REQUEST FOR PROPOSAL (RFP)

Non-Emergency Medical Transportation Broker for Fee for Service Population
MED-23-003

Shannon Mueller
Iowa Department of Human Services
Fiscal Management, Floor 1
1305 E Walnut St
Des Moines, IA 50319
Phone:  515-321-8679
MED-23-003@dhs.state.ia.us

RFP Purpose.
It is the intent of the Iowa Department of Human Services (referred to herein as the “Agency”) to solicit proposals from Bidders who wish to contract with the State under a risk-based contractual arrangement as described in this Request for Proposal (RFP).  The selected Broker will be responsible for providing the Non-emergency Medical Transportation (NEMT) services for the fee-for-service Medicaid population in an efficient and effective manner, within federal, state, and Agency specifications, ensuring the highest standards of performance, program integrity, and customer service at a reasonable cost to the State.  Bidders should note that emergency air Ambulance and emergency ground Ambulance services are excluded from the scope of work outlined in this RFP and will not be the responsibility of the selected Broker.  Certain Medicaid Providers such as Federally Qualified Health Centers (FQHC’s) and Local Education Agencies (LEA’s) provide NEMT as a directly reimbursable service under the Medicaid Program.  This RFP excludes the directly reimbursable non-emergency transportation service of those providers, as the Agency intends to continue directly reimbursing such claims. 

Duration of Contract.
The Agency anticipates executing a contract that will have an initial 3 year contract term with the ability to extend the contract for 3 additional 1-year terms.  The Agency will have the sole discretion to extend the contract.  

Procurement Timetable	
There are no exceptions to any deadlines for the Bidder; however, the Agency reserves the right to change the dates.  Times provided are in Central Time.

Event	Date	
Agency Issues RFP Notice to Targeted Small Business Website (48 hours):	October 12, 2021	
Agency Issues RFP to Bid Opportunities Website	October 14, 2021	
Bidder Letter of Intent to Bid Due By 	November 2, 2021
3:00 p.m.	
Bidder Written Questions Due By	Date and Time for First Round of Questions:  November 2, 2021
3:00 p.m.
Date and Time for Second Round of Questions:  November 16, 2021
3:00 p.m.	
Agency Responses to Questions Issued By	Date for First Round of Responses:  November 9, 2021 
Date for Second Round of Responses:  November 23, 2021	
Bidder Proposals and any Amendments to Proposals Due By	February 1, 2022
12:00 p.m.	
Agency Announces Apparent Successful Bidder/Notice of Intent to Award 	April 12, 2022	
Contract Negotiations and Execution of the Contract Completed 	May 3, 2022	
Anticipated Start Date for the Provision of Services	January 1, 2023	

Section 1  Background and Scope of Work	

1.1  Background.
The Iowa Department of Human Services (“Agency”) is responsible for operation of the state Medicaid program under Title XIX of the Social Security Act.  The Agency operates this program through its business unit, the Iowa Medicaid Enterprise (“IME”).  On April 1, 2016, the IME transitioned to a managed care system within the state.  Managed care organizations (MCOs) are responsible for assuring their assigned Members get to and receive reimbursement for medical Trips.  The successful Bidder of this RFP will be responsible for the Agency’s Fee-for-Service (FFS) population, which is estimated to be approximately 10,000 – 12,000 Members.  Historically, approximately 1.3% of Members utilize NEMT services.  Members utilizing NEMT average five Trips per month.

Prior to October 1, 2010, the Agency provided limited Non-Emergency Medical Transportation to Medicaid Members through direct reimbursement to Members for claims approved by Agency Income Maintenance Workers.  In 2010, the Agency posted its first NEMT Brokerage RFP and transitioned the NEMT program to a transportation brokerage system as recognized by Section 6083 of the Deficit Reduction Act of 2005.  On October 1, 2010, the IME began implementing the Iowa NEMT brokerage system through its contracted vender.  At the same time, the IME began the process of updating its administrative rules to both implement the NEMT brokerage system and to expand NEMT coverage.  

Through the NEMT program, the Agency seeks to eliminate transportation barriers for Iowa Medicaid Members and to ensure that Medicaid Members receive NEMT services consistent with all governing rules and regulations.  The successful Broker will ensure that NEMT services are:
-	Similar in scope and duration throughout the state;
-	Consistent with the best interests of the state’s Medicaid Members;
-	Appropriate to available services, geographic location and limitations of Members;
-	Prompt, cost-effective, and efficient;
-	Provide Medicaid Members with necessary Transportation Services so that they can receive on-time transportation to and from their medical appointments; and
-	Delivered with high customer service and satisfaction.

Capitation Rates
The current NEMT broker is compensated based on a single Capitated Rate.  The broker contracted through this RFP process will also be paid a single Capitated Rate, as outlined in the draft contract attached to this RFP as Attachment G.  The capitated payment will provide all compensation to the broker for all costs of providing transportation to Members, including brokerage administrative costs and the actual cost of transportation.  The Agency did consider other payment methodologies and has determined that the straight “at-risk” Capitated Rate payment provides the greatest benefit to the Agency and state taxpayers.  

The Agency requires that a minimum of 70% of capitation payments must be spent in paying third parties for providing transportation.

For statistical information on the NEMT brokerage system and other helpful information, please go to the following link:  https://dhs.iowa.gov/ime/members/medicaid-a-to-z/nemt.

1.2  RFP General Definitions.  
See Attachment 3.1.3 Definitions

1.3 Scope of Work. 
1.3.1 Deliverables.
The Scope of Work for this RFP is set forth in Section 1.3 of the Sample Contract attached to this RFP as Attachment G.  

Section 2  Basic Information About the RFP Process	

2.1  Issuing Officer.
The Issuing Officer is the sole point of contact regarding the RFP from the date of issuance until selection of the successful Bidder.  The Issuing Officer for this RFP is:
Kera Oestreich
Iowa Department of Human Services
Fiscal Management, Floor 1
1305 E Walnut St
Des Moines, IA 50319
Phone:  515-321-8679
koestre@dhs.state.ia.us

2.2  Restriction on Bidder Communication. 
From the issue date of this RFP until announcement of the successful Bidder, the Issuing Officer is the point of contact regarding the RFP.  There may be no communication regarding this RFP with any State employee other than the Issuing Officer, except at the direction of the Issuing Officer or as otherwise noted in the RFP.  This section shall not be construed as restricting communications related to the administration of any contract currently in effect between a Contractor and the Agency.

The Issuing Officer will respond only to questions regarding the procurement process.  Questions pertaining to the interpretation of this RFP may be submitted in accordance with the Questions, Requests for Clarification, and Suggested Changes section of this RFP.  

2.3  Downloading the RFP from the Internet.
The RFP and any related documents such as amendments or attachments (collectively the “RFP”), and responses to questions will be posted at the State of Iowa’s website for bid opportunities:  http://bidopportunities.iowa.gov/.  Check this website periodically for any amendments to this RFP.  The posted version of the RFP is the official version.  The Agency will only be bound by the official version of the RFP document(s).  Bidders should ensure that any downloaded documents are in fact the most up to date and are unchanged from the official version.  

2.4  Online Resources. 
Resources related to this RFP are available at the following website:  https://dhs.iowa.gov/ime/members/medicaid-a-to-z/nemt   

Materials available electronically include:
-	Iowa Medicaid Mileage Reimbursement Policy
-	Iowa Medicaid Meals and Lodging Policy
-	Iowa Medicaid Meals and Lodging Claim Form 470-4991
-	Iowa Medicaid Mileage Reimbursement Claim Form 470-5480

2.5  Intent to Bid.
The Agency requests that Bidders provide their intent to bid by email to the Issuing Officer by the date and time in the Procurement Timetable.  The Bidder may wish to request confirmation of receipt of the email from the Issuing Officer to ensure delivery.  Do not submit letters of intent by mail, shipping service, or hand delivery.  The intent to bid should include the Bidder's name, contact person, mailing address, email address, telephone number, and a statement of intent to submit a bid in response to this RFP.  Though it is not mandatory that the Agency receive an intent to bid, the Agency will only respond to questions about the RFP that have been submitted by Bidders who have expressed their intent to bid.  The Agency may cancel an RFP for lack of interest based on the number of letters of intent to bid received.    

2.6  Reserved.  (Bidders’ Conference)

2.7  Questions, Requests for Clarification, and Suggested Changes. 
Bidders who have provided their intent to bid on the RFP are invited to submit written questions, requests for clarifications, and/or suggestions for changes to the specifications of this RFP (hereafter “Questions”) by the due date and time provided in the Procurement Timetable.  Bidders are not permitted to include assumptions in their Bid Proposals.  Instead, Bidders shall address any perceived ambiguity regarding this RFP through the question and answer process.  If the Questions pertain to a specific section of the RFP, the page and section number(s) must be referenced.  Bidders shall submit questions to the Issuing Officer by email.  The Bidder may wish to request confirmation of receipt from the Issuing Officer to ensure delivery.  Do not submit questions by mail, shipping service, or hand delivery.

The Agency will post responses to questions received on the State’s website at: http://bidopportunities.iowa.gov/ by the dates provided in the Procurement Timetable.  Follow-up questions to initial responses are permissible as long as all questions are received by the final due date and time for Bidder Questions as provided in the Procurement Timetable.  

The Agency assumes no responsibility for verbal representations made by its officers or employees unless such representations are confirmed in writing and incorporated into the RFP.  In addition, the Agency’s written responses to Questions will not be considered part of the RFP.  If the Agency decides to change the RFP, the Agency will issue an amendment.    

2.8  Submission of Bid Proposal.
Each Bidder is responsible for ensuring that the Issuing Officer receives the Bid Proposal by the time and date specified in the Procurement Timetable at the address provided in the RFP for the Issuing Officer.  The Agency will not waive this mandatory requirement.  Any Bid Proposal received after this deadline will be rejected and will not be evaluated.  

Bid Proposals are to be submitted in accordance with the Bid Proposal Formatting section of this RFP.  Bid Proposals may not be hand-delivered to the Issuing Officer.  Rather, Bid Proposals are to be mailed through the postal service or shipping service.   

2.9  Amendment to the RFP and Bid Proposal.    
Each Bidder is responsible for ensuring that the Issuing Officer receives the Bid Proposal and any permitted amendments by the established deadlines at the address provided in the RFP for the Issuing Officer.  Amendments must be received utilizing the same delivery method as set forth in the RFP for the submission of the original Bid Proposal.

Bidders may amend a previously submitted Bid Proposal at any time before the bid submission date and time.  Any such amendment must be in writing and signed by the Bidder.  The Bidder shall provide the same number of copies of the amended Bid Proposal as is required for the original Bid Proposal, for both hardcopy and electronic copies, in accordance with the Bid Proposal Formatting Section.  

The Agency reserves the right to amend or provide clarifications to the RFP at any time.  RFP amendments will be posted to the State’s website at http://bidopportunities.iowa.gov/.  If an RFP amendment occurs after the closing date for receipt of Bid Proposals, the Agency may, in its sole discretion, allow Bidders to amend their Bid Proposals.    

2.10  Withdrawal of Bid Proposal.
The Bidder may withdraw its Bid Proposal prior to the closing date for receipt of Bid Proposals by submitting a written request to withdraw signed by the Bidder, scanned, then emailed to the Issuing Officer.  The Bidder should request confirmation of receipt of the email from the Issuing Officer to ensure delivery.

2.11  Costs of Preparing the Bid Proposal.
The costs of preparation and delivery of the Bid Proposal are solely the responsibility of the Bidder.      

2.12  Rejection of Bid Proposals.
The Agency reserves the right to reject any or all Bid Proposals, in whole and in part, and to cancel this RFP at any time prior to the execution of a written contract.  Issuance of this RFP in no way constitutes a commitment by the Agency to award or enter into a contract.    

2.13  Review of Bid Proposals.
Only Bidders that meet the mandatory requirements and are not subject to disqualification will be considered for award of a contract.    

2.13.1  Mandatory Requirements.
Bidders must meet these mandatory requirements or will be disqualified and not considered for award of a contract: 

•	The Issuing Officer must receive the Bid Proposal, and any amendments thereof, prior to or on the due date and time (See RFP Sections 2.8 and 2.9).
•	The Bidder is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from receiving federal funding by any federal department or Agency (See RFP Additional Certifications Attachment).
•	The Bidder’s Cost Proposal adheres to any pricing restrictions regarding the project budget or administrative costs (See RFP Section 3.3). 

2.13.2  Reasons Proposals May be Disqualified.
Bidders are expected to follow the specifications set forth in this RFP.  However, it is not the Agency’s intent to disqualify Bid Proposals that suffer from correctible flaws.  At the same time, it is important to maintain fairness to all Bidders in the procurement process.  Therefore, the Agency reserves the discretion to permit cure of variances, waive variances, or disqualify Bid Proposals for reasons that include, but may not be limited to, the following: 

•	Bidder initiates unauthorized contact regarding this RFP with employees other than the Issuing Officer (See RFP Section 2.2);
•	Bidder fails to comply with the RFP’s formatting specifications so that the Bid Proposal cannot be fairly compared to other bids (See RFP Section 3.1);
•	Bidder fails, in the Agency’s opinion, to include the content required for the RFP;
•	Bidder fails to be fully responsive in the Bidder’s Approach to Meeting Deliverables Section, states an element of the Scope of Work cannot or will not be met, or does not include information necessary to substantiate that it will be able to meet the Scope of Work specifications (See RFP Section 3.2.3); 
•	Bidder’s response materially changes Scope of Work specifications;
•	Bidder fails to submit the RFP attachments containing all signatures (See RFP Section 3.2.6);
•	Bidder marks entire Bid Proposal confidential, makes excessive claims for confidential treatment, or identifies pricing information in the Cost Proposal as confidential (See RFP Section 3.1);
•	Bidder includes assumptions in its Bid Proposal (See RFP Section 2.7); or
•	Bidder fails to respond to the Agency’s request for clarifications, information, documents, or references that the Agency may make at any point in the RFP process.
•	Bidder is a “scrutinized company” included on a “scrutinized company list” created by a public fund pursuant to Iowa Code §12J.3. This list is maintained by the Iowa Public Employees’ Retirement System. The list is currently found here: https://www.ipers.org/about-us/investments/restrictions-regarding-companies-boycotting-israel#main-content. 

The determination of whether or not to disqualify a proposal and not consider it for award of a contract for any of these reasons, or to waive or permit cure of variances in Bid Proposals, is at the sole discretion of the Agency.  No Bidder shall obtain any right by virtue of the Agency’s election to not exercise that discretion.  In the event the Agency waives or permits cure of variances, such waiver or cure will not modify the RFP specifications or excuse the Bidder from full compliance with RFP specifications or other contract requirements if the Bidder enters into a contract.  

2.14  Bid Proposal Clarification Process.    	
The Agency may request clarifications from Bidders for the purpose of resolving ambiguities or questioning information presented in the Bid Proposals.  Clarifications may occur throughout the Bid Proposal evaluation process.  Clarification responses shall be in writing and shall address only the information requested.  Responses shall be submitted to the Agency within the time stipulated at the occasion of the request.    

2.15  Verification of Bid Proposal Contents.    
The contents of a Bid Proposal submitted by a Bidder are subject to verification.  

2.16  Reference Checks.
The Agency reserves the right to contact any reference to assist in the evaluation of the Bid Proposal, to verify information contained in the Bid Proposal, to discuss the Bidder’s qualifications, and/or to discuss the qualifications of any subcontractor identified in the Bid Proposal.    

2.17  Information from Other Sources.
The Agency reserves the right to obtain and consider information from other sources concerning a Bidder, such as the Bidder’s capability and performance under other contracts, and the Bidder’s authority and ability to conduct business in the State of Iowa.  Such other sources may include subject matter experts.      

2.18  Criminal History and Background Investigation.
The Agency reserves the right to conduct criminal history checks and background investigations (hereafter, “Investigations”) of the Bidder and the Bidder’s officers, directors, shareholders, partners, and managerial and supervisory personnel involved in the performance of the Contract.  The Agency’s right to perform such Investigations also extends to the Bidder’s staff, agents, or subcontractors who may have direct contact with the Agency’s clients or those that may provide services for the Agency’s clients.  By submitting its Proposal, the Bidder hereby explicitly authorizes the Agency to conduct such Investigations.  These Investigations may include, but may not be limited to:  Child Abuse Registry, Dependent Adult Abuse Registry, Sexual Offender Registry Checks, and DCI/FBI Criminal History Record checks for specific categories of persons who may have direct contact with the Agency’s clients or may provide services for the Agency’s clients.  Upon the Agency’s request, the Bidder shall fully cooperate with the Agency in obtaining authorizations on Agency forms and any required waivers or releases in a timely manner.  The Agency may determine, in its sole discretion, to either not award or not enter into a contract with a Bidder, or to terminate a subsequent contract, based on the results of these Investigations.

2.19  Disposition of Bid Proposals.    
Opened Bid Proposals become the property of the Agency and will not be returned to the Bidder.  Upon issuance of the Notice of Intent to Award, the contents of all Bid Proposals will be in the public domain and be open to inspection by interested parties subject to exceptions provided in Iowa Code chapter 22 or other applicable law.    

2.20  Public Records and Request for Confidential Treatment.
Original information submitted by a Bidder may be treated as public information by the Agency following the conclusion of the selection process unless the Bidder properly requests that information be treated as confidential at the time of submitting the Bid Proposal.  See the Bid Proposal Formatting Section for the proper method for making such requests.  The Agency’s release of information is governed by Iowa Code chapter 22.  Bidders are encouraged to familiarize themselves with Chapter 22 before submitting a Bid Proposal.  The Agency will copy public records as required to comply with public records laws.    

The Agency will treat the information marked confidential as confidential information to the extent such information is determined confidential under Iowa Code chapter 22 or other applicable law by a court of competent jurisdiction.  However, the Bidder shall certify by signing and returning RFP Attachment B its understanding that any Agency references to Bid Proposal information marked confidential made during the evaluation process may become part of the public domain  

In the event the Agency receives a request for information marked confidential, written notice shall be given to the Bidder seventy-two (72) hours prior to the release of the information to allow the Bidder to seek injunctive relief pursuant to Iowa Code § 22.5 or 22.8.    

The Bidder’s failure to request confidential treatment of material pursuant to this section and the relevant law will be deemed, by the Agency and State personnel, as a waiver of any right to confidentiality that the Bidder may have had.    

2.21  Copyrights.
By submitting a Bid Proposal, the Bidder agrees that the Agency may copy the Bid Proposal for purposes of facilitating the evaluation of the Bid Proposal or to respond to requests for public records.  By submitting a Bid Proposal, the Bidder acknowledges that additional copies may be produced and distributed, and represents and warrants that such copying does not violate the rights of any third party.  The Agency shall have the right to use ideas or adaptations of ideas that are presented in the Bid Proposals.    

2.22  Release of Claims.
By submitting a Bid Proposal, the Bidder agrees that it shall not bring any claim or cause of action against the Agency based on any misunderstanding concerning the information provided herein or concerning the Agency's failure, negligent or otherwise, to provide the Bidder with pertinent information as intended by this RFP.    

2.23  Reserved.  (Presentations)  

2.24  Notice of Intent to Award.
Notice of Intent to Award will be sent to all Bidders that submitted a Bid Proposal by the due date and time.  The Notice of Intent to Award does not constitute the formation of a contract between the Agency and the apparent successful Bidder.    

2.25  Acceptance Period.
The Agency shall make a good faith effort to negotiate and execute the contract.  If the apparent successful Bidder fails to negotiate and execute a contract, the Agency may, in its sole discretion, revoke the Notice of Intent to Award and negotiate a contract with another Bidder or withdraw the RFP.  The Agency further reserves the right to cancel the Notice of Intent to Award at any time prior to the execution of a written contract.    

2.26  Review of Notice of Disqualification or Notice of Intent to Award Decision.
Bidders may request reconsideration of this disqualification decision by submitting a written request to the Agency:

	Bureau Chief
	c/o Bureau of Service Contract Support
	Department of Human Services 
	Hoover State Office Building, 1st Floor
	1305 E. Walnut Street
	Des Moines, Iowa 50319-0114
	email:  reconsiderationrequest@dhs.state.ia.us
	
The Agency must receive the written request for reconsideration within five days from the date of the notice of disqualification or notice of intent to award decision, whichever is earlier.  The written request may be emailed or delivered by postal service or other shipping service.  Do not deliver any requests for reconsideration to the office in person.  It is the Bidder’s responsibility to ensure that the request for reconsideration is received prior to the deadline.  Postmarking or submission to a shipping service by the due date shall not substitute for actual receipt of a request for reconsideration by the Agency. 

