BabyE inSAP

State of South

Carolina

Request for Proposal

Amendment #1

Solicitation:

Date Issued:

Procurement Officer:

Phone:

E-Mail Address:

Mailing Address:

5400018456

10/18/2019

ROB MALPASS

(803) 898-0541

Robert.Malpass@scdhhs.gov 1801 Main Street

Columbia, SC 29201

DESCRIPTION: Provide Statewide Integrated Early Intervention Case Management System for

South Carolina Individuals with Disabilities Education Act (IDEA) Part C Program (BabyNet)

USING GOVERNMENTAL UNIT: SC Department of Health & Human Services

SUBMIT YOUR OFFER ON-LINE AT THE FOLLOWING URL: http://www.procurement.sc.gov

SUBMIT OFFER BY (Opening Date/Time): 11/08/2019 3:00PM EDT (See "Deadline For Submission Of Offer" provision)

QUESTIONS MUST BE RECEIVED BY: 10/24/2019 5:00PM EDT (See "Questions From Offerors" provision)

NUMBER OF COPIES TO BE SUBMITTED: One (1) Electronic and One (1) Redacted Electronic Version submitted online OR Nine (9) CD’s with both technical and price proposals on separate CDs; and One (1) identical paper copy of both the Technical and Price Proposals

CONFERENCE TYPE: Pre-Proposal

DATE & TIME: 10/02/2019 10:00AM EDT

(As appropriate, see "Conferences - Pre-Bid/Proposal" & "Site Visit" provisions)

LOCATION: SCDHHS

Jefferson Square

1801 Main Street, 10th Floor

Columbia, SC 29201

AWARD &

AMENDMENTS

Award will be posted on 12/06/2019. The award, this solicitation, any amendments, and any related notices will be posted at the following web address: http://www.procurement.sc.gov

You must submit a signed copy of this form with Your Offer. By signing, You agree to be bound by the terms of the

Solicitation. You agree to hold Your Offer open for a minimum of one hundred twenty (120) calendar days after the

Opening Date. (See "Signing Your Offer" provision.)

NAME OF OFFEROR

(full legal name of business submitting the offer)

Any award issued will be issued to, and the contract will be formed with, the entity identified as the Offeror. The entity named as the Offeror must be a single and distinct legal entity. Do not use the name of a branch office or a division of a larger entity if the branch or division is not a separate legal entity, i.e., a separate corporation, partnership, sole proprietorship, etc.

AUTHORIZED SIGNATURE

(Person must be authorized to submit binding Offer to contract on behalf of Offeror.)

DATE SIGNED

TITLE

(business title of person signing above)

STATE VENDOR NO.

(Register to Obtain S.C. Vendor No. at www.procurement.sc.gov)

PRINTED NAME

(printed name of person signing above)

STATE OF INCORPORATION

(If you are a corporation, identify the state of incorporation.)

OFFEROR'S TYPE OF ENTITY: (Check one) (See "Signing Your Offer" provision.)

___ Sole Proprietorship___ Partnership___ Other_____________________________

___ Corporate entity (not tax-exempt)___ Corporation (tax-exempt)___ Government entity (federal, state, or local)

COVER PAGE - ON-LINE ONLY (MAR. 2015)

mailto:Robert.Malpass@scdhhs.gov http://www.procurement.sc.gov/ http://www.procurement.sc.gov/

SAP

SAP

PAGE TWO

(Return Page Two with Your Offer)

HOME OFFICE ADDRESS (Address for Offeror’s home office / principal place of business)

NOTICE ADDRESS (Address to which all procurement and contract related notices should be sent.) (See "Notice" clause)

Area Code - Number - Extension Facsimile

E-mail Address

PAYMENT ADDRESS (Address to which payments will be sent.)

(See "Payment" clause)

____Payment Address same as Home Office Address ____Payment Address same as Notice Address (check only one)

ORDER ADDRESS (Address to which Purchase Orders will be sent)

(See "Purchase Orders and "Contract Documents" clauses)

____Order Address same as Home Office Address ____Order Address same as Notice Address (check only one)

ACKNOWLEDGMENT OF AMENDMENTS

Offerors acknowledges receipt of amendments by indicating amendment number and its date of issue. (See "Amendments to Solicitation" Provision)

Amendment No. Amendment Issue

Date Amendment No. Amendment Issue

Date Amendment No. Amendment Issue

Date Amendment No. Amendment Issue

Date

DISCOUNT FOR

PROMPT PAYMENT

(See "Discount for Prompt

Payment" clause)

10 Calendar Days (%) 20 Calendar Days (%) 30 Calendar Days (%) _____Calendar Days (%)

PREFERENCES - A NOTICE TO VENDORS (SEP. 2009):

PREFERENCES DO NOT APPLY TO THIS PROCUREMENT

PREFERENCES - ADDRESS AND PHONE OF IN-STATE OFFICE:

PREFERENCES DO NOT APPLY TO THIS PROCUREMENT

PAGE TWO (SEP 2009) End of PAGE TWO

Table of Contents

1. SCOPE OF SOLICITATION

ACQUIRE SERVICES (JAN 2006)

MAXIMUM CONTRACT PERIOD - ESTIMATED (JAN 2006)

INTRODUCTION AND PROGRAM BACKGROUND

PURPOSE AND GOALS

CURRENT BABYNET CASE MANAGEMENT SYSTEM

TARGET BABYNET CASE MANAGEMENT SYSTEM

MEDICAID ENTERPRISE SYSTEM TECHNOLOGY

CASE MANAGEMENT SYSTEM INTEGRATION

EXECUTIVE STEERING AND GOVERNANCE

AGENCY ORGANIZATION

INSTRUCTIONS TO OFFERORS - A. GENERAL INSTRUCTIONS

DEFINITIONS, CAPITALIZATION, AND HEADINGS (DEC 2015)

ADDITIONAL DEFINITIONS

AMENDMENTS TO SOLICITATION (JAN 2004)

AUTHORIZED AGENT (FEB 2015)

AWARD NOTIFICATION (MODIFIED)

BID/PROPOSAL AS OFFER TO CONTRACT (JAN 2004)

BID ACCEPTANCE PERIOD (JAN 2004)

