T1932 Exhibit E Performance Standards 5.29.26.docx
DOCX document 114 KB Posted
- Solicitation number
- 26DPP01212
- Issued by
- New Jersey
About this file
This Performance Standards Document for the Contracted System Administrator (CSA) serves the New Jersey Department of Children and Families (DCF) Division of Child Behavioral Health Services (CSOC) and outlines comprehensive operational and performance metrics for the statewide Children's System of Care. The CSA is responsible for managing a complex integrated system serving children, youth, and young adults requiring behavioral health, developmental disability, and related services across New Jersey. Key deliverables include maintaining a 24/7/365 call center with 30-second answer time standards, operating a Management Information System (MIS) supporting 2,500 simultaneous users and approximately 25,000 total users, managing eligibility determinations and authorizations, coordinating care across multiple service categories including crisis response, mobile response and stabilization services, out-of-home treatment, substance use treatment, and family support services, and producing approximately 300-500 reports and extracts as required. The contract encompasses a transition period from the incumbent CSA with system implementation planned for no later than November 1, 2025, and includes detailed performance standards for staffing, training, customer service, clinical operations, financial management, and system security with quarterly and monthly reporting requirements throughout the contract term.
The performance standards establish specific quantitative metrics and timeframes across all operational areas, including 95% compliance rates for customer service functions, 98% accuracy requirements for Medicaid eligibility matching, maximum response times ranging from 10 seconds for emergency calls to five business days for various clinical reviews, and monthly or quarterly submission of reports covering activity performance, financial data, quality improvements, and system analytics. The CSA must maintain a designated Executive Director as full-time Program Manager, retain minimum staffing levels including at least two full-time training specialists and bilingual/multicultural staff available during business hours with 24/7 interpreter services, conduct annual independent financial audits and triennial operational audits, maintain comprehensive business continuity and disaster recovery plans with 24-hour data recovery capability, and provide weekly project status reports during the transition period. All performance metrics are subject to quarterly and annual reviews, with the contractor required to implement measurement and quality improvement plans within 12 months of contract start and resubmit these plans annually by January 30th.
View the file
Other files
Show all 18
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Performance Standards Document for the CSOC Contracted System Administrator (CSA)
| Item # |
| Performance Standard |
| Metric Expected Task Frequency |
| Metric Achieved |
Task Completed (Yes/No)
| Report to CSOC |
| Referenced Report # or Comment |
| Business Owner |
Administrative
General Requirements
| 1 |
| The Contractor will designate the Executive Director (or CSOC-approved temporary designee) as the full-time Program Manager (PM) within one (1) week of the contract award. The ED will serve as the PM throughout the life of the contract. |
| Within 1 week of contract award; Ongoing |
Ongoing
| 2 |
| The Contractor shall submit quarterly management reports in a form to be prescribed by DCF/DCSOC within five (5) business days of the end of each quarter. |
| Quarterly, within five (5) business days of the end of each quarter |
Quarterly
| 3 |
| The Contractor shall attend and participate in virtual and in-person meetings and committees with DCF/CSOC staff, CSOC providers, stakeholders, and other parties, as required by the State. |
| As required |
Monthly
| 4 |
| The Contractor shall participate in operational touchpoint meetings with DCF/CSOC at minimum monthly or as deemed necessary by CSOC. |
| Monthly or as deemed necessary |
Monthly
| 5 |
| The Contractor shall develop and maintain a protocol that addresses the process flow for receipt, review, approval, and implementation of all business rules. The Contractor shall report out monthly on all newly received business rules. |
| Ongoing |
Monthly
| 6 |
| The Contractor shall develop and maintain a business rule repository that is readily accessible to DCF/CSOC. |
| 7 |
| The Contractor shall produce the monthly voucher packet as both a hard copy and an electronic upload to SharePoint which shall be readily available to approved CSOC staff. |
Monthly
| 8 |
| The Contractor shall follow the established protocol for deliverables, including creation, submission, approval, and distribution, as outlined in the contract. |
| Ongoing |
| 9 |
| The Contractor shall report any problems and corrective actions within 48 hours. A complete report shall be submitted within one (1) week after reported issue. |
| 48 hours |
Report is submitted one week after reported issue.
Staffing
| 10 |
| The Contractor shall maintain sufficient personnel working and operating within the 10-15 mile radius of Trenton, NJ area as identified within the Contractor’s Work Model Plan. |
Monthly
| 11 |
| At least 50% of all new hire training/orientation will occur physically on-site at the Contractor’s office space. |
| 50% |
Quarterly
| 12 |
| The Contractor shall maintain adequate staff to endure timely ongoing enhancements and maintenance of the MIS system. |
Monthly
| 13 |
| The Contractor shall update and submit their Work Model Plan and all related policies annually or as deemed necessary by DCF/CSOC for review. The Contractor’s Work Model Plan shall include all required components outlined in contract. |
Annually or as deemed necessary by DCF/CSOC
| 14 |
| The Contractor will fully staff for management, implementation, and technical needs. |
Monthly
| 15 |
| State must be notified 48 hours of any major staffing changes throughout life of contract. |
| 48 hours |
48 hours
| 16 |
| The Contractor shall submit an annual report on all outside employment activities including employee name, outside employer information, and short job description. |
| Annually and |
upon hire
Annually
| 17 |
| Contractor shall maintain the guaranteed minimal staffing level included in the Contractor’s approved proposal to ensure the successful accomplishment of duties per contract. This will include, but not limited to, Call Center and Customer Service staff, executive and managerial staff, clinically licensed professionals, adequate training staff, DCPP dedicated unit staff, and contractor staff dedicated to the CSA. |
Monthly
| 18 |
| The Contractor shall provide a Position Control List on a monthly basis. |
| Monthly |
Monthly
| 19 |
| No changes to executive management or supervisory staff will be made without prior consultation with the State. |
As needed
| 20 |
