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NEW MEXICO HUMAN SERVICES DEPARTMENT
REQUEST F OR PROP OSALS
Integration Platform Services for MMISR Project
Amendment #3
RFP#17-630-4000-1001
Amendment #3 Issued: October 4, 2016
Original RFP Issued: August 25, 2016
Submissions Due: October 21, 2016
Request for Proposal Number 17-630-4000-1001 is amended as described herein:
1. Change to The MMISR Modular Procurements section 1b, page 15:
Removal of reference of EDW in the Data Services section.
From:
1. The MMISR Modular Procurements
a. Integration Platform – Through this IP procurement, HSD will acquire the core technologies and associated services needed to support and implement the remainder of the MMISR solution, including:
1) The enterprise service bus (ESB) that forms the central integrating technology for our modular services and technology architecture;
2) A number of technology applications and tools that support programmatic needs within the HHS 2020 framework (e.g., master index, monitoring tools);
3) Essential data-related infrastructure, including:
a) Implementation of operational/production database(s) needed to monitor IP solution performance, support MMIS transition, serve on-going operational requirements and feed data to an enterprise data warehouse (EDW) (or other repository(s) that support reporting and analytics), and
b) Infrastructure for the Data Services (DS) procurement;
4) Contractor services to implement and operate the IP;
5) Contractor services to facilitate and ensure successful integration of subsequent modules and components, and to plan and lead conversion from the legacy MMIS to the new MMISR solution to meet CMS Certification requirements;
6) Contractor services to provide support to the State’s HHS 2020 Project Management Organization (PMO);
7) Contractor services to manage the IP contract and interact with the State and other HHS 2020 contractors to support HHS 2020 and MMISR.
b. Data Services (DS) – The Data Services procurement is focused on designing, implementing, operating and continually improving the structures,
processes and data needed to support HSD – and HHS 2020 – current and future reporting and analytics requirements. The DS Contractor will develop data structures – e.g., EDW, multiple linked data stores, data marts, data lakes – leveraging infrastructure provided through the IP contract.
HSD anticipates the DS Contractor will focus initially on defining and implementing the processes, analytics and technology tools and structures required to establish a foundational integrated data solution that supports reporting and analytics. However, the module goals also include providing insightful analytics to support population health management (i.e., an outcomes-focused approach to designing, delivering and managing services, with the ability to run New Mexico-specific experience against national databases) and to enable HHS enterprise-wide reporting and analytics through an integrated data, services and technology platform. The DS Contractor will also deliver timely and accurate reports, analytics and related work products using the DS solution.
The DS Contractor also will be responsible for analyzing data requirements, both current and projected; working with the State to define and implement an enterprise data governance approach; planning and implementing Master Data Management (MDM) for HHS 2020 data assets; providing data analytic and Business Intelligence tools and working with the State to plan an approach to achieve increasing levels of data maturity for HHS 2020.
c. Financial Services (FS) – HSD will contract with a BPO vendor to obtain claims processing and comprehensive financial services (e.g., accounting, payment handling) using a CMS-compliant platform and processes. The FS contractor also will provide services necessary for managing the FS contract, for interacting with the State and other HHS 2020 contractors to effectively support HHS 2020 and MMISR, and for providing to the IP and Data Service contractors the data elements essential to federal reporting requirements.
d. Quality Assurance (QA) – Through a BPO contract, HSD will contract with a vendor to obtain and perform the following services for the QA module using a CMS-compliant platform and processes:
1) Program Integrity support, including Third-Party Liability (TPL), Fraud and Abuse Detection Services, audit coordination, quality reporting, and compliance;
2) Provider enrollment and management;
3) Management of Prior Approval, and Recovery and Audit responsibilities;
4) Manage the QA contract and interact with the State and other HHS 2020 contractors to effectively support HHS 2020 and the MMISR Project; and
5) Coordinate efforts and projects with the HSD Office of Inspector General (OIG) and the Medicaid Fraud Control Unit (MFCU) of the Office of the Attorney General.
e. Population Health Management (PHM) – PHM represents realization of a vision for an outcomes-focused approach to serving the needs of New Mexico citizens and to managing and delivering services and benefits. PHM will be realized through a combination of services and information available through the other elements of the MMISR solution. Through the PHM module procurement, HSD will obtain through a vendor the services listed below:
1) Pharmacy benefits management (including rebate services);
2) Assistance with Managed Care Organization (MCO) management;
3) Focused analytics and datasets related to population health, outcomes and health improvement;
4) Coordination of the Electronic Health Records initiative;
5) Assistance with the systems and data support necessary for effective care and case management; and
6) Changes to the Fee-for-Service (FFS) program.
The PHM module contractor also will perform services necessary to manage the PHM contract and to interact with the State and with other HHS 2020 module contractors to effectively support HHS 2020 and the MMISR Project.
f. Unified Public Interface (UPI) – A key element of the HHS 2020 framework is a unified interface serving all stakeholders, in keeping with the vision of presenting a more customer-centric view of HHS services and processes. For this module HSD plans to procure contractor services to develop, implement and operate a UPI serving New Mexico citizens, providers, state agencies and employees, and other stakeholders. The goal of the UPI is to offer a “one-stop shop” that embraces a “no wrong door” approach to customer service.
The State is evaluating the procurement approach to achieve this goal. The State’s current plan is to separately acquire two principal UPI components.
1) Consolidated Customer Service Center (CCSC) – The goal for the CCSC is to provide a single, integrated contact center serving all HSD programs, to increase efficiency and to make it easier for our customers and providers to obtain needed information and/or actions. HSD intends to procure the CCSC through a BPO contract that will encompass:
a) CCSC set-up/tailoring to meet HSD-specific needs, including technology, processes, training and staff;
b) CCSC operation, reporting and continuous improvement; and
c) Services necessary to manage the CCSC contract and to interact with the State and with other HHS 2020 contractors to effectively support HHS 2020 and MMISR.
2) Unified Web Portal and Mobile Technology – The second principal UPI component encompasses both a unified web portal and the use of social media, mobile technology and other user-friendly technologies to improve user ease of access and to enhance HSD’s ability to readily and effectively reach customers, providers or other stakeholders. Work associated with this component includes:
a) Development of a comprehensive concept and design to effectively serve all stakeholders, via web portal(s), mobile technology, and other user-friendly technologies;
b) Implement, operate and maintain the unified portal(s) and other recommended technologies; and
c) Services needed to manage this component and to interact with the State and with other HHS 2020 contractors to effectively support HHS 2020 and MMISR.
In addition to these procurements, HSD released a competitive procurement in 2015 for MMISR IV&V services. The State has selected a finalist and anticipates the vendor to begin operations in July 2016. The MMISR IV&V Contractor will perform IV&V services throughout MMISR implementation and CMS Certification, in accordance with CMS and NM Department of Information Technology (DoIT) requirements. All MMISR module prime contractors will be required to interact and collaborate with the IV&V Contractor.
To:
2. The MMISR Modular Procurements
g. Integration Platform – Through this IP procurement, HSD will acquire the core technologies and associated services needed to support and implement the remainder of the MMISR solution, including:
8) The enterprise service bus (ESB) that forms the central integrating technology for our modular services and technology architecture;
9) A number of technology applications and tools that support programmatic needs within the HHS 2020 framework (e.g., master index, monitoring tools);
10) Essential data-related infrastructure, including:
c) Implementation of operational/production database(s) needed to monitor IP solution performance, support MMIS transition, serve on-going operational requirements and feed data to an enterprise data warehouse (EDW) (or other repository(s) that support reporting and analytics), and
d) Infrastructure for the Data Services (DS) procurement;
11) Contractor services to implement and operate the IP;
12) Contractor services to facilitate and ensure successful integration of subsequent modules and components, and to plan and lead conversion from the legacy MMIS to the new MMISR solution to meet CMS Certification requirements;
13) Contractor services to provide support to the State’s HHS 2020 Project Management Organization (PMO);
14) Contractor services to manage the IP contract and interact with the State and other HHS 2020 contractors to support HHS 2020 and MMISR.
h. Data Services (DS) – The Data Services procurement is focused on designing, implementing, operating and continually improving the structures, processes and data needed to support HSD – and HHS 2020 – current and future reporting and analytics requirements. The DS Contractor will develop data structures – e.g., multiple linked data stores, data marts, data lakes – leveraging infrastructure provided through the IP contract.
HSD anticipates the DS Contractor will focus initially on defining and implementing the processes, analytics and technology tools and structures required to establish a foundational integrated data solution that supports reporting and analytics. However, the module goals also include providing insightful analytics to support population health management (i.e., an outcomes-focused approach to designing, delivering and managing services, with the ability to run New Mexico-specific experience against national databases) and to enable HHS enterprise-wide reporting and analytics through an integrated data, services and technology platform. The DS Contractor will also deliver timely and accurate reports, analytics and related work products using the DS solution.
The DS Contractor also will be responsible for analyzing data requirements, both current and projected; working with the State to define and implement an
enterprise data governance approach; planning and implementing Master Data Management (MDM) for HHS 2020 data assets; providing data analytic and Business Intelligence tools and working with the State to plan an approach to achieve increasing levels of data maturity for HHS 2020.
i. Financial Services (FS) – HSD will contract with a BPO vendor to obtain claims processing and comprehensive financial services (e.g., accounting, payment handling) using a CMS-compliant platform and processes. The FS contractor also will provide services necessary for managing the FS contract, for interacting with the State and other HHS 2020 contractors to effectively support HHS 2020 and MMISR, and for providing to the IP and Data Service contractors the data elements essential to federal reporting requirements.
j. Quality Assurance (QA) – Through a BPO contract, HSD will contract with a vendor to obtain and perform the following services for the QA module using a CMS-compliant platform and processes:
6) Program Integrity support, including Third-Party Liability (TPL), Fraud and Abuse Detection Services, audit coordination, quality reporting, and compliance;
7) Provider enrollment and management;
8) Management of Prior Approval, and Recovery and Audit responsibilities;
9) Manage the QA contract and interact with the State and other HHS 2020 contractors to effectively support HHS 2020 and the MMISR Project; and
10) Coordinate efforts and projects with the HSD Office of Inspector General (OIG) and the Medicaid Fraud Control Unit (MFCU) of the Office of the Attorney General.
k. Population Health Management (PHM) – PHM represents realization of a vision for an outcomes-focused approach to serving the needs of New Mexico citizens and to managing and delivering services and benefits. PHM will be realized through a combination of services and information available through the other elements of the MMISR solution. Through the PHM module procurement, HSD will obtain through a vendor the services listed below:
7) Pharmacy benefits management (including rebate services);
8) Assistance with Managed Care Organization (MCO) management;
9) Focused analytics and datasets related to population health, outcomes and health improvement;
10) Coordination of the Electronic Health Records initiative;
11) Assistance with the systems and data support necessary for effective care and case management; and
12) Changes to the Fee-for-Service (FFS) program.
The PHM module contractor also will perform services necessary to manage the PHM contract and to interact with the State and with other HHS 2020 module contractors to effectively support HHS 2020 and the MMISR Project.
l. Unified Public Interface (UPI) – A key element of the HHS 2020 framework is a unified interface serving all stakeholders, in keeping with the vision of presenting a more customer-centric view of HHS services and processes. For this module HSD plans to procure contractor services to develop, implement and operate a UPI serving New Mexico citizens, providers, state agencies and employees, and other stakeholders. The goal of the UPI is to offer a “one-stop shop” that embraces a “no wrong door” approach to customer service.
The State is evaluating the procurement approach to achieve this goal. The State’s current plan is to separately acquire two principal UPI components.
1) Consolidated Customer Service Center (CCSC) – The goal for the CCSC is to provide a single, integrated contact center serving all HSD programs, to increase efficiency and to make it easier for our customers and providers to obtain needed information and/or actions. HSD intends to procure the CCSC through a BPO contract that will encompass:
d) CCSC set-up/tailoring to meet HSD-specific needs, including technology, processes, training and staff;
e) CCSC operation, reporting and continuous improvement; and
f) Services necessary to manage the CCSC contract and to interact with the State and with other HHS 2020 contractors to effectively support HHS 2020 and MMISR.
2) Unified Web Portal and Mobile Technology – The second principal UPI component encompasses both a unified web portal and the use of social media, mobile technology and other user-friendly technologies to improve user ease of access and to enhance HSD’s ability to readily and effectively reach customers, providers or other stakeholders. Work associated with this component includes:
d) Development of a comprehensive concept and design to effectively serve all stakeholders, via web portal(s), mobile technology, and other user-friendly technologies;
e) Implement, operate and maintain the unified portal(s) and other recommended technologies; and
f) Services needed to manage this component and to interact with the State and with other HHS 2020 contractors to effectively support HHS 2020 and MMISR.
