NE MDR Attachment A_CMS.docx
DOCX document 156 KB Posted
- Attached to
- Medicaid Drug Rebate System (MDR)
- Solicitation number
- 124528 ON
- Issued by
- Lancaster County, Nebraska
About this file
This is a Request for Proposal (RFP) attachment document from the State of Nebraska Department of Health and Human Services for the selection of a qualified contractor to design, develop, test, implement, and provide five-year operational support for a new Medicaid Drug Rebate System (MDR). The system will manage Medicaid drug rebates, including rebate calculations, claims processing, vendor management, and reporting, with integration requirements across eighteen defined data interfaces connecting to Nebraska's Medicaid Management Information System (MMIS), Health Insurance Administration (HIA), Centers for Medicare & Medicaid Services (CMS), managed care organizations, and pharmacy benefit managers. Written questions are due June 23, 2026, with proposals due July 23, 2026, at 2:00 p.m. Central Time. The evaluation period spans July 30 through August 13, 2026, with an Intent to Award expected August 27, 2026, and contract finalization targeted for September and October 2026. The initial contract term is five years with one optional three-year renewal, and the anticipated award and start date is January 2027.
The contractor must comply with Section 1927 of the Social Security Act, applicable Code of Federal Regulations provisions (42 CFR 447.509, 447.511, 447.520), HIPAA regulations, and NIST standards, while designating Privacy and Information Security Officials and implementing required administrative, physical, and technical safeguards. Performance guarantees include daily monetary penalties ranging from $500 to $5,000 per incident for non-compliance across six requirement categories. The vendor must provide trained operational staff 30 calendar days prior to Go Live, replace key personnel within 30 calendar days of notification, and submit a DHHS-approved Turnover Plan at least 180 days before contract end. Critical system performance requirements include capturing rebate data for invoicing within 60 days of each quarter end, generating automatic delinquent letters within 10 business days, completing quarterly rebate file generation within 1 business day of invoice cycle completion, and providing dispute resolution support within 5 business days. Pricing must remain fixed for the first five years, and the State reserves the right to consider resident disabled veteran and designated enterprise zone preferences under Nebraska Revised Statutes, conduct best and final offer rounds, and request vendor demonstrations.
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ATTACHMENT A - Functional Requirements
RFP # 124528 ON
Medicaid Drug Rebate (MDR) System State of Nebraska, Department of Health and Human Services
IMPORTANT:
Please note that any additional costs must be captured only on the Cost Sheet and NOT within the response to the specification.
Failure to adhere to these instructions shall result in the bidder being deemed as "Non-Responsive".
General Guidelines for Vendors
1. Thoroughly Review Requirements: Carefully read each requirement, including subpoints and links provided. Ensure responses clearly address each aspect of the requirement.
2. Provide Supporting Details: Each response should include clear descriptions, processes, tools, or diagrams demonstrating how the solution meets the requirement.
3. Organize Responses:
· Use headings and subheadings to structure responses.
· Include bullet points for clarity.
4. Use Standards and Best Practices:
· Refer to relevant standards (e.g., Section 508, NIST, FIPS, HIPAA).
· Provide details of certifications, tools, and industry-compliant processes.
5. Clarity and Precision:
· Avoid vague language or ambiguous claims.
· Use concise, professional terminology.
· Ensure responses are tailored to DHHS requirements and align with federal and state guidelines.
6. Supporting Artifacts:
· Include visuals such as diagrams, charts, and flowcharts where applicable.
· Reference external documents or standards as appropriate.
7. Testing and Validation: Detail testing approaches, validation processes, and evidence that the solution meets outlined expectations.
Specific instructions to complete Functional Requirements
Bidders are to refrain from providing a solution where that would result in additional fees and/or expressing that a feature or functionality is available at an additional cost.
This document contains tables for each Functional Requirement type. The requirement types are as follows:
| Requirement Type |
| Range |
Invoice Management (IVM)
IVM-01 - IVM-76
Accounting (ACC)
ACC-01 – ACC – 15
Customer Support, Documentation, and Training (CDT)
CDT-01 – CDT-30
Staffing and Resource (SAR)
SAR-01 – SAR-03
| Turnover and Contract Closeout (TCC) |
| TCC-01 – TCC-04 |
| Project Management and Implementation (PMI) |
| PMI-01 – PMI-24 |
For each requirement listed under the tables in this document, the bidder shall choose whether their solution “Met The Requirement” then choose the “Implementation Approach” and the “Describe Bidder’s approach/ability to meet the requirement” by following the instructions provided for each requested information directly below.
