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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 C: PERFORMANCE RELATED REQUIREMENTS
PERFORMANCE EXPECTATIONS
Performance Expectations establish timeliness and quality standards related to specific Contract requirements. Performance Expectations are considered an obligation of the Contractor and are enforceable by the executed Contract, but are not tied to penalties or liquidated damages.
| RELATED REQUIREMENT ID |
| CATEGORY |
| PERFORMANCE EXPECTATION |
| PS 1-1 |
| Start-Up |
| Provide a revised Project Work Plan within thirty (30) calendar days of the Contract Effective Date. |
| PS 1-3 |
| Start-Up |
| The Kick-Off meeting shall be held no more than ten (10) calendar days after the Contract Effective Date. |
| PS 1-4 |
| Transition |
| Provide a revised Transition Plan and Checklist within thirty (30) calendar days of the Contract Effective Date. |
| PS 1-5 |
| Transition |
| Provide a Provider Training, Certification, and Monitoring Plan within forty-five (45) calendar days of the Contract Effective Date. |
| PS 1-6 |
| Transition |
| 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.
| PS 1-7 |
| Transition |
| Provide Data Migration Plan within ninety (90) calendar days of the Contract Execution Date |
| PS 1-8 |
| Transition |
| Provide the Test Plan within thirty (30) calendar days of the Contract Effective Date |
| PS 1-9 |
| Transition |
| Provide the Testing Results, including Accessibility Test results, within one hundred and twenty days (120) calendar days of the Contract Effective Date. |
| PS 1-10 |
| Transition |
| Provide a proposed Design Session Schedule and Topics within thirty (30) calendar days of the Contract Execution Date. |
| PS 1-11 |
| Transition |
| Provide a Solution Architecture Document within sixty (60) calendar days of the Contract Execution Date. |
| PS 1-12 |
| Transition |
| Establish IT infrastructure necessary to support scope of work within sixty (60) calendar days of the Contract Effective Date. |
| PS 1-13 |
| Transition |
| Provide Hosting Plan within sixty (60) calendar days of the Contract Execution Date. |
| PS 1-14 |
| Transition |
| Provide Workflow documentation within ninety (90) calendar days of the Contract Execution Date. |
| PS 1-15 |
| Transition |
| Provide a Data Management Plan and Data Models within sixty (60) calendar days of the Contract Execution Date. |
| PS 1-16 |
| Transition |
| Provide a Systems Operating Manual within twenty (120) calendar days of the Contract Execution Date. |
| PS 1-17 |
| Transition |
| Attend question and answer sessions with the Incumbent Contractor, if necessary, and advise the Agency of any areas of concern based on previous presentations and reviews of documentation. |
| PS 1-19 |
| Transition |
| Provide the Training Plan within sixty (60) calendar days of the Contract Effective Date. |
| PS 1-20 |
| Transition |
| Provide the Training Platform within ninety (90) calendar days of the Contract Effective Date. |
| PS 1-21 |
| Transition |
| Tier One Training shall be completed for each provider within 30 days of the start of the training for 90% of providers. |
| PS 1-22 |
| Transition |
| Provide a documented Referral Process within sixty (60) calendar days the Contract Effective Date. |
| PS 1-23 |
| Transition |
| Provide the Customer Service Plan within ninety (90) calendar days of the Contract Effective Date. |
| PS 1-24 |
| Transition |
| Conduct the operational readiness walkthrough with the Agency by April 30, 2027. |
| PS 1-26 |
| Turnover |
| Provide a turnover plan no less than five (5) months prior to the end of the base Contract period(s) or any extension thereof. |
| GR 2-8 |
| Quality Assurance/ Quality Control |
| Submit and update the Quality Management Plan annually and upon Agency request. |
Communication 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.
Communication Distribute minutes to the Agency within two (2) days of the meeting.
