COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES ONE ASHBURTON PLACE, 11TH FLOOR BOSTON, MASSACHUSETTS 02108
REQUEST FOR RESPONSES For PROVIDER ANALYTICS SOFTWARE Document # 14EHSPROVANALYTICSWME ISSUED: FEBRUARY 28, 2014
TABLE OF CONTENTS Section 1. INTRODUCTION ........................................................................................................ 1 1.1
Overview.................................................................................................................. 1
1.2
RFR Goals ............................................................................................................... 3
1.3
Anticipated Start and Completion Dates for Development Phase ........................... 3
1.4
Response Structure .................................................................................................. 3
1.5
Comm-PASS Transition to COMMBUYS eProcurement System .......................... 4
1.6
General Procurement Requirements ........................................................................ 4
1.7
Payment ................................................................................................................... 5
1.8
Anticipated Term of Contract .................................................................................. 5
1.9
Changes in Scope/Additional Responsibilities ........................................................ 6
Section 2. DEFINITION OF TERMS .......................................................................................... 6 Section 3. BIDDER MINIMUM QUALIFICATONS .............................................................. 10 Section 4. RESPONSE REQUIREMENTS AND EVALUATION ......................................... 11 4.1
Bid Process ............................................................................................................ 11
4.2
Submission Instructions and Logistics .................................................................. 13
4.3
Evaluation Criteria ................................................................................................. 15
4.4
Other Response Requirements ............................................................................... 16
Section 5. BUSINESS RESPONSE SUBMISSION REQUIREMENTS ................................ 19 5.1
Transmittal Letter .................................................................................................. 19
5.2
Bidder’s Contact Information ................................................................................ 19
5.3
Required Forms ..................................................................................................... 19
5.4
Conflict of Interest ................................................................................................. 20
5.5
Certificate of Insurance.......................................................................................... 20
5.6
Financial Disclosures ............................................................................................. 20
5.7
Contract Terms ...................................................................................................... 21
i
5.8
Information About the Bidder’s Firm .................................................................... 21
Section 6. TECHNICAL REQUIREMENTS ............................................................................ 24 6.1
Provision of Software Package (including if applicable Software as a Service) and Services ........................................................................................................... 24
6.2
Data Storage........................................................................................................... 26
6.3
Data Sharing with PCCs ........................................................................................ 26
6.4
Cost, Quality, and Utilization Reporting ............................................................... 27
6.5
Patient Registries ................................................................................................... 27
6.6
Hosting Services .................................................................................................... 28
6.7
Training.................................................................................................................. 29
6.8
Technical Support .................................................................................................. 29
6.9
Demonstrations ...................................................................................................... 29
6.10
Quality Data Repository (Optional Bid Item) ....................................................... 31
Section 7. TECHNICAL RESPONSE SUBMISSION REQUIREMENTS ........................... 33 7.1
Technical Response-Overview .............................................................................. 33
7.2
Technical Response-Detailed ................................................................................ 34
7.3
State Contracts ....................................................................................................... 36
7.4
Technical Support .................................................................................................. 36
7.5
Training.................................................................................................................. 36
7.6
Patient Registries ................................................................................................... 36
7.7
Reports ................................................................................................................... 36
7.8
Demonstration........................................................................................................ 36
7.9
Technical Response for Quality Data Repository (Optional Bid Item) ................. 36
Section 8. COST RESPONSE SUBMISSION REQUIREMENTS ......................................... 36 8.1
Analytical Software ............................................................................................... 37
8.2
Quality Data Repository (Optional Bid Item) ....................................................... 38
8.3
Rate Requirements ................................................................................................. 38
Section 9. PROJECT SPECIFIC TERMS AND CONDITIONS ............................................ 39 ii
9.1
Proprietary Rights .................................................................................................. 39
9.2
Warranty ................................................................................................................ 43
9.3
Certain Rights of the United States ....................................................................... 45
Section 10. OTHER REQUIRED TERMS and Conditions..................................................... 47 10.1
RFR Contract ......................................................................................................... 47
10.2
Fraud ...................................................................................................................... 47
10.3
New Initiatives ....................................................................................................... 48
10.4
Insurance ................................................................................................................ 48
10.5
Effect of Invalidity of Clauses ............................................................................... 48
10.6
No Third-Party Enforcement ................................................................................. 48
10.7
Compliance with Laws .......................................................................................... 48
10.8
Independent Contractors ........................................................................................ 48
10.9
Force Majeure ........................................................................................................ 49
10.10 Intellectual Property and Work Effort Agreement for Successful Vendor’s Employees, Consultants and Agents...................................................................... 49 10.11 Publicity ................................................................................................................. 49 10.12 Publications Regarding or Derived From This Contract ....................................... 50 10.13 Covenant against Contingent Fees......................................................................... 50 10.14 Corrective Action Plan .......................................................................................... 50 10.15 Dispute Resolution................................................................................................. 51 10.16 Enterprise Information Technology Policies, Standards and Procedures .............. 51 10.17 Accessibility .......................................................................................................... 52 10.18 Maintenance Agreements ...................................................................................... 53 10.19 Authorizations........................................................................................................ 54 10.20 Confidentiality, Business Associate and Data Use Requirements......................... 54
ATTACHMENTS ATTACHMENT A: PCPR PCC Contract Addendum iii
ATTACHMENT B: Certification of Non-Collusion ATTACHMENT C: Certification Regarding Debarment and Suspension ATTACHMENT D: Disclosures ATTACHMENT E: Certification with Regard to Financial Condition ATTACHMENT F: Cost Response Worksheet ATTACHMENT G: Model Contract / Statement of Work Exhibit A: Intellectual Property and Work Effort Agreement for Successful Vendor’s Employees, Consultants and Agents Exhibit B: Sample Business Associate (BA) Provisions (MassHealth Only) Exhibit D: SaaS or Service Software Provisions
iv
Section 1. INTRODUCTION 1.1
Overview The Massachusetts Executive Office of Health and Human Services, Office of Medicaid (EOHHS) administers the Commonwealth of Massachusetts Medicaid program (MassHealth) pursuant to M.G.L. c. 118E, Titles XIX and XXI of the Social Security Act, and other applicable laws and waivers. EOHHS is issuing this Request for Responses (RFR) for Provider Analytics Software to solicit Responses from qualified entities to provide reporting and analytical software solutions to support the implementation of the Commonwealth’s Primary Care Payment Reform Initiative (PCPR). Software solutions may be provided as developed software, Commercial Off-The-Shelf Software (COTS) or Software as a Service (SaaS). EOHHS has developed plans for PCPR, a three-year program, that EOHHS intends to begin in March 2014. As part of PCPR, EOHHS invited applications from qualified providers in the state’s Primary Care Clinician (PCC) Plan to participate in a new care delivery model emphasizing Patient-Centered Medical Homes, the integration of Primary Care Services with Behavioral Health Services, and an alternative payment mechanism. PCPR includes requirements for coordinating care across providers, identifying highrisk members and managing care across settings, improving on defined quality metrics, and taking accountability for patients’ total cost of care. The goal of this RFR is to provide analytical capabilities and reports that support these efforts. Primary care practices currently receive limited data on care their patients receive outside the practice. Services under this RFR will include both internal and physician-facing report generation, as well as a portal for accessing and analyzing raw data. The portal will be accessed by PCCs, either individually or by groups of PCCs, participating in PCPR. These tools will support the goals of better care for individual patients, quality improvement, and tracking the practices’ performance on quality and cost metrics associated with PCPR. Pursuant to this RFR, EOHHS plans to select a Bidder to provide the software and related analytic, professional and support services needed to implement and support the provider reporting and data analytics requirements under the PCPR and other MassHealth programs. EOHHS seeks to contract with a single Bidder to provide, implement, and support cost, utilization, and quality reporting software, capable of customization by the Bidder. The Bidder will be responsible for providing a comprehensive software solution for reporting and analysis for PCPR, constructing the digital infrastructure for storing report related data, and providing training and ongoing support. The Bidder will also provide dashboards and reports that will assist MassHealth in the evaluation of PCPR. The software to be acquired pursuant to this procurement is required to draw on MassHealth claims paid data, stored in the MassHealth Data Warehouse, with possible expansion to other data sets in the future. The claims data will include medical, pharmacy, and dental datasets. Part of the implementation activity is to perform the technical work required to integrate with these three claims data sets.
1
The resulting software may be a previously developed Commercial Off-The-Shelf Software (COTS) (perhaps with customization and/or custom configuration), or fully custom software (perhaps based on Open Source software if available). Bidders may propose as a compensation plan a traditional upfront license and monthly/annual support arrangement or Bidders may propose a Software as a Service (SaaS) compensation model. In addition to providing the software capability, it is desirable for the Bidder to provide hosting services where the software runs in a Bidder supplied and managed data center. The price bid templates provide opportunity to bid appropriately. The Technical Response should clearly state the software history (COTS vs Custom), the compensation model (traditional vs SaaS) and whether hosting is included or not. EOHHS is seeking to select a Bidder that can provide:
Software capable of receiving health care claims data, including, but not limited to, inpatient, outpatient/ambulatory, emergency department, and pharmacy data from a variety of providers such as hospitals, medical providers, behavioral health providers, and dentists. The software must produce patient-specific and aggregate patient reports relating to the cost and nature of all care provided to patients at an individual and/or aggregate level.
Technical professional services related to designing capabilities beyond what may be available in a COTS product and/or related to developing a complete system. The Commonwealth prefers a COTS solution but is willing to accept a full or partially customized solution.
Technical professional services related to integrating existing MassHealth services with the procured software or software services.
Technical and professional services related to integrating the procured software or software services system with the EOHHS Virtual Gateway single sign on system to enable practitioners to access this system with the same credentials that they use to access other EOHHS systems.
Ongoing software Maintenance and support including new releases, defect remediation, and general technical support.
In the case of solutions that include hosting services: o Bidders may propose a solution hosted in a US data center of their choosing. o Ongoing management of the datacenter including ensuring that the system is operational 24x7. Bidders to define availability in their Technical Response.
Pricing (rates) for technical professional services to enhance the system over time including additional data set integration, additional reporting and/or other functionality
If requested by EOHHS at some later date during the term, the Bidder may be asked to offer a software solution to include an interface to an external Quality Data Repository to the extent that the Successful Bidder declines to offer the Optional Quality Data Repository discussed below.
Optional Bid Item: Provision of Quality Data Repository Software EOHHS is also seeking support to develop a Quality Data Repository with the goal of centralizing quality data collected through claims data, medical records and patient experience surveys. EOHHS is seeking to select a Bidder that can provide: 2
o A software component, referred to as a Quality Data Repository (QDR), capable of receiving and storing quality data from several sources, including provider EHR systems certified for Meaningful Use and the state health information exchange (Mass HIway), for manual entry/upload to an existing portal or to a new portal provided by the Bidder. o Technical professional services related to integrating the procured software (or SaaS solution) with the Mass HIway. o Technical services, if necessary, to integrate the QDR software with the main analytics software. o Ongoing software Maintenance and support including new releases, defect remediation, and general technical support. o In the case of software solutions that include hosting services: Bidders may propose a solution hosted in a US data center of their choosing. Ongoing management of the datacenter including ensuring that the system is operational 24x7. Bidders to define availability in their Technical Response. 1.2
RFR Goals Acquisition of the software is sought to give PCPR Participants reports and analyses of their claims and encounter data. This analysis will enable PCPR Participants to lower the total cost of care, manage utilization, improve performance on quality metrics, and meet clinical delivery model milestones. The software should also provide functionality to support MassHealth reporting and evaluation needs. For example, EOHHS plans to use this software to support its MassHealth office (MassHealth) in analyzing claims and encounter data to understand trends and opportunities for cost and quality improvement as well as the evaluation of the impact of PCPR.
1.3
Anticipated Start and Completion Dates for Development Phase The pre-launch phase of this project is expected to be completed, including all design, development, testing, pre-launch training, and deliverables, by the GO LIVE date, tentatively January 1, 2015. Work is expected to commence one week after execution of the Contract. MassHealth will pilot test the software used for analytic reporting prior to its implementation. As part of the pilot, MassHealth will be given the option to test the software's interface, usability, as well as any other purchased software components and/or capabilities. The Successful Bidder will work with MassHealth to identify data extracts and any other reporting elements needed to test the software. The pilot period will not exceed 6 months during which time any warrantees associated with the software will not begin. At the conclusion of the pilot and upon implementation of the software, the warrantee for the software will go into effect.
1.4
Response Structure The Response to this RFR will include:
3
1.5
A Business Response, including all required forms and legal declarations and certifications, the Bidder’s firm and staff qualifications, and any subcontracting firm qualifications as specified in Section 5; A Technical Response which describes the Bidder’s approach to addressing the requirements generally and discusses how each specific requirement will be met as specified in Section 7; and A Cost Response which contains costs broken down as specified in Section 8.
Comm-PASS Transition to COMMBUYS eProcurement System The Commonwealth Procurement Access & Solicitation System (Comm-PASS), in use since 2004, is being retired and replaced by a new eProcurement system known as COMMBUYS. In order for data to migrate from Comm-PASS to COMMBUYS the Operational Services Division (OSD) has identified a transition period during which no new solicitations or updates to existing solicitations and contracts will be able to be published by agency staff on Comm-PASS. This transition period is tentatively scheduled for February 28, 2014 – March 23, 2014. During this transition period any information that EHS would normally post to Comm-PASS will be posted to the following website: http://www.mass.gov/eohhs/comm-pass. Respondents are cautioned to check this site regularly, as this will be the sole method used for notification of changes to open solicitations and new solicitations during the transition period. Bidders may also contact the issuer identified in the solicitation document to confirm that they have the most recent documents necessary to respond to the relevant solicitation. After March 24, 2014, all information about this solicitation can be found on COMMBUYS by searching the Alternate ID field for the RFR document number listed on the front page of this RFR. All Bidders responding to this RFR agree that: (1) they will maintain an active Comm-PASS account until such time as the Commonwealth’s new eProcurement system, COMMBUYS, replaces the Comm-PASS system; (2) they will maintain an active vendor account in COMMBUYS; (3) they will, if directed to do so by the procuring entity, activate and maintain a contract and technically compliant catalog in COMMBUYS; (4) they will comply with all requests by the procuring entity to utilize COMMBUYS for the purposes of conducting all aspects of purchasing and invoicing with the Commonwealth, as added functionality for the COMMBUYS system is activated; (5) Bidder understands and acknowledges that all references to the CommPASS website or related requirements throughout this RFR shall be superseded by comparable requirements pertaining to the COMMBUYS website upon replacement of the Comm-PASS system; and (6) in the event the Commonwealth adopts an alternate eProcurement system, successful Bidders will be required to utilize such system, as directed by the procuring entity. To learn more about the COMMBUYS system, please visit: http://www.mass.gov/anf/budgettaxes-and-procurement/procurement-info-and-res/conduct-a-procurement/commbuys/
1.6
General Procurement Requirements EOHHS is issuing this RFR in accordance with the provisions of 801 CMR 21.00, which governs the procurement of services by state agencies and requires a competitive procurement process, including the issuance of an RFR, for acquisitions of commodities and services. Words used in this 4
RFR shall have the meanings defined in 801 CMR 21.00. Unless otherwise specified in this RFR, all communications, Responses, and documentation must be in English, all measurements must be provided in feet, inches, and pounds and all cost proposals or figures in U.S. currency. EOHHS makes no guarantee that a Contract, or any obligation to purchase any products or services, will result from this RFR. EOHHS reserves the right to amend this RFR at any time prior to the date Responses are due. Any such amendment will be posted on EOHHS' website at http://www.mass.gov/eohhs/comm-pass. Bidders are cautioned to check this site regularly, as this will be the sole method used for notification of changes as well as for any clarifications of this RFR that EOHHS might issue. Acquisition method: Fixed Price (except for certain Operations and Maintenance tasks) Single or multiple vendor(s): Single vendor Use of Procurement by single or multiple agencies: EOHHS Anticipated Payment Structure: see RFR Section 1.7, as well as Section 8 (Cost Response) Anticipated Duration of Contract: see Section 1.8 Funding Source: Federal funds are expected to be used to fund 100% of this contract. 1.7
Payment All payments shall be made in accordance with the Commonwealth’s bill paying policy. The selected Bidder must submit invoices for payment, in such detail as to adequately substantiate amounts invoiced, as follows:
The attachment shall show the agreed-upon payment amount; and
Any deductions owed EOHHS.
