ESBD_434200_1752063002671_26-001 RFP SHARS Medicaid Reimbursement Services (Final).pdf

Request for Competitive Sealed Proposals

School Health and Related Services (SHARS)

Medicaid Reimbursement Services

(RFP #26-001)

July 11, 2025

Spring Independent School District

P r o c u r e m e n t S e r v i c e s De p a r t m e n t 1 6 7 1 7 E l l a B l v d . • H o u s t o n , T e x a s 7 7 0 9 0 • T e l . 2 8 1 . 8 9 1 . 6 4 6 5

SPRING INDEPENDENT SCHOOL DISTRICT

PROCUREMENT SERVICES DEPARTMENT

16717 Ella Blvd.

Houston, TX 77090

1. GENERAL OVERVIEW OF SPRING ISD

The Spring Independent School District serves nearly 34,000 pre-kindergartens through twelfth-grade students within a diverse and growing district located 20 miles north of downtown Houston, extending along the Interstate 45 corridor in an urban area of Harris County that spans 57 square miles. Currently, there are 12 administration facilities and 42 campuses comprising 26 elementary schools, 9 middle schools, and 7 high schools.

For additional information about Spring ISD (SISD), including demographics and other facts and figures, please refer to the District’s website at www.springisd.org. Various SISD publications with additional District information are also available in digital format by clicking on the following link: Spring ISD Publications.

1.2. SPECIAL EDUCATION OVERVIEW:

Currently, Spring ISD has over 4,000 students who qualify for Special Education services, and of these students, over 50% qualify for Medicaid. The District provides medically necessary services to these students that are Medicaid eligible for reimbursement from the Health and Human Services Commission (HHSC).

CLAIMS HISTORY:

Below is a five-year claims history, which will provide prospective vendors an idea of Spring ISD’s reimbursement and settlement amounts from 2020 – 2025.

Five Year Claim History-Reimbursement and Settlement 2020-21 through 2024-2025

Fiscal Year

INTERIM PAYMENTS SETTLEMENT AMOUNT

Income Expense Net Income Expense Net Net for

Fiscal Year http://www.springisd.org/ http://www.springisd.org/default.aspx?name=ccr.publications

2. SCOPE OF WORK, BACKGROUND/OBJECTIVES, ETC.

2.1. SCOPE OF WORK:

The Spring ISD is accepting Proposals from qualified firms to provide SHARS/MEDICAID REIMBURSEMENT SERVICES on an as-needed basis under a multi-year contractual agreement. The term of the agreement shall be a one (1) year agreement with four (4) one (1) year extension clauses. Any and all fees associated with the services requested in this Solicitation must be disclosed in Vendor’s proposal. The Special Education Manager, or designee, will be the named primary contact for Spring Independent School District and will coordinate the purchases or services utilized under any contract resulting from this Request for Proposals. The terms and conditions of this RFP will become part of any subsequent contract and, in case of conflict, the terms/conditions of the RFP take precedence over the District’s “standard” Services Contract.

2.2. OBJECTIVES:

Spring ISD seeks a qualified Vendor that will help the District achieve the following objectives:

2.2.1. Provide SHARS/Medicaid Reimbursement Services as required by HHSC in the most efficient and cost-effective manner;

2.2.2. Provide a user-friendly claims submission system that meets TMHP requirements;

2.2.3. Be present and able to assist district staff in the District-wide implementation and training with minimal impact on regular operations;

2.2.4. Provide timely and dedicated ongoing support for the Provider’s claims submission system;

2.2.5. Provide HHSC program support, as needed, for cost report reporting and HHSC program audits.

2.3. VENDOR QUALIFICATIONS:

Qualified Vendors should have the experience, qualifications, and resources to provide the requested services and must meet the following qualifications:

SISD Employee SHARS Claims

Submitted

Vendor Claims

Processing Fee (6% with

$50K Cap)

Settlement for

RMTS / SHARS

2023-24 TBD TBD TBD TBD TBD TBD TBD

2022-23 $1,274,312.00 $116,746.03 $1,391,058.03 $4,229,373.68 ($4,464,939.55) ($235,565.87)

2021-22 $1,588,138.00 $259,306.03 $1,847,444.03 $6,059,781.64 ($3,334,775.11) $2,725,006.53

2020-21 $1,449,661.00 $243,411.48 $1,693,072.48 $6,734,467.17 ($871,935.84) $5,862,531.32

2019-20 $922,744.00 $11,740.45 $934,484.45 $5,828,709.33 ($11,740.45) $5,816,968.88

2.3.1. Must have proven experience and expertise in developing and implementing a direct service School Health and Related Services (SHARS) program with a working knowledge of Medicaid rate structures, timelines, regulations, etc., in a school district of a comparable size to the Spring ISD within the state of Texas.