The request for reconsideration shall clearly and fully identify all issues being contested by reference to the page and section number of the RFP.  If a Bidder submitted multiple Bid Proposals and requests that the Agency reconsider a notice of disqualification or notice of intent to award decision for more than one Bid Proposal, a separate written request shall be submitted for each.  At the Agency’s discretion, requests for reconsideration from the same Bidder may be reviewed separately or combined into one response.  The Agency will expeditiously address the request for reconsideration and issue a decision.  The Bidder may choose to file an appeal with the Agency within five days of the date of the decision on reconsideration in accordance with 441 Iowa Admin. Code r. 7.41 et seq.  

2.27  Definition of Contract.
The full execution of a written contract shall constitute the making of a contract for services and no Bidder shall acquire any legal or equitable rights relative to the contract services until the contract has been fully executed by the apparent successful Bidder and the Agency.    

2.28  Choice of Law and Forum.
This RFP and the resulting contract are governed by the laws of the State of Iowa without giving effect to the conflicts of law provisions thereof.  Changes in applicable laws and rules may affect the negotiation and contracting process and the resulting contract.  Bidders are responsible for ascertaining pertinent legal requirements and restrictions.  Any and all litigation or actions commenced in connection with this RFP shall be brought and maintained in the appropriate Iowa forum.    

2.29  Restrictions on Gifts and Activities.    	
Iowa Code chapter 68B restricts gifts that may be given or received by state employees and requires certain individuals to disclose information concerning their activities with state government.  Bidders must determine the applicability of this Chapter to their activities and comply with the requirements.  In addition, pursuant to Iowa Code § 722.1, it is a felony offense to bribe or attempt to bribe a public official.    

2.30  Exclusivity.
Any contract resulting from this RFP shall not be an exclusive contract.

2.31  No Minimum Guaranteed.
The Agency anticipates that the selected Bidder will provide services as requested by the Agency.  The Agency does not guarantee that any minimum compensation will be paid to the Bidder or any minimum usage of the Bidder’s services. 

2.32  Use of Subcontractors.
The Agency acknowledges that the selected Bidder may contract with third parties for the performance of any of the Contractor’s obligations.  The Agency reserves the right to provide prior approval for any subcontractor used to perform services under any contract that may result from this RFP.

2.33 Bidder Continuing Disclosure Requirement.
To the extent that Bidders are required to report incidents when responding to this RFP related to damages, penalties, disincentives, administrative or regulatory proceedings, founded child or dependent adult abuse, or felony convictions, these matters are subject to continuing disclosure to the Agency.  Incidents occurring after submission of a Bid Proposal, and with respect to the successful Bidder after the execution of a contract, shall be disclosed in a timely manner in a written statement to the Agency.  For purposes of this subsection, timely means within thirty (30) days from the date of conviction, regardless of appeal rights.  

Section 3 How to Submit A Bid Proposal: Format and Content Specifications
These instructions provide the format and technical specifications of the Bid Proposal and are designed to facilitate the submission of a Bid Proposal that is easy to understand and evaluate.  

3.1  Bid Proposal Formatting.
	
Subject		Specifications	
Paper Size	8.5" x 11" paper (one side only).  Charts or graphs may be provided on legal-sized paper.	
Font	Bid Proposals must be typewritten.  The font must be 11 point or larger (excluding charts, graphs, or diagrams).  Acceptable fonts include Times New Roman, Calibri and Arial. 	
Page Limit	Pages included in Proposal Tab 3 and any attachments the Bidder creates in a “Tab 3 Attachments” section is limited to 200 pages.  See Section 3.2 for further information about Tab 3 Attachments.	
Pagination	All pages in Proposal Tabs 1-5 are to be sequentially numbered from beginning to end (do not number these Proposal sections independently of each other).  The contents in Proposal Tab 6 may be numbered independently of other sections.	
Bid Proposal General Composition
	•	Bid Proposals shall be divided into two parts: Technical Proposal and Cost Proposal. 
•	Technical Proposals submitted in multiple volumes shall be numbered in the following fashion: 1 of 4, 2 of 4, etc.
•	Bid Proposals must be bound and use tabs to label sections.	

Envelope Contents and Labeling 	•	Envelopes shall be addressed to the Issuing Officer.
•	The envelope containing the original Bid Proposal shall be labeled “original.” The Technical and Cost Proposal must be packaged separately. 	

Number of Hard Copies	Submit one (1) original hard copy of the Proposal (separate Technical and Cost proposals).  The original hard copy must contain original signatures.  	
USB Flash Drive	•	The Technical Proposal and Cost Proposal must be provided on separate USB flash drives.  Bidders shall submit 4 flash drives, each with a copy identical to the content of the original hard copy of the Technical Proposal and 1 flash drive of the Cost Proposal, each with a copy identical to the content of the original hard copy of the Cost Proposal.  
•	The Technical Proposal must be saved in less than three files, with a preference for the entire Technical Proposal in one file.  Proposals shall be provided in either PDF or Microsoft Word format.  Files shall be text-based and not scanned image(s) and shall be searchable and not password protected or contain restrictions that prevent copying, saving, highlighting, or printing of the contents.   	
Request for Confidential Treatment	Requests for confidential treatment of any information in a Bid Proposal must meet these specifications:
•	The Bidder will complete the appropriate section of the Primary Bidder Detail Form & Certification which requires the specific statutory citation supporting the request for confidential treatment and an explanation of why disclosure of the information is not in the best interest of the public. 
•	The Bidder shall submit one complete paper copy of the Bid Proposal from which confidential information has been redacted.  This copy shall be clearly labeled on the cover as a “public copy” and each page upon which confidential information appears shall be conspicuously marked as containing confidential information.  The confidential material shall be redacted in such a way as to allow the public to determine the general nature of the material removed.  To the extent possible, pages should be redacted sentence by sentence unless all material on a page is clearly confidential under the law.  The Bidder shall not identify the entire Bid Proposal as confidential.    
•	The Cost Proposal will be part of the ultimate contract entered into with the successful Bidder.  Pricing information may not be designated as confidential material.  However, Cost Proposal supporting materials may be marked confidential if consistent with applicable law.   
•	The transmittal letter may not be marked confidential.   
•	The Bidder shall submit a USB flash drive containing an electronic copy of the Bid Proposal from which confidential information has been redacted.  This USB flash drive shall be clearly marked as a “public copy”.  
•	The Technical Proposal must be saved in less than three files, with a preference for the entire Technical Proposal in one file.  Proposals shall be provided in either PDF or Microsoft Word format.  Files shall be text-based and not scanned image(s) and shall be searchable and not password protected or contain restrictions that prevent copying, saving, highlighting, or printing of the contents.  	
Exceptions to RFP/Contract Language
	If the Bidder objects to any term or condition of the RFP or attached Sample Contract, specific reference to the RFP page and section number shall be made in the Primary Bidder Detail & Certification Form.  In addition, the Bidder shall set forth in its Bid Proposal the specific language it proposes to include in place of the RFP or contract provision and cost savings to the Agency should the Agency accept the proposed language.
The Agency reserves the right to either execute a contract without further negotiation with the successful Bidder or to negotiate contract terms with the selected Bidder if the best interests of the Agency would be served. 	

3.2  Contents and Organization of Technical Proposal.
This section describes the information that must be in the Technical Proposal.  Bid Proposals should be organized into sections in the same order provided here.  Hard copies of Bid Proposals should use tabs to separate each section.  If a Bidder chooses to provide  information in attachments to respond to any section below, please create a new tabbed attachment section immediately behind the applicable section.  For example, to add attachments related to information asked for in Section 3.2.3 Information to Include Behind Tab 3: Bidder’s Approach to Meeting Deliverables, the Bidder would create a new tab in the Technical Proposal that is called Tab 3 Attachments and place the attachment(s) there.  The Bidder would follow suit by creating new tabbed sections for attachments created to respond to any other section below in their bid proposal

3.2.1  Information to Include Behind Tab 1:
Transmittal Letter.
The transmittal letter serves as a cover letter for the Technical Proposal.  It must consist of an executive summary that briefly reviews the strengths of the Bidder and key features of its proposed approach to meet the specifications of this RFP.  

3.2.2  Information to Include Behind Tab 2: Proposal Table of Contents.
The Bid Proposal must contain a table of contents.

3.2.3  Information to Include Behind Tab 3: Bidder’s Approach to Meeting Deliverables.
The Bidder shall address each Deliverable that the successful contractor will perform as listed in Section 1.3,Scope of Work of the Sample Contract attached to this RFP as Attachment G, by first restating the Deliverable from the RFP and then detailing the Bidder’s planned approach to meeting each contractor Deliverable immediately after the restated text.  Bid responses should provide sufficient detail so that the Agency can understand and evaluate the Bidder’s approach, and should not merely repeat the Deliverable.    

Bidders are given wide latitude in the degree of detail they offer or the extent to which they reveal plans, designs, examples, processes, and procedures.  Bidders do not need to address any responsibilities that are specifically designated as Agency responsibilities.

Note:
•	Responses to Deliverables shall be in the same sequence as presented in the RFP.  
•	Bid Proposals shall identify any deviations from the specifications the Bidder cannot satisfy.  
•	Bid Proposals shall not contain promotional or display materials unless specifically required.

If a Bidder proposes more than one method of meeting the RFP requirements, each method must be drafted and submitted as separate Bid Proposals.  Each will be evaluated separately.  

Information Bidders Must Submit That is Specific to This RFP: Special Submissions
The Agency is requesting the following information in addition to the contents immediately above.  
The Bidder shall provide the following in a separate attachment to the RFP:
Draft comprehensive project work plan detailing all activities and timelines; and
Sample reports (See Section 1.3.4.4  Reporting of the Sample Contract attached to this RFP as Attachment G)  

3.2.4  Information to Include Behind Tab 4: Bidder’s Experience.  

3.2.4.1  Level of technical experience in providing the types of services sought by the RFP.

3.2.4.2  Description of all services similar to those sought by this RFP that the Bidder has provided to the Agency and other businesses or governmental entities within the last twenty-four (24) months. 

3.2.4.3  Letters of reference from three (3) of the Bidder’s previous clients knowledgeable of the Bidder’s performance in providing services similar to those sought in this RFP, including a contact person, telephone number, and email address for each reference.  It is preferred that letters of reference are provided for services that were procured in a competitive environment.  Form letters of reference that do not elaborate on the Bidder’s performance under the specific relationships addressed in the reference letter may negatively impact the Bidder’s evaluation/score.  Persons who are currently employed by the Agency are not eligible to be references.  

3.2.4.4  Description of experience managing subcontractors, if the Bidder proposes to use subcontractors.

3.2.5  Information to Include Behind Tab 5:  Personnel.  
The Bidder shall provide the following information regarding personnel:  

3.2.5.1  Tables of Organization.
Illustrate the lines of authority in two tables:
•	One showing overall operations
•	One showing staff who will provide services under the RFP  

3.2.5.2 Names and Credentials of Key Corporate Personnel. 
•	Include the names and credentials of the owners and executives of your organization and, if applicable, their roles on this project.  
•	Include names of the current board of directors, or names of all partners, as applicable.  
•	Include resumes for all key corporate, administrative, and supervisory personnel who will be involved in providing the services sought by this RFP.  The resumes should include: name, education, years of experience, and employment history, particularly as it relates to the scope of services specified herein.  Resumes shall not include social security numbers.

3.2.5.3  Information About Project Manager and Key Project Personnel.
•	Include names and credentials for the project manager and any additional key project personnel who will be involved in providing services sought by this RFP.  Include resumes for these personnel. The resumes shall include: name, education, and years of experience and employment history, particularly as it relates to the scope of services specified herein.  Resumes shall also include the percentage of time the person would be specifically dedicated to this project on a monthly basis, if the Bidder is selected as the successful Bidder.  Resumes should not include social security numbers.
•	Include the project manager’s experience managing subcontractor staff if the Bidder proposes to use subcontractors.

3.2.5.4  Disclosures.
List any details of whether the Bidder or any owners, officers, primary partners, staff providing services or any owners, officers, primary partners, or staff providing services of any subcontractor who may be involved with providing the services sought in this RFP, have ever had a founded child or dependent adult abuse report, or been convicted of a felony.  

3.2.6 Information to Include Behind Tab 6: RFP Forms.
The forms listed below are attachments to this RFP.  Fully complete and return these forms behind Tab 6:
•	Release of Information Form
•	Primary Bidder Detail & Certification Form
•	Subcontractor Disclosure Form (one for each proposed subcontractor)
•	Certification and Disclosure Regarding Lobbying

3.2.7  Financial Statements. 
The Bidder shall submit 1 complete hard copy and a USB flash drive containing an electronic copy of audited financial statements from independent auditors for the last three (3) years.  Entities not required to have audited financial statements may submit CPA-prepared unaudited financial statements.  Hard copies should be submitted in a separate binder from the Technical and Cost proposals. 

3.3  Cost Proposal. 
Pricing Restrictions. 
Administrative Costs.
The Agency is placing a cap on the amount of funds that may be spent for Administrative Costs in any contract(s) resulting from this RFP.  Spending on Administrative Costs under each contract, for both the contractor and all their subcontractors, cannot exceed 30% of the total contract amount.  For the purposes of this subsection, “Administrative Costs” means the costs that may include, but are not limited to, such categories as:  salary and benefits for administrators and support staff, rent and lease payments, utilities, data collection and data processing costs, printing, communications equipment and services, and other costs necessary to support the delivery of services.  

Content and Format.
The Bidder shall provide the following information in the Cost Proposal: 
The Cost Proposal shall be submitted using the pricing worksheet set forth in Attachment F of this RFP. Bidders should submit an Excel version of Attachment F. 

Section 4 Evaluation Of Bid Proposals

4.1  Introduction.
This section describes the evaluation process that will be used to determine which Bid Proposal provides the greatest benefit to the Agency.  When making this determination, the Agency will not necessarily award a contract to the Bidder offering the lowest cost to the Agency or to the Bidder with the highest point total.  Rather, a contract will be awarded to the Bidder that offers the greatest benefit to the Agency. 

4.2  Evaluation Committee.
The Agency intends to conduct a comprehensive, fair, and impartial evaluation of Bid Proposals received in response to this RFP.  In making this determination, the Agency will be represented by an evaluation committee.  

4.3  Proposal Scoring and Evaluation Criteria.  
The evaluation committee will use the method described in this section to assist with initially determining the relative merits of each Bid Proposal.

Financial Stability.
The Agency reserves the right to evaluate Bidder financial stability on a pass/fail basis.  
The Agency reserves the right to seek clarification from Bidders in connection with this evaluation.

Scoring Guide.
Points will be assigned to each evaluation component as follows, unless otherwise designated:
4 	Bidder has agreed to comply with the requirements and provided a clear and compelling description of how each requirement would be met, with relevant supporting materials.  Bidder’s proposed approach frequently goes above and beyond the minimum requirements and indicates superior ability to serve the needs of the Agency.	
3	Bidder has agreed to comply with the requirements and provided a good and complete description of how the requirements would be met.  Response clearly demonstrates a high degree of ability to serve the needs of the Agency.	
2	Bidder has agreed to comply with the requirements and provided an adequate description of how the requirements would be met.  Response indicates adequate ability to serve the needs of the Agency.	
1	Bidder has agreed to comply with the requirements and provided some details on how the requirements would be met.  Response does not clearly indicate if all the needs of the Agency will be met.	
0	Bidder has not addressed any of the requirements or has provided a response that is limited in scope, vague, or incomplete.  Response did not provide a description of how the Agency’s needs would be met.	

Technical Proposal Components.
When Bid Proposals are evaluated, the total points for each component are comprised of the component’s assigned weight multiplied by the score the Bid Proposal earns.  Points for all components will be added together.  The evaluation components, including maximum points that may be awarded, are as follows:

Technical Proposal Components	Weight	Score (0-4)	Potential Maximum Points	
Attachment G: Sample Contract: 
Section 1.3 Scope of Work & Deliverables 	-		-	
•	Transition Phase Project Work Plan (Section 1.3.1.a)	20		80	
•	Operations  (Section 1.3.2)	-		-	
•	System and Database Obligations (Section 1.3.2.1)	10		40	
•	Verification of Trip Eligibility (Section 1.3.2.2)	10		40	
•	Scheduling and Trip Dispatch  (Section 1.3.2.3)	10		40	
•	Denial of Service (Section 1.3.2.4)	5		20	
•	Transportation Providers  (Section 1.3.2.5.1)	10		40	
•	Service Agreements with Transportation Providers (1.3.2.5.2)	5		20	
•	Volunteers  (Section 1.3.2.6)	5		20	
•	Transportation Provider Orientation and Training  (Section 1.3.2.7)	5		20	
•	Quality Assurance (Section 1.3.2.8)	10		40	
•	NEMT Grievance & Appeal System  (Section 1.3.2.9)	5		20	
•	Broker Payment Obligations  (Section 1.3.2.10)	10		40	
•	Member Management  (Section 1.3.2.11)	20		80	
•	Maintain Telephone Call Center/Office  (Section 1.3.2.12)	20		80	
•	Turnover (Section 1.3.3)	5		20	
•	General Obligations (Section 1.3.4)	-		-	
•	Staffing  (Section 1.3.4.1)	10		40	
•	Meetings  (Section 1.3.4.2)	5		20	
•	Communication  (Section 1.3.4.3.1)	10		40	
•	Communication Specific to Website, Including Member And Provider Online Portals (Section 1.3.4.3.2)	10		40	
•	Reporting  (Section 1.3.4.4)	10		40	
•	Broker Contract Management (Section 1.3.4.5)	10		40	
•	Program Integrity/Medicaid Fraud Control Investigations  (Section 1.3.4.6)	10		40	
•	Program Integrity & Disclosure Requirements  (Section 1.3.4.7)	10		40	
•	Agency State Payment Recovery Rights  (Section 1.3.4.8)	5		20	
Draft of the Project Work Plan and sample reports
(Section 3.2.3 Special Submissions)	20		80	
Bidder’s Background	-		-	
•	Experience  (Section 3.2.4)	30		120	
•	Personnel  (Section 3.2.5)	15		60	
•	Disclosures  (Section 3.2.5.4)	5		20	

Scoring of Cost Proposal Pricing.
Cost Proposal pricing will be scored based on a ratio of the lowest Cost Proposal versus the cost of each higher priced Bid Proposal.  Under this formula, the lowest Cost Proposal receives all of the points assigned to pricing.  A Cost Proposal twice as expensive as the lowest Cost Proposal would earn half of the available points.  The formula is:

Weighted Cost Score = (price of lowest Cost Proposal/price of each higher priced Cost Proposal) X (points assigned to pricing)

Total Points Assigned to Pricing: 400.

Total Points Possible for Technical and Cost Proposals:  1600  

4.4  Recommendation of the Evaluation Committee.  
The evaluation committee shall present a final ranking and recommendation(s) to the Contract Owner for consideration.  In making this recommendation, the committee is not bound by any scores or scoring system used to assist with initially determining the relative merits of each Bid Proposal.  This recommendation may include, but is not limited to, the name of one or more Bidders recommended for selection or a recommendation that no Bidder be selected.  The Contract Owner shall consider the committee’s recommendation when making the final decision, but is not bound by the recommendation.  

Attachment A: Release of Information
(Return this completed form behind Tab 6 of the Bid Proposal.)

	_________________________________ (name of Bidder) hereby authorizes any person or entity, public or private, having any information concerning the Bidder’s background, including but not limited to its performance history regarding its prior rendering of services similar to those detailed in this RFP, to release such information to the Agency.    

	The Bidder acknowledges that it may not agree with the information and opinions given by such person or entity in response to a reference request.  The Bidder acknowledges that the information and opinions given by such person or entity may hurt its chances to receive contract awards from the Agency or may otherwise hurt its reputation or operations.  The Bidder is willing to take that risk.  The Bidder agrees to release all persons, entities, the Agency, and the State of Iowa from any liability whatsoever that may be incurred in releasing this information or using this information.    

