Cherokee Indian Hospital Tribal Option Request for Proposal

Responses to Questions concerning the Request for Proposals

For the Cherokee Indian Hospital Authority (CIHA)


CIHA Responses

RFP Due Date and other Timeline Questions

The cover page of the RFP indicates the “Opening Date” as April 10, 2018, yet the timeline on page 38 of 39 indicates a proposal due date of May 15, 2018. Please confirm the correct proposal due date.

All proposals are due on May 15, 2018. Hard copies must be post marked by May 15, 2018 and softcopy submission by 4:30 p.m. EST.  We apologize for the typo on the cover page of the RFP.  The Cherokee Indian Hospital Authority assumes no responsibility for bid responses that are late due to delay or failure of delivery by the U. S. Postal Service, private courier, email or any other reason.   

What time of day on May 15, 2018 are submissions due?

Electronic submissions are due 4:30 p.m. EST, May 15, 2018.  This is close of business for Cherokee Indian Hospital Authority Administration.

Please clarify the Operational Start Date for the Contract.

The contract effective date is targeted for July 2018.  The start date of operating the actual business functions of the Tribal Option will align with DHHS operational go live date of Medicaid Managed Care, currently scheduled for July 1, 2019.   This operational date may change based upon direction from NC DHHS.

Please confirm the Contract Effective Date is the date of signature on the Contract.

The contract effective date will be designated in the contract and reflective of selection process.  Selection is targeted by July 2018 with contract date to be determined based upon negotations. 


Will the bidders’ names and their proposals be kept confidential, or will EBCI publicly disclose the responses?

Yes, the bidders’ names and proposals will be kept confidential.  CIHA is not subject to the NC public records laws. 

Provider Network

In the Provider Network Adequacy Standards section (page 17 of 39), question #1, it refers to “the existing CIHA contract provider list”. Can you provide the existing CIHA contract provider list including names, specialties, addresses and NPI numbers?

Attached is a copy of provider names, type of service provided and location of providers.  CIHA will provide a list of all providers serving Medicaid enrolled Tribal members as part of the final contract activity. 

Page 35 of 39 mentions the current number of Medicaid- enrolled providers in the CHSDA as approximately 100 that would potentially need to be credentialed. Are these 100 providers CIHA providers or non-CIHA providers found in Cherokee, Graham, Haywood, Jackson and Swain?

Most of the Medicaid enrolled providers are in the CHSDA counties (Cherokee, Graham, Haywood, Jackson and Swain) currently have contracts with CIHA.  Additional providers are located outside of the five (5) counties and are typically accessed for specialty care.   For example, Mission Health Systems is used for inpatient care and other specialty outpatient or ambulatory care. 


All providers are currently enrolled with NC Medicaid or NC Health Choice. 

Please confirm that Indian health/Tribal providers will not be required to be part of the Tribal Option’s network.

Based upon federal regulations, enrolled Tribal members can access any Indian Health Service (IHS) provider, whether the IHS provider is in a PHP network or not. The Tribal Option will include all IHS/Tribal providers in their network.

Based on your experience, how likely is it that the Indian Health/Tribal providers who serve this population today will agree to network contracts?

IHS/Tribal providers who currently serve this population are willing to and will be part of the Tribal Option network. 

Please confirm the Tribal Option network is not limited to Indian health/tribal providers (i.e., the Tribal Option network can include non-tribal providers.)

The Tribal Option network is not limited to IHS/Tribal providers. CIHA currently contracts with non-Tribal providers.  The Tribal Option is subject to meeting the network adequacy standards established by NC DHHS. 

What is the payment mechanism by which tribal providers are paid today? How do Federal funding considerations affect payment model, if at all?

Medicaid services rendered by Tribal providers are paid either the federally established OMB rates for outpatient, inpatient and dental services via an encounter approach.  The established state fee schedule is used for other services such as behavioral health case management and pharmacy. 

Tribal Option Beneficiaries

Please confirm the beneficiaries covered under this agreement are the ~4,458 EBCI Medicaid and CHIP Beneficiaries in the CHDSA. And not the 15,000 total EBCI population in the CHDSA. (page 35 of 39)

The beneficiaries covered under this agreement are the EBCI Medicaid and CHIP beneficiaries in the CHSDA who choose the Tribal Option Prepaid Health Plan (PHP).  The March, 2018 Medicaid/CHIP eligibles is 4,458.  This number is subject to change based up Medicaid enrollment and member choice.

