MassHealth PCA Program PCM Functions RFR.docx

Commonwealth of Massachusetts Executive Office of Health and Human Services MassHealth Office of Long Term Services and Supports

MASSHEALTH PERSONAL CARE ATTENDANT (PCA) PROGRAM

REQUEST FOR RESPONSES

FOR PERSONAL CARE MANAGEMENT FUNCTIONS

Issued: May 22, 2026 Document #: 26EHSKWPCMRFR

TABLE OF CONTENTS

MassHealth PCA Program PCM Functions RFR Page 2 of 2 Introduction Overview The Massachusetts Executive Office of Health and Human Services (EOHHS) is the single state agency responsible for administering the Commonwealth’s Medicaid program and its Children’s Health Insurance Program (together, MassHealth) in accordance with M.G.L. c. 6A, § 16, Titles XIX and XXI of the Social Security Act, M.G.L. c. 118E and other applicable federal and state laws, regulations, waivers and demonstration projects. Through the MassHealth program EOHHS pays for a wide range of preventative, acute, chronic and facility-based long term support services, as well as medically necessary community-based long-term services and supports for certain eligible individuals.

One of the many community-based long-term services and supports offered under the MassHealth program, and which is the subject of this procurement, is Personal Care Attendant (PCA) services. MassHealth PCA services are self-directed personal care services provided by a personal care attendant, which consist of physical assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) provided in a community-based setting. MassHealth PCA services are provided pursuant to MassHealth regulations at 130 CMR 422.000.

PCA services provided under the Medicaid state plan are directed by the MassHealth Members. MassHealth Members receiving PCA services are referred to as “Consumers,” are the employers of their PCA(s), and are responsible for recruiting, hiring, training, and scheduling of their PCA(s). As described in further detail in Section 3: Program Description, EOHHS contracts with Personal Care Management (PCM) agencies to perform certain administrative functions under the MassHealth PCA program to assist Consumers in managing their PCA services.

Purpose of Procurement Through this RFR, EOHHS seeks to contract with multiple qualified entities (Bidders) to provide PCM Functions to eligible MassHealth Members as described in Section 3 herein and in the Model Contract (Attachment A), with particular focus on the Northeast and Southeast Regions of Massachusetts. PCM functions include a broad range of support functions that assist Consumers with the management of their PCA services.

EOHHS is issuing this Request for Responses (RFR) pursuant to 801 CMR 21.00 to solicit responses from qualified entities interested in contracting with EOHHS to perform PCM functions under the MassHealth PCA Program.

Bidder Qualifications EOHHS seeks to contract with multiple qualified Bidders to perform PCM Functions as specified in the Model Contract (Attachment A). EOHHS has a strong preference for Bidders that have experience supporting each of the following populations in a consumer-directed model with the management of their personal care needs, or with providing assistance with similar relevant functions:

A. Individuals with physical disabilities;

B. Older adults with personal care needs; and C. Children and youth with personal care needs.

Only Bidders possessing the above identified minimum qualifications will be further evaluated by EOHHS for selection.

Contract Term Any Contract awarded as a result of this RFR shall be effective for an initial term through June 30, 2029. EOHHS may extend the Contract for up to two additional three-year terms at the sole discretion of EOHHS. EOHHS reserves the right to further extend the Contract for any reasonable increment it determines necessary to complete a subsequent procurement. Extension of the Contract resulting from this RFR is subject to further legislative appropriations, continued legislative authorization, and EOHHS’ determination of satisfactory performance.

Definitions All capitalized terms are defined as set forth in Section 1 of Attachment A.

Program Description Through this procurement EOHHS will procure entities to perform PCM functions. A description of the scope of functions and Contractor responsibilities is provided in Section 3.2.

Model Contract Each successful qualified Bidder that becomes a Contractor shall perform the activities requested in this RFR and set forth in the Model Contract (Attachment A). The Model Contract (Attachment A) contains provisions that shall be incorporated into any Contract to be executed between EOHHS and all successful Bidders. EOHHS reserves the right to modify Attachment A as it deems necessary prior to execution of the Contract. Changes to the Contract after its execution by the parties shall be made only by written amendment.

