Chapter 5 - CMS Certification Milestone 3: RFP, Proposal and Contract

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Primary Guidelines MITA 3.0 Documentation, Medicaid Enterprise Certification Roadmap[1]
Primary Methodology State- or Vendor-specific Methodology
Input As-Is and To-Be Assessments, Supporting Evidence, Gap Analysis, MITA Maturity Roadmap, MECT Checklists
Primary Activities Developing RTMs for Inclusion in RFPs, (state), Developing Responses to the RTMs (vendor), Scoring Proposed Solutions, (state), Finalizing Contract Documentation, (state and vendor)
Output RTMs (based on MECT Checklists), To-Be Assessments, MITA Maturity Roadmap, Proposed Solution SRC and Related Information, Scoring Summaries, Contract Version of RTM for Selected Solution
Downstream Activities Supported Validated MMIS Functionality

Introduction

The activities included in Milestone 3 are extensive and involve participation by the state and vendor communities. State participation generally involves multiple agencies and departments. Vendor participation generally involves the bidding entities as well as [[PMO[[ and IV&V vendors that support the state’s Medicaid procurements. ReadyCert helps the state and vendor communities develop and refine the RTM at each stage of the procurement process.

Figure 5-1: States must achieve 6 CMS certification milestones to receive federal funds for their IT investments

Milestone 3 in the Medicaid Enterprise Certification Roadmap is called, "Release RFP; Sign Contract." The title of the milestone uses the first and last deliverable, (RFP and Contract, respectively), in a long process. The activities leading up to a signed contract generally cover a long period, (sometimes years), and many iterations of information.

The activities described in this chapter relate to the RTM, which is a key part of the RFP. RTM is a standard term in system and solution deployment projects. The TM is a checklist-type document that outlines the state’s requirements. It is used to evaluate the fit of proposed solutions to meet the state’s requirements and trace the requirements to the solution as it is readied for deployment.

In Design, Development and Implementation projects in previous generations of Medicaid system installations, the RTM was used to describe how a system would be designed to meet the requirements. Under MITA, the RTM is used to prove that the solution meets the requirements. This is a key difference between system and solution procurements. Systems must be Designed, Developed and Implemented. Solutions must be Analyzed, Configured and Deployed.

The MECT Checklists provide the basis for the RTM and were developed with the MITA principles in mind. Each Business Objective has CMS-mandated and state-specific SRC. The SRC describe what CMS and states will evaluate to prove that the solution meets the requirements as built, (or to be built based on the vendor’s committed product development roadmap). Once a vendor’s solution is selected and the deployment begins, the RTM is used to validate solution functionality in accordance with the SRC.

ReadyCert significantly streamlines the process of creating and using the RTM. Information collected in preceding activities is carried forward to allow this milestone to begin with a solid set of MECT Checklists, which form the baseline RTM. Information collected in preceding activities is linked to the MECT Checklists, allowing state and vendor teams to modify and refine it, rather than recreate it. It also allows the state and vendor teams to link the work products in this milestone to the To-Be assessments, providing a real time picture of the SMA's planned transition to the future state.

This Chapter is organized in 4 parts, one for each of the major activity categories that lead to a signed contract, as depicted in the Figure 5-2.

Figure 5-2: Chapter 5 TOC

Part 1: RFP/Develop RTM - State

1.1 Create the Baseline RTM

The MECT Checklists for the Medicaid solution that is to be procured are contained in ReadyCert. They are carried forward from the SS-A to Milestone 1, State Goals and Objectives, and submitted with the APD in Milestone 2. Use these MECT Checklists to create the baseline RTM for the planned procurement.

It is recommended that the team members responsible for generating and finalizing the RTM for inclusion in the RFP use the ReadyCert screens to transform the MECT Checklists into the RTM. It is not advisable to download the MECT Checklists to Excel or another tool as ReadyCert seamlessly accommodates the creation of the RTM.

The RTM is organized by MITA Business Process Area and within each area, by Business Objective. Within each Business Objective, the specific SRC for CMS-mandated and state-specific requirements are displayed. The As-Is and To-Be assessments from the SS-A are automatically linked to each Business Objective and numbered SRC.

