliance 38. Please describe the final results and attach copies of your most recent state and federal

regulatory agency audits. Include the executive summary of your most recent CMS audit and any reports resulting from any investigations of your organization regarding Medicare fraud.

39. Has your organization undergone any of the following? If yes, explain each.

• Governmental investigations of your organization regarding Medicare fraud. • Investigations or audits by the Federal Department of Labor or a state licensing

agency in the preceding three years. • California Department of Insurance, Department of Managed Health Care, and/or

California Department of Health Services investigations.

40. Are any of the members of your board of directors, officers, employees assigned to this contract, or consultants affiliated with the Los Angeles City Employees’ Retirement System? If so, describe the relationship. Are any of these individuals responsible, in whole or in part, for the preparation of your proposal or would they have any decision-making role if your company were awarded the contract(s)?

41. Please provide the number of complaints regarding your organization’s Medicare

Exchange filed with the California Department of Managed Health Care, Department of Insurance, and/or other jurisdictional agencies. Please include complaints for all products.

Complaints per 1,000 Members

Regulatory Agency 2010 2011 2012 CA Department of Managed Health Care

CA Department of Insurance

Other Agency (Name)

TOTAL Account Management 42. Please describe your proposed account management team and structure. Specifically

address:

• Name and background of account manager and other key team members • Who from account team would be 100% dedicated to this account • Location of staff • Office Hours • Responsibility for any subcontracted relationships


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B. Implementation 1. Please confirm if the open enrollment period can be based on LACERS’ current group plan

period effective January 1 of every year vs. the Medicare open enrollment period from October 15 through December 7.

2. Provide your implementation process recommendations and a detailed timetable assuming notice in June for a January 1, 2014 implementation. Also, assume that LACERS specific open enrollment will begin October 15, 2013. Be specific with regard to the following:

Timing of significant tasks, Names, titles and responsibilities of account manager and key implementation staff, Percent of time dedicated to LACERS during implementation by your team, Responsibilities of LACERS, Data requirements (indicate type, format and frequency of data required), Transition with incumbent vendors, and Staff assigned to attend open enrollment/educational sessions.

3. In relation to the required Annual Notice of Change (ANOC) requirements per CMS, please explain how and when the notice will be sent to Medicare members based on the LACERS open enrollment period occurring from October 15 to November 15 each year.

4. Describe your proposed transition of care plan. At a minimum, the transition plan must address:

Individuals who are in a course of medical treatment Transition of prescriptions Communication of transition issues to all plan members

5. Please note that LACERS will require the chosen Medicare Exchange vendor to sign LACERS issued provisions per their service agreement and contract. In the meanwhile, please provide a sample of your master contract, business associate agreement and any related documents for LACERS to review.


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C. Exchange Administration Eligibility and Membership 1. Please provide the total number of covered members through your Medicare Exchange

program. Please provide a breakdown of your membership by those who reside in California and who reside outside of California.

2. Does your Medicare Exchange offer the option to allow participants to enroll all year-round rather than during an Open Enrollment period? If so, please describe how a year-round enrollment option would work.

3. Some of LACERS’ members qualify for Part B of Medicare but not premium-free Part A.

Would your exchange provide options for members who have Medicare Part B coverage but not Part A?

4. Some of LACERS’ members enrolled in Medicare have dependents that are not yet

Medicare-eligible. Would your exchange be able to provide enrollment options for dependents who are not enrolled in Medicare?

5. What are the required data elements for eligibility feeds from LACERS? What are your

capabilities for loading and correcting data? Do you have the capability to enter corrections to eligibility records in real time?

6. Please provide your desired eligibility file format/layout. As part of your eligibility data feed

which is shared with LACERS, please confirm if you are able to include any member’s change with Medicare (i.e. disenrollment from Part A, B, C or D).

7. How long does it take your organization to produce ID cards after receipt of clean eligibility

data?

8. How often can the eligibility feeds be sent back to LACERS? What is your standard eligibility feed schedule? Once the Exchange takes on the administrative duties, please confirm if you are able to share updated data back to LACERS. If yes, how often can data be shared?

Enrollment and Premium Payments 9. How do you receive payments for medical plan premiums? Do you bill the enrollees

directly or would you bill LACERS?

10. How do you handle retroactive enrollment and cancellations? What are your time limitations relative to processing retroactive eligibility adjustments?

11. LACERS subsidizes medical plan premiums for eligible Retirees and Survivors. Would you be able to accept subsidy payments directly from LACERS and credit them toward the premiums for its members participating in your Medicare exchange? If so, please describe how this process would work.


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12. LACERS’ current Medicare Advantage plans notify LACERS when a member loses coverage due to a lapse in Medicare Part B or Part D coverage. Would your Medicare exchange be able to notify LACERS when a member is no longer eligible to participate due to lapse of Medicare Part B or Part D coverage?

13. How do you administer the Medicare Low Income Subsidy (LIS) and Late Enrollment Penalty (LEP) for participants in your Medicare exchange?

Enrollee Communications 14. Please indicate the response that matches your practice for member identification

numbers:

A. Utilize Social Security Number (SSN) exclusively B. Utilize unique number (NOT SSN) C. Purchaser option to use SSN or other number D. Utilize SSN, but able to make individual exceptions and use non-SSN for those

unwilling to utilize SSN for this purpose

15. Provide samples of the following communication materials with your proposal. Each set of your proposal should contain a copy of each of these materials.

A. Medicare plans offered in California (we may later request other locations) B. Medicare plans offered in one other state C. All pre-enrollment communication materials provided to LACERS

16. Describe any limits to customizing each of the above at no cost to LACERS.

17. Describe the resources you will provide to work with LACERS in the development of member communication materials (education, open enrollment, and ongoing communications).

COBRA 18. Describe your capabilities and any restrictions related to the administration of COBRA for

any plans you are awarded.

19. How will you track COBRA enrollees?

20. LACERS extends COBRA provisions to all family members eligible under the Group Insurance Regulations even though COBRA does not specifically cover them (for example, same-sex domestic partners and grandchildren). Do you agree to extend COBRA Continuation and conversion privileges to all individuals LACERS deems eligible?

21. LACERS extends COBRA coverage to those who it deems eligible for 36 months, even

though under certain circumstances, federal rules would allow for a shorter coverage


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period. Do you agree to allow members who LACERS deems eligible to maintain coverage under COBRA for up to 36 months?

Privacy and HIPAA

22. Please confirm your compliance with all administrative simplification provisions under

HIPAA. Specifically address each of the following regulations: • Health information privacy • Unique identifier for employers • Security requirements • Unique identifier for health plans • Enforcement procedures

23. Do you agree to indemnify LACERS for any liabilities resulting from the improper

disclosure of protected health information by you or any of your subcontractors? 24. Do you agree to indemnify LACERS for all liabilities resulting from the improper disclosure

of information by you or any of your subcontractors that results in identity theft for a LACERS member?

Contracts 25. What documents must be developed to accommodate LACERS' performance

guarantees? Provide a short statement indicating your willingness to draft such documents to the mutual satisfaction of your organization and LACERS.


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D. Member Services

Staffing & Operations

1. Please refer to Member Services.xls found in Appendix D and provide the requested information on the customer service center that will handle the LACERS account.

2. Please provide your annual turnover rate for the office you are proposing. Provide the precise calculation you use to calculate turnover.

2010 2011 2012

Supervisors

Customer Service Representatives

3. Describe the formal training (initial and ongoing), qualifications and minimum experience

required of your member service representatives. 4. Describe the systems you use to track phone and staff utilization and how you adjust

staffing based on call volume. 5. Would you propose to offer a dedicated or partially dedicated unit/staff to LACERS?

Describe your proposal in detail and any conditions on that proposal. If you are proposing a partially dedicated unit, please indicate the current number of other groups and total membership served by the partially dedicated unit.

6. Would you offer a dedicated toll-free phone number? 7. Can calls be shifted to another customer service/call center if the time on hold or call

abandonment rate exceed the desired thresholds? If so, how often does this occur? 8. Please confirm whether your customer service personnel are U.S. based. If so, please

confirm you will provide sufficient notification to LACERS should the customer service personnel ever be outsourced to another country.

Telephone Systems

9. What information is the member required to enter into the VRU system (e.g., group

number, SSN, etc.)? 10. Can a member leave a message at your member service line after working hours? If yes,

what is the protocol for responding to that call?


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11. Please indicate if your telephone system reports the following measures:

• Average Speed of Answer • % of Calls Answered Within Target (e.g., 80% in 30 sec.) • Busy Signal Rate • Abandonment Rate • Number of calls transferred

12. Please specify your 4 busiest months. How do you handle the increased call volume (e.g.,

hire temporary employees, contract with an outside vendor, etc.)? What is your average speed of answer during these 4 busiest months?

13. Please indicate if your telephone system tracks the following time intervals.

• First ring to call pick-up (VRU or person) • IVR Time • Wait Time to speak with CSR • Talk Time • Hold Time after first CSR contact • Total Time

14. Do you have the ability to warm-transfer the calls to any sub-contractors you utilize?

15. Does your system allow members to opt to speak to a live person at any time during a

call? Is this option, and how to exercise it, made clear to callers initially? Please describe.

16. Do you offer members the ability to contact the customer service operation after normal working hours? If so, please describe what methods are available and how these are communicated to members.

17. Please describe your telephone technology and/or ability to accommodate the hearing impaired.

Customer Service System

18. Are complaints identified in a discrete field on your system (so as to be reportable as a

percentage of member service calls/inquiries)? Performance

19. What was your call abandonment rate or percentage by month for 2012?

Jan Feb Mar Apr May Jun

Jul Aug Sep Oct Nov Dec


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20. Please refer to Member Services.xls found in Appendix D and provide your target service standards and performance statistics as requested in the attached chart. Do not leave fields blank; indicate N/A where no response is available or intended.