In addition to these procurements, HSD released a competitive procurement in 2015 for MMISR IV&V services. The State has selected a finalist and anticipates the vendor to begin operations in July 2016. The MMISR IV&V Contractor will perform IV&V services throughout MMISR implementation and CMS Certification, in accordance with CMS and NM Department of Information Technology (DoIT) requirements. All MMISR module prime contractors will be required to interact and collaborate with the IV&V Contractor.
2. Change to APPENDIX G – NM HHS 2020 – INTEGRATION PLATFORM DETAILED STATEMENT OF WORK, page 84:
Removal of reference of EDW in the section 3 Database in relation to the Operational Data Store (ODS).
From:
APPENDIX G - NM HHS 2020 - INTEGRATION PLATFORM DETAILED STATEMENT OF WORK
This APPENDIX contains the Statement of Work. The Statement of Work is a companion document to the requirements found in APPENDIX H, and should be read and interpreted as a statement of both expectation and explanation of requirements found in APPENDIX H.
1. IP CONTRACTOR ROLE
a. KEY ROLE
The IP Contractor is central to successful MMISR implementation and operation. The IP Contractor will have a dual role:
Design, implement, maintain and operate the IP solution, which includes the ESB, enterprise technology service components, tools, the production database(s), data warehouse and ODS, and infrastructure to support enterprise data and interfaces; and
Work with the State to lead and coordinate the planning, management and successful integration of the remaining MMISR vendor modules and components.
b. IP SOLUTION AND APPROACH
HSD is seeking a solution and a service-delivery approach that:
Effectively addresses the HHS 2020 vision and the chosen approach to MMISR, while identifying risks or trade-offs and making informed recommendations for an approach that blends the “best” use of technology and related processes, with cost-effective implementation, maintenance and operation – including consideration of sustainability, flexibility, maximized reuse and interoperability;
Demonstrates experience with the technologies, challenges, compliance requirements, and opportunities associated with the recommended solution and service-delivery approach;
Demonstrates a well-established understanding and application of proven management, system engineering, testing, training and other applicable processes;
Credibly explains how the resources (including any subcontractors) will effectively work as a single team to meet State requirements;
Explains how the IP solution, and the associated integration of the subsequent MMISR vendor modules, will be planned and executed to enable successful completion within a very aggressive time frame; and
Explains how the Contractor will manage interactions with HSD, with disparate state and federal stakeholders, and with other involved vendors to deliver and operate an MMISR solution comprising multiple modules.
c. COMPLETE SOLUTION
Offerors are responsible for proposing a complete Integrated Platform solution, including all components of the IP architecture necessary to handle capacity and performance requirements throughout the contract life, and an approach to delivering all services required to complete all life cycle phases and responsibilities related to the IP contract. Offerors should propose an IP architectural solution that is geared to the intent of the HHS 2020 framework (see APPENDIX G, Section III). Offerors may propose alternative technologies to those listed, but should explain how these serve HSD requirements and why they are advantageous to HSD.
Offerors must propose an approach to implement and operate the IP solution that will also use the IP solution to enable a functional MMISR solution across all involved modules and contractors. While NOT responsible for the work of other MMISR module contractors, the IP Contractor will be responsible for setting standards that apply across the whole MMISR solution; for facilitating problem diagnosis and resolution across the integrated solution; and for providing guidance, review, testing, coordination and troubleshooting as additional MMISR contracts are awarded and modules are implemented.
A key deliverable under this contract is an MMISR Migration Plan documenting the approach that will be taken to migrate from the legacy MMIS to the new, multiple-module, multiple-contractor MMISR solution on a very tight timeline. Offerors should describe how this plan will be developed, how risks associated with the migration will be mitigated or minimized, how continuity of operations (COO) will be maintained, how legacy system data will be tested and validated, and the factors that will determine the proposed sequencing, migration processes, timelines, and responsibilities that must be incorporated in this plan. Offerors should frame their IP solution and approach in context of the HHS 2020 vision, of HSD’s goal of obtaining Medicaid Information Technology Architecture (MITA) maturity level 4, and of the CMS Seven Conditions and Standards (SCS). HSD may, as planning evolves, request the Contractor to extend support to the CSESR project, or to other HHS 2020 initiatives, in the future to the extent that these initiatives align with and benefit from the HHS 2020 framework.
The IP Contractor will be responsible for supporting HSD through the CMS MMIS certification process, ensuring that the IP solution meets certification requirements, that each subsequent module will address those requirements, and that the MMISR solution as a whole can be certified. The MMISR project will follow the CMS Enterprise Performance Life Cycle (EPLC). Offerors should refer to http://www.hhs.gov/ocio/eplc for further information related to those requirements. Offerors also should refer to CMS Certification guidelines, updated March 31, 2016, at https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/mect.html.
As noted in the RFP, as part of the HSD commitment to maximizing the benefits of a modular MMISR solution, each Offeror may win no more than two MMISR procurements and the selected IP Contractor cannot win the DS procurement.
d. SUBCONTRACTORS
While the use of subcontractors is acceptable with prior approval by HSD, the State is seeking an IP Contractor who will perform the majority of required work, and who thus will be directly accountable for the quality of the technology solutions, as well as for the associated services delivered throughout the contract life. The IP Contractor is solely responsible for performance under the contract resulting from this IP RFP. All work, including any work performed by subcontractors, must be performed onshore. No offshoring of work is permitted by either the prime IP Vendor or its subcontractors.
2. IP TECHNOLOGY REQUIREMENTS
a. THE IP SOLUTION
The IP solution forms the technology core for the HHS 2020 enterprise framework and for the MMISR solution. The IP solution is the heart of an extensible and relatively fluid solution framework that relies upon both service- and technology-based components to enable sustainable and affordable support to HSD programs and customers.
HSD envisions the IP solution as a SOA-based platform that will enable the Department and its partners to be more agile and flexible by providing connectivity and universal data transformation among disparate applications, systems and services regardless of platform, data formats or vendor. Additionally, the IP solution is intended to create and support a system of applications and services bound together in unified workflows and processes to meet business needs – and to be more readily changeable or changed out to meet business requirements as they evolve over time.
The IP solution will automate many types of repetitive business and IT tasks, and will contain pre-built integration to enable quick and easy connection to commercial-off-the-shelf (COTS) products, cloud solutions, and BPO services. HSD is moving away from requiring custom integration and programming to connecting disparate applications and systems. The IP solution must use standard transaction formats, such as the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 electronic transactions. Similarly, HSD envisions the use of an evolving set of web services, delivered through the SOA framework, to meet a wide variety of needs.
At a minimum, the IP solution will provide four essential services for the HHS 2020 framework (Figure 3):
Monitoring, management and platform administration; Security management; Integration services; and Automation and orchestration.
Figure 1 IP Solution Essential Services
b. IP TOOLS
The IP solution will provide tools for IT administrators to monitor MMISR solution performance against required targets. Security management will ensure appropriate authentication and authorization of integration services among applications, systems and services, and also will control user (e.g., client, provider, MMISR contractor) access to the MMISR solution as a whole. IP solution security management will integrate with
HSD’s Microsoft Active Directory environment for internal user access. Integration services will enable end-to-end communication across all applications, systems and services within in the HHS 2020 framework using application program interfaces (APIs), third-party adapters, standard web services and secure (server to server) file transfer formats. Automation and orchestration services will handle all message creation, transformation, routing, validation, and translation. This service will ensure messages are reliably transported and received among applications, systems and services.
HSD will gradually replace legacy systems as required to support changing business needs. The IP Contractor will assist the migration to new technology solutions – and service-based solutions – by enabling integration of legacy and new systems. The IP solution must be “future proof” and be ready to adapt to a constantly changing IT and business environment.
c. REUSE
NM has made significant investments in technology to support service delivery and program management. Too often, these investments result in stand-alone solutions with minimal shared services or infrastructure. The CMS Seven Conditions and Standards (SCS) require states to consider reuse when planning and implementing MMIS replacement solutions. Although SCS language emphasizes sharing across states, NM also is applying this internally to the existing assets that support HSD program delivery.
HSD’s investments in technology assets include virtualized servers, storage area network (SAN) devices, Exadata Oracle database devices, COTS software, and a variety of tools to support the system life cycle. HSD seeks to reduce architectural complexity by limiting our technology stack, where appropriate, to a small set of best-of-class solutions and tools that are expandable, maintainable and for which a talented pool of local staff exist.
With that in mind, Offerors are encouraged (but are not required) to propose an IP architecture that reuses existing technology assets to the extent that this can be done without sacrificing architectural integrity, maintainability, interoperability, scalability or flexibility; and without creating undue complexity that isn’t commensurate with a tradeoff in cost.
Table 8 lists assets that may be reused for the IP. VENDOR PRODUCT PURPOSE VERSION comments
Corticon Corticon Business rules engine 5.3.4.6 Planned for upgrade to 5.5
Hewlett Packard
Exstream Notices Generation 2.3.2
IBM Websphere Application Server 8.0.0.10 Planned for upgrade to 8.5. Additional licenses may be required depending on requirements
Informatica Informatica Identity Resolution
MCI Clearance 9.2 Additional licenses may be required depending on requirements
Informatica PowerCenter ETL 9.6.1SMA Opcon Batch management 5.1Oracle Oracle Database
EditionRDBMS 11g
(11.2.0.4)Perceptive Image Now Enterprise document
management7.1
SAP Data Services Address validation 4 Planned for upgrade to 4.2
IBM Clearquest Defect tracking 8.0.0.05 Additional licenses may be required depending on requirements
IBM Clearcase Version control 8.0.0.05 Genuitec MyEclipse Development IDE 10.7 Additional licenses may
be required depending on requirements
CA Erwin Data modeling software 9.64Hewlett Packard
UFT Testing tools 12.51
Hewlett Packard
Loadrunner Performance testing 12.01
Author-IT Author-IT On-line help development software
5.5
Adobe Captivate eLearning content 9CA Nimsoft Infrastructure monitoring 8.4Nessus Security Center Security scanning 5.1Symantec Scan Engine Anti-Virus 7Splunk Splunk Core Log Analytics 6.2.5 Additional licenses may
be required depending on requirements
Vormetric Vormetric Encryption at rest 5.1 Additional licenses may be required depending on requirements
Microsoft Active Directory Domain Controller 2008VMware vSphere Virtualization platform 5.5VMware View Desktop virtualization 4.x will be upgrading to
version 5.x
Red Hat Linux Operating System 6.11Microsoft Windows Operating System 2008 R2Symantec NetBackup Backup software 7.7.2EMC Recover Point Storage Replication 4,5 Additional licenses may
be required depending on requirements
VCE vBlock Virtualization Infrastructure 320GX Additional hardware may be required depending on requirements
Oracle Exadata Database Infrastructure X5-2Simplivity OmniCubes Virtualization hosts CN3000 could be expanded by
adding more units
CISCO ASA 5585 Firewall 9.1F5 BIG IP 6900 Load Balancers 11.3EMC Data Domain Backup Storage 5.4 Additional hardware may
be required depending on requirements
Table 1 Current HSD assets
d. CORE TECHNOLOGY
This subsection identifies technologies comprising the IP solution core infrastructure. As noted earlier, Offerors should propose an architecture that reflects an understanding of HSD’s HHS 2020 vision and of MMISR and IP solution requirements, but that also reflects Offeror’s best recommendation regarding an efficient and sustainable approach to implementing that vision. HSD is seeking an IP solution that incorporates virtualization and real-time failover. Offerors are encouraged to propose COTS products, open source and to adopt proven industry best practices throughout their proposed solution.
This subsection is organized around the major HHS 2020 framework components.
e. Infrastructure
The IP solution is intended to provide the host infrastructure, and to organize and manage the structure and visibility of data and applications required to support the MMISR solution and the HHS 2020 enterprise. Offerors shall propose all required hardware, software, telecommunications or other infrastructure required to implement the IP, with emphasis on leveraging HSD’s existing investments in infrastructure, resilience, scalability and security. (See also APPENDIX G, Section III, D. HOSTING.)
The Contractor also shall provide all necessary infrastructure, software and tools to support, in case of disaster, full recovery to the production IP solution at HSD’s non-production site.
f. Service Access Layer
HSD envisions IP solution service access layer built upon an Enterprise Service Bus
(ESB) within a SOA-enabling technology solution. The IP solution must:
a. Manage, monitor and control routing, integrity and security of message exchanges;
b. Resolve contention between communicating service components, e.g.,
1) Control deployment and versioning of services, and the use of redundant services;
2) Develop and manage common services, such as event handling, data transformation and mapping, and message and event queuing and sequencing;
3) Handle security;
4) Provide structured exception and error handling;
5) Provide protocol conversion;
6) Enforce communication service quality;
c. Secure and ensure the integrity of State information;
d. Use Single Sign-on (SSO) and Identity and Access Management (IdAM) to establish, integrate and manage unique logon IDs and security profiles for State-authorized users, including other contractors seeking access to the MMISR solution;
1) Use the HSD Active Directory for State employees; and
2) Use IdAM for all other users;
f. Allow access to services for data sharing between applications and entities;
g. Provide for successful integration of APIs;
h. Support automated and integrated service checkpoints to monitor service accuracy and completeness before proceeding to the next step or application batch process;
i. Design and maintain a suite of web services to enable processing across the HHS 2020 framework, access to data, effective MMISR solution management and other functions as agreed-upon with HSD;
j. Identify and use standards, protocols and methodologies to develop, maintain and execute privacy and security audit processes, procedures, and audit trail information and restrict access when anomalies are detected;
k. Provide the ability to suspend processing of erroneous transactions until the error is resolved;
l. Monitor usage and maintain a record of resource levels and consumption;
m. Provide a central log of all problems and errors that includes error statistics by module, transaction, and source;
n. Distinguish between errors (stop process) and exception (skip transaction and continue process) conditions;
o. Perform SOA-related business process and service management;
p. Capture performance data (e.g., elapsed time, dates) to support continuous improvement; and
q. Support “mashup” where the web server consumes several web services from different machines and compiles content into a single user interface.
