Attachment K - Scope of Work 2.pdf

Attachment K; Scope of Work

RFP 26-85965

Indiana is seeking a data management system to submit the Minimum Data Element(s) (MDE) to the Center for Disease Control and Prevention (CDC), maintain a searchable database for MDEs, facilitate coordination of efforts between regional coordinators, providers, patients, state/community stakeholders, support nurse case management of patients, record community clinical linkages, submit reimbursement for services rendered to providers, and support program organization and policies as written by IDOH and CDC.

Vendor may propose a customized solution or an off the shelf option with the ability to support Indiana’s delivery system for Indiana WISEWOMAN and the Indiana Breast and Cervical Cancer Program (IN-BCCP).

The two programs which will currently be using this system are IN-BCCP and Indiana WISEWOMAN. IN-BCCP is Indiana’s implementation of the 1990 Breast and Cervical Cancer Mortality Prevention Act which created a national cancer screening program, leading to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Indiana BCCP (IN- BCCP) provides access to breast and cervical cancer screenings, diagnostic testing, and treatment for low income, underserved, and uninsured or underinsured women qualifying for services. IN-BCCP serves approximately 4,000 women annually. Since its inception, IN-BCCP has served over 68,000 patients through approximately 145,000 unique visits. Services provided by IN-BCCP include:

o Colposcopies (with or without biopsies) o Liquid-based cytology tests o High risk panel HPV testing o Office visits o Pelvic exams/tests o Clinical breast exams (CBEs) o Mammograms (screening and diagnostic) o Diagnostic breast ultrasounds o Breast biopsies o Consultations o Patient Navigation Services o Breast MRI’s o Diagnostic LEEPps

Deidentified data for these services as well as ongoing information for follow up must be submitted to the CDC twice a year as specified by the cooperative agreement and detailed in the Breast and Cervical Cancer Early Detection Program Manual. At a minimum the data management system shall assure correct and complete enrollment of clients and work with regional coordinators, support patient navigation by IN-BCCP nurse consultants, IDOH staff and providers to correct data errors and data entry.

Additionally, Indiana seeks support for provider reimbursement for services rendered by Indiana providers who are part of the IN-BCCP network. The data management systems shall review remittance reports, communicate with IDOH, regional coordinators and providers regarding payment discrepancies and payment status and pay claims on behalf of IDOH.

Indiana does anticipate growth in the number of women served in the next funding period.

IN-WISEWOMAN is Indiana’s implementation of the CDC funded program, Well-Integrated Screening and Evaluation for Women Across the Nation Program (WISEWOMAN). IN WISEWOMAN expands services to women as part of the NBCCEDP. IN-WISEWOMAN provides cardiovascular disease screening and prevention services to IN-BCCP participants in targeted geographic areas. IN-WISEWOMAN offers education and early detection screening to reduce the risk of cardiovascular disease to low-income, uninsured, and underinsured women between the ages of 40 and 64 years old. Services provided by the IN-WISEWOMAN Program include cardiovascular screenings, risk reduction counseling, healthy behavior support services, and health coaching to promote long-term, healthy lifestyles. IN-WISEWOMAN serves approximately 500 women annually.

Identified data for these services as well as ongoing information for follow-up must be submitted to the CDC twice a year as specified by the cooperative agreement and detailed in the Indiana Well-Integrated Screening and Evaluation for Women Across the Nation program manual. At a minimum, the data management system should ensure correct and complete enrollment of clients and work with regional coordinators, IDOH staff and providers to correct data errors and data entry.

Additionally, Indiana seeks support for provider reimbursement for services rendered by Indiana providers who are part of the WISEWOMAN network. The data management systems shall review remittance reports, communicate with IDOH, regional coordinators and providers regarding payment discrepancies and payment status and pay claims on behalf of IDOH.

In summary, the State requires a modern, web-based system which supports a paperless claims process, the collection of essential data, and that is in full compliance with federal requirements. Proposed web-based systems must be compliant with assistive technology standards (508 compliant) and describe compliance in their response.

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.html), and the State’s architectural standards. Any deviation from these requirements must be approved in writing by IOT in advance.

