MMIS - ND.gov

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State Of North dakota
Department of Human Services
Division of Medical Services
600 E. Boulevard Ave., Dept. 325
Bismarck, ND, 58505-0250



Request for Proposal
RFP # 325-05-10-016
Date of Issue: June 1, 2005



For the

North Dakota Medicaid
Systems Replacement Project




Geoff Lowe
Procurement Officer
Department of Human Services









Table of Contents




Table of Contents i


1.0 Introduction and Instructions 1

1.1 Background of this Procurement 1
1.1.1 Medicaid Information Technology Architecture (MITA) 1
1.1.2 Current Systems 2
1.1.3 Authority for this RFP 2
1.2 Purpose and Summary of this RFP 2
1.3 Organization of this RFP 3
1.4 Glossary of Terms and Acronyms 4
1.5 General Instructions 4
1.5.1 Assistance to Bidders with a Disability 4
1.5.2 Required Review 4
1.5.3 Authorized Signature 4
1.5.4 Vendor Registration 5
1.5.5 Subcontractors 5
1.5.6 Joint Ventures 6
1.5.7 Conflict of Interest 6
1.5.8 Offer Held Firm 7
1.5.9 Bidder's Certification 7
1.5.10 State Not Responsible for Preparation Costs 7
1.5.11 Disclosure of Proposal Contents and Compliance with ND Open
Records Laws 8
1.5.12 Public Notice 8
1.5.13 News Releases 8
1.5.14 Budget 8

2.0 Procurement Process 9

2.1 Procurement Officer and Contact Information 9
2.2 Restrictions on Communication Between Bidder and DHS 9
2.3 Downloading RFP Materials from the Internet 10
2.4 Procurement Schedule of Events 10
2.5 Bidders' Library 11
2.6 Mandatory Letters of Intent to Bid 11
2.7 Bidders' Questions 12
2.8 Amendments to the RFP 13
2.9 Submittal of Bid Proposals 13
2.10 Bid Proposal Opening 13
2.11 Amendments to Proposals and Withdrawals of Proposals 14
2.12 Alternate Proposals 14
2.13 Right of Rejection 14
2.14 Supplemental Terms and Conditions 15
2.15 Evaluation of Proposals 15
2.16 Preference Laws 15
2.17 Clarification of Offers 15
2.18 Disposition of Bid Proposals 16
2.19 Public Records and Requests for Confidential Treatment 16
2.20 Oral Presentations 16
2.21 Site Visits 17
2.22 Best and Final Offers 17
2.23 Contract Negotiations 17
2.24 Failure to Negotiate 18
2.25 Notice of Intent to Award 18
2.26 Acceptance Period 18
2.27 Definition of Contract 18
2.28 Choice of Law and Forum 19
2.29 Protest and Appeal 19

3.0 Contract terms and Conditions 21

3.1 Proposal as a Part of the Contract 21
3.2 Order of Priority 21
3.3 Standard Contract Provisions 21
3.3.1 Purchase of Service Agreement Provisions 21
3.3.2 Additional Terms and Conditions 22
3.3.3 Contract Approval 22
3.3.4 Contract Changes - Unanticipated Amendments 22
3.3.5 Taxes and Taxpayer Identification 22
3.4 Term of Contract and Renewal Options 23
3.4.1 Base Contract 23
3.4.2 Renewal Options 23
3.5 Contract Type 24
3.6 Change Service Requests / Contract Enhancements 24
3.6.1 Change Service Requests 24
3.6.1.1 Procedure 24
3.6.1.2 No Agreement on Change Service Request 24
3.6.1.3 Additional Services 25
3.6.2 Contractor-Proposed Enhancements to Contract 25
3.6.2.1 Procedure 25
3.7 Contract Payment 25
3.7.1 Proposed Payment Procedures 25
3.7.2 Payment Terms 26
3.7.3 Inspection & Modification - Reimbursement for Unacceptable
Deliverables 26
3.7.4 Contract Funding 26
3.8 Project Management 26
3.8.1 Contract Personnel 26
3.8.2 Right to Inspect Place of Business 27
3.8.3 Disputes - Applicable Law and Venue 27
3.9 Indemnification and Insurance Requirements 27
3.10 Bond Requirements 27
3.10.1 Bid Bond 27
3.10.2 Performance Bond 28
3.11 Termination 28
3.11.1 Immediate Termination 28
3.11.2 Termination for Default 29
3.11.2.1 Contractor's Default and Opportunity to Cure 29
3.11.2.2 Contractor's Default Cured by the Department 29
3.11.2.3 Procurement of Similar Services 29
3.11.2.4 Delay or Impossibility of Performance 29
3.11.3 Termination Upon Notice 30
3.11.4 Termination for Insolvency or Bankruptcy 30
3.11.5 Termination for Withdrawal of Department's Authority 30
3.11.6 Termination or Contract Modifications Due to Unavailability of
Funds 30
3.11.7 Rights upon Termination 31
3.12 Damages 31
3.12.1 Actual Damages 31
3.12.1.1 Systems Certification 32
3.12.1.2 Operations Start Date 32
3.12.1.3 Erroneous Payments 33
3.12.2 Liquidated Damages 33
3.13 General Provisions 38
3.13.1 Independent Entity 38
3.13.2 Assignment 38
3.13.3 Confidentiality 38
3.13.4 Work Product, Equipment, and Material 38
3.13.5 Informal Debriefing 38

