MES EVV RFI - RFI 4-21-2025.pdf

RFI :#30-2025-029-DHB EVV Page 1 of 9 Rev. 2025.04.21

STATE OF NORTH CAROLINA REQUEST FOR INFORMATION NO.30-2025-029-DHB

Department of Health and Human Services Division of Health Benefits

Issue Date: April 22, 2025 Due Date: May 20, 2025

Refer ALL Inquiries regarding this RFI to:

Tyler Ragor, Contract Specialist Tyler.ragor@dhhs.nc.gov

Commodity Number: 811620 – Cloud based Software as a Service Description: Electronic Visit Verification Solution

Using Agency: Department of Health and Human Services Division of Health Benefits

This Request for Information (“RFI”) is available electronically on the North Carolina electronic Vendor Portal (“NC eVP”) at https://evp.nc.gov/.

The purpose of this RFI is to survey the market for information requested herein and not to award a contract. Submission of a response does not create an offer, and no award will result by submitting a response.

The State recognizes that considerable effort may be required in preparing a response to this RFI. However, the Respondent shall bear all costs for preparing and submitting a response. Information obtained through this RFI process may be used to develop a future solicitation.

Responses to this RFI will be received until 2:00 p.m. EST, May 20, 2025.

EXECUTION

RESPONDENT NAME: E-MAIL:

STREET ADDRESS: P.O. BOX: ZIP:

CITY & STATE: TELEPHONE NUMBER: TOLL FREE TEL. NO:

TYPE OR PRINT NAME & TITLE OF PERSON SIGNING: FAX NUMBER:

AUTHORIZED SIGNATURE:

DATE:

https://evp.nc.gov/

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Table of Contents

SECTION I. RESPONDENT QUESTIONS, RESPONSE INSTRUCTIONS, AND CONFIDENTIALITY

A. Anticipated Schedule B. Instructions for Developing Responses C. Instructions for Submitting Responses D. Notice Regarding Confidentiality

SECTION II. RIGHTS AND OBLIGATIONS

A. Rights to Submitted Material B. Obligations of the State

SECTION III. ELECTRONIC VISIT VERIFICATION SOLUTION

A. Background and Program Information B. Purpose of the RFI C. Definitions and Acronyms D. Desired Outcomes

SECTION IV. REQUESTED INFORMATION FROM RESPONDENT

A. Content and Format B. Information about Respondent C. Solution Functionality and Performance D. Financial / Total Cost of Ownership E. Implementation Timeline

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SECTION I. RESPONDENT QUESTIONS, RESPONSE INSTRUCTIONS, AND

CONFIDENTIALITY

A. Anticipated Schedule The Department Contract Specialist will make every effort to adhere to the following schedule.

Action Responsibility Date Time (EST)

RFI Issued Department 4/22/2025

Responses Due Respondent(s) 5/20/2025 2:00 pm

Table 1 – Anticipated Schedule

B. Instructions for Developing Responses When developing Responses to this RFI, the Respondent should consider the following:

1. Read and carefully review all Sections of this RFI.

2. Prepare responses in a straightforward and detailed manner. Responses are to be submitted to the

Department according to the instructions found on the cover page of the RFI and this Section II.

3. Complete the Execution section on Page 1 of this RFI and number the pages in the responses.

4. Clearly identify the specific question, section, and subsection number(s) or other identifier that corresponds with each response. This allows the Department to clearly understand the specific questions or items addressed. To the extent possible within each section of the response, the items should be addressed in the order in which they appear in the RFI.

5. Provide detailed information in a format that may include a narrative, exhibits, charts, tables or other artifacts that support the response.

6. Responses to all questions and items within the RFI are encouraged but there is no obligation to do so.

7. The Department reserves the right to contact any Respondent and request additional information.

Include the contact information for the individual(s) best suited to engage with the Department.

C. Instructions for Submitting Responses

1. Respondent must submit its response to this RFI via the Ariba Sourcing Tool by the specified time and date provided in the Anticipated Schedule.

2. When submitting a response, include all pages of the RFI, a completed and signed EXECUTION Section on page 1, and responses to the requested information contained in Section IV.

3. The following copies are required to be provided to the Department in response to this RFI:

a. One (1) electronic copy of the signed, completed response identified as RFI #30-2025-029-DHB

- Respondent’s Name.

b. One (1) electronic copy of a redacted response in accordance with Chapter 132 of the North

Carolina General Statutes, the Public Records Act, identified as RFI #30-2025-029-DHB - Respondent’s Name - Redacted. For the purposes of this RFI, redaction means to edit a document by obscuring or removing information that is considered confidential and/or proprietary by the Respondent and that meets the definition of Confidential Information set forth

RFI :#30-2025-029-DHB EVV Page 4 of 9 Rev. 2025.04.21 in G.S. 132-1.2. Any information removed by the Respondent should be replaced with the word, “Redacted.” If Respondent’s response does not contain Confidential Information, the Respondent must submit a signed statement to that effect identified as RFI #30-2025-029-DHB

- Respondent’s Name - Statement of Confidential Information.