Overview of Contractor Responsibilities In addition to the other requirements set forth in Attachment A and regulations at 130 CMR 422.000, Bidders selected for Contract award pursuant to this RFR will be required to provide PCM functions that will consist of the following components:

A. Assessing a Consumer’s ability to manage PCA Services, including identifying whether the Consumer requires a Surrogate or Administrative Proxy to assist in the management of PCA Services, in accordance with 130 CMR 422.422(A) and Section 2.1.C. of the Model Contract in Attachment A;

B. Assessing the ability of a Surrogate or Administrative Proxy, if applicable, to assist the Consumer in managing PCA Services in accordance with 130 CMR 422.422(A) and Section 2.1.C. of the Model Contract in Attachment A;

C. Providing Intake and Orientation to educate a Consumer about the rules, policies, and procedures that govern the PCA Program and the Consumer’s rights and responsibilities when using the PCA Program as well as the skills and tasks necessary to manage their PCA services in accordance with 130 CMR 422.421(A) and Section 2.1.B. of the Model Contract in Attachment A;

D. Conducting Evaluations and Re-evaluations of a Consumer’s functional abilities and need for PCA Services. Evaluations and Re-evaluations must be conducted in accordance with 130 CMR 422.422(B) and (C) and Section 2.2.C.1 of the Model Contract in Attachment A;

E. Submitting prior authorization requests, including required documentation, to EOHHS in accordance with 130 CMR 422.416, 130 CMR 422.418(B), and Section 2.2.C.2. of the Model Contract in Attachment A F. Developing, in conjunction with the Consumer and Surrogate or Administrative Proxy, if any, a Service Agreement that describes the responsibilities of the PCA, the Consumer, the Surrogate, the Fiscal Intermediary, and the Personal Care Management (PCM) Agency in accordance with 130 CMR 422.423 and Section 2.2.D. of the Model Contract in Attachment A;

G. Submitting requests for overtime requiring authorization in accordance with 130 CMR 422.418(A) and Section 2.2.F of the Model Contract in Attachment A, and H. Providing Functional Skills Training of the appropriate type (in-person comprehensive, in-person issue-focused, telephonic) and within specified timeframes that instructs a Consumer and the Consumer’s Surrogate or Administrative Proxy, if any and as applicable, in the development of the skills and resources needed to maximize the management of the PCA Program in accordance with 130 CMR 422.421(B) and Section 2.2.E. of the Model Contract in Attachment A.

Service Volume As of January 2026, approximately 25,000 Consumers were receiving PCA services through the MassHealth fee for service PCA Program. PCM functions assisting Consumers covered through managed care programs are contracted separately.

Nothing in this RFR shall be construed as an express or implied guarantee of any level of Consumers to be served by a Bidder awarded a Contract under this procurement.

PAYMENT

Subject to the terms and conditions set forth in Attachment A and as described therein, EOHHS shall pay a Contractor for functions performed under the Contract at the rates set forth in the Contract at Appendix 5: Payment Rates, Attachment A.

RFR RESPONSE SUBMISSION REQUIRements Originals and Copies Responses to this RFR must consist of the following documents (note: original copies must clearly be labeled as “original”) A. An electronic response, submitted via COMMBUYS, as described in Section 5.3.A.

Responsiveness Each document submitted must include all information specific to the topic of that document as required by this RFR. EOHHS will evaluate only those materials that are responsive to this RFR and presented in accord with the instructions in Sections 6 and 7.

Submission Requirements A. Response Format Requirements Each document submitted must be clearly labeled and must state on the cover the following:

a. The title of the RFR;

b. The Bidder’s legal name; and

c. The title of the document (that is, Business Response and Programmatic Response).

Each document must contain a table of contents, and each section of the document must be separated by a tabbed page that includes reference to the RFR section number and heading (for example, “Section 7.2: Background and Experience”). Each attachment of the document must also be separated by a tabbed page that includes the attachment number and heading (for example, “Attachment D: Service Area Coverage Form”).

The Bidder must respond to each item in the order in which it appears in the RFR. The Bidder’s response to each section must include headings and numbering to match the corresponding section of the RFR. The Bidder’s Business Response and Programmatic Response must be submitted as separate sections as described in Section 5.1.

Electronic media submissions such as videotapes, audiotapes, and diskettes will not be accepted, other than the required electronic files submitted via COMMBUYS. Facsimile and emailed responses will not be accepted.

The Bidder must adhere to page limits where specified. Attachments and other supporting documentation specifically permitted or required by this RFR are not counted in calculating the Bidder’s page limits. The narrative section of each document must be formatted as follows:

a. Typewritten;

b. Single-spaced;

c. 12-point or larger font, except for charts and tables, which may be in 10-point font or larger;

d. Pages numbered;

e. Double-sided;

f. 1-inch or greater margins; and

g. Six lines or fewer per inch.

B. The Bidder must include with its response a Cover Letter that clearly states the name of the Bidder, principal address, and the name, address, email, fax and telephone number of the Bidder’s contact person. The letter must:

0. Include name of the RFR for which the Bidder is submitting the Response;

0. Include a statement that clearly articulates that the Bidder accepts the following:

1. Terms of this RFR and of the applicable Model Contract provided in Attachment A without substantive change;

1. Standard Contract Form;

1. Standard Contract Form Instructions and Contractor Certifications; and

1. Commonwealth Terms and Conditions.

0. Include a statement that the Bidder’s response will remain in effect until a Contract resulting from this RFR is executed;

0. Include the name, address, email address, and telephone number of the individual who should be contacted for the purpose of discussing any aspect of the Bidder’s response; and

0. Be signed by an individual authorized to bind the Bidder and execute a Contract on behalf of the Bidder resulting from this RFR.

