RFP 202605096 QIO Quality Mngmt and Support-FINAL.docx

STATE OF MAINE

Department of Health and Human Services Office of Aging and Disability Services

RFP# 202605096

Quality Improvement Organization (QIO) Quality Management and Support for Aging and Disability Services

no later than 4:00 p.m., local time

no later than 4:00 p.m., local time

TABLE OF CONTENTS

Page

A. PURPOSE AND BACKGROUND

B. GENERAL PROVISIONS

C. ELIGIBILITY TO SUBMIT A BID

D. CONTRACT TERM

E. NUMBER OF AWARDS

A. VENDOR SELF SERVICE SYSTEM (VSS)

B. QUESTIONS

C. AMENDMENTS

D. PROPOSAL SUBMISSION

A. EVALUATION PROCESS – GENERAL INFORMATION

B. SCORING WEIGHTS AND PROCESS

C. NEGOTIATIONS

D. SELECTION AND AWARD

E. APPEAL OF CONTRACT AWARDS

A. CONTRACT DOCUMENT

B. STANDARD STATE CONTRACT PROVISIONS

APPENDIX A – PROPOSAL COVER PAGE

APPENDIX B – RESPONSIBLE BIDDER CERTIFICATION

APPENDIX C – ELIGIBILITY TO SUBMIT A BID FORM

APPENDIX D – QUALIFICATIONS and EXPERIENCE FORM

APPENDIX E – SUBCONTRACTORS FORM

APPENDIX F – LITIGATION FORM

APPENDIX G – PROPOSED SERVICES RESPONSE FORM

APPENDIX H – COST PROPOSAL FORM

APPENDIX I – REPORTABLE EVENT FORM EXAMPLES

PUBLIC NOTICE

State of Maine Department of Health and Human Services

RFP# 202605096

Quality Improvement Organization (QIO) Quality Management and Support for Aging and Disability Services

The State of Maine is seeking proposals for a Quality Improvement Organization (QIO) or QIO-Like organization to assist with Critical Incident management and related services.

A copy of the RFP and all related documents can be obtained through Vendor Self Service (VSS): https://mevss.hostams.com/PRDVSS1X1/AltSelfService

Proposals must be submitted to the Office of State Procurement Services, via Vendor Self Service (VSS). Proposal submissions must be received no later than 4:00 p.m., local time, on July 20, 2026. Proposals will be opened the following business day.

RFP TERMS/ACRONYMS with DEFINITIONS

The following terms and acronyms, as referenced in the RFP, have the meanings indicated below:

Instances of harm that require reporting to the Department and have impacted a person receiving HCBS services. Critical Incident management is governed by 1915(c) Waiver requirements related to incident management systems and monitoring health and safety. Critical incidents include, but are not limited to, medication errors and hospitalizations.

The terms Critical Incident and Reportable Event may be used interchangeably.

Long-Term Services and Supports

(LTSS)

Medical and/or personal care and supportive services needed by older adults and/or adults with physical disabilities who have lost some capacity to perform activities-of-daily-living, such as bathing, dressing, eating, transfers, and toileting, and/or activities that are essential to daily living, such as housework, preparing meals, and shopping.

First, section 1902 (a)(30)(A) of the Social Security Act (the Act) requires that state Medicaid Agencies provide methods and procedures to safeguard against unnecessary utilization of care and services and to assure “efficiency, economy and quality of care.”

Under Section 1902 (d), a State can contract with a QIO or QIO-like entity to perform medical and utilization review functions required by law.

State of Maine Department of Health and Human Services Office of Aging and Disability Services

RFP# 202605096

Quality Improvement Organization (QIO) Quality Management and Support for Aging and Disability Services

PART I INTRODUCTION

A. Purpose and Background

The Department of Health and Human Services (Department) is seeking to enhance the effectiveness of its Critical Incident system and to improve the consumer experience when reporting other system concerns, such as Grievances and licensing related Consumer Complaints, as defined in this Request for Proposals (RFP) document. This document provides instructions for submitting proposals, the procedure and criteria by which the awarded Bidder will be selected, and the contractual terms which will govern the relationship between the State of Maine (State) and the awarded Bidder.

