COMMONWEALTH OF MASSACHUSETTS

EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

ONE ASHBURTON PLACE, 11TH FLOOR

BOSTON, MASSACHUSETTS 02108

REQUEST FOR RESPONSES

FOR THE

PROVISION OF

MASSHEALTH BUSINESS SUPPORT SERVICES

Document #: 26EHSPMMHPROBSS Issued Date: April 24, 2026

TABLE OF CONTENTS

ATTACHMENTS (posted separately under “File Attachments” for this solicitation):

Attachment A: Model Contract Attachment B: Cost Response Instructions and Workbook Attachment C: Reference Materials

1. Provider Types

2. Provider Application Cover Letter and Check List – Independent Clinic/Center

3. Provider Application - Independent Clinic/Center

4. Provider Application Cover Letter and Check List - Medical Practitioner

5. Provider Application – Medical Practitioner

6. Provider Application and Contract – Ordering, Referring and Prescribing (ORP)

7. BSS Average Monthly Volume

INTRODUCTION

Overview The Executive Office of Health and Human Services (EOHHS) is issuing this Request for Responses (RFR) pursuant to 801 CMR 21.00, which governs procurement of services by state agencies and requires a competitive procurement process, including the issuance of an RFR, for acquisitions of all commodities and services.

EOHHS is the single state agency responsible for administering the Commonwealth’s Medicaid program and the Children’s Health Insurance Program within Massachusetts (collectively, MassHealth), pursuant to M.G.L. c. 6A, § 16, Titles XIX and XXI of the Social Security Act, M.G.L. c. 118E, and other applicable federal and state laws, regulations, waivers and demonstration projects.

MassHealth is the Commonwealth’s Medicaid and Children’s Health Insurance Program. MassHealth provides comprehensive, affordable health care coverage for over two million low-income Massachusetts residents, including 40% of all Massachusetts children and 60% of all residents with disabilities. MassHealth’s mission is to improve the health outcomes of our diverse members and their families by providing access to integrated health care services that sustainably and equitably promote health, well-being, independence, and quality of life.

MassHealth may offer benefits directly or help pay for all or part of members’ health insurance premiums. Many factors influence eligibility determination, including citizenship or immigration status, Massachusetts residency, existing healthcare insurance coverage, income, age, dependents, household composition, and health needs. Coverage types include Standard, CommonHealth, Buy-In, Family Assistance, CarePlus, Premium Assistance, and MassHealth Limited. Health plan types include Accountable Care Partnership Plans, Primary Care ACOs, Managed Care Organizations (MCOs), Primary Care Clinician (PCC) Plan, Senior Care Options (SCO), One Care, and the Program of All-Inclusive Care for the Elderly (PACE).

MassHealth also partners with a network of approximately 120,000 providers and serves hundreds of stakeholders and multiple state, federal, and private partners, including but not limited to advocacy groups and organizations, commercial third party liability insurers, federal entities including CMS, the University of Massachusetts, the Massachusetts Legislature, the Executive Office of Technology Services and Security (EOTSS), sister agencies including the Department of Public Health (DPH), the Department of Developmental Services (DDS), the Commonwealth Health Insurance Connector Authority, the Department of Transitional Assistance (DTA), the Department of Mental Health (DMH), and the Department of Children and Families (DCF), and business support and IT vendors.

Bidder Resources Operational data and information are available in Attachment C to assist potential Bidders in preparing response submissions.

PROCURED SERVICES DESCRIPTION

Procurement Purpose EOHHS is issuing this RFR to solicit bids from interested vendors qualified to provide key business support services, in anticipation of procuring such services. The EOHHS-selected vendor would perform services in scope that ultimately serve EOHHS and MassHealth, MassHealth Members, MassHealth Applicants, Providers, Provider Applicants, Relationship Entities and other interested parties.

The anticipated scope of business support services and Bidder-developed systems required by MassHealth includes, but is not limited to, the following, as described in more depth in Model Contract, Attachment A:

Managing Provider enrollment, credentialing, revalidation, onboarding, and data management for Providers participating in MassHealth;

Delivering services related to Provider outreach, education and communication and relationship support and management;

Conducting Provider trainings, developing communication material, and participating in internal and external stakeholder engagement;

Supporting Electronic Data Interchange (EDI) testing, compliance, and transactions;

Assisting with claims processing, monitoring and resolution;

Providing paper and digital document management and fulfillment, including imaging, storing, printing, and mailing;

Creating and maintaining a Knowledge Center;

Fostering excellence, efficiency, and cost-effectiveness in all processes;

Applying continuous quality improvement practices to and incorporating EOHHS feedback into services provided;

Forging positive Provider relations with EOHHS by ensuring that the points of interaction and the supporting processes are streamlined, appropriate, and accurate;

Resolving all relevant Customer inquiries;

Adjusting services in collaboration with EOHHS to be responsive to evolving MassHealth needs;

