RFP 5531Zl - Nebraskadas.nebraska.gov/materiel/purchasing/5531/NASBMC - Tech and Cost.pdfRFP 5531Zl John C. Spatz, ... 1311 Stockwell Street Lincoln, NE 68502 402·423-4951 Office

NASBMC Nebraska Association of School Boards

MEDICAID CONSORTIUM

RESPONSE TO DEPARTMENT OF HEALTH AND

HUMAN SERVICES

RFP 5531Zl

John C. Spatz, NASBMC Chief Executive Officer

Matthew G. Dunning, NASBMC Chief Operating Officer

1311 Stockwell Street Lincoln, NE 68502

402·423-4951 Office 800-422-4572 Toll Free

402-817·0289 Fax www.NASBonline.org

RESPONSE TO DEPARTMENT OF HEALTH AND HUMAN SERVICES

RFP 5531Zl

Nebraska Association of School Boards Medicaid Consortium (NASBMC)

Table of Contents

State of Nebraska (State Purchasing Bureau) Request for Proposal for Contractual Services Form with attached Form A. (RFP 5531Zl) (58 Pgs)

Addenda

• Addendum One - Revised Schedule of Events (2 Pgs) • Addendum Two - Questions and Answers (8 Pgs) • Addendum Three -Attachment 3, Cost Proposal - REVISED Dated 3/3/2017 (1 Pg)

Corporate Overview of Nebraska Association of School Boards Medicaid Consortium (NASBMC) (8 Pgs)

Financial Statements (30 Pgs Total)

• CliftonLarsonAllen Letter accompanying the Financial Statements and Single Audit Compliance Reports (9 Pgs)

• Financial Statements and Single Audit Compliance Reports (20 Pgs) • Bank Reference ( 1 Pg)

Technical Proposal, including Corporate Overview for Subcontractor Go Solutions Group, Inc. (GSGD (72 Pgs)

• Attachment 1, Deliverables and Penalties (2 Pgs) • Attachment 2, Provider List (21 Pgs) • Attachment 3, Cost Proposal Revised Dated 3/3/2017 RFP (1 Pg) • Attachment 4, Optional Fixed Hourly Rates Request for Proposal Number 5531Zl(l

Pg)

MIPS-Cost·Report (14 Pgs Total)

• Exhibit 1 - Certification Page (J Pg) • Exhibit 2 - Provider Data (1 Pg) • Exhibit 3 - Statistics (J Pg) • Exhibit 4A - Time Study (1 Pg)

llPage

• Exhibit 4B · Time Study·TCM (J Pg) • Exhibit 4C · Time Study· ADM (J Pg) • Exhibit 5A · Direct Medical Cost (J Pg) • Exhibit 5B · TCM Cost (J Pg) • Exhibit 5C · Direct Adm Cost (J Pg) • Exhibit 5D · Transportation Cost (J Pg) • Exhibit 6 · Settlement (J Pg) • Exhibit 7 • Payroll Costs (J Pg) • Exhibit 8 · Contracted Costs (J Pg) • Final Statement Summary (1 Pg)

Fall Financials 16· 17 (3 Pgs Total)

• Audit Conti·ol Worksheet (J Pg) • Category #1 · Business Manager's Work Sheets· Time Study Participants· Optional

Work Sheets (J Pg) • Category #2 · Business Manager's Work Sheets· 'rime Study Participants· Optional

Work Sheets (J Pg)

NE Claim Fall 16· 17 (3 Pgs Total)

• Nebraska Education Based Medicaid Administrative Claiming (NEBMAC) Claim Invoice (J Pg)

• Working Paper (2 Pgs)

Implementation Timeline for NEBMAC RMTS and MIPS Cost Settlement (Gantt Chart) (1 Pg)

Go Solutions Informational Materials

• Go Help Desk Call Log Analysis (1 Pg) • Go In the Know -January 1, 2015 (5Pgs) • Quick Tips - January 2015

Go Solutions Claims Documents

• RMTS Claim Submission Breakdown (1 Pg) • eMAC Dashboard Summary (lPg) • System Maintenance Statistics (1 Pg)

21Page

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RFP 553121

State of Nebraska (State Purchasing Bureau) REQUESTFORPROPOSALFORCONTRACTUAL SERVICES FORM

SOLICITATION NUMBER RELEASE DATE

RFP 553121

RETURN TO: State Purchasing Bureau 1526 K Street, Suite 130 Lincoln, Nebraska 68508 Phone: 402-471-6500 Fax· 402-471-2089

Februarv 3, 2017 OPENING DATE AND TIME PROCUREMENT CONTACT

March 10, 2017 2:00 p.m. Central Time Michelle Thompson/Teresa Fleming .. . .

This form 1s part of the spec1f1cat1on package and must be signed 1n ink and returned, along with proposal documents, by the opening date and time specified.

PLEASE READ CAREFULLY! SCOPE OF SERVICE

The State of Nebraska, Administrative Services (AS), Materiel Division, State Purchasing Bureau, is issuing this Request for Proposal. RFP Number 5531Z1 for the purpose of selecting a qualified contractor to provide Medicaid school-based claiming by applying Random Momeni Time Study (RMTS) methodology and cost settlement processes to support proper Medicaid reimbursement for both direct medical services and administrative activities.

Written questions are due no later than February 17, 2017, and should be submitted via e-mail to [email protected] Written questions may also be sent by facsimile to (402) 471-2089.

Bidder should submit one (1) original of the entire proposal. Proposals must be submitted by the proposal due date and time.

PROPOSALS MUST MEET THE REQUIREMENTS OUTLINED IN THIS REQUEST FOR PROPOSAL TO BE CONSIDERED VALID. PROPOSALS WILL BE REJECTED IF NOT IN COMPLIANCE WITH THESE REQUIREMENTS.

1. Sealed proposals must be received in State Purchasing Bureau by the date and time of proposal opening per the schedule of events. No late proposals will be accepted. No electronic, e-mail, fax, voice. or telephone proposals will be accepted.

2. This form "REQUEST FOR PROPOSAL FOR CONTRACTUAL SERVICES" MUST be manually signed, in ink, and returned by the proposal opening date and time along with bidder's proposal and any other requirements as specified in the Request for Proposal in order for a bidder's proposal to be evaluated.

3. It is the responsibility of the bidder to check the website for all information relevant to this solicitation to include addenda and/or amendments issued prior to the opening date. Website address is as follows: http://das.nebraska.gov/materiel/purchasing.html

IMPORTANT NOTICE: Pursuant to Neb. Rev. Stat. § 84-602.02, all State contracts in effect as of January 1, 2014, and all contracts entered into thereafter. will be posted to a public website. Beginning July 1. 2014, all contracts will be posted to a public website managed by the Department of Administrative Services.

In addition. all responses to Requests for Proposals will be posted to the Department of Administrative Services public website. The public posting will include figures, illustrations, photographs. charts, or other supplementary material. Proprietary information identified and marked according to state law is exempt from posting. To exempt proprietary information you must submit a written showing that the release of the information would give an advantage to named business competitor(s) and show that the named business competitor(s) will gain a demonstrated advantage by disclosure of information. The mere assertion that lnformalion is proprietary is not sufficient. (Attorney General Opinion No. 92068, April 27, 1992) The agency will then determine if the interests served by nondisclosure outweigh any public purpose served by disclosure. Cost proposals will not be considered proprietary.

To facil itate such public postings, the State of Nebraska· reserves a royalty-free. nonexclusive, and irrevocable right to copy, reproduce, publish, post to a website. or otherwise use any contract or response to this RFP for any purpose, and to authorize others to use the documents. Any individual or entity awarded a contract, or who submits a response to this RFP. specifically waives any copyright or other protection the contract or response to the RFP may have: and, acknowledge that they have the ability and authority to enter into such waiver. This reservation and waiver is a prerequisite for submitting a response to this RFP and award of the contract. Failure to agree to the reservation and waiver of protection will result in the response to the RFP being non-conforming and rejected.

Any entity awarded a contract or submitting a RFP agrees not to sue, file a claim, or make a demand of any kind, and will indemnify. hold, and save harmless the State and its employees, volunteers, agents, and its elected and appointed officials from and against any and all claims, liens, demands, damages, liability, actions, causes of action, losses, judgments, costs. and expenses of every nature, including investigation costs and expenses, settlement costs, and attorney fees and expenses ("the claims"), sustained or asserted against the State, arising out of, resulting from. or attributable to the posting of contracts, RFPs and related documents.

BIDDER MUST COMPLETE THE FOLLOWING

By signing this Request for Proposal for Contractual Services form, the bidder guarantees compliance with the provisions stated in this Request for Proposal, agrees to the terms and conditions unless otherwise agreed to (see Section Ill) and certifies that bidder maintains a drug free work place environment.

Per Nebraska's Transparency in Government Procurement Act, Neb. Rev Stat § 73-603 DAS is required to collect statistical informatior regarding the number of contracts awarded to Nebraska Contractors. This information is for statistical purposes only and will not be considered for contract award purposes.

_X_ NEBRASKA CONTRACTOR AFFIDAVIT: Bidder hereby attests that bidder is a Nebraska Contractor. "Nebraska Contractor' shall mean any bidder who has maintained a bona fide place of business and at least one employee within this state for at least the si) (6) months immediately preceding the posting date of this RFP.

_ _ I hereby certify that I am a Resident disabled veteran or business located in a designated enterprise zone in accordance with Neb. Rev. Stat.§ 73-107 and wish to have preference, if applicable, considered in the award of this contract.

FIRM: Nebraska Association of School Boards Medicaid Consortium (NASBMC)

COMPLETE ADDRESS: 1311 Stockwell Street· Lincoln NE 68502

SIGNATURE· - ~ '7 -TELEPHONE NU~ 3-4~

TYPED NAME ~ NE;, John C. Spatz, Ch;ef Executive Off;cer

ii

FAX NUMBER: (402} 817-0289

DATE: March 161h 2017

SPB RFP Revised: 01/29/2016

TABLE OF CONTENTS

TABLE OF CONTENTS ............................................................................................................................................................................ iii

.OSSARY OF TERMS .... ......................... ........ ....... .... .......... ................. ....... .... ......... ........... .... .............. .................... ....... ..................... v

I. SCOPE OF THE REQUEST FOR PROPOSAL .......................................... ................................................. ................................ 1

A. SCHEDULE OF EVENTS ................................... ................ ............ ............................................................................... 1

II. PROCUREMENT PROCEDURES ............................................................................................. ............... ........... ........................ 2

A. PROCURING OFFICE AND CONTACT PERSON ........................................................................................................ 2 B. GENERAL INFORMATION ... .. .. ...... ......... ....... .. .. ... ...... .... ..... ...... ......... .... ... ................................................................... 2 C. CUSTOMER SERVICE ........ ..... ........... .......... ................. ... ..... .... .... ................. ............ ..................... ............................. 2 D. COMMUNICATION WITH STATE STAFF AND EVALUATORS ................................................................................... 2 E. WRIITEN QUESTIONS AND ANSWERS ..... ........... ... ...... ... .. .. .. ......... .... ...................................................................... 3 F. ORAL INTERVIEWS/PRESENTATIONS AND/OR DEMONSTRAT10NS ... .. ................ ................................................ 3 G. SUBMISSION OF PROPOSALS ............. .................. .. .................................................................................................. 3 H. PROPOSAL OPENING .... ....... ..... ... ... ........ ..... ....... ....... ..... .. .. ... ........... .... ...................................................................... 4 I. LATE PROPOSALS ..... ........ ..... .... ....... ........... .. ..... ................ ........................ .......... ........................... ........................... 4 J. REJECTION OF PROPOSALS ....... ............. .... ... ...... ...... ......... .............. .. .. ...................... ......... .................................... 4 K. EVALUATION OF PROPOSALS ... ... ........ .. ... ... .. ..... ... ......... ..... .. ...... .... ..... .................................................................... 4 L. EVALUATION COMMITTEE ... .............. .. ......... ................. .... ........ ......... .... ..... .. .................................... ..... ... .. ............... 5 M. MANDATORY REQUIREMENTS ............................. ................................................................. ........ ..... ............ ........... 5 N. REFERENCE CHECKS .. .. ........... .... ......... ...... ....... ... .. ......... ... ........ ...... .. ....... ... ........... .. ................................................ 5 0. SECRETARY OF STATE/TAX COMMISSIONER REGI STRATION REQUIREMENTS ....... .......... ....... ... ..................... 5 P. VIOLATION OF TERMS AND CONDITIONS ............. .............. .. ......... .... ... ........ ... ............................ ............................ 6

Ill. TERM S AND CONDITIONS .... ............... .................. ...... ........................... .. ........... ........ .. ... .. ....... ...... ....... ... .... ......... .................. 7

A. GENERAL ...................... ......................................... ....................................................................................................... 7 B. AWARD ...... .. .................... ...... .. .. .......................................................................... ......................................................... 8 C. COMPLIANCE WITH CIVIL RIGHTS LAWS ANO EQUAL OPPORTUNITY EMPLOYMENT/

NONDISCRIMINATION ....... .... ..... ... ......... .............. ............... ... ...................... .... ......... .................................. ..... ........... 8 0. PERMITS, REGULATIONS, LAWS .............. ............. .................................................................................................... 9 E. OWNERSHIP OF INFORMATION AND DATA ..... .... .. ............ .................................. ........... .......................................... 9 F. INSURANCE REQUIREMENTS ........... ......... ......... .... ... ..................... .... ............................ ............................. ...... ........ 9 G. COOPERATION WITH OTHER CONTRACTORS ...................................................................................................... 11 H. INDEPENDENT CONTRACTOR .............. .............. ...... ...... .. ..... ... .. .. .. ....... ............ ...................................................... 11 I. CONTRACTOR RESPONSIBILITY , .. ......... ....... .......... ... ..... .... ....... .......................................................... .. .. ........ ....... 12 J. CONTRACTOR PERSONNEL .. ........... ... ............. .................... ..... ... .... ......... .............................................................. 12 K. CONTRACT CONFLICTS .... ... .. ... ...... ... .... .. .. .. ..... .. .. .... ..... .. .. ....... ...... ....... ... .... .... ........................................................ 12 L. STATE OF NEBRASKA PERSONNEL RECRUITMENT PROHIBITION .... ... ....... ........................ ............................... 13 M. CONFLICT OF INTEREST ............................................... .. ... ... ....................... ............................................................ 13 N. PROPO SAL PREPARATION COSTS .. ..... ...... ..... ... .... ......... ..... ......... ...... ....... .... ........................................................ 13 0. ERRORS AND OMISSIONS .. ... .... .... ... ................. .... .... ..... .... ..... ................. ..... ............. ......... .... ....................... .......... 13 P. BEGINNING OF WORK ............ ..... ... ................ ... ............... .... .... ............. ..... .... ........................................................... 14 Q. ASSIGNMENT BY THE STATE .. ....... ...... .. ..... ..... .. .. ...... .......... ... .. .. ... ... .... ................................................................... 14 R. ASSIGNMENT BY THE CONTRACTOR ............ .. ... ....... ................ ............ .. .... .... ............ ... ........................................ 14 S. DEVIATIONS FROM THE REQUEST FOR PROPOSAL .. ..................... ............. ........................... ............................. 14 T. GOVERNING LAW ....... ...... ...... ..... ... ....... ................... ... ........ .. .. .. ............. ................................................... ................ 15 U. ATTORNEY'S FEES ... .... ........ .. .... ..... .. ...... ....... .. .. .......... .... .. ........ .. ............ ....... .. ....... ............................................ ..... 15 V. ADVERTISING .... .. ... ........... .. .. ...... ....... ...... .. .. .. ........................ .. ......... ..... .... ...... ......................................................... 15 W. STATE PROPERTY ... .. .. .... ..... .. .. .... ... ....... .. ..... .......... .. ..... ....... .. .................................................................................. 15 X. SITE RULES AND REGULATIONS ... .... ... ........ .. .. ... ........... ... ... ..... ..... ... ...................................................................... 16 Y. NOTIFICATION ....... .. ......... ..... ... .. .... ....... .. .... ............. ..... ........ ............................... ........................................... .......... 16 Z. EARLY TERMINATION .... .. ............ ... .. .. .... ..... .......... .. ............ ..................................................................................... 17 AA. FUNDING OUT CLAUSE OR LOSS OF APPROPRIATIONS .. ............ .... ...................................................... ............. 17 BB. BREACH BY CONTRACTOR ...... ....... ..... ....... .... ............. .......... ........... ..... ........................... ................ ....................... 18 CC. ASSURANCES BEFORE BREACH ... .. ... ........... .. ...... .. ......... .. ..................................................................................... 18 OD. ADMINISTRATION - CONTRACT TERMINATION ........ .... ..... .. ... ... .. ..... .......................................... ...................... ..... 18 EE. PENALTY ......... ... ....................................................................... ........... ...................................................................... 19 FF. PERFORMANCE BOND ................................................................. ............................................................................. 19 GG. FORCE MAJEURE .. .... .. ................. .. ......................... ......... ............................... .. .............. .......................................... 19

3 SPB RFP Revised: 01/29/2016

HH. PROHIBITION AGAINST ADVANCE PAYMENT .............................. ................................. ......................................... 19 II. PAYMENT ....... .. ...... ...... .......... .. ... ...... .. ... .... ............................................................................................................ .... 20 JJ. INVOICES .... ..... ... ..... .. ..... ... .......... .... ........... .. ..... ............... ............ ..................................... ............ ............................. 20 KK. RIGHT TO AUDIT ... ....... ....... ..... .. ....... ........ .... ..................................................... ........................................................ 20 LL. TAXES ... ....... ........ ... ... .. .. ............. .. ........ ..... .... ....................................... .................. ......................... ........................... 21 MM. INSPECTION AND APPROVAL .... ... ... .. ... ........ ..................................................... ................... ........... ..... ... ........... ..... 21 NN. CHANGES IN SCOPE/CHANGE ORDERS .. ............. ........................................... .............. .. ......................... .... ....... .. 21 00. SEVERABILITY .. .... .. .................................................. ........................... ...................................................................... 22 PP. CONFI DENTlALITY ........ .... ................. ....................... ..... ........... ......................... .. ........ ................... ... ..................... ... 22 QQ. PROPRIETARY INFORMATION ....... ...................... ....... ..... .......................... ...... ... ....... ..... ......................................... 22 RR. CERTIFICATION OF INDEPENDENT PRICE DETERMINATION/COLLUSIVE BIDDING ........................... ............. . 23 SS. STATEMENT OF NON-COLLUSION .. .... ........ ... .. .... .... .... ............ ..... ......... ....... ....... ............................................... .... 23 TT. PRICES .... ... ........................ .. ... .... ............ ........ .................. ................ ... ............ .................. ........ .. .. ......................... ... 23 UU. BEST AND FINAL OFFER ....... .. ... .... ... ... ....................... ........ ....... .................. .......................................................... ... 24 W, ETHICS IN PUBLIC CONTRACTING ... .............. .. .... .... ..... ............. .... ........ ...... ........ ................................................... 24 WW. INDEMNIFICATION ........ ........................................... ....... ..... ........................... .......... ................................ ................. 25 XX. NEBRASKA TECHNOLOGY ACCESS STANDARDS ....................................................................... ....................... ... 26 YY. ANTITRUST .. ............ ..... ....... ... ... ......... ... ..... ... ..... ........... ...................... .... ............. ......................................... ......... .... 26 ZZ. DISASTER RECOVERY/BACK UP PLAN ....... ........ ....... ................... ............ .......... ........ ..................... .. .. ....... ............ 26 AAA. TI ME IS OF THE ESSENCE ... ............. ......... .............. ... .................................... ..... ............................. ........................ 26 BBB. RECYCLING .. ......... ..... .......... .. ... ...... ..... .......... ..... ......... .............................................................................................. 27 CCC. DRUG POLICY ... ... ... ... .................. ........... .......... .................... .... ................. ....... ............................. .......................... .. 27 DDD. EMPLOYEE WORK ELIGIBILITY STATUS ..... ............. .......... .. ............. .. ... ......... ................................................ ........ 27 EEE. CERTI FICATION REGARD ING DEBARMENT, SUSPENSION AND INELIGIBILITY .............. ................................... 28 FFF. POLITICAL SUB-DIVISIONS .. .... ... ....... .. .... ..... ..... ..... ... .... ............ ....... ........... .............. ..................................... ... .. .... . 28 GGG. OFFICE OF PUBLIC COUNSEL ................. ..... ........ ...... ... ..... .......... ... .................. ..... .... ................................... .......... 28 HHH. LONG-TERM CARE OMBUDSMAN ... ... ...... .. ........... ... ........... ...... ........... ... ....... ..... .......... .............. ..... ........................ 29

IV. PROJECT DESCRIPTION AND SCOPE OF WORK ................................................................................................................ 30

A. PROJECT OVERVIEW .. ... .......... .... ... ... .. .. .. ...... ......... ... ... ............................................................................................ 30 B. PROJECT ENVIRONMENT .... .. .... ...... .... ... ...... ............. .. ...... ......... .... ............. .. ............................. ..... .. ............... ... ..... 30 C. PROJECT REQUIREMENTS ..... ......... .......... ......... ....... ..... ......................................................................................... 31 D. REPORTING REQUIREMENTS ..... ... .......... .......... ... ..... .... .......................................................................................... 32 E. AU DITING REQUIREMENTS .... .. ...... .. .. ... ........ ....... ........ ............... ... ...................... .. ... ................................... .......... .. 33 F. PROJECT PLANNING AND MANAGEMENT .... .... ... ..... .... .. ............................................. ........................................... 34 G. IMPLEMENTATION AND END OF CONTRACT .... .... ................................................................................................. 36 H. CONTRACTOR COMMUNICATION ... ... .......... ... .. ......... .. .. .... ............. .. ............................ ....... , ....... ........................ .... 38 I. CONTRACTOR SUPPORT ... .... .... ................. ........ .......... .......................... ........................ ......................................... 38 J, DELIVERABLES ... ..... .... .. .......... ............. ........ .... .. ....... .... ......... ................................................................................... 40

V. PROPOSAL INSTRUCTIONS ....................................................................................................................... ................... ......... 41

A. PROPOSAL SUBMISSION ............................... ...... ...................... ........... ..... .............. ........................................ ......... 41 8. COST PROPOSAL REQUIREMENTS .. ...... .... .... ......... ............... ...... .. ..... .. ... ..... .. ......... ... ... ...... .............. ............. ..... .. 43 C. PAYMENT SCHEDULE ... ..... ......... ........ ... ..... ...... ........................ ......... ...... ................ .................. ........ .... ..... .... ....... ... 44

Form A Bidder Contact Sheet ............................................................................................................................................................... 45


GLOSSARY OF TERMS

Acceptance Test Procedure : Benchmarks and other performance criteria, developed by the State of Nebraska or other sources of testing standards. for measuring the effectiveness of products or seNices and the means used for testing such performance.

Addendum: Something to be added or deleted to an existing document; a supplement.

After Receipt of Order (ARO): After Receipt of Order

Agency: Any state agency, board, or commission 01her than the University of Nebraska, the Nebraska State colleg es. the courts, the Legislature, or any other office or agency established by the Constitution of Nebraska.

Agent/Representative: A person authorized to act on behalf of another.

Amend: To alter or change by adding, subtracting. or substituting.

Amendment: A written correction or alteration to a document.

Appropriation: Legislative authorization to expend public funds for a specific purpose. Money set apart for a specific use.

Award: All purchases, leases, or contracts which are based on competitive proposals wil l be awarded according lo the provisions in the Request for Proposal. The State reserves the right to reject any or all proposals, wholly or in part. or to award to multiple bidders in whole or in part. The State reserves the right to waive any deviations or errors that are not material, do not invalidate the legitimacy of the proposal. and do not improve the bidder's competitive position. All awards will be made in a manner deemed in the best interest of the State.

Best and Final Offer (BAFO): In a competitive bid, the final offer submitted which contains the bidder's (vendor's) most favorable terms for price.

Bid/Proposal: The offer submitted by a vendor in a response to written solicitation.

Bid Bond: An insurance agreement, accompanied by a monetary commitment. by which a third party (the surety) accepts liability and guarantees that the vendor will not withdraw the bid.

Bidder: A vendor who submits an offer bid in response to a written solicitation.

Business: Any corporation , partnership, individual, sole proprietorship, joint-stock company, joint venture. or any other private legal entity.

Business Day: Any weekday. except State-recognized holidays.

Calendar Day: Every day shown on the calendar including Saturdays. Sundays, and State/Federal holidays.

Cancellation: To call off or revoke a purchase order without expectation of conducting or performing it at a later time.

Centers tor Medicaid and Medicare Services (CMS): An agency of the U.S. Department of Health and Human Services responsible for the administration of Medicare and Medicaid.

Central Processing Unit (CPU): Any computer or computer system that is used by the State to store, process. or retrieve data or perform other functions using Operating Systems and applications software.

Certified Public Expenditure (CPE): CPE'S are utilized to draw down federal funds to compensate for unreimbursed cost for medical care provided to Medicaid recipients.

Collusion: An agreement or cooperation between two or more persons or entities to accomplish a fraudulent, deceitful, or unlawful purpose.

Commodities: Any equipment, material, supply or goods; anything movable or tangible that is provided or sold.

Commodities Description: Detailed descriptions of the items to be purchased; may include information necessary to obtain the desired quality, type, color. size, shape, or special characteristics necessary to perform the work intended to produce the desired results.

V SPB RFP Revised: 01/29/201 6

Competition: The effort or action of two or more commercial interests to obtain the same business from third parties.

Confidential Information: Unless otherwise defined below, "Confidential Information" shall also mean proprietary trade secrets, academic and scientific research work which is in progress and unpublished, and other information which if released would give advantage to business competitors and serve no public purpose (see Neb. Rev. Stat.§ 84-712.05(3)). In accordance with Nebraska Attorney General Opinions 92068 and 97033, proof that information is proprietary requires identification of specific. named competitor(s) who would be advantaged by release of the information and the specific advantage the competitor(s) would receive.

Contract: An agreement between two or more parties creating ohligations that are enforceable or otherwise recognizable at law; the writing that sets forth such an agreement.

Contract Administration: The management of the contract which includes and is not limited to; contract signing, contract amendments and any necessary legal actions.

Contract Management: The management of day to day activities at the agency which indudes and is not limited to ensuring deliverables are received, specifications are met, handling meetings and making payments to the Contractor.

Contract Period: The duration of the contract.

Contractor: Any individual or entity having a contract to furnish commodities or services.

Cooperative Purchasing: The combining of requirements of two or more poliUcal entities to obtain advantages of volume purchases, reduction in administrative expenses or other public benefits.

Copyright: A property right in an original work of authorship fixed In any tangible medium of expression, giving the holder the exclusive right to reproduce, adapt and distribute the work .

Critical Program Error: Any Program Error, whether or not known to the State, which prohibits or significantly impairs use of the Licensed Software as set forth in the documentation and intended in the contract.

Customer Service: The process of ensuring customer satisfaction by providing assistance and advice on those products or services provided by the Contractor.

Default: The omission or failure to perform a contractual duty.

Deviation: Any proposed change(s) or alteration(s) to either the terms and conditions or deliverables within the scope of the written solicitation or contract.

Eva luation: The process of examining an offer after opening to determine the vendor's responsibility, responsiveness to requirements, and to ascertain other characteristics of the offer that relate to determination of the successful award.

Evaluation Committee: Committee(s) appointed by the requesting agency that advises and assists the procuring office in the evaluation of bids/proposals (offers made in response to written solicitations).

Extension: Continuance of a contract for a specified duration upon the agreement of the parties beyond the original Contract Period. Not to be confused wilh "Renewal Period".

Fee-for-Service: A system in health care by which particular services are paid for individually rather than provided as part of a comprehensive plan .

Federal Financial Participation (FFP): Federal portion of the total Medicaid payment.

Free on Board (F.O.B.} Destination: The delivery charges are included in the quoted price and prepaid by the vendor. Vendor is responsible for all claims associated with damages during delivery of product.

Free on Board (F.O.B.) Point of Origin: The delivery charges are not included in the quoted price and are the responsibility of the agency. Agency is responsible for all claims associated with damages during delivery of product.

Foreign Corporation: A foreign corporation that was organized and chartered under the laws of another state, government, or country.

Health Insurance Portability and Accountability Act (HIPAA): A 1996 Federal law that restricts access to individuals' private medical information


Individualized Education Plan (IEP): A written document required for each child who is eligible to receive special education services. The plan provides information on the child's current levels of performance and directs the special services and supports that are to be provided to meet defined goals.

Individualized Family Service Plan (IFSP): A written document required for each child birth to years of age who is eligible to receive special education services. The plan is the management tool that identif ies fami ly based priorities and goals and directs the special services and supports that are to needed to meet them.

Individuals with Disabilities Education Act (IDEA): A four part (A-0) piece of American legislation that ensures students with a disability are provided with Free Appropriate Public Education (FAPE) that is tailored to their individual needs.

Installation Date: The date when the procedures described In "Installation by Contractor", and "Installation by State", as found in the RFP, or contract. are completed.

Late Bid/Proposal: An offer received after the Opening Date and Time.

Licensed Software Documentation: The user manuals and any other materials in any form or medium customarily provided by the Contractor to the users of the Licensed Software which will provide the State with sufficien1 information to operate, diagnose, and maintain the Licensed Software properly, safely, and efficiently.

Mandatory/Must: Required, compulsory, or obligatory.

May: Discretionary, permitted; used to express possibility.

Medicaid in Public Schools {MIPS): Public schools receive Medicaid funds for direct services provided to students at school.

Module (see System): A collection of routines and data structures that perform a specific function of software.

Must: See Shall/v'VilVMust.

National Institute for Governmental Purchasing (NIGP): National Institute of Governmental Purchasing - Source used for assignment of universal commodity codes to goods and services.

Nebraska Medicaid Administrati ve Claiming {NEBMAC): Medicaid offers reimbursement for the costs of administrative activities such as outreach which supports the Medicaid program

Open Market Purchase: Authorization rnay be given to an agency to purchase items above direct purchase authority due to the unique nature, price, quantity, location of the using agency, or time limitations by the AS Materiel Division, State Purchasing Bureau.

Opening Date and Time: Specified date and time for the public opening of received, labeled, and sealed formal proposals.

Operating System: The control program in a computer that provides the interface to the computer hardware and peripheral devices, and the usage and allocation of memory resources. processor resources, input/output resources, and securi ty resources.

Outsourcing: The contracting out of a business process which an organization may have previously performed internally or has a new need for, to an independent organization from which the process is purchased back.

Payroll & Financia l Center (PFC): Electronic procurement system of record.

Performance Bond: An insurance agreement, accompanied by a monetary commitment, by which a third party (the surety) accepts liability and guarantees that the Contractor fulfills any and all obligations under the contract.

Platform: A specific hardware and Operating System combination that ls different from other hardware and Operating System combinations to the extent that a different version of the Licensed Software product is required to execute properly in the environment established by such hardware and Operating System combination.

Pre-Bid/Pre-Proposal Conference: A meeting scheduled for the purpose of clarifying a written solicitation and related expectations.

Product: Something that is distributed commercially for use or consumption and that is usually (1) tangible personal property, (2) the result of fabrication or processing, and (3) an item that has passed through a chain of commercial

7 SPB RFP Revised: 01129/2016

distribution before ultimate use or consumption.

Program Error: Code in Licensed Software which produces unintended results or actions, or which produces results or actions other than those described in the specifications. A program error includes, without limitation, any Critical Program Error.

Program Set: The group of programs and products, including the Licensed Software specified in the RFP, plus any additional programs and products licensed by the State under the contract for use by the State.

Project: The total scheme, program, or method worked out for the accomplishment of an objective, including all documentation, commodities, and services to be provided under the contract.

Proposal: See Bid/Proposal.

Proprietary Information: Proprietary information is defined as trade secrets, academic and scientific research work which ls in progress and unpublished, and other infom,ation which if released would give advantage to business competitors and service no public purpose (see Neb. Rev. Stat.§ 84-712.05(3)). In accordance with Attorney General Opinions 92068 and 97033, proof that information is proprietary requires identification of specific named competitor(s) advantaged by release of the information and the demonstrated advantage the named competitor(s) would gain by the release of information.

Protest/Grievance: A complaint about a governmental action or decision related to a Request for Proposal or resultant contract, brought by a vendor who has timely submitted a bid response in connection with the award in question, lo AS Materiel Division or another designated agency with the intention of achieving a remedlal result.

Public Proposal Opening: The process of opening correctly submitted offers at the time and place specified in the written solicitation and in the presence of anyone who wished to attend.

Random Moment Time Study (RMTS): The RMTS method polls participants on an individual basis at random time intervals over a given time period and totals the results to determine work effort for the entire population of participating staff over that same period.

Recommended Hardware Configuration: The data processing hardware (including all terminals, auxiliary storage, communication, and other peripheral devices) to the extent utilized by the State as recommended by the Contractor.

Release Date: The date of public release of the written solicitation to seek offers

Renewal Period: Optional contract periods subsequent to the original Contract Period for a specified duration with previously agreed to terms and conditions. Not to be confused with Extension.

Request for Information (RFI): A general invitation to vendors requesting information for a potential future solicitation. The RFI is typically used as a research and information gathering 'tool for preparation of a solicitation.

Request for Proposal (RFP): A written solicitation utilized for obtaining competitive offers.

Responsible Bidder: A bidder who has the capability in all respects to perform fully and lawfully all requirements with integrity and reliability to assure good faith performance.

Responsive Bidder: A bidder who has submitted a bid which conforms to all requirements of the solicitation document.

School Based Service Provider: The providers located in the schools that carry out direct and Indirect services.

Shall/Will/Must: An order/command; mandatory.

Should: Expected; suggested, but not necessari ly mandatory.

Software License: Legal instrument with or without printed material that governs the use or redistribution of licensed software.

Sole Source - Commodity: When an item is available from only one source due to the unique nature of the requirement, its supplier. or market conditions.

Sole Source - Services: A service of such a unique nature that the vendor selected is clearly and justifiably the only practical source lo provide the service. Determination that the vendor selected is justifiably the sole source is based on either the uniqueness of the service or sole availability at the location required.


Specifications: The detailed statement, especially of the measurements, quality, materials, and functional characteristics, or other items to be provided under a contract.

System (see Module): Any collection or aggregation of two (2) or more Modules that is designed to function, or is represented by the Contractor as functioning or being capable of functioning, as an entity.

Termination: Occurs when either party, pursuant to a power created by agreement or law, puts an end to the contract prior to the stated expiration date. All obligations which are still executory on both sides are discharged but any right based on prior breach or performance survives.

Trade Secret: Information, including, but not limited to. a drawing, formula, pattern, compilation, program. device, method, technique. code. or process that (a) derives independent economic value. actual or potential, from not being known to, and not being ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use: and (b) is the subject of efforts that are reasonable under the circumstances to maintain its secrecy (see Neb. Rev. Stat. §87-502(4)).

Trademark: A word, phrase, logo. or other graphic symbol used by a manufacturer or vendor to distinguish its product from those of others, registered with the U.S. Patent and Trademark Office.

Upgrade: Any change that improves or alters the basic function of a product of service.

Vendor: An individual or entity lawfully conducting business in the State of Nebraska, or licensed to do so, who seeks to provide goods or services under the terms of a written solicitation.

Vendor Performance Report: A report issued to the Contractor by State Purchasing Bureau when products or services delivered or performed fail to meet the terms of the purchase order, contract, and/or specifications, as reported to State Purchasing Bureau by the agency. The State Purchasing Bureau shall contact the Contractor regarding any such report. The vendor performance report will become a part of the permanent record for the Contractor. The State may require vendor to cure. Two such reports may be cause for immediate termination.

Will: See Shall/Will/Must.

Work Day: See Business Day.


ACRONYM LIST

CMS - Centers for Medicare and Medicaid Services

CPE - Certified Public Expenditures

DHHS- Department of Health and Human Services

HIPAA - Health Insurance Portability and Accountability Act

IDEA - Individuals with Disabilities Education Act, PL 108-446 (amended by the Individuals with Disabilities Education Improvement Act of 2004)

IEP - Individual Education Plan

IFSP - Individualized Family Service Plan

MAC - Medicaid Administrative Claiming

MIPS - Medicaid in Public Schools

MMIS - Medicaid Management Information System

NEBMAC - Nebraska Education Based Medicaid Administrative Claiming

OIG - Office of Inspector General

RFP - Request for Proposal

RMTS - Random Moment Time Study

SFY - State Fiscal Year

SPA - State Plan Amendment

X Revised: 10/02/2013

I, SCOPE OF THE REQUEST FOR PROPOSAL

The State of Nebraska, Administrative Services (AS), Materiel Division, State Purchasing Bureau (hereafter known as State Purchasing Bureau), is issuing this Request for Proposal, RFP Number 553121 for the purpose of selecting a qualified Contractor to provide Medicaid school-based claiming by applying Random Moment Time Study (RMTS) methodology and cost settlement processes to support proper Medicaid reimbursement for both direct medical services and administrative activities. Any resulting contract is not an exclusive contract to furnish the services provided for in this Request for Proposal, and does not preclude the purchase of similar services from other sources.

A contract resulting from this Request for Proposal will be issued approximately for a period of three (3) years effective the date of award . The contract has the option to be renewed for two (2) additional one {1) year periods as mutually agreed upon by all parties. The State reserves the right to extend the period of this contract beyond the termination date when mutually agreeable to the Contractor and the State of Nebraska.

ALL INFORMATION PERTINENT TO THIS REQUEST FOR PROPOSAL CAN BE FOUND ON THE INTERNET AT: http.//das.nebraska.gov/materiel/purchasing.html

A. SCHEDULE OF EVENTS

1. 2. 3.

4.

5. 6 .

7. 8.

9. 10. 11. 12.

The State expects to adhere to the tentative procurement schedule shown below. It should be no1ed, however, that some dates are approximate and subject to change.

ACTIVITY DATE/TIME Release Request for Proposal February 3, 2017 Last day to submit written questions February 17, 2017

State responds to written questions tt,rough Request for Proposal "Addendum• and/or "Amendment" to be posted to the Internet at: February 27, 2017 htto·//das.nebraska.aov/materiel/ourchasina.html Proposal opening

March 10, 2017 Location: State Purchasing Bureau 2:00 PM

1526 K Street, Suite 130 Central Time

Lincoln, NE 68508 Review for conformance of mandatory requirements March 1 o, 2017

Evaluation period March 15, 2017 -April 14, 2017

·oral Interviews/Presentations and/or Demonstrations· (if required) TBD

Post "Letter of Intent to Contract" to Internet at: April 24. 201 7 J,ttn://das.nebraska.oov/materiel/ourchaslna.html

Contract finalization period April 24, 2017

Contract award May 22, 2017

Implementation June 1, 2017 Contractor start date October 1, 2017

Page 1 SPB RFP Revised: 01/29/2016

II, PROCUREMENT PROCEDURES

A. PROCURING OFFICE AND CONTACT PERSON Procurement responsibilities related to this Request for Proposal reside with the State Purchasing Bureau. The point of contact for the procurement is as follows:

Name: Agency: Address :

Telephone: Facsimile: E-Mail:

Michelle Thompsonfferesa Fleming State Purchasing Bureau 1526 K Street, Suite 130 Lincoln, NE 68508 402-4 71-6500 402-471-2089 [email protected]

B. GENERAL INFORMATION The Request for Proposal is designed to solicit proposals from qualified vendors who will be responsible for providing Medicaid school-based claiming by applying Randon Moment Time Study (RMTS) methodology and cost settlement processes to support proper Medicaid reimbursement for both direct medical services and administrative activities at a competitive and reasonable cost. Proposals that do not conform to the mandatory items as indicated in the Request for Proposal will not be considered.

Proposals shall conform to all instructions, conditions, and requirements included in the Request for Proposal. Prospective bidders are expected to carefully examine all documentation, schedules, and requirements stipulated in this Request for Proposal. and respond to each requirement in the format prescribed.

A fixed-price contract will be awarded as a result of this proposal. In addition to the provisions of this Request for Proposal and the awarded proposal, which shall be incorporated by reference in the contract. any additional clauses or provisions required by the terms and conditions wlll be included as an amendment to the contract.

C. CUSTOMER SERVICE In addition to any specified seNice requirements contained in this agreement, the Contractor agrees and understands that satisfactory customer service is required. Contractor will develop or provide technology and business procedures designed to enhance the level of customer satisfaction and to provide the customer appropriate information given their situation. Contractor, its employees, Subcontractors, and agents must be accountable, responsive, reliable, patient, and have well-developed communication skills as set forth by the customer service industry's best practices and processes.

D. COMMUNICATION WITH STATE STAFF ANO EVALUATORS From the date the Request for Proposal is issued until a determination is announced regarding the select.ion of the Contractor , contact regarding this project between potential Contractors and individuals employed by the State is restricted to only written communication with the staff designated above as the point of contact for this Request for Proposal. Bidders shall not have any communication with, or attempt to communicate with or influence in any way, any evaluator involved in this RFP .

Once a Contractor is preliminarily selected, as documented in the intent to contract, that Contractor is restricted from communicating with State staff until a contract is signed. Violation of this condition may be considered sufficient cause to reject a Contractor's proposal and/or selection irrespective of any other condition.

The following exceptions to these restrictions are permitted:

1. written communication with the person(s) designated as the point(s) of contact for this Request for Proposal or procurement;

2. contacts made pursuant to any pre-existing contracts or obligations; and 3. State-requested presentations, key personnel interviews, clarification sessions or discussions to finalize a

contract.

Violations of these conditions may be considered sufficient cause to reject a bidder's proposal and/or selection Irrespective of any other condition. No individual member of the State, employee of the State, or member of the Evaluation Committee is empowered to make binding statements regarding this Request for Proposal. The buyer will issue any clari fications or opinions regarding this Request for Proposal in writing.


E. WRITTEN QUESTIONS AND ANSWERS Any explanation desired by a bidder regarding the meaning or interpretation of any Request for Proposal provision must be submitted in writing to the State Purchasing Bureau and clearly marked "RFP Number 553121: Random Moment Time Study Questions· . It is preferred that questions be sent via e-mail to [email protected]. Questions may also be sent by facsimile to 402-471-2089, but must include a cover sheet clearly indicating that the transmission is to the attention of Michelle Thompsonrreresa Fleming, showing the total number of pages transmitted, and clearly marked ' RFP Number S531Z1; Random Momeni Time Study Questions".

rt is recommended that Bidders submit questions sequentially numbered, include the RFP reference and page number using the following format. ·

Question RFP Section RFP Page Question Number Reference Number

Written answers will be provided through an addendum to be posted on the Internet at http://das.nebraska.gov/materiel/purchasing.html on or before the date shown in the Schedule of Events.

F. ORAL INTERVIEWS/PRESENTATIONS AND/OR DEMONSTRATIONS The Evaluation Committee(s) may conclude after the completion of the Technical and Cost Proposal evaluation that oral interviews/presentations and/or demonstrations are required in order to determine the successful bidder. All bidders may not have an opportunity to interview/present and/or give demonstrations; the State reserves the right to select only the top scoring bidders to presenUgive oral interviews in its sole discretion . The scores from the oral interviews/presentations and/or demonstrations will be added to the scores from the Technical and Cost Proposals. The presentation process will allow the bidders to demonstrate their proposal offering, explaining and/or clarifying any unusual or significant elements related to their proposals. Bidders' key personnel may be requested to participate in a structured interview to determine their understanding of the requirements of this proposal, their authority and reporting relationships within their firm. and their management style and philosophy. Bidders shall not be allowed to alter or amend their proposals. Only representatives of the State and the presenting bidders will be permitted to attend the oral interviews/presentations and/or demonstrations.

Once the oral interviews/presentations and/or demonstrations have been completed the State reserves the right to make a contract award without any further discussion with the bidders regarding the proposals received.

Detailed notes of oral interviews/presentations and/or demonstrations may be recorded and supplemental information (such as briefing charts, et cetera) may be accepted; however, such supplemental information shall not be considered an amendment lo a bidders' proposal. Additional written information gathered In this manner shall not constitute replacement of proposal contents.

Any cost incidental to the oral interviews/presentations and/or demonstrations shall be borne entirely by the bidder and will not be compensated by the State.

G. SUBMISSION OF PROPOSALS The following describes the requirements related to proposal submission. proposal handling. and review by the State.

To facilitate the proposal evaluation process, one (1) original of the entire proposal must be submitted. Proposals must be submitted by the proposal due date and time. A separate sheet must be provided that clearly states which sections have been submitted as proprietary or have copyrighted materials. All proprietary information the bidder wishes the State to withhold must be submitted in accordance with the instructions outlined in Section Il l, Proprietary Information. Proposal responses should include the completed Form A. Bidder Contact Sheet. Proposals must reference the Request for Proposal number and be sent to the specified address. Please note that the address label should appear as specified in Section II part A on the face o f each container or bidder's bid response packet. Rejected late proposals will be returned to the bidder unopened, if requested, at bidder's expense. If a recipient phone number is required for delivery ptirposes. 402-471 -6500 should be used. The Request for Proposal number must be included in all correspondence.

Emphasis should be concentrated on conformance to the Request for Proposal instructions, responsiveness to requirements, completeness, and clarity of content. If the bidder's proposal is presented in such a fashion that makes evaluation difficult or overly time consuming, it is likely that the proposal will be rejected.

The Technical and Cost Proposals should be presented in separate sections (loose-leaf binders are preferred) on standard 8 Ya" x 11 • paper, except that charts. diagrams and the like may be on fold-outs which, when folded, fit into the 8 !-'2" by 11" format. Pages may be consecutively numbered for the entire proposal, or may be numbered


consecutively within sections. Figures and tables must be numbered consecutively within sections. Figures and tables must be numbered and referenced in the text by that number. They should be placed as close as possible to the referencing text.

H. PROPOSAL OPENING The sealed p roposals will be publicly opened and the bidding entities announced on the date. time, and location shown in the Schedule of Events. Proposals will be available for viewing by those present at the proposal opening. Vendors may also contact the State to schedule an appointment for viewing proposals after the Intent to Award has been posted to the website.

I. LATE PROPOSALS Proposals received after the time and date of the proposal opening will be considered late proposals. Rejected late proposals will be returned to the bidder unopened, if requested, at bidder's expense. The State is not responsible for proposals that are late or lost due to mail service inadequacies. traffic , or any other reason(s).

J. REJECTION OF PROPOSALS The State reserves the right to reject any or all proposals, wholly or in part, or to award to multiple bidders in whole or in part. The State reserves the right to waive any deviations or errors that are not material, do not invalidate the legitimacy of the proposal and do not improve the bidder's competitive position. All awards will be made in a manner deemed in the best interest of the State.

K. EVALUATION OF PROPOSALS All proposals that are responsive to the Request for Proposal will be evaluated. Each category will have a maximum possible point potential. The State will conduct a fair, impartial , and comprehensive evaluation of all responsive proposals in accordance with the criteria set forth below. The State may elect to use a third-party to conduct credit checks as part of the corporate overview evaluation. Areas that will be addressed and scored during the evaluation include:

1. Corporate Overview should include but is not limited to: a. the abil ity, capacity, and skill of the bidder to deliver and implement the system or project that

meets the requirements of the Request for Proposal ; b. the character, integrity, reputation, judgment. experience, and efficiency of the bidder; c. whether the bidder can perform the contract within the specified time frame; d. the quality of bidder performance on prior contracts: e. such other information that may be secured and that has a bearing on the decision to award the

contract; 2. Technical Approach; and 3 . Cost Proposal.

Neb. Rev. Stat.§ 73-107 allows for a preference for a resident disabled veteran or business located in a designated enterprise zone. When a state contract is to be awarded to the lowest responsible bidder, a resident disabled veteran or a business located in a designated enterprise zone under the Enterprise Zone Act shall be allowed a preference over any other resident or nonresident bidder, if all other factors are equal.

Resident disabled veterans means any person (a) who resides in the State of Nebraska, who served in the United States Armed Forces. including any reserve component or the National Guard, who was discharged or otherwise separated with a characterization of honorable or general (under honorable conditions), and who possesses a disability rating letter issued by the United States Department of Veterans Affairs establishing a service-connected disability or a disability determination from the United States Department of Defense and (b)(i) who owns and controls a business or, in the case of a publicly owned business, more than fifty percent of the stock is owned by one or more persons described in subdivision (a) of this subsection and (ii) the management and daily business operations of the business are controlled by one or more persons described in subdivlsion(a) of this subsection. Any contract entered into without compliance with this section shall be null and void.

Therefore, if a resident disabled veteran or business located in a designated enterprise zone submits a bid in accordance with Neb. Rev. Stat. § 73-107 and has so indicated on the RFP cover page under "Bidder must complete the following" requesting priority/preference to be conside1red in the award of this contract. the following will need to be submitted by the vendor within ten (10) business days of request:

1. Documentation from the United States Armed Forces confirming service; 2. Documentation of discharge or otherwise separated characterization of honorable or general (under

honorable conditions); 3. Disability rating letter issued by the United States Department of Veterans Affairs establishing a service

connected disability or a disability determination from the United States Department of Defense; and


4 . Documentation which shows ownership and control of a business or, in the case of a publicly owned business, more than fifty percent of the stock is owned by one or more persons described in subdivision (a) of this subsection; and the management and daily business operations of the business are controlled by one or more persons described in subdivision (a) of this subsection.

Failure to submit the requested documentation within ten (10) business days of notice will disqualify the bidder from consideration of the preference.

Evaluation criteria weighting will be released with the Request for Proposal. Evaluation criteria weighting and a list of respondents will be posted to the State Purchasing Bureau website at: http://das.nebraska.gov/materiel/purchasing.html

L. EVALUATION COMMITTEE Proposals will be independently evaluated by members of the Evaluation Committee(s) . The Evaluation Committee(s) will consist of staff with the appropriate expertise to conduct such proposal evaluations. Names of the members of the Evaluation Commillee(s) will not be published.

Prior to award. bidders are advised that only the point of contact indicated on the front cover of this Request for Proposal For Contractual Services Form can clarify issues or render any opinion regarding this Request for Proposal. No individual member of the Stale, employee of the State, or member of the Evaluation Committee(s) is empowered to make binding statements regarding this Request for Proposal.

Any contact, or attempted contact, with an evaluator that is involved with this RFP may result in the rejection of this proposal and further administrative actions may be taken.

M. MANDATORY REQUIREMENTS The proposals will first be examined to determine if all mandatory requirements listed below have been addressed to warrant further evaluation. Proposals not meeting mandatory requirements will be excluded from further evaluation, The mandatory requirement items are as follows:

1. Request for Proposal For Contractual Services form, signed in ink; 2. Corporate Overview; 3. Completed Section Ill; 4. Technical Approach; and 5. Cost Proposal.

