Att K - Scope of Work.docx

RFP 26-87449

Scope of Work Indiana Department of Health (IDOH)

Telehealth & Teleconsultation Landscape Assessment RFP

EXECUTIVE SUMMARY

On Dec. 29, 2025, Indiana was awarded a grant of nearly $207 million for the first year of a five-year federal Rural Health Transformation Program (RHTP) to address health outcomes in the State’s rural communities. The RHTP is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $206,927,896.80 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.

This contract will deliver a comprehensive, statewide landscape assessment of telehealth (provider-to-patient) and teleconsultation (provider-to-provider) services to inform strategic planning, investment, and sustainability under the Rural Health Transformation Program (RHTP). Depending on the findings of the landscape assessment, the State may determine that additional funding and follow-on engagement are needed to address emerging priorities.

Per federal guidance on the RHTP grant, the Contract resulting from this RFP will have a five-year contract term, but the Contract only has funding for the initial budget period (Budget Period 1). This Contract may be amended to add subsequent funding for later budget periods based on federal funding awarded for those budget periods and the State’s needs. The federal funding supporting this Contract must be expended within strict deadlines; therefore, failure to complete work by specified deadlines may subject this Contract to termination to ensure funds are spent in accordance with federal requirements.

This assessment will support the State’s goals to:

· Improve access to care in rural and underserved communities

· Address specialty access gaps and workforce shortages

· Support care coordination and system integration

· Develop scalable, sustainable telehealth and teleconsultation programs beyond initial grant funding

Vendor Qualifications and Minimum Requirements Respondents should demonstrate experience with:

· Statewide or multi-region health landscape assessments,

· Telehealth and teleconsultation, including specialty access models,

· Medicaid, Medicare, and multi-payer reimbursement analysis,

· Rural health systems,

· Mixed-methods research and stakeholder facilitation

· Prioritization and decision-support frameworks

Minimum Requirement: At a minimum, the Respondent shall have conducted a healthcare, public health, or statewide landscape assessment (or similar assessment) in the last seven (7) years.

BACKGROUND AND CURRENT STATE

Access to timely, appropriate, and specialty healthcare services remains a persistent challenge for many communities, particularly in rural areas. Geographic distance, workforce shortages, long wait times for specialty care, transportation barriers, limited provider capacity, and uneven access to supportive infrastructure, among other factors, contribute to gaps in care delivery. These challenges can delay diagnosis and treatment, increase the burden on patients and families, and exacerbate disparities in health outcomes across regions and populations.

Telehealth and teleconsultation present important opportunities to address these challenges by extending the reach of clinical expertise, improving care coordination, and increasing access to services that may otherwise be difficult to obtain locally. For purposes of this assessment telehealth refers broadly to technology-enabled clinical and care-support services delivered between providers and patients, while teleconsultation refers to provider-to-provider models, such as eConsults or other asynchronous and synchronous consultations, that support primary care and community-based providers in obtaining specialty input without requiring every patient encounter to result in a referral or in-person specialty visit.

While both telehealth and teleconsultation have gained visibility and adoption in recent years, implementation across the healthcare landscape remains uneven. Many organizations have established some level of telehealth capability, but the maturity, scope interoperability, sustainability, and effectiveness of those services may vary significantly. In some settings telehealth is well integrated into care delivery workflows and supported by reimbursement mechanisms, technology infrastructure, training, and governance. In others, telehealth remains fragmented, limited to select use cases, dependent on temporary funding, or hindered by operational and technical barriers. Teleconsultation models are often even less mature, despite their potential to improve access to specialty guidance, strengthen care in rural and community settings, reduce unnecessary referrals, and support more appropriate use of limited specialty capacity.

From a statewide and system-level planning perspective, there is a need to better understand the existing telehealth and teleconsultation environment before making future investment decisions. This includes identifying what services and capabilities already exist; where meaningful gaps remain; which populations, specialties, and geographies face the greatest barriers; what models have shown promise; and what foundational conditions are necessary to support scale, sustainability, and measurable impact. A structured landscape assessment can provide that baseline understanding and help inform future policy, programmatic, operational, and funding decisions.

