In a Request for Proposal (RFP) released July 15, the California Department of Developmental Services is seeking respondents to stand up a “solution and services” to support the federal billing system for the state’s “Home- and Community-Based Services (HCBS) programs” under Medicaid Waivers and state plan amendments. The solutions and services provided will be the “primary tool” the state uses to support “federal reimbursement programs that recover federal dollars for expenditures associated with qualified services provided to individuals with developmental disabilities” in California, according to the statement of work. Among the takeaways:
• The state seeks a system in a cloud-based, Software-as-a-Service (SaaS) environment, with capabilities that include data aggregation, software licenses, interface and transformation services, data storage, information security, hosting, and overall program and project management. The work will require the contractor to “establish initial and on-going data interfaces with multiple data partners.”
An overall goal is modernizing the current “legacy mainframe technology stack” with a flexible, scalable system that can be modified and will allow the inclusion of new reimbursement programs and changes to existing ones. Specific needs include dashboards and analytics; shared business, tech and information architectures “common across other health and human services departments”; a system designed with the end user in mind, that can leverage “existing and open-source technologies,” and improve staff recruitment and retention; stability of operations to enable staff to “focus on pursuing every eligible dollar for the recovery of federal funds with confidence in data accuracy”; and streamlined processes and good data stewardship.
• The solution that’s created must support business functions including data intake and verification from regional centers; Medi-Cal eligibility verification, through interfacing with the California Department of Health Care Services; monthly billing and invoicing including notifying staff when billing data is ready for processing, and creation of electronic invoices and details claim files; administrative processes “needed to maintain accurate reimbursement program, consumer, and claims information”; and the reporting and analytics necessary to measure the “performance and accuracy of consumer data and federal reimbursement invoices.”
• Among the responsibilities and qualifications for key staff, the project manager will be overall responsible for performance and contract compliance, developing and following the schedule and managing the team; and must have at least four years’ experience managing projects for public-sector clients and organizing and managing teams of at least 20 people. The federal reimbursement technical lead will be responsible for the system design process and ensuring technical requirements are met, interfacing data sources and ensuring data integrity and quality, creating and maintaining “logical and physical data models” and advising the State Project Management Team on the impacts and costs of changes to project scope and requirements; he or she must have at least five years’ experience “managing a system development life cycle”; and at least four years’ “information technology, data architecture, and management experience for a public-sector project” with at least three years devoted to “medium scale, complex projects.” The federal reimbursement programs lead will be responsible for managing the contractor’s business analysis activities, serving as liaison between the contractor and the department project team on “new federal reimbursement system functional requirements,” and identifying and managing impacts, cost and consequences of changes in scope. He or she must have at least four years’ experience as a “business analyst for a health program that includes functional processes for medium scale, complex systems”; and at least two years’ experience on a client project supporting a program “administered or overseen by the Centers for Medicare and Medicaid Services (CMS).”
• Initial contract term will be three years upon approval of the California Department of Technology, which has “sole authority to approve information technology projects for General Fund departments and agencies” according to the RFP. The state will have the option of four one-year extensions for maintenance and operations, hosting, licensing, and customer support services, for a seven-year maximum contract term. The budget for the three-year initial term is $18.4 million. Solution development and implementation is anticipated to last up to two years. Intents to bid and written questions are due by 5 p.m. July 29; state responses to questions will come on Aug. 5. Detailed technical proposals are due by 5 p.m. Aug. 19 and will be evaluated through Sept. 2 with confidential discussions with bidders following Sept. 3-16. Final proposals are due by 5 p.m. Oct. 7. Anticipated contract start date is April 1.
