RFP 0049-N_ADDENDUM 2 - NEW SECTION 4 Key Dates.pdf

RFP 0049-N, Page 1 of 47

STATE OF WYOMING

DEPARTMENT OF ADMINISTRATION & INFORMATION

GENERAL SERVICES DIVISION, PROCUREMENT SECTION

2323 CAREY AVENUE

CHEYENNE, WY 82002

REQUEST FOR PROPOSAL NUMBER 0049-N

WYOMING DEPARTMENT OF HEALTH

DIVISION OF HEALTHCARE FINANCING

COORDINATING OUTCOMES: MEMBER PATHWAYS, ADVOCACY,

SUPPORT, AND STABILITY (C.O.M.P.A.S.S.)

PROPOSAL DUE DATE AND TIME

SEPTEMBER, 30, 2026 – 2:00:00 P.M. MOUNTAIN TIME

AGENCY REPRESENTATIVE:

BRENDA STOUT

PROCUREMENT REPRESENTATIVE:

JAMIE RAFF

Jamie.raff1@wyo.gov 307-777-6721

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Table of Contents

SECTION 1: REQUEST FOR PROPOSAL

SECTION 2: GENERAL PROVISIONS

SECTION 3: SPECIAL PROVISIONS INFORMATION

SECTION 4: KEY DATES

SECTION 5: ADMINISTRATIVE BACKGROUND

SECTION 6: REQUIREMENTS/SPECIFICATIONS

SECTION 7: PROPOSAL SUBMISSION REQUIREMENTS

SECTION 8: EVALUATION METHODOLOGY

SECTION 9: PROPOSAL PRICE SHEET AND SIGNATURE PAGE

APPENDIX A RFP REQUIREMENTS

APPENDIX B RFP DELIVERABLES

APPENDIX C RFP PERFORMANCE RELATED REQUIREMENTS

APPENDIX E SAMPLE IT CONTRACT TEMPLATE

APPENDIX F SAMPLE BUSINESS ASSOCIATE AGREEMENT (BAA)

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SECTION 1: REQUEST FOR PROPOSAL

1. SUBMISSION OF PROPOSALS:

The A&I Procurement Office will receive proposals for providing care coordination with a high-fidelity wraparound model to Medicaid youth for the State of Wyoming, Department of Health (Agency) through the Public Purchase online bidding system. Proposals are due no later than 2:00:00 P.M. (Mountain Time) on September 30, 2026.

The technical proposal and cost proposal should be uploaded as separate documents and identified as such.

1.1. Proposals should be accompanied by the attached Proposal Price Sheet and signed by the proper official of the firm. All proposals should be uploaded on the Public Purchase online bidding system. Proposals sent by facsimile, email or paper copy may be rejected.

1.2. Proposals should be submitted through the Public Purchase online bidding system on or before the date and time specified. Proposals received after the date and time specified may be rejected.

1.3. The State of Wyoming reserves the right to withdraw this Request for Proposal, without cause, at any time before a contract has been fully signed and submitted to the A&I Procurement Office.

2. MODIFICATIONS OR WITHDRAWAL OF PROPOSALS:

2.1. A proposal may be altered through the Public Purchase online bidding system before the proposal due date and time contained in this document.

2.2. The proposer may withdraw its proposal through the Public Purchase online bidding system up to the proposal due date and time contained in this document. If a proposal is accepted and the proposer fails to furnish the service agreed upon in the proposal, that proposer may be eliminated from future consideration.

3. PREPARATION OF PROPOSALS:

3.1. A proposal may be rejected if it modifies any of the provisions, specifications or minimum requirements of the Request for Proposal.

3.2. In case of error in the extension of prices in the proposal, unit prices will govern.

4. AWARD AND CONTRACT INFORMATION:

4.1. The State of Wyoming will ensure that minority business enterprises will be afforded full opportunity to submit proposals. The State of Wyoming will not discriminate on the grounds of age, race, color, sex, creed, national origin, or disability status.

4.2. The proposer also, agrees that should their firm be awarded a contract, it will not discriminate against any person who performs work there under because of age, race, color, sex, creed, national origin or disability. In addition, the successful proposer shall comply with the Americans with Disability Act and the Wyoming Fair Employment Practices Act.

4.3. The proposer expressly warrants to the State that it has the ability and expertise to perform the contract if awarded. In doing so, it shall use the highest standards of professional workmanship.

4.4. The State of Wyoming reserves the right to reject any or all proposals, to waive any informality or technical defect in the proposals, or to award the contract in whole or in part, if deemed to be in the best interest of the State to do so. The A&I Procurement Office will award the contract to the firm, determined to have the most responsive and responsible proposal by the Wyoming Department of Health, Division of Healthcare Financing.

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4.5. The successful proposer will be required to agree to and execute a formal contract with the State containing terms required by the Attorney General with reasonable adjustments acceptable to the State.

4.6. If applicable, the State will negotiate payment terms based upon a schedule to be determined by the proposer and the State. Paying invoices will be based upon the proposer successfully completing the deliverables within the stated deadlines, and upon the Agency’s written acceptance of the deliverables or services.

DATED: August 27, 2026

State of Wyoming Procurement Section Buyer: Jamie Raff

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SECTION 2: GENERAL PROVISIONS

1. INSURANCE:

1.1. The contract between the successful proposer and the State shall require the successful proposer to carry certain insurance policies. All such insurance policies, except workers’ compensation and unemployment compensation policies, shall contain a waiver of subrogation against the Agency and the State, its agents and employees.

