F2000563062_AHCAITN0012122_AddendumNo.2.pdf

RON DESANTIS

GOVERNOR

SIMONE MARSTILLER

SECRETARY

Facebook .com/AHCAFlo r ida Youtube.com/AHCAFlor i da

Twi t te r . com/AHCA_FL S l ideShare.net /AHCAFlo r ida

2727 Mahan Dr ive • Mai l S top #15 Ta l lahassee, FL 32308 AHCA.MyFlor i da.com

November 24, 2021

Prospective Vendor(s):

Subject: Solicitation Number: ITN 001-21/22

Title: Unified Operations Center (UOC) Solution

Addendum No. 2

The enclosed information has been provided for consideration in the preparation of your response to the above referenced solicitation.

All other terms and conditions of the solicitation remain in effect.

Section 120.57(3)(b), Florida Statutes and Section 28-110.003, Florida Administrative Code require that a Notice of Protest of the solicitation documents shall be made within seventy-two hours after the posting of the solicitation. Failure to file a protest within the time prescribed in section 120.57(3), Florida Statutes, or failure to post the bond or other security required by law within the time allowed for filing a bond shall constitute a waiver of proceedings under chapter 120, Florida Statutes.

Sincerely, Ashley Balkcom Issuing Officer, Purchasing Manager Bureau of Support Services

Enclosures: Addendum No. 1 (2 Pages) Exhibit A-4-b, Submission Requirements and Evaluation Criteria Components

(Technical Response) – (37 Pages) Attachment B-2, Scope of Services (120 Pages) Exhibit B-1-a, Deliverables and Performance Standards (23 Pages) Questions and Answers (16 Pages)

ITN 001-21/22

ADDENDUM NO. 2

ITN 001-21/22, Addendum No. 2, Page 1 of 2

Item #1

Attachment A, Instructions and Special Conditions, Exhibit A-4-a, Submission Requirements and Evaluation Criteria Components (Technical Response), is hereby deleted in its entirety and replaced with Exhibit A-4-b, Submission Requirements and Evaluation Criteria Components (Technical Response), attached hereto, and made a part of the ITN. All references in the ITN to Exhibit A-4-a shall hereinafter refer to Exhibit A-4-b.

Item #2

Attachment B-1, Scope of Services, is hereby deleted in its entirety and replaced with Attachment B-2, Scope of Services, attached hereto, and made a part of the ITN. All references in the ITN to Attachment B-1 shall hereinafter refer to Attachment B-2.

Item #3

Attachment B-1, Scope of Services, Exhibit B-1, Deliverables and Performance Standards, is hereby deleted in its entirety and replaced with Exhibit B-1-a, Deliverables and Performance Standards, attached hereto, and made a part of the ITN. All references in the ITN to Exhibit B-1 shall hereinafter refer to Exhibit B-1-a.

Item #4

Attachment B, Scope of Services, Exhibit B-2-a, Service Level Metrics, the following metrics are hereby amended to now read:

SLM

Number SLM Description Measure-ment Formula

Data Source

Measure-ment

Frequency

Reporting Frequency

Financial Consequence

SLM-

T007 Removed.

SLM-

T008

The UOC Vendor shall perform patching and corrections to mitigate security vulnerabilities according to the vulnerability priority: Critical within twenty-four (24) hours, Major priority within seven (7) calendar days, High priority within thirty (30) calendar days, Minor priority

Time vulnerability corrected minus Time vulnerability identified

Security vulnerability scans

Quarterly Quarterly

$18,000.00 per occurrence if the patch or correction is not Implemented within the Performance Standard timeframe.

ITN 001-21/22

ADDENDUM NO. 2

ITN 001-21/22, Addendum No. 2, Page 2 of 2

SLM

Number

SLM Description Measure-ment

Formula

Data Source

Measure-ment

Frequency

Reporting Frequency

Financial Consequence within ninety (90) calendar days, Low priority within one hundred eighty (180) calendar days. The Agency will determine the level of priority in consultation with the UOC Vendor.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

EXHIBIT A-4-b

SUBMISSION REQUIREMENTS AND EVALUATION CRITERIA

COMPONENTS (TECHNICAL RESPONSE)

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 1 of 37

Instructions to Respondents for the Completion of Exhibit A-4-b:

The Agency is seeking information to determine the ability of Respondents to provide a Unified Operations Center (UOC) Solution as described in this ITN, to include development and ongoing operations and maintenance services.

All Respondents to this ITN shall utilize Exhibit A-4-b, Submission Requirements and Evaluation Criteria Components (Technical Response), for submission of its response and shall adhere to the instructions below for each Submission Requirement Component (SRC).

Respondents shall not include website links, embedded links and/or cross-references between SRCs unless otherwise instructed within a particular SRC.

Each SRC contains form fields. Population of the form fields with text will allow the form field to expand and cross pages. There is no character limit.

Attachments are acceptable for any SRC but must be referenced in the form field for the respective SRC and located behind each respective SRC response. Respondents shall name and label attachments to refer to respective SRCs by the SRC identifier number.

Agency evaluators will be instructed to evaluate the responses based on the narrative contained in the SRC form fields and the associated attachment(s), if applicable.