The Department is dedicated to promoting health, safety, resiliency, and opportunity to all Maine Residents. The Department’s Office of Aging and Disability Services (OADS) is responsible for the provision of services that promote the highest level of independence, health, and safety of older citizens, vulnerable adults, and adults with disabilities.

The Department’s delivery of Home and Community Based Services (HCBS) requires a consistent, timely, and accessible system for managing Reportable Events, Consumer Complaints, and Grievances. Currently, intake and follow-up for Reportable Events and related concerns may occur through multiple pathways, creating barriers to rapid triage, appropriate routing, and reliable resolution. Through standardized Desk-level Reviews, use of clinical expertise, and inter-rater reliability processes, the Department aims to reduce variability and improve the quality and consistency of decision-making. Robust daily, monthly, and quarterly reporting and trending related to triage, case progression, and remediation will support the Department in identifying systemic issues and developing targeted policy and quality interventions. Grievance and Consumer Complaint review services are needed to manage reports from consumers with concerns. Currently, different Grievance and Consumer Complaint processes exist for each HCBS Waiver population. These differences could contribute to inconsistency in the public’s experience. Additionally, due to many informal reporting structures and follow-up processes, there are sometimes parallel responses to submitted concerns. Through the introduction of a standardized front door, additional capacity to complete review and resolution activities, and enhanced tracking, the Department aims to improve the efficiency of Grievance and Consumer Complaint management. The Department’s long-term vision is a single, centralized front door for clear and consistent reporting processes and tools, and multiple reporting methods (including web-based forms, hotline, and written and oral submissions) to minimize barriers for Reporters and enable OADS to respond to reports quickly and consistently.

Currently, several changes are underway or under consideration by the Department, including efforts to achieve compliance with the federal Access Rule established under 42 CFR 431, 438, 441, and 447 (CMS-2442-F), planned updates to the Grievance Rule (14-197 CMR Chapter 8), the phase-out of planned restraints (34-B M.R.S. § 3803), updates to the Reportable Events Rule (14-197 CMR Chapter 12), expansion of provider licensing requirements (10-144 CMR Chapter 108), and alignment of processes across service populations (10-144 CMR Chapter 101 Ch. II Sections 18, 19, 20, 21, and 29). Additionally, the Department is working on the introduction of a new HCBS Waiver, “the Lifespan Waiver”, which will offer services to adults with Developmental Disabilities (DD).

Through this RFP, the Department intends for a Quality Improvement Organization (QIO) or QIO-Like entity to:

· Improve the effectiveness of the Department’s Critical Incident system;

· Support Department efforts to prepare for Access Rule implementation;

· Improve intake and tracking of reports of service quality issues and instances of harm to a person receiving HCBS, regardless of the type of Reporter or type of report made;

· Improve the consumer experience when reporting system concerns, such as licensing Consumer Complaints;

· Support OADS quality management activities.

The QIO or QIO-Like entity will provide Reportable Event review services needed to manage the volume and complexity of approximately thirty thousand (30,000) reportable events, annually, while maintaining the following standards:

· One (1) business-day triage for all events;

· Next business day routing for high-risk situations involving a person’s health or safety; and

· Three (3) business-day routing for events deemed to not meet criteria to qualify as high risk.

The scale of work, which is a collection of descriptive statistics for review, is described in Exhibit 1.

Exhibit 1 - Descriptive Statistics

At the Department’s discretion, the services under this RFP may be expanded to include:

· Technical Assistance (TA) and training to providers in response to identified quality trends associated with Reportable Events, Grievances, and licensing Consumer Complaints, including integrating data related to Reportable Events, Consumer Complaints, APS, and licensing into a meaningful compliance and quality framework, including strategies to address data limitations.

· Surge review capacity for urgent on-site assessments using standardized State tools to evaluate the likelihood of harm.

· Client prior authorization review services to conduct timely, clinically appropriate prior authorization approvals in accordance with the MaineCare Benefits Manual.

B. General Provisions

1. From the time the RFP is issued until award notification is made, all contact with the State regarding the RFP must be made through the RFP Coordinator. No other person/ State employee is empowered to make binding statements regarding the RFP. Violation of this provision may lead to disqualification from the bidding process, at the State’s discretion.

2. Issuance of the RFP does not commit the Department to issue an award or to pay expenses incurred by a Bidder in the preparation of a response to the RFP. This includes attendance at personal interviews or other meetings and software or system demonstrations, where applicable.

