(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-MER
000_Cover Page_Technical Proposal
00_Table of Contents_KY RFP
01_A. Transmittal Letter
03_B. Disclosure of Violation of Statutes
04_C. Kentucky Tax Registration Application
05_D. Registration with the Secretary of State by a Foreign Entity
5a_Attachment D-1_Certificate of Authority_HHP
06_E. Required Annual Affidavit and Other Affidavits
07_F. Signed Face of Solicitation_R
08_G. Signed Face of Addendum
09_H. EEO Forms
10_I_A_Executive Summary
11_I_B_1_Corporate Experience PROPRIETARY
12_I_B_2_Corporate Information_PROPRIETARY
13_Attachment I.B.2-1_Corporate Service Agreement
14_Attachment I.B.2-2_Services Agreement_284
15_Attachment I.B.2-3_Services Agreement_194R
16_Attachment I.B.2-4_PBM Services Agreement
17_Attachment I.B.2-5_Articles_Bylaws_HHP
18_Attachment I.B.2-6_Articles_Bylaws_Humana Inc
19_Attachment I.B.2-7_Certifiate of Authority_HHP
20_Attachment I.B.2-8 Last 4 Quarters Prompt Pay Reports and Dental Annual Prompt Pay Reports
21_Attachment I.B.2-9 Data Reporting Manual and HEDIS Reports
22_Attachment I.B.2-10_Humana Health Plan Audited Financials_Insert Page_Proprietary
23_Attachment I.B.2-11_2016-2018 Annual Health Statements
24_Attachment I.B.2-12_Humana Inc_2016-2018 10-K Reports
25_Attachment I.B.2-13_Humana Insurance Company Audited Financials_Insert Page_Proprietary
26_Attachment I.B.2‐14_Humana Pharmacy Solutions Audited Financials_Insert Page_Proprietary
27_Attachment I.B.2-15_Arcadian Telepsychiatry Unaudited Profit and Loss_Insert Page_Proprietary
28_Attachment I.B.2-16_MYnd Analytics, Inc.’s 10-K report_Insert Page_Proprietary
29_Attachment I.B.2-17_Guardian Life Insurance Co_Audited Financials_Insert Page_Proprietary
30_Attachment I.B.2-18_Braillet Profit and Loss Statements_Insert Page
31_Attachment I.B.2-19_Centauri Holdings Audited Financials_Insert Page_Proprietary
32_Attachment I.B.2-20_DST 2016-2017 10K_SSC 2018 10K
33_Attachment I.B.2-21_DSS Research’s Unaudited Financials_Insert Page_Proprietary
34_Attachment I.B.2-22_Equian Audited Financials_Insert Page_Proprietary
35_Attachment I.B.2-23_FOCUS Health Unaudited Balance Sheet_Insert Page_Proprietary
36_Attachment I.B.2-24_Citra Health Solutions Audited Financials_Insert Page_Proprietary
37_Attachment I.B.2-25_LanguageSpeak Unaudited Profit and Loss_Insert Page_Proprietary
38_Attachment I.B.2-26_MDLIVE Audited Financials_Insert Page_Proprietary
39_Attachment I.B.2-27_NCH Audited Financials_Evolent Health 10K_Insert Page_Proprietary
40_Attachment I.B.2-28_Bertelsmann’s Audited Financials_Insert Page_Proprietary
40_Attachment I.B.2-29_Cardinal Health 2017-2019 10-K Reports
41_Attachment I.B.2-30_Revel Health Unaudited Balance Sheets_Insert Page_Proprietary
42_Attachment I.B.2-31_United Language Group Audited Financials_Insert Page_Proprietary
43_Attachment I.B.2-32_VIA LINK Audited Financials_Insert Page_Proprietary
44_Attachment I.B.2-33_Condensed Cryacom Audited Financials_Insert Page_Proprietary
45_Attachment I.B.2-34_2016-2018 Tivity Health Annual Reports
46_Attachment I.B.2-35_Litigation Report
47_Attachment I.B.2-36_Legal Opinion