1.2 Configure the RTM Headings and Links

Based on the procurement regulations and the SMA’s preferences, configure the ReadyCert screens to the state’s specifications for desired input by vendors. At a minimum, the categories of information to include are:

  • Solution Description– a free form text box that allows vendors to describe the solution and how it meets the SRC
  • Compliant– a Yes or No check box that allows vendors to indicate whether the solution is currently compliant
  • Release or Increment– a date-driven or numeric box that allows vendors to indicate the planned release date or release number for any SRC that is not compliant at the time the proposals are submitted
  • Business Process Models– flowcharts and diagrams depicting workflow supported by the solution
  • Screen Shots and Artifacts– visuals aids and reports that prove the solution is deployed and in use in the market at the time proposals are submitted

The categories of information listed above allow the state to determine the fit of the solution to the state’s SRC and compare vendor responses in downstream activities.

Additional categories may be included based on the state’s preference. These include:

  • Project Plan and Schedule– links to the Project Plan submitted with the proposal to depict the activities and schedule for deploying the solution
  • Video– vendor narrative about the solution and its proof points

These and other additional categories should be considered only if the state is prepared to evaluate them.

The state should also decide what links to related information it wishes to share with the vendors. It is recommended that all MITA-related information included in the SS-A and submitted with the APD be linked to the RTM. At a minimum, links should be included to the As-Is and To-Be assessments so that vendors can view the current state, (at the time the RFP was released), and the future condition that the state plans when the solution is deployed. Links to the supporting evidence for the assessed values, the Gap Analysis and the MITA Maturity Roadmap are also desirable; however, the state should make this determination based on its procurement regulations and preferences.

1.3 Review the Baseline RTM

Once all the headings are configured, simulate vendor response to the RTM and test the format. The outcome of this activity is to ensure that the format is conducive to vendor response and that the linkages are correct. Make any corrections necessary.

Click on the links built into the Business Objectives and numbered SRC to ensure that the appropriate As-Is and To-Be states are displayed. The state and vendors will refer to these assessments throughout the remainder of this milestone.

1.4 Finalize the RTM

The overall project management methodology will determine the process for finalizing the RTM to be released with the RFP. However, it is recommended that a core team cross-reference the RTM to textual requirements contained in the body of the RFP. For example, if textual requirements call for the vendors to manually adjudicate certain claims and the SRC call for the solution to automatically adjudicate them, the discrepancy must be resolved.

In cases where there is a discrepancy, the MECT Checklist should prevail. If there are requirements that are not included in the MECT Checklist, and accordingly, the RTM, additional state-specific requirements may be necessary. If that is the case, add the state-specific requirements and applicable SRC and update the baseline MECT Checklists. This, in turn, will automatically update the RTM. The SMA should work with the CMS RO to determine how it wants to be apprised of changes to the MECT Checklists as the RTM is being reviewed, refined and finalized.

When the review and refinement is complete, finalize the RTM for inclusion in the RFP. This version of the RTM represents the Business Objectives and SRC that vendors will respond to. It does not represent the final RTM that will be included in the contract or used to trace solution requirements to the deployment of business functionality. The RTM will be refined as this milestone continues. Change is inevitable and ReadyCert supports seamless change management and automatic updating of source input.

1.5 Export RTM to the RFP and Prepare Instructions

The final RTM is exported from ReadyCert and included with the RFP. The process for exporting and including it in the RFP is automatic and seamless. It is exported and included as a link in the RFP. When vendors click on the link, they are presented with the RTM for response.

The state prepares the response instructions, detailing each heading and the information required to be included under each heading. It is recommended that the instructions be included in the main body of the RFP, as well as in the RTM that is exported to the RFP.

1.6 Submit the RTM with the RFP for CMS Approval

The RFP is submitted for CMS’s approval as part of Medicaid Enterprise Certification Roadmap, Milestone 3. Include the link to the RTM in ReadyCert with the submission to CMS. If required by the CMS RO, generate Excel, Word or PDF output as well.

Part 2: Proposal/RTM Response - Vendor

2.1 Access and Review the RTM

The state has included a link to the RTM in the RFP. Click on the link to retrieve a copy of the RTM that is included in the RFP. Download it and save it according to the vendor’s document management protocols.

