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Texas Health and Human Services Commission (HHSC ) Texas State Pharmacy Assistance Program (SPAP) Request for Proposals # 53700-08-34885 Vendor Conference.

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Presentation on theme: "Texas Health and Human Services Commission (HHSC ) Texas State Pharmacy Assistance Program (SPAP) Request for Proposals # 53700-08-34885 Vendor Conference."— Presentation transcript:

1 Texas Health and Human Services Commission (HHSC ) Texas State Pharmacy Assistance Program (SPAP) Request for Proposals # Vendor Conference

2 Welcome Introductions Steve Bailey, Manager, Enterprise Contract and Procurement Services (ECPS) Shawn Constancio, HUB Coordinator, Department of State Health Services (DSHS) Dwayne Haught, Manager, Texas HIV Medication Program Housekeeping Items

3 HHSC Procurement Roles ECPS- Responsible for procurement activity HUB- Responsible for HUB activity Program- Responsible for project scope, requirements, performance, results, contract management/monitoring Legal- Questions/answers and legal activity

4 Texas HIV SPAP Vendor Conference Overview Procurement Activities HUB Items RFP Overview Questions Submittal Break Preliminary Responses to Questions Closing Comments

5 Procurement Activities Questions & Answers Sole Contact, Elizabeth Ward, ECPS Procurement Schedule Solicitation Access Submission Requirements Solicitation Changes Screening & Evaluation Award Information

6 HUB Subcontracting Plan (HSP) Requirements

7 Agenda Topics RFP Section 4.0 Historically Underutilized Business RFP Section 4.0 Historically Underutilized Business Participation Requirements Participation Requirements HUB Subcontracting Plan HUB Subcontracting Plan Self Performance HSP Self Performance HSP HSP Prime Contractor Progress Assessment Report HSP Prime Contractor Progress Assessment Report

8 HUB Participation Goals HUB Participation Goals Potential Subcontracting Opportunities Potential Subcontracting Opportunities Vendor Intends to Subcontract Vendor Intends to Subcontract Minority or Women Trade Organizations Minority or Women Trade Organizations Self Performance Self Performance HSP Changes After Contract Award HSP Changes After Contract Award Reporting and Compliance with the HSP Reporting and Compliance with the HSP RFP Section Historically Underutilized Business Participation Requirements

9 If HSP is inadequate, response will be rejected HSP Information Page

10 HUB GOALS

11 Special reminders and instructions HSP Information Page

12 Company Information HSP Information Page

13 Subcontracting Declaration HSP Information Page

14 Self Performance Declaration HSP Information Page

15 If more than 20, provide attached list HSP Information Page

16 One page for each area subcontracted (listed on page 1) HSP Information Page

17 List Line # and Subcontracting Opportunity HSP Information Page

18 Protégé performing the work HSP Information Page Skip to Sections 8 and 10

19 Professional Services Category HSP Information Page

20 Good Faith Efforts to find Texas Certified HUB Vendors HSP Information Page

21 Contact HUB Trade Organization HSP Information Page

22 Written Notification Requirements HSP Information Page

23 List 3 HUBs Contacted for this Subcontracting Opportunity HSP Information Page

24 List Subs to be used (HUBs & Non-HUBs) for this Subcontracting Opportunity HSP Information Page

25 Reason why HUB was not selected for this Subcontracting Opportunity HSP Information Page

26 Self Performance Explanation HSP Information Page

27 Signature Affirms that True and Correct Information is Provided HSP Information Page

28 Required with ALL Pay Requests Required even if not subcontracting List ALL Sub payments (HUBs & Non- HUBs) HSP Prime Contractor Progress Assessment Report ATTACHMENT E

