MLTC Data Management and Analytics RFI Addendum 2 for QA_FINAL.docx
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- Solicitation number
- Not on record
- Issued by
- Douglas County, Nebraska
About this file
This document is an Addendum to a Request for Information (RFI) issued by the State of Nebraska, Department of Health and Human Services, Division of Medicaid and Long-Term Care (MLTC), regarding Medicaid data analytics, reporting, and processing options. The RFI seeks information on companies interested in providing solutions for a Program Integrity Case Management (PICM) system, an Enterprise Data Warehouse (EDW), data analytics capabilities, and integration with existing systems. The State expects approximately 15 PICM users and processes around 1-1.5 million encounter claims per month. The RFI has a response deadline of June 6, 2024, with no option for extension at this time. Information gathered through the RFI will help the State determine if a future procurement process will occur and inform the associated timeline.
Regarding pricing, the State does not release budget information prior to a solicitation. The current contract for these services is 78047 O4, and all State of Nebraska contracts can be found online. Vendors can propose standalone or bundled capabilities, and the State is interested in information on advanced analytics and artificial intelligence capabilities. The existing system does not utilize any external analytics solutions or integrate with the State's Health Information Exchange or other external data sources at this time.
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DATA MANAGEMENT AND ANALYTICS
REQUEST FOR INFORMATION (RFI)
ADDENDUM 1 QUESTIONS and ANSWERS
Date: May 21, 2024
To: All Bidders
From: Carrie DeFreece, Procurement Contracts Officer Department of Health and Human Services
RE: Addendum for Request for Information for Data Management and Analytics to be opened June 6, 2024, at 2:00 p.m. Central Time
Questions and Answers
Following are the questions submitted and answers provided for the above-mentioned Request for Proposal. The questions and answers are to be considered as part of the Request for Proposal. It is the Bidder’s responsibility to check the State Purchasing Bureau website for all addenda or amendments.
This addendum will become part of the proposal and should be acknowledged with the Request for Proposal.
| Question Number |
| RFI Section Reference |
| RFI Page Number |
| Question |
| Answer |
| 1 |
| b. PROGRAM INTEGRITY CASE MANAGEMENT (PICM) |
| 6 |
| How many expected users for Case Management (PICM) product outlined in the RFI? |
| The State expects about 15 PICM users. |
| 2 |
| b. PROGRAM INTEGRITY CASE MANAGEMENT (PICM) |
| 6 |
| Will provider/member claims be pdfs and uploaded to the system manually or will need an API to integrate with the PICM? |
| Claims will not be in .pdf format. Claims/Encounter data is sent to the State Medicaid Management Information System (MMIS) database, from which extracts are generated, placed on an SFTP server, and picked up and loaded to the DMA solution “landing” environment. Subsequently, the data is loaded into the Enterprise Data Warehouse (EDW) and made available in the PICM module. |
| 3 |
| b. PROGRAM INTEGRITY CASE MANAGEMENT (PICM) last bullet point |
| 6 |
| General question about this section: Has the Nebraska participated in multiple demonstrations of products that satisfy all requirements described in this RFI? |
| This is not within the scope of the RFI. |
| 4 |
| b. PROGRAM INTEGRITY CASE MANAGEMENT (PICM) last bullet point |
| 6 |
| Which products will the new PICM need to integrate with? |
| Currently, the new PICM would just need to integrate with the existing EDW. |
| 5 |
| b. PROGRAM INTEGRITY CASE MANAGEMENT (PICM) last bullet point |
| 6 |
| If integration is required, will the integration between products be bi-directional? |
The State does not anticipate the integration to be bi-directional.
| 6 |
| b. PROGRAM INTEGRITY CASE MANAGEMENT (PICM) last bullet point |
| 7 |
| PI Algorithms: Can you elaborate on the Algorithm referred to in this section? |
| PI Algorithms are a set of standard reports developed on known vulnerabilities in claims payment systems. |
· A detail algorithm report produces claim line level data by provider with information regarding all claims that match the specifications of the report.
· A summary algorithm report produces results totals by provider with information regarding total number of claims, number of members affected, count of services provided, units, or net pay amounts that match the specifications of the report and function of the algorithm.
· The majority of the PI Algorithms are sorted by paid amount to assist in identifying the maximum amount of recoverable funds. Summary reports specifically assist in the prioritization of which providers should be considered for potential waste and abuse investigation, and at what priority.
