Request for Quote RFQ

NCQA Accreditation Readiness Consultant Services

 

I. Background

 

The Santa Barbara Regional Health Authority was legislatively created in 1983 as a pilot program established by the California Welfare & Institutions Code and the California Health and Safety Code. At that time, the Santa Barbara Regional Health Authority was created to make accessible locally managed, quality healthcare, for residents of Santa Barbara County eligible for Medicaid (Medi-Cal in California). The Santa Barbara Regional Health Authority evolved into CenCal Health, the regional managed care plan that serves Santa Barbara and San Luis Obispo County residents eligible for Medi-Cal medical services.

 

Quality of care was a fundamental principle of the program that evolved into CenCal Health, and that principle today is just as central to the achievement of CenCal Health’s current Mission and Vision. As such, quality of care is at the core of all CenCal Health’s managed care operations in service to its members.

 

This public posting is CenCal Health’s notice of an opportunity to respond to CenCal Health’s Request for Quote (RFQ). Please review the information below to respond to the interests expressed by CenCal Health. A detailed proposal, including but not limited to, a detailed Statement of Work and cost proposal is requested in response to this RFQ.

 

The CenCal Health Executive Leadership team is eager to learn more about how RFQ respondents can help CenCal Health achieve National Committee for Quality Assurance (NCQA) Health Plan and Health Equity Accreditation, and evolve and remain an innovative model of accessible, quality healthcare. The deadline to respond to the RFQ is on or before 5:00 PM PST, Friday, December 30, 2022. At the conclusion of this RFQ response period, CenCal Health may host one or more exploratory meetings with a subset of RFQ respondents, subject to CenCal Health’s assessment of each respondent’s potential to satisfy CenCal Health’s needs. Any respondent’s invitation or ability to participate in any future meeting in response to this RFQ is not required to participate in a future solicitation if any is offered.

 

II. Purpose

 

a. Primary Interest: NCQA Health Plan & Health Equity Accreditation Subject Matter Expertise: CenCal Health’s primary interest is to engage subject matter expertise of respondent as an independent consultant to assess and independently validate CenCal Health’s readiness to achieve its first NCQA Health Plan and Health Equity Accreditations. Therefore, this RFQ is a solicitation for detailed information to understand the experience, expertise, relevant achievement, and capability of respondents to quantitatively and qualitatively assess, and independently validate (inclusive of file review) CenCal Health’s readiness to achieve NCQA Health Plan and Health Equity Accreditation before January 2025. RFQ respondents must describe how their proven capability will maximize CenCal Health’s potential, as a Medicaid Managed Care plan, to successfully achieve NCQA accreditation. Respondents must highlight their NCQA Health Plan and Health Equity Accreditation achievements and how their unique expertise, if chosen for this consultancy, will maximize CenCal Health’s readiness to achieve Health Plan and Health Equity Accreditation.

 

b. NCQA Health Plan & Health Equity Accreditation Expertise: CenCal Health is requesting RFQ respondents to describe how respondent will fulfill the requirements described herein to quantitatively assess and validate CenCal Health’s accreditation readiness, and quantitatively and qualitatively document all needed operational refinements necessary to achieve timely compliance with NCQA Health Plan and Health Equity Accreditation standards.

 

c. CenCal Health Commitment: CenCal Health’s NCQA accreditation readiness is fundamental to achievement of CenCal Health’s organizational Mission and Vision, and as such, NCQA Health Plan and Health Equity Accreditation is business critical to CenCal Health prior to January 2025. CenCal Health’s stakeholders in this RFQ include all levels of its operations team, including:

 

i. Quality & Population Health

 

ii. Network Management

 

iii. Credentialing & Recredentialing

 

iv. Utilization Management

 

v. Member Services

 

vi. Human Resources

 

CenCal Health recognizes that respondent will rely upon CenCal Health to design, document, implement, and monitor processes, and generate work products, which will serve as evidence to demonstrate compliance with NCQA Health Plan and Health Equity Accreditation standards. To this end, CenCal Health employs full-time dedicated staff to achieve NCQA accreditation, including an employed and active NCQA Accreditation Surveyor that provides expert guidance to all internal stakeholders to maximize and sustain accreditation readiness.

 

In contrast, respondent is assured that their consultancy services will be limited to quantitative and qualitative assessment and reports, informed expert advice, and NCQA Health Plan and Health Equity Accreditation subject matter consultation to CenCal Health to maximize accreditation readiness.

 

III. Scope & Requirements

 

a. Timeframe: The anticipated consultancy engagement is approximately 3 months from October through December 2023, with execution of an agreement with CenCal Health in January 2023. This timeframe is negotiable based on respondent’s availability.

 

b. Expertise: RFQ respondents must demonstrate the specific NCQA Health Plan and Health Equity Accreditation expertise necessary to quantitatively and qualitatively assess CenCal Health’s managed care operations. Respondents must demonstrate proven expertise and experience providing readiness validation and consultation services to health plans that have achieved NCQA Health Plan and Health Equity Accreditation. Multiple surveyors may be proposed if a division of surveyor responsibilities is advantageous to assure the provision of administrative and clinical surveyor expertise.

 

c. Required NCQA Accreditation Standards: RFQ respondent’s assessment of CenCal Health’s operations must be based on the prevailing NCQA Health Plan Accreditation and Health Equity Accreditation Standards available at the time of respondent’s assessment to validate CenCal Health’s accreditation readiness. Furthermore, if newer NCQA Health Plan Accreditation Standards or Health Equity Accreditation Standards are released by NCQA during the duration of this engagement, respondent’s assessment of CenCal Health must be based upon the most recent standards applicable to CenCal Health’s anticipated NCQA Health Plan Accreditation and Health Equity Accreditation survey.

