ESBD_354649_1714764059819_HHS0014128 RFO Provider Finance Reporting System.pdf

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Cecile E. Young, Executive Commissioner

Request for Offers (RFO) for

Provider Finance Reporting System

RFO No. HHS0014128

Date of Release: May 3, 2024

Responses Due: May 31, 2024 by 10:30 a.m. Central Time

NIGP Class/Item Codes

208-61* OCR and Scanner Software, Microcomputer

920-05* Application, Infrastructure, Hosting, Data Hosting and Cloud Computing Services, Vendor Hosted and Internally Hosted

920-45* Software Maintenance and Support Services and Updates and Data Hosting Services

946-10 Accounting and Billing Services, Including Payroll Services, 3rd Party Reimbursements for Medicare, Medicaid, Private Insurance, etc.

958-77* Project Management Services

(*) Automated Information Systems (AIS)

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Table of Contents Article I. Executive Summary, Definitions, and Authority

1.1 Executive Summary

1.2 Definitions

1.3 Authority

Article II. Scope of Work

2.1 Introduction

2.1.1 Texas Risk and Authorization Management Program

2.1.2 Contract Phases

2.1.2.1 Transition

2.1.2.2 Operations

2.1.2.3 Turnover

2.1.3 Provider Finance Reporting System General Overview

2.1.3.1 Financial and Statistical Reports

2.1.3.2 Programs

2.1.3.3 Medicaid Administrative Claiming Services

2.1.3.4 State and Federal Guidelines and Statutes

2.1.3.5 State of Texas Automated Information Reporting System Legacy System Information

2.1.4 Provider Finance Reporting System Functional Requirements

2.1.4.1 General

2.1.4.2 PFRS Feature Requirements

2.1.4.3 Automation

2.1.4.4 Reports

2.1.4.5 Communication Portal

2.1.5 Provider Finance Reporting System Technical Requirements

2.1.5.1 Software-as-a-Service (SaaS)

2.1.5.2 Texas Risk and Authorization Management Program

2.1.5.3 Provider Finance Reporting System (PFRS) System

2.1.5.4 Interfaces

2.1.5.5 System Availability

2.1.5.6 Security

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2.1.5.7 Disaster Recovery and Business Continuity

2.1.6 Testing

2.1.7 Project Management

2.1.7.1 Project Management Office (PMO)

2.1.7.2 Key Personnel

2.1.7.3 Project Documentation

2.1.8 Audit and Records Retention

2.1.9 Transition Services

2.1.9.1 Planning and Development

2.1.9.2 Training

2.1.9.3 Deployment

2.1.10 Operations

2.1.10.1 Operational Support

2.1.10.2 System Support and Maintenance

2.1.10.3 Severity Levels

2.1.10.4 Service Requests (SRs)

2.1.10.5 Technical Help Desk

2.1.10.6 Customer Relationship Management (CRM) Software

2.1.11 Turnover Services

2.1.11.1 Turnover Requirements

2.2 Supplemental Services

2.2.1 Supplemental Services Cost Proposal

2.3 Reduced Services

2.4 Contract Award, Term, and Historical Compensation

2.4.1 Contract Award and Execution

2.4.2 Contract Term

2.4.3 Historical Compensation

2.5 Invoicing

2.6 Data Use Agreement and Security Privacy Inquiry

2.7 No Guarantee of Volume, Usage, or Compensation

Article III Administrative Information

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3.1 Schedule of Events

3.2 Ambiguity, Conflict, or Discrepancy

3.3 Inquiries

3.3.1 Sole Point of Contact

3.3.2 Prohibited Communication

3.3.3 Exception to Sole Point of Contact

3.3.4 Solicitation Questions

3.4 Pre-proposal Conference

3.4.1 Attendance

3.4.2 Conference Logistical Information

3.4.3 Questions at Pre-Proposal Conference

3.5 Solicitation Response Composition

3.5.1 General Information

3.5.2 Page Limit and Supporting Documentation

3.5.3 Discrepancies

3.5.4 Exceptions

3.5.5 Assumptions

3.5.6 Binding Offer

3.6 Solicitation Response Submission and Delivery

3.6.1 Deadline

3.6.2 Submission Option

3.6.3 Submission Checklist

3.6.4 Labeling and Delivery for USB Submission and Other Materials

3.6.5 Modifications and Withdrawals

Article IV. Solicitation Response Evaluation and Award Process

4.1 Conformance with State Law

4.2 Best Value Determination

4.2.1 Selection Methodology

4.2.2 Minimum Qualifications

4.2.3 Initial Compliance Screening

4.2.4 Written Solicitation Response Evaluation

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4.2.5 Written Response Evaluation Criteria