· The State is interested in information from vendors on any reporting functions, algorithms, etc. they utilize to detect possible Fraud, Waste and Abuse (FWA).
| 7 |
| General question for the entire RFI |
Has the Nebraska participated in multiple demonstrations of products that satisfy all requirements described for the Case Management (PICM) portion of the RFI?
This is not within the scope of the RFI
| 8 |
| General question for the entire RFI |
Regarding the response deadline date of June 6th; while we will do our best to submit a response by that date, we recognize the importance of this project and the need for DHHS to receive a thorough and comprehensive response. In support of providing that level of response, we respectfully request a four (4) week extension to the deadline to enable respondents to provide a comprehensive response.
At this point, the State is unable to extend the deadline as there is some time sensitivity to the project.
| 9 |
| General question for the entire RFI |
If this RFI greenlights a solicitation, what is the estimated timeframe for procurement?
Information gathered through the RFI will help the State determine if a procurement will occur in the future and will inform the timeline.
| 10 |
| General question for the entire RFI |
What is the anticipated contract value?
DHHS does not release this information prior to a solicitation.
| 11 |
| General question for the entire RFI |
Is there a current vendor providing these services? If so, how may I obtain copies of any incumbent contract documents?
The current contract for these services is 78047 O4.
All State of Nebraska contracts can be found at: https://statecontracts.nebraska.gov
| 12 |
| General |
| 4 |
| While the RFI references a modular approach and states that respondents do not need to possess all capabilities, are there certain capabilities which you expect to be “bundled” together from a single vendor? |
| Vendors can propose to support either bundled or individual capabilities. We are interested in information on standalone and bundled options. |
| 13 |
| Enterprise Data Warehouse |
| 10 |
| With what frequency do you expect to integrate to the data types listed on pages 8 and 9? Does this vary by data type? |
| Yes, the frequency may vary by the data type. It may be daily, weekly, monthly, and/or quarterly. |
| 14 |
| Encounter Claims Processing System |
| 11 |
| What are the typical monthly volumes of encounter claims data to be processed? |
| Approximately 1 – 1.5 million per month. Volumes can fluctuate over the course of business. |
| 15 |
| Data Analytics |
| 12 |
| The RFI specifically mentions long-term care, are there any other key initiatives or focus areas for the state beyond long-term care? |
| The mention of “long-term care” is merely in the name of the division within the Department of Health and Human Services, i.e. “Division of Medicaid and Long-Term Care (MLTC)”. The RFI does not refer specifically to long-term care initiatives. Additional key initiatives are outside of the scope of the RFI. |
| 16 |
| Integration Capabilities |
| 12 |
| Beyond CMS, what other entities would we expect to integrate with and who are other downstream recipients of these data? |
| They are yet to be determined. A few external interfaces may be considered for integration. |
| 17 |
| Training Outline |
| 13 |
| How many users do you expect to utilize this system? |
| On average, we have between 100-120 users. |
| 18 |
| Training Outline |
| 13 |
| Will the system be limited to use by DHHS staff, or will other parties have access as well? If so, which parties? |
| Only Nebraska State staff will have access to this system. |
| 19 |
| Training Outline |
| 13 |
| What are the types of user roles that you expect to utilize this system? |
| The specific user roles are not detailed out at this time. They will be in-line with industry standards. |
B - 1
Could the State provide details on its current efforts regarding CMS-9115-F and CMS-0057-F?
This is not within the scope of the RFI.
B- 2 (a, e)
6, 7 Could the state share any details on future priority strategy/goals/expectations for leveraging analytics/AI in the next generation DMA?
This is not within the scope of the RFI.
B - 2
Could the state please provide additional detail on the various non-Medicaid agencies who are users of the current DMA solution (details such as agency/department name, user types, utilization details (types of data accessed, how frequent, reports/analytics used, etc… )?
The existing system is limited to Medicaid data, and the usage varies based on individual user needs.
B - 2 (f)
Does the state currently ingest MDS and/or other data from statewide long-term care facilities (if so could the state describe the nature of this data and its utilization in DMA-related functions/goals)?
The State maintains some Casemix Minimum Data Set (MDS) records for claims adjudication but does not include this data within the scope of its data warehouse.
B - 2 (f)
Does the state currently ingest data from Community-based organizations (if so could the state describe the nature of this data and its utilization in DMA-related functions/goals)?
No, the existing system does not ingest Social Determinants of Health (SDOH) data.
