REQUEST FOR PROPOSAL (RFP)

Provider Cost Audits and Rate Setting Services
MED-24-001

Lisa Burk 
Iowa Medicaid
1305 East Walnut Street
Des Moines, IA  50319-0114
Phone:  515-371-4703
RFPMED-24-001@dhs.state.ia.us

RFP Purpose.
The purpose of this RFP is to obtain a Contractor to perform provider cost audits and rate setting functions and other related activities for the Iowa Medicaid Program. Through this contract, the Agency intends to meet the following objectives:

• Support the unique and highly competitive nature of Iowa's Medicaid program administration 
   structure;
• Continue to meet all State and federal requirements; and
• Support components of Iowa Medicaid.

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

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

Event	Date	
Agency Issues RFP Notice to Targeted Small Business Website (48 hours):	May 27, 2022	
Agency Issues RFP to Bid Opportunities Website	May 29, 2022	
Bidder Letter of Intent to Bid Due By 	July 1, 2022
3:00 p.m.	
Bidder Written Questions Due By	Date and Time for First Round of Questions:  July 1, 2022
3:00 p.m.
Date and Time for Second Round of Questions:  July 22, 2022
3:00 p.m.	
Agency Responses to Questions Issued By	Date for First Round of Responses:  July 15, 2022 
Date for Second Round of Responses:  August 5, 2022	
Bidder Proposals and any Amendments to Proposals Due By	October 3, 2022
3:00 p.m.	
Agency Announces Apparent Successful Bidder/Notice of Intent to Award 	November 11, 2022	
Contract Negotiations and Execution of the Contract Completed 	January 30, 2023	
Anticipated Start Date for the Provision of Services	July 1, 2023	

Section 1  Background and Scope of Work	

1.1  Background.
The Iowa Department of Human Services (DHS) is the single State entity responsible for administering the Medicaid Program in Iowa. The Iowa Medicaid Program reimburses providers for delivery of services to eligible Medicaid recipients under the authority of the Title XIX of the Social Security Act through enrolled providers and health plans. The Agency operates this program through its business unit, Iowa Medicaid (IM). Iowa Medicaid is a collaboration of third-party professional and system services contractors and State staff.  The Agency is also responsible for the Children’s Health Insurance Program (CHIP), also known as the Healthy and Well Kids Iowa (Hawki) Program. 

On April 1, 2016, Iowa Medicaid transitioned to a managed care system, also referred to as Medicaid modernization.  As a result, the model for service delivery and reimbursement went from a primarily fee-for-service (FFS) model to a managed care organization (MCO) model.  The majority of services are included in the statewide managed care structure, including long-term services and supports, behavioral health, and pharmacy, and the Agency saw a large reduction in its FFS population. As of April 2022, approximately 92% of Iowa Medicaid members were enrolled with the contracted MCOs, with an estimated 8% remaining under FFS.  The Contractor will play a role in assisting the Agency in managed care oversight. 

Additionally, the Agency has continued its efforts to modernize Iowa’s Medicaid Program. The Agency is currently vetting options for reducing the number of provider types required to submit cost reports and is considering moving to a statewide fee schedule. It is the Agency’s expectation that the Contractor collaborate with the Agency in finding new and innovative ways to deliver Provider Cost Audit (PCA) services. 

Bidders must propose an auditing solution that does not reside in the Agency’s data center, and meets the requirements of Sections 1.3.1.1.C and D.

1.2  RFP General 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.  

“Bidder” means the entity that submits a Bid Proposal in response to this RFP.

“Contractor” means the Bidder who enters into a Contract as a result of this Solicitation.

“Deliverables” means all 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 the 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, such as a General Accounting Expenditure (GAX) form.

Definitions Specific to this RFP. 
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.

“Actual Acquisition Cost” or “AAC” means the Agency's determination of the pharmacy providers' actual prices paid to acquire drug products marketed or sold by specific manufacturers. 

“Business Hours” means 8:00 AM thru 5:00 PM Central Standard Time (CST), Monday thru Friday, excluding State holidays. 

“Managed Care Organization (MCO)” means an entity that (1) is under contract with the Agency to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” in Iowa Code section 514B.1.

“Resource Utilization Group (RUG)” means any of a number of classifications into which a nursing facility resident is categorized, based on functional status and anticipated use of services and resources. RUGs are assigned to individuals based on data elements derived from the Long-Term Care (LTC) Minimum Data Set (MDS).

“Service Organization Control 2” or “SOC 2” means the internal controls in place at the third-party service organization. For a company to receive SOC 2 certification, it must have sufficient policies and strategies that satisfactorily protect the client’s data.