BID IN ENGLISH AND DOLLARS (JAN 2004)

CERTIFICATE OF INDEPENDENT PRICE DETERMINATION (MAY 2008)

CERTIFICATION REGARDING DEBARMENT AND OTHER RESPONSIBILITY MATTERS (JAN 2004)

CODE OF LAWS AVAILABLE (JAN 2006)

DISCLOSURE OF CONFLICTS OF INTEREST OR UNFAIR COMPETITIVE ADVANTAGE (FEB 2015)

DEADLINE FOR SUBMISSION OF OFFER (JAN 2004)

DRUG FREE WORK PLACE CERTIFICATION (JAN 2004)

DUTY TO INQUIRE (FEB 2015)

ETHICS CERTIFICATE (MAY 2008)

OMIT TAXES FROM PRICE (JAN 2004)

OPEN TRADE REPRESENTATION (JUN 2015)

PROTESTS (MAY 2019)

PROHIBITED COMMUNICATIONS AND DONATIONS (FEB 2015)

PUBLIC OPENING (JAN 2004)

QUESTIONS FROM OFFERORS (MODIFIED)

REJECTION/CANCELLATION (JAN 2004)

RESPONSIVENESS/IMPROPER OFFERS (JUN 2015)

SIGNING YOUR OFFER (JAN 2004)

STATE OFFICE CLOSINGS (JAN 2004)

SUBMITTING CONFIDENTIAL INFORMATION (FEB 2015)

SUBMITTING A PAPER OFFER OR MODIFICATION (MAR 2015)

TAX CREDIT FOR SUBCONTRACTING WITH DISADVANTAGED SMALL BUSINESSES (JAN 2008)

VENDOR REGISTRATION MANDATORY (JAN 2006)

WITHDRAWAL OR CORRECTION OF OFFER (JAN 2004)

2. INSTRUCTIONS TO OFFERORS -- B. SPECIAL INSTRUCTIONS

CONFERENCE - PRE-BID/PROPOSAL (JAN 2006)

CONTENTS OF OFFER (RFP) -- (FEB 2015)

CLARIFICATION (NOV 2007)

ELECTRONIC COPIES - REQUIRED MEDIA AND FORMAT (MODIFIED)

MAGNETIC MEDIA WITH DEMONSTRATION/ PRESENTATION (JAN 2006)

ON-LINE BIDDING INSTRUCTIONS (MAR 2015)

OPENING PROPOSALS -- INFORMATION NOT DIVULGED (FEB 2015)

PROTEST - CPO - ITMO ADDRESS (JUN 2006)

SCOPE OF WORK/STATEMENT OF OBJECTIVES

CONTRACT STRUCTURE

Contract Scope and Structure Modification Pool Implementation Phase Operations Phase Turnover Phase

CONTRACT INCENTIVE STRUCTURE

Implementation Phase Incentives Operations Liquidated Damages

CURRENT VENDORS STAFF INVOLVEMENT IN PROPOSALS

FINANCIAL MANAGEMENT OBJECTIVES AND STRATEGY

Financial Management Objectives Financial Reporting Interfacing to the State’s Accounting System Modification Pool Invoicing

SOLUTION ENVIRONMENT

SOLUTION REQUIREMENTS

Parent Guardian and Professional Referral Program Eligibility Determination Assessment Individual Family Service Plan (IFSP) Provider Network Management Provider Payment Management Transition and Exit Reporting and Alerts Documentation and Support

System Maintenance and Support Privacy and Usability Requirements

SCHEDULE STRATEGY

Contractually Binding Dates Weekend and Holiday Work

MANAGEMENT GOALS AND STRATEGY

Management Goals General Management Strategy

PROJECT MANAGEMENT

Contractor Duties SCDHHS Duties

STAFFING AND KEY PERSONNEL

Staffing Removal of Personnel Personnel Turnover Key Personnel Other Key Personnel Persistent Vacancies of Key Personnel Vacancies of Key Personnel Contractor Staff Location

PROGRAM GOVERNANCE

CHANGE MANAGEMENT AND GOVERNANCE

DELIVERABLES

COMMUNICATIONS

TECHNICAL OBJECTIVES

Solution Standards Utilize Industry Best Practices

SERVICES STRATEGY AND OBJECTIVES

Hosting

Client Access

SERVICE DESIGN

Service Level Management Availability Management Capacity Management Disaster Recovery and Business Continuity

SERVICE TRANSITION

Configuration Management Risk Mitigation during System Transitions Data Conversion

SERVICE OPERATIONS

Request Fulfillment Access Management Events and Incident Management Problem Management

TECHNICAL REFERENCE ARCHITECTURE

SCDHHS Portal Integration Hub Enterprise Data Services

SECURITY AND PRIVACY

Security and Privacy Controls Security and Privacy Approach Independent Assessment of Security and Privacy Controls

ADAPTABILITY AND EXTENSIBILITY

TESTING

SOLUTION IMPLEMENTATION

TRAINING

DOCUMENTATION

Additions to CDML

HELP DESK

INVOICING AND PAYMENT

Invoices Generally Labor Hours Rates Invoicing for Fixed Price Work Invoicing for the Turnover Phase Travel Expenses

INFORMATION FOR OFFERORS TO SUBMIT

INFORMATION FOR OFFERORS TO SUBMIT -- GENERAL (MAR 2015-M)

Administrative Submission Requirements Proposal Structure Section by Section Instructions

MINORITY PARTICIPATION (DEC 2015)

SERVICE PROVIDER SECURITY ASSESSMENT QUESTIONNAIRE - REQUIRED (FEB 2015) (ATTM 015 SPSAQ)

SUBMITTING REDACTED OFFERS (MAR 2015)

QUALIFICATIONS

QUALIFICATIONS OF OFFEROR (MAR 2015)

QUALIFICATIONS – SPECIAL STANDARDS OF RESPONSIBILITY (MAR 2015)

QUALIFICATIONS -- REQUIRED INFORMATION (MODIFIED)

SUBCONTRACTOR -- IDENTIFICATION (FEB 2015)

AWARD CRITERIA

AWARD CRITERIA -- PROPOSALS (JAN 2006)