Met The Requirements Within each requirement there is a dropdown option to select three options to answer whether the bidder will meet the requirement or not. The available options to choose from and their descriptions are as follows.
| Available Options |
| Description |
YES
The Bidder confirms that their solution meets the specified requirement
| NO |
| The Bidder confirms that their solution does not meet their requirement |
| MET WITH DEVIATION |
| The Bidder Confirms that their solution meets the specified requirement with deviation taken to the specified requirement. |
(If this option is selected, then the bidder shall explain within the “Describe Bidder’s approach/ability to meet the requirement” section how they plan to meet the requirement.
Implementation Approach:
The Implementation Approach requested in this document can be described as the methodology that will be utilized by the bidder to meet the specific requirement. Within each requirement there is a dropdown option provided to select your Implementation Approach from which an option must be selected. The available options to choose from and their descriptions are as follows:
| Available Options |
| Description |
Out of Box (OOB)
Indicates that the functionality is available in the solution without any modifications.
| Customization |
| Refers to changes made to the base product to meet specific requirements. This may involve coding or other significant alterations |
| Configuration |
| Refers to adjustments or settings changes within the solution that do not require coding but adapt the product to meet requirements. |
TPS
Met with third party software
NA
Not Available
Describe Bidder’s approach/ability to meet the requirement As bidders prepare responses to each individual requirement, the responses are expected to address the individual requirement in a manner that demonstrates to DHHS that the bidder understands the requirement and how the bidder will meet the specific requirement. If the bidder’s response simply repeats the requirement, acknowledges, or adds sales materials in the Bidder’s response, DHHS will reserve the right to deem the response as a “Non-Responsive Solicitation Response”. However, if needed to appropriately explain bidder’s response, a mix of tables, graphical details, and written narrative is acceptable.
The bidder’s response to each requirement must include confirmation and a detailed explanation for the Implementation Approach taken. Bidders shall capture any assumptions, risks, or dependencies related to fulfilling each individual requirement.
Provide specifics, such as:
· Tools or methods used.
· Estimated effort for customizations/configurations.
Invoice Management (IVM)
| Number |
| Requirement Description |
| IVM-01 |
| Solution must support automated generation of the Drug Rebate Electronic Invoice Files for each drug manufacturer with current rebate information, with the ability to generate and distribute electronically and on paper. |
Met the requirement: Choose an item.
Implementation Approach: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-02 |
| Vendor must work with DHHS to develop routine extract files containing MDR data to be interfaced to DHHS’s Medicaid enterprise data warehouse, with format, data elements, and frequency to be agreed upon by DHHS. These extracts will support drug rebate oversight and analysis by DHHS. The extracts will cover the following three domains: |
a. Detailed claim level information on drug claims sent to MDR and included or excluded from rebate invoicing.
b. Manufacturer invoice level data on drug rebates invoiced, amounts disputed, and rebates collected.
c. NDC level drug reference information, including rebate status, unit rebate amounts, and other data elements utilized in rebate determination.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-03 |
| Solution must automatically accurately calculate compound interest due on quarterly rebate amounts per Federal Regulations. Interest must be itemized at the NDC/line level. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-04 |
| Solution must provide the capability to transmit detailed drug claim listings (CLD) to manufacturers electronically using federal and state defined formats. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-05 |
| Solution must limit invoicing of drugs to those that are manufactured by companies on the CMS listing of manufacturers with drug rebate agreements (except as directed by DHHS). |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
IVM-06
Solution must provide the capability to include and exclude claims from the drug rebate invoice cycle based on DHHS defined criteria (e.g. labeler, provider, members, drug, etc.). The solution shall also provide a detailed report, to be provided with the Technical Response, which outlines excluded claims from the drug rebate invoice cycle process. The report must include the business reason(s) why each claim was excluded from the invoice process. The report must be available on demand for DHHS staff to retrieve by invoiced quarter.
