KY.gov

Humana Response

(2)81-10975-4-COM-HMOPA-KENTUCKY(2)5206-8949-1026-H5619-HMO-ARC-MAINE-MER(2)5206-13633-1554-H5619 046-HMO-ARC-MAINE-MER(2)5206-13634-1557-H5619 054-HMO-ARC-MAINE-MER(2)5206-13635-1598-H5619 055-HMO-ARC-MAINE-MER(2)5206-13636-1599-H5619 067-HMO-ARC-MAINE-MER(2)5206-13637-1664-H5619 075-HMO-ARC-MAINE-MER(2)5206-13638-1665-H5619 076-HMO-ARC-MAINE-MER(2)5206-13639-1551-H5619 082-HMO-ARC-MAINE-MER(2)5206-13640-1675-H5619 087-HMO-ARC-MAINE-MER(2)5206-13641-1597-H5619 093-HMO-ARC-MAINE-MER(8)81-6748-28-COM-PPO-KENTUCKY(8)81-10975-4-COM-HMOPA-KENTUCKY(8)5206-8949-1026-H5619-HMO-ARC-MAINE-MER(8)5206-13633-1554-H5619 046-HMO-ARC-MAINE-MER(8)5206-13634-1557-H5619 054-HMO-ARC-MAINE-MER(8)5206-13635-1598-H5619 055-HMO-ARC-MAINE-MER(8)5206-13636-1599-H5619 067-HMO-ARC-MAINE-MER(8)5206-13637-1664-H5619 075-HMO-ARC-MAINE-MER(8)5206-13638-1665-H5619 076-HMO-ARC-MAINE-MER(8)5206-13639-1551-H5619 082-HMO-ARC-MAINE-MER(8)5206-13640-1675-H5619 087-HMO-ARC-MAINE-MER(8)5206-13641-1597-H5619 093-HMO-ARC-MAINE-MER000_Cover Page_Technical Proposal00_Table of Contents_KY RFP01_A. Transmittal Letter03_B. Disclosure of Violation of Statutes04_C. Kentucky Tax Registration Application05_D. Registration with the Secretary of State by a Foreign Entity5a_Attachment D-1_Certificate of Authority_HHP06_E. Required Annual Affidavit and Other Affidavits07_F. Signed Face of Solicitation_R08_G. Signed Face of Addendum09_H. EEO Forms10_I_A_Executive Summary11_I_B_1_Corporate Experience PROPRIETARY12_I_B_2_Corporate Information_PROPRIETARY13_Attachment I.B.2-1_Corporate Service Agreement14_Attachment I.B.2-2_Services Agreement_28415_Attachment I.B.2-3_Services Agreement_194R16_Attachment I.B.2-4_PBM Services Agreement17_Attachment I.B.2-5_Articles_Bylaws_HHP18_Attachment I.B.2-6_Articles_Bylaws_Humana Inc19_Attachment I.B.2-7_Certifiate of Authority_HHP20_Attachment I.B.2-8 Last 4 Quarters Prompt Pay Reports and Dental Annual Prompt Pay Reports21_Attachment I.B.2-9 Data Reporting Manual and HEDIS Reports22_Attachment I.B.2-10_Humana Health Plan Audited Financials_Insert Page_Proprietary23_Attachment I.B.2-11_2016-2018 Annual Health Statements24_Attachment I.B.2-12_Humana Inc_2016-2018 10-K Reports25_Attachment I.B.2-13_Humana Insurance Company Audited Financials_Insert Page_Proprietary26_Attachment I.B.2‐14_Humana Pharmacy Solutions Audited Financials_Insert Page_Proprietary27_Attachment I.B.2-15_Arcadian Telepsychiatry Unaudited Profit and Loss_Insert Page_Proprietary28_Attachment I.B.2-16_MYnd Analytics, Inc.’s 10-K report_Insert Page_Proprietary29_Attachment I.B.2-17_Guardian Life Insurance Co_Audited Financials_Insert Page_Proprietary30_Attachment I.B.2-18_Braillet Profit and Loss Statements_Insert Page31_Attachment I.B.2-19_Centauri Holdings Audited Financials_Insert Page_Proprietary32_Attachment I.B.2-20_DST 2016-2017 10K_SSC 2018 10K33_Attachment I.B.2-21_DSS Research’s Unaudited Financials_Insert Page_Proprietary34_Attachment I.B.2-22_Equian Audited Financials_Insert Page_Proprietary35_Attachment I.B.2-23_FOCUS Health Unaudited Balance Sheet_Insert Page_Proprietary36_Attachment I.B.2-24_Citra Health Solutions Audited Financials_Insert Page_Proprietary37_Attachment I.B.2-25_LanguageSpeak Unaudited Profit and Loss_Insert Page_Proprietary38_Attachment I.B.2-26_MDLIVE Audited Financials_Insert Page_Proprietary39_Attachment