eCAS Vendor RFR~1.docx

Commonwealth of Massachusetts

Executive Office of Health and Human Services, Office of Medicaid/MassHealth

Request for Responses for the EHS Comprehensive Assessment System Vendor

Issue Date: June 22, 2022

Document Number: 22EHSLCe-CASRFR

COMMBUYS Bid Number: BD-22-1039-EHS01-EHS01-70914

This procurement is subject to the World Trade Organization Government Procurement Agreement, established January 1, 1996, to encourage worldwide trade by ensuring fairness, non-discrimination, and equal treatment of laws, regulations and procedures in the government procurement process.

Table of Contents

SECTION 1. INTRODUCTION AND PROJECT DESCRIPTION

1.1 Overview

The Executive Office of Health and Human Services (“EOHHS” or “EHS”) is the Commonwealth of Massachusetts secretariat comprised of the agencies described in M.G.L. c. 6A, § 16, including the Department of Children and Families, the Department of Youth Services, the Department of Mental Health, the Massachusetts Rehabilitation Commission, and the Executive Office of Elder Affairs, among other agencies. EOHHS is also the single state agency responsible for administering the Commonwealth’s Medicaid program and its Children’s Health Insurance Program (together, MassHealth) in accordance with M.G.L. c. 6A, § 16, Titles XI and XXI of the Social Security Act, M.G.L. c. 118E and other applicable federal and state laws, regulations, waivers and demonstration projects. EOHHS is issuing this Request for Responses (RFR) to procure a qualified vendor to implement, maintain and support a software solution for digitized clinical and functional assessments and workflows for certain EOHHS services, including Long-Term Services and Supports (LTSS) and certain behavioral health services for youth under the age of 21 , with potential expansion to include other state programs.

The EHS Comprehensive Assessment System (e-CAS) will include the Uniform Core Assessment (“UCA”) Tool, the Child and Adolescent Needs and Strengths (“CANS”) Tool, and the Time-to-Task (“TTT”) Tool (collectively “Assessment Tools” or “e-CAS Assessment Tools”). These Assessment Tools may be used for a variety of purposes including, but not limited to, assessing an individuals’ health and functional needs to inform clinical practice, determining clinical eligibility for certain MassHealth programs, calculating level of payment for certain MassHealth programs, and/or appropriate referrals to other MassHealth or EOHHS programs or services. Furthermore, e-CAS will include functionality for assessors to create new assessments and review assessment outcomes, and a database with multiple interfaces to enable care planning and service delivery and provide reporting for population health analytics, program and policy development, and program integrity efforts. Additional Assessment Tools may be implemented in the future according to the Change Management processes outlined in Section 1.11.

1.2 Definitions

Unless otherwise noted, capitalized terms in this RFR and its Attachments are defined in Attachment 1, Template Statement of Work, Section 2.

1.3 Procurement Process

EOHHS is issuing this RFR in accordance with the provisions of 801 CMR 21.00. Any Contract that may result from this RFR is subject to sufficient appropriation, availability of state and federal funds, and all necessary state and federal approvals.

1.4 The EHS Comprehensive Assessment System (e-CAS) Platform

The e-CAS is a common platform upon which multiple Assessment Tools will be implemented as required by EOHHS. Features, functionality, and requirements discussed in this Section 1.4 are considered universal and may apply to all Assessment Tools. However, each Assessment Tool may not require all features, or may require additional configuration and/or customization of the features as described in RFR Section 1.5. Final scope of features, functionality, and requirements for each Assessment Tool will be agreed upon as part of scope definition described in Section 3.2.1. EOHHS has provided in Attachment 6, EOHHS Requirements and in RFR Section 1.5 any known requirements for each specific Assessment Tool.

1.4.1 Functions of the e-CAS

The e-CAS will include an array of functions to support the assessment process for each Assessment Tool. A high-level summary of key functions is described below, organized by functions related to the assessment process followed by functions related to Selected Bidder supports, primarily for back-end processes. See Attachment 6, EOHHS Requirements for additional details.

1.4.1.1 System Assessment Functions

1.4.1.1.1 Assessment Tool Elements

Each specific Assessment Tool on the e-CAS platform will include a question bank, workflow features to facilitate the effective completion of assessments, and system logic to calculate assessment Outputs. The Selected Bidder shall ensure that any necessary updates to each Assessment Tool can be completed easily and, to the greatest extent possible, the Assessment Tools are configurable by EOHHS administrative staff.