1.3 Scope of Work. 
1.3.1 Deliverables.
The Contractor shall provide the following:  
1.3.1.1 General Obligations
A.  Independence. The Contractor, its affiliated companies ("affiliates"), and its subcontractors shall meet the following independence requirements. To qualify as "independent," the Contractor, its affiliates, or subcontractors may not:
1. Exert control over any MCO, prepaid inpatient health plan (PIHP), prepaid ambulatory health plan (PAHP), or Medicaid provider contracted with the Agency through:
a.   Stock ownership;
b.   Stock options and convertible debentures;
c.   Voting trusts;
d.   Common management, including interlocking management; and 
e.   Contractual relationships.
2.   Have a present or known future, direct or indirect financial relationship that requires the Contractor, its affiliates, or its subcontractors to code, file, process and pay member claims for any MCO, PIHP, PAHP, or Medicaid provider contracted with the Agency.
B.   Staffing.
1.    The Contractor shall designate individuals as "key personnel," subject to Agency approval.
Special requirements for key personnel are as follows:
a. Account Manager.  Responsible for the overall service delivery of the team, complying with contractual requirements and meeting the Agency's expectations. The Account Manager shall be responsible for Contract compliance and general project oversight. The Account Manager shall represent the Contractor and be the primary liaison with the Agency. Minimum qualifications include:
i. Three-years of experience in account management or major supervisory role for government or in the private sector as a healthcare payer or provider.
ii. Bachelor's Degree or at least four years relevant experience to the position. 
iii. Previous management experience with Medicaid, specifically in financial operations, reimbursement rate setting, cost auditing, and knowledge of Health Insurance Portability and Accountability Act (HIPAA) rules and requirements is desired.
b. Transition Manager. Responsible for facilitating all planning and operational readiness activities necessary to ensure a successful transition. This position will no longer be required once the Contractor has successfully transitioned to operations. The Transition Manager may also serve as the Account or Operations Manager. Minimum qualifications include:
i. Three years of experience in account management or major supervisory role for government or in the private sector as a healthcare payer or provider.
ii. Bachelor’s Degree or equivalent relevant experience to the position.
c. Operations Manager. Responsible for day-to-day project management and supervision.
Minimum qualifications include:
i. Four years of experience managing a major component of a healthcare operation in an environment similar in scope and volume to the Iowa Medicaid Program. The experience shall include financial accounting, reimbursement rate setting, and cost auditing.
ii. Bachelor’s Degree or equivalent relevant experience to the position.
d. Audit Manager. Responsible for creating and compiling documentation to analyze, support, or modify the Agency’s reimbursement policies and procedures; assisting the Agency in developing solutions to Medicaid reimbursement policy issues; and creating and compiling documentation to support review and application of Medicaid Cost Report information. Minimum qualifications include:
i. Certified Public Accountant.
ii. Three years of financial accounting, auditing, reimbursement and rate setting experience for government or in the private sector as a healthcare payer or provider.
e. Drug Pricing and Pharmacy Reimbursement Specialist. Responsible for overseeing and managing all pharmacy related activities within the Contract; and creating and compiling documentation to analyze, support, or modify the Agency’s drug pricing and pharmacy reimbursement policies and procedures. Minimum qualifications include:
i. Licensed Doctor of Pharmacy.
ii. Previous Medicaid program oversight and subject matter expertise related to 340B drug pricing, average Actual Acquisition Cost reimbursement, Federal Supply Schedule/Nominal Price reimbursement and Cost of Dispensing surveying.
2.   Named key personnel shall:
a. Be committed to the project full time;
b. Be available during normal Business Hours to respond to questions and concerns related to the contract;
c. Provide policy advice and support to the Agency and participate in meetings with the Agency as subject matter experts;
d. Prepare and present status updates periodically to the Agency and other stakeholders, as requested by the Agency;
e. Comply with all timelines in the Agency-approved implementation plan; and
f. Develop and maintain a plan for job rotation and knowledge transfer to ensure that all functions can be adequately performed during the absence of key personnel for vacation and other reasons.  Any planned absences of key personnel shall be immediately communicated to the Agency. The Contractor shall ensure staff are trained and able to perform the functions of sensitive positions when the primary staff member is absent.
3.   The Agency reserves the right of prior approval for any replacement of the key personnel:
a. The Contractor must commit named key personnel to the project on or before the conclusion of the transition period of the Contract and for at least six months and must not replace key personnel during this period except in cases of termination, death, or the key person's resignation.
b. The Contractor shall provide the Agency with a minimum of 15 days’ notice prior to any proposed transfer or replacement of named key personnel. At the time of providing notice, the Contractor shall also provide the Agency with the resumes and references of the proposed replacement of named key personnel;
c. Replacement personnel must be in place performing their new functions before the departure of the personnel they are replacing;
d. Replacement personnel shall have knowledge transfer, experience, and ability comparable to the person originally in the position; and
e. The Agency may waive requirements (a) through (d) above upon presentation of good cause by the Contractor. In instances when good cause is granted, the Contractor commits to replacing key personnel within 30 days of the departure of a key person and to providing temporary personnel in the interim that are capable of maintaining operational performance at acceptable levels.
4.   The Contractor shall provide the following non-managerial positions:
a. Web content staff with the capacity to assist in assembling content for updating the
Agency’s Medicaid website;
b. IT staff to maintain any systems and software necessary to support all PCA functions;
and
c. Quality assurance/quality control staff.
C.  System Requirements
1.   The Contractor shall maintain a system, as necessary, to support all PCA functions, including the ability to interface with data sources as determined by the Agency.
a. The Contractor shall perform ongoing data collection, data analysis, and data transfer in accordance with Agency-approved implementation plan.
b. The Contractor shall perform system quality assurance and testing in accordance with
Agency-approved implementation plan.
c. The Contractor shall meet the Agency and the Office of the Chief Information Officer's (OCIO’s) 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 2.9.6.
2. The Contractor shall ensure security safeguards are in place to assure the integrity of system hardware, software, records, and files, including, but not limited to:
a. Orienting new employees to security policies and procedures;
b. Conducting periodic review sessions on security procedures;
c. Developing lists of personnel to be contacted in the event of a potential or suspected security breach;
d. Maintaining entry logs for limited access areas;
e. Maintaining an inventory of Agency assets, not including any financial assets;
f. Limiting physical access to systems hardware, software, and libraries; 
g. Maintaining confidential and critical materials in limited access, secured areas; and 
e. If the Contractor’s system will host Agency data, the Contractor shall provide the
following to the Agency:
i. Completed Vendor Security Questionnaire (VSQ) using the template provided in
Attachment G; 
ii. Documentation of SOC 2 compliance or the following documentation prior to system implementation and annually thereafter:
a). Attestation of passed information security risk assessment;
b). Attestation of passed network penetration scan; and
c). If the Contractor utilizes a web application in performance of services under this Contract, attestation of passed web application security scan.
3. The Contractor shall develop and maintain, subject to Agency approval, an interface control document (ICD) describing the data exchange and processing necessary to implement and operate PCA functions, interfaces necessary for electronic transmissions of data files, processing rules, and required sequence of data to manage the services. Contractor shall develop this document with consultation from Agency data management staff. The Contractor shall comply with the Agency-approved ICD at all times.
4. The Contractor shall take all steps necessary to maintain connectivity to Agency digital
infrastructure, including updating interfaces as needed.
5. The Contractor shall develop and maintain, subject to Agency approval, a disaster recovery and business continuity plan to address recovery of business functions, business units, business processes, human resources, and the technology infrastructure. The Contractor shall comply with the Agency-approved plan at all times. The Contractor shall protect against hardware and software failures, human error, natural disasters, and other emergencies that could interrupt services and operations.
6.  The Contractor shall maintain data exchange with the following:
a. Providers to conduct audits;
b. Medicare intermediaries operating in the State of Iowa to obtain Form CMS 2552
Hospital and Healthcare Complex Cost Report or other Medicare cost reports; and 
c. Agency Contractors for information stored in the minimum data set (MDS) data
repository.

