ALABAMA MEDICAID AGENCY

Eyeglasses

INVITATION TO BID (ITB)

SECTION 1 INTRODUCTION TO PROCUREMENT

1.0 PURPOSE

The Alabama Medicaid Agency (Medicaid) solicits bids for the procurement of services with a Contractor to provide eyeglasses to Medicaid recipients.

1.1 GENERAL ITB REQUIREMENTS

Alabama Code, Section 22-6-7.1, states the contract(s) for the procurement of prescription eyewear for the recipients of the Alabama Medicaid program must be competitively bid.

The successful supplier will be responsible for furnishing eyeglasses that meet all federal, state, and Medicaid standards. Contractor acknowledges and understands that this contract is not effective until it has received all requisite state and federal government approvals. Contractor shall not begin performing work under this contract until notified to do so by Medicaid. Contractor is entitled to no compensation for work performed prior to the effective date of this contract.

Medicaid will enter into one initial contract for twelve (12) months. Medicaid shall have two (2) one-year options for extending this contract at the original contract price. At the end of each contract year Medicaid may at its discretion, exercise the extension option and allow the period of performance to be extended for an additional contract year. Such option shall be exercised by written notice to the Contractor within ninety (90) days prior to the termination date of the contract or any extension. The bid response must present a complete and detailed description of the supplier’s qualifications to perform, and its approach to carry out the requirements of this ITB.

All bids must be received by the State of Alabama’s Office of the Chief Procurement Officer, as specified in Alabama Buys.

1.2 PROJECT MANAGER

The individual designated by this bid to coordinate activities, resolve questions, monitor Contractor performance, ensure that all contract requirements are met, approve payments and act as the Medicaid contact for the Contractor is:

Calvin Binion

Alabama Medicaid Agency P.O. Box 5624 501 Dexter Avenue Montgomery, Al 36103-5624

1.3 SUPPLIER QUALIFICATIONS

Medicaid actively solicits bids from entities interested in serving as an Eyeglasses Contractor. Any entity wishing to serve as an Eyeglasses Contractor must submit a written bid for participation. By submitting a proposal in response to this ITB, the proposing party grants Medicaid the right to contact any or all of the suppliers’ clients.

This document outlines the qualifications which must be met in order for an entity to serve as an Eyeglasses Contractor. It is imperative that potential Contractors describe in detail how they intend to approach the Scope of Work specified in Section 3 of the ITB. The ability to perform these services must be carefully documented, even if the supplier has been, or is currently, participating in a Medicaid Program and providing eyeglasses for Medicaid recipients. Bids will be evaluated based on the written information that is presented in the bid. This underscores the importance and the necessity of providing in-depth information in the bid with all supporting documentation necessary.

The supplier must demonstrate in the bid a thorough working knowledge of program policy requirements as described in these ITB specifications, including but not limited to the applicable Operational Manuals, State Plan for Medical Assistance, Administrative Code requirements and Code of Federal Regulations (CFR) requirements.

Bids shall include proof of capability of the supplier to carry out the performance requirements of the State of Alabama as required in Section 22-6- 7.1, Code of Alabama 1975, which takes into consideration cost factors, program suitability factors, technical factors including understanding of program requirements, management plan, excellence of program design, key personnel, corporate or company resource and designated location, and other factors including financial condition and capability of the supplier, corporate experience and past performance and priority of the business to ensure the contract awarded is the best for the purposes required. Each of these criteria shall be given weight value designated in the ITB. Suppliers owning multiple facilities must indicate that they will furnish all eyewear materials during contract period from the facility submitting the bid. The evaluation of proof to carry out performance requirements as set forth will be based solely on supplier’s written responses.

Entities that are currently excluded under federal and/or state laws from participation in Medicare/Medicaid or any State’s health care programs are prohibited from submitting bids.

Entities submitting bids must:

a. Have all necessary business licenses, registrations, and professional certifications at the time of the contracting to be able to do business in Alabama. All companies submitting proposals in response to this ITB must be qualified to transact business in the State of Alabama in accordance with to include, but not limited to, § 10A-1- 7.01 et seq., Code of Alabama 1975, and shall have filed and possess a valid “Application for Registration” issued by the Secretary of State at the time of responding to this ITB. To obtain forms for the application, contact the Secretary of State, (334) 242-5324, www.sos.state.al.us.

b. Be able to provide reports to the State on utilization, expenses, and quality measures.

c. Be fiscally sound and possess adequate financial reserves.

d. Submit a minimum of two (2) actual written performance references and two (2) credit references to include contact name, title, telephone number, and addresses. Performance references should also include contract type, size, and duration. An additional list of major lens and frame suppliers shall be included.

e. Submit corporate experience information to include the number of current state eyeglass contracts held, repeat business, percent of business representing contract sales, and company longevity.

f. Submit a statement that the Supplier accepts and understands the contract requirements to include compliance with general federal and state rules, record maintenance, recipient confidentiality, security requirements, and on-line computer system requirements as defined in the ITB and must demonstrate the ability to submit hard-copy clean claims when necessary.

g. Submit a management plan to address their ability to absorb contract into present operation. This plan shall provide plans for lab management and data reporting, disaster plans, and quality control. Labor issues to include whether employees are unionized should be expressed in this plan. If employees are unionized, have any walkouts and/or strikes occurred within the last five-(5) years. If employees are not unionized, have there been any labor problems in the last five-(5) years.

h. Submit resumes for the following key personnel positions. Resumes should include education, training, and experience for each position.