1.2. The contract between the successful proposer and the State shall require cyber liability insurance which shall be sufficiently broad to cover all duties and obligations undertaken by successful proposer and shall include, but not limited to, claims involving infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or description of electronic information, release of private information, alteration of electronic information, extortion and network security, with minimum limits as follows:

1.2.1. $2,000,000.00 each occurrence; and

1.2.2. $2,000,000.00 general aggregate.

1.2.3. Coverage should include breach response, regulatory fines and penalties, and credit monitoring expenses, with limits sufficient to respond to these obligations. Higher limits may be required when the contract involves large amounts of protected information or is high risk.

2. LAWS TO BE OBSERVED:

2.1. The proposer shall keep fully informed of, and comply with, all applicable federal and state laws or rules, all local bylaws, regulations and all orders and decrees of bodies or tribunals having any jurisdiction or authority. The proposer shall protect and indemnify the State and its representatives against any claim or liability arising from or based on the violation of any law, bylaw, ordinance, regulation, order or decree whether by himself or its employees.

3. ASSIGNMENT:

3.1. The proposal shall not be assigned by the proposer. Third party participation is authorized only as a joint venture that shall be clearly stated in detail in the original proposal and signed by all parties participating.

3.2. The proposer shall not enter into any subcontracts for any of the work contemplated under this Request for Proposal without the State’s prior written authorization.

4. EXTENSION AND AMENDMENT:

4.1. The proposer and the State covenant and agree that this proposal or subsequent contract may, with the mutual approval of the proposer and the State, is for an initial contract period of five years with the option to extend an additional two years, for a total contract period not to exceed seven (7) years.

5. AUDIT AND ACCESS TO RECORDS:

5.1. The State or any of its duly authorized representatives shall have access to the proposer’s books, documents, papers, electronic data and records that are directly pertinent to this Request for Proposal.

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6. CONFLICT OF INTEREST:

6.1. The proposer warrants that no kickbacks, gratuities, or contingency fees have been paid in connection with this Request for Proposal and none have been promised. The proposer warrants that no one being paid pursuant to the proposal is engaged in any activity that would constitute a conflict of interest with respect to the purchases of the proposal.

7. NO FINDER’S FEE:

7.1. The proposer warrants that no finder’s fee, employment agency fee, or any such fee related to the proposal shall be paid.

8. SOVEREIGN IMMUNITY:

8.1. Pursuant to Wyoming Statute § 1-39-104(a), the State of Wyoming and the Agency expressly reserve sovereign immunity and specifically retain all immunities and defenses available to them as sovereigns. The proposer acknowledges that the State of Wyoming has sovereign immunity and only the Wyoming Legislature has the power to waive sovereign immunity. Designation of venue, choice of law, enforcement actions, and similar provisions shall not be construed as a waiver of sovereign immunity. The parties agree that any ambiguity in this Request for Proposal shall not be strictly construed, either against or for either party, except that any ambiguity as to sovereign immunity shall be construed in favor of sovereign immunity.

9. INDEMNIFICATION:

9.1. The proposer shall release, indemnify, and hold harmless the State, the Agency and its officers, agents, and employees from any and all claims, suits, liabilities, court awards, damages, costs, attorneys’ fees, and expenses arising out of the proposer’s failure to perform any of the proposer’s duties and obligations hereunder or in connection with the negligent performance of proposer’s duties and obligations, including, but not limited to, any claims, suits, liabilities, court awards, damages, costs, attorneys’ fees, and expenses arising out of proposer’s negligence or other tortious conduct.

10. APPLICABLE LAW/VENUE:

10.1. The construction, interpretation, and enforcement of this Request for Proposal shall be governed by the laws of the State of Wyoming, without regard to conflicts of law principles. The terms “hereof,” “hereunder,” “herein,” and words of similar import, are intended to refer to this Request for Proposal as a whole and not to any particular provision or part.

11. RIGHT OF OWNERSHIP AND MARKETING OF INTELLECTUAL PROPERTY

AND INTELLECTUAL ASSETS SUBMITTED FOR THE RFP (IF APPLICABLE):

11.1. It is acknowledged and agreed that the only party with a right to market, trademark, patent, copyright, or any like right to any intellectual property or intellectual assets submitted in relation to the Request for Proposal shall be and is solely vested in the State. This includes all intellectual property and intellectual assets related to both the written proposal and the oral presentation and any and all documents, pitches, products, media pitches, web screens, layouts, etc. produced for the written proposal and the oral presentation, and any updates, changes, alterations, or modifications to or derivative works.

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SECTION 3: SPECIAL PROVISIONS INFORMATION

PROPOSALS SHOULD BE SUBMITTED THROUGH THE PUBLIC PURCHASE ONLINE BIDDING

SYSTEM BY 2:00:00 P.M. MOUNTAIN TIME ON SEPTEMBER 30, 2026. PROPOSALS RECEIVED

AFTER THE DATE AND TIME SPECIFIED MAY BE REJECTED.

It is the responsibility of the proposer to clearly identify all information that is considered confidential in accordance with the Wyoming Public Records Act, Wyoming Statute §16-4-201 through §16-4-205. Please identify each confidential page with the word “CONFIDENTIAL” in capital, bold letters centered at the bottom of each page. Information not clearly marked may be considered public. If the proposer submits information that it believes is confidential, it should include a statement justifying its basis for that belief.

1. STATE PARTIES:

1.1. This Request for Proposal is issued by the Wyoming Department of Administration and

Information, General Services Division, Procurement Section (Procurement) on behalf of the Wyoming Department of Health, Division of Healthcare Financing (Agency).