Refer to the MMISR Bidders Library for a summary of known web services required for the MMISR solution. Offerors should assume an additional thirty (30) as-yet-unknown services will be required, following requirements sessions.Table 9 below lists types of services that the ESB must perform for the MMISR solution and for the HHS 2020 framework (as well as related services from the preceding list).
OPERATIONS and MANAGEMENTStatistics and status error trackingLogging and reportingAlertingService level agreement (SLA) rulesService usage tracking for chargeback/showbackMessage trackingMessage throttlingMessage re-deliveryError trackingEndpoint failoverLoad balancingHigh availabilityTraceability
SECURITYAuthenticationAuthorizationEncryptionIdentity proofingSingle sign on (SSO)
Rights managementMEDIATION
Message transformation and protocol translationMessage routingMessage validation cachingMessage re-sequencingReliable messagingPass-through messagingProtocol translationCachingService calloutService composition
SERVICE HOSTINGService containersComponent modelService registry
ADAPTERS AND TRANSPORTSOAPHTT/HTTPS/RESTJMSEJFEmailFTP/SFTP/SSHDatabase adaptersCustom adaptersThird-party adapters
Table 2 IP solution service access layer
1. Interfaces
The IP solution provides the framework for all internal and external interfaces required for the MMISR solution. Refer to the MMISR Bidders Library for a summary of interfaces required for the MMISR solution. Offerors shall propose an IP architecture that can efficiently and accurately handle these interfaces – including initial set-up, testing, modifications, and additions. Offerors should propose an architecture and approach that uses flexible interface standards, to enable interfaces and data extracts with other applications and products.
2. Enterprise Technology Service Components
This subsection identifies IP solution enterprise technology service components – software or services required to support the Medicaid enterprise and the HHS 2020 framework.
a. Extract, Transform and Load (ETL) tool – to load data into the operational data store (ODS) and also into the Enterprise Data structure (e.g., EDW).
b. Electronic Data Interchange (EDI) tool – to handle exchange of approved EDI transactions. HSD expects the MMISR solution to use the following X.12 transaction sets (see https://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/TransactionCodeSetsStands/ TransactionsandCodeSetsRegulations.html):
1) Eligibility Benefit Inquiry and Response (Set ID 270, 271);
2) Claim Status Request and Response (Set ID 276, 277);
3) Prior Authorization Review Request and Response (Set ID 278);
4) Managed Care Organization (MCO) Capitation Payment (Set ID 820); MCO Enrollment and Maintenance (Set ID 834);
5) Claim Payment/Advice (Set ID 835);
6) Professional Claim (Set ID 837P);
7) Institutional Claim (Set ID 837I); and
8) Dental Claim (Set ID 837D).
c. Master Index – an index designed to verify identity of one or more categories of entity across the MMISR solution and HHS 2020 framework. HSD requires a master index design to address:
1) Master Client Index (MCI ) –compare client records from disparate systems including federal verification and commercial data sources and link them to create a master demographic record, containing the most current data from all matched systems, for each citizen receiving State services and creating a unique identifier for each individual;
2) Master Provider Index (MPI) – match source records and identifiers from disparate systems to create a master provider record containing the most current data from all matched systems for each provider participating in the HSD programs and those of partner agencies, create a unique identifier for each provider, and maintain relationships between providers, groups and practice locations;
3) Master Agency Index (MAI) – match source records and identifiers from disparate systems to create an master agency record to reliably indicate which HHS 2020 participating agency provided, requested or received data from the IP, with each participating agency to have a unique identifier.
4) Master Employer Index (MEI) – match source records and identifiers from disparate systems to create a master employer record containing the most current data from all matched systems for each employer, and create a unique identifier for employer. (There is a possibility that this will be handled through an agreement with NM Department of Workforce Solutions.)
HSD expects the master index(es) to:
1) Provide a sophisticated matching function to locate records, to prevent creation of duplicate records, to provide a configurable method for resolving near matches, and to allow the State to manually or automatically link or unlink an individual or entity within an identified index;
2) Improve data quality by identifying and correcting data inconsistencies between systems and data duplication within systems;
3) Support ongoing control of data through established data governance practices that store and maintain items in a consistent fashion and format across all systems; and
4) Enable sharing of data throughout state government by storing essential demographic information in a common repository.
IP Vendor will be responsible for creating and enforcing standards, protocols, web service definition language (WSDL) and governance for all consumers of the indexes. This procurement does not include scope to modify any of the consuming systems.
3. Database
The IP solution encompasses three principal database/database-related requirements:
a. Operational Data Store (ODS)
HSD expects the ODS to support both IP solution and MMISR solution operations, as well as to be the master data repository for Medicaid-related data and for other programmatic data that may be needed in the HHS 2020 framework over time. The ODS is intended also to be a direct source of data for the DS solution (e.g., EDW). The ODS must provide a secure data repository during migration from the monolithic, legacy MMIS to the multiple-module MMISR solution, ensuring that HSD does not lose any required data as migration occurs. The Contractor will, through the requirements process, work with HSD to determine which data must be retained in the ODS to support operations; HSD does not expect all Medicaid-
related data (or other programmatic data) to reside in the ODS.
The IP Contractor will procure all hardware and software needed to implement, maintain and operate the ODS; configure the infrastructure; design and develop the ODS; perform data conversion and load the ODS prior to go-live for the IP; and maintain the ODS through the contract life. Offerors should propose a data architecture to support the requirements listed immediately below:
The ODS must, at a minimum:
1) Have sufficient capacity to support known workload requirements and be readily expandable to accommodate increasing or changing workloads;
2) Be maintained through processes and tools that cleanse and organize data before it is stored, and that maintain the data integrity once in the ODS, including referential integrity and foreign key constraints on all reference tables;
3) Support the intake and sharing of quality, secured data through MMISR and other HHS 2020 interfaces of all types;
4) Comply with all business and regulatory requirements;
5) Support transaction handling and auditing for the MMISR solution (and ultimately for HHS 2020);
6) Have the ability to interact with a wide range of data structures, and to ensure that any data transmitted into the IP solution ODS maintains the appropriate metadata necessary for identification of the original system and data format;
7) Support data replication and synchronization across multiple servers and provide automatic replication of table updates to multiple databases;
8) Include a metadata registry solution that provides descriptions of data structures, formats and definitions;
9) Provide for data consolidation, federation, and sharing among enterprise partners;
10) Use effective-dated transactions and table updates, either future dated or retroactive, with the ability to specify data edits by transaction type;
11) Provide a service that automatically reconciles all imported and exported data, and that provides automatic program checks to verify correct processing and data integrity;
12) Support physical-to-logical model mapping and rationalization, and provide ability to define model-to-model relationships among repository objects, data models and data flows via graphical, attribute-level mapping;
13) Extend and share metadata bi-directionally with other tools and through automated synchronization of metadata across multiple instances of the tools;
14) Support multiple environments required for IP solution and for the MMISR solution (e.g., development, test, production);
15) Enable role-based security, security to the attribute level of the database, audit trails, and safe storage and handling of data in accordance with all applicable security requirements; and
16) Minimize the need for translators and interface entities.
b. Data Warehouse Infrastructure
The IP Module r Contractor will have responsibility for the planning, design, implementation, operation and maintenance of an EDW that will be the master repository for reporting, ad hoc queries and analytics for the MMISR solution and for HHS 2020. While the Data Services Module Contractor will identify and provide the specific tools, techniques and approaches used to deliver these services, HSD wants to ensure that the core infrastructure supporting DS is consistent with and is hosted by the IP Contractor.
c. Master Data Management
The IP Contractor also will provide the metadata management and Master Data Management (MDM) tools and disciplines required for the MMISR project. This includes a requirement for the MDM solution to maintain and support the HHS 2020 logical data model (LDM), including but not limited to associated standards, entities, relationships, definitions, domains, keys and entity-relationship diagrams (ERDs).
To:
APPENDIX G - NM HHS 2020 - INTEGRATION PLATFORM DETAILED STATEMENT OF WORK
This APPENDIX contains the Statement of Work. The Statement of Work is a companion document to the requirements found in APPENDIX H, and should be read and interpreted as a statement of both expectation and explanation of requirements found in APPENDIX H.
1. IP CONTRACTOR ROLE
a. KEY ROLE
The IP Contractor is central to successful MMISR implementation and operation. The IP Contractor will have a dual role:
Design, implement, maintain and operate the IP solution, which includes the ESB, enterprise technology service components, tools, the production database(s), data warehouse and ODS, and infrastructure to support enterprise data and interfaces; and
Work with the State to lead and coordinate the planning, management and successful integration of the remaining MMISR vendor modules and components.
b. IP SOLUTION AND APPROACH
HSD is seeking a solution and a service-delivery approach that:
Effectively addresses the HHS 2020 vision and the chosen approach to MMISR, while identifying risks or trade-offs and making informed recommendations for an approach that blends the “best” use of technology and related processes, with cost-effective implementation, maintenance and operation – including consideration of sustainability, flexibility, maximized reuse and interoperability;
Demonstrates experience with the technologies, challenges, compliance requirements, and opportunities associated with the recommended solution and service-delivery approach;
Demonstrates a well-established understanding and application of proven management, system engineering, testing, training and other applicable processes;
Credibly explains how the resources (including any subcontractors) will effectively work as a single team to meet State requirements;
Explains how the IP solution, and the associated integration of the subsequent MMISR vendor modules, will be planned and executed to enable successful completion within a very aggressive time frame; and
Explains how the Contractor will manage interactions with HSD, with disparate state and federal stakeholders, and with other involved vendors to deliver and operate an MMISR solution comprising multiple modules.
c. COMPLETE SOLUTION
Offerors are responsible for proposing a complete Integrated Platform solution, including all components of the IP architecture necessary to handle capacity and performance requirements throughout the contract life, and an approach to delivering all services required to complete all life cycle phases and responsibilities related to the IP contract. Offerors should propose an IP architectural solution that is geared to the intent of the HHS 2020 framework (see APPENDIX G, Section III). Offerors may propose alternative technologies to those listed, but should explain how these serve HSD requirements and why they are advantageous to HSD.
Offerors must propose an approach to implement and operate the IP solution that will also use the IP solution to enable a functional MMISR solution across all involved modules and contractors. While NOT responsible for the work of other MMISR module contractors, the IP Contractor will be responsible for setting standards that apply across the whole MMISR solution; for facilitating problem diagnosis and resolution across the integrated solution; and for providing guidance, review, testing, coordination and troubleshooting as additional MMISR contracts are awarded and modules are implemented.
A key deliverable under this contract is an MMISR Migration Plan documenting the approach that will be taken to migrate from the legacy MMIS to the new, multiple-module, multiple-contractor MMISR solution on a very tight timeline. Offerors should describe how this plan will be developed, how risks associated with the migration will be mitigated or minimized, how continuity of operations (COO) will be maintained, how legacy system data will be tested and validated, and the factors that will determine the proposed sequencing, migration processes, timelines, and responsibilities that must be incorporated in this plan. Offerors should frame their IP solution and approach in context of the HHS 2020 vision, of HSD’s goal of obtaining Medicaid Information Technology Architecture (MITA) maturity level 4, and of the CMS Seven Conditions and Standards (SCS). HSD may, as planning evolves, request the Contractor to extend support to the CSESR project, or to other HHS 2020 initiatives, in the future to the extent that these initiatives align with and benefit from the HHS 2020 framework.
The IP Contractor will be responsible for supporting HSD through the CMS MMIS certification process, ensuring that the IP solution meets certification requirements, that each subsequent module will address those requirements, and that the MMISR solution as a whole can be certified. The MMISR project will follow the CMS Enterprise Performance Life Cycle (EPLC). Offerors should refer to http://www.hhs.gov/ocio/eplc
for further information related to those requirements. Offerors also should refer to CMS Certification guidelines, updated March 31, 2016, at https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/mect.html.