If the parties negotiate additional responsibilities that call for additional compensation, the scope of the additional responsibilities and compensation will be reflected in an amendment to the Contract/SOW and will be shown as a separate line item on the invoice. The selected Bidder shall maintain detailed records that substantiate claims for payment. Payment for products and/or services under the Contract resulting from this RFR will be based on a firm, fixed-price. Block payments will be made upon completion of defined Milestones, based on the value of completed work. Both the amount of payments and definition of Milestones will be determined in the Contract negotiation process. EOHHS reserves the right to include a holdback of up to 5% in the final Contract. Payment of hold-back amounts shall be made at the expiration of the Warranty Period. Specific additional services required will be paid for on a time and materials basis. 1.8
Anticipated Term of Contract The Contract that results from this RFR will have an initial term that begins with Contract execution and terminates on December 31, 2016. The Contract may be extended at the discretion 5
of EOHHS, in any time period increments up to five years, with any required extension, amendment, or statement(s) of work to be negotiated by the contracting parties. 1.9
Changes in Scope/Additional Responsibilities EOHHS shall have the option, at its sole discretion, to modify, increase, reduce or terminate any activity related to any Contract that may result from this RFR whenever, in the judgment of EOHHS, the goals of the project have been modified or altered in a way that necessitates such changes. EOHHS reserves the right to amend this RFR or any Contract resulting from this RFR. EOHHS may negotiate changes to the original performance measures, reporting requirements or payment methodologies tied to performance at any time during the Contract duration if they are consistent with the specifications of this RFR. EOHHS reserves the right to negotiate and execute Contract amendments with the Contractor(s) which EOHHS determines as necessary to result in the intent of this RFR, to amend the specifications for necessary requirements, or to result in a better valued Contract. Negotiation would be with the Successful Vendor(s) of this RFR. Amendments may include, but are not limited to, contract dollars, contract performance, increased or decreased obligations, scope of work, quantity, etc. EOHHS will provide prior written notice of any such action to the Vendor, and the parties will negotiate the effect of such changes in scope on the schedule and payment terms. No compensation shall be owed, nor credits given, until the parties reach agreement on the modified Change Order or Contract/SOW amendment. Such Change Order or Contract/SOW amendment, when approved, shall detail the changes, the cost impact (if any) and the timeline impact (if any).
Section 2. DEFINITION OF TERMS The following terms appearing capitalized throughout this RFR and Attachments have the following meanings, unless the context clearly indicates otherwise; provided further, all terms in this RFR not otherwise defined shall have the meaning ascribed to them in the Contract Addendum to the PCC Plan Provider Contract regarding EOHHS’s Primary Care Payment Reform Initiative (PCPR PCC Contract Addendum), attached hereto as Attachment A. All Payer Claims Database (APCD): A statewide database for the Commonwealth of Massachusetts established with authority to collect medical, pharmacy, and dental claims data, and information from member eligibility, provider, and product files encompassing fully-insured, self-insured, Medicare, and Medicaid data. Behavioral Health Services: Health care services related to mental illness, emotional disorders and substance use, and the application of behavioral principles to address lifestyle and health risk issues. Bidder: The entity that submits a Response to this Request for Responses. When the Bidder is selected, this RFR refers to that entity as the Successful Bidder, Selected Vendor, or Contractor. Commercial Off-The-Shelf Software (COTS): Software products that are ready-made and developed for the open market. 6
Commonwealth Data: All data used, controlled or owned by EOHHS and/or the Commonwealth to which the Contractor gains access through the Contract resulting from this RFR including without limitation all Personal Information as that term is defined below, personal data as defined in M.G.L. Chapter 66A and referenced in Massachusetts Executive Order 504, and any other data obtained by EOHHS or its constituent agencies pursuant to Federal law permitting EOHHS to gather data. Comprehensive Primary Care Payment (CPCP): A risk-adjusted, per Panel Enrollee, per month payment for a defined set of Primary Care Services and Behavioral Health Services. Contract: The Contract between EOHHS and a Bidder that results from this RFR. Contract Addendum to PCC Plan Provider Contract (or PCPR PCC Contract Addendum): The addendum to the PCC Plan Provider Contract executed between each PCPR Participant and EOHHS pursuant to the PCPRI RFA and any amendments thereto. The PCPR PCC Contract Addendum incorporates by reference all attachments and appendices to the PCPRI RFA, including each PCPR Participant’s response to the PCPRI RFA. The PCPR PCC Contract Addendum is attached hereto as Attachment B. Cooked Claims: MassHealth claims from either FFS or PCC Plan Members that have been fully adjudicated. Executive Office of Health and Human Services (EOHHS): The single state agency responsible for the administration of the MassHealth program, pursuant to M.G.L. c. 118E and Title XIX and XXI of the Social Security Act and other applicable laws and waivers. Federal Information Security Management Act of 2002 (FISMA): United States federal law (44 USC §3541 et seq.) that addresses Information Security: http://csrc.nist.gov/drivers/documents/FISMA-final.pdf. Fee-for-Service or FFS: A payment mechanism in which all reimbursable health care activity is described and categorized into discrete and separate units of service and each health care provider is separately reimbursed for each discrete service rendered to a patient. GO LIVE: The point at which a software project is activated or turned on for use by the intended users accessing production data to accomplish real work. Health Insurance Portability and Accountability Act of 1996 (HIPAA): United States federal law (P.L. 104-91, see 42 USC §§ 1301 et seq.), enacted to improve the continuity of health insurance coverage in group and individual markets, combat waste, fraud and abuse in health insurance and health care delivery, standardize the electronic exchange of health related transactions by payers and relationship entities, and assure the privacy and security of Protected Health Information (PHI). Highest Risk Panel Enrollee: A Panel Enrollee with one or more chronic conditions who EOHHS or the PCPR Participant determines would benefit from the provision of Clinical Care Management services which would reasonably be expected to result in improved health status and decreased health care expenditures through avoidable high cost or high intensity services, such as inpatient services or emergency department services.
7
Highest Risk Panel Enrollee Reporting: Reports that focuses on cost and utilization of the Highest Risk Panel Enrollees which may include Panel and Member level reporting for providers in order to better manage this population. Information Security (Security): Refers to the processes, methodologies, and means which are designed and implemented to protect information systems and information including print, electronic, or any other form of confidential, private and sensitive information or data – from unauthorized access, use, misuse, disclosure, destruction, modification or disruption, which includes but is not limited to the ability to authenticate and authorize users to provide secure access to the system in a traceable (auditable) manner. Information Technology Division (ITD): The Massachusetts Division that provides a range of centralized IT services; oversees IT policies, standards and architecture; and promotes cross-agency collaboration and adoption of shared services. Key Personnel: Personnel directly responsible for management of the Contract; or those personnel whose professional/technical skills are determined to be essential to the successful implementation of the Agreement. Maintenance: The preventive or corrective action(s) undertaken to maintain the functionality and to improve or increase the processing performance of the software or the infrastructure on which it runs. Managed Care Organization (MCO): A managed care organization, as defined in 42 CFR section 438.2, that contracts with MassHealth; provided, however, that Managed Care Organization shall not include a Senior Care Organization or an Integrated Care Organization. MassHealth: The medical assistance or benefit programs administered by EOHHS to provide and pay for medical services to eligible Members pursuant to Title XIX of the Social Security Act, Title XXI of the Social Security Act, M.G.L. c. 118E, and other applicable laws and waivers. MassHealth Data Warehouse: The Data Warehouse is the central repository for all Medicaid reporting and analytics activity. The Warehouse is specifically designed and optimized for querying and reporting. The Warehouse supports non-operational business reporting and analytic needs for all MassHealth business units as well serving as the source for all Federal Reporting. MassHealth Performance Dashboard: A performance management tool identifying MassHealth’s key performance indicators, including, but not limited to, current measures and/or historical trends of cost, utilization, quality and process measures, where applicable. Member: A person determined by EOHHS to be eligible for MassHealth. Metrics Reports: Reports that provide performance-related data. Milestone: A pre-defined event that marks the completion of a subset of the project activities, tasks, and deliverables scheduled in the project plan. Panel: All Members enrolled (i) in the PCC Plan or (ii) with a MCO that has entered into a contract amendment for the PCPRI, that are assigned to a particular PCC. 8
Panel Enrollee: A Member enrolled (i) in the PCC Plan or (ii) with a MCO that has entered into a contract amendment with the Participant pursuant to Section 2.5(I) of the PCPRI RFA, that is assigned to the Panel of a Primary Care Clinician that is a Participant; provided, however, that a Panel Enrollee does not include Members enrolled with an Integrated Care Organization or who have third party insurance. Patient-Centered Medical Home (PCMH): A model of care delivery in which a Primary Care Clinician and members of his or her care team coordinate all of a patient’s health needs, including management of chronic conditions, visits to specialists, hospital admissions, and reminding patients when they need check-ups and tests. Patient-Centered Medical Home Initiative (PCMHI): The three-year demonstration initiative established in 2010 and administered by EOHHS in which each Primary Care Clinician selected for the program receives payment through Alternative Payment Methodologies and / or technical assistance to transform its practice into a Patient-Centered Medical Home. Patient Registry: An electronic system for tracking Members that EOHHS has determined is critical to the management of the health of a Panel, including dates of delivered and needed services, laboratory values needed to track a chronic condition, and other measures of health status. PCPR Participant or Participant: A PCC that has been selected by and contracts with EOHHS to participate in the PCPRI. PCPRI RFA: The Request for Applications, together with all attachments, released by EOHHS on March 7, 2013 and Amended and Restated on May 8, 2013, and as subsequently amended on May 14, June 6, and June 11, 2013 (accessible at www.comm-pass.com under Document Number 13CBEHSPCPRIRFA until March 23, 2014; after that date search the Alternate ID field on COMMBUYS for this Document Number). Personal Information (PI): Information that can be used to uniquely identify, contact, or locate a single person or can be used with other sources to uniquely identify a single individual as that term is defined in M.G.L. Chapter 93H. Pharmacy Claims: Claims related to pharmacy related prescriptions. Primary Care Clinician (PCC): A physician, independent nurse practitioner, group practice organization, community health center, hospital-licensed health center, or acute hospital outpatient department, with a signed PCC Plan provider agreement that is approved by EOHHS, pursuant to 130 CMR 450.118. Primary Care Clinician (PCC) Plan: The Primary Care Case Management Program administered by EOHHS through which Panel Enrollees receive coordinated Primary Care Services and certain other medical services. Procurement Management Team (PMT): The evaluation committee for this procurement. Protected Health Information (PHI): Individually identifiable health information as further defined under HIPAA. 9
Quality Data Repository (QDR): A mechanism to receive and store clinical quality measures (CQM) as well as other quality data. The source of CQM will be electronic health record systems (EHRs) and related clinical systems maintained by providers and clinical organizations who provide care to patients. Raw Claims: MassHealth claims from either FFS or PCC Plan Members that have not been fully adjudicated. Response: The submission of an application for this Request for Responses. Request for Responses (RFR): This document requesting Responses from eligible Bidders for provider analytics software. Risk Score: A factor determined by EOHHS for use in calculating the CPCP or Shared Savings / Risk Payment, to reflect the age, sex, diagnoses or other characteristics of PCPR Participant’s Panel. Significant Subcontractor: An entity that makes a significant contribution to the project based on the nature and extent of its responsibilities, not the dollar amount it contracts for with the prime Contractor. Software as a Service (SaaS): Selected Vendor’s software application(s) and any third-party or other software, and all new versions, updates, revisions, improvements and modifications of the foregoing, that the Selected Vendor provides remote access to and use of as part of the software and services procured under this RFR, including hosting, management and operation of such software in accordance with all terms and conditions set forth in the Agreement and any applicable service order. Successful Bidder, Selected Vendor, or Contractor: The Bidder who has been selected by the PMT and entered into a Contract with EOHHS for the products and services procured under this RFR. Virtual Gateway: An internet portal designed by the Executive Office of Health and Human Services to provide the general public, medical providers, community-based organizations and EOHHS staff with online access to health and human services
Section 3. BIDDER MINIMUM QUALIFICATONS Bidders for this RFR must meet the following minimum qualifications: 1. Have at least 2 years’ experience providing large scale provider analytic software computing products and services; 2. Have been in business for a minimum of five (5) years; 3. Have offices and operations within the United States; 4. Have a demonstrated ability to deliver projects within budget and on time, especially with aggressive timelines;
10
5. Have implemented the same or similar software or SaaS product (including hosting, management and operation as applicable) and support with other payers; 6. Have direct project experience with state and federal laws and regulations pertaining to privacy and security; 7. Have experience working on enterprise-scale projects with multiple vendors and multiple stakeholders; and 8. Possess all necessary business licenses, registrations, and professional certifications necessary to do business in Massachusetts at the time of the contracting.
Section 4. RESPONSE REQUIREMENTS AND EVALUATION 4.1
Bid Process 4.1.1 Procurement Calendar The following timetable represents EOHHS’ best estimate of the schedule that shall be followed. Unless otherwise specified, the time of day for the following events shall be between 8:00 a.m. and 4:30 p.m., Eastern Time. EOHHS reserves the right, at its sole discretion, to adjust this schedule as it deems necessary. Notification of any adjustment to the RFR timetable shall be posted on EOHHS' website at http://www.mass.gov/eohhs/comm-pass. EVENT
RFR Issued Deadline for Bidder Submission of Questions Posting of Answers to All Questions (estimated) Responses Due
DATE/TIME February 28, 2014 Friday, March 14, 2014, 4:00 p.m. March 28, 2014 Friday, April 11, 2014, 4:00 p.m.