B - 2 (f)
Does the state currently ingest data from Nebraska human/social services? (if so could the state describe the nature of this data and its utilization in DMA-related functions/goals) ?
We do not understand what is implied by “Nebraska human/social services”. The existing system does not ingest SDOH data
B - 2 (f)
Does the state currently ingest data from Nebraska statewide and/or regional health information exchanges? (if so could the state describe the nature of this data and its utilization in DMA-related functions/goals) ?
No, the existing system does not currently integrate with State’s Health Information Exchange (HIE).
B - 2 (f)
Does the state currently ingest data from Nebraska homeless management systems? (if so could the state describe the nature of this data and its utilization in DMA-related functions/goals) ?
No, the existing system does not ingest SDOH data.
B - 2 (f)
Does the state currently ingest health (or other) data from Nebraska correctional institutions? (if so could the state describe the nature of this data and its utilization in DMA-related functions/goals) ?
The Data Warehouse does not currently ingest corrections information electronically.
B - 2 (f)
Does the state currently receive real-time ADT notifications alerting the state of beneficiary activity in acute care settings?
The Data Warehouse does not currently receive Admission Discharge and Transfer( ADT) notifications directly.
B - 2 (f )
Could the state please provide any details on DMA support for NE 1115 Substance Use Disorder Demonstration Waiver? (how the DMA is leveraged, are there other outside data sources that are merged such as those from public health, etc… )?
The DMA solution is used to generate required CMS Part A metric reporting for the 1115 SUD, as well as support programmatic oversight of the waiver via ad hoc reports. Data needed for 1115 SUD metrics are standard Medicaid data set, such as claims/encounters, provider information, and beneficiary information.
B - 3
Could the state provide any details on the processing performance of the current data/analytic systems (data ingest/quality/matching; query performance, analytic/reporting performance)?
The State is looking to improve the quality of our existing data management systems and analytics capabilities.
| 32 |
| General |
Does [COMPANY] need to register with the state to respond to the RFI & be notified of the RFP?
The company does not need to be registered with the State to respond to the RFI. Registration is only necessary if there is an intended award. All RFP notifications are posted online at: https://das.nebraska.gov/materiel/bid-opportunities.html
To be directly notified, please email: DHHS.RFPQuestions@nebraska.gov with company name, contact name, phone number and email address. Use the subject “Vendor to add to MLTC DMA”.
| 33 |
| General |
Does [COMPANY] need to sign the “respondent form” to respond to the RFI? In the RFI it mentioned by a specific date, however no date is listed?
Yes. The respondent information must be completed and signed, either electronically or hard copy then scanned. The deadline for submission is June 6, 2024, at 1:59 p.m. Central.
| 34 |
| Section 1 – A Schedule of Events |
| 1 |
| In Section I, subsection A – A Schedule of Events, the RFI states in the Activity Table, row #4, “RFI DUE – Online Via WebEx.” While vendors are directed to submit questions using the provided sharefile.com link, a WebEx meeting link is also provided. |
Please confirm the delivery method of the RFI. Do vendors need to submit the RFI using the ShareFile Electronic Proposal Submission Link and also join the Webex on June 6 at 2:00 CST to submit the RFI?
Vendors must submit the RFI using the ShareFile proposal link provided. The Webex link is provided to join the proposal opening. Attendance at the Opening is optional.
| 35 |
| III, B, 2, a |
| 6 |
| Given that overall the data types and sources noted here look comprehensive, but can you please explain this sentence and define what gaps in data currently exist: “Only a portion of the data available in the Integrated Database is available in the Analytics Software Solution, which can cause variances in report data.” |
Not all data available in the Integrated Database is mapped to the user facing Analytics Software Solution.
| 36 |
| III, B, 2, c |
| 7 |
| Language in this section discusses DMA staff loading encounter data for processing into the warehouse. The Enterprise Architecture diagram on page 9 shows a data flow from the MCEs through EDI gateway to the MMIS, just wanting to understand if this another data flow and data set to account for. |
No, there is not another data flow or set to account for.
| 37 |
| III, B, 2, a |
| 6 |
| Bullet point in this section states “Directly querying the database requires a user to have an advanced skillset, limiting the number of users with access to all data sets.” Is this a proprietary language or is standard SQL utilized. |
Structured Query Language (SQL) is utilized.
| 38 |
| Section 4 - Program Integrity Case Management, Item e FADS and PI Analytics |
| 11 |
| Does the State desire to expand FWA analytics to include the use of Artificial Intelligence and Machine Learning - including unsupervised learning? |
Vendors can propose advanced capabilities for State’s consideration.
| 39 |
| Section D - Pricing |
What degree of specificity is anticipated in this section?
