Attachment A - Proposer Requirements Response Sheet.xlsx
XLSX spreadsheet 37 KB Posted
- Solicitation number
- 215273
- Issued by
- Wyoming
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Attachment A - Proposer Requirements Response Sheet Summary
This is a proposer requirements response document prepared by the Wyoming Department of Administration and Information, General Services Division on behalf of the Wyoming Department of Health, Division of Healthcare Financing for RFP 0036-N regarding Medicaid rate analysis and reimbursement services. The scope encompasses comprehensive technical assistance in establishing and analyzing Medicaid reimbursement rates across ten provider categories: ambulance services, care management, disproportionate share hospitals, durable medical equipment, federally qualified health centers, home and community-based services waivers, inpatient and outpatient hospital services, physician and professional services, rural health clinics, and psychiatric residential treatment facilities. Deliverables include rate files, upper payment limit demonstrations, disproportionate share hospital calculations, audit reports for healthcare facilities, research and policy compliance support, external quality review activities, and on-request analytical support. Questions must be submitted by September 14, 2026 at 2:00 p.m. Mountain Time, with proposals due October 5, 2026 at 2:00 p.m. Mountain Time. Award is expected in November 2026, with work commencement anticipated April 1, 2027. The initial contract term is one year with options to extend for up to five years total subject to mutual approval. This is a single-contractor engagement, and all submissions must be made through the Public Purchase online bidding system in PDF, Excel, or Microsoft Office format.
Proposers must demonstrate at least five years of experience in Medicaid rate setting and analysis across multiple provider types and payment methodologies, along with research and policy compliance capabilities. Required submissions include completed mandatory requirements spreadsheets, current financial statements, professional certifications or accreditations, staffing plans with estimated hours by discipline, and detailed quality assurance and project management plans. Cyber liability insurance with minimum limits of $2 million per occurrence and $2 million general aggregate is mandatory. Contractor proposals are binding for 180 days. Wyoming Medicaid currently serves approximately 104,296 eligible individuals annually with approximately 22,256 enrolled service providers. The incumbent contractor has provided these services for twenty years.
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| File | Type | Posted |
|---|---|---|
| 0036-N.docx | DOCX document | |
| Addendum 1.pdf |
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Instructions
| Attachment A: Proposer Requirements Response Sheet |
| Purpose |
| This document contains the mandatory requirements matrix for Attachment A as specified in Section 6 of the RFP. Proposers are required to complete the Proposer Compliance Code column using one of the following valid values: Comply, Propose Alternative, or Subproposer, and provide explanations in the Comments column where applicable. |
| Valid Proposer Compliance Codes | |||
| Code | When to Use | ||
| Comply | The Proposer will meet the requirement as written, with no exceptions. | ||
| Propose Alternative | The Proposer proposes an alternative approach to meeting the requirement. An explanation must be provided in the Proposer Comments column. | ||
| Subproposer | The requirement will be met through a subproposer. Identify the subproposer and describe the scope in the Proposer Comments column. | ||
| How to Complete This Workbook | |||
| 1. | Each requirement table from the RFP is presented on its own tab, in the order it appears in the source document. | ||
| 2. | Complete every row. Select a value from the drop-down in the Proposer Compliance Code column (column D). | ||
| 3. | Provide explanations in the Proposer Comments column (column E) for any response of Propose Alternative or Subproposer. | ||
| 4. | Do not modify the Req #, Requirement Type, or Requirement Language columns (columns A-C). | ||
| 5. | Do not add, delete, or reorder rows, columns, or tabs. | ||
| 6. | Response fields are shaded for easy identification. Use the Tab Index below to navigate. | ||
| Tab Index | |||
| Tab | Requirement Type | Req # Range | Requirement Count |
| T1 - Rate Setting & Analysis | Rate Setting & Analysis | 1.01 - 1.49 | 49 |
| T2 - Reimbursement Assistance | Reimbursement Assistance | 2.01 - 2.17 | 17 |
| T3 - External Quality Review & | External Quality Review & Independent Assessment | 3.01 - 3.06 | 6 |