AWARD TO ONE OFFEROR (JAN 2006)

COMPETITION FROM PUBLIC ENTITIES (JAN 2006)

DISCUSSIONS AND NEGOTIATIONS - OPTIONAL (FEB 2015)

EVALUATION FACTORS -- PROPOSALS (MODIFIED)

UNIT PRICE GOVERNS (JAN 2006)

TERMS AND CONDITIONS -- A. GENERAL

ASSIGNMENT, NOVATION, AND CHANGE OF NAME, IDENTITY, OR STRUCTURE (FEB 2015)

BANKRUPTCY - GENERAL (FEB 2015)

CHOICE-OF-LAW (JAN 2006)

CONTRACT DOCUMENTS AND ORDER OF PRECEDENCE (FEB 2015)

DISCOUNT FOR PROMPT PAYMENT (JAN 2006)

DISPUTES (JAN 2006)

EQUAL OPPORTUNITY (JAN 2006)

FALSE CLAIMS (JAN 2006)

FIXED PRICING REQUIRED (JAN 2006)

NO INDEMNITY OR DEFENSE (FEB 2015)

NOTICE (JAN 2006)

OPEN TRADE (JUN 2015)

PAYMENT AND INTEREST (FEB 2015)

PUBLICITY (JAN 2006)

PURCHASE ORDERS (JAN 2006)

SURVIVAL OF OBLIGATIONS (JAN 2006)

TAXES (JAN 2006)

TERMINATION DUE TO UNAVAILABILITY OF FUNDS (JAN 2006)

THIRD PARTY BENEFICIARY (JAN 2006)

WAIVER (JAN 2006)

7. TERMS AND CONDITIONS -- B. SPECIAL

BANKRUPTCY - GOVERNMENT INFORMATION (FEB 2015)

CHANGES (JAN 2006)

COMPLIANCE WITH LAWS (JAN 2006)

CONTRACT LIMITATIONS (JAN 2006)

CONTRACTOR'S LIABILITY INSURANCE - GENERAL (FEB 2015)

CONTRACTOR'S LIABILITY INSURANCE - INFORMATION SECURITY AND PRIVACY (FEB 2015)

CONTRACTOR PERSONNEL (JAN 2006)

CONTRACTOR'S OBLIGATION -- GENERAL (JAN 2006)

CONTRACTOR'S USE OF STATE PROPERTY (JAN 2006)

DEFAULT (JAN 2006)

ESTIMATED QUANTITY – UNKNOWN (JAN 2006)

ILLEGAL IMMIGRATION (NOV 2008)

INDEMNIFICATION-THIRD PARTY CLAIMS - GENERAL (NOV 2011)

INDEMNIFICATION - THIRD PARTY CLAIMS - DISCLOSURE OF INFORMATION (FEB 2015)

INDEMNIFICATION-INTELLECTUAL PROPERTY (JAN 2006)

INFORMATION SECURITY - DEFINITIONS (FEB 2015)

INFORMATION SECURITY - SAFEGUARDING REQUIREMENTS (FEB 2015)

INFORMATION SECURITY - LOCATION OF DATA (FEB 2015)

INFORMATION USE AND DISCLOSURE (FEB 2015)

INFORMATION USE AND DISCLOSURE - STANDARDS (FEB 2015)

LICENSES AND PERMITS (JAN 2006)

MATERIAL AND WORKMANSHIP (JAN 2006)

OFFSHORE CONTRACTING PROHIBITED (FEB 2015)

OWNERSHIP OF DATA AND MATERIALS (JAN 2006)

PRICE ADJUSTMENTS (JAN 2006)

PRICE ADJUSTMENT - LIMITED -- AFTER INITIAL TERM ONLY (JAN 2006)

PRICING DATA -- AUDIT -- INSPECTION (JAN 2006)

RELATIONSHIP OF THE PARTIES (JAN 2006)

RELATIONSHIP OF USING GOVERNMENTAL UNITS (JAN 2006)

RESTRICTIONS ON PRESENTING TERMS OF USE OR OFFERING ADDITIONAL SERVICES (FEB 2015)

SERVICE PROVIDER SECURITY REPRESENTATION (FEB 2015)

TERM OF CONTRACT -- EFFECTIVE DATE / INITIAL CONTRACT PERIOD (JAN 2006)

TERM OF CONTRACT – NON-TERMINATION OR SUSPENSION BY CONTRACTOR (SCDHHS)

TERM OF CONTRACT -- OPTION TO RENEW (MODIFIED)

TERMINATION FOR CONTRACTOR INSOLVENCY

TERMINATION FOR CONVENIENCE -- INDEFINITE DELIVERY / INDEFINITE QUANTITY CONTRACTS (JAN 2006)

TERMINATION FOR CONVENIENCE (JAN 2006)

CONTRACTOR HOSTING/SAAS/CLOUD HOSTING

Turnover Services Service Level Agreements System Currency System Updates

7. MISCELLANEOUS TERMS – C. CONDITIONS/REQUIREMENTS

HIPAA COMPLIANCE/CONFIDENTIALITY (SCDHHS)

SAFEGUARDING INFORMATION (SCDHHS)

LAWSUIT NOTIFICATION AND COOPERATION (SCDHHS)

DEBARMENT NON-PROCUREMENT/SCREENING REQUIREMENTS (SCDHHS)

NON-DISCLOSURE (SCDHHS)

RESTRICTIONS FOR LOBBYING (SCDHHS)

SAFETY PRECAUTIONS (SCDHHS)

USE AND OWNERSHIP OF INFORMATION AND DOCUMENTATION (SCDHHS)

OWNERSHIP OF DATA (SCDHHS)

NO CONTRACTOR UTILIZATION OF WORKERS OUTSIDE OF THE UNITED STATES (SCDHHS)

APPLICABLE LAWS AND REGULATIONS (SCDHHS)

AUTHORITY TO OPERATE (ATO) (SCDHHS)

BIDDING SCHEDULE / PRICE PROPOSAL

PRICE PROPOSAL (JAN 2006)

Price Proposal Instructions Pricing Table Background Prices and Costs Pricing Table Instructions

ATTACHMENTS TO SOLICITATION

ATTACHMENTS LIST

PROCUREMENT LIBRARY LIST

IMPORTANT NOTICE: In order to make the solicitation document easier to read, the state has opted to issue a complete new document. This approach has been selected in an effort to ensure the clarity of the contract documents during both the “Pre-Award” and “Post Award” phases of this procurement.