Does the State require the pricing information in a particular format or structure?
Is it preferable to present the pricing as a detailed breakdown of each component, or as a bundled pricing structure?
Any pricing information vendors are able to share will support Nebraska’s budget planning for future activities.
| 40 |
| III.B.2.a |
| 6 |
| Currently, data is updated monthly. How frequently does MLTC expect to update the data in the future? |
See response to question 13.
| 41 |
| III.C.1 |
| 10 |
| Does MLTC have a preference for an on-premise or cloud data warehouse? |
Vendors can propose to support on-premise or cloud data warehouse. We are interested in information on options available in the market.
| 42 |
| III.C |
| 10 |
| Does MLTC have a preference for a single vendor to provide all Areas of Examination or is it open to vendors who may provide a portion of them? |
See response to question 12.
| 43 |
| III.C.5 |
| 12 |
| Does MLTC currently use any standard COTS solutions for data analytics such as Tableau, Power BI, or Qlik? |
For purposes of this RFI, vendors can propose any COTS solution(s) for data analytics.
| 44 |
| III.C.1 |
| 10 |
| Is MLTC planning to migrate data from the existing DMA to the new EDW? If so, can MLTC provide a high-level description of the scope and size? |
Information gathered through the RFI will help the State determine if a procurement will occur in the future and will inform the timeline.
| 45 |
| III.C |
| 10 |
| Does MLTC have a preferred cloud partner (e.g. Azure, Google, AWS)? |
For purposes of this RFI, vendors can propose any cloud partner.
| 46 |
| III.B.2.a |
| 6 |
| Does MLTC have an estimate on the number of internal end users? |
See response to question 17.
| 47 |
| III.B.2.a |
| 6 |
| Does MLTC maintain any existing analytics solutions licensure? |
MLTC does not maintain any outside analytics solutions licenses.
| 48 |
| III.B.2.a |
| 6 |
| Does MLTC expect the selected vendor(s) to provide and maintain licensure on MLTC's behalf? |
Information gathered through the RFI will help the State with future planning.
| 49 |
| III.B.2.e |
| 7 |
| Does MLTC desire to provide the same permissions to all end users? |
No, MLTC would expect to be able to configure access permissions based on the needs of various users/groups.
| 50 |
| C |
| 10 |
| In reference to the RFI response, may respondents only submit the pages that require a response, such as page 1, pages 10-17, or transmittal letters? |
| Respondents shall submit all necessary pages requiring a response as well as any related attachments. |
| Kindly please advise when the resulting RFP is expected to be released. |
| This is to be determined. |
| Who is the incumbent and when does their contract expire? |
| See response for question 11. |
| For bidders to better understand the scope and scale of the project, does the State have an identified budget for this project? |
| DHHS does not release this information prior to a solicitation. |
| Is there an anticipated implementation period for this project? |
| See response to question 9. |
| Is there currently or expected to be a system integrator? What type of services would the integrator provide? |
| Nebraska does not contract with a 3rd-party Systems Integrator. Information gathered through the RFI will help the State with future planning. |
| Who are the MCOs that the State currently works with? |
| Information on NE Managed Care Program can be found at - https://dhhs.ne.gov/Pages/Heritage-Health-Contacts.aspx |
| 57 |
| A. Schedule |
of Events
| 1 |
| Please clarify the use of the Webex |
meeting for RFI Submission Vendors must submit the RFI using the ShareFile link provided. The Webex link is provided to join the proposal opening.
| 58 |
| B. Medicaid |
Data and Analytics Operations
| 5 |
| Within the 1.Program Overview the |
RFI states “The FFS claims remaining in the State are processed by the State’s legacy system. FFS claims processing is not within the scope of this RFI”.
Please confirm if the intent is that all FFS claims are excluded from all aspects of the scope: DW/DSS, T- MSIS, PICM, and fraud abuse detection system and analytics.
Fee For Service (FFS) Claims data is included in the scope for Data Warehouse (DW)/ Decision Support System (DSS), Transformed Medicaid Statistical Information System (T-MSIS), PICM, and fraud abuse. Claims processing for FFS claims is not within scope.
Revised 07/31/08
File details come from the government source that posted it. Updated .