D.   Software Requirements
1. The Contractor shall utilize software as necessary to support all PCA functions.
2. Any software utilized by the Contractor that is not listed in Attachment G shall not be licensed or hosted by the Agency.

E.   Receipt of Checks
1. The Contractor may receive checks or money orders related to the work that it performs. These checks and money orders may be for refunds, recoveries, cost settlements, premiums, or drug rebates.  The Contractor shall meet the following requirements for checks or money orders:
a. Log and prepare all payments for deposit on the day of receipt and deliver them to the
Agency’s designated point of contact for daily deposits. 
b. Provide deposit receipt and check log to the Agency within 24 hours of depositing checks. The log shall include the daily beginning number and amount of checks located in the Agency-owned safe, the number and amount of the daily deposit, and the ending number of checks located in the Agency-owned safe. 
c. Submit credits or adjustments to the core Medicaid Management Information System (MMIS) Contractor within 10 business days of depositing the check, in those instances in which deposited checks are associated with claims.
d. Complete a request for refund through the process established by the Agency in those instances in which deposited checks are unable to be credited or adjusted through claims offsets in the Agency’s MMIS system. 
e. Assist in the maintenance and updating of the existing check classification code
schematic, as necessary.
f. Assist the Agency in the reconciliation of the monthly Title XIX Recovery bank account, if requested.

F.   Appeals and Hearings
1.   The Contractor shall provide assistance in any stage of the appeal process concerning Contractor’s findings that result in an appeal by a provider, including but not limited to:
a. Researching issues as necessary;
b. Providing administrative support in preparing for and participating in appeals;
c. Providing written statements; 
d. Providing expert testimony where appropriate to defend Agency decisions; and
e. Provide assistance with other unit appeals where necessary.

