HD159049_Addendum_1,_Solicitation.pdf

STATE OF CALIFORNIA--HEALTH AND HUMAN SERVICES AGENCY EDMUND G. BROWN JR., Governor

DEPARTMENT OF DEVELOPMENTAL SERVICES

1600 NINTH STREET, Room 300, MS 3-18

SACRAMENTO, CA 95814

TDD 654-2054 (For the Hearing Impaired)

(916) 654-3488

REQUEST FOR PROPOSAL--SECONDARY

Notice to Prospective Proposers

May 6, 2016

You are invited to review and respond to the State onsite consultation for the Department of Developmental Services (DDS) Request for Proposal (RFP), HD159049, Addendum 1, entitled “Registered Health Information Administrator, Registered Health Information Technician and Certified Coding Specialist”. You must comply with these instructions as well as all provisions in the Sample Contract in order for your proposal to be considered. Vendor must be able to supply personnel for all three positions.

The term of this contract is from June 17, 2016, or when approved through June 30, 2017. The State has the option of extending the term for two additional one-year periods at the same rates proposed by the Contractor for the original two years of the contract. The use of these funds is contingent upon the Department of Developmental Services’ Headquarters and developmental centers requests for services.

Implementation of the contract is contingent upon the Budget Act of the current fiscal year and/or any subsequent fiscal years covered under the Agreement and the appropriation of sufficient funds for the program.

Note that all agreements entered into with the State of California will include by reference General Terms and Conditions (GTC 610) and Contractor Certification Clauses that may be viewed and downloaded at the following Internet site: www.ols.dgs.ca.gov/standard+language . If you do not have Internet access, a hard copy can be provided by contacting the person listed below.

In the opinion of DDS, this RFP is complete and without need of explanation. However, if you have questions, or should you need any clarifying information, the contact person for this RFP is:

Karen Russ Department of Developmental Services

Contract Management Unit 1600 Ninth Street, Room 300, MS 3-18

Sacramento, CA 95814

(916) 653-0743

Please note that no verbal information given will be binding upon the State unless such information is issued in writing as an official addendum.

The Department of Developmental Services is waiving Disabled Veteran Business Enterprise (DVBE) participation requirements for this contract.

“Building Partnerships, Supporting Choices”

**PLEASE REFER TO PAGE 19 FOR MODIFICATIONS TO THE TRAVEL LANGUAGE.**

http://www.ols.dgs.ca.gov/standard+language

RFP # HD159049, Addendum 1

Table of Contents

Section Page

A) Purpose and Description of Services Purpose Description of Services Background Description of Facilities 5 B) Job Descriptions and Duties For Record Health Information Administrator (RHIA) 11 For Record Health Information Technician (RHIT) 14 For Certified Coding Specialist (CCS) 17 Travel 18 C) Proposal Requirements and Information 19

1) Key Action Dates 19

2) Electronic Questions and Answers 19

3) Submission of Proposal 19

4) Evaluation Process 22

5) Award and Protest 24

6) Disposition of Proposals 24

7) Agreement Execution and Performance 25

D) Preference Programs 25 E) Required Attachments 25

1) Required Attachment Check List 27

2) Cover Sheet 28

3) Cost Sheet 29

4) Proposer References 30

5) Payee Data Record (STD 204) 31

6) Proposer’s Small Business Certification (if applicable) 32

7) Bidder Declaration 33

8) Darfur Certification 34

9) Copy of Certificate of Liability Insurance and Worker’s Compensation 35

10) DDS Sexual Harassment Prevention Policy 36

11) Contractor's Certification Clauses (CCC 307) 37

12) Confidentiality Statement 38

13) Voluntary Statistical Data Sheet 39

14) Statement of Assurances for Protection of Personal Information (HIPAA) 40

A) PURPOSE AND DESCRIPTION OF SERVICES

1) Purpose

The Department of Developmental Services (DDS), Developmental Centers Division (DCD) is looking for a contractor to provide and manage a qualified Heath Information Management (HIM)/Clinical Records consultative and onsite services: one Registered Health Information Administrator (RHIA), two Registered Health Information Technicians (RHIT), and six Certified Coding Specialists (CCS’s). The purpose of this contract is to obtain HIM consultative onsite services from an experienced HIM contractor to provide HIM Professional RHIA consultation services to three state-operated Developmental Centers (DC’s), one State-Operated Community Facility (SOCF), and Developmental Centers Division. In addition, the candidate will act as a consult resource to Information Technology Division (ITD) Director, staff for Client Financial Services (CFS), Cost Recovery System (CRS), and the Document Management System (DMS) vendor(s). Consequently, the DCD RHIA will provide consultation, oversight and direction to the RHIT’s and CCS’s at all three DC’s and SOCF. One CCS will be provided from Fairview DC. The contractor will be expected to retain specialists with experience in HIM service provision for licensed and certified facilities (i.e. Acute Skilled Nursing and Intermediate Care Facilities for Individuals with Intellectual Disability (ICF/IID).