| T4 - On-Request Support | On-Request Support | 4.01 - 4.10 | 10 |
| T5 - Communication | Communication | 5.01 - 5.10 | 10 |
| T7 - Equipment | Equipment | 6.01 | 1 |
| T8 - Technology & Specification | Technology & Specifications | 7.01 - 7.04 | 4 |
| T9 - Location & Work Environmen | Location & Work Environment | 8.01 - 8.02 | 2 |
| T10 - Staffing & Qualifications | Staffing & Qualifications | 9.01 - 9.19 | 19 |
| T11 - Project Management | Project Management | 10.01 - 10.15 | 15 |
| Total | 133 |
T1 - Rate Setting & Analysis
| Table 1: Rate Setting & Analysis Requirements | ||||
| Req # | Requirement Type | Requirement Language | Proposer Compliance Code | Proposer Comments |
| 1.01 | Rate Setting & Analysis | Contractor shall develop and deploy predictive models to forecast utilization, cost trends, and the budgetary impact of proposed policy or demographic changes. | ||
| 1.02 | Rate Setting & Analysis | Contractor shall conduct advanced cost driver analysis to identify and report on the primary factors (e.g., price, utilization, acuity) influencing Medicaid expenditures by service category. | ||
| 1.03 | Rate Setting & Analysis | Contractor shall conduct rate studies as requested (e.g., CMHSA, Behavioral Health), including designing conceptual models and providing rate recommendations. | ||
| 1.04 | Rate Setting & Analysis | Contractor shall create and maintain SOPs for all UPL processes and rate calculations. | ||
| 1.05 | Rate Setting & Analysis | Contractor shall maintain audit-ready UPL files for CMS review. | ||
| 1.06 | Rate Setting & Analysis | Contractor shall calculate the Care Management Entity (CME) Per Member Per Month (PMPM) rates and shall assist with the 1915(b)/1915(c) waiver. | ||
| 1.07 | Rate Setting & Analysis | Contractor shall provide actuarial certification and policy support for any State Directed Payments (SDPs), ensuring compliance with new federal payment limits and regulations. | ||
| 1.08 | Rate Setting & Analysis | Contractor shall implement a Health Equity Rate Impact Framework by stratifying all major rate analyses (e.g., FFS, DSH, APM proposals) by demographic factors (e.g., Race, Ethnicity, Language, Geography). | ||
| 1.09 | Rate Setting & Analysis | Contractor shall analyze and report to WDH any identified payment disparities or access-to-care impacts resulting from rate structures or methodologies. | ||
| 1.10 | Rate Setting & Analysis | Contractor shall recommend specific rate or policy adjustments (e.g., incentive payments, rate add-ons) to WDH to mitigate identified health inequities. | ||
| 1.11 | Rate Setting & Analysis | Contractor shall support WDH in identifying and closing data gaps related to demographic data (e.g., SOGI, SDOH) needed for robust health equity analysis. | ||
| 1.12 | Rate Setting & Analysis | Contractor shall provide research and business analysis to support the development of the annual Multi-divisional Report on behavioral health services. | ||
| 1.13 | Rate Setting & Analysis | Contractor shall develop, test, and deliver provider rate files in a DHCF-approved format at least thirty (30) days prior to implementation. | ||
| 1.14 | Rate Setting & Analysis | Contractor shall ensure all budget impact estimates for proposed rate changes shall incorporate impacts across all applicable programs, including but not limited to UPL, DSH, OPPS, FQHC/RHC, RBRVS, HCBS, Ground Ambulance, and QRA. | ||
| 1.15 | Rate Setting & Analysis | Contractor shall, on an annual basis, analyze the impact of CMS's ICD-10-CM/PCS code updates on all relevant rate methodologies, including but not limited to the APR-DRG grouper and service-specific fee schedules. | ||
| 1.16 | Rate Setting & Analysis | Contractor shall develop and maintain a set of Key Performance Indicators (KPIs) for the rate setting program, to be included in the Monthly Status Report. | ||
| 1.17 | Rate Setting & Analysis | Contractor shall perform annual UPL calculations for all non-state government-owned (NSGO) ground ambulance providers. | ||
| 1.18 | Rate Setting & Analysis | Contractor shall complete annual PSSP UPL calculations for all non-private (state or local government-owned) PSSP providers. | ||
| 1.19 | Rate Setting & Analysis | Contractor shall implement and document a formal onboarding protocol for new ambulance providers (private and non-state government-owned) entering the UPL program. | ||
| 1.20 | Rate Setting & Analysis | Contractor shall annually establish Inpatient Hospital (IPH) and Rehab Hospital rates, including the APR-DRG rates, the prospective per diem rate, and the rate for transplants set at a percentage of billed charges. | ||