Prospective bidders should discard the original solicitation document and use this document when preparing their on-line bids.

In an effort to assist your review of the amendment, we have endeavored to highlight changes in yellow. To use this feature, offerors will need to view the electronic version of this document.

Despite our best efforts, there is a chance that a change was inadvertently left unhighlighted. Therefore, offerors are cautioned that they are responsible to review the content of the entire document and cannot rely detrimentally on highlights identifying all changes.

Please refer to the Summary of Questions and Answers which is ATTM 016 of this solicitation.

1. SCOPE OF SOLICITATION

ACQUIRE SERVICES (JAN 2006)

The purpose of this solicitation is to acquire Services complying with the enclosed description and/or specifications and conditions.

It is the intent of the South Carolina Department of Health and Human Services (SCDHHS) to solicit proposals for Services, supplies, and equipment to support the case management, prior authorization, claiming, remittance, and reporting of the

Individuals with Disabilities Education Act (IDEA) Part C program, also known as BabyNet, services; interfacing at the data layer with other components of the Medicaid Enterprise; and supporting Work.

The primary objective of this request for proposal (RFP) is to seek a Software-as-a-Service (SaaS) solution and support

Services for BabyNet, administered by SCDHHS for the state of South Carolina.

MAXIMUM CONTRACT PERIOD - ESTIMATED (JAN 2006)

Start date: 01/01/2020 End date: 12/31/2024. Dates provided are estimates only. Any resulting contract will begin on the date specified in the notice of award. See clause entitled "Term of Contract - Effective Date/Initial Contract Period" [01-1040-1]

This contract is for an initial term of three (3) years, with two (2) subsequent one (1) year renewal options. The maximum contract term is five (5) years.

INTRODUCTION AND PROGRAM BACKGROUND

Governor Nikki Haley signed Executive Order 2016-20, which transferred the BabyNet program from First Steps to

SCDHHS, effective July 1, 2017. The BabyNet program is sometimes called “Part C” because it is established under Part C of the IDEA. BabyNet provides early intervention services for children with disabilities from birth until their third (3rd) birthday. These services are designed to identify and meet a child’s needs in five (5) developmental areas: physical development, cognitive development, communication development, social or emotional development, and adaptive development.

SCDHHS assumed administration of BabyNet while the program was under Corrective Action Plan (CAP) with the federal

Office of Special Education Programs (OSEP). Included in the CAP was a federal mandate to improve timeliness of Claims payments to BabyNet service providers. To achieve this goal, SCDHHS is seeking the services of an established solution provider to replace the existing solution approach with a case management and claiming solution that integrates with

SCDHHS’ benefit eligibility determination, service referral, Claims adjudication, and reporting systems.

https://www.scstatehouse.gov/Archives/ExecutiveOrders/exor2016-20.pdf https://www.scdhhs.gov/resource/babynet

PURPOSE AND GOALS

The purpose of the Statewide Integrated Early Intervention Case Management System Contract is to implement a case management system for Early Intervention services for children aged birth to three who are diagnosed with developmental delays and/or disabilities. The case management system shall support the following functions:

• Accept child referrals daily from SCDHHS’ BabyNet Parent Guardian and Professional Referral Web Portal

• Receive and display both Medicaid-eligible and IDEA Part C-only children daily for case management from

SCDHHS’ benefit eligibility determination system, Cúram

• Receive and display child participation in Managed Care Organization (MCO) plan and plan eligibility time spans

• Generate and maintain an Individualized Family Service Plan (IFSP) for each child receiving BabyNet services

• Receive private insurance (also called other health insurance, or OHI) information from SCDHHS’ third-party liability (TPL) system and display relevant information in the case management system

• Manage primary and secondary payor information for each child, which may include OHI, Medicaid, and Part C

• Generate and deliver daily electronic prior authorization (PA) files to individual fee-for-service providers and MCOs for services recorded on a child’s IFSP

• Capture information about individual providers and services rendered as part of the approved IFSP

• Generate and distribute daily a claiming file for services rendered to SCDHHS’ Claims adjudication system, the

Medicaid Management Information System (MMIS)

• Receive a remittance file daily from MMIS and display relevant payment information in the case management system

• Enable authorized case management system users to edit Claim records that have already been adjudicated in MMIS

• Enable authorized case management system users to void and replace records for Claims paid by gross-level adjustment (GLA) to adjust previous Claims transactions

• Establish and maintain traceability of each claim from the IFSP through remittance for auditing and compliance purposes

• Provide mandated operational and federal compliance reports per the requirements of OSEP

• Deliver daily extracts of the case management system database to SCDHHS for analysis

CURRENT BABYNET CASE MANAGEMENT SYSTEM

The current IDEA Part C program case management system, known as the BabyNet Reporting & Intervention Data Gathering

Electronic System (BRIDGES), was implemented in South Carolina in 2013 by First Steps, the lead agency for BabyNet prior to the program’s transfer to SCDHHS in 2017. BRIDGES is a web-based, stand-alone system designed to manage child intake and program enrollment, needs assessment and service planning, documentation of service delivery, payment management, and federal compliance reporting.