N. REFERENCE CHECKS The State reserves the right to check any reference(s), regardless of the source of the reference information, including but not limited to, those that are identified by the company in the proposal, those indicated through the explicitly specified contacts, those that are identified during the review of the proposal, or those that result from communication with other entities involved with similar projects. The State may use a third-party to conduct reference checks.

Information to be requested and evaluated from references may include, but is not limited to, some or all of the following: financial stability of the company, project description and background, job performed, functional and 1echnical abilities, communication skil ls and timeliness, cost and schedule estimates and al':curacy, problems (poor quality deliverables, contract disputes, work stoppages, et cetera), overall performance, and whether or not 1he reference would rehire the firm or individual. Only top scoring bidders may receive reference checks, and negative references may eliminate bidders from consideration for award.

O. SECRETARY OF STATE/TAX COMMISSIONER REGISTRATION REQUIREMENTS All bidders should be authorized to transact business in the State of Nebraska. All bidders are expected to comply with all Nebraska Secretary of State Registration requirements. It is the responsibility of the bidder to comply with any registration requirements pertaining to types of business entities (e.g. person , partnership, foreign or domestic limited liability company, association. or foreign or domestic corporation or other type of business entity). The bidder who is the recipient of an Intent to Award will be required to certify that it has so complied and produce a true and exact copy of its currenl (within ninety (90) calendar days). valid Certificate of Good Standing or Letter of Good Standing: or in the case of a sole proprietorship, provide written documentation of sole proprietorship. This must be accomplished prior to the award of the contract. Construction Contractors are expected to meet all applicable requirements of the Nebraska Contractor Registration Act and provide a current, valid certificate of registration . Further, a ll bidders shall comply with any and all other applicable Nebraska statutes regarding transacting business in the State of Nebraska. Bidders should submit the above certification(s) with their bid.

Pages SPB RFP Revised: 01/29/2016

If a bank is registered with the Office of Comptroller of Currency, it is not required to register with the State. However, the Office of Comptroller of Currency does have a certificate of good stand ing/registration. The bank could provide that for verification. (Optional)

P. VIOLATION OF TERMS AND CONDITIONS Violation of the terms and conditions contained in this Request for Proposal or any resultant contract, at any time before or after the award. shall be grounds for action by the State Which may include, but is not limited to, the following:

1. Rejection of a bidder's proposal; 2. Withdrawal of the Intent to Award 3. Termination of the resulting contract. 4. Legal action. 5. Suspension of the bidder from furtt1er bidding with the State for the period of time relative to the

seriollsness of the violation, such period to be within the sole discretion of the State.


Ill. TERMS AND CONDITIONS

By signing the "Request for Proposal for Contractual Services" form, the bidder guarantees compliance with the provisions stated in this Request for Proposal, agrees to the Terms and Conditions unless otherwise agreed to, and certifies bidder maintains a drug free work place environment.

Bidders are expected to closely read the Terms and Conditions and provide a binding signature of intent to comply with the Terms and Conditions; provided, however, a bidder may indicate any exceptions to the Terms and Conditions by (1) clearly identifying the term or condition by subsection, and (2) including an explanation for the bidder's inability to comply with such term or condition which includes a statement recommending terms and conditions the bidder would find acceptable. Rejection in whole or in part of the Terms and Conditions may be cause for rejection of a bidder's proposal. Bidders must include completed Section Ill with their proposal response.

The State of Nebraska is soliciling bids in response to the RFP. The State of Nebraska will not consider proposals that propose the substitution of the bidder's contract, agreements, or terms for those of the State of Nebraska's. Any License, Service Agreement, Customer Agreement, User Agreement, Bidder Terms and Conditions, Document. or Clause purported or offered to be included as a part of this RFP must be submitted as individual clauses, as either a counter-offer or additional language, and each clause must be acknowledged and accepted in writing by the State. If the Bidder's clause is later found to be in conflict with the RFP or resulting contract the Bidder's clause shall be subordinate to the RFP or resulting contract.

A, GENERAL

Accept (Initial)

~

Reject Reject & Provide NOTES/COMMENTS: (Initial) Alternative within

RFP Response (Initial)

The contract resu!ting from this Request for Proposal shall incorporate the following documents :

1. Amendment to Contract Award with the most recent dated amendment having the highest priority; 2. Contract Award and any attached Addenda; 3. The Request for Proposal form and the Contractor's Proposal , signed in ink 4. Amendments lo RFP and any Questions and Answers; and 5. The original RFP document and any Addenda.

These documents constitute the entirety of the contract.

Unless otherwise specifically stated in a contract amendment, in case of any conflict between the Incorporated documents, the documents shall govern in the following order of preference with number one (1) receiving preference over all other documents and with each lower numbered document having preference over any higher numbered document: 1) Amendment to Contract Award with the most recent dated amendment having the highest priority, 2) Contract Award and any attached Addenda, 3) the signed Request for Proposal form and the Contractor's Proposal, 4) Amendments to RFP and any Questions and Answers, 5) the original RFP document and any Addenda.

Any ambiguity in any provision of this contract which shall be discovered after its execution shall be resolved in accordance with the rules of contract interpretation as est~1bl ished in the State of Nebraska.

Once proposals are opened they become the property of the State of Nebraska and will not be returned.


B. AWARD

Accept (Initial)

~ '

Reject Reject & Provide NOTES/COMMENTS: {Initial) Alternative within


All purchases. leases, or contracts which are based on competitive proposals will be awarded according to the provisions in the Request ror Proposal. The State reseNes the right to reject any or all proposals, in whole or in part, or lo award to multiple bidders in whole or in part, and at its discretion, may withdraw or amend the Request for Proposal at any time, The State reserves the right to waive any deviations or errors that are not material, do not invalidate the legitimacy of the proposal, and do not improve the bidder's competitive position, All awards will be made in a manner deemed in the best interest of the State. The Request for Proposal does not commit the State to award a contract. If, in the opinion of the State, revisions or amendments will require substantive changes in proposals, the due date may be extended.

By submitting a proposal in response to this Request for Proposal, the bidder grants to the Stale the right to contact or arrange a visit in person with any or all or the bidder's clients.

Once intent to award decision has been determined, it will be posted to the Internet at: http://das.nebraska.gov/materiel/purchasing.html

Grievance and protest procedure is available on the Internet at: http://das.nebraska.gov/rnateriel/purchase bureau/docs/vendors/protest/ProtestGrievanceProcedureForVendors%2 0(2).pdr

Any protests must be filed by a vendor within ten (10) business days after the intent to award decision is posted to the Internet

C. COMPLIANCE WITH CIVIL RIGHTS LAWS AND EQUAL OPPORTUNITY EMPLOYMENT/ NONDISCRIMINATION

Accept (Initial)

V:5



The Contractor shall comply with all applicable local, stale, and federal statutes and regulations regarding civil rights laws and equal opportunity employment. The Nebraska Fair Employment Practice Act prohibits Contractors of the State of Nebraska, and their Subcontractors, from discriminating against any employee or applicant for employment, with respect to hire. tenure. terms, conditions, compensation, or privileges of employment because of race, color, religion. sex, disability, marital status. or national origin (Neb. Rev. Stat.§§ 48-1101 to 48-1 125). The Contractor guarantees compliance with the Nebraska Fair Employment Practice Act, and breach of this provision shall be regarded as a material breach or contract. The Contractor shall insert a similar provision in all Subcontracts ror seNices to be covered by any contract resulting from this Request for Proposal.


D. PERMITS, REGULATIONS, LAWS

Accept Reject Reject & Provide NOTES/COMMENTS: (Initial)

~7

(Initial) Alternative within RFP Response (Initial)

The Contractor shall procure and pay for all permits, licenses. and approvals necessary for the execution of the contract. The Contractor shall comply with all applicable local, state. and federal laws, ordinances, rules, orders, and regulations.

E. OWNERSHIP OF INFORMATION ANO DATA

Accept Reject Reject & Provide NOTES/COMMENTS: (Initial) (Initial) Alternative within


V? The State of Nebraska shall have the unlimited right to publish, duplicate, use, and disclose all Information and data developed or derived by the Contractor pursuant to this contract.

The Contractor must guarantee that it has the full legal right to the materials, supplies, equipment. and other rights or lilies (e.g. rights to licenses transfer or assign deliverables) necessary to execute this contract. The contract price shall, without exception, include compensation for all royalties and costs arising from patents, trademarks. and copyrights that are in any way involved in the contract. It shall be the responsibility of the Contractor to pay for all royalties and costs, and the State must be held harmless from any such claims.

F. INSURANCE REQUIREMENTS



~ V-//

The Contractor shall not commence work under this contract until all the insurance required hereunder has been obtained and such insurance has been approved by the State. The Contractor shall maintain all required insurance for the life of this contract and shall ensure that the State Purchasing Bureau has the most current certificate of insL1rance ll1roughout the life of this contract. If Contractor will be utilizing any Subcontractors, the Contractor is responsible for obtaining the certificate(s) of insurance required herein Linder from any and all Subcontractor(s). The Contractor is also responsible for ensuring Subcontractor(s) maintain the lnsurance required until completion of the contract requirements . The Contractor shall not allow any Subcontractor to commence work on any Subcontract until all similar insurance required of the Subcontractor has been obtained and approved by the Contractor. Approval of the insurance by the State shall not limit, relieve, or decrease the liability of the Contractor hereunder.

If by the terms of any insurance a mandatory deductible is required, or if the Contractor elects to increase the mandatory deductible amount, the Contractor shall be responsible for payment of the amount of the deductible in the event of a paid claim.

Insurance coverages shall function independent of all other clauses in the contract, and in no instance shall the limits of recovery from the insurance be reduced below the limits required by this section.

1. WORKERS' COMPENSATION INSURANCE The Contractor shall take out and maintain during the life of this contract the statutory Workers' Compensation and Employer's Liability Insurance for all of the contadors' employees to be engaged in work

Page 9 $PB RFP Revised: 01/29/2016

on the project under this contract and, in case any such work is sublet, the Contractor shall require the Subcontractor similarly to provide Worker's Compensation and Employer's Liability Insurance for all of the Subcontractor's employees to be engaged in such work. This policy shall be written lo meet the statutory requirements for the state in which the work is to be peirformed, including Occupalional Disease. This policy shall include a waiver of subrogation in favor of the State. The amounts of such insurance shall not be less than the limits stated hereinafter.

2. COMMERCIAL GENERAL LIABILITY INSURANCE AND COMMERCIAL AUTOMOBILE LIABILITY INSURANCE The Contractor shall take out and maintain during the life of this contract such Commercial General Liability Insurance and Commercial Automobile Liability Insurance as shall protect Contractor and any Subcontractor performing work covered by this contract from claims for damages for bodily injury, including death, as well as from claims for property damage, which may arise from operations under this contract, whether such operation be by the Contractor or by any Subcontractor or by anyone directly or indirectly employed by either of them, and the amounts of such insurance shall not be less than limits stated hereinafter.

The Commercial General Liabiiily Insurance shall be written on an occurrence basis, and provide Premises/Operations. Products/Completed Operations. Independent Contractors, Personal Injury, and Contractual Liability coverage. The policy shall include the State, and others as required by the contract documents, as Additional lnsured(s). This policy shall be primary, and any insurance or self-insurance carried by the State shall be considered excess and non-contributory. The Commercial Automobile Liability Insurance shall be written to cover all Owned. Non-owned, and Hired vehicles.

3. INSURANCE COVERAGE AM OUNTS REQUIRED

COMMERCIAL GENERAL LIABILITY General Aaareqate $2,000,000 Products/Comoleted Ooerations Aaareqate $2,000,000 Personal/Advertising Injury $1 ,000,000 per occurrence Bodily Injury/Property DamaQe $1,000,000 per occurrence Medical Pavments $10,000 any one person DamaQe to Rented Prernises $300,000 each occurrence Contractual Included XCU Liability (Explosion, Collapse, and Underground Included DamaQe) Independent Contractors Included Abuse & Molestation Included If higher limits are required, the Umbrella/Excess Liabllitv limits are allowed to satisfy the hiaher limit. WORKER'S COMPENSATION Employers Liability Limits $500K/$500K/$500K Statutorv Limits- All States Statutory - State of Nebraska USL&H Endorsement Statutory Voluntarv Compensation Statutory COMMERCIAL AUTOMOBILE LIABILITY Bodily lnjurv/Property Damage $1 ,000,000 combined sinQle limit Include All Owned, Hired & Non-Owned Automobile Included liability Motor Carrier Act Endorsement Where APPiicabie UMBRELLA/EXCESS LIABILITY Over Primary Insurance $5,000,000 COMMERCIAL CRIME Crime/Emplovee Dishonesty lncludinq 310 Party Fidelity $1,000,000 CYBER LIABILITY Breach of Privacy, Security Breach. Denial of Service, $10,000,000 Remediation, Fines and Penalties SUBROGATION WAIVER 'W orkers' Compensation policy shall include a waiver of subroQation in favor of the State of Nebraska." LIABILITY WAIVER ··commercial General Liability & Commercial Automobile Liability policies shall be primary and any insurance or self-insurance carried by the State shall be considered excess and non-contributory as additional insured."

Page10 SPB RFP Revised: 01/29/2016

4. EVIDENCE OF COVERAGE The Contractor should furnish the State, with their proposal response, a certificate of insurance coverage complying with the above requirements to the attention of the Buyer at 402-4 71-2089 (fax)

Administrative Services State Purchasing Bureau 1526 K Street, Suite 130 Lincoln, NE 68508

These certificates or the cover sheet shall reference the RFP number, and the certificates shall include the name of the company, policy numbers, effective dates, dates of expiration , and amounts and types of coverage afforded. If the State is damaged by the failure of the Contractor to maintain such insurance, then the Contractor shall be responsible for all reasonable costs properly attributable thereto.

Notice of cancellation of any required insurance policy must be submitted to Administrative Services State Purchasing Bureau when issued and a new coverage binder shall be submitted immediately to ensure no break in coverage.

G. COOPERATION WITH OTHER CONTRACTORS

Accept (Initial)

17



The State may already have in place or choose to award supplemental contracts for work related to this Request for Proposal, or any portion thereof.

1. The State reserves the right to award the contract jointly between two or more potential Contractors, if such an arrangement is in the best interest of the State.

2. The Contractor shall agree to cooperate with such other Contractors, and shall not commit or permit any act which may interfere with the performance of work by any other Contractor.

H. INDEPENDENT CONTRACTOR

Accept (Initial)

~/ /

Reject Reject & Provide NOTES/COMMENTS: {Initial) Alternative within


It ls agreed that nothing contained herein is intended or should be construed In any manner as creating or establishing the relationship of partners between the parties hereto. The Contractor represents that it has, or will secure at its own expense, all personnel required to perform the services under the contract. The Contractor's employees and other persons engaged in work or services required by the contractor under the contract shall have no contractual relationship with the State; they shall not be considered employees of the State.

All claims on behalf of any person arising out of employment or alleged employment (including without limit claims of discrimination against the Contractor, its officers, or lts agents) shall In no way be the responsibility of the State. The Contractor will hold the State harmless from any and all such claims. Such personnel or other persons shall not require nor be entitled to any compensation, rights, or benefits from the Stale including without limit, tenure rights, medical and hospital care, sick and vacation leave, severance pay, or retirement benefits.


I. CONTRACTOR RESPONSIBILITY

Accept (Initial)

~



The Contractor is solely responsible for fulfilling the contract. with responsibility for all services offered and products to be delivered as stated in the Request for Proposal, the Contractor's proposal, and the resulting contract. The Contractor shall be the sole point of contact regarding all contractual matters.

If the Contractor intends to utilize any Subcontractor's services. the Subcontractor's level of effort, tasks, and time allocation must be clearly defined in the Contractor's proposal. The Contractor shall agree that it will not utilize any Subcontractors not specifically included in its proposal in the performance of the contract without the prior wri tten authorization of the State. Following execution of the contract, the Contractor shall proceed diligently with all services and shall perform such services with qualified personnel in accordance with the contract.

J. CONTRACTOR PERSONNEL



77 ~

The Contractor warrants that all persons assigned to the project shall be employees of the Contractor or specified Subcontractors, and shall be fully qualified to perform the work required herein. Personnel employed by the Contractor to fulfill the terms of the contract shall remain under the sole direction and control of the Contractor. The Contractor shall include a similar provision in any contract with any Subcontractor selected to perform work on the project.

Personnel commitments made in the Contractor's proposal shall not be changed without the prior written approval of the State. Replacement of key personnel, if approved by the State, shall be with personnel of equal or greater ability and qualifications.

The State reserves the right to require the Contractor to reassign or remove from the project any Contractor or Subcontractor employee.

In respect to its employees. the Contractor agrees to be responsible for the following:

1. any and all employment taxes and/or other payroll withholding; 2. any and all vehicles used by the Contractor's employees, including all insurance required by state law; 3. damages incurred by Contractor's employees within the scope of their duties under the contract; 4 . maintaining workers' compensation and health insurance and submitting any reports on such insurance to

the extent required by governin·g State law; and 5. determining the hours to be worked and the duties to be performed by the Contractor's employees.

K. CONTRACT CONFLICTS

Accept (Initial)

~D



Contractor shall insure that contracts or agreements with sub-contractors and agents, and the performance of services in relation to this contract by sub-contractors and agents, does not conflict with this contract.

Page 12 SPB RFP Revised: 01/29/201 6

L, STATE OF NEBRASKA PERSONNEL RECRUITMENT PROHIBITION



,rt:> The Contractor shall not, at any lime, recruit or employ any State employee or agent who has worked on the Request for Proposal or project. or who had any influence on decisions affecting the Request for Proposal or project.

M. CONFLICT OF INTEREST



-~ By submitting a proposal, bidder certifies that there does not now exist any relationship between the bidder and any person or entity which is or gives the appearance of a conflict of interest related to this Request for Proposal or project.

The bidder certifies that it shall not take any action or acquire any interest, either directly or indirectly, which will conflict in any manner or degree with the performance of its services hereunder or which creates an actual or appearance of conflict of interest.

The bidder certifies that it will not employ any individual known by bidder to have a conflict of interest.

N. PROPOSAL PREPARATION COSTS



47 The State shall not incur any liability for any costs incurred by bidders in replying to this Request for Proposal. in the demonstrations and/or oral presentations, or in any other activity related to bidding on this Request for Proposal.

O. ERRORS AND OMISSIONS


RFP Response (Initial )

4 The bidder shall not take advantage of any errors and/or omissions in this Request for Proposal or resulting contract. The bidder must promptly notify the State of any errors and/or omissions that are discovered.


P. BEGINNING OF WORK


RFP Response (Initial}

~~ The bidder shall not commence any billable work until a valid contract has been fully executed by the State and the successful Contractor. The Contractor will be notified in writing when work rnay begin.

Q , ASSIGNMENT BY THE STATE



~~? The State shall have the right to assign or transfer the contract or any of its interests herein to any agency, board, commission, or political subdivision of the State of Nebraska. There shall be no charge to the State for any assignment hereunder.

R. ASSIGNMENT BY THE CONTRACTOR



~~ The Contractor may not assign. voluntarily or involuntarily, the contract or any of its rights or obligations hereunder (including without limitation rights and duties of performance) to any third party, without the prior written consent of the State, which will not be unreasonably withheld.

S. DEVIATIONS FROM THE REQUEST FOR PROPOSAL



~4 The requirements contained in the Request for Proposal become a part of the terms and conditions of the contract resulting from this Request for Proposal. Any deviations from the Request for Proposal must be clearly defined by the bidder in its proposal and, if accepted by the State, will become part of the contract. Any specifically defined deviations must not be in conflict with the basic nature of the Request for Proposal, mandatory requirements, or applicable state or federc1l laws or statutes . ''Deviation", for the purposes of this RFP, means any proposed changes or alterations to either the contractual language or deliverables within the scope of this RFP. The State discourages deviations and reserves the right to reject proposed deviations.


T. GOVERNING LAW



~~ The contract shall be r:1overned in all respects by the laws and statutes of the State of Nebraska. Any legal proceedings against the State of Nebraska regarding this Request for Proposal or any resultant contract shall be brought in the State of Nebraska administrative or judicial forums as defined by State law. The Contractor must be in compliance with all Nebraska statutory and regulatory law.

U. ATTORNEY'S FEES

Accept (Initial)

-~7



In the event of any litigation, appeal, or other legal action to enforce any provision of the contract, the Contractor agrees to pay all expenses of such action, as permitted by law, including attorney's fees and costs, if the State is the prevailing party.

V. ADVERTISING



~7 The Contractor agrees not to refer to the contract award in advertising in such a manner as to state or imply that the company or its services are endorsed or preferred by the State. News releases pertaining to the project shall not be issued without prior written approval from the State.

W. STATE PROPERTY



# The Contractor shall be responsible for the proper care and custody of any State-owned property which Is furnished for the Contractor's use during the performance of the contract The Contractor shall re imburse the State for any loss or darnage of such property; normal wear and tear is expected.


X. SITE RULES AND REGULATIONS

Accept Reject Reject & Provide NOTES/COMMENTS: (Initial) (lnltial) Alternative within


~ The Contractor shall use its best efforts to ensure that its employees, agents , and Subcontractors comply with site rules and regulations while on State premises. If the Contractor must perform on-site work outside of the daily operational hours set forth by the State. it must make arrangements with the State to ensure access to the facility and the equipment has been arranged. No additional payment will be made by the State on the basis of lack of access, unless the State fails to provide access as agreed to between the State and the Contractor.

Y . NOTIFICATION

Accept Reject Reject & Provide NOTESICOMMENTS: (Initial) (Initial) Alternative within

RFP Response {Initial)

~ During the bid process, all communication between the State and a bidder shall be between the bidder's representative clearly noted in its proposal and the buyer noted in Section II.A. Procuring Office and Contact Person, of this RFP. After the award of the contract. all notices under the contract shall be deemed duly given upon delivery to the staff designated as the point of contact for this Request for Proposal, in person, or upon delivery by U.S. Mail, facsimile, or e-mail. Each bidder should provide in its proposal the name, title, and complete address of its designee to receive notices.

1. Except as otherwise expressly specified herein. all notices, requests. or other communications shall be in writing and shall be deemed to have been given if delivered personally or mailed, by U.S. Mail, postage prepaid, return receipt requested, to the parties at their respective addresses set forth above, or at such other addresses as may be speclfled in writing by either of the parties. All notices, requests, or communications shall be deemed effective upon personal delivery or three (3) calendar days following deposit in the mail.

2. Whenever the Contractor encounters any difficulty which is delaying or threatens to delay Its timely performance under the contract, the Contractor shall immediately give notice thereof in writing to the State reciting all relevant information with respect thereto. Such notice shall not in any way constitute a basis for an extension of the delivery schedule or be construed as a waiver by the State of any of its rights or remedies to which it is entitled by law or equity or pursuant to the provisions of the contract. Failure to give such notice, however, may be grounds for denial of any request for an extension of the delivery schedule because of such delay.

Either party may change its address for notification purposes by giving notice of the change, and setting forth the new address and an effective date.

For the duration of the contract, all communication between Contractor and the State regarding the contract shall take place between the Contractor and individuals specified by the State in writing. Communication about the contract between Contractor and individuals not designated as points of contact by the State is strictly forbidden.


Z. EARLY TERMINATION



.//5 The contract may be terminated as follows: 1. The State and the Contractor. by mutual written agreement. may terminate the contract at any time.

2. The State, in its sole discretion, may terminate the contract for any reason upon thirty (30) calendar day's written notice to the Contractor. Such termination shall not relieve the Contractor of warranty or other service obligations incurred under the terms of the contract. In the event of termination the Contractor shall be entitled to payment, determined on a pro rate basis, for products or services satisfactorily performed or provided .

3. The Slate may termlnate the contract immediately for the following reasons:

a. if directed to do so by statute; b. Contractor has made an assignment for the benefit of creditors, has admitted In writing its inability

to pay debts as they mature, or has ceased operating 1n the normal course of business; c. a trustee or receiver of the Contractor or of any substantial part of the Contractor's assets has

been appointed by a court; d. fraud, misappropriation, embezzlement, malfeasance, mfsfeasance, or illegal conduct pertaining

to performance under the contract by fts Contractor, its employees, officers, directors. or shareholders;

e. an involuntary proceeding has been commenced by any party against the Contractor under any one of the chapters of Title 11 of the United States Code and (i) the proceeding has been pending for at least sixty (60) calendar days; or (ii} the Contractor has consented, either expressly or by operation of law, to the entry of an order for relief; or (iii) the Contractor has been decreed or adjudged a debtor;

f. a voluntary petition has been filed by the Contractor under any of the chapters of Tille 11 of the United States Code;

g. Contractor intentionally discloses confidential information; h. Contractor has or announces it will discontinue support of the deliverable; i. second or subsequent documented "vendor performance report'' form deemed acceptable by the

State Purchasing Bureau; or j. Contractor engaged in collusion or actions which could have provided Contractor an unfair

advantage in obtaining this contract.

AA. FUNDING OUT CLAUSE OR LOSS OF APPROPRIATIONS

Accept (Initial)

~~



The State may terminate the contract, in whole or in part, in the event funding is no longer available. The State's obligation to pay amounts due for fiscal years following the current fiscal year is contingent upon legislative appropriation of funds for the contract. Should said funds not be appropriated, the State may terminate the contract with respect to those payments for the fiscal years for which such funds are not appropriated. The State will give the Contractor written notice thirty (30) calendar days prior to the effective date of any termination, and advise lhe Contractor of the location (address and room number) of any related equipment. All obligations of the State to make payments after the termination date will cease and all interest of the State in any related equipment will terminate. The Contractor shall be entitled to receive just and equitable compensation for any authorized work which has been satisfactorily completed as of the termination date. In no event shall the Contractor be paid for a loss of anticipated profit.


BB. BREACH BY CONTRACTOR

Accept Reject Reject & Provide NOTES/COMMENTS: (Initial) (Initia l) Alternative within


.~ The Stale may terminate the contract, in whole or in part. if the Contractor fails to perform its obligations under the contract in a timely and proper manner. The State may, by providing a written notice of default to the Contractor. allow the Contractor to cure a failure or breach of contract within a period of thirty (30) calendar days (or longer at State's discretion considering the gravity and nature of the default). Said notice shall be delivered by Certified Mail, Return Receipt Requested. or in person with proof of delivery. Allowing the Contractor time to cure a failure or breach of contract does not waive the State's right to immediately terminate the contract for the same or different contract breach which may occur at a different time. In case of d~?fault of the Contractor, the State may contract the service from other sources and hold the Contractor responsible for any excess cost occasioned thereby.

CC. ASSURANCES BEFORE BREACH



~5 If any document or deliverable required pursuant to the contract does not fulfill the requirements of the Request for Proposal/resulting contract. upon written notice from the State, the Contractor shall deliver assurances in the form of additional Contractor resources at no additional cost to the project in order to complete the deliverable, and to ensure that other project schedules will not be adversely affected.

DD. ADMINISTRATION - CONTRACT TERM INATION



~~7 1. Contractor must provide confirmation that upon contract termination all deliverables prepared in

accordance with this agreement shall become the property of the State of Nebraska; subject to the ownership provision (section E) contained herein, and is provided to the State of Nebraska at no additional cost to the State.

2. Contractor must provide confirmation that in the event of contract termination, all records that are the property of the State will be returned to the State within thirty (30) calendar days. Notwithstanding the above, Contractor may retain one copy of any information as required to comply with applicable work product documentation standards or as are automatically retained in the course of Contractor's routine back up procedures.

Page18 SPB RFP Revised: 01129/2016

EE. PENALTY



.,, ~ See Attachment 1, Deliverables/Penalties.

F~ PERFORMANCE BONO



-~

/

The Contractor will be required to supply a bond executed by a corporation authorized to contract surety in the State of Nebraska, payable to the State of Nebraska, which shall be valid for the life of the contract to include any renewal and/or extension periods. The amount of the bond must be $2,000,000.00. The bond will guarantee that the Contractor will faithfully perform a ll requirements, tenns and conditions of the contract. Failure to comply shall be grounds for forfeiture of the bond as liquidated damages. Amount of forfeiture will be determined by the agency based on loss to the State. The bond will be returned when the service has been satisfactorily completed as solely determined by the State, after termination or expiration of the contract.

GG. FORCE MAJEURE

Accept (Initial)

Reject {Initial)

Reject & Provide Alternative within RFP Response Initial)

NOTES/COMMENTS:

Neither party shall be liable for any costs or damages resulting from its inability to perform any of its obligations under the contract due to a natural disaster. or other similar event outside the control and not the fault of the affected party ("Force Majeure Event"). A Force Majeure Event shall not constitute a breach of the contract. The party so affected shall immediately give notice to the other party of the Force Majeure Event. The State may grant relief from performance of the contract if the Contractor is prevented from performance by a Force Majeure Event. The burden of proof for the need for such relief shall rest upon the Contractor. To obtain release based on a Force Majeure Event, the Contractor shall file a written request for such relief with the State Purchasing Bureau. Labor disputes with the impacted party's own employees will not be considered a Force Majeure Event and will not suspend performance requirements under the contract.

HH. PROHIBITION AGAINST ADVANCE PAYMENT

Accept Reject Reject & Provide NOTES/COMMENTS: (Initial) {Initial) Alternative within


// Payments shall not be made until contractual deliverabie(s) are received and accepted by the State.

Page19 SPB RFP Revised; 01/29/2016

II. PAYMENT

Accept (Initial)

Reject (Initial )

Reject & Provide NOTES/COMMENTS: Alternative w ithin RFP Response (Initial)

State will render payment to Contractor when the terms and conditions of the contract and specifications have been satisfactorily completed on the part of the Contractor as solely determined by the State. Payment will be made by the responsible agency in compliance with the State of Nebraska Prompt Payment Act (See Neb. Rev. Stat. §§ 81 -2401 through 81-2408}. The State may require the Contractor to accept payment by electronic means such as ACH deposit. In no event shall the State be responsible or liable to pay for any services provided by the Contractor prior to the Effective Date, and the Contractor hereby waives any claim or cause of action for any such services.

JJ, INVOICES



-fY Invoices for payments must be submitted by the Contractor to the agency requesting the services with sufficient detail to support payment. Invoices should be submitted to DHHS Medicaid Long-Term Care/MIPS and NEBMAC. PO Box 95026, Lincoln, NE 68509. The terms and conditions included In the Contractor's invoice shall be deemed to be solely for the convenience of the parties. No terms or conditions of any such invoice shall be binding upon the State, and no action by the State, Including without limitation the payment of any such invoice in whole or in part. shall be construed as binding or estopping the State with respect to any such term or condition, unless the invoice term or condition has been previously agreed to by the State as an amendment to the contract.

KK, RIGHT TO AUDIT



~77 Contractor shall establish and maintain a reasonable accounting system that enables the State to readily audit contract. The State and its authorized representatives shall have the right to audit, to examine, and to make copies of or extracts from all financial and related records (in whatever form they may be kept. whether written, electronic, or other) relating to or pertaining to this contract kept by or under the control of the Contractor, including, but not limited to those kept by the Contractor, its employees, agents, assigns, successors, and Subcontractors. Such records shall include, but not be limited to, accounting records. written policies and procedures; all paid vouchers including lhose for out-of-pocket expenses; other reimbursement supported by invoices; ledgers; cancelled checks; deposit slips; bank statements; journals; original estimates; estimating work sheets; contract amendments and change order files; back charge logs and supporting documentation; insurance documents; payroll documents; limesheets; memoranda; and correspondence.

Contractor shall, at all times during the term of this contract and for a period of five (5) years after the completion of this contract. maintain such records, together with such supporting or underlying documents and materials. The Contractor shall at any time requested by the State, whether during or after completion of this contract and at Contractor's own expense make such records available for inspection and audit (including copies and extracts of records as required) by the State. Such records shall be made available to the State during normal business hours at the Contractor's office or place of business. In the event that no such location is available, then the financial records, together with the supporting or underlying documents and records, shall be made available for audit at a time and


location that is convenient for the State. Contractor shall ensure the State has these rights with Contractor's assigns. successors, and Subcontractors, and the obligations of these rights shall be explicitly included in any subcontracts or agreements formed between the Contractor and any Subcontractors to the extent that those Subcontracts or agreements relate to fulfillment of the Contractor's obligations to the State.

Costs of any audits conducted under the authority of this right to audit and not addressed elsewhere will be borne by the State unless certain exemption criteria are met. If the audit identifies overpricing or overcharges (of any nature) by 1he Contractor to the State in excess of one-half of one percent (.5%) of the total contract billings, the Contractor shall reimburse the State for the total costs of the audit 11· the audit discovers substantive findings related to fraud, misrepresentation. or non-performance, the Contractor shall reimburse the State for total costs of audit. Any adjustments and/or payments that must be made as a result of any such audit or inspection of the Contractor's invoices and/or records shall be made within a reasonable amount of lime (not to exceed 90 days) from presentation of the State's findings to Contractor.

LL. TAXES



-~ The State is not required to pay taxes of any kind and assumes no such liability as a result of this solicitation. Any property tax payable on the Contractor's equipment which may be installed in a state-owned facil ity is the responsibility of the Contractor.

MM. INSPECTION AND APPROVAL

Accept (lnftlal)

-~



Final inspection and approval of all work required under the contract shall be perfo rmed by the designated State officials. The State and/or its authorized representatives shall have the right to enter any premises where the Contractor or Subcontractor duties under the contract are being performed, and to inspect, monitor or othetwise evaluate the work being performed. Al l inspect ions and evaluations shall be at reasonable times and in a manner that will not unreasonably delay work.

NN . CHANGES IN SCOPE/CHANGE ORDERS

Accept Reject Reject & Provide NOTES/COMMENTS: (In itial) (lnitlal) Alternative within


# ·r7/

The State may. upon the written agreement of Contractor, make changes to the contract within the general scope of the RFP. The State may, at any time work is in progress, by written agreement, make alterations in the terms of work as shown in the specifications, require the Contractor to make corrections, decrease the quantity of work, or make such other changes as the State may find necessary or desirable. The Contractor shall not claim forfeiture of contract by reasons of such changes by the State. Changes in work and the amount of compensation to be paid to the Contractor shall be determined in accordance with applicable unit prices if any, or a pro-rated value.

Corrections of any deliverable, service or performance of work required pursuant to the contract shall not be deemed a modification. Changes or additions to the contract beyond the scope of the RFP are not permitted.


00. SEVERABILITY



~~ If any term or condition of the contract is declare<! by a court of competent jurisdiction to be illegal or in conflict with any law, the validity of the remaining terms and conditions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the contract did not contain the particular provision held to be invalid.

PP . CONFIDENTIALITY



·~5' ,

All materials and information provided by the State or acquired by the Contractor on behalf of the State shall be regarded as confidential information. All materials and information provided by the State or acquired by the Contractor on behalf of the State shall be handled in accordance with federal and state law, and ethical standards. The Contractor must ensure the confidentiality of such materials or information . Should said confidentiality be breached by a Contractor; Contractor shall notify the State immediately of said breach and take immediate corrective action.

It is incumbent upon the Contractor to inform its officers and employees of the penalties for improper disclosure imposed by the Privacy Act of 1974, 5 U.S.C. 552a. Specifically, 5 U.S.C. 552a (i)(1), which is made applicable to Contractors by 5 U.S.C. 552a (m)(1), provides that any officer or employee of a Contractor, who by virtue of his/her employment or official position has possession of or access to agency records which contain individually identifiable information, the disclosure of which is prohibited by the Privacy Act or regulations estabfished thereunder, and who knowing that disclosure of the specific material is prohibited, willful ly discloses the material In any manner to any person or agency not entitled to receive it, shall be guilty of a misdemeanor and fined not more than $5,000.

QQ. PROPRIETARY INFORMATION



~ Data contained in the proposal and all documentation provided therein, become the property of the State of Nebraska and the data becomes public information upon opening the proposal. If the bidder wishes to have any information withheld from the public, such information must fall within the definition of proprietary information contained wilt1in Nebraska's public record statutes. All proprietary information the bidder wishes the State to withhold must be submitted in a sealed package, which is separate from the remainder of the proposal, and provide supporting documents showing why such documents should be marked proprietary. The separate package must be clearly marked PROPRIETARY on the outside of the package. Bidders may not mark their entire Request for Proposal as proprietary. Bidder's cost proposals may not be marked as proprietary information . Failure of the bidder to follow the instructions for submitting proprietary and copyrighted information may resul t in the information being viewed by other bidders and the public. Proprietary information is defined as trade secrets, academic and scientific research work which is in progress and unpublished, and other information which if released would give advantage lo business competitors ahd serve no public purpose (see Neb. Rev. Slat. § 84-712.05(3)). In accordance with Attorney General Opinions 92068 and 97033, bidders submitting information as proprietary may be required to prove specific. named competitor(s) who would be advantaged by release of the information and the specific advantage the competitor(s) would receive. Althougl1 every effort will be made to withhold information that is properly

Page 22 SPB RFP Revfsed: 01/29/2016

submitted as proprietary and meets the State's definition of proprietary information, the State is under no obligation to maintain the confidentiality of proprietary Information and accepts no liability for the release of such information.

RR. CERTI FICATION OF INDEPENDENT PRICE DETERMINATION/COLLUSIVE BIDDING

Accept Reject Reject & Provide NOTES/COMMENTS: (In itial) (Initial) Alternative w ith in


~-

By submission of this proposal, the bidder certifies that ii is the party making the foregoing proposal and that the proposal is not made in the interest of. or on behalf of, any undisclosed person. partnership, company, association, organization. or corporation; that the proposal is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham proposal, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham proposal, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the proposal price of the bidder or any other bidder, or to fix any overhead, profit. or cost element of the proposal price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the proposal are true; and further that the bidder has not, directly or Indirectly, submitted the proposal price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association. organization, proposal depository, or to any member or agent thereof to effectuate a collusive or sham proposal.

SS. STATEMENT OF NON-COLLUSION

Accept (Initial)

~



The proposal shall be arrived at by the bidder independently and be submitted without collusion with, and without any direct or indirect agreement. understanding or planned common course of action with, any person; firm; corporation; bidder: Contractor of materials. supplies. equipment or services described in this RFP. Bidder shall not collude with, or attempt to collude with, any state officials, employees or agents; or evaluators or any person involved In this RFP. The bidder shall not take any action in the restraint of free competition or designed to limit independent bidding or to create an unfair advantage.

Shoufd it be determined that collusion occurred, the State reserves the right to reject a bid or terminate the contract and Impose further administrative sanctions.

TT. PRICES

Accept Reject Reject & Provide NOTES/COMMENTS: (Initial) (Initial) Alternative w ith in


I~ ,

All prices, costs, and terms and condi tions outlined in the proposal shall remain fixed and valid commencing on the opening date of the proposal until an award is made or the Request for Proposal is cancelled.

Prices quoted on the Cost Proposal form shall remain fi xed for the first year of the contract period. Any request for a price increase subsequent to the first year shall not exceed seven percent (7%) of the previous Contract period and must be submitted in writing to the State Purchasing Bureau a minimum of 120 days prior to the end of the current

Page 23 SPB RFP Revised: 01 /29ri016

contract period, and be accompanied by documentation justifying the price increase. Further documentation may be required by the State to justify the increase. The State reserves the right to deny any requested price increase. No price increases are to be billed to any State Agencies prior to written amendment of the contract by the parties.

The State will be given full proportionate benefit of any price decrease during the term of the contract. Contractor represents and warrants that all prices for services, now or subsequently specified, are as low as and no higher than prices which the Contractor has charged or intends to charge customers other than the State for the same or similar products and services of the same or equivalent quantity and quality for delivery or performance during the same periods of time. If, during the term of the contract, the Contractor shall reduce any and/or all prices charged to any customers other than the State for the same or similar products or services specified herein, the Contractor shall make an equal or equivalent reduction in corresponding prices for said specified products or services .

Contractor also represents and warrants that all prices set forth in the contract and all prices in addition. which the Contractor may charge under the terms of the contract, do not and will not violate any existing federal, state, or municipal law or regulations concerning price discrimination and/or price fixing. Contractor agrees to hold the State harmless from any such violation. Prices quoted shall not be subject to increase throughout the contract period unless specifically allowed by these specifications.

UU. BEST AN D FINAL OFFER

Accept (lnit[al)

~ i7/

Reject Reject & Provide NOTES/COMMENTS: (Initia l) Alternative w ithin

RFP Response (Init ial)

The State will compile the final scores for all parts of each proposal. The award may be granted to the highest scoring responsive and responsible bidder. Alternatively, the highest scoring bidder or bidders may be requested to submit best and final offers. If best and final offers are requested by the State and submitted by the bidder, they will be evaluated (using the slated criteria), scored , and ranked by the Evaluation Committee. The award will then be granted to the highest scoring bidder. However. a bidder should provide its best offer in its original proposal. Bidders should not expect that the State will request a best and final offer.

VV. ETHICS IN PUBLIC CONTRACTING


RFP Response {Initia l)

~ No bidder shall pay or offer to pay, either directly or indirectly, any fee, commission compensation, gift, gratuity, or anything of value to any State officer, legislator, employee or evaluator based on the understanding that the receiving person's vote, actions. or judgment will be influenced thereby. No bidder shall give any item of value to any employee of the State Purchasing Bureau or any evaluator.

Bidders shall be prohibited from utilizing the services of lobbyists, attorneys, political activists. or consultants to secure the contract. It is the intent of this provision to assure that the prohibition of state contact during the procurement process is not subverted through the use of lobbyists, attorneys, political activists, or consultants. It is the intent of the State that the process of evaluation of proposals and award of the contract be completed without external influence. II is not the intent of this section to prohibit bidders from seeking professional advice, for example consulting legal counsel, regarding terms and conditions of this Request for Proposal or the format or content of their proposal.

If the bidder is found to be in non-compliance with this section of the Request for Proposal, they may forfeit the contract if awarded to them or be disqualified from the seli:iction process.

Page 24 SPB RFP Revised: 01 /29/2016

WW. INDEMNIFICATION

Accept (Initial)

~



1. GENERAL The Contractor agrees to defend. indemnify, hold, and save harmless the State and its employees, volunteers, agents, and its elected and appointed officials {"the indemnified parties") from and against any and all claims, liens. demands, damages, liability, actions. causes of action, losses. Judgments, costs, and expenses of every nature. including investigation costs and expenses, settlement costs. and attorney fees and expenses ("the claims"), sustained or asserted against the State, arising out of, resulting from, or attributable to the willful misconduct, negligence, error, or omission of the Contractor, its employees, Subcontractors. consultants. representatives. and agents, except to the extent such Contractor liability is attenuated by any action of the State which directly and proximately contributed to the claims.

2. INTELLECTUAL PROPERTY The Contractor agrees ii will, at its sole cost and expense, defend, indemnify, and hold harmless the indemnified parties from and against any and all claims, to the extent such claims arise out of. result from, or are attributable to. the actual or alleged infringement or misappropriation of any patent, copyright, trade secret, trademark. or confidential information of any third party by the Contractor or its employees, Subcontractors, consultants, representatives, and agents; provided. however, the State gives the Contractor prompt notice in writing of the claim. The Contractor may not settle any infrihgement claim that will affect the State's use of the Licensed Software without the State's prior written consent. which consent may be withheld for any reason.

If a judgment or settlement is obtained or reasonably anticipated against the State's use of any intellectual property for which the Contractor has indemnified the State, the Contractor shall, at the Contractor's sole cost and expense. promptly modify the item or items which were determined to be infringing, acquire a license or licenses on the State's behalf to provide the necessary rights to the State to eliminate the infringement, or provide the State with a non-infringing substitute that provides the State the same functionality. At the State's election, the actual or anticipated judgment may be treated as a breach of warranty by the Contractor, and the State may receive the remedies provided under this RFP.

3. PERSONNEL The Contractor shall, at its expense, indemnify and hold harmless the indemnified parties from and against any claim with respect to withholding taxes, worker's compensation, employee benefits, or any other claim, demand. liability, damage, or loss of any nature relating to any of the personnel provided by the Contractor.

4. SELF~NSURANCE The State of Nebraska is self-insured for any loss and purchases excess insurance coverage pursuant to Neb. Rev. Stat. § 81-8,239.01 (Reissue 2008). If there is a presumed loss under the provisions of this agreement, Contractor may file a claim with the Office of Risk Management pursuant to Neb. Rev. Stat. §§ 81-8,829- 81 -8,306 for review by the State Claims Board. The State retains all rights and immunities under the State Miscellaneous (Section 81-8,294), Tort (Section 81-8,209), and Contract Claim Acts (Section 81-8,302). as outlined in Neb. Rev. Stat. § 81-8,209 et seq. and under any other provisions of law and accepts liability under this agreement to the extent provided by law.


XX. NEBRASKA TECHNOLOGY ACCESS STANDARDS

Accept Reject Reject & Provide NOTES/COMMENTS: (Initial)

-[~ .. ~,7

(Initial) Alternative w ithin RFP Response (Initial)

Contractor shall review the Nebraska Technology Access Standards, found at hltp://nltc .nebraska.qov/standards/2-201 .html and ensure that products and/or services provided under the contract are in compliance or will comply with the applicable standards to the greatest degree possible. In the event such standards change during the Contractor's performance, the State may create an amendment to the contract to request the contract comply with the changed standard at a cost mutually acceptable to the parties.

YY. ANTITRUST

Accept (Initial)

.,,;?_.

~~



The Contractor hereby assigns to the State any and all claims for overcharges as to goods and/or services provided in connection with this contract resulting from antitrust violations which arise under antitrust laws of the United States and the antitrust laws of the State.

ZZ. DISASTER RECOVERY/BACK UP PLAN

Accept (Initial)

~



The Contractor shall have a disaster recovery and back-up plan, of which a copy should be provided to the State. whict, includes, but is not limited to equipment, personnel, facili ties, and transportation, in order to continue services as specified under the specifications in the contract in the event of a disaster.

AAA. TIME IS OF THE ESSENCE



~ Time is of the essence in this contract. The acceptance of late performance with or without objection or reservation by the State shall not waive any rights of the State nor constitute a waiver of the requirement of timely performance of any obligations on the part of the Contractor remaining to be performed.


BBB. RECYCLING



~ ~

Preference will be given to items which are manufactured or produced from recycled material or which can be readily reused or recycled after their normal use as per Neb. Rev. Stat.§ 81-15,159.

CCC. DRUG POLICY



/5 Contractor certifies it maintains a drug free work place environment to ensure worker safety and workplace integrity. Contractor agrees to provide a copy of its drug free workplace policy at any time upon request by the State.

DDD. EMPLOYEE WORK ELIGIBILITY STATUS

Accept (In itial)

~



The Contractor is required and hereby agrees to use a federal immigration verification system to determine the work eligibility status of employees physically performing services within the State of Nebraska. A federal immigration verification system means the electronic verification of the work authorization program authorized by the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 8 U.S.C. 1324a, known as the E-Verify Program, or an equivalent federal program designated by the United States Department of Homeland Security or other federal agency authorized to verify the work eligibility status of an employee.

If the Contractor is an individual or sole proprietorship, the following applies:

1. The Contractor must complete the United States Citizenship Attestation Form, available on the Department or Administrative Services website at http://das.nebraska.gov/materiel/purchasing.hlrnl

The completed United States Attestation Form should be submitted with the Request for Proposal response.

2. If the Contractor indicates on such attestation form that he or she is a qualified alien, the Contractor agrees to provide the US Citizenship and Immigration Services documentation required to verify the Contractor's lawful presence in the United States using the Systematic Alien Verification for Entitlements (SAVE) Program .

3. The Contractor understands and agrees that lawful presence in the United States is required and the Contractor may be disqualified or the contract terminated if such lawful presence cannot be verified as required by Neb. Rev. Stat.§ 4-108.


EEE. CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND INELIGIBILJTY

Accept Reject Reject & Provide NOTESICOMMENTS: (Initial) (Initial) Alternative within


47 The Contractor, by signature to this RFP, certifies that the Contractor is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any federal department or agency from participating In transactions (debarred). The Contractor also agrees to Include the above requirements in any and all Subcontracts into which it enters. The Contractor shall immediately notify the Department if, during the term of this contract, Contractor becomes debarred . The Depa rtment may immediately terminate this contract by providing Contractor written notice if Contractor becomes debarred during the term of this contract.

Contractor, by signature to this RFP, certifies that Contractor has not had a contract with the State of Nebraska terminated early by the State of Nebraska. If Contractor has had a contract terminated early by the State of Nebraska, Contractor must provide the contract number, along with an explanation of why the contract was terminated early. Prior early termination may be cause for rejecting the proposal.

FFF. POLITICAL SUB-DIVISIONS

Accept Reject Reject & Provide NOTES/COMMENTS: (Initial) (lnltlal) Alternative within


~ .--"7

The Contractor may extend the contract to political sub-divisions conditioned upon the honoring of the prices charged to the State. Terms and conditions of the Contract must be met by political sub-divisions. Under no circumstances shall the State be contractually obligated or liable for any purchases by political sub-divisions or other public entities not authorized by Neb. Rev. Stat. § 81 -145, listed as "all officers of the state, departments, bureaus, boards, commissions, councils, and institutions receiving legislative appropriations." A fisting of Nebraska political subdivisions may be found at the website of the Nebraska Auditor of Public Accounts.

GGG. OFFICE OF PUBLIC COUNSEL



.4'.

~~ If it provides, under the terms of this contract and on behalf of the State of Nebraska, health and human services to individuals; service delivery; service coordination; or case management, Contractor shall submit to the jurisdiction of the Office of Public Counsel, pursuant to Neb. Rev. Stat. §§ 81 -8,240 et seq. This section shall survive the termination of this contract and shall not apply if Contractor is a long-term care facility subject to the Long-Term Care Ombudsman Act, Neb. Rev. Stat. §§ 81-2237 et seq.


HHH. LONG-TERM CARE OMBUDSMAN

Accept Reject Reject & Provide NOTES/COMMENTS: (Initial) (Ini tial ) Alternative within


~ If it is a long-term care facility subject to the Long-Term Care Ombudsman Act. Neb. Rev. Stat. §§ 81-2237 et seq., Contractor shall comply with the Act. This section shall suNive the termination of this contract.


IV. PROJECT DESCRIPTION AND SCOPE OF WORK

The bidder should provide the following information in response to this Request for Proposal.

A. PROJECT OVERVI EW Medicaid School-Based Claiming Is a joint federal-state program that offers reimbursement for both the provision or covered medically necessary school-based services and for the costs of administrative activities, such as outreach, which support the Medicaid school-based program. Schools can provide a wide range of health care and related services to their students, which may or may not be reimbursable under the Medicaid program.