48_Attachment I.B.2-37_Sanctions Report
49_Attachment I.B.2-38_2009-2018 Material Litigation
50_Attachment I.B.2-39_Humana PHI Breaches
51_I_B_3_Staffing PROPRIETARY
52_Attachment I.B.3-1_Articles_Bylaws_HHP
53_Attachment I.B.3-2_Resumes_PROPRIETARY
54_Attachment I.B.3-3 Kentucky Medicaid Organizational Chart
55_Attachment I.B.3-4_Humana Corporate Org Chart
56_Attachment I.B.3-5_KY Medicaid Contract Subcontractor Training Attestation Form
57_Attachment I.B.3-6_KY Medicaid Contract Training_Current Contract
58_I_C_1_Subcontracts
59_Attachment I.C.1-1_Medicaid Relationship Management Six Step Process
60_Attachment I.C.1-2_Financial Due Diligence Summary
61_Attachment I.C.1-3_Request for Delegation Form
62_Attachment I.C.1-4_Corrective Action Plan Template
63_Attachment I.C.1-5_Delegation Services Addendum_Delegation Attachments
64_Attachment I.C.1-6_Business Associate Agreement BAA
65_Attachment I.C.1-7_KY Medicaid Contract Subcontractor Training Attestation Form
66_Attachment I.C.1-8_KY Medicaid Contract Training_Current Contract
67_Attachment I.C.1-9_Subcontractor Periodic Performance Summary Report Example
68_I_C_2_Collaboration PROPRIETARY
69_I_C_3_Capitation Payments_PROPRIETARY
70_I_C_4_Financial Security Obligations
71_Attachment I.C.4-1_HHP RBC Dec 2018
72_I_C_5_Third Party Resources_PROPRIETARY
73_Attachment I.C.5-1 Third Party Liability Process Flow
74_I_C_6_Management Information System_PROPRIETARY
75_Attachment I.C.6-1 System Flow Diagram_PROPRIETARY
76_Attachment I.C.6-2 Enrollment Data Flow_PROPRIETARY
77_Attachment I.C.6-3 Third Party Liability Process Flow_PROPRIETARY
78_Attachment I.C.6-4 Provider Subsystem Data Flow_PROPRIETARY
79_Attachment I.C.6-5 Reference Subsystem Data Flow_PROPRIETARY
80_Attachment I.C.6-6 Claims Adjudication Process Flow_PROPRIETARY
81_Attachment I.C.6-7 Non-Pharmacy Encounter Submission Process_PROPRIETARY
82_Attachment I.C.6-8 Pharmacy Encounter Submission Process_PROPRIETARY
83_Attachment I.C.6-9 Utilization Management Process Flow_PROPRIETARY
84_Attachment I.C.6-10 Integrated Systems Overview_PROPRIETARY
85_Attachment I.C.6-11 Utilization Management Quality Improvement Data Flow_PROPRIETARY
86_Attachment I.C.6-12 Quality Improvement_HEDIS Data Flow_PROPRIETARY
87_Attachment I.C.6-13 SURS Data and Process Flow_PROPRIETARY
88_I_C_7_Encounter Data
89_Attachment I.C.7-1 Non-Pharmacy Encounter Submission Process_PROPRIETARY
90_Attachment I.C.7-2 Pharmacy Encounter Submission Process_PROPRIETARY
91_I_C_8_KHIE and Electronic Health Records
92_I_C_9_Quality Management and Health Outcomes_PROPRIETARY
93_Attachment I.C.9-1 Accreditation Certificate Kentucky Medicaid
94_Attachment I.C.9-2 Humana-CS QAC Meeting Minutes
95_Attachment I.C.9-3 Compass Overview and Screenshots
96_Attachment I.C.9-4 Compass Brochure
97_Attachment I.C.9-5 2017-2019 Provider Satisfaction Survey Results
98_I_C_10_Utilization Management_PROPRIETARY
99_I_C_11_Monitoring and Oversight
100_I_C_12_Enrollee Services
101_Attachment I.C.12-1 IVR Process Flow
102_Attachment I.C.12-2 Verification of Benefits Training Example
103_Attachment I.C.12-3 Addressing Customer Needs Training Example