| 1.21 | Rate Setting & Analysis | Contractor shall quarterly establish Outpatient Hospital (OPPS) rates using the CMS Ambulatory Payment Classification (APC) based system and shall perform annual monitoring of the OPPS system. | ||
| 1.22 | Rate Setting & Analysis | Contractor shall annually determine the Disproportionate Share Hospital (DSH) calculations based on each qualifying hospital's unreimbursed Medicaid and uninsured costs. | ||
| 1.23 | Rate Setting & Analysis | Contractor shall annually complete the Intergovernmental Transfer (IGT) / Qualified Rate Adjustment (QRA) analysis to support supplemental payments. | ||
| 1.24 | Rate Setting & Analysis | Contractor shall annually complete and establish the Inpatient Hospital Cost-to-Charge Ratios (CCRs) for rate-setting and settlement purposes. | ||
| 1.25 | Rate Setting & Analysis | Contractor shall annually establish rates for physicians and other practitioners (including psychologists and CMHSAs) according to the Resource-Based Relative Value Scale (RBRVS) fee schedule methodology. | ||
| 1.26 | Rate Setting & Analysis | Contractor shall annually establish Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) rates based on the Prospective Payment System (PPS) methodology (100% of average costs per encounter). | ||
| 1.27 | Rate Setting & Analysis | Contractor shall annually establish rates for Psychiatric Residential Treatment Facilities (PRTFs) based on provider-specific, all-inclusive per diem costs. | ||
| 1.28 | Rate Setting & Analysis | Contractor shall conduct annual rate rebasing for Home and Community-Based Services (HCBS) Waivers, including the Child DD, Adult DD, ABI, Comprehensive, and Supports programs. | ||
| 1.29 | Rate Setting & Analysis | Contractor shall perform Per Member Per Month (PMPM) rate calculations for the Care Management Entity (CME) and shall assist with the 1915(b)/1915(c) waiver documentation as requested. | ||
| 1.30 | Rate Setting & Analysis | Contractor shall annually complete Upper Payment Limit (UPL) demonstrations for physicians, clinics, ASCs, inpatient/outpatient hospitals, IMDs, PRTFs, and CMHSAs. | ||
| 1.31 | Rate Setting & Analysis | Contractor shall conduct specific rate studies as requested by WDH (e.g., for CMHSA, Behavioral Health), including designing conceptual models and providing rate recommendations. | ||
| 1.32 | Rate Setting & Analysis | Contractor shall develop provider rate files in a DHCF-specified format and submit them at least thirty (30) days prior to the implementation date of the new or revised rates. | ||
| 1.33 | Rate Setting & Analysis | Contractor shall conduct a Medicaid HEDIS rate validation study as requested by WDH. | ||
| 1.34 | Rate Setting & Analysis | Contractor shall annually complete Upper Payment Limit (UPL) demonstrations for physicians, clinics, ASCs, inpatient hospitals, outpatient hospitals, IMDs, PRTFs, CMHSAs, and all other provider types included in the Wyoming State Plan. All demonstrations shall fully comply with federal UPL regulations. | ||
| 1.35 | Rate Setting & Analysis | Contractor shall perform all UPL demonstrations using only CMS‑approved State Plan (SPA) methodologies, maintain complete SPA version control, and shall not implement any methodology changes until CMS has approved the associated SPA language. | ||
| 1.36 | Rate Setting & Analysis | Contractor shall provide full version‑controlled documentation for all UPL calculations, conduct multi‑layer quality assurance reviews prior to submission, and deliver a CMS‑aligned methodology crosswalk linking SPA language to each step of the UPL calculation. | ||
| 1.37 | Rate Setting & Analysis | Contractor shall conduct quarterly Private Hospital UPL calculations using CMS‑aligned methodologies and deliver results by the State‑specified deadline. | ||
| 1.38 | Rate Setting & Analysis | Contractor shall perform quarterly UPL calculations for all private ground ambulance providers. | ||
| 1.39 | Rate Setting & Analysis | Contractor shall complete quarterly PSSP UPL calculations for private PSSP providers and submit results by DHCF-specified deadlines. | ||
| 1.40 | Rate Setting & Analysis | Contractor shall perform annual UPL reconciliations for ground ambulance, PSSP, QRA, and other eligible services. | ||
| 1.41 | Rate Setting & Analysis | Contractor shall implement and document a formal onboarding protocol for new hospitals entering the UPL program. | ||
| 1.42 | Rate Setting & Analysis | Contractor shall calculate and update Ambulance rates (Ground and Air) in accordance with State-defined methodologies and CMS guidelines. | ||
| 1.43 | Rate Setting & Analysis | Contractor shall develop and maintain reimbursement schedules for Durable Medical Equipment (DME), prosthetics, orthotics, and supplies, per Wyoming SPA requirements. | ||
