Request for Proposal
Agency of Human Services
Department of Disabilities, Aging and Independent Living
REQUEST FOR PROPOSAL
FISCAL/EMPLOYER AGENT
1.0Overview and General Information
1.1.Scope: The State of Vermont, Department of Disabilities, Aging and Independent Living seeks proposals from qualified vendors to act in the capacity as aFiscal/Employer Agent (F/EA) (also sometimes called an Intermediary Service Organization [ISO] or Financial Management Service [FMS)]) for consumer and surrogate directed services. The F/EA shall provide a payroll service for individuals authorizedby the State to receive services from the Developmental Disability Services (DDS), Children’s Personal Care Services (CPCS) (including both cash allowance and hourly authorization options),Attendant Services Program (ASP) (including ASP-General Fund [ASP-GF], Medicaid Participant Directed Attendant Care [MPDAC] and Attendant Services Program-Personal Services [ASP-PS] options) or the Choices for Care Long Term Care Medicaid (CFC) (including the Flexible Choices [FC] option) programs. The FE/A shall enroll participating employers and employees associated with these programs. The FE/A shall also make miscellaneous payments for goods and services, pay all employment-related taxes for participating employers and employees, and make direct cash payments to consumers as defined by the State. The FE/A shall provide support and assistance to beneficiaries of these programs to assist participating employers and employees with administration of required documentation, including the completion of the enrollment and payroll documents necessary for each participating employee, paperwork, program understanding, and other related services needed to assist in conjunction with the supportive ISO and appropriate state and community agencies,. The FE/A shall meet all applicable state and federal requirements for payroll agents and fiscal intermediaries.
1.2.Background: The State has been operating consumer- directed programs for nearly twenty years. The State currently operates four (4) consumer-directed programs, all of which have more than one consumer-directed option. These programs serve close to 3,500 consumers with annual growth in most programs continuing. Each of these programs has its own set of rules governing eligibility, kinds of services available, and reimbursement processes. Over the past fifteen years, the State has twice let a contract for this service via a Request for Proposal to an out-of-state company. Each time, that company has had to withdraw from providing the service in mid-contract. As a result, the State is extraordinarily concerned that any prospective contractor demonstrates the ability to function in Vermont, serving a complicated mix of programs to a relatively small number of consumers.
2.0Scope of Work
2.1Working with Employers and Employees: The vendor shall demonstrate the ability and capacity to assist participating employers to learn and to carry out their responsibilities as employers and to adapt its procedures to reflect that participating employers are not professionals and need support, patience, and clear instructions to carry out their responsibilities. The vendor shall demonstrate its ability provide prompt and accessible assistance to participating employers through a toll-free phone line for people at any Vermont exchange with convenient hours, FAX, internet access, and clear written instructions.
2.2Authorizations and Program Limitations: The vendor will need to adhere to the State’s processes for prior written authorizationbefore the vendor initiates services to an employer. Limits are established differently in each of the various programs.
2.2.1The service allocations for the programs as follows:
2.2.1.1Choices for Care for the aged and adults with disabilities uses service allocation of bi-weekly hours or dollars.
2.2.1.2Children’s Personal Care Services, six month Prior Authorizations measured in dollars or in hours.
2.2.1.3Participant Directed Personal Care gives annual plan, with daily and bi-weekly allocations of hours.
2.2.1.4Developmental Services uses dollars from annual Authorized Spending Limits (ASL), which are inclusive of employer payroll taxes. The calculated amount of the timesheet submitted must not exceed the remaining amount of funds in the ASL, unless there is another Budget item for that individual, in which case, only the single timesheet that exceeds the budget may be paid by using funds from the second budget item. These budgets will need to be maintained in the database as Developmental Services Plans of Care.
