Humana Response



(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)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


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


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


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







Attachment I.C.18.e-1 Humana Kentucky Medicaid Provider Network





KY ANNUAL Data Reporting Manual_2018