RFP+325-25-415-027.docx

STATE OF NORTH DAKOTA

DEPARTMENT OF HEALTH AND HUMAN SERVICES

MEDICAL SERVICES DIVISION

600 EAST BOULEVARD AVENUE, DEPT. 325

BISMARCK, ND 58505-0250

Solicitation Number: 325-25-415-027

Solicitation Type: Request for Proposal (RFP)

RFP Title: Disproportionate Share Hospital Audit, Hospital Upper Payment Limits, Intermediate Care Facilities Upper Payment Limits and Payment Transparency, Critical Access Hospital Cost Settlement, and Medicaid Inpatient Utilization Rate Calculation

Issued: August 4, 2025

Purpose of RFP: To procure an offeror to conduct an annual audit and reporting of the North Dakota Medicaid Disproportionate Share Hospital (DSH) program, calculate the annual hospital Upper Payment Limits (UPL) for Inpatient and Outpatient Hospital Services and Institutes of Mental Disease (IMD), calculate the annual Upper Payment Limit and Medicaid Institutional Payment Transparency reporting for Intermediate Care Facilities, calculate annual cost settlement amounts for Critical Access Hospitals (CAH), and calculate annual Medicaid Inpatient Utilization Rate (MIUR).

Procurement Officer: LeeAnn Thiel

TABLE OF CONTENTS

SECTION ONE

Introduction and Instructions

1.03 RFP Schedule

1.04 Assistance to Individual with a Disability

1.05 Secretary of State Registration Requirements

1.06 Bidders List Registration

1.07 Notice Provided

1.08 Pre-Proposal Conference or Site Inspection

1.09 Deadline for Submission of Questions and Objections

1.010 Amendments to the RFP

1.011 Proposal Submission Instructions

1.012 Proposal Receipt Deadline – Late Proposals Rejected

1.013 Proposal Opening

1.014 News Releases

1.015 Attempt to Influence Prohibited

1.016 Collusion Prohibited

1.017 Specifications Prepared by Non-State Personnel

1.018 Supplier Registration (Payee)

SECTION TWO

Scope of Work

2.01 Background Information

2.02 Scope of Work

2.03 Location of Work

2.04 Prior Experience

2.05 Required Licenses

2.06 Federal and State Requirements

SECTION THREE

General Contract Information

3.06 Supplemental Terms and Conditions

3.07 Contract Approval

3.08 Contract Changes – Unanticipated Amendments

3.09 Taxes and Taxpayer Identification Number

3.010 Proposed Payment Procedures

3.011 Contract Personnel

3.012 Right to Inspect Place of Business

3.013 Inspection & Modification – Reimbursement for Unacceptable Services

3.014 Business Associate Agreement

SECTION FOUR

Proposal Format and Content

4.01 Proposal Format and Content

4.02 Introduction

4.03 Understanding of the Scope of Work

4.04 Management Plan

4.05 Experience and Qualifications

4.06 Cost Proposal

4.07 Required Enclosures

SECTION FIVE

Award and Proposal Evaluation

5.01 Award

5.02 Responsiveness

5.03 Proposal Evaluation

5.04 Understanding of the Scope of Work

5.05 Management Plan

5.06 Experience and Qualifications

5.07 Cost Proposal

SECTION SIX

Standard Proposal Information

6.01 STATE Not Responsible for Preparation Costs

6.02 Conflict of Interest

6.03 Offer Held Firm

6.04 Amendments to Proposals and Withdrawal of Proposals

6.05 Alternate Proposals

6.06 Subcontractors

6.07 Joint Ventures

6.08 Disclosure of Proposal Contents and Compliance with North Dakota Open Records Laws

6.09 Right of Rejection

6.010 Clarification of Proposals - Discussions

6.011 Best and Final Offers

6.012 Preference Laws

6.013 Negotiations

6.014 Notice of Intent to Award – Offeror Notification of Selection

6.015 Protest and Appeal

ATTACHMENTS

Attachment A – North Dakota Medicaid State Plan 4.19-A Attachment B – Sample Purchase of Service Agreement Attachment C – Business Associate Agreement Attachment D – Cost Proposal Attachment E – Evaluation Tool

SECTION ONE

INTRODUCTION AND INSTRUCTIONS

1.01 Purpose of the RFP

The state of North Dakota, acting through its North Dakota Department of Health and Human Services, Medical Services Division (STATE) is soliciting proposals for an offeror to conduct an annual audit and reporting of the North Dakota Medicaid Disproportionate Share Hospital (DSH) program, calculate the annual hospital Upper Payment Limits (UPL) for Inpatient and Outpatient Hospital Services and Institutes of Mental Disease (IMD), calculate the annual Upper Payment Limit and Medicaid Institutional Payment Transparency reporting for Intermediate Care Facilities, calculate annual cost settlement amounts for Critical Access Hospitals (CAH), and calculate annual Medicaid Inpatient Utilization Rate (MIUR).

1.02 Procurement Officer Contact Information

The procurement officer is the point of contact for this RFP. All communication regarding this RFP must be directed to the procurement officer by email. Please do not add the procurement officer to any marketing distribution lists.