Hiring, training, retraining, and retaining all necessary staff;

Ensuring visibility into operations through the provision of user-friendly reporting tools, and operational forecasting;

Facilitating Provider Contact Center support;

Managing and providing technology Design, Development & Implementation (DDI), any applicable certification and Maintenance & Operations (M&O) activities and Contract operations included in RFR, Section 5.3.G.2;

Acting as a proactive, collaborative, resourceful partner to MassHealth, through recommending best practices and learnings, and facilitating consistent communication;

Overseeing Non-Emergency Transportation Authorization (NETA) requests, personal reimbursements, and Customer support (Request transportation for a member | Mass.gov); and Providing a Health Plan Comparison Tool (if included in the Bidders response and as directed by EOHHS), currently known as MassHealth Choices (http://www.masshealthchoices.com), to allow Members to compare Managed Care Health Plans and select a Primary Care Provider, using business and functional specifications from and as directed by EOHHS Any Bidder that becomes a Contractor shall provide services in accordance with the requirements of the Attachment A and its Appendices contain provisions that shall be incorporated into any Contract to be executed between EOHHS and the successful Bidder.

EOHHS reserves the right to modify Attachment A and its Appendices as it deems necessary prior to the execution of the Contract. Changes to the Contract after its execution by the parties shall be made only by written amendment.

Bidder Qualifications To be considered for the Contract award pursuant to this RFR, the Bidder in addition to satisfying all other requirements specified herein, must:

Certify that it is capable and willing to, perform all services and activities, take on obligations related to, and work with EOHHS on the efforts detailed in Attachment A;

Have been in business for a minimum of five (5) years, at least three of which must have been in a business performing some similar services or related activities; and Not have and ensure that none of its subcontractors have, any financial, legal, contractual or other business interest in EOHHS’ External Quality Review Organization Contractor, or in such vendor’s subcontractors, if any.

Number of Contract Awards and Contract Term EOHHS anticipates entering into a Contract with a single selected Bidder. This Contract shall commence on the Contract Effective Date. From the Contract Effective Date through June 30, 2027, Contractor shall perform start-up and implementation activities (the Start-up Period). The Operational Start Date is July 1, 2027.

The initial term for operational services shall be five (5) years beginning on the Operational Start Date and ending on June 30, 2032 (the Initial Term). EOHHS may, in its sole option, extend this Contract beyond the Initial Term for up to an aggregate of two (2) additional years, in one or more increments, by providing written notice to Contractor. If extended for the full two (2) years, the Contract shall end on June 30, 2034.

EOHHS reserves the right to further extend the Contract for any reasonable increment it determines necessary to complete a subsequent procurement or facilitate transition of functions under this contract to EOHHS. The foregoing is subject to, and conditioned upon, sufficient appropriations, availability of state and federal funds, all necessary state and federal approvals, and EOHHS’s determination of satisfactory performance.

Procurement Timetable The following timetable represents EOHHS’ best estimate of the schedule to be followed. Unless otherwise specified, the time of day for the following events shall be between 8:00 a.m. and 4:30 p.m., Eastern Time.

EOHHS may adjust this schedule as it deems necessary. Notification of any adjustment to the RFR Timetable shall be posted on COMMBUYS.

(Note: COMMBUYS refers to this deadline as the “Bid Opening Date”) Thursday, June 18, 2026, by 5:00 p.m. Eastern Time

Definitions See Section 1 of Attachment A, for definitions.

GENERAL PAYMENT PROVISIONS

Payment to the Contractor selected pursuant to this RFR will be in accordance with the payment provisions described in Section 6 of Attachment A.

INSTRUCTIONS FOR SUBMISSION OF RESPONSES

Response Submission Instructions All procurements posted on COMMBUYS, known as Bids, require the submission of electronic responses, known as Quotes. To submit an electronic Quote, Bidders must register and maintain an active COMMBUYS Seller subscription account. Questions regarding COMMBUYS should be directed to the COMMBUYS Help Desk at osdhelpdesk@mass.gov. Instructions for creating a Quote can be found on COMMBUYS by clicking the hyperlink labeled “Job Aids for Sellers”. In addition, Bidder’s may find helpful the webcast How to Create a Quote in COMMBUYS. See Section 7.4 of this RFR for further information about COMMBUYS.

Bidders must submit electronic Quotes on COMMBUYS by the date and time specified in Section 2.4, Procurement Timetable. COMMBUYS will not accept submissions after the specified deadline.

Response Format Requirements Each electronic document submitted must be clearly labeled with the following information:

The title of the RFR;

The Bidder’s legal name; and The title of the document (that is, Business Response, Programmatic Response or Cost Response).

Electronic media submissions, other than the electronic files submitted via COMMBUYS will not be accepted. Facsimile and e-mailed responses will not be accepted.

