122125 O3 Deloitte File 7 of 9 Corp Experience and Tech Response (Redacted).pdf

Source: capitol.nebraska.gov

Nebraska Department of Health and Human Services Program Integrity Case Management (PICM) / Fraud Abuse Detection (FADS) Analytics Request for Proposal Number: RFP 122125 O3

July 10, 2025

Program Integrity Case Management (PICM) / Fraud Abuse Detection (FAD) Analytics

RFP 122125 O3

ii Copyright © 2025 Deloitte. All rights reserved.

Table of Contents

1. Corporate Overview 3

1.a. Bidder Identification and Information 3

1.b. Financial Statements 4

1.c. Change of Ownership 5

1.d. Office Location 5

1.e. Relationships with the State 5

1.f. Bidder’s Employee Relations to State 8

1.g. Contract Performance 8

1.h. Summary of Bidder’s Corporate Experience 8

1.i. Summary of Bidder’s Proposed Personnel/Management Approach 18

1.j. Subcontractors 33

2. Technical Response: Project Description and Scope of Work (Part I) 34

2.A Project Requirements and Information 34

2.A.1. Scope of Work 34

2.A.2. Project Environment 37

2.A.3. Compliance Requirements 38

2.A.4. Project Requirements 39

2.B. Proposed Development Approach 65

2.C. Technical Considerations 70

2.D. Project Work Plan, Management, and Implementation 71

2.E. Deliverables and Due Dates 79

3. Appendix 81

3.a. Contractual Agreement Form 81

3.b. Completed Attachment 1 – Minimum Qualifications 82

3.c. Responses to Sections II through IV 84

3.d. Any license, user agreement, service level agreement, or similar documents that the bidder desires to have reviewed and considered. 104

1 Copyright © 2025 Deloitte. All rights reserved.

July 10, 2025

Dhinesh Santhakumar Procurement Contract Officer Nebraska Department of Health and Human Services 301 Centennial Mall South, 5th Floor Lincoln, NE 68508

Subject: Response to RFP 122125 O3 - Program Integrity Case Management (PICM) / Fraud Abuse Detection (FAD) Analytics solution

Dear Mr. Santhakumar:

Deloitte1 is pleased to present this proposal to the State of Nebraska, Department of Health and Human Services (DHHS) in response to your Request for Proposal #122125 O3, PICM / FAD Analytics solution. We have reviewed the requirements in your RFP and have assembled a team with the depth of experience and skills to meet your needs and an out-of-the-box solution that exceeds your required functionality.

Deloitte’s Program Integrity practice is dedicated to supporting Nebraska DHHS and your program integrity professionals, program administrators, investigators, analysts, and external stakeholders. Our solution drives increased productivity, efficiencies, and output in a cost-effective manner by being a one-stop shop for fraud detection algorithms, case management, and enabling various stakeholder workflows. These features are delivered through Deloitte’s Program Integrity Software-as-a-Service (SaaS) solution Pallium™. Pallium meets your stated needs of providing a data analytics component to triage, validate, and escalate fraud, waste, and abuse (FWA) leads; and a case management solution to manage the process, communications, alerts, assignments, documentation, status, and results of each case.

Our team brings a passion for delivering high-quality client service and a commitment to achieving the objectives of the PICM/FAD Analytics solution. Furthermore, our firm has spent decades serving the State of Nebraska and with over 250 Deloitte employees calling Nebraska home, we have incredible pride in what we do and a vested interest in delivering successful solutions to DHHS. This blend of Medicaid, Program Integrity, and Nebraska-specific experiences positions us to deliver a superior solution for the State, with the following elements highlighting the uniqueness of our team and approach:

• Our Ongoing Commitment to the State of Nebraska. Deloitte has partnered with the State of Nebraska for over 20 years. We know Nebraska and specifically, we know Nebraska Medicaid. We will leverage the experience of our current Data Management Analytics (DMA) team (supporting since November 2017) to better configure the Pallium platform. As part of the DMA project, our team helped to build static program integrity “algorithms”, and we will build upon this experience to implement a full scale, AI-enabled platform for the PICM/FAD solution.

• Proven PICM/FAD Performance with Significant Return on Investment. We have a demonstrable track record of providing Program Integrity services and solutions to multiple State Medicaid agencies

1As used in this document, “Deloitte” means Deloitte Financial Advisory Services LLP, and its subsidiary Deloitte Transactions & Business Analytics LLP; Deloitte Consulting LLP, which provides consulting services; Deloitte & Touche LLP, which provides audit and enterprise risk services, which provides financial advisory services.

These entities are separate subsidiaries of Deloitte LLP. Deloitte Financial Advisory Services LLP will be responsible for the services and the other subsidiaries may provide services. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.