Bidder Oral Presentations (estimated)
April 2014
Bidder selection (estimated)
May 2014
Contract signed/Work begins (estimated)
May 2014
11
4.1.2 Questions Bidders may make written inquiries concerning this RFR until the questions due date set forth in Section 4.1.1. Written inquiries may be sent via email to the RFR contact listed below. Microsoft Word is the preferred file format; a plain text email is also acceptable. Bidders are prohibited from communicating directly with any employee or contractor of the procuring department or any member of the PMT regarding this RFR except as specified in this RFR, and no other individual Commonwealth employee or representative is authorized to provide any information or respond to any question or inquiry concerning this RFR. Bidders may contact the contact person using the contact information below in the event that this RFR is incomplete or information is missing. Bidders experiencing technical problems accessing information or attachments stored on Comm-PASS should contact the Comm-PASS Helpdesk. RFR Contact: Melissa Morrison, Procurement Coordinator Executive Office of Health and Human Services, Legal Unit One Ashburton Place, 11th floor, Boston, MA 02108 Phone: (617) 573-1683 E-mail:
[email protected] No other individual(s) at EOHHS should be contacted regarding any aspect of this procurement. EOHHS will review inquiries and prepare written answers to questions, at its discretion. The written answers will be posted on EOHHS' website at http://www.mass.gov/eohhs/comm-pass. Only written answers are binding on EOHHS. 4.1.3 Oral Presentation/Interview The PMT, in its sole discretion, will determine which Bidders, if any, will be asked to make an oral presentation. Oral presentations may be held to allow the Bidder to clarify details or further inform the committee regarding the Bidder’s organization or Response, but not to change or correct the original Responses in any way. Oral presentations shall not be open to the public nor to any competitors. Section 4.1.1 provides the date(s) on which an oral presentation may be held. Failure of a Bidder to agree to a date and time for an oral presentation may result in rejection of the Bidder’s Response. 4.1.4 Best and Final Offer (BAFO) Pursuant to 801 CMR 21.06(11), EOHHS may offer one or more Bidders an opportunity to provide a Best and Final Offer (BAFO). If it so chooses, EOHHS will distribute specific information regarding submission requirements, timelines, and information about its BAFO evaluation process to those Bidder(s) selected for participation in the BAFO. Bidders may be asked to reduce costs or provide additional clarification to specific sections of the RFR Response. Bidders are not required to submit a BAFO in response to EOHHS’ offer, and may notify EOHHS in writing that their Response remains as originally submitted.
12
4.2
Submission Instructions and Logistics 4.2.1 Certifications In addition to the certifications found in the Commonwealth’s Standard Contract Form, by submitting a Bid Response, the Bidder certifies that the Response has been arrived at independently and has been submitted without any communication, collaboration, or without any agreement, understanding or planned common course or action with, any other Bidder of the commodities and/or services described in the RFR. 4.2.2 Public Records All Response and related documents submitted in response to this RFR become public records and are subject to the Massachusetts Public Records Law, M.G.L. c. 4, s. 7, ss. 26, and M.G.L. c. 66, s. 10. Any statements in submitted Responses that are inconsistent with these statutes will be disregarded. 4.2.3 Alterations Bidders may not alter (manually or electronically) the solicitation language or any solicitation component files, except as directed in the RFR. Modifications to the body of the solicitation, specifications, terms and conditions, or which change the intent of this solicitation are prohibited and may disqualify a Response. 4.2.4 Response Documents All Responses must be sealed and submitted in accordance with the instructions in this section. Response documents must be signed in ink. Facsimile signatures are unacceptable. Responses that are priced or signed in pencil may be rejected as nonresponsive. Bidders are cautioned that handwritten alterations to Response documents must be initialed by the person signing the Responses, or by his/her authorized designee. Failure to do so may result in rejection of the Response. Response documents must be typewritten or computer printed. Handwritten Responses are not acceptable. Responses should be printed double sided with one inch margins and font no smaller than 11pt. Times New Roman is the preferred font. The Response documents shall consist of the following:
Business Response -The Business Response must contain the documents specified in Section 5: Business Response Submission Requirements of this RFR;
Technical Response -The Technical Response must contain the Technical Response text as described in Section 7: Technical Response Submission Requirements of this RFR; and
Cost Response-The Cost Response must contain the Cost Response forms completed following the instructions detailed in Section 8: Cost Response Submission Requirements of this RFR.
13
4.2.5 Environmental Response Submission Compliance In an effort to promote greater use of recycled and environmentally preferable products and minimize waste, all Responses submitted should comply with the following guidelines: All copies should be printed double-sided; All submittals and copies should be printed on recycled paper with a minimum post-consumer content of 30% or on tree-free paper (i.e., paper made from raw materials other than trees, such as kenaf). To document the use of such paper, a photocopy of the ream cover/wrapper should be included with the Response; Unless absolutely necessary, all Responses and copies should minimize or eliminate use of nonrecyclable or non-reusable materials such as plastic report covers, plastic dividers, vinyl sleeves and GBC binding. Three-ringed binders, glued materials, paper clips and staples are acceptable; Bidders should submit materials in a format which allows for easy removal and recycling of paper materials; Bidders are encouraged to use other products which contain recycled content in their Response documents. Such products may include, but are not limited to, folders, binders, paper clips, diskettes, envelopes, boxes. Where appropriate, Bidders should note which products in their Responses are made with recycled materials; and Unnecessary samples, attachments or documents not specifically asked for should not be submitted. 4.2.6 Response Logistics Complete Responses must be submitted by the date and time listed in Section 4.1.1, Procurement Calendar. The Response package must include one original and six hard copies of the Business Response, the Technical Response and the Cost Response, and one electronic copy, either CD or thumb drive, as set forth below. The Response package shall be sent in two separate sealed envelopes (both can be contained within one sealed package); One envelope that is clearly marked “Business Response & Technical Response” with the RFR reference number 14EHSPROVANALYTICSWME that includes both the originals, six hardcopies and the electronic copy of the Business and Technical Responses; One envelope that is clearly marked “Cost Response” with the RFR reference number 14EHSPROVANALYTICSWME that includes both the original, six hardcopies and the electronic copy of the Cost Response; and Each electronic Response should be provided in a single PDF file using any Response templates provided in this RFR.
14
Bidders must NOT include any costs in their Business or Technical Responses. Cost Responses must be submitted separately in a clearly labeled and sealed envelope, and must only include a Response to Procurement Coordinator. If any cost information is found in the Business or Technical Responses, or if the Cost Response is not submitted in a separate, clearly labeled, sealed package, the entire Response may be disqualified at the discretion of EOHHS. All sealed envelopes and packages must be addressed and sent to the RFR contact listed in Section 4.1.2. Responses will be accepted until the date and time set forth in Section 4.1.1. Responses received after that date and time will not be considered. In the event that the Response is received by the Commonwealth but has not reached the individual named in Section 4.1.2, the Commonwealth reserves the right, but is not obligated, to accept the Response. This Commonwealth’s right may be exercised only if the Bidder presents, in a timely manner, proof acceptable to the Commonwealth that the Bidder’s Response was received as specified. Emergency Circumstances in Regard to Response Submissions: In the event of unforeseen complicating circumstances, as determined by EOHHS, the due date for the submission of Responses may be extended. EOHHS may do this without issuing an addendum to the RFR. 4.3
Evaluation Criteria Responses shall be evaluated by the PMT. EOHHS shall select the Bidder whose proposal, in the aggregate, provides the best business, technical, and financial value for EOHHS. Cost will be among several factors in the PMT’s consideration; however, EOHHS is not required to choose the Bidder that proposes the lowest costs, but will choose the Bidder that offers the best value to the Commonwealth. The PMT will evaluate all RFR Responses as follows: 4.3.1 Compliance with Bidder Minimum Submission Requirements: Initially, all Responses will be reviewed to determine compliance with the minimum submission requirements set forth in Section 3 of this RFR. The PMT will evaluate the Business Response of all Responses that comply with these minimum submission requirements. The PMT will evaluate the Technical Responses of all Responses that comply with the Business Response requirements. The PMT will evaluate the Cost Responses of all Responses that satisfy the Technical Response requirements for this initiative. 4.3.2 Evaluation of Technical Response: The PMT shall qualitatively rate each Bidder’s Technical Response by evaluating it for comprehensiveness; feasibility; appropriateness; clarity; effectiveness; innovation; responsiveness to the needs of EOHHS; and responsiveness to the goals of the project. Bids will be evaluated based on the Bidder’s ability, as described in its Response, to meet the following requirements, in order of importance: 4.3.2.1 Technological approach and suitability of the solution proposed including suitability of the technical equipment and elements proposed, compliance with required
15
standards, and assessment of the quality of the professional and support services proposed. 4.3.2.2 Flexibility in offering to enable EOHHS to address a wide range of needs and future issues that might emerge. 4.3.2.3 Approach to addressing reliability and availability requirements and approach to implementing the flexibility required in this area; approach to required service levels. 4.3.2.4 Business suitability including administrative, organization and project management abilities; 4.3.2.5 Approach to the Operations and Maintenance requirements and assessment of the quality of services proposed, including training and all tech support. 4.3.3 Overall Cost 4.3.4 Demonstrated Performance: 4.3.4.1 Bidder presentations/demonstrations 4.3.5 Supplier Diversity Program - will be evaluated at 10% of the total evaluation. The PMT will (1) evaluate Responses in accordance with the criteria described above; (2) give a composite rating of “Excellent,” “Very Good,” “Good,” “Fair,” “Poor,” or “Non-Responsive” for each category of the Technical Response; (3) assign an overall rating to each Response; and (4) compare the Responses to one another. Cost will be one factor, but not the sole factor, the PMT considers in its overall evaluation. EOHHS reserves the right to reject a Bidder’s Response at any time during the evaluation process if the Bidder: Fails to demonstrate to EOHHS’ satisfaction that it meets all RFR requirements; Fails to submit all required information or otherwise satisfy all Response Requirements Receives a rating of “Poor” or “Non-Responsive” in the evaluation of one or more categories of its Business or Technical Response; or Has any interest that may, in EOHHS’ sole determination, conflict with performance of services for the Commonwealth or be anti-competitive. The PMT, in its sole discretion, may determine whether non-compliance with any of the above requirements is insubstantial. In such cases, the PMT may seek clarification, allow the Bidder to make minor corrections, apply appropriate penalties in evaluating the Response, or apply a combination of all three remedies. Responses to this RFR may be reviewed and evaluated by any person(s) at the discretion of the PMT including non-allied and independent consultants retained by EOHHS, or any constituent agency, for the purpose of obtaining an analysis of Responses. Any and all respondents may be asked to further explain or clarify in writing areas of their Response during the review process. EOHHS retains the right to request further information from respondents. 4.4
Other Response Requirements 4.4.1 Reasonable Accommodation
16
Bidders with disabilities or hardships that seek reasonable accommodation, which may include the receipt of RFR information in an alternative format, must submit a written statement to the RFR contact person in Section 4.1.2 describing the Bidder’s disability and the requested accommodation. EOHHS reserves the right to reject unreasonable requests. 4.4.2 Supplier Diversity Program Massachusetts Executive Order 524 established a policy to promote the award of state contracts in a manner that develops and strengthens Minority and Women Business Enterprises (M/WBEs) that resulted in the Supplier Diversity Program in Public Contracting. M/WBEs are strongly encouraged to submit Responses to this RFR, either as prime vendors, joint venture partners or other type of business partnerships. Similarly, Executive Order 546 established the ServiceDisabled Veteran-Owned Business Enterprise (SDVOBE) Program to encourage the participation of businesses owned and controlled by service-disabled veterans in all areas of state procurement and contracting, thereby including them in the SDP. All Bidders must follow the requirements set forth in the SDP section of the RFR, which will detail the specific requirements relating to the prime vendor’s inclusion of M/WBEs and/or SDVOBEs. Bidders are required to develop creative initiatives to help foster new business relationships with M/WBEs and/or SDVOBEs within the primary industries affected by this RFR. In order to satisfy the compliance of this section and encourage Bidder’s participation of SDP objectives, the Supplier Diversity Program (SDP) Plan for large procurements greater than $150,000 will be evaluated at 10% or more of the total evaluation. Once an SDP commitment, expressed as a percentage of contract revenues, is approved, the agency will then monitor the Contractor’s performance, and use actual expenditures with SDO certified M/WBE contractors and the Center for Veterans Enterprise certified SDVOBEs to fulfill their own SDP expenditure benchmarks. M/WBE and SDVOBE participation must be incorporated into and monitored for all types of procurements regardless of size; however, submission of an SDP Plan is mandated only for large procurements over $150,000. Unless otherwise specified in the RFR, the following SDP forms are required to be submitted by the deadlines noted below in order to meet the mandatory participation requirements of the SDP: SDP Plan Form #/Name
Submitted By
When Submitted
SDP Plan Form #1 – SDP Plan Commitment All Bidders
With Bid Response
SDP Plan Form #2 – Declaration of SDP Partners
Newly Awarded Contractors
Within 30 days of Contract execution
SDP Plan Form #3 – SDP Spending Report
Contractors
Within 45 days of the end of each quarter
Supplier Diversity Program (SDP) Resources: Resources available to assist Prime Bidders in finding potential Minority Business Enterprises (MBE) and Women Business Enterprises (WBE) partners can be found on the Supplier Diversity Program Website (www.mass.gov/sdp).
17
Resources available to assist Prime Bidders in finding potential Service-Disabled VeteranOwned Business Enterprise (SDVOBE) partners can be found on the SDO webpage on the Supplier Diversity Office Website (www.mass.gov/sdo). The Supplier Diversity Program offers training on the SDP Plan requirements. The dates of upcoming trainings can be found on the OSD Training and Outreach Website. In addition, the SDP Webinar can be located on the Supplier Diversity Program Website (www.mass.gov/sdp). Supplier Diversity Program Subcontracting Policies. In addition to the Subcontracting Policies (See Subcontracting Policies section below and see Section 9, Subcontracting By Contractor, in the Commonwealth Terms and Conditions) that apply to all subcontracted services, agencies may define specific required deliverables for a Contractor’s SDP Plan, including, but not limited to, documentation necessary to verify subcontractor commitments and expenditures with Minority- or Women-Owned Business Enterprises (M/WBEs) and Service-Disabled Veteran-Owned Business Enterprises (SDVOBE) for the purpose of monitoring and enforcing commitments made in a Contractor’s Supplier Diversity Program (SDP) Plan. 4.4.3 Electronic Funds Transfer (EFT) All Bidders responding to this RFR must agree to participate in the Commonwealth Electronic Funds Transfer (EFT) program for receiving payments. EFT is a benefit to both Contractors and the Commonwealth because it ensures fast, safe and reliable payment directly to Contractors and saves both parties the cost of processing checks. Vendors are able to track and verify payments made electronically through the Comptroller’s Vendor Web system. A link to the EFT application can be found on the OSD Forms page (www.mass.gov/osd). Additional information about EFT is available on the VendorWeb site (www.mass.gov/osc). The Successful Vendor, upon notification of Contract award, will be required to enroll in EFT as a Contract requirement by completing and submitting the Authorization for Electronic Funds Payment Form to this department for review, approval and forwarding to the Office of the Comptroller. If the Bidder is already enrolled in the program, it may so indicate in its Response. Because the Authorization for Electronic Funds Payment Form contains banking information, this form, and all information contained on this form, shall not be considered a public record and shall not be subject to public disclosure through a public records request. 4.4.4 Response Duration The Bidder’s Response shall remain in effect for the later of 90 days or until a Contract resulting from this RFR is executed. 4.4.5 Prompt Payment Discounts (PPD) All Bidders responding to this procurement must agree to offer discounts through participation in the Commonwealth Prompt Payment Discount (PPD) initiative for receiving early and/or on-time payments, unless the Bidder can provide compelling proof that it would be unduly burdensome. PPD benefits both Contractors and the Commonwealth. Contractors benefit by increased, usable cash flow as a result of fast and efficient payments for commodities or services rendered. Participation in the Electronic Funds Transfer initiative further maximizes the benefits with payments directed to designated accounts, thus eliminating the impact of check clearance policies and traditional mail lead time or delays. The Commonwealth benefits because Contractors reduce 18
the cost of products and services through the applied discount. Payments that are processed electronically can be tracked and verified through the Comptroller’s Vendor Web system. The PPD form can be found under the “Forms & Terms” tab of this solicitation. Bidders must submit agreeable terms for Prompt Payment Discount using the PPD form within their proposal, unless otherwise specified by the PMT. The PMT will review, negotiate or reject the offering as deemed in the best interest of the Commonwealth.
