AGE Next Gen. Aging Info. System RFI.docx

Commonwealth of Massachusetts Executive Office of Health and Human Services

Commonwealth of Massachusetts Executive Office of Health and Human Services On behalf of the Executive Office of Aging and Independence (AGE)

One Ashburton Place, 10th Floor Boston, MA 02108

REQUEST FOR INFORMATION (RFI)

For Next-Generation Aging Services Information System Modernized Information & Referral, Case Management, Provider Credentialing, Licensing, Billing, Reporting, and Certification System

Document Number: 26EHSKWAGENEXTGENSYSRFI Issue Date: May 26, 2026

THIS IS A REQUEST FOR INFORMATION ONLY. Respondents to this Request for Information (RFI) are invited to respond to any or all of the questions in this document. Responses to this RFI shall serve solely to assist the Commonwealth in understanding the current state of the marketplace with regards to the solicited information. This RFI does not in any way obligate the Commonwealth to issue or amend a solicitation or to include any of the RFI provisions or responses in any solicitation. Responding to this RFI is entirely voluntary and will in no way affect the Commonwealth’s consideration of any proposal submitted in response to any subsequent solicitation, nor will it serve as an advantage or disadvantage to the Respondent in the course of any RFR or RFQ that may be subsequently issued or amended.

TABLE OF CONTENTS

Acronyms and Key Terms

Section 1. Overview The Executive Office of Health and Human Services (EOHHS), on behalf of the Executive Office of Aging & Independence (AGE), formerly the Executive Office of Elder Affairs (EOEA), is issuing this Request for Information (RFI) to solicit information from qualified technology vendors, system integrators, and other interested parties regarding modernized, integrated information systems capable of supporting the full continuum of aging services operations across the Commonwealth of Massachusetts.

AGE seeks to better understand the current technology solution landscape and available vendor capabilities in order to inform the agency’s procurement strategy for a next-generation system to replace and significantly expand upon its current Senior Information Management System (SIMS). A critical objective of this RFI is to gather sufficient information to determine the most effective procurement approach—whether that involves a single comprehensive platform, a system integrator working with the existing environment, a multi-system approach, or another model. The envisioned solution must support the agency’s core operational functions, including but not limited to: Information & Referral (I&R); clinical, financial, and transitional assessments and eligibility determination; case management and care planning; service authorization, delivery, and tracking; provider contracting and management; billing, claims processing, and reimbursement; quality assurance and provider auditing; federal and state reporting (Title III OAA, 1915(c) HCBS Medicaid waivers, Nutrition programs, Adult Protective Services, Long-Term Care Ombudsman); Assisted Living Residence (ALR) certification; home care agency certification/ licensing; SHINE counseling program management; Council on Aging (COA) coordination; constituent relationship management (CRM); integrated help desk and ticket resolution functionality; and enterprise-level data analytics and business intelligence.

The current SIMS environment serves as the multi-programmatic system of record for state and federal operations, including but not limited to the state-funded Home Care Program, the Medicaid HCBS Frail Elder Waiver, the Community Transition Liaison Program (CTLP), Title III Older Americans Act programs, and ASAP-administered local programs, connecting AGE to its network of 27 Aging Services Access Points (ASAPs), Area Agencies on Aging (AAAs), and their sub-contracted direct-service providers. The system tracks approximately 100,000+ consumers annually, manages care planning, service authorizations, service deliveries, invoicing, and reimbursement for numerous home and community-based services, supports clinical assessment and eligibility determinations, and supports federal reporting obligations under the Older Americans Act (OAAPS) and Medicaid waiver programs.

AGE will use the feedback collected through this RFI to inform the development of a formal Request for Response (RFR). The information gathered will be critical in helping AGE evaluate the strengths, limitations, and approaches of available solutions and shape a procurement that reflects the actual capabilities of the marketplace. Responding to this RFI is entirely voluntary and will not provide any advantage or disadvantage in subsequent procurement processes.

Interested organizations are invited to provide AGE with information, feedback, and responses regarding the functional areas and topic questions outlined in Section 5 of this document. AGE encourages responses from a broad range of organizations, including those offering comprehensive platforms, modular or specialized solutions, system integration services, or hybrid approaches.