Communication Contract review shall be conducted within thirty (30) days before the Contract review period.
| GR 2-23 |
| Risk Management |
| Provide the Agency access to the Risk Register within three (3) business days of a request. |
| IT 3-38 |
| Privacy and Security |
| Conduct audit reviews for suspicious activity no less than quarterly. |
| IT 3-46 |
| Privacy and Security |
| Submit updates annually to the SSP to identify all potential threats and hazards to the physical sites and Contractor-deployed IT solutions, including the probability of occurrence, and identify the assets and controls to protect against such threats and hazards. |
| IT 3-47 |
| Privacy and Security |
| Provide the Agency with the raw output from penetration testing within two (2) business days of completing the test. |
| IT 3-48 |
| Privacy and Security |
| Provide the Agency with the raw output from vulnerability testing within two (2) business days of completing the test. |
| Staff 4-8 |
| Providers and Support Staff |
| The FSP to youth ratio should be no more than one (1) FSP for a total of twenty-five (25) youth (1:25). |
| Staff 4-12 |
| Staffing and Resource Management |
| Any updates to the Staffing and Resource Management Plan shall be made within three (3) business days upon receipt of request, unless otherwise determined by the Agency. |
Staff 4-13 Staff 4-15
| Staffing and Resource Management |
| When possible, the Agency shall be notified at least thirty (30) calendar days prior to key personnel changes or departures. |
In unexpected termination circumstances, the Agency shall be notified at least two (2) days after receiving notification of departure.
Key Personnel positions may not be open for more than two (2) weeks without a qualified substitute (temporary replacement). A qualified substitute must be in place no more than two (2) weeks after the separation date of the original resource. The definition of a qualified substitute is having experience in the position, meeting the requirements of the position and understanding of the COMPASS SOW. The Contractor will have sixty (60) calendar days to fill this position with the permanent replacement.
| Staff 4-18 |
| Staffing and Resource Management |
| Notify the Agency of any negative findings resulting from employee or subcontractor background checks within five (5) business days of the finding discovery. |
| Staff 4-20 |
| Staffing and Resource Management |
| At minimum, the Contractor shall provide staff with HIPAA and Security training annually. |
| Ops 5-2 |
| Ongoing Operations |
| Provide the Policies and Procedures Manual within ninety (90) calendar days of Contract execution. |
| Ops 5-9 |
| Ongoing Operations |
| The toll-free number for members and services shall be available to members 24 hours a day, 365 days a year. |
Follow up triaged calls to the Agency within two (2) business days of receipt.
The monthly average wait time for members to connect to a customer service representative shall not exceed three (3) minutes.
Provide email responses to member or public emails within three (3) business days of receipt.
| Ops 5-10 |
| Ongoing Operations |
| The provider customer service representatives shall be available 9 AM-5 PM MST Monday – Friday. |
Follow up with the provider on the status of inquiry within two (2) business days of receipt, if appropriate.
| Ops 5-13 |
| Ongoing Operations |
| The Contractor shall maintain website uptime of 99.0%, excluding planned downtime. |
| Ops 5-17 |
| Ongoing Operations |
| Submit the outline of the draft survey to the Agency for review and approval ten (10) business days prior to release. |
Conduct the survey on a bi-annually basis, at minimum, in a timeframe agreed upon by the Agency.
| Ops 5-18 |
| Ongoing Operations |
| The Contractor shall notify the Agency within two (2) business days of any critical incident event. Data showing compliance with this requirement shall be included in the quarterly data report. |
| Ops 5-19 |
| Ongoing Operations |
| The Contractor shall notify the Agency of the issue and corrective action plan within two (2) business days of any critical incident event. |
| Ops 5-21 |
| Ongoing Operations |
| Provide agendas within one (1) business day of the meeting. |
Provide minutes within two (2) business days of the meeting.
| Ops 5-23 |
| Outreach and Communication |
| Submit notice and communication templates for Agency review and approval within ninety (90) days after the Contract Execution Date. |
| Ops 5-28 |
| Complaints, Appeals & Grievances |
| An appeal must be filed within sixty (60) days from the date of adverse benefit determination notice date. A grievance may be filed by a member at any time. |
The Contractor must present a proposed resolution to the issue reported within forty-five (45) calendar days from the date the Contractor receives the grievance or appeal. If the Contractor’s proposed resolution is not accepted by the individual or entity acting on their behalf, the Contractor has thirty (30) calendar days to review and respond to the grievance or appeal. After exhausting the grievance and appeal process with the Contractor, the member may request an Agency fair hearing within twenty (20) days after receipt of the final notice of Contractor’s decision or action.