104_Attachment I.C.12-4 Verifying Provider Status Training Example
105_Attachment I.C.12-5 Medicaid Member Journey
106_Attachment I.C.12-6 KY Medicaid Enrollee ID Card
108_Attachment I.C.12-7 Welcome Packet Letter
109_Attachment I.C.12-8 Sample KY Enrollee Handbook
110_Attachment I.C.12-9 Child Well Visit Reminder Letter
111_Attachment I.C.12-10 Male Wellness Campaign Letter
112_Attachment I.C.12-11 Mom's First Congratulatory Letter
113_I_C_13_Enrollee Selection of Primary Care Provider
114_I_C_14_Enrollee Grievances and Appeals
115_Attachment I.C.14-1 Enrollee Grievances and Appeals
116_I_C_15_Marketing
117_Attachment I.C.15-1 Humana Statewide Marketing Plan
118_I_C_16_Enrollee Eligibility Enrollment and Disenrollment
119_I_C_17_Provider Services
120_Attachment I.C.17.b-1 Provider Automated Info Line Flow
121_Attachment I.C.17.c-1 Provider Website Screenshots
122_Attachment I.C.17.d-1 Proposed Provider Manual Table of Contents
123_Attachment I.C.17.d-2 Humana Kentucky Medicaid Provider Manual
124_Attachment I.C.17.e-1 KY Medicaid Orientation and Training Modules
126_Attachment I.C.17.e-2 New Provider Orientation Checklist
127_Attachment I.C.17.e-3 YourPractice Provider Newsletters
128_Attachment I.C.17.f-1-KY Medicaid Provider Enrollment Policy
129_Attachment I.C.17.f-2 Provider Office Site Evaluation Tool
130_Attachment I.C.17.f-3 CVO Credentialling Process Flow
131_Attachment I.C.17.f-4 Credentialing Policies and Procedures
132_Attachment I.C.17.f-5 CVO Credentialing Policies and Procedures
133_I_C_18_Provider Network_PROPRIETARY
134_Attachment I.C.18.d-1 HUM KY Medicaid Physician Template
135_Attachment I.C.18.d-2 HUM KY Medicaid Ancillary Template
136_Attachment I.C.18.d-3 HUM Physician All Products Template
137_Attachment I.C.18.d-4 HUM Ancillary All Products Template
138_Attachment I.C.18.d-5 HUM Hospital All Products Template
139_Attachment I.C.18.d-6 HUM IPA All Products Template
140_Attachment I.C.18.d-7 HUM PHO All Products Template
141_Attachment I.C.18.d-8 KY HUM Phys Medicaid Amendment
142_Attachment I.C.18.e-1 Humana Kentucky Medicaid Provider Network INSERT PAGE
143_Attachment I.C.18.e-2 Geographic Access Report
144_Attachment I.C.18.g-1 Sample Tools and Reports
145_Attachment I.C.18.h-1 Major Term Resource Library
146_Attachment I.C.18.h-2 Network Termination Policy and Procedure
147_Attachment I.C.18.h-3 Sample Network Term Notification Letter
148_I_C_19_Provider Payment Provisions
149_Attachment I.C.19-1 Claims Adjudication Process Flow_PROPRIETARY
150_Attachment I.C.19-2 Claims Process and Payment Procedures
151_Attachment I.C.19-3 Claims Editing Process Flow_PROPRIETARY
152_Attachment I.C.19-4 Electronic Claims Payment Data Flow_PROPRIETARY
153_Attachment I.C.19-5 Claims Auditing Process Flow_PROPRIETARY
154_I_C_20_Covered Services_PROPRIETARY
155_I_C_21_Pharmacy Benefits_PROPRIETARY
156_Attachment I.C.21.a.i-1_PBM Subcontract
157_Attachment I.C.21.e.i-1_Prescriber Quick Reference Guide
158_I_C_22_Special Program Requirements
159_I_C_23_Behavioral Health Services_PROPRIETARY
160_I_C_24_Population Health Management Program_PROPRIETARY
161_Attachment I.C.24-1 Physician Quick Guide to Addressing Food Insecurity
