2-USBE-CC26314-RFP - Scope of Work.pdf

Scope of Work

USBE-CC26314-RFP

Medicaid Billing Services

1. Introduction & Background

Utah Schools for the Deaf and the Blind (“USDB”) is soliciting proposals from qualified Offerors to provide a documentation program that can track the delivery of health-related services and submit claims to Medicaid for allowable services provided.

USDB educates students who are deaf, hard of hearing, deafblind, blind, or have low vision across the state of Utah and serves approximately 375 students across three campuses. All students receive special education services. USDB employs approximately 150 special education and related service staff, including but not limited to Special Education Teachers, Audiologists, Speech-Language Pathologists, Orientation and Mobility Specialists, Nurses, School Psychologists, and Physical and Occupational Therapists.

USDB is seeking a solution that provides an intuitive, user-friendly experience for service providers and program administrators while streamlining documentation and billing processes to improve efficiency and support timely Medicaid claiming. The system must support the collection and use of data necessary to optimize the delivery of special education services and must support USDB business processes at the business office, school, and staff levels.

The proposed solution must support the electronic submission of Medicaid claims through the UHIN tool for allowable services and be flexible and customizable to adapt and grow as USDB’s needs evolve. The selected Offeror is expected to be familiar with the Utah School-Based Skills Development Program and knowledgeable in applicable State and Federal laws, rules, and regulations governing School-Based Medicaid Services.

The selected vendor will be responsible for the implementation, hosting, training, and ongoing support of the system. The solution must be fully implemented and ready for use by the start of the 2026–2027 school year (July 1, 2026).

SCOPE OF WORK

This Scope of Work (“SOW”) outlines the specific functionality, technical, and service requirements for the platform. The proposed solution must be a single, unified platform that allows users to access all functions.

a) Medicaid Documentation

The system must deliver full-service documentation for all student health-related services and include internal system controls that validate all documentation and claim submission requirements in accordance with State and Federal Medicaid regulations including but not limited to:

I. Eligibility:

a. Student age, 3 years to 21 years

b. Student has a Medicaid covered service listed in their Document Medical

Necessity (“DMN”)

II. Documented Medical Necessity (“DMN”):

a. DMN covers billing on the claim

b. Services rendered match the services rendered in the DMN

c. CPT/HCPCS codes match the DMN

III. Rendering and Supervising providers:

a. Provider licensure and supervision of rendering provider when necessary

b. Provider signature(s) and date

c. Label indicating the rendering provider and the supervising provider

d. Electronic signature

IV. Clinical notes – must include

a. Student’s name

b. Type of service rendered

c. Date service was rendered

d. Duration of time spent rendering the service

e. Clinical description of services rendered

V. Skilled nursing service documentation

a. Must ensure skilled nursing is billed correctly in fifteen (15) min increments.

VI. Student eligibility at different times of the year

VII. Parental consent to bill

VIII. CPT/HCPCS codes

IX. ICD-10 diagnosis code

b) Claim Submissions and Management

I. Full service automated claims submission, management, and reporting that must be inclusive of the following:

a. Capability must include current and active ability to submit claims to UT

Medicaid directly through UHIN tool using HIPAA compliant software required electronic submission signature

b. Meet all state and federal requirements

c. Exportable claims management reporting

d. Reporting to allow for claim status inquiries to include “paid”, “denied”, or held service claims

e. Ability to correct and resubmit claims

f. Health Insurance Portability and Accountability Act (HIPAA) compliant with data collection and electronic data sets to meet HIPAA standards.

c) Software Features/Capabilities

I. The desired solution must have the following features and capabilities:

a. Current integration with PowerSchool. Must fully integrate with PowerSchool by linking to USDB's PowerSchool API for seamless, secure data exchange; read and write-back capabilities allow frequent (daily is preferred) bi-directional data integration with PowerSchool.

b. Must be fully web-based, be accessible on mobile devices, be compatible with screen readers and WCAG compliant.

c. Application hosting services provided by Offeror.

d. Auto Save features for all areas of the program.

e. Ability to schedule and enter data for individual and/or group sessions.

f. Calendar features to plan and schedule future sessions.

g. Workflow capabilities which direct the user to complete required information or steps.

h. Ability to create a caseload per staff member, school and with students able to be assigned to more than one caseload.

i. Ability to view related services caseload in one place/screen and easily enter services.

j. Compliance reporting capability.

k. System has a full audit trail with date/time stamp showing all updates to information and user access

l. Customizable employee access based on the level of access needed (by role or location)

m. Ability to set separate school calendars for each school and campus to reflect different schedules for each (currently 7 separate schools).

n. All information is updated in real time.

o. Integrated spelling and grammar checks.

p. Provides error messages that are user-friendly and advise of possible corrections.

