New Mexico Human Services Department

NEW MEXICO HUMAN SERVICES DEPARTMENT

REQUEST FOR PROPOSALS

Integration Platform Services for MMISR Project

Amendment #3

RFP#

17-630-4000-1001

Amendment #3 Issued: October 4, 2016

Original RFP Issued: August 25, 2016

Submissions Due: October 21, 2016

Request for Proposal Number 17-630-4000-1001 is amended as described herein:

1. Change to The MMISR Modular Procurements section 1b, page 15:

Removal of reference of EDW in the Data Services section.

From:

1. The MMISR Modular Procurements

a. Integration Platform – Through this IP procurement, HSD will acquire the core technologies and associated services needed to support and implement the remainder of the MMISR solution, including:

1) The enterprise service bus (ESB) that forms the central integrating technology for our modular services and technology architecture;

2) A number of technology applications and tools that support programmatic needs within the HHS 2020 framework (e.g., master index, monitoring tools);

3) Essential data-related infrastructure, including:

a) Implementation of operational/production database(s) needed to monitor IP solution performance, support MMIS transition, serve on-going operational requirements and feed data to an enterprise data warehouse (EDW) (or other repository(s) that support reporting and analytics), and

b) Infrastructure for the Data Services (DS) procurement;

4) Contractor services to implement and operate the IP;

5) Contractor services to facilitate and ensure successful integration of subsequent modules and components, and to plan and lead conversion from the legacy MMIS to the new MMISR solution to meet CMS Certification requirements;

6) Contractor services to provide support to the State’s HHS 2020 Project Management Organization (PMO);

7) Contractor services to manage the IP contract and interact with the State and other HHS 2020 contractors to support HHS 2020 and MMISR.

b. Data Services (DS) – The Data Services procurement is focused on designing, implementing, operating and continually improving the structures, processes and data needed to support HSD – and HHS 2020 – current and future reporting and analytics requirements. The DS Contractor will develop data structures – e.g., EDW, multiple linked data stores, data marts, data lakes – leveraging infrastructure provided through the IP contract.

HSD anticipates the DS Contractor will focus initially on defining and implementing the processes, analytics and technology tools and structures required to establish a foundational integrated data solution that supports reporting and analytics. However, the module goals also include providing insightful analytics to support population health management (i.e., an outcomes-focused approach to designing, delivering and managing services, with the ability to run New Mexico-specific experience against national databases) and to enable HHS enterprise-wide reporting and analytics through an integrated data, services and technology platform. The DS Contractor will also deliver timely and accurate reports, analytics and related work products using the DS solution.

The DS Contractor also will be responsible for analyzing data requirements, both current and projected; working with the State to define and implement an enterprise data governance approach; planning and implementing Master Data Management (MDM) for HHS 2020 data assets; providing data analytic and Business Intelligence tools and working with the State to plan an approach to achieve increasing levels of data maturity for HHS 2020.

c. Financial Services (FS) – HSD will contract with a BPO vendor to obtain claims processing and comprehensive financial services (e.g., accounting, payment handling) using a CMS-compliant platform and processes. The FS contractor also will provide services necessary for managing the FS contract, for interacting with the State and other HHS 2020 contractors to effectively support HHS 2020 and MMISR, and for providing to the IP and Data Service contractors the data elements essential to federal reporting requirements.

d. Quality Assurance (QA) – Through a BPO contract, HSD will contract with a vendor to obtain and perform the following services for the QA module using a CMS-compliant platform and processes:

1) Program Integrity support, including Third-Party Liability (TPL), Fraud and Abuse Detection Services, audit coordination, quality reporting, and compliance;

2) Provider enrollment and management;

3) Management of Prior Approval, and Recovery and Audit responsibilities;

4) Manage the QA contract and interact with the State and other HHS 2020 contractors to effectively support HHS 2020 and the MMISR Project; and

5) Coordinate efforts and projects with the HSD Office of Inspector General (OIG) and the Medicaid Fraud Control Unit (MFCU) of the Office of the Attorney General.

e. Population Health Management (PHM) – PHM represents realization of a vision for an outcomes-focused approach to serving the needs of New Mexico citizens and to managing and delivering services and benefits. PHM will be realized through a combination of services and information available through the other elements of the MMISR solution. Through the PHM module procurement, HSD will obtain through a vendor the services listed below:

1) Pharmacy benefits management (including rebate services);

2) Assistance with Managed Care Organization (MCO) management;

3) Focused analytics and datasets related to population health, outcomes and health improvement;

4) Coordination of the Electronic Health Records initiative;

5) Assistance with the systems and data support necessary for effective care and case management; and

6) Changes to the Fee-for-Service (FFS) program.

The PHM module contractor also will perform services necessary to manage the PHM contract and to interact with the State and with other HHS 2020 module contractors to effectively support HHS 2020 and the MMISR Project.

f. Unified Public Interface (UPI) – A key element of the HHS 2020 framework is a unified interface serving all stakeholders, in keeping with the vision of presenting a more customer-centric view of HHS services and processes. For this module HSD plans to procure contractor services to develop, implement and operate a UPI serving New Mexico citizens, providers, state agencies and employees, and other stakeholders. The goal of the UPI is to offer a “one-stop shop” that embraces a “no wrong door” approach to customer service.

The State is evaluating the procurement approach to achieve this goal. The State’s current plan is to separately acquire two principal UPI components.

