Health Benefits Manager

Agency: State Government of Delaware
State: Delaware
Level of Government: State & Local
  • Q - Medical Services
  • R - Professional, Administrative and Management Support Services
Opps ID: NBD10705946313656684
Posted Date: Jan 4, 2019
Due Date: Feb 22, 2019
Source: Members Only
Bid Solicitation Details
Bid Status Details
Health Benefits Manager,
Solicitation Ad Date 1/4/2019
Deadline for Bid Responses 2/22/2019 at 11:00 a.m. Local Time
Supporting Documents ? RFP - Professional Services
Contact Information

Attachment Preview

For Health Benefits Manager
I. Overview
II. Required Information
III. Professional Services RFP Administrative Information
IV. Contract Terms and Conditions
V. RFP Miscellaneous Information
VI. Attachments
Exhibit 1- Cost proposal work sheets
Exhibit 2- Overview of State information systems
Exhibit 3- Definition of target populations and caseload estimates.
3.1 List of exclusion conditions.
3.2 List of exemption conditions
3.3 Reasons for transfer to/from health plan.
3.4 Reasons for disenrollment from Diamond State Health Plan
Exhibit 4-Statement of Resources to Operate Health Benefits Manger Program.
Exhibit 5- Service package description.
Exhibit 6- Key terms.
I. Overview
The State of Delaware Department of Health and Social Services, Division of Medicaid and Medical
Assistance (DHSS/DMMA) seeks professional services from interested vendors to provide a set of
services to the Delaware Medicaid and Delaware Healthy Children Program (DHCP) populations
through the Diamond State Health Plan (DSHP), and Diamond State Health Plan Plus (DSHP-Plus). This
request for proposals (“RFP”) is issued pursuant to 29 Del. C. §§ 6981 and 6982.
The proposed schedule of events subject to the RFP is outlined below:
Public Notice
Date: January 4, 2019
Deadline for Questions
Date: January 18, 2019
Response to Questions Posted by:
Date: February 1, 2019
6982(b) Version: July 7, 2017
DHSS May 16, 2018
Deadline for Receipt of Proposals
Date: February 22, 2019 at 11:00 AM (Local
Estimated Notification of Award
Date: February 28, 2019
Each proposal must be accompanied by a transmittal letter, which briefly summarizes the proposing
firm’s interest in providing the required professional services. The transmittal letter must also clearly
state and justify any exceptions to the requirements of the RFP, which the applicant may have taken
in presenting the proposal. (Applicant exceptions must also be recorded on (Attachment 3).
Furthermore, the transmittal letter must attest to the fact, at a minimum, that the Vendor shall not
store or transfer non-public State of Delaware data outside of the United States. For technology
related solicitations, Vendors may refer to the Delaware Department of Technology and Information
identified terms and conditions included in this solicitation.
The State of Delaware reserves the right to deny any and all exceptions taken to the RFP requirements.
A mandatory pre-bid meeting has not been established for this Request for Proposal.
This document is a Request for Proposals for interested vendors to provide a set of services to the
Delaware Medicaid and Delaware Healthy Children Program (DHCP) populations through the Diamond
State Health Plan (DSHP), and Diamond State Health Plan Plus (DSHP-Plus). The services to be provided
by the selected vendor consist of activities to support Members both before and after enrollment in an
MCO. These activities include but are not limited to benefit and program education and non-biased
assistance to Members in the choice of an enrollment into managed care organizations (MCOs). It also
includes the billing for and collection of monthly premiums for the Delaware Healthy Children Program
(Delaware’s Title XXI SCHIP program). These services are to be delivered as an integral part of the
Medicaid managed care programs, Diamond State Health Plan, Diamond State Health Plan Plus and
Delaware Healthy Children Program. The purpose of this Request for Proposal (RFP) is to solicit bids
from qualified organizations to perform services according to the terms and conditions set forth
herein. The State of Delaware desires to contract with one (1), independent Health Benefits Manager
(HBM) per the attached specifications. This RFP primarily describes the program standards with which
the contracting HBM must comply. It also includes information on the policies and procedures that the
State will follow in carrying out its program management and oversight responsibilities.