3. All proposals must adhere to the instructions and format requirements outlined in the RFP and all written supplements and amendments (such as the Summary of Questions and Answers), issued by the Department. Proposals must follow the format and respond to all questions and instructions specified below in the “Proposal Submission Requirements” section of the RFP.

4. Bidders will take careful note that in evaluating a proposal submitted in response to the RFP, the Department will consider materials provided in the proposal, information obtained through interviews/presentations (if any), and internal Departmental information of previous contract history with the Bidder (if any). The Department also reserves the right to consider other reliable references and publicly available information in evaluating a Bidder’s experience and capabilities.

5. The proposal must be signed by a person authorized to legally bind the Bidder and must contain a statement that the proposal and the pricing contained therein will remain valid and binding for a period of 180 days from the date and time of the bid opening.

6. The RFP and the awarded Bidder’s proposal, including all appendices or attachments, will be the basis for the final contract, as determined by the Department.

7. Following announcement of an award decision, all records and documents regarding this RFP, including bid submissions, will be public records, available for public inspection pursuant to 5 M.R.S. §1825 B (6 &15) and the State of Maine Freedom of Access Act (FOAA) (1 M.R.S. § 401 et seq.). State contracts and information related to contracts, including all records, documents, supporting documents, and bid submissions, are public records unless otherwise excepted by statute (Id).

8. Subject to the above and pursuant to applicable law, in the event that a Bidder believes any information that it submits in response to this RFP is confidential, it must mark that information accordingly, and include citation to legal authority in support of the Bidder’s claim of confidentiality. In the event that the Department receives a FOAA request that includes submissions marked as confidential, the Department shall evaluate the information and any legal authority from the Bidder to determine whether the information is an exception to FOAA’s definition of public record. If the Department determines to release information that a Bidder has marked confidential, it shall provide advance notice to the Bidder to allow for them to seek legal relief.

9. The Department, at its sole discretion, reserves the right to recognize and waive minor informalities and irregularities found in proposals received in response to the RFP.

10. If awarded a contract resulting from this RFP, vendors shall be required to disclose, in writing and in accordance with applicable Maine law, any actual or potential conflicts of interest. Such disclosure must include any financial, professional, or personal relationships that could give rise to a conflict of interest or the appearance of a conflict of interest. Failure to disclose a known conflict or appearance of conflict may result in disqualification, contract termination, or other remedies as provided by law.

11. All applicable laws, whether or not herein contained, are included by this reference. It is the Bidder’s responsibility to determine the applicability and requirements of any such laws and to abide by them.

C. Eligibility to Submit a Bid

Bidders must be designated by the Centers for Medicare & Medicaid Services (CMS) as a Quality Improvement Organization (QIO) or QIO-Like entity.

D. Contract Term

The Department is seeking cost-efficient proposals to provide services, as defined in this RFP, for the anticipated contract period defined in the table below. The dates below are estimated and may be adjusted, as necessary, in order to comply with all procedural requirements associated with the RFP and the contracting process. The actual contract start date will be established by a completed and approved contract.

Contract Renewal: Following the initial term of the contract, the Department may opt to renew the contract for three (3) renewal periods, as shown in the table below, and subject to continued availability of funding and satisfactory performance.

The term of the anticipated contract, resulting from the RFP, is defined as follows:

E. Number of Awards

The Department anticipates making one (1) award as a result of this RFP process.

PART II SCOPE OF SERVICES TO BE PROVIDED

Specific instructions for the Bidder to provide a narrative response to the Scope of Services may be found in Part IV, Section III, Proposed Services.

1. Start-Up Capabilities (First six (6) months)

1. Develop and provide a project plan to the Department within thirty (30) calendar days of the start of the initial period of performance.

2. Reportable Event Categories: Work with the Department to integrate the Office of Aging and Disability Services (OADS) reportable event categories, refer to Appendix I (Reportable Events Review Form Examples), into the Bidder’s proposed workflow.

a. Evaluate existing categories and identify strategies to use categories and related information for reporting.

i. Make recommendations to the Department, as appropriate, about changes to how reportable event information is collected from Reporters due to overlap between existing categories.

b. Update workflows and reports when reporting categories change or when information collection fields change.