Section 5. BUSINESS RESPONSE SUBMISSION REQUIREMENTS 5.1
Transmittal Letter The Bidder must submit a Transmittal Letter signed in blue ink by an individual with the authority to bind the Bidder. The Transmittal Letter must include the Bidder’s name and address. As part of the Transmittal Letter, the Bidder must acknowledge the terms and conditions found in this RFR will apply to any Contract resulting from this RFR. Bidder’s Contact Information
5.2
The Bidder must provide contact information, including valid email addresses, for at least two (2) people at the Bidder’s organization who EOHHS can contact for clarification, notification of selection, etc. 5.3
Required Forms All Bidders must submit the following forms, executed as appropriate. Unless otherwise noted, these forms will be available under the “Forms & Terms” tab for this solicitation on Comm-PASS until March 23, 2014, after which all of the forms listed below will be migrated to COMMBUYS for this solicitation. 1.
Commonwealth Terms and Conditions
2.
Standard Contract Form
3.
W-9 Request for Verification of Taxation Reporting Information
4.
Contractor Authorized Signatory Listing
5.
Authorization for Electronic Funds Transfer (EFT) Form
6.
SDP Plan Form #1 – SDP Plan Commitment
7.
Prompt Payment Discount Form
8.
Consultant Contractor Mandatory Submission Form
9.
Certification of Non-Collusion (Attachment B to this RFR)
10. Certification Regarding Debarment and Suspension (Attachment C to this RFR) 11. Disclosures (Attachment D to this RFR) 12. Certification with Regard to Financial Condition (Attachment E to this RFR) 19
5.4
Conflict of Interest As part of its Business Response, the Bidder (on its own behalf and for any partner(s) or subcontractor(s)) must: (i) Acknowledge that, in governmental contracting, even the appearance of a conflict of interest is harmful to the interests of the Commonwealth; and, therefore, the Bidder agrees to take measures to ensure that its officers, employees, agents, consultants and/or subcontractors comply with applicable ethical standards and requirements of the Massachusetts Conflict of Interest law, Massachusetts General Law Chapter 268 A. (ii) Disclose any potential or actual conflict of interest, including but not limited to, any relationship or interest, financial, business, beneficial or otherwise, which is in conflict with the proper discharge of their responsibilities described under the RFR and Contract. If there is no conflict(s) of interest, so indicate. In cases where such relationship (s) and/or interests exist or appear to exist, the Bidder shall describe how a potential or actual conflict of interest will be avoided.
5.5
Certificate of Insurance Section 10.4 requires that the Successful Bidder shall provide, at their own expense, and shall ensure that any of its teaming partners and Significant Subcontractors maintain at their expense, insurance. As part of its Business Response, the Bidder must provide EOHHS with certificates of insurance coverage.
5.6
Financial Disclosures As part of its Business Response, the Bidder must submit documentation to demonstrate to the satisfaction of EOHHS that the Bidder’s organization is in sound financial condition and that any significant financial problems are being addressed with appropriate corrective measures. The documents submitted must include at least the following: 1. Complete audited financial statements for the Bidder’s last two fiscal years; 2. Interim financial statements for fiscal quarters elapsed since the period covered by the audited financial statements; 3. Proof of an acceptable credit rating by a recognized credit rating bureau, such as Dun & Bradstreet; 4. A certification by the Bidder’s financial officer that he/she is not aware of any circumstance materially and adversely affecting the Bidder’s financial condition that is not reported in the foregoing financial statements and that, to the best of his/her knowledge, the Bidder is not delinquent in the payment of any federal or state tax; and 5. A disclosure of any recently concluded or ongoing audit of the Bidder’s operations and a copy of the report with the Bidder’s Response. The Bidder shall submit to EOHHS with its Response a certificate from the taxing authority of the state in which the Bidder has its principal office, attesting that the Bidder is not in default of any 20
obligation under its tax laws. To illustrate this requirement, corporations with principal offices in Massachusetts would satisfy this requirement by submitting a “Certificate of Good Standing” issued by the Massachusetts Department of Revenue (DOR). Instructions for obtaining the DOR certificate may be found on the Commonwealth of Massachusetts DOR website at https://wfb.dor.state.ma.us/webfile/Certificate/Public/WebForms/Welcome.aspx. The Bidder shall also submit to EOHHS with its Response a completed “Certification with Regard to Financial Condition” (see Attachment E). EOHHS may disqualify a Bidder if the Bidder fails to submit the documents required by this section, or if the documents indicate to EOHHS, in its reasonable discretion, that the Bidder’s financial condition is unsatisfactory. Note: If performance of the Bidder’s proposal depends in substantial part upon the performance of a teaming partner, a Significant Subcontractor or other third party, EOHHS requires statements, certificates, and information equivalent to the foregoing regarding the financial condition of the partner, subcontractor, or third party. 5.7
Contract Terms As part of its Business Response the Bidder must acknowledge the terms and conditions found in this RFR will apply to any Contract resulting from this RFR. While Bidders must provide copies of all Vendor Agreements (see Section 5.8.6 below), Bidders may not condition their Response to this RFR or its execution of a Contract on the use of any Vendor supplied contract form or require that any Bidder terms and conditions apply to the proposed Contract. Bidder must specify any proposed additional Contract terms and conditions as a part of their Business Response to be evaluated by the committee. It is expected that any Bidder legal review of the required contract forms will be done prior to a bid submission as many of these terms are not negotiable.
5.8
Information About the Bidder’s Firm 5.8.1 Bidder History (limited to 7 pages) The Bidder shall provide: 1. A brief history of its organization, including an organizational overview, which shall include any parent or subsidiary organizations; 2. A description of the business units in which the Bidder is organized; and 3. A listing of the products and services offered by the Bidder. 5.8.2 Bidder Experience The Bidder shall provide a description of the Bidder’s experience that demonstrates that the Bidder meets the requirements defined in this RFR. 5.8.2.1 Information on Past Projects
21
The Bidder shall provide information on past projects in which the Bidder has been contracted to perform services similar to those requested herein. The goal is to demonstrate that the Bidder has the business and technical capability to successfully perform this project, including: 1. The total number of payers for whom the Bidder has provided provider analytics software and the number of covered lives represented by these payers 2. The total number of Medicaid payers for whom the Bidder has provided provider analytics software and the number of covered lives represented by these payers 3. The total number and the names of payers in Massachusetts for whom the Bidder has provided provider analytics software and the number of covered lives represented by these payers 4. The total number and the names of Medicaid payers in Massachusetts for whom the Bidder has provided provider analytics software and the number of covered lives represented by these payers For each project/client listed, the Bidder shall state the following: 1. The contract or project name; 2. The name of the client’s organization; 3. The name, title, email address, and telephone number of a person at the organization who can respond to inquiries about the Bidder’s involvement with the project; 4. The specific activities the Bidder performed under the contract; and 5. The dates of performance. 5.8.3 Cancelled Projects The Bidder must provide a statement about whether any customer has, in the past three years, cancelled any contract with the Bidder for cause and, if so, an explanation providing relevant details. 5.8.4 Information About Significant Subcontractors The Bidder shall describe its teaming structure and the roles and responsibilities of each teaming partner and any Significant Subcontractor. For each proposed subcontracting firm, the Bidder shall provide the following information: 1. 2. 3. 4. 5.
Subcontracting firm name; Complete address of the subcontractor; Project tasks to be performed by the subcontractor; Number of years of direct project collaboration with the subcontractor; Percentage of total project price and time and task-specific work the subcontractor will be providing; 6. A written statement, signed by each proposed subcontractor that clearly verifies that the subcontractor is committed to render the services required by the Contract; 7. A written statement by the Bidder indicating the number of subcontracting employees who are directly involved with the project and percentage of work on the overall project expected to be completed by that subcontractor. 22
5.8.5 Information About Staff The Bidder shall provide a description of its proposed project team, to demonstrate that staff meets the recommended requirements defined in Section 2.1. The goal is for this proposed organization chart to show the management structure for project oversight and the names of all Key Personnel who will be involved in each stage of each project. Key individuals identified in the submission must be included on the organization chart and resumes must be provided for those individuals. The organization chart shall include any elements of the project for which the Bidder intends to use a teaming partner or a Significant Subcontractor. The Bidder shall describe, for each individual identified as Key Personnel on the organization chart(s) described above, their role and responsibilities in the project and a description of that individual: 1. Describing the relevant experience of each named Key Person and how his/her particular experience relates to the proposed role on the project(s); 2. Presenting any joint project experience that the Key Personnel may have had with other proposed staff members; 3. Describing the individual’s experience with systems of scope and size similar to that described in this RFR, specifically experience with start-up and implementation of similar systems or capabilities. Resumes must be provided for those Key Persons who will be responsible for providing the products and/or services defined in this RFR. The following information must be included in the resumes: 1. Full name; 2. Education including degrees or relevant certifications and the institution from which they were obtained; 3. Years of experience and employment history particularly as it relates to the requirements of the RFR; 4. Specify the employment status of the personnel (e.g., subcontractor, employee of the Contractor); 5. Location from where the personnel will perform applicable services (e.g., agency facility, remote Contractor facility, offsite facility, offshore facility); 6. Optional: Client reference, including a contact name, title, address, e-mail and telephone number, for each Key Person proposed as a part of the project team. The reference shall provide a description of the role that the proposed staff member performed in that project, the relationship of the proposed staff member to the referenced individual, and a brief description of the overall project. 5.8.6 Vendor Agreements The Bidder shall provide copies of all Vendor Agreements and documents, in editable format, pertaining to the provision, on a recurring basis, of hardware infrastructure, hosting services, software and services hereunder.
23
Section 6. TECHNICAL REQUIREMENTS 6.1 Provision of Software Package (including if applicable Software as a Service) and Services 6.1.1 Software Package and Portal Functions The Bidder must be able to develop, customize and configure if required, install and/or provide and install a software package or SaaS and portal capable of performing the following functions: 1. Handling, processing, and generating reports on large pharmacy and claims-based datasets 2. Sharing data with PCCs and, as further described in Section 6.3 below; 3. Calculating cost, quality, and utilization measures and generating reports, as further detailed in Section 6.4 below; 4. Creating Patient Registries, as further detailed in Section 6.5 below; 5. Performing analytic functions based on claims and encounter data from the MassHealth Data Warehouse, with a potential to migrate to the All Payer Claims Database in future years; 6. Creating a view for each PCC, individual clinician, practice site level, combinations of PCCs for PCCs that pool together for PCPR participation, and plan-wide level; 7. Ensuring via appropriate security measures that PCCs are able to access PCC-level data only for their own facilities and for the Panel of patients for which they are responsible; 8. Ensuring the ability of PCC level data to be aggregated to the MassHealth level and deaggregated to display Member level data. 9. Providing actionable analysis for a range of cost and utilization measures, including a list of Panel Enrollees with potentially preventable utilization (such as ambulatory sensitive emergency department care) and ranking of opportunities for cost savings in imaging; 10. Performing episode-of-care level analysis (such as episode treatment groups); 11. Producing Raw Claims data feeds to PCCs and PCC practice sites; 12. Incorporating data uploaded from PCCs and PCC practice sites; and 13. Integrate with the Virtual Gateway single sign on security system, as further described in Subsection 6.1.4 below 6.1.2 Other Requirements The Bidder shall provide users manuals, ongoing training, and technical support of the software to MassHealth staff and PCC staff, to the satisfaction of MassHealth and consistent with the provisions of Sections 6.6 and 6.7 below and included in the cost sheet described in Section 8.
24
The Bidder must identify a single point of contact for MassHealth and provide project management for implementation, technical support, and information technology support to the satisfaction of MassHealth. 6.1.3 Nature of Model The Bidder should be able to provide a largely off-the-shelf software product. If the model requires customization to meet the requirements of this RFR, the Bidder must specifically describe each needed customization, and how it proposes to achieve those timely to meet the requirements of this RFR. As stated in the overview there are 3 areas of flexibility that Bidders have:
Software development history. The alternatives include COTS (possibly with customization and/or configuration) and full custom code (possibly based on an Open Source solution). EOHHS prefers a COTS solution but will consider other alternatives.
Compensation plan. Alternatives include a traditional license with a periodic support charge and a SaaS model where the Successful Bidder is compensated periodically for use of the product. Any SaaS model proposed must be for unlimited usage by PCC and EOHHS staff as well as by staff of PCPR participating organizations.
Hosting included or not.