The State’s future system must meet the following requirements:

o Maintain all data for the Indiana Breast and Cervical Cancer Program (IN-BCCP) and IN

WISEWOMAN to meet grantor requirements for submission of Minimum Data Elements (MDE). This shall include data system upgrades if MDEs are modified by the Centers for Disease Control (CDC).

o Develop and employ systems to enter, adjudicate and process all claims for IN-BCCP providers in an electronic and paperless format. Coordinate disbursement of funds to providers on behalf of IN-BCCP. This shall include Indiana WISEWOMAN providers who offer IN WISEWOMAN supports only. Support IN-BCCP and associated program’s efforts to maintain an accurate and up to date provider list. IN WISEWOMAN may solicit additional support for their provider list as the program grows. Additionally, vendor should engage in continuous quality improvement and continue to seek ways to decrease payment and data collection times. Vendor should offer hands-on support and training to program staff at the state and local levels. Vendor should provide a minimum of ten hours every month to support data and claims correction.

o Support program efficiency and standardization of processes across regions, programs and staff. Create and maintain a data management system capable of provider and regional coordinator electronic forms and administrative information. Allow for client matching across regions and programs.

o Provide secure data access including the ability for state staff, grantee, and contract staff to query and search identified program data for program needs, evaluation and public presentations as needed or requested. Provide access to state and regional staff necessary for evidence-based patient services, patient navigation and staff query capability within program guidelines. Comply with emerging Indiana Data requirement including but not limited to Indiana GovRamp.

o The proposed solution is expected to integrate with Access Indiana. The IN.gov Program is tasked with implementing a single sign-on authentication mechanism and Identity Provider for online applications for the State of Indiana, referred to as Access Indiana. The benefits of a standard authentication solution, integration strategy, integration process, and more can be found at Access Indiana Authentication (https://www.in.gov/inwp/applications/authentication/) o System must be capable of creating automated warnings for provider, regional coordinators and IDOH staff inaccurate data entry and duplicate claims. System should be maintained, clean, and analyze data according to IDOH and grant requirements.

o Maintain a system wherein women’s breast cancer, cervical cancer and cardiovascular disease risk factor outcomes can be tracked seamlessly to assure adequate case management, to encourage best clinical and lifestyle practices, to increase access to healthcare and to assure swift payment to providers.

o Retain electronic and searchable copies of provider agreements. Support efforts to streamline provider recruitment across regions and programs. Maintain a system to alert state and regions of upcoming provider agreement expiration. Explore ongoing methods to assure correct payment, refund allocation and o Indiana WISEWOMAN requires support for data specific to that program. This data includes, but is not limited to, tracking number and type of visits, needed follow-up appointment dates, identification of and flagging of abnormal values or lab work for patients, tracking of dollars spent, estimating cost per person served and other add-ons as needed.

Systems shall have stated capacity to scale up for other early cancer detection programs as funding is identified.

o Coordinate data sharing with the Indiana Cancer Registry.

o Provide ongoing training and support for system users at the state, regional and, dependent on system nature, provider levels.

o Comply with all state and national data protection including, but not limited to, the

Health Insurance Portability and Accountability Act (HIPAA).

o Develop and make available the annual Health Insurance Portability and Accountability

Act (HIPAA) for providers.

o Support the development of new and innovative methods of submitting claims at provider request.

o Provide a mechanism for Indiana to record and house a catalogue of state developed training modules.

A system should be able to electronically provide the following services:

Data Review, Entry, and Management IN-BCCP o Manage all providers contact and financial information and support semi-annual updates of provider contact information o Provide for the secure submission of enrollment and diagnostic information including client signatures, client enrollment and preauthorization forms from state, regional and provider levels and file sharing by program state and grantee staff.

o Provide secure ability to upload and store diagnostic reports, pathology, and medical documents.

o Review all enrollment forms, bills, and reports to ensure accuracy and eligibility.

o Support data submission and assure patient confidentiality.

o Pre-screen and enter all IN-BCCP provider claims and explanation of benefits to determine reimbursement for services.

o Interact with IN-BCCP Regional Coordinators, Indiana Data Manger, Indiana Data

Coordinator and Nurse Case Managers to correct data errors and missing information o Review remittance reports for final provider payment authorization.

o Communicate with providers regarding payment discrepancies and issues.

o Allow for shared data access across all state, regional and other grantee levels.