Many children receive covered Medicaid services through their schools. Medicaid will reimburse schools for documented medically necessary services that are provided to children who are both Medicaid eligible and who have been identified as eligible under the Individuals with Disabilities Education Act (IDEA) see 34 CFR 300 et seq. In Nebraska, schools can be reimbursed for physical therapy, occupational therapy and speech therapy. Additional services are to be added in the future. including nursing. personal assistance, mental health, vision and transportation by Department of Health and Human Services (OH HS or the Department). Services must be identified in an Individual Education Plan (IEP) or Individualized Family Service Plan {IFSP). These activities are considered "direct medical services·.

Schools are often involved in informing families of their potential eligibility for Medicaid or in helping them arrange medical services for children. These activities are considered administrative. and schools are able to receive reimbursement through Medicaid.

DHHS is committed to providing efficient and effective Medicaid school-based claiming by applying RMTS methodology and cost settlement processes to support proper Medicaid reimbursement for both direct medical services and administrative activities.

RMTS is particularly useful, because ii uses a verifiable, statistically valid random sampling technique that produces accurate labor distribution results, greatly reducing the amount of staff time needed to record an individual time study participant's activit'ies. The RMTS method polls participants on an individual basis at random time intervals over a quarterly (three month) time period and totals the results to determine work effort for the entire population of eligible staff over that same period. The RMTS method provides a statistically valid means of determining what portion of the selected group of participants' workload is spent performing activities that are reimbursable by Medicaid with payments made on a "cost settlement" basis.

B. PROJECT ENVIRONMENT DHHS' program for reimbursing schools for the provision of direct medical services is titled, "Medicaid in Public Schools," or MIPS. The program for reimbursing schools for administrative activities is titled, "Nebraska EducationBased Medicaid Administrative Claiming," or NEBMAC. MIPS and NEBMAC are administered by the DHHS Division of Medicaid and long-Term Care.

1. Medicaid reimbursement to schools is currently available for the direct service provision of occupational therapy, physical therapy and speech therapy. Direct services are currently reimbursed through feefor -service.

2. As the result of legislative action in 2014, Nebraska Revised Statute 68-91 1, reimbursement for direct services is planned for expansion to include five additional services. These services are nLJrsing, personal assistance, mental health, vision and transportation. This expansion is dependent upon the successful implementation of RMTS and cost settlement for the current three services and submission of a Nebraska Medicaid State Pian Amendment (SPA). Medicaid reimbursement ls currently available for administrative activities such as coordinatlon of medical and mental health related services covered by Medicaid; linking students to Medicaid services; and monitoring the delivery of medical and mental health services performed in the community. These services are currently reimbursed through RMTS and cost settlement conducted with Nebraska Schools Medicaid and Nebraska Association School Board consortiums.

Two hundred forty-seven (24 7) public school districts operated within the State of Nebraska during the 2015-2016 school year. Each of these districts is required to enroll as a Nebraska Medicaid provider and participate in MIPS (Nebraska Revised Statute 43-2511). They are referenced throughout this RFP as "school providers".

School districts hire or contract with individual providers of direct services (i.e .. physical, occupational, or speech therapy) to provide services for children with special educational needs. These individual providers must also be enrolled as Nebraska Medicaid providers in order for the school districts to participate in MIPS. The individual providers are referenced as "direct service providers" throughout this RFP.


Schools have the option to participate in NEBMAC. Personnel within schools who perform administrative activities are not enrolled Medicaid providers unless they also provide direct medical services. They are referenced as "school employees performing administrative activities".

During the 2013-2014 school year, 26.69% of students were Medicaid eligible, and out of 41,559 special education students, 11,091 were eligible for MIPS.

Nebraska Medicaid's managed care program is Heritage Health, for which there are three (3) MCO's. The Contractor will be expected to work collaboratively with the MCO's, school providers. including direct service providers and school employees performing administrative activities, to ensure access to and provision of medlcal services for Medicaid eligible children.

C. PROJECT REQUIREMENTS Bidder should provide a response to each of the following contractor requirement in the space provided below.

1. Develop and maintain Random Moment Online System a. The Contractor shall develop and maintain a Random Moment Online System in accordance with CPEs payment

methodology. Bidders Response: Bidder complies with this requirement (Technical Proposal pg. 49-53)

NASBMC and the subcontractor. GSGI, have performed Medicaid Administrative Claiming administration in Nebraska since 1999. Since the 2013/2014 school year, GSGI has provided an RMTS application for 220 of the schools throughout Nebraska. This school year represented the year in which DHHS unified the Medicaid Administrative Claiming methodologies, eliminating the five-day time study, and applying the RMTS methodology between two established consortiums. The bidder and GSGI will continue to provide, host. operate and maintain the online system, eMacrM, as well as operate a statewide random moment time study (RMTS), in accordance with the approved Nebraska Administrative Claiming Program, NEBMAC.

b. The Contractor shall develop an online system for collecting schools' providers' random moments that at a minimum: i. Allows the contractor to send RMTS queries to direct service providers and school employees performing

administrative activities to doc1,1ment the amount of time spent doing Medicaid allowable services. and ii. Allows school providers to upload roster over the internet.

Bidders Response: Bidder complies with this requirement (Technical Proposal pg. 49-53).

i. Time study participants are notified via e-mail of their requirement to participate in the time study and of their sampled moment. Sampled participants are notified of their sampled moment by email no more than five days prior to their sampled moment and at least one reminder e-mail is sent out 24 hours before the moment. The participant logs onto web site using any Internet-ready computer and fills out the time study online within five calendar days after end of the moment to ensure the accuracy of the time. A moment is no longer available to a participant five calendar days after the end of the moment.

ii. The financial data to be included in the calculation of the Administrative claim are be based on actual expenditures incurred during the quarter. GSGI current captures this data in the form of spreadsheets completed by designated staff at each individual school district. This functionality is due for implementation into eMAC™ at the beginning of the 2017/2018 school year.

These costs are obtained from actual detailed expenditure reports generated by the provider's financial accounting system. The only costs that are included are those that meet reporting requirements and that are from eligible categories.

C. The Contractor shall modify site content at the direction of the DHHS. Bidders Response: Bidder will work with DHHS to comply (Technical Proposal pg. 38-39). The systems of the subcontractor are flexible and customizable so that they will be modified at the direction of the Department or as the program changes.

d. The Contractor shall deliver all site content to the DHHS for review and approval. Bidders Response: Bidder shall receive DHHS approval for site content. (Technical Proposal pg. 38-39). All site content will be delivered to the Department in whatever format is requested for prior approval. The bidder will make any modification necessary to the Department.

e. The Contractor shall not publicly post any content prior to the DHHS's approval of that content. Bidders Response: Bidder shall not post any content without DHHS first approving. (Technical Proposal pg. 38-39).

f. The Contractor shall make the Random Moment Online System available to the Department in a testing environment. Bidders Response: Bidder complies with this requirement. (Technical Proposal pg. 49).


g. The Contractor shall make the Random Moment Online System avallable to the Department in a production environment.

Bidders Response: Bidder complies with this requirement. (Technical Proposal pg. 49). 2. Develop and conduct a statewide RMTS.

a. The Contractor shall plan, develop and conduct a statewide RMTS through the Random Moment Online System. b. The intervals of the RMTS will be done on a quarterly basis. The Contractor shall:

i. Update the Department's current RMTS methodology, materials and the Random Moment Online System, as necessary or as directed by the Department, by incorporating the most current guidance from CMS.

Ii. Collect RMTS rosters for all participating school providers and distribute RMTS moments. iii. Vet and analyze rosters collected from all participating school providers for consistency and any deviations

from previous rosters. iv. Collect and distribute all RMTS data and information electronically. The Contractor shall do this through the

use of e-mail and the Random Moment Online System. v. Establish the t ime frame for RMTS to be within 7:00 AM and 4:00 PM. vi. Code RMTS appropriately to demonstrate Medicaid allowable services and activities. vii. Maintain all RMTS data for storing and analyzing all RMTS responses, data and information. viii. Monitor and compile reports of participating schools' RMTS response compliance rate. ix. Code and review the quality of RMTS responses in accordance with the CMS approved methodology and

calculate a time study percentage based on direct medical, administrative services provided . Bidders Response: Bidder complies with this requirement (Technical Proposal pgs. 49-53).

Response to 2.a. The bidder currently operates an on line system applying the RMTS methodology. GSGI will continue to provide, host, operate and maintain our online system, eMac ™, and operate a statewide random moment lime study (RMTS), in accordance with the approved Nebraska Administrative Claiming Program, NEBMAC.

c. The Contractor shall ensure the ability to duplicate each random sampling that is conducted. Bidders Response: Bidder complies with this requirement (Technical Proposal pgs. 50-53). 3. Develop and maintain Cost Reporting Online System

a. The Contractor shall develop and maintain a Cost Reporting Online System. Bidders Response: Bidder will develop the Cost Reporting Online System {Technical Proposal pg. 53-58).

The MIPS Cost Report is designed to capture the actual costs of the provider. Currently, the Cost Settlement process is through a spreadsheet form, summary worksheets are formula driven, and are "locked" to provide additional assurance of accuracy. Providers will only need to access specific worksheets to input provider and financial data. These worksheets include: Certification Page; Provider Data; Statistics; Direct Medical Cost; Direct Admin Cost; Transportation Cost; Settlement; Payroll Costs; and Contract Costs worksheets. The online system will be developed for use during the 2017-2018 school year

b. The Cost Reporting Online System shall contain all information required by the CPEs payment methodology.

The Chief Financial Officer (CFO), Chief Executive Officer (CEO), Executive Director (ED), Superintendent {SI) or other individual designated as the financial contact by the LEA will be required to certify the availability of necessary public matching funds, referred to as CPEs. All information will be included in the online system. Bidders Response: Bidder complies with this requirement (Technical Proposal pg. 53-58 and Reports Section).

c. The Contractor shall develop an online system for completing required cost reporting that has, at a minimum, the following capabili ties: i. Allows school providers to report salaries, benefits and other relevant

financial information in accordance with the CMS approved methodology. ii. Calculates final CPEs numbers. iii. Calculates final settlement numbers.

Bidders Response: Bidder complies with this requirement (Technical Proposal pgs. 53-58 and Reports Section). d. The Contractor shall modify site content at the direction of the Department.

Bidders Response: Bidder will work with the department for site content modifications. (Technical Proposal pg. 38-39). e. The Contractor shall deliver all site content to the Department for review and approval.

Bidders Response: Bidder will receive Departmental approval on all site content. (Technical Proposal pg. 38-39).

f. The Contractor shall not publicly post any content prior to the Departments' approval of that content. Bidders Response: Bidder will not allow site content posts to be made without Departmental approval. (Technical Proposal pg. 38-39).

g . The Contractor shall make the Cost Reporting Online System available to the Department in a testing environment.


Bidders Response: This functionality will be developed for the Cost Reporting Online System. (Technical Proposal pg. 53). h . The Contractor shall make the Cost Reporting Online System available to the Department in a production environment.

Bidders Response: This functionality will be developed for the Cost Reporting Online System. (Technical Proposal pg. 53). i. The Contractor shall ensure the cost report template is available in an online format that is accessible to school

providers. B idders Response: This functionality will be developed for the Cost Reporting Online System (See Reports Section). Project Requirements for MIPS 4. Interim Rate Setting

a. The Contractor shall establish school provider-specific interim rates of payment for the schools each State Fiscal Year (SFY) and after any update to the reimbursement methodology. To establish interim rates, the Contractor shall complete all of the following: i. Develop and submit to the Department a methodology to calculate school provider- specific interim rates, as

required by CMS. ii. Gather and analyze historical cost data from school providers to calculate a monthly school provider-

specific interim rate of payment based on the Department-approved methodology. iii. Review all school provider-specific monthly rate-setting calculations for accuracy. iv. Collect and analyze quarterly financial data from each direct service provider so that the interim rates can

be adjusted mid-year if necessary. Bidders Response: Bidder will comply with this requirement (Technical Proposal pg. 56 and Reports Section).

b. The Contractor shall establish interim rates based on the prior years' cost reports. Bidders Response: Bidder will comply with this requirement (Technical Proposal pg. 56 and Reports Section).

C. The Contractor shall submit the school provider-specific interim rates to the Department for review and approval. Bidders Response: Bidder will comply with this requirement. (See Reports Section).

d. Upon approval by the Department, the Contractor shall inform the schools of the provider-specific interim rates. Bidders Response: Bidder will comply with this requirement. 5. Direct Service Provider Management

a. The Contractor shall ensure that schools are using direct service providers that are enrolled in Nebraska Medicaid. Bidders Response: Bidder will comply with this requirement (Technical Proposal pgs. 41-49).

NASBMC and GSGI will ensure services are provided by qualified providers who are employed by or contracted with the school district or individual schools within the district. The providers will be enrolled in Nebraska Medicaid as required.

b. The Contractor shall work collaboratively with the Department and its contracted Medicaid provider enrollment vendor to assist schools in enrolling direct service providers and troubleshoot any issues that may arise.

Bidders Response: Bidder will comply with this requirement (Technical Proposal pgs. 41-49).

The GoClairn TM application has logic in place to ensure that all Medicaid requirements are documented for each encounter, and if a requiremenl is missing, the encounter cannot be billed, including but not limited to provider eligibility. The bidder will work with the Department and its eligibility contractor to enroll direct service providers and troubleshoot any issue arising ..

c. The Contractor shall collect and routinely analyze direct service provider enrollment issues schools may encounter.

Bidders Response: Bidder will comply with this requirement (Technical Proposal pgs. 41-49). This is a part of our customer service and communication processes.

D. REPORTING REQUIREMENTS Bidder should provide a response to each of the following contractor requirement in the space provided below.

1. RMTS Quarterly Updates a. The Contractor shall create written quarterly updates on the RMTS results for the Department's review and

subsequent submission to CMS that shall include, but not be limited to: i. Participant statistics. ii. Moments generated. iii. Valid coded responses received. iv. Raw compliance percentages.


Bidders Response: Bidder will comply with this requirement (See Reports Section). At the end of each quarter, once all random moment data has been received and lime study results have been calculated, statisllcal compliance reports are generated to serve as documentation that the statewide sample results met the necessary statistical requirements. Further, the sample results will be stored for future review, if needed. These reports will be provided to the Department for review and subsequent submission to CMS will include participant statistics, comments generated, valid coded responses received and raw compliance percentages.

b. The Contractor shall submit the quarterly RMTS updates to the Oepartment for the following four (4) quarters: i. Quarter 1 - September through November

ii. Quarter 2 -December through February iii. Quarter 3 - March through May iv. Quarter 4 - June through August

Bidders Response: Bidder will comply with this requirement.

c. The Contractor shall make available to the Department reports in exportable documents.

Bidders Response: Bidder will comply with this requirement. (See Reports Section) 2. Quarterly Cost Reporting

a. The Contractor shall perform the following activities for the quarterly CPEs documentation process:

i . Compare actual payments to school providers to costs identified on each specific school provider's quarterly cost report.

ii. Ensure that each school provider receives a quarterly report of the actual costs of providing Medicaid allowable services.

Bidders Response: Bidder will comply with this requirement {See Reports Section).

b. The Contractor shall prepare, file and review administrative claiming financial information for the quarterly cost reports and submit the cost report outcomes to the Department in a Department approved format.

Bidders Response: Bidder will comply with this requirement. (See Reports Section).

C. The Contractor shall make available to the Department reports in exportable documents.

Bidders Response: Bidder will comply with this requirement. (See Reports Section).

3. Annual Cost Reporting a. The Contractor shall collect cost reports for direct seNices from each of the school providers according to the CMS

approved methodology by October 1st of each year.

Bidders Response: Bidder will comply with this requirement (See Reports Section).

b. The Contractor shall complete an annual cost reconciliation proce ss to compare interim payments to costs identified on each cost report.


c. The Contractor shall create a cost settlement report that includes the cost settlement amount for each school provider and shall submit the report to the Department for approval.


d. The Contractor shall obtain salaries, benefits, contracted costs and other allowable costs from the school providers for the RMTS participants.

Bidders Response: Bidder will comply with this requirement {See reports Section). The bidder will obtain financial data through the Payroll Costs Sheet - This sheet must be entered by the provider and uses data to determine the total allowable costs for salary and benefits for the various professionals providing services. Data will also include contracted costs and other allowable costs.

e. The Contractor shalt assist the Department in the annual direct service CPEs documentation process. To assist in this process, the Contractor shall:

i. Merge appropriate interim payment data into the CPEs documentation materials . ii. Manage, review and resolve Interim payment inquiries from school providers.

Bidders Response: Bklder will comply with this requirement (See Technical Proposal pgs. 41 -49).

f. The Contractor shall perform a reconciliation of CPEs at the school provider level in accordance with CMS' guidance.


g. The Contractor shall make available to the Department reports in exportable documents. Bidders Response: Bidder will comply w ith this requirement.

4. RMTS and Cost Report Help Desks Report


a. The Contractor shall create a written monthly RMTS and Cost Report Help Desks Report that contains the total number of cans and e-mails received by each Help Desk broken out as follows:

i. Number of calls received. ii. Number of calls answered. iii. Number of calls routed to voice mail. iv. Number of calls routed to voice mail that were responded to within·two (2) business days. v. Average call hold time. vi. Average call abandonment rate. vii. Number of e-mails received. ... VIII . Number of e-mails responded to within two (2) business days . ix. Summary of subjects of calls and emails received. x. Summary of trends relating to the Help Desk information as described above.

Bidders Response: Bidder will comply with this requirement (See Reports Section). NASBMC and GSGI will provide to DHHS reports related to:

• Total number of inquiries with answer rate; • Inquiry count by topic; • Inquiry response times .

The GSGI Team also provides our school district customers useful lips and guidance in the form of our Quick Tips and Go in the Know publications. Quick Tips is a newsletter for providers that nives specific information about Medicaid, GoClaim tM, eMac ™ and how the documentation process can be simplified for the user. We also use this to publish responses to FAQs from our Helpdesk, along with discussion of hot-topic issues that providers encounter on a daily basis. Go in the Know, on the other hand, is a quarterly newsletter for administrators. Its purpose is to inform them of national Medicaid issues, and case studies on how others have handled those issues. Each newsletter discusses administrative functions within G0Claim1 tv1 and eMac™ that aid in the management of their district's performance. NASBMC and GSGI are committed to prompt and accurate problem resolutions at all times.

The information listed in I through x is included in the reports. b. The Contractor shall submit the RMTS and Cost Report Help Desks Report to the Department

Bidders Response: Bidder will comply with this requirement. c. The Contractor shall make available to the Department reports in exportable documents.


E. AUDITING REQUIREMENTS Bidder should provide a response to each of the following contractor requirement in the space provided below.

1. The Contractor shall develop an Audit Process and Plan for school providers that will ensure program compliance based on CMS requirements, guidance and audit findings.

Bidders Response: Bidder will comply with this requirement (See Technical Proposal pgs. 64-67). GSGI has a robust, state-of-the-art, compllant, secure, web-based reporting system for all of its contracted school districts across the nation. 2. The Contractor shall ensure the Audit Process and Plan includes, but is not limited to:

a. A description of the procedures the Contractor will follow when performing claims reviews, audits of costs reports and audits of the RMTS.

b. Audit methodologies the Contractor will use. C. A process for determining which school providers will be placed on a corrective action plan and a plan for following

up with those providers. Bidders Response: Bidder will comply with this requirement (See Technical Proposal pgs. 64-67). 3. Audits shall include, but are not limited to, the following

a. Claims Reviews. b. Cost Reports. c. RMTS moments. d. RMTS rosters' eligible categories . e. Direct service provider qualifications. f. Annual and quarterly financial reports.

Bidders Response: Bidder will comply with this requirement (See Reports Section). 4. The Contractor shall review audit materials maintained in, at a minimum, all of the following records or systems: a.

MMIS (or system of record} claims. b. Cost reports. C. RMTS. d. Educational records. e. Desk reviews and claims reviews


Bidders Response: Bidder will comply with this requirement (See Technical Proposal pgs. 64-67). 5. The Contractor shall develop a plan to determine which school providers will be audited during the next SFY and when

those school providers will be audited. This plan shall contain, at a minimum, the following components and shall include the due dates described: a. The Contractor shall ensure that at least fifty percent (50%) of all school providers are audited during each SFY and

that each direct service provider is audited at least once every three (3) SFYs. b. The Contractor shall ensure that ei ther a si te review or a desk audit is completed for each audited school provider. c. The Contractor shall deliver the annual audit plan to the Department for review and approval by June 1 of each

year. d. The Contractor shall update the audit plan annually to account for any changes to the process. e. The Contractor shall implement the audit plan upon approval by the Department. f. The Contractor shall develop and draft all documents and templates necessary to implement the audit plan approved

by the Department. These shall Include, at a minimum, all documents and templates necessary for performing, documenting and reporting all audit activities.

g. The Contractor shall submit all documents and templates to the Department for review and approval. The Contractor shall not use any documents or templates for any audit plan until those documents and templates have been approved by the Department.

Bidders Response: Bidder will comply with this requirement (See Technical Proposal pgs. 64-67).

F. PROJECT PLANNING AND MANAGEMENT Bidder should provide a response to each of the following contractor requirement in the space provided below.

1. Outreach a. The Contractor shall provide outreach on a quarterly basis to school providers that are not participating in school

based claiming. See Attachment 2, Provider Listing. This outreach shall include, but is not limited to, all of the following: i. E-mail contact or newsletters. ii. Conference calls or video meetings. iii. Making available mock cost reports and other information that show what a new school provider would be

required to do for school based claiming so that the school provider can perform a cost-benefit analysis. iv. Receiving and answering questions posed by school providers. v. Creating and disseminating fact sheets and other materials to market school based claiming.

Bidders Response: Bidder will comply with this requirement (See Technical Proposal pgs. 56-58). GSGl's company philosophy has always been to provide maximum service its customers. As a part of their duties, OSGI representatives are available and routinely meet with district administrators and providers. The bidder will produce outreach quarterly to school providers not participating in school based claiming by email or newsletter, conference call or video meetings and make available mock cost reports and other information. The bidder will receive and answer question by school providers and create and disseminate fact sheets and other materials to market school based claiming.

b. The Contractor shall submit all outreach materials to the Department at least ten (10) business days prior to the Contractor printing or disseminating such outreach materials to any school provider, unless the Department approves a shorter submission deadline. This submission requirement shall not apply to items that are directed toward and addressed to direct service providers.

Bidders Response: Bidder will comply with this requirement. (See Technical Proposal pgs. 38-39).

2. Ongoing Email Communication

a. The Contractor shall provide ongoing email communication with direct service providers and school employees providing administrative activities as needed. This communication shall include, but is not limited to, the following: i. Submission deadlines for RMTS, RMTS rosters, salaries, benefits and other relevant financial information. ii. Certification of financials. iii. School provider compliance for lime studyparticipation.

Bidders Response: Bidder will comply with this requirement (See Technical Proposal pgs. 56-62). b. The Contractor shall copy the Department on all ongoing email communication.

Bidders Response: Bidder will comply with this requirement (See Technical Proposal pg. 38-39).

3. Consulting Work {Approximately 200 hours for the entire contract period including the renewal options. See Attachment 4, Optional Fixed Hourly Rates.) The Department, at its sole discretion, may request the Contractor perform consulting work as listed in this section.


a. Consulting services may include, but are not to be limited to, the following: i. Make recommendations that are in accordance with federal guidelines, regulations and statutes. ii. Identify opportunities to improve Nebraska Medicaid school based claiming services. iii. Identify and advise on potential federal policy or regulation changes as the result of Government

Accountability Office reports, OIG audits, CMS financial management review, or other federal reports or directives.

iv. Review and advise regarding the impact of State Medicaid Director Letters, proposed or final CMS regulations, or other federal policy changes that may impact Nebraska Medicaid school based claiming services.

v. Make recommendations for strategies to respond to changes in the overall healthcare market in Nebrasl<a vi. Draft responses or provide strategic feedback on the Department's responses to questions from CMS. vii . Provide technical guidance to the Department to respond to informal and formal requests for

additional information from CMS. viii. Draft position papers or questions to CMS. Ix. Attend meetings and/or conference calls between the Department and CMS. x. Provide technical guidance to the Department regarding development or changes to the school based

claiming reimbursement methodology. xi. Provide guidance in developing communication strategies and responding to questions raised by the

following parties: a). OIG. b}. State or federal auditors.

C). The Nebraska governor's office. d). The Nebraska General Assembly and its committees.

xii. Assist the Department in any school based claiming services audit conducted at either the state or school provider level.

xiii. Assist the Department in compiling documentation, draft responses and participate in audit conference calls or meetings as requested by the Department.

Bidders Response: Bidder will comply with this requirement. The bidder and subcontractor have extensive expertise as set out In the experience and resumes sections which highlight the areas each person possesses. We have successful experience in each of the listed areas of possible consultation.

b. The Contractor shall ensure that any consulting projects will not compromise any deliverable due dates specified in the Scope of Work.


c. The Department may initiate a consulting project by submitting a written request to the Contractor for an estimate of the hours and services required to complete the work. The Contractor shall respond in writing to the Department's request for an estimate within three (3) business days of receipt of the request. The Contractor's response shall include: i. An estimate of the hours needed to complete the project. ii. The activities and milestones required to complete the project. iii. In the event the Contractor's estimate of hours needed to complete the consulting project exceeds twenty

(20) hours, the Contractor's response shall also include all of the following:

a). A description of the personnel commitments for the consulting project including: i. The names of all persons assigned to the consulting project. ii. The work responsibilities of each person assigned to the consulting project. ... Ill. The estimated hours that each person will need to complete his/her work responsibilities .

b). A timeline delineating the estimated completion dates of activities critical to the consulting project. c). A breakdown of the hours re qui red per critical activity. iv. The Department will review the Contracto(s

response and may elect not to have the Contractor perform any or all of the additional consulting projects or may request changes to the Contractor's response. v. The Department will elect to have the Contractor perform additional consulting projects at the Department's sole

discretion .


d. The Contractor shall not begin a consulting project without the prior written approval between the Department and the Contractor.


e. The Contractor shall not perform any consulting project for which funds are not available in the Contract.



4. Cooperation with Other Entities and Programs The Contractor shall develop processes and procedures and designate points of contact for collaboration with programs that serve children and their families including but not limited to the Nebraska Medicaid Managed Care Organizations. Collaboration is expected to ensure access to and provision of medical services for Medicaid elig ible children.


G. IMPLEMENTATION AND END OF CONTRACT Bidder should provide a response to each of the following contractor requirement in the space provided below.

The Contract shall have an Implementation Period and an End of Contract Period. 1. Implementation

a. The Implementation shall begin upon Contract award. The Implementation shall end on the Contractor Start Date. i. The Contractor Start Date shall not occur until the Contractor has completed all requirements of the

Implementation, including, but not limited to, the completion of the operational readiness review contained in the Implementation Plan, unless the Department provides written approval otherwise.

ii. The Contractor shall not engage in any work under the Contract, other than the work described below in the Implementation, prior to the Contractor Start Date .

iii. The Department shall not be liable to the Contractor for, and the Contractor shall not receive, any payment for any period prior to the Contractor Start Date.

Bidders Response: Bidder will comply with this requirement (See Technical Proposal pg. 38 - 39). The bidder and subcontractor agree that implementation begins on contract award. Implementation will end on the start date. The start date will not begin until the operation readiness review contained in the Implementation Plan is complete unless otherwise approved by the Department in writing.

b. Implementation deliverables I. During the Implementation , the Contractor shall :

a). Create a Policies and Procedures Manual that contains the policies and procedures for all systems and functions necessary for the Contractor to complete its obligations under the Contract.

b). Prepare all documents, forms, training materials, and any other documents, information and protocols that require approval by the Department.

Ii. The Contractor shall deliver all documents, forms, training materials, and any other documents, information and protocols that require approval by the Department to the Department for review and approval in a timely manner that allows the Department to review and approve these documents prior to end of the Implementation.

Bidders Response: Bidder will comply with this requirement (See Technical Proposal pg. 38-39).

c. Implementation Plan. i. During the Implementation, the Contractor shall create an Implementation Plan that contains, at a minimum,

all of the following: a}. A description of all steps, timelines and milestones necessary to fully transition the services

described in the Contract from a prior school based claiming services contractor or DHHS to the Contractor.

b). A description of all steps, timelines, milestones and deliverables necessary for the Contractor to be fu lly able to perform all work by the Go Live Date.

c). A listing of all personnel involved in the implementation and what aspect of the implementation for which they are responsible.

d). An operational readiness review for the DHHS to determine if the Contractor is ready to begin performance of all work.

e). The risks associated with the implementation and a plan to mitigate those risks. ii. The Contractor shall provide weekly updates to the DHHS throughout the Implementation that show the

Contractor's status toward meeting the timelines and milestones described in the DH HS-approved Implementation Plan.

iii. The Contractor shall ensure that all requirements of the Implementation are complete by the deadlines contained in the DHHS-approved Implementation Plan and that the Contractor is ready to perform all work by the Go Live Date.

iv. The Contractor shall deliver the Implementation Plan to the DHHS for review and approval. Bidders Response: Bidder will comply with this requirement (See Reports Section). The bidder and subcontractor will complete an Implementation plan which meets at a minimum all steps listed in this section, a thorough e. Weekly updates to the Department will be provided with shorter Intervals as needed or requested lo ensure successful Implementation. All requirements for Implementation will be completed by deadlines contained in the preapproved Plan. NASBMC and GSGI will be ready to perform all work by the Go Live Dale. This readiness will ensure a successful program for DHHS, the schools and the children who receive services.


Coordination will also occur between NASBMC, GSGI and DHHS regarding transition tasks, prioritization and any conflicting activities interfering with maintaining and operating daily business. At the conclusion of the transition phase, NASBMC and GSGI will provide a transition results report . This will provide the status of each high-level task and activity that took place during the transition period.

2. End of Contract Period a. The End of Contract shall begin on the earlier of ninety (90) days prior to the end of the last renewal year of the

Contract or notice by the Department of non-renewal, or termination of contract. b. The End of Contract shall end on the day the Department has accepted the final deliverable for the End of Contract.

as determined in the Department-approved and updated End of Contract Plan, and has determined that the end of contract is complete.

c. This End of Contract period may extend past the expiration/termination of the Contract and the requirements of the End of Contract shall survive expiration/termination of the Contract.

d. End of Contract Deliverables i. During the End of Contract Period, the Contractor shall complete all of the following:

a). Implement the most recent End of Contract Plan or End of Contract Plan Update that has been approved by the Department and complete all steps, deliverables and miles.tones contained in the most recent End of Contract Plan or End of Contract Plan Update that has been approved by the Department.

b). Provide to the Department, or any other contractor at the Department's direction, all reports, data, deliverables and other information reasonably necessary for a transition as determined by the Department or included in the most recent End of Contract Plan or End of Contract Plan Update that has been approved by the Department.

c). Ensure that all responsibilities under the Con1ract have been transferred to the Department, or to another contractor at 1he Department's direction, without significant Interruption.

d.) Notify any Subcontractors of the expiration/termination of the Contract, as directed by 1he Department.

e). Notify all school providers that the Contractor will no longer be the school based claiming services contractor as directed by the Department. The Contractor shall create these notifications and deliver them to the Department for approval.

f). Once the Department has approved the notifications, the Contractor shall deliver these notifications to all school providers , but in no even1 shall the Contractor deliver any such notification prior to approval of that notification by the Department.

g). Continue meeting each requirement of the Contract as described in the Department approved and updated End of Contract Plan , or until the Department determines that a specific requirement is being performed by the Department or another contractor, whichever is sooner. The Department will determine when a specific requirement is being performed by the Department or another contractor, and will notify the Contractor of this determination for that requirement.

h). The Contractor shall transfer both the RMTS and Cost Report Help Desk telephone number and email address to the Department upon request by the Department.

ii. The Department will perform an end of contract review to ensure that the Contractor has completed all requirements of the End of Contract Period. In the event that the Contractor has not completed all of the requirements of the End of Contract Period by the date of the expiration/termination of the Contract, then any Incomplete requirements shall survive termination of the Contract.

Bidders Response: Bidder will comply with this requirement (See Technical Proposal pg. 67-68) A turnover plan will be implemented, once approved by DHHS, to include, but ls not limited to:

• Transfer of information and documentation, including historical files of administrative claiming, direct services and specialized transportation claims;

• A quality assurance (QA) process to monitor turnover activities; • Notification to subcontractor of contract expiration • DHHS approved notification to school providers of contract expiration • Training plan for the DHHS or other staff in the delivery of the services; • Provision of a Turnover Results Report and access to GSGI staff with technical and operational expertise; • Appoint a DHHS approved manager to coordinate all turnover activities outlined in the DHHS-approved turnover plan.

Success will be measured by an acceptable turnover plan, requirements or results and turnover results report. Notlces required will be as prior approved by the Department. which will then be delivered by the bidder.

The telephone number and email address of the RMTS and Cost Report Help Desk will be transferred to the Department upon request.


e. End of Contract Plan i. The Contractor shall create an End of Contract Plan that describes all requirements, steps, timelines,

milestones and deliverables necessary to fully transition the services described in the Contract from the Contractor to the Department or to another contractor selected by the Department to be the school based claiming services contractor after the expiration/termination of the Contract.

ii. The End of Contract Plan shall also designate an individual to act as an end of contract coordinator, who will ensure that all requirements, steps, timelines, milestones and deliverables contained in the End of Contract Plan are completed and work with the Department and any other contractor to minimize the impact of the transition on school providers and the Department. The Contractor shall deliver the End of Contract Plan to the Department for review and approval Iii. The Contractor shall update the

End of Contract Plan, at least annually, to include any technical, procedural or other changes that impact any steps, timelines or milestones contained in the End of

Contract Plan, and deliver this End of Contract Plan Update to the Department for review and approval. Bidders Response: Bidder will comply with this requirement (See Technical Proposal pg. 67-68).

H. CONTRACTOR COMMUNICATION Bidder should provide a response to each of the following contractor requirement in the space provided below.

The Contractor shall create publications as follows: 1. School Provider Manual

a. The Contractor shall create a comprehensive School Provider Manual that includes, but is not limited to, all of the following topics: i . Definitions and abbreviations. ii. Program overview. iii . School provider enrollment. Iv. Direct medical service eligibility. v. Covered services. vi. Direct seNice provider qualifications. vii. RMTS overview including program features and processes. viii. Time study implementation guide. ix. Record keeping and documentation. x. Claims submission and billing. xi. Interim payments and reimbursement. xii. Annual cost reporting. xiii. Annual cost reconciliation and final payment. xiv. System guides for web based system(s) that includes RMTS and quarterly and annual costreporting. xv. Quality assurance and program reviews. xvi. Program features and processes pertaining to Medicaid Administrative Claiming (MAC).

Bidders Response: Bidder will comply with this requirement. (See Technical Proposal pgs. 38-39). b. The Contractor shall submit the School Provider Manual to the Department for review and approval.


c. The Contractor shall update the School Provider Manual as requested by the Department. Bidders Response: Bidder will comply with this requirement. (See Technical Proposal pgs. 38-39).

d. The Contractor shall submit all updates to the School Provider Manual to the Department for review and approval.


e. The Contractor shall not publish or make the updated School Provider Manual available to direct service providers or school employees performing administrative activities prior to the Department's approval of the updated School Provider Manual.


f. The Contractor shall create and maintain an electronic version of the School Provider Manual for publication to the general public. It shall include any appropriate hyperlinl<s as determined by the Contractor or the Department.



2. Newsletter a. The Contractor shall develop and publish an electronic school provider newsletter for school providers. The

newsletter shall meet the following requirements: I. Be in a Department approved format and template. ii. Be published at least quarterly on a schedule determined by the Department. iii. Be submitted to the Department for review and approval. iv. Contain information about, but not limited to, the RMTS, cost reports, quarterly time study percentages,

compliance and oversight, web-based systems, trainings, and programmatic features, reminders, deadlines or changes.

Bidders Response: Bidder will comply with this requirement (See Reports Section - Go in the Know and Quick Tips examples). b. The Contractor shall not publish any school provider newsletter prior to receiving Department approval to publish

that newsletter. Bidders Response: Bidder will comply with this requirement. (See Technical Proposal pgs. 38-39).

I. CONTRACTOR SUPPORT Bidder should provide a response to each of the following contractor requirement in the space provided below.

1. Help Desks a. RMTS Help Desk

i. The Contractor shall operate a RMTS Help Desk to receive and respond to communications from school providers regarding the RMTS.

ii. The Contractor shall ensure that the RMTS Help Desk will be able to receive and respond to communications received through telephone as well as through e-mail.

iii. The Contractor shall provide a toll-free telephone number and a general e-mail address for the RMTS Help Desk.

Iv. The Contractor shall ensure that the RMTS Help Desk is staffed and available to receive and respond to calls, al a minimum, between 8:00 am and 5:00 pm Central Time, every business day.

V, The Contractor shall have voice mail capability to receive calls when the RMTS Help Desk is not staffed. vi. The Contractor shall only use the voice mail system to receive calls when the RMTS Help Desk is not staffed,

unless the Contractor receives prior written permission from the Department to receive calls through this system at other times.

vi. The Contractor shall track call volume during all times that the RMTS Help Desk is available to receive and respond to calls.

viii. For each call received, the Contractor shall document all of the following: a) The name of the school provider or direct service provider. b) The school district in which the direct service provider practices. c) The general nature of the call. d} The resolution to the call.

Bidders Response: Bidder will comply with this requirement {See Technical Proposal P9S. 39-41 ). b. Cost Report Help Desk

I. The Contractor shall operate a Cost Report Help Desk to receive and respond to communications from school providers regarding the cost reports, interim rates and any cost settle amounts.

ii. The Cost Report Help Desk shall be able lo receive and respond to communications received via telephone as well as via e-mail.

iii. The Contractor shall provide a toll-free telephone number and a general e-mail address for the Cost Report Help Desk.

iv. The Cost Report Help Desk is staffed and available to receive and respond to calls, at a minimum, between 8:00 am and 5:00 pm, Central Time, every business day.

v. The Contractor shall have voice mail capability to receive calls when the help desk is not staffed. vi. The Contractor shall only use the voice mail system to receive calls when the Cost Report Help Desk is not

staffed, unless the Contractor receives prior written permission for the Department to receive calls through this system at other times.

vii. The Contractor shall track call volume during all times that the Cost Report Help Desk is available to receive and respond to calls.

viii. For each call received, the Contractor shall document all of the following: a) The name of the school provider. b) The District in which the school provider is located. c) The general nature of the call. d) The resolution to the call.


Bidders Response: Bidder will comply with this requirement {See Technical Proposal pgs. 39-41 ). C. Help Desk Performance Standard

The Contractor shall meet or exceed all performance standards at all times during the term of this contract. The performance standards under this contract are as follows: i. RMTS Help Desk

a) The Contractor shall respond to all e-mail and voice mail inquiries directed to the RMTS help desk within two (2) business days of receipt.

b) All e-mails and voice mails received by the RMTS help desk during a time when the help desk is not staffed shall be considered received at the beginning of the next period of time that the help desk is staffed.

ii. Cost Report Help Desk a) The Contractor shall respond to all email and voice mail inquiries directed to the Cost Report help

desk within two (2) business days of receipt. b) All e-mails and voice mails received by the Cost Report help desk during a time when the help desk is

not staffed shall be considered received at the beginning of the next period of time that the help desk is staffed.

Bidders Response: Bidder will comply with this requirement (See Technical Proposal pgs. 39-41 ). 2. Training

The Contractor shall develop an Annual Training Plan and conduct training classes for school providers. a. The Contractor shall create an Annual Training Plan that includes, but is not limited to, the following:

i. The number of training classes the Contractor will conduct during the coming year. a) The Contractor shall ensure that a minimum of five (5) training classes occur each year and that these

classes are held in multiple locations throughout the State of Nebraska. b) The Contractor shall ensure that a minimum of three (3) quarterly (Fall, Winter and Spring) online

system trainings occur each year. ii. The topics that each class will cover. Topics may include, but are not limited to, the following:

a) Cost report system. b) The RMTS. c) Audit policies and procedures. d) Changes to any cost report, RMTS or audit process or requirements. e) Changes to any electronic systems that directly affect how a school provider inputs or extracts data

from any of the Contractor's systems. f) The submission of the quarterly cost reports and their supporting auditable documentation. g) The submission of the annual cost report and its supporting auditable documentation. h) Trainings for new school providers during their first year in the program. i) Trending training needs based upon summary of calls and emails received by the RMTS and Cost

Report Help Desk. Bidders Response: Bidder will comply with this requirement (See Technical Proposal pgs. 56-64).

b. The Contractor shall provide the Annual Training Plan to the DHHS for review and approval. The DHHS may direct the Contractor to modify the topics covered, the materials used, and/or the location or timing of any proposed training class in the Annual Training Plan .

Bidders Response: Bidder will comply with this requirement. C. The Contractor shall implement the Annual Training Plan upon DHHS approval and shall conduct all t rainings at a

time and date specified by the DHHS. Bidders Response: Bidder will comply with this requirement.

d. The Contractor shall make all training sessions available through Internet based, real time broadcast of live training sessions if requested by the DHHS.

Bidders Response: Bidder will comply with this requirement. e. The Contractor shall make electronic, on-demand recordings of live training classes available if requested by the

DHHS. Bidders Response: Bidder will comply with this requirement.

f. The Contractor shall provide recorded trainings to the DHHS to be published on the DHHS' website upon DHHS request.

Bidders Response: Bidder will comply with this requirement. g. The Contractor shall be responsible for all costs associated with travel, lodging, meeting handouts and training

materials pertaining to the Contractor's portion of any meeting or training event. Bidders Response: Bidder will comply with this requirement.


J. DELIVERABLES See Attachment 1, Deliverables/Penalties.

See Attachment 3, Cost Proposal.


V. PROPOSAL INSTRUCTIONS This section documents the mandatory requirements that must be met by bidders in preparing the Technical and Cost Proposal. Bidders should identify the subdivisions of "Project Description and Scope of Work" clearly in their proposals; failure to do so may result in disqualification. Failure to respond to a specific requirement may be the basis for elimination from consideration during the State's comparative evaluation.

Proposals are due by the dale and time shown in the Schedule of Events. Content requirements for the Technical and Cost Proposal are presented separately in the following subdivisions; format and order:

A. PROPOSAL SUBMISSION

1. REQUEST FOR PROPOSAL FORM By signing the "Request for Proposal for Contractual Services" form. the bidder guarantees compllance with the provisions slated in this Request for Proposal, agrees to the Terms and Conditions stated in this Request for Proposal unless otherwise agreed to, and certifies bidder maintains a drug free work place environment.

The Request for Proposal for Contractual Services form must be signed in ink and returned by the stated date and time in order to be considered for an award.

Further, Section Ill. Terms and Conditions must be returned with the proposal response.

3. CORPORATE OVERVIEW The Corporate Overview section of the Technical Proposal should consist of the following subdivisions :

a. BIDDER IDENTIFICATION AND INFORMATION The bidder must provide the full company or corporate name, address of the company's headquarters, entity organization (corporation, partnership, proprietorship), state in which the bidder is incorporated or otherwise organized to do business, year in which the bidder first organized to do business and whether the name and form of organization has changed since first organized.

b. FINANCIAL STATEMENTS The bidder must provide financial statements applicable to the firm. If publicly held, the bidder must provide a copy of the corporation's most recent audited financial reports and statements, and the name, address, and telephone number of the fiscally responsible representative of the bidder's financial or banking organization.

If the bidder is not a publicly held corporation, either the reports and statements required of a publicly held corporation, or a description of the organization, including size, longevity, client base, areas of specialization and expertise, and any other pertinent information, must be submitted in such a manner that proposal evaluators may reasonably formulate a determination about the stability and financial strength of the organization. Additionally, a non-publicly held firm must provide a banking reference.

The bidder must disclose any and all judgments. pending or expected litigation, or other real or potential financial reversals, which might materially affect the viability or stability of the organization, or state that no such condition is known to exist.

The State may elect to use a third-party to conduct credit checks as part of the corporate overview evaluation.

c. CHANGE OF OWNERSHIP If any change in ownership or control of the company is anticipated during the twelve (12) months following the proposal due dale, the bidder must describe the circumstances of such change and indicate when the change will likely occur. Any change of ownership to an awarded vendor(s) will require notification to the State.

d. OFFICE LOCATION The bidder's office location responsible for performance pursuant to an award of a contract with the State of Nebraska must be identified.


e. RELATIONSHIPS WITH THE STATE The bidder shall describe any dealings with the State over the previous five (5) years. If the organization, its predecessor, or any party named in the bidder's proposal response has contracted with the State, the bidder shall identify the contract number(s) and/or any other information available to identify such contract(s}. If no such contracts exist, so declare.

f. BIDDER'S EMPLOYEE RELATIONS TO ST ATE If any party named in the bidder's proposal response is or was an employee of the State within the past six (6) months, identify the individual(s) by name, State agency with whom employed, job title or position held with the State. and separation date. If no such relationship exists or has existed, so declare.

If any employee of any agency of the State of Nebraska is employed by the bidder or is a Subcontractor to the bidder, as of the due date for proposal submission, identify all such persons by name, position held with the bidder, and position held with the State (including job title and agency). Describe the responsibilities of such persons within the proposing organization. If, after review of this information by the State, it is determined that a conflict of interest exists or may exist, the bidder may be disqualified from further consideration in this proposal. If no such relationship exists, so declare.

g. CONTRACT PERFORMANCE If the bidder or any proposed Subcontractor has had a contract terminated for default during the past five (5) years. all such instances must be described as required below. Termination for default is defined as a notice to stop performance delivery due to the bidder's non-performance or poor performance, and the issue was either not litigated due to inaction on the part of the bidder or litigated and such litigation determined the bidder to be in default.

It is mandatory that the bidder submit full details of all termination for default experienced during the past five (5) years, including the other party's name, address, and telephone number. The response to this section must present the bidder's position on the matter. The State will evaluate the facts and will score the bidder's proposal accordingly. If no such termination for default has been experienced by the bidder in the past five (5) years, so declare.

If at any time during the past five (5} years, the bidder has had a contract terminated for convenience, non-performance, non-allocation of funds, or any other reason, describe fully all circumstances surrounding such termination, including the name and address of the other contracting party.

h. SUMMARY OF BIDDER'S CORPORATE EXPERIENCE The bidder shall provide a summary matrix listing the bidder's previous projects similar to this Request for Proposal in size, scope, and complexity. The State will use no more than three (3) narrative project descriptions submitted by the bidder during its evaluation of the proposal.

The bidder must address the following:

i. Provide narrative descriptions to highlight the similarities between the bidder's experience and this Request for Proposal. These descriptions must include:

a) The time period of the project; b) The scheduled and actual completion dates; c) The Contractor's responsibilities; d) For reference purposes, a customer name (including the name of a contact

person, a current telephone number, a facsimile number, and e-mail address); and

e) Each project description shall identify whether the work was performed as the prime Contractor or as a Subcontractor. If a bidder performed as the prime Contractor, the description must provide the originally scheduled completion date and budget, as well as the actual (or currently planned} completion date and actual (or currently planned) budget.


ii. Contractor and Subcontractor(s) experience must be listed separately. Narrative descriptions submitted for Subcontractors must be specifically identified as Subcontractor projects.

iii. If the work was performed as a Subcontractor, the narrative description shall identify the same information as requested for the Contractors above. In addition, Subcontractors shall identify what share of contract costs, project responsibilities, and time period were performed as a Subcontractor.

i. SUMMARY OF BIDDER'S PROPOSED PERSONNEUMANAGEMENT APPROACH The bidder must present a detailed description of its proposed approach to the management of the project.

The bidder must identify the specific professionals who will work on the State's project if their company is awarded the contract resulting from this Request for Proposal. The names and titles of the team proposed for assignment to the State project shall be identified in full, with a description of the team leadership, interface and support functions, and reporting relationships. The primary work assigned to each person should also be identified.

The bidder shall provide resumes for all personnel proposed by the bidder to work on the project. The State will consider the resumes as a key indicator of the bidder's understanding of the skill mixes required to carry out the requirements of the Request for Proposal in addition to assessing the experience of specific individuals.

Resumes must not be longer than three (3) pages. Resumes shall include, at a minimum, academic background and degrees, professional certifications, understanding of the process, and at least three (3} references (name, address, and telephone number) who can attest to the competence and skill level of the individual. Any changes in proposed personnel shall only be implemented after written approval from the State.

j . SUBCONTRACTORS If the bidder intends to Subcontract any part of its performance hereunder, the bidder must provide:

i. name, address, and telephone number of the Subcontractor(s}; ii. specific tasks for each Subcontractor(s}; iii. percentage of performance hours intended for each Subcontract; and iv.

total percentage of Subcontractor(s} performance hours.

3. TECHNICAL APPROACH The technical approach section of the Technical Proposal must consist of the following subsections:

a. Understanding of the project requirements; b. Proposed development approach; c. Technical considerations; d. Detailed project work plan; and e. Deliverables and due dates.

8. COST PROPOSAL REQUIREMENTS This section describes the requirements to be addressed by bidders in preparing the Cost Proposal. The bidder must submit the Cost Proposal in a section of the proposal that is a separate section or is packaged separately as specified in this RFP from the Technical Proposal section.

The component costs of the fixed price proposal for providing the services set forth in the Request for Proposal must be provided by submitting forms substantially equivalent to those described below.

1. PRICING SUMMARY This summary shall present the total fixed price to perform all of the requirements of the Request for Proposal. The bidder must include details in the Cost Proposal supporting any and all costs. These details


must include, at a minimum, detailed descriptions and/or specifications of the goods and/or services to be provided, quantities, and timing and unit costs, if applicable.

The State reserves the right to review all aspects of the Cost Proposal for reasonableness and to request clarification of any proposal where the cost component shows significant and unsupported deviation from industry standards or in areas where detailed pricing is required.

2. PRICES Prices quoted shall be net, including transportation and delivery charges fully prepaid by the bidder, F.0.8. destination named in the Request for Proposal. No additional charges will be allowed for packing, packages. or partial delivery costs. When an arithmetic error has been made in the extended total, the unit price will govern.

C. PAYMENT SCHEDULE The payment schedule for the project is tied to specific dates and deliverables. Invoices may be submitted by the Contractor on specific dates based on the completion and acceptance of related deliverables. No invoice will be approved unless the associated deliverables have been approved.

The Contractor shall be compensated based upon the terms and conditions set forth in Section. Ill, Terms and Conditions, Subsection II, Payment. Method of compensation shall be quarterly based upon the DHHS' approval of deliverables required under Section. IV, Project Description and Scope of Work, Subsection J, Deliverables. Payments shall begin upon the contract start date and will be based upon the contracted amount as indicated on the Cost Sheet. Payments shall be distributed equally every quarter, pending submission of invoice.

