STATE OF ARKANSAS
OFFICE OF STATE PROCUREMENT 1509 West Seventh Street,
Department of Finance and Administration
Suite300 Little Rock, Arkansas 72203-2940 Phone: (501) 324-9316 Fax: (501) 324-9311 http://www.state.ar.us/dfa
April 24, 2014
RE: REQUEST FOR INFORMATION The State of Arkansas plans to award a contract for an Enterprise Medicaid Fraud and Abuse Detection (EMFAD) System during Fiscal Year 2015 (which ends June 30, 2015). As an initial step in the procurement process, the attached Request for Information has been prepared to assist the State in fully understanding the EMFAD system functionality and associated support services that are available in the marketplace. If your organization currently markets an Enterprise Medicaid Fraud and Abuse Detection (EMFAD) System and support services as briefly outlined in the attached Request for Information document then please submit your written response to this document to my attention NO LATER THAN Wednesday, May 14, 2014 BY 4:00 P.M. at the following email address:
[email protected]. Following review of the written responses, the Office of State Procurement intends to competitively bid the system requirements by issuing a formal Request for Proposal document, including associated terms and conditions. I sincerely appreciate your interest in this important EMFAD System project for the State as represented by the Office of State Procurement. If you should have any questions regarding this document prior to submitting your response, please call me at 501-671-1476. Sincerely,
Julie Lombard, CPPB
Attachment
REQUEST FOR INFORMATION TITLE: ENTERPRISE MEDICAID FRAUD AND ABUSE DETECTION (EMFAD) SYSTEM AGENCY: OFFICE OF STATE PROCUREMENT ON BEHALF OF THE OFFICE OF THE MEDICAID INSPECTOR GENERAL (OMIG) BUYER:
JULIE LOMBARD (501) 671-1476 OR EMAIL:
[email protected]
RESPONSE DUE NO LATER THAN: MAY 14, 2014 AT 4:00 P.M. CENTRAL TIME
1.
Purpose: Through this Request for Information (RFI) document, the State of Arkansas, Office of State Procurement (OSP) desires to acquire information from vendors regarding an Enterprise Medicaid Fraud and Abuse Detection (EMFAD) System (hereafter referred to as “EMFAD” or “system”) available in the marketplace. The information received in response to this document will be reviewed by a steering committee and will serve as a basis for preparing the formal Request for Proposal (RFP) document which will be issued at a later date. (NOTE: A response to this RFI does not constitute a bid; however, any information provided in a response to this RFI document may be considered as historical data by the State of Arkansas in the actual RFP process.) NOTE: ALL DOCUMENTATION SUBMITTED IN RESPONSE TO THIS RFI SHALL BE CONSIDERED PUBLIC INFORMATION AND SUBJECT TO THE FREEDOM OF INFORMATION ACT.
2.
Background: Pursuant to Senate Bill (SB) 99/Act 259, the Office of Medicaid Inspector General is required to establish a program known as the “Enterprise Fraud Program” that is focused on fraud, waste, abuse, and improper payments within the Arkansas Medicaid Program that utilizes state-of-the-art enterprise fraud detection technology to further support the detection and prevention within the Arkansas Medicaid Program. Vendors may view SB 99 by going to the following website: http://www.arkleg.state.ar.us/assembly/2013/2014F/Acts/Act259.pdf The Arkansas Office of Medicaid Inspector General (OMIG) requires that the systems and components it will procure through the eventual issuance of an RFP will comply fully with standards as required by statute, including: A. Title II, subtitle F, sections 261 through 264 of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Pub. L. 104-191 B. ASC X12 Version 5010/National Council for Prescription Drug Programs (NCPDP) Version D.0 and 3.0, and International Classification of Diseases Version 10 (ICD-10) standards, as required by Federal Register Vol. 74, No. 11/Friday, January 16, 2009/Rules and Regulations C. 42 CFR 433 Subpart C - Mechanized Claims Processing and Information Retrieval Systems D. Medicaid IT Supplement 11-01-v1.0, Enhanced Funding Requirements: Seven Conditions and Standards 1) The previously stipulated Medicaid IT Supplement 11-01-v1.0, Enhanced Funding Requirements: Seven Conditions and Standards re-emphasizes Centers for Medicare & Medicaid Services’ (CMS) right to reuse software “designed, developed or installed” with enhanced federal financial participation. F. The Centers for Medicare & Medicaid Services (CMS) requires the following Seven Conditions and Standards to be met in order to receive enhanced funding: http://www.medicaid.gov/Medicaid-CHIPProgram-Information/By-Topics/Data-and-Systems/Downloads/EFR-Seven-Conditions-andStandards.pdf G. In accordance with CMS’s utilization of the Medicaid Information Technology Architecture (MITA) Framework, final version 3.0. MITA is a CMS initiative that fosters an integrated business and
information technology (IT) transformation across the Medicaid enterprise in an effort to improve the administration and operation of the Medicaid program. Therefore, vendor’s solutions must integrate with MITA: http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/MITA/MedicaidInformation-Technology-Architecture-MITA-30.html H. Vendors must also meet the certification criteria in the Medicaid Enterprise Certification Toolkit (MECT) in order for the State agency to continue receiving matching funds: http://www.cms.gov/ResearchStatistics-Data-and-Systems/Computer-Data-and-Systems/MMIS/MECT.html 3.