Each SRC response will be independently evaluated and awarded points based on the criteria and points scale using the Standard Evaluation Criteria Scale below unless otherwise identified in each SRC contained within Exhibit A-4-b.

The SRCs in Exhibit A-4-b may not be retyped and/or modified and must be submitted in the original format.

Failure to submit SRC responses via Exhibit A-4-b, may result in the rejection of the response.

STANDARD EVALUATION CRITERIA SCALE

Point Score Evaluation

0 The component was not addressed anywhere in the response submission.

1 The response contained significant deficiencies and omissions and lacked meaningful detail.

2 The response is below average. It met some of the minimum requirements but did not address all elements requested.

3 The response is average and met the minimum requirements with minimum detail.

4 The response is above average. It exceeded the minimum requirements and provided good detail.

5 The response is excellent. It exceeded the minimum requirements and contained exceptional content and detail.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 2 of 37

Exhibit A-4-b is available for Respondents to download at:

http://ahca.myflorida.com/procurements/index.shtml http://ahca.myflorida.com/Procurements/index.shtml

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 3 of 37

Respondent Name:

SRC #1 – TABLE OF CONTENTS

The Respondent shall include a Table of Contents in its response. The Table of Contents shall contain section headings and subheadings along with corresponding page numbers. The Table of Contents page(s) shall be provided as the first page(s) of the Respondent’s Technical Response.

Response:

Score: No points will be awarded for the Table of Contents.

SRC #2 – EXECUTIVE SUMMARY

The Respondent shall include an Executive Summary, which demonstrates its overall understanding of the Scope of Services described in this ITN and describes the prominent features of its Technical Proposal.

Score: No points will be awarded for the Executive Summary.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 4 of 37

SRC #3 – ORGANIZATIONAL STRUCTURE AND HISTORY

The Respondent shall demonstrate its capability to provide the services described in this ITN by describing its organizational structure and history. For responses including use of proposed subcontractors, the same descriptions of organizational structure and history shall be provided for each subcontractor, including the organizational structure connecting the Respondent and each proposed subcontractor. At a minimum, the description shall include:

1. The Respondent's, and its proposed subcontractor, organizational structure, ownership, affiliations, and location(s);

2. A copy of the Respondent's, and its proposed subcontractor, corporate organizational chart and a depiction of where the UOC Solution services described in this ITN falls within the organizational structure; and

3. Background information on the Respondent’s corporation, and on its proposed subcontractor corporation(s), the size, and resources to include:

a. Name of Respondent and any subcontractor(s);

b. Date established;

c. Ownership (public company, partnership, subsidiary, etc.);

d. Corporation's Federal Employer Identification Number (FEIN) and Florida Corporate

Charter Number;

e. Corporation's primary line of business; and

f. Total number of employees.

Attachments are limited to the following:

• Organizational chart of Respondent and subcontractor(s); and

• List of the Respondent’s and its proposed subcontractor physical locations.

Score: No points will be awarded for Organizational Structure and History.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 5 of 37

SRC #4 – RESPONDENT QUALIFICATIONS

The Respondent shall demonstrate its capability to provide the services described in Attachment B-2, Scope of Services, by describing its relevant experience with large customer service delivery systems, qualifications and length of experience in providing services similar in nature to those described in this ITN. The description shall include how these experiences will be applied to move the Agency forward based on its current Strategic Plan. Details of corporate experience (including any subcontractor experience and capabilities) shall include a list of all contracts related to services similar in nature to those described in this ITN within the last five (5) years and shall include, at a minimum:

1. Relevant experience with designing, developing, implementing, hosting, and maintaining information technology and business solutions including mail operations, call center operations, and supporting business operations;

2. Relevant experience with developing and implementing technology services, business operations, and contact centers for large healthcare systems including project and program management, business requirements elicitation and development, system testing, and system implementation;

3. Capability to work in parallel on multiple projects, with multiple vendors, and maintain timelines while effectively working as a single, distributed team to meet Agency and federal requirements;

4. How the Respondent’s and any subcontractor qualifications and experience prepares the Respondent to move the Agency forward based on the goals, objectives, and guiding principles as described within the Agency’s Strategic Plan;

5. Relevant experience with designing, developing, and implementing Customer centric solutions including notable industry certifications, accreditations, and/or awards (URAC, ICMI, NCQA, JD Power); and

6. Any relevant experience the Respondent has with obtaining CMS certification for overall operations.

SRC #4 Evaluation Criteria:

1. The adequacy of the Respondent’s capability and approach to meet the requirements described in this ITN, based on the relative experience in the performance of current or previous contracts for which it is/was the lead vendor on any projects similar in size, scope, and complexity to the UOC Project in the past five (5) years.

2. The adequacy of the Respondent's relevant experience with large healthcare systems.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 6 of 37

3. The adequacy of the Respondent’s experience and demonstrated capability to work in parallel to perform project and program management, business requirements elicitation and development, systems testing, and systems implementation.

4. The adequacy of the Respondent’s and any subcontractor qualifications and experience to move the Agency forward based on the goals, objectives, and guiding principles as described within the Agency’s Strategic Plan and to limit the potential for vendor lock-in and conflict of interest for future Agency acquisitions.