The Bidder must respond to each item in the order in which it appears in the RFR. The Bidder’s response to each section must include headings and numbering to match the corresponding section of the RFR.

Each document must contain a table of contents.

The Bidder must adhere to page limits wherever specified. Attachments and other supporting documentation specifically permitted or required by this RFR are not counted in calculating the Bidder’s page limit.

The narrative section of each document must be formatted as follows:

Word processed;

Single-spaced;

One inch or greater margins;

Six lines or fewer per inch;

Pages numbered; and Sans serif or similar font, 12-point font, except in tables and graphs, where 10-point font may be used.

Business Response Requirements For purposes of the submission requirements set forth in this Section, the following terms shall have the following meanings:

Parent – each of the Bidder’s parent organizations and each of the parents of such parent organizations, if any.

Subsidiary – each of the Bidder’s partially or wholly owned subsidiary organizations, and each of the partially or wholly owned subsidiaries of any such subsidiary organizations.

Affiliated or Related Entity – any organization, if any, with which the Bidder has any direct or indirect financial, legal, contractual or other business relationship, as well as any and all of the Contractor’s Subcontractors, and partner of Subcontractors’, Parents, subsidiaries, and any other entity directly or indirectly related to any such Subcontractor. The Bidder shall provide the following information in their Business Response:

0. Organizational Overview The Bidder’s legal name, trade name(s), and any other name(s) under which the Bidder does, or has done, business;

The Bidder’s ownership status (whether the bidding organization is publicly traded or privately held). If privately held, identify the owner(s) with five percent or more financial interest in the organization;

The Bidder’s principal address, e-mail address, website URL, and telephone number;

A listing of the Board of Directors, if any, of the Bidder’s organization and of the Bidder’s parent organization, if any;

The type of legal entity (for example, corporation (profit or not for profit), limited partnership, general partnership, or trust), and the state or foreign country where the entity is organized, including any parent organization; and The Bidder’s organizational chart, which shall include the names, titles, and reporting relationships of all key organizational officers (such as CEO and CFO) as well as any subsidiary relationships and subcontractors.

Requirements Regarding Subcontractors The Bidder shall state whether Subcontractors will be used to perform any services under the Contract, and if so, shall identify each such subcontractor by corporate or other legal entity name, address, telephone number and status as a Supplier Diversity Office (SDO)-certified business enterprise.

The Bidder shall describe generally in this section the respective responsibilities and services that each subcontracting entity would perform if the Bidder were awarded the Contract, and how the Contractor will manage each subcontracting entity;

The Bidder must submit a statement that:

Guarantees that all subcontracts and other agreements or arrangements for reimbursement will be in writing and will contain terms consistent with all terms and conditions of the Contract; and Acknowledges that proposals to use subcontractors shall not cause any additional administrative burden on EOHHS as a result of the use of multiple entities, and shall not relieve the Bidder of any legal obligations under the Contract.

Interests Neither the Bidder nor any Subcontractor may have any interest that will conflict, as determined by EOHHS, with the performance of services required under this RFR. To demonstrate freedom from conflicting interests, the Bidder must submit the following:

A description of how the Bidder will assure that no interest will conflict with the performance of services required under the Contract;

A statement of any and all of the financial, legal, contractual, and other business interests of the Bidder and any Subcontractor, its affiliates, partners, parent(s), subsidiaries, and related organizations, if any, that may affect or impact its performance with the requirements of the Contract;

A statement describing whether the Bidder or any employee or Subcontractor who shall perform work under the Contract has a possible conflict of interest and, if so, the nature of that conflict and proposal to eliminate or mitigate such conflicting interest;

The names, addresses, and website URLs, if applicable, of any person or entity, if any, with which the Bidder has any direct or indirect financial, legal, contractual or other business relationship, including any Subcontractor(s), and such Subcontractors’ partners, parents, subsidiaries, and any other entity directly or indirectly related to any such Subcontractor, that may create a conflict of interest or the appearance of such a conflict, and a description explaining the exact nature of each such relationship and the possible conflict;

A list of any other contracts or agreements that the Bidder or any Subcontractor has entered into with the Commonwealth that will be in effect at the same time as a Contract that may result from this RFR; and Any other information requested by EOHHS that, in EOHHS’ judgment, is relevant to the Bidder’s or any Subcontractor’s financial, legal, contractual, or other business interests If EOHHS determines that a Bidder possesses a conflicting interest, EOHHS reserves the right to propose or consider any proposal of the Bidder of any measures that would eliminate or mitigate such conflicting interest to EOHHS’ satisfaction.