4.2.6 Advancement Criteria

4.2.7 Best and Final Offer (BAFO)

4.2.8 Summary of Best Value Determination

4.2.8 TX-RAMP Certification Assessment

4.3 Questions or Requests for Clarification

Article V. Narrative/Technical Proposal

5.1 Narrative Proposal

5.1.1 Executive Summary

5.1.2 Corporate Background and Experience

5.1.3 Project Management and Project Work Plans

5.1.4 Phase I – Transition Approach

5.1.5 Phase II – Operations Approach

5.1.6 Phase III – Turnover Approach

5.1.7 Key Staffing Profile

5.2 Technical Proposal

5.2.1 Technology Architecture

5.2.2 System Availability and Capacity

5.2.3 Software and Hardware Components

5.2.4 System Integration

5.2.5 System Administration, Support, and Maintenance

5.2.6 System Security and Disaster Recovery

5.2.7 Performance Monitoring and Management

Article VI. Required Respondent Information

6.1 Company Information

6.1.1 Company Narrative

6.1.2 Company Profile

6.2 Authorization to Conduct Business in Texas

6.3 References

6.4 Major Subcontractor Information

6.5 Affirmations and Certifications

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6.6 Other Reports

6.6.1 Dun and Bradstreet Reports

6.6.2 Financial Statements and Financial Solvency

6.6.3 Alternate Report

6.7 Corporate Guarantee

6.8 HUB Subcontracting Plan

6.9 TX-RAMP Documentation

Article VII. Cost Proposal

7.1 Cost Proposal

Article VIII. General Terms and Conditions

8.1 General Conditions

8.1.1 Changes, Modifications, and Cancellation

8.1.2 Offer Period

8.1.3 Costs Incurred

8.1.4 Contract Responsibility

8.1.5 Public Information Act - Respondent Requirements Regarding Disclosure

8.1.6 Respondent Waiver – Intellectual Property

8.1.7 Standards of Conduct for Vendors

8.1.8 Disclosure of Interested Parties

8.2 Insurance

8.2.1 Required Coverage

8.2.2 Alternative Insurability

8.3 Protest

Article IX. List of Exhibits

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Table of Tables

Table 1 – STAIRS Legacy System Details and Volume Table 2 – General Requirements Table 3 – Feature Requirements Table 4 – Automation Requirements Table 5 – Reports Requirements Table 6 – Communication Portal Requirements Table 7 – System Requirements Table 8 – Interface Requirements Table 9 – System Availability Requirements Table 10 – Security Requirements Table 11 – Disaster Recovery and Business Continuity Requirements Table 12 – Testing Requirements Table 13 – Project Management Office (PMO) Requirements Table 14 – Project Documentation Requirements Table 15 – Audit and Records Retention Requirements Table 16 – Planning and Development Requirements Table 17 – Training Requirements Table 18 – Deployment Requirements Table 19 – Operational Support Requirements Table 20 – System Support and Maintenance Requirements Table 21 – Severity Levels, Response and Resolution Times Table 22 – Service Request (SR) Requirements Table 23 – Technical Help Desk Requirements Table 24 – Customer Relationship Management (CRM) Requirements Table 25 – Turnover Requirements

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ARTICLE I. EXECUTIVE SUMMARY, DEFINITIONS, AND AUTHORITY

1.1 EXECUTIVE SUMMARY

The State of Texas, by and through the Health and Human Services Commission (HHSC), issues this Request for Offer (RFO) to solicit a qualified Contractor develop and provide to HHSC a Provider Finance Reporting System (PFRS), which will replace the HHSC owned, State of Texas Automated Information Reporting System (STAIRS); assist HHSC in obtaining reimbursements through Medicaid Administrative Claiming (MAC) Services; and support other State and federally funded Programs in accordance with the Scope of Work (SOW) and other requirements in this Solicitation. The System will be delivered to HHSC as Software-as-a-Service (SaaS) providing end-to-end cloud-based Services.

Services required by the Solicitation include System development; configuration; integration;

Customer Relationship Management (CRM) software; Transition; testing; training; System management; ongoing support; and Turnover. As a result of this Solicitation, HHSC intends to award one (1) Contract.

HHSC PCS will administer the procurement process for this Solicitation, which includes RFO publication, handling of communications from vendors, as well as managing the receipt of Solicitation Responses for review and evaluation.

To be considered for award, Respondent must execute Exhibit A, HHSC Solicitation Affirmations, Version 2.4 of this Solicitation and provide all other required information and documentation as set forth in this Solicitation.

Prior to award of the Contract, Respondent must obtain TX-RAMP Level 2 certification or TX- RAMP Provisional Certification, at the sole discretion of HHSC.

Information regarding HHSC and its programs is available online and can currently be accessed at https://hhs.texas.gov/.

1.2 DEFINITIONS

Refer to Exhibit B, Health and Human Services (HHS) Uniform Terms and Conditions (UTC) – Vendor, Version 3.4, and Exhibit D, Data Use Agreement (DUA), Version 8.5, for additional definitions.

As used in this Solicitation, unless a different definition is specified or the context clearly indicates otherwise, the following terms and conditions have the meanings assigned below:

“Addendum” means a written clarification or revision to this Solicitation issued by HHSC PCS and posted to the ESBD.

“Advancement Criteria” means the published criteria for Respondent to advance to the next phase of evaluation if multiple evaluation methods are utilized.

https://hhs.texas.gov/

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“Award Consideration (AC) Documents” means documents Respondent must submit as part of the Solicitation Response to be considered for negotiations or award.

“Business Day” means any day (24-hour period) in which normal business Operations of HHSC are conducted (e.g., excludes weekends and the national holidays specified in Section 662.003(a) of the Texas Government Code).

“Calendar Day” means each day shown on the calendar beginning at 12:00 Midnight and ending at 11:59 p.m. the following day, including Saturdays, Sundays, and national and State holidays listed in Texas Government Code § 662.003.

“Combined Entity (CE)” means one or more commonly owned corporations and one or more limited partnerships where the general partner is controlled by the same identical persons as the commonly owned corporation(s).

“Contract Term” means the period of time beginning with the commencement date or Effective Date of a Contract and ending when the Contract expires in accordance with its terms, or when it has been terminated.

“Effective Date” has the same meaning as the definition in Exhibit B, Health and Human Services (HHS) Uniform Terms and Conditions – Vendor, Version 3.4.

“Downtime” means the total time a System is out of service or offline.