2.3.2. Must be fully versed in legal requirements of Health Care Financing Administration, Texas Education Agency, Texas Health and Human Services Commission, Centers for Medicare and Medicaid services and/or any other state or federal agencies governing SHARS program and Services.

2.3.3. Must be able to comply at all times with all requirements (and any revisions of such) set forth by the HHSC, CMS and any other state, local or federal agency governing the SHARS program and services (including documentation requirements).

2.3.4. Must have the capacity to fully implement all aspects of the SHARS reimbursement services within the time frame established by Spring ISD.

2.3.5. Must have the capacity to accept /process both electronic (preferred method) and paper service tickets for filing claims.

2.3.6. Must have the internal capacity to assess and ensure that all SHARS claims are at least 99% correct within +/- 3% error with a confidence level of 95%.

2.3.7. Must have an internal systemic capacity of validating all SHARS requirements for billing to include—but not limited to:

a. Parental consent to bill;

b. Existence of a current Individualized Educational Plan (IEP);

c. IEP that authorizes the frequency and duration of school health and related services;

d. Verification of licensure and certifications for all service providers;

e. Verification of prescription for services provided to students;

f. Medicaid eligibility at different times of the year;

g. Proper documentation on SHARS.

2.3.8. Must provide relevant training to District personnel as needed to ensure legal compliance and efficient claim processing;

2.3.9. Must provide, and agree to furnish all Spring ISD billing and related data at the end of each contract year, or at any time within 10 business days of receipt of a written request. Such data should be given to Spring ISD in a standard Microsoft Excel file, comma -separated-values format, or any other standard format acceptable to the District;

2.3.10. Must submit claims on a timely basis to be determined by Spring ISD, notify Spring ISD when claims have been submitted, and resubmit rejected claims repeatedly to obtain alignment with floating Medicaid eligibility periods;

2.3.11. Must represent Spring ISD before state and federal officials relating to SHARS matters, upon request;

2.3.12. Must be able to meet with Spring ISD project implementation manager in person at Spring ISD as needed for the duration of the implementation period and via teleconference at least once a week to review implementation plan and coordinate the implementation of services;

2.3.13. Must give Spring ISD’s primary contact access to all reports used to submit claims;

2.3.14. Must be able to provide billing data reports in a standard Microsoft Excel, “comma-separated-values” (CSV) format, or any other information systems standard acceptable to the District to be able to reconcile for each billed session to include—but not limited to—the following fields:

h. Student ID

i. Student SSN

j. Student Medicaid Number

k. Medicaid Eligibility as of Date of Service

l. Beginning Date of Service

m. Ending Date of Service

n. Date Claim Submitted

o. Date Claim was Paid

p. RNS Report Reference

q. Service Provider ID

r. Service Provider Name

s. Transaction ID

t. Claim Amount

u. Reimbursed Amount

v. Type of Service

w. Amount

x. Billing Code

y. Modifier 1

z. Modifier 2

2.3.15. The Proposer’s account management team has a minimum of three (3) years of experience in K-12 education and SHARS services prior to the RFP due date with experience in building and maintaining successful relationships servicing independent school districts in Texas comparable to the size of the Spring ISD. (Please attach list of school districts served by Proposer with dates of services).

2.3.16. The Proposer has corporate personnel dedicated solely to SHARS claim processing, management and support for Spring ISD.

2.3.17. The Proposer has been in business for more than five (5) years in succession.

2.3.18. The Proposer has been the service provider for at least two (2) independent school districts with successful reviews by HHSC during the last 2 years.

2.3.19. The Proposer must offer needs analysis for proper implementation or continuation of all aspects of the SHARS program.

2.3.20. The Proposer will establish a dedicated Account Manager as the point of contact for Spring ISD throughout the term of the contract.

