T3099 EVVMS Final RFP 011419~1.docx

Bid Solicitation

Vendor’s {Bidder’s} Electronic Question Due Date (Refer to Bid Solicitation Section 1.3.1 for more information.)

Quote Submission Date (Refer to Bid Solicitation Section 1.3.2 for more information.)

Dates are subject to change. All times contained in the Bid Solicitation refer to Eastern Time. All changes will be reflected in Bid Amendments to the Bid Solicitation posted on the Division of Purchase and Property website and on www.njstart.gov.

Small Business Set-Aside Status ☐ Not Applicable

☐ Entire Blanket P.O.

☐ Partial Blanket P.O.

☒ Subcontracting Only Category

☒ I ☐ IV

☒ II ☐ V

☒ III ☐ VI

Bid Solicitation Issued By Using Agency/Agencies

Date: January 14, 2019

Table of Contents

INFORMATION FOR VENDORS {BIDDERS}

NOTICE: This Bid Solicitation is part of the NJSTART Procurement Program. The Vendor {Bidder} is advised to thoroughly read all sections, as many have been revised, and follow all instructions contained in this Bid Solicitation, including the instructions on the Bid Solicitation’s Offer and Acceptance Page and read through all Quick Reference Guides (QRGs) located on the NJSTART Vendor Support Page (http://www.state.nj.us/treasury/purchase/njstart/vendor.shtml), before preparing and submitting its Quote.

NJSTART terminology is used throughout this document. See Bid Soliciation Section 2.1 for a crosswalk of NJSTART terminology to legacy terminology.

Please be advised that in accordance with P.L. 2018, c. 9, also known as the Diane B. Allen Equal Pay Act, which was signed in to law by Governor Phil Murphy on April 24, 2018, a contractor performing “qualifying services” or “public work” to the State or any agency or instrumentality of the State shall provide the Commissioner of Labor and Workforce Development a report regarding the compensation and hours worked by employees categorized by gender, race, ethnicity, and job category. For more information and report templates see https://nj.gov/labor/equalpay/equalpay.html.

PURPOSE AND INTENT

This Bid Solicitation is issued by the Procurement Bureau, Division of Purchase and Property (Division), Department of the Treasury on behalf of the Department of Human Services (DHS), Division of Medical Assistance and Health Services (DMAHS). The purpose of this Bid Solicitation is to solicit Quotes from Vendors {Bidders} that provide a centralized web-based Electronic Visit Verification Management System (EVVMS) for Personal Care Services (PCS) and Home Health Care Services (HHCS) to prevent inappropriate billing/payment, safeguard against fraud, improve program oversight, and enhance quality of services. Many healthcare providers have already implemented their own EVVMS; therefore, the State is seeking a Vendor {Bidder} to develop a vendor hosted application to serve as the State’s EVVMS, with the additional capacity to act as a “data aggregator” to combine EVVMS data from multiple EVVMS platforms.

The intent of this Bid Solicitation is to award a Master Blanket Purchase Order (Blanket P.O.) to that responsible Vendor {Bidder} whose Quote, conforming to this Bid Solicitation is most advantageous to the State, price and other factors considered. The State may award any and all price lines. The State, however, reserves the right to separately procure individual requirements that are the subject of the Blanket P.O. during the Blanket P.O. term, when deemed by the Director of the Division of Purchase and Property (Director) to be in the State’s best interest.

The State of NJ Standard Terms and Conditions (SSTC) accompanying this Bid Solicitation will apply to all Blanket P.O.s made with the State of New Jersey. These terms are in addition to the terms and conditions set forth in this Bid Solicitation and should be read in conjunction with them unless the Bid Solicitation specifically indicates otherwise.

The State of New Jersey (State) may extend the Blanket P.O.(s) awarded to the Division's Cooperative Purchasing Program participants after Blanket P.O(s) award. In that circumstance, the State will request that the Vendor(s) {Contractor(s)} complete the Cooperative Purchasing Form indicating willingness or unwillingness to extend State Blanket P.O. pricing and terms to Cooperative Purchasing Program participants. The Cooperative Purchasing Form is located on the Division’s website. These participants include quasi-State entities, counties, municipalities, school districts, volunteer fire departments, first aid squads, independent institutions of higher learning, County colleges and State colleges. Although the State, with the consent of the Vendor(s) {Contractor(s)}, may make use of any Blanket P.O. resulting from this Bid Solicitation available to non-State Agencies, the State makes no representation as to the acceptability of any State Bid Solicitation terms and conditions under the Local Public Contracts Law or any other enabling statute or regulation.

BACKGROUND

In 2012, the Government Accountability Office reported that 40% of all fraud convictions initiated by a group of Medicaid fraud units were for HHCS. The key factor that makes home health care so susceptible to fraud is the lack of oversight and connectivity. As a result, the Centers for Medicare/Medicaid (CMS) are mandating that states begin utilizing an EVVMS for PCS by January 1, 2020 and HHCS by January 1, 2023.