“ESBD” means the Electronic State Business Daily, the electronic marketplace where State of Texas bid opportunities over $25,000 are posted. The ESBD may currently be accessed at http://www.txsmartbuy.com/esbd.

“Final Written Response Score” refers to the final scoring of the written response as documented in the Solicitation.

“GovDelivery” is a web-based e-mail subscription management System that allows a member of the public to subscribe to news and information on Department of Homeland Security (DHS) websites.

“Help Desk” means a centralized team within the Contractor’s organization that provides help, training, and troubleshooting assistance to many internal and external users.

“HHSC” means the Health and Human Services Commission.

“HHSC PCS” means Procurement and Contracting Services (PCS), a division of HHSC.

“HUB” means Historically Underutilized Business, as defined by Chapter 2161 of the Texas Government Code.

“HUB Subcontracting Plan” or “HSP” means written documentation regarding the use of Subcontractors, which is required to be submitted with all responses to State agency contracts with an expected value of $100,000 or more where the State agency has determined subcontracting opportunities are probable. The HSP subsequently becomes a provision of the awarded Contract and shall be monitored for compliance by the State agency during the term of the Contract.

http://www.txsmartbuy.com/esbd

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“Internet Protocol” or “IP” is a protocol, or set of rules, governing the format of data sent over the internet or other network.

“Joint Application Design” or “JAD” means a methodology that uses collaborative workshops held between the Contractor and HHSC to gather additional information about the RFO requirements and the business needs to effectively develop the software application.

“Medicaid Administrative Claiming” or “MAC” means the program that provides Texas school districts, including public charter schools, the ability to obtain reimbursement for costs related to administrative activities that support the Medicaid program.

“Operational Readiness” refers to the readiness of PFRS to be fully operational as required by the RFO after all development, training, and testing activities have been completed; this includes the development of all System documentation (i.e., System manuals, Trouble-Shooting Guides, etc.), the remediation of all System or process problems, and when the vendor support Services are ready for PFRS.

“Operations” means all Transition activities were completed and all Contract requirements for the operational support are functional; the Contractor has received written approval from HHSC to begin Operations.

“Operations Start Date” means the date the PFRS implementation and configuration is completed and moves to a testing environment.

“Preparer” means an external user who has the required training credit in order to be added as a listed Preparer and who is permitted to prepare and make edits to assigned reports, may provide certification of reports, and also may be a third-party vendor.

“Procurement Library” means the repository of additional information that is made available to the Respondent subject to the terms and conditions of this Solicitation. All documents in the Procurement Library are provided only for background information and are not to be considered requirements for the Solicitation. Unless explicitly incorporated by reference in this Solicitation, documents in the Procurement Library do not become part of the Contract.

“Production” means when PFRS is live and fully operational.

“Provider” means an external user permitted to perform certain activities determined by the assigned roles and responsibilities in STAIRS/PFRS and is allowed to assign primary and secondary roles for financial contacts and Preparers.

“Provider Finance Reporting System” or “PFRS” means the new System to be provided under this Solicitation, which System will collect financial and statistical data from Providers. Also referred to as “System.”

“Program” means various Texas groups that provide Medicaid Services to eligible children and adults that seek Medicaid reimbursements.

“Random Moment Time Studies” or “RMTS” means a valid random sampling technique that measures the participant’s time performing work activities.

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“Rate Enhancement Program” is a voluntary program where HHSC pays an enhanced rate to participating Medicaid Providers who commit to ensuring enhanced funds support higher compensation for staff performing attendant or direct care Services.

“Respondent” means the individual or entity responding to this Solicitation.

“Rollback” means restoring the System to a previous state by canceling a change made to the System through a specific action or transaction set.

“System of Contract Operation and Reporting” or “SCOR” is an application used by HHSC as the System-of-record for the management, reporting, and compliance of all HHSC contracts.

“Solicitation Consideration (SC) Documents” means documents that must be submitted by Respondent with the Solicitation Response in order to be considered for evaluation and cannot be resubmitted or have errors remedied after the submission due date and time identified in the Schedule of Events.

“State” means the State of Texas and its instrumentalities, including HHSC, and any other State agency, its officers, employees, or authorized agents.

“State of Texas Automated Information Reporting System” or “STAIRS” means the name of the legacy System currently used to collect financial and statistical data.

“Test Plan” is a document that outlines the strategies, goals, timelines, estimations, deadlines, and resources needed for testing software or hardware products.

“Transition” refers to the activities performed by the Contractor during the Contract Term to prepare the System and resources for Operations.

“Turnover” refers to the administrative and Operations activities performed by the Contractor to transfer the System to either HHSC or an HHSC designee.

“TX-RAMP” means the Texas Risk and Authorization Program established by the Texas Department of Resources (DIR) that provides a standardized approach for security assessment, authorization, and continuous monitoring of cloud computing Services that process the data of a State agency. To become TX-RAMP certified, entities must submit prescribed documentation to DIR. Information regarding TX-RAMP is currently located at: https://dir.texas.gov/texas-risk-and-authorization-management-program-tx-ramp.

“Uptime” means the total time a System is available for use by end users.

“VPTS” means Vendor Performance Tracking System, as defined under Section 2262.055 of the Texas Government Code and Title 34 of the Texas Administrative Code Part 1, Chapter 20, Subchapter B, Division 2, Rule §20.115 and Subchapter F, Division 2, Rule §20.509.

