122125 O3 PICM RFP.docx.docx
DOCX document 454 KB Posted
- Attached to
- Program Integrity Case Management (PICM) and Fraud Abuse Detection (FAD) Analytics Solution
- Solicitation number
- 122125 O3
- Issued by
- Blaine County, Nebraska
About this file
This is a Request for Proposal (RFP) issued by the Nebraska Department of Health and Human Services (DHHS) seeking a qualified vendor to provide a Program Integrity Case Management (PICM) and Fraud Abuse Detection (FAD) Analytics solution. The solicitation aims to replace the current Medicaid program case management system with a comprehensive, cloud-based software platform designed to support fraud detection, case management, advanced analytics, and predictive modeling for approximately 340,000 Medicaid recipients. The RFP was released on May 28, 2025, with proposal responses due by July 10, 2025, at 2:00 p.m. Central Time. The contract will have an initial five-year term with options to renew for two additional two-year periods, and the state expects the vendor to implement the new solution in production no later than October 31, 2026.
The solicitation requires vendors to have a current implemented PICM/FADS contract with another State Medicaid agency and will be evaluated across three categories: Corporate Overview (25 points), Technical Response (60 points), and Cost Sheet (15 points). The solution must integrate with existing state systems, including the Medicaid Management Information System (MMIS) and the Nebraska Family Online Client User System (N-FOCUS), and comply with extensive security and technical requirements. The project is eligible for enhanced federal financial participation (FFP), and the vendor will be responsible for supporting the Centers for Medicare and Medicaid Services (CMS) certification process. The state will allocate up to 500 vendor hours annually for system modifications at no additional cost, with the ultimate goal of improving program integrity, minimizing financial losses, and enabling automated monitoring for targeted interventions.
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Text version
State of Nebraska Department of Health and Human Services
REQUEST FOR PROPOSAL FOR SERVICES CONTRACT
| SOLICITATION NUMBER |
| RELEASE DATE |
| 122125 O3 |
| May 28, 2025 |
| OPENING DATE AND TIME |
| PROCUREMENT CONTACT |
| July 10, 2025, 2:00 p.m. Central Time |
| Dhinesh Santhakumar |
PLEASE READ CAREFULLY!
SCOPE OF SERVICE
The State of Nebraska (State), Department of Health and Human Services (DHHS), is issuing this solicitation for a service contract for the purpose of selecting a qualified bidder to provide Program Integrity Case Management (PICM) / Fraud Abuse Detection (FAD) Analytics solution. A more detailed description can be found in Section VI. The resulting contract may not be an exclusive contract as the State reserves the right to contract for the same or similar services from other sources now or in the future.
The term of the contract will be five (5) years commencing upon execution of the contract by the State and the Vendor (Parties). The Contract includes the option to renew for two (2) additional two (2) Year periods upon mutual agreement of the Parties. State reserves the right to extend the period of this contract beyond the termination date when mutually agreeable to the Parties.
In the event that a contract with the awarded bidder(s) is cancelled or in the event that the State needs additional Vendors to supply the solicited services, this solicitation may be used to procure the solicited services for up to eighteen (18) months from the date the Intent to Award is posted, provided that 1) the solicited goods or services will be provided by a bidder (or a successive owner) who submitted a response pursuant to this solicitation, 2) the bidder’s solicitation response was evaluated, and 3) the bidder will honor the bidder’s original solicitation response, including the proposed cost, allowing for any price increases that would have otherwise been allowed if the bidder would have received the initial award.
ALL INFORMATION PERTINENT TO THIS SOLICITATION CAN BE FOUND ON THE INTERNET AT: https://das.nebraska.gov/materiel/bidopps.html.
IMPORTANT NOTICE: Pursuant to Neb. Rev. Stat. § 84-602.04, State contracts in effect as of January 1, 2014, and contracts entered into thereafter, must be posted to a public website. The resulting contract, the Solicitation, and the awarded solicitation response will be posted to a public website managed by DAS, which can be found at http://statecontracts.nebraska.gov and https://www.nebraska.gov/das/materiel/purchasing/contract_search/index.php.
In addition and in furtherance of the State’s public records Statute (Neb. Rev. Stat. § 84-712 et seq.), all responses received regarding this Solicitation will be posted to the State Purchasing Bureau public website.
These postings will include the entire solicitation response. Bidder must request that proprietary information be excluded from the posting. The bidder must identify the proprietary information, mark the proprietary information according to state law, and submit the proprietary information in a separate file named conspicuously as "PROPRIETARY INFORMATION". The bidder should submit a detailed written document showing that the release of the proprietary information would give a business advantage to named business competitor(s) and explain how the named business competitor(s) will gain an actual business advantage by disclosure of information. The mere assertion that information is proprietary or that a speculative business advantage might be gained is not sufficient. (See Attorney General Opinion No. 92068, April 27, 1992). THE BIDDER MAY NOT ASSERT THAT THE ENTIRE SOLICITATION IS PROPRIETARY. COST SHEETS WILL NOT BE CONSIDERED PROPRIETARY AND ARE A PUBLIC RECORD IN THE STATE OF NEBRASKA. The State will determine, in its sole discretion, if the disclosure of the information designated by the Bidder as proprietary would 1) give advantage to business competitors and 2) serve no public purpose. The Bidder will be notified of the State’s decision. Absent a determination by the State that the information may be withheld pursuant to Neb. Rev. Stat. § 84-712.05, the State will consider all information a public record subject to disclosure.
If the State determines it is required to release withheld proprietary information, the bidder will be informed. It will be the bidder's responsibility to defend the bidder's asserted interest in non-disclosure.
To facilitate such public postings, with the exception of proprietary information, the State of Nebraska reserves a royalty-free, nonexclusive, and irrevocable right to copy, reproduce, publish, post to a website, or otherwise use any contract, or solicitation response for any purpose, and to authorize others to use the documents. Any individual or entity awarded a contract, or who submits a solicitation response, specifically waives any copyright or other protection the contract, or solicitation response may have; and acknowledges that they have the ability and authority to enter into such waiver. This reservation and waiver are a prerequisite for submitting a solicitation response, and award of a contract. Failure to agree to the reservation and waiver will result in the solicitation response being found non-responsive and rejected.