_______________________________
Printed Name of Bidder Organization

_______________________________		___________________________
Signature of Authorized Representative 		Date

_______________________________		
Printed Name		

Attachment B: Primary Bidder Detail & Certification Form
(Return this completed form behind Tab 6 of the Proposal.  If a section does not apply, label it “not applicable”.)

Primary Contact Information (individual who can address issues re: this Bid Proposal)	
Name:		
Address:		
Tel:		
Fax:		
E-mail:		
Primary Bidder Detail	
Business Legal Name (“Bidder”):		
“Doing Business As” names, assumed names, or other operating names:		
Parent Corporation Name and Address of Headquarters, if any:		
Form of Business Entity (i.e., corp., partnership, LLC, etc.):		
State of Incorporation/organization:		
Primary Address:		
Tel:		
Local Address (if any):		
Addresses of Major Offices and other facilities that may contribute to performance under this RFP/Contract:		
Number of Employees:		
Number of Years in Business:		
Primary Focus of Business:		
Federal Tax ID:		
DUNS #:  		

Bidder’s Accounting Firm:		
If Bidder is currently registered to do business in Iowa, provide the Date of Registration:  		
Do you plan on using subcontractors if awarded this Contract?  {If “YES,” submit a Subcontractor Disclosure Form for each proposed subcontractor.}		
	(YES/NO)	

Request for Confidential Treatment (See Section 3.1)	
Check Appropriate Box:                  
  Bidder Does Not Request Confidential Treatment of Bid Proposal 
  Bidder Requests Confidential Treatment of Bid Proposal	
Location in Bid Proposal (Tab/Page)	Specific Grounds in Iowa Code Chapter 22 or Other Applicable Law Which Supports Treatment of the Information as Confidential	Justification of Why Information Should Be Kept in Confidence and Explanation of Why Disclosure Would Not Be in The Best Interest of the Public	

	

Exceptions to RFP/Contract Language (See Section 3.1)	
RFP Section and Page	Language to Which Bidder Takes Exception	Explanation and Proposed Replacement Language:	Cost Savings to the Agency if the Proposed Replacement Language is Accepted	

PRIMARY BIDDER CERTIFICATIONS 

1.	BID PROPOSAL CERTIFICATIONS.  By signing below, Bidder certifies that:  

1.1	Bidder specifically stipulates that the Bid Proposal is predicated upon the acceptance of all terms and conditions stated in the RFP and the Sample Contract without change except as otherwise expressly stated in the Primary Bidder Detail & Certification Form.  Objections or responses shall not materially alter the RFP.  All changes to proposed contract language, including deletions, additions, and substitutions of language, must be addressed in the Bid Proposal.  The Bidder accepts and shall comply with all Contract Terms and Conditions contained in the Sample Contract without change except as set forth in the Contract;
1.2	Bidder has reviewed the Additional Certifications, which are incorporated herein by reference, and by signing below represents that Bidder agrees to be bound by the obligations included therein;
1.3	Bidder has received any amendments to this RFP issued by the Agency; 
1.4	No cost or pricing information has been included in the Bidder’s Technical Proposal; 
1.5	If Bidder requests confidential treatment of any information submitted in its Proposal, the Bidder expressly acknowledges and agrees that the Agency’s evaluation document(s) may reference information of which the Bidder requested confidential treatment in the Bid Proposal.  These Agency evaluation documents may then be in the public domain and be open to inspection by interested parties upon the Agency’s issuance of a Notice of Intent to Award.  The Agency will not redact information or references to information in evaluation documents even in instances which a Bidder requested confidential treatment in the Bid Proposal; and,
1.6	The person signing this Bid Proposal certifies that he/she is the person in the Bidder’s organization responsible for, or authorized to make decisions regarding the prices quoted and, Bidder guarantees the availability of the services offered and that all Bid Proposal terms, including price, will remain firm until a contract has been executed for the services contemplated by this RFP or one year from the issuance of this RFP, whichever is earlier.

2.	SERVICE AND REGISTRATION CERTIFICATIONS.  By signing below, Bidder certifies that:  

2.1	Bidder certifies that the Bidder’s organization has sufficient personnel and resources available to provide all services proposed by the Bid Proposal, and such resources will be available on the date the RFP states services are to begin.  Bidder guarantees personnel proposed to provide services will be the personnel providing the services unless prior approval is received from the Agency to substitute staff;
2.2	Bidder certifies that if the Bidder is awarded the contract and plans to utilize subcontractors at any point to perform any obligations under the contract, the Bidder will (1) notify the Agency in writing prior to use of the subcontractor, and (2) apply all restrictions, obligations, and responsibilities of the resulting contract between the Agency and contractor to the subcontractors through a subcontract.  The contractor will remain responsible for all Deliverables provided under this contract;
2.3	Bidder either is currently registered to do business in Iowa or agrees to register if Bidder is awarded a Contract pursuant to this RFP; 
2.4	Bidder certifies it is either: 1) registered or will become registered with the Iowa Department of Revenue to collect and remit Iowa sales and use taxes as required by Iowa Code chapter 423; or 2) not a “retailer” of a “retailer maintaining a place of business in this state” as those terms are defined in Iowa Code subsections 423.1(42) & (43).  The Bidder also acknowledges that the Agency may declare the Bid Proposal void if the above certification is false.  Bidders may register with the Department of Revenue online at:  http://www.state.ia.us/tax/business/business.html; and,
2.5  Bidder certifies it will comply with Davis-Bacon requirements if applicable to the resulting contract.

3.	EXECUTION.

By signing below, I certify that I have the authority to bind the Bidder to the specific terms, conditions and technical specifications required in the Agency’s Request for Proposals (RFP) and offered in the Bidder’s Proposal.  I understand that by submitting this Bid Proposal, the Bidder agrees to provide services described herein which meet or exceed the specifications of the Agency’s RFP unless noted in the Bid Proposal and at the prices quoted by the Bidder. The Bidder has not participated, and will not participate, in any action contrary to the anti-competitive obligations outlined in the Additional Certifications.  I certify that the contents of the Bid Proposal are true and accurate and that the Bidder has not made any knowingly false statements in the Bid Proposal.  

Signature:	
	
Printed Name/Title:	
	
Date:	

Attachment C: Subcontractor Disclosure Form
(Return this completed form behind Tab 6 of the Bid Proposal.  Fully complete a form for each proposed subcontractor.  If a section does not apply, label it “not applicable.” If the Bidder does not intend to use subcontractor(s), this form does not need to be returned.)

Primary Bidder (“Primary Bidder”):		
Subcontractor Contact Information (individual who can address issues re: this RFP)	
Name:		
Address:		
Tel:		
Fax:		
E-mail:		

Subcontractor Detail	
Subcontractor Legal Name (“Subcontractor”):		
“Doing Business As” names, assumed names, or other operating names:		
Form of Business Entity (i.e., corp., partnership, LLC, etc.)		
State of Incorporation/organization:		
Primary Address:		
Tel:		
Fax:		
Local Address (if any):		
Addresses of Major Offices and other facilities that may contribute to performance under this RFP/Contract:		
Number of Employees:		
Number of Years in Business:		
Primary Focus of Business:		
Federal Tax ID:		
Subcontractor’s Accounting Firm:		
If Subcontractor is currently registered to do business in Iowa, provide the Date of Registration:  		
Percentage of Total Work to be performed by this Subcontractor pursuant to this RFP/Contract.		
General Scope of Work to be performed by this Subcontractor	

Detail the Subcontractor’s qualifications for performing this scope of work	

By signing below, Subcontractor agrees to the following:

1.	Subcontractor has reviewed the RFP, and Subcontractor agrees to perform the work indicated in this Bid Proposal if the Primary Bidder is selected as the winning Bidder in this procurement;
2.	Subcontractor has reviewed the Additional Certifications and by signing below confirms that the Certifications are true and accurate and Subcontractor will comply with all such Certifications;
3.	Subcontractor recognizes and agrees that if the Primary Bidder enters into a contract with the Agency as a result of this RFP, all restrictions, obligations, and responsibilities of the contractor under the contract shall also apply to the subcontractor; 
4.	Subcontractor agrees that it will register to do business in Iowa before performing any services pursuant to this contract, if required to do so by Iowa law; and,
5.	Subcontractor certifies that it will comply with Davis-Bacon requirements if applicable to the resulting contract.  

The person signing this Subcontractor Disclosure Form certifies that he/she is the person in the Subcontractor’s organization responsible for or authorized to make decisions regarding the prices quoted and the Subcontractor has not participated, and will not participate, in any action contrary to the anti-competitive obligations outlined in the Additional Certifications.

I hereby certify that the contents of the Subcontractor Disclosure Form are true and accurate and that the Subcontractor has not made any knowingly false statements in the Form.

Signature for Subcontractor:	
	
Printed Name/Title:	
	
Date:	

Attachment D: Additional Certifications
(Do not return this page with the Bid Proposal.)

1.	 CERTIFICATION OF INDEPENDENCE AND NO CONFLICT OF INTEREST
By submission of a Bid Proposal, the Bidder certifies (and in the case of a joint proposal, each party thereto certifies) that:

1.	The Bid Proposal has been developed independently, without consultation, communication or agreement with any employee or consultant of the Agency who has worked on the development of this RFP, or with any person serving as a member of the evaluation committee;
2.	The Bid Proposal has been developed independently, without consultation, communication or agreement with any other Bidder or parties for the purpose of restricting competition;
3.	Unless otherwise required by law, the information in the Bid Proposal has not been knowingly disclosed by the Bidder and will not knowingly be disclosed prior to the award of the contract, directly or indirectly, to any other Bidder;
4.	No attempt has been made or will be made by the Bidder to induce any other Bidder to submit or not to submit a Bid Proposal for the purpose of restricting competition;
5.	No relationship exists or will exist during the contract period between the Bidder and the Agency that interferes with fair competition or is a conflict of interest.
6.	The Bidder and any of the Bidder’s proposed subcontractors have no other contractual relationships which would create an actual or perceived conflict of interest.

2.	CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION -- LOWER TIER COVERED TRANSACTIONS
By signing and submitting this Bid Proposal, the Bidder is providing the certification set out below:

1.	The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into.  If it is later determined that the Bidder knowingly rendered an erroneous certification, in addition to other remedies available to the federal government the Agency or Agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.
2.	The Bidder shall provide immediate written notice to the person to whom this Bid Proposal is submitted if at any time the Bidder learns that its certification was erroneous when submitted or had become erroneous by reason of changed circumstances.
3.	The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principle, proposal, and voluntarily excluded, as used in this clause, have the meaning set out in the Definitions and Coverage sections of rules implementing Executive Order 12549.  You may contact the person to which this Proposal is submitted for assistance in obtaining a copy of those regulations.
4.	The Bidder agrees by submitting this Proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the Agency or Agency with which this transaction originated.
5.	The Bidder further agrees by submitting this Proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
6.	A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded from covered transactions, unless it knows that the certification is erroneous.  A participant may decide the method and frequency by which it determines the eligibility of its principals.  A participant may, but is not required to, check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs.
7.	Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause.  The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.
8.	Except for transactions authorized under paragraph 4 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the federal government, the Agency or Agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.

3.	CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND/OR VOLUNTARY EXCLUSION--LOWER TIER COVERED TRANSACTIONS
1.	The Bidder certifies, by submission of this Proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or Agency.
2.	Where the Bidder is unable to certify to any of the statements in this certification, such Bidder shall attach an explanation to this Proposal.

4.	CERTIFICATION OF COMPLIANCE WITH PRO-CHILDREN ACT OF 1994
By signing and submitting this Bid Proposal, the Bidder is providing the certification set out below:

The Bidder must comply with Public Law 103-227, Part C Environmental Tobacco Smoke, also known as the Pro-Children Act of 1994 (Act).  This Act requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted by an entity and used routinely or regularly for the provision of health, day care, education, or library services to children under the age of 18, if the services are funded by federal programs either directly or through State or local governments.  Federal programs include grants, cooperative agreements, loans or loan guarantees, and contracts. The law also applies to children’s services that are provided in indoor facilities that are constructed, operated, or maintained with such federal funds.  The law does not apply to children’s services provided in private residences; portions of facilities used for inpatient drug or alcohol treatment; service providers whose sole source of applicable federal funds is Medicare or Medicaid; or facilities (other than clinics) where WIC coupons are redeemed.

The Bidder further agrees that the above language will be included in any subawards that contain provisions for children’s services and that all subgrantees shall certify compliance accordingly.  Failure to comply with the provisions of this law may result in the imposition of a civil monetary penalty of up to $1000 per day.

5.	CERTIFICATION REGARDING DRUG FREE WORKPLACE
1.	Requirements for Contractors Who are Not Individuals.  If the Bidder is not an individual, by signing and submitting this Bid Proposal the Bidder agrees to provide a drug-free workplace by:
a.	publishing a statement notifying employees that the unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance is prohibited in the person’s workplace and specifying the actions that will be taken against employees for violations of such prohibition;  
b.	establishing a drug-free awareness program to inform employees about:
(1)  the dangers of drug abuse in the workplace;  
(2)  the person’s policy of maintaining a drug- free workplace;  
(3)  any available drug counseling, rehabilitation, and employee assistance programs; and  
(4)  the penalties that may be imposed upon employees for drug abuse violations;  
c.	making it a requirement that each employee to be engaged in the performance of such contract be given a copy of the statement required by subparagraph (a);    
d.	notifying the employee in the statement required by subparagraph (a), that as a condition of employment on such contract, the employee will:
(1)  abide by the terms of the statement; and 
(2)  notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than 5 days after such conviction;  
e.	notifying the contracting Agency within 10 days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction;  
f.	imposing a sanction on, or requiring the satisfactory participation in a drug abuse assistance or rehabilitation program by, any employee who is so convicted, as required by 41 U.S.C. § 703; and  
g.	making a good faith effort to continue to maintain a drug-free workplace through implementation of subparagraphs (a), (b), (c), (d), (e), and (f).  
2.	Requirement for Individuals.  If the Bidder is an individual, by signing and submitting this Bid Proposal the Bidder agrees to not engage in the unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance in the performance of the contract.  
3.	Notification Requirement. The Bidder shall, within 30 days after receiving notice from an employee of a conviction pursuant to 41 U.S.C. § 701(a)(1)(D)(ii) or 41 U.S.C. § 702(a)(1)(D)(ii):
a.	take appropriate personnel action against such employee up to and including termination; or  
b.	require such employee to satisfactorily participate in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate Agency.  

6.	NON-DISCRIMINATION
The Bidder does not discriminate in its employment practices with regard to race, color, religion, age (except as provided by law), sex, marital status, political affiliation, national origin, or handicap.

Attachment E: Certification and Disclosure Regarding Lobbying Attachment
(Return this executed form behind Tab 6 of the Bid Proposal.)

Instructions: 
Title 45 of the Code of Federal Regulations, Part 93 requires the bidder to include a certification form, and a disclosure form, if required, as part of the bidder’s proposal.  Award of the federally funded contract from this RFP is a Covered Federal action.  

1)	The Bidder shall file with the Agency this certification form, as set forth in Appendix A of 45 CFR Part 93, certifying the Bidder, including any subcontractor(s) at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) have not made, and will not make, any payment prohibited under 45 CFR § 93.100.  
2)	The Bidder shall file with the Agency a disclosure form, set forth in Appendix B of 45 CFR Part 93, in the event the Bidder or subcontractor(s) at any tier (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) has made or has agreed to make any payment using non-appropriated funds, including profits from any covered Federal action, which would be prohibited under 45 CFR § 93.100 if paid for with appropriated funds.  All disclosure forms shall be forwarded from tier to tier until received by the Bidder and shall be treated as a material representation of fact upon which all receiving tiers shall rely.

Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an Agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of  any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to  influence an officer or employee of any Agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the  undersigned shall complete and submit Standard Form-LLL, ‘‘Disclosure Form  to Report  Lobbying,’’ in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into.  Submission of this certification is a prerequisite for making or entering into this transaction  imposed by section 1352, title 31, U.S. Code.  Any person who fails to file the required certification shall be   subject to a civil penalty of  not less than $10,000 and not more than $100,000 for each such failure.

Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief, that:
If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, ‘‘Disclosure Form to Report Lobbying,’’ in accordance with its instructions.
Submission of this statement is a pre-requisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code.  Any person who fails to file the required statement shall be subject to a civil penalty of not less than $10,000 for each such failure.

I certify that the contents of this certification are true and accurate and that the Bidder has not made any knowingly false statements in the Bid Proposal.  I am checking the appropriate box below regarding disclosures required in Title 45 of the Code of Federal Regulations, Part 93.

  The Bidder is NOT including a disclosure form as referenced in this form’s instructions because the Bidder is NOT required by law to do so. 
  The Bidder IS filing a disclosure form with the Agency as referenced in this form’s instructions because the Bidder IS required by law to do so.  If the Bidder is filing a disclosure form, place the form immediately behind this in the Proposal. 

Signature:	
	
Printed Name/Title:	
	
Date:	

Attachment F: Pricing Worksheet

NOT CONFIDENTIAL – this form may not be designated as confidential in whole or in part.

Note:  Bidders are instructed to bid a Per Member Per Month (PMPM) price for each date range outlined below.  The Agency will average the six PMPM rates to arrive at an overall average PMPM.  The average PMPM will be used to evaluate Cost Proposals.  Bidders are instructed to not bid a Transition/Implementation cost, as the Agency is not permitting any Transition and Implementation cost to the winning bidder. The table below is for illustrative purposes. Bidders must use the Attachment F Excel workbook. 

	Transition and Implementation	Year 1  1/2/2023- 12/31/2023	Year 2  1/1/2024 - 12/31/2024	Year 3  1/1/2025 - 12/31/2025	Year 4 1/1/2026 - 12/31/2026	Year 5  1/1/2027 – 12/31/2027	Year 6  1/1/2028 – 12/31/2028	Average PMPM	
PMPM		 	 	 	 	 	 		

Attachment G: Sample Contract

(These contract terms contained in the Special Terms, General Terms, and Contingent Terms for Services Contracts are not intended to be a complete listing of all contract terms but are provided only to enable Bidders to better evaluate the costs associated with the RFP and the potential resulting contract.  Bidders should plan on such terms being included in any contract entered into as a result of this RFP.  All costs associated with complying with these terms should be included in the Cost Proposal or any pricing quoted by the Bidder.  See RFP Section 3.1 regarding Bidder exceptions to contract language.)

This is a sample form.  DO NOT complete and return this attachment.

CONTRACT DECLARATIONS AND EXECUTION

RFP #	Contract #	
MED-23-003	{To be completed when contract is drafted.}	

Title of Contract	
{To be completed when contract is drafted.}	

This Contract must be signed by all parties before the Contractor provides any Deliverables.  The Agency is not obligated to make payment for any Deliverables provided by or on behalf of the Contractor before the Contract is signed by all parties.  This Contract is entered into by the following parties:

Agency of the State (hereafter “Agency”)	
Name/Principal Address of Agency:   
Iowa Department of Human Services
1305 E. Walnut
Des Moines, IA 50319-0114

	Agency Billing Contact Name / Address:
{To be completed when contract is drafted.}
	
Agency Contract Manager (hereafter “Contract Manager” ) /Address (“Notice Address”): 
{To be completed when contract is drafted.}
 
	Agency Contract Owner (hereafter “Contract Owner”) / Address:  
{To be completed when contract is drafted.}

Contractor:  (hereafter “Contractor”)	
Legal Name:  {To be completed when contract is drafted.}	Contractor’s Principal Address:
{To be completed when contract is drafted.}	
Tax ID #:  {To be completed when contract is drafted.}	Organized under the laws of:  {To be completed when contract is drafted.}	
Contractor’s Contract Manager Name/Address (“Notice Address”):  
{To be completed when contract is drafted.}	Contractor’s Billing Contact Name/Address:  
{To be completed when contract is drafted.}	

Contract Information	
Start Date:  {To be completed when contract is drafted.}	End Date of Base Term of Contract:  
End Date of Contract:  {To be completed when contract is drafted.}	
Possible Extension(s):  {To be completed when contract is drafted.}	
Contract Contingent on Approval of Another Agency:  
No
	ISPO Number:  ISPO-21-56	
Contract Include Sharing SSA Data?  Yes
	DoIT Number:  N/A

Contract Execution	
This Contract consists of this Contract Declarations and Execution Section, the Special Terms, any Special Contract Attachments, the General Terms for Services Contracts, and the Contingent Terms for Service Contracts.