Procurement Officer: LeeAnn Thiel E-Mail: lthiel@nd.gov Phone: 701-328-4893 TTY Users Call: 7-1-1

Engaging in unauthorized communication or seeking to obtain information about an open solicitation with any state employee or official other than the responsible procurement officer or designee is sufficient grounds for suspension or debarment. [N.D.A.C. § 4-12-05-04(7)]

1.03 RFP Schedule

This schedule of events represents STATE’s best estimate of the schedule that will be followed for this RFP. If a component of this schedule, such as the Deadline for Receipt of Proposals, is delayed, the rest of the schedule will be shifted by the same number of days. The estimated RFP Schedule is as follows:

Secretary of State Registration, if determined to be required

1.04 Assistance to Individual with a Disability

Contact the procurement officer, as soon as possible, if an individual with a disability needs assistance with this RFP, including any events in the RFP Schedule, so reasonable accommodations can be made.

1.05 Secretary of State Registration Requirements

The North Dakota Secretary of State has registration requirements for individuals and businesses transacting business in North Dakota. If the successful Offeror is determined to have a registration requirement with the North Dakota Secretary of State, they must be registered before the contract award and registration must remain active for the duration of the contract period (N.D.C.C. § 54-44.4-09.1).

· See the OMB Guidelines to Vendor Registry for more information.

Visit the Secretary of State's Vendor Registration webpage for information on registration requirements and fees. Visit FirstStop, the Secretary of State's business and licensing software, for online form options.

· Check the Business Records database to see if a business is registered.

· Contact Secretary of State's office by email or call 701-328-2900 (choose menu item 2, then option 1).

· If you need to register, fees apply.

· Vendors may need to obtain businesses licenses. See the list of licenses required of businesses in the State of North Dakota. The link includes information on who to contact, application fees, renewal dates, and the legal reference.

1.06 Bidders List Registration

Individuals or business entities desiring to be notified of bidding opportunities may apply to be placed on the Bidders List. (N.D.C.C. § 54-44.4-09) Bidders Lists are used to notify vendors when solicitations are issued on the State Procurement Office Online system (SPO Online). Placement on the Bidders List does not guarantee a vendor will receive notice of every solicitation (N.D.A.C. § 4-12-05-01). There are no fees to register as a bidder. The online application form requests contact information for the receipt of solicitation notices. The Bidders List application and SPO Online system use commodity codes to identify categories of goods, services, and information technology.

The commodity code used for this solicitation is: 918 - 04

Visit the OMB website for instructions and the online Bidders List Application: Bidders List Registration Website

For assistance with Bidders List Registration, contact State Procurement Help Desk at 701-328-1728 or infospo@nd.gov.

1.07 Notice Provided

This RFP, and any related amendments and notices, will be posted on North Dakota’s OMB’s website using SPO Online. Offerors are responsible for checking this website to obtain all information and documents related to this RFP:

https://apps.nd.gov/csd/spo/services/bidder/main.htm

Select “Recent Solicitations”. Recent Solicitations are listed by close date (see Deadline for Receipt of Proposals date in Section 1.03 RFP Schedule).

Notices related to this RFP will be sent to the Bidders List for the needed commodity or service and other known potential offerors.

Offerors not having completed the Bidders List registration may request to receive notices related to this RFP by contacting the Procurement Officer, by email, with the following information: RFP title, business name, contact person, mailing address, telephone number, and email address.

This RFP will also be posted on the North Dakota Department of Health and Human Services website: Solicitation Notice | Health and Human Services North Dakota

1.08 Pre-Proposal Conference or Site Inspection

No pre-proposal conference or site inspection will be held for this RFP.

1.09 Deadline for Submission of Questions and Objections

Offerors should carefully review this RFP, including all attachments. Offerors may ask questions to obtain clarification and request additional information, or object to material in the RFP. Questions and objections must be submitted to the procurement officer, by email, by the deadline identified in the RFP Schedule. The RFP number should be cited in the email subject line. The procurement officer may elect to respond to questions received after the deadline.

Questions and objections should include a reference to the applicable RFP section or subsection.

Responses to questions will be distributed as a Solicitation Amendment, unless the question can be answered by referring the offeror to a specific section of the RFP.

1.10 Amendments to the RFP

If an amendment to this RFP is issued, it will be provided to all offerors on the Bidders List for the solicitation and to those prospective offerors who have contacted the procurement officer to receive notices related to the RFP. An offeror shall include in its proposal any required acknowledgements of amendments to the RFP.

1.11 Proposal Submission Instructions

UPLOAD RESPONSE THROUGH THE STATE PROCUREMENT ONLINE SYSTEM (SPO ONLINE):

Offeror must electronically submit proposals through the State Procurement Office Online system (SPO Online) by the Deadline for Receipt of Proposals.

DO NOT WAIT UNTIL THE “LAST MINUTE” TO SUBMIT A RESPONSE. It is recommended that proposals be uploaded 24 hours prior to the Deadline for Receipt of Proposals.

Offeror must begin the electronic submission process well in advance of the Deadline for Receipt of Proposals to allow for transmission and resolution of any technical difficulties. Be advised that the STATE is not responsible for an offeror’s failure to timely submit a proposal due to any technical difficulties. If you experience any technical difficulties contact the Procurement Officer or the State Procurement Office at infospo@nd.gov or 701.328.2740.

