state of vermont - Department of Vermont Health Access

STATE OF VERMONT
PURCHASING AND CONTRACT ADMINISTRATION DIVISION
128 STATE STREET, DRAWER 33
MONTPELIER, VT 05633-7501 SEALED BID
REQUEST FOR PROPOSAL MMIS CORE CLAIMS PROCESSING TAKEOVER DATE: January 22, 2003 REQUISITION NUMBER: MMIS/lw QUESTIONS DUE BY: February 21, 2003 DATE OF BID OPENING: April 4, 2003 TIME OF BID OPENING: 3:00 PM LOCATION OF BID OPENING: 128 State Street, Montpelier, VT
PLEASE BE ADVISED THAT ALL NOTIFICATIONS, RELEASES AND AMENDMENTS WILL BE
POSTED AT http://www.path.state.vt.us/rfp/rfpintro.html
THE STATE WILL MAKE NO ATTEMPT TO CONTACT VENDORS WITH UPDATED
INFORMATION. IT WILL BE THE RESPONSIBILITY OF EACH VENDOR TO
PERIODICALLY CHECK THIS SITE FOR THE LATEST DETAILS. PURCHASING AGENT: Lee Wallace
TELEPHONE : (802) 828-2210
E-MAIL: lee.wallace@state.vt.us
FAX: (802) 828-2222
CHAPTER 1
INTRODUCTION AND GENERAL INFORMATION 1-1 1.1 BACKGROUND 1-1 1.1.1 Procurement Strategy 1-1
1.1.2 Procurement Objectives 1-1
1.1.3 Authority 1-2
1.1.4 Accuracy of Statistical Data 1-2
1.1.5 Contract Term 1-2
1.1.6 Contract Categories 1-3
1.1.7 Language and Glossary 1-3 1.2 PROCUREMENT BACKGROUND 1-3 1.2.1 Takeover Procurement 1-3
1.2.2 New MMIS Business Model 1-4 1.3 PROCUREMENT PROCESS 1-7 1.3.1 Legal Basis 1-7
1.3.2 Procurement Protest 1-8
1.3.3 Anticipated Schedule 1-8
1.3.4 Issuing Agency and Communications Restrictions 1-
9
1.3.5 RFP Issuance and Amendments 1-9
1.3.6 RFP Corrections and Changes 1-10
1.3.7 Collection and Correction of Bidder Information 1-
10
1.3.8 Certification of Independent Price Determination 1-
11
1.3.9 Procedure for Submitting Written Questions 1-11
1.3.10 Procurement Library 1-12
1.3.11 Optional Bidders' Conference 1-12
1.3.12 Mandatory Letter of Intent 1-13
1.3.13 Proposal Amendments and Withdrawal 1-14
1.3.14 Alternative Proposals 1-14
1.3.15 Acceptance of Proposals 1-14
1.3.16 Rejection of Proposals 1-15
1.3.17 Oral Presentation 1-15
1.3.18 Best and Final Offers (BAFO) 1-16
1.3.19 Contract Award Notice 1-16
1.3.20 Bidder Debriefing 1-16
1.3.21 Protest of Contract Award 1-17
Continued 1.3.22 Cost of Preparing Proposals 1-17
1.3.23 Disposition of Proposals 1-17
1.3.24 Freedom of Information and Privacy Act 1-18 1.4 VERMONT MEDICAID PROGRAM OVERVIEW 1-18 1.4.1 General Medicaid 1-18
1.4.2 Organizational Structure 1-19
1.4.2.1 Department of PATH 1-19
1.4.2.1.1 Office of Vermont Health Access (OVHA) 1-20
1.4.2.2 Other Agency of Human Services Departments 1-21 1.4.3 Medicaid Eligibility 1-23 1.4.4 Medical Assistance Programs 1-24
1.4.4.1 Administration of Waiver Programs 1-27 1.4.5 Covered Services 1-28
1.4.6 Provider Types 1-29
1.4.7 Provider Reimbursement Categories 1-29
1.4.8 Current Claims Processing Environment 1-30
1.4.9 ACCESS Background 1-32 1.4.10 Pharmacy Benefits Manager Background 1-34
1.4.10.1 Drug Transaction Processing 1-36 1.4.11 Other EDS Relationships 1-36 CHAPTER 2
SCOPE OF WORK 2-1 2.1 ORGANIZATION OF THE SCOPE OF WORK WITHIN
CATEGORIES 2-1 2.2 DAMAGES AND FAILURE TO COMPLY CLAUSE 2-2 2.3 ALTERNATIVE BUSINESS PRACTICES 2-2
Continued 2.4 GENERAL DATA PROCESSING REQUIREMENTS 2-3 2.4.1 Recurring State Responsibilities 2-4
2.4.2 Recurring Contractor Responsibilities 2-5 2.5 TAKEOVER 2-8 2.5.1 State Responsibilities 2-9
2.5.2 Contractor Responsibilities 2-10
2.5.3 Milestones 2-14
2.5.4 Deliverables 2-14 2.5.5 Failure to Meet January 1, 2004 - Operational Start
Date 2-14