Contractor must resolve grievances and provide notice according to the member’s health condition, no more than ninety (90) calendar days from grievance receipt.
| Ops 5-29 |
| Complaints, Appeals & Grievances |
| Provide a written notice to the member of the grievance resolution within two (2) business days of the resolution acceptance by the Agency. |
| Ops 5-31 |
| Complaints, Appeals & Grievances |
| Make expedited authorization decisions and provide notice no later than seventy-two (72) hours after receipt of the request for service if the provider indicates or the Contractor determines, that following the standard authorization and/or adverse action decision time frame could seriously jeopardize the member’s life or health or ability to attain, maintain, or regain maximum function. This may be extended up to fourteen (14) calendar days if the member requests an extension or the Contractor justifies a need for additional information and is able to demonstrate how the extension is in the member’s best interest. |
If the Contractor denies a request for expedited resolution of an appeal, the Contractor must transfer the appeal to the standard timeframe of no longer than thirty (30) calendar days from the day the appeal was received.
| Ops 5-32 |
| Complaints, Appeals & Grievances |
| Appeals can be filed orally or in writing by the member or an authorized representative, including the provider, within sixty (60) calendar days from the date on the adverse action notice. |
If the Contractor’s review results in an adverse action, the Contractor shall provide a thirty (30) calendar day advance notification to the member and the member’s family care coordinator prior to implementing a change in program eligibility and/or service amount, duration or frequency.
The Contractor must mail the notice of adverse action notification at least ten (10) days before the date of action, when the action is a termination, suspension, or reduction of previously authorized Medicaid covered services. If the Agency has facts indicating that action should be taken because of probable fraud by the member, and the facts have been verified, if possible, through secondary sources, the Contractor must mail the notice of adverse action notification within five (5) days prior to the date of action.
| Ops 5-33 |
| Complaints, Appeals & Grievances |
| If services were not furnished during the appeal, the Contractor must authorize or provide the services as expeditiously as the member’s health condition requires, but no later than seventy-two hours from the date that the State fair hearing officer reverses a decision to deny, limit or delay services. |
| Ops 5-34 |
| Complaints, Appeals & Grievances |
| Provide the member or provider with the receipt of the compliant and timeframe for resolution to the member or provider within two (2) business days. |
| Ops 5-35 |
| Complaints, Appeals & Grievances |
| The Contractor must respond to any complaint received directly or by the Agency in regard to Contractor performance within five (5) business days after receiving the complaint. |
| Ops 5-36 |
| Data Management and Reporting |
| Develop a Data and Quality Management Plan and process for reporting outcomes of youth/children served within one hundred and twenty (120) calendar days from the Contract Effective Date. |
| Ops 5-37 |
| Data Management and Reporting |
| Develop report templates within one hundred and twenty (120) calendar days from the Contract Effective Date. |
| Ops 5-38 |
| Data Management and Reporting |
| The Contractor must provide Monthly Reports to the Agency by the fifth (5th) business day of the month. |
| Ops 5-39 |
| Data Management and Reporting |
| The Contractor must provide quarterly reports to the Agency by the fifteenth (15th) business day of the following quarter. |
| Ops 5-40 |
| Data Management and Reporting |
| The Contractor must provide quarterly reports to the Agency by the fifteenth (15th) business day of the following quarter. |
| Ops 5-41 |
| Data Management and Reporting |
| The Contractor must provide Annual Reports to the Agency by the fifteenth (15th) business day following the annual date. |
| Ops 5-43 |
| Data Management and Reporting |
| Agency shall be granted access to all reports and data within one (1) business day of the request. |
| Ops 5-45 |
| Financial Management |
| Submit independently audited financial statements annually, in accordance with the agreed upon timeframe. |
| EM 6-1 |
| Member Eligibility and Enrollment |
| Provide the Application Packet, including required Agency forms, within ninety (90) calendar days of the Contract Execution Date. |
| EM 6-7 |
| Member Eligibility and Enrollment |
| Complete all member applications within three business (3) days once application information is complete. |
| EM 6-4 |
| Member Eligibility and Enrollment |