The e-CAS will support specific workflows to facilitate the completion of each Assessment Tool, which may be updated to support assessment operations over time. Assessors will administer the tool and enter the responses on a computer or device, such as a tablet. Assessors will complete the assessment by asking questions to each individual and navigating through the digitized tool based on a natural flow of conversation. “Smart questions” lead to logical next questions based on automated rules, such as linking between diagnoses, treatments, and medications. For example, an Assessor completing the Uniform Core Assessment (UCA) tool who notes that an individual has a COPD diagnosis will be offered links to questions about bronchodilator medications and oxygen therapy that the Assessor can click on to jump easily to additional relevant questions. In addition, each tool will include limited Skip Logic that will offer an appropriate next question based on the answer to a particular question. The tool display will clearly distinguish what sections and questions still need to be asked or are completed. This navigation will allow the Assessors to document responses through a conversational style of interaction with individuals, rather than a linear pattern where the Assessor must scroll through the whole document or re-ask questions when the Assessor reaches the new section.

Finally, the e-CAS will support System Logic, which is established at the direction of EOHHS program staff and may be updated over time, to calculate preliminary and final assessment Outputs based on an individual’s answers to the Assessment Tool questions and following the relevant quality review process. Outputs may include recommendations to be used to inform treatment practices, clinical eligibility for certain MassHealth programs, level of payment for certain MassHealth programs, and referrals to other MassHealth or EOHHS programs or services.

Further details are provided in Attachment 6, EOHHS Requirements and EOHHS expects to refine and finalize question banks and workflows, including skip logic and smart questions, during requirements gathering. Additional information about each Assessment Tool, including known specifics about the question bank, workflows, and Outputs, is provided in Section 1.5 of this RFR.

1.4.1.1.2 Assessment Workflow and Statuses

The e-CAS will assign and track statuses as assessments go through the assessment lifecycle. The purpose of assessment statuses is to facilitate user workflows and ensure that assessments are appropriately maintained throughout the assessment lifecycle. Although many elements of the assessment workflows will be common for all Assessment Tools, some Assessment Tools will have unique assessment workflow elements that must be configurable; for example, the UCA Tool will include clinical reviews and Appeals in the workflows, but these elements are not required for the CANS Tool. Please see Figure 1 below for the anticipated assessment status workflow.

Figure 1. Anticipated Assessment Status Workflow

1.4.1.1.3 Intake and Referral

The e-CAS will support assessment intake and referral processes that will screen assessment requests, determine the purpose of the requested assessment, and support the appropriate assessment workflow(s) presented to Assessors.

The e-CAS must incorporate an external-facing portal to enter requests for assessment. Referral sources may include but are not limited to PCPs, other health care providers, care coordinators/managers, applicants, guardians, and family members, and would not be required to be e-CAS users. Once a referral is entered, the assessment request would be added to a queue generated by the e-CAS and assigned to Assessors. The e-CAS intake functionality must be able to manage situations using different business rules where multiple users from different Providers attempt to assess the same individual at the same time.

1.4.1.1.4 Scheduling

The e-CAS will include scheduling functionality to enable certain users to manage assessment appointments with individuals for which the functionality can be turned on or off for each Assessment Tool. This functionality will support appointment scheduling and tracking, appointment confirmations and reminders, and calendar integration.

1.4.1.1.5 Consent to Complete Assessment

Consent is defined as the agreement of the individual or their legal guardian, as applicable, to complete the assessment process with the Assessor and the Assessor’s organization or Assessment Team, as applicable. Consent results in EOHHS access to assessment data stored electronically. Prior to the completion of certain specified Assessment Tools (e.g., CANS), verification of Consent and completion of a Consent form may be required. If Consent is required for an assessment, the e-CAS must not allow an assessment to be completed until the Consent form is completed. Consent to complete an assessment shall expire within a certain timeframe, and reminders should be provided to Assessors when the expiration date of Consent is approaching. Additional details related to Consent are provided in Attachment 6, EOHHS Requirements.

1.4.1.1.6 Release of Information (ROI)

Release of Information (ROI) is defined as the agreement of the individual or their legal guardian, as applicable, for assessment information to be shared with specified Assessor organizations or Assessment Teams, as applicable, EOHHS state agencies, and/or other parties. Certain specified Assessment Tools (e.g., CANS) will require a ROI prior to assessment data being made available to users or via data sharing interfaces. The e-CAS will track and maintain ROI, including maintaining a record of which users are authorized to view which assessments, tracking and providing notifications of impending ROI expiration dates, and ensuring ROI authorization compliance for all data sharing done with Trading Partners . The e-CAS will also provide and maintain ROI forms, which can be electronically signed and downloaded by users.