Deloitte Financial Advisory Services LLP 1100 Capitol Ave, Suite 300 Omaha, NE 68102 +1 402 346 7788 www.deloitte.com

PROPRIETARY INFORMATION

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1. Corporate Overview 1.a. Bidder Identification and Information Deloitte has had the opportunity to serve the State of Nebraska for more than 20 years, building on our 70-year local legacy of supporting the Nebraska community. Our commitment extends beyond client services; we are dedicated to making a meaningful difference in the lives of our neighbors through the more than 30 Local Community Organizations and Boards that our professionals belong to or actively support, including the Aksarben Foundation, United Way of the Midlands, Habitat for Humanity, Nebraska Chamber of Commerce. Deloitte is the recipient of the Governor’s

Wellness Award which demonstrates our commitment and dedication to incorporate a culture of health and wellness into our workplace.

Deloitte has a 175-year history of setting the standard for excellence and integrity and a US workforce of over 170,000 professionals across 108 cities. We provide a comprehensive risk and financial advisory, consulting, audit & assurance, and tax services, we combine a global and national reach with deep local roots and focus.

Program Integrity is a well-established focus area within our practice, not a new business venture or afterthought.

Our dedicated Program Integrity practice, with over 300 professionals, delivers an end-to-end offering for health care FWA prevention and recovery. This enables commercial, federal, and state health care organizations to effectively prevent and recover costs, limit risk, and increase efficiencies. With immediate access to a deep pool of subject matter experts (SMEs), medical professionals, data analysts, auditors, and investigators, we provide specialized expertise to tackle your most difficult program integrity challenges.

Deloitte is committed to the continued development of this group. We invest in both internal and external trainings as well as onboarding sessions for our entire PI practice. Our commitment is further demonstrated by our role as the title sponsor and leader at national anti-FWA conferences, including the National Association for Medicaid Program Integrity (NAMPI), National Health Care Anti-Fraud Association (NHCAA), and Medicaid Enterprise Systems Community (MESC). This commitment to training increases our ability to quickly ramp up operations at the Department.

Contractor Identification and Information

Name: Deloitte Financial Advisory Services LLP

Nebraska Office:

Headquarters:

1100 Capitol Avenue, Suite 300 Omaha, NE 68102

30 Rockefeller Plaza New York, NY 10112

Entity organization: (corporation, partnership, proprietorship)

Limited Liability Partnership

State in which the bidder is incorporated or otherwise organized to do business

Delaware

Year in which the bidder first organized to do business Original entity founded in 1845. Current entity, Deloitte Financial Advisory Services LLP, became a limited liability partnership in 2003.

Whether the name and form of organization has changed since first organized

Yes, since Deloitte was founded in 1845, it has undergone numerous organizational changes. The bidder for this RFP is Deloitte Financial Advisory Services LLP, which is a subsidiary of Deloitte LLP. Please

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Contractor Identification and Information see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries.

1.b. Financial Statements For the most recent fiscal year ended June 1, 2024, Deloitte LLP and its subsidiaries (the “U.S. Firms”) had revenue of U.S. $33.0 billion. The subsidiaries of Deloitte LLP provide industry-leading audit & assurance, consulting, tax, and risk and financial advisory services to a broad cross-section of the largest corporations and governmental agencies. With nearly 173,000 professionals, the U.S Firms operate in 108 cities.

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1.c. Change of Ownership Deloitte does not anticipate a change of ownership during the twelve months following the proposal due date.

Should a change occur, Deloitte will communicate this to the State of Nebraska in writing.

1.d. Office Location Deloitte’s Nebraska-based leaders will provide program support, knowledge, and experience having supported efforts in collaboration with 10+ agencies in Nebraska. Our local leaders continue to build trusted relationships as the lead a variety of cross-functional programs focusing on financial management, operations, and technology solutions.

Deloitte will provide national resources with the experience in designing and implementing Program Integrity Case Management (PICM) / Fraud Abuse Detection (FAD) Analytics solutions. Our mix of local leaders and national experience empowers DHHS with a wide range of subject matter experience as is required for the performance of the scope of work.

Office Location Name: Deloitte

Nebraska Office Address: 1100 Capitol Avenue, Suite 300 Omaha, NE 68102-1113

Contact Person & Title: Barton Bishop, State Medicaid Program Integrity Leader Daniel Kinsella, Nebraska Office Managing Partner

E-mail Address:

Telephone Number (Office): +1 402 346 7788

Figure 1.3 Deloitte’s Nebraska office

1.e. Relationships with the State Deloitte has had the opportunity to serve the State of Nebraska, the University System, and various local jurisdictions for more than 20 years as part of our 70-year history supporting local clients. Deloitte has built a strong reputation for delivering results and fostering trusted relationships, bringing a local focus with our national experience. In addition to our existing Pallium and Nebraska EDW collaboration, Deloitte assisted the State in managing its $158.6 million Emergency Rental Assistance Program (ERAP) funds. Working with key state agencies, Deloitte helped design program rules, set up the GovConnect cloud platform, integrated a 20-agent contact center, implemented case management and financial controls, and enhanced public transparency through geospatial reporting on the State’s website. Deloitte integrated Pallium into the Nebraska ERAP program

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controls that identified and prevented approximately in prospective fraudulent or program abuse of funds. Our leadership team’s deep knowledge of Nebraska’s unique needs, combined with our proven track record in grants management and program integrity, positions us as a committed and capable partner. We are proud to consider Nebraska one of our most valued clients and look forward to continuing our support in the years ahead.