Contract Term Claiming Quarter Deadline for Invoice Submission

June 1, 2017-May31, 2018 June, July, August 2017 November 15, 2017

September, October, November 2017 February 15, 2018

December 2017, January, February 2018 May 15, 2018

March. April, May 2018 July 15, 2018

June 1. 2018-May 31, 2019 June, July, August 2018 November 15, 2018

September. October, November 2018 February 15, 2019


March, April, May 2019 July 15, 2019

June 1, 2019-May 31, 2020 June, July, August 2019 November 15, 2019

September, October. November 2019 February 15, 2020



June 1, 2020-May 31. 2021 June, July, August 2020 November 15, 2020

September. October, November 2020 February 15, 2021



June 1, 2021-May 31, 2022 June, July, August 2021 November 15. 2021

September, October, November 2021 February 15, 2022




Form A Bidder Contact Sheet

Request for Proposal Number 553121

Form A should be completed and submitted with each response to this Request for Proposal. This is intended to provide the State with information on the bidder's name and address. and the specific person(s) who are responsible for preparation of the bidder's response.

Preparation of Response Contact Information

Bidder Name: Nebraska Association of School Boards Medicaid Consortium

Bidder Address: 1311 Stockwell Street; Lincoln, NE 68502

Contact Person & Title: 1ohn C. Spatz, Chief Executive Officer

E-mail Address: [email protected]

Telephone Number (Office): (402) 423-4951

Telephone Number (Cellular) : (402) 440-2496

Fax Number: (402) 817-0289

Each bidder shall also designate a specific contact person who will be responsible for responding to the State if any clarifications of the bidder's response should become necessary. This will also be the person who the State contacts to set up a presentation/demonstration, if required.

Communication with the State Contact Information

Bidder Name: Nebraska Association of School Boards Medicaid Consortium

Bidder Address: 1311 Stockwell Street; Lincoln, NE 68502

Contact Person & Title: Matthew G. Dunning, Chief Operating Officer

E-mail Address: [email protected]

Telephone Number (Office): (402) 423-4951

Telephone Number (Cellular) : (402) 889-5889

Fax Number: (402) 817-0289

SPB RFP Revised: 01/29/2016

1 •

NEB~,l\ £~,L\_ Good Life. Great Service.

DEPT. OF ADMINISTRATIVE SERVICES

Date: March 2, 2017

To: All Bidders

ADDENDUM ONE, REVISED SCHEDULE OF EVENTS

From: Michelle Thompson/Teresa Fleming, Buyer AS Materiel State Purchasing

RE: Addendum for Request for Proposal Number 5531 Z1 to be opened March 10, 2017 March 16, 2017 at 2:00 p.m. Central

Schedule of Events

The State expects to adhere to the tentative procurement schedule shown below. It should be noted, however, that some dates are approximate and subject to change. It is the Bidder's responsibility to check the State Purchasing Bureau website for all addenda or amendments.

ACTIVITY 3. State responds to written questions through Request for Proposal

"Addendum" and/or "Amendment" to be posted to the Internet at: htto://das.nebraska.aov/materiel/ourchasina.html

4. Proposal opening Location: State Purchasing Bureau

1526 K Street, Suite 130 Lincoln. NE 68508

5. Review for conformance of mandatory requirements

6 . Evaluation period

7. "Oral Interviews/Presentations and/or Demonstrations" {if reauiredl

Bo Botelho, Chief Operations Officer

1rtment of Administrative Services I MATERIEL DMSION

. _., K Street, Ste. 130

Lincoln. Nebraska 68508

das.nebraska.org

OfFICc 402-471-0972 FAX 402-471-2089

DATE/TIME

i;'.el:m1ai=y 27, 2G17 March 2, 2017

Mai:sh 1G. 2G~ 7 March 16, 2017

2:00 PM Central Time

March 1 D, 2017 March 16, 2017 Marsh 1 e. 2G17

March 21, 2017 -Amil 14. 2017

TBD

Name Date Page2

8.

9. 10. 11 . 12.

ACTIVITY Post "Letter of Intent to Contract" to Internet at: htto://das.nebraska.aov/materiel/nurchasinc.html Contract finalization oeriod Contract award Implementation Contractor start date

DATE/TIME

April 24, 2017

Aoril 24. 2017 Mav 22, 2017 June 1, 2017

GstebeF 1. 201 + September 1. 2017

\ Admi n i st r ativeServices Byron L. Diamond

Director

Pete Ricketts, Governor

ADDENDUM TWO, QUESTIONS and ANSWERS

Date: March 2, 2017

All Bidders To:

From: Michelle Thompson/Teresa Fleming, Buyers AS Materiel State Purchasing

RE: Addendum for Request for Proposal Number RFP Number 5531 21 to be opened March 10, 2017 March 16, 2017 at 2:00 p.m. Central Time

Questions and Answers

Following are the questions submitted and answers provided for the above mentioned Request for Proposal. The questions and answers are to be considered as part of the Request for Proposal. It is the Bidder's responsibility to check the State Purchasing Bureau website for all addenda or amendments.

Materiel Division • Bo Botelho, Materiel Administrator

Administrative Services • 1526 K Street. Suite 130 • Lincoln, Nebraska 68508 • Phone: 402-471-6500 • Fax: 402-471-2089

Question RFP RFP Question Number Section Page

Reference Number

1. I.A. Page 1 Based on the tentative procurement schedule, the The contract amended to S

IV.G.1.a Page 36 Implementation Date is defined as 6/1/17, and the quarter will b(

V.C. Page 44 Contractor Start Date as 10/1 /17.

2017 quarter. Based on these tentative dates, what is the initial claiming quarter that the state anticipates the awarded Please see vendor will administer? For example: Schedule of E

• If the Jun-Aug 2017 quarter is to be the initial claiming quarter, how will the summer time study results be calculated? Are the existing vendors expected to complete Jun-Aug 2017 claim? If not, will the new State vendor be provided the time study results from the State, and then collect financial data from each participating district?

• If the Sep-Nov 2017 quarter is the initial claiming quarter, and the Contractor Start Date remains Oct 1 (the middle of the 2nd quarter), how will the RMTS be conducted for the Sep-Nov quarter?

Any additional clarification regarding the above scenarios and anticipated first claiming quarter would be helpful.

2. IV.A Page 30 Current direct service categories include PT, OT, and This is not a c

Speech. Is it correct to assume that these categories The bidder sh, will comprise one cost pool to also be used for Cost

best meets thE Settlement? And, all other categories will comprise the other cost pool, that will be used for Administrative

See the respo Claiming purposes only? Then, once services are expanded, the cost pool construction will change to the newly approved categories?

Or, is it expected that the current plan, with the existing cost pool structure, be followed until a new plan can be approved by CMS?

Does the State know how it plans to capture the Medicaid IEP ratio used for Cost Settlement? Or, will this be part of the CMS negotiations for a new State Plan?

3. IV.A Page 30 Please confirm that the State plans to follow the The State current State Plan Amendment (SPA), until a modified communicatio SPA is submitted and approved by CMS? Does the implementatio State have an anticipated date for the submission of Settlement M1 the revised SPA? will be require

the language 1 4. V.A.3.a Page 43 The Technical Approach, which is approximately 55% Section V.A.3.

of the total points, is broken into 5 subsections. Does to pages 31-41 section a."Understanding of the project requirements" correlate to pages 31-40?

5. V.A.3.a Page43 Does 3.b. 'Proposed Development Approach' include Section V.A.3. the development of operational methodology to be to the de'J followed to implement RMTS and Cost Settlement? methodology < Or, does it also include the development of the for impleme technology methodology for implementing RMTS and Settlement ap Cost Settlement aoolications?

6. V.A.2. Page 41- Please validate that the Corporate Overview, which The Corpora1 Evaluation 43 includes Experience and Staffing is only 140 points, or points. Criteria 2% of the total points.

7. Ill.FF Page 19 Is the requirement of a $2,000,000.00 Performance The Performc Bond only for a company that has a contract awarded, from the bid· or is it a requirement that a Performance Bond be contract. included as part of the RFP response?

8. IV.C.4 Page 32 The RFP calls for the establishment of monthly, DHHS does provider specific interim rates via an approved settlement sys methodology. Can you please provide the existing DHHS does interim rate methodology used by the State of established be Nebraska?

9. IV.C.5 Page 32 Can you please provide the name of the existing The State of r contracted Medicaid provider enrollment vendor and have a contra, share the existino contract terms?

10. IV.D.1.c Page 33 The RFP states "The Contractor shall make available Documents in

to the Department reports in exportable documents." acceptable. A IV.D.2.c Does the State have a definition or a preference for be approved t

IV.D.3.g the type or format of "exportable documents?"

IV.D.4.c 11 . IV.F.3.a-e Page 35- Please confirm that this section of the RFP outlines The consultir

36 "oossible" consulting oroiects that mav be reauested scope of the c

Page3

outside of the scope of this RFP. paid per hou quarterly pay1 Optional Fixec

12. IV.C2.b 31 How many separate cost pools (time studies) are Two - direct a

there? 13.

IV.C2.b 31 How many moments are sent out for each time study? Under the cur only one pn estimated bet\

14. IV.C.5.a 32 How many direct service providers are in the Currently, the

program? being provic Occupational Therapy. Not therapies.

15. IV.E.5.a 34 Regarding the direct service provider audits, are 3.e - The contracto

direct service provider qualifications, 4.d - educational the items incl records and Medicaid enrollment the areas being Auditing Requ audited???

As part of the ~ should providi meet the requ

16. What organization is currently providing the requested See the respo services and what has been their quarterly payment?

17. 31 Bidder's response 2.b.v - Establish the time frame for The State's gc RMTS to be within 7:00 AM and 4:00 PM.

a. School districts may maintain hours frame is to giv State of Nebri:

inconsistent with these hours. Mandating all and same cha RMTS moments to be pulled for these specified moment even time ranges may negatively impact the RMTS

fluctuate betw results statewide by creating moments when and Mountain participants are not at work. Would it be

location of the acceptable to obtain working hours for each school district/LEA individually to lessen the The bidder sh, chances of selecting participants who are not at that best meel work? RFP.

Page4

18. 31 Bidder's response 2.c - The Contractor shall ensure It refers to ma the ability to duplicate each random sampling that is an individual n conducted.

a. This request is a bit confusing as there is no way to ensure the ability to duplicate any random sample universe if it is truly randomized. Does this refer to maintain a master copy of each random selected universe or does this refer to maintaining a duplicate copy of an individual moment sample? Please clarify this requirement.

19. 31 Bidders response 4 - Interim Rate Setting The interim r; specific proce,

a. Please confirm if the interim rates referred to to direct servic are School specific procedure code rates to be applied to direct services claims or Interim payments that are calculated for each school district to pay out estimated CR payments in advance of each year's annual cost reconciliation payment.

20. 31 Can you please provide a current copy of the MIPS The State of billing guide and any other DHHS guidance as to the MIPS billing 91 current Administrative claiming and Annual Cost reconciliation programs?

21 . 31 The Schedule of events on page 1 of the RFP lists a See the respo Contractor Start Date of October 1, 2017. However, on page 44 of the RFP there is a chart of Contract Terms that shows a contract Term starting on June 181, 2017 - and a deadline for invoice submissions for the JUN-AUG 2017 quarter. Please clarify either the contract start date or the contract term to match.

22. 31 What vendor(s) is the state/individual LEAs currently See the respo contracted with for these services?

Pages

23. 31 How much revenue has each LEA received for the last The State curr 4 years from the NE Education-Based Medicaid consortiums. Administrative Claiming Program and Cost Settlement process (broken down bv vear and orooram)

24. Section 1 - 1 The introductory paragraph of this section references See Section II Scope of that any contract resulting from this RFP is not the exclusive. For clarification purposes, no public school See the respo1 Request for or ESU will be required to utilize the services of the Proposal vendor awarded the contract for services described in

this RFP, correct? 25. N/A N/A Would the resulting contract for services described in No. The inten

this RFP eliminate the ability for districts to create a is to procure consortium under Nebraska's lnterlocal Cooperation agent/contrac1 Act (Nebraska R.R.S. §13-801 thru §13-827) and scope of the S(

Joint Public Agency Act (Nebraska R.R.S. §13-2501 statewide. thru &13-2550) to provide these same services?

26. N/A N/A As referenced in the Nebraska Education Based The bidder wh Medicaid Administrative Claiming (NEBMAC) Guide, be the sole en would the resulting contract for services described in of services de this RFP eliminate consortiums with Intergovernmental agreements to submit claims under the NEBMAC program? This reference may be found in Section Ill of the NEB1VIAC Guide.

27. N/A NIA If the resulting contract for services described in this Changes may RFP require changes to the NEBMAC Guide, will those changes require Centers for Medicare & Medicaid Services (CMS} approval prior to implementation?

28. General General Does the state currently utilize a vendor to perform See the respo any of the services outlined in the RFP? If so, who is the current vendor and what is the annual contract value?

29. B. Project 30 Has the state already submitted SPA language to See the respo Environ me CMS for the implementation of a Medicaid cost nt settlement methodology? If not, will the selected

vendor be responsible for drafting this language, and supporting the state throughout the aooroval process?

30. B. Project 31 Is the Medicaid in Public Schools (MIPS) and MIPS and NEI

Page6

Environme Nebraska Education Based Medicaid Administrative managed care nt Claiming (NEBMAC) programs carved out of the

managed care program? Will DHHS expand upon or provide some examples of how the selected vendor is expected to interact with the 3 MCOs?

31 . 2. 31 Is the Department's current RMTS methodology See the respo Statewide approved by CMS? Can DHHS make the current RMTS version available to orosoective bidders?

32. 4. Interim 32 Will the selected vendor be responsible for collecting The contract( Rate the data necessary to calculate interim rates directly collecting the Setting from school providers, or does DHHS currently have interim rates

this information? providers. 33. 3. Annual 33 Can DHHS provide the CMS approved methodology Link to CMS:

Cost language pertaining to cost report collection occurring Reporting by October 1st of each year? Or is this date subject to It is the centre

change based on SPA approval? and understar methodoloov.

34. 4. Auditing 34 Will DHHS provide clarity on what will be provided to The contracto Requireme the selected vendor in regards to auditing MMIS MMIS system. nts claims? Will the vendor have direct access to the The auditing o

states MMIS systems? How often are claim audits outlined in the performed for each district? Has the audit process The audit pre historically included reviewing IEPs for service IEPS, documE documentation, session notes, provider credentials, provider crede etc.? If so, how many claims are audited per contract The Contractc year? fifty percent (!

are audited du direct service once every thr

35. 1.School 38 Does a School Provider Manual exist today? If so, can There is not a Provider the Department make the current version available to exists today. Manual prospective bidders?

This addendum will become part of the proposal and should be acknowledged with the Request for Proposal.

Page7

Pages

Good Life. Great Service.

DEPT. OF ADMINISTRATIVE SERVICES

ADDENDUM THREE

Date: March 3, 2017

To: All Bidders

From: Michelle Thompson/Teresa Fleming, Buyer AS Materiel State Purchasing

RE: Addendum for Request for Proposal Number 5531 Z1 to be opened March 16, 2017 at 2:00 p.m. Central

Due to a formula error in Attachment 3, Cost Proposal; the State has posted Attachment 3, Cost Proposal- REVISED dated 3/3/2017.

This addendum will become part of the proposal and should be acknowledged with the Request for Proposal.

Bo Botelho, Chief Operations Officer

"'clrtment of Administrative Services I MATERIEL D1v1s10N

J K Street, Ste. 130 Lincoln, Nebraska 66508

das.nebraska.org

OFFICE 402•471-0972 FAX 402,471-2089

Corporate Overview NASBMC

NASBMC Nebraska Association of School Boards

MEDICAID CONSORTIUM

Nebraska Association of School Boards Medicaid Consortium (NASBMC)

Corporate Overview

Provided in response to State of Nebraska (State Purchasing Bureau) Request for Proposal for·Contractual Services Form (RFP 5531Zl)

a. Bidder Identification and Information

Nebraska Association of School Boards Medicaid Consortium (NASBMC) 1311 Stockwell Street Lincoln, NE 68502 Contact: Matthew G. Dunning; (402) 817·0288; [email protected]

NASBMC is an Interlocal Government Entity, formed under the Nebraska Interlocal Cooperation Act, organized in the State of Nebraska.

NASBMC was first organized to do business in 2009, and the name and form of the organization has not changed since that time.

The NASB Medicaid Consortium (NASBMC) is a program created by the Nebraska Association of School Boards (NASB) that exists to help Nebraska School Districts and Educational Service Units (ESU) request recoveries on expenses eligible for Medicaid reimbursement. NASBMC has a demonstrated record of success, and its character, integrity, reputation, judgment, experience and efficiency are demonstrated in its performance as a subrecipient under the Nebraska Education-Based Medicaid Administrative Claiming Subaward from the Nebraska Department of Health and Human Services. Federal law authorizes federal grants to be paid to schools and ESUs for a portion of expenditures a school or ESU spends for medical assistance to students. NASBMC helps their members easily submit their Medicaid administrative expenditure claims to receive the allowable federal matching funds. Working closely with the Department of Health and Human Services (DHHS), the NASBMC ensures that reimbursed dollars are maximized, with as minimal amount of interference as possible from the school districts' daily responsibilities.

NASBMC works with Go Solutions to help collect and submit all the data required by the DHHS for reimbursable claims. If a district becomes an NASBMC member, the NASBMC and Go Solutions will work with that district, providing the proper training and documents needed to submit the claims. Go Solutions works to ensure that all claims are in full compliance with all of the applicable policies and procedures required by DHHS and the

Federal Centers for Medicare & Medicaid Services (CMS). Currently, there are more than 200 school districts from across the state of Nebraska participating in the NASBMC.

NASBMC is an associated organization of the Nebraska Association of School Boards (NASB), which is a private, nonprofit organization that serves the needs of Nebraska's public schools. Since 1918, NASB has been committed to serving school boards across the state. NASB's mission to enhance public education for the children of Nebraska is assembled upon the beliefs that:

Every public school board will govern effectively and with integrity.

Every public school board member will understand the importance, and emphasize increased student achievement.

Every public school board will practice good stewardship of resources.

In support of the stated beliefs, NASB provides a variety of supportive programs, including NASBMC, which are managed by a professional staff; governance oversight is carried out by a statewide Board of Directors consisting of 24 school board members elected by their peers. NASBMC's relationship with NASB makes NASBMC uniquely qualified to perform this project on a statewide basis. NASB is the only statewide organization representing school boards, and NASB's access to school districts throughout the state will enable NASBMC to successfully establish and implement the Random Moment Time Study project, and complete it successfully, and timely. This has been the record of NASBMC's performance under the subaward with DHHS; with the support of Go Solutions, NASBMC anticipates that the same level of success will be achieved on the RMTS project.

b. Financial Statements

Please see the attached Financial Statements, and bank reference. There are no judgments, pending or expected litigation, or other real or potential financial reversals which might materially affect the viability of NASBMC.

c. Change of Ownership

There is no anticipated change of ownership or control of NASBMC in the next twelve (12) months.

d. Office Location

NASBMC is located at 1311 Stockwell Street in Lincoln, Nebraska.

e. Relationships with the State

NASBMC is a subrecipient under a Nebraska Education-Based Medicaid Administrative Claiming Subaward from the Nebraska Department of Health and Human Services, and has received such a subaward for each of the past five (5) years.

f. Bidder's Employee Relations to State

No party named in NASBMC's proposal response is or was an employee of the State of Nebraska within the past six (6) months.

g. Contact Performance.

Neither NASBMC nor GSGI has had a contract terminated for default during the past five (5) years.

h. Summary of Bidder's Corporate Experience

NASBMC has been a subrecipient under a Nebraska Education·Based Medicaid Administrative Claiming Subaward from the Nebraska Department of Health and Human Services since 2009, and has received such a subaward for each of the past five (5) years. NASBMC has contracted with Go Solutions Group, Inc. (GSGI, or Go Solutions) in providing services to the school districts who are members of the NASBMC Medicaid Consortium. Further information regarding this corporate experience is contained in Go Solutions' Technical Proposal, at pages 7 · 8. Go Solutions performed approximately 82% of the work under the subaward, and NASBMC performed approximately 18% of the work under the subaward.

i. Summary of Bidder's Proposed Personne1/Management Approach

NASBMC will manage this project with Matthew G. Dunning, Chief Operating Officer, and Rachel Horstman, Chief Financial Officer for NASBMC, and will subcontract with Go Solutions. Please see attached resumes and references and Go Solutions' Technical Proposal.

Matt Dunning will be responsible for coordinating the relationship between NASBMC and Go Solutions, and will oversee the marketing, training, information technology and other services to be provided to the school districts under the project.

Rachel Horstman will be responsible for all financial reporting, audit preparation, cash flows and oversight of the financial operations for the project, and will coordinate with Go Solutions in the delivery and management of data and other information as needed.

j. Subcontractors

NASBMC will be using Go Solutions as a subcontractor:

Go Solutions Group, Inc. 5840 Enterprise Drive Lansing, MI 48911 ·4107 Phone: (800) 260 · 2544 or (517) 853 - 6556

Go Solutions will be responsible for the tasks as specified in its Technical Proposal, enclosed, and will be responsible for 82% of the performance hours under the project, and 100% of the performance hours under its subcontract.

PROFILE

MATTHEW G. DUNNING 18815 Bennington Road; Bennington, NE 68007

(402) 889·5889 MGDunningLA [email protected]

Accomplished attorney with extensive experience managing risk for clients in highly regulated environments. Strengths include analytical and problem·solving skills, research and writing expertise, and the ability to negotiate and resolve complex disputes. Selected accomplishments:

• Advised large non·profit organization regarding employment compliance issues across eleven jurisdictions, including the District of Columbia.

• Successfully represented state agency in numerous administrative and judicial proceedings.

• Defended clients against discrimination and harassment claims in state and federal court in Iowa and Nebraska, and in administ1·ative proceedings in multiple states.

• Litigated issues arising out of employment contracts, including for·cause terminations and non·competition and non-solicitation ag1·eements.

ExPERIENCE

Nebraska Association of School Boards 2016-present • Responsible for legal affairs of Association and its affiliated organizations,

including for·profit technology subsidiary. • Drafted, negotiated and reviewed purchase agreements, service contracts,

membership agreements, and other commercial business agreements. • Supported Association recruiters conducting superintendent searches for

school districts. • Advised school boards and administrators on state and federal education

laws and regulatory requirements including FERPA and HIPAA.

Father Flanagan,s Boys' Home (Boys Town) 2012-2016 • Advised management and human resources personnel regarding wage

hour, wage payment, and wage notification requirements under applicable state and federal law, including independent contractor issues.

• Analyzed FMLA and ADA issues and leave of absence accommodation 1·equirements under state laws throughout the country.

• Advised organization regarding various privacy and confidentiality issues, including HIP AA and GINA.

• Investigated allegations of unlawful discrimination and harassment; defended administrative claims in multiple jurisdictions.

• Prepa1·ed and revised policies to comply with laws for all Boys Town sites.

State of Nebraska, Department of Health and Human Services 2008-2012 • Advised agency on Medicaid compliance issues, including extensive

analysis of state and federal statutory and regulatory framework. • Advised Chief Executive Officer and Division Directors on significant

conti·oversies involving complex legal issues. • Defended agency from various participant and provider appeals. • Worked with Administrator and Deputy Administrator of legal division to

defend agency against litigation.

Stinson Morrison Hecker LLP 1998-2008 • Defended clients in state and federal courts in Nebraska and Iowa and in

administrative proceedings. • Counseled employers regarding interplay of ADA, FMLA and workers

compensation, including review and analysis of regulations and case law. • Worked with risk management and human resources personnel in

conducting investigations of diverse groups of employees at various levels. • Advised employers regarding employee handbooks, workplace policies and

independent contractor and employment agreements. • Litigated several cases involving non-compete agreements. • Defended claims of breach of fiduciary duty and wrongful denial of

benefits under Employee Retirement Income Security Act. • Supervised paralegal staff including workload balance, opportunities for

continuing legal education and professional development.

Kennedy Holland DeLacy and Svoboda 1993-1998 • Developed litigation and counseling expertise in employment law. • Developed experience in various areas of litigation.

EDUCATION State University of New York at Buffalo, J.D. (cum laude) University of Nebraska at Lincoln, B.A., Philosophy

ADMISSIONS AND AsSOCIATIONS • President and Board Member, Legal Aid of Nebraska Board of Directors. • Admitted: State Bar of Neb1·aska, Omaha Tribe of Nebraska Tribal Court,

District of Nebraska Federal Court and Eighth Circuit Court of Appeals. • Delegate to the Nebraska State BaT Association House of Delegates. • Nebraska Supreme Court Minority Justice Diversity Subcommittee • Contributing Editor, Employment Discrimination Law 4th Edition, BNA.

Pl.JBLIC SPEAKING • Beyond the Basics··Advanced ADA and FMLA Issues • The ADA: Permissible Inquiries and Employee 1\/Iedical Records • Estate Planning and Probate Seminar, Ivledicaid Issues in Probate

Patty Zieg 1327 S 35th Avenue Omaha, NE 68105 (402) 7 40·9904

Deb Wiens Immanuel Communities 1044 N 115th St Suite 500 Omaha, NE 68154 (402) 829·2920

Bob Kmiecik Stinson Law Firm 1299 Farnam St Omaha, NE 68102 (402) 930· 1713

David J. Kramer Baird Holm LLP 1700 Farnam Street Suite 1500 Omaha, NE 68102·2068 (402) 636·8306

EXPERIENCE

RACHEL HORSTMAN 73665 611 Ave.

Sterling, NE 68443

(402) 866-2012 [email protected]

Nov 2003 - Present Nebraska Association of School Boards Lincoln, NE Business Manager

• Operate and oversee computerized accounting system (Sage/Peachtree)

• Prepart: financial reports for multiple companies (ALICAP, CoW1cil of School Attorneys, NASB, NETS, NASB Medicaid Consortiwn)

• Present financial statements and other financial data to respective boards

• Assist Executive Director with annual budget planning

• Manage all casI1 flow matters and cash requirements for multiple companies

• Prepare and issue monthly payroll and complete monthly, quarterly, and annual payroll tax forms

• Serve as lead in annual audit preparation and assistance for multiple financial audits

• Prepare and enter monthly adjusting journal entries for insurance program following Statutory Accow1ting Principals

• Prepare and file Personal Property tax return

• Manage asset software (FAS) for annual depreciation calculations

• Oversee Medicaid reimbursements and serve as Cl•'O of the Medicaid reimbursement program

• Issue cash disbursements for multiple companies and oversee NASB payahles

• Supervise Accounting & Data Specialist

Mar 2003 - Nov 2003 HobbyTown USA Lincoln, NE Corporate Accountant

• Processed monthly Financial Statements for Ilobby'l'own USA franchises

• Audited general ledgers of franchise stores and made adjusting journal entries

• Printed checks for check-writing stores and reconciled their bank statements

• J\nswered accounting/sales phone inquiries of store owners

Jun 2001- Mar 2003 DAC Services Lincolnt NE Accou11ting Assistant

• Handled accounts receivable situations and customer inquiries

• Applied incoming payments to the appropriate :i.ccounts

• Recorded, paid, and invoiced all emergency services

• Prepared NE and CA sales tax returns

• Coordinated kit orders and supply orders

Apr 2000 - Jun 2001 Lincoln Benefit Life Lincoln, NE Accou11ting Assistant

• Prepared cash receipts for Allstate business

• Entered journal entries and corrected on-line errors ofjoumal entries

• Encoded checks and prepared them for daily deposit

Data Prep Clerk • Reviewed customer applications for accuracy and completeness

• Contacted agents to verify any questions on applications

• Input application information on system in a timely manner

EDUCATION

Oct 2006 - May 2009 Doane College Lincoln, NE • Earned a Bachelor's Degree in Accounting

Oct 1998 - Ma.r 2000 Southeast Community College Lincoln, NE

REFERENCES

• Earned an Associate's Degree in Business Administration with a focus in Accounting

Lyndee Black Lincoln, NE

[email protected] 402-467-2700

Andy Detlefsen Lincoln, NE


J aqut: Collison Pierce, NE


Sallie Svatora Waverly, NE


I •

Board of Directors NASB Medicaid Consortium Lincoln, NE

, Cl iftonLarsonAllen

CliftonlarsonAllen LLP ClAronnect.c.om

We have audited the financial statements of NASB Medicaid Consortium (the Organization) as of and for the year ended August 31, 2015, and have issued our report thereon dated May 13, 2016. We have previously communicated to you information about our responsibilities under auditing standards generally accepted in the United States of America, Government Auditing Standards, and 0MB Circular A-133, as well as certain information related to the planned scope and timing of our audit. Professional standards also require that we communicate to you the following information related to our audit.

Significant audit findings Qualitative aspects of accounting practices

Accounting policies

Management is responsible for the selection and use of appropriate accounting policies. The significant accounting policies used by the Organization are described in Note 1 to the financial statements.

·1 . . - No new accounting policies were adopted and the application of existing policies was not changed

during 2015.

We noted no transactions entered into by the entity during the year for which there is a lack of authoritative guidance or consensus. All significant transactions have been recognized in the financial statements in the proper period.

Accounting estimates Accounting estimates are an integral part of the financial statements prepared by management and are based on management's knowledge and experience about past and current events and assumptions about future events. Certain accounting estimates can be particularly sensitive because of their significance to the financial statements and because of the possibility that future events affecting them may differ significantly from those expected. There were no accounting estimates affecting the financial statements which were particularly sensitive or required substantial judgments by management.

Financial statement disclosures

Certain financial statement disclosures ·can be particularly sensitive because of their·significance to financial statement users. There were no particularly sensitive financial statement disclosures. .. . . _ .....

The financial statement disclosures are neutral, consistent, and clear.

Board of Directors NASB Medicaid Consortium Page2

Difficulties encountered in performing the audit We encountered no significant difficulties in dealing with management in performing and completing our audit.

Uncorrected misstatements

Professional standards require us to accumulate all misstatements identified during the audit, other than those that are clearly trivial, and communicate them to the appropriate level of management. Management did not identify and we did not notify them of any uncorrected financial statement misstatements.

Corrected misstatements Professional standards require us to accumulate all misstatements identified during the audit, other than those that are clearly trivial, and communicate them to the appropriate level of management. There were no misstatements identified during the audit.

Disagreements with management For purposes of this letter, a disagreement with management is a financial accounting, reporting, or auditing matter, whether or not resolved to our satisfaction, that could be significant to the financial statements or the auditors' report. No such disagreements arose during our audit.

Management representations · We have requested certain representations from management that are included in the management

representation letter dated May 13, 2016.

Management consultations with other independent accountants In some cases, management may decide to consult with other accountants about auditing and accounting matters, similar to obtaining a "second opinion" on certain situations. If a consultation involves application of an accounting principle to the entity's financial statements or a determination of the type of auditors' opinion that may be expressed on those statements, our professional standards require the consulting accountant to check with us to determine that the consultant has all the relevant facts. To our knowledge, there were no such consultations with other accountants.

Significant issues discussed with management prior to engagement We generally discuss a variety of matters, including the application of accounting principles and auditing standards, with management each year prior to engagement as the entity's auditors. However, these discussions occurred in the normal course of our professional relationship and our responses were not a condition to our engagement.

Other information in documents containing audited financial statements With respect to the schedule of expenditures of federal awards (SEFA) accompanying the financial statements, on which we were engaged to report in relation to the financial statements as a whole, we made certain inquiries of management and evaluated the form, content, and methods of preparing the SEFA to determine that the SEFA complies with the requirements of U.S. Office of Management .and Budget Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations, the method of preparing it has not changed from the prior period or the reasons for such changes, and the SEFA is appropriate and complete in relation to our audit of the financial statements. We compared and

Board of Directors NASB Medicaid Consortium Page 3

reconciled the SEFA to the underlying accounting records used to prepare the financial statements or to the financial statements themselves. We have issued our report thereon dated May 13, 2016.

* ., ..

This communication is intended solely for the information and use of the Board of Directors and management of the Organization and is not intended to be, and should not be, used by anyone other than these specified parties.

~~LL? CliftonLarsonAllen LLP

West Des Moines, Iowa May 13, 2016

May 13, 2016

CliftonLarsonAllen LLP 5550 Wild Rose Lane, Suite 300 West Des Moines, Iowa 50266

This representation letter is provided in connection with your audits of the financial statements of NASB Medicaid Consortium, which comprise the statements of financial position as of August 31, 2015 and 2014, and the related statements of activities and cash flows for the years then ended, and the related notes to the financial statements, for the purpose of expressing an opinion on whether the financial statements are presented fairly, in all material respects. in accordance with accounting principles generally accepted in the United States of America (U.S. GAAP).

Certain representations in this letter are described as being limited to matters that are material. Items are considered material, regardless of size, if they involve an omission or misstatement of accounting information that, in light of surrounding circumstances, makes it probable that the judgment of a reasonable person relying on the information would b~e changed or influenced by the omission or misstatement.

We confirm, to the best of our knowledge and belief, as of May 13, 2016, the fallowing representations made to you during your audits.

Financial Statements • We have fulfilled our responsibilities, as set out in the terms of the audit engagement letter

dated October 23, 2015, for the p.reparation and fair presentation of the financial statements in accordance with U.S. GAAP.

• We acknowledge and have fulfilled our responsibility for the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error.

• We acknowledge our responsibility for the design, implementation, and maintenance of internal control to prevent and detect fraud.

• Significant assumptions used by us in making accounting estimates are reasonable.

• Related party relationships and transactions, including, but not limited to, accounts receivable or payable, sales, purchases, loans, transfers, leasing arrangements. and guarantees, have been appropriately accounted for and disclosed in accordance with the requirements of U.S. GAAP.

• No events, including instances of noncompliance, have occurred subsequent to the financial statement date and through the date of this letter that would require adjustment to, or disclosure in, the financial statements or in the schedule of findings and questioned costs.

• We have not identified or been notified of any uncorrected financial statement misstatements.

CliftonlarsonAllen LLP Page 2

• We are not aware of any pending or threatened litigation, claims, or assessments or unasserted claims or assessments that are required to be accrued or disclosed in the financial statements in accordance with U.S. GAAP, or which would affect federal award programs, and we have not consulted a lawyer concerning litigation, claims, or assessments.

• Material concentrations have been properly disclosed in accordance with U.S. GAAP. Concentrations refer to individual or group concentrations of contributors, granters, clients, customers, suppliers, lenders, products, services, fund-raising events, sources of labor or materials, licenses or other rights, or operating areas or markets for which events could occur that would significantly disrupt normal finances within the next year.

• Guarantees, whether written or oral, under which the entity is contingently liable, have been properly recorded or disclosed in accordance with U.S. GMP.

• Receivables recorded in the financial statements represent valid claims against debtors for sales or other charges arising on or before the financial statement date and have been reduced to their estimated net realizable value.

• Arrangements with financial institutions involving compensating balances or other arrangements involving restrictions on cash balances, lines of credit, or similar arrangements have been properly disclosed.

• We have no plans or intentions that may materially affect the carrying value or classification of assets, liabilities, or net asset balances.

Information Provided

• We have provided you with:

o Access to all information, of which we are aware, that is relevant to the preparation and fair presentation of the financial statements such as records, documentation, and other matters.

o Additional information that you have requested from us for the purpose of the audits.

o Unrestricted access to persons within the entity from whom you determined it necessary to obtain audit evidence.

o Complete minutes of the meetings of the governing board and related committees, or summaries of actions of recent meetings for which minutes have not yet been prepared.

o Access to all audit or relevant monitoring reports, if any, received from funding sources.

• All material transactions have been recorded in the accounting records and are reflected in the financial statements and the schedule of expenditures of federal awards.

• We have disclosed to you the results of our assessment of the risk that the financial statements may be materially misstated as a result of fraud.

CliftonlarsonAllen LLP Page 3

• We have no knowledge of any fraud or suspected fraud that affects the entity and involves:

o Management;

o Employees who have significant roles in internal control; or

o Others when the fraud could have a material effect on the financial statements.

• We have no knowledge of any allegations of fraud, or suspected fraud, affecting the entity's financial statements communicated by employees, former employees, grantors, regulators, or others.

• We have no knowledge of any instances of noncompliance or suspected noncompliance with provisions of laws, regulations, contracts, and grant agreements, or abuse whose effects should be considered when preparing financial statements.

• There are no other material liabiHties or gain or loss contingencies that are required to be accrued or disclosed in accordance with U.S. GAAP.

• We have disclosed to you the identity of the entity's related parties and all the related party relationships and transactions of which we are aware.

• We are responsible for compliance with the Jaws, regulations, and provisions of contracts and grant agreements applicable to NASS Medicaid Consortium; and we have identified and disclosed to you all laws, regulations, and provisions of contracts and grant agreements that we believe have a direct and material effect on the determination of financial statement amounts or other financial data significant to the audit objectives.

• We understand that you prepared the trial balance for use during the audit and that your preparation of the trial balance was limited to formatting information into a working trial balance based on management's chart of accounts.

• As part of your audit, you prepared the draft financial statements and related notes and schedule of expenditures of federal awards. We have designated an individual who possesses suitable skill, knowledge, and/or experience to understand and oversee your services; have made all management judgments and decisions; and have assumed all management responsibilities. We have evaluated the adequacy and results of the service. We have reviewed, approved, and accepted responsibility for those financial statements and related notes and schedule of expenditures of federal awards.

• With respect to federal award programs:

o We are responsible for understanding and complying with, and have complied with the requirements of 0MB Circular A-133, Audits of States, Local Governments, and NonProfit Organizations, including requirements relating to preparation of the schedule of expenditures of federal awards.

o We acknowledge our responsibility for presenting the schedule of expenditures of federal awards (SEFA) in accordance with the requirements of OMS Circular A-133

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§310.b, and we believe the SEFA, including its form and content, is fairly presented in accordance with 0MB Circular A-133 §310.b. The methods of measurement and presentation of the SEFA have not changed from those used in the prior period, and we have disclosed to you any significant assumptions and interpretations underlying the measurement and presentation of the SEF A

o If the SEFA is not presented with the audited financial statements, we will make the audited financial statements readily available to the intended users of the SEFA no later than the date we issued the SEF A and the auditors' report thereon.

o We have identified and disclosed to you all of our government programs and related activities subject to 0MB Circular A-133, and included in the SEFA expenditures made during the audit period for all awards provided by federal agencies in the form of grants, federal cost-reimbursement contracts, loans, loan guarantees, property (including donated surplus property), cooperative agreements, interest subsidies, insurance, food commodities, direct appropriations, and other direct assistance.

o We are responsible for understanding and complying with, and have complied with, the requirements of laws, regulations, and the provisions of contracts and grant agreements related to each of our federal programs and have identified and disclosed to you the requirements of Jaws, regulations, and the provisions of contracts and grant agreements that are considered to have a direct and material effect on each major program.

o We are responsible for establishing and maintaining, and have established and maintained, effective internal control over compliance requirements applicable to federal programs that provides reasonable assurance that we are managing our federal awards in compliance with laws, regulations, and the provisions of contracts and grant agreements that could have a material effect on our federal programs. We believe the internal control system is adequate and is functioning as intended.

o We have made available to you all contracts and grant agreements (including amendments, if any) and any other correspondence with federal agencies or passthrough entities relevant to federal programs and related activities.

o We have received no requests from a federal agency to audit one or more specific programs as a major program.

o We have complied with the direct and material compliance requirements, including when applicable, those set forth in the 0MB Circular A-133 Compliance Supplement, relating to federal awards and have identified and disclosed to you all amounts questioned and all known noncompliance with the direct and material compliance requirements of federal awards.

o We have disclosed to you any communications from granters and pass-through entities concerning possible noncompliance with the direct and material compliance requirements, including communications received from the end of the period covered by the compliance audit to the date of the auditors' report.

CliftonlarsonAllen LLP Pages

o We have disclosed to you the findings received and related corrective actions taken for previous audits, attestation engagements, and internal or external monitoring that directly relate to the objectives of the compliance audit, including findings received and corrective actions taken from the end of the period covered by the compliance audit to the date of the auditors' report.

o Amounts claimed or used for matching were determined in accordance with relevant guidelines in 0MB Circular A-122, Cost Principles for Nonprofit Organizations, and Subpart C, Cost Sharing and Matching, of O MB Circular A-110, Grants and Agreements with Institutions of Higher Education, Hospitals, and Other Nonprofit Organizations. We are not considered to be a state or local agency.

o We have disclosed to you our interpretation of compliance requirements that may have varying interpretations.

o We have made available to you all documentation related to compliance with the direct and material compliance requirements, including information related to federal program financial reports and claims for advances and reimbursements.

o We have disclosed to you the nature of any subsequent events that provide additional evidence about conditions that existed at the end of the reporting period affecting noncompliance during the reporting period.

o There are no known instances of noncompliance with direct and material compliance requirements that occurred subsequent to the period covered by the auditors' report.

o We have disclosed to you whether ahy changes in internal control over compliance or other factors that might significantly affect internal control, including any corrective action we have taken regarding significant deficiencies and/or material weaknesses in internal control over compliance, have occurred subsequent to the date as of which compliance was audited.

o Federal program financial reports and claims for advances and reimbursements are supported by the books and records from which the basic financial statements have been prepared.

o The copies of federal program financial reports provided to you are true copies of the reports submitted, or electronically transmitted, to the respective federal agency or passthrough entity, as applicable.

o We have charged costs to federal awards in accordance with applicable cost principles.

o We are responsible for and have accurately prepared the summary schedule of prior audit findings to include all findings required to be included by 0MB Circular A-133, and we have provided you with all information on the status of the follow-up on prior audit findings by federal awarding agencies and pass-through entities, including all management decisions.

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o We are responsible for and have accurately prepared the auditee section of the Data Collection Form as required by 0MB Circular A~133.

o We are responsible for preparing a corrective action plan and taking corrective action on each audit finding.

o We have disclosed to you all contracts or other agreements with service organizations, and we have disclosed to you all communications from the service organizations relating to noncompliance at the service organizations.

• We have a process to track the status of audit findings and recommendations.

• We have identified to you any previous audits, attestation engagements, and other studies related to the audit objectives and whether related recommendations have been implemented.

• We have provided our views on reported findings, conclusions, and recommendations, as well as our planned corrective actions, for the report.

Signature: _______ ____________ Title: --------

John Spatz, Executive Director .

Signature: _ _ _________________ Title: --------

Rachel Horstman, CFO

NASB MEDICAID C!ONSORTIUM LINCOLN, NEBRASKA

FINANCIAL STATEMENTS AND SINGLE AUDIT COMPLIANCE REPORTS

YEARS ENDED AUGUST 31 , 2015 AND 2014

NASS MEDICAID CONSORTIUM TABLE OF CONTENTS

YEARS ENDED AUGUST 31 , 2015 AND 2014

INDEPENDENT AUDITORS' REPORT

FINANCIAL STATEMENTS

1

STATEMENTS OF FINANCIAL POSITION 3

STATEMENTS OF ACTIVITIES 4

STATEMENTS OF CASH FLOWS 5

NOTES TO FINANCIAL STATEMENTS 6

SUPPLEMENTARY INFORMATION

SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS 9

NOTE TO SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS 10

INDEPENDENT AUDITORS' REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING AND ON COMPLIANCE AND OTHER MATTERS BASED ON AN AUDIT FINANCIAL STATEMENTS PERFORMED IN ACCORDANCE WITH GOVERNMENTAUDIT(NG STANDARDS 11

INDEPENDENT AUDITORS' REPORT ON COMPLIANCE WITH REQUIREMENTS THAT HAVE A DIRECT AND MATERIAL EFFECT ON EACH MAJOR PROGRAM AND ON INTERNAL CONTROL OVER COMPLIANCE IN ACCORDANCE WITH 0MB CIRCULAR A-133 13

SCHEDULE OF FINDINGS, QUESTIONED COSTS, AND RESPONSES 16

Board of Directors NASS Medicaid Consortium Lincoln, Nebraska

Cl iftonlarsonAllen

INDEPENDENT AUDITORS' REPORT

Report on the Financial Statements

CliftonlarsonAlleo LL P CLAconnect.com

We have audited the accompanying financial statements of NASB Medicaid Consortium (the Organization), which comprise the statements of financial position of August 31, 2015 and 2014, and the related statements of activities and cash flows for the years then ended, and the related notes to the financial statements.

Management's Responsibility for the Financial Statements Management is responsible for the preparation of these financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error.

Auditors' Responsibility Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our audits In accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards issued by the Comptroller General of the United States. Those standards require we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement.

An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditors' judgment, including the assessment of the risks of material misstatement of the financial statements, whether du~ to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity's preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity's internal control. Accordingly, we express no such opinion. An audit also Includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the financial statements.

We believe the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion.

(1)

Board of Directors NASS Medicaid Consortium

Opinion

In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of the Organization as of August 31 , 201 5 and 2014, and the changes in its net assets and its cash flows for the years then ended in accordance with accounting principles generally accepted in the United States of America. '

Other Matters

Our audits were performed for the purpose of forming an opinion on the basic financial statements taken as a whole. The schedule of expenditures of federal awards, as required by U.S. Office of Management and Budget Circular A-133, Audits of States, Local Governments, and Nonprofit Organizations, is presented for purposes of additional analysis and is not a required part of the financial statements. Such information is the responsibility of management and was derived from and relate directly to the underlying accounting and other records used to prepare the financial statements. The information has been subjected to the auditing procedures applied in the audit of the financial statements and certain additional procedures, including comparing and reconciling such information directly to the underlying accounting and other records used to prepare financial statements themselves, and other additional procedures in accordance with auditing standards generally accepted in the United States of America. In our opinion, the information is fairly stated, in all material respects, in relation to the financial statements takes as a whole.

Other Reporting Required by Government Auditing Standards

In accordance with Government Auditing Standards, we have also issued our report dated May 13, 2016, on our consideration of the Organization's internal control over financial reporting a_nd on our tests of its compliance with certain provisions of laws, regulations, contracts, and grant agreements, and other matters. The purpose of that report is to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on the internal control over financial reporting or on compliance. That report Is an integral part of an audit performed in accordance with Government Auditing Standards in considering the Organization's internal control over financial reporting and compliance.

~~LL>'-7 CliftonLarsonAllen LLP


(2)

NASB MEDICAID CONSORTIUM STATEMENTS OF FINANCIAL POSITION

AUGUST 31, 2015 AND 2014

ASSETS

CURRENT ASSETS Cash $

Accounts Receivable Grant Reimbursements Receivable

Total Current Assets

Total Assets $

LIABILITIES AND NET ASSETS

CURRENT LIABILITIES Accounts Payable $

Due to Members Total Current Uabilities

NET ASSETS Unrestricted Net Assets

Total Llabilities and Net Assets $

See accompanying Notes to Financial Statements. (3)

2015 2014

69,259 $ 110,042

5,405 245 1,417,408 1,717,796

1,492,072 1,828,083

1,492,072 $ 1,828,083

1,099 $ 596

1,411,221 1,753,577

1,412,320 1,754,173

79,752 73,910

1,492,072 $ 1,828,083

NASB MEDICAID CONSORTIUM STATEMENTS OF ACTIVITIES

YEARS ENDED AUGUST 31, 2015 AND 2014

2015

REVENUES Medicaid Grant Revenue -

Nebraska Department of Health and Human Services $ 5,811,086

EXPENDITURES Reimbursements and Fees:

Member Reimbursements 5,104,081

Third Party Administration: Nebraska Association of School Boards 2,500

Administrative Fees 507,308

State of Nebraska, Statutory Share 174,332

Total Reimbursements and Fees 5,788,221

Net Retained by Consortium 22,865

Administrati1.e Expenses - Office Expenses 17,023

CHANGE IN NET ASSETS 5,842

Net Assets. Beginning of Year 73,910

NET ASSETS • END OF YEAR $ 79,752

See accompanying Notes to Financial Stafements. (4)

2014

$ 7,019,026

6,168,460

2,500 612,761 210,571

6,994,292

24,734

19,366

5,368

68,542

$ 73,910

NASS MEDICAID CONSORTIUM STATEMENTS OF CASH FLOWS

YEARS ENDED AUGUST 31, 2015 AND 2014

2015 CASH FLOWS FROM OPERATING ACTIVITIES

Change In Net Assets $ 5,842 Adjustments to Reconcile Change in Net Assets to Net Cash

Used in Operating Actiliitles: (Increase) Decrease in Accounts Receivable (5,160) Decrease in Grant Reimbursements Receivable 300,388

Decrease in Due to Members (342,356)

Increase (Decrease) in Accounts Payable 503 Net Cash Pro\.ided (Used) by Operating Acti\Aties (40,783)

Cash. Beginning of Year 110,042

CASH· END OF YEAR $ 69,259

See accompanying Notes to Financial Statements. (5)

2014

$ 5,368

4,360 2,715,115

(2,661 ,974) (3,391) 59,478

50,564

$ 110,042

NASB MEDICAID CONSORTIUM NOTES TO FINANCIAL STATEMENTS

AUGUST 31, 2015 AND 2014

NOTE 1 SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Description of Organization

NASB Medicaid Consortium (the Organization) was organized on August 15, 2009, pursuant to the Nebraska lnterlocal Corporation Act to pEirmit member school districts and educational service units to act as a single administrative claiming unit and agent for its members for federal fund participation and payment.

The Nebraska Association of School Boards is comprised of approximately 220 members, all of which have entered into a membership agreement with the Organization. The Organization operates under an intergovernmental agreement with the Nebraska Department of Health and Human Services Division of Medicaid and Long-Term Care to submit claims and obtain reimbursement pursuant to the Case Management Setvices Claiming Guide.

The Organization has entered into a sponsor agreement with Go Solutions Group, Inc. to provide the administrative and consulting services necessary to permit the Organization members to obtain Medicaid reimbursement for the administrative outreach and case management services they have and will provide on behalf of the Nebraska Department of Health and Human Services.

Medicaid claims are submitted on a quarterly basis. The state of Nebraska receives a statutory fee of 3% of the gross amount claimed.

Third-party administrative fees are calculated at 9% of the amount of the quarterly Medicaid claim, net of the fees paid to the state of Nebraska. Of the third-party administrative fees, Go Solutions Group, Inc. receives 82% and the Organization receives 18%.

As of August 31, 2015 and 2014, the Organization retains 0.45% and 0.40%, respectively, of the net fees to cover administrative costs and provide services to members.