4.0 Program Description & background 39

4.1 Organizational Structure 39
4.2 Project Governance 43
4.3 Medicaid Program Administration 46
4.3.1 State of North Dakota 46
4.3.2 U.S. Department of Health and Human Services 46
4.4 Overview of Present Operation 46
4.4.1 Medicaid Management Information System (MMIS) 46
4.4.1.1 Claims 46
4.4.1.2 HIPAA Transactions 47
4.4.1.3 Data Entry 47
4.4.2 Eligibility 48
4.4.2.1 Covered Programs 49
4.4.2.2 State Children's Health Insurance Program (SCHIP) 50
4.4.2.3 Managed Care 50
4.4.3 Covered Services 51
4.4.4 Provider Services 51
4.4.4.1 Provider Enrollment 51
4.4.5 Customer Relations 52
4.4.6 Provider Reimbursement 52
4.4.7 Cost Containment 53
4.4.7.1 Recipient Liability and Recipient Responsibility 53
4.4.7.2 Surveillance and Utilization Review 54
4.4.7.3 Third Party Liability 55
4.4.7.4 Cost Sharing 56
4.4.8 Pharmacy Point-of-Sale 57
4.4.8.1 Drug Rebate 57
4.4.9 Decision Support System 57
4.4.10 Management and Administrative Reporting (MAR) 58
4.4.11 Current MMIS Interfaces with Other Systems 58

5.0 Scope of Work & Project Schedule 59

5.1 Procurement Vision 59
5.2 Business Needs 60
5.2.1 MMIS Replacement 60
5.2.1.1 Provider Services 60
5.2.1.2 Recipient Services 61
5.2.1.3 Data Management 65
5.2.1.4 Prior Authorization 65
5.2.1.5 Claims 66
5.2.1.6 Administrative Reporting 67
5.2.1.7 Utilization Management 68
5.2.1.8 Financial Management 68
5.2.1.9 Managed Care 69
5.2.2 POS Replacement 71
5.2.2.1 Pharmacy Claims 71
5.2.2.2 Drug Utilization Review (DUR) 72
5.2.2.3 Drug Rebate 72
5.2.3 DSS Replacement 73
5.3 Technical Needs 75
5.4 Project Schedule 78

6.0 General Requirements 81

6.1 Vendor Qualifications 81
6.1.1 Minimum Bidder Qualifications 81
6.1.2 Project Summaries Demonstrating Prior Experience 82
6.1.3 Corporate Reference Requirements 84
6.1.4 Required Licenses 85
6.2 Staffing Requirements 85
6.2.1 Key Personnel To Be Named 85
6.2.2 DHS Approval of Key Personnel 88
6.2.3 Changes to Contractor's Key Personnel 88
6.2.4 Supporting Staff 88
6.2.5 State Resource Planning 89
6.2.6 Right of Termination of Personnel 90
6.2.7 Special Staffing Needs 90
6.2.7.1 Job Rotation 90
6.2.7.2 Coverage During Vacations for Sensitive Positions 90
6.3 Facility Requirements 90
6.3.1 Location of Work 90
6.3.1.1 DDI Phase / Start-up Activities 90
6.3.1.2 Knowledge Transfer / Training Period 91
6.3.1.3 Operations Phase Activities 92
6.3.2 State Furnished Property / Equipment / Services 92
6.3.3 Contractor Furnished Property / Equipment / Services 93

7.0 System Requirements 95

7.1 General System Requirements 95
7.1.1 Overview 95
7.1.1.1 General Technical Requirements 96
7.1.1.2 Standards 97
7.1.1.3 Technical Architecture Vision 101
7.1.1.4 Operating Systems and Platform Systems 103
7.1.1.5 Security 104
7.1.1.6 Error Handling 105
7.1.1.7 Databases 105
7.1.1.8 Back-up and Recovery 106
7.1.1.9 System Integration 107
7.1.1.10 Test Environment and Integrated Test Facility 108
7.1.1.11 Network Services 112
7.1.1.12 Internet Development 113
7.1.1.13 System Performance and Sizing 114
7.1.1.14 Development Standards 115
7.1.1.15 Documentation Standards 116
7.1.1.16 Version Control 117
7.1.1.17 Change Control Process 117
7.1.1.18 System Maintenance 119
7.1.1.19 Software Upgrade Process 121
7.1.1.20 Training 121
7.2 MMIS Replacement System Requirements 125
7.2.1 Provider Services 125
7.2.1.1 Functional Requirements 126
7.2.1.2 Interfaces 131
7.2.1.3 Inputs 132
7.2.1.4 Outputs 132
7.2.2 Recipient Services 132
7.2.2.1 Eligibility 133
7.2.2.2 Third Party Liability 138
7.2.2.3 Waivers and Special P