1.2. Throughout this document and others in connection with this project, various references are made, or will be made to the “State.” Generally, whenever this reference appears, the term “State” incorporates all state agencies working on this project.

1.3. It should be understood that the Director of Wyoming Department of Health is empowered to be the signatory on all contracts, agreements, or modifications pertaining to this project. Any contracts, agreements, or modifications not bearing this signature or that of a designee are invalid.

2. CONTENT AND PROCUREMENT POINTS OF CONTACT:

2.1. Procurement is the primary point of contact from the date of release of the Request for Proposal until a proposer is selected and the selection is announced.

2.2. Written questions about the procurement should be submitted through the Public Purchase online bidding system until 2:00:00 P.M. Mountain Time on September 15, 2026. Any questions received after that deadline may not be accepted or considered. Each question should be submitted individually. It is the proposer’s responsibility to check the Public Purchase online bidding system for answers to questions, addenda, or bid tabulations. Telephone calls, emails or faxes may not be accepted.

2.3. Written responses will be available through the Public Purchase online bidding system. Responses will not identify the firm that submitted the question. Only the written answers issued by the Agency are the official position on an issue, and these answers shall become part of the Request for Proposal.

3. RESTRICTIONS ON COMMUNICATIONS WITH AGENCY STAFF:

3.1. Until a proposer is selected and the selection is announced, proposers shall not communicate with

Agency staff except via written questions through the Public Purchase online bidding system.

3.2. If a proposer violates this restriction, the State reserves the right to reject the proposal.

4. EFFECTIVE DATES OF PROPOSAL:

4.1. All terms, conditions and costs quoted in the proposer’s response will be binding on the proposer for one-hundred eighty (180) days from the effective date of the proposal.

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5. ADVERTISING AWARD CONDITIONS:

5.1. A fully executed contract should be completed with the State before the successful proposer may advertise the award of the contract or the services being performed. The proposer should agree not to refer to awards in commercial advertising in such a manner that states or implies that the firm or its services are endorsed or preferred by the State of Wyoming.

6. CONTRACT NEGOTIATIONS:

6.1. The State will notify the most qualified/successful proposer and negotiate a contract in accordance with the Wyoming Attorney General’s contract guidelines. The successful proposer will be required to enter into and sign a formal contract with the Agency.

6.2. In the event the Agency determines contract negotiations are making no forward progress, negotiations will be terminated, and at the State’s sole discretion, negotiations may be initiated with the next most qualified/successful proposer, or the RFP may be withdrawn or reissued. This process will be followed until an agreement is reached, or until the State determines that the RFP will be withdrawn or reissued. The State assumes no obligation to a selected proposer until an agreement is reached and a contract is fully executed. The State will not negotiate concurrently with more than one proposer for the same award.

7. BEGINNING WORK:

7.1. The successful proposer may not perform any work that could be billed until a contract has been executed. The State will not pay for any work by the proposer before a contract is executed.

8. COPYRIGHT INFRINGEMENT:

8.1. The proposer warrants that no materials, products, and services proposed will infringe upon or violate any patent, copyright, trade secret, or other proprietary right of any third party. In the event of a claim by any third party against the State, the State shall promptly notify the proposer, and the proposer shall defend the claim. The defense will be at the proposer’s expense.

9. COST OF PREPARING PROPOSALS:

9.1. All costs incurred for preparing the proposal and for other procurement related activities are solely the proposer’s responsibility. The State of Wyoming will not provide reimbursement of these costs.

10. RISKS AND LIABILITIES:

10.1. By submitting a proposal, a proposer assumes any and all risks and liability associated with information in the proposal and its release.

11. AMENDMENTS:

11.1. The State reserves the right to amend this Request for Proposal before the proposal submission date. Amendments shall be uploaded to the Public Purchase online bidding system. It is the proposer’s responsibility to check the Public Purchase online bidding system for amendments.

12. PROPERTY DAMAGE AND LIABILITY INSURANCE:

12.1. The proposer may be required to furnish proof of property damage liability insurance in the amount deemed necessary by the Agency for this project, if applicable.

12.2. Questions regarding required insurance coverage and limits for this project should be submitted in writing, in accordance with instructions outlined in the special provisions.

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13. MISREPRESENTATION OF INFORMATION:

13.1. Misrepresentation of a proposer’s status, experience, or capability in the proposal may result in disqualification of that proposer from the selection process. Discovery of litigation or investigations in a similar area of endeavor may, at the discretion of the Agency and after consultation with Procurement, preclude the proposer from the selection process.

14. DISPOSITION OF PROPOSALS:

14.1. All material submitted becomes property of the State of Wyoming, which is under no obligation to return any of the material submitted.

15. LEGAL CONSIDERATIONS:

15.1. This Request for Proposal is issued under Wyoming Statute §9-2-3204.

16. PROPOSER RELATIONS WITH STATE:

16.1. The proposer and its staff will have an ongoing relationship with the State that is based on trust, confidentiality, objectivity and integrity. The proposer will operate at all times in the State’s best interests and in a straightforward, trustworthy and professional manner. The proposer shall:

16.1.1. Work cooperatively with the State’s staff and business partners whenever required.

16.1.2. Work cooperatively with the staff of other proposers whenever required.

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SECTION 4: KEY DATES

Event Description Date Time (Mountain Time)

RFP Release Date August 31, 2026

Closing Date for Questions September 15, 2026 2:00 P.M.

Response to Questions Returned September 21, 2026 2:00 P.M.

Proposal Submission Due Date September 30, 2026 2:00 P.M.

