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									                                    STATE OF MONTANA
                               REQUEST FOR PROPOSAL (RFP)
                              FOR INFORMATION TECHNOLOGY
                       RFP Title:
RFP Number:
                       MEDICAID MANAGEMENT INFORMATION SYSTEM DESIGN, DEVELOPMENT,
RFP09-1610P
                       IMPLEMENTATION, OPERATION AND FISCAL AGENT SERVICES
     RFP Response Due Date and Time:
          THURSDAY, MAY 7, 2009              Number of Pages: 202
             2:00 p.m., Local Time

                               ISSUING AGENCY INFORMATION
Procurement Officer:                                                     Issue Date:
Penny Moon                                                               January 13, 2009
          State Procurement Bureau
                                                          Phone: (406) 444-2575
          General Services Division
                                                           Fax: (406) 444-2529
        Department of Administration
                                                           TTY Users, Dial 711
         Room 165, Mitchell Building
           125 North Roberts Street
               P.O. Box 200135
                                                     Website: http://vendor.mt.gov/
            Helena, MT 59620-0135

                                INSTRUCTIONS TO OFFERORS
                                             Mark Face of Envelope/Package:
Return Sealed Proposal to:
                                              RFP Number: RFP09-1610P
         State Procurement Bureau             RFP Response Due Date: 05/07/09
          General Services Division
        Department of Administration          Special Instructions:
         Room 165, Mitchell Building
          125 North Roberts Street            A Pre-Proposal Conference will be conducted at
                                              1:00 p.m., local time, on February 3, 2009 at
              P.O. Box 200135
                                              DPHHS Sanders Building Auditorium, 111 North
           Helena, MT 59620-0135              Sanders, Helena MT.

                   IMPORTANT: SEE STANDARD TERMS AND CONDITIONS

                     OFFERORS MUST COMPLETE THE FOLLOWING
Offeror Name/Address:                  Authorized Offeror Signatory:


                                                          (Please print name and sign in ink)

Offeror Phone Number:                         Offeror FAX Number:


Offeror E-mail Address:

             OFFERORS MUST RETURN THIS COVER SHEET WITH RFP RESPONSE
                                                                                                Revised 2/08
                      MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P




           MONTANA
Medicaid Management Information System
 Design, Development, Implementation,
                Operation
                   and
          Fiscal Agent Services




                                                                   Page 2
                                                                                        MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P




                                                   Table of Contents
1.   PROJECT OVERVIEW ............................................................................................................. 14
     1.1     Contract Term............................................................................................................................ 14
     1.2     Single Point of Contact ............................................................................................................. 14
     1.3     Required Review ....................................................................................................................... 15
             1.3.1    Review RFP .................................................................................................................. 15
             1.3.2    Form of Questions ........................................................................................................ 15
             1.3.3    State’s Response.......................................................................................................... 15
     1.4     Pre-Proposal Conference ......................................................................................................... 15
     1.5     General Requirements .............................................................................................................. 15
             1.5.1    Acceptance of Standard Terms and Conditions/Contract .............................................. 15
             1.5.2    Resulting Contract ........................................................................................................ 16
             1.5.3    Mandatory Requirements .............................................................................................. 16
             1.5.4    Understanding of Specifications and Requirements ...................................................... 16
             1.5.5    Prime Contractor/Subcontractors .................................................................................. 16
             1.5.6    Offeror’s Signature ........................................................................................................ 17
             1.5.7    Offer in Effect for 365 Days ........................................................................................... 17
     1.6     Submitting a Proposal .............................................................................................................. 17
             1.6.1    Organization of Proposal .............................................................................................. 17
             1.6.2    Failure to Comply with Instructions ............................................................................... 17
             1.6.3    Multiple Proposals ........................................................................................................ 17
             1.6.4    Copies Required and Deadline for Receipt of Proposals ............................................... 17
             1.6.5    Late Proposals .............................................................................................................. 18
     1.7     Cost of Preparing A Proposal................................................................................................... 18
             1.7.1    State Not Responsible for Preparation Costs ................................................................ 18
             1.7.2    All Timely Submitted Materials Become State Property ................................................ 18

2.   AUTHORITY ............................................................................................................................. 19
     2.1     Offeror Competition .................................................................................................................. 19
     2.2     Receipt of Proposals and Public Inspection ........................................................................... 19
             2.2.1    Public Information ......................................................................................................... 19
             2.2.2    Procurement Officer Review of Proposals..................................................................... 19
     2.3     Classification and Evaluation of Proposals ............................................................................ 20
             2.3.1    Initial Classification of Proposals as Responsive or Non-responsive ............................. 20
             2.3.2    Determination of Responsibility ..................................................................................... 20
             2.3.3    Evaluation of Proposals ................................................................................................ 20
             2.3.4    Completeness of Proposals .......................................................................................... 20
             2.3.5    Achieve Passing Score ................................................................................................. 20
             2.3.6    Opportunity for Discussion/Negotiation and/or
                           Oral Presentation/Product Demonstration ............................................................... 21
             2.3.7    ―Best and Final Offer‖.................................................................................................... 21
             2.3.8    Evaluator/Evaluation Committee Recommendation for Contract Award ........................ 21
             2.3.9    Request for Documents Notice ..................................................................................... 21


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                                                                                         MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


             2.3.10 Contract Negotiation ..................................................................................................... 21
     2.4     State’s Rights Reserved ........................................................................................................... 22
     2.5     Department of Administration Powers and Duties ................................................................. 22
     2.6     Compliance with State of Montana IT Standards .................................................................... 22

3.   PURPOSE AND BACKGROUND ............................................................................................. 24
     3.1     Executive Vision........................................................................................................................ 24
     3.2     Medicaid Information Technology Architecture (MITA) Assessment .................................... 24
     3.3     Montana Health Care Programs Overview............................................................................... 27
     3.4     Today’s Montana MMIS Overview ............................................................................................ 29
     3.5     State Organization..................................................................................................................... 30
             3.5.1   Functions of the MMIS/PBM/DSS ................................................................................. 31
             3.5.2   External Relationships with MMIS Access .................................................................... 32
             3.5.3   External Relationships without MMIS Access ............................................................... 32

4.   SCOPE OF WORK ................................................................................................................... 33
     4.1     Background ............................................................................................................................... 33
     4.2     Contract Phases ........................................................................................................................ 34
             4.2.1     Start Up Phase ............................................................................................................. 35
                 4.2.1.1 State Responsibilities ............................................................................................ 35
                 4.2.1.2 Contractor Responsibilities .................................................................................... 35
                     4.2.1.2.1     Kick Off Meeting .......................................................................................... 35
                     4.2.1.2.2     Prepare Project Management Deliverables ................................................. 35
                     4.2.1.2.3     Prepare Primary Project Site ....................................................................... 35
             4.2.2     Analysis and Design Phase .......................................................................................... 36
                 4.2.2.1 State Responsibilities ............................................................................................ 36
                 4.2.2.2 Contractor Responsibilities .................................................................................... 37
                     4.2.2.2.1     Review, Validate and Refine Requirements ................................................. 37
                     4.2.2.2.2     Document Rules .......................................................................................... 37
                     4.2.2.2.3     Construct Requirements Specifications Document (RSD) ........................... 37
                     4.2.2.2.4     Requirements Traceability Matrix and Repository ........................................ 38
                     4.2.2.2.5     Prepare Detailed Systems Design Document .............................................. 38
                     4.2.2.2.6     Contractor Deliverables ............................................................................... 40
             4.2.3     Development Phase ..................................................................................................... 40
                 4.2.3.1 State Responsibilities ............................................................................................ 40
                 4.2.3.2 Contractor Responsibilities .................................................................................... 40
                     4.2.3.2.1     Software/Hardware Configuration ................................................................ 41
                     4.2.3.2.2     MMIS/PBM/DSS Systems Documentation ................................................... 41
                     4.2.3.2.3     Provide MMIS/PBM/DSS User Electronic Documentation ........................... 43
                     4.2.3.2.4     Development and Unit Testing .................................................................... 43
             4.2.4     Testing Task ................................................................................................................. 46
                 4.2.4.1 State Responsibilities ............................................................................................ 47
                 4.2.4.2 Contractor Responsibilities .................................................................................... 47
                     4.2.4.2.1     Test Plans ................................................................................................... 49
                     4.2.4.2.2     Contingency Plan to Mitigate Testing Risks ................................................. 50
                     4.2.4.2.3     Test Cases/Scripts ...................................................................................... 50


                                                                                                                                                   Page 4
                                                                           MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


        4.2.4.2.4     Performance Tuning Document ................................................................... 51
        4.2.4.2.5     UAT Plan ..................................................................................................... 51
        4.2.4.2.6     Operational Readiness Test Report ............................................................. 52
        4.2.4.2.7     Contractor Deliverables ............................................................................... 53
4.2.5     Data Cleansing and Conversion Task ........................................................................... 53
    4.2.5.1 State Responsibilities ............................................................................................ 54
    4.2.5.2 Contractor Responsibility ....................................................................................... 54
        4.2.5.2.1     Update Data Conversion Plan ..................................................................... 54
        4.2.5.2.2     Contingency Plan to Mitigate Data Conversion Risks .................................. 55
        4.2.5.2.3     Proposed Approach to Parallel Runs Between MMIS and MMIS/PBM/DSS 55
        4.2.5.2.4     Data Cleansing and Data Conversion Specifications Document .................. 55
        4.2.5.2.5     Update Data Conversion Requirement Document ....................................... 57
        4.2.5.2.6     Data Conversion Checklists ......................................................................... 57
        4.2.5.2.7     Develop Data Reconciliation Procedures..................................................... 57
        4.2.5.2.8     Develop or Provide Conversion Programs ................................................... 57
        4.2.5.2.9     Convert and Reconcile Data for Implementation .......................................... 57
        4.2.5.2.10 Data Conversion Test Scripts ...................................................................... 58
        4.2.5.2.11 Data Conversion Reports ............................................................................ 58
        4.2.5.2.12 UAT of Converted Data ............................................................................... 58
        4.2.5.2.13 Data Conversion Test Results Report.......................................................... 58
    4.2.5.3 Contractor Deliverables ......................................................................................... 58
4.2.6      Training Task ............................................................................................................... 59
    4.2.6.1 State Responsibilities ............................................................................................ 59
    4.2.6.2 Contractor Responsibility ....................................................................................... 59
        4.2.6.2.1     Staff and Management User Training .......................................................... 59
        4.2.6.2.2     On-line Tutorial ............................................................................................ 60
        4.2.6.2.3     Provider Training ......................................................................................... 60
        4.2.6.2.4     Training Schedule........................................................................................ 61
        4.2.6.2.5     Training Plans ............................................................................................. 61
        4.2.6.2.6     Develop, Provide and Maintain Training Documentation.............................. 61
        4.2.6.2.7     Certificate of Completed Training ................................................................ 62
        4.2.6.2.8     Prepare Evaluation Tool .............................................................................. 62
        4.2.6.2.9     Training Report ............................................................................................ 62
        4.2.6.2.10 Contractor Deliverables ............................................................................... 62
4.2.7     Implementation Phase .................................................................................................. 63
    4.2.7.1 Implementation Plan .............................................................................................. 63
    4.2.7.2 Implementation ...................................................................................................... 64
        4.2.7.2.1     State Responsibilities .................................................................................. 64
        4.2.7.2.2     Contractor Responsibilities .......................................................................... 64
    4.2.7.3 Post Takeover Implementation .............................................................................. 66
        4.2.7.3.1     Contractor Responsibilities .......................................................................... 66
4.2.8     Operations Phase ......................................................................................................... 67
    4.2.8.1 Operations Requirements ...................................................................................... 67
        4.2.8.1.1     Operations Training ..................................................................................... 67
4.2.9     Certification Phase ........................................................................................................ 67
    4.2.9.1 State Responsibilities ............................................................................................ 67
    4.2.9.2 Contractor Responsibilities .................................................................................... 67

                                                                                                                                    Page 5
                                                                                     MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


              4.2.9.2.1          Update Federal Certification Plan ................................................................ 67
              4.2.9.2.2          Provide Required Documentation for Federal Certification .......................... 68
              4.2.9.2.3          Provide Personnel as Required for Federal Certification.............................. 68
              4.2.9.2.4          System Remediation ................................................................................... 68
              4.2.9.2.5          Correction of Items Not Certified.................................................................. 68
              4.2.9.2.6          Change Control for Certification................................................................... 68
              4.2.9.2.7          Contractor Deliverables ............................................................................... 68
      4.2.10 Enhancement Phase..................................................................................................... 68
      4.2.11 Turnover Phase ............................................................................................................ 69
          4.2.11.1 State Responsibilities ............................................................................................ 69
          4.2.11.2 Contractor Responsibilities .................................................................................... 69
              4.2.11.2.1 Planning ...................................................................................................... 69
              4.2.11.2.2 General Planning with State ........................................................................ 70
              4.2.11.2.3 General Planning with Contractor ................................................................ 70
              4.2.11.2.4 Develop Turnover Plan ................................................................................ 70
              4.2.11.2.5 Develop Requirements Statement ............................................................... 70
              4.2.11.2.6 Provide Turnover Services .......................................................................... 70
              4.2.11.2.7 Cooperation with Successor ........................................................................ 70
              4.2.11.2.8 Turnover of Archived Materials .................................................................... 70
              4.2.11.2.9 Additional Contractor Turnover Responsibilities .......................................... 70
              4.2.11.2.10 Deliverables................................................................................................. 72
4.3   Staffing....................................................................................................................................... 73
      4.3.1     Named Staff for the Design, Development and Implementation Phase ......................... 73
      4.3.2     Named Staff for the Certification Phase ........................................................................ 74
      4.3.3     Named Staff for the Turnover Phase............................................................................. 74
      4.3.4     Named Staff for the Operations Phase ......................................................................... 74
      4.3.5     Categorized Staff .......................................................................................................... 76
      4.3.6     Minimum Numbers of Categorized Staff - Operations Phase ........................................ 76
      4.3.7     General Requirements for Employees .......................................................................... 77
      4.3.8     Residency and Work Status .......................................................................................... 77
      4.3.9     Background Checks ...................................................................................................... 77
4.4   Location of Operations Facilities ............................................................................................. 78
      4.4.1     Meeting Room Requirements for Design and Development .......................................... 78
      4.4.2     Space Provided for File and Archive Storage ................................................................ 79
      4.4.3     State Access to Processing Facilities and Contractor Staff ........................................... 79
      4.4.4     Computer Resources .................................................................................................... 79
          4.4.4.1 User Access .......................................................................................................... 79
          4.4.4.2 Location of Backup and Contingency Facilities ...................................................... 80
          4.4.4.3 Location of System Analysis and Programming Resources ................................... 80
          4.4.4.4 Location of Subcontractors .................................................................................... 80
4.5   Project Governance Requirements .......................................................................................... 80
      4.5.1     State Responsibilities.................................................................................................... 80
      4.5.2     Contractor Responsibilities ........................................................................................... 81
          4.5.2.1 PMBOK ................................................................................................................. 81
          4.5.2.2 Information Technology Iterative Project Management .......................................... 82
          4.5.2.3 Separation of Duties .............................................................................................. 82
          4.5.2.4 Financial Control.................................................................................................... 82

                                                                                                                                                 Page 6
                                                                                MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


          4.5.2.5 Security ................................................................................................................. 83
          4.5.2.6 Quality Control ....................................................................................................... 83
      4.5.3     Project Management ..................................................................................................... 83
          4.5.3.1 Project Management Portal ................................................................................... 83
          4.5.3.2 Project Management Office (PMO) ........................................................................ 84
              4.5.3.2.1    PMO Processes, Policies and Procedures .................................................. 84
          4.5.3.3 Project Management Plans .................................................................................... 84
              4.5.3.3.1    Communication Management Plan .............................................................. 84
              4.5.3.3.2    Project Plan ................................................................................................. 86
              4.5.3.3.3    Management Plan ....................................................................................... 87
              4.5.3.3.4    Issues Management Plan ............................................................................ 87
              4.5.3.3.5    Quality Management Plan ........................................................................... 87
              4.5.3.3.6    Staffing Management Plan .......................................................................... 88
              4.5.3.3.7    Applications Development and Maintenance Plan ....................................... 88
              4.5.3.3.8    Change Management Plan .......................................................................... 89
          4.5.3.4 Project Execution and Control ............................................................................... 91
          4.5.3.5 Integrated Management......................................................................................... 91
          4.5.3.6 Project Management Deliverables ......................................................................... 91
      4.5.4     Management of System Modifications or Operation Improvements............................... 91
          4.5.4.1 Cost Management ................................................................................................. 91
          4.5.4.2 Project Execution and Control ............................................................................... 92
              4.5.4.2.1    Project Thresholds....................................................................................... 92
              4.5.4.2.2    Project Management Requirements Deliverables ........................................ 92
      4.5.5     General Contract Management ..................................................................................... 95
4.6   Deliverable Procedures and Standards ................................................................................... 97
      4.6.1     Deliverable Procedures................................................................................................. 97
      4.6.2     Deliverables Standards ................................................................................................. 97
4.7   Record Retention Requirements .............................................................................................. 98
4.8   Performance Monitoring ........................................................................................................... 99
      4.8.1     Performance Standards ................................................................................................ 99
          4.8.1.1 Provider Performance Standards ......................................................................... 100
              4.8.1.1.1    State Inquiries ........................................................................................... 100
              4.8.1.1.2    Provider Database Maintenance, Update and Edit .................................... 100
              4.8.1.1.3    Provider Licensure and Certification .......................................................... 100
              4.8.1.1.4    Automated Voice Response System (AVRS) and FAXBACK .................... 100
              4.8.1.1.5    Provider Enrollment ................................................................................... 101
              4.8.1.1.6    Provider Relations ..................................................................................... 101
              4.8.1.1.7    Provider Education .................................................................................... 102
              4.8.1.1.8    Provider 1099 Production .......................................................................... 102
              4.8.1.1.9    Care Management Provider Relations Performance Standards ................. 102
          4.8.1.2 Telephone Response .......................................................................................... 102
          4.8.1.3 Reference Performance Standards...................................................................... 103
          4.8.1.4 Pharmacy Benefit Management ........................................................................... 104
              4.8.1.4.1    Pharmacy POS Performance Standards ................................................... 104
              4.8.1.4.2    Drug Rebate Performance Standards ........................................................ 104
          4.8.1.5 Client Performance Standards ............................................................................. 104
          4.8.1.6 EPSDT Performance Standards .......................................................................... 105

                                                                                                                                        Page 7
                                                                                MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


          4.8.1.7 Managed Care Performance Standards .............................................................. 105
              4.8.1.7.1     Client Enrollment Performance Standards ................................................. 105
              4.8.1.7.2     Client Outreach and Education Performance Standards ............................ 106
      4.8.2     Prior Authorization (PA) Performance Standards ........................................................ 106
      4.8.3     Claim Adjudication Performance Standards ................................................................ 107
      4.8.4     Claims Payment Performance Standards ................................................................... 108
      4.8.5     Financial Services Performance Standards ................................................................ 108
      4.8.6     Quality Assurance Performance Standards ................................................................ 108
          4.8.6.1 Quality Assurance/Improvement – Provider Enrollment and Relations ................ 109
      4.8.7     DW/DSS Performance Standards ............................................................................... 109
          4.8.7.1 Reports Performance Standards ......................................................................... 110
          4.8.7.2 Surveillance and Utilization Review Performance Standards ............................... 110
      4.8.8     TPL Performance Standards....................................................................................... 110
      4.8.9     Web Portal Performance Standards............................................................................ 111
4.9   Actual and Liquidated Damages ............................................................................................ 112
      4.9.1     Transfer of Named Staff Proposed Requirements ....................................................... 112
          4.9.1.1 Liquidated Damages ............................................................................................ 113
      4.9.2     Named Staff Vacancy Requirements .......................................................................... 113
          4.9.2.1 Liquidated Damages ............................................................................................ 113
      4.9.3     Categorized Staffing Levels Requirements ................................................................. 113
          4.9.3.1 Liquidated Damages ............................................................................................ 113
      4.9.4     Performance Reporting System Report Requirements................................................ 113
          4.9.4.1 Liquidated Damages ............................................................................................ 114
      4.9.5     Provider Activation Prior to Meeting Eligibility Requirements ...................................... 114
          4.9.5.1 Actual Damages .................................................................................................. 114
      4.9.6     Ineligible Client Enrollment Requirements................................................................... 114
          4.9.6.1 Actual Damages .................................................................................................. 114
      4.9.7     System Certification and Performance Review Requirements .................................... 114
          4.9.7.1 Actual Damages .................................................................................................. 114
      4.9.8     Documentation Requirements..................................................................................... 115
          4.9.8.1 Liquidated Damages ............................................................................................ 115
      4.9.9     Claims Entry ............................................................................................................... 115
          4.9.9.1 Liquidated Damages ............................................................................................ 115
      4.9.10 Correctness of Payments Requirements ..................................................................... 115
          4.9.10.1 Actual Damages .................................................................................................. 115
      4.9.11 Data Conversion Requirements .................................................................................. 116
          4.9.11.1 Liquidated Damages ............................................................................................ 116
      4.9.12 Milestones or Phases Requirements ........................................................................... 116
          4.9.12.1 Liquidated Damages ............................................................................................ 116
      4.9.13 Project Management Requirements ............................................................................ 116
          4.9.13.1 Liquidated Damages ............................................................................................ 116
      4.9.14 Data Communications Requirements .......................................................................... 116
          4.9.14.1 Liquidated Damages ............................................................................................ 116
      4.9.15 EDP Audit Requirements ............................................................................................ 117
          4.9.15.1 Liquidated Damages ............................................................................................ 117
      4.9.16 Sponsorship Requirements ......................................................................................... 117
          4.9.16.1 Liquidated Damages ............................................................................................ 117

                                                                                                                                         Page 8
                                                                                      MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


          4.9.17 Record Retention and Access Requirements .............................................................. 117
              4.9.17.1 Liquidated Damages ............................................................................................ 117
          4.9.18 Back Up Site/Data Requirements................................................................................ 117
              4.9.18.1 Liquidated Damages ............................................................................................ 118
          4.9.19 System Capacity Requirements .................................................................................. 118
              4.9.19.1 Liquidated Damages ............................................................................................ 118
          4.9.20 Confidentiality and HIPAA Compliance Requirements ................................................ 118
              4.9.20.1 Actual Damages .................................................................................................. 119
          4.9.21 Correction of Deficiencies Identified by the State ........................................................ 119
              4.9.21.1 Requirements ...................................................................................................... 119
              4.9.21.2 Liquidated Damages ............................................................................................ 119
          4.9.22 Inadequate Performance Requirements...................................................................... 119
              4.9.22.1 Liquidated Damages ............................................................................................ 119
          4.9.23 Deduction of Damages from Payments ....................................................................... 120
              4.9.23.1 Liquidated Damages ............................................................................................ 120
              4.9.23.2 Actual Damages .................................................................................................. 120
     4.10 Additional Services ................................................................................................................. 120

5.   PROPOSAL INSTRUCTIONS ................................................................................................ 121
     5.1     Technical Proposal Instructions ............................................................................................ 121
             5.1.1    TAB 1 – Title Page and Summary ............................................................................... 122
             5.1.2    TAB 2 – Proposal Security .......................................................................................... 124
             5.1.3    TAB 3 – Corporate Background and Experience......................................................... 124
             5.1.4    TAB 4 – Overall Technical Approach .......................................................................... 126
             5.1.5    Technical Approach Instructions ................................................................................. 127
             5.1.6    TAB 5 – Technical Approach to Design and Development .......................................... 130
             5.1.7    TAB 6 – Technical Approach to Implementation ......................................................... 132
             5.1.8    TAB 7 – Technical Approach to Operations ................................................................ 133
             5.1.9    TAB 8 – Technical Approach to MMIS Certification ..................................................... 133
             5.1.10 TAB 9 –Approach to Technical Architecture Requirements ......................................... 134
             5.1.11 TAB 10 – Technical Approach to MMIS Enhancements .............................................. 134
             5.1.12 TAB 11 – Technical Approach to Turnover ................................................................. 134
             5.1.13 TAB 12 – Performance Bond ...................................................................................... 134
     5.2     Cost Proposal Instructions..................................................................................................... 134
     5.3     General Requirements for the Cost Proposal ....................................................................... 135
             5.3.1    Total Systems Planning, Design, Development, Testing, and Implementation Price ... 135
             5.3.2    Operations Price ......................................................................................................... 135
             5.3.3    MMIS Enhancement Prices......................................................................................... 135
             5.3.4    Signature Block........................................................................................................... 136
     5.4     Pricing Schedule A - Summary of Total Proposal................................................................. 136
     5.5     Pricing Schedule B - MMIS/PBM/DSS Planning, Design, Development, Testing,
                and Implementation Price Components ............................................................................ 136
     5.6     Pricing Schedule B-1 - MMIS/PBM/DSS Planning, Design, Development, Testing,
                and Implementation Price .................................................................................................. 136
     5.7     Pricing Schedules C - Operational Prices ............................................................................. 137
             5.7.1    Pricing Schedules C-1 through C-8 ............................................................................. 138


                                                                                                                                             Page 9
                                                                                        MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


     5.8    Pricing Schedule D - Additional Managed Care Functionality ............................................. 139
     5.9    Pricing Schedule E - Electronic Health Records (EHR) ........................................................ 139
     5.10   Pricing Schedule F - Payroll System Price ............................................................................ 140
     5.11   Pricing Schedule G - Software Costs..................................................................................... 140
            Pricing Schedule A .................................................................................................................... 141
            Pricing Schedule B .................................................................................................................... 142
            Pricing Schedule B-1 ................................................................................................................. 143
            Pricing Schedule C .................................................................................................................... 144
            Pricing Schedule C-1................................................................................................................. 145
            Pricing Schedule C-2................................................................................................................. 146
            Pricing Schedule C-3................................................................................................................. 147
            Pricing Schedule C-4................................................................................................................. 148
            Pricing Schedule C-5................................................................................................................. 149
            Pricing Schedule C-6................................................................................................................. 150
            Pricing Schedule C-7................................................................................................................. 151
            Pricing Schedule C-8................................................................................................................. 152
            Pricing Schedule D .................................................................................................................... 153
            Pricing Schedule E .................................................................................................................... 154
            Pricing Schedule F .................................................................................................................... 155
            Pricing Schedule G ................................................................................................................... 156

6.   TECHNICAL PROPOSAL EVALUATION .............................................................................. 157
     6.1    Introduction ............................................................................................................................. 157
     6.2    State’s Right to Investigate and Reject .................................................................................. 157
     6.3    Evaluation Procedures ........................................................................................................... 157
     6.4    Evaluation Organization ......................................................................................................... 157
     6.5    Phase 1 - Evaluation of Mandatory Requirements of Technical Proposal .......................... 158
     6.6    Phase 2 - Evaluation of Technical Proposals ........................................................................ 158
            6.6.1    Technical Proposal Points (1,400 points) .................................................................... 159
            6.6.2    Project Staffing ........................................................................................................... 159
            6.6.3    Corporate Background and Experience (200 points) ................................................... 160
            6.6.4    Overall Technical Approach (150 points) .................................................................... 160
            6.6.5    Technical Approach to Design and Development (250 points) .................................... 161
            6.6.6    Technical Approach to Implementation (150 points) ................................................... 163
            6.6.7    Technical Approach to Operations (250 points) .......................................................... 164
            6.6.8    Technical Approach to MMIS Certification (100 points) ............................................... 165
            6.6.9    Technical Approach to MMIS Enhancements (75 points) ............................................ 166
            6.6.10 Technical Approach to Turnover (50 points) ............................................................... 167
            6.6.11 System Architecture (175 points) ................................................................................ 168
     6.7    Scoring of Offeror Cost Proposals ........................................................................................ 168




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                                                                             MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P




                                                     Appendices
Appendix 1 - Montana Health Care Programs Summary .......................................................... 170

Appendix 2 - Glossary of Terms ................................................................................................. 175

Appendix 3 - Items in the Procurement Library ........................................................................ 192

Appendix 4 - Agency Organizational Chart ............................................................................... 193

Appendix 5 - Checklist of Mandatory Items ............................................................................... 194

Appendix 6 - Cross Reference Matrix ........................................................................................ 197




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                                                      MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P



                                    Attachments

Note-These documents are not available in this RFP. They can be found at the following link:
http://gsd.mt.gov/osbs/Results.asp?CategoryID=14 in the Zip file called ―Group 1
Attachments.‖

Attachment A: Standard Terms and Conditions

Attachment B: Contract

Attachment C: Results of MITA Self-Assessment

Attachment D: Medicaid Enterprise Certification Toolkit

Attachment E: Architectural Requirements

Attachment F: Operational Requirements

Attachment G: System Requirements Matrix




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                                             MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P



                          SCHEDULE OF EVENTS
EVENT                                                                                 DATE

RFP Issue Date                                                      January 13, 2009

Pre-Proposal Conference                                              February 3, 2009

Deadline for Receipt of Written Questions                          February 13, 2009

Deadline for Posting Written Response to State Website                   March 6, 2009

RFP Response Due Date                                                       May 7, 2009

Evaluation Begins                                                          May 11, 2009

Contract to CMS for Approval                                      September 1, 2009

Contract Begin Date                                                   October 1, 2009




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                                                                 MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


1.            PROJECT OVERVIEW
The STATE OF MONTANA, Department of Public Health and Human Services (hereinafter referred to as
―the State‖ or ―DPHHS‖) is seeking proposals for services to develop a new Medicaid Management Information
System (MMIS), Pharmacy Benefit Manager (PBM) with point-of-sale capability, drug utilization review and
drug rebate functionality and a data warehouse with decision support functionality (DSS), hereinafter referred
to as an MMIS/PBM/DSS. Montana is also seeking the provision of full Fiscal Agent services and program
operations. The Contractor will design, develop, implement, maintain and operate the MMIS/PBM/DSS that will
be owned by the State. The Contractor will not take over Fiscal Agent duties for the current MMIS until the
new MMIS/PBM/DSS is implemented.

A more complete description of the services sought for this project is provided in Section 4. Proposals
submitted in response to this solicitation must comply with the instructions and procedures contained herein.

1.1           Contract Term
The Contract will start on October 1, 2009 (assuming approval by the Centers for Medicare and Medicaid
Services (CMS)), and will allow the Contractor 24 months (October 1, 2009 – September 30, 2011) to
implement the replacement MMIS/PBM/DSS, and then 48 months (October 1, 2011 – September 30, 2015) to
operate the MMIS/PBM/DSS as Fiscal Agent.

Renewals of the Contract, by mutual agreement of both parties, include a maximum of four one-year extension
intervals, or any extension interval that is advantageous to the State.

All equipment used in the operation of MMIS/PBM/DSS will become the property of the State upon the
termination of the Contract. The Contractor shall provide the State the perpetual rights and/or license to
operate and maintain all proprietary software after the termination of the Contract.

1.2           Single Point of Contact
From the date this Request for Proposal (RFP) is issued until an Offeror is selected and the selection is
announced by the Procurement Officer, Offerors are not allowed to communicate with any State staff or
officials regarding this procurement, except at the direction of Penny Moon, the Procurement Officer in charge
of the solicitation. Any unauthorized contact may disqualify the Offeror from further consideration. Contact
information for the single point of contact is as follows:
                                         Procurement Officer: Penny Moon
                                             State Procurement Bureau
                                            Room 165, Mitchell Building
                                                 125 North Roberts
                                                   PO Box 200135
                                               Helena MT 59620-0135
                                               Phone: (406) 444-3313
                                                Fax: (406) 444-2529
                                               E-mail: pmoon@mt.gov




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                                                                   MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


1.3           Required Review
1.3.1         Review RFP

Offerors should carefully review the instructions; mandatory requirements; specifications; Standard Terms and
Conditions; and Contract set out in this RFP and promptly notify the Procurement Officer identified above in
writing or via e-mail of any ambiguity, inconsistency, unduly restrictive specifications, or error which they
discover upon examination of this RFP. This should include any terms or requirements within the RFP that
either preclude the Offeror from responding to the RFP or add unnecessary cost. This notification must be
accompanied by an explanation and suggested modification and be received by the deadline for receipt of
written or emailed inquiries set forth below. The State will make any final determination of changes to the RFP.

1.3.2         Form of Questions

Offerors with questions or requiring clarification or interpretation of any Section within this RFP must address
these questions in writing or via e-mail to the Procurement Officer referenced above on or before Friday,
February 13, 2009. Each question must provide clear reference to the Section, page, and item in question.
Questions received after the deadline will not be considered.

1.3.3         State’s Response

The State will provide an official written response by Friday, March 6, 2009 to all questions received by
February 13, 2009. The State’s response will be by formal written addendum. Any other form of interpretation,
correction, or change to this RFP will not be binding upon the State. Any formal written addendum will be
posted on the State’s website alongside the posting of the RFP at http://gsd.mt.gov/osbs/Default.asp by the
close of business on the date listed. Offerors must sign and return with their RFP response an
Acknowledgment of Addendum for any addendum issued.

1.4           Pre-Proposal Conference
An optional Pre-Proposal Conference will be conducted at 1:00 p.m., local time, on February 3, 2009 at
DPHHS Sanders Building Auditorium, 111 North Sanders, Helena MT. Offerors are encouraged to use this
opportunity to ask clarifying questions, obtain a better understanding of the project, or to notify the State of any
ambiguities, inconsistencies, or errors discovered upon examination of this RFP. All responses to questions at
the Pre-Proposal Conference will be oral and in no way binding on the State.

1.5           General Requirements
1.5.1         Acceptance of Standard Terms and Conditions/Contract

By submitting a response to this RFP, Offeror agrees to acceptance of the Standard Terms and Conditions and
Contract as set out in Attachments A and B of this RFP. Much of the language included in the Contract reflects
requirements of Montana law. Requests for additions or exceptions to the Contract, including any necessary
licenses, or any added provisions must be submitted to the Procurement Officer referenced above by the date
for receipt of written/emailed questions and must be accompanied by an explanation of why the exception is


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                                                                  MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


being sought and what specific effect it will have on the Offeror’s ability to respond to the RFP or perform the
Contract. The State reserves the right to address non-material requests for exceptions with the highest scoring
Offeror during Contract negotiation. Any material exceptions requested and granted to the Contract language
will be addressed in any formal written addendum issued for this RFP and will apply to all Offerors submitting a
response to this RFP. The State will make any final determination of changes to the Contract.

1.5.2         Resulting Contract

This RFP, all attachments, and any addenda, the Offeror’s RFP response, including any amendments, a ―Best
and Final Offer‖, and any clarification question responses shall be included in any resulting Contract. In the
event of a dispute as to the duties and responsibilities of the parties under this Contract, the Contract, along
with any attachments prepared by the State, will govern in the same order of precedence as listed in the
Contract.

1.5.3         Mandatory Requirements

To be eligible for consideration, an Offeror must meet the intent of all mandatory requirements listed in
Appendix 5. The State will determine whether an Offeror’s RFP response complies with the intent of the
requirements. RFP responses that do not meet the full intent of all requirements listed in this RFP may be
subject to point reductions during the evaluation process or may be deemed non-responsive.

1.5.4         Understanding of Specifications and Requirements

By submitting a response to this RFP, Offeror agrees to an understanding of and compliance with the
specifications and requirements described in this RFP.

1.5.5         Prime Contractor/Subcontractors

The highest scoring Offeror will be the prime Contractor if a Contract is awarded and shall be responsible, in
total, for all work of any subcontractors. All subcontractors, if any, must be listed in the proposal. The
Contractor may not subcontract or delegate performance under this Contract with other entities or third parties
or change subcontractors without written consent of the State. The Contractor shall provide the State with
complete copies of any agreements made by and between the Contractor and all subcontractors. All
subcontracts included in the Contractor’s Technical Proposal and Cost Proposal shall require review and
approval by the State prior to the Contractor’s start of work.

The Contractor shall remain solely responsible for the performance and payment of its subcontractors. The
Contractor shall be responsible to the State for the acts and omissions of all subcontractors or agents and of
persons directly or indirectly employed by such subcontractors, and for the acts and omissions of persons
employed directly by the Contractor. Further, nothing contained within this document or any Contract
documents created as a result of any Contract awards derived from this RFP shall create any Contractual
relationships between any subcontractor and the State. Any Contracts made by the Contractor with a
subcontractor shall include an affirmative Statement that the State is an intended third party beneficiary of the
Contract, that the subcontractor has no agreement with the State, and that the State shall be indemnified by
the Contractor for any claim presented by the subcontractor.



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                                                                  MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


The Contractor warrants that its services, including the services of its subcontractors, will be provided in a
professional manner. "Professional manner" means that the personnel performing the services will possess the
skill and competence consistent with the prevailing business standards in, as applicable, the information
technology industry or the market for performing Fiscal Agent operations on behalf of State governments.

The Contactor shall require all subcontractors, if any, to adhere to the same standards required of the
Contractor. Performance of any work by individually directed ―Contract employees‖ hired by the Contractor
shall be considered the sole responsibility of the prime Contractor. Notwithstanding any other term herein, the
Contractor shall timely exercise its Contractual remedies against any non-performing subcontractor and, when
appropriate, substitute another subcontractor.

1.5.6         Offeror’s Signature

The proposals must be signed in ink by an individual authorized to legally bind the business submitting the
proposal. The Offeror’s signature on a proposal in response to this RFP guarantees that the offer has been
established without collusion and without effort to preclude the State of Montana from obtaining the best
possible supply or service. Proof of authority of the person signing the RFP response must be furnished upon
request.

1.5.7         Offer in Effect for 365 Days

A proposal may not be modified, withdrawn or canceled by the Offeror for a 365-day period following the
deadline for proposal submission as defined in the Schedule of Events, or receipt of ―Best and Final Offer‖, if
required, and Offeror so agrees in submitting the proposal.

1.6           Submitting a Proposal
1.6.1         Organization of Proposal

Offerors must organize their proposal in accordance with the requirements of Section 5.

1.6.2         Failure to Comply with Instructions

The State may choose to not evaluate, may deem non-responsive, deduct points, and/or may disqualify from
further consideration any proposals that do not follow requirements of Section 6, are difficult to understand, are
difficult to read, or are missing any requested information.

1.6.3         Multiple Proposals

Offerors may, at their option, submit multiple proposals, in which case each proposal shall be evaluated as a
separate document.

1.6.4         Copies Required and Deadline for Receipt of Proposals

Offerors must submit one signed original proposal and 13 copies of the same to the State Procurement
Bureau. In addition, Offerors must submit three electronic versions of the proposal along with all attachments

                                                                                                              Page 17
                                                                   MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


searchable as a whole, preferably in PDF format, on compact disk or DVD. Offerors unable to provide an
electronic copy of the proposal in PDF format must provide it in Microsoft Word or text format. If any
confidential materials are included, per the requirements of Section 2.2.2, they must be submitted on a
separate compact disk or DVD.

PROPOSALS MUST BE SEALED AND LABELED ON THE OUTSIDE OF THE PACKAGE to clearly indicate
that they are in response to RFP09-1610P. Proposals must be received at the receptionist’s desk of the
State Procurement Bureau by 2 p.m., Mountain Time, Thursday, May 7, 2009.

1.6.5         Late Proposals

Regardless of cause, late proposals will not be accepted and will automatically be disqualified from
further consideration. It shall be the Offeror’s sole risk to assure delivery at the receptionist's desk at the
designated office by the designated time. Late proposals will not be opened and may be returned to the Offeror
at the expense of the Offeror or destroyed if requested.

1.7           Cost of Preparing a Proposal
1.7.1         State Not Responsible for Preparation Costs

The costs for developing and delivering responses to this RFP and any subsequent presentations of the
proposal as requested by the State are entirely the responsibility of the Offeror. The State is not liable for any
expense incurred by the Offeror in the preparation and presentation of their proposal or any other costs
incurred by the Offeror prior to execution of a Contract.

1.7.2         All Timely Submitted Materials Become State Property

All materials submitted in response to this RFP become the property of the State and are to be appended to
any formal documentation, which would further define or expand any Contractual relationship between the
State and Offeror resulting from this RFP process.




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                                                                  MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


2.            AUTHORITY
This RFP is issued under the authority of Section 18-4-304, MCA (Montana Code Annotated) and ARM
2.5.602 (Administrative Rules of Montana). The RFP process is a procurement option allowing the award to be
based on Stated evaluation criteria. The RFP States the relative importance of all evaluation criteria. No other
evaluation criteria, other than as outlined in the RFP, will be used.

2.1           Offeror Competition
The State encourages free and open competition among Offerors. Whenever possible, the State will design
specifications, proposal requests, and conditions to accomplish this objective, consistent with the necessity to
satisfy the State’s need to procure technically sound, cost-effective services and supplies.

2.2           Receipt of Proposals and Public Inspection
2.2.1         Public Information

All information received in response to this RFP, including copyrighted material, is deemed public information
and will be made available for public viewing and copying shortly after the time for receipt of proposals has
passed with the following three exceptions: (1) bona fide trade secrets meeting the requirements of the
Uniform Trade Secrets Act, Title 30, chapter 14, part 4, MCA, that have been properly marked, separated, and
documented; (2) matters involving individual safety as determined by the State; and (3) other constitutional
protections. See MCA § 18-4-304. The State will make a copier available for interested parties to use at $0.10
per page. The interested party is responsible for the cost of copies and to provide personnel to do the copying.

2.2.2         Procurement Officer Review of Proposals

Upon opening the proposals received in response to this RFP, the Procurement Officer in charge of the
solicitation will review the proposals and separate out any information that meets the referenced exceptions in
Section 2.2.1 above, providing the following conditions have been met:
    1. Confidential information is clearly marked and separated from the rest of the proposal.
    2. The proposal does not contain confidential material in the cost or price Section.
    3. An affidavit from an Offeror’s legal counsel attesting to and explaining the validity of the trade secret
         claim as set out in Title 30, chapter 14, part 4, MCA, is attached to each proposal containing trade
         secrets. Counsel must use the State of Montana ―Affidavit for Trade Secret Confidentiality‖ form in
         requesting the trade secret claim. This affidavit form is available on the General Services Division’s
         website at: http://gsd.mt.gov/procurement/forms.asp or by calling (406) 444-2575.

Information separated out under this process will be available for review only by the Procurement Officer, the
evaluator/evaluation committee members, and limited other designees. Offerors must be prepared to pay all
legal costs and fees associated with defending a claim for confidentiality in the event of a ―right to know‖ (open
records) request from another party.




                                                                                                              Page 19
                                                                   MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


2.3           Classification and Evaluation of Proposals
2.3.1         Initial Classification of Proposals as Responsive or Non-responsive

All proposals will initially be classified as either ―responsive‖ or ―non-responsive,‖ in accordance with ARM
2.5.602. Proposals may be found non-responsive at any time during the procurement process if any of the
required information is not provided; the submitted price is found to be excessive or inadequate as measured
by criteria Stated in the RFP; or the proposal is not within the plans and specifications described and required
in the RFP. If a proposal is found to be non-responsive, it will not be considered further.

2.3.2         Determination of Responsibility

The Procurement Officer will determine whether an Offeror has met the standards of responsibility in
accordance with ARM 2.5.407. Such a determination may be made at any time during the procurement
process if information surfaces that would result in a determination of non-responsibility. If an Offeror is found
non-responsible, the determination must be in writing, made a part of the procurement file and mailed to the
affected Offeror.

2.3.3         Evaluation of Proposals

The Proposal Evaluation Committee (PEC) will evaluate the remaining proposals in accordance with the
provisions of Section 6 and recommend whether to award the Contract to the highest scoring Offeror or, if
necessary, to seek discussion/negotiation or a ―Best and Final Offer‖ in order to determine the highest scoring
Offeror. All responsive proposals will be evaluated based on Stated evaluation criteria. In scoring against
Stated criteria, the State may consider such factors as accepted industry standards as Stated in this RFP and
a comparative evaluation of all other qualified RFP responses in terms of differing price, quality, and
Contractual factors. These scores will be used to determine the most advantageous offering to the State. If an
evaluation committee meets to deliberate and evaluate the proposals, the public may attend and observe the
evaluation committee deliberations.

2.3.4         Completeness of Proposals

Selection and award will be based on the Offeror’s proposal and other items outlined in this RFP. Submitted
responses may not include references to information located elsewhere, such as Internet websites or libraries,
unless specifically requested. Information or materials presented by Offerors outside the formal response or
subsequent discussion/negotiation or ――Best and Final Offer‖,‖ if requested, will not be considered, will have no
bearing on any award, and may result in the Offeror being disqualified from further consideration.

2.3.5         Achieve Passing Score

Any proposal that fails to achieve a passing score for any Section for which a passing score is indicated will be
eliminated from further consideration. A "fail" for any individual evaluation criteria may result in proposal
disqualification at the discretion of the Procurement Officer.




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                                                                   MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


2.3.6         Opportunity for Discussion/Negotiation and/or Oral Presentation/Product
              Demonstration

After receipt of all proposals and prior to the determination of the award, the State may initiate discussions with
one or more Offerors should clarification or negotiation be necessary. Offerors may also be required to make
an oral presentation and/or product demonstration to clarify their RFP response or to further define their offer.
In either case, Offerors should be prepared to send qualified personnel to Helena, Montana, to discuss
technical and Contractual aspects of the proposal. Oral presentations and product demonstrations, if
requested, shall be at the Offeror’s expense.

2.3.7         ―Best and Final Offer‖

The ――Best and Final Offer‖‖ is an option available to the State under the RFP process, which permits the State
to request a ――Best and Final Offer‖‖ from one or more Offerors if additional information is required to make a
final decision. Offerors may be contacted asking that they submit their ――Best and Final Offer‖,‖ which must
include any and all discussed and/or negotiated changes. The State reserves the right to request a ――Best and
Final Offer‖‖ for this RFP, if any, based on price/cost alone.

2.3.8         Evaluator/Evaluation Committee Recommendation for Contract Award

The evaluator/evaluation committee will provide a written recommendation for Contract award to the
Procurement Officer that contains the scores, justification and rationale for the decision. The Procurement
Officer will review the recommendation to ensure its compliance with the RFP process and criteria before
concurring in the evaluator's/evaluation committee’s recommendation.

2.3.9         Request for Documents Notice

Upon concurrence with the evaluation committee's recommendation, the Procurement Officer will issue a
―Request for Documents Notice‖ to the highest scoring Offeror to obtain the required documents/information,
such as insurance documents, Contract performance security, an electronic copy of any requested material,
i.e., RFP response, response to clarification questions, and/or ―Best and Final Offer‖, and any other necessary
documents. Receipt of the ―Request for Documents Notice‖ does not constitute a Contract and no work may
begin until a Contract signed by all parties is in place. The Procurement Officer will notify all other Offerors of
the State's selection.

2.3.10        Contract Negotiation

Upon receipt of all required materials requested in the ―Request for Documents Notice," a formal Contract
utilizing the Contract attached as Attachment B, and incorporating the Standard Terms and Conditions
attached as Attachment A, as well as the highest scoring Offeror's response to the RFP, will be provided to the
highest scoring Offeror for signature. The highest scoring Offeror will be expected to accept and agree to all
material requirements contained in the Contract and set out in Attachment B of this RFP. If the highest scoring
Offeror does not accept all material requirements, the State may move to the next highest scoring Offeror, or
cancel the RFP. Work under the Contract may begin when the Contract is fully executed, i.e., when the
Contract is signed by all parties.



                                                                                                               Page 21
                                                                  MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


2.4           State’s Rights Reserved
While the State has every intention to award a Contract as a result of this RFP, issuance of the RFP in no way
constitutes a commitment by the State of Montana to award and execute a Contract. Upon a determination
such actions would be in its best interest, the State, in its sole discretion, reserves the right to:
   1. Cancel or terminate this RFP (MCA § 18-4-307);
   2. Reject any or all proposals received in response to this RFP (ARM 2.5.602);
   3. Waive any undesirable, inconsequential, or inconsistent provisions of this RFP which would not have
        significant impact on any proposal (ARM 2.5.505);
   4. Not award if it is in the best interest of the State not to proceed with Contract execution (ARM 2.5.602);
        or
   5. If awarded, terminate any Contract if the State determines adequate State funds are not available
        (MCA § 18-4-313).

2.5           Department of Administration Powers and Duties
The Department of Administration is responsible for carrying out the planning and program responsibilities for
information technology (IT) for State government. (Montana Code Annotated §2-17-512.) The Chief
Information Officer is the person appointed to carry out the duties and responsibilities of the Department of
Administration relating to information technology. The Department of Administration shall:
    1. Review the use of information technology resources for all State agencies;
    2. Review and approve State agency specifications and procurement methods for the acquisition of
       information technology resources; and
    3. Review, approve, and sign all State agency Contracts and shall review and approve other formal
       agreements for information technology resources provided by the private sector and other government
       entities.

2.6           Compliance with State of Montana IT Standards
The Offeror is expected to be familiar with the State of Montana IT environment. All services and products
provided as a result of this RFP must comply with all applicable State of Montana IT policies and standards in
effect at the time the RFP is issued. The Offeror must request exceptions to State IT policies and standards in
accordance with Section 1.5 of this RFP. It will be the responsibility of the State to deny the exception request
or to seek a policy or standards exception through the Department of Administration, Information Technology
Services Division (ITSD). Offerors are expected to provide proposals that conform to State IT policies and
standards. It is the intent of ITSD to utilize the existing policies and standards and not to routinely grant
exceptions. The State reserves the right to address non-material requests for exceptions with the highest
scoring Offeror during Contract negotiation.

The links below will provide information on State of Montana IT strategic plans, current environment, policies,
and standards.

State of Montana Information Technology Strategic Plan
http://itsd.mt.gov/stratplan/statewideplan.asp




                                                                                                              Page 22
                                                      MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


State of Montana Information Technology Environment
http://itsd.mt.gov/techmt/compenviron.asp

State of Montana IT Policies
http://itsd.mt.gov/policy/itpolicy.asp

State of Montana Software Standards
http://itsd.mt.gov/policy/software.asp




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                                                                MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


3.             PURPOSE AND BACKGROUND
The State of Montana intends to procure a State-of-the-art MMIS/PBM/DSS that meets the business needs of
DPHHS. The MMIS/PBM/DSS must be capable of supporting multiple benefit plans including, but not limited
to, Medicaid, the State Mental Health Services Plan, the Disabilities Services Program, the Montana Breast
and Cervical Health Program (MBCHP), and Children’s Health Insurance Program (CHIP); collectively referred
to herein as Montana Health Care Programs. The system must have the flexibility to support fee-for-service
Plans, primary care case management Plans, and premium payment Plans for these and other programs that
are not listed here. It must also support managed care enrollment broker functions.