1.4.1.1.7 Quality Review

The e-CAS will support quality reviews of clinical assessments before and after each Assessment Tool’s Outputs are calculated. Certain assessments will require quality review according to logic that identifies them for review. Quality reviews may be triggered in various situations, such as the need for new Assessors to have their work reviewed by supervisors, or the need for a second layer of review by a different Assessor prior to approving certain clinical eligibility outcomes or service level changes, such as possible clinical eligibility denials or downgrades from a higher to a lower level of care.

1.4.1.1.8 Assessor Certification and Credentialling

Certain assessments require Assessors to be appropriately credentialled, including specific clinical licensure (e.g., Registered Nurse (RN)) or special training to complete an assessment type (e.g., CANS Certification). The e-CAS will track users’ credentials via self-attestation and, in some cases, verify credentials prior to allowing the user to complete assessments. Verification of credentials may include querying a national database to verify information provided by the user or interfacing with a specific organization to confirm certifications (e.g., University of Massachusetts T.H. Chan Medical School (UMCMS)). Requiring credentials via self-attestation and/or verification may occur initially at the time a user is registered on the e-CAS system, on a regular cadence moving forward (e.g., annual re-certification), or on an ad hoc basis in response to EOHHS requests (e.g., after an audit).

The e-CAS will track certification information, provide notifications of impending credentialling expiration dates, ensure that user access ends if verification of certification is not received by the expiration date and reinstate the user when credential verification notification is received.

1.4.1.1.9 Appeals

When applicable, certain Assessment Tools will require the processing of Appeals. The e-CAS will include an Appeals module for Users to track e-CAS-related Appeals, supporting the process from when Appeals are filed with the Board of Hearings through a pre-hearing review process to implementation of the Board of Hearings decisions, if applicable. Disposition of Appeals may be analyzed as part of quality review and may trigger recommendations for re-training or supervisor interventions.

1.4.1.1.10 Reporting

The Selected Bidder will provide reports including:

· User reports to support ongoing assessment management and operations by e-CAS users. Reports will be available as part of each user’s dashboard and will include standard programmatic reports and the capacity for users to customize reports based on a set of predetermined parameters. Reports will be populated with data available based on each user’s authorized access (i.e., based on user role, Provider organization, Assessment Team, and Release of Information).

· CMS reports to support EOHHS performance reporting to CMS. CMS reports will be available in a form, format and cadence to be specified by EOHHS.

· System performance reports to support EOHHS with monitoring ongoing system performance.

· Project reports to allow EOHHS to monitor Selected Bidder project progress.

Reports will be available in a form, format, and cadence as specified by EOHHS, and may include daily reporting. Furthermore, data extracts should be available to EOHHS and authorized vendors/contractors for download on a regularly scheduled or ad hoc basis via data interfaces.

User reports and CMS reports will be specific to each Assessment Tool. The Selected Bidder will work with EOHHS to define and implement reporting requirements for each Assessment Tool as part of the e-CAS implementation process described in Section 3.2.

Additional details on reporting are provided in Attachment 3, e-CAS Reports and Plans.

EOHHS Contract Document Repository The Selected Bidder will create and maintain an EOHHS Contract Document Repository for designated EOHHS staff to access system and project reports in a separate Module or portal. The Selected Bidder’s portal will:

1. Organize the content in an EOHHS-approved user-friendly format;

2. Ensure all reports and report data are accessible via an API;

3. Comply with all applicable privacy and security laws, regulations and other requirements as specified by EOHHS (including those described in Attachment 1, Template Statement of Work, and the Data Management and Confidentiality Agreement - Exhibit B to the Statement of Work), publish and maintain content as described in Attachment 3, e-CAS Reports and Plans or as otherwise requested by EOHHS, to include but not be limited to the following:

a. Contact information for all administrative and programmatic Selected Bidder staff who perform services under the Contract, including a listing of titles, responsibilities, telephone numbers, and e-mail addresses;

b. Organizational chart(s) that depicts all administrative, functional, and programmatic reporting relationships of staff who will perform services under the Contract, including any Significant Subcontractor(s);

c. Copies of all project plans and updates to such plans;

d. Copies of each Deliverable (see Sections 3.2 and 3.4);

e. Copies of each standard report;

f. Copies of each program report, including reports relating to performance standards; and

g. Copies of all ad hoc reports.

1.4.1.1.11 Noticing

The e-CAS will generate paper and electronic notices that will be sent to communicate various updates and outcomes produced by users within the e-CAS. Notices may be sent to Members and authorized representatives, referral sources/entities, Health Plans, LTSS or BH Providers, and other health care Providers, such as PCPs. Notices may include UCA System Logic Outputs, TTT Outputs, and other pertinent data.