| The Contractor shall provide bilingual/multi-cultural staff during regular business hours and the availability of an interpreter service 24/7. |
| Regular business hours/ 24/7 |
Monthly
| 21 |
| The Contractor will provide a robust training program for all CSA employees that includes instruction on the need for confidentiality and all related regulations, including HIPAA, 42, CFR-Part 2, etc. |
Annually
Staffing
| 22 |
| The Contractor shall have a sufficient number of qualified personnel to comply with all Quality Management requirements in a specified timeframe (as determined by DCF/CSOC). |
Staffing
| 23 |
| Throughout the life of the contract, the Contractor shall communicate to DCF/CSOC (within 48 hours) any changes in IT staffing and provide an updated organizational chart monthly. |
| 48 hours |
Monthly
Staffing
| 24 |
| The Contractor will review staffing with CSOC annually. |
| Annually |
Annually
Staffing
Training
| 25 |
| The Contractor shall insure that at minimum, two (2) full-time training specialists are hired and available to meet the training needs of all users, stakeholders, and providers. If key training staff are unavailable to conduct training, the contractor is responsible for ensuring that the training coverage is adequately prepared to cover the necessary training material. |
Minimum 2 full-time staff
| 26 |
| The Contractor shall work with, at minimum, three (3) advocacy groups in NJ, and DCF’s CSOC contracted parent peer providers to develop training on best practices in family engagement and interaction. |
| Minimum 3 NJ advocacy groups |
| 27 |
| The Contractor shall maintain and provide a complete set of any training and procedure manuals, web-based training, and orientation software, and any updates, and make them available to CSOC at all times. |
| 28 |
| The Contractor will provide training and support of all MIS functions relevant to the contractor referral process, paper and electronic service submission(s), and approval process. |
Monthly
| 29 |
| The Contractor must maintain procedural manuals in a current and updated manner so that as staff turnover occurs, new staff can be immediately effective within their job function. |
Annually
| 30 |
| All training documents that are publicly posted on the CSA website shall be reviewed and updated by the CSA annually. |
| Annually |
Annually
| 31 |
| The CSA shall provide training to providers, stakeholders, MIS users and State staff, both functional and technical, and others as deemed necessary by DCF/DCSOC to gain an understanding of the CSA operations and MIS system to support successful nitration with the CSA. New users should be trained on a regular basis (ongoing). |
| Ongoing |
Monthly
| 32 |
| Contractor will provide initial and ongoing training for functional and technical staff who work within DCF. This in addition to standard training for users, stakeholders, and providers. The contractor shall train State technical staff on the MIS system with the objective that State personnel must gain an in depth knowledge of the MIS data structures, logical data model, physical data model, data fields’ functional definitions as well as data fields’ location and usage in the system. |
| Initial and ongoing |
Monthly
| 33 |
| The contractor shall develop a Training and Orientation Plan that describes how the contractor will implement a comprehensive training and support program for providers, stakeholders, and State staff and others as deem necessary by DCF/CSOC to gain a clear understanding of the contractor operation and MIS system to support successful interaction with the contractor. This plan shall be updated and submitted annually. |
| Annually |
Annually
| 34 |
| The Contractor will provide functional training related to any system changes ongoing. |
| Ongoing |
| 36 |
| The Contractor shall train the DCF/DCSOC staff and other stakeholders in the use of the Contractor’s reporting tool. |
Monthly
| 37 |
| The Contractor must complete a metric to measure the success of training. At the completion of training, the Contractor will survey all training attendees with the CSA Training Evaluation Survey. |
Monthly
| 38 |
| 75% of the responses must rate “Excellent” (or equivalent to highest rating in each category). |
| 75% |
Monthly
| 39 |
| Minimal Requirements of survey include: a) Aspects of Trainer b) Aspects of Training Class Content c) Aspects of Training Organization Format, and d) Overall Experience |
Monthly
Establishing Medical Eligibility
| 40 |
| Provide Physician Certificates/Certification of Need as required. |
Monthly
| 41 |
| Develop a process with DCF/DCSOC, Medicaid, and Medicaid’s State Fiscal Agent) to coordinate benefits and collect information on private pay insurance coverage in coordination of care. |
Monthly
| 42 |
| In cases where the child, youth, young adult and their family/caregivers have private health insurance coverage, the contractor shall coordinate benefits and third-party liability in order to ensure that State and federal funds are used as the payers of last resort. |
Annually
Eligibility Management Responsibilities for 3560 Coverage
| 43 |
| The Contractor will be required to develop a database that contains DCF/DCSOC defined data elements including demographic data of the DCF/DCSOC only covered children, youth and young adults, to transmit elements of this eligibility data to OIT and/or the Division of Medical Assistance and Health Services, as needed. The eligibility system shall be able to provide periodic reports to DCF/DCSOC. |
| 44 |
| Example-Data on children, youth and young adults who have continuous 3560 coverage for extended periods of time, which means at a minimum, children, youth and young adults who have 3560 coverage for at least 10 months |
| 45 |
| The Contractor shall maintain and provide DCF/CSOC, a complete set of user and technical manuals, procedure manuals, web-based training and orientation software, CBT, CDs, and any updates, for the contractor operations, database, and systems. These materials shall be made available to DCF/CSOC at all times. |
| 46 |
| The Contractor shall develop procedures, manuals, forms and reports necessary for the smooth operation of the Telephone Call Center. |
Annually
| 47 |
| The Contractor shall help educate families on the CSOC-Only Medicaid process. |
| 48 |
| The Contractor shall be prepared to manually review Medicaid/NJ FamilyCare and DCF/CSOC-Only eligibility applications in order to determine eligibility for the CSOC-only coverage; |
| 49 |
| Routinely issue DCF/CSOC-Only coverage within 2 business days of the receipt of the material for review. |
| 2 business days |
Monthly
| 50 |
| Issue coverage by close of business hour if the request has been deemed urgent by CSOC. |
| Close of business hour |
Monthly
| 51 |
| Manage special programs and their requirements as result of recently approved Comprehensive waiver. |
Annually
Fiscal Requirements and Accountability
| 52 |
| The Contractor shall properly execute eligibility matching with Division of Medical Assistance, Health Services and/or private insurer for at least 98% of records. |