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AGE administers a comprehensive network of aging services across the Commonwealth of Massachusetts, serving older adults aged 60 and older, caregivers and individuals with disabilities, as well as individuals age 22+ living in long term care facilities presenting informed choice for options to transition to community. AGE operates through regional contracts with 27 ASAPs and AAAs, each covering a unique geographic area of the Commonwealth. These agencies provide care coordination, case management, and direct or contracted services to consumers enrolled in a range of programs. AGE also contracts with 19 Protective Services Agencies, stand-alone nutrition providers, and an array of direct-service providers across the Commonwealth

Key programs administered through or in coordination with AGE include:

1. Adult Protective Services (APS)

1. Assisted Living Residence (ALR) certification and oversight, including incident reporting

1. Clinical Assessment and Eligibility (CAE) for MassHealth long-term care and certain home- and community-based programs

1. Community Transition Liaison Program (CTLP) - program designed to support and provide informed choice to residents living in nursing facilities interested in transitioning to community

1. Congregate Housing

1. Frail Elder Waiver (FEW) – a 1915(c) Medicaid HCBS waiver

1. Guardianship

1. Home Care Direct Care Provider Management Enrollments

1. Home Care Agency Certification and/or Licensing

1. Home Care Program (state-funded home and community-based services)

1. Information & Referral (I&R) services, including the MassOptions information line and Aging and Disability Resource Center (ADRC) functions

1. Long-Term Care Ombudsman Program (LTCOP)

1. Money Management Program

1. Nutrition programs (Home Delivered Meals, Congregate Meals)

1. Options Counseling for individuals and families navigating long-term services and supports

1. Senior Care Options (SCO) and One Care programs – FIDE-SNP managed care programs integrating Medicare and Medicaid benefits for dual-eligible older adults and individuals with disabilities

1. SHINE (Serving the Health Insurance Needs of Everyone) counseling program

1. Supportive Housing

1. Title III Older Americans Act programs (Supportive Services, Nutrition, Caregiver Support, Disease Prevention)

2.2 Current System Environment (SIMS)

The current Senior Information Management System (SIMS) is a centralized database and suite of applications linking AGE to its operating partners. The core application is an Aging & Disability (A&D) platform delivered as a Software-as-a-Service (SaaS) solution. SIMS supports the full business process continuum from initial consumer contact through service delivery, billing, and federal reporting.

Key SIMS components and business processes include:

1. Information & Referral (I&R): Call records (caller, consumer, consumer groups), call history tracking, referral type classification (including MassOptions), internal task assignment and routing (e.g., from I&R to Home Care), topic and outcome logging, and connection to provider resource databases. Caller and consumer, calls are tracked to consumers as service deliveries, reportable under NAPIS Title III. ADRC referral exchange functionality exists but has been largely dormant.

1. Options Counseling: Person-centered counseling to help consumers and families understand and navigate available long-term services and supports; currently tracked through a combination of call records, journal entries, and activities/referrals rather than a dedicated workflow on a time-limited, short-term basis

1. Clinical Assessment & Eligibility (CAE): RN-administered CDS-3 assessments and Nursing Determination Module (NDM) desk reviews for MassHealth program eligibility determinations, as well as other clinical assessments and tools

1. Home Care Program Operations: Consumer intake and eligibility determination, clinical and financial assessments, copayment determination and contribution calculation, service authorization, and client billing

1. Case Management Lifecycle: Consumer assessment, goal setting, care plan development, service coordination, advocacy, monitoring, documentation (journal notes, visit records, correspondence logs, and file uploads), crisis intervention, empowerment planning, and case suspension/closure/disenrollment”

1. Care Planning & Service Authorization: CDS-3-based needs assessment, service plan development, provider and schedule identification, and service authorization visibility to providers via the Service Delivery Manager (SDM) application

1. Service Delivery & Tracking: Service orders, electronic invoicing via SDM, and 837 claims generation for Waiver, SCO, and One Care programs

1. Billing & Reimbursement: Monthly billing cycles between ASAPs and contracted service providers, ASAP-to-AGE billing linked to consumer care plans and service deliveries, consumer copayment determination and billing, and Payment Voucher (PV) processing

1. Provider Management: Electronic provider contracting, audit tracking, credentialing and tracking of contracted service providers, nutrition providers, ASAPs as providers, and other provides as needed.

