Attachment A-Model Contract_ Wheelchair Operations Manager.docx

ATTACHMENT A

MODEL CONTRACT

FOR

WHEELCHAIR OPERATIONS MANAGER

BY AND BETWEEN

THE EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

AND

[TBD]

This Contract is by and between the Massachusetts Executive Office of Health and Human Services (EOHHS) and [TBD] (Contractor), WHEREAS, EOHHS is the single state agency responsible for the administration of the medical assistance or benefit programs, pursuant to Titles XIX and XXI of the Social Security Act, M.G.L.118E, and other applicable laws and waivers, to pay for medical services for eligible individuals (MassHealth); and

WHEREAS, EOHHS issued a Request for Responses (RFR) on [TBD], to procure an entity to perform such services and EOHHS selected the Contractor, based on the Contractor’s response to the RFR submitted on [TBD]; and

WHEREAS, the Contractor appears qualified and is willing to perform its duties as set forth herein subject to the terms and conditions hereof;

NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein, the Contractor and EOHHS agree as follows:

TABLE OF CONTENTS

APPENDICES

APPENDIX A: BUDGET

APPENDIX B: KEY PERSONNEL

APPENDIX C: PLANS

APPENDIX D: PERFORMANCE METRICS

APPENDIX E: CONTRACTOR ACKNOWLEDGEMENT

DEFINITIONS

The following terms and acronyms shall have the meaning stated in this section unless the context clearly indicates otherwise.

After-hours: The hours of each day, seven days of the week, that are outside of the regular business hours when the Contractor’s Customer Service unit is available.

Approval (or Approve; Approved) – Refers to EOHHS’s right under the Contract to approve, disapprove, or modify an action, request, document, or submission by the Contractor. EOHHS’s silence shall not constitute Approval by EOHHS. Neither EOHHS’ silence nor Approval related to Contractor’s action, request, document, or submission will operate to indemnify, modify liability, or otherwise absolve Contractor of any responsibility arising from its performance of the Contract, unless otherwise agreed upon by EOHHS and Contractor in writing.

Bidder: An entity that submits a Response to this RFR.

Business Day – Any day on which EOHHS employees are expected to report to work.

Calendar Day: Any day of the week regardless of whether work is performed, including weekends and holidays.

Centers for Medicare and Medicaid Services (CMS): The agency within the U.S. Department of Health and Human Services that is responsible for oversight of the federal Medicare and the state Medicaid programs.

Change Order or Change Request: A written amendment to the SOW, directing the Bidder to change the contract price, requirements, or project schedule. Such changes must be within the scope of the SOW and this RFR.

COMMBUYS: The Commonwealth of Massachusetts' sole online procurement record site.

Commonwealth Data: All data used or owned by the Commonwealth to which the Bidder gains access through a contract resulting from this RFR.

Community Provider: An organization that provides Simple Repairs to Members through the Community Wheelchair Repair Program. Operations Manager staff and subcontracted organizations who provide Simple Repairs are both considered Community Providers.

Complaint: A telephonic or written expression of dissatisfaction with the Contractor or other Community Providers.

Complex Repairs: Repairs of wheelchairs that require highly-skilled technicians to repair and generally cost more than $750 for parts and labor.

Contractor or Selected Bidder or Vendor: Bidder who is selected and executes a contract or agreement with the EOHHS under this RFR.

Contract Year – A Project Year shall be a 12-month period beginning on July 1st and ending on June 30, unless otherwise specified by EOHHS. Contract Year 1 shall be the period beginning on XXXX 1, 2022 and ending on XXXX, 2023.

Customers: Individuals or entities provided support services by the Operations Manager, including Members, DME Providers and Community Providers.

Deliverable: Any work product that the Selected Bidder delivers for the purposes of fulfilling its contractual obligations.

Durable Medical Equipment (DME): The durable medical equipment and medical supplies covered by 130 CMR 409.000, which includes wheelchairs.

DME Providers or MassHealth-contracted DME Provider(s): An organization or individual that has enrolled with MassHealth and has signed a provider contract with the MassHealth agency who meets all applicable requirements of 130 CMR 409.404 and 130 CMR 450.000: Administrative and Billing Regulations and provides mobility systems, including wheelchairs, to Members.

Executive Office of Health and Human Services (EOHHS): A secretariat-level executive agency under the Governor of Massachusetts. EOHHS oversees constituent agencies.

Executive Office of Technology and Security Services (EOTSS): A secretariat-level executive agency under the Governor of Massachusetts. EOTSS provides a range of centralized IT services; oversees IT policies, standards, and architecture; and promotes cross-agency collaboration and adoption of shared services.

Full-Time Equivalent (FTE): An individual who works forty hours per week or individuals who work in aggregate forty hours per week.

Grievance: An elevated complaint with the Contractor or other Community Providers.

Key Personnel: Personnel directly responsible for management of the contract; or those personnel whose professional/technical skills are determined to be essential to the successful implementation of the contract.