The EVVMS method is used to verify home health care visits to ensure patients are not neglected and to reduce fraudulently documented home visits. Health Care Providers can record visits using the Beneficiary’s home phone, a Forward Operating Base (FOB) device, or a Global Positioning System (GPS) mobile application.

The EVVMS is a software platform where Medicaid Payers, Managed Care Organizations (MCOs), and their contracted network of Health Care Providers communicate. EVVMS provides real-time visibility into visit confirmation and Health Care Provider compliance, enhances care coordination, streamlines the billing process, and provides an audit trail of all communication between the Medicaid Payer, MCOs, and Health Care Providers.

KEY EVENTS

ELECTRONIC QUESTION AND ANSWER PERIOD

The Division will electronically accept questions and inquiries from all potential Vendors {Bidders} via the “Q&A” Tab of the Bid Solicitation in NJSTART.

A. Questions should be directly tied to the Bid Solicitation and asked in consecutive order, from beginning to end, following the organization of the Bid Solicitation; and

B. Each question should begin by referencing the Bid Solicitation page number and section number to which it relates.

Vendors {Bidders} may refer to the QRG “Submit a Quote” for additional instruction. QRGs are located on the NJSTART Vendor Support Page.

A Vendor {Bidder} shall not contact the Using Agency and/or the Procurement Specialist directly, in person, by telephone or by e-mail, concerning this Bid Solicitation, prior to the final award of the Blanket P.O.

The cut-off date for electronic questions and inquiries relating to this Bid Solicitation is indicated on the Bid Solicitation cover sheet. In the event that questions are posed by Vendors {Bidders}, answers to such questions will be issued by Bid Amendment. Any Bid Amendment to this Bid Solicitation will become part of this Bid Solicitation and part of any Blanket P.O. awarded as a result of this Bid Solicitation. Bid Amendments to this Bid Solicitation, if any, will be posted as a File Attachment on the “Summary” page of the Bid Solicitation in NJSTART after the cut-off date. (See Bid Solicitation Section 1.4.1 for further information.)

EXCEPTIONS TO THE STATE OF NJ STANDARD TERMS AND CONDITIONS (SSTC)

Questions regarding the State of New Jersey Standard Terms and Conditions (SSTC) and exceptions to mandatory requirements must be posed during this Electronic Question and Answer period and shall contain the Vendor’s {Bidder’s} suggested changes and the reason(s) for the suggested changes.

SUBMISSION OF QUOTES

In order to be considered for award, the Quote must be received by the Procurement Bureau of the Division at the appropriate location by the required time. Vendors {Bidders} shall submit a Quote electronically through NJSTART.

QUOTES NOT RECEIVED PRIOR TO THE QUOTE OPENING DEADLINE SHALL BE REJECTED. THE DATE AND TIME OF THE QUOTE OPENING ARE INDICATED ON THE BID SOLICITATION COVER SHEET AND ON THE “SUMMARY” TAB OF THE BID SOLICITATION WEBPAGE WITHIN NJSTART.

IF THE QUOTE OPENING DEADLINE HAS BEEN REVISED, THE NEW QUOTE OPENING DEADLINE SHALL BE SHOWN ON THE POSTED BID AMENDMENT AND ON THE “SUMMARY” TAB OF THE BID SOLICITATION WEBPAGE WITHIN NJSTART.

Procedural inquiries concerning the use of NJSTART may be directed to njstart@treas.nj.gov and/or (609) 341-3500.

The State will not respond to substantive questions related to the Bid Solicitation or any other Blanket P.O. via this e-mail address or phone number. For inquiries related to substantive questions refer to Section 1.3.1 (Electronic Question and Answer Period).

VENDOR {BIDDER} SUPPORT

Vendors {Bidders} are strongly encouraged to visit the NJSTART Vendor Support Page, which contains Quick Reference Guides (QRGs), supporting videos, a glossary of NJSTART terms, and helpdesk contact information.

The Vendor {Bidder} should utilize the QRGs before attempting to submit its Quote using the NJSTART process. It is the Vendor’s {Bidder’s} responsibility to ensure that the NJSTART Quote and attachments have been properly submitted.

MANDATORY/OPTIONAL SITE VISIT

Not applicable to this procurement.

MANDATORY/OPTIONAL PRE-QUOTE CONFERENCE

Not applicable to this procurement.

PRE-QUOTE DOCUMENT REVIEW

Not applicable to this procurement.

ADDITIONAL INFORMATION

BID AMENDMENTS: Revisions to this BID SOLICITATION

In the event that it becomes necessary to clarify or revise this Bid Solicitation, such clarification or revision will be by Bid Amendment. Any Bid Amendment to this Bid Solicitation will become part of this Bid Solicitation and part of any Blanket P.O. awarded as a result of this Bid Solicitation.