| 1.44 | Rate Setting & Analysis | Contractor shall calculate and update rates for Rural Health Clinics (RHCs), including PPS and APM methodologies. | ||
| 1.45 | Rate Setting & Analysis | Contractor shall provide advanced actuarial and policy support for the design, development, pricing, and certification of new Value-Based Payment (VBP) and Alternative Payment Model (APM) initiatives as directed by WDH. | ||
| 1.46 | Rate Setting & Analysis | Contractor shall develop, validate, and apply appropriate risk adjustment methodologies for diverse populations within proposed VBP/APM models. | ||
| 1.47 | Rate Setting & Analysis | Contractor shall perform and certify all budget neutrality calculations comparing proposed VBP/APM models against FFS cost projections. | ||
| 1.48 | Rate Setting & Analysis | Contractor shall draft all required methodology documentation, provider-facing specifications, provider contract language, and State Plan Amendment (SPA) language for new VBP/APM models. | ||
| 1.49 | Rate Setting & Analysis | Contractor shall model the financial impact of various VBP incentive structures, quality measures, and shared savings/risk arrangements. |
T2 - Reimbursement Assistance
| Table 2: Reimbursement Assistance Requirements | ||||
| Req # | Requirement Type | Requirement Language | Proposer Compliance Code | Proposer Comments |
| 2.01 | Reimbursement Assistance | Contractor shall perform a biennial Comparative Rate Analysis comparing Wyoming Medicaid FFS rates for primary care, OB/GYN, and outpatient mental health/SUD services against the latest available Medicare rates. | ||
| 2.02 | Reimbursement Assistance | Contractor shall support WDH in publicly publishing all FFS Medicaid fee schedule payment rates on an accessible public website in a machine-readable format. | ||
| 2.03 | Reimbursement Assistance | Contractor shall support WDH in publicly publishing the results of the biennial Comparative Rate Analysis (from COMP-01) and any accompanying rate adequacy justifications. | ||
| 2.04 | Reimbursement Assistance | Contractor shall monitor and analyze all proposed FFS rate changes (reductions or restructurings) for compliance with Access Rule provisions, including assessing potential impacts on access to care. | ||
| 2.05 | Reimbursement Assistance | Contractor shall assist DHCF in developing and updating Medicaid Administration Rules (Chapters) related to rate methodologies and reimbursement. | ||
| 2.06 | Reimbursement Assistance | Contractor shall maintain strict SPA version control and ensure that only CMS‑approved SPA language is applied. Contractor shall identify where SPA language governs methodology calculations and shall not implement changes until CMS approval is received. | ||
| 2.07 | Reimbursement Assistance | Contractor shall follow CMS‑approved SPA versions only for UPL calculations and maintain full version control. | ||
| 2.08 | Reimbursement Assistance | Vendor must provide a CMS-oriented methodology crosswalk linking UPL calculations to SPA language. | ||
| 2.09 | Reimbursement Assistance | Contractor shall, as directed by the State, design, conduct, and analyze the results of statewide provider and recipient surveys to support access to care monitoring. | ||
| 2.10 | Reimbursement Assistance | Contractor shall develop and deliver the annual "Plan for Reimbursement / Annual Benchmarking Study" by early October. | ||
| 2.11 | Reimbursement Assistance | Contractor shall continuously research and assess the impact of State and Federal initiatives, providing recommendations to DHCF on at least a quarterly basis. | ||
| 2.12 | Reimbursement Assistance | Contractor shall ensure that all annual Medicaid rate‑setting reports maintain consistent formats, templates, methodologies, and data structures across years unless the State approves changes. All changes must be documented in a program‑wide year‑over‑year continuity log. | ||
| 2.13 | Reimbursement Assistance | Contractor shall maintain a consistent UPL report structure year-to-year unless the State approves changes. | ||
| 2.14 | Reimbursement Assistance | Contractor shall develop and update payment policies, provider costs, relative weights, and conversion factors for all payment systems as directed by DHCF. | ||
| 2.15 | Reimbursement Assistance | Contractor shall, for new or changing programs, develop conceptual rate models, collect and scrub all necessary cost/wage information, and present final rate models. | ||
| 2.16 | Reimbursement Assistance | Contractor shall proactively research and provide formal recommendations regarding national best practices, industry trends, and innovative reimbursement methodologies that maximize program value, enhance fiscal sustainability, and align with CMS quality-based payment initiatives for the State. | ||