• General Manager

• Production Manager

• Contract Manager

• Finishing Lab Manager

• Stockroom Manager http://www.sos.state.al.us/

• Comptroller

i. Submit company resource information to include facility size and design, computer capabilities, level of skilled employees, training programs, age/condition of equipment, and company’s financial base (debits, credits, holds, etc.). The supplier shall submit a Profit and Loss Statement for the last fiscal year.

j. Submit documentation for past performance to include previous and/or current related experience, which shall include product quality, returned jobs, average time of order completion, and client satisfaction.

k. Submit an acknowledgement and compliance statement for the requirement of a performance bond of approximately two hundred seventy-five thousand dollars ($275,000).

l. Submit a fixed price quote to furnish the services required by the ITB.

m. Submit a State of Alabama “Bid Sheet” form (Attachment C), with the address to which orders will be sent, signed in ink by the supplier (or an officer of the supplier who is legally authorized to bind the supplier to the ITB) and notarized by a notary public.

n. Submit a signed copy of the Authorization for Release of Business

Information Form (Attachment F).

o. Submit a listing of frames and lenses available through its company as well as similar in-stock frames (by manufacturer) of equal quality that would be utilized as replacements.

p. Be able to provide reports to the state on specific utilization (e.g., glass versus plastic or polycarbonate lenses), expenses, and quality measures.

q. Be enrolled with the Alabama Medicaid Agency in good standing

SECTION 2 PROGRAM REQUIREMENTS AND SPECIFICATIONS

2.1 PERFORM QUALITY ASSURANCE MONITORING

Contractor must monitor the quality of its operation and performance standards.

The Contractor shall provide quality control processes and procedures for all eyeglasses mailed on behalf of a Medicaid recipient. The Contractor shall maintain an individual on staff trained in optical quality control to complete the monitoring and inspections.

The Contractor is required, upon receipt, to process and ship all properly completed job orders within ten (10) working days. Date of receipt is considered the 1st working day after order is received and the last working day is the day an order is transmitted for delivery, or a provider is notified of a delay. The successful monthly fill rate shall be at least 95%. Records shall be maintained on ordering, work status, tracking, shipping, inquiries, and any corrective actions taken for resolution.

Any time there is a legitimate delay in job order processing the Contractor will notify the providers of the reason and expected date of shipment. Justified delays in orders may include, but are not limited to, lens/frame back-orders, breakage, inventory, complex lens orders, computer failure, power failures, and natural disasters. Justified delays are defined as being beyond the control of the Contractor.

The Contractor shall ensure that all lenses are of first quality, finished and assembled in accordance with the prescription from which the request was initiated. Contractor shall ensure that all lenses supplied are of clear glass, clear plastic, hi-index plastic or polycarbonate, or polycarbonate meeting existing FDA impact-resistant regulations and conforming to ANSI requirements. Flat top 25, 28, and 35 will be the standard bifocal lens size unless 22 round is requested.

The Contractor shall provide only those frames evaluated and approved by the Alabama Medicaid Agency and the Optometric Peer Review Committee, Attachment D. These frames shall be available in standard colors, eye sizes, bridge sizes, and temple length as are available from the frame manufacturer.

All frames must meet ANSI Standards. Samples should not be included as part of the ITB.

If, during the contract period any of the contract frames become unavailable, Contractor shall furnish similar frames of equal or better quality. Substitute frames shall have a price no greater than the original contract frames and shall be approved by Alabama Medicaid. Medicaid will not reimburse the Contractor for any lenses or frames that do not meet or exceed the quality as outlined.

Contractor shall guarantee all products against defective workmanship and/or materials. If within 90 days after delivery, a product is found by the dispensing provider to be unsatisfactory due to Contractor’s error, defective workmanship, or materials, the Contractor shall make necessary adjustments or replacements at the Contractor’s expense. Additionally, corrected and/or replacement products shall be returned to the provider within 10 working days of receipt of product.

2.2 REPORTING

During the implementation phase of the contract, Contractor must submit monthly status reports covering activities, problems, and recommendations.

During the first three months of operation, Contractor must also include the information outlined below. After the first three months of operation, the Contractor must submit the same status reports on a quarterly basis.

The status report must summarize all information for the reporting period and the year-to-date and provide analysis and commentary on the numerical figures presented in the reports. All reports must be provided electronically, unless otherwise specified.