o Assure safe and secure linking with the Indiana Cancer Registry to assure adequate tracking of all missing IN-BCCP cases.

o Support vendor submission of data and claims through other means as requested by the

IN-BCCP providers.

o Participate in meetings and support upon request of IDOH staff

Data Review, Entry, and Management Indiana WISEWOMAN o Manage all providers contact and financial information and support semiannual updates of provider contact information o Provide for the secure submission of enrollment and diagnostic information including client signatures, client enrollment and preauthorization forms from state, regional and provider levels and file sharing by program state and grantee staff for approximately 500 women.

o Review all enrollment forms, bills, and reports to ensure accuracy and eligibility.

o Support data submission and assure o Pre-screen and enter all IN WISEWOMAN provider claim and explanation of benefits to determine reimbursement for services.

o Interact with Regional Coordinators o Review remittance reports for final provider payment authorization.

o Communicate with providers regarding payment discrepancies and issues.

o Support vendor submission of data and claims through other means as requested by the

Well-Integrated Screening and Evaluation for Women Across the Nation Program (WISEWOMAN) providers o Allow for shared data access across all state, regional and other grantee levels.

Database Management and Claims Adjudication and Payment o Provide database application services and support to assure accuracy, submit claims to the state of Indiana within 14 days of receipt and provide payment to providers within one week of receipt of payment from the State of Indiana.

o Provide security, data warehousing, and data backup.

o Allow shared data access across all state, regional and other grantee(s).

o Maintain all required demographic and clinical data collected, enter and adjudicate IN-

BCCP provider bills, and correct any errors for a minimum of 4600 women. Be prepared to add additional services for a minimum of one additional program as needed.

o Maintain all required demographic and clinical data collected, enter and adjudicate Indiana WISEWOMAN provider bills and correct any errors for a minimum of 500 women.

o Make any necessary changes to the database to comply with data collection requirements to meet the minimum data elements (MDEs) as required by CDC and any program evaluation needs.

o Comply with all HIPAA policies and procedures.

o Provide ongoing technical assistance and support for state, grantee and provider system users.

The State has robust and comprehensive security standards that permeate all levels of the organization. The Indiana Office of Technology (IOT) has been tasked with establishing and maintaining these security standards. The security standards include assessing security risks, developing, and implementing effective security procedures, and monitoring the effectiveness of those procedures. If the proposed solution involves information technology-related products or services, all such products or services are to be compatible with any of the technology standards found in the Information Security Framework (https://www.in.gov/iot/iot-vendor-engagement/) that are applicable, including the assistive technology standard. Respondents will be required to sign a Non-Disclosure Agreement (NDA) to access the IOT Information Security Framework; Respondent’s should review the IOT Information Security Framework, and ensure their proposed solution meets all standards therein.

Business Continuity-Disaster Recovery Plan The Contractor shall maintain and share with the State a Disaster Recovery Plan, and shall make available to the State all amendments, changes, or modifications to its Disaster Recovery Plan.

The Contractor’s Disaster Recovery Plan is deemed a trade secret and is deemed information that would jeopardize a record keeping or security system and shall be exempt from disclosure under Indiana’s Access to Public Records Act, Ind. Code § 5-14-3-4(a) and (b)(10), (11) and (19).

Please refer to section 1.5 Confidential Information[of the main RFP document for further information about identifying aspects of a proposal to remain confidential.

The Contractor shall, in coordination with the State, maintain a specific Business Continuity Plan dedicated to operating State systems for which it is responsible in the event of a disaster, as well as a specific Continuity of Operations Plan dedicated to the Contractor’s organization itself.

Over the course of the contract, the Contractor shall make updates to their Business Continuity- Disaster Recovery Plan on an annual basis to ensure that staffing and procedures are up to date. All said updates shall be shared with the State in a timely manner.

Patient Navigation Database o Maintain a web-based patient navigation database to track all patient navigation data including but not limited to, demographic data, follow-up, screening results, and all other required data elements for CDC and program evaluation.

o Maintain and secure all data.

o Support the database and ensure it is operational for IN-BCCP Nurse Consultants

Indiana. Provide an efficient process for BCCP Nurse Consultants to follow patients and be able to request missing reports. Provide continuous data management support and run reports as necessary to collect and analyze data.

o Train all staff on how to enter and track data in the database. Provide ongoing technical support to IDOH, IN-BCCP and, as needed, provider staff.

Reimbursing Providers for Services o Submit claims for reimbursable services on a minimum of a twice per month cycle.

o Issue individual payments to direct IN-BCCP providers for approved services within seven business days of receipt of funds from the Indiana Department of Health.

o Pay 98 percent of the claims without payment error. Claim payment accuracy represents the percentage of claim transactions paid or denied correctly.The Vendor must utilize one of the State's contracted payment processors if subcontracting out the payment processes. (https://www.in.gov/inwp/payment-processing/), according to IC 5-27-3-2 Governmental bodies; contracting with provider companies. Two payment processing models are available through these agreements: Convenience Model – Credit card users pay the payment processing fees and Merchant Model – Agency pay the payment processing fees. The payment processing services provided by both companies have been tailored for the unique requirements of Indiana and its governmental entities.

Independent Verification & Validation Engagement If the State decides to add Independent Verification & Validation (IV&V) services as part of this engagement, the contractor will copy the Indiana Department of Administration (IDOA) – Independent Verification & Validation (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.

IV&V Payment Approval If IDOA elects to deploy Independent Verification and Validation (IV&V) services in connection with this engagement, the IV&V Team shall review and assess all Deliverables to determine compliance with the State’s requirements as set forth in the Contract and/or applicable Statement(s) of Work. For contracts entered into, renewed, or amended after June 30, 2026, IV&V shall serve as an approving authority, and no payment shall be issued to the Vendor unless and until IV&V has provided such approval.

End of Contract Turnover (Separation of Service)

The services to be performed under the Contract resulting from this RFP are vital to the State and must be continued without interruption. Procedures must be in place to ensure a seamless transition and uninterrupted service throughout the transition to a project successor at contract end. The State seeks to ensure that program stakeholders experience no adverse impact from the transfer of scope to either the State or to the successor contractor(s) should the Contract not be extended or terminated early.

The Contractor shall be responsible for planning and performing end of contract turnover and disengagement activities. Disengagement includes transition planning to ensure a seamless operational transition to the State or its designee in the event of required contract transition.

The Contractor shall work with the State to ensure that all end of contract turnover tasks are completed and that all responsibilities are transitioned in a timely and effective manner.

The Contractor shall complete, at a minimum, the following tasks and activities during the End of Contract Turnover period:

• Develop an End of Contract Turnover Plan, subject to State approval, including a detailed schedule and resources (quantity, type, and role) who will be available for all months of the End of Contract Turnover period. The End of Contract Turnover Plan shall outline the following:

• Contractor roles and responsibilities

• State roles and responsibilities

• A schedule with key milestones and deliverables

• Method to transfer information to the State and/or a successor contractor(s)

• An inventory of detailed documentation about operations, applications, architecture, and infrastructure, as well as any supporting information related to the technical architecture and infrastructure.

• An inventory of all work-in-progress that need to be completed by the State and/or a successor contractor(s)

• Plans for coordination and transition of specific responsibilities from the incumbent to the future contractor.

• An inventory of project documentation, work-in-progress, technology, systems, and assets necessary for a successive Contractor to perform the duties of the Scope of Work

• Conduct training of State staff or successor contractor(s) staff, in the operations and procedures performed by Contractor staff.

• Perform shadowing and training activities for the State and successor contractor(s)

• Transfer the following information to the State or a successor contractor(s) on a medium acceptable to the State:

• All relevant project artifacts created, maintained, and updated throughout the Contract term

• Project documentation, work-in-progress, technology, systems, and assets necessary for a successive Contractor to perform the duties of the Scope of Work

• Other documentation including, but not limited to:

• User, provider, and operations manuals

• Training materials

• Documentation of any interfaces developed to support business activities between contractors

• Participate in reverse shadowing for the State and/or successor contractor(s) staff on all aspects of workflows, releases, and assignments as requested by the State

• Be available to provide support as requested by the State by the end date of the Contract, the Contractor must turn over all State property to the State, and Contractor’s access to all State infrastructure and facilities shall be terminated. The State has the right to initiate the disengagement process for any service under the Contractor Scope of Work with thirty (30) calendar day’s written notice. The notice of termination initiates these disengagement activities and responsibilities.