6.1.4 Integration with Commonwealth Data The medical claims data noted in Section 1.1 is currently stored in an Oracle Data Warehouse which is loaded on a weekly basis. Based on the solution proposed the vendor will either be required to integrate directly with the existing Oracle Data Warehouse 1) pulling directly from materialized views or tables or 2) load from raw extracts in a standard delimited format (e.g. comma delimited csv etc.). If the vendor proposes an offsite solution they will be required to provide return extracts for any derived data/metrics that the Commonwealth would like to store in the Data Warehouse. Quality data are currently stored in an off-site portal with Commonwealth Medicine. Based on the solution proposed, the vendor will either have to integrate directly with this portal or pull directly from materialized views or tables. If the vendor proposes an offsite solution they will be required to provide return extracts for any derived data/metrics that the Commonwealth would like. 6.1.5 Integration with EOHHS Virtual Gateway Single Sign On Security Systems. The system must integrate with EOHHS’s existing security systems. EOHHS utilizes Oracle Identity and Access Manager. This capability shall be integrated with system for single sign-on functionality. 6.1.6 Reports 6.1.6.1 Internal – for EOHHS Use
25
1. System must be capable of generating reports that represent the claims / encounter data available, e.g., plot cost and utilization trends over time, across different patient sub-populations, across different sites, across different categories of service, drill-down ability etc.. 2. Reporting structure must support plan-wide performance measurement of cost, utilization and quality. 3. Software product must be capable of extracting measures and packaging them and reporting in analytic framework of use to EOHHS, as determined by EOHHS. 4. Software reports must include plan-wide, individual clinician, practice site, and group level performance measurement on utilization, cost, and quality measures. 6.1.6.2 External – for PCC and Clinician Use 1. Portal should have the ability to create a view for the individual clinician, practice site level, combinations of PCCs for PCCs that pool together for PCPR participation, and plan-wide level. 2. Reports should provide actionable analysis, e.g., list of Members with potentially preventable emergency department visits, ranking of opportunities for cost savings in imaging, etc. 3. Software must be capable of doing episode-of-care level analysis and reporting. 6.1.7 Access and Flexibility 1. Portal must give users – including EOHHS employees and network providers – access to claims and encounter data for both bulk export and in-system analysis. 2. As future needs arise, the proposed software package proposed pursuant to this RFR must be capable of quickly and easily producing ad hoc reports as well as new standard periodical reports. 6.2 Data Storage The Bidder shall provide a software product that has been satisfactorily used in similar production environments and is capable of working with large data sets, including claims corresponding to a population of 800,000 members over at least 5 years. This corresponds to 450 million claims. This includes the ability to extract data from multiple sources and to manipulate data from various formats. This may also include the ability to load, store, and update member and provider databases. All potential Bidders shall provide specifications that indicate the software’s ability to handle claims and eligibility data for more than 800,000 MassHealth Members. 6.3 Data Sharing with PCCs One of the key capabilities of the software is to allow for data sharing with PCCs. Data shared with PCCs through the tool will, at a minimum, include:
26
PCC Panel information
PCC Raw Claims
PCC Cooked Claims
MCO Raw Claims
MCO Cooked Claims
Pharmacy Claims
Risk Scores
Highest Risk Panel Enrollee Reporting
6.4 Cost, Quality, and Utilization Reporting The software shall provide or incorporate PCC and MassHealth-level (i.e., plan level) cost, quality, and utilization reporting. Data for each of these three areas will be based on MassHealth claims and encounter data as well as PCC and PCC practice site uploaded data. Data should be displayed using both graphs and tables, as appropriate. The software shall produce MassHealth-level and PCC-level reports. The Successful Bidder shall provide MassHealth with documentation and/or specifications related to the calculation of cost, quality, and utilization reporting. The reporting must also show MassHealth provided risk scores. All cost reporting items should include, but not be limited to, total cost, trends, average cost and mix adjusted cost, and per Member per month for various services. These services include inpatient, outpatient and emergency department, and all other services as identified by MassHealth. All quality reporting should use nationally accepted measures including, but not limited to, HEDIS, NQF, AHRQ, CMS, and CAMHI created or endorsed measures. The quality reporting software is not required to be HEDIS-certified software. All utilization reporting items should include but not be limited to, total volume, total unique Members, utilization per 1,000 Members, utilization trends, and CPT level reporting for inpatient, outpatient, emergency department, and all other service categories as identified by MassHealth. All reporting should include trended data where appropriate and include the capacity for analyses for sub-populations (as defined by MassHealth), at the PCC site level, category of service, and other variables as determined by MassHealth. All reporting should include the capability of providing aggregated data at the MassHealth level and de-aggregated data at the Member level for all the items listed above as well as additional items as identified by MassHealth or the vendor. Benchmarks should be provided for each of the three types of reports: cost, utilization, and quality. 6.5 Patient Registries The Bidder shall deliver software that provides or incorporates either condition-specific or cost- or utilization-driven Patient Registries for PCCs in multiple, usable formats (i.e., Excel, Access or other generally used format). The software must produce disease prevalence reports, show disease specific utilization and provide disease management stratification. The software must be flexible
27
to allow for the creation of eligibility and condition specific registries as determined by MassHealth. 6.6 Hosting Services If you have a SaaS solution, Bidders may include hosting services in conjunction with a conventional license model or as part of a SaaS offering. The following sets forth basic requirements of a hosting service
Adequate computing resources; Flexibility to rapidly provision additional resources or release resources in response to cyclical or episodic fluctuations in demand; High security to properly protect Personal Health Information (PHI); High reliability and availability in support of mission critical health care services; Suitable planning and infrastructure to support backup and recovery in the face of urgent situations; Compliance with all applicable State and Federal regulations and standards; Utilization of best practices in all aspects of the establishment and maintenance of the data center to ensure excellence in all operating metrics and flexibility to respond to future needs as they arise.
Under no circumstances may Commonwealth Data be relocated, transmitted, hosted or stored outside the United States in connection with any services provided under the Contract entered under this RFR, either directly by the Selected Vendor or by its subcontractors. 6.6.1 Ongoing Support Where Bidder’s Response includes the provision of a hosted computing environment, it is expected that ongoing support will be provided as part of that service and will be included in the recurring costs stated for that service. The following provisions set forth a minimum level of support services expected to be provided for this capability:
Defect management related to the computing environment. On-call coverage to address critical defects or performance issues which significantly impair or degrade operations; Application monitoring and addressing issues that might arise; Application enhancements. Implement minor enhancements that might be needed from time to time. Major enhancements will be implemented via a change order to the resulting Contract or by a separate procurement.
The Commonwealth expects the Successful Bidder to perform the following activities as a matter of course and to provide information, reports and support to the Commonwealth from time to time when requested
Respond to any manual provisioning requests; Ensure that all resources are functioning properly. Perform any tuning or adjustments as needed; Perform backups of all data, settings, and the like; 28
Maintain archives, including implementing planned data purges as necessary; Monitor resource utilization (storage, bandwidth, etc.) and ensuring that impending shortages are addressed by the support team; Security monitoring and management Address problems by reallocating resources when necessary; Log failures or other anomalies and report to the support team; Perform business continuity/disaster recover planning and drills as necessary; Perform routine hardware, operating system, and software support, including enhancements and upgrades Implement any data center changes in a well-organized, well documented fashion to avoid or minimize any impact to ongoing operations; Provide assistance as requested by the Commonwealth in the event of an audit, litigation, discovery request or other situation necessitating access to data and/or to the systems; Provide and update on an annual basis a transition plan, in the event the service needs to be transferred to another vendor.
6.7 Training The Bidder shall provide training to MassHealth and MassHealth PCCs on the use and functionality of the software. Training shall be structured to enable MassHealth to safely and properly utilize, operate, maintain and support the software being procured in this RFR. Separate training approaches and sessions shall be used to differentiate between and satisfy the needs of operation versus Maintenance and repair. The Bidder will deliver training to MassHealth and its PCCs in a format and ongoing timetable acceptable to MassHealth. 6.8 Technical Support The Bidder shall provide technical support for all questions related to the software including installation, use, Maintenance, and updating of the software to MassHealth staff and to PCCs. 6.9 Demonstrations EOHHS may request that a Bidder to perform demonstrations of its software product prior to selecting a Bidder. EOHHS plans to ask questions of each Bidder it invites to perform a demonstration. Each Bidder should bring the Key Personnel Bidder proposes to work on this project to any demonstration it is asked to perform for EOHHS. If Bidder is invited to an oral presentation (demonstration), Bidder must respond to the following questions. Note that not all of this information must be present in the written submission. 6.9.1 Describe and demonstrate your software package capable of producing reports including, but not limited to: 1. Cost 2. Utilization 3. Episodes of care
29
4. Quality 5. Panel demographics 6. Patient registries 7. Risk Score 8. Practice pattern variation analysis 9. Report usage (i.e., extent to which reports are accessed/downloaded by users) 10. Other reports not included in this list. 6.9.2 Describe the training options, including cost, that are available with the software package. 1. How is the training delivered (i.e., in person, webinar, etc.)? 2. Describe your ongoing technical support capabilities. 6.9.3 How does the software product perform with large data sets that use eligibility data, and pharmacy and medical claims data? 6.9.4 What level of technical assistance is available and how is it delivered? 6.9.5 How does the software handle the extraction of data by providers? What are the capabilities of the software regarding providers uploading data to the software? 6.9.6 How flexible are the reporting options in the software? Can the software be tailored to meet EOHHS reporting needs for provider and internal EOHHS stakeholder? 6.9.7 How can the software be customized to meet other EOHHS needs (i.e., possess the “look and feel” of EOHHS)? At a minimum it is required to be able to place a logo on each page 6.9.8 Describe how Bidder will obtain the input of the provider community utilizing the reports generated from Bidder’s software, to ensure the best quality of report and product. 6.9.9 Describe the data, information, and personnel access Bidder anticipate needing from EOHHS for a successful implementation. 6.9.10 Describe the team that will be working with EOHHS, both during implementation and on an ongoing basis. 6.9.11 Describe recent projects that best reflect Bidder’s ability to execute on the requested tasks. 6.9.12 Would Bidder recommend a software package that EOHHS would run in-house or a contracted service? Why? 6.9.13 Describe any other capabilities Bidder’s product has to support plan-wide performance measurement. 30
6.9.14 Describe Bidder’s experience engaging appropriate expertise for meeting the requirements of this RFR. 6.10
Quality Data Repository (Optional Bid Item)
6.10.1 QDR Requirements The Quality Data Repository (QDR) is a mechanism to receive and store clinical quality measures (CQM) as well as other quality data about providers. The source of CQM will be EHRs and related clinical systems maintained by clinical organizations who provide care to patients. The EHRs will communicate with the QDR via the Mass HIway, Massachusetts’ implementation of a DIRECT based Health Information Exchange. Additional quality metrics must be accommodated; this data will typically be survey data or other metrics which may originate from systems or may be manually derived. The QDR must be capable of receiving data for CQM from providers and their EHR systems. CQMs are generally expressed as percentages with a numerator and denominator. These CQM data elements pertain to a medical organization or to a particular clinician. This system must be capable of storing both the numerator and denominator of each measure. Some provider organizations may provide the information manually through data input with an attestation process. Others have EHR systems which are capable of automatically determining and submitting the CQM measures (including the numerators and denominators separately). The selected QDR system must be capable of storing all defined standard CQMs as well as any additional CQMs defined by EOHHS and submitted by the providers using standard formats (e.g., QRDA). To support measures beyond that which is submitted by a certified EHR, the QDR system must provide an interface to the web portal to allow submission of quality measures manually or via a file upload. The interface may be a web service or some other API mechanism. In the Technical Response to this optional bid item, Bidders are requested to describe their technical approach. During the early stages of delivery of this system the Successful Bidder will conduct an internal requirements gathering process to document all the specific requirements of this system in detail, especially this interface. The data storage shall integrate with the analytics in the main tool and the user interface in the QDR shall include, at a minimum, a user interface to facilitate data extract to enable analysis using external reporting or statistical software. It is desired that Bidders include a reporting and analysis capability within the QDR product. The details of this capability shall also be defined during the requirements gathering process. As part of the CMS Meaningful Use program, providers are required to utilize certified EHR technology which is required to be capable of transmitting certain quality metrics known as CQMs. See http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/ClinicalQualityMeasures.html . There are other quality measures beyond the CQM measures required for Meaningful Use. NQF has defined approximately 800 individual measures. See www.qualityforum.org . The Physician Consortium for Performance Improvement has also defined approximately275 individual measures. See http://www.ama-assn.org/ama/pub/physician-resources/physician-consortium31
performance-improvement/pcpi-measures.page . The CMS Meaningful Use measure set is the minimum starting point. MassHealth plans to require providers and other entities it contracts with to submit different measures based on different programs such as the Delivery System Transformation Initiative, Primary Care Payment Reform and others. Accordingly, it is required that this QDR be flexible to be able to accept any of these measures. Measurement data should be associated with information describing the source of the measure and any qualifiers around the data such as the applicable time period. The QDR shall be capable of receiving quality data indexed and aggregated at an individual provider, provider site, provider organization, or other level, as indicated by MassHealth, submitted. Numerators and denominators shall be collected and stored as discrete data. The primary source of quality measurement data is submission by EHRs utilizing Mass HIway as the secure communication mechanism. Therefore, it is required that the QDR provide an interface to an existing web based portal which will be extended to permit organization to periodically submit files of data related to quality measures. The particulars of such an interface shall be defined in the requirements gathering described above. 6.10.2 Data Retention It is required that the retention of data be flexible and configurable due to varying state requirements. 6.10.3 Query, Extract, and Analysis The system needs to be flexible and “open” in that there are no artificial barriers to developing or executing queries which extract or analyze data. Data needs to be tagged appropriately to permit the kind of flexibility required given the projected dynamic changes to the definition and use of Quality Measures described above. 6.10.4 Sizing Estimates It is anticipated that quality data will be submitted quarterly or monthly. The various programs in EOHHS require in aggregate on approximately 500 measures. The system should be designed and architected to support growth limited only by the size of the storage devices configured. 6.10.5 Intended Uses of Data 1. Clinical Quality Measures Various programs in EOHHS and MassHealth will require the direct collection of CQM measures including numerators and denominators by clinician and/or by provider organization. These data elements are anticipated to be utilized as follows
Quality measurement and reporting Quality improvement activities requiring the comparison of quality measures from the same submitter over time or different submitters for the same time period Payment programs involving pay for performance or pay for quality. Research programs 32
2. Interface to Mass HIway Massachusetts has implemented a Health Information Exchange based on the DIRECT standard promoted by ONC http://www.directproject.org. The QDR must be established as a node on Mass HIway using the XDR/SOAP protocol. The QDR system will be assigned a DIRECT address and an encryption certificate. 6.10.6 Additional Provision of Software Package (including if applicable Software as a Service) and Services 1. Handling, processing, and generating reports on large pharmacy and claims-based datasets and additional QM datasets; 2. Sharing data with PCCs, MassHealth and the Mass HIway, as further described in Section 6.3 above; 3. Performing analytic functions based on claims and encounter data from the MassHealth Data Warehouse, with a potential to migrate to the All Payer Claims Database in future years and the Mass HIway;
Section 7. TECHNICAL RESPONSE SUBMISSION REQUIREMENTS The Bidder shall limit its Technical Response to 15 pages. 7.1
Technical Response-Overview In this subsection, the Bidder shall provide a single overview of the services it will provide in response to this RFR. The overview must include the following:
Technical Response Overview Component Goals, Objectives and Timeline Constraints
Requirements Include the Bidder's understanding of the project(s)'s goals, objectives, and timeline Include the Bidder's understanding of the project(s) constraints and its approach to overcoming them.
Risks
Define project risks and the Bidder's approach to managing them.
Partner Management
Describe the methodology by which the Bidder plans to monitor and evaluate the performance of partners and subcontractors, if applicable, and Bidder personnel.
Project Management
Describe the overall approach the Bidder will take to the provider analytic software implementation project for PCPRI and management thereof. The project management approach must also describe the Bidder's staffing strategy.
33
Technology Innovation Conclusion
7.2
Describe the technical approach that the Bidder will utilize to identify, recommend, and implement technology innovations. Provide a brief concluding statement summarizing why the Bidder offers the best response for providing and implementing provider analytic software for the PCPR.