In addition, Offeror must propose solutions that may or may not be implemented for:
    1. The capability to handle Electronic Health Records (EHRs) utilizing standard transactions and data
        sets.
     2. Payroll system for managing withholding for self-directed personal care workers.
     3. Capability to support managed care programs including generation of capitation payments and
        processing of encounter data from the managed care organizations.

3.1            Executive Vision
Montana Health Care Program administrators and directors intend the new MMIS/PBM/DSS be a means to
improve Health Care for Montanans as well as improving the efficiency and effectiveness of management of
these programs. To that end, an executive vision was established to guide this procurement process.
Highlights of that vision include:
   1. Integration of data from siloed systems to enable enterprise-wide program management.
     2. Business functions must drive technical solutions.
     3. The MMIS/PBM/DSS must be flexible to meet future needs, new regulations, and innovations.
     4. The MMIS/PBM/DSS must be able to support the use of clinical data and must support the information
        needed to measure the outcome of treatment and the changing health status of clients.
     5. Manual processes must be automated wherever possible.
     6. Cost sharing, benefit limits, and new reimbursement methodologies must be readily calculated and
        must be available to system users.
     7. Care coordination and coordination of benefits among State agencies, public health programs, and
        other payers must enable a focus to the needs of the client.
     8. Privacy and security must be maintained, while data sharing must be enabled.

3.2            Medicaid Information Technology Architecture (MITA) Assessment
In preparation for issuance of this RFP, DPHHS conducted a MITA Self-Assessment. A summary of the
results of the assessment are set forth in Attachment C, Results of MITA Self-Assessment. DPHHS also
reviewed the requirements of the CMS Medicaid Enterprise Certification Toolkit and the certification checklists


                                                                                                            Page 24
                                                                 MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


included in the CMS Toolkit. The business areas and business objectives from the checklists were used by the
State to ensure that each Medicaid business area has been considered and that the State’s unique business
objectives are included. The objectives Sections of the checklists that will apply to the MMIS/PBM/DSS
procurement are included in Attachment D, Medicaid Enterprise Certification Toolkit.

In addition to the current functionality of the current MMIS, Pharmacy point-of-sale and DSS; the
MMIS/PBM/DSS requirements include the following targeted capabilities identified in the MITA assessment:
     1. Capability to create and modify unlimited, dynamic, parameter-driven benefit plans.
     2. Rules Engines for business processes and pricing methodologies with table-driven data management.
     3. Capability to capture and use all data that is available within standard health care transactions.
     4. Web-based MMIS with n-tier architecture that is Thin client, browser independent, a relational
        database and Graphical User Interface(s) (GUI), for subsystems and functions accessed by users.
     5. Easy navigation (Drop-down menus, navigation menus, fields, and page tabs, etc.) incorporated into
        the MMIS/PBM/DSS.
     6. One-click access to on-line context-sensitive Help screens and resources accessible from all
        subsystems, windows, tabs, and frames.
     7. System architecture that would facilitate implementation of ICD-10 procedure and diagnosis codes,
        HL7 and/or LOINC functionality , new HIPAA transaction including, but not limited to, attachments
        (275/277), and the Unsolicited 277, an electronic health record and RHIOS.
     8. Centralized web-based prior authorization management.
     9. Integrated financial management application to support accounts payable and accounts receivable
        functions that is compliant with Generally Accepted Accounting Principles and facilitate Federal
        financial reporting.
    10. Ability to generate payments that are not claims related such as primary care case management fees,
        PACE capitation payments, hospital and clinic settlements, reimbursement to clients for transportation
        and other expenses, and payments to other entities for insurance premiums, etc.
    11. Ability to generate recoveries that are not claims related such as hospital and clinic settlements.
    12. Account and Federal report coding stamped at the claim line level.
    13. An automated voice response system (AVRS).
    14. A Workflow Management System integrated with an Electronic Data Management System.
    15. Enhanced web-based capabilities to support batch upload of claims’ transactions and on-line real-time
        transactions processing and direct data entry for claims and inquiries.
    16. Enterprise Application Integration (EAI) to include web services technology and standards to promote
        web-based and backend MMIS applications integration including an Enterprise Service Bus (ESB) for
        interfaces.
    17. Enterprise Service Bus (ESB) middleware to support Medicaid enterprise data transfer and
        conversion between all Medicaid-related systems based on XML-based messaging including Simple
        Object Access Protocol (SOAP) and Web Service Description Language (WSDL). The ESB will be
        used to replace custom-coded point to point interfaces between the MMIS and other systems. The

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        ESB must support X12 EDI, HL7, Web Services, and other standards required for MMIS and health
        care data exchange.
    18. New interfaces with other State systems including, but not limited to, the death and immunization
        registries and licensure boards.
    19. Metadata Management that is accessible by State staff.
    20. Service Oriented Architecture (SOA).
    21. Enhanced inquiry in the MMIS by configurable search criteria.
    22. Web Portal for use by State staff, clients and providers for inquiries and information retrieval –
        providers are to have the ability to use direct data entry and batch upload for inquiry and claim
        submission.
    23. Call Center Management System.
    24. Translator for health care transaction.
    25. Desktop publishing system.
    26. Computer-Based Training and Web-Based Training for all users.
    27. A DW/DSS that supports ad hoc reporting and complex data analytics capabilities, in addition to all
        reporting capability that currently exists. The DW/DSS must meet the special and ad hoc reporting
        needs of the MMIS users, including user-friendly on-line report request capability and replacement of
        printed reports with on-line viewing of outputs. It is desired that the ad hoc processes be run against
        a relational database of program information reflective of all major MMIS data repositories in their
        most current status.
    28. The DW/DSS must support all MARS and SUR/FADS functions.
    29. The DW/DSS must have Geographic Information Systems (GIS) and mapping functionality.
    30. The DW/DSS must have predictive modeling capabilities.

This is not meant to be an exhaustive list. The specific business, architecture and system requirements are set
forth in the RFP and Attachments E, F, and G.

The Contractor is required to implement and maintain the systems with strict adherence to published, industry
recognized standards including, but not limited to the Capability Maturity Model Integration ® (CMMI) and
Standards from the Institute of Electrical and Electronic Engineers (IEEE) or a comparable model approved by
the State for all application development and maintenance.

The Contractor is further required to use a proven Project Management, Software Development Methodology,
and System Development Life Cycle (SDLC) methodology for managing design, development and
implementation projects that conforms with:
           IEEE/EIA 12207.0-1996, IEEE/EIA Standard-Industry Implementation of ISO/IEC 12207:1995,
              Standard for Information Technology-Software Life Cycle Processes
              IEEE Standard 1058-1998, IEEE Standard for Software Project Management Plans (SPMP)



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                                                               MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


              IEEE Standard 1074-1997, IEEE Standard for Developing Life Cycle Processes

The Contractor is also required to adhere to the American National Standards Institute (ANSI) and Project
Management Institute, Inc. (PMI) principles for project management as Stated in the Project Management
Body of Knowledge ® (PMBOK).

3.3            Montana Health Care Programs Overview
The Department includes management and administration of all activities related to Title XIX Medicaid
Program, Title XXI State Children’s Health Insurance Program (CHIP), and the State funded Mental Health
Services Program (MHSP). In State Fiscal Year 2007 (July 1, 2007 through June 30, 2008), there were a total
of 115,551 unique individuals eligible for the Title XIX program; an average of 15,500 children enrolled per
month in the Title XXI program (the number of XXI enrollees was 16,500 for July 2008); and 7,168 unique
individuals eligible for the MHSP program. In State Fiscal Year 2008, the Department reimbursed
$637,003,130 for title XIX, $2,534,127 (dental and eyeglasses claims) for Title XXI and $8,907,157 for MHSP
benefits.

Montana Medicaid offers a generous benefits package to those clients who are eligible. These services
include:

        Inpatient hospital                 Durable medical equipment, prosthetics and supplies

        Outpatient hospital                Optometric, optician and eyeglasses
        Lab and X-ray                      Transportation and per diem
        Nursing facility                   Ambulance
        EPSDT                              Specialized non-emergency transportation
        Physician                          Family Planning
        Podiatry                           Home and community services
        Physical therapy                   Mid-level practitioner
        Speech therapy                     Hospice
        Occupational therapy               Licensed psychologist
        Audiology and hearing aids         Licensed clinical social worker
        Personal care                      Licensed professional counselor
        Home dialysis                      Inpatient psychiatric
        Clinics                            Mental health center
        Dental and denturist services      Case management
        Pharmacy                           Institutions for mental diseases for persons age 65
                                           and over
        Home Health                        Indian Health Services (IHS)




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                                                               MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


The other health care programs pay for services similar to Medicaid but may also pay health insurance
premiums. The services are paid by a number of payment methodologies: fee for service, percent-of-charges,
Resource-Based Relative Value Scale (RBRVS); Diagnosis Related Groups (DRG); Ambulatory Payment
Classification (APC); Prospective Payment System (PPS), Relative Value for Dentists (RVD) and negotiated
rates.

Montana Medicaid eligibility categories for clients include:
   Pregnant Women
    Qualified Medicare Beneficiary (QMB)
    Supplemental Low-Income Medicare Beneficiary (SLMB)
    Qualified Individual (QI)
    Aged, Blind, Disabled
    Poverty Children
    Transitional Medicaid
    Family Medicaid
    Waivers – For further description of these waivers, see Appendix 1.
               Behavioral Health Waiver for Adults with Severe Disabling Mental Illness (SDMI)
               The ―Community Supports‖ Waiver (0371) – 1915 (c)
               MT – PRTF Waiver 1915 (c) Home and Community Based Waiver
               The Developmentally Disabled Waiver (0208.90) – 1915 (c)
               Home and Community Based Services Waiver – SLTC - 1915 (c)
               Montana Basic Medicaid for Able-Bodied Adults 1115(a)
               Montana Passport to Health 1915 (b) - Care Management Program
               Family Planning 1915 (b)
    Client Lock-In
    Disease Management
    Other programs that are housed on the current MMIS include:
               Children’s Health Insurance Plan (CHIP) – for processing dental, vision and extended mental
                health claims only
               Mental Health Services Plan (MHSP)
    The Montana Breast and Cervical Health Program (MBCHP) is managed by the Public Health & Safety
    Division.




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3.4           Today’s Montana MMIS Overview
Montana’s current MMIS was previously updated in 1997 and certified by CMS in 1998. ACS State Health
Care, LLC is Contracted with the State to provide Fiscal Agent operations of the MMIS. Due to the old
technology and data integrity of our existing system, the State has found it necessary to replace the current
MMIS with a system using the most current technology. Another issue considered in the replacement of the
existing MMIS system is that ongoing system maintenance and enhancements take additional time and
resources due to the dated technology.

Montana’s current MMIS system is mainframe CICS/VSAM and utilizes COBOL legacy language that has been
in operation since 1985. As with all COBOL systems, this language is becoming obsolete, making it more
difficult to obtain programmers with this expertise. COBOL does not offer any advantages as a career builder
for new developers. COBOL does not have the flexibility for new technologies and is not easily adaptable to
changes required for these technologies. Montana currently has six programmers and four business analysts
employed with the current Fiscal Agent. While staffing is not currently a problem for Montana, it could result in
additional cost to the program. Hourly programming rates will continue to rise because of the shortage of
COBOL expertise available and the need for the Contractor to pay more to obtain the services of these
experts. This results in the cost being passed to the State.

The core MMIS resides on the Affiliated Computer Systems (ACS) mainframe located in Pittsburgh,
Pennsylvania. MMIS system maintenance and enhancements are performed by dedicated systems
maintenance staff based in Helena, Montana. When the number of system changes or enhancements are
greater than can be reasonably accomplished by the systems maintenance staff, the State has the option of
purchasing additional programming resources, purchasing a project at an ―extra-Contractual‖ rate specified in
the Contract or prioritizing the projects to ensure that the more important and more immediate needs of the
State are met in a timely manner.

Montana utilizes several subsystems to expand the functional capability of the core MMIS. The subsystems
include the Pharmacy Benefits Management System (PDCS); Drug Rebate Analysis and Management System
(DRAMS), Data Warehouse and Decision Support System (DSS); Advance Fraud Detection support
(OmniAlert); a HIPAA EDI Translator solution and a Provider Web Portal, including a Claims-Based Medical
History component.

The Pharmacy Benefits Management system is an on-line real time system utilized by enrolled pharmacy
providers to submit pharmacy claims to the Montana Medicaid and MHSP program. The system electronically
verifies recipient eligibility, product coverage status, applicable co-pay requirements, and adjudicates the claim.
Also integrated into the system are prospective drug utilization review edits. The PDCS and DRAMS systems
are owned and operated by the existing MMIS Fiscal Agent, with the State being one of several government
and private users of the system. No separate Contract is involved as the use and specific program application
for Montana was provided as an enhancement to the existing MMIS system.

The State maintains ownership of the Data Warehouse used in support of the current DSS solution, but
licenses the query tool used to access the data.

The State licenses an advanced fraud detection tool (known as OmniAlert) from the existing MMIS Fiscal
Agent. OmniAlert creates peer groups of individual providers and recipients with similar characteristics and


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                                                                 MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


compares behaviors and service utilization. Additionally the State employs a pre-adjudication editing tool
(ClaimsGuard) to detect potential variations from claiming protocols.

The State licenses the HIPAA EDI translator solution from the existing MMIS Fiscal Agent.

The Montana Web Portal provides static content (such as provider manuals, notices, and newsletters), and
dynamic content (ANSI X12 transactions, both real-time and batch) to all authorized providers. In addition, the
Montana Web Portal provides secure Medical Claims History functionality. The Medical Claims History portion
of the Montana Web Portal assists providers in the treatment of patients by allowing them to access a client’s
medical claims history interactively. For example, a primary care provider can view information related to
emergency room visits for their Care Management clients. Providers can inquire on up to three years of patient
claims history. The information returned is from claims data processed by Medicaid and includes the name of
the provider who rendered the service, diagnosis codes(s), service(s) delivered by procedure/revenue/NDC
code, service description(s) (office visit, lab, etc.), and prescribed drug information. Effective March 1, 2007,
providers were able to enroll in Medicaid or CHIP utilizing the enrollment capability built into the Web Portal.

Although the core MMIS and the majority of the additional subsystems reside outside of Montana, the Fiscal
Agent operations are located within Montana.

3.5           State Organization
The Department of Public Health and Human Services (DPHHS) is the single State agency responsible for the
administration of the Montana Medicaid Program as well as other Montana Health Care programs (see
Appendix 4, Agency Organizational Chart, for the current Department Organization Chart). The Medicaid
Director and the Division Administrators are responsible for the Medicaid activities of the Department. These
include, among other responsibilities:
             The Office of Planning, Coordination and Analysis (OPCA) resides in the Director’s Office and
              reports to the Medicaid Director and has the Contractual administration responsibilities, as well
              as the technical oversight responsibilities for all aspects of the MMIS system and Fiscal Agent
              operations.
             The Human and Community Services Division (HCSD) is responsible for Medicaid client eligibility
              determinations.
             The Business and Financial Services Division (BFSD) is responsible for the accounting and
              financial functions of the Medicaid Program.
             The Health Resources Division (HRD) is responsible for overseeing and managing the Acute,
              Physician, Hospital and Children’s Mental Health program operations of Medicaid. The CHIP
              program is also located in this Division. HRD is also responsible for the management of the
              Care Management and Lock-In programs.
             The Senior and Long Term Care Division (SLTC) is responsible for overseeing and managing the
              Medicaid Nursing Facility and Home and Community Services programs including the (HCBS)
              waiver.




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             The Addictive and Mental Disorders Division (AMDD) is responsible for overseeing and managing
              the adult mental health and chemical dependency program. The State funded Mental Health
              Services Plan (MHSP) is also located in this Division.
             The Quality Assurance Program (QAD) is responsible for all activities related to recovery of
              overpayments, fraud and third party liability programs.
             The Disability Services Division (DSD) currently does not reimburse providers through the MMIS
              system. However, this Division will be utilizing the MMIS when the State re-procures a new
              MMIS system. This division is responsible for overseeing the Developmental Disability HCBS
              waiver.

For additional information on the State programs please refer to the DPHHS internet site at
http://www.dphhs.mt.gov/index.shtml.

3.5.1        Functions of the MMIS/PBM/DSS

Within the Department HRD, SLTC, AMDD, and QAD are the primary users of the MMIS. Here are the main
functions of their involvement with the MMIS system:

Provider Services: Overseeing provider enrollment; provider training and assistance, in partnership with
Montana’s Fiscal Agent and Department staff; provider policy enforcement and authorizing updates to the
provider subsystem files.

Client Services: Overseeing the interfaces between the MMIS and the Montana Health Care programs client
eligibility determination systems, client enrollment in the benefit plans and Care Management program and
updating the client files.

Quality Assurance: Utilizing the MMIS Surveillance and Utilization Review System (SURS) subsystem,
reporting and coordinating activities with the Department’s Office of Program Compliance which includes
program integrity, SURS and Third Party Liability; the Medicaid Fraud Control Unit of the Department of Justice
and the Attorney General’s Office.

Program Administration: Utilizing the MMIS Management and Administrative Reporting System (MARS)
subsystem, reports and preparing and monitoring the program budget.

Contract and Special Program Administration: Managing the Contracts and relationships with the Care
Management and Lock-In providers, school systems, long-term care services and alternatives to long-term
institutional care, and the Home and Community Based Services waiver programs.

Once the new MMIS/PBM/DSS is implemented, DSDD will be managing the Contracts and relationships with
providers of services to the developmentally disabled. These Contractors are enrolled in both the Medicaid
waiver program and State funded programs. This division currently uses the AWACS system to manage
eligibility determinations and Contractor payments. MBCHP will also be managed through the
MMIS/PBM/DSS. Currently, the MBCHP program claims for clients who are diagnosed with cancer and
receiving treatment are processed through the MMIS.



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                                                                 MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


3.5.2         External Relationships with MMIS Access

The State has relationships with other organizations with staff that access the MMIS system. These users
access the MMIS within the scope of their responsibilities. The organizations are:

Mountain-Pacific Quality Health Foundation and First Health Services Contract with the Department to
complete medical and mental health services prior authorizations. These Contractors utilize the eligibility
information housed in MMIS to determine if a patient is eligible as well as provide prior authorization
information to the Fiscal Agent to record within the MMIS.

A number of other State agencies such as the Department of Justice, the Immunization Section of the
Communicable Disease Control and Prevention Bureau, the Legislative Auditor will regularly access the
MMIS/PBM/DSS.

3.5.3         External Relationships without MMIS Access

The DPHHS also has peripheral relationships with other State agencies indirectly related to the MMIS. The
other agencies do not have access to MMIS. The agencies are:

The office for the State’s Chief Information Officer (State CIO) who works in the Department of Administration,
Information Technology Service Division. This office has responsibilities related to computer system
architecture standards and requirements, and integration issues for all State computer systems and
information technology.

The State Procurement Bureau of the Department of Administration establishes rules and guidelines for RFP
that must be met in this procurement. They provide assistance with activities related to procurements; such as
notification of interested parties and reviewing and responding to vendor concerns regarding the procurement
process leading to the Contract award.

Blue Cross Blue Shield enrolls medical providers into the CHIP program and adjudicates medical claims for
services provided to CHIP children. The State provides CHIP eligibility information via the Fiscal Agent, to Blue
Cross Blue Shield so they may pay claims appropriately.




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                                                                   MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


4.             SCOPE OF WORK

4.1            Background
The DPHHS is issuing this RFP to obtain the services of a Fiscal Agent to design, develop, implement and
operate a new MMIS/PBM/DSS. The current Fiscal Agent will continue to operate the current systems until the
new MMIS/PBM/DSS is implemented. The RFP requires Offerors to implement a new system that will meet all
the Contractual requirements described in this Section and Attachments E, Architectural Requirements;
Attachment F, Operational Requirements; and Attachment G, System Requirements. The system must be and
has to be certifiable by CMS for enhanced Federal funding. The proposed solution must include:
     All required components of an MMIS
        A managed care enrollment broker component
        A Pharmacy Benefit Manager that includes a point-of-sale system (POS) with drug utilization review
         functionality for processing claims for drugs, supplies and durable medical equipment
        A Pharmacy Drug Rebate System
        A DSS that supports SURS, MARS, ad hoc reporting, predictive modeling, and sophisticated data
         analysis

These components and capabilities are referred to collectively as the ―MMIS/PBM/DSS‖ throughout this
Section. DPHHS requires the system to be installed on the Offeror’s hardware and supported through staff at
both the Offeror’s data center and the Helena, Montana location.

The DPHHS is seeking to take advantage of recent technological advancements and replace the current MMIS
with a system that meets all the automation and interfacing requirements presented in this Section of the RFP.
It is important that Offerors present the best solution to satisfy all the functional and technological requirements
and to provide a system that will be usable for the Montana Health Care programs well into the future. As part
of the successful Offeror’s proposal, the State of Montana expects a comprehensive management approach,
system design and testing plan that results in a concurrent implementation of the MMIS, PBM, and DSS. This
concurrent implementation must include the conversion of all data from the current MMIS, POS and data
warehouse prior implementation. In addition, there are data cleansing activities that must be accomplished
prior to data conversion.

The proposed solution for the new MMIS/PBM/DSS must be flexible enough to support a variety of health care
delivery systems, including fee-for-service and managed care. The system must provide the capability to
process claims and data from multiple programs and multiple plans within programs. A program is defined as a
group of clients eligible to receive medical services paid by State and/or Federal funds by virtue of the client’s
demographic or other characteristics. A ―Plan‖ is defined as a subset of clients in a program eligible to receive
a specific subset of medical services. The proposed system must also support the information requirements
necessary for the evaluation, comparison, and management of alternate Health Care delivery systems.

The Contractor will warrant that the solution proposed and implemented will meet CMS certification
requirements, and the certification will be available retroactively to the first day of operation.



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                                                                   MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


In broad terms, this Section of the RFP describes when, who, where, and how the Contractor must meet the
business and technical requirements of the Contract. To be more specific, it addresses requirements for
project phases; staffing; location of work; project planning and management; and deliverable procedures.

The scope of work is described in this Section along with Attachment E, Architectural Requirements;
Attachment F, Operational Requirements; and Attachment G, System Requirements Matrix.

4.2           Contract Phases
Within the parameters of the phases described below, the Contractor must develop detailed plans to design,
develop and implement MMIS/PBM/DSS and to take over all operations from the current Fiscal Agent by July
1, 2011. There are specific requirements for each phase. Phases may overlap in their time schedules.
The Contract Phases are:
     Start Up
      Analysis and Design
      Development, Testing, Data Conversion and Training
      Implementation
      Operations
      MMIS Enhancements
      MMIS Certification
      Turnover

The detailed plan and schedule must consider phased deployment of business functions to reduce risk. The
Contractor should consider such functions as provider enrollment, production of manuals and handbooks,
creation of the Web Portal, on-line eligibility verification, infrastructure creation, quality assurance processes,
performance reporting and paper claims data entry as possible candidates for early deployment. Deployment
of core functions, such as claims adjudication, PBM processing, and the DSS are planned to occur on July 1,
2011.

The State requires a Readiness Testing Period of at least five months for parallel, user acceptance and limited
beta provider testing after MMIS/PBM/DSS is ready for implementation, including all critical business functions.
All data to date must be converted from the incumbent before this testing period begins. Testing must be
completed by July 1, 2011. Implementation by July 1, 2011 is of critical importance to the State. The following
factors are in order of importance to the State:
    1. Assumption of operations without disruption in services or payments.
   2. Achieving and maintaining Federal MMIS certification.
   3. Compliance with all HIPAA requirements.
   4. Timely design and development of components affecting providers (Web Portal, Web-based claims
      submission).
   5. Design and development of components that improve efficiency and convenience for State staff.


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                                                                 MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


   6. Design and development of components that improve Contractor efficiency.

4.2.1         Start Up Phase

The Contractor must create all project management Deliverables, conduct a kickoff meeting and prepare the
DDI facility.

4.2.1.1       State Responsibilities

   1. Provide a State Project Management Office.
   2. Participate in Kick-off meetings.
   3. Review all Deliverables and provide response within 10 business days.
   4. Identify the members of the MMIS Implementation Team. The Implementation Team will consist of up
      to 12 State staff with duties that include working with the Contractor on the implementation of
      MMIS/PBM/DSS. This Implementation Team will participate in the all phases of the Contract through
      the implementation phase and work under the direction of the State Project Management Office.

4.2.1.2       Contractor Responsibilities

4.2.1.2.1     Kick Off Meeting

The Contractor will conduct a kick off meeting within 10 business days the Contract start date.

4.2.1.2.2     Prepare Project Management Deliverables

The Contractor will prepare the project governance Deliverables required in Section 4.5.2.

4.2.1.2.3     Prepare Primary Project Site

The Contractor must select and establish the project site in Helena, Montana where DDI Phase functions will
be performed.

The following DDI functions must be performed at the Contractor’s primary Project site:
   1. Contract administration/key personnel
   2. Joint Application Design (JAD) sessions
   3. Demonstrations of design prototypes
   4. Deliverable walk-throughs
   5. Conversion mapping
   6. System testing task walk-throughs
   7. User acceptance test support
   8. Implementation Planning


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                                                                     MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


   9. Provider communications

The DDI will be performed in the United States unless the Contractor receives prior approval from the State for
any development work to be performed off-shore.

4.2.2          Analysis and Design Phase

The major objectives of the System Analysis and Design task are as follows:
   1. Ensure that the Contractor has a thorough, detailed understanding of the Montana Health Care
      programs and business requirements.
   2. Validate and refine the business requirements specified in Attachments F with State staff.
   3. Confirm how the proposed solution meets the following MITA requirements:
          a.   Industry based, open architectural standards
          b.   Modular components
          c.   Relational database
          d.   Web and real-time processing
          e.   Rules Engine management
          f.   Data privacy, security, and integrity with access limited by staff role
          g.   Interoperable systems that support e-communication and processing between systems
   4. Elaborate and document the architectural and system requirements in Attachments E and G of the
      MMIS/PBM/DSS.
   5. Support and participate in requirements management.
   6. Document the requirements validation.
   7. Identify the requirements for a minimum of 500 reports to be produced by the MMIS, PBM and DSS.
   8. Design the MMIS/PBM/DSS.

4.2.2.1        State Responsibilities

   1. Provide a State Project Management Office.
   2. Provide the Implementation Team of up to 12 individuals with duties that include working with the
      Contractor on the design and development of MMIS/PBM/DSS.
   3. Participate in Joint Application Design (JAD) sessions to ensure that the Contractor has adequate
      understanding of the State role, Contractor role and system requirements for each business function.
   4. Review all prototypes, screen designs, architecture designs, work plans, requirements documents, and
      Deliverables and provide response within 10 business days.




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                                                                MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


4.2.2.2      Contractor Responsibilities

The Contractor must perform a detailed review and analysis of all requirements provided in the RFP and must
develop the detailed specifications required to construct and implement the MMIS/PBM/DSS. These activities
must result in the creation of a Requirements Specification Document (RSD) and Detail Design Document
(DSD). The Contractor must complete activities consistent with its proposed methodology to accomplish the
task objectives and meet all RFP requirements. The State prefers methodologies that allow the State multiple
opportunities to validate requirements and design. For this reason, an iterative development methodology must
be used in the development of the MMIS/PBM/DSS application.

The Contractor must ensure that the technical system requirements are continually updated in the RSD and
the DSD documents. This includes a desire to view rapid prototypes of requirements and design concepts,
screens, content, and application flow. Prototypes do not necessarily need to become operational or be reused
during development. Workflow and performance simulation within the design phase is also preferred. At a
minimum, completion of this task must include the following activities:

4.2.2.2.1    Review, Validate and Refine Requirements

The Contractor must thoroughly review, validate, and update, if necessary, all requirements specified in the
RFP. In addition, the Contractor must work with State staff to fully understand the scope, purpose, and
implications of each requirement. The Contractor must thoroughly review all appropriate Montana Health Care
programs and policies.

4.2.2.2.2    Document Rules

The Contractor must document the rules for benefit plan assignment and the edit and audit rules in the current
MMIS and PBM for use in populating the rules engine during the Development Phase. The rules must be in a
format approved by the State.

4.2.2.2.3    Construct Requirements Specification Document (RSD)

The Contractor must develop a System Requirements Specification Document. This System Requirements
Specification Document must include system functional, and non-functional requirements (e.g., quality
attributes, legal and regulatory requirements, standards, performance requirements, and design constraints).
The requirements covered in this RFP are the base requirements. They must be further refined to arrive at the
detailed design requirements and traced throughout the system development life cycle. These detailed
requirements must be traceable back to the requirements specified in the RFP Supplements. At a minimum,
the Contractor must:
     1. Conduct Joint Application Design (JAD) sessions to finalize requirements and ensure that responses to
        all RFP requirements are acceptable to the State.
   2. Evaluate business model/process changes and approved changes to the current Medicaid system
      since the RFP release date and identify corresponding requirements.
   3. The specification for each requirement should include a means of measuring that the requirement has
      been satisfied. This measurement will be used to generate the necessary test cases for system and
      acceptance testing.


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                                                                   MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


   4. The RSD will take RFP requirements, validate them, and identify how and where the requirements are
      met in the MMIS/PBM/DSS design. Additionally, the RSD must include:
       a.    A cross-walk or map of each business requirement
       b.    Verification of the all external interface requirements
       c.    A listing of any open change orders, as well as any requirements subsequently identified in JAD
             Identification of all internal and external interfaces
       d.    Linkages across the business model and component functions
       e.    The specification for each requirement must include a means of measuring that the requirement
             has been satisfied. This measurement will be used to generate the necessary test cases for
             system and acceptance testing.

4.2.2.2.4     Requirements Traceability Matrix and Repository

The Contractor must develop a requirements traceability matrix to track all requirements specified in the RSD.
Requirements must be tracked through each stage of the development life cycle from requirement specification
through production deployment. The requirements must be stored in a requirements management repository
that permits reporting of a specific requirement, selected requirements based on type or attributes, and a
complete detailed listing of all requirements. This matrix and the repository will be used throughout the Project
to assure the design; development, test, and final production system meet the specified requirements.

4.2.2.2.5     Prepare Detailed Systems Design Document

At a minimum, the Detailed System Design (DSD) must be available in hardcopy and electronic media, and a
format approved by the State and must include:
    1. A systems standards manual, listing all standards, practices, and conventions, such as, language,
       special software, identification of all development, test, training and production libraries, and qualitative
       aspects of data modeling and design.
   2. An identification of system files and processing architecture.
   3. A general narrative of the entire system and the flow of data through the system.
   4. A detailed description and diagram of the system architecture identifying how components are
      integrated to meet RFP requirements.
   5. General and detailed subsystem narratives describing each function, process, and feature.
   6. A security design description for each business area that defines access control including specifying
      roles, role locations, and a matrix of roles by inputs/outputs.
   7. A flow diagram of each subsystem, identifying all major inputs, processes, and outputs.
   8. Lists of all inputs and outputs by subsystem.
   9. A listing and brief description of each file.
   10. A listing and brief description of a minimum of 500 reports to be produced by the DSS, PBM and DSS.
   11. Preliminary screen and report layouts.


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                                                                   MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


   12. Preliminary screen and report narrative descriptions.
   13. Preliminary layouts for on-line, context-sensitive help screens for all MMIS/PBM/DSS functions
       including Web-based components.
   14. A preliminary layout for the data element dictionary.
   15. Hardware/software detail.
   16. A high level data model and a detailed and physically specific data model.
   17. Entity relationship diagrams.
   18. Hierarchy charts or Use Case models identifying system objects and their relationships.
   19. High and medium level batch flowcharts to the job, procedure, and program level.
   20. Detailed program logic descriptions and edit logic, including, at a minimum, the sources of all input
       data, each process, all editing criteria, all decision points and associated criteria, interactions with other
       programs, and all outputs.
   21. Final layouts for all inputs to include, at a minimum, input names and numbers; data element names,
       numbers, and sources for each input field; and examples of each input.
   22. Final layouts for all outputs to include, at a minimum, output names and numbers, data element names,
       numbers, and sources for each output field, and examples of each outputs.
   23. Final layouts for all files to include, at a minimum, file names and numbers; data element names,
       numbers, number of occurrences, length and type; record names, numbers, and length; and file
       maintenance data such as number of records, file space.
   24. A Domain Object Model of the MMIS/PBM/DSS for all Contractor developed components of the
       MMIS/PBM/DSS.
   25. Site maps for all web-based interface components.
   26. A detailed comprehensive data element dictionary, including, at a minimum, data element names,
       numbers, and business area definitions; valid values with business area definitions; sources for all
       identified data elements; and lists from the data element dictionary (DED) in multiple sort formats.
   27. A logical and physical data model must be included in the documents.

The Contractor must provide and present the changes to prototypes for State staff to review throughout the
design process. The Contractor must conduct walk-throughs of the Design Documents with the State and
demonstrations during the development of the design specification to enhance the State’s understanding; and
to facilitate the approval process. Application Programming Interfaces (APIs) used within the application to
communicate between components and modules or with external systems must be defined in this document as
well.

Glossary − The Contractor must produce and maintain a MMIS/PBM/DSS Glossary to define terminology
specific to the MMIS/PBM/DSS domain. It must explain terms and system usage that may be unfamiliar to the
reader of Project documents. In addition, it will be the repository for agreed upon definitions of terms open to
various interpretations. This glossary should build upon the Glossary of Terms included as Appendix 2.



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                                                                  MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


4.2.2.2.6       Contractor Deliverables

Deliverables to be produced by the Contractor for this task include:
     1. Updated RFP documents.
    2.      Edit and audit rules documentation.
    3.      Requirements specification document.
    4.      Requirements traceability matrix & repository.
    5.      Detailed systems design document (DSD) and artifacts.
    6.      MMIS/PBM/DSS architectural component procurement plan.
    7.      Glossary Update.

4.2.3           Development Phase

4.2.3.1         State Responsibilities

    1.      Provide an Implementation Team of up to 12 individuals with duties that include working with the
            Contractor on the design and development of MMIS/PBM/DSS.
    2.      Participate in Joint Application Design (JAD) sessions to ensure that the Contractor has adequate
            understanding of the State role, Contractor role and system requirements for each business function.
    3.      Review all prototypes, screen designs, architecture designs, work plans, requirements documents,
            and all Deliverables defined in this Section and provide quick response and comment. The standard
            turnaround for State review shall be 10 work days. The State encourages early submission of draft
            documents to expedite State review.

4.2.3.2         Contractor Responsibilities

The Contractor is responsible for developing, testing, and maintaining all MMIS/PBM/DSS applications. Key
elements associated with this task are:
   1. Ensure that the developed solution meets design criteria and satisfies the intended purpose.
   2. Install and enhance or modify components of the proposed system according to the specifications
      developed and approved by the State in the Systems Design Task.
   3. Provide system walk-throughs and system demonstrations to State and designated staff.
   4. Present all standard output reports.
   5. Demonstrate that all hardware, software, and teleprocessing linkages are functional and will support the
      State’s requirements.
   6. Complete the MMIS/PBM/DSS architectural component procurement plan.
   7. Demonstrate functionality of all external interfaces.




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                                                                     MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


4.2.3.2.1          Software/Hardware Configuration

The State has based the requirements for the new MMIS on the current, as well as anticipated, needs of the
Montana Health Care Program. While any hardware platform may be proposed that meets these requirements,
the State requires software/hardware configuration that can accommodate future changes in the Montana
Health Care Program, changes in standards and transactions, and increased transaction volumes. The
Contractor must:
    1. Provide a software and hardware solution that is upgradeable and expandable:
            a. Perform regular maintenance to ensure optimum performance
            b. Perform resource capacity utilization and capacity planning
            c. Implement needed expansions at the Contractor’s own expense before 90% of maximum
               capacity is reached.
   2. Ensure all hardware, software or communications components installed for use by State staff are
      compatible with the State currently supported versions of the Microsoft Operating System, Microsoft
      Office Suite and Internet Explorer; and current technologies for data interchange.

4.2.3.2.2          MMIS/PBM/DSS Systems Documentation

 1.    The Contractor must implement and maintain MMIS/PBM/DSS documentation. The Contractor must
       provide six copies within 60 calendar days prior to the Operations Phase. In addition to the hard
       copies, all MMIS/PBM/DSS documentation must be maintained on-line, with access by State
       authorized personnel. For changes during operations, six updated copies of the documentation must
       be prepared to reflect any modifications, corrections, or enhancements to MMIS/PBM/DSS and must be
       delivered to the State within 15 calendar days of the State’s approval of implementation of the change.
       Any documentation not approved by the State must be corrected and resubmitted by the Contractor
       within 15 calendar days of the transmittal date. The electronic version of the approved system
       documentation must be posted to the Web site within three business days of the State’s approval. The
       Contractor is responsible for providing the copies requested by CMS.
   The following standards will apply to MMIS/PBM/DSS system documentation:
       a.     The documentation must be prepared in a format that facilitates updating.
       b.     System and module narratives must be written so that they are understandable by persons not
              trained in data processing.
       c.     The documentation must contain an overview of MMIS/PBM/DSS, including general system
              narrative, general system flow, and a description of the operating environment. The nomenclature
              used in the overview shall correspond to the nomenclature used in the module documentation. All
              modules must be referenced, and documentation must be consistent across all modules.
       d.     Module level documentation, for each module, must contain:
             i.       Module name and numeric identification.
             ii.      Module narrative.
            iii.      Module flow, identifying each program, input, output, and file.


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                                                                     MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


       iv.         Job streams within each module, identifying programs, inputs and outputs, control, job
                   stream flow, operating procedures, and error and recovery procedures.
        v.         Name and description of input documents, example of documents, and description of fields
                   or data elements on the document.
       vi.         Listing of the edits and audits applied to each input item and the corresponding error
                   messages.
      vii.         Narrative and process specifications for each program.
      viii.        Screen layouts, report layouts, and other output definitions, including examples and content
                   definitions.
       ix.         Listing and description of all control reports.
        x.         File descriptions, and record layouts, with reference to data element numbers, for all files,
                   including intermediate and work files.
       xi.         Listing of all files by identifying name, showing input and output with cross-reference to
                   program identifications.
      xii.         Facsimiles or reproductions of all reports generated by the modules.
      xiii.        Instructions for requesting reports must be presented with samples of input documents
                   and/or screens.
      xiv.         Narrative descriptions of each of the reports and an explanation of their use must be
                   presented.
      xv.          Definition of all fields in reports, including a detailed explanation of all report item
                   calculations.
      xvi.         Desk level procedures.
   e. Documentation must include a data element dictionary that shows, for each data element:
              i.   Unique data element number.
               ii. Standard data element name.
              iii. Narrative description of the data element.
              iv. List of aliases or technical names used to describe the data element.
              v. Listing of programs using the data element, describing the use as input, internal, or output.
              vi. Table of values for each data element.
              vii. Data element source.
          viii. List of files containing the data elements.
Documentation of MMIS/PBM/DSS must include data structures, Entity Relationship Diagrams (ERD), user
   manuals, business rules, and all other documentation appropriate to the MMIS, PBM and DSS
   platforms, operating systems and programming languages.




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                                                                      MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


4.2.3.2.3       Provide MMIS/PBM/DSS User Electronic Documentation

The Contractor must prepare user documentation for each business process. The Contractor must prepare
draft user documentation during the development task and update during the testing and implementation tasks,
as appropriate. The Contractor will be responsible for the production and distribution of all user documentation
updates in a timely manner. The following are minimum requirements for MMIS/PBM/DSS user electronic
documentation:
    1.    The electronic documentation must be rules-based driven using meta-data where ever possible,
          allowing for automatic updates to the documentation when system or requirement changes occur.
          The documentation must also include on-line, context-sensitive help screens for all MMIS/PBM/DSS
          functions including web-based components.
   2.       The electronic documentation must include the use of content/document management capability to
            link, track, and update all documentation affected by a system or requirement change.
   3.       The documentation must be available on-line via the MMIS/PBM/DSS application and provide an on-
            line search capability with context-sensitive help; the State requires one paper copy using 8-1/2" x 11"
            pages in three-ring binder form, pages numbered within each Section, and a revision date on each
            page. Revisions must be clearly identified in bold print.
   4.       User documentation must be created and maintained in Microsoft Office 2003 Suite or higher
            (consistent with the current the State standard) and Visio and must be provided on request to the
            State on diskette or CD and be accessible via the Web to users during the Operations Phase.
   5.       User documentation must be written and organized so that users not trained in data processing can
            learn from reading the documentation how to access the on-line windows/screens, read subsystem
            reports, and perform all other user functions.
   6.       User documentation must be written in a procedural, step-by-step format and should be aligned with
            the business transformation documents.
   7.       Instructions for sequential functions must follow the flow of actual activity (that is, balancing
            instructions and inter-relationship of reports).
   8.       User manuals must contain a table of contents and an index.
   9.       Descriptions of error messages for all fields incurring edits must be presented and the necessary
            steps to correct such errors must be provided.
   10.      Definitions of codes used in various Sections of a user manual must be consistent.
   11.      Acronyms used in user instructions must be identified and must be consistent with windows, screens,
            reports, and the data element dictionary.
   12.      All system errors must be handled by a standardized error handling module that translates technical
            messages into commonly understood terminology.
   13.      Abbreviations must be consistent throughout the documentation.
   14.      Field names for the same fields on different records must be consistent throughout the
            documentation.




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                                                                MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


15.   Each user manual must contain "tables" of all valid values for all data fields (for example, provider
      types, claim types), including codes and an English description, presented on windows, screens, and
      reports.
16.   Each user manual must contain illustrations of windows and screens used in that subsystem, with all
      data elements on the screens identified by number.
17.   Each user manual must contain a Section describing all reports generated within the subsystem,
      which includes the following:
      a.   A narrative description of each report.
      b.   The purpose of the report.
      c.   Definition of all fields in the report, including detailed explanations of calculations used to create
           all data and explanations of all subtotals and totals.
      d.   Definitions of all user-defined, report-specific code descriptions; and a copy of representative;
           and pages of each report.
18.   Instructions for requesting reports or other outputs must be presented with examples of input
      documents and/or screens.
19.   All functions and supporting material for file maintenance (for example, coding values for fields) must
      be presented together and the files presented as independent Sections of the manual.
20.   Instructions for file maintenance must include both descriptions of code values and data element
      numbers for reference to the data element dictionary.
21.   Instructions for making on-line updates must clearly depict which data and files are being changed.
22.   Desktop guide that includes appropriate instructions from this bullet list and that provides users with
      all the information they need for role-based access to the screens and functions that are necessary
      for their jobs.
23.   Draft user documentation will be used as the basis for user acceptance testing and training, unless
      otherwise specified by the State, as well as final versions will be used for training before the start of
      operations.
24.   Each user manual must contain illustrations of windows and screens used in that subsystem, with all
      data elements on the screens identified by number.
25.   Each user manual must contain a Section describing all reports generated within the subsystem,
      which includes the following:
      a.   A narrative description of each report.
      b.   The purpose of the report.
      c.   Definition of all fields in the report, including detailed explanations of calculations used to create
           all data and explanations of all subtotals and totals.
      d.   Definitions of all user-defined, report-specific code descriptions; and a copy of representative;
           and pages of each report.
      e.   Instructions for requesting reports or other outputs must be presented with examples of input
           documents and/or screens.

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                                                                  MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P



4.2.3.2.3.1   Provide Provider Electronic Documentation

Provider documentation is used to enable the provider community to submit claim records in the proper format
for adjudication. The Contractor must prepare draft provider documentation during the development task and
update it during the testing and implementation tasks, as appropriate. All documentation must be specific to
individual provider types or groups of related provider types and support the multiple communication channels
available to each provider type. The provider documentation at a minimum must:

   1.    Be rules-based driven using meta-data where ever possible, allowing for automatic updates to the
         documentation when system or requirement changes occur.
   2.    The electronic documentation must include the use of content/document management capability to
         link, track, and update all documentation affected by a system or requirement change.
   3.    Contain an introduction, policy Section, billing instructions for fee for service and encounter claims,
         billing examples, and rate methodologies.
   4.    Be created and maintained in Microsoft Office 2003 Suite or higher (consistent with the State
         standard) and Visio and must be provided to the State on request, on diskette or CD and be
         accessible to providers via the Web during the Operations Phase.
   5.    Provide general program information and highlight differences in programs and in processes among
         programs.
   6.    Contain a table of contents and be indexed.
   7.    Include an on-line search capability for the electronic version.
   8.    Describe provider certification (enrollment) and recertification procedures, general participation
         requirements, and termination procedures.
   9.    Describe provider profile change process.
   10.   Describe general medical record content and record retention procedures and audit procedures and
         responsibilities.
   11.   Describe third party resource (coordination of benefits) identification and recovery procedures,
         including Medicare benefits.
   12.   Identify methods of verifying Client eligibility, describe information contained or accessible through
         Medicaid Identification Cards, describe all relevant consumer information supplied to the provider,
         describe each eligibility verification access method available and how to use it, and describe why this
         information is relevant to providing services.
   13.   Identify covered services and service limitations.
   14.   Identify reimbursement procedures, including co-payment requirements and managed care
         procedures.
   15.   Identify any special forms needed and describe how to complete them and submit them (for example,
         Prior Authorization, sterilization consent).




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                                                                      MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


   16.      Provide detailed billing instructions and filing requirements for all billing methods, including electronic
            and paper submission.
   17.      Describe the process for claim voids and replacements and refunds.
   18.      Describe utilization review and control procedures.
   19.      Describe methods to access data and submit provider inquiries.

4.2.3.2.4       Development and Unit Testing

The Contractor responsibilities for this deliverable include programming, and unit testing on all system
functions. The State requires an iterative methodology that allows for multiple development increments, in
either parallel or sequential, with discrete testing for each such increment. The Contractor must enforce the
established development standards and document deviations from the established development standards,
including the rationale behind the deviation. These deviations must be included in the test results.

The Contractor must develop the application software for the required interfaces as defined in the completed
Detailed System Design Document. The Contractor must develop any bridges and integration code necessary
for MMIS/PBM/DSS to interface with other software and systems.

The Contractor must test all components (i.e. programs) as stand-alone entities. Unit testing ensures that a
single component is resilient and will function correctly on a stand-alone basis (e.g. the modified component
can take inputs and produce expected outputs).

4.2.3.2.4.1     Contractor Deliverables

Deliverables to be produced by the Contractor for the development task must include the following:
    1. System documentation;
   2. User electronic documentation;
   3. Provider electronic documentation;
   4. Development and unit testing.

4.2.4           Testing Task

Within the testing task, appropriate testing must occur for each development iteration. Planning for the testing
task must occur as early in the Project as possible to ensure successful testing results. Test Plan development
must occur during the systems analysis and design task using the requirements traceability matrix.
Additionally, various types of testing require a separate test environment, and the State requires the
Contractor’s testing methodology to appropriately address the testing requirements described in this task. The
objectives of the testing task are to perform unit, system/sub-system, integration, and regression (baseline)
testing to ensure all relevant MMIS/PBM/DSS requirements are satisfied for each iteration. Load/stress and
user acceptance testing (UAT) are also included in this task Deliverable. Upon successful completion of the
UAT, the Contractor must perform the operational readiness test. Through comprehensive and extensive
internal testing, Contractor staff will demonstrate that the functions under test meet all relevant requirements,
e.g., MMIS/PBM/DSS will appropriately process and pay all claim transactions, process and report eligibility


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                                                                   MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


updates, enroll providers, process prior authorization requests, update all types of files, produce required
reports and support all analytical requirements. The Contractor will be working closely with the State IV&V
Contractor during all testing phases. The Contractor must permit complete system access to the State IV&V
Contractor and offer timely assistance when requested.

This task will result in the following for unit, system, integration, regression, load/stress, UAT, and operational
testing:
    1. Test Plans, Test Cases/Scripts, and other documentation.
   2. Execution and Tracking Tools.
   3. Results and Reports.

4.2.4.1       State Responsibilities

   1. Review all Test Plans. The standard turnaround for State review shall be 10 work days.
   2. Review test results. The standard turnaround for State review shall be 10 work days.
   3. Provide the Implementation Team of up to 12 individuals with duties that include working with the
      Contractor on the acceptance and readiness testing activities.
   4. Approve MMIS/PBM/DSS for operations upon successful conclusion of all activities described in this
      phase.

