Appendix A -WY COMPASS RFP__Requirements.docx

STATE OF WYOMING

DEPARTMENT OF ADMINISTRATION AND INFORMATION

PROCUREMENT SECTION

2800 CENTRAL AVENUE

CHEYENNE, WY 82002

REQUEST FOR PROPOSAL NUMBER #0049-N

THE WYOMING DEPARTMENT OF HEALTH

DIVISION OF HEALTHCARE FINANCING

COORDINATING OUTCOMES: MEMBER PATHWAYS, ADVOCACY, SUPPORT, AND STABILITY (C.O.M.P.A.S.S.)

RFP APPENDIX A: REQUIREMENTS

DEPARTMENT OF HEALTH, DIVISION OF HEALTHCARE FINANCING

REPRESENTATIVE: Brenda Stout

OVERVIEW

The Agency is issuing Appendix A to RFP 0049-N Coordinating Outcomes: Member Pathways, Advocacy, Support, and Stability (C.O.M.P.A.S.S.) also known as the Care Management Entity (CME) for Medicaid Children, to define requirements of the selected Contractor. The Proposer should utilize Appendix A to inform approach, scope, schedule, and budget.

Appendix A includes a comprehensive collection of Contract requirements. Requirements are grouped into categories to align with RFP Section 6. Requirement categories are further broken down into sub-categories of requirement topics. Each requirement has a unique identifier that aligns with the requirement category for reference purposes. Where appropriate, requirements include references to Contract deliverables (summarized in Appendix B), and performance related requirements (summarized in Appendix C).

Proposers should utilize Appendix A to provide a brief response in the Proposer’s Approach column to each Contract requirement to demonstrate the Proposer’s approach and compliance with the Contract requirements. The completed Appendix A should be included as an attachment to the Proposer’s Technical Proposal. This attachment will not be considered in the total page limit.

TABLE OF CONTENTS

RFP 0049-N, WY COMPASS RFP

Appendix A: Requirements

Phase-Specific Requirements

Start-Up Requirements

Provide a revised Project Work Plan originally submitted as part of the Proposal Response to address the following:

A. One-time Start-Up and Transition schedule and milestones and deliverable dates;

B. A description of the administrative service model that describes the Contractor’s approach to operational requirements;

C. Resource and Staffing Management Plan that includes:

I. Personnel and level of effort in hours for Start-Up and Transition activities;

II. Personnel and level of effort in hours for Operational activities;

III. Approach for having key staff available at appropriate timeframes, as designated in the proposal;

IV. An Organization chart for both Transition and Operations, with hours by position;

V. Approach for demonstrating that staff is sufficiently hired, trained, and ready to perform activities associated with their position.

D. Approach for ongoing risk and issue management, including risk and issue identification and tracking, for both Start-Up and ongoing Operations;

E. Approach for ongoing quality assurance and quality control; and F. Change Management approach that conforms to Change Management requirements include in Appendix A, Section 2.4 (A-2.4).

Additional details on the proposal response requirement are included in RFP Section 7.

Provide a revised Project Work Plan within thirty (30) calendar days of the Contract Effective Date. The Project Work Plan shall be in place prior to serving children and youth.

See Deliverable: DEL-2

A. Introducing project teams and stakeholders and defining roles and responsibilities;

B. Determining format and protocol for project status meetings and reporting;

C. Defining lines of communication and reporting relationships;

D. Reviewing the project mission and guiding principles;

E. Reviewing the deliverable review process;

F. Discussing high-risk or problem areas and strategies for mitigation;

G. Describing the proposed issue resolution process; and H. Finalizing the project schedule and milestones.

The Kick-Off meeting shall be held no more than ten (10) calendar days after the Contract Effective Date.

See Deliverable: DEL-1

Transition Requirements

Provide a revised Transition Plan and Checklist originally submitted as part of the proposal response that details the Contractor’s approach to ensuring a seamless transition to providers, staff, and clients. At minimum, the Plan and Checklist shall include the Contractor’s approach to transitioning:

A. Current Plans of Care (POCs);

B. Member records and documentation;

C. Eligibility and enrollment forms and other forms deemed necessary for Operations;

D. Phone lines, website URL(s), and other IT infrastructure in accordance to the Project Work Plan;

E. Active member and provider roster;

F. Level of Care (LOC) and any other assessments;

G. Approach for conducting a knowledge transfer from the Incumbent Contractor to the new Contractor, if appropriate;

H. Entrance and exit criteria that reflect the approved SLA, where applicable; and I. Stabilization criteria that will demonstrate the Contractor is ready to transition to operations.

