ESBD_378841_1729103213163_HHS0014624 RFP Solicitation.pdf

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Version 2.10

Revision Date 09/12/2023

Cecile E. Young, Executive Commissioner

Request for Proposals (RFP) for

Financial Analysis and Financial Data Management and Modeling Services

RFP No. HHS0014624

Date of Release: October 16, 2024

Responses Due: Section 3.1 for Schedule of Events

NIGP Class/Item Codes:

920-21 Data Entry Services

946-12 Actuarial Services

946-29 Cash Management Service, Including Budgeting Services

946-48 Financial Advisor

946-77 Statistical Services

952-77 Research and Evaluation, Human Services, Including Productivity Audits

958-56 Health Care Management Services, Including Managed Care Services

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Contents Article I. Introduction, Definitions, and Authority

1.1 Introduction

1.2 Definitions

1.3 Authority

Article II. Scope of Work

2.1 Introduction

2.1.1 Background

2.2 Service Requirements

2.2.1 Work Order Process

2.2.2 HHSC Roles and Responsibilities

2.2.3 Contractor Requirements

2.2.4 Contractor’s Key Personnel

2.2.5 Replacement of Key Personnel Requirements

2.2.6 Deliverables

2.3 Associated Remedies and Liquidated Damages

2.3.1 General

2.3.2 Waiver for Good Cause

2.3.3 Key Performance Measures

2.3.4 Payments and Invoices

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 Data Use Agreement and Security Privacy Inquiry

2.6 No Guarantee of Volume, Usage, or Compensation

2.7 Governmental Entities

Article III. Administrative Information

3.1 Schedule of Events

3.2 Ambiguity, Conflict, or Discrepancy

3.3 Inquiries

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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

4.2.5 Written Response Evaluation Criteria

4.2.6 Advancement Criteria

4.2.7 Best and Final Offer (BAFO)

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4.2.8 Final Written Response Score

4.2.9 Summary of Best Value Determination

4.3 Questions or Requests for Clarification

Article V. Narrative Proposal

5.1 Narrative Proposal

5.1.1 Executive Summary

5.1.2 Qualifications and Experience

5.1.3 Contractor’s Abilities to Meet Requirements

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

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

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

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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, Forms, and Attachments

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ARTICLE I. INTRODUCTION, DEFINITIONS, AND AUTHORITY

1.1 INTRODUCTION

The State of Texas, by and through the Texas Health and Human Services Commission (HHSC), issues this Request for Proposal (RFP) to solicit a qualified Contractor with the expertise, financial resources, and experience necessary to provide financial analysis and financial data management and modeling. The Contractor will work with the State to support the Texas

Medicaid program including the Texas Healthcare Transformation and Quality Improvement

Program in accordance with the specifications contained in this Request for Proposal (RFP).

The Contractor must have a demonstrated experience in and knowledge of the Texas Medicaid program including the Texas Healthcare Transformation and Quality Improvement Program, Managed Care (MC) delivery systems, and HHSC supplemental payment program funding methodologies. The resulting Contract will enable HHSC to fulfill its role as the single State agency responsible for the administration of Medicaid and to responsibly and efficiently meet its federal and State legislative obligations.

HHSC PCS will administer the procurement process for this Solicitation, which includes RFP publication, handling of communications from vendors, as well as managing the receipt of

Solicitation Responses for review and evaluation.

To be considered for award, a Respondent must execute Exhibit A, HHS Solicitation

Affirmations Version 2.4 and provide all other required information and documentation as set forth in this Solicitation.

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

1.2 DEFINITIONS

Refer to Exhibit B, Health and Human Services (HHS) Uniform Terms and Conditions

(UTC) – Vendor, Version 3.4, Exhibit C, Health and Human Services (HHS) Additional

Provisions, Version 1.0, and Exhibit D, Data Use Agreement (DUA) and Attachment 1, 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.

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

“Business Day” is any day (24-hour period) in which normal business Operations of HHSC are conducted (e.g., excludes weekends, State holidays, and the national holidays specified in

Section 662.003(a) of the Texas Government Code).

https://www.hhs.texas.gov/ https://statutes.capitol.texas.gov/Docs/GV/htm/GV.662.htm#662.003

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“Calendar Day” is 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 Section 662.003.

“Children’s Healthcare Insurance Program” or “CHIP” means the health insurance program authorized and funded pursuant to Title XXI, Social Security Act (42 U.S.C. §§ 1397aa-

1397mm) and administered by HHSC.

“Competitive Range” has the same meaning as the definition under Title 1 of the Texas

Administrative Code Part 15, Chapter 391, Subchapter A, Rule §391.107(3).