The e-CAS will support creating and maintaining notice templates and enable EOHHS staff to make changes through configuration of standard notice components (e.g., salutation, introduction, etc.) and add new notices over time. The Selected Bidder in collaboration with EOHHS staff, will manage changes and version control of these templates. The Selected Bidder will establish and maintain an interface between the e-CAS and the MMIS web service to send necessary notice information.

1.4.1.2 Vendor Supports

1.4.1.2.1 Interfaces

The e-CAS will interface with several EOHHS systems, Partner Systems and Provider systems. Figure 2 below conceptualizes how information may flow within the e-CAS and how the data elements may flow between the e-CAS and related Partner Systems. Additional details about e-CAS interface requirements are found in Attachment 6, EOHHS Requirements Matrix.

Figure 2. e-CAS Diagram: Interfaces with Other Systems

The e-CAS must provide multiple secure options for data exchange, including FTP and API. EOHHS has a preference for API-based exchanges; however, the Selected Bidder must be able to offer alternative solutions based on needs of other parties. The data may be moved in either batches or record level.

1.4.1.2.2 Data Quality Assurance

The e-CAS will receive extracts from several outside sources, which may contain data of varying levels of quality. The Selected Bidder will be responsible for establishing and executing a process to identify, research, and correct Bad Data received from other systems. The Selected Bidder will also be responsible for ensuring the integrity of data entered by e-CAS users. The Selected Bidder is expected to follow standard procedures for accepting and rejecting data from other source systems and for checking the accuracy of data entered by e-CAS users to ensure data quality. Additionally, EOHHS recognizes that when errors are discovered, the correction of Bad Data is a collaborative process, and therefore expects the Selected Bidder to make data correction as efficient as possible. For example, if a record does not comply with requirements, the Selected Bidder may flag it for review and provide a web interface for e-CAS users or EOHHS, Provider, or Health Plan staff to review and correct the record.

1.4.1.2.3 Mapping of Assessments

The e-CAS will be a repository of assessments that have been directly entered into the e-CAS and assessments that are received from other systems operated by EOHHS and/or Providers and Health Plans. Assessments received from other systems will include Assessment Tools that are a part of the e-CAS system as well as assessment forms that are not built into the e-CAS platform (e.g., for the UCA, there may be related assessments administered by the Executive Office of Elder Affairs (EOEA) and held in its data management system).

Assessments from other systems will include both a historical upload to be performed prior to e-CAS Go Live (see Section 3.2.4 of this RFR) and regular ongoing uploads at a frequency to be determined by EOHHS.

The Selected Bidder is responsible for maintaining in its database the information from both ongoing and, at a minimum, 10 years’ worth of historical assessments as an archive. The Selected Bidder will also implement and maintain a mapping of assessment tools that is developed by EOHHS.

1.4.1.2.4 Mail Management Services

Certain assessment tools will require that Members, Providers, and others receive notice mailings. Mail management services may be implemented within EOHHS or by the Selected Bidder, as determined by EOHHS. If EOHHS determines the Selected Bidder will implement mail management services, EOHHS expects the Selected Bidder to provide the services described below. Bidders must provide a separate cost estimate for mail management services as part of Attachment 2, Cost Response Worksheet.

1.4.1.2.4.1 Outbound mailing

Outbound mailing includes printing and mailing of paper notices generated by the e-CAS, including all required attachments as specified by EOHHS (e.g., language assistance information, appeal rights). These notices will be sent to communicate final Outputs and other updates as specified by EOHHS that are produced by users of the e-CAS specific to each Assessment Tool as outlined in Section 1.5 and Attachment 6, EOHHS Requirements. For mailing of paper notices, the Selected Bidder shall:

Ensure that all addresses conform to U.S. Postal Service mailing address conventions; and Record the following outbound mail metadata, including, at a minimum, the unique tracking ID assigned to the document, date/time sent, type of outbound mail, and Member ID (if applicable).

1.4.1.2.4.2 Inbound mail processing

Processing of inbound mail, including but not limited to returned mail, triggered by the mailing of paper notices includes:

Recording of inbound mail metadata, including unique tracking ID assigned to the document, date/time received, inbound mail sender, inbound mail recipient, type of inbound mail (e.g., returned notice about a specific subject), reason(s) for inbound mail (e.g., undeliverable, address change), and Member ID (if applicable);

Digitization of inbound mail, including indexing and linking to metadata; and Determination of action associated with returned mail, (e.g., attempt to resend mailed document based on updated address provided by the U.S. Postal Service, notification of address change, emailing of notice as an alternative based on undeliverable mail, etc.).

