Kyle L. Janek , M.D., Executive Commissioner VENDOR CONFERENCE

Kyle L. Janek, M.D., Executive Commissioner VENDOR CONFERENCE Electronic Visit Verification (EVV) Request for Proposal No. 529-14-0060 December 3, 2013

Welcome • Introductions • Rick Blincoe,Procurement and Contracting Services (PCS) • Deborah Keyser, Medicaid Chip Project Management • Jimmy Ramirez, Asst. General Counsel • Housekeeping Items

HHSC Procurement Roles • PCS- Responsible for procurement activity • Program- Responsible for project scope, requirements, performance, results, contract management/monitoring • Legal- Questions/answers and legal activity

Vendor Conference Overview • Procurement Activities • RFP Overview • Legal Overview • Questions • Break • Preliminary Responses to Questions • Closing

Procurement Activities • Sole Point of Contact -- Section 1.2 • Procurement Schedule -- Section 1.3 • Solicitation Access http://www.hhsc.state.tx.us/about_hhsc/BusOpp/BO_opportunities.asp • Submission Requirements – Section 3.14 • Solicitation Changes • Proposal Screening and Evaluation • Award Information

Procurement Schedule • RFP Release Date November 21, 2013 • Vendor Conference December 3, 2013 • Respondent Questions Due December 10, 2013 • Post Response to Questions (est.) December 16, 2013 • Proposals Due (2:00 PM Central Time) January 3, 2014 • Deadline for Proposal Withdrawal January 3, 2014 • Tentative Award Posting (est.) February 7, 2014 • Anticipated Contract Start Date March 3, 2014

HUB Subcontracting Plan(HSP) Requirements

Historically Underutilized Business Participation • Because the estimated value of the solicitation or resulting contract is less than $100,000, respondents are not required to submit a HUB Subcontracting Plan with their proposal at the time of submission. If subcontractors are used in the delivery of the goods and/or services, the awarded contractor(s) is requested to submit monthly progress reports, in the prescribed format, to HHSC’s HUB Program Office. When applicable, the reports should include a narrative description of the contractor’s good faith efforts and accomplishments, and financial information reflecting payments to all subcontractors, including HUBs. • During the term of the original contract, HHSC and the awarded contractor(s) may have the opportunity to modify its arrangement, which may require a new scope of work through an amendment, renewal, or extension of the contract. As a result, the amendment, renewal, or extension of the contract may potentially increase the contract value to equal or exceed $100,000. As applicable and in accordance with statute and the HUB rules, the HHSC HUB Program Office may review the proposed amendment, renewal, or extension for potential subcontracting opportunities and determine if there is a probability for subcontracting and make an assessment for the inclusion of the HUB Subcontracting Plan.

Request for Proposals No. 529-14-0060 RFP Overview • Mission Objectives • Project Objectives • Project Scope • Contractor Responsibilities • Value-Added Benefits • Evaluation Criteria

Mission Objectives The Texas Health and Human Services Commission’s (HHSC) objectives for this procurement are as follows: • To promote program efficiencies and realize savings during the current biennium by the utilization of EVV systems to verify individuals are receiving authorized services for which the state is being billed. • A statewide implementation of EVV to require certain home and community-based providers in both managed care and Fee-for-Service (FFS) to utilize EVV systems. • To secure EVV vendors who are knowledgeable of current EVV telephony technology, products and services available, as well as the Texas Medicaid programs and services in which HHSC plans to utilize EVV. • To secure EVV vendors who provide excellent customer service in the delivery of EVV services and who demonstrate best practices used in providing customer service, including responding to issues and concerns from contracting entities and providers.

Project Objectives Texas Government Code §531.024172 requires HHSC, if it is cost-effective and feasible, to implement an electronic visit verification system to electronically verify and document, through a telephone or computer-based system, basic information relating to the delivery of Medicaid acute nursing services, including the provider's name; the recipient's name; and the date and time the provider begins and ends each service delivery visit. In addition, the 2012-13 and 2014-15 appropriations acts require HHSC to reduce the amount of general revenue funds expended for Medicaid by implementing a plan that may include an initiative to conduct “statewide monitoring of community care and home health through electronic visit verification in Medicaid fee-for-service and managed care.” General Appropriations Act, 83d Leg., R.S., ch. 1411, art. II, rider 51(b)(8), at II-100 (Health & Human Servs. Section, Health & Human Servs. Comm'n); General Appropriations Act, 82d Leg., R.S., ch. 1355, art. II, rider 61(b)(8), at II-94 (Health & Human Servs. Section, Health & Human Servs. Comm'n).