Program Oversight
The Delaware Department of Health and Social Services (DHSS) is an umbrella agency that is responsible
for the administration of most of the State's health-related services. Included in its twelve Divisions is
the Division of Medicaid & Medical Assistance (DMMA). The DMMA is officially designated as the
administrator of the State's Medicaid and Healthy Children programs. This administrative responsibility
is discharged at the operational level through the Managed Care Operations Unit in the Division of
Medicaid & Medical Assistance. The Medicaid program is the Title XIX Federal-State health program for
certain categorically eligible low-income groups. The Delaware Healthy Children Program is the State’s
Title XXI program for low- income children (SCHIP). In addition to State agency oversight, the Center for
Medicare and Medicaid Services (CMS) also will monitor Delaware's Medicaid managed care program
activities through its Regional office in Philadelphia, Pennsylvania and its central office in Baltimore,
Maryland. The Delaware Department of Health and Social Services (DHSS) is the issuing agency for this
Delaware Medicaid
Delaware receives on average 54 percent matching funds from the Federal government for this
program. In State Fiscal Year (SFY) 2018 (July 2017 to June 2018), total Medicaid expenditures were
$2,306,708,964. There were 236,702 average monthly eligibles for SFY 2018. There were 186,380
average monthly eligibles in the Diamond State Health Plan for SFY 2018.
Presently, the DMMA State Managed Care program contracts with two Managed Care Organizations
(MCOs) to provide services to 229,810 Medicaid and 7,933 Delaware Healthy Children enrollees. The
services required under the Diamond State Health Plan program for this proposal shall be provided for
one or more MCOs if more than one MCO is enrolled during the term of the contract. Delaware
Medicaid provides coverage to various populations who meet the Federal Poverty Level (FPL) and other
eligibility requirements. Below are the FPL guidelines:
Pregnant women and infants with incomes up to 212% of the FPL
Children ages 1 to 5 with incomes up to 142% of the FPL
Children ages 5 to 18 (until the end of the month when the child turns 19) with incomes up to
133% of the FPL
Adults with incomes up to 133% of the FPL
The Delaware Healthy Children Program (DHCP) covers children at or below 212% of the Federal Poverty
level. A monthly premium is charged per eligible household based on the household’s income level.
Families of children determined eligible for the DHCP must also pay a monthly premium and maintain
the child’s enrollment in an MCO to be eligible for the program. If the family does not pay the DHCP
premium for two consecutive months, the DHCP-eligible child would be dis-enrolled from his/her MCO.
If the family pays the premium, the DHCP-eligible child would be re-enrolled in the same MCO he/she
was in prior to his/her disenrollment for nonpayment. All these activities are managed by the HBM.
Effective 12/20/17, an Amendment was made to the 1115 Waiver to provide Medicaid state plan
coverage to former foster care youth under age 26 who were in foster care under the responsibility of
another state or tribe when they "aged out" of foster care at age 18 (or such higher age as elected by
the other state) and were enrolled in Medicaid at that time.
Delaware Medicaid also provides Long Term Services and Supports (LTSS) through both managed Long
Term Care under Diamond State Health Plan Plus and through fee-for-service for the Division of
Developmental Disabilities Services (DDDS) waiver. Individuals must qualify both medically and
financially to receive LTSS in Delaware. The HBM would be responsible for providing assistance to these
groups of individuals as well.
The 1915(c) DDDS Lifespan Waiver amendment increases the waiver enrollment limits to include
individuals with intellectual and developmental disabilities, autism, and/or Prader-Willi Syndrome who
have left school but who do not require a residential support as of the time of enrollment. The
individuals that are the target of the waiver expansion typically live in the family home and are currently
enrolled in Delaware’s 1115 Diamond State Health Plan (DSHP) Waiver to receive their regular Medicaid
State Plan benefits via enrollment with a Managed Care Organization.