29 HSP ASSISTANCE FROM TBPC HUB Subcontracting Plan (HSP) Forms Step-by-step instructions and an audio on How to Complete an HSP is located on the Texas Building and Procurement Commissions (TBPCs) website at: -subcontracting-plan -subcontracting-plan How to Complete an HSP Play Windows Media VersionPlay Windows Media Version (2.9 mb download) Play Macromedia Flash versionPlay Macromedia Flash version (1.8 mb download) Read Video TranscriptRead Video Transcript (.rtf file) (43k download) HUB Subcontracting Plan (HSP) Forms Step-by-step instructions and an audio on How to Complete an HSP is located on the Texas Building and Procurement Commissions (TBPCs) website at: -subcontracting-plan -subcontracting-plan How to Complete an HSP Play Windows Media VersionPlay Windows Media Version (2.9 mb download) Play Macromedia Flash versionPlay Macromedia Flash version (1.8 mb download) Read Video TranscriptRead Video Transcript (.rtf file) (43k download)

30 Department of State Health Services HUB Program Office Shawn Constancio, CTPM Shawn Constancio, CTPM DSHS HUB Coordinator DSHS HUB Coordinator (512) or (800) (512) or (800)

31 RFP Overview Texas HIV State Pharmacy Assistance Program (SPAP)

32 Project Background The Medicare Modernization Act included a prescription drug benefit for Medicare beneficiaries The prescription drug benefit/Medicare Part D was implemented on January 1, 2006 Medicare beneficiaries with incomes <135% of FPL and who have limited assets receive financial assistance through Social Security with Part D premiums and out of pocket costs related to their medication regimens Referred to as extra help or Low Income Subsidy

33 Project Background Medicare Part D is a tiered benefit with three phases of reimbursement Phase I is a mix of client paid OOP expenses and Medicare paid drug costs Phase II is the self pay phase commonly called the doughnut hole Phase III is the catastrophic pay phase where clients OOP expenses are only 5% of the total cost of their medication regimen

34 Project Background The obvious goal is to advance the client into the catastrophic payment phase of Medicare Part D

35 Project Background In 2006, when Part D started ~ 25% of Texas ADAP Clients were eligible for Medicare Most were eligible for LIS and were transitioned from Texas ADAP to Medicare Part D Plans Approximately 850 individuals with Medicare remain on the Texas ADAP Denied LIS or have partial LIS High out of pocket costs for HIV medications through Medicare Texas ADAP does not have the infrastructure to pay Part D Costs ADAP contributions toward Part D do not count as TrOOP

36 State Pharmacy Assistance Program Uniquely designed programs that assist elderly and disabled clients with accessing prescription medications Funded totally with State General Revenue (GR) State GR counts as Medicare Part D TrOOP Clients advance to the money-saving catastrophic payment phase of Medicare Part D Existing GR from Texas ADAP will fund SPAP Medicare Part D clients currently served by ADAP will move to the SPAP

37 Project Mission Provide Medicare Part D wrap around coverage for Texas ADAP Clients who are eligible for Medicare Interface electronically with pharmacies, prescription drug plans and Medicare Manage drug expenditures Obtain Manufacture Rebates

38 Scope of Work Oversee the payment of Medicare Part D deductibles, coinsurance, co-payments and costs of medications during any gaps in coverage for clients enrolled in the SPAP Coordinate with all Part D Plans in Texas Ensure that applicable expenditures are credited toward clients annual TrOOP expenditure requirements

39 Scope of Work Establish and monitor cost containment measures Example: annual cap on client expenditures Ensure SPAP does not pay for Medicare excluded medications under Part D Ensure that SPAP does not pay for medications not approved by the SPAP or the Part D plan formulary for which the client is enrolled

40 Scope of Work Pursue and coordinate pharmaceutical manufacturer rebates available to DSHS for medications dispensed to Texas HIV SPAP clients. This coordination would include adjudication of claims and dispute resolution with pharmaceutical companies

41 Performance Measures Submits required program data within negotiated DSHS timeframe Resolves payment errors made to Medicare part D plans within negotiated timeframe Reports SPAP enrollee out-of-pocket payments to the CMS Troop facilitator monthly following CMS guidelines Convenes, at minimum, quarterly SPAP/PBM contractor conference calls

42 Texas Health and Human Services Commission (HHSC ) Questions Submittal Followed by Break

43 Texas HIV SPAP Tentative Responses to Vendor Questions Formal, written responses to vendor questions will be posted on the procurement website as the questions are answered. All responses will be posted on the website by September 10, 2007.


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