| 98% |
Monthly
| 53 |
| The Contractor shall ensure that all fiscal requirements are met and any changes in fiscal needs and circumstances are addressed quickly and appropriately. |
| Ongoing |
| 54 |
| Data views that allow for data mining, projections, and other fiscal needs must be made available nightly, weekly, and monthly (depending on the functional requirement) and must reflect the one to one relationship of children, youth, young adults, authorizations, providers, service time spans, etc. must be available to the State and must reflect information needed for tracking eligibility, authorizations and the actual utilization of services authorized. |
| Nightly, |
Weekly, Monthly
Monthly
| 55 |
| Prior Authorizations must be accurately transmitted by the contractor to the Fiscal Agent. Contractor shall provide accurate, timely, and complete integration of data between the two systems that is essential for operations. |
Monthly
| 56 |
| The Contractor and Fiscal Agent interchange is exceedingly important, as it generates significant federal match revenue for the State. Data must be performed with 100% accuracy. |
| 100% |
Monthly
| 57 |
| The Contractor shall use a federal match hierarchy in the assignment of primary eligibility to a youth. |
Quarterly
| 58 |
| The Contractor shall generate and provide reports of program utilization by Medicaid enrollees by program. |
Quarterly
| 59 |
| The Contractor’s records must be maintained. and, at a minimum, there must be regular backups of Contractor data made and available in order to facilitate the auditing of the Contractor operation. |
Annually
Customer Service and Call Center
Call Center
| 60 |
| Maintain a 24/7/365 day call center with access to a toll free (1-800/877) telephone answering system that will respond in person within 30 seconds throughout the life of the contract. |
24/7/365; Calls: 30 seconds
Monthly
| 61 |
| Coordinate the customer Call Center function allowing for staff to respond to inquiries twenty-four (24) hours per day, seven (7) days a week. |
| 24/7/365 |
Monthly
| 62 |
| Hours of Operation - Call Center functions required for facilitating service provision or crisis response must be available on a 24 hour, seven (7) days per week basis. |
| 24/7/365 |
| 63 |
| Bilingual/Multi Cultural Staff – The Contractor will have full time bilingual/multicultural staff available during regular business hours. |
| 64 |
| Translation Services - The CSA will utilize a language line translation system for callers whose primary language is not English. This service will be available 24/7/365. |
| 24/7/365 |
Monthly
| 65 |
| The Contractor shall provide a Telecommunicate Device for the Deaf (TDD) and relay systems. |
| Ongoing |
| 66 |
| Maintenance of current inventory, updated on a quarterly basis, of New Jersey’s provider network for all covered services that offers a choice of providers and a comprehensive array of services to children, youth, young adults and their family/caregivers. |
| Quarterly |
Quarterly
| 67 |
| Call Center abandonment rates shall not exceed three percent (3%) of all calls within the queue. |
| < 3% |
Monthly
| 68 |
| Call center abandonment rates shall not exceed five percent (5%) of all emergency calls contained within the queue. |
| < 5% |
Monthly
| 69 |
| Call Center average speeds to answer all calls shall not exceed thirty (30) seconds for all calls. |
| 30 seconds |
Monthly
| 70 |
| Waiting times within the queue shall not exceed three (3) minutes. |
| < 3 minutes |
Monthly
| 71 |
| Emergency calls identified through the telephone prompt must be answered within 10 seconds. Emergency calls are expedited immediately (within 10 seconds) for clinical triage and appropriate referral. |
| Within 10 seconds |
Monthly
| 72 |
| All non-emergency calls go to Customer Service (CS) within 30 seconds. |
| Within 30 seconds |
Monthly
| 73 |
| Answer 90% of calls within 30 seconds. |
| 90% of calls within 30 seconds |
Monthly
| 74 |
| Solicit routine input from stakeholders, including children, youth and young adults and their family/caregivers receiving services, that informs the Contractor about needed system improvements. |
Biannually
| 75 |
| Call Coaching (call monitoring) will be conducted on a regular basis for quality assurance purposes on each operator randomly a minimum of two (2) to five (5) hours per month and not all during the same shift. Information on call monitoring will be available to DCF/DCSOC at any time. |
| 2-5 hours per month |
Monthly
| 76 |
| Call coaching results will be recorded on a standard form and reported to DCF/DCSOC weekly during the first six (6) months and monthly post six (6) months. |
| Weekly/ |
Monthly
Monthly
| 77 |
| The Contractor shall develop and execute telephone and texting monitoring metrics related to Customer Service staff performance and submit monthly outcomes to DCF/CSOC monthly. |
| Monthly |
Monthly
| 78 |
| Call Routing a toll free number (1-800-000-0000) access line message shall be (no longer than 15 seconds long) (in Spanish and English) instructing the caller to choose one of several options to expedite the call. |
| Within 15 seconds |
| 79 |
| Callers who do not choose a prompt must be transferred to a customer service representative for assistance within thirty (30) seconds. |
| Within 30 seconds |
Monthly
Call Center Reporting Requirements
| 80 |
| Report on activity/performance will be produced monthly. |
| Monthly |
Monthly
Customer Service/Member Services
| 81 |
| Customer Service must assist and triage callers who may be in crisis by making an immediate (within ten (10) seconds) transfer to a clinical care manager. The call will be answered immediately and only transferred to a warm line (if necessary). |
| Within 10 seconds |
Monthly
| 82 |
| Member Service staff talk time for registration shall not exceed five (5) minutes. |
| Within 5 minutes |
Monthly
| 83 |
| Complete the registration process within 24 hours. |
| 24 hours |
Monthly
| 84 |
| Program literature and informational materials will be mailed within one (1) to two (2) business days depending on the urgency of the request. |
| 1-2 business days |
Monthly
| 85 |
| The Contractor shall submit the disposition extract (call reason and resolution) on a weekly basis. |
| Weekly |
Weekly
| 86 |
| Bilingual/Multi-cultural staff at a minimum, must represent English and Spanish and any other language spoken by 5% of the target population. |
| At minimum 5% |
Annually
| 87 |
| Verify Medicaid status for all children, youth and young adults. |
Monthly
| 88 |
| Review policies and procedures on an annual basis. |
| Annually |
Annually
Customer Service Help Desk
| 89 |
| The Contractor’s Customer Service Help Desk must be sufficiently staffed and provide support during the hours of 8:00am to 6:00pm Monday through Friday. Outside of normal business hours can be provided via on-call schedule. |
| 8am-6pm M-F; |
On-call after hours
Monthly
| 90 |