G.  Quality
1.   The Contractor shall implement quality improvement procedures that are based on proactive improvements rather than retroactive responses. The Contractor must understand the nature of and participate in quality improvement procedures that may occur in response to critical situations and shall assist in the planning and implementation of quality improvement procedures based on proactive improvement. Procedures must include:
a.  Contractor’s procedure for monitoring quality and accuracy of the work outlined in this scope of work;
b. Contractors Quality Assurance (QA) plan and schedule subject to Agency approval; and
c. Contractor’s procedure for performing continuous workflow analysis to improve performance of Contractor functions.
2.  The Contractor submit quarterly reports of quality assurance activities, findings and corrective actions (if any) to the Agency electronically.
a. The Contractor shall provide the Agency with a description of any changes to the
workflow for approval prior to implementation.

H.  Performance Reporting and Corrective Actions
1. The Contractor shall submit monthly performance reports using an Agency-approved format, detailing all deliverables and performance measures that have been met or unmet during the month. This report shall be submitted with the monthly invoice.
2. The Contractor shall provide written notification to the Agency within two business days of
discovery of any problems, concerns, or issues of non-compliance.
3. The Contractor shall maintain records of such reports and other related communications issued electronically and in writing during the course of Contract performance.
4. The Agency’s Contract Owner has final authority to approve problem-resolution activities.
5. 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.
6. 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 corrective action plan (CAP) to resolve the deficiencies, subject to Agency approval.

I.  Requests for Information
1. The Contractor shall respond to Agency requests for information and other requests for assistance within the timeframe that the Agency specifies. The Contractor shall provide information in response to:
a. Freedom of Information Act (FOIA) requests;
b. Requests for Information (RFIs) from State and Federal Legislators; and
c. Open records act requests, as required under Iowa Code Chapter 22.
2. The Contractor shall comply with information protocols and response timeframes determined by the Agency’s Public Information Officer.

J.   The Contractor shall not reference the Contractor’s corporate name in any Deliverables associated with this Contract.

K.  Planning. The Contractor shall develop, maintain, and comply with the following, subject to Agency approval:
1.  Project work plans. Work plans shall include, but not be limited to:
a. A transition plan detailing Contractor’s strategy to implement the staff, systems and services contemplated by this Contract;
b. An operations plan detailing the daily performance of all required activities by the
Contractor, including required coordination and safeguards;
c. A communications plan specifying expectations for all parties involved. This plan shall be developed in consultation with the Agency;
d. A pharmacy reimbursement plan detailing timeline and activities necessary to develop and review overall pharmacy reimbursement methodology;
e. A reporting plan detailing requirements for submitting reports to the Agency. This plan shall be developed in consultation with the Agency. Reporting plan requirements include, but are not limited to:
i. Use of standard naming conventions;
ii. Templates for standardized reports that may be necessary to implement the project. 
iii. Use of the Agency-designated site to upload reports, with links sent
to relevant Agency staff via email;
iv.  Detail of whom the reports should be delivered to for review and approval, as
necessary;
v.  Any posting requirements for external stakeholders;
vi. Frequency and due dates for reports; and 
vii. A monthly performance reporting tool.
f.   A training plan detailing, at minimum:
i. Training of Contractor staff in all systems functions that they will use. This may include the Medicaid Management Information System (MMIS), Pharmacy Point of Sale (POS) system, Data Warehouse/Decision Support system (DW/DS) and other State systems.
ii. Training of Contractor staff in system and operational procedures required to
perform the Contractor’s functions under the Contract.
iii.   Continuous standard operating procedures training process for Contractor staff.
At minimum, the Contractor shall train staff when:
a).  New staff or replacement staff are hired;
b).  New policies or procedures are implemented; and
c).  Changes are made to any existing policies or procedures prior to the change's implementation if possible, and if not, concurrent with the change’s implementation.
iv. Training of Agency employees and other Agency Contractors, as requested.
Such training shall be at no additional cost to the Agency.
Each plan shall generally adhere to the approximate timing and requirements set forth in
Section 1.3.1.3, to include, at minimum: 
a).  Definition of each project activity; 
b).  Sequence of activities;
c).  Identification of who is responsible for each project activity;
d).  Defined deliverables and outcomes;
e).  Timeframe in which each activity will be completed;
f).  A plan update schedule, which shall include updates no less frequently than quarterly; and
g).  Identification of Agency responsibilities and expectations.
2.   Standard operating procedures (SOPs).
a. SOPs shall be maintained in the Agency-prescribed format using standard naming conventions in the documentation.
b. SOPs shall document the processes and procedures used by the Contractor in the
performance of its obligations under this Contract, including, but not limited to:
i. Notification and issue escalation procedures and timelines; and 
ii. Policy manuals required for all PCA functions.
c.   SOPs shall be updated with any changes to the methods and procedures used by the Contractor in the performance of its duties under this Contract. The Contractor shall document all changes within 10 business days of the change. The Contractor shall use version control to identify the most current documentation and any previous versions, including their effective dates. The Contractor shall provide all documentation in electronic form and store all documentation within the Agency-designated repository.
d.   SOPs shall be reviewed with the Agency no less than annually.

