Falling Colors-compressed.pdf

January 22, 2025

Ms. Julie Schliltz, NDCS Assistant Materiel Administrator Nebraska Department of Correctional Services 801 W. Prospector Place, Bldg. #1 Lincoln, NE 68522

Dear Ms. Schiltz:

Falling Colors Corporation is pleased to submit materials responsive to NDCS Revised Request for Proposal for Services Contract 120173 03.

As requested, we’ve identified each of our uploaded files with the RFP number, our name, and “File X of X.”

These numbers refer to the following documents:

File 1 of 15: Cover Letter and TOC File 2 of 15: Overview (Sections V and VI) File 3 of 15: Scope of Service File 4 of 15: Revised Attachment A, Bidder Questionnaire File 5 of 15: Cost Proposal File 6 of 15: Key Personnel Resumes File 7 of 15: Standard Reports File 8 of 15: Average Days to Payment Report File 9 of 15: Claim Failure Detail Report File 10 of 15: Staff Certifications Report File 11 of 15: Accepted Claims Report File 12 of 15: CSV File Example File 13 of 15: Sample Dashboard 1 File 14 of 15: Sample Dashboard 2 File 15 of 15: HITRUST Certification Engagement Letter

Falling Colors appreciates the opportunity to submit these materials in our bid to provide third party payor services to NDCS. We are absolutely confident in our ability to deliver extraordinary value to NDCS and look forward to demonstrating our capabilities, answering any questions NDCS may have, and providing such additional information and materials as may be requested.

Sincerely, Jorie Koster-Hale, CEO Sam Wolf, COO/Gen. Counsel

V. Project Description and Scope of Work

A. Project Overview

Falling Colors was created in 2014 when CEO Pamela Koster and CFO Mindy Hale merged their two companies: Koster’s evaluation research company (founded 1996) and Hale’s database technology company (founded 1999). This merger established a company whose mission is using information technology to support health delivery systems at scale. In nearly a decade since, Falling Colors has stayed true to this mission, developing tools to provide program managers, decision-makers, and executives with the data they need to meet the challenge of understanding the financial and health impacts of numerous large programs. To accomplish this, we deliver straightforward, configurable, and user-friendly platform that simplifies and reduces administrative burdens of data collection and billing on providers around New Mexico, delivering accountability and transparency to public health programs.

Since 2017, Falling Colors has served as the Administrative Services Organization for the New Mexico Behavioral Health Collaborative, an inter-agency entity comprised of 15 different state agencies involved in the provision of non-Medicaid behavioral healthcare services. In this capacity, Falling Colors contracts with close to 800 healthcare providers statewide and, at present, processes nearly $200 million annually to those providers to facilitate the delivery of healthcare services to tens of thousands of New Mexicans. In the process, we collect myriad data points and return that data to state staff, leadership, and program managers in the form of standard reports, interactive dashboards, and individual data requests.

When Falling Colors took over as the third-party payor and administrative services provider for the State of New Mexico in 2017, New Mexico’s behavioral health provider network had essentially been dismantled as the result of a series of political events. Hardly any providers were available to work with the state; those providers that would contract with the state were used to waiting between 90 and 180 days to be paid for services; and the state was denied access to any meaningful data.

Falling Colors rebuilt the provider network to nearly 800 providers who are consistently paid in an average of six days from invoice approval and provides a steady flow of robust, clear, and accurate data to dozens of state stakeholders. With our demonstrated track record of bringing extraordinary value to states and state agencies wanting to better understand and draw meaning from their data, Falling Colors is the ideal partner to assist the NDCS with ensuring timely, accurate payments to healthcare providers and delivery of requisite data through reports, dashboards, and other mechanisms. Our service platform can be easily configured to ensure that only those services that NDCS has agreed to pay for are submitted and processed, and that those services are paid at rates that NDCS has specified. Our powerful rules engine ensures that no unapproved service – and no service that isn’t accompanied by requisite corollaries, such as pre-authorization where necessary – is processed for payment. And most importantly, Falling Colors has specific expertise in dealing with non-Medicaid claims, ensuring that all funds paid through our platform are “funds of last resort” and that anything that can be billed to Medicaid is properly billed to Medicaid.

As a company, we’re passionate about the impact good data can deliver. To a person, our staff (presently located in ten states) want to participate in improving lives – and they see data as a core factor in that mission. Our team works with program stakeholders to ensure that our service platform is gathering the right information and asking the right questions to deliver necessary metrics – giving those with the burden of making policy decisions the tools they need to understand the issues their communities are facing. With Falling Colors as a partner, decision makers can be confident that they’re receiving the insight they need to know when they’re on the right track and when a new approach might be necessary.

Falling Colors also believes that being a good corporate citizen and supporting our communities, our environment, and our staff are necessary parts of being a good business. We were one of the first companies to organize under the public benefit corporation act passed in New Mexico in 2020 (a law that allows us to incorporate environmental or community considerations into our corporate decision making). We’re also certified as a B-Corporation by the global non-profit B-Lab, using their rigorous third-party business impact assessment. This assessment measures hundreds of individual factors relating to employees, community support, environmental impact, and other elements. In 2024, we received the fourth highest score in the world—out of over eight thousand certified entities.