The HIM contractor must be knowledgeable in both applicable California and Federal statutory and regulatory law and their interpretations including:

Federal Code of Regulations, Title 42 Intermediate Care Facilities for Individuals with Intellectual Disability (ICF/IID), Skilled Nursing Facilities (SNF) and General Acute Care Hospitals (GACH);

California Code of Regulations Title 22 Intermediate Care Facilities for Individuals with Intellectual Disability (ICF/IID), Skilled Nursing Facilities (SNF) and General Acute Care Hospitals (GACH);

California’s Health and Safety Code relating to ICFs/IID, SNFs and GACHs;

California’s Lanterman Act (contained in the Welfare and Institutions Code);

Federal Health Insurance Portability and Accountability Act (HIPAA) requirements;

CMS billing coding (ICD-10, CPT) documentation requirements for different levels of care.

2) Overall Contract

The HIM contractor will be responsible for the overall project management and may designate a project manager to oversee this contract and develop a work plan blueprint for services and management of the contract staff.

3) Description of Services

The HIM contractor/designated staff will be expected to:

Retain and assign skilled qualified Health Information professionals and coders;

Deploy Qualified RHIA, RHITs and certified coding specialists that meet the AHIMA Credential requirements with direct knowledge and expertise to licensed and certified facilities (Acute, SNF, ICF) for individuals with intellectual disabilities to the DCD contract facilities;

Deploy the DCD RHIA to provide guidance and consultation for the RHITs and CCS staff;

Meet the need to travel to the facilities as determined (e.g. DCD RHIA to DCs and SOCF; the RHIT at FDC goes to CS; other travel and meetings may be arranged ad hoc);

Work with DCD, ITD, DMS system contractors, DCD designated staff onsite, the DCD record repository located at FDC, and the three DCs and one SOCF;

Provide direct service guidance and consultation through observations, interaction with staff, record and system reviews, and communication at the facility and the DCD;

Work with the DDS/DCD representatives, DDS management and the DCs/SOCF;

Provide overall clinical record management advice to the Executive Director, the Medical Director, Medical Staff committees and management staff at the DCs/SOCF and DCD;

Support and enhance the facilities’ attendance to compliance with nationally-accepted practices and services of Health Information Management;

Demonstrate experience in developing, reviewing, maintaining, evaluating and providing guidance to refine the Clinical Record system to address regulatory compliance;

The HIM contractor will provide one RHIA, two RHITs and six Certified Coders as specified below:

● RHIA: operating out of the DCD in headquarters while providing services as needed at each of the DCs and provide oversight/consultation to the RHITs and CCS.

● RHITs: at Fairview Developmental Center (FDC)/with support to Canyon Springs

Community Facility (CS) and Sonoma Developmental Center (SDC) – providing consultative and supportive services.

● Certified Coding Specialist: FDC (2); PDC (2); and SDC (2) – providing review, advice and assisting the current staff with coding and documentation requirement.

● Individuals assigned to a designated facility or location shall reside within 30 miles of said facility or location.

4) Background: The DDS provides treatment services to individuals who reside in licensed, state-operated developmental centers, and one community facility. The three DCs provide services to consumers who function in the mild to profound range of intellectual disability with varying degrees of medical, physical, sensory, behavioral and/or mental health challenges. The number of consumers in each facility varies from facility to facility with a range of approximately 225 to 400 consumers. The SOCF provides services to an average of 52 consumers with mild to moderate levels of intellectual disability, typically with mental health challenges and some with forensic histories.

DESCRIPTIONS OF FACILITIES

CANYON SPRINGS COMMUNITY FACILITY

69-696 Ramon Road

Cathedral City, CA 92234

(760) 770-6200

(Riverside County)

HISTORY: Canyon Springs Community Facility (Canyon Springs) represents a new approach to providing services to individuals with intellectual disabilities. The Canyon Springs facility is leased by DDS, which it staffs and operates. Canyon Springs offers residential and treatment approaches for up to 63 adults with intellectual disabilities and challenging behavior issues. Canyon Springs opened its doors for service in December 2000 and as of August 20, 2014 the facility population was 53. The youngest consumer was 20 and the oldest was 59 years old.

CONSUMERS: Canyon Springs serves adults with intellectual disabilities who have moderate to mild intellectual disability. Most individuals have mental health needs and severely challenging behaviors in addition to an intellectual disability.

SERVICES: Canyon Springs is licensed and certified as an ICF/ID. Similar to the developmental centers, Canyon Springs provides a full range of health care, educational, recreational, and vocational services. Individualized services and supports are identified by the interdisciplinary team in accordance with a person-centered planning model and is based upon a comprehensive assessment, including personal and family preferences.

Medical and psychological serves are generally provided at the facility. Ancillary services are contracted out. Billing is ‘mostly’ billed directly by outside provider.

PROGRAM: Consumers live and work at Canyon Springs while receiving focused training and treatment to learn how to manage their lives, gain control over impulsive and inappropriate behaviors, develop work skills and receive job training. The highly structured program that Canyon Springs provides is designed to help residents progress at improving abilities and personal conduct while working closely with an interdisciplinary team composed of psychiatrists, psychologists and direct care staff and others members of the team. As individuals demonstrate acceptable behavioral control and personal responsibility, as well as appropriate work, social and living skills, they are assisted in returning to the community.