Please confirm the Tribal Option PHP will be managing care and services for the entire EBCI population within the CHSDA (approximately 15,000 members).

The Tribal Option PHP will be managing care and services for the Medicaid and CHIP beneficiaries within the CHSDA.  At a date to be determined after Medicaid go live, the nonMedicaid/CHIP members will be phased in to the operations.

Please confirm the maximum possible EBCI Medicaid and CHIP beneficiaries in the Contract Health Service Delivery Area (CHSDA) is 4,458, and this is the upper end of potential membership range (given tribal members will have the choice between Medicaid fee-for-service or enrollment in a PHP.)

The 4,458 is the Medicaid/CHIP enrolled members as of March, 2018.  This number will vary based upon enrollment and eligibility.  Medicaid enrollment has continued to grow over the last several years and there is an expectation of some continued growth due to onboarding of the Medicaid eligibility determination onsite at EBCI.  The Tribal Option PHP will be managing care and services for the Medicaid and CHIP beneficiaries within the CHSDA.

Can CIHA provide any additional information on the 15,000 members such as insurance eligibility (Medicare, Medicaid including break down of Age, Blind Disabled vs TANF, etc.), age ranges, detailed utilization of services information (i.e. use of ED, inpatient, pharmacy, outpatient, etc.), disease burden or % with chronic condition, etc.? This information will be aid us in providing a more accurate budget projection as it will impact number of care management staffing.

At this point, the breakout by eligibility categories and other demographic information is not readily available.  NC DHHS will be providing specific data regarding eligibility demographics. 

How will we receive this membership?  Will we receive it directly from the state as an 834?  Will CIHA forward it to us?  Will it be an 834 or some sort of proprietary format from CIHA?

It is anticipated that DHHS will deliver a nightly global eligibility file from NCFAST.  This is the process currently utilized by other managed care activity within DMA.

In the Budget workbook instructions, EBCI notes that there are approximately 14,290 active health care users (FY17), 4,403 of which are Medicaid recipients. Will the services contracted under this procurement be provided for all health care users, or only for Medicaid recipients?

There are 4,458 Medicaid/CHIP enrolled members.  Services procured through this RFP are for Medicaid/CHIP enrolled members.  At a date to be determined after Medicaid go live, the nonMedicaid/CHIP members will be phased in to the operations.

What is your estimate of other tribal (i.e., non-EBCI) Medicaid enrollment in the CHSDA?

The 4,458 represents all Tribal (all federally recognized Tribes) Medicaid enrolled members within the CHSDA. 

Non-Medicaid EBCI Members – Could this health plan serve any other populations of EBCI members that are not eligible for Medicaid (e.g., employees of EBCI public administration – hospitals, schools, etc.)? Would EBCI be interested in such an expansion opportunity?

Yes, CIHA would be interested in exploring this expansion option. This procurement is for only Medicaid/CHIP enrollees and services.

Non-EBCI Members – Could Medicaid beneficiaries who are not members of EBCI enroll in the Tribal Option, or is eligibility limited to EBCI members only? Would EBCI be interested in such an expansion opportunity?

Eligibility for the Tribal Option includes enrolled members of EBCI as well as other federally recognized tribes.

Geographic Region – Please confirm the Tribal Option’s service area is limited to the CHSDA counties.  Could the plan offer membership in other counties within Region 1?  In Region 2 and/or Region 3?  Statewide? Would EBCI be interested in such an expansion opportunity?

This procurement is limited to the CHSDA counties since these are the counties subject to their current obligations.  CIHA will be open to discussions but will not viewed those possibilities in this selection process.

Phone Lines

For the member services line, must calls be answered by a live phone agent within 30 seconds or would the system IVR answering the initial call within 30 seconds meet this target?

1.     If calls must be answered by live agents, does that mean 24/7 or would IVR with voicemail box be sufficient coverage for non-business hours?

2.     If calls must be answered by a live agent within 30 seconds, what is the timeframe for measurement – monthly, weekly, other?

These are the current standards used by other managed care entities in NC Medicaid and were established by NC DHHS.   Measurement details will be part of the contractual relationship with NC DHHS. 


Current Medicaid managed care practice require a live agent to answer the phone with 30 seconds 24/7. 

Does the nurse line have the same 30 second answer target?


That guidance has not been issued to date by NC DHHS.

Does the nurse line need to staff with Registered Nurses registered in the state of NC?