“Walk-through” means an informal way of presenting a technical document before the Deliverable deadline that allows the Contractor to outline the Deliverable and obtain clarification from the System Agency that the Deliverable meets Contract requirements and is acceptable to HHSC.

https://dir.texas.gov/texas-risk-and-authorization-management-program-tx-ramp https://dir.texas.gov/texas-risk-and-authorization-management-program-tx-ramp https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2262.htm#2262.055 https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=34&pt=1&ch=20&rl=115 https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=34&pt=1&ch=20&rl=509

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1.3 AUTHORITY

HHSC is soliciting the Services stated in this Solicitation under the authority of Texas Government Code Section 2157.006(a)(2).

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ARTICLE II. SCOPE OF WORK

2.1 INTRODUCTION

HHSC intends to award one (1) Contract to develop, provide, and support PFRS, and provide Services related to financial and statistical reporting for MAC and Random Moment Time Studies (RMTS) Services. HHSC anticipates RMTS will be provided through an add-on application that will integrate with PFRS. PFRS will also integrate with MAC to process claims and reimbursements.

Contractor shall provide the following Services during the Contract Term: development, configuration, integration, CRM software, Help Desk Services, project management, Transition, testing, training, System management, System upgrades and enhancements, maintenance Services, ongoing support, and Turnover. Contractor will establish a toll-free Help Desk telephone line and Contractor hosted websites that are exclusively owned by HHSC and will transfer to HHSC upon termination of the Contract.

This SOW includes the Services, requirements, Deliverables and key performance measures (KPMs), to be performed by the Contractor during the Contract Term.

For additional clarifications and information on the SOW, refer to the Exhibits, Procurement Library, and other documents expressly designated by HHSC as part of this Solicitation.

Note: All Procurement Library artifacts are to be considered current information used by HHSC and are provided as background information only and are not illustrative of Deliverable requirements.

2.1.1 Texas Risk and Authorization Management Program

The Contractor shall comply with the program requirements of TX-RAMP as they currently exist and as amended throughout the Contract Term. Commencing on the Effective Date, the Contractor shall have achieved TX-RAMP Level 2 Certification, and the Contractor shall maintain such certification for the duration of the Contract Term. At the sole discretion of HHSC, the Contractor’s attainment of TX-RAMP Provisional Certification may satisfy the TX-RAMP Certification Level 2 requirement for the length of active TX-RAMP Provisional Certification. If HHSC permits TX-RAMP Provisional Certification, the Contractor is solely responsible for obtaining and maintaining TX-RAMP Level 2 Certification prior to the expiration of TX-RAMP Provisional Certification. Contractor acknowledges that HHSC shall not provide Agency-sponsored Interim Provisional Certification or otherwise assist Contractor in Contractor’s compliance with TX-RAMP requirements.

In addition, Contractor shall:

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a. Upon HHSC’s request, provide Contractor’s submission(s) to DIR that supports DIR’s approval of certification status and respond promptly to HHSC and DIR TX-RAMP staff inquiries;

b. Provide written notification to HHSC of any lapse in TX-RAMP certification including, but not limited to, DIR revocation of TX-RAMP certification within two (2) Business Days of Contractor’s discovery of non-compliance with TX-RAMP requirements;

c. Complete all TX-RAMP monitoring reports required by DIR and submit copies of reports to HHSC on or before the second (2nd) Business Day following the DIR submission deadline;

d. Routinely assess and monitor for compliance with required security controls and demonstrate that the security posture of the cloud computing Services offered is acceptable to maintain TX-RAMP certification;

e. If the Contractor has TX-RAMP Provisional Certification, provide a progress update to HHSC on Contractor’s application for TX-RAMP Level 2 Certification no later than the third (3rd) Business Day of each calendar month, or as requested by HHSC, until the expiration of the TX-RAMP Provisional Certification; and

f. If the Contractor has TX-RAMP Level 2 Certification, commencing six (6) months prior to the expiration date of the TX-RAMP Level 2 Certification, provide a progress update to HHSC on Contractor’s application for renewal or extension of its TX-RAMP Level 2 Certification no later than the third (3rd) Business Day of each calendar month, unless HHSC requires more frequent reporting.

The Contractor’s failure to comply with any TX-RAMP requirements including, but not limited to, continuous maintenance of the minimum certification required by the Contract shall constitute a material breach of Contract, and HHSC reserves the right to hold Contractor accountable by taking any remedial or corrective actions available under the Contract, at law, or in equity. If Contractor is unable to achieve TX-RAMP Level 2 Certification or re-certification, as applicable, for any reason before the 120th Calendar Day prior to the expiration date of the TX-RAMP Provisional Certification or TX-RAMP Level 2 Certification, as applicable, the Contractor shall provide, at no cost to HHSC, Turnover Services in accordance with Section 2.1.11 Turnover, and Section 2.1.11.1, Turnover Requirements.

2.1.2 Contract Phases

The Contractor shall provide Services, as described in this SOW, within the following three (3) phases: (1) Transition, (2) Operations, and (3) Turnover.

2.1.2.1 Transition

Transition refers to the activities performed by the Contractor during the Contract Term to prepare the System and resources for Operations. Transition activities include the development and testing of the PFRS. Transition requires intense focus on knowledge transfer (i.e., sharing or dissemination

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2.1.2.2 Operations

Operations will not commence until after HHSC determines that the Contractor has successfully completed all Transition activities and HHSC provides written notice to the Contractor to proceed with the commencement of Operations. Operations includes all Contract requirements for the operational support of PFRS set forth in Section 2.1.10, Operations.

2.1.2.3 Turnover

Turnover begins six (6) months prior to the end of the Contract Term or as requested by HHSC.

Turnover includes the administrative and Operations activities performed by the Contractor to transfer the System to either HHSC or an HHSC successor service provider to ensure that the Programs do not experience any adverse impact during Turnover. Turnover Services requirements are set forth in Section 2.1.11, Turnover Services.

2.1.3 Provider Finance Reporting System General Overview

PFRS must facilitate the collections, processing, and reporting of financial and statistical data.

PFRS must serve as a secured repository of data and supporting documentation for System Agency staff. The data within PFRS will be used for cost determinations, rate settling, accountability, cost settlements and time studies.

PFRS must connect to a RMTS application which performs State-wide Random Moment Time Studies (“RMTS”). RMTS studies are performed each Federal Fiscal Year quarter and are required for MAC. MAC and reimbursements will be entered, tracked, reconciled, audited, and reimbursed for the Programs through PFRS.

PFRS must allow System Agency staff to collect, review, examine and adjust cost and accountability reports submitted by Providers for the Programs. Programs may employ Preparers to submit the required reporting to HHSC.

PFRS must comply with State and federal mandates related to calculation methodologies, reimbursable tasks, not to exceed thresholds, and reporting deadlines. Information about the Provider Finance Department is available at https://pfd.hhs.texas.gov/.

2.1.3.1 Financial and Statistical Reports

PFRS must collect statistical and financial data for cost determinations, rate settings, settlements, accountability reports, and for other analytical purposes. Providers/Preparers will submit https://pfd.hhs.texas.gov/

Version 2.10 (09/12/2023) RFO No. HHS0014128 Page 16 of 126 information required to generate cost reports to PFRS. At HHSC’s direction at various times throughout the year, Providers/Preparers will submit information for the following reports:

a. 24-hour Residential Child Care (24RCC);

b. 24-hour Residential Child Care - Single Source Continuum Contract (24RCC-SSCC);

c. Ambulance Services (AMS);

d. All three Programs combined onto a single cost report known as CPC which includes

Community Living Assistance & Support Services - Case Management Agency (CLASS- CMA), CLASS - Direct Services Agency (CLASS-DSA), and Primary Home Care (PHC);

e. CPC Accountability Report (CPC-AR);

f. DAHS Accountability Report (DAHS-AR);

g. Day Activity and Health Services (DAHS);

h. Deaf-Blind Multiple Disabilities Waiver Accountability Report (DBMD-AR);

i. Disproportionate Share Hospitals/Uncompensated Care Application (DSH/UC);

j. All five Programs combined onto a single cost report known as MEI which includes Early

Childhood Intervention - Case Management (ECI-CM), ECI – Specialized Rehabilitation Services (ECI-SRS), Rehabilitation Services - Mental Health (RSMH), Services Coordination - ICF/ID (SC-ICF/ID), and Targeted Case Management - Mental Health

(TCM-MH);

k. Financial Management Services Agency (FMSA) Cost Report;

l. Hospital Augmented Reimbursement Program (HARP);

m. Home and Community-based (HCS)/Texas Home Living Waiver (TxHmL) Accountability

Report (HCS/TxHmL-AR);

n. Home and Community-Based Services and Texas Home Living (HCS/TxHmL);

o. Intermediate Care Facility (ICF)/Intellectual Disability (ID) Accountability Report

(ICF/ID-AR);

p. Intermediate Care Facility (ICF)/Intellectual Disability (ID) State Supported Living Center

(ICF/ID-SSLC);

q. Intermediate Care Facilities for Individuals with an Intellectual Disability or Related

Condition (ICF/ID);

r. Nursing Facility (NF) - Accountability Report (NF-AR);

s. Nursing Facility (NF);

t. Residential Care (RC) - Accountability Report (RC-AR);

u. Residential Care (RC);

v. School Health and Related Services (SHARS);

w. VLB Cost Report;

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x. YES Waiver Cost Report; and

y. MAC Financial Report.

2.1.3.2 Programs

PFRS will collect information from various Programs throughout the State of Texas. PFRS shall be available to the following Programs:

a. 24-hour Residential Child Care - Single Source Continuum Contract (24RCC-SSCC);

b. 24-hour Residential Child Care (24RCC);

c. Community Living Assistance and Support Services – Case Management Agency

(CLASS-CMA);

d. Community Living Assistance and Support Services – Direct Service Agency (CLASS-

DSA);

e. Comprehensive Hospital Increase Reimbursement Program (CHIRP);

f. Day Activity Health Services (DAHS);

g. Deaf Blind Multiple Disabilities (DBMD);

h. Directed Payment Program for Behavioral Health Services (DPP BHS);

i. Disproportionate Share Hospitals/Uncompensated Care Application (DSH/UC);

j. Early Childhood Intervention (ECI);

k. Home and Community Services (HCS) / Texas Home Living (TxHmL);

l. Independent School Districts (ISD);

m. Intermediate Care Facilities – State Supportive Living Centers (ICFSSLC);

n. Intermediate Care Facilities (ICF);

o. Local Health Districts (LHD);

p. Mental Health, Early Childhood Intervention and Individuals with Developmental

Disabilities (MEI);

q. Mental Health/Intellectual and Developmental Disability (MHIDD);

r. Nursing Facilities (NF);

s. Primary Home Care – (PHC ASPCC);

t. Primary Home Care and Community Living Assistance and Supportive Services (CPC);

u. Public Health Provider-Charity Care Program (PHP-CCP);

v. Quality Incentive Payment Program (QIPP);

w. Residential Care (RC);

x. Rural Access to Primary and Preventative Services (RAPPS);

y. School Health and Related Services (SHARS);

z. STAR+PLUS;

aa. Texas Home Living;

bb. Texas Incentives for Physicians and Professional Services (TIPPS);

cc. Uncompensated Care (UC) Ambulance Services Supplemental Payments Program; and

dd. Veteran Homes.