The Contractor shall leverage the Transition Checklist to demonstrate successful transition of the components required to support a seamless transition.

Additional details on the proposal response requirement are included in RFP Section 7.

Provide a revised Transition Plan and Checklist within thirty (30) calendar days of the Contract Effective Date.

See Deliverable: DEL-3

Develop a comprehensive Provider Training, Certification, and Monitoring Plan that includes, at minimum, the Contractor’s approach to:

A. Verifying qualifications of providers;

B. Monitoring provider geographic coverage and performance;

C. Authorizing POCs submitted by providers; and

Provide a Provider Training, Certification, and Monitoring Plan within forty-five (45) calendar days of the Contract Effective Date.

See Deliverable: DEL-7

A. Project schedule (current status of all activities);

B. Near term activities;

C. Key milestones and activities;

D. Deliverables (submitted, due, overdue, approval status, and payment status);

E. Staffing levels;

F. Project risks from the risk register, including mitigation status;

G. Issues from the issues tracking tool and H. Action items.

The Agency reserves the right to review and approve each Status Report and request that additional information be added to the report template at any point in the project.

Status Meetings will be held weekly during Transition. After Transition, the Contractor and Agency will schedule meetings, as necessary.

Distribute the status agendas at least one (1) business day in advance of the meeting.

Distribute minutes to the Agency within two (2) business days of the meeting.

See Deliverable: DEL-37

The Agency anticipates the following data to require migration into the Contractor’s IT solution:

A. Provider information, including eligibility B. Member information

C. POC

D. WrapTrack and survey information

Provide a Data Migration Plan that includes:

E. The approach and timeline for migration;

F. Extract, Load, Transform (ELT) approach; and G. Approach for testing and validating target vs. source data.

H. Propose acceptance criteria that should include record counts, hash totals, reconciliation thresholds, exception handling, rollback plan, data quality rules, and sign-off by Agency data owners.

Provide Data Migration Plan within ninety (90) calendar days of the Contract Execution Date.

See Deliverable: DEL-14

A. System requirement testing;

B. System integration testing;

C. Data migration testing;

D. Accessibility testing;

E. Security testing;

F. Regression testing; and G. User acceptance testing, where appropriate.

Provide the Test Plan within thirty (30) calendar days of the Contract Effective Date.

See Deliverable: DEL-5

See Deliverable: DEL-23

See Deliverable: DEL-4

See Deliverable: DEL-9

See Deliverable: DEL-10

See Deliverable: DEL-12

A. The data structure of the Contractor’s IT solutions;

B. The approach for maintaining data integrity; and C. Delineation of the data table structure.

Provide a Data Management Plan and Data Models within sixty (60) calendar days of the Contract Execution Date.

See Deliverable: DEL-18

See Deliverable: DEL-21

Provider training shall span the minimum topics:

· HFWA principles and components;

· Behavioral and social needs of children and families, which includes coordination of a broad array of behavioral health services and social supports and coordination with the schools, courts, child welfare workers, juvenile probation, etc.

· Billing processes and payment models;

· An overview of common clinical diagnoses seen in members, including but not limited to abuse and neglect training, attachment disorders, and ADHD;

· Assessment requirements and processes, including CASII, ECSII, CANS, and ACE; and

· Motivational interviewing skills.

At minimum, the Plan shall include:

A. Approach to Tier One and Tier Two training requirements, as described in RFP Section 6.8;

B. Approach for training providers on minimum training topics above;

C. For FCCs, FSPs, and YSPs who are trained and certified prior to the start of the COMPASS’s Contract, how the FCCs, FSPs, and YSPs will be required to comply with any new training guidelines implemented by the Contractor through the yearly recertification process;

D. Approach to working with the Agency and DFS to cross-train providers as necessary to effectively support services;

E. Approach to initial training and certification, including the training schedule;

F. Approach to annual training to maintain certification;

G. Approach to required criminal background checks;

H. Use of classroom and online training;

I. Approach to and platform for providing online and on-demand training options for providers;

J. Approach to training materials. The Agency reserves the right to review and approve all related training materials;

K. Approach to keeping training current with the National Wraparound Initiative’s (NWI) curriculum and best practices and how the Contractor will implement new practices per the NWI as needed;

L. Approach for conducting ad hoc training and refresh training;

M. How the Contractor will leverage COMPASS coaches and customer service avenues to provide technical assistance to providers throughout the Contract term; and N. Approach to validating training was successful and staff are equipped to support the scope of services under this Contract.