4.2.4.2       Contractor Responsibilities

Since the development of MMIS/PBM/DSS is an iterative process, the following tests must be executed for
each iteration. The Contractor should automate all possible functional tests. With the written approval of the
State, certain tests may not be relevant for a specific iteration. However, at a minimum, the Contractor must
perform the following activities during this task:
    1. Structured Data Tests: The Contractor will create test scenarios or use cases before construction with
        anticipated outcome for each scenario. When structured data tests are run, the Contractor must
        present a report on the structured data test to the State, including the anticipated and actual outcomes.
        The Contractor must include any scenarios submitted by the State. All discrepancies must be identified
        and explained.
   2. System Test: The Contractor must test modifications to a collection of components within the context of
      the system/sub-system in which they function. The testing function must be automated. System testing
      ensures that the system functions as designed after development and modification of its components.
      These tests must use a sample of preliminary converted files.
   3. Integration Test: The Contractor must test modifications within the context of the integrated system/sub-
      systems (the collection of interconnected systems or sub-systems) in which it functions. Integration
      testing helps ensure that a defined set of interconnected systems/sub-systems will perform as designed
      after additions/modifications to components. The testing must also ensure that interfaces with external
      systems are exchanging data correctly. These tests must use a sample of preliminary converted files.
   4. Regression (Baseline) Test: The MMIS/PBM/DSS parallel test is designed to ensure that the Contractor
      is ready to process claim input and adjudicate claims correctly upon termination of the current systems

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                                                             MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


   and conversion to the new MMIS/PBM/DSS. This will be executed in the production mode using a
   representative dataset of claims to ensure inclusion of claim variations that are likely to occur. The
   Contractor will develop and execute an iterative process to adjudicate and pay six months of claims in
   the new MMIS/PBM/DSS that were previously adjudicated and paid by the current MMIS. These tests
   must use a sample of preliminary converted files. The six months dataset of claims to be parallel tested
   must be selected from the nine-month period prior to the MMIS/PBM/DSS production installation date.
   This claims adjudication and payment parallel processing must include both claims paid successfully
   and claims denied from the legacy system. The parallel run reconciliation process will include an
   electronic match for paid and denied claims. The denied claims identified in this parallel processing in
   MMIS/PBM/DSS must contain equivalent error codes to those identified on the current MMIS paid
   claims files. The parallel run reconciliation process must include an electronic match of dollar amounts
   paid for each of the claims paid/denied in both files. Where there is no dollar amount for a payment
   status due to the claim being denied or placed in a suspended status, the claim status and reason and
   remark code(s) must be electronically matched and reported.
5. Load/Stress Test: The Contractor performs this test using a load testing tool, such as Mercury
   Interactive or an equivalent State approved tool to document that MMIS/PBM/DSS will function within
   the normal work day, work week, and work month schedule of the State. The Contractor must conduct
   load/stress testing to determine on-line, Web-access, and batch performance levels under expected
   system loading conditions with production-sized databases. Load/stress testing must also be conducted
   to evaluate how the system performs under maximum stress conditions and to determine the maximum
   capacity within specified performance levels. The results of the load test may also result in re-work and
   system tuning if the processing schedule negatively impacts the State’s ability to work a normal
   business day. These tests must use a sample of preliminary converted files. The successful completion
   of regression and load testing must assure the State that they can successfully participate in the user
   acceptance testing.
6. User Acceptance Test (UAT): The UAT demonstrates that the Contractor is ready to perform all
   required functions for MMIS/PBM/DSS; that MMIS/PBM/DSS system meets RFP requirements; that
   MMIS/PBM/DSS meets CMS certification criteria; and that all the State-approved change orders
   function properly. All MMIS/PBM/DSS subsystems & modules will be tested before start of operations.
   This will also include but not be limited to testing of all: business processes, commercial off the shelf
   (COTS) products, and business rules engines. Components of the test will require that the Contractor
   demonstrate readiness to perform all MMIS/PBM/DSS functions and Contractual requirements,
   including manual processes. User acceptance testing will be conducted in a controlled and stable
   environment. No modifications to the software or files in the acceptance test library will be made without
   prior written approval from the State. The UAT is designed to test the existence and proper functioning
   of edits and audits, account and Federal report coding the accuracy of claim records payment and file
   maintenance, and the format and content of the MM IS/PBM/DSS outputs, including outputs from the
   DSS for Federal reporting, ad hoc reporting and data analysis, all business processes, utilization
   management, and EPSDT (Early Periodic Screening, Diagnosis and Testing). These tests must use all,
   or select parts of, preliminary converted files.
7. Operational Readiness Test: The operational readiness test is designed to ensure that the Contractor is
   ready to process all inputs, price claim records correctly, meet all reporting requirements, use a
   properly functioning data communications network, and have a demonstrated back-up capacity. The
   Contractor also must assess the operational readiness of the State staff that perform activities such as,
   customer service, correspondence management, drug rebate, financial operations, quality assurance,


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                                                                 MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


       fraud and abuse oversight, workflow and electronic document management, and analytical services.
       Operational readiness testing will include a pilot test of actual claims processing in a full operational
       environment starting with the submission of EDI transactions into the translator through the payment
       process, including but not limited to document imaging and) workflow management. Operational
       readiness testing must be done with full data volumes. The success of the operational readiness test,
       as determined by the metrics developed by the State IV&V Contractor, will determine the
       implementation date for the MMIS/PBM/DSS system. An additional component of the operational
       readiness test is the demonstration and verification of data security and fire/disaster prevention and
       recovery procedures. The Contractor must also execute disaster recovery processing, including switch-
       over to an alternate back-up site and back. The disaster recovery portion of the test will be limited to a
       recovery during a daily and a weekly process cycle. The length of the test will be the amount of time
       that is necessary to recover from the disaster and provide proof that the recovery has been successfully
       completed.
   8. Beta Tests: For system components that affect external users, such as Web Portals, Web-based
      claims submission, claims software, and data entry by other Contractors, the Contractor must have a
      Beta testing plan, allowing external users to participate in the testing process. The Contractor must
      describe its approach to Beta testing in response to this RFP. Beta Testing is a part of the Readiness
      Testing Period.

4.2.4.2.1        Test Plans

The Contractor must develop test plans (this includes unit, system, integration, regression, load, user
acceptance, and operational readiness). The plans must include the defined progress path to achieving
operational readiness testing. Additionally, the plans must show valid links from operational readiness testing
all the way back to achieving each functional requirement. The plans must identify the inputs to the test, the
steps in the testing process, and the expected results. The plans also must identify any software tools used
during testing and any State resources needed. In addition, proposed test metrics and progress reports (which
will be issued at intervals approved by the State) must be defined. The plans must provide detailed
descriptions of the test environments, methods, workflow, training required, management of the testing
processes, and the defect identification and resolution processes to be executed during the tests. The
Contractor must take responsibility for the execution of the plans. Additional requirements are:
     1. Test Plans and schedules must be conducted to show the same processing through the existing
         systems and the newly developed MMIS/PBM/DSS for each of the following:
            a. System module.
            b. Subsystem.
            c. Business processes.
            d. Automated integrated system.
            e. Automated regression testing.
            f.   Business rules.
            g. Business requirements.
            h. Automated load testing that simulates the actual uploads.



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            i.   Integrated system testing which must include testing all MMIS/PBM/DSS features including
                 those which involve more than one subsystem or system module, such as updates to client or
                 provider records based on paid claims.
            j.   Interfaces between TPL records.
            k. Claim records payments.
            l.   Processing of claim records from input through reporting.
            m. Generation of Federal and State reports.
            n. Creation of system generated payments.
   2. Test Plans and schedules for COTS products including integration testing.
   3. A description of every test scenario, linkage to the approved RSD and DSD, the State policy and/or
      business function, and expected test results.
   4. A mapping of every test scenario to every element in the requirements traceability matrix developed in
      the design phase and modified in the development phase.
   5. An organization plan showing Contractor personnel responsible for testing.
   6. A discussion of management of the testing effort, including strategies for dealing with delays in the
      testing effort, high volume of defects, back-up plan, back-up personnel, and related issues.
   7. Procedures for tracking and correcting deficiencies discovered during testing.
   8. A plan for updating documentation based on test results.
   9. Procedures for notifying the State of problems discovered in testing, testing progress, adherence to the
      test schedule, and so forth.
   10. Plan for organizing and presenting test results for the State review.

4.2.4.2.2        Contingency Plan to Mitigate Testing Risks

The Contractor must identify possible risks associated with type of test, qualify the possibility of the risk’s
occurrence and provide a Contingency Plan to accommodate risks that may be encountered during
MMIS/PBM/DSS testing. For each risk, the Contractor must provide a detailed response on how they plan to
mitigate that risk. The Contractor must provide a walk-through of the Contingency Plan before submitting to the
State for final approval.

4.2.4.2.3        Test Cases/Scripts

The Contractor must develop test scripts and test cases (this includes unit, system, integration, regression,
load, and user acceptance testing) that thoroughly test the functionality of the system. These scripts must
provide step-by-step instructions for executing the tests. Test scripts may take the form of either documented
textual instructions that are executed manually or computer readable instructions that enable automated test
execution. The scripts must address all data scenarios that the system will process.




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4.2.4.2.4     Performance Tuning Document

The Contractor must perform all application system modifications required to ensure that the system meets
performance requirements specified in the system design specification document. The majority of the
modifications will be identified using a load testing tool, such as Mercury Interactive or an equivalent State
approved tool. Performance tuning must be planned and completed using tier-by-tier and end-to-end
methodologies. The Contractor may suggest changes to system settings (server, database, network, and
optical scanning hardware and software) to improve performance. The State may consider suggested changes
to system settings as appropriate. All results and recommendations must be provided in the performance
tuning document.

4.2.4.2.5     UAT Plan

In addition to the requirements described in the Test Plan Section, the Contractor must work with the State to
develop a User Acceptance Test (UAT) Plan. The Plan must include documentation of UAT scripts,
procedures, timelines, and processes. This includes training State staff and IV&V Contractors that will be
responsible for the UAT process. Minimum requirements are:
    1. Define the approach, scope, and criteria for user acceptance testing.
   2. Identify anticipated State and Contractor resources involved in testing.
   3. Describe how the development of the test scenarios ensure that all subsystems and functions of
      MMIS/PBM/DSS are evaluated and acceptable.
   4. Define the schedule of the acceptance testing effort.
   5. Describe how the acceptance testing process is tracked and monitored to ensure that all testing and re-
      testing have been satisfactorily completed.

Letter Certifying That Data for UAT Has Been Provided - The Contractor must provide a letter certifying that all
data necessary to perform UAT has been provided. This includes populating the UAT database with suitable
test data.

4.2.4.2.5.1   UAT Defect Tracking Report

The Contractor must track all defects throughout UAT in the State approved defect-tracking tool and repair the
defects. The Contractor must make the changes necessary to the application to meet the RSD requirements.
Additionally, the Contractor must update the requirements traceability matrix and repository verifying that UAT
successfully meets the requirements of the system. Metrics from the UAT will be reported weekly from an
automated test scenario tracking tool reporting the current status of every test scenario currently available for
testing or in progress. At a minimum, the automated tracking tool must:
    1. Define the UAT universe.
   2. Capture or assign a unique ID for each acceptance test scenario.
   3. Store scenarios and UAT results by MMIS/PBM/DSS business function (subsystem).
   4. Cross-reference to RSD requirements covered by each test scenario.
   5. Define and report UAT status by:


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       a. Number of UAT scenarios identified for the business process and sub-business process.
       b. Number ready for testing.
       c. Number released for UAT.
       d. Number of UAT scenarios that have passed.
       e. Number of UAT scenarios that have failed.
       f.     Number of defects identified by severity.
       g. Number of test cases under further research after initial results.
       h. Number of UAT scenarios passed and signed off by the State as completed and number of UAT
          scenarios that failed.
       i.     Number of UAT scenarios to be retested.
       j.     Number of remaining test scenarios to be tested/retested.
       k. Grand total.
       l.     Percent complete.

In addition, the Contractor must work with the State staff to analyze UAT results and to identify any corrections
needed and make those corrections.

4.2.4.2.5.2     UAT Final Report

The Contractor must summarize the results of the UAT in the UAT Final Report. The Contractor also must
include a written certification letter certifying that UAT was successfully completed. This certification must
include all issues identified that have been corrected. Minimum content requirements for this deliverable are:
    1. A summary of the testing process, including number of problems identified and corrected, by type.
   2. A listing of all acceptance test scenarios that passed acceptance testing by functional area within the
      business model.
   3. Descriptions of problems identified, details of defects created, severity, and corrective steps taken.
   4. Description of issues outstanding at the end of acceptance testing, the Plan for resolution, and the
      impact on operations.

4.2.4.2.6       Operational Readiness Test Report

The Contractor must submit a report that details the results of the operational readiness assessments and
certifies that the MMIS/PBM/DSS, its subsystems, functions, processes, operational procedures, staffing,
telecommunications, and all other associated support is in place and ready for operation. The metrics,
developed by the State IV&V Contractor on the State staff performance during the operational readiness test,
also must be included in this report.

Proposed Test Environment(s) - The Contractor must update its description of the environment(s) that will be
needed to execute all the tests described in this task, including its approach to creating data to drive these


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tests, and obtain approval from the State. The testing and training environment(s) may be used for load/stress
testing, UAT, and operational readiness testing, as well as for training users prior to implementation.

4.2.4.2.7     Contractor Deliverables

The Deliverables to be produced by the Contractor for the testing task include the following:
   1. Test Plans (creating preliminary converted data, unit, system, integration, regression, load/stress, user
      acceptance and operational readiness).
   2. Risk Identification and Contingency Plan.
   3. Test cases/scripts and completed systems test.
   4. Integration test cases/scripts and completed integration test.
   5. Regression test cases/scripts and completed regression test.
   6. Load/stress test cases/scripts and completed load/stress test.
   7. Capacity analysis document.
   8. Performance tuning document.
   9. UAT Plan.
   10. Written certification that UAT data has been provided.
   11. User acceptance test cases/scripts and completed user acceptance test.
   12. UAT defect tracking report.
   13. UAT final report.
   14. Operational readiness test cases/scripts and completed operational readiness test.
   15. Operational readiness test report.
   16. Finalized proposed test environment(s) specifications.

4.2.5         Data Cleansing and Conversion Task

All historical and active data including all imaged documents in the current systems (e.g. PBM, drug rebate
system, MMIS, DSS, AWACS, and MBCHP Payment System) that are needed to meet MMIS/PBM/DSS
requirements must be converted. The State requires a sound conversion strategy and approach that
addresses data conversion using conversion programs and manual data entry. The data conversion task often
involves planning, identifying, and analyzing conversion requirements, preparing conversion specifications,
developing and testing conversion programs, and converting the data. Objectives of this task are described
below:
    1. Data integrity.
   2. Data cleansing and purification.
   3. Data quality.
   4. Data verification.


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   5. Data loads for testing purposes.
   6. Data load completion.

The Contractor must address the data conversion requirements described for this Task. The State believes
that the data conversion task should begin early in the life of the Project.

Data Cleansing for Client Data - The current MMIS and PBM have a nine-digit Client ID using the Client
Social Security Number, or a seven digit system generated number assigned by the State. The number is sent
in the eligibility file supplied to the Contractor by the State. When the Client has obtained a permanent Social
Security Number or when an incorrect Social Security Number has been corrected by the State both numbers
are included in the eligibility file. All Social Security Number or seven digit system generated number changes
are handled in a similar manner. State does not intend that the Social Security Number be used as the client
ID in the new MMIS/PBM/DSS.

There are numerous incidences for which the same client has more than one client ID. Prior to data
conversion the Contractor must perform data clean-up of existing Client IDs to collectively identify all
information concerning a single client under one MMIS Client ID and convert this data to assure that each
client has only one Client ID in the new system and that all client, prior authorization, and claims history for the
client is linked the one Client ID.

4.2.5.1       State Responsibilities
    1. Provide the Implementation Team of up to 12 individuals with duties that include working with the
        Contractor on the data cleansing and data conversion activities.
   2. Review all data cleansing and data conversion plans. The standard turnaround for State review shall
      be 10 work days.
   3. Review data cleanings and data conversion results. The standard turnaround for State review shall be
      10 work days.

4.2.5.2       Contractor Responsibility

The Contractor must provide for conversion of all data elements in the current systems. Additionally, the
Contractor must provide application functionality to allow for the initial loading of all information currently
captured on paper that will be automated in MMIS/PBM/DSS.

4.2.5.2.1     Update Data Conversion Plan

The Contractor must revise the data cleansing and conversion plan submitted as necessary to meet the
current State business and technical environment. Before conducting the UAT test for conversion, the
Contractor must submit, for State review and approval, a conversion test plan that clearly sets forth how the
process is designed to fully test the functions and features of the conversion software. The Plan must identify
the inputs to the test, the steps in the testing process and the expected results, and any software tools used
during testing. The minimum requirements for the conversion Plan are:
    1. A detailed plan for conversion of all files, images, user validation of converted data, and final
        conversion of files; the Plan should include a detailed conversion schedule, definition of the universe of


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       files to be converted, any metrics to use to monitor data quality and personnel resources assigned to
       the conversion of each file.
   2. A discussion of the management of the conversion effort, including strategies for dealing with delays,
      contingencies, data reconciliation procedures, back-up plan, back-up personnel, process verification,
      and other issues impacting data conversion and data cleaning.
   3. Procedures for tracking and correcting conversion problems when encountered.

4.2.5.2.2     Contingency Plan to Mitigate Data Conversion Risks

The Contractor must provide a Contingency Plan to accommodate risks that may be encountered during
MMIS/PBM/DSS conversion. For each risk, the Contractor must provide a detailed response on how they Plan
to mitigate that risk. The Contractor must provide a walk-through of the Contingency Plan before submitting to
the State for final approval.

4.2.5.2.3     Proposed Approach to Parallel Runs between MMIS and MMIS/PBM/DSS

The Contractor must detail an approach to conducting parallel system and subcomponent runs to validate data
conversion results. The State will validate the accuracy of the data conversion both by using comparative
reports and record counts, and the execution of parallel system and system component runs. Actual daily,
weekly, and monthly data sets will be run through both the current system and the new MMIS/PBM/DSS
system components to measure both the accuracy of the converted data and the MMIS/PBM/DSS
components. The results of these parallel runs must be reconcilable back to the equivalent historical data from
current systems.

4.2.5.2.4     Data Cleansing and Data Conversion Specifications Document

The Contractor must review the State's conversion requirements and include the specific data cleansing and
conversion criteria for all data elements in the current systems as well as those targeted for manual conversion
of data in a Data Conversion Specification Document. Additionally, the Contractor must provide:
    1. Specifications for data clean up of Client ID and associated client, prior authorization, and claims
        history.
   2. Specifications for manually converting data and capturing data elements that are missing or are so
      unreliable, as defined in the specification, that they can not be converted.
   3. Specifications for converting imaged documents.
   4. Data collection forms and create procedures to gather and capture that data.
   5. A review of the data conversion criteria with State staff and design appropriate conversion reports to
      support the conversion process.
   6. Layouts of the reports produced as a result of conversion.
   7. A definition of the metrics that will be generated by the conversion process.
       a. These metrics will be used to measure the completeness of the conversion.
       b. The metrics must include record counts for each major grouping of data elements from both the
          legacy source systems and the new system (i.e. Number of persons, cases, resources, etc.).

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8. A data cleansing strategy for any data that does not convert.
9. A data cleansing strategy for provider and provider data.
10. A detailed description of all files to be converted and whether it will be a manual or an automated
    conversion or a combination of both.
11. Data element mappings, including values, of the old system data elements to the new system data
    elements, and new data elements to old data elements to ensure all data elements are addressed.
12. Identification of default values, where necessary.
13. Interim reporting on each file/table conversion test within one business day of each scheduled file/table
    conversion test; this interim report will include the following for each file/table conversion:
   a.   All test results.
   b.   Any problems encountered and the impact on the rest of the conversion schedule; and before and
        after versions of each converted file/table, including default values.
   c.   A summary of the status of the conversion, including:
        i.      Number of problems identified by type of problem.
        ii.     Number of problems corrected and any significant outstanding issues.
        iii.    The effect of any findings on the implementation schedule.
        iv.     Any other relevant findings.
14. Copies of all conversion programs and program listings used during the test.
15. At a minimum, the Contractor must produce the following reports to ensure adequate checks and
    balances in the conversion process:
        a. Detailed mapping of the Conversion elements (Source fields to Target Fields) for each Entity.
        b. Weekly status reports on the conversion progress and identify any issues.
        c. Conversion progress by environment, by Data area.
        d. Statistics on conversion (% complete, % error, Volume, exceptions)
               i. By data areas.
               ii. By application source.
               iii. Time estimated versus actual time taken.
               iv. Data Verification reports.
               v. Manual spot check results.
               vi. Automated check results.
        e. Data reconciliation reports.
        f. Data cleansing reports by data areas, by application data source.
        g. Capacity Plans (if applicable).



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4.2.5.2.5     Update Data Conversion Requirement Document

The Contractor must review the MMIS/PBM/DSS RSD and the DSD documents to determine which data
elements are actually required for the conversion process. The only exceptions to this are those data elements
that are identified as obsolete, redundant, calculated fields and those strictly used for the internal processing of
the legacy systems. Working with the State, the Contractor must establish the requirements for data
conversion. The results must be documented in an updated data conversion requirements document.

4.2.5.2.6     Data Conversion Checklists

The Contractor must prepare data conversion checklists, provide walk-throughs for the State staff, and then
submit the checklist for final review and approval.

4.2.5.2.7     Develop Data Reconciliation Procedures

The Contractor must prepare data reconciliation procedures and scripts. Walk-throughs must be conducted for
the State staff before submission of these procedures and scripts for final review and approval. Data
conversion from existing complex data formats to relational database schema will require the application of
conversion rules to transform the data. The Contractor must detail all procedures and develop scripts to
reconcile the converted data back to its original content during the execution of parallel runs and regression
testing between MMIS/PBM/DSS and existing systems. These procedures and scripts will be an integral part of
the Contractor’s approach to the regression testing requirements and the parallel runs between the existing
systems and MMIS/PBM/DSS.

4.2.5.2.8     Develop or Provide Conversion Programs

The Contractor must write programs, use tools, or utilize existing extract routines to extract data from the
current systems. The Contractor must develop or provide any training, documentation, maintenance, or
enhancement software identified in the conversion specification document as being required to support the
conversion from the existing system to MMIS/PBM/DSS.

4.2.5.2.9     Convert and Reconcile Data for Implementation

Before converting the data, the Contractor must perform trial conversions and conduct walk-throughs of
completed file/table conversions for the State staff and submit the results for approval.

The Contractor must convert and reconcile data and produce all necessary reports defined in the data
conversion specification document. The conversion results must be used to further refine the cleansing criteria.
The Contractor must review the results of each conversion run to ensure the correctness and completeness of
the conversion before allowing user access to the system. The Contractor must verify the data selected for
pilot implementation before any other use of the system. The Contractor must perform a final conversion of all
data and cases as part of the system wide implementation phase and produce all necessary reports defined in
the data conversion specification document. The Contractor must verify all converted data before any other
use of the system, and the State will review the conversion results for approval.

The Contractor must review the results of conversion and coordinate an effort with the State to cleanse
remaining data that do not convert under normal conversion or data cleansing tasks in a separate environment.

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4.2.5.2.10    Data Conversion Test Scripts

The Contractor must develop and use test scripts based on the design and specific functions included in the
conversion process. These scripts should be step-by-step instructions addressing every activity in the
conversion process for each data file converted.

4.2.5.2.11    Data Conversion Reports

The Contractor must produce a number of reports to assure that there are adequate checks and balances in
the data conversion process. The Contractor must document any instance categorized as a serious data
quality issue in the conversion specification document.

4.2.5.2.12    UAT of Converted Data

The Contractor must conduct UAT to confirm that data conversion has been done correctly, including
certification that the ―new‖ data matches the ―old‖ data. The UAT test for data conversion must actively use all
of the conversion functions, process all types of input, and produce all conversion reports. The State may
require that the Contractor include certain types of data in the conversion test.

4.2.5.2.13    Data Conversion Test Results Report

The Contractor must conduct a system test of all conversion software to demonstrate its functionality and
performance before conversion. The Contractor must provide a data conversion software confirmation letter
certifying that the programs used for conversion are error free and are appropriate for performing the
conversion into MMIS/PBM/DSS.

Additionally, the information that data conversion test results report must contain the following:
   1. Permits the State to validate that the test has been successfully executed in accordance with the
       approved plan and any problems encountered and the impact on the remaining conversion schedule.
   2. Before-and-after versions of each converted file formatted for review by non-technical personnel,
      including default values (in certain cases, the State may require only a portion of the file be formatted
      for review).
   3. Copies of version of manually and automated converted files available for review on-line, where
      appropriate.

4.2.5.3       Contractor Deliverables

Deliverables to be produced by the Contractor for conversion include the following:
    1. Updated data conversion plan.
   2. Risk Identification and Contingency Plan to mitigate data cleansing and data conversion risks.
   3. Approach to parallel runs between current systems and MMIS/PBM/DSS.
   4. Data cleansing and conversion specification document.


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   5. Updated data conversion requirements document.
   6. Data conversion checklists.
   7. Data reconciliation procedures.
   8. Conversion software readiness certification letter.
   9. Conversion programs.
   10. Conversion and reconciliation of data.
   11. Data conversion test scripts.
   12. Convert and reconcile data for implementation.
   13. Conversion reports.
   14. UAT of converted data.
   15. Data conversion test results report.

4.2.6         Training Task

4.2.6.1     State Responsibilities
    1. Work with the Contractor to identify staff training needs.
   2. Make staff available for training.
   3. Review all training materials.

4.2.6.2       Contractor Responsibility

The Contractor will be responsible for developing training plans and training e-documentation for identified
State users and trainers supporting MMIS/PBM/DSS functionality, business processes, and other training
needs. The Contractor must provide training to MMIS/PBM/DSS users, trainers, administrators, managers, and
MMIS/PBM/DSS test teams. The Contractor must develop a training curriculum based and segmented toward
specific security levels and role-based groups. The Contractor must develop all training documentation and
training curriculum for user and provider training sessions. The Contractor must also train and prepare the
State staff to present and conduct provider training sessions. The Contractor must develop a training plan to
ensure just in time training activities.

4.2.6.2.1     Staff and Management User Training

The Contractor must provide training to State personnel who have varying computer skills and who perform
different functions within their organizations. The Contractor must provide classroom "style of instruction" for
each MMIS/PBM/DSS job function with job aids. The Contractor must provide various levels of
MMIS/PBM/DSS training such as users, super users, and train-the-trainer. The State staff training must be
role-based, structured to support all system security levels for the MMIS/PBM/DSS business model business
processes and sub business processes as identified in this RFP, such as, but not limited to:
     1. System Features and system interoperability.
   2. Process and Operations.

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                                                               MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


   3. Reporting.
   4. Document Management and Workflow.
   5. Security.
   6. Authentication/Registration.
   7. System Tutorials/System Navigation.
   8. Rules-based Engine.
   9. Claims Processing, Prior Authorization/Consumer Eligibility.
   10. Web Portal.

4.2.6.2.2    On-line Tutorial

The Contactor must provide an on-line tutorial capability for the major functions within the MMIS/PBM/DSS
system. This tutorial must provide basic "dummy" data, and allow the user to enter or modify information to
simulate actual use of the system. This tutorial must be used for training and made a part of the final
MMIS/PBM/DSS system so that new users accessing MMIS/PBM/DSS will have an on-line tutorial to assist in
learning the system’s functionality. Users must be allowed to click their way through the entire process
including but not limited to:
    1. Mass adjustment processing.
   2. Financial transaction processing.
   3. Prior authorization.
   4. Benefit packages.
   5. Edits and audits.
   6. Rules-based engine.
   7. Reporting.
   8. Account and Federal report coding.
   9.   Web Portal application.
   10. Decision support tools.
   11. Drug rebate processing.
   12. Electronic document and workflow management.

4.2.6.2.3    Provider Training

The Contractor must develop the provider training e-documentation, such as Frequently Asked Questions and
instructions, by provider type. The Contractor must also develop web seminar and video-based provider
training.

The Contractor must train the provider community. The training must be structured to address the
MMIS/PBM/DSS system functionality to include claim submission, claim processing and edits, prior

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authorization, provider enrollment, and use of the Web Portal. There must be specialized training tailored to
meet the needs of Contractors that do not currently use the MMIS and for the providers who do not currently
use the PBM.

4.2.6.2.4     Training Schedule

The Contractor must create and maintain ongoing training schedules for staff and provider sessions. The
Contractor must provide training throughout the operations and maintenance stage for new staff and staff who
change positions. Training must be provided at a Contractor facility and the Contractor must schedule the
training with the State. The training will be conducted Monday through Friday, excluding State holidays,
between the hours of 9:00 a.m. and 4:00 p.m. The Contractor is responsible for furnishing the trainees with
whatever training materials are necessary.

4.2.6.2.5     Training Plans

The Contractor must create, maintain, and update, as required, the approved training plans. The training plans
must include at least the following:
   1. Provide an overview of the training methodology for a security/ role based MMIS/PBM/DSS
       environment and training objectives for the State users.
   2. Identify the training courses and associated course objectives, competency level and skill set
      assessment tools, including the format and content of all training material to be developed by the
      Contractor.
   3. Identify the training presentation style.
   4. Identify the number of role based training sessions necessary to train all identified staff per designated
      security levels.
   5. Identify the number of users to be trained by type of training.
   6. Identify the length of each training course.
   7. Describe the on-line real-time training on electronic communications and claims and other
      documentation.
   8. Define procedures for implementing and maintaining a training database.
   9. Provide for evaluation of training sessions and feedback to the State.
   10. Provide milestones for training.

4.2.6.2.6     Develop, Provide and Maintain Training Documentation

The Contractor must develop and update all training e-documentation, manuals, materials, training guides,
speaker notes, and course curricula (including training objectives and outcomes). The Contractor must develop
a document version control plan and for the version control and maintenance for training documentation to
include all user and provider training e-documentation.

The Contractor also must incorporate on-line help, on-line policy, and procedure manuals and hard copy user
manuals for the delivery of training. All training materials must be reviewed and approved by the State before


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the start of the training. The Contractor must provide sufficient copies of all training materials for all staff plus a
reserve equal to five percent (5%) of the total number of copies. The Contractor must provide all electronic
source documents, graphics, used in the development and presentation of all aspects of training.

4.2.6.2.7      Certificate of Completed Training

Training must be implemented in accordance with the Contractor’s approved training plans. Upon completion
of the training the Contractor must submit a letter certifying that all initial training has been completed.

4.2.6.2.8      Prepare Evaluation Tool

The Contractor must specify the expected performance and the expected outcomes of each type of training in
the Training Plan. In conjunction with this, the Contractor must develop evaluation survey tools to determine
whether the trainings produced the expected results. The evaluation must consist of various tests administered
to trainees at each training session. This evaluation survey tool must be used to identify weaknesses in the
training program and specific revisions that need to be made. This survey tool must also be used for
implementation training to assess the effectiveness of the training sessions. The trainers for all training must
implement the evaluation survey tool.

4.2.6.2.9      Training Report

The Contractor must develop training reports that include information such as, but not limited to, the number of
training sessions, type of training, training locations, number of trainees, and information regarding the actual
training results and recommendations for follow up training.

4.2.6.2.10     Contractor Deliverables

Deliverables to be produced by the Contractor include the following:
    1. Update organizational assessment and gap analysis.
   2. Training Plan/schedule including train-the-trainer plan and schedule.
   3. Electronic training documentation.
   4. Training database and application software.
   5. Letter certifying training database is built and software is operational.
   6. Document version control plan.
   7. Conduct training.
   8. Letter certifying completion of training.
   9. Evaluation survey tools.
   10. Training report.




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4.2.7        Implementation Phase

Upon receipt of the Authorization to Begin Work, the Contractor will begin an Implementation Phase. During
this phase, the Contractor will plan and prepare to assume all responsibilities of the Montana Fiscal Agent.
The Contractor must convert all data necessary to operate MMIS/PBM/DSS and meet all requirements. The
Contractor must plan to phase in operations on a schedule that will minimize risk. The Implementation
Planning Phase will end upon successful assumption of all Fiscal Agent responsibilities and resolution of
startup issues. The scheduled end of this phase will be on June 30, 2011.

4.2.7.1      Implementation Plan

The Contractor must produce and update the Plan as necessary to reflect all Project changes that directly
impact implementation. The most critical update to the Plan during this task is the development of a
Contingency Plan for identifying, mitigating and resolving those risks that have been identified as impacting
implementation. It must address the strategies for business and system continuity planning as a result of
implementation issues. The Contingency Plan must include one or more alternate solutions for each risk that
are acceptable to the State. The Contractor must execute the Contingency Plan as issues arise during
implementation, upon approval of the State. The Contractor, upon approval of the State, must implement
MMIS/PBM/DSS in accordance with the Contractor’s approved Implementation Plan.

The Implementation Plan must describe to the State how the Contractor will implement MMIS/PBM/DSS. The
Plan must detail the approach for coordinating the following:
   1. Final data conversion activities.
   2. Technical preparation and system changeover activities.
   3. Development of an implementation activities check list.
   4. Implementation schedule.
   5. The process for developing a Contingency Plan for identifying, communicating, resolving risks and
      maintaining the current production capability if the implementation is delayed. This Contingency Plan
      must be developed during the Implementation phase.
   6. Activities required to effectively implement, operate, and maintain the MMIS/PBM/DSS; Identify cutover
      procedures and dates for submittal of claim records on electronic media claims and hard copy.
   7. Document resolution of inventory issues (for example, suspense, claim records on hand, provider
      enrollments) and associated dates.
   8. Document plans for installation of lines and workstations.
   9. Specify methodology for handling adjustments to incumbent-processed claim records.
   10. Identify procedures and dates for any required provider certification activity and/or recertification.
   11. Identify the process to accommodate provider updates, consumer data changes, reference changes,
       and prior authorizations after final conversion but before implementation.
   12. A plan for managing future modifications and enhancements of the system including the type and
       number of staff to be involved based on the requirements of Section 4.5.4.



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4.2.7.2       Implementation

The Contractor must ensure that the system is ready to be implemented and that DPHHS approvals have been
obtained to begin operations of the new MMIS/PBM/DSS. To be ready for implementation, the systems must
satisfy all the functional and technological requirements specified in the RFP and documented during the
requirements analysis and systems design activities. DPHHS staff must be given sufficient time to review all
system, user and security documentation for completeness prior to implementation. The system response time
and all user and automated interfaces must be clearly assessed and operational. A complete file transfer plan
must be developed and executed.

This plan must identify:
   1. The name of each file, table or database.
   2. Destination of transferred data.
   3. Transfer start and completion times.
   4. Location and phone numbers of person(s) responsible to execute the transfer.
   5. A complete fall back plan if the file transfer does not go as planned.

DPHHS expects the implementation of the new system to be transparent to the client and the provider
communities and that all functions and processes work correctly, timely, and efficiently. The new system must
function without interruptions or non-scheduled downtimes. The response time from the new system must be
within acceptable limits. All documentation must be current and available to State and Contractor staff to assist
them in their new job functions and responsibilities.

4.2.7.2.1     State Responsibilities
    1. Participate in Implementation Planning sessions.
   2. Provide the Implementation Team of up to 12 individuals with duties that include working with the
      Contractor on implementation activities.
   3. Review all implementation Deliverables. The standard turnaround for State review shall be 10 work
      days. The State encourages early submission of draft documents to expedite State review.
   4. Approve MMIS, PBM and DSS for operations upon successful conclusion of all activities described in
      this phase.

4.2.7.2.2     Contractor Responsibilities

At a minimum, the Contractor will have the following responsibilities for this task:
    1. Repeat portions of the operability test as requested by DPHHS.
   2. Develop and obtain DPHHS approval of an emergency back out strategy.
   3. Produce and update all system, user, provider, and operations documentation.
   4. Produce and distribute report distribution schedule.
   5. Establish production environment.


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   6. Establish hardware, software, and facility security procedures.
   7. Develop and obtain DPHHS approval of production schedule.
   8. Develop and implement backup and recovery procedures.
   9. Develop and obtain DPHHS approval of plan that includes detailed proposed staffing for managing
      future modifications and enhancements.
   10. Ensure complete and accurate data conversion.
   11. Complete all Fiscal Agent, State, and provider training.
   12. Ensure that communications between State users and the Fiscal Agent systems have been established
       and meet performance requirements.
   13. Establish and begin mailroom operations.
   14. Obtain written approval from DPHHS to start operations.
   15. Begin operations.

4.2.7.2.2.1   Correction and Adjustment Activities

The Contractor must monitor the implemented MMIS/PBM/DSS for quality control and verification that all
activities are functioning properly. The Contractor must expeditiously repair or remedy any function that does
not meet standards set during system definition and the quality planning process. The Contractor must inform
the State within one hour of its awareness of any significant implementation problem that would indicate a
possible need to execute the back out plan. The Contractor must provide the State with a weekly report of any
problem identified, the proposed repair or remedy, and impact of the repair or remedy and the implementation
date.

4.2.7.2.2.2   Execution of Contingency Plans

If any part of MMIS/PBM/DSS does not perform according to specification, the Contractor must execute the
appropriate Section of its emergency back out strategy.

4.2.7.2.2.3   Final Implementation Report

The Contractor must produce an implementation report detailing the results of all implementation activities.

4.2.7.2.2.4   Contractor Deliverables

Deliverables to be produced by the Contractor for the implementation task must include the following for each
phase of delivery:
    1. Implementation Plan.
   2. Report distribution schedule.
   3. Software release plan.
   4. Emergency back out plan.


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   5. Backup and recovery plan.
   6. System modification and enhancement Plan.
   7. Hardware, software, and facility security manual.
   8. Final implementation checklist.
   9. Final documentation and policy manuals.
   10. Final transition plan.
   11. Signed implementation certification letter.
   12. Final implementation report.

4.2.7.2.2.5   Implementation Certification

The Contractor must provide an implementation certification letter that certifies that the system is ready for
production. The certification letter must confirm at a minimum:
   1. All training activities required have been completed.
   2. All staff have completed non-technical training.
   3. All data has been converted, cleaned and accepted.
   4. All site preparation requirements have been met.
   5. Help desk is established.
   6. All user and system supports are in place.
   7. All production jobs have been through the change control process and locked down in production
      libraries.
   8. All production databases have been appropriately sized and are ready for production processing to
      begin.

4.2.7.3       Post Takeover Implementation

The Contractor will be required to assign Contractor resources to conduct a post-takeover implementation
evaluation to validate State stakeholder; provider; and Client service satisfaction.

4.2.7.3.1     Contractor Responsibilities

Contractor’s responsibilities for the post-implementation evaluation task will be to:
   1. Provide free access to the evaluation team to review operational and system areas.
   2. Prepare Corrective Action Plan for problems or deficiencies identified by the evaluation team for review
      and obtain approval by DPHHS.
   3. Develop the Post Implementation Evaluation Report for review by DPHHS.
   4. Execute the Corrective Action Plan.
   5. Archive all first-run Federally required reports for inclusion in the certification documentation.

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4.2.8         Operations Phase

This phase will begin on July 1, 2011, and end on June 30, 2015, or as extended by the exercise of Contract
provisions or amendments to the Contract.

4.2.8.1       Operations Requirements

The Contractor must operate MMIS/PBM/DSS; perform all functions described in Attachment F, Operational
Requirements; and the all operations tasks set forth in Section 4 from the date of implementation of each
component until each function is turned over to a successor Fiscal Agent at the end of the Contract, including
any optional additional periods or extensions.

4.2.8.1.1     Operations Training

The Contractor must create and maintain ongoing training schedules for staff. The Contractor must provide
training throughout the operations and maintenance stage for new staff and staff who change positions.
Training must be provided at a Contractor facility and the Contractor must schedule the training with the State.
The training will be conducted Monday through Friday, excluding State holidays, between the hours of 9:00
a.m. and 4:00 p.m. The Contractor is responsible for furnishing the trainees with whatever training materials
are necessary.

4.2.9         Certification Phase

Montana must apply for and receive certification of their system from the Center for Medicare Medicaid (CMS)
by demonstrating that the system meets all requirements and performance standards before receiving full
Federal matching funds. The objective of this task is to obtain Federal certification of MMIS/PBM/DSS.

4.2.9.1      State Responsibilities
    1. Serve as the point of contact with CMS. Communicate all pertinent information from the Contractor to
        CMS and from CMS to the Contractor.
   2. Review and approve the Demonstration Plan.
   3. Facilitate certification meetings.
   4. Review and approve MMIS/PBM/DSS changes and schedule.

4.2.9.2       Contractor Responsibilities

During this task, the Contractor must provide technical support and assistance with Federal certification as
described in this Section. Federal certification must be obtained within 12 months of the production start date.

4.2.9.2.1     Update Federal Certification Plan

The Contractor must work with the State to update the Federal Certification Plan submitted in the proposal.




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4.2.9.2.2     Provide Required Documentation for Federal Certification

The Contractor must work with the State to provide necessary documentation for Federal certification. At a
minimum the Contractor must:
   1. Prepare all reports and documentation necessary for submission of the preliminary letter request to
      CMS.
   2. Submit current updated system documentation for submission to CMS.
   3. Assist State staff in preparing certification materials.
   4. Update the report distribution lists.
   5. Update the data element dictionary.

4.2.9.2.3     Provide Personnel as Required for Federal Certification

The Contractor must provide necessary resources to the State for certification as per the approved Federal
Certification Plan.

4.2.9.2.4     System Remediation

The Contractor is required to deliver a certifiable MMIS/PBM/DSS for the proposed price. The Contractor must
expeditiously correct any item that CMS will not certify on a schedule to be approved by CMS and the State.

4.2.9.2.5     Correction of Items Not Certified

The Contractor must correct all items not certified at no additional charge to the State.

4.2.9.2.6     Change Control for Certification

The Contractor must execute appropriate controls for changes made during the certification process, including
testing requirements. Change must be managed in accordance with the requirements of Section 4.5.4.

4.2.9.2.7     Contractor Deliverables

Deliverables to be produced by the Contractor for the certification task include the following:
    1. Updated Federal Certification Plan.
   2. Required documentation for Federal Certification.
   3. System corrections.

4.2.10        Enhancement Phase

At the discretion of the State, the Contractor must design, develop and implement the following enhancements
to the MMIS:
    1. Electronic Health Records.



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   2. Payroll System for managing tax and benefit withholding for personal care workers.
   3. Capability to support managed care programs including generation of capitation payments and
      processing of encounter data from the managed care organizations.

The Contractor must describe its approach to the development of these MMIS enhancements and the
operation and management of system components to provide storage and access of the data. The date of
implementation of each enhancement will be determined by the State.

Upon receipt of notice to begin work, the Contractor must conduct all planning, design, development and
implementation activities in accordance with the provisions of Section 4.5.4.

Payment for these services will be based on the schedules D, E or F in the Cost Proposal.

4.2.11        Turnover Phase

This phase will begin 12 months before the end of the Contract period and end six months after the end of the
Contract period, or as extended by the exercise of Contract provisions or amendments to the Contract. For
planning purposes, this phase should begin on July 1, 2014 and end on December 31, 2015 unless the
Contract is extended. The Contractor must prepare for turning over responsibilities and operations at the end
of the Contract. The Contractor must cooperate with the successor Fiscal Agent, other Contractors and the
State in the planning and transfer of operations. The Contractor must dedicate special additional resources to
this phase.

4.2.11.1      State Responsibilities
    1. Notify the Contractor of the State's intent to transfer or replace the system at least 12 months prior to
       the end of the MMIS/PBM/DSS Contract.
   2. Review and approve a Turnover Plan to facilitate transfer of MMIS/PBM/DSS to the State or to its
      designated agent.
   3. Review and approve a Statement of resources, which would be required to take over operation of
      MMIS/PBM/DSS.
   4. Make State staff or designated agent staff available to be trained in the operation of MMIS/PBM/DSS.
   5. Coordinate the transfer of MMIS/PBM/DSS documentation (in hard and soft copy formats), software
      and data files.
   6. Review and approve a turnover results report that documents completion of each step of the Turnover
      Plan.
   7. Obtain post turnover support from the Contractor in the event of software malfunction.

4.2.11.2      Contractor Responsibilities

4.2.11.2.1    Planning

The Contractor must create a schedule for MMIS/PBM/DSS turnover activities and submit the schedule for
State approval.


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4.2.11.2.2    General Planning with State

The State will be the point of contact with CMS for this task. The Contractor must track both State and
Contractor responsibilities associated with the Turnover Phase.

4.2.11.2.3    General Planning with Contractor

The Contractor will work closely with the successor Contractor during the planning for the Turnover Phase.

4.2.11.2.4    Develop Turnover Plan

The Contractor must provide a Turnover Plan to the State within six months of the start of the turnover phase.
This Plan must include:
   1. Proposed approach to the turnover.
   2. Tasks and sub-tasks for the turnover.
   3. Schedule for the turnover.
   4. All MMIS/PBM/DSS production data, program libraries, and documentation, including documentation
      update procedures for the turnover.

4.2.11.2.5    Develop Requirements Statement

As part of the Turnover Plan the Contractor must furnish to the State a Statement of resource requirements
that would be required by the State or a successor Contractor to take over MMIS/PBM/DSS.

4.2.11.2.6    Provide Turnover Services

The Contractor will provide the required turnover services.

4.2.11.2.7    Cooperation with Successor

The Contractor will cooperate with the successor Contractor while providing all required turnover services.
This will include meeting with the successor and devising work schedules that are agreeable for both State and
the successor Contractor.

4.2.11.2.8    Turnover of Archived Materials

When requested by the State, the Contractor must transfer all source program code onto magnetic media
approved by the State. The Contractor will be required to supply all magnetic media used in the transfer of
data and files and will be responsible for all associated shipping charges.

4.2.11.2.9   Additional Contractor Turnover Responsibilities
    1. The Contractor must ensure that MMIS/PBM/DSS will be error free and complete when turned over to
       the State or the successor Contractor.


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2. The Contractor must correct, at no cost to the State, any malfunctions that existed in the system prior to
   turnover or were caused by the lack of support, by the Contractor, as may be determined by the State.
3. The Contractor must supply an estimate of the number, type, and salary of personnel to operate the
   equipment and other functions of MMIS/PBM/DSS. The estimate shall be separated by type of activity
   of the personnel, including, but not limited to, the following categories:
   a. Data processing staff.
   b. Computer operators.
   c. Systems analysts.
   d. Systems programmers.
   e. System/Business Analysts.
   f.    Project management staff.
   g. Data entry and imaging operators.
   h. Provider services staff.
   i.    Administrative staff.
   j.    Provider field representatives.
   k. Clerks.
   l.    Managers.
4. The Contractor must provide a Statement that includes all facilities and any other resources required to
   operate MMIS/PBM/DSS including, but not limited to:
         a. Data processing and imaging equipment.
         b. System and special software.
         c. Other equipment.
         d. Telecommunications circuits.
         e. Telephones.
         f.     Office space.
5. The Contractor must provide a Statement that includes all resource requirements based on the
   Contractor’s experience and must include the actual Contractor resources devoted to the operation of
   MMIS/PBM/DSS.
6. The Contractor must provide a detailed organizational chart depicting the Contractors total
   MMIS/PBM/DSS operation.
7. The Contractor must transfer to the State or the successor Contractor, as needed, a copy of
   MMIS/PBM/DSS including, but not limited to:
    a.        All necessary data and reference files.
    b. Imaged documents stored on optical and magnetic disk.


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                                                               MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


       c. All production computer programs.
       d. All production scripts, routines, control language, and schemas.
   8. Provide all production documentation including, but not limited to user and operations manuals, system
      documentation in hard and soft copy needed to operate and maintain MMIS/PBM/DSS and the
      procedures of updating computer programs and other documentation.
   9. The Contractor must provide training to the successor staff in the operation of MMIS/PBM/DSS. Such
      training must be completed at least two months prior to the end of the Contract. Such training shall
      include:
      a.   Data entry, imaging, and claims processing.
      b.   Computer operations.
      c.   Controls and balancing procedures.
      d.   Exception claims processing.
      e.   Other manual procedures.
   10. The Contractor must provide updates or replacements for all data and reference files, computer
       programs, and all other documentation that will be required by the State or the successor Contractor to
       run acceptance tests.
   11. On a schedule to be determined by the State, the Contractor must package, insure and deliver all
       hardware used in MMIS/PBM/DSS to a location designated by the State.
   12. At a turnover date to be determined by the State, the Contractor must provide to the State or the
       successor Contractor all updated computer programs, data, and reference files, and all other
       documentation and records as will be required by the State or its agent to operate MMIS/PBM/DSS.
   13. The Contractor must turn over all:
       a. Paper claims and paper claim adjustments.
       b. Paper provider files.
       c. Paper file maintenance forms.
       d. Financial paper records.

4.2.11.2.10 Deliverables
    1. Turnover Plan.
   2. MMIS/PBM/DSS requirement Statement.
   3. MMIS/PBM/DSS software, files, and system, and user and operations documentation in hard and soft
      copy format.
   4. Turnover results report.




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4.3          Staffing
4.3.1        Named Staff for the Design, Development and Implementation Phase

Named Staff for the Design, Development and Implementation Phase are those staff positions named in this
Section. Named Staff must be available for assignment on MMIS/PBM/DSS project on a full-time basis and
must be solely dedicated to this project. Each Named Staff member must have the required experience. Any
proposed change to this staff after Contract execution must have prior written approval by the State. In all
circumstances, Named Staff shall be replaced only with persons of equal ability and qualifications. The State
shall have the right to conduct separate interviews of proposed replacements for Named Staff and all Named
Staff replacements must be approved in advance in writing by the State Project Manager.

Resumes along with letters of commitment for this staff must be supplied with the proposal.
   1. Manager for Project Management Office - The Contractor will assign a Project Management Officer
      certified to lead the Contractor’s PMO. This person may not hold any other concurrent position during
      the Design and Development Phase. Qualifications: Minimum five years (60 months) of project
      management experience including the management of at least one MMIS systems design and
      development project similar in size and scope to this project that encompassed the full system
      development life cycle from initiation through post implementation. Individual must be certified by the
      Project Management Institute or have an equivalent certification from an entity not related to the
      Contractor. Minimum of two years of experience using Microsoft Project.
   2. Manager for Design and Development - The Contractor will assign an individual to manage the design
      and development phase. This person may not hold any other concurrent position during the Design
      and Development Phase. This person may become the Implementation Manager. Qualifications:
      Minimum of five years of Medicaid related system design and management experience including the
      management of one MMIS systems design and development project similar in size and scope to this
      project. Experience must involve project management of an enterprise-wide architecture, networking,
      multiple systems integration, hardware and software and managing a technical team and its activities
      from inception through implementation on a minimum of one project of similar size and complexity to
      this project. A Bachelor’s Degree in Information System Engineering, Computer Science or a related
      field is also required.
   3. Project Management Specialists - The Contractor will assign three Project Management Specialists to
      manage the design and development of the MMIS, PBM and DW/DSS. Qualifications: Minimum two
      years of project management experience in the design and development of the MMIS, Pharmacy
      Benefit Manager or data warehouse and decision support system. A Bachelor’s Degree in Information
      System Engineering, Computer Science, Database Administration or a related field is also required.
      This person may not hold any other concurrent position during the Design and Development Phase.
   4. Implementation Planning Manager - Contractor will assign an individual to manage the implementation
      phase. This person may not hold any other concurrent position during the implementation phase.
      Qualifications: Minimum of five years of Medicaid related system design and management experience
      including the management of one MMIS systems design and development project similar in size and
      scope to this project. A Bachelor’s Degree in Information System Engineering, Computer Science or a
      related field is also required. This person may not hold any other concurrent position during the Design
      and Development Phase.