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At the sole discretion of HHSC, additional Programs may be added during the Contract Term.

HHSC will notify Contractor with additions through the process outlined in the Change Management Plan, see Exhibit M, PFRS Deliverables, DEL-02.

2.1.3.3 Medicaid Administrative Claiming Services

Title XIX of the Social Security Act allows states under an approved Medicaid state plan, to claim and be reimbursed for a portion of administrative costs related to Medicaid. Texas will use PFRS to manage, monitor, and audit MAC claims to confirm that federal requirements are met. PFRS will be a repository for Provider’s MAC contracts.

RMTS moments are collected each quarter from Program participants to identify the proportion of administrative time allowable and reimbursable under MAC and identify the proportion of direct service time allowable and reimbursable under Medicaid. Time study moments will be collected by the RMTS application and sent to PFRS for claims.

Additional information about MAC and federal requirements is located at https://www.medicaid.gov/medicaid/financial-management/medicaid-administrative-claiming/index.html.

2.1.3.4 State and Federal Guidelines and Statutes

As determined by HHSC, PFRS must adhere to the Centers of Medicare and Medicaid Services (CMS) guidelines for the cost and accountability reports for the Programs and as required by the Texas Administrative Code, Title 1, Part 15, Chapters 353 and 355.

2.1.3.5 State of Texas Automated Information Reporting System Legacy System Information

The legacy STAIRS data, coding, and design will not be migrated into PFRS. HHSC makes no guarantee that PFRS will have the same volume as the legacy System, see Section 2.7, No Guarantee of Volume, Usage, or Compensation. The information shown in Table 1 – STAIRS Legacy System Details and Volume is based on historical information and provided for illustrative purposes only.

Table 1 – STAIRS Legacy System Details and Volume STAIRS Legacy System Details and Volume

Letter and Item Details

a. Legacy System Linux servers housed in Cloud

System built in Java and uses Mongo DB https://www.ssa.gov/OP_Home/ssact/title19/1900.htm https://www.medicaid.gov/medicaid/financial-management/medicaid-administrative-claiming/index.html https://www.medicaid.gov/medicaid/financial-management/medicaid-administrative-claiming/index.html

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STAIRS Legacy System Details and Volume Letter and Item Details

b. Servers 3 – Amazon m4.xlarge 3 – Amazon m4.xlarge (scaled up during peak times) 3 – Amazon m4.large

c. Storage Production – 1.5 terabytes (TB) Database – 341 gigabytes (GB) Amazon S3 – 74.5 GB (unlimited capacity) Webserver – 98 GB (capacity 300 GB)

d. Internal Users 200

e. External users 1,000

f. Active Accounts PFRS – 15,000

g. Time Study Metrics Participants - 112,000

Time Study Moments (per year) – 34,280

h. Web Sessions PFRS – 91,000 sessions per year

i. Page Views PFRS – 2,100,000 per year

j. Peak Volume PFRS – 1,000 users generate 2,100 web sessions (per day) with

86,000 page views

2.1.4 Provider Finance Reporting System Functional Requirements

The Contractor shall work with HHSC to achieve successful outcomes in completing the PFRS functional requirements.

2.1.4.1 General

The System must meet or exceed the requirements set forth in Table 2 - General Requirements.

HHSC will provide additional information and guidance during Joint Application Design (JAD) sessions during the Contract Term.

Table 2 – General Requirements

General Requirements

Req ID Detailed Requirements

GFR-01 Contractor is responsible for System development, configuration, implementation, management, maintenance and operation of a web-based PFRS and to seamlessly integrate a Communication Portal and CRM software within PFRS. HHSC uses PFRS to perform various activities, including, but not limited to, the following:

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General Requirements

Req ID Detailed Requirements

a. Collecting and tracking financial and statistical cost reporting, including cost and accountability reports creation and collection;

b. Executing cost settlements;

c. HHSC workflows specific to Programs;

d. Conducting financial examinations and audits;

e. Performing reconciliation and settlement tracking;

f. Tracking Random Moment Time Studies;

g. Conducting compliance and monitoring tasks;

h. Producing Texas legislative and federal reporting;

i. Validating data and performing edits;

j. Managing large data sets and auditing records;

k. Importing and exporting of large data sets; and

l. Communicating to external users.

Additional activities may be added to PFRS through State and/or federal mandates or at HHSC’s discretion. Additional activities within the scope of this RFO and Contract, will be added at no additional cost to HHSC through the process outlined in Change Management Plan in Exhibit M, PFRS Deliverables

(DEL-02).

GFR-02 Contractor will provide a web-based data collection and payment processing application for MAC and RMTS. The internal and external users must have the ability to access MAC and RMTS data and reporting as specified by HHSC through PFRS.

GFR-03 PFRS must be available to the Programs as shown in Section 2.1.3.3, Programs. At the sole discretion of HHSC, additional Programs may be added during the Contract Term.

GFR-04 PFRS collects financial and statistical data needed for cost determination, rate setting, accountability, and other analytical purposes. At various times throughout the year, per HHSC direction, service Providers must submit all information related to approximately thirty (30) reports. Examples of the reports provided in the current System can be found in the Procurement Library in:

a. Artifact E – Attachment T PHP-CCP;

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Req ID Detailed Requirements

b. Artifact F – UC Payment Protocol;

c. Artifact G – ASSPP Cost Reporting;

d. Artifact H – CPC Worksheet;

e. Artifact I – CPC Cot Reporting;

f. Artifact J – HCS TxHML Cost Reporting;

g. Artifact K – NF Analytical Review Workpaper;

h. Artifact L – NF Cost Reporting;

i. Artifact M – NF Optional Cost Reporting Worksheet; and

j. Artifact N – SHARS Cost Reporting.