Provide the Training Plan within sixty (60) calendar days of the Contract Effective Date.

Revise Training Plans and documents upon identification of recommendations and findings from Annual Report, as directed by the Agency. All approved revisions shall be implemented within thirty (30) calendar days upon delivery of the Annual Report. Additional details on the Annual Report are included in Appendix A, Section 5.4 (A- 5.4)

See Deliverable: DEL-13

See Deliverable: DEL-22

Tier One Training shall be completed for each provider within 30 days of the start of the training for 90% of providers.

See Deliverable: DEL-8

See Deliverable: DEL-15

Turnover

A. Proposed approach to Turnover;

B. Tasks and subtasks for Turnover;

C. Schedule for Turnover;

D. Documentation update procedures during Turnover; and E. Description of Contractor coordination activities that shall occur during Turnover to ensure continued system and services as deemed appropriate by the Agency.

No less than five (5) months prior to the end of the base Contract period(s) or any extension thereof.

See Deliverable: DEL-39

Training shall be completed prior to the end of the contract or any extension thereof.

General Requirements

1.1. Location and Equipment

1.2. Quality Assurance/Quality Control

Quality Control Report all quality monitoring, assurance and improvement metrics to the Agency as outlined in the Social Security Act Sec. 1915(c) waiver, as applicable to the Contract. Metrics shall also be included in the Quarterly Report.

Quality Control Deploy methodologies for monitoring and assessing any changes to the Contractor’s service model. The monitoring and assessment methodologies must remain consistent to appropriately reflect impacts of the change implemented. Results of the changes will be communicated to stakeholders under direction of the Agency. The Agency reserves the right to participate in any change discussions as needed.

Quality Control The Contractor shall maintain a Quality Management Plan describing its approach to quality assurance, quality control, performance monitoring, corrective action, and continuous improvement for all services performed under this Contract. The Plan shall align with the Contractor's quality management, reporting, provider oversight, and performance monitoring activities described throughout this Appendix and shall be updated at least annually or upon Agency request.

Escalate areas of non-compliance or issues as part of the Monthly Report in accordance with the SLA included in Appendix C.

Submit and update the Plan annually and upon Agency request.

See Deliverable: DEL-11

1.3. Deliverable Management

Management Adhere to the Agency's Deliverable Review Process. The Deliverable Review Process defines how deliverables are:

A. Submitted for review;

B. Reviewed;

C. Commented on;

D. How requests for changes are managed;

E. The schedule for review;

F. The schedule for updates; and G. Deliverables acceptance.

Management Submit all deliverables included in the RFP within the Agency defined timeframes and in accordance with the deliverables document standards and acceptance form template provided in RFP Attachment V. A comprehensive list of Contract deliverables is included in Appendix B.

Participate in deliverable walkthroughs when requested by the Agency.

Correct any issues identified by the Agency relating to deliverables and engage in any investigation necessary to determine the source of such deficiencies, at no cost to the Agency.

All deliverables will be in Microsoft Windows Suite; Word, Excel, MS Project, PowerPoint or, if applicable, Visio, or other industry standard tools. Deliverables shall not be submitted in PDF unless otherwise agreed to in advance. Graphics and drawings shall be in industry standard file format.

Obtain written acceptance approval from the Agency on all final deliverables. Any payment tied to deliverables shall be based on the Agency’s written approval of the deliverable.

1.4. Change Management

A. The reason for the change;

B. A complete description of work to be performed;

C. An estimate of time and cost to complete the task;

D. A completion date for the change; and E. An impact analysis indicating ramifications or impact to the project.

1.5. Contract Communication

Communication Maintain communications as outlined in the approved Project Work Plan.

Communication Conduct weekly operational calls as outlined in Appendix A, Section 5.1 (A-5.1) with the Agency Contract Manager during operations.

Distribute the agendas at least one (1) business day in advance of the meeting.

Distribute minutes to the Agency within two (2) business days of the meeting.

Maintain regular telephone and email contact with the Agency’s designated Contract Manager and designated staff throughout the Contract period.

Communication

Provide the ability to use secure and encrypted email account(s) for the Contractor staff to report problems, questions or client issues to the Agency while safely exchanging PHI/PII, as required.