Bidder’s Financial Condition The Bidder shall submit documentation to demonstrate to the satisfaction of EOHHS that the Bidder’s organization (and the Bidder’s parent organization and Subcontractors, if any), is in sound financial condition and that any significant financial problems are being addressed with appropriate corrective measures. The documents submitted must include at least the following and the Bidder must submit the same for any parent organization and Subcontractor, if any:

Complete, independent, audited financial statements for the Bidder’s (and the Bidder’s parent organization and Subcontractors, if any) last two (2) fiscal years;

A statement signed by the Bidder’s financial officer certifying that he/she is not aware of any circumstance materially and adversely affecting the Bidder’s financial condition that is not reported in the foregoing financial statements and that, to the best of his/her knowledge, the Bidder is not delinquent in the payment of any federal or state tax. The Bidder shall also submit such a statement from the Bidder’s parent organization and Subcontractors, if any;

A disclosure of any recently concluded or ongoing audit of the Bidder’s operations and a copy of the report with the Bidder’s response. The Bidder shall also submit such a disclosure from the Bidder’s parent organization and Subcontractors, if any;

A statement as to whether, in the last ten (10) years, the Bidder (or the Bidder’s parent organization and Subcontractors, if any) has filed (or had filed against it) any bankruptcy or insolvency proceeding, whether voluntary or involuntary, or undergone the appointment of a receiver, trustee, or assignee for the benefit of creditors; and if so, an explanation providing relevant details; and A certificate from the taxing authority of the state in which the Bidder has its principal office, attesting that the Bidder is not in default of any obligation under its tax laws. Corporations with principal offices in Massachusetts may satisfy this requirement may be satisfied by submitting a “Certificate of Good Standing” issued by the Massachusetts Department of Revenue (DOR). For instructions on obtaining the DOR certificate, visit http://www.mass.gov/dor/businesses/programs-and-services/certificate-of-good-standing.html.

EOHHS may disqualify a Bidder if the Bidder fails to submit the documents required by this section, or if the documents indicate to EOHHS, in its reasonable discretion, that the Bidder’s, the Bidder’s parent organization’s, or the Bidder’s Subcontractors’ (if any) financial condition is unsatisfactory.

Security Policies and Procedures As part of its Business Response, Bidders must provide: (1) a summary of their own and their proposed Subcontractors’ respective internal security procedures and policies applicable to work performed by them for customers and (2) the particulars of any circumstances over the past five (5) years in which the Bidder or its proposed Subcontractor(s) has caused a breach of the security, confidentiality or integrity of a customer's data. See also RFR, Section 7.28.

Disclosure of Litigation The Bidder shall disclose any material litigation affecting its organization, if any. The Bidder shall describe any past or pending litigation related to the duties, responsibilities and role(s) foreseen for the organization(s).

Cover Letter The Bidder must include with its response a Cover Letter that clearly states the name of the Bidder organization, principal address, and the name, address, e-mail, fax and telephone number of the individual authorized to negotiate for and execute the contract on behalf of Bidder. The letter must:

Include a statement that (1) clearly articulates that the Bidder accepts the terms of this RFR and of the Model Contract provided in Attachment A, without substantive change; and (2) acknowledges that the Bidder has read and agrees to the Standard Contract Form Instructions and the Commonwealth Terms and Conditions (see Section 5.2.H);

Include a statement that the Bidder’s response will remain in effect until a Contract resulting from this RFR is executed;

Include the name, address, e-mail address, and telephone number of the individual who should be contacted for the purpose of discussing any aspect of the Bidder’s response; and Be signed by an authorized Contractor signatory.

Each response document should contain only relevant information that is specific to the topic of that response document as required by the RFR. Superfluous information may be disregarded.

Required Forms and Certifications Please note that bidders do not need to complete the following forms, but should acknowledge that they have read and understood these forms in their cover letter (see Section 5.1.G):

Standard Contract Form;

Standard Contract Form and Contractor Certifications;

Commonwealth Terms and Conditions; and Massachusetts Substitute W-9 Form – Request for Taxpayer Identification Number and Certification;

Contractor Authorized Signatory Listing.

The Bidder shall complete, sign, and submit the following forms which may be downloaded from COMMBUYS:

1. Prompt Payment Discount Form (see Section 7.28);

2. Supplier Diversity Program (SDP) Plan Form (see Section 7.22); and

3. Business Reference Form (see Section 5.3.B).

Programmatic Response Requirements The Bidder shall demonstrate to EOHHS in its Programmatic Response submission its ability to assume all programmatic responsibilities of the Contract. The Bidder shall submit all required materials, including narrative and attachments as specified in this Section 5.3. If a Bidder is unable to provide the information required in a specific submission requirement, the Bidder shall expressly identify which information it is not submitting and why. The Bidder shall submit the most comparable information it has available and shall explain, in accordance with this section, how it will have the capability to perform all Contract responsibilities. The Bidder may, as applicable and at its discretion, provide as a response to any item below a cross-reference to another section of its response.