There are no designated dates for release of Bid Amendments. Those Vendors {Bidders} who are on the bid holder list either through commodity code registration in NJSTART or by acknowledging the bid in NJSTART should receive notification of any Bid Amendment(s). If a Vendor {Bidder} is not on the bid holder list to receive notifications related to a Bid Solicitation, Bid Amendments are still viewable on the “Summary” page of the Bid Solicitation in NJSTART.

BID AMENDMENTS WILL BE ISSUED AS FILE ATTACHMENTS, AND ARE VIEWABLE ON THE “SUMMARY” PAGE OF THE BID SOLICITATION IN NJSTART. Vendors {Bidders} may refer to the QRG “Submit a Quote” for additional instructions. QRGs are located on the NJSTART Vendor Support Page.

It is the sole responsibility of the Vendor {Bidder} to be knowledgeable of all Bid Amendments related to this procurement. An interested Vendor {Bidder} should check the NJSTART “Open Bids” Tab on a daily basis to ensure review of the most updated information.

VENDOR {BIDDER} Responsibility

The Vendor {Bidder} assumes sole responsibility for the complete effort required in submitting a Quote in response to this Bid Solicitation. No special consideration will be given after Quotes are opened because of a Vendor’s {Bidder’s} failure to be knowledgeable as to all of the requirements of this Bid Solicitation.

COST LIABILITY

The State assumes no responsibility and bears no liability for costs incurred by a Vendor {Bidder} in the preparation and submittal of a Quote in response to this Bid Solicitation.

CONTENTS OF QUOTE

Quotes can be released to the public pursuant to N.J.A.C. 17:12-1.2(b) and (c), or under the New Jersey Open Public Records Act (OPRA), N.J.S.A. 47:1A-1.1 et seq., or the common law right to know.

After the opening of sealed Quotes, including Quotes submitted through the NJSTART electronic process, all information submitted by a Vendor {Bidder} in response to a Bid Solicitation is considered public information notwithstanding any disclaimers to the contrary submitted by a Vendor {Bidder}. Proprietary and confidential information may be exempt from public disclosure by OPRA and/or the common law. When the Bid Solicitation contains a negotiation component, the Quote will not be subject to public disclosure until a notice of intent to award a Blanket P.O. is announced.

As part of its Quote, a Vendor {Bidder} may designate any data or materials it asserts are exempt from public disclosure under OPRA and/or the common law, explaining the basis for such assertion. Vendor {Bidder} must provide a detailed statement clearly identifying those sections of the Quote that it claims are exempt from production, and the legal and factual basis that supports said exemption(s) as a matter of law. Please include a redacted copy of the Quote indicating the sections identified as confidential. The State will not honor any attempts by a Vendor {Bidder} to designate its entire Quote as proprietary, confidential and/or to claim copyright protection for its entire Quote.

The State reserves the right to make the determination as to what is proprietary or confidential, and will advise the Vendor {Bidder} accordingly. Any proprietary and/or confidential information in a Quote will be redacted by the State. Copyright law does not prohibit access to a record which is otherwise available under OPRA.

In the event of any challenge to the Vendor’s {Bidder’s} assertion of confidentiality with which the State does not concur, the Vendor {Bidder} shall be solely responsible for defending its designation, but in doing so, all costs and expenses associated therewith shall be the responsibility of the Vendor {Bidder}. The State assumes no such responsibility or liability.

A Vendor {Bidder} shall not designate any price lists and/or catalogs submitted as exempt from public disclosure as the same must be accessible to State Using Agencies and Cooperative Purchasing Program participants (if the Bid Solicitation has been extended to these participants) and thus must be made public to allow all eligible purchasing entities access to the pricing information.

In order not to delay consideration of the Quote or the State’s response to a request for documents, the State requires that Vendor {Bidder} respond to any request regarding confidentiality markings within the timeframe designated in the State’s correspondence regarding confidentiality. If no response is received by the designated date and time, the State will be permitted to release a copy of the Quote with the State making the determination regarding what may be proprietary or confidential.

ANNOUNCEMENT OF QUOTE INFORMATION

On the date and time Quotes are due under the Bid Solicitation, all information concerning the Quotes submitted may be publicly announced and shall be available for inspection and copying except as noted below:

A. Information appropriately designated as proprietary and/or confidential shall not be available for inspection and copying; and B. Where negotiation is contemplated, only the names and addresses of the Vendors {Bidders} submitting Quotes will be announced, and the contents of the Quotes shall not be available for inspection and copying until the Notice of Intent to Award is issued by the Director.

RESERVED

QUOTE ERRORS

In accordance with N.J.A.C. 17:12-2.11 “Proposal errors,” a Vendor {Bidder} may withdraw its Quote as described below.

QUOTE WITHDRAWAL PRIOR TO QUOTE OPENING

NJSTART: A Vendor {Bidder} may withdraw its Quote submission in NJSTART prior to the Quote opening; however, Vendors {Bidders} should note that while withdrawn NJSTART Quotes remain viewable by the Vendor {Bidder} on its Vendor Profile Homepage, they are removed from the Division’s view and cannot be considered for Blanket P.O. award. The Vendor {Bidder} may submit a revised Quote as long as the Quote is received prior to the announced date and time for Quote submission. Vendors {Bidders} may refer to the QRG “Submit a Quote” for additional instruction. QRGs are located on the NJSTART Vendor Support Page.