Any entity awarded a contract or submitting a solicitation response agrees not to sue, file a claim, or make a demand of any kind, and will indemnify and hold harmless the State and its employees, volunteers, agents, and its elected and appointed officials from and against any and all claims, liens, demands, damages, liability, actions, causes of action, losses, judgments, costs, and expenses of every nature, including investigation costs and expenses, settlement costs, and attorney fees and expenses, sustained or asserted against the State, arising out of, resulting from, or attributable to the posting of the contract or solicitation response, awards, and other documents.
ii SPB Form 22 | RFP Template | Effective 12162024
TABLE OF CONTENTS
| REQUEST FOR PROPOSAL FOR SERVICES CONTRACT | i | |
| GLOSSARY OF TERMS | vi | |
| ACRONYM LIST | xiii | |
| I. | PROCUREMENT PROCEDURE | 1 |
| A. | GENERAL INFORMATION | 1 |
| B. | PROCURING OFFICE AND COMMUNICATION WITH STATE STAFF AND EVALUATORS | 1 |
| C. | SCHEDULE OF EVENTS | 1 |
| D. | WRITTEN QUESTIONS AND ANSWERS | 3 |
| E. | SECRETARY OF STATE/TAX COMMISSIONER REGISTRATION REQUIREMENTS (Nonnegotiable) | 3 |
| F. | ETHICS IN PUBLIC CONTRACTING | 3 |
| G. | DEVIATIONS FROM THE SOLICITATION | 3 |
| H. | SUBMISSION OF SOLICITATION RESPONSES | 4 |
| I. | SOLICITATION PREPARATION COSTS | 5 |
| J. | FAILURE TO COMPLY WITH SOLICITATION | 5 |
| K. | SOLICITATION RESPONSE CORRECTIONS | 5 |
| L. | LATE SOLICITATION RESPONSES | 5 |
| M. | BID OPENING | 5 |
| N. | SOLICITATION REQUIREMENTS | 5 |
| O. | EVALUATION COMMITTEE | 6 |
| P. | EVALUATION OF SOLICITATION RESPONSES | 6 |
| Q. | BEST AND FINAL OFFER | 7 |
| R. | REFERENCE AND CREDIT CHECKS | 7 |
| S. | AWARD | 7 |
| T. | LUMP SUM OR “ALL OR NONE” SOLICITATION RESPONSES | 7 |
| U. | REJECTION OF SOLICITATION RESPONSES | 8 |
| V. | PRICES & COST CLARIFICATION | 8 |
| W. | VENDOR DEMONSTRATIONS | 8 |
| II. | TERMS AND CONDITIONS | 9 |
| A. | GENERAL | 9 |
| B. | NOTIFICATION | 10 |
| C. | BUYER’S REPRESENTATIVE | 10 |
| D. | GOVERNING LAW (Nonnegotiable) | 10 |
| E. | BEGINNING OF WORK & SUSPENSION OF SERVICES | 10 |
| F. | AMENDMENT | 10 |
| G. | CHANGE ORDERS OR SUBSTITUTIONS | 10 |
| H. | RECORD OF VENDOR PERFORMANCE | 11 |
| I. | NOTICE OF POTENTIAL VENDOR BREACH | 11 |
| J. | BREACH | 11 |
| K. | NON-WAIVER OF BREACH | 11 |
| L. | SEVERABILITY | 11 |
| M. | INDEMNIFICATION | 11 |
| N. | ATTORNEY'S FEES | 12 |
| O. | ASSIGNMENT, SALE, OR MERGER | 12 |
| P. | CONTRACTING WITH OTHER NEBRASKA POLITICAL SUBDIVISIONS OF THE STATE OR ANOTHER STATE | 12 |
| Q. | FORCE MAJEURE | 13 |
| R. | CONFIDENTIALITY | 13 |
| S. | EARLY TERMINATION | 13 |
| T. | CONTRACT CLOSEOUT | 14 |
| U. | PROHIBITED PRODUCTS | 14 |
| V. | AMERICANS WITH DISABILITIES ACT | 14 |
| W. | LONG-TERM CARE OMBUDSMAN (Nonnegotiable) | 14 |
| X. | OFFICE OF PUBLIC COUNSEL (Nonnegotiable) | 14 |
| Y. | LOBBYING | 14 |
| Z. | LIQUIDATED DAMAGES | 15 |
| III. | VENDOR DUTIES | 17 |
| A. | INDEPENDENT VENDOR / OBLIGATIONS | 17 |
| B. | FOREIGN ADVERSARY CONTRACTING PROHIBITION ACT CERTIFICATION (Nonnegotiable) | 18 |
| C. | EMPLOYEE WORK ELIGIBILITY STATUS | 18 |
| D. | COMPLIANCE WITH CIVIL RIGHTS LAWS AND EQUAL OPPORTUNITY EMPLOYMENT / NONDISCRIMINATION (Nonnegotiable) | 18 |
| E. | COOPERATION WITH OTHER VENDORS | 19 |
| F. | DISCOUNTS | 19 |
| G. | PRICES | 19 |
| H. | PERMITS, REGULATIONS, LAWS | 19 |
| I. | OWNERSHIP OF INFORMATION AND DATA / DELIVERABLES | 19 |
| J. | INSURANCE REQUIREMENTS | 19 |
| K. | ANTITRUST | 22 |
| L. | CONFLICT OF INTEREST | 22 |
| M. | STATE PROPERTY | 22 |
| N. | SITE RULES AND REGULATIONS | 22 |
| O. | ADVERTISING | 22 |
| P. | NEBRASKA TECHNOLOGY ACCESS STANDARDS (Nonnegotiable) | 22 |
| Q. | DISASTER RECOVERY/BACK UP PLAN | 23 |
| R. | DRUG POLICY | 23 |
| S. | INDUSTRY STANDARDS WARRANTY | 23 |
| T. | TIME IS OF THE ESSENCE | 23 |
| U. | BUSINESS ASSOCIATE PROVISIONS | 23 |
| IV. | PAYMENT | 25 |
| A. | PROHIBITION AGAINST ADVANCE PAYMENT (Nonnegotiable) | 25 |
| B. | TAXES (Nonnegotiable) | 25 |
| C. | INVOICES | 25 |
| D. | INSPECTION AND APPROVAL | 26 |
| E. | PAYMENT (Nonnegotiable) | 26 |
| F. | LATE PAYMENT (Nonnegotiable) | 26 |
| G. | SUBJECT TO FUNDING / FUNDING OUT CLAUSE FOR LOSS OF APPROPRIATIONS (Nonnegotiable) | 26 |
| H. | RIGHT TO AUDIT (First Paragraph is Nonnegotiable) | 26 |
| V. | PROJECT INFORMATION AND ESSENTIAL QUALIFICATIONS | 27 |
| A. | PROJECT OVERVIEW | 27 |
| B. | BACKGROUND INFORMATION | 27 |
| C. | MINIMUM REQUIREMENTS FOR EVALUATION | 28 |
| D. | OTHER INFORMATION AVAILABILE AND/OR RELATED DOCUMENTS: | 28 |
| VI. | PROJECT DESCRIPTION AND SCOPE OF WORK | 30 |
| A. | PROJECT REQUIREMENTS AND INFORMATION | 30 |
| B. | PROPOSED DEVELOPMENT APPROACH | 53 |
| C. | TECHNICAL CONSIDERATION | 54 |
| D. | PROJECT WORK PLAN, MANAGEMENT, AND IMPLEMENTATION | 54 |
| E. | DELIVERABLES AND DUE DATES | 55 |
| VII. | SOLICITATION RESPONSE INSTRUCTIONS | 58 |