Based upon federal regulations, Tribal Providers must be licensed in a state.  CIHA policy allows 1 year for clinicians to obtain a NC license. 

Does the call center need to be housed in NC? 


No, the call center does not need to be housed in NC; however, there MUST be an understanding and active knowledge about the geography, culture and environment of EBCI and the CHSDA.  A local presence is preferred but the housing of the call center is not mandatory. 

Please provide historical call volume information by month, week, day.


Monthly Call Volume at CIHA (all locations)

In: 58,344

Out:  32,087

Average Duration: 1:30

Please provide historical call volume and average handle time for calls for member service line and for nurse line.


Monthly Call Volume at CIHA (all locations)

In: 58,344

Out:  32,087

Average Duration: 1:30

Please provide historical volume on grievance inquiries.


CIHA experiences 3 to 7 grievances per month in general

Budget & Finance

In the Budget workbook instructions, EBCI asks the vendor to itemize, for each FTE, annual salary, fringe benefits, and overhead. Will EBCI accept standard bill rates in lieu of individuals’ discrete salary and benefit information?

Yes, EBCI will accept standard bill rates rather than individual discrete salary and benefit information.  CIHA recognizes that this information may be proprietary.

Can EBCI provide an average expenditure for health care users in FY17?


Based up data released by NC DHHS, Tribal members accessed care from Tribal and nontribal providers totals $46.1 million for 2017.  Average SFY 2017 annual per member costs were $3,533 for Tribal providers and $6,810 to nontribal providers. 

Please confirm the contractor is not expected to take on any financial risk for medical services costs exceeding revenue from NC DHHS.

That is correct, there is no financial risk for Medicaid services with this procurement.

Page 28 mentions uncompensated care pool.  How does CIHA envision we administer? (page 28 of 39)

CIHA is asking responders to propose the management of this process.

Capital –

ü  What amount of capital reserves is required for the shared risk model?

ü  What entity will be posting reserves for start-up and ongoing capital requirements?

ü  Is CIHA looking for capital contributions from its business services partner?

ü  d) Is there any government or grant funding to support infrastructure/reserves?

Since this is a financial no risk procurement, CIHA will not release answers to these questions.  If the responder would like to propose options in the response for consideration at a later date, CIHA will accept the information as part of the response.

Is there a set amount that bidders must come in or are you asking for various pricing methods?

Pricing methods are up to the responders to propose. CIHA will not release budgeting expectations at this point in the process.

Risk Model

The RFP indicates the Tribal Option will be “shared risk.” What are the terms?

ü  Will the Department of Health and Human Service (DHHS) pay Tribal Option a capitated per member per month (PMPM) at the beginning of each month, with a reconciliation periodically (i.e., DHHS pays Tribal Option for savings, or Tribal Option pays DHHS for overages)?  

ü  How will the benchmark be set to determine shared savings/shared risk?

ü  What is the historical PMPM cost for EBCI Medicaid beneficiaries?

This procurement is not for a shared risk arrangement.  The arrangement between CIHA and NC DHHS is a shared risk arrangement.  

Information Technology

In the description of the Information Technology – CIHA RPMS section, EBCI requests a timeline for interfacing with all third-party payor sources. In addition to RPMS, what sources does EBCI expect the vendor to interface with?

CIHA expects to have to interface with all state systems that will be part of the contract.  This will include but not limited to NCTracks, NCFast, NC HIE, etc.   At this point, other systems have not been referenced in discussions with NC DHHS. 

Upon contract implementation, will the successful bidder maintain some level of administrative oversight and management of the RPMS system?  -OR- will it be solely controlled by CIHA, as done today? If co-managed between entities, please describe what that shared ownership will look like.

CIHA anticipates managing the relationship with RPMS however is open to discussions. 

Are there technologies or systems that CIHA would like to see incorporated into this initiative?


Will the successful bidder need to provide a new public facing website specific for the PHP to support contract requirements or does CIHA envision enhancing their existing Web Page to support beneficiaries and providers of the PLE Tribal Option?

CIHA anticipates utilizing the CIHA website with enhancements.  CIHA is willing to consider other options. 

Business Model and Plans

Are you looking for a single business partner to provide all services listed in the RFP, or would you be open to vendors proposing a subset of the services listed?

CIHA is interested in finding a single vendor who can provide all services listed in the RFP.   Subcontracting or partnering with other vendors to achieve a comprehensive response is acceptable.