1) Consolidated Customer Service Center (CCSC) – The goal for the CCSC is to provide a single, integrated contact center serving all HSD programs, to increase efficiency and to make it easier for our customers and providers to obtain needed information and/or actions. HSD intends to procure the CCSC through a BPO contract that will encompass:

a) CCSC set-up/tailoring to meet HSD-specific needs, including technology, processes, training and staff;

b) CCSC operation, reporting and continuous improvement; and

c) Services necessary to manage the CCSC contract and to interact with the State and with other HHS 2020 contractors to effectively support HHS 2020 and MMISR.

2) Unified Web Portal and Mobile Technology – The second principal UPI component encompasses both a unified web portal and the use of social media, mobile technology and other user-friendly technologies to improve user ease of access and to enhance HSD’s ability to readily and effectively reach customers, providers or other stakeholders. Work associated with this component includes:

a) Development of a comprehensive concept and design to effectively serve all stakeholders, via web portal(s), mobile technology, and other user-friendly technologies;

b) Implement, operate and maintain the unified portal(s) and other recommended technologies; and

c) Services needed to manage this component and to interact with the State and with other HHS 2020 contractors to effectively support HHS 2020 and MMISR.

In addition to these procurements, HSD released a competitive procurement in 2015 for MMISR IV&V services. The State has selected a finalist and anticipates the vendor to begin operations in July 2016. The MMISR IV&V Contractor will perform IV&V services throughout MMISR implementation and CMS Certification, in accordance with CMS and NM Department of Information Technology (DoIT) requirements. All MMISR module prime contractors will be required to interact and collaborate with the IV&V Contractor.

To:

2. The MMISR Modular Procurements

g. Integration Platform – Through this IP procurement, HSD will acquire the core technologies and associated services needed to support and implement the remainder of the MMISR solution, including:

8) The enterprise service bus (ESB) that forms the central integrating technology for our modular services and technology architecture;

9) A number of technology applications and tools that support programmatic needs within the HHS 2020 framework (e.g., master index, monitoring tools);

10) Essential data-related infrastructure, including:

c) Implementation of operational/production database(s) needed to monitor IP solution performance, support MMIS transition, serve on-going operational requirements and feed data to an enterprise data warehouse (EDW) (or other repository(s) that support reporting and analytics), and

d) Infrastructure for the Data Services (DS) procurement;

11) Contractor services to implement and operate the IP;

12) Contractor services to facilitate and ensure successful integration of subsequent modules and components, and to plan and lead conversion from the legacy MMIS to the new MMISR solution to meet CMS Certification requirements;

13) Contractor services to provide support to the State’s HHS 2020 Project Management Organization (PMO);

14) Contractor services to manage the IP contract and interact with the State and other HHS 2020 contractors to support HHS 2020 and MMISR.

h. Data Services (DS) – The Data Services procurement is focused on designing, implementing, operating and continually improving the structures, processes and data needed to support HSD – and HHS 2020 – current and future reporting and analytics requirements. The DS Contractor will develop data structures – e.g., multiple linked data stores, data marts, data lakes – leveraging infrastructure provided through the IP contract.

i. Financial Services (FS) – HSD will contract with a BPO vendor to obtain claims processing and comprehensive financial services (e.g., accounting, payment handling) using a CMS-compliant platform and processes. The FS contractor also will provide services necessary for managing the FS contract, for interacting with the State and other HHS 2020 contractors to effectively support HHS 2020 and MMISR, and for providing to the IP and Data Service contractors the data elements essential to federal reporting requirements.

j. Quality Assurance (QA) – Through a BPO contract, HSD will contract with a vendor to obtain and perform the following services for the QA module using a CMS-compliant platform and processes:

6) Program Integrity support, including Third-Party Liability (TPL), Fraud and Abuse Detection Services, audit coordination, quality reporting, and compliance;

7) Provider enrollment and management;

8) Management of Prior Approval, and Recovery and Audit responsibilities;

9) Manage the QA contract and interact with the State and other HHS 2020 contractors to effectively support HHS 2020 and the MMISR Project; and

10) Coordinate efforts and projects with the HSD Office of Inspector General (OIG) and the Medicaid Fraud Control Unit (MFCU) of the Office of the Attorney General.

k. Population Health Management (PHM) – PHM represents realization of a vision for an outcomes-focused approach to serving the needs of New Mexico citizens and to managing and delivering services and benefits. PHM will be realized through a combination of services and information available through the other elements of the MMISR solution. Through the PHM module procurement, HSD will obtain through a vendor the services listed below:

7) Pharmacy benefits management (including rebate services);

8) Assistance with Managed Care Organization (MCO) management;

9) Focused analytics and datasets related to population health, outcomes and health improvement;

10) Coordination of the Electronic Health Records initiative;

11) Assistance with the systems and data support necessary for effective care and case management; and

12) Changes to the Fee-for-Service (FFS) program.

l. Unified Public Interface (UPI) – A key element of the HHS 2020 framework is a unified interface serving all stakeholders, in keeping with the vision of presenting a more customer-centric view of HHS services and processes. For this module HSD plans to procure contractor services to develop, implement and operate a UPI serving New Mexico citizens, providers, state agencies and employees, and other stakeholders. The goal of the UPI is to offer a “one-stop shop” that embraces a “no wrong door” approach to customer service.

The State is evaluating the procurement approach to achieve this goal. The State’s current plan is to separately acquire two principal UPI components.

d) CCSC set-up/tailoring to meet HSD-specific needs, including technology, processes, training and staff;

e) CCSC operation, reporting and continuous improvement; and

f) Services necessary to manage the CCSC contract and to interact with the State and with other HHS 2020 contractors to effectively support HHS 2020 and MMISR.