The Bidder’s Programmatic Response shall include the following information Bidder experience with Medicaid and similar organizations (page limit: 5 pages) Provide a brief history of experience with Medicaid, Medicare, or other large-scale health care operations; making sure to include:

The name, title, e-mail address, and telephone number of a person who can respond to inquiries about the Bidder’s involvement with the project; and The start and end date of each existing project, client name and type (e.g., public or private, financial, health care).

Provide a brief history of experience with any Commonwealth of Massachusetts agency; making sure to include:

The name, title, e-mail address, and telephone number of a person who can respond to inquiries about the Bidder’s involvement with the project; and The start and end date of each existing project, client name and type (e.g., public or private, financial, health care).

Provide a list of all organizations with which the Bidder or its Material Subcontractor(s) have or have had material relevant business experience in the past five years, preferably involving the provision of all or most of the services described in the Contract. Such list shall include:

Any state agency, other than in Massachusetts, with which the Bidder or Material Subcontractor currently contracts with for a similar set of services set forth in the Contract; and Any agency, division, or department within the Commonwealth of Massachusetts for which the Bidder has performed services in the last five (5) years.

The Bidder shall provide the following information for each organization listed in response to the subsection above:

The organization’s name and address;

The contact person’s name, title, address, telephone number, and e-mail address;

A brief description of the Bidder’s or Material Subcontractor’s responsibilities;

The start and end dates of the contract for the project; and As applicable, the most recent statistics reflecting the volume of activities performed under the Contract by the Bidder or its Material Subcontractor, including the volume of customers for which the Bidder provided services by type of customer (e.g., provider, member, etc.)

References Please complete a Business Reference Form for three references, for whom the Bidder has provided similar services as those described in Attachment A.

Approach Narrative (page limit: 20 pages) Provide an Approach Narrative that summarizes the Bidder’s overall and detailed approach to performing each of the major obligations and activities described in Attachment A, BSS Model Contract. The narrative shall follow the sequencing set forth in the Attachment A and include section headings and numbering. Responses may include not only the items listed in a requirement, but also additional relevant items that the Bidder determines may fall under such requirement. The Approach Narrative shall include, but shall not be limited to:

The Bidder’s understanding of the Contract’s requirements and objectives;

The Bidder’s understanding of the obstacles and constraints to performing the Contract’s requirements and its approach to overcoming them;

Any risks to performing the Contract requirements and the Bidder’s approach to managing them;

A description of how the Bidder’s staff resources required under the Contract will be provided and allocated;

A description of how personnel, systems and other resources at the corporate level will be utilized to support the Bidder’s successful performance of the requirements in this Contract;

A description of how the Bidder will develop the disparate systems required by the Contract and integrate their testing (including security/privacy compliance), documentation, and training into the timeline; and The methodology by which the Bidder plans to monitor and evaluate the performance of subcontractors (if applicable) and the Bidder’s staff and personnel.

Project Plan (page limit: 5 pages) Provide a project plan for the period of time between the Contract Effective Date and the Contract Operational Start Date. The project plan must include major milestones including, but not limited to, the start-up and transition activities (described in Section 3 of the Contract), systems development, staff training, and all other necessary activities to ensure a smooth implementation of the Contract as of the Contract Operational Start Date. The project plan shall show task duration and dependencies for all milestones and deliverables, listing task numbers and descriptions, responsible parties, and start and end dates.

Bidder’s Organization (page limit: 15 pages, excluding resumes) Provide the Bidder’s planned organizational structure if awarded the Contract and the roles and responsibilities of any Material Subcontractor.

Provide an organizational chart showing proposed Key Personnel. Include a job description and qualifications for each position and the name and resume of the individual expected to hold each position, if known and available. If the Bidder anticipates that different individuals will hold such Key Personnel positions during the Transition Period of the Contract and then as of the Operational Start Date of the Contract, the Bidder shall submit separate organizational charts for each period. Key Personnel includes positions in middle and senior management.

The Bidder shall indicate in the organizational chart any responsibilities under the Contract for which the Bidder intends to use a subcontractor.

The Bidder shall submit a staff loading chart (by month) showing the phase-in of Bidder’s staff until staff hiring is completed. This chart shall reflect the Transition Period of the Contract and the Contract as of the Operational Start Date. If the Bidder anticipates different staffing during the Transition Period of the Contract and then as of the Operational Start Date of the Contract, the Bidder shall submit separate staff loading charts for each period. The Bidder may include with its response a narrative describing the assumptions, limitations, and constraints on which the organizational and staff loading charts are based.

Subcontracting (page limit: 3 per subcontractor) If the Bidder proposes to use a subcontractor for any element of the Contract, the Bidder shall:

Identify each Subcontractor(s) by name, address, telephone number, and status as a minority or women owned business enterprise (see Section 7.22);

Briefly describe the organization, including years in business, its organizational structure, experience in the Commonwealth, and a synopsis of any previous experience similar to that proposed for their role with the Contract; and Identify the services, element(s), or I.T. components/solutions of the Contract to be performed by the partner(s) or subcontractor(s), whether or not such Subcontractor shall be a Material Subcontractor under Attachment A, and how the Bidder will coordinate with the subcontractor.