BRIDGES includes functionality to track payments made to service coordinators and therapy providers, but it does not have the native ability to manage prior authorization of services, Claim submission, remittance, or payment modifications and corrections necessary to conform to SCDHHS’ case management integration standards. Moreover, in the current operating environment, BRIDGES is one of several case management systems used by service coordinators and therapy providers for administering the IDEA Part C program in South Carolina, and these systems are not integrated with each other; most data from outside case management systems must be re-keyed into BRIDGES to collect necessary data for compliance reporting to OSEP. The BRIDGES platform was not designed for extensive integration into a larger operating environment, making performance and quality improvements to service delivery through automation limited with this technology

Figure 1 - BabyNet Case Management System: Current State Architecture

TARGET BABYNET CASE MANAGEMENT SYSTEM

As part of a corrective action plan (CAP) with OSEP on behalf of the BabyNet program, SCDHHS seeks to improve service delivery timeliness and quality through better alignment of BabyNet operations and technology with those of SCDHHS. This includes program referral and eligibility determination, Claims submission and payment processing, and operational and federal compliance reporting. As part of an effort to ensure timely provision of services, as well as efficient and accurate payment for services, SCDHHS also seeks to mandate all service, Claims, and payment data into a single case management system, enforcing system exclusivity so no provider can submit Claims for payment through any route other than the case management system of record. SCDHHS plans to use system exclusivity as a means of managing payor source — prioritizing private insurance over Medicaid, and both private insurance and Medicaid over BabyNet — and managing prior authorization

(PA) activity to support service limits for both fee-for-service Claims and Encounters under the MCO service delivery model.

To make all of this possible, SCDHHS is seeking a case management solution built on a service-oriented architecture (SOA) that can use both industry standard data exchange —such as x12 electronic data interchange (EDI) files — as well as proprietary file formats to integrate the solution at the data layer with SCDHHS’ enterprise service bus (ESB) and enterprise data warehouse (EDW), referred to collectively as the SCDHHS Medicaid Enterprise System (MES).

Referral

System Point of Entry

(SPOE)

Service Coordination

BRIDGES

BabyNet Finance

Provider

SC School for Deaf and Blind (SCSDB)

SC Department of Disabilities and Special

Needs (SCDDSN)

Service notes

Invoice

Payment

Individualized Family Service

Plan (IFSP)

Service notes

Figure 2 - BabyNet Future State

MEDICAID ENTERPRISE SYSTEM TECHNOLOGY

The MES is a collection of loosely coupled, highly integrated components built on SOA principles. The MES enables

SCDHHS to implement a consolidated Technical Reference Architecture (TRA) for enterprise system integration capabilities.

These capabilities support business and technology transformation efforts across the enterprise without disrupting daily

Medicaid operations and data processing activities. This approach also mitigates the risks associated with establishing interim interfaces to retiring legacy systems.

SCDHHS’ strategy to distribute information management functionality across independent subsystems, while maintaining control over SCDHHS’ data, is reliant on enabling technical capability with a defined enterprise architecture. The MES enterprise architecture integrates, manages, and distributes data using three major components:

• User Portal Platform – The Portal framework encapsulates the user interface for constituents to interact with the

MES. SCDHHS uses standard identity federation protocols, such as Security Assertion Markup Language (SAML), to establish the business capability of interoperating security with all technology solutions.

• Integration Hub – The central integration point for web services, messaging, and file exchanges utilizes an enterprise service bus (ESB) to facilitate loose coupling of components.

• Enterprise Data Services (EDS) – A coordinated system of data integration technologies and services designed to manage, access, ingest, materialize, and deliver SCDHHS data. EDS encapsulates a NoSQL-based raw data lake

(RDL), Operational Data Store (ODS), and the technologies that maintain them.

Trading Partners interact with the MES by integrating the identity services of portlets exposed by the User Portal Platform and consuming web services and file exchanges exposed by the Integration Hub. This allows enterprise solutions to securely expose Trading Partner portlets, web services, or file exchanges for consumption by the MES.

SCDHHS will provide flexibility for Solution Providers (SPs) to integrate their solutions through clearly communicated architecture standards, expectations, and artifacts. At the same time, loose coupling across the enterprise allows SCDHHS to incrementally retire legacy components (as SCDHHS replaces legacy functionality), without impacting business operations or other components.

SCDHHS is committed to continuing to expose and integrate existing systems-as-services to leverage its current information technology (IT) investments. Critical technical development objectives include:

• Moving SCDHHS production workloads accurately and efficiently

• Providing appropriate and sufficient disaster recovery and business continuity capabilities

• Facilitating the migration and transition of SCDHHS business owner applications into new processing

CASE MANAGEMENT SYSTEM INTEGRATION

With the establishment of the MES, SCDHHS has begun a comprehensive, multi-year effort to align its case management systems with the core eligibility, Claims submission, payment, and remittance functions driven by Cúram and the MMIS.

Our goal is to ensure that all member enrollment and payment processing for any case management system are administered by SCDHHS systems of record and not independently through other systems. To ensure adherence to these goals, SCDHHS has established a set of design principles for SPs to follow when preparing their case management systems to integrate with the MES. These principles include:

• Service authorization – a case management system must transmit provider, recipient, service type, duration, units, and service delivery authorization data through an approved prior authorization (PA) file to quality improvement organizations (QIOs) and/or managed care organizations (MCOs) designated by SCDHHS.

• Gross Level Adjustment – for programs that allow payment for services through gross-level adjustment (GLA), that case management system’s financial management module must allow authorized users to reconcile GLA payments with associated Claims transactions sent to MMIS for adjudication.

• Claim Adjustment – a case management system’s financial management module must allow authorized users to void and replace Claims that have already been adjudicated and send this updated information to MMIS.

• Enterprise Interaction – any new service types and/or procedure codes associated with a program supported by a case management system must be tested against SCDHHS editing rules (e.g. MMIS adjudication) to ensure system-of-record compatibility prior to deployment. New service adjudication and accounts payable logic must conform to existing SCDHHS policy-based configuration in MMIS.

• System Exclusivity – Claims for services covered by an authorization originated by a case management system are contained to, and must be constrained to originate from, that system. Submission of Claims for programs using a case management system must not be submitted to MMIS from any other system (ex., Webtool).

• Enterprise Data Services – Query access and/or exposure to a reporting database to facilitate Claims troubleshooting (operations), detection of line-level fraud and abuse (program integrity), utilization consistency and review (policy), pricing of future carve-ins and budget projections (finance), and appropriation requests

(Director).

• Auditability – each Claim submitted by a case management system must include a means of uniquely identifying and tracing that Claim through the entire case management and adjudication process, from prior authorization to remittance and reconsideration/appeals.

SPs seeking to integrate their case management systems with the MES must comply with all design principles above, and demonstrate their compliance, to receive permission from SCDHHS for integration.

