RFP 202605096 Q
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- Solicitation number
- RFP - 10A - 202605096
- Issued by
- Maine
About this file
This is a Request for Proposals Questions and Answers document issued by the Maine Department of Health and Human Services, Office of Aging and Disability Services (OADS) for a Quality Improvement Organization (QIO) Quality Management and Support contract. The scope encompasses comprehensive management of approximately 30,000 reportable events annually across multiple Home and Community Based Services waiver populations, including services for older adults, individuals with developmental disabilities, intellectual disabilities, autism spectrum disorder, and brain injury. Core deliverables include event triage completion within one business day, desk-level reviews of reportable events, routing of high-risk incidents within one business day and non-high-risk incidents within three business days, consumer grievance and complaint intake and resolution, and monthly and quarterly trend analysis and reporting. The contract requires the awardee to establish an on-site presence in Maine with a project manager maintaining 16-24 hours per week on-site, preferably in the Augusta area. The initial contract period runs from September 1, 2026 through August 31, 2028 (two years), with three optional two-year renewal periods available through August 31, 2034 for a potential eight-year total contract duration. Proposals were due July 20, 2026 by 4:00 p.m., with questions due by June 24, 2026.
The cost proposal must be submitted as a firm fixed price covering the full eight-year period and must address pricing tiers based on estimated volume ranges for reportable events (30,001 to 40,000 annually) and grievances/consumer complaints (1,001 to 2,000 annually). Only the lowest cost proposal receives full points (30 points), with higher proposals receiving proportionally fewer points within the evaluation framework, which weights cost at 30 points, organizational qualifications and experience at 30 points, and proposed services at 40 points. The awardee must be a CMS-designated QIO or QIO-Like entity and must comply with federal Ensuring Access to Medicaid Services Final Rule requirements, including independence in grievance decision-making and conflict-of-interest restrictions. The Department will provide state-issued devices for system access and will negotiate specific technology needs including devices, accounts, authentication methods, and VPN access with the selected vendor. Data will be extracted daily from existing state systems (Evergreen and LTSS) and may be processed by the contractor using tools of the contractor's discretion. The state anticipates making one award and reserves the right to reject all proposals or negotiate with the highest-ranked bidder, with no best and final offers solicited.
Text of this file
RFP 202605096
RFP 202605096 Quality Improvement Organization (QIO) Quality Management and Support for Aging and Disability Services
| Question | Answer | |
| 1 | Pg. 7: Does the Department envision the centralized front door as a technology solution with role-based access for both internal users and public/provider submissions, or as a business process model supported by existing systems? | Through this RFP the Department is seeking a business process model to support existing systems. |
| 2 | Pg. 7, Pg. 14: Throughout the RFP the word "system" is used. (e.g. "system for managing Reportable Events", "the Grievance system") Please clarify where the Department seeks a technology solution and where the Department seeks a business process. | "System" used within the RFP is referring to a business process. |
| 3 | Pg. 8: The RFP states that there are approximately 30,000 reportable events per year. |
a. Approximately how many reportable events occur per month?
b. Of the 30,000 annual reportable events, approximately how many are high-risk/low risk? a. Approximately 2,500 reportable events per month.
b. Events are not reported by high or low risk, instead they are reported by type. Assessment of risk is assigned during event review and specific criteria will be confirmed during the contract start-up period. Current event types include: Dangerous Situation, Emergency Room Visits, Hospital Admissions, Suicide Attempts/Threats, Death, Medication Errors, Serious Injury, Assault, Physical Plant Disaster, Rights Violations, Transportation Accidents, and Law Enforcement Interventions.
4 Pg. 8:
a. Does "30,000 reportable events per year" include report submissions that are spam, submitted in error, or simply do not describe reportable events?
b. If not, what is the total number of reports submitted each year? a. No
b. Approximately 30,000
| 5 | Pg. 8: How many reports submitted per year are spam, submitted in error, or do not describe reportable events? | The Department does not have this data readily available. |
| 6 | Pg. 11: Will there be a transition period with the current staff or vendor? If so, how long? Does this coincide with the start-up period? | No, this is a new service for the Department. |
| 7 | Pg. 11: |
a. At contract start, does the department expect there to be a backlog of reportable events, grievances, and customer complaints requiring triage, review, and routing?
b. If so, what is the estimated size of the backlog? a. No.
b. N/A 8 Pg. 11:
a. After contract award, when should the awardee be able to take sole responsibility for triage, routing, and review of all reportable events, grievances, and customer complaints?
b. Is there an expected timeline to ramp up to full performance? a. After the first 6 month of the start of the initial contract period.
b. Within the first 6 months of the start of the initial contract period.