162_Attachment I.C.24-2 KY Medicaid EPSDT Provider Toolkit
163_I_C_25_Enrollees with Special Health Care Needs_PROPRIETARY
164_I_C_26_Program Integrity_PROPRIETARY
165_I_C_27_Contractor Reporting Requirements
166_Attachment I.C.27-1 KY Medicaid Rate Template
167_Attachment I.C.27-2 KY Financial Summary Template
168_Attachment I.C.27-3 KY Medicaid Overview Dashboard
169_Attachment I.C.27-4 KY PPE MCO Report Template
170_Attachment I.C.27-5 KY Medicaid Network Access Report Template
171_Attachment I.C.27-6 PPE Report Metrics Scorecard
172_Attachment I.C.27-7 Medicaid Dashboard
173_Attachment I.C.27-8 Compliance Metrics Homepage Dashboard
174_Attachment I.C.27-9 Medicaid Regulatory Reporting Status_PROPRIETARY
175_Attachment I.C.27-10 Early Indicator Report
176_Attachment I.C.27-11 Customizable Medicaid Operation Dashboard
177_Attachment I.C.27-12 Network Oversight_Adequacy Report
178_Attachment I.C.27-13 UM_DM Report
179_Attachment I.C.27-14 Early Indicator_Emergency Department Report
180_Attachment I.C.27-15 ER High Utilizer Report
181_I_C_28_Records Maintenance and Audit Rights_PROPRIETARY
182_I_C_29_Use Cases_1
183_I_C_29_Use Cases_2
183a_Attachment I.C.29.Katy-1 KY Medicaid EPSDT Provider Toolkit
183b_Attachment I.C.29.Use Case 2_Katy-2 Physician Quick Guide to Addressing Food Insecurity
184_I_C_29_Use Cases_3
185_I_D_Implementation Plan_PROPRIETARY
186_Attachment I.D.1-1 Proposed Program Implementation Plan
187_I_E_Emergency Response and Disaster Recovery Plan_PROPRIETARY
188_I_F_Turnover Plan
191_I_G_1 Executive Summary
192_Attachment I.G.1-1 University of Kentucky Letter of Support
193_Attachment I.G.1-2 University of Louisville Letter of Support
194_Attachment I.G.1-3 Children's Alliance Letter of Support
195_Attachment I.G.1-4 KVC KY Letter of Support
196_Attachment I.G.1-5 Centerstone Letter of Support
197_Attachment I.G.1-6 Mountain Comprehensive Care Center Letter of Support
198_Attachment I.G.1-7 Bounce Coalition Letter of Support
199_Attachment I.G.1-8 Healing TREE Letter of Support
200_Attachment I.G.1-9 CASA Letter of Support
201_I_G_2_Company Background PROPRIETARY
202_Attachment I.G.2-1_Resumes_Staffing PROPRIETARY
203_Attachment I.G.2-2 Humana Corporate Org Chart
204_Attachment I.G.2-3 KY SKY Org Chart
205_Attachment I.G.2-4 KY Medicaid Contract Subcontractor Attestation Form
206_Attachment I.G.2-5 KY Medicaid Contract Training_Current Contract
207_I_G_3_Kentucky SKY Implementation
208_Attachment I.G.3-1 KENTUCKY SKY ENROLLEE DAILY CHANGE REPORT SAMPLE
209_Attachment I.G.3-2 SKY Implementation Plan
210_Attachment I.G.3-3 University of Kentucky Letter of Support
211_I_G_4_Contractor Training and Education
211a_Attachment I.G.4-1 Children's Alliance Letter of Support
212_Attachment I.G.4-2 University of Kentucky Letter of Support
213_Attachment I.G.4-3 University of Louisville Letter of Support
214_Attachment I.G.4-4 CASA Letter of Support
215_I_G_5_Enrollee Services
216_Attachment I.G.5-1 Sample Report
217_I_G_6_Provider Network PROPRIETARY
218_Attachment I.G.6-1 University of Kentucky Letter of Support
219_Attachment I.G.6-2 University of Louisville Letter of Support