Project Objectives The State of Texas, by and through HHSC, seeks to select a pool of vendors to develop and provide products, solutions, tools, and other applicable services for statewide implementation of EVV through the use of telephony in managed care and FFS programs in a consistent and standardized manner, in accordance with the specifications contained in this Request for Proposals (“RFP”). EVV refers to various home visit tracking systems that verify service visits occur in the home or in the community and document the precise time the provision of service begins and ends. Subject to positive vendor performance, and success with this initiative, HHSC may expand services, such as therapy services and habilitative services, of the procured EVV system(s) throughout the state of Texas dependent upon the need and type of services.

Project Objectives The vendor(s) approved for participation will negotiate contracts directly with managed care health plans that require EVV services to provide EVV services to managed care providers, and the Medicaid claims administrator, Xerox State Healthcare, LLC (dba Texas Medicaid & Healthcare Partnership (TMHP)), to provide EVV services to FFS providers. The contract(s) with TMHP will also include all functionality under the current Department of Aging and Disability Services (DADS) EVV system in seven regions for long-term care services providers, and provide for expansion to the remaining regions in Texas, and the inclusion of nursing services. Texas Medicaid providers enrolled to deliver services utilizing EVV will have the option to select an EVV vendor(s) contracted with the managed care health plan or TMHP for delivery of EVV services.

Project Objectives Selected vendor(s) will implement EVV in several phases as follows: • Phase 1: • Implement personal assistance services (PAS) and nursing services in the managed care STAR+PLUS program by June 1, 2014 • Implement personal care services (PCS) and acute nursing services in FFS by June 1, 2014 • Implement DADS EVV programs/services and expand those services in remaining regions by June 1, 2014, adding nursing services statewide • Phase 2: • Implement select services in the managed care STAR program • Possible implementation of therapy services and habilitative services • Possible implementation of EVV services in the HCS and TxHmL waiver programs • Phase 3: • Possible implementation of a closed loop system (also referred to as “claims scrubbing”) NOTE: EVV implementation in phases of services or programs as described above is subject to change as needed, or not be implemented at all, if HHSC determines it is not in the best interest of the State.

Project Scope – Required Program Coverage The EVV system must capture data for the services provided statewide in the following programs: • Managed Care (STAR+PLUS; later expansion to STAR): • Personal Assistance Services (PAS) • Nursing Services • FFS: • Personal Care Services (PCS) • Acute Nursing Services

Project Scope – Required Program Coverage • DADS (current regions with expansion to remaining regions): • Personal assistance services and in-home respite in the Community Based Alternatives Program (CBA) • Habilitation and in-home respite in the Community Living Assistance and Support Services Program (CLASS) • In-home respite and flexible family support services provided by a non-licensed service provider in the Medically Dependent Children Program (MDCP) • Personal assistance services in Primary Home Care (PHC) • Personal assistance services in Community Attendant Services (CAS) • Personal assistance services in Family Care services (FC) • Individuals in the Consumer Directed Services (CDS) option of the aforementioned programs may choose their level of participation in EVV. • The EVV system(s) must have flexibility to accommodate a range and scope of services across multiple programs as well as additional services and/or programs that may be added by HHSC to the EVV program after initial implementation.

Project Scope - Tracking The proposed EVV system must include, at a minimum, the capacity to electronically track and document: • the service recipient’s (individual’s) identity; • the service provider’s identity; • the date and time the service provider begins and ends the delivery of services; • location of service delivery; • changes made to the EVV system data after the service provider has recorded their time, including the name of the program provider staff making the changes, the date the changes were made, and the reason for changes; and • on a standardized format approved by HHSC.

Project Scope - Training • The selected EVV vendor(s) will initially train state agency employees, program providers and individuals on the use of the EVV system and provide ongoing training and technical assistance. The training plan must include access to and use of a test environment where state agency employees and provider agency employees can test various aspects of the EVV system. • All training (classroom, online and webinar training) must be available to HHSC staff prior to implementation. The training must be approved by HHSC and must include how to access the system and how to produce reports required to conduct oversight activity.