At Falling Colors, our expertise is in delivering data and other solutions to state governments and agencies, particularly relating to healthcare and specifically in the non-Medicaid arena.

VI. Solicitation Response Instructions

A. Solicitation Response Submission

1. Corporate Overview

a. Bidder Identification and Information

Falling Colors’ full name is Falling Colors Corporation, headquartered at 206 McKenzie Street in Santa Fe, New Mexico. We are incorporated as a Public Benefit Corporation under the laws of New Mexico, and have been incorporated in New Mexico since 2014. We converted from a standard Corporation to a Public Benefit Corporation after New Mexico passed its Public Benefit Corporation law in 2020.

b. Financial Statements

Falling Colors is not a publicly held corporation and accordingly submits the following information regarding the company rather than financial statements. Falling Colors presently has approximately thirty-five employees, who reside in New Mexico, Colorado, Pennsylvania, Oregon, California, Texas, New York, Minnesota, Kentucky, and Utah. We have existed in this form since approximately 2016; prior to that, our founders used data and technology solutions to deliver program assessments.

In 2017, Falling Colors was contracted with the State of New Mexico to provide third party payor and administrative services for behavioral healthcare programs. Initially, the total of funds to be processed was near $35 million; since, the totals have grown annually to nearly $200 million.

During that time, Falling Colors has grown its client base from only two state agencies to seven New Mexico state agencies as well as private entities (such as the Thornburg Foundation and the New Mexico Farmer’s Marketing Association) and has contracted since 2020 with Advocates for Human Potential, a private contractor delivering Access to Recovery and other services in Massachusetts.

Falling Colors specializes in extracting actionable data from public healthcare spending, and in ensuring that that spending is handled according to specified rules. We recognize that state government is in a unique position: program managers often lack sufficient resources to engage as thoroughly as might be required in various programs, especially in light of overlapping funders, fund sources, grants, rules and requirements, and public and political pressures. Our mission is to bring powerful technological tools and data to aid those program managers with delivering maximum value from the precious public dollars they are entrusted with.

c. Change of Ownership

No change of ownership of Falling Colors is anticipated in the next 12 months.

d. Office Location

Falling Colors’ primary office location is in Santa Fe, New Mexico, and this office will be responsible for performance of any award coming from this proposal. Falling Colors will ensure that necessary staff are available remotely and on site in Nebraska where necessary.

e. Relationship with the State

Falling Colors has had no dealings with any agency of the State of Nebraska during the last there years or at any other time.

f. Bidders Employee Relations to State

No party named in any of Falling Colors solicitation response has been an employee of the State of Nebraska in the last six months or prior.

g. Contract Performance

Falling Colors has not had any contract terminated for default or any other reason during the past three years or at any other time. Falling Colors notes that its initial contract with the State of New Mexico, executed to begin on July 1, 2017, was for a term of three years, with three options to renew. The State of New Mexico took advantage of each of those three renewals. When the contract ended, the State of New Mexico submitted the contract to a public RFP process in accordance with state procurement rules. Falling Colors was again selected and begin our second contract period on July 1, 2023.

h. Summary of Bidder’s Corporate Experience

Here, Falling Colors provides a summary matrix detailing previous projects similar to this solicitation in size, scope, and complexity.

Project ASO Services for NM (Behavioral Healthcare Services Division; Department of Health; Children, Youth, and Families Division; Aging and Long Term Services Division; Developmental Disabilities Division.

ASO Services for Advocates for Human Potential

Data Analytics, Technical Infrastructure, and Strategy:

Kevin S Project for Children, Youth, and Families Division of NM

Time Period 2017 – Present 2020 – present 2020 – 2024 Scheduled/ actual completion

In connection with these services, Falling Colors has delivered numerous projects of varying degrees of complexity.

These have included, for example, incorporation of new agencies into the Falling Colors Service platform; with regard to one such agency, we were asked to contract with hundreds of new providers in only a few months, to train numerous program staff and providers to use our platform;

and to develop and incorporate rules and configurations to ensure appropriate expenditure and processing of millions of dollars in federal funding to ensure that the State of New Mexico would not lose that funding. Falling Colors has also incorporated new agencies that required substantial new technology.

For example, the Developmental Disabilities Counsel needed both third-party payor services and what amounted to a case-management platform facilitating management of guardianship and related cases. Falling Colors delivered this platform to specifications on time and has successfully worked with DDC for years since to incorporate additional functionality as new requirements have been identified.

Falling Colors executed a contract with AHP in the spring of 2020 for a “go-live” of September 30, 2020. Falling Colors delivered the project on time. The project is anticipated to sunset sometime in 2025 as the pertinent portion of AHP’s contract with the State of Massachusetts is ending. In addition to developing a robust set of services aiding AHP with tracking numerous aspects of their access to recovery programs, the project commenced with a historic data import and evaluation, which Falling Colors also handled timely and effectively.