Proposal Reviews, Evaluation, Scoring September 30, 2026 – November 4, 2026 NA

Oral Presentations/Interviews November 23, 2026 – November 30, 2026 TBD

Contract Award Date (Estimated) December 11, 2026 N/A

Creation of SOW and Contract Negotiations (Estimated)

December 14, 2026 – February 26, 2027 N/A

Finalized Contract and State Approvals (Estimated)

March 1, 2027 – April 30, 2027 N/A

DDI Begin Date (Estimated) May 1, 2027 N/A

DDI End Date (Estimated) June 30, 2027 N/A

(5 Years) Operation and Maintenance (with 2 Optional Years)

July 1, 2027 – June 30, 2032 (with Optional Years, June 30, 2034)

N/A

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SECTION 5: ADMINISTRATIVE BACKGROUND

1. INTRODUCTION AND BACKGROUND:

1.1. The Wyoming Department of Health (WDH), Division of Healthcare Financing (DHCF) is soliciting proposals from qualified vendors to serve as a Coordinating Outcomes: Member Pathways, Advocacy, Support, and Stability (COMPASS) previously known as the Care Management Entity (CME) will support Medicaid-eligible children and youth with serious mental and behavioral health challenges throughout the State of Wyoming.

WDH is the single State agency appointed pursuant to the Social Security Act to administer the Medicaid program in Wyoming. The Wyoming Medicaid program has operated since 1967 under Title XIX of the Social Security Act, as amended. The Department’s Division of Healthcare Financing (herein referred to as the Agency) directly administers the Medicaid program and is funded by appropriations authorized by the Wyoming State Legislature for each biennium.

The Agency’s goal of the procurement is to implement a provider model using High Fidelity Wraparound (HFWA), as defined by the National Wraparound Initiative (NWI), to improve the quality and cost of care for Medicaid children and youth with serious emotional and behavioral health challenges. The population served by COMPASS will include:

1.1.1. Medicaid youth at risk of out-of-home placement (defined and identified as youth with 180 days or more of behavioral health services within one State fiscal year);

1.1.2. Medicaid youth who currently meet Psychiatric Residential Treatment Facility (PRTF) level of care or are placed in a PRTF;

1.1.3. Medicaid youth who meet acute, psychiatric stabilization hospital level of care; had an acute hospital stay for mental or behavioral health conditions in the last 365 days; or are currently placed in an acute hospital stay for mental or behavioral health conditions;

1.1.4. Youth on the Children’s Mental Health Waiver (1915(c)); and

1.1.5. Medicaid youth referred to COMPASS (who meet defined eligibility);

1.1.6. Kid Care Children’s Health Insurance Program (CHIP).

1.1.7. Youth that are directly referred to COMPASS, must meet the following criteria:

1.1.7.1. Youth ages 6-20 years must have a minimum Child and Adolescent Service Intensity Instrument (CASII) composite score of 20, and youth ages four (4) & five (5) must have an Early Childhood Service Intensity Instrument (ECSII) score of 18 or 30, OR the appropriate social and emotional assessment information provided to illustrate level of service needs; and

1.1.7.2. Must have a DSM Axis 1 or ICD diagnosis that meets the State’s diagnostic criteria.

1.1.8. Children and youth with serious emotional and behavioral health challenges often receive fragmented care of various services, contributing to poor outcomes and unnecessarily high costs. Wyoming’s spending on this population is consistent with trends in other states.

Behavioral health services for Medicaid children with serious emotional and behavioral health challenges and Medicaid children and youth receiving PRTF level of care often have increased emergency room visits, significantly higher utilization of psychotropic drugs at doses that often exceed national parameters (use of “too much, too many, and too young”), disruption to family and youth/child resiliency, and consequently, higher service costs. Due to the large number of service providers typically involved with these children and their out-

RFP 0049-N, Page 12 of 47 of-home placements, the Agency recognizes the need to improve service delivery and increase the coordination of care in order to improve healthcare outcomes and reduce costs.

1.1.9. The HFWA process relies on a set of 10 guiding principles (listed below). The process may vary in different in communities, but it’s these family-centric principles that create success for the program. They are based on those from the National Wraparound Initiative1 and include:

1.1.9.1. Family voice and choice: Youth and families identify their team. The team provides options so that the plan reflects family values and preferences.

1.1.9.2. Team-based: The team is committed to youth and families through informal, formal, and community support relationships.

1.1.9.3. Natural supports: The plan supports individual and community relationships for youth and families.

1.1.9.4. Collaboration: Team members blend ideas to develop the plan. They share responsibility for setting up the plan and monitoring its results.

1.1.9.5. Community-based: Services should be provided in the most responsive, open, and easy-to-access settings possible.

1.1.9.6. Culturally competent: The plan respects and builds on the values, preferences, beliefs, and culture of the child/youth and family.

1.1.9.7. Individualized: The team develops an approach to supports and services that closely fits each youth/family’s needs.

1.1.9.8. Strengths-based: The plan builds on the capabilities, knowledge and skills of the child and family. It also does this for their community and for other team members.

1.1.9.9. Unconditional: Despite hardships, the team persists in working toward the plan of care goals. They do this until the team agrees that a formal HFWA process is no longer required.

1.1.9.10. Outcomes-based: Through the plan of care, the team strives to reach clear goals that youth and families say are important. The team monitors progress toward goals and revises the plan if needed.