| The Contractor shall maintain proper procedures for help desk management and shall meet all help desk response time standards as outlined in contract. |
| Ongoing |
Monthly
| 91 |
| The Contractor shall provide an automated help desk tracking system that collects and tracks all relevant data, and provides a report on data trends on a monthly basis. |
Monthly
Monthly
Marketing Plan
| 92 |
| The Contractor shall develop and follow a Marketing Plan that meets all contract requirements. The Marketing Plan shall be submitted to DCF/CSOC prior to initial implementation and annually thereafter for review and approval. |
| Prior to implementation/ |
Annually thereafter
Prior to implementation/ Annually thereafter
Website
| 93 |
| The Contractor shall maintain a customized website that provides online access to general customer service information and meets the required guidelines per contract. |
Monthly
| 94 |
| The Contractor shall solicit feedback from youth, families, providers, and stakeholders about the website annually. |
| Annually |
Annually
Youth and Family Guide
| 95 |
| The Contractor shall distribute the Youth and Family Guide to each newly enrolled child, youth, or young adult within 10 calendar days of first receiving a covered service. This can be provided via e-mail or US Postal mail, depending on the preference of the family. If delivered via e-mail, the guide can be provided in the form of a link to the contractor’s website to download. |
| 10 calendar days |
Monthly
| 96 |
| Unless otherwise instructed by CSOC, the Contractor shall distribute the Youth and Family Guide to youth and their family/caregivers, and system partners at least 30 days prior to the contract start date. This can be done electronically and providing a link on the contractor’s website is acceptable. |
| 30 days prior to contract start date |
| 97 |
| The Contractor shall review the Youth and Family Guide at least annually and distribute an updated guide to each child, youth, young adult, and their family/caregivers, CMO, MRSS, FSO and other system partners on or before September 1st of each year. |
| On or before September 1st |
Annually
| 98 |
| The Contractor shall update and submit the Youth and Family Guide to CSOC within 30 calendar days of receiving/making any changes. |
| Within 30 days of changes |
As needed
Written Notices
| 99 |
| The Contractor shall provide advanced written notification to the affected persons at least 30 calendar days before implementation of CSOC program changes. |
| 30 calendar days of changes |
As needed
| 100 |
| The Contractor will provide youth and family/caregivers with written notice of significant changes related to member rights, advance directives, grievances, reconsiderations or State Fair Hearings at least 10 days in advance of the intended effective date. |
| 10 days in advance |
As needed
Information Dissemination
| 101 |
| Timely and accurately disseminate and communicate information required by DCF/DCSOC. |
Performance Criteria for Customer Service
| 102 |
| Customer Service functions outlined above will be performed 95% within timeframes outlined above. |
| 95% |
Monthly
Children Involved with Division of Child Protection and Permanency (DCP&P)
| 103 |
| Referrals from DCP&P: The Contractor shall track the number of warm transfers received from DCP&P monthly. |
| Monthly |
Monthly
| 104 |
| Referrals to DCP&P: The Contractor shall track the number of warm transfers to DCP&P monthly. |
| Monthly |
Monthly
| 105 |
| Maintain warm line transfer capability on an ongoing basis. |
| Ongoing |
| 106 |
| The Contractor shall report on the total number of DCP&P children register in the system monthly. |
| Monthly |
Monthly
Overall Performance Criteria
| 107 |
| Member Information functions outlined above must be performed 95% within timeframes outlined above. |
| 95% |
Monthly
Management of Care
Utilization Management
| 108 |
| The Contractor shall annually, no later than January 30, provide a Utilization Management Plan and Workplan. The plan shall be specific and include quantitative and qualitative measures of performance, along with quarterly and annual targets for performance. Plans shall be subject to review and acceptance by DCF/DCSOC prior to implementation. |
| Annually |
Annually (January)
| 109 |
| The Contractor shall report on assessed intensity of service according to the IMDS tools intensity of service determinations on a monthly basis to demonstrate any divergence between assessed intensity of service determined by the Contractor. |
| Monthly |
Monthly
| 110 |
| The Contractor shall develop the capacity to verify the Strength and Needs Assessment (SNA) certification status of the identified Intensive/In Community (IIC) assessor prior to issuing a Bio Psychosocial (BPS) for a youth within six (6) months of contract execution. |
| Within 6 months of contract execution |
As determined by CSOC
| 111 |
| The Contractor shall comply with Federal utilization control requirements, including the certification of need and recertification of need for continued stay in Psychiatric Residential Treatment Facilities within required timeframes. |
Monthly
| 112 |
| The Contractor shall work with DCF/CSOC to review and review and revise the clinical criteria and utilization controls at regular intervals as determined by DCF/CSOC, and report on reviewed/revised criteria on a quarterly basis. |
| Regular intervals |
Quarterly
| 113 |
| The core goal of ensuring that children, youth and young adults access the right services in intensity, duration and scope at the right time. Concurrent reviews shall take place regularly to meet this goal, and retrospective reviews shall take place no less than quarterly and the results of these reviews shall be provided to DCF/CSOC within a determined timeframe established by DCF/CSOC. |
| Quarterly |
Quarterly
Crisis Management
| 114 |
| Crisis response must be available on a 24/7 basis. |
| 24/7 |
Monthly
| 115 |
| Make referrals: Within 15 minutes |
| 15 minutes |
Monthly
| 116 |
| Report on activity/performance quarterly or as determined by CSOC. |
Quarterly or as determined by CSOC
Mobile Response and Stabilization Services (MRSS)
| 117 |
| Make dispatch decisions within twenty (20) minutes. |
| 20 minutes |
Monthly
| 118 |
| Review the Initial ICP within one (1) working day. |
| 1 Working Day |
Monthly
| 119 |
| Review ICP Update within five (5) working days. |
| 5 Working Days |
Monthly
| 120 |
| Review Transition ICP within five (5) working days. |
| 5 Working Days |
Monthly
| 121 |
| Report activity/performance quarterly; includes tracking dispatch rate. |
| Quarterly |
Quarterly
Out of Home (OOH) Treatment: Intensity of Service (IOS) Determinations
| 122 |
| Complete Intensity of Service (IOS) determinations within two (2) working days (BH and IDD IOS). |
| 2 Working Days |
Monthly
Out of Home (OOH) Treatment: Continued Stay, Transition, Discharge, Youth Link, Court Orders
| 123 |
| Complete Joint Care Review (JCR) reviews within five (5) working days. |
| 5 Working Days |
Monthly
| 124 |