| A. | SOLICITATION RESPONSE SUBMISSION | 58 |
| CONTRACTUAL AGREEMENT FORM | 61 |
GLOSSARY OF TERMS
Acceptance Criteria: The conditions that a deliverable or project phase must satisfy to be accepted by the State.
Acceptance Test Procedure: Benchmarks and other performance criteria, developed by the State or other sources of testing standards, for measuring the effectiveness of products or goods and the means used for testing such performance
Acceptable Risk Safeguards: A set of CMS-required security and privacy controls that align with federal standards to protect Medicaid systems and data.
Addendum: A written correction or alteration to a document during the solicitation process (e.g., Questions and Answers, Revised Schedule of Events, Addendum to Contract Award)
Agency: All officers of the state, departments, bureaus, boards, commissions, councils, and institutions receiving legislative appropriations
Agent/Representative: A person authorized to act on behalf of another
Algorithm Library: A collection of pre-built algorithms used for fraud detection and program integrity efforts.
Amend: To alter or change by adding, subtracting, or substituting
Amendment: A written correction or alteration to a document
Appropriation: Legislative authorization to expend public funds for a specific purpose; money set apart for a specific use
Audit Trails: A record of all system activities to ensure data integrity and accountability
Automated Clearing House (ACH): Electronic network for financial transactions in the United States
Award: All purchases, leases, or contracts which are based on competitive solicitations will be awarded according to the provisions in the solicitation
Best and Final Offer (BAFO): In a competitive solicitation, the final offer submitted which contains Vendor’s most favorable terms for price
Bid: See Solicitation Response
Bid Opening: The process of opening correctly submitted solicitation responses at the time and place specified in the written solicitation and in the presence of any bidder who wishes to attend
Bidder: A Vendor who submits a Solicitation Response
Breach: Violation of a contractual obligation by failing to perform or repudiation of one’s own promise
Business: Any corporation, partnership, individual, sole proprietorship, joint-stock company, joint venture, or any other private legal entity
Business Continuity and Disaster Recovery Plan (BC/DR): A plan outlining procedure to maintain or recover operations in the event of a disruption
Business Day: Any weekday, except State-recognized holidays
Calendar Day: Every day shown on the calendar including Saturdays, Sundays, and State/Federal holidays
Cancellation: To call off or revoke a solicitation, purchase order, or contract without expectation of conducting or performing at a later time
Catalog/Non-Core: A printed or electronic list of products a Vendor may provide at a discounted rate or discount off list price to the State. Initial contract award(s) is not based on Catalog/Non-Core items
Centers for Medicare and Medicaid Services (CMS): A federal agency within the U.S. Department of Health and Human Services (HHS) responsible for administering the nation’s major healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). CMS oversees regulatory compliance, funding, and quality standards for healthcare providers and ensures access to affordable and effective care for eligible populations.
Central Processing Unit (CPU): Any computer or computer system that is used by the State to store, process, or retrieve data or perform other functions using Operating Systems and applications software
Confidentiality, Integrity, and Availability (CIA): A foundational security model that ensures data is protected from unauthorized access (confidentiality), remains accurate and unaltered (integrity), and is accessible when needed by authorized users (availability).
Change Order: Document that provides amendments to an executed purchase order or contract
Collusion: An agreement or cooperation between two or more persons or entities to accomplish a fraudulent, deceitful, or unlawful purpose
Commodities: Any equipment, material, supply, or goods; anything movable or tangible that is provided or sold
Commodities Description: Detailed descriptions of the items to be purchased; may include information necessary to obtain the desired quality, type, color, size, shape, or special characteristics necessary to perform the work intended to produce the desired results
Communication Plan: A plan defining how project information will be shared with stakeholders
Competition: The effort or action of two or more commercial interests to obtain the same business from third parties
Confidential Information: See Proprietary Information
Conditions for Enhanced Funding: A set of 22 federal standards states must meet to qualify for enhanced (90/75%) federal Medicaid system funding.