Technical Response-Detailed The Technical Response for this project shall include but not be limited to the following elements. 7.2.1 A description of the Bidders proposed solution (including if applicable the proposed solution to the Bid Option) including an overview discussion of the Bidder's overall provider analytic software services and implementation approach, including design considerations, and approaches to reliability and availability. 7.2.2 Topics to be addressed in the Technical Response include: 1. Proposed overall technical infrastructure; 2. Proposed software including a description of key features and functions; 3. Input data requirements including minimum fields required by the proposed software to function properly. Also what additional data elements are supported and how these additional elements can be used; 4. Description of outputs or reports that one can obtain using the proposed software; 5. Discussion of which software is selected, advantages and limitations, approach to addressing limitations; 6. Approach to rapid scale up/scale down of all resources; 7. Approach to security, both physical and technical; 8. Approach to adherence to Federal and State privacy and security standards; 9. Approach to business continuity planning, and disaster recovery; 10. Proposed start-up activities, schedule, and staffing plan; 11. Discussion of alternatives available to interface the proposed software to existing data sources and recommendation of an approach. Startup plan and schedule shall include completing this interface. 12. Plan for testing aforementioned interface and validating its proper operation 13. Proposed ongoing staffing plan and approach to ongoing operational services defined in Section 6;
34
14. Proposed approach to quality assurance and testing for initial setup and for each change relating to additional provisioning; 15. Proposed approach to ongoing monitoring and testing to assure ongoing achievement of security and performance metrics; 16. Roadmap of any upcoming functionality changes to Bidder's services that may impact this procurement; analysis of likely impacts; 17. Character and level of EOHHS resources that will be required for transition to Bidder's environments, including training requirements; and 18. Other aspects of the software solution that the Bidder determines is relevant to this procurement. 7.2.3 The Bidder shall describe its experience with providing the services described in Section 6 of the RFR including the Bidder’s: 1. Ability to implement Patient Registries, episodes of care, cost, utilization, and quality reports for a Medicaid client; 2. Ability to successfully integrate or provide Quality Measure reporting software with a variety of health information architectures including Medicaid Managed Information Systems (MMIS) Data Warehouse and the Mass HIway, comprised of the following types of data: a) Member (eligibility, demographics); b) Claims (Fee-For-Service); c) Encounter (managed care entity data); d) Pharmacy; and e) Dental. 3. Ability to provide ongoing training and technical support prior to and following installation of the software. 7.2.4 The Bidder shall submit the names, titles, and resumes of all Key Personnel it proposes to provide the services under this RFR. The Bidder shall describe in detail the nature of the roles and responsibilities of each Key Personnel listed, and their internal reporting and management structure. 7.2.5 The Bidder shall describe whether its product is “off the shelf” or requires any customization to meet the requirements of this RFR, and if so, each and every modification to its existing product that would be needed to perform all required services.
35
7.3
State Contracts The Bidder shall provide names of the state agencies with which the Bidder currently contracts to provide Patient Registry, episode of care, health care cost, quality and utilization software.
7.4
Technical Support The Bidder shall describe in detail the technical support it proposes to provide under this RFR, as required by Section 6.8.
7.5
Training The Bidder shall describe in detail the training it proposes to provide under this RFR, as required by Section 6.7.
7.6
Patient Registries The Bidder shall describe how its software allows for the creation and use of Patient Registries for all purposes and uses described in this RFR in multiple, usable formats, as required by Section 6.5 of the RFR.
7.7
Reports The Bidder shall provide copies of all reports that their propose software generates relevant to this RFR (i.e. provider utilization reports, quality performance reports, and other similar relevant reports).
7.8
Demonstration The Bidder must attest that it agrees, if requested by EOHHS, to participate in and cooperate fully to perform a demonstration of their software product for EOHHS prior to selection, with Key Personnel proposed as part of Bidders’ submission to this RFR in attendance, as described in Section 6.9, and as requested by EOHHS.
7.9
Technical Response for Quality Data Repository (Optional Bid Item) If the optional QDR component is included (Section 6.10) the Technical Response should include
A description of the proposed software solution, including key features and functions
A description of a plan to interface the QDR to the Mass HIway to
A description of how the QDR component relates to the primary Analytics tool, including how data is shared by the two components, if/how the QDR information can be accessed using a common user interface
Section 8. COST RESPONSE SUBMISSION REQUIREMENTS Bidders are asked to provide costs for several elements of capability and service. Bidders are requested to include costs on the indicated tab of Attachment F: Cost Response Worksheet, preferably in the form indicated. Cost models other than that indicated will be accepted. 36
8.1
Analytical Software 8.1.1 Initial Design and Implementation Services These services include those noted in Section 6.1.4 and Section 6.1.5 related to planning the project implementation and deployment. These services should be priced on a firm fixed price basis. Tab A of Attachment F: Cost Response Worksheet provides the template. The key items to be priced include:
Project planning/requirements gathering defining the scope of the implementation, Accessibility testing if required, customizing the user interface screens to include the EOHHS logo. To the extent that standard reports or templates need to be configured that work should be included in this activity. This cost should include other initial planning necessary and described in the Technical Response (Section 7). This cost should also include a single operations training course for up to 20 people and a single maintenance training course for up to 20 people. Bidder to define the approach and duration of such training.
Interface planning, development, and testing to interface with the claims data noted in Sections 6.1.4 and 6.1.5. This activity will include initial data loading if necessary and establishing a plan for ongoing data load or access to the data warehouse.
Any configuration or customization to a COTS solution that is required. Please describe in the Technical Response as described in Section 7.
Optionally, services to interface the system being delivered pursuant to this RFR with the MASS HIway to the extent that the QDR component is offered.
8.1.2 Software License and/or Usage Costs This section is for proposing the cost of the software.
If an off the shelf solution is proposed, use Tab B of Attachment F: Cost Response Worksheet to express costs if a traditional license/support model is being proposed. Use Tab C to express costs if the software is being offered on a SaaS basis
It is expected that all periodic costs related to software upgrades, defect remediation, help desk capability and the like are included above. 8.1.3 Ongoing Services This section is for proposing costs of ongoing consulting costs that may be required to make this project a success. Include these costs on Tab D of Attachment F: Cost Response Worksheet. These services should include:
Subject matter experts who can advise EOHHS on best practices, and approaches to using this software to achieve the goals of PCPR
37
Technical experts who can implement further EOHHS specific customization to the software Operations administrators who can provide assistance to providers above and beyond basic help desk support.
These services will be priced on a time and material basis. Please provide an hourly rate assuming short duration ad hoc assignments and a monthly rate assuming that the resource in question will be dedicated to this project for a minimum of one month, possibly several months to accomplish the goals to be stated at the time of engagement. 8.2
Quality Data Repository (Optional Bid Item)
The Bidder shall describe all pricing options, for any varying levels of product sophistication, service, and financing. 8.2.1 Initial design and implementation services These services include those noted in Section 6.10 related to planning the project implementation and deployment. These services should be priced on a firm fixed price basis. Tab E of Attachment F: Cost Response Worksheet provides the template.
To the extent that QDR is bid, prices for QDR should be included in the indicated lines of the relevant Tab(s).
8.2.2 Software Development and License and/or Usage Costs This section is for proposing the cost of the software.
To the extent that QDR is bid, prices for QDR should be included on Tabs F, G, and H of Attachment F: Cost Response Worksheet.
To the extent that QDR is bid, use Tab I of Attachment F: Cost Response Worksheet to express costs for hosting services if proposing a traditional license model or if the SaaS model is proposed but the SaaS fees do not include hosting.
8.2.3 Ongoing Services This section is for proposing costs of ongoing consulting costs that may be requested by EOHHS. Include these costs on Tab D of Attachment F: Cost Response Worksheet. 8.2.4 Incremental costs for items for QDR 8.3
Incremental costs for items for QDR items should be included on the appropriate line of Tab F.
Rate Requirements
The Bidder shall attest to hold the rates and prices bid by Bidder. 38
Bidders must NOT include any costs in their Business or Technical Responses. Cost Responses must be submitted separately in a clearly labeled and sealed envelope, and must only include a Response to Procurement Coordinator. If any cost information is found in the Business or Technical Responses, or if the Cost Response is not submitted in a separate, clearly labeled, sealed package, the entire Response may be disqualified at the discretion of EOHHS.
Section 9. PROJECT SPECIFIC TERMS AND CONDITIONS 9.1
Proprietary Rights As used in this Section 9.1, the term “Vendor” is used to mean the successful or selected Bidder for consistency with the Statement of Work and the term “Agreement” is used to mean the Contract executed between the Vendor and EOHHS pursuant to this RFR. 9.1.1 Definition of Proprietary Information The term “Proprietary Information” as used herein includes the following forms of property: (1) confidential, proprietary, and trade secret information; (2) trademarks, trade names, discoveries, inventions processes, methods and improvements, whether or not patentable or subject to copyright protection and whether or not reduced to tangible form or reduced to practice; and (3) works of authorship, wherein such forms of property are required by the Vendor to perform the work that may consist of computer programs (in object and source code form), scripts, data, documentation, the audio,, text, photographs, video, pictures, animation, sound recordings, training materials, images, techniques, methods, algorithms, program images, text visible on the Internet, HTML code and images, illustrations, graphics, pages, storyboards, writings, drawings, sketches, models, samples, data, other technical or business information, reports, and other works of authorship fixed in any tangible medium. 9.1.2 EOHHS-Owned Proprietary Information In conformance with the Commonwealth’s Standard Terms and Conditions, all deliverables created under this Agreement, whether made by the Vendor, Vendor’s subcontractor or both, are the property of EOHHS, except for the Vendor’s Proprietary Information (as defined below) embodied in the deliverable. The Vendor irrevocably and unconditionally sells, transfers, and assigns to EOHHS or its designee(s), the entire right, title, and interest in and to all intellectual property rights that it may now or hereafter possess in said deliverables, except for the Vendor’s Proprietary Information embodied in the deliverables, and all derivative works thereof. This sale, transfer and assignment shall be effective immediately upon creation of each deliverable and shall include all copyright, patent, trade secret, trademark and other intellectual property rights created by the Vendor or the Vendor’s subcontractor in connection with such work (hereinafter the "EOHHS Owned Deliverables" or “EOHHS Proprietary Information”). 9.1.3 The Vendor’s Proprietary Information The Vendor will retain all right, title and interest in and to all proprietary information developed by it, i) for clients other than the Commonwealth, and ii) for internal purposes and not yet 39
delivered to any client, including all copyright, patent, trade secret, trademark and other intellectual property rights created by the Vendor in connection with such work (hereinafter the "Vendor’s Property” or “Vendor’s Proprietary Information”. EOHHS acknowledges that its possession, installation or use of the Vendor’s Proprietary Information will not transfer to it any title to such property. 9.1.4 Work Made for Hire Subject to the balance of this Section 9.1, to the fullest extent permitted by applicable law and in addition to the rights and obligations set forth in 45 CFR § 92.34 and 45 CFR § 95.617, the Selected Vendor hereby irrevocably and unconditionally sells, transfers and assigns to EOHHS, or its designee(s), the entire right, title and interest in and to all EOHHS owned deliverables. Such sale, transfer and assignment shall be effective immediately upon creation of each EOHHS owned deliverable. The Selected Vendor acknowledges that all EOHHS owned deliverables, as applicable, also constitute “works made for hire”, as that term is defined in the United States Copyright Act, 17 U.S.C. § 101. If under any applicable law (A) any of the EOHHS owned deliverables fail to constitute a “work made for hire”; or (B) the fact that a EOHHS owned deliverable is a “work made for hire” is not effective to place authorship and ownership of such EOHHS owned deliverable and all rights therein in EOHHS, then to the fullest extent allowable and for the full term of protection otherwise accorded to the Vendor under such law (including any and all renewals, extensions and revivals thereof), the Vendor shall and hereby irrevocably does, assign and transfer to EOHHS, free from all liens and other encumbrances or restrictions, all right, title and interest the Vendor may have or come to have in and to such EOHHS owned deliverable. VENDOR HEREBY WAIVES IN FAVOR OF EOHHS (AND SHALL CAUSE ITS PERSONNEL AND SUBCONTRACTORS TO WAIVE IN FAVOR OF EOHHS IN A WRITING SIGNED BY SUCH PERSONNEL) ANY AND ALL ARTIST’S OR MORAL RIGHTS (INCLUDING, WITHOUT LIMITATION, ALL RIGHTS OF INTEGRITY AND ATTRIBUTION) IT MAY HAVE PURSUANT TO ANY STATE OR FEDERAL LAWS OF THE UNITED STATES IN RESPECT OF ANY EOHHS OWNED DELIVERABLE AND ALL SIMILAR RIGHTS UNDER THE LAWS OF ALL OTHER APPLICABLE JURISDICTIONS. 9.1.5 License to the Vendor EOHHS hereby grants to the Vendor a nonexclusive, revocable license to use, copy, modify, and prepare derivative works of the EOHHS owned deliverables only during the term of the Agreement and only for the purpose of performing services for EOHHS’s benefit. 9.1.6 Vendor Technology The Vendor shall grant to EOHHS and the Commonwealth a nontransferable, worldwide, perpetual, nonexclusive, irrevocable, fully paid-up, royalty-free license to the Vendor’s technology to: Use, implement, install, copy, modify, demonstrate, distribute, and prepare derivative works of, the Vendor’s technology for EOHHS’s and the Commonwealth’s use; Copy and use the Vendor’s technology, on an unlimited basis, including, without limitation, in nonproduction environments for the purpose of development, testing, back-up, disaster recovery, high availability, clustering and archiving; 40
Use the Vendor’s technology on any or all current and future operating systems and any or all current and future hardware platforms on which the Vendor’s technology is capable of running, regardless of hardware or operating system capacity; and Transfer the Vendor’s technology to other systems, hardware platforms or locations owned or controlled by EOHHS and/or the Commonwealth within any of its global computing environments or systems, hardware platforms or locations owned or controlled by other entities under contract with EOHHS and/or the Commonwealth without charge and without notification to the Vendor; and sublicense any of the foregoing rights to any third party solely for purposes of creating, implementing, maintaining or enhancing a deliverable for EOHHS and the Commonwealth’s use, provided that EOHHS executes a confidentiality agreement with such third party to protect the confidentiality of the Vendor’s Technology. The Vendor’s technology to be licensed to EOHHS, as well as other licensed deliverables, including COTS products, must be specifically identified as such by the Vendor in their Response to this RFR, such list, which may be amended from time to time pursuant to the Contract between the Vendor and EOHHS resulting from this RFR, (herein after referred to as the “Agreement”), to add or delete the Vendor’s technology and/or such other licensed deliverables. The Vendor shall not encumber or otherwise transfer any rights in and to the Vendor’s Technology or any components thereof that would preclude a free and clear license grant to EOHHS as contemplated in this Section 9. 9.1.6.1. Vendor’s Rights to SaaS (i)
Except as otherwise provided in this Agreement, the SaaS and SaaS documentation are the sole and exclusive property of Selected Vendor and its licensors. All modifications, enhancements, updates, and translations of SaaS shall be deemed a part thereof.
(ii)
Any customizations made for EOHHS’s operation or use of the SaaS or for interoperability with other Commonwealth systems or applications paid for by the Commonwealth, are and shall remain the sole and exclusive property of the Commonwealth. Additionally, all right, title and interest in any customizations relating to EOHHS’s business shall remain the property of Commonwealth, whether or not supplied to Selected Vendor or uploaded into the SaaS. Nothing in this Agreement shall be construed as conveying any rights or interest in such customizations to the Selected Vendor. Upon termination of an order issued hereunder, Selected Vendor agrees to either provide the customizations to EOHHS, or, at EOHHS’s request, certify in writing that said customizations have been destroyed.