EMPLOYEES: Canyon Springs has 150 authorized positions in 40 civil service classifications in addition to external medical contractors that provide specialty and ancillary services on the grounds of the facility. Professional level of care staff and professional ancillary staff provide services and supports based upon individual preferences and comprehensive assessments of strengths and needs of each consumer. CLINICAL RECORDS: One Standard Compliance Coordinator with past Health Information Management experience (non-credentialed) is in charge of the Clinical Record Dept. Two Health Record Technician II staff Clinical Records. The Client Record staff are trained in the DDS-electronic record (ER2000) Admission Discharge Transfer module (not a full EHR);

are trained in ICD-10, but have not been conducting their own fee for service monitoring, documentation and are not on the document management system. The Document Management System is not deployed here; except for some scanning of old documents.

BUILDINGS AND GROUNDS: The building now occupied by Canyon Springs originally opened in 1989 as a mental health program under private ownership. The facility is approximately 57,000 square feet and has the following features: three nursing stations, consumer rooms, two large multi-purpose rooms, cafeteria/kitchen, offices, four secured outdoor courtyards, swimming pool, full court gymnasium, emergency generator, training and staff development annex, and ample parking. It is located in close proximity to retail and public services.

FAIRVIEW DEVELOPMENTAL CENTER

2501 Harbor Boulevard Costa Mesa, CA 92626

(714) 957-5000 (Orange County)

HISTORY: Fairview Developmental Center (Fairview) is the newest of the developmental centers, receiving its first consumers in 1959. By 1964, all major construction had been completed and the consumer population had peaked at 2,650. Today’s consumer population of approximately 250 reflects recent efforts to redirect admissions and place persons with intellectual disabilities in alternative community living arrangements.

CONSUMERS: Fairview has a population with an age range of 18 to 97 years old, with the vast majority being adults. Fairview serves consumers with primarily moderate, profound or severe intellectual disabilities with varying degrees of physical, mental health, behavioral and specialized healthcare needs.

SERVICES: Fairview is licensed and certified as a General Acute Care Hospital, with distinct parts for SNF, and ICF/ID. The center provides a full range of health care, specialized rehabilitation training in activities of daily living, behavior supports, educational, recreational, vocational, and leisure services. There are four residential treatment programs. Consumers are placed according to the individualized services and supports identified by their interdisciplinary team, in accordance with a person-centered planning model based on a comprehensive assessment, including personal and family preferences.

Currently, all laboratory services are contracted out to UCI Medical Center. Residents with severe medical/surgical conditions that cannot be treated safely at FDC are sent to acute community hospitals. (i.e., UCI, Hoag, Costal Community).

EMPLOYEES: Fairview is staffed with 1,083 authorized positions in 150 civil service classifications. Fairview also has external medical contractors that provide specialty and ancillary services on the grounds of the facility. Clinical Records is staffed with Associate Program Analyst, Health Record Technicians, III, II, I and one transcriptionist.

(Transcription is currently outsourced). The Client Record staff are trained in the DDS-electronic record (not a full EHR) Admission, Discharge and Transfer, Diagnosis Profile, Physician’s orders for medication and ancillary, reporting of fees, etc., Minimum Data Set transmission; train other staff at times, are trained in ICD-10, fee for service monitoring, documentation and other general health information/record tasks. An active document management system is utilized to augment the limited E HR and functionality is being expanded.

BUILDINGS AND GROUNDS: Fairview occupies approximately 100 acres and is surrounded on three sides by a 36-hole golf course operated by the city of Costa Mesa. There are 50 buildings with approximately 920,670 square feet. Of this area, approximately 425,000 square feet are used for 24-hour consumer occupied areas, and the balance is for day-use, support areas, and leases.

PORTERVILLE DEVELOPMENTAL CENTER

26501 Avenue 140 Porterville, CA 93258-2000

(559) 782-2222 (Tulare County)

HISTORY: Porterville Developmental Center (Porterville) is the second newest of the four centers. In 1945, 1,245 acres were purchased for the Porterville State Home. The initial groundbreaking began in 1949 and the first consumers arrived at the renamed facility, Porterville State Hospital, in 1953. By 1957, the consumer population had grown to over 2,700. Porterville’s population significantly decreased, consistent with the downsizing trend in California, but in 1997, with the closure of a southern developmental center, Porterville began accepting forensic consumers to their newly developed Secure Treatment Program. In addition to the efforts to redirect admissions and place persons with intellectual disabilities in alternative community living arrangements, new legislation in recent years has capped the population in the Secure Treatment Program. There are currently 370 consumers residing at Porterville.

CONSUMERS: Porterville’s population ranges in age from 17 to 85 years, with the vast majority being adults. Individuals served at Porterville are diagnosed with disabilities that range from profound to mild, and many have severe chronic medical, mental health and/or behavioral needs. Over one-third of the individuals living at Porterville require services within a secure treatment program (forensic services). These individuals are in the mild to moderate range of intellectual disability, have come in contact with the legal system, have been determined to be a danger to themselves or others and/or incompetent to stand trial, and have been determined by the court to meet the criteria requiring treatment in a secure area.

SERVICES: Porterville is licensed and certified as a General Acute Care Hospital with distinct parts for Skilled Nursing Facility (SNF) and Intermediate Care Facility/ Intellectually Disabled (ICF/ID). The Secure Treatment Area is not currently ICF/ID certified. The center provides a full range of health care, educational, recreational, and vocational services. Consumers are placed according to the individualized services and supports identified by their interdisciplinary team, in accordance with a person-centered planning model, and based upon a comprehensive assessment, including personal and family preferences. Porterville has the only Secure Treatment Program in California’s Developmental Center system serving individuals who have been involved with the judicial system.