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
| IVM-07 |
| Solution must provide the capability to hold or suspend the issuance of a drug rebate invoice (electronically and paper) based on DHHS defined criteria (e.g. labeler, invoice amount, variances between paid claim information and CMS rebate information, etc.) to allow DHHS to remediate any issues or discrepancies before the invoice is generated. |
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
| IVM-08 |
| Solution must accept and store data for physician administered drugs (e.g., J codes), as directed by DHHS for rebate processing. |
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
| IVM-09 |
| Solution must provide the capability of an automatic default on the unit rebate amount to the most recent CMS known Unit Rebate Amount. |
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
| IVM-10 |
| Solution must have the capability to automatically determine the amount of rebate due from each manufacturer, based on quantity of units paid for each NDC (both original and adjusted claims), rebate amounts, data specific interest rate and prior period adjustments, per data received from CMS and DHHS. |
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
IVM-11
Solution must automatically generate delinquent (38 and 68 day notice) letters to manufacturers who have not paid an invoice or have an outstanding balance.
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
| IVM-12 |
| Solution must maintain and display original and corrected invoice records for reporting purposes. |
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
IVM-13
Solution must maintain all historical drug rebate and invoice information to accommodate prior period adjustment processing.
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
IVM-14
Solution must generate invoices for provider administered drugs billed on professional and institutional claims.
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
IVM-15
Solution must meet federal drug rebate format and content requirements and display, at a minimum, the following information on all drug invoices. Final content will be affirmed with vendor during implementation sessions:
a. Manufacturer name
b. Manufacturer address
c. Invoice number
d. Date invoice created
e. Period covered
f. OMB Format Number
g. NDC number
h. Drug name
i. Messages
j. Rebate amount per unit
k. Total units reimbursed per NDC
l. Total rebate claimed per NDC
m. Total reimbursement amount
n. Grand totals
o. Third Party Liability (TPL) portion paid Plan
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
IVM-16
Solution must apply basic file validation (e.g., manufacturer data, unit dose and measure conversion) provided by CMS, used in generating rebate invoices, to confirm that the information received is complete and accurate.
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
| IVM-17 |
| Solution must generate and provide electronic files of all rebate invoices, prior period adjustments and collections by NDC on a quarterly basis in a format defined by DHHS. |
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
| IVM-18 |
| Solution must monitor drug rebate information to determine if any URA is zero, and if more than two quarters have a URA of zero, the solution must issue an alert prior to invoice generation to provide sufficient time for research, analysis, and resolution. |
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
IVM-19
Solution must record and track manufacturer disputes of drug rebate invoices at the NDC detail level for encounter and FFS claims.
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
| IVM-20 |
| Vendor must perform all aspects of the formalized dispute resolution process, with direction and approval of DHHS. |
Met the requirement: Choose an item.
[Describe Bidder’s ability to meet the requirement]
| IVM-21 |
| Solution must maintain an automated drug rebate tracking system for disputes that identifies and tracks non-responsive manufacturers and allows responding manufacturers to submit disputes electronically. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-22 |
| Vendor must support DHHS in dispute resolution meetings (informal, appeal, judicial review, etc.) with manufacturers or labelers, including providing staff to participate with DHHS in meetings. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-23 |
| Solution must maintain a history of the data used to support DHHS in case of a drug manufacturer dispute over the rebate invoice. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-24 |
| Solution must support manual rebate updating, overriding the CMS quarterly update, for specific drugs and at the manufacturer (labeler) level across all NDCs for that manufacturer. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-25 |
| Solution must perform adjustments when corrections are made to paid claims or when billing errors are discovered through the rebate dispute resolution process. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-26 |
| Solution must allow rebate adjustments and payments to be applied at the NDC level and to report accordingly. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-27 |
| Solution must provide drug rebate adjustment reason code(s) associated to each adjustment. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-28 |
| Solution must link all adjustment activity to the quarter in which the original invoice was generated. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-29 |
| Solution must migrate, convert, and manage the transfer of historical rebate data provided by DHHS. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-30 |
| Solution must obtain and maintain CMS quarterly drug rebate information necessary for rebate invoicing and CMS federal reporting, including but not limited to: |
a. Unit Rebate Amounts