This assessment should examine the telehealth and teleconsultation landscape across multiple dimensions including:

· Existing programs, platforms, and delivery models within the State and all participating community partners

· Provider participation and readiness

· Specialty access needs and priority service lines

· Patient and community barriers to adoption

· Technical infrastructure, interoperability, and data exchange capabilities

· Policy, operational, and reimbursement considerations

· Governance, partnerships, and coordination structures

· Sustainability and opportunities for future investment

The findings from this work will help inform a future-state vision for telehealth and teleconsultation that is responsive to local and regional needs, grounded in practical implementation realities, and aligned with broader system and RHTP goals. By establishing a clear baseline of current capabilities, barriers, opportunities, and priorities, this landscape assessment can support more targeted planning, strategic allocations of resources, and more sustainable approaches in improving access to care.

SCOPE OF WORK

Objectives of Engagement The selected contractor (“Contractor”) shall provide end-to-end support for the design, execution, analysis and reporting of a statewide telehealth and teleconsultation landscape assessment, aligned with Indiana and CMS definitions, payment frameworks, delivery system goals, and the Rural Health Transformation Program’s five strategic goals. This includes the following objectives:

1. Assess the current landscape, utilization, readiness, and gaps in telehealth and teleconsultation statewide, including trends or differences by county or region.

2. Identify priority use cases and specialties aligned to RHTP goals.

3. Coordinate baseline data collection and alignment across RHTP initiatives.

4. Evaluate cost, return on investment (ROI), and sustainability models that extend beyond reimbursement.

5. Deliver an implementation ready roadmap to guide phased deployment of telehealth and teleconsultation solutions.

Project Phases and Activities

3.2.1 Planning

The Contractor shall complete a structured planning phase to establish the foundation for the telehealth and teleconsultation landscape assessment. This phase will ensure alignment on scope, approach, stakeholder engagement, data collection methods, and deliverables prior to execution of assessment activities. This phase is expected to result in clearly defined, state approved plans and instruments that will guide all subsequent phases of the assessment. This includes the development of a project management plan and detailed assessment methodology plan that defines how the current state of telehealth and teleconsultation will be evaluated. Components of the assessment framework should include:

· Overall Assessment Framework

· Mixed-Methods Approach

· Stakeholder Identification & Segmentation

· Telehealth and Teleconsultation Scope

· Data Collection Strategy

· Gap and Opportunity Analysis Approach

· Equity and Access Considerations

Deliverables:

· Project Management Plan

· Assessment Methodology and Instruments

3.2.2 Data Gathering and Analysis

3.2.2.1 Stakeholder Engagement & Readiness

The Contractor shall design and implement a stakeholder engagement strategy that includes rural oversampling and coordination with other RHTP vendors conducting similar assessments. This includes representation from:

· Rural and urban healthcare providers and health systems.

· Hospitals and critical access hospitals.

· Federally Qualified Health Centers (FQHCs) and rural health clinics.

· Specialty providers and referral partners.

· Managed care organizations and other payers.

· Public health agencies and community-based organizations.

· Patients and caregivers, as feasible.

Telemedicine Advisory Committee. As part of stakeholder engagement efforts, the Contractor shall establish a Telemedicine Workgroup, in collaboration with the IDOH and key stakeholder groups, that brings together clinical subject matter experts (SMEs). The Contractor shall engage with the clinical SMEs throughout the project to inform the development, execution, and analysis of the telehealth and teleconsultation landscape assessment to ensure that clinical perspectives and priorities are accurately understood and reflected in findings and recommendations.

The Contractor and the State shall mutually agree upon a target percentage of the total identified stakeholder population to be surveyed (for more information, see Section 8). Stakeholder engagement shall focus on access, quality, administrative burden, reimbursement adequacy, readiness, and sustainability for both telehealth and teleconsultation models.

Deliverable: Stakeholder Engagement Summary, including validation of KPI target for stakeholder engagement coverage (see Section 8).

3.2.2.2 National Models and Evidence Scan

The Contractor shall identify and summarize successful or widely adopted national models including:

· Specialty interprofessional consultation programs

· Hub-and-spoke specialty telehealth models supporting rural providers

· Workforce mentoring and capacity-building models

· Evidence on outcomes, utilization, cost, access, and provider experience

· Key success factors, barriers, and lessons learned

· Applicability to Indiana’s rural health context

Deliverable: National Models and Evidence Scan. This deliverable will also include an evaluation of the impact of wearable electronics such as biometric monitoring devices or similar technology that is rapidly emerging in the telemedicine space.