L. 	Operational Readiness
1.   The Contractor shall prepare for the onset of operations in the existing Agency environment.
This includes, but is not limited to, the following:
a. Review the turnover plan from the current Contractor;
b. Develop a comprehensive operational readiness checklist of its start-up activities;
c. Provide the Agency assurance that all checklist activities have been satisfactorily completed and signed-off by the Agency;
d. Develop and implement a corrective action plan (CAP) for all outstanding activities for review and approval by the Agency;
e. Conduct training for Contractor staff;
f. Gather and document all Agency technical and operational requirements pertaining to work performed under this Contract;
g. Produce and update all operations documentation and obtain Agency approval of each iteration;
h. Establish Agency-approved interfaces, as necessary; and
i. Obtain written approval from the Agency to start operations.
2.   The Contractor shall work proactively with the Agency and the outgoing Contractor to take over the management of any cost settlements that remain open when the outgoing contract ends on June 30, 2023.
a.   In order to take over the caseload, the Contractor shall take the following steps:
i.  Develop a transition plan in collaboration with the Agency and the current Contractor;
ii. Understand the Agency’s criteria for opening and closing cases; and
iii. Take over the outgoing Contractor’s databases that house the Agency's Medicaid provider cost audit information.

1.3.1.3 Operations

A.   Cost Audits
1.   The Contractor shall be responsible for reviewing cost and statistical information to use in rate-setting calculations for the following provider types:
a.  General medical/surgical hospitals 
b.  Critical access hospitals
c.  Psychiatric (mental) hospitals
d.  Psychiatric medical institutions for children (PMICs)
e.  Nursing facilities (NFs)
f.  Intermediate care facilities for individuals with intellectual disability (ICF/ID)
g.  Residential care facilities (RCFs)
h.  Home health agencies (HHAs)
i.   Rural health clinics (RHCs)
j.  Rehabilitation agencies
k.  Home health agencies and other providers providing services under Home and Community-Based Services (HCBS) waivers
1.  Federally qualified health centers (FQHCs)
m. Case management providers
n.  Habilitation (HAB) service providers
o.   Providers under the purview of the Departments of Education, i.e., Licensed Education Agencies (LEAs) and Area Education Agencies (AEAs)
p. Providers under the purview of the Departments of Public Health, i.e., Title V
q. Community mental health centers
r. Dentists
2.   The Contractor shall develop, maintain and adhere to an Agency approved Medicaid desk review program for the providers identified by the Agency.  The desk review program shall include recognition of the differences between Medicare coverage, rules, and regulations and those of Medicaid.
3.  The Contractor shall perform desk reviews or on-site field audits for the provider types listed above to ensure the accuracy of financial information submitted by Medicaid providers (including review of financial statements to determine provider unit costs), to compile and analyze fiscal and statistical data from the financial statements, and to advise and assist the Agency as necessary in administering the Medicaid Program.
4.  Audits shall be sufficiently detailed to enable the Contractor to express an opinion on total
costs and statistical data provided by the cost report.
5.  The Contractor shall gather necessary information to perform desk reviews, including Form CMS 2552, Hospital and Healthcare Complex Cost Report or other Medicare cost reports and supporting work papers from providers.
6.  The Contractor shall perform on-site audits for providers identified by the Agency, as requested. Audits shall be sufficiently detailed to enable the Contractor to express an opinion on total costs and statistical data provided by the cost report. The protocol for and selection of providers subject to on-site audits shall be based on criteria developed by the Contractor and shall be subject to approval by the Agency.
7.  The Contractor shall notify each provider in writing of any corrections made as a result of an audit or desk review. The Contractor shall ensure the thoroughness and mathematical accuracy of submitted reports and ensure conformance to the requirements for allowance of costs, as stated in the Code of Federal Regulations (CFR) and Iowa Administrative Code (IAC).
8.   The Contractor shall complete cost and statistical data compilation reports for each provider according to the Agency’s schedule for each provider type.
9.   Annually, the Contractor shall compile and provide detailed analysis of cost reports submitted by providers and the resulting desk review and field audit adjustments to reclassify and
amend provider cost and statistical data.
10. The Contractor shall send appropriate blank cost reporting forms, when requested, in a format specified by the requestor within five business days.
11. The Contractor shall receive cost reports and process requests for extension of due dates when necessary. The Contractor shall have the ability to accept cost reports submitted electronically.
12. The Contractor shall contact providers within 30 days who are untimely in submission and/or submit incomplete reports and enforce Agency regulations regarding timely submittal of late reports and adjustment reports.
13. The Contractor shall communicate and work with providers to obtain information on, or clarification of, their cost report information.
14. The Contractor shall respond to all audit request confirmations received from providers' Certified Public Accounting (CPA) firms within the timeframe the Agency specifies.
15. The Contractor shall make corrections to submitted cost reports, incorporating changes identified in adjustment reports.
16. The Contractor shall develop arrangements with all Medicare intermediaries operating in the State of Iowa to obtain Form CMS 2552, Hospital and Healthcare Complex Cost Report or other Medicare cost reports. The Contractor shall use the final Medicare cost report in reconciling Medicaid costs.
17. The Contractor shall submit to the Agency a monthly audit activity report to include, but not be limited to:
a.  Field audit summary to include, at a minimum, the names of providers audited, the
dates of each audit, and audit findings;
b.  Cost report summary to include the number of cost reports received, date received, date processed, the number of desk audits completed, and the amounts of overpayments and underpayments identified.