| Complete Transitional Joint Care Reviews (TJCR) within five (5) working days. |
| 5 Working Days |
Monthly
| 125 |
| Complete Discharge Joint Care Reviews (DJCR) within five (5) working days. |
| 5 Working Days |
Monthly
| 126 |
| Provide a summary of Youth Link activity. |
Monthly
| 127 |
| Track and trend court orders. |
Monthly
Substance Use Treatment (SUT) Services
| 128 |
| Complete initial review within the same working day as receipt of information. |
| Same Working Day |
Monthly
| 129 |
| Complete Detox Service Requests (Transition) within two (2) working days. |
| 2 Working Days |
Monthly
| 130 |
| Complete Service Extension Requests (Routine) within five (5) working days. |
| 5 Working Days |
Monthly
| 131 |
| Complete Service Extension Requests (Discharge) within five (5) working days. |
| 5 Working Days |
Monthly
| 132 |
| The Contractor shall provide Enhanced Care Coordination for youth who are not involved with a Care Management Organization (CMO) when authorized for SUT services in order to ensure that they are connected to the appropriate supports and services. |
| Ongoing |
Quarterly
Care Management Organization (CMO) Services
| 133 |
| Complete Initial 30-Day Service Plans (ISP) within three (3) working days. |
| 3 Working Days |
Monthly
| 134 |
| Complete Continued Care 90-Day Comprehensive ISP reviews within five (5) working days. |
| 5 Working Days |
Monthly
| 135 |
| Complete Transition ISP reviews within five (5) working days. |
| 5 Working Days |
Monthly
| 136 |
| Complete CMO Annual Reviews within five (5) working days. |
| 5 Working Days |
Monthly
| 137 |
| Complete Service Changes and Service Updates within five (5) working days. |
| 5 Working Days |
Monthly
| 138 |
| Complete Behavioral Health Home (BHH) Transition Plans within five (5) working days. |
| 5 Working Days |
Monthly
| 139 |
| Report activity/performance monthly. |
| Monthly |
Monthly
Wrap/Flex Services
| 140 |
| Complete initial reviews within five (5) working days. |
| 5 Working Days |
Monthly
| 141 |
| Complete continued care reviews (CCR) within five (5) working days. |
| 5 Working Days |
Monthly
| 142 |
| Report financial activity/performance monthly. |
| Monthly |
Monthly
| 143 |
| Track non-Medicaid expenditures where CSA-NJ is the requestor and report out monthly. |
| Monthly |
Monthly
| 144 |
| Manage within the cap: Report annually. |
| Annually |
Annually-December
| 145 |
| Include a plan to manage under-utilization. |
| Annually |
Annually-November
Intermediate Units (IU)
| 146 |
| Complete initial reviews within one (1) working day. |
| 1 Working Day |
Monthly
| 147 |
| Complete continued stay reviews within two (2) working days. |
| 2 Working Days |
Monthly
System Partner Referrals: DCP&P, Court Referrals, DDD, Schools, Probation, Detention Centers, Emergency Shelters, Others
| 148 |
| Complete routine requests within five (5) working days. |
| 5 Working Days |
Monthly
| 149 |
| Report activities/performance monthly. |
| Monthly |
Monthly
Provider Information Profiles (PIFs) for OOH
| 150 |
| Allow CSOC access to PIFs, as indicated, by CSOC. |
| As indicated |
| 151 |
| Per receipt of contract modifications from CSOC, update PIF information within five (5) working days. |
| 5 Working Days |
Out-of-Home (OOH) Bed Tracking (Youth Link)
| 152 |
| Submit OOH bed tracking summary reports on a monthly basis. |
| Monthly |
Monthly
| 153 |
| Produce metrics report on a quarterly basis. |
| Quarterly |
Quarterly
| 154 |
| Develop a QA process to improve the quality of youth/OOH program matches in order to reduce the number of inappropriate referrals. Ensure that appropriate referrals are made 95% of the time. |
| 95% |
DD Eligibility Determinations
| 155 |
| The Contractor shall make a determination of eligibility for intellectual and developmental disability (I/DD) within sixty (60) calendar days of receiving a completed application. A weekly report subscription will be provided to CSOC reflecting application data. |
| Within calendar 60 days of application receipt |
Weekly report
| 156 |
| The Contractor shall consult weekly or bi-weekly with CSOC psychologist to discuss eligibility applications that appear to be ineligible for I/DD functional eligibility. All applicants determined ineligible by CSA will be referred to CSOC within five (5) business days for final review and determination. |
5 Working Days
Quarterly—hard copy applications are transferred weekly
| 157 |
| The Contractor may administratively close an application for the following reasons: a complete application was never received; the documentation is insufficient to make a determination; family fails to submit documentation after outreach by the CSA via phone and mail. The CSA will notify the family of the administrative closing and hold the application for one year from date of the original application. If the family submits required documentation the application may be re-opened for determination. After one (1) year, the application will be closed and the family will have to re-apply. |
Quarterly
| 158 |
| The Contractor shall report monthly statistics on all eligibility applications: number received, number deemed eligible, number pending review, number incomplete, number referred to CSOC for final review, and number administratively closed. |
| Monthly |
Monthly
| 159 |
| The Contractor shall report quarterly on gender, age, and diagnosis of children who have applied for eligibility determinations. |
| Quarterly |
Quarterly
DD Family Support
| 160 |
| The Contractor shall post those children, youth, and young adults with high and moderate scores to provider queues immediately upon completion of FSS applications. |
| Immediately |
| 161 |
| The Contractor shall respond to all emergent requests within 24 hours. |
| 24 hours |
Monthly
| 162 |
| The Contractor shall monitor monthly within five (5) working days of the end of previous month the statuses of review, schedule, and admit to ensure the providers are using timely actions to fill vacancies and discharge youth. |
| 5 Working Days |
Monthly
| 163 |
| The Contractor shall review all not accept reasons for appropriateness to ensure the providers are first serving all high and moderate youth before gaining access to low scoring youth. CSA will provide a monthly report by provider detailing reasons the providers are not accepting referrals. |
| Monthly |
Monthly
| 164 |
| The Contractor shall provide quarterly analysis to identify trends such as number of rejections (not accepts) and reasons by provider. |
| Quarterly |
Quarterly
| 165 |
| The Contractor shall provide monthly reports on the number of FSS applications, types of services requested, all requests filled by county, service type, requests unfilled, waitlist numbers by county, service type and providers, number of children admitted per month, number of children discharged per month, reason for discharge and census data. |
Monthly
Monthly
| 166 |