“Contract Manager” is the assigned System Agency staff that oversees the administration of the

Contract and ensures the work performed by a Contractor is in compliance with the Contract.

“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.

“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.

“HHSC” means the Health and Human Services Commission.

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

“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.

“Managed Care” or “MC” is a service delivery model where HHSC contracts with Managed

Care Organizations (MCOs) to provide Medicaid and Children’s Health Insurance Program

(CHIP) services to clients. Overall care of clients under MC is coordinated by the MCOs to improve quality and control costs.

“Purchase Order” is an official document the procuring entity sends to a vendor or contractor requesting and authorizing a purchase of goods or services.

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

“Solicitation” means this RFP including all exhibits, attachments, forms, and Addenda, if any.

“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 in the Schedule of

Events has passed.

https://statutes.capitol.texas.gov/Docs/GV/htm/GV.662.htm#662.003 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=1&pt=15&ch=391&rl=107 http://www.txsmartbuy.com/esbd

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

“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.

“Work Order” means an individually negotiated document that is executed by both Parties, and which authorizes a Project, if any, in an indefinite quantity Contract.

“Work Order Request” means an instrument drafted by HHSC used to request offers from an eligible contractor for the completion of specific tasks or the delivery of certain goods.

“Work Order Response” means an offer submitted by a Contractor in an eligible pool describing how the Contractor will accomplish the work for a specific price in response to a Work Order

Request – Response Form.

“Work Order Request-Response Form” means an instrument that contains the WO Request

Requirements, the WO Response, and a Work Order Authorization sections on one form, see

Exhibit E.

1.3 AUTHORITY

HHSC is soliciting the services stated in this Solicitation under the authority of the Texas

Government Code, Section 2155.144 (a), (b-1) (2).

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 https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2155.htm#2155.144

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ARTICLE II. SCOPE OF WORK

2.1 INTRODUCTION

HHSC intends to award a single Contract to a qualified Contractor to provide financial analysis and financial data management and modeling Services as requested by HHSC to support the

Texas Medicaid program including the Texas Healthcare Transformation and Quality

Improvement Program. Work performed under the Contract will be identified, as needed, through Work Orders (WO) as described in Section 2.2.1 (Work Order Process) of the RFP.

In addition to Article II, Scope of Work, of the RFP, each Work Order will include a detailed statement of work, schedule of Services, description of Services and Contractor requirements, including, Deliverables, liquidated damages, and the estimated value of Services to be performed by the Contractor during the Contract Term and as required by each Work Order (see Exhibit E, Work Order Request–Response Form).

2.1.1 Background

The Texas Healthcare Transformation and Quality Improvement Program, a Section 1115

Demonstration Waiver, is a federally approved Medicaid waiver that began in 2011 and has been extended through 2030. The waiver allows for Medicaid MC expansion to additional areas of the

State while preserving some aspects of the former Upper Payment Limit (UPL) program.

Historically, the waiver’s funding has been established through supplemental payment funding, MC savings, and negotiated funding worth more than $20 billion (all funds) and is comprised of two statewide pools: Uncompensated Care (UC) and Delivery System Reform Incentive

Payment (DSRIP).

The pool funding is available to encourage Medicaid providers to establish better service delivery practices to improve quality, health status, patient experience, coordination and cost effectiveness. The waiver also allows HHSC to establish other budget neutral Medicaid MC reimbursement programs. Currently, HHSC’s Uniform Hospital Rate Increase Program (UHRIP) is funded through the waiver.

Contractor Services provided through this Contract will cover the UC pool, UHRIP, and

Disproportionate State Hospital (DSH) and other future HHSC programs as allowed under the waiver. The Delivery System Reform Incentive Payment (DSRIP) pool is outside the scope of this Solicitation.

Waiver funds may be used to help reimburse the costs incurred by hospitals (public and private), physician group practices that had previously participated in the physician UPL program, and certain other public providers for patient care services provided to low-income uninsured patients that are not reimbursed through Medicaid rates, by other payors or by other Medicaid supplemental payments.

HHSC’s Rate Analysis Department manages the UC program. HHSC uses two (2) UC applications for providers to submit their UC-eligible project demonstration cost data, (1) the

Texas Hospital Uncompensated Care (TXHUC) tool, and (2) the Texas Physicians

Uncompensated Care (TXPUC) tool. The TXHUC tool is also used for determining DSH payments to hospitals. Annually between October 1 and ending September 30 of the applicable year, the UC applications collect the UC-eligible cost data from providers. HHSC reviews the

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Revision Date 09/12/2023 submitted UC-eligible cost data and performs edits of the data to check for accuracy. HHSC may request additional information from providers if needed. The providers’ eligible UC amounts are calculated by HHSC for fund distribution among the eligible providers from the pool. Distributed funds cannot exceed the annual statewide pool limit. Additionally, non-hospital providers and non-physician groups submit cost reports for calculating their UC payments through the tools.