In 2020, the State of New Mexico Children, Youth, and Families Division (CYFD) reached a settlement agreement with a group of plaintiffs who had sued alleging mistreatment of children committed to the foster care system. This settlement agreement included an extraordinarily robust set of data metrics, tied to specific reforms, that would enable the plaintiffs and the public at large to gauge CYFD’s progress towards its commitments.

CYFD asked Falling Colors to step in to assist it in developing these metrics and data solutions that would enable CYFD to take its various sources of data and turn them into robust, detailed, and substantial annual reports. The project included a detailed and lengthy set of deadlines and deliverables, all of which Falling Colors met timely and effectively.

The contract executed by Falling Colors and CYFD was for four years, and ended in December of 2024. As a return by the CYFD and the plaintiffs to arbitration has rendered the future of the project unclear, Falling Colors elected not to renew the contract. However, Falling Colors continues to work in good faith with CYFD to ensure a smooth, effective transfer of knowledge and data to the state.

Customer Name

David Gonzales Davids.gonzales@ddc.nm.gov

PH 505.263.7232

Liesl Martin lmartin@ahpnet.com

PH 703.298.8363

Bianca Foppert Bianca.foppert@cyfd.nm.gov 505.479.2622

Fax 505.841.4455

Jim Farmer James.farmer@doh.nm.gov

PH 505.487.0822

Raymond Duran Raymond.duran@doh.nm.gov

PH 505.623.1225

Brita Loftus bloftus@ahpnet.com

PH 734.717.1578

Milissa Soto Milissa.soto@cyfd.nm.gov

PH 505.257.8759

Kathyleen Kunkel Kathy.kunkel@hsd.nm.gov Kathy_kunkel@hotmail.com

PH 505.827.0002

Prime Vendor/Sub

Falling Colors has always acted as the prime vendor on this contract.

Falling Colors has always acted as the prime vendor on this contract.

Falling Colors has always acted as the prime vendor on this contract.

i. Summary of Bidder’s Proposed Personnel/Management Approach

The following individuals will be designated as key personnel in this project.

Tim Harville, Senior Product Manager. Tim serves in the invaluable role of being a bridge between our technical team and clients, gathering information about a business or public need and helping to translate that information into detailed technical requirements for our engineers or other technical staff to implement. With regard to the work contemplated here, Tim will (in conjunction with Tracy Archuleta, below) work directly with NDCS staff to ensure that we have a thorough understanding of all of NDCS’s needs and will work to ensure that our service platform is appropriately configured to ensure efficiency and accuracy at every step. Tim also ensures that our projects stay on track and are timely delivered.

Tracy Archuleta, Principal Business Analyst. Tracy has extensive experience with analyzing and delivering on business needs, and is adept at understanding process flows to design efficient solutions. She also heads our compliance and customer success teams, ensuring that clients receive excellent service and that all solutions are compliant with applicable regulatory or other regimes – from HIPAA to Title 42 and beyond. During her tenure at Falling Colors, Tracy has been an invaluable part of teams developing approaches to numerous new data projects, and brings an extraordinary ability to design workflow and process around data collection, integration of data streams, and system/platform design that supports the work to be accomplished. For the present contract, Tracy will work tirelessly to ensure that every service and associated rule is properly designed and configured to work as expected; she’ll also oversee the development of all training materials and modules to make certain they include all of the right information in the right places.

Spencer Williams, Quality Assurance Manager. Heading our quality assurance team, Spencer is responsible for ensuring that our dashboards, reports, and other data delivery mechanisms are sound and reliable on the back end. Design of complex systems and sets of interlocking rules requires extensive testing and verification to transition from “we built what was asked for” into “it functions the way we expect it to.” Spencer and his team test every assumption and edge case to ensure that the system functions as expected.

Kyle Kleisinger, Public Health Data Analyst Team Lead. Kyle brings extensive experience with behavioral healthcare programs in the public health field to Falling Colors, and has been the lead on our Kevin S project since joining Falling Colors. Kyle has a decade of experience with designing, coordinating, and evaluating social programs in the public health arena, and will bring his superb data skills to this project. Kyle works closely on several Falling Colors data projects, each of which involves incorporation of multiple data sets from various sources. For the present contract, Kyle (will work directly with NDCS staff to ensure that Falling Colors knows exactly what NDCS needs in a periodic report, what it needs in a dashboard, what it needs to be able to pull from the database at a moment’s notice, and how to approach a complex question asked by a state senator or a persistent reporter with a public records request. Kyle also ensures that the reports and dashboards, when delivered, are clear and easy to understand.

Adrian Mee, Principal Data Architect. Adrian has been with Falling Colors for nearly ten years and during that time has led our data architecture and security departments. With an expertise in data architecture and SQL, Adrian brings an extraordinary capacity to design data solutions that will ensure the accuracy and security of reporting and access solutions. Adrian is passionate about incorporating new technology into our platforms, and keeps us abreast of new developments in the data field that can help draw data streams together in maximally efficient and effective ways.

For the present contract, Adrian will ensure that the data is structured in such a way as to keep it safe and secure and available to deliver insight as needed.