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   5. Quality Assurance Manager for Implementation - The Contractor will assign a manager for quality
      assurance activities during the implementation phase. Qualifications: A Bachelor’s Degree with at least
      three courses in Statistics and/or Quality Assurance and a minimum of three years progressive
      experience in the quality assurance function of a large scale claims processing organization or have at
      least five years progressive experience in the quality assurance function of a large scale claims
      processing organization. This person may not hold any other concurrent position during the Design and
      Development Phase.
   6. Data Conversion Manager - The Contractor will assign a Conversion Specialist to manage all data
      conversion activities of the project. Qualifications: Minimum of five years experience managing data
      conversion for MMIS implementation projects or health care information systems. A Bachelor’s Degree
      in Information System Engineering or a related field is also required.
   7. Interface Manager - The Contractor will assign an Interface Specialist to manage all interface
      development and implementation activities of the project. Qualifications: Minimum of three years
      experience in systems integration, messaging components, and interface development. A Bachelor’s
      Degree in Information System Engineering or a related field is also required.
   8. Testing Manager - The Contractor will assign Testing manager to manage all testing activities during
      design, development and implementation. Qualifications: Minimum of three years experience
      conducting system and user acceptance tests for an MMIS or major health payor system. A Bachelor’s
      Degree in Business Management or a related field is also required.

4.3.2         Named Staff for the Certification Phase

Certification Manager - Contractor will assign manager for certification activities. Qualifications: Minimum of
five years of Medicaid related system design and management experience including the management of one
MMIS/PBM/DSS systems design and development project similar in size and scope to this project. A
Bachelor’s Degree in Computer Science or a related field is also required. Any proposed change to this staff
after Contract execution must have prior written approval by the State.

4.3.3         Named Staff for the Turnover Phase

One Turnover Manager - Qualifications: A Bachelor’s Degree and at least three years MMIS experience, and
experience turning over operations similar in size and scope to Montana. Turnover Manager must have
sufficient delegation of management authority to make decisions and obligate Contractor resources to fulfill
obligations of the Turnover Phase. Any proposed change to this staff after Contract execution must have prior
written approval by the State.

4.3.4         Named Staff for the Operations Phase

Named Staff for the Operations Phase are those staff members with the following titles. Individuals in these
positions may not hold any other concurrent position and must be full-time positions. Any proposed change to
this staff after Contract execution must have prior written approval by the State.
    1. Account Manager - The Contractor will assign an Account Manager, to serve as liaison with the State
        during the Operations Phase. The Account Manager shall be available and responsible to the State for
        consultation and assistance. He/she shall attend, upon request, meetings and hearings of Legislative
        Committees and interested governmental bodies, agencies, and officers. He/she shall also provide

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   timely and informed responses to operational and administrative inquiries arising in the Montana Health
   Care Program. Whenever the Account Manager is not reasonably available, he/she shall provide a
   designated alternate fully capable of meeting the requirements of this Section. The Account Manager
   shall meet with the State staff or such other person as the State may designate on a regular basis to
   provide oral and written status reports and other information as required. Qualifications: Minimum of
   four years of MMIS and supervisory experience for a government or private sector health care payor,
   including a minimum of three years MMIS experience in a State of equivalent scope to Montana.
2. Operational Systems Group Manager- The Contractor will assign a manager for maintenance and
   enhancement of the MMIS/PBM/DSS. Qualifications: Minimum of two years of MMIS operation
   experience as manager in a State of equivalent scope to Montana. A Bachelor’s Degree in Information
   System Engineering or Computer Science or a related field is also required. Equivalent experience
   may be substituted for the degree providing this manager is an active participant during the Montana
   design, development and implementation phase.
3. Claims Operations Manager - The Contractor will assign a manager for Claims Operations
   Management, including claims, transaction processing and third party liability. Qualifications: A
   Bachelor’s Degree, or equivalent experience, and minimum of four years experience managing claims
   processing operations and personnel for a Medicaid Fiscal Agent or private sector health care payor,
   including a minimum of two years MMIS experience.
4. PBM Operations Manager - The Contractor will assign a manager for the PBM business area.
   Qualifications: A Bachelor’s Degree, or equivalent experience, and minimum of four years experience
   managing pharmacy PBM operations and personnel for a government or private sector health care
   payor, including a minimum of two years Medicaid PBM experience.
5. Quality Assurance Manager for Operations - The Contractor will assign a manager for quality
   assurance for the operation phase. Qualifications: A Bachelor’s Degree with at least three courses in
   Statistics and/or Quality Assurance and a minimum of three years progressive experience in the quality
   assurance function of a large scale claims processing organization or at least five years progressive
   experience in the quality assurance function of a large scale claims processing organization.
6. Provider/Client Relations Manager – The Contractor will assign a manager for provider/client relations
   and associated Help Desks business areas. Qualifications: A Bachelor’s Degree and minimum of two
   years experience managing provider relations and enrollment, and/or client relations for a Medicaid
   Fiscal Agent or private sector health care payer. Equivalent experience may be substituted for the
   degree providing this manager is an active participant during the Montana design, development and
   implementation phase.
7. Program Support Manager – The Contractor will assign a manager for program support activities,
   including code maintenance, fraud abuse detection and SUR/S support, DSS support and data
   analysis, and other administrative support, as required. Qualifications: A Bachelor’s Degree and
   minimum of four years experience managing personnel and coverage of services, medical coding and
   terminology, health record administration, and/or payment methods development and maintenance for
   a Medicaid Fiscal Agent or private sector health care payer, including a minimum of two years MMIS
   experience.
8. Third Party Liability (TPL) Manager – The Contractor will assign a manager for TPL operation activities.
   Qualifications: A Bachelor’s Degree and minimum of two years experience managing TPL personnel



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        for a Medicaid Fiscal Agent or private sector health care payer, including a minimum of two years MMIS
        experience.

4.3.5         Categorized Staff

Categorized Employees are those staff required to be maintained by the Contractor in agreed quantities by
category, either as part of the Minimum Numbers of Categorized Staff required in this RFP, or as part of the
Sufficient Numbers of Categorized Staff described in the Vendor’s proposal. These persons must be assigned
full-time to this project and may not hold any other concurrent positions.

The Contractor must supply sufficient staff to design, develop, implement and operate MMIS/PBM/DSS and to
meet all other requirements of the Contract. The design and development staff must include an adequate
number of system engineers and system architecture personnel that specialize in current and future MMIS
development. This staff is over and above the Named Staff and the Minimum Numbers of Categorized Staff set
by the State. The Contractor may be required to increase staffing levels if requirements or standards are not
being met, based solely on the discretion of the State. In making this determination, the State will evaluate
whether the Contractor is meeting deliverable dates, producing quality materials, maintaining high quality and
production rates, and meeting RFP standards without significant rework or revision.

4.3.6         Minimum Numbers of Categorized Staff - Operations Phase

The Contractor must supply the staff described in this Section. The Contractor must maintain the number and
qualifications of this staff for the Operations Phase.
   1. Systems Management Staff - Sufficient staff to perform network and database management, and other
        technical personnel as required to maintain all other system components (PBM, Web Portal, EDMS and
        workflow, DSS, etc.) Qualifications: A Bachelor’s Degree and two year experience in the application to
        which the individual is assigned. Experience can be substituted for the Bachelor’s Degree on a year-
        for-year basis.
   2. Claims Supervisor – Supervises categorized staff assigned to management of claims business
      activities. Qualifications: A Bachelor’s Degree and five year experience in medical claims processing.
      Experience can be substituted for the Bachelor’s Degree on a year-for-year basis.
   3. Managed Care Supervisor – Supervises categorized staff assigned to enrollment and management of
      clients enrolled in Care Management and Lock-In, and other managed care programs determined by
      the State. Qualifications: A Bachelor’s Degree and one year experience in a managed care field.
      Experience can be substituted for the Bachelor’s Degree on a year-for-year basis.
   4. TPL Supervisor – Supervises categorized staff assigned to determination of Third Party Liability (TPL),
      cost avoidance procedures, and recovery of funds through coordination of benefits. Qualifications: A
      Bachelor’s Degree and one year experience in Third Party Liability. Experience can be substituted for
      the Bachelor’s Degree on a year-for-year basis.
   5. Two Provider Field Representatives - Qualifications: A Bachelor’s Degree and one year experience in
      the health care billing or health care public relations field. Experience can be substituted for the
      Bachelor’s Degree on a year-for-year basis.




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   6. One Instructional Design Specialist - Managed training. Qualifications: A Bachelor’s Degree and two
      years of instructional design professional experience in training, education, staff development,
      personnel or a DPHHS program area.
   7. Three Quality Assurance (QA) Support Personnel Assist in QA activities. Qualifications: High School
      diploma and three years Medicaid or health care quality assurance support experience.
   8. Three Third Party Liability Support Personnel. Qualifications: High school diploma and three years
      experience in coordination of benefits investigation and management for Medicaid or a large health
      care payor.
   9. The Contractor must provide an adequate number of Systems and Business Analysts as provided for in
      the approved plan for managing future modifications and enhancements required in Section 4.2.7.2.2 -
      Qualifications: A Bachelor’s Degree and three years experience in analyzing business requirements for
      Medicaid, Medicare or a large health payor.
   10. One Registered Health Information Administrator (RHIA) to manage code maintenance. Qualifications:
       Certification as a RHIA and at least two years in the development and maintenance of procedure and
       diagnosis code (CPT, HCPCS, ICD-9, RBRVS, DMERC, APC and DRG). Must provide training for
       Contractor and State staff related to ICD-10 up to six months prior to implementation of ICD-10.
   11. One Decision Support Analyst - Qualifications: A Bachelor’s Degree and at least three years
       experience supporting data analysis for Medicaid or other health care programs.
   12. One SURS Support Analyst Qualifications: A Bachelor’s Degree and at least three years experience
       supporting SURS for Medicaid or other health care programs. Experience can be substituted for the
       Bachelor’s Degree on a year-for-year basis.

4.3.7        General Requirements for Employees

The Contractor shall comply with all Federal and State requirements concerning fair employment and
employment of the disabled and concerning the treatment of all employees without regard to discrimination by
reason of race, color, religion, sex, national origin, or physical disability.

4.3.8        Residency and Work Status

The Contractor must follow all Federal and State laws regarding Social Security registration and legal work
status of all staff employed or Contracted by the Contractor.

4.3.9        Background Checks

All Contractor employees working on MMIS/PBM/DSS must have a criminal background check done prior to
employment and periodically as required by the State, with results submitted to the State for review. Any
employee with a background unacceptable to the State may not be employed or must be immediately
dismissed from the project by the Contractor.




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4.4           Location of Operations Facilities
The Contractor’s local facility shall be located in Helena, Montana. The facility will be established and will have
adequate meeting space for all DDI sessions within 45 days of Contract Award. The facility will be fully
operational 60 days prior to the start of the Operations Phase. Staff monitoring the maintenance and
enhancing of the various systems are located in Helena and work directly with the Contractor on a daily basis.
Daily interaction is required for serving the citizens of Montana for assuring accurate payment to service
providers. The MMIS/PBM/DSS systems may be operated on computers located elsewhere, as long as
adequate connectivity and sufficient staff is provided. The following Contractor functions will be performed at its
local Helena facility:
    1. Auditing (except for audits performed at provider sites).
   2. Business operations.
   3. Claims receipt (hard copy) and pre-screening.
   4. Mail room.
   5. Data entry.
   6. Imaging operations.
   7. Exception claims processing.
   8. All call center operations.
   9. Provider enrollment and re-enrollment.
   10. Provider relations (excluding provider field representatives).
   11. Account Management.
   12. System modification and enhancement activities described in Section 4.5.4 including staffing
       requirements.

The Contractor will be required to supply separately lockable office space in the Contractor’s Helena facility for
use by five DPHHS staff and IV&V Contractors. This office space must be fully equipped with furniture;
telephone service; five personal computers with access to the MMIS/PBM/DSS, Microsoft Office Suite, and the
internet; and access to a printer and copier. Reserved or paid parking spaces must be provided to
accommodate DPHHS staff and IV&V Contractors.

4.4.1         Meeting Room Requirements for Design and Development

The Contractor must supply adequate meeting room facilities to accommodate required Contractor staff and up
to 20 State Implementation Team members in regular status and strategy meetings.

The meeting room must have a computer and projector for displaying Internet-based and Windows™
PowerPoint presentations, and a high-quality speakerphone for multiple remote staff to attend meetings by
telephone. Meeting room must also accommodate video conferencing and web-based application sharing for
attendees.




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4.4.2         Space Provided for File and Archive Storage

The Contractor shall maintain records of all claims received, transactions processed, and adjudication
decisions made by the MMIS/PBM/DSS for an indefinite period. The term ―indefinite period‖ in connection with
records retention shall mean that records will be retained by the Contractor (or other specified entity) until the
Contractor receives specific written disposition instructions from the State. At the expiration or termination of
the Contract, the Contractor shall request disposition instructions if not previously received and shall comply
with those instructions. The Contractor shall not destroy, purge, or dispose of records related to this Contract
or the Contractor’s performance without the State’s express prior written approval.

Notwithstanding the Contractor’s receipt of disposition instructions to the contrary, should any litigation, claim,
negotiation, audit, disallowance action, or other action involving the subject matter of this Contract be
commenced, the applicable records shall be retained until completion of any said litigation, claim, negotiation,
audit, disallowance action, or other action involving this Contract and resolution of all issues arising thereof.
The Contractor shall promptly inform the State that for such reason it has retained the records notwithstanding
the State's initial instructions.

4.4.3         State Access to Processing Facilities and Contractor Staff

The Contractor will provide twenty-four-hours, seven-days-a-week access to Contractor named staff.
Contractor must grant access to all other operations employees during regular business hours without prior
notice, admission, escort, or other requirements. The State and the Contractor will establish appropriate
protocols to ensure that physical property/facility security and data confidentiality safeguards are maintained.
Access to any facility used to support MMIS/PBM/DSS will be granted within five business days of the request.

4.4.4         Computer Resources

MMIS/PBM/DSS computer processing will be performed at a site to be selected by the Contractor and
approved by the State.

The Contractor will be responsible for providing computer resources to support the completion of all tasks. No
State computer resources will be available to the Contractor except those necessary to transmit eligibility data
and those that may be necessary to test system interfaces during the design, development, implementation
planning, and acceptance testing tasks. Contractor computer resources must be available 24-hours-a-day,
seven-days-a-week, except for authorized down time and maintenance.

4.4.4.1       User Access

Contractor may schedule maintenance during the off hours, from 7:00 p.m. to 6:00 a.m. (Mountain Time). An
application is considered unavailable when a user does not get the complete, correct full-screen response to
an input transaction after depressing the ―enter‖ or another specified function key. The State will notify the
Contractor when they have determined the system is unavailable.

The Contractor will report to the selected service level indicators from the MMIS/PBM/DSS applications to
indicate availability of the selected application, plus an exception log identifying those applications that were
not available during the reporting period. The Contractor will also include the calculation of user access


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availability in the report. The frequency, content, and methodology for the reports must be approved by the
State. The Contractor will be responsible for providing and maintaining all necessary telecommunications
circuits between the State offices and the Contractor's facilities.

4.4.4.2       Location of Backup and Contingency Facilities

Backup, disaster recovery and contingency facilities will be performed at sites specified in Business Continuity
and Disaster Recovery Plans developed for State approval. The Privacy and Security Plan must describe the
Contractor staff position(s) responsible for privacy and security requirements. The Contractor will be required
to include plans to house designated State staff during deployment.

4.4.4.3       Location of System Analysis and Programming Resources

Contractor System Analysis and Programming resources must be located at the Contractor’s local Helena
facility, except as approved by the State. Approval for off-site work will be rarely granted by the State.

During the DDI and Operations Phases of the Contract functions related to system processing and computer
operations may be performed at a site selected by the Contractor as approved by the State except that all
requirements sessions will be held in the Helena facility.

4.4.4.4       Location of Subcontractors

Subcontractor locations must be approved by the State before operations begin at that location.

4.5           Project Governance Requirements
4.5.1         State Responsibilities

The State responsibilities regarding Project Governance include:
   1. Implementation of State Project Management Office (PMO).
   2. Provide direction to the Independent Validation and Verification (IV&V) Contractor.
   3. Review and approve project governance approach and methodologies and Deliverables.
   4. Participate in weekly project status meetings with the MMIS and IV&V Contractors.
   5. Review and approve MMIS Contractor Project Status Reports.
   6. Review and approve the Deliverables for each project undertaken.
   7. Report ongoing project progress to the State Executive Management.
   8. Use the PMO Project Work plans and Status Meeting discussions to prepare the quarterly report of
      progress to CMS.
   9. Monitor progress of projects and quality of MMIS Contractor Deliverables.
   10. Obtain decisions from Executive Steering Committee on any identified issues as needed to keep the
       project on schedule.


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   11. Complete, review and approve any customer service request (CSRs) arising from maintenance and
       system enhancement requests that do not meet the definition of a project.
   12. Review and approve the Project Management Plans that must be implemented for each project during
       the Operations Phase.
   13. Work with the Contractor to reach agreement concerning the levels of quality that are desirable,
       acceptable and substandard for each area.
   14. Work with the Contractor to develop means to measure the performance levels on a monthly basis,
       using the Performance Reporting System.
   15. Review and approve the measurement, calculation, content, and format of Contract management
       reports.
   16. Approve Contractor’s key personnel, including reviewing resumes of proposed key personnel and
       notifying the Contractor in writing of its approval or disapproval.
   17. Review the results of background checks supplied by the Contractor.
   18. Monitor the Contractor’s performance of all Fiscal Agent Contractor responsibilities, processes, and
       compliance with Contract terms, standards, and conditions.
   19. Provide the Fiscal Agent with the name of the DPHHS Contract administrator who will be the primary
       point of contact between the State and the Fiscal Agent.
   20. Provide access to appropriate DPHHS staff to the Contractor in its performance of Contract activities.
   21. Assess and invoke damages for Contractor performance that does not meet Contract requirements and
       for non-compliance.
   22. Review and approve Contractor invoices and supporting documentation for payment of services.
   23. Coordinate State and Federal reviews, certifications and compliance audits.

4.5.2        Contractor Responsibilities

The Contractor must know and actively apply professional project management standards to every aspect of
the work performed under this Contract. The Contractor must adhere to the highest ethical standards, and
exert financial and audit controls and separation of duties consistent with Generally Accepted Accounting
Principles (GAAP) and Generally Accepted Auditing Standards (GAAS).

During the Project Start-Up Phase, the Contractor must establish the appropriate level and type of project
management standards and procedures to successfully complete the requirements of each phase of the
Contract. This Section identifies the mandatory requirements, tasks, and Deliverables for project governance,
which the Contractor must perform. The following are minimum requirements.

4.5.2.1      PMBOK

The Contractor must adhere to the American National Standards Institute (ANSI) and Project Management
Institute, Inc. (PMI) principles recorded in the latest version of the Project Management Body of Knowledge
Guide® (PMBOK).



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4.5.2.2       Information Technology Iterative Project Management

The Contractor is required to implement and maintain the systems with strict adherence to published, industry
recognized standards including, but not limited to the Capability Maturity Model Integration ® (CMMI) and
Standards from the Institute of Electrical and Electronic Engineers (IEEE) or a comparable model approved by
the State for all application development and maintenance. The Contractor must include in its response to this
RFP a description of its application development and maintenance methodology, and identify the approach to:
    1. Requirements Management.
   2. Project Planning.
   3. Project Tracking and Oversight.
   4. Subcontractor Management.
   5. Quality Assurance.
   6. Software Configuration Management.
   7. Process Focus.
   8. Process Definition.
   9. Training.
   10. Integrated Software Management.
   11. Software Product Engineering.
   12. Peer Reviews.

The State prefers that the Contractor use Agile/Scrum development method for management and execution of
all development tasks. If the Offeror does not utilize this methodology, they must propose another
development methodology for approval by the State.

4.5.2.3       Separation of Duties

The Contractor must separate functions and segregate duties of personnel to assure adequate financial,
security, quality and auditing controls consistent with the size and volume of the Montana Health Care
programs and Generally Accepted Accounting Principles (GAAP) and Generally Accepted Auditing Standards
(GAAS).

4.5.2.4       Financial Control

The Contractor must operate its cash receipt unit under separate management from its claims, computer
operations and security units. Individuals in the same family may not work in any combination of the following:
Provider Communications (call-center), Provider Enrollment, Cash Receipt, Audit, and Systems Security.
Appropriate separation of duties must be applied to all aspects of financial management.




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4.5.2.5       Security

The Contractor must operate a Systems Security unit under direct management control. The Contractor must
separate duties of staff responsible for network connections, routing, firewall management, intrusion detection,
email service, user authentication and verification, password management, and physical access control to
ensure appropriate administrative, physical and technical controls are in place. At a minimum, the Contractor
must implement and maintain the security and privacy standards set forth in Section 4.

4.5.2.6       Quality Control

The Contractor must operate a Quality Monitoring and Control Unit under direct management control. Staff in
this unit may not participate in the day-to-day operations they are monitoring. For each Large Project, the
Contractor must employ a formal Quality Management Plan (QMP). Early in the Project, the Contractor must
develop checklists, measures and tools to measure the level of quality of each deliverable. The quality
measurement process applies to plans and documents, as well as programs and operational functions. The
Quality Management Plan must document a process for sampling and audits and for continuous quality
improvement.

4.5.3         Project Management

4.5.3.1       Project Management Portal

Within 30 days of the award to the Contract the Contractor will establish a secure Enterprise Project Portal
(Portal) to serve as the electronic repository for the official Project Work Plan (PWP), all Deliverables, and
other project artifacts. The Portal must allow authorized users to view the Plan in a real-time environment and
generate reports on project status. The Portal must provide the capability to email alerts advising individuals of
task assignments, task status and notification that due date for an assigned task has passed. All project
deliverable drafts and working copies must be stored and shared in the Portal to facilitate communication and
collaborative work. Authorized State staff must have the capability of uploading documents onto the Portal.
The Portal must operate in a secure environment where user access and privileges are dependent on
authorizations that will be decided by the State, but the Contractor is responsible for:
    1. Maintaining security settings.
   2. Establishing Portal folders.
   3. Populating folders with appropriate documentation.
   4. Identifying authorized Contractor Portal users.
   5. Providing access privileges to authorized users.
   6. Notifying and training authorized users in Portal usage.

The Contractor will maintain the project Portal during the Operations Phase of the Contract.




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4.5.3.2       Project Management Office (PMO)

The Contractor must establish a PMO in Helena, Montana within 30 calendar days of award of the Contract.
The PMO must be managed by a PMI professional as defined in 4.5.2.1. The Contractors PMO will be
required to work closely with the State’s PMO throughout the project.

4.5.3.2.1     PMO Processes, Policies and Procedures

The Contractor must deliver to the State a PMO Policy and Procedure Overview document. The document
must describe all PMO processes and procedures, including PMO methodologies and tools used to control the
projects, scheduling and prioritization of project activities, PMO staff roles and responsibilities, project scope
and change management, procedures to control costs, managing issues and risks, methods to track and
approve accomplishments, document management and provide a central repository of all project artifacts.

4.5.3.3       Project Management Plans

Within 45 days of award of the Contract the Contractors PMO will submit, for approval by the State, Project
Management Plans prepared in accordance PMBOK ® principles. The Plan must describe the Contractor’s
management approach, organizational structure, formal and informal communications procedures, meeting
agendas and meeting notes, progress reporting, correspondence tracking, issues resolution procedures, risk
management and mitigation, submission of invoices and procedures for reporting earned value performance
management statistics.

No development will begin on the project until the State has approved all Project Management Plans. The
Project Management Plans must be kept current at all times throughout the project. The Project Management
Plans are as follows.

The Contractor must update Project Management Plans as needed throughout the life of the project.

4.5.3.3.1     Communication Management Plan

The Contractor must deliver to the State a Communications Management Plan. The Contractor will determine
all State communications needs, including status reporting and project monitoring, and create a process to
meet those needs. During all phases of the project, the Contractor will execute the Plan, with formal weekly
status reports in formats approved by the State.

4.5.3.3.1.1   Status Meetings

The Contractor must participate in regularly scheduled meetings with the State to discuss all projects and
progress made during the reporting period, as well as ongoing operations. Except as otherwise approved,
status meetings will be held on a weekly basis. The IV&V Contractor may participate in meetings during
Project Start-up, Takeover, and DDI phases as requested by the State. The meeting schedule will be proposed
by the Contractor in its PMO and Project Management Plans and will be mutually agreed upon between the
Contractor and the State. The Contractor must prepare an agenda for each meeting for approval by the State


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and prepare and publish meeting minutes for the status meetings within five business days following the
meeting in a format approved by the State.

4.5.3.3.1.2   Weekly Status Reports

The Contractor must prepare written status reports on a schedule approved by the State. Except as otherwise
approved, status will be delivered on a weekly basis and will include the following:
   1. A report on the status of each task in the Work Breakdown Structure that is in progress or overdue.
   2. Tasks completed during the week.
   3. Tasks planned to start during week that were not started along with a projected start date, an
      explanation of the reason for late start, and corrective action taken to assure that the tasks will be
      started on the revised date.
   4. Tasks planned to be completed during week that were not completed along with a projected completion
      date, an explanation of the reason for late completion, and corrective action taken to assure that the
      tasks will be completed on the revised date.
   5. A report on issues that need to be resolved.
   6. A report on the status of risks, with special emphasis on change in risks, risk triggers, or the occurrence
      of risk items.
   7. A cost variance report showing the planned value of the work completed to date, the actual cost of the
      work completed to date and the variance.
   8. A schedule variance report showing the earned value of the work completed, the planned value of the
      work completed, and the variance.

4.5.3.3.1.3   Monthly Status Reports

The Contractor must submit an electronic status report, which is due to the State by the close of business, the
second business day following the end of each month during the Project. Monthly status reports must contain,
at a minimum, the following:
    1. A complete set of updated and current output from the Microsoft Project 2002, including an updated
       Gantt chart, along with a copy of the corresponding Project schedule files in electronic version.
   2. A description of the overall completion status of the Project in terms of the approved Project schedule.
   3. The plans for activities scheduled for the next month.
   4. The Deliverable status, with percentage of completion and time ahead or behind schedule for particular
      tasks.
   5. Identification of Contractor employees assigned to specific activities.
   6. Problems encountered, proposed resolutions, and actual resolutions.
   7. A list of all change requests.
   8. An analysis of risk anticipated, proposed mitigation strategies, and resolved risks.
   9. Any updates required in the change management strategy.


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   10. Testing status and test results.
   11. Proposed changes to the Project schedule, if any.
   12. Financial information related to expenses and billings for the project.
   13. Executive summaries for presentation to management and oversight bodies.

The format for these reports shall be at the direction of the State.

4.5.3.3.1.4   Independent Validation and Verification

An Independent Validation and Verification (IV&V) Contractor will be selected to assist the State with: (1)
assessing the Project methodologies, planning, and execution, (2) assessing implementation quality, and (3)
evaluating quality and compliance of Deliverables. The selected IV&V Contractor will assist the State in
developing and implementing Project monitoring procedures in the following areas, among others:
   1. Schedule.
   2. Project scope.
   3. Project quality assurance.

4.5.3.3.2     Project Plan

The Contractor will revise the Project Work Plan submitted in the Technical Proposal to reflect any change in
dates or activities based on Contract negotiations. The Detailed Project Work Plan will identify all tasks,
activities, milestones, and Deliverables for the project and will be used by the State to monitor the Contractor’s
progress. Elements of this deliverable include:
    1. A narrative overview of the work plan tasks and schedule, including any assumptions and constraints
         the Contractor used in the development of the work plan.
   2. Description of each task, subtask, and activity.
   3. A WBS in Microsoft Project or an alternative acceptable to the State identifying all tasks, subtasks,
      milestones and Deliverables with key dates for each associated with the DDI phase of the project. The
      work must be decomposed into tasks that allow for accurate estimation of the work and resources
      required in terms of Contractor and State Implementation Team resources to complete the Project and
      must take into consideration the State’s commitment of State staff to the project as Stated in Section
      4.2. Any task that requires more than 80 hours or 10 work days to complete must be further
      decomposed. The Project Plan must include dependencies, begin and end dates and duration
      estimates for each task in the WBS; the sequence of tasks, including identification of the critical path;
      and the method to be used by the Contractor to control time spent on the Project. Resources must be
      allocated by name or by type to the WBS.
   4. Proposed location for activities to be performed.
   5. Personnel resources applied by name and level of effort in hours.
   6. State resource requirements.
   7. Gantt chart.



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   8. PERT or dependency chart.
   9. Resource matrix by subtask, summarized by total hours per person, per month.

4.5.3.3.2.1   Project Plan Baselines

The original estimates will form the project baseline. Once established, the baseline will only be modified with
approval from the Sate. The approved baseline will be used for all Project metrics reported on a weekly status
reporting schedule. During execution of the Project, the Contractor must measure performance according to
the WBS and manage changes to the plan requested by the State. When tasks are complete, the Contractor
must seek verbal acceptance from the State for each task, and formal acceptance of each deliverable.

4.5.3.3.3     Management Plan

The Contractor must deliver to the State and use a standard Risk Management Plan that must address the
process and timing for risk identification, describe the process for tracking and monitoring risks, identify the
Contractor staff that will be involved in the risk management process, identify the tools and techniques that will
be used in risk identification and analysis, describe how risks will be quantified and qualified, and how the
Contractor will perform risk response planning. For each risk, the Contractor must evaluate and set the risk
priority based on likelihood and impact, assign risk management responsibility, and create a risk management
strategy. For each significant accepted risk, the Contractor must develop risk mitigation strategies to limit the
impact. The Risk Management Plan must include aggressive monitoring for risks, identify the frequency of risk
reports, and describe the plan for timely notification to the State of any changes in risk or trigger of risk events.

4.5.3.3.4     Issues Management Plan

The Contractor shall deliver to the State an Issues Management Plan. The Plan must describe the process,
tools, and techniques used in issue identification and analysis, tools for tracking and monitoring issues, identify
the Contractor staff that will be involved in the issue management process, describe how issues will be
quantified and qualified, and how the Contractor will perform issue response planning.

4.5.3.3.5     Quality Management Plan

The Contractor must deliver to the State and employ a formal Quality Management Plan that includes
checklists, measures and tools to measure the level of quality of each deliverable. The quality measurement
process applies to plans and documents, as well as programs and operational functions. The Quality
Management Plan must reflect a process for sampling and audits and for continuous quality improvement. An
updated Quality Assurance Plan must be submitted to the State for approval annually. The Plan must include a
proposed process for State review and approval of Contractor Deliverables.

The Plan must address how the Contractor will organize an internal Quality Assurance Unit (QAU) with at least
the minimum staffing indicated in Section 4.3. This unit will be an integral functional part of the Contractor
PMO. During implementation, this unit is responsible for ensuring the quality of all Deliverables prior to
submission to the State. After implementation, this unit is responsible for quality review of all output, including
an appropriate sampling by the Contractor of all processed claims from the MMIS, quality assurance of all
performance standards and Corrective Action Plans (CAP).



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4.5.3.3.6     Staffing Management Plan

The Contractor must deliver to the State a Staffing Management Plan based on the requirements in Section
4.3, including organizational charts with defined responsibilities and contact information. Resources must be
allocated by name or by type to the WBS during the implementation phase and for projects during the
Operations Phase. During Project execution, the Contractor must provide appropriate training and
management supervision to all staff. Alternates for named staff must be provided.

The Contractor must deliver at the inception and annually, a staffing plan for each operations Section. If the
Contractor staff for any operations Section is found to be deficient by the State, the Contractor must revise the
staffing plan within 15 days of notice and employ the additional staff at no additional cost to the State.

4.5.3.3.7     Applications Development and Maintenance Plan

The Contractor must deliver to the State a comprehensive Applications Development and Maintenance Plan,
describing the Contractor’s approach to development and maintenance methodologies, approach to
requirements gathering and tools for managing requirements; project planning; subcontractor management;
software configuration management; process focus; process definition; quality assurance process and
monitoring, as described in the QMP; training; integrated software management approach; software product
engineering; and peer reviews.


This Plan describes the approach to the development of the software, and it should be designed as the top-
level plan developed and used by managers to direct the development effort. It provides the Project Manager
with the tools needed to plan the project schedule and resource needs and to track the progress against the
schedule. This Plan will provide to project team members an understanding of what they need to do, when they
need to do it, and what other activities they are dependent upon. The State prefers that the Contractor use
Agile/Scrum development method for management and execution of all development tasks. However the
Contractor may utilize another methodology if approved by the State.

Artifacts that are to be included in the Application Development Plan must include (but are not limited to):
    1. Iteration Plan.
   2. Requirements Management Plan.
   3. User-interface Guidelines.
   4. Design Guidelines.
   5. Programming Guidelines and Standards to be Used for all Vendor Developed Software (The State is
      aware the COTS software cannot be included in these programming guidelines and standards), this
      includes all development standards, practices, and conventions, such as, language, special software,
      identification of all development, test, training and production libraries, and qualitative aspects of data
      modeling and design.
   6. Test Guidelines.



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   7. Infrastructure Plan.
   8. Configuration Management Plan.
   9. Documentation Plan.
   10. Problem Resolution Plan.
   11. MITA Compliance Plan that demonstrates how the software will align with the MITA model of industry –
       based open architectural standards; modular components; relational database; Web and real-time
       processing; rules engine management; data privacy, security and integrity; and interoperability.

4.5.3.3.8     Change Management Plan

The Contractor must work with the State to develop a Change Management Plan that establishes the change
management roles and responsibilities, polices, guidelines, processes, and procedures necessary for
controlling and managing the changes during the life of the project. Changes may be based on scope (both
technical and functional) or schedule. This document must identify how changes are identified, defined,
evaluated, approved, and tracked through completion. This Plan must identify responsibilities and define the
composition, function, and procedures for a Change Management Board.

The Plan must include a change management process that governs, not only the changes made through
modification of software and system tables, but also the user generated changes in the rules engine(s) or any
other modification of business processes. The change management process must include a multi-level
approval process for changes in the rules engine(s) or any other modification of business processes. The
Contractor must also develop a proposed procedure for resolving any dispute between the State and the MMIS
Contractor as to whether any requirement of the State is within the scope of work covered by the Contract.

The Contractor must provide and maintain a Change Management System. This system will allow State and
Contractor management staff to review current priorities and timeliness, change priorities by adding new tasks
and target dates, and then immediately see the impact of these new priorities on pre-existing priorities and their
target dates. It is imperative that all modifications to the systems be performed in a structured, controlled
manner.

Additionally, the Contractor must implement and use proven promotion and version control procedures for the
implementation of modified system modules and files. The Change Management System must also serve to
track research issues identified by the State or the Contractor in which the system does not appear to be
functioning as expected. The following requirements must be met:
    1. Provide the State with on-line access to a Change Management System:
       a. Allow on-line entry of new Customer Service Requests (CSRs) and research issues.
       b. Image and include all attachments pertinent to each CSR.
       c. Provide on-line reporting and status inquiry for any CSR, all CSRs or all CSRs in a category.
       d. Provide automatic notification to affected parties when CSR status changes.
       e. Maintain and provide access to all changes made by the State or the Contractor to each
          CSR, identifying the change made, the person making the changes, and the date and time
          of the change.


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       f.   Show status, report coding changes, attach test results, and record all notes from State and
            Contractor staff related to each CSR.
   Provide an on-demand CSR status priority report and an on-demand report showing the current
      status of all CSRs. Information for these reports must be updated at least weekly.
   Provide a SOA Service Repository which is where all the system services are listed and made
      available to each component of the system. This ensures that reusable services are known
      along with all their characteristics. This allows change control to know what is there for use.

The system must produce Change Control Reports that meet the following requirements:
   1. Produce reports that are downloadable to other formats, such as Excel.
   Information to be captured shall include, at a minimum, the following:
       a. Customer Service Request number.
       b. Priority number.
       c. Modification description.
       d. Modification related notes or comments.
       e. Request date.
       f.   Requester.
       g. Modification start date.
       h. Assigned resource(s).
       i.   Estimated completion date.
       j.   Estimated hours.
       k. Hours worked to date.
       l.   Documentation impact and status.
       m. Testing status.
       n. State Modification approval.
   Maintain documented, proven code promotion procedures for promoting changes from the initiation
      of unit testing through the final implementation to production.
   Maintain documented version control procedures that include the performance of regression tests
      whenever a code change or new software version is installed, including maintaining an
      established baseline of test cases to be executed before and after each update to identify
      differences.
   Ensure the Contractor provides the specified number of staff required to complete a CSR within the
      specified timeframe.
   Ensure that all CSR requests are responded to within five business days or within twenty-four (24)
      hours for an emergency CSR.
   Ensure an approved CSR has been started on within five business days of approval.

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   Randomly survey the submitters of CSRs to verify that the user was satisfied with the timeliness,
      communication, accuracy, and result of the CSR process 90% of the time.

4.5.3.4         Project Execution and Control

During implementation and execution of every project during the Operations Phase, the Contractor must exert
control to assure the completion of all tasks according to the Project Schedule and Project Budget. All
variances must be reported to the State, and the Contractor must work with the State to deal with any variance
in a manner that will assure overall completion of the Project within time and budget constraints. The State will
work with the Contractor to approve fast-tracking or reallocation of Contractor resources as necessary.

4.5.3.5         Integrated Management

All requirements for project management are interrelated. The Contractor may apply integrated project
management tools or commercial off the shelf (COTS) products to consolidate reports required for the
management of Projects. The Contractor must execute careful change control on the implementation tasks
and throughout the project.

4.5.3.6         Project Management Deliverables

          Deliverable                                       Date
          Project Portal 4.5.3.1                            30 Days after Contract award
          Project Management Office 4.5.3.2                 30 Days after Contract award
          Project Management Plans 4.5.3.3                  45 Days after Contract award

4.5.4           Management of System Modifications or Operation Improvements

It is the State’s intention that all maintenance and enhancements be accomplished by staff required in Section
4.3.4 and 4.3.6. This staff will be responsible for system changes as well as changes in the rules engine, and
maintenance of the benefit plans.

During the Operations Phase, any system modification or operations improvement activity will be considered a
project. For any project undertaken during the Operations Phase the Contractor will comply with all aspect of
the approved Contract Management Plans required in Section 4.5.3.3 as deemed appropriate by the State for
the size of the project and comply with the development standards set forth in Section 4.5.2.2 for any system
modification projects. All projects will be controlled by the Contractor’s PMO under the direction of the State.

4.5.4.1         Cost Management

The Contractor must determine the resources necessary to complete the project in a timely and efficient
manner, must estimate and budget for costs, and post these estimates to each task in the WBS. Although in
most cases the costs will not be chargeable to the State, the estimate will be used by the State for Planning
and setting priorities and will be used by the State and the Contractor to report cost variance. During execution
of the project, the Contractor must regularly report cost variance at the task level, based on the percentage
completion of the task and the actual number of hours or days worked on the task.


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4.5.4.2         Project Execution and Control

During execution of every project, the Contractor must exert control to assure the completion of all tasks
according to the Project Schedule and Project Budget. All variances must be reported to the State, and the
Contractor must work with the State to deal with any variance in a manner that will assure overall completion of
the Project within time and budget constraints. The State will work with the Contractor to approve fast-tracking
or reallocation of Contractor resources as necessary.

4.5.4.2.1       Project Thresholds

Any work task undertaken by the Contractor not described in Section 4.2 and Attachment F, Operational
Requirements, and exceeding 15 Full-time Equivalent (FTE) workdays of work effort will be considered a
Project. Small Projects consist of less than 30 FTE workdays effort; Medium Projects consist of 30 to 90 FTE
workdays effort; Large Projects exceed 90 FTE workday effort.

                                           Figure 1 - Project Definitions
                  Project             Any work task during the Operations Phase with a
                                      defined beginning and end, a defined result, and
                                      requiring more than 15 FTE workdays of estimated
                                      effort.

                  Small Project       Any work task with 16 to 29 FTE workdays of estimated
                                      effort.

                  Medium Project      Any work task with 30 to 90 FTE workdays of estimated
                                      effort.

                  Large Project       Any work task with more than 90 FTE workdays of
                                      estimated effort.


4.5.4.2.2       Project Management Requirements Deliverables

Figure 2 presents the project management Deliverables that are required for any activity that meets the
definition of a project in Figure 1.

                                   Figure 2 - Project Management Deliverables

                                                                    Small          Medium           Large
              Deliverable                  Contents
                                                                   Project          Project         Project
          Project Charter         Title of Project                    X                X               X
                                  Name of the Project
                                  Manager


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                                                    Small           Medium           Large
    Deliverable             Contents
                                                    Project         Project          Project
                  Authority of the Project
                  Manager
                  Result/Product of the Project
                  Constraints
                  Assumptions
                  Executing Authority
                  Date Approved

                                                     Small          Medium           Large
    Deliverable             Contents
                                                    Project          Project         Project
Stakeholder       Identification of stakeholders                        X               X
Analysis          Stakeholder role/
                  interests/expectations
                  Stakeholder contact
                  information
Communications    Feedback loops                       X                X               X
Management Plan   Method and frequency of
                  reports for each stakeholder
                  Project contact list
                  Frequency of meetings and
                  status reports
Work Breakdown    Identify all tasks,                  X                X               X
Structure (WBS)   Deliverables and milestones
                  Start date, end date, and
                  work effort for all tasks
                  Task dependencies
                  Resource allocation by task
                  and role
                  Decompose so no task has
                  estimated work effort more
                  than eighty (80) hours.
Risk Management   Identification of risks                               X               X
Plan              Process for tracking and
                  monitoring risks
                  Risk management
                  Contractor staff
                  Tools and techniques used
                  to identify risks
                  Schedule for assessment of
                  risks
                  Assignment of risk
                  management responsibility



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                                                     Small           Medium           Large
    Deliverable               Contents
                                                     Project         Project          Project
Quality Management   Checklists, measures, and                                           X
Plan                 tools used to measure
                     quality
                     Process for sampling and
                     auditing for quality
                     improvement

                                                      Small          Medium           Large
    Deliverable               Contents
                                                     Project          Project         Project
Staffing             Organizational charts                               X               X
Management Plan      Defined responsibilities of
                     staff
                     Staff schedules
                     Staff contact information
Project Schedule     Task duration estimates            X                X               X
                     Task sequence
                     Critical path identification
                     Time control methods
Requirements         Executive Summary                                   X               X
Analysis Document    Overview of all processes
                     Overview and purpose of all
                     interfaces
                     Discussion of the design
                     implications for each major
                     element of the project
                     System designs or
                     modifications necessary to
                     complete the project
                     General report definitions
                     General screen definitions
                     Process overview
                     System behavior model
                     (user interfaces-free form)
                     High-level flowcharts
Business Design      Purpose and general                                 X               X
Document             business description of each
                     program, module, screen,
                     process, and report
                     Lists of inputs, outputs and
                     interfaces
                     Process flowcharts
                     General resource
                     requirements


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                                                                   Small          Medium           Large
            Deliverable                  Contents
                                                                  Project          Project         Project
        Technical Design      Hardware and software                                   X               X
        Document              requirements
                              Program, screen and report
                              specifications sufficient to
                              begin programming and
                              construction
                              Prototypes
                              Pseudo-code
                              Database design or change
                              specifications
                              Data conversion and
                              interface requirements
        Project Status        General status report                  X                X               X
        Reporting:            Completed activities
                              Planned activities
        Weekly
                              Project issues
        Monthly               Risk status
        Quarterly             Cost variance report
                              Schedule variance report
                              Financial information
                              Executive summaries

4.5.5         General Contract Management

The Contract Management Function encompasses both automated and manual functions necessary to
manage the Fiscal Agent operation and to report to DPHHS on the status of operational activities. These
functions are primarily the responsibility of the Contractor’s Quality Assurance Unit, following approval of the
procedures and processes from DPHHS.
   1. Provide an automated project tracking and control system to track operational performance and monitor
        operational activities. The automated tracking and control system shall be the repository for inventories
        of work done and work to be completed, and will include all areas of Fiscal Agent services including
        subcontracts and EDI.
   2. Provide operational activity and performance reports, accessible and updatable on-line by DPHHS and
      Fiscal Agent management staff. These activity reports must be in a downloadable format compatible
      with standard desktop applications for data manipulation, such as Excel or Access. The automated
      tracking with production reports must comply with the performance standards in Section 4.5.3.3.8.
   3. Provide an automated performance monitoring system to produce the ―report card‖ on Fiscal Agent
      performance, including reporting which is accessible on-line by DPHHS and Fiscal Agent management
      staff. The scope, format, content, measure criteria, and standards used in the report card must be
      approved by the State.



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4. Provide monthly management summary reports to DPHHS, accessible on-line, to report on the overall
   status of the project including, but not limited to the following minimum expectations:
   a. Status of operational activities.
   b. Status of system maintenance and modification activities.
   c. Status of internal quality control and assurance activities.
   d. Performance monitoring.
   e. Fiscal Agent staffing levels.
   f.   A report of all rules engine modifications during the period.
   g. These reports will include baselines and aging data, as well as prior period performance data.
   h. Provide internal Contract management procedures and controls including:
        i.      Management and control procedures to monitor all Contractor functions.
        ii.     Management and control procedures to monitor all subcontractor functions.
        iii.    Inventory management procedures and controls.
        iv.     Internal quality control and assurance tools.
        v.      Backlog monitoring, controls, and Contingency Plans.
        vi.     Project monitoring, controls, and Contingency Plans.
        vii.    Back-up and cross training plans.
        viii.   Inventory/database of all provider, client, State, and other contacts (i.e., in person, telephone,
                written).
        ix.     Inventory/database of all other activities, i.e. training and educational, publications, appeals,
                fair hearings, maintenance items and enhancements, SURS cases, EOBs, complaints,
                pends, claims resolution, and all other Fiscal Agent activities.
5. These Contract management control procedures must be fully documented in operations procedures
   manuals.
6. Provide the State with reasonable access to Contractor staff during normal working hours. Maintain
   access to staff for emergencies by designating and publishing an on-call list of Contractor staff with
   contact information for after business hours.
7. Provide coordination of on-site and any off-site work performed by Fiscal Agent staff.
8. Monitor quality and work toward continued quality improvement in all Contract areas in accordance with
   the approved Quality Management Plan.
9. Provide, at no additional cost to the State, an annual SAS 70 audit report by October 1st of each year.
   The Contractor must submit annually, a ―Report on the Processing of Transactions by Services
   Organizations‖, as defined in Statement on Auditing Standards No. 70 (SAS70). The Contractor must
   respond to each SAS 70 audit with a proposed Corrective Action Plan within 30 calendar days of the
   audit, if necessary. The Contractor must complete implementation of the State approved Corrective
   Action Plan within 40 calendar days of approval unless otherwise specified by the State.


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   10. The Contractor shall maintain an auditing system and employ accounting/auditing procedures and
       practices that conform to Generally Accepted Accounting Principals (GAAP) Generally Accepted
       Accounting and Auditing Standards (GAAS). All charges applicable to the Contract shall be readily
       ascertainable from such records. The Contractor is required to submit annual financial reports to
       DPHHS within 30 calendar days of receipt of the report from their independent auditor.

4.6           Deliverable Procedures and Standards
The Contractor must meet specific requirements for all Deliverables in all phases of this Contract. Deliverables
are itemized in Section 4.2 and deliverable specifications are in Section 4.5 for project management.

4.6.1         Deliverable Procedures

The State must approve the content and format of all Deliverables prior to the Contractor start on the
deliverable. The State reserves the right to reject any deliverable that is not in the proper format or does not
appear to completely address the function of the deliverable requirement. Deliverables standards are
described in Section 4.6. The Contractor is responsible to provide all additional documents and materials
necessary to support its Information Systems Development Methodology (ISDM) at the appropriate time,
whether itemized in these lists or not.

As the Contractor provides Deliverables, in written and electronic format, for each task to the State, the State
will review the materials or documents within 10 business days after the receipt date, except design
Deliverables where there must be a minimum of 15 business days for review. The receipt date is not counted
as one of the 10 days. If the material or document is determined to be in non-compliance, the State will send
written notification to the Contractor’s Project Manager outlining the reason(s) for his or her determination. The
Contractor at no expense to the State will bring work determined by the State to be in non-compliance with the
Contract into conformance within 10 business days of notice and resubmit the Deliverable to the State. If the
State accepts the Deliverable, Deliverable material or documents, an acceptance letter, signed by the State,
will be submitted to the Contractor.

The State will review Deliverables in a timely manner. The Contractor must allow a minimum of 10 business
days for review by State staff for most Deliverables. Weekly Status Reports, Monthly Status Reports and
Project Plans are not subject to a 10 day review cycle.

Upon receipt of a signed Deliverable Submittal Form indicating the State agrees that a deliverable is approved
or a milestone has been met and payment will be made, the Contractor may submit an invoice for that
deliverable or milestone according to the payment schedule set forth in the Consideration and Payments
Section of Attachment B, Contract.

4.6.2         Deliverables Standards

The State requires the use of iterative development in a cooperative and participatory environment, in which
the State may give immediate feedback on prototypes, design concepts, and early document drafts. The State
hopes to speed development through this participatory process, and minimize misunderstandings concerning
business and technical requirements.



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   1. The Contractor must conduct participatory meetings with State staff as documents are drafted and
      business and systems requirements are being ascertained, including concept discussions, design
      prototyping, Joint Application Design (JAD) sessions, and meetings for requirements gathering and to
      receive State feedback on design and documents.
   2. The Contractor must have open communication with the State during the development of documents
      and systems. The Contractor must provide document drafts and allow State review of programs,
      screens and design concepts at any stage of development at the State’s request.
   3. The Contractor must render all designs and itemized Deliverables in writing for formal approval, in a
      format agreed on by the State and the Contractor as part of the Project Management process. State
      approval will be streamlined for items in which the State was involved at earlier stages.
   4. The Contractor must supply professional Deliverables, with proper spelling, punctuation, grammar,
      tables of contents and indices where appropriate and other formatting as deemed appropriate by the
      State. The deliverable document must meet the business requirements it is intended to fulfill.
      Documents must be easily readable and written in language understandable by State staff
      knowledgeable in the area covered by the deliverable. The State reserves the right to reject any
      deliverable that does not meet these standards. The Contractor can not consider any deliverable
      complete before it is accepted formally by the State.
   5. All Deliverables and correspondence produced in the execution of this RFP must be clearly labeled
      with, at a minimum, project name, deliverable title, deliverable tracking or reference number, version
      number and date.
   6. The Contractor will conduct walk-throughs of Deliverables at stages during the development of
      documents and systems. A final walk-through will be conducted at the delivery of the final deliverable.

4.7           Record Retention Requirements
The Contractor will agree to the following terms for retention and access to records relating to the Contract:
   1. All original paper claims adjudicated under the Contract will be retained for 30 calendar days from date
      documents are imaged, indexed and have met QA processing standards. Original claims may be
      destroyed after the retention period in accordance with State and Federal guidelines. Copies of all
      claims and related records in optical image, or on micro media will be retained for eight years. All
      imaged documentation older than the specified retention period must be archived for potential retrieval
      for the duration of the Contract period. At the end of the Contract, copies of all claims and any related
      records in the custody of the Contractor will, at State direction, be either destroyed or transferred to the
      State.
   2. Unless the State specifies in writing a shorter period of time, the Contractor agrees to preserve and
      make available all other pertinent books, documents, papers, and records (including electronic storage
      media) of the Contractor involving transactions related to the Contract for a period of eight years from
      the date of expiration or termination of the Contract. Any records requiring longer retention will be
      defined by the State.
   3. Records, which relate to appeals, audits or litigation that have been initiated and not resolved at the
      end of eight years, will be retained until resolution of the findings.




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   4. The Contractor will agree that authorized Federal and State representatives will have full access to the
      Contractor’s facility and all records in any way related to the performance of this Contract. This access
      will be granted during the Contract period and during the eight year post-Contract period or until
      resolution. During the Contract period, the access to these items will be provided at the Contractor's
      office in Lewis and Clark County at all reasonable times. Records not required to be kept in Lewis and
      Clark County will be made available in Lewis and Clark County within two business days and will
      remain available there for up to 30 consecutive calendar days. During the eight year post-Contract
      period, delivery of and access to the listed items will be at no cost to the State.

4.8           Performance Monitoring
The State will monitor the Contractor’s performance using a Performance Reporting System to be implemented
by the Contractor. The State believes that this is the most effective way to monitor the quality of the
Contractor's performance, document performance levels in all critical areas of the system, facilitate the
management of the Fiscal Agent Contract and enhance the investment made by the State and Federal
government in the administration of the Montana Health Care programs.

The State has identified certain areas of Contractor performance where quality is critical to the mission of the
Montana Health Care program. These performance criteria are identified in Section 4.8.1. During the
Implementation Planning Phase, the State may identify other performance criteria and will reach agreement
with the Contractor concerning the levels of quality that are desirable, acceptable and substandard for each
criterion.

The Contractor will develop the methodology and statistical sampling methods for use after approval by the
State, to measure those performance levels on a monthly basis, using the Performance Reporting System.
   1. The Contractor will provide an automated method for MMIS/DSS/PBM and other system/operations
        tools used to provide the monthly reports of the performance measurements agreed upon by the State
        and the Contractor at no additional cost to the State.
   2. The automated reports will be flexible and adaptable to changes in the performance measurements as
      agreed upon by the State and Contractor during the Operations Phase through a rules-based engine,
      or component of a rules-based engine, in the MMIS/DSS/PBM.
   3. During the course of the Contract, the Contractor will measure performance using the Performance
      Reporting System. State Contract management staff will actively participate with the Contractor in the
      performance reporting process and will approve the results recorded.
   4. Performance measurements will be reviewed by the State and the Contractor on a quarterly basis to
      assess any measurements that should be changed, added or deleted for the next reporting period.
   5. An independent, accredited auditing firm will review all audit reports on an annual basis, at no
      additional cost to the State.
   6. Reports will include staffing reports on all named and categorized staff.

4.8.1         Performance Standards

Indicated below are the performance standards established at the time the RFP was published.


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4.8.1.1         Provider Performance Standards

The performance standards for the provider enrollment and relations functions are provided below.

4.8.1.1.1     State Inquiries
    1. Respond to questions from the State concerning provider and client enrollment, claims and other
        operations issues within one business day.

4.8.1.1.2   Provider Database Maintenance, Update and Edit
    1. Update provider data received electronically within one business day of receipt of file.
   2. Perform on-line updates to provider data within one business day of receipt of the update.
   3. Maintain a 98% accuracy rate for on-line update transactions.
   4. Identify and correct errors within one business day of error detection.
   5. Provide backup documentation for provider database updates to DPHHS within one business day of
      the written request for the documentation.

4.8.1.1.3     Provider Licensure and Certification
    1. Update the Provider database with licensing updates at least twice a month for providers licensed by
        Department Of Labor and Industry (DOLI) or other Montana licensing agencies with on-line interfaces.
   2. Update the Provider database with licensing/certification information for Providers licensed by agencies
      for which there is no on-line interface at least annually.
   3. Verify Provider licensure and eligibility to provide services to Montana Health Care Program Clients
      when out of State providers apply for enrollment. Licensure verification will be at Contractor cost if
      applicable.
   4. Validate the licensing update process within two business days of application of the update
      transmission.
   5. Resolve licensing transactions that fail the update process within two business days of error detection.
   6. Refer to the State all licensing transactions and OIG sanctions that fail the update process and cannot
      be resolved by Contractor staff pursuant to edit update rules or State-approved procedures within two
      business days of attempted error resolution.

4.8.1.1.4    Automated Voice Response System (AVRS) and FAXBACK
    1. Provide sufficient in-bound access lines so that AVRS users:
          a. Are connected with the AVRS system within three rings at least 99% of the time.
          b. Report the call abandonment rate, which shall not exceed 5% maximum
          c. Are connected to the FAXBACK machine 95% of the time on the first attempt.
          d. Receive AVRS/FAXBACK response within 10 seconds of entry of required information (provider ID,
             client ID, etc.) at least 99% of the time.
          e. Receive a busy signal less than 5% of the time they call.


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       f.   Are not dropped and do not receive a busy signal in excess of 1% of the total daily call volume.
       g. Are successfully transferred to live assistance at the customer service call center in less than 120
          seconds of the request to transfer.
   2. The AVRS/FAXBACK must be available 24-hours a day, seven days a week with an allowance for
      scheduled maintenance time as agreed upon by the State.
   3. Resolve all AVRS/FAXBACK system downtimes caused by the AVRS/FAXBACK hardware, software,
      or other components under the Contractor’s control, within 30 minutes of initial notification of system
      failure. If the system is not in service within that time frame, the Contractor shall provide an alternative
      AVRS/FAXBACK system to ensure that system downtime is limited to a maximum of 30 consecutive
      minutes.
   4. Alert appropriate department MMIS staff in the event of AVRS/FAXBACK system failure as soon as
      problem is identified.
   5. Maintain and retain for 24 months electronic records of all AVRS/FAXBACK inquiries made, information
      requested, and information conveyed.
   6. Make updates to the AVRS/FAXBACK recorded messages/prompts/responses within two business
      days of receiving a request from the department, unless otherwise directed by the department.

4.8.1.1.5     Provider Enrollment
    1. Send enrollment application packets to provider within two business days of receipt of request by
        provider.
   2. Screen and review enrollment applications for accuracy, validity, and completeness within two business
      days of receipt from provider.
   3. Contact provider within two business days of receipt of incomplete enrollment application explaining
      additional information required.
   4. Process completed provider enrollment applications received and send notification information to
      providers within 10 business days from date of receipt of a completed application.

4.8.1.1.6      Provider Relations
    1. Screen and resolve pended and denied claims within 10 business days from identification of a provider
        requiring proactive support.
   2. Respond to at least 98% of telephone inquiries during the initial call from the provider.
   3. Resolve 98% of inquiries from the Provider or the State within 24 hours and answered within three
      business days. If the inquiry cannot be answered in three business days, a resolution date must be
      communicated to the provider or the State within 24 hours of the inquiry.
   4. Announce and make available via web site, for printing by the Provider, all new or updated provider
      manuals within three business days of written approval by the State.
   5. Print and mail Provider manuals and updates or bulletins within three business days of receipt of a
      request from a Provider.




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   6. Send print ready documentation of newsletters, bulletins, inserts or other special mailings to the
      Contracted print vendor within five business days of written approval by the State.
   7. Publish updates on the provider web site within one business day of the date of DPHHS written
      approval for publication.
   8.      Publish remittance advice messages within one payment cycle from the date of DPHHS approval of
          the message.
   9. Produce and distribute new publications and publications with extensive changes in final form no more
      than 60 calendar days from the date of DPHHS written request for the new or updated publication or
      the date changes proposed by the Fiscal Agent were approved by DPHHS.
   10. Deploy surveys by web Portal within two days of State approval.

4.8.1.1.7    Provider Education
    1. Provide the annual training plan to DPHHS by July 15 of each year of the Contract.
   2. Solicit provider input to training topics through the newsletter by 90 days prior to the training.
   3. Develop and update professional training materials for use in seminar and web-based delivery and
      provide appropriate department staff with hard and electronic copies of all training materials for review
      and approval at least 45 days prior to semi annual training sessions.
   4. Develop and update professional training materials for use in seminar and web-based delivery and
      provide hard and electronic copies to department staff no less than 30 days prior to unplanned training
      sessions unless change implementation necessitates faster implementation.
   5. Provide a monthly report on provider education and provider relations activity by the fifth business day
      of the month for the previous month’s activity using the automated tracking capability.

4.8.1.1.8   Provider 1099 Production
    1. Produce and transfer to SABHRS by January 15 of each calendar year a file for provider 1099s.

4.8.1.1.9       Care Management Provider Relations Performance Standards
    1. 100% of all eligible candidates will be mailed the initial recruitment letter and Contract within two weeks
        of notification.
   2. Monthly enrollee lists will be made available to the provider via the web Portal prior to the first of the
      month.
   3. 98% of provider changes will be entered into MMIS accurately within two business days of receipt.
   4. Enter 95% of provider changes into the provider database accurately.
   5. Enter 95% of provider changes into the provider database timely.
   6. Maintain a positive rating from at least 80% of provider training/visit attendees.

4.8.1.2         Telephone Response

The response time for all calls from providers and clients including the PBM help desk must be as follows:


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   1. Sufficient staff and lines shall be provided, including a minimum of eight toll-free lines, so that average
      call waiting time (i.e., on hold) shall not exceed one minute, 30 seconds.
   2. No more than 5% of incoming calls may ring busy.
   3. 95% of all calls that do not ring busy must be answered on or before the fourth ring.
   4. 95% of calls that are answered must be answered by a live person.
   5. Hold time must not exceed two minutes for 95% of calls.
   6. The average hold time must not exceed 30 seconds.
   7. Report the call abandonment rate, which shall not exceed 5% maximum.
   8. Utilize same telephone system for both provider relations and client help line and have the ability to
      record and report statistics separately.
   9. Provide voice messaging system for after hours callers indicating hours of operation and provide
      options for leaving messages in addition to voice messaging option at State designated intervals during
      the queue hold times. Scripts to be approved by the State.
   10. Provide State approved educational scripts for callers on hold or waiting in queue.
   11. Review scripts monthly to determine if revisions are necessary and report recommendations to State.
   12. Monitor, record, and audit calls for quality control, customer service, program integrity, and training
       purposes. Contractor shall document and retain results on all calls and submit documentation to the
       State upon request.

4.8.1.3        Reference Performance Standards
    1. Update pricing changes to the drug formulary file within one business day from receipt of update from
        pricing authority.
   2. Update the Clinical Laboratory Improvement Amendments (CLIA) laboratory designations within one
      business day of receipt of file.
   3. Perform on-line updates to reference data within one business day of receipt.
   4. Process and update procedure, diagnosis, and other electronic files to the reference databases within
      five business days of receipt or upon a schedule approved by the State.
   5. Provide update error reports and audit trails to the State within one business day of completion of the
      update.
   6. Update the edit and audits documentation within three business days of the request from DPHHS.
   7. Update error text file documentation within three business days of DPHHS approval of the requested
      change.
   8. Maintain a 98% accuracy rate for all reference file updates.
   9. Identify and correct errors within one business day of error detection.




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4.8.1.4           Pharmacy Benefit Management

The performance standards for the Pharmacy Benefit Management functions are provided below.

4.8.1.4.1      Pharmacy POS Performance Standards
    1. The Pharmacy POS shall provide on-line response notifications to providers within 10 seconds of
        receipt of incoming claim transactions.
   2. The Pharmacy POS shall provide POS function availability 24 hours a day, seven days a week, with
      exception of maintenance downtimes.
   3. The Pharmacy POS will notify the State within 24 hours of any claims processing errors/problems
      identified.
   4. The Pharmacy POS will comply with all standards relating to system outages as provided in other
      Sections of this RFP.

4.8.1.4.2   Drug Rebate Performance Standards
    1. Update the manufacturer rebate data within five days of receipt of the update from CMS.
   2. Generate and mail invoices to manufacturers within five days of the receipt of the CMS drug rebate
      tape.
   3. Generate initial collection letters to non-responding manufacturers 38 days from the mailing date of the
      invoice.
   4. Collect at least 90% of the total of accounts receivables outstanding at the beginning of the quarter plus
      invoices issued during the current quarter by the end of the current quarter.
          a. DRAMS (in general)
             i.   Maintain the DRAMS server
             ii. Load CMS tape quarterly
             iii. Update DRAMS nightly
             iv. Update Provider file weekly
             v. Load claims weekly
             vi. Update the weekly US T-Bill rate

4.8.1.5        Client Performance Standards
    1. Update the Client eligibility database with electronically received data, and provide DPHHS with update
        and error reports within 24 hours of receipt of the update. The update will start within two hours of
        receipt and updates must be done prior to daily claims processing.
   2. Maintain a 99% accuracy rate on electronic eligibility file updates.
   3. Resolve eligibility transactions that fail the update process within two business days of error detection.




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   4. Refer to the State all eligibility transactions that fail the update process and cannot be resolved by
      Contractor staff pursuant to edit rules or State approved standards within two business days of
      attempted error resolution.
   5. Reconcile the MMIS eligibility data with the all State eligibility Systems daily, and provide DPHHS with
      reconciliation reports within 24 hours of receipt of the reconciliation file.
   6. Produce Client mailing labels within three business days of receipt of the request.
   7. Provide access to archived and purged data within three business days of receipt of the request.
   8. Respond to at least 98% of telephone inquiries during the initial call from the Client.
   9. Respond to written, faxed, or emailed inquiries within three business days of receipt.
   10. Prepare and deliver in final form updates to publications to DPHHS for review and approval within three
       business days of the date requested by DPHHS or the date changes proposed by the Fiscal Agent
       were approved by DPHHS.
   11. Publish updates on the Fiscal Agent web site within two business days of the date of DPHHS written
       approval for publication.
   12. Participate in meetings as requested by DPHHS.
   13. Provide monthly performance reports on call center activity.
   14. Produce, and submit to Medicare, the daily file regarding Medicare Modernization Act (MMA)/dual
       eligibles file.
   15. Upload Client data to the Web Portal nightly available for Client download.
   16. Assure 99% accuracy of Client data available for Client access to their own data through the Web
       Portal.
   17. Produce and submit a daily coordination of benefits file – adds/updates/deletes to the Coordination of
       Benefits Contractor.

4.8.1.6     EPSDT Performance Standards
    1. Accept and update EPSDT screening data from claims on a daily basis.
   2. Produce and distribute EPSDT reports meeting EPSDT program standards in accordance with the
      schedule set by the State.
   3. Produce and distribute EPSDT outreach letters in accordance with requirements set by the State.
   4. Track unmatched referrals for follow-up and reporting.
   5. Track immunization records of recipients by interfacing with Immunization Registry.

4.8.1.7      Managed Care Performance Standards

4.8.1.7.1    Client Enrollment Performance Standards
    1. Voluntary enrollment rate into the Care Management program is 75% or greater.
   2. 100% of enrollment forms entered into MMIS within three business days of receipt.


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   3. 100% of telephone enrollments entered into MMIS within one business day of receipt unless the system
      is down.
   4. 98% accuracy on all enrollment forms.
   5. 100% of all clients that were assigned were also mailed a reminder letter 10 days after enrollment letter
      is sent.
   6. 100% of Lock-In clients are assigned providers, or DPHHS notified within three business days of the
      reason for inability to assign 90% of the time or greater, auto-assignment is run no later than six
      business days before cut-off.

4.8.1.7.2   Client Outreach and Education Performance Standards
    1. 98% of client enrollment packets have required components.
   2. 90% of welcome and enrollment packets are mailed to clients within the business day that the file is
      received, and 100% within the second business day.
   3. 80% of clients are contacted and give education during enrollment period through 30 to 60 days post
      initial listing on the eligibility file (Contractor and DPHHS will work together to define an acceptable
      method for calculating the client outreach rate, and may include parameters such as telephone contact,
      web Portal evaluation and paper-based evaluation).
   4. 98% of preventive packets for clients that are eligible each week are mailed by the end of the week
      prior to their birthday.
   5. 98% of preventive packets are compiled accurately for the intended client (age specific).
   6. 95% accuracy will be met on all outgoing outreach calls.
   7. 98% of new "Lock-In" clients will receive a welcome letter no later than 10 days before cutoff date.

4.8.2        Prior Authorization (PA) Performance Standards
   1. Enter all hard copy PA requests that have been approved or denied into the MMIS within one business
      day of receipt.
   2. Enter approved or denied PAs received from other agencies and Contractors that contain no critical
      errors into the MMIS within one business day of receipt.
   3. Return 100% of PA requests with critical errors (i.e., the PA does not contain enough information to
      process the request) to the submitter within one business day of identification of the critical error.
   4. Generate and mail or electronically transmit 98% of prior authorization decisions to the requesting
      provider and the recipient (for denials) within one business day of the adjudication of the prior
      authorization request. Generate and mail the remaining 2% within three business days of adjudication
      of the request.
   5. Complete all PA interface updates within one business day of receipt of a file if there are no critical
      errors.
   6. Generate all error reports within one business day of the interface or file update.
   7. Resolve 98% of all Contractor errors (as identified on error reports) within five business days of
      generation of the error report and the remaining 2% within 10 business days.


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4.8.3        Claim Adjudication Performance Standards
   1. Notify provider of all Electronic Media Claims (EMC) claims that were rejected as a result of front-end
      editing within 24 hours of receipt.
   2. 90% of all claims must be adjudicated for payment or denial within seven business days of receipt.
   3. 99% of all claims must be adjudicated for payment or denial within 30 calendar days of receipt.
   4. 100% of all claims must be adjudicated for payment or denial within 60 calendar days of receipt.
   5. 100% of all clean provider-initiated void and or replacement claims must be adjudicated within five
      business days of receipt.
   6. All EMC claims, including Medicare crossover claims, must be processed in the next daily cycle after
      receipt.
   7. For claims submitted on tape or diskette, notify the provider within one business day of receipt when
      claims cannot be processed and include the reason for the rejections in the notice.
   8. For claims submitted via the Web Portal return an electronic receipt and/or notification within four
      business hours of receipt.
   9. Return hard copy claims which fail the mailroom prescreening process within one business day of
      receipt.
   10. Notify provider of the rejection of electronic claims which fail the prescreening process within one
       business day of receipt.
   11. Log, image and assign a unique control number to every claim, attachment, adjustment/void, prior
       authorization and other documents submitted by providers within one business day of receipt.
   12. Data enter all hard copy claims including voids and replacements within three business days of receipt.
   13. Resolve all rejected batches within three business days of the rejection.
   14. Produce and provide to DPHHS all daily, weekly and monthly claims entry statistics reports within one
       business day of production of the reports.
   15. Provide access to imaged documents to all users within one business day of completion of the imaging.
       Response time for accessing imaged documents at the desk top must not exceed 10 seconds.
   16. Claims processed in error must be reprocessed within 10 business days of identification of the error or
       upon a schedule approved by the State.
   17. Produce and submit to the State balancing and control reports that reconcile all claims input to the
       processing cycle to the output of the cycle by the next business day following the cycle.
   18. Maintain at least a 98% keying accuracy rate for data entered and OCR documents.
   19. Maintain a 99% accuracy rate for electronic claims receipt and transmission.
   20. Respond within 2.5 seconds of receipt with a TA1 or other HIPAA-compliant acknowledgement
       transaction response approved by the State when errors occur in the interchange envelope (ISA/ISE) of
       HIPAA-compliant electronic transaction batch transmissions.



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   21. Respond within 60 seconds of receipt of HIPAA-compliant electronic transaction set batch
       transmissions to provide positive and negative acknowledgement response for each segment within the
       HIPAA transaction.
   22. Respond within 60 seconds of receipt of all other electronic batch transmissions to provide positive or
       negative acknowledgement response.
   23. Contractor must produce mass adjustments at the request of the State within five business days of the
       request.
   24. Mass adjustments prepared by the Contractor must be approved through two levels (one Contractor,
       one State) within five business days of creation.
   25. Mass adjusted claims approved by the State must be adjudicated for payment within one business day.
   26. On-line mass adjustment generated by a State user must process for approval within one business day
       of submission of mass adjustment criteria.
   27. Financial transactions initiated by Contractor or the State must be adjudicated within one business day
       of submission of entry of the financial transaction data.
   28. Obtain the annual DRG grouper and quarterly OPPS grouper from the vendor, modify it to the State
       calibrations, and install the grouper by the effective date or within 15 workdays of receipt.

4.8.4        Claims Payment Performance Standards
   1. Transmit payment file to DOA by 8:00 p.m. on the day of the payment processing cycle.
   2. Provide payment cycle reports to DPHHS by 12:00 p.m. on the day following the payment processing
      cycle including daily processing cycles.
   3. Process the payment file from DOA and update the claims data by 8:00 a.m. on the day following
      receipt of the file.

4.8.5        Financial Services Performance Standards
   1. Deposit refund checks daily.
   2. Provide deposit ticket and check log to the State within one business day of the deposit.
   3. Enter all cash receipts and refunds to the accounts receivable module within one business day of
      receipt.
   4. Process returned warrants within three business days of receipt.
   5. Process emergency payment requests within one business day of receipt of request.
   6. Federal reports must be produced at time intervals and in the format specified required by DPHHS.

4.8.6        Quality Assurance Performance Standards
   1. Identify deficiencies and provide the State with a 1) report of the problem within one business day of
      discovery, and 2) Corrective Action Plan within 10 business days of discovery of a problem found
      through the internal quality control reviews.




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   2. Perform quality control sampling that includes monthly audits of the operations described in Attachment
      F, Operational Requirements, and weekly audits of a statistical sample of adjudicated claims.
   3. Produce and distribute reports in accordance with the schedule specified in the Quality Management
      Plan developed in accordance with Section 4.5.3.3.5.
   4. Within five business days, document, notify the State, and implement plans for improvement for any
      areas of operations identified by the State or Contractor as not meeting performance standards.
   5. Produce and distribute Fiscal Agent report card by the fifteenth of each month following the previous
      month.

4.8.6.1       Quality Assurance/Improvement – Provider Enrollment and Relations
    1. Monitor quality and work toward continued quality improvement in all areas related to Provider
        Enrollment and Relations. In addition to provisions otherwise included in this Section, the following
        monitoring and reporting requirements must be met:
   2. Notify the department immediately of any significant failure (or factor that may otherwise signal
      impending failure) to properly carry out the business and other required functions contained within this
      Provider Enrollment and Relations Section.
   3. Provide information from reviewers independent of the staff performing the provider services functions
      and provide capability to monitor or record communication with providers via operator calls and training
      sessions for quality assurance purposes.
   4. Monitor activities, maintain and review data including statistics showing reasons for calls, claim
      editing/errors, and initiate enhancements to reduce the number, duration, and manual processing time
      for claims and calls through better automation, better provider and/or staff training, or other
      interventions.
   5. Report on quality in performance reports to department; include comparison quality measures in current
      and previous reporting periods.
   6. Initiate, document and implement at the Contractor’s own initiative, plans for improvement for any
      function when quality deteriorates for two consecutive months.
   7. Document and implement Corrective Action Plans when requested by the Department.
   8. Provide support for survey of customers (providers, trading partners, other), including printing survey
      forms/web completion support, selection of providers, distribution, data results collection and reporting,
      analysis and summary of survey results. Customer satisfaction surveys are to be conducted at least
      quarterly at the direction of the State.

4.8.7         DW/DSS Performance Standards
   1. Update DW/DSS on a daily basis from the MMIS and all data sources. Balancing and validation reports
      must be prepared and submitted to DPHHS to demonstrate the update was successful.
   2. Resolve all DW/DSS data load errors within one business day of identification of the error.
   3. Resolve DW/DSS functionality errors within five business days of identification of the error.
   4. DW/DSS application availability is defined as are all system components with the same daily
      availability, performance standards, and maintenance timeframes as the MMIS system.

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4.8.7.1        Reports Performance Standards
    1. The following performance standards apply to all reports generated by the MMIS, PBM or DSS. All
        standard production reports must be available on line for review by DPHHS staff pursuant to the
        following schedule:
        a. Daily reports – the following business day.
        b. Weekly reports – by the next business day after the scheduled production date.
        c. Monthly reports – by the third business day after month end cycle.
        d. Quarterly reports – by the fifth business day after quarterly cycle.
        e. Annual reports – by the 10th business day after year end cycle (State fiscal year, Federal fiscal
           year, waiver year or calendar year).
        f.   Balancing reports are to be provided to DPHHS within two business days after completion of the
             MARS production run.
   2. 98% accuracy is required on all MMIS reports. The Contractor is expected to identify and correct any
      errors on reports. For report errors identified by DPHHS, the Contractor has 10 business days to
      correct the error.

4.8.7.2     Surveillance and Utilization Review Performance Standards
    1. Produce and distribute reports in accordance with the schedule approved by the State.
   2. Produce and mail client Explanation of Benefits (EOB) by the 15th calendar day of the month.
   3. Perform adjudicated claims sampling assessment and provide outcome reports to the State within five
      business days of month end.
   4. SURS Support Analyst shall be present at State office during days and hours specified by State.
   5. Provide SURS training to State staff by SURS Support Analyst as specified by State.

4.8.8          TPL Performance Standards
   1. Contractor TPL unit obtains and discovers client TPL information from claims reports reflecting claims
      with TPL information present on the claim from the MMIS (including pharmacy claims); from possible
      insurance coverage related information from providers; from possible coverage by an absent parent
      information from the Child Support Division of DPHHS; from information regarding SSI determination
      and availability of other health insurance; and from various data matches with Insurance Companies
      and others to assist in discovery of other insurance. Contractor is responsible for the following tasks:
        a. Working the reports and provider information within 10 business days of receipt and entry of TPL
           information into the Medicaid Eligibility System.
        b. Contacting the client and/or provider to gather other insurance information within 15 business days
           of receipt.
        c. Completing the TPL updates within 30 business days.
   2. There are limited circumstances where the Contractor is unable to determine the extent of third party
      liability or is required to pay for services prior to the other liable third party. In these circumstances the

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        Contractor will generate monthly billing to other payers for services paid by Medicaid as a result of pay
        and chase. Contractor is responsible for the following tasks:
        a. Generating, screening and mailing the monthly bills within 10 days of notification of amount due
           (Preferred method of billing is electronic).
        b. Generating second billing within 30 days of the initial billing for carriers that did not respond to the
           initial billing.
        c. Generating a third and final billing with copies to the DPHHS and the Insurance Commissioner
           within 30 days of the second billing for carriers that did not respond to either billing.
        d. Collecting or processing by the other health insurer at least 90% of the total carrier billings for three
           month time period by the end of the next three month time period.
   3. Generate an initial trauma questionnaire from the MMIS within 10 business days of notification of a
      trauma claim.
   4. If no response from the initial trauma questionnaire, generate the second request to be sent to the OPA
      County Directors or other entity identified by the State 14 days after the original questionnaire.
   5. Close coverage in the Medicaid Eligibility system within 10 days of notification of no TPL coverage.
   6. Complete verifications and enter information into the Medicaid Eligibility system within 30 days of
      identification for all coverage accessible via on line, fax or phone. Carriers only accessible via a letter
      will be resolved within 60 days.
   7. Review claims pended to the TPL unit for special handling related to denials, issues with payment from
      other payers, or other TPL research within two business days.
   8. Update the Medicaid Eligibility system with any appropriate TPL information as a result of
      documentation submitted with a claim the on the same day as the claim is handled by the Contractor
      TPL unit.
   9. Respond to providers, clients, insurance companies and local Office of Public Assistance offices
      telephone, email and fax TPL inquiries by phone, written or email within one business day.
   10. Enter new TPL carriers or modify existing information as required within three business days of
       receiving the information.
   11. Identifying claims that should have been paid by Medicare, reversing the claim, recovering the funds
       from the previously paid provider, and preparing a report of reversed claims to the State within 30
       business days of identifying a retroactive Medicare span in the event a client has a Medicare
       entitlement span entered retroactively.

4.8.9         Web Portal Performance Standards
   1. Provide a web Portal, available to State, Provider, Drug manufacturer, and Client users 24 hours per
      day, seven days per week.
   2. Web Portal must be of sufficient capacity to enable usage by 1,000 users concurrently.
   3. Update Frequently Asked Questions (FAQ) within two business days of receipt of approval by the
      State.
   4. Review Frequently Asked Questions monthly and recommend changes, deletions, and additions.

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   5. Provide help desk personnel to respond to user questions Monday through Friday from 7 AM to 6 PM.
   6. Prepare, and deliver to DPHHS for final review, client and provider survey formats annually by July 1.
   7. Deploy surveys by web Portal within two business days of State approval.
   8. Provide for secure, ―once only‖ responses and summarize within five business days of completion of
      survey.
   9. Post remittance advice concerning paid, denied and suspended claims on web Portal within one
      business day of the completion of an adjudication cycle.

4.9           Actual and Liquidated Damages
The Contractor is obligated under this Contract to provide the State with an MMIS/PBM/DSS that, as
determined by the State, is fully operational, compliant with Federal requirements pertaining to the
MMIS/PBM/DSS and compliant with the further requirements of this Contract inclusive of those requirements
appearing in incorporated documents and referenced standards. Failure of the Contractor to deliver a system
in conformance with the applicable requirements and to do so on a timely basis would cause the State great
harm both in relation to compliance with Federal mandates and to the delivery through this Contract in an
appropriate and timely manner of medical and other services to persons eligible for Montana Health Care
program. Upon such a failure the State would have to pursue anew the procurement of the services
encompassed by the Contract. The damages resulting from the Contractor's failure to deliver to the State a
functional and acceptable MMIS/PBM/DSS and to do so in a timely manner, can not be fully and completely
calculated. Consequently, the compensation of the State for failure of the Contractor to deliver the
MMIS/PBM/DSS, to the extent that those damages can not be calculated with specificity, is to be in liquidated
damages.

The availability of recovery by the State of liquidated damages does not preclude the State from obtaining
actual damages under this Contract from the Contractor in those circumstances where the amount of damages
can be calculated with specificity.

Failure of the Contractor in the course of the development of the MMIS/PBM/DSS to perform particular
services in an appropriate and timely manner may result in the State being harmed in significant ways that
cause damages to the State. Liquidated and actual damages for specific failures in delivery by the Contractor
are set forth in subsections 4.9.1 through 4.9.22.

4.9.1         Transfer of Named Staff Proposed Requirements

The Contractor will maintain all proposed Named Staff throughout each phase of the Contract (Analysis and
Design; Development, Testing, Data Conversion and Training; Implementation, Operations, Certification and
Turnover). In addition, the Contractor will maintain all Named Operating Staff for two years from the start of
Operations Phase. Only after the first two years of operations will the Contractor be allowed to request the
replacement of any Named Staff, subject to prior approval of the State. Named Staff are identified in Section
4.3.

―Divert‖ or ―diversion‖ is defined as the transfer of Key Personnel by Contractor or its subcontractors to another
assignment within the control of Contractor or such subcontractor. ―Divert‖ or ―diversion‖ does not include the


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removal of an employee pursuant to a request by State, or the resignation, death, disablement, or dismissal or
removal for cause of an employee or for other reasons which are beyond the control of Contractor or its
subcontractors.

4.9.1.1       Liquidated Damages

Diversion of Named Staff will cause significant damage to State that would be difficult to estimate. Therefore,
any such diversion of any Named Staff identified in Section 4.3.1 and the Named Operations Staff identified in
Section 4.3.4, the Account Manager or Operational Systems Manager will result in the imposition of liquidated
damages in the amount of $2,000 per business day for each diverted Named Staff. Diversion of any other
Named Staff identified in 4.3.2, 4.3.3, or 4.3.4 will result in the imposition of liquidated damages in the amount
of $1,000 per business day or each diverted Named Staff.

4.9.2         Named Staff Vacancy Requirements

Positions that are designated as Named Staff shall not remain vacant for more than 30 calendar days. A
permanent replacement must be named within the 30 calendar days of the date the position becomes vacant.
Named Staff positions shall not be filled with employees who are acting in a temporary capacity and also
maintain responsibilities for another position for more than 30 days after vacancy. No position may be filled
with a temporary appointee for more than 30 calendar days in any one year period.

Named Staff are identified in Section 4.3.

4.9.2.1       Liquidated Damages

The liquidated damages will be $500 per workday for each day that the Contractor fails to meet this
requirement.

4.9.3         Categorized Staffing Levels Requirements

The Contractor will maintain the minimum number and levels of qualified staff specified in its proposal and in
the proposed staffing for managing future modifications and enhancements required by Section 4.2.7.2.2 and,
in all other respects meet the staffing requirements of Section 4.3.5 and the personnel requirements of Section
4.3.7.

4.9.3.1       Liquidated Damages

Staffing levels of categorized staff are subject to State audit at any time during the Operations Phase of the
Contract. If the audit reveals staffing levels of more than 5% below the requirements of the Contract, liquidated
damages will be assessed as the sum of amounts derived by multiplying the number of hours for which the
positions were vacant by the rate identified in Schedule C for each vacant position.

4.9.4         Performance Reporting System Report Requirements




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The Contractor must provide a monthly performance report produced by the Performance Reporting System in
a manner acceptable to the State, as specified in Section 4.8, within 14 business days after the end of the
reporting month.

4.9.4.1       Liquidated Damages

The liquidated damages for failure to provide the report timely or in a manner acceptable to the State will be
$500 a day for each workday the report is not received or acceptable.

4.9.5         Provider Activation Prior to Meeting Eligibility Requirements

The Contractor is responsible for enrolling providers according to the rules established by the State that
include but are not limited to: licensure, background check, training and site visits.

4.9.5.1       Actual Damages

The Contractor must pay the State the actual damages incurred by the State that result from the Contractor's
improper enrollment of a provider that does not meet all the requirements of enrollment. The actual damages
are the total of the sums of monies that were paid by the Department to the improperly authorized provider
during the period that the provider did not meet all the requirements for enrollment. The Contractor has the
right to recover such payments from the provider.

4.9.6         Ineligible Client Enrollment Requirements

The Contractor is responsible for enrolling clients in benefit plans in accordance with data sent by the State’s
designated eligibility systems or other written directives provided by the State.

4.9.6.1       Actual Damages

The Contractor will be assessed actual damages that result from the enrollment of a client in a benefit plan if
there is no data from a State designated eligibility system or other written State directive to support the
eligibility for benefit plan for any period. Actual damages will be measured based on the payments made for
services rendered to the client during a period of ineligibility for the benefit plan.

4.9.7         System Certification and Performance Review Requirements

The Contractor will ensure that MMIS Federal certification is achieved and continued throughout Operation
Phase of the MMIS. The Contractor is responsible for meeting any new or modified Federal standards,
conditions or functional requirements for the operation of the MMIS.

The Contractor will provide all support requested by the State during certification and any recertification
conducted by CMS and by the State. The support will include assisting the State and CMS in sample
selections, document and data gathering, and responding to CMS and State questions.

4.9.7.1       Actual Damages



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The Contractor must pay the State the actual damages incurred by the State, during the course of the
MMIS/PBM/DSS development and implementation and upon completion of the MMIS/PBM/DSS, if CMS does
not fully compensate the State at the maximum allowable Federal financial participation rate for the
MMIS/PBM/DSS and its components as delivered by the Contractor. The actual damages are the difference
between the total of the sums of monies actually received from CMS by the Department and the total of the
sums of monies that could have been received by the Department at maximum allowable Federal financial
participation rate.

4.9.8         Documentation Requirements

The Contractor is responsible for providing to the State complete, accurate, and timely system, user, and
provider documentation of the operational MMIS/PBM/DSS. Such documentation must be produced according
to the specifications described in Section 4.2.3. In addition to the required hard copies, the MMIS/PBM/DSS
documentation will be maintained on the Contractor’s Web Portal.

One copy of updated documentation and on-line documentation must be provided to the State in final form
within 60 business days prior to the beginning of the operations task.

The Contractor must update documentation with all modifications and modernizations that are made to the
system after the initial delivery of the documentation. One copy of updated documentation must be provided to
the State in final form within 15 business days of the State’s approval of the implementation of the change. On-
line documentation must be posted within three business days of the State’s approval of the documentation.

4.9.8.1       Liquidated Damages

The State will assess liquidated damages of $100 for each workday that complete documentation is not
submitted or is unacceptable to the State.

4.9.9         Claims Entry

All claims must be entered into the system within three business days of receipt of the claim.

4.9.9.1       Liquidated Damages

The State will assess liquidated damages of $1,000 for each day for which less than 95% of the total claims
received three or more days previously have not been entered into the system.

4.9.10        Correctness of Payments Requirements

All payments made through MMIS must be made on behalf of eligible clients, to enrolled, eligible providers, for
approved services, and in accordance with the payment rules and other policies of the State.

4.9.10.1      Actual Damages

If an overpayment or duplicate payment is made to a provider or any other entity and that payment is the result
of Contractor error then the Contractor will be liable for the immediate reimbursement to the State for the actual


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overpayment or duplicate payment. The Contractor has the right to recover such overpayments or duplicate
payments from the provider.

4.9.11        Data Conversion Requirements

The Contractor must cleanse and convert all data from the State’s existing MMIS, DSS and PBM necessary to
operate MMIS/PBM/DSS/PBM and produce comparative reports for previous periods of operation. Data
conversion must be completed before the parallel and user acceptance testing period begins, and must be
applied before implementation.

4.9.11.1      Liquidated Damages

The State will assess liquidated damages of $1,000 for each workday that data conversion is not completed or
applied as Stated above. Data conversion must be approved by the State before it is considered complete and
before it is applied.

4.9.12        Milestones or Phases Requirements

Unless otherwise specified, milestones and phases that occur during the Planning, Design, Development,
Testing, and Implementation Phases must be completed by the Contractor in final form as required in Section
4.2 on the dates specified in the Contractor's work plan including written acceptance of all milestones or
phases.

4.9.12.1      Liquidated Damages

The liquidated damages will be $1,000 per workday for each day the milestone or phase is late or
unacceptable.

4.9.13        Project Management Requirements

Unless otherwise specified, milestones and projects must be completed by the Contractor in final form on the
dates specified in the Contractor's work plan for the project including written acceptance by the State.

4.9.13.1      Liquidated Damages

The liquidated damages will be $1,000 per workday for each day the milestone or phase is late or
unacceptable.

4.9.14        Data Communications Requirements

The Contractor will provide connection to the State’s network as described in Section 4.2.5. Failure to provide
this connection must be remedied immediately upon notification by the State.

4.9.14.1       Liquidated Damages
The liquidated damage for failure to remedy a lack of network connection will be $1,000 per hour after four
hours of notification by the State, if lack of connection occurs as a result of Contractor error or omission.


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4.9.15        EDP Audit Requirements

The Contractor will have completed by October 1 of each year an electronic data processing (EDP) systems
audit using SAS (Statement of Accounting Standards) 70.

The Contractor must respond to each SAS 70 audit with a proposed Corrective Action Plan within 30 calendar
days of the audit, if necessary.

The Contractor must complete implementation of the State approved Corrective Action Plan within 40 calendar
days of approval unless otherwise specified by the State.

4.9.15.1      Liquidated Damages

The State will assess liquidated damages of $100 per workday or any part thereof beyond October 1 of each
year that the audit is not completed to the State’s satisfaction; $100 per workday or any part thereof beyond
the 30 calendar day requirement for submitting a Corrective Action Plan which is satisfactory to the State; and
$100 per workday or any part thereof beyond the 40 calendar day requirement for implementing the Corrective
Action Plan.

4.9.16        Sponsorship Requirements

Any publicity, concerning this Contract, including, but not limited to, notices, information pamphlets, press
releases, research, reports, signs, and similar public notices prepared by or for the Contractor will contain a
Statement indicating sponsorship by the Contractor and the State. The language of the Statement will be
specified by the State after the Contract is awarded.

4.9.16.1      Liquidated Damages

The liquidated damages will be $5,000 per incident in which the State approval is not obtained.

4.9.17        Record Retention and Access Requirements

The Contractor will maintain and will make available within three business days of request all records
described in Section 4.7.

4.9.17.1      Liquidated Damages

The liquidated damages will be $300 per request per work day or any part thereof for failure to produce
requested records.

4.9.18        Back Up Site/Data Requirements

In the event of a natural or man-made disaster all data/files must be protected in an off-site location as
specified in Privacy and Security Business Continuity Plan/Disaster Plan requirements. The Contractor must
provide an alternate business site if the primary business site becomes unsafe or inoperable. The business


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site must be fully operational within five business days of the primary business becoming unsafe or inoperable.
See Attachment F, Operational Requirements, for requirements for disaster recovery and back up. The
Business Continuity Plan must include operational requirements for temporary operations in light of power
outages of any duration.

4.9.18.1      Liquidated Damages

The liquidated damages for failure to provide the backup site/data will be $10,000 per day for each day that the
backup site is not fully operational.

4.9.19        System Capacity Requirements

The Contractor must maintain the system capacity to operate MMIS/DSS/PBM without interruption, except for
scheduled down-time, and meet all operational requirements and process all claims and transactions in a
timely manner. The following are indications that the system is operating below capacity:
    1. Delays or interruptions in the operation of MMIS/DSS/PBM and related services caused by inadequate
       equipment or processing capacity.
   2. System not available for use by State or Contractor staff at all times except for scheduled downtime.
   3. Inability to adjudicate to a paid, denied, or suspended status, all claims received by the Contractor
      within one business day of receipt.
   4. Frequent delays of more than five seconds in screen response time.
   5. Web Portal not available for use at all times except for scheduled downtime.
   6. Provide sufficient processing/storage for the creation of reports and predicative modeling and
      sophisticated data analysis by State staff.

4.9.19.1      Liquidated Damages

If the system is operating below capacity based on these measurements and the Contractor fails to correct the
capacity issues within one business day, liquidated damages will be assessed at $2,000 per day.

The Contractor must maintain the system capacity to complete all jobs in a scheduled cycle. The processing
cycle must be completed each night to allow the system to be available each morning by 7:00 a. m. Mountain
Time, for inquiry and update.

4.9.20        Confidentiality and HIPAA Compliance Requirements

The Contractor must deliver, maintain, and operate MMIS/PBM/DSS and all other Deliverables under the
Contract in full compliance with all Federal and State legal authorities governing the confidentiality of personal
information including Medicaid and Health Insurance Portability and Accountability Act (HIPAA) regulations.
The HIPAA requirements are specified in Attachment B, Contract.

The Contractor is responsible for compliance with these confidentiality requirements in its development,
implementation, and on-going administration of the MMIS/PBM/DSS and any other Deliverables under the
Contract regardless of the Contractor's status as either a covered entity or a business associate of the State.

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4.9.20.1      Actual Damages

The Contractor must compensate fully the State the actual damages incurred by the State in the form of
administrative penalties applied by Federal authorities for failure of the Contractor to implement and administer
the operation of the MMIS/PBM/DSS and any other Deliverables under the Contract in compliance with HIPAA
and other Federal and State confidentiality law requirements. The Contractor must also compensate the State
for the actual damages incurred by the State in the form of damages and other costs of litigation awarded
through the courts against the State based on legal actions brought in tort for violations of confidentiality arising
out of the implementation and administration by the Contractor of the MMIS/PBM/DSS and any other
Deliverables under the Contract. The Contractor must also pay to the compensate the State for any payments
the State must make under any formal settlement agreed to by the State in settlement of legal actions brought
in tort for violations of confidentiality arising out of the implementation and administration by the Contractor of
the MMIS/PBM/DSS and any other Deliverables under the Contract.

4.9.21        Correction of Deficiencies Identified by the State

4.9.21.1      Requirements

If the State identifies deficiencies in the Contractor’s performance of requirements as described in the RFP, not
otherwise addressed in other liquidated or actual damages provisions, the State will require the Contractor to
develop a Corrective Action Plan (CAP) within 10 business days. The Corrective Action Plan will be reviewed
by the State within five business days and modified by the Contractor in five business days.

4.9.21.2      Liquidated Damages

The liquidated damages shall be equal to $500 per day for each day that the Corrective Action Plan is late or
not acceptable to the State and $1,000 per day for each day that the deficiency is not corrected, past the date
specified in the approved CAP or not acceptable to the State.

4.9.22        Inadequate Performance Requirements

In addition to the damages specified above, damages may be assessed if the Contractor fails to meet other
Contract requirements and fails to submit and/or implement a successful Corrective Action Plan. The
performance criteria will have a performance measure and scoring mechanism established in this Contract
through negotiation with the Contractor.

A Corrective Action Plan (CAP) will be required for performance measures that fall below Contract
requirements. The Contractor will submit the CAP to the State within 10 business days of notification. The
CAP must meet State approval. Liquidated and actual damages will be assessed for performance measures
that fail to occur within CAP specified times or do not meet requirements established in the CAP.

4.9.22.1       Liquidated Damages
The liquidated damages shall be equal to $500 per day for each day that the Corrective Action Plan is late or
not acceptable to the State and $1,000 per day for each day that the deficiency is not corrected, past the date
specified in the approved CAP or not acceptable to the State.


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4.9.23        Deduction of Damages from Payments

4.9.23.1      Liquidated Damages

Amounts due the State as liquidated damages may be deducted by the State from any money payable to the
Contractor pursuant to this Contract. The State will notify the Contractor in writing of any claim for liquidated
damages at least 30 calendar days prior to the date the State deducts such sums from money payable to the
Contractor. Such amounts as they relate to Section 4.9.7 may be deducted during the entire period that MMIS
certification is lacking. Should certification subsequently be granted retroactively, the State will reimburse the
Contractor for any amounts that have been withheld due to lack of certification.

4.9.23.2      Actual Damages

Amounts due the State as actual damages may be deducted by the State from any money payable to the
Contractor pursuant to this Contract. The State will notify the Contractor in writing on or before the date the
State deducts such sums from money payable to the Contractor.

4.10          Additional Services
The State reserves the right to acquire additional services during the Contract period from the Contractor for
related activities that are outside the scope of the Contract or for system enhancements that cannot be
accomplished by the system and business analysts required under Section 4.3. These services will be
obtained through Contract amendments. Should the services include additional staffing, the cost will be
determined based on the Contractor’s hourly rate Stated in the Schedule C of the Cost Proposal. If the
Contractor accomplishes these additional services without adding staff there will be no additional payment for
this staff.

DPHHS will present a written request for additional services to the Contractor, in a standard format to be
designated by DPHHS. The request will explain the scope of the project and the tasks the agency desires the
Contractor to perform, including applicable business and technical specifications.

The Contractor must respond (within a prescribed number of days mutually agreed upon by the State and the
Contractor) to each request with a draft response which provides a Statement of cost (based upon the
hourly/daily rates specified on the pricing pages) and time, technical and strategic alternatives, and solution
recommendations. The Contractor’s final PAQ must include:
   1. Brief title of Additional Services.
   2. A detailed itemization and description of all of the project tasks that shall be completed by the
      Contractor (i.e. project work), including requirements for and specified frequency of any required status
      reports; the specified project tasks and Deliverables must be clearly Stated and must be quantifiable.
   3. The firm, fixed total number of project hours for each of the Contractor’s personnel classification
      assigned to the project and the firm, fixed cost (based upon the hourly/daily rates specified in schedule
      C of the Cost Proposal).




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5.           PROPOSAL INSTRUCTIONS
The State discourages overly lengthy and costly proposals; therefore, brochures or other presentations,
beyond that sufficient to present a complete and effective proposal, are not desired. Elaborate artwork or
expensive paper is not necessary or desired. Audio and/or videotapes are not allowed. Offeror proposals
including audio or videotapes will be deemed non-responsive and rejected. In order for the Proposal Evaluation
Committee (PEC) to evaluate proposals completely, Offerors must follow the format set out below to provide all
requested information. The use of tabs as specified in this Section is required.

The format and content requirements for each Section of the technical proposal are described below. The
technical proposal shall include complete responses to all required items listed under each heading. Without
providing overly lengthy descriptions, the proposal must provide clear descriptions and/or responses so that
the PEC members can adequately evaluate the Offeror’s response and intent. Offerors are advised to follow
the defined format. The evaluation of technical proposals will follow the submission format.

Each technical proposal (including all copies) shall be clearly page numbered on the bottom of each page and
submitted in three-ring binders. Offeror’s proposal may include 11 by 17-inch pages. All pages must have one-
inch (or more) margins at the top, bottom, left and right sides of each page and with text in at least 11-point
font size. A smaller font size may be used for graphics and Microsoft Project WBS text.

The executive summary in Tab 1 is limited to 25 pages.

Resumes for named staff shall be limited to no more than five pages for each resume.

An Offeror’s proposal shall conform to the following requirements and be prepared according to the instructions
in this Section.

The Offeror shall submit its Technical and Cost proposals in accordance with the terms of Section 1.6 and this
Section.

