ESBD_File_343291_Exhibit G Credentialing Software SOW.pdf

Exhibit G Credentialing Software Statement of Work (SOW)

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1. INTRODUCTION/BACKGROUND

The Health and Human Services Commission (HHSC) is the state umbrella agency for Texas Health and Human Services (HHS) programs. The HHSC Health and Specialty Care System provides support services to the State Hospitals. HHSC’s vision is making a positive difference in the lives of the people they serve. Their mission is improving health, safety, and well-being of Texans with good stewardship of public resources.

HHSC is charged with oversight and operation of nine (9) State Hospitals, one (1) Center for Infectious Diseases Hospital and one (1) Psychiatric Residential Treatment Facility, which provides psychiatric services and care for adults, adolescents, and children with major mental illnesses. Some State Hospitals provide maximum security adult forensic psychiatric services, and one provides secured forensic services to adolescents referred from throughout the state.

“Practitioner credentialing is a critical safety issue for healthcare organizations that ensures clinicians have the necessary training and experience to provide safe care.”1 It is the Health and Specialty Care System State Hospital’s intent to procure and implement a cloud-based credentialing system that meets the standards of the Centers for Medicare & Medicaid Services (CMS), The Joint Commission (TJC), and the Texas Medical Board (TMB). These processes directly affect the care that patients receive through the ongoing validation of practitioner competency. The State Hospitals need a credentialing system that is user friendly and efficient to enable practitioners to begin providing services quickly. The State Hospitals are required to keep pace with new and emerging federal revalidation requirements, which a cloud-based system will allow.

Currently, all State Hospitals credential and privilege their medical staff independently through a paper-based system. This paper process and lack of ability to share physician credentialing information across the system is a hinderance to sharing practitioner services at multiple Hospitals. For practitioners to work at multiple State Hospitals the credentialing process must be repeated at each State Hospital independently.

1 Joint Commission FAQ Credentialing and Privileging - Use of Distributed Ledger Technology (DLT) Are organizations permitted to use DLT to improve efficiencies in the credentialing process? https://www.jointcommission.org/standards/standard-faqs/ambulatory/human-resources-hr/000002456/

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2. PURPOSE

To implement and provide a cloud-based service by which potential providers (physicians, advanced practice registered nurses, physician assistants, dentists, optometrists, and podiatrists) may be evaluated for participation with State Hospitals. Evaluation includes collecting, assessing, and validating qualifications and other relevant information pertaining to a provider to determine eligibility to deliver health care services.

3. DESCRIPTION OF SERVICES

Provide a cloud-based credentialing system to evaluate physicians, advanced practice registered nurses, physician assistants, dentists, optometrists, and podiatrists in accordance with Texas Administrative Code 28 TAC §21.3201 SUBCHAPTER X utilizing the standardized credentialing application forms required by the Texas Insurance Code 8 §§ 1452.051-1452.052.

a. Provide a cloud-based credentialing system that meets the CMS Conditions of Participation (CoP), standard of The Joint Commission (TJC), and the requirements of Texas Medical Board (TMB).

i. CMS Conditions of Participation defined here: Organized medical staff that operates under bylaws approved by the governing body, and which is responsible for the quality of medical care provided to patients by the hospital.

ii. The Joint Commission Requirements defined here:

1. MS.06.01.03, The Hospital collects information regarding each practitioner’s current license status, training, experience, competence, and ability to perform the requested privilege.