Detailed Response Questions (page limit: maximum of 3 pages per sub-question). For each item below, describe your relevant experience and demonstrated ability, and explain your proposed approach to performing the requirement for MassHealth, including key assumptions, risks, and how you will measure success. The Bidder shall provide sample materials and documents, which do not count toward the page limit, where available. Bidders are not required to create the samples below for the purposes of responding to this RFR. Bidders may choose to include their proposed approach for Item 16, Health Plan Comparison Tool in their Response but are not required to contract to provide such Tool to EOHHS and therefore may choose not to include it in their Response.

Relevant Business Support Services Experience Describe your demonstrated ability in providing business support services similar to those described in the Contract to state Medicaid or similar agencies and entities.

Provider Portal and Digital Services Describe any experiences and their outcomes where you have implemented a provider portal and digital services processes that required support of core functions such as; Provider Enrollment, Re-enrollment, Revalidation, and Provider Data Management and Maintenance, as described in Attachment A, Sections 3.2.A–3.2.K, including security and role-based access (Section 3.2.E) and interfaces/interoperability (Section 3.2.F). Include any challenges and positive provider experiences throughout the lifecycle of the process.

Non-Emergency Transport Authorization Demonstrate your capability to perform MassHealth requirements regarding non-emergency transport authorization, including development and maintenance of online systems for recording and adjudication of requests, as described in Attachment A, Section 3.8 (Non-Emergency Transport Authorization).

Provider Enrollment, Credentialing, Re-Enrollment, and Revalidation Demonstrate your capability to perform MassHealth requirements regarding provider enrollment, credentialing, re-enrollment, and revalidation, as described in Attachment A, Sections 3.2.B (Provider Enrollment and Credentialing) and 3.2.C (Provider Revalidation), as well as any universal credentialing capabilities.

Provider Review Committee Demonstrate your capability to perform MassHealth requirements facilitating a provider review committee, as described in Attachment A, Section 3.3.E (Provider Review Committee (PRC)).

Provider Data Management and Maintenance Demonstrate your capability to perform MassHealth requirements maintaining provider information and updating provider files, as described in Attachment A, Section 3.2.D (Provider Data Management and Maintenance).

Provider Materials Demonstrate your capability to perform MassHealth requirements developing enrollment materials, portal templates, educational materials, training materials for existing providers, and onboarding materials for newly enrolling providers, as described in Attachment A, Section 3.2.11 (Provider Materials) and related written materials expectations under the Provider Contact Center (Section 3.5.D).

Provider Contact Center Demonstrate your capability to perform MassHealth requirements operating a provider contact center consistent with Attachment A, Section 3.5 (Provider Contract Center), including complaints and grievances, email correspondence, and written correspondence, and how you will manage escalation, quality monitoring, and peak volume staffing.

Provider-Related Audit Support Demonstrate your capability to perform MassHealth requirements supporting provider-related audits, as described in Attachment A, Section 3.3.D (Provider Audits).

Provider Claims Demonstrate your capability to perform MassHealth requirements regarding provider claims, including enrollment of electronic claims submitters, claim review (including claims that need timely filing waivers), paper claims processing (including Direct Data Entry and rejections), claims monitoring, claims attachments, COB/TPL, etc., as described in Attachment A, Section 3.4 (Claims Operations).

Electronic Data Interchange (EDI) Trading Partner Testing (including Batch EDI Transactions and Testing) Demonstrate your capability to perform MassHealth requirements with respect to creating, conducting, and modifying EDI testing and communication plans, as described in Attachment A, Section 3.4.D (Electronic Data Interchange (EDI)).

Provider Education, Outreach, and Communications and Onboarding Demonstrate your capability to perform MassHealth requirements regarding provider education, outreach, training, communication activities, including onboarding and your ability to develop a learning management product for training materials and events, as described in Attachment A, Section 3.3.A (Provider Education and Training).

Document Management Demonstrate your capability to perform MassHealth requirements regarding document management, as described in Attachment A, Section 3.3.C (Document Management).

Fulfillment and Mailing Demonstrate your capability to perform MassHealth requirements regarding fulfillment and mailing services, as described in Attachment A, Section 3.3.B (Mail Services and Fulfillment).

Marketing Demonstrate your capability to perform MassHealth requirements regarding the design, development, and implementation of marketing materials and initiatives, as well as experience conducting focus groups, as described in Attachment A, Section 3.5.E (Marketing).

Health Plan Comparison Tool (optional) Demonstrate your capability to perform MassHealth requirements regarding the development, configuration, testing, and management of a web-based health plan comparison tool, as described in Attachment A, Section 4.1 (MassHealth Choices – Health Plan Comparison Tool). This section is optional and only requires a response if being bid upon.

