Passport Response

A Executive Summary

A. Transmittal Letter


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