Leadership

The Falling Colors leadership team engages directly in development and support for our projects to ensure success, and will step in as needed. This includes the following individuals:

Jorie Koster-Hale, PhD, CEO: With a background including a PhD in cognitive neuroscience from MIT, a postdoctoral fellowship at Harvard, and experience as the lead data scientist for an enterprise AI company in Paris, Jorie has an unparalleled understanding of how to use data to support public policy.

Sam Wolf, Esq., COO/General Counsel: With thirty years of business management experience and fifteen years of business law and litigation experience, Sam brings a valuable perspective to legislative and policy initiatives and an in-depth understanding of regulatory and compliance issues facing the world of sensitive data.

Barbara Serna, Director of Finance: One of the most fundamental questions posed by any third-party payor service provider relationship is “where did the money go?” and Barbara always has the answer. For the present contract, Barbara will handle invoicing and accounting-related functions, including verification that data sets and reports are drawing accurate information at all times.

j. Subcontractors

Falling Colors does not anticipate relying on subcontractors in connection with this Contract.

2. Technical Response

a. Understanding of the Project Requirements

NDCS needs a third-party payor who can contract with necessary service providers in all metro areas where it has facilities located, make certain that those providers are providing necessary information and billing appropriately, and ensure that any service NDCS is paying for is paid at the correct amount, is not Medicaid eligible, and includes preauthorization or other prerequisites.

Then, NDCS needs to have easy access to clear, actionable data about all of these and related steps.

Falling Colors thoroughly understands all of these steps and how to deliver them; this is exactly what we’ve been doing for numerous agencies of the State of New Mexico for nearly eight years.

Falling Colors understands the importance of ensuring that non-state sources of funding such as Medicaid are utilized to their fullest extent, and how to build a system that will prevent erroneous payment of Medicaid-eligible services by NDCS. Falling Colors understands the importance of ensuring that services are only paid at approved rates, whether based on Medicaid or a negotiated rate; and has built a system that can deliver certainty that services are never paid at unapproved rates. And Falling Colors understands that NDCS staff, who are busy handling the important work of the state, need to have on-demand access to crucial data that will help them understand exactly what’s happening with services and money at any given moment. Falling Colors specializes in developing data tools that can fill this need.

Falling Colors has extensive experience working with state agencies to understand and enforce rules – which services can or can’t be paid for, which services require special treatment or authorization, which services should be billed to Medicaid – and how to translate that complex morass of requirements into an easy-to-use platform that automatically enforces all of these rules so that providers can focus on delivering healthcare and state staff can focus on running programs. We can ensure that NDCS gets a platform that pays the right amounts to the right providers, prevents erroneous payments and maximizes Medicaid utilization, and delivers the data NDCS needs.

With regard to Medicaid, Falling Colors has particular expertise in dealing with non-Medicaid funds and, therefore, with ensuring that any funds that can be belled to Medicaid are. Falling Colors interfaces with the Medicaid Eligibility system to ensure all clients or services that are Medicaid eligible are billed to Medicaid. This process includes:

• Training providers to determine client eligibility for Medicaid services and billing through the MCOs first, where appropriate, rather than through Falling Colors;

• Falling Colors provides a Medicaid Eligibility Check utility (integrated into our platform) that will allow designated NDCS staff to download the three most recent months of accepted claims activity and compare it against the Medicaid membership registry.

• Based on this reconciliation, NDCS staff or Falling Colors can identify a monthly list of claims that should be recouped. Any claims paid within the three-month retroactive eligibility period are added to this tally for recoupment.

• Falling Colors support staff loads the affected claims into the Recoupment module, where the affected payments are recouped, generally as a reduction in future payments to the provider.

b. Proposed Development Approach

Falling Colors will take the following approach to development of this project. Specified time periods begin with award of the Contract.

Information and requirements gathering (days 1 - 90). Falling Colors will engage in an intensive information and requirements gathering phase. During this time, Falling Colors will work directly with NDCS to identify all services to be covered by NDCS for incarcerated persons, as well as any limitations to or special requirements for those services (for example, services that require any pre-authorization or have other prerequisites such as a certain diagnosis); and any limitations on those services (for example, dental cleanings might be covered but only at six-month intervals).

Data collection and design (days 30- 90). As Falling Colors works with NDCS to identify and define all approved services, we’ll also work with NDCS to determine what data NDCS would like to collect in relation to any of these services, ensuring that services are constructed in our platform in a manner facilitating that data collection and delivery in such formats that NDCS requires. This will include identification of any surveys or assessments NDCS would like to include (such as TEDS or GPRA).

This data design phase includes the following elements, among others:

Keys/Primary Fields: We ensure all entities in our system (clients, providers, staff, users, etc.) have primary keys to allow for search and deduplication. These unique identifier keys are automatically generated when a new record is created.

Required Fields: Required fields ensure all data that is needed to verify a service is collected. Additionally, Agencies may request that certain fields be required (such as Activity Type) to increase specificity, transparency, and analytic potential.

Data Type Validation: Limiting the types of data that can be entered into a certain field ensures data is collected in a reliable manner with the correct format (e.g., a phone number must be of the correct format, or a date must be between a certain range).

Forced Choice Constraints: Like data type validation, forced-choice as an alternative to free-text entry can ensure higher data quality and consistency; fields can be set to dropdown or multiple choice as appropriate.