| Send all CMHW referrals to the Agency within two (2) calendar days of discovery. |
| EM 6-6 |
| Plan of Care |
| A POC must be developed for each member within forty-six (46) calendar days after enrollment. |
| EM 6-7 |
| Plan of Care |
| The Contractor shall review and issue an authorization decision for one hundred percent (100%) of all POC submitted with in three business (3) days. |
| EM 6-8 |
| Plan of Care |
| Review one hundred percent (100%) of all initial and re-evaluations. |
| EM 6-13 |
| Plan of Care |
| Conduct transition readiness assessments every three (3) months of a child/youth’s enrollment. |
| EM 6-23 |
| Coordination of Care |
| Complete and resubmit PRTF discharge forms as dictated by the Agency. |
| PM 7-1 |
| Provider Training, Certification, and Monitoring |
| All providers shall complete and successfully pass the certification process prior to enrolling as a Medicaid provider. |
The Contractor shall provide Tier 1 training on the foundations of HFWA that incorporates the principles of Motivational Interviewing. Tier 1 training must be delivered in-person, unless individuals or groups request virtual Tier 1 training. Training must be offered in different regions of the State on a quarterly basis (at a minimum), if not more frequently, based on demand. The Agency currently uses Vroon VDB Training and Certification Manuals for the pertinent provider role as part of the training curriculum.
Tier One Training shall be completed for each provider within 30 days of the start of the training for 95% of providers.
| PM 7-3 |
| Provider Training, Certification, and Monitoring |
| The additional training topics may be delivered through remote learning opportunities and teleconference or e-learning technologies and recorded for later viewing. Topics range from ethics in practice, generating referrals, recognizing and reporting abuse/neglect, documentation standards, and information on working with children and youth with specific diagnoses or Medicaid documentation standards. All trainings should be made available to providers as part of a tool-kit approach to provider development, retention, and quality improvement. Providers may request training on specific topics and peer to peer learning is also encouraged. |
Complete Tier Two training within 60 days of the start of training for 95% of HFWA providers
| PM 7-4 |
| Provider Training, Certification, and Monitoring |
| Submit the Provider Handbook within sixty (60) days of the Contract Execution Date. |
| PM 7-9 |
| Provider Training, Certification, and Monitoring |
| Each HFWA provider shall be recertified annually from their initial certification date. |
Complete Tier Two training within 60 days of the start of training for 95% of HFWA providers.
| PM 7-15 |
| Provider Training, Certification, and Monitoring |
| Publish the Provider Scorecards de-identified on an annual basis for HFWA Agencies for providers. |
| PM 7-16 |
| Provider Training, Certification, and Monitoring |
| Submit the Provider Report Card Manual within one-hundred and twenty (120) days of the Contract Execution Date. |
| PM 7-18 |
| Provider Training, Certification, and Monitoring |
| Document in the Contractor’s deployed solution within 24 hours of contact. |
RFP 0049-N, WY COMPASS RFP Page 11 Appendix C: Performance Related Requirements
SERVICE LEVEL AGREEMENTS
The below table represents Service Level Agreements (SLAs) for the COMPASS Contract. Compliance with SLAs shall be reported monthly as part of the Monthly Report Deliverable. The Agency reserves the right to independent validate the Contractor’s compliance with SLAs.
Liquidated damages, if assessed, shall constitute the State’s sole remedy for the applicable failure giving rise to the failed SLA. Contractor shall not be assessed liquidated damages for any SLA failure if such failure is not solely caused by Contractor.
The total liquidated damages assessed in any month or for any single month shall not exceed 20% of the fees payable to the Contractor in that month or the associated month.
If multiple SLA failures are caused by or the result of the same occurrence, event, or act or omission (as applicable), the State shall only be entitled to the assessment of the liquidated damages associated with the SLA with the highest liquidated damages,
| ID |
| CATEGORY |
| REQUIREMENT |
| LIQUIDATED DAMAGE |
| SLA-1. |
| Start-Up and Transition |
| The Contractor shall successfully complete the readiness walkthrough and receive Agency approval for Operations by June 30, 2027. |
| $1,000.00 liquidated damages per day after June 30, 2027. |
| SLA-2. |
| Ongoing Operations: |
System and Website and Provider Portal Availability The Contractor shall maintain websites and provider portal uptime of 99.0%. For every 1.0% of time the system(s) is down (excluding scheduled downtime), the Agency, without further notice, may assess liquidated damages for each month.