Loaner Wheelchair: A wheelchair provided to a Member as a mobility solution for a temporary period of time to allow Members to support their safety and independence as much as possible. Loaner wheelchairs can be manual or power wheelchairs.

Managed Care Entities (MCEs) – collectively, Managed Care Organizations (MCOs), Senior Care Organizations (SCOs); One Care Plans; Accountable Care Partnership Plans (ACPPs) and the BHV, as those terms are defined in this Contract. The Primary Care Clinician (PCC) Plan and Primary Care ACOs are not MCEs.

Managed Care Organization (MCO) – any entity, contracted with EOHHS as an MCO, which is approved by the Commissioner of the Massachusetts Division of Insurance as a Health Maintenance Organization (HMO), or is organized primarily for the purpose of providing health care services to MassHealth enrollees, that (a) meets advance directives requirements of 42 CFR Part 489, subpart I; (b) makes the services it provides to its MassHealth enrollees as accessible (in terms of timeliness, amount, duration, and scope) as those services are to other MassHealth members within the area served by the entity; (c) meets MassHealth’s solvency standards; and (d) assures that Enrollees will not be liable for the Contractor’s debts if the Contractor becomes insolvent. MassHealth members enrolled in an MCO use the MCO’s network of providers.

Managed Care Plans (MCPs) – collectively, Managed Care Entities, the PCC Plan, and Primary Care ACOs.

Massachusetts Management Accounting and Reporting System (MMARS): The system used by the Massachusetts Office of the Comptroller through which payments to Contractors, certain members, and providers are made.

MassHealth – the Medicaid program of the Commonwealth of Massachusetts, administered by EOHHS pursuant to Title XIX of the Social Security Act (42 U.S.C. § 1396), Title XXI of the Social Security Act (42 U.S.C. § 1397), M.G.L. c. 118E, and other applicable laws and waivers to provide and pay for medical services for eligible Members.

Member: A person determined by the MassHealth agency to be eligible for MassHealth with a coverage type that includes a DME benefit, in accordance with MassHealth regulations at 130 CMR 450.105: Coverage Types, which specifically states, for each coverage type, which services are covered, and which members are eligible to receive those services.

Pick-up: The process to retrieve a wheelchair from one location for delivery to another location for repair or storage.

Project Manager: Individuals identified and designated as Project Managers who shall perform project management on behalf of the EOHHS and Selected Bidder under the contract.

Protected Information (PI) – see Section 5 herein.

Provider: A provider that furnishes medical services.

Remote Assessment: A process conducted by MassHealth-contracted DME Providers that employs service technicians via telehealth to receive and evaluate Member service and repair requests.

Request for Responses or RFR or Bid: This RFR procurement specification and referenced documents. All solicitations (e.g., RFRs, Requests for Quotes (RFQs), etc.) are referred to as Bid Solicitations in the COMMBUYS system.

Response: Any information submitted by the Bidder in response to the Requirements and other information outlined in this RFR, including any clarifying information provided by the Bidder if requested EOHHS. The terms Proposal and Quote are used interchangeably with Response.

Security: Refers to the processes, methodologies, and means which are designed and implemented to protect information systems and information - including print, electronic, or any other form of confidential, private and sensitive information or data - from unauthorized access, use, misuse, disclosure, destruction, modification or disruption, which includes but is not limited to the ability to authenticate and authorize users to provide secure access to the system in a traceable (auditable) manner.

Simple Repairs: Repairs with limited complexity that can be performed by Community Providers. Repairs with limited complexity generally cost no more than $1000 for parts and labor based on EOHHS’ rates established at 101 CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment, however, some repairs with limited complexity may cost more than $1000 for parts and labor based on the rates established at 101 CMR 322.00.

Subcontractor(s): An individual, agency, or organization to which the Operations Manager has contracted or delegated some of its functions or responsibilities of providing services to Members.

Task: A material activity engaged in by a Selected Bidder for the purpose of fulfilling its obligations to the EOHHS under the terms of this RFR, which may or may not result in the creation of a Deliverable.

Urgent Request: An ask to the Operations Manager for a Simple Repair or Loaner Wheelchair for a Member without a useable chair or who will be without a usable chair within 72 hours.

Wheelchair Programs: Refers to the set of programs administered through this Contract, including the Wheelchair Loaner Program and the Community Provider Wheelchair Repair Program.

1. CONTRACTOR RESPONSIBILITIES

The Contractor shall perform all requirements of this Contract as follows.

Wheelchair Operations Manager Activities The Contractor shall perform the following activities to support the implementation of the Community Provider Wheelchair Repair Program and the Wheelchair Loaner Programs.