The status report must include the following:

1. Quarterly performance report to include, at a minimum:

• procedure code

• name of frames

• description of lenses

• monthly volume

• year-to-date volume

• reimbursement amount (monthly and year-to-date)

• average turnaround time by lens category

• contract error return

2. Quarterly record of job orders to include, at a minimum:

• Recipient name

• Medicaid number

• Provider number

• Date order was received

• Date eyewear mailed

• Date eligibility verified

The contractor shall be responsible for timeliness, accuracy, and completeness of reports as defined below:

• Timeliness – Reports or other required data must be received on or before scheduled due dates.

• Accuracy – Reports or other required data must be prepared in conformity with appropriate authoritative sources and/or Medicaid defined standards.

• Completeness – All required information must be fully disclosed in a manner that is both responsive and pertinent to report intent with no material omissions.

• Contractor must agree to be responsible for continued reporting beyond the term of the contract. For example, processing claims and reporting encounter data will likely continue beyond the term of the contract because of lag time in filing source documents by subcontractors.

Medicaid requirements regarding reports, report content, and frequency of submission of reports are subject to change at any time during the terms of the contract. Contractor shall comply with all changes specified by Medicaid.

Medicaid will serve timely notice of any changes.

2.3 ADDITIONAL CONTRACTOR RESPONSIBILITIES

Contractor shall be expected to perform all responsibilities and deliverables within this ITB. Additional Contractor responsibilities are listed below.

Contractor shall coordinate with the Medicaid Project Manager throughout the term of this contract for any questions and further direction as it relates to the functions of this ITB. Contractor shall make recommendations for approval for services or equipment to increase efficiency, effectiveness, and appropriate utilization as it relates to this ITB.

2.4 ADDITIONAL MEDICAID RESPONSIBILITIES

Medicaid agrees to correspond to inquiries from the Contractor in a timely and accurate manner, interpreting Medicaid policy so that Contractor is able to respond and provide deliverables as indicated throughout this ITB. Medicaid shall inform Contractor of policy changes which could directly affect Contractor's operations.

2.5 OPERATIONAL REQUIREMENTS

Contractor shall reference Chapter 4 of the Alabama Medicaid Provider Manual, “Obtain Prior Authorization,” as needed, to ensure cost-monitoring, utilization review, measure, and quality assurance mechanism for the Alabama Medicaid program.

Contractor must verify the Medicaid recipient’s eligibility and benefit limits prior to making the eyeglasses. Contractor should reference Chapter 3 of the Alabama Medicaid Provider Manual “Verifying Recipient Eligibility" as needed to ensure aid categories are eligible to receive eyeglasses before the eyeglasses are made. In order to verify recipient eligibility and eyeglass benefit usage, the Contractor shall interface and access Medicaid's online Information System (MMIS) via the Medicaid Provider Web Portal.

Contractor system responsibilities include:

1. Submission of requests for employee passwords for the Medicaid system.

2. Notifying Medicaid and fiscal agents when an issued password is no longer needed due to termination of employment or change in duties within five days.

3. Ensuring its employees are informed of the importance of system security and confidentiality.

4. Documenting and notifying Medicaid of system problems to include the type of problem, action(s) taken by Contractor to resolve the problem, and length of system down-time within eight hours of problem identification. Contractor shall ensure that the problem is resolved within 24 hours of system down time.

Medicaid system responsibilities include:

1. Obtain security passwords from the Fiscal Agent upon Contractor's request

2. Serve as liaison between Contractor and Fiscal Agent

Contractor must have a HIPAA-compliant system with effective security measures to prevent the unauthorized use of or access to, data. The selected Contractor must maintain confidentiality and only use information from the Agency to fulfill its contractual obligations.

2.6 KEY PERSONNEL

Contractor must maintain sufficient staffing levels to meet program requirements and maintain the capability to provide quality frames and lenses to Medicaid eligible recipients as outlined in this ITB. At a minimum, Contractor shall maintain full-time employees in each of these positions during the term of the contract:

• General Manager

• Production Manager

• Contract Manager

• Finishing Lab Manager

• Stockroom Manager

• Comptroller

Contractor shall, upon request, provide Medicaid with a resume of any members of its staff or a subcontractor’s staff assigned to or proposed to be assigned to any aspect of the performance of this contract. Medicaid shall have the absolute right to approve or disapprove the Contractor’s, or any subcontractor’s, General Manager, Production Manager, Contract Manager, Finishing Lab Manager, Stockroom Manager, or Comptroller, and to approve or disapprove any proposed changes in these personnel, or to require the removal or reassignment of any personnel found by Medicaid to be unwilling or unable to perform under the terms of the contract.

2.7 OTHER PERSONNEL

Contractor shall demonstrate the ability to secure and retain adequate staff to meet contract requirements.