Duplication Checks: Beyond field level validation and constraints, we have the ability to implement duplication checks; for example, our system checks for possible duplicates when clients are registered in the system, permitting merging of duplicates as they are identified.

Credentialing standards (days 1 – 30). An important aspect of developing a provider network is to ensure the existence of clear written standards for provider credentialing. Falling Colors is experienced in approaching this question in various ways: for example, many providers in our network are credentialed through a simple certification and attestation that the provider has already been credentialed through one of the MCOs serving the state. Other providers, who do not have MCO contracts or relationships, can be credentialed through uploading credentialing documents to the Falling Colors service platform, which documents are then available for review by state program managers. Different types of providers may have different requirements for their credentials, and the system needs to be designed and configured to incorporate these differences (for example, a dental hygienist may have a recertification requirement annually, while a physician’s assistant may need to recertify every two years). While some of these requirements are established by credentialling bodies (the Nebraska medical authority) others may be subject to NDCS discretion and requirements.

Provider Network (days 31 - 120). While our technical team is working to define and construct all necessary services, our legal and customer service team will be engaging with medical providers in appropriate areas to execute contracts protecting NDCS and Falling Colors and specifying the terms on which these providers will be contracted to deliver services to NDCS inmates. The first step here is to establish template documents (at minimum, a contract and HIPAA-compliant Business Associate Agreement). Falling Colors standard practice is to establish such a contract that provides all protections required by the contracting agency (here, NDCS) and then to work with legal departments for every provider to ensure timely execution. In the event that there are providers who wish to make changes to the contract template, NDCS will be offered a choice between a “no negotiation” approach (“This is the NDCS-approved contract; take it or leave it”) or a “discussion” approach (“Reasonable changes will be considered”). Either way, Falling Colors handles all aspects of this process, and gives NCDS final approval over any requested changes.

System Configuration (days 91 – 150). When our team understands all system requirements and NDCS has signed off on our design and rules configuration, our technical team will configure the system to incorporate all of these elements into the service platform. As elements of the platform are completed, subsequent stages can begin with regard to those areas.

Rules engine and automated quality checks (days 120 - 180). Once the information gathering and data design phases are complete, Falling Colors will conduct rigorous internal testing of the system to ensure that performance is as expected. This period will include test cases and claims to verify that rules are properly executed and sequenced, testing of claims processing and data collection, and robust system stability checks to identify and eliminate any weak points or system bugs.

User resource design and development (days 60 - 150). As the information and requirements gathering phase begins to wrap up, our customer service team will begin developing system documentation and training materials, which will include both live training sessions, recorded sessions available on demand, and short-form training resources for individual system elements.

Thus all system users will have access to written training manuals, training videos, and short form “how to” video or slide presentations.

User Acceptance Testing (days 120 - 150). Following Falling Colors’ own system quality checks, the system will be opened to testing by NDCS staff and selected providers. Importantly, NDCS staff will already have had the opportunity to see system demonstrations to ensure that it serves all identified needs; the testing period is an additional opportunity to have hands-on experience with the platform and to identify any final improvements that can be delivered. During this period, NDCS staff will also have the opportunity to see data deliverables such as reports and dashboards. While data included in these deliverables will at that point still be test data, it will enable NDCS staff to identify adjustments to formats or structure that will ensure maximum utility.

User training (days 150 - 180). Once the system is ready for go-live, Falling Colors will provide training sessions for all system users. These training sessions will be recorded and archived, and therefore will be available to any new system users or those who are unable to attend live sessions. Importantly, these training sessions will include provider training regarding how to determine client eligibility for Medicaid services, ensuring that providers are aware of how and when to bill Medicaid rather than NDCS for services. Note that the Falling Colors customer service team is always available to provide additional trainings as necessary to ensure that all system users get maximum value from the system.

c. Attachment A, Bidder Questionnaire Requirements

See Attachment A.

d. Detailed Project Work Plan

FC Key Activities FC Team

Resources Potential Obstacles

Plans to Address Obstacles Days

Information and Requirements Gathering: Work with NMDC program staff to understand workflows, services, and claims needs. During this stage, all necessary configuration changes would be identified; for example, if NDCS required a new field to be added to the consumer registration platform, we would gather all necessary information about that field at this stage. Such information would include not only the field itself but information about what insights NDCS hoped to gather from data collected through that field, whether it was mandatory, if it would be used by other programs or agencies, etc.

Technical Availability of

NDCS

personnel

Ensure designation of key NDCS staff and plan commencement of this period to match their availability

1 - 60

Legal and Contracting: Work with NDCS authorities and legal counsel to establish a provider contract template and BAA to be used for NDCS providers. This template will include all items deemed required by NDCS counsel in the context of the nature of services to be provided, items required by Falling Colors, and a HIPAA-compliant BAA.

The goal of this process is to establish a contract template acceptable to NDCS: a template that incorporates state rules, HIPAA, and any other applicable requirements, and will be tailored to the type of providers NMCD anticipates using to deliver the services at issue. This contract will include credentialing requirements (e.g., do qualified providers need to have a current LISW?); additional qualification requirements (e.g., background checks or similar); security requirements (for Falling Colors, agreement to abide by our security protocols and, for example, not share user IDs; for NDCS, this might include agreement to abide by requirements for admission to NDCS facilities).

