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REQUEST FOR INFORMATIONFORCONTACT CENTER SERVICESCONNECTICUT HEALTH INSURANCE EXCHANGEDBA Access Health CTProject: Contact Center Services 2016Key Dates:RFI ISSUE DATEREQUESTS/CLARIFICATION DUE DATERFI REVISIONS/ADDENDA POSTING DATERFI RESPONSE DUE DATEJune 23, 2015June 29, 2015July 1, 2015July 21, 2015Page 1 of 1412:00pm EST4:00pm EST4:00pm EST4:00pm EST
TABLE OF CONTENTSPAGEREFERENCEIBackground3IIRFI General Information4IIIRevisions to RFI5IVReservations of Rights by Exchange5VProprietary Material/Freedom of Information6VICurrent Contact Center Environment7VIIResponses to RFI How to Deliver Response Introductory Letter Format and Content of RFI Responses Questions and Clarifications Contact Protocol Vendors Selected to Submit Proposals8VIIIMinimum Qualifications11IXRFI Evaluation12AppendicesA : Exchange Volumes (Historical/Projected)Page 2 of 14
I.BACKGROUNDSince the passage of the Patient Protection and Affordable Care Act (ACA) in March of 2010, andGovernor Malloy’s signing of Public Act 11-53 in July of 2011, the State of Connecticut (the “State”)quickly worked to build an effective and functional state-based exchange (SBE) through theestablishment and operation of the Connecticut Health Insurance Exchange d/b/a Access Health CT(the “Exchange”), a quasi-public agency of the State.The Exchange’s primary mission is to increase the number of insured residents in Connecticut,promote positive health outcomes, lower costs and eliminate health disparities. To accomplish thismission and fulfill key requirements of the ACA, the Exchange has developed an online health carecoverage shopping and enrollment experience for state residents and small businesses. TheExchange also established an extensive communication and enrollment infrastructure to informConnecticut residents of healthcare coverage options and facilitate enrollment through theExchange. The Exchange shares an online application system with the State of ConnecticutDepartment of Social Services (“DSS”), the single state agency for the Medicaid and CHIP (Children’sHealth Insurance Program). The health coverage available through the Exchange includes, HUSKYHealth Programs and qualified health plans through private carriers. Since the establishment of theExchange, nearly 500,000 Connecticut residents have enrolled in health care coverage through theExchange, lowering Connecticut’s uninsured rate to less than 4%.The ACA and its implementing regulations require state-based exchanges to provide a number ofconsumer assistance tools. 45 CFR § 155.205. Among other things, the ACA requires the Exchangeto provide for the operation of a toll-free call center that addresses the needs of consumersrequesting assistance and provides information to applicants and enrollees in plain language. Thecall center must offer information in a manner that is accessible to individuals living with disabilitiesor with limited English proficiency.To meet this ACA requirement, the Exchange issued a Request for Proposals in October 2012 toidentify and assess potential vendors to operate its call center (the “Contact Center”). As a result ofthe Request for Proposals process, the Exchange selected Maximus Health Services, Inc.(“Maximus”) as its Contact Center vendor.The Contact Center commenced operations on October 1, 2013, at the commencement of openenrollment for 2014 coverage. In compliance with ACA requirements, the Contact Center receivesinquiries from individual consumers and answers their questions about healthcare coverageeligibility, enrollment, rates and benefits. It further assists them in enrolling in Qualified HealthPlans, Medicaid and CHIP, refers calls to certified brokers to assist them with health plan selection,and otherwise fulfills the requirements of 45 CFR § 155.205.Page 3 of 14
Unless the Exchange elects to extend the current vendor contract according to its terms, thatcontract will expire on August 31, 2016. To assist the Exchange in making a determination onpotential options for cost-effective, efficient, accurate and high-quality Contact Center operations,the Exchange seeks to gather information through this Request for Information (“RFI”) concerningvendor capabilities, interest and general market research.Based in large part upon the results of this RFI, the Exchange will determine whether or not it is inits best interests to proceed with a Request for Proposals (“RFP”). If the Exchange decides toinitiate an RFP process, it is anticipated that the RFP would be issued in or about the 3rd-4th quarterof 2015, and that Contact Center services would be in place in time for the 2017 ACA openenrollment period.II.RFI GENERAL INFORMATIONThis RFI is not a request for proposals (RFP) and should not be construed as such. However,responding to this RFI generally will be a prerequisite to responding to an RFP issued by theExchange for Contact Center services.The Exchange seeks to identify qualified and experienced respondents that will submit a statementof qualifications or other relevant information for the operation of the Contact Center inaccordance with the Connecticut Exchange’s stated requirements, the ACA, implementingregulations and other federal guidance (the “Services” or “Project”). RFI responses should