2.2.2For consumers, the number of hours in one calendar day cannot exceed 24 hrs between multiple Provider/Employees
2.2.3For employees, the number of hours in one calendar day cannot exceed 24 hrs between multiple Participant/Employers
2.3Patient Share: The vendor shall demonstrate the ability to manage the Patient Share process in Choices for Care by:
2.3.1Billing participating employers for the amounts of any 'patient share' payments as determined by the State.
2.3.2Tracking amounts of Patient Share withheld by Medicaid.
2.3.3Managing and tracking Patient Share notices from Vermont’s Department of Children and Families (DCF)
2.3.4Where necessary, interacting with other providers to ensure “highest paid provider” determination accurately reflects the collection, withholding and payment of Patient Share
2.4Payroll Reports: At the completion of each payroll the vendor shall provide to participating employers and, if requested, to the State, case management or designated agency: a statement showing the funds paid or obligated, the balance remaining in the authorized funding limits, dates of service. These reports will vary according to the program the employer is using.
2.5Unique Identifier: The vendormay be required to maintain a unique identifier for each employer for the purposes of tax reporting
2.6Qualifying as the Fiscal Agent: The vendor shall qualify to serve as a fiscal agent for each participantas directed by the State.
2.7Withholding and Judgments: The vendor shall assure that the employer's share of all taxes due, including state and federal income tax, FICA, and unemployment compensation taxes are withheld, filed, and paid on time and in full for each participating employee, and shall make advance payments of federal Earned Income Credit to eligible employees. The vendor shall also process all judgments, garnishments, tax levies or related holds on an employee's wages required by local, state, or federal law.
2.8Background Checks: The vendor shall perform background checks on all employees in accordance with the State’s Background Check Policy.
2.9Accepting Timesheets: The vendor shall be able to securely accept timesheets through a variety of media, includingthe internet, email, fax and the US Mail.
2.9.1The vendor shall provide participating employers and participating employees as necessary with timesheet forms printed on NCR paper and pre-addressed, pre-stamped envelopes for submission of timesheets.
2.9.2However accepted, timesheets shall be retained in compliance with Medicaid requirements established by the Center for Medicaid and Medicare Services, as determined by the State.
2.9.3The vendor shall prepare the payroll from timesheets submitted by participating employers and their employees.
2.10Processing Timesheets: The vendor shall process time sheets and non-payroll payments as follows:
2.10.1Inspection: The vendor shall inspect timesheets and non-payroll payment requests to assure that they are completed correctly. Inspection shall include both “eyes-on” and electronic methods as determined to be necessary by the State.
2.10.2Review: The vendor shall review the number of hours and the types of services contained on timesheets and non-payroll payment requests to ensure that
2.10.2.1The participant is eligible for dates and services or payments represented,
2.10.2.2The amount to be paid does not exceed the authorized limits established bythe State, the Designated Agency, the Specialized Service Agency, or other contracted provider.
2.10.3The vendor shall contact the responsible employer regarding all issues related to paperwork, timesheets, and invoices. The vendor shall notify the appropriate case manager and the State in a timely manner, by telephone or in writing, if an employer demonstrates a continued inability to comply with the payroll paperwork and/or procedures
2.11Payment to Employees: The vendor shall pay employees via direct deposit although it will have the capacity to pay via check for those employees who require it.
2.11.1The vendor shall develop a process to answer questions and provide information to resolve administrative disputes between employees and employers regarding payroll matters, as well as between employers and the vendor.
2.11.2The vendor shall have a process to replace checks not received by the participating employee.
2.11.3The vendor shall establish a protocol and procedure to address un-cashed checks in compliance with statutory requirements and procedures established by the State Treasurer.
2.11.4The vendor shall make payments, for goods, services and in cash when requested by a participating employer and as allowed under State policies and procedures.
2.12Tax Related Services: The vendor shall provide the following tax-related services:
2.12.1Preparation and mailing of W-2 forms and annual tax reports required by the Internal Revenue Service and the State of Vermont, including W-5 forms;
2.12.2Completion of 941 deposits;
2.12.3Payment of workers' compensation insurance policy premiums. The State carries a single workers’ compensation policy for all employees managed by the FE/A so the FE/A will not be expected to manage multiple individual policies.