2. MS 06.01.07 EP 4 The hospital completes the credentialing decision process in a timely manner.

Center for Medicare and Medicaid Services CoP 482.22(a)(2) The medical staff must examine the credentials of all eligible candidates for medical staff membership and make recommendations to the governing body on the appointment of the candidates in accordance with State law, including scope-of-practice laws, and the medical staff bylaws, rules, and regulations.

https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=28&pt=1&ch=21&rl=3201 https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=28&pt=1&ch=21&rl=3201 https://statutes.capitol.texas.gov/DocViewer.aspx?DocKey=IN%2fIN.1452&Phrases=credential&HighlightType=1&ExactPhrase=False&QueryText=credential

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b. Texas Medical Board Requirements as defined here: Texas Administrative Code 22 TAC §163.4

c. Provide credentialing services to all State Hospitals.

d. Service availability should begin no later than January 1, 2024.

i. The contract may be renewed annually for four (4) one-year terms for a total not to exceed 5 years.

ii. If a subscription service, billed annually.

e. Provide a credentialing system that is user friendly and efficient to enable practitioners to begin providing services quickly.

f. Provide a cloud-based system that permits information sharing between State Hospitals for faster, more efficient, same day credentialing when practitioners provide services concurrently at more than one State Hospital or move between State Hospitals providing services.

g. This system should provide for a user interface that is in compliance with industry credentialing requirements issued by CMS, and TJC with continuous system upgrades and performance improvements.

h. Increase ease of data entry and reduce errors when completing required information by physicians. Forms are referenced here:

https://www.tdi.texas.gov/forms/form9credential.html

i. Provide for an electronic release of information by each provider such that State Hospitals may obtain additional information for the credentialing process when necessary.

j. Provide a cloud-based credentialing system that keeps pace with changing federal revalidation requirements.

k. Provide emails to medical staff office when re-credentialing is required at least 90 days prior to the date required for completion.

https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=9&ch=163&rl=4 https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=9&ch=163&rl=4 https://www.tdi.texas.gov/forms/form9credential.html

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4. LOCATION

– State Hospitals

Facility Name Address City State Zip Code

Austin State Hospital 4110 Guadalupe Austin TX 78751 Big Spring State Hospital 1901 N. Hwy 87 Big Spring TX 79720 El Paso Psychiatric Center 4615 Alameda Ave. El Paso TX 79905 Kerrville State Hospital 721 Thompson Dr. Kerrville TX 78028 North Texas State Hospital

– Vernon 4730 College Dr. Vernon TX 76385 North Texas State Hospital

- Wichita Falls 6515 Kemp Blvd Wichita Falls TX 76308 Rio Grande State Center 1407 Rangerville Harlingen TX 78550 Rusk State Hospital 805 N. Dickinson Dr. Rusk TX 75785

San Antonio State Hospital 6711 S. New Braunfels San Antonio TX 78223

Terrell State Hospital 1200 E. Brin Terrell TX 75160 Waco Center for Youth 3501 N. 19th St. Waco TX 76708

– Other Facility

Facility Name Address City State Zip Code

Texas Center for Infectious Disease 2303 SE Military Dr. San Antonio TX 78223

5. DELIVERABLES

a. Provide credentialing services to evaluate all physicians, advanced practice registered nurses, physician assistants, dentists, optometrists, and podiatrists requesting credentialing for work at any State Hospital.

b. Application management that allows applicants to electronically fill out and sign an application online, check application status, and upload supplemental documents.

c. Licensure management continuously monitors license expiration dates.

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d. Reappointment management continuously monitors reappointment expiration dates.

e. CME management continuously tracking required practitioner continuing medical education.

f. Template generator to deliver documents, reports, and packets from within the database.

g. Built in primary source verifications include Office of Inspector General (OIG), System for Award Management (SAM), Drug Enforcement Administration (DEA), National Practitioner Data Bank (NPDB), American Medical Association (AMA), Educational Commission for Foreign Medical Graduates (ECFMG), state medical boards and other primary source entities as applicable.

h. Implementation of an import management system to import diverse types of data elements from a paper-based credentialing system.

Internal and external users can view provider information based on specific security permissions. Supply ongoing maintenance to cloud-based system.

i. Update cloud-based system within 30 days of any non-critical federal or state requirements for credentialing.