Deadline for Submission The Bidder shall submit its Response (business and programmatic) no later than the date and time specified in Section 10.

EOHHS requests that interested Bidders submit their RFR responses by the initial submission date listed in Section 10. Each response will be subject to the review and evaluation process as described in Section 8 and must meet the criteria established by this RFR and any amendment hereto. EOHHS will make every effort to timely evaluate all responses received by the initial submission date and will notify Bidders of their status for the anticipated Contract start date as listed in Section 1.4.

Open Enrollment This is an “Open Enrollment” procurement. After the initial selection process, EOHHS will accept RFR responses from Bidders during any open enrollment period or periods through the term of the Contract. Any Bidder submitting a Response during such open enrollment period must follow the submission instructions outlined in this Section 5.

If EOHHS, after the initial deadlines for responses has passed, has not received sufficient responses, in EOHHS’ sole determination, EOHHS may immediately reopen the RFR to accept additional Responses, including but not limited to:

0. EOHHS may reopen the RFR if EOHHS does not receive a sufficient number of qualifying Responses to meet EOHHS’ goals as described in Section 1.3, including but not limited to contracting with sufficient PCMs to support the MassHealth PCA program;

0. EOHHS may reopen the RFR for Bidders from a specific geographic area if EOHHS does not receive a sufficient number of qualifying Responses from Bidders in that area to provide sufficient support for Members, in EOHHS’ sole determination;

0. EOHHS may reopen the RFR for initial Bidders to submit additional Responses, if EOHHS determines that the initial Responses may not support EOHHS’ goals as described in Section 1.2; and

0. EOHHS may reopen this RFR for any other reason, at any other time during the term of the Contract, at its sole discretion.

business response submission requirments The Bidder shall meet all standards and must comply with all Business Response submission requirements in this section.

Submission of Forms with the Business Response The forms described below must be completed, signed, and submitted with the Business Response. All of the referenced forms may be downloaded from the COMMBUYS website (refer to Section 9.4 for information about COMMBUYS).

A. Contractor Authorized Signatory Listing;

B. MassHealth Federally Required Disclosures Form;

C. EOHHS-Required Bidder Certification Form;

D. Supplier Diversity Program (SDP) as described in Section 9.16;

E. Cost Response (Attachment B); and F. References as described in Section 6.12.

Organizational Overview The Bidder shall provide the following information:

A. The Bidder’s legal name, trade name(s), and any other name(s) under which the Bidder does, or has done, business;

B. The Bidder’s MassHealth Provider ID/service location (PID/SL) (if applicable);

C. The Bidder’s principal address, email address, website URL, and telephone number;

D. The type of legal entity (for example, corporation (profit or not for profit), and the state where the entity is organized, including any parent organization; and E. A statement regarding whether or not the Bidder is a Minority Business Enterprise as defined in Section 9.16.

Ownership and Control The Bidder shall include the following required documentation in its Business Response:

A. If the Bidder is a not-for-profit corporation, the Bidder must provide the following documents:

0. A current original “Short Form Certificate of Legal Existence with Officers,” from the Secretary of State’s Office. Note: Foreign (non-Massachusetts) for profit corporations must submit equivalent documentation from the Secretary of State where incorporated and a copy of the corporation’s Massachusetts Foreign Corporation Certificate; and A current original Clerk’s Certificate certifying that the individual executing the Contract on behalf of the Bidder has the authority to do so, and listing the names and titles of all current officers.

B. If the Bidder is a for-profit corporation, the Bidder must provide the following documents:

1. A current original “Short Form Certificate of Legal Existence with Officers,” which Massachusetts corporations may obtain from the Secretary of State’s Office at the address listed above. Note: Foreign (non-Massachusetts) for profit corporations must submit equivalent documentation from the Secretary of State where incorporated and a copy of the corporation’s Massachusetts Foreign Corporation Certificate; and

2. A current original Clerk’s Certificate certifying that the individual executing the Contract on behalf of the Bidder has the authority to do so.

Governance Structure A. The Bidder shall submit an executive-level organizational chart of the Bidder’s Governance Structure, including functional titles and names of incumbent individuals.