clearlyaddress a responder’s capability to deliver a Contact Center that will:1. Serve Exchange consumers with a simple and streamlined approach to ensure ease of useand customer satisfaction.2. Facilitate the application and enrollment process and provide assistance for both web-basedand paper-based applications.3. Help Exchange consumers with information and choices about the overall Exchangeprogram and plans, private-industry qualified health plans (“QHPs”) including the AdvancedPremium Tax Credit (“APTC”) and Cost Sharing Reduction programs (“CSR”), and the HUSKYHealth programs.4. Triage more complex questions to the Exchange’s Internal Resolution Department, certifiedbrokers, issuers of QHPs, or DSS, as needed.5. Be the first point of contact for many Exchange consumers with questions about applyingfor, determining eligibility for, and enrolling in healthcare coverage through the Exchange.6. Assist Exchange consumers with enrollment and information regarding insuranceaffordability programs.Page 4 of 14
7. Assist Exchange consumers with information and support during the annual IRS Form 1095delivery period.8. Comply with the standards set forth by the ACA and the State of Connecticut and allapplicable state and federal laws, regulations, rules, and guidance.RFI responses should also include a description of the responding vendor’s:1.2.3.4.III.Strategy for managing Exchange call volumes;Approach to hiring, training and quality management to the Exchange’s specifications;Plan for transition services from the Exchange’s current vendor; andStandard and Customized reportingREVISIONS TO RFIIn the event that it is necessary to revise any part of the RFI, timely addenda will be posted to theExchange’s website by 4:00 pm EST on June 26, 2015. Interested respondents are solely responsiblefor checking the Exchange website for RFI changes before responding.IV.RESERVATION OF RIGHTS BY EXCHANGEThe issuance of this RFI does not guarantee that the Exchange will engage in an RFP process oraward a contract to any respondent. The Exchange reserves the right to withdraw, extend orotherwise modify the RFI or the related schedule or process, in any manner, solely at its discretion.The Exchange also reserves the right to: Consider any source of information in evaluating responses; Omit any planned evaluation step if, in the Exchange’s view, the step is not needed; At its sole discretion, reject any or all responses at any time; Waive any immaterial defect or informality in any response or response procedure; Request additional information and data from any or all respondents; Disqualify any respondent who fails to provide information or data requested herein or whoprovides inaccurate or misleading information or data; Disqualify any respondent on the basis of any real or apparent conflict of interest; and Disqualify any respondent on the basis of past performance on other projects.Page 5 of 14
The Exchange shall have the sole discretion to select the vendor(s) that provide the bestcombination of qualifications, relevant positive experience, available resources, and cost. TheExchange may determine that it is in its best interests to select one vendor to provide the servicesor a combination of vendors each providing specific services to the Exchange.V.PROPRIETARY MATERIAL / FREEDOM OF INFORMATIONThe Exchange is a quasi-public agency and its records are public records. See Conn. Gen. Stat. §§ 1200, et seq., and especially §§ 1-210(b)(4) and 1-210(b)(5)(B). Due regard will be given to theprotection of proprietary or confidential information contained in all RFI responses received.However, all materials associated with this RFI are subject to the terms of the Connecticut Freedomof Information Act (“FOIA”) and all applicable rules, regulations and administrative decisions.If a respondent wishes to preserve the confidentiality of any part of its RFI response, it will not besufficient merely to state generally in the response that the response is proprietary or confidentialin nature and not, therefore, subject to release to third parties. Instead, those particular sentences,paragraphs, pages or sections that a vendor believes to be exempt from disclosure under FOIA mustbe specifically identified as such. A convincing explanation and rationale sufficient to justify eachexemption consistent with § 1-210(b) of FOIA must accompany the response. The rationale andexplanation must be stated in terms of the reasons the materials are legally exempt from releasepursuant to FOIA. Respondents should not request that their entire proposal, or the majority of theproposal, be confidential. The Exchange has no obligation to initiate, prosecute or defend any legalproceeding or to seek a protective order or other similar relief to prevent disclosure of anyinformation that is sought pursuant to a FOIA request. The respondent has the burden ofestablishing the availability of any FOIA exemption in any proceeding where it is an issue.In no event shall the Exchange have any liability for the disclosure of any documents or informationin its possession that the Exchange believes are required to be disclosed pursuant the FOIA or anyother law.Page 6 of 14