If documents are in the process of being uploaded when the Deadline for Receipt of Proposals occurs, the upload process will stop. The attempted submission will not be uploaded successfully and is ineligible for consideration. The STATE takes no responsibility for electronic submissions that are captured, blocked, filtered, quarantined, or otherwise prevented from uploading by any anti-virus or other security software.

1. This solicitation is posted on SPO Online at: https://apps.nd.gov/csd/spo/services/bidder/main.htm

2. Select “Recent Solicitations” and find this solicitation. Solicitations are listed by close date.

3. Use “Upload Response” to upload a maximum of five (5), clearly labeled documents before the Deadline for Receipt of Proposals provided in the RFP Schedule.

4. Offeror must upload their Technical Proposal and Cost Proposal in separate files.

5. The maximum file size allowed is 50mb per file.

6. There is a 50-character file name limitation for the document being uploaded.

7. There is a 75-character limit in the TITLE field within SPO Online.

8. All SPO Online field entries must be alphanumeric. Dashes and underscores are allowed; however, the system DOES NOT accept other special characters, such as apostrophe, & symbol, quotation marks, etc.

9. DO NOT submit documents that are embedded (zip files), movies, wmp, encrypted, or mp3 files.

10. Offeror will receive an email confirmation from infospo@nd.gov that the upload response was received including the “File Description” for the uploaded files. Review this email to ensure all files were successfully uploaded. If offeror DOES NOT receive an email confirmation, the upload was NOT successful, and the files will need to be uploaded again. If offeror does not receive an email confirmation after the reattempt, contact the Procurement Officer or the State Procurement Office at infospo@nd.gov or 701.328.2740.

Visit https://www.omb.nd.gov/sites/www/files/documents/doing-business-with-the-state/procurement/spo-electronic-response-external-job-aid.pdf for the SPO Electronic Response Job Aid which describes how to submit an electronic response.

1.12 Proposal Receipt Deadline – Late Proposals Rejected

An offeror is responsible for ensuring its proposal is received by STATE prior to the Deadline for Receipt of Proposals identified in Section 1.03 RFP Schedule. A Solicitation Amendment will be issued if this deadline is changed. An offeror may contact the procurement officer to inquire whether its proposal has been received. Offerors assume the risk of the method of dispatch chosen. STATE assumes no responsibility for delays caused by any delivery service. Postmarking by the Deadline for Receipt of Proposals shall not substitute for actual proposal receipt by STATE. Proposals delivered late will be rejected pursuant to N.D.A.C. § 4-12-08-13.

1.13 Proposal Opening

This is a formal sealed RFP process. Proposals will be secured and held unopened until the Deadline for Receipt of Proposals. A public opening will not be held.

1.14 News Releases

An offeror shall not make any news releases related to this RFP without prior approval of the procurement officer.

1.15 Attempt to Influence Prohibited

Offerors must not give or offer to give anything to a state employee or official anything that might influence, or appear to influence, procurement decisions. Suspected attempt to influence will be handled in accordance with N.D.A.C. § 4-12-04-05.

1.16 Collusion Prohibited

Offerors must prepare proposals independently, without collusion. Suspected collusion will be handled in accordance with N.D.A.C § 4-12-04-06.

1.17 Specifications Prepared by Non-State Personnel

When a purchasing agency has specifications prepared by someone other than a state employee or official on behalf of the STATE, that person or business entity must be excluded from submitting bids or proposals in accordance with N.D.A.C. § 4-12-06-06.

1.18 Supplier Registration (Payee)

The successful offeror will be required to complete Supplier Registration, if not already registered as a Supplier. Any individual or business who will be receiving payment from a state agency or higher education institution must complete a registration process to collect important financial and taxpayer information. Payments are generally made by check or automatic clearing house (ACH), and taxpayer information must be collected in compliance with IRS requirements. The State and North Dakota University System (NDUS) have separate financial systems and vendor registration processes.

SECTION TWO

SCOPE OF WORK

2.01 Background Information

North Dakota has six Prospective Payment System (PPS) hospitals, 36 CAH, two psychiatric hospitals, two long-term acute care hospitals, and two rehabilitation hospitals.

Instate PPS inpatient hospital services are paid based on classification to a Diagnosis-Related Group (DRG). The current DRG classification and grouper system is 3MTM All Patient Refined Diagnosis Related Groups (APR DRG) version 39. PPS outpatient hospital services are paid based on episode using 3MTM Enhanced Ambulatory Payment Grouping (EAPG) system version 3.17.

Inpatient hospital services furnished by an instate CAH are reimbursed based on the Medicare interim payment rates less 1% and are subject to cost settlement. Outpatient hospital services, exclusive of lab and professional services, furnished by a CAH are reimbursed on a percentage of charges. Outpatient hospital services furnished by a CAH are subject to cost settlement.

Inpatient services furnished by a long-term acute care hospital are paid using a percentage of charges.

Inpatient psychiatric services are paid based on a fixed per diem rate.

Inpatient rehabilitation services are paid based on a fixed per diem rate.