1. Consumer Lifecycle Management: Enrollment, program controls, disenrollment, and cross-program consumer record linking

1. Correspondence Generation: System-generated letters, notices, and communications

1. Federal Claiming & HIPAA Transactions: 837P claims for FEW, SCO, and One Care

1. Adult Protective Services: Separate application module with strict data firewall protections ensuring one-directional, permission-based data access; system must support secure identification of shared consumers across APS and A&D when coordination is required by federal mandate, with deep audit logging

1. Long-Term Care Ombudsman: Case and complaint management and program activities as outlined in the National Ombudsman Reporting System (NORS)

1. Reporting & Analytics: Federal reporting (OAAPS/NAPIS, NAMRS, NORS), ad hoc reporting (HAR), business intelligence dashboards, and program analytics

1. Information Exchange: EVV interfaces, REST-based FHIR compliant APIs operated by UMass Commonwealth Medicine, and Master Data Management (MDM) integrations

1. Community Transition Liaison Program (CTLP): transitional assessments, tracking consumer activities and enrollments.

2.3 Challenges with the Current System

Through extensive stakeholder engagement—including regional working sessions with ASAPs and AAAs, user surveys, and system enhancement assessments—AGE has identified significant challenges with the current system environment that a next-generation solution must address:

Information & Referral, Options Counseling, and ADRC Limitations

1. Limited dedicated Options Counseling workflow capabilities; person-centered counseling sessions tracked through generic call records and journal entries rather than a structured, dedicated process

1. ADRC referral exchange functionality exists but has been largely dormant; limited capacity for electronic closed-loop referrals with community partners, hospitals, health plans, and disability organizations

1. Resource directory management is cumbersome, with limited ability to maintain current, comprehensive community resource information and match consumers to services based on location, eligibility, and needs

1. No integrated screening and triage tools to support the No Wrong Door model and quickly assess consumer needs across multiple program areas

1. Limited tracking of I&R outcomes and referral conversion rates, making it difficult to measure whether consumers successfully connected with services Constituent Relationship Management (CRM) Gaps

1. No unified constituent relationship management capability; interactions with consumers, caregivers, families, providers, and community partners are tracked in disparate, disconnected records across program areas with no holistic view of the relationship

1. Limited ability to track the full history of a constituent’s engagement with the aging services network across I&R contacts, Options Counseling sessions, program enrollments, service episodes, complaints, and other touchpoints

1. No proactive outreach or engagement management tools; inability to segment constituents for targeted communications, follow-up campaigns, program announcements, or satisfaction surveys

1. Lack of centralized contact and communication management; no consolidated log of all communications (calls, emails, letters, texts) with a constituent across agencies and programs

1. No constituent self-service portal or digital engagement channel for consumers and caregivers to view their information, communicate with their care team, or manage their service preferences System Performance and Stability

1. Frequent system freezing, lagging, and crashes that disrupt daily workflows

1. Slow load times, excessive clicks, and complex navigation to complete routine tasks

1. Pop-up error messages, date rounding errors, and broken data fields

1. Limited auto-save and offline functionality resulting in data loss Data Quality and Integrity

1. Limited ability to configure algorithms supporting end-user directional workflows

1. Limited ability to set field-level validation parameters to prompt better data hygiene in real time

1. Inconsistent data formats and mismatched consumer records across systems

1. Limited ability to configure and extend standardized data definitions and validation checks across programs \

1. Conflicting consumer records leading to billing errors and claim denials

1. Difficulty assembling a complete, unified consumer profile across programs Interoperability and Integration

1. Minimal interoperability between the core system and external systems (MassHealth, DTA, USPS, DPH Vital Statistics, such as death records)

1. Inability to share data effectively across care teams and programs

1. Manual, redundant data entry across multiple disconnected systems

1. Limited API functionality for automated data exchange

1. Limited capability to conduct clinical and program assessments in the field or in-home settings due to system architecture constraints

1. No integration with Medicare Advantage and FIDE-SNP health plan care management systems; care coordination for consumers enrolled in SCO and One Care programs requires manual exchange of information between ASAP/AAA care managers and health plan care teams, resulting in duplicative assessments, fragmented care plans, and limited visibility into services and supports being provided across the aging services network and managed care organizations

1. No CRM or coordination capabilities with SCO, One Care, and PACE programs; AGE and ASAPs/AAAs lack the ability to track referrals to organizations, monitor consumer transitions between organizations, or maintain relationship management with organizations as part of the broader aging services network

1. No integrated bi-directional help desk or ticket resolution system; staff must enter tickets into two separate systems.