Basis of Accounting and Presentation

The financial statements have been prepared on the accrual basis of accounting in accordance with generally accepted accounting principles in the United States of America. The· Organization has reported information regarding its financial position and activities according to three classes of net assets: unrestricted net assets, temporarily restricted net assets, and permanently restricted net assets. A description of the three categories follows:

Unrestricted Net Assets

Net assets that are not subject to donor-imposed stipulations.

Temporarily Restricted Net Assets

Net assets subject to donor-imposed stipulations that may or will be met by actions of the Organization and/or the passage of time. There were no temporarily restricted net assets as of August 31, 2015 and 201 4.

(6)

NASB MEDICAID CONSORTIUM NOTES TO FINANCIAL STATEMENTS

AUGUST 31, 2015 AND 2014

NOTE 1 SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (CONTINUED}

Basis of Accounting and Presentation (Continued)

Permanently Restricted Net Assets

Permanently restricted net assets include gifts which require, by donor restriction, that the corpus of the gift be invested in perpetuity and only the income be made available for operations in accordance with donor restrictions. There were no permanently restricted net assets as of August 31, 2015 and 2014.

Use of Estimates In Preparing Financial Statements

The preparation of financial statements in conformity with generally accepted accounting principles in the United States of America requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.

Grant Reimbursement Receivable and Due to Members

The Organization has a short-term uncoilateralized grant reimbursement receivable for its Medicaid reimbursement claims. According to the intergovernmental agreement with the Nebraska Department of Health and Human Services Division of Medicaid and Long-Term Care, the Organization expects the receivable balance to be collected in full in the next quarter. Due to members liability consists of the Medicaid claims made by each of the member school districts and Is paid once funds are received from the Nebraska Department of Health and Human Services Division of Medicaid and Long-Term Care.

Concentrations of Credit Risk

Financial instruments, which potentially subject the Organlzation to credit risk, consist primarily of cash. At times throughout the year, the Organization may maintain certain bank accounts in excess of FDIC insured limits. The Organization had cash balances on deposit that exceeded the insured balances at August 31,· 2015 and 2014 by $341,863 and $99,246, respectively.

Income Taxes

The Organization is composed exclusively of member school districts and educational service units and constitutes a separate public body corporate and politic of the state of Nebraska; as such, the Organization is not subject to income tax.

NOTE 2 CONCENTRATIONS

The Organization received 100% of its revenues from the Nebraska Department of Health and Human Services for the years ended August 31, 201 5 and 2014.

(7)

NASS MEDICAID CONSORTIUM NOTES TO FINANCIAL STATEMENTS

AUGUST 31, 2015 ANO 2014

NOTE3 SUBSEQUENTEVENTS

Management evaluated subsequent events through May 13, 2016, the date the financial statements were available to be issued. Events or transactions occurring after August 31 , 2015, but prior to May 13, 2016 that provided additional evidence about conditions that existed at August 31, 2015, have been recognized in the financial statements for the year ended August 31, 2015. Events or transactions that provided evidence about c·onditions that did not exist at August 31, 2015, but arose before the financial statements were available to be issued, have not been recognized in the financial statements for the year ended August 31, 2015.

(8)

NASB MEDICAID CONSORTIUM SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS

YEAR ENDED AUGUST 31, 2015 (SEE ACCOMPANYING NOTE TO SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS)

Federal Grantor/Pass Through Grantor/Program Title

U.S. Department of Health and Human SeNces

Pass Through Program from Nebraska Department of

Health and Human Services

Medicaid

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CFDA Number

93.778

Federal

Expenditures

$ 5,811,086

NASS MEDICAID CONSORTIUM NOTE TO SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS

YEAR ENDED AUGUST 31 , 2015

NOTE 1 SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Basis of Presentation The accompanying schedule of expenditures of federal awards includes the federal grant activity of NASB Medicaid Consortium and is presented on the accrual basis of accounting. The information in this schedule Is presented in accordance with the requirements of 0MB Circular A-133, Audits of States, Local Governments, and Nonprofit Organizations.

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• Cl if ton Larson Allen

CliftonlarsonAllen LL P CLAconnect.com

INDEPENDENT AUDITORS' REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING AND ON COMPLIANCE AND OTHER MATTERS BASED ON AN AUDIT OF FINANCIAL

STATEMENTS PERFORMED IN ACCORDANCE WITH GOVERNMENT AUDITING STANDARDS

Board of Directors NASB Medicaid Consortium Lincoln, Nebraska

We have audited, in accordance with the auditing standards generally accepted In the United States of America and the standards applicable to financial audits contained in Government Auditing Standards issued by the Comptroller General of the United States, the financial statements of NASS Medicaid Consortium (the Organization), which comprise the statement of financial position as of August 31, 2015, and the related statements of activities, and cash flows for the year then ended, and related notes to the financial statements, and have issued our report thereon dated May 13, 2016.

Internal control over financial reporting

In planning and performing our audit of the financial statements, we considered the Organization's internal control over financial reporting (internal control) to determine the audit procedures that are appropriate in the circumstances for the purpose of expressing our opinion on the financial statements, but not for the purpose of expressing an opinion on the effectiveness of internal control. Accordingly, we do not express an opinion on the effectiveness of the Organization's internal control.

A . deficiency in internal control exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct, misstatements on a timely basis. A material weakness is a deficiency, or combination of deficiencies, in internal control, such that there is a reasonable possibility that a material misstatement of the entity's financial statements will not be prevented, or detected and corrected on a timely basis. A significant deficiency is a deficiency, or a combination of deficiencies, in internal control that is less severe than a material weakness, yet important enough to merit attention by those charged with governance.

Our consideration of internal control was for the limited purpose described in the first paragraph of this section and was not designed to identify all deficiencies in internal control that might be material weaknesses or significant deficiencies. Given these limitations, during our audit we did not identify any deficiencies In internal control that we consider to be material weaknesses. However, material weaknesses may exist that have not been identified.

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Board of Directors NASB Medicaid Consortium

Compliance and other matters As part of obtaining reasonable assurance about whether the Organization's financial statements are free of material misstatement, we performed tests of its compliance with certain provisions of laws, regulations, contracts, and grant agreements, noncompliance with which could have a direct and material effect on the determination of financial statement amounts. However, providing an opinion on compliance with those provisions was not an objective of our audit, and accordingly, we do not express such an opinion. The results of our tests disclosed no instances of noncompliance or other matters that are required to be reported under Government Auditing Standards.

Purpose of this report The purpose of this report is solely to describe the scope of our testing of internal control and compliance and the result of that testing, and not to provide an opinion on the effectiveness of the entity's internal control or on compliance. This report is an integral part of an audit performed in accordance with Government Auditing Standards in considering the entity's internal control and compliance. Accordingly, this communication is not suitable for any other purpose.

~~LL? CliftonlarsonAllen LLP

West Des Moines, Iowa May 13, 201 6

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~ff) ~Jr?

Cl if ton LarsonAllen

CliftonLarsonAllen LLP CL.Aconnect.com

INDEPENDENT AUDITORS' REPORT ON COMPLIANCE WITH REQUIREMENTS THAT COULD HAVE A DIRECT AND MATERIAL EFFECT ON EACH MAJOR PROGRAM AND ON

INTERNAL CONTROL OVER COMPLIANCE IN ACCORDANCE WITH 0MB CIRCULAR A-133

Board of Directors NASS Medicaid Consortium Lincoln, Nebraska

Report on compliance for major federal program

We have audited NASS Medicaid Consortium's (the Organization) compliance with the types of compliance requirements described in the 0MB Circular A-133, Compliance Supplement, that could have a direct and material effect on the Organization's major federal program for the year ended August 31 , 2015. The Organization's major federal program is identified in the summary of auditors' results section of the accompanying schedule of findings and questioned costs.

Management's responsibility Management is responsible for compliance with the requirements of laws, regulations, contracts, and grants applicable to its federal programs.

Auditors' responsibility Our responsibility is to express an opinion on compliance for the Organization's major federal program based on our audit of the types of compllance requirements referred to above. We conducted our audit of compliance in accordance with auditing standards generally accepted in the United States of America; the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States; and 0MB Circular A-133, Audits of States, Local Governments, and Nonprofit Organizations. Those standards and 0MB Circular A-133 require we plan and perform the audit to obtain reasonable assurance about whether noncompliance with the types of compliance requirements referred to above that could have a direct and material effect on a major federal program occurred. An audit includes examining, on a test basis, evidence about the Organization's compliance with those requirements and performing such other procedures as we considered necessary in the circumstances.

We believe our audit provides a reasonable basis for our opinion on compliance for the major federal program. However, our audit does not provide a legal determination of the Organization's compliance.

§l&.J'!1 11\'T ~R NATIO l'A I.

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Board of Directors NASS Medicaid Consortium

Opinion on major federal program

In our opinion, the Organization complied in all material respects, with the types of compliance requirements referred to above that could have a direct and material effect on its major federal program for the year ended August 31, 2015.

Other matters

The results of our auditing procedures disclosed an instance of noncompliance, which is required to be reported in accordance with 0MB Circular A-133 and which is described in the accompanying schedule of findings and questioned costs as item 201 5-001 . Our opinion on the major federal program is not modified with respect. to this matter.

Report on internal control over compliance

Management of the Organization is responsible for establishing and maintaining effective internal control over compliance with the types of compliance requirements referred to above. In planning and performing our audit of compliance, we considered the Organization's Internal control over compliance with the types of requirements that could have a direct and material effect on each major federal program to determine the auditing procedures that are appropriate in the circumstances for the purpose of expressing an opinion on compliance for each major federal program and to test and report on internal control over compliance in accordance with 0MB Circular A-1 33, but not for the purpose of expressing an opinion on the effectiveness of internal control over compliance. Accordingly, we do not express an opinion on the effectiveness of the Organization's internal control over compliance.

A deficiency in internal control over compliance exists when the design or operation of a control over compliance does not allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct, noncompliance with a type of compliance requirement of a federal program on a timely basis. A material weakness in internal control over compliance is a deficiency, or combination of deficiencies, in internal control over compliance, such that there is a reasonable possibility that material noncompliance with a type of compliance requirement of a federal program will not be prevented, or detected and corrected, on a timely basis. A significant deficiency in internal control over compliance is a deficiency, or a combination of deficiencies, in internal control over compliance with a type of compliance requirement of a federal program that is less severe than a material weakness in internal control over compliance, yet important enough to merit attention by those charged with governance.

Our consideration of internal control over compliance was for the limited purpose described in the first paragraph of this section and was not designed to identify all deficiencies in internal control over compliance that might be material weaknesses or significant deficiencies and therefore, material weaknesses or significant deficiencies may exist that were not Identified. We did not identify any deficiencies in Internal control over compliance that we consider to be material weaknesses, as defined above. However, we identified a certain deficiency in internal control over compliance that we consider to be a significant deficiency as described in the accompanying schedule of findings and questioned costs as item 201 5-001 .

The Organization's response to the compliance and internal control over compliance finding, identified in our audit is described in the · accompanying schedule of findings and questioned costs. The Organization's response was not subject to the procedures applied In the audit of compliance and, accordingly, we express no opinion on it.

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Board of Directors NASB Medicaid Consortium

The purpose of this report on internal control over compliance is solely to describe the scope of our testing of internal control over compliance and the result of that testing based on the requirements of 0MB Circular A-133. Accordingly, this report is not suitable for any other purpose.

~~LL? CliftonLarsonAIIen LLP


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NASS MEDICAID CONSORTIUM SCHEDULE OF FINDINGS, QUESTIONED COSTS, AND RESPONSES

YEAR ENDED AUGUST 31, 2015

Section 1- Summary of Auditors' Results

Financial Statements

Type of auditors' report issued: Unmodified

Internal control over financial reporting:

• Material weakness identified? ___ yes X no

• Significant deficiencies identified that are not considered to be material weaknesses? yes X none reported

Noncompliance material to financial statements noted? ___ yes

Federal Awards

Internal control over major programs:

• Material weakness identified? ___ yes X no

• Significant deficiencies identified that are not considered to be material weaknesses? X yes none reported

X no

Type of auditors' report issued on compliance for major programs: Unmodified

Any audit findings disclosed that are required to be reported in accordance with section 51 O(a) of 0MB Circular A-133? X yes no

Identification of major program:

CFDA Number Name of Federal Program or Cluster

93. 778 Medicaid

Dollar threshold used to distinguish between type A and type B programs: $300,000

Auditee qualified as low-risk auditee? X yes no

Section II - Financial Statement Findings

Our audit did not disclose any matters required to be reported in accordance with Government Auditing Standards.

{16)

2015-001



Section Ill - Findings and Questioned Costs - Major Federal Programs

Federal agency: U.S. Department of Health and Human Services

Federal program: Medical Assistance Program (Medicaid)

CFDA number: 93. 778

Pass-Through Agency: Nebraska Department of Health and Human SeNices

Award Identifier Number: 051505NE5Adm & 051005NE5ADM

Award Period: October 1, 2014 - October 31, 2015 & September 1, 2008 - September 30, 2014

Type offinding:

, Significant deficiency in internal control over compliance

Criteria or specific requirement: Cost Principles for State, Local, and Indian Tribal Governments (0MB Circular A-87), section (B) Definitions, (18) (C) (1-j) states that allowable costs must be adequately documented.

Condition: Significant deficiency - The school district members of the Organization submit quarterly wage and benefit expense reports for all employees that perform activities are eligible for Medicaid reimbursement to Go Solutions Group, Inc., who performs the calculation for the Medicaid reimbursement based on the quarterly expense report and submits the claim. The Medicaid reimbursement claim submitted was overstated due to incorrect reporting of wage and benefit expense in the quarterly reports.

Questioned cost None.

Context: When reviewing the supporting payroll information for wage and benefit expenses reported in the quarterly reports from the member school districts, it was discovered that 4 out of 40 wage expenses were incorrect.

Cause: The quarterly reimbursement report contained inaccurate payroll data when submitted to Go Solutions Group, Inc.

Effect: The amount of Medicaid payments received by the Organization was more than the amount that should have been reimbursed. However, the overall error is immaterial.

Recommendation: Management's close supeNision and review is the best means to ensure all requirements are met. To ensure the accuracy of the report, we recommend the Organization implement a second level of review over the wage and benefit expense that is recorded into the quarterly report before it is submitted to Go Solutions Group, Inc.

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Section Ill- Findings and Questioned Costs - Major Federal Programs (Continued)

Views of Responsible Officials and Planned Corrective Actions:

Explanation of disagreement with audit findings : There is no disagreement with the audit findings.

Actions planned in response to finding: NASB Medicaid Consortium will implement additional training and reiterate the importance of a thorough second review being completed by accounting staff within each school district. GoSolutlons representatives visit several districts on a regular basis. They will be utilized to communicate this information during those visits. Also, NASS Medicaid Consortium will incorporate the issue into their annual letter to member schools .

Responsible party: Rachel Horstman, Director of Finance

Plannec;t completion date for corrective action plan: August 31, 2016

Plan to monitor completion of corrective action plan: NASS Medicaid Consortium will continually monitor the information described in the action plan.

Section IV- Prior Year Major Federal Program Findings

2014-001

See current year finding 2015~001

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Bank Reference

Wells Fargo Bank Andrew J. Detlefsen Vice President MAC N8032-035/1248 0 Street Lincoln, NE 68508 Phone: 402-434-6701 Fax: 402-434-6123 [email protected]

Technical Proposal / Overview GSGI

Technical Proposal

Subcontractor - Go Solutions Group, Inc. (GSGI)

Go Solutions Group, lnc. (OSGI) is pleased to submit to the State of Nebraska, Administrative Services (AS), Materials Division, State Purchasing Bureau, and to the Nebraska Association of School Boards Medicaid Consortium (NASBMC) our response as a subcontractor for Solicitation Number RFP 5531Zl. GSGI's Medicaid claiming experience with districts across the country positions us well to effectively support this engagement.

OSGI has assembled a dedicated team that understands the unique needs of the Nebraska Department of Health and Human Services (DHHS), and the school districts throughout the state of Nebraska. We will partner with NASBMC to ensure that DHHS can implement a Medicaid program with sound practices that ensmes full compliance to maximize compliant Medicaid reimbursement. Given the current economic climate and demands on district staff time, there is no better choice than GSGI to support NASBMC, DHHS and the state's school districts in this crucial engagement.

This Technical Proposal details GSGI's unique combination of easy-to-use technology inclusive of full reporting capabilities, our subject matter expertise and billing experience. Specifically, our comprehensive Medicaid procedures support the entire billing process, relieving the districts' burden, and allowing more focus on student service delivery. Given our holistic process and comprehensive support, GSGI is able to provide exceptional service.

OSGI is proud to be known for its long-term client relationships attributed to an ongoing, customer.focused approach. Our clients identify our dedication, exceptional support, and client focus as key factors that distinguish GSGI's implementations and operations from the competition. With over 21 years of experience in school-based Medicaid claiming, DHHS and school districts throughout the slate can be assured of a successful implementation.

GSGI has worked with more than 1,500 school districts of varying sizes to provide innovative technology solutions and provide expansive knowledge to this project. GSGI understands the complex requirements of the Medicaid reimbmscment program, including necessary parental consent, physician authorization, audit preparation, reporting and trend analysis, provider credentialing, administrative claiming, and reimbursement maximization strategies. It is with this insight that GSGI will mitigate risk and ensure program compliance for DHHS and the Nebraska districts.

At OSGI, we work side-by~side with our clients as partners to ensure successful implementation, and take great pride in the strong relationships that we have built. GSGI will support DHHS and the state's districts locally with a qualified team of experts. Our entire team holds a vested interest in making this partnership successful and will focus on project planning and management, change management, communication, training, and

1

end-user support. This approach, along with our sound technology and billing practices, will help ensure project success.

We are appreciative of this opportunity to submit this subcontractor proposal for your consideration. If selected for this vital program, OSGI will work in conce1i with DHHS and other stake-holders to ensure success. As a full-service Medicaid billing and consulting organization, no matter the capacity, we will fully support DHHS with the resources needed to accomplish its goals. Please contact me at 800-260-2544 or by email at [email protected] for clarification of any information contained in this Technical Proposal, or Matt Dunning at 402-817-0288 or by email at [email protected] for questions relating to NASBMC's bid.

Prior Experience - GSGI

GSGT, a Lansing, Michigan based company, began in 1994 exclusively supporting school districts in the pursuit and recovery of Medicaid reimbursements for School Based Health Services. As one of only a hand-full of companies attempting this nationally, over time OSGI has evolved into a leading expe1t in this field. With our exclusive focus on schools, we were able to develop programs and procedures that focus on the myriad of challenges schools face in translating school based services and terminology into the wellestablished Medicaid "Medical Model." With over twenty years of experience supporting schools in their Direct Service and Medicaid Administrative Claiming reimbursement programs, GSGI is recognized as a national leader. However, OSGI is much more than a traditional ,:billing agent" and has served as a consultant and partner with hundreds of school districts in each of the states it supports. This national experience has allowed GSGl to consult with and represent numerous school districts of varying student populations in their efforts to receive their entitled reimbursements for these programs.

GSGJ continues as one of the original and most successful providers of school-based Medicaid reimbursement services nationally. Our commitment to excellence and maximization of compliant reimbursements for school districts remains our primary focus. Specifically, GSGI has been providing Medicaid Administrative Claiming services to over 85% of the State of Nebraska's school districts since 1999!

OSGI has the experience, personnel, systems, and attention to details such as staffing, training, interagency-coordination between federal and state agencies and the school districts. This allows GSGl to assure that all federal and state programs are managed properly, comply with program rules, regulations, and policies while maximizing Medicaid reimbursement.

Advocacy

Over the years, OSGI has provided Medicaid consulting, billing and related services to more than 1500 school districts in 10 states, and assisted those school districts in generating and receiving more than $800,000,000 in Medicaid reimbursements.

As a result of OSGI' s customer base consisting exclusively of school districts, our experience has allowed our organization to become involved and assist in the

2

development and implementation of meetings with State Auditors, State Officials. the formation of Focus Groups for our clients, and support and representation of various professional organizations within our clients' states. Within this public sector, GSGI has a long and continued history of supporting local, state, and national organizations and associations directly related to school districts, and, particularly, Special Education and Medicaid reimbursement for schools. Historically, these associations have been reluctant to involve vendors to aid in the evaluations or offer recommendations to various issues. The GSGI business model is not the pursuit of commendation; rather, it is to be an

integral team member in the collective efforts to ensure the maximization of compliant Medicaid reimbursements for school districts and the special education populations they

serve.

OSGI is an active participant in the Research and Evaluation, and Governmental Affairs & Public Relations committees through the National Alliance for Medicaid in Education (NAME). Additionally, GSGI provides support, both financial and participatory, to annual conventions and trade shows for many additional associations. Below is a sample of the various organizations GSGI supports.

NAME - National Alliance for Medicaid in Education

LEAnet-Local Education Agency Network

IAASE - Illinois Alliance of Special Education

I CASE - Indiana Council of Administrators of Special Education

IASBO - Indiana Association of School Business Officials

AASBO - Arizona Association of School Business Officials

GAEL - Georgia Association of Educational Leaders

OSBA - Ohio School Board Association

NASB - Nebraska Association of School Boards

MSBO - Michigan School Business Officials

MAASE- Michigan Association of Administrators of Special Education

WCASS - Wisconsin Council of Administrators of Special Education

GSGI's systems and services arc in compliance with the Family Educational Rights and Privacy Act (FERPA), Privacy and Security regulations, and with the Health Insurance Portability and Accountability Act (HIP AA) of 1996, Privacy and Security regulations. All GSGI's employees are HIP AA trained and certified, and are required to take refresher courses at least once a year or with any change in HIP AA Regulation.

Corporate Capabilities and Experience

Experienced in working with state-level education and Medicaid agencies:

3

OSGI began its operations during the period when billing Medicaid in schools commenced in the mid-1990s. Because of its endeavors, OSGI has worked closely with many state's Departments of Education and Medicaid agencies developing programs, policies, and state plan amendments allowing school districts to bill Medicaid for the provision of eligible IBP-related services. GSGI was instrumental in the States of Alabama, Georgia, Nebraska, and Ohio assisting them in gaining approval of their state plan amendments to include administrative claiming.

OSGI also researched and prepared a "'White Paper" for the State of Ohio's Department of Mental Retardation and Developmental Disabilities (formerly the state agency responsible for the school-based claiming program administration) evaluating the State's 1115 waiver, Community Alternative Funding System (CAFS) that had been highly criticized by the Centers for Medicare and Medicaid Services and addressed in the White Paper.

Recent work in this area of grass-roots legislative initiatives also occurred in Nebraska. During Nebraska's 2013 legislative session, with assistance from the Nebraska Association of School Boards and NASBMC, we were able to achieve sponsorship for a bill that would expand the claimable services for the state's school-based Medicaid program, as well as proposed language to amend the financing distribution to the schools for this program. The bill was passed and signed into law in 2014 with scheduled implementation at a later date.

Experienced in conducting site visits to schools

OSGI's company philosophy has always been to provide maximmn service its customers. As a part of their duties, OSGI representatives are available and routinely meet with district administrators and providers. By continually maintaining contact with its clients, OSGI has set itself apart from the competition. Many competitors routinely employ only management level personnel to oversee large or statewide contracts. OSGI has always used local personnel whose assigrunent it is to visit school districts routinely to conduct in-person meetings on short notice.

Background and understanding of special education practices

All GSGI employees that will be working on this project have an understanding of and experiences in special education practices. In addition to the lmowledge they possess from working with school districts, they have an understanding of the development and management of individual education plans and how they are implemented in the general education setting. GSOI strives to recruit new personnel with experience in special education.

National Efforts

Medicaid is managed by state goverrunents and overseen at regional CMS Medicaid offices (regions). With this complex and multilevel govenunental structure, it is no surprise that the intricacies and associated tasks can seem overwhelming. GSGI has extensive experience with developing required forms and the expert processing of these

4

fo1ms as well. Historically, OSGI has provided complete and customized solutions including paper forms, electronic transfer, and the combination of both designed to meet the specific needs of our individual school district clients and their associated state requirements. We currently maintain a wide range of technologies that ensure our ability to meet any need. GSGI's has a vast experience with printing and processing formsover the years we have developed, printed, collected, and processed many hundreds of thousands of forms in multiple States. Cun-ently we still process forms for clients nationally, for the tracking and processing of IEP-related transportation services, although most have moved to tracking electronically for transportation as well.

The process of converting from paper fonns to electronic solutions began with the submission of paper claim forms to the State Medicaid offices in individual States. In the late 1990s as state Departments of Health / Medicaid offices migrated from paper claims to electronic claim submission, GSGI took a leading role in supporting this transition at the individual state level and assuring our client-school districts were able to take full advantage ofthcse streamlined, emerging technologies. A prime example was the State of Michigan's transition from paper claim submission to submission of claims via "Magne6c Tape" files. This was at that time the accepted technology. OSGI and Blue Cross of Michigan were the two pilot vendors selected by the state to test this process prior to implementation statewide. Since that time, GSGI has continued to support and develop solutions designed to eliminate paper forms throughout the claiming process. This includes providing leading technology solutions directly to the school staff, designed to ease the burden placed on them within the school district. GSGl's web-based application, GoClaim™> for collecting service encounter data for Medicaid claiming is now widely used throughout the country. GSGI's attention to accurate database design, implementation and staff training has been crucial to our continued success.

Below is a history of our success with state-specific efforts.

Alabama + 1999 - 2008

OSGI began consulting services in Alabama in 1999 providing Fee for Service billing services. With our previous experience in other states, GSGI introduced the Medicaid administrative claiming program to its participating school district clients, as well. OSGI was required to provide a methodology to the State Medicaid Agency, and approved by CMS, prior to its implementation.

Arizona + 1999 - Present

In 1999, OSGI negotiated a three-year contractual agreement with the Arizona School Health Insurance Program (ASHIP) who had oversight of the statewide program, representing all school districts in Arizona, to provide Medicaid Administrative Claiming and direct service (fee-for-service) claiming services.

OSGI was required to draft and submit methodology for Medicaid Administrative Claiming to CMS Region IX for approval. OSGI worked with the Arizona Health Care Cost Containment System (AHCCCS- the state's Medicaid agency), A1thur Andersen

5

(the state's CPAs), and CMS Region IX concluded with written approval of the methodology.

During the contract period, OSGI dramatically increased compliant annual reimbursements to the participating school districts.

GS01 currently provides their contracted Arizona school districts participating in the FeeFor-Service program with GoClaimTM, our web-based IEP-related service documentation and Medicaid billing software, associated account management and cons11lting services. These Arizona school districts have fully embraced the school based health service Medicaid program and have required superior products and services necessary to the support of GoClaim™, which has proven to be an important tool for compliance. In addition to the speed and ease of use, OoClaimTM provides great flexibility in data reporting and GSGI has been able to provide customization of associated reports to meet the needs of its school district clients in real-time.

The Arizona Health Care Cost Containment System awarded a statewide contract for Medicaid administrative claiming in 2003; however, GSGI continues to provide direct service claiming services to Arizona school districts, with the largest client being Peoria Unified School District with 4,500 special education students.

Illinois + 1995 - Present

Illinois was one of the first states to aggressively pursue Medicaid direct service reimbursements in 1995. From that time, school districts throughout the state were aggressively seeking competent, expert consulting partners to assist with their emergence into this new and complex process. GSGI played a leading role by assisting with this effort, and with the support of GSGI, in excess of two hundred (200) school districts in Illinois were receiving their first Medicaid direct service reimbursements. OSGI also played a key role in interfacing with state agencies and the HCF A (CMS) region to assist with the Illinois State Medicaid Plan changes and Code of Federal Regulation revisions necessary for the successful implementation of a School Based Health Service (SBHS) Medicaid reimbursement program. Illinois districts started in this program when all phases were entrenched in established paper claim processes. Currently, GSGI client districts throughout the state have transitioned to GoClaimTM.

In 1995 Illinois was also a national leader in the investigation and implementation of additional Federal Medicaid ftmds available to school districts through the then new Medicaid Administrative Outreach Claiming program. Once again, Illinois schools tumed to OSGI as their consultant to assist them in the addition of these newly available reimbursements.

In 1995, the only Jllinois school district capturing Administrative Claim reimbursements was Chicago Public Schools tlll'ough its vendor Deloitte & Touche.

Illinois was the first state, in the spring of 1996, which GSGI implemented its Medicaid Administrative Claiming process, and GSGI quickly assisted its school district clients throughout the state with their participation into this phase of Medicaid claiming.

6

Additionally, GSGI played an instrumental role and subsequently was required to provide a methodology that could be approved by HCF A (CMS) and the Illinois Department of Public Aid (now the Department of Health and Family Services). OSGI submitted its methodology, which was later accepted, and began to provide this expanded service to its client base. During this time, OSGI was also able to expand the number of Illinois district they supported, as many of the first districts emolled for Medicaid Administrative Claiming did not wish to participate in the more complex, direct, Fee-For-Service program.

When CMS released its new Medicaid School-Based Administrative Claiming Guide in 2003, OSGI was required to resubmit an amended version of the prior methodology. The amendment included the required changes from the Technical Assistance Guide of 1997, issued by HCF A. Along with the required changes, OSGI included a section on sampling that would allow our school district clients an option of I 00% sampling, or joining a claiming universe that would allow for a stratified sample, reducing the burden on many

of its personnel.

Indiana + 2000 - Present

Indiana is among one of the most recent states to participate in the school based Medicaid Claiming program. As with many other states, limitations in state budgets and associated resources provided tittle state level direction or support to schools wishing to seek these available funds. OSGI, once again, took a leadership role and bridged the gap between the associated state agencies and the schools. OSGI continues to play an active consulting role with the Indiana Department of Education and their interface with both the Indiana Office of Medicaid Policy and Planning (OMPP) and the Indiana Department of Education, the agency responsible for this program in this state. GSGI has been providing consulting and billing services to approximately 70% of all Indiana districts participating in the program, which represents approximately 80% of the reimbursements generated statewide. As ofthis date, GSGI clients exceed 60 participating school districts

throughout the state.

Indiana was among one of the first states to utilize an electronic solution and not use a paper claiming system for the Fee-for~Service program. Today, all GSGI Indiana clients utilize GoClaim™ to report their direct service encounters for reimbursement.

GSOI had worked with the Indiana OMPP for several years assisting in the development of a Medicaid Administrative Claiming program, which is now in effect.

Nebraska + 1999 - 2005 and 2007 to Present

GSGI aligned itself with the Nebraska Association of School Boards (NASB) in 1999. NASB, representing all Nebraska school districts, was seeking a company to develop, manage, and implement a Medicaid Administrative Claiming program.

Over a period of approximately 18 months, OSGI worked with NASS, the Nebraska Department of Health and Human Services Finance and Support, and CMS to reach an agreement for the claiming methodology in the State of Nebraska. During the years of

7

1999 to 2005 GSGI assisted 173 Nebraska school districts with filing quaiterly Medicaid Administrative claims and helped these districts recover over $57 million in Medicaid reimbursements. Since 2007, OSGI has serviced over 220 districts and has recovered over $75 million in Medicaid reimbursements on behalf of our districts. Also, as previously mentioned, GSGl's and NASBMC's legislative efforts will continue as may be needed to achieve greater efficiencies in Medicaid claiming and reimbursement processes.

New Mexico + 1997 - Present

OSGI began working with the Cooperative Education Services (CES), a cooperative state purchasing agency, in 1997 to assist its school district clients with Fee-For-Service reimbursement, and to develop and implement a Medicaid Administrative Claiming program. GSGI worked with the New Mexico Departments of Education and Medical Assistance Division in the development of this methodology, which took approximately one year to gain its approval.

Prior to the end of the contractual period, GSGl was filing administrative and Fee-ForServicc claims for CES-participating school districts, including Albuquerque Public Schools, the 11th largest school district in the cotmtry.

GSGl continues to work with school districts in New Mexico.

Wisconsin • 1996 - Present

GSGl began providing Wisconsin school districts with superior consulting and claiming services for the school based direct Fee-For-Service program in 1996.

With our national recognition and experience in the development and implementation of the lllinois Administrative Claiming program, GSGI also introduced Medicaid Administrative Claiming to the State of Wisconsin and their participating school districts. GSOI worked closely with the applicable state agencies to develop a methodology that could gain approval from CMS. The OSGI methodology was so well received and competent that within approximately 2 years, the State of Wisconsin was able to utilize the GSGI methodology to develop an in-house administrative claiming system, which was provided at no cost to participating school districts.

(The remainder of this page is intentionally blank)

8

Proposed Management Approach and Project Personnel - GSGI

Management Summary - GSGI

GSGI offers solutions that meet the needs ranging from small rural to large metropolitan school districts, and draws upon its vast experience in multiple states and its ability to serve clients from the smallest to the largest. This "shared" knowledgebase, drawing upon experiences with federal and state challenges faced in multiple states, makes OSGI the right choice. The solution can be further customized depending on the needs and requests of the client. Our Application Service Provider (ASP) model, gives the client increased flexibility in its internal network configuration by having OSGI maintain all necessary hardware, teclmical support, and the associated infrastructure to support the efficient operation of the Medicaid billing process.

The Appl ication Service Provider (ASP) model

Utilizing the ASP model, GSOI maintains the necessary hardware, software, and infrastructure, along with skilled teclmical staff, to interface our system automatically with the district's systems and those of the State's, thereby providing a clean end-to-end solution to maximize Medicaid reimbursement with transparency to the district.

The ASP approach would allow the district increased flexibility in their internal network configuration. All that is required for a user to connect to eMacTM, our web-based RMTS application, GoClaimTM, or district data, is a user-name and password. The system can be accessed anywhere the Internet is available.

OSGI's ASP staff completes all upgrades, updates, performance monitoring, capacity planning, back-ups, and other tasks that a districts in-house staff would otherwise have to complete. OSGI includes an industry leading Service Level Agreement (SLA) as part of its ASP model to ensure compliance with mutually agreed upon levels of performance and system responsiveness.

GSGI's ASP solution utilizes web-based technology that complies with the Health Insurance P011ability and Accountability Act (HTPAA) because no student data, or protected health info1mation, is resident on individual workstations. All data is centrally located and maintained in secure facilities with FM200 fire suppression equipment, biometric data center security, and redundant backup power supplies in Lansing, Michigan. Not only does HIPAA require that this data be kept secure, the loss of this data can pose a serious liability to a client. The GSGI data center has passed numerous SAS-70 Type 11 certifications (now refe1Ted to as SSAE No. 16 Audits) - a certification long valued by financial institutions for data security.

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GSGl utilizes industry standard 128-bit encryption over SSL to allow for the encryption of data that is transmitted over the Internet. Utilizing a multi-tiered security approach on the GoClaimTM and eMac™ applications, transmission, and hardware levels, GSGl again meets or exceeds the security requirements as defined by HIPAA. The GoClaim™ application is also compliant with all administrative simplification requirements ofHIPAA with respect to Privacy.

Under the ASP model and utilizing the GoClaimTM application, OSGI handles all tasks related to billing and reimbursement (see Figure 1). As district staff documents the services they provide to the children, the GoClaim™ application will seamlessly and transparently collect encounters for potential Medicaid reimbursement without client involvement. OSGI billing administrators then verify the encounters to prepare for submission. This process involves proper CPT and ICD-10 coding, verifying student Medicaid eligibility, and ensuring encounters are within accepted state, federal, and Individualized Education Plan (IEP) limits. Any issues found during this level 1 processing are researched and investigated for potential correction and future submission by our expert OSGI billing administrative staff. Only "clean" encounters will be compiled into a HIP AA compliant Xl 2 837P claim for submission. Once submitted, the GoClaimTM application waits to receive the HIPAA Xl2 835 transaction set from the state. The HIP AA X 12 83 5 transaction set, otherwise known as the Remittance Advice (RA), is then loaded. processed, and analyzed. GSGI billing administrators, utilizing the GoClaim TM application, review the accepted and denied claims for any potential resubmissions resulting in additional Medicaid

reimbursement.

Another valued characteristic of the ASP model is our commitment to timely and useful management reports. OSGI is committed to providing NASBMC and the districts with meaningful and timely management reports in a highly secure but easily retrievable environment. OSGI will make these reports available to authorized personnel in real-time. OSGI utilizes highly flexible reporting tools within a secure web environment, and because the district will have direct access to GSGI technology and support personnel, the production and delivery of ad-hoc reports will be simple and timely. These reports may also be scheduled for email delivery to key district personnel upon request.

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Billing Process

Figure 1 - Billing Process

OSGI understands the necessity for the management of information and information technology to assure the appropriate transfer of information to generate data that will result in reimbursement for services in accordance with federal and state requirements. Moreover, OSGI is committed to providing participating school districts with meaningful and timely management reports and to maintain data in such a way that it is highly secure but easily retrieved and

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managed. GSGI will make these reports available to authorized personnel on a real-time basis.

Further, jn general, districts have multiple systems to manage, each one containing different data. Y ct each system is related, and used in conjunction with one another. The process itself can be cumbersome on the district and the providers they manage. It can also make the compliance of the special education documentation that much more difficult. GoClaimTM is now much more than a billing system; it is an integration tool, and can be used to integrate all systems together for the greatest compliance, and eliminate undue complication.

Because of the framework that GoClaim™ was built on, it can be used to easily import data from other systems, and export data from GoClaim™ to those very same systems.

Lastly, GSGI will monitor all updates on billing within the state of Nebraska and at the federal level. As part of the ASP full -service model, any required updates or system modifications are included in our fee. The process fo r system modifications includes:

• Notification sent to district on changes;

• Set up trainings, as needed;

o All training methods discussed in tab 4 will be available

• Service packs (system updates) will be run after hours to minimize service interruption;

• Unscheduled, critical updates are performed as necessary;

• System updates are implemented in a timely manner, to ensure maximwn program and policy compliance;

Three-stage testing process to ensure stability of system changes.

Administrative Claiming and Random Moment Time Study

GSGI will provide, host, operate and maintain our online system, eMac™, which supports accurate invoicing ofLEA's administrative claiming, as well as operate a statewide random moment time study (RMTS), in accordance with the approved Nebraska plan.

Centralized coding will be a function performed by GSGI, not the LEAs; therefore, LEA staff will not be trained on Medicaid allowable activities vs. nonMedicaid activities. However, the training for the school district Administrative Claiming Coordinators has been designed to assist them in appropriately identifying staff that are eligible to paiticipate in the RMTS program. The t raining materials will outline examples of activities that are reimbmsable under the program, which will enable the Administrative Claiming Coordinator to match cl igible staff and reimbursable activities.

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GSGI will collect eligible staff pool lists from each of the participating districts throughout the state. Each district staff pool member is assigned to one of two cost pools, and a total of 3,000 staff-moments will be selected for each cost pool.

A random moment is defined as a randomly chosen one-minute interval. For example, a participant could be randomly chosen to record his or her activities on May 25th for one minute beginning at 2:01 p.m. At the start of each quarter the sample generation tool will generate the random moments to be sampled and create associated random moment sample documentation tools. The total pool of moments within the time study is represented by calculating the nwnber of working days in the sample period, times the number of hours represented in the work schedules, times the number of minutes per hour, and times the number of participants within the time study. The total pool of moments for the quarter excludes weekends, holidays and hours during which employees are not scheduled to work, to the maximum extent possible.

Each time the selection of a minute and the selection of a name occurs, both the minute and the name are returned to the overall sample pool to be available for selection again. In other words, the random selection process is done with replacement so that each minute and each person are available to be selected each time a selection occurs. However, a sample participant cannot be selected twice for the same moment in time. This step guarantees the randorrmess of the selection process.

Randomly selected participants will document their activities for each random moment they are selected during the given quarter. A patiicipant may be polled multiple times in a quarter or not at all, due to the randomness of moments and participant selections. Each moment chosen for a participant will require a response. Regardless of the activity being perfo1med, selected participants are required to respond.

The time study is designed to capture 100% of the activities a participant could potentially perform at a given moment. The time study coding process assures that there is no duplication in claiming between the district's Medicaid in Public Schools MIPS and MAC programs. Time associated with the provision of direct medical services and therefore the cost associated with the provision of direct medical services is offset by way of application of the time study results. Furthermore, any paperwork, clerical activities or staff travel time is coded to the activity perfonned, thus assuring that time and costs integral to the performance of an activity such as MIPS is not duplicated as Medicaid administration.

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Project Personnel - GSGI

Project Director

Matthew Flaminio, Esq.

I I I I I I

Information Operations Manager Consultant Business Development Technology Director Manager

Project Manager

Mindy Benzler Gregory Morris, Esq. Mike Nevells Brent Cadwell

Jeremy Whitwam

Project Biographical Information

Mr. Matthew M. Flaminio, Esq.: As a licensed attorney in Michigan and the United States Supreme Court, his focus has been related to special education and Medicaid reimbursement for the last fourteen years. He has worked closely with the Nebraska Association of School Boards for the expansion of the state's school-based Medicaid program. Further, he has many years of experience providing insight and guidance to school-based Medicaid billing vendors as they have navigated the myriad of intricacies at the state and federal levels. Among his other activities, he is an active member of the American Bar Association, Michigan Bar Association, served as a panel member at a National Alliance for Medicaid in Education (NAME) Conference as well as an active conunittee participant of the organization, and has submitted pub]jshed works to the American Bar Association's E-Privacy Project. As President and Chief Legal Officer, he directs and oversees all aspects of the company in matters of day-today management and pol icy decision-making. He is responsible for establishing, planning and administering the overall policies and goals of the Board of Directors.

Mr. Jeremy Whitwam: As Information Technology Director, Mr. Whitwam directs and oversees all aspects of the intranet and extranet Web bilUng systems including design, release, and maintenance. He js responsible for establishing, planning and administering the overall policies and goals for the information technology department. With over eleven years of service at OSGI, he has designed and developed an extensible web based GoClaim TM framework for a national school based Medicaid billing system on Microsoft's .NET platform which allows for one code base to support a multi-state implementation with differing billing fonnats and screen layouts. Designed and built the databases to

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suppo1t the extensible framework on Microsoft SQL Server 2000. Developed strategies for data acquisitions and archive recovery, including monitoring the health and performance of the system, along with leveraged SQL Servers DTS technology to create files supp01ting EDI-X12 270,271, and 837 formats.

Mrs. Mindy Denzler: Ms. Benzi er has been with GSGI since 2001. Starting as the AZ and OH Account Manager, her responsibilities had included ensuring timely and accurate initial client set-up, collection of billing information, and processing of data. With her exceptional knowledge of school based Medicaid, Mrs. Benzler transition into the Fee for Service Manager where she oversaw the daily operations of the GoClaimTM system, and Medicaid processing for all direct service claims. Mrs. Benzler's current position oversees the Operations of GSGI where she is responsible for insuring the vision of GSGI, meets that of our valued customers. Her Focus is to make certain that our clients receive exceptional customer support, and feel confident in reporting their data. This responsibility includes the monitoring of any changes made in the state plans, and making sure that these changes are reflected in our software to guarantee the maximum level in compliance for our customers. She manages the processing of Medicaid submissions to various state agencies to ensure quality control of Medicaid reimbursements for our clients. Mrs. Benzler is also oversees the creation of training materials to assist our customers in the understanding of our data management software while managing training procedures.

Mr. Brent Cadwell: Since 1999, Mr. Cadwell has served as the Medicaid Administrative Claiming Manager for GSGI's Nebraska clients. Throughout this time, he has developed an expertise for creating and filing administrative claims, provided professional training on program methodologies for MIPS, MAC, and the financial requirements for claims processing. He has also targeted technical advances aiding in the reduction of errors, in addition to program monitoring, and assistance with audits and reviews.

Mr. Gregory Morris, Esq.: Greg Morris is an attorney with more than 30 years of practice in public policy law, and has been a specialist in special education and Medicaid reimbursement issues for nearly 20 years. 1-Ie served as a school Medicaid consultant to the New Mexico Coalition of School Administrators, the State of Wyoming Department of Education, the Ohio School Coalition, Standing Executive Director of LEAnet, other state government and LEA entities, and eight billing companies. He drafted the response for proposals (RFP) for Alabama's first Medicaid billing program, and wrote legislative language that led to Mississippi's first billing programs. With the Nebraska Association of School Boards, Greg developed Nebraska's first Medicaid Administrative Claiming program. In California, he served as Chairman of former Gov. Deukmejian's Efficiency Task Force which overhauled the state's health budget. In addition, Greg has represented a variety of clients as a registered lobbyist in several states, co~authored a book on the use of computers in public policy management, and

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held a variety of minor local, regional, and federa) elected and appointed offices. He is a frequent presenter on Medicaid in the schools at state and national conferences. Greg holds a J.D. from the University of Santa Clara College of Law, where he was Co-Outstanding Graduate, and a B.A. with Honors from Stanford University. He interned with the California Supreme Court and completed graduate level coursework in public administration at the University of Santa Clara School of Business, and is a graduate of the Public Affairs Council Institute. He has been admitted to practice in California and the U.S. District Court, Northern District of California since 1974 and has practiced pro hac vice in Nevada, New York, and Illinois.

Mr. Mike Nevells: Mr. Nevells has 26 years of experience supporting both State and Federa) goverrunent agencies with developing, implementing and supporting technology, including over 17 years within the School Based Health Services Medicaid reimbursement envirorunent. Prior to his promotion to Business Development Manager, he was the dedicated Indiana Senior Account Executive for the day-to-day operations and delivery of the Fee-for-Service (FFS) billing programs, including serving as the lead with implementation for new school districts, and providing the associated training. As the Senior Account Manager, Mr. Nevells has been supporting Indiana schools for nearly two decades, maximizing fully compliant Medicaid reimbursements for all qualified School Based medical services. Additionally, Mr. Nevells has developed and maintains a strong working relationship with the Indiana Department of Education (IDOE) and was instrnmental in the development and execution of the Indiana school based Medicaid Focus Group, which included support for the initial development and release of the TDOE's Medicaid Billing Guide and companion Tool Kit. Mr. Nevel ls also supports his Indiana accounts through his ongoing efforts with the National Alliance of Medicaid in Education (NAME). His new role as Business Development Manager will continue to foster his existing and build new relationships with school districts and state administrators throughout the country.

GSGI will not divert or replace personnel without approval of the DHHS and in accordance with the following procedures. GSGT will provide written notice of a proposed diversion or replacement to the DHHS at least thirty (30) days in advance and provide the name, qualifications, and background check (if necessary) of the person who will replace the diverted or removed staff. DHHS will then notify GSGI within ten (10) days of the diversion notice as to whether the proposed diversion is acceptable and if the replacement is approved.

Resumes of key personnel are included below.

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Matthew M. Flaminio

Executive Profile

Ambitious Executive who creates strategic alliances with organization leaders to effectively align with and support key business initiatives. Also a diligent attorney offering skill in innovative problem solving and finding unique theories, ideas and solutions to create effectual case arguments. Works aggressively to achieve continued success.

Skill Highlights

• Project management

• Leadership/communication skills

• Negotiations expert

• Extensive accounting experience

• Professional and personable

• Healthcare industry best practices

• Market research and analysis

• Customer-oriented

• Civil litigation

• Corporate litigation

• Outstanding public speaker

• Healthcare technology

Core Accomplishments

Legal Document Review

• Negotiated and finalized all company contracts including product agreements, service agreements, software license agreements, nondisclosure agreements and vendor agreements.

Litigation

• Assisted outside counsel with trial preparation, developed trial exhibits to motions and reviewed/organized documents for trial discovery.

Staff Development

• Launched well-received program for professional development courses for all staff.

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• Mentored and coached employees resulting in a 12% increase in productivity

Professional Experience

Go Solutions Group, Inc.

President and Chief Legal Officer

Lansing, Ml

Dec 201 1 to Current

Focus on federal and state regulatory policy and compliance. Worked closely with the Nebraska Association of School Boards for the expansion of the state's school-based Medicaid program and modificat ion of school funding legislation within the state. Direct and oversee aJI aspects of the company related to day-to-day management and policy decision-making. Responsible for establishing, planning and administering the overall policies and goals of the Board of Directors. Serve an integral role for planning for the future of the company, instituting measures to ensure compliance with the applicable laws and rules pertinent to the organization, and monitor the activity of the organization and its employees. Provide contract administration and regulatory subject-matter expertise with respect to state and federal compliance, including, but not limited to, matters involving the Centers for Medicare & Medicaid Services (CMS).

Flaminio Law, PLLC

Managing Member

Williamston, MI

Oct 2009 to Current

Specialized in Small Business, Education Law, Administrative and Regulatory Law and General Civil matters. Typical clients include small businesses wishing to consult an attorney on daily business operations, and individuals or organizations wishing to resolve employment, estate planning or other general civil matters. Investigated complaints of retaliatory and discriminatory employment practices. Reviewed and negotiated legal documents relating to the techno)ogy industry. Addressed contract-specific matters during case and precedent research. Analyzed data to test compliance with all legal reporting regulations. Drafted all necessary motions relevant to each case. Appeared for status conferences and settlement conferences. Explained the legal process to each client and answered questions to help ease concerns. Analyzed employer policies, procedures and work rules to verify full compliance.

Horizon Consulting Group

Member

Williamston, MI

Jan 2009 to Oct 2009

Independent Medicaid policy consultant through bar exam studies and corresponding exam results. Identified inefficiencies and made reconunendations for process improvements. Built and maintained effective accounts receivable and cash flow monitoring systems.

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Healthmaster Holdings, LLC

Divisional Director 2008

Walled Lake, MI

Mar 2006 to Dec

Conducted research on Medicaid policies and regulations, both nationally and statespecific, to advise executive staff on the intricacies of Medicaid reimbursement as it applies to the company's software product. Monitored the company's software compliance, including compliance with the Health Insurance Portability and Accountability Act (HTP AA), and procedures for client compliance.

Additional positions held include Senior Associate, Arthur Andersen; Financial Analyst, Delphi Automotive, Plant Controller, GKN Sinter Metals.

Education

Thomas M. Cooley Law School 2009 J.D.: Business Transactions Lansing, MT, USA

Bar Admissions: Michigan- October, 2009; U.S. Supreme Court-April, 2013

Michigan State University 2003 Master of Science: Professional Accounting East Lansing, MI, USA

Michigan State University 1997 Bachelor of Arts: Accounting

East Lansing, MI, USA

Professional References

Jolm Wurdeman Nebraska Association of School Boards Medicaid Consortium, Board Chairman (2009-2013) ( 402) 276-0597 [email protected]

Lauri Hawley Medicaid Coordinator Peoria Unified School District (623) 487-5189 lhawley(@pusd l I .net

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Sandy Noffsinger Board Member-Dundy County, Stratton Public Schools (308) 297-3287 [email protected]

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B1·ent J. Cadwell

Summary of Qualifications

• More than 20 years of management experience

• Familiar with all aspects of School-Based Medicaid reimbursement

• Hard working, able to multi-task effectively

• Outstanding training, leadership, and conununication skills

• Extensive customer service background


Go Solutions Group, Inc., Lansing, MI - Present

1999

Administrative Claiming 1vfanager

• Creation/ filing of the Administrative Claims

• Provide training of professionals on program methodologies for FFS, MAC, and financial requirements for claims processing

• Targeting teclmical advances that reduce errors and increases revenues in the claiming

processes.