5. The adequacy of the Respondent's experience designing and implementing Customer centric solutions including notable industry certifications, accreditations, and/or awards.

6. The adequacy of the Respondent's relevant experience with obtaining CMS certification.

Score: This section is worth a maximum of 30 raw points with each of the above criteria being worth a maximum of 5 points each.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 7 of 37

SRC #5 – CUSTOMER EXPERIENCE STRATEGY AND METHODOLOGY

The Respondent shall demonstrate its capability to continuously improve the experience of UOC Customers including Recipients, Providers, and Stakeholders. The Respondent shall provide an overview of its Customer experience design thinking methodology and tools to continuously improve the Customer experience. The Respondent shall provide eight (8) journey maps (reference Attachment B-2, Scope of Services, Section 9.1 – Customer Experience Strategy and Methodology) demonstrating its Customer experience capability and understanding of the future vision of the UOC Customer journey.

As part of the overall methodology, a journey map is a valuable tool for designing compelling Customer experiences. In order to demonstrate Customer experience expertise along with the Respondent’s experience and understanding of the Agency Customer segments, as defined in Attachment B-1, Definitions, the Respondent shall provide a high-level journey map for each of the below eight (8) processes leveraging the respective Agency personas (Please refer to FX UOC Persona Descriptions and FX UOC Journey Map Format in the UOC Proposal Library).

The Respondent shall use the FX UOC Journey Map Format document to structure how the information will be presented back to the Agency as part of its Response to SRC #5. It is expected that the Respondent will add information (i.e., stages, touchpoints), as necessary.

High-level processes:

1. Recipient – Managed Care Enrollment Referral o Suzanne received a letter informing her that open enrollment for her children will begin the first of the following month. Open enrollment lasts for two months. Any changes made during the period will not take effect until the first day of the month following the end of the period. The UOC Vendor shall create a journey map on how the solution will meet Suzanne’s needs.

2. Recipient – Complaint o Suzanne wishes to file a complaint against the current health plan for her children. She wants to make sure she is able to upload documents securely to support her concerns.

She also wants to be notified of her complaint status as it progresses, while maintaining the ability to check the status for herself. Because of her work, she often is able to communicate more easily electronically, but expects prompt responses. The UOC Vendor shall create a journey map on how the solution will meet Suzanne’s needs.

3. Provider – Initial Enrollment o Dr. Press has recently filed an application to become a Medicaid provider who hopes to contract with the SMMC plans in her area. She has recently been informed that her application may be rejected due to unresponsiveness to requests for additional information.

She alleges that she never received the request, and the Provider Services Management Vendor indicates they called her multiple times. Considering the FX vision of module integration, the UOC Vendor shall create a journey map on how the solution will meet Dr.

Press’ needs.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 8 of 37

4. Provider – Claims Status Inquiry o Dr. Press currently bills Medicaid Fee-For-Service and some managed care plans. She is often pressed for time and dislikes the need to log in to multiple portals to check the status of claims. She also struggles to keep track of all the different login requirements and passwords. Considering the FX vision of module integration, the UOC Vendor shall create a journey map on how the solution will meet Dr. Press’ needs.

5. Provider [Facility] – Survey Inquiry o Lifecare Health Center received a recent facility survey related to a patient complaint about the care they received. Preliminary findings were shared with the Chief Operating Officer (COO) on the day of the survey, but the COO has not heard any further information. The COO is anxious to receive the final findings so that she can work with the Director of Nursing and the compliance team to correct any deficiencies. The UOC Vendor shall create a journey map on how the solution will meet the needs of the Agency and the COO.

6. Provider [Facility] – Medicaid Managed Care Contracting o The COO of Lifecare Health Center has been working for weeks to secure a contract with several of the Medicaid Managed Care plans to no avail. The COO is frustrated with the process and does not know what to do next. The UOC Vendor shall create a journey map on how the solution will meet the needs of the Agency and the COO.

7. Stakeholder – Complaint o John has been contacted by several Medicaid recipients regarding receiving services from their managed care plans, after providers were denied payment for services. The reason provided by the plan is that the service is covered by Fee-For-Service (FFS) Medicaid and not the plan, but the providers are not FFS providers. When John contacts the plans they will not speak to him. The UOC Vendor shall create a journey map on how the solution will meet John’s need to advocate on behalf of recipients.

8. Stakeholder – Training o John has established himself as a point of contact for recipients and providers. His goal is to help educate them about Medicaid and navigating health care service delivery issues.

He would like to receive training or access training information of the same nature as the recipients and providers. The UOC Vendor shall create a journey map on how the solution will meet John’s need to learn about the various programs.