The non-federal share of supplemental payments comes from intergovernmental transfers, largely from local public entities and a number of Local Provider Participation Funds (LPPF) in the State into which some private hospitals pay. The non-federal share for certain providers is met through Certified Public Expenditures (CPE).

The UHRIP program is established under 42 CFR § 438.6(c). Under this program, participating hospitals can receive an enhanced reimbursement for inpatient and outpatient services provided to Medicaid clients beyond their provider agreement with the Medicaid Managed Care

Organization (MCO). The program is renewed annually and is funded by intergovernmental transfers. Each of the participating seven hospital classes in UHRIP (children's hospitals, non-urban public hospitals, rural private hospitals, rural public hospitals, State-owned hospitals, urban public hospitals, and all other hospitals, except institutions for mental diseases) in one of the thirteen (13) Medicaid MC service delivery areas in Texas are eligible to receive a percentage increase in their reimbursements from MCOs. More details on UHRIP can be accessed at 1 Texas

Administrative Code, Part 15, Chapter 353, Subchapter O, Sections 353.1301 and 353.1305.

2.2 SERVICE REQUIREMENTS

2.2.1 Work Order Process

All work performed under the Contract must be initiated through the Exhibit E, Work Order

Request-Response Form. Section III, Work Order Authorization, of the Exhibit E, must be executed by Parties prior to performing any Work, or invoicing for any Work, associated with each individual Work Order.

Each Exhibit E, Work Order Request–Response Form, will include a detailed Work Order statement of work, individual requirements including Deliverables, schedule of Services, estimated value of Services to be performed and evaluation criteria. A fully executed Work

Order Request – Response Form, see the Exhibit E, Work Order Request – Response Form, must accompany the HHS issued Purchase Order. The Work Order Request – Response Form must be signed by both HHSC and the Contractor.

a. The Contractor and HHSC will follow the WO process described below:

1. HHSC will draft a Work Order Request using Exhibit E, Work Order Request –

Response Form.

2. HHSC will email Contractor the draft Exhibit E, Work Order Request-Response

Form which contains the due date and template for the Work Order Response.

3. Contractor must send an acknowledgement of receipt of the Exhibit E, Work Order

Request – Response Form via email: DSQI@hhs.texas.gov within one (1) Business

Day of receipt of HHSC’s email.

https://www.ecfr.gov/current/title-42/part-438/section-438.6#p-438.6(c) https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=5&ti=1&pt=15&ch=353&sch=O&rl=Y https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=5&ti=1&pt=15&ch=353&sch=O&rl=Y mailto:DSQI@hhs.texas.gov

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4. Within five (5) Business Days of the receipt of HHSC’s email, Contractor may submit written questions regarding the draft Work Order Request to the point of contact via email: DSQI@hhs.texas.gov.

5. HHSC will respond to the Contractor’s questions within five (5) Business Days of the receipt of the questions.

6. Within ten (10) Business Days after HHSC’s response to the Contractor’s questions, Contractor will submit the completed Exhibit E, Work Order Request – Response

Form, including its Work Order Response, to HHSC’s point of contact via email:

DSQI@hhs.texas.gov. This information may include, but not be limited to:

A. Contractor will provide its Work Order Response using the Section II, Work

Order Response, in the Exhibit E, Work Order Request-Response Form.

B. HSP modifications and detailed cost information for each Deliverable or task;

C. Costs associated with travel, if applicable, to fulfill the WO and/or a proposed project schedule.

7. Work Order Response will be evaluated in accordance with Section I(E)(1), of the

Exhibit E, Work Order Request – Response Form.

8. If the WO Response is not approved, HHSC will work with Contractor to resolve the outstanding issues with the WO until Parties can mutually agree to an outcome.

9. If the WO Response is approved by HHSC, Contractor must sign the Section III, Work Order Authorization, of the Exhibit E, Work Order Request – Response

Form and return it to HHSC’s point of contact via email: DSQI@hhs.texas.gov.

within five (5) Business Days.

b. Within five (5) Business Days of receiving Contractor signed WO, HHSC will sign the

Section III, Work Order Authorization, of the Exhibit E, Work Order Request –

Response Form.

c. HHSC will forward the executed Work Order Exhibit E, Work Order Request-

Response Form, and accompanying Purchase Order, to the Contractor. Contractor must not start work until the fully executed Work Order is received.

d. Each Work Order will be automatically incorporated into the Contract.

e. Contractor will invoice HHSC based on instructions provided in Section 2.3.4

(Payments and Invoices) below and any special instructions set forth in individual WO.

f. All communications and submission of documents required for WOs will be conducted by email.