VI.CURRENT CONTACT CENTER ENVIRONMENTThe Contact Center is one of the most public-facing elements of the Exchange’s operations. It is criticalfor the Exchange that Contact Center services consistently remain available during Contact Centerhours, operate efficiently and without undue delays, and are delivered according to customerexpectations.Overview of Exchange operating platformThe Connecticut Exchange, in conjunction with DSS, has implemented an eligibility and enrollmentsystem (“EES”). This EES was built specifically for the Connecticut Exchange by Deloitte. Ongoingmaintenance and operations for the EES is also currently supported by Deloitte.The EES enables consumers to ‘self-serve’ and go on-line to get a predetermination of health insurancecoverage eligibility, eligibility for HUSKY Health Programs, potential premium costs, APTC’s (tax credits)and shop for health plans. If the consumer is ready to buy health insurance, the online EES assists theself-serve consumer with every stage of the process. Consumers that wish to either initiate enrollmentor complete an online enrollment with assistance by the Exchange – may opt to do so over thetelephone by calling the Exchange’s Contact Center.The Contact Center’s customer service representative (“CCR”) utilizes the EES through a worker portal.CCR’s also have real-time access to a Siebel CRM and an Oracle Knowledge Management System toprovide quick and easy access while working with the Exchange consumer during the call. The KMSprovides the CCR with a full electronic repository for all reference materials to fully resolve theconsumer’s request. CCR’s may not only assist consumers with enrollment, but also assist consumerswith more difficult questions and transactions at any time during their relationship with the Exchange.Upon completion and submission of the consumer’s enrollment and eligibility information into the EESthe information is presented in real time to the Federal Data Services Hub for identity and eligibilityverification. An eligibility determination is received back from the Federal Data Services Hub instantly.This allows consumers to receive an immediate eligibility determination as well as an APTC dollaramount, if applicable. Once the eligibility is confirmed, the system will enable a consumer to select ahealth plan, and coverage level. Those consumers who are eligible for APTC, will have a systemgenerated determination of a preliminary monthly premium for them. Consumers eligible for HUSKYHealth do not have premiums or additional health plan choices. After the enrollment is completed an834 file is generated nightly to the health plan carriers transmitting the consumer’s enrollment data.Overview of the Exchange Contact Center platformThe Exchange Contact Center services platform is currently provided through Maximus.Maximus handles all inbound calls from individuals interested in applying for or renewing healthcarecoverage through the Exchange. Appendix A provides a high level overview of the volumes of calls aContact Center provider will be expected to handle for the Exchange. Maximus provides approximatelyPage 7 of 14
between 150 (off peak) and 400 (peak) call center representatives at four call center locations, includingone in Hartford, Connecticut. The peak call period is generally from November through the end ofFebruary each year, depending on ACA yearly open enrollment directives issued by the Centers forMedicare & Medicaid Services (“CMS”).The current Exchange call center architecture consists of a number of vendor/subcontractor licensedand/or owned sub-systems and interfaces. This list below is illustrative of those components and is notmeant to represent a complete list at this time. VII.Interactive Voice Response (IVR)Automatic Call Distributor (ACD)/Private Branch Exchange (PBX) SystemsSoft Phones, IP Desk Phones and Digital PhonesCall Management SystemWorkforce Management SystemCall Recording and Agent Screen Recording SystemReporting and Analytics SystemIntelligent Call Routing SystemToll Free Network ServiceToll Free Network Routing PlatformBusiness Rules Engine for Hours of Operation/Per Site/Per SkillOutbound Dialer Notification CapabilitiesAgent, Skill Group, IVR, Call Routing and Toll Free ReportingExchange -Developed Customer and Worker Portal Health Exchange platformWeb-Based Self-Registration Application with Exchange Provided Registration TechnicalAssistanceRESPONSES TO RFIHow to Deliver the ResponseRESPONSE DUE DATE: Responses shall be submitted no later than 4:00 PM EST on July 21, 2015.Response packages must be sent by email to David Lynch at:[email protected]’s response email Subject line should read: insert COMPANY NAME Response to Access Health CT RFI - Contact Center Services 2016.Page 8 of 14