 

d. Operational Insight: Fundamental to this request is RFQ respondent’s ability to evaluate and assess the operational compliance of CenCal Health’s managed care enterprise in accordance with the prevailing NCQA Health Plan Accreditation and Health Equity Accreditation Standards. Respondent must have a keen ability to evaluate managed care plan processes and systems and assess compliance with NCQA accreditation standards.

 

e. Experience: Respondents to the RFQ must describe their experience consulting on preparation for accreditation surveys, whether as an employee of a managed care plan or as an external consultant, and describe the managed care operations for which their depth of expertise is greatest, and the number of accreditation surveys completed in the past three (3) years.

 

Provide the following detail to quantify and demonstrate respondent’s 2021 or 2022 experience conducting NCQA accreditation surveys:

 

  • Health Plan Type (public entity, or commercial)
  • Health Plan State of Operation
  • Product Line(s) surveyed
  • Year of Engagement
  • Type of Accreditation (Health Plan, Health Equity, or both)
  • NCQA Accreditation Outcome, if known
  • NCQA Survey Standards Personally Surveyed (QI, PHM, NET, UM, CR, ME, LTSS, MED, MA, SNP, HE)

 

While experience as a certified NCQA surveyor is not a minimum requirement for this RFQ response, preference will be given to respondents with recent certified NCQA surveyor experience and expertise, including but not limited to engagements that resulted in successful Medicaid product line NCQA accreditation outcomes. While this RFQ does not request any of respondent’s surveyed plans to be identified, no health plan revealed in response to this RFQ will be contacted without respondent’s advance written approval and only if CenCal Health has interest to engage respondent to provide the consultancy services defined herein.

 

f. RFQ Response Content: A comprehensive description of services offered in response to this RFQ must provide a thorough description of the consultancy services offered to validate CenCal Health compliance with the prevailing NCQA Health Plan Accreditation and Health Equity Accreditation Standards applicable to CenCal Health’s anticipated NCQA survey and available at the time of respondent’s assessment. A detailed Statement of Work must be submitted that fully identifies the services respondent will provide and estimated costs for services.

 

Additionally, a detailed schedule must identify the anticipated start and end dates for each element of the Statement of Work to illustrate the proposed timeline and milestones for each element of the engagement. The Statement of Work must include, at minimum:

 

i. A mock survey to quantify baseline compliance with each NCQA Standard, Element, and Factor.

 

ii. A written assessment after the mock survey that quantifies compliance for each NCQA Standard, Element, and Factor, and a qualitative assessment to describe the findings and additional needs to achieve full compliance.

 

iii. Informed expert advice, and limited NCQA Health Plan and Health Equity Accreditation subject matter consultation to CenCal Health to present respondent’s quantitative and qualitative report to describe respondent’s findings and any additional actions needed to be taken by CenCal Health to achieve full compliance.

 

g. RFQ Evaluation Criteria: The following factors may be used for evaluation of bids.

 

i. Relevant experience and/or expertise

 

ii. Demonstrated quality, dependability, and responsiveness with respect to items/services sought

 

iii. Familiarity with CenCal Health’s business

 

iv. Reputation in the community

 

v. Payment or financial terms offered by the vendor

 

vi. Price

 

vii. Level of risk associated with potential contract acquisition

 

viii. Financial solvency of the vendor

 

ix. Other selection criteria that CenCal Health deems appropriate

 

IV. Disclaimers

 

a. This RFQ does not create any representation, either express or implied, that:

 

i. any tender or procurement process will proceed; or

 

ii. if a tender or procurement process does proceed, that the participant’s response or other form of application (if any) will be given any preference or special consideration.

 

b. This RFQ is not a commitment to any course of action. Respondents must still follow any tender or procurement process that may take place in response to a future Request for Proposal (RFP), if any.

 

c. If any respondent is an existing partner to CenCal Health, this RFQ does not preclude the extension or expansion of an existing agreement if the extension or expansion is to obtain services that are complementary to existing services provided to CenCal Health.

 

d. CenCal Health is an official subdivision of California State government; therefore, CenCal Health is a public entity. As such, materials submitted in response to this RFQ may be discoverable upon lawful demand in accordance with the California Public Records Act (GOVERNMENT CODE SECTION 6250 ET SEQ.), or other state or federal laws as applicable.

 

e. CenCal Health reserves the right to reject any and all bids. CenCal Health is not required to choose any bid.

 

f. CenCal Health may at any time decide to suspend, continue, or terminate the RFP process at any time prior to the formal award to a bidder.

 

g. Nothing in this RFQ requires CenCal Health to enter into a contract with a successful bidder if CenCal Health and the successful bidder cannot agree to a fair price or contract terms.

 

V. Response Due Date & Point of Contact for RFQ

 

a. Please respond to this RFQ via email, with the required content supplied as PDF document attachments to the email submission. Reply to: NCQA-RFQ@cencalhealth.org Complete responses must be submitted on or before 5:00 PM PST, Friday, December 30, 2022.

 

b. Questions about any aspect of this RFQ must be submitted on or before 5:00 PM PST, Friday, December 16, 2022. Written questions may be submitted to NCQA-RFQ@cencalhealth.org

 

Answers to questions received will be shared with all RFQ respondents via a Frequently Asked Questions log on CenCal Health’s web site.