QUOTE WITHDRAWAL AFTER QUOTE OPENING, BUT PRIOR TO BLANKET P.O. AWARD

If, after the Quote opening, but before Blanket P.O. award, a Vendor {Bidder} discovers an error in its Quote, the Vendor {Bidder} may make a written request to the Supervisor of the Proposal Review Unit to withdraw its Quote from consideration for award. If the Vendor’s {Bidder’s} request to withdraw is made in good faith, and the State will not be significantly prejudiced by granting the withdrawal of the Quote beyond the loss of the benefit of the bargain to the State of the withdrawing Vendor’s {Bidder’s} offer, the request shall be granted. Evidence of the Vendor’s {Bidder’s} good faith in making this request can be demonstrated by one (1) or more of the following factors: A mistake is so significant that to enforce the Blanket P.O. resulting from the Quote would be unconscionable; that the mistake relates to a material feature or term of the Blanket P.O.; and that the mistake occurred notwithstanding the Vendor’s {Bidder’s} exercise of reasonable care. After Quote opening, while pursuant to the provisions of this section a Vendor {Bidder} may request to withdraw its Quote and the Director may in his/her discretion allow said Vendor {Bidder} to withdraw it, the Division also may take notice of repeated or unusual requests to withdraw by a Vendor {Bidder} and take those prior requests to withdraw into consideration when evaluating the Vendor’s {Bidder’s} future Quotes.

All Quote withdrawal requests must include the Bid Solicitation identification number and the final Quote submission date and be sent to the following address:

Department of the Treasury Division of Purchase and Property PO Box 230 33 West State Street – 9th Floor Trenton, New Jersey 08625-0039 Attention: Supervisor, Proposal Review Unit

If during a Quote evaluation process, an obvious pricing error made by a potential Blanket P.O. awardee is found, the Director or his/her designee shall issue written notice to the Vendor {Bidder}. The Vendor {Bidder} will have up to five (5) business days after receipt of the notice to confirm its pricing. If the Vendor {Bidder} fails to respond, its Quote shall be considered withdrawn, and no further consideration shall be given to it.

JOINT VENTURE

If a Joint Venture is submitting a Quote, the agreement between the parties relating to such Joint Venture should be submitted with the Joint Venture’s Quote. Authorized signatories from each party comprising the Joint Venture must sign the Offer and Acceptance Page. Each party to the Joint Venture must individually comply with all the forms and certification requirements in Sections 4.4.1 and 4.4.2 of this Bid Solicitation.

RECIPROCITY FOR JURISDICTIONAL VENDOR {BIDDER} PREFERENCE

In accordance with N.J.S.A. 52:32-1.4 and N.J.A.C. 17:12-2.13, the State of New Jersey will invoke reciprocal action against an out-of-State Vendor {Bidder} whose state or locality maintains a preference practice for its in-state Vendors {Bidders}. The State of New Jersey will use the annual surveys compiled by the Council of State Governments, National Association of State Procurement Officials, or the National Institute of Governmental Purchasing or a State’s statutes and regulations to identify States having preference laws, regulations, or practices and to invoke reciprocal actions. The State of New Jersey may obtain additional information as it deems appropriate to supplement the stated survey information.

A Vendor {Bidder} may submit information related to preference practices enacted for a State or Local entity outside the State of New Jersey. This information may be submitted in writing as part of the Quote response, including name of the locality having the preference practice, as well as identification of the county and state, and should include a copy of the appropriate documentation, i.e., resolution, regulation, law, notice to Vendor {Bidder}, etc. It is the responsibility of the Vendor {Bidder} to provide documentation with the Quote or submit it to the Director within five (5) business days after the deadline for Quote submission. Written evidence for a specific procurement that is not provided to the Director within five (5) business days of the public Quote submission date may not be considered in the evaluation of that procurement, but may be retained and considered in the evaluation of subsequent procurements.

QUOTE ACCEPTANCES AND REJECTIONS

N.J.A.C. 17:12-2.7(d), the Director’s right to waive minor irregularities or omissions in a Quote and N.J.A.C. 17:12-2.2 which defines causes for Quote rejection, apply to all Quotes.

1.1.1 ELECTRONIC SIGNATURES

Vendors {Bidders} submitting Quotes through NJSTART may sign the forms listed in Section 4.4.1 (Forms, Registrations and Certifications Required with Quote) and Section 4.4.2 (Forms, Registrations and Certifications Required Before Blanket P.O. Award and That Should Be Submitted with the Quote) of this Bid Solicitation electronically by typing the name of the authorized signatory in the “Signature” block as an alternative to downloading, physically signing the form, scanning the form, and uploading the form to NJSTART.

Vendors {Bidders} submitting Quotes in hard copy format, must provide forms with original, physical signatures, otherwise its Quote may be deemed non-responsive.