Reporting and Analytics

1. Inadequate ad hoc reporting capabilities and slow report generation

1. Lack of customizable dashboards, real-time analytics, and predictive reporting

1. Manual processes for federal reporting (NAPIS/OAAPS, NORS)

1. Does not enable direct database access for analytics applications (such as R, Power BI, or similar tools) from standard workstations; automated reporting and data analysis require access to a separate remote environment Workflow and Process Efficiency

1. Excessive manual steps and paper-based processes alongside the electronic system

1. Assessment instruments that have limited flexibility for modification after submission within policy-defined timeframes

1. Limited configurable guided workflows that can accommodate varied ASAP business practices while maintaining statewide standards, as well as automated task assignments, and bulk-action tools

1. Manual tracking of referrals, provider audits, and corrective action plans outside the system User Experience and Training

1. System interface is not intuitive or consumer-centered

1. Insufficient training resources, no integrated learning management system for the core A&D environment (note: APS maintains a separate LMS)

1. Limited mobile functionality for field workers conducting home visits

1. System interface limitations including restricted text formatting in journal notes, manual spell-check activation, and character limits that truncate user information Provider Management Gaps

1. Provider audit processes conducted outside the system using paper or external tools

1. No centralized mechanism for corrective action plan tracking

1. Limited visibility into provider performance metrics and contract compliance Program Coverage Gaps

1. No integrated support for Assisted Living Residence (ALR) or other provider-type certification, inspection tracking, and compliance management

1. SHINE counseling program operations (counselor management, session tracking, reporting) not supported

1. Council on Aging (COA) coordination, grant management, and reporting conducted through separate manual processes

1. Long-Term Care Ombudsman Program facility tracking capabilities and robust reporting options.

2.4 Desired Capabilities and Areas for Demonstration

Through prior assessment work and stakeholder engagement, AGE has identified a number of specific functional capabilities that are critical priorities for a next-generation system. AGE is particularly interested in understanding how respondents would address these needs and, during subsequent vendor demonstration sessions, seeing these capabilities in action:

API and Third-Party Data Integration

1. Standard API functionality to automatically generate journal entries and activities/referrals for known (existing) consumers based on data updates from external systems; workflow approaches for accepting inbound API referrals for new (unknown) consumers while avoiding duplicate record creation; and users should be able to easily generate outbound API-based referrals to external partners.

1. Real-time or near-real-time integration with Medicaid MMIS data (e.g., eligibility, enrollment, service authorization, and claims), DTA SNAP benefits information, USPS verified address data, and consumer death records from vital statistics

1. Interface capabilities with the Master Data Management (MDM) systems

1. Integration capability with federal reporting systems

1. Ability to flag consumers who are involved with other state agencies or programs (e.g., DDS, DMH, MassHealth managed care including SCO, One Care, and PACE; Optum authorizations reflecting AFC/PCA program enrollment) through API-based data exchange

1. Integration with electronic visit verification (EVV) systems, including bi-directional exchange of consumer, service authorization, and service delivery data and reconciliation of visit records

1. Integration with state data warehouse infrastructure (Snowflake) for centralized analytics and reporting

1. Patient event notification capabilities (e.g., ADT feeds, admission/discharge/transfer alerts) to support care coordination and real-time awareness of consumer status changes

1. Bidirectional data exchange with health plans (SCO, One Care, FIDE-SNP) for pertinent consumer clinical and enrollment data, and API support for agency data warehouse population

1. Support for SMART on FHIR API standards for healthcare interoperability Enhanced Consumer Profile and Care Planning

1. A unified CRM and consumer profile summary panel displaying demographics, care manager(s), emergency contacts, current service plan, assessment information, ADL/IADL scores (both federal and state calculations), and Medicaid State Plan and relevant waiver services

1. Care plan features supporting entry and tracking of both formal and informal services, summary display of consumer needs and goals, suggested services notifications based on unmet needs, and automated data population from the most recent clinical assessment

1. Support for multiple care managers per consumer organized by discipline (primary, nursing, nutrition, GSSC, etc.)

1. Voice-to-text functionality for journal note documentation Wellness and Risk Assessment Algorithms

1. Configurable algorithms that analyze consumer data across multiple indicators—including suspensions, medications, falls, comorbidities, and nutritional risk—to generate wellness and care consideration profiles with overall risk scores

1. A risk indicator panel within the consumer record that enables care managers to quickly identify at-risk consumers and prioritize interventions

1. Automated journal entries and activity/referral generation triggered by risk indicator changes Electronic Provider Audit Management

1. Ability to create, conduct, and track provider audits directly within the system, with configurable audit templates by type (standard, ad-hoc, new provider)