3. Reportable Event Review Form: Redesign the Reportable Event Review Form, a form directly built in Evergreen where documentation of triage scores occur, (not the Reportable Events Form referenced in Appendix I) in collaboration with OADS, ensuring the necessary fields are included for Event Triage.

a. Ensure the newly designed form is inclusive of reportable events under 10-144 CMR Chapter 101 Ch. II Sections 18, 19, 20, 21, and 29, with an ability to be hosted in Evergreen and the Long-Term Services and Supports (LTSS) Data System (i.e., SharePoint).

i. Event Triage for Sections 18, 20, 21, and 29 must be documented in the Evergreen system. Work with the Department to finalize processes for event intake, triage, review, and investigation, including the design of necessary Evergreen system components for triage.

ii. Event Triage for Section 19 must be documented in the LTSS Reportable Event System, including SharePoint. Work with OADS to finalize processes for event intake, triage, review, and investigation, including the design of necessary Reportable Event System components for triage.

4. Consumer Concern Management, Including Grievances: Work with the Department to integrate the management of consumer concerns at OADS, including Grievances, into the awarded Bidder’s workflow.

a. Update workflows and reports when changes to processes are made, such as updates to the State’s Grievance Rule outlined in 14-197 CMR Ch. 8.

b. Work with the Department to finalize processes for intake, investigation, resolution or escalation, and tracking consumer concerns, including Grievances, within the first six (6) months of the start of the initial period of performance.

i. Develop standardized resolution activities for Grievances and escalation criteria to be used to determine which Grievances will escalate to the Department for resolution.

c. Implement customer-service functionalities, including a hotline during business hours, to make information submission as accessible to the public as possible.

5. Routing Business Rules: Facilitate decision-making and provide subject-matter expertise to ensure business rules are developed and documented to guide the routing / resolution process for reportable events and Grievances / Consumer Complaints.

a. For reportable events, make recommendations about what thresholds must be in place before an event and/or a cluster of events is escalated to the Department for further review during a Desk-level Review.

b. For Grievances and Consumer Complaint management, identifying relevant sources of intake for each distinct type of complaint and associated resolution pathway.

6. On-Site Presence: Establish a presence in Maine, which includes, at minimum, part-time on-site presence for the project manager in order to meet with Department staff, providers, or other interest holders at a meeting space provided by OADS.

7. Establish Adequate Staffing: Provide sufficient staff to perform the services outlined in this RFP.

a. Ensure staff have adequate home and community-based service expertise, including knowledge of federal requirements such as 1915(c) Waiver requirements, Access Rule requirements (CMS-2442-F), and Settings Rule requirements (CMS-2499-F/CMS-2296-F).

8. Enhanced Federal Financial Participation: Maintain the designation of a Quality Improvement Organization (QIO) or QIO-Like entity, which qualifies the Department to receive Medicaid enhanced Federal Fund Participation match from CMS.

a. Work with the Department and its Medicaid partners to develop the application to CMS for activities within the scope of work that is eligible for the seventy-five (75%) enhanced match.

9. Scalability of Work: Provide rapid scaling up or down of services as the Department moves towards aligning reportable events and Grievance practices across LTSS and Developmental Disability (DD) services.

10. Provider Technical Assistance (TA) and Communications Planning: Educate the OADS provider community about newly developed processes during the Start-up Period and the awarded Bidder’s role.

11. Adapting to Changes: Work with the Department to update the project plan, workflows, and reporting requirements impacted by future federal and/state rule changes (e.g., federal Access Rule (CMS-2442-F), Grievance Rule (14-197 CMR Ch. 8), (34-B M.R.S.A. § 3803), Reportable Events Rule (14-197 CMR Ch. 12,), provider licensing requirements (10-144 CMR Ch. 108) and the addition of new programs, such as Lifespan Waiver).

1. Reportable Event Management (aka Critical Incident Management)

1. Event Triage: Complete Event Triage and tracking of approximately thirty thousand (30,000) reportable events submitted annually for OADS (10-144 CMR Chapter 101 Ch. II Sections 18, 19, 20, 21, 29, and the anticipated Lifespan Waiver).

0. View submitted events and run reports through the Department’s Evergreen system and SharePoint.

0. Ensure Event Triage identifies clusters of related events, so that situational risk is identified even when individual triaged events may not identify the risk.