A copy of the current North Dakota Medicaid State Plan for DSH is included as Attachment A – North Dakota Medicaid State Plan 4.19-A.

Section 1923 of the Social Security Act requires states to make DSH payments to hospitals serving disproportionate numbers of low-income patients with special needs. Payments exceeding the hospital specific DSH limit, generally considered as the amount of incurred uncompensated care costs, are prohibited.

Section 1923(j)(2) of the Social Security Act requires states to have their DSH payment programs independently audited and submitted annually to the Centers for Medicare and Medicaid Services (CMS). The audits conducted must meet the requirements of 42 CFR parts 447 and 445. CMS has developed a General DSH Audit and Reporting Protocol, which the successful offeror shall use to comply with this rule. Successful offeror must incorporate any subsequent guidance issued by CMS for DSH into the annual audit and report.

Each report and audit must be completed by September 30th of the year ending three years from the end of the Medicaid State Plan rate year under audit. Each audit report must be submitted to CMS within 90 days of the completion of the audit.

North Dakota issued DSH payments to four hospitals in federal fiscal year 2023 and two hospitals in federal fiscal year 2024.

An annual calculation of the UPL for inpatient and outpatient hospital services is required by 42 CFR § 447.272.

North Dakota has 69 in-state licensed private Intermediate Care Facilities (ICF) and one state-owned ICF. Services are reimbursed based on an individual per diem acuity-adjusted rate.

2.02 Scope of Work

STATE is seeking an offeror to perform all five deliverables identified in this RFP.

Deliverable One: Annual Certified Audit of the DSH Program

1. Successful offeror shall complete an independent certified audit of the DSH program incorporating current CMS standards.

2. Successful offeror shall prepare a DSH report according to the most current CMS specifications.

3. Successful offeror shall submit a DSH report to STATE by September 30, 2026, including each hospital that received a DSH payment from STATE for Medicaid State Plan year 2023.

4. Successful offeror shall submit a DSH report to STATE by September 30, 2027, including each hospital that received a DSH payment from STATE for Medicaid State Plan year 2024.

5. DSH reports for subsequent contract renewals are due to STATE by September 30 of the third year following each state plan year.

Deliverable Two: Annual Hospital UPL for Inpatient and Outpatient Services and IMD

1. Successful offeror shall perform separate UPL calculations annually for:

a. Inpatient hospital services for PPS hospitals,

b. Inpatient hospital services for CAH,

c. IMD,

d. Outpatient hospital services for PPS hospitals, and

e. Outpatient hospital services for CAH.

2. Determination of the UPL must follow Medicaid UPL guidance and federal regulations. The UPL calculation on the CMS required forms and supporting documentation shall be submitted to STATE.

3. Successful offeror shall provide responses to the UPL guidance questions for each of the UPL demonstrations.

4. Successful offeror shall submit to STATE the UPL calculations for state fiscal year ending June 30, 2026, by June 1, 2026.

5. Successful offeror shall submit to STATE the UPL calculations for state fiscal year ending June 30, 2027, by June 1, 2027.

6. Submission of calculations of the UPL for subsequent contract renewal periods must be submitted by June 1 of the applicable state fiscal year ending June 30th.

Deliverable Three: ICF UPL and Medicaid Institutional Payment Transparency

1. Successful offeror shall perform separate UPL calculations annually for ICFs.

2. Determination of the UPL must follow Medicaid UPL guidance and federal regulations. The UPL calculation on the CMS required forms and supporting documentation shall be submitted to STATE.

3. Successful offeror shall provide responses to the UPL guidance questions for the ICF UPL demonstration.

4. Successful offeror shall submit to STATE the UPL calculation for state fiscal year ending June 30, 2026, by June 1, 2026.

5. Successful offeror shall submit to STATE the UPL calculations for state fiscal year ending June 30, 2027, by June 1, 2027.

6. Submission of calculations of the UPL for subsequent contract renewal periods must be submitted by June 1 of the applicable state fiscal year ending June 30th.

7. Successful offeror shall work with STATE to develop a cost report that provides the necessary information to perform UPL calculations and Medicaid Institutional Payment Transparency calculations. The cost report template will need to include entities’ other lines of business.

8. Successful offeror shall provide training to providers on completion of the cost report and federal regulations for Medicaid Institutional Payment Transparency.

9. Successful offeror shall work with STATE to identify the level of auditing necessary for ICF cost reports.

10. Successful offeror shall perform calculations for Medicaid Institutional Payment Transparency annually for ICF. Calculations must comply with CMS guidance.

11. Successful offeror shall perform cost settlement for state-owned ICF annually.

Deliverable Four: Annual Cost Settlement of CAH

1. Successful offeror shall calculate the amount due to or from STATE for cost settlement for inpatient and outpatient services provided by CAH using audited Medicare cost reports.

a. Successful offeror will be responsible for obtaining Medicare cost reports from fiscal intermediaries.

b. STATE will provide Medicaid Provider Statistical Reports (PS&R) for inpatient and outpatient hospital services. Professional fees will not be cost settled.

c. Certified Registered Nurse Assistant (CRNA) services and laboratory serves shall be cost settled. The cost settlement for these services must be reported separately.

d. Calculation of the cost settlement shall incorporate the provider’s charge master.