EMPLOYEES: Porterville is staffed with 1,304 authorized positions in more than 180 civil service classifications. There are also outside medical contractors that provide specialty and ancillary services. Clinical Records is staffed with Associate Program Analyst, Health Record Technicians, III, II, I and transcriptionist/s. (Transcription will be outsourced in July, 2016). The Client Record staff are trained in the DDS-electronic record (not a full EHR) Admission, Discharge and Transfer, Diagnosis Profile, Physician’s orders for medication and ancillary, reporting of fees, etc., Minimum Data Set transmission; train other staff;

trained/trainers in ICD-10, fee for service monitoring, documentation and other general health information/record tasks. An active document management system is utilized to augment the limited E HR and functionality will be expanded in the near future.

BUILDINGS AND GROUNDS: Porterville occupies 668 acres, of which 350 acres are core campus. There are 26 buildings that provide approximately 1.1 million square feet for 24-hour consumer occupied areas, day-use and support services. Porterville has its own water supply, reservoir and steam plant. Some acreage is leased for grazing animals and a unit of the California Conservation Corps. The Department of Forestry fire station, the Yaudanchi Wildlife Reserve and a Blue Heron rookery are immediately adjacent to the grounds.

SONOMA DEVELOPMENTAL CENTER

15000 Arnold Drive Eldridge, CA 95431

(707) 938-6000 (Sonoma County)

HISTORY: Sonoma Developmental Center (Sonoma) is the oldest facility in California established specifically for serving the needs of individuals with intellectual disabilities. The facility opened its doors to 148 residents on November 24, 1891 culminating a ten-year project on the part of two prominent Northern California women who had children with intellectual disabilities. The facility was first opened near Vallejo and then moved to Santa Clara a few years later. After lengthy legislative battles over the proposed funding, the current site of Eldridge was selected. At its peak in 1960, Sonoma had a population of 3,745. Sonoma’s population today is 370.

CONSUMERS: Sonoma has an adult population with an age range of 22 to 90 years and generally serves consumers who are diagnosed at the moderate, severe and profound levels of intellectual disability. Many of these individuals also have challenging behaviors and/or require specialized health care services.

SERVICES: Sonoma is licensed and certified as a General Acute Care Hospital with distinct parts for Skilled Nursing Facility (SNF) and Intermediate Care Facility/Intellectually Disabled (ICF/ID) and four additional ICF residences which are not currently certified. Like other developmental centers, it provides a full range of health care, educational, recreational, and vocational services. There are currently four residential treatment programs and consumers are placed according to the individualized services and supports identified by their interdisciplinary team, in accordance with a person-centered planning model, and based upon a comprehensive assessment, including personal and family preferences.

EMPLOYEES: Sonoma is staffed with 1,520 authorized positions in 150 civil service classifications. There are also external medical contractors that provide specialty and ancillary services. Clinical Records is staffed with Associate Program Analyst, Health Record Technicians, III, II, I and transcriptionist/s. (Transcription will be outsourced in July, 2016). The Client Record staff are trained in the DDS-electronic record (not a full EHR) Admission, Discharge and Transfer, Diagnosis Profile, Physician’s orders for medication and ancillary, reporting of fees, etc., Minimum Data Set transmission; train other staff;

trained/trainers in ICD-10, fee for service monitoring, documentation and other general health information/record tasks. An active document management system is utilized to augment the limited E HR and functionality will be expanded in the near future.

BUILDINGS AND GROUNDS: The core campus at Sonoma comprises 400 acres of a 909 acre campus. Most of the property is timberland areas which serve as a watershed for the two collection lakes that provide water to the campus. There are 131 buildings with approximately 1,475,000 square feet of space. The 24-hour living areas comprise 850,000 square feet, and the balance is used for day-use areas, support areas, and leased space. The campus is divided into two areas bisected by Arnold Drive and Sonoma Creek. Most of the living areas are on the east side of Arnold Drive and the timberland is located to the west of Arnold Drive.

B) Job Description and Duties

REGISTERED HEALTH INFORMATION ADMINISTRATOR (RHIA)

The Registered Health Information Administrator (RHIA) will provide consultation and guidance, oversight, and direction to the RHIT/Clinical Records Directors/HRT IIIs, CCS, other Clinical Records staff, consultation/training for Medical/Clinical and other professional staff in the Developmental Centers and serve as consultant to the Department of Developmental Services (DDS), the Developmental Center Division (DCD), Information Technology Division (ITD) and Client Financial Services/the billing coordination staff (CFS) and Cost Report Systems/the computer billing system (CRS) related to Health Information Records Management. Services that may be requested during the contract term include, but are not limited to:

Administer/consult related to a statewide health records system in the developmental centers;

Provides DDS/DCD, the Developmental Centers, State Operated Community Facility, Information Technology Division, CFS, CRS, and others with assistance and monitoring of client record systems, ICD/Current Procedural Terminology (CPT) coding updates, billing practices, documentation requirements and policies/procedures, DSM V and CDI processes;

Provides administrative and technical knowledge in the utilization of client care data for developmental centers to department staff and other State agencies;

Provides functional supervision and develop training for facility client health records staff, physicians and other clinical staff;

Lead consultant in charge of, or acts as, the department’s lead administrative and technical advisor on matters concerning computerized health record systems and clinical data;

Update as needed program policies and procedures which have statewide implications for client health records that are in conformance with the applicable Federal, State and local statutes and regulations;

Formulates, reviews, and analyzes legislative proposals affecting client health record and documentation practices;

Work with ITD, DMS contractors and DCD designated staff onsite at the DCs, the DCD staff and the DCD record repository located at Fairview Developmental Center

(FDC).