b. Labeler Information
c. Unit Rebate Offset Amounts
d. Applicable, accrued labeler interest
e. Guaranteed Net Unit Rebate Prices (GNUPs) by NDC when applicable.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-31 |
| Solution must accept and maintain information provided by DHHS necessary for the generation of accurate rebate invoices, which includes, but is not limited to the following: |
a. Claims utilization information
b. Managed Care Organization (MCO) encounter information
c. Drug description information
d. Nebraska Medicaid Provider information
e. National Provider Identification (NPI) information
f. 340B modifiers at a claim level when applicable
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-32 |
| Solution must include the capability to maintain multiple effective date spans for drug manufacturer records to accommodate periods where a manufacturer becomes ineligible to participate in the drug rebate program as identified by CMS or DHHS. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-33 |
| Solution must update drug rebate information related to a claim when claim adjustments are provided by DHHS. Further discussion will be necessary with Department staff during implementation. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-34 |
| Solution must convert between the drug database unit and quantity used for invoicing to those used by CMS. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-35 |
| Solution must maintain a complete history of the claims information provided by DHHS to support the drug rebate invoice process. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-36 |
| Solution must capture and store unit rebate amount (URA) data from CMS then identify, calculate, and apply modifications as needed. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-37 |
| Solution must allow access to claim level drug rebate information on-line. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-38 |
| Solution must generate a report listing all adjustments made to drug rebate invoices, with the capability to be filtered at least by labeler, time period, invoice number, NDC, number of units adjusted, total dollar amount adjusted, and adjustment code. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-39 |
| Solution must generate a report listing claims paid for any terminated drugs, in a specific quarter. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-40 |
| Solution must generate a report listing of all claims paid for a specific labeler, in a specific quarter. A sample of the report must be submitted with the Technical Response. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-41 |
| Solution must generate a report listing the total amounts billed, collected, adjusted, interest accrued, credits, disputed, not invoiced, and balance due, for all labelers, broken down by quarter and program. A sample of the report must be submitted with the Technical Response. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-42 |
| Solution must generate a report listing current outstanding balances or credits of a labeler code at the invoice level. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-43 |
| Solution must generate a report listing current outstanding balances or credits of a labeler code at the NDC level. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-44 |
| Solution must generate a report (38 and 68 day reports) listing the total amounts for all labelers that are a specified number of days past due, broken down by invoice number. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-45 |
| Solution must generate a report listing the outstanding balances by labeler for all invoices and PQAS (Prior Quarter Adjustment Statement) sent in a specified quarter. A sample of the report must be submitted with the Technical Response. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-46 |
| Solution must generate a report listing total amount of Drug Rebate deposits, by deposit, for a user-requested time period. A sample of the report must be submitted with the Technical Response. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-47 |
| Solution must generate a report of all the Unit Rebate Offset Amounts that occurred in the quarter plus any changes to previous quarters’ Unit Rebate Offset Amounts. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-48 |
| Solution must generate required Federal expenditure reporting for the CMS 64 which is summations of adjustments (credits and debits), rebates billed and payments that occurred in the quarter. Each amount is summed by the quarter where the first invoice was recorded. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-49 |
| Solution must generate a report listing invoices created for a specified invoice quarter or labeler. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-50 |
| Solution must generate a report listing the amount billed, paid, adjusted, and outstanding for all labelers. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-51 |
| Solution must generate a report listing the date the quarterly file was received from CMS, the date the quarterly file was processed by the vendor, the date the invoices were submitted to labelers, and the date the invoices were received by the labelers. A sample of the report must be submitted with the Technical Response. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-52 |
| Solution must generate a report listing information on all invoices and prior quarter adjustment statements sent for a specific labeler in a specific time frame (Rebate Claimed, Adjustments, Interest Accrued, Payments, Outstanding Balance), broken down by program group (fee-for-service and encounter pharmacy and professional claims). Interest must be itemized at the NDC/line level. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-53 |