Community Provider Wheelchair Repair Program (Wheelchair Repair Program) Eligibility and Referral for the Community Provider Wheelchair Repair Program The Operations Manager will collaborate with MassHealth-contracted DME Providers to refer Members to the Wheelchair Repair Program as follows:

0. After an individual needing wheelchair repair contacts a MassHealth-contracted DME Provider that determines the individual is eligible for MassHealth DME coverage, the DME Provider will attempt to conduct a Remote Assessment with the Member;

If the DME Provider and Member are unable to complete the Remote Assessment, the DME Provider will refer the Member to the Community Provider for assistance with the assessment; or Following completion of a Remote Assessment indicating that the Member requires a Simple Repair and consideration of whether the Member’s wheelchair is in its warranty period, the DME Provider will inform the Member of their options for wheelchair repair, including using a DME Provider technician or a Community Provider.

The DME Provider will refer the Member to the Operations Manager using the Member’s preferred method(s) for outreach by:

transferring the call to an Operations Manager Customer Service employee, and, when possible, relaying all relevant information to the Customer Service employee prior to the Customer Service employee’s conversation with the Member;

sending a request on behalf of the Member using secure email or some other secure communication method;

providing the Member with contact information; or other methods developed by the Contractor and DME Provider.

Once the Member contacts the Operations Manager, the Operations Manager will:

triage the contact based on level of urgency and reason for the contact;

offer the Community Provider options available based on the phase of program implementation (see Implementation Phases in Section 2.1.A.2 below); and support the performance of the Simple Repair by the Contractor’s technicians or by another Community Provider the Member chooses.

In the event that an individual directly contacts the Operations Manager for support, the Operations Manager will refer them to a DME Provider for confirmation of eligibility using one of the following outreach methods:

1. transferring the call to a DME Provider and, when possible, relaying all relevant information to the DME Provider prior to the DME Provider’s conversation with the individual;

sending a request on behalf of the individual using secure email or some other secure communication method;

Providing the individual with contact information; or Other methods developed by the Contractor and DME Provider.

Implementation Phases

a. Start-up Activities: The Contractor, in collaboration with EOHHS and the DME Providers, shall prepare for each of the two phases of implementation set forth below, in accordance with Section 2.6.

During the Start-up period prior to phase 1, EOHHS expects to issue a Request for Application (RFA) and anticipates the execution of a Special Conditions Contract with one or more MassHealth-contracted DME Providers in accordance with Section 3.1.

The Operations Manager shall execute an agreement with each MassHealth-contracted DME Provider that executes a Special Conditions Contract with EOHHS, as described further in Section 2.1.C.9 below, which will set forth the terms of the relationship and will be operationalized as part of phase 1 activities. The Contractor must execute at least one agreement with a DME Provider during the Start-up period in order to move to phase 1 implementation.

b. Phase 1: Home-based Simple Repairs by Operations Manager Staff

1. For phase 1 implementation and following the Start-up Activities in Section 2.6, the Contractor shall provide home-based Simple Repairs for Members using its own technicians. The Contractor shall implement activities in accordance with Section 2.1.A including:

Providing training on Simple Repairs to technicians;

Stocking common parts needed to perform Simple Repairs;

Triaging Customer contacts, including from DME Providers or Members;

Performing Remote Assessments as requested by DME Providers;

Performing Simple Repairs for Members; and Submitting invoices to DME Providers.

c. Phase 2: Simple Repairs by Community Providers in Community-based Locations

For phase 2 implementation, the Contractor shall recruit additional Community Providers to perform Simple Repairs at community-based service locations through the Commonwealth in consultation with the Operations Manager advisory board described in Section 2.1.C. Phase 2 Start-up Activities in Section 2.6 will begin in Contract Year Two and the phase 2 program will be fully implemented by the end of Contract Year Three.

The Operations Manager shall support the Community Providers in phase 2 by:

1. Providing training on Simple Repairs in accordance with Section 2.1.C.5;

Performing parts stock management so that Community Providers have common parts on hand for Simple Repairs in accordance with Section 2.1.A.4;

Sharing information about Community Provider locations to Members and referring Members to Community Providers for Simple Repairs, as appropriate;

Providing payment to Community Providers for Simple Repairs they perform in accordance with Section 2.1.A.5; and Performing pass-through billing with DME Providers for Simple Repairs provided by Community Providers in accordance with Section 2.1.C.3.

Wheelchair Remote Assessment

a. The Contractor’s technicians shall perform Remote Assessments with the Member in their home to determine the need for Simple Repairs when the Member does not have the capability to perform the assessment independently.

b. Following the assessment and confirmation by the DME Provider that the Member requires a Simple Repair, the Operations Manager will offer the Member the available options for Simple Repairs by a Community Provider and will support scheduling of the Simple Repairs or will perform the Simple Repairs at the same visit, when possible.

Parts Stocking and Restocking

a. The Contractor shall develop and implement processes to coordinate part stocking and restocking with Community Providers and MassHealth-contracted DME providers, which shall be informed by EOHHS research with wheelchair manufacturers and consultation with DME providers.

1. For phase 1, the Contractor shall purchase common parts stocks for Simple Repairs by its own technicians.

For phase 2, initial parts stocks will be provided by the Operations Manager to participating Community Providers.

b. The Operations Manager shall conduct stock management of parts used by Community Providers and will restock parts, when necessary, to ensure Community Providers have parts readily available for Simple Repairs.

c. There may be circumstances where the Operations Manager orders specific parts not in stock for a Simple Repair, which will be set forth in the Operations Manager’s policies and procedures.