DEFINITIONS

CROSSWALK

GENERAL DEFINITIONS

The following definitions will be part of any Blanket P.O. awarded or order placed as a result of this Bid Solicitation.

STANDARD DEFINITIONS

All-Inclusive Hourly Rate – An hourly rate comprised of all direct and indirect costs including, but not limited to: labor costs, overhead, fee or profit, clerical support, travel expenses, per diem, safety equipment, materials, supplies, managerial support and all documents, forms, and reproductions thereof. This rate also includes portal-to-portal expenses as well as per diem expenses such as food.

Best and Final Offer or BAFO – Pricing timely submitted by a Vendor {Bidder} upon invitation by the Bureau after Quote opening, with or without prior discussion or negotiation.

Bid or Bid Solicitation – This series of documents, which establish the bidding and Blanket P.O. requirements and solicits Quotes to meet the needs of the Using Agencies as identified herein, and includes the Bid Solicitation, State of NJ Standard Terms and Conditions (SSTC), State-Supplied Price Sheet, attachments, and Bid Amendments.

Bid Amendment – Written clarification or revision to this Bid Solicitation issued by the Bureau. Bid Amendments, if any, will be issued prior to Quote opening.

Business Day – Any weekday, excluding Saturdays, Sundays, State legal holidays, and State-mandated closings unless otherwise indicated.

Calendar Day – Any day, including Saturdays, Sundays, State legal holidays, and State-mandated closings unless otherwise indicated.

Change Order – An amendment, alteration or modification of the terms of a Blanket P.O. between the State and the Vendor(s) {Contractor(s)}. A Change Order is not effective until it is signed and approved in writing by the Director or Deputy Director, Division of Purchase and Property.

Cooperative Purchasing Program – The Division’s intrastate program that provides procurement-related assistance to New Jersey local governmental entities and boards of education, State and county colleges and other public entities having statutory authority to utilize select State Blanket P.O.s issued by the Division, pursuant to the provisions of N.J.S.A. 52:25-16.1 et seq.

Days After Receipt of Order (ARO) – The number of calendar days ‘After Receipt of Order’ in which the Using Agency will receive the ordered materials and/or services.

Director – Director, Division of Purchase and Property, Department of the Treasury, who by statutory authority is the Chief Contracting Officer for the State of New Jersey.

Discount – The standard price reduction applied by the Vendor {Bidder} to all items.

Division – The Division of Purchase and Property.

Evaluation Committee – A committee established or Division staff member assigned by the Director to review and evaluate Quotes submitted in response to this Bid Solicitation and recommend a Blanket P.O. award to the Director.

Firm Fixed Price – A price that is all-inclusive of direct cost and indirect costs, including, but not limited to, direct labor costs, overhead, fee or profit, clerical support, equipment, materials, supplies, managerial (administrative) support, all documents, reports, forms, travel, reproduction and any other costs.

Joint Venture – A business undertaking by two (2) or more entities to share risk and responsibility for a specific project.

Master Blanket Purchase Order (Blanket P.O.) – The Blanket P.O. consists of the State of NJ Standard Terms and Conditions (SSTC), the Bid Solicitation, the responsive Quote submitted by a responsible Vendor {Bidder} as accepted by the State, the notice of award, any Best and Final Offer, any subsequent written document memorializing the agreement, any modifications to any of these documents approved by the State and any attachments, Bid Amendment or other supporting documents, or post-award documents including Change Orders agreed to by the State and the Vendor {Contractor}, in writing.

May – Denotes that which is permissible or recommended, not mandatory.

Must – Denotes that which is a mandatory requirement.

No Bid – The Vendor {Bidder} is not submitting a price Quote for an item on a price line.

No Charge – The Vendor {Bidder} will supply an item on a price line free of charge.

Primary Form – An electronic form contained within a Vendor’s {Bidder’s} NJSTART profile designated by the Vendor {Bidder} as the primary or principal version of the required form.

Procurement Bureau (Bureau) - The Division unit responsible for the preparation, advertisement, and issuance of Bid Solicitations, for the tabulation of Quotes and for recommending award(s) of Blanket P.O.(s) to the Director and the Deputy Director.

Project – The undertakings or services that are the subject of this Bid Solicitation.

QRGs – Quick Reference Guides.

Quote – Vendor’s {Bidder’s} timely response to the Bid Solicitation including, but not limited to, technical Quote, price Quote, and any licenses, forms, certifications, or other documentation required by the Bid Solicitation.

Retainage – The amount withheld from the Vendor {Contractor} payment that is retained and subsequently released upon satisfactory completion of performance milestones by the Vendor {Contractor}.

Revision – A response to a BAFO request or a requested clarification of the Vendors {Bidders} Quote.

Shall – Denotes that which is a mandatory requirement.

Should – Denotes that which is permissible or recommended, not mandatory.