1.10. Through use of the HFWA program, the Agency has previously demonstrated improved clinical and functional outcomes among its members, increased access to home- and community-based services (HCBS), youth and family resiliency for the population of focus, and overall cost savings for the State. In this model, the Child and Family Team (CFT) is held accountable to the family, team members, participants, and the public for achieving the goals of the Plan of Care (POC). Wyoming recognizes that families are currently operating within a limited continuum of services, and are coping based on strengths, life circumstances, and individual histories. The system needs different types of services, supports, and interventions for the families to be successful. Through the use of COMPASS, the Agency recognizes and wants to account for each family’s uniqueness and strengths. Working within the enhanced System of Care (SOC) that this model deploys, the Agency wants to assist youth and families in achieving their individual goals.

1.11. The Agency anticipates to see an increase in positive outcomes for the enrolled children and youth’s medical care as a result of focusing on more frequent preventative screenings, 1 Bruns, Erin, Walker, Janet, National Wraparound Initiative Advisory Group. “Ten Principles of the Wraparound Process.” 2004.

https://nwi.pdx.edu/NWI-book/Chapters/Bruns-2.1-(10-principles-of-wrap).pdf https://nwi.pdx.edu/NWI-book/Chapters/Bruns-2.1-(10-principles-of-wrap).pdf

RFP 0049-N, Page 13 of 47 ensuring each child has a Primary Care Provider (PCP), coordinating communication and other activities across agencies, and providing the natural supports for each child or youth as a result of ongoing HFWA activities. Detailed objectives for this procurement are defined in subsequent sections.

1.2. Current Operating Model

1.2.1. The current contractor (herein referred to as the Incumbent) has been operating the statewide Care Management Entity (CME) model (a.k.a. COMPASS) in Wyoming since July 1, 2015.

The current contract is scheduled to end on June 30, 2027.

1.2.2. The Incumbent currently serves an average of 475 Medicaid children and youth statewide per year. The Division’s goal is to expand to the 600-700 Medicaid members that likely qualify for COMPASS services during the course of the five-year base Contract.

1.2.3. The current provider network consists of eighteen agencies employing 108 provider staff, as well as five (5) individual providers not affiliated with an agency, 32 network provider applications are currently in process within the 18 agencies, and four potential agencies joining the provider network.

1.3. Future Operating Model

1.3.1. The federal authority for CME program has been provided through a concurrent 1915(b) &

(c) waiver and a State Plan Targeted Case Management option for Children with SED. The program will be operating as a State Plan Targeted Case Management option and under the 1915 (c) waiver effective July 1, 2027. The vendor will be reimbursed utilizing a per member per month (PMPM) payment methodology for each member served. The HFWA providers will be paid on a fee-for-service (FFS) basis for each authorized service provided. The current coding structure reimburses on a fifteen-minute unit basis. Claim transaction volume averages 31,329 transactions with an average of 185,837 units of service paid per year.

1.3.2. The Agency is considering adding zero to three (0-3) year old children to the high-fidelity wraparound program. Early childhood wraparound services are intensive, family-driven care management strategies for young children who are at risk of or experiencing significant behavioral and mental health challenges. The approach unites professionals, families, and community supports to build individualized, holistic plans that keep children in their homes.

Children with caregivers experiencing their own mental health or substance misuse issues or because the family is involved in multiple systems (such as Department of Family Services, mental health, special medical services, among others).

1.4. Identified Challenges to Address

1.4.1. The Agency is seeking a trusted partner to bring knowledge and experience with building SOCs and high-fidelity wraparound programs in other states, while understanding and embracing Wyoming’s unique challenges that present from its small population dispersed throughout a large, rural, and frontier State. As part of this procurement, the Agency desires to work with the selected Contractor to help address some of these unique challenges identified by the Agency and its stakeholders. Priorities include:

1.4.1.1. Improving statewide understanding and utilization of high-fidelity wraparound through targeted outreach and communications with stakeholders.

1.4.1.2. Strengthening the customer service model for members and providers.

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1.4.1.3. Streamlining technology to reduce administrative workload and improve the enrollment and payment timeframes.

1.4.1.4. Improving the coordination of services and care between providers, specifically for members in PRTFs and members with an active Wyoming Department of Family Services (DFS) case.

1.4.1.5. Improving the family and youth participation in care.

1.5. Proposers shall specify their approach to addressing the priority challenges as part of their Technical Proposal response, further detailed in Section 6 of this RFP.

2. PURPOSE AND INTENT:

2.1. The purpose of this Request for Proposal (RFP) is to solicit competitive proposals from proposers who can serve as COMPASS for Medicaid children and youth with serious mental and behavioral health challenges to meet the Agency’s needs and expectations, as described within this RFP.

3. STAKEHOLDERS:

3.1. The Contractor may be required to work with many different Agency staff, other State agencies, third party vendors, community and family and youth stakeholders, and healthcare providers to support the Scope of Work described in this RFP.

3.1.1. Internal Stakeholders

3.1.1.2. Table 1-3.1.1-1 provides an overview of the internal COMPASS stakeholders. Specific requirements related to coordination of services are included in Appendix A, Section A-6.3.

Table 1-3.1.1-1: Internal COMPASS Stakeholders

Stakeholder Description Primary Involvement with

COMPASS

Wyoming Department of Health, Division of Healthcare Financing

The DHCF, within WDH, oversees Wyoming’s Medicaid program and oversees and administers Medicaid-related services.

• WDH is the lead Agency and is responsible for COMPASS contract administration and activities.

• DHCF will manage the Contract for the COMPASS and will coordinate with other stakeholders as needed for COMPASS tasks.

Department of Family Services (DFS)

The DFS serves youth who are at-risk of abuse and neglect, seeking to ensure their safety, permanency, and well-being. In addition, DFS provides necessary services to families in crisis, and helps at-risk youth become successfully educated and prepared for life’s opportunities. The DFS local staff serves youth and families in all twenty-three (23)

• DFS will collaborate with the Contractor and the Agency in regard to serving the population of focus, including the growth and expansion of the service delivery model for the youth served as well as oversight of outcomes.