Contract: An agreement between two or more parties creating obligations that are enforceable or otherwise recognizable at law; the writing that sets forth such an agreement
Contract Administration: The management of the contract which includes and is not limited to contract signing, contract amendments and any necessary legal actions
Contract Award: Document that officially awards a contract to a bidder(s) as the result of a competitive solicitation or a vendor(s) in a contract that qualifies for an exception or exemption from the competitive bidding requirements of the State Procurement Act
Contract Management: The management of day-to-day activities at the agency which includes but is not limited to ensuring deliverables are received, specifications are met, handling meetings and making payments to the Vendor
Contract Period: The duration of the contract
Contractor: See Vendor
Cooperative Purchasing: The combining of requirements of two or more political entities to obtain advantages of volume purchases, reduction in administrative expenses or other public benefits
Copyright: A property right in an original work of authorship fixed in any tangible medium of expression, giving the holder the exclusive right to reproduce, adapt and distribute the work
Cost Sheet: A required document that is completed by the vendor in the prescribed format to show the vendor’s pricing to provide the commodities or perform the services requested.
Critical Incident: An event or occurrence that significantly impacts program operations, client safety, data integrity, or system performance, requiring immediate investigation, documentation, and potential escalation by the Program Integrity team or relevant authorities.
Critical Path: The sequence of project tasks that directly impact the overall timeline
Critical Program Error: Any Program Error, whether or not known to the State, which prohibits or significantly impairs use of the Licensed Software as set forth in the documentation and intended in the contract
Customer Service: The process of ensuring customer satisfaction by providing assistance and advice on those commodities or services provided by a Vendor
Data Encryption: A security measure to protect sensitive data in transit and at rest
Data Migration: The process of transferring data from one system to another
Data Warehousing: The storage of large volumes of data for analysis and reporting
Default: The omission or failure to perform a contractual duty
Deliverables: Specific outputs or products provided by the vendor as part of the project
Design, Development, and Implementation (DDI): The DDI phase covers the time from project start-up until the required functionality is implemented and operational. The goal of this phase is to develop a system that must be certified by CMS.
Deviation: Any proposed change(s) or alteration(s) to either the terms and conditions or deliverables within the scope of the written solicitation or contract
Deliverable Review and Approval Process (DRAP): A formalized procedure through which the State reviews, requests revisions, and approves contract deliverables submitted by the Vendor, ensuring they meet specified quality and contractual standards.
Electronic Visit Verification: A technology system that electronically confirms home or community-based service visits by capturing data such as date, time, location, provider, and recipient. Required under Section 12006 of the 21st Century Cures Act for certain Medicaid services.
Evaluation: The process of examining a solicitation response after opening to determine the bidder’s responsibility, responsiveness to requirements, and to ascertain other characteristics of the solicitation response that relate to determination of the successful award
Evaluation Committee: Individual(s) identified by the agency that leads the solicitation to evaluate solicitation responses
Extension: Continuance of a contract for a specified duration upon the agreement of the parties beyond the original Contract Period; not to be confused with “Renewal Period”
Federal Medical Assistance Percentage: The federal matching rate for Medicaid expenditures, varying by state income levels
Federal Risk and Authorization Management Program: A U.S. government-wide program that standardizes security assessment, authorization, and continuous monitoring for cloud products and services, ensuring they meet federal data protection requirements.
Fee-for-Service (FFS): A payment model where providers are reimbursed for each individual service or procedure delivered to a Medicaid recipient.
Free on Board (F.O.B.) Destination: The delivery charges are included in the quoted price and prepaid by the Vendor. Vendor is responsible for all claims associated with damages during delivery of product.
Free on Board (F.O.B.) Point of Origin: The delivery charges are not included in the quoted price and are the responsibility of the agency. Agency is responsible for all claims associated with damages during delivery of product
Foreign Corporation: A foreign corporation that was organized and chartered under the laws of another state, government, or country
Goods: See Commodities
Home and Community-Based Services (HCBS): Medicaid-funded services that support individuals with disabilities or chronic conditions to live independently in their homes or community settings rather than in institutional care.
HealthInteractive Analytics (HIA):
An analytics platform used by Program Integrity teams to monitor provider billing patterns, conduct case management, and generate reports related to claims, investigations, and potential fraud, waste, or abuse in Medicaid programs.
Health Insurance Portability and Accountability Act (HIPAA): U.S. legislation providing data privacy and security provisions for medical information
Hosting Plan: A document detailing the infrastructure and hosting arrangements for the system
Installation Date: The date when the procedures described in “Installation by Vendor“ and “Installation by State” as found in the solicitation or contract are completed
Interested Party: A person acting in their personal capacity or an entity entering into a contract or other agreement creating a legal interest therein
Key Performance Indicators (KPIs): Metrics to evaluate project progress or system performance
Late Solicitation Response: A solicitation response received after the Opening Date and Time
Licensed Software Documentation: The user manuals and any other materials in any form or medium customarily provided by the Vendor to the users of the Licensed Software which will provide the State with sufficient information to operate, diagnose, and maintain the Licensed Software properly, safely, and efficiently
Mandatory: Required, compulsory, or obligatory
May: Discretionary, permitted; used to express possibility
Metrics: Measures used to evaluate system performance and project progress
Modular Design: A system design approach focusing on creating independent, interchangeable components
Module (see System): A collection of routines and data structures that perform a specific function of software
Must: See Shall
National Institute for Governmental Purchasing (NIGP): National Institute of Governmental Purchasing – Source used for assignment of universal commodity codes to goods and services
Non-core: See Catalog
Non-Responsive Solicitation Response: Any solicitation response that does not comply with the requirements of the solicitation or cannot be evaluated against the other solicitation responses
Nonnegotiable: These clauses are controlled by state law and are not subject to negotiation
NoSQL: A type of database designed for unstructured or semi-structured data
OAuth 2.0: An open standard for access delegation
Open Web Application Security Project: An open-source organization focused on improving software security through freely available tools, documentation, and widely adopted guidelines, such as the OWASP Top 10 security risks.
Opening Date and Time: Specified date and time for the opening of received, labeled, and sealed formal solicitation responses
Operating System: The control program in a computer that provides the interface to the computer hardware and peripheral devices, and the usage and allocation of memory resources, processor resources, input/output resources, and security resources
Outsourcing: The contracting out of a business process that an organization may have previously performed internally or for which an organization has a new need to an independent organization from which the process is purchased back
Payroll & Financial Center (PFC): Electronic procurement system of record
Penetration Testing: A security assessment to identify vulnerabilities in a system.
Performance Bond: An insurance agreement accompanied by a monetary commitment by which a third party (the surety) accepts liability and guarantees that the Vendor fulfills any and all obligations under the contract
Personal Property: See Commodities
PI Algorithms: Automated reporting models used to identify potential fraud, waste, abuse, or improper payments in healthcare and government programs.
PI Team: A designated group of employees within the State responsible for overseeing activities related to fraud, waste, abuse, and improper payments, ensuring compliance with Program Integrity objectives and statutory requirements.
Platform: A specific hardware and Operating System combination that is different from other hardware and Operating System combinations to the extent that a different version of the Licensed Software product is required to execute properly in the environment established by such hardware and Operating System combination
Point of Contact (POC): The person designated to receive communications and to communicate
Product: Something that is distributed commercially for use or consumption and that is usually (1) tangible personal property, (2) the result of fabrication or processing, and (3) an item that has passed through a chain of commercial distribution before ultimate use or consumption
Program Error: Code in Licensed Software that produces unintended results or actions or that produces results or actions other than those described in the specifications. A program error includes, without limitation, any Critical Program Error.
Program Set: The group of programs and products, including the Licensed Software specified in the solicitation, plus any additional programs and products licensed by the State under the contract for use by the State
Program Integrity Case Management (PICM): A system module focused on managing fraud detection and case investigations.
Project: The total scheme, program, or method worked out for the accomplishment of an objective, including all documentation, commodities, and services to be provided under the contract
Proposal: See Solicitation Response
Proprietary Information: Trade secrets, academic and scientific research work that is in progress and unpublished or other information that if released would give advantage to business competitors and service no public purpose. See Neb. Rev. Stat. § 84-712.05(3). In accordance with Attorney General Opinions 92068 and 97033, proof that information is proprietary requires identification of specific named competitor(s) advantaged by release of the information and the demonstrated advantage the named competitor(s) would gain by the release of information.
Protest/Grievance:
A complaint about a governmental action or decision related to the solicitation or resultant contract under SPB’s Protest Policy.
Quote: See Solicitation Response
Recommended Hardware Configuration: The data processing hardware (including all terminals, auxiliary storage, communication, and other peripheral devices) to the extent used by the State as recommended by the Vendor
Release Date: The date of public release of the solicitation
Renewal Period: Optional contract periods subsequent to the original Contract Period for a specified duration with previously agreed to terms and conditions; not to be confused with “Extension”
Request for Proposal (RFP): See Solicitation
Responsible Bidder: A Vendor who has the capability in all respects to perform fully and lawfully all requirements with integrity and reliability to assure good faith performance
Responsive Bidder: A Vendor who has submitted a solicitation response which conforms to all requirements of the solicitation
Role-Based Access Control (RBAC): A security mechanism restricting system access based on user roles
Service Level Agreement (SLA): A contract specifying the performance standards for a service
Shall: An order/command; mandatory
Should: Expected; suggested, but not necessarily mandatory
Software License: Legal instrument with or without printed material that governs the use or redistribution of licensed software
Solicitation: A formal invitation to receive quotes in the form of a Request for Proposal or Invitation to Bid
Solicitation Bond: An insurance agreement, accompanied by a monetary commitment, by which a third party (the surety) accepts liability and guarantees that the Vendor will not withdraw the solicitation response
Solicitation Conference: A meeting scheduled for the purpose of clarifying a written solicitation and related expectations
Solicitation Response: An offer, quote, bid, or proposal submitted by a Vendor in response to a Solicitation
Specifications: The detailed statement, especially of the measurements, quality, materials, and functional characteristics, or other items to be provided under a contract
System Security Plan: A comprehensive document outlining the security controls, policies, and procedures implemented to protect an information system, required for assessing and maintaining compliance with federal or state security standards.
State Medicaid Director Letter: Official federal policy guidance issued by CMS to state Medicaid directors, providing guidance and updates on CMS policy.
Subcontractor: Individual or entity with whom the Vendor enters a contract to perform a portion of the work awarded to the Vendor
Surveillance Utilization Review System: A system mandated by federal Medicaid regulations to monitor provider and recipient activity, identify patterns of misuse, and support investigations of fraud, waste, or abuse within the Medicaid program.
System (see Module): Any collection or aggregation of two (2) or more Modules that is designed to function, or is represented by the Vendor as functioning or being capable of functioning, as an entity
Termination:
Occurs when either Party, under a power created by agreement or law, puts an end to the contract prior to the stated expiration date; all obligations that are still executory on both sides are discharged but any right based on prior breach or performance survives
Third-Party: Any person or entity, including but not limited to fiduciaries, shareholders, owners, officers, managers, employees, legally disinterested persons, and subcontractors or agents, and their employees. It shall not include any entity or person who is an interested party to the contract or agreement
Trade Secret: Information, including but not limited to, a drawing, formula, pattern, compilation, program, device, method, technique, code, or process that (a) derives independent economic value, actual or potential, from not being known to, and not being ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use; and (b) is the subject of efforts that are reasonable under the circumstances to maintain its secrecy (see Neb. Rev. Stat. § 87-502(4))
Trademark: A word, phrase, logo, or other graphic symbol used by a manufacturer or Vendor to distinguish its product from those of others, registered with the U.S. Patent and Trademark Office
Upgrade: Any change that improves or alters the basic function of a product of service
Uptime: The amount of time a system, network, or application is operational and available for use without interruptions. Uptime is typically expressed as a percentage of total time and is a critical metric for assessing the reliability and performance of IT systems or services. For example, an uptime of 99.9% means the system was available 99.9% of the time in a given period.