Updates shall be made outside of normal working hours, which are 8:00 AM to 5:00 PM, MT, Monday through Friday, with the exception of State Observed Holidays, or at times agreed to by the Agency. Planned downtime shall not exceed five (5) hours per month.
$1,000.00 per month if unplanned downtime exceeds 1.0%.
| SLA-3. |
| Ongoing Operations: |
Toll-Free Number The toll-free number for members and services shall be available to members 24 hours a day, 365 days a year.
Updates shall be made outside of normal working hours, which are 8:00 AM to 5:00 PM, MT, Monday through Friday, with the exception of State Observed Holidays, or at times agreed to by the Agency. Planned downtime shall not exceed five (5) hours per month.
$1,000.00 per day if unplanned downtime.
| SLA-4. |
| Staff Resource Management |
| Key Personnel positions may not be open for more than two (2) weeks without a qualified substitute (temporary replacement). A qualified substitute must be in place no more than two (2) weeks after the separation date of the original resource. The definition of a qualified substitute is having experience in the position, meeting the requirements of the position and understanding of the COMPASS SOW. The Contractor will have sixty (60) days to fill this position with the permanent replacement. |
| $2,500.00 liquidated damages per week after the second calendar week a key personnel position is not filled. |
| SLA-5. |
| Ongoing Operations: |
Training Effectiveness Feedback from trainees will be collected through a survey to determine the effectiveness of the training and materials. Training survey responses should demonstrate at least an overall 85% satisfactory level with the Provider training.
All training surveys should be evaluated and feedback provided to the Agency within four (4) business days of the training.
The Contractor shall work with the Agency to put in place a corrective action plan to address training deficiencies reported in surveys.
$1000.00 per month if corrective action plan is not executed within one (1) calendar month of identified deficiencies.
| SLA-6. |
| Emergency/Critical Priority Issues: |
| The Contractor shall notify the Agency of the issue and corrective action plan within two (2) business days of any critical incident event. |
| $500.00 per business day after the third business day of the critical incident report. |
| SLA-7. |
| Security Incidents |
| 0% of Security Incidents affecting 100 or more clients annually. 0% of security incidents affecting 500 or more clients annually. For any Security incidents affecting a population of 500 clients or more, the Contractor will work collaboratively with the Agency to gather, analyze and report findings to the Office Civil Rights (OCR). The Contractor will receive sanctions, if any, determined by Office Civil Rights (OCR) and be responsible for OCR and other associated costs such as call center costs, credit reporting, publications, and media centers. A security incident is defined for purposes of this Contract in 45 CFR Part 164.304.). All Security Incidents must be reported. SLA will be determined after sufficient technical evaluation is complete to verity the number of clients potentially affected. |
| Cost of mitigation plus $50,000.00 per occurrence for any security incident affecting 500 or more clients that results from actions attributed to Contractor's performance of the Contract based on State’s discretion. |
| SLA-8. |
| Compliance with Applicable Regulations |
| Adhere to applicable State and federal laws, rules, regulations, guidelines, policies, and procedures relating to information systems, information systems security and privacy, physical security, PHI confidentiality and privacy. 0% out of compliance. If the system is out of compliance, a mitigation plan to regain compliance is due to the agency within ten (10) business days with mitigation to be complete and testing to be complete in timeframe defined in the mitigation plan. The Contractor will assume all liabilities including any incurred cost to the Department for the violation of applicable State and Federal laws, rules, regulations, guidelines, policies, and procedures relating to information systems, information systems security and privacy, physical security, PHI confidentiality and privacy. |
| Cost Incurred to Agency |
| SLA-9. |
| Security Awareness Training |
| Conduct annual HIPAA and security training with Contract staff. This training can be part of the onboarding processes and the documentation will be consolidated and submitted annually to the Agency. |
| $1,000.00 per Contractor employee per day late receiving annual HIPAA and security training. The 13th month is excluded from the penalty. |