3.2.2.3 Gap Analysis and Needs Identification

The Contractor shall:

· Identify gaps related to access, specialty availability, infrastructure, workforce capacity, technology readiness, interoperability, and administrative burden,

· Clearly distinguish needs and barriers for:

· Direct-to-patient telehealth, and

· Provider-to-provider teleconsultation.

· Assess readiness for expansion or scaling of tele-enabled models

· Identify priority populations and high-impact clinical domains where tele-enabled models may reduce disparities and improve outcomes.

· Describe how identified gaps impact the State’s ability to achieve the RHTP’s five strategic goals (see CMS’ RHTP Overview page for more information on strategic goals)

Deliverable: Gap Analysis and Needs Identification Report

3.2.2.4 Specialty Care Provider and Program Assessment

The Contractor shall conduct a targeted assessment of specialty care access and programs relevant to telehealth and teleconsultation. Findings should include trends or differences by county or region as well as statewide, and should include the following components:

· Inventory of specialty care providers and programs delivering services via telehealth and/or teleconsultation

· Assessment of specialty access gaps (wait times, travel burden, limited availability), stratified by geography and priority populations

· Assessment of operational models for specialty telehealth and specialty teleconsultation

· Assessment of enabling conditions for specialty participation (credentialing, privileging, workflows, technology integration)

· Assessment of payer and reimbursement dynamics for specialty participation

· Identification of specialties with high unmet need, high avoidable utilization, or strong feasibility for tele-enabled models in Indiana

Deliverable: Specialty Care Provider and Program Assessment

3.2.2.5 Billing, Coverage, and Reimbursement Assessment

The Contractor shall assess current billing, coverage, and reimbursement practices, including:

· Common billing codes and reimbursement mechanisms for telehealth and interprofessional consultation (teleconsultation)

· Differences in coverage and reimbursement by payer type (Medicaid, Medicare, commercial)

· Managed care plan policies and administrative requirements

· Originating site, distant site, and site-of-service considerations

· Provider-reported barriers related to billing complexity, documentation, credentialing, and payment adequacy

· Sustainability risks associated with temporary versus permanent policy flexibility

· Opportunities to improve reimbursement alignment to support long-term sustainability

Deliverable: Billing/Coverage/Reimbursement Assessment Summary

3.2.3 Final Report and Executive Presentation

3.2.3.1 Final Report

The Contractor shall develop and deliver the Indiana Statewide Telehealth & Teleconsultation Plan, which consists of the following components. The Planning deliverables and the Data Gathering and Analysis deliverables shall be used to help develop and support these components.

· Statewide Environmental Scan and Current State Analysis. Outputs from this component directly support the data gathering and analysis phase to inform the development of a framework for the State’s strategic planning:

· Baseline data framework and data dictionary

· Visual mapping of access, utilization, and gaps

· Summary of baseline data limitations

· Methodology and stakeholders

· Existing telehealth and teleconsultation programs operating in Indiana

· Current technology platforms and infrastructure supporting virtual care

· Interoperability and health information exchange considerations (such as technical standards, integration with health information exchange technology, and data governance considerations)

· Workforce capacity and readiness (clinical, administrative, technical)

· Broadband access and digital equity considerations

· Alignment with existing statewide or regional care coordination, public health, and delivery system reform initiatives.

· Development of standardized baseline data elements and data definitions

· Rural vs. urban access analysis, including broadband and infrastructure factors

· Identification of geographic, specialty, and population-level gaps

· Specialty Prioritization and Funding Focus Recommendations.

· A transparent prioritization framework and scoring rubric, subject to State approval, that considers:

· Burden of disease

· Access gaps and rural workforce shortages

· Feasibility for telehealth and teleconsultation

· Expected impact on outcomes, utilization, and equity

· Reimbursement and sustainability feasibility

· A ranked list of specialty areas for investment

· Recommendations for appropriate telehealth and/or teleconsultation models by specialty

· Funding focus scenarios (e.g. Top 3, Top 5, tiered rollout), sequencing, and measures of success.

· Policy and Sustainable Funding Recommendations.

· Policy recommendations to support telehealth and teleconsultation expansion and coordination.

· Recommendations for sustainable funding strategies, including multi-payer and reimbursement-based approaches.