| 2.17 | Reimbursement Assistance | Contractor shall maintain a structured Communication Plan for interacting with DHCF staff, providers, and other stakeholders. This may include bulletin and newsletter development when necessary. |
T3 - External Quality Review &
| Table 3: External Quality Review & Independent Assessment Requirements | ||||
| Req # | Requirement Type | Requirement Language | Proposer Compliance Code | Proposer Comments |
| 3.01 | External Quality Review & Independent Assessment | Contractor shall conduct all mandatory and optional External Quality Review (EQR) activities for the Care Management Entity (CME) in compliance with 42 CFR 438, Subpart E. This shall include, at a minimum, Protocols 1, 2, 3, and 6. | ||
| 3.02 | External Quality Review & Independent Assessment | Contractor shall conduct an annual Independent Assessment (IA) of the CME program, including tool development, data collection, and a cost-effectiveness analysis. | ||
| 3.03 | External Quality Review & Independent Assessment | Contractor shall perform recurring analysis of the Medicaid provider network to verify member access to services, ensuring compliance with State and Federal (42 CFR § 438.68) time and distance standards. | ||
| 3.04 | External Quality Review & Independent Assessment | Contractor shall utilize Geographic Information System (GIS) software to produce maps and data visualizations illustrating provider proximity to member populations. | ||
| 3.05 | External Quality Review & Independent Assessment | Contractor shall develop and submit all draft and final EQR technical reports and Independent Assessment (IA) reports for WDH and CMS review. | ||
| 3.06 | External Quality Review & Independent Assessment | Contractor shall validate compliance with federal requirements in accordance with 42 CFR § 438.66(e) and 42 CFR 438.68 |
T4 - On-Request Support
| Table 4: On-Request Support Requirements | ||||
| Req # | Requirement Type | Requirement Language | Proposer Compliance Code | Proposer Comments |
| 4.01 | On-Request Support | Contractor shall perform ad-hoc queries and complex business analyses as requested by DHCF to support policy decisions. | ||
| 4.02 | On-Request Support | Contractor shall provide actuarial certification and policy support for any State Directed Payments (SDPs), ensuring compliance with new federal payment limits and regulations. | ||
| 4.03 | On-Request Support | Contractor shall provide litigation support to the Division of Healthcare Financing (DHCF) as requested, including preparing materials and providing expert witness testimony. | ||
| 4.04 | On-Request Support | Contractor shall provide administrative, research, and policy support for the Medicaid Advisory Committee (MAC) and Beneficiary Advisory Council (BAC) as requested. | ||
| 4.05 | On-Request Support | Contractor shall facilitate trainings with providers and provider groups as requested to support Medicaid initiatives. | ||
| 4.06 | On-Request Support | Contractor shall prepare and conduct provider training (on-site or webinar) on new cost reporting processes and new rate methodologies (e.g., VBP, FFS changes) as needed. | ||
| 4.07 | On-Request Support | Contractor shall provide ongoing stakeholder engagement and facilitation, including communicating changes and addressing concerns. | ||
| 4.08 | On-Request Support | Contractor shall maintain provider inquiry logs and respond to questions regarding any Medicaid rate‑setting program—including UPL, DSH, OPPS, RBRVS, HCBS, Ground Ambulance, APR-DRG and others—within the SLA-defined timeframe. All responses must clearly explain calculation methodology and figures. | ||
| 4.09 | On-Request Support | Contractor shall maintain a provider inquiry log and respond to UPL questions within defined SLAs. | ||
| 4.10 | On-Request Support | Contractor shall provide advanced actuarial and policy support for the design, development, pricing, and certification of new Value-Based Payment (VBP) and Alternative Payment Model (APM) initiatives as directed by WDH. |
T5 - Communication
| Table 5: Communication Requirements | ||||
| Req # | Requirement Type | Requirement Language | Proposer Compliance Code | Proposer Comments |
| 5.01 | Communication | Contractor shall provide a Single Point of Contact (SPOC) and a comprehensive Communication Plan that defines communication objectives, escalation paths, key audiences, and tools for top‑down, bottom‑up, and cross‑organizational communication. | ||
| 5.02 | Communication | Contractor shall assist DHCF in researching, developing, and drafting Wyoming Medicaid rules, State Plan Amendments (SPAs), waiver documentation, and similar policy materials to support CMS submissions and program compliance. | ||