Consult on and assist with and develop educational materials and conducts instructional programs for clinical record, administrative, medical and other clinical staff (i.e. HIPPA, coding, billing documentation requirements, ICD-10, CPT use and accuracy) for each of the DCs and the SOCF;

Provide guidance for DDS on California and Federal statutory and regulatory law, including: HIM and Clinical Records department management, HIPAA, billing, coding and documentation in Electronic Health Record (EHR) and Minimum Data Set (MDS) requirements. The DCs do not have a certified EHR;

Interprets laws, agency regulations, Licensing, HIPPA, and Centers for Medicare & Medicaid Services (CMS) standards, third-party payer, and other legal and regulatory requirements;

Provides consultation and assistance and instruction to physicians, clinical records staff, client care staff in clinical record documentation, record systems management, and related subjects;

Provides onsite consultation and assistance to each of the Developmental Centers (DC) and State Operated Community Facility (SOCF) based on the work plan;

Serves as a member of IT governance and administrative committees;

Works with designated DCD and DC/SOCF facility staff to maintain retention schedule/s and retrieval system/s;

Acts as resource consultant and liaison for clinical records issues to governmental and private agencies, including the Department of Developmental Services, Regional Center, as applicable, State and/or Federal certifying agencies and between DCD- CFS, ITD, the DCs and the SOCF;

Serves as a consultant in surveys coordinated by the DDS/DCD Health and Direct Care Services Section. This may include consultation and coaching to focus survey team members on Health Information practice and compliance with documentation and billing;

As areas of need are identified, the contractor may be requested to deliver consultative services to include audits, document/policy reviews, analysis of corrective measures, etc.;

Advise and work with DCD and DDS management to review, revise and implement (as needed) for a system-wide strategy for augmenting the Department’s oversight of regulatory Administrative, documentation, coding, billing, survey compliance;

May participate in surveys onsite at the facilities to evaluate survey readiness and regulatory compliance. This includes providing interpretive guidance for implementation of both California and Federal statutory regulatory law. The consultants must have the ability to positively interact with and provide effective coaching to facility staff during mock surveys;

Prepare periodic verbal and written status reports and work plans related to the HIM services, findings and recommendations;

At an agreed on timeframe, a written report of any significant and/or concerning findings, along with recommendations will be provided to the Executive Director of the facility for facility based services or designee and to the DCD by the DCD RHIA with collective summary based on pre-determined report format. The reports will include:

A restatement of objective previously identified for the requested consultation Follow-up or additional work that needs to be completed or was requested by the facility A description of the contractor’s work performed, status The findings and recommendations for progress

The contractor will provide guidance, oversight, and direction to staff, as identified above, at the following locations:

Canyon Springs Community Facility

Fairview Developmental Center

Porterville Developmental Center

Sonoma Developmental Center

Headquarters

The DCD RHIA must be knowledgeable in applicable California and Federal statutory and regulatory law and their interpretations including:

The DCD RHIA must be credentialed with the AHIMA and in good standing; with knowledge of and ability to effectively administer a health information/record system that meets;

Federal Health Insurance Portability and Accountability Act (HIPAA) requirements;

Acute Hospital – Federal Regulations 482.24 et’l;

California Code of Regulations Title 22 Intermediate Care Facilities for Individuals with Intellectual Disability (ICF/IID), Skilled Nursing Facilities (SNF) and General Acute Care Hospitals (GACH);

California’s Health and Safety Code relating to ICFs/IID, SNFs and GACHs;

● California’s Lanterman Act (contained in the Welfare and Institutions Code);

MINIMUM QUALIFICATIONS

Proposers must meet the following minimum qualifications in order for their proposals to be considered:

● The DCD RHIA must have a current registration in good standing by the American

Health Information Management as a Registered Health Information Administrator;

and

● Possess 4 years of experience in performing duties: 1) as a Director of Health

Information in a health facility or consulting in i.e., acute hospital or similar organization with knowledge of acute, skilled and intermediate care facility regulatory, documentation, ICD-10 and CPT coding, billing requirements; 2) knowledge of electronic health record and HIPAA requirements; 3) ability to plan, organize, implement and manage health information management projects; 4) skills in consulting with various levels of Administrative, electronic health record systems, regulatory and legal entities; 5) strong consultative to the RHITs and CCS staff deployed at the DCs/SOCF; 6) must possess training skills.

REGISTERED HEALTH INFORMATION TECHNICIAN (RHIT)

The Registered Health Information Technician (RHIT) will provide consultation and guidance, oversight, and direction to the Clinical Records, Medical/Clinical and other professional staff at Sonoma Developmental Center and at Fairview Developmental Center.