B. If the Bidder has any or anticipates working with Material Subcontractors in the performance of the Contract, the Bidder shall provide the following information with respect to each Material Subcontractor:

1. Legal name, trade name(s), and any other name under which the Material Subcontractor does, or has done business; and

2. The Material Subcontractor’s principal address and telephone number, and Massachusetts address and telephone number.

Conflict of Interest Neither the Bidder nor any Material Subcontractor may have any interest that will conflict, as determined by EOHHS, with the performance of services required under this RFR. To demonstrate freedom from conflicting interests, the Bidder must submit the following:

A. A signed EOHHS-required Bidder’s Certification, as referenced in Section 6.1, attesting that no interest will conflict in any manner or degree with the performance required under the Contract and that the Bidder agrees to submit any additional information requested by EOHHS that, in EOHHS’ judgment, may be relevant to the Bidder’s financial, legal, contractual, or other business interests as they relate to the RFR and Contract.

B. A statement describing any and all of the financial, legal, contractual, and other business interests of the Bidder, and any Material Subcontractors, parent(s), subsidiaries, and related organizations, if any, that may affect or impact its performance under the Contract. In cases where such relationships or interests exist or appear to exist, describe how a potential or actual conflict of interest will be avoided or remedied.

C. Any other information that may be relevant to the Bidder’s or any of the Bidder’s Material Subcontractor’s financial, legal, contractual, or other business interests as they relate to the RFR and Contract.

Financial Condition The Bidder shall submit documentation to demonstrate to the satisfaction of EOHHS that the Bidder’s organization and Material Subcontractor’ organizations, if any, are in sound financial condition and that any significant financial problems are being addressed with appropriate corrective measures.

EOHHS may disqualify a Bidder if the Bidder fails to submit the documents required by this section, or if the documents indicate to EOHHS, in its reasonable discretion, that the Bidder’s, or Material Subcontractors’, if any, financial condition is unsatisfactory.

The documents submitted must include at least the following:

A. A signed EOHHS-required Bidder’s Certification, as referenced in Section 6.1;

B. A disclosure of any financial audit of the Bidder or Material Subcontractor that is either ongoing or concluded in the last two years and a copy of the auditor’s report; and C. A certificate from the taxing authority of the state in which the Bidder or Material Subcontractor have their principal office, attesting that the Bidder or Material Subcontractor is not in default of any obligation under its tax laws. Corporations with principal offices in Massachusetts may satisfy this requirement by submitting a “Certificate of Good Standing” issued by the Massachusetts Department of Revenue (DOR). For instructions on obtaining the DOR certificate, go to: https://mtc.dor.state.ma.us/mtc/_/.

Security Policies and Procedures (Page Limit: 2 pages for each entity) The Bidder shall provide:

A. The Bidder’s and Material Subcontractors’ respective internal data security procedures and policies applicable to work that are in place and would be performed under the Contract (e.g. data backup procedures, encryption, training for employees, enforcement of strong passwords, VPN, multi-factor authentication, monitoring of access to sensitive information);

B. A copy of the Bidder’s and Material Subcontractors’ most recent security assessment and audit and incident response plan; and C. The particulars of any circumstances over the past five (5) years in which the Bidder or the Material Subcontractor(s), if any, has reported or otherwise been involved in a breach of the security, confidentiality or integrity of a customer’s data.

Legal Actions A. The Bidder shall submit a statement indicating whether the Bidder or Material Subcontractor, parent, or subsidiary is subject of any current litigation or findings of non-compliance under state or federal law in which:

1. In the past three years, has had any claims, judgments, injunctions, liens, fines or penalties secured by any governmental agency;

2. Has any outstanding liabilities to the Internal Revenue Service or any other government agency (state or federal); or

3. In the past three years, had any governmental audits that revealed material weaknesses in its system of internal controls, compliance with contractual agreements, and/or laws and regulations or any material disallowances.

B. If the Bidder responds affirmatively to any item above, the Bidder will briefly describe the circumstances including, but not limited to, the regulatory agency or authority, a description of the deficiency, corrective actions, findings of non-compliance, and/or sanctions. The Bidder will also indicate which of these actions or fines, if any, were related to Medicaid or CHIP programs.

Compliance with Contracts The Bidder must state whether the Bidder or Material Subcontractor:

A. Has ever had a contract terminated or not renewed for poor performance or non-performance in the last five years, including any contracts with EOHHS; or B. Has had warnings, sanctions or corrective action requirements imposed for non-compliance with contract terms in the last five years, including any imposed by EOHHS.

If the Bidder responds affirmatively to any item above, the Bidder shall briefly describe the circumstances, including but not limited to, the name of the state and contracting entity, the date and description of the violation or findings of non-compliance, and a description of the action taken (e.g., warning, fine, contract termination).

Cost Response The Bidder must provide a Cost Response document (Attachment B) that includes the Bidder’s proposed Administrative Fee (Per Member Per Month) for its performance of the Administrative Tasks and PCM Required Tasks specified in the Model Contract (Attachment A) that the Bidder calculates is necessary to reimburse it for the performance of these functions. Additional information about the payment of an Administrative Fee can be found at Section 6.11 of this RFR and in Section 4.3.E of the Model Contract, (Attachment A).