Small Business – Pursuant to N.J.A.C. 17:13-1.2, “small business” means a business that meets the requirements and definitions of “small business” and has applied for and been approved by the New Jersey Division of Revenue and Enterprise Services, Small Business Registration and M/WBE Certification Services Unit as (i) independently owned and operated, (ii) incorporated or registered in and has its principal place of business in the State of New Jersey; (iii) has 100 or fewer full-time employees; and has gross revenues falling in one (1) of the three (3) following categories: For goods and services - (A) 0 to $500,000 (Category I); (B) $500,001 to $5,000,000 (Category II); and (C) $5,000,001 to $12,000,000, or the applicable federal revenue standards established at 13 CFR 121.201, whichever is higher (Category III). For construction services: (A) 0 to $3,000,000 (Category IV); (B) gross revenues that do not exceed 50 percent of the applicable annual revenue standards established at 13 CFR 121.201 (Category V); and (C) gross revenues that do not exceed the applicable annual revenue standards established at CFR 121.201, (Category VI).

State – The State of New Jersey.

State Contract Manager or SCM – The individual, as set forth in Section 8.0, responsible for the approval of all deliverables, i.e., tasks, sub-tasks or other work elements in the Scope of Work. The SCM cannot direct or approve a Change Order.

State-Supplied Price Sheet – the bidding document created by the State and attached to this Bid Solicitation on which the Vendor {Bidder} submits it proposal pricing as is referenced and described in Bid Solicitation Section 4.4.5.

Subtasks – Detailed activities that comprise the actual performance of a task.

Subcontractor – An entity having an arrangement with a Vendor {Contractor}, whereby the Vendor {Contractor} uses the products and/or services of that entity to fulfill some of its obligations under its State Blanket P.O., while retaining full responsibility for the performance of all [the Vendor’s {Contractor's}] obligations under the Blanket P.O., including payment to the Subcontractor. The Subcontractor has no legal relationship with the State, only with the Vendor {Contractor}.

Task – A discrete unit of work to be performed.

Unit Cost – All-inclusive, firm fixed price charged by the Vendor {Bidder} for a single unit identified on a price line.

Using Agency[ies] – A State department or agency, a quasi-State governmental entity, or a Cooperative Purchasing Program participant, authorized to purchase products and/or services under a Blanket P.O. procured by the Division. This Blanket P.O. may be used by the Using Agencies or quasi-governmental agencies specifically identified in the Bid Solicitation. In addition, with the approval of the Director of the Division of Purchase and Property and the agreement of the Vendor {Contractor}, the Blanket P.O. may be used by any Using Agency or quasi-State governmental entity.

Vendor {Bidder} – An entity offering a Quote in response to the Division’s Bid Solicitation.

Vendor {Contractor} – The Vendor {Bidder} awarded a Blanket P.O. resulting from this Bid Solicitation.

TECHNOLOGY SPECIFIC DEFINITIONS

These definitions apply only to the Ownership of Material and Performance Guarantee of Vendor {Contractor} outlined in Section 5.0 of this Bid Solicitation.

Acceptance – The written confirmation by the Using Agency that Vendor {Contractor} has completed a Deliverable according to the specified requirements.

Commercial Off the Shelf (COTS) – Software provided by Vendor {Contractor} that is intended for general use.

Custom Software – Software and Work Product that is developed by Vendor {Contractor} at the request of the Using Agency to meet the specific business requirements of the Using Agency and is intended for its use.

Customized Software – COTS that is adapted by Vendor {Contractor} to meet specific business requirements of the Using Agency that differ from the standard requirements of the base product.

Deliverable – Goods, products, Services and Work Product that Vendor {Contractor} is required to deliver to the State under the Blanket P.O.

Hardware – Includes computer equipment and any Software provided with the Hardware that is necessary for the Hardware to operate.

Services – Includes, without limitation (i) Information Technology (IT) professional services, (ii) Software and Hardware-related services, including without limitation, installation, configuration, and training, and (iii) Software and Hardware maintenance and support and/or Software and Hardware technical support services.

Software – Includes, without limitation, computer programs, source codes, routines, or subroutines supplied by Vendor {Contractor}, including operating software, programming aids, application programs, application programming interfaces and software products, and includes COTS, Customized Software and Custom Software, unless the context indicates otherwise.

State Intellectual Property – Any intellectual property that is owned by the State. State Intellectual Property includes any derivative works and compilations of any State Intellectual Property.

Third Party Intellectual Property – Any intellectual property owned by parties other than the State or Vendor {Contractor} and contained in or necessary for the use of the Deliverables. Third Party Intellectual Property includes COTS owned by Third Parties, and derivative works and compilations of any Third Party Intellectual Property.

Vendor {Contractor} Intellectual Property – Any intellectual property that is owned by Vendor {Contractor} and contained in or necessary for the use of the Deliverables or which the Vendor {Contractor} makes available for the State to use as part of the work under the Blanket P.O. Vendor {Contractor} Intellectual Property includes COTS or Customized Software owned by Vendor {Contractor}, Vendor’s {Contractor’s} technical documentation, and derivative works and compilations of any Vendor {Contractor} Intellectual Property.