2.3.21. The Proposer will be capable of maintaining consistent service levels throughout the term of the contract.

2.3.22. The Proposer will train Spring ISD project manager to seek reimbursement from TMHP.

2.3.23. The Proposer will be capable of providing clear documentation designed for the appropriate audience – end user, manager, administrator, etc., with complete for each target in an organized and easy to reference format.

2.3.24. The Proposer’s proposed pricing must include the use of an electronic documentation system to be used for claim submissions.

2.3.25. The Proposer must provide separate pricing for the preparation and submission of a SHARS Cost Report. Although Spring ISD currently develops the Cost Reports, the District is interested in this option.

2.4. PROPOSED IMPLEMENTATION SCHEDULE:

2.4.1. Kick-off Meeting: October 1, 2025 (Tentative)

2.4.2. Implementation & Training: Complete by October 30, 2025 (Tentative)

2.4.3. Go Live: November 1, 2025 (Tentative)

2.5. PROJECT LOGISTICS:

The successful Vendor will be expected to provide the appropriate onsite resources at any given time during the implementation based on the current needs of the project. Building access, work hours, and any offsite work must be approved in advance by Spring ISD’s project manager. Members of the vendor’s implementation team shall provide their own laptops.

The vendor will designate a project manager who will be the primary point of contact with Spring ISD during the implementation. The project manager will be responsible for all project activities performed by the vendor and the vendor’s team. Although it is not necessary for the vendor project manager to be onsite during the implementation, he or she must be readily accessible via e-mail or phone in order to provide adequate turnaround on Spring ISD questions or requests.

The vendor project manager will also participate, in person, in Spring ISD management team biweekly meetings, or as needed at the district’s discretion, as the vendor’s point of authority for all issues related to the project. The vendor project manager is expected to bring to Spring ISD’s attention any resource deficiencies.

The following deliverables are also expected for a successful system implementation:

• Conduct project kick-off meeting

• Provide implementation leadership and guidance to Spring ISD project team

• Conduct unit and system testing

• Conduct integration testing

• Conduct volume/stress testing

• Support user acceptance testing

• Perform production tests

• Cutover to new system

• Conduct training in conjunction w/district staff

• Conduct project close-out meeting

Spring ISD will also have a project manager for the duration of the project, and will provide a project team comprised of subject matter experts (SMEs) who will be teamed up with the vendor consultant to:

- Define new business workflows;

- Configure the system;

- Perform unit, integration, and parallel testing;

- Share knowledge;

- Determine initial reporting requirements (as applicable); and

- Execute data conversion and data migration activities to populate the new system.

2.6. TECHNOLOGY INFRASTRUCTURE:

The table below lists some of the major administrative systems and applications currently utilized in the District:

System/Application Vendor/Product SHARS/Medicaid Reimbursement System Service Management System/Application Vendor/Product Special Education IEP Management System eStar eSped Student Information System Aeries Credit Recovery, Grade Repair, and Initial Credit Edmentum/APEX Web Content Management System (WCMS) APPTEGY Network Operating System (NOS) MS Active Directory Financial and Payroll Management System SunGard eFinancePLUS Payroll Time clock TimeClock Plus Identity Management Identity Automation's DSS Email Google Gmail for Education

Servers/Desktop/Laptop hardware Dell Storage Area Networks Dell EMC/Dell Equalogic Web Filter Content Keeper Food Service point-of-sale system PrimeroEdge by Cybersoft Technologies Anti-virus software Crowdstrike Data warehouse software Decision ED District portal for staff and students Classlink Virtual server software VMWare Desktop management Microsoft System Center Firewall Palo Alto Networks Internet connections Two (2) ISPs / Total of 1,700 Mbps

While preparing a response to this RFP, vendors should take into account the existing infrastructure of Spring ISD in an effort to determine which components may require upgrade or total replacement in order to successfully implement and continually support their proposed solution.

2.7. SYSTEM AND PROGRAM SUPPORT:

The awarded vendor shall provide the following support to the District over the entire duration of the resulting contract:

2.7.1. Initial claims reimbursement system implementation and ongoing dedicated technical support to the District’s two primary SHARS/Medicaid Administrators via email and phone during regular operating hours (8:00 am – 5:00 pm CST);

2.7.2. HHSC program support and guidance to ensure compliance with HHSC program rules and regulations.

2.7.3. A project manager presents on site for 4 hours every two weeks, unless the district administrator deems it unnecessary at that time.