Under general direction of the Quality Assurance Director and in coordination of the DCD RHIA, the RHITs typical tasks include, but are not limited to:

Provides consultation to assist with planning, developing, and direction of clinical records staff system to meet the facility's goals, Licensing and Certification for Medicare & Medicaid Services (CMS) standards, third-party payer, and other legal and regulatory requirements;

Consults on the policies and procedures for information handling and dissemination in accordance with professional ethics and in conformity with applicable Federal, State, and local statutes and regulations and DCD policies/procedures;

Reviews methods for and conducts qualitative and quantitative evaluation of clinical record content;

Provides guidance to the Utilization Review program, other medical staff committees and the Medicare committee, as indicated;

Collects and analyzes clinical record data for statistical, reimbursement, and client care evaluation;

Advises and assists with development and implementation of clinical documentation improvement, including policies and procedures for all levels of staff, i.e. physician, nursing, ancillary services, and professional health information guidance in many areas: i.e. legalities of manual and electronic records, coding and reimbursement expertise, legalities of Health Insurance Portability and Accountability and the requirements to meet licensing and certification requirements which affects reimbursement as well;

Provides consult and direction from and coordinates with the DCD RHIA and Facility Administration;

Supervises and oversees the Health Record Technicians, other clinical record staff, Certified Coding Specialists;

Supervises or coordinates with other staff who may be assigned some Client Record Department duties;

Assists in maintaining a hybrid record system; becomes knowledgeable re: the document management system and assists with the enhanced implementation, record planning for e-storage of records for all departments at facility closure;

Follows up on clinical record/billing questions and edits to link clinical documentation to reimbursement;

Is a resource person at the facility for Federal and State regulations, Medicare, Medi-Cal, HIPPA, and other third-party payer provider reviews, and utilization review of program requirements;

Acts as liaison between the facility and RHIA in the Developmental Centers Division (DCD), Client Financial Services (CFS) and Information Technology Division (ITD);

Serves as an integral part of the facility-wide Medicare Compliance Quality Assurance programs;

● Develops in-service educational materials and conducts instructional programs for clinical record, administrative, medical and other clinical staff in coordination with the DCD-RHIA;

● Plans and implements retention schedules and retrieval systems with the DCD assigned representative;

● Coordinates and works with the medical staff and all the clinical staff internally on the standards set by regulation and in coordination with the DCD RHIA;

● Provides consultative supervision and develop training for facility client records and clinical staff;

● Coordinates with other key facility staff re: technical matters concerning complex and/or computerized health record systems and clinical data;

● Consults and assists in training and follow up re: ICD-10 and Current Procedural Terminology (CPT) and updates/DSM V;

● May participate in surveys onsite at the facilities to evaluate survey readiness and regulatory compliance. This includes providing interpretive guidance for implementation of both California and Federal statutory regulatory laws and providing effective coaching to facility staff during surveys;

● Review training and assists to train facility medical and other clinical staff in HIPAA, Acute, Skilled Nursing (no Part A), ICF/IID, ICD-10 coding, CPT billing, documentation and regulatory requirements.

● The RHIT must be credentialed with the AHIMA and in good standing;

● Knowledge of International Classification of Disease (ICD)/Current Procedural Terminology

(CPT) coding and reporting, use during the application for Medicare and Medicaid claims on behalf of the client and to work with Client Financial Services on issues as they relate to the detail of billing, coding and reimbursement;

The candidate must be knowledgeable in:

1) Federal Acute Hospital, Intermediate Care Facilities for the Intellectually Disabled (ICF/IID), Code of Regulations, Title 42;

2) California Code of Regulations Title 22 Intermediate Care Facilities for Individuals with Intellectual Disability (ICF/IID), Skilled Nursing Facilities (SNF) and General Acute Care Hospitals (GACH);

3) California’s Health and Safety Code relating to ICFs/IID, SNFs and GACHs;

4) California’s Lanterman Act (contained in the Welfare and Institutions Code);

5) Federal Health Insurance Portability and Accountability Act (HIPAA) requirements.

MINIMUM QUALIFICATIONS

Proposers must meet the following minimum qualifications in order for their proposals to be considered:

Registered Health Information Technician (RHIT) must have a current registration in good standing by the American Health Information Management as a registered

Health Information Technician; and possess at least: 1) two years of experience in a medical records office or consultation to an approved hospital or health facility or similar organization with knowledge of acute, skilled and intermediate care facility regulatory documentation, ICD-10, CPT coding, billing requirements; 2) which must have involved the supervision of health information/ records personnel; 3) ability to plan, organize, implement, and manage health information management projects at the local facility; 4) has experience in consultation, training and supervising others; 5) strong consultation and supervision skills;

6) ability to plan and implement projects.

