01/02/04: In response to the CHIP Exclusive Provider Organization (EPO) RFP, HHSC has selected Bankers Reserve Insurance Company of Wisconsin (d.b.a. Superior HealthPlan Network) and Clarendon National Insurance Company for further discussions. Final contract award is contingent upon the satisfactory completion of these discussions. Final discussions are expected to be completed by January 31, 2004

12/03/03: There has been a further delay in the announcement of the CHIP Exclusive Provider Organization (EPO) tentative contract award(s). HHSC anticipates that an announcement will be made the week of December 8, 2003, with contract negotiations to begin immediately following the announcement.

CLARIFICATION OF DIFFERENCES BETWEEN THE EPO LAG REPORT AND THE EPO FSR: The CHIP EPO claims lag report does not balance with the Medical Expense item on the EPO FSR for several reasons:

1. The FSR includes prescription drug services provided through a pharmacy for months prior to the prescription drug carve-out (March 1, 2002). The lag report does not include those services.
2. The FSR includes case management expenses in the the Medical Expense item for months after September 2001. The lag report does not include case management expenses.
3. The Medical Expense item in the FSR includes an estimate of the reserve for incurred but unpaid claims. The lag report does not include such a reserve.

Additionally, HHSC directs the Vendor's to the following website to assist the Vendor in the preparation of the Price Proposal. The website, www.eds-nhic.com, provides the Official State Medicaid Rates for physician's and other practitioners and information necessary to compute the Medicaid Rates for facilities (hospitals). The practitioner Medicaid rates are located under "Services Provided by NHIC, 2002 Fee Schedules". Please note that these fees are for both 2003 and 2004 but will be reduced by 2.5% when the payment is made to the practitioner.

To compute the State Medicaid Rates for facilities, (hospitals), the Vendors will find the 2003 DRG Case Weights on the www.eds-nhic.com website under "Services Provided by NHIC, HHSC-NHIC 2002 Publications" in the 2003 Grouper 20.0 DRG Intro files. To obtain the Standard Dollar Amounts used to compute the actual rates paid to the facilities, please contact Scott Reasonover at (512) 338-6464 or Merle Moden at (512) 794-6870."

1. A correction has also been made to Section 8, 8.2.3.8.1, Required Plans and Reports, RRC-7, which had an incorrect Texas Administrative Code citation. The correct citations are: TIC §843.260 (a) and 28 TAC §11.205
2. The Appendix G has been replaced with the "June 2003 CHIP Caseload Forecast". The revision supersedes the enrollment estimates previously provided in Appendix G.

08/18/03: HHSC announces a one week extension of the due date for submission of mandatory Letters of Intent, from Tuesday, August 19, 2003 at 4:00pm Central Time to Tuesday, August 26, 2003 at 4:00pm Central Time.

• RFP Documents Updated: Sections 2 & 3

08/12/03

RFP Documents Updated (Sections 8 & 10), Appendix D added and  zipped Microsoft Excel file of Chip Enrollment Data included in procurement library.

08/06/03

Vendor Conference Attendees List posted

07/30/03

Appendix F- File Layouts is updated by adding the CHIP Encounter File as Appendix F-3

07/18/03

The final release of the Children's Health Insurance Program (CHIP) Exclusive Provider Organization (EPO) RFP has been posted.

The Health and Human Services Commission (HHSC) of the State of Texas issues this Request for Proposals (RFP) to solicit responses from qualified providers to provide health care coverage for the Children's Health Insurance Program (CHIP). The successful Vendor(s) will provide health care benefits to CHIP members through contracts with health care providers across the State of Texas. The Vendor must enroll, train and support CHIP providers, and maintain a statewide accessible call center for CHIP providers and eligible families. The Vendor will process and pay the enrolled CHIP providers' claims for services provided to CHIP eligible clients. The successful Vendor will assume risk in the provision of the health care benefits and will be paid a rate for each age group that includes a health care claims component, an administrative fee component and a profit/risk component.

The objectives of the procurement are to:

• Provide qualified, accessible and comprehensive health care coverage by qualified, accessible providers.
• Provide health care services tailored to meet the health care needs of Texas children and promote optimal preventive health care.
• Provide coverage for health care benefits to all persons who are eligible for and enrolled in CHIP in an efficient, cost-effective manner.

A Vendor Conference will be conducted on July 29, 2003, from 1:30 p.m. to 4:00 p.m. at the Riata Complex, Building III, Public Hearing Room, 12555 Riata Vista, Austin, Texas 78727. Attendance at the conference is strongly recommended, but is not required.

Vendors will have the opportunity to ask questions and HHSC will make a reasonable attempt to answer questions at the Conference. Oral answers will not be binding on HHSC and responses will not be official until they are posted on the HHSC website.

Timely submission of a Letter of Intent is a prerequisite to submission of a proposal in response to this RFP. Failure to timely submit a Letter of Intent will disqualify a prospective Vendor from submitting a proposal. The mandatory Letters of Intent will be due to HHSC's official point of contact by no later than 4:00 p.m. Central Time, on August 19, 2003.

The contact person for the RFP is: Jill Melton, HMO/EPO/Dental Services Unit, Medicaid/CHIP Program, Texas Health and Human Services Commission, 12555 Riata Vista, Austin, TX 78727. The telephone number is (512) 794-5194 and the email address is Jill.Melton@hhsc.state.tx.us.

07/01/03

The final release of the Children's Health Insurance Program (CHIP) Exclusive Provider Organization (EPO) RFP originally scheduled for release on July 1, 2003 has been delayed until July 18, 2003. The delay in the final release of the RFP is associated with changes currently being made to the CHIP benefit package as a result of the 78th Texas Legislative Session.

For additional information contact jill.melton@hhsc.state.tx.us

04/03/03

The Health and Human Services Commission (HHSC) announces the release for public comment of the DRAFT Children's Health Insurance Program (CHIP) Exclusive Provider Organization (EPO) RFP, including appendices. The comment period for the draft will be from April 3, 2003 through April 30, 2003.

The HHSC point-of-contact for this DRAFT RFP is:

All comments on this RFP must be sent electronically to the HHSC point-of-contact.