Each journey map should consider the following guideposts when being developed:

• The need to build empathy and better understand the UOC Customers’ experiences;

• The need to communicate information and insights regarding the UOC Customers’ experiences to a broad internal audience;

• The desire to resolve current UOC Customer experience pain points; and

• The desire to identify moments that matter in order to design signature experiences that drive

Customer loyalty and value.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 9 of 37

SRC #5 Evaluation Criteria:

Score: No points will be awarded for the Customer Experience Strategy and Methodology.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 10 of 37

SRC #6 – SANCTIONS

The Respondent shall list and describe any sanctions levied against the Respondent, the Respondent’s affiliates, its subsidiaries, its parent company, the affiliates and subsidiaries of its parent company, its affiliate’s subsidiaries and subcontractors (handling subcontracts related to consultant services when the subcontracts are for $250,000.00 or more annually), within the five

(5) years preceding the date of its response to this ITN. Sanctions shall include those imposed by a state or federal entity in relation to a contract under which the Respondent provided health care system implementation and operations services or government service contracts in excess of one million dollars ($1,000,000). Sanctions shall include financial consequences, damages, liquidated damages, or other amounts paid by the Respondent in a settlement of a contract dispute.

Information requested for each sanction shall be provided by the Respondent for administrative and non-administrative sanctions. An administrative sanction means the issue pertains to timeliness or the use of an incorrect format (i.e., report, deliverable, or another required item submitted late or submitted in the wrong format). A non-administrative sanction means the issue pertains to performance in accordance with the contract scope of services (i.e., incomplete or inaccurate deliverable or services).

SRC #6 Evaluation Criteria:

1. The extent to which sanctions were due to issues with performance (non-administrative) in accordance with the contract scope of services, versus administrative issues.

2. The severity of the sanction(s) from minor (dollar amounts less than $10,000.00 or resolution time less than 90 calendar days) to significant (dollar amounts above $10,000.00 or resolution time longer than 90 calendar days or numerous sanctions (more than one (1) sanction among two (2) or more contracts)).

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 11 of 37

Score: This section is worth a maximum of 10 raw points with each of the above criteria

For item 1:

1. 5 points if no sanctions;

2. 4 points if sanction(s) were related only to administrative issues;

3. 3 points if non-administrative sanction(s) were all minor and there were fewer than four (4) incidents;

4. 2 points if non-administrative sanctions were all minor but four (4) or more incidents;

5. 1 point if any significant administrative sanction; or

6. 0 points if any significant non-administrative sanction.

For item 2:

1. 5 points if no sanctions;

2. 4 points if sanction(s) were minor and there were fewer than four (4) incidents;

3. 3 points if sanctions were all minor but four (4) or more incidents;

4. 2 points if up to two (2) significant sanction(s); or more than two (2) contracts with multiple sanctions;

5. 1 point if more than two (2) significant sanctions but fewer than five (5); or more than two (2) but fewer than five (5) contracts with multiple sanctions; or

6. 0 points if performance falls below the above limits.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 12 of 37

SRC #7: SECURITY RISK RATING SCORE SCAN

In accordance with Attachment B-2, Scope of Services, Section E., Special Provisions, subsection 7, Information Technology, Item 7.1, Development Requirements, sub-item 31., the Agency will conduct an initial IT security risk rating score scan on the Respondent through an IT security risk rating service, at the Agency's expense, to enable the Agency to effectively measure and mitigate the successful Respondent’s security risks. The Respondent shall work with the Agency’s security risk rating service provider to define the relevant Respondent assets providing Agency services.

SRC #7 Evaluation Criteria:

The adequacy of the Respondent’s IT security risk rating score by determining whether the Respondent has received:

1. A score in the top 90-100% of the scan recommendations;

2. A score in the top 80-89% of the scan recommendations;

3. A score in the top 70-79% of the scan recommendations;

4. A score in the top 60-69% of the scan recommendations;

5. A score in the top 50-59% of the scan recommendations; or

6. A score in the lower 0-49% of the scan recommendations.

Score: This Section is worth a maximum of 5 raw points as outlined below:

1. 5 points for a score in the top 90-100% of the scan recommendations;

2. 4 points for a score in the top 80-89% of the scan recommendations;

3. 3 points for a score in the top 70-79% of the scan recommendations;

4. 2 points for a score in the top 60-69% of the scan recommendations;

5. 1 point for a score in the top 50-59% of the scan recommendations; or

6. 0 points for a score in the lower 0-49% of the scan recommendations.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 13 of 37

SRC #8 – PROJECT MANAGEMENT AND SERVICE DELIVERY

APPROACH

The Respondent shall present its project management and service delivery approach and explain how it reflects industry best practices in service delivery excellence. The Respondent shall demonstrate its capabilities in working with third-party organizational standards by developing an approach that complies with the Agency's FX Project Management Standards included in the UOC Proposal Library.

The Respondent shall describe its proposed approach to PD-1: Project Management Plan (includes the UOC Vendor Resource Management Plan) and provide a draft PD-2: Project Schedule, as described in Attachment B-2, Scope of Services, Exhibit B-1-a, Deliverables and Performance Standards.

The proposed project schedule must show a thorough understanding of the scope of work and the capability to successfully complete each deliverable. The draft schedule shall include a high-level project timeline for successful management and completion of the project, as well as identify major project phases with consideration to Attachment B-2, Scope of Services, Section B.7.1.

High-Level Implementation Plan. The schedule timeline must include timeframes and durations for key milestones and deliverables.

The Respondent shall demonstrate the following:

1. Approach to following project management best practices to ensure adherence to the P-2:

FX Project Management Standards, including, but not limited to:

a. Communications management;

b. Risk and Issue management;

c. Change management;

d. Scope management;

e. Schedule management;

f. Quality management; and

g. Status reporting.

2. Experience following third party standards (such as the FX Program standards included in the UOC Proposal Library).

3. Experience implementing the System Development Life Cycle (SDLC) for multi-component configurable and customizable technology platforms.

4. Experience in and approach to successful delivery of services and solutions in a multi-vendor and multi-agency environment.

5. Ability to effectively manage multiple contact center teams that include the UOC Vendor, subcontractor, and Agency UOC staff.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 14 of 37

6. Ability to implement and provide services and solutions to be adapted to accomplish the UOC Objectives and FX Guiding Principles outlined in Attachment B-2, Scope of Services, Section A.3.2. Overview of the FX Transformation.

SRC #8 Evaluation Criteria:

1. The adequacy of the Respondent’s proposed approach to project management and service delivery, and its alignment with FX Project Management Standards, including demonstrated understanding and approach to the System Development Life Cycle (SDLC) for a multi-component configurable and customizable technology platform.

2. The adequacy of the Respondent’s draft Project Schedule to demonstrate a high-level project timeline for successful management and capability to successfully complete each deliverable.

3. The adequacy of the Respondent's experience following third party standards (such as the

FX Program standards included in the UOC Proposal Library).

4. The adequacy of the Respondent’s experience and demonstrated ability to successfully deliver in a multi-vendor and multi-agency environment.

5. The demonstrated ability of the Respondent to effectively manage multiple contact center teams including UOC Vendor, subcontractor and Agency staff.

Score: This Section is worth a maximum of 25 raw points with each of the above criteria

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 15 of 37

SRC #9 – DISASTER RECOVERY AND BUSINESS CONTINUITY

The Respondent shall demonstrate its capability and approach to meeting the disaster recovery and business continuity requirements described in:

1. Attachment B-2, Scope of Services, Section B.8.3 – Disaster Recovery and Business

Continuity

2. Attachment B-2, Scope of Services, Section B.10.1 – Operations and Maintenance Phase

Requirements

3. Attachment B-2, Scope of Services, Section B.14 – Facilities and Service Location(s)

4. Attachment B-2, Scope of Services, Exhibit B-1-a, Deliverables and Performance Measures

SRC #9 Evaluation Criteria:

For both technology and services, the adequacy of the Respondent’s ability to:

1. Maintain and annually test a Contingency Plan (for Disaster Recovery and Business continuity) for the UOC Solution with the FX Technical Management Strategy;

2. Support the Agency’s Enterprise Contingency Plan, and coordination of related activities;

3. Provide backup procedures, hot sites, redundancy, and support to prevent and accommodate the disruption of systems and communications;

4. Minimize downtime and disruption of services;

5. Provide timely failover; and

6. Create effective policies and procedures to implement a recovery, as well as business continuation services.

Score: This Section is worth a maximum of 30 raw points with each of the above criteria

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 16 of 37

SRC #10 – TECHNICAL SOLUTION COMPONENTS – PLATFORM

REQUIREMENTS

The Respondent shall demonstrate its capability and approach to meeting the requirements described in Attachment B-2, Scope of Services, Section B.8.0 - UOC Platform Solution (Technology), including but not limited to its proposed approach to ensuring its UOC Solution provides all of the required technology components and specified options, and all components are integrated into one common solution. In addition, the Respondent shall complete Exhibit B- 3, Technology Matrix for the components of their solution.

SRC #10 Evaluation Criteria:

The adequacy of the Respondent's demonstrated ability to:

1. Provide hosting services to meet the Agency’s requirements and support optimal performance of the UOC Solution;

2. Provide a UOC solution that includes best in class Interactive Voice Response capabilities;

3. Provide a UOC solution that includes adequate automatic call distribution;

4. Provide a UOC solution that includes adequate cloud-hosted VOIP-enabled PBX;

5. Provide a cloud-hosted UOC solution that includes an adequate Customer Relationship Management (CRM);

6. Provide a UOC solution that includes adequate Workforce Management capabilities;

7. Provide a UOC solution that includes adequate quality management capabilities;

8. Provide a UOC solution that includes adequate call recording capabilities;

9. Provide a UOC solution that includes adequate knowledge management capabilities;

10. Provide a UOC solution that includes adequate service/ticket management capabilities; and

11. Provide a UOC solution with relevant business operations technologies.

Score: This Section is worth a maximum of 55 raw points with each of the above criteria

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 17 of 37

SRC #11 – BUSINESS SOLUTION COMPONENTS – CUSTOMER

SERVICE

The Respondent shall demonstrate its proposed approach to the Customer Service and Business Operations Solution requirements, addressing all requirements in Attachment B-2, Scope of Services, Section 9.2 – Enterprise Customer Service Support. This shall include, at a minimum, the following:

1. Respondent's experience and proposed approach to providing an enterprise UOC Solution with an initial focus on Medicaid Customers (Medicaid Recipients, Medicaid Providers, Agency partners and other groups referenced in the Customer definition in Attachment B-2, Scope of Services, Section A.1, Definitions and Acronyms. This includes Customer access to the following services:

a. Agent assistance via phone and/or email during Business Hours;

b. Assistance via self-serve technology twenty-four (24) hours per day, seven (7) days per week, three hundred and sixty-five (365) days per year (24*7*365); and

c. Proactive communications including required correspondence and opt-in alerts for account updates.

2. Respondent's experience and proposed approach to providing the following enterprise

Customer service support services:

a. Hire, train, and onboard sufficient, qualified staff for tiered and General Support staff functions (as described in Attachment B-2, Scope of Services, Section B.9.2.3.1, Staffing, Table: B.9.2.3.1 – UOC Customer Service Support Tier Structure);

b. Provide a Customer service support infrastructure with a comprehensive CRM solution that can be used within the UOC and across the Agency for escalated and/or referred items; This CRM shall include Customer inquiry management, Customer issue management, a Customer support infrastructure, and contact tracking and reporting;

c. Provide sufficient, qualified staff for correspondence activities to be performed by the UOC, as agreed to by the Agency;

d. Provide an Agency-approved Training and Knowledge Management function within the UOC Solution that has been proven in a large-scale Customer service environment; and

e. Design, develop, and operate the UOC technical support services as defined in Attachment B-2, Scope of Services, Section B.9.2.4 – Technical Support Services.

3. Respondent's experience and proposed approach to providing an Agency-approved correspondence process with Agency-approved messaging that includes but may not be limited to:

a. Developing correspondence (system generated and manual);

b. Developing and managing up-to-date correspondence templates;

c. Sending all direct mailings and electronic correspondence timely, as agreed to by the

Agency;

d. Automated tracking of correspondence;

e. Making correspondence accessible for users to view and download; and

f. Integrating with other FX Module Vendors so that notifications generated from a FX

Module Vendor’s system is routed and tracked through the UOC CRM.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 18 of 37

4. Respondent's experience and proposed approach to partnering with a firm that specializes in

Customer Service training and can support potential site certification for the UOC.

SRC #11 Evaluation Criteria:

1. The adequacy of the Respondent’s relevant experience with and proposed approach to designing, developing, implementing, hosting, and maintaining an enterprise Customer contact center operation that meets the Customer access criteria described.

2. The adequacy of the Respondent’s relevant experience with and proposed approach to providing the described enterprise Customer service support and business operations services.

3. The adequacy of the Respondent’s relevant experience with and approach to developing and executing a large-scale correspondence process, including coordination with an Agency and/or organization for messaging, reviews, and approvals.

4. The adequacy of the Respondent’s relevant experience with and approach to partnering with a firm that specializes in Customer Service and Business Operations training.

Score: This Section is worth a maximum of 20 raw points with each of the above criteria

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 19 of 37

SRC #12 – BUSINESS SOLUTION COMPONENTS – PROVIDER

BUSINESS SERVICES

The Respondent shall demonstrate its proposed approach to the Provider Management Business Services Solution requirements, addressing all requirements in Attachment B-2, Scope of Services, Section B.9.3 – Business Services – Provider Management. At a minimum, this includes the following:

1. Respondent's approach to providing and supporting the enrollment, re-enrollment, and file maintenance activities of new and existing providers. This includes the following services:

a. Providing general Tier 1 customer support and self-service options for provider inquiries via multiple communication channels;

b. Developing and delivering provider communications;

c. Receiving and processing inbound and outbound provider mail operations (including returned mail processing) and communications fulfillment;

d. Supporting the business services associated with Background Screening and Provider

Credentialing; and

e. Coordinating with the FX Provider Services Module (PSM) Vendor and partners to efficiently deliver end-to-end provider management services.

2. Respondent's approach to providing support services for Facility Licensure and Intake.

a. Providing general Tier 1 customer support for facility inquiries via multiple communication channels;

b. Developing and delivering communications and notices;

c. Receiving and processing inbound and outbound Facility mail operations (including returned mail processing) and communications fulfillment;

d. Controls to account for the receipt of funds related to fees or sanctions to be securely tracked and routed; and

e. Coordinating with the Agency's Health Facility Regulation Bureau to efficiently delivery end-to-end Facility Licensure services.

3. Respondent's approach to providing Training, Outreach, and Site Support to Providers that includes but may not be limited to:

a. Developing training and outreach materials;

b. Methodology and techniques for conducting training and outreach activities;

c. Process for recruiting and maintaining qualified specialist to develop and conduct training or site support activities;

d. Supporting the design, development, and distribution of provider communications including, but not limited to, bulletins, forms, public content forums, provider policy updates, website content, provider letters and surface mail, provider emails, policy alerts, provider texts, mass messaging and system alerts, user guides, technical documents, and education and training opportunities.

4. Respondent's approach to supporting the Provider Complaint process. This includes the following services:

a. Receiving, acknowledging, and tracking the receipt of a provider complaint;

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 20 of 37

b. Routing of complaints to the appropriate Agency staff or partner (e.g., health or dental plan);

c. Responding to complaints through approved communications channels.

SRC #12 Evaluation Criteria:

1. The adequacy of the Respondents relevant experience with and approach to providing

Customer support through multiple communications channel that would meet the provider enrollment criteria described.