9.1.7 Third-Party Software The Vendor shall list which third-party software shall be included in the solution and will list such software in the Technical Response (described in Section 7 of the RFR). EOHHS shall determine how to procure such software. EOHHS may purchase such software from the Vendor, who shall procure such software in EOHHS’s name or directly from the third party. In the event that the Vendor procures such software on behalf of EOHHS it shall negotiate the license agreement such that the terms and conditions are acceptable to EOHHS. The result is that EOHHS shall possess the third-party software under license and shall have, in addition to its rights and 41
remedies hereunder, such license rights and remedies in the third-party software as are set forth in the applicable commercial license agreements offered by and/or negotiated with the third party. For those items of third-party software for which the applicable license agreements shall be entered into between the Vendor and a third party, the Vendor shall provide EOHHS with all license agreements and Maintenance agreements prior to the execution of any such Agreement and all such agreements shall be subject to the review and approval of EOHHS, such review not to be unreasonably delayed. The Vendor shall, at EOHHS’s request, conduct negotiations with the third party in accordance with EOHHS’s source code escrow requirements and shall, if agreement can be reached with the applicable third party enter into Escrow Agreements on behalf of EOHHS to access the source materials for critical third-party software. With respect to any other third-party software for which EOHHS would prefer the source materials to be escrowed, the Vendor must use commercially reasonable efforts to enter into source code escrow agreements satisfactory to permit EOHHS access to the source materials for such third-party software. The Vendor shall identify for each Project, the third-party software that is critical third-party software or software for which EOHHS would prefer the source materials to be escrowed. Notwithstanding the obligations set forth above, if EOHHS and the Vendor agree that acceptable terms cannot be negotiated with a third-party software provider regarding the escrow of the third-party software and the source materials, if such escrow is required by the Agreement resulting from this RFR, or if the third-party commercial license terms are considered to be unacceptable based upon the mutual agreement of EOHHS and the Vendor, the Vendor shall substitute another third-party software provider to be approved in writing by EOHHS if one is available. Upon payment, following delivery to EOHHS of any the Vendor provided third-party software, all license, Maintenance and support agreements entered into by the Vendor and any third party related to such Vendor provided third-party software shall be assigned to EOHHS, provided that the Vendor shall continue to have the same obligations to EOHHS with regard to such Vendor provided thirdparty software as to EOHHS provided third-party software. 9.1.8 EOHHS Proprietary Information and the Vendor’s Proprietary Information EOHHS retains complete ownership of all EOHHS Proprietary Information, and the Vendor retains complete ownership of all Vendor Proprietary Information. The Vendor will use such EOHHS Proprietary Information solely as necessary to provide deliverables and perform the Projects and services described in this RFR and will protect the EOHHS Proprietary Information in the same manner that it protects the confidentiality of its own proprietary and confidential information. EOHHS acknowledges that Vendor’s Proprietary Information contains or constitutes commercially valuable and proprietary information, the development of which involved the expenditure of substantial time and money and the use of skilled development experts. EOHHS acknowledges that Vendor’s Proprietary Information is being disclosed to EOHHS to be used only as expressly permitted under the terms of this RFR and the resulting Agreement. EOHHS will take no affirmative steps to disclose such information to third parties, and, if required to do so under the Commonwealth’s Public Records Law, M.G.L. c. 66 § 10, or by legal process, will promptly notify Vendor of the imminent disclosure so that Vendor can take steps to defend itself against such disclosure.
42
Under no circumstances may the Vendor distribute, disseminate or otherwise disclose EOHHS’s Proprietary Information to any party other than to an EOHHS approved third party, including Subcontractors providing third-party equipment, third-party services and third-party software in support of the VG Project , and then only if such third parties have entered into confidentiality agreements substantially similar to the confidentiality obligations of this RFR and resulting Agreement and its Exhibits with the party making the disclosure. EOHHS’s obligations under this section are subject to the requirements of Massachusetts Public Records Law. The Vendor’s Response and any other information submitted in response to the RFR are subject to the Massachusetts Public Records Law, M.G.L. Chapter 66, Section 10 and Chapter 4, Section 7, Clause 26. Any statements in the Bidder Response that are inconsistent with these statutes will be disregarded. 9.1.9 Document Deliverables The Vendor acknowledges and agrees that the document deliverables (excluding documentation relating to or comprising the Vendor’s Technology, third-party software, third-party equipment or other licensed deliverables and updates or other modifications and enhancements thereto or derivative works based thereon) and all derivative works thereof are and shall be owned exclusively by EOHHS and/ or the Commonwealth, and the Vendor hereby irrevocably and unconditionally sells, transfers and assigns to EOHHS and the Commonwealth, or their designee(s), all rights (including all intellectual property rights), title and interest in and to all such document deliverables and all derivative works thereof to be provided hereunder to EOHHS. During the term of any Agreement, the Vendor shall (i) maintain all such document deliverables; (ii) ensure that all such updates are integrated into the text of the applicable document deliverable and not merely appended thereto; and (iv) make all copies of such document deliverables available to EOHHS upon EOHHS’s request and promptly at the expiration or termination of an Agreement. EOHHS hereby grants to the Vendor a nonexclusive, revocable license to use, copy, modify and create derivative works of the documentation which are subject to this Section, only during the term of the Agreement and only for the purpose of performing services for EOHHS’s benefit. 9.2
Warranty In the Agreement entered into under this RFR, Selected Vendor will represent and warrant to EOHHS that (i) Vendor and its subcontractors are sufficiently staffed and equipped to fulfill Vendor’s obligations under this Agreement; (ii) Vendor’s services will be performed: (a) By appropriately qualified and trained personnel; (b) With due care and diligence and to a high standard of quality as is customary in the industry; (c) In compliance with the schedule and the terms and conditions of the Agreement; and (d) In accordance with all applicable professional standards for the field of expertise; (iii) Deliverables delivered under the Agreement will substantially conform with the Tasks and Deliverable descriptions set forth in the Agreement; (iv) All media on which Vendor provides any software under this Agreement shall be free from defects; (v) All software delivered by Vendor under this Agreement shall be free of Trojan horses, back doors, and other malicious code; (vi) Vendor has obtained all rights, grants, assignments, conveyances, licenses, permissions and authorizations necessary or incidental to any materials owned by third parties supplied or specified by Vendor for incorporation in the Deliverables to be developed; (vii) Documentation provided by Vendor under this Agreement shall be in sufficient detail so as to allow suitably skilled, trained, and educated EOHHS personnel to understand the 43
operation of the Deliverables. Vendor shall promptly, at no additional cost to EOHHS make corrections to any documentation that does not conform to this warranty. Any systems created or modified by Vendor under the Agreement shall operate in substantial conformance with the specifications for the system or modifications for a minimum of 6 months (the “Warranty Period”) after Agency accepts such system or modifications pursuant to the Agreement/SOW. During the Warranty Period, Vendor shall correct any Severity Level I, II or III defects, as defined in the Agreement, at no charge to EOHHS. 9.2.1 SaaS Limited Warranty 9.2.1.1 Without limiting the generality of Section 9.2., with respect to the provision of SaaS services, the Selected Vendor will also warrant that: 1. Selected Vendor has acquired any and all rights, grants, assignments, conveyances, licenses, permissions and authorizations necessary for Selected Vendor to provide the Service to Customer; 2. Selected Vendor will host the Service on servers hosted and maintained by Selected Vendor, and located within the continental United States; 3. The Service will perform materially as described in the Agreement 4. Selected Vendor will maintain adequate and qualified staff and subcontractors to perform its obligations under this Agreement; 5. Selected Vendor and its employees, subcontractors, partners and third party providers have taken all necessary and reasonable measures to ensure that all software provided under this Agreement shall be free of Trojan horses, back doors, known security vulnerabilities, malicious code, degradation, or breach of privacy or security; 9.2.1.2 Correction of Defects The SaaS provided by Selected Vendor under this Agreement shall operate in substantial conformance with the specifications for the system or modifications for a minimum of six (6) months (the “Warranty Period”) after the service is introduced to EOHHS for its use. During the Warranty Period, Selected Vendor shall correct any Severity Level I, II or III defects, as defined below: (a) Severity Level I: A safety issue or an issue that affects a central requirement for which there is no workaround. It prevents either use or testing of the system. All substantive accessibility issues shall fall into this category. (b) Severity Level II: An issue that affects a central requirement for which there is a workaround, where use or testing of the system can proceed in a degraded mode, or an issue that affects a non-central requirement for which there is no workaround, where the feature cannot be used. (c) Severity Level III: An issue that affects a non-central requirement for which there is a workaround, or a cosmetic issue. 44
9.2.1.3 Operating System and Software Supportability Selected Vendor warrants that Selected Vendor and its employees, subcontractors, partners and third party providers have taken all necessary and reasonable measures to ensure that the SaaS and any other deliverables do not have dependencies on other operating systems or software that are no longer supported by Selected Vendor, or its subcontractors, partners and third-party providers. 9.3
Certain Rights of the United States 9.3.1 Certification and Audits The selected Bidder shall provide unlimited support in connection with federal certification of any portion of the hosted application as well as federal and state audits. The selected Bidder’s support shall include, but is not limited to, providing:
Contractor staff; Documentation; Sufficient copies of all output including labeling and cataloging all output; Computer time; Supplies (both business and computer); and Assistance in responding to any findings including providing detailed work-effort analysis.
The selected Bidder shall notify EOHHS’s project manager of any action, or inaction, by any party known to the selected Bidder that threatens the timely and accurate completion of any selected Bidder obligation. Such notification must be made orally by the close of business on the day of discovery and in writing within three Business Days of discovery. Examination. In addition to the obligations set forth, above and in Section 7 of the Commonwealth Terms and to the rights of EOHHS and the Commonwealth pursuant to the terms of the Standard Contract Form, the selected Bidder will permit authorized representatives of EOHHS, the Commonwealth, and/or any other Agency of the United States government, upon reasonable prior notice, to inspect all facilities where the services are performed and data is maintained or accessed, to have reasonable access to all personnel assigned to perform services under this RFR and Agreement and to perform such further audit or examination of the security practices, procedures and safeguards employed by the selected Bidder in the performance of services and development of deliverables as EOHHS, the Commonwealth, and/or any other Agency of the United States government may reasonably request to assure itself of the security of any personally identifiable data or EOHHS confidential data. Such inspection, access, audit and examination may be made at such time as is mutually convenient to the selected Bidder and EOHHS, the Commonwealth, and/or any other Agency of the United States government during the Vendor‘s normal business hours. Audit. In addition to the obligations set forth above, and in Section 7 of the Commonwealth Terms and to the rights of EOHHS and the Commonwealth pursuant to the terms of the Standard Contract Form, EOHHS, the Commonwealth and/or any other Agency of the United States government may request, upon at least five (5) Business Days prior written notice, that the selected Bidder produce records to verify, or have an independent auditor verify, the selected Bidder’s compliance with the Agreement and the reports provided by the selected 45
Bidder to EOHHS. The selected Bidder shall make any applicable books, records and personnel available for such audit and inspection during normal business hours at the selected Bidder’s principal place of business or any other location mutually agreed upon by the parties. The selected Bidder must promptly respond to the authorized representatives of the Commonwealth, EOHHS and/or any other Agency of the United States government regarding any issues that require follow-up. Access. The selected Bidder, and its subcontractors, will provide to the United States government the same access to records relating to the project as it is required to provide to EOHHS and other Commonwealth entities under Section 7 of the Commonwealth Terms and under the Public Records and Access provision of the Standard Contract Form. 9.3.2 Pricing Federal Government Services Administration (GSA) or Veteran’s Administration Supply: EOHHS reserves the right to request from the selected Bidder(s) initial pricing schedules and periodic updates available under their GSA or other federal pricing contracts. In the absence of proprietary information being part of such contracts, compliance for submission of requested pricing information is expected within 30 days of any request. If the selected Bidder receives a GSA or Veteran’s Administration Supply contract at any time during this Contract period, it must notify the EOHHS Contract manager. Price Limitation: The selected Bidder must agree that no other state or public-entity customer within the United States of similar size and with similar terms and conditions shall receive a lower price for the same commodity and service during the Contract period, unless this same lower price is immediately effective for EOHHS. If EOHHS believes that it is not receiving this lower price as required by this language, the selected Bidder must agree to provide current or historical pricing offered or negotiated with other state or public entities at any time during the Contract period in the absence of proprietary information being part of such contracts. 9.3.3 Byrd Anti-Lobbying Amendment If the selected Bidder receives $100,000 or more of federal funds through any contract, by signing that contract it certifies it has not and will not use federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress in connection with obtaining any federal contract, grant or any other award covered by 31 U.S.C. 1352. The selected Bidder shall disclose any lobbying with non-federal funds that takes place in connection with obtaining any federal award. 9.3.4 Equal Employment Opportunity Any contracts entered into by the selected Bidder shall contain a provision requiring compliance with federal Executive Order 11246, as amended by Executive Order 11375, and as supplemented by regulations at 41 CFR part 60. 9.3.5 Prohibited Activities and Conflict of Interest
46
The selected Bidder represents that no person who is an owner, employee, consultant, or subcontractor of the Vendor, has been debarred by any federal agency, excluded from participation in a issuing program under Titles XVIII, XIX, or XXI of the Social Security Act, or subjected to a civil money penalty under the Social Security Act. The selected Bidder shall not have any interest that conflicts with the performance of services under the Agreement for the duration of the Agreement, it being understood that the sale of similar goods or services to other customers does not of itself constitute such a conflict.
Section 10. OTHER REQUIRED TERMS AND CONDITIONS 10.1
RFR Contract
The agreement resulting from this RFR shall consist of the following documents: 1. The Commonwealth Terms and Conditions; 2. The Commonwealth Standard Contract Form; 3. This RFR, including all exhibits and attachments; 4. The Successful Bidder’s Response to this RFR; and 5. The Statement of Work (see sample posted on Comm-PASS as Attachment G). If there are conflicting provisions among the documents that make up the Agreement, the order of precedence as listed above shall apply. The provisions in the Commonwealth Terms and Conditions and the Commonwealth Standard Contract Form are mandatory and non-negotiable; many of the provisions in the Statement of Work are also mandatory and non-negotiable. 10.2
Fraud
The Successful Vendor shall notify EOHHS in writing within ten (10) calendar days if it or, where applicable, any of its subcontractors receive or identify any information that gives them reason to suspect that a MassHealth Provider or Member has engaged in fraud as defined under 42 CFR 455.2. In the event of suspected fraud, no further contact shall be initiated with the Provider or Member on that specific matter without EOHHS’ approval. The Successful Vendor and, where applicable, its subcontractors shall cooperate fully with the Office of the Attorney General’s Medicaid Fraud Control Unit (MFCU) and the Office of the State Auditor’s Bureau of Special Investigations (BSI). Such cooperation shall include, but not be limited to, providing at no cost, prompt access and copies of any documents and other available information determined necessary by such agencies to carry out their responsibilities regarding Medicaid fraud and abuse, maintaining the confidentiality of any such investigations, and making knowledgeable staff available at no cost to support any investigation, court, or administrative proceeding.