1.4.1.2.5 Help Desk Escalation Support

EOHHS provides comprehensive customer service support to LTSS Providers through its LTSS Provider Service Center, to individuals/Members and non-LTSS Providers through the MassHealth Customer Service Center, and to CANS Providers via the CANS help desk. To continue to support a model of centralized service with the introduction of the e-CAS, EOHHS anticipates that all Providers and individuals/Members will continue to contact the current service centers for any issues using the e-CAS and that the current service centers will triage and resolve the issues, when possible. If the LTSS Provider Service Center, the Customer Service Center, or the CANS help desk are unable to resolve the issue, the service centers will follow the process specified by EOHHS to escalate the issue to the Selected Bidder.

The Selected Bidder shall support the LTSS Provider Service Center, MassHealth Customer Service Center, and the CANS help desk in a timely and effective manner to ensure appropriate e-CAS user support. The Selected Bidder will provide training and materials to help desk staff so that they can adequately triage and resolve e-CAS issues effectively. The Selected Bidder must also maintain sufficient staff and systems to support escalation requests received from the service centers. The Selected Bidder will track and report on its performance in resolving escalated requests from the service centers. The Selected Bidder must act to resolve any Defects or issues discovered via the service centers according to standards set forth in Attachment 5, EOHHS Key Performance Indicators.

Additionally, the Selected Bidder is expected to provide timely and effective technical support and training to EOHHS, Trading Partners, and other EOHHS-contracted vendors for the purposes of facilitating data exchange, including facilitating resolution of issues with multiple parties at once. The Selected Bidder must ensure that it has adequate staff to resolve any issues related to data exchange and that staff are available during Business Hours on Business Days and can report on issues escalated to its staff, including the resolution of issues.

1.4.1.2.6 Issue Resolution Support

The Selected Bidder shall support EOHHS staff, the LTSS Provider Service Center, the Customer Service Center, the CANS help desk, any relevant EOHHS Ombudsmen (e.g., My Ombudsman, Assisted Living Ombudsman, Community Care Ombudsman, Long Term Care Ombudsman), and other Commonwealth entities (e.g., Office of the Inspector General, Office of the Attorney General) in resolving any issues related to the e-CAS from individuals. Support will include communicating and cooperating as needed to investigate and resolve requests for information, issues, or concerns related to e-CAS functions, including:

· Designating a staff person as liaison who must be available to work on and resolve identified issues;

· Providing access to records or systems needed to investigate and resolve complaints or issues; and

· Ensuring ongoing communication and cooperation of Selected Bidder staff in working to investigate and resolve individual complaints or issues, including updates on progress made towards resolution, until such time as the complaint or issue has been resolved.

1.4.1.2.7 Response to User and Other Feedback

To ensure that the e-CAS provides a good user experience, the Selected Bidder will be responsible for collecting regular feedback from e-CAS users. In particular, the Selected Bidder will collect user feedback via user surveys on a regular cadence. The content of surveys, surveying methods, and frequency of surveys will be agreed upon by EOHHS and the Selected Bidder. It is anticipated that the Selected Bidder will utilize the System Usability Scale (SUS), Customer Satisfaction Score (CSAT), and any other tools EOHHS deems necessary to measure user experience. The Selected Bidder is expected to review feedback with EOHHS on at least a quarterly basis and make upgrades or other appropriate changes to the e-CAS in response to user feedback and as requested by EOHHS.

Additionally, the Selected Bidder will participate in any additional forums (e.g., Member-facing advisory boards or meetings, Provider meetings) to gather feedback on the e-CAS and Assessment Tools, including attending, preparing materials, presenting, and advising EOHHS staff. The Selected Bidder will incorporate feedback gathered in these forums into the e-CAS function and design with EOHHS approval.

1.4.1.2.8 Training

The Selected Bidder shall conduct knowledge transfer and training activities for the EOHHS project team and system administrators, EOHHS staff end users, and other end users (e.g., Provider staff, Health Plan staff, other vendor staff) during the implementation and maintenance and support phases of work. Knowledge transfer and training activities include production of materials and engaging in activities outlined below and in Section 3.2.6. Training on clinical guidance (i.e., what clinicians need to know about how to conduct a specific assessment from a clinical perspective) is provided by the UMMS CANS Training and Certification Program. The Selected Bidder will work with the UMMS CANS Training and Certification Program staff to ensure continuity and to support development of training materials, including providing screenshots and information to provide a seamless experience for users across different training vendors.

The aim of training by the Selected Bidder will be to ensure:

· Select users can effectively participate in testing and/or pilot activities during the process to build the e-CAS; and

· All users have the knowledge and documentation to use and support the Application at Go Live and on an ongoing basis.

The Selected Bidder will provide e-CAS trainings to users by conducting:

· In person or live web-based trainings hosted by the Selected Bidder; and

· Recorded content based on prior live trainings or recordings made specifically for these purposes.

