Optical Benefits to Medicaid Beneficiaries RFP
|Agency:||State of Vermont|
|Level of Government:||State & Local|
|Posted Date:||Feb 13, 2019|
|Due Date:||Mar 26, 2019|
|Title||Question Due||Answers posted||Due date||No posting After|
|Optical Benefits to Medicaid Beneficiaries RFP||02/26/2019 03:00PM||03/26/2019 03:00PM|
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State of Vermont
Agency of Human Services,
Department of Vermont Health Access (DVHA)
NOB 1 South, 280 State Drive
Waterbury, VT 05671-1010
REQUEST FOR PROPOSAL
Optical Benefits to Medicaid Beneficiaries
QUESTIONS DUE BY:
RFP RESPONSES DUE BY:
February 13, 2019
February 26, 2019 3:00PM
March 26, 2019 3:00PM
PLEASE BE ADVISED THAT ALL NOTIFICATIONS, RELEASES, AND AMENDMENTS
ASSOCIATED WITH THIS RFP WILL BE POSTED AT:
THE STATE WILL MAKE NO ATTEMPT TO CONTACT INTERESTED PARTIES WITH UPDATED
INFORMATION. IT IS THE RESPONSIBILITY OF EACH BIDDER TO PERIODICALLY CHECK
THE ABOVE WEBPAGE FOR ANY AND ALL NOTIFICATIONS, RELEASES AND AMENDMENTS
ASSOCIATED WITH THIS RFP.
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SCOPE AND BACKGROUND: Through this Request for Proposal (RFP), the Agency of
Human Services, Department of Vermont Health Access (hereinafter the “State”) is seeking
to establish contracts with one or more entities for eyeglasses, lenses, frames, cases and
associated parts for repairs and replacements for eligible beneficiaries of the Vermont
Medicaid program. The successful eyeglass provider/contractor will provide eyeglasses,
lenses, frames, cases and associated parts of high quality and durability with consideration of
cost effectiveness and customer service.
The purchase and replacement of eyeglasses shall be through the State’s supplier, per
Medicaid Rule. The State has contracted for the provision of eyeglasses to eligible Medicaid
beneficiaries since February 1, 1985. The current provider agreement expires June 30, 2019.
VERMONT MEDICAID: The Department Vermont Health Access (DVHA) is the
designated State agency for administration of Vermont’s publicly funded health insurance
programs including the Vermont Medicaid Program. The number of covered lives in the
health insurance programs in SFY 2019 was over 164,000, and over 60,000 of those were
children. Eyeglasses, lenses, and frames are a covered benefit for Vermont Medicaid
members under 21 years of age. Adult Medicaid beneficiaries (age 21 and older) are not
covered for vision care devices. Any contract resulting from this RFP will be for the
provision of eyeglasses (includes lenses, frames and related parts) for eligible beneficiaries
enrolled in the Vermont Medicaid Program, and per Health Care Administrative Rules
(HCAR) 4.214 - Eyewear and Vision Care Services (http://humanservices.vermont.gov/on-
Contact lenses and other aids to vision are NOT a part of this RFP.
1.1. CONTRACT PERIOD: Contracts arising from this RFP will be for a period of two-years with
an option to renew for up to two additional twelve-month periods. The State anticipates the start
date will be 7/1/2019.
1.2. SINGLE POINT OF CONTACT: All communications concerning this RFP are to be
addressed in writing to the State Contact listed on the front page of this RFP. Actual or
attempted contact with any other individual from the State concerning this RFP is strictly
prohibited and may result in disqualification.
1.3. BIDDERS’ CONFERENCE: N/A
1.4. QUESTION AND ANSWER PERIOD: Any vendor requiring clarification of any section of
this RFP or wishing to comment on any requirement of the RFP must submit specific questions
in writing no later than the deadline for question indicated on the first page of this RFP.
Questions may be e-mailed to the point of contact on the front page of this RFP. Questions or
comments not raised in writing on or before the last day of the question period are thereafter
waived. At the close of the question period a copy of all questions or comments and the State's
responses will be posted on the State’s web site noted on the front page of this RFP. Every effort
will be made to post this information as soon as possible after the question period ends,
contingent on the number and complexity of the questions.
2. DETAILED REQUIREMENTS/DESIRED OUTCOMES:
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2.1. TECHNICAL PROPOSAL
2.1.1. PROGRAM SUMMARY
Eyewear & Vision Care Services: Eyeglasses, lenses, frames, cases and associated
replacement parts are a covered benefit for eligible Medicaid beneficiaries and are to be
provided under the resulting contract with the DVHA. Vision service providers must
procure eyeglasses, frames, lenses, cases and replacement parts from the single source
Beneficiary Eligibility: Medicaid coverage of eyewear is limited to beneficiaries under
the age of 21. Vision care services are provided to beneficiaries of any age.
The Contractor will process all orders received and is responsible for verifying that the
beneficiary is Medicaid eligible for eyeglasses, lenses, and frames before making the
eyeglasses or processing the order. If the beneficiary was not eligible for the benefit on the
date the prescription/order was issued, the Contractor will not be paid by Medicaid.
Duplicate orders or incorrect prescriptions will not be the responsibility of the State. The
amount charged by the Contractor for such orders is outside of the provisions of this
Verification of eligibility is obtained by accessing the information on the Vermont
Medicaid Portal https://www.vtmedicaid.com/secure/logon.do or the voice response
system (VRS) at Hewlett Packard (fiscal agent for DVHA/Medicaid) at (800) 925-1706 or
Conditions for Coverage Health Care Administrative Rules (HCAR) 4.214 -
Eyewear and Vision Care Services (http://humanservices.vermont.gov/on-line-
Eyeglasses that have been pre-approved for coverage are limited to a prescription for
frames and lenses as follows:
• For beneficiaries under the age of six:
o One pair of eyeglass frames per year; and
o One new lens per eye per year.