As noted in the RFP, as part of the HSD commitment to maximizing the benefits of a modular MMISR solution, each Offeror may win no more than two MMISR procurements and the selected IP Contractor cannot win the DS procurement.
d. SUBCONTRACTORS
While the use of subcontractors is acceptable with prior approval by HSD, the State is seeking an IP Contractor who will perform the majority of required work, and who thus will be directly accountable for the quality of the technology solutions, as well as for the associated services delivered throughout the contract life. The IP Contractor is solely responsible for performance under the contract resulting from this IP RFP. All work, including any work performed by subcontractors, must be performed onshore. No offshoring of work is permitted by either the prime IP Vendor or its subcontractors.
2. IP TECHNOLOGY REQUIREMENTS
a. THE IP SOLUTION
The IP solution forms the technology core for the HHS 2020 enterprise framework and for the MMISR solution. The IP solution is the heart of an extensible and relatively fluid solution framework that relies upon both service- and technology-based components to enable sustainable and affordable support to HSD programs and customers.
HSD envisions the IP solution as a SOA-based platform that will enable the Department and its partners to be more agile and flexible by providing connectivity and universal data transformation among disparate applications, systems and services regardless of platform, data formats or vendor. Additionally, the IP solution is intended to create and support a system of applications and services bound together in unified workflows and processes to meet business needs – and to be more readily changeable or changed out to meet business requirements as they evolve over time.
The IP solution will automate many types of repetitive business and IT tasks, and will contain pre-built integration to enable quick and easy connection to commercial-off-the-shelf (COTS) products, cloud solutions, and BPO services. HSD is moving away from requiring custom integration and programming to connecting disparate applications and systems. The IP solution must use standard transaction formats, such as the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 electronic transactions. Similarly, HSD envisions the use of an evolving set of web services, delivered through the SOA framework, to meet a wide variety of needs.
At a minimum, the IP solution will provide four essential services for the HHS 2020 framework (Figure 3):
Monitoring, management and platform administration; Security management; Integration services; and Automation and orchestration.
Figure 2 IP Solution Essential Services
b. IP TOOLS
The IP solution will provide tools for IT administrators to monitor MMISR solution performance against required targets. Security management will ensure appropriate authentication and authorization of integration services among applications, systems and services, and also will control user (e.g., client, provider, MMISR contractor) access to the MMISR solution as a whole. IP solution security management will integrate with HSD’s Microsoft Active Directory environment for internal user access. Integration services will enable end-to-end communication across all applications, systems and services within in the HHS 2020 framework using application program interfaces (APIs), third-party adapters, standard web services and secure (server to server) file transfer formats. Automation and orchestration services will handle all message creation, transformation, routing, validation, and translation. This service will ensure messages are reliably transported and received among applications, systems and services.
HSD will gradually replace legacy systems as required to support changing business needs. The IP Contractor will assist the migration to new technology solutions – and service-based solutions – by enabling integration of legacy and new systems. The IP solution must be “future proof” and be ready to adapt to a constantly changing IT and business environment.
c. REUSE
NM has made significant investments in technology to support service delivery and program management. Too often, these investments result in stand-alone solutions with minimal shared services or infrastructure. The CMS Seven Conditions and Standards (SCS) require states to consider reuse when planning and implementing MMIS replacement solutions. Although SCS language emphasizes sharing across states, NM
also is applying this internally to the existing assets that support HSD program delivery.
HSD’s investments in technology assets include virtualized servers, storage area network (SAN) devices, Exadata Oracle database devices, COTS software, and a variety of tools to support the system life cycle. HSD seeks to reduce architectural complexity by limiting our technology stack, where appropriate, to a small set of best-of-class solutions and tools that are expandable, maintainable and for which a talented pool of local staff exist.
With that in mind, Offerors are encouraged (but are not required) to propose an IP architecture that reuses existing technology assets to the extent that this can be done without sacrificing architectural integrity, maintainability, interoperability, scalability or flexibility; and without creating undue complexity that isn’t commensurate with a tradeoff in cost.
Table 8 lists assets that may be reused for the IP. VENDOR PRODUCT PURPOSE VERSION comments
Corticon Corticon Business rules engine 5.3.4.6 Planned for upgrade to 5.5
Hewlett Packard
Exstream Notices Generation 2.3.2
IBM Websphere Application Server 8.0.0.10 Planned for upgrade to 8.5. Additional licenses may be required depending on requirements
Informatica Informatica Identity Resolution
MCI Clearance 9.2 Additional licenses may be required depending on requirements
Informatica PowerCenter ETL 9.6.1SMA Opcon Batch management 5.1Oracle Oracle Database
EditionRDBMS 11g
(11.2.0.4)Perceptive Image Now Enterprise document
management7.1
SAP Data Services Address validation 4 Planned for upgrade to 4.2
IBM Clearquest Defect tracking 8.0.0.05 Additional licenses may be required depending on requirements
IBM Clearcase Version control 8.0.0.05 Genuitec MyEclipse Development IDE 10.7 Additional licenses may
be required depending on requirements
CA Erwin Data modeling software 9.64Hewlett Packard
UFT Testing tools 12.51
Hewlett Loadrunner Performance testing 12.01
Packard Author-IT Author-IT On-line help development
software5.5
Adobe Captivate eLearning content 9CA Nimsoft Infrastructure monitoring 8.4Nessus Security Center Security scanning 5.1Symantec Scan Engine Anti-Virus 7Splunk Splunk Core Log Analytics 6.2.5 Additional licenses may
be required depending on requirements
Vormetric Vormetric Encryption at rest 5.1 Additional licenses may be required depending on requirements
Microsoft Active Directory Domain Controller 2008VMware vSphere Virtualization platform 5.5VMware View Desktop virtualization 4.x will be upgrading to
version 5.x
Red Hat Linux Operating System 6.11Microsoft Windows Operating System 2008 R2Symantec NetBackup Backup software 7.7.2EMC Recover Point Storage Replication 4,5 Additional licenses may
be required depending on requirements
VCE vBlock Virtualization Infrastructure 320GX Additional hardware may be required depending on requirements
Oracle Exadata Database Infrastructure X5-2Simplivity OmniCubes Virtualization hosts CN3000 could be expanded by
adding more units
CISCO ASA 5585 Firewall 9.1F5 BIG IP 6900 Load Balancers 11.3EMC Data Domain Backup Storage 5.4 Additional hardware may
be required depending on requirements
Table 3 Current HSD assets
d. CORE TECHNOLOGY
This subsection identifies technologies comprising the IP solution core infrastructure. As noted earlier, Offerors should propose an architecture that reflects an understanding of HSD’s HHS 2020 vision and of MMISR and IP solution requirements, but that also reflects Offeror’s best recommendation regarding an
efficient and sustainable approach to implementing that vision. HSD is seeking an IP solution that incorporates virtualization and real-time failover. Offerors are encouraged to propose COTS products, open source and to adopt proven industry best practices throughout their proposed solution.
This subsection is organized around the major HHS 2020 framework components.
e. Infrastructure
The IP solution is intended to provide the host infrastructure, and to organize and manage the structure and visibility of data and applications required to support the MMISR solution and the HHS 2020 enterprise. Offerors shall propose all required hardware, software, telecommunications or other infrastructure required to implement the IP, with emphasis on leveraging HSD’s existing investments in infrastructure, resilience, scalability and security. (See also APPENDIX G, Section III, D. HOSTING.)
The Contractor also shall provide all necessary infrastructure, software and tools to support, in case of disaster, full recovery to the production IP solution at HSD’s non-production site.
f. Service Access Layer
HSD envisions IP solution service access layer built upon an Enterprise Service Bus (ESB) within a SOA-enabling technology solution. The IP solution must:
a. Manage, monitor and control routing, integrity and security of message exchanges;
b. Resolve contention between communicating service components, e.g.,
1) Control deployment and versioning of services, and the use of redundant services;
2) Develop and manage common services, such as event handling, data transformation and mapping, and message and event queuing and sequencing;
3) Handle security;
4) Provide structured exception and error handling;
5) Provide protocol conversion;
6) Enforce communication service quality;
c. Secure and ensure the integrity of State information;
d. Use Single Sign-on (SSO) and Identity and Access Management (IdAM) to establish, integrate and manage unique logon IDs and security profiles for State-authorized users, including other contractors seeking access to the MMISR solution;
1) Use the HSD Active Directory for State employees; and
2) Use IdAM for all other users;
f. Allow access to services for data sharing between applications and entities;
g. Provide for successful integration of APIs;
h. Support automated and integrated service checkpoints to monitor service accuracy and completeness before proceeding to the next step or application batch process;
i. Design and maintain a suite of web services to enable processing across the HHS 2020 framework, access to data, effective MMISR solution management and other functions as agreed-upon with HSD;
j. Identify and use standards, protocols and methodologies to develop, maintain and execute privacy and security audit processes, procedures, and audit trail information and restrict access when anomalies are detected;
k. Provide the ability to suspend processing of erroneous transactions until the error is resolved;
l. Monitor usage and maintain a record of resource levels and consumption;
m. Provide a central log of all problems and errors that includes error statistics by module, transaction, and source;
n. Distinguish between errors (stop process) and exception (skip transaction and continue process) conditions;
o. Perform SOA-related business process and service management;
p. Capture performance data (e.g., elapsed time, dates) to support continuous improvement; and
q. Support “mashup” where the web server consumes several web services from different machines and compiles content into a single user interface.
Refer to the MMISR Bidders Library for a summary of known web services required for the MMISR solution. Offerors should assume an additional thirty (30) as-yet-unknown services will be required, following requirements sessions.Table 9 below lists types of services that the ESB must perform for the MMISR
solution and for the HHS 2020 framework (as well as related services from the preceding list).
OPERATIONS and MANAGEMENTStatistics and status error trackingLogging and reportingAlertingService level agreement (SLA) rulesService usage tracking for chargeback/showbackMessage trackingMessage throttlingMessage re-deliveryError trackingEndpoint failoverLoad balancingHigh availabilityTraceability
SECURITYAuthenticationAuthorizationEncryptionIdentity proofingSingle sign on (SSO)Rights management
MEDIATIONMessage transformation and protocol translationMessage routingMessage validation cachingMessage re-sequencingReliable messagingPass-through messagingProtocol translationCachingService calloutService composition
SERVICE HOSTINGService containersComponent modelService registry
ADAPTERS AND TRANSPORTSOAPHTT/HTTPS/RESTJMSEJFEmailFTP/SFTP/SSHDatabase adapters
Custom adaptersThird-party adapters
Table 4 IP solution service access layer
1. Interfaces
The IP solution provides the framework for all internal and external interfaces required for the MMISR solution. Refer to the MMISR Bidders Library for a summary of interfaces required for the MMISR solution. Offerors shall propose an IP architecture that can efficiently and accurately handle these interfaces – including initial set-up, testing, modifications, and additions. Offerors should propose an architecture and approach that uses flexible interface standards, to enable interfaces and data extracts with other applications and products.
2. Enterprise Technology Service Components
This subsection identifies IP solution enterprise technology service components – software or services required to support the Medicaid enterprise and the HHS 2020 framework.
a. Extract, Transform and Load (ETL) tool – to load data into the operational data store (ODS) and also into the Enterprise Data structure (e.g., EDW).
b. Electronic Data Interchange (EDI) tool – to handle exchange of approved EDI transactions. HSD expects the MMISR solution to use the following X.12 transaction sets (see https://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/TransactionCodeSetsStands/ TransactionsandCodeSetsRegulations.html):
1) Eligibility Benefit Inquiry and Response (Set ID 270, 271);
2) Claim Status Request and Response (Set ID 276, 277);
3) Prior Authorization Review Request and Response (Set ID 278);
4) Managed Care Organization (MCO) Capitation Payment (Set ID 820); MCO Enrollment and Maintenance (Set ID 834);
5) Claim Payment/Advice (Set ID 835);
6) Professional Claim (Set ID 837P);
7) Institutional Claim (Set ID 837I); and
8) Dental Claim (Set ID 837D).
c. Master Index – an index designed to verify identity of one or more categories of entity across the MMISR solution and HHS 2020 framework. HSD requires a master index design to address:
1) Master Client Index (MCI ) –compare client records from disparate systems including federal verification and commercial data sources and link them to create a master demographic record, containing the most current data from all matched systems, for each citizen receiving State services and creating a unique identifier for each individual;
2) Master Provider Index (MPI) – match source records and identifiers from disparate systems to create a master provider record containing the most current data from all matched systems for each provider participating in the HSD programs and those of partner agencies, create a unique identifier for each provider, and maintain relationships between providers, groups and practice locations;
3) Master Agency Index (MAI) – match source records and identifiers from disparate systems to create an master agency record to reliably indicate which HHS 2020 participating agency provided, requested or received data from the IP, with each participating agency to have a unique identifier.
4) Master Employer Index (MEI) – match source records and identifiers from disparate systems to create a master employer record containing the most current data from all matched systems for each employer, and create a unique identifier for employer. (There is a possibility that this will be handled through an agreement with NM Department of Workforce Solutions.)