The Selected Bidder will set up and provide an online, web-based training application/tool. The tool’s features will include but not be limited to:

· Supporting users to sign up for voluntary and/or required trainings, including functions such as sending email notifications about training availability and how to register;

· Tracking training status of required trainings for select users (e.g., enrolled, completed, outstanding, etc.) and making information about training status available to authorized users (e.g., allow supervisors of users to view training status);

· Sending post-training communications; and

· Allowing users to access a library of recorded content.

Training will be developed and customized for each Assessment Tool’s users with input and approval of EOHHS and will include the following per Assessment Tool:

· Trainings for testing and/or pilot participants about the testing and/or pilot process and relevant features, including support for feedback.

· EOHHS estimates up to 25 live or recorded training sessions may be required, with an average length of 2.5 hours, for various user types, including trainings to review system functionality and sessions to collect feedback.

· Trainings to support the Go Live implementation process with tailored content based on target end users, which may include trainings prior to or following the Go Live date.

· EOHHS estimates approximately 35 live or recorded training sessions, with an average length of 2.5 hours, may be required as part of the Go Live process.

· Trainings to support ongoing operations, including trainings when substantive changes are made to the system that require retraining.

· EOHHS estimates up 25 live or recorded training sessions may be required per year.

If the e-CAS Go Live date is significantly delayed due to the Selected Bidder’s actions or faults, any repeat live training sessions must be performed at no cost to EOHHS.

The Selected Bidder will be responsible for the Knowledge Transfer and Training Tasks and Deliverables in Section 3.2.6.

1.4.1.2.9 User and Provider Management and Maintenance

The Selected Bidder is responsible for creating and maintaining accounts and profiles for individual users (e.g., Assessors) and Provider organizations. This includes registering users and Provider organizations on the e-CAS and using data feeds from EOHHS systems, EOHHS-contracted vendor (e.g., LTSS TPA) systems, or other relevant systems, as applicable, to verify information entered by users. The Selected Bidder must engage in industry best practices to ensure data integrity and the ongoing maintenance of user accounts (e.g., disabling inactive user accounts). The e-CAS will follow a Primary User and Secondary User structure, allowing Primary Users to manage Secondary User accounts. Additionally, the e-CAS will support Assessment Teams, which are sub-groups of users within a Provider (e.g., a Provider may include multiple outpatient clinics operating under one license and with one MassHealth Provider ID; each outpatient clinic may be an Assessment Team), and other affiliations between users (e.g., supervisors/subordinates).

1.4.2 Technical Requirements

EOHHS anticipates that the e-CAS will have the technical requirements set forth in this Section 1.4.2 and in Attachment 6, EOHHS Requirements. Requirements will be further clarified as part of requirements gathering, which may include adding, deleting, or modifying requirements subject to the collaborative system design and development process between the Selected Bidder and EOHHS as described in Section 3.2.

1.4.2.1 Solution Attributes

The following attributes are preferred and will be given preference in evaluation of the Programmatic/Technical Response:

· Customizable common platform that enables easy addition of future Assessment Tools;

· Modular architecture;

· Application Programming Interface (API) capability for data exchange;

· Easy to create microservices;

· Platform-independent model;

· Regularly scheduled software updates; and

· Web-based solutions that are mobile-friendly.

Should the Selected Bidder provide a cloud offering (i.e., SaaS, IaaS, PaaS), the Selected Bidder must comply with the Commonwealth's established requirements for cloud offerings described in Exhibit D of Attachment 1, Template SOW.

1.4.2.2 Configurability

To the maximum extent possible, EOHHS is seeking the ability to easily configure Assessment Tools (i.e., question banks, workflows, System Logic and Outputs) that will allow certain EOHHS users to make updates to the Assessment Tools and certain e-CAS functions directly. Specific requirements on the functionality that should be configurable are in Attachment 6, EOHHS Requirements.

1.4.2.3 Specific Solution Requirements

The Selected Bidder shall implement a solution with the capabilities found in Attachment 6, EOHHS Requirements. The solution requirements in Attachment 6, EOHHS Requirements were designed using a modular approach, with each functional area broken down into more detailed features. The anticipated structure for the e-CAS and its functional areas and features is summarized in Table 1 below. Each Assessment Tool will utilize core system functionality, but may have some features that are not necessary. Table 1 outlines anticipated functionality for the CANS, UCA, and TTT Assessment Tools.

