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Passport Response

A Executive Summary A. Transmittal Letter ATF877_1 Attachment A-1_Passport Community Engagement Examples Attachment A-2 Passport Letters of Support Attachment B.2-3_Justify Holdings Articles of Incorporation and Amendment Attachment B.2-4_Justify Holdings Bylaws Attachment B.2-5_Uniform Certificate of Authority Name Change Attachment B.2-6_University of Louisville Physicians, Inc. Articles of Incorporation and ByLaws Attachment B.2-7 Certificate Of Authority Passport Health Plan Inc Attachment B.2-8_Name Change Documentation Attachment B.2-9_Management Report of Internal Controls to DOI Attachment B.2-11_PP_Reports_181228_Report 53 Revised_R Attachment B.2-12_PP_Reports_190329_Report 53_R Attachment B.2-13_PP_Reports_190628_Report 53_R Attachment B.2-14_PP_Reports_190926_Report 53_R Attachment B.2-15_PP_Reports_190926_Report 53 Revised_R Attachment B.2-16_PP_Reports_191218_Report 53_R Attachment B.2-19_Evolent Health Financial Statements_2018_2017_2016_Audited_R Attachment B.2-20_Evolent Health Financial Statements_09302019 Attachment B.2-21_Avesis Financial Statements_2016 to 2017_Audited Attachment B.2-22_Avesis Financial Statements_2017_2018_Audited Attachment B.2-23_Conduent Annual Report_Financial Statements_2016_Audited Attachment B.2-24_Conduent Annual Report_Financial Statements_2017_Audited Attachment B.2-25_Conduent Annual Report_Financial Statements_2018_Audited Attachment B.2-26_CVS Financial Statements_2018_2017_2016_Audited Attachment B.2-30_Schoenbaechler Law Firm Letter Attachment B.2-31_Frost Brown Todd Law Firm Letter Attachment B.2-32_King and Spalding Law Firm Letter Attachment B.2-33_McguireWoods Law Firm Letter Attachment B.2-34_Sanctions and Adverse Actions Summary Attachment B.2-35_CVS HIPAA Breaches Attachment B.3-1_Resumes Attachment B.3-2_Job Descriptions Attachment C.6 - 1 DMS Report Summary Attachment C.7-1_ENC.001.E.KY Encounter Policies and Procedures Attachment C.9-1_2021 Proposed Member Rewards Attachment C.9-2_Passport 2019 QI Workplan Attachment C.9-3_Passport 2020 QI Program Description Attachment C.9-4_Passport 2019 QI Program Evaluation Attachment C.9-5_Passport Health Plan Provider Satisfaction Survey Results Attachment C.10-1_Passport 2019 Utilization Management Program Description Attachment C.12-1_Passport Community Engagement Examples Attachment C.12-2_Annual Outreach Plan Attachment C.12-3_Member ID Card Attachment C.12-4_Member Welcome Kit Attachment C.12-5_Member Handbook Attachment C.12-6_myhealthmylife Member Newsletter Attachment C.12-7_Care Connectors Flyer in Vietnamese Attachment C.12-8_EPSDT Rack in Somali Attachment C.13-1_Policy EE-PHKY-305 PCP Assignment Attachment C.13-2_Policy MS.006.E.KY Primary Care Provider Change 2019 Attachment C.14-1_Grievance Resolution Workflow Attachment C.14-2_Appeals Resolution Process Workflow Attachment C.14-3_Expedited Appeals Resolution Process Workflow Attachment C.15-1_2020 Marketing Plan Attachment C.16-1_Eligibility Data Load Process Attachment C.16-2_834 Reject Reconciliation Attachment C.16-3_Reinstatement Process Flow Attachment C.17-1_Provider Web Screenshots Attachment C.17-2_Passport Provider Manual Attachment C.17-3_Provider Welcome Kit Attachment C.17-4_Practitioner Credentialing and Recredentialing Attachment C.17-5_Practitioner Credentialing Rights Attachment C.17-6_Organizational Provider Credentialing and Recredentialing Attachment C.17-7_Ongoing Monitoring of Sanctions, Complaints and Quality Issues Attachment