B.  Cost Settlements, provider assessment fees, and supplemental payment arrangements
1.  The Contractor shall perform rate setting and cost settlements to ensure that payments made to Medicaid providers are in accordance with State and federal requirements. Cost settlements entail a mix of retrospective and prospective methodologies.
2. The Contractor shall provide a notice of provider reimbursement to cost-based providers,
including comparisons of submitted and audited data. 
3.  The Contractor shall reopen cost report settlements as a result of amendments to Medicare or
Medicaid regulations or because of a provider appeal.
4.  On a quarterly basis, the Contractor shall submit a report of cost settlement, provider assessment fees, and supplemental payment arrangements findings to the Agency.
5.  The Contractor shall track, monitor and assist the Agency in projecting expenditures and recommend adjustments to reimbursement systems based on the findings.

C.   Provider Rate Setting
1. The Contractor shall set rates for the provider types listed in Section 1.3.1.3.A.l.
2.  The Contractor shall develop interim rates for providers who are reimbursed on a percentage of-charges basis. The interim rates are a percentage of charges (as obtained from historical data and expected future costs). The Contractor shall make adjustments, if necessary, and adjust provider rates as appropriate.
3.  The Contractor shall update or make changes to rate methodologies to comply with any
change in federal or State law.
4.  The Contractor shall correct rate sheets to incorporate reimbursement revisions.
5.  The Contractor shall calculate overpayments or underpayments that result from adjustments of interim rates.
6.  At the request of the Agency, the Contractor shall modify any rebasing or rate setting calculations to incorporate more recent claims experience, including encounter claims.
7. The Contractor shall work with the Agency to modernize the rate setting process. Information sharing and distribution shall be conducted electronically.  This includes all information
shared between the Agency and the Contractor, as well as all information distributed to providers.
8. The Contractor shall work with the Agency and the Agency’s actuary as required to determine the impact of any provider rate changes on the managed care capitation rates and support capitation rate development and the Agency's managed care program. This includes maintaining a schedule of all rate changes projected during the duration of the Contract and projected fiscal impacts, updated regularly but no less than semi-annually.
9. The Contractor shall consult with the Agency when medical judgment is
needed for manual pricing of claims when no current fee or payment exists for the service.
10. The Contractor shall report to the Agency the projected cost impact of rate changes 14 days in advance of rate changes going into effect. The Contractor shall model different scenarios, as specified by the Agency, when developing the projected cost impact of rate changes.

D.  Nursing Facility (NF) and Long-Term Care (LTC) Rate Setting
1.  The Contractor shall maintain the per diem rates for hospitals with Medicaid-certified physical rehabilitation units and update the rates as specified by the Agency. The Contractor shall submit the rates to be loaded in the MMIS.
2. The Contractor shall calculate rates for nursing facilities on an annual basis, with a quarterly case-mix adjustment based on the Medicaid case mix index of each NF.  The Contractor shall perform initial rebasing requirements as established by the Agency and every two years thereafter. The Contractor shall utilize the Medicare costs reports for the hospital-based NFs and utilize the annual Medicaid financial and statistical reports for the other NFs' rate calculation.
3.  On a quarterly basis, the Contractor shall provide a rate sheet to each NF based on the case
mix index adjustment or as needed if the provider submits an amended cost report.
4. The Contractor shall recognize and honor the Agreements for Exchange of Medicare and Medicaid information that the Agency has entered into with the Medicare intermediaries that serve Iowa. Because Medicaid generally follows the Medicare reimbursement methodology for institutional providers, the Medicare audit will suffice. The Contractor shall perform such an audit if Medicaid utilization or other factors indicate the need, even if the provider does not participate in Medicare or if Medicare utilization is so low that a Medicare on-site audit is not required.
5.  The Contractor shall request MDS data through the Agency’s data use agreement (DUA) with the Centers for Medicare and Medicaid Services (CMS) for purposes of utilizing MDS information for nursing facility rate setting.
6.  The Contractor shall provide support and technical assistance for any updates to MDS.
7.  On a quarterly basis, the Contractor shall provide a NF Resource Utilization Group report to the Agency.
8.  On a quarterly basis, the Contractor shall estimate the NF budget, compare to the cap identified in the annual appropriations bill, and provide the results to the Agency.
9.  On an annual basis, the Contractor shall analyze and compare individual NF employee turnover rates with the State average and recommended improvements and trends. The Contractor shall include this information in the annual long term care (LTC) compilation reports.
10. Per 441 Iowa Administrative Code 81.6(16)(h), NFs that have completed a complete replacement, new construction, or major renovations may apply for additional reimbursement for the purpose of rectification of a violation of Life Safety Code requirements or to develop home-and-community-based waiver program services. If funding is appropriated for this purpose, the Contractor shall review and process applications from NFs interested in applying for this increased reimbursement to determine whether they meet the criteria. The Contractor shall monitor NF providers with approved applications to ensure continued compliance with all requirements and track expenditures to report, upon request, to the Agency.
11. On an annual basis, the Contractor shall compile and submit to the Agency a detailed analysis to demonstrate growth of NF direct care costs, increased acuity and care needs of residents.
12. The Contractor shall prepare annual LTC compilation reports of costs and other statistical data taken from the cost reports for NFs, hospital-based NFs, and ICFs/ID. These reports will be used to set individual payment rates for providers, establish statewide reimbursement limits, and to evaluate changes in cost that can be used to assist the legislature and the Agency in determining fiscal impacts to proposed changes and in developing budgets.
13. The Contractor shall review and analyze hospital and nursing facility Medicaid and Medicare reimbursement data and other financial and statistical data, including cost reports and forecasting data.