EXECUTIVE STEERING AND GOVERNANCE

SCDHHS has taken strategic steps to establish and maintain ownership of the Medicaid Enterprise from a programmatic perspective. Strategies focusing on governance, contract management, and project management are indicative of SCDHHS’ desire to dictate how the agency’s technical vision will be designed, developed, and implemented.

A strong governance structure will be needed to accomplish the project’s high-level goals and objectives. SCDHHS has defined the framework—which will include standards, processes, and service definitions—to be leveraged by Contractor, Vendors, state entities and internal teams working within SCDHHS environment. The executive Steering Committee will stipulate all stakeholder roles and responsibilities while facilitating constant assessments of project progress and Vendor performance. The Steering Committee will dictate operating principles to Contractor, including how gaps, risks, and issues are to be addressed. Service Level Agreements (SLAs), Contract Management, and Information Technology Infrastructure

Library (ITIL) service level management will dictate key performance indicators (KPIs) that will be tied into the governance framework and used to measure the performance of Contractor.

AGENCY ORGANIZATION

SCDHHS Director

The Director is a Cabinet-level official appointed by the Governor and serves as the State Medicaid Director. The Director is

Joshua D. Baker.

Chief Operating Officer (COO)

The COO reports to the Director and is responsible for the management and oversight of all operations areas at SCDHHS.

Functions such as Claims processing, provider enrollment, reference administration, project management, and data governance are the responsibility of the COO.

Contract Administrator

Contractor will address all contractual matters with and receive approval from the Contract Administrator. The Contract

Administrator works in the Finance and Contract Management section and reports to SCDHHS’ Chief Financial Officer

(CFO).

Key Stakeholders

Below is a chart of key SCDHHS stakeholders with whom the Contractor may interface during the term of the Contract, which is believed to be accurate at the time of the release of this RFP. SCDHHS makes no representation that these stakeholders will be as presented throughout the term of the Contract.

Position Person Role/Responsibility

Program Sponsor and

Chief Operating Officer

Jim Coursey Reports to the SCDHHS Director and is responsible for management and oversight of all operations areas at

SCDHHS

Chief Information Officer David Ulmer Reports to the SCDHHS Director. Responsible for approval of case management solution integration with

SCDHHS technical environment.

BabyNet Program Director Jennifer Buster Reports to the SCDHHS Director and is responsible for overseeing the operations of the BabyNet Program.

Assistant Deputy Director for

Claims and Provider Services

Jeremy

Faulkenburg

Reports to the COO and is responsible for the Claims and

Provider Services Catalog which includes Claims processing, provider enrollment, and reference administration.

Data Governance Director Sam Fields Reports to the COO and is responsible for leading and directing the implementation of data operations.

Chief Information Security

Officer (CISO)

Thomas Scott The CISO, under the direction of the CIO, is responsible for the SCDHHS Cybersecurity and IT Risk Management program, assuring alignment of the program to applicable

State and Federal regulatory requirements such as CMS

MARS-E, HIPAA Privacy and Security Rules, as well guidance set-forth in the South Carolina Information

Security and Privacy program.

Project Management Office

(PMO) Director

TBD Reports to the COO and is responsible for leading and directing the implementation of programs and projects based on SCDHHS’ strategic goals and objectives;

develops and implements PMO governance, policies, and procedures; directs project management staff; and works with other internal and external areas as well as

SCDHHS leaders to define, prioritize, and develop projects and programs.

Contract Administrator TBD SCDHHS shall designate a Contract Administrator to administer the awarded Contract. The SCDHHS Contract

Administrator shall be responsible for all administrative contractual matters. The SCDHHS Contract

Administrator or authorized designee(s), shall establish and oversee Contract management functions, including ongoing monitoring and enforcement of Contractor compliance with performance standards.

INSTRUCTIONS TO OFFERORS - A. GENERAL INSTRUCTIONS

DEFINITIONS, CAPITALIZATION, AND HEADINGS (DEC 2015)

CLAUSE HEADINGS USED IN THIS SOLICITATION ARE FOR CONVENIENCE ONLY AND SHALL NOT BE USED

TO CONSTRUE MEANING OR INTENT. EVEN IF NOT CAPITALIZED, THE FOLLOWING DEFINITIONS ARE

APPLICABLE TO ALL PARTS OF THE SOLICITATION, UNLESS EXPRESSLY PROVIDED OTHERWISE.

AMENDMENT means a document issued to supplement the original solicitation document.

AUTHORITY means the State Fiscal Accountability Authority or its successor in interest.

BUSINESS means any corporation, partnership, individual, sole proprietorship, joint stock company, joint venture, or any other legal entity. [11-35-310(3)]

CHANGE ORDER means any written alteration in specifications, delivery point, rate of delivery, period of performance, price, quantity, or other provisions of any contract accomplished by mutual agreement of the parties to the contract. [11-35-

310(4)]

CONTRACT See clause entitled Contract Documents & Order of Precedence.

CONTRACT MODIFICATION means a written order signed by the procurement officer, directing the Contractor to make changes which the clause of the contract titled "Changes," if included herein, authorizes the Procurement Officer to order without the consent of the Contractor. [11-35-310(9)]

CONTRACTOR means the Offeror receiving an award as a result of this solicitation.

COVER PAGE means the top page of the original solicitation on which the solicitation is identified by number. Offerors are cautioned that Amendments may modify information provided on the Cover Page.

OFFER means the bid or proposal submitted in response this solicitation. The terms Bid and Proposal are used interchangeably with the term Offer.

OFFEROR means the single legal entity submitting the Offer. The term Bidder is used interchangeably with the term Offeror.

See bidding provisions entitled Signing Your Offer and Bid/Proposal As Offer To Contract.

PAGE TWO means the second page of the original solicitation, which is labeled Page Two.

PROCUREMENT OFFICER means the person, or his successor, identified as such on either the Cover Page, an amendment, or an award notice.

YOU and YOUR means Offeror.

SOLICITATION means this document, including all its parts, attachments, and any Amendments.

STATE means the Using Governmental Unit(s) identified on the Cover Page.

SUBCONTRACTOR means any person you contract with to perform or provide any part of the work.

US or WE means the using governmental unit.