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Stakeholder Description Primary Involvement with

COMPASS

Wyoming counties and the Wind River Reservation.

Medicaid Health & Utilization Management Contractor (UM Contractor)

The Agency uses a contractor to offer total population health & services utilization management, disease management, and complex case management services on behalf of the Wyoming Medicaid program.

• The Contractor will need to communicate and coordinate with the UM Contractor for youth receiving COMPASS services that may be involved with the Agency’s Health & Utilization Management programs. This includes collaboration around Medicaid children served in a PRTF.

Fiscal Agent The Fiscal Agent is responsible for operations of the MMIS and corresponding administrative operations of Wyoming’s Medicaid program.

• The Contractor will be responsible for coordinating with the Agency’s Fiscal Agent to obtain information and, as needed, provide information related to Medicaid provider enrollment, fee-for-service claims processing, and other information pertaining to services provided through the

COMPASS.

3.1.2 External Community Stakeholders

3.1.2.1 Table 2 provides an overview of the external COMPASS community stakeholders.

Table 2-3.1.2-1: COMPASS Community Stakeholders

Stakeholder Description Primary Involvement with

COMPASS

Healthcare Providers The Contractor will work with both behavioral and medical health providers, including Medicaid providers, to ensure the HFWA teams have access to services and are able to coordinate these services for each youth.

• The Contractor will establish relationships with these providers to support referrals to appropriate services as outlined in each POC.

• The Contractor will request that these providers participate in the CFT to ensure providers communicate with the CFT appropriately regarding the scope of services being delivered to the youth.

Primary Care Providers (PCPs)

The PCP will perform and manage all Early and Periodic Screening, Diagnosis, and

• The Contractor will ensure that every child has a PCP documented in the POC, or a

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Stakeholder Description Primary Involvement with

COMPASS

Treatment (EPSDT) requirements.

goal to help the family identify a PCP.

• The PCP, COMPASS, and the assigned FCC must maintain ongoing communications to ensure appropriate tracking of EPSDT and other health-related requirements and coordination of care.

• PCPs may refer high-risk youth to COMPASS.

Community-Based Organizations

Include informal support services, such as faith-based organizations, before and after school programs, or other community programs.

• The Contractor will be required to work with community-based organizations to include these informal supports, as required by the SOC.

Legal and Court Community

Wyoming Statutes require the juvenile court to appoint a Multi-Disciplinary Team (MDT) in all child abuse and neglect, Child in Need of Services (CHINS), and delinquency cases within ten

(10) days of the filing of a petition. Pursuant to the statutes, MDTs shall review the child’s personal and family history; school, health and DFS records; and any other pertinent information, for the purpose of making written recommendations to the juvenile pursuant to Wyoming Statutes (W.S.) §§ 14-3-427(e), 14-6-427(e) and 14-6-227(f).

• The Contractor will work closely with the MDT and may potentially be appointed as a member of the MDT.

• The Contractor will train all staff and providers to understand and comply with all confidentiality requirements of the juvenile court system.

• The HFWA Providers should not have any interactions with the court hearings unless subpoenaed or they are specifically requested to attend by the attorneys appointed in the case. Due to confidentiality, the family cannot allow a HFWA Provider to attend a hearing, only the Judge may allow this, so an invite from an attorney is necessary before attending a court hearing.

Schools Includes the child or youth’s school, teacher, or principle.

• The Contractor will ensure that educational advocacy is provided to youth and families they serve, especially critical for youth with IEPs or 504 plans. Educational advocacy may be provided directly by the HFWA providers, or through partnerships with other community entities with expertise in working within the special education process.

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SECTION 6: REQUIREMENTS/SPECIFICATIONS

1. SCOPE OF PROJECT:

1.1. Wyoming is seeking a Contractor to serve as the administrative vendor responsible for overseeing and coordinating COMPASS operations in alignment with the core principles of HFWA. The Agency will require the awarded Contractor to seamlessly transition applicable existing COMPASS services, as directed.

1.2. At a high-level, the Contractor shall:

1.2.1. Oversee operational management of COMPASS program;

1.2.2. Serve as the primary point of contact for members and providers, ensuring timely access to services and ongoing communication;

1.2.3. Conduct initial training of all providers and facilitate the certification of each provider during the onboarding process;

1.2.4. Facilitate annual provider recertifications and trainings;

1.2.5. Review and authorize plans of care;

1.2.6. Develop a transparent reporting structure to measure and monitor program services and outcomes;

1.2.7. Leverage innovative health information technology (HIT) to support its providers and provide “real-time” data access for care monitoring and quality improvement for HFWA services to the youth and families.

1.3. RFP STRUCTURE

1.3.1. A basic summary of the Contractor’s responsibilities is included in Figure 6-1.

Figure 6-1: Summary of COMPASS Scope Areas

1.3.2. An overview of primary responsibilities of both the Contractor and Agency are included in subsequent sections.

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1.3.3. To support Proposers in evaluating and responding to this RFP, the Agency has consolidated detailed requirements, deliverables, and performance related requirements into a series of supporting appendices to streamline the proposal response and evaluation process.

Appendices are referenced throughout this Section where appropriate and include:

1.3.3.1. Appendix A: Requirements – This Appendix includes a comprehensive collection of Contract requirements. Requirements are grouped into categories that align with RFP Section 6. Each requirement category is further broken down into sub-categories of requirement topics. Each requirement has a unique identifier that aligns with the requirement category. Where appropriate, requirements include references to Contract deliverables (summarized in Appendix B), and performance related requirements (summarized on Appendix C).