Compliance and legal

Availability of

NDCS

personnel and understanding of overlapping requirements

Communication and engagement are key by all parties. Falling Colors has extensive experience in this arena and is adept at defining templates and understanding credentialing considerations.

However, the decisions regarding many of these elements – what must be included in the contract template, or what should be included in credentialing requirements – is ultimately up to NDCS staff or counsel. Timely decisions in this regard will be crucial to the success of the project.

1 - 60

Data Collection and Design: Work with NDCS authorities and program staff to identify all required reports and dashboards.

Ensure availability of data needed to serve those reports and dashboards, or build plan to develop and collect necessary data flows.

Data NDCS clarity and understanding on what data elements are crucial and how it needs data to be delivered.

Continued training and education with all relevant personnel of the agency, from leadership to financial to program staff. Ensuring appointment of a point of contact at NDCS who knows who to ask or bring it when decisions need to be made.

30 - 120

Potential Obstacles

Plans to Address Obstacles Days

System Configuration: Configure claims rules engine to integrate all identified services and implement all identified rules associated with those services. Integrate new claims codes and enforce any supporting rules. Ensure that all services and associated rules are designed to support and require collection of data fields necessary to deliver required reports, dashboards, or other data elements to NDCS staff.

Compliance, Development, Data, Quality Assurance

Lack of clear specification during business analysis stage

Ensuring that all relevant stakeholders at NDCS and Falling Colors have reviewed and signed off on the program requirements and approach.

61 - 150

Financial Setup: Develop the NDCS Funding Tables to ensure delivery of financial information meets NDCS needs.

For example, if NDCS wishes to track delivery or outcomes of particular grant funds, the Falling Colors service platform will need to be configured to track these grant funds appropriately..

Finance Incomplete or late budget detail sections.

Continued training and education with all relevant personnel of the agency, from leadership to financial to program staff. Ensuring FC has the correct points of contact to address financial questions.

61 - 120

Internal testing: Falling Colors configuration testing, review, correction, release. Falling Colors will demo new services and functionality to NDCS where appropriate.

Compliance, Quality Assurance

Availability of NDCS staff for demo purposes.

Ensuring adequate planning for demo schedule in advance of demo readiness to ensure appropriate availability.

120 - 180

Provider Onboarding and training: As soon as Falling Colors begins identifying providers to integrate into the provider network (through historic data regarding NDCS providers, work with NDCS, and other research) and has developed a contract template with NDCS, Falling Colors will reach out to those providers to begin the process of contracting and onboarding them into the system. We will reach out to these providers with our Provider Welcome Packet, orienting designated staff around Falling Colors processes and roles. Falling Colors support staff will proceed to gather all required information from provider staff and to set up necessary infrastructure like EFT registration, W9 forms, provider registration in our platform, etc.

Note that new providers can be added to the network at any time; the target timeline for this section is based on ensuring that an adequate provider network is contracted, comfortable using the Falling Colors service platform, and ready to begin delivering services under this Contract on day one of the go live period.

Customer Success

Provider confusion or discomfort with contract/BAA

Falling Colors keeps an open line of communication and facilitates coming to an agreement that can be approved by NDCS.

31 - 210

Internal Training: Falling Colors will train our internal support staff to be ready to answer questions and provider technical assistance, as well as update our help documentation and training materials.

Customer Success, Quality Assurance, Compliance, and Finance

Key staff being absent due to illness or vacation. // Configuration error.

Knowledge shared across teams, with each key staff person having at least one back-up for BHC-related tasks // All changes to our system go through our rigorous QA process before release.

1 - 210

Potential Obstacles

Plans to Address Obstacles Days

NDCS Training: develop and schedule trainings for NMCD staff on invoice approval and other aspects of the process that they will need to engage with.

Falling Colors customer success team

Availability of NDCS staff.

Schedule multiple trainings at convenient times, ensure that trainings and help videos are available on-demand, send out multiple notices and reminders for upcoming trainings.

120 – 210 (ongoing)

Provider Training: Falling Colors will schedule trainings for all designated personnel. Depending on the number and availability of provider staff, such trainings will be offered on multiple dates. Trainings will be recorded, and recordings made available to any staff who were unable to attend live or who would like to review the materials.

Falling Colors customer success team

Lack of engagement from provider staff.

Schedule multiple trainings at convenient times, ensure that trainings and help videos are available on-demand, send out multiple notices and reminders for upcoming trainings. Include training attendance as a metric on the Provider Scorecard.

180 – 210 (ongoing)

Please note that all of these time frames are dependent on NDCS and provider engagement, resources, and availability

e. Deliverables and Due Dates

Because actual dates for key items are TBD based on contract award and agreement regarding go-live of the system and service delivery, the “Due Dates” provided here are based on days from execution of the Contract. This list is subject to modification by mutual agreement of the parties as individual deliverables and requirements are identified and defined. All deadlines presume availability of necessary NDCS staff to provide information and formalize approvals.