1.e.1 State of Nebraska Projects and Sponsorships

Department or Agency

Description

Sponsorships Governor’s Summit: Growing Nebraska Deloitte is a Sponsor of the 2025 Governor’s Summit hosted by the Departments of Economic Development and Agriculture to be held in Kearney on August 14th. The summit will focus on Nebraska’s workforce, manufacturing, and bioeconomy. The Governor’s Youth Summit will enable high school students navigate their path to career success and connect with businesses to learn more about internships and career opportunities in Nebraska.

Contract: Not Applicable

Governor’s Operational Excellence Summit: Leading through Change Deloitte sponsored the 2021 Governor’s Operational Excellence Summit hosted by the Department of Administrative Services. The summit focused on improving government services and driving operational excellence.

Contract: Not Applicable

Health and Human Services

Data Management and Analytics Deloitte currently supports DHHS’s Medicaid & Long-Term Care Division with the operations and original implementation of the data management and analytics (DMA) solution. One of DHHS’ DMA objectives is to improve the capability to manage the large amounts of data received by the Department. Deloitte manages the data and produces correct and timely reports to help the State make informed business decisions to better manage and grow the Medicaid program. As part of this project, Deloitte provided program integrity specific algorithms and reports that helped identify potential anomalous providers and claims within the Nebraska Medicaid ecosystem. This overall experience will better enable Deloitte to deliver the Program Integrity Case Management and FAD platform.

Contract: 78047 O4

Child Care Stabilization Program Deloitte administered a $150+ million Child Care Stabilization program with the Children and Family Services Division.

Deloitte supported Nebraska with helping over 2,500 childcare providers remain open, improve operations, and financially support providers during and to recover from the COVID-19 pandemic.

Contract: NDAS-21-0000-MSA-HHSCC

Governor’s Office Nebraska Coronavirus Relief Funds (CRF) Deloitte supported the State in the administration of $1.08 billion in CARES Act CRF to assist Nebraskans. Deloitte worked with the Governor’s Office, the Budget Office, State Accounting and multiple other agencies including the Departments of Health and Human Services, Economic Development, and the Emergency Management Agency to support current state assessment of the State capabilities, support the implementation of Coronavirus Relief Fund processes and procedures to enable program application, fund reimbursement, compliance monitoring, closeout, and reporting. We also hosted the COVID-19 CARES Act Statewide Online Transparency website to provide constituents with detailed information on available COVID-19 related services and programs, communities served, and outcomes of each of the programs.

Contract: 20-NE-C19-SA

Emergency Rental Assistance Program Deloitte was engaged to assist the State to administer its $158.6 million allocation of the Emergency Rental Assistance Program (ERAP) fund. Deloitte worked with the Budget Office, Emergency Management Agency, and the Nebraska Investment Finance Authority and supported the design and configuration of the program rules, configuration of GovConnect, a cloud-based technology solution; integration of a 20-agent contact center; case management function with internal controls for case managers to review eligibility requirements, supervisors and quality assurance personnel; delivery of financial management capabilities to support the processing, reconciliation, and disbursement of

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Department or Agency

Description program funds; program integrity; and enabling public transparency and accountability via the State’s website with geospatial reporting.

Contract: NE-21-0000-MSA-ERAP

State Broadband Support Deloitte supported the Statewide Broadband Coordinator in development, implementation, initial maintenance, and transition of the broadband.nebraska.gov website which serves as a hub for communicating broadband activities funded with ARPA, IIJA, and state funding sources.

Contract: 95281 O4

Economic Development

American Rescue Plan Act Deloitte supported 23 ARPA programs accounting for $700 million with the program design and implementation including program manuals, website content, grant applications, and an internal federal fund management guide.

Deloitte also supported the development of community outreach and communications strategy and a program-wide risk management assessment and monitoring processes.

Contract: 95281 O4

Nebraska Emergency Management Agency

Federal Emergency Management Agency Public Assistance Deloitte supports the administration of the 2019 Floods and COVID-19 FEMA Public Assistance grants to eligible subrecipients, such as cities, counties, medical care facilities, school districts, and other entities. Deloitte has helped disburse over $200 million of eligible grant funds while supporting compliance with applicable local, state, and federal regulations and statutes. We also support NEMA with program administration support for the ARPA statewide administration of funds.

Contract: 20-NE-C19-SA and 95281 O4

Administrative Services

Accounting and Financial Reporting Deloitte supported the State Accounting Office with improving the timeliness and quality of the year-end closing, financial reporting processes, and lease and IT subscription-based accounting requirements. Deloitte developed a roadmap for process and technology enhancements, leading to the State’s first unmodified opinion in FY2023, since

FY2019.