| 5.03 | Communication | Contractor shall assist in the development, updating, and implementation of Medicaid regulations by providing supporting analysis, documentation, and coordinated communication materials. | ||
| 5.04 | Communication | Contractor shall collaborate with WDH to resolve provider reimbursement issues, including clarifying methodologies, responding to provider questions, and supporting resolution of reimbursement-related inquiries. | ||
| 5.05 | Communication | Contractor shall develop and communicate clear rationales for proposed changes to reimbursement methodologies, rate models, or payment strategies, including analytical justification and fiscal implications. | ||
| 5.06 | Communication | Contractor shall manage provider communications—including mail, email, phone, virtual meetings, and website updates—regarding any services described in this RFP. Communications shall use WDH branding and may include information related to rate setting, reimbursement assistance, EQR/IA activities, reconsiderations, hearings, research, and analytical work. | ||
| 5.07 | Communication | Contractor shall provide copies of work papers, supporting documentation, calculations, and related materials upon WDH request, in accordance with confidentiality, HIPAA, and data security requirements. | ||
| 5.08 | Communication | Contractor shall respond to provider inquiries that fall outside the specific scope of an audit, rate review, or other discrete activity, ensuring DHCF is informed of provider concerns, trends, and issues requiring follow‑up. | ||
| 5.09 | Communication | Contractor shall provide weekly project status reports summarizing progress across all functional areas, including key accomplishments, emerging risks, pending decisions, issues requiring DHCF attention, and updates on milestones and deliverables. | ||
| 5.10 | Communication | Contractor shall maintain regular communication with the DHCF Contract Manager and designated staff, including routine phone and email contact, active participation in scheduled meetings, and submission of monthly status reports alongside monthly invoices. |
T7 - Equipment
| Table 7: Equipment Requirements | ||||
| Req # | Requirement Type | Requirement Language | Proposer Compliance Code | Proposer Comments |
| 6.01 | Equipment | Contractor shall provide desktop systems capable of producing and accepting electronic versions of rate‑setting files, cost reports, and deliverables in formats compatible with WDH’s current desktop environment. |
T8 - Technology & Specification
| Table 8: Technology & Specifications Requirements | ||||
| Req # | Requirement Type | Requirement Language | Proposer Compliance Code | Proposer Comments |
| 7.01 | Technology & Specifications | Contractor shall maintain the capability to receive reports, deliverables, and information file transfers through a secure repository allowing exchange between the Contractor, WDH, and providers. | ||
| 7.02 | Technology & Specifications | Contractor shall provide all technology needed to complete the scope of work and shall coordinate with WDH, the State’s Fiscal Agent, and A&I–ITD to obtain access to BMS/MMIS and the Data Warehouse (via COGNOS) for research and analysis. The Contractor shall request additional BMS/MMIS information as needed to support its functions. | ||
| 7.03 | Technology & Specifications | Contractor shall provide and maintain all hardware and equipment necessary to perform all duties in the scope of work, including computers, printers, network devices, and other administrative resources. | ||
| 7.04 | Technology & Specifications | Unless otherwise specified by WDH, Contractor shall deliver all reports and contract deliverables in electronic format. If necessary, paper reports and deliverables will be specified on a case-by-case basis by WDH. |
T9 - Location & Work Environmen
| Table 9: Location & Work Environment Requirements | ||||
| Req # | Requirement Type | Requirement Language | Proposer Compliance Code | Proposer Comments |
| 8.01 | Location & Work Environment | Contractor shall work with WDH for appearing and testifying during case preparation, administrative hearings and judicial reviews. | ||
| 8.02 | Location & Work Environment | Contractor shall maintain its Wyoming operations within the continental United States. An office in Cheyenne is not required; however, the Contractor shall make key personnel available on‑site in Wyoming when requested and shall attend meetings or other on‑site responsibilities as directed. Work may otherwise be performed remotely. |
T10 - Staffing & Qualifications
| Table 10: Staffing & Qualifications Requirements | ||||
| Req # | Requirement Type | Requirement Language | Proposer Compliance Code | Proposer Comments |