Provider Directory Demonstrate your capability to perform MassHealth requirements regarding the development, configuration, testing, and management of web-based provider directories, including but not limited to, managed care and fee-for-service providers.

Customer Surveys Demonstrate your capability to perform MassHealth requirements regarding the design and implementation of customer surveys, as well as the analysis of their results and the design and implementation of action plans based thereon, as described in Attachment A, Section 3.5.F (Customer Surveys).

Reporting Demonstrate your capability to perform MassHealth requirements in providing specified reports and dashboards, as well as providing real-time access to an ad hoc reporting tool, as described in Attachment A, Section 3.7 (Reporting and Analysis).

System Integration and Interfaces Describe your approach to ensure interoperability between your IT systems and your customers’ IT systems, such as your provider portal, knowledge management system, and their learning management system, Attachment A, Section 3.2.F (interfaces) and Section 3.10 (Access to System and Data).

Performance & Service Level Agreements (SLA) Describe how you incorporate pay-for performance strategies, and list the most frequently reported performance metrics and SLAs you track for your comparable customers along with the respective targets and past twelve (12) months’ average performance levels.

Describe how you will design and implement an internal tracking system that will produce accurate performance results and will allow EOHHS to conduct performance data audits within one Business Day of request.

Transition Approach Describe how you managed a large-scale contract transition in the past from an operations, finance, and technology perspective. Please see Attachment A, Sections 3.1.E (Startup, Transition and Contract Readiness), Section 3.1.F (Contract Implementation), and Section 3.1.H (Turnover and Transition at Termination/Expiration).

Other Include a list of any other services you currently provide to your customers in addition to the services you described in your answers to the questions above.

Summarize your disaster recovery and contingency plans.

Cost Response Requirements The Bidder shall complete and submit Attachment B, Cost Response Instructions and Workbook, in accordance with the instructions specified therein. Bidders should not submit a Per-Customer Per-Month (PCPM) cost model. The Cost Response must include the bidder name and be signed by an authorized Contractor signatory.

RESPONSE EVALUATION PROCESS

Response Review and Evaluation All Responses of qualified Bidders that comply with the requirements of Sections 5.2 and 5.3 will be evaluated by an evaluation committee (the “Committee”).

Evaluation Criteria The Committee will determine whether the Bidder has satisfied all Business Response requirements (Section 5.2), and will evaluate each element of the Bidder’s Programmatic Response (Section 5.3) for comprehensiveness, appropriateness, feasibility, clarity, effectiveness, and responsiveness to the needs of EOHHS. In addition, EOHHS may consider any relevant information about the Bidder known to EOHHS.

The Bidder’s Cost Response will be evaluated based on reasonableness of cost, competitiveness of cost, and value to EOHHS. EOHHS is not required to choose the Bidder that proposes the lowest cost to EOHHS.

Response Rating The Committee will (1) evaluate Programmatic Responses in accordance with the criteria described in Section 6.1.B; (2) give a composite rating of “Excellent”, “Very Good”, “Good”, “Fair”, “Poor”, or “Non-Responsive” for each section evaluated; (3) assign an overall rating to each response; (4) compare the responses to one another; and (5) rank the responses in order of preference.

The Bidder’s proposed cost will be one factor, but not the sole factor, considered in the Committee’s evaluation.

Oral Presentations, Staff Interviews, and Product Demonstration The Committee may, at its sole discretion, determine which Bidders, if any, will be asked to make an oral presentation. Oral presentations may be held to allow the Bidder to clarify details or further inform the Committee regarding the Bidder’s organization or response, but not to change or correct the original responses in any way. Oral presentations shall neither be open to the public nor any competitors. The results of oral presentations will be included in the overall evaluation of responses.

The Committee may, at its sole discretion, ask some Bidders to make a presentation(s) about their response and demonstrate their products and/or services. Virtual demonstrations may be scheduled for Bidders, however, some Bidders who provide virtual demonstrations may be asked to provide onsite demonstrations with the expectation that the Bidders will provide more in-depth and detailed demonstrations with set expectations that will be communicated prior to the demonstration. If selected for an onsite demonstration, the Bidder should plan for no less than a four-hour on-site visit at a location to be determined by EOHHS.

Site Visit/Inspection EOHHS may, in its sole discretion and at its convenience, elect to visit or inspect any of a Bidder’s offices, facilities, or resources prior to executing a Contract under this RFR. Such a visit or inspection could include a detailed review of the Bidder’s operations and systems relevant to this RFR. Failure to agree to such an inspection may result in rejection of the Bidder’s response.

References EOHHS, in its sole discretion, may verify or contact any references provided by Bidder pursuant to Section 5.3.B at any time during the evaluation process. In addition, EOHHS reserves the right to request, verify and contact additional references from any Bidder at any time prior to executing a Contract under this RFR.