Contractor may, if justified, during the contract period, subcontract for any services necessary to the completion and maintenance of this contract and to the performance of its duties under this contract after obtaining prior written approval from Medicaid. If disapproved, contract may be terminated and awarded to next supplier. Contractor shall, at all times, remain responsible for the performance of any subcontractors approved by Medicaid. The percentage of subcontract work to be performed, as measured by percentage of total contract price, shall be provided by the prime contractor. Subcontract work shall not exceed thirty percent (30%). If the use of subcontractors is necessary to meet bid requirements, a statement from each subcontractor, on official letterhead, shall be attached to the Transmittal Letter, signed by an individual authorized to legally bind the subcontractor to perform the scope of work as assigned, stating:

• The general scope and volume of work to be performed by the subcontractor;

• The subcontractor's willingness to perform the work indicated;

• The names and titles of individuals who will be responsible for the subcontractor's efforts;

• The rate or methodology (if a varying rate is to be paid) of reimbursement to be received for the subcontract services;

• That the subcontractor's firm does not discriminate in its employment practices with regard to race, color, religion, age (except as provided by law), sex, marital status, developmental disability, political affiliation, national origin, or handicap, and complies with all applicable provisions of Public Law 101-336, Americans With Disabilities Act.

The use of subcontractors does not in any way relieve the Contractor from its responsibilities under this ITB and/or contract with Medicaid. These letters will be used in determining whether the Contractor can meet program requirements.

2.8 MANAGEMENT PLAN AND IMPLEMENTATION SCHEDULE

Contractor must provide a proposed management plan, work plan and implementation schedule as a part of this ITB response submission.

SECTION 3 SCOPE OF WORK

3.0 SCOPE OF WORK

All attachments are made part of this ITB and incorporated by reference. The Contractor shall perform all of the services listed below and as further explained in the attachments to this ITB.

• Furnishing eyeglasses that meet all federal, state and Agency standards.

• Furnishing eyeglasses as prescribed by medical doctors and optometrists to Medicaid recipient eligible for full Medicaid.

o Full Medicaid - TXIX o Full Medicaid with QMB Plus – XIXQ

• Provide a selection of frames suitable for men, women, teens, and children.

• Furnishing and designate lenses made of, plastic, glass, and polycarbonate.

• Submitting a firm and fixed single quoted price for all V2020 frames.

• Converting all previous (stand-alone) codes (e.g., polycarbonate code

[V2784]) to an “add-on” code and submit a firm and fixed single quoted price for each code. Add-on codes will be allowed in addition to other lens codes.

• Verifying recipient eligibility and eyeglass benefit limits using Medicaid’s fiscal agent contractor system.

• Maintaining key contract personnel as described in Section 2.6 of this

ITB.

• Submitting claims for approved services to Medicaid in accordance with federal, state and Agency policies.

• Submitting hard-copy clean claims for overrides and administrative reviews when appropriate.

• Communicating directly with eye care providers in resolving billing questions or issues regarding frames and lenses prior to requesting an administrative review.

• Maintaining necessary records to fully disclose the volume of services provided to eligible recipients.

• Ensure HIPAA compliance and the safety and security of all information, data, procedures, methods, and funds involved in the performance authorized under the contract.

• Meet with the Alabama Medicaid Agency and the Optometric Peer Review Committee at least semi-annually, unless the State determines Contractor’s presence is not necessary.

• Maintain quality control procedures and programs.

• Furnish monthly performance reports as specified by the state.

• Maintain extensive work order and status tracking system with documentation of problem resolution, and mail/ship deliveries to ensure job orders are completed and provided within acceptable timeframes, meet reporting requirements, and ensure eyeglasses are furnished with the highest quality assurance standards.

• Maintain web-based, telephonic, email and mail customer service inquiry lines/services available during regular business hours to assist providers and customers with inquiries/disputes/complaints/resolutions.

• Maintain interactive website for providers to check availability of frames, submit orders, receive updates, make disputes, perform corrective actions, and provide an ongoing comprehensive means (fax, email, mail, etc.) for accepting work orders to ensure the most efficient access, availability, and shipment of eyeglasses.

• Provide sample frames and display kits at the Contractor’s cost to include mailing. Further described in Section 3.1 of this ITB.

• Inform Medicaid and providers of changes to available frames and lens as described in Section 3.2 of this ITB.

• Inform Medicaid of any potential problems in providing contract frames and lens.

• Supplier must provide proposed Order Form to be used by Optometric and Eye Care Providers when ordering glasses.

3.1 SAMPLE FRAME KITS

The Contractor agrees to provide sample frames and display kits upon request by the eye care practitioners for a review. If the practitioner does not elect to keep the frames and display kits, the practitioner will return them to the Contractor and pay the return shipping cost. In the alternative, if the practitioner desires to keep the Contractor’s sample frames and display kits, these frame kits may then be purchased by the eye care practitioner at the Contractor’s price plus mailing. Contractor further agrees to provide Medicaid with sample frame kits at no charge. Upon request, Medicaid will return the sample frame kit(s) to Contractor at the end of the contract period. The Contractor agrees to provide pictures of all Medicaid approved frames on its website for access by practitioners and recipients.

3.2 NOTIFICATION REQUIREMENTS

Contractor shall inform providers, by letter, whenever Medicaid deletes or adds frames or lenses. Additionally, Contractor shall inform Medicaid of any potential problems in logistics of products so substitutes or replacements can be considered (see Section 2.2).