Community Provider Payment The Operations Manager shall implement payments to Community Providers as follows:

0. Receive monthly invoices from Community Providers for completed Simple Repairs, including parts, incidentals and labor expenses;

Perform a quality check, account for parts used in accordance with Section 2.1.A.4 and submit the invoice for Simple Repairs to the appropriate MassHealth-contracted DME Provider for processing. The DME Provider shall be responsible for submitting the claim to the appropriate MassHealth payer or primary insurance, including Medicare and requesting authorizations for services, where needed;

Provide payment to Community Providers the following month after receipt of a completed invoice; and Process payment from the DME Provider, once received.

Wheelchair Loaner Program For the Wheelchair Loaner Program, the Operations Manager shall perform the following:

1. Delivery/Pick-up of Wheelchairs

0. The Operations Manager will process requests for delivery or Pick-up of Loaner Wheelchairs by:

1. A MassHealth-contracted DME Provider when:

1. the DME Provider’s inventory does not meet their Member’s needs but the Operations Manager has an appropriate Loaner Wheelchair available for delivery; or the Member’s Loaner Wheelchair needs a Pick-up when no longer needed; or

A Member, for reasons including but not limited to:

1. The Member’s wheelchair may be unusable or will be unusable without repair; or Repair to the Member’s primary wheelchair may need to be performed by a MassHealth-contracted DME Provider. The Loaner Wheelchair will be used while the primary wheelchair is brought to the MassHealth-contracted DME Provider to complete a repair; or After completion of a Remote Assessment by the DME Provider or Operations Manager that determines the need for a Loaner Wheelchair; or the Member’s Loaner Wheelchair needs a Pick-up when it is no longer needed.

The Operations Manager shall Pick-up Loaner Wheelchairs when the Member no longer requires a Loaner Wheelchair. The Operations Manager may also Pick-up a Member’s primary wheelchair at the same time that they deliver a Loaner Wheelchair.

1. If a picked up primary wheelchair or Loaner Wheelchair require repair by the MassHealth-contracted DME provider, the Operations Manager shall:

1. notify the MassHealth-contracted DME provider when the Operations Manager is unable to perform the repair;

determine the appropriate location for Pick-up/delivery; and ensure the wheelchair is delivered to the appropriate DME provider service location for repair.

Primary Wheelchairs repaired by DME Providers for Members who receive Loaner Wheelchairs from the Operations Manager may be picked up by the Operations Manager and delivered to the Member at the same time the Loaner Wheelchair is picked up.

Maintenance and Storage The Operations Manager shall maintain and store the Loaner Wheelchair fleet. Once Loaner Wheelchairs are picked up from a Member, the Contractor shall:

0. Return the Loaner Wheelchair to an appropriate location for assessment and storage that is separate from the location of Loaner Wheelchairs that have been repaired, thoroughly cleaned and are ready to be put back into circulation;

Assess the wheelchair for damage:

1. If not damaged, perform a thorough cleaning before putting the wheelchair back into circulation; or If damaged, schedule the wheelchair for repair. Repairs may be performed by the Operations Manager if a Simple Repair is needed or by a MassHealth-contracted DME Provider for a Complex Repair, in accordance with Section 2.1.B.1.b.

If applicable, perform billing for parts, incidentals and labor associated with the Simple Repair in accordance with Section 2.1.C.3; and Update the Loaner Wheelchair inventory tracking system described in Section 2.1.B.3 to reflect that the chair is available, after the repair is complete.

Loaner Wheelchair Fleet Inventory Management

0. The Operations Manager shall develop and implement a system to track the Loaner Wheelchair fleet inventory across MassHealth-contracted DME Providers and the Operations Manager to:

1. support Loaner Wheelchair distribution coordination;

track the availability of requested Loaner Wheelchairs; and identify for MassHealth when there may be the need to purchase additional Loaner Wheelchairs to address capacity or fill a particular gap based on unmet requests in accordance with Section 2.1.C.4.

Tracking shall be performed by serial number and the tracking system should be able to identify make, model, size, type and location of each Loaner Wheelchair at any given time.

The Contractor shall develop and implement a process to coordinate delivery and Pick-up of Loaner Wheelchairs when a specific DME Provider’s available loaner fleet does not meet a Member’s needs, but the Contractor’s inventory tracking system identifies an appropriate Loaner Wheelchair from the Contractor’s fleet to meet the Member’s needs.

Cross-Initiative Functions The following Operations Manager functions will support both the Wheelchair Loaner and Community Provider Wheelchair Repair Programs.

1. Customer Service The Contractor shall perform Customer Service in accordance with Section 2.5.

Issue Management

0. The Operations Manager will support proactive, timely resolution of issues that may arise during program operations, including addressing issues related to other entities involved in the Wheelchair Programs, including MassHealth-contracted DME Providers and Community Providers.