I.B.2-27_NCH Audited Financials_Evolent Health 10K_Insert Page_Proprietary40_Attachment I.B.2-28_Bertelsmann’s Audited Financials_Insert Page_Proprietary40_Attachment I.B.2-29_Cardinal Health 2017-2019 10-K Reports41_Attachment I.B.2-30_Revel Health Unaudited Balance Sheets_Insert Page_Proprietary42_Attachment I.B.2-31_United Language Group Audited Financials_Insert Page_Proprietary43_Attachment I.B.2-32_VIA LINK Audited Financials_Insert Page_Proprietary44_Attachment I.B.2-33_Condensed Cryacom Audited Financials_Insert Page_Proprietary45_Attachment I.B.2-34_2016-2018 Tivity Health Annual Reports46_Attachment I.B.2-35_Litigation Report47_Attachment I.B.2-36_Legal Opinion48_Attachment I.B.2-37_Sanctions Report49_Attachment I.B.2-38_2009-2018 Material Litigation50_Attachment I.B.2-39_Humana PHI Breaches51_I_B_3_Staffing PROPRIETARY52_Attachment I.B.3-1_Articles_Bylaws_HHP53_Attachment I.B.3-2_Resumes_PROPRIETARY54_Attachment I.B.3-3 Kentucky Medicaid Organizational Chart55_Attachment I.B.3-4_Humana Corporate Org Chart56_Attachment I.B.3-5_KY Medicaid Contract Subcontractor Training Attestation Form57_Attachment I.B.3-6_KY Medicaid Contract Training_Current Contract58_I_C_1_Subcontracts59_Attachment I.C.1-1_Medicaid Relationship Management Six Step Process60_Attachment I.C.1-2_Financial Due Diligence Summary61_Attachment I.C.1-3_Request for Delegation Form62_Attachment I.C.1-4_Corrective Action Plan Template63_Attachment I.C.1-5_Delegation Services Addendum_Delegation Attachments64_Attachment I.C.1-6_Business Associate Agreement BAA65_Attachment I.C.1-7_KY Medicaid Contract Subcontractor Training Attestation Form66_Attachment I.C.1-8_KY Medicaid Contract Training_Current Contract67_Attachment I.C.1-9_Subcontractor Periodic Performance Summary Report Example68_I_C_2_Collaboration PROPRIETARY69_I_C_3_Capitation Payments_PROPRIETARY70_I_C_4_Financial Security Obligations71_Attachment I.C.4-1_HHP RBC Dec 201872_I_C_5_Third Party Resources_PROPRIETARY73_Attachment I.C.5-1 Third Party Liability Process Flow74_I_C_6_Management Information System_PROPRIETARY75_Attachment I.C.6-1 System Flow Diagram_PROPRIETARY76_Attachment I.C.6-2 Enrollment Data Flow_PROPRIETARY77_Attachment I.C.6-3 Third Party Liability Process Flow_PROPRIETARY78_Attachment I.C.6-4 Provider Subsystem Data Flow_PROPRIETARY79_Attachment I.C.6-5 Reference Subsystem Data Flow_PROPRIETARY80_Attachment I.C.6-6 Claims Adjudication Process Flow_PROPRIETARY81_Attachment I.C.6-7 Non-Pharmacy Encounter Submission Process_PROPRIETARY82_Attachment I.C.6-8 Pharmacy Encounter Submission Process_PROPRIETARY83_Attachment I.C.6-9 Utilization Management Process Flow_PROPRIETARY84_Attachment I.C.6-10 Integrated Systems Overview_PROPRIETARY85_Attachment I.C.6-11 Utilization Management Quality Improvement Data Flow_PROPRIETARY86_Attachment I.C.6-12 Quality Improvement_HEDIS Data Flow_PROPRIETARY87_Attachment I.C.6-13 SURS Data and Process Flow_PROPRIETARY88_I_C_7_Encounter Data89_Attachment I.C.7-1 Non-Pharmacy Encounter Submission Process_PROPRIETARY90_Attachment I.C.7-2 Pharmacy Encounter Submission Process_PROPRIETARY91_I_C_8_KHIE and Electronic Health Records92_I_C_9_Quality Management and Health Outcomes_PROPRIETARY93_Attachment I.C.9-1 Accreditation Certificate Kentucky Medicaid94_Attachment I.C.9-2 Humana-CS QAC Meeting Minutes95_Attachment