1.3.3.2. Appendix B: Deliverables – This Appendix provides a comprehensive list of Contract deliverables. Each deliverable is assigned a unique identifier to reference corresponding requirements included in Appendix A: Requirements.

1.3.3.3. Appendix C: Performance Related Requirements – Includes a comprehensive set of performance related requirements for the Scope of Work. Performance-related requirements include the following sub-categories:

1.3.3.3.1. Performance Expectations establish timeliness and quality standards related to specific Contract requirements. Performance Expectations are considered an obligation of the Contractor and are enforceable by the executed Contract but are not tied to penalties or liquidated damages.

1.3.3.3.2. COMPASS Service Outcome Measurements are specific to COMPASS and HFWA services and monitor areas of expected improvement. COMPASS Service Outcome Measurements will be reported and assessed by the Agency quarterly as part of the Quarterly Report Deliverable, with an annual summary that identifies trends and includes any program improvement or other quality improvement efforts.

1.3.3.3.3. Service Level Agreements (SLAs) include quality, availability, and other responsibilities expected for COMPASS Contract. Compliance with SLAs shall be reported monthly as part of the Monthly Report Deliverable. A performance dashboard approach to monthly tracking of SLAs would be acceptable as well.

1.3.3.4. Appendix D: Pricing Schedules – Includes Pricing Schedule worksheets to support the Cost Proposal response, as detailed in Section 7.

1.3.3.5. Appendix E: Glossary of Terms – Summarizes terms and acronyms referenced throughout this RFP.

1.3.3.6. Appendix F: Sample IT Contract Template – Example of the contract between the Agency and Contractor.

1.3.3.7. Appendix G: Sample Business Associate Agreement (BAA) – Example of the agreement to ensure privacy and security of protected health information.

2. GENERAL REQUIREMENTS:

The primary goal of the procurement is to select a Contractor that that will support WDH in administering and strengthening COMPASS program under a fee-for-service delivery model. The Contractor will oversee HFWA processes, including provider training and certification, plan of care review and authorization, and provider and member communications. Through these functions, the

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Contractor will promote consistent application of the HFWA model, improve the quality and timeliness of program operations, and reduce administrative burden for providers and the State

2.1. SCOPE OF ACTIVITY

Primary scope areas include:

2.1.1. PHASE-SPECIFIC REQUIREMENTS

This includes requirements specific to the Start-Up, Transition, and Turnover phases of the Contract. Note that operational requirements are included in a separate requirement category below. The Contractor must successfully complete all Start-Up and Transition requirements and activities and be ready to start operations by July 1, 2027.

Each phase includes an overview of activities, the Contractor responsibilities, Agency responsibilities, Incumbent Contractor responsibilities (where appropriate), and Exit Criteria that objectively demonstrates that that phase has been successfully completed.

2.1.1.1. START-UP

The Start-Up activities will ensure that adequate planning and project management resources are dedicated to this project and the awarded Contractor is ready to begin work on Transition activities, if necessary.

The Agency anticipates that Start-Up activities will be completed within the first few weeks of the Contract Execution Date to ensure a successful transition of services by June 30, 2027, but will work with the selected Contractor to determine the appropriate timeframe.

2.1.1.1.1. CONTRACTOR RESPONSIBILITIES

2.1.1.1.1.1. Facilitate the Project Kick-Off meeting with key Agency, stakeholders, and Contractor staff to introduce the project, teams, and plans for COMPASS transition and Contract, as detailed in Requirement PS 1-3 included in Appendix A.

2.1.1.1.1.2. Provide all services and requirements included in Appendix A: Section A-1 in accordance to Agency expectations and the approved Project Work Plan.

2.1.1.1.1.3. Provide all deliverables in accordance with deliverable expectations within the agreed upon timeframe. A comprehensive list of Contract deliverables is included in Appendix B.

2.1.1.1.2. PERFORMANCE EXPECTATIONS

2.1.1.1.2.1. The Contractor shall adhere to any performance requirements related to Start-Up requirements, as outlined in Appendix C.

2.1.1.1.3. AGENCY RESPONSIBILITIES

2.1.1.1.3.1. Participate in Project Kick-Off and provide feedback to the Contractor on deliverables and plans.

2.1.1.1.3.2. Orient external stakeholders and other agencies on the goals and objectives of COMPASS, the HFWA process, the role of COMPASS, and the importance of coordination across agencies.

2.1.1.1.3.3. Provide overview and training of the applicable Agency systems.

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2.1.1.1.3.4. Provide a contract manager who will track and monitor the Contractor’s performance according to the Scope of Work and Contract.

2.1.1.1.3.5. Provide access to the Agency’s existing infrastructure, as needed.

2.1.1.1.3.6. Facilitate communications between the Incumbent, the selected Contractor (if necessary), and external stakeholders, as appropriate.

2.1.1.1.4. INCUMBENT RESPONSIBILITIES

2.1.1.1.4.1. If appropriate, participate in Start Up meetings, as directed by the Agency.

2.1.1.1.5. EXIT CRITERIA

At minimum, the Contractor shall meet the following requirements prior to exiting the Start-Up phase. Additional Exit Criteria may be negotiated during Contract negotiations and Start-Up planning:

2.1.1.1.5.1. Successfully facilitate the Project Kick-Off meeting.

2.1.1.1.5.2. Receive Agency approval of all phase deliverables listed in Appendix B.

2.1.1.2. TRANSITION

2.1.1.2.1. CONTRACTOR RESPONSIBILITIES

2.1.1.2.1.1. If a new Contractor is selected, the awarded Contractor will work with the Incumbent Contractor to successfully transition COMPASS services, documentation, knowledge, and training needs.

