Exhibit B - Scope of Work.docx.pdf

Exhibit 1 – Scope of Work

1. Staffing

Vendor must provide key staff to fulfill the services under this agreement. DHS reserves the right to accept or reject any staff assignment. Key staff include, but are not limited to, principle project lead, rate setting, analytics, policy analysis, and support staff.

Key staff must include at least one qualified and certified actuary, compliant with the U.S.

Qualifications Standards, to assist with repricing work.

The Vendor may not divert key staff for any period except in accordance with the procedure outlined by DHS. The Vendor shall provide a notice of proposed diversion or replacement to

DHS's Contract Administrator at least sixty (60) calendar days in advance, together with the name and qualifications of the person(s) who will take the place of the diverted or replaced staff.

At least thirty (30) calendar days before the proposed diversion or replacement, DHS's Contract

Administrator will notify the Vendor whether the proposed diversion or replacement is approved or rejected, and if rejected will provide reasons for the rejection. DHS's reason for rejection may not be unreasonable or unlawful or the decision to accept or reject may not be unreasonably withheld or delayed.

"Divert" or "diversion" is defined as the transfer of personnel by the Vendor or a Subcontractor to another assignment within the control of the Vendor or a Subcontractor. "Divert" or

"diversion" does not include the resignation, death, disablement, or dismissal for cause of an employee which is beyond the control of the Vendor or Subcontractor.

Replacement staff shall be on-site at least two (2) weeks prior to the departure date of the person being replaced. The Vendor shall provide DHS with reasonable access to any staff diverted by the Vendor.

Diversion of key personnel defined in section 3.2.1 will cause damage to the Department by delayed or less accurate rates and analyses. Diversion is defined as a movement of key personnel from the Wisconsin contract. It is expected diversion will not occur with this contract unless approved by DHS. Replacement of key personnel who have left employment for reasons other than diversion shall be with persons of equal ability and qualifications. Impact to DHS with unapproved vendor staff change will be subject to penalties.

Diversion of key personnel with replacement personnel of lower ability or qualifications will cause damage to the Department that would be difficult to determine. Therefore, any such diversion of Contractor staff will subject Contractor to the imposition of liquidated damages in the amount of $100 per business day for each such offense. The damages will begin on the first business day of the diversion and will continue until the Contractor assigns a replacement of

DocuSign Envelope ID: A7CC6132-0A34-45A8-B951-978230D6ADC8 equal ability and qualifications and the replacement begins work. The maximum assessable damage under this provision, per unapproved diversion, is $10,000.00. Replacement of key personnel who have left employment for reasons other than diversion shall be with persons of equal ability and qualifications. DHS shall have the right to review and conduct separate interviews of proposed replacements for key personnel. DHS shall have the right to approve, in writing, the replacement of key personnel.

2. Rate Setting

Vendor shall provide nursing home rate setting services for the Wisconsin Medicaid Program.

The Vendor shall be experienced with nursing home cost reports and have the ability to conduct nursing home rate modelling and set cost report targets corresponding to a budgeted amount of funding.

Vendor must be able to access relevant data for use in rate development or other nursing home analysis including federal publications, inflation indices, labor market studies, quality indicators, and practices of other states or payers.

Vendor must analyze nursing home resident-level MDS assessment data, and have the ability to download and analyze this data for the purposes of nursing home rate setting analysis.

Vendor must work with cost report templates used by nursing home providers in WI to submit annual cost reports, and have the ability to download and analyze them for the purposes of nursing home rate setting analysis. Downloads of cost report information shall be made available to DHS staff in easily usable formats for further analysis.

Vendor must estimate Medicaid Fee for Service and managed care nursing home expenditures resulting from proposed changes to the rate formula by analyzing relevant data including prior year cost data, predicted facility quarterly case mix indices, and Behavior/CI scores based on historical trends.

Vendor must calculate facility-specific estimates of profits and losses from nursing home facility operations.