· Recommendations to reduce administrative burden while maintaining program integrity.

· Alignment with broader rural health and delivery system reform efforts.

· Baseline Key Performance Outcome (KPO) Measurements.

The Contractor shall establish baseline measurements that will be used to assess progress against KPO metrics that the State has committed to for the RHTP Telehealth and Teleconsultation initiatives. The Contractor shall clearly define and document the methodology used to establish KPO baseline measurements. The selected methodology must be repeatable and support ongoing data collection for evaluation of progress against KPOs throughout the RHTP grant period. These KPO metrics include, but are not limited to:

1. Teleconsultation KPOs

a. Number of interfacility transfers

b. Wait time and travel for an appointment with a specialist, by county

c. Number of specialists available via teleconsultation

d. Utilization rate for providers

2. Telehealth KPOs

a. Number of telehealth encounters (including teleconsultation, virtual urgent care, and remote patient monitoring)

b. Percentage of patients achieving improved HbA1c control (<8% for diabetics) or blood pressure control (<140/90 for hypertensive patients), measured at county level

c. Timeliness of access to appropriate care, by county

d. Preventable ED visit rates for ambulatory care-sensitive conditions measured at county level

The State shall provide available baseline data and access to other data sources where applicable to support the establishment of baseline KPO measurements.

· Supporting Data and Appendices

· All supplementary materials, datasets, and reference documents that provide additional context and validation for findings and recommendations.

· Appendices may contain information such as detailed tables and charts, stakeholder engagement summaries, and relevant regulatory or policy references that informed the assessment

· Supporting data shall be presented in an organized manner that supports transparency and clarity for reviewers.

Deliverable: Indiana Statewide Telehealth & Teleconsultation Plan and Executive Presentation

3.2.3.2. Executive Presentation

The Contractor shall develop a clear, informative, and visually engaging Executive Presentation of slides summarizing the Final Report. After the Executive Presentation content is approved, the Contractor shall conduct one presentation of the content in coordination with IDOH to select State executives on the RHTP project and address any questions.

Deliverables and Deadlines The project shall be completed within eight months of contract execution, unless otherwise approved by the State. The Contractor shall propose a detailed timeline with milestones and deliverables as part of the Project Management Plan (see Section 4.1). The following high-level milestones shall drive the detailed timeline.

Table 1: Milestones and Deliverables

· Assessment Methodology and Instruments

· Billing, Coverage, Reimbursement Assessment Summary

· Specialty Care Provider and Program Assessment

· National Models and Evidence Scan

· Gap Analysis and Needs Identification Report

3.5 Payment Points

The Contractor shall invoice IDOH when the following payment points are met and approved for invoicing by IDOH. The invoice must have sufficient information describing the work performed for reimbursement.

Table 2: Payment Points

· Assessment Methodology and Instruments

· National Models and Evidence Scan

· Billing, Coverage, Reimbursement Assessment Summary

· Gap Analysis and Needs Identification Report

PROJECT MANAGEMENT AND COORDINATION

The Contractor shall designate an engagement manager, participate in regular status meetings, provide written progress updates, and coordinate closely with designated State staff. Drafts of each deliverable will be reviewed by the State before the final deliverables are submitted.

Project Management Plan The Contractor shall develop an overall Project Management Plan (PMP) that addresses the approach to and execution of the Contractor’s duties. The PMP shall be submitted for approval to the State. Once approved, the Contractor shall maintain the PMP by updating it to reflect the evolving schedule, priorities, and resources (i.e., it is a living document). At a minimum, the PMP shall include:

· A Project Workplan that is attainable based on the requirements and their prior experience, including the project schedule and resource allocations.

· A Communications Management Plan that addresses communication needs for internal and external stakeholders.

· A Project Organization Chart and Staffing Plan, inclusive of the staffing requirements identified in Section 4.2.

· A Risk and Issue Management Plan that addresses how risks and issues are identified, communicated, monitored, mitigated, and resolved.