Contract: 95281 O4

Agriculture American Rescue Plan Act Deloitte supported the Department of Agriculture with compliance research and reviews for ARPA funded grant programs. These reviews assisted the department in evaluating the success and failures of each program, along with identify areas of improvement for future programs. As new funding became available, we also supposed the Department of Agriculture with program administration, application intake, and review.

Contract: 95281 O4

Labor Audit Remediation and Annual Comprehensive Financial Report Deloitte supported the Department of Labor to review and reconcile data conversion balances between a predecessor tax system and its current tax system. The goal of the conversion process was to correct entries and decommission the predecessor system prior to the end of the 2023 fiscal year. Leveraging Deloitte’s understanding of the current tax system, Deloitte was further engaged to support NDOL in performing current year account reconciliations, audit remediation related to prior year audit findings as well as accounting support for the FY23 annual audit.

Contract: 95281 O4

American Rescue Plan Act Deloitte supported the Department of Labor with eligibility determinations for their ARPA programs. These programs included the Teacher Recruitment and Retention Program and the Nursing Recruitment and Retention Program. These reviews assisted the department in distributing over $5M to eligible teachers and nurses.

Contract: 95281 O4

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1.f. Bidder’s Employee Relations to State No Party mentioned in Deloitte’s proposal response is or was an employee of the State within the past twelve (12) months. To the best of our knowledge and belief, no employee of any State agency is employed by Deloitte or is a subcontractor to Deloitte, as of the due date for proposal submission.

1.g. Contract Performance Deloitte, like other major professional services firms, provides a broad array of services to its many clients and has a significant position in respect of large-scale projects in the public sector. Occasionally there are disagreements over contract requirements; however, Deloitte has experienced no terminations for default of a Deloitte engagement by a state, local or federal governmental entity in the past five (5) years. From time to time, projects may be canceled or terminated by clients or Deloitte for various other reasons. However, given the size of our practice and the many hundreds of projects that are performed each year, Deloitte does not centrally track these instances or situations where the client may have canceled projects due to a change in business needs, direction, or funding, and the information about our client projects is generally subject to confidentiality obligations. We are confident in our track record of success and believe there is no issue with any prior engagement that would affect our ability to provide the requested services.

1.h. Summary of Bidder’s Corporate Experience Deloitte is proud to have partnered with states across the country to provide innovative solutions that detect and prevent fraud, waste, and abuse (FWA) in Medicaid and other healthcare programs. Our approach combines advanced analytics, robust technology platforms, and deep subject matter expertise to help states modernize their program integrity operations, achieve regulatory compliance, and maximize the impact of public funds. Deloitte's dedicated Program Integrity (PI) practice brings our institutional knowledge of the full scope of program integrity technology and services, including medical record reviews, comprehensive pre- and post-payment analytics, data science, audit and investigation support, and PICM/FADS solutions. Deloitte’s PI practice fuses federal, state, and commercial experiences, providing us with unique end-to-end payment life cycle insights from program initiation, through processing and management, to payment, which informs our approach to tailor a truly Nebraska-specific solution.

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In addition to our program integrity specific experience and practitioners, we will bring the full breadth and depth of our Medicaid practice. As depicted in the above figure, addressing their most difficult Medicaid challenges. Through our work with state Medicaid programs, commercial managed care organizations, and health networks, As the largest global public sector consulting and professional services firm, we embed discipline in project management, fiscal responsibility, ethics, and regulatory compliance are engrained in everything we do. Our proposed program executive, program manager, key project lead, workstream leads, and SMEs have

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1.h.2

Client Name

Time Period September 2022 – February 2026

Scheduled Date and Actual Completion Date

Scheduled Completion Date: February 2024 Actual Completion Date: February 2024

Responsibilities Similar to Nebraska, Deloitte’s HealthInteractive platform. Deloitte has implemented Pallium integrated with HealthInteractive for to enhance and mature their FWA detection and prevention capabilities.

Pallium serves as a true “one-stop shop” for program integrity team, centralizing case management, document management, analytics, and reporting in a single, secure platform. This has eliminated inefficiencies caused by siloed systems and provided a unified workspace for all investigative activities.

PI Case Management: Pallium enables real-time collaboration and coordination among audit, compliance, and investigations, and other stakeholders through

Pallium’s PICM module. With role-based access and shared workflows, everyone involved in a case can contribute efficiently and transparently, while masking sensitive data as required by law. Instead of relying on email, users communicate directly within Pallium through notes and task assignments, automated alerts and notifications, streamlining case discussions, improving accountability, and making certain relevant information is captured and auditable.

Consistency and legal defensibility have been greatly enhanced by Pallium’s configurable workflows. The platform manages every investigative step, reducing the risk of missed procedures and improving the effectiveness of cases. This consistency is critical for legal reasons, helping investigations withstand scrutiny and avoid dismissal due to process gaps.