6. KEY MILESTONES

a. Prepare software cloud-based system for operation by 01/01/2024

b. Teach/train staff how to utilize cloud-based system for operation by 03/01/2024

c. Create documentation/manual for use by staff and for use by applicants 01/01/2024

d. Create customized forms/reports for use by staff and for use by applicants 01/01/2024.

7. RECORD KEEPING

Confidentiality and Safeguarding of HHSC Records; Location of Data. Under this Agreement, Contractor may

a. Create,

b. Receive from or on behalf of HHSC, or

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c. Have access to, records or record systems collectively, “Health and Human Services Records” or “HHSC Records”.

i. Among other things, HHSC Records may contain social security numbers, or data protected or made confidential or sensitive by applicable federal, state, and local, laws, regulations, and ordinances, and the Family Educational Rights and Privacy Act, 20 U.S.C. §1232g (“FERPA”).

ii. If HHSC Records are subject to FERPA,

1. HHSC designates Contractor as a HHSC official with a legitimate educational interest in HHSC Records, and

2. Contractor acknowledges that its improper disclosure or redisclosure of personally identifiable information from HHSC Records will result in Contractor’s exclusion from eligibility to contract with HHSC for at least five (5) years.

iii. Contractor warrants and represents that it will:

1. Hold HHSC Records in strict confidence and will not use or disclose HHSC Records except as

a. permitted or required by this Agreement,

b. required by law, or

c. otherwise authorized by HHSC in writing;

2. Safeguard HHSC Records according to commercially reasonable administrative, physical and technical standards (such as standards established by

a. The National Institute of Standards and Technology and

b. The Center for Internet Security that are no less rigorous than best practices in the data security industry;

3. Continually monitor its operations and take any action necessary to assure that HHSC Records are safeguarded and the confidentiality of HHSC Records is maintained in accordance with all applicable federal, state and local, 7 | P a g e laws, regulations, and ordinances, including FERPA, and the terms of this Agreement; and

4. Comply with the HHSC’s rules, policies, and procedures regarding access to and use of HHSC’s computer systems.

iv. Contractor warrants and represents that it complies with HHSC’s Data Use Agreement. At the request of HHSC Contractor warrants and represents that it complies with HHSC’s Vendor Data Use Agreement. At the request of HHSC, Contractor agrees to provide HHSC with a written summary of the procedures Contractor uses to safeguard and maintain the confidentiality of HHSC Records.

d. Notice of Impermissible Use. If an impermissible use or unauthorized disclosure of any HHSC Records occurs, Contractor will provide written notice to the HHSC and its Chief Information Officer, within one (1) day after Contractor’s discovery of that use or disclosure. Contractor will promptly provide HHSC with all information requested by HHSC regarding the impermissible use or disclosure.

e. Return of HHSC Records. Contractor agrees that within thirty (30) days after the expiration or termination of this Agreement, for any reason, all HHSC Records created or received from or on behalf of HHSC will be (1) returned to HHSC, with no copies retained by Contractor; or (2) if return is not feasible, destroyed. Contractor will provide HHSC with written notice of Contractor’s intent to destroy HHSC Records twenty (20) days before destruction of any HHSC Records. Within five (5) days after destruction, Contractor will confirm to HHSC in writing the destruction of HHSC Records.

f. Disclosure. If Contractor discloses any HHSC Records to a permitted subcontractor or agent, Contractor will require the permitted subcontractor or agent to follow the same restrictions and obligations as are imposed on Contractor by this Section.

g. Location of Data. Regardless of any other provision of the Contract or its incorporated or referenced documents, all of the data for this agreement shall remain, and be stored, processed, accessed, 8 | P a g e viewed, transmitted, and received, always and exclusively within the contiguous United States.

h. Agency Confidential Information Remains Within United States.

Respondent shall ensure that all Agency Confidential Information, including such information residing on back-up systems, remains and is stored, processed, accessed, viewed, transmitted, and received, always and exclusively within the contiguous United States.