2.5.5.1 Disruption Penalty 2-15 2.6 OPERATIONS 2-15 2.6.1 General Operations and Administration 2-15
2.6.1.1 General State Responsibilities 2-15
2.6.1.2 General Contractor Responsibilities 2-16
2.6.1.3 Milestone 2-18
2.6.1.4 Deliverable 2-18 2.6.2 Contract Administration and Management 2-18
2.6.2.1 State Responsibilities 2-19
2.6.2.2 Contractor Responsibilities 2-20 2.6.3 Operations Documentation 2-21
2.6.3.1 Vermont AIM MMIS System Documentation 2-22
2.6.3.1.1 Contractor Responsibilities 2-22
2.6.3.2 User Manuals for AIM Screens 2-24
2.6.3.2.1 Contractor Responsibilities 2-24
2.6.3.3 Systems Test Document 2-25
2.6.3.3.1 Contractor Responsibilities 2-25
2.6.3.4 Operating Procedures Manual 2-26
2.6.3.4.1 Contractor Responsibilities 2-26
2.6.3.5 Provider Manual 2-27
2.6.3.5.1 State Responsibilities 2-27
2.6.3.5.2 Contractor Responsibilities 2-27
Continued 2.6.3.6 State Personnel Education Plan 2-28
2.6.3.6.1 State Responsibilities 2-28
2.6.3.6.2 Contractor Responsibilities 2-28
2.6.3.7 Business Continuity and Disaster Recovery Plan 2-
29
2.6.3.7.1 State Responsibilities 2-29
2.6.3.7.2 Contractor Responsibilities 2-29
2.6.3.8 Standard Report Production 2-29
2.6.3.8.1 Contractor Responsibilities 2-29 2.6.4 Milestones 2-30
2.6.5 Deliverables 2-30 2.6.6 Turnover 2-30
2.6.6.1 State Responsibilities 2-32
2.6.6.2 Contractor Responsibilities 2-32
2.6.6.3 Milestones 2-34
2.6.6.4 Deliverables 2-34 2.6.7 Certification and Re-certification 2-35
2.6.7.1 Contractor Responsibilities 2-35
2.6.7.2 Failure to Meet Contractor Responsibilities 2-35 2.6.8 Medicaid Laws and Regulations 2-35
2.6.8.1 Contractor Responsibilities 2-35 2.6.9 HIPAA Translator Services 2-36
2.6.9.1 State Responsibilities 2-37
2.6.9.2 Contractor Responsibilities 2-37 2.6.10 Privacy, Security and Confidentiality 2-38
2.6.10.1 State Responsibilities 2-38
2.6.10.2 Contractor Responsibilities 2-38 2.6.11 Statement on Auditing Standards 70 Report 2-39
2.6.11.1 State Responsibilities 2-40
2.6.11.2 Contractor Responsibilities 2-40 2.6.12 Accounting Requirements 2-41
2.6.12.1 Contractor Responsibilities 2-41
Continued 2.6.13 Records Retention 2-42
2.6.13.1 Contractor Responsibilities 2-42 2.6.14 Contractor Staff Requirements 2-43
2.6.14.1 State Responsibilities 2-43
2.6.14.2 Contractor Responsibilities 2-44 2.6.15 System Reliability 2-45
2.6.15.1 State Responsibilities 2-46
2.6.15.2 Contractor Responsibilities 2-46 2.6.16 Customer Service Requests 2-47
2.6.16.1 State Responsibilities 2-48
2.6.16.2 Contractor Responsibilities 2-48 2.6.17 MMIS Access Requirements 2-49
2.6.17.1 State Responsibilities 2-50
2.6.17.2 Contractor Responsibilities 2-50
2.6.17.3 Failure to Meet Contractor Responsibilities 2-52 2.6.18 Electronic Claims Submission (ECS) 2-52
2.6.18.1 State Responsibilities 2-52
2.6.18.2 Contractor Responsibilities 2-52 2.6.19 System and Acceptance Testing 2-53
2.6.19.1 State Responsibilities 2-54
2.6.19.2 Contractor Responsibilities 2-54 2.6.20 Timeliness of Processing 2-55
2.6.20.1 Contractor Responsibilities 2-55
2.6.20.2 Failure to Meet Contractor Responsibilities 2-55 2.6.21 Correctness of Payments 2-56
2.6.21.1 Contractor Responsibilities 2-56 2.6.22 Data Entry 2-56
2.6.22.1 Contractor Responsibilities 2-56
Continued 2.6.23 Resolutions and Suspense 2-57
2.6.23.1 Contractor Responsibilities 2-57
2.6.23.2 Failure to Meet Contractor Responsibilities 2-57
2.6.24 Financial Management 2-58
2.6.24.1 Contractor Responsibilities 2-58
2.6.24.1.1 Bank Reconciliation 2-58
2.6.24.1.2 Cash Mana