2.8. STAFF TRAINING:

The awarded vendor shall have the resources and experience to provide claims reimbursement system training as follows:

2.8.1. Staff Training (End Users): Initial training during implementation will involve staff training of at least 570 District staff members, including employees and contractors involved in the claim’s reimbursement process. The awarded vendor would be required to provide this training over multiple sessions grouped by SHARS job category.

2.8.2. Administrator Training: Initial training during implementation will involve training of the district’s two (2) Administrators, including one SHARS Coordinator and one SHARS Medicaid clerk.

3. PROPOSAL EVALUATIONS

The review and evaluation of the Supplier’s responses will determine the Supplier(s) most capable of delivering the "best overall value" to the District, consistent with the requirements herein and as evidenced by the respondent’s experience in providing the type and scope of services required within this Solicitation.

Depending on the number and quality of vendor responses received, the District will facilitate an evaluation process to identify either a sole vendor or multiple Suppliers to be considered for contract award, as described herein:

3.1. Phase 1 Evaluation: Phase 1 entails the evaluation of written proposals submitted by Providers meeting the requirements referenced in this Solicitation. In phase 1, each vendor’s response will be reviewed for completeness and adherence to the submission requirements and will be ranked based on the evaluation criteria referenced in the table below. The District will be the sole judge of the quality of proposals and reserves the right, at its own discretion, to disqualify any vendor that submits a proposal that is incomplete, does not properly adhere to the solicitation requirements, and/or clearly does not meet the needs of the District. A Vendor’s response that is disqualified will not be scored nor ranked.

Phase 1 Evaluation Criteria

Criteria Description and Scoring Points System Maximum

Points Attainable

1. Purchase Price Each Vendor’s overall pricing proposal will be scored based on the pricing structure and anticipated costs over the term of the contract.

• Percentage of Medicaid Payments received from Reimbursements (15 pts)

• Percentage of Medicaid Payments received from Settlements (15 pts)

2. Quality of Vendor’s Goods or Services

Each Vendor’s quality of goods/services will be scored based on the information/products provided to the RFP. Factors may also include, but are not limited to:

• Proven Increased Revenue with use of Proposed Services (based on client references provided). (10 pts)

• Extent to Which the Vendor Offers Training and Support. (10 pts)

• Respondent’s demonstrated capability and resources to perform the required services. (5 pts)

*Note: Score based on the District’s opinion of the Supplier's ability to meet their needs.

3. Extent to which the Vendor’s Proposed Services meet the needs of the District

May include, but is not limited to:

• Provided information on how proposed services would increase SHARS reimbursement for the District.

• Provided Information on Proposed Electronic Documentation Increasing

Efficiency of Service Submissions to TMHP.

*Note: Score based on the District’s opinion of the Supplier's ability to meet their needs.

4. Vendor Reputation

May include but is not limited to:

• Quality of Client References Provided.

• Proven Increased Revenue with use of Proposed Services (based on client references provided).

*Note: Score may be impacted by the District’s opinion of the quality of the client references provided.

Criteria Description and Scoring Points System Maximum Points

Attainable

5. Vendor’s Past

Relationship with the District

Vendor's Past Service History with Spring ISD or Staff:

• Great (10 pts) / Fair (7 pts) / Unsatisfactory (1 pts)

• No Experience (7 pts)

6. Long Term Costs

Costs incurred beyond the initial contract term that may include, but is not limited to:

Not applicable

NA

7. Historically Underutilized Businesses

(HUB)

Compliance

Impact on the ability of the district to comply with laws and rules relating to historically underutilized businesses

Not applicable

NA

Total Points 100

3.2. Phase 2 Evaluation - Onsite Interviews and System Demonstrations (If necessary): The District, at its sole discretion, may select one or more Proposers to be invited to participate in an on-site interview process to further evaluate the qualifications and experience of the Proposer and to evaluate the functionality of the Proposer’s claim submission system.

Upon completion of the evaluation process, the total points earned by each vendor will be calculated to determine the final scores. The District, at its sole discretion, will determine which Vendor(s) to consider for contract award.

3.2.1. Discussions/Consultation:

Discussions/Consultation may be conducted with Proposer(s) who are deemed to be within the final competitive range. The competitive range will be determined by Spring ISD and will include only those initial proposals that Spring ISD determines have a reasonable chance of being awarded a contract. If discussions/consultation are conducted, Proposer(s) may be required to submit projected Medicaid reimbursement for a 3-year period.