E.   Ground Emergency Medical Transportation (GEMT) Cost Report Review
1. The Contractor shall perform GEMT cost settlements (including supplemental
payment arrangements) to ensure that payments made to Medicaid providers are in accordance with State and federal requirements. Cost settlements entail a mix of retrospective and prospective methodologies.
2. The Contractor shall provide a notice of provider reimbursement to cost-based providers, including comparisons of submitted and audited data.
3.  The Contractor shall reopen cost report settlements as a result of amendments to Medicare or Medicaid regulations or because of a provider appeal.
4.  On an annual basis, the Contractor shall submit a report of prospective rate calculations to the Agency.
5.  The Contractor shall track, monitor and assist the Agency in projecting expenditures and recommend adjustments to reimbursement systems based on the findings.

F. Provider Overpayments (Credit Balance)
1.	The Contractor shall identify provider overpayments that have created a credit balance within 30 days.
2.	The Contractor shall notify providers of balances due by sending an initial provider notification letter within five days of identification of the credit balance.  
3.	The Contractor shall send a second letter if payment has not been received within 30 days
4.	The Contractor shall refer any providers with an identified overpayment who have filed for Chapter 7 or Chapter 11 bankruptcies to the Iowa Attorney General’s Office.
5.	The Contractor shall refer to the Agency any deceased providers with a provider overpayment.
6.	The Contractor shall prepare and submit the adjustment forms to transfer the overpayment amount to the actively enrolled provider, when a provider is in a credit balance and their federal tax identification number matches that of an actively enrolled provider.
7.	 The Contractor shall prepare and process credits or adjustments against recoveries received within 10 business days of receipt of the recoveries. 
8.	The Contractor shall refer the provider overpayment account to Program Integrity after  90 days of the initial notice date, when a Provider with an overpayment fails to pay in full, sign a payment agreement, and/or has exhausted appeal rights.
9.	The Contractor shall prepare and submit the adjustment forms to write off the provider overpayment as bad debt, when the amount of the credit balance is below a threshold, as determined by the Agency.
10.	The Contractor shall submit a monthly report to the Agency of provider overpayment collection activity and overpayments referred to the Agency from the previous month.

G.  Rebasing, Diagnosis Related Group (DRG) and Ambulatory Payment Classification (APC)  Recalibration. 
1.The Contractor shall:
a. Calculate accurate rebasing of hospital base, capital cost, direct and indirect medical education, and disproportionate share rates every three years or as specified by the Agency.
b. Calculate accurate recalibration of DRG and APC weights every three years or as specified by the Agency.
2.  The Contractor shall maintain interfaces with the Agency-approved systems Contractor, or the Agency for historical data for:
a.  Inpatient services for use of the Medicare DRG grouper, with Medicaid-specific weights; and
b. Those outpatient services subject to reimbursement under the APC system for APC
weights.
3. The Contractor shall maintain data exchange with Medicare intermediaries operating in the State of Iowa to obtain Form CMS 2552, Hospital and Healthcare Complex Cost Report or other Medicare cost reports.
4. The Contractor shall perform calculations to apportion costs to Medicaid from hospital cost reports (Form CMS 2552, Hospital and Healthcare Complex Cost Report), rebase the base, capital cost, direct and indirect medical education, and disproportionate share rates, and recalibrate the weights for APCs and DRGs every three years, or as specified by the Agency.
5. The Contractor shall maintain and operate the DRG-based prospective payment system for
inpatient hospital services. The Contractor shall update the base and capital cost rates by applying an inflation index to these rates, if authorized by the Agency to do so. The Contractor shall submit the rates to be loaded in the Agency-approved system.
6. The Contractor shall maintain and operate the APC-based prospective payment system for
(most) outpatient hospital services. The Contractor shall update the base rates by applying an inflation index to these rates, if authorized by the Agency to do so. The Contractor shall submit the rates to be loaded in the Agency-approved system.
7. The Contractor shall provide the following reports at a frequency determined in
collaboration with the Agency:
a.  Hospital-specific and statewide average inpatient and outpatient case-mix index schedules.
b.  Revised DRG and APC weight schedules.
c.  Hospital-specific and statewide average rate sheets, documenting calculations used to derive revised base, capital cost, direct and indirect medical education, and disproportionate share rates.
d.  Summary of projected charges to projected payments based on hospital cost report and claims data.
e. Hospital payment estimation report for inpatient services and payment simulation report for outpatient services, using revised case-mix indices, base, capital cost, direct and indirect medical education and disproportionate share rates. 