SECTION 4 TERMS AND CONDITIONS

4.0 COOPERATION

Effective implementation and maintenance of these services shall require close cooperation between Medicaid and Contractor. To this end, the parties agree to work mutually in solving problems. Contractor shall make known and fully describe to Medicaid, in writing, any difficulties encountered that threaten required performance or when such a potential exists. Such difficulties may include, but are not limited to:

a. interpretation of Medicaid policies and procedures

b. meeting reporting requirements

c. identification of errors in calculations submitted

Contractor shall notify Medicaid’s designee for Project Manager, by telephone within one business day of discovery of any problem that has already occurred, or within one working day of the identification of potential problems that threaten required performance. All telephone notices shall be followed up in writing, including any action taken, within three business days.

4.1 COMPLIANCE WITH STATE AND FEDERAL REGULATIONS

Contractor shall perform all services under the contract in accordance with applicable federal and state statutes and regulations. Medicaid retains full operational and administrative authority and responsibility over this contract in accordance with the requirements of the federal statutes and regulations as the same may be amended from time to time.

4.2 CONFIDENTIALITY

Contractor shall treat all information, and in particular information relating to enrollees that is obtained by or through its performance under the contract, as confidential information to the extent confidential treatment is provided under State and Federal laws including 45 CFR §160.101 – 164.534. Contractor shall not use any information so obtained in any manner except as necessary for the proper discharge of its obligations and duties under this contract.

All information as to personal facts and circumstances concerning enrollees obtained by Contractor shall be treated as privileged communications, shall be held confidential, and shall not be divulged to anyone other than the agencies already specified without written consent of Medicaid or the enrollee, provided that nothing stated herein shall prohibit the disclosure of information in summary, statistical, or other form that does not identify particular individuals. The use or disclosure of information concerning enrollees shall be limited to purposes directly connected with the administration of the State Plan. Upon signing of this contract by all parties, the terms of the contract become available to the public pursuant to Alabama law.

Contractor agrees to allow Medicaid or its designee access to all documents, papers, letters, or other material generated under this contract. Contractor will not allow access to such documents to any other person or entity without express written consent of Medicaid.

Contractor shall ensure safeguards that restrict the use or disclosure of information concerning applicants and recipients to the purpose directly connected with the administration of the State Plan in accordance with 42 CFR Part 431, Subpart F, as specified in 42 CFR § 434.6(a)(8). Purposes directly related to the State Plan administration include:

a. Establishing eligibility;

b. Determining the amount of medical assistance;

c. Providing services for recipients; and

d. Conducting or assisting an investigation, prosecution, or civil or criminal proceedings related to the administration of the State Plan.

Pursuant to requirements of the Health Insurance Portability and Accountability Act (HIPPA) of 1996 (Public Law 104-191), the successful Contractor shall be required to sign a Business Associate Agreement with Medicaid.

4.3 FEDERAL NON-DISCLOSURE REQUIREMENTS

Each officer or employee of any person to whom Social Security information is or may be disclosed shall be notified in writing by such person that Social Security information disclosed to such officer or employee can be only used for authorized purposes and to that extent and any other unauthorized use herein constitutes a felony punishable upon conviction by a fine of as much as $5,000 or imprisonment for as long as five years, or both, together with the cost of prosecution. Such person shall also notify each such officer or employee that any such unauthorized further disclosure of Social Security information may also result in an award of civil damages against the officer or employee in an amount not less than $1,000 for each instance of unauthorized disclosure.

These penalties are prescribed by IRC Sections 7213 and 7431 and set forth at 26 CFR 301.6103(n).

Additionally, it is incumbent upon the Contractor to inform its officers and employees of penalties for improper disclosure implied by the Privacy Act of 1974, 5 U.S.C. 552a. Specifically 5 U.S.C. 552a(i)(1), which is made applicable to Contractors by 5 U.S.C. 552a(m)(1), provides that any officer or employee of a Contractor, who by virtue of his/her employment or official position, has possession of or access to agency records which contain identifiable information, the disclosure of which is prohibited by the Privacy Act or regulations established thereunder, and who knowing that disclosure of specific material is prohibited, willfully discloses that material in any manner to any person or agency, not entitled to receive it, shall be guilty of a misdemeanor and fined not more than $5,000.

Contractors shall take all reasonable precautions to ensure the safety and security of all information, data, procedures, methods, and funds involved in the performance under the contract, and shall require the same from all employees so involved. In compliance with 42 CFR §431.300 et seq. Contractor shall conform to the requirements of federal and state regulations regarding confidentiality of information about eligible recipients. Contractors shall not release any data or other information relating to the Medicaid Program without prior written consent of Medicaid. This provision covers both general summary data as well as detailed, specific data. Contractor shall not be entitled to use of Medicaid Program data in its other business dealings without prior written consent of Medicaid. All requests for program data shall be referred to Medicaid for response by the Commissioner only.

4.4 NOTICE TO PARTIES

Any notice to Medicaid under the contract shall be sufficient when mailed to the project manager listed in Section 1.2. Any notice to the Contractor shall be sufficient when mailed to Contractor at the address given in the response to this ITB or on the contract after signing. All notices shall be given by certified mail, return receipt requested.