0. Establish contingency plans which address triage and track operations in the event submitted information is routinely not sufficient to complete valid triaging for OADS.

0. Promote inter-rater reliability of all triaging and tracking decisions for OADS.

0. Complete triage and tracking activities for OADS within one (1) business day from the date of reportable event submission in Evergreen.

1. Event Desk-Level Reviews: Complete and track Desk-Level Reviews of all Reportable Events

1. During the Start-Up Period, make recommendations about what thresholds must be in place before an event and/or a cluster of events is escalated to the Department for further review/action (i.e., events identified as “high risk”).

1. Complete expedited Desk-Level Reviews for events identified as high risk during the triage process.

1. Develop and document a recommended process for event intake, triaging, and review, including expedited review of high-risk events, for review and approval by OADS, including but not limited to:

2. Determining what, if any, Desk-Level Review and tracking requirements are to be included in the triaging process.

2. Completing and tracking a Desk-Level Review, including what activities are a part of this type of review.

2. A standard approach and/or tool to guide completion and tracking of Desk-Level Reviews.

2. Leveraging clinical expertise in review, tracking, and triage activities.

1. Event Routing: Route, prioritize, and track events that require review from Department teams.

Routing teams may include but are not limited to the Division of Licensing and Certification (DLC), Adult Protective Services (APS), Crisis Management Services, Child Protective Services, Quality Assurance teams (ID or DD, Brain Injury (BI), and LTSS), and/or other appropriate parties/partners.

2. Determine the final list of teams, circumstances, and timing for routing during the Start-Up Period.

2. Determine which teams, offices, and/or groups need to receive routing of each event type.

2. Develop a process to identify redundancy in reporting and tracking (times in which a single event may have been Reported multiple times, or in which a single quality concern led to the reporting of multiple, related events) that protects against duplicate referrals to Department teams for review and approval by OADS.

2. Ensure events are routed and tracked within no more than three (3) business days, with high-risk events being routed within one (1) business day.

2. The awarded Bidder must have processes in place to ensure systematic routing of events.

1. Trend Analysis: Identify and track trends in reportable events, including the identification of clusters of related events.

3. Analyze and report to OADS, at least monthly, any notable trends in event reporting or underreporting, including the timeliness of provider reporting.

0. To support analysis on underreporting, OADS will provide access to a dashboard that includes a cross comparison of Medicaid claims data and reportable event data.

3. Analyze and report to OADS, at least monthly, descriptive statistics regarding the number of events Reported, triaged, and reviewed, which must include:

1. Subcategory reporting that identifies the type of review for an event received and any routing that occurred.

1. Analysis of whether the events occurred during service provision or due to the failure to deliver services.

3. Analyze and report to OADS, at last quarterly, any notable trends in event remediation and follow up.

2. Ensure trends are actionable and able to lead to Department decision making regarding system-level interventions such as issuing new training.

3. Provide trending by program, population group, or other meaningful breakdowns, across all reports, where there are identified trends.

3. Provide ad hoc reporting, as needed and as requested by the Department.

3. Manage duplicate report submissions or event clusters.

1. Tracking: Follow up with OADS regarding the final outcome of items escalated to the Department (or other designated entities) for actions to document final outcomes and mitigate unresolved activity.

C. Consumer Concern Management, including Grievances

1. Complete intake, resolution, and tracking of Consumer Complaints and concerns, including Grievances from recipients of services of MaineCare Home and Community Based Services (HCBS) Waiver programs and services for persons with an Intellectual Disability (ID), Autism Spectrum Disorder (ASD), or an acquired BI consistent with 34-B M.R.S. § 5604, which must include but is not limited to:

a. Consumer Complaints regarding noncompliance of licensed providers;

b. Consumer Grievances; or

c. Concerns from public community members about the safety and welfare of Waiver members or impacted parties.

