INVITATION TO NEGOTIATE BIDDERS CONFERENCE Florida Healthy Kids

INVITATION TO NEGOTIATE BIDDER’S CONFERENCE Florida Healthy Kids Corporation Health Benefits Coverage Underwriting and Services March 22, 2010 – 9: 00 a. m. FLORIDA HEALTHY KIDS CORPORATION 1

What is the Florida Healthy Kids Corporation? • Non-profit corporation created in 1990 • One of 4 Florida Kid. Care Program Components • Part of Florida’s CHIPTitle XXI Program • Serving children ages 5 through age 18 • This ITN covers only children in the Healthy Kids program www. healthykids. org

Scope of Invitation to Negotiate • To secure a choice of managed care plans in designated counties (Phase I) • Covers 14 counties with at least 3, 000 enrollees • An overlay with the existing insurer • Effective January 1, 2011 www. healthykids. org

Scope of Invitation to Negotiate • No guarantee of minimum enrollment – FHKC expects to continue to insure existing enrollment – Future enrollment based on funding – Award of contracts based on available funding – Continuation of incumbent based on contract negotiations; not a rebid of current contracts www. healthykids. org •

Evaluation Process • Two Step Process – First Step: • • Must offer an insured product Must meet the minimum benefit specifications Cannot increase the cost sharing specifications Cannot change the program’s objectives – Second Step: • Evaluated consistent with state law • Factors that may be considered under Section III www. healthykids. org

Evaluation Process • Personal Interviews – Conducted in Tallahassee – Open Meetings • Submissions should be complete, organized and concise – Subject to public review after award – FHKC can review and evaluate without further input or clarification www. healthykids. org

Calendar • Subject to Change – Monitor the Healthy Kids Website regularly – Keep contact information up to date • Key Dates to Remember – Mandatory Letter of Intent: March 26, 2010 – Question & Answer Period Ends: April 23, 2010 – Proposal Deadline: May 19, 2010 – 12: 00 Noon www. healthykids. org

Single Point of Contact • Contact only the Issuing Officer – lloydj@healthykids. org – (850) 701 -6108 • Contacting any other person is grounds for disqualification www. healthykids. org

Questions Regarding this ITN • Must be submitted in writing to Issuing Officer • Faxed or emailed only – no phone calls • Accepted through April 23, 2010 • Questions will be posted to web by May 7 th www. healthykids. org

Mandatory Bidder’s Conference - NEW • Mandatory participation at Bidder’s Conference – Bids will only be accepted from Bidder’s Conference participants – Questions answered today will be transcribed and posted – Answers today are preliminary until posted www. healthykids. org

Supplemental Information Requests • Written requests will be considered on a case by case basis – Information will be posted to the web – Public records can be viewed through appointments – Proposals, grading tools, materials as part of this ITN are not available until the process has been concluded www. healthykids. org

Other Terms • Amendments to the ITN • Special Disclosures • Most Favorable Terms • Withdrawals www. healthykids. org •

Competitive Negotiation Process • FHKC may enter negotiations with selected bidders • FHKC may elect to execute a contract or contracts with a selected bidder or bidders without any further negotiation • Therefore, proposals should be submitted in complete form www. healthykids. org

Limitations Bidders cannot submit proposals for the same county under multiple plans that are affiliated or linked by shared ownership or controlling interests. www. healthykids. org •

Submission Requirements • Submission Deadline: May 19, 2010 NOON • Volume I and Volume II 5 Notebooks Each 5 CDs Each • Volume III 2 Notebooks Each 2 CDs Each www. healthykids. org

Submission Requirements • Volumes must be 3 -Ring Notebooks • Easily flip-able and read-able materials • WORD, EXCEL and PDF files only • Clearly marked Tabs and sub-tabs required www. healthykids. org

Changes Since Last ITN • Mandatory Letter of Intent (LOI) Tab B – Required Letter of Intent by deadline to submit proposal – Due Friday, March 26, 2010 – LOI is non-binding and can be withdrawn at any time – Organization, contact information, counties www. healthykids. org •

Changes Since Last ITN • Evidence of Regulatory Authority Tab C – Evidence of regulatory authority must be in place as of the date the proposal is submitted to FHKC – Evidence required is based on the model being proposed www. healthykids. org •

Changes Since Last ITN • Program ManagementConfidentiality Tab G-6 – Describe compliance with activities related to Health Information Technology for Economic and Clinical Health Act (HITECH) www. healthykids. org