4.5 DEBARMENT

Contractor hereby certifies that neither it nor its principals nor any subcontractor or its principals, is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any Federal Department or Agency.

4.6 DUTIES UPON EXPIRATION/TERMINATION

a. Transfer of Documents

At Medicaid’s discretion, but no later than three working days following the expiration or termination of the contract, Contractor at its own expense, shall box, label, and deliver to Medicaid the following:

1. All information, data, manuals, records, claims, and other documentation by contract component and label information, data, manuals and other documentation so that it may be easily understood and identified by Medicaid to continue contract performance or contract for further performance with another Contractor.

b. Dialogue

Contractor shall at any time during the transition period and up to 90 calendar days after expiration of the contract answer all questions and provide all dialogue and training that Medicaid deems necessary to enable the successor Contractor to take over the provision of independent assessment services. All such communications shall be with or through the Project Manager.

4.7 PROCEDURE FOR TERMINATION

Contractor must:

a. Stop work under the contract on the date and to the extent specified in the notice of termination;

b. Place no further orders or subcontracts for materials, services, except as may be necessary for completion of such portion of work under the contract as is not terminated;

c. Terminate all orders and subcontracts to the extent that they relate to the performance of work terminated by the notice of termination;

d. Assign to Medicaid in the manner and to the extent directed by Medicaid all of the rights, title, and interest of the Contractor under the orders or subcontracts so terminated, in which case Medicaid shall have the right, in its discretion, to settle or pay any and all claims arising out of termination of such orders and subcontracts;

e. With the approval or ratification of Medicaid, settle all outstanding liabilities and all claims arising out of such termination or orders and subcontracts, the cost of which would be reimbursable in whole or in part, in accordance with the provisions of contract;

f. Complete the performance of such part of the work as shall not have been terminated by the notice of termination; and

g. Take such action as may be necessary, or as Medicaid may direct for the protection and preservation of any and all property or information related to the contract which is in the possession of the Contractor and in which Medicaid has or may acquire an interest.

4.8 TERMINATION CLAIMS

After a receipt of a notice of termination, Contractor must submit to Medicaid any termination claim in the form and with the certification prescribed by Medicaid. Such claims shall be submitted promptly but in no event later than 60 days from the effective date of termination. Upon failure of the Contractor to submit its termination claims within the time allowed, Medicaid may, subject to any review required by State procedures in effect as of the date of execution of the contract, determine, on the basis of information available, the amount, if any, due to the Contractor by reason of termination and shall thereupon cause to be paid to the Contractor the amount determined.

Contractor has no entitlement to receive any amount for lost revenues or anticipated profits or for expenditures associated with this or in any other contract. Contractor will be paid only by the following upon termination:

a. At the contract price(s) for completed deliverables and services delivered to and accepted by Medicaid;

b. At a price mutually agreed upon by the Contractor and

Medicaid for partially completed deliverables.

In the event of the failure of the Contractor and Medicaid to agree in whole or in part as to the amounts with respect to costs to be paid to the Contractor in connection with the total or partial termination of work pursuant to this article, Medicaid shall determine on the basis of information available the amount, if any, due to the Contractor by reason of termination and shall pay to the Contractor the amount so determined.

4.9 EMPLOYMENT PRACTICES

a. Nondiscrimination Compliance

Contractor shall comply with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, Executive Order No. 11246, as amended by Executive Order No. 11375, both issued by the President of the United States, the Americans with Disabilities Act of 1990, and with all applicable federal and state laws, rules and regulations implementing the foregoing statutes with respect to nondiscrimination in employment.

b. Small and Minority Business Enterprise Utilization

In accordance with the provisions of 45 CFR Part 74 and Attachment 0, paragraph 9 of OMB Circular A-102, affirmative steps shall be taken to ensure that small and minority businesses are utilized when possible as sources of supplies, equipment, construction, and services.

c. Worker’s Compensation

Contractor shall provide and maintain workman’s compensation insurance for all of its employees under the contract or any subcontract thereof, if required by state law during the life of this contract.

d. Employment of State Staff

Contractor shall not knowingly engage on a full-time, part-time, or other basis during the term of this contract any professional or technical personnel or contractual consultants who are or have been in the employment of Medicaid during the 12 months prior to the effective date of this contract without the written consent of Medicaid.

Certain Medicaid employees may be subject to more stringent employment restrictions under the Alabama Code of Ethics, §36-25-1 et seq. Code of Alabama 1975.

4.10 GUARANTEES, WARRANTIES, CERTIFICATIONS

a. Indemnification

Contractor shall hold harmless, defend and indemnify Medicaid as to any penalties or federal recoupment and any interest incurred by reason of any Title XIX noncompliance due to the fault of Contractor and/or any subcontractors. The term "Title XIX noncompliance" shall be construed to mean any failure or inability of Medicaid to meet the requirements of Title XIX of the Social Security Act--and/or any regulations promulgated by the federal government therewith due to an act or omission of Contractor or subcontractor.