5.1          Technical Proposal Instructions
The Technical Proposal shall include the following Sections separated by tabs.
       Tab 1      Title Page and Summary
        Tab 2      Proposal Security
        Tab 3      Corporate Background and Experience
        Tab 4      Overall Technical Approach
        Tab 5      Technical Approach to Design and Development
        Tab 6      Technical Approach to Implementation
        Tab 7      Technical Approach to Operations
        Tab 8      Technical Approach to MMIS Certification
        Tab 9      Approach to Technical Architecture Requirement

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         Tab 10      Technical Approach to MMIS Enhancements
         Tab 11      Technical Approach to Turnover
         Tab 12      Performance Bond

5.1.1          TAB 1 – Title Page and Summary

Tab 1 shall be labeled Title Page and Summary and shall include the following information:
   1. Title Page:
        a. RFP number.
        b. Title of proposal.
        c. Offeror’s name.
        d. Name, title, phone number, fax number, mailing address and email address of the person who can
           respond to inquiries regarding the proposal.
        e. Name of project director.
   2. Transmittal Letter:
        The transmittal letter shall be submitted on official business letterhead by the prime Offeror. The
        original of the transmittal letter, including original signature of an individual authorized to bind the
        Offeror to the provisions of the RFP, shall be submitted within the original version of the technical
        proposal. A copy of the letter shall be included in each technical proposal. All transmittal letters shall
        include the following:
        a. The complete name and address of the firm and the name, mailing address, e-mail address, and
           telephone number of the person the State should contact regarding the proposal.
        b. A Statement that the Offeror accepts the Contract terms and conditions contained in this RFP,
           including the Attached Contract. Exceptions to any the RFP language, requirements, or conditions
           must be reflected in this Statement. All exceptions must be identified and fully described in a
           separate attachment to the proposal and include any suggested alternatives and language. The
           State reserves the right to reject proposals as non-responsive based on exceptions taken by an
           Offeror and is not bound to accept or negotiate any suggested alternatives.
        c. A Statement that the Offeror complies with the all applicable local, State, and Federal laws, codes,
           and regulations.
        d. A Statement that the Offeror does not restrict the rights of the State or otherwise qualify their
           proposal.
        e. A Statement declaring onsite staffing in Montana, as well as other system development support
           completed and managed at the Offeror’s central offices or other locations, will be as approved by
           the State.
        f.   A Statement that no attempt has been made or will be made by the Offeror or its Sub-Offeror(s) to
             induce any other firm or person to submit or not to submit a proposal in response to this RFP.
        g. A Statement that cost or pricing information has not been included in this letter, nor in the entire
           technical proposal.

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    h. A Statement that the Offeror certifies that in connection with this procurement the prices proposed
       have been arrived at independently, without consultation, communication, or agreement, as to any
       matter relating to such prices with any other Offeror or with any competitor for the purpose of
       restricting competition.
    i.   A Statement indicating whether or not the Offeror, Sub-Offeror, or any individuals proposed to work
         on the project have a possible conflict of interest (e.g., employed by the State of Montana) and, if
         so, the nature of that conflict.
    j.   A Statement indicating that the Offeror commits to producing a Turnover Plan when instructed to do
         so and to fully cooperating in implementing a turnover when required.
    k. If a proposal with Sub-Offerors is submitted, the Offeror must submit a Statement indicating that the
       Offeror will perform at least 45% of the amount of work for the entire project. This percentage is
       measured in terms of the total price of the Contract. The Offeror must provide the following
       information concerning each prospective Sub-Offeror in an appendix to the proposal:
    l.   Complete name of the Sub-Offeror.
    m. Complete address of the Sub-Offeror.
    n. Type of work the Sub-Offeror will be performing.
    o. Percentage of work the Sub-Offeror will be providing.
    p. Evidence that the Sub-Offeror presently holds a valid Montana business license.
    q. A Statement that clearly verifies that the Sub-Offeror is committed to render the services required
       by the Contract.
    r.   A general description of the scope of work to be performed by the Sub-Offeror.
    s. The Sub-Offeror’s assertion that it does not discriminate in its employment practices.
    t.   This appendix must be signed by an individual authorized to legally bind the Sub-Offeror.
    u. A Statement that identifies whether or not the concept of this proposal’s prime Offeror is as a joint
       venture. If it is a joint venture, a copy of the joint venture agreement must be included in the
       appendix which identifies the principles involved, and their rights and responsibilities regarding
       performance and payment.
    v. A Statement that the Offeror acknowledges the State’s commitment of State staff for this project as
       set forth in Section 4.2.1.1 and recognizes that the Contractor will be required to submit a work plan
       to based on this State staff commitment.
3   Executive Summary
    The proposal shall be responsive to all requirements of the RFP and include a beginning narrative
    containing information that indicates an understanding of the overall need for and purpose of the project
    as presented in the RFP. Offerors should include in the executive summary a list of suggested Offeror
    operation locations from which the State may select for a site visit in the evaluation phase.




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5.1.2         TAB 2 – Proposal Security

Each proposal must be accompanied by security made payable to the State of Montana. The security shall be
in an amount of not less than 20% of the total bid/offer, in one of the forms listed below. ONLY THE
FOLLOWING TYPES OF SECURITY ARE ACCEPTABLE AND MUST BE IN ORIGINAL FORM. FACSIMILE,
ELECTRONIC, OR PHOTOCOPIES ARE NOT ACCEPTABLE.
      (a) A sufficient bond from a surety company licensed in Montana with a Best's rating of no less than A-
          and supplied on the State of Montana's designated form found at
          http://www.mt.gov/doa/gsd/procurement/forms.asp and entitled "Bid or Proposal Bond"; or
      (b) Lawful money of the United States; or
      (c) A cashier’s check, certified check, bank money order, bank draft, certificate of deposit, or money
          market certificates drawn or issued by a Federally or State-chartered bank or savings and loan
          association that is insured by or for which insurance is administered by the FDIC or that is drawn
          and issued by a credit union insured by the National Credit Union Share Insurance Fund.
          Certificates of deposit or money market certificates will not be accepted as security for bid, proposal
          or Contract security unless the certificates are assigned only to the State. All interest income from
          these certificates must accrue only to the Contractor and not the State.
      (d) Personal or business checks are not acceptable.

Any vendor failing or refusing to enter into a subsequent Contract shall forfeit said security. State warrants will
be issued to unsuccessful Offerors who submit negotiable forms of security.

5.1.3         TAB 3 – Corporate Background and Experience

Tab 3 shall be labeled Corporate Background and Experience and include the corporate background and
experience for the Offeror and each subcontractor (if any); details of the background of the company, its size
and resources, details of corporate experience relevant to the proposed Fiscal Agent Contract, financial
Statements, and a list of all current or recent MMIS, PBM, and DSS related projects. The specific role of any
subcontractor must be identified.

The proposal shall include evidence of the Offeror’s and subcontractor’s capability by describing its
organizational background and experience to include:
   1. Corporate Background:
        Background information of the corporation, its size, and resources shall cover:
         a. Name of Offeror or subcontractor.
         b. Date established.
         c. Ownership (public company, partnership, subsidiary, etc.).
         d. Corporation’s Federal Employer's Identification Number (FEIN).
         e. Corporation’s primary line of business.
   2. Corporate Financial Statements:
        Offerors shall demonstrate their financial stability to supply, install, and/or support the services specified
        by: (1) providing financial Statements, preferably audited, for the three consecutive years immediately


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   preceding the issuance of this RFP, and (2) providing copies of any quarterly financial Statements that
   have been prepared since the end of the period reported by its most recent annual report. NOTE: The
   State cannot guarantee that this requested information can be held confidential if such a claim is made.
   (See Section 2.2)
   Internal Control Assessment: Financial and IT Service Organization’s Internal Control Assessment
   Offerors responding to solicitations related to Financial and IT Services must provide assurance they
   have effective Internal Controls over the processing of transactions included as part of this RFP. As a
   service organization, Offerors must demonstrate they have adequate controls and safeguards over data
   and transactions maintained and processed on behalf of the State.
   SAS70 Requirement: Offeror must submit a ―Report on the Processing of Transactions by Services
   Organizations‖, as defined in Statement on Auditing Standards No. 70 (SAS70).
   SAS70 Frequency: The State expects service organizations to provide a SAS70 Audit which covers
   Internal Controls for at least six months (SAS70, Type II Audit) Offeror must disclose the frequency of
   all SAS70 Audits. Contractor will be required to provide the State future SAS70 audits completed
   during Contract period.
3. Corporate Experience:
   The details of corporate experience, to include all Medicaid Contracts (including subcontractors), within
   the last five years, relevant to the proposed Fiscal Agent Contract shall cover:
     a. Experience with large-scale data processing system development (medical claims, MMIS, PBM
        and DSS or otherwise).
     b. Experience with the operation of a large-scale data processing system (medical claims, MMIS,
        PBM, and/ or DSS or otherwise).
     c. Experience with MMIS, PBM and/or DSS (indicate clearly which projects demonstrate experience
        with system design and development, implementation, operation, modification, certification, or
        turnover).
     d. Experience with multiple benefit plan administration.
     e. Experience with Web Portal development and operations.
     f.   Experience with rules engine implementation and operation.
     g. Experience with Prescription Benefit Management (PBM) and other Benefit Management Plan
        development and operations.
     h. Experience with Decision Support System (DSS).
     i.   Experience working directly with managed care providers, HMOs, etc.
     j.   Experience as a Fiscal Agent or fiscal intermediary.
     k. Experience with other health care systems.
4. Corporate References:
   For each referenced project, the Offeror and subcontractors shall provide the following items, one
   project per page:
     a. Name of Offeror

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         b. Reference
         c. Firm/Agency Name
         d. Address
         e. Contact Person
         f.   Name/Title
         g. Phone Number
         h. Project Dates
         i.   Title of the Project
         j.   Start and End Dates of the Original Contract
         k. Total Contract Value
         l.   Average Staff Hours in FTEs During Operations
         m. Transaction Processing Volume
         n. Brief Description of Scope of Work

5.1.4          TAB 4 – Overall Technical Approach

Tab 4 shall be labeled Overall Technical Approach and include the Offeror’s overall technical approach to the
items listed below for each aspect and phase of this Contract. The response in this Tab must cover the
Offeror’s overall technical approach to the requirements specified in this Section, at a minimum:
    1. Discuss the Offeror’s general approach to address the Contract Phases described in Section 4.2
        according to the State’s priorities.
   2. Discuss the Offeror’s general approach to address the facility requirements in Section 4.4
   3. Discuss the Offeror’s general approach to address the requirements in Section 4.5, Project
      Governance:
         a. PMBOK
         b. Information Technology Iterative Project Management
         c. Separation of Duties
         d. Financial Control
         e. Security
         f.   Quality Control
         g. Project Management
         h. General Contract Management
   4. Discuss the Offeror’s general approach to address the requirements in Section 4.6, Deliverable
      Procedures and Standards.
   5. Respond in detail to the Offeror requirements in Sections 4.6, Deliverable Procedures and Standards.

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5.1.5         Technical Approach Instructions

Each phase of the Contract is described in Tabs 5 through 11, which contain the Offerors approach to the
technical requirements of this RFP. For each phase the Offeror must fully describe the following:
    1. Details of the Offeror’s approach to Project Management specific to each phase of the Contract shall be
       included in Tabs 5 through 11. These details shall cover:
         a. Project management approach for each phase.
         b. Authority of project manager for each phase;
         c. Project control approach, including reporting to the State.
         d. Work hours and time estimating methods.
         e. Sign-off procedures and internal quality control for completion of all Deliverables and major
            activities.
         f.   Assessment of project risks and anticipated problem areas and Offeror's approach to managing
              them.
         g. Approach to routine problem identification and resolution.
         h. Interfaces with the State.
         i.   Approach to Quality Control.
         j.   Assumptions and constraints associated with the phase.
         k. Use of walk-throughs for each major task.
   2. Work Plan and Schedule: The Offeror must include a work plan and a schedule for the performance of
      each phase in Tabs 5 through 11. The schedule must include State tasks and allow adequate time for
      State approval of each deliverable. The Agency expects the Offeror to provide a detailed work plan
      produced in Microsoft Project that will track Deliverables, tasks, milestones and resources.
      Additionally, the Offeror will be expected to participate in detailed project management meetings that
      will report the status of Deliverables, tasks, milestones, resources, project risks, and action items for the
      entire Contract start-up process. The work plan and schedule must include:
         a. A narrative overview of the work plan tasks and schedule, including any assumptions and
            constraints the Offeror used in the development of the work plan.
         b. Description of each task, subtask, and activity.
         c. A Work Breakdown Structure (WBS) in Microsoft Project or an alternative acceptable to the State
            identifying all tasks, subtasks, milestones and Deliverables with key dates for each associated
            with the DDI phase of the project. The work must be decomposed into tasks that allow for
            accurate estimation of the work and resources required to complete the Project. Any task that
            requires more than 80 hours or 10 workdays to complete must be further decomposed. The
            Project Plan must include dependencies, begin and end dates and duration estimates for each
            task in the WBS; the sequence of tasks, including identification of the critical path; and the
            method to be used by the Offeror to control time spent on the Project. Resources must be
            allocated by name or by type to the WBS.


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     d. Proposed location for activities to be performed.
     e. Personnel resources applied by name and level of effort in hours.
     f.   State resource requirements.
     g. Gantt chart.
     h. PERT or dependency chart.
     i.   Resource matrix by subtask, summarized by total hours per person, per month.
     j.   Each of the items set forth in Section 4.5.3.3.2 Project Plan.
     k. Any assumptions or constraints identified by the Offeror, both in developing and completing the
        work plan.
     l.   Person weeks of effort (in maximum of two-week units) for each sub-task.
     m. A discussion of how the work plan provides for handling of potential and actual problems.
     n. A schedule for all Deliverables providing adequate review time by the State, revision time if
        needed, and subsequent review time.
     o. Since the RFP is organized by business areas, it is a requirement that system design activities be
        organized by business area to facilitate requirements traceability and to simplify State resource
        availability.
3. Technical approach to the phases: In preparing the response to Tabs 5 through 11 the Offeror shall not
   simply provide Statements that the requirements of the RFP will be met. Offerors must respond
   concisely but fully with their approach and how they will comply with the requirements the RFP. The
   Offeror must respond to all of the requirements in the RFP, explaining their technical approach,
   identifying tools to be used, describing staffing commitments and explaining in detail how they will meet
   all requirements, as they apply to each phase.
   Offerors should assemble the best overall solution to each major task required to design, develop, and
   operate the MMIS/PBM/DSS. To that end, Offerors are encouraged to enter into partnerships with firms
   that have the greatest expertise and most innovative solutions for the major components of the system,
   e.g., MMIS, PBM, DSS, system design, and development etc., and describe how the partners are
   integrated into a seamless solution.
     a. Project Organization and Staffing:
          Include the project organization and staffing for each phase for the Offeror and each subcontractor
          (if any): project team organization charts of proposed personnel, the number of FTE proposed, and
          resumes of all staff specified in Section 4.3.
     b. Organizational Charts:
          Proposals shall specify the number of experienced staff that will be working on each phase of this
          project and describe the organizational structure. The organizational charts shall include:
               (1) All proposed individuals for whom resumes are included, identifying their major areas of
                   responsibility during each task, percent of time dedicated to the MMIS/PBM/DSS and
                   location where work will be performed; and



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               (2) Total number FTE personnel for each unit, by staff level, for each unit of staff shown on
                   the organizational chart.
     c. Resumes
         Individual resumes must be supplied for the named management positions identified in each
         phase. The appropriate resumes for other professionals must be supplied at the State’s request.
         Resumes must show employment history for all relevant and related experience and all education
         and degrees (including specific dates, names of employers, and educational institutions).
         Individuals whose resumes are included in the proposal must be available to work on this Contract.
         Individuals proposed for the named positions and other key professional positions must meet the
         minimum training and experience specified in Section 4.3.
     d. Resume Contents:
         The resumes of such personnel proposed shall include:
               (1) Experience with Offeror (or subcontractor to Offeror)—list number of years and positions
                   held.
               (2) Experience with Medicaid claims processing systems.
               (3) Experience with development and operation of large-scale data processing systems.
               (4) Project management experience.
               (5) Experience with other medical claims processing systems.
               (6) Other data processing experience.
               (7) Relevant education and training, including college degrees, dates and institution name
                   and location.
               (8) Names, positions, and phone numbers of a minimum of three clients, within the past five
                   years who can give information on the individual's experience and competence. If the
                   individual has not worked for three different clients in the last five years, provide three
                   references that can give information on the individual’s experience and competence.
                   References must not be from employees of the same company.
               (9) Each project listed in a resume must include the following:
                  (a) Full name, title, and (current) telephone number of a client reference for the last five
                      years, including the current project of the staff person.
                  (b) Start and end dates of the referenced project.
                  (c) Position(s) of the individual within the project organization.
                  (d) Brief description of the individual's responsibilities.
4. All Deliverables and correspondence produced in the execution of this RFP must be clearly labeled
   with, at a minimum, project name, deliverable title, deliverable tracking or reference number, version
   number and date.
5. The State requests that Offerors develop a Cross Reference between the proposal and the RFP
   requirements in Section 4, and attachments E, F, and G using the format described in Appendix 6.


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5.1.6         TAB 5 – Technical Approach to Design and Development

Tab 5 shall be labeled Technical Approach to Design and Development and include a detailed discussion of
the Offeror's approach to the Design and Development Phase. The response must address these components
of the phase:
    1. Planning:
        A draft schedule must be included in response to this RFP. See Section 4.2.1 and 4.5.3.3 for complete
        instructions on the details to be covered in the planning and management of the phase.
   2. Systems Analysis and Design Phase:
        The Offeror must describe the approach completing the Contractor’s responsibilities during the analysis
        and design phase and producing the Deliverables required under Section 4.2.2:
         a. Updated RFP documents.
         b. Requirements Specification Document.
         c. Requirements Traceability Matrix and Repository.
         d. Detailed Systems Design Document.
         e. MMIS/PBM/DSS Glossary.
   3. Development Phase:
        The Offeror must describe the approach completing the Contractor’s responsibilities for the development
        tasks and for producing the Deliverables required under Section 4.2.3:
         a. System documentation.
         b. User electronic documentation.
         c. Provider electronic documentation.
         d. Development and unit testing.
         e. Contingency Plan to Mitigate Development Risks.
   4. Software/Hardware:
        The Offeror must describe the approach to meeting the system requirements in Attachments E and G,
        Systems Requirements Matrix, and providing the following information for each system requirement:
         a. Agree/Not Agree to meet as Stated (Yes/No)
         b. Existing Capability (Yes/No)
         c. Agree to meet through System Modification (Yes/No)
         d. Propose Alternate Process (Yes/No)
         e. Referenced Proposal Section for description of Bidder System or proposed solution capability
            (enter the Section number)
         f.   How solution obtained (Custom or COTS)


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     g. Estimated Hours if Custom development (number hours for custom development)
   The Offeror must describe the approach completing the Contractor’s responsibilities for hardware and
   software configuration and for producing the Deliverables required under Section 4.2.3.2.1.
5. Comprehensive Testing Plan for Design and Development:
   The Offeror must describe the approach completing the Contractor’s responsibilities for each testing
   step and for producing the Deliverables required under Section 4.2.4.
     a. Test cases/scripts and completed systems test.
     b. Integration test cases/scripts and completed integration test.
     c. Regression test cases/scripts and completed regression test.
     d. Load/stress test cases/scripts and completed load/stress test.
     e. Capacity analysis document.
     f.   Performance tuning document.
     g. UAT Plan.
     h. Written certification that UAT data has been provided.
     i.   User acceptance test cases/scripts and completed user acceptance test.
     j.   UAT defect tracking report.
     k. UAT final report.
     l.   Operational readiness test cases/scripts and completed operational readiness test.
     m. Operational readiness test report.
     n. Finalized proposed test environment(s) specifications.
     o. Contingency Plan to Mitigate Testing Risks.
6. Data Cleansing and Conversion Task:
   The Offeror must describe the industry standard data conversion tools proposed to facilitate data
   conversion and the strategy to completing the Contractor’s responsibilities for data conversion and
   cleansing and for producing the Deliverables required under Section 4.2.5:
     a. Updated data cleansing plan.
     b. Data cleansing specification document.
     c. Updated data conversion plan.
     d. Contingency Plan to mitigate data conversion risks.
     e. Approach to parallel runs between MMIS and MMIS/PBM/DSS.
     f.   Data conversion specification document.
     g. Updated data conversion requirements document.
     h. Data conversion checklists.


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         i.    Data reconciliation procedures.
         j.    Conversion software readiness certification letter.
         k. Conversion programs.
         l.    Conversion and reconciliation of data.
         m. Data conversion test scripts.
         n. Convert and reconcile data for implementation.
         o. Conversion reports.
         p. Data conversion test results report.
        The Offeror is responsible to meet the overall deadlines for this implementation; therefore, the Offeror
        must include a description of its strategy and methodology for dealing with the situation where unit tests,
        structured data tests, operation readiness tests or parallel tests fail to produce the desired results in
        response to this RFP. The State will place special scoring emphasis on the Offeror’s control and
        management of project risks in this phase of the project.
   7. Training:
        The Offeror must describe the approach completing the Contractor’s responsibilities for training and for
        producing the Deliverables required under Section 4.2.6:
         a. Update organizational assessment and gap analysis.
         b. Training Plan/schedule including train-the-trainer plan and schedule.
         c. Electronic training documentation.
         d. Training database and application software.
         e. Letter certifying training database is built and software is operational.
         f.    Document version control plan.
         g. Conduct training.
         h. Letter certifying completion of training.
         i.    Evaluation survey tools.
          j.   Training report.

5.1.7          TAB 6 – Technical Approach to Implementation

Tab 6 shall be labeled Technical Approach to Implementation and include a detailed discussion of the Offeror's
approach to the Implementation Phase. The response must address these components of the phase:
   1. Implementation Planning Task:
       The Offeror must create and submit for State approval a schedule for assumption of all Fiscal Agent
       processes and include a draft schedule in response to this RFP. The Offeror must describe the
       approach completing the Contractor’s responsibilities for Implementation Planning and for producing the
       Implementation Plan required under Section 4.2.7.1.


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   2. Implementation Tasks:
        The Offeror must describe the approach completing the Contractor’s responsibilities for implementation
        and for producing the Implementation Plan required under Section 4.2.7.1.

   Contractor Deliverables

Deliverables to be produced by the Contractor for the implementation task must include the following for each
phase of delivery:
         a. Report distribution schedule.
         b. Software release plan.
         c. Emergency back out plan.
         d. Backup and recovery plan.
         e. Hardware, software, and facility security manual.
         f.   Final implementation checklist.
         g. Final documentation and policy manuals.
         h. Final transition plan.
         i.   Signed implementation certification letter.
         j.   Final implementation report.

5.1.8         TAB 7 – Technical Approach to Operations

Tab 7 shall be labeled Technical Approach to Operations and include a detailed discussion of the Offeror's
approach to the Operations Phase. The Offeror must operate MMIS/PBM/DSS and perform all functions
described in Attachment F, Operational Requirements, from the date of implementation of each component
until each function is turned over to a successor Fiscal Agent at the end of the Contract, including any
extensions. Offerors must respond concisely but fully with their approach and how they will comply with the
requirements of the RFP. The Offeror must respond to all of the requirements in the RFP, explaining their
technical approach, identifying tools to be used, describing staffing commitments and explaining in detail how
they will meet all requirements. Specifically the Offeror must:
    1. Acknowledge all information contained in the Overview, and State Responsibilities Interfaces, Inputs,
        Outputs in Section 4.
   2. Respond in detail to every Contractor Responsibilities item in Section 4.
   3. Respond in detail to the Offeror requirements in Sections 4.3 and 4.4, Staffing and Location of Work.

5.1.9         TAB 8 – Technical Approach to MMIS Certification

Tab 8 shall be labeled Technical Approach to MMIS Certification and include a detailed discussion of the
Offeror's approach to the MMIS Certification Phase. The response must address requirements of Section
4.2.9.



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5.1.10        TAB 9 –Approach to Technical Architecture Requirements

Tab 9 shall be labeled Technical Architecture and include a detailed discussion of the Offeror's approach to
meeting the architecture requirements in Attachment E, Architectural Requirements. This Section must identify
what percentage of the business object will be executed in the rules engine and which percentage will rely on
programmed business logic.

5.1.11        TAB 10 – Technical Approach to MMIS Enhancements

Tab 10 shall be labeled Technical Approach to MMIS Enhancements and include a detailed discussion of the
Offeror's approach to the implementation of the MMIS enhancement required in 4.2.10:
    1. Electronic Health Records.
   2. Payroll System for managing tax and benefit withholding for personal care workers.
   3. Capability to support managed care programs including generation of capitation payments and
      processing of encounter data from the managed care organizations.

5.1.12        TAB 11 – Technical Approach to Turnover

Tab 11 shall be labeled Technical Approach to Turnover and include a detailed discussion of the Offeror's
approach to meeting all requirements in Section 4.2.11.

5.1.13        TAB 12 – Performance Bond

Tab 12 shall be labeled Performance Bond. Offeror shall explicitly state agreement to provide a Contract
performance security bond based upon 100% of the Contract total within 10 working days from the Request for
Documents Notice. This security must remain in effect for the entire term of the Contract. No pricing
information is to be Stated in this Tab, only the Offeror’s agreement to supply the performance bond in the
amount required.

5.2           Cost Proposal Instructions
Offerors shall propose a firm fixed price for each of the requirements contained on the pricing schedules within
this Section. All Pricing Schedules provided in this RFP shall be submitted as part of the Cost Proposal. No
cost information shall be included in the Technical Proposal. The requirements and schedules are:
    1. Summary of Total Proposal (Pricing Schedule A).
   2. Systems Planning, Design, Development, Testing, and Implementation Price Components (Pricing
      Schedule B).
   3. Systems Planning, Design, Development, Testing, and Implementation Price (Pricing Schedule B-1).
   4. Operational Price Summary (Pricing Schedule C).
   5. Operational Price Components (Pricing Schedules C1-C8).
   6. Price for Additional Managed Care Functionality (Pricing Schedule D).
   7. Price for Electronic Health Record (EHR) Price (Pricing Schedule E).

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   8. Price for Payroll System (Pricing Schedule F).

Required formats for the pricing schedules that shall be used by Offerors in preparing their Cost Proposals are
included later in this Section.

5.3           General Requirements for the Cost Proposal
5.3.1         Total Systems Planning, Design, Development, Testing, and Implementation Price

The total Systems Planning, Design, Development, Testing, and Implementation price as set forth in Pricing
Schedule B will include the combined sums for all activities to complete the requirements set forth in Sections
4.2.1 through 4.2.7.

The Contractor will be paid according to the payment terms in the Consideration and Payments Section of
Attachment B, Contract.

5.3.2         Operations Price

The pricing schedules prepared for Fiscal Agent operations shall include all prices for all activities associated
with the operation and modification of the MMIS/PBM/DSS as set forth in Section 4.2.8 as well as the
requirements set forth in Sections 4.2.9 and 4.2.11. The resulting firm fixed price per month (Pricing Schedule
C, Line 2, columns B through G) will be paid according to the payment terms in the Consideration and
Payments Section of Attachment B, Contract.

The operations firm fixed price per month shall be calculated assuming a projected average monthly client
count as specified in Section 5.7. For the purpose of this Section, a "client" is defined as an individual who is
eligible for a month under at least one benefit plan. If a client is enrolled in multiple benefit plans, the client is
counted only once. The benefit plans and clients enrolled in these plans may vary as defined by the State
legislature. The State may also modify the services provided under a plan or may modify the services paid by
the MMIS/PBM/DSS. This action may alter the number of claims processed without changing the client count.
If the actual average monthly client count and/or annual adjudicated claim volume is higher or lower than the
projected ranges in Section 5.7, the monthly payment will be adjusted in accordance with the terms of Section
5.7.

A monthly report produced by the DSS will be defined during DDI for the purpose of determining the number of
members per month and the annual claim volume.

5.3.3         MMIS Enhancement Prices

The pricing schedules prepared for MMIS Enhancements shall include the full price for all activities associated
with the modification of the system to meet the requirements of Section 4.2.10. The Contractor will be paid
according to the payment terms established at the time the State authorizes the Contractor to begin work on
each enhancement.




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5.3.4         Signature Block

All pricing schedules must be signed and dated by an authorized corporate official.

5.4     Pricing Schedule A - Summary of Total Proposal
   1. Line 1 presents the Offeror’s price for all System Planning, Design, Development, Testing, and
      Implementation activities.
   2. Line 2 presents the Offeror’s Operational Price.
   3. Line 3 represents the Additional Managed Care Functionality Price.
   4. Line 4 represents of Electronic Health Records (EHR) Price.
   5. Line 5 represents of Payroll System Price.
   6. Line 6 represents the Total Contract Price.

5.5           Pricing Schedule B - MMIS/PBM/DSS Planning, Design, Development,
              Testing, and Implementation Price Components
Pricing Schedule B shall include the total cost components of System Planning, Design, Development, Testing,
and Implementation.

Instructions for completing Pricing Schedule B:
    1. Offerors are required to furnish detailed price information used in deriving the proposed price for each
        of the categories and subcategories shown on the detailed Pricing Schedule B. The total price on
        Pricing Schedule B shall be allocated to Pricing Schedule B-1 using the percentages shown on each
        line.
   2. Offerors are required to indicate the specific number of full-time equivalent personnel in each of the
      subcategories and the average hourly rate of pay including benefits on Lines 1a-1u. The prices shown
      on the schedules are to be the total annual salary and benefits necessary for this phase of the Contract.
      The number of specific levels of personnel and their associated prices must agree with the work effort
      and staffing levels proposed in the Technical Proposal.
   3. Telephone prices for equipment and line charges, including toll free lines.
   4. If a price category is not already shown on Schedule B, Line 1 through Line 8, Offerors are to indicate
      the category under the Section headed Other, Line 9. Offerors should list any subcontractor amounts
      under the Section headed Other, Line 9.

5.6           Pricing Schedule B-1 - MMIS/PBM/DSS Planning, Design,
              Development, Testing, and Implementation Price
Pricing Schedule B-1 presents the prices from Schedule B, Price Components. The total of Line 13, Column C
must equal the total of Line 10, Pricing Schedule B.




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The Offeror shall compute the total MMIS/PBM/DSS Planning, Design, Development, Testing, and
Implementation price for each milestone by multiplying the percentages in Column B by the total of Line 10,
Pricing Schedule B.

The total price from Pricing Schedule B-1, Line 11, column C shall be entered in Pricing Schedule A, Line 1.
   1. For the purpose of completing line 1a, the following positions will be considered management:
           a. Account Manager
           b. Operational Systems Group Manager
           c. Claims Operations Manager
           d. PBM Operations Manager
           e. Quality Assurance Manager for Operations
           f.   Provider/Client Relations Manager
           g. Program Support Manager
           h. Third Party Liability (TPL) Manager
   2. For the purpose of completing line 1c the following positions will be considered management:
           a. Manager for Project Management Office
           b. Project Management Specialists
           c. Implementation Planning Manager
           d. Quality Assurance Manager for Implementation
           e. Data Conversion Manager
           f.   Interface Manager
           g. Testing Manager
           h. Manager for Design and Development

5.7             Pricing Schedules C - Operational Prices
Pricing Schedule C is a summary of prices for all operational costs, presented in the State fiscal years from
July 1, 2011, through June 30, 2019, excluding costs for the Electronic Health Records (EHR), Payroll System
and Managed Care Functionality identified in Section 4.2.10.

Offerors shall propose a firm fixed price per month for each year of the Contract period and each extension
year. The Offeror's propose cost shall be based upon a projected average monthly member count of between
90,000 and 110,000 and an annual adjudicated claim volume of 6.2 to 6.8 million. This amount shall be
entered in line 1 of Pricing Schedule C and must equal the amount entered for the "Total Price All
Components" from Pricing Schedule C1-C9, Line 10. The amount entered on line 2 Price per Month (Line 1/12
months) will be the amount paid each month of the Contract and possible extension years. The amount
entered on line 3 shall be the eight Year Average Price per Month and is for informational purposes only.



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Actual average monthly client count and annual adjudicated claim volume may be higher or lower than the
projected ranges. For average monthly client count higher (or lower) than the projected range, the Offeror
must State on lines 4.1 through 4.3 a firm price the fixed additional price per increment of 5,000 clients or part
thereof, which shall be credited if client count is lower than projected range. Should the average monthly client
count be within the projected range as adjusted for changes in client count, but the annual adjudicated claim
volume higher than the projected volume, the Offeror must State on and 5.1 through 5.3 a firm, fixed additional
price per increment of 250,000 claims or part thereof, which shall be credited if adjudicated claim volume is
lower than projected range. In any year there is an adjustment for client count, the projected adjudicated claim
volume range will be adjusted by adding and subtracting 250,000 claims per 5,000 members. In any year
there is an adjustment for client count, the Offeror will not be paid for additional claims volume unless the
volume of claims increases over the 250,000 per 5,000 clients.

5.7.1         Pricing Schedules C-1 through C-8

Instructions for completing Pricing Schedules C-1 through C-8:

Offerors shall propose a firm fixed price per month for the Contract period. The monthly price will include all
costs associated with the Fiscal Agent operation described in Section 4.2.8 as well as the requirements set
forth in Sections 4.2.9 and 4.2.11 of this RFP. Pass through costs for postage and printing will be paid
separately.
    1. Offerors are required to furnish detailed price information used in deriving the proposed price per month
         for each of the categories and subcategories shown on the detailed Pricing Schedules C-1 through C-8.
         The Total Price This Year, Line 10 on Schedules C-1 through C-8, is to be reported in Line 1, Columns
         B through F of Pricing Schedule C.
   2. Offerors are required to indicate the specific number of full-time equivalent personnel in each of the
      subcategories and the average hourly rate of pay including benefits on Lines 1a-1u. The prices shown
      on the schedules are to be the total annual salary and benefits necessary for the operation of the
      MMIS/PBM/DSS system. The number of specific levels of personnel and their associated prices must
      agree with the work effort and staffing levels proposed in the Technical Proposal.
   3. Telephone prices for equipment and line charges, including toll free lines.
   4. If a price category is not already shown on Schedules C-1 through C-8, Line 1 through Line 8, Offerors
      are to indicate the category under the Section headed Other, Line 9. Offerors should list any
      subcontractor amounts under the Section headed Other, Line 9.
   5. If the total price for any subcontractor exceeds 10% of the price shown on line 10 for schedules C-1
      through C-8 attach a supplemental schedule C schedule for the applicable years in the same format
      that details and equals the subcontractor price shown on schedules C-1 through C-8.
   6. For the purpose of completing line 1a, the following positions will be considered management:
           a. Account Manager
           b. Operational Systems Group Manager
           c. Claims Operations Manager
           d. PBM Operations Manager



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                                                                MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


           e. Quality Assurance Manager for Operations
           f.   Provider/Client Relations Manager
           g. Program Support Manager
           h. Third Party Liability (TPL) Manager
   7. For the purpose of completing line 2a, the following positions will be considered supervision:
           Systems Management Staff
           Claims Supervisor
           Managed Care Supervisor

5.8             Pricing Schedule D - Additional Managed Care Functionality
Instructions for completing Pricing Schedule D:
    1. Offerors shall propose a firm fixed price for implementing the additional managed care functionality as
        described in Section 4.2.10.
   2. Offerors are required to furnish detailed price information used in deriving the proposed price for each
      of the categories and subcategories shown on the detailed Pricing Schedule D.
   3. Offerors are required to indicate the specific number of full-time equivalent personnel in each of the
      subcategories and the average hourly rate of pay including benefits on Lines 1a-1u. The prices shown
      on the schedules are to be the total annual salary and benefits necessary for this phase of the Contract.
      The number of specific levels of personnel and their associated prices must agree with the work effort
      and staffing levels proposed in the Technical Proposal.
   4. Telephone prices for equipment and line charges, including toll free lines.
   5. If a price category is not already shown on Schedule D, Line 1 through Line 8, Offerors are to indicate
      the category under the Section headed Other, Line 9. Offerors should list any subcontractor amounts
      under the Section headed Other, Line 9.

5.9             Pricing Schedule E - Electronic Health Records (EHR)
Instructions for completing Pricing Schedule E:
    1. Offerors shall propose a firm fixed price for performing the Electronic Health Records (EHR) as
        described in Section 4.2.10.
   2. Offerors are required to furnish detailed price information used in deriving the proposed price for each
      of the categories and subcategories shown on the detailed Pricing Schedule E.
   3. Offerors are required to indicate the specific number of full-time equivalent personnel in each of the
      subcategories and the average hourly rate of pay including benefits on Lines 1a-1u. The prices shown
      on the schedules are to be the total annual salary and benefits necessary for this phase of the Contract.
      The number of specific levels of personnel and their associated prices must agree with the work effort
      and staffing levels proposed in the Technical Proposal.
   4. Telephone prices for equipment and line charges, including toll free lines.


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                                                                 MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


   5. If a price category is not already shown on Schedule E, Line 1 through Line 8, Offerors are to indicate
      the category under the Section headed Other, Line 9. Offerors should list any subcontractor amounts
      under the Section headed Other, Line 9.

5.10          Pricing Schedule F - Payroll System Price
Instructions for completing Pricing Schedule F:
    1. Offerors shall propose a firm fixed price for performing the Payroll System as described in Section
        4.2.10.
   2. Offerors are required to furnish detailed price information used in deriving the proposed price for each
      of the categories and subcategories shown on the detailed Pricing Schedule E.
   3. Offerors are required to indicate the specific number of full-time equivalent personnel in each of the
      subcategories and the average hourly rate of pay including benefits on Lines 1a-1u. The prices shown
      on the schedules are to be the total annual salary and benefits necessary for this phase of the Contract.
      The number of specific levels of personnel and their associated prices must agree with the work effort
      and staffing levels proposed in the Technical Proposal.
   4. Telephone prices for equipment and line charges, including toll free lines.
   5. If a price category is not already shown on Schedule E, Line 1 through Line 8, Offerors are to indicate
      the category under the Section headed Other, Line 9. Offerors should list any subcontractor amounts
      under the Section headed Other, Line 9.

5.11          Pricing Schedule G - Software Costs
Instructions for completing Pricing Schedule G:
    1. Offerors shall indicate all software costs included in schedules B through F.




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PRICING SCHEDULE A
SUMMARY OF TOTAL PROPOSAL

1. Price of MMISPBM//DSS System Planning, Design,
Development, Testing, and Implementation
(Schedule B-1, Line 13, Column C)                           $_________________
2. Operational Price
(Schedule C, Line 1, Column I)                              $_________________
3. Price of Additional Managed Care Functionality
(Schedule D, Column D)                                      $_________________
4. Price of Electronic Health Records (EHR)
(Schedule E, Column E)                                      $_________________
5. Price of Payroll System
(Schedule F, Column E)

6. Total Contract Price                                     $_________________


  AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
  THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.



  Signature of Corporate Official         Title                        Date




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                                                                       MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


PRICING SCHEDULE B
MMIS/PBM/DSS PLANNING, DESIGN, DEVELOPMENT, TESTING AND IMPLEMENTATION
PRICE COMPONENTS
                               Price Component                 #FTE      Avg. Rate/Hr     Costs
 1.    Salaries and Benefits                                   _____     $_________       $___________
       1a.        Management                                   _____     $_________       $___________
       1b.        Supervision                                  _____     $_________       $___________
       1c.        Project Management Staff                     _____     $_________       $___________
       1d.        QA Staff                                     _____     $_________       $___________
       1e.        Data Administrator                           _____     $_________       $___________
       1f.        System Analyst                               _____     $_________       $___________
       1g.        Business Analyst                             _____     $_________       $___________
       1h.        Trainer/Publications                         _____     $_________       $___________
       1i.        Field Representative                         _____     $_________       $___________
       1j.        PR Service Representative                    _____     $_________       $___________
       1k.        SURS Analyst                                 _____     $_________       $___________
       1l.        Drug Rebate                                  _____     $_________       $___________
       1m.        Third Party Liability                        _____     $_________       $___________
       1n.        DSS                                          _____     $_________       $___________
       1o.        RHIA                                         _____     $_________       $___________
       1p.        Transaction Processing                       _____     $_________       $___________
       1q.        Clerical/Administrative                      _____     $_________       $___________
       1r.        Call Center Staff                            _____     $_________       $___________
       1s.        Other Professionals                          _____     $_________       $___________
       1t.        Total                                        _____     $_________       $___________
 2.    Travel                                                                             $___________
 3     Building                                                                           $___________
 4.    Utilities                                                                          $___________
 5.    Telephone                                                                          $___________
 6.    Furniture, Office Machines & Other Equipment (include
       Medicaid Contract Management office furniture)                                     $___________
 7.    Computer Resources                                                                 $___________
 8.    Consultants                                             _____     $_________       $___________
 9.    Other (Itemize)                                                                    $___________
       9a.      ____________________________                   _____     $_________       $___________
       9b.      ____________________________                   _____     $_________       $___________

 10.   Total (Sum of Lines 1 thorough 9b)                      _____                      $___________

AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.


Signature of Corporate Official                    Title                                  Date


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                                                              MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P




PRICING SCHEDULE B-1
MMIS/PBM/DSS PLANNING, DESIGN, DEVELOPMENT, TESTING AND IMPLEMENTATION
PRICE

Tasks are shown as a percentage of the total from Pricing Schedule B. The total of Column C must
equal the total of Line 10, Pricing Schedule B.

                    A                            B                               C
                                                                           Total Phase
                     #                      Milestones
                                                                              Price
                    1    Project Initiation Activities (5%)
                    2    Requirements Analysis (15%)
                    3    Business and Technical Design (10%)
                    4    Comprehensive Testing Plan (5%)
                    5    Conversion Activities (10%)
                    6    Development Activities (15%)
                    7    System Testing (10%)
                    8    Acceptance Testing (10%)
                    9    MMIS Implementation (15%)
                    10 Certification of MMIS (5%)
                    11 Total

Post total Line 11 on column C to Schedule A, Line 1.

AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.



Signature of Corporate Official             Title                                Date




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                                                                                                                                                   MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P




PRICING SCHEDULE C - OPERATIONAL PRICE SUMMARY
                (A)                     (B)                   (C)           (D)           (E)               (F)            (F)           (G)           (H)                (I)                (H)
 Price Components                     Year 1                Year 2        Year 3        Year 4          Year 5           Year 6        Year 7         Year 8             Total       Eight Year
                                                                                                                                                                                     Average
                                    (2011-2012)           (2012-2013)   (2013-2014)   ((2014-2015)    (2015-2016)      (2016-2017)   (2017-2018)   (2018-2019)       (Schedule A)
 1. Total Price All Components
 (From C1-C9, Line 10)
                                       $________            $________     $________      $________      $________        $________     $________      $________         $________
 2. Price Per Month
 (Line 1/12 months)                    $________            $________     $________      $________      $________        $________     $________      $________
 3. Eight (8) Year Average Price
 Per Month
 (Line H1/96 months)                                                                                                                                                                       $_________
 4. Adjustment for Monthly Client
 Count
 4.1 Plus or minus 10,000 clients      $________            $________     $________      $________      $________        $________     $________      $________
 4.2 Plus or minus 10,001 to
 20,000 clients                        $________            $________     $________      $________      $________        $________     $________      $________
 4.3 Plus or minus 20,001 to
 30,000 clients                        $________            $________     $________      $________      $________        $________     $________      $________

 5. Annual Volume Adjustment
 5.1 Plus or minus 250,000 claims      $________            $________     $________      $________      $________        $________     $________      $________
 5.2 Plus or minus 250,001 to
 500,000                               $________            $________     $________      $________      $________        $________     $________      $________
 5.3 Plus or minus 500,001 to
 750,000                               $________            $________     $________      $________      $________        $________     $________      $________


AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM. THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.



Signature of Corporate Official                   Title                                              Date




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PRICING SCHEDULE C-1
OPERATIONAL PRICE COMPONENTS FROM JULY 1, 2011 THROUGH JUNE 30, 2012.
                                           Price Component                 #FTE      Avg. Rate/Hr       Costs
 1.    Salaries and Benefits                                               _____     $_________         $___________
       1a.         Management                                              _____     $_________         $___________
       1b.         Supervision                                             _____     $_________         $___________
       1c.         Systems Management Staff                                _____     $_________         $___________
       1d.         QA Staff                                                _____     $_________         $___________
       1e.         Data Administrator                                      _____     $_________         $___________
       1f.         System Analyst                                          _____     $_________         $___________
       1g.         Business Analyst                                        _____     $_________         $___________
       1h.         Trainer/Publications                                    _____     $_________         $___________
       1i.         Field Representative                                    _____     $_________         $___________
       1j.         PR Service Representative                               _____     $_________         $___________
       1k.         Clerical/Administrative                                 _____     $_________         $___________
       1l.         Medical Professionals                                   _____     $_________         $___________
       1m.         SURS Analyst                                            _____     $_________         $___________
       1n.         Drug Rebate                                             _____     $_________         $___________
       1o.         Third Party Liability                                   _____     $_________         $___________
       1p.         DSS                                                     _____     $_________         $___________
       1r.         RHIA                                                    _____     $_________         $___________
       1s.         Transaction Processing                                  _____     $_________         $___________
       1t.         Call Center Staff                                       _____     $_________         $___________
       1u.         Other Professionals                                     _____     $_________         $___________
       1v.         Total                                                   _____     $_________         $___________
 2.    Travel                                                                                           $___________
 3     Building                                                                                         $___________
 4.    Utilities                                                                                        $___________
 5.    Telephone                                                                                        $___________
 6.    Furniture, Office Machines & Other Equipment (include Medicaid
       Contract Management office furniture)                                                            $___________
 7.    Computer Resources                                                                               $___________
 8.    Consultants                                                         _____     $_________         $___________
 9.    Other (Itemize)                                                                                  $___________
       9a.         ____________________________                            _____     $_________         $___________
       9b.         ____________________________                            _____     $_________         $___________
 10.   Total (Sum of Lines 1 thorough 9b)                                  _____                        $___________

AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.


Signature of Corporate Official                        Title                               Date


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                                                                  MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


PRICING SCHEDULE C-2
OPERATIONAL PRICE COMPONENTS FROM JULY 1, 2012 THROUGH JUNE 30, 2013.
                                          Price Component           #FTE      Avg. Rate/Hr     Costs
    1.    Salaries and Benefits                                     _____     $_________       $___________
          1a.         Management                                    _____     $_________       $___________
          1b.         Supervision                                   _____     $_________       $___________
          1c.         Systems Management Staff                      _____     $_________       $___________
          1d.         QA Staff                                      _____     $_________       $___________
          1e.         Data Administrator                            _____     $_________       $___________
          1f.         System Analyst                                _____     $_________       $___________
          1g.         Business Analyst                              _____     $_________       $___________
          1h.         Trainer/Publications                          _____     $_________       $___________
          1i.         Field Representative                          _____     $_________       $___________
          1j.         PR Service Representative                     _____     $_________       $___________
          1k.         Clerical/Administrative                       _____     $_________       $___________
          1l.         Medical Professionals                         _____     $_________       $___________
          1m.         SURS Analyst                                  _____     $_________       $___________
          1n.         Drug Rebate                                   _____     $_________       $___________
          1o.         Third Party Liability                         _____     $_________       $___________
          1p.         DSS                                           _____     $_________       $___________
          1r.         RHIA                                          _____     $_________       $___________
          1s.         Transaction Processing                        _____     $_________       $___________
          1t.         Call Center Staff                             _____     $_________       $___________
          1u.         Other Professionals                           _____     $_________       $___________
          1v.         Total                                         _____     $_________       $___________
    2.    Travel                                                                               $___________
    3     Building                                                                             $___________
    4.    Utilities                                                                            $___________
    5.    Telephone                                                                            $___________
    6.    Furniture, Office Machines & Other Equipment (include
          Medicaid Contract Management office furniture)                                       $___________
    7.    Computer Resources                                                                   $___________
    8.    Consultants                                               _____     $_________       $___________
    9.    Other (Itemize)                                                                      $___________
          9a.         ____________________________                  _____     $_________       $___________
          9b.         ____________________________                  _____     $_________       $___________


    10.   Total (Sum of Lines 1 thorough 9b)                        _____                      $___________

AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.

Signature of Corporate Official                      Title                           Date


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                                                                        MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


PRICING SCHEDULE C-3
OPERATIONAL PRICE COMPONENTS FROM JULY 1, 2013 THROUGH JUNE 30, 2014.
                                           Price Component                 #FTE      Avg. Rate/Hr       Costs
 1.    Salaries and Benefits                                               _____     $_________         $___________
       1a.         Management                                              _____     $_________         $___________
       1b.         Supervision                                             _____     $_________         $___________
       1c.         Systems Management Staff                                _____     $_________         $___________
       1d.         QA Staff                                                _____     $_________         $___________
       1e.         Data Administrator                                      _____     $_________         $___________
       1f.         System Analyst                                          _____     $_________         $___________
       1g.         Business Analyst                                        _____     $_________         $___________
       1h.         Trainer/Publications                                    _____     $_________         $___________
       1i.         Field Representative                                    _____     $_________         $___________
       1j.         PR Service Representative                               _____     $_________         $___________
       1k.         Clerical/Administrative                                 _____     $_________         $___________
       1l.         Medical Professionals                                   _____     $_________         $___________
       1m.         SURS Analyst                                            _____     $_________         $___________
       1n.         Drug Rebate                                             _____     $_________         $___________
       1o.         Third Party Liability                                   _____     $_________         $___________
       1p.         DSS                                                     _____     $_________         $___________
       1r.         RHIA                                                    _____     $_________         $___________
       1s.         Transaction Processing                                  _____     $_________         $___________
       1t.         Call Center Staff                                       _____     $_________         $___________
       1u.         Other Professionals                                     _____     $_________         $___________
       1v.         Total                                                   _____     $_________         $___________
 2.    Travel                                                                                           $___________
 3     Building                                                                                         $___________
 4.    Utilities                                                                                        $___________
 5.    Telephone                                                                                        $___________
 6.    Furniture, Office Machines & Other Equipment (include Medicaid
       Contract Management office furniture)                                                            $___________
 7.    Computer Resources                                                                               $___________
 8.    Consultants                                                         _____     $_________         $___________
 9.    Other (Itemize)                                                                                  $___________
       9a.         ____________________________                            _____     $_________         $___________
       9b.         ____________________________                            _____     $_________         $___________


 10.   Total (Sum of Lines 1 thorough 9b)                                  _____                        $___________
AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.