Work Product – Every invention, modification, discovery, design, development, customization, configuration, improvement, process, Software program, work of authorship, documentation, formula, datum, technique, know how, secret, or intellectual property right whatsoever or any interest therein (whether patentable or not patentable or registerable under copyright or similar statutes or subject to analogous protection) that is specifically made, conceived, discovered, or reduced to practice by Vendor {Contractor} or Vendor’s {Contractor’s} subcontractors or a third party engaged by Vendor {Contractor} or its subcontractor pursuant to the Blanket P.O. Notwithstanding anything to the contrary in the preceding sentence, Work Product does not include State Intellectual Property, Vendor {Contractor} Intellectual Property or Third Party Intellectual Property.

BLANKET P.O.-SPECIFIC DEFINITIONS/ACRONYMS

Beneficiary – A person determined as eligible for assistance in accordance with the State Plan(s) under Title XIX and Title XXI of the Social Security Act and/or other New Jersey medical assistance programs.

Business Hours – Official hours of operation, Monday through Friday, 8:00 AM to 5:00 PM EST.

Centers for Medicare and Medicaid Services (CMS) - An agency of the Federal Department of Health and Human Services that is responsible for the administration of the Medicare and Medicaid programs in the United States.

Code of Federal Regulations (CFR) – The codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the federal government. CFR Titles 42 and 45 govern Public Health and Public Welfare programs. Each volume of the CFR is updated once each calendar year and is issued on a quarterly basis. Additional information is located at: http://www.gpoaccess.gov/cfr/.

DHS – New Jersey Department of Human Services

Direct Care Provider (Home Health Aid) – Is an individual employed by a health care provider that administers health care services to beneficiaries.

DMAHS – Division of Medical Assistance and Health Services within the New Jersey Department of Human Services.

Health Care Providers – A business entity or a licensed individual that provides health care services to individuals, families or communities.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) – A law enacted in August 1996 requiring all protected patient information be safeguarded in specific ways to prevent accidental or purposeful disclosure, loss, or misuse.

Home Health Care Services (HHCS) – Health related tasks limited to skilled nursing, supervised by a registered professional nurse and medical social services which are necessary for the treatment of the Beneficiary’s medical condition.

Managed Care Organization (MCO) – An entity that has, or is seeking to qualify for, a comprehensive risk contract that is:

A. A Federally Qualified Health Maintenance Organization (HMO) that meets the advance directive requirements of 42 CFR 489 subpart I; or B. Any public or private entity that meets the advance directive requirements and is determined to also meet the following conditions:

1. Makes the services it provides to its Medicaid beneficiaries as accessible (in terms of timeliness, amount, duration, and scope) as those services are to other Medicaid recipients within the area served by the entity; and

2. Meets the solvency standards of 42 CFR 438.116.

Medicaid – A program to provide certain medical services to eligible low income people under Title XIX and Title XXI of the Social Security Act. The program is administered by states in accordance with federal statutes and regulations.

Medicaid Payer – The State’s Fiscal Agent. Please reference Blanket P.O. T2409.

Medicare – The federal health insurance program for people 65 year of age or older, individuals disabled for 24 months, and people with end-stage renal disease (permanent kidney failure with dialysis or a transplant).

Personal Care Services (PCS) – Health related tasks performed by a qualified individual in a Beneficiary’s home, under the supervision of a registered professional nurse, as certified by a physician in accordance with a Beneficiary’s written Plan of Care.

Plan of Care – A written treatment plan that identifies medical care objectives, interventions, timeframe for accomplishments, and evaluations for patient care.

Policy and Procedure Manual – Broad overview of standard operating policies and procedures such as process descriptions and standards.

Social Security Act – 74 P.L. 271, 49 Stat. 620

Title XIX – A section of the Social Security Act governing the Medicaid program that outlines states’ responsibilities in administering the program.

Title XXI – A section of the Social Security Act governing the Children’s Health Insurance Program (CHIP) that outlines states’ responsibilities in administering the program.

SCOPE OF WORK

PROJECT OVERVIEW

The Vendor {Contractor} shall implement and support an EVVMS that verifies HHCS have been delivered according to established policies and procedures. The proposed EVVMS shall:

A. Be a secure, centralized, Vendor {Contractor} hosted, web-based software platform where MCOs and State/County agencies are linked to all Health Care Providers, creating an environment for real-time communication, transparency, operational efficiency, report generation, and payment integrity as well as provide a verifiable audit trail of all information input into the EVVMS;

B. Utilize multiple technologies to track, maintain, and audit the time, location, and task performance of Health Care Providers and Direct Care Providers during service delivery;

C. Have the ability to provide receipt/authorized confirmation of services having been provided for the purpose of safeguarding against fraud, waste and abuse, compliance with the Beneficiary’s Plan of Care, and improving service delivery and program oversight;

D. Utilize multiple technology options for those responsible for inputting information into the EVVMS to provide adequate coverage Statewide. Options shall include, at a minimum, telephone, real-time GPS technology, and/or a fixed location tracking device when no landline or cellular service is available;

E. Interface with the State’s Medicaid Management Information System (MMIS) and MCO’s Prior Authorization system(s) to authorize payment of claims based on verified service delivery and compliance with the policies and procedures associated with the service;

F. Comply with the seven (7) conditions and standards for enhanced federal funding as provided by CMS (see Attachment 1). The technical architecture must provide a modular design based on the Medicaid Information Technology Architecture (MITA) framework.