At the sole discretion of HHSC, additional reports may be added during the Contract Term. HHSC will address changes to the reports through the process outlined in Change Management Plan in Exhibit M, PFRS Deliverables

(DEL-02).

GFR-05 After HHSC-staff and Providers log in, the PFRS landing page must include, at a minimum, the following:

a. HHSC branding;

b. Provider Finance Reporting System (PFRS) in the header;

c. The user's name and link to log off;

d. Dashboards with any alerts, notices, messages or reminders specific to the user type; and

e. Help Desk contact information (email, phone number, and messages chat icon).

GFR-06 PFRS must maintain and provide a contacts list for all users that includes, at a minimum, the following:

a. Username;

b. User role;

c. Entity name (e.g., company name);

d. Email;

e. Telephone number;

f. Cost report groups; and

g. Any additional information provided by HHSC during JAD sessions.

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Req ID Detailed Requirements

GFR-07 Upon viewing a Providers profile, PFRS must provide the internal user visibility to specific screens within the application. These screens must include, but are not limited to, the following:

a. Reports;

b. Data (i.e., adding, search, exporting, reporting, and filtering issues);

c. Combined Entity (CE);

d. Contracts;

e. Cost Report Group (CRG);

f. Data Change Request (DCR);

g. Not Prior/New;

h. Searches;

i. Administration; and

j. Adjustor.

During the Contract Term, HHSC may request the Contractor to add or edit PFRS screens. All requested changes must go through the process outlined in the Change Management Plan, see Exhibit M, PFRS Deliverables (DEL-02).

GFR-08 PFRS must be able to use and track codes with variable digit lengths, including, but not limited to:

a. Adjustment;

b. Status;

c. Component;

d. Combined Entity;

e. Cost Report Group (CRG);

f. Accountability Report (AR);

g. AR CRG;

h. Entity; and

i. Postal.

HHSC designated staff must have the capability to add, remove, and edit the codes in the System, without impacting any existing processes or reports in Production.

GFR-09 PFRS must show status steps for Providers, including, but not limited to:

a. Provider data requested;

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Req ID Detailed Requirements

b. Returned for corrections;

c. In Progress;

d. Certified; and

e. Not Certified.

GFR-010 Based on the action required, the Program that requires the action, and the status of the report, PFRS must generate due dates as specified by HHSC.

GFR-011 The System must include status and status history tracking related to the processing and various stages of requested and submitted reports. The System must track and maintain the status history for each Provider report.

HHSC designated staff must have the ability to configure workflow statuses based on multiple criteria.

GFR-012 The System must allow HHSC designated staff to create, modify, configure, and delete workflows within PFRS. Workflows will be developed to include:

a. Statuses and status history tracking;

b. Tracking various stages of report processing and submissions;

c. Automated notifications and alerts;

d. HHSC staff assignments;

e. Processing steps for HHSC staff;

f. Sequenced reviews from various HHSC staff;

g. HHSC approval gates; and

h. Other workflows as required by HHSC.

HHSC designated staff must have the ability to manually override the workflow status to a previous or subsequent workflow status.

GFR-013 PFRS must provide for configurable workflow status based on multiple criteria defined by HHSC designated staff (e.g., Program type, Report type, Role type, Permission type).

GFR-014 For specific Programs, PFRS must prompt the Provider/Preparer to participate in RMTS and must track when the Provider/Preparer conducts the time study.

GFR-015 PFRS must provide and maintain configurable templates for emails, notifications, and letters. HHSC designated staff must have the ability to change, add, or delete PFRS templates.

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Req ID Detailed Requirements

GFR-016 The System must allow HHSC the ability to perform bulk data uploads into

PFRS.

GFR-017 PFRS must allow Providers/Preparers to confirm pre-populated data fields and to make changes to the data within the fields.

GFR-018 PFRS must allow documents to be uploaded into PFRS.

GFR-019 PFRS must exchange Provider payment information in real time to the Centralized Accounting and Payroll/Personnel System (CAPPS) Financials System.

GFR-020 PFRS must allow HHSC-staff and Providers the ability to connect uploaded documentation with specific steps in the reports process. PFRS must allow internal and external users the ability to view the uploaded documents from the associated step.

GFR-021 PFRS must provide a mechanism for external users to automatically enroll in GovDelivery.

GFR-022 PFRS must allow internal users to manage their own notifications and alerts preferences (e.g., emails, user interface alerts, etc.).

GFR-023 PFRS must allow HHSC designated staff to create and update instructions for reports for external users. PFRS must allow brief instructions pop-up message per data field and allow the external user to download and print step-by-step detailed instructions specific to the report.

GFR-024 PFRS must have the capability for HHSC designated staff to condense username/password logins for multiple Programs within PFRS.

GFR-025 PFRS must have the capability for HHSC designated staff to add, delete, and update external user contact information.

GFR-026 PFRS must provide HHSC designated users the ability to mark a Provider as active or inactive.

GFR-027 PFRS must allow HHSC designated staff to adjust the Medicaid Enrollment Rate (MER) as needed.

GFR-028 PFRS must have specific dashboards for internal users that are configurable and provide views and features as designated by user and role type.

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Req ID Detailed Requirements

GFR-029 Upon login, and based on HHSC specified criteria, PFRS must notify the Provider/Preparers of any pending mandatory training requirements.