9 Pg. 11:
a. Which elements of the reporting, triage, routing, and resolution workflows are fixed vs expected to be redesigned by the contractor?
b. What authority will the contractor have to define triage and routing rules? a. Reporting is fixed. Triage, routing and resolution workflows may be redesigned with the Department during the first 6 month of the initial contract period.
b. All triage and routine rules will need to be developed and approved by the Department to ensure consistency with both State and federal requirements.
| 10 | Pg. 11: Is the awardee expected to build the Reportable Event Review Form into Evergreen, or will the awardee provide a redesigned form to State employees for deployment in Evergreen? | The awarded Bidder will not be expected to build the Reportable Event Review Form into Evergreen. Instead, the awarded Bidder will assist the Department in developing the content of a revised form. The deployment of the revised form in the Evergreen data system will be managed by the Department. |
| 11 | Pg. 11: If the awardee is expected to build the redesigned Reportable Event Review Form directly into Evergreen |
a. What is the process for creating forms in Evergreen?
b. What software and/or programming languages are used, if any? a. The awarded Bidder will not be building forms in Evergreen.
b. N/A
| 12 | Pg. 11: What are the expectations for hotline operations, including anticipated call volumes, average handle time, and required language support? | The grievance hotline must be available during regular business hours. It is estimated that 1,000 grievances could be received per year (either by phone or in writing). Refer to Part II, C.2.a.ii and C.3.e. of the RFP for language support and handling time requirements. |
| 13 | Pg. 12: |
a. Beyond the required part-time on-site presence for the project manager, are there other roles expected to have on-site presence?
b. If so, which roles?
c. How frequently is their presence required or expected? a. No.
b. N/A
c. N/A 14 Pg. 12:
a. What constitutes "part time" on-site presence for the project manager? (How many hours per month?)
b. Will the PM be provided a workspace in addition to meeting space access while onsite? a. 16-24 hours per week
b. Yes.
15 Pg. 12: (Establish Adequate Staffing)
a. Are any of the tasks described in the RFP required to be performed by licensed clinicians?
b. If so, which tasks? a. No, refer to Part II, A.7. of the RFP.
b. N/A 16 Pg. 12: (Establish Adequate Staffing)
a. Is in-state staffing mandatory for any tasks described in the RFP?
b. If so, which tasks? a. Yes.
b. At minimum, part-time on-site presence for the project manager is expected in order to meet with Department staff, providers, or other interest partners at a meeting space provided by OADS.
17 Pg. 12:
a. What hours of operation are required for event triage?
b. Is overtime permitted in the event of a large increase in reports? a. Reportable event triage may be completed during regular business hours.
b. Overtime may be permitted with the prior approval of the Department.
| 18 | Pg. 12: In the event of a large increase in reportable events to be triaged, what level of surge support, if any, is expected from the awardee? | It is at the Bidder's discretion to determine what level of surge support would be necessary at any given time if there is a large increase in reportable events to be triaged. |
| 19 | Pg. 12: In the event the Department's application to CMS for the seventy-five (75%) enhanced funding match is denied, does Maine have sufficient funds to support full contract performance? | As this is outside the scope of the RFP, the Department declines to answer. |
| 20 | Pg. 12: |
a. To educate the OADS provider community about newly developed processes, is the awardee expected to develop and conduct formal training sessions for providers?
b. If so, does Maine have any format or delivery requirements for the training? a. Yes.
b. Final format and mode of delivery will be confirmed during start up period. Historically, provider technical assistance has included informational sessions with presentation and a Q&A period as well as informational material that is distributed via email, listservs, or a dedicated webpage.
21 Pg. 13:
a. What specific actions are expected within a Desk-Level Review (e.g., documentation review, provider outreach, claims validation)?
b. Are reviewers expected to obtain additional documentation beyond what is submitted or only use what is provided? a. Refer to the definition of Desk-level Review.
b. Refer to the definition of Desk-level Review.
22 Pg. 13:
a. What data is currently being tracked related to reportable events, grievances, and consumer complaints?
b. What is the current data quality and completeness level? a. Currently there are specific forms that are used to collect information about reportable events, grievances, and consumer complaints. Any data collected is documented in either the Evergreen data system or SharePoint.
b. The data records are of good quality and complete.
23 Pg. 13:
a. Does the department currently have a data dictionary for data related to reportable events, grievances, and consumer complaints?
b. If so, has data mapping been completed for data elements? a. No.
b. No.
| 24 | Pg. 13, Pg. 14: What intake channels (i.e. web forms, phone, email, etc.) exist today for reportable events, grievances, and consumer complaints, and what percentage of volume currently comes from each channel? | Currently all information is collected on via web-based forms. |
| 25 | Pg. 14: What is the annual volume of grievances and complaints? | Refer to Part I, A. Exhibit 1, 7. of the RFP. |
| 26 | Pg. 14: For grievance forms submitted in writing, which languages is the awardee required to provide translations for? | The most common spoken non-English languages in Maine include: Arabic, Chinese, French, Khmer, Russian, Somali, Spanish, and Vietnamese. However, it is expected that the awarded Bidder will comply with all language access and effective communication requirements of the Civil Rights Act, Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and Section 1557 of the Affordable Care Act, and relevant regulations of each, including but is not limited to: |
i. Scheduling and coordinating interpreting services, or auxiliary aids and services necessary to ensure language access and effective communication.
ii. Utilizing the Statewide Interpreter Services agreement or other translation services per-approved by the Department in writing.
iii. Determining the primary language of the individual requesting services and ensuring information and/or services are provided with a qualified interpreter when English is not the primary language.
iv. Determining whether the individual requesting services is deaf, late deafened, hard of hearing, no-verbal or has a disability affecting communication and ensuring the necessary auxiliary aids or services are provided to for effective communication.
v. Translating written documents in the primary language of the individual requesting services.
More information is available at the link below.
| https://www.maine.gov/dhhs/ada/ada-civil-rights-compliance/effective-communication-language-access | ||
| 27 | Pg. 14: What percentage of grievances require escalation or result in hearings? | The Department estimates that approximately 10% of grievances escalate to the hearings process. |
| 28 | Pg. 15: What type of subject matter expertise is the awardee expected to provide in grievance hearings? (Clinical expertise? Administrative in the grievance process? Something else?) | Refer to Part II, A.7. of the RFP, including CMS-2442-F and CMS-2499-F/CMS-2296-F in the links below. |
| https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-final-rule-cms-2442-f | ||
| https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-441/subpart-K/section-441.530 | ||
| 29 | Pg. 15: Clarify the requirement to develop a public facing intake form for consumer complaints. Will the contractor provide web hosting and identify a software solution for the form, or will the form be hosted on a state server using State software? | The form will be hosted on a State server using State software. |
| 30 | Pg. 15: Can the State provide examples/templates of required reports? | Per Appendix I, Bidders may obtain the Reportable Event Review Form Examples in VSS. |
| 31 | Pg. 15: What are the current limitations of the Evergreen and LTSS systems as pertaining to the event triage, routing, and resolution process? | As this is outside the scope of the RFP, the Department declines to answer. |
| 32 | Pg. 15: |
a. Are there any tasks in the event triage, routing, and resolution process that are currently completed manually, but could be automated in the future?
b. If so, which tasks?
c. Is automation possible within Evergreen, LTSS, or other state systems? a. Yes.
b. Event review assignment and routing.
c. Yes, however, the Bidder's response to this RFP should reflect systems and procedures the Bidder currently has in place.
| 33 | Pg. 16: The RFP states that the Department will "provision" devices, accounts, authentication methods, and a VPN to access state systems. Is there a maximum number of devices, accounts, or licenses the Department is able to provide? | The Department and awarded Bidder will negotiate the specific need for devices, accounts, authentication methods, and virtual private network, provisioned by the Department. |
| 34 | Pg. 17: How does the department plan to track, audit, and validate the performance measures? | Refer to Part II, F. of the RFP. |
| 35 | Pg. 17: What factors outside contractor control may impact performance against the performance measures? | The awarded Bidder is expected to develop a system which ensure the performance measures are met. Demonstrated factors outside of the awarded Bidder's control will not have a negative impact against the performance measures. |
| 36 | Pg. 17: What is the penalty or enforcement mechanism if a contractor fails to meet the performance measures? | The Department may require the awarded Bidder to provide a corrective action plan on how performance measures will be met. |
| 37 | Pg. 19: How many ad hoc reports does the Department estimate will request per year? | The Department cannot estimate at this time the number of ad hoc reports that may be needed per year. Bidders should propose the number of ad hoc reports that could be available to the Department upon request. |
| 38 | Pg. 39: Will the State allow post-award adjustments to the cost proposal if volumes significantly increase or decrease from the figures provided on Page 39? | No, the Department expects a firm fixed cost proposed by Bidders. |
| 39 | Appendix I: Is the current Evergreen Reportable Events Form referenced in Appx I web based into Evergreen? (Do reporters submit the form directly into Evergreen via a web portal, or is the form submitted a different way and data is entered manually?) | The Evergreen Reportable Events Form is submitted directly in the web-based Evergreen Data System. |
| 40 | Appendix I: Is the current LTSS Event Form referenced in Appendix I web based into LTSS? (Do reporters submit the form directly into LTSS via a web portal, or is the form submitted a different way and data is entered manually?) | The LTSS Event Form is a web based form that is stored in SharePoint. |
| 41 | Pg. 15-16: Is the use of Contractor-issued devices permitted under any circumstances for this project? | Refer to Part II, D.5. of the RFP, access to State systems may only be conducted using State-issued devices. Other contract functions may be conducted using the awarded Bidder's devices while complying with all security and confidentiality requirements for protecting State data. |
| 42 | Pg. 12: Are there location-based or conditional access requirements (e.g., Maine-based access, geo-restrictions, or hybrid/on-site expectations beyond the Project Manager role)? | No. |
| 43 | Pg. 40: Is Appendix I required to be included in the proposal response? If so, in which file should Appendix I be included? | No. |
| 44 | Pg 9-10: Can the Department clarify if there would be an actual/potential conflict of interest for a Bidder to hold this QIO contract and provide Community Resource Coordination services under the Maine LifeSpan Waiver or other OADS waiver programs? | Per Ensuring Access to Medicaid Services Final Rule (CMS-2442-F), a decision maker should not be involved in any previous level of review or decision-making related to the grievance nor a subordinate of any such individual, refer to the link below. |
| https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-final-rule-cms-2442-f | ||
| 45 | Pg 11-20: Does the RFP require a specific retention period or audit timeframe for documentation, including proposal submissions, or should records be maintained per applicable laws and made available upon request? | The Department complies with the State Record Retention Policy, refer to the link below. |
| https://www.maine.gov/sos/archives/records-management/state-government-agency-policies-and-guidance/state-general-schedules-for-records | ||
| 46 | Pg. 4-7: The RFP references APS and reportable events. |
a. Does the State require contractors to provide or maintain abuse/neglect/exploitation reporting training?
b. If so, please clarify expectations regarding scope, frequency, and applicable standards. a. Yes
b. Refer to the State Law and Rule Related to Adult Protective Services under 22 MRS Chapter 958-A: Adult Protective Services Act and 10-149 CMR Ch. 2 Adult Protective Services System at the links below.
| https://www.mainelegislature.org/legis/statutes/22/title22ch958-Asec0.html | ||
| https://www.maine.gov/sos/rulemaking/agency-rules/department-health-and-human-services-rules#149 | ||
| 47 | App G / p. 1: Are bidder's permitted to use their own proposal formatting, in lieu of entering information into form text boxes - understanding that the sequencing and question structure, labeling, and file division specifications are maintained? | Refer to the Proposal Submission Requirements outlined in Part IV of the RFP. |
| 48 | Part I, B.8. / p. 9: |
a. Please clarify what is meant by "mark that information".
b. Is it the desire of the state to receive a separate copy of Files 1-3 with redacted information? If so, please clarify how these files should be labeled. a. Bidders may mark some portion of their proposal as confidential. If a Bidder marks some portion of their proposal as confidential then the Department will provide the Bidder with a reasonable opportunity to object to public disclosure of the proposal. The Department, however, provides no assurance regarding whether any portion of the proposal will ultimately be determined to be confidential and not publicly disclosed.
b. No.
| 49 | III.B.2.e / P. 22: If file sizes exceed the 15MB limit, please clarify what labeling the state desires for multiple files. | It is at the Bidder's discretion, however, the naming must be clearly identified by File. | |
| 50 | IV.II.3 / p. 24: Please confirm that the requested organizational chart does not include bidder's corporate-level organizational positions (i.e.. President/CEO, COO, etc.). | Confirmed. | |
| 51 | App G A.6 / p. 2: Please confirm whether the project manager needs to reside in Maine, or if out-of-state residence is permitted as long as position's on-site responsibilities/requirements are met. | There are no residency requirements as long as on-site requirements are met. | |
| 52 | II.D.3-4 / p. 15: Please explain what processing of the data feeds the vendor will be expected to do. For example, will the vendor need to store any of this data on behalf of the state in its databases? | The awarded Bidder may need to consume data from State systems in order to issue reports. | |
| 53 | a. Will Evergreen be the primary system of record for all services within the RFP scope? | ||
| b. Are there any services listed where Evergreen will not have functionality to host those data collection tools that may require vendor to provide a tech solution? | a. Evergreen and SharePoint are the primary systems of record. |
b. Data may be extracted from each system for additional analysis. It is at the Bidder's discretion to choose a tool to perform analyses and develop reports.
54 App G H.3 / p. 12:
a. Please define "Provide urgent support to the Department".
b. Please also confirm if there will there be an on-site requirement for the selected vendor, or will the state be on-site for Surge Reviews? a. As this is an optional service, Bidders are expected to propose a timeframe regarding availability for urgent support needed to complete on-site provider reviews. Currently, urgent on-site reviews need to be conducted within a one (1) week notice.
b. The awarded Bidder will be required to be on-site.
| 55 | App G H.3 / p. 12: Please provide volume data (for the past 1-2 years, by month, if possible) of surge reviews conducted. | It is estimated that 70-100 surge reviews may be completed annually. |
| 56 | II.D / p. 15: Please confirm that the state is supplying IT equipment for reviewers and the type of equipment that will be supplied. | The Department in collaboration with MaineIT will provide laptops for staff/personal who require access to State systems. |
| 57 | II.D / p. 15: If bidder is proposing an external platform to integrate with state systems, and the state is supplying IT equipment (including laptops), will the state-supplied equipment allow access to the bidder's web-based platform? | External platforms will not integrate with the State systems. |
| 58 | II.D/p.15: Confirm data from the Evergreen system & LTSS Data System related to incidents will be able to be extracted daily to allow for analysis & identification of incident clusters or related events to effectively triage & route reportable events. | Yes, confirmed that data will be available daily. |
| 59 | II.D/p.15: Please confirm if there is capability through an API connection to connect directly to the bidder's web-based platform. | No, there is not that capability. |
| 60 | II.D/p.13: Please clarify if the Event Desk-Level Review will include requests for additional information from either participants, reporters and/or providers & if a secure documentation platform will be required for the collection of additional info. | Refer to the definition of Desk-level Review. If additional documentation is needed beyond what is available in existing State data systems, then yes, a secure documentation platform would be required. However the Department intends to provide the awarded Bidder with devices which will include the necessary secure platforms. |
| 61 | p.8: |
a. Provide clarity on how "high-risk" is flagged/determined?
As it relates to Next business day routing for high-risk situations.
b. Does the state make the determination or is there criteria that can be shared on how high-risk is determined? a. High-risk refers to incidents involving a participant's health and safety.
b. During the start up period, the awarded Bidder is expected to review and update current criteria and provide to the Department for approval. The awarded Bidder is expected to use the agreed upon risk criteria when determining if an incident warrants escalation back to the Department for additional follow up.
| 62 | II.C/p.14: Confirm that the bidder is responsible for providing a web-based platform to document intakes, resolutions & tracking to completion of consumer concerns including grievances or if the state plans to develop this functionality w/in a state system. | The Department plans to offer this functionality in a State system. | |
| 63 | II.C/p.15: Clarify if documentation requests & remote and/or in-person investigation of grievances and/or other consumer complaints are included activities in the bidder's scope of work or if those activities are conducted by appropriate state entities in which the complaints are routed to. | Refer to Part II, C.3.a.-d. of the RFP which describes the resolution requirements. However, the Department does not anticipate in-person investigations of grievances. | |
| 64 | II.C/p.15: Please confirm if state entities that receive appropriately routed complaints/grievances will need access to the bidder's web-based platform to document resolution activities and resolution completion in order for the bidder to issue a written notice of decision within 90 days or if the bidder will need to track that information within a state system. | All documentation of complaint/grievance resolution will occur in the Evergreen data system. | |
| 65 | II.G/p.18: | ||
| Clarify how the Event Triage including Daily Reportable Events report should be transmitted to the state and in what format. Please confirm if this report is to be generated from the state system or the bidder's system. | Daily Event Triage will be documented on an Event Review Form in Evergreen. Data may be exported into Excel. | ||
| 66 | p.12-13: Regarding insurance requirements, what is the anticipated number of PII Records associated with this Contract? | The anticipated number of PII records is greater than 1 million. | |
| 67 | II.C.4/p.15: Clarify for #1 "Provide a public intake form" - will the vendor be using the state's technologies to build and host the intake form or will the bidder need to provide the technology solution to host the intake form? | The awarded Bidder will use the State systems, through devices provided by the State. | |
| 68 | Is Evergreen and LTSS used for different waiver or state populations? If yes, which system is the system of record for each population? | Refer to Part II, A.3.a.i.-ii. of the RFP. | |
| 69 | II.B.2/p. 13: | ||
| Where will the Event Desk-level Reviews data be housed? Will this be entered into Evergreen or LTSS or will this data need to be housed in the bidder's system? | In the State systems. | ||
| 70 | Grievance Form General Question: | ||
| For the Consumer Complaint and Intake Form, is the bidder required to provide the web form in multiple languages? If yes, which languages are required? | Refer to the answer to question 26 of this document. | ||
| 71 | Vi.A.1/p.32: The RFP link to the Forms & Templates webpage directs to multiple Service Contract Templates, including the State's Service Contract (SC) and the IT Service Contract (IT-SC). Which contract template does the State intend to use? | State Service Contract (SC). | |
| 72 | Part II, Section B.2: | ||
| Does OADS anticipate that all reportable events will require a complete desk-level review, or may review activities be tiered based on risk stratification and thresholds established during the Start-Up Period? | All events will require a review and assignment of a triage score. The final triage score criteria will be confirmed during the start up period. The triage score informs how the event is managed and whether the incident requires additional desk level review. | ||
| 73 | Part II, Section H | ||
| To what extent will pricing submitted for Optional Activities be considered binding if OADS elects to exercise those services in the future? | In the event the Department elects to incorporate the optional activities in future deliverables, the Department and awarded Bidder will negotiate the terms including the proposed costs. | ||
| 74 | Part II, Section H | ||
| Would OADS allow vendors to provide pricing ranges with documented assumptions for Optional Activities rather than fixed prices? | Bidders should provide fixed pricing for optional services, but assumptions used may also be documented. | ||
| 75 | Part II, Section H: Would the State accept hourly labor rates (by resource type) for Optional Activities rather than fixed activity pricing? | Bidders should provide fixed pricing for optional services, but assumptions used may also be documented. | |
| 76 | Part I, Section A. |
a. Who currently performs the reportable event review, investigation, quality oversight, and related functions described in this RFP; and
b. What is the current staffing model supporting these activities? a. Currently the Department's Quality Assurance staff perform reportable event review and follow up.
b. The staffing model varies by population/program, but generally includes the Department's Quality Assurance Supervisor and Quality Assurance Staff.
| 77 | Part I, Section C. How does the State plan to ensure independent oversight when the contractor may also perform operational functions or services within the same program area? | Per Ensuring Access to Medicaid Services Final Rule (CMS-2442-F), a decision maker should not be involved in any previous level of review or decision-making related to the grievance nor a subordinate of any such individual, refer to the link below. | |
| https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-final-rule-cms-2442-f | |||
| 78 | Part II, Section A, Requirement 7. Can the State clarify any required professional licenses, certifications, credentials, or minimum clinical qualifications expected for personnel performing review, investigation, technical assistance. | Refer to Part II, A.7.a. of the RFP. | |
| 79 | Part II, A.4.c. | ||
| Can the State clarify the expected business hours, staffing expectations, and historical call volumes associated with the hotline/customer service function? | Business hours are Monday-Friday, 8 a.m. to 5 p.m. ET, excluding state holidays and administrative closings. It is estimated that 1,000 grievances could be received per year (either by phone or in writing). |
It is at the Bidder's discretion to propose staffing expectation which meet the anticipated volume necessary to meet the requirements outlined in the RFP.
| 80 | Part II, Section A: Can the State clarify the expected scope, frequency, and contractor responsibilities associated with urgent on-site reviews of providers? | Urgent Surge Review Capacity requirements are described as on optional service which includes on-site reviews of providers using a State approved tool. These on-site visits generally need to occur within a one (1) week notice. It is estimated 70-100 visits may need to occur annually. | |
| 81 | Part II, A.4.c. | ||
| What are the State's defined "business hours" for customer service operations? | Monday-Friday, 8 a.m. to 5 p.m. ET. | ||
| 82 | Part II, A.4.c. | ||
| What are the expected hours of operation for the hotline? | Monday-Friday, 8 a.m. to 5 p.m. ET. | ||
| 83 | Part II, A.4.c. | ||
| If calls are received outside business hours, is a live person required to answer the hotline, or is voicemail/call-back support acceptable? | Live answering is not required during non-business hours, voicemail/call-back support is acceptable. | ||
| 84 | Part II, A.6. | ||
| Can the State clarify whether the Project Manager is expected to be dedicated to this contract throughout the contract term and provide additional detail regarding the anticipated frequency of on-site attendance during Start-Up? | The RFP does not require this expectation, but Bidders must describe how changes in staffing are handled. During the start-up and throughout the contract, at a minimum, the part-time on-site presence for the project manager is 16-24 hours per week at a location provided by the Department. | ||
| 85 | Part III / Cost Proposal: Can the State provide the anticipated budget, funding range, or estimated contract value for this procurement, including any optional renewal periods? | As this is a competitive process the Department declines to answer. | |
| 86 | Does the Evergreen system provide all reports necessary to satisfy the reporting and performance measurement requirements identified in the RFP (including Table 2 requirements)? | No. | |
| 87 | Please provide the last 24-36 months of reportable event data showing: |
a. Volume by reportable event category
b. Volume by waiver/program
c. High-risk designation rates
d. Escalation/routing rates
| e. Duplicate/clustered event rates | Refer to Part I, A. Exhibit 1, 7. of the RFP. Additional data is not readily available at this time. | |
| 88 | Please provide: |
a. Average handling time for triage
b. Average handling time for desk-level review
c. Average handling time for grievance review
| d. Current staffing levels supporting these functions | The Department does not have the detailed data readily available at this time. | ||
| 89 | Please confirm how the one-business-day triage requirement applies to events submitted after business hours, on weekends, or on State holidays. Does the clock begin on the next business day? | Yes, the expectation would be by the next business day for events submitted after business hours, on weekends, or on State holidays. | |
| 90 | Can the Department clarify technical constraints, configuration options, and contractor responsibilities for hosting the redesigned Reportable Event Review Form in Evergreen and the LTSS Data System? | The awarded Bidder will not provide hosting of the redesigned of the Reportable Event Review Form in Evergreen or the LTSS Data System. | |
| 91 | Should grievance intake, tracking, and workflow management occur in an existing State system, or is the contractor expected to provide and manage a separate workflow solution? | Grievance intake, tracking, and workflow management will occur in the existing State systems. | |
| 92 | Please define the "essential components" of the grievance process and identify any required documentation, milestones, or compliance checkpoints. | Essential components are found in standards defined in the federal Ensuring Access to Medicaid Services Final Rule (CMS-2442-F), refer to the link below. | |
| https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-final-rule-cms-2442-f | |||
| 93 | Please describe the contractor's role in administrative hearings, including expected frequency, required expertise, and whether participation may be virtual or in person. | If a grievance results in a request for a hearing, the awarded Bidder's participation may be remote (e.g., teleconference). Annually, it is estimated that 100 hearings maybe scheduled due to a grievance. Refer to Part II, A.7. of the RFP for specifics on required expertise as well as CMS-2442-F and CMS-2499-F/CMS-2296-F in the links below. | |
| https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-final-rule-cms-2442-f | |||
| https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-441/subpart-K/section-441.530 | |||
| 94 | Will contractor personnel be provided State-owned devices, or may contractor-owned devices be used if they meet Department security requirements? | The Department in collaboration with MaineIT will provide laptops for staff/personal who require access to State systems. Contractor-owned devices may not access State systems. Other contract functions may be conducted using the awarded Bidder's devices while complying with all security and confidentiality requirements for protecting State data. | |