q. System can automatically inactivate students who unenroll from school and reactivate students who re-enroll.

r. Will store and provide access to information/records/data for the duration of time required by Medicaid for record retention – five years from the date of payment.

s. Use the USDB student number as a unique student identifier where required.

a. **USDB will have current ownership, right, title and interest in all data stored and generated, both historical and current.**

t. Utilize design elements that are compatible with and maintain current Family

Education Rights and Privacy Act (FERPA) security guidelines.

d) Customer Service & Training

I. Offeror’s Customer Service and training solutions must be inclusive of the following:

a. Must have a 24-hour response time or less with technical difficulties.

b. Provide a direct contact for USDB to interface with on issues, training, reports and all other processes.

c. Frequent collaboration meetings with our coordinators and direct contact.

d. Live technical support during regular business hours for all staff via toll-free number or via helpdesk using chat or email.

e. Online user guides and support accessible to all users.

f. Must provide a user manual specific to the actual program and/or module.

g. Online training modules available for all new users throughout the contract.

h. Training must be accessible to those who are blind, low vision, deaf or hard of hearing.

e) Audit Support & Compliance

The Offeror shall provide assistance and representation during State and Federal Medicaid audits related to claims submitted through the system. This includes data retrieval, explanation of system controls, and claim documentation support.

f) Participation & Volume

USDB does not guarantee any minimum level of participation, service utilization, claim submissions, or Medicaid reimbursement under this Agreement. Participation levels and claim volumes may fluctuate due to factors including, but not limited to, student eligibility, parental consent, service delivery levels, documentation sufficiency, and changes in State or Federal Medicaid requirements. Contractor acknowledges that compensation is contingent upon services actually performed and accepted in accordance with this Scope of Work, and that payment is not guaranteed in the absence of eligible services or claimable activity.

g) Federal Disallowance & True-Up Adjustments

USDB/USBE reserves the right to recover or adjust payments determined to be unallowable, disallowed, or subject to recoupment as a result of State or Federal audit, reconciliation, or Medicaid true-up. Contractor shall not be entitled to compensation attributable to amounts that are subsequently reduced, disallowed, or recouped. Any such recovery or adjustment may be applied as a refund or credit and survives the expiration or termination of the Agreement.

Contract Award

It is anticipated this RFP will result in a single contract award to the responsive and responsible Offeror with the highest score justified by the Procurement Code.

The contract resulting from this RFP will be for five (5) years. However, USBE reserves the right to terminate the contract at any time in accordance with the provisions set forth in the USBE Standard Terms and Conditions.

Contract Budget

The maximum contract budget is $30,000.00 per year for a total of $150,000.00 for the duration of the contract. However, this is NOT a guaranteed total amount. You are not required to expend the entire amount of funds when calculating your cost proposal. Cost proposals exceeding these identified amounts will be considered non-responsive and ineligible for contract award.

Evaluation shall be based on the GRAND TOTAL of the contract.

NOTE: Costs MUST be all-inclusive. If travel for meetings, trainings, or other engagements is required, you must arrange and pay for your own transportation, meals, and lodging. Travel time and travel expenses shall NOT be included in any invoice to USBE.

Invoicing

Contractor shall submit quarterly invoices electronically to the USDB email account at ap@usdb.org and the USDB program manager(s) identified in any contract resulting from the RFP for all goods and/or services provided in accordance with the terms on the agreement.

Invoices will not be considered for payment if submitted by another method.

Invoices shall include the following:

a. Contractor Name

b. Uniquely identifiable invoice number

c. Invoice date

d. Contract Number

e. Recipient Entity’s contact information (phone number and email address)

f. Contractor’s authorized signature

g. Date(s) goods/services were provided

h. Detailed description of goods and/or services for which payment is requested

i. Dollar amount requested

j. Invoices must be submitted within 30 days of end of Quarter.

Invoices submitted by Contractor to USDB without the required information will not be paid and shall be returned to the Contractor for completion.

All payments made to the Contractor under the agreement shall be made in the name of the Contractor, as it appears in the agreement. All payments will be sent to the Contractor to the address for the Contractor as it appears in the agreement. Changes to the information identified in this section must be requested in writing.

To obtain payment for the goods and/or services authorized by this agreement, Contractor shall submit the itemized invoice together with supporting documentation of work performed.

USBE reserves the right to question or seek clarification for any cost invoiced if the invoice is not supported by proper documentation.

Contractor may be required to repay USBE if, during or after the contract period, an audit or other review determines that payments made by USBE to Contractor were incorrectly paid or were based on incorrect information received from the Contractor. USBE reserves the right to withhold any or all subsequent payments to the Contractor until the incorrect amounts paid have been fully recovered.