| Solution must generate a report listing of all drugs that were invoiced for, in a specific invoice quarter, but were not on the CMS file (rebateable). |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-54 |
| Solution must generate a report listing of all invoices and prior quarter adjustment statements created in a specified invoice quarter. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-55 |
| Solution must generate a report listing the received and/or accrued interest for a specified labeler for a user specified time frame. Interest must be itemized at the NDC/line level. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-56 |
| Solution must generate a report listing any drug that was invoiced an amount greater than Medicaid paid + payment from other source (total Medicaid allowable). A sample of the report must be submitted with the Technical Response. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-57 |
| Solution must generate a report to notify labelers of the status of disputes, or how a dispute was resolved. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-58 |
| Solution must generate a report listing all family planning drugs invoiced, including the Medicaid + paid by other sources amount paid, and amount invoiced. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-59 |
| Solution must generate and maintain an electronic file and report of all paid encounter physician and pharmacy claims with disputed products (NDCs) for the rebate quarter under review to facilitate dispute research and resolution. A sample of the report must be submitted with the Technical Response. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-60 |
| Vendor must provide DHHS with a copy of CMS pharmacy-related communications (e.g., manufacturer or labeler code changes, DESI code changes, product deletions, labeler terminations, new manufacturer or labelers). |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-61 |
| Solution must generate a report listing all instances in which a quarter-to-quarter variation equal to or exceeding a parameterized percentage occurs, in terms of either units invoiced or dollars collected for each NDC , the reason(s) for the variance (e.g. billing error, conversion issue), and convey this information to DHHS for review prior to quarterly invoicing. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-62 |
| Solution must generate a report that demonstrates the claims information provided by DHHS is used in each quarterly invoicing cycle, and any exceptions with reasons for not including specific claims in the applicable cycle. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-63 |
| Solution must have the capability to generate ad-hoc reports against information provided by CMS and DHHS and information (e.g. drug rebate invoicing, dispute management, and accounting processes). |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-64 |
| Solution must allow users to run ad-hoc queries against information provided by CMS and DHHS and information generated by the vendor’s proposed solution used for drug rebate invoicing, dispute management, and accounting processes. DHHS users must be able to choose from multiple pre-built defined parameters, singularly or in combination, to generate user-customized results. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-65 |
| Vendor must provide DHHS with a report documenting any deficiencies between the vendor’s proposed solution and federal and state rebate standards. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-66 |
| Vendor must provide DHHS with white papers that provide an analysis, impact, and applicable options and recommendations for changes identified in Federal rebate standards. Vendor must notify DHHS within one (1) business day of becoming aware of a change to Federal rebate standards. The Vendor notification must include an estimate of the time necessary to provide DHHS with the white paper. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-67 |
| Solution must allow all reports with claims information to be identified and reported based on claim type (e.g. pharmacy, professional) and procedure code (e.g. NDC, J-Code, modifiers, units). Frequency request is on request – query functionality must be real-time for data maintained within the system used for invoicing, disputes, and accounting. All reports with a standard monthly, quarterly, and annual frequency must also be available on request based on user-customized time periods. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-68 |
| Solution must accommodate leap year processing. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-69 |
| Vendor must complete all disputes received through each quarterly invoicing cycle in entirety before the initiation of the subsequent invoicing cycle. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-70 |
| The Vendor will store and report on current and historical Unit Rebate Amount (URA) information by labeler, year, and quarter. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| IVM-71 |
| Solution must provide the capability to allow retrieval of the detailed drug claim listings (CLD) for IQVIA electronically using IQVIA defined format. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
IVM-72
DHHS must meet all federal reporting requirements, as well as those imposed by Nebraska regulations and policies. The MDR solution must have the flexibility to provide reporting for multiple perspectives: e.g. state staff, providers, labelers, participants, etc. Sample reports must be provided with the proposal and will be finalized after reviews with DHHS to determine what additional reporting may be required to meet DHHS needs. Reporting capabilities need to be flexible enough for printing, transfer via multiple output formats and methods, and be customizable by the end user to meet that user’s individual needs.