220_Attachment I.G.6-3 Children's Alliance Letter of Support
221_Attachment I.G.6-4 BounceCoalition Letter of Support
222_Attachment I.G.6-5 Healing TREE Letter of Support
223_Attachment I.G.6-6 Centerstone of Kentucky Letter of Support
224_Attachment I.G.6-7 KVC KY Letter of Support
225_I_G_7_Provider Services
226_Attachment I.G.7-1 Children's Alliance Letter of Support
227_Attachment I.G.7-2 University of Kentucky Letter of Support
228_Attachment I.G.7-3 University of Louisville Letter of Support
229_Attachment I.G.7-4 BounceCoalition Letter of Support
230_Attachment I.G.7-5 Healing TREE Letter of Support
231_Attachment I.G.7-6 Relias Children Youth and Family Solutions
232_Attachment I.G.7-7 Relias Initial Kentucky SKY Trainings
233_Attachment I.G.7-8 Relias Fact Sheets
234_Attachment I.G.7-9 Relias Information
235_Attachment I.G.7-10 TIC Training Materials
236_Attachment I.G.7-11 TIC Training Screenshots
239_I_G_8_Covered Services
240_Attachment I.G.8-1_Medicaid Enrollee Needs Assessment
241_Attachment I.G.8-2_Medicaid Pediatric Survey
242_Attachment I.G.8-2_Medicaid Pediatric Survey
243_Attachment I.G.8-3_Medicaid PH Comprehensive Survey
244_Attachment I.G.8-4_Medicaid BH Comprehensive Assessment
245_Attachment I.G.8-5_Pediatric Comprehensive Survey
246_Attachment I.G.8-6_KY SKY Pediatric Needs Assessment
247_Attachment I.G.8-7 Humana-CareSource Pediatric Needs Assessment
248_Attachment I.G.8-8 Centerstone Letter of Support
249_Attachment I.G.8-9 University of Kentucky Letter of Support
250_Attachment I.G.8-10 University of Louisville Letter of Support
251_Attachment I.G.8-11 Bounce Coalition Letter of Support
252_I_G_9_Health Outcomes
253_I_G_10_Population Health Management and Care Coordination
254_Attachment I.G.10-1_Proposed Kentucky SKY Enrollee Needs Assessment
255_Attachment I.G.10-2 Bounce Coalition Letter of Support
256_Attachment I.G.10-3 University of Kentucky Letter of Support
257_Attachment I.G.10-4 University of Louisville Letter of Support
258_Attachment I.G.10-5 United Way Letter of Support
259_I_G_11_Utilization Management
260_Attachment I.G.11-1 Centerstone Letter of Support
261_I_G_12 Aging Out Services
262_Attachment I.G.12-1 United Way Letter of Support
263_Attachment I.G.12-2 University of Louisville Letter of Support
264_Attachment I.G.12-3 University of Kentucky Letter of Support
265_Attachment I.G.12-4 BounceCoalition Letter of Support
266_I_G_13 Use Case 1
267_I_G_13 Use Case 2
268_I_G_13 Use Case 3
269_I_G_13 Use Case 4
270_I_G_13_Use Case 5
271_I_G_13_Use Case 6
272_I_G_13_Use Case 7
273_I_G_13_Use Case 8
274_J. Proof of Ability to Obtain Performance Bond
ADULTCOM6748_DeIdentifiedMemberFile
ADULTCOM6748_FinalResultsReport
ADULTCOM10975_DeIdentifiedMemberFile
ADULTCOM10975_FinalResultsReport
Attachment I.C.18.e-1 Humana Kentucky Medicaid Provider Network
CBD_Dental_PromptPayReport_2018
HDIC_Dental_PromptPayReport_2018
HHP_Dental_PromptPayReport_2018
HIC_Dental_PromptPayReport_2018
KY ANNUAL Data Reporting Manual_2018
Q1_2019_HHP_PromptPayReport
Q2_2019_HHP_PromptPayReport
Q3_2018_HHP_PromptPayReport
Q4_2018_HHP_PromptPayReport
TDC_Dental_PromptPayReport_2018