Fraud Abuse Detection: Pallium’s FAD solution provides advanced analytics and Tableau-based reporting, offering unprecedented insights to PI stakeholders. The FADS models are configured for policies and trained on Medicaid data, making the analytics highly relevant and actionable. Users access powerful, customizable dashboards to explore trends, risk scores, and program performance metrics leveraging source Medicaid data and detailed analytic results from the FADS module. This data-driven approach supports continuous improvement and more effective decision-making.

Program compliance and quality management are top priorities, with proactive monitoring, operational reporting, and comprehensive project management supporting CMS Outcomes Based Certification (OBC). Continuous improvement was embedded in the approach, with system enhancements driven by operational insights and stakeholder feedback. Notably, in January 2025, received CMS Streamlined Modular Certification for the Pallium solution, enabling enhanced federal funding for the life of the system.

Key Outcomes of Our Approach: The Pallium FAD solution has supported in documenting recoveries in the form of financial settlements and from February 2024

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Client Name through September 2024, helping identify at risk for FWA. The platform has been instrumental in helping the team initiate new investigations, informing tips coming from for ‘pill mills’, and identifying non-compliance issues resulting in the identification of over

The platform’s efficiency and speed enable rapid processing and analysis of vast claims and encounter data, accelerating investigations and the resolution of FWA. Predictive analytics and advanced pattern recognition have allowed the team to anticipate emerging fraud trends and identify subtle anomalies, facilitating proactive intervention. Pallium is also seamlessly integrated with Tennessee’s Data and Cloud Ecosystem, including the Enterprise Data Warehouse, making it a unified and scalable solution.

Customer Contact Information

Role and Budget Prime Vendor Planned DDI Budget:

Actual DDI Budget:

Full Contract Budget:

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1.h.3

Client Name

Time Period June 2018 – May 2025

Scheduled Date and Actual Completion Date

Scheduled Completion Date: March 2019 Actual Completion Date: May 2019

Responsibilities For the , Deloitte implemented the Pallium suite as the technical foundation for Medicaid Program Integrity activities. Deloitte’s key responsibilities and achievements included a comprehensive platform implementation and modernization. The team deployed Pallium’s full PICM/FAD solution - including the case management platform, analytics engine, and reporting module - to modernize

Program Integrity approach.

PI Case Management: Our robust case management system was deployed, enabling case initiation, status tracking, role-based access, financial tracking, statistical sampling for overpayment calculations, and automated letter generation to reduce manual effort when creating Audit Notification or Financial Calculation of Overpayment letters. Deloitte focused on workflow automation and stakeholder collaboration by working closely with Program Integrity stakeholders to automate business processes and configure workflows tailored to their needs. This resulted in a consistent, repeatable alert review process and optimized analytic outputs. The client was supported through the design, development, and implementation phases with regular communication and detailed reporting. The solution also enabled efficient, single sign-on access to Pallium, prioritized provider risk profiling, and provided rapid identification of risk indicators with detailed drill-down to claim line data. Additionally, the system supported ad-hoc querying and robust reporting for case investigation and tracking.

Fraud Abuse Detection: Pallium’s analytics were integrated with cloud-based Enterprise Data Warehouse (EDW) to securely ingest, cleanse, and process weekly healthcare transactions. Our team configured the FAD solution algorithms to generate alerts for investigations and audits using policy-based edits, predictive models, and entity risk scoring. Predictive models were implemented to identify high cost/utilization cases, abnormal treatment patterns, and anomalous billing based on state Medicaid policy.

Deloitte led through the CMS certification process for their Program Integrity module, making Pallium the first standalone platform to achieve CMS MECT 2.3 certification. The team supported documentation, meetings, and demonstrations with the IV&V vendor and CMS stakeholders.

Key Outcomes of Our Approach: The engagement delivered significant operational efficiency and impact. Deloitte achieved time savings of over for staff by automating quarterly regulatory reporting and streamlined alert, lead, and case review/tracking, increasing process efficiency by in 2021. The volume of cases reaching Paid-in- Full recovery status increased by Another key benefit of the engagement was the creation of a more modular and interoperable environment to allow to have better access to their data and achieve better health outcomes. Finally, Pallium has improved the Department’s data management practices (Data Integrity, Data Quality, RFP 122125 O3

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volume handled by the previous contractor. Deloitte has launched 21 quality improvement initiatives to enhance program efficiency and fraud surveillance. Additional accomplishments include creating an Electronic Visit Verification (EVV) audit plan to drive compliance with state and federal requirements, developing dynamic monitoring methods for EFT account changes in response to new CMS guidance, and facilitating a seamless transition of all key responsibilities from the prior contractor. Deloitte has also reviewed and updated over 95 Program Integrity SOPs, reducing onboarding time and improving process adherence, while fostering cross-functional collaboration with key state teams to strengthen oversight and recovery efforts. Collectively, these achievements have positioned Iowa’s Medicaid program for greater integrity, efficiency, and responsiveness to evolving needs.