4. The electronic copies of the response must not be password protected.

5. The electronic copies of the response must be in PDF format.

For training on how to use the Ariba Sourcing Tool to view solicitations, submit questions, develop responses, upload documents, and submit offers to the State, Respondents should go to the following site: https://eprocurement.nc.gov/training/vendor-training.

Questions or issues related to using the Ariba Sourcing Tool itself can be directed to the North Carolina eProcurement Help Desk at 888-211-7440, Option 2. Help Desk representatives are available Monday through Friday from 7:30 AM EST to 5:00 PM EST.

D. Notice Regarding Confidentiality

1. Per NCGS 132-1, et seq., information or documents provided to the Department in response to this RFI are Public Record and subject to inspection, copy and release to the public unless properly marked and exempt from disclosure by statute, including, but not limited to, NCGS § 132-1.2.

2. As provided for in the North Carolina Administrative Code (NCAC), including but not limited to 01 NCAC 05B .0103, 09 NCAC 06B .0103 and 09 NCAC 06B .0302, all information and documentation whether electronic, written or verbal relative to the development of a contractual document for a proposed procurement or contract shall be deemed confidential in nature. In accordance with these and other applicable rules and statutes, such material shall remain confidential until the award of a contract or until the need for procurement no longer exists. Any proprietary or confidential information, which conforms to exclusions from public records as provided by NCGS § 132, must be clearly marked as such with each page containing the trade secret or confidential information identified in boldface as “CONFIDENTIAL.” If only a portion of each page marked “CONFIDENTIAL” contains trade secret information, the trade secret information shall be designated with a contrasting color or by a box around such information. In addition to marking confidential information as required by NCAC 05B.0103, confidential pages or portions of the response shall be reflected in the redacted copy identified as RFI 30-2025- 029-DHB - Respondent’s Name – Redacted. By submitting a redacted copy, the Respondent warrants that it has formed a good faith opinion, having received such necessary or proper review by counsel and other knowledgeable advisors that the portions marked confidential and redacted meet the requirements of NCGS §132. The Respondent must identify the legal grounds for asserting that the information is confidential, including the citation to state law.

SECTION II. RIGHTS AND OBLIGATIONS

A. Rights to Submitted Material

All responses, inquiries or correspondence relating to or in reference to this RFI, and all documentation submitted by the various Respondents shall become the property of the Department when received.

Ideas, approaches, and options presented by Respondents may be used in whole or in part by the https://eprocurement.nc.gov/training/vendor-training

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State in developing a future solicitation should the Department decide to proceed with a solicitation.

Further, combinations of ideas from various Respondents may also become part of a solicitation, based on consideration of various RFI submissions and the needs of the Department, which may differ from any Respondent’s experience in other places.

B. Obligations of the State The Department may choose to issue a solicitation for the procurement of a solution. However, this RFI is not a guarantee that a solicitation will be issued for any or all of the services or systems referenced herein, about which ideas and approaches are being sought. As provided in Section I.E of this RFI, information submitted by Respondents for this RFI will remain confidential until after the award of any solicitation or until the State decides not to issue a solicitation.

SECTION III. ELECTRONIC VISIT VERIFICATION SOLUTION

Background and Program Information The North Carolina Medicaid Enterprise System landscape currently consists of modular solutions, including provider and claims functionality, prior authorization vendors, managed care organizations, third party solutions, and the Medicaid data warehouse. In the future, these interfaces will be managed by the Department’s Medicaid Integration Services which is a central platform that facilitates data exchanges among Medicaid technology partners. Electronic Visit Verification (EVV) is one of the NC Medicaid modules that has been operating since 2021.

The EVV solution that the Department is now seeking includes two separate but related components – Data Visit Collection and Data Aggregation. The data visit collection system must be available for visit verification, provide adequate statewide coverage, and securely collect data of the seven core components required under the 21st Century Cures Act.

The EVV solution must be flexible, scalable, and capable of supporting delivery of services in accordance with CMS and Department guidelines, as operationalized across various programs, service delivery models, and payor sources. The solution must accommodate the full range of program requirements and end user capacity. The solution must provide system architecture that is configurable to support multiple programs which have different policies, procedures, and business rules, all of which are subject to change during the contract period in response to state and federal regulations.

System users will include approximately 100 staff members, including personnel from the Division of Health Benefits (DHB), the Information Technology Division (ITD), the Department of Justice (DOJ), the Medicaid Investigative Division (MID), the Office of Compliance and Program Integrity (OCPI), as well as provider agencies and their workers who render personal care services and home health care services to the Medicaid population throughout the State.

A. Purpose of the RFI The purpose of the RFI is to:

1. Solicit feedback from potential vendors with experience developing and deploying EVV solutions for states of similar size and business as North Carolina.

2. Obtain a rough order magnitude estimate of the total cost of ownership to develop, implement, and maintain the solution defined in the RFI over a five-year contract term.