| 95 | Must contractor personnel complete State-provided security and privacy training, or will equivalent organizational training satisfy this requirement? | For staff granted access to a State directory account, the State-provided Security & Privacy Training must be completed, otherwise equivalent training as approved by the Department and/or MaineIT is acceptable. | |
| 96 | Are Reportable Event Desk-Level Reviews intended as full QIO investigations or reviews of completed provider investigations to verify adequacy and follow-up actions? | A Reportable Event Desk Level review may include an assessment of provider investigations. Provider investigations are documented on a Reportable Event follow up reports. | |
| 97 | For File 4, should bidders submit only the Cost Proposal Excel workbook from VSS, or also the Appendix H PDF/Word file? If separate files are required, what naming convention should be used? | Bidders must submit the Cost Proposal form in VSS in Excel format and Appendix H in either Word or PDF format. The naming convention is at the Bidder’s discretion. | |
| 98 | Historically, what percentage of reportable events are triaged to desk level reviews? | The Department does not have this data readily available. | |
| 99 | Historically, what percentage of desk reviews are classified as high risk? | The Department does not have this data readily available. | |
| 100 | How is underreporting defined (i.e. significant deviation from normal reporting)? | Through a cross comparison with Medicaid claims data and reportable event data. refer to Part II, B.4.a.i. of the RFP. | |
| 101 | How will the selected vendor receive Medicaid claims data for cross comparison? | There are currently two (2) primary options, Evergreen consumes Medicaid claims data which is included in the person record. In addition, the Department manages a dashboard that the QIO may have access to. | |
| 102 | How many state users will require access to the dashboard? | The Dashboard is a State managed tool. As this is outside the scope of the RFP, the Department declines to answer. | |
| 103 | Historically, how many annual administrative hearings have there been? | It is estimated that up to a 120 hearings annually could involve a grievance. | |
| 104 | For reportable events and grievances complaint management, which pricing tier will be used in cost evaluation? | Refer to Appendix H, 3. under Note. |
Reportable Event Range 2: 30,001 to 40,000 Grievance/ Consumer Complaint Range 2: 1,001-2,000,
| 105 | Will pricing for optional activities be included in cost evaluation? | No, refer to Appendix H, 3. under Note. |
| 106 | No Appendix or VSS document is explicitly titled Review Form, although Appendix I indicates it is available on VSS. Can the Department provide an example of the form which is to be redesigned? | Appendix I Reportable Event Review Form Examples include the OADS - Evergreen Reportable Event Form.pdf and OADS - LTSS Event Form.pdf available in VSS under Attachments. |
| 107 | Please confirm that in the Organizational Chart and in the Staffing Plan that Maine does NOT wish vendors to identify individual names. Our understanding is that no names are to be included, only team positions/titles - is that correct? | Yes, that is correct. |
| 108 | Does DHHS have a preferred geographic location within Maine and/or set amount of time that it desires for the part-time on-site presence to be available? | The Department expects at a minimum, the part-time on-site presence for the project manager to be available 16-24 hours per week, preferably in the Augusta, ME area. |
https://www.maine.gov/dhhs/ada/ada-civil-rights-compliance/effective-communication-language-accesshttps://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-final-rule-cms-2442-fhttps://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-441/subpart-K/section-441.530https://www.maine.gov/sos/archives/records-management/state-government-agency-policies-and-guidance/state-general-schedules-for-recordshttps://www.maine.gov/sos/rulemaking/agency-rules/department-health-and-human-services-ruleshttps://www.mainelegislature.org/legis/statutes/22/title22ch958-Asec0.htmlhttps://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-final-rule-cms-2442-fhttps://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-final-rule-cms-2442-fhttps://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-441/subpart-K/section-441.530https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-final-rule-cms-2442-fhttps://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-final-rule-cms-2442-f
Other files
| File | Type | Posted |
|---|---|---|
| RFP 202605096 QIO Quality Mngmt and Support-FINAL.docx | DOCX document | |
| OADS - Evergreen Reportable Event Form.pdf | ||
| QIO Proposed Services Response Form.docx | DOCX document | |
| RFP 202606104 Public School Electronic Health Record_FINAL.docx | DOCX document | |
| QIO Cost Proposal Template toDHHS.xlsx | XLSX spreadsheet | |
| OADS - LTSS Event Form.pdf |
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