2.2.1.1 Minor Work Order Changes

Minor changes to the resulting WO are authorized informally without amending the original

WO. The minor changes identified below are permitted, without a major Work Order change, under the specific WO.

a. Changes in Contractor’s personnel that will participate in traveling, if applicable, so long as the changes do not result in the Contractor’s travel expenditures invoiced for mailto:DSQI@hhs.texas.gov

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Work Order Response. A minor change is permitted under the following conditions:

1. It must be agreed upon by Parties;

2. It must be in writing, via email correspondence; and

3. It must be documented in the Contract file.

b. Changes in a Deliverable timeline/deadline, so long as a Deliverable timeline/deadline does not exceed the WO end date of the Exhibit E, Work Order Request – Response

Form. Minor changes are permitted under the following conditions:

1. It must be agreed upon by Parties;

2. It must be in writing, via email correspondence; and

3. It must be documented in the Contract file.

c. Changes in Contractor’s expenditures for any individual Deliverable, either an increase or a decrease in expenditures, of this Work Order Response, so long as Contractor’s total invoiced expenditures for reimbursement for all Deliverables listed in the Work Order

Request does not exceed the “Total Expenditures for Deliverables” of this Work Order

Response. This minor change does not require:

1. HHSC prior authorization; or

2. Documenting the change within the Contract file.

d. Changes to the HHSC Work Order Request Point of Contact, identified in Exhibit E, Work Order Request-Response Form, Section I, Work Order Request Requirements, B.1, and Contractor’s Point of Contact, identified in Section II, Work Order Response, A.1. Contractor or HHSC will notify the other Party’s contact, via email, of any changes to its Point of Contact, and the notification email will be documented in the Contract file.

This minor change does not require authorization by Contractor or HHSC.

2.2.1.2 Major Work Order Changes

Contractor must submit all major WO changes to HHSC’s assigned Contract Manager for approval. Major WO changes are defined as changes affecting the terms of the agreed upon

Work to be performed; and/or changes to the timeline that exceeds the original WO end date;

and/or changes to costs previously agreed upon in the WO. HHSC reserves the right to request a revised, Exhibit E, Work Order Request-Response Form, or to request the Work to be moved to another WO or to reduce the Work requested.

2.2.1.3 Contract Amendment

Any changes that affect the Contract’s budget, or amends any parts of the Contract, including terms and conditions, Contract exhibits, and attachments of the Contract must be addressed through an Amendment.

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2.2.2 HHSC Roles and Responsibilities

a. HHSC will provide access, remote and physical, to the necessary documentation, data and/or HHSC staff, as outlined in the Exhibit E, Work Order Request-Response

Form.

b. HHSC will respond to Contractor inquiries within the timeframes set forth in Section

2.2.1 (Work Order Process).

c. HHSC will provide the necessary data to perform data analysis, rate setting, reimbursement reviews, and other Medicaid related information as needed for the

Contractor to perform the Services.

d. HHSC will provide administrative support in coordinating with MCOs in the gathering of data and reports.

e. HHSC will organize meetings, update distribution lists, and coordinate responses to data requests.

f. HHSC will communicate data and reports to the Executive Commissioner (EC), Legislative Budget Board (LBB), State Auditor’s Office (SAO), Office of the Governor

(OOG), and CMS.

g. HHSC will review WOs, reports, and other documentation submitted by the Contractor.

h. HHSC will provide policy clarification and updates related to Medicaid programs and agency rules and regulations.

i. HHSC will provide clarification regarding HHSC operations, directives, policies, and

Contract provisions.

j. HHSC will collect and provide historical data, reports, and other information needed by the Contractor to meet the requirements of the Contract.

k. HHSC will monitor the Contractor’s performance of Contract requirements, WOs (as required in Section 2.2.1 (Work Order Process)), Deliverables, and compliance with the

Contract’s terms and conditions.

l. HHSC will provide at least one (1) point of contact for the Contractor.

2.2.3 Contractor Requirements

Contractor must demonstrate the knowledge, expertise, skills, and abilities to complete the

Services as described in the Contract. The Services included in this Contract are applicable to all

WOs under the Contract. The Contractor must:

a. Provide actuarial expertise in financial analysis, quality assurance and financial data modeling Services;

b. Assist HHSC to formulate solutions for issues related to Medicaid reimbursement and financial analysis quality assurance as needed, including supplemental payment programs;

c. Provide financial analysis expertise, financial data management and modeling support that include the provisions of trend, efficiency and qualitative analysis;