It is recommended that a core team review the construction of the RTM and the response requirement categories and practices, completing a cross-section of the SRC.

Designate one or two people from the proposal team as RTM SMEs so that any questions are answered consistently.

2.2. Train Proposal Team on RTM Completion using ReadyCert

Vendors have access to the ReadyCert Wiki to obtain user information and how-to documentation. It is recommended that the RTM SMEs train the proposal team on how to complete the RTM using ReadyCert. Administrative protocols allow the vendor to assign view-only and update rights to individual members of the proposal team. Make the appropriate assignments and enter the permissions in ReadyCert.

2.3 Review Proposed Solution Collateral

The team responsible for completing the RTM must have access to collateral for the proposed solution. This collateral includes:

  • Solution design specifications
  • User documentation
  • Product development roadmaps
  • Screen shots
  • Reports
  • Performance standards
  • Business process models

Review the proposed solution collateral with the RTM completion team. Define the process for seeking clarifications and answers to questions.

2.4 Complete the RTM

In compliance with the RFP instructions, begin completing the RTM. It is recommended that complete Business Objectives be assigned to individual SMEs to provide consistency in the response.

Select the SRC for response. Click on the link to the As-Is and To-Be assessments to understand the current state and the planned future state.

Based on the state’s instructions, enter information in each of the headings in the RTM. Suggested RTM response headings and appropriate entries are described below.

  • Solution Description– describe the functionality enabled by the vendor’s solution. Focus on the SRC and specifically address the solution’s proof points. Enter business-centric descriptions and explain the information and technology used to deliver the business functionality.
  • Compliant– indicate whether the solution has the functionality at present or if it is planned for a future release.
  • Release or Increment– enter the appropriate release or increment in which the functionality will be deployed.
  • Business Process Models– attach business process models that depict the functionality supported by the Business Objective or SRC.
  • Screen Shots and Artifacts– attach screen shots from the solution and other system-generated artifacts, such as reports, to substantiate that the solution currently exists in the market and the fit of it to meet the state’s requirements.

Define the review and approval process. As Business Objectives, or a subset of a Business Objective, are complete, the RTM completion team submits the RTM for review and approval.

The reviewers may make corrections directly in the ReadyCert or may communicate the corrections to the team members, based on the vendor’s preferred method.

Continue the entry, review and correction process until the entire RTM is complete.

2.5 Finalize the Proposed RTM

The vendor’s proposal development methodology will define the RTM review and approval process. Once the RTM is approved and finalized, save a copy of it for submission with the proposal.

When the proposal is ready to submit, (per the state’s response instructions), upload a copy of the RTM to the state’s ReadyCert site. If required by the RFP, produce output in Excel, Word or PDF format for submission with the main body of the proposal.

Part 3: Proposal Evaluation - State

3.1 Configure ReadyCert with the State’s Scoring Scheme

ReadyCert facilitates side-by-side evaluation and scoring of vendors’ proposed solutions for Business Objectives and individual SRC. The tool does not prescribe the weighting, ranking and application of scores to the solution as state procurement regulations and preferences generally dictate these protocols.

Using the Proposal Scoring screens, enter the weighted values assigned to Business Objectives. For example, the state may decide to weigh Managed Care more heavily than any other category, in which case, the RTM sections devoted to managed care solution components would be configured to the appropriate weight.

Weightings are generally contained in the background so as not to distract evaluators. Evaluators should be concerned with scores, while the evaluation methodology should be concerned with the weightings that deliver best value to the state. The two go hand-in-hand; however, the separation of weightings and rankings from scores in the configuration is desirable.

3.2 Train Proposal Evaluation Team on Scoring Process

Using the state’s overall project management methodology, train the team on the evaluation policies and process and how to use ReadyCert for evaluating the RTM.

It is recommended that practice evaluations and scoring be performed to ensure that the entire team is practicing the methodology consistently.

Make assignments to the team and grant access to the scoring features and functions in ReadyCert.

3.3 Score the RTM Responses

Access the RTM and bring-up the evaluator’s assigned sections. Review the SRC, As-Is and To-Be assessments and any other background information required by the state’s overall evaluation methodology.