Key Persons The Contractor shall provide adequate personnel to meet the requirements identified in this Scope of Work. The following key types of staff are required for this project:

Table 3: Key Persons

· Ensure alignment with state priorities and funding strategy

· Serve as escalation point for risks and key decisions

· Engage executive-level stakeholders and external partners

· Extensive experience leading large-scale healthcare or public sector initiatives

· Experience with statewide or multi-region programs

· Strong executive stakeholder engagement experience

· Oversee day-to-day execution across workstreams

· Coordinate stakeholder engagement activities

· Track risks, dependencies, and reporting

· Ensure consistent communication cadence

· 5+ years project management in healthcare/public sector

· Experience coordinating complex, multi-stakeholder engagements

· Strong organizational and communication skills

· Lead engagement with providers and clinical stakeholders

· Advise on care models, workflows, and specialty prioritization

· Validate feasibility and provider adoption consideration

· Direct experience with telehealth and/or eConsult models

· Experience engaging providers and clinical leadership

· Experience across multiple care settings

· Engage IT, HIE, and vendor stakeholders

· Evaluate interoperability readiness and infrastructure needs

· Define technical requirements for telehealth/eConsult solutions

· Identify barriers and opportunities for scalable implementation

· 5+ years in health IT, interoperability, or digital health

· Experience with FHIR, HL7, APIs, and/or HIEs

· Experience integrating telehealth platforms with clinical systems

· Experience working with IT stakeholders and vendors

· Engage data owners and validate data inputs

· Conduct analysis to inform recommendations

· Develop ROI and cost-benefit models

· Support sustainability and funding strategy recommendations

· Experience in healthcare analytics, public health, or health economics

· Experience developing KPI frameworks and ROI models

· Experience working with multi-source data

· Familiarity with CMS reporting or value-based care preferred.

*Please note that the positions and responsibilities may be shifted or shared amongst staff. The Contractor must ensure that the responsibilities outlined for each position are accounted for and fulfilled through their Staffing Plan.

Other Project Staff

Vendors may include additional roles to strengthen their proposed approach. Examples may include:

Table 4: Other Project Staff

· Identify operational barriers

· Recommend scalable care delivery models for telehealth and eConsul

· Assess feasibility across health systems, FQHCs, and local health departments

· Define infrastructure requirements

· Assess security, privacy, and scalability considerations

· Recommend future-state technical architecture and platform strategy

· Quantify cost avoidance, utilization impacts, and long-term value

· Support funding and sustainability strategy development

· Validate financial assumptions used in recommendations

· Translate technical findings into accessible messaging

· Support adoption readiness and change management planning

· Develop materials for diverse audiences

· Analyze vendor landscape and emerging trends

· Identify best practices and scalable program models

· Support synthesis of findings into recommendations

Document Management The Contractor shall:

· Maintain complete, accurate, and up‑to‑date project records (e.g., documentation of communications, deliverables, reports, approvals) in accordance with all applicable federal, State, and local records laws and regulations.

· Use a secure, organized filing structure with logical naming and version control so records are easily identifiable and retrievable.

· Provide the State with timely access to all Contract-related records.

· Protect confidential and personally identifiable information through security protocols consistent with applicable privacy and security standards (e.g., HIPAA).

Status Updates and Reporting The Contractor shall submit the following reports to the State:

· Status Reports shall be submitted monthly on the 5th day of each month, or as requested by the State. The reports shall be in a form determined by IDOH and contain information required by IDOH.

· Quarterly Success Reports shall be submitted quarterly on the 5th day of each quarter or as requested by the State and shall capture successes encountered throughout the quarter. These reports should reflect the project’s progress to meet the strategic goals set forth in the RHTP Grant. The report shall be submitted on a form required by the State.

OWNERSHIP

All work products, data, and materials produced under this contract shall become the property of the State of Indiana, subject to applicable laws and regulations.

INDEPENDENT VERIFICATION & VALIDATION

If the State decides to add Independent Verification & Validation (IV&V) services as part of this Contract, the Contractor will copy the Indiana Department of Administration (IDOA) -- IV&V Team member(s) on all project related communications (emails, meeting invites, collaboration tools, etc.) and will grant access to all documents and deliverables throughout the term of the Contract. If IDOA elects to deploy IV&V services in connection with this engagement, the IV&V Team will review and assess all deliverables to determine compliance with the State's requirements set forth in the Contract including the Statement of Work. For contracts entered into, renewed, or amended after June 30, 2026, the IV&V Team shall serve as an approving authority, and no payment shall be issued to the Contractor unless and until IV&V has provided such approval.

COMPLIANCE REQUIREMENTS

The Contractor shall:

· Abide by all applicable State and federal laws.