Best and Final Offer EOHHS reserves the right to request a best and final offer (BAFO) from any Bidder.

Recommendation to Enter Into Contract Negotiations After the Committee completes its evaluation, comparison, and ranking of all proposals, and, if applicable, oral presentation(s), site visit(s), reference check(s) and BAFO, the Committee may recommend to the Secretary of Health and Human Services or his designee a Bidder or Bidders with which to enter into Contract negotiations. The Undersecretary’s decision shall consider the Committee’s recommendation and the best interests of the Commonwealth. EOHHS is under no obligation to award a Contract pursuant to this RFR.

Best Value Selection and Negotiation EOHHS will select the response which it determines, in its sole discretion, demonstrates the best value overall to EOHHS and the Commonwealth. EOHHS and a selected Bidder may negotiate a change in any element of Contract performance or cost identified in the original RFR or the selected Bidder’s response which results in lower costs or a more cost-effective or better value than was presented in the selected Bidder’s response.

Contract Award The award of a Contract under this RFR shall be subject to sufficient appropriation, availability of state and federal funds, all necessary state and federal approvals, and successful negotiation of Contract terms.

Non-Qualifying Proposals Rejection of Responses EOHHS reserves the right to reject a Bidder’s proposal at any time during the evaluation process if the Bidder:

Fails to demonstrate to EOHHS’ satisfaction that it meets the Bidder Qualifications set forth in Section 2.2;

Fails to demonstrate to EOHHS’ satisfaction that it meets all other RFR requirements;

Fails to satisfy all Response Submission instructions described in Section 5.1, to submit a response organized in accordance with all instructions, or to submit a response that is complete in all respects;

Fails to submit all required information and to otherwise comply with all requirements of the Business Response described in Section 5.2, to submit all required information and to otherwise comply with all requirements of the Programmatic Response described in Section 5.3, or to meet any Cost Response requirement described in Section 5.4;

Receives a rating of “Non-Responsive” or “Poor” in the evaluation of one or more sections of the Bidder’s Programmatic Response;

Has any interest that may, in EOHHS’ sole determination, conflict with performance of services for the Commonwealth or is anti-competitive;

Fails to demonstrate to EOHHS’ satisfaction that it and all Subcontractors are in sound financial condition (see Section 5.2.D.)

Fails to make an oral presentation/demonstration pursuant to Section 6.1.D or allow for a site visit/inspection pursuant to Section 6.1.E requested by EOHHS at a time, place, and manner satisfactory to EOHHS;

Has a reference, oral presentation/product demonstration or site visit/inspection that, in EOHHS’ sole determination, indicates the inability of the Bidder to adequately perform the services sought under the RFR;

Rejects or qualifies its agreement to any of the mandatory provisions of the RFR; or Fails to reach an agreement with EOHHS on all Contract terms, including, but not limited to, payment provisions.

Other Actions EOHHS may, in its sole discretion, determine that non-compliance with any RFR requirement is not material. In such cases, the Committee may seek clarification from a Bidder, allow the Bidder to make technical corrections, apply appropriate adjustments to scoring in the evaluation, or utilize any other remedial action EOHHS deems appropriate.

RFR information Issuing Office Executive Office of Health and Human Services Office of Medicaid One Ashburton Place, 11th Floor Boston, MA 02108 Requirements of 801 CMR 21.00 The terms of 801 CMR 21.00: Procurement of Commodities and Services are incorporated by reference into this RFR. Words used in this RFR shall have the meanings defined in 801 CMR 21.00. Additional definitions may also be identified in this RFR. Unless otherwise specified in this RFR, all communications, responses, and documentation must be in English, all measurements must be provided in feet, inches, and pounds and all cost proposals or figures in U.S. currency. All responses must be submitted in accordance with the specific terms of this RFR.

Commonwealth of Massachusetts Standard Contract Form and Terms and Conditions Any Bidder selected as the Contractor shall agree to and abide by the terms of the Commonwealth of Massachusetts Standard Contract Form and Terms and Conditions (See Section 5.2.H). EOHHS is prohibited from amending these documents or agreeing to any change in the language. Any Bidder suggestion or requirement altering these documents will be disregarded.

COMMBUYS Market Center COMMBUYS is the official source of information for this Bid and is publicly accessible at no charge at www.commbuys.com. Information contained in this document and in COMMBUYS, including file attachments, and information contained in the related Bid Questions and Answers (Q&A), are components of the Bid, as referenced in COMMBUYS, and are incorporated into the Bid and any resulting contract.

Bidders are solely responsible for obtaining all information distributed for this Bid via COMMBUYS. Bid Q&A supports Bidder submission of written questions associated with a Bid and publication of official answers.

It is each Bidder’s responsibility to check COMMBUYS for:

· Any amendments, addenda, or modifications to this Bid, and

· Any Bid Q&A records related to this Bid.

The Commonwealth accepts no…