Vendor must calculate the amount that would be payable, facility by facility, if Medicaid Fee for

Service residents were to receive services under the Medicare Prospective Payment System for

Skilled Nursing Facilities, or calculate the Medicare Upper Limit Test. This includes calculations for State and Tribal owned and operated nursing facilities.

Vendor must complete an annual analysis of deficits incurred by local government facilities in providing services to Medicaid Fee for Service and managed care residents.

Vendor must maintain a nursing home quality metric reporting system for use as a basis for performance-adjusted payment rates.

Vendor must ensure that rates are appropriate for the populations covered and that the rates are appropriate for the services furnished by these nursing homes.

Vendor must be able to develop rate structures in the event that the Medicaid program undergoes fundamental changes in structure and/or a substantial expansion.

Vendor must develop appropriate trend factors for the populations and services included in the calculation of rates for these programs.

Vendor must perform analysis of possible pay-for-performance measures as well as compute pay-for-performance payments after measures are implemented.

Vendor must provide additional analyses to support DHS decision making on nursing home rate development and policy.

Vendor must provide a report each year summarizing the assumptions used in rate development, the source of and rationale for those assumptions, and the individual impact of those assumptions on a percentage, daily rate, and aggregate expenditure basis.

3. Date Hosting

Vendor must receive and load all data provided by the state and nursing homes including cost reports, in electronic formats, by the transmission mode described by the state.

Vendor must receive and load supplemental data, such as general ledger detail, census and payroll detail, property tax bills, fixed asset addition invoices, and other required uploads for nursing home cost report audits, in electronic formats, and make the data available for review by state auditors.

Vendor must be able to manage nursing home provider access to submit and extract cost reports, including processes to onboard new providers, remove old providers, and control which providers have access to which cost reports including the ability to allow one user to access more than one provider’s cost reports.

Vendor must allow data extracts of nursing home provider cost report information to the requirements of the state, including the ability to customize by year (extract cost reports of all or individual nursing homes for a single year), by provider (extract cost reports for a single or multiple providers over multiple years), and by ownership type (extract cost reports for state owned or privately owned providers).

Vendor must provide customer services support staff trained on the data warehouse system, including staff availability and escalation protocols.

Vendor must validate submitted data, including “warning” and “error” edit checks on submitted cost reports.

4. Flexibility

Vendor must respond flexibly to variations in project deadlines and evolving scope of work, particularly (but not exclusively) in conjunction with proposed state or federal rules or law changes.\

5. Quality Control

Vendor must perform reliability and validity checks, early enough in the analytical process to allow for any necessary corrections, on all nursing home rate development data provided by nursing homes and DHS, including nursing home rate calculation algorithms and/or sourcing

Medicare cost report data.

Vendor shall work directly with nursing homes and DHS to resolve reliability and validity problems with nursing home provided data in all phases of rate development, including post-nursing home rate notification queries and appeals.

6. Annual Work Plan

Vendor shall submit an annual detailed work plan for approval by DHS with thirty (30) days of the contract effective date and within the first month of each subsequent calendar year of the contract. This work plan will include the work breakdown structure and timeline for all project deliverables. Any modifications to the work plan should be discussed with and approved by DHS in advance of any impacted deliverable deadlines.

7. Meetings and Calls

The Vendor shall participate in meetings as needed with state and nursing home staff throughout each rate cycle, for appropriate nursing home programs, to discuss the parameters, priorities, methodology, and ongoing results of nursing home rate development in each rate cycle, providing documents and data, as directed by state staff, to discuss at these meetings.

As directed by the State, the Vendor shall develop and explain methodologies used to set rates.

The target audience will vary but may include trade associations, DHS management and staff, and Wisconsin political leaders. This may be in-person or remote, at the Department’s discretion and consistent with guidelines under declared public health emergencies.

8. Invoicing

The Vendor shall invoice in 12 equal monthly installments in each year of the contract.