State of Connecticut

I. Statement of Objectives

The State of Connecticut, acting through Office of the State Comptroller (OSC) and the Health Care Cost Containment Committee (HCCCC) is seeking a consultant to provide claims recovery services relative to its self-insured health plan vendors for the period from April 1, 1992 to June 30, 1996.

The project consists of three major areas:

  1. Ascertain whether claims recoveries can be made as a result of fraud or abuse, third party liability, coordination of benefits (including workers' compensation), overpayment, and managed care reimbursements.
  2. Recover any such payments.
  3. Make recommendations for improvement.

II. Background Information

The State Comptroller is empowered by the General Statutes to arrange and procure a "group hospitalization and medical and surgical insurance plan." The Comptroller's Retirement and Benefit Services Division administers the state health program.

HCCCC was established through collective bargaining in 1985 and is composed of six labor representatives, six management representatives, and a neutral chairperson. It is responsible for implementing cost control measures, monitoring and improving plan quality, and initiating health promotion and wellness programs for state employees, retirees, and their eligible dependents.

Prior to April 1, 1992, the state contracted with traditional hospital and medical service plans, indemnity insurers, and several Health Maintenance Organizations (HMO). On April 1, 1992 a plan underwritten by Blue Cross and Blue Shield of Connecticut (BC&BS), which covered approximately eighty percent of all state participants was converted from a fully-insured to an administrative services only (ASO) arrangement. On October 1, 1993, as an outcome of collective bargaining agreement, a Preferred Provider Organization (PPO) was created and elements of managed care were introduced into the state medical plan with the goal of restraining health care costs while improving access and quality of care. Currently, medical plans being offered include a Point of Service (POS) option (Blue Care State Preferred), three Point of Enrollment options (Blue Care State Premier, Blue Care State Advantage, and M.D. Health Plan), and a traditional HMO (Kaiser Foundation Health Plan). Each of these plans provides a supplement to Medicare- enrolled retirees. Prior to July 1, 1996, out-of-state employees and retirees were enrolled in a BC&BS indemnity plan; as of July 1, 1996, this plan is available only to retirees enrolled in Medicare who reside outside Connecticut; non-resident employees and retirees not enrolled in Medicare may choose either Blue Care State Preferred or, where available, Kaiser Foundation.

At present, the state dental program consists of a CIGNA Dental HMO and a BC&BS indemnity plan. The BC&BS plan is self-insured; CIGNA is fully-underwritten. Proposals for a new dental plan are currently under review.

All BC&BS plans and the M.D. Health Plan offering were self-insured during the period under consideration; M.D. Health Plan was converted from ASO to fully-underwritten as of July 1, 1995. These vendor agreements, which have been extended through June 30, 1999, contain risk-sharing arrangements and performance guarantees.

Appendix A provides enrollment totals, as well as claims expenditures, associated with the state's self- insured program for the following periods: April 1992 to September 1993; October 1993 to June 1994; and July 1994 to June 1995. Final data for the period from July 1995 to June 1996 will be available in January 1997.

Appendix B sets forth by plan year the health care offerings for which claims recovery services are required.

III. Consultant Tasks

The contractor selected will be required to perform the following tasks:

  1. Provide a comprehensive service to assist the state in recovering paid medical and dental claims of the plan to which it is entitled as the result of fraud and abuse, third party liability, coordination of benefits (including workers' compensation), overpayment, and managed care reimbursements.
  2. Provide a comprehensive review of all paid claims data and make recoveries through the use of such techniques as computer detection, field investigation, and litigation (where authorized).
  3. Determine whether recoveries can be made, and identify and document all such claims.
  4. Investigate and pursue all eligible cases regardless of the amount at issue and, where authorized, pursue litigation.
  5. Report claims to the state and, upon obtaining approval, proceed to recover any such payments or duplicate payments.
  6. Summarize in writing recoveries identified, actions taken, and results to date on a monthly or quarterly basis, as mutually agreed.
  7. Meet with the state from time to time on an as needed basis.
  8. Recommend actions the state should take in order to avoid overpayment and duplicate payments in the future.


Request for Proposals and Response Phase
December 16, 1996 Release of RFP by State Comptroller and HCCCC
January 6, 1997 Contractors Conference at Comptroller's Office (see note 1)
January 21, 1997 Proposals due at Comptroller's Office by 4:30 p.m.
Proposed Review and Selection Schedule (see note 2)
January 22 - 31, 1997 Reading and Scoring of Proposals by Screening Committee
February 5, 1997 Interviews with Finalists
February 14, 1997 Award of Contract
February 28, 1997 Commence Project
December 31, 1997 Conclude Project

Contract Term

It is anticipated that the agreement negotiated as a function of this RFP will commence on February 28, 1997 and terminate on December 31, 1997.