| 9.01 | Staffing & Qualifications | Proposer shall demonstrate at least five (5) years of experience providing Medicaid rate setting, rate analysis, and reimbursement assistance services across multiple provider types and payment methodologies. | ||
| 9.02 | Staffing & Qualifications | Proposer shall demonstrate at least five (5) years of experience conducting research, analysis, and policy compliance activities supporting Medicaid programs. | ||
| 9.03 | Staffing & Qualifications | Proposer shall include a current financial statement and proof of federal or professional certifications or accreditations. | ||
| 9.04 | Staffing & Qualifications | Proposer shall define the firm’s competitive advantage over other firms in the same industry. | ||
| 9.05 | Staffing & Qualifications | Proposer shall provide a written description of all work to be subcontracted to third parties. | ||
| 9.06 | Staffing & Qualifications | Proposer shall provide staffing levels (estimated by staff disciplines by month for the duration of the project). | ||
| 9.07 | Staffing & Qualifications | Proposer shall identify total hours to be expended, per phase and for the entire project, for both Contractor staff and Agency staff. | ||
| 9.08 | Staffing & Qualifications | Proposer shall describe its firm’s objectives with respect to future growth.▪ Services that will be emphasized or de-emphasized in the future. ▪ The firm’s expectations of demand for its services, and how does it plan to manage the future growth of these services.▪ Discuss how the firm plans to ensure that future growth does not compromise the quality of your existing services. Include how the firm plans to manage growth in terms of client/consultant ratio. | ||
| 9.09 | Staffing & Qualifications | Proposer shall provide a written explanation of any existing contractual relationships between the prime and subcontractors, or among subcontractors. | ||
| 9.10 | Staffing & Qualifications | Proposer shall document differentiated staff, subcontractor staff, and Agency staff. | ||
| 9.11 | Staffing & Qualifications | Personnel whose names and resumes are submitted in the proposal shall not be removed from this project without prior approval of WDH. The substitution or addition of personnel shall require the submission of a resume and formal approval from WDH. | ||
| 9.12 | Staffing & Qualifications | WDH shall have the right to request the removal of any staff member from all work on this project, and the Contractor shall comply with any such request immediately. | ||
| 9.13 | Staffing & Qualifications | Contractor shall replace any staff member who is removed from or leaves the project for any reason with a staff member who meets or exceeds the skill level and experience of the departed staff member. Such replacements are subject to WDH approval at the time of the assignment and again 90 days later. | ||
| 9.14 | Staffing & Qualifications | Proposer shall confirm that the Project Manager will:▪ Be the single point of contact for the duration of the engagement.▪ Be responsible for timely completion of all phases of the project.▪ Be responsible for meeting all contractual requirements for the duration of the project.▪ Attend status, quality review and acceptance meetings as required and present status and progress reports on the project.▪ Remain assigned to the project through completion of the project as determined by WDH.▪ Identify project responsibilities and job functions. | ||
| 9.15 | Staffing & Qualifications | Subcontractor(s) shall report to and be responsible to the prime contractor. | ||
| 9.16 | Staffing & Qualifications | Proposer shall certify that any supporting contractor who may assist the primary contractor meets the minimum qualifications. | ||
| 9.17 | Staffing & Qualifications | Proposer shall provide a description of the nature and duration of the previous relationship of all subcontractors and/or third parties with the prime contractor. | ||
| 9.18 | Staffing & Qualifications | Proposer shall provide a breakdown of staff disciplines, including titles and job responsibilities, for all personnel assigned to the project. | ||
| 9.19 | Staffing & Qualifications | Contractor shall provide: A Contract Administrator with binding authority to act on behalf of the Contractor. A Contract Manager responsible for day‑to‑day operations, meeting all contractual requirements, attending required meetings, presenting progress reports, and remaining assigned through contract completion. |
T11 - Project Management
| Table 11: Project Management Requirements | ||||
| Req # | Requirement Type | Requirement Language | Proposer Compliance Code | Proposer Comments |