Contractor shall be liable and agrees to be liable for and shall indemnify, defend, and hold the State and Medicaid and their officers, employees, and agents harmless from all claims, suits, judgments or damages, including court costs and attorney fees, arising out of or in connection with this contract due to negligent or intentional acts of omissions of the Contractor and/or any subcontractors. Contractor shall hold the State and Medicaid harmless from all subcontractor liabilities under the terms of this contract.

Contractor agrees to indemnify, defend, and hold harmless Medicaid, its officers, agents, and employees from:

Any claims or losses attributable to a service rendered by Contractor or any subcontractor, person, or firm performing or supplying services, materials, or supplies in connection with the performance of the contract regardless of whether Medicaid knew or should have known of such improper service, performance, materials or supplies unless otherwise specifically approved by Medicaid in writing in advance;

Any claims or losses attributable to any person or firm injured or damaged by the erroneous or negligent acts, including without limitation, disregard of Federal or State Medicaid regulations or statutes, of Contractor, its officers, employees, or subcontractors in the performance of the contract, regardless of whether Medicaid knew or should have known of such erroneous or negligent acts;

Any failure of Contractor, its officers, employees, or subcontractors to observe Alabama laws, including, but not limited to, labor laws and minimum wage laws, regardless of whether Medicaid knew or should have known of such failure.

If at any time during the operation of this contract, Medicaid gains actual knowledge of any erroneous, negligent, or otherwise wrongful acts by Contractor, its officers, employees, or subcontractors, Medicaid agrees to give Contractor written notice thereof. Failure by Medicaid to give said notice does not operate as a waiver of the Contractor’s obligations to Medicaid, or as a release of any claims Medicaid may have against Contractor.

b. Security

Contractor shall take all reasonable precautions to ensure the safety and security of all information, data, procedures, methods, and funds involved in the performance under the contract, and shall require the same from all employees so involved. In compliance with 42 CFR §431.300 et seq., Contractor shall conform to the requirements of federal and state regulations regarding confidentiality of information about eligible recipients. Contractor shall not release any data or other information relating to the Alabama Medicaid Program without prior written consent of Medicaid.

This provision covers both general summary data as well as detailed, specific data. Contractor shall not be entitled to use of Alabama Medicaid Program data in its other business dealings without prior written consent of Medicaid. All requests for program data shall be referred to Medicaid for response by the Commissioner only.

c. Performance Guarantee

In order to assure full performance of all obligations imposed on a Contractor contracting with the State of Alabama, the Contractor will be required to provide a performance guarantee in the amount of $275,000.00. The performance guarantee shall be extended in the event Medicaid exercises its option to extend the contract. The performance guarantee must be submitted by Contractor at least ten calendar days prior to the contract start date. The form of performance guarantee shall be one of the following:

• Cashier’s check (personal or company checks are not acceptable)

• Other type of bank certified check

• Money order

• An irrevocable letter of credit

• Surety bond issued by a company authorized to do business within the State of Alabama

The Chief Financial Officer of Medicaid shall be the custodian of the performance guarantee. The performance guarantee shall reference this ITB, and it shall be made payable to the State of Alabama.

If Contractor fails to deliver the required performance guarantee, the proposal shall be rejected and the contract may be awarded to the provider of the next ranked proposal.

In the event of a breach of contract, Medicaid will notify Contractor in writing of the default and may assess reasonable charges against the Contractor’s performance guarantee. If after notification of default, the Contractor fails to remedy the State’s damages within 30 calendar days, Medicaid may initiate procedures for collection against Contractor’s performance guarantee.

Failure of the Contractor to perform satisfactorily, breach of contract, or termination of contract shall cause the performance guarantee to become due and payable to the State of Alabama to the extent necessary to cover the costs incurred by Medicaid as a result of the Contractor’s failure to perform its contractual obligations.

These costs include, but are not limited to, costs to correct any Medicaid errors caused by the Contractor’s default and costs incurred by Medicaid for completion of contracted work including any costs associated with preparation, solicitation, and award of a competitive bid for these contract services and any federal, state or other penalties, sanctions, disallowances, or any other costs incurred by Medicaid as a result of the Contractor’s default and any liquidated damages necessary as a result of the Contractor’s default.

In order to achieve the greatest economy for the State, Medicaid may choose the next responsive supplier, re-release the ITB, or complete any other action consistent with state purchasing laws. The performance guarantee will be released within 60 days of the end of the contract term.

4.11 DISASTER RECOVERY PLAN

Contractor shall provide Medicaid, for approval, prior to contract start date, a written implementation plan addressing satisfactory back-up arrangements for data processing equipment and files to provide continued contract performance in the event of machine failure or loss of records.

4.12 METHOD OF PAYMENT

For any terms of the contract which allow reimbursement for the cost of procuring goods, materials, supplies, equipment, or services, such procurement shall be made on a competitive basis (including the use of competitive bidding procedures) where practicable, and reimbursement for such cost under the contract shall be in accordance with 48 CFR, Chapter 1, Subchapter E, Part 31. Further, if such reimbursement is to be made with funds derived wholly or partially from federal sources, such reimbursement shall be subject to Contractor’s compliance with applicable federal procurement requirements, and the determination of costs shall be governed by federal cost principles.