CERTIFIED CODING SPECIALIST

The Certified Coding Specialist (CCS) must have a current, approved AHIMA CCS certification shall have knowledge and/or provide the following services, which are not limited to:

Has experience in coding that would affect all levels of care (not including ICD-10 PCS) familiarity with clinical documentation requirements; has experience working with physicians who provide general medical and acute medical services (no surgeries are performed at the Developmental Center, Acute Hospital) re: accuracy of coding and supporting clinical documentation;

Understanding and can provide consultation and training and monitoring of diagnosis and coding requirements for acute medical hospital and health conditions primarily to support ancillary/fee for service and Acute Medical stays;

Using their coding and clinical knowledge as well as their understanding of the complexity of electronic record systems and manual processes, ICD-CM, Current Procedural Terminology and billing requirements;

Adapting to DDS/DC workflow processes that vary to some extent from DC to DC and State Operated Community Facility (SOCF);

Consulting with and working closely with the Medical Director and physicians re:

diagnosis specificity; supporting documentation for clinical services provided, and Clinical Documentation Improvement (CDI);

Working with staff to follow up on Client Financial Services edits, working toward efforts to reduce the risk of loss of revenue and adhere to compliance issues; including responses to Health Data Insight or other intermediary requests;

Providing consult support for the physicians, but not replace the physician’s selection of the diagnosis in the E HR (DDS-ER2000) and as close as possible the related diagnosis code;

Being aware of the Electronic Health Records (EHR) and manual process (i.e., DDS system is a hybrid Developmental Services computer system; use HealthCare Systems [HCS] used for MDS;) ER2000 provides for i.e., selection of diagnoses and Current Procedural Terminology codes;

Providing oversight through consultation services in coordination with the Clinical Record Director/Supv. Health Record Technician staff and conduct fee-for-service reviews; utilize the ER2000 Claims Editor and Encoder Professional/Payer;

Consult with, train, and mentor staff who conduct fee for service reviews;

Preparing Medicare Compliance, Coding and Billing Reports for the Developmental Center/State Operated Community Facility;

Receiving direction from the facility assigned consultant RHIT-contractor in coordination with the DCD RHIA;

Have ICD-10 Coding practical application and experience in training and consultation – working with physicians on coding and documentation accuracy and billing requirements;

Have analytical experience in preparing and presenting clinical/coding/statistical information;

Possess advanced computer skills, PC experience in Windows-based applications.

MINIMUM QUALIFICATIONS

Proposers must meet the following minimum qualifications in order for their proposals to be considered:

● CCS—Certificate from AHIMA—current;

● 2 years of acute care, knowledge of ICD-10, CPT coding experience, and clinical documentation evaluation experience;

● Training and working with physicians on coding and Clinical Documentation Improvement (CDI);

● Trained in ICD-10 and has demonstrated training capability in training others in ICD-10

Conventions, new coding requirements, documentation improvement to support the ICD-10 correct coding for clinical and billing purposes.

Travel

Lodging, per diem and transportation will be reimbursed at the state rate as specified by the CalHR web site http://www.calhr.ca.gov/employees/Pages/travel-reimbursements.aspx. Any anticipated travel costs shall be included as a separate line item on the cost sheet. Initial transportation, i.e. airfare, taxi, bus fare, mass transit, or mileage, will be reimbursed based upon actual cost. Upon permanent assignment, lodging and per diem reimbursement will not be required. as all positions must be filled by individuals residing 30 miles of their assigned facility/location. No travel outside the State of California shall be reimbursed. Relocation costs will not be reimbursed.

In the event travel between facilities/locations is required:

● Locations and miles must be reported for personal vehicle reimbursement at current IRS rates;

● Rental Cars are to be the lowest possible rate for an economy car;

● Air Fares need to be the lowest rate;

● Overnight stay on half work days ending in early afternoon must be approved by Project Representative.

REQUESTS FOR TRAVEL EXPENSE EXCEPTION APPROVAL refer to State Administrative Manual (SAM) Chapter 0700. Department of General Services web site for SAM is http://sam.dgs.ca.gov/.

Otherwise, Contractor is responsible for added costs.

Project Representative

During the term of this contract, DDS’ Project Representative will be:

Rhonda Anderson Developmental Centers Division 1600 9th Street, Room 340, MS 3-17

Sacramento, CA 95814 http://www.calhr.ca.gov/employees/Pages/travel-reimbursements.aspx http://www.calhr.ca.gov/employees/Pages/travel-reimbursements.aspx http://sam.dgs.ca.gov/

C) PROPOSAL REQUIREMENTS AND INFORMATION

1. Key Action Dates

Event Date Time

RFP available to prospective proposers 04/25/2016 5 PM PST

Deadline to submit written questions 05/02/2016 3 PM PST

DDS answers to submitted questions 05/06/2016 3 PM PST

Deadline for submission of proposal 05/18/2016 5 PM PST

Notice of Intent to Award posted 05/25/2016 Noon PST

2. Electronic Q&A for this RFP

For the purpose of posing questions or concerns regarding this RFP, e-mails are to be sent to Karen Russ at karen.russ@dds.ca.gov . All questions and answers regarding this RFP will be shared via e-mail with each of the agencies/organizations that submit questions.

3. Submission of Proposal

a) Proposals must provide straightforward and concise descriptions of the proposer’s ability to satisfy the requirements of this RFP. The proposal must be complete and accurate.