2. Grievance Intake: Complete intake and tracking of Grievances from individuals receiving services in alignment with, or in pursuit of alignment with, standards defined in the federal Ensuring Access to Medicaid Services Final Rule (CMS-2442-F), 14-197 CMR Chapter 8 Grievance Process for Persons with an Intellectual Disability, ASD or acquired BI, and 14-197 CMR Chapter 12: Reportable Events System.

a. Receive Grievances from consumers using the method of their choice, which must include written or oral communication.

i. Provide reasonable assistance to Grievances with the completion of forms and other administrative steps related to the Grievances.

ii. Ensure the Grievance system provides accessibility to people with disabilities and/or limited English proficiency, including assistance such as written translation and/or auxiliary aids, and translators or interpreters.

iii. Ensure the Grievances system includes a toll-free number with adequate teletypewriter capabilities.

iv. Upon receipt, acknowledge receipt of a Grievance in writing regardless of how the grievance was received and request information necessary to investigate (this does not apply to any other types of Consumer Complaints and concerns received.)

3. Grievance Resolution and Routing: Initiate resolution activities for all Grievances received.

a. Ensure consumer Grievances are reviewed, and resolution is pursued by an individual who has the appropriate expertise needed to attempt to resolve the Grievances.

b. Escalate Grievances that require Department action for resolution to OADS in alignment with the workflows and escalation criteria established during the Start-Up Period.

c. Provide assistance and tracking to the Department to ensure that essential components of the Grievance process are met, such as sending written documentation of final outcomes.

d. Participate in administrative hearings related to Grievances as a subject matter expert.

e. Issue a written notice of decision or track OADS’ issuance of a notice of decision within ninety (90) calendar days of the receipt of a Grievance.

f. In the event a notice of decision cannot be issued within ninety (90) days due to external factors or parallel administrative or legal processes, receive written approval from OADS to extend the timeline and notify grievant of decision status.

4. Consumer Complaint and Concern Intake: In coordination with implementing intake of Grievances, complete intake and tabulation of other Consumer Complaints and concerns.

a. Provide a public facing intake form that can receive Consumer Complaints.

b. Provide a mechanism for submission of Consumer Complaints via oral communication, such as a hotline.

c. Operate intake in alignment with industry best practice for accessibility and ease of documentation.

d. Offer customer service support to people who are having trouble completing concern / complaint submission without assistance.

5. Consumer Complaint and Concern Routing: In coordination with implementing intake of Grievances, route other Consumer Complaints and concerns appropriately.

a. Have processes in place such that intakes are sorted into appropriate classifications and routed to the appropriate entity, as designated by the Department during the Start-Up Period.

6. Reporting: Design and deliver monthly, quarterly, and annual reports related to Grievances and Consumer Complaint management that provide meaningful insights.

a. Ensure reporting includes a detailed excerpt that includes a data set of all Grievances with key information fields, including but not limited to beneficiary name, description of Grievance reason, date received, date of each review or review meeting, date of resolution, and resolution summary narrative (if applicable).

b. Provide, as needed, an analysis of the number of reports and Consumer Complaints aggregated by agencies across complaints, Grievances, incident management.

c. Provide ad hoc:

i. Reporting to support urgent or emerging OADS quality priorities.

ii. Analysis for Evergreen and SharePoint.

7. Tracking: Follow up with OADS regarding the final outcome of items escalated to OADS (or other designated entities) for follow-up actions to:

a. Document final outcomes; and

b. Mitigate unresolved activity.

D. State Systems and Confidentiality

0. Evergreen: Leverage Evergreen to view information needed to manage reportable events and Grievances.

0. LTSS Data Systems: Leverage the LTSS Reportable Event Management and Grievance Systems, inclusive of SharePoint, Microsoft Forms, and Excel, to view, triage, and route reportable events.

3. State Licensing Data System (ALMS): Work within or receiving regular extracts from the State’s licensing data system (ALMS).

4. Process Information: Process all information exchanges and feeds, including potentially retrieving/sending daily incoming/outgoing file feeds, with secure mechanisms (FTPS or HTTPS, encrypted to at least TLS 1.0).

5. Ensure all access to the State systems are performed using devices, accounts, authentication methods, and virtual private network, provisioned by the Department.

a. Ensure all staff/personnel comply with current MaineIT Policies & Standards related to its:

i. Access Control Policy;

ii. Access Control Procedure for Users;

iii. Security Awareness Training;

iv. Rules of Behavior Policy; and

v. User Device and Commodity Application Policy.

6. Comply with all applicable State and Federal confidentiality regulations when providing quality management services including, but not limited to: the Health Insurance Portability and Accountability Act Privacy, 45 C.F.R. Part 160, and 45 C.F.R. Part 164.