1. Auto-population of audit questions based on audit type, real-time data entry capability during onsite audits, and automated determination of whether a Corrective Action Plan (CAP) is required

1. Historical audit records, CAP tracking, and provider performance reporting Learning Management and Training

1. A centralized learning portal integrated with or accessible from the system, including a training library with modules, job aids, and manuals

1. Training completion tracking with certificate generation, email notifications for due and overdue trainings, and compliance reporting

The primary goal of this RFI is to gain a comprehensive understanding of the technology solution landscape and the capabilities of vendors serving the aging services, HCBS, and health and human services sectors. AGE intends to use the information gathered to determine the most effective procurement strategy for a next-generation system—including whether to pursue a single comprehensive platform replacement, a system integrator approach that leverages and modernizes elements of the existing environment, a strategy combining specialized solutions, or another model altogether.

AGE seeks responses from a broad range of organizations—including comprehensive platform vendors, modular or niche solution providers, system integrators, and consulting firms with relevant implementation experience—to ensure the agency has a thorough understanding of available options before issuing a formal RFR.

3.2 Objectives

1. Understand the Solution Landscape: Identify the range of available technology solutions, architectural approaches, and vendor capabilities that could support the Commonwealth’s aging services operations, including comprehensive platforms, modular systems, and integration frameworks.

1. Inform Procurement Strategy: Gather sufficient information to determine whether the subsequent RFR should seek a single-vendor replacement, a multi-vendor best-of-breed approach, a system integrator model, or a hybrid strategy. Understand the trade-offs, timelines, and cost implications of each approach.

1. Assess Comprehensive Functional Coverage: Evaluate vendor capabilities across the full lifecycle of aging services operations including I&R, Options Counseling, ADRC functions, constituent relationship management (CRM), clinical assessment, eligibility, case management, care planning, service authorization and delivery, provider management and licensing, billing, claims, quality assurance, LTCOP, SHINE, COA coordination, ALR certification, and federal/state reporting.

1. Evaluate Interoperability and Data Exchange: Understand how solutions enable seamless, standards-based integration with Medicaid MMIS systems, state agency data sources (DTA, vital records, USPS), Electronic Visit Verification (EVV) platforms, and other health and human services systems using HL7, FHIR, X12, and RESTful API standards.

1. Assess Data Quality, Reporting, and Analytics Capabilities: Understand how solutions provide robust data validation, standardized data definitions, customizable reporting and dashboards, real-time analytics, and automated support for federal reporting obligations (OAAPS, NAMRS, NORS, HCBS quality measures).

1. Evaluate User-Centered Design: Assess the availability of intuitive, accessible interfaces that reduce manual burden, support mobile and field-based use, and accommodate diverse user roles across AGE, ASAPs/AAAs, COAs, and providers.

1. Understand Provider Management and Oversight Capabilities: Evaluate how solutions support credentialing, licensing, certification tracking (including ALR and home care agency licensing), electronic provider auditing, corrective action plan management, and contract compliance monitoring.

1. Assess Scalability and Adaptability: Understand how solutions support future program expansion, integration with additional EOHHS agencies, and emerging requirements such as consumer self-service portals, AI-assisted workflows, and advanced predictive analytics.

3.3 Guiding Principles

1. Person-Centered Approach: The system must place the consumer and caregiver at the center of all workflows, enabling holistic views of needs, services, and outcomes

1. Single Point of Data Entry: Minimize or eliminate duplicate data entry by enabling data to flow across modules and programs without re-entry

1. Transparency and Visibility: Provide all authorized users with timely, accurate, role-appropriate views of consumer information, service plans, referral status, and provider activity

1. Standardization with Flexibility: Establish statewide standards for data definitions, workflows, and reporting while allowing appropriate local customization

1. Security and Compliance: Ensure full compliance with HIPAA, state privacy laws, CMS regulations, and federal data security requirements; the system must support record- and field-level security controls, role-based access with minimally necessary permissions, and appropriate cross-agency visibility restrictions to protect consumer confidentiality

1. Continuous Improvement: Support an iterative approach to system enhancements, with built-in mechanisms for user feedback, performance monitoring, workflow optimization, and feature development

1. Equity and Accessibility: Ensure the system supports multilingual capabilities, accessible design (ADA/Section 508 compliance), and culturally responsive service delivery

Section 4. Scope of Functional Requirements The following describes the core functional areas that the next-generation system must support. Respondents should address their solution’s capabilities relative to each area in their RFI response (see Section 5 for specific questions).

4.1 Information & Referral (I&R)

Information & Referral is often the first point of contact between consumers, families, and caregivers and the aging services network. The system must support comprehensive, high-quality I&R operations that enable staff to efficiently connect individuals with appropriate services and supports while maintaining accurate records of all interactions.

Core I&R capabilities must include:

1. Call and contact record management supporting multiple contact types (telephone, walk-in, email, web-based, chat) with the ability to record caller information, consumer information, and consumer group records

1. Complete call and contact history by caller and by consumer, enabling I&R specialists to quickly review prior interactions and service connections

1. Robust automated duplicate detection with configurable matching algorithms that generate potential match lists during data entry, with appropriate override controls and audit logging when staff bypass match suggestions

1. Referral type classification and routing, including support for MassOptions and other statewide information lines, with the ability to configure referral categories and pathways

1. Internal task assignment and routing capabilities to hand off from I&R to other program units (e.g., Home Care intake, Protective Services, SHINE, Options Counseling, Nutrition, Family Caregiver Support) with automated notifications and status tracking

1. Referral tracking with closed-loop status updates, enabling both the referring and receiving agency or unit to see referral progress and outcomes in real time

1. Topic and outcome documentation using standardized, configurable taxonomies aligned with AIRS (Alliance of Information and Referral Systems) standards and 211 compatibility where applicable

1. Integration with community resource directories, including the ability to search, filter, and match consumers to available community resources based on geography, eligibility, service type, language, and accessibility needs

1. Comprehensive resource directory management, including the ability to maintain, update, and publish a statewide directory of aging and disability services, community organizations, government programs, and other resources with detailed service descriptions, eligibility criteria, contact information, hours of operation, and geographic service areas

1. Warm handoff and transfer functionality enabling I&R staff to transfer consumers and associated records to partner agencies, programs, or external organizations with appropriate consent tracking

1. Follow-up tracking and scheduling, including the ability to set reminders for consumer follow-up contacts and track whether referrals resulted in successful service connections

1. Reporting on I&R contact volumes, referral patterns, unmet needs, wait times, and outcomes to support program management, resource planning, and federal reporting requirements

1. Multi-channel communication support, including the ability to send referral confirmations, resource information, and follow-up communications to consumers via email, text, or printed correspondence

4.2 Options Counseling

Options Counseling is a person-centered, time limited, interactive process in which individuals receive assistance in understanding and evaluating their long-term services and support options. The system must support dedicated Options Counseling workflows that enable counselors to guide consumers and families through the decision-making process.

Required Options Counseling capabilities include:

1. A structured Options Counseling workflow supporting the key stages of the counseling process: intake and needs identification, exploration of options (including home and community-based services, facility-based care, self-directed options, and other supports), decision support, action planning, and follow-up

1. Person-centered planning tools that capture consumer preferences, goals, values, cultural and linguistic needs, informal support networks, and financial considerations alongside clinical and functional needs

1. The ability to present and compare available service options to consumers, drawing from the resource directory, eligibility data, and program availability to generate personalized options summaries

1. Action plan documentation that records the consumer’s chosen course of action, agreed-upon next steps, responsible parties, and timelines, with the ability to track plan progress and completion

1. Seamless handoff from Options Counseling to appropriate program enrollment teams , with all counseling documentation and consumer preferences flowing into subsequent workflows without re-entry

1. Tracking of Options Counseling contacts, sessions, topics covered, and outcomes to support compliance with ACL (Administration for Community Living) reporting requirements and ADRC performance metrics

1. Support for conducting Options Counseling in multiple settings—including in-person, telephone, video, and community-based settings—with mobile and remote access capabilities for field-based counselors

1. Integration with benefits screening tools and eligibility systems to help consumers understand their potential eligibility for Medicaid, Medicare, Title III, state-funded, and other programs during the counseling process

1. Consent and privacy management to document consumer authorization for information sharing across agencies and programs involved in the Options Counseling and referral process

4.3 Aging and Disability Resource Center (ADRC) Functions

Massachusetts ASAPs and AAAs serve as Aging and Disability Resource Centers (ADRCs), functioning as highly visible and trusted points of entry into the long-term services and supports system. The system must support the full scope of ADRC operations, which encompass I&R, Options Counseling, and streamlined access to services, with a particular focus on the "no wrong door" philosophy.