2.1.1.2.1.2. Train and certify providers to enable the start of COMPASS services by July 1, 2027.

2.1.1.2.1.3. Provide all Transition services and requirements included in Appendix A:

Section A-1.2 in accordance to Agency expectations and the approved Project Work Plan.

2.1.1.2.1.4. Provide all phase deliverables in accordance with deliverable expectations within the agreed upon timeframe. A comprehensive list of Contract deliverables is included in Appendix B.

2.1.1.2.1.5. Work with the Agency to determine stabilization criteria that reflects the agreed upon SLA requirements.

2.1.1.2.2. PERFORMANCE EXPECTATIONS

2.1.1.2.2.1. The Contractor shall adhere to any performance requirements related to Transition requirements, as outlined in Appendix C.

2.1.1.2.3. AGENCY RESPONSIBILITIES

2.1.1.2.3.1. Facilitate communications between the Incumbent Contractor, the selected Contractor, and external stakeholders, as necessary.

2.1.1.2.3.2. Provide access to the necessary Agency facilities, personnel, documentation, and other items under its control and provide coordination with and access to third parties, to facilitate transition services.

2.1.1.2.3.3. Provide appropriate program policy training and to the Contractor in accordance to the agreed upon Training Plan.

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2.1.1.2.3.4. Attend any Contractor conducted training as identified by the Agency.

2.1.1.2.3.5. Work with the Contractor to determine stabilization criteria and approve final transition to operations.

2.1.1.2.4. INCUMBENT RESPONSIBILITIES

2.1.1.2.4.1. Provide the selected Contractor with the necessary data access, documentation, and other components identified in the Incumbent’s Turnover Plan as necessary to successfully transition COMPASS operations.

2.1.1.2.4.2. Participate in meetings and knowledge transfer sessions with the Agency and COMPASS Contractor.

2.1.1.2.4.3. Clarify questions or concerns from the Agency or COMPASS Contractor on COMPASS-related items.

2.1.1.2.5. EXIT CRITERIA

At minimum, the Contractor shall meet the following requirements prior to exiting the Transition Phase. Additional Exit Criteria may be negotiated during Contract negotiations and Start-Up planning.

2.1.1.2.5.1. Objectively demonstrate readiness to seamlessly transition COMPASS operations by July 1, 2027 in accordance to the agreed upon stabilization criteria, as detailed in Requirement PS 1-24 in Appendix A.

2.1.1.2.5.2. Receive Agency approval of all phase deliverables listed in Appendix B.

2.1.1.2.5.3. Successful transfer of operations, as deemed by the Agency.

2.1.1.3. TURNOVER

As requested, but approximately six (6) months prior to the end of the base contract period(s) or any extension thereof, the Contractor shall provide, at no extra charge, assistance in turning over the final Contractor responsibilities to the Agency or another contractor.

2.1.1.3.1. CONTRACTOR RESPONSIBILITIES

2.1.1.3.1.1. Provide all Turnover services and requirements included in Appendix A:

Section 1-3 in accordance to Agency expectations.

2.1.1.3.1.2. Provide all phase deliverables in accordance with deliverable expectations within the agreed upon timeframe. A comprehensive list of Contract deliverables is included in Appendix B.

2.1.1.3.2. PERFORMANCE EXPECTATIONS

2.1.1.3.2.1. The Contractor shall adhere to any performance requirements related to Turnover requirements, as outlined in Appendix C.

2.1.1.3.3. AGENCY RESPONSIBILITIES

2.1.1.3.3.1. Oversee the Turnover phase and participate in necessary meetings to facilitate Turnover activities.

2.1.1.3.3.2. Initiate turnover services with the Contractor.

2.1.1.3.3.3. Review and approve Turnover Plan to facilitate transfer of the operational responsibilities to the State or its designee.

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2.1.1.3.3.4. Identify training and support requirements.

2.1.1.3.3.5. Make Agency staff or designated replacement Contractor operations designee available to be trained in the operation of the system.

2.1.1.3.4. EXIT CRITERIA

At minimum, the Contractor shall meet the following requirements prior to exiting the Turnover Phase. Additional Exit Criteria may be negotiated during Contract negotiations and Start-Up planning.

2.1.1.3.4.1. Receive Agency approval of all phase deliverables listed in Appendix B.

2.1.1.3.4.2. Fulfill all requirements and obligations in accordance to the agreed upon Contract.

2.1.2. GENERAL OPERATIONAL FUNCTIONS

During the Operations Phase, the Contractor will be responsible for operating COMPASS.

COMPASS must provide provider training and certification, member and provider customer service support and ongoing communication, and plan of care review and authorization, while meeting or exceeded performance related requirements included in Appendix C.

The Agency expects the Contractor to implement an operational philosophy that focuses on continuous improvement and efficiency in service delivery to maximize outcomes for Wyoming’s children and youth with serious emotional challenges. As part of this effort, the Contractor shall provide dedicated staff to routinely monitor for and response to compliance risks.

2.1.2.1. GENERAL OPERATIONS

2.1.2.1.1. CONTRACTOR RESPONSIBILITIES

2.1.2.1.1.1. Provide all operational services and requirements included in Appendix A: Section A-5 in accordance to Agency expectations.

2.1.2.1.1.2. Provide all deliverables in accordance with deliverable expectations within the agreed upon…