HSD expects the master index(es) to:
1) Provide a sophisticated matching function to locate records, to prevent creation of duplicate records, to provide a configurable method for resolving near matches, and to allow the State to manually or automatically link or unlink an individual or entity within an identified index;
2) Improve data quality by identifying and correcting data inconsistencies between systems and data duplication within systems;
3) Support ongoing control of data through established data governance practices that store and maintain items in a consistent fashion and format across all systems; and
4) Enable sharing of data throughout state government by storing essential demographic information in a common repository.
IP Vendor will be responsible for creating and enforcing standards, protocols, web service definition language (WSDL) and governance for all consumers of the indexes. This procurement does not include scope to modify any of the consuming systems.
3. Database
The IP solution encompasses three principal database/database-related requirements:
a. Operational Data Store (ODS)
HSD expects the ODS to support both IP solution and MMISR solution operations, as well as to be the master data repository for Medicaid-related data and for other programmatic data that may be needed in the HHS 2020 framework over time. The ODS is intended also to be a direct source of data for the DS solution. The ODS must provide a secure data repository during migration from the monolithic, legacy MMIS to the multiple-module MMISR solution, ensuring that HSD does not lose any required data as migration occurs. The Contractor will, through the requirements process, work with HSD to determine which data must be retained in the ODS to support operations; HSD does not expect all Medicaid-related data (or other programmatic data) to reside in the ODS.
The IP Contractor will procure all hardware and software needed to implement, maintain and operate the ODS; configure the infrastructure; design and develop the ODS; perform data conversion and load the ODS prior to go-live for the IP; and maintain the ODS through the contract life. Offerors should propose a data architecture to support the requirements listed immediately below:
The ODS must, at a minimum:
1) Have sufficient capacity to support known workload requirements and be readily expandable to accommodate increasing or changing workloads;
2) Be maintained through processes and tools that cleanse and organize data before it is stored, and that maintain the data integrity once in the ODS, including referential integrity and foreign key constraints on all reference tables;
3) Support the intake and sharing of quality, secured data through MMISR and other HHS 2020 interfaces of all types;
4) Comply with all business and regulatory requirements;
5) Support transaction handling and auditing for the MMISR solution (and ultimately for HHS 2020);
6) Have the ability to interact with a wide range of data structures, and to ensure that any data transmitted into the IP solution ODS maintains the appropriate metadata necessary for identification of the original system and data format;
7) Support data replication and synchronization across multiple servers and provide automatic replication of table updates to multiple databases;
8) Include a metadata registry solution that provides descriptions of data structures, formats and definitions;
9) Provide for data consolidation, federation, and sharing among enterprise partners;
10) Use effective-dated transactions and table updates, either future dated or retroactive, with the ability to specify data edits by transaction type;
11) Provide a service that automatically reconciles all imported and exported data, and that provides automatic program checks to verify correct processing and data integrity;
12) Support physical-to-logical model mapping and rationalization, and provide ability to define model-to-model relationships among repository objects, data models and data flows via graphical, attribute-level mapping;
13) Extend and share metadata bi-directionally with other tools and through automated synchronization of metadata across multiple instances of the tools;
14) Support multiple environments required for IP solution and for the MMISR solution (e.g., development, test, production);
15) Enable role-based security, security to the attribute level of the database, audit trails, and safe storage and handling of data in accordance with all applicable security requirements; and
16) Minimize the need for translators and interface entities.
b. Data Warehouse Infrastructure
The IP Module Contractor will have responsibility for the planning, design, implementation, operation and maintenance of an EDW that will be the master repository for reporting, ad hoc queries and analytics for the MMISR solution and for HHS 2020. While the Data Services Module Contractor will identify and provide the specific tools, techniques and approaches used to
deliver these services, HSD wants to ensure that the core infrastructure supporting DS is consistent with and is hosted by the IP Contractor.
d. Master Data Management
The IP Contractor also will provide the metadata management and Master Data Management (MDM) tools and disciplines required for the MMISR project. This includes a requirement for the MDM solution to maintain and support the HHS 2020 logical data model (LDM), including but not limited to associated standards, entities, relationships, definitions, domains, keys and entity-relationship diagrams (ERDs).
3. Change to APPENDIX G – NM HHS 2020 – INTEGRATION PLATFORM DETAILED STATEMENT OF WORK, page 102:
Removal of reference of DS in relation to the Operational Data Store (ODS) in section b. Operational Data Store.
From:
3. IP IMPLEMENTATION
This Section identifies work the Contractor must perform to complete planning related to the IP; to design, develop, procure, implement and test the IP; to bring the IP solution operational; and to ensure CMS Certification of the IP module of the MMISR solution. The Contractor is required to perform all work necessary to achieve these goals, regardless of whether an action or task is expressly identified in this Section. Offerors should identify in their proposals any additional work they believe is required to successfully implement and obtain CMS Certification for the IP.
a. IP Infrastructure Procurement and Setup
The Contractor shall procure all hardware, software or other items required to implement the final agreed-upon IP solution.
The Contractor shall have the option to install infrastructure, as appropriate, in the NM DoIT Simms Data Center in Santa Fe, NM, and in HSD’s non-production data center in Albuquerque, NM, with the agreement and consent of the State. The Contractor shall work with HSD and DoIT representatives well in advance to fully understand all requirements related to such an installation (e.g., floor space, security, preparations, installation services, support services, timing, change control, safety), and shall plan and perform the installation in accordance with these requirements.
If the decision is made by both parties to install infrastructure in the NM DoIT Data Center, then in collaboration with HSD and DoIT, the Contractor shall
perform all work required to install all proposed software on appropriate hardware as agreed upon with the State. The Contractor shall configure the installed software in all environments as required to meet IP solution requirements, and explain in detail which environments will be set up for each component, whether any components share resources and the rationale behind the proposed architecture and setup.
Irrespective of whether the IP infrastructure solution is hosted on State equipment or the cloud or vendor hosted solution, the Contractor shall implement multiple environments including, at a minimum: development, quality assurance testing (QAT), user acceptance testing (UAT), system integration testing (SIT), production, production patch, production support, training and performance. Contractor’s testing must demonstrate that the infrastructure is functioning fully and correctly, as needed to support other aspects of IP solution development, implementation and operation.
The Contractor shall document – and shall maintain current documentation of – the IP solution production and disaster recovery infrastructure, including the initial installation, software configuration, and comprehensive, accurate architecture maps and diagrams showing the fully installed solution. The Contractor shall work with HSD technical staff throughout this process to ensure knowledge sharing and knowledge transfer is completed sufficient to ensure adequate HSD technical understanding of the installation.
The Contractor shall develop or update all required documentation (not previously completed) for the following CMS EPLC phases: Planning (Configuration Management Plan), Requirements Analysis, Design, Development, Test, and Implementation.
b. Operational Data Store
The Contractor shall perform all work required to plan, design, create, manage, maintain, monitor, back up and patch an operational data store (ODS) to support the IP solution, the MMISR solution as a whole and HHS 2020. At a minimum, the Contractor shall perform the following tasks related to the ODS:
a. Assess current and future data needs to determine ODS capacity requirements, both immediate and projected over the contract life, and project an expansion timeline based upon these requirements;
b. Develop, document and implement (working in collaboration with the HHS 2020 PMO staff and the legacy MMIS contractor – Xerox Corporation) a comprehensive Data Conversion Plan to address data cleanup and conversion of data from the legacy MMIS to the IP ODS;
c. Create ETL processes to successfully import legacy data from the existing Omnicaid databases into the ODS as needed for continuity of service and to support the planned migration from the legacy MMIS to the MMISR solution;
1) Xerox will be responsible for: (1) extracting to comma-delimited files all required data for the IP ODS and for the data warehouse (or other structures) based upon business requirements; (2) cleansing all extracted data; (3) filling the extract file with agreed-upon default data is no data is available for a particular new field or table; (4) preparing reports for user data clean-up from the current MMIS during dry run extract and load processes; and (5) working with the IP Contractor and with HSD to understand data currently in the MMIS and how it will fit into new data tables, and to assist with mapping existing values to new meanings and/or values.
2) The IP Contractor will: (1) work with Xerox to understand data meaning and mapping to load data correctly to new tables; (2) transform comma-delimited files into new values, including creating new values as needed from legacy data that may not currently exist; (3) ensure data integrity during loads, using referential integrity and foreign keys; (4) load database tables and fields in the ODS (and in the EDW or other DS structures); (5) create exception reports from dry run loads to inform Xerox and HSD of inaccurate data that cannot be loaded; and (6) create validation reports to confirm all data was loaded for final conversion runs.
d. Create ETL processes to initially load and then update the MMISR data warehouse or other structure designed by the DS Contractor;
e. Revise and expand the data model over time as necessary to accommodate additional data fields to support HSD, program requirements, analytics and other user or enterprise requirements;
f. Manage the integrated metadata repository, including defining data relationships that support applications, supporting software version updates, and generating reports as needed to resolve data redundancies and/or inconsistencies;
g. Extract data and/or receive data from operational systems, and transform and merge this data into integrated data structures;
h. Manage the ODS, including monitoring performance, security, and data quality; reporting on data-related activities; performing data cleansing; and managing database performance;
i. Support physical-to-logical model mapping and rationalization, and provide the ability to define model-to-model relationships of repository objects, data models and data flows via graphical, attribute-level mapping;
j. Ensure data integrity using integrated security controls to ensure quality assurance functionality and to validate key identifiers to ensure accuracy of data as it enters the ODS, including referential integrity;
k. Deliver data, as required, to the DS solution;
l. Ensure new data items are automatically included in migration paths during software upgrades;
m. Track and report on, as required, all records included in purges; and
n. Implement MDM, including creating and maintaining full documentation of the ODS and of all related processes, including, but not limited to: logical data model, physical data model, data dictionary, database administration guide, schemas, metadata, hierarchies, data standards and harmonization strategies, data quality management (e.g., cleansing, matching, linking, merging, duplicate detection) and database architecture.
c. Implementation Services
The Contractor shall perform all services necessary to fully implement the IP solution and to support attainment of CMS Certification. These services include, but are not limited to, those listed below.
a. Requirements Analysis . The Contractor shall perform work necessary to arrive at a final set of requirements as necessary to implement the proposed IP solution. This work shall include, but is not limited to:
1) Analyzing requirements documentation provided by the State at the time of contract award;
2) Planning, scheduling, conducting, documenting and coordinating the results of requirements gathering, confirmation and/or Joint Application Design (JAD) sessions as necessary to finalize specific requirements for the complete IP solution, including (but not limited to):
a) Design and implementation of all components identified in the proposed architecture in response to the requirements in APPENDIX G, Section III;
b) Capacity planning, including system sizing and expansion;
c) All inbound and outbound interfaces;
d) Connection with DoIT and HSD-provided applications (e.g., email, antivirus, network);
e) Data conversion;
f) Performance, including workload, monitoring operational availability and performance, and logging reports;
g) Security, including monitoring and logging reports;
h) Database back-up and recovery;
i) Disaster recovery;
j) Standards and protocols for all ESB connections for web service interoperability among all MMISR modules, Federal Facilitated Marketplace (FFM), HIE, and State and Federal systems;
k) Migration from the legacy MMIS to the MMISR solution (see APPENDIX G, Section IV.E.1);
l) ESB governance; and
m) Data governance.
3) Scheduling, conducting and documenting requirements review sessions, including updates and production of final documents;
4) Collaborating with HSD 2020 PMO staff to ensure all requirements are captured and managed using an agreed-upon requirements management tool and process;
5) Uploading all final documents, and supporting working documents (as requested by HSD), to the HHS 2020 Document Library; and
6) Actively managing IP solution requirements through the contract life using the agreed-upon requirements management tool and processes.
b. NM DoIT Certification . The IP, and MMISR solution as a whole, must be certified by the Technology Architecture Review Committee (TARC) prior to entering development. The Contractor shall complete all required documents to be submitted to the TARC, will support the HHS 2020 PMO staff in preparing presentation materials, will support the TARC presentation, will address technical questions raised by the TARC and will work with HSD to make adjustments, if necessary, in IP solution plans and documentation to achieve the required certification.
The Contractor shall provide comparable support as required for the TARC for each subsequent DoIT phase/gate review necessary for the project.
c. Design . The Contractor shall design the complete IP solution, and shall document this in clear, accurate and concise design documents in accordance with CMS EPLC and NM DoIT requirements. The IP System Design Documents (SDD) must address all IP solution elements identified in this RFP, and identified in the preceding “Requirements Analysis” subsection.
The Contractor shall plan, schedule, conduct and document review sessions for the SDD, including for updates and production of final documents. The Contractor shall upload all final documents, and supporting working documents (as requested by HSD), to the HHS 2020 Document Library.