7. Comply with all applicable Department Privacy and Security of Health Information policies.

8. Comply with all current State and Federal laws regarding the protection of confidential and/or sensitive information that is collected or maintained by the awarded Bidder, including, as applicable, notification to individuals in the event of unauthorized access or disclosure.

9. Obtain and maintain insurance as outlined in the current State of Maine IT-Service Contract (IT-SC), Rider B-IT, Section 19. Insurance Requirements. The current IT-SC may be obtained on the Office of State Procurement Services Forms & Templates webpage.

10. Implement risk assessment and vulnerability scanning policies and procedures for collecting sensitive information electronically (PII, PHI, and/or other confidential data) as part of the services provided as a result of the contract awarded under this RFP, at minimum to be equivalent to current MaineIT Policies & Standards for:

a. Risk Assessment Policy & Procedures;

b. Rules of Behavior; and

c. Vulnerability Scanning Procedure.

11. The State will not consume (use) any awarded Bidder application, but the awarded Bidder will consume (use) one/more State application(s).

E. Compliance with Applicable Laws and Regulations

1. Develop processes that promotes an understanding and align with governing laws and regulations; specifically:

a. Relevant Federal Law and Rule

i. Social Security Act Section 1915(c)

ii. 42 CFR Section 441.301(c)(4)

iii. 42 CFR Section 441.302(a): State Assurances

iv. 45 CFR Part 1324

v. CMS-2442-F

vi. CMS-2449-F/CMS-2296-F

b. Relevant State Rule Related to HCBS

i. 10-149 Chapter 5: Home Based Supports and Services for Older and Disabled Adults and Disability Services Policy Manual

c. State Law and Rule Related to Reportable Events

i. 14-197 Chapter 12: Reportable Events System

ii. 34-B M.R.S. § 5604-A: Duty to Report Incidents; Adult Protective Services Act and Rights Violations

d. State Rule Related to Grievances

i. 14-197 Chapter 8: Grievance Process for Persons with an Intellectual Disability, Autism Spectrum Disorder or Acquired Brain Injury

e. State Law and Rule Related to Provider Licensing

i. 10-144 CMR Chapter 108: Home and Community Support Services Agencies Licensing Rule

ii. 34-B M.R.S §1203-B: Licenses for Agencies that Provide Services to Adults with Certain Conditions

iii. 10-144 CMR Chapter 129: Personal Care Agency Licensing Rule

f. State Law and Rule Related to Adult Protective Services

i. 10-149 Chapter 2: Adult Protective Services System

ii. 22 M.R.S. Chapter 958-A: Adult Protective Services Act

F. Performance Measures

1. Perform all services proposed in response to this RFP by achieving all Performance Measures listed in Table 1.

0. Submit data to support the performance measures utilizing the Department’s Deliverables Performance Tracking Template (to be provided upon contract execution) or via a third-party data source, as indicated within the performance measure data source column of Table 1.

Table 1 Mandatory Performance Measures

G. Reports

1. Ensure Reportable Event, Grievance and/or Consumer Complaint Reporting complies with Social Security Act Section 1915(c) reporting requirements described in the federal Access rule 42 CFR 431, 438, 441, and 447 (CMS-2442-F). Reports developed to meet requirements in subsections (3) – (10) must include program-level reporting.

2. Track and record all data/information necessary to complete the required reports listed in Table 2:

Table 2 – Required Reports

a. Reportable Events Reporting

b. Grievance/ Consumer Complaint Reporting

c. General Reporting

Summarizes activities for the previous 12-month period as determined by the Department, including breakdowns of data to provide insights into underlying trends, and recommendations about how to improve service quality. Explain the Bidder’s approach to incorporating staff insights into the Annual Report.

2. Submit all the required reports to the Department in accordance with the timelines established in Table 3:

Table 3 – Required Reports Timelines

a. Reportable Events Reporting

b. Grievance/ Consumer Complaint Reporting

c. General Reporting

H. Optional Future Requirements

Based on the awarded Bidder’s demonstrated capabilities, the Department may consider expanding the scope of work under the contract resulting from this RFP.

1. Technical Assistance (TA) and Training

a. Provide TA, and potentially training, to providers.

i. TA requests must be at the discretion of the Department or in response to quality trends identified by the awarded Bidder through reportable event reviews and consumer quality Consumer Complaint reviews.