2. The adequacy of the Respondents relevant experience with and approach to providing the described mail and communications fulfillment operations.

3. The adequacy of the Respondents relevant experience with and approach to the receipt of funds and the controls associated with the relevant accounting principles.

4. The adequacy of the Respondents relevant experience with and approach to the development and delivery of training, outreach, and website content and materials.

5. The adequacy of the Respondents relevant experience with and approach to the design, development, and distribution of communications utilizing various medium.

6. The adequacy of the Respondents relevant experience with and approach to complaint administration processes.

7. The adequacy Respondents relevant experience with and approach to providing support services for the provider community.

Score: This Section is worth a maximum of 35 raw points with each of the above criteria

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 21 of 37

SRC #13 – BUSINESS SOLUTION COMPONENTS – RECIPIENT

BUSINESS SERVICES

The Respondent shall demonstrate its proposed approach to the Recipient Service Business Solution requirements, addressing all requirements in Attachment B-2, Scope of Services, Section B.9.4 – Business Services – Recipient Management. At a minimum, this includes the following:

1. Respondent's experience and proposed approach to providing and supporting the eligibility and enrollment activities of recipients, including:

a. Providing general Tier 1 Customer support and self-service options for recipient inquiries via multiple communication channels;

b. Supporting seamless transfer of recipients to appropriate partner agencies and other FX

Module Vendors;

c. Providing secure production, delivery, and tracking of recipient Medicaid Cards;

d. Providing deactivation, destruction, and tracking of returned Medicaid Cards;

e. Receiving, processing and supporting inbound and outbound recipient mail operations

(including returned mail processing) and communications fulfillment; and

f. Providing a self-service platform in coordination with other FX Module Vendors for recipients to inquire about their health plan options and enable plan selection by the recipient.

2. Respondent's experience and proposed approach to providing support services for Recipient

File Maintenance Activities, including:

a. Providing general Tier 1 Customer support for recipient inquiries via multiple communication channels;

b. Routing and escalation of file maintenance activities to the appropriate Agency business unit or partner agency; and

c. Receiving inbound mail operations, storing, tracking, and forwarding to partner agencies as appropriate.

3. Respondent's experience and proposed approach to providing Outreach and

Communications services for Recipients, including:

a. Developing Training and Communications materials;

b. Methodology and Techniques for conducting training and outreach activities;

c. Process for recruiting and maintaining qualified specialist to develop and conduct training;

and

d. Supporting the design, development, and distribution of recipient communications including but not limited to, bulletins targeted to the general recipient population, forms, Florida Medicaid or FX website content, recipient letters and surface mail, secure messaging, and appropriate social media engagement, news articles, mass messaging and system alerts, program brochures, user guides, and educational information.

. Respondent's experience and proposed approach to supporting the Recipient Complaint, Grievance, Appeals, and Fair Hearing process, including:

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 22 of 37

a. Approach for the development and implementation of a single-entry point solution for receiving, acknowledging, and tracking recipient complaints, grievances, appeals, or fair hearings in accordance with applicable federal and state regulations;

b. Providing general Tier 1 Customer support for the complaint process;

c. Routing of complaints to the appropriate Agency business unit or health plan for triage and assignment; and

d. Responding to complaints through approved communications channels.

SRC #13 Evaluation Criteria:

providing Customer support through multiple communication channels that would meet the recipient eligibility and enrollment support criteria described.

2. The adequacy of the Respondent’s relevant experience with and proposed approach to developing self-service options that support the required business processes and outcomes.

3. The adequacy of the Respondent’s relevant experience with and proposed approach to producing, distributing, destroying, and tracking items that contain PII or PHI.

4. The adequacy of the Respondent’s relevant experience with and proposed approach to providing the described mail and communications fulfillment operations.

5. The adequacy of the Respondent’s proposed approach to escalate activities to the appropriate Agency business unit or partner agency.

6. The adequacy of the Respondent’s relevant experience with and proposed approach to the development and delivery of training and outreach materials.

7. The adequacy of the Respondent’s relevant experience with and proposed approach to the design, development, and distribution of communications utilizing various medium.

8. The adequacy of the Respondent’s relevant experience with and proposed approach to complaint administration processes.

9. The adequacy of the Respondent’s relevant experience with and proposed approach to coordinating and transferring data or information to external entities in a seamless manner.

10. The adequacy of the Respondent’s relevant experience with and proposed approach to providing services that support the targeted Medicaid recipient population.

Score: This Section is worth a maximum of 50 raw points with each of the above criteria

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 23 of 37

SRC #14 – BUSINESS SOLUTION COMPONENTS – ENTERPRISE

OPERATIONS SERVICES (COMMUNICATIONS MANAGEMENT, MAIL

AND FULFILLMENT)

The Respondent shall demonstrate its proposed approach to the Enterprise Operations Business Solution requirements, addressing all requirements in Attachment B-2, Scope of Services, Section B.9.5 – Enterprise Operations Management. At a minimum, this includes the following:

1. Respondent's experience and proposed approach to providing and supporting the Provider and Recipient Claims Processing and Payment Support activities, including:

a. Providing general Tier 1 Customer support and self-service options for provider and recipient inquiries via multiple communication channels;

b. Methodologies and processes for escalating and routing complex issues to the appropriate Agency staff or FX Module Vendor; and

c. Receiving and processing inbound and outbound mail operations and communications fulfillment.