Required ADRC capabilities include:

1. A unified intake and screening process that supports the ADRC’s role as a single point of entry, enabling staff to identify consumer needs across multiple programs and domains (aging services, disability services, behavioral health, housing, transportation, nutrition, etc.) and route individuals to appropriate services regardless of which door they entered

1. Cross-program visibility enabling ADRC staff to view a consumer’s complete interaction history, referrals, and service connections across all programs and agencies within the network, supporting the "no wrong door" model

1. Standardized screening and triage tools that help ADRC staff quickly assess the level of need and urgency, identify potential eligibility for multiple programs, and determine the appropriate level of service (information only, referral, Options Counseling, crisis intervention, care management)

1. Closed-loop referral management for both inbound and outbound referrals between ADRCs and partner organizations (hospitals, health plans, disability organizations, veteran services, housing authorities, community-based organizations, Councils on Aging), with electronic referral exchange, status tracking, and outcome documentation

1. Support for the ADRC partnership model, enabling appropriate data sharing and referral exchange between ASAP/AAA ADRC partners and other organizations serving the ADRC function (e.g., Independent Living Centers, disability organizations, Councils on Aging), with configurable access permissions and information sharing agreements

1. Consumer consent management and tracking, including the ability to document, manage, and enforce consumer authorizations for information sharing across ADRC partners and service providers

1. ADRC-specific performance metrics and reporting, including contact volumes by channel, referral conversion rates, time to service connection, consumer satisfaction, unmet needs tracking, and reporting aligned with ACL ADRC program requirements and No Wrong Door (NWD) system performance measures

1. Integration with statewide resource databases and 211 systems to provide comprehensive, up-to-date information on available services and supports across the Commonwealth

1. Support for ADRC outreach and community engagement tracking, including documentation of presentations, events, partnerships, and marketing activities

4.4 Assessment and Eligibility Determination

The system must accommodate clinical assessments (e.g., Nursing Determination Module, CDS-2-NF,CDS-3-RN, and MDS-HC administered by RNs) for MassHealth clinical eligibility including Adult Day Health, Nursing Facility Level of Care, Frail Eder Waiver and Enhanced Community Options Program, as well as non-clinical assessments (e.g., financial assessments and copayment determination, CTLP transitional assessments, nutrition assessments, Family Caregiver Support assessments, and I&R screening tools). It should support configurable assessment instruments, electronic signature capture, assessment versioning and history, automated ADL/IADL scoring (both federal and state calculations), and data flow from assessments into care plans and consumer profiles. The system should enable quality metrics derivation from assessment and screening data. The consumer’s care plan care plan must be visible to the ASAP, provider, and consumer through appropriate role-based access. The system should also be able to obtain and consume standard MMIS EDI transaction files such as 270/271 and 834 files.

4.5 Home Care Case Management, Care Planning and Documentation The system must provide comprehensive case management functionality including consumer intake and enrollment workflows, comprehensive care plan development with identified needs and goals, service plan construction formal supports, informal supports and with specific authorized services, interventions, providers, schedules, and unit authorizations. Care plans should support both formal and informal interventions tracking, suggested services notifications based on unmet needs and goals, data pre-population from assessments, and a summary view of consumer needs and supports. The system must support multiple care managers per consumer by discipline (primary, nursing, nutrition, GSSC, etc.) and provide a unified consumer profile summarizing demographics, emergency contacts, service plans, assessment information, and risk indicators. The case management and care planning workflows must also link with the comprehensive assessment capabilities outlined in Section 4.4 and connect with consumer psychosocial, financial, eligibility, ADL/IADL, behavioral health, medications, proxies/guardians, nutrition history, journal note documentation, and the full case management lifecycle.

4.6 Service Authorization, Delivery, and Tracking

The system must manage the complete service delivery cycle including service plan maintenance, change logging visible to providers, monthly service order generation, suspension recording and management, and electronic service delivery entry by providers. The system should support 15-minute unit increments for in-home services, accommodate EVV integration requirements, and generate 837 claims for Medicaid waiver and managed care programs (FEW, SCO, One Care). Service authorizations must be visible to providers through an integrated portal or application. Additionally, the system must manage and track consumer disenrollment, case closure, and program exit processes with configurable closure reasons, automated notifications, and transfer/transition workflows.