47
10.3
New Initiatives
EOHHS and the Successful Vendor may amend any Agreement to implement new initiatives related to this scope of services or the programs and agencies impacted by this scope of services. The parties shall negotiate in good faith to implement any initiatives proposed by EOHHS. The Successful Vendor’s responsibilities, including schedule, payment, staffing, space, and budgetary requirements shall be adjusted appropriately to accommodate the implementation of such initiatives. 10.4
Insurance
The Successful Vendor shall maintain at the Selected Vendor’s expense, and shall ensure that any of its teaming partners and Significant Subcontractors maintain at their expense, all insurance required by law for their employees, including worker’s compensation and unemployment compensation and public liability and property damage insurance and any other insurance that may be necessary for its performance under the Agreement, and shall provide EOHHS with certification of same upon request. In addition, the Successful Vendor and any of its teaming partners and Significant Subcontractors shall provide comprehensive employer-sponsored health insurance on both an individual and family basis for all their full-time and part-time employees performing work on any part of the Agreement. The Selected Vendor and its teaming partners and Significant Subcontractors shall contribute at least 50% of the premium cost of this health insurance for fulltime employees and a pro-rated share of the premium cost for part-time employees. For example, for a part-time employee that works .60 of a full-time schedule, the employer shall contribute at least 30% (50% x .60) of the premium cost. 10.5
Effect of Invalidity of Clauses
If any clause or provision of the Agreement is in conflict with any state or federal law or regulation, that clause or provision shall be null and void and any such invalidity shall not affect the validity of the remainder of the Agreement. 10.6
No Third-Party Enforcement
The Agreement shall be enforceable only by the parties, or officers or agencies of the Commonwealth authorized to act on behalf of EOHHS or its successors. Nothing in the Agreement shall be deemed to confer benefits or rights to any other parties. 10.7
Compliance with Laws
The Selected Vendor shall comply with all applicable statutes, orders, and regulations promulgated by any federal, state, municipal, or other governmental authority relating to its property or its operations under the terms of the Agreement. 10.8
Independent Contractors
The Selected Vendor, its employees, and any other of its agents shall act in an independent capacity in the performance of the Agreement, and not as officers or employees of EOHHS or the Commonwealth of Massachusetts. 48
10.9
Force Majeure
Neither EOHHS nor the Selected Vendor shall be liable to any other party or be deemed to be in breach of the Agreement for any failure or delay in rendering performance arising out of causes beyond its reasonable control and without its fault or negligence. Such causes may include, but are not limited to, acts of God or the public enemy, fires, floods, epidemics, quarantine restrictions, strikes, freight, embargoes and unusually severe weather. If the Selected Vendor’s failure to perform is caused by the default of a subcontractor, and if such default arises out of causes beyond the reasonable control of both the Selected Vendor and subcontractor, and without the fault or negligence of either of them, the Selected Vendor shall not be liable for failure to perform, unless the equipment or services to be furnished by the subcontractor were obtainable from other sources in sufficient time to permit the Selected Vendor to meet the requirements of the Agreement. Dates or times of performance will be extended to the extent of delays excused by this Section, provided that the party whose performance is affected notifies the other promptly of the existence and nature of such delay. It is agreed, however, that since the performance dates of the Agreement are important to the implementation of essential EOHHS work, continued failure to perform for periods aggregating 30 or more calendar days due to force majeure shall be deemed to render performance impossible, and EOHHS shall thereafter have the right to terminate the Agreement without liability, except that EOHHS shall pay the Selected Vendor for services rendered by the Selected Vendor prior to the termination date. 10.10 Intellectual Property and Work Effort Agreement for Successful Vendor’s Employees, Consultants and Agents The Selected Vendor shall ensure that all Selected Vendor personnel providing services under the Agreement, regardless of whether they are the Vendor’s employees, or Vendor’s agents, shall, prior to rendering any services under this Agreement, sign the “Intellectual Property Agreement for Vendor’s Employees, Consultants and Agents,” attached hereto as Attachment G, Exhibit A, and return signed copies to the EOHHS Project Manager prior to the delivery of any services. 10.11 Publicity The Selected Vendor is prohibited from selling or distributing any information collected or derived from the Agreement, including lists of participating Entities, Commonwealth employee names, telephone numbers or addresses, or any other information except as specifically authorized by the Commonwealth and EOHHS. The Selected Vendor may not use its relationship with the Commonwealth or EOHHS, for advertising or any form of publicity without the Commonwealth’s or EOHHS’ approval of text and images used in advertising. The Selected Vendor may not directly or indirectly represent that a product or service purchased by the Commonwealth or EOHHS from the Selected Vendor is endorsed by the Commonwealth or EOHHS. Bidders and the Selected Vendor(s) are not allowed to display the Commonwealth of Massachusetts Seal in their bid package or subsequent marketing materials if they are awarded a 49
Contract because use of the coat of arms and the Great Seal of the Commonwealth for advertising or commercial purposes is prohibited by law. 10.12 Publications Regarding or Derived From This Contract In the performance of the Agreement, the Selected Vendor may develop material suitable for publication under copyright as reports, manuals, pamphlets or other forms. Such material derived from the Selected Vendor’s performance of a Contract shall not be published or offered for publication through any medium of communication, including press release, without the prior approval of EOHHS. If the Selected Vendor or any subcontractor publishes a work dealing with its performance under this Agreement, or the results and accomplishments attained in such performance, the Commonwealth shall have a non-exclusive, irrevocable, royalty-free license to reproduce, publish or otherwise use and authorize others to use the publication. The Selected Vendor shall not disseminate, reproduce, display or publish any report, information, data or other materials or documents produced in whole or in part pursuant to this Agreement without the prior consent of EOHHS, nor shall any such report, information, data or other materials or documents be the subject of an application for copyright by or on behalf of the Selected Vendor without the prior written consent of EOHHS. 10.13 Covenant against Contingent Fees The Selected Vendor represents that no persons other than bona fide employees working solely for the Selected Vendor, have been employed or retained to solicit or secure this Agreement upon an arrangement or understanding for a commission, percentage, brokerage fee, gift or any other consideration contingent upon the award or making of this Agreement. For breach or violation of this representation, then in addition to any other remedies it may have for such breach, EOHHS shall have the right to deduct from the Agreement price or consideration, or otherwise recover, the full amount of such commission, percentage, brokerage fee or other consideration. 10.14 Corrective Action Plan At any point during this Agreement, if EOHHS identifies, in its sole judgment, any deficiency in the Selected Vendor’s performance under this Agreement, EOHHS may require the Vendor to develop a corrective action plan to correct such deficiency. The Selected Vendor must submit any such corrective action plan to EOHHS and must, within three business days of the request, implement such corrective action plan only as approved or modified by EOHHS. Under such corrective action plan, EOHHS may require the Selected Vendor to:
Subcontract with a material subcontractor deemed satisfactory by EOHHS to perform certain Agreement responsibilities at no additional cost to EOHHS; Otherwise alter the manner or method in which the Selected Vendor performs certain Agreement responsibilities at no additional cost to EOHHS; and Implement, at no additional cost to EOHHS, any other action that EOHHS may deem appropriate. 50
10.15 Dispute Resolution Should any disagreement arise between the parties regarding any contract matter, including performance or quality standards, that the parties fail to resolve promptly by negotiation, EOHHS may, at the option of its Secretary, submit the matter to the Commonwealth’s Attorney General’s Office and seek approval for mediation. With the Attorney General’s Office’s approval, EOHHS shall contact the Massachusetts Office of Dispute Resolution to retain the services of an independent mediator. The parties shall participate in mediation and share the costs thereof. If mediation is not approved, or does not resolve the conflict, the parties may seek redress in the courts of Massachusetts. 10.16 Enterprise Information Technology Policies, Standards and Procedures All IT systems and applications developed by or for Executive department agencies or operating within the Massachusetts Access to Government Network (MAGNet), must conform to the Enterprise Information Technology Policies, Standards and Procedures promulgated by the Commonwealth’s CIO. Non-conforming IT systems cannot be deployed unless the purchasing agency and their Contractor have jointly applied for and received in writing from the Commonwealth’s CIO or his designee, notice that a specified deviation will be permitted. The Enterprise Information Technology Policies, Standards and Guidance, with the exception of the Enterprise Public Access Policy For e-Government Applications and the Enterprise Public Access For e-Government Applications Standards, are available at http://www.mass.gov/anf/research-andtech/it-pols-stnds-and-guidance/ http://www.mass.gov/itd The Enterprise Public Access Policy For e-Government Applications and the Enterprise Public Access For e-Government Applications Standards are available in hard copy from the purchasing agency. Purchasing agencies may also obtain a current copy of these documents, on behalf of their contractor, by contacting the Information Technology Division's CommonHelp group at
[email protected] or 1 (866) 888-2808. Please Note: Given the pace of information technology innovation, purchasing agencies and their Contractors are encouraged to contact the Information Technology Division's CommonHelp group at
[email protected] or 1 (866) 888-2808 to signal a system or application design and development initiative. Such advance notice helps to ensure conformance with the relevant Enterprise Technology Policies, Standards and Procedures. Contractor delivery of IT systems and applications that fail to conform to the Commonwealth’s Enterprise Information Technology Policies, Standards and Procedures, absent the Commonwealth CIO’s grant of written permission for a deviation, shall constitute breach of any Contract entered as a result of this Request for Response and any subsequent Request for Quotes. The Commonwealth may choose to require the Contractor, at his own cost, to re-engineer the non-conforming system for the purpose of bringing it into compliance with Commonwealth Enterprise Information Technology Policies, Standards and Procedures. The Enterprise Technical Reference Model (ETRM) provides an architectural framework used to identify the standards, specifications and technologies that support the Commonwealth's computing environment. The ETRM defines the target state for the Commonwealth’s technology 51
environment. Bidders are required to conform with the Enterprise policies, as stated in the ETRM, where applicable to the Bidder’s solution. Commonwealth of Massachusetts Enterprise Technical Reference Model (v. 5.1) (effective November 18, 2011) is located at: www.mass.gov/itd/etrm 10.17 Accessibility 10.17.1 Software and Systems Developed or Provided under the Agreement For deliverables that are to be delivered under the Agreement, including but not limited to COTS, SaaS. transfer systems, software developed by the Selected Vendor, and any updates, new releases, versions, upgrades, improvements, bug fixes, patches or other modifications to such deliverables, the Selected Vendor shall ensure that the deliverables adhere to the ITD Enterprise Information Technology Accessibility Standards and the ITD Web Accessibility Standards (collectively, the “Enterprise Accessibility Standards”) issued by Massachusetts’ Information Technology Division (ITD). The Enterprise Accessibility Standards may be modified from time to time, and the Selected Vendor shall be responsible for compliance with the most current version in effect on the date that the Vendor executes the Agreement. A list of the specific assistive technology (AT) (including class, brand, and version) and specific desktop configuration against which the deliverables will be tested under the Agreement (the “AT/IT Environment List”) is available online at www.mass.gov/accessibility. Prior to commencing any design work under the Agreement, the Selected Vendor’s project manager and design professionals shall meet with the EOHHS HIE Phase I project manager to review the Enterprise Accessibility Standards, and the AT/IT Environment List, and to discuss their impact on the design process, and the impact of this section on planning, testing, training and documentation. 10.17.2 Accessibility Advisory Committee The Selected Vendor and EOHHS will collaborate and communicate throughout the Project with and among the third-party vendors, including third-party accessibility testing vendors and thirdparty software vendors, as well as with EOHHS' Accessibility Advisory Committee (AAC). The purpose of such meetings shall be to discuss any questions relating to accessibility testing or any other requirements set forth in this RFR and to ensure that any concerns raised by a member of the AAC or a third party regarding accessibility of the deliverables are discussed, identified and addressed as required in this RFR. 10.17.3 Contractor Testing The Selected Vendor shall test every deliverable under the Agreement including but not limited to all COTS or SaaS systems, COTS or SaaS components or new COTS or SaaS version releases (“new versions”) delivered under the Agreement prior to their delivery to EOHHS against the Enterprise Accessibility Standards, and for interoperability with the AT and IT environment listed in the AT/IT Environment list. At the time each such deliverable is delivered to EOHHS the Selected Vendor shall deliver to EOHHS the results of such testing. Such accessibility testing will be incorporated as part of the overall quality assurance process. In this regard, the Selected Vendor shall test for accessibility during any or all of unit testing, integration testing, final acceptance 52
testing and system testing. In addition, the Selected Vendor shall cooperate with EOHHS thirdparty vendors, including its third-party accessibility testing vendor, in its performance of testing. The Selected Vendor shall conduct testing against the Enterprise Accessibility Standards, and for interoperability with the AT and IT environment listed in the AT/IT Environment List. The Selected Vendor shall deliver to EOHHS and the ITD Assistive Technology Office the results of such testing with each delivery of COTS or SaaS components or new versions. 10.17.4 Third-Party Accessibility Testing The Selected Vendor shall cooperate with the third-party accessibility testing vendor engaged by EOHHS in the performance of third-party vendor testing. Any third-party accessibility testing vendor engaged by EOHHS shall test each deliverable, including but not limited to all COTS, SaaS, COTS or SaaS components or new versions, against the Enterprise Accessibility Standards, and for interoperability with the AT and the IT environment described in the AT/IT Environment List. 10.17.5 Addressing Accessibility Problems For deliverables subject to the requirements of the Agreement, the Selected Vendor shall: Be responsible for curing each instance in which its deliverables fail to comply with the Enterprise Accessibility Standards; Cooperate with EOHHS and any third-party accessibility tester engaged by EOHHS to correct any problems pertaining to the interoperability of the deliverables with the AT and the IT environment specified in the AT/IT Environment List; and Provide a credit against amounts due by EOHHS under the Agreement for all repeat thirdparty accessibility testing conducted by EOHHS under the Agreement with respect to deliverables that fail initial testing with respect to the Enterprise Accessibility Standards and are required by, EOHHS to be retested in that regard. Such credits shall not exceed 5% of the total fixed price due the Selected Vendor under the Agreement. 10.17.6 Training and Documentation In coordination with the AAC, the Selected Vendor shall coordinate with EOHHS in the identification of all prospective attendees at training who require accommodation, and shall cooperate with EOHHS in its provision of such accommodation. All documentation delivered by the Vendor under the Agreement shall be accessible to users of AT. Where such documentation specifies a mouse command, it shall also include alternative keyboard commands. Any additional training materials developed by the Selected Vendor under the Agreement and wholly owned by the EOHHS and the Commonwealth shall be in an agreed-upon, accessible and editable format. Where such materials specify a mouse command, they shall also include alternative keyboard commands. 10.18 Maintenance Agreements Any Maintenance agreement and/or work order for operations and Maintenance support entered into by the Selected Vendor and EOHHS in connection with the software delivered under the Agreement shall require Selected Vendor to cooperate with EOHHS in its efforts to resolve 53
interoperability problems that arise related to the use of the software with specific AT in a specific AT/IT Environment. 10.19 Authorizations Any Contract resulting from this RFR and any amendments thereto are subject to all necessary federal and state approvals, which may include, where applicable, CMS and the Massachusetts Office of the Comptroller. 10.20 Confidentiality, Business Associate and Data Use Requirements In addition to Section 6 of the Commonwealth Terms and Conditions, the Vendor agrees to reasonably prevent the unauthorized use and disclosure of confidential and personally identifiable data, pursuant to the terms set forth in the Confidentiality and Business Associate Addendum attached hereto as Attachment G, Exhibit B. Notwithstanding the obligations and responsibilities set forth in the Confidentiality and Business Associate Addendum, if the Vendor is made aware of, or reasonably suspects, that a violation of data confidentiality or security has occurred, it shall notify the EOHHS Contract Officer of such known or suspected activity, via e-mail, within six hours. ATTACHMENTS ATTACHMENT A: PCPR PCC Contract Addendum ATTACHMENT B: Certification of Non-Collusion ATTACHMENT C: Certification Regarding Debarment and Suspension ATTACHMENT D: Disclosures ATTACHMENT E: Certification with Regard to Financial Condition ATTACHMENT F: Cost Response Worksheet ATTACHMENT G: Model Contract / Statement of Work Exhibit A: Intellectual Property and Work Effort Agreement for Successful Vendor’s Employees, Consultants and Agents Exhibit B: Sample Business Associate (BA) Provisions (MassHealth Only) Exhibit D: SaaS or Service Software Provisions
54