Project Scope – Cost Savings • All required EVV services must be provided at a highly competitive fee level, (i.e., the fee quoted should be the best value to HHSC when all evaluation criteria are considered).The selected EVV vendor(s) must continually provide information regarding innovations which may result in cost savings and improved program efficiency. Descriptions of proposed innovations should clearly illustrate how the proposed innovation could result in cost savings and improved program efficiency.

Project Scope - Scalability • The EVV vendor(s) will be proficient in providing services that effectively track and report large volumes of EVV data, understanding control systems and weaknesses, and project administration and management. The system must allow adequate access from a large volume of people (i.e., providers and provider’s staff), at the same time including numerous state employees, without disruption to the system. EVV vendor(s) will support commonly available operating systems, browsers, and software/hardware platforms, and ensure compatibility with providers and contracting entities systems. • Respondents should provide knowledge and experience in implementing EVV systems for self-directed services. Individuals in the Consumer Directed Services (CDS) option of the aforementioned programs may choose their level of participation in EVV.

Project Scope -Compliance • EVV services must be provided in accordance with all related laws, statutes, rules, policies, and any contract terms. EVV vendor(s) will report to HHSC any identified potential fraud, waste or abuse by communicating this information to HHSC. EVV vendor(s) must provide any information HHSC requests for proof of the potential fraudulent activities when the information is available to the EVV vendor(s). EVV vendor(s) may refer to HHS Circular C-027 for general guidelines for reporting fraud, waste, or abuse by Medicaid providers. HHSC will refer any fraudulent activities identified by the EVV vendor(s) to the HHSC OIG. • EVV vendor(s) will supply HHSC with electronic reports and data files, in formats and at frequencies as requested and approved by HHSC via an approved secured interface. • EVV vendor(s) shall retain all documentation relating to all EVV services provided for a minimum of 5 years following the date the EVV data is received by the EVV vendor(s) for verification of services provided, or until all audits, appeals, investigations, or court cases are completed. The documentation is subject to review by the State Auditor’s Office. • EVV vendors, including, without limitation, their shareholders, members, partners, officers, directors, board members and employees, who: (1) hold a financial interest; or (2) exercise control, either directly or indirectly, in a provider entity or managed care organization that will be a participant in HHSC’s EVV program, are not eligible to be approved as an HHSC EVV vendor. • EVV vendor(s) will provide all EVV services in compliance with all requirements of this RFP and the contract. EVV vendor(s) shall perform the EVV services consistent with HHSC’s guidelines, directives, and rules, which may be passed and as amended in the future. HHSC is currently proposing a new rule for EVV which, if adopted, will be effective May 25, 2014. If adopted, the new rule can be found at 1 TAC §354.1177. Additionally, DADS EVV rules, currently proposed with changes to be effective May 25, 2014, can be found at 40 TAC §§68.101, 68.102, and 68.103.

Project Scope – Project Management • Development Phase - Prior to June 1, 2014, the selected vendor must submit a bi-monthly report that illustrates the vendor’s progress in meeting goals outlined in the final Project Work Plan. • Operations Phase - On June 1, 2014, and monthly thereafter, the selected vendor must submit a progress report in a format specified by HHSC. This progress report must include at a minimum the following elements: • hours of service delivered by billing code; • number of individuals served; • number of program providers utilizing EVV; • number of program providers yet to implement EVV; • status updates on the work that has been done towards fulfilling each major component of the statement of work; • identification of implementation barriers; • recommendations of proposed solutions; and • report on expenditures and potential savings based on pre-defined metrics. • Respondents must submit in their respective response to this RFP how the proposed EVV system will generate data reports. Additionally, HHSC reserves the right to require ad hoc reports.