2. Successful offeror shall issue to STATE a cost settlement report, for each hospital subject to cost settlement, no later than 90 days following receipt of Medicare cost report from the fiscal intermediary and PS&R report from STATE. Cost settlement report shall include the following:

a. Name of hospital and Medicaid Provider Number.

b. Cost settlement period. Cost settlements shall be made based on provider's fiscal year.

c. Amount due to or from hospital for inpatient and outpatient services for Title XIX.

d. Amount due to or from hospital for CRNA services and lab services for Title XIX.

Deliverable Five: Calculation of MIUR

1. Successful offeror shall calculate the MIUR in accordance with Section 1923(b)(1)(A) of the Social Security Act.

2. No later than June 1, 2026, successful offeror shall submit to STATE the MIUR calculation for state fiscal year 2025. Successful offeror shall submit to STATE the MIUR calculation for state fiscal year 2026 no later than June 1, 2027.

3. Submission of MIUR calculations for subsequent contract renewal periods must be submitted by June 1 for the prior state fiscal year.

Successful offeror shall submit a final detailed work plan prior to implementation that includes all the activities required to begin work under the contract resulting from this RFP. The final plan must contain a project timeline with milestones and steps necessary to implement the certified independent audits, calculation of the hospital UPLs, calculation of the ICF UPL and Medicaid Transparency, CAH cost settlement, and calculation of MIUR. The final detailed work plan must be submitted to STATE within 20 calendar days of the execution of the contract.

2.03 Location of Work

STATE will not provide workspace for the successful offeror.

The successful offeror shall provide office space, supplies, telecommunication equipment, computer, and any necessary software or other supplies to carry out the scope of work.

2.04 Prior Experience

Successful offeror must have a minimum of five consecutive years of experience in: governmental accounting; professional rules and generally accepted standards of audit practice; Medicare and Medicaid cost reports; hospital-specific limit calculations; Medicaid DSH payments; Medicaid DSH audits; payment methodologies; interpretation of CMS rules; and UPL calculations for hospital services. Offerors must include information for any major subcontractors or suppliers. Offerors must submit a list of previous and current long-term Medicaid accounts whose scope of work is considered similar to the scope of work included in this RFP.

A proposal that does not identify its prior experience may cause the STATE to consider the proposal nonresponsive and the STATE may reject the proposal.

2.05 Required Licenses

Successful offeror must be a Certified Public Accountant (CPA) firm whose principals are licensed to practice in any jurisdiction within the United States and are in good standing with that state's Professional Licensure Board, or a CPA who is licensed to practice in any jurisdiction within the United States and is in good standing with that state's Professional Licensure Board. Offeror must include necessary proof in their cover letter. A proposal that does not identify its required licenses may cause the STATE to consider the proposal nonresponsive and the STATE may reject the proposal.

By the Deadline for Receipt of Proposals, an offeror must have and keep current any professional licenses and permits required by federal, state, and local laws for performance of a contract entered as a result of this RFP. An offeror who does not possess required licenses at the time proposals are due will be determined non-responsive.

2.06 Federal and State Requirements

An offeror shall identify all known federal and state requirements that apply to the proposal, the evaluation, or the contract to be entered as a result of this RFP.

SECTION THREE

GENERAL CONTRACT INFORMATION

3.01 Contract Term, Extension, and Renewal Options

STATE intends to enter a contract effective January 1, 2026, through December 31, 2027.

STATE may extend the contract period for an additional period of time, not to exceed 12 months, beyond the normal expiration date of the contract, upon mutual written agreement by both parties.

The contract resulting from this RFP may be renewed upon satisfactory completion of the initial contract term. STATE reserves the right to renew the contract for up to three additional periods, each period of renewal being for 24 months, upon written agreement by both parties. The contract will not automatically renew. STATE will provide written notice to the successful offeror of its intent to renew this contract at least 30 days before the contract’s expiration date. The estimated dollar amount for renewal options is dependent upon legislative appropriation. STATE and successful offeror may negotiate the firm fixed deliverable costs at each renewal option.

3.02 Contract Type

A contract resulting from this RFP is a Firm Fixed Price. Successful offeror will be required to hold the price firm for the contract period, except as otherwise provided in the contract.

3.03 Standard Contract Provisions

The successful offeror will be sent a contract to sign and return to STATE. The successful offeror shall comply with the contract provisions set out in the “Sample Purchase of Service Agreement” document, attached as Attachment B, and made a part of this RFP. An offeror may state any objections or propose changes or additions to the Sample Purchase of Service Agreement. Describe the changes to the contract being proposed or provide a red-line of STATE’s Sample Purchase of Service Agreement. Offerors are not to submit their own contract or standard terms and conditions with their proposals. Offerors should address the specific language in the attached Sample Purchase of Service Agreement and submit any proposed changes with an offeror’s proposal.

North Dakota procurement statutes, rules, and policies allow some negotiation of the terms and conditions. No changes to the terms and conditions will be permitted without prior written approval from STATE.

3.04 Proposal as a Part of the Contract

Part or all of this RFP and the successful offeror’s proposal may be incorporated into any contract resulting from this RFP.