• For beneficiaries age six (6) through 20:
o One pair of eyeglass frames per two years; and
o One new lens per eye per two years.
• Earlier replacement of eyeglasses is limited to the following circumstances:
o Eyeglasses have been lost.
o Eyeglasses have been broken beyond repair.
o Lenses are scratched to the extent that visual acuity is compromised. Note: Dispensing
providers will make the decision about being broken beyond repair or visual acuity being
o The beneficiary’s vision has changed by at least one-half diopter in a single lens. Note:
Strength is documented by the dispensing provider on the Medicaid order form.
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2.1.2. RESPONSIBILITIES OF CONTRACTOR
Bidders must have the ability to successfully supply eyeglasses, lenses, frames, cases and
component parts for repairs and replacements, and to perform all of the functions and
responsibilities as set forth in this RFP. Materials supplied under a resulting contract will
be first quality and in strict adherence to current industry guidelines regarding quality and
Sample Frame Kits: The Contractor will assemble sample frame kits for display,
representing frame styles and colors available under the contract. Subject to the approval of
the State, a kit will be available at the quoted kit cost submitted with the bid response, to
providers who request one. The Contractor may charge the provider for the cost of the
frame kit and the provider is responsible for payment. Charges may not exceed the
contracted frame cost. The State will not be responsible for payment of any costs
associated with frame kits.
Bidders will include the frames and cases in a kit at no charge to the State as part of the
response to this RFP.
Communication and Support to Vision Service Providers: The Contractor will, within one
week of finalized contract:
1) Notify enrolled active vision care providers in writing regarding the contract and all
pertinent information related to the contract, such as ordering and processing
information, Contractor contacts, frames available, forms, etc.;
2) Provide a complete, detailed list of Vermont Medicaid frames to vision service
providers, free of charge;
3) Provide frame information and assistance to dispensing providers on procedures and
ordering throughout the term of any resulting contract.
Bidder will demonstrate the ability to consistently provide appropriate technical and
professional service to vision care providers and DVHA.
Bidders and the resulting Contractor are encouraged to propose methods and work
proactively with DVHA to positively impact health outcomes, manage the eyeglass benefit
and reduce costs to the Medicaid program.
Contractor must complete a Provider Enrollment Form at the time of contract award or
provide proof of enrollment in Vermont Medicaid.
Frames: Considerations for frames include that they be lightweight, strong, durable, and
include some options that are flexible and of substantial materials with sturdy hinge
structure without adding bulk. Frames offered must be suitable for females and males
under age 21 years and be fashionable and current. Bidders are encouraged to propose
options and will provide information to substantiate their frames proposals.
Frame Quality and Durability
The State desires to contract for frames that offer durability, quality and features that can
help to reduce costs for the Medicaid program by helping to reduce the incidents of
breakage to frames and the number of replacement frames supplied to beneficiaries due to
breakage. Some considerations include hinge structure, such as spring hinges that allow the
temples to flex outward, away from the frames, without causing any damage and/or sturdy
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spring structure, and ‘memory metal’, such as flexon, and other strong and flexible frame
materials. Stronger, durable materials will stand up to use by children who are hard on
their eyeglasses while not adding weight, thickness or bulkiness to the eyeglasses.
Wraparound temples, known as "cable temples," will be offered for metal frames and are
helpful to keep glasses in place on toddlers and others.
Frame Standards & Bid Requirements
The bidder shall offer a selection of frames with a good representation of sizes and colors
appropriate to ages 0 to 21, male and female. Variety and selection of frame styles will
include suitable zyl (plastic) and metal frames of first quality, colors, eye sizes, bridge
sizes, which ensure that the frame fits the nose and temple lengths including frames
specifically designed for children with Downs Syndrome. Frames must be current and
readily available. Frames furnished will meet the current American National Standard
All frames must meet current Federal and State requirements and be sturdy and of good
quality and demonstrate durability to help reduce the need for replacement of frames due to
breakage. Frames may be from one manufacturer or from a mix of manufacturers and
must be frames that are also available to the public. No discontinued or close-out frames or
special "Medicaid" frames are permitted, either in response to this RFP or subsequently
provided under any resulting contract.
Frames bid will include a substantial offering to meet the size, gender and choices for ages
up to 21 years. Bidders are asked to provide approximately
• two (2) toddler frame styles (minimum);
• seven (7) metal and five (5) plastic frame styles for kid sizes; and
• seven (7) metal and five (5) plastic frame styles for adult/teen sizes.
• Unisex frames are acceptable for all categories (toddler, kids and
teens/adults to age 21).
All frames must be offered in at least two (2) eye sizes. The bidder is responsible for
choosing the appropriate or popular sizes for each frame. The bidder is also responsible for
providing a variety of shapes, colors and styles for each age and gender category. At least
one of the toddler frame styles shall have regular temple pieces. Adjustable temple bands
are acceptable for one of the styles. A range of color choices must be made available
within a style, gender and age category. Frame material must contain no scratches, fissures,
bubbles, discoloration, or other defects in workmanship.
A list of frames by age and gender, specifying the two eye sizes and a list of color choices
per frame must be included with the bid and on the form provided. Bidder will provide a
written explanation of the reasons for the frame selections provided they meet the
requirements and specifications of this RFP.
Standard frames available under any resulting contract will be billed at one price using
HCPCS code V2020.
All eyeglasses must include a case to protect the eyeglasses during shipping and for use
after receipt by the user.
NOTE: The Contractor may be asked to provide deluxe/non-standard frames in
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