| Upon submission, if the reauthorization form is not automatically approved, it is electronically routed to the Contractor (CSA) for review. The CSA has five (5) working days to review and take action on the reauthorization request. The actions are either approved or returned. An approved action will generate a 90-day authorization for continued service. A returned action will require the FSS provider to review progress notes within the child’s electronic record, determine what is required and resubmit to re-authorization form to the CSA for another review. |
| 5 Working Days |
Monthly
Care Coordination Requirements for Child Welfare Populations
| 167 |
| The Contractor shall establish a workflow that ensures youth involved in the child welfare system receive simple and clear access to needed services, and that these services are coordinated across systems. The workflow shall be updated annually to ensure its effectiveness. |
Annually
| 168 |
| The Contractor shall engage in regular reviews of the child welfare population for both over and under-utilization. The Contractor shall propose a process whereby DCF/DCSOC is alerted to such over- and underutilization at regular intervals (no longer than quarterly) to ensure that services are properly and effectively delivered based upon the strengths and needs of each individual child. |
| Quarterly |
Quarterly
Clinical/Service Criteria
| 169 |
| Revise/update all service and clinical criteria on a on a cyclical schedule determined by DCF/CSOC. CSA will coordinate with CSOC and applicable committees to revise/update criteria. Updated criteria will be posted in a timely manner as directed by DCF/CSOC. |
| As determined by DCF/CSOC |
Quarterly
| 170 |
| The Contractor shall ensure that applicable staff are trained on approved service and clinical criteria on an ongoing basis. |
| Ongoing |
Ongoing
| 171 |
| New hires shall receive training on service and clinical criteria as part of their new employee orientation. |
| Upon hire |
Ongoing
| 172 |
| Staff shall receive consistent supervision with regard to service and clinical criteria understanding and application to IOS determinations. |
| Ongoing |
Ongoing
Overall Performance Criteria
| 173 |
| Functions outlined above will be performed 95% within timeframes outlined above. |
| 95% |
Monthly/Quarterly
Measurement, Monitoring, and Performance Improvement
| 174 |
| The Contractor shall implement an approved Measurement Plan and Quality Improvement Plan within twelve (12) months of the contract start date. |
| Within 12 months of contract start date. |
| 175 |
| The Contractor shall resubmit their Measurement Plan and Quality Improvement Plan annually by January 30th which shall be based on performance from the previous contract year. |
| Annually by January 30th |
Annually
| 176 |
| The Contractor shall submit a report to DCF/CSOC on the Quality Improvement Plan deliverables annually by December 31st. |
| Annually by December 31st |
Annually
| 177 |
| The Contractor shall provide quarterly customer service satisfaction reports to DCF/CSOC. |
| Quarterly |
Quarterly
Complaints, Reconsiderations, and Appeals
| 181 |
| The resolution of all issues via the local informal process must be attempted. If the parties can agree to a resolution within five (5) working days the issue will be considered resolved. The agreed upon services will be authorized. |
| 5 Working Days |
Monthly
Reconsideration Process
| 182 |
| Reconsideration process shall be Initiated automatically where the child, youth, or young adult and the family/caregiver are eligible for and request a Medicaid Fair Hearing in writing through the Medicaid OL/RL. |
Monthly
| 183 |
| When initiated, the CSA will provide a minimum of two levels of review: 1. CSA Director of Clinical Services and; 2. CSA Medical Director |
| 2 levels of review |
Monthly
| 184 |
| An initial attempt to resolve the request for a DCF/DCSOC Reconsideration shall be made within five (5) business days of the request. In the event a resolution cannot be achieved, the reconsideration decision shall be made within 30 calendar days of the request. |
| 5 Business Days or 30 Calendar Days |
Monthly
| 185 |
| In all reconsiderations cases, a letter acknowledging receipt of the request is sent by the CSA to the complainant, provider, and family within one (1) business day. |
| 1 Business Day |
Monthly
| 186 |
| The CSA Director of Clinical Services initiates the DCF/DCSOC Reconsideration Process within one (1) business day following notification by the OL/RL of a request for a Medicaid Fair Hearing. The Director of Clinical Services reviews all relevant information, and, if necessary, contacts the provider/care management entity/family/caregiver to complete a telephonic review at a mutually convenient time. |
| 1 Business Day |
Monthly
| 187 |
| A determination must be made within five (5) business days of the request. |
| 5 Business Days |
Monthly
| 188 |
| At the time of the determination, the CSA will provide verbal and written confirmation of the decision within two (2) business days to provider/care management entity and the family/caregiver. |
| 2 Business Days |
Monthly
| 189 |
| All expedited reconsiderations must be reviewed and a determination made within 24 hours |
| 24 hours |
Monthly
| 190 |
| If the determination is acceptable to all parties, and the family/caregiver/provider opts to withdraw the request for a Medicaid Fair Hearing, a written statement of this request must be made to the Medicaid OL/RL by the requestor of the Medicaid Fair Hearing as soon as possible. |
ASAP
Monthly
| 191 |
| In all DCF/DCSOC Reconsideration cases, a written response is sent to the provider and family/caregiver, with copies to DCF/DCSOC and Medicaid, including the OL/RL, no later than forty-eight (48) hours from the determination or the authorization. (The authorization should be sent to the Medicaid Fiscal Agent within five (5) business days of the determination.) |
| 48 hours; |
5 Business Days
Monthly
Support for Network Providers
| 192 |
| The Contractor is expected to provide dynamic solutions and innovations in the course of the contract. |
| Ongoing |
Ongoing
| 193 |
| In order to ensure accessible, culturally competent care the Contractor shall pay special attention to linguistic and other communication needs of a child, youth, young adult or family/caregiver and notify DCF/CSOC with a quarterly analysis of when cultural or linguistic appropriate providers are not available to meet the needs of children, youth, young adults, and their family/caregivers in a geographic area. |
| Quarterly |
Quarterly
| 194 |
| The Contractor shall provide a quarterly analysis of provider availability based upon geography. |
| Quarterly |
Quarterly
| 195 |
| The Contractor shall provide a quarterly gap in service analysis, which analyzes service requests and service availability to identify areas where service gaps exist. |
| Quarterly |
Quarterly
| 196 |
| The Contractor shall annually assist DCF/CSOC in conducting a system sizing analysis including providing data analysis and data support for DCF/CSOC review. |
| Annually |
Annually-as requested
| 197 |