*DHHS reserves the right to add additional reports, change reporting requirements and request on-demand reports as deemed necessary. All reporting must be available in a format that easily allows the data to be imported into state data warehouses and decision support systems.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
IVM-73
Solution must transmit a copy of the quarterly CMS rebateable labeler file to MMIS for claims adjudication purposes. (List of Labelers)
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
IVM-74
Solution must interface with CMS to send a quarterly drug rebate utilization file and receive back utilization errors file. (CMS Drug Rebate Utilization and CMS Utilization Errors)
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
IVM-75
Solution must receive a list of labelers from DHHS for which claims will be included on the IQVIA paid claims file. (IQVIA Labeler List)
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
IVM-76
Solution must interface with Nebraska’s preferred drug list vendor to supply a utilization data file for supplemental rebate purposes. (Supplemental Utilization Data file and Tag file)
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
Accounting (ACC)
| Number |
| Requirement Description |
| ACC-01 |
| Solution must capture, or convert electronically, the prior quarter adjustment statement (PQAS) and reconciliation of state invoices (ROSIs), perform line-item match by drug, link to the invoice and identify disputes when payments are received. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
ACC-02
Solution must maintain NDC level information on the drug rebate accounts receivable.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
ACC-03
Solution must provide multiple methodologies (e.g., percentage and actual), for allocation of the drug rebates to program funding source(s) and identify drug rebate amounts by benefit program.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| ACC-04 |
| Solution must produce accounting reports (configured for a specific time of inactivity for inactive labelers who have not paid a payment for a period of time) for outstanding drug rebate debt including interest calculated based on CMS rules. Interest must be itemized at the NDC/line level (Doubtful Account Report). Monthly or within one (1) business day of request. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
ACC-05
Solution must provide real-time online query and retrieval of interest rates, calculation, accumulation, invoicing, and reporting of interest amounts on outstanding balances related to the drug rebate program.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| ACC-06 |
| Solution must systematically establish Accounts Receivables at the Manufacturer or Labeler level for drug manufacturers invoiced for each drug rebate invoice generated by the system. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
ACC-07
Solution must provide quarterly drug rebate reconciliation according to DHHS defined criteria. The solution will write a quarterly report at the end of each invoicing cycle comparing both FFS and MCO encounter claims that were received from DHHS input source(s) for invoicing. It will use the DHHS-defined business rules for which claims meet criteria for invoicing. The solution will identify claims which were flagged as meeting criteria for invoicing but not included in the rebating process and include identified claims which were flagged as not meeting criteria for invoicing but should have been invoiced. The report will be available to DHHS within thirty (30) calendar days after the end of each invoicing quarter.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
ACC-08
Solution must provide reconciliation between the drug rebates received and the amount reported on the CMS-64.9R form for the quarter.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| ACC-09 |
| Solution must compare invoices to payment documentation returned by the manufacturer to determine which NDC line items are paid or in dispute. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
ACC-10
Solution must provide automated and, on an exception basis, manual processes to reconcile amounts paid to amounts invoiced by NDC line item.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
ACC-11
Solution must maintain, display, and report an audit trail of all changes made to invoices and identify invoice records that have been changed to facilitate future processing. The audit trail must minimally include invoice details before and after the change, date of change, reason for change, and source of change. The audit trail must be accessible to DHHS staff online and in a report format.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
ACC-12
Solution must record all receipts of rebate payments, made to DHHS, distinguishing between federal and state business units and between rebates for FFS and managed care claims (pharmacy and professional) and apply to correct invoice (e.g., appropriate calendar quarter, invoice and manufacturer or labeler, program, NDC).
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
ACC-13
Solution must maintain a process to track drug rebate activities (invoicing, adjustments, payments, credits, disputes, sending of letters and requests of information from labelers) by NDC and manufacturer.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
ACC-14
The solution must be able to accurately report deposit data in correct categories for deposit and federal reporting using underlying paid claims data for which drug rebate payments are received.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
ACC-15
Solution must have the ability to generate an on-demand report summarizing the rebates invoiced for a given therapeutic drug class and date range as defined by DHHS.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
Customer Support, Documentation, and Training (CDT)
| Number |
| Requirement Description |
CDT-01
Vendor must provide technical assistance to all entities included in the drug rebate process, including CMS, DHHS, Labelers, and other Vendors. Vendor must provide acknowledgement of the request to the requestor within one (1) business day. The Vendor’s acknowledgement must include an estimate of the time necessary to provide the requested technical assistance.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-02 |
| Vendor must provide DHHS with support, including Vendor staff participation in meetings, and documentation if a drug manufacturer dispute, or other rebate-related action, proceeds to an administrative or judicial review. Vendor must provide acknowledgement of the request to the requestor within one (1) business day. The Vendor’s acknowledgement must include an estimate of the time necessary to provide the requested support or documentation. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
CDT-03
Vendor must coordinate with appropriate CMS staff and, as necessary, appropriate contacts for pharmaceutical manufacturers when the Vendor determines that necessary CMS information pertaining to any given manufacturer’s rebate-qualified drug is incomplete or otherwise inaccurate. Vendor must provide acknowledgement of the request to the requestor within one (1) business day. The Vendor’s acknowledgement must include an estimate of the time necessary to provide the requested support, coordination, or response.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
CDT-04
Vendor must support communication with other Vendors or parties, regarding the inclusion of applicable claims for rebates invoicing purposes, both state and federal. Vendor must provide acknowledgement of the request to the requestor within one (1) business day. The Vendor’s acknowledgement must include an estimate of the time necessary to provide the requested support, coordination, or response.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
CDT-05
Vendor must provide DHHS, Vendor staff, and impacted stakeholders (e.g. manufacturers, pharmacies, etc.) training on the Vendor’s proposed solution that includes the Vendor’s applications and operational process.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-06 |
| Vendor must provide a draft Training Plan with the proposal. A sample of the Training Plan must be submitted with the Technical Response. A final detailed Training Plan must be developed, reviewed and approved by DHHS within 45 calendar days of the contract start date. The approved Training Plan must minimally address the following topics for training activities: |
a. Approach and scope (including all audience groups).