Omissions, inaccuracies or misstatements shall be cause for rejection of a proposal;

b) The proposal must include clearly delineated sections that address the following:

i. The entity’s experience in health information management, preferably in multi-level HI management services such as acute, skilled, intermediate care - The proposer must clearly demonstrate the contracting entity’s experience in training, development, and project management including a list of references for similar services;

ii. The Contractor’s Administrative experience related to clinical record and reimbursement – The proposer must clearly demonstrate the contractor’s administrative experience in project development and management. This is the highest level individual that will directly develop and assist with projects and administration/coordination with Clinical Record Directors and designated staff in charge in the DC/SOCF;

iii. Services offered - The proposers must list a straightforward and concise description of services that can be offered, the professionals utilized and the approach they would take to provide the services;

mailto:karen.russ@dds.ca.gov

iv. Curriculum Vitae (C.V.) – or specified qualifications listed in the proposal that clearly demonstrates his/her expertise;

v. The following cost detail:

■ Cost for providing an RHIA that will be assigned full time at DDS headquarters to assist in development, consultation, training, oversight of the Clinical Record services, electronic and manual;

■ Complete list of all costs associated with this contract must be included in the attachment section of the proposal. In addition to the hardcopy form submitted in the proposal, this information must be submitted in an unprotected electronic Excel spreadsheet on a USB flash drive;

■ Lodging and per diem will be reimbursed at the California State rate as published by the California Human Resources Agency (CalHR).

Transportation will be reimbursed based upon actual cost.

c) All proposals must be submitted under sealed cover and sent to DDS by the dates and times shown in Section C, Proposal Requirements and Information, Item 1) Key Action Dates, page 16. Proposals received after this date and time will not be considered;

d) One (1) original and five (5) copies of the proposal must be submitted. The original proposal—minus the Cost Sheet—must be marked "ORIGINAL”. All documents contained in the original proposal must have original signatures and must be signed by a person who is authorized to bind the proposing firm. All additional proposal sets may contain photocopies of the original. One (1) original Cost Sheet and five (5) Cost Sheet copies must be placed in a separate, sealed envelope and must be marked “COST SHEETS—DO NOT OPEN”. The original Cost Sheet must be marked “ORIGNAL”;

e) The proposal envelopes must be plainly marked with the RFP number and title, the firm name and address, and must be marked with "DO NOT OPEN", as shown in the following example:

(RFP # HD159049)

Registered Health Information Administrator

DO NOT OPEN

If the proposal is made under a fictitious name or business title, the actual legal name of proposer must be provided. The legal business name will be used on/in any contract awarded. Proposals not submitted under sealed cover and marked as indicated will be rejected;

f) All proposals shall include the items listed in Section C, 3.b, as well as the documents identified on Attachment I, Required Attachment Checklist. Proposals without these items shall be deemed non-responsive. A non-responsive proposal is one that does not meet the basic proposal requirements. Proposals not meeting the basic proposal requirements will not be considered;

g) Mail or deliver proposals to the following address:

1600 Ninth Street, Room 300, Mail Stop 3-18

Sacramento, California 95814 Attention: Karen Russ, Contracts Management Unit

h) Proposals must be submitted for the performance of all the services described herein. Any deviation from the contract scope will not be considered and will cause a proposal to be

i) A proposal may be rejected if it is conditional or incomplete, or if it contains any alterations of form or other irregularities of any kind. The State may reject any or all proposals and may waive an immaterial deviation in a proposal. The State's waiver of an immaterial deviation shall in no way modify the RFP document or excuse the proposer from full compliance with all requirements if awarded the agreement;

j) Costs incurred for developing proposals and in anticipation of award of the agreement are entirely the responsibility of the proposer and shall not be charged to the State of California;

k) An individual who is contractually authorized to bind the proposing firm shall sign the Attachment 2, Proposal/Proposer Certification Sheet, page 20. The signature must indicate the title or position that the individual holds in the firm. An unsigned proposal may be

l) A proposer may modify a proposal after its submission by withdrawing its original proposal and resubmitting a new proposal prior to the proposal submission deadline as set forth in the Key Action Dates. Proposal modifications offered in any other manner, oral or written, will not be considered;

m) A proposer may withdraw its proposal by submitting a written withdrawal request to the

State, signed by the proposer or an authorized agent in accordance with (k) above. A proposer may thereafter submit a new proposal prior to the proposal submission deadline.

Proposals may not be withdrawn without cause subsequent to proposal submission deadline;

n) The awarding agency may modify the RFP prior to the date fixed for submission of proposals by the issuance of an addendum to all parties who received a proposal package;

o) The awarding agency reserves the right to reject all proposals. The agency is not required to award an agreement;

p) Before submitting a response to this solicitation, bidders should review their proposal, correct all errors and confirm compliance with the RFP requirements;

q) Where applicable, proposer should carefully examine work sites and specifications. No additions or increases to the agreement amount will be made due to a lack of careful examination of work sites and specifications;

r) More than one proposal from an individual, firm, partnership, corporation or association under the same or different names, will not be considered;

s) The State does not accept alternate contract language from a prospective contractor. A proposal with such language will be considered a counter proposal and will be rejected.

The State’s General Terms and Conditions (GTC) are not negotiable;

t) No oral understanding or agreement shall be binding on either party.

4. Evaluation Process

a) At the time of proposal opening, each proposal will be checked for the following:

i) Screening Criteria:

Submitted on time Submitted under sealed cover An original and at least six copies are provided Contains the following, completed mandatory attachments:

✓ Required Attachment Checklist

✓ Proposal/Proposer Certification Sheet

✓ Salaries Cost Sheet

✓ Proposer References

✓ Copy of Small Business…