Project Scope - Miscellaneous • EVV vendor(s) will furnish all material, labor, equipment, and supplies necessary to perform the EVV services required. The EVV vendor(s) will not remove any original state agency records from the site of their location at the agencies. When travel is necessary to conduct EVV services, the EVV vendor(s) will be responsible for all travel expenses incurred; • HHSC will not supply postage, long distance phone service, email services, or other related incidental expenses or costs to EVV vendor(s) for associated EVV services provided; • EVV vendor(s) will remain mindful of the sensitive business relationship that exists between the State and its Medicaid providers. EVV vendor(s) must obtain HHSC approval prior to communicating, either in writing or orally, with any Medicaid providers regarding any EVV service activities; once HHSC has approved EVV services to be provided, the EVV vendor(s) will contact and correspond with providers only in a manner so as to complete the scope of work within the agreed upon timeframes. • EVV vendor(s) must work with Medicaid providers to identify and develop an efficient method to collect service scheduling information (based off of prior authorized service information) from providers that do not own or utilize an automated scheduling system in order for the EVV vendor(s) to complete EVV services; the method developed must be provided at no cost to the provider.

Project Work Plan • The respondent must submit a well-organized draft Project Work Plan that clearly identifies: • a Development Phase; • All activities that must take place between the time of contract award and the operational start date (no later than June 1, 2014). During the Development Phase, the vendor must establish working relationships with affected program providers to ensure smooth start-up and transition. Development activities for each phase of implementation must include (and may not be limited to): • EVV system set-up and interfacing • Training for state and provider staff • EVV system testing for state and provider staff • Provider and stakeholder outreach and communication • Approval of a disaster recovery and business continuity plan. These may be combined. • Approval of a comprehensive security plan and risk assessment

Project Work Plan - continued • an Operations Phase; • The Operations Phase will begin on June 1, 2014. During this phase, the EVV system must be fully functional as the sole methodology utilized to document service delivery for reimbursement. Operations activities for each phase of implementation must include (and may not be limited to): • On-going system performance and interfacing • On-going Support/Help desk via toll-free telephone lines • Track and monitor EVV data • Provide standard and ad-hoc reporting • all tasks required to meet the Project Scope and implement EVV by June 1, 2014; and • timeframes within which each task will be accomplished. • As a part of contract execution, a final Project Work Plan will be based on negotiations with HHSC. The final Project Work Plan may include elements of the original plan submitted in the respondent’s proposal, but will include more detail, such as specific deadlines for completing tasks.

Contractor Responsibilities All vendors selected for participation in the HHSC EVV initiative, and as a condition to remain eligible to participate, will be required to demonstrate and maintain compliance with the HHSC-approved minimum standard requirements as set forth in the following requirements sections.

General Requirements for EVV Vendors • All EVV vendor supported systems must maintain security and privacy features to ensure: • The system is protected against unauthorized use, disclosure, or access, in accordance with the Health and Human Services (HHS) Enterprise Information Security Standards and Guidelines (EISSG), DADS Information Security Policies and Standard Operating Procedures (SOP), State and Federal laws, rules, regulations and guidelines. • Health Insurance Portability and Accountability Act (HIPAA) compliance; EVV vendors selected for participation will be required to sign and adhere to HHSCs BAA/Data Use Agreement, in addition to adhering to any HIPAA and security requirements of additional contracting entities in the EVV initiative. • EVV systems must be flexible and user-friendly allowing access for services outside the home and accommodate the needs of the consumers receiving services. • EVV systems and training and support services must accommodate people with disabilities and adhere to all State and Federal laws, rules, regulations and guidelines. The Voluntary Product Accessibility Template (VPAT) will be provided upon request from HHSC that demonstrates that the software product meets the state’s web accessibility standards, outlined in the Texas Administrative Code, Title 1, Chapters 206 and 213, that is in alignment with federal regulations outlined in Section 508 of the Rehabilitation Act of 1973.

General Requirements for EVV Vendors - cont. • All EVV components (data input, EVV system, data/claims scrubbing (if applicable), and data/reporting access system) must be flexible and customizable to meet the needs of a broad range of program specific documentation. • Includes support of commonly available operating systems, browsers, and software/hardware platforms. • Includes support in multiple languages. • Ensure system has the capacity to allow access and use by multiple users at the same time. • All EVV components must be able to demonstrate an audit trail and traceability and be provided to the contracting entity upon request and/or at a defined frequency. • EVV vendors must support all activities and operations associated with the transition of services to another EVV vendor when a provider chooses to select a different vendor for the provision of EVV services. • A comprehensive disaster recovery and business continuity plan must exist and be approved by the contracting entity to ensure recovery from disaster and continued functionality. Plans may be combined. • Any occurrence of recovery from disaster or continued functionality must be documented and reported to the contracting entity with a corrective action plan. • The disaster recovery and business continuity plan(s) will be reviewed and approved annually by the contracting entity to ensure continued compliance. EVV Vendors must timely provide all supporting EVV documentation necessary for the contracting entity to conduct dispute resolution and appeals. • EVV must provide a comprehensive security plan and annual risk assessment.