EVVMS INTERFACE

Many Health Care Providers and MCOs already employ various types of EVVMS to track employees’ delivery of services. The proposed EVVMS must be a vendor hosted application that services as the State’s EVVMS with additional capacity to act as a “data aggregator” to combine EVVS data from multiple EVVS platforms. The system must be able to interface with the State’s Medicaid Management Information System (MMIS) and Managed Care Systems.

STAFFING

A. The Vendor {Contractor} shall maintain staffing levels to ensure successful implementation and on-going operation of the EVVMS throughout the duration of the Blanket P.O.; and B. The Vendor {Contractor} shall assign a Manager who will maintain coordination and communication with the State Contract Manager (SCM). This individual shall be responsible for the day-to-day operations of the project and shall be responsible for ensuring that all deliverables are delivered correctly, on time, and within budget.

SCHEDULING CAPABILITIES

The Vendors {Contractors} EVVMS shall provide role-based access controls that allow system administrators to create and assign access to user roles. The EVVMS shall:

A. Allow MCOs to create a case and assign authorization;

B. Allow Health Care Providers to create and manage schedules of each case they are assigned;

C. Provide MCOs with “view only” access to the schedule;

D. Allow Health Care Providers “view only” access for the authorizations;

E. Automatically broadcast cases to only those Health Care Providers that meet the specific needs of a patient for timely placement and create a time stamped audit trail of all communication; and F. Provide the State and MCO’s access to the Beneficiary’s schedule, authorization, visit confirmation, and plan of care.

VENDOR {CONTRACTOR} COMPLIANCE

The Vendor’s {Contractor’s} EVVMS shall include a comprehensive Vendor {Contractor} compliance database to ensure services are being delivered and billed by compliant staff. The database shall:

A. Track real-time start and end times, identifiers for the Health Care Provider and Direct Care Provider, location of service provided, missed visits, late visits, include the Plan of Care and all updates thereto, and task performance of Health Care Providers during service delivery;

B. Capability to receive confirmation that the service was provided;

C. Maintain an audit trail that documents and tracks the name/identifier of the Health Care Provider and the Direct Care Provider as well as the start and end times of the Health Care Provider’s (or Direct Care Provider) visits;

D. Prevent payment to Health Care Providers and Direct Care Provider who are:

1. Not licensed or certified;

2. Excluded or suspended;

3. Not an approved provider or otherwise not eligible to provide services;

4. Lacking hours available in the service plan; and/or

5. Not physically present at the Beneficiary’s location;

E. Have the ability to track and report modifications to data input elements after the Direct Care Provider has called or otherwise notified the Health Care Provider of their times and services, including the name of staff making the change and the reason for the change;

F. Create timesheets with start and end times;

G. Ensure that the hours reported occurred in the Beneficiary’s home or community; and H. Require review/approval by the Beneficiary or the Beneficiary’s designee that the services were performed, and time spent by the health care provider were in accordance with the Plan of Care.

UPDATES

The Vendor’s {Contractor’s} EVVMS shall have the capability to receive and store daily updates from MCOs, Health Care Providers, and Plan of Care data.

PRE-BILLING CLAIMS ENGINE

The Vendor’s {Contractor’s} EVVMS shall include a configurable pre-billing claims engine so the State can accommodate specific compliance requirements in advance of claims submission, thereby preventing compliance issues before they occur. The pre-billing claims engine shall not allow a health care provider to submit a claim that does not conform to all applicable regulatory requirements and satisfies all pre-edits. The pre-billing claims engine shall have the ability to:

A. Confirm that the physician’s order (including the Plan of Care) is in the EVVMS before services can be rendered since HHCS must be certified in writing by a physician;

B. Provide a pre-billing rule so that claims cannot be submitted if the patient does not have a Plan of Care;

C. Track the activities provided in the home of the patient. Those activities shall then be compared with the Plan of Care and workflows set up based on the compliance level of those checks;

D. Prevent claims with no activities from being submitted to the State;

E. Provide a rules-based billing and scheduling software platform across all service providers; and F. Send verified claims to the MMIS or MCO for payment.

The pre-billing claims engine shall prevent the provider from submitting claims that are not 100% compliant.

open system requirement

The Vendor’s {Contractor’s} EVVMS shall have the capability to integrate data and maintain audit trails of all historical documents and electronic record change.

medicaid and hipAa requirements

The Vendor {Contractor} shall securely handle and store sensitive Beneficiary…