As part of its Cost Response, the Bidder must include a detailed and itemized budget for all costs associated with its performance of all functions covered under this RFR and the Model Contract, both as related to costs incorporated into the Administrative Fee as well as any costs incorporated into the Bidder’s proposed one-time startup payment or software upgrades. In addition, the Bidder must include their staffing matrix inclusive of salary range and number of required FTEs dedicated to each role.

The Bidder must create a document and include as Attachment B of its submission, a completed Cost Response statement that sets forth the following information:

· The Bidder’s proposed per member/per month Administrative Fee for performing the Administrative Tasks and PCM Specific Tasks specified in the Model Contract

· The Bidder’s proposed one-time startup or software upgrade payment The Bidder must also include, in its Cost Response, a copy of its most recent Uniform Financial Statement that includes its line-by-line expenditures and revenue for its Personal Care Management program.

While not the sole factor in evaluating responses, EOHHS will take into consideration the Bidder’s cost response when evaluating the overall proposal.

Description of Administrative Fee The Administrative fee is the rate paid to the PCM for its performance of the Administrative Tasks and PCM Tasks specified in the Model Contract. The Administrative Fee is a per month payment that is paid for each consumer/participant for each month the consumer/participant is enrolled with the PCM as described in Section 4.3.E of the Attachment A. Note: In FY 2024, MassHealth paid for PCM services using an administrative fee of $58.99 per member/per month.

References The Bidder shall provide at least one (1), but no more than three (3), written letters of support from organizations with whom the Bidder has, or has had, business experience, preferably involving the performance of functions to be provided under the Contract, as described below.

A. The Bidder shall provide one (1) reference for each of the following types of organizations with whom the Bidder has worked in the past:

1. Consumer or Advocacy organizations

2. Provider organizations or associations or social services agencies

3. Healthcare organizations B. All references shall include, at a minimum, the following information:

1. The name, address, and telephone number of the organization, as well as, name, telephone number, and email address of the person EOHHS may contact as a reference;

2. A summary of the scope of the contract or nature of the Bidder’s relationship with the organization providing the reference;

3. The duration and effective period of the contract or length of the relationship;

4. The Bidder’s experience and effectiveness in providing any of the functions to be performed under the Contract; and

5. The number of individuals and populations served by the Bidder under contract or through this relationship.

C. By submitting these references, the Bidder agrees that EOHHS may, at its option, contact these references.

PROGRAMMATIC RESPONSE REQUIREMENTS

All responses for the subsections below will constitute the Bidder’s Programmatic Response.

Instructions for Submitting the Programmatic Response A. The Programmatic Response must demonstrate how the Bidder intends to perform the Contractor’s Responsibilities specified in Attachment A. EOHHS specifically seeks to ascertain whether the Bidder has the organizational capabilities and protocols to meet the Contract requirements. Each Bidder shall provide a narrative response that demonstrates the Bidder’s understanding of the Contract requirements, and provides a clear description of how the Bidder will meet the requirements specified in the RFR and Contract, and in each topic area listed in this Section 7.

B. Preference may be given to Bidders that, through their Programmatic Response:

1. Demonstrate the capability to support Consumers across multiple geographic regions; or

2. Demonstrate the capability to support a high Consumer capacity or an ability to expand Consumer capacity.

C. The Bidder shall submit all required materials as follows:

1. The Bidder shall submit all required materials, including narrative and attachments as specified in this Section 7.1.

2. The Bidder shall collate electronic materials so that the narrative and attachments follow one another in the order in which the information is requested. Responses must be tab-separated by Section and Subsection number, with attachments to follow each subsection response. Responses must be clearly labeled with the subsection.

3. EOHHS assumes no responsibility for knowledge of any material that is not presented in accordance with EOHHS’s instructions. Do not place attachments in a separate Section.

4. When similar information is requested under multiple headings below, Bidders may provide the information once and cross-reference it in other areas, or repeat the information under each heading.

D. For any programmatic submission requirement for which the Bidder relies on the experience of Material Subcontractors the Bidder must provide, in addition to the information requested in each subsection, the following:

1. Indicate where relevant experience is the experience of the Bidder or proposed Material Subcontractor;

2. Make explicit what work the Bidder will be doing and what work the Material Subcontractor will be doing;

3. The processes the Bidder will implement to monitor and evaluate the performance of the Material Subcontractor to ensure that all Contract requirements are met; and

4. How the Bidder will ensure that efforts are coordinated and not duplicated.

Background and Experience (Page limit: 8 pages) The Bidder shall describe its organization in terms of its historical and present operations that are related to the provision of PCM functions as described in the Contract, including the following:

A. Describe the Bidder’s experience in providing PCM functions in a Consumer-directed personal care services delivery system.

B. Indicate the number of years that the Bidder has been in business, highlighting specific years in which the Bidder was engaged in providing PCM functions.