The Contractor shall ensure that any modifications to requirements that arise through the design process are captured, coordinated, documented in updated IP documentation as well as in the requirements management tool.
d. Programming and Configuration . The Contractor shall perform all programming and configuration work necessary to implement all approved IP designs. When performing this work, the Contractor shall:
1) Follow efficient, standardized coding methodologies appropriate to this solution;
2) Follow coding and configuration checklists and standards appropriate to this solution;
3) Conduct code and configuration walkthroughs or reviews with HSD technical staff and with other contractors as needed or as requested; and
4) Plan, perform and document unit testing of all code or configurations.
e. Test Planning and Execution . The Contractor shall develop, document and execute a comprehensive test strategy and plan for the IP, working in collaboration with HSD. Work shall include, but is not limited to:
1) Documenting and obtaining HSD approval of the IP Test Plan;
2) Creating functional test scripts for full requirements traceability;
3) Generating appropriate test data (not live production data) that is sufficiently representative of production data to enable valid testing;
4) Preparing and maintaining the test environments throughout the test process;
5) Creating and modifying as needed automated test scripts that will provide end-to-end coverage of base functionality to be rerun for each release to ensure regression compatibility;
6) Scheduling and coordinating testing;
7) Performing QAT and SIT for the IP;
8) Supporting UAT for the IP (e.g., run batch jobs, advance system clocks, run queries to provide test data);
9) Documenting test results;
10) Making all necessary fixes and completing retesting; and
11) Analyzing test results to identify trends or issues.
f. Data Conversion . The Contractor shall complete all required data clean-up and conversion activities, in collaboration with the legacy MMIS Contractor (Xerox) and HSD 2020 PMO staff. Prior to roll-out of the IP solution, the Contractor shall complete an initial load of legacy MMIS data to the IP operational data store, in accordance with the Contractor-provided Data Conversion Plan.
g. Training . The Contractor shall develop appropriate training documentation, in accordance with CMS EPLC requirements, for the IP solution, addressing all components as appropriate. The Contractor shall collaborate with the HSD 2020 PMO staff to determine the specific types of training that may need to be delivered to HSD staff, other MMISR contractor staff and others, as appropriate. The Contractor shall support development and delivery of that training.
The Contractor shall ensure that all appropriate IP Contractor (and subcontractor) staff are trained on the IP solution to the level needed to effectively perform their work throughout the contract life.
h. Disaster Recovery and Back-up . The IP, and the MMISR solution as a whole, are mission critical systems for HSD. The IP Contractor shall develop, document, coordinate and implement a comprehensive Contingency Plan that addresses, at a minimum, disaster recovery, back-up and continuity of operations. This Plan shall address all CMS, DoIT and HSD requirements. The Contractor shall update this Plan quarterly, at a minimum, with any changes to the IP architecture, application inventory, procedures and processes.
The IP Contractor must perform and manage all system back-up activities in accordance with HSD policies and requirements, including regular testing of restore procedures and performing capacity management related to back-up files. The IP Contractor also must plan, lead and document an annual end-to-end disaster recovery exercise that includes failover of all components of the IP solution.
i. Implementation . The Contractor shall perform all tasks required to roll the IP
solution into production, including, but not limited to:
1) Scheduling a release date appropriate to HSD (in collaboration with the HHS 2020 PMO staff);
2) Create a baseline for the IP solution release using an agreed-upon configuration control tool and process;
3) Migrate the IP solution release to production;
4) Verify the IP’s operational readiness;
5) If necessary due to partial or full failure of the IP solution rollout, execute the planned approach to roll back and to recover operations until the IP solution can be successfully implemented; and
6) Implement system diagnostics and tools to provide automatic system monitoring.
j. CMS Certification . The Contractor shall create all required documentation of the IP solution needed to support CMS Certification. (See also APPENDIX G, Section IV.E, INTEGRATION MANAGEMENT, for additional service requirements related to the MMISR solution as a whole.) The Contractor is responsible for supporting CMS Certification of the IP module, and for taking any corrective actions, completing additional document, participating in meetings or presentations, or other work required to ensure CMS Certification is received.
From:
4. IP IMPLEMENTATION
This Section identifies work the Contractor must perform to complete planning related to the IP; to design, develop, procure, implement and test the IP; to bring the IP solution operational; and to ensure CMS Certification of the IP module of the MMISR solution. The Contractor is required to perform all work necessary to achieve these goals, regardless of whether an action or task is expressly identified in this Section. Offerors should identify in their proposals any additional work they believe is required to successfully implement and obtain CMS Certification for the IP.
d. IP Infrastructure Procurement and Setup
The Contractor shall procure all hardware, software or other items required to implement the final agreed-upon IP solution.
The Contractor shall have the option to install infrastructure, as appropriate, in the NM DoIT Simms Data Center in Santa Fe, NM, and in HSD’s non-production data center in Albuquerque, NM, with the agreement and consent of the State. The Contractor shall work with HSD and DoIT representatives well in advance to fully understand all requirements related to such an installation (e.g., floor space, security, preparations, installation services, support services, timing, change
control, safety), and shall plan and perform the installation in accordance with these requirements.
If the decision is made by both parties to install infrastructure in the NM DoIT Data Center, then in collaboration with HSD and DoIT, the Contractor shall perform all work required to install all proposed software on appropriate hardware as agreed upon with the State. The Contractor shall configure the installed software in all environments as required to meet IP solution requirements, and explain in detail which environments will be set up for each component, whether any components share resources and the rationale behind the proposed architecture and setup.
Irrespective of whether the IP infrastructure solution is hosted on State equipment or the cloud or vendor hosted solution, the Contractor shall implement multiple environments including, at a minimum: development, quality assurance testing (QAT), user acceptance testing (UAT), system integration testing (SIT), production, production patch, production support, training and performance. Contractor’s testing must demonstrate that the infrastructure is functioning fully and correctly, as needed to support other aspects of IP solution development, implementation and operation.
The Contractor shall document – and shall maintain current documentation of – the IP solution production and disaster recovery infrastructure, including the initial installation, software configuration, and comprehensive, accurate architecture maps and diagrams showing the fully installed solution. The Contractor shall work with HSD technical staff throughout this process to ensure knowledge sharing and knowledge transfer is completed sufficient to ensure adequate HSD technical understanding of the installation.
The Contractor shall develop or update all required documentation (not previously completed) for the following CMS EPLC phases: Planning (Configuration Management Plan), Requirements Analysis, Design, Development, Test, and Implementation.
e. Operational Data Store
The Contractor shall perform all work required to plan, design, create, manage, maintain, monitor, back up and patch an operational data store (ODS) to support the IP solution, the MMISR solution as a whole and HHS 2020. At a minimum, the Contractor shall perform the following tasks related to the ODS:
o. Assess current and future data needs to determine ODS capacity requirements, both immediate and projected over the contract life, and project an expansion timeline based upon these requirements;
p. Develop, document and implement (working in collaboration with the HHS 2020 PMO staff and the legacy MMIS contractor – Xerox Corporation) a
comprehensive Data Conversion Plan to address data cleanup and conversion of data from the legacy MMIS to the IP ODS;
q. Create ETL processes to successfully import legacy data from the existing Omnicaid databases into the ODS as needed for continuity of service and to support the planned migration from the legacy MMIS to the MMISR solution;
3) Xerox will be responsible for: (1) extracting to comma-delimited files all required data for the IP ODS and for the data warehouse (or other structures) based upon business requirements; (2) cleansing all extracted data; (3) filling the extract file with agreed-upon default data is no data is available for a particular new field or table; (4) preparing reports for user data clean-up from the current MMIS during dry run extract and load processes; and (5) working with the IP Contractor and with HSD to understand data currently in the MMIS and how it will fit into new data tables, and to assist with mapping existing values to new meanings and/or values.
4) The IP Contractor will: (1) work with Xerox to understand data meaning and mapping to load data correctly to new tables; (2) transform comma-delimited files into new values, including creating new values as needed from legacy data that may not currently exist; (3) ensure data integrity during loads, using referential integrity and foreign keys; (4) load database tables and fields in the ODS (and in the EDW or other DS structures); (5) create exception reports from dry run loads to inform Xerox and HSD of inaccurate data that cannot be loaded; and (6) create validation reports to confirm all data was loaded for final conversion runs.
r. Create ETL processes to initially load and then update the MMISR data warehouse or other structure designed by the DS Contractor;
s. Revise and expand the data model over time as necessary to accommodate additional data fields to support HSD, program requirements, analytics and other user or enterprise requirements;
t. Manage the integrated metadata repository, including defining data relationships that support applications, supporting software version updates, and generating reports as needed to resolve data redundancies and/or inconsistencies;
u. Extract data and/or receive data from operational systems, and transform and merge this data into integrated data structures;
v. Manage the ODS, including monitoring performance, security, and data quality; reporting on data-related activities; performing data cleansing; and managing database performance;
w. Support physical-to-logical model mapping and rationalization, and provide the ability to define model-to-model relationships of repository objects, data models and data flows via graphical, attribute-level mapping;
x. Ensure data integrity using integrated security controls to ensure quality assurance functionality and to validate key identifiers to ensure accuracy of data as it enters the ODS, including referential integrity;
y. Deliver data, as required, to the DS solution;
z. Ensure new data items are automatically included in migration paths during software upgrades;
aa. Track and report on, as required, all records included in purges; and
bb. Implement MDM, including creating and maintaining full documentation of the ODS and of all related processes, including, but not limited to: logical data model, physical data model, data dictionary, database administration guide, schemas, metadata, hierarchies, data standards and harmonization strategies, data quality management (e.g., cleansing, matching, linking, merging, duplicate detection) and database architecture.
f. Implementation Services
The Contractor shall perform all services necessary to fully implement the IP solution and to support attainment of CMS Certification. These services include, but are not limited to, those listed below.
k. Requirements Analysis . The Contractor shall perform work necessary to arrive at a final set of requirements as necessary to implement the proposed IP solution. This work shall include, but is not limited to:
1) Analyzing requirements documentation provided by the State at the time of contract award;
2) Planning, scheduling, conducting, documenting and coordinating the results of requirements gathering, confirmation and/or Joint Application Design (JAD) sessions as necessary to finalize specific requirements for the complete IP solution, including (but not limited to):
n) Design and implementation of all components identified in the proposed architecture in response to the requirements in APPENDIX G, Section III;
o) Capacity planning, including system sizing and expansion;
p) All inbound and outbound interfaces;
q) Connection with DoIT and HSD-provided applications (e.g., email, antivirus, network);
r) Data conversion;
s) Performance, including workload, monitoring operational availability and performance, and logging reports;
t) Security, including monitoring and logging reports;
u) Database back-up and recovery;
v) Disaster recovery;
w) Standards and protocols for all ESB connections for web service interoperability among all MMISR modules, Federal Facilitated Marketplace (FFM), HIE, and State and Federal systems;
x) Migration from the legacy MMIS to the MMISR solution (see APPENDIX G, Section IV.E.1);
y) ESB governance; and
z) Data governance.
3) Scheduling, conducting and documenting requirements review sessions, including updates and production of final documents;
4) Collaborating with HSD 2020 PMO staff to ensure all requirements are captured and managed using an agreed-upon requirements management tool and process;
5) Uploading all final documents, and supporting working documents (as requested by HSD), to the HHS 2020 Document Library; and
6) Actively managing IP solution requirements through the contract life using the agreed-upon requirements management tool and processes.
l. NM DoIT Certification . The IP, and MMISR solution as a whole, must be certified by the Technology Architecture Review Committee (TARC) prior to entering development. The Contractor shall complete all required documents to be submitted to the TARC, will support the HHS 2020 PMO staff in preparing presentation materials, will support the TARC presentation, will address technical questions raised by the TARC and will work with HSD to make adjustments, if necessary, in IP solution plans and documentation to achieve the required certification.
The Contractor shall provide comparable support as required for the TARC
for each subsequent DoIT phase/gate review necessary for the project.
m. Design . The Contractor shall design the complete IP solution, and shall document this in clear, accurate and concise design documents in accordance with CMS EPLC and NM DoIT requirements. The IP System Design Documents (SDD) must address all IP solution elements identified in this RFP, and identified in the preceding “Requirements Analysis” subsection.
The Contractor shall plan, schedule, conduct and document review sessions for the SDD, including for updates and production of final documents. The Contractor shall upload all final documents, and supporting working documents (as requested by HSD), to the HHS 2020 Document Library.