User Acceptance Testing (UAT): A testing phase where end-users validate system functionality.
Vendor: An individual or entity lawfully conducting business with the State. or licensed to do so, who seeks to provide and contract for goods or services under the terms of a Solicitation and/or Contract
Vendor Performance Report: A report completed by the using agency and submitted to State Purchasing Bureau documenting products or services delivered or performed which exceed or fail to meet the terms of the purchase order, contract, and/or solicitation specifications
Will: See Shall
Work Day: See Business Day
Written Deliverable: A formal, documented work product created by the Vendor that is text-based (e.g., reports, plans, manuals) and submitted to the State to fulfill a specific contractual requirement. Written Deliverables are subject to State review, revision requests, and formal approval.
ACRONYM LIST
ACA: Affordable Care Act
ACH: Automated Clearing House
APD: Advanced Planning Documents
ARO: After Receipt of Order
ARS: Acceptable Risk Safeguards
BAFO: Best and Final Offer
BI: Business Intelligence
CCB: Change Control Board
CEF: Conditions for Enhanced Funding
CIA: Confidentiality, Integrity, and Availability
CMS: Centers for Medicare & Medicaid Services
COI: Certificate of Insurance
COTS: Commercial Off-The-Shelf
CPU: Central Processing Unit
CR: Certification Review
DAS: Department of Administrative Services
DDI: Design, Development, and Implementation
DED: Deliverable Expectation Document
DHHS: Department of Health and Human Services
DMA: Data Management and Analytics
DRAP: Deliverable Review and Approval Process
DW/DSS: Data Warehouse/Decision Support System
ESB: Enterprise Service Bus
ETL: Extract, Transform, Load
EVV: Electronic Visit Verification
F.O.B.: Free on Board
FADS: Fraud Abuse Detection System
FFP: Federal Financial Participation
FFS: Fee-for-Service
FIPS: Federal Information Processing Standards
FMAP: Federal Medical Assistance Percentage
FedRAMP: Federal Risk and Authorization Management Program
FWA: Fraud, Waste, and Abuse
HCBS: Home and Community-Based Services
HIA: HealthInteractive Analytics
HIPAA: Health Insurance Portability and Accountability Act
HITECH: Health Information Technology for Economic and Clinical Health
ICM: Integrated Case Management
ICT: Information and Communication Technology
IMS: Integrated Master Schedule
IT: Information Technology
ITB: Invitation to Bid
IV&V: Independent Validation and Verification
MCOs: Managed Care Organizations
MES: Medicaid Enterprise Systems
MITA: Medicaid Information Technology Architecture
MMIS: Medicaid Management Information Systems
NF: Nursing Facility
NFOCUS: Nebraska Families Online Customer Service
NIGP: National Institute for Governmental Purchasing
NIST: National Institute of Standards and Technology
NoSQL: Not Only SQL
O&M: Operations and Maintenance
OCM: Organizational Change Management
ORR: Operational Readiness Review
OWASP: Open Web Application Security Project
PA: Participating Addendum
PFC: Payroll & Financial Center
PI: Program Integrity
PICM: Program Integrity Case Management
PM: Project Management
PMO: Project Management Office
PPACA: Patient Protection and Affordable Care Act
QA: Quality Assurance
RBAC: Role-Based Access Control
RFP: Request for Proposal
RTM: Requirements Traceability Matrix
SAAS: Software as a Service
SIT: System Integration Testing
SLA: Service Level Agreement
SMC: Streamlined Modular Certification
SMDL: State Medicaid Director Letter
SOA: Service Oriented Architecture
SPB: State Purchasing Bureau
SSP: System Security Plan
SURS: Surveillance Utilization Review System
T-MSIS: Transformed Medicaid Statistical Information System
UAT: User Acceptance Testing
UI: User Interface
UX: User Experience
WBS: Work Breakdown Structure
WCAG: Web Content Accessibility Guidelines
PROCUREMENT PROCEDURE
A. GENERAL INFORMATION
This solicitation is designed to solicit responses from qualified bidders who will be responsible for Program Integrity Case Management (PICM) / Fraud Abuse Detection (FAD) Analytics solution at a competitive and reasonable cost.
Solicitation responses shall conform to all instructions, conditions, and requirements included in the solicitation. Prospective bidders are expected to carefully examine all documents, schedules, and requirements in this solicitation, and respond to each requirement in the format prescribed. Solicitation responses may be found non-responsive if they do not conform to the solicitation.
B. PROCURING OFFICE AND COMMUNICATION WITH STATE STAFF AND EVALUATORS
Procurement responsibilities related to this solicitation reside with the Nebraska Department of Health and Human Services (DHHS). The point of contact (POC) for the procurement is as follows:
| RFP Number: | 122125 O3 | |
| Name: | Dhinesh Santhakumar, Procurement Contract Officer | |
| Agency: | Nebraska Department of Health and Human Services | |
| Address: | 301 Centennial Mall South, 5th Floor | |
| Lincoln, NE 68508 | ||
| Telephone: | 402-471-5031 | |
| E-Mail: | Dhhs.rfpquestions@nebraska.gov |
From the date the solicitation is issued until the Intent to Award is issued, communication from the bidder is limited to the POC listed above. After the Intent to Award is issued, the bidder may communicate with individuals the State has designated as responsible for negotiating the contract on behalf of the State. No member of the State Government, employee of the State, or member of the Evaluation Committee is empowered to make binding statements regarding this solicitation. The POC will issue any answers, clarifications, or amendments regarding this solicitation in writing. Only the SPB or awarding agency can award a contract. Bidders shall not have any communication with or attempt to communicate or influence any evaluator involved in this solicitation.
The following exceptions to these restrictions are permitted:
Contact made pursuant to pre-existing contracts or obligations;
Contact required by the schedule of events or an event scheduled later by the POC; and
Contact required for negotiation and execution of the final contract.
The State reserves the right to reject a bidder’s solicitation response, withdraw an Intent to Award, or terminate a contract if the State determines there has been a violation of these procurement procedures.
C. SCHEDULE OF EVENTS
The State expects to adhere to the procurement schedule shown below, but all dates are approximate and subject to change.
NOTE: All ShareFile links in the Schedule of Events below, are unique links for each schedule step. Please click the correct link for the upload step you are requesting.
Schedule of Events
| ACTIVITY |
| DATE/TIME |
| 1 |
| Release solicitation |
| May 28, 2025 |
Last day to submit written questions.
Email to send questions: Dhhs.rfpquestions@nebraska.gov June 10, 2025
| 1 |
| State responds to written questions through solicitation “Addendum” to be posted to the Internet at: http://das.nebraska.gov/materiel/bidopps.html |
| June 25, 2025 |
| 1 |
| Electronic Solicitation Opening – Online Via Webex |
IT IS THE BIDDER’S RESPONSIBILTY TO UPLOAD ELECTRONIC FILES BY OPENING DATE AND TIME. EXCEPTIONS WILL NOT BE MADE FOR TECHNOLOGY ISSUES.
ShareFile Electronic Solicitation Submission Link: https://nebraska.sharefile.com/r-r6f0a44537a834e1bace7f2cfa2259552
Join Webex Meeting https://sonvideo.webex.com/sonvideo/j.php?MTID=m5e2e3cc237912a0e70dfb2052fa0b3bf Join by meeting number
Meeting number (access code): 2494 107 1343
Meeting password: 2DqQMFVBQ49
July 10, 2025
2:00 PM
Central Time
| 1 |
| Review for conformance to solicitation requirements |
| July 10, 2025 |
through July 17, 2025
| 1 |
| Evaluation period |
| July 18, 2025 |
through August 14, 2025
| 1 |
| Vendor Demonstrations |
| Week of September 1, 2025 |
(if held)
| 1 |
| Post “Notification of Intent to Award” to Internet at: https://das.nebraska.gov/materiel/bidopps.html |
| On or around October 1, 2025 |
| 1 |
| Contract finalization period |
| October 1, 2025 |
through December 11, 2025
| 1 |
| Contract award |
| December 26, 2025 |
| 2 |
| Vendor start date |
| January 2, 2026 |
SPB Form 22 | RFP Template | Effective 12162024
D. WRITTEN QUESTIONS AND ANSWERS
Questions regarding the meaning or interpretation of any solicitation provision must be submitted in writing to Nebraska Department of Health and Human Services and clearly marked “Solicitation Number 122125 O3; PICM / FADS Analytics solution Questions”. The POC is not obligated to respond to questions that are received late per the Schedule of Events.
Bidders should submit questions for any items upon which assumptions may be made when preparing a response to the solicitation. Any solicitation response containing assumptions may be deemed non-responsive and may be rejected by the State. Solicitation responses will be evaluated without consideration of any known or unknown assumptions of a bidder. The contract will not incorporate any known or unknown assumptions of a bidder.
Questions should be emailed to the email address provided in the solicitation Schedule of Events, Section I.C.
It is recommended that bidders submit questions using the following format:
| RFP Section Reference |
| RFP Page Number |
| Question |
Written answers will be posted at https://das.nebraska.gov/materiel/bidopps.html per the Schedule of Events.
E. SECRETARY OF STATE/TAX COMMISSIONER REGISTRATION REQUIREMENTS (Nonnegotiable) All bidders must be authorized to transact business in the State of Nebraska and comply with all Nebraska Secretary of State Registration requirements. The bidder who is the recipient of an Intent to Award may be required to certify that it has complied and produce a true and exact copy of its current (within ninety (90) calendar days of the intent to award) Certificate or Letter of Good Standing, or in the case of a sole proprietorship, provide written documentation of sole proprietorship and complete the United States Citizenship Attestation Form, available on the Department of Administrative Services website at:
https://das.nebraska.gov/materiel/docs/pdf/Individual%20or%20Sole%20Proprietor%20United%20States%20Attestation%20Form%20English%20and%20Spanish.pdf This should be accomplished prior to execution of the contract.
F. ETHICS IN PUBLIC CONTRACTING
The State reserves the right to reject solicitation responses, withdraw an intent to award or award, or terminate a contract if an ethical violation has been committed, which includes, but is not limited to:
Offering or giving, directly or indirectly, a bribe, fee, commission, compensation, gift, gratuity, or anything of value to any person or entity in an attempt to influence the bidding process;
Utilizing the services of lobbyists, attorneys, political activists, or consultants to influence or subvert the bidding process;
Being considered for, presently being, or becoming debarred, suspended, ineligible, or excluded from contracting with any state or federal entity:
Submitting a solicitation response on behalf of another Party or entity; and Colluding with any person or entity to influence the bidding process, submit sham solicitation responses, preclude bidding, fix pricing or costs, create an unfair advantage, subvert the solicitation response, or prejudice the State.
The bidder shall include this clause in any subcontract entered into for the exclusive purpose of performing this contract.
Bidder shall have an affirmative duty to report any violations of this clause by the bidder throughout the bidding process and throughout the term of this contract for the awarded bidder and their subcontractors.
G. DEVIATIONS FROM THE SOLICITATION
The requirements contained in the solicitation (Sections II through VII) become a part of the terms and conditions of the contract resulting from this solicitation. Any deviations from the solicitation in Sections II through VI must be clearly defined by the bidder in its solicitation response and, if accepted by the State, will become part of the contract. Any specifically defined deviations must not be in conflict with the basic nature of the solicitation, requirements, or applicable state or federal laws or statutes. “Deviation”, for the purposes of this solicitation, means any proposed changes or alterations to either the contractual language or deliverables within the scope of this solicitation. The State discourages deviations and reserves the right to reject proposed deviations.
H. SUBMISSION OF SOLICITATION RESPONSES
The State is only accepting electronic responses submitted in accordance with this solicitation. The State will not accept solicitation responses by mail, email, voice, or telephone, unless otherwise explicitly stated in writing by the State.