GFR-030 The System must provide alerts on external user dashboards for specific events.

Examples of events to include:

a. Missed deadlines;

b. Report submissions not received;

c. Participant list not certified;

d. Missed and expired moment time studies;

e. Correspondence from HHSC staff;

f. Office closures and upcoming national and State holidays; and

g. Other HHSC specific information.

GFR-031 PFRS must provide external users the ability to view an upload history within the Provider's dashboard of all information uploaded by or for the Provider.

2.1.4.2 PFRS Feature Requirements

The System must meet or exceed the requirements set forth in Table 3 - Feature Requirements.

HHSC will provide additional information and guidance during JAD sessions during the Contract Term.

Table 3 – Feature Requirements

Feature Requirements

Req ID Detailed Requirements

FEA-01 PFRS must provide the following features and functionalities:

a. Send automated letters and notices to Providers and Participants;

b. Provide a HHSC branded web portal for service Providers to prepare and submit reports;

c. Allow Providers the ability to view submitted reports at any time;

d. Grant Providers the ability to individually assign a Preparer;

e. Serve as a tracking System to identify the status of reports throughout the entire process;

f. Send work assignments and monitor workloads of HHSC staff;

g. Perform verifications of the submitted data through built-in edits and prompts;

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Feature Requirements

Req ID Detailed Requirements

h. Allow HHSC users to make adjustments as well as quantifying and qualifying all adjustments to reports;

i. Electronically communicate notices of adjustments and applicable settlement amounts to Providers;

j. Collect Provider’s responses (i.e., agreement or disagreement) with the adjustments and settlement amounts;

k. Process all Provider appeals for informal reviews and display all additional applied adjustments;

l. Notify service Providers of the final adjusted settlements;

m. Electronically store all required supporting documentation submitted by the Provider or added by HHSC staff;

n. Create standard and ad-hoc reports;

o. Create databases used for analysis purposes;

p. Integrate with a communication portal; and,

q. Program specific error messages (i.e., informational messages, explanation messages, data entry errors).

FEA-02 HHSC must have the ability in PFRS to produce and deliver accurate ad hoc queries, extract results, and templates within specified timeframes, with content, and in a format (e.g., Excel, CSV, PDF) approved by HHSC.

FEA-03 PFRS must allow for Providers/Preparers to import data into the cost reports through the use of HHSC approved standard templates.

FEA-04 Internal users must have the ability to search and filter PFRS contact information by either individual user, service Provider, user type or all three. The results from the search must be exportable and printable in various formats (e.g., XLS, XLSX, CSF, PDF).

FEA-05 PFRS must allow internal users to link contracts and identify the Provider's "Parent" company.

FEA-06 PFRS must have the ability for HHSC designated staff to select their fiscal year end.

FEA-07 PFRS must display a prompt that notifies the user when an upload is required.

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Req ID Detailed Requirements

FEA-08 PFRS must allow HHSC designated internal users the ability to change the Provider name, group name, contact name, reporting period dates, and rate enhancement information.

Additional items to be changed may be added to the list above during JAD sessions.

FEA-09 PFRS must record the date and the internal user that verified the Combined Entity's ownership and corporation information.

FEA-010 PFRS must allow a Provider to submit an excusal request through the System that excuses the Provider from submitting reports within PFRS. The Provider must be able to upload supporting documentation for the excusal request. PFRS must generate an automated email confirming the submission of the excusal request.

FEA-011 After selecting the excusal request, PFRS must require the Provider to indicate how the Provider meets the requirements for the excusal. PFRS must display the excusal requirements that are specific to the type of Provider. PFRS will not accept excusal requests without the Provider selecting an excusal requirement.

PFRS must allow the Provider to upload supporting documentation for specific excusal requests.

FEA-012 PFRS must alert designated HHSC staff of all pending excusal requests.

FEA-013 HHSC must have the ability to approve, reject, or request additional information for excusal requests within PFRS. PFRS must send automated notices to the Providers of the approval, rejection, or request for additional information on the Provider's excusal request.

FEA-014 HHSC designated users must be able to select from predetermined excusal determinations, rejection reasons, request specific missing information, or manually enter messaging into a field to publish on the automated notices.

FEA-015 PFRS must have the capability to allow Providers to submit extension requests for reports and informal reviews and collect specific information (i.e., date, requested by, and reason) from the Provider. PFRS must only allow the Provider's current owner or authorized signor to submit an extension request.

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Req ID Detailed Requirements

FEA-016 PFRS must reject extension requests submitted by the Provider after the report or informal review due date. If the due date falls on a weekend, national or State holiday, or federal holiday, the due date rolls over to the next Business Day.

Extension requests submitted after the due date are automatically rejected by PFRS and the Provider is prompted to contact HHSC.

FEA-017 PFRS must have the capability for HHSC designated staff to flag Providers that they have "Unauditable" or "Unacceptable" reports. PFRS must generate an editable letter template and editable email template for each Providers that has been flagged. PFRS will automatically assign the applicable status once the letter is sent to the Provider from within the PFRS Communication Portal.

PFRS must track the letter due date and will notify the designated HHSC staff the day the Provider has recertified the report or after the due date that a report has not been "Corrected".

PFRS must continue tracking the Provider with "Unauditable" or Unacceptable" reports until the 60th day from letter date when HHSC will request recoupment due to nonsubmittal.

FEA-018 Vendor Hold Warning (VHW) notices, as specified by HHSC, are automatically sent to Providers that have not submitted their accountability reports (AR) / cost reports (CR) and have not been granted an extension or excusal. The notices will be sent the day after a report is due.