In consideration of the mutual covenants in this Contract and for other good and valuable consideration, the receipt, adequacy and legal sufficiency of which are hereby acknowledged, the parties have entered into this Contract and have caused their duly authorized representatives to execute this Contract.

SECTION 1: SPECIAL TERMS

1.1 Special Terms Definitions.
See Attachment 3.1.3 Definitions
1.2 Contract Purpose. 
Contractor will be responsible for providing the Non-emergency Medical Transportation (NEMT) services for the fee-for-service Medicaid population in an efficient and effective manner, within federal, state, and Agency specifications, ensuring the highest standards of performance, program integrity, and customer service at a reasonable cost to the State.  

1.3 Scope of Work. Deliverables.
Contractor (i.e., the “Broker”) shall be responsible for NEMT services provided to the Agency’s FFS eligible Members and will negotiate rates through subcontracts with NEMT transportation providers (“Transportation Providers”), make the arrangements for Transportation Services, and manage all aspects of transportation provided under the FFS NEMT program.  The Broker shall also meet the minimum federal requirements, as defined in 42 C.F.R. § 440.170, for provision of Transportation Services, as well as applicable Agency rules found in 441 Iowa Admin. Code § 78.13(249A).  

NEMT Broker’s obligations include but are not necessarily limited to the following:

1.3.1  Transition Phase
Following execution of the Contract, the Broker shall initiate a Transition Phase that will provide a seamless transition to the Iowa FFS NEMT program in an efficient and timely manner with no impact on Members and the IME.  The Broker’s duties during the Transition Phase shall include but are not necessarily limited to the following tasks.  
a.	The Broker shall submit for Agency approval a comprehensive Project Work Plan (“PWP”) no later than 20 days following the Contract award date, and obtain Agency approval of the PWP no later than 45 days following the Contract award date.  At minimum, the PWP shall:
1.	Outline key transition and operational Deliverables, as well as submission and Agency approval timeframes, including but not limited to:
i.	The NEMT Call Center and database Implementation, demonstration, and approval timelines; and
ii.	Initial Member educational protocols including approval of communication and website updates.
2.	Include the following brokerage planning documents:
i.	NEMT Transition Plan, which shall:
A.	Identify phases, activities, and task dependencies, which shall include at a minimum:
1)	Infrastructure ordering timelines;
2)	Building complete by date, if necessary;
3)	Systems complete and tested by date;
4)	Transportation Provider network contracted by date;
5)	Transportation Provider network credentialed by date;
6)	Staff hired by date; and
7)	Staff trained by date;
B.	Include a Transition Risk Management Plan; and
C.	Include a Transition Communication Plan for how communication will occur between the Broker and the Agency, with communication protocols to be approved by the IME Policy/Contract Manager.
ii.	NEMT Transition and Operational Staffing Plan, which shall include. 
A.	Identification of an Account Manager to supervise and manage the day-to-day operations of the brokerage and the Contract.  The Account Manager shall be the Agency’s point of contact through whom the parties will communicate, resolve issues, and negotiate with regarding the contract responsibilities.  The Broker shall obtain the Agency’s approval of the Account Manager prior to filling the position.  The Agency reserves the right to require the Broker to replace the Account Manager during the term of the contract.
iii.	Transportation Provider Network Plan, which shall include:
A.	An alternate access plan for areas with limited service availability; and
B.	A draft Transportation Provider contract, which must obtain Agency approval before use by the Broker.
iv.	NEMT Member Grievances and Appeals Plan, which shall include:
A.	Member rights and responsibilities, including information on how the Broker will respond to complaints and provide Members with information on how to file Grievances, and initiate Appeals. 
B.	Identify specific activities the Broker shall do to provide Members with information on Grievances and Appeals initially and ongoing.
v.	Transportation Provider Orientation  and Training Plan, which shall include at a minimum:
A.	References to relevant statutes, administrative rules, and Medicaid policies and procedures;
B.	An outline of any Agency-approved, Broker-specific policies and procedures;
C.	An Agency-approved electronic claim form;
D.	An explanation of how Transportation Providers may submit claims electronically;
E.	Agency-approved information about Member sensitivity training for Transportation Providers;
F.	An outline of all pertinent Affordable Care Act (“ACA”) requirements; 
G.	Training on fraud, waste, and abuse, and whistleblower training; and
H.	An explanation of how all training requirements identified in Section 1.3.2.7 Transportation Provider Orientation and Training, will be met.
vi.	NEMT Call Center/Service Staff Orientation and Training Plan, which shall include at a minimum:
A.	Details of how the Broker will provide orientation and training for all personnel prior to permitting any personnel to have public contact or answer scheduling lines;
B.	Details of how the Broker will provide HIPAA Privacy and Security training to all personnel, with supporting documentation of the trainings for each person trained;
C.	Details of sensitivity training (i.e., “soft skills”) to be provided to Broker staff before any staff have direct contact with Members and quarterly thereafter that include soft skills components dealing with:
1)	Aged individuals, children and persons with disabilities;
2)	Multi-cultural contacts, including the use of interpreter services;
3)	Handling hostile calls;
4)	Public contact; and
5)	Communication with hearing or speech-impaired individuals through interpreting services.
D.	Information about how the Broker will identify and address ongoing training needs; and
E.	Details of how the Broker will provide quarterly staff training programs addressing some aspect of Medicaid, NEMT services, or other issues relevant to the Member population.
vii.	NEMT Database Backup, Archival, Restore, and Recovery Plan.
viii.	NEMT Quality Assurance Plan, with the overarching goal of delivering courteous, safe and timely Transportation Services, and shall include at a minimum:
a.	Details of how to assure transportation providers meet health and safety standards for Vehicle maintenance, operation, and inspection;
b.	Details of maintaining driver qualifications and training;
c.	Member Grievance resolution review; and
d.	Details of how the Broker will implement Contract Section 1.3.4.9 entitled Performance Measures.
ix.	Turnover Plan.

1.3.2 Operations
Following successful completion of the Transition Phase the Broker shall enter the Operations Phase of the Contract.  Contractor shall enter the Operations Phase no later than January 1, 2023.  The operational responsibilities will include meeting Performance Measures set forth in Contract Section 1.3.4.9 for the functions performed by the Broker.  Broker shall be responsible for addressing all NEMT claims with dates of service on or after the Operations start date.  Broker’s obligations during the Operations phase of the contract include but are not necessarily limited to the following:

1.3.2.1  System and Database Obligations During Operations:
a.	The Broker shall back up the database on a daily basis and be able to retrieve complete data for no less than five (5) years, in compliance with Agency-approved plans.  This retrieval shall be efficient enough to provide data to the Agency within 24 hours of any request.
b.	The Broker shall run analysis and develop reports as directed by the Agency.  This includes, but is not limited to, providing the Agency with monthly Encounter data in the American National Standards Institute (ANSI) X12 837 format including the billed and reimbursed amounts. 
c.	The Broker shall be responsible for all costs associated with the development, acquisition, and maintenance of the system and database.  All data contained in the database shall at all times be the property of the Agency.  The Broker shall provide a copy of the data to the Agency upon request.  
d.	The Broker shall assure the accuracy of the database information by developing a detailed testing protocol and testing the data structure at a minimum, quarterly.
e.	The Broker shall provide the Agency direct access to the database, at any time, from the IME. The Broker shall provide access to a minimum of three (3) IME staff.  The IME staff must be able to review, run reports, and audit NEMT files, including information in the database.
f.	The Contractor shall meet Agency and the State of Iowa's Enterprise security standards for data collection, storage, and secured electronic transmissions. This includes, but is not limited to, a minimum 256 bit encryption for both authentication and data transmission. See Contract Section 1.5.
g.	The Contractor shall ensure security safeguards are in place to assure the integrity of system hardware, software, records, and files.

1.3.2.2  Verification of Trip Eligibility
a.	The Broker shall provide NEMT services to those Members with full Medicaid benefits who are being transported to an enrolled Medicaid Provider for a Medicaid Covered Service.  
b.	The Broker shall receive and process requests for NEMT services from Iowa FFS Medicaid Members and/or their representatives.  
c.	For each FFS Member requesting NEMT services, the Broker shall verify the Member’s Medicaid eligibility at the time that services are requested through the Iowa Medicaid Member eligibility file submitted daily and/or through the IME Member Services call center.  Note: Members have varying levels of eligibility for services; the Broker will receive only NEMT- FFS eligible Members in the Member eligibility file.  

1.3.2.3	Scheduling and Trips Dispatch 
a.	The Broker shall arrange for all transportation consistent with the obligations set forth in 441 Iowa Admin. Code § 78.13.  Advance notice from the Medicaid Member is mandatory when the Broker must arrange NEMT Provider Transportation, except when Urgent Care Trips as defined in 441 Iowa Admin. Code § 78.13(3)(a)(2) are required.  The Broker shall not schedule any Trip to an excluded service as set forth in 441 Iowa Admin. Code § 78.13(2) or any Trip not consistent with the obligations as set forth in 441 Iowa Admin. Code § 78.13(3).
b.	The Broker shall:  
1.	Determine at the time of scheduling whether the Member is eligible for Ambulatory or non-Ambulatory NEMT.  NOTE: Emergency Ambulance services are not provided through the NEMT program. 
2.	Assure provision of NEMT transportation to Members consistent with 441 Iowa Admin. Code § 78.13(1).  
3.	Accommodate Members who have disabilities or special health care needs.  Members with a brain injury, chronic mental illness ,developmental or intellectual disabilities who have recurring or Standing Order Trips must, to the extent possible, be scheduled continuously with the same Transportation Providers and drivers.  Similar accommodations must be provided to Members who are physically frail, receiving dialysis, or are dealing with other significant mobility or healthcare issues.  The Broker or the Transportation Provider on the Broker’s behalf, shall notify the Member and/or their representative at least 24 hours in advance of any known changes in drivers or Transportation Providers. The Broker and Transportation Provider shall maintain consistent routes and pick-up and drop off times when possible, once efficient routes have been established. 
4.	Accommodate Members who are unable to travel alone due to age of the Member, physical incapacity, or mental infirmity.  The Broker shall arrange travel for a medically necessary Escort and pay travel expenses of a medically necessary Escort when an Escort is required.  The Broker shall allow, one (1) Escort to accompany a Member (or group of Members),   who due to the nature of their disability or condition require the support of an Escort, less than 21 years of age, or as otherwise determined by IME staff, to a Covered Service.  The Broker shall be obligated to pay for Escort transportation costs only when the Member or a Member’s representative requests reimbursement for Escort costs.  For children under the age of sixteen (16) years, a consent form signed by a parent, caretaker, or guardian shall be required for a child to be transported without an Escort, unless access to the service is without parental consent as specified by State (i.e., for family planning and mental health treatment).  For children 16 years of age and older, no consent form shall be required.
5.	Accommodate Member requests to allow a minor to accompany the Member to Medicaid Covered Services, not as an Escort, but when the Member, who is a parent, guardian, or legal representative, does not have alternative childcare available.  The Broker shall allow a child to be transported with the adult Member if there is room or an available seat.  The Broker shall not reimburse the child’s meals when the child is being transported pursuant to this provision.
6.	Pick up and drop off consistent with the following obligations;  
i.	Pick-up times before the medical appointment can be spans of time (e.g.. 2:00 pm - 2:30 pm) but shall not be longer than thirty (30) minutes.  Arrival before the scheduled pick-up time is permitted; however, a Member shall not be required to board the Vehicle before the scheduled pick-up time (e.g., 2:00 pm). The Transportation Provider is not required to wait more than five (5) minutes after the scheduled pick-up time. 
ii.	The Broker shall assure that Members are aware of pick-up time for transportation no later than 24 hours in advance of appointments.  Any deviation from the stated time of more than fifteen (15) minutes shall be deemed untimely service. 
iii.	The Broker shall ensure that a Member is not late in arriving at a medical appointment due to a delay caused by a Transportation Provider.
iv.	If the return pick-up from an appointment was scheduled, the time requirements identified in Section 1.3.2.3.(b)(6)(i) shall apply. 
v.	If the return pick-up was not scheduled, the Vehicle shall arrive within one (1) hour from notification. In the event of an emergency or unforeseen circumstance that prevents the Transportation Provider from meeting the approved window of time for pick up or delivery, the Transportation Provider must contact the Broker and/or the Member to notify them of the occurrence and coordinate resolution.  The Broker shall be responsible at all times for ensuring that the transportation request is fulfilled to the satisfaction of the Member. 
A.	In the event that a delay renders the Member late (not on time) for their appointment or causes them to miss the appointment, the details of the occurrence and resolution shall be recorded as a Grievance against the Broker and the Transportation Provider and provided to the IME during monthly reporting.   
B.	In the event the Member is delayed due to a time overage for a medical appointment or service, and the Transportation Provider has waited at least 10 minutes past the time of scheduled pick-up: 
1)	The Transportation Provider must notify the Broker of their intention to leave the pickup location, prior to leaving.  
2)	The Broker shall have procedures in place and shall address and assist the Member whose medical appointment or treatment has gone past the time of the scheduled pick-up and the Transportation Provider has left the pick-up location. 
3)	Upon notification that the Member is available for their return Trip, the Broker shall make arrangements to have a Vehicle available to return to pick up the Member within 60 minutes of notification. 
C.	The Broker shall be responsible for arranging for back-up Vehicles and/or personnel when notified by a Member, medical/Transportation Provider, or the Agency that a Vehicle is Late (30 or more minutes), is otherwise unavailable for services, or when specifically requested by the Agency.  The Vehicle is Late if it is thirty (30) or more minutes Late in meeting its assigned schedule.
7.	Work with the Transportation Provider to group Trips, often called “shared rides,” to promote efficiency, and cost effectiveness.  However, increased travel time for a shared ride (one way trip) shall not exceed by more than sixty (60) minutes when compared to the time that would normally be taken if the Member was the sole person being transported.  
8.	Have in route a back-up Vehicle for a Late (30 or more minutes) or an otherwise unavailable Vehicle within thirty (30) minutes after a Vehicle has been deemed unavailable for any reason.
9.	Not require Members who are Ambulatory and can walk unassisted to walk more than one-half (1/2) of a mile one way during the Trip.
10.	Develop procedures to accommodate scheduling changes, rider no-shows and Late (30 or more minutes) running Transportation Provider Vehicles.  Medicaid Members may not be billed a fee for “no shows.”  Rather, the Broker shall identify such Members and report them to the IME on a monthly basis. 
11.	Recognize that residents/Members residing at Nursing Facilities (NF) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF ID), the NF and/or ICF ID is responsible for arranging and transporting Members within 30 miles of the facility (one way). However, when the facility residents/Members require transportation beyond 30 miles one way, the NEMT Broker shall be responsible for arranging NEMT Services and reimburse the Member’s Trips. 

1.3.2.4  Denial of Service
a.	Broker may deny requests for NEMT services only when one or more of the denial criteria set forth in 441 Iowa Admin. Code § 79.13(2) and (3) are met.
b.	When the Broker denies a request for NEMT services because of a denial criterion, the Broker shall verbally notify the Member the same day and then enter the reasons for the denial in its database.
c.	When the Broker denies a request for NEMT services because of a denial criterion, the Broker shall generate and mail a notice of decision (NOD) letter to the Member no later than the next Business Day following the date of denial.  The NOD shall identify the reason or reasons for the denial and the Member’s right to Appeal the decision.  The Agency may add, modify, or delete denial procedures without additional payment to the Broker or a contract amendment being required.  The following list highlights denial criteria: 
1.	The requested NEMT was not a Medicaid–covered benefit for the individual on the date of request, per 441 Iowa Admin. Code § 78.13(249A). 
2.	Individual requested transportation to a medical Provider who is not enrolled in the Iowa Medicaid program (including any Iowa MCO or HMO providers), per 441 Iowa Admin. Code § 78.13(249A).
3.	Individual requested transportation to a destination for a purpose other than the delivery of a Medicaid Covered Service, per 441 Iowa Admin. Code § 78.13(249A).
4.	Individual did not contact the Broker consistent with 441 Iowa Admin. Code § 78.13(3)(a)(1)-(3). 
5.	Individual requested transportation to a destination other than the closest qualified Medicaid Provider, and does not comply with the requirements in 441 Iowa Admin. Code § 78.13(3)(f). 
6.	For mileage reimbursement, a copy of the driver’s license and/or proof of automobile insurance were not received from the driver, was expired, or was illegible, per 441 Iowa Admin. Code § 78.13(3)(c)(3). 
7.	The Member refused the most appropriate and economical mode of transportation. 
8.	The Broker was unable to verify that a medical appointment exists (persons contacted at medical office are listed on the NOD including dates and times).
9.	The Member resides in a nursing facility or intermediate care facility for the intellectually disabled and the destination of the requested transportation is within 30 miles of the facility, thereby, the facility is responsible for the transportation, per 441 Iowa Admin. Code § 78.13(2)(c). 
10.	The Member requested mileage reimbursement for an amount different than amount documented in the Broker’s Mileage Reimbursement Policy  as described in Contract Section 1.3.2.10 Broker Payment Obligations.
11.	The Member requested meals and/or lodging reimbursement for an amount different than amount documented in the Broker’s Meals and Lodging Policy and identified in 441 Iowa Admin. Code § 78.13(3).
12.	Meals and Lodging reimbursement request did not include all information required on the Meals and Lodging Claim form (form 470-4991) and/or without receipts.
13.	Reimbursement request form(s) (form 470-0386 and/or 470-4991) were not signed by an Iowa Medicaid Provider.
14.	Claim submitted exceeds the time period permitted for claim submission.  441 Iowa Admin. Code § 78.13(3)(i). 

1.3.2.5.1  	Transportation Providers.
a.	The Broker shall establish a network of Transportation Providers to deliver NEMT Transportation Services to eligible Members. Transportation Providers must meet CMS requirements, including, but not limited to:
i.	A) Each provider and individual driver is not excluded from participation in any federal health care program (as defined in section 1128B(f) of the Act) and is not listed on the exclusion list of the Inspector General of the Department of Health and Human Services; 
ii.	(B) Each such individual driver has a valid driver’s license; 
iii.	(C) Each such provider has in place a process to address any violation of a state drug law; and 
iv.	(D) Each such provider has in place a process to disclose to the state Medicaid program the driving history, including any traffic violations, of each such individual driver employed by such provider, including any traffic violations.
b.	The Broker shall secure sufficient Transportation Provider resources (numbers and types of Vehicles and drivers) under service agreements so that the failure of any Transportation Provider to perform will not impede the ability of the Broker to provide NEMT services in accordance with the requirements of the Contract. The Broker shall provide specific counts on Vehicles, driver’s, Transportation Providers, and other information prior to the Operations Phase and annually thereafter specific to Counties and regions. 
c.	The Broker shall utilize Public Transit agencies, private transportation agencies, and may develop and use Volunteers.  The network of Transportation Providers shall also include other transportation alternatives, such as the services of Specialized Medical Vehicles (SMV).  SMV may include, but is not limited to Wheelchair Accessible Vehicles, stretcher vans, and Ambulances used in a non-emergency manner.  
d.	The Broker shall ensure that Transportation Providers meet all driver standards and Vehicle standards, as well as deliver the required Transportation Services.  See Attachment 3.1.1 and 3.1.2.  The Broker may establish additional standards, as long as such standards are not inconsistent with the standards set forth in Attachment 3.1.1 and 3.1.2.   Any additional standards require written approval by the Agency.  The Broker shall ensure that driver standards are maintained at all times, regardless of the form of transportation.  Any driver other than a Volunteer receiving two (2) or more Grievances from passengers concerning standards in Attachment 3.1.1, within a five (5) Business Day period must not be utilized until an approved corrective action plan is implemented.  All Grievances shall be documented and if valid, become a part of the driver’s permanent record maintained by the Broker.