2.12.4Payment of any other employment-related federal and state taxes;
2.12.5Completion of any other payroll-related reports or forms;
2.12.6Preparation and mailing of IRS 1099 forms for independent vendor;
2.12.7Payment of actual unemployment claim costs, as forwarded to the vendor by the Vermont Department of Labor (VT DOL). Employees served by the FE/A are state employees for purposes of Unemployment Insurance only. Thus, the FE/A will not need to file multiple sets of unemployment premiums. (see 2.16) The FE/A will be expected to file unemployment forms by program.
2.12.8Participation in the annual Worker’s Compensation Audit with the current Policy Carrier
2.12.9The vendor shall refund any FICA payments withheld to employees and to the State for those employees for whom FICA withholding is not required.
2.13Providing Information:The vendor shall respond to questions and requests for information from employers, employees, case managers, and the State.
2.13.1The vendor shall provide the opportunity for the State to provide information to employers and employees by inserting stuffers in pay or report envelopes or posting notices on the vendor’s website.
2.14Claims and Reimbursement: The vendorwill enroll and maintain status as a Medicaid provider in order to process claims.
2.14.1The vendor shall routinely work to resolve denied claims in a timely manner. Claims denied due to timely filing issues become the responsibility of the vendor unless the vendor can prove otherwise
2.14.2The vendor will need to be able to send claims to different funding sources dependent upon the program the participant is in. These may include, other than Vermont Medicaid, Designated or Specialized Service Agencies or directly to the State.
2.15Employer and Employee Enrollment: The vendor shall produce and distribute program-specific enrollment packets, including all required forms and instructions including state employer handbooks,
2.15.1The vendor shall develop procedures to regularly segregate inactive participants, employers, and employees from the payroll system.
2.16Unemployment and Workers’ Compensation: The vendor shall follow the procedures established to ensure coverage of eligible individuals under the group Workers’ Compensation Insurance policy secured by the State.
2.16.1The State is a self-insured entity for purposes of unemployment coverage of employees employed by participants utilizing the services of the vendor under this contract. The vendor shall establish a separate account with the DOL for each of the employee groups represented by the respective programs.
2.16.2Employees employed by participants are not considered employees of the State for purposes of health insurance coverage.Nonetheless, vendor shall file any reports relating to health insurance coverage which are or will become required.
2.16.3The vendor shall act on behalf of the employer as the employer's representative with VTDOL when claims are filed and shall cooperate with the Department of Labor in accordance with State procedures.
2.16.4Cost of Coverage: The State shall provide for the cost of the unemployment coverage on a 'pass-thru' basis.
2.17 Other Duties: The vendor shall provide reports to the State including financial statements and other reports which will assist the State in monitoring the programs the vendor is serving.
2.17.1The vendor shall report any suspected abuse and fraud in a timely fashion to the State via both the Department contacts and the Medicaid Program Integrity Unit.
2.17.2The vendor shall maintain all timesheets, billing records, background check records, and payroll records for a minimum of seven (7) years.
2.17.3The vendor shall establish a procedure to ensure that participants who live out of state will continue to receive services under this Contract when approved by the State.
2.17.4The vendor shall be required to notify the VTDOL of any newly hired persons, in the manner determined by VT DOL, in accordance with the requirements set forth by the State under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
2.17.5The vendor shall periodically produce reports as requested by the State so of vendor will have a database which allows for easy reporting of information about consumers, employers, and employees.
2.18Evaluation and Performance Measures: The State shall evaluate the vendor during the contract.
2.18.1The State will include performance measures in the contract which will require the vendor to meet a prescribed standard. This may include measures of payroll timeliness and accuracy or in the development of new program capacity. Payment will, to some extent, be based on these standards.