Table 1: e-CAS Functional Areas

Noticing – General

Noticing – MMIS

MDS-HC2 Application

X

Senior Information Management System (SIMS)

X

Optum Long-Term Services and Supports Management System (LTMS)

Center for Medicare & Medicaid Services (CMS) Data Exchange

X

X

Versions/Split TTT

X

Versions/Initial

X

Versions/Extension

X

Outputs

X

Time-to-Task Tool (TTT)

X

Time-to-Task Tool (TTT)/Adjustments

X

Time-to-Task Tool (TTT)/Re-assessment

X

Time-to-Task Tool (TTT)/Split Tools

X

Time-to-Task Tool (TTT)Adjustments

X

PCP Input

Referrals – Multiple Active Assessments

Referrals – Centralized Assessor Entity Intake

Appeals Workflow

Appeals Outcome

1.5 Assessment Tools

1.5.1 Child and Adolescent Needs and Strengths (CANS)

1.5.1.1 Goals and Program Scope

As part of the implementation of the e-CAS platform, EOHHS will transition the Child and Adolescent Needs and Strengths (CANS) assessment onto the e-CAS platform. During this transition, the modules that comprise the CANS tool will be updated, and tailored to support utilization by multiple EOHHS state agencies, including MassHealth, the Department of Children and Families (DCF), the Department of Youth Services (DYS), and the Department of Mental Health (DMH). The proposed changes are anticipated to address the current limitations in administering the CANS assessment and improve the overall Provider, agency, family and individual experience. EOHHS seeks to ensure that the CANS assessment process and the user interface for providers is:

· User friendly;

· Supportive of information sharing among Providers and state agencies;

· Able to provide real-time data on each individual’s progress and outcomes; and

· Able to support effective treatment planning.

EOHHS seeks to achieve the following programmatic and operational goals through the implementation of the CANS assessment on the e-CAS:

· Provide effective on-boarding and adequate support for CANS Assessors and e-CAS users;

· Ensure the CANS assessment is easy to use and will assist in summarizing information and treatment planning;

· Support a thorough and trauma-informed assessment of a child's behavioral health (BH) needs and strengths in order to facilitate effective treatment planning;

· Monitor youth and family needs and strengths over time;

· Support clinicians’ meaningful engagement with families by providing user-friendly, real-time information to families;

· Promote health equity by identifying health-related social needs that may be barriers to effective service delivery; and

· Provide individual-level, Provider-level, Assessor-level, and EOHHS state agency-level reports to ensure compliance, support high quality clinical supervision, and to enable program planning.

1.5.1.2 Child and Adolescent Delivery System Background

Multiple EOHHS state agencies, including MassHealth, DCF, DYS, and DMH work closely together to ensure that the Commonwealth’s children, youth, and their families receive necessary services to meet the individual needs of the youth and family. To support coordination of services, EOHHS agencies may also partner with other stakeholders including BH Providers, and Health Plans.

Together, EOHHS state agencies, Providers, Health Plans, and other organizations (e.g., social service organizations) work together to pursue the following guiding principles for service delivery:

· Support timely access to appropriate services

· Expand array of community-based services

· Reduce health disparities

· Promote clinical best practice and innovation

· Establish an integrated behavioral health system across EOHHS agencies

· Strengthen, expand, and diversify workforce

· Ensure mutual accountability, transparency and continuous quality improvement

1.5.1.3 Current CANS Assessments and Background

1.5.1.3.1 CANS Tool Design

The Child and Adolescent Needs and Strengths (CANS) tool was originally developed by psychologist John Lyons for clinicians to: 1) Assess a youth and family at the case level; 2) Understand their trajectory over time; 3) Evaluate program effectiveness; and 4) Understand the needs and strengths the mental health system at a state-level. Each locale that uses the CANS has a unique version tailored to their system, including Massachusetts. However, unlike some other psychometric tools, there is no standardized process for understanding the CANS data or national CANS norms against which to compare an individual youth’s score or progress over time. Thus, the structure of the e-CAS CANS must serve these purposes.

1.5.1.3.2 Current CANS Tool Usage

MassHealth requires that Providers of various BH services administer the CANS tool to youth aged 20 or younger. MassHealth has memorialized these CANS administration and frequency requirements through both its Provider regulations for Fee-for-Services (FFS) members and its contracts with its current contracted Health Plans. The CANS tool focuses on needs (i.e., areas where the youth requires help or intervention) and strengths (i.e., areas of the youth’s life where he or she is doing well or has an interest or ability). CANS supports the treatment planning process by enabling Providers and caregivers to assess, prioritize, and address the youth’s most urgent needs. Providers are required to administer the CANS assessment tool at the initiation of behavioral health services and every 90 days thereafter. Currently, MassHealth Providers complete CANS assessments either on paper or within the CANS application hosted by EOHHS IT on the Virtual Gateway. Approximately 34,000 youth have a CANS administered annually.