8. PERFORMANCE MONITORING AND MANAGEMENT

Contractor must describe its proposed methodology for monitoring and reporting system performance and the proposed approach to technology management including the methods for centrally managing system resources for providers and State Hospital staff members during credentialing and recredentialing. At a minimum, the following items shall be included:

• Access to vendor customer service for technical assistance

• Vendor software system outages

• Software performance

• Billing

9. SOFTWARE PAYMENT TERMS

Software perpetual license fees shall be a one-time charge for a non-exclusive license granted for the specified software. Maintenance fees, software subscription and any other fees are invoiced per the billing frequency stated in the contract. Services required, such as training, consulting, and implementation, are a one-time charge (unless otherwise noted in the contract) and reflected in the invoice.

All fees for services payable in full within thirty (30) days of receipt of invoice by HHSC. HHSC may exceed the maximum number of providers set forth, two hundred providers, by up to fifteen percent (15%) during the initial term or any renewal term without penalty.

10. IMPLEMENTATION - VENDOR CREDENTIALING ENTERPRISE

a. Vendor will have access to technical resources during the duration of the deployment.

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b. Vendor should be available and committed to the project to complete the deployment in 8-12 weeks. Additional hours may be required if the project length be extended past 8 weeks.

11. INSURANCE REQUIREMENTS, please see Appendix S–1

12. ELIGIBLE POPULATION

Physicians, advanced practice registered nurses, physician assistants, dentists, optometrists, and podiatrists requiring credentialing and Texas State Hospital staff submitting and reviewing credentialing applications and supporting documentation.

13. CHARACTERISTICS OF THE SERVICE POPULATION

Employed or contracted physicians, advanced practice registered nurses, physician assistants, dentists, optometrists, and podiatrists may self-enter credentialing requests through the cloud-based system. Prospective employee or contract physicians, advanced practice registered nurses, physician assistants, dentists, optometrists, and podiatrists may self-enter credentialing requests through the cloud-based system.

State Hospital credentialing staff submitting credentialing requests for physicians, advanced practice registered nurses, physician assistants, dentists, optometrists, and podiatrists.

14. SERVICE AUTHORIZATION AND REFERRAL PROCESS

Physicians, advanced practice registered nurses, physician assistants, dentists, optometrists, and podiatrists may submit credentialing requests through the cloud-based system attached to an identified state hospital.

State Hospital credentialing staff may request credentialing for identified staff.

15. TEXAS RISK AND AUTHORIZATION MANAGEMENT

PROGRAM (TX-RAMP)

Commencing on the Effective Date and during the Contract Term, Contractor must provide Services that comply with TX-RAMP Certification Level 2. Contractor acknowledges that TX-RAMP Provisional Status does not satisfy the TX-RAMP Certification Level 2 requirement.

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TX-RAMP compliance is outlined in the Texas Government Code § 2054.0593(a) for proposed cloud computing Services. Respondents are required to adhere to clauses as specified in Texas Administrative Code § 202.27 and 202.77.

To become certified, Respondents must submit documentation to DIR as to meeting the minimum requirements for TX-RAMP Level 2 certification. Information on TX- RAMP is located at: https://dir.texas.gov/texas-risk-and-authorization-management-program-tx-ramp. DIR will certify a cloud computing service under the corresponding impact level from accepted statuses of FedRAMP and StateRAMP using the FedRAMP Marketplace & StateRAMP Authorized Product List (APL) designations. Respondents may provide proof of this certification to be added to the TX-RAMP list.

All Respondents must provide to HHSC proof of DIR TX-RAMP Level 2 certification or equivalent StateRAMP or FedRAMP prior to contracting and maintain certification through the Contract Term.

https://dir.texas.gov/texas-risk-and-authorization-management-program-tx-ramp https://dir.texas.gov/texas-risk-and-authorization-management-program-tx-ramp