1.3.2.5.2 Service Agreements With Transportation Providers
 
The Broker shall only enter into service agreements with transportation providers that are currently certified by the Agency, Department of Transportation, or are certified by the State of Iowa, in the case of non–emergency Ambulance services and maintain an active valid registration through the term of the service agreement with the Broker. The Broker is prohibited from establishing or maintaining service agreements with transportation providers which have been determined to have committed fraud of a State or federal Agency or been terminated from the Iowa Medicaid program. The Broker must have a process for terminating a service agreement with a transportation provider. The Broker must terminate a service agreement with a transportation provider when substandard performance is identified or when the transportation provider has failed to take satisfactory corrective action within a reasonable time period. The Agency reserves the right to direct the Broker to terminate any service agreement with a transportation provider when DMMA determines it to be in the best interest of the State.Medicaid funds may not be used to pay for NEMT services that are otherwise available without charge. In addition, Medicaid is the payer of last resort. The Broker is encouraged to utilize federally funded and public transportation whenever possible if it is cost-effective, and to negotiate service agreements with such entities when appropriate. 

The Broker shall submit a copy of its standard service agreement with the transportation providers to the Agency as part of the proposal. The Agency must approve the standard service agreement and all of its provisions, including penalties and sanctions, in advance. The Agency must be notified and approve any amendments to the standard service agreement, excluding rates. 
The service agreement shall include, at a minimum, the following requirements as specified in this RFP: 

a. Scope of Service; 
b. Levels of transportation; 
c. Reimbursement and payment administration; 
d. Service agreement effective dates; 
e. IT system requirements; 
f. Companion and Attendant services; 
g. Broker’s Policy and Procedures; 
h. Financial penalties; 
i. Report requirements; 
j. Records retention; 
k. Accident reporting and investigation; 
l. Grievance investigation and resolution; 
m. Provider Grievance procedure; 
n. Communication requirements; 
o. Telephone & Vehicle communication systems; 
p. Computer requirements; 
q. Scheduling; 
r. Pick-up and delivery standards; 
s. Urgent Care; 
t. Driver qualifications; 
u. Driver conduct; 
v. Vehicle requirements; 
w. Back-up service; 
x. Quality assurance and performance standards; 
y. Non-compliance with standards; 
z. Training for drivers and Attendants; 
aa. Confidentiality of information; 
bb. Specific provision – that in the instance of default by the Broker, the agreement will pass to the Agency or its agent for continued provision of Transportation Services. All terms, conditions and rates established by the agreement shall remain in effect until or unless renegotiated with the Agency or its agent subsequent to default action or unless otherwise terminated by the Agency at its sole discretion; 
cc. Indemnification language to protect the State; 
dd. Required certification of small businesses, minority-owned businesses, and women-owned business, if applicable; 
ee. Health Insurance Portability and Accountability Act (HIPAA) requirements; 
ff. Evidence of adequate insurance; and 
gg. Submission of documentation as required by the Agency 
These requirements are applicable when transportation providers are used. The requirements will vary when public transportation, gas reimbursement, or other appropriate Transportation Services are used.

1.3.2.6  	Volunteers
a.	Broker shall reimburse Volunteers only on basis of mileage unless an alternative method is approved by the Agency in advance of the Trip.  
b.	The Broker shall develop Volunteer services as part of their responsibility to provide NEMT services throughout the state.  
c.	Use of Volunteer transportation shall not alleviate the Broker’s responsibility to ensure the safety, comfort and appropriate mode of transportation to meet the Member’s health care needs.  
d.	The Broker shall ensure that all Volunteers and Vehicles used to provide Volunteer transportation are properly licensed, insured and inspected and that Volunteer drivers and Vehicles meeting all driver and Vehicle standards set forth in Attachment 3.1.1 and 3.1.2.

1.3.2.7  Transportation Provider Orientation and Training
a.	The Broker shall provide a Transportation Provider training program, which shall include the following at a minimum:
1.	An overview of the NEMT program and division of responsibilities between the Broker and the Transportation Provider;
2.	Vehicle requirements;
3.	Procedures for handling Accidents, Incidents, moving violations and Vehicle breakdowns;
4.	Driver qualifications;
5.	Expected driver conduct;
6.	Scheduling procedures during regular operating hours, including criteria for determining the most appropriate mode of transportation for the Member;
7.	Scheduling procedures for after hours, weekends, and holidays;
8.	Procedures for handling Urgent Trips;
9.	Criteria for Trip assignments;
10.	Dispatching and delivery of services;
11.	Procedures for obtaining reimbursement for authorized Trips;
12.	Driver customer service standards and requirements during pickup, transport, and delivery;
13.	Record keeping and documentation requirements for scheduling, dispatching and driver personnel, including completion of required transportation logs if required by law or rule;
14.	Procedures for handling Appeals and Grievances from Members and Providers;
15.	Procedures for notifying Members when services are denied or terminated by the Broker;
16.	Criteria and procedures for documenting and notifying Members when services are denied or terminated by the Transportation Provider; 
17.	Training on fraud, waste, and abuse, and whistleblower training for staff and subcontractors
18.	Any additional training standards the Broker may establish and implement for categories of Transportation Providers, subject to Agency approval. 

1.3.2.8 Quality Assurance 
The Broker shall provide assurance that transportation providers meet health and safety standards for Vehicle maintenance, operation, and inspection; driver qualifications and training; Member Grievance resolution; and the delivery of courteous, safe, and timely Transportation Services. The Broker is responsible for all transportation provided by transportation providers. The Broker shall develop, implement and maintain a Performance Monitoring Plan. The Broker shall assure that all provided services comply with all applicable State and Federal laws and regulations. The Broker shall monitor their transportation providers to ensure compliance with the terms of their service agreements State of Iowa transportation provider related requirements of this RFP including driver requirements, Vehicle requirements, Grievance resolution and delivery of courteous, safe, timely and efficient Transportation Services. Monitoring activities shall include but not be limited to: 
a. On-Street observations; 
b. Random audit of existing rides performed (minimum 10% of Trips) 
c. Accident/Incident reporting; 
d. Statistical reporting of Trip characteristics 
e. Analysis of Grievances, including the tracking and investigating of Grievances and disposition of the cases; 
f. Driver and Attendant licensure, driving record, background checks, experience and appropriate driver training; 
g. Member safety; 
h. Completion of driver logs and inspection of manifests; 
i. Vehicle inspections, insurance coverage, maintenance, etc.; 
j. Monitoring of on-time performance; 
k. Monitoring responsiveness to Member’s requests for transportation rides; and 
l. Monitoring condition of Vehicles. 

1.3.2.9 NEMT Grievance & Appeal System.
The Broker shall provide Agency-approved communications on the Grievance and Appeals process and inform Members how to access the Agency’s fair hearing system.
a.	Account Manager: The Account Manager shall receive and track all NEMT Transportation provider Grievances and Appeals.  
b.	Member and Provider Notice of Adverse Action:  The Broker shall notify the requesting Member of any decision to deny a Service Authorization request, or to authorize a service in an amount, duration, or scope that is less than requested.  The Broker’s notice shall conform to Agency format and verbiage requirements.
c.	Member Grievance or Appeal Process: General Requirements:  
1.	The Broker shall give Members information on completing forms and other procedural steps associated with any Grievance, Appeal, or Fair Hearing process.   
2.	The Broker shall provide interpreter services and toll-free numbers with TTY/TDD and interpreter capability in association with any Grievances.   
3.	The Broker shall provide a full and complete explanation of the process to the Member.  After a Grievance has been reviewed, the Broker shall:    
i.	Research the issue and make a determination. 
ii.	Upon the Member’s request, the Broker will respond to the Member of the disposition of the Grievance, in writing, within seven Business Days of receipt, in a format approved by the IME.
iii.	In the written response, the Broker shall have information informing the Member of the availability of the State fair hearing process for any Adverse Action taken against the Member. 
d.	Record keeping and reporting.  The Broker shall maintain records of all Grievances and Appeals to the State Fair Hearing process.  Broker shall make such records available to the Agency upon request. 
f.	Access to State Fair Hearing.  The Broker shall provide information regarding the State Fair Hearing process and the availability of the process to any Member.  The Broker shall assist the Agency in any NEMT State Fair Hearing.
g.	Transportation Provider Arbitration. The Broker shall include a clause in its standard Transportation Provider agreement that affords Transportation Providers the right to bring disputes to binding arbitration following completion of the Broker’s internal Grievance process.  Binding arbitration shall be conducted free of charge by state staff of the Agency.  The decision of the state staff arbitrator shall be final and binding on the parties.

1.3.2.10 	Broker Payment Obligations.
a.	Claims Payment.  The Broker shall reimburse all NEMT claims to Transportation Providers and Members/Individuals/Volunteers, including claims for mileage, meals, and lodging.  The Broker shall also comply with all state and federal tax reporting laws in relation to such payments.
b.	Mileage Reimbursement.  The Broker shall reimburse for mileage costs incurred by Medicaid Members/Individuals/Volunteers consistent with 441 Iowa Admin. Code § 78.13.  
c.	Related Travel Expenses.  The Broker shall reimburse related travel expenses consistent with 441 Iowa Admin. Code § 78.13.  The Broker shall require receipts for reimbursement of all related travel expenses. 
d.	Commercial Airline Tickets.  The Broker shall reimburse commercial airline tickets for Members and an Escort, if necessary, when required to allow Members to receive Medicaid Covered Services.
e.	Taxi/Auto Rental.  The Broker shall reimburse Taxi and auto rental when such costs are necessary to meet the Member’s need.  The Broker shall reimburse auto rental or the rental of other special Vehicles when public or ordinary means of transportation are not available to the Member or when such public or ordinary means of transportation does not meet the Member’s medically necessary needs.
f.	Meal Reimbursement. The Broker shall reimburse for meals incurred by Medicaid Members/Individuals/Volunteers and an Escort if necessary, consistent with 441 Iowa Admin. Code § 78.13.  
g.	Lodging Reimbursement.  The Broker shall reimburse for Lodging costs incurred by Medicaid Members/Individuals/Volunteers and an Escort, if necessary, consistent with 441 Iowa Admin. Code § 78.13.  
h.	Parking. The Broker shall reimburse for Parking costs incurred by Medicaid Members/Individuals/Volunteers and an Escort, if necessary, consistent with 441 Iowa Admin. Code § 78.13.  

1.3.2.11 Member Management.
a.	The Broker shall leverage and coordinate efforts with other funding sources, programs, and resources including but not limited to, the Agency’s managed care originations (MCO’s), local, county, state, federal, private, for-profit, and nonprofit entities, such as:
1.	Local hospitals and Emergency Departments (ED);
2.	Accountable Care Organizations (ACO’s);
3.	Primary Care Case Management (PCCM) Providers;
4.	Patient-Centered Medical Home (PCMH) and Health Home Providers;
5.	PCMH & Health Home Community Care Teams; and
6.	Other area social service providers.
b.	The Broker shall establish linkages with community programs to coordinate activities with existing programs serving the program population and to minimize or avoid duplicate efforts and fragmentation of services to the same consumers.  These linkages may include referral protocols, or formal written coordination agreements with such programs.  These resources will also aid the Broker in determining appropriate strategies to ensure safe transportation for Members with behavioral challenges and other issues that could affect the safety and comfort of drivers and other passengers.
c.	The Broker shall ensure that all qualified Members have access to appropriate services and may not deny services based on conduct of the Members.  The Broker may, at its discretion, choose to use a less cost effective mode of transportation if determined necessary based on a Member’s conduct.  Only the Agency can place a restriction of mileage reimbursement consistent with 441 Iowa Admin. Code § 78.13(3)(h). 

1.3.2.12  Maintain Telephone Call Center/Office
a.	The Broker shall maintain a call center/office.  All documentation must reflect the Broker’s address, local and toll free telephone number.  The location must meet the wiring specs for connectivity with Agency systems.  The Broker shall bear the expenses of connecting to Agency systems and will provide first-level computer/technical support for those systems.  
b.	The Broker shall have the capacity to send and receive facsimiles at the office/call center at all times during Business Hours. Fax servers with multiple lines are required. The Broker’s call center/office shall be equipped with an adequate high-speed internet connection.  The successful Bidder shall take control of the following call center telephone lines on January 1, 2023:
1.	Call Center Number 		1-866-572-7662
2.	Call Center Fax			1-866-584-7601
3.	Call Center Administration	1-866-584-7597
c.	The Broker shall provide a separate administrative telephone number that enables the IME staff to reach the Account Manager and other key staff directly.  
d.	The Iowa Call Center shall begin operations no later than 8:00 AM, and end operations no earlier than 5:00 PM Monday-Friday, excluding State holidays.  The Broker shall create and maintain a system by which a Member with immediate transportation needs, such as a Hospital Discharge, may reach a Customer Service Representative (CSR) with the ability to facilitate transportation 24/7.
e.	The Broker shall handle calls outside of normal Business Hours and may utilize a secondary call center, located within the United States, to handle calls received outside of operational hours.  The Broker shall utilize the same software and database as the primary center should a secondary call center be used by the Broker.
f.	The Broker shall utilize an automated call distribution (ACD) system with reporting functionality.  This system shall:
1.	Have an Integrated Voice Response (IVR), a system that answers all calls in three rings or less.  Additionally, the IVR message must include recorded instruction to callers with emergency medical issues to hang up and call 911.
2.	Include a menu system that prioritizes and routes calls based on the reason for the call, including but not limited to separate queues for routine scheduling, urgent same day scheduling, and billing questions.  The Broker may choose to utilize additional queues to best manage its call volume.  
3.	Ensure that telephone interpreter services are accessible via the toll-free number and service providers, Members, or facilities can be involved in three-way conversation with an interpreter service without having to make an additional call. The Broker shall comply with the language requirements of this Section.
4.	Record, and report the following at a minimum:
i.	Number of calls received in a defined period;
ii.	Number of calls answered in a defined period;
iii.	Average wait time in queue for callers in a defined period;
iv.	Number of calls abandoned in a defined period;
v.	Number of calls placed on hold in a defined period;
vi.	Average hold time in a defined period; and
vii.	Be scalable to allow for increases and decreases in call volume.
g.	The Broker shall maintain all toll free numbers in such a way as to ensure that the Agency’s continued use of the toll free numbers shall not be interrupted or impeded.  The Broker shall transfer the toll free numbers back to the Agency upon request and without cost to the Agency.
h.	The Broker shall be responsible for all costs associated with maintaining the toll-free numbers during the term of the Contract as well as for all costs accrued or due and owed as of the date of termination or expiration of the Contract, including but not limited to any taxes, penalties or fines.
i.	The Broker shall provide the Agency direct access to the call center phone system, at any time, from the IME.  The Broker will provide access to at least three (3) IME staff so IME staff will be able to listen in, review and audit NEMT phone calls at any time and at the Agency’s discretion. 
j.	The Broker’s phone system shall be able to provide an automated customer service survey available at the end of each phone call. The Agency will work with the Broker in developing and modifying the customer service survey.  The automated phone customer service survey must have Agency approval.  
k.	Language and Alternate Communication.  The Broker shall ensure that the communication needs of all Members are addressed.  The Broker’s obligations in this regard include but are not limited to providing access to interpreter or translation services at no cost to the Members or the Agency.
l.	Alternate Communication Devices.  The Broker shall acquire and maintain the necessary equipment and/or resources and train staff in the use of equipment and resources, to answer calls using a Telecommunication Device for the Deaf (TDD), such as a teletypewriter (TTY) or other Agency-approved method.  Staff shall also be proficient in the protocols of using a relay service for the deaf and hard of hearing.  
m.	Alternative Communication Methods.  The Broker shall develop alternative methods for interacting with Members in order to schedule appointments, receive Member feedback, etc., as is necessary for the proper communication with Members.  Examples of such methods include but are not necessarily limited to: secure, HIPAA-compliant email, instant message, and/or internet web site.  
n.	Prior Agency Approval of Communication Methods.  The Broker shall not use any method of Member communication in production until those communication methods have been approved by the Agency and cleared by the Agency’s Security and Privacy Officer.  

1.3.3  Turnover
The turnover phase is activated when the state contractually transfers responsibility for the operations function to a new entity (such as a newly awarded contractor). The Broker shall fully cooperate during the turnover responsibility that comes at the end of the contract term, including full compliance with the Agency approved turnover plan.  This phase will begin 12 months before the end of the contractor’s operations phase and end six months after the end of the contract period or as extended by the exercise of contract provisions or amendments to the contract. The contractor must prepare for turning over responsibilities and operations at the end of the contract. The contractor must cooperate with the successor contractor, other contractors and the Agency in the planning and transfer of operations. The final contract payment will be based on the contractor meeting all turnover Deliverables and must receive approval from the Agency.

1.3.4  General Obligations Applicable to All Phases.
1.3.4.1  Staffing
a.	The Broker shall maintain sufficient levels of supervisory and support staff with appropriate training and work experience to perform all Contract requirements on an ongoing basis. The Agency shall have the right to require reassignment or removal of any staff found unacceptable by the Agency. 
b.	Account Manager.  The Broker shall appoint and maintain, subject to written IME approval, a full time Account Manager for this Contract.  The Account Manager shall have sufficient authority for resource control to manage the allocation of resources needed to meet all contractual obligations without service interruption to Iowa Medicaid Members.  The Account Manager and supervisory personnel must be available to Broker staff in person or by telephone with fifteen (15) minute response time during all hours of operation.  The Agency retains authority at all times to require removal and replacement of the Account Manager.  
c.	Key Staff.  The Broker shall hire, or assign, qualified staff to the following positions for purposes of managing the Iowa NEMT program for the duration of the Contract.  Each position is not required to be filled by one individual, unless identified as such, but someone in the organization must be designated as Iowa’s Senior Manager for these specific areas. 
1.	Iowa Senior Manager of Call Center Operations.
2.	Iowa Senior Manager of Education and Training 
3.	Iowa Senior Manager of Information Systems.
d.	Customer Service Representatives (CSRs).  The Broker shall maintain sufficient staffing levels to answer calls, schedule Trips, verify Trips, receive and reimburse claims, within the defined requirements of this Scope of Work and meeting all performance measures. 

1.3.4.2  Meetings
The Broker shall be available to meet in person with any Agency representative at the IME, at least monthly and upon request by the Agency to discuss the NEMT program and answer pertinent inquiries regarding the program, its transition, and its operational phases. The Broker shall attend other meetings as directed by the Agency.

1.3.4.3.1  Communication
a.	The Broker shall ensure that all standard communication issued by the Broker in relation to the NEMT Brokerage meets all Agency requirements, including but not limited to prior Agency approval of the standard communication language (including scripts) and inclusion of Agency form numbers on the standardized document template.
b.	The Broker shall provide a minimum of 30 days’ written notice to Members of a policy or process change. 
c.	The Broker shall provide educational information and material to Members through IME approved venues.   
d.	The Broker shall maintain a live Member Education Plan or written materials available to Members.  The Broker shall update the plan within ten (10) Business Days after the Agency has approved any NEMT program or policy change.
e.	The Broker shall assure that all Member educational materials are written in a 6th grade reading level or less and are available in the predominate foreign languages in the region, as well as made available in alternative formats as required by Members with special needs and/or visual impairments.  The Broker shall assure that all informational Member mailings include a Census Language Identification Flashcard offering translation services to non-English speaking Members seeking or receiving NEMT services.  
1.3.4.3.2 Communication Specific to Website, Including Member And Provider Online Portals
The Broker shall provide and maintain an Internet website or multiple websites for Iowa’s Members and transportation providers to access information pertaining to the Broker’s NEMT services. The Broker will continually update the website(s) to add increased functionality. The website(s)’ design and content must be presented in a user friendly, intuitive manner and provide for the information and content to be viewed and/or downloadable. The Broker shall update the website as needed to reflect changes and revisions in the NEMT services program. Updates to the website must be applied within three (3) Business Days of receipt of State approved content changes. Any non-availability of the website must be addressed within one (1) hour of discovery.
a.	The Broker’s website shall provide, at a minimum, the following information for transportation providers:
1.	Information on how to apply to become a transportation provider; 
2.	Provider reimbursement information; 
3.	Central business office address, phone, and fax number; 
4.	Directions to the Broker’s central business office and office hours; 
5.	Frequently asked questions (FAQ); 
6.	NEMT policies, procedures, and a copy of the Broker’s provider manual; 
7.	Transportation provider meeting/training dates, time, and locations; 
8.	Sample reporting requirements, instructions, and templates as applicable; 
9.	Transportation provider education and training plan updates; and 
10.	Any other information as determined appropriate by the State.
b.	The Broker’s website shall provide, at a minimum, the following information for Members: 
1.	Call center contact information, including information for after-hours and holiday assistance; 
2.	Description of Transportation Services available and how to access them; 
3.	How to file a Grievance or Appeal; 
4.	Translation assistance; 
5.	Copies of written Member materials; 
6.	Member rights; 
7.	Links to other web sites as determined by the State; 
8.	Frequently asked questions (FAQ), including definitions; and 
9.	Any other information as determined by the State.
c.	The Broker shall submit any website content specific to Iowa’s NEMT program to the Agency for review and approval prior to posting the information on the website.
d.	The Broker shall maintain, as part of the Member website, an online scheduling tool for clients to view their Trip information and schedule/change Trips.
e.	The Broker shall disseminate an initial Member notice on the IME letterhead informing Members of the new contract and Broker if appropriate, effective January 1, 2023.  The letter shall also discuss the availability of NEMT services, including the Broker’s name, address, telephone numbers, and hours of operation, as well as a brief description of how to utilize the Broker to arrange for NEMT services.  The notice shall also provide contact information for the broker and IME Member Services Unit if Members wish to lodge a Grievance. The Broker shall mail the notice on or around December 1, 2022, to all Members who have used the program since April 1, 2022.  A copy of this letter shall also be posted to the Brokerage website. 