| The Contractor shall report on a monthly basis when providers are not available to recipients and families in accordance with DCF/DCSOC defined timeframe standards. DCF/DCSOC reserves the ability to change timeframe standards based on a recipient and family need. Participate in and report on provider meetings monthly as scheduled. |
| Monthly |
Monthly
| 198 |
| The Contractor shall assist in managing the timely access to the appropriate services and supports identified in the individualized service plan through the development and maintenance of a statewide service provider database. The database shall be updated as needed; at minimal, quarterly. |
| Quarterly |
Quarterly
| 199 |
| The Contractor shall deliver membership roster to CSOC on a monthly basis. |
| Monthly |
Monthly
Audits/Fiscal Records
Corporate Records Provided to the State
| 200 |
| The Contractor shall operate according to standard accounting principles and shall maintain standard accounting records including corporate balance sheets, statement of income, quarterly income statements and annual audits or annual budget reports for inspection by the State, upon request, at no cost to the State. The contractor shall provide the state with a copy of its annual report to shareholders. |
| Annually |
Annually
| 201 |
| The Expenditures for CSA operations shall be provided to the DCSOC Director and SCM quarterly, due by 30th day after the end of each quarter, and annually, due April 1st or with Annual Financial Reports (whichever is earlier), and shall show funds expended, in DCF/DCSOC Contract Annex B format, by separate category and detailing, including but not limited to, salaries and wages, fringe, consultant and other professional, material and supplies, other costs e.g. facility lease, utilities, equipment costs and maintenance, hardware and software costs and maintenance, G&A allocations etc. |
| Quarterly/Annually |
Quarterly/Annually
| 202 |
| The Annual Budget for CSA operations shall be provided to DCF/CSOC on or before March 1st or with the Annual Financial Reports (whichever is earlier), and shall show budgeted amounts , in DCF/DCSOC Contract Annex A format, by separate category and detailing, including but not limited to, salaries and wages, fringe, consultant and other professional, material and supplies, other costs e.g. facility lease, utilities, equipment costs and maintenance, hardware and software costs and maintenance, G&A allocations etc. |
| Before March 1st |
Annually-March
Audits
| 203 |
| Financial Audit – The Contractor shall have an independent financial audit of the CSA’s operations performed annually and submitted to the State within 120 calendar days of the end of the Vendor’s {Contractor’s} fiscal year. This audit must be performed by a New Jersey Certified Public Accountant in accordance with Generally Accepted Audit Standards (GAAS) and/or Government Audit Standards (GAS) and by an organization approved by the State. |
| Annually |
Annually
| 204 |
| Comprehensive Information System/Operational Audit: The Contractor shall conduct an annual examination and/or a periodic review of the controls within its Information Technology infrastructure and an independent operational audit of the Contractor’s operations performed every three (3) years; The IT portion of the audit shall address IT risk exposures, obtain and review evidence of the safeguarding of IT assets, the maintenance of data integrity and security, and the effective and efficient achievement of the Contractor’s stated IT obligations as part of the contract; This audit shall be performed by a New Jersey Certified Public Accountant, Certified Information Systems Auditor (i.e., SAS 70 audit) or certified professional approved by DCF’S CSOC. The Operational portion of the audit must focus on the adequacy of internal control procedures, effectiveness and efficiency of operations, and other safeguards against fraud and theft. Audit must be performed by a New Jersey Certified Public Accountant or certified professional in accordance with GAAS and/or by an organization approved by the State. |
| Every 3 years |
Every 3 years
| 205 |
| MIS Security: The Contractor shall conduct a biannual security review to ensure that access to protected health information is granted or restricted to only authorized users. |
| Biannually |
Biannually
Management Information System (MIS)
MIS General Requirements
| 206 |
| The Contractor shall make available to New Jersey any new features and/or functionalities available to other clients of the contractor as part of the bid proposal (no additional costs to the state). |
| 207 |
| MIS shall accommodate business changes and program enhancements that may occur at any time during the contract. |
| Ongoing |
| 208 |
| The Contractor shall provide a data transfer after the initial conversion to a server on the State network. |
| 209 |
| The Contractor shall provide access to all data on a 24-hour a day, seven (7) day a week basis for ad hoc and scheduled reporting. |
| 24/7 |
| 210 |
| The Contractor shall provide access to an IT Help Desk on a 24 hour a day basis. |
| 24/7 |
Monthly
| 211 |
| The Contractor shall provide access to online policy manuals on a 24 hour a day basis. |
| 24/7 |
| 212 |
| The Contractor shall provide for a maximum five (5) second response time for users to access a data entry or inquiry screen. |
| 5 Seconds |
Monthly
| 213 |
| The Contractor shall provide for a maximum five (5) second response time to process a data entry or inquiry screen. |
| 5 seconds |
Monthly
| 214 |
| The Contractor shall provide reliability of the system such that the response time standards described above are met a minimum of 98% of the time. |
| 98% |
Monthly
| 215 |
| The Contractor shall provide functionality to support 2500 simultaneous MIS users at all times. |
| 2500 simultaneous MIS users |
Monthly
| 216 |
| The Contractor shall provide functionality to support approximately 25,000 MIS users. |
| 25,000 MIS users |
Monthly
| 217 |
| The Contractor shall ensure that the MIS architecture is capable of providing adequate response time and performance for all MIS users on an ongoing basis. |
| Ongoing |
Annually
| 218 |
| New functionality, and/or DCF’S CSOC modifications of the baseline application, are designed and deployed based on the prioritization level and timeframes established by the CSOC MIS Application Governance Committee. |
| Ongoing |
| 219 |
| The Contractor shall support a call center that requires the retrieval and input of data from the MIS on a 24/7/365 basis. |
| 220 |
| The Contractor will build and transfer specialized reporting views or tables of data on a nightly, weekly, and monthly basis, at DCF/CSOC’ discretion to a State server so DCF/CSOC can develop and implement reports. |
| Nightly, Weekly, Monthly (at DCF/CSOC discretion) |
| 221 |
| The Contractor shall work with the incumbent CSA, if different from awardee, and the State Contract Manager on the conversion of data and mapping data. Once data is converted, the vendor will provide full export of their database to a state designated server via a secure file transfer (FTP) which is compliant with the State’s FTP protocol. Periodic updates to the data will be provided (nightly, weekly, monthly) as determined by the State. |