C. Describe the Bidder’s knowledge and experience working with and supporting each of the following groups:

1. Individuals with physical disabilities;

2. Older adults with personal care needs; and

3. Children and youth with personal care needs.

Key Personnel and Staffing (Page Limit: 6 pages) The Bidder shall provide its proposed staffing plan to perform all Contractor Responsibilities set forth in Attachment A, including fully implementing the required scope of PCM functions as well as administrative aspects of the Contract. The Bidder shall provide:

1. An organizational chart attachment that identifies Key Personnel as defined in the Model Contract in Attachment A, senior managers, and other staff by title to be assigned to accomplish the Contractor Responsibilities described in Attachment A;

2. A sample staffing model for the number of Consumers the Bidder intends to serve as indicated in Section 7.5, including the number of full-time equivalent (FTEs) for supervision, administration, and functional skills training positions;

The titles, job responsibilities, and qualifications for staff directly responsible for ensuring compliance with all billing requirements;

A description of the Bidder’s recruitment plans, including timelines to recruit staff for any Key Personnel positions not currently filled, and job descriptions and qualifications for each Key Personnel position (job descriptions shall be submitted as attachments). The description shall include Bidder’s assumptions regarding staff turnover rates and how the Bidder intends to minimize excessive staff turnover;

A description of the Bidder’s plan to expand staff to perform PCM functions for an increased capacity of Consumers; and A description of how the Bidder will recruit and hire staff from the cultural and linguistic communities it intends to serve.

Training The Bidder shall describe initial and ongoing training for all staff involved in the Contract, including subcontractors. The Bidder must describe its plan for ensuring all staff and subcontractors are aware of the policies, procedures, and regulations of the PCA Program and the Model Contract in Attachment A, and must include a description of what documentation will be maintained to record participation in training. The Bidder must attach a curriculum of training for staff or other sample documentation related to staff training.

Information Systems and Reporting Capacity (Page limit: 2 pages) The Bidder shall describe its capacity to perform the information management and reporting functions specified in the Contract, including maintaining data and producing the required reports described at Section 2.3.E. and Appendix 1 of the Model Contract in Attachment A, and any other reports requested by EOHHS, by describing its current and proposed information systems and software to be used. The Bidder shall submit the following information:

Describe its information system and architecture, including the name of the systems and the vendors the Bidder uses for hardware, billing, customer service, financial systems and reporting. Describe the technical qualifications of staff operating the information system(s).

Describe the software it will use to establish a database and track information required by the Model Contract in Attachment A, including Prior Authorization (PA) information, PA utilization, and functional skills trainings conducted. The Bidder must specify whether such software is currently used by the Bidder and in what capacity or whether it needs to be purchased.

Describe the use of its information system(s) for day-to-day management of operations and long-term planning of the key organization functions described in each of the sections under the Contract.

Indicate how data pertaining to the Consumer, the Consumer and surrogate, or the Consumer and administrative proxy, and data in the aggregate, can be collected and retrieved.

Describe its plans to coordinate with the Eligibility Verification System (EVS), the online MassHealth Member eligibility verification system, and all other pertinent online transactions accessible to providers participating in MassHealth.

Geographic Area and Consumer Volume (Page Limit: 2 pages) The Bidder shall list the geographic area it intends to cover and the total volume of Consumers in intends to be able to serve under the Contract. The Bidder shall submit the following information:

The geographic area within which it intends to perform PCM functions, listed by county and city/town. If the intended geographic area within which the Bidder will perform PCM functions requires expansion of operations, the Bidder must describe how it will expand operations into new geographic areas by the Contract start date.

The total number of Consumers it intends to be able to provide PCM functions under the Contract. If the intended capacity requires expansion of operations, describe how the Bidder will expand operations by the Contract start date.

PCM Functions The Bidder shall provide an overall description of how it intends to provide PCM functions to Consumers in the timeframes specified in the Model Contract in Attachment A and 130 CMR 422.400. The description must address the following functions, but may contain additional information about the functions described in the Model Contract (Attachment A) and regulation. The description of each function must not exceed the page limit requirement stated below for each function.

Intake and Orientation (Page limit: 2 pages)

0. The Bidder shall describe how it will respond to initial requests for PCA Services from Consumers within the timeframes specified in Section 2.1.B. of the Model Contract in Attachment A. The Bidder shall describe its process for evaluating the Consumer’s initial eligibility for PCA services, including who in the organization will be responsible for this function, how the results will be recorded, how timelines will be tracked, and how the Bidder will work with the Fiscal Intermediary to ensure that the Consumer enrolls with the Fiscal Intermediary in a timely fashion.