1.3.4.4  Reporting.  
The Broker shall comply with the following reporting obligations.  All reports shall be accurate and to the extent applicable, monthly, calendar year to date, SFY to date, and previous 12 month figures.
a.	Database Reporting.  The Broker shall report the following information on a monthly basis, no later than 15 days after the end of each month:
1.	The number of non-duplicative Members who received at least one Trip during the month;
2.	The Member utilization rate, total eligible Members divided by non-duplicative Member Trips;
3.	The number of Trips approved, denied, and pending further information (on last day of the month). The Broker shall also provide a description of why Trips were denied or pending;
4.	The total non-duplicative (number of individuals) Members who were late (not on time) for their medical appointments and the percentage that were late for the month (Total Members who were late divided by the total number of Members who were provided a ride);
5.	The total number and percentage of Trips that were late (not on time) for medical appointments; (Total Trips that were late divided by the total number of Trips provided) 
6.	The names of the Members and the number of Members picked up more than twenty (20) minutes late;
7.	The names of the Members and the number of Members who were late due to medical overages and the average time to pick-up;
8.	The names of the Transportation Providers and the number of Transportation Providers who identified unforeseen circumstances that prevented them from picking up before or returning to pick up the Member after the appointment;
9.	The number of non-duplicative (individual Member) NF and ICF ID Members Trips per month;
10.	The number of total NF and ICF ID Member Trip’s per month;
11.	The number of non-duplicative (individual) Escort Trips per month;
12.	The number of total Escort Trips per month;
13.	The number of new Members scheduling Trips as Mileage Reimbursement; and
14.	The number of new Members scheduling Trips as non-Mileage Reimbursement. 

b.	General Reporting.  The Broker shall report the following information on a monthly basis, no later than 15 days after the end of each month:  
1.	The total number of Trips and total amount paid to transportation providers, monthly by mode of transportation (including mileage reimbursement);
2.	The Members and their Trips over 30 miles, one way, whether it is by mileage reimbursement or a different mode of transportation and total dollars dispersed;
3.	The total number of meals purchased, by category (breakfast, lunch, dinner) and total dollars dispersed;
4.	The total number of nights lodging reimbursed each month and total dollars paid;
5.	The total number of airline tickets purchased or reimbursed each month and total dollars paid;
6.	The total number of parking claims each month and total dollars paid;
7.	The total number of Taxi Trips each month and total dollars paid;
8.	The total number of auto rentals each month and total dollars paid;
9.	The Member and total number of Hospital Discharges each month; and
10.	The number of Urgent Care Trips.

c.	Claims Paid Reporting.  The Broker shall report the following information on a monthly basis, no later than 15 days after the end of each month:  
1.	The total number of claims and total amount paid to transportation providers each month;
2.	The number, percentage, and dollar amount of reimbursement and Transportation Providers paid each month;
3.	The number, percentage, (the number of claims paid within time period divided by the number of claims received in the same time period) and dollar amount of claims paid within ten (10) Business Days of receipt of complete and valid claim form;
4.	The number, percentage, (the number of claims paid within time period divided by the number of claims received in the same time period) and dollar amount of claims paid within fifteen (15) days of a complete and valid claim form;
5.	The total number and dollar amount of claims denied;
6.	The number and percentage of NOD’s mailed to Members for full and partial claim denials; and
7.	The number and percentage of denial types/criteria as identified in Section 1.3.2.4 Denial of Service.

d.	Appeals, Grievances, and State Fair Hearings Reporting.  The Broker shall report the following information on a monthly basis, no later than 15 days after the end of each month:  
1.	The number of Grievances and Appeals each month and the type of each.
2.	The number of Members requesting a State Fair Hearings each month and the number of hearings held each month.  The Broker shall also identify the reasons for Appeals.
3.	Of the actions/claims Appealed, the Broker shall track and report the final outcome:
i.	Affirmed.
ii.	Reversed.
iii.	Decision modified.
iv.	Broker settled prior to hearing.
v.	Member withdrew.
vi.	Member abandoned.
vii.	Broker abandoned.
viii.	Director’s Review: numbers and outcomes.

e.	Monthly Call Center Reporting.  The Broker shall report the following information on a monthly basis, no later than 15 days after the end of each month:  
1.	The total number of incoming calls per month.
2.	The number of incoming calls answered by the IVR and the percent rate.
3.	The number of outbound calls per month.
4.	The average time from when the call was answered to when the caller talks to a live person.
5.	The abandoned calls statistics such as number of abandoned calls and the percent rate.
6.	The average queue time (minutes).
7.	The average talk time (minutes).
8.	The total calls received after hours.
9.	The results of the monthly automated phone customer service survey will be reported. The list below is not all inclusive but does contain some of the required reporting elements: 
i.	The number and percentage of Members who participated in the phone customer service survey each month.
ii.	On a scale of 1 – 5, with 5 being extremely satisfied, the monthly average score for CSR friendliness and helpfulness. 
iii.	On a scale of 1 – 5, with 5 being extremely satisfied, the monthly average score for the overall experience.

f.	Education and Training/Inspection Activities Reporting.  The Broker shall report the following information on a monthly basis, no later than 15 days after the end of each month:  
1.	The total number of Transportation Provider trainings provided during the month and the number of attendees at each training.  The Broker shall also write a brief summary of the training(s) and Transporter feedback. 
2.	The total number of Transportation Provider inspections provided during the month and the names of all Transportation Providers inspected in the reporting period. The Broker shall also identify issues or corrective action plans developed and implemented as a result of inspection(s).   
3.	The number and type of Member education activities the Broker participated in during the month. The Broker shall write a brief summary and any feedback received from the activity. 

g.	Reports Of Accidents And Moving Violations 
1.	The Broker shall notify the Agency or its agent immediately of any Accident resulting in driver or passenger injury or fatality while delivering services under this contract. The Broker shall file a written Accident report with the Agency within ten (10) working days of the Accident and will cooperate with the Agency during any ensuing investigation. A police report is also required as supporting documentation. The Broker shall notify Agency immediately of any moving violations that occur while delivering services under this contract. The Broker must provide a copy of the police report within ten (10) working days of the moving violation. 
2.	The Broker shall maintain copies of each Accident report in the files of both the Vehicle and the driver involved in the Accident. Police reports associated with moving violations must be maintained in the file of the responsible driver. 
3.	The requirements in this section must be incorporated in all service agreements between the Broker and transportation providers

1.3.4.5  Broker Contract Management.
The Broker shall comply with the following contract management activities:
a.	Developing an operational procedures manual for the Agency’s review and approval, in the format required.  
b.	Updating the operational procedures manual when changes are made, for the Agency’s review and approval, in the format required.
c.	Developing an electronic billing invoice and system that will allow Members/Individuals/Volunteers and Transportation agencies to bill electronically through the Internet or on paper.
d.	Providing reports necessary to show compliance with all performance standards and other contract requirements. 
e.	Providing to the Agency reports/updates regarding the Broker’s in state and out-of-state activities. 
f.	Providing effective and efficient communication protocols and lines of communication both internally and with Agency staff.  No action shall be taken which has the appearance of or effect of reducing open communication and association between the Agency and the Broker. 
g.	Refraining from using or participating in unapproved communication concerning the NEMT Brokerage.  
h.	Meeting regularly with the Policy/Contract Manager and/or other staff/units of the Agency to review account performance and resolve issues between the Broker and the Agency.  
i.	Working with the Agency to implement quality improvement procedures that are based on proactive improvements rather than retroactive responses.  The Broker shall participate in quality improvement procedures that may occur in response to critical situations and shall assist in the planning and use in operations of quality improvement procedures based on proactive improvement. 
j.	Explaining the problems and identifying the corrective action to improve the rating for any performance falling below a state-specified level, including:
1.	Implementing an Agency-approved corrective action plan within the timeframe negotiated with the Agency.
2.	Providing documentation to the Agency demonstrating the corrective action is complete and meets the state requirements.
3.	Meeting the corrective action commitments within the agreed upon timeframe. 
k.	Maintaining Agency-approved documentation of the methodology used to measure and report completion of all requirements and attainment of all performance standards. 

1.3.4.6  Program Integrity/Medicaid Fraud Control Investigations
The Broker shall fully participate with Program Integrity (PI) Unit and Medicaid Fraud Control Unit (MFCU), including providing information on Transportation Providers.   

1.3.4.7  Program Integrity & Disclosure Requirements.
The Broker shall comply with all Program Integrity & Disclosure Requirements as set forth in Attachment 3.1.4

1.3.4.8  Agency State Payment Recovery Rights.
The Broker shall recognize the Agency’s rights to recover state payments made through the NEMT brokerage.  Upon receipt of an Agency request to set off payments to a particular Transportation Provider, the Broker shall set off payments to the effected Transportation Provider to the fullest extent permitted by contractual obligations between the Broker and the Transportation Provider and return such set-off funds to the Agency.  The Broker’s agreements with Transportation Providers shall include an Agency-approved clause recognizing this Agency right to set off of payments.

1.3.4.9  Performance Measures 
Unless the Agency has stated otherwise, the Performance Measures identified below shall be met monthly. 

1.3.4.9.1  Performance Measures for Call/Service Center
a.	The Broker’s Call abandonment rate must be 5% or less. Calls are considered abandoned if the Member does not talk with a Customer Service Representative. 
b.	Average wait time of calls to be answered by a live person shall be less than three minutes 90% of the time.
c.	The Broker shall schedule and make transportation arrangements for same day mileage reimbursement Trips and Urgent Care Transportation Services 100% of the time.
d.	Members shall arrive on time for their medical appointments 95% of the time. 
e.	The Broker shall maintain a service level (SL) percentage of at least eighty percent (80%) for incoming calls. The SL will be calculated by the following formula:

SL = ((T – (A + B) / T) * 100)

Where		T = all calls that enter the queue
A = calls that are answered after 30 seconds
B = calls that are abandoned after 30 seconds
f.	The Broker shall respond to at least ninety percent (90%) of telephone inquiries, excluding billing inquiries, during the initial call. 
g.	The Broker shall respond to at least 90 percent of written, faxed, or e-mailed inquiries within three (3) Business Days of receipt excluding bill inquiries. If a complete response cannot be made within three (3) Business Days, provide an interim response within the first three (3) Business Days and every three (3) days thereafter until resolved. Provide final resolution of 100 percent of inquiries within 15 Business Days.
h.	The Broker shall assure that at least ninety five percent (95%) of bill inquiries will be responded to by phone or in writing within two (2) Business Days. One hundred percent (100%) of bill inquiries will be responded to by phone or in writing within three (3) Business Days.

1.3.4.9.2  Performance Measures for Reimbursements
a.	90% of all Transportation Providers and Member/Individual/Volunteer claims will be processed and paid, denied, or suspended within ten (10) Business Days of a complete and valid claim form. 
b.	100% of all Transportation Providers or Member/Individual/Volunteer claims will be processed and paid, denied, or suspended within fifteen (15) Business Days of a complete and valid claim form. 

1.3.4.9.3  Performance Measures for Education and Training
a.	The Broker shall inspect 100% of Network Transporters at least annually for compliance with Driver and Vehicle Standards identified in Sections 1.3.2.5, 1.3.2.7, and Special Contract Attachments 3.1.1 and 3.1.2.  The Agency may grant a waiver to the Broker for Transportation Providers who have low or no utilization during the previous year. The Broker shall deliver a written report, electronically, by September 15th of each year detailing the audits and any corrective action plans placed on Transport providers during the previous SFY that would have ended June 30th.  The Agency will post this report to the Agency’s website after the report is reviewed and approved. 
b.	The Broker shall, at a minimum, provide a one hour CSR staff training quarterly.  The Broker shall deliver a written report, electronically, by September 15th of each year detailing the subject matter that was taught, the date it was taught, and a summary of the training.  The Agency will post this report to the Agency’s website after the report is reviewed and approved.

1.3.4.9.4  Performance Measures for Timely Submission of Encounter Data
c.	The Broker shall submit complete and valid Encounter data on or before the 20th calendar day of each month, and in the 837 format prescribed by the Agency.  

1.3.4.10 Agency Monitoring, Review Clause.  
The Contract Manager or designee will:
•	Verify Invoices and supporting documentation itemizing work performed prior to payment;
•	Determine compliance with general contract terms, conditions, and requirements; and 
•	Assess compliance with Deliverables, performance measures, or other associated requirements based on the following:
The Agency Contract Manager or designee will: 
•	Verify Invoices and supporting documentation itemizing work performed prior to payment;
•	Determine compliance with general contract terms, conditions, and requirements; and 
•	Assess compliance with Deliverables, performance measures, or other associated requirements based on the following:
o	The Agency’s representative will perform at minimum monthly desk monitoring of Deliverables, reports, and results to determine the success of the Contractor.
o	The Agency’s representative will sign-off on completed Scope of Work items, provide feedback on progress and determine if other measures are required to ensure achievement of items approved and documented.

The Contract Manager or designee will use the results of monitoring activities and other relevant data to assess the Contractor’s overall performance and compliance with the Contract.  At a minimum, the Agency will conduct a review annually; however, reviews may occur more frequently at the Agency’s discretion.  As part of the review(s), the Agency may require the Contractor to provide additional data, may perform on-site reviews, and may consider information from other sources. 

The Agency may require one or more meetings to discuss the outcome of a review.  Meetings may be held in person.  During the review meetings, the parties will discuss the Deliverables that have been provided or are in process under this Contract, achievement of the performance measures, and any concerns identified through the Agency’s contract monitoring activities.  

1.3.4.11 Problem Reporting.  As stipulated by the Agency, the Contractor and/or Agency shall provide a report listing any problem or concern encountered.  Records of such reports and other related communications issued in writing during the course of Contract performance shall be maintained by the parties.  At the next scheduled meeting after a problem has been identified in writing, the party responsible for resolving the problem shall provide a report setting forth activities taken or to be taken to resolve the problem together with the anticipated completion dates of such activities.  Any party may recommend alternative courses of action or changes that will facilitate problem resolution.  The Contract Owner has final authority to approve problem-resolution activities.

The Agency’s acceptance of a problem report shall not relieve the Contractor of any obligation under this Contract or waive any other remedy.  The Agency’s inability to identify the extent of a problem or the extent of damages incurred because of a problem shall not act as a waiver of performance or damages under this Contract.  

1.3.4.12 Addressing Deficiencies.  To the extent that Deficiencies are identified in the Contractor’s performance and notwithstanding other remedies available under this Contract, the Agency may require the Contractor to develop and comply with a plan acceptable to the Agency to resolve the Deficiencies.

1.3.5  Contract Payment Methodology		 
a.	Initiation of Payments.  The Agency will pay the Broker starting on January 2, 2023 for providing NEMT services.  The Agency will not pay a separate Implementation fee or for other costs incurred by the Broker during the Transition Phase.  
b.	Operations Payments.  During Operations, the Agency will pay the Broker before the 15th day of the then current month based on Members currently eligible for NEMT services based on a breakdown of NEMT-eligible Members as detailed by the Agency’s fiscal department.  Adjustments to the number of eligible Members and categories of eligibility may be made at any time that the data is determined to be in error, and adjustments may either increase or decrease payments made to the Broker.  The Per-Member-Per-Month (“PMPM”) Capitated Rate paid to the Broker shall be the Broker’s sole compensation for providing NEMT Brokerage services under the Contract.

The PMPM Capitated Rate to be paid during each Contract period is as follows:
	Year 1  1/2/2023- 12/31/2023	Year 2  1/1/2024 - 12/31/2024	Year 3  1/1/2025 - 12/31/2025	Year 4 1/1/2026 - 12/31/2026	Year 5  1/1/2027 – 12/31/2027	Year 6  1/1/2028 – 12/31/2028	
PMPM							

c.	No later than 90 days after the close of each calendar year, the Broker shall report to the Agency the total amount paid to the Broker in capitated payments for the calendar year and the total amount paid out to third parties for providing transportation.  If the amount paid out in transportation claims is not 70% or greater, the broker shall refund to the Agency the difference between the percentage of capitation payments paid out in claims and the 70% floor.  For example, if in calendar year 2023 the Broker paid only 65% of capitation payments in transportation claims, the Broker would be obligated to repay 5% of capitation payments made during the year to the Agency (70% - 65% = 5%).  Repayment shall occur no later than 120 days after the end of the calendar year.
d.	Deliverables and Performance Measure Withholding Payment.  The Agency will withhold 5% of the Brokers monthly Capitated payments to assure the Broker meets required Deliverables and Performance Measures.  The Contractor shall submit monthly performance reports to accompany an Invoice for the withhold amount if all performance measures are met. Determination of whether performance measures have been met is strictly and solely at the discretion of the Agency.  
e.	Withholding of Final Capitated Payment.  The Agency may withhold the very last monthly capitated PMPM payment due the Broker at the end of the Contract until such time as the Broker has fully completed all Turnover activities and completely closed out the Contract.
f.	Unless otherwise agreed to by the parties in an amendment to the Contract that is executed by the parties, the Contractor shall not be entitled to receive any other payment or compensation from the State for any Deliverables provided by or on behalf of the Contractor pursuant to this Contract.  The Contractor shall be solely responsible for paying all costs, expenses, and charges it incurs in connection with its performance under this Contract. 

1.4 Insurance Coverage.  
The Contractor and any subcontractor shall obtain the following types of insurance for at least the minimum amounts listed below: 

Type of Insurance	Limit	Amount	
General Liability (including contractual liability) written on occurrence basis	General Aggregate

Product/Completed
Operations Aggregate

Personal Injury

Each Occurrence	$2 Million

$1 Million

$1 Million

$1 Million	
Automobile Liability (including any auto, hired autos, and non-owned autos)
	Combined Single Limit
	$1 Million	
Excess Liability, Umbrella Form	Each Occurrence

Aggregate	$1 Million

$1 Million	
Workers’ Compensation and Employer Liability	As required by Iowa law	As Required by Iowa law	
Property Damage
	Each Occurrence

Aggregate	$1 Million

$1 Million	
Professional Liability	Each Occurrence

Aggregate	$2 Million

$2 Million	

1.5 Data and Security.  If this Contract involves Confidential Information, the following terms apply:
1.5.1 Data and Security System Framework.  The Contractor shall comply with either of the following: 
•	Provide certification of compliance with a minimum of one of the following security frameworks, if the Contractor is storing Confidential Information electronically: NIST SP 800-53, HITRUST version 9, SOC 2, COBIT 5, CSA STAR Level 2 or greater, ISO 27001 or PCI-DSS version 3.2 prior to Implementation of the system and again when the certification(s) expire, or
•	Provide attestation of a passed information security risk assessment, passed network penetration scans, and passed web application scans (when applicable) prior to Implementation of the system and again annually thereafter.  For purposes of this section, “passed” means no unresolved high or critical findings.