| Nightly, Weekly, Monthly (as determined by the State) |
| 222 |
| The first dataset must be received immediately prior to deployment of the system, frequency of interim updates will be determined. |
| Immediately prior to deployment |
| 223 |
| The MIS shall allow for an automated process of determining clinical appropriateness and utilization management, thus providing real-time system wide continuous quality review. |
| Ongoing |
| 224 |
| The Contractor shall build an initial batch interface for each system, and if required by the State during the contract period, upgrade it to a real-time interface within one (1) year of the request; |
| Within 1 year of request |
| 225 |
| The Contractor will work with DCF/CSOC to coordinate design, develop, test activities with state technical staff administering the systems that require interfaces. The Contractor shall document the interface designs including identifying areas at risk for change. Once approved by DCF/CSOC, the Contractor will be responsible for executing and overseeing the MIS data interface plan in a timely fashion. |
| As Needed |
As Needed
| 226 |
| The Contractor shall provide a schedule of maintenance timeframes including all planned outages and a user’s contingency plan for down times to DCF/CSOC throughout the life of the contract. This schedule must include duration, systems impacted (i.e., interface systems) reports impacted, and start up process. |
Monthly
| 227 |
| The Contractor shall upgrade the software used to operate the MIS as new releases of the software become available. The Contractor shall implement all software upgrades in a timely manner, conducive to the support and security risks identified. The Contractor shall provide a summary of the software upgrades, and the risks associated with installing the upgrades. |
| 228 |
| The Contractor shall maintain and update the Project Plan as necessary, and will make the Project Plan available to DCF/CSOC on request. Reporting of activity for Project Plan is to be delivered weekly as a status report. |
| On Request |
Weekly
| 229 |
| The Contractor shall be responsible for the ongoing support and maintenance of the MIS. |
| 230 |
| The Contractor shall build, maintain, and share with DCF on an ongoing basis the Conceptual, Logical, Physical, and Semantic Data Models for the system per RFP specifications. |
| Ongoing |
| 231 |
| The Contractor shall upload clean transmittals within 12 hours. |
| 12 Hours |
| 232 |
| The Contractor shall notify sender of transmittal errors within 24 hours. |
| 24 Hours |
| 233 |
| The Contractor shall provide feedback capability such that MIS users may comment on the functionality of the MIS and provide recommendations for improvements and enhancements, which shall include a provider-specific MIS workgroup on a quarterly basis. |
Quarterly
| 234 |
| The Contractor shall provide an online provider database that contains demographic information as well as treatment specialties. The database shall be updated no less often than quarterly. |
| Quarterly |
Quarterly
MIS Reports, Forms, and Notices
| 235 |
| The Contractor shall provide DCF/DCSOC with a series of approximately 20 to 25 reporting views that will be defined during analysis sessions after contract award. |
| 20-25 Reporting Views |
| 236 |
| The Contractor shall create and maintain an accessible User Interface with embedded analytics where users may create custom reports based on live CYBER data. |
| Ongoing |
| 237 |
| The State anticipates from 300-500 reports/extracts to be required as part of the contract. The MIS must be capable of generating reports for the major service distribution categories (CMOs, MRSS, FSO and 1 statewide CSA). The CSA shall work with the State IT staff to identify the actual reports and reporting intervals as part of program operations. |
| 300-500 |
MIS User Support and Help Desk
| 238 |
| The MIS Help Desk must provide support from 8 AM to 6 PM (ET) on all business days. Support outside of normal business hours can be provided by an on-call Help Desk staff person. All staffing levels and procedures will be subject to the approval of DCF/DCSOC |
| 8am-6pm |
Monthly
MIS Security
| 239 |
| The Contractor shall develop and implement procedures to regularly review MIS activity, such as audit logs, access reports, and security incident reports to assure that the MIS is maintained in accordance with the above guidelines and the Information Security Plan. |
| Regularly Review |
Biannual
Disaster Recovery
| 240 |
| The Contractor shall provide a data backup plan that will ensure the data is retrievable in the specified primary and backup sites within 24 hours with no loss of data and must utilize their most current versions of software during the recovery process. |
| 24 Hours |
Annually
| 241 |
| The Contractor shall ensure the system remains operational with minimal downtime (not exceed 24 hours per incident), to enable continuation of critical business processes. The plan must address hardware failure, data failure, program failure, system failure, network outage, electrical power outage, and phone outages. |
| 24 hours |
Annually
MIS Quality Management
| 242 |
| MIS Quality Management Assurance is ongoing for the duration of this contract. The Contractor shall update their MIS Quality Management/Assurance Plan annually. |
| Ongoing |
Annually
Manual and Reference Guides
| 243 |
| The Contractor shall develop and deliver a technical specifications/operations manual and a user’s manual for MIS the DCF/DCSOC State Contract Manager within 90 days of program implementation. |
| Within 90 days of implementation |
| 244 |
| The Contractor shall develop reference guides for each major MIS function. Reference guides shall be updated regularly to reflect any system, database, application, or process changes throughout the length of the contract. |
| Update Regularly |
Business Continuity and Risk Management
| 245 |
| Business Continuity Planning is a comprehensive process to ensure the continuation of business in the face of whatever challenges may face the organization. Contractor shall provide a Plan that identifies mitigation strategies that reduce risks that could result in business disruptions. Process shall be updated no less than annually |
| Annually |
Annually
| 246 |
| The Contractor shall ensure that there is the absolute minimum interruption of service, (including call center, customer service, care management and authorization processing) not to exceed 24 hours with no loss of data and must utilize their most current versions of software during the recovery process. |
| < 24 Hours |
Monthly
| 247 |
| The Contractor shall outline the backup cycle and must be at least 3 months in length. |
| 3 Months |
Annually
MIS Source Code
| 248 |
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .