122125 O3 PICM RFP.docx.pdf

i SPB Form 22 | RFP Template | Effective 12162024

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 determinat ion 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, https://das.nebraska.gov/materiel/bidopps.html http://statecontracts.nebraska.gov/ https://www.nebraska.gov/das/materiel/purchasing/contract_search/index.php ii SPB Form 22 | RFP Template | Effective 12162024 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.

iii 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

A. GENERAL INFORMATION

B. PROCURING OFFICE AND COMMUNICATION WITH STATE STAFF AND EVALUATORS

C. SCHEDULE OF EVENTS

D. WRITTEN QUESTIONS AND ANSWERS

E. SECRETARY OF STATE/TAX COMMISSIONER REGISTRATION REQUIREMENTS (Nonnegotiable)

F. ETHICS IN PUBLIC CONTRACTING

G. DEVIATIONS FROM THE SOLICITATION

H. SUBMISSION OF SOLICITATION RESPONSES

I. SOLICITATION PREPARATION COSTS

J. FAILURE TO COMPLY WITH SOLICITATION

K. SOLICITATION RESPONSE CORRECTIONS

L. LATE SOLICITATION RESPONSES

M. BID OPENING

N. SOLICITATION REQUIREMENTS

O. EVALUATION COMMITTEE

P. EVALUATION OF SOLICITATION RESPONSES

Q. BEST AND FINAL OFFER

R. REFERENCE AND CREDIT CHECKS

S. AWARD

T. LUMP SUM OR “ALL OR NONE” SOLICITATION RESPONSES

U. REJECTION OF SOLICITATION RESPONSES

V. PRICES & COST CLARIFICATION

W. VENDOR DEMONSTRATIONS

II. TERMS AND CONDITIONS

A. GENERAL

B. NOTIFICATION

C. BUYER’S REPRESENTATIVE

D. GOVERNING LAW (Nonnegotiable)

E. BEGINNING OF WORK & SUSPENSION OF SERVICES

F. AMENDMENT

G. CHANGE ORDERS OR SUBSTITUTIONS

H. RECORD OF VENDOR PERFORMANCE

I. NOTICE OF POTENTIAL VENDOR BREACH

J. BREACH

K. NON-WAIVER OF BREACH

L. SEVERABILITY

M. INDEMNIFICATION

N. ATTORNEY'S FEES

O. ASSIGNMENT, SALE, OR MERGER

P. CONTRACTING WITH OTHER NEBRASKA POLITICAL SUBDIVISIONS OF THE STATE OR ANOTHER

STATE

Q. FORCE MAJEURE

R. CONFIDENTIALITY

S. EARLY TERMINATION

T. CONTRACT CLOSEOUT

iv SPB Form 22 | RFP Template | Effective 12162024

U. PROHIBITED PRODUCTS

V. AMERICANS WITH DISABILITIES ACT

W. LONG-TERM CARE OMBUDSMAN (Nonnegotiable) X. OFFICE OF PUBLIC COUNSEL (Nonnegotiable)

Y. LOBBYING

Z. LIQUIDATED DAMAGES

III. VENDOR DUTIES

A. INDEPENDENT VENDOR / OBLIGATIONS

B. FOREIGN ADVERSARY CONTRACTING PROHIBITION ACT CERTIFICATION (Nonnegotiable)

C. EMPLOYEE WORK ELIGIBILITY STATUS

D. COMPLIANCE WITH CIVIL RIGHTS LAWS AND EQUAL OPPORTUNITY EMPLOYMENT /

NONDISCRIMINATION (Nonnegotiable)

E. COOPERATION WITH OTHER VENDORS

F. DISCOUNTS

G. PRICES

H. PERMITS, REGULATIONS, LAWS

I. OWNERSHIP OF INFORMATION AND DATA / DELIVERABLES

J. INSURANCE REQUIREMENTS

K. ANTITRUST

L. CONFLICT OF INTEREST

M. STATE PROPERTY

N. SITE RULES AND REGULATIONS

O. ADVERTISING

P. NEBRASKA TECHNOLOGY ACCESS STANDARDS (Nonnegotiable)

Q. DISASTER RECOVERY/BACK UP PLAN

R. DRUG POLICY

S. INDUSTRY STANDARDS WARRANTY

T. TIME IS OF THE ESSENCE

U. BUSINESS ASSOCIATE PROVISIONS

IV. PAYMENT

A. PROHIBITION AGAINST ADVANCE PAYMENT (Nonnegotiable) B. TAXES (Nonnegotiable)

C. INVOICES

D. INSPECTION AND APPROVAL

E. PAYMENT (Nonnegotiable) F. LATE PAYMENT (Nonnegotiable) G. SUBJECT TO FUNDING / FUNDING OUT CLAUSE FOR LOSS OF APPROPRIATIONS (Nonnegotiable)

H. RIGHT TO AUDIT (First Paragraph is Nonnegotiable)

V. PROJECT INFORMATION AND ESSENTIAL QUALIFICATIONS

A. PROJECT OVERVIEW

B. BACKGROUND INFORMATION

C. MINIMUM REQUIREMENTS FOR EVALUATION

D. OTHER INFORMATION AVAILABILE AND/OR RELATED DOCUMENTS:

VI. PROJECT DESCRIPTION AND SCOPE OF WORK

A. PROJECT REQUIREMENTS AND INFORMATION

B. PROPOSED DEVELOPMENT APPROACH

C. TECHNICAL CONSIDERATION

D. PROJECT WORK PLAN, MANAGEMENT, AND IMPLEMENTATION

E. DELIVERABLES AND DUE DATES

VII. SOLICITATION RESPONSE INSTRUCTIONS

v SPB Form 22 | RFP Template | Effective 12162024

A. SOLICITATION RESPONSE SUBMISSION

CONTRACTUAL AGREEMENT FORM

vi SPB Form 22 | RFP Template | Effective 12162024

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.

vii SPB Form 22 | RFP Template | Effective 12162024

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 viii SPB Form 22 | RFP Template | Effective 12162024

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 ix SPB Form 22 | RFP Template | Effective 12162024

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 x SPB Form 22 | RFP Template | Effective 12162024

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 xi SPB Form 22 | RFP Template | Effective 12162024

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 xii SPB Form 22 | RFP Template | Effective 12162024

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.

xiii SPB Form 22 | RFP Template | Effective 12162024

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 xiv SPB Form 22 | RFP Template | Effective 12162024

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 xv SPB Form 22 | RFP Template | Effective 12162024

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

SPB Form 22 | RFP Template | Effective 12162024

I. 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:

1. Contact made pursuant to pre-existing contracts or obligations;

2. Contact required by the schedule of events or an event scheduled later by the POC; and

3. 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.

mailto:Dhhs.rfpquestions@nebraska.gov

Schedule of Events

ACTIVITY DATE/TIME

1. 1 Release solicitation May 28, 2025

2.

Last day to submit written questions.

Email to send questions: Dhhs.rfpquestions@nebraska.gov

June 10, 2025

3. 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

4. 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=m5e2e3cc23 7912a0e70dfb2052fa0b3bf

Join by meeting number

Meeting number (access code): 2494 107 1343

Meeting password: 2DqQMFVBQ49

July 10, 2025

2:00 PM

Central Time

5. 1 Review for conformance to solicitation requirements July 10, 2025 through July 17, 2025

6. 1 Evaluation period July 18, 2025 through August 14, 2025

7. 1 Vendor Demonstrations Week of September 1, 2025

(if held)

8. 1 Post “Notification of Intent to Award” to Internet at:

https://das.nebraska.gov/materiel/bidopps.html

On or around October 1, 2025

9. 1 Contract finalization period October 1, 2025 through December 11, 2025

10. 1 Contract award December 26, 2025

11. 2 Vendor start date January 2, 2026 mailto:Dhhs.rfpquestions@nebraska.gov http://das.nebraska.gov/materiel/bidopps.html https://nebraska.sharefile.com/r-r6f0a44537a834e1bace7f2cfa2259552 https://sonvideo.webex.com/sonvideo/j.php?MTID=m5e2e3cc237912a0e70dfb2052fa0b3bf https://sonvideo.webex.com/sonvideo/j.php?MTID=m5e2e3cc237912a0e70dfb2052fa0b3bf https://das.nebraska.gov/materiel/bidopps.html

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%20Attest ation%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:

1. 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;

2. Utilizing the services of lobbyists, attorneys, political activists, or consultants to influence or subvert the bidding process;

3. Being considered for, presently being, or becoming debarred, suspended, ineligible, or excluded from contracting with any state or federal entity:

4. Submitting a solicitation response on behalf of another Party or entity; and

5. 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.

https://das.nebraska.gov/materiel/docs/pdf/Individual%20or%20Sole%20Proprietor%20United%20States%20Attestation%20Form%20English%20and%20Spanish.pdf https://das.nebraska.gov/materiel/docs/pdf/Individual%20or%20Sole%20Proprietor%20United%20States%20Attestation%20Form%20English%20and%20Spanish.pdf

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:

1. Rejection of a bidder’s solicitation response,

2. Withdrawal of the Intent to Award,

3. Withdrawal of the Award,

4. Negative documentation regarding Vendor Performance,

5. Termination of the resulting contract,

6. Legal action; and

7. 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.