2. Provider Data Management

a. Combine existing data about providers into a single meaningful view of provider compliance and quality.

i. Data elements to consider include reportable events, Consumer Complaints, APS data, and licensing reviews; as well as alternative or additional data elements identified by the awarded Bidder.

ii. Manage imperfect data by developing at minimum strategies to address:

(1) Data sets with missing provider information; and

(2) Discrepancies in provider settings across data sets.

iii. Outline the frequency of updates, key elements that will be presented, and anticipated limitations.

3. Surge Review Capacity

a. Provide urgent support to the Department to complete on-site reviews of providers.

i. Reviews will be completed using a standardized tool developed by the Department.

ii. Reviews will assess the likelihood that a provider compliance issue would contribute harm to a person receiving services from the same provider.

4. Special Projects Capacity

a. Provide special project support on an ad hoc basis (e.g., reviewing behavior support plans).

5. Data Entry Capacity

a. Provide time-limited support to the Department to complete data entry activities, for example, within the Evergreen system.

6. Client Prior Authorization Review

a. Provide service authorization requests in accordance with medical necessity criteria defined in 10-144 CMR Chapter 101 Ch. I Section 1.

i. Ensure reviews are timely and consistent with the quality review policy of provider prior authorization submissions and associated person-centered planning documentation defined in 10-144 CMR Chapter 101 Ch. I Section 6.

ii. Use the Department’s Evergreen database to receive and review requests associated with service planning for prior authorization of services, level of support needed and determination of services by type, amount and frequency.

PART III KEY RFP EVENTS

A. Vendor Self Service System (VSS)

1. The Office of State Procurement Services Vendor Self Service System website is found at: https://www.maine.gov/dafs/bbm/procurementservices/vendors/vendor-self-service-system

2. A copy of the RFP and all associated documents will be published in VSS.

3. Only documents published in VSS will be considered binding.

4. Any interested party may view open solicitations in VSS using the Public Access feature.

5. Vendors must have an active User ID and password in VSS to submit questions and respond to solicitations, including this RFP.

a. Vendor registration instructions and User Guide may be found at the link above, which include steps for searching for an existing account/User ID, or registering for a new account/User ID.

b. Vendors interested in responding to a solicitation are encouraged to obtain a User ID and password for VSS as soon as possible.

6. Vendors must have an active Vendor Code (VC or VS) to contract with the Department.

B. Questions

1. General Instructions: It is the responsibility of all Bidders and other interested parties to examine the entire RFP and to seek clarification, in writing, if they do not understand any information or instructions.

a. Questions must be submitted in VSS as soon as possible but no later than the date and time published in VSS.

b. Questions should be clearly stated and reference the applicable section and/or page number of the RFP.

c. The Department assumes no liability for assuring accurate/complete/on time transmission and receipt.

2. Question & Answer Summary: Responses to all questions will be compiled in writing and published in VSS no later than seven (7) calendar days prior to the Proposal Submission Deadline. It is the responsibility of all interested parties to go to VSS to obtain a copy of the Question & Answer Summary. Only those answers issued in writing in VSS will be considered binding.

C. Amendments

All amendments released in regard to the RFP will be published in VSS. It is the responsibility of all interested parties to go to VSS to obtain amendments. Only those amendments published in VSS are considered binding.

D. Proposal Submission

1. Proposals Due

a. Proposals must be received no later than the Proposal Submission Deadline (closing date) published in VSS.

b. Any proposal submissions or any additional or revised proposal files received after the Proposal Submission Deadline will be rejected without exception.

2. Delivery Instructions

a. Proposal submissions must be submitted to the Office of State Procurement Services via VSS.

b. Only proposal submissions received via VSS will be considered. The Department assumes no liability for assuring accurate/complete receipt.

c. Submissions containing links to file sharing sites or online file repositories will not be accepted as submissions. Only proposal submissions that have the actual requested files attached will be accepted.

d. Encrypted submissions received which require opening attachments and logging into a proprietary system will not be accepted. Bidders should work with their Information Technology team to ensure that the proposal submission will not be encrypted due to any security settings.

e. File size limits are 15MB per file. Bidders may separate the submissions into multiple files, as necessary, due to file size concerns.

3. Submission Format

a. Bidders must submit multiple files, with each file named and…