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3. Obtain information that may be used to develop a Request for Proposal (RFP) to solicit a vendor to provide an Electronic Visit Verification solution to the Department.

B. Definitions and Acronyms - RESERVED C. Desired Outcomes

With the EVV Solution, NC Medicaid intends to meet the Centers for Medicare and Medicaid Services’ (CMS) stated goals for EVV implementation and associated outcomes in compliance with the 21st Century Cures Act.

• The EVV solution shall enhance NC Medicaid’s ability to prevent fraud, waste, and abuse by providing increased visibility into NC Medicaid Home and Community-Based Services programs.

• The EVV solution shall be reliable, accessible, and minimally burdensome for providers, beneficiaries, and their caregivers.

• The EVV solution shall implement and maintain appropriate safeguards for electronic protected health information (ePHI) and personally identifiable information (PII).

The solution, in accordance with the CMS MES Certification Checklist, should have the capability to provide the following functionality:

• The EVV solution captures and verifies data with respect to personal care services or home healthcare services, including: type of service performed, individual receiving the service, date of service, location of service delivery, individual providing the service, and the time the service begins and ends.

• The EVV solution is able to save and transmit data regardless of the mode of communication (e.g., internet connectivity, telephony, or cellular coverage). The system is designed such that even if there is a break in communication service, the data is stored locally and can be transmitted when service is restored.

• Each visit initiated is captured within the EVV solution, whether or not the visit was verified.

• Validates incoming data against its EVV data standards, whether submitted through the EVV solution or through another data aggregation function.

• Customizable reporting and tracking features to monitor service delivery.

SECTION IV. REQUESTED INFORMATION FROM RESPONDENT

A. Content and Format

The Department requests concise, detailed responses to the inquiries in Sections IV.B., IV.C, IV.D, and IV.E below. The response in its entirety shall be limited to ten (10) pages.

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B. Information about Respondent

1. Responses should provide an overview of Respondent company’s history, scope of products and services offered, and locations of operation. Response should describe Respondent(s) experience providing solutions similar in size and scope to the projects desired outcomes.

2. Response should provide the following:

a. Description of the Respondent’s primary customer base or market, including other state

Medicaid programs;

b. Description of relevant additional services offered by Respondent;

c. Listing of states or agencies which utilize Respondent’s solution in a manner that is the same as or similar to those required by this RFI. Response should include the state/agency name, most recent implementation, contract start and end date, description of scope of work, the duration of the any contracts, and the termination dates;

d. Lessons learned from working with other states or agencies to implement a solution of similar size, scope and with requirements the same or similar to those required by the Department;

C. Solution Functionality and Performance Respondents should provide information regarding its Solution and associated capabilities on how the desired outcomes are achieved to include sufficient information in the following areas:

1. Solution Architecture

2. Data Architecture

3. Security Architecture

4. Analytics and Reporting

5. Operations

D. Financial / Total Cost of Ownership

1. Respondents are asked to provide information regarding estimated costs to procure and operate a Solution as described in this RFI. This information will help the Department understand acquisition and on-going costs and be used to support budget development and funding requests.

2. Respondents are asked to provide cost information in the format of the Respondent’s choosing, and to the extent possible, include the following:

a. An estimated cost model or likely range of costs to design, develop, implement, operate, and maintain the described solution including the cost items in Table 2. Include any basis of estimates and assumptions used to develop the costs; and

b. If pricing information is limited or unavailable, describe Respondent’s preferred pricing model or structure, including unit costs based on key variables. Include any basis of estimates and assumptions used to develop the costs

Table 2 – Cost Items

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Cost Items Guidance

Design, Develop and Implementation (DDI) Services

Describe scope of services provided during the DDI phase

Design, Develop and Implementation (DDI) Fees

Describe the fees required during the DDI phase

Operation and Maintenance (O&M) Services

Describe the scope of services provided during the Operation and Maintenance phase. If variable rate pricing model is used, please provide explanation.

Operation and Maintenance (O&M) Fees

Describe fees required during Operations and Maintenance phase

Annual Software Licensing Fees

Provide any annual software licensing fees

Annual Software Maintenance Fees

Provide any annual software maintenance fees

Annual Cloud Hosting Fees

Provide any annual cloud hosting fees

Annual Other Fees Describe any other annual fees

Other Unit Costs - Describe

Describe any unit costs associated with event driven activities or cost per unit of data storage or similar.

Note whether the cost falls within the DDI or O&M Phase of the project.

3. Respondents will not be held to pricing estimates provided in response to this RFI should the

Department decide to proceed with a competitive solicitation.

E. Implementation Timeline

1. Respondents are asked to provide information regarding estimated Implementation schedules and timelines including the project phases listed in Table 3. This information will help the Department understand the time required to plan, design, develop, and implement the solution.

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Phase Guidance Range of Time

Planning Provide scope of activities during the planning phase

Design Provide scope of activities during the design phase

Development Provide scope of activities during the development phase

Implementation Provide scope of activities during the implementation phase

Table 3 – Project Phases