1.5.2 Vendor Security Questionnaire.  If not previously provided to the Agency through a procurement process specifically related to this Contract, the Contractor shall provide a fully completed copy of the Agency’s Vendor Security Questionnaire (VSQ) (Attachment 3.1.5).

1.5.3 Cloud Services.  If using cloud services to store Agency Information, the Contractor shall comply with either of the following:
•	Provide written designation of FedRAMP authorization with impact level moderate prior to Implementation of the system, or
•	Provide certification of compliance with a minimum of one of the following security frameworks: HITRUST version 9, SOC 2, COBIT 5, CSA STAR Level 2 or greater or PCI-DSS version 3.2 prior to Implementation of the system and again when the certification(s) expire.

1.5.4 Addressing Concerns.  The Contractor shall timely resolve any outstanding concerns identified by the Agency regarding the Contractor’s submissions required in this section.

1.6 Contract Work Hours and Safety Standards Act.  The Contractor shall comply with the following contract provisions and related matters.

(b) Contract Work Hours and Safety Standards Act. The Agency Head shall cause or require the contracting officer to insert the following clauses set forth in paragraphs (b) (1), (2), (3), and (4) of this section in full in any contract in an amount in excess of $100,000 and subject to the overtime provisions of the Contract Work Hours and Safety Standards Act. These clauses shall be inserted in addition to the clauses required by [29 CFR] § 5.5(a) or § 4.6 of part 4 of this title. As used in this paragraph, the terms laborers and mechanics include watchmen and guards.
(1)  Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours in such work week unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such work week.
(2) Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth in paragraph (b) (1) of this section the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic, including watchmen and guards, employed in violation of the clause set forth in paragraph (b)(1) of this section, in the sum of $26 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph (b)(1) of this section.
(3)  Withholding for unpaid wages and liquidated damages.  The Agency shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contractor, or any other federally-assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph (b)(2) of this section.
(4)  Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses set forth in paragraph (b)(1) through (4) of this section and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs (b)(1) through (4) of this section.
(c)  In addition to the clauses contained in paragraph (b), in any contract subject only to the Contract Work Hours and Safety Standards Act and not to any of the other statutes cited in § 5.1, the Agency Head shall cause or require the contracting officer to insert a clause requiring that the contractor or subcontractor shall maintain payrolls and basic payroll records during the course of the work and shall preserve them for a period of three years from the completion of the contract for all laborers and mechanics, including guards and watchmen, working on the contract. Such records shall contain the name and address of each such employee, social security number, correct classifications, hourly rates of wages paid, daily and weekly number of hours worked, deductions made, and actual wages paid. Further, the Agency Head shall cause or require the contracting officer to insert in any such contract a clause providing that the records to be maintained under this paragraph shall be made available by the contractor or subcontractor for inspection, copying, or transcription by authorized representatives of the Agency and the Department of Labor, and the contractor or subcontractor will permit such representatives to interview employees during working hours on the job.

1.8 Incorporation of General and Contingent Terms.  
1.8.1 General Terms for Service Contracts (“Section 2”).  The version of the General Terms for Services Contracts Section posted to the Agency’s website at https://dhs.iowa.gov/contract-terms that is in effect as of the date of last signature in the Contract Declarations and Execution section, or a more current version if agreed to by amendment, is incorporated into the Contract by reference.  The General Terms for Service Contracts may be referred to as Section 2.  

The contract warranty period (hereafter "Warranty Period") referenced within the General Terms for Services Contracts is as follows:  The term of this Contract, including any extensions. 
1.8.2 Contingent Terms for Service Contracts (“Section 3”). The version of the Contingent Terms for Services Contracts posted to the Agency’s website at https://dhs.iowa.gov/contract-terms that is in effect as of the date of last signature in the Contract Declarations and Execution section, or a more current version if agreed to by amendment, is incorporated into the Contract by reference.  The Contingent Terms for Service Contracts may be referred to as Section 3.  

All of the terms set forth in the Contingent Terms for Service Contracts apply to this Contract unless indicated otherwise in the table below:

Contract Payments include Federal Funds?  Yes
{The items below will be completed if the Contract includes Federal Funds}  
The Contractor for federal reporting purposes under this Contract is a:  {To be completed when contract is drafted.} 
Office of Child Support Enforcement (“OCSE”) Funded Percentage:  {To be completed when contract is drafted.}
Federal Funds Include Food and Nutrition Service (FNS) funds?  {To be completed when contract is drafted.}
DUNS #:  {To be completed when contract is drafted.}
The Name of the Pass-Through Entity:  {To be completed when contract is drafted.}
CFDA #:  {To be completed when contract is drafted.}
Grant Name:  {To be completed when contract is drafted.}
Federal Awarding Agency Name:  {To be completed when contract is drafted.}  
	
Contractor a Business Associate?  Yes	Contractor a Qualified Service Organization?  Yes	
Contractor subject to Iowa Code Chapter 8F?  Unknown	Contract Includes Software (modification, design, development, installation, or operation of software on behalf of the Agency)? No	

Attachment 3.1.1: Driver Standards

SMV Driver Standards
The Broker is responsible for ensuring that Transportation Providers meet all RFP driver standards as well as deliver the required Transportation Services. The Broker may establish additional standards.  Any additional standards require written approval by the Agency. 
All drivers: 
a.	Must Possess a current valid driver’s license with no restrictions other than corrective lenses.
b.	Must have no limitation or restrictions that would interfere with safe driving.  This includes, but not limited to, medical conditions, ignition interlock restriction, or prescribed medication that would interfere with the safe, lawful operation of a motor Vehicle.
c.	Must pass a pre-employment drug screening.
d.	Must pass a Department of Criminal Investigation (DCI) background check prior to the start of employment, if required to do so by the Transportation Provider.  
e.	Must pass a child and dependent adult abuse background check, if required to do so by the Transportation Provider.
f.	Must be eligible to receive reimbursement and not an individual or entity identified on the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE) or the General Services Administration (GSA) System for Award Management (SAM).  Such individuals or entity’s are not eligible for payment from the Broker.  Also, any provider or individual who has been suspended by a State Medicaid Agency for Credible Allegation of Fraud, is not eligible for payment from the Broker. 
g.	Must be trained in Basic Red Cross or equivalent training in First Aid and Cardio Pulmonary Resuscitation (CPR).
h.	Must be trained in the use of ADA access equipment, if Vehicle is so equipped.
i.	Must use passenger restraint devices as required by law. 
j.	Must provide assistance to passengers, as needed or requested, particularly for passengers with mobility impairments requiring assistance in boarding, deboarding, or securing a mobility device. 
k.	Must not smoke while transporting Members.
l.	Must not transport Members while under the influence of alcohol or any drug that impairs the ability to drive safely.
m.	Must not provide transportation if they have an illness that could pose a threat to the health and well being of the Member. 
n.	Must submit to random drug and alcohol screenings, if required to do so by the Transportation Provider.

Mileage Reimbursement Driver Standards (These are applicable to Volunteers as well).
All drivers: 
a.	Must possess a current valid driver’s license with no restrictions other than corrective lenses.
b.	Must have no limitation or restrictions that would interfere with safe driving. This includes but is not limited to, medical conditions, ignition interlock restriction, or prescribed medication that would interfere with the safe, lawful operation of a motor Vehicle.
c.	Must be eligible to receive reimbursement and not an individual identified on the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE) or the General Services Administration (GSA) System for Award Management (SAM).  Such individuals are not eligible for payment from the Broker.  Also, any provider or individual who has been suspended by a State Medicaid Agency for Credible Allegation of Fraud, is not eligible for payment from the Broker.
d.	Must be trained in the use of ADA access equipment, if Vehicle is so equipped.
e.	Must use passenger restraint devices as required by law. 
f.	Must provide assistance to passengers, as needed or requested, particularly for passengers with mobility impairments requiring assistance in boarding, deboarding, or securing a mobility device. 
g.	Must not smoke while transporting Members.
h.	Must not transport Members while under the influence of alcohol or any drug that impairs the ability to drive safely.

Transportation Driver Standards
The Broker shall implement oversight procedures to ensure that all drivers are legally licensed by the State of Iowa, or appropriate state of business, to operate their assigned Vehicle.  The Broker shall also ensure that all drivers are competent in their driving habits, are courteous and helpful to all passengers, and are neat and clean in appearance. 
All drivers: 
a.	Must possess a current valid driver’s license with no restrictions other than corrective lenses.
b.	Must have no limitation or restrictions that would interfere with safe driving.  This includes but is not limited to, medical conditions, ignition interlock restriction, or prescribed medication that would interfere with the safe, lawful operation of a motor Vehicle.
c.	Must pass a pre-employment drug screening.
d.	Must pass a Department of Criminal Investigation (DCI) background check prior to the start of employment, if required to do so by the Transportation Provider.
e.	Must pass a child and dependent adult abuse background check, if required to do so by the Transportation Provider.
f.	Must be eligible to receive reimbursement and not an individual or entity identified on the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE) or the General Services Administration (GSA) System for Award Management (SAM).  Such individuals or entity’s are not eligible for payment from the Broker.  Also, any provider or individual who has been suspended by a State Medicaid Agency for Credible Allegation of Fraud, is not eligible for payment from the Broker.
g.	Must be trained in Basic Red Cross or equivalent training in First Aid and Cardio Pulmonary Resuscitation (CPR). 
h.	Must be trained in the use of ADA access equipment, if Vehicle is so equipped.
i.	Must use passenger restraint devices as required by law. 
j.	Must provide assistance to passengers, as needed or requested, particularly for passengers with mobility impairments requiring assistance in boarding, de-boarding, or securing a mobility device. 
k.	Must not smoke while transporting Members.
l.	Must not transport Members while under the influence of alcohol or any drug that impairs the ability to drive safely.
m.	Must not provide transportation if they have an illness that could pose a threat to the health and well being of the Member. 
n.	Must submit to random drug and alcohol screenings, if required to do so by the Transportation Provider.

 

Attachment 3.1.2: Vehicle Standards
 
SMV Vehicle Standards 
All Vehicles: 
a.	Must have current license and registration as required by law.
b.	Must have proof of financial responsibility maintained on any Vehicle used to transport Iowa Medicaid Members as required by law.  The Broker shall confirm compliance with applicable financial responsibility and/or insurance requirements, which may include Iowa Code chapter 321A, and 761 Iowa Admin. Code § 910.5(1).
c.	Must be kept at all times in proper mechanical condition.
d.	Must have adequately functioning heating and air-conditioning systems and shall maintain a temperature at all times that is comfortable to the Member. 
e.	Must be equipped with operable passenger restraint devices, turn signals, lights, horn, brakes, a front and rear windshield, windows, and mirrors.
f.	Must pass a safety inspection, if required by state or federal law. 
g.	Must carry equipment for two-way emergency communication (two-way radio or cell phone acceptable).	

Mileage Reimbursement and Volunteer Vehicle Standards (Applicable to Volunteers as well).
All Vehicles: 
a.	Must currently be licensed and registered as required by law.
b.	Must have proof of financial responsibility maintained on any Vehicle used to transport Iowa Medicaid Members as required by law.  The Broker shall confirm compliance with applicable financial responsibility and/or insurance requirements, which may include Iowa Code chapter 321A, and 761 Iowa Admin. Code § 910.5(1).
c.	Must be kept at all times in proper mechanical condition.
d.	Must be equipped with operable passenger restraint devices, turn signals, lights, horn, brakes, a front and rear windshield, windows, and mirrors.
e.	Must pass a safety inspection, if required by state or federal law.

Common Carrier Vehicle Standards
All Vehicles: 
a.	Must have current license and registration as required by law.
b.	Must have proof of financial responsibility maintained on any Vehicle used to transport Iowa Medicaid Members as required by law.  The Broker shall confirm compliance with applicable financial responsibility and/or insurance requirements, which may include Iowa Code chapter 321A, and 761 Iowa Admin. Code § 910.5(1).
c.	Must be kept at all times in proper physical and mechanical condition.
d.	Must have adequately functioning heating and air-conditioning systems and shall maintain a temperature at all times that is comfortable to the Member. 
e.	Must be equipped with operable passenger restraint devices, turn signals, lights, horn, brakes, a front and rear windshield, windows, and mirrors.
f.	Must pass a safety inspection, if required to do so by state or federal law.
g.	Must carry equipment for two-way emergency communication (two-way radio or cell phone acceptable).

Attachment 3.1.3: Definitions
When appearing as capitalized terms in this RFP, including attachments, the following quoted terms (and the plural thereof, when appropriate) have the meanings set forth in this section.

“Agency” means the Iowa Department of Human Services. 

“Bid Proposal” or “Proposal” means the Bidder’s proposal submitted in response to the RFP.  

“Business Day” means Monday-Friday, excluding State holidays.

“Business Hours” means 8:00 AM to 5:00 PM central time.

“Deliverables” means all of the services, goods, products, work, work product, data (including data collected on behalf of the Agency), items, materials and property to be created, developed, produced, delivered, performed, or provided by or on behalf of, or made available through, the contractor (or any agent, contractor or subcontractor of contractor) in connection with any contract resulting from this RFP.

“Invoice” means a contractor’s claim for payment.  At the Agency’s discretion, claims may be submitted on an original invoice from the contractor or may be submitted on a claim form accepted by the Agency.

Definitions Specific to this RFP. 

“Accident”: Unexpected, unusual and unintended external action that occurs in a particular time and place, with no apparent and deliberate cause but with marked effects.

“Adverse Action”: An Adverse Action taken by the Broker to deny, terminate, suspend, reduce services and/or date range(s) for services, or partially approve a Covered Service.  The Broker’s failure to take action on a request for services within established timeframes is also an Adverse Action.

“Ambulance”: Any vehicle, vessel or craft that meets the criteria for participation in the Medicare program, per 441 Iowa Admin. Code § 77.11.  This RFP applies only to non-emergency Ambulance transportation where medical assistance or supervision is not required.

“Ambulatory”: Capable of walking; not bedridden.

“Appeal”: A request made to the Iowa Department of Human Services’ Appeals Division by a Member or by a Transportation Provider on behave of a Member, for a neutral party to review an Adverse Action taken by the Broker to determine whether the action complied with Medicaid laws, regulations, and/or rules.  The Appeal shall be governed by the Agency’s administrative rules and any and all applicable court orders.

“Attendant”: see Transportation Attendant.

“Bidder”: An entity that is offering a proposal in response to this RFP. 

“Broker”: An entity with which the Agency has contracted to manage, authorize, coordinate and reimburse the provision of necessary Non-Emergency Medical Transportation for eligible Medicaid Members. 

“Capitated Rate”:  A rate based on a set monthly cost per count of NEMT-eligible Members. The rate is not adjusted based on actual utilization of services.  

“CFR”: Code of Federal Regulations

“Closest Medical Provider”: The closest qualified and enrolled Medicaid Provider, or as authorized in 441 Iowa Admin. Code § 78.13(3)(f). 

“Complaint”: An oral or written expression of dissatisfaction by a Member, a Member’s family member or other responsible party, a facility or a medical Provider.

“Encounter”: A “proxy claim” for each service provided, utilizing current claims submission guidelines.  IME utilizes the Encounter reporting to evaluate all aspects of quality and utilization management.  Encounter claims must be submitted in the HIPAA 837 format.

“Escort”:  An individual who is required to accompany a Member to a medical appointment due to the Member’s age, health, or cognitive condition. 

“Grievance”: A written complaint expressing dissatisfaction with the quality of services provided or authorized by the Broker. A Grievance may also come to the State through a complaint to the Governor, the Director, a request for information (RFI) or freedom of information act (FIOA). 

“Home and Community Based Services”: Home & Community Based Services (HCBS) are Medicaid programs that give Members more choices about how and where they receive services.  Home and Community Based Services are for people with disabilities and older Iowans who need supports to live in their home and community instead of going to an institution.  There are several programs that provide home and community based supports. The program names are HCBS Waivers (there are seven waivers).

“Hospital Discharge”: Notification by a hospital that a Medicaid Member is ready for discharge. A Hospital Discharge is considered an Urgent Trip. 

“Implementation”: The date that the Broker must begin providing transportation to Members eligible for NEMT services.

“Incident”: An occurrence, event, breakdown, or public disturbance that interrupts a Trip causing the driver to stop the Vehicle, such as a passenger who becomes unruly or ill. 

“Late”: More than 30 minutes after the scheduled pick-up time from a residence; more than 5 minutes after the scheduled drop-off time for an appointment/Medicaid Covered Service; more than 30 minutes after the scheduled pick-up time from an appointment/Medicaid Covered Service. 

“Medicaid Covered Services” or “Covered Services”: Services provided to a Medicaid Member that are eligible to be paid by the Iowa Medicaid program.  

“Medicaid Member” or “Member”: Persons currently enrolled with IME who are receiving full Medicaid services under the Iowa State Plan for Medical Assistance Services.

“Medicaid Provider”: An organization, person, or entity that is enrolled as a provider in the Iowa Medicaid program and provides Medicaid services to Members. Medicaid Provider includes: Doctors, Hospitals, etc. It does not include Transportation Providers contracted with the Broker. 

“Non-Emergency Medical Transportation”: Transportation Services for an eligible Member to access Non-Emergency Medical Treatment Services as authorized by 441 Iowa Admin. Code § 78.13(249A). 

“Per-Member-Per-Month (PMPM)”: A calculation that indicates an average cost or payment for each Member of a population per calendar month that shall constitute full payment to the successful Bidder for providing all NEMT services.

“Public Transit”: Transportation available for use by the general public. May include fixed route, semi-fixed route, or on-demand services.

“Rural”: Defined as zip codes categorized as codes 3-10 using the United States Department of Agriculture (USDA) Economic Research Service (ERS) Rural Urban Commuting Area (RUCA) codes.

“Service Authorization”: The final determination made for specified medical services for a specified Member by a specified Provider. Most services require an approved Service Authorization prior to service delivery.
 
“Specialized Medical Vehicle (SMV)”: A Vehicle equipped with a permanently installed lift or ramp. All SMV Vehicles, except for Ambulances, shall comply with the Americans with Disabilities Act (ADA) Accessibility Specifications for Transportation. The driver of a SMV must have first aid training and CPR certification. 

“Standing Orders”: Recurring or repetitive Trips that occur one (1) or more days a week with the same pick-up point, destination and return.  Examples of services treated as Standing Orders include, but are not limited to; Trips to dialysis, methadone treatment, cancer treatment, and mental/behavioral health therapy appointments. 

“State Identification (SID) Number”: A unique identification number assigned to each Medicaid Member. 

“TANF”: Temporary Assistance for Needy Families.  In this RFP, the term TANF includes those Medicaid Members who have full Medicaid benefits but do not otherwise fall within the Social Security Income population. 

“Taxi”: Any motor Vehicle having a seating capacity of not more than six passengers, excluding the driver, not operating on a regular route or between fixed terminals and used in the transportation of passengers for hire or for compensation. 

“Transportation Attendant”: An employee of a Transportation Provider, approved and reimbursed by the Broker, who assists the driver and accompanies a Member or group of Members during transport in order to ensure the safe operation of the Vehicle and the safety of the Members. 

“Transportation Provider”: Transportation network companies, ambulance services, regional transit authorities, or other transportation providers that contract with the NEMT broker to deliver NEMT to medically necessary services for eligible Medicaid enrollees.

“Transportation Services”: NEMT services provided to Members to ensure reasonable access to and from Covered Services that meet the medical needs of the Member. 

“Trip”: A Trip means one leg of a transport. A round trip means two Trips or two legs of a transport. 

“Urban”: Defined as zip codes categorized as codes 1 and 2 using the United States Department of Agriculture (USDA) Economic Research Service (ERS) Rural Urban Commuting Area (RUCA) Codes.

“Urgent Care”: Post-surgical and/or medical follow-up care specified by a health care Provider to occur in fewer than two Business Days; imminent availability of an appointment with a physician/specialist/therapist when the next available appointment would require a delay of one week or more; the result of administrative or technical delay caused by the Broker or medical Provider and requiring that an appointment be rescheduled; and Hospital Discharges.

“Urgent Trip”:  A Trip necessitated by the need for Urgent Care.