Data Input Requirements for EVV Vendors • Consumers and service provider information, and service schedules (scheduled, or non-scheduled based (some nursing services are based on total number of hours authorized, or have frequent changes to schedules based on consumer needs)) must be entered into the EVV system for validation either through an automated system or a manual system. • For providers that do not currently utilize an automated scheduling system, EVV vendors must provide the functionality, including interfacing from multiple providers, for a manual entry system at no cost to the provider. • For providers currently utilizing an automated scheduling system, EVV vendors must provide the functionality to interface from multiple providers at no cost to the provider. • A manual data input system must include a uniform and simplified process for HHSC allowed exception reporting (i.e. service scheduled, but not performed; service performed, but not scheduled, etc.), as defined and approved by HHSC, for services performed both in the home and outside the home.

Visit Verification Requirements for EVV Vendors • Technology and associated systems must verify visits, maintain visit data, and transfer data to contracting entities: • Including, when a single provider performs multiple services at the same time, or when there are multiple consumers in the home receiving services at the same time. • EVV systems must have the ability to interface with multiple data input systems for visit verification. • EVV systems must capture consumer identity, service provider identity, and date, begin and end time, and location of services provided. • EVV systems must be configurable to support specific program and/or customer needs (i.e. service tracking by variable units – minutes, hours, days, and service hours in standard or military time; assigning a visit to the quarter in which the EVV record was completed by the provider rather than the quarter the visit occurred). • EVV technology must have the functionality to be used inside a consumer’s home, or in the community (outside the home). • Alternatives must be available, and approved by HHSC, for visit verification via use of telephony in the event a consumer does not have a landline, landline is in use or a consumer is unwilling to allow for use of landline. • Alternatives must be provided with no added cost to the consumer, provider, health plan, or state. • Alternatives must be available, and approved by HHSC, when other forms of EVV technology for visit verification is limited or non-existent. • Alternatives must be provided with no added cost to the consumer, provider, health plan, or state.

Training and Support Requirements for EVV Vendors • EVV vendor must work with the contracting entity to develop a work plan, including estimated schedules and milestones necessary for a successful EVV implementation. • EVV vendor must work with the contracting entity to develop a plan that addresses the initial and on-going training and support needs for all end users. The plan must include the following components: • A provider and stakeholder communication plan that reflects how the EVV vendor will perform outreach necessary to implement EVV. • A provider plan that reflects how the EVV vendor will perform testing prior to implementation of EVV and testing of the system during the contract period, if necessary. • Training sessions and materials must be available in multiple languages. • Support/help desk must be available via toll-free telephone lines during standard business hours, extended hours, and in multiple languages. • Technical support must be available to the contracting entity and providers for any questions and/or issues that occur on a day to day basis.

Compliance Requirements for EVV • All compliance and quality review processes required by the contracting entity, which may be program or agency-specific, must be adhered to at all times. • Establish a corrective action plan process, with contracting entity approval, to initiate when product(s) or services(s) do not conform to accessibility standards. • A defined and documented process and procedure must be in place to document, respond to and resolve any complaints or issues regarding accessibility of product(s) or service(s). • Work with the contracting entity to develop and implement a change management process.

Data/Record Access System Vendor • Must have the ability to interface with multiple vendors for reporting and maintenance of visit verification records. • Work with the contracting entity, providers, and EVV vendors to identify data elements necessary to perform all required reporting functions. • Includes reporting requirements for contracting entity that will be used to evaluate a provider’s compliance with EVV usage requirements under program or agency-specific EVVcompliance plans. • Track and monitor services authorized vs. services rendered, services used vs. services remaining, and individual instances of service delivery including validation data and any exceptions to service. • Must allow contracting entity the ability to view the same information that a provider can access and view. • Provide HHSC-defined standard, as well as adhoc, reporting capability for any EVV technology method used (i.e. telephony, mobile phone, etc.). • The system must support ability for the contracting entity to generate real-time reports, and reports based on all data available in the system, as required to support program requirements and monitoring. • NOTE: All EVV vendors that meet the minimum standard requirements as listed in this section will be required to demonstrate and provide examples of their ability to effectively implement the requirements as intended.