C.17-8_Practitioner Sanctioning and Reporting Attachment C.17-9_Aperture Credentialing LLC Primary Source Verification and Provider Credentialing Attachment C.17-10_Responsibilities of Chief Medical Officer, Designated Medical Director, and Credentialing Committe Attachment C.18-1_Passport Provider Contract Template Attachment C.18-2_Passport Hospital Contract Template Attachment C.18-3_Passport Provider Type Listing All Providers Attachment C.18-4_Passport Provider Counts by Provider Type Attachment C.18-5_Passport Geo Access Provider Type Attachment C.18-6_Passport Geo Access Maps Attachment C.19-1_Policy PQA.001.E.KY Quality Auditing of Claims Attachment C.19-2_Policy PRW.002.E.KY Confidentiality & Provider Claims Attachment C.19-3_PRW.003.E.KY Processing Projects Attachment C.19-4_Policy PRW.004.E.KY Provider Claims Statutory Reporting Attachment C.19-5_Policy PRW.005.E.KY Timeliness of Claims Payment & Paying Interest Attachment C.19-6_Policy PRW.006.E.KY Processing PLP Claims Attachment C.19-7_Policy PFR.001.E.KY Recovery of Overpayments Attachment C.19-8_Policy PFR.002.E.KY High Dollar Claims Review Attachment C.19-9_Policy PFE.001.E.KY Claims Adjudication Process Attachment C.19-10_Policy UHG.GEN.33 Delegated Entity Oversight Attachment C.21-1 2016 Delegation Agreement (09-01-16)Attachment C.21-2_Policy RX.059.E.KY Preferred Drug List Attachment C.21-3_Policy RXOPS.051.E.KY Pharmacy and Therapeutics Advisory Committee Attachment C.22-1 Special Programs Brochure 2018 Attachment C.24-1_New Hire Training Participant Guide Attachment C.26-1_Passport Program Integrity Plan Attachment C.26-2_Policy UHC-CO-08 Program Integrity – Prevention, Detection and Investigation of FWA Attachment C.27-1_DMS Quick Reference Guide Attachment C.27-2_2019 Passport Cost_Use_Dashboard Sample Attachment C.27-3_2019 Passport OB Report Sample Attachment C.27-4_2019 Passport Readmission Report Sample Attachment C.27-5_2019 Passport Pharmacy Report Sample Attachment C.27-6_DMS Inquiries 2018 Attachment C.28-1_Policy QI.033.E.KY Medical Record Standards and Review Attachment D-1_Program Implementation Plan Phases and Key Milestones Attachment D-2_Passport Program Implementation Plan Attachment E-1_2019 PCI DSS AOC Attachment E-2_Flexential-2018-HITRUST Certificate Attachment E-3_Flexential-2019-HITRUST Interim Letter Attachment E-4_Flexential-2019-Corp ISO 27001 Re-Issue Certificate Attachment E-5_Flexential-2019-FISMA High SAR Attachment G.1-1_Passport Letters of Support Attachment G.2-1_Kentucky SKY Job Descriptions Attachment G.2-2_Kentucky SKY Resumes Attachment G.3-1_SKY Implementation Plan Attachment G.3-2_SKY Program Implementation Plan Phases and Key Milestones Attachment G.5-1_SKY Pediatric Assessment Attachment G.5-2_SKY Former Foster Assessment Attachment G.5-3_Sample PCP Roster Attachment G.7-1_Addressing Vicarious Trauma in Foster Parent Training and Retention Attachment G.7-2_Trauma Informed Care Training Sample Material Attachment G.8-1_CAGE AID Sample Attachment G.8-2_PSC 17 Sample Attachment G.8-3_PHQ9 Sample Attachment G.8-4_PHQA Sample Attachment G.8-5_GAD7 Sample Attachment G.8-6_Catastrophic Care Pediatrics Tool Attachment G.8-7 Medicaid Initial Pediatrics Tool Attachment G.9-1_Evaluation Sample Attachment G.10-1_Passport Community Engagement Examples B.1 Corporate Experience B.2 Corporate Information B.3 Staffing C.01 Subcontracts C.02 Collaboration C.03 Capitation Payments C.04 Financial Security Obligations C.05 Third Party Resources C.06 Management Information System C.07 Encounter Data C.08 