Phase 2 Evaluation Criteria

Criteria Description Maximum Points Attainable

1. Claims Submission System Functionality (software demonstration)

• Degree to which software application meets the functional, technical, and other related requirements of the District

• Ease of use (navigation) of software/hardware

2. Implementation Methodology • Proposer’s will be evaluated based on clarity and thoroughness of their approach and methodology for a successful implementation

3. Review and Discussion of Projected Medicaid Reimbursement for a 3-Year Period

• Ideas to increase revenue of submitted claims that are feasible for the District to implement in their claim’s submission process

Maximum Score Attainable

3.3. Phase 3 Evaluation (Negotiation): The purpose of Phase 3 is to identify a single vendor for contract award consideration. In Phase 3, best-and-final offers, will be evaluated and scored based on the criteria specified below.

Phase 3 Evaluation Criteria

Criteria Description Maximum Points Attainable

Final Pricing (Best and Final Offers)

Analyze and compare initial and long-term costs of the system, including licensing and maintenance costs, and any other related costs to be incurred by the District.

NOTE: Pricing evaluations take into consideration the cost(s) to be incurred by the District and the overall value of the proposed products/services the District would receive at such costs.

Maximum Score Attainable

4. PROPOSAL SUBMISSION INSTRUCTIONS AND REQUIRED DOCUMENTS

Vendor responses (“Proposals”) shall be submitted electronically through the District’s web-based eSourcing system (the “System”). If you require assistance either with the online registration process or technical assistance with the System, please contact Procurement Services at 281-891-6465.

All Suppliers submitting a proposal shall review and abide by the instructions referenced herein:

4.1. DEADLINE FOR ELECTRONIC SUBMISSION OF PROPOSALS (“BID OPENING”): Proposals shall be submitted electronically via the District’s System prior to 12:00 p.m. (CST) on Friday, July 25, 2025. After such time, the System “locks” and does not allow the submission of any responses.

Respondents are encouraged to submit their electronic responses with plenty of time in advance of the deadline indicated to ensure a timely response. The District will not be responsible for lateness of receipt due to Internet delays or unavoidable circumstances.

4.2. REVIEW/RESPOND TO ITEMS WITHIN THE E-SOURCING SYSTEM: Within the e-Sourcing system, proposing Suppliers shall review all information provided and respond to all required information (if applicable) that may be listed under the following sections of the e-Sourcing system:

i. Attachment’s tab: This section of the e-Sourcing system may contain documents in electronic format (i.e., Word, Excel, PDF, etc.) that require the Vendor’s review and/or completion, as directed.

ii. Attributes tab: This section of the e-Sourcing system may contain important Vendor instructions and/or requests from the District for miscellaneous Vendor information.

Suppliers must review and/or respond to (if applicable) all Attributes associated with this Solicitation.

iii. Line Items tab: This section of the e-Sourcing system may contain one or more-line items for which the proposing Suppliers must provide the requested product/service information, which often constitutes item price, item description, item brand and model, manufacturing part #, etc. Suppliers must supply all requested item information.

iv. Response Attachments tab: This section of the e-Sourcing system may reference one or more documents that must accompany the Proposer’s response. Any documents referenced in this section must be uploaded through the District’s e-Sourcing system in the format specified, if applicable.

4.3. PROVIDE REQUIRED DOCUMENTS (‘RESPONSE ATTACHMENTS’), AS INSTRUCTED HEREIN: This Solicitation requires proposers to provide the documents listed below by uploading them into the District’s e-Sourcing system as electronic documents under the ‘Response Attachments’ tab.

Unless specified otherwise within this Solicitation, the documents should be uploaded in PDF file format (either as separate attachments or combined into a single PDF file). Any required documents not provided by the proposing Vendor may be grounds for disqualification from participation in this Solicitation.

i. Company Summary & Narrative: Responding proposers are required to provide a Company Summary & Narrative of the related work that your company has provided to other organizations that are similar in size to the School District. This narrative shall include the name, address, and contact information of the referred organization.

NOTE: All required documents must be completed and signed (if applicable), and then uploaded to the District’s e-Sourcing system under the ‘Response Attachments’ tab.

-- End of Solicitation document –