  1. The Contractors Conference will be conducted, as follows:
TIME: 1:00 p.m.
LOCATION: Office of the State Comptroller
55 Elm Street, Third Floor
Hartford, CT 06106
  1. This schedule is proposed. On or about January 21, 1997, contractors who respond to this RFP will be notified of the final review and selection schedule.


  1. Each contractor must submit an original plus five (5) copies of its written proposal in loose-leaf binders to:

Retirement and Benefit Services Division
Office of the State Comptroller
55 Elm Street, Third Floor
Hartford, Connecticut 06106
Attention: Steven Weinberger, Division Director

  1. Contractors who have questions regarding this RFP should submit them in writing to Mr. Weinberger at the address set forth above.
  2. Proposals must be received on or before 4:30 p.m., Tuesday, January 21, 1997.
  3. Each proposal must be formatted as below-specified and contain the following information:


A cover letter, including the name, address, telephone number, and facsimile number of the contractor's contact person, signed by an individual authorized to enter into a contract with the state on behalf of the contractor, and describing the office that would support the state's activities. This cover letter must also certify the accuracy of all information contained in the proposal, and disclose any assignments, relationships, or other employment that the contractor (including all employees) has which might create, or be perceived as, a conflict of interest.


A description of the contractor's approach and methodology, including a detailed work plan and project schedule. This section, which may not exceed twenty (20) one-sided pages, must also address the following:

  1. List and describe the categories of services your firm provides.
  2. Describe the processes by which you would conduct business with the state and its self-insured health plan vendors, along with any variances you anticipate in these processes due to the nature of this engagement.
  3. Except for project management, describe the cooperation and resources required from the state, indicating staff involvement, the amount of staff time that might be involved, access to data required, space requirements within state offices for the contractor, and the use of any other state property or resources.
  4. Describe the cooperation and resources required from the state's self-insured health plan vendors.
  5. Estimate the amount of recoveries you would anticipate from this assignment based upon your experience with clients similar to the state.
  6. Describe the amount of time you will require in order to become familiar with the state's processes and practices prior to commencing work.
  7. Describe any actions that the state will need to take to enable you to perform the proposed services, such as letters of agency to the self-insured health plan vendors, information regarding organizational structure and reporting relationships, and similar matters.
  8. Describe any involvement of state staff in the management of the project.
  9. Describe the relationship (either employment or independent contractor) between your firm and all personnel who will be assigned to this project.
  10. Describe the contractor's experience relevant to this project and a summary of key strengths and qualifications.
  11. Provide evidence of sufficient indemnification and insurance.


Resumes of the personnel to be assigned to this project.


Submit at least three references for whom you performed consulting services during the last three years similar to those described in this RFP. For each, provide the name of a contact person and telephone number.


Discuss in detail your fees for performing the services requested herein. The state intends to compensate the contractor selected on a contingency basis with a pre-determined percentage of amounts recovered. Such contingency fees will not be paid until such time as the state has actually received the amounts recovered. Please be advised that workers' compensation recoveries will be excluded from the selected contractor's contingent fee arrangement as the state is self-insured for this purpose. The selected contractor will bear all expenses for such recoveries, including but not limited to investigation, retention of counsel, and the payers' reasonable costs incurred in transmitting claims data.


Proposals must include a summary of the contractor's experience with affirmative action. This information is to include a summary of the contractor's affirmative action plan and the contractor's affirmative action policy statement.

Section 4-114a-3(10) of the regulations of Connecticut State Agencies requires agencies to consider the following factors when awarding a contract which is subject to contract compliance requirements:

  1. The contractor's success in implementing an affirmative action plan;
  2. The contractor's success in developing an apprenticeship program complying with Section 46a-68-1 to 46a-68-17 of the Connecticut General Statutes, inclusive;
  3. The contractor's promise to develop and implement a successful affirmative action plan;
  4. The contractor's submission of EEO-1 data indicating that the composition of its work force is at or near parity when compared to the racial and sexual composition of the work force in the relevant labor market area; and
  5. The contractor's promise to set aside a portion of the contract for legitimate small contractors and minority business enterprises, where applicable. (See Section 32-9e of the Connecticut General Statutes.)

A "Notification to Contractors" form is attached, to be read, signed, and returned by the contractor. (Attachment I)

Also attached is a Contract Compliance Requirements reporting form, which the contractor must complete sign, and return; such form will be sent by OSC to the Commission on Human Rights and Opportunities (CHRO). (Attachment II)


At the contractor's option, an executive summary may be included in its proposal.