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d. Perform comparisons and analyses of reimbursement rates and supplemental payment programs including development of options for allocating supplemental payments among various types of providers;

e. Review pool fund data and distribution to check for completeness, accuracy, and consistency;

f. Provide expertise of Centers for Medicare and Medicaid (CMS) regulations and waiver requirements;

g. Respond to and provide supplemental documentation to meet federal and State legislative mandates and other program data requirements as needed;

h. Assist HHSC in leading and presenting information in various forums that include, but are not limited to, workgroup meetings with System Agency staff, external industry advocacy groups, provider associations, appointed boards and committees, task forces, and other forums as requested by HHSC within the scope of Contract;

i. Provide financial support services and reports not covered under other contracts, as needed by HHSC;

j. Perform objective financial analysis associated with assessment, evaluation, planning and reporting on behalf of HHSC;

k. Provide data management and modeling related, but not limited, to uncompensated care costs and encounter data;

l. Participate in meetings with HHSC staff, HHSC contractors, legislative committees and

CMS representatives as needed. Meetings may be held on a regular basis and may be scheduled on a short notice;

m. Support and respond to inquiries from HHSC, CMS, and Stakeholders regarding any program development and the related contract with the MCOs. The Contractor will work with HHSC to provide written responses to CMS;

n. Act as a liaison between CMS and HHSC;

o. Develop Uncompensated Care (UC) and other supplemental payment templates and workflows to respond to HHSC needs concerning provider cost reporting requirements;

and

p. Assist HHSC in any additional waiver related projects, within the scope of this Contract, assigned by HHSC.

q. Provide knowledgeable and experienced key personnel set forth in Section 2.2.4

(Contractor’s Key Personnel) to perform the Services as required in this section.

r. Maintain confidentiality of Medicaid recipient information and other documents provided by HHSC and/or its vendors/providers.

s. Provide guidance and expertise with financial and health insurance services in the public sector.

t. Possess the competence related to Medicaid long‐term care initiatives, including:

1. Eligibility criteria and processes;

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2. Delivery systems and methods, such as integration of home and community-based care delivery systems with MC in a manner consistent with recently published CMS home and community-based services regulations; and

3. Payment systems.

u. Provide expertise with Medicaid delivery system transformation and improvement, specifically including integrated care models, case management models, and care delivery innovation.

v. Provide expertise with Medicaid payment system transformation and improvement, specifically including reimbursement methodologies, payment reform, and innovative payment systems.

2.2.4 Contractor’s Key Personnel

Contractor shall provide qualified personnel for the following roles:

a. Senior Actuary (Healthcare) – The Contractor shall provide one (1) position that serves as the senior actuary during the Contract Term. The senior actuary shall:

1. Possess a minimum of eight (8) years of experience in Medicare or Medicaid rate setting, analysis of health trends, forecasted medical costs, and leading projects of similar scope;

2. Possess the Fellow of the Society of Actuaries (FSA) designation.

3. Possess the ability to render actuarial opinions set forth by the Actuarial Standards

Board.

4. Possess experience in regulatory compliance to effectively navigate State and federal laws relevant to public sector or government sponsored health insurance.

5. Be responsible to deliver, coordinate, and direct the Contractor’s resources to meet the requirements of the Contractor and to address all concerns and issues raised by

HHSC;

6. Possess the ability to effectively manage the scope, schedule, cost, and service quality to meet the Contract requirements;

7. Possess the experience and judgment to plan and accomplish goals and objectives of this Solicitation and subsequent Contract;

8. Possess the ability to use a wide degree of creativity and latitude to independently perform a variety of complicated tasks with competing deadlines;

9. Provide effective communication and collaboration skills to work seamlessly with cross functional teams; and

10. Possess the ability to effectively handle clients and stakeholders’ relationships.

b. Associate Actuary (Healthcare) – The Contractor shall provide one (1) position that serves as the associate actuary during the Contract Term. The associate actuary shall:

1. Possess a minimum of four (4) years of experience in Medicare or Medicaid rate setting, and analysis of health trends and forecasted medical costs;

https://www.soa.org/education/exam-req/edu-fsa-req/

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2. Possess a bachelor’s or master’s degree in actuarial science, mathematics, statistics or a related field;

3. Possess the Associate of the Society of Actuaries (ASA) designation.

4. Possess the ability to render actuarial opinions set forth by the Actuarial Standards

Board;

5. Knowledge of State and federal laws and regulations relevant to public sector and government sponsored health insurance;

6. Be skilled in benefit plan analysis, design, cost avoidance, risk and funding strategies, developing pricing, and modelling plan design alternatives;

7. Possess the ability to manage multiple projects simultaneously and produce quality deliverables on time and within budget;

8. Provide effective communication and collaboration skills to work seamlessly with cross functional teams; and

9. Possess the ability to effectively communicate with stakeholders.

c. Financial Analyst(s) – The Contractor shall provide the number of financial analysts to deliver the Services required by each Work Order during the Contract Term. The financial analysts shall:

1. Possess a minimum of four (4) years of experience in Medicare or Medicaid rate setting, and analysis of health trends and forecasted medical costs;

2. Possess a bachelor’s or master’s degree in actuarial science, mathematics, statistics or a related field;

3. Possess the ability to administer financial processes and systems to perform and interpret numerical analyses, statutes, rules and regulations;

4. Possess knowledge of financial analyses and examination procedures for regulated entities, financial and industry terminology and practices, and statistical analysis;

5. Possess knowledge of analyzing, evaluating, and summarizing financial records for accuracy and conformance to state and federal laws and regulations relevant to public sector and government sponsored health insurance;

6. Be skilled in benefit plan analysis, design, cost avoidance, risk and funding strategies, developing pricing, and modeling plan design alternatives;

7. Possess the ability to analyze, coordinate, and solve complex problems and collaboratively work in a team environment to handle competing tasks; and

8. Possess the ability to effectively communicates with agency subject matter experts and support staff.

d. Project Manager – The Contractor shall provide one (1) position that serves as the dedicated account and project manager currently certified by Project Management

Institute (PMI) to serve as the Contractor’s primary point of contact to HHSC during the

Contract Term. The Project Manager shall:

1. Possess a minimum of eight (8) years of experience leading projects of similar scope;

https://www.soa.org/education/exam-req/edu-asa-req/

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2. Possess a minimum of five (5) years of experience in Medicare or Medicaid claims and analysis of health trends and forecasted medical costs;

3. Possess a bachelor’s or master’s degree in actuarial science, accounting, business administration, finance, mathematics, statistics or a related field;

4. Possess proficient knowledge in project management methodologies;

5. Possess knowledge of State and federal laws and regulations relevant to public sector and government sponsored health insurance;

6. Be skilled in benefit plan analysis, design, cost avoidance, risk and funding strategies, developing pricing, and modeling plan design alternatives;

7. Possess the ability to effective communication and collaboration skills to work seamlessly with cross functional teams;

8. Possess the ability to effectively manage the scope, schedule, cost, and service quality to meet the Contract requirements; and

9. Possess the ability to effectively communicate with stakeholders.

e. Business Analyst(s) – The Contractor shall provide the number of business analysts to deliver the Services required by each Work Order during the Contract Term. The business analyst shall:

1. Possess a minimum of three (3) years of experience with projects of similar scope;

2. Possess a minimum of three (3) years of performing analysis of business processes related to Medicare or Medicaid claims and reimbursements;

3. Possess the ability to research, document, and analyze state and federal trends, policy issues, proposed legislation, regulations and rules to assist with the development;

4. Possess the ability to disseminate, present, review, and approve of the development, analysis, implementation, and documentation of business requirements;

5. Possess the ability to perform data analysis of claims processing and reimbursements, and other related matters to identify and make recommendations for business requirement update or new projects;

6. Respond to stakeholder inquiries, prepares and approves written reports for stakeholders;

7. Assist the Project Manager to effectively manage the scope, schedule, cost, and service quality to meet the Contract requirements; and

8. Possess the ability to effectively communicate with stakeholders.

f. Reimbursement Analyst(s) – The Contractor shall provide the number of reimbursement analysts to deliver the Services required by each Work Order during the

Contract Term. The reimbursement analysts shall:

1. Possess a minimum of five (5) years of experience in Medicare or Medicaid claims reimbursement and forecasted medical costs for public sector and government sponsored health insurance;

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2. Possess a minimum of one (1) year of experience developing, compiling, analyzing, and interpreting statistical data for rate analysis for public sector and government sponsored health insurance;

3. Possess a bachelor’s or master’s degree in accounting, business administration, finance, mathematics, statistics or a related field;

4. Possess the ability to design and study of special cost and statistical research and analysis to valuation the feasibility and cost implications regarding payment rate structure options, new program initiatives or enhancements, and new regulations;

5. Be proficient in developing and conducting economic studies and analyses and preparing financial reports;

6. Possess knowledge of Government Audit Standards (as applicable), accounting, budget control, and management methods, policies, and procedures; laws rules and regulations governing reimbursement and public administration;

7. Possess knowledge of reimbursement methodologies, payment rates, fees, formulas, rates, pricing, statistical analysis processes and research techniques;

8. Possess the ability to aggregate, review, and analyze data to create solutions to problems, prepare reports, meet deadlines, and to communicate effectively to with stakeholders; and

9. Possess knowledge of State and federal laws and regulations relevant to public sector and government sponsored health insurance.

g. Data Analyst(s) – The Contractor shall provide the number of data analysts to deliver the