H.   340B Drug Pricing Program
1. The Contractor shall collaborate with IME Provider Services to develop a requirement, as part of the enrollment/re-enrollment process for providers, to identify participation in 340B, federal supply schedule (FSS), and nominal price (NP) programs and a process to relay that provider participation detail in the provider file.  The Contractor shall compare the 340B results to the Health Resources and Services Administration (HRSA) exclusion file. Duties include, but are not limited to the following:
a.  Collaborate with IME Provider Services in developing enrollment/re-enrollment form questions.
c.  Compare 340B results to the HRSA Office of Pharmacy Affairs (OPA) exclusion file for consistency.
d.  Address issues of 340B pricing policy compliance to ensure accuracy of status on HRSA OPA Exclusion file (e.g., prevent duplicate discounts).
e.  Develop the process for maintaining/monitoring of provider compliance.
f.  Provide an annual report on consistency between IME 340B Attestation From and
HRSA covered entities file and Medicaid Exclusion File.
2.  The Contractor shall compile a list of providers as identified through the enrollment/re-enrollment process to the Agency as follows:
a.  340B- self-identified and confirmed through HRSA. 
b.   Not self-identified but included though HRSA.
3.  The Contractor shall perform a quarterly Fee for Service (FFS) Point-of-Sale (POS) and Professional claims compliance audit, to include the following activities:
a.  Address issues with potential non-compliance with policy to identify 340B claims (e.g.,
prevent duplicate discounts).
b.  Select claims representing FFS Pharmacy and FFS Professional. The selected sample of claims must include Pharmacy claims, UB04 and CMS 1500 claims. The Contractor shall propose, subject to Agency approval, the number and proportion of claims to be sampled, based on Contractor’s review of utilization and expenditure data and industry sampling standards.
c.  Develop a risk assessment that incorporates a comparison of providers registered with
the HRSA OPAwebsite against IME providers to assist in identifying claims submitted without the appropriate modifier or indicator but potentially obtained via the 340B Pricing Program.
d.  Evaluate whether claims are being submitted in compliance with IME guidelines for billing Carve-In and Carve-Out 340B services.
e.  Review claims for compliance with required use of claim modifiers or indicators. The Contractor shall give consideration to include, both claims that were submitted with the required modifier/indicator, as well as those where the modifier/indicator may have been omitted (as identified via risk assessment).
f.  Review claims for reasonableness of submitted charges compared to proxy amounts:
i.  Reviews must evaluate whether providers accurately submitted Actual
Acquisition Cost for drugs obtained through the 340B Pricing Program (340B AAC).
ii.  Reviews must also evaluate if provider accurately adjusted 340B claims
submitted to Medicaid to reflect any price reductions received through the manufacturer's periodic recalculation process.
g.  Provide a report of findings within 30 days of completion of the review.
4.  The Contractor shall perform semi-annual MCO Professional Claims Compliance Audits to include the following activities:
a.  Address issues with potential non-compliance with policy to identify 340B claims (e.g., prevent duplicate discounts).
b.  Select a sample of claims that include UB-04 and CMS 1500 claims with the number and proportion to be determined based on review of utilization and expenditure data and industry sampling standards.
c.  Develop a risk assessment that incorporates a comparison of providers registered on the HRSA website against IME providers to assist in identifying claims submitted without the appropriate modifier but potentially obtained via the 340B Pricing Program.
d.  Evaluate whether claims are being submitted in compliance with IME guidelines for billing Carve-In and Carve-Out 340B services.
e.  Review claims for compliance with required use of claim modifiers or indicators.
f.  Consider claims that were submitted with the required modifier/indicator, as well as those where the modifier/indicator may have been omitted (as identified via risk assessment). The Contractor shall evaluate whether claims are billed at appropriate rates, as defined by IME 340B policy.
g.  Evaluate what controls MCOs have in place to ensure that contract pharmacies are not
billing 340B products.
h.  Provide a report of findings within 30 days of completion of the review.

5.    The Contractor shall perform the following activities related to 340B pricing:
a.  Research manufacturer revisions of 340B prices and provide the Agency with feedback and suggestions.
b.  Address issues with the opportunity for refund of payment made for 340B