Click on Vendor 1’s response and evaluate it. Click on Vendor 2”s response and evaluate it, and so on. When each vendor’s response has been evaluated, determine the appropriate score to enter for the SRC.

Continue to the next SRC or Business Objective and repeat the process. Continue to evaluate SRC and enter scores until the assigned RTM sections are complete.

It is recommended that quality control is performed on a cross-section of scored RTM sections. This step will help ensure that the evaluation has been consistently performed and that independent review results in the consistent scores.

3.4 Evaluate the Variances between Vendor Scores (Optional)

The state’s procurement policies and regulations may allow the SMA to request a best and final offer. If that is the case, it is advisable that the state evaluate the variances to determine if a specific vendor’s solution components scored much higher than the other vendors did in the same category. This would generally be performed for a group of SRC or at the Business Objective level. ReadyCert supports individual and summary score tallies.

This exercise is useful if the state intends to give all vendors a chance to meet the preferred approach in a best and final offer.

3.5 Compare RTM Summary Scores and Rank Solutions

Generate reports in ReadyCert to display summary scores for each vendor, based on the evaluation methodology configured at the start of this process. Using the overall project management methodology, review and discuss the summary scores. Drill down into the detail as necessary to address inquiries and issues. All information needed to review and finalize the scoring is resident in ReadyCert. For example, if To-Be supporting evidence is needed to resolve a scoring question, go to the applicable SRC and click on the To-Be assessed value and then open the supporting evidence.

Determine the ranking of solutions and transfer the appropriate score or value to the overall evaluation methodology.

Part 4: Contract Finalization - State and Vendor

4.1 Refine RTM as Part of Contract Negotiation

The state’s procurement policies and regulations are used to determine the selected vendor and the method for finalizing the contract. While there is generally a negotiated contract, some states may go directly from selection to a contract award. In those cases, the proposed and accepted RTM becomes the contracted baseline.

When a negotiation takes place before the contract is finalized, the RTM may require refinement. The process used by the state to request changes will determine the vendor’s response to such requests. However, when the state requests changes to the proposed solution, corresponding changes to the RTM are generally required.

The state and vendor work together to communicate and understand requested changes. When the contract negotiation results in modification to the RTM, the vendor makes the changes to the last and most current version of the RTM. When the vendor makes the change, it automatically updates the state’s copy of the RTM. The state reviews and approves the change. This process is completed for any negotiated changes that result in modifications to the RTM.

4.2 Finalize the RTM as an Attachment to the Contract

The state’s procurement policies and regulations are used to determine the relationship of the RTM to the contract. However, if possible, the RTM should be an attachment to the contract. Attachments are generally easier to update and incorporate by reference to the contract. Change to the RTM is inevitable as the solution is readied for deployment. Accordingly, the easier it is to update the RTM and reference it by attachment to the contract, the better able the state and vendor are to accommodate future change.

4.3 Update the To-Be Supporting Evidence

When the contract is finalized, upload the proposed SRC details to the SS-A/To-Be supporting evidence. The solution details provide additional evidence of the state’s plans to achieve the future state.

4.4 Update the Gap Analysis

Update the Gap Analysis to describe and depict the plans to close the gaps, as represented in the final contract.

4.5 Update the MITA Maturity Roadmap

Update the MITA Maturity Roadmap to reflect the plan to transition to the future, To-Be state, based on the final contract.

4.6 Submit Required Documentation to CMS for Approval of Source Selection

Upload a copy of ReadyCert, with all the input and output from the SS-A and the first three Medicaid Enterprise Certification Milestones to the CMS RO.

Throughout this process, the SMA is in touch with the CMS RO. The CMS RO must approve the decision to award the contract to the selected vendor. Communication throughout the process is key. The documentation in ReadyCert supports communication and bolsters the state’s case for the award decision. CMS is able to view the entire decision as a process, from the SS-A through to the first three Medicaid Enterprise Certification Milestones. The information is carried forward from one activity to the next. This level of re-use and seamless integration of information throughout the MITA 3.0 model facilitates CMS review and approval.

Notes

  1. State procurement policies and regulations are the primary guidelines the influence the RFP and procurements.