When appropriate, the Contractor will escalate issues to EOHHS for guidance. However, all press inquiries must be escalated to EOHHS in accordance with Section 5.6.

Billing Support between Operations Manager and DME Provider

0. To support EOHHS’s ability to collect federal financial participation funding in accordance with Centers for Medicare and Medicaid Services rules, the Operations Manager shall submit invoices with parts, incidentals and labor for Simple Repairs and any other required documentation needed for billing and auditing to MassHealth-contracted DME Providers for processing.

The DME Providers shall process the invoices and submit claims and prior authorizations, if applicable, with MassHealth or other primary payers and will pay the Contractor the amount paid by the payer less a fee that is agreed upon between the DME Provider and the Contractor in the DME Provider and Operations Manager Agreement described in Section 2.1.C.9.

Purchasing of Wheelchairs and Parts Stock The Operations Manager shall purchase items in support of the Wheelchair Programs as follows:

0. For the Loaner Wheelchair Program, the Contractor shall:

1. Partner with EOHHS and MassHealth-contracted DME providers to identify the number and type of Loaner Wheelchairs that will be purchased for the fleet;

Purchase Loaner Wheelchairs as part of program Start-Up Activities pursuant to Section 2.6;

Track information on requests for Loaner Wheelchairs that are unable to be met due to lack of inventory;

Review unmet request information at least semi-annually to inform recommendations to EOHHS about potential enhancements to the Wheelchair Loaner fleet;

Propose additional Loaner Wheelchairs to enhance the fleet, as needed, and purchase wheelchairs following proposal review and Approval by EOHHS;

For the Community Provider Wheelchair Repair Program, the Contractor shall:

1. Purchase initial stock parts for its own technicians and other Community Providers who are onboarded in Phase 2; and Periodically or as needed purchase stock parts, depending on parts used to perform Simple Repairs by Community Providers.

Community Provider Trainings The Contractor shall:

0. develop and conduct trainings for Community Provider staff on policies and procedures for the Wheelchair Programs;

provide or coordinate delivery of technical trainings to technicians on Simple Repairs. For the technical trainings, the Contractor shall collaborate with the MassHealth-contracted DME Providers with support from wheelchair manufacturers, as appropriate, to ensure the technicians have the skills and certifications to provide Simple Repairs in accordance with the requirements established by the DME Providers for technicians providing repairs for MassHealth Members;

develop hands-on trainings in community-based settings, when possible, such as by offering service days for Members, where DME Provider technicians can mentor Community Provider technicians as they practice specific skills and promote the Community Provider Wheelchair Repair Program; and review and periodically update training materials to ensure they accurately reflect program policies and procedures.

Quality Improvement and Performance Monitoring The Operations Manager shall develop and implement processes for continuously monitoring and improving program operations. The Contractor shall:

0. collaborate with EOHHS as part of Start-up Activities in Section 2.6 to agree upon program metrics applicable to both phases of implementation;

develop and implement systems to track program metrics;

monitor performance metrics and develop strategies to improve program performance in partnership with EOHHS, DME Providers, Community Providers, and advocates;

provide ongoing program reporting to monitor performance in accordance with Section 2.8 including:

1. Standard and ad hoc reporting; and Results of Member experience surveys.

Operations Manager Advisory Board

0. The Contractor shall establish and maintain a statewide Operations Manager advisory board. The advisory board shall include participants reflecting diversity across race, age, ethnicity, disability, socioeconomic status, geography and gender, and bring together a diverse collection of health professionals, MassHealth Members who are wheelchair users, and other key stakeholders with wheelchair experience or expertise. The advisory board shall be comprised of:

1. A minimum of three wheelchair users served by the Contractor;

A minimum of two disability advocates, including individuals with technical experience related to wheelchair repairs; and other stakeholders, which may include DME Providers or Community Provider representatives, as needed.

EOHHS staff may also participate in advisory board meetings to efficiently collaborate with the Contractor and advisory board members in addressing issues, especially during the implementation of the Wheelchair Programs, as appropriate.

The Contractor must seek feedback from the advisory board on the provision of Contractor services including, but not limited to:

1. Specific challenges faced by wheelchair users requiring Simple Repairs, including issues in specific locations or regions in the state;

Potential changes to improve the performance of the Operations Manager;

Quality of the Contractor’s performance including, but not limited to operations measured by the performance metrics required in Section 2.9; and Strategies for engaging Community Providers.

The Contractor must convene the advisory board at least four times per year.

The Contractor must provide necessary accommodations and supports to advisory board members to allow meaningful participation.

The Contractor must develop and maintain a summary of the advisory board meetings, including the topics discussed, the specific feedback from the advisory board as to those topics, the time and location of the meeting, and who attended the meetings from the advisory board and the Contractor. The Contractor must provide the summary of the consumer advisory board meetings within 10 Business Days of such meeting to EOHHS.

