Información General
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| Agencia: Administración de Seguros de Salud (ASES) |
Tipo Subasta:
Requerimiento de Propuesta (RFP) | | Localización del Proyecto:
Todo Puerto Rico |
Fecha Reunión Pre-Subasta:
martes, 14 de junio de 2022
Hora: 10:00 a. m.
| | Lugar Pre-Subasta:
There will be an Actuarial Mandatory Meeting as well, on the same day, at 1:30 PM.
Virtual meeting through MS Teams. The link will be sent to those entities that acquire the RFP Document Package.
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Fecha Entrega Pliegos:
Desde: lunes, 23 de mayo de 2022
Hora: 8:00 a. m.
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Hasta: viernes, 3 de junio de 2022
Hora: 5:00 p. m. |
Fecha Apertura:
Hora:
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Costo Pliegos:
$15,000.00
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Descripción:
This is a request for competitive proposals from insurace companies or otherwise approved health organizations in Puerto Rico that meet the CMS definition of an MCO, to provide services to Enrollees of the Puerto Rico Government Health Plan (GHP) program known as “Plan Vital" through an island-wide at-risk managed care program for all eligible populations including Vieques and Culebra and foster children/domestic violence victims. The term of the initial Contract will be from January 1, 2023, through December 30, 2025, with an option to extend for up to two additional years each, at ASES' discretion.
A high level summary of the Contractor's obligations under Plan Vital is as follows:
a. Guarantee quality care and timely access to covered services for all Enrollees through an integrated (physical and behavioral health) and coordinated care model.
b. Implement and execute models that result in cost efficiencies and savings to the program.
c. Participate in the efforts by government agencies for the prevention, promotion and education in health, at a minimum, HIV/AIDS, substance abuse, prenatal and maternal care and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT).
d. Provide benefits in accordance with the Puerto Rico Medicaid state plan.
e. Establish an adequate Provider network, fully credentialed*, to provide beneficiaries appropriate and timely access to health services through the PMG and PPN model. NOTES: *Contractor will be responsible for this process while ASES transitions to a centralized State created Credentialing Verification Organization (CVO).
f. Establish a call center in Puerto Rico available 24 hours-a-day/365 days per year, for Enrollees to receive assistance related to their health condition and the health facilities available.
g. Develop and maintain an information system with the capacity to collect, process and transmit all data related to the program.
h. Develop third-party liability (TPL) and coordination of benefits (COB) procedures to ensure that Plan Vital is the payer of last resort.
i. Make timely payments to Providers.
j. Conduct internal audits and audits of Subcontractors and Providers.
k. Establish programs to prevent and detect cases of fraud, waste and abuse among Providers and Enrollees.
l. Comply with federal Medicaid/CHIP Mental Health Parity and Addiction (MHPAEA) regulations.
m. Cooperate closely and effectively with the Plan Vital's PBM and the Rebate Aggregator.
n. Establish a super-utilizer program for all Enrollees in the Plan Vital program.
Roxanna Rosario
Deputy Executive Director
Notas Especiales
I. Acquisition of RFP:
A. As of May 23, 2022, entities interested in obtaining an electronic copy of the RFP Document Package must send a written request by email to GHPRFP2022@asespr.org, signed at least by the Offeror's President, CEO or highest-ranking management official in Puerto Rico, stating:
1. the entity's interest in submitting a Proposal;
2. that it possesses legal and financial capacity to submit a Proposal;
3. the contact information (name, position, email address and telephone number) of the person authorized to communicate during the process with the ASES' Procurement Contact.
B. Upon receipt of the request, ASES will send the bank account information for the corresponding electronic payment of the RFP Document Package. The deadline for payment is 5:00 PM (AST) on June 3, 2022.
C. After payment, the interested entity will send to ASES, by email, the evidence of payment provided by the financial institution which must include:
(1) date of payment;
(2) amount of the electronic transfer made to ASES; and
(3) name of the interested entity making the payment.
WARNING: Any unresolved deficit in payment, even caused by a transaction fee charged by the financial institution or an intermediary, WILL PRECLUDE THE POTENTIAL PROPONENT FROM SUBMITTING A PROPOSAL.
II. Minimum Requirements to Contract with the Government:
At the time of adjudication of the RFP, the Offeror must:
be licensed or authorized by the Office of the Insurance Commissioner of Puerto Rico;have a current Certificate from the “Registro Único de Proveedores de Servicios Profesionales (RUP)" of the General Service Administration of Puerto Rico;be registered in the System for Award Management (SAM); andnot be disqualified, suspended, proposed for disqualification or declared ineligible for the award of contracts by any federal and state department or agency. II. Conflict of Interest: A. Neither the Offeror nor any of its Material Subcontractors shall own or control nor be owned or controlled by Vital's Enrollment Counselor (Truenorth Corporation) or any of its Subcontractors (Aval Resources, LLC). Likewise, the Offeror and any of its Material Subcontractors shall have no direct or indirect financial interest with the Enrollment Counselor, including any on-going contract or agreement. B. In case of a conflict of interest, the Offeror shall submit with its Proposal a: (i) Divestiture Action Plan, or (ii) a detailed explanation as to why a conflict of interest is eligible to be waived, and/or a Conflict Avoidance Plan.
III. BID BOND: Offerors must submit no later than 1:00 PM (AST) on July 15, 2022 a Bid Bond in the amount of $2,000,000.00.
IV. PROPOSAL: A. The proposal will be submitted in an electronic document repository no later than 1:00 PM (AST) on July 15, 2022. B. ASES will only consider proposals from entities that: (1) acquired the RFP Document Package;(2) participated in both mandatory conferences; and(3) submitted the Bid Bond and the Proposal on time. WARNING: Failure to comply with these requirements will result in disqualification of the Offeror.
VI. Performance Bond:
Prior to signature of the Contract, the awarded Offerors shall procure an initial Performance Bond in the amount of $40,000,000.00, which shall be adjusted after the Open Enrollment process. The adjusted amount shall be equal to 50% of the total Capitation Payment made the month following the end of the Open Enrollment process.
ASES reserves the right to cancel or modify this RFP, reject any or all of the proposals and award the contract under the most favorable conditions for the Government of Puerto Rico. ASES does not discriminate in any way on the basis of age, race, color, sex, birth, veteran status, political or religious belief, origin or social status, sexual orientation or gender identity, physical or mental disability.
Información de Contacto
Contacto Agencia: Martha L. Vélez González
Teléfono Contacto: 787-474-3300 Ext. 3006
Fecha Publicación:5/20/2022