Conformance - All responses to this RFP must conform to these instructions. Failure to conform may be considered appropriate cause for rejection of the response.

Delivery of Responses - RFP responses must be in sealed envelopes upon which a clear indication has been made of the RFP reference title, as well as the date and time the proposal is due. The name and address of the vendor must appear on the envelope. FAX responses are not acceptable.

Structure of Response - Contractors must structure the responses as outlined in this RFP.

Exclusion of Taxes from Prices - The State of Connecticut is exempt from the payment of excise, transportation, and sales taxes imposed by the Federal Government and the State. Such taxes must be excluded from quoted prices.

Signature and Responsible Persons - The proposal must be signed by an authorized official. The proposal must also provide name, title, address, and telephone number for individuals with authority to negotiate and contractually bind the contractor, and for those who may be contacted for the purpose of clarifying the information provided.

"Not to Exceed" Quotations - All cost estimates will be considered as "not to exceed" quotations.


Any contractor responding to this RFP must be willing to adhere to the following conditions and must so state in its submission:

  1. Acceptance or Rejection by the State - The state reserves the right to accept or reject any or all proposals submitted for consideration. All proposals will be kept sealed and safe until the deadline for submission has passed.
  2. Conformance with Statutes - Any contract awarded as a result of this RFP must be in full conformance with statutory requirements of the State of Connecticut.
  3. Ownership of Proposals - All proposals in response to this RFP are to be the sole property of the state, and subject to the provisions of Section 1-19 of the Connecticut General Statutes (Freedom of Information).
  4. Ownership of Subsequent Products - Any product, whether acceptable or unacceptable, developed under the contract awarded as a result of this RFP is to be the sole property of the state unless stated otherwise in the RFP or contract.
  5. Availability of Work Papers - All work papers and data used in the process of performing this project must be available for inspection by the State of Connecticut Auditors of Public Accounts for a period of three (3) years or until audited.
  6. Timing and Sequence - Timing and sequence of events resulting from this RFP will ultimately be determined by the state.
  7. Stability of Proposed Prices - Any price offerings from contractors must be valid for a period of one hundred eighty (180) days from the due date of contractor proposals.
  8. Oral Agreements - Any alleged oral agreement or arrangement made by a contractor with any agency or employee will be superseded by the written agreement.
  9. Amending or Canceling Requests - The state reserves the right to amend or cancel this RFP, prior to the due date and time, if it is in the best interests of the state.
  10. Rejection for Default or Misrepresentation - The state reserves the right to reject the proposal of any contractor which is in default of any prior contract or for misrepresentation.
  11. State's Clerical Errors in Awards - The state reserves the right to correct inaccurate awards resulting from its clerical errors.
  12. Rejection of Qualified Proposals - Proposals are subject to rejection in whole or in part if they limit or modify any of the terms and conditions and/or specifications of the RFP.
  13. Contractor Presentation of Supporting Evidence - A contractor, if requested, must be prepared to present evidence of experience, ability, service facilities, and financial standing necessary to satisfactorily meet the requirements set forth or implied in the proposal.
  14. Changes to Proposal - No additions or changes to the original proposal will be allowed after submittal. While changes are not permitted, clarification at the request of the agency may be required at the contractor's expense.
  15. Expenses Incurred - The state will not reimburse any contractor for any costs or expenses incurred in preparing proposals or in any other connection with this RFP, including travel expenses relating to an oral presentation.
  16. Collusion - By responding, the contractor implicitly states that the proposal is not made in connection with any competing contractor submitting a separate response to the RFP, and is in all respects fair and without collusion or fraud. It is further implied that the contractor did not participate in the RFP development process, had no knowledge of the specific contents of the RFP prior to its issuance, and that no employee of the agency participated directly or indirectly in the contractor's proposal preparation.


Each proposal will be evaluated by a screening committee using the following criteria to determine which contractor is most capable of implementing the state's requirements:

  1. Contractor's experience with and ability to do the specific work, including experience in working on similar projects with joint labor-management entities.
  2. Contractor's understanding of the project's purpose and scope, as evidenced by the proposed approach and the level of effort.
  3. Competitiveness of proposed cost.
  4. Availability and competence of personnel.
  5. Conformity with specifications contained herein.
  6. Demonstration of commitment to affirmative action by full compliance with the regulations of the Commission on Human Rights and Opportunities.
  7. At the option of the screening committee, an oral presentation.


The state reserves the right to award in part, to reject any and all proposals in whole or in part, to waive technical defects, irregularities and omissions if, in its judgement, the best interest of the state will be served.

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