4.7 Billing, Claims, and Reimbursement

The system must support the full billing lifecycle including service order generation, provider invoice submission and reconciliation, Payment Voucher (PV) functionality for AGE-to-ASAP and AGE-to-contractor reimbursement processing, 837P/837I claims creation and submission, remittance processing, rate table management with automated annual updates, consumer-level detail in electronic invoicing to eliminate the need for supplemental documentation and reduce duplication of effort, claims adjustment and corrected claim processing, denial code tracking and cash application, vendor claim remediation within the system, and financial reporting. The system should reduce the manual burden of the monthly billing cycle between ASAPs and their contracted providers and support varied billing arrangements across programs and funding sources, as well as ability to accommodate non-ASAP entities contracted with and reimbursed by AGE (e.g., Supportive Housing and Congregate Housing contractors). The system should accommodate automated billing adjustment, remediation, and reconciliation capabilities.

4.8 Provider Management, Credentialing, and Auditing

The system must support comprehensive provider management including provider enrollment and credentialing, license and certification tracking with expiration alerts, contract management and compliance monitoring, and electronic provider auditing. Provider audit functionality should include configurable audit templates by type (standard, ad-hoc, new provider), auto-populated audit questions, real-time data entry during onsite audits, automated corrective action plan (CAP) determination and tracking, and historical audit record maintenance. The system should generate provider performance reports and support contract accountability metrics.

4.9 Reporting and Analytics

The system must provide robust reporting and analytics capabilities including automated federal report generation (OAAPS/NAPIS, NAMRS, NORS, HCBS quality measures), customizable ad hoc reporting with user-friendly tools, real-time dashboards and key performance indicators (KPIs), drill-down analytics by program, agency, geography, and consumer characteristics, comparative and enterprise-wide analytics with features such as heat mapping and PMPM cost analysis, and data export in standard formats. The system should support report subscriptions, scheduling, and distribution, and should provide programmatic access to completed reports through standard mechanisms such as APIs, SFTP, or scripted retrieval to support agency-level downstream data workflows and automation.

In addition to operational and federal reporting, the system must support comprehensive quality measurement capabilities aligned with nationally recognized frameworks applicable to aging services and HCBS programs. Specifically, the system must:

1. Support the capture, calculation, and reporting of quality measures aligned with the CMS Home and Community-Based Services (HCBS) Quality Measure Set, the National Core Indicators – Aging & Disabilities (NCI-AD) framework, Administration for Community Living (ACL) and Older Americans Act performance measures, and Medicaid LTSS or managed LTSS quality measures

1. Capture the underlying data elements necessary for quality measure calculation, including data from clinical assessments, service authorizations, service delivery records, consumer outcomes, and consumer experience surveys

1. Include preconfigured quality measures where available and allow administrators to define, configure, and modify custom quality measures to align with evolving federal and state reporting requirements without vendor involvement

1. Support measure calculation logic with built-in validation, auditing, and exception handling to ensure accuracy and consistency of reported quality data

1. Provide dashboarding and visualization of quality indicators, with the ability to stratify measures by demographic characteristics (e.g., age, race/ethnicity, language, geography, disability status) to support health equity analysis

1. Enable performance tracking at multiple levels—statewide, regional, ASAP/AAA, provider, program, and individual consumer level—to support continuous quality improvement at every tier of the aging services network

1. User-configurable ad-hoc reporting with the ability to tailor reports to specific programmatic, operational, and analytical needs without requiring vendor or technical staff involvement

1. Support state-specific performance metrics for ASAPs, AAAs, and community-based aging services networks, including contract performance measures, consumer satisfaction indicators, and operational efficiency benchmarks

1. Provide export and integration capabilities with external analytics platforms and business intelligence tools to support advanced quality analysis beyond the system’s native capabilities that are scheduled reliably and retrieved automatically (via API, SFTP, etc.).

Data security controls and audit logging for any export, download, or external use of consumer data outside the system environment

4.10 Nutrition Program Management

The system must support nutrition program operations including Home Delivered Meals and Congregate Meals programs, nutrition provider management, meal tracking and delivery verification, HDM delivery route planning and management, nutritional risk screening, and reporting for Title III Nutrition programs. The system should accommodate both ASAP-operated and standalone nutrition provider workflows. Additionally, the system should provide support for diverse meal types with configurable modifiers and cost assignments; route management and delivery sequencing for home delivered meals; congregate meal site roster and attendance tracking; nutrition assessment with automated risk-based referral workflows; integration across multiple program funding sources (federal, state, MassHealth); and quality measures reporting by location, payer, and program.

4.11 Adult Protective Services Integration

The system must either include or integrate with an Adult Protective Services (APS) module supporting intake, investigation, and workflow management for protective services, with appropriate data sharing and information barriers between APS and other program areas.