0. The Bidder shall describe what methods it will use to perform intake and orientation functions for Consumers inquiring about the PCA Program, including instruction on the Consumer’s responsibility to schedule PCA services in accordance with PCA Program requirements and each Consumer’s approved prior authorization. The Bidder must enclose as attachments all written information developed by the Bidder that it intends to distribute, or proposes to distribute, as part of a Consumer’s orientation to the PCA Program.

Assessment of Consumer, Surrogate, or Administrative Proxy Capacity to Manage the PCA Program (Page limit: 2 pages) The Bidder shall submit a description of how it will perform the Assessments required at Section 2.1.C in the Model Contract in Attachment A, including:

1. Which types of personnel will be responsible for completing the Assessments, including title and role within the Bidder’s organization;

2. How the Bidder will work with the Consumer, Surrogate, or Administrative Proxy, to resolve any dispute regarding the Assessment, including the process for resolving disagreements about the findings in the Assessment; and

3. How the Bidder will assist a Consumer in locating a Surrogate or Administrative Proxy and what action it will take when the Bidder determines that one cannot be located. The Bidder should propose creative methods for assisting Consumers who are unable to manage PCA Services independently in locating quality Surrogates or Administrative Proxies.

Clinical Evaluations and Re-evaluations; Prior Authorization Requests (Page limit: 3 pages) The Bidder shall describe how it will meet evaluation and re-evaluation requirements in Section 2.2.C of the Contract in Attachment A, including how it will ensure that sufficient clinical personnel are available at all times to conduct initial Evaluations and Re-evaluations in the specified timeframes. The Bidder must include a description of the intent for a written plan for supervising the evaluation and re-evaluation process, and supervising registered nurses, licensed practical nurses, and occupational therapists in conducting evaluations and re-evaluations, in accordance with Section 2.2.B.4 of the Model Contract in Attachment A The Bidder should include any applicable information about cultural and ability sensitivity as well as linguistic capacity of the Bidder.

The Bidder shall describe the training protocols in place and its methods to ensure inter-rater reliability. The quality assurance process shall be described, specifically how the Bidder will ensure its clinical staff will be retrained when necessary and under what circumstances.

The Bidder shall describe how it will ensure that Prior Authorization Requests for PCA Services accurately represent the Consumer’s functional abilities and need for physical assistance with ADLs and IADLs, in accordance with the PCA Program regulations at 130 CMR 422.000 and the Model Contract in Attachment A.

Service Agreement (Page limit: 2 pages) The Bidder shall describe how it intends to:

1. Fulfill the specifications of Section 2.2.D of the Model Contract in Attachment A regarding development and maintenance of the Service Agreement, including how the Bidder intends to provide assistance in addressing backup PCAs and delineating PCA management duties between Consumers and Surrogate or Administrative Proxies, and also including how the Bidder intends to ensure the Service Agreement remains current within the timelines specified in the Model Contract; and

2. Resolve disagreements related to development or review of the Service Agreement.

Functional Skills Training (Page limit: 6 pages) The Bidder shall:

1. Describe how it intends to conduct Functional Skills Training as described at Section 2.2.F. of the Contract in Attachment A, including any creative methods the Bidder’s organization has implemented or proposes to implement to assist Consumers in recruiting PCAs.

2. Describe its proposed program of Functional Skills Training, including as related to effective implementation of the types of Functional Skills Training: in-person comprehensive, in-person issue-focused, and telephonic. This proposed program must include specific plans on Functional Skills Training related to Electronic Visit Verification set-up and continued use.

3. Describe how it works or proposes to work with Consumers and the Fiscal Intermediaries when a Consumer is overutilizing PCA services, which may result in the exhaustion of the Consumer’s approved PCA hours before the expiration date of the Consumer’s prior authorization, or not utilizing their PCA services.

4. Describe how it works or proposes to work with Consumer and Surrogates or Administrative Proxies in addressing issues related to scheduling of PCAs, including as related to overtime requiring authorization, scheduling PCAs to provide services that are covered and not scheduling PCAs to provide services that are not covered pursuant to the PCA Program regulation at 130 CMR 422.000, and other scheduling or related PCA management issues.

5. Describe how it will implement and oversee the provision of Functional Skills Training, including but not limited to oversight by the Key Personnel Functional Skills Training Supervisor or other Key Personnel, including a description of the intent for a written plan for supervising the skills training process, and supervising skills trainers, in accordance with Section 2.2.D.4 of the Model Contract in Attachment A.

6. Describe how it will determine and maintain the number of functional skills trainers needed to provide Functional Skills Training services as described at Section 2.2.B.1. in the Contract in Attachment A and respond promptly to requests for Functional Skills Training, regardless of the number of Consumers served, the type of Functional Skills Training provided, or increased utilization.

7. Describe how it will keep Consumers demographics updated in the database and how it will ensure that the Fiscal Intermediary has the updated demographics including but not limited to physical address, mailing address and email.