USING GOVERNMENTAL UNIT means the unit(s) of government identified as such on the Cover Page. If the Cover Page identifies the Using Governmental Unit as "Statewide Term Contract," the phrase "Using Governmental Unit" means any

South Carolina Public Procurement Unit [11-35-4610(5)] that has submitted a Purchase Order to you pursuant to the contract resulting from this solicitation. Reference the clauses titled "Purchase Orders" and "Statewide Term Contract."

WORK means all labor, materials, equipment, Services, or property of any type, provided or to be provided by the Contractor to fulfill the Contractor’s obligations under the Contract.

[02-2A003-3]

ADDITIONAL DEFINITIONS

ACTUAL OPERATIONAL START DATE is the actual date on which SCDHHS determines, in its sole discretion, that the solution and system is operational substantially as a whole and has begun generating official data of record for all functional areas associated with the system.

BUSINESS RULE means a statement that defines or constrains some aspect of the business, which is intended to assert business structure, or to control or influence the behavior of the business such as restrictions, guidelines, computations, inferences, timing, and triggers. Business Rules include, but are not limited to, system edits and audits; pricing; laws, regulations, and policies; and other automatable or non-automatable elements of practicable guidance.

CHANGE(s) means a Change(s) to the Work or to the time of performance (i.e., hours of the day, days of the week, etc.), or place of performance of the Work.

CLAIM means a bill for services that is appropriate for the provider type and type of service(s), whether submitted as a paper

Claim or electronically, and identified by a unique Claim Control Number (CCN). A single Claim is defined as a billing comprised of a single member with the same date of service (or range of dates for service), submitted by a single billing provider which may include one or more service(s) or document(s).

CONFIGURATION ITEM means all functional and physical items included in the scope of Configuration management, including hardware, software, and design.

DEFECT means any aspect of a Deliverable’s performance that does not meet its requirements.

DELIVERABLES mean those items identified in the Contract to be delivered by the Contractor including, without limitation, the acquired items, hardware, Services, software, etc., required hereunder. The South Carolina Department of Health and

Human Services (SCDHHS) defines a Deliverable as a quantifiable good or service that will be provided or adhered to throughout the project lifecycle. Deliverables can be tangible or intangible and are most often specified functions or characteristics of the project.

ENCOUNTER means a Claim submitted by a managed care entity for reporting purposes only or a fee-for-service Claim that has been adjudicated, priced, and paid or adjusted by an entity other than the Contractor.

KEY PERSONNEL means the Account Manager, Project Manager, Configuration Manager, Conversion Manager, Operations Manager(s), Information Security Manager, and Medical Director required to be identified by name in

Contractor’s Offer, any approved successor to such named individuals and any other individual and his/her approved successor designated in Contractor’s Offer as Key Personnel.

MEDICAID ENTERPRISE means the hardware, software and services designed to meet the demands of South Carolina’s

Medicaid members, stakeholders and appropriate staff.

MILESTONES mean significant specific points along a project timeline. These points may signal anchors, a need for external review, or input. In many instances, Milestones do not impact project duration. Instead, they focus on major progress points that must be reached to achieve success.

MMIS means the Medicaid Management Information System.

OSEP means the Office of Special Education Programs and is part of the U.S. Department of Education. OSEP provides leadership and support for professionals working with children with disabilities. OSEP is supervised by the Office of the Deputy Secretary of Education through the Office of Special Education and Rehabilitative Services (OSERS).

SERVICES mean the Services to be delivered by Contractor pursuant to the Contract Documents.

SOFTWARE-AS-A-SERVICE (SaaS) means a software delivery model in which software is managed and licensed by its

Vendor-owner on a pay-for-use or subscription basis, centrally hosted, on-demand, and common to all users.

SYSTEM OF RECORD (SOR) is the system in which a set of data is managed through its transactional lifecycle; for example, a Claim or a provider record.

SOURCE OF TRUTH (SOT) is the aggregation of data from all Systems of Record (SORs), enhanced with metadata and adjunct sources for enrichment, providing more reliable information to data Trading Partners than any individual SOR.

TRADING PARTNER is an entity that submits Claims information to SCDHHS or Contractor. A Trading Partner may be a provider or a clearinghouse working on behalf of a provider.

VENDOR is a company, other than the Contractor or Offeror, which contributes goods or services.

AMENDMENTS TO SOLICITATION (JAN 2004)

(a) The Solicitation may be amended at any time prior to opening. All actual and prospective Offerors should monitor the following web site for the issuance of Amendments: www.procurement.sc.gov (b) Offerors shall acknowledge receipt of any amendment to this solicitation (1) by signing and returning the amendment, (2) by identifying the amendment number and date in the space provided for this purpose on Page Two, (3) by letter, or (4) by submitting a bid that indicates in some way that the bidder received the amendment. (c) If this solicitation is amended, then all terms and conditions which are not modified remain unchanged. [02-2A005-1] https://en.wikipedia.org/wiki/U.S._Department_of_Education https://en.wikipedia.org/wiki/Deputy_Secretary_of_Education https://en.wikipedia.org/wiki/Office_of_Special_Education_and_Rehabilitative_Services https://en.wikipedia.org/wiki/OSERS

AUTHORIZED AGENT (FEB 2015)

All authority regarding this procurement is vested solely with the responsible Procurement Officer. Unless specifically delegated in writing, the Procurement Officer is the only government official authorized to bind the government with regard to this procurement or the resulting contract. [02-2A007-1]

AWARD NOTIFICATION (MODIFIED)

Notice regarding any award, cancellation of award, or extension of award will be posted at the location and on the date specified on the Cover Page or, if applicable, any notice of extension of award. Should the contract resulting from this

Solicitation have a total or potential value of one hundred thousand dollars or more, such notice will be sent electronically to all Offerors responding to the Solicitation and any award will not be effective until the calendar day (including weekends and holidays) immediately following seventh business day after such notice is given.