I.C.9-3 Compass Overview and Screenshots96_Attachment I.C.9-4 Compass Brochure97_Attachment I.C.9-5 2017-2019 Provider Satisfaction Survey Results98_I_C_10_Utilization Management_PROPRIETARY99_I_C_11_Monitoring and Oversight100_I_C_12_Enrollee Services101_Attachment I.C.12-1 IVR Process Flow102_Attachment I.C.12-2 Verification of Benefits Training Example103_Attachment I.C.12-3 Addressing Customer Needs Training Example104_Attachment I.C.12-4 Verifying Provider Status Training Example105_Attachment I.C.12-5 Medicaid Member Journey106_Attachment I.C.12-6 KY Medicaid Enrollee ID Card108_Attachment I.C.12-7 Welcome Packet Letter109_Attachment I.C.12-8 Sample KY Enrollee Handbook110_Attachment I.C.12-9 Child Well Visit Reminder Letter111_Attachment I.C.12-10 Male Wellness Campaign Letter112_Attachment I.C.12-11 Mom's First Congratulatory Letter113_I_C_13_Enrollee Selection of Primary Care Provider114_I_C_14_Enrollee Grievances and Appeals115_Attachment I.C.14-1 Enrollee Grievances and Appeals116_I_C_15_Marketing117_Attachment I.C.15-1 Humana Statewide Marketing Plan118_I_C_16_Enrollee Eligibility Enrollment and Disenrollment119_I_C_17_Provider Services120_Attachment I.C.17.b-1 Provider Automated Info Line Flow121_Attachment I.C.17.c-1 Provider Website Screenshots122_Attachment I.C.17.d-1 Proposed Provider Manual Table of Contents123_Attachment I.C.17.d-2 Humana Kentucky Medicaid Provider Manual124_Attachment I.C.17.e-1 KY Medicaid Orientation and Training Modules126_Attachment I.C.17.e-2 New Provider Orientation Checklist127_Attachment I.C.17.e-3 YourPractice Provider Newsletters128_Attachment I.C.17.f-1-KY Medicaid Provider Enrollment Policy129_Attachment I.C.17.f-2 Provider Office Site Evaluation Tool130_Attachment I.C.17.f-3 CVO Credentialling Process Flow131_Attachment I.C.17.f-4 Credentialing Policies and Procedures132_Attachment I.C.17.f-5 CVO Credentialing Policies and Procedures133_I_C_18_Provider Network_PROPRIETARY134_Attachment I.C.18.d-1 HUM KY Medicaid Physician Template135_Attachment I.C.18.d-2 HUM KY Medicaid Ancillary Template136_Attachment I.C.18.d-3 HUM Physician All Products Template137_Attachment I.C.18.d-4 HUM Ancillary All Products Template138_Attachment I.C.18.d-5 HUM Hospital All Products Template139_Attachment I.C.18.d-6 HUM IPA All Products Template140_Attachment I.C.18.d-7 HUM PHO All Products Template141_Attachment I.C.18.d-8 KY HUM Phys Medicaid Amendment142_Attachment I.C.18.e-1 Humana Kentucky Medicaid Provider Network INSERT PAGE143_Attachment I.C.18.e-2 Geographic Access Report144_Attachment I.C.18.g-1 Sample Tools and Reports145_Attachment I.C.18.h-1 Major Term Resource Library146_Attachment I.C.18.h-2 Network Termination Policy and Procedure147_Attachment I.C.18.h-3 Sample Network Term Notification Letter148_I_C_19_Provider Payment Provisions149_Attachment I.C.19-1 Claims Adjudication Process Flow_PROPRIETARY150_Attachment I.C.19-2 Claims Process and Payment Procedures151_Attachment I.C.19-3 Claims Editing Process Flow_PROPRIETARY152_Attachment I.C.19-4 Electronic Claims Payment Data Flow_PROPRIETARY153_Attachment I.C.19-5 Claims Auditing Process Flow_PROPRIETARY154_I_C_20_Covered Services_PROPRIETARY155_I_C_21_Pharmacy Benefits_PROPRIETARY156_Attachment I.C.21.a.i-1_PBM Subcontract157_Attachment I.C.21.e.i-1_Prescriber Quick Reference Guide158_I_C_22_Special Program