Value-added Benefits • Describe any services or deliverables that are not required by the RFP that the respondent proposes to provide at no additional cost to HHSC. Respondents are not required to propose value-added benefits, but inclusion of such benefits may result in a more favorable evaluation. • HHSC may consider later implementation of a closed loop system (also referred to as “claims scrubbing”) as part of the HHSC EVV initiative. Vendors that provide EVV claims scrubbing services are encouraged to provide information in response to this RFP that describes in detail their capability, along with experiences, in providing these services. • A closed loop system is described as a system that compares and validates that the actual services billed on a claim match the visit data as verified by the EVV vendor prior to submission to the payor for payment, or prior to payment of the claim if the payor is responsible for performing the claim scrubbing.

RFP Evaluation Criteria HHSC will evaluate proposals based on the criteria listed below in the order of priority: • Knowledge of and demonstrated ability to comply with the HHSC EVV RFP mission statement andSection 2(Project Schedule/Scope of Work and General Requirements), including a well-reasoned approach to fulfilling the RFP’s minimum standard requirements as stated in Section 2.4). • Past performance on similar projects and qualifications of key project personnel, including without limitation a demonstrated understanding of: • Experience with successful implementation and ongoing operation of EVV systems; • Knowledge of and compliance with HIPAA standards; and • Experience with community-based long-term services and supports. • The extent of EVV system scalability. • Total cost of acquiring vendor's goods or services. • The ability to provide EVV services statewide.

Office Of General Counsel Jimmy Ramirez Assistant General Counsel HHSC Office of General Counsel

Legal Reminders to be Awareof the Following • Collusion • Conflict of Interest-Former Agency Employees • Permissible Contacts-HHSC Point of Contact

Definition of Collusion(This is not exhaustive but merely representative) • Collusion occurs when two persons or representatives of an entity or organization make an agreement to deceive or mislead another. • Such agreements are usually secretive, and involve fraud or gaining an unfair advantage over a third party, competitors, consumers or others with whom they are negotiating. • The collusion, therefore, makes the bargaining process inherently unfair. • Collusion can involve price or wage fixing, kickbacks, or misrepresenting the independence of the relationship between the colluding parties.

Conflict of Interest • A vendor must certify that it does not have personal or business interests that present a conflict of interest with respect to the RFP and resulting contract (see the Required Certifications form). Additionally, if applicable, the vendor must disclose all potential conflicts of interest. • The vendor must describe the measures it will take to ensure that there will be no actual conflict of interest and that its fairness, independence and objectivity will be maintained (see the Vendor Information and Disclosures form) over the course of the contract. HHSC will determine to what extent, if any, a potential conflict of interest can be mitigated and managed during the term of the contract.Failure to identify potential conflicts of interest may result in HHSC’s disqualification of a proposal or termination of the contract.

Former Employees of a State Agency Vendors must comply with Texas and federal laws and regulations relating to the hiring of former state employees (see e.g., Texas Government Code §572.054 and 45 C.F.R. §74.43). Such “revolving door” provisions generally restrict former agency heads from communicating with or appearing before the agency on certain matters for two years after leaving the agency. The revolving door provisions also restrict some former employees from representing clients on matters that the employee participated in during state service or matters that were in the employees’ official responsibility.

Permissible Contact The sole point of contact for inquiries concerning this RFP is Rick Blincoe. As a reminder, all communications relating to this RFP must be directed to the sole HHSC contact person for this procurement. Otherwise failure to comply with these requirements may result in proposal disqualification.

Texas Health and Human Services Commission Questions Submittal Followed by Break

Vendor Question/Response • Verbal answers to vendor questions will be provided to the extent practicable. • Responses are not binding until the final written addendum is posted on the HHSC website. HHSC estimates the addendum will post by December 16, 2013.

Closing Comments Texas Health and Human Services Commission

Kyle L. Janek , M.D., Executive Commissioner VENDOR CONFERENCE