b. Training activity, schedule, duration, types (i.e., in person, online, pre-recorded, real time, interactive, etc.), locations, for various stakeholder groups (e.g. state staff, labelers, etc.) by task.
c. Assurances for providing timely, appropriate training activities for all stakeholders.
d. Roles and responsibilities for all stakeholder types.
e. Training to support the initial implementation of solution.
f. Post implementation training activities and frequency throughout the life of the contract.
g. Languages that training will be provided in and basis for verifying accuracy of all translations; and
h. Identification of standardized and ad hoc training materials.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-07 |
| Vendor must collaborate with DHHS to finalize a training schedule that will be approved by DHHS. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
CDT-08
Vendor must provide for development and implementation of technical and user training programs.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-09 |
| Vendor must provide Training Plan updates on the following basis: |
a. Prior to the scheduled pre-solution Implementation training.
b. Each time a solution change or upgrade is implemented. The updated and DHHS approved plan must be distributed to solution users prior to the implementation of the system change or upgrade; and
c. A complete review and update must be performed on an annual basis within thirty (30) calendar days of the start of each contract year. The annually updated, DHHS-approved plan must be distributed or made available to all solution users.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-10 |
| Vendor must perform updates to standardized training and communication materials. Updated materials must be reviewed and approved by DHHS on the following basis: |
a. At a minimum, on an annual basis in accordance with the training schedule,
b. A minimum of fourteen (14) calendar days prior to a scheduled training event; and
c. All updates must include a version identifier and date updated notation.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-11 |
| Vendor must provide training to all users of the solution prior to the implementation and on an ongoing basis during operations in accordance with the DHHS-approved Training Plan and Materials. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-12 |
| Vendor must provide train-the-trainer sessions for DHHS resources or designated DHHS resources and other staff responsible for training. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-13 |
| Vendor must develop and deliver training in a format and modality as agreed upon with DHHS. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-14 |
| Vendor must utilize a variety of delivery methods for training, including online self-paced training presentations, written materials, webinars, demonstrations and at the discretion of DHHS. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-15 |
| Vendor’s training materials must be offered in accessible formats consistent with requirements of the Americans with Disabilities Act. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-16 |
| Vendor must provide a training environment that is available to DHHS and must maintain and update the training environment with training data to use during user training. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-17 |
| Vendor must make training records available to be included in the data available for reporting. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-18 |
| Solution must have system and user documentation to allow for efficient maintenance and operational use of the Vendor’s solution. The draft version of system and user documentation must: |
a. Be submitted within ninety (90) calendar days of the Go Live date.
b. Be reviewed and approved by DHHS within timeframes agreed in approved work plan.
c. Address the remaining documentation requirements within this section.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-19 |
| Solution documentation must include a detailed, comprehensive data element dictionary (DED), including, at a minimum: |
a. Data element names, numbers, descriptions, and definitions (including length and type).
b. Valid values with definitions; sources for all identified data elements.
c. Field calculations.
d. Table listings for all table(s) elements.
e. Lists from the DED in multiple sort formats (e.g., data element name, data element number).