Services required by each Work Order during the Contract Term. The data analyst shall:

1. Possess a minimum of five (5) years of experience in Medicare or Medicaid claims reimbursement and forecasted medical costs for public sector and government sponsored health insurance;

2. Possesses a bachelor’s in data science, business analytics, computer science, accounting, finance, mathematics, statistics or a related field;

3. Possess knowledge of Government Audit Standards (as applicable), generally accepted accounting principles, federal and state rules and regulations;

4. Be skilled in numerical and record analysis, statistical data tools, applications, methods, and techniques;

5. Possess the ability to perform advanced organizational and policy analysis work, analyzing procedures, preparing concise reports, identifying problems, evaluating alternatives, and making sound decisions;

6. Possess the ability to interpret historical, current, and projected data to identify problems, causes, and areas where process improvements are needed;

7. Be skilled in the oversight and design, evaluation, collection, and reporting of cost report data; and

8. Possess the ability to effectively communicate with stakeholders.

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2.2.5 Replacement of Key Personnel Requirements

Contractor shall not remove any key personnel from its Work Order team until a WO has been completed.

a. HHSC reserves the right to alter the designation of any Contractor personnel as key personnel. HHSC, at its discretion, may request that the Contractor remove key personnel providing Services under the Contract, if HHSC believes that such an individual is not providing the Services as described within the Contract and the Contractor, after notice, has been unable to resolve performance issues relative to such individual.

b. Contractor shall obtain prior approval from HHSC before the reassignment of any key personnel.

c. In the event the Contractor proposes replacement or substitution of key personnel during the Contract Term, the Contractor shall provide HHSC with the resumes of qualified individual(s). The resume for the proposed key personnel must be provided to HHSC either:

1. Within 10 Business Days prior to the proposed start date of any additional (e.g., individual filling a new position) or replacement (i.e., individual replacing a removed individual) key personnel; or

2. Within 10 Business Days of notification of resignation or illness, if less than ten

Business Days is given by key personnel, immediately upon key personnel’s notice of resignation or illness, provide the substitute key personnel’s resume; and

3. Replacement and substitute key personnel must have a level of qualification and experience equal or superior to the original key personnel replaced.

d. HHSC will have the right to conduct an interview of all proposed key personnel, provided such interview occurs before the commencement of Services by the relevant individual. HHSC will have the right to contact references of proposed key personnel.

HHSC will provide Contractor with written notice of approval or rejection of proposed key personnel within five (5) Business Days of receipt of the resume. HHSC shall have the right to reject assignment of any of the Contractor’s proposed key personnel by providing to Contractor a reasonable basis for such rejection. Within five (5) Calendar

Days of HHSC’s written notification of rejection, Contractor shall provide HHSC with additional resumes of proposed qualified individuals for review. This process shall be repeated until HHSC provides written notice to Contractor of HHSC’s approval of the individual selected. The approved individual must commence Services within 21

Business Days of the Contractor’s receipt of the HHSC selection approval notice.

2.2.6 Deliverables

The completed and authorized Work Order Request – Response Form as required by Exhibit E, Work Order Request – Response Form, will provide detailed Deliverables required for each

Work Order. In completing the Deliverables, the Contractor will do the following:

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a. Provide written reports that itemizes work performed with the associated costs against the budget as outlined in each WO.

b. Provide complete written explanations of all calculations, methodologies, and formulas to

HHSC or its contractors.

c. Provide written Deliverables in accordance with the timelines established for each approved WO. These written Deliverables may include, but may not be limited to, any or all of the following as specified in each individual WO:

1. Project plans;

2. Workflows;

3. Diagrams;

4. Financial spreadsheets;

5. Preliminary reports;

6. Progress reports; and/or

7. Final reports.

d. Develop effective presentations on analyses performed as requested by System Agency.

Presentations may be face-to-face or via electronic means as established per each individual WO.

e. Additional examples of deliverables may include, but may not be limited to, the following as specified in each individual WO:

1. Rate calculations;

2. Financial modeling;

3. Rebasing of rates;

4. Support in the development, and implementation of modernization and quality improvement initiatives and strategies, such as:

A. Eligibility simplification;

B. Managed long‐term care delivery systems; or

C. Health Homes delivery programs;

5. Support in the development of innovative service delivery systems, with modernized reimbursement methods and processes, which:

A. Are tailored to special medical and support needs of targeted populations; and

B. Are driven by analysis of clinical and financial data regarding the needs of targeted populations.

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2.2.6.1 Deliverable Acceptance Criteria

Each Deliverable must meet all the requirements set forth in the Contract, Article II, Scope of

Work of the RFP, and in Exhibit E, Work Order Request – Response Form. HHSC, at its sole discretion, will decide whether Deliverable(s) met all the requirements.