• Assist clients with Audits/ Reviews

• Interaction with government agencies on plan methodology and to resolve concerns

• Program monitoring

• 17 years as NEBMAC Program Manager

Holt Auto Sales, Holt, Ml 1993 -1999

Specialty Vehicle Sales & General Manager

• Increased sales every year employed, tlu-ough effective sales planning and improved self presence of product lines, and repeat customers.

• Managed all non-sales employees to the highest level of quality through effective training, monitoring, and evaluating of performance.

• Customer Financing

• Helped create and managed upkeep of company web page

• Create'd and managed the specialty vehicle service and parts depaitment.

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Ci vie/Community Leadership

• Volunteered as an event coordinator for the 2001 National Folk Festival

Awards

• 1993 - Received the Civilian Life Saving Award from the Lansing Police Department and the City of Lansing

Education

Northwood University, Lansing, MI

B.S. in Business Administration, (expected 2017)

Michigan State University, East Lansing, MI

Lansing Conununity College, Lansing, MI


Michaella (Mitch) Esters, Principle CHAP Bellevue Public Schools 1600HWY 370 Bellevue, NE 68005 402-293-4000 m [email protected]

John Brazell, Director of Business Affairs Beatrice Public Schools 320 N 5th St, Beatrice, NE 68310 402-223-1500 X 1004 j braze I [email protected]

Jeff Schneider, Director of Finance Hastings Public Schools 1924 West A ST Hastings, NE 68901 402-461-7501 [email protected]

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Larry Witt. Superintendent Gibbon Public Schools 1030 CT ST Gibbon, NE 68840 308-468-6555 [email protected]

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Mindy S. Benzler

Accomplislunents

Created two new positions for account representatives, reducing overhead and increasing productivity. The positions reorganized the way an old-time account 'manager worked, going from an individual approach to a team approach.

Developed written procedures for cross training between positons and departments. This allowed for additional resources and cross functionality for greater coverage. This also allowed for the development of streamlined processes, shortening the time for Medicaid payments, while increasing payments.

Increased communication to accounts by developing informational newsletters; one for providers, one for administrators. These newsletters help with the understanding of Medicaid policy changes along with bringing an easier approach to documentation.

Created a training program which expanded access to training for district personnel. This program included enhanced training documents with easy to follow instructions. The training and training docwnents are now accessible both in person, and online.

Developed a coaching program for staff encouraging professional development, and empowering staff to develop problem solving ideas and creatjve thinking. The program enhances growth along with development tools to meet goals and objectives.

Successfully implemented the change to the code set of ICD-10. This implementation included staff training> development of training documents for customers, along with the process to roll out the change for the federal mandate of October, 1, 2015.


Go Solutions Group Inc. Lansing MI

September 2001- Present

Operations Manager • June, 2015- Present

Ensures the daily operations mns smoothly

Responsible for meeting financial goals for forecasting and budget management

Supervised completion of financial paperwork and tracking reports

Lead Project manager for new product development, and program upgrades

Collaborate across teams to share information and coordinate new ideas for continuous improvement

Identified process inefficiencies and enhanced new processes for company improvements

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Developed a sales program by coaching staff on effective prospecting and lead development

Hold weekly employee meetings to give information, feedback, and provide updated training

Consistently maintru.ned professional development by attending Seminars on Medicaid Policy, HIPAA compliance, and ICD-1 0 coding

Service & Support Manager • June, 2010 - June, 2015

Co-managed the Fee for Service and Administrative programs within Service & Support

Developed a help desk with task resolution, complaint handling

Exemplified tl1e second-to-none customer service delivery

Developed a process for customer service inquiries in a timely and accurate fashion

Developed a Customer Satisfaction Survey to monitor and measure out the Go Solutions core value of reliable and exceptional customer service

Introduced a new training program for both accounts and internal staff that enhanced performance and understanding of policy

Oversaw the billing department for Medicaid claim submission and reciliation.

Fee for Service Manager • June, 2004- June, 2010

Streamlined processes for Billing of Fee for Service Claims with an emphasis in error corrections and financial increase for customers

Developed and maintained effective accounts receivable and cash flow monitoring systems.

Account Executive & Billing Specialist • September, 2001 - June, 2004

Responsible fo r the sales and implementation of computer based Medicaid billing software in the states of Ohio, and Arizona.

Executed sales presentations, and yearly training presentations to established accounts

Responsible for submission of Medicaid claims in Ohio and Arizona

Programming and Software Skills

Proficient in Sequel Server for running back ground information and repo1ts to fit all of our customer's needs.

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Education

Bachelor of Science in Interdisciplinary Studies in Hwnan Resources- Michigan State University, East Lansing MI • 2002

• Minor in Psychology

• Minor in Business Management

Certified in Health Insurance Portability Accountability Act (HIPAA), September 2001-

Current

Professional Training on new ICD-10 code set, (March, 2014)

Organizations

Member of National Alliance for Medicaid in Education" 2012-present


Paula Nichols, Director South LaPorte County Special Education Cooperative Phone: 219.324.3287 Ext. 3584 [email protected]

Phillip Quack, Senior Data Architect-Big Data Stryker Corporation Phone: 517.719.7265 [email protected]

Stephen M. Rivet, Director Chain-Systems Corporation Phone: 517.719.9498 [email protected]

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Jeremy Whinvam

Jeremy Whitwam has over nineteen years of professional experience in data and technology driven fields, including designing, coding and maintaining web applications used by over five hundred school districts and hospitals. He has also brought multiple corporations into compliance with HIP AA-mandated electronic data interchange standards both on the Federal and state level, for medical billing interactions with both Medicaid and several other insurance companies. Technical skills are complimented by excellent team-leading, communication, and resource management abilities.

Professional Highlights

IT Director I Database and Software Engineer - Go Solutions Group Inc. (2004-present)

Directed and implemented the architecture, design, development and maintenance of GOCLAIM and EMAC, Go Solutions Fee-for-Service and Administrative Claiming management and entry web applications, developed using C#, .NET framework 4.0, SQL Server 2008 R2, and Telerik ASP.NET AJAX. Applications include over fifty reports developed with Microsoft Repo1ting Services. Brought both applications through an SSAE 16 audit. Developed and maintained HIPAA and FERPA compliant pass-tlrrough authentication system integrating various applications together. Developed and maintained HIPAA-compliant X12 EDI Standard billing engine, including updates for v50J O addendum and ICDlO diagnosis codes, in over ten states.

Database and SQftware Engineer - Med Bill Corporation (2001-2004)

Implemented the architecture, design and development of the Medical Invoice Processing System, which was a N-tier Windows application developed using C#, ADO.NET and SQL Server 2000. Network support with production web applications, US 5.0, SQL Server 2000, Windows 2000 servers and a variety of third party systems. Supported the day to day operations of the systems department including AS400 Emergency Physician Medical Billing system change requests, current Medicaid Administrative Outreach Claims billing software and School Based Health Services billing software.

Project Engineer - Quantum Consultants, Inc. ( 1998-2001)

Responsible for systems analysis, static and dynamic analysis of finite element models, and computer aided structural analysis of automotive systems.

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Validation Engineer - General Motors Co,poration (1998)

Designed and implemented fuel economy experiments to test EPA compliance of automobiles, and tracked/monitored progress of prototype vehjcles, controlled information flow.

Education

Holds a Bachelor of Science Degree in Mechanical Engineering from Michigan State University (East Lansing, MI)


Andy LeRoy Software Engineer First National Bank of America [email protected]

Phillip Quack Information Technology and Services Stryker [email protected]

Mitch Bean Former Director of Michigan House Fiscal Agency Michigan House of Representatives [email protected]

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Michael P. N evells

Mr. Nevells has 35 years of experjence supporting both State and Federal govenunent agencies with developing, implementing, and supporting technology. Including Digital Equipment Corporation and ATEK Information Systems, culminating with Project / Account Management for the State of Michigan $22 milHon Child Support Enforcement system. Currently with 24 years of experience with Go Solutions providing Medicaid recovery / Billing for special needs programs in Public Schools.

Professional Highlights

Senior Account Manager Go Solutions Group, inc. - - 2010 to Present

Responsible for Account Management for 93 Indiana School Districts as well as accounts in Illinois & Ohio including Sales in 11 States Nationally. Including the development and implementation of a combined account management strategy, national sales campaign, and presentations & trainings to large groups.

Director of Sales and Marketing Mecca-Tech, Inc. - 2008 to 2010

Responsible for 6 Account Managers / Sales representatives supporting 9 States Nationally. Including the development and implementation of a combined account management strategy and national sales campaign.

Midwest Regional Director - Mecca-Tech, Inc. - 2004 to 2007

Responsible for the administrative functions and the implementation and development of the Web-Based billing system, including the training of school district personnel to orientate them to the claiming process in several states. Responsible for the implementation and ongoing delivery ofMeccaTech' s services within the Great Lakes Region including Indiana, Illinois, Ohio, and Wisconsin. Includes all MeccaTech service offerings with the Medicaid Fee For Service and Administrative Outreach claiming programs.

Manager ofState Operations- Mecca-Tech, Inc. - 2002 to 2004

Responsible for the day-to-day operations and delivery of the Fee-for-Service (FFS) billing programs including the implementation in new states and school districts, and providing the associated training, maintaining the Medicaid eligibility information, maintaining student and clinician information, management of associated remittance advise data, providing all required management reports. Oversaw a staff often people

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and was instrwnental in the development of the WebMecca billing system and the implementation of the billing system into MeccaTech's existing accounts in nine states.

Virginia State Director - Mecca-Tech, inc. - 2000 to 2002

Responsible for the marketing and development of the Fee.for-Service billing process and the expansion of the School Based Health Service programs in the State of Virginia.

Special Projects Manager - Mecca-Tech, inc. -1998 to 2000

Responsible fo r the development and implementation ofMeccaTech's corporate Compliance Review program, and the development and implementation of the Random Moment Sample time study process for the Chicago Department of Health's Administrative Outreach claiming program.

Project Manager -ATEK information Systems - 1992 to 1998

Field Service Engineer, Contract Manager, Sales - Digital Equipment Corporation -1983 to 1992

Education

Holds degrees in Electrical Engineering from the University of Cincirmati and Forestry Management from the University of Maine.

P rofessional References

Pam Wright Director of Special Education Indiana D epartment of Education 115 W. Washington Street Indianapolis, IN 46204 317-232-0507 [email protected]. gov

Fred Mc Whorter II Chief Business Officer New Albany-Floyd County School Corporation 2813 Grant Line Rd New Albany, IN 471 50 812-542-2129 [email protected] 2.in.us

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Tracy Brnner Medicaid Specialist Indiana Department of Education 115 W. Washington Street Indianapolis, IN 46204 317-232-0507 [email protected]

Heather Paskis School City of Hammond 41 Williams Street Hammond, IN 46320 219-554-4517 hwpask:[email protected]

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G1·egory Morris

Education:

B.A., Stanford University. M~jor in English, Honors Program in creative writing. Completed baccalaureate degree in two and a half years while employed full time.

J.D., Santa Clara University School of Law. Co-Valedictorian, Student Body President, extern at the California Supreme Court. Achieved degree while employed full time.

Public Affairs Council. Graduate of the Cotmcil's three-year, one week a year residential program

Work Experience:

USAF, Air Traffic Controller

Mountain View Police Department, Police Qfficer

Industrial Indemnity Insurance, Public Affairs Manager

Managed a campaign to permit private sector operation of Washington state's workers compensation program, represented the company in Alaska, Oregon, Arizona and as a board member on the California Tort Reform Assembly.

Deaver and Hannaford Public Relations, California Vice President

Managed government relationships for Republic of China, Bechtel, Sony, the Keidanren, other clients. Successfully participated in stopping California' s unitary tax program.

KPIX Television [San Francisco Bay Area CBS affiliate] On-Camera Talent

Provided election coverage as an advisor and on-camera talent and provided legal on-air pieces.

Syntex Pharmaceuticals, Public Affairs Manager

Successfully managed dioxin spill situation in Missouri [Times Beach], created and produced television updates for international distribution. Represented the company before legislative bodies in California and Missouri.

Leslie Salt Company/Cargill, Public Affairs Manager

Created and managed a multimember organization that resulted in both preservation of property value and environmental protections in San Francisco Bay, successfully managed resolution of toxic pollution of Gulf of Mexico in Florida by company-owned entity.

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Central Michigan University, Senior Officer, University Lobbyist

As the University's lobbyist, increased state funding, including construction of two new buildings, created and managed a residential training program for state legislative staff members.

Bellwether Group, Cofounder and President/CEO

Created and managed a multi-state entity providing Medicaid billing services for school districts in Mississippi, Alabama, and Georgia.

LEAnet, Co.founder and Executive Director

Managed a national coalition of school districts, including New York City Board of Education, Los Angeles Unified and Chicago Public Schools. Created and managed an organization of more that eighty non-profits and private sector clients that successfully overturned a federal regulation that would have resulted in the annual loss of hundreds of millions of federal dollars to schools.

Attorney at Law

Mr. Morris has represented the states of Alabama, Wyoming, and South Carolina in matters directly related to Medicaid reimbursement for school-based health services. He has presented at state, regional and national conferences on these issues; has served as pro bono general counsel for the National Alliance for Medicaid in Education; as an expert witness in helping Ohio school districts reestablish that state's Medicaid reimbursement program; represented the Los Angeles Unified School District, both at the state and national level, in the protection of Medicaid billing; represented the New Mexico Association of School Superintendents in completely rebuilding that state 's Medicaid reimbursement program for schools; and has led a national coalition of school districts for nearly a decade in a variety of debates involving school based health services and special education financing.

Other Activities:

California Coalition for Trucking Deregulation, President

Managed a group of nearly 300 shippers, including Del Monte, Procter and Gamble, 3M, in overturning a harmful action of the California Public Utilities Commission. In seventeen months, changed the PUC vote from four to zero against to five to zero in favor of our position.

National Association of Charter Schools, Executive Direclor

Created the first national charter school entity, organized and managed two multinational annual conferences, published a monthly newsletter subscribed to by several state libraries.

33

City of Sunnyvale, California, City Councilmember

Elected to the City Council, co-led a community group that resulted in the election of two new members, overturning the previous Council majority. Served on several County agencies representing Sunnyvale. Served on the seven-member Redevelopment Agency that successfully rebuilt downtown Sunnyvale's commercial center.

Federal Criminal Justice Agency, Chairman ofRegion J [Santa Clara County, California J

Successfully created a year-long coordinated campaign that reduced in-county burglaries. Testified before Congressional Committee in support of continued funding of similar agencies.

Governor's Efficiency Team, Chairman

Served as Chairman of the GET team charged with overhauling California's state health department budget. Directly appointed by the Governor.

Combined Health Agency Drive (CHAD], Board Member and President

Increased corporate contributions to CHAD, reorganized the entity to reduce internal expenses, fired and replaced Executive Director.

Marine Science Institute, Board Member

Arranged the transfer of Bay Area waterfront land from private company to the Institute, co-managed the scientific analysis and disposal of a whale cadaver recovered on Institute property.


Mary Kusler

Mary Kusler, Senior Director of the National Education Association Center for Advocacy. The Center for Advocacy houses the departments of Government Relations, Campaigns and Elections, and Collective Bargaining. Prior to joining NEA, Kusler served as the Assistant Director of Policy and Advocacy for the American Association of School Administrators. In her role with AASA, she represented more than 13,000 school superintendents and local educational leaders before Members of Congress. Kuster has served as an executive committee member and past president for the Committee for Education Funding, chair of the National Coalition for Public Education, a national coalition of education and religious liberty organizations dedicated to fighting against vouchers.

[email protected]

202-822-7031

34

John Hill

On April 1, 2014, John became the first Executive Director for the National Alliance for Medicaid in Education (NAME). The NAME organization, chartered in 2003, brings together professionals who have an interest in Medicaid reimbursement and Medicaid outreach in our nation's public schools.

He previously managed Indiana's Horne & Community-Based Services Waiver for Persons with Developmental Disabilities and served as the Director of Indiana's Bureau of Developmental Disabilities. More recently, John worked for the Indiana Depru1ment of Education where his assignments included addressing racial/ etlmic disproportionality in special education and acting as the Department's liaison with the state Medicaid agency to enhance Indiana's public schools' reimbursement for medically related education services and Medicaid outreach.

John retired from state service on March 3 J, 2014 as the Director of Policy, Planning and Program Development with the Divjsion of Disability & Rehabjlitation Services within Indiana's Family and Social Services Administration.

[email protected]

317-902-5446

Stan Rosenstein

Stan Rosenstein is a principal advisor at Health Management Associates. Previously, he was Deputy Director of Medical Care Services and head of Medi-Cal for the California Department of Health Services. He began his career in state government in 1974 and joined the California Department of Health Services' Medi-Cal program as an analyst in 1977. As deputy director, he managed an operating budget of more than $30 billion, oversaw a workforce of approximately 1,600 employees, and played a major role in both formulating Medi-Cal program's benefits and eligibility policies and coordinating and directing the health care delivery system of approximately 6.5 million beneficiaries. Rosenstein graduated with a bachelor's degree from the University of Iowa and earned a master's degree in public administration from the University of Southern California.

srosenstei n@heal thmanagemen t. com

916-792-3740

35

AlexaPosny

Dr. Alexa Posny has almost four decades of experience in education spanning from classroom teacher to Chief State School Officer in Kansas to Assistant Secretary of Education, Office of Special Education and Rehabilitative Services in the U.S. Department of Education. Prior to that, she was appointed as the Director of the Office of Special Education Programs (OSEP) for the U.S. Department of Education, was the Deputy Commissioner of Education with the Kansas State Department of Education, State Director of Special Education, Director of Special Education for the Shawnee Mission School District.

[email protected]

785-850-9671

36

Subcontractor Information

Go Solutions Group, Inc. (GSGD 5840 Enterprise Drive Lansing, Ml 48911 (800) 260-2544

GSGI will perform all aspects of the RMTS and MIPS Cost Settlement process, which will be comprised of approximately 82% of the performance hours, and 100% of the subcontract hours.

37

Technical Approach

Understanding of the Project Requirements

The scope of this project includes the provision of Medicaid school-based claiming by applying Random Moment Time Study (RMTS) methodology and cost settlement processes to support proper Medicaid reimbursement for both direct medical services and administrative activities. The following narrative will provide insight to our solution, including the technical considerations, development approach, and project work plan.

Transition Planning

Our operational plan is comprised of project management tasks inter-related to operational tasks that are performed on an ongoing basis, and will be based upon, initially, the project work plan (Gantt Chart). As a leading Medicaid consulting vendor, GSGI is dedicated to improving processes both internally and with our clients. If NASBMC is awarded this contract, GSGI would work diligently with DHHS and NASBMC to implement various process improvement and reimbursement enhancement strategies. We will work in concert with DHHS and NASBMC, and it will be impo1iant to schedule a kick-off meeting to re-assess the previous fiscal year and determine a direction for the future. This will allow DHHS, NASBMC and GSGI to update tasks as needed. Most importantly, the meeting will provide the opportunity to determine which services can be maximized and identify any new operational efficiencies that should be implemented. All communications, materials and other media will first be approved by DHHS before GSGI releases the information to the end users. GSGI representatives will work closely with DHHS and NASI3MC to complete the following:

• Comprehensive transition plan to incorporate the activities necessary to turn over the business operations in an orderly manner;

• A plan for the transition of the on-going business operations and policy activities performed hy DHHS or NASBMC;

• Knowledge transfer to NASBMC and GSGI staff to confidently assLUne ownership without disrupting business operations.

Upon DHHS's approval of the transition plan, NASBMC and GSGI will begin transitioning the business operating functions and provide the transition progress assessments and status updates on a weekly or more frequent basis if needed or requested. Coordination will also occur between DHHS, NASBMC and GSGI regarding transition tasks, prioritization and any conflicting activities interfering with maintaining and operating daily business. At the conclusion of the transition phase, NASBMC and GSGI will provide a transition results report. This will provide the status of each highlevel task and activity that took place during the transition period.

This transition planning will lead the way for the development and DHHS approval of the fo llowing publications:

38

o Definitions and abbreviations o Program overview o School provider enrollment o Direct medical service eligibility o Covered services o Direct service provider qualifications o RMTS overview, including program features and processes o Time study implementation guide o Record keeping and documentation o Claims submission and billing o Interim payments and reimbursement o Annual cost reporting o Annual cost reconciliation and final payment o System guides for web-based systems o Quality assurance and program reviews o Program features and processes pertaining to MAC

Communication and Coordination with DHHS

NASBMC and GSGI will hold status meetings with DHHS at least semi-monthly, or as directed by DHHS, to discuss matters such as program policies, ongoing project updates, new project consideration, issue resolution, and progress on work or action plans. Also , document drafts related to training materials, forms, and notices to LEAs can be discussed during these meetings. NASBMC will provide materials in electronic fonnat to allow efficient use of time. All quarterly outreach materials will be provided for review by D HHS at least 10 business days before outreach materials are printed or disseminated to a school provider, unless a shorter time is approved by DHHS.

With the goal of successfully implementing, managing, and maximizing compliant reimbursements, DHHS is assured that NASBMC's and GSGI's experience and methods will result in project success. Our project management approach leverages our proven methodology. This methodology provides a step-by-step approach for implementing our program and employs project management best practices such as using a project plan to manage timelines, milestones, and deliverables. Another key component of our joint and collaborative work together will be communication management to help DHHS deliver a consistent message to all stakeholders.

Help Desk and Customer Service

One of the best ways to measure how well a vendor serves you is the speed in which they respond to a problem. NASBMC and GSGI are committed to prompt and accurate problem resolutions at all times. Below is a display of our average response times:

Type of Request Response Time

39

Non-Emergent: E-mail (Level 1)

Urgent: Telephone (Level 2)

Emergency: After Hours Contact (Level 3)

Within 3 business days

Inunediate handling in order of received

Within 4 hours

Non-Emergent: E-mail (Level )) (Does not prevent continued functionality)

• General questions or suggestion about your computer or its current set-up

• Non-time urgent matters: If you are having difficulty with a program or machine, but the situation is not preventing you from continuing your work.

• System response time: If you are concerned that the network is slow, or your computer seems sluggish.

• Requests for training.

• Billing error notifications.

• Request for specialized report.

• Questions regarding invoiced amounts.

• Program questions regarding Direct Service Claiming or Ad-Claim Claiming.

Urgent: Telephone (Level 2) (Prevents continued functionality)

• Time sensitive issues: if the solution of this problem has to be reached within a small time-frame.

• Critical system wide issues: lf the system is down.

• Work inhibiting: If you cannot continue with your job responsibilities until the problem has been resolved.

• Unlock locked out users.

• Reset password requests.

Emergency: After Hours Contact (Level 3)

• 24 hours per day/ 7 days a week/ 365 days per year

40

GSGI's corporate toll-free telephone number for customer support is l-800-260-2544. Staff is available from 8:30 a.m.-5:00 p.m. EST. For your convenience, we offer a User Support Help Desk available by e-mail ([email protected]).

NASBMC and GSGI will also provide to DHHS reports related to:

• Total number of inquiries with answer rate;

• Inquiry count by topic;

• Inquiry response times.

The GSGJ Team also provides our school district customers useful tips and guidance in the form of our Quick Tips and Go in the Know publications. Quick Tips is a newsletter for providers that gives specific information about Medicaid, GoClaim™, eMac™ and how the docwnentation process can be simplified for the user. We also use this to publish responses to FAQs from our Helpdesk, along with discussion of hot-topic issues that providers encounter on a daily basis. Go in the Know, on the other hand, is a quarterly newsletter for administrators. Its purpose is to inform them of national Medicaid issues, and case studies on how others have handled those issues. Each newsletter discusses administrative functions within GoClaim™ and eMac™ that aid in the management of their district's performance. Samples of these newsletters follow below.

Exemplary Customer Service is one of GSGT's core competencies. We are only as good as the services and products we can provide to our customers. Even though we have regular communication with our customer districts, and in an effort to offer candid communication between ourselves and the district, we provide an annual questiormaire to our districts ' staff, upon approval by DHHS and NASBMC, to offer feedback. We use the feedback to update our products and services to better fit the needs of DHHS and the school districts. This is what makes GSGI such a unique solution: we are in partnership with each of our customers to make this process as simple and streamlined as possible. A stunmary of this survey will be provided to DHHS within thirty (30) days of administration.

Technical Considerations

Direct Service and Special Transportation Claims

GSGI offers a technically advanced, yet easy to use Medicaid data management and billing solution that works in partnership with school administrators and the Medicaid providers. GSGrs solution includes its technological superiority for capturing, storing, auditing, and electronically transmitting claims for Medicaid reimbursement. The data management module has the reports necessary to provide school districts with tracking from select data entered from a child's IEP, for compliance challenges. Additional information school districts must have for providers, such as the records required for licensing, service delivery and caseloads, is included in this application. The GSGT solution provides a simple, readily accepted and complete method of providing the clinicians with the recording and reporting tools required by their profession, while

41

imputing the information necessary for Medicaid claiming. The Medicaid claiming is therefore seamless to the activities of the providers.

GoClaim™ includes administrative and reporting functions providing the most useful standard reports. It is customizable allowing the administrators to track, view and report all data stored in the application, including any information entered or imported from a child's JEP. Depending on the interoperability of the district's existing student information system, the GSGI solution will provide the school district with an interface between its system, electronic IBP and GoClaim™. GoClaim™ will electronically transfer data directly to the State for payment of Medicaid claims.

GoClaim™ is compliant with all HIPAA privacy, security and electronic transmission specifications. GoClaim™ is accessible 24 hours a day; 7 days a week from anywhere the user has access to the Internet. This allows the user flexibility during the working day to input encounter data on their schedule without interrupting their day-to-day responsibilities.

Incorporated into the web-based encounter-data management platform is a robust administrative reporting module that assists special education administrators and supervisors' access and the ability to create reports on all data captured. GoClaim™ has the capability to receive data from any student information system or IBP database that can be exported into an array of standard file formats. If the data is received in the correct format, it can be imported in a matter of minutes. We request this information from all districts on a monthly basis, but the data can be updated as often as nightly based on the specification of the district and their technical staff. All student information will be verified for Medicaid eligibility no less than weekly, prior to billing (837) transaction files.

School districts that take full advantage of the application's capabilities have realized that encounter data is accurately recorded and maintained. This allows administrators access to all encounter info1mation entered on every child with an IEP and every provider. The provider database includes such information as provider caseloads, and reports on services provided vs. services prescribed. Additional information stored in the database includes licensing information that consists of active or inactive status and expiration dates. This depth of access provides administrators the ability to instantly review and analyze encow1ter activity on all levels. GSGI has always committed its resources to assist our clients in maximizing reimbursement from Medicaid programs. We have the experience, personnel, systems, and dedication to details through our staffing, training, interagency-coordination between federal and state agencies and the school districts to assure that all federal and state programs are managed properly, comply with program rules, regulations, and polices while maximizing Medicaid reimbursement.

GSGI continues to utilize its knowledge and experience to provide a level of service that complements our state-of-the-art, web-based, direct service application. A significant factor in GSGI's ongoing success is the level of service it provides to its clients. Unlike many Medicaid consulting companies that typically manage accounts from their

42

corporate headquarters, GSGI has always strived to provide its clients local, as well as corporate support and service. In many states where GSGI operates, we employ multiple account executives to work with their clients on a daily basis. GSGI believes that upon an evaluation of its proposed solution, it will be the ideal contractor that can continue to increase compliant reimbursements, simplify the operation, and provide the administration with tools to help better manage the special education program.

Upon verification and claim processing, GoClaim™ will audit all new encounters for data integrity and completeness in the following areas:

• Required data elements for the recipient of the service are populated on the student's profile within the database. Upon adding a new student to GoClaim™, the student's Medicaid nwnber may not be known. If this number is not present or does not meet the criteria for a valid data set, claims for this individual will not be processed.

• Child to whom the service was provided meets the definition of a qualified child on the claim service date by utilizing the eligibility data to verify the child was eligible on the date of service.

• Any available third party liability is held for processing until such a time that the insurance company has been contacted to insure no payment can be made. GSGI utilizes the eligibility data to verify if any third party liability is indicated. If third party liability is indicated, claim is pended for review of possible payment or denial.

• Service provided by an individual provider who meets the definition of a qualified provider and is eligible to provide the service on the claim service date. This is accomplished by refening to the provider information table withiu GoClaim™, which is populated with provider eligibility data that includes, but is not limited to, individual provider number and license expiration date.

• Dates of service are within the 180 day time limit by examining the date of service against the current system date.

• If the child's IEP information has been entered as part of the student's profile within the GoClaim™ database, entered services may be verified against the prescribed services for that student according to his/her IEP.

43

Illinois - Bedford Falls

P,oyfdcr; STEWART, HMMY (Sp(((h)

Sen.ice Entry Stf\ '1(U

I Student: ~ U~Y

Place af Ser~l<e: Ol . Scllool

CPT Code: [;2~07 .1na.,ido11 J 3min.

Oi11no1I, Code: (::~v] Slut lime: la 00 AM ! °0' (ndlime, Is 15 AM lh ~ -----~ Units: 13 00 j ~

Noles: , .~ ,') . (' • .

Rich Text Formatting for notes. including a built-in spellchecker.

\ • t • .I

Oates of service highlighted in yellow Indicate a nonworking day or holiday. Service entry is prohibited on these days.

• l ll)X • To!oons

Service Entry

Intuitive calendar based data entry. Dates of service in the future and on

s weekends are highlighted In red to prevent data entry

In addition to these processes, the application ensures encounter compliance, in real time, during the data entry process. For example, attempts to enter a duplicate service by a provider for a specific student will be blocked for submission. Additionally, our graphical calendar method of entering services directly into GoClaim™ (see above) limits users from back-casting dates of service outside of the claimable limitation (from date of service) on claims and also prevents entering of future encounters. GoClaim™ also provides the ability to import a custom school calendar to further limit the entry of services on non-working days or holidays.

Utilizing batch control, GSGI wilJ submit for reimbursement, on at least a weekly basis, all collected and verified claims not previously submitted and paid. The submission file will be provided in accordance with the Nebraska submission requirements.

All claims that have failed the verification process will remain in the GoClaim™ database for any edits to the data elements missing from the claim (clinician or student eligibility information) and will be re-verified within the 180 day claiming period.

44

Services are Captured

100% of billable services

appear 1n the IEP

Critical Factors:

• Attendance of Student

• Attendance of Provider

• Parent informed consent

• Record of Annual Notice Sent to Parents

• Eligibility Determination

• Complete I accurate student data base

• All IBP Required services documented in GoClaim™

How a Claim is Prepared

Services Entered into

GoClaim™

Critical Factors (Timeliness):

• Services entered monthly

GoClaimn,,

Verifies services, and

Claim Created

Claims are stored in

system waiting for

submission

45

• Workload of Coordinator

• Provider registration/licensure

• Provider NP! registration

How a Claim is Submitted

Factor that Influence Claims Submission:

• Formatting of claims

• Submission of clean claims

State

receives claim batch

for processing

and payment

The GoClaim™ application is a robust data management and billing software. The application helps increase compliant Medicaid reimbursement, deliver superior special education services, and make faster, more informed decisions. With the built-in dashboard to help highlight activity and trends, a district would be able to improve special education service delivery, reimbursement, and improve compliance. The application's functionality also allows administrators to gain insight into your special education population with customizable key performance indicators, including Service Activity, Monthly Progress Reports, and Student Eligibility.

Eligibility

CutTently, student eligibility is provided by the Nebraska Department of Education. However, OSGI has the ability to verify student eligibility in real time, utilizing batch eligibility in the form of an X l 2 270P will be created for submission as often as needed,

46

but no less than prior to claim submission. The administrative functions allow for a selection of students, or all students to be run within a file. GSGT administrators have the option to run the eligibility file based on the parameters selected. Once the parameters have been set, GoClaim™ will compile the selected criteria into an X12 270P file. The X12 270P file will then be submitted to Medicaid. The process of setting parameters, file creation, and submission is an automated process, and will be scheduled at the time of transition of the contract. Although additional files can be created and processed as needed. The billing specialist will review all outcomes ensuring the processed has been

completed, and completed accurately.

If a student is lacking information needed to process eligibility, an error file will also be created. Student errors generally contain students that are missing a gender, or have special characters located within their name. Errors can be cotTected, and the corrected student(s) will be processed within the next X12 270P file and or by hand through the state eligibility site. Once the Xl2 270P file has been processed and the Xl2 271 file has been generated by the state, the results will be imported back into GoClaim ™. Further, GoClaim™ has the ability to store both the child's name in the district's database as well

as the legal name of the chi Id on file with the state, if different.

This is an automated process, therefore most person hours will be at time of transition to GSGI, to set up the eligibility schedule. With the standard file format for student information, e1Tor creation is at a minimum, but will be reviewed after each file creation.

Verification and File Creation- 83 7, sample errors

GSGI billing specialists have the capability to verify all encounters that are cWTently in GoClaim™, or may set parameters to only verify a selection of data. Parameters can be set based on therapy type, date range, encounter type or all the

above.

The GoClaimTM application has logic in place to ensure that all Medicaid requirements are docwnented for each encounter, and if a requirement is missing, the encounter caIU1ot be billed. This is also where each district options will be considered; for instance, if a district has selected for GoClaim™ to monitor supervisor sign-off for documentation, the verification will make sure valid paperwork is documented prior to allowing those services to pass verification

procedures of claim processing.

All claims that are determined to be "verified" will be marked as such in the GoClaimTM database and will be available for submission for reimbursement, at a specified date in intervals not to exceed one week. Those claims that have failed the verification process will remain in the GoClaim™ database for any updates to the data elements missing from the claim (e.g. student or clinician eligibility information) and will be re-verified during the next batch processing. An exception report can be generated and be provided to the school district's personnel in attempt to correct service-record information to allow processing. This information can also be monitored through the Dashboard of the GoClaim

47

application, here an administrator can review all critical pieces missing from their database, and an example would be students missing a parental consent on file.

Utilizing batch control, OSGI will submit for reimbursement all collected and verified claims not previously submitted and paid. The submission file will be provided in accordance with the Nebraska submission requirements.

Any encounters that have not met all system requirements will stay in the verification stage until a time that the error has been corrected, or until the claim has exceeded the time for eligible submission. All encounters that have not met the system requirements will be viewable within the View Error page for further

research.

The View Error page will list all encounters that have not passed verification, and those encounters will be listed by the errors it has triggered. For example, if an encounter is missing both a Medicaid nwnber and Parental Consent, the encOlmter will be listed under both "Stlldent missing Medicaid number" and "Missing/expired parental consent". Any encounter on the View Error page can be corrected by selecting the error, correcting, and saving the information. The next time the encounters are verified, the corrected encounter will pass verification to the batch creation staging area.

Once all errors have been corrected and re-verified, those in the batch creation staging area can be created into an Xl2 837P claim file from the billing dashboard. The created Xl2 837P claim file will be in the GoClairn™ file manager for submission to Medicaid.

Each district will be placed on a schedule for 837P billing file creation and submission to the state for processing. The schedule will be developed as part of the transition plan for at the begiruiing of the contract period, and will be agreed upon by both DHHS and GSGL The process will take place after office hours and will be automated for time efficiencies.

Claim reconciliation- 835. Void, Replacement

Once the Xl2 835P remittance file has been uploaded into GoClaimTM, the encounters can be reviewed for acceptance and denials by the GSGI billing

specialists.

Within the Claim lookup page, parameters can be set for the billed encounter data you wish to view. The data can be limited to a specific student or provider, or can be expanded to an entire billing batch. Upon first view, the claim lookup page will show the claims that have been submitted within the search parameters, to expand to the encounter information select the arrow next to that claim.

From the Encounter View of the claim lookup page (Figure 2), you are able to view the status of the claims submitted along with any remark or denia) codes for those encounters. This is also the location where the encounters can be flagged for

48

resubmission , or apply a void or adjustment to a claim. Once any encounter has been Hagged for an adjustment, void, or resubmission, it will be available for X12 83 7P verification and claim creation, and will be processed as needed.

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=·= l;'.Oi,'lOli

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"

Figure 2- Claim Lookup

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As a district option, and in addition to the robust GoClaim™ software, if a district captures its services through an electronic IEP application, GoClaimTM has the capability of importing nearly any database file format, and OSGI will work in collabo ration with the district to establish this process for automated imports of data.

When the data has been verified, and based upon access rights established by the district, the information on encounters, children, and providers is available fo r

viewing. In summary, this is the most efficient method of capturing and billing of services at the school district and is an integral element of a successful direct serviccMclaiming program w ith the greatest ability to comply with audit standards.

All qualifying covered services, including any additional covered services added in the future, will be:

• Prescribed on a child' s Individualized Education Plan (IEP);

• Provided by qualified providers who are employed by or contracted with the school district or individual schools within the district;

• Provided on school grounds Lmless the IEP specifies that a qualified child be educated in an alternative setting due to the condition of the child;

49

• Prescribed and provided in accordance with the Nebraska Standards;

• Approved for submission by way of signed parental consent.

Only qualified covered services provided to Title XIX eligible children, who arc also eligible under IDEA, will be eligible for submission under the program. OSGI will maintain compliance with all cwTent and futme CMS and Nebraska regulatory requirements pertaining to the claims reirnbmsement process. GSGI's claim authentication process will determine the eligibility of the valid claims based upon criteria established by CMS and approved by Nebraska.

OSGI will also provide reports based on remittance advices loaded into the application that wiB outline the claims accepted and denied. Reports on the review of remittance advices and resubmission of corrected, eligible claims will be included in the services available to the district. This report also includes a breakdown of those claims resubmitted.

Proposed Development Approach

Administrative Claiming and Random Moment Time Study

GSGI has performed Medicaid Administrative Claiming administration in Nebraska since 1999. Since the 2013/2014 school year, OSGI has provided an RMTS application for 220 of the great schools throughout Nebraska. 1bis school year represented the year in which DHHS unified the Medicaid Administrative Claiming methodologies, eliminating the five-day time study, and applying the RMTS methodology between two established consortiums. GSGI will continue to provide, host, operate and maintain our online system, eMacTM, to allow invoicing of LEA's administrative claiming, as well as operate a statewide random moment time study (RMTS), in accordance with the approved Nebraska Administrative Claiming Program, NEBMAC. This RMTS system will be available to DHHS in both a testing and production environments.

Centralized coding will be a function performed by OSGI, not the LEAs; therefore, LEA staff will not be trained on Medicaid allowable activities vs. non-Medicaid activities. However, the training for the NEBMAC Coordinators has been designed to assist them in appropriately identifying staff that are eligible to participate in the RMTS program. The training materials will outline examples of activities that are reimbursable under the program, which will enable the NEBMAC Coordinator to match eligible staff and

reimbursable activities.

NEBMAC Coordinators will be required to attend an initial RMTS training and all additional mandatory RMTS trainings.

To achieve statistical validity, maintain program efficiencies and reduce unnecessary LEA administrative burdens, GSGI will implement a consistent sampling methodology for all activity codes and groups to be used. The statewide RMTS sampling methodology has been constructed to achieve a level of precision of+/- 2% (two percent) with a 95% (ninety-five percent) confidence level for activities. Statistical calculations show that a

50

minimum statewide sample of2,401 completed moments each quarter, per cost pool, is adequate to obtain this precision when the total pool of moments is greater than 3,839,197. Additional moments arc selected each quarter to account for any invalid moments. Invalid moments are observations that cannot be used for analysis, i.e., moments selected for staff who are no longer at the school district, or who changed jobs and are no longer in an allowable position and the former position has not been filled. GSGI will conduct a minimum state-wide sample of 3,000 moments per staff pool quarterly: the direct service cost pool and the administrative service providers cost pool.

Before the statewide sample is generated, each LEA must submit a staff pool list and certify that all staff included on the list are appropriate for inclusion in the time study. Staff deemed inappropriate during review of time study quarters will be removed from the time study and excluded from claims. If a staff person leaves the LEA in the middle of the quarter and the position is filled, the LEA must notify the RTMS contractor to update the contact information associated with that position. If a new position is created or a LEA does not include an existing position on the staff pool list created at the beginning of the quarter and used to generate the statewide sample, the LEA must wait until the next quarter to add that staff person/position. All allowable staff must be listed on an approved staff pool list prior to the time study quarter. If an allowable staff person is not listed included on the staff pool list, costs cannot be claimed for the position.

OSGI will assign staff to a specific job category in one of the two cost pools. The LEA's certified staff list for each cost pool will be used to generate the statewide sample for each pool. The cost pools, and staff within the pools will be created by the LEA's NEBMAC Coordinator, with the assistance of GSGI staff.

The following is the moment generation process used by OSGI:

A moment is generated in a specific sequence. A date and a time, collectively called a moment, are initially randomly selected; then this moment is assigned (associated) to a randomly selected participant from the roster poll. The statewide sample comprises all LEAs that participate in the NEBMAC Program; each LEA may have its own work/non-work days (defined by the calendar of the LEA) and work hotrrs. Moments are generated for the entire three month quarterly period prior to the start of the quarter. To generate moments randomly in compliance, the following steps take place by order in advance of each quarterly period:

I . Random Date

a. Obtain the start date and end date for the LEA quarter. Typically, these dates wi 11 be the quarter start date and quarter end date;

b. Randomly generate a date within the two above dates;

c. Evaluate the date to make sure it is not on a weekend or non-work day. If it does fall on a non-work day, another date will be generated until a work day is generated.

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2. Random Time

a. Obtain the time parameters:

1. Morning start time (7:00 AM)

11. Afternoon end time (4:00 PM)

b. Randomly generate a moment

c. Evaluate the generated moment to confirm it is within the limit of time parameters.

3. Random participant

a. Randomly select a participant from the staff pool list;

b. Check the generated moment against the non-work days;

1. If the date of the generated moment falls into a non-work day, the participant will be abandoned and another randomly selected participant will be chosen until the date of the generated moment is contained within the work day;

11. If the date of the generated moment falls into a work day, the generated moment wi II be verified against the work hours of the LEA;

m . lfthe generated moment falls within a non-work hour, the participant will be abandoned and another randomly selected participant will be chosen Wltil the participant is working on the generated moment;

iv. If the generated moment falls within the work hour, associate the participant with the moment.

Time study participants are notified via e-mail of their requirement to participate in the time study and of their sampled moment. The following steps are taken to ensure that participants enrolled in the time study receive their moments and proper notifications:

1. Sampled participants are notified of their sampled moment no more than five days prior to their sampled moment and at least one reminder e-mail is sent out 24 hours before the moment.

2. Participant logs onto web site using any Intemet-ready computer and fills out the time study online within five calendar days after end of the moment to ensure the accuracy of the time. A moment is no longer available to a participant five calendar days after the end of the moment.

3. After the prescribed moment has passed, each sampled partjcipant is asked to record and submit his/her activity for that particular moment.

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4. GSGI and/or the NEBMAC Coordinator follows up with the participant within 24 hours after the moment has occurred to ensure compliance.

a. GSGI and/or the NEBMAC Coordinator will contact the sampled participant whose moments have not been completed to remind them of the moment and the importance of completing the moment.

b. GSGI and/or the NEBMAC Coordinator can provide the participant a website or the support telephone number that they can utilize to receive additional support they may need to complete the moment such as their usemame, password, website, etc.

Throughout this entire process, the NEBMAC Coordinators have real-time access in eMacTM to view their sampled staff, the dates/times of their sampled staffs moments, and whether or not the moment has been completed. If the return rate of valid moments is less than 85%, then all non-returned moments will be included and coded as non-Medicaid.

A validity check of the time study results is completed each quarter prior to the calculation of the claim. The validity check ensures the minimum number of valid responses is received each quaiter to meet the required confidence level. The number of completed and returned time study moments is analyzed to confirm that confidence level requirements have been met. Once the validity of the sample has been confirmed the time study results are calculated, prepared for use in the annual cost settlement and reconciliation process, and included in the overall quarterly time study results. At the end of each quarter, once all random moment data has been received and time study results have been calculated, statistical compliance reports are generated to serve as documentation that the statewide sample results met the necessary statistical requirements. Further, the sample results will be stored for future review, if needed.

As previously mentioned, all documentation of sampled moments must be returned within five days after the sampled moment date. Documentation of moments not received within the required period cannot be used in the calculation of the necessary number of moments needed to satisfy the level of precision of+/-2% (two percent) with a 95% (ninety-five percent) confidence interval.

Documentation of sampled moments must be sufficient to provide answers to six questions needed for accurate coding:

1. Were you working during your sampled moment?

2. Who were you with?

3. What were you doing? (must be specific)

4. Why were you doing this activity?

5. Is this activity related to a Special Education student?

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6. Is the service you provided part of the child's TEP?

Each sampled paiticipant must complete the six questions above for each moment in which they were selected. Responses to questions one to four are completed by the participant in free form text. Participants choose a response of yes, no or NIA for question five and six. After answering the six questions the sampled staff certifies the accuracy of their response prior to submission.

Administrative Claiming Financial Data

The financial data to be included in the calculation of the Administrative claim are to be based on actual expenditures incurred dming the quarter. OSGI current captures this data, all infonnation required by the Certified Public Expenditures (CPE) payment methodology, in the form of spreadsheets completed by designated staff at each individual school district. This functionality is due for implementation into eMAC™ at the beginning of the 2017/2018 school year. This functionality will be available in both the testing and production environments.

These costs must be obtained from actual detailed expenditure reports generated by the provider's financial accounting system. The only costs that will be included are those that meet reporting requirements and that are from eligible categories.

LEAs will only be reimbursed the federal share of any administrative and direct service billings. The Chief Financial Officer (CFO), Chief Executive Officer (CEO), Executive Director (ED), Superintendent (ST) or other individual designated as the financial contact by the LEA will be required to certify the availability of necessary public matching funds. The ce1tification statement will be included as part of the invoice. LEAs will be required to maintain documentation that substantiates the certified funds used for administrative and direct service claiming.

One of the main drivers of MIPS cost settlement is the use the Random Moment Time Study. Random Moment Time Study is a sampling methodology used to determine, in a statistically significant manner, the percentage oftime spent on different tasks by different types of people. The time study divides participants into two cost pools. Each pool is mutually exclusive, which means each person is only in one cost pool. However, the activity codes for each pool may be applicable to more than one program. For instance, speech therapists in the direct services pool may spend the majority of their hours on direct services claimable through MIPS, but also may perform some Medicaid administrative activities as well.

The MIPS Cost Report is designed to capture the actual cost of Medicaid reimbursable services. Before the cost reporting functionality is available electronically, OSGI will make available a cost reporting spreadsheet to capture the require data. Annually, or as needed, OSGI will update and place an electronic

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version of the MIPS Cost Report and Instructions on its website. Additional downloadable reports will be available for the districts to complete the MIPS cost reporting process. These reports include, but are not limited to, Indirect Cost Recovery Rates, Random Moment Time Study percentage and MIPS Medicaid Eligibility Rates.

Allowable and Unallowable Cost Guidelines

Further, all MIPS providers shall adhere to the following guidance:

1. The cost principles contained in 2 CFR 225 (formerly A-87);

2. The general administrative rule contained in 45 CFR 92, formerly A-102 "Common Rule',

Any costs specifically subsidized by other federal monies are unallowable, except for federal funds authorized by federal law for use in matching other federal funds.

Administrative Overhead Costs

Administrative Overhead costs are those incurred for common or joint objectives and cannot be readily identified with a particular final cost objective (i.e., salary, fringe benefits, rent, depreciation, utilities, supplies, equipment, etc.)

1. A provider may choose any allowable allocation methodology found in 0MB Circular A-2 CFR 225 as long as the cost is treated consistently between reporting periods and with other costs incurred for the same purpose in like circumstances and if it is incurred specifically for the award;

2. Benefits both the award and other work and can be distributed in reasonable proportion to the benefits received; and/or

3. Is necessary to the overall operation of the organization, although a direct relationship to any particular cost objective is unclear.

Indirect Cost Rate

MIPS providers can report an Indirect Cost Rate if the rate has been approved by the department of education.

Revenue

Revenue is not reported on the MIPS Cost Report. However, if an expense is incurred where the provider has received federal revenue to assist in paying the expense, the amount of the expense being reported in allowable areas should be reduced (net applicable credit).

Documentation

It is imperative that the provider maintain detailed records to evidence the actual Medicaid allowable services expenses. Auditing of the documentation will be

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utilized to trace reported costs on the MIPS Cost Report to the data source (e.g., general )edger).

Documentation includes, but is not limited to, accounting records, invoices, payroll journals, Personal Activity Reports (PAR)/fime and Effort Logs, IEPs, Parental Consent, evidence of orders/referrals/prescriptions. Methodologies for allocating costs to various programs and services should also be adequately documented and available for review.

Cost Settlement Calculation

The MIPS Cost Report is designed to capture the actual costs of the provider. Since the initial phase of the Cost Settlement process will be through a spreadsheet fo1m, summary worksheets are formula driven, and are "locked" to provide additional assurance of accuracy. Providers will only need to access specific worksheets to input provider and financial data. These worksheets include: Certification Page; Provider Data; Statistics; Direct Medical Cost; Direct Admin Cost~ Transportation Cost; Settlement~ Payroll Costs; and Contract Costs worksheets.

The MIPS Cost Report is formula driven and will use the provider and financial data entered by the provider. This information, along with the Random Moment Time Study, IEP Rate and Medicaid Eligibility Rate is used in various formulae to compute the Cost Summaries for Direct Services and Administrative Claiming.

Annually, the GSGI will update the MIPS Cost Report to include the newest Random Moment Time Study percentage. Since the time study is statewide, GSGI will input time study averages as an Allocation Basis. The Cost Summary worksheet wi II then use these rates as part of the cost summary worksheets formula. MIPS providers participate in quarterly, statewide time studies utilizing random moments for each cost pool to calculate time study results, which use data from every participating provider. As a result, every provider uses the same percentage by activity.