Signature of Corporate Official                        Title                               Date


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                                                                        MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


PRICING SCHEDULE C-4
OPERATIONAL PRICE COMPONENTS FROM JULY 1, 2014 THROUGH JUNE 30, 2015.
                                           Price Component                 #FTE      Avg. Rate/Hr       Costs
 1.    Salaries and Benefits                                               _____     $_________         $___________
       1a.         Management                                              _____     $_________         $___________
       1b.         Supervision                                             _____     $_________         $___________
       1c.         Systems Management Staff                                _____     $_________         $___________
       1d.         QA Staff                                                _____     $_________         $___________
       1e.         Data Administrator                                      _____     $_________         $___________
       1f.         System Analyst                                          _____     $_________         $___________
       1g.         Business Analyst                                        _____     $_________         $___________
       1h.         Trainer/Publications                                    _____     $_________         $___________
       1i.         Field Representative                                    _____     $_________         $___________
       1j.         PR Service Representative                               _____     $_________         $___________
       1k.         Clerical/Administrative                                 _____     $_________         $___________
       1l.         Medical Professionals                                   _____     $_________         $___________
       1m.         SURS Analyst                                            _____     $_________         $___________
       1n.         Drug Rebate                                             _____     $_________         $___________
       1o.         Third Party Liability                                   _____     $_________         $___________
       1p.         DSS                                                     _____     $_________         $___________
       1r.         RHIA                                                    _____     $_________         $___________
       1s.         Transaction Processing                                  _____     $_________         $___________
       1t.         Call Center Staff                                       _____     $_________         $___________
       1u.         Other Professionals                                     _____     $_________         $___________
       1v.         Total                                                   _____     $_________         $___________
 2.    Travel                                                                                           $___________
 3     Building                                                                                         $___________
 4.    Utilities                                                                                        $___________
 5.    Telephone                                                                                        $___________
 6.    Furniture, Office Machines & Other Equipment (include Medicaid
       Contract Management office furniture)                                                            $___________
 7.    Computer Resources                                                                               $___________
 8.    Consultants                                                         _____     $_________         $___________
 9.    Other (Itemize)                                                                                  $___________
       9a.         ____________________________                            _____     $_________         $___________
       9b.         ____________________________                            _____     $_________         $___________


 10.   Total (Sum of Lines 1 thorough 9b)                                  _____                        $___________
AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.


Signature of Corporate Official                        Title                               Date


                                                                                                                   Page 148
                                                                        MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


PRICING SCHEDULE C-5
OPERATIONAL PRICE COMPONENTS FROM JULY 1, 2015 THROUGH JUNE 30, 2016.
                                           Price Component                 #FTE      Avg. Rate/Hr       Costs
 1.    Salaries and Benefits                                               _____     $_________         $___________
       1a.         Management                                              _____     $_________         $___________
       1b.         Supervision                                             _____     $_________         $___________
       1c.         Systems Management Staff                                _____     $_________         $___________
       1d.         QA Staff                                                _____     $_________         $___________
       1e.         Data Administrator                                      _____     $_________         $___________
       1f.         System Analyst                                          _____     $_________         $___________
       1g.         Business Analyst                                        _____     $_________         $___________
       1h.         Trainer/Publications                                    _____     $_________         $___________
       1i.         Field Representative                                    _____     $_________         $___________
       1j.         PR Service Representative                               _____     $_________         $___________
       1k.         Clerical/Administrative                                 _____     $_________         $___________
       1l.         Medical Professionals                                   _____     $_________         $___________
       1m.         SURS Analyst                                            _____     $_________         $___________
       1n.         Drug Rebate                                             _____     $_________         $___________
       1o.         Third Party Liability                                   _____     $_________         $___________
       1p.         DSS                                                     _____     $_________         $___________
       1r.         RHIA                                                    _____     $_________         $___________
       1s.         Transaction Processing                                  _____     $_________         $___________
       1t.         Call Center Staff                                       _____     $_________         $___________
       1u.         Other Professionals                                     _____     $_________         $___________
       1v.         Total                                                   _____     $_________         $___________
 2.    Travel                                                                                           $___________
 3     Building                                                                                         $___________
 4.    Utilities                                                                                        $___________
 5.    Telephone                                                                                        $___________
 6.    Furniture, Office Machines & Other Equipment (include Medicaid
       Contract Management office furniture)                                                            $___________
 7.    Computer Resources                                                                               $___________
 8.    Consultants                                                         _____     $_________         $___________
 9.    Other (Itemize)                                                                                  $___________
       9a.         ____________________________                            _____     $_________         $___________
       9b.         ____________________________                            _____     $_________         $___________


 10.   Total (Sum of Lines 1 thorough 9b)                                  _____                        $___________
AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.


Signature of Corporate Official                        Title                               Date


                                                                                                                   Page 149
                                                                        MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


PRICING SCHEDULE C-6
OPERATIONAL PRICE COMPONENTS FROM JULY 1, 2016 THROUGH JUNE 30, 2017.
                                    Price Component                        #FTE      Avg. Rate/Hr       Costs
 1.    Salaries and Benefits                                               _____     $_________         $___________
       1a.        Management                                               _____     $_________         $___________
       1b.        Supervision                                              _____     $_________         $___________
       1c.        Systems Management Staff                                 _____     $_________         $___________
       1d.        QA Staff                                                 _____     $_________         $___________
       1e.        Data Administrator                                       _____     $_________         $___________
       1f.        System Analyst                                           _____     $_________         $___________
       1g.        Business Analyst                                         _____     $_________         $___________
       1h.        Trainer/Publications                                     _____     $_________         $___________
       1i.        Field Representative                                     _____     $_________         $___________
       1j.        PR Service Representative                                _____     $_________         $___________
       1k.        Clerical/Administrative                                  _____     $_________         $___________
       1l.        Medical Professionals                                    _____     $_________         $___________
       1m.        SURS Analyst                                             _____     $_________         $___________
       1n.        Drug Rebate                                              _____     $_________         $___________
       1o.        Third Party Liability                                    _____     $_________         $___________
       1p.        DSS                                                      _____     $_________         $___________
       1r.        RHIA                                                     _____     $_________         $___________
       1s.        Transaction Processing                                   _____     $_________         $___________
       1t.        Call Center Staff                                        _____     $_________         $___________
       1u.        Other Professionals                                      _____     $_________         $___________
       1v.        Total                                                    _____     $_________         $___________
 2.    Travel                                                                                           $___________
 3     Building                                                                                         $___________
 4.    Utilities                                                                                        $___________
 5.    Telephone                                                                                        $___________
 6.    Furniture, Office Machines & Other Equipment (include Medicaid                                   $___________
       Contract Management office furniture)
 7.    Computer Resources                                                                               $___________
 8.    Consultants                                                         _____     $_________         $___________
 9.    Other (Itemize)                                                                                  $___________
       9a.        ____________________________                             _____     $_________         $___________
       9b.        ____________________________                             _____     $_________         $___________

 10.   Total (Sum of Lines 1 thorough 9b)                                  _____                        $___________
AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.



Signature of Corporate Official                   Title                                    Date


                                                                                                                   Page 150
                                                                        MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


PRICING SCHEDULE C-7
OPERATIONAL PRICE COMPONENTS FROM JULY 1, 2017 THROUGH JUNE 30, 2018.
                                    Price Component                        #FTE      Avg. Rate/Hr       Costs
 1.    Salaries and Benefits                                               _____     $_________         $___________
       1a.        Management                                               _____     $_________         $___________
       1b.        Supervision                                              _____     $_________         $___________
       1c.        Systems Management Staff                                 _____     $_________         $___________
       1d.        QA Staff                                                 _____     $_________         $___________
       1e.        Data Administrator                                       _____     $_________         $___________
       1f.        System Analyst                                           _____     $_________         $___________
       1g.        Programmer/Analyst                                       _____     $_________         $___________
       1h.        Trainer/Publications                                     _____     $_________         $___________
       1i.        Field Representative                                     _____     $_________         $___________
       1j.        PR Service Representative                                _____     $_________         $___________
       1k.        Clerical/Administrative                                  _____     $_________         $___________
       1l.        Medical Professionals                                    _____     $_________         $___________
       1m.        SURS Analyst                                             _____     $_________         $___________
       1n.        Drug Rebate                                              _____     $_________         $___________
       1o.        Third Party Liability                                    _____     $_________         $___________
       1p.        DSS                                                      _____     $_________         $___________
       1r.        RHIA                                                     _____     $_________         $___________
       1s.        Transaction Processing                                   _____     $_________         $___________
       1t.        Call Center Staff                                        _____     $_________         $___________
       1u.        Other Professionals                                      _____     $_________         $___________
       1v.        Total                                                    _____     $_________         $___________
 2.    Travel                                                                                           $___________
 3     Building                                                                                         $___________
 4.    Utilities                                                                                        $___________
 5.    Telephone                                                                                        $___________
 6.    Furniture, Office Machines & Other Equipment (include Medicaid                                   $___________
       Contract Management office furniture)
 7.    Computer Resources                                                                               $___________
 8.    Consultants                                                         _____     $_________         $___________
 9.    Other (Itemize)                                                                                  $___________
       9a.        ____________________________                             _____     $_________         $___________
       9b.        ____________________________                             _____     $_________         $___________

 10.   Total (Sum of Lines 1 thorough 9b)                                  _____                        $___________
AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.

Signature of Corporate Official                   Title                                    Date



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                                                                        MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


PRICING SCHEDULE C-8
OPERATIONAL PRICE COMPONENTS FROM JULY 1, 2018 THROUGH JUNE 30, 2019.
                                    Price Component                        #FTE      Avg. Rate/Hr       Costs
 1.    Salaries and Benefits                                               _____     $_________         $___________
       1a.        Management                                               _____     $_________         $___________
       1b.        Supervision                                              _____     $_________         $___________
       1c.        Systems Management Staff                                 _____     $_________         $___________
       1d.        QA Staff                                                 _____     $_________         $___________
       1e.        Data Administrator                                       _____     $_________         $___________
       1f.        Senior Programmer/Analyst                                _____     $_________         $___________
       1g.        Programmer/Analyst                                       _____     $_________         $___________
       1h.        Trainer/Publications                                     _____     $_________         $___________
       1i.        Field Representative                                     _____     $_________         $___________
       1j.        PR Service Representative                                _____     $_________         $___________
       1k.        Clerical/Administrative                                  _____     $_________         $___________
       1l.        Medical Professionals                                    _____     $_________         $___________
       1m.        SURS Analyst                                             _____     $_________         $___________
       1n.        Drug Rebate                                              _____     $_________         $___________
       1o.        Third Party Liability                                    _____     $_________         $___________
       1p.        DSS                                                      _____     $_________         $___________
       1r.        RHIA                                                     _____     $_________         $___________
       1s.        Transaction Processing                                   _____     $_________         $___________
       1t.        Call Center Staff                                        _____     $_________         $___________
       1u.        Other Professionals                                      _____     $_________         $___________
       1v.        Total                                                    _____     $_________         $___________
 2.    Travel                                                                                           $___________
 3     Building                                                                                         $___________
 4.    Utilities                                                                                        $___________
 5.    Telephone                                                                                        $___________
 6.    Furniture, Office Machines & Other Equipment (include Medicaid                                   $___________
       Contract Management office furniture)
 7.    Computer Resources                                                                               $___________
 8.    Consultants                                                         _____     $_________         $___________
 9.    Other (Itemize)                                                                                  $___________
       9a.        ____________________________                             _____     $_________         $___________
       9b.        ____________________________                             _____     $_________         $___________

 10.   Total (Sum of Lines 1 thorough 9b)                                  _____                        $___________
AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.



Signature of Corporate Official                   Title                                    Date


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                                                                        MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


PRICING SCHEDULE D
PRICE COMPONENTS FOR ADDITIONAL MANAGED CARE FUNCTIONALITY:
                                        Price Component                    #FTE      Avg. Rate/Hr       Costs
 1.    Salaries and Benefits                                               _____     $_________         $___________
       1a.         Management                                              _____     $_________         $___________
       1b.         Supervision                                             _____     $_________         $___________
       1c.         Systems Management Staff                                _____     $_________         $___________
       1d.         QA Staff                                                _____     $_________         $___________
       1e.         Data Administrator                                      _____     $_________         $___________
       1f.         System Analyst                                          _____     $_________         $___________
       1g.         Business Analyst                                        _____     $_________         $___________
       1h.         Trainer/Publications                                    _____     $_________         $___________
       1i.         Field Representative                                    _____     $_________         $___________
       1j.         PR Service Representative                               _____     $_________         $___________
       1k.         Clerical/Administrative                                 _____     $_________         $___________
       1l.         Medical Professionals                                   _____     $_________         $___________
       1m.         SURS Analyst                                            _____     $_________         $___________
       1n.         DSS                                                     _____     $_________         $___________
       1o.         Transaction Processing                                  _____     $_________         $___________
       1p.         Call Center Staff                                       _____     $_________         $___________
       1q.         Other Professionals                                     _____     $_________         $___________
       1s.         Total                                                   _____     $_________         $___________
 2.    Travel                                                                                           $___________
 3     Building                                                                                         $___________
 4.    Utilities                                                                                        $___________
 5.    Telephone                                                                                        $___________
 6.    Furniture, Office Machines & Other Equipment (include Medicaid
       Contract Management office furniture)                                                            $___________
 7.    Computer Resources                                                                               $___________
 8.    Consultants                                                         _____     $_________         $___________
 9.    Other (Itemize)                                                                                  $___________
       9a.         ____________________________                            _____     $_________         $___________
       9b.         ____________________________                            _____     $_________         $___________


 10.   Total (Sum of Lines 1 thorough 9b)                                  _____                        $___________
AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.



Signature of Corporate Official                     Title                                  Date



                                                                                                                   Page 153
                                                                        MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


PRICING SCHEDULE E
PRICE COMPONENTS FOR ELECTRONIC HEALTH RECORDS:
                                        Price Component                    #FTE      Avg. Rate/Hr       Costs
 1.    Salaries and Benefits                                               _____     $_________         $___________
       1a.         Management                                              _____     $_________         $___________
       1b.         Supervision                                             _____     $_________         $___________
       1c.         Systems Management Staff                                _____     $_________         $___________
       1d.         QA Staff                                                _____     $_________         $___________
       1e.         Data Administrator                                      _____     $_________         $___________
       1f.         System Analyst                                          _____     $_________         $___________
       1g.         Business Analyst                                        _____     $_________         $___________
       1h.         Trainer/Publications                                    _____     $_________         $___________
       1i.         Field Representative                                    _____     $_________         $___________
       1j.         PR Service Representative                               _____     $_________         $___________
       1k.         Clerical/Administrative                                 _____     $_________         $___________
       1l.         Medical Professionals                                   _____     $_________         $___________
       1m.         SURS Analyst                                            _____     $_________         $___________
       1n.         Transaction Processing                                  _____     $_________         $___________
       1o.         Call Center Staff                                       _____     $_________         $___________
       1p.         Other Professionals                                     _____     $_________         $___________
       1q.         Total                                                   _____     $_________         $___________
 2.    Travel                                                                                           $___________
 3     Building                                                                                         $___________
 4.    Utilities                                                                                        $___________
 5.    Telephone                                                                                        $___________
 6.    Furniture, Office Machines & Other Equipment (include Medicaid
       Contract Management office furniture)                                                            $___________
 7.    Computer Resources                                                                               $___________
 8.    Consultants                                                         _____     $_________         $___________
 9.    Other (Itemize)                                                                                  $___________
       9a.         ____________________________                            _____     $_________         $___________
       9b.         ____________________________                            _____     $_________         $___________


 10.   Total (Sum of Lines 1 thorough 9b)                                  _____                        $___________
AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.



Signature of Corporate Official                     Title                                  Date




                                                                                                                   Page 154
                                                                        MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


PRICING SCHEDULE F
PRICE COMPONENTS FOR PAYROLL SYSTEM
                                        Price Component                    #FTE      Avg. Rate/Hr       Costs
 1.    Salaries and Benefits                                               _____     $_________         $___________
       1a.         Management                                              _____     $_________         $___________
       1b.         Supervision                                             _____     $_________         $___________
       1c.         Systems Management Staff                                _____     $_________         $___________
       1d.         QA Staff                                                _____     $_________         $___________
       1e.         Data Administrator                                      _____     $_________         $___________
       1f.         System Analyst                                          _____     $_________         $___________
       1g.         Business Analyst                                        _____     $_________         $___________
       1h.         Trainer/Publications                                    _____     $_________         $___________
       1i.         Field Representative                                    _____     $_________         $___________
       1j.         PR Service Representative                               _____     $_________         $___________
       1k.         Clerical/Administrative                                 _____     $_________         $___________
       1l.         Medical Professionals                                   _____     $_________         $___________
       1m.         SURS Analyst                                            _____     $_________         $___________
       1n.         Transaction Processing                                  _____     $_________         $___________
       1o.         Call Center Staff                                       _____     $_________         $___________
       1p.         Other Professionals                                     _____     $_________         $___________
       1q.         Total                                                   _____     $_________         $___________
 2.    Travel                                                                                           $___________
 3     Building                                                                                         $___________
 4.    Utilities                                                                                        $___________
 5.    Telephone                                                                                        $___________
 6.    Furniture, Office Machines & Other Equipment (include Medicaid
       Contract Management office furniture)                                                            $___________
 7.    Computer Resources                                                                               $___________
 8.    Consultants                                                         _____     $_________         $___________
 9.    Other (Itemize)                                                                                  $___________
       9a.         ____________________________                            _____     $_________         $___________
       9b.         ____________________________                            _____     $_________         $___________


 10.   Total (Sum of Lines 1 thorough 9b)                                  _____                        $___________
AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.



Signature of Corporate Official                     Title                                  Date




                                                                                                                   Page 155
                                                                                                               MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P




Schedule G - Software Costs
 Item    Description         License         # of          Total    DDI*        Year 1       Year 2    Year 3      Year 4       Year 5     Year 6       Total
 #                           Fees            Licenses
     1.
     2.
     3.
     4.
     5.
     6.
     7.
     8.
     9.
     10.
     11.
     12.
     13.
     14.

* List software costs for Additional Managed Care Functionality, EHR and Payroll System under DDI and indicate that the software will be implemented to support
this functionality.

AN AUTHORIZED CORPORATE OFFICIAL OF THE VENDOR MUST SIGN THIS FORM.
THE OFFICIAL’S TITLE AND THE DATE THIS FORM WAS SIGNED MUST BE ENTERED.



Signature of Corporate Official                                         Title                           Date




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                                                                  MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


6.            TECHNICAL PROPOSAL EVALUATION

6.1           Introduction
The State will conduct a comprehensive, fair, and impartial evaluation of proposals received in response to this
procurement effort.

This evaluation will be conducted in five phases:
   Phase 1 – Evaluation of Mandatory Requirements of Technical Proposals
   Phase 2 – Evaluation of Technical Proposals
   Phase 3 – Evaluation of Mandatory Requirements of Cost Proposals
   Phase 4 – Evaluation of Cost Proposals
   Phase 5 – Ranking of Proposals

6.2           State’s Right to Investigate and Reject
The State may make such investigations as deemed necessary to determine the ability of the Offeror to
provide the supplies and/or perform the services specified. The State reserves the right to reject any proposal if
the evidence submitted by, or investigation of, the Offeror fails to satisfy the State that the Offeror is properly
qualified to carry out the obligations of the Contract. This includes the State’s ability to reject the proposal
based on negative references.

6.3           Evaluation Procedures
The evaluation process begins with a review of the mandatory items of the Technical Proposals. The technical
evaluators will then evaluate the corporate background and experience, project management, technical
approach, including the project organization and staffing for each phase of the Contract, and System
Architecture Sections of all responsive Technical Proposals.

The Cost Proposals will be evaluated at the same time as the Technical Proposal evaluation. The Cost
Proposal evaluation process begins with a review of the mandatory items of the Cost Proposals. The Cost
Proposal evaluators will evaluate the price for each component and the total proposal price for each Cost
Proposal.

The Procurement Officer will rank Offerors by the resulting scores and summarize the findings in a report
presented to the Contracting Officer.

6.4           Evaluation Organization
Evaluators will conduct a strictly controlled evaluation of the Technical Proposals submitted in response to this
RFP. Evaluations will be based on the criteria Stated in this RFP.




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                                                                  MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


6.5        Phase 1 - Evaluation of Mandatory Requirements of Technical Proposal
Each proposal will be reviewed for responsiveness to the mandatory requirements set forth in this RFP. This
will be a yes/no evaluation. The purpose of this phase is to determine if the Technical Proposal is sufficiently
responsive to the RFP to permit a complete evaluation. Mandatory requirements for the Technical Proposal
are presented in a checklist in Appendix 5, Checklist of Mandatory Items.

Failure to comply with the instructions or to submit a complete proposal will deem a proposal non-responsive,
and will cause the proposal to be rejected with no further evaluation. The State reserves the right to waive
minor irregularities.

No points will be awarded for passing the mandatory requirements.

6.6           Phase 2 - Evaluation of Technical Proposals
Only those proposals passing the mandatory requirements will be considered in Phase 2.

The written proposals will be evaluated during this phase and comprise the substantive portion of the technical
evaluation. The State will evaluate the responses based on the instructions provided to the Offerors in this
RFP, including the instruction to Offeror regarding the detail of their responses. In Section 5, Offerors have
been instructed to not simply provide Statements that the requirements of the RFP will be met, but to respond
concisely but fully with their approach and how they will comply with the requirements in each item listed in the
Scope of Work Section and Attachments E, F, and G. Additionally, Offerors must acknowledge their
understanding of each Overview, Inputs, Outputs, and State Responsibility Sections in Attachment F,
Operational Requirements, of this RFP. The criteria used to evaluate the Technical Proposals are described in
the subsections below. Any Technical Proposal in which there are significant inconsistencies or inaccuracies
may be rejected by the State. The State reserves the right to reject any and all proposals.

As a part of the Phase 2 evaluation, the State will require oral presentations by Offerors successfully
completing mandatory requirements. The oral presentations will be arranged with Offerors individually during
the State’s evaluation phase. The State shall expect proposed project managers to play a key role in oral
presentations. The State may make site visits during the evaluation phase to Offeror locations at which MMIS,
PBM, and/or DSS or large medical claim payment systems are operational or at which the Offeror provides
Fiscal Agent services. The State will select the location of the site visit from a list of suggested sites supplied
by the Offeror. It shall be the State's preference to visit sites at which an operational MMIS/PBM/DSS has
been developed and installed by the Offeror at a site that is comparable in size and complexity to the Montana
Heath Care programs. At the site visits, each Offeror shall be expected to respond to specific questions and to
have appropriate personnel (including the proposed project manager) available for discussions. Relevant
systems documentation, procedure manuals, rules engine documentation, and operational processes shall be
available for review by the PEC. The PEC members that conduct the site visits will record their observations of
the Offeror’s operations at the site selected, which will be shared with all evaluators.

The observations by the evaluators during oral presentations and site visits, if they occur, will be considered in
evaluating the Technical Proposal.




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                                                                  MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


6.6.1          Technical Proposal Points (1,400 points)

The evaluation of Technical Proposals will involve the point scoring of each proposal according to pre-
established criteria. A maximum of 1,400 points will be available for each Offeror’s Technical Proposal. The
areas that technical proposals will be evaluated are:

                 Corporate Background and Experience                       200
                 Overall Technical Approach                                150
                 Technical Approach to Design, Development                 250
                 Technical Approach to Implementation                      150
                 Technical Approach to Operations                          250
                 Technical Approach to MMIS Certification                  100
                 Technical Approach to MMIS Enhancements                    75
                 Technical Approach to Turnover                             50
                 System Architecture                                       175
                 Total                                                   1,400

Evaluation criteria have been developed to cover each of these areas. The following paragraphs describe
generally the factors covered by the detailed criteria.

6.6.2          Project Staffing

The evaluation of project staffing will be conducted during the evaluation of each phase of this RFP and will
include detailed criteria evaluating the Offeror’s staffing approach, the qualifications of named personnel, and
the past performance of the company and the individuals for each phase of the Contract. No separate points
are awarded for project staffing alone. The proposed project organization and use of staff resources will also
be evaluated to assess the Offeror’s capability to perform all major tasks within the project timetable for each
phase. References for proposed individuals will be checked and included in the evaluation of each technical
phase Section. Reference checking is not limited to those references supplied by the Offeror. Requirements
for organization, staffing, and the personal experience of specified management positions are defined in
Section 4.3 of this RFP. The evaluation criteria that will be applied to the Offeror’s approach to staffing for
each phase are:
    1. Organization structure and staffing levels for all project phases.
   2. Relative experience of management and key professional personnel for whom resumes are supplied.
   3. Number of full-time equivalent personnel by staff level proposed for each task.
   4. The evaluation criteria for the Offeror’s management personnel for whom resumes are required are:
        a. Experience with Offeror (or subcontractor).
        b. Experience with Medicaid or other large scale health care claims processing systems.
        c. Large scale data processing systems design, development, implementation and operations.
        d. Experience with the focus of the phase to which the personnel are assigned.
        e. Project management experience.
        f.   Other data processing experience.


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                                                                   MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


        g. Education.
        h. References.

6.6.3         Corporate Background and Experience (200 points)

The evaluators will evaluate the experience, performance, corporate resources, and corporate qualifications of
the Offeror and any subcontractors. References will be verified and findings will be incorporated into the
evaluation of the corporation. Reference checking may not be limited to those references supplied by the
Offeror. The evaluation criteria for corporate background and experience are:
    1. Large-scale data processing system development
   2. MMIS, PBM, DSS or similar health care claims processing experience (system planning, design,
      development, implementation and operation).
   3. Web-based approaches to claims processing.
   4. Multiple benefit plan administration.
   5. Rules engine implementation and operation.
   6. Prescription Benefit Management (PBM) and other Benefit Management Plan development and
      operations.
   7. Decision Support System (DSS).
   8. Experience with other health care systems.
   9. Corporate financial statements.

6.6.4         Overall Technical Approach (150 points)

This part of the evaluation assesses the Offeror’s overall approach to project management and project control
in terms of the Offeror’s previous ability to use those tools to successfully complete projects on schedule, as
well as the specific project management approach in each phase. Project Management activities that are
specific to a phase of the project will be part of the evaluation of the individual phases. The evaluation criteria
for overall project management are:
     1. General approach to address the Contract Phases described in Section 4.2.
   2. Approach to completing project plans required in Section 4.5.3.
   3. Authority of project manager.
   4. Project control approach (including previous ability to use control tools to successfully complete
      projects on schedule; plan for reporting to the State).
   5. Work hours and time estimating methods.
   6. Sign-off procedures and internal control over deliverable production and major activities.
   7. Assessment of project risks and anticipated problem areas, and the Offeror’s approach to managing
      them.




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                                                                  MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


   8. Approach to routine problem identification, prevention, and interfaces with the State, including
      resolution.
   9. Approach to interfaces with the State.
   10. Practicality and effectiveness of the Offeror’s quality assurance plan for this Contract.
   11. Assessment of Offeror’s assumptions and constraints.
   12. Assessment of Offeror’s approach to the Contract Phases described in Section 5.
   13. Assessment of the Offeror’s approach to the requirements in Attachment F, Operational Requirements.
   14. Approach to use of walk-throughs with users to ensure agreement and understanding of each task.
   15. Information Technology Iterative Project Management.
   16. Detailed response to Deliverable Procedures and Standards in Section 4.6.
   17. Approach to producing Deliverables.

6.6.5          Technical Approach to Design and Development (250 points)

Evaluation criteria for this Section assess the Offeror’s approach to the design and development phase. The
evaluation criteria for technical approach to design and development are:
   1. Approach to Planning:
        a. Assumptions and constraints associated with the work plan.
        b. Resource loading of work plan tasks, including separately identified Contractor and State staff.
        c. Adequacy of the work plan.
        d. Logical structure of work plan and supporting Gantt chart and critical path diagram.
        e. Provision for handling problem identification and resolution.
        f.   Schedule (including adequate review time by the State) for each deliverable.
   2. Approach to Project Management:
        a. Project management approach to this phase.
        b. Authority of project manager for this phase.
        c. Project control approach (including reporting to the State).
        d. Work hours and time estimating methods.
        e. Sign-off procedures and internal quality control for completion of all Deliverables and major
           activities.
        f.   Assessment of project risks and anticipated problem areas, and the Offeror’s approach to managing
             them.
        g. Approach to routine problem identification and resolution.
        h. Approach to interfaces with the State.
        i.   Approach to Quality Control.


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                                                              MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


   j.   Assumptions and constraints associated with this phase.
   k. Use of walk-throughs for each major task.
3. Approach to MITA Concept.
4. Approach to Requirements Analysis.
5. Approach to Business and Technical Design.
6. Approach to the use of COTS.
7. Approach to use of subcontractors to address specialized areas of the requirements.
8. Approach to the use of Web-based applications.
9. Approach to the use of relational database applications.
10. Approach to use of rules engine for:
   a. Benefit plan administration.
   b. Claims and encounter adjudication.
   c. System monitoring.
   d. Report production.
11. Approach to development and unit testing.
12. Approach to documentation production.
13. Approach to Contingency Planning.
14. Approach to Software/Hardware Configuration.
15. Approach to meeting the system requirements by Attachment G, Systems Requirements Matrix.
16. Approach to producing Deliverables.
17. Approach to Comprehensive Testing:
        a. Approach to Testing Execution.
        b. Adequacy of Deliverable Prototypes.
        c. Approach to Staffing for each testing activity.
        d. Approach to Contingency Planning.
        e. Adequacy of Deliverable Prototypes.
        f.   Approach to producing Deliverables.
18. Approach to Data Cleansing and Conversion:
        a. Approach to planning.
        b. Approach to risk analysis and Contingency Planning.
        c. Approach to client data cleansing.
        d. Approach to provider cleansing.

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                                                                MONTANA MMIS/PBM/DSS Request for Proposal # 09-1610P


            e. Approach to data conversion.
            f.   Approach to producing Deliverables.

6.6.6 Technical Approach to Implementation (150 points)

Evaluation criteria for this Section assess the Offeror’s approach to the implementation phase. The evaluation
criteria for technical approach to Implementation Planning are:
     1. Approach to Planning:
       a. Assumptions and constraints associated with the work plan.
       b. Person loading of work plan tasks, including separately identified Contractor and State staff.
       c. Adequacy of the work plan.
       d. Logical structure of work plan and supporting Gantt chart and critical path diagram.
       e. Provision for handling problem identification and resolution.
       f.   Schedule (including adequate review time by the State) for each deliverable.
   2. Approach to Project Management:
       a. Project management approach to this phase.
       b. Authority of project manager for this phase.
       c. Project control approach (including reporting to the State).
       d. Work hours and time estimating methods.
       e. Sign-off procedures and internal quality control for completion of all Deliverables and major
          activities.
       f.   Assessment of project risks and anticipated problem areas, and the Offeror’s approach to managing
            them.
       g. Approach to routine problem identification and resolution.
       h. Approach to interfaces with the State.
       i.   Approach to Quality Control.
       j.   Assumptions and constraints associated with this phase.
       k. Use of walk-throughs for each major task.
       l.   Approach to cooperation with incumbent.
   3. Approach to Data Conversion.
   4. Approach to Risk Analysis and Contingency Planning.
   5. Approach to Staffing for Implementation Planning Phase.
   6. Approach to Implementation:
       a. Approach to implementation activities.


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        b. Approach to correction and adjustment activities.
        c. Approach to execution of Contingency Plans.
        d. Approach to finalized implementation schedule.
        e. Approach to implementation of all components.
        f.   Adequacy of deliverable prototypes.
        g. Approach to producing Deliverables.
        h. Staffing for the Implementation Phase, including the transition of staffing from the Design and
           Development and Implementation Phase into the Operations Phase.

6.6.7          Technical Approach to Operations (250 points)

Evaluation criteria for this Section assess the Offeror’s approach to the Operations Phase. The evaluation
criteria for ongoing operations are:
     1. Approach to Project Management:
        a. Project management approach to this phase.
        b. Authority of project manager for this phase.
        c. Project control approach (including reporting to the State).
        d. Work hours and time estimating methods.
        e. Sign-off procedures and internal quality control for completion of all Deliverables and major
           activities.
        f. Assessment of project risks and anticipated problem areas, and the Offeror’s approach to managing
           them.
        g. Approach to routine problem identification and resolution.
        h. Approach to interfaces with the State.
        i. Approach to Quality Control.
        j.   Assumptions and constraints associated with this phase.
        k. Use of walk-throughs for each major task.

   2.    Approach to Operations Requirements Attachment F, Operational Requirements:
        a. Acknowledgement of all information contained in the Overview, State Objectives, Interfaces, Inputs,
           Outputs and State Responsibilities Sections.
        b. Detailed Approach to Contractor Responsibilities:
             i. Client Management including Benefit Plan Administration
             ii. Provider Management
             iii. Operations Management
             iv. Reference Management
             v. Claim Receipt Management


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             vi. Claims Adjudication Management
             vii. Prior Authorization Management
             viii. Pharmacy Benefit Management
             ix. Third Party Liability Management
             x. Web Portal Management
        c. Program Management
             i.       Financial Management
             ii.      Federal Reporting
             iii.     Program Integrity
             iv.      Security and Privacy
        d. Care Management
             i.       Immunization Registry
             ii.      Waiver
             iii.     Managed Care
   3. Location of Operations Facilities
   4. Approach to Staffing for Operations Phase

6.6.8              Technical Approach to MMIS Certification (100 points)

Evaluation criteria for this Section assess the Offeror’s approach to the MMIS Certification phase. The
evaluation criteria for technical approach to MMIS certification are:
   1. Approach to Planning:
        a. Assumptions and constraints associated with the work plan.
        b. Person loading of work plan tasks, including separately identified Contractor and State staff.
        c. Adequacy of the work plan.
        d. Logical structure of work plan and supporting Gantt chart and critical path diagram;
        e. Provision for handling problem identification and resolution.
        f.   Schedule (including adequate review time by the State) for each deliverable.
   2. Approach to Project Management:
        a. Project management approach to this phase.
        b. Authority of project manager for this phase.
        c. Project control approach (including reporting to the State).
        d. Work hours and time estimating methods.
        e. Sign-off procedures and internal quality control for completion of all Deliverables and major
           activities.
        f.   Assessment of project risks and anticipated problem areas, and the Offeror’s approach to managing
             them.


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        g. Approach to routine problem identification and resolution.
        h. Approach to interfaces with the State.
        i.   Approach to Quality Control.
        j.   Assumptions and constraints associated with this phase.
        k. Use of walk-throughs for each major task.
   3. Approach to Meet with Federal and State Certification Team.
   4. Approach to System Remediation, if needed to obtain certification.
   5. Adequacy of Deliverable Prototypes.
   6. Approach to Staffing for MMIS Certification.

6.6.9             Technical Approach to MMIS Enhancements (75 points)

Evaluation criteria for this Section assess the Offeror’s approach to the MMIS Enhancement Phase (EHR,
Payroll, and Additional Managed care.) The evaluation criteria are:
   1. Approach to Planning:
        a. Assumptions and constraints associated with the work plan.
        b. Person loading of work plan tasks, including separately identified Contractor and State staff.
        c. Adequacy of the work plan.
        d. Logical structure of work plan and supporting Gantt chart and critical path diagram.
        e. Provision for handling problem identification and resolution.
        f.   Schedule (including adequate review time by the State) for each deliverable.
   2. Approach to Project Management:
             a. Project management approach to this phase.
             b. Authority of project manager for this phase.
             c. Project control approach (including reporting to the State).
             d. Work hours and time estimating methods.
             e. Sign-off procedures and internal quality control for completion of all Deliverables and major
                activities.
             f.   Assessment of project risks and anticipated problem areas, and the Offeror’s approach to
                  managing them.
   3. Approach to routine problem identification and resolution.
   4. Approach to interfaces with the State.
   5. Approach to Quality Control.
   6. Assumptions and constraints associated with this phase.
   7. Use of walk-throughs for each major task.
   8. Approach to Planning.


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   9. Approach to design and development.
   10. Approach to implementation.
   11. Approach to Operations.

6.6.10       Technical Approach to Turnover (50 points)

Evaluation criteria for this Section assess the Offeror’s approach to the Turnover Phase. The evaluation
criteria for technical approach to Turnover are:
     1. Approach to planning.
   2. Assumptions and constraints associated with the work plan.
   3. Person loading of work plan tasks, including separately identified Contractor and State staff.
   4. Adequacy of the work plan.
   5. Logical structure of work plan and supporting Gantt chart and critical path diagram.
   6. Provision for handling problem identification and resolution.
   7. Schedule (including adequate review time by the State) for each deliverable.
   8. Approach to Project Management.
   9. Project management approach to this phase.
   10. Authority of project manager for this phase.
   11. Project control approach (including reporting to the State).
   12. Work hours and time estimating methods.
   13. Sign-off procedures and internal quality control for completion of all Deliverables and major activities.
   14. Assessment of project risks and anticipated problem areas, and the Offeror’s approach to managing
       them.
   15. Approach to routine problem identification and resolution.
   16. Approach to interfaces with the State.
   17. Approach to quality control.
   18. Assumptions and constraints associated with this phase.
   19. Use of walk-throughs for each major task.
   20. Approach to general planning with State.
   21. Approach to general planning with successor.
   22. Approach to providing turnover services.
   23. Approach to providing Contract closeout services.
   24. Approach to Contractor responsibilities.
   25. Approach to deliverables.


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   26. Approach to Staffing for Turnover.

6.6.11        System Architecture (175 points)

This area includes assessment of the Offeror’s system architecture approach. Evaluators will evaluate the
extent to which the Offeror’s proposed approach to system architecture meets the requirements in Attachment
E, Architectural Requirements.

6.7      Scoring of Offeror Cost Proposals
The PEC will review and score the Cost Proposals from all Offerors meeting the mandatory requirements. This
committee will note any cost limitations imposed by the Offerors that could prevent the State from achieving
the objectives of the procurement and report these limitations to the Procurement Officer for a decision on
rejection of the proposal.

The maximum score for the Cost Proposal is 700 points. Points will be allocated in accordance with the
process described below.

           Cost Category                                                       Points        % of Total
           Price of MMIS/PBM/DSS System Planning, Design,
           Development, Testing, and Implementation
           (Schedule B-1, Line 13, Column C – Cost Proposal)                          280             40%

           Operational Price
           (Schedule C-7, Line 61, Column D – Cost Proposal)                          385             55%

           Price of Additional Managed Care Functionality
           (Schedule D, Column E – Cost Proposal)                                       14             2%

           Price of Electronic Health Records (EHR)
           (Schedule E, Column E – Cost Proposal)                                       14             2%

           Price of Payroll System
           (Schedule F, Column E – Cost Proposal)                                        7             1%

           Total                                                                      700           100%

The lowest price received from any Offeror for each of the Cost Proposal categories will receive the maximum
points designated for that portion of the Cost Proposal points. In order to calculate every other Offeror’s score
(other than the Offeror who received maximum points) for each Cost Proposal sub-factor, the other Offeror’s
cost will be divided into the corresponding value of the lowest Offeror and then multiplied by the maximum
points designated for that cost category. Answers will be rounded to the nearest 100th percent (186.666666…
will be rounded to 186.67). The formula for each cost category is expressed as follows:
                 (Lowest Cost / Offeror Cost) x Maximum Points = Offeror’s Score



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Using the formula above, if the lowest price for the DDI phase is $10,000,000 and another Offeror’s proposed
bid is $12,500,000, the point allotment for the 2nd Offeror is:
               ($10,000,000 /$12,500,000) x 280 points = 224 points

In order to calculate the total Cost Proposal score, the Proposal Evaluation Committee will add the points
awarded for each Section. Indicated below is an example of the application of this scoring methodology.

                                                                         Vendor A                           Vendor
                                                        Vendor A         cost                               B cost
                                          MAX           cost             proposal                           proposal
                                          Points        proposal         points           Vendor B          points
 Price of MMIS/PBM/DSS System
 Planning, Design, Development,
 Testing, and Implementation
 (Schedule B-1, Line 13, Column C –
 Cost Proposal)                                 280     $10,500,000                227       $8,500,000           280
 Operational Price
 (Schedule C-7, Line 61, Column D –
 Cost Proposal)                                 385     $40,000,000                385     $45,000,000            343
 Price of Additional Managed Care
 Functionality
 (Schedule D, Column E – Cost
 Proposal)                                         14      $100,000                  14        $125,000             11
 Price of Electronic Health Records
 (EHR)
 (Schedule E, Column E – Cost
 Proposal)                                         14      $120,000                  11         $95,000             14
 Price of Payroll System
 (Schedule F, Column E – Cost
 Proposal)                                         7        $30,000                  7         $35,000              6
 Total                                                  $50,750,000                644     $53,755,000            654




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APPENDICES
Appendix 1 - Montana Health Care Programs Summary


Waivered Services Descriptions
Waivered Services consist of but are not limited to the services listed below:

    Behavioral Health Waiver for Adults with Severe Disabling Mental Illness (SDMI)
    The Behavioral Health Waiver for Adults with Severe Disabling Mental Illness (SDMI Waiver) is
    designed to provide a consumer with SDMI a choice of receiving long term care services in a
    community setting as an alternative to receiving long term care services in a nursing home setting.
    The consumer must meet nursing home level of care and reside in an area of the State where the
    SDMI Waiver is available.
    The objective of the SDMI Waiver is rehabilitation and recovery, while encouraging the consumer to
    accept personal responsibility for services and desired outcomes. The State will ensure the providers
    of HCBS services possess and demonstrate the capability to effectively serve consumers with SDMI.
    Concurrently, another goal includes providing quality care while maintaining financial accountability.
    SDMI Waiver providers will be enrolled Montana Medicaid providers and all payments will occur
    through the MMIS. The providers of waiver services receive payments directly and providers retain
    100% of these payments. Public and non-public providers receive the same amount of Medicaid
    reimbursement. There are no intergovernmental transfer policies or certified public expenditures of
    non-State public agencies included within the SDMI Waiver.
    The goal of providing quality care while maintaining financial accountability will be accomplished by
    the field offices of the State:
    -Conducting quality assurance reviews;
    -Conducting satisfaction surveys with waiver enrollees;
    -Completing regular audits of SDMI Waiver providers’ records for compliance;
    -Providing training/education to all waiver providers; and
    -Monitoring all waiver expenditures.
    The SDMI Waiver will not be available Statewide and will be located in three geographical areas
    based on an urban core. Those areas are Yellowstone County (including counties of big Horn,
    Carbon, Stillwater and Sweet Grass), Silver Bow County (including counties of Beaverhead, Deer
    Lodge, Granite and Powell) and Cascade County (including counties of Blaine, Chouteau, Glacier,
    Hill, Liberty, Pondera, Teton and Toole).
    The package of services to be included in the SDMI waiver are: Case Management, Chore,
    Homemaker, Personal Assistance (and Specially Trained Attendant Care), Adult Day Health,
    Residential Habilitation, Day Habilitation, Prevocational Services, Supported Employment, Respite,
    Psychosocial Rehabilitation, Adult Residential Care, Chemical Dependency Counseling,
    Dietitian/Nutrition/Meals, Habilitation Aide, Personal Emergency Response Systems, Private Duty
    Nursing (and Registered Nurse Supervision), Specialized Medical Equipment and Supplies,
    Supported Living, Non-Medical Transportation, Extended State Plan-Occupational Therapy, Illness
    Management and Recovery, and Wellness Recovery Action Plan. Services are reimbursed fee for
    service; there is no managed mental health plan.
    All waivers must send 372 annual report.


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The ―Community Supports‖ Waiver (0371) – 1915 (c)
The Community Supports (CS) waiver was approved by the Centers for Medicare and Medicaid
Services in 2001. This waiver served 262 adults (age 18 years and up) with developmental
disabilities for the period 7/1/04-6/30/05, expending $1,637,905 in Medicaid funds. The average cost
per person was $6,252, thus it is considered a relatively low cost service option. Many persons in the
Community Supports waiver live at home, so supports are often purchased to help unpaid primary
care givers better meet the needs of an adult family member with DD. Services available in the
Community Supports waiver include: homemaker, personal care, respite, residential habilitation, day
habilitation, prevocational training, supported employment, environmental modifications,
transportation, specialized medical and adaptive equipment, adult companion, private duty nursing,
social/leisure/recreation opportunities, health/safety supports and educational services.
MT – PRTF Waiver 1915 (c) Home and Community Based Waiver
To provide wraparound services to youth who are at risk of entering an RTC or to youth who could
discharge from an RTC early if services were available in the community and home. The youth must
be Medicaid eligible and meet the criteria for RTC level of care. It is for youth between the ages of 6
and 16. It is only for youth in the county in which the waiver is provided. We are beginning the
Waiver in Yellowstone County and will move to 4 other sites within the State within the next 4 years.
We will provide in-home therapy; education and support to parents and other care givers; non-
medical transportation; respite care; consultation for a physician or mid level practitioner to consult
with a psychiatrist; and therapeutic goods and services not covered by Medicaid. This is a new
waiver with limited experience. As this waiver progresses, it may be rewritten.
372 report is based on date of payment instead of date of service – all the rest are date of service.

The Developmentally Disabled Waiver (0208.90) – 1915 (c)
This waiver was initiated in 1981 (one of the first waivers in the country) to provide community based
services to persons receiving services in a small program which had been decertified as an
Intermediate Care Facility for Mental Retardation (ICF-MR). This waiver has grown in size and scope
during the past 24 years. For the period 7/1/06-6/30/07, Medicaid reimbursed $63,882,230 for 1,993
persons with DD in this waiver. Services consist of supports to 356 children (age 0 through 21) with
DD and intensive supports needs. The majority of these children live at home.

The remainder of individuals received services under this waiver in SFY07. The vast majority of
reimbursement is for group home, supported living, work/day, and transportation services to adults
with DD. Other services available under this waiver include the following (which are different in
scope, duration or amount from any related State Plan services): psychological services, personal
care, homemaker, respite, occupational therapy, physical therapy, speech therapy, environmental
modifications, nutritional evaluations, private duty nursing, meals and respiratory services. The
average cost per person served in this waiver was $32,053 in SFY07 (excluding the cost of any State
Plan services accessed by the recipient).

This waiver requires a report that compares open with closed eligibility.




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Home and Community Based Services Waiver – SLTC - 1915 (c)


Home and Community Based Services are individually prescribed and arranged according to the
individual needs of the consumer. To be eligible for the Home and Community Based Services
Program, individuals must be financially eligible for Medicaid, require the level of care of a nursing
facility or hospital, and be physically disabled or over 65 years of age. Access to the program is also
dependent upon funding by the legislature. The Department Contracts with case management teams
to develop an individual plan of care in conjunction with the consumer and health care provider. An
individual's total HCBS Plan of care costs may not exceed a cost limit set by the Department.
Available services include: case management, respite, adult residential care, specialized services for
those with traumatic brain injuries, environmental modifications, adult day health, and personal
emergency response systems just to name a few. This program gives individuals the opportunity to
live fully integrated lives within their own communities – offering choice, control and self-
determination.
Quality Assurance for this waiver is similar to the Behavioral Health waiver but the information will
need to come from the MMIS/DSS. All HCBS providers are Medicaid and all bill on the 1500 form.
They share the same providers w/ the other waivers. There is a need to assure that payments can
be made to the same provider for a similar service using different rates depending on the waiver
program.
At this point Clients cannot be on more than one waiver at the same time. The client can be eligible
of more than one waiver but they can’t be on two waivers at the same time. This is subject to change
as more waivers become approved in Montana.
Exception 320 report-When the case managers notify the Office of Public Assistance of the selected
waiver, the date is entered onto the WACI (eligibility screen) along with a code. When claims come
in, if the date isn’t on there yet or they were discharged, it’s an exception 320. The MMIS must have
an ability to notify the appropriate State Program Manager of this issue through the Workflow
functionality.

Medicaid Home and Community Based Services Waiver 1915 (c)
Section 1915(c) waivers are referred to as the Medicaid Home and Community-Based Services
(HCBS) waiver program and are alternatives to providing long-term care in institutional settings.
Section 1915(c) of the Act authorizes the Secretary of Health and Human Services to waive certain
Medicaid statutory requirements to enable you to cover a broad array of home and community-based
services as an alternative to institutionalization.
**This waiver will be combined w/ above down the road.

Montana Basic Medicaid for Able-Bodied Adults 1115(a)

In 1996 under the authority of an 1115 welfare reform waiver referred to as Families Achieving
Independence in Montana (FAIM), Montana implemented a limited Medicaid benefit package of
optional services to the same group of adults eligible for Medicaid under Sections 1925 or 1931 of
the Social Security Act (the individuals were age 21 to 64, not pregnant and not disabled). The limited
Medicaid benefit package was referred to as ―Basic Medicaid‖. The FAIM welfare reform waiver


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expired on January 31, 2004. A replacement 1115 waiver was approved effective February 1, 2004
continuing basic Medicaid coverage for able-bodied adults ages 21 - 64 who are not disabled or
pregnant and who are eligible for Medicaid under Sections 1925 (Transitional Medicaid) or 1931
(Family Medicaid) of the Social Security Act. This waiver excludes coverage by Medicaid for certain
optional services: audiology and hearing aids, personal assistance services, durable medical
equipment, routine eye exams provided by an ophthalmologist or an optometrist, eyeglasses, dental
and denturist services. The Department recognizes there may be situations where the excluded
services are necessary as in an emergency or medical situation or if essential for employment. Under
these defined situations, if the standards and criteria are met, Medicaid may cover the excluded
service. Each individual request is evaluated. Montana submitted an extension request in January
2008 for the Montana Basic Medicaid Section 1115 Waiver for Able-Bodied Adults. We requested a
Section 1115(e) extension as we will continue the waiver with no material program changes. The
Basic Medicaid Waiver will expire on January 31, 2009. We requested to continue the Basic
Medicaid Waiver for an additional three years, through January 31, 2012. The waiver has been in
effect since 1996 with no significant change.
An amendment for the 1115 waiver was submitted July 21, 2006. Montana has been working with
CMS regarding technical waiver and budget neutrality issues from that submission. The Department
plans to submit a revised amendment application early in 2008.
The amendment proposes to significantly change the Basic Waiver’s operations by requesting to
cover several new populations; Uninsured Mental Health Services Plan (MHSP) participants,
Uninsured Working Adults with Children on Medicaid, Uninsured Working Youth Aged 18-20,
Uninsured Working Adults with Children Under 21, certain participants from Montana Comprehensive
Health Association (MCHA) and from Insure Montana, and Uninsured SED Youth Formerly in Foster
Care.