HHSC shall immediately or as specified in each WO notify the Contractor in writing via email of approval or rejection of the Deliverable. If the Deliverable is rejected, HHSC shall identify the specific inadequacies and/or failures in the Deliverable. The Contractor shall have two (2)

Business Days, or otherwise agreed upon deadline as approved in writing by HHSC, to address or correct specific inadequacies and/or failures in the Deliverable.

2.3 ASSOCIATED REMEDIES AND LIQUIDATED DAMAGES

2.3.1 General

Section 2261.101 of the Texas Government Code requires that all Contracts contain a remedies schedule, a graduated sanction schedule, or both. In accordance with that statutory requirement, sanctions and remedies will apply for the incidents specified in this section. This Contract will refer to the sanctions and remedies as “Sanctions.” In compliance with Section 2261.101, HHSC reserves the right, in its sole discretion, to include in each Work Order Request a schedule of liquidated damages in addition to those stated in this section.

2.3.2 Waiver for Good Cause

Liquidated damages and other remedies may be waived for good cause shown at the discretion of

HHSC. Contractors shall not be liable for any failure or delay in the performance of this Contract for the period that such failure or delay is beyond reasonable control of the Contractor.

2.3.3 Key Performance Measures

HHSC will monitor the performance of the Contract including all WO’s. All Services and

Deliverables under the Contract shall be provided at an acceptable quality level and in a manner consistent with acceptable industry standard, custom, and practice.

In the event Contractor fails to timely meet the performance measures enumerated below, it will be difficult if not impossible for HHSC to determine the actual damage to HHSC. As such, a reasonable estimate of HHSC’s projected financial loss and damage from Contractor’s failure to timely meet performance measures may be assessed against the Contractor as liquidated damages. HHSC reserve the right to waive liquidated damages at any time. The performance measures and liquidated damages are indicated in the table below.

https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2261.htm#2261.101 https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2261.htm#2261.101

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Key Performance

Measure ID

Performance Measure Frequency Liquidated

Damages

KPM-01 Contractor must complete the requested

Services and reports within the negotiated date contained in the WO.

Per

Occurrence

$500 for each

Business Day after the negotiated date.

KPM-02 Contractor must complete the requested reports within the negotiated date contained in the WO.

Per

Occurrence

$500 for each

Business Day after the negotiated date.

KPM-03 Contractor must complete the requested

Services by the WO end date for each

Project.

Per

Occurrence

$500 for each

Business Day after the WO end date.

KPM-04 Contractor must provide sound analysis for financial impact pertaining to program changes to HHSC within two

(2) Business Days, or otherwise agreed upon in writing by HHSC.

Per

Occurrence

$500 Per

Business Day after the correction period ends.

KPM-05 Contractor must provide and replace key personnel as required in Section 2.2.4

(Contractor’s Key Personnel) within

10 Business Days.

Per

Occurrence

$500 Per

Business Day after tenth

(10th) Business

Day.

KPM-06 For monthly performance or delivery cycle for Service, or Deliverable provided in the previous month, Contractor must provide an invoice within 10 Business Days of the end of the previous month of when the

Per

Occurrence

$250 Per

Business Day after tenth

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Key Performance

Measure ID

Performance Measure Frequency Liquidated

Damages

Service was performed, or Deliverable was accepted by HHSC as required in

Section 2.3.4 (Payments and Invoices).

(10th) Business

Day.

KPM-07 For a Service or Deliverable not associated with monthly performed or delivery cycle, an invoice must be submitted within 10 Business Days following the date the Service was performed or the Deliverable was accepted by HHSC as required in

Section 2.3.4 (Payments and Invoices).

Per

Occurrence

$250 Per

Business Day after tenth

(10th) Business

Day.

2.3.4 Payments and Invoices

2.3.4.1 Prompt Payment

All payments to a Contractor by HHSC, any payments by a Contractor to any Subcontractor, and any payments by a Subcontractor to any other person or entity that provides Goods or Services under this Contract shall be made in compliance with Chapter 2251 of the Texas Government

Code and Title 34 of the Texas Administrative Code Part 1, Chapter 20, Subchapter F, Division

1, Section 20.487.

2.3.4.2 Compensation Method

Compensation for WOs associated with this procurement will be made upon acceptance of

Deliverables. Compensation will be based on either a lump sum or fixed fee payment structure or time and materials, fully loaded hourly rates, with a not to exceed amount. Contractor’s Work

Order pricing may not exceed established rates identified in this Contract.

2.3.4.3 Reimbursement

HHSC will reimburse Contractor for successfully completing each Deliverable set forth in the

WO. Contractor may invoice upon its completion of each individual Deliverable and does…