“Vehicle”: Vehicles utilized by Transportation Providers to provide NEMT services to Members.

“Volunteer”: An individual who meets the credentialing and training requirements; who transports Members in a personal Vehicle that meets the insurance, inspection and other safety requirements as defined by the Broker ; and who accepts NEMT Trips from the Broker in exchange for gas reimbursement.

“Waiver Transportation”: A service that is provided under some of the Home and Community Based Services (HCBS) Waiver programs.  Only four of the seven HCBS waiver programs have a Waiver Transportation component. 

“Wheelchair Accessible Vehicle” : A motorized Vehicle equipped specifically with certified wheelchair lifts or other equipment designed to allow persons in wheelchairs or other mobility devices to safely enter a Vehicle and secure their wheelchair or device for transportation, in accordance with national safety standards. Wheelchair Accessible Vehicle services are used in non-emergency situations by Members who can sit upright and have no acute medical problems that require the Member to remain in a lying position but who can transfer on their own to a seated position ; and by Members who use a mobility device and are unable to transfer between their wheelchair and a Vehicle with minimal assistance.

Attachment 3.1.4 Program Integrity and Disclosure Requirements

3.1.6(A)  The Broker shall diligently safeguard against the potential for, and promptly investigate reports of, suspected fraud and abuse by employees, subcontractors, providers, and others with whom the Broker does business. The Broker shall provide DHS with the Broker’s policies and procedures on handling issues of suspected fraud and abuse. 
a.	Verification of Services Provided.  The Broker shall have in place a method to verify whether services reimbursed by the Broker were actually furnished to eligible persons as billed by providers. 
b.	Coordination of Program Integrity Efforts.  The Broker shall coordinate any and all program integrity efforts with IME personnel.  At minimum, Broker shall:
1.	Provide any and all documentation or information upon request to DHS related to any aspect of this Contract, including but not limited to policies, procedures, subcontracts, provider agreements, claims data, Encounter data, and reports on recoupment actions and receivables.
2.	Report within two working days to DHS, and any appropriate legal authorities any evidence indicating the possibility of fraud and abuse by any member of the provider network. 
3.	Provide DHS with an annual update of investigative activity, including corrective actions 
c.	Procedures to guard against Fraud & Abuse.  The Broker shall have administrative and management arrangements or procedures, and a mandatory compliance plan, that are designed to guard against fraud and abuse and include the following: 
1.	Written policies, procedures, and standards of conduct consistent with all applicable federal and state laws pertaining to fraud and abuse.  Attached hereto and incorporated herein by reference as Exhibit A is a document entitled “CMS Performance Standard for Referrals of Suspected Fraud from a Single State Agency to a Medicaid Fraud Control Unit,” which was published by CMS in September 2008 (also available at:  https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/FraudAbuseforProfs/Downloads/fraudreferralperformancestandardsstateAgencytomfcu.pdf).   Broker shall incorporate the guidance document and fraud referral performance standards, as well as any other appropriate guidance and/or future CMS guidance, into written policies and procedures and training materials on developing suspected Medicaid fraud cases for referral to DHS and appropriate authorities, including but not limited to MFCU.   
d.	Obligation to Suspend Payments to Providers.  The Broker shall comply with 42 C.F.R. § 455.23 by suspending all payments to a provider after the DHS determines that there is a credible allegation of fraud for which an investigation is pending under the Medicaid program against an individual or entity unless DHS has identified in writing good cause for not suspending payments or to suspend payments only in part.  
1.	Broker shall issue a notice of payment suspension to its provider that comports in all respects with the obligations set forth in 42 C.F.R. § 455.23(b) and maintain the suspension for the durational period set forth in 42 C.F.R. § 455.23(c).  In addition, the notice of payment suspension shall state that payments are being withheld in accordance with 42 C.F.R. § 455.23.
2.	Whenever DHS suspends payments in compliance with this subsection in whole or in part, the Broker shall issue a written notice to the provider not later than the next Business Day after the Broker receives notice from DHS that a payment suspension is enacted.  
3.	Broker shall maintain all materials related to payment suspensions for a minimum of five years in compliance with the obligations set forth in 42 C.F.R. § 455.23(g).
e.	Reporting of Ownership & Control of Broker.  Broker shall report ownership and control information consistent with 42 CFR 455.100-455.107, including:
1.	What disclosures must be provided.  Broker shall report the following:
i.	The name and address of any person (individual or corporation) with an ownership or control interest in the Broker.  The address for corporate entities must include as applicable primary business address, every business location, and P.O. Box address.
ii.	The date of birth and Social Security Number (in the case of an individual).
iii.	Other tax identification number (in the case of a corporation) with an ownership or control interest in the Broker or in any subcontractor in which the Broker has a 5 percent or more interest.
iv.	Whether the person (individual or corporation) with an ownership or control interest in the Broker is related to another person with ownership or control interest in the Broker as a spouse, parent, child, or sibling; or whether the person (individual or corporation) with an ownership or control interest in any subcontractor in which the disclosing entity has a 5 percent or more interest is related to another person with ownership or control interest in the disclosing entity as a spouse, parent, child, or sibling.
v.	The name of any other disclosing entity (or fiscal agent or managed care entity) in which the owner of the disclosing entity (or fiscal agent or managed care entity) has an ownership or control interest.
vi.	The name, address, date of birth, the Social Security Number of any managing employee of the disclosing entity (or fiscal agent or managed care entity).
2.	When the disclosures must be provided.  
i.	Disclosures from Broker are due:
A.	Upon Broker submitting the proposal in accordance with the State’s procurement process.
B.	Upon Broker executing a contract with the State.
C.	Upon renewal or extension of the Contract.
D.	Within 35 days after any change in ownership of Broker.
3.	To Whom Must the Disclosures be Provided.  All disclosures must be provided to DHS.
4.	Consequences for Failure to Provide Required Disclosures.  Federal financial participation (FFP) is not available in payments made to a disclosing entity that fails to disclose ownership or control information as required by law.
f.	Reporting of Business Transactions of Broker.  
1.	Broker shall furnish to DHS and/or the Secretary on request, information related to business transactions in accordance with subparagraph (2) immediately below.
2.	Broker must submit, within 35 days of the date on a request by the Secretary or DHS, full and complete information about – 
i.	The ownership of any subcontractor with whom the Broker has had business transactions totaling more than $25,000 during the 12-month period ending on the date of the request; and
ii.	Any significant business transactions between the Broker and any wholly owned supplier, or between the provider and any subcontractor, during the 5-year period ending on the date of the request.
3.	FFP is not available in expenditures for services furnished by Broker if the Broker fails to comply with a request made by the Secretary or the Medicaid Agency under paragraph (2) of this section or under 42 C.F.R. § 420.205.  Broker shall not be entitled to payment under the Contract (i.e., no capitation payment will be paid) for services provided during the period beginning on the day following the date the information was due to the Secretary or DHS and ending on the day before the date on which the information was supplied.
g.	Broker Disclosure of Information on Persons Convicted of Crimes.  
1.	Information that must be disclosed.  Upon signing this Contract and prior to renewal of the Contract, or at any time upon written request by DHS, Broker must disclose to DHS the identity of any person who:
i.	Has ownership or control interest in the Broker, or is an agent or managing employee of the Broker; and
ii.	Has been convicted of a criminal offense related to that person’s involvement in any program under Medicare, Medicaid, or the title XX program since the inception of those programs.
2.	Notification to Inspector General.  
i.	DHS must notify the Inspector General of the HHS of any disclosures made under paragraph (a) of this subsection within 20 working days from the date it receives the information.
ii.	DHS will also promptly notify the Inspector General of HHS of any action it takes in respect to Broker.
3.	Denial or Termination of Contract.
i.	DHS may refuse to enter into or renew a Contract with Broker if any person who has an ownership or control interest in the Broker, or who is an agent or managing employee of the Broker, has been convicted of a criminal offense related to that person’s involvement in any program established under Medicare, Medicaid or the title XX Services Program.
ii.	DHS may refuse to enter into or may terminate the Contract if it determines that the Broker did not fully and accurately make any disclosure required under subparagraph (a) of this section.
h.	Broker Reporting Obligations for Adverse Actions Taken on Provider Applications for Program Integrity Reasons.  Broker shall implement in its provider enrollment processes the obligation of providers to disclose the identity of any person described in 42 C.F.R. § 1001.1001(a)(1).  Broker shall forward such disclosures to DHS.  Broker shall abide by any direction provided Broker on whether or not to permit the applicant to be a provider in the NEMT program.  Specifically, Broker shall not permit the provider into the provider panel if DHS or Broker determines that any person who has ownership or control interest in the provider, or who is an agent or managing employee of the provider, has been convicted of a criminal offense related to that person’s involvement in any program established under Medicare, Medicaid or the title XX Services program, or if DHS or Broker determine that the provider did not fully and accurately make any disclosure required pursuant to 42 C.F.R. § 1001.1001(a)(1).
i.	Disclosure by Broker Providers and Fiscal Agents: Information on Ownership and Control.  
1.	Who must provide disclosures. Broker must obtain disclosures from disclosing entities, fiscal agents, and network providers.
2.	What disclosures must be provided. Broker must require that disclosing entities, fiscal agents, and network providers provide the following disclosures:
i.	
A.	The name and address of any person (individual or corporation) with an ownership or control interest in the disclosing entity, fiscal agent, or network provider. The address for corporate entities must include as applicable primary business address, every business location, and P.O. Box address.
B.	Date of birth and Social Security Number (in the case of an individual).
C.	Other tax identification number (in the case of a corporation) with an ownership or control interest in the disclosing entity (or fiscal agent or network provider) or in any subcontractor in which the disclosing entity (or fiscal agent or network provider) has a 5 percent or more interest.
ii.	Whether the person (individual or corporation) with an ownership or control interest in the disclosing entity (or fiscal agent or network provider) is related to another person with ownership or control interest in the disclosing entity as a spouse, parent, child, or sibling; or whether the person (individual or corporation) with an ownership or control interest in any subcontractor in which the disclosing entity (or fiscal agent or network provider) has a 5 percent or more interest is related to another person with ownership or control interest in the disclosing entity as a spouse, parent, child, or sibling.
iii.	The name of any other disclosing entity (or fiscal agent or network provider) in which an owner of the disclosing entity (or fiscal agent or network provider) has an ownership or control interest.
iv.	The name, address, date of birth, and Social Security Number of any managing employee of the disclosing entity (or fiscal agent or network provider).
3.	When the disclosures must be provided.
i.	Disclosures from network providers or disclosing entities. Disclosure from any network provider or disclosing entity is due at any of the following times:
A.	Upon the network provider or disclosing entity submitting the provider application.
B.	Upon the network provider or disclosing entity executing the provider agreement.
C.	Upon request of DHS or during the re-validation of enrollment process.
D.	Within 35 days after any change in ownership of the disclosing entity or network provider.
ii.	Disclosures from fiscal agents. Disclosures from fiscal agents are due at any of the following times:
A.	Upon the fiscal agent submitting the proposal in accordance with the procurement process.
B.	Upon the fiscal agent executing the contract with the Broker.
C.	Upon renewal or extension of the contract with a fiscal agent.
D.	Within 35 days after any change in ownership of the fiscal agent.
iii.	Disclosures from managed care entities. Disclosures from managed care entities (MCOs, PIHPs, PAHPs, and HIOs), except PCCMs are due at any of the following times:
A.	Upon the managed care entity submitting the proposal in accordance with the procurement process.
B.	Upon the managed care entity executing the contract with the Broker.
C.	Upon renewal or extension of the contract.
D.	Within 35 days after any change in ownership of the managed care entity.
iv.	Disclosures from PCCMs. PCCMs will comply with disclosure requirements under paragraph (c)(1) of this section.
4.	To whom must the disclosures be provided. All disclosures must be provided to Broker, who will make them available to DHS.
5.	Consequences for failure to provide required disclosures. Federal financial participation (FFP) is not available in payments made to a disclosing entity that fails to disclose ownership or control information as required by this section.
j.	Disclosure by Providers: Information Related to Business Transactions.
1.	Provider agreements. Broker must enter into an agreement with each provider under which the provider agrees to furnish to it or to the Secretary on request, information related to business transactions in accordance with paragraph (2) of this section.
2.	Information that must be submitted. A provider must submit, within 35 days of the date on a request by the Secretary, DHS, or Broker, full and complete information about—
i.	The ownership of any subcontractor with whom the provider has had business transactions totaling more than $25,000 during the 12-month period ending on the date of the request; and
ii.	Any significant business transactions between the provider and any wholly owned supplier, or between the provider and any subcontractor, during the 5-year period ending on the date of the request.
3.	Denial of Federal financial participation (FFP). 
i.	FFP is not available in expenditures for services furnished by providers who fail to comply with a request made by the Secretary, DHS, or the Broker under paragraph (2) of this section or under 42 C.F.R. § 420.205 .
ii.	FFP will be denied in expenditures for services furnished during the period beginning on the day following the date the information was due to the Secretary, DHS, or the Broker and ending on the day before the date on which the information was supplied.
k.	Disclosure by Providers: Information on Persons Convicted of Crimes.
1.	Information that must be disclosed. Before the Broker enters into or renews a provider agreement, or at any time upon written request by DHS or the Broker, the provider must disclose to the Broker and/or DHS the identity of any person who:
i.	Has ownership or control interest in the provider, or is an agent or managing employee of the provider; and
ii.	Has been convicted of a criminal offense related to that person's involvement in any program under Medicare, Medicaid, or the title XX services program since the inception of those programs.
2.	Notification to Inspector General. 
i.	Broker shall notify DHS of any disclosures made under paragraph (1) of this section within 10 working days from the date it receives the information.  DHS will forward the information to the Office of Inspector General of HHS.
ii.	The Broker must also promptly notify the DHS of any action it takes on the provider's application for participation in the program.
3.	Denial or termination of provider participation. 
i.	Broker may refuse to enter into or renew an agreement with a provider and DHS may refuse to allow Broker to renew or enter into such an agreement if any person who has an ownership or control interest in the provider, or who is an agent or managing employee of the provider, has been convicted of a criminal offense related to that person's involvement in any program established under Medicare, Medicaid or the Title XXI Services Program.
ii.	Broker may refuse to enter into or may terminate a provider agreement and DHS may refuse to allow Broker to renew or enter into such an agreement if any of the entities determines that the provider did not fully and accurately make any disclosure required under paragraph (1) of this section.
l.	Federal Database Checks.  Broker must do all of the following:
1.	Confirm the identity and determine the exclusion status of providers and any person with an ownership or control interest or who is an agent or managing employee of the provider through routine checks of Federal databases.
2.	Check the Social Security Administration’s Death Master File, the National Plan and Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE), the General Services Administration’s Excluded Parties List System (EPLS), the Medicare Exclusion Database (the MED) and any such other databases as the Secretary of HHS may prescribe.
3.		
i.	Consult appropriate databases to confirm identity upon enrollment and reenrollment; and
ii.	Check the LEIE, EPLS, the MED and any such other databases as the Secretary of HHS may prescribe, no less frequently than monthly.
m.	Prohibition on Certain Relationships.  
1.	The Broker may not knowingly have a relationship with the following: 
i.	an individual who is debarred, suspended, or otherwise excluded from participating in procurement activities under the Federal Acquisition Regulation or from participating in non-procurement activities under regulations issued under Executive Order No.12549 or under guidelines implementing Executive Order No. 12549, or 
ii.	an individual who is an affiliate, as defined in the Federal Acquisition Regulation, of a person described in paragraph (a)(1) of the regulation. 
2.	For the purposes of this section, “Relationship” is defined as follows: 
i.	a director, officer, or partner of the Broker; 
ii.	a person with beneficial ownership of five percent or more of the Broker’s equity, or 
iii.	a person with an employment, consulting or other arrangement with the Broker under its contract with the State. 
n.	The Broker shall not expend Medicaid funds for providers excluded by Medicare, Medicaid, or CHIP, as notified by DHS.
o.	N/A.
p.	The Broker shall report fraud and abuse information to DHS. The report will include the following to the extent such information is available: 
1.	the number of complaints of fraud and abuse made to DHS that warrant preliminary investigation, and 
2.	for each complaint which warrants investigation, the following information: name-ID number; source of complaint; type of provider; nature of complaint; approximate dollars involved; disposition of the case. 
q.	The Broker shall document that safeguards at least equal to federal safeguards (at 41 USC 423 § 27) are in place.

Vendor Name:	Completed by:	Date:	
		Updated:	
Question	Response	
Data Protection	
1	In what geographic location(s) will DHS data be stored? Specify the timeframe in which DHS will be notified if this changes.		
2	How does the vendor detect changes to the integrity of DHS data and what measures are in place to ensure DHS data is not lost, modified or destroyed?     		
3	How does the vendor ensure deleted data cannot be recoverable?		
4	How does the vendor detect degradation of DHS data?		
5	Define a security incident. 		
6	Describe the vendor’s incident response and reporting program. 		
Cloud Service Providers	
7	Will DHS data be stored in a cloud? 		
8	Who is the cloud service provider?		
9	Is the cloud service provider FedRAMP authorized and if so, specify the impact level.		
10	If not FedRAMP authorized, specify the security framework for which the cloud service provider is certified.  		
11	How can DHS be assured cloud service providers meet the same security standards as that of the vendor?		
Access Control	
12	Who has access to the systems providing DHS data and services? How is this access controlled?		
13	What authentication method is required to access DHS data and applications (e.g. username and password)?	

14	Which multi-factor authentication methods does the vendor support?	

15	Does the vendor allow the use of personal devices for access to DHS data?		
16	Specify the frequency vendor staff access to DHS data is reviewed.		
17	Which access control methodology does the vendor support: Role-based access control (RBAC), mandatory access control (MAC), or discretionary access control (DAC)? Define how you meet this methodology.		
Regulatory Compliance	
18	Is the vendor a HIPAA covered entity?  		
19	Is the vendor a business associate of DHS? If yes, does the vendor have downstream business associate agreements with subcontractors?		
20	Define the vendor’s HIPAA training. List the training modules and the time allotted for each module.		
21	Is the vendor audited or assessed by a third party? If yes, specify the security framework.  		
22	Explain how the vendor performs an information security risk assessment. What is the frequency?	

23	Explain how the vendor manages their information security risk assessment program.		
Business Continuity and Resiliency	
24	Does the vendor have a business continuity plan? 		
25	How often is the business continuity plan tested?	

26	How does the vendor ensure DHS can continue doing business at all times, even if there is a permanent catastrophic failure or natural or man-made disaster where DHS data or services are located?	

27	What guarantees does the vendor provide for recovery time objectives (RTO) and recovery point objectives (RPO)?	

Service and Data Integrity	
28	Is DHS data encrypted in transit? If so, specify the encryption algorithm and cipher strength. 
Who owns the encryption key?		
29	Is DHS data encrypted at rest? Is so, specify the encryption algorithm and cipher strength. 
Who owns the encryption key?		
30	Specify the network security tools used to monitor data flow into the vendor’s network for malware or cyber-attacks.		
31	What tools and procedures does the vendor utilize for intrusion detection and at what frequency? How is this capability tested for functionality at the hardware, network, and database levels?   		
Multi-Tenancy	
32	How does the vendor separate DHS data and services from those of other clients?	

33	In what ways could the vendor’s other client’s affect the quality of the service or service levels provided to DHS?	

34	What resources will DHS share with other clients?	

Infrastructure and Application Security	
35	Who owns and operates the vendor’s data centers and what physical and environment security measures are in place?	
	
36	What parts of the vendor’s infrastructure are owned and operated by the vendor and what parts are obtained from a colocation service?	

37	What standards are followed for hardening network equipment, operating systems, and applications?	

38	Specify the tools used to perform vulnerability scans and the frequency. What is the timeframe to re-mediate high and critical findings?	

39	Specify the frequency of third party penetration tests to assess infrastructure security. Include the type of third party report received. 	

40	What specifications does the vendor follow to purge data when equipment is retired or replaced? How does the vendor purge any resident DHS data?		
41	Does the vendor utilize a web application for this service? If so, does the vendor follow the OWASP Top 10 List?		
Non-production Environment Exposure	
42	Is DHS data loaded to a test environment? If so, who has access to the test environment?		
43	Which copies are de-identified and which are not?		
44	Is live DHS data used in testing?