Stakeholder Collaboration Support The Operations Manager shall support stakeholder collaboration during implementation and ongoing operations, as needed, by:

0. Assisting with the ongoing development of the Wheelchair Programs, in collaboration with EOHHS, DME Providers, Community Providers and Advocates; and Participating in meetings with stakeholders monthly or as needed.

Agreement with MassHealth-contracted DME Providers

0. The Contractor and each DME Provider that enters into Special Conditions Contract with EOHHS to participate in the Wheelchair Programs as described in Section 3.1 shall enter into and adhere to a DME Provider and Operations Manager Agreement. Each agreement shall, at a minimum, include policies and procedures for:

1. Referrals to the Operations Manager following determination of program eligibility by the DME Provider for Remote Assessment support or Simple Repairs by Community Providers;

Management of Simple Repairs for a Member whose wheelchair is under warranty;

Marketing and outreach activities to promote awareness of the Wheelchair Programs, subject to review and Approval by EOHHS;

Invoice processing;

Training for technicians on Simple Repairs or other requirements for DME Provider network participation; and Coordination of Loaner Wheelchair pick-up, delivery and inventory management.

The agreement between the Contractor and DME Provider(s):

1. must ensure that the policies and procedures comply with the requirements of this Contract;

must be in the best interests of Members and intended to improve the performance of Simple Repairs and Loaner Wheelchair servicing;

shall not absolve the Contractor of any responsibility to EOHHS for the requirements of this Contract or the DME Provider for the requirements of their MassHealth DME contract;

shall establish a fee that will be paid to the DME Provider for each Simple Repair for which they process an invoice with payers;

shall specify the requirements of Community Providers to perform Simple Repairs as subcontractors to the DME Provider, including training and certification requirements and documentation requirements to support any audits by EOHHS, CMS or other government entities; and shall be executed within six months following notification by EOHHS of execution of a Special Conditions Contract with EOHHS, pursuant to Section 3.1.B.

MassHealth Member Confidentiality

1. The Contractor shall, upon the request of any DME Provider or EOHHS, enter into a HIPAA compliant Business Associate Agreement or other agreement to assure confidentiality of MassHealth Members’ PI.

The Contractor shall, in collaboration with DME Providers, support Community Providers with entering into a HIPAA compliant Business Associate Agreement or other agreement to assure confidentiality of MassHealth Members’ PI.

Information Systems and Reporting Capacity The Contractor shall establish and keep current information systems for efficient program operations that include, at a minimum, the following:

1. Reporting information and capabilities, including the capability of readily producing reports on activities performed in Section 2.1.

Payment and invoicing capabilities that ensure accurate payment processes;

Inventory tracking capabilities to track Loaner Wheelchair inventory and parts for Simple Repairs; and Customer Encounter management capabilities.

Staffing The Contractor shall:

1. Designate as Key Personnel a Project Director, Operations Director, and Training Director. Key Personnel shall be designated in Appendix B. The parties may agree to designate other personnel as Key Personnel.

Ensure that qualified and competent project staff performs all Operations Manager Activities specified in this Contract. Depending on the activity, the Contractor shall ensure that project staff includes the Project Director, Project Manager, and Training Director and other individuals with demonstrated experience and knowledge of:

1. Medicaid population and Assistive Technologies;

Inventory tracking systems and processes;

Training development and implementation;

Quality management and improvement methods; and Other areas as required to perform specific requirements.

Ensure that staffing resources are sufficient to perform all tasks specified in this Contract in an accurate, complete, and timely manner.

Notify EOHHS of any individual whom the Contractor is proposing to employ or replace as Key Personnel. If any individual named as Key Personnel becomes unavailable, the Contractor shall notify EOHHS immediately and provide the name(s) and resume(s) of suitable replacements, subject to EOHHS’s Approval. EOHHS reserves the right to interview and approve the employment or continued employment of individuals for all Key Personnel positions. If EOHHS is not reasonably satisfied that the proposed replacement(s) has ability and experience comparable to the originally approved Key Personnel, EOHHS will notify the Contractor within ten business days after receiving the resume(s) and completing any interview(s). The Contractor must then propose another replacement for Approval. This process shall be repeated until EOHHS approves new Key Personnel.

Fill any positions relevant to the performance of the obligations set forth in this Contract that become vacant during the course of this Contract in a timely manner; all positions shall be filled within 60 days. In the event that a Key Personnel position is vacant, the Contractor shall continue to fulfill all contractual obligations and submit to EOHHS for review and Approval a workplan that demonstrates how the Contractor will meet its Contract responsibilities until the position is filled.

Ensure the Project Director:

1. Has sufficient skills, qualifications, and experience necessary to oversee implementation of the Wheelchair Programs;

Has sufficient skills, qualifications, and experience necessary to supervise staff and oversee the work of any subcontractors responsible for performing the tasks specified in this Contract;

Directly supervises project staff (including subcontractors, if any) responsible for performing the tasks specified in this Contract;

Serves as primary liaison to EOHHS and DME Providers for the performance of the requirements of this Contract;

Attends all meetings with EOHHS staff, and other meetings as requested by EOHHS or provides a qualified alternate approved by EOHHS;

Ensures that all EOHHS Approvals are obtained in accordance with requirements and that all work is performed in accordance with EOHHS approved protocols and workplans; and Ensures that all deliverables are clearly written, accurate and provided in a timely manner.