| 10.01 | Project Management | Contractor shall meet all performance expectations for Medicaid rate setting, rate analysis, reimbursement assistance, and related activities throughout the contract lifecycle. | ||
| 10.02 | Project Management | Contractor shall maintain a comprehensive Change Control Management process with all changes approved through the WDH Change Control Board. The change control process shall include: the reason for the change, a complete description of the work to be performed, estimates of time and cost, a completion date, and an analysis of project impacts. No changes to methodologies, templates, calculations, assumptions, data sources, or State Plan Amendment (SPA) or regulatory interpretations used in Medicaid rate‑setting may be implemented without formal WDH approval. | ||
| 10.03 | Project Management | If unforeseen circumstances arise requiring dispute resolution, the Contractor shall submit a written description of the issue and proposed resolution to the State’s Project Manager and designated point of contact. If change orders or change requests are necessary, the Contractor shall continue work at the hourly rate specified in its proposal until resolution is reached. | ||
| 10.04 | Project Management | When changes to the Statement of Work (SOW) are required, a Contract Amendment shall be executed in accordance with State requirements. The Project Change Request (PCR) shall serve as the Contractor’s formal justification for any SOW change. | ||
| 10.05 | Project Management | Contractor shall establish procedures for developing deliverables and for WDH’s review and approval of such deliverables within thirty (30) calendar days of contract signing. | ||
| 10.06 | Project Management | Contractor shall track adherence to all RFP, contract, and performance requirements throughout the contract lifecycle. | ||
| 10.07 | Project Management | Contractor shall provide verbal walkthroughs of key deliverables. | ||
| 10.08 | Project Management | Contractor shall ensure that all deliverables conform to WDH standards, including templates, formatting, documentation requirements, quality expectations, and version control. | ||
| 10.09 | Project Management | The Contractor shall develop and submit weekly and monthly status reports in a format agreed upon by WDH. Reports shall include: Status of all Medicaid rate‑setting deliverables (including but not limited to UPL, DSH, QRA, PRTF, OPPS/EAPG, RBRVS, HCBS, APR-DRG), Risks, dependencies, and mitigation actions, Budget status, Progress against milestones, Staffing updates, Any potential delays, reported at least 10 business days in advance, with a formal mitigation plan. Reports may include ad hoc or customized reporting as requested. | ||
| 10.10 | Project Management | If a new Contractor is selected, Contractor shall become familiar with the processes, procedures, and documentation of current rate setting activities and other activities. | ||
| 10.11 | Project Management | Contractor shall submit a comprehensive Project Work Plan identifying: All required tasks and activities, Milestones and deliverable due dates, Personnel hours and assignments, Dependencies and risks, Quality assurance checkpoints. The plan shall demonstrate understanding of Medicaid rate setting responsibilities, reimbursement methodologies, and State expectations. | ||
| 10.12 | Project Management | Contractor shall provide a Project Management Plan describing: Organization structure, Progress reporting methods, Decision‑making and sign‑off procedures, Internal controls, Processes for managing scope changes, Approaches for handling project delays. | ||
| 10.13 | Project Management | Contractor shall develop and maintain a Risk Register reviewed weekly with WDH. The register shall identify risks, mitigation strategies, assigned owners, probability, impact, and status. | ||
| 10.14 | Project Management | Contractor shall maintain a formal QA/QC Plan applying to all Medicaid rate‑setting activities. The plan must include: Multi‑layer peer review, Automated validation checks, Clerical accuracy standards, Version control for all tools, templates, and workpapers, Error‑prevention procedures to avoid formula errors, data inconsistencies, and unauthorized methodology changes. The Contractor shall maintain a near‑zero clerical error rate across all UPL and rate‑setting documentation. | ||
| 10.15 | Project Management | Contractor shall: Meet all UPL quarterly and annual deadlines, Implement multi‑layer QA/QC for all UPL spreadsheets and formulas, Document all changes to UPL logic, templates, SPA interpretations, and data sources, Maintain an auditable record of all UPL calculations, Adhere to SLA‑based penalties for late UPL submissions (if required by WDH). |
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