The Contractor shall ensure that any modifications to requirements that arise through the design process are captured, coordinated, documented in updated IP documentation as well as in the requirements management tool.
n. Programming and Configuration . The Contractor shall perform all programming and configuration work necessary to implement all approved IP designs. When performing this work, the Contractor shall:
1) Follow efficient, standardized coding methodologies appropriate to this solution;
2) Follow coding and configuration checklists and standards appropriate to this solution;
3) Conduct code and configuration walkthroughs or reviews with HSD technical staff and with other contractors as needed or as requested; and
4) Plan, perform and document unit testing of all code or configurations.
o. Test Planning and Execution . The Contractor shall develop, document and execute a comprehensive test strategy and plan for the IP, working in collaboration with HSD. Work shall include, but is not limited to:
1) Documenting and obtaining HSD approval of the IP Test Plan;
2) Creating functional test scripts for full requirements traceability;
3) Generating appropriate test data (not live production data) that is sufficiently representative of production data to enable valid testing;
4) Preparing and maintaining the test environments throughout the test process;
5) Creating and modifying as needed automated test scripts that will provide end-to-end coverage of base functionality to be rerun for each release to ensure regression compatibility;
6) Scheduling and coordinating testing;
7) Performing QAT and SIT for the IP;
8) Supporting UAT for the IP (e.g., run batch jobs, advance system clocks, run queries to provide test data);
9) Documenting test results;
10) Making all necessary fixes and completing retesting; and
11) Analyzing test results to identify trends or issues.
p. Data Conversion . The Contractor shall complete all required data clean-up and conversion activities, in collaboration with the legacy MMIS Contractor (Xerox) and HSD 2020 PMO staff. Prior to roll-out of the IP solution, the Contractor shall complete an initial load of legacy MMIS data to the IP operational data store, in accordance with the Contractor-provided Data Conversion Plan.
q. Training . The Contractor shall develop appropriate training documentation, in accordance with CMS EPLC requirements, for the IP solution, addressing all components as appropriate. The Contractor shall collaborate with the HSD 2020 PMO staff to determine the specific types of training that may need to be delivered to HSD staff, other MMISR contractor staff and others, as appropriate. The Contractor shall support development and delivery of that training.
The Contractor shall ensure that all appropriate IP Contractor (and subcontractor) staff are trained on the IP solution to the level needed to effectively perform their work throughout the contract life.
r. Disaster Recovery and Back-up . The IP, and the MMISR solution as a whole, are mission critical systems for HSD. The IP Contractor shall develop, document, coordinate and implement a comprehensive Contingency Plan that addresses, at a minimum, disaster recovery, back-up and continuity of operations. This Plan shall address all CMS, DoIT and HSD requirements. The Contractor shall update this Plan quarterly, at a minimum, with any changes to the IP architecture, application inventory, procedures and processes.
The IP Contractor must perform and manage all system back-up activities in accordance with HSD policies and requirements, including regular testing of restore procedures and performing capacity management related to back-up
files. The IP Contractor also must plan, lead and document an annual end-to-end disaster recovery exercise that includes failover of all components of the IP solution.
s. Implementation . The Contractor shall perform all tasks required to roll the IP
solution into production, including, but not limited to:
1) Scheduling a release date appropriate to HSD (in collaboration with the HHS 2020 PMO staff);
2) Create a baseline for the IP solution release using an agreed-upon configuration control tool and process;
3) Migrate the IP solution release to production;
4) Verify the IP’s operational readiness;
5) If necessary due to partial or full failure of the IP solution rollout, execute the planned approach to roll back and to recover operations until the IP solution can be successfully implemented; and
6) Implement system diagnostics and tools to provide automatic system monitoring.
t. CMS Certification . The Contractor shall create all required documentation of the IP solution needed to support CMS Certification. (See also APPENDIX G, Section IV.E, INTEGRATION MANAGEMENT, for additional service requirements related to the MMISR solution as a whole.) The Contractor is responsible for supporting CMS Certification of the IP module, and for taking any corrective actions, completing additional document, participating in meetings or presentations, or other work required to ensure CMS Certification is received.
To:
4. IP IMPLEMENTATION
This Section identifies work the Contractor must perform to complete planning related to the IP; to design, develop, procure, implement and test the IP; to bring the IP solution operational; and to ensure CMS Certification of the IP module of the MMISR solution. The Contractor is required to perform all work necessary to achieve these goals, regardless of whether an action or task is expressly identified in this Section. Offerors should identify in their proposals any additional work they believe is required to successfully implement and obtain CMS Certification for the IP.
a. IP Infrastructure Procurement and Setup
The Contractor shall procure all hardware, software or other items required to implement the final agreed-upon IP solution.
The Contractor shall have the option to install infrastructure, as appropriate, in the NM DoIT Simms Data Center in Santa Fe, NM, and in HSD’s non-production data center in Albuquerque, NM, with the agreement and consent of the State. The Contractor shall work with HSD and DoIT representatives well in advance to fully understand all requirements related to such an installation (e.g., floor space, security, preparations, installation services, support services, timing, change control, safety), and shall plan and perform the installation in accordance with these requirements.
If the decision is made by both parties to install infrastructure in the NM DoIT Data Center, then in collaboration with HSD and DoIT, the Contractor shall perform all work required to install all proposed software on appropriate hardware as agreed upon with the State. The Contractor shall configure the installed software in all environments as required to meet IP solution requirements, and explain in detail which environments will be set up for each component, whether any components share resources and the rationale behind the proposed architecture and setup.
Irrespective of whether the IP infrastructure solution is hosted on State equipment or the cloud or vendor hosted solution, the Contractor shall implement multiple environments including, at a minimum: development, quality assurance testing (QAT), user acceptance testing (UAT), system integration testing (SIT), production, production patch, production support, training and performance. Contractor’s testing must demonstrate that the infrastructure is functioning fully and correctly, as needed to support other aspects of IP solution development, implementation and operation.
The Contractor shall document – and shall maintain current documentation of – the IP solution production and disaster recovery infrastructure, including the initial installation, software configuration, and comprehensive, accurate architecture maps and diagrams showing the fully installed solution. The Contractor shall work with HSD technical staff throughout this process to ensure knowledge sharing and knowledge transfer is completed sufficient to ensure adequate HSD technical understanding of the installation.
The Contractor shall develop or update all required documentation (not previously completed) for the following CMS EPLC phases: Planning (Configuration Management Plan), Requirements Analysis, Design, Development, Test, and Implementation.
b. Operational Data Store
The Contractor shall perform all work required to plan, design, create, manage, maintain, monitor, back up and patch an operational data store (ODS) to support the IP solution, the MMISR solution as a whole and HHS 2020. At a minimum,
the Contractor shall perform the following tasks related to the ODS:
a. Assess current and future data needs to determine ODS capacity requirements, both immediate and projected over the contract life, and project an expansion timeline based upon these requirements;
b. Develop, document and implement (working in collaboration with the HHS 2020 PMO staff and the legacy MMIS contractor – Xerox Corporation) a comprehensive Data Conversion Plan to address data cleanup and conversion of data from the legacy MMIS to the IP ODS;
c. Create ETL processes to successfully import legacy data from the existing Omnicaid databases into the ODS as needed for continuity of service and to support the planned migration from the legacy MMIS to the MMISR solution;
1) Xerox will be responsible for: (1) extracting to comma-delimited files all required data for the IP ODS and for the data warehouse (or other structures) based upon business requirements; (2) cleansing all extracted data; (3) filling the extract file with agreed-upon default data is no data is available for a particular new field or table; (4) preparing reports for user data clean-up from the current MMIS during dry run extract and load processes; and (5) working with the IP Contractor and with HSD to understand data currently in the MMIS and how it will fit into new data tables, and to assist with mapping existing values to new meanings and/or values.
2) The IP Contractor will: (1) work with Xerox to understand data meaning and mapping to load data correctly to new tables; (2) transform comma-delimited files into new values, including creating new values as needed from legacy data that may not currently exist; (3) ensure data integrity during loads, using referential integrity and foreign keys; (4) load database tables and fields in the ODS (and in the EDW); (5) create exception reports from dry run loads to inform Xerox and HSD of inaccurate data that cannot be loaded; and (6) create validation reports to confirm all data was loaded for final conversion runs.
d. Create ETL processes to initially load and then update the MMISR data warehouse or other structure designed by the DS Contractor;
e. Revise and expand the data model over time as necessary to accommodate additional data fields to support HSD, program requirements, analytics and other user or enterprise requirements;
f. Manage the integrated metadata repository, including defining data relationships that support applications, supporting software version updates, and generating reports as needed to resolve data redundancies and/or inconsistencies;
g. Extract data and/or receive data from operational systems, and transform and merge this data into integrated data structures;
h. Manage the ODS, including monitoring performance, security, and data quality; reporting on data-related activities; performing data cleansing; and managing database performance;
i. Support physical-to-logical model mapping and rationalization, and provide the ability to define model-to-model relationships of repository objects, data models and data flows via graphical, attribute-level mapping;
j. Ensure data integrity using integrated security controls to ensure quality assurance functionality and to validate key identifiers to ensure accuracy of data as it enters the ODS, including referential integrity;
k. Deliver data, as required, to the DS solution;
l. Ensure new data items are automatically included in migration paths during software upgrades;
m. Track and report on, as required, all records included in purges; and
n. Implement MDM, including creating and maintaining full documentation of the ODS and of all related processes, including, but not limited to: logical data model, physical data model, data dictionary, database administration guide, schemas, metadata, hierarchies, data standards and harmonization strategies, data quality management (e.g., cleansing, matching, linking, merging, duplicate detection) and database architecture.
c. Implementation Services
The Contractor shall perform all services necessary to fully implement the IP solution and to support attainment of CMS Certification. These services include, but are not limited to, those listed below.
a. Requirements Analysis . The Contractor shall perform work necessary to arrive at a final set of requirements as necessary to implement the proposed IP solution. This work shall include, but is not limited to:
1) Analyzing requirements documentation provided by the State at the time of contract award;
2) Planning, scheduling, conducting, documenting and coordinating the results of requirements gathering, confirmation and/or Joint Application Design (JAD) sessions as necessary to finalize specific requirements for the complete IP solution, including (but not limited to):
a) Design and implementation of all components identified in the proposed architecture in response to the requirements in APPENDIX G, Section III;
b) Capacity planning, including system sizing and expansion;
c) All inbound and outbound interfaces;
d) Connection with DoIT and HSD-provided applications (e.g., email, antivirus, network);
e) Data conversion;
f) Performance, including workload, monitoring operational availability and performance, and logging reports;
g) Security, including monitoring and logging reports;
h) Database back-up and recovery;
i) Disaster recovery;
j) Standards and protocols for all ESB connections for web service interoperability among all MMISR modules, Federal Facilitated Marketplace (FFM), HIE, and State and Federal systems;
k) Migration from the legacy MMIS to the MMISR solution (see APPENDIX G, Section IV.E.1);
l) ESB governance; and
m) Data governance.
3) Scheduling, conducting and documenting requirements review sessions, including updates and production of final documents;
4) Collaborating with HSD 2020 PMO staff to ensure all requirements are captured and managed using an agreed-upon requirements management tool and process;
5) Uploading all final documents, and supporting working documents (as requested by HSD), to the HHS 2020 Document Library; and
6) Actively managing IP solution requirements through the contract life using the agreed-upon requirements management tool and processes.
b. NM DoIT Certification . The IP, and MMISR solution as a whole, must be certified by the Technology Architecture Review Committee (TARC) prior to
entering development. The Contractor shall complete all required documents to be submitted to the TARC, will support the HHS 2020 PMO staff in preparing presentation materials, will support the TARC presentation, will address technical questions raised by the TARC and will work with HSD to make adjustments, if necessary, in IP solution plans and documentation to achieve the required certification.
The Contractor shall provide comparable support as required for the TARC for each subsequent DoIT phase/gate review necessary for the project.
c. Design . The Contractor shall design the complete IP solution, and shall document this in clear, accurate and concise design documents in accordance with CMS EPLC and NM DoIT requirements. The IP System Design Documents (SDD) must address all IP solution elements identified in this RFP, and identified in the preceding “Requirements Analysis” subsection.
The Contractor shall plan, schedule, conduct and document review sessions for the SDD, including for updates and production of final documents. The Contractor shall upload all final documents, and supporting working documents (as requested by HSD), to the HHS 2020 Document Library.
The Contractor shall ensure that any modifications to requirements that arise through the design process are captured, coordinated, documented in updated IP documentation as well as in the requirements management tool.
d. Programming and Configuration . The Contractor shall perform all programming and configuration work necessary to implement all approved IP designs. When performing this work, the Contractor shall:
1) Follow efficient, standardized coding methodologies appropriate to this solution;
2) Follow coding and configuration checklists and standards appropriate to this solution;
3) Conduct code and configuration walkthroughs or reviews with HSD technical staff and with other contractors as needed or as requested; and
4) Plan, perform and document unit testing of all code or configurations.
e. Test Planning and Execution . The Contractor shall develop, document and execute a comprehensive test strategy and plan for the IP, working in collaboration with HSD. Work shall include, but is not limited to:
1) Documenting and obtaining HSD approval of the IP Test Plan;
2) Creating functional test scripts for full requirements traceability;
3) Generating appropriate test data (not live production data) that is sufficiently representative of production data to enable valid testing;
4) Preparing and maintaining the test environments throughout the test process;
5) Creating and modifying as needed automated test scripts that will provide end-to-end coverage of base functionality to be rerun for each release to ensure regression compatibility;
6) Scheduling and coordinating testing;
7) Performing QAT and SIT for the IP;
8) Supporting UAT for the IP (e.g., run batch jobs, advance system clocks, run queries to provide test data);
9) Documenting test results;
10) Making all necessary fixes and completing retesting; and
11) Analyzing test results to identify trends or issues.
f. Data Conversion . The Contractor shall complete all required data clean-up and conversion activities, in collaboration with the legacy MMIS Contractor (Xerox) and HSD 2020 PMO staff. Prior to roll-out of the IP solution, the Contractor shall complete an initial load of legacy MMIS data to the IP operational data store, in accordance with the Contractor-provided Data Conversion Plan.
g. Training . The Contractor shall develop appropriate training documentation, in accordance with CMS EPLC requirements, for the IP solution, addressing all components as appropriate. The Contractor shall collaborate with the HSD 2020 PMO staff to determine the specific types of training that may need to be delivered to HSD staff, other MMISR contractor staff and others, as appropriate. The Contractor shall support development and delivery of that training.