Our team performs analytics for eight FWA focus areas and helped the identify over . We fuse claims and encounter data with other state and external data sources (e.g., tax liens, death master) to correlate findings. We streamlined this capability in Pallium through our third-party data reporting module, providing our data science team and our clients access to a myriad of third-party sources. This data was used to facilitate analytics development and to augment investigations and audits. As a result of this work, we developed

The engaged our team to assist with key Program Integrity initiatives, including the building and modernization of their newly established Program Integrity Unit (PIU). Throughout this effort, Deloitte assisted establishing policies and procedures to align the priorities, which include establishing compliance with Federal regulations as well as CMS program requirements.

Our team advised on the development and implementation plans for newly mandated compliance programs where Program Integrity plays a leading role.

Throughout these activities, Deloitte helped as an integral part of the Medicaid enterprise while establishing communication pipelines to enhance collaboration across , MCOs, and stakeholders.

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deliver on its mission. For more details on our project management approach, please see Section 2.A and Section 2.D.

1.j. Subcontractors

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Pallium supports all aspects of PI operations including overall management, audit support, investigations, clinical and coding reviews, financial operations, litigation, appeals, and referrals.

Some of Pallium’s key features include

For more details on the features and benefits of our PICM/FADS solution, please see our detailed response to Attachment 2.

DHHS requires a FAD analytics module that leverages large amounts of claims, encounters, eligibility, and third-party data sources and applies algorithms for identifying potential PI concerns, prioritizing findings to prevent and recover improper payments through efficient use of limited resources. A successful system must enhance a PI’s capabilities, providing new FWA insights and the ability to identify hidden or more complex vulnerabilities.

For many years, states have relied on the Surveillance Utilization Review Subsystem (SURS) methodology of exception processing and static rules-based “algorithms”, where providers whose behavior differs from their peers in narrow scenarios are targeted for investigation.

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CMS certification process means DHHS stays on schedule, on budget, and will set the standard for other states as they progress through the Medicaid modernization process.

A Program Integrity solution needs to be stable and reliable for day-to-day use and provide the ability for PICM/FADS components to adapt to emerging State and Federal policy changes and the evolving needs of the PI team. Our team knows the importance of clear lines of communication and demonstrating a high level of responsiveness to business needs.

We also appreciate the need to work together with the State to prioritize, triage, and as needed, expedite changes and enhancements through the process.

Throughout the implementation phase, Our operations and maintenance (O&M) team also follows

As a part of our lessons learned, we understand the importance of implementing, testing, operating, and maintaining the solution in a formal way that allows it to be optimally aligned to the State’s needs while also positioning the State to achieve CMS certification with ease. In Section 2.a.4, we detail our understanding and approach to address each of planned tasks and activities and associated deliverables. We have demonstrated successes in other states, having delivered projects in alignment with these activities before and know that we will successfully execute them for Nebraska.

2.A.2. Project Environment

The environment for the PICM/FAD analytics solution is an important dimension that shapes a multitude of decisions throughout the project.

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2.A.3. Compliance Requirements

A successful solution needs to align to the appropriate standards and security requirements to protect the privacy of Nebraska’s constituents and align to the objectives that CMS has set forth for program integrity. Effective compliance also positions Nebraska to receive the enhanced federal financial participation necessary to keep the State ahead of the shifting landscape of fraud, waste, and abuse.

Deloitte continually stays abreast of emerging and shifting policies, regulations, and standards.

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General (j.i) Deloitte will provide experienced staff to support the necessary CMS certification activities, including Operational Readiness Review, Certification Review, and related planning and meetings. Our team will support CMS Certification requirements including:

Pre-Operational Readiness Review (ORR) (j.ii)

Operational Readiness Review (ORR) (j.iii)

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2.C. Technical Considerations Our team has outlined the following key considerations included in our implementation approach based on our understand of the technical and functional requirements and our lesson learned from other Medicaid implementations:

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Building from our project work plan and guiding project management principles, we will create a project timeline that is not only actionable and achievable but also informed by our experience developing similar PICM Medicaid solutions for other states.

* CMS Certification activities will continue into the next year. Deloitte stands ready to support Nebraska through the Pre-ORR and ORR process including all back and forth with the CMS stakeholders including all communication regarding defect fixes and patching. We expect that final CMS certification notification will come about 6-months after go-live.

3. Project Management

Project Management

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Staffing Plan

Background Checks on Personnel Accessing Sensitive and Confidential Information

Project Management Tools

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Project Management Methodology Questions

a) Designate a Lead Project Manager to coordinate and schedule implementation, configuration, and associated deliverables. The Lead Project Manager shall be reasonably acceptable to the State.

b) Employ a project management approach that will satisfy the scope of work and incorporate all activities described in the RFP.