The population affected by this Demonstration is comprised of individuals who are enrolled in the 1115
DSHP Waiver that qualify to be enrolled in the 1915(c) DDDS Lifespan Waiver on or after July 1, 2017
and are not receiving Residential Habilitation. This population will receive their regular Medicaid State
Plan benefits via enrollment with a Managed Care Organization. Individuals who are enrolled in the
1915(c) DDDS Lifespan Waiver and are receiving Residential Habilitation will continue to be carved-out
of the 1115 DSHP Waiver and will receive their acute care benefits via fee for service.
Members that are currently receiving DSHP Plus LTSS under the 1115 Waiver will be unaffected by this
change if they choose to remain enrolled in DSHP Plus. DSHP Plus LTSS members with intellectual and
developmental disabilities cannot be concurrently enrolled in the 1115 waiver and the DDDS Lifespan
1915(c) waiver. Individuals must choose the LTSS program that will best meet his or her needs. Individuals
will be assisted to make that choice by the MCO case manager and a DDDS Community Navigator.
A. We have recently submitted a request to the Centers for Medicare and Medicaid Services
(CMS) to extend our current CMS 1115 waiver by 5-years as well as a request for a Substance
Use Disorder Amendment. Target Population
Qualification for the Diamond State Health Plan, Diamond State Health Plan Plus and Delaware Healthy
Children’s Program are based on a combination of factors including family composition, income level,
insurance status, and medical level of care and pregnancy status, depending on the eligibility group. The
specific eligibility groups that will be included in these Plans are described in more detail in Exhibit 3,
along with the State's estimate of the size of each group in the target population.
The contractor shall perform the following duties described below:
II. Required Information
The following information shall be provided in each proposal in the order listed below. Failure to
respond to any request for information within this proposal may result in rejection of the proposal at
the sole discretion of the State.
A. Minimum Requirements
1. Provide Delaware license(s) and/or certification(s) necessary to perform services as identified
in the scope of work.
Prior to the execution of an award document, the successful Vendor shall either furnish the
Agency with proof of State of Delaware Business Licensure or initiate the process of
application where required.
2. Vendor shall provide responses to the Request for Proposal (RFP) scope of work and clearly
identify capabilities as presented in the General Evaluation Requirements below.
3. Complete all appropriate attachments and forms as identified within the RFP.
4. Proof of insurance and amount of insurance shall be furnished to the Agency prior to the start
of the contract period and shall be no less than as identified in the bid solicitation, Section V,
Item 8, subsection g (insurance).
1. General Evaluation Requirements Experience and Reputation
2. Expertise (for the particular project under consideration)
3. Capacity to meet requirements (size, financial condition, etc.)
4. Location (geographical)
5. Demonstrated ability
6. Familiarity with public work and its requirements
III. Professional Services RFP Administrative Information
A. RFP Issuance
1. Public Notice
Public notice has been provided in accordance with 29 Del. C. §6981.
2. Obtaining Copies of the RFP
This RFP is available in electronic form through the State of Delaware Procurement website
at . Paper copies of this RFP will not be available.
3. Assistance to Vendors with a Disability
Vendors with a disability may receive accommodation regarding the means of communicating
this RFP or participating in the procurement process. For more information, contact the
Designated Contact no later than ten days prior to the deadline for receipt of proposals.
4. RFP Designated Contact
All requests, questions, or other communications about this RFP shall be made in writing to
the State of Delaware. Address all communications to the person listed below;
communications made to other State of Delaware personnel or attempting to ask questions
by phone or in person will not be allowed or recognized as valid and may disqualify the
vendor. Vendors should rely only on written statements issued by the RFP designated
Loriann Broome
Social Service Administrator
1901 North DuPont Highway
Lewis Building
New Castle, DE 19720
To ensure that written requests are received and answered in a timely manner, electronic
mail (e-mail) correspondence is acceptable, but other forms of delivery, such as postal and
courier services can also be used.
5. Consultants and Legal Counsel
This is the opportunity summary page. You are currently viewing an overview of this opportunity and a preview of the attached documentation. For more information, please visit the Publication URL Web page.


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