2. Respondent's experience and proposed approach to providing Centralized Mail and

Communications, including:

a. Providing a mail service center to act as a central hub for all inbound and outbound mail;

b. Processing inbound mail from traditional mail, email, web portal communications;

c. Providing a solution that uses automation to create a digital mail room that will standardize the processing and distribution of paper and electronic mail;

d. Providing Document Capture technology to scan all incoming traditional paper mail documents while importing electronic files to process them together through the same platform;

e. Include Intelligent Data Capture capability to automatically extract data from semi-structured documents and automatically extract key information that can be used to index the document and/or route the document to the right Agency business unit or FX Module Vendor; and

f. Process for the destruction of documents per state and Agency record retention policies, and its certification.

3. Respondent's experience and proposed approach to providing support services for Pharmacy

Benefit Management Activities, including:

a. Providing Tier 1 general support to callers regarding pharmacy benefits (e.g., who should they call, covered drugs, complaint intake, etc.);

b. Routing fee-for-service recipients to the PBM Ombudsman for pharmacy related issues and to the health plan for SMMC recipients; and

c. Process for communicating to the provider or recipient the result of the review through various communication channels (mail, email, text, web-portal, etc.).

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 24 of 37

SRC #14 Evaluation Criteria:

1. The adequacy of the Respondent’s relevant experience with and approach to providing

Customer support through multiple communication channels that would meet the Enterprise Operations criteria described.

2. The adequacy of the Respondent’s relevant experience with and approach to developing self-service options that support the required business processes and outcomes.

3. The adequacy of the Respondent’s relevant experience with and approach to collaborating with other entities to develop and agree upon escalation and routing processes to transfer complex issues.

4. The adequacy of the Respondent’s relevant experience with and approach to providing the described mail and communications fulfillment operations.

5. The adequacy of the Respondent’s relevant experience with and approach to providing electronic mail processing to include email and web portal communications.

6. The adequacy of the Respondent’s relevant experience with and approach to providing document capture and intelligent data capture technologies.

7. The adequacy of the Respondent’s relevant experience with and approach to providing secure destruction of sensitive documents.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 25 of 37

SRC #15 – PERFORMANCE STANDARDS AND REPORTING

The Respondent shall demonstrate its experience, understanding and ability to provide an automated method or system/operations tools to provide reports of the quality measurements and performance monitoring dashboards for the post-implementation UOC Solution services as defined in Attachment B-2, Scope of Services, Section B.11 – Reporting and, Attachment B-2, Scope of Services, Exhibit B-2, Operations and Maintenance Service Level Agreement. At a minimum, the Respondent shall demonstrate the following:

1. The Respondent’s experience and proposed approach to providing a UOC performance reporting dashboard system and resulting generated reports to the Agency’s Contract Manager;

2. The Respondent’s experience and proposed approach to providing real-time performance reporting dashboards for contracted performance standards and Service Level Metrics described in Attachment B-2, Scope of Services, Exhibit B-2-b, Operations and Maintenance Service Level Metrics in this ITN;

3. The Respondent’s experience and proposed approach to storing and reporting relevant data for ongoing and ad hoc reporting, including methods for conducting quality control; and

4. The Respondent’s experience and proposed approach to adhering to and reporting on Service Level Metrics provided in Exhibit B-2-b - Operations and Maintenance Service Level Metrics.

The Respondent shall provide samples of the following types of dashboard report exports:

a. Staffing Report

b. Executive Level Dashboard Report

c. Contact Center Activity Report

d. Contract Compliance / Service Level Metrics Dashboard

SRC #15 Evaluation Criteria:

providing web-based reporting dashboard solutions and tools for performance reporting.

2. The adequacy of the Respondent's proposed approach and demonstrated ability to meet the Service Level Metrics.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 26 of 37

3. The adequacy of the Respondent’s relevant experience and proposed approach to developing standard report dashboard extracts and ad hoc queries for the UOC Solution.

4. The adequacy of the Respondent’s sample dashboard reports to demonstrate a successful performance and status reporting approach for the UOC Solution.

ITN 001-21/22, Attachment A, Exhibit A-4-b, Page 27 of 37

SRC #16 – SECURITY

The Respondent shall demonstrate its experience, capability, approach and proposed solution for the Security Life Cycle to include activities defined in certification and accreditation, risk assessment, and system security plan phases and to address all requirements in Attachment B- 2, Scope of Services, Section B.8.7 – Security to:

1. Coordinate with stakeholders to develop and execute a Systems Security Plan, security controls, security assessments, and risk assessments, in compliance with all Florida and federal enterprise information security policies, standards, security initiatives, and regulations;

2. Develop and execute a Security Controls Test Plan that includes objectives, scope, misuse cases, testing type, entrance and exit criteria, schedule, testers, software tools, and test results;

3. Develop and execute a Security Test Plan for all shared infrastructure, connectivity and communications between the EDW Solution, the Integration…