In addition to MassHealth Providers, EOHHS staff and contracted entity staff from DCF, DYS, and DMH currently administer the CANS as part of the comprehensive assessment process for certain programs and services. These assessments are largely done on paper and may be scanned into a relevant provider or EOHHS IT system (e.g., DYS staff scan copies of the CANS into Juvenile Justice Electronic Management System), although some organizations or EOHHS agencies complete the CANS within their own IT system (e.g., DCF staff enter CANS assessments into iFamilyNet).

MassHealth, DCF, DYS, and DMH each administer the CANS to support their agency’s specific services, fulfill any mandated reporting requirements (e.g., reports to state auditors), and generate reports that are shared with Providers, Health Plans, or other contracted entities, as required. However, the agencies employ distinct modules of the CANS tailored to the population served, use different IT systems and operate in data silos. Bringing the various CANS activities to one platform provides an opportunity to address these administrative redundancies across state agencies utilizing the CANS Tool. Similarly, moving these various applications of the CANS assessment to one central platform and unifying the modalities may support care coordination activities within and between state agencies. Finally, the current system has limited capacity to issue real time data back to the assessor, the program and/or the child/youth serving system, rendering the data ineffective for program assessment and planning.

1.5.1.3.3 Anticipated Structure of the Revised Massachusetts CANS The Massachusetts version of the CANS is unique from the version used in other locales and includes the following components:

1. Demographics

2. Serious Emotional Disturbance (SED) determination

3. Behavioral/Emotional Needs Domain

4. Caregiver Needs & Resources Domain

5. Cultural Factors Domain

6. Life Functioning Domain

7. Risk Behaviors Domain

8. Strengths Domain

9. Individualized Assessment Modules (contained within Domains) A. Trauma Module

i. Traumatic/Adverse Childhood Experiences (Yes/No variables)

ii. Traumatic Stress Symptoms B. Substance Use Disorder Module C. School Performance D. Family Functioning E. Parenting Skills F. Cultural Stress In 2021, Massachusetts engaged in an extensive effort to review current utilization of the CANS tool by MassHealth agencies and providers. This review leveraged extensive stakeholder engagement as well as academic expertise. Based on this review, the revised structure of the CANS tool has 48 core variables. Of these core variables, six function as identification variables. When they are rated as actionable (a score of a 2 or a 3) then additional variables targeting that specific issue are added to the core assessment. These sets of variables are called Modules. For example, if the trauma Identification Variable is scored a “2” or a “3,” the Trauma Module is opened, and consists of a set of 13 additional variables that would accompany the core assessment. The following Modules were added to the Massachusetts CANS during the revision process, each of which has an Identification Variable: 1) Substance use; 2) Trauma, 3) Family Functioning, 4) School Performance 5) Parenting Skills, and 6) Cultural Stress. Some of these Modules were introduced as a way to collapse existing variables to make assessment more efficient, while others were added to gain depth of information about the population. These additional variables follow the scoring structure of the core variables, with a zero to three rating. With exception, the trauma module contains several variables with categorical yes/no answers. EOHHS will direct the Selected Bidder regarding skip logic and other workflow features to ensure the CANS assessment is completed as required.

1.5.1.3.4 CANS Tool Outputs

Below are the CANS Tool Outputs currently anticipated by EOHHS. The Selected Bidder shall have the capability to implement the full array of Outputs set forth below and work collaboratively with EOHHS to identify the most effective approach to implementation. In addition, the Selected Bidder shall have the ability and flexibility to implement additional Outputs as the needs of EOHHS evolve over time. Final determination of Outputs requirements will occur during the requirements gathering process as described in Section 3.2.2.

The CANS Tool Outputs will be used to inform clinical practice, program planning, and operations, as indicated above. Outputs may be required to be reflected in dashboards or regular reports. Examples of Outputs include:

· Indication that a youth has a behavioral health, physical health, or social need.

· Indication that a caregiver requires support and, if so, suggestions about what kinds of support may be helpful.

· Indication that a youth may have an elevated clinical risk, such as a high risk for suicide, self-harm, or violence towards others.

· Recommendation for further assessment or continued monitoring of a specific clinical or behavioral health need.

Recommendation for specific treatment planning goals or interventions.

Information regarding child welfare system placements.

In addition to these Outputs, data from the CANS may be used by case managers to determine and balance caseloads, Provider agencies to determine staffing levels, and EOHHS staff to consider where and what services are needed in geographic regions. For each CANS Output, the e-CAS vendor will be responsible for implementing, maintaining, and updating System Logic in collaboration with EOHHS.

In addition to Outputs, reports provided to CANS users are a critical component of the CANS assessment process.