Changes Since Last ITN • Implementation and Transition Plans Tab H – Plans for handling members transitioning from other insurers after January 1, 2011 – Transition plan goes through September 30, 2011 www. healthykids. org

Reporting Requirements • Existing Insurers: Current Compliance status • Non-Incumbent: – Must initiate testing phase prior to Personal Interview with at least one (1) exchange to move on in process – Must complete testing process to continue evaluation process or may be disqualified – Completion determined by date of Purchasing & Oversight Committee meeting (final grades) – Bidder’s sole responsibility to complete www. healthykids. org •

Standard ContractContract Amendment • Existing Insurers will be asked to execute an amendment if awarded additional counties • New Insurers will execute the final contract • Revisions not generally accepted q Must affirmatively accept contract q Points deducted for substantive changes www. healthykids. org

ContractContract Amendment • Current contract template provided for reference with most recent changes highlighted • New provisions recently identified by federal CMS • Updated template with required revisions will be posted by April 5 th www. healthykids. org

Provider Networks – Volume II • Must be provided EXACTLY as prescribed • Information only for counties covered by LOI unless Enrollees may access services in those counties AND meets access standards • Required Summary Sheets (NEW) www. healthykids. org

Changes Since Last ITN • Provider Listings NEW – List only those providers already under contract – If the provider must still complete contracting, their rows must be shaded – FHKC may request evidence of such contracts www. healthykids. org •

Changes Since Last ITN • Summary Sheets Appendix Tab A & – Summary Sheet found in Appendix should be first page in Tab A followed by EXCEL listing of providers – GEO ACCESS map of board certified only providers mapped to Enrollees required www. healthykids. org

Changes Since Last ITN • Specialists Tab B & Appendix – Summary Sheet found in Appendix listing Specialists should be first page in Tab B followed by EXCEL listing of providers – Providers for the county being bid should be first followed by any other providers available within neighboring counties meeting contract standards – Within the county listing, the next sort order should be alphabetical by the specialty and then alphabetical by provider last name www. healthykids. org

Changes Since Last ITN • Affiliated Entities Tab I – New Tab – Response required – Affirmative response if does not apply www. healthykids. org

Volume III – Rate Proposals • Three presentation options provided • Single combined rate for 14 counties • Single rate for any group of counties • Individual county rates • Special Optional response for a statewide proposal www. healthykids. org

Other New Provisions Since Last ITN Effective July 1, 2009: • Permits children income and clinically eligible children for CMS to opt-out of CMS into Healthy Kids. Effective October 1, 2009: • Managed Care Protections Policy – 90 day free look policy for all new Enrollees – Good cause exceptions after lock-in occurs – 90 day choice period after implementation for all existing Enrollees in new choice counties www. healthykids. org •

Delivery of Services – Background Information • Standards for delivery of services • Access (Primary Care, Specialty, Hospital, BHSA) • Appointment • Credentialing • Board certified primary care physicians only • Pediatricians and family practice • Calculations used adequacy provided www. healthykids. org

Appendix Documents • Word versions of these will be posted to the website • Current FHKC Insurers may use FHKC as one of the three required references • Summary sheets for designated Tabs are required www. healthykids. org •

Specialty Care Provider Summary Sheets • Only those providers that see the majority of Enrollees within the Healthy Kids age range (518) should be listed. • Example: • A Specialist only sees those over age 16 – should not be included on summary sheet; can be included on the EXCEL provider listing behind the summary sheet • Ok, if sees children over age 10 www. healthykids. org

Premium Rate Proposal Form • Premium Rate Proposal Form – Only those rates that are presented on the required form will be considered www. healthykids. org

Supplemental Information • Utilization Data – Will be posted to the website in EXCEL – Notation regarding change in plans • Data Layouts and Submission Guidelines www. healthykids. org •

Question and Answer Period Break www. healthykids. org

Final Words • Any conflict between today’s presentation and the ITN, the ITN provision controls • Today’s verbal responses are preliminary. Final written responses will be posted to the Healthy Kids’ website – www. healthykids. org • Contact Only the Issuing Officer www. healthykids. org

Issuing Officer Contact Information Jennifer Kiser Lloyd Chief External Affairs Officer lloydj@healthykids. org (850) 701 -6108 – Phone ; (850) 224 -0615 – Fax 661 E. Jefferson Street 2 nd Floor, Florida Bar Annex Tallahassee, Florida 32301 www. healthykids. org •