3.05 Additional Terms and Conditions

STATE reserves the right to add, delete, or modify terms and conditions during contract negotiations. These terms and conditions will be within the scope of the RFP and will not affect the proposal evaluations.

3.06 Supplemental Terms and Conditions

A proposal that includes supplemental terms and conditions may be accepted, but acceptance of the proposal does not constitute acceptance of supplemental terms and conditions that conflict with those contained in this RFP or that diminish STATE's rights under any contract resulting from the RFP. STATE reserves the right to consider these types of terms and conditions null and void. STATE is not responsible for identifying conflicting supplemental terms and conditions before issuing a contract award. After award of contract:

A) if conflict arises between a supplemental term or condition included by the offeror in its proposal and a term or condition of the RFP, the offeror agrees that the term or condition of the RFP will prevail; and B) if the result of the application of a supplemental term or condition included in the proposal would diminish STATE's rights, the supplemental term or condition will be considered null and void.

3.07 Contract Approval

This RFP, by itself, does not obligate STATE. STATE’s obligation will commence when it signs the contract but not earlier than the contract start date. Upon written notice to the successful offeror, STATE may set a starting date for a contract resulting from this RFP, which is different from the Contract Start Date set out in Section 1.03 RFP Schedule and Section 3.01 Contract Term, Extension, and Renewal Options. STATE is not responsible for reimbursing the successful offeror for any work, even work done in good faith, if the work occurs prior to the contract start date set by STATE.

3.08 Contract Changes – Unanticipated Amendments

During the course of a contract resulting from this RFP, the successful offeror may be required to perform additional work due to a legitimate unforeseen circumstance. That work will be within the general scope of the initial contract. When additional work is required, STATE shall provide the successful offeror a written description of the additional work and request the successful offeror to submit a proposal for accomplishing the additional work. The successful offeror shall not begin the additional work until STATE has approved the additional work and signed a written contract amendment.

3.09 Taxes and Taxpayer Identification Number

The successful offeror shall provide STATE with a valid Vendor Taxpayer Identification Number as a provision of the contract resulting from this RFP.

STATE is not responsible for and will not pay itemized local, state, or federal taxes. Purchases of tangible personal property made by a state government agency is exempt from sales tax. STATE’s sales tax exemption number is E-2001, and STATE will furnish certificates upon request. The state tax exemption number should not be used by the successful offeror in the performance of the contract resulting from this RFP.

STATE will determine if services provided under the contract resulting from this RFP are 1099 reportable. STATE may require the successful offeror to submit an IRS Form W-9.

A vendor performing any contract, including service contracts, for the United States Government, state of North Dakota, counties, cities, school districts, park board, or any other political subdivisions within North Dakota is not exempt from payment of sales or use tax on materials, tangible personal property, and supplies used or consumed in carrying out contracts. In these cases, the vendor is required to file returns and pay sales and use tax just as required for contracts with private parties. Contact the North Dakota Tax Department at 701-328-1246 or visit its website at https://www.nd.gov/tax/tax-resources/ for more information.

A vendor performing any contract, including a service contract, within North Dakota is also subject to the corporation income tax, individual income tax, and withholding tax reporting requirements, whether the contract is performed by a corporation, partnership, or other business entity, or as an employee of the vendor. In the case of employees performing the services in the state, the vendor is required to withhold state income tax from the employees' compensation and remit to the state as required by law. Contact the North Dakota Tax Department at 701-328-1248 or visit its website for more information.

3.10 Proposed Payment Procedures

STATE will issue payment within 30 days after receipt of the request for reimbursement and required reporting, except that no payment will be made until the reimbursement and reporting have been approved by STATE.

STATE will not make any advance payments before performance of services by the successful offeror under a contract resulting from this RFP.

3.11 Contract Personnel

STATE must approve any change of the successful offeror’s project team members named in the proposal, in advance and in writing. Personnel changes that are not approved by STATE may be grounds for STATE to terminate the contract.

3.12 Right to Inspect Place of Business

At reasonable times, STATE may inspect those areas of the successful offeror’s place of business which are related to the performance of a contract resulting from this RFP. If STATE makes an inspection, the successful offeror must provide reasonable assistance.

3.13 Inspection & Modification – Reimbursement for Unacceptable Services

The successful offeror is responsible for the completion of all work set out in a contract resulting from of this RFP. All work is subject to inspection, evaluation, and approval by STATE. STATE may employ all reasonable means to ensure that the work is progressing and being performed in compliance with a contract resulting from this RFP.

If STATE determines that corrections or modifications are necessary for performance of a contract resulting from this RFP, STATE may direct the successful offeror to make changes. The successful offeror will not unreasonably withhold changes.

Substantial failure of the successful offeror to perform a contract resulting from this RFP may cause STATE to terminate a contract. If STATE terminates a contract resulting from this RFP because the successful offeror fails to perform the contract, STATE may require the successful offeror to reimburse monies paid (based on the identified portion of unacceptable work received) and may seek associated damages.