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3.b. Completed Attachment 1 – Minimum Qualifications

Attachment 1 Minimum Qualifications

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Program Integrity Case Management (PICM) System

If Bidder meets the minimum requirements as outlined in the RFP under Section (V) MINIMUM ESSENTIAL QUALIFICATIONS, EXPERIENCE AND/OR CAPABILITIES, please complete this form and include in the Appendix section of your RFP response. Fill in your company name in the two areas listed below, sign and date.

D. MINIMUM REQUIREMENTS FOR EVALUATION

MINIMUM ESSENTIAL QUALIFICATIONS, EXPERIENCE AND/OR CAPABILITIES

The State of Nebraska, Department of Health and Human Services (DHHS) is seeking a Vendor with the following minimum qualifications and/or capabilities to be deemed responsible and eligible for evaluation. If your company does not meet and/or exceed all essential qualifications, experience, and/or capabilities as listed herein, your company is advised to not proceed with preparing and submitting an RFP response to this solicitation.

Confirmation that your company has read, understands, and meets the minimum essential qualifications, experience, and/or capabilities is to be included in your proposal submission – see Attachment 1 - Minimum Qualifications. Complete the form and include in a PDF copy in the proper area of the RFP solicitation response as requested in the submission instructions outlined in Section [VI or VII]. Failure to include a signed Attachment 1 - Minimum Qualifications in your proposal submission shall result in the proposal being deemed as a “Non-Responsive Solicitation Response” and disqualification from consideration. Meeting the minimum essential qualifications, experience and/or capabilities is a required element to be deemed responsible and eligible for evaluation. Minimum essential qualifications are:

V. Bidder has the capability to perform all functions of PICM / FADS components as outlined herein this RFP and any related attachments.

VI. Bidder must have current implemented contract for providing PICM / FADS services to a State Medicaid agency. This must be supported by demonstrating an active contract with another State Medicaid agency for the PICM / FADS solution.

VII. Bidder must provide references for the contract referenced in #2, directly above.

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3.d. Responses to Sections II through IV

3.d.1 Section II Terms and Conditions Bidder should read the Terms and Conditions within this section and must initial either “Accept All Terms and Conditions With in Section as Written” or “Exceptions Taken to Terms and Conditions Within Section as Written” in the table below. If the bidder takes any exceptions, they must provide the following within the “Exceptions” field of the table below (Bidder may provide responses in separate at tachment if multiple exceptions are taken):

1. The specific clause, including section reference, to which an exception has been taken,

2. An explanation of why the bidder took exception to the clause; and

3. Provide alternative language to the specific clause within the solicitation response.

By signing the solicitation, bidder agrees to be legally bound by all the accepted terms and conditions, and any proposed alternative terms and conditions submitted with the solicitation response. The State reserves the right to negotiate rejected or proposed alternative language. If the State and bidder fail to agree on the final Terms and Conditions, the State reserves the right to reject the solicitation response. The State reserves the right to reject solicitation responses that attempt to substitute the bidder’s commercial contracts and/or documents for this solicitation.

Accept All Terms and Conditions

Within Section as

Written (Initial)

Exceptions Taken to

Terms and Conditions

Within Section as

Written (Initial)

Exceptions:

(Bidder must note the specific clause, including section reference, to which an exception has been taken, an explanation of why the bidder took exception to the clause, and provide alternative language to the specific clause within the solicitation response.)

BNB

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The bidders should submit with their solicitation response any license, user agreement, service level agreement, or similar documents that the bidder wants incorporated in the Contract. The State will not consider incorporation of any document not submitted with the solicitation response as the document will not have been included in the evaluation process. These documents shall be subject to negotiation and will be incorporated as addendums if agreed to by the Parties.

If a conflict or ambiguity arises after the Addendum to Contract Award has been negotiated and agreed to, the Addendum to Contract Award shall be interpreted as follows:

1. If only one (1) Party has a particular clause, then that clause shall control,

2. If both Parties have a similar clause, but the clauses do not conflict, the clauses shall be read together,

3. If both Parties have a similar clause, but the clauses conflict, the State’s clause shall control.

A. GENERAL

1. The contract resulting from this Solicitation shall incorporate the following documents:

These documents constitute the entirety of the contract.

Unless otherwise specifically stated in a future contract amendment, in case of any conflict between the incorporated documents, the documents shall govern in the following order of preference with number one (1) receiving preference over all other documents and with each lower numbered document having preference over any higher numbered document: 1) Amendment to the executed Contract with the most recent dated amendment having the highest priority, Unless otherwise specifically agreed to in writing by the State, the State’s standard terms and conditions, as executed by the State, shall always control over any terms and conditions or agreements submitted or included by the Vendor.

Any ambiguity or conflict in the contract discovered after its execution, not otherwise addressed herein, shall be resolved in accordance with the rules of contract interpretation as established in the State of Nebraska.

B. NOTIFICATION

Bidder and State shall identify the contract manager who shall serve as the point of contact for the executed contract.