Requirements159_I_C_23_Behavioral Health Services_PROPRIETARY160_I_C_24_Population Health Management Program_PROPRIETARY161_Attachment I.C.24-1 Physician Quick Guide to Addressing Food Insecurity162_Attachment I.C.24-2 KY Medicaid EPSDT Provider Toolkit163_I_C_25_Enrollees with Special Health Care Needs_PROPRIETARY164_I_C_26_Program Integrity_PROPRIETARY165_I_C_27_Contractor Reporting Requirements166_Attachment I.C.27-1 KY Medicaid Rate Template167_Attachment I.C.27-2 KY Financial Summary Template168_Attachment I.C.27-3 KY Medicaid Overview Dashboard169_Attachment I.C.27-4 KY PPE MCO Report Template170_Attachment I.C.27-5 KY Medicaid Network Access Report Template171_Attachment I.C.27-6 PPE Report Metrics Scorecard172_Attachment I.C.27-7 Medicaid Dashboard173_Attachment I.C.27-8 Compliance Metrics Homepage Dashboard174_Attachment I.C.27-9 Medicaid Regulatory Reporting Status_PROPRIETARY175_Attachment I.C.27-10 Early Indicator Report176_Attachment I.C.27-11 Customizable Medicaid Operation Dashboard177_Attachment I.C.27-12 Network Oversight_Adequacy Report178_Attachment I.C.27-13 UM_DM Report179_Attachment I.C.27-14 Early Indicator_Emergency Department Report180_Attachment I.C.27-15 ER High Utilizer Report181_I_C_28_Records Maintenance and Audit Rights_PROPRIETARY182_I_C_29_Use Cases_1183_I_C_29_Use Cases_2183a_Attachment I.C.29.Katy-1 KY Medicaid EPSDT Provider Toolkit183b_Attachment I.C.29.Use Case 2_Katy-2 Physician Quick Guide to Addressing Food Insecurity184_I_C_29_Use Cases_3185_I_D_Implementation Plan_PROPRIETARY186_Attachment I.D.1-1 Proposed Program Implementation Plan187_I_E_Emergency Response and Disaster Recovery Plan_PROPRIETARY188_I_F_Turnover Plan191_I_G_1 Executive Summary192_Attachment I.G.1-1 University of Kentucky Letter of Support193_Attachment I.G.1-2 University of Louisville Letter of Support194_Attachment I.G.1-3 Children's Alliance Letter of Support195_Attachment I.G.1-4 KVC KY Letter of Support196_Attachment I.G.1-5 Centerstone Letter of Support197_Attachment I.G.1-6 Mountain Comprehensive Care Center Letter of Support198_Attachment I.G.1-7 Bounce Coalition Letter of Support199_Attachment I.G.1-8 Healing TREE Letter of Support200_Attachment I.G.1-9 CASA Letter of Support201_I_G_2_Company Background PROPRIETARY202_Attachment I.G.2-1_Resumes_Staffing PROPRIETARY203_Attachment I.G.2-2 Humana Corporate Org Chart204_Attachment I.G.2-3 KY SKY Org Chart205_Attachment I.G.2-4 KY Medicaid Contract Subcontractor Attestation Form206_Attachment I.G.2-5 KY Medicaid Contract Training_Current Contract207_I_G_3_Kentucky SKY Implementation208_Attachment I.G.3-1 KENTUCKY SKY ENROLLEE DAILY CHANGE REPORT SAMPLE209_Attachment I.G.3-2 SKY Implementation Plan210_Attachment I.G.3-3 University of Kentucky Letter of Support211_I_G_4_Contractor Training and Education211a_Attachment I.G.4-1 Children's Alliance Letter of Support212_Attachment I.G.4-2 University of Kentucky Letter of Support213_Attachment I.G.4-3 University of Louisville Letter of Support214_Attachment I.G.4-4 CASA Letter of Support215_I_G_5_Enrollee Services216_Attachment I.G.5-1 Sample Report217_I_G_6_Provider Network PROPRIETARY218_Attachment I.G.6-1 University of Kentucky Letter of Support219_Attachment I.G.6-2 University of Louisville Letter of Support220_Attachment I.G.6-3 Children's Alliance Letter of Support221_Attachment