f. Align with industry standards for definition and use as applicable.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-20 |
| Solution documentation must include descriptions showing the flow of business processes, business rules, and interface(s) with DHHS. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-21 |
| Solution must provide on-line help for all of its features, functions, and data element fields, as well as descriptions and resolutions for error messages, using help features including indexing, searching, tool tips, and context- sensitive help topics. Solution must also provide a customer service support line and subject matter expert staff to be available to assist with resolution of various questions related to the operations of the system. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-22 |
| All solution documentation must be accessible to users online, with a printable version available. Browse and search capabilities must be provided to permit users to easily locate specific information in the documentation (e.g., training, user manuals, etc.). |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-23 |
| The solution user manual documentation must include full mock-ups of all screens/windows and provide narrative descriptions of the navigation features for each screen/window. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-24 |
| All solution documentation must be organized in a format that facilitates updating and maintenance, including version control. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-25 |
| Solution on-line tutorials must provide on-line access to the user manual and training materials. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-26 |
| Solution documentation must include a user guide for the reporting management and repository feature. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-27 |
| Solution must provide and keep all system and user documentation current at the time changes and upgrades are applied to the system. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-28 |
| Solution must use system design documents that utilize a widely supported modeling language (e.g., UML, BPMN). |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-29 |
| Solution must provide context sensitive help (situational clarification and support associated with process specific steps), to support user activities (e.g., maintenance activities). |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| CDT-30 |
| Solution must retain the following files and data for the term of the contract. |
a. CMS Unit Rebate Amounts
b. CMS Labeler Information
c. CMS Unit Rebate Offset Amounts
d. State Claims utilization information
e. State Managed Care Organization (MCO) information
f. State Drug description information
g. State Medicaid Provider information
h. State National Provider Identification (NPI) information
i. System Reference Files
j. CMS Utilization Data
k. State Supplemental Utilization Data
l. Quarterly Invoices
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
Staffing and Resource (SAR)
| Number |
| Requirement Description |
| SAR-01 |
| Vendor must provide implementation and operational staff to support the following functions: |
a. Project Management/Support (e.g. requirements, design, development, testing, implementation, etc.)
b. Development or Configuration Management / Coordination
c. Testing Management/Coordination
d. Training Management/Coordination
e. Certification Management/Coordination
f. System and Data Security Management/Coordination
g. Dispute resolution operations
h. Conversion adjustments and application review
i. Monetary invoicing threshold review
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
SAR-02
Vendor must provide technical operations support for all system related functionality.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
SAR-03
Vendor must provide operational staff to support the following functions:
a. Disputes, Conversion adjustments and Monetary invoicing threshold review
b. Customer Support (DHHS staff and partners, labelers, CMS, etc.)
c. Training
d. System Maintenance
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
Turnover and Contract Closeout (TCC)
| Number |
| Requirement Description |
TCC-01
At least one hundred eighty (180) days before the end of the Contract, the Vendor must develop and implement a DHHS approved Turnover Plan. The Turnover Plan must be comprehensive detailing the proposed schedule, activities, and resource requirements associated with turnover tasks.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| TCC-02 |
| Vendor must work with the successor Vendor for data conversion activities from the current system to the proposed system. |
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
TCC-03
Vendor must turnover all Nebraska data, including archived claims, to DHHS and the successor Vendor.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
TCC-04
Vendor must turnover all documents and Repositories, in a format prescribed by DHHS.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
Project Management and Implementation (PMI)
| Number |
| Requirement Description |
PMI-01
Vendor must utilize, maintain, and facilitate an industry recognized project management process, tool, and documentation, such as the Project Management Institute’s (PMI’s) Project Management Body of Knowledge (PMBOK) or Scaled Agile Framework to complete the scope of work. Vendor must follow agreed upon project management lifecycle process, and work with DHHS project management resources to align activities and resources during the implementation and operations phases of the contract.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
| PMI-02 |
| Vendor must develop and maintain a Project Management Plan (PMP). The PMP minimally must include the following: |
a. Executive Summary
b. Communications Management Plan
c. Change Management Plan
d. Staffing Management Plan
e. Quality Management Plan
f. Risk Management Plan
g. Issue Management Plan
h. Deliverable Review and Approval Process (DRAP)
i. Application Configuration and Maintenance Plan
j. Scope Management
k. Schedule Management Plan
l. Performance Management Plan
The Vendor must maintain a defective ticket tracking system, which is readily available via direct access by DHHS staff. The vendor must also provide phone and email customer support related to defect reporting and management. The PMP must address this requirement.
The PMP plan must be reviewed and approved by DHHS staff, and any identified adjustments will be made prior to signoff. A sample of the PMP plan must be submitted with the Technical Response.
Met the requirement: Choose an item.
[Describe Bidder’s approach/ability to meet the requirement]
PMI-03
Vendor must utilize, maintain, and…
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