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State Health Entity Seeks Payment Maintenance, Modernization Assistance

In a new request for offer, the California Department of Health Care Services is seeking a contractor to provide maintenance and operation assistance with a key payment system and to help modernize aspects of it.

The state department that ensures residents have access to affordable quality health care is looking for assistance from IT companies to maintain a vital system that’s key to managing payments.

In a request for offer (RFO) also involving the California Department of General Services, the California Department of Health Care Services is seeking a contractor to provide “Capitation Payment Management (CAPMAN) system Maintenance and Operation (M&O) Services.” The system uses technologies including .NET, BizTalk and Edifecs, according to the RFO, and DHCS Enterprise Technology Services staff “lack sufficient expertise in these skill sets to perform all the required system maintenance.” Among the takeaways:

  • The CAPMAN system does “extremely complex calculations to accurately produce invoices” during each monthly cycle, per the RFO. But maintenance and management of its code base is complex and changes in structure as additional policy and legislation changes happen. The incumbent M&O vendor is training DHCS staffers now – but DHCS expects a transition period as long as three months between that company and the new contractor selected. The respondent chosen will be expected to continue “active and daily technology knowledge transfer to state staff.” Beyond that, however, the contractor will be responsible for providing modernization in functionality, technology and in the System Development Life Cycle (SDLC) methodology. The contractor must assess these three areas following the transition and create an iterative plan with initiatives in each area.
  • System operations activities required of the contractor include standard maintenance, training for users and technical staff, software updates and upgrades, and system documentation. Modernization activities required include application modernization, or developing an assessment and “road map” for a functional modernization; migration to Amazon Web Services, or designing, testing and implementing an AWS migration strategy for CAPMAN; and establishing and integrating DevOps into the overall CAPMAN SDLC process – setting DevOps specialized resources to follow best practices. Other activities required of the contractor include adopting “new tools (Jira, Confluence, GitHub) and best practices and methodologies (i.e. Agile/SCRUM, Critical Path, Prototyping, RAD)” as part of the CAPMAN modernization.
  • Contractor responsibilities include reviewing all performance aspects relating to the system’s technical components, identifying “emerging technical risks and issues” as early as possible; doing system updates/changes; storing all project work papers in the “file structures established by the DHCS Office of (Health Insurance Portability and Accountability Act) HIPAA Compliance”; and providing six key staff and 26 full-time staff. Experience requirements for the delivery manager include five years’ experience as lead system engineer on large-scale integration projects with multiple interfaces from external systems and three years’ experience with HIPAA transactions. Experience requirements for the senior project manager include seven years’ “broad, extensive and increasingly responsible project experience”; and three years’ experience in health-care IT. Experience requirements for the senior technical architect include three years’ full-time experience managing complex implementations and continuous improvement of at least two digital solutions; and seven years’ full-time experience as lead architect on digital services projects using Microsoft technology and development platform.
  • The contract’s precise value is not stated; its term is expected to be 60 months, likely from Aug. 1 or upon DGS approval through July 31, 2027, with two optional one-year extensions. The state and the contractor may amend the pact in writing in accordance with the terms of the master agreement and solicitation, with mutual consent. Questions are due by 2 p.m. Wednesday. Responses to the RFO are due by 2 p.m. May 26.
Theo Douglas is Assistant Managing Editor of Industry Insider — California.