3.14 Business Associate Agreement

A successful offeror is a "business associate" of STATE and must comply with all of the requirements for a business associate under the Health Insurance Portability and Accountability Act and the Health Information Technology for Economic and Clinical Health Act and the regulations issued pursuant to the Health Insurance Portability and Accountability Act and the Health Information Technology for Economic and Clinical Health. Successful offeror shall sign a Business Associate Agreement (Attachment C) with the North Dakota Department of Health and Human Services, and provide assurance that it has similar agreements with any subcontractor providing services on behalf of successful offeror in connection with any services provided to successful offeror by a subcontractor related to a contract resulting from this RFP.

An offeror may state any objections or propose changes or additions to the Business Associate Agreement. Describe the changes to the Business Associate Agreement being proposed or provide a red-line of STATE’s Business Associate Agreement. Offerors are not to submit their own contract or standard terms and conditions with their proposals. Offerors should address the specific language in the attached Business Associate Agreement and submit any proposed changes with an offeror’s proposal.

SECTION FOUR

PROPOSAL FORMAT AND CONTENT

4.01 Proposal Format and Content

STATE discourages overly lengthy proposals. For STATE to evaluate proposals fairly and completely, offeror shall follow the format set out in this RFP and provide all information requested. If an offeror submits more than one proposal, each proposal must be prepared in accordance with these instructions.

Each proposal will include a technical proposal and a cost proposal prepared in accordance with these instructions. The technical proposal and cost proposal must be submitted as separate documents, clearly labeled with the name of the offeror and marked “Technical Proposal” and “Cost Proposal.” Costs must not be revealed in the technical proposal.

4.02 Introduction

Proposals must include the complete name and address of offeror’s firm and the name, email address, mailing address, and telephone number of the person STATE should contact regarding the proposal.

An offeror shall identify its prior experience of having a minimum of five consecutive years of experience in: governmental accounting; professional rules and generally accepted standards of audit practice; Medicare and Medicaid cost reports; hospital-specific limit calculations; Medicaid DSH payments; Medicaid DSH audits; payment methodologies; interpretation of CMS rules; and UPL calculations for hospital services. Offerors are to include information for any major subcontractors or suppliers. Offerors are to submit a list of previous and current long-term Medicaid accounts whose scope of work is considered similar to the scope of work included in this RFP. A proposal that does not identify its prior experience may cause the STATE to consider the proposal nonresponsive and the STATE may reject the proposal.

An offeror shall provide proof that it is a CPA firm whose principals are licensed to practice in any jurisdiction within the United States and are in good standing with that state's Professional Licensure Board or a CPA who is licensed to practice in any jurisdiction within the United States and is in good standing with that state's Professional Licensure Board. A proposal that does not identify its required licenses may cause the STATE to consider the proposal nonresponsive and the STATE may reject the proposal.

Offerors are instructed to review Section 6.02 Conflict of Interest. If the firm, its employees, or subcontractors working on the contract have an apparent or actual conflict of interest, provide a statement disclosing the circumstances of the apparent or actual conflict of interest. Otherwise, provide a statement that your firm, employees, and subcontractors do not have a conflict of interest.

Offerors are instructed to review Section 6.08 Disclosure of Proposal Contents and Compliance with North Dakota Open Records Law. An offeror shall provide a statement indicating that their proposal does not contain any confidential information or make a written request to hold confidential any trade secrets and other proprietary data contained in their proposals.

Proposals must confirm that the offeror will comply with all provisions in this RFP. Proposals must be signed by an individual with authority to bind the offeror. By signing the cover letter, an offeror certifies that it complies with:

If an offeror fails to comply with this paragraph, STATE reserves the right to reject the proposal. If the offeror who is awarded the contract resulting from this RFP fails to comply with this paragraph, STATE also reserves the right to terminate the contract or consider the successful offeror in default.

4.03 Understanding of the Scope of Work

An offeror shall demonstrate a thorough understanding of the purpose and requirements of the scope of work.

An offeror shall provide a detailed plan that will be sufficient to accomplish the requirements of this RFP.

An offeror shall demonstrate a thorough understanding of the DSH audit process and independent audit report requirements.

An offeror shall demonstrate a thorough understanding of the UPL requirements for PPS hospitals and IMD.

An offeror shall demonstrate a thorough understanding of the cost settlement requirements for CAHs and state-owned ICF.

An offeror shall demonstrate a thorough understanding of the Medicaid Institutional Transparency requirements.

An offeror shall demonstrate a thorough understanding of the MIUR calculation.

An offeror shall indicate in their proposal that they can meet the report deadlines specified.

4.04 Management Plan

An offeror shall provide a management plan that supports all the requirements of this RFP.

An offeror shall provide a management plan that illustrates the lines of authority and communication.

An offeror shall identify the designated staff members responsible and accountable for the completion of each component of the RFP.

An offeror shall disclose any instances where the firm or any individuals working on the contract resulting from the RFP has a possible conflict of interest, and, if so, the nature of that conflict (e.g. employed by state of North Dakota).

4.05 Experience and Qualifications

An offeror shall demonstrate experience with performing a DSH audit.

An offeror shall demonstrate experience with performing UPL calculations.

An offeror shall demonstrate experience with performing hospital cost settlements.

An offeror shall demonstrate its proven ability to effectively work with other Medicaid agencies for similar work.

An offeror shall describe its experience and how the experience applies to the work required in this RFP.

