PICM Intent to award Final.docx

The document is a Solicitation Notice of Intent to Award from the State of Nebraska, specifically for the Department of Health and Human Services (DHHS), concerning the Program Integrity Case Management (PICM) and Fraud Abuse Analysis and Detection (FAD) System. The solicitation, identified as RFP 122125, was released on May 28, 2025, with proposal responses due by July 10, 2025, and an intent to award posting date of August 19, 2025. The state intends to award the contract to Alivia Analytics for a comprehensive cloud-based, modular software solution to replace the current Medicaid program case management system. The contract will have an initial five-year term with options for two additional two-year renewals, with an expected implementation date no later than October 31, 2026.

The project requires a Software as a Service (SaaS) platform capable of tracking recoupments, identifying billing practice outliers, conducting retrospective drug utilization reviews, and referring suspected provider fraud cases to the state's Medicaid Fraud Unit. The solution must integrate with existing state systems, including the Medicaid Management Information System (MMIS) and the Nebraska Family Online Client User System (N-FOCUS). Evaluation criteria will assess responses across three categories: Corporate Overview (25 points), Technical Response (60 points), and Cost Sheet (15 points), with a potential total of 100-120 points. The project is eligible for enhanced federal financial participation (FFP), and the vendor will be responsible for supporting CMS certification, data migration, training, and ongoing maintenance. The state will allocate up to 500 vendor hours annually for system modifications at no additional cost, and the solution must meet rigorous security requirements including TLS encryption, AES-256 data protection, role-based access control, and HIPAA compliance.