Communications regarding the executed contract shall be in writing and shall be deemed to have been given if delivered personally; electronically, return receipt requested; or mailed, return receipt requested. All notices, requests, or communications shall be deemed effective upon receipt.

Either party may change its address for notification purposes by giving notice of the change and setting forth the new address and an effective date.

C. BUYER’S REPRESENTATIVE

The State reserves the right to appoint a Buyer's Representative to manage or assist the Buyer in managing the contract on behalf of the State. The Buyer's Representative will be appointed in writing, and the appointment document will specify the extent of the Buyer's Representative authority and responsibilities. If a Buyer's Representative is appointed, the bidder will be provided a copy of the appointment document and is expected to cooperate accordingly with the Buyer's Representative. The Buyer's Representative has no authority to bind the State to a contract, amendment, addendum, or other change or addition to the contract.

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D. GOVERNING LAW (Nonnegotiable) Notwithstanding any other provision of this contract, or any amendment or addendum(s) entered into contemporaneously or at a later time, the parties understand and agree that, (1) the State of Nebraska is a sovereign state and its authority to contract is therefore subject to limitation by the State’s Constitution, statutes, common law, and regulation; (2) this contract will be interpreted and enforced under the laws of the State of Nebraska; (3) any action to enforce the provisions of this agreement must be brought in the State of Nebraska per state law; (4) the person signing this contract on behalf of the State of Nebraska does not have the authority to waive the State's sovereign immunity, statutes, common law, or regulations; (5) the indemnity, limitation of liability, remedy, and other similar provisions of the final contract, if any, are entered into subject to the State's Constitution, statutes, common law, regulations, and sovereign immunity; and, (6) all terms and conditions of the final contract, including but not limited to the clauses concerning third party use, licenses, warranties, limitations of liability, governing law and venue, usage verification, indemnity, liability, remedy or other similar provisions of the final contract are entered into specifically subject to the State's Constitution, statutes, common law, regulations, and sovereign immunity.

The Parties must comply with all applicable local, state, and federal laws, ordinances, rules, orders, and regulations.

E. BEGINNING OF WORK & SUSPENSION OF SERVICES

The bidder shall not commence any billable work until a valid contract has been fully executed by the State and the successful Vendor. The Vendor will be notified in writing when work may begin.

The State may, at any time . In the event of such suspension, the Contract Manager or POC, or their designee, will issue a written order to stop work. The written order will specify which activities are to be suspended and the reason(s) for the suspension. Upon receipt of such order, the Vendor shall comply with its terms and take all necessary steps to mitigate and eliminate the incurrence of costs allocable to the work affected by the order during the period of suspension. The suspended performance or deliverables may only resume when the State provides the Vendor with written notice that such performance or deliverables may resume, in whole or in part.

F. AMENDMENT

This Contract may be amended in writing, within scope, upon the agreement of both parties.

G. CHANGE ORDERS OR SUBSTITUTIONS

The State and the Vendor, upon the written agreement, may make changes to the contract within the general scope of the solicitation. Changes may involve specifications, the quantity of work, or such other items as the State may find necessary or desirable. Corrections of any deliverable, service, or work required pursuant to the contract shall not be deemed a change. The Vendor may not claim forfeiture of the contract by reasons of such changes.

The Vendor shall prepare a written description of the work required due to the change and an itemized cost sheet for the change.

Changes in work and the amount of compensation to be paid to the Vendor shall be determined in accordance with applicable unit prices if any, a pro-rated value, or through negotiations.

No change shall be implemented by the Vendor until approved by the State, and the Contract is amended to reflect the change and associated costs, if any. If there is a dispute regarding the cost, but both parties agree that immediate implementation is necessary, the change may be implemented, and cost negotiations may continue with both Parties retaining all remedies under the contract and law.

In the event any good or service is discontinued or replaced upon mutual consent during the contract period or prior to delivery, the State reserves the right to amend the contract to include the alternate product at

***Vendor will not substitute any item that has been awarded without prior written approval of SPB***

H. RECORD OF VENDOR PERFORMANCE

The State may document the vendor’s performance, which may include, but is not limited to, the customer service provided by the vendor, the ability of the vendor, the skill of the vendor, and any instance(s) of products or services delivered or performed which fail to meet the terms of the purchase order, contract, and/or specifications. In addition to other remedies and options available to the State, the State may issue one or more notices to the vendor outlining any issues the State has regarding the vendor’s performance for a specific contract (“Contract Compliance Request”). The State may also document the Vendor’s performance in a report, which may or may not be provided to the vendor (“Contract Non-Compliance Notice”). The Vendor shall

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respond to any Contract Compliance Request or Contract Non-Compliance Notice in accordance with such notice or request.

At the sole discretion of the State, such Contract Compliance Requests and Contract Non-Compliance Notices may be placed in the State’s records regarding the vendor and may be considered by the State and held against the vendor in any…