4.13 CLAIM SUBMISSION

Contractor shall submit claims for reimbursement for services provided according to the terms and conditions of this agreement. Contractor should submit claims electronically via the 837P format as specified in the Alabama Medicaid Provider Billing Manual upon production of eyeglasses.

4.14 PAYMENT

a. Payments shall be made in accordance with the Medicaid fiscal year check-write schedule, see Attachment E. This schedule is released by Medicaid at the beginning of each fiscal year.

b. Please refer to the Alabama Medicaid Provider Billing Manual Chapter 5 Filing Claims at www.medicaid.alabama.gov.

c. The Contractor is responsible for collecting all third-party insurance information prior to submitting a request for payment to Medicaid.

http://www.medicaid.alabama.gov/

Recipients with third party coverage (including COBRA) are required to follow program guidelines.

4.15 RECORDS RETENTION AND STORAGE

In accordance with 45 CFR 75.361 Contractor shall maintain financial records, supporting documents, statistical records, and all other records pertinent to the Alabama Medicaid Program for a period of three years from the date of the final payment made by Medicaid to the Contractor under this contract.

However, if audit, litigation, or other legal action by or on behalf of the State or Federal Government has begun but is not completed at the end of the three-year period, or if audit findings, litigation, or other legal action have not been resolved at the end of the three-year period, the records shall be retained until resolution. Subsequent to the contract term, documents shall be returned to Medicaid within three working days following expiration or termination of the contract. Micro-media copies of source documents for storage may be used in lieu of paper source documents subject to Medicaid approval.

4.16 INSPECTION OF RECORDS

Contractor agrees that representatives of the Comptroller General, HHS, the General Accounting Office, the State of Alabama Department of Examiners of Public Accounts, Medicaid, and their authorized representatives shall have the right during business hours to inspect and copy Contractor’s books and records pertaining to contract performance and costs thereof. Contractor shall cooperate fully with requests from any of the agencies listed above and shall furnish free of charge copies of all requested records. Contractor may require that a receipt be given for any original record removed from Contractor’s premises.

4.17 ALABAMA INTERCHANGE INTERFACE STANDARDS

Contractor hereby certifies that any exchange of MMIS data with the Agency’s fiscal agent will be accomplished by following the Alabama InterChange Interface Standards. Further information may be obtained on Medicaid’s website at www.alabama.medicaid.gov

4.18 IMMIGRATION COMPLIANCE

Contractor will not knowingly employ, hire for employment, or continue to employ an unauthorized alien within the State of Alabama. Contractor shall comply with the requirements of the Immigration Reform and Control Act of 1986 and the Beason- Hammon Alabama Taxpayer and Citizen Protection Act (Ala, Act 2012- 491 and any amendments thereto) and certify its compliance by executing Attachment G. Contractor will document that the Contractor is enrolled in the E- Verify Program operated by the US Department of Homeland Security as required by Section 9 of Act 2012-491. During the performance of the contract, the Contractor shall participate in the E-Verify program and shall verify every employee that is required to be verified according to the applicable federal rules http://www.alabama.medicaid.gov/ and regulations. Contractor further agrees that, should it employ or contract with any subcontractor(s) in connection with the performance of the services pursuant to this contract that the Contractor will secure from such subcontractor documentation that subcontractor is enrolled in the E-Verify program prior to performing any work on the project. The subcontractor shall verify every employee that is required to be verified according to the applicable federal rules and regulations. This subsection shall only apply to subcontractors performing work on a project subject to the provisions of this section and not to collateral persons or business entities hired by the subcontractor. Contractor shall maintain the subcontractor documentation that shall be available upon request by the Alabama Medicaid Agency.

Pursuant to Ala. Code §31-13-9(k), by signing this contract, the contracting parties affirm, for the duration of the agreement, that they will not violate federal immigration law or knowingly employ, hire for employment, or continue to employ an unauthorized alien within the state of Alabama. Furthermore, a contracting party found to be in violation of this provision shall be deemed in breach of the agreement and shall be responsible for all damages resulting therefrom.

Failure to comply with these requirements may result in termination of the agreement or subcontract.

Attachment A

BUSINESS ASSOCIATE AGREEMENT

Revised 02/2026

This Agreement is made effective Enter Begin Date, by and between the Alabama Medicaid Agency (“Covered Entity”), an agency of the State of Alabama, and Contractor Name (“Business Associate”) (collectively the “Parties”).

2. BACKGROUND

1.1. Business Associate agrees to perform the following services for or on behalf of Covered Entity: Enter a description below of the service(s) to be provided with sufficient detail to ensure clarity.

1.2. The relationship between Covered Entity and Business Associate is such that the Parties believe Business Associate is or may be a “business associate” within the meaning of the HIPAA Rules (as defined below).

1.3. The Parties enter into…