21. Please define your process for handling issues that are not resolved in the initial call.


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E. Available Medical Plans Plan Availability 1. Please list all medical plans offered on your Medicare exchange in the states of California,

Nevada, Arizona, Texas, Oregon, and Washington. Are there any areas in these states where you do not have plans available?

2. Are you able to offer Medicare plan carriers throughout the entire United States? If there are any states where you are unable to offer Medicare plans, please list them.

3. How many days’ notice do you provide to a member whose medical plan is no longer

participating in your exchange?

Plan Quality

4. Describe your efforts at providing the medical plans on your Medicare Exchange with feedback:

A. Do you provide medical plans with information comparing their rates to the other medical plans on your exchange?

B. Do you forward customer complaints about the medical plans you offer back to the medical plans?

5. Do you provide information (e.g., provider report cards) to members regarding the quality

or performance of medical plans on your exchange? Provider Satisfaction Surveys

6. Do you survey your contracted medical plan providers for their satisfaction with your

organization? If so, explain your program, including: • The frequency of issuing the survey • The instrument and method used • The percentage of medical plans surveyed, response rates and recent results • Any specific actions you have taken in direct response to provider survey results.


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F. Prescription Drug Coverage Plan Design / Product Issues 1. Does your Medicare Exchange offer prescription drug coverage integrated with the

medical plans you offer, as a stand-alone product, or both? 2. LACERS is committed to encouraging our members to maintain creditable coverage

pursuant to the requirements of the Medicare Part D program. If LACERS were to require its members enrolling in Medicare plans through your exchange to select prescription drug coverage, would your exchange be able to enforce such a requirement?

3. If your Medicare Exchange offers prescription drug coverage through stand-alone plans,

please list the plans you offer in California, Nevada, Arizona, Texas, Oregon, and Washington.

G. Questions Concerning Your Proposal

1. Is your firm requesting any alternatives and/or substitutions to the scope of services

required in this RFP or LACERS standard RFP and contracting provisions? See General Conditions (Appendix A) and the Standard Provisions for City Contracts (Appendix B). Your proposal will be deemed non-responsive if the alternatives/substitutions are not acceptable to LACERS.

2. Provide evidence that your firm meets the minimum required qualifications. 3. List representative clients for whom similar services have been provided. Include client

name and address, scope of services, beginning and ending dates of contract, contract amount for services, and contact person to provide verification of the contract (name and telephone number).

4. Provide five references from public pension fund clients with assets each in excess of

$100 million, for whom the primary account manager and principal assistant have provided medical plan services. For each reference include:

• The name of the proposer’s account manager • Client name and address • Client contact person name, phone number, e-mail address • The time period during which the services were provided • A brief summary of the services provided

5. Provide documents to demonstrate that your account manager meets the minimum

required qualifications. This should include at minimum a resume and professional credentials.

6. List the name and office location of the primary individual(s) who would be responsible for

our account and provide brief biographies including titles, functions, academic credentials, relevant experience, past clients served, and number of health plan clients, and the dates


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they managed each account, anticipated to be assigned to each individual concurrently with this engagement.

7. What policies are in effect to control the workload as it relates to the number of clients

serviced by account manager? Is there a limit on the number of accounts that an account manager may handle?

8. Please describe your understanding of the scope and level of services required by this

RFP.

9. Describe your account manager’s experience and involvement with public pension client(s) who were in the process of transitioning retirees to your Medicare Exchange.

10. Are there any services which you will not be providing to LACERS, which were required by

this RFP? 11. Describe your firm’s ability to provide periodic updates regarding federal legislation and/or

IRS Rules that may affect the operation of the LACERS and the payment of benefits. 12. Describe the media your firm uses to inform clients of changes in pending federal

legislation or regulations. 13. Does your firm produce a newsletter specifically for public retirement plans or is the

material produced for both public and private plans? 14. Include as an addendum item samples of your firm’s reports to clients. H. REQUIRED COMPLIANCE DOCUMENTS Please submit all REQUIRED COMPLIANCE DOCUMENTS specified in the General Conditions and Compliance Documents (Appendix A). Failure to complete these documents will deem your proposal as non-responsive.

o Request for Proposal Warranty/Affidavit (Appendix A, Attachment 3) - The document must be signed and notarized

o Affirmative Action Plan (Appendix A, Attachment 4) - Complete with the proposal, or submit your own Affirmative Action Plan that meets all the requirements of the City of Los Angeles’ Affirmative Action Program

o Equal Employment Practice Form (Appendix A, Attachment 5) o Bidder Certification – City Ethics Commission Form 50 (Appendix A, Attachment 6) o Bidder Certification – City Ethics Commission Form 55 (Appendix A, Attachment 7) o MBE/WBE/OBE Subcontractor List (Appendix A, Attachment 8)

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