2.18.2The vendor will work with the State to determine the extent to which the vendor is meeting the expectations of its stakeholder groups, including consumers, employees and community agencies.
3.0Vermont Presence
The vendor shall maintain a physical presence in Vermont. This will include an office with sufficient staff to receive timesheets, verify availability of resources in plans of care and answer questions posed by employers and employees. The vendor shall also have the capacity for staff to meet regularly with State staff, at least monthly, on a face-to-face basis. These staff will need to be sufficiently senior as to have the authority to make decisions regarding the vendor’s operations in Vermont.
4.0Proposal Format and Timeline
4.1Defining the Contract Period: The contract period for this project is for 24 months, renewable for up to 2 additional 1-year periods. The first date of operations is January 1, 2013. The bidder awarded the contract must provide the State with the amount of time required to commence operations on that date. Should it be necessary, bidders must be prepared to cooperate with the existing vendor in a smooth transition of services.
4.2Point of Contact: All communications concerning this RFP are to be addressed in writing to the attention of: Merle Edwards-Orr, Vermont Agency of Human Services, Department of Disabilities, Aging & Independent Living, . Any attempts by bidders to contact any other party could result in the rejection of their proposal
4.3Schedule: The table below presents the State’sexpected schedule for the Request for Proposal (RFP) and contracting process. Please note the Department may change the schedule at any point.
RFP Published June 12, 2012
Optional Bidders Conference June 21, 20121:00 PM EDT
Letters of intent due June 28, 2012
Questions from Bidders Due June 28, 2012
State Responses to questions posted July 6, 2012
Proposals Due July 24, 2012, 3PM
State Questions Submitted August 10, 2012
to Bidder Regarding Proposals
Due Date for Bidder August 20, 2012
Responses to State Questions
Contractor Selection August 28, 2012
Contractor Negotiation Period August 29-
September 28, 2012
Contractor Processing and Review Period October 1 -
December 3, 2012
FE/AcommencesVermont operations January 1, 2013
4.4Optional Bidders Conference: A bidders’ conference for this project will be held on June 21, 2012 from 1:00 to 3:00 pm in the Conference Room A, 94 Harvest Lane, Williston, VT05495. The purpose of the event will be to review the terms of this Request for Proposal and allow potential bidders an opportunity to formulate any remaining questions they might wish to submit. Questions may be collected and responded to in writing by July 6, 2012. Bidder attendance at this conference is optional. Phone-in option will be available upon request.
4.5Letters of intent: Potential bidders may submit a letter of intent by close of business on June 28, 2012 to the state contact person. While letters of intent are not required to submit a bid they will assure that the potential bidder receives all questions, answers and clarifications about the RFP that are published before the July 6 deadline.
4.6Question and Answer Period: Any vendor requiring clarification of any section of this proposal or wishing to comment or take exception to any requirements or other portion of the RFP must submit specific questions at the bidders’ conference or in writing according to Schedule listed above. Questions should be in writing and directed to Merle Edwards-Orr, Department of Disabilities, Aging and Independent Living, . Any question to the RFP or to any provision of the RFP that is not raised in writing before the last day of the question period is waived. After the close of the question period a copy of all questions or comments and the State’s responses will be distributedto all bidders who have submitted a letter of intent. Every effort will be made to have these available soon after the question period ends, contingent on the number and complexity of the questions.
4.7Proposal submission: All proposals are due into the State by 3:00 PM on July 24 2012. All proposals are to be submitted electronically in PDF or other non-alterable format to the state contact person: . Bidders shall submit their proposals with requests to verify receipt. The State is not responsible for undelivered bids.
4.8State Questions to Bidders: Following submission of written proposals, vendors may be asked by State to provide supplementary written information on specific questions where additional information is needed to make a final determination on bid selection.
4.9Method of Award
4.9.1Contract award: Awards will be made under the provisions of VSA Title 29 Chapter 49§903.