Payroll Costs Sheet - This sheet must be entered by the provider and uses data to determine the total allowable costs for salary and benefits for the various professionals providing services. They are stmctured to begin with total amounts computed by the district. Reductions to the Gross Salary are then reported on a participant basis. The result is a net amount of personnel expenditures used for the MIPS Cost Report. This worksheet is the key to what figures the program uses to calculate the district's allowable expenditures. Due to the number of participants, the district should input the "Total Gross Salary" for the given participants but maintain corresponding accounting records that support the amounts. Districts must maintain proper documentation to support these expenditures. This includes, but is not limited to, accounting records, time and effort documentation (logs or semi-annual certification).

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Contracted Costs Sheet - This sheet uses provider data to determine the total allowable costs for non-employees. Contracted nonemployees are currently required to participate in the random moment time study. However, allowable contracted costs must fol low local and federal procurement practices in order to be reimbursable. For program integrity purposes, the provider must list each contractor indicated with an overall contract with an agency to allow the department of education to ensure that those contractors indicated for potential reimbursement are participating in the requirements of MIPS program by submitting required documentation related to serving Medicaid-eligible special education students. Simjlar to the Payroll Costs tab, this worksheet allows the district to prorate any positions that may only be partly eligible for potential reimbursement, such as a position partly funded through another federal funding source.

Settlement Sheet - This worksheet uses data to reconcile between reimbursable activities and paid claims received. Certain locked and populated cells import from other parts of the workbook. The Medicaid reimbursement amount received to date by the MIPS provider must be entered by the provider.

Interim Rate Setting

The financial information will become vital to establishing the interi m MIPS rates. Utilizing this data, methodologies will be developed, with the Department's approval. Since GSGI has a long history of providing NEB MAC services throughout the state, we have the historical cost data, which will become critical to establishing the interim rates. This data will be used to calculate districtspecific interim rates, utilizing the Department's agreed-upon methodology.

Trainings and Materictls

NASBMC and GSGl will conduct annual trainings for MIPS Cost Settlement, Administrative Claiming, and RMTS, regionally. The location of trainings will be dependent on region and availability of trainees and specific venues.

Initial and sustained/updated training for both staff and administrators is the cornerstone for a school district's success in recovering and retaining compliant Medicaid reimbursements. The participating school staff must have a full working knowledge of the activities and associated processes they will be required to perform while reporting required/compliant information. In the case of MIPS claiming, timely and accurate reporting of service encounter data is critical. GSGI recognized early the imperative need for school staff to be provided with ongoing, comprehensive training. The challenge here is to provide this comprehensive training efficiently, assuring that the staffs normal workload is not adversely impacted. Additionally, there is a clear need for concise training documentation as well as a strong post-training support structure. Therefore, a school district seeking to maximize compliant Medicaid reimbursements on an ongoing basis must have all personnel involved in the program properly trained.

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NASBMC and GSGI concur that training is a crucial element in the success of a

school based Medicaid reimbursement program.

GSGT has developed a superior range of training options for its contracted school districts. We provide both initial training for new clients as well as annual and

expanded sessions throughout the contract period.

Our initial training sessions are in two parts: the introduction of the training session focuses on "Why Medicaid in Schools'' and the second part on use of GSGl's web-based application, GoClaim™ for recording their services, providing

a basis and purpose for their participation.

Too often initial training is considered sufficient. GSGI realizes it is imperative to assme training needs are monitored, and, where necessary, additional training is scbeduled and provided. GSGI's open lab training sessions have proven beneficial to its client's persom1el. Districts provide a schedule of training dates and access to computer labs. These open lab sessions provide the participating staff with an opportunity to enter current service data guided by a GSGI training specialist who can provide one-on-one assistance to the participants. This allows individual participants to receive specific answers to their questions and needs.

We have refined our training practices imparting necessary information and insight about the Medicaid program to school district persom1el. Training provided hy OSGI exceeds the requirements set fo1th in state and federal plans.

Training will include regular updates as well as local and regional meetings as necessary for district personnel. GSGI will provide training at the beginning of the program and thereafter as needed, but not less than am1ually. Training sessions will be conducted at appropriate district locations. Training sessions will employ efficient audiovisuals, handouts, booklets, other electronic media, and/or the use

of personal computers.

GSGI's training will include information regarding the basics of the MIPS claiming program. This will include an overview of the specific requirements that must be complied in order to receive reimbursement for qualifying services; review of the requirements outlined in the Nebraska State Plan; and federal and state laws, regulations, and requirements. Training ,vill also include the requirements for program participants outlining subjects that include assurance:

• Billed services meet the requirements for qualified covered services;

• Non-federal monies generated by the school's participation in the Medicaid program are available to provide the required Title XIX state match for qualifying

covered services.

Training will also include the program description, program updates, paiticipation, and required documentation. Additional clements of the training provided to your schools will include but not be limited to:

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• Program requirements related to qualified children and qualified covered

services;

• Eligibility verification;

• Reimbmsement and submission of claims;

• Documentation and record keeping;

• Parental consent;

• Calculation and certification of non-federal match;

• Confidentiality, including both FERPA and HlPAA requirements;

• Third party liability;

• Fraud and abuse;

• Compliance.

GSGI has developed provisions to address training issues/concerns including:

• Rescheduling training sessions for providers that were unable to attend initial training;

• Providing training to new personnel who join mid-year;

• Providing training to address any needs or concerns as they arise such as state and federal program changes;

• GSGI staff will coordinate and conduct training sessions. Training sessions are generally scheduled for two (2) hours and can be extended based upon the specific needs or requests of tne individual schools or questions from participating staff.

GSGI School Based Medicaid Training Overview

GSGI continues to expand and refine a full suite of training options to best align with DHHS and the needs of the school district clients. In addition to the traditional on-site computer lab trainings and open labs, we offer training on-line via our webinar services utilizing web-based technologies such as GoToMeetingrM. We find that many times it is hard for a provider to take time out of their busy schedule to attend a formal training session. The webinar allows the training to take place at their desk.

During the school year, GSGI will continue to expand its regularly scheduled webinars providing refresher trainings and demonstrations for both the clinical end-user as well as

the district administrative staff.

Examples of webinars being scheduled for 2017 /2018 include, but are not limited to:

• GoClaim TM provider training; How to document your services online;

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• lCD·lO usage;

• The Administrators Guide to Reports - What reports will help my district monitor otrr service entry.

In addition to the webinars, GSGI has developed online training videos for any user to view at their own convenience. Each video lasts only a few minutes and shows the user how to accomplish some of the common questions they may have. Some examples

include:

• How to change your password;

• How to change a student's default diagnosis;

• How to edit or delete a service that was entered in error;

• How to login the first time;

• I low to obtain a forgotten password;

• How to modify yotrr user profile;

• How to add/remove students from your caseload;

• How to enter services from your caseload.

Who should be trained?

GSGI provides training in accordance with Federal and State laws, regulations, and policies relevant to the MIPS and NEBMAC programs.

The list below identifies key staff and the training modules they should receive:

Contract Manager:

Special Education Director:

Business Manager and Staff:

Administrators:

Healthcare Providers:

Program Overview, GoClaimTM

Program Overview, GoClaim™, Finance

Program Overview, Finance

Program overview, GoClaimTM

Program Overview, GoClaimTM

What are the OSGI Training Modules?

Program Overview - History of Medicaid in schools, Nebraska specifics, Q&A

GSGI has found that an info1med participant with a basic understanding of the program and its impo1tance to the district and special education students historically increases in their paiticipation including efficient and timely capture of required data.

GoClaimTM - Computer lab hands-on (administrative and user access levels)

OSGI provides a comprehensive lab training session. With the completion of this single session, participants are proficient in their use of GoClaim™. GoClaim™ provides both

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user and an administrative level access. The user level is provided for participating healthcare providers (OT, PT, SPL, etc.) to manage their student class lists (caseloads) and record required service data necessary to process Medicaid claims. The administrative level access provides management and designated administrative staff

expanded access to data and reporting options.

OSGI has training modules broken down by the following provider groups:

• Nmsing training modules

• Audiologist training modules

• Speech Therapist and Speech Language Assistant training modules

• Occupational/COT A/Physical /PT A Therapist modules

• Health Aide training module

• Psych/school based license training module

OSGI GoClaim™ Training Agenda

Introduction & Overview

• Introduction of presenter

• OSGI Company Overview

• Why Medicaid in the schools:

o History of Medicaid in schools

o Review of national program

o Review of state specific program

Program and GoClaim™ Training

• Compliance / Audits

o Who can claim

o Review of what services can be reimbursed

o IEP requirements, etc.

• OoClaim™ Overview

o Hands on review of OoClaim TM

o Clinician information

o Student information

o ICD-10, and how to select

o Caseload

o Enter services

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o Reports

• GoClaim TM Individual Access

o Start with accessing internet

o Individual account access

o Review individual clinician information

o Review caseload infonnation

o Password selection

• Practical GoClaimTM review> access and utilization

• Frequency

• Compliance

• FAQ

OSGI training staff and Service & Supp011 staff are on hand to answer questions and assist in any way possible. At the conclusion of this session the clinicians become very proficient at the use of GoClaimTM.

Training Set up & Check-list

1.) Confinnation of internet access to GoClaimTM

• GoClaim TM Internet access must be through a compatible workstation.

• Each user will have their own unique GoClaim™ account (user ID & Password).

• Demoffraining account - verify that the staff will be able to access GoClaimTM through the school network/firewall/security/etc.

• Ideal training room - computer lab, equipped with internet access, instructor's workstation with overhead projection, and Microsoft PowerPoint.

2.) "Training Agenda.doc" & "MEDICAID BILLTNG FACT SHEET.doc"

• Training typically runs 2 hour(+/- depending on Q&A time).

• A portion of the training time is dedicated to why & how we are billing Medicaid

through the school

3.) "CPT Descriptions.xis"

• List of current procedures listed in GoClaim™ with expanded CPT text/clarification.

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• OSGI can conduct follow-up meetings with staff and administration to review current available CPT codes to identify additional services to be added to GoClaim™.

4.) Available training dates

• NASBMC and OSGI will schedule training dates that best suit the district/staff schedule.

5.) Follow-up training- "Open Lab"

Medicaid services can be reimbursed up to six ( 6) months after the date they were provided. Thus, any services provided within that time can be entered into GoClaim™ and claimed. This presents both potential reimbmsements for the school districts and an additional training opportunity for the staff/clinicians. Two to three weeks after the initial training session, OSGI may conduct a second training session.

The clinicians return to a designated computer lab/training session with associated notes/documentation for any services they have provided in the past six (6) months. Each participant receives a "QUICK REFERENCE GUIDE" at training.

Training is recommended to be conducted at the district in a lab setting where computers are available for trainee use, grouping individuals together that will have similar system requirements or job duties.

All training material will be provided at the time of training, geared toward the group being trained. Additional resomces are available within the GoClaim TM application, including tutorials and step-by-step guides on processes, as well as Medicaid reference material.

Training Outline GoClaim TM Administrative Overview

• Reviewing the basic administrative functions of GoCJaim™

• Setting up the district specifications of GoClaimTM

o District options

o Setting the calendar

• Editing of calendar information

o Setting up of student demographics

• Updating students

o Setting up of provider demographic/login

• Updating provider demographic

o Updating administrative look up tables

• Reviewing and tracking district data via reporting features

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o Types of reports available

o Running reports and setting parameters

NEBMAC RMTS Coordinator Training

All RMTS training materials will be approved prior to training. NASBMC and GSGI will provide initial training for the NEBMAC Coordinators, which includes an overview of the RMTS software system and information on how to access and input information into said system. The NEBMAC Coordinator for each LEA is required to attend the time study training. It is essential for the NEBMAC Coordinators to understand the purpose of the time studies, the appropriate completion of the RMTS, the timeframes and deadlines for participation, and the importance of their role to the success of the program. The NEBMAC Coordinator is supplied with the "Medicaid School-Based Administrative Claiming Guide" and "Medicaid and School Health: A Technical Assistance" which identify Medicaid allowable activities. In addition, annual training is provided to the NEBMAC Coordinators to cover topics such as NEBMAC updates, process modifications and compliance issues.

Centralized Coding Staff Training (Activitv Coding)

Coders will be employed by GSGl to review the documentation of participant activities perfonned during the selected moments and to determine the appropriate activity code. Jn a situation when insutlicient information is provided to determine the appropriate activity code, the coder may contact the NEBMAC Coordinator and request submission of additional information. Once the infotmation is received, the moment is coded and included in the final time study percentage calculation. The moments and the assigned codes are reviewed for consistency and adherence to the state approved activity codes.

Sampled (Pa1ticipant) Staff Training

Since GSGI will implement a centralized coding methodology, training around the activity codes is not required as sampled staff members do not code their moments. However, eMacTM includes an online tutorial containing information about the program, the participant's role in the program, as well as> how to complete the sampled moment in the system. The sampled staff member must visit these screens prior to being able to document their moment. For these reasons, training of sampled staff members on Medicaid allowable activities and non-Medicaid activities is not a required element for completion of their moment.

Quality Assurance

NASBMC and GSGI will conduct annual on-site quality assurance reviews ofLEAs, representing at least 50% of the NEBMAC participating school districts, which will also be included in the Annual Year End Report provided to DHHS. All NEBMAC participating school districts will receive this during a three-year period.

Our application is equipped to randomly select a ce1tain number of claims per scope for auditing of service records, with a GSGI Account Manager continuing to assist in the following capacity:

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• Assist in the gathering of records needed

• Review of records requested to determine compliance

• On-site supp01t day(s) of the audit

• Assistance in developing policy needed to assure compliance

• Assistance in responding to Corrective Action Plan

• Assistance on implementation and training of staff for policy changes needed for compliance

• Re-training of staff on cu1Tently in place procedures that need reinforcement

• Assistance on follow-up self-audits to assure compliance is being met

Are you Compliant and Audit Ready?

Our robust, state-of-the-rut, compliant, secure, web-based rep01ting system provides a compliant environment for related service tracking for all of its contracted school districts.

This system is designed not only as a reporting system from which districts can choose which services to seek Medicaid reimbursement, but, more importantly, it provides school staff with an expanded reporting system, includjng sections for expanded notes and documentation of services not found in existing IDEA reporting mechanisms.

Medical documentation is not only a requirement of the medical providers' licensure and State Practice Acts, it also provides the School, reporting staff, and the students they support with security, audit readiness, and maximization of all entitled benefits.

PROS:

•!• Who is "Billing" Medicaid - No school staff or school-based medical service providers are billing Medicaid. The school District is the Medicaid Provider and it is this entity making the determination of which services to submit for reimbursement. In turn, the School District is ultimately responsible for compliance with appropriate billing practices. School staff and schoolbased medical service providers are simply documenting the services they have provided.

•!• Reporting Services to Employer - GoClaimTM is NOT a Medicaid Billing System. OSGI provides the GoCla.im™ system to client districts to enable the district's staff to report the services they have provided to IEP Students. The process of creating the billing file is performed by GSGI staff, without any burden on the district's staff.

•:• Medical License Requirements - Traditional School, Education, and IDEA documentation requirements do not fully recognize the necessary documentation of the "Medical Services" being provided by the Licensed Medical professionals they employ.

•!• IDEA documentation does not address all Medical/ State Practice Act I Medical Licensure documentation requirements.

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•:• School staff frequently document within their own formats and levels which provides for missing and non-standard documentation throughout the school district.

•!• School staff frequently will take their hard-copy, personal notes and documentation with them upon leaving the district. This provides severe exposure to the district within the seven-year audit

window.

•:• Missing Eligible Students - School districts and the students they serve are not maximizing the entitled public health benefit reimbursements. The practice of reporting only the services provided to known eligible students at any given time does not address those students who are enrolled at the school (listed in the school's database) under alternate names, have misspelled names, or any other data errors such as incorrect date of birth. Additionally, Medicaid eligibility

can and does change frequently on an individual basis.

•!• Ease of Use - GoClaim™ provides for efficient, compliant, and secure reporting of services as well as a complete service history. GoClaim™ provides extensive rcpo1ting capabilities. School districts and staff realize clear advantages in many scenarios because of having complete, accurate, and secure GoClaimTM documentation.

•!• Increased Compliance & Reimbursements -School districts that have implemented and utilize the full scope of the GoClaimTM system have realized increased compliant reimbursements, and

audit readiness.

CONS:

Although there are no "Cons" to proper documentation, adverse perceptions surrounding this

topic typically include:

•!• Time - School staff are required to maintain records in a multitude of existing school systems. The addition of yet an additional system can be overwhelming. However, our proven training methods and user-friendly application will decrease this perception.

•!• Duplication of Efforts - Traditionally, school staff rely on their own personal documentation methods or techniques as satisfactory in meeting the full scope of the "Medical" documentation required as part of their licensure and State Practice Acts. Medicaid participation tends to overshadow this requirement as the sole need for this extended documentation requirement. In fact, the district's participation in the Medicaid program is not a matter of requiring additional documentation; however, it illustrates the required documentation levels and what has traditionally been missing.

In case a district is selected for an audit, GSGI will provide the district with audit preparation and assistance from assigned regional account manager.

GSGI takes great pride in preparing and educating our districts to be audit-ready. We want our district customers to be ready if they are subject to the routine state or federal audits. To prepare them for this, we've developed an audit-ready checklist and template to ensure that they arc

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ready, and continue to be compliant as a participant in the school-based Medicaid reimbursement process. Below is a sample of how we ensure compliance with the districts that entrust our services.

At GSGI, we acknowledge that auditing services does not begin at the time that a district audit is announced and the importance of conducting self-audits. Claims entered are reviewed and analyzed on an ongoing basis to determine compliance. Our system has many built in edits to flag these claims for review. Flags appear on Dashboard reports for district review as well as om many other reports that are available to be downloaded are used as valuable resource tools. These reports serve as a roadmap for areas of weakness that help focus on the appropriate scope of the self-audit. Our Account Managers will work hand-in-hand with the district coordinator to remedy any non-compliance that need corrective action.

Compliance Review

We will review all associated paperwork and audit trail relating to direct service claiming. The review is based upon a statistical sample of all providers tracking encounter data for claiming Medicaid for reimbursement. Upon the completion of the review, a report is generated, and a debriefing meeting is held to highlight any areas or issues that need attention to assure compliance will all Medicaid rules and policies.

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1

Self Audit Checklist Medicaid-reimbursed Services

Claim Specific Review (evaluate documentation and compare to billing):

Attendance locate the Attendance ,eco,ds for this student, were they in School on the date of service sel ected?

ls tJ1ere a refer,a l/order on .Ale for this servi ce? Appropriate referral/order for Order o r Refe rral service: by a physician (M.O. or 0.0.) or Health Service Provider in Psychology and

or HSPP as re ui red b s ecific servke rovided.

Assessment Review

Listed io the IEP

Is there an assessment/evaluation/re·evalutation on file that supports the need of the services and placments into special Education?

Following the initial evaluation and initiation of services, is there ongoing assessment of progress toward goals, and are changes in the student's condition noted?

locate the active IEP for the date of service selected. The service(s) must be listed as a related service detailing frequency, duration, scope, and applicable goals.

IDEA Informed Consent Is there a Parental informed consent for Medicaid billing on file?

Documentation should contain the following information, and should be legable to Service Documentation somewone olher than the author; Description of session, description of students

Providers' Signature

FINAL STEP

ro ress towards established oals len h of times entwith student

Review service providers' license(s)/certification(s)/credentials at the time of service: Is it effective for the Date of service pulled?

Did the Provider or Supervisor of Provider sign off on the service provided? • • • Pleose note the provider ho$ entered into GoC/aim by their unique ID, it would qualify as

their electronic signature

Evaluate if sup~vision/oversight was reguired for this service, if yes did they meet the requirments? ***Required/or PTA, SLPA, COTA

FINAL STEP: If neccessary, revise procedures, educate staff, improve forms/protocols based on findings. GSGI is here to help!

End of Contract and Turnover

Finding/Notes

In the event that the contract activities performed by GSGI are awarded to a new vendor or transitioned to designated DHHS resources, GSGI will continue to be cooperative resource in the transition. A turnover plan will be implemented. once approved by DHHS, to include, but is not

limited to:

• Transfer of inf01mation and documentation. including historical files of administrative claiming. direct services and specialized transportation claims;

• A quality assurance (QA) process to monitor tumover activities;

• Notification to subcontractor of contract expiration

• DHHS approved notification to school providers of contract expiration

• Training plan for the DHHS or other staff in the delivery of the services;

• Provision of a Turnover Results Report and access to GSGJ staff with technical and operational expe11ise;

68

• Appoint a DHHS approved manager to coordinate all turnover activities outlined in the DHHSapproved turnover plan.

Success will be measured by an acceptable turnover plan and turnover results report.

Data Backup and Contingency Planning Procedure

Scope of Procedure

The scope of this Procedure covers the steps that GSGI follows to protect or recover from an emergency, disaster or other occun-ence (i.e., fire, vandalism, system failure and natural disaster, sabotage, etc.).

• Data backup

• Disaster Recovery Planning

Data Backup Plan

The following general plan is provided to describe the GSGI's backup procedures for infrast:ructlll'e. The plan is split into two sides, customer databases and in-house operations.

Customer Databases are backed up nightly, stored in two physical locations, HQ and Production located 6.6 miles in distance. Transaction logs are saved every 15 minutes to ensure minor data loss in the event of system or server faillll'e, located in Production only.

In-House operations which include user files, CRM system, and customer databases are backed up in complete once a week to both tape and bare metal storage. Monday-Thursday nights, differentials are taken, tape and bare metal. Tape backups arc moved offsite twice a week, differential and full to a bank vault located 7.9 miles away.

Operations related to email, instant messenger and voice services are hosted by our cloud provider with a 99.9% SLA. Backups from our cloud provider are stored with another cloud provider to ensure redundancy and security of data.

Servers are also backed up to the cloud as an additional measlU'e of stability. Cloud backups use AES encryption with changes tracked in real-time. Cloud backups are stored securely in multiple locations within the United States, Europe and Asia.

Testing for recovery: Twice per year, all databases and users files are restored for testing on development servers, which are reviewed by IT Seclll'ity Committee once a year. Requests for recovery of files throughout the year also provide a real-time test of backup recovery. 2) Disaster Recovery Plan

Two sites are cun-ently active; HQ and Production located 6.6 miles apart. In the event one site goes down, the traffic and data for the down site will be restored to the other site.

ln the event of catastrophic failure, sites are taken offline beyond repair, data storage will be rented from another provider, and data from cloud storage will be restored to the new provider. We have two accmmts with companies located both within the state and outside the state that could provide these services. Data loss will be minimal based on real-time backups to our cloud provider.

69

Computer Disaster Recovery Procedures

1. Response

• Notify the appropriate Information Technology staff:

• Assessment of availability and capability of:

o Personnel

• Assess operational status and damage to:

o Computer rooms (power, HV AC, etc.)

o Network infrastructme(firewalls, switches, links)

o Network services

o Servers (evaluate operational status, event logs)

o Applications (evaluate operational status)

o Data (perform database integrity checks, evaluate logs)

• Formulate and execute recovery plan based upon damage assessment

o Plan staged recovery at recovery computing site

o Restore vital network links and infrastructure as needed

o Reconfigure servers as needed

o Restore Applications and data from backup

o Restore secondary services

• Reevaluate

Emergency Preparedness

Ove1-view

OSGI has an Emergency Preparedness Plan in place to ensure continuity of operations during a catastrophe. Along with the Disaster Recovery Plan, GSGI employees are trained to follow a simple procedure to maintain contact with each other, partners and clients. Backup offices and communication methods have been laid out, distributed, and tested.

GSGI's national headquarters is located in Lansing, MI. In late December 2013, Lansing was hit with a severe ice st01m that disabled over 2400 power lines, leaving 40 percent of local customers without power (the largest utility event in Michigan's history). By following the Emergency Preparedness Plan, GSGI was able to prevent any downtime in web applications, and minimal delays in communications with clients; rather, all were easily within typical business response times.

70

EMERGENCY PREPAREDNESS PLAN DETAIL

GSGI maintains several communication methods with all key contacts, including electronic, physical and cellular phones, and traditional mail. Key contacts include partners, clients, employees, emergency contacts for each employee, and the various State Medicaid offices we work with.

Company President and Chief Legal Officer, Matthew Flaminio, has been appointed as primary decision maker/coordinator in the case of an emergency. Backup decision makers are Director of Technology, Jeremy Whitwam, and Operations Manager, Mindy Benzler.

Besides the home office in Lansing, Ml, GSGl has appoin1ed three offsite offices in Illinois, Arizona and Georgia as secondary communication hubs.

GSGI has appointed two local secondary offices/communication hubs. One is a Class A office space in East Lansing, Ml and another office space with a backup generator in nearby Eaton Rapids, MI.

The Disaster Recovery Plan describes the process taken to restore electronic communications and web services for GSGI.

Go Solutions regularly tests its cross-training through temporary employee re-assignments. Employee knowledge of the Emergency Preparedness Plan is tested on a regular basis. Both electronic and hardcopies of the Emergency Preparedness Plan are distributed as updates occur.

Emergency Preparedness Plan:

The first response of an employee to a disaster should be securing the safety of their families and smTotmding commtmity.

The next response is to follow a simple communications tree: Each employee is to try to contact each person in their department (Upper Management, Information Technology, Service and Support, and Sales). The leader of each department will maintain contact with other employees in Upper Management. If the nature of the disaster limits the amount of available communication, the employees should prioritize top-down communications, with each individual employee also con1acting their one pre-determined 'buddy-system' contact.

The three appointed decision makers will assess whether the home office and offsite data center are operational. lf either location has been compromised, the other will become the base of electronic communications. If both locations have been compromised, data will be restored from the cloud, to a third party hosting service.

When appropriate and necessary, employees will be directed to work from one of the secondary local offices.

Contact will be made with partners to determine if any contracted services will be delayed.

Contact will be made ,vi.th clients to update them on the status of our response.

Both inter-departmental and cross-departmental training has prepared GSGI to cover all aspects of our daily company processes.

71

g (J SOLUTIONS Implementation Timeli ne for NEB MAC RMTS and MIPS Cost Settlement

I I Duration

-~, --8d

I d I

1d i 12d _ _ J

I I 15d

T I

I

- - ----- I __ -- ----___ _ =i. 6/1/2017 l 6/12/2017 ! I

: , ;::~::::1s:f-:-:-:, ~~= -_-_·. . ~ ~~-:::: 1

:::::

S I Ob;i; Updated ~ta; ~tudent, provider, Staff pool. ~e~~~- 6/11~/:;;;;;- r 6/30/2017 15d

6 r Sch~u; Reports f;;;.,,o~th~Submission ___ -- --- - --r- 6/11/2017 I 6/30/2017 ----- -------

School Based ACCESS Program Task Nome 5rorr Finish ___ Jun2017 .- _ __ Ju/W17 ___ I__ AualOP_

------+-'--6-f._4 o111 6/1~.J sas I 7/2 i 119 1

1110_ 11n 1130 s/6 8/13 8/20 8/11

,

1 ; Implementation with OHS/Commonwealth

-- ----------0 II II

II

j_ 6d I

_ld

~ - - -- ---·- ------ ---- -i [ 7/3/2017 7/10/2017

-i 7/6/20;--- 7/20/2017 . __ _

7 , Check Eligibility •--1 8 ' Review needed info from DiStricts; PC/scripts etc.

----I 15d I

-- 7/17/2017 i 8/4/2017 - ---9 1

Pull Sample for MAC/RMTS

15d ---

17

1

10 i Create Usernamesand Passwords L 7/17/2017 8/4/2017

---1 ------;;;;~1-;--1 8/29/2017 -I_ i_iiii_.Mi.- •1 I I

*0 Timeline can be changed based upon discussions with OHHS to meet all state specified dc.ites.

Attachment 1

Deliverables/Penalties

DELIVERABLE: Project Reauirements DELIVERABLE: Random Moment Online Svstem content. DELIVERABLE: Random Moment Online System in Test Environment.

DELIVERABLE: Random Moment Online System in Production Environment. DELIVERABLE: Cost Reporting Online Svstem content. DELIVERABLE: Cost Reporting Online System in Test Environment.

DELIVERABLE: Cost Reporting Online System in Production Environment. DELIVERABLE: Cost settlement amount for each school provider. DELIVERABLE: School provider-specific interim rate methodology.

DELIVERABLE: Interim rates.

DELIVERABLE: Approved interim rates.

DELIVERABLE: Reporting Reauirements DELIVERABLE: Quarterly RMTS updates.

DELIVERABLE: Quarterly Cost Reports.

DELIVERABLE: Quarterly cost report outcomes.

DELIVERABLE: Annual Cost Reoorts. DELIVERABLE: Monthly RMTS and Cost Report Help Desks Report

DELIVERABLE: Auditing Reauirements DELIVERABLE: School provider Audit Process and Plan. DELIVERABLE: Updated school orovider Audit Process and Plan. DELIVERABLE: PROJECT PLANNING AND MANAGEMENT

Due Date Penalty

DUE: Fifteen (15) days after the $10,000.00/business day Contract effective date. DUE: Fifteen (15) days after the $10,000.00/business day Contract effective date.

DUE: Operational Start Date. $10,000.00/business day

DUE: Fifteen (15) days after the $10,000.00/business day Contract effective date. DUE: Fifteen (15) days after the $10,000.00/business day Contract effective date. DUE: Contractor Start Date. $10,000.00/business day

DUE: Annually, by March 151 . $100.00/business day

DUE: Thirty (30) days prior to the end of $10,000.00/business day the first quarter for which claims will be submitted following the Operational Start Date.

DUE: Annually, by September 30 and $100.00/business day within thirty (30) days of an update to the reimbursement methodology and the mid-year results of the school provider's quarterly cost report if it shows the need for an update or at the Department's reauest. DUE: Annually, by September 30 and $100.00/business day within ten (10) days of the Department's annroval of an uodate. Due Date

DUE: Within ninety (90) days of the end $100.00/business day of the calendar quarter for which the UDdate annlieS. DUE: Within ninety (90) days of the end $100.00/business day of the quarter to which the cost report aonlies. DUE: Within ninety (90) days of the end $100.00/business day of the quarter for which the cost report outcomes annlv. DUE: Annuallv, bv Seotember 30. $100.00/business dav DUE: By the fifth (5th) business day of $100.00/business day the month following the month for which the reoort annlies. Due Date

DUE: Within sixty (60) days after the $100.00/business day Contract effective date. DUE: Annually, by September 30. $100.00/business day

DELIVERABLE: Outreach Materials. DUE: At least ten (10) business days $100.00/business day prior to the Contractor printing or disseminatina the materials.

DELIVERABLES: Start-up and Due Date Closeout Periods DELIVERABLE: Policies and DUE: Contract effective date. $10,000.00/business day

Procedures Manual. DELIVERABLE: School provider DUE: Thirty {30) days prior to $10,000.00/business day

notifications. termination of the Contract.

DELIVERABLE: Start-Up Plan. DUE: Within five (5) business days after the Contract effective date.

$10,000.00/business day

DELIVERABLE: Closeout Plan. DUE: Thirty (30} days following the $100.00/business day Contract effective date.

DELIVERABLE: Perform Due Date lmclementation DELIVERABLE: School Provider DUE: Contract effective date. $10.000.00/business day

Manual. DELIVERABLE: Updated School DUE: Thirty (30) days from the $100.00/business day

Provider Manual. Department's request for an update to the School Provider Manual.

DELIVERABLE: School Provider DUE: Thirty (30) days from the $100.00/business day

Manual in electronic format. Department's request for an update to the School Provider's Manual.

DELIVERABLE: School provider DUE: Quarterly. on a schedule $100.00/business day

program newsletter in electronic determined by the Department. format. DELIVERABLE: Provide Post Due Date lmolementation Suooort DELIVERABLE: Annual Trainina Plan. DUE: Annuallv, bv June 1st. $100.00/business dav

Attachment 2, Provider Listing

Therapies offered NAME

Adams Central Public

PTST Schools - -

Ainsworth Community STOT Schools

Allen Consolidated PTSTOT Schools

PTSTOT Alliance Public Schools

STOT Alma Public Schools

PTSTOT Amherst Public Schools

Anselmo-Merna Public PTSTOT Schools

PTSTOT Ansley Public Schools

PTSTOT Arapahoe Public Schools

PTSTOT Arcadia Public Schools

PTSTOT Arlington Public Schools

$TOT Arnold Public Schools

PTSTOT Arthur County Schools

Ashland-Greenwood PTSTOT Public Schools

PTSTOT Auburn Public Schools

PTSTOT Aurora Public Schools

PTSTOT Axtell Community Schools

Bancroft-Rosalie PTSTOT Community Schools

Banner County Public

STOT Schools

Battle Creek Public PTSTOT Schools

$TOT Bayard Public Schools

PTSTOT Beatrice Public Schools

PTSTOT Bellevue Public Schools

Bennington Public Schools

PTSTOT Bertrand Public Schools

IPTSTOT Blair Community Schools

Bloomfield Community

ST Schools ~

PTSTOT Blue Hill Public Schools

PTSTOT Boone Central Schools

OTPT Brady Public Schools

PTSTOT Bridgeport Public Schools

Broken Bow Public

PTSTOT Schools

Bruning-Davenport

PTSTOT Unified System

PTSTOT Burwell Public Schools

PTSTOT Callaway Public Schools

ST Cambridge Public Schools

Cedar Bluffs Public

PTSTOT Schools

PTSTOT Centennial Public Schools

PTSTOT Central Valley

Central City Public PTSTOT Schools

STOT Centura Public Schools

PTSTOT Chadron Public Schools

PTSTOT Chambers Public Schools

STPT Chase County Schools

OTST Clarkson Public Schools

Cody-Kilgore Public OTST Schools

PTSTOT Columbus Public Schools

PTSTOT Conestoga Public Schools

PTSTOT Cozad City Schools

ST Crawford Public Schools

Creek Valley Public OTPT Schools

Creighton Public Schools

PTSTOT Crete Public Schools

Crofton Community

PTSTOT Schools

Cross County Community

PTSTOT Schools

PTSTOT David City Public Schools

STOT Deshler Public Schools

STOT Diller-Odell Public Schools

Doniphan-Trumbull Public

PTSTOT Schools

Dorchester Public Schools

Douglas County West

PTSTOT Community Schools

Dundy County Stratton

PTSTOT Public Schools

East Butler Public Schools

Educational Service Unit

#1

Educational-Service Unit

#10


#11


#13


#15


#16


#17


#18


#19


#2


#3


#4


#5


tt6


#7


#8


#9

STOT Elba Public Schools

PT STOT Elgin Public Schools

PTSTOT Elkhorn Public Schools

PTSTOT Elkhorn Valley Schools

PT $TOT Elm Creek Public Schools

Elmwood-Murdock Public

STOT Schools

PTSTOT Elwood Public Schools

Emerson-Hubbard Public Schools

Eustis-Farnam Public

STOT Schools

PTSTOT Ewing Public Schools

Exeter-Mi lligan Public Schools

PTSTOT Fairbury Public Schools

PTSTOT Falls City Public Schools

Fillmore Central Public

PTST Schools

Fort Calhoun Community

PTSTOT Schools

PTSTOT Franklin Public Schools

Freeman (Daniel) Public

PTSTOT Schools

PTSTOT Fremont Public Schools

Friencl Public Schools

IPTST Fullerton Public Schools

PTSTOT Garden County Schools

PTSTOT Gering Public Schools

PTSTOT Gibbon Public Schools

PTSTOT Giltner Public Schools

Gordon-Rushville Public

$TOT Schools

Gothenburg Public

PTSTOT Schools

Grand Island Public

PTSTOT Schools

PTSTOT Gretna Public Schools

STOT Hampton Public Schools

Hartington/Newcastle PTSTOT Public Schools

PTSTOT Harvard Public Schools

PTSTOT Hastings Public Schools

Hay Springs Public

ST Schools

Hayes Center Public

ST PT Schools

Heartland Community

PTSTOT Schools

Hemingford Public

STOT Schools

PTSTOT Hershey Public Schools

High Plains Community

PTSTOT Schools

Hitchcock Public Schools

PTSTOT Holdrege Public Schools

Homer Community

ST Schools

Howells-Dodge Unified

STPT School District

Humboldt Table Rock

Steinauer

Humphrey Public Schools

PTSTOT Hyannis

Johnson County Central

PTSTOT Public Schools

Johnson-Brock Public

PTSTOT Schools

PTSTOT Kearney Public Schools

PTSTOT Kenesaw Public Schools

Keya Paha County

PT STOT Schools

STOT Kimball Public Schools

Lakeview Community

PTSTOT Schools

Laurel-Concord Public

PTSTOT Schools

ST Leigh Community Schools

Lewiston Consolidated

ST Schools

PTSTOT Lexington Public Schools

PTSTOT Leyton Public Schools

PTSTOT Lincoln Public Schools

ST Litchfield Public Schools

Logan View Public

PTSTOT Schools

PTSTOT Loomis Public Schools

STOT Louisville Public Schools

PTSTOT Loup City Public Schools

Loup County Public

PTSTOT Schools

PTSTOT Lynch Public Schools

Lyons-Decatur Northeast

PTSTOT Schools

PTSTOT Madison Public Schools

$TOT Malcolm Public Schools

PTSTOT Maxwell Public Schools

Maywood Public Schools

PTSTOT McCook Public Schools

McCool Junction Public

PTSTOT Schools

McPherson County

PTSTOT Schools

PTSTOT Mead Public Schools

Medicine Valley Public

PTSTOT Schools

STOT Meridian Public Schools

STPT Milford Public Schools

PTSTOT Millard Public Schools

ST Minatare Public Schools

PTSTOT Minden Public Schools

PTSTOT Mitchell Public Schools

PTSTOT Morrill Public Schools

PTSTOT Mullen Public Schools

Nebraska City Public

PTSTOT Schools

Nebraska Unified District

I 1

PTSTOT Neligh-Oakdale Schools

Newman Grove Public

STPT Schools

STOT Niobrara Public Schools

PTSTOT Norfolk Public Schools

PTSTOT Norris School District 160

North Bend Central Public

STOT Schools

North Platte Public

PTSTOT Schools

STOT Northwest Public Schools

Oakland-Craig Public

PTSTOT Schools

PTSTOT Ogallala Public Schools

PT STOT Omaha Public Schools

PTSTOT O'Neill Public Schools

PTSTOT Ord Public Schools

STOT Osceola Public Schools

PTSTOT Osmond Public Schools

PTSTOT Overton Public Schools

ST Palmer Public Schools

ST Palmyra District O R 1

Pa pillion-La Vista Public

PTSTOT Schools

Pawnee City Public

OTPT Schools

Paxton Consolidated

PTSTOT Schools

ST Pender Public Schools

PTSTOT Perkins County Schools

PTSTOT Pierce Public Schools

PTSTOT Plainview Public Schools

Plattsmouth Community

PTSTOT Schools

PTSTOT Pleasanton Public Schools

ST Ponca Public Schools

ST Potter-Dix Public Schools

PTSTOT Ralston Public Schools

PTSTOT Randolph Public Schools

PTSTOT Ravenna Public Schools

Raymond Central Schools

Red Cloud Community PTSTOT Schools

PTSTOT Riverside Public schools

Rock County Public PTSTOT Schools

PTSTOT Sandhills Public Schools

Santee Community ST Schools

ST Sargent Public Schools

Schuyler Community

PTSTOT Schools

PTSTOT Scottsbluff Public Schools

Scribner-Snyder


PTSTOT Seward Public Schools

Shelby-Rising City Public Schools

PTSTOT Shelton Public Schools

PTSTOT Shickley Public Schools

PTSTOT Sidney Public Schools

STPT Silver Lake Public Schools

Sioux County Public Schools

South Central Nebraska PTSTOT Unified System 5

South Platte Public PTSTOT Schools

South Sioux City


PTSTOT Southern School District 1

PTSTOT Southern Valley Schools

OT Southwest Public Schools

Springfield-Platteview

Community Schools

PTSTOT St. Edward Public Schools

$TOT St. Paul Public Schools

Stanton Community

PTSTOT Schools

PTSTOT Stapleton Public Schools

Sterling Public Schools

PTSTOT Stuart Public Schools

Sumner-Eddyville-Miller

IPTSTOT Schools

PT $TOT Superior Public Schools

PT STOT Sutherland Public Schools

ST Sutton Public Schools

Syracuse-Dunbar-Avoca

PTSTOT Schools

Tekamah-Herman


Thayer Central

PT STOT Community Schools

Thedford Rural High

ST PT School

PTSTOT Tri-County Public Schools

PTSTOT Twin River Public Schools

Umo"Ho"Nation Public

PT Schools

Valentine Community

PTSTOT Schools

PTSTOT Wahoo Public Schools

PTSTOT Wakefield Public Schools

Wallace Public School

STOT District 65 R

PTSTOT Walthill Public Schools

Wauneta-Palisade Public

STOT Schools

ST Wausa Public Schools

Waverly School District

$TOT 145

Wayne Community

Schools

Weeping Water Public

PTSTOT Schools

West Boyd Unified

PTSTOT System

PT STOT West Holt Public Schools

PTSTOT West Point Public Schools

'PT ST OT

Westside Community

Schools

PTSTOT Wheeler Central Schools

Wilber-Clatonia Public STPT School

Wilcox-Hildreth Public PTSTOT Schools

Winnebago Public Schools

ST Winside Public Schools

Wisner-Pilger Public

STOT Schools

PTSTOT Wood River Rural Schools

PTSTOT Wynot Public Schools

PTSTOT York Public Schools

STOT Yutan Public Schools

ATTACHMENT 3, COST PROPOSAL- REVISED dated 3/3/2017 RFP 5531 Z1

COMPLETE YELLOW HlGHLIGHTED CELLS ONLY. NO FORMATTING CHANGES PERMITTED.

The Contractor shall be compensated based upon the terms and conditions set forth in Section. Ill, Terms and Conditions, Subsection 11, Payment. Method of

compensation shall be quarterly based upon the DHHS' approval of deliverables required under Section. IV, Project Description and Scope of Work, Subsection .J, Deliverables. Payments shall begin upon the contract start date and will be based upon the contracted amount as indicated on the Cost Sheet. Payments shall be

distributed equally every quarter, pending submission of invoice upon approval by DHHS.

Bidder Name: Nebraska Association of School Boards

MIPS/Administrati" Claiming Deliverables Vear1 Vear2 Year3 Development and maintenance of Random Moment Online System {Section IV ,C, 1) $350,000.00 $350.000.00 $350,000.00

Development an·d Implementation of statewide Random Moment Time Study (RMTS} {Section IV,C,2) $475.000.00 $475.000.00 $475.000.00

Oevelqpmantand maintenance of Cost Repprtlng C>_nllne Sys1em {Section IV,C,3) $250,000.00 $200,000.00 $150,000.00

Cost settlement amount for each school provider annually (Section IV,D,3) $300.000.00 $300.000.00

School providar.apecilic il'ltertm rate m_ethdology (Section IV,C,1) $20,000.00 $20.000.00

Interim rates for each school provider annually (Section rv,c, 1) $55.000.00 $55,000.00 $55.000.00

Quaner1y RMTS updates (Section IV,O, 1) $10.000.00 $10,000.00 $10,000.00

Quarterly cost reports {Section IV,D,2) $40,000.00 $40,000.00 $40.000.00

Develoement of quanerty cost reeort outcomes tSectlon IV,0,2) $15,000.00 $15,000.00 $15,000.00

Annual cost reports l Sectlon IV,0,3) $160,000.00 $120,000 00 $100,00000

Monthly RMTS and Cost Report Help DH.ks Rep<>rt_{Sectlon IV,D,41 $10,000.00 $10.000.00 $10,000.00

School provider Audit Process and Plan (Section IV.El $20,000.00 $20,000.00 $20,000.00

Audit Process and Plan annual update (Section IV ,E) $25,000.00 $25,000.00 $25,000.00

Outre.ach materials (Section IV,F) $10,000.00 $10,000.00

Policies and Procedures Manual {Section IV,H,11 $10,000.00 $10.000.00

Start.Up Plan (Section IV,G, 1) $10,000.00 $10,000.00

Closeout Plan (Section IV,G,2}

Development ,1nd Mainwnance of School Provider Manual (Section l~,1-1_.11 $25,000.00 $25,000.00

School provider program newsletter (S!_ctlon IV,H,2) $10,000.00 $10.000.00

Annual Training Plan (Section IV,1,2) $15,000.00 $15,000.00

;a:-.~ JJ.&10.000.00 $1~720.000.001

Attachment 4

Optional Fixed Hourly Rates

Request for Proposal Number 553121

Bidder: Nebraska Association of School Boards Medicaid Consortium

There may arise from time to time a need for work not originally specifically delineated in this RFP but considered within the scope of work. This additional work may stem from legislative mandates, emerging trends, and regulatory changes unknown at the time of the RFP.

The State may request the contractor, subject to mutual agreement by both parties, to engage in short onetime special consulting projects, related to State benefit plans.

The bidder should provide the hourly rate for each Staff position used to complete onetime special consulting projects in the following table. Please identify any additional Staff titles and their appropriate rates, which bidder believes may be used to complete said projects.

All special consulting project costs must be based upon the hourly rates provided below per Section IV, F. Project Planning and Management, 3. Consulting Work.

Position Title Hourly Rate fdentify as Employee or

Subcontractor Proiect Manaaer $150.00 Subcontractor IT Specialist(s) $100.00 Subcontractor Financial Analyst(s) $50.00 Subcontractor Business Analvst(s) $50.00 Subcontractor Account Representative(s) $35.00 Subcontractor Administrative Assistant{s) $25.00 Subcontractor

MIPS Cost Reports

1 IPS COST REPORT ertification Statement

Provide, Name and Addross:

Provid~r (o;strkt) Name

Address line 1

Address line 2

Citv. OH, zip code

kepo,t111gPerlod:

from: (00/MM/YYYVJ

To: (l)O/MM/VYVVI

Any Schoo~

I 7/l/201A

6/J0/201S

a. Total Cumputable E•penditure by Type:

Medlcol Scf\fltes

TCM

Administr~tion

rransi>ortalion

Total Computab1e

$20029!

$0

~,ns

$14,09'

Complete Yellow Shaded Areas Only

Any School

12345

7/1/2014 to 6/30/2015

Type of Report Oinitial Cost Report

0Final Cost Report

'tRN {lnterno, Retrieval Number~; 12345

Medioid Provider Number: 1U4S67

National Provider ldentifie, (NPI): 1234567890

b. Clr1imet1 fxpenditures:

rhis stat~ment is of bpenditur~s th.tt the undi!'rSii;netJ certifies ari.- all allocallle at1d allowable to the Ohio Medic:)ld

program under Ti~e XIX of the Socfal Sec:urity Ac.t (tht- Act), ;n ~coordance with all procedures, initru<:tioris anti soici;:u1ce

Tot.al ~21gi7os lssu~d by th~ single state .agency in effect during the V~.ar ~oded

6/30/2015

INTENTIONAL MISREPRESENTATION OR FALSIFICATION OF ANY INFORMATION CONTAINED HEREIN MAY BE PUNISHABLE SY FINE AND/OR IMPRISONMENT UNDER FEDERAL AND/OR STATE LAW.

CERTIFICATION BY OFFICER OF THE PROVIDER

I HEREBY CERTIFY that:

1. I h.:ive eKamined this statement, the .lccompanving Supporting Schedules, the dllocation of expenses and services. and the attached Worksheets for the period from 7/1/2014 to 6/30/2015 and that to the bast of my knowledge and belief they are true and correct statements prepared from the books and records of the Provider In accordance with applicable Instructions. 2. The expenditures Included In this statement are based on the actual cost of recotded expenditures. 3. All cost Included herein comply with cenlfled Public Expenditure (CPE) requirements and all local, state and federal ,equlrements (Including that the funds were not Federal funds In origin, or are Federal funds authorized by

Federal law to be used to match other Federal lunds, and that the claimed expendltu"'s were not used to meet matching requirements under other Federally funded proiirams). 4. t-ederal fund!. are betng clatmed on this report In accordance wrth the Coit Meport instructions provided

by the ODE effective for the above reporting period. !>. I am the offrrer authorized by the referenced provider to submit this form and~ have made a good faith

effort to assure that all information reported b true and accurate.

6. I understand that this information will be used as a bas;s for claims for feder.JI funds, and possibly state funds, and th.Jt

falsification and concealment of a m.1teri.ll fact mav be prosecuted under fed@ra\ or state civil or crimin.,1 law.

SIGNATURE {Officer uf th~ Pro•1ider) OATe (00/MM/YYYYI

TIRE PHONE NUMBl:R l)(XX)l()(X·XXXX

I E-MAII.AOO~ESS

Revised 5/11/2016 Page 1 Exhibit 1-Certification Page

MEDICAID SCHOOL COST REPORT Provider Data


Provider (LEAi Name

Provider IRN

Medicaid Provider Number

National Provider Identifier (NPI)

Provider Name:

Business Manager/Treasurer:

Provider Contact:

Contact PhOne:

Contact E-mall Address:

Provider Address 1

Provider Address 2

Provider City, State. Zip

Submission Date

Time Period of Time Study Begin

Time Period of Time Study End

Any School

12345

1324567

1234567890

Any School

0

0

711120141

6130£20151

Cost Report Date

Month/Day/Year Reoortlna Period (mmldd/yyyy)

FROM 7/1/2014

TO 6130/2015

Prepared by:

Preparer's Phone:

Preparer's E-mail Address:

Provider Restricted Indirect Cost Rate from Cognizant Agency• .__ _____ 1_2._o_Oo/.~.lenter ·o· if no indirect cost ,ate is known

Granter Agency OH Department of Education

• The Restricted Indirect Cost Rate must cover the same petlod of time as the cost report period.

5/1112016 Page 2

Exhibit2 Any School

12345 7/112014 to 6/30/2015

Exhibit 2 -Provider Data

MEDICAID SCHOOL COST REPORT Medicaid Eligibility Rate (MER) Calculation

Enter Data for Applicable Period

Exhibit 3 Any School

12345 7/1/2014 to 6130/2015

ENTER DATA IN ALL YELLOW, GREEN, AND SALMON COLORED AREAS This data CQmes from the ODM MER Dala Results.