KHIE and EHR C.09 QM and Health Outcomes C.10 Utilization Management C.11 Monitoring and Oversight C.12 Enrollee Services C.13 Enrollee Selection of Primary Care Provider C.14 Enrollee Grievances and Appeals C.15 Marketing C.16 Enrollee Eligibility Enrollment C.17 Provider Services C.18 Provider Network C.19 Provider Payment Provisions C.20 Covered Services C.21 Pharmacy Benefits C.22 Special Program Requirements C.23 Behavioral Health Services C.24 Population Health Management C.25 Enrollees with Special Health Care Needs C.26 Program Integrity C.27 Contractor Reporting Requirements C.28 Records Maintenance and Audit Rights C.29.1 Use Case 1 C.29.2 Use Case 2 C.29.3 Use Case 3 D Implementation Plan E Emergency Response and Disaster Recovery Exhibit A-1_Flash Drive Certification Statement Exhibit A-2_Passport Articles of Incorporation and Articles of Amendment Exhibit A-3_1_Required Annual Affidavit and Other Affidavit(s)Exhibit A-3_2_Legal Statement Regarding Resident Bidder Status Exhibit A-4_1_Signed Face of Solicitation_R Exhibit A-4_2_Signed Face of Addendum_R Exhibit A-5_EEO Form I Exhibit A-6_EEO Form II Exhibit A-7_EEO Form III Exhibit A-8_Performance Bond Proof F Turnover Plan G.01 Executive Summary G.02 Company Background G.03 Kentucky SKY Implementation G.04 Kentucky SKY Contractor Educational and Training Requirements G.05 Kentucky Sky Enrollee Services G.06 Provider Network G.07 Provider Services G.08 Covered Services G.09 Health Outcomes G.10 Population Health Management and Care Coordination G.11 Utilization Management G.12 Aging Out Services G.13.1 Use Case 1 G.13.2 Use Case 2 G.13.3 Use Case 3 G.13.4 Use Case 4 G.13.5 Use Case 5 G.13.6 Use Case 6 G.13.7 Use Case 7 G.13.8 Use Case 8 KY RFP Technical Proposal A-G SKY 2020 RFP - G.1 Executive Summary SKY 2020 RFP - G.2 Company Background SKY 2020 RFP - G.3 Kentucky SKY Implementation SKY 2020 RFP - G.4 Kentucky SKY Contractor Educational and Training Requirements SKY 2020 RFP - G.5 Kentucky Sky Enrollee Services SKY 2020 RFP - G.6 Provider Network SKY 2020 RFP - G.7 Provider Services SKY 2020 RFP - G.8 Covered Services SKY 2020 RFP - G.9 Health Outcomes SKY 2020 RFP - G.10 Population Health Management and Care Coordination SKY 2020 RFP - G.11 Utilization Management SKY 2020 RFP - G.12 Aging Out Services SKY 2020 SKY RFP Transmittal Letter SKY Attachment G.1-1_Passport Letters of Support SKY Attachment G.2-1_Kentucky SKY Job Descriptions SKY Attachment G.2-2_Kentucky SKY Resumes SKY Attachment G.3-1_SKY Implementation Plan SKY Attachment G.3-2_Implementation Plan Phases and Key Milestones SKY Attachment G.5-1_Pediatric Assessment SKY Attachment G.5-2_SKY Former Foster Assessment SKY Attachment G.5-3_Sample PCP Roster SKY Attachment G.7-1_Addressing Vicarious Trauma in Foster Parent Training and Retention SKY Attachment G.7-2_Trauma Informed Care Training Sample Material SKY Attachment G.8-1_CAGE AID Sample SKY Attachment G.8-2_PSC 17 Sample SKY Attachment G.8-3_PHQ9 Sample SKY Attachment G.8-4_PHQA Sample SKY Attachment G.8-5_GAD7 Sample SKY Attachment G.8-6_Catastrophic Care Pediatrics Tool SKY Attachment G.8-7 Medicaid Initial Pediatrics Tool SKY Attachment G.9-1_Evaluation Sample SKY Attachment G.10-1_Passport Community Engagement Examples SKY Technical Proposal_G.1-G.13 SKY Use Case 1 SKY Use Case 2 SKY Use Case 3 SKY Use Case 4 SKY Use Case 5 SKY Use Case 6 SKY Use Case 7 SKY Use Case 8

Contact

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

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

Phone
502-564-4510