The Contractor shall ensure that all appropriate IP Contractor (and subcontractor) staff are trained on the IP solution to the level needed to effectively perform their work throughout the contract life.
h. Disaster Recovery and Back-up . The IP, and the MMISR solution as a whole, are mission critical systems for HSD. The IP Contractor shall develop, document, coordinate and implement a comprehensive Contingency Plan that addresses, at a minimum, disaster recovery, back-up and continuity of operations. This Plan shall address all CMS, DoIT and HSD requirements. The Contractor shall update this Plan quarterly, at a minimum, with any
changes to the IP architecture, application inventory, procedures and processes.
The IP Contractor must perform and manage all system back-up activities in accordance with HSD policies and requirements, including regular testing of restore procedures and performing capacity management related to back-up files. The IP Contractor also must plan, lead and document an annual end-to-end disaster recovery exercise that includes failover of all components of the IP solution.
i. Implementation . The Contractor shall perform all tasks required to roll the IP
solution into production, including, but not limited to:
1) Scheduling a release date appropriate to HSD (in collaboration with the HHS 2020 PMO staff);
2) Create a baseline for the IP solution release using an agreed-upon configuration control tool and process;
3) Migrate the IP solution release to production;
4) Verify the IP’s operational readiness;
5) If necessary due to partial or full failure of the IP solution rollout, execute the planned approach to roll back and to recover operations until the IP solution can be successfully implemented; and
6) Implement system diagnostics and tools to provide automatic system monitoring.
j. CMS Certification . The Contractor shall create all required documentation of the IP solution needed to support CMS Certification. (See also APPENDIX G, Section IV.E, INTEGRATION MANAGEMENT, for additional service requirements related to the MMISR solution as a whole.) The Contractor is responsible for supporting CMS Certification of the IP module, and for taking any corrective actions, completing additional document, participating in meetings or presentations, or other work required to ensure CMS Certification is received.
5. Change to Section V. CONDITIONS GOVERNING THE PROCUREMENT, page
35:
Date Change for Action #6 Submission of Proposal. Change also includes new dates to Action # 7,8,9,10,11.
From:
CONDITIONS GOVERNING THE PROCUREMENT
This section of the RFP presents the schedule, description and conditions governing the procurement.
A. SEQUENCE OF EVENTS
The Procurement Manager will make every effort to adhere to the following schedule:
Action Responsible Party Due Date1. Issue RFP HSD August 25, 20162. Distribution List Confirmation HSD September 7, 20163. Pre-Proposal Conference HSD September 7, 20164. Deadline to Submit Questions Potential Offerors September 14, 20165. Response to Written Questions Procurement Manager September 22, 20166. Submission of Proposal Potential Offerors October 14, 20167. Proposal Evaluation Evaluation Committee October 15-24, 20168. Selection of Finalists Evaluation Committee October 24, 20169. Best and Final Offer Finalist Offerors November 1, 201610. Oral Presentation(s) Finalist Offerors November 8-9, 201611. Finalize Contractual Agreements HSD/Finalist Offerors December 5, 201612. Approval of Contract (Federal & State)
CMS/DoIT February 5, 2017
13. Contracts Award HSD/Finalist Offerors February 6, 201714. Protest Deadline HSD 15 calendar days after
contract award notice* Dates subject to change based on number of responses and final approval from Federal partners.
Table 5 Sequence of Events.
From:
CONDITIONS GOVERNING THE PROCUREMENT
This section of the RFP presents the schedule, description and conditions governing the procurement.
A. SEQUENCE OF EVENTS
The Procurement Manager will make every effort to adhere to the following schedule:
Action Responsible Party Due Date1. Issue RFP HSD August 25, 20162. Distribution List Confirmation HSD September 7, 20163. Pre-Proposal Conference HSD September 7, 20164. Deadline to Submit Questions Potential Offerors September 14, 20165. Response to Written Questions Procurement Manager September 22, 20166. Submission of Proposal Potential Offerors October 21, 20167. Proposal Evaluation Evaluation Committee October 22-31, 20168. Selection of Finalists Evaluation Committee October 31, 20169. Best and Final Offer Finalist Offerors November 8, 201610. Oral Presentation(s) Finalist Offerors November 15-16, 201611. Finalize Contractual Agreements HSD/Finalist Offerors December 12, 201612. Approval of Contract (Federal & State)
CMS/DoIT February 5, 2017
13. Contracts Award HSD/Finalist Offerors February 6, 201714. Protest Deadline HSD 15 calendar days after
contract award notice* Dates subject to change based on number of responses and final approval from Federal partners.
Table 6 Sequence of Events.
6. Change to Section IV BACKGROUND INFORMATION –Business Objectives, page 33:
Addendum #13, and 15 added.
From:
G. MMISR PROCUREMENT LIBRARY
An MMISR Procurement Library has been established and can be accessed at https://nmhsd-public.sharepoint.com/Pages/HSDProcurementLibrary.aspx. Offerors are encouraged to review the materials contained in the Procurement Library by selecting the link provided in the electronic version of this document through your own internet connection or by contacting the Procurement Manager and scheduling an appointment. The procurement library, accessible at [link], contains the information listed below.
The RFP is posted on the NM HSD website: htt p:/ /www.hsd.st ate.nm.us/ Lookin gFo r Inform ati on/open -rfps.aspx
NM Procurement regulations and RFP instructions: htt p:/ /www.gene ralservi c es.st ate.nm.us/statepurch asing/ IT Bs RFPs_and_Bid_Tabulation.aspx.
42 CFR Part 433 (c): ht t p : / /ww w . ec f r . g ov / c g i - bin / te x t - idx ? S I D = f100e c f eaa 4b 4 f 7032 c 97 c 20d774688 6 & n od e= sp42.4.433. c & r g n = div6
45 CFR Part 95 (f): ht t p: / /ww w . e c f r . g ov/ c g i - bin / t ex t - idx ? S I D = 735 a 4 b eac 7b3 9 103 a 5 c 80483d3 f f a 20 9 &node = sp45.1.95. f & r g n = d iv6
State Medicaid Manual Part 11: ht t p: / /ww w . c ms.gov/ R e g ulation s -a n d - Guid a n ce /Guida n ce /Ma n u a ls /P a p e r - B a s e d - M a nu a l s - I tems/CM S 021927. h tml
CMS Seven Conditions and Standards: ht t p: / /ww w .medi ca id . g ov/Medi ca i d - C H I P - P ro g r a m - I nf o rm a t i on/ B y- Topi c s/D a ta - a nd - S y st e ms / Do w nloads/E F R - S e v e n - Condi t ion s - a nd - S tand a rds.pdf
CMS MMIS Certification Toolkit and Checklist: ht t p: / /ww w . c ms. g ov/ R e s ea r c h - S tatis t ics- D a ta -a n d - S y s t e ms / Com p uter - D a t a -a n d - S y stems / M M I S /ME C T.html
Privacy and Security Standards – NIST Special Publications: htt p:/ /csrc.nist .gov/publ icati ons/P ubsSP s.html
CMS MITA: ht t p: / /ww w .medi ca id . g ov/ m e dic a i d- c hip - pr o g r a m - info r mati o n/ b y - top i c s/dat a - a nd - s y stems / medi ca i d - i n fo r matio n - te c hnol o g y - a r c hi t ec tur e - m i ta.html
NM 2015 MITA 3.0 State Self-Assessment, on the NMHSD website: https://nmhsd-public.sharepoint.com/HSDProcurementLibrary/MAD%20MITA%20SSA
%203.0.docx?d=wc57dba127139437bafef040e5aa36dc9
HIPAA and ACA: Administrative Simplification Overview https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html
Program-related Documents in the Library: The library contains reference documents related to this procurement, including:
1. HHS 2020 Roles and Responsibilities
2. HHS 2020 Background Information NM HHS and Medicaid
3. HHS 2020 Work Flows
4. HHS 2020 Stakeholder Relationship Diagrams
5. HHS 2020 User Views
6. HHS 2020 Data Flows
7. HHS 2020 Acronyms
8. HHS 2020 Terms and Definitions
9. HHS 2020 Activity Data
10. HHS 2020 CMS Seven Standards and Conditions
11. HHS 2020 Overview of the NM Medicaid Program
12. HHS 2020 Legacy Interfaces
To:
G. MMISR PROCUREMENT LIBRARY
An MMISR Procurement Library has been established and can be accessed at https://nmhsd-public.sharepoint.com/Pages/HSDProcurementLibrary.aspx. Offerors are encouraged to review the materials contained in the Procurement Library by selecting the link provided in the electronic version of this document through your own internet connection or by contacting the Procurement Manager and scheduling an appointment. The procurement library, accessible at [link], contains the information listed below.
The RFP is posted on the NM HSD website: htt p:/ /www.hsd.st ate.nm.us/ Lookin gFo r Inform ati on/open -rfps.aspx
NM Procurement regulations and RFP instructions: htt p:/ /www.gene ralservi c es.st ate.nm.us/statepurch asing/ IT Bs RFPs_and_Bid_Tabulation.aspx.
42 CFR Part 433 (c): ht t p : / /ww w . ec f r . g ov / c g i - bin / te x t - idx ? S I D = f100e c f eaa 4b 4 f 7032 c 97 c 20d774688 6 & n od e= sp42.4.433. c & r g n = div6
45 CFR Part 95 (f): ht t p: / /ww w . e c f r . g ov/ c g i - bin / t ex t - idx ? S I D = 735 a 4 b eac 7b3 9 103 a 5 c 80483d3 f f a 20 9 &node = sp45.1.95. f & r g n = d iv6
State Medicaid Manual Part 11: ht t p: / /ww w . c ms.gov/ R e g ulation s -a n d - Guid a n ce /Guida n ce /Ma n u a ls /P a p e r - B a s e d - M a nu a l s - I tems/CM S 021927. h tml
CMS Seven Conditions and Standards: ht t p: / /ww w .medi ca id . g ov/Medi ca i d - C H I P - P ro g r a m - I nf o rm a t i on/ B y- Topi c s/D a ta - a nd - S y st e ms / Do w nloads/E F R - S e v e n - Condi t ion s - a nd - S tand a rds.pdf
CMS MMIS Certification Toolkit and Checklist: ht t p: / /ww w . c ms. g ov/ R e s ea r c h - S tatis t ics- D a ta -a n d - S y s t e ms / Com p uter - D a t a -a n d - S y stems / M M I S /ME C T.html
Privacy and Security Standards – NIST Special Publications: htt p:/ /csrc.nist .gov/publ icati ons/P ubsSP s.html
CMS MITA: ht t p: / /ww w .medi ca id . g ov/ m e dic a i d- c hip - pr o g r a m - info r mati o n/ b y - top i c s/dat a - a nd - s y stems / medi ca i d - i n fo r matio n - te c hnol o g y - a r c hi t ec tur e - m i ta.html
NM 2015 MITA 3.0 State Self-Assessment, on the NMHSD website: htt p:/ /www.hsd.st ate.nm.us
HIPAA and ACA: Administrative Simplification Overview https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html
https://nmhsd-public.sharepoint.com/Pages/HSDProcurementLibrary.aspx.: The library contains reference documents related to this procurement, including:
1. HHS 2020 Roles and Responsibilities
2. HHS 2020 Background Information NM HHS and Medicaid
3. HHS 2020 Work Flows
4. HHS 2020 Stakeholder Relationship Diagrams
5. HHS 2020 User Views
6. HHS 2020 Data Flows
7. HHS 2020 Acronyms
8. HHS 2020 Terms and Definitions
9. HHS 2020 Activity Data
10. HHS 2020 CMS Seven Standards and Conditions
11. HHS 2020 Overview of the NM Medicaid Program
12. HHS 2020 Legacy Interfaces
13. HHS2020 Data Needs for Reporting
14. HHS 2020 Security Privacy and Standard
15. HHS 2020 Turnover Plan
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