Ensuring Proper use of Electronic Visit Verification (EVV) (Page limit: 2 pages) The Bidder shall describe how it will effectively support Consumers in the proper use of EVV. The Bidder’s response shall include, at minimum, the following:

1. The Bidder’s explanation of how a Consumer will be supported during Intake and Orientation to ensure a Consumer’s proper use of EVV begins immediately;

2. The sequencing and content of EVV-specific Functional Skills Training, including detail about how the Bidder will respond to and resolve escalations as a Consumer continues to not use or refuse to use EVV; and

3. How the Bidder will support the Consumer in resolving challenges the Consumer may encounter with EVV, including but not limited to: email address creation, account activation, interacting with the Fiscal Intermediary, and submitting timesheets in EVV.

Consumer Relations (Page limit: 4 pages) The Bidder shall describe how it will meet each requirement of Sections 2.2.G and 2.2.H the Model Contract in Attachment A related to consumer relations, transfers, and transition planning. The Bidder’s response shall include, at minimum, the following:

1. The Bidder’s understanding of the Consumer’s role in a self-directed program, and how the Bidder intends to support that role;

2. The Bidder’s philosophy related to, and ability to provide, cultural and ability sensitivity as well as linguistic capacity in serving a diverse population;

3. How the Bidder will ensure timely response to Consumer or Surrogate or Administrative Proxy inquiries and an explanation of how these inquiries are tracked;

4. The Bidder’s plan for developing a complaint and grievance policy and a description for how it would resolve complaints and grievances, including as it relates to consumer transfers and an explanation of how these issues will be tracked and how records will be maintained;

5. How the Bidder would ensure effective, efficient, cooperative, and safe transition planning when a Consumer will no longer be receiving PCA services; and

6. How the Bidder would conduct Consumer Satisfaction surveys, and how such surveys would be used to improve the functions performed by the Bidder. The Bidder may provide a copy of its proposed survey tool.

Quality Management (Page limit: 2 pages) The Bidder shall describe how it will ensure that quality management principles are applied in all aspects of its functions in accordance with Section 2.3.F of the Model Contract in Attachment A, including but not limited to;

0. How the Bidder would implement and incorporate feedback from consumer satisfaction surveys.

0. How the Bidder would implement and incorporate feedback from consumers received through other pathways outside of satisfaction surveys.

0. Draft(s) of the Bidder’s policies and procedures related to quality management.

0. A description of the Bidder’s quality assurance process that ensure evaluations submitted to MassHealth are medically necessary and accurately reflect the Consumer’s need for physical assistance with ADLs and IADLs. The description shall include how the Bidder intends to monitor consistency between staff in the way evaluations are conducted.

Fiscal Intermediary Relations (Page limit: 1 page) The Bidder shall describe how it maintains or proposes to maintain, a cooperative working relationship with the Fiscal Intermediary and comply with Section 2.2.H. of the Model Contract in Attachment A.

Billing Requirements (Page limit: 2 pages) The Bidder shall provide a detailed narrative of how it will develop, implement, and maintain compliance with each of the billing requirements listed in Section 4.3 of the Model Contract (Attachment A), and include a description of the internal controls it will utilize to ensure that billing functions are being performed accurately and within the timeframes required by the Contract.

Response evaluation process Evaluation Committee An Evaluation Committee appointed by EOHHS will evaluate responses submitted pursuant to this RFR.

Evaluation Process

1. Response Review Process All responses submitted pursuant to this RFR will be reviewed by EOHHS to determine compliance with the response submission instructions. For those responses that comply with the response submission instructions, EOHHS will review the Business Response. Responses that include all required information under the Business Response and that otherwise comply with all Business Response requirements will be reviewed and evaluated by the Evaluation Committee.

One or more Bidders may be invited to provide additional information about specific provisions of the response through an oral presentation, through additional written material, or through a site visit by two or more members of the Evaluation Committee.

1. Evaluation Criteria For those responses that comply with the Business Response, the Evaluation Committee will evaluate each element of the Bidder’s Programmatic Response for comprehensiveness, appropriateness, feasibility, clarity, effectiveness, innovation, and responsiveness to the needs of EOHHS. In addition to the Programmatic Response, EOHHS may consider any relevant information about the Bidder known to EOHHS.

1. Response Rating The Evaluation Committee will:

1. Oral Presentations EOHHS, in its sole discretion, will determine which Bidders, if any, will be asked to make an oral presentation. Oral presentations may be held to allow a Bidder to clarify details or further inform the Evaluation Committee regarding the Bidder’s organization or response, but such presentations may not change or correct the original responses in any way.

EOHHS reserves the right to apply restrictions to the structure and content of the Oral Presentation, and to instruct the Bidder regarding attendees.

Oral presentations shall not be open to the public or to any competitors. The Evaluation Committee will schedule the time and location of any oral presentation.