Pages may be consecutively numbered for the entire solicitation response or may be numbered consecutively within sections. Figures and tables should be numbered and referenced in the text by that number. They should be placed as close as possible to the referencing text.
The Technical Responses should not contain any reference to dollar amounts. However, information such as data concerning labor hours and categories, materials, subcontracts and so forth, shall be considered in the Technical Response so that the bidder’s understanding of the scope of work may be evaluated. The Technical Response shall disclose the bidder’s technical requirements in as much detail as possible, including, but not limited to, the information required by the Technical Response instructions.
It is the bidder’s responsibility to ensure the solicitation response is received electronically by the date and time indicated in the Schedule of Events. Solicitation Responses must be submitted via ShareFile by the date and time of the opening per the Schedule of Events. No late solicitation responses will be accepted.
It is the responsibility of the bidder to check the website for all information relevant to this solicitation to include addenda and/or amendments issued prior to the opening date. The website can be found here: https://das.nebraska.gov/materiel/bidopps.html.
Emphasis should be concentrated on conformance to the solicitation instructions, responsiveness to requirements, completeness, and clarity of content. If the solicitation response is presented in such a fashion that makes evaluation difficult or overly time consuming the State reserves the right to reject the solicitation response as non-conforming.
The ShareFile link for uploading Solicitation Response(s) is provided in the Schedule of Events, Section I.C.
***UNLESS OTHERWISE NOTED, DO NOT SUBMIT DOCUMENTS
THAT CAN ONLY BE ACCESSED WITH A PASSWORD***
1. Bidders must submit responses via ShareFile using the solicitation submission link.
Note: Not all browsers are compatible with ShareFile. Currently Google Chrome, Internet Explorer, Microsoft Edge, Safari, and Firefox are compatible. After the bidder clicks the solicitation response submission link, the bidder will be prompted to enter contact information including an e-mail address. By entering an e-mail address, the bidder should receive a confirmation email confirming the successful upload directly from ShareFile.
ShareFile link for uploading solicitation response(s) provided in the Schedule of Events, Section I.C.
a. The Solicitation response and Proprietary information should be uploaded as separate and distinct files.
i. If duplicated responses are submitted, the State will retain only the most recently submitted response.
ii. If it is the bidder’s intent to submit multiple responses, the bidder must clearly identify the separate submissions.
iii. It is the bidder’s responsibility to allow time for electronic uploading. All file uploads must be completed by the Opening date and time per the Schedule of Events. No late responses will be accepted.
b. ELECTRONIC SOLICITATION RESPONSE FILE NAMES The bidder should clearly identify the uploaded solicitation response files. To assist in identification the bidder should use the following naming convention:
i. 122125 O3 Company Name If multiple files are submitted for one solicitation response, add number of files to file names:
122125 O3 Company Name File 1 of 2 122125 O3 Company Name File 2 of 2
ii. If multiple responses are submitted for the same solicitation, add the response number to the file names:
122125 O3 Company Name Response 1 File 1 of 2
The “Contractual Agreement Form” must be signed manually in ink or by DocuSign and returned by the opening date and time along with the bidder’s solicitation response and any other requirements as stated in this solicitation in order for the bidder’s solicitation response to be evaluated.
By signing this Contractual Agreement Form, the bidder guarantees compliance with the provisions stated in this solicitation and agrees to the terms and conditions unless otherwise indicated in writing.
I. SOLICITATION PREPARATION COSTS
The State shall not incur any liability for any costs incurred by bidder’s in replying to this solicitation, including any activity related to bidding on this solicitation.
J. FAILURE TO COMPLY WITH SOLICITATION
Violation of the terms and conditions contained in this solicitation or any resultant contract, at any time before or after the award, shall be grounds for action by the State which may include, but is not limited to, the following:
Rejection of a bidder’s solicitation response, Withdrawal of the Intent to Award, Withdrawal of the Award, Negative documentation regarding Vendor Performance, Termination of the resulting contract, Legal action; and Suspension or Debarment of the bidder from further bidding with the State for the period of time relative to the seriousness of the violation. Such period to be within the sole discretion of the State.
K. SOLICITATION RESPONSE CORRECTIONS
A bidder may correct a mistake in an electronically submitted solicitation response prior to the time of opening by uploading a revised and completed solicitation response.
1. If a corrected electronic solicitation response is submitted, the file name(s) date/time stamped with latest date/time stamp will be accepted. The corrected solicitation response file name(s) should be identified as:
| a. | Corrected 122125 O3 Company Name Response #1 File 1 of 2, |
| b. | Corrected 122125 O3 Company Name Response #2 File 2 of 2, etc. |
Changing a solicitation response after opening may be permitted if the change is made to correct a minor error that does not affect price, quantity, quality, delivery, or contractual conditions. In case of a mathematical error in extension of price, unit price shall govern.
L. LATE SOLICITATION RESPONSES
Solicitation Responses received after the time and date of the opening will be considered late responses. Late responses will be considered non-responsive. The State is not responsible for responses that are late or lost regardless of cause or fault.
M. BID OPENING
The opening will consist of opening solicitation responses and announcing the names of bidders. Responses WILL NOT be available for viewing by those present at the opening. Responses will be posted to the State Purchasing Bureau website once an Intent to Award has been posted to the website. Once responses are opened, they become the property of the State of Nebraska and will not be returned.
N. SOLICITATION REQUIREMENTS
The solicitation responses will first be examined to determine if all requirements listed below have been addressed and whether further evaluation is warranted. Solicitation responses not meeting the requirements may be rejected as non-responsive. The requirements are as follows:
Original Contractual Agreement Form signed manually in ink or by DocuSign;
Clarity and responsiveness;
Completed Corporate Overview;
Completed Sections II through IV;
Completed Technical Response;
Completed Cost Sheet;
Attachment 1 – Minimum Qualifications;
Attachment 2 – Functional Specifications;
Attachment 3 – Technical Specifications;
Attachment 4 – Data Integration…
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