Falling Colors notes that the 210-day schedule proposed here is aggressive; although we are confident in our ability to execute, successful adherence to the proposed schedule would require consistent availability and prompt responsiveness by necessary NDCS staff. An additional consideration relates to accounting considerations tied to the fiscal year. In our experience, implementing a new financial and accounting system during a fiscal year injects substantial and avoidable complexity. In our view, the most successful approach to this project would be to plan “go live” of the new system on the first day of a fiscal year. Given the implausibility of such a go-live occurring on July 1, 2025 for state FY 2026, Falling Colors believes that the most successful implementation of this project would occur with a go-live date on day one of state FY 2027 or July 1, 2026.

• List of covered services and applicable rules 60 days

• Preliminary provider network list 60 days

• Contract template with supporting documents (BAA etc) 45 days

• Credentialing requirements and standards 60 days

• Data dictionary providing standards for data collection 60 days

• List of standard reports to be available at no cost 90 days

• List of standard dashboards to be available at no cost 90 days

• Mockups of reports and dashboards for NDCS signoff 120 days

• Preliminary system design and configuration 120 days

• NDCS approval of system design and configuration 135 days

• Falling Colors preliminary testing complete 160 days

• NDCS and provider UAT complete 180 days

• NDCS training materials complete 150 days

• Provider onboarding complete (EFT tested, documents executed) 180 days

• Provider training materials complete 180 days

• Provider training schedule established 180 days

• Provider training complete 200 days

Falling Colors notes that most of these proposed deliverable dates depend on coordination of schedules between Falling Colors and NDCS. While Falling Colors is prepared to commit to availability and execution of a timeline such as the one proposed, we recognize that NDCS may have annual “crunch times” or other challenges along the way. Accordingly, we recommend that if Falling Colors is selected for this contract, one of our first efforts is to work closely with NDCS to build an actual project schedule with dates to accommodate such crunch times or other pressures and to ensure success.

SPB Form 22 | RFP Template | Effective 07192024 i State of Nebraska Department of Correctional Services

REVISED REQUEST FOR PROPOSAL FOR SERVICES CONTRACT

SOLICITATION NUMBER RELEASE DATE

120174 O3 November 01, 2024

OPENING DATE AND TIME PROCUREMENT CONTACT

January 0722, 2025, 2:00 p.m. Central Time Julie Schiltz

PLEASE READ CAREFULLY!

SCOPE OF SERVICE

The State of Nebraska (State), Department of Correctional Services, is issuing this solicitation for a service contract for the purpose of selecting a qualified bidder to process payments for claims/ invoices for an incarcerated individual(s) healthcare services on behalf of NDCS. A more detailed description can be found in Section V. The resulting contract may not be an exclusive contract as the State reserves the right to contract for the same or similar services from other sources now or in the future.

The term of the contract will be four (4) years commencing upon notice to proceed. The Contract includes the option to renew for two (2) additional two (2) year periods upon mutual agreement of the Parties. The State reserves the right to extend the period of this contract beyond the termination date when mutually agreeable to the Parties.

In the event that a contract with the awarded bidder(s) is cancelled or in the event that the State needs additional Vendors to supply the solicited services, this solicitation may be used to procure the solicited services up to twenty-four (24) months from the date the Intent to Award is posted, provided that 1) the solicited goods or services will be provided by a bidder (or a successive owner) who submitted a response pursuant to this solicitation, 2) the bidder’s solicitation response was evaluated, and 3) the bidder will honor the bidder’s original solicitation response, including the proposed cost, allowing for any price increases that would have otherwise been allowed if the bidder would have received the initial award.

ALL INFORMATION PERTINENT TO THIS SOLICITATION CAN BE FOUND ON THE INTERNET AT:

https://das.nebraska.gov/materiel/bidopps.html.

IMPORTANT NOTICE: Pursuant to Neb. Rev. Stat. § 84-602.04, State contracts in effect as of January 1, 2014, and contracts entered into thereafter, must be posted to a public website. The resulting contract, the Solicitation, and the awarded solicitation response will be posted to a public website managed by DAS, which can be found at http://statecontracts.nebraska.gov and https://www.nebraska.gov/das/materiel/purchasing/contract_search/index.php.

In addition and in furtherance of the State’s public records Statute (Neb. Rev. Stat. § 84-712 et seq.), all responses received regarding this Solicitation will be posted to the State Purchasing Bureau public website.

These postings will include the entire solicitation response. Bidder must request that proprietary information be excluded from the posting.

The bidder must identify the proprietary information, mark the proprietary information according to state law, and submit the proprietary information in a separate file named conspicuously as "PROPRIETARY INFORMATION". The bidder should submit a detailed written document showing that the release of the proprietary information would give a business advantage to named business competitor(s) and explain how the named business competitor(s) will gain an actual business advantage by disclosure of information. The mere assertion that information is proprietary or that a speculative business advantage might be gained is not sufficient. (See Attorney General Opinion No. 92068, April 27, 1992). THE BIDDER MAY NOT ASSERT THAT THE ENTIRE SOLICITATION IS PROPRIETARY. COST SHEETS WILL NOT BE CONSIDERED PROPRIETARY AND ARE A PUBLIC RECORD IN THE STATE OF NEBRASKA. The State will determine, in its sole discretion, if the disclosure of the information designated by the Bidder as proprietary would 1) give advantage to business competitors and 2) serve no public purpose. The Bidder will be notified of the State’s decision. Absent a determination by the State that the information may be withheld pursuant to Neb. Rev. Stat. § 84-712.05, the State will consider all information a public record subject to disclosure.