An offeror shall identify their capacity to complete the work identified in this proposal.

4.06 Cost Proposal

An offeror shall provide a cost proposal that follows the same format of the “Cost Proposal” document, attached as Attachment D, and made a part of this RFP.

An offeror shall submit an annual amount for each Deliverable for the first year (January 1, 2026, through December 31, 2026), and second year (January 1, 2027, through December 31, 2027) to provide Deliverable One: Annual Certified Audit of the DSH Program, Deliverable Two: Annual Hospital UPL for Inpatient and Outpatient Services and IMD, Deliverable Three: ICF UPL and Medicaid Institutional Payment Transparency, Deliverable Four: Annual Cost Settlement of CAH, and Deliverable Five: Calculation of MIUR, and the total amount for all five Deliverables for the first and second years (January 1, 2026, through December 31, 2027).

The Cost Proposal must consider STATE’s standard terms and conditions included in this RFP. Offeror must state all associated costs in U.S. currency.

A cost proposal that does not follow the format in Attachment D may be considered nonresponsive and may be rejected.

4.07 Required Enclosures

An offeror’s failure to provide all documents and information specifically required in this RFP or an offeror’s failure to sign the documents as required, may cause the proposal to be considered nonresponsive and may be rejected.

SECTION FIVE

AWARD AND PROPOSAL EVALUATION

5.01 Award

STATE intends to award a contract to the responsible offeror whose proposal is determined to be responsive to the requirements of the solicitation and is determined to be most advantageous in consideration the RFP evaluation criteria.

5.02 Responsiveness

All proposals will be evaluated to determine if they are responsive to the requirements of the solicitation. STATE reserves the right to waive minor informalities in accordance with N.D.A.C. chapter 4-12-10. Minor informalities are insignificant omissions or nonjudgmental mistakes that are matters of form rather than substance, evident from RFP document, with a negligible effect on price, quantity, quality, delivery, or contractual conditions that can be waived or corrected without prejudice to other offerors. Responsive proposals will be evaluated by the procurement officer or evaluation committee using the evaluation criteria stated in the RFP.

5.03 Proposal Evaluation

The Evaluation Tool, which is attached as Attachment E, will be the scoring tool used to score proposals. The total number of points used to score this proposal is 100 points. The technical proposal evaluation score and cost proposal evaluation score will be added together to determine the total evaluation score. The final evaluation score may consider information received by STATE, including, but not limited to, discussions with offerors, reference checks, and best and final offers.

5.04 Understanding of the Scope of Work

Forty (40) of the total possible evaluation points will be assigned to this criterion.

Proposals will be evaluated against the questions set out below:

A) How well does the offeror demonstrate a thorough understanding of the purpose and requirements of the scope of work?

B) How well does the offeror detail a plan that will be sufficient to accomplish the requirements of this RFP?

C) How well does the offeror demonstrate a thorough understanding of the DSH audit process and independent audit report requirements?

D) How well does the offeror demonstrate a thorough understanding of the UPL requirements for PPS hospitals and IMD?

E) How well does the offeror demonstrate a thorough understanding of the cost settlement requirements for CAHs and state-owned ICF?

F) How well does the offeror demonstrate a thorough understanding of the Medicaid Institutional transparency requirements?

G) How well does the offeror demonstrate a thorough understanding of the MIUR calculation?

H) Has the offeror indicated in their proposal that they can meet the report deadlines specified?

5.05 Management Plan

Fifteen (15) of the total possible evaluation points will be assigned to this criterion.

Proposals will be evaluated against the questions set out below:

A) How well does the management plan support all the requirements of this RFP?

B) Does the management plan illustrate the lines of authority and communication?

C) Has the offeror identified the designated staff members responsible and accountable for the completion of each component of the RFP?

D) Has the offeror disclosed any instances where the firm or any individuals working on the contract resulting from the RFP has a possible conflict of interest and, if so, the nature of that conflict (e.g. employed by State of North Dakota)?

5.06 Experience and Qualifications

Thirty (30) of the total possible evaluation points will be assigned to this criterion.

Proposals will be evaluated against the questions set out below:

A) How well does the offeror demonstrate its experience with performing a DSH audit?

B) How well does the offeror demonstrate its experience with performing UPL calculations?

C) How well does the offeror demonstrate its experience with performing hospital cost settlements?

D) Has the offeror demonstrated a proven ability to effectively work with other Medicaid agencies for similar work?

E) How well does the offeror describe its experience and how the experience applies to the work required in this RFP?

F) Has the offeror identified their capacity to complete the work identified in this proposal?

5.07 Cost Proposal

Fifteen (15) of the total possible evaluation points will be assigned to cost.

The reciprocal preference law, N.D.C.C. § 44-08-01, was repealed effective August 1, 2023.

The proposal with the lowest total amount for all five deliverables (January 1, 2026, through December 31, 2027) will receive the maximum number of points allocated. The point allocations for cost on the other proposals will be evaluated and determined as follows:

· Lowest Total Amount for all Five Deliverables Cost being rated X Total Points for Cost Available = Awarded Points

In the event, N.D.C.C. § 54-44.4-05.1 requires that if two or more proposals contain identical pricing or receive identical evaluation scores,…