I.G.6-4 BounceCoalition Letter of Support222_Attachment I.G.6-5 Healing TREE Letter of Support223_Attachment I.G.6-6 Centerstone of Kentucky Letter of Support224_Attachment I.G.6-7 KVC KY Letter of Support225_I_G_7_Provider Services226_Attachment I.G.7-1 Children's Alliance Letter of Support227_Attachment I.G.7-2 University of Kentucky Letter of Support228_Attachment I.G.7-3 University of Louisville Letter of Support229_Attachment I.G.7-4 BounceCoalition Letter of Support230_Attachment I.G.7-5 Healing TREE Letter of Support231_Attachment I.G.7-6 Relias Children Youth and Family Solutions232_Attachment I.G.7-7 Relias Initial Kentucky SKY Trainings233_Attachment I.G.7-8 Relias Fact Sheets234_Attachment I.G.7-9 Relias Information235_Attachment I.G.7-10 TIC Training Materials236_Attachment I.G.7-11 TIC Training Screenshots239_I_G_8_Covered Services240_Attachment I.G.8-1_Medicaid Enrollee Needs Assessment241_Attachment I.G.8-2_Medicaid Pediatric Survey242_Attachment I.G.8-2_Medicaid Pediatric Survey243_Attachment I.G.8-3_Medicaid PH Comprehensive Survey244_Attachment I.G.8-4_Medicaid BH Comprehensive Assessment245_Attachment I.G.8-5_Pediatric Comprehensive Survey246_Attachment I.G.8-6_KY SKY Pediatric Needs Assessment247_Attachment I.G.8-7 Humana-CareSource Pediatric Needs Assessment248_Attachment I.G.8-8 Centerstone Letter of Support249_Attachment I.G.8-9 University of Kentucky Letter of Support250_Attachment I.G.8-10 University of Louisville Letter of Support251_Attachment I.G.8-11 Bounce Coalition Letter of Support252_I_G_9_Health Outcomes253_I_G_10_Population Health Management and Care Coordination254_Attachment I.G.10-1_Proposed Kentucky SKY Enrollee Needs Assessment255_Attachment I.G.10-2 Bounce Coalition Letter of Support256_Attachment I.G.10-3 University of Kentucky Letter of Support257_Attachment I.G.10-4 University of Louisville Letter of Support258_Attachment I.G.10-5 United Way Letter of Support259_I_G_11_Utilization Management260_Attachment I.G.11-1 Centerstone Letter of Support261_I_G_12 Aging Out Services262_Attachment I.G.12-1 United Way Letter of Support263_Attachment I.G.12-2 University of Louisville Letter of Support264_Attachment I.G.12-3 University of Kentucky Letter of Support265_Attachment I.G.12-4 BounceCoalition Letter of Support266_I_G_13 Use Case 1267_I_G_13 Use Case 2268_I_G_13 Use Case 3269_I_G_13 Use Case 4270_I_G_13_Use Case 5271_I_G_13_Use Case 6272_I_G_13_Use Case 7273_I_G_13_Use Case 8274_J. Proof of Ability to Obtain Performance BondADULTCOM6748_DeIdentifiedMemberFileADULTCOM6748_FinalResultsReport (PDF)ADULTCOM6748_FinalResultsReport (XLS)ADULTCOM10975_DeIdentifiedMemberFileADULTCOM10975_FinalResultsReport (PDF)ADULTCOM10975_FinalResultsReport (XLS)Attachment I.C.18.e-1 Humana Kentucky Medicaid Provider NetworkCBD_Dental_PromptPayReport_2018HDIC_Dental_PromptPayReport_2018HHP_Dental_PromptPayReport_2018HIC_Dental_PromptPayReport_2018KY ANNUAL Data Reporting Manual_2018Q1_2019_HHP_PromptPayReportQ2_2019_HHP_PromptPayReportQ3_2018_HHP_PromptPayReportQ4_2018_HHP_PromptPayReportTDC_Dental_PromptPayReport_2018

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Contact

Kathy Robinson, CPPO, CPPB, NIGP-CPP, KCPMExecutive Director

Office of Procurement
200 Mero Street, 5th Floor
Frankfort, KY 40622

Phone
502-564-4510

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