Introductory LetterAn introductory letter shall accompany the RFI response. The letter shall be dated and shouldintroduce the respondent’s RFI response, list a primary contact name, email address, and phonenumber, and should be addressed to:Access Health CTc/o David Lynch, Call Center Operations Manager280 Trumbull St.15th FloorHartford, CT 06103Format and Content of RFI ResponsesTotal length of the RFI response should not exceed thirty (30) pages. The length of the introductoryletter will not be counted in the thirty (30) page criteria.Each RFI response shall provide the information described in the Minimum Qualifications andEvaluation Criteria sections below, along with the introductory cover letter and any otherinformation required in this RFI. Clarity and completeness are important.Questions and ClarificationsQuestions and requests for clarifications on this RFI must be sent to attention of David Lynch at:[email protected]’s email requesting clarifications or to pose questions - Subject line should read: insert COMPANY NAME QUESTION or Clarification re: Access Health CT RFI - Contact Center Services 2016Questions received after 4:00 pm EST on June 29, 2015, will not be answered.At the discretion of the Exchange, relevant questions and the corresponding answers will be madeavailable to all respondents by posting them on the Exchange’s website. In the event that it isnecessary to revise any part of the RFI, addenda will be posted to the Exchange’s website by 4pmEST on July 1, 2015. Interested respondents are solely responsible for checking the Exchangewebsite for RFI changes before responding.Contact ProtocolRespondents may not contact anyone other than the person(s) identified above in this RFI withrespect to inquiries and responses to this RFI. Inquiries must be made in writing via email. Noquestions will be answered orally. No questions will be accepted by telephone.Page 9 of 14
Failure to comply with the stated contact and response procedures articulated in this RFI will result inthe respondent being disqualified from further consideration in the sole discretion of the Exchange.Vendors Selected to Submit ProposalsBased on the responses to this RFI, the Exchange may select three or more vendors to submit aresponse to a future Request for Proposals issued by the Exchange to the selected vendors. TheExchange is under no obligation to issue an RFP or to invite RFI respondents to participate.Page 10 of 14
VIII. MINIMUM QUALIFICATIONSPlease describe your Company’s relevant experience and performance relating to the minimumqualifications for Services, for the items set forth below:1. Your Company’s relevant experience, expertise and performance in performing the types ofduties described in this RFI, including at least one example of a similar project executed inthe last 24 months;2. The personnel and other resources available for the Project;3. The experience and qualifications of your key personnel and the name of the primarycontact(s) for the Exchange;4. Identification and description of any subcontractor(s) you anticipate using on the Project,including their area of expertise, background of key personnel, and history of work withyour Company;5. Demonstration of the necessary financial resources to fulfill the obligations described in thisRFI;6. References for at least three (3), but no more than five (5), projects/engagements to whichyour Company has provided contact center services for ACA exchanges or similargovernment operations servicing eligibility and enrollment processing for healthcareprograms;7. A clear overview, but not estimated amounts, of the types of fees and costs as well as thepricing model your Company will apply to provide the Services and any associated materials.You must define the full range of acceptable pricing models that your Company would applyto estimate costs to service the requirements of the Exchange. You must be clear on thosepricing models that are unacceptable. You must separately disclose and itemize anycommissions or fees anticipated to be received by your Company, any mark-ups forproducts and services from other vendors that would be charged to the Exchange (for anyservice, license, product or materials), and any consideration or compensation provided toyour Company from contracted vendors that you anticipate using on this Project.8. Your Company’s process to appropriately handle the conflicts of interest that may arise onthe Project and copy of your Company’s conflict of interest policy. Including how theresponder would plan to comply with all applicable state and federal laws, including, but notlimited to, Connecticut General Statutes Title 1, Chapter 10, concerning the State’s Codes ofEthics.9. A clear overview of your Company’s hiring, training and quality management approach.Include your Company’s approach to involving the Exchange in these critical functions.10. A clear approach and plan demonstrating that your Company has effectively managed atransition from an existing call center vendor to yours. If your Company has experiencetransitioning services from the Exchange’s current vendor, please provide an overview ofthat experience. If the Company is an existing AHCT Exchange vendor, this section will notbe required for consideration. Please outline your transition plan and services , including,but not limited to:a. Telephonics/Telecommunicationsb. Data Transition and Migrationc. Customer Relationship Management Platform and DataPage 11 of 14