New waiver benefits, specific to certain new waiver populations, would include; employee premium
assistance, private insurance premium assistance, Basic Medicaid Health Care benefits, continued
current MHSP benefits, limited acute inpatient psych services, CHIP-like basic and extended mental
health benefits, transitional mental health services, MCHA benefits, and Insure Montana benefits.
Montana proposes budget neutrality by Medicaiding portions of MHSP, Insure Montana, and MCHA
State only plans, and by using reserve Federal funds from Basic Medicaid Program savings.
The Montana Basic waiver does not require the 372 report, but rather requires annual and quarterly
reports-quarterly reports contain budget neutrality. It also contributes to the CMS 64 reports.
The new system will require a way to capture just the Medicaid populations. Various waiver
populations and expenditures will need to be captured and accounted to the appropriate program
within this waiver. Each population will have its own benefit plans. .

Montana Passport to Health 1915 (b)

Passport To Health (Passport): is Montana’s managed health care program. Under Passport, eligible
Medicaid enrollees choose a primary care provider (PCP) who manages their health care. Most
services must be provided by the PCP or require the PCP’s authorization to be reimbursed by
Medicaid. The care management provided by the PCP enhances care while reducing costs by
minimizing ineffective or inappropriate medical care to Medicaid recipients. Passport cost avoids over
$20 million per year in medical costs and improves quality of care. Quality of and access to care is
continuously monitored, and is consistently equal to or better than Medicaid-funded care to similar


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    non-Passport clients. Medicaid covered approximately 114,000 different people during State Fiscal
    Year 2005. Approximately 83,000 of these people were enrolled in the Passport Program. Passport
    operates in 55 of 56 counties. Team care functions under Passport.

    Medicaid Health Improvement Plan (MHIP)
    Components:
         Nurse advice line
         Health assessment
         Low risk population—wellness education
         Medium risk population—health coaches and care coordination
         High risk population—care management, case management
    planned implementation early 2009

    Montana Plan First—Medicaid Family Planning Waiver
    Will provide access to family planning for Montana women not eligible for Medicaid or CHIP who are
    ages 14 through 44, with incomes of 185 percent FPL, who do not have access to family planning
    coverage.
    Planned implementation late 2008



The Montana Breast and Cervical Cancer screening program has about 900 providers (most of whom are also
Medicaid providers) with about 4000 women who are screened in a year. The screening is the only service
provided under this program. Woman found to have cancer may become eligible for the Medicaid program.




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Appendix 2 - Glossary of Terms

GLOSSARY OF TERMS and DPHHS Acronyms

ACS - Affiliated Computer Systems (incumbent Fiscal Agent)

ADAP - AIDS Drug Assistance Program (not included in the initial MMIS implementation.)

AD HOC REQUEST – A request to provide non-production reports.

AD HOC REPORT – A non-production report.

ADJUDICATE – To determine whether all benefit plan requirements have been met and whether a claim
should be paid or denied.

ADJUDICATED CLAIM VOLUME - For the purpose of Section 0, means the number of claims fully
adjudicated. For the purposes of counting adjudicated claims, a claim shall be defined as one (1)
claim regardless of the number of lines on the claim. System created financial transactions and Mass void and
replacements initiated by DPHHS shall be included in this definition. Rejected claims, any void or replacement
initiated by a provider or as a result of Fiscal Agent processing errors shall not be included in this definition.

ADJUDICATED CLAIM – A claim that has reached final disposition paid or denied. An adjudicated claim is
ready for payment processing.

ADJUSTMENT – A transaction that changes any payment information on a previously paid claim. (In the
replacement MMIS, adjustments will be made by voiding the original claim and, if applicable, creating a
replacement through submission of a paper claim, 837, or use of direct data entry on the web Portal.

ADVANCE – A payment to a provider based on an estimate of claims that have not be adjudicated to pay
status at the time the Advance is issued.

AID CATEGORY – An alpha and numeric code identifying the criteria used to determine an individual's benefit
plan enrollment.

ALS - Advanced Life Support (a type of emergency transportation service.)

AMDD - Addictive and Mental Disorders Division

AMP - Average Manufacturer Pricing

ANSI - American National Standards Institute




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ANSI X12N 270/271 – The HIPAA named transaction between a provider and a health plan or between two
health plans to determine eligibility for health plan benefits. The 270 transaction is submitted and the 271
transaction returns the eligibility information.

ANSI X12N 278 – The HIPAA required transaction to request prior authorization or referral and receive such
authorization.

ANSI X12N 820 – The HIPAA required transaction to make premium payments

ANSI X12N 834 – The HIPAA required transaction to enroll individuals in a health plan.

ANSI X12 N 835 – The HIPAA required transaction to send Health Care claim payment and remittance advice

ANSI X12 N 837 – The HIPAA required transactions to submit Health Care claims or equivalent encounters.
There are three versions of the 837, Institutional, Professional, and Dental.

ANSI X12 N 276/277 – The HIPAA required transaction to inquire as to the status of a previously submitted
claim. The 276 makes the inquiry and the 277 is the response from the Health Plan.

APC - Ambulatory Payment Classification

APD – Advance Planning Document (also called IAPD: Implementation Advance Planning Document.)

ARM - Administrative Rules of Montana

ARNP – Advanced Registered Nurse Practitioner

ASC - Ambulatory Surgery Center

AVRS – Computerized Automated Voice Response System – Used to supply recipient eligibility information or
claims status to providers via telephone.

AWP- Average Wholesale Price

BBA - Balanced Budget Act

BCP – Business Continuity Plan

Bed Hold – This definition is for Nursing Facilities Bed Hold - Bed Hold days are days when the facility is
holding a bed for a resident who is temporarily away from the facility and expected to return. The resident may
be out of the facility on a Therapeutic Home Visit or while receiving medical treatment in another facility that is
not a Nursing Home.

BENDEX – Beneficiary Data Exchange System – A file containing data from the Federal government regarding
all persons receiving benefits from the Social Security Administration. This file is received and processed by
TEAMS/CHIMES, the State’s eligibility determination system, and the data is forwarded to the MMIS.



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Business Day - A day scheduled for regular State of Montana employees to work; Monday through Friday
except holidays observed by regular State of Montana employees. Timeframes in the RFP requiring
completion with a number of workdays shall mean by 5:00 p. m. Mountain Time on the last workday.

BUY-IN – A procedure whereby the State pays a monthly premium to the Social Security Administration on
behalf of eligible Medicaid recipients, enrolling them in the Medicare Title XVIII Part A and Part B Program. All
Buy-In activities are managed by TEAMS/CHIMES, the State’s eligibility determination system.

CAH - Critical Access Hospital

CALENDAR DAY – A 24 hour period between midnight and midnight, regardless of whether or not it occurs on
a weekend or holiday.

CALENDAR YEAR – A 12 month period beginning on January 1 and ending on December 31.

CAN – Used to express non-mandatory provisions; words denote the permissive.

CAPS – Limits on services available to a Client enrolled in a Benefit plan, such as the number of dentures a
recipient may receive.

CARRIER – An organization processing Medicare Part B claims on behalf of the Federal government.

CBT – COMPUTER BASED TRAINING – Formal course materials delivered thorough an interactive web-
based training application.

CCR - Cost to Charge Ratio

CDT – Current Dental Terminology

CERTIFICATION – written acknowledgment from CMS that the operational MMIS meets all legal and
operational requirements necessary for 90% and 75% Federal Financial Participation (FFP).

CFR – CODE OF FEDERAL REGULATIONS – The Federal rules that direct the State in its administration of
the Medicaid program and implementation and operation of an MMIS.

CFSD - Child and Family Services

CHIMES - Combined Health Care Information & Montana Eligibility System

CHIP - Children’s Health Insurance Plan, a fee-for-service benefit plan managed on the MMIS and through a
Contract with Montana Blue Cross Blue Shield

CHOW - Change of Ownership

CLAIM – A request for a Benefit plan to pay for health care services.




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CLIA – THE CLINICAL LABORATORY IMPROVEMENT AMENDMENTS – Provisions of 1988 which requires
all laboratory testing sites to obtain either a certificate of waiver or a certificate of registration along with an
identification number in order to legally perform testing anywhere in the United States.

Client – A person who has been determined to be eligible for a one or more of the Montana Health Care
programs.

CMHSP - Children’s Mental Health Service Plan

CMM – CAPABILITY MATURITY MODEL – An Information Technology (IT) system development methodology
developed and promoted by Carnegie Mellon University to measure and certify the methods and controls used
by a company or agency in the development of IT systems.

CMS – CENTERS FOR MEDICARE AND MEDICAID SERVICES – The organizational unit of the U.S.
Department of Health and Human services responsible for administration of the Title XIX Program under the
Social Security Act.

CMT - Case Management Team

COB – Coordination of Benefits

COBA - Coordination of Benefits Agreement

COBC - Coordination of Benefits Contractor

COMPOUND DRUG – A medication that is a combination of two or more pharmaceuticals.

CONTRACT – The written, signed agreement resulting from, and inclusion of, this RFP, any subsequent
amendments thereto and the Offeror’s proposal.

CONTRACT AMENDMENT – Any written alteration in the specifications, delivery point, rate of delivery,
Contract period, price, quantity, or other Contract provisions of any existing Contract, whether accomplished by
unilateral action in accordance with a Contract provision, or by mutual action of the parties to the Contract; it
shall include bilateral actions, such as administrative changes, notices of termination, and notices of the
exercise of a Contract option.

CONTRACTOR – The successful Offeror (Fiscal Agent) with which the State has executed a Contract that
processes and adjudicates provider claims on behalf of the State.

COOP – CONTINUITY OF OPERATIONS PLAN – A plan that incorporates disaster recovery, risk analysis and
Contingency Planning to assure continued operation of Fiscal Agent responsibilities in case of a disaster,
system failure, work stoppage, or other occurrence. Same as Business Continuity Plan BCP

COST SETTLEMENTS – Reimbursement based on the provider’s actual costs for rendering services to
Montana Health Care Program recipients. Some providers who are reimbursed on a cost basis include:
Critical Access Hospitals and Nursing facilities.



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COTS – Commercial-Off-The-Shelf software

COVERED SERVICE – Mandatory medical services required by CMS and optional medical services approved
by the State for which enrolled providers will be reimbursed for services provided to eligible Montana Health
Care Programs recipients.

CPA – Certified Public Accountant

CPT-4 - Current Procedural Terminology, Fourth Edition

CPT – CURRENT PROCEDURE TERMINOLOGY – Unique coding structure scheme for all medical
procedures approved by the American Medical Association - Fourth Edition.

CREDENTIALING – For the purposes of this RFP, credentialing is validation by the Fiscal Agent that providers
or applicants meet the Montana Health Care Program requirements for enrollment either through data
exchange or document review.

CRM - Customer relationship management is a term applied to processes implemented by a company to
handle their contact with their customers. CRM software is used to support these processes, storing
information on customers and prospective customers. Information in the system can be accessed and entered
by employees in different departments, such as sales, marketing, customer service, training, professional
development, performance management, human resource development, and compensation.

CROSSOVER CLAIM – A claim submitted by a Medicare/Medicaid provider to a Medicare carrier or
intermediary on behalf of a dual Medicare/Medicaid eligible or Qualified Medicare Beneficiary that has been
paid by Medicare and crossed over to Medicaid for payment of the Medicare deductible and/or coinsurance.

CSR – CUSTOMER SERVICE REQUEST – An official work request notification to the Fiscal Agent to initiate
an update, research discrepancy modify or complete maintenance work in the MMIS/PBM/DSS.

CSCT - Comprehensive School & Community Treatment

CSHS - Children’s Special Health Services

CTCM – Children’s Targeted Case Management

DAW - Dispense as Written

DAY – Calendar day, unless specified as a business day.

DDP – Developmental Disability Program

DEA – Drug Enforcement Agency

DELIVERABLE – All software, documentation, reports, manuals, and any other item that the Vendor is
required to produce and/or tender to the State under terms and conditions of this Contract.



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DENIED CLAIM – A claim for which no payment is made to the provider because the claim is for non-covered
services, is for an ineligible provider or recipient, is a duplicate of another similar or identical transaction, or
does not otherwise meet State standards for payment.

DESI - Drug Efficacy Study Index. (A Federal determination of a drug’s safety and effectiveness)

DIAGNOSIS – The classification of a disease or condition (see ICD-9-CM).

DISASTER RECOVERY AND BACK-UP PLAN – A plan to ensure continued claims processing through
adequate alternative facilities, equipment, back-up files, documentation and procedures in the event that the
primary processing site is lost to the Contractor.

DOLI/DLI – Department of Labor and Industry. The agency that is responsible for licensure of most health
care professionals.

DM - Disease Management

DME - Durable Medical Equipment

DOA – Department of Administration

DOB - Date of Birth

DOS - Date of Service

DPHHS - The State Department of Public Health and Human Services also referred to as the ―Department‖.

DRA - Deficit Reduction Act

DRAMS - Drug Rebate Administration Management System managed by the current Fiscal Agent

DRG – Diagnosis Related Group

DRUG REBATE – Program authorized by the Omnibus Budget Reconciliation Act of 1990 (OBRA-90) in which
legend drug manufacturers or labelers enter into an agreement with the Secretary, DHHS, to provide financial
rebates to States based on dollar amount of their drugs reimbursed by the Montana Health Care Programs.

DSH - Disproportionate Share Hospital

DSS – DECISION SUPPORT SYSTEM – Component of a data warehouse that provides analytical-level
queries and reporting.

DUE CARE - Drug Use Education, Concurrent and Retrospective Evaluation

DUR – DRUG UTILIZATION REVIEW – Drug Utilization review is a process whereby the pharmacist reviews
the prescription and the patient record for therapeutic appropriateness.



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EAC - Estimated Acquisition Cost

ECD - Expected Completion Date

ECS – ELECTRONIC CLAIMS SUBMISSION – Electronic methods of claims submission.

ED - Emergency Department

EDB – Medicare Enrollment Database

EDI - Electronic Data Interchange

EDIT – Validation of data.

EDMS – Electronic Data Management System

EDP – Electronic Data Processing

EFT – ELECTRONIC FUNDS TRANSFER – The payment of funds made by direct deposit to a provider's bank
account.

EHR – ELECTRONIC HEALTH RECORD – (See also EMR, Electronic Medical Record), a record of
diagnoses, treatments and laboratory results stored in an electronic record for retrieval and use by authorized
treatment professionals

EIN – Employer Identification Number

ELIGIBILITY FILE – A file that maintains pertinent data for each Montana Health Care Program eligible
recipient.

ELIGIBILITY VERIFICATION – Refers to the process of validating whether an individual is determined to be
eligible for health care coverage through the Montana Health Care Program Eligibility for the Client is
determined by the State.

EMR – ELECTRONIC MEDICAL RECORD (See also EHR, Electronic Health Record), a record of diagnoses,
treatments and laboratory results stored in an electronic record for retrieval and use by authorized treatment
professionals

ENCOUNTER DATA – Detailed data about individual health care related services provided by a capitated
managed care organization (MCO) or other State designated managed care providers. Encounter data is
equivalent to a standard Montana Health Care Program claim except that it is submitted to provide service
delivery data to the Agency and is not eligible for reimbursement.

ENHANCEMENTS – MMIS/PBM/DSS system changes to update payment methodologies, program changes
per State or Federal mandates, etc.




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EOB – EXPLANATION OF BENEFITS – An explanation of denial or reduced payment included on the
provider’s remittance advice.

EOMB – EXPLANATION OF MEDICARE BENEFITS – The result of Medicare claims processing reported to a
provider.

EPSDT - Early and Periodic Screening, Diagnosis, and Treatment

ESRD - End Stage Renal Disease

EVALUATION – The in-depth review and analysis of Contractor’s proposals.

FA – FISCAL AGENT – Refers to the Vendor operating the MMIS. A Contractor who processes Montana
Health Care Program provider claims for payments and performs certain other related functions as an agent for
the State.

FAD – Fraud and Abuse Detection

FAQ - Frequently Asked Questions

FDA - Food and Drug Administration

FFP – FEDERAL FINANCIAL PARTICIPATION – The percentage amount contributed by the Federal
government towards administrative costs in the Montana Medicaid costs or the State Children’s Health
Insurance Program.

FFS – FEE FOR SERVICE

FFY - Federal Fiscal Year

FINANCIAL TRANSACTION - A system generated non-claim transaction used to make to related payments or
recovery funds from clients, providers and other entities such as insurance carriers.

FMAP - Federal Medical Assistance Percentage - The percentage amount contributed by the Federal
government towards the costs of most benefits in the Montana Medicaid program.

FPL - Federal Poverty Level

FQHC - Federally Qualified Health Center

FTP – File Transfer Protocol

FUL - Federal Upper Limit aka MAC

FY – FISCAL YEAR – State: the twelve (12) month period beginning July 1 and ending June 30. Federal: the
12 month period beginning October 1 and ending September 30.



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GAAP – Generally Accepted Accounting Principles

GIS – GEOGRAPHICAL INFORMATION SYSTEMS – Software program that allow data to be displayed
spatially.

GSD – GENERAL SYSTEM DESIGN – Defines the major feature and functions of an automated system to
include major system logic, reports, screens, and input forms and files required for a certifiable MMIS.

GUI – Graphical User Interface

HCBS - Home & Community Based Services

HCPCS – HEALTH CARE COMMON PROCEDURE CODING SYSTEM – A coding system designed by CMS
that describes the physician and non-physician patient services covered by Medicaid and Medicare Programs
and used primarily to report reimbursable services provided to patients.

HEDIS – Health Care Effectiveness Data and Information Set

HIFA - Health Insurance & Flexibility Accountability Waiver

HIPAA – THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 – A Federal law
that includes requirements to protect patient privacy, to protect security of electronic health information, to
prescribe methods and formats for exchange of electronic administrative transactions, and to uniformly identify
providers.

HIPP – Health Insurance Premium Payment

HIPPS - Health Insurance Premium Payment System

HMO - Health Care Management Organization

HRD - Health Resources Division

HTML – HYPERTEXT MARKUP LANGUAGE – A standardized computer language for displaying information
in Web browser screens across various operating systems and platforms.

ICD-9-CM – INTERNATIONAL CLASSIFICATION OF DISEASE, NINTH EDITION, CLINICAL MODIFICATION
– A classification and coding structure of diseases used by the State and health care community to describe
patients' conditions and illnesses and to facilitate the collection of statistical and historical data.

ICN – INTERNAL CONTROL NUMBER – A unique serial number applied to each imaged document stored in
MMIS/DSS. Several ICNs may be associated with a single Transaction Control Number and non-claim
documents may have an ICN as their sole control number.

ICP – Individual Cost Plan - Benefits limited by a cost plan established for an individual.

ICR – Intelligent Character Recognition


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ID – Identification number

IDTF - Independent Diagnostic Testing Facilities

IG - Implementation Guide

IHS - Indian Health Services

INTERMEDIARY – Private insurance organization under Contract with the Federal government handling Part A
Medicare claims.

IRL - Interface Record Layout

IRS – Internal Revenue Service (Federal)

IVRS - Interactive Voice Response Service

J2EE - JAVA 2 PLATFORM, ENTERPRISE EDITION or J2EE- A Standard for developing distributed Multi-tier
architecture applications, based on modular components running on an application server. It uses several
technologies, including JDBC and CORBA, and extends their functionality with Enterprise Java Beans, Java
Servlets, Java Server Pages and XML technologies.

JAD – Joint Application Design

KIDS - Kids Insurance Determination System (CHIP eligibility)

LAN – LOCAL AREA NETWORK – Backbone and Network Servers

LIS - Low Income Subsidy

LOCK-IN – An MMIS/DSS function that a Medicaid recipient receives certain benefits from a single, identified
source. Lock-In is most used in Pharmacy Benefits Management to require a potentially abusive recipient to
pick up prescriptions at a certain pharmacy only. Lock-In is used in managed care to require a recipient to
receive care through a certain HMO or service network for a set period of time. See Team Care

LTC – Long Term Care

MAC - Maximum Allowable Cost or Medicaid Administrative Claiming

MANAGED CARE – Systems of care designed to improve recipients’ access to health care and continuity of
care, while reducing the overall costs of care.

MARS – Management and Administrative Reporting Subsystem – a part of the DSS.

MATH - Montana Access to Health

MCO – MANAGED CARE ORGANIZATIONS


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MDS – Minimum Dataset

MEDICAID – The Federal medical assistance program as described in Title XIX of the Social Security Act.

MEDICARE – The Federal health care program as described in Title XVIII of the Social Security Act. Part A
covers hospitalization and Part B covers medical insurance.

MEPS - Medicaid Eligibility and Payment System

MFCU – MEDICAID FRAUD CONTROL UNIT – A Section under the Attorney General that investigates
potential Medicaid fraud and abuse.

MHC - Mental Health Center

MHSP - Mental Health Services Plan

MILESTONE – The measuring point used to review and approve progress, to authorize continuation of work,
and, depending on the terms of the Contract, to pay for work completed.

MITA – MEDICAID INFORMATION TECHNOLOGY ARCHITECTURE – An initiative by the Federal Centers
for Medicare and Medicaid Services to modernize Medicaid Management Information Systems operated by the
States by promoting greater interoperability with other systems, use of Commercial-Off-The-Shelf software,
reusable programs and systems, and system analysis that allows business needs to drive system
development.

MMA – Medicare Prescription Drug, Improvement and Modernization Act of 2003

MMIS – MEDICAID MANAGEMENT INFORMATION SYSTEM – Medicaid claims processing and information
system.

MOA - Memorandum of Agreement

MODIFICATION – Routine MMIS system changes that are identified throughout the life of the Contract,
documented on the Customer Service Request (CSR) form, and submitted to the Contractor for design,
programming, and implementation.

MOU - Memorandum of Understanding

MPQHF - Mountain-Pacific Quality Health Foundation

MSIS - Medicaid Statistical Information System

NABP - National Association of Boards of Pharmacies.

NCPDP – National Council of Prescription Drug Programs

NDC – National Drug Code


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NPDB – National Practitioner Database

NPI – National Provider Identification

NPPES - National Plan and Provider Enumeration System

NPS – National Provider System

OBRA - Omnibus Budget Reconciliation Act

OCE – Outpatient Prospective Payment System Code Editor

OCR - Optical Character Recognition

Offeror – A Vendor who returns a properly completed response to a request for proposal from an authorized
State or agency-purchasing agent.

OIG - Office of the Inspector General

OLA - Office of Legal Affairs

ON-LINE – Interaction between a user operating a cathode ray tube (CRT), personal computer, or point of
sale(POS) device to send and receive information on a video display via a telecommunications network to a
central computer processing unit (CPU).

OOS - Out of State

OPA - Office of Public Assistance

OPCA - Office of Planning, Coordination and Analysis

OPPS - Outpatient Prospective Payment System

OSCAR – ON-LINE SURVEY CERTIFICATION & REPORTING – The Federal file which contains CLIA
certified providers and their classifications. The interface loads and verifies the CLIA provider number, status
and specialties for which a provider is approved and can deny claims based upon CLIA specialties and
subspecialties found on the OSCAR file

OTC - Over-the-Counter

OVERPAYMENT – Payment made to a provider in excess of the amount allowed under the reimbursement
rules of the benefit plan.

P4P – Pay for Performance - a mechanism to pay providers additional reimbursement for participation in
specific treatment protocols.

PA - Prior Authorization


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PACE - The Program of All-inclusive Care for the Elderly (PACE) program is a model of managed care service
delivery for the frail community-dwelling elderly, most of whom are dually eligible for Medicare and Medicaid
benefits, and all of whom are assessed as being eligible for nursing home level of care.

PAID CLAIM – A claim that has resulted in the provider being reimbursed for some dollar amount or a zero
paid amount.

PAS - Personal Assistance Services

PASSPORT - Partners in Access to Services Providers and Recipients Together

PBM – Pharmacy Benefit Management. Composed of a functionality to support point-of-sale, drug utilization
review and drug rebate.

PCCM – Primary Care Case Management

PCP – Primary Care Physician or Primary Care Providers

PDCS – PRESCRIPTION DRUG CARD SYSTEM – Claims processing system used by the incumbent Fiscal
Agent to process all pharmacy claims with nightly data passed to MMIS. (Same as POS.)

PDDD - Procedure, Drug, Diagnosis & DRG

PDP - Private Prescription Drug Plan

PDL - Preferred Drug List

PEC - Proposal Evaluation Committee

PENDED CLAIM – see Suspended Claim.

PHI - Protected Health Information

PMBOK™ – THE PROJECT MANAGEMENT BODY OF KNOWLEDGE – A library of project management
skills, tools and standards used by the Project Management Institute to measure and certify Project
Management Professionals.

PMI – PROJECT MANAGEMENT INSTITUTE – A body that certifies Project Management Professionals

PMP – Project Management Professional

POA – Present on admission – used to indicate diagnoses that were documented when a patient was admitted
to a facility. The implication is that additional diagnoses that occurred as a result of the admission would not
generate additional payment.

POS – PLACE OF SALE – Sometimes used to mean "Point of Service" for Pharmacy.



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PROCUREMENT LIBRARY – The collection of MMIS documentation, provider policy manuals, and general
information related to the Montana Health Care Programs and the Montana MMIS.

PRO-DUR - Prospective Drug Utilization Review

PROVIDER – A person, organization or institution that provides health care related services and is enrolled in
the Montana Health Care Programs.

PROVIDER HANDBOOK – Provider manuals that contain the State’s program specific coverage, limitation,
and reimbursement policies.

PRTF - Psychiatric Residential Treatment Facility

PSI - Policy Studies Incorporated

QAD - Quality Assurance Division

QDWI - Qualified Disabled Working Individual

QMB - Qualified Medicare Beneficiary

QI - Qualified Individual

RA – Remittance Advice

RBRVS – Resource Based Relative Value Scale

RECIPIENT – A client who has received services.

REIMBURSEMENT HANDBOOK – Provider manuals that contain billing instruction for reimbursement by
Montana Health Care Programs.

REJECTED CLAIM – A claim containing errors found during front-end screening such as missing provider ID
or other key data elements, or has some conflicting information that will impede the proper adjudication
through the automated system. Such claim is returned to the responsible provider without entering it into the
MMIS.

RA - REMITTANCE ADVICE –A summary of claim payments and denials produced by MMIS. An RA can
mailed or posted to the web Portal

RetroDUR – RETROACTIVE DRUG UTILIZATION REVIEW

RFP – REQUEST FOR PROPOSAL – The document that describes to prospective Offerors the requirements
of the Fiscal Agent, MMIS, terms and conditions and technical information.

RHC - Rural Health Clinic



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RHIA – Registered Health Information Administrator

RVS - Relative Value Scale

RVU - Relative Value Unit

SAMHSA - Substance Abuse & Mental Health Services Administration

SDMI - Severe Disabling Mental Illness

SED - Serious Emotional Disturbance

SERVICE AUTHORIZATION – The approval required from a designate authority for reimbursement for certain
Montana Health Care Program services

SFY - State Fiscal Year

SLMB - Supplemental Low-Income Medicare Beneficiary

SLTC - Senior and Long Term Care

SNF - Skilled Nursing Facility

SOA – Service Oriented Architecture

SOAP - SOAP (Simple Object Access Protocol) - A light-weight protocol for exchanging messages between
computer software, typically in the form of software components. It is an XML based protocol that consists of
three parts: an envelope that defines a framework for describing what is in a message and how to process it, a
set of encoding rules for expressing instances of application-defined datatypes, and a convention for
representing remote procedure calls and responses. SOAP can potentially be used in combination with a
variety of other protocols; however, the only bindings defined in this document describe how to use SOAP in
combination with HTTP and HTTP Extension Framework.

SOR - Statement of Remittance

SOW - Scope of Work - A document prepared by the requestor and included in the requisition package, which
delineates and fully describes the service to be performed or the required end result.

SPEND DOWN – The Medically Needy program requires that an individual incur medical expenses equal to
his/her share of cost amount, a.k.a. spend down amount, in order to become eligible for Medicaid. Medicaid is
Federally prohibited from reimbursing providers any portion of a recipient’s spend down amount, however
share of the cost information and medical expenses are currently tracked on the State’s welfare eligibility
system. The Client reports medical expenses to the OLA and those expenses are recorded in the
TEAM/CHIMES. Once the Client has met the spend down amount, TEAM/CHIMES sends an eligibility
authorization to the MMIS.

SSA – SOCIAL SECURITY ADMINISTRATION


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SSI - Supplemental Security Income

STATUTES – Laws passed by Congress or a State legislature and signed by the President or the Governor of
a State, respectively, that are codified in volumes called ―codes‖ according to subject matter.

SUBCONTRACTOR – Any entity Contracting with the Prime Contractor to perform services or to fulfill any of
the requirements requested in this RFP or any entity that is a subsidiary of the Prime Contractor that performs
the services or fulfills the requirements requested in this RFP.

SURS – SURVEILLANCE AND UTILIZATION REVIEW SUBSYSTEM. SURS functionality is provided by the
DSS.

SUSPENDED CLAIM – a claim that has been suspended for manual review during the adjudication.

SYSTEM DOCUMENTATION – Documents that contain the technical description of the configuration,
components and operation of the MMIS or DSS.

TANF - Temporary Assistance for Needy Families

TCM - Targeted Case Management

TCN – TRANSACTION CONTROL NUMBER – An internal control number assigned to each claim as the
current Fiscal Agent for processing receives it. The TCN is used in both current MMIS and current POS.

TEAMS - The Economic Assistance & Management System. This eligibility determination system is being
replaced by CHIMES.

Team Care – Montana term for Lock-In

TPA – Third Party Administrator

TPL – THIRD PARTY LIABILITY – A situation in which a claim submitted as a result of an accident or injury
and for which another entity may be responsible for payment or situation in which a client has health insurance
resources, including Medicare, which are responsible for at least partial payment of a claim.

TPMS - Trading Partner Management System

TRICARE – The US Government program that provides insurance to military dependents and retirees.
(Previously known as CHAMPUS)

TSD - Technology Services Division

UAT – User Acceptance Testing

U&C - Usual & Customary

UCF – UNIVERSAL CLAIM FORM – The NCPDP standard paper claim form for pharmacy claims.


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UPIN – Universal Provider Identifier

URL - Uniform Resource Locator

USER – Any individual or a group identified by the State as the persons authorized to use all or parts of
MMIS/PBM/DSS functions.

UDDI Version 3.0.2 Specification describes the Web services, data structures and behaviors of all instances of
a UDDI registry. UDDI uses the XML Schema Language (See http://www.w3.org/TR/xmlschema-0/,
http://www.w3.org/TR/xmlschema-1/ and http://www.w3.org/TR/xmlschema-2/) and its terminology, such as
"sequence" and "choice" to formally describe its data structures.

VFC - Vaccines for Children

VENDOR – Any responsible source that provides a supply or service.

VHSP - Virtual Human Services Pavilion

WAN – WIDE AREA NETWORK – Connection between two LANs.

WBS – WORK BREAKDOWN STRUCTURE – A detailed plan used to complete and track a project. The WBS
identifies every task in the project, estimates time and resource requirements, identifies predecessor and
successor tasks, identifies the critical path, and is used to compare to actual project performance

WS-Notification is a family of related white papers and specifications that define a standard Web services
approach to notification using a topic-based publish/subscribe pattern. The Event-driven, or Notification-
based, interaction pattern is a commonly used pattern for inter-object communications. Examples exist in many
domains, for example in publish/subscribe systems provided by Message Oriented Middleware vendors, or in
system and device management domains. This notification pattern is increasingly being used in a Web
services context.

WS-MTOM Policy - This specification describes a domain-specific policy assertion that indicates endpoint
support of the optimized MIME multipart/related serialization of SOAP messages defined in Section 3 of the
SOAP Message Transmission Optimization Mechanism specification.

XML – EXTENSIBLE MARKUP LANGUAGE – Designed to improve the functionality of the Web by providing
more flexible and adaptable information identification. XML is actually a meta language-a language for
describing other languages-which allows users to design their own customized markup languages for limitless
different types of documents.

 XSL/XSLT - A language for transforming XML documents into other XML documents. XSLT is designed for
use as part of XSL, which is a stylesheet language for XML. In addition to XSLT, XSL includes an XML
vocabulary for specifying formatting. XSL specifies the styling of an XML document by using XSLT to describe
how the document is transformed into another XML document that uses the formatting vocabulary.




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Appendix 3 - Items in the Procurement Library

Note-These documents are not available in this RFP. They can be found at the following link:
http://gsd.mt.gov/osbs/Results.asp?CategoryID=14 in the Zip file called ―Group 2 Procurement
Library.‖
State Medicaid Manual

Medicaid Enterprise Certification Toolkit

Provider Manuals and Bulletins-Links to additional documents can be found in the ―Library
Contents.doc‖ document.

Current State Architecture Report (Includes Interfaces)

Current MMIS User Documentation

Sample of Current Reports

Edits/Audits Business Rules

Current Fiscal Agent Call Center Statistics

Current Fiscal Agent Workload Statistics

Current Fiscal Agent Organizational Charts

Current Fiscal Agent Contract

AWACS – DD Documentation

Montana Health Care Programs Statistics

Procurement Documents

MITA Self Assessment Results




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Appendix 4 - Agency Organizational Chart




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Appendix 5 - Checklist of Mandatory Items
This appendix identifies the mandatory items for the Technical and Cost Proposals. Failure, in whole or in part,
to respond to a specific mandatory item shall result in rejection of the proposal during the evaluation phase.


                       Checklist of Mandatory Items                                     RESULTS
                          TECHNICAL PROPOSAL                                    Pass (Yes)        Fail (No)
       GENERAL RESPONSE REQUIREMENTS
    1. Was the proposal received by the State of Montana on the
       date and time as specified in the RFP?
    2. Did the vendor submit separate sealed packages containing
       the Technical Proposal (and all required documents) and the
       Cost Proposal?
    3. Did the Agency receive the following:
            A transmittal letter, with an original signature
            Thirteen (14) copies of the technical proposal (1 original
             and 13 copies)

            Two electronic version of the technical proposal (DVD or
             CD format) meeting the requirements of Section 0


                      Checklist of Mandatory Items                                    RESULTS
                        TECHNICAL PROPOSAL                                      Pass (Yes) Fail (No)
    4. Is the Transmittal Letter on the official business letterhead
        from the entity submitting the proposal as the prime
        Contractor?
    5. Does the Transmittal Letter contain all of the required
        Statements specified in Section 5.1?
    6. Is the Transmittal Letter signed by an individual authorized to
        legally bind the vendor?
    14. If subcontractors are proposed, has each subcontractor
        submitted a Statement, on official letterhead, and signed by
        an individual authorized to legally bind the subcontractor to
        perform the scope of work?
    7. Does the proposal appear to be free of additional


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                   Checklist of Mandatory Items                                  RESULTS
                       TECHNICAL PROPOSAL                                Pass (Yes)        Fail (No)
      stipulations, assumptions, and constraints?
8.    Does the technical proposal include a response for each tab
      listed in Section 0?
9.    Was a proposal guarantee submitted, with the original of the
      technical proposal? (Tab 2)
10.   Does the technical proposal include information on the
      vendor’s corporate background and experience? (Tab 3)
11.   Does the technical proposal (Tab 3) include corporate
      financial Statements or an adequate Statement as to their
      omission?
12.   Does the technical proposal include information on the
      vendor’s overall project management plan for the Contract?
      (Tab 4)
13.   Does the technical proposal include information on the
      vendor’s staffing plan? (Tabs 5- 11 )
14.   Does the vendor agree to comply with the Performance
      Bond requirement? (Tab 12)
15.   Does the technical proposal include the signed forms
      required in this RFP?
16.   Is there a Cross Reference Matrix included in the technical
      proposal?

                               COST PROPOSAL CHECKLIST
                    Checklist of Mandatory Items                                   RESULTS
                          COST PROPOSAL                                    Pass (Yes)        Fail (No)
1. Was the cost proposal received on time?
2. Were fourteen (14) copies of the Cost Proposal submitted in a
   separate sealed package? (1 original and 13 copies)
3. Did the proposal contain a firm, fixed price without any additional
   stipulations or limitations?
4. Is there a signed and completed Pricing Schedule for each schedule
   required by Section 6?

     Pricing Schedule A


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                Checklist of Mandatory Items                                     RESULTS
                       COST PROPOSAL                                     Pass (Yes)        Fail (No)
Pricing Schedule B
Pricing Schedule B-1
Pricing Schedule C
Pricing Schedule C-1
Pricing Schedule C-2
Pricing Schedule C-3
Pricing Schedule C-4
Pricing Schedule C-5
Pricing Schedule C-6
Pricing Schedule C-7
Pricing Schedule C-8
Supplemental Pricing C Schedule(s) for subcontractors’ costs that
exceed 10% of line 10 on the corresponding C schedule (C-1
through C-8)
Pricing Schedule D
Pricing Schedule E
Pricing Schedule F
Pricing Schedule G




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Appendix 6 - Cross Reference Matrix
The Offerors must complete a Cross Reference between the proposal and the RFP requirements in Section
4.1 through 4.7, and Attachments E, F, and G using the Cross Reference Matrix below.
    Cross Reference Matrix
    RFP #         Description                                             Proposal #        Description
    4             SCOPE OF WORK
    4.1           Background
    4.2           Contract Phases
    4.2.1         Start Up Phase
    4.2.1.1       State Responsibilities
    4.2.1.2       Contractor Responsibilities
    4.2.2         Analysis and Design Phase
    4.2.2.1       State Responsibilities
    4.2.2.2       Contractor Responsibilities
    4.2.2.2.1     Review, Validate and Refine Requirements
    4.2.2.2.2     Document Rules
    4.2.2.2.3     Construct Requirements Specification Document (RSD)
    4.2.2.2.4     Requirements Traceability Matrix and Repository
    4.2.2.2.5     Prepare Detailed Systems Design Document
    4.2.2.2.6     Contractor Deliverables
    4.2.3         Development Phase
    4.2.3.2.1     Software/Hardware Configuration
    4.2.3.2.2     MMIS/PBM/DSS Systems Documentation
    4.2.3.2.3     Provide MMIS/PBM/DSS User Electronic
                  Documentation
    4.2.3.2.4     Development and Unit Testing
    4.2.4         Testing Task
    4.2.4.1       State Responsibilities
    4.2.4.2       Contractor Responsibilities
    4.2.4.2.1     Test Plans
    4.2.4.2.2     Contingency Plan to Mitigate Testing Risks
    4.2.4.2.3     Test Cases/Scripts
    4.2.4.2.4     Performance Tuning Document
    4.2.4.2.5     UAT Plan
    4.2.4.2.6     Operational Readiness Test Report
    4.2.4.2.7     Contractor Deliverables
    4.2.5         Data Cleansing and Conversion Task
    4.2.5.1       State Responsibilities
    4.2.5.2       Contractor Responsibility
    4.2.5.2.1     Update Data Conversion Plan
    4.2.5.2.2     Contingency Plan to Mitigate Data Conversion Risks
    4.2.5.2.3     Proposed Approach to Parallel Runs between MMIS
                  and MMIS/PBM/DSS
    4.2.5.2.4     Data Cleansing and Data Conversion Specifications
                  Document
    4.2.5.2.5     Update Data Conversion Requirements Document
    4.2.5.2.6     Data Conversion Checklists
    4.2.5.2.7     Develop Data Reconciliation Procedures
    4.2.5.2.8     Develop or Provide Conversion Programs
    4.2.5.2.9     Convert and Reconcile Data for Implementation
    4.2.5.2.10    Data Conversion Test Scripts
    4.2.5.2.11    Data Conversion Reports
    4.2.5.2.12    UAT of Converted Data



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4.2.5.2.13    Data Conversion Test Results Report
4.2.5.3       Contractor Deliverables
4.2.6         Training Task
4.2.6.2.1     Staff and Management User Training
4.2.6.2.2     On-line Tutorial
4.2.6.2.3     Provider Training
4.2.6.2.4     Training Schedule
4.2.6.2.5     Training Plans
4.2.6.2.6     Develop, Provide and Maintain Training Documentation
4.2.6.2.7     Certificate of Completed Training
4.2.6.2.8     Prepare Evaluation Tool
4.2.6.2.9     Training Report
4.2.6.2.10    Contractor Deliverables
4.2.7         Implementation Phase
4.2.7.1       Implementation Plan
4.2.7.2       Implementation
4.2.7.2.1     State Responsibilities
4.2.7.2.2     Contractor Responsibilities
4.2.7.3       Post Takeover Implementation
4.2.7.3.1     Contractor Responsibilities
4.2.8         Operations Phase
4.2.8.1       Operations Requirements
4.2.9         Certification Phase
4.2.9.2.1     Update Federal Certification Plan
4.2.9.2.2     Provide required Documentation for Federal Certification
4.2.9.2.3     Provide personnel as required for Federal certification
4.2.9.2.4     System Remediation
4.2.9.2.5     Correction of Items Not Certified
4.2.9.2.6     Change Control for Certification
4.2.9.2.7     Contractor Deliverables
4.2.10        Enhancement Phase
4.2.11        Turnover Phase
4.2.11.2.1    Planning
4.2.11.2.2    General Planning with State
4.2.11.2.3    General Planning with Contractor
4.2.11.2.4    Develop Turnover Plan
4.2.11.2.5    Develop Requirements Statement
4.2.11.2.6    Provide Turnover Services
4.2.11.2.7    Cooperation with Successor
4.2.11.2.8    Turnover of Archived Materials
4.2.11.2.9    Additional Contractor Turnover Responsibilities
4.2.11.2.10   Deliverables
4.3           Staffing
4.3.1         Named Staff for the Design, Development and
              Implementation Phase
4.3.2         Named Staff for the Certification Phase
4.3.3         Named Staff for the Turnover Phase
4.3.4         Named Staff for the Operations Phase
4.3.5         Categorized Staff
4.3.6         Minimum Numbers of Categorized Staff - Operations
              Phase
4.3.7         General Requirements for Employees
4.3.8         Residency and Work Status
4.3.9         Background Checks
4.4           Location of Operations Facilities
4.4.1         Meeting Room Requirements for Design and
              Development


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4.4.2          Space Provided for File and Archive Storage
4.4.3          State Access to Processing Facilities and Contractor
               Staff
4.4.4          Computer Resources
4.4.4.1        User Access
4.5            Project Governance Requirements
4.5.1          State Responsibilities
4.5.2          Contractor Responsibilities
4.5.2.1        PMBOK
4.5.2.2        Information Technology Iterative Project Management
4.5.2.3        Separation of Duties
4.5.2.4        Financial Control
4.5.2.5        Security
4.5.2.6        Quality Control
4.5.3          Project Management
4.5.3.1        Project Management Portal
4.5.3.2        Project Management Office (PMO)
4.5.3.2.1      PMO Processes, Policies and Procedures
4.5.3.3        Project Management Plans
4.5.3.3.1      Communication Management Plan
4.5.3.3.2      Project Plan
4.5.3.3.3      Management Plan
4.5.3.3.4      Issues Management Plan
4.5.3.3.5      Quality Management Plan
4.5.3.3.6      Staffing Management Plan
4.5.3.3.7      Applications Development and Maintenance Plan
4.5.3.3.8      Change Management Plan
4.5.3.4        Project Execution and Control
4.5.3.5        Integrated Management
4.5.3.6        Project Management Deliverables
4.5.4          Management of System Modifications or Operation
               Improvements
4.5.4.1        Cost Management
4.5.4.2        Project Execution and Control
4.5.4.2.1      Project Thresholds
4.5.4.2.2      Project Management Requirements Deliverables
4.5.5          General Contract Management
4.6            Deliverable Procedures and Standards
4.6.1          Deliverable Procedures
4.6.2          Deliverables Standards
Attachment E: Architectural Requirements
1              Technical Requirements
1.1            Service Oriented Architecture (SOA)
1.2            Programming Language Requirements
1.3            Data Quality Control
1.4            Application Environments
1.5            Defect/Issue Tracking Tool
2              System Architecture Requirements
2.1            MMIS and PBM Architecture Requirements
2.2            Data Warehouse and Decision Support System (DSS)
               Architecture Requirements
2.2.1          DSS Information Processing Requirements
2.3            Workflow and Electronic Document Management
2.3.1          Electronic Document Management System (EDMS)
2.3.2          Automated Letter Generation System
2.3.3          Document Imaging
2.3.4          Workflow Management


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2.4            Rules Engine
2.5            Benefit Plan Administration
2.6            Web Portal
2.7            Call Center Management System
2.8            Automated Voice Response System (AVRS) Capability
2.9            Fax Back Capability
2.1            Translator
2.11           Desktop Publishing System
2.12           Computer Based Training or Learning Management
               System
2.13           Automated, Web-based Survey Tools
2.14           Financial Management Application
Attachment F: Operational Requirements
1              CLIENT MANAGEMENT
1.1            Client Eligibility and Enrollment
1.1.1          State Responsibilities
1.1.2          Contractor Responsibilities
1.1.3          Systems Requirements
1.1.4          Interfaces including but not limited to
1.1.4.1        Inputs including but not limited to
1.1.4.2        Outputs including but not limited to
1.2            Early and Periodic Screening Diagnosis and Treatment
               (EPSDT)
1.2.1          State Responsibilities
1.2.2          Contractor Responsibilities
1.2.3          Systems Requirements
1.2.4          Interfaces
1.2.4.1        Inputs
1.2.4.2        Outputs
1.3            Benefit Plan Administration
1.3.1          State Responsibilities
1.3.2          Contractor Responsibilities
1.3.3          Systems Requirements
1.3.4          Interfaces
1.3.4.1        Inputs
1.3.4.2        Outputs
2              PROVIDER MANAGEMENT
2.1            Provider Management
2.1.1          State Responsibilities
2.1.2          Contractor Responsibilities
2.1.3          System Requirements
2.1.4          Interfaces
2.1.4.1        Inputs
2.1.4.2        Outputs
3              OPERATIONS MANAGEMENT
3.1            Reference Data Management
3.1.1          State Responsibilities
3.1.2          Contractor Responsibilities
3.1.3          Systems Requirements
3.1.4          Interfaces
3.1.4.1        Inputs
3.1.4.2        Outputs
3.2            Claims Receipt
3.2.1          Claims Receipt State Responsibilities
3.2.2          Contractor Responsibilities
3.2.3          Systems Requirements
3.2.4          Interfaces


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3.2.4.1   Inputs
3.2.4.2   Outputs
3.3       Claims Adjudication
3.3.1     State Responsibilities
3.3.2     Contractor Responsibilities
3.3.3     Systems Requirements
3.3.4     Interfaces
3.3.4.1   Inputs
3.3.4.2   Outputs
3.4       Prior Authorization
3.4.1     State Responsibilities
3.4.2     Contractor Responsibilities
3.4.2.1   Processing Requests Authorized by Other Agencies and
          Contractors
3.4.3     Systems Requirements
3.4.4     Interfaces
3.4.4.1   Inputs
3.4.4.2   Outputs
3.5       Pharmacy Benefit Management
3.5.1     State Responsibilities
3.5.2     Contractor Responsibilities
3.5.2.1   Point of Sale (POS)
3.5.2.2   Drug Rebate
3.5.2.3   Prospective Drug Utilization Review
3.5.2.4   Retrospective Drug Utilization Review
3.5.2.5   Systems Requirements
3.5.3     Interfaces
3.5.3.1   Inputs
3.5.3.2   Outputs
3.6       Third Party Liability (TPL)
3.6.1     State Responsibilities
3.6.2     Contractor Responsibilities
3.6.3     Systems Requirements
3.6.4     Interfaces
3.6.4.1   Inputs
3.6.4.2   Outputs
3.7       Web Portal
3.7.1     State Responsibilities
3.7.2     Contractor Responsibilities
3.7.3     Systems Requirements
3.7.4     Interfaces
3.7.4.1   Inputs
3.7.4.2   Outputs
4         PROGRAM MANAGEMENT
4.1       Financial Management
4.1.1     State Responsibilities
4.1.2     Contractor Responsibilities
4.1.3     Systems Requirements
4.1.4     Interfaces
4.1.4.1   Inputs
4.1.4.2   Outputs
4.2       Decision Support System/Data Warehouse (DSS/DW)
4.2.1     State Responsibilities
4.2.2     Contractor Responsibilities
4.2.3     Systems Requirements
4.2.4     Interfaces
4.2.4.1   Inputs


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4.2.4.2      Outputs
4.3          Federal Reporting
4.3.1        State Responsibilities
4.3.2        Contractor Responsibilities
4.3.3        Systems Requirements
4.3.4        Interfaces
4.3.4.1      Inputs
4.3.4.2      Outputs
4.4          Program Integrity Management
4.4.1        State Responsibilities
4.4.2        Contractor Responsibilities
4.4.3        Systems Requirements
4.4.4        Interfaces
4.4.4.1      Inputs
4.4.4.2      Outputs
4.5          Security and Privacy
4.5.1        Security and Privacy Requirements
4.5.1.1      State Responsibilities:
4.5.1.2      Contractor Responsibilities:
4.5.2        Disaster Recovery (DR) and Business Continuity (BC)
4.5.2.1      State Responsibilities
4.5.2.2      Contractor Responsibilities
5            CARE MANAGEMENT
5.1          Immunization Registry
5.1.1        State Responsibilities
5.1.2        Contractor Responsibilities
5.1.3        Systems Requirements
5.1.4        Interfaces
5.1.4.1      Inputs
5.1.4.2      Outputs
5.2          Waiver Services
5.2.1        State Responsibilities
5.2.2        Contractor Responsibilities
5.2.3        Systems Requirements
5.2.4        Interfaces
5.2.4.1      Inputs
5.2.4.2      Outputs
5.3          Current Managed Care
5.3.1        State Responsibilities
5.3.2        Contractor Responsibilities
5.3.3        Systems Requirements
5.3.4        Interfaces
5.3.4.1      Inputs
5.3.4.2      Outputs
6            MMIS ENHANCEMENTS
6.1          Electronic Health Records
6.1.1.1      State Responsibilities
6.1.2        Contractor Responsibilities
6.2          Payroll System
6.3          Additional Managed Care Requirements
6.3.1        State Responsibilities
6.3.2        Contractor Responsibilities
6.3.3        Systems Requirements
Attachment   System Requirements Matrix
G




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