If the State determines it is required to release withheld proprietary information, the bidder will be informed. It will be the bidder's responsibility to defend the bidder's asserted interest in non-disclosure.

To facilitate such public postings, with the exception of proprietary information, the State of Nebraska reserves a royalty-free, nonexclusive, and irrevocable right to copy, reproduce, publish, post to a website, or otherwise use any contract, or solicitation response for any purpose, and to authorize others to use the documents. Any individual or entity awarded a contract, or who submits a solicitation response, specifically waives any copyright or other protection the contract, or solicitation response may have; and acknowledges that they have the ability and authority to enter into such waiver. This reservation and waiver are a prerequisite for submitting a solicitation response, and award of a contract. Failure to agree to the reservation and waiver will result in the solicitation response being found non-responsive and rejected.

Any entity awarded a contract or submitting a solicitation response agrees not to sue, file a claim, or make a demand of any kind, and will indemnify and hold harmless the State and its employees, volunteers, agents, and its elected and appointed officials from and against ii any and all claims, liens, demands, damages, liability, actions, causes of action, losses, judgments, costs, and expenses of every nature, including investigation costs and expenses, settlement costs, and attorney fees and expenses, sustained or asserted against the State, arising out of, resulting from, or attributable to the posting of the contract or solicitation response, awards, and other documents.

iii

TABLE OF CONTENTS

REQUEST FOR PROPOSAL FOR SERVICES CONTRACT ....................................................................................................i

GLOSSARY OF TERMS ..........................................................................................................................................................vi

ACRONYM LIST ......................................................................................................................................................................xi

I. PROCUREMENT PROCEDURE

A. GENERAL INFORMATION

B. PROCURING OFFICE AND COMMUNICATION WITH STATE STAFF AND EVALUATORS

C. SCHEDULE OF EVENTS

D. WRITTEN QUESTIONS AND ANSWERS

E. SECRETARY OF STATE/TAX COMMISSIONER REGISTRATION REQUIREMENTS

(Nonnegotiable)

F. ETHICS IN PUBLIC CONTRACTING

G. DEVIATIONS FROM THE SOLICITATION

H. SUBMISSION OF SOLICITATION RESPONSES

I. SOLICITATION PREPARATION COSTS

J. FAILURE TO COMPLY WITH SOLICITATION

K. SOLICITATION RESPONSE CORRECTIONS

L. LATE SOLICITATION RESPONSES

M. BID OPENING

N. SOLICITATION REQUIREMENTS

O. EVALUATION COMMITTEE

P. EVALUATION OF SOLICITATION RESPONSES

Q. BEST AND FINAL OFFER

R. REFERENCE AND CREDIT CHECKS

S. AWARD

T. LUMP SUM OR “ALL OR NONE” SOLICITATION RESPONSES

U. REJECTION OF SOLICITATION RESPONSES

V. PRICES & COST CLARIFICATION

W. VENDOR DEMONSTRATIONS

II. TERMS AND CONDITIONS

A. GENERAL

B. NOTIFICATION

C. BUYER’S REPRESENTATIVE

D. GOVERNING LAW (Nonnegotiable)

E. BEGINNING OF WORK & SUSPENSION OF SERVICES

F. AMENDMENT

G. CHANGE ORDERS OR SUBSTITUTIONS

H. RECORD OF VENDOR PERFORMANCE

I. NOTICE OF POTENTIAL VENDOR BREACH

J. BREACH

K. NON-WAIVER OF BREACH

L. SEVERABILITY

M. INDEMNIFICATION

N. PERFORMANCE BOND

O. ASSIGNMENT, SALE, OR MERGER

iv

P. CONTRACTING WITH OTHER NEBRASKA POLITICAL SUBDIVISIONS OF THE STATE OR

ANOTHER STATE

Q. FORCE MAJEURE

R. CONFIDENTIALITY

S. EARLY TERMINATION

T. CONTRACT CLOSEOUT

III. VENDOR DUTIES

A. INDEPENDENT VENDOR / OBLIGATIONS

B. EMPLOYEE WORK ELIGIBILITY STATUS

C. COMPLIANCE WITH CIVIL RIGHTS LAWS AND EQUAL OPPORTUNITY EMPLOYMENT /

NONDISCRIMINATION (Nonnegotiable)

D. COOPERATION WITH OTHER VENDORS

E. DISCOUNTS

F. PRICES

G. PERMITS, REGULATIONS, LAWS

H. OWNERSHIP OF INFORMATION AND DATA / DELIVERABLES

I. INSURANCE REQUIREMENTS

J. ANTITRUST

K. CONFLICT OF INTEREST

L. SITE…