· Maintain compliance with:

· All State policies and procedures.

· Requirements related to the RHTP, including submission of data and reports as requested by the State and/or CMS.

· Indiana Office of Technology’s RAMP policy

· Health Insurance Portability and Accountability Act (HIPAA).

· Accessibility: Any materials the Contractor develops in partnership with the State for public distribution and/or to be published on State websites must comply with the State’s Assistive Technology standards and architectural standards, and Section 508 of the US Rehabilitation Act. The Contractor specifically agrees that all hardware, software and services provided to or purchased by the State shall be compatible with the principles and goals contained in the Assistive Technology Standard, within the State’s Information Security Framework (https://www.in.gov/iot/iot-vendor-engagement/), State Assistive Technology (https://www.in.gov/core/accessibility), and the State’s architectural standards. Any deviation from these requirements must be approved in writing by IOT in advance.

· State of Indiana AI Policy: The State of Indiana has adopted an enterprise-level policy governing the use of Artificial Intelligence (AI) within state government. The State of Indiana AI Policy is issued and monitored by the Office of the Chief Data Officer (OCDO), in cooperation with the Chief Privacy Officer (CPO) and the Management Performance Hub (MPH). The State Agency Artificial Intelligence Systems Standard outlines the AI Readiness Assessment process required for any use of AI. The Contractor shall support the State’s AI Policy and follow the AI Readiness Assessment Process, including submission of the Readiness Assessment Questionnaire, prior to implementation or use of any AI tool or system. See https://www.in.gov/mph/AI/ for more information.

KEY PERFORMANCE INDICATORS

The State will use Key Performance Indicators (KPIs) to measure performance and outcomes of the Contract. The specific KPIs and their targets will be defined and agreed upon by the State and the Contractor during the initial phases of the requirements under the Contract. At a minimum, on time delivery at quality standards of the scope provided within the budget set forth in the Contract will each be measured. Additionally, the State will collect a modified Net Promoter Score from customers to this Contract in its discretion. Low ratings on the modified Net Promoter Score or failure to meet any other KPIs may be deemed, at the discretion of the State, to constitute default under the Contract.

The Contractor shall report on the following KPIs in monthly Status Reports, which shall be submitted on the 5th day of each month. The Contractor shall provide full transparency to access all materials and associated work products included in this Contract if requested. The KPIs for this contract are:

Table 5: Key Performance Indicators

· Submit monthly Status Reports on the 5th day of each month or as requested by the State.

· Submit Quarterly Success Reports on the 5th day of each quarter or as requested by the State.

The Contractor shall accurately track and report on performance against KPIs in monthly Status Reports. If the Contractor fails to meet requirements set forth in the Contract, then the State will provide the Contractor with a written notice of non-compliance and may require any of the corrective actions or remedies discussed below.

Corrective Actions. If the Contractor does not meet the threshold for compliance for the KPIs defined in this section, or if the State determines that the Contractor is not performing to the satisfaction of the State, the Contractor shall submit, within ten (10) business days of the State’s written notice of non-compliance, a written Corrective Action Plan (CAP). The nature of the corrective action(s) will depend upon the nature, severity, and duration of the deficiency and repeated nature. Severity shall be determined by the State, in its sole discretion.

At a minimum, the CAP shall address the causes of the deficiency, the impacts and the measures being taken or recommended to remedy the deficiency, and whether the solution is permanent or temporary. It must also include a schedule showing when the deficiency will be remedied, and when the permanent solution will be implemented, if appropriate. Including specific dates is recommended.

The Contractor and the State shall schedule regular meetings to discuss the Contractor’s performance on the CAP. The Contractor is required to show satisfactory progress towards milestones and otherwise provide information that can be used to show that performance is satisfactory. Scheduling of review meetings shall be agreed upon mutually between Contractor and the State.

Payment Withholds. The State may elect to withhold 10% of the payment amount for payment points related to the CAP. When the CAP is completed and the proposed remedy to all deficiencies are completed to the satisfaction of the State, the withheld amount shall be returned to the Contractor within 30 days. Should the CAP not be submitted as required or should the remedy not be implemented within the time frame specified by the CAP, the Contractor shall forfeit the withheld amount. In addition, the State reserves the right to pursue appropriate legal recourse for any damage sustained because of this failure to perform.