d.e.f.g.Knowledge Management Platform and DataCustomer Contact InformationHistorical Management Information Data and ReportsComponents of cost (one time and recurring) involved in transitioning services froma prior vendorh. Please include and illustrate any other services or value added transition areas youwould provide to the Exchange.IX.RFI EVALUATIONAn Evaluation Committee will evaluate and determine the individual and comparative merits ofeach of each response received. It is the respondent’s responsibility to ensure that its responsecomplies with the requirements of this RFI, demonstrates qualifications, and provides theinformation requested. If the respondent fails to comply with the contact and response proceduresor fails to provide any information requested in this RFI, such failure may result in either nonqualification of a particular category of service or rejection of the submission.Evaluation CriteriaThe Exchange will use the following criteria to evaluate the responses to this RFI: CRITERIA 1 – CORPORATE STRUCTURE AND EXPERIENCEa) History of the Company (include weblink).b) Business size and size (be sure to include the standard/applicable North American IndustryClassification System (NAICS) codes.c) Financial strength (be sure to include your Dun & Bradstreet (DUNS) number).d) Primary Contact information (address, telephone, facsimile, e-mail, website address).e) Annual company revenue from contact center services, as a value and as a percentage of totalrevenue; from government contact center services as a value and as a percentage of totalrevenue.f) Clear articulation of corporate structure and ownership.g) Organization, number and type of personnel and the location of the Company’s officesshould be included, particularly those locations that would be contemplated as call centersites.h) Clear context of the commercial (financial, telecommunications, healthcare, etc.) andgovernment markets for which your Company provides contact center services.i) Names of current or recent contact center customers and a brief description of thoseengagements, including: dates, your Service Level Agreement goals with these customers andyour demonstrated ability to meet or exceed these goals.j) Clear identification and summary of several projects performed pertaining to the type ofwork you are proposing to perform under this RFI. This should include specific informationon the dates, type of services provided and length of relationship, as well as any otherpertinent information.k) Description of how the Company is structured and set up to handle this type of work.Page 12 of 14
l) Clear identification of at least three (3), but no more than five (5), verifiable professionalservices references for whom you have provided similar services, with a contact person, titleand phone number.CRITERIA 2 EXPERIENCE AND QUALIFICATIONSa) Demonstration that your Company has the experience and qualifications to perform theduties described in this RFI.b) Clear articulation of a call center services transition model or plan for a phased transition fromthe current vendor to your Company’s proposed solution that at a minimum addresses:timeframe, complexity, process, and cost considerations.c) Clear articulation of the hiring, training and quality management approach.d) Provision of any independent call center benchmarking results, the name of the benchmarkingorganization and dates of the benchmarking, including a description of the industry benchmarkgroup you were measured against. Copies of independent benchmarking must be in originalform (unredacted) form. CRITERIA 3 PRICING MODEL/FEES AND COSTS (see Minimum Qualifications Item 7)) CRITERIA 4 FINANCIAL WHEREWITHALDemonstration of the Company’s financial wherewithal to meet these service obligations. CRITERIA 5 CONFLICTS OF INTERESTClear identification of how your organization will ensure that conflicts of interest areappropriately disclosed and addressed. Including how the responder would plan to comply withall applicable state and federal laws, including, but not limited to, Connecticut General StatutesTitle 1, Chapter 10, concerning the State’s Codes of Ethics.RatingThe Exchange will evaluate submitted responses that conform to the contact and deliveryinstructions as outlined in this RFI and all subsequent addenda.The Exchange will assign scores of zero (0) to five (5) for the RFI criteria, with ratings assigned asfollows:5 - Excellent4 - Good3 - Satisfactory2 - Marginal0 – UnsatisfactoryPage 13 of 14
APPENDIX A – EXCHANGE VOLUMES (HISTORICAL/PROJECTED)The Exchange volume exhibits below represent actual call volume from September 1, 2013 – May 30,2015. The call volumes projected through August, 2016 are for illustrative purposes and vendors shouldnote that volume projections for future planning periods would be finalized closer to the actual issuanceof an RFP.13-SepCallsOffered toCall MonthYear/MonthCalls Offeredto Call Center14-Aug40,654Call volume for the months June 2015 – August 2016 are estimates of call volume based on seasonalityand population growth.Call volume growth is attributed to an increasing population due to new growth, transitions fromexisting Medicaid program, and reenrollment activity beginning in the second year of operations.It is estimated that approx. 83% of all calls are related to a HUSKY A, B, or D program, while theremaining 17% are related to QHP enrollment. This distribution fluctuates during the months of QHPopen enrollment.Page 14 of 14
The Contact Center commenced operations on October 1, 2013, at the commencement of open enrollment for 2014 coverage. In compliance with ACA requirements, the Contact Center receives inquiries from individual consumers and answers their questions about healthc