BID/PROPOSAL AS OFFER TO CONTRACT (JAN 2004)

By submitting Your Bid or Proposal, You are offering to enter into a contract with the Using Governmental Unit(s). Without further action by either party, a binding contract shall result upon final award. Any award issued will be issued to, and the contract will be formed with, the entity identified as the Offeror on the Cover Page. An Offer may be submitted by only one legal entity; "joint bids" are not allowed. [02-2A015-1]

BID ACCEPTANCE PERIOD (JAN 2004)

In order to withdraw Your Offer after the minimum period specified on the Cover Page, You must notify the Procurement

Officer in writing. [02-2A020-1]

BID IN ENGLISH and DOLLARS (JAN 2004)

Offers submitted in response to this solicitation shall be in the English language and in US dollars, unless otherwise permitted by the Solicitation. [02-2A025-1]

CERTIFICATE OF INDEPENDENT PRICE DETERMINATION (MAY 2008)

GIVING FALSE, MISLEADING, OR INCOMPLETE INFORMATION ON THIS CERTIFICATION MAY

RENDER YOU SUBJECT TO PROSECUTION UNDER SECTION 16-9-10 OF THE SOUTH CAROLINA CODE

OF LAWS AND OTHER APPLICABLE LAWS.

(a) By submitting an Offer, the Offeror certifies that-

(1) The prices in this Offer have been arrived at independently, without, for the purpose of restricting competition, any consultation, communication, or agreement with any other Offeror or competitor relating to-

(i) Those prices;

(ii) The intention to submit an Offer; or

(iii) The methods or factors used to calculate the prices offered.

(2) The prices in this Offer have not been and will not be knowingly disclosed by the Offeror, directly or indirectly, to any other Offeror or competitor before bid opening (in the case of a sealed bid solicitation) or contract award (in the case of a negotiated solicitation) unless otherwise required by law; and

(3) No attempt has been made or will be made by the Offeror to induce any other concern to submit or not to submit an Offer for the purpose of restricting competition.

(b) Each signature on the Offer is considered to be a certification by the signatory that the signatory-

(1) Is the person in the Offeror’s organization responsible for determining the prices being offered in this bid or proposal, and that the signatory has not participated and will not participate in any action contrary to paragraphs (a)(1) through (a)(3) of this certification; or (2)(i) Has been authorized, in writing, to act as agent for the Offeror’s principals in certifying that those principals have not participated, and will not participate in any action contrary to paragraphs (a)(1) through (a)(3) of this certification [As used in this subdivision (b)(2)(i), the term "principals" means the person(s) in the Offeror’s organization responsible for determining the prices offered in this bid or proposal];

(ii) As an authorized agent, does certify that the principals referenced in subdivision (b)(2)(i) of this certification have not participated, and will not participate, in any action contrary to paragraphs (a)(1) through (a)(3) of this certification; and

(iii) As an agent, has not personally participated, and will not participate, in any action contrary to paragraphs (a)(1) through

(a)(3) of this certification.

(c) If the Offeror deletes or modifies paragraph (a)(2) of this certification, the Offeror must furnish with its Offer a signed statement setting forth in detail the circumstances of the disclosure. [02-2A032-1]

CERTIFICATION REGARDING DEBARMENT AND OTHER RESPONSIBILITY MATTERS (JAN

2004)

(a) (1) By submitting an Offer, Offeror certifies, to the best of its knowledge and belief, that-

(i) Offeror and/or any of its Principals-

(A) Are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any state or federal agency;

(B) Have not, within a three-year period preceding this Offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public

(Federal, state, or local) contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of

Offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, or receiving stolen property; and

(C) Are not presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in paragraph (a)(1)(i)(B) of this provision.

(ii) Offeror has not, within a three-year period preceding this Offer, had one or more contracts terminated for default by any public (Federal, state, or local) entity.

(2) "Principals," for the purposes of this certification, means officers; directors; owners; partners; and, persons having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a subsidiary, division, or business segment, and similar positions).

(b) Offeror shall provide immediate written notice to the Procurement Officer if, at any time prior to contract award, Offeror learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

(c) If Offeror is unable to certify the representations stated in paragraphs (a)(1), Offer must submit a written explanation regarding its inability to make the certification. The certification will be considered in connection with a review of the

Offeror’s responsibility. Failure of the Offeror to furnish additional information as requested by the Procurement Officer may render the Offeror non-responsible.

(d) Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render, in good faith, the certification required by paragraph (a) of this provision. The knowledge and information of an Offeror is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

(e) The certification in paragraph (a) of this provision is a material representation of fact upon which reliance was placed when making award. If it is later determined that the Offeror knowingly or in bad faith rendered an erroneous certification, in addition to other remedies available to the State, the Procurement Officer may terminate the contract resulting from this solicitation for default. [02-2A035-1]

CODE OF LAWS AVAILABLE (JAN 2006)

The South Carolina Code of Laws, including the Consolidated Procurement Code, is available at:

http://www.scstatehouse.gov/code/statmast.php

The South Carolina Regulations are available at: http://www.scstatehouse.gov/coderegs/statmast.php [02-2A040-2]

DISCLOSURE OF CONFLICTS OF INTEREST OR UNFAIR COMPETITIVE ADVANTAGE (FEB 2015)

You warrant and represent that your Offer identifies and explains any unfair competitive advantage you may have in competing for the proposed contract and any actual or potential conflicts of interest that may arise from your participation in this competition or your receipt of an award. The two underlying principles are (a) preventing the existence of conflicting roles that might bias a Contractor’s judgment, and (b) preventing an unfair competitive advantage. If you have an unfair competitive advantage or a conflict of interest, the state may withhold award. Before withholding award on these grounds, an Offeror will be notified of the concerns and provided a reasonable opportunity to respond. Efforts to avoid or mitigate such concerns, including restrictions on future activities, may be considered. Without limiting the foregoing, you represent that your Offer identifies any services that relate to either this solicitation or the work and that has already been performed by you, a proposed Subcontractor, or an affiliated business of either. [02-2A047-2]

DEADLINE FOR SUBMISSION OF OFFER (JAN 2004)

Any Offer received after the Procurement Officer of the governmental body or his designee has declared that the time set for http://www.scstatehouse.gov/code/statmast.php http://www.scstatehouse.gov/coderegs/statmast.php opening has arrived, shall be rejected unless the Offer has been delivered to the designated purchasing office or the governmental body's…