Will EBCI entertain multiple awards, or will all functions be awarded to a single vendor?

CIHA is interested in finding a single vendor or who can provide all services listed in the RFP. Subcontracting or partnering with other vendors to achieve a comprehensive response is acceptable.

We understand from the RFP that the Cherokee Indian Hospital Authority will control the PLE. Is CIHA looking for minority capital investors?  Does it have ability/interest in setting up a Joint Venture with split equity stake?

CIHA will be the sole owner and has no interest in capital investors.

The RFP indicates applicants must be a registered entity with the NC Secretary of State. If a bidder is not currently a registered entity, can we include a plan to register as a qualifying response?

Yes, a plan is acceptable. 

Do you know if a DOI TPA would be required for NC for this proposal?


CIHA is still exploring this issue with NC DOI.    Willingness to become licensed in NC will be accepted until clarification is obtained. 

Utilization Management

Will “integral business functions” performed by the successful bidder include Utilization Management services such as prior authorization of select services and concurrent review of inpatient services based on the application of adopted clinical criteria?

Utilization Management will be provided in partnership between the successful bidder and CIHA Tribal Option.

Vision for the Tribal Option

Can you help us understand the strategic drivers for EBCI setting up the Tribal Option?

EBCI Goals of the Tribal Option Project include:

§   Support Tribal sovereignty in managing the care for Tribal members and their families

§   Support alternative, culturally sensitive services and social determinants of health

§   Enhance the authority of CIHA as the Medical Home to effectively address the adverse impact of risk factors (social determinants) in the EBCI community, through the development and management of a quality health care system that includes all Medicaid services by all Tribal providers, CIHA direct services and contract specialty/health services

§   Provide a health care plan option for Tribal members that offers a comprehensive and culturally sensitive healthcare system, utilizing multiple resources in conjunction with the benefits of the Federal rights afforded to members of Federally Recognized Tribes

§   Improve continuity of care with a health benefit plan that is more beneficial to the Tribal population than other commercial or provider led plans that may not have experience addressing the disparate health issues of Tribal members

§   Increase employment options for the community with increased revenue provided for the administration of the Tribal Option

§   Embrace and incorporate the needs of Tribal members into a Prepaid Health Plan design

§   Establish unique financing mechanisms to provide for alternative or complimentary services.



Aspects of the current CIHA healthcare system provide indicators for the success of a CIHA Tribal Option. These include:

§  CIHA currently manages health revenues on a capitated basis, sets budget and Tribal appropriation.

§  CIHA currently manages multiple funding sources for the CIHA healthcare system.

§  With more emphasis on the role of the medical home, CIHA can prioritize EBCI values and traditions across the full network of providers in the Tribal Option (i.e. CIHA can partner with network providers to implement specialty projects and training on appropriate engagement practices with Tribal members and their families).

What is your vision in five years for your health management program?


To enhance the prosperity of the next seven generations of the Eastern Band of Cherokee Indians through relationship-based quality healthcare.


Our mission is to be the partner of choice for the community by providing accessible, patient and family centered quality healthcare with responsible management of the tribe's resources.


Our vision is to be significant in the lives of Tribal members, chosen for excellence and exceeding customer expectations, recognized for improving the health of the Eastern Band the Cherokee Indians.


We encourage responders to review our foundational beliefs about the management and operations of our health system.

In managing your current program today, what are your largest obstacles?

Obstacles for CIHA:

§   Addressing health disparities for our community while not being responsible or knowing about all health care/billing provided to enrolled members.

§   Fitting tribal health needs within a federal framework

§   Identifying and addressing Adverse Childhood Experiences in the health system

§   Managing patient health while the patient changes from provider to provider

Scoring of the RFPs

Can you please provide more specifics on how points will be awarded for the Budget Sections of the response? Are there other criteria being evaluated in the Budget besides cost for each section? (page 38 of 39)


2 C.F.R. § 200.320(d)(4) requires the EBCI to award contracts “to the responsible firm whose proposal is most advantageous to the program, with price and other factors considered.” The CIHA will evaluate proposals in two phases:  1) technical (programmatic) review; and 2) financial review.  The scores in each phase will be weighted in the overall proposal selection process.  The technical (programmatic) review score will be weighted to comprise 70 percent of the proposal evaluation; the financial review will be weighted to comprise 30 percent of the proposal evaluation.  The technical (programmatic) review will be scored before reviewing the financial (budget) section of the proposals.