Ensure the Operations Director provides operational direction for the Contractor’s activities performed under this Contract.

Ensure the Training Director develops trainings for technicians that meet the requirements of the Contract and allow Community Providers to provide Simple Repairs.

Ensure Community Provider technicians have sufficient skills, qualifications and experience to perform Simple Repairs, including completing and maintaining relevant trainings (continuing education units or CEUs) and certifications required by manufacturers and DME Providers.

Customer Service

1. Customer Service Unit The Contractor shall:

1. Establish a Customer Service unit, effective on a mutually agreeable start date in Contract Year One, to respond to all Customer encounters related to the Wheelchair Programs;

Establish and maintain an accessible, Culturally and Linguistically Competent dedicated telephone line(s), to answer calls Monday-Friday from at least 9:00 a.m. – 5:00 p.m. EST, accessible through a statewide toll-free number and staffed by the Contractor to provide information and assistance to Customers;

Ensure that an After-hours answering service is available to triage calls from Customers and ensure a response aligned with the level of urgency of the call;

Maintain an email address through which Customers can submit electronic requests for information, referral, and direct assistance. The Contractor will respond to email inquiries within one business day;

Develop and implement a Customer Service Plan as part of Start-up Activities in Section 2.6 that will:

0. address the importance of Customer Service in the Contractor’s responsibilities;

include a plan for at least the following:

1. how the Contractor will address categories of issues;

how the Contractor will review customer service implementation and implement improvements to customer service provision;

the plan for quality assurance oversight and review;

the Complaint and Grievance process;

escalation procedures for Urgent Requests and issues of heightened sensitivity or difficulty;

training of Customer Service Unit staff;

oversight of the Customer Service Unit; and other elements as appropriate.

The plan shall be updated at least semi-annually in accordance with Appendix C and will be subject to review and Approval by EOHHS.

Employ sufficient Customer Service Unit staff to assist Customers;

Collect and track specific Customer Service metrics approved by EOHHS to gauge the success of its efforts and execute ongoing programmatic improvement; and Ensure that its Customer Service resources are made accessible for a wide range of linguistically, culturally, and geographically diverse individuals with varying abilities, needs, and communication methods.

Customer Service Encounters

1. The Operations Manager shall track, analyze and report on each encounter using an easily sortable and searchable format to understand the volume and type of inquiries and any notable trends requiring action, in accordance with Section 2.8.

Encounter information shall include, but not be limited to:

0. Customer contact information;

Customer type (Individuals/Members, Community Providers, DME Providers, Other);

program type (inquiry about the Wheelchair Loaner Program, Community Provider Wheelchair Repair Program, other);

contact type (email or phone call);

the reason(s) for the contact;

whether the request is routine or urgent;

the disposition;

timeframe for resolution; and other relevant demographic and programmatic information.

Complaints and Grievances

The Contractor shall:

1. Establish and maintain written policies and procedures for the receipt and timely resolution of Complaints and Grievances from Customers. The policies and procedures shall be available to EOHHS upon request, and shall include at a minimum:

0. A standardized Complaint and Grievance process for resolving issues related to the Contractor’s responsibilities pursuant to this Contract;

A process and means for reviewing, assessing, and categorizing the nature and seriousness of each Complaint or Grievance and the time frame for response; and A mechanism for ensuring written acknowledgment within one business day of receipt of any written Complaint or Grievance, which shall include information concerning the resolution process, in addition to a mechanism for ensuring a response from the Contractor within one business day of any verbal Complaint.

A process for reviewing all Complaint or Grievance dispositions at least monthly for the purpose of improving the Contractor’s activities in accordance with this Contract.

Create, maintain, and submit to EOHHS, upon request, a Complaint and Grievance log that documents the date and time the Complaint was received, the name of the person making the Complaint or Grievance and their relationship to Member, the Complaint or Grievance as stated by the complainant, the type and nature of each oral or written Complaint or Grievance, the name and title of the staff person receiving the Complaint or Grievance, the date on which the Contractor first responded to the Complaint or Grievance, how each Complaint or Grievance was addressed, and what, if any, corrective action was taken to resolve the Complaint or Grievance and the date the Complaint or Grievance was resolved;

Review all Complaint and Grievance dispositions at least monthly or as directed by EOHHS, making amendments to improve applicable policies and procedures as appropriate; and Track and report to EOHHS the number and types of Complaints and Grievances filed by or on behalf of Customers and received by the Contractor, as well as how such Complaints and Grievances were resolved, in accordance with Section 2.8.