Technical Specifications: A. The Enterprise Medicaid Fraud and Abuse Detection (EMFAD) System shall be a vendor hosted (software as a service) solution. The vendor’s hosted system must demonstrate the ability to securely host sensitive and regulated State data (such as Health Insurance Portability and Accountability Act HIPAA compliant). B. The vendor shall provide the staff expertise to examine data to generate the investigation leads for fraud, waste, abuse, and improper payments within the Arkansas Medicaid Program. All the investigative work shall be performed by the vendor, where the Office of the Medicaid Inspector General (OMIG) will utilize the information provided to pursue the necessary legal actions based on the vendor’s EMFAD system results. C. The EMFAD System must include: 1) Automated detection and alerting; 2) Continuous monitoring of program transactions; 3) Identification of fraud, noncompliance, and improper payments both prospectively and retrospectively; 4) Detection of nontransactional fraud such as program eligibility issues and identity theft; 5) Use of state-of-the-art analytical techniques, to include at a minimum: a. Predictive modeling; b. Complex pattern analysis; c. Link analysis; d. Text mining; and e. Geospatial analysis 6) Feedback and self-learning capability that allow the technology to adapt to changing schemes and trends
4.
Contractor Performance Requirements: OSP anticipates needing the following support services, at a minimum: A. B. C. D. E.
5.
Project Management to include a Project Plan with detailed Implementation Schedule Implementation Services, Training, Data Conversion, and Ongoing Maintenance and Technical Support.
Vendor Response to Request for Information: Please fully describe how your organization could satisfy the requirements identified herein for the EMFAD System and support therefor. A. The detailed response shall be intended for review by technical end users of the EMFAD system. B. Vendor’s detailed response should include: 1) A description of the vendor’s understanding of the OMIG’s business needs as outlined in the Section 2 Background information; 2) a description of the EMFAD system design including a description of the Infrastructure Conceptual Architecture, which is a high-level understanding of the overall system (components and larger subsystems, their responsibilities and relationships), and the strategies (expressed as architecture strategies, principles, mechanisms, approaches, etc.) for the key system capabilities. Further describe generally how each of the components interface with each other;
3) a complete description of the all aspects of the proposed EMFAD system, specifically addressing items listed in Section 3 of this RFI, 4) the description of investigative services that will be provided by the vendor, 5) a complete description of the reporting capabilities, 6) a description of any additional functional capabilities or value added services not described in Section 3 of this RFI with indication how these additional functional capabilities/services are relevant and beneficial for consideration in inclusion of the future Request For Proposal procurement, and 7) a complete description of any minimum hardware, software, or networking requirements needed to access the hosted EMFAD system. C. Vendor’s detailed response should also include a complete description of vendor support offerings, including installation, training, data conversion services, ongoing maintenance and technical support, as well as any additional support services which would be necessary for successful implementation of vendor’s system. D. While detailed pricing information is not required as part of this RFI, vendor should explain in the detailed response the most economical pricing/licensing structure for the EMFAD System and for the support offerings (cost per class or per user for training, Data Conversion, Ongoing Maintenance, etc.). E. Vendor’s RFI response must be emailed to:
[email protected] by NO LATER THAN Wednesday, May 14, 2014 BY 4:00 P.M. It is desirable that the vendor’s RFI response does not exceed 50 pages. NOTE: due to the email system restrictions, the file size per email must not exceed 10 MB; however, the vendor may submit multiple emails if needed in order to submit a complete response that exceeds a file of size of 10 MB broken out in smaller file size attachments.