Communication

1.6. Risk and Issue Management

A. All COMPASS-related risks;

B. Initial risk prioritization (urgency), and potential risk impacts (each risk);

C. Risk responses for each risk;

D. A risk mitigation strategy for each risk; and E. Assignments and updated ownership, due dates, and status tracking notes to each risk.

Report on status of risks as part of routine Status Reports to the Agency. The Agency reserves the right to request access to the Contractor’s Risk Register.

Provide the Agency access to the Risk Register within three (3) business days of a request.

A. All applicable information about the issue;

B. Initial issue prioritization (urgency), and potential impacts;

C. An issue resolution strategy for each issue; and D. Assignments and updated ownership, due dates, and status tracking notes to each issue.

Report on status of issues as part of routine Status Reports to the Agency.

1.7. Standards and Compliance

This includes:

Applicable State of Wyoming Enterprise Technology Services and CIO policies, WDH standards and best practices, CMS Medicaid enterprise system requirements, CMS life cycle and certification guidance, MITA, FAR 52.239-1, IRS Publication 1075 where Federal Tax Information is involved, ISO/IEC 27001 and 27002, NIST SP 800-53 Rev. 5, NIST SP 800-57 Rev. 5.

Also all applicable system interconnection, security, privacy, encryption, access control, audit logging, vulnerability management, incident response, contingency planning, and secure development requirements.

The Contractor shall provide documentation and evidence of compliance upon request and shall comply with current or successor versions of applicable standards unless otherwise directed by WDH in writing.

Accreditation by URAC, NCQA, or another relevant accrediting body may be used to demonstrate applicable quality management processes but is not required. If accredited, the Contractor shall identify the accrediting body and scope, provide current accreditation documentation upon request, and notify the Agency of any status change.

If not accredited, the Contractor shall provide documentation upon request demonstrating that its quality assurance, Plan of Care review, provider certification, and related processes meet Agency-defined standards. The Agency may require corrective action for identified deficiencies, performance concerns, or noncompliance.

The Contractor shall provide to the Agency a Statement on Standards for Attestation Engagements (SSAE) No. 16/18, Reporting on Controls at a Service Organization SOC1 and SOC2 reports. Unabridged and/or non-redacted SOC1 and SOC2 reports shall be provided for the Contractor's hosting vendor, if separate from the Contractor, and for the services provided by the Contractor. The sharing of these documents shall not require any additional agreements or authorization.

The Contractor's hosting environment for all system environments shall be compliant with SSAE 16/18 Type 2 and have Federal Risk and Authorization Management Program (FedRAMP) Moderate certification. Contractor shall provide proof of a current SOC 2 Type II certification covering Security, Availability, and Confidentiality principles.

Technology and Specifications

1.8. Contractor Deployed IT Solution(s)

Minimum required functions include, but are not limited to, the ability to:

A. Provide a correspondence module to support member and provider letters, notices, notifications, and other communications;

B. Support provider documentation, notes, and other Contract-required documentation;

C. Manage, track, and generate reports on required data sets, waiver performance measures, and other required metrics;

D. Track and report outcomes and performance metrics as required by the executed Contract;

E. Track and manage referrals;

F. Manage and report provider scorecards;

G. Manage, store, and track Plans of Care;

H. Manage, store, and track Prior Authorizations related to Plans of Care;

I. Track and manage provider compliance with required member and provider contact standards;

J. Track provider training, certification, compliance status, and related requirements;

K. Allow providers to upload training documentation and other required materials for trainer or Agency review;

L. Track utilization of services;

M. Track, manage, and report member and provider grievances, complaints, and appeals;

N. Support the generation and administration of surveys as required by Appendix A, Section 5.1;

O. Allow providers to capture meeting invitees and attendees;

P. Allow providers to document informal and formal supports;

Q. Monitor the use of formal and informal supports, including transitions from formal to informal supports;

R. Support critical incident reporting, tracking, monitoring, and follow-up; and S. Capture and track crisis support information.

Alerts shall include, but are not limited to:

A. Monitoring compliance with assessment requirements and proactively alerting staff and providers when assessments are due, overdue, missing, or incomplete;

B. Alerting staff when no Plan of Care is on file or when required Plan of Care documentation is missing or incomplete;

C. Alerting staff to compliance issues related to minimum provider contact requirements with members;

D. Proactively alerting the Contractor and designated staff of upcoming WFI-EZ survey requirements; and E. Supporting follow-up, escalation, resolution tracking, and reporting for alerts and workflow tasks, as required by the Agency.

1.9. Interaction with Agency and External Systems