Start-up Activities

1. Initial Implementation Start-up The Initial Start-up period and Phase 1 implementation shall not extend beyond 18 months from when this Contract is executed. For Start-up prior to Phase 1 implementation, the Contractor shall:

1. Develop operational workflows with MassHealth-contracted DME Providers and Subcontractors for review and Approval by EOHHS;

Set up information systems, tracking systems and reporting;

Contract with Subcontractors, subject to EOHHS Approval, as needed for Wheelchair Program support services, including for Wheelchair Loaner program logistics for securing storage of Loaner Wheelchairs;

Submit an Implementation Plan to EOHHS within 30 days of execution of the Contract that shall be subject to review and Approval by EOHHS and shall include, but not be limited to:

0. an updated workplan required to establish the Wheelchair Programs, including timeframes for the Start-up activities through the completion of Phase 1 implementation;

documentation of any factors affecting program implementation, such as hiring of new staff;

a description of the roles and responsibilities of the Contractor and its Subcontractors, if any;

policies and procedures for addressing Customer encounters;

a description of how the Contractor shall:

1. provide the Wheelchair Programs statewide;

identify the topics of potential training sessions; and obtain performance measurement metrics and Member satisfaction responses from Members receiving Loaner Wheelchairs or Simple Repairs.

Propose program metrics and Standard Reports for phase 1 for which the Contractor shall report to EOHHS at least monthly and discuss as part of its regular meetings to monitor Contractor performance, in accordance with Sections 2.7, 2.8 and 2.9;

Purchase initial parts stock for Simple Repairs by Operations Manager technicians and Loaner Wheelchairs in accordance with Section 2.1.C.4; and Develop and submit a Customer Service Plan in accordance with Section 2.5.A.

Start-up Activities Prior to Phase 2 The second Start-up period and Phase 2 implementation shall not extend beyond Contract Year Three. For Start-up activities prior to Phase 2, the Contractor shall:

1. Develop operational workflows with Subcontractors, EOHHS, MassHealth-contracted DME Providers and Community Providers;

Submit a Phase 2 Implementation Plan to EOHHS no later than 30 days following Contract Year Two, which shall be subject to review and Approval by EOHHS and shall include, but not be limited to:

0. an updated workplan required for the Start-up activities Prior to Phase 2 through the completion of Phase 2 implementation;

documentation of any factors affecting program implementation, such as hiring of new staff;

a description of the roles and responsibilities of the Operations Manager, other Community Providers and Subcontractors, if any;

policies and procedures for addressing Customer encounters, including Community Providers;

a description of how the Contractor shall:

1. provide the programs statewide;

identify the topics of potential training sessions; and obtain performance measurement metrics and Member satisfaction responses from Members receiving Simple Repairs by Community Providers.

Collaborate with EOHHS to identify any additional program metrics and Standard Reports for Phase 2, which the Contractor shall report on to EOHHS at least monthly in accordance with Section 2.8.

Purchase initial parts stock for Simple Repairs by other Community Providers in accordance with Section 2.1.C.4 following Approval by EOHHS.

Communications and Meetings The Contractor shall:

1. Meet with EOHHS for regular meetings or as often as EOHHS requests to discuss process, progress, barriers, and any other related issues proposed by EOHHS or the Contractor, as related to Operations Manager activities;

Designate appropriate staff to meet with EOHHS staff;

Provide the agenda for and facilitate meetings with EOHHS staff;

Take notes during meetings and distribute minutes of these meetings to EOHHS within seven days.

Reporting

1. Standard Reports The Contractor shall:

1. Provide to EOHHS standard reports in agreed upon formats as further directed by EOHHS.

0. Reports shall be able to be summarized on a daily, weekly, monthly, quarterly, annual basis, or as otherwise specified by EOHHS.

Content of the reports shall include, but not be limited to:

1. Contractor performance and activity;

Customer encounters;

Contractor staffing;

Inventory management;

Community Provider activities;

Payments to Community Providers;

Invoices to DME Providers;

Customer education and communications; and Training.

The Contractor shall establish a process to add, modify, or terminate standard reports as directed by EOHHS.

Report to EOHHS monthly on information or issues from Customers that may require Customer communication by EOHHS.

Report to EOHHS on issues that may delay or impact Contractor responsibilities and, as further directed by EOHHS, develop, propose, and implement corrective action plans subject to EOHHS Approval to correct such delays or impacts.

Ad Hoc Reports

1. The Contractor shall provide EOHHS with ad hoc reports and analyses as directed by EOHHS.

Performance Metrics The Contractor will be evaluated on the basis of performance metrics for the Wheelchair Programs agreed upon between the Contractor and EOHHS and reflected in Appendix D.

1. EOHHS intends to finalize performance metrics in collaboration with the Contractor during the Start-up periods described in Section 2.6 and reserves the right to revise performance metrics during the life of this RFR.

EOHHS may conduct routine or unscheduled site visits at any time to assess the Contractor’s performance or administration of the Wheelchair Programs.

Performance Metrics for consideration during the Start-up period shall…