1roiii'Uia DiiiJiii IEP S\udiil,t'C'Qiiiit ~ ~N (l)l)M wra

A

Me{llcald Ellglblllty Rate · All Students

Total Number of Students: Medicaid Eligible

Total All Students

Computed Medicaid Eligibiltty Rate • All Students

M&dicald Eligib ility Data • IEP Students

Total Number of IEP "Regula(' Medicaid Eligible Students

Total Number of IEP "Healthy Start" Medicaid Eligible Students

Total Number of IEP Students

Total Number of IEP Students not receiving an MSP Billable Se,vice (Related Se,vice)

Medicaid Ellg lbllity Rate - IEP Related Service Students

Total Number of IEP Students w~h a Paid Interim Claim

Total Number of IEP Students with a MSP Billable Service

Computei:t Medicaiel Eligibility Rate· All IEP Relateel Service Students

Computed Medicaid Eligibility Rate • Regular Medicaid· IEP Related Services

Computed Medicaid Eligibility Rate • Healthy Start • IEP Related Services

Transpor1alion

T1 Special Education Student Count

Days Special Education Student Count

# of Paid Claim Trips

5/11/2016 Page3

Re orted Audtt Ad.. Revised

500 .5 495

1,000

50.00%

26

40

75

53.33%

33.82%

19.51%

213

178

1.260 'i"._!'1-"""'f~

995

49.75%

21

10

95

25

35

70

50.00%

33.67%

16.13%

213

178

1.280

Exhibtt 3-Statistics

MEDICAID SCHOOL COST REPORT Pool 1 - Time Study Results & Reallocation of General Administrative Time

All Discipline Direct Medical Service Personnel ~o Yellow Shaded Areas to Complete

Activity% After Reallocation

Data Entry - Time Study Data from of Total

Time Study Codes Time Study General Admin Medical%

- l Code 1 - IEP Oirect Medical Services 0.3696 0.4829 : 0.4829

Code 2 -Non-lEP Direct Medical Services 0.0894 0.1168! ---Code 3 -Targeted Case Management (IEP) 0.0000!

Code 4 - Targeted Case Management (non-lEP) ;

o.ooooi

Code 5 - Other Educational and Social Services (Non-Medical Services) 0.2184 ------0.285;1 -~----~--~- I

Code 6 - Medicaid Program Outreach 0.0000!

Code 7 - Outreach N0<1-Medicaid Program 0.0003

- I 0.00041

Code 8 - Facilitating Medicaid Program Eligibili1y Determinations -----------,

D.00001 -Code 9 · Facilitating Non-Medicaid Program Eligibility Determinations 0.0008 ______ 0.001.1:.i

Co<le 10 - Referral, Coordination and Monitoring of Medical Services 0.0522 ___ 0.068~!

Code 11 - Referral. Coordination and Monitoring of Non-Medical Services 0,0297 i 0.0388, ···--- - -Code 12. IEP Transportation Coordination end Translation for Medical Services 0.0005 0.0007! 11.,oae 1~ -rwn-,c~ , ransportat,on 1.,oord,nauon ano I rans1et1on ~or Norl-Mea,ca,

0.00121 Services 0.0010 11.,oae 14 -nogram !'1ann1ng, veve1opment ana fnteragency c.;ooromalion tor --·---------· I Medical Sef'llices 0.0010 0.0012! ICo<le 15 - Program Planmng, Development and lnteragency Coordination for -·--·-----I Non-Medical Services 0.0026 0.0034i --····-···-·..-------·· eode 16 - Allocable General Administration 0.2347 -

' ::1,, I t'?: .. ..: ,; ~ .I",:..:,.. :: •. --. 'ill .-: • \"'.l;: ,:':"!" ~.-:-.-:.. • .-- J -· ... Total Allocation Percentage 100.00% 100.00% 48.29%

5/11/2016 Page4

7/1/2014

Total Medical

TCM% Admin%

-

-

-

0.0682

0,0005

0.0012

~· r ·' - . ~ -·- rT. v. f-"~7"_'?. ,i

0.00% 7.00%

to

Administrative %

Discounted Rate

-

-

-

-

-1.0000

1.0000

-0.5000

-0.5000

-0.5000

.

-.c. ........ _ ~~ .. ..

Exhibit4A Any School

6/30/2015

Medicaid Administrative

-

-

-

--

-

--

-

0.0341

-0,0003

-0.0006

.

. ·-;.--·~~ . r

3.50%

Exhibit 4A-Time Study- Direct

Pool 2 - Time Study Results & Reallocation of General Administrative Time

TCM And Administrative Personnel Only No Yellow Shaded Areas to Complete

Alter

Activity% Reallocation Total

Data Entry -Time Study Data from of TCM% Medical

Time Study Codes Time Study General Admin A<lmin%

Code 1 - IEP Direct Medical Services - -Code 2 -Non-lEP Oirect Medical Services - -Code 3-Targeted Case Mana11ement (IEP) - - -Code 4 - Targeted Case Mana11ement (non-lEP) -

Code 5 - Other Educational and Social Services (Non-Medical Services) -Code 6 - Medicaid Prooram Outreach - -

Code 7 - Outreach Non-Medicaid Proaram -Code 8 - Facilitating Medicaid Program Eligibility Oetenninations - -

Coae 9 - Facilitalina Non-Medicaid Proaram Eligibility Determinations -

Code 1 O - Referral, Coordination and Monitoring of Medical Services - -

Code 11 - Referral. Coordination and Monitorina of Non-Medical Services -

Code 12 - IEP Transportation Coordination and Translation for Medical Services - - .

Code 13 -Non-lEP Transportation Coordination and Translation For Non-Medical Services - -

Code 14 -Proaram Plannina, Development and lnteraoency Coordination for Medical Services - . -

Code 15 - Program Planning, Development and lnteragency Coordination for Non-Medical Services 0.0001 1.0000

Code 16 -Allocable General Administration - - . . - -t - ~ .,~ ..... - .~ .. --... :lo•,o::1 ~.:. -...- ~

Total Allocation Percentage 0.01% 100.00% 0.00%

Page 5 5/11/2016

7/1/2014 to

Exhibit4B Any School

12345 6/30/2015

Administrative %

Discounted Medicaid

Rate Administrative

- -- -

-

- -.

1.0000 .

-1.0000 -

-

0.5000 -

-

0.5000 -

-

0.5000 -

- -.

.~~y..,n 1,1 .:au_~ .. ~ ~.-::.•• ... "i

0.00%

E.xhibit 4B- Time Study - TCM

MEDICAID SCHOOL COST REPORT Pool 3· Time Study Results & Realloca!ion of General Administrative nme

Administrative Personnel Only

A V1ty % Data Entry • Time Study Data rrom Time Study Cooes T""°Sl\iety

Code 1 - IEP Direct Medical Servittt 0.0000

Code 2-•Noo•IEP Direct Me<licaJ Se,vices 0.0000

Code 3 -Tar 00000

0.0000

0 .0000

coot 6 - Medicaid Pro ram OU1Mae~ 0.0000

Code 7 • Outte_acr, NQ(Wl\~di(aid Pt 0.0000

Code 8 .. Facill\alin Oetenninations 0.0000

Code 9 • Facllllalin 00000

Cod~ 10 - R6ferral. Coordlnatiol\ and MonitorinQ of Medical Services 0.0000

Cocfe 11 -R_efercat coo,olMlion an.a Monitocln of Non-MeatcaJ Services 00000

Code 12 • IEP Transportation Coordination and Translation for Medi<;::tl services 0.0000

COde t 3 •Noc,.JEP Transpo<lalion Coordin.olioru 1no T=ta!io~ For Non-Malli.caJ S~Me•$ 0.0000 COde 14 -Pro9ram P1annm9, Development and lnter3gency Coo,cmauon for Med1ce1 Sel"l/iC$:s 0.0000 cooe 15 - Program Planning, oevelOpment and lnteragency Coor<J1nat1on for Non-Med1ca1 Service$ o_oooo

Co<Je 16 -Allocar>ie General Administration 0.0000 .....,._!_~ _:-L~~---=-~~..:. ..

-' . ~- -- . -·

Tollll Alloeatlon Percemage 0.0000

S/11/2016

No Yellow Shadtd Areas to Complete

After Reauocat,on of Medla31

Genecal Admin Admj,,%

0,0000

0.0000

0.0000

0.0000

0.0000

0.0000 0 .0000

0,0000

0 .0000 0 .0000

0.0000

0.0000 0.0000

0.0000

0.0000 0.0000

0 .0000

0 .0000 0.0000

0.0000

. ~' ~= 1.0000 1.0000

Page6

7/1f20f4

Adminiscrative % Discounted

R'ate

1.0000

t .0000

0.5000

o.5000

0.5000

0,0000 . :··G.mJ9,.

to

Medlcald AdmlnlstraUve

0.0000

0.0000

0.0000

0.0000

0.0000

0.0000

00000

Exhibit4C Any School

12345 6/30/201S

Exhibtt 4C,. Time Study • ADM

MEDICAID SCHOOL COST REPORT

Summary of Cost • Direct Medical Services

Blue Text= MER% Purple Text:; RMTS %

Purchased Direct Medical services

Billing cost for direct medical services Audit Fee

T,

Direct Medical supplies Direct Medical equipment {less than Capitalization threshold'

Qfil:>rect@on

Total Medical Equipment and Supplies

S/16/2016


Page7

Exhibit5A

Any School

12345

6/30/2015

Administration

$5!318

EXllib~ SA-Direct Medical Cost

MEDICAID SCI ,_ COST REPORT Summary of Cost - , ~M Activities

Blue Text= MER% Purple Text= RMTS %

I. Exclusive TCM Personnel

Pool2

Total

Purchased Services

Allocation%

Purchased TCM Services

Total

5/11/2016


$0 $0 $0

$0 $0

$0 $0 $0

$0 $0 $0

$0 $0 $0

Page 8

7/1/2014 to

$0 $0 $0

$0 $0 $0

$0 $0 $0

$0 $0 $0

$0 $0 $0

12345

xhibit 58 Any School

6/3012015

$0

$0

$0

$0

$0

$0

Exhibit 5B TCM Cost

MEDICAID 51 IOL COST REPORT Summary of Cost- Administrative Activities


7/1/2014 to

"0

-~ .:...;.:.,, . .L 1_ '_ .• : . . ,,,:J!,~.s;.~_.:,:;:_1;~~-:_:" ,~'.Jt,~,i4:,:.;2 i:(~i]j~\~]i:~~j

ic-, -

~~~iyr-~,l_lf._~-:~~~

Pool3 I $01 $0 $0

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

$0 Total I $01 $01 $0

5/11/2016 Page 9

Exhibit SC Any School

12345 6/30/2015

Administrative TS 0.00%

$0 $0

$0

$0

$0

$0

$0

$0

$0

$0

$0 $0

Admin $0

Exhibit 5C- Direct Admin Cost

MEDICAID SCHOOL COST REPORT Summary of Cost • Tr:ansporta11on Services

Complete Yellow Shaded Arau Only

Otlle< costs Maintenance

Gasoline Insurance

Depreciation

Other

Total Purchased Services

owned vehicles other than school bus

Total Transportation

$1000001

sol sol sol so! so!

$100t000[

11112014 to

SOL s100.ooo I

$01 s100,ooot

5111/2016

$0 I

$01

$5.20

Exhil>it50

0 0

6/3012015

$0

$0

S1111201e

MEDICAID SCHOOL COST REPORT Reconciliation and Settlement l'ur))()Se: to reconcile interim claims ,ecelved against the actual allowable costs ldemlffed for the reporting period Complete Yellow Slla4ed A...es Only

EKtllblt # Ref;()n<::itiation

Exhibit SA of Cost - Direct Medical Servioes Exhlblt50 Summary of Cost - TCM Activities Extlibit SC_ Summary of Cost• Administmijve Activities E.xniDit5D Summary_of Cost- Trans2_ortation Servioes

Total CM.lf/ed Public Expend/lures (CPEJ

Total Interim Medicaid Claims R~eived

7/1/2014

SETTLEMENT AND CALCULATION OF FMAPIFFP PERCENTAGES

Total

$135.682 bJej

$135 662

$9548 1

Total Reconclliation

H&allt!y Start: Medic.11,TCM and Transportation 564,61 1 AUP Uni/ Cost AdiuS/lnen1 (if ooo/icablel Amount After Adiuslment S64611 Healthv Stan Med~id - FMAP %

~ieable FMAP tion ~ .54_6_ ate Interim Claims Paid

Tobll Re<:oncliiatlon

$5,318

Total Reconclli;,tion

MSP Reimbursement Summa, Total Medicaid Related Costs Derived Through RMTS when applicable Total Medicaid Allowable Costs Derived Through MER and IEP Rates when a

Total Medicaid Allowable Transportation Costs (not included in amount above· 'Tolal_Reirrtbursable Costs {Total Medicaid Allowable CQSts ><i=_f'l"_8ates: Total Interim Claims Paid

Total Final Settlement

711114 ·9130/14

$33.921

$33.921 64.\5%

$21 760 S1 531

S16,153

S16153 74.91 ...

S, 2.100 5&51

S1 .330 5000%

$665

Pag• 11

1011114 ·12131114 1/1/15 -3/31116

$33.921 $33.921

$33.921 S33.921 63.58% 63.56%

S21 567 S21 .567 $1 516 $1516

S16,1S3 $16.153

S161S3 $16153 74 61% 7451%

S12 035 S12.035 SB47 S847

$1.330 $1,330 5000% 5000%

S665 $665

Number of I Cost per Students Student

701 $ S,879

, _5_[_$ _ __ 5,875

10

411115 -613j)11S I

s33.921 I 533,921 63.58%

S21.567 $1 516

S16,153

$1.330

~ $665

E.tlibit5 Any School

12345 6/30/2015

Amount

Exhibit S.Rec:Qnt;ili.ltion

MEOICAIO SCHOOL COST REPORT

Parti<>iponl"$ (La$! Name. First Name. Se,vice Tole1Gro$S Mil Staff ID C3t(1l Satary Sample 6 75.000.00

75,000.00

l..eQIN1d All servl<:es must use the l&gend de,lgn3tion below:

Cetego,y

A41dlologbl Psydllotry Spoecll Therapy Ps)'Chology O<;cupationol Therapy Pt,ylical T~erapy Nursing Couns&ling Soc:ial Woo: ~.ctm,n.stra"vo T~M

S.rvlc<! catego,y

1 2 3 4 5 6 7 a 9 A C

5/1112016

Total frir,9e Total Salary

Ben.efits aod F~oga

25.000.00 $ 100.000.00 s

$

s

$

s s s s s s $ s s s

25,000.00 t 00.000.00

r -~~-27 ·:---i.:- .. r,~!.=-~~0.·I ~ ~::·'-~f.-~~ [~· •-::.·!f ~T _ _.~=-1; ),.r · I ---~~~~~~ . , .. j ~ -~-----..: "L ...:..:.:..:;.._. .'..J-- ---

Is position

funded in part or

totally by %ag .. other funded Other

federal with SlateMatct> amount$ gram? federal E1ig;b1e Salary <equir«I for tobe Salary Less

"Y'·or"N" granl. and F~oge federal flJl"ld:S ramoved Reduction$ Pool1 Pool2 Pooll Tota.I s,00.000.00 100.000.00 A~lo "st S0.00 Tou,rTCM S0.00 To1a1Adtrun S0.00 COS! Pool 1 s,00.000.00

$000 0,00 Psy<,T11atry sooo Cos1 Poo12 so.oo Speeeh

$0.QO 0.00 Therapy sooo Co.s.lPool3 sooo $0.00 0.00 P.sydl y S0.00

Oocupstionar $000 000 Therapy sooo

Physical so_oo 0 .00 Therapy $100.000.00 $0.00 0.00 Nursing S0.00 $0.00 0.00 Counseling S0.00 $0.00 Q_QQ SocialWol'X S0.00 $0 00 0.00 $000 0.00 $0.00 000 S0.00 0.00 $0.00 0.00 $000 000

u • ota: U • Ota: U .. Otl;

100,000.00 0.00 0.00 100.000.00 Co.stPool 1 $100,000.00 C~IPoot2 S0.00 CostPool 3 $0,00 Total: ALL $100.000.00

Total Oif!erenee Ctied<. 100.000.00

Page 12 Exhibit .7

MEDICAID SCHOOL COST REPORT

Purchased Services

Contracted Providers (Company Name by service area)

ABC ESC - Speech

ABC ESC-OT

ABC ESC- PT

ABC ESC- Nursing

ABC ESC - Psychology

123 Company- OT

123 Company - PT

Legend

Therapist

Julie Smith Michael Jones Sally Brown

Gail White Jill Green

Martha Gray

Susan Williams

Jane Jenkins

Sam Samuel

Carol King

All services must use the legend designation below:

Category

Audiologist

Psychiatry

Speech Therapy

Psychology

Occupational Therapy

Physical Therapy

Nursing

Counseling

Social Work

Administrative

TCM

Transportation

Code

1

2

3

4

5

6

7

e 9

A

C T

Service Cat(1)

3

Contracted Costs

$75,000.00

5 $50,000.00

6 $40,000.00

7 $45,000.00

4 $90,000.00

s sso.000.00

6 $40,000.00

390,000.00

Is position funded in

part or totally by

other federal grant?

"Y11 or'1N''

y

%age funded

with federal grant.

100%

Other State Match amounts to Contract Costs

Eligible Contract required for be Less Costs federal funds removed Reductions MSP Direct Services MSP TCM MSP Administration Total

$75,000.00 75,000.00 Audiologist $0.00 Total TCM $0.00 Total Admin $0.00 Direct Service $345,000.00

$50,000.00 50,000.00 Psychiatry $0.00 TCM $0.00

Speech

$40,000.00 40,000.00 Therapy $75,000.00 Administration $0.00

$0.00 0.00 Psychology $90,000.00

Occupational

$90,000.00 90,000.00 Therapy $100,000.00 Physical

$0.00 0.00 Therapy $80,000.00

$50,000.00 50,000.00 Nursing $0.00

$0.00 0.00 Counseling $0.00

$40,000.00 40,000.00 Social Work $0.00

$0.00 0.00

$0.00 0.00 1rec

345,000.00 0.00 0.00 345,000.00 Service $345,000.00 TCM $0.00 Admin $0.00 Total: ALL $345,000.00

Total Difference Check 345,000.00

Exhibit-8

3/15/2017

State Fiscal Year Ending

6/30/2015

IRN (Internal Retrieval Number):

12345

Medicaid Provider Number: 1324567

1. Estimated Net MSP Reimbursement from OMA

2. TOTAL INTERIM CLAIMS RECEIVED

3. THIRD PARTY LIABILITY

4.ADJUSTMENTS

5. AMENDED FINAL

6. NET AMT PD {SUM 2 THROUGH 5)

7. TOTAL DUE OMA/(Schools) lines 1 - 6

7(a). TOTAL ADMIN DUE OMA/(Schools)*

7(b). NET SUBSIDY DUE OMA/(SCHOOLS)**

($)=Monies owed/paid to Schools by OMA $ = Monies owed/paid to OMA by Schools

Title XIX

(146,801)

0

0

0

0

0

(146,801)

(2,659)

(144,142)

FINAL SETTLEMENT SUMMARY for: Any School

NPI Number 1234567890

Dates of Service 7/1/2014 - 6/30/2015

Total

(146,801)

0

0

0

0

0

(146,801)

(2,659)

(144,142) **Net Subsidy allocation: Re ular (97,644.83) Sc hip (46,497.54)

(144,142.36

.. NOTICE•• THE ATIACHED WORKSHEETS MAY REFLECT MINOR DIFFERENCES CAUSED BY ROUNDING WHICH WILL NOT AFFECT THE SETILEMENT RESULTS

Settlement Approved By Auditor In ChargeCost Reporting Unit

Date

• Fund Code Group 4593-Admin Only ,.. Fund Code Group 4591 - Regular & Healthy Start 5/11/2016

Fall Financials 16·17

NEBRASKA BUSINESS MANAGER AUDIT CONTROL WORK SHEET SCHOOL DISTRICT NAME: SCHOOL DISTRICT#: I I

Fall Quarter Se~mber 1 • November 30, 2016 Save Until 12/2022 WHEN COMPLETED SEND TO: brentcadwell gosolutions.net

INUMBEROFI TOTAL BENEFIT CONTRACTED RENTALS&

LIABILITY INS I MATERIAi.$ AND I MISC COST 111•••) FEDERAL NEBMAC FINANCIALS WAGES TRAVEL TRAINING DUES& FEES OPERATIONAL STAFF PACKAGE SERI/ICES

LEASES ' SUPPLIES ' FUNDING

0 I $0 $0 $0 $0 $0 $0 $01 $01 $01 $01 $01 CATEGORY #I • All Audiologists, OT's, J>T's,

SLP'•, ~bster Level Socfal Workers, Psycl>ologisls, Nurse RN's, COTAs, YfAs, and

SLPAs

I 0 I sol $01 $01 $01 $01 $01 $01 $01 $01 $01 $01 CATEGORY #12 - Aides, BSWs, Counsdon,

[nterpreiers, LPNs, llealth Aides, O&M Specialisls, Administrators, Program Sped•list,

andOthen

a $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

School District Name: 0 School District Complete Number: 0

I TBD

Total Student Medicaid Count: To Be Determined (T.B.D.) by~BD the State NDE. These numbers will be entered for you. TBD NOTE; THERE SHOULD BE NO DUPLICATION OF COLLAR FIGURES FROM ABOVE LISTED HERE.

YEARLY MEDICAID ELIGIBILITY RATE: #VALUE!

I certify that to the best of my knowledge and belief all of this reported information is correct. Prepared By: _________ _. Date:l ! Phoned I I have reviewed the above information for accuracy and certify to the best of my Verified By : .__ ________ _. knowledge and belief all of this reported information is correct

Date:! ! Phoned ! *Must be personally signed by the supervisor. Preparer cannot sign/initil for the supervisor.

• NOTE: PLEASE SEE ATTACHED CATEGORY 1-2 SHEETS FOR A COMPLETE LIST OF ALL ELIGIBLE PARTICIPANTS THAT YOU MAY CLAIM FOR

IMPORTANT: THE TOTAL'S COLUMN fN CATEGORIES 1·2 ABOVE AND INFORMATION FOR ALL CELLS HIGHLIGHTED IN YELLOW MUST BE FILLED IN.

E-Mail Addresses: Last Name: First: E-Mail Address: Superintendent:

Special Ed. Director: Business Manager:

Other: Other: Other:

©Go Solutions Group

Page 1013

Cfe.C:, SOLUTIONS

GR..C>"LTPINC

5840 Enterprise Dr, Lansing, Ml 48911

PH: 877-204-0640 Fax: 517-853-8266

$0

$0

$0

BUSINESS MANAGER'S WORK SHEETS· TIME STUDY PARTICIPANTS· OPTIONAL WORK SHEETS SCHOOL l)ISTRJCT NAME: 0

l'IUWl8EAIOI= tofA.1.. BEtEFtl' CONTRACTED Fl!ltrAI..S&.

fM.TEA~$ANO (lus)

EXPEH$E$ S.t.UF GR0$$WAGES PA.a<AGE

TRA\<EL - PURCMlttSEO DUES &F'EES OPEMTIOIW. t.""81UT"t'•IS. $0PPLIE$ t,1!SC,(:0$1 F'EOER.U. TOTAL

er 30. 2016 SERVICES LEASES: FUNO!NG

LP'1i, "'•ste< levet Soc:ia.t Work•rs1 fCCOJM'I.IJ•'BERU>) oi;,t1t.l(.rJCttJ.Se:IES

~s, PTA•, •r>d SLPA< .,. Cale£or,#J LAS'f FDtST MIOOL-£ 0 $0 so so so $0 so so $0 $0 so so so Spt-ec:I\ lhtl'lpiSt $0

r,""'RN $0 SpHCh U.tr=-piSt $0 Psyohologist $0

' $0

I $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 so so so so so so so so so so so so so so so $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $_0 $0 $0 $0 $0 $0

Page2oD

BUSINESS MANAGER'S WORK SHEETS• TIME STUDY PARTICIPANTS· OPTIONAL WORK SHEETS SCHOOL DISTRICT NAME: 0

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NEBRASKA EDUCATION BASED MEDICAID ADMINISTRATIVE .CLAIMING (NEBMAC) CLAIM INVOICE

SCHOOL DISTRICT»

FALL CLAIMING QUARTER 2016-17 SEPTEMBER, OCTOBER, NOVEMBER 2016

SCHOOL STREET» t-------------------------------1 CITY, STATE, ZIP» f-------- - ------- - - -------------1

1--------------------------------1 DISTRICT NUMBER» 1--------------------------------1 TAX ID NUMBER» 1--------------------------------1 CONTACT» 1--------------------------- -----1 DATE PREPARED» .__ ____________________________ __,

A. How many people were in the cost allocation category this quarter? Cat 1 = 0 Cat 2= 0

B. How many of those people completed continuous time logs? C. The random moment time study utilized how many actual days during the quarter? D. Method used to determine district's Non-restricted Indirect Cost Rate? N.D.E E. District's Medicaid Eligibility Rate determined? ACTUAL:

GROSS COSTS ALLOCATED Category 1

Category 2

OTHER COSTS

TOTAL OF ALLOCATED COSTS

GROSS CLAIM

FEDERAL FINANCIAL PARTICIPATION

TOTAL AMOUNT CLAIMED BY FFP

TOTAL FOR 50% ABOVE: TOTAL FOR 75% ABOVE:

INDIRECT COST RATE: MEDICAID ELIGIBILITY RATE:

CLAIM AMOUNT:

iii•i•IMYMHI -$

$

$

$

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$

$

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Cl.AIMED QUARTER>»» SEPTEMe~ ocroe~ NOVEMBER 201~

TIME STUDY RESULTS

GENERAL ADMINISTRATION TIME REALLOCATION

CATEGQRy' #'I -All Auo10109i,ts. OT'$ Pt's. sU"·,, ~illS!H L•..-ef Social Wor1C91'$, P:.ychOlogi:s.lis, NutS6 RN'$, S 82 233 2 33 116 171,13 1280 57 116 116 3'4,92 34 92 11 64 109 43 117$8 4&;l 83 COTAs, PTAfl., end SLPA.s I 2,241

~~~~: :d~~6e:~~=ia~::~~~i::r:s•s. 1s s, Ol)O 20.29 3 58 192115 64 ... 955 000 !,608 3 58 31 02 3 58 10620 3102 ram Soecblls.t, and Q;Mn. I uee

2122 236 :.239 .,, 201082 I 1360. 11 10 61 118 9075 38 89 4243 1103 I 2:1394 I son1 4.SO'T

CATEGORY •1 -Ai, Aua1010916ts, OT'S, PT'S. SL.P's, M.ot1eir t.~et Soclil Wol'ktN, P1.ycno1og1:sti, Nu,se AN't, 0211% 010% 010% 005% 76'1% 5714% 005% 005% 156% 156% 052% 4b8% 525% 20,83% COTA&. PTA:s arut SLPAs. 100% CATE.GORY #2- AiCl*5, 9SWs., Coun1ff011S, lnte,pr&t8fJ, t.PNs, rlesl'th Aides, O&M Speciaiist:s, Administrators. 068% 000% 090')(, 016~> s-w .. 2&4% 0,2~. ooim 247% 016% , 37% 0,16% 469% 1 ~7% Ptoottim Soocl.allat. and OthM 100%

- 0,47% o.o~ 0.50% 010% 45,95% 30,18% 0 .. 2•% 0.03% 201% 0-96% Q_94% 2,54% 4,97% 11 .17% 100%

1 OF2

OTHER

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TOTAL Cl.AIM ~

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COST ALLOCATIO

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Implementation Timeline

,..

g~ SQ LUTI ON S Implementation Timeline for NEBMAC RMTS and MIPS Cost Settlement

[ __ I ______ -------------

' I I ID I School 8osed ACCESS Program Task Nome I Start finich

L_ : __ - -- - -- --- - --- -- __ I ' -·· ' .... , _,._ , ,, __ , ·- . ... ' .... , --· · -, .. , 1

l J Implementation with OHS/Commonwealth _______ =-=-=i 6/1/2017 6/1

Ill -· -12d I 2 : Transfer of Data with Current Vendor J 6/12/2017

I 3 ;-;~d W-e-lcom;~-ci<;~-to-0- is-tri~ts -- - ------ --i--6-/_12_/_2_01_7_ ---.;.-----------'-- ------.---------------·---------- 1 -- ld 0 1~ • · - - - -------

! 4 ! ReviewTrainingMaterialwithDHHS 6/12/2017 6/27/2017 J

[ s -;~;~n ~~~;~-~~is~de-;-~~~der, staff pool, c;fendar _j__ 6/12/2017 6/30/2017 j

I 6 ; Schedule Reports for Monthly Submission I 6/12/2017 [ 6/30/2017

1

---e------ · - - ------------------~---1- -,

7 I Check Eligibility 7/3/ I

12d I

15d I

15d I 6d I c:J I

r1--~ t:-R-e-~~-e1.1-~-n-ee_d_ed inf;;;~- Districts; Pqsaiptset~- _ _ __ _ ,__ __ 1_f6_f _____ +---------i-------...------------

9 I Pull Sample for MAC/RMTS l 7 / 17

j 10 : Create Usernamesand Passwords I 7

lld I !

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017

017

_ 17/2017 --

1---;"--- -- ------- - - - --

~ f Schedule Trainings

I 15d

17d I ___ 1 ___ _

8/7/2017 8/29/2017

*" *Timeline can be cha~ed based upon discussions with DHHS to meet all state specified dates.

--

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.,..

Go Solutions lnfom,ational Materials

gQ Help Desk Call Log Analysis Call log analysis is run to determine what areas that need to be addressed with follow-up to districts, it also outlines the districts having the greatest trouble.

The pie chart below, outlines the percentage of time each districts calls the help desk. Please note that large percentages may indicate the need for additional training.

PERCENTAGE ANALYSIS FOR ILLINOIS DISTRICTS

Township 211 .2%_ Tri Val1ev

0% taylorvute \ OX T~v1nshlp 2Ul.

v;.,·,"·•1;,i e,oomlnt:(on Brownstown 17., >II l "

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lJ~(' Pan.I

01vmpl1 1%

NS5!0 -4%

1'1

Ntw Ath1n1 Muibtny G:n:,vt 211 0%

The bar graph below outlines the reason districts are calling.

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Execution Time: 9 second(s) Date Generated: 9/5/2014 10:52:30 AM

{c} www.go-sqi.com "Special Education Management" Page 1 of 1

. --- ·--... --. -·-· --· -. --· .. --- ·-· .. --- .. ---- -- 0 ·-·-----. ·---...... ·- ·-·· ............... ---Go Solutions Group, Inc. January 1, 2015

Volume 4, lssue3

go U1;t/w; kru,w ...

CMS, A LEITER ON THE FREE CARE RULE ... On December 15, 2014, the Centers for Medicare & Medicaid Services (CMS) issued State Medicaid Director Letter #14-006 regarding Medicaid Payment for

Services Provided without Charge (Free Ca1·e}. The Letter addresses Free Care

in terms of Medicaid reimbursement for covered services undel' the approved state plans that are provided to Medicaid beneficiaries. (full letter attached).

The Letter also provides direction regarding third party liability (TPL), pointing out that the Medicaid statute requires that states take all reasonable measures to identify and pursue claims for payment of health care items and services against legally liable third parties. The Letter goes on to address TPL in terms of services provided pursuant to §504 of the Rehabilitation Act of 1973.

Regarding Free Care, the Letter states that Medicaid reimbursement is available for covered sen.ices under an approved state plan that are provided to Medicaid beneficiaries, regardless of whether there is any charge for the service, either to the beneficiary or to an non-beneficiary. As a result, Federal Financial Participation (FFP) is available for Medicaid payments for care pro.ided through providers that do not charge individuals for the service, as long as all other Medicaid requirements are met.

These requirements include:

• The individual is a Medicaid beneficiary.

• The service is a covered Medicaid service, provided in accordance with the approved state plan methodologies, including coverage under the Early and Periodic Screening Diagnostic and Treatment (EPSDT) benefit provided to children.

• The provider is a Medicaid-participating provider and meets all federal and/or state provider qualification requirements.

• The state plan contains a payment methodology for determining rates that are consistent with efficiency, economy and quality of care.

• TPL requirements are met.

INSIDE THIS ISSUE

Free Care Rule Cont' ................ 2

Doing a Self Audit .................... 3

Reconciliation of Claims .......... 4

ICD10 ....................................... 5

SPECIAL POINTS OF INTEREST

• Increase your Medicaid ReimbUl'sements on Multiple levels

• Make sure your district is Compliant, minimizing payback of claims.

2

ClVIS, A LEITER ON THE FREE CARE RULE,

CONTINUED ...

• Medicaid payment does not dupli- are legally liable third parties, the cate other specific payments fo1· Medicaid statute contains an exception the same service. at section 1903(c) of the Social Securi-

•

•

The state and provider maintain auditable documentation to support claims for federal financial pa11icipation.

ty Act. Moreover, Medicaid law provides that nothing in the IDEA permits a state to reduce medical or other assistance available, or to alter eligibility, under Titles V (relating to maternal and child health) and XIX of the Social The state conducts

financial oversight billing practices.

appropriate Security Act in the state. of provider

• All other program requirements (statutory, regulatory, policy) for the service, payment, and associ-ated claiming are met.

In its explanation of TPL, the Letter points out that the Medicaid statute of the Social Security Act requires that states take all reasonable measures to determine and pursue claims for payment of health care items and services against legally liable third parties. However, the Letter goes on, CMS does not view public agencies or programs that are carrying out general responsibilities to ensure access to needed health care, such as schools, public health agencies, and child protective services agencies, as legally liable third parties at the federal level for purposes of Medicaid reimbursement.

The Letter suggests that states review their own legal laws and regulations to determine whether such agencies or programs are required by stale law to pay for services when there are other available payers.

Even if a state determines that schools or providers of Individuals with Disabilities Education Act (IDEA) services

Further, under this guidance, CMS would not consider schools to be legally liable third parties to the extent that they are acting lo ensure that students receive needed medical services to access a free appropriate public education consistent with section 504 of the Rehabilitation Act of 1973.

Jn summary, the Letter announces changes in CMS Free Care doctrine to allow provision of services to Medicaid recipients, either under the IDEA or the ADA, without billing either those recipients or to the general population otherwise eligible for those services.

We will provide further information on this as it becomes available.

42 U.S.C. 1902(a)(25) of the Social Security Act 42 CFR 433 subpart D describes the TPL provisions for the Medicaid program. 29 u.s.c. §794

"We find that the

most issues for uudits

come from not being

tible to locate dt1ta, or that service documc11,

tation was not suffl,

dent. Please t.1kc

steps now to make

sure you are audit

ready."

3

LEARN FROM THOSE WHO WALKED BEFORE YOU ...

THE BENEFITS OF DOING A SELF AUDIT.

Most districts will be alldited at least once over a lhree year period. The audits will

he conducted either on a state auditor level or a federal auditor level. Regal'dlcss of the type of auditor, they will both l>e looking for the same thing; Was this service provided, was it documented correctly, and was it medically neces&'Hy.

Please remember in order to prove all thre.e points, you must keep the documen

tation for upward of seven years and have the ability to be made available upon request. l::lclow is a list of documentation ret1uirements that arc stanchml, the time limit for stoJ·ing 1·ecords can VlllY across states.

,. Cmrent and Valid Plan of care- in most cases the IEP or treatment plan is valid documentation to ('.over this requirement.

2 . Tesl Results and evaluation rep01ts -needed for initial evaluation anti rce,0.1luations for all thcmt>Y types listed as a 1'datcd sci·vicc in lhe TF.P / Treatment plan.

3. Service Documentation- most of which is listed on the senice documentation rcpo1t of GoClaim.

• StndenL~ Nnme

• Uate of service

• Type of service

• If group session, number of students listed in group

• Length of time of the ser

vice

• DeBcription of therapy

activity or method used

• Students progress toward goals 11nd the effectiveness of therapy.

• Signature or electronic signature of provider that gave se1vice

4. Prescription, Order or referral for treatment- not all services require an order, please check \,ith your account manager for darific:ntion.

5. IDEA lni'ormed Consent- the consent does need to be ptior to the date of service provided, except if service

occuned after 03/18/2013 where a one time signed consent will suffice.

6. License or certification- make s11re the correct liccnsui:e/ccrtification was in place on the date of ser,ice.

7. Attend,mce record- was the student

in school on the date of service.

Documentation must he qualitative as well as qmuttitativc. Remember lhat an auditor has not mt.>t or seen the student. The more informalion provided on the students health condition, the easier for the auditor to detem1ine if mcuically neces

sary.

Go S0lulio11s is equipped to pull a self audit to see where your district stacks up

on doc11mentation. This would entail pulling a selection of services that have been processed lo Medicaid on your he, halt: Frum he1·c all documentation information \\'Ollld need to he gathered to see if all components are on file for those dales of service.

Benefits of doing a self audit

0 Locale any problem areas on docu

mentation wilhin your <li.~tiict ptior to a formal audit being held

0 Train staff on proper <lor.umentation

standat·ds, and develop processes to make sure those standard~ are held.

We find that the most issues for audits come from not heing able tu locate clala or that service documentation was not sufficient. Please take sleps now to make sure you al'e audit ready.

Please email us al hdpclcskcwi;qsglt1t11ms.tl(;l or through your account manager lo request .i self audil loday. And please rememher we are here to help.

gg Batch Detail by Student

500.U'l'IOtd

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l;)·o:,X::SCIM:1i.tt;,;J;£;.t.l!>A¥MU:t:fft

.... , .... C!M!'II - An11t.8,t'-I Arnt.Feld

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DISCOVERING HOW YOUR MEDICAID CLAIMS ARE RECONCILED ...

!!!very Go Solutions district is on a schedule of when we suhmit claims to Medicaid on you!' behalf; be it monthly or weekly. Once your claims are submitted, we l'CCcive what is called a Remittance Ad,ice; <letailing if your claims have paid or denied, and if denied, the reason in which they have denied. The remittance ad-vice is what is know as an 835 HIPAA transaction file.

Once Go receive.~ the 835 file from the state, is it loaded into GoClaim™. Once it has heen loaded, we review all claims for c1·rors resulting in service denials. Any errors found within the claims, arc corrected and rcsul>millcd to Medicai<l for pmcessini,:;. Please note, that not all denials arc foun<I to contain errors, so not all denials v.~ll result in ,·eproccssing for payment; for instance a student has reached the spendin11; max within their Medicaid henefits vs. an incorrectly seled.ed ICD9 code. Any sen·icc lines fottn<l to be in error are re-processed, or re-hilled on a monthly uasis or as needed to make sure timeliness is met.

As impo1tant as it is for Go to review you.r 835 infoi·mation, it is equally as important for you at the <listl'ict lo review the infonnation, if to do nothing else but to understand the financial impact of the Medicaid program for your district.

There are a number of different reports that you can review to check on the financials that are associated with the files we suumit, along with the detail of the service lines per student or per provider.

lets look first al the billing history repm1. This report will show the batches we have suhmitt~d on your hehalf, with a detail of payment or denial information.

• The detail shows what had denied for process, what is still pending (or what the state is still reviewing) and what had paid.

This report ,,111 also show a breakdown of the dollars pct provider type submitted

and paid over a certain time period.

The Batch Detail by student is a great report when looking deeper into your payments. This repo1t will breakdown the sul,missions at the service line level, and will show detail into the payments or why pa:i,ments did not occul'.

• Each page will show the service lines that were suhmitted within the batch, followed by the payment detail, or denial reason.

• The last paieofthe repo11 will wvc the ovel' view of the batch submitted, followed by the error code.~ with a descrip-

tion.

1f you cve1· have questions on what we have submitted on your behalf, or payment or <lenial information, please email your account manager or the hclpdcsk at

lwlu<k-:;k~1tions.nt't ,. ~

= IM'C

H• .. .. ,.

':...__:c._:::

UNLOCKlNG YOUR PROVERS USER ID'S IN GOCLAIMTM

As au administrator you have tbe power to unlock users attached to your district that have been locked 0111 ofGoChtim'"'.

This can all h~ done from the Dashoo1rd on your iuitial login screen. Under System Monitor, GoClaimT" will show the number of individual~ from your district currently Jogged into GoClaim'"', it will also show the number of individuals locked out of the system that have access to your district.

1'o unlock the user, select Users Locked Ont. This will open up the locked out user grid, select the user you wish to unlock, and bit Unlock/Reset/Email. This function will also nutomatic11lly email the user letting them know that the user ID has now been unlocked.

System Monitor:

UMH~ Ont!nc: U5

• U.,.•,i lt1t1' t!OUI.:

4

GSGI Support Team

Account Managers

Glenelle Bruneskc, supporling AZ,

and NM

Glcnc:J le.Urn [email protected]

Brent Cadwell, suppmting NE, and

OH

nccnt,CadweJl@g,(lsvlutions,aet

Megan J.'lerning, supporting IL, and

MT.

.Mw1n,Flcmmgfwgosolutions.nct

Mike Nevells, supporting TN.

Mikc,Ne\<e))s~r1gosol11tions.nct

Heather Smith, supporting FL, GA, SC, andWl

11eather,Smitbc0>gosoJulious,net

Information Technology

Aaron I.um, sttpportingsystem

maintenance and data file uploads,

automatic file uploatL'l.

[email protected]

Invoicing and Contracts

Pam Strihnatter, supporting all your contract and invoicing needs.

Service & Support

Help Desk, supporting program

questions, training, database

maintenance, and email notifica

tions.

(800 )260.2544

hclmm.<:kQ1J1;osoJ11lions.net

Mindy Benzltir, S&S Manager

Mindy [email protected]~t

-------------·- 0 -------·-·····

TRANSITIONING TO ICD10 NOVEMBER 1, 2015

Go Solutions is in preparation for the upcoming trnnsition date of November 1, 2015. Oui· plan is to have GoClaimT" Ul> and nmning with all progrnmming changt'S prior to the en<l

oflhc 2014-2015 School year.

What you can do to he prepared regarding education and training:

+ Assess educational n~eds of your providers; whom do you think will need extra as-

sistance?

+ Identify the type and level of training needed; in person, or on line?

• Infonn all staff of the need to move to TCD10 and how it "'ill affect them .

• Make sure to reinforce with your providel'S, you are not diagnosing yom students

but informing Medicaid why that student was placed ,,~th them, just as they have

been with thecunent ICD9.

Areas to remember for the ICD10 transition:

* If cunently on a automatic upload of students, mnl<~ sure to update the new lC010

crosswalk for e.<lucation codes to ICD10

* Setup a training with your Account mimagers

Tool&lkj Wt Ste.rt tr ~w ·. eht:lpteY ti,'\; OIA.Y ltfe, 365 bt&fa,\,~ J>&l0ts, we dee.tole whe.t aces. ti,'\; the~, so ft-Lt the~ to ~e.lree tt the btst chttpteY eVtY.

funnyquroeimege.s. c:om

Quality Solutions for schools and their students

g g soLUTIONS

For entering Medicaid on GoClaim ™

This month we are focusing on how to answer questions posed by parents when requesting parental consent. We hope you will keep these tips in mind when parents ask about Parental Consent Forms, and what this means for their benefits.

Parental Consent is required to be kept on file for all students, and are required for a district to be compli

ant with state regulations. To be compliant, Parental consent must be dated after March 18, 2013 with an

annual notification sent thereafter. The annual notification will likely be sent by your district office.

Frequently Asked Questions by Parents

Why is Parental Informed Consent necessary?

The Individuals with Disabilities Education Act of

2004 requires that a parent be informed when

their Medicaid benefits are accessed. This

notification is in the form of the signed Consent

for Release of Information/Parent Informed

Consent form.

What if I change my mind, and no longer give

consent?

You may revoke your consent at anytime by

writing a letter indicating the date consent is

withdrawn, with your signature. Non-consent

will be from the date of the letter forward and

will not affect previous claims.

Does this affect my benefits?

No, giving your consent does not affect your

benefits in any way, or the services covered in

the IEP your child receives. It also will not im

pact the services you child may receive outside

of the school setting.

What am I giving the School

District permission to do?

You are giving the School District

permission to release information

from education records and to

access your child's Medicaid

benefits for the purpose of

receiving funds to supplement local

funding for educational programs.

What benefits are there to sign a

consent form?

By billing Medicaid, the District will

receive funds to supplement

local funding for

educational programs.

If I verbally told the District that I

am not giving consent, do I still

need to sign a Parent Informed

Consent?

Yes, you must put it in writing.

More on Parent Informed Consent

The new parental consent regulation protects family rights by ensuring that:

· 1. the one time parental consent specifies that the parent understands and agrees that the public

agency may access their or their child's public benefits or insurance [e.g., Medicaid] to pay for

services under the IDEA.; and

2. The annual written notification provides parents with critical information that they may not have re

ceived in the past to enable parents to understand their rights and protections when a public agency

seeks to access their child's public benefits or insurance services as part of the IEP

W Go Solutions Group has Parental Consent Information brochures available

upon request if you would like to give one to parents during an IEP meeting.

Have additional questions regarding parental consent?

Contact your account manager!

For more information, questions, or concerns regarding trainings feel free to contact us or your

Go Solutions Account Manager.

Office telephone: (800) 260-2544

Helpdesk Email: [email protected]

Arizona and New Mexico:

Glenelle Bruneske: (480) 839-0294 [email protected]

Ohio and Nebraska:

Brent Cadwell; Ext 544 [email protected]

Indiana:

Mike Nevells: Ext 532 [email protected]

Georgia, South Carolina, Wisconsin:

Heather Smith: (404) 230-9416 [email protected]

Illinois and Michigan:

Megan Fleming: Ext 527 [email protected]

AP NEWYEAR

Check us out on

Facebook & Twitter!

2015 Training Sessions

Tuesday, January 20th - 1:00 PM EST

Monday, February 23rd - 12:00 PM EST

Wednesday, March 18th - 3:00 PM EST

Friday, April 3rd - 9:30 AM EST

Tuesday, April 21st - 11:00 AM EST

Monday, May 4th - 9:00 AM EST

<•

'

Go Solutions Claims Documents

e MAC RMTS Claim Submission Breokdown The RMTS Claim Submission Breakdown will show the total claim amount submitted to the state for a specific

C1:JOO·•••• li'1l:leJ."1.~"{i°:leI•lLJ'ali~·1•m•re1~11il;b . . .. . · · .. · . . · · . quarter, per district. 1 ·~ fMnl} _ I btlifil©~;j~~~ ~ _ -;, _ ( -- . - - .. - .. . . - . . - . i' 1-fi:t•l!l~ -~ : l•l~iim!iP . .

09-0010 Sample District 1 26-0070 Sample District 2 07-0006 Sample District 3 42-0002 Sample District 4 10-0119 Sample District 5 33-0018 Sample District 6 89-0024 Sample District 7 21-0089 Sample District 8 78-0001 Sample District 9 64-0029 Sample District 10 41-0504 Sample District 11 50-0501 Sample District 12 20-0020 Sample District 13 04-0001 Sample District 14 59-0005 Sample District 15 62-0021 Sample District 16 34-0015 Sample District 17 77-0001 Sample District 18 85-2001 Sample District 19 36-0100 Sample District 20 33-0021 Sample District 21 78-0107 Sample District 22 06-0006 Sample District 23 80-0567 Sample District 24

Totals

Execution Time: 9 second(s) (c) Date Generated: 9/5/2014 10:52:30 AM

..

~ .- . 11

,!

- . ~ - ~-

~ ~ $4,139 $124.17 $2,768 $83.04

$21,670 $650.10 $5,114 $153.42 $1,298 $38.94 $3,133 $93.99 $3,828 $114.84 $1,285 $38.55 $5,927 $177.81

$10,548 $316.44 $12,243 $367.29 $1,817 $54.51 $2,448 $73.44 $2,360 $70.80 $3,219 $96.57 $5,402 $162.06

$30,254 $907.62 $43,794 $1,313.82 $2,963 $88.89 $2,937 $88.11 $2,814 $84.42 $1,615 $48.45 $1,576 $47.28 $9,612 $288.36

$182,764 $5,483

- -..:.

rt1ll'•111•inf•• ... , 1. I

$4,014.83 $2,684.96

$21,019.90 $4,960.58 $1,259.06 $3,039.01 $3,713.16 $1,246.45 $5,749.19 $10,231.56 $11,875.71 $1,762.49 $2,374.56 $2,289.20 $3,122.43 $5,239.94

$29,346.38 $42,480.18 $2,874.11 $2,848.89 $2,729.58 $1,566.55 $1,528.72 $9,323.64 $177,281

www.gosolutions.net/emac Page 1 of 1

e MAC _. Dashboard Summary

Timestudy Administration

Quarter:

Dashboard Summary. shows an overview of all information pertaining to this quarter. Areas listed in RED ore areas of concern. and need to be reviewed.

I Spring Qtr 2013·2014

- ---- --------~----~~--~----------- --Sample Management

Districts in t imestudw

Districts in 5am ple :

Staff Iota\;:

IParticinant s:

!Partfcipaots vmh no entry:

Districts with staff fn sample but no mac coordinator ;

Districts with staff in sam ple but no time study dates:

St aff in sample w it h no user ID:

Us,ers with no d ist.ric-:t acces:s:

Tiorlay's RMi"S Mome nts

Upcoming R1MTS Moment5

Com pleted RMTS Moments Needing Certificatio n

Certif ied RW•,1H S rvroments That A re Not Coded

QuarteO' : I spring Q1r l:013•1014

Original Mark Counts

10 IU st& 0 l

2 16 15 J ieos 41 l

Tel.Ila: Zt Ila 17 7 I ,,rr 11 us ., . • 71

Execution Time: 9 second(s) (c)

Date Generated: 9/!>/2014 10:52:30 AM

· I

21 3) • 48 ~

S"t • 1 ·~ Ii t7 11 I 11 ,.,. . \[ 4TI

222

222

15389

3302

0

173

222

! \

4!.2

ll

16

0

0

0

1

0

m

4n .o~ J 501 IM

11 m

www.gosolutions.net/emac Paee 1 of 1

gg System Maintenance Statistics

System Maintenance Statistics will show the

percentage of time the eMac and GoClaim

databases are up and running. Scheduled vs.

unscheduled time is also indicated.

System Availabllty

• ur,ume Sdleduled Mnutee

• Unscheduled Minutes

Week of Scheduled Allowance Maintenance Total Scheduled Minute,;. Unscheduled Minutes Percent Uptime

11/22/2015

11/15/201S

11/08/2015

11/01/2015

10/2S/201S

10/18/2015

10/11/2015

10/04/ 2015

09/27/2015

09/20/2015

09/13/2015

09/06/2015

0 8/30/2015

08/23/201S

08/16/2015

~/2015

vwv2/2015

07/26/2015

07/19/2015

07/12/2015

0 7/05/2015

06/28/2015

06/21/2015

06/14/2015

0 6/07/2015

05/31/2015

05/24/2015

OS/17/201S

OS/10/201S

05/03/2015

04/26/2015

04/19/2015

04/12/2015

04/05/2015

Execution Time: 10 second(s)

{c) www.gosolutjons.net

240

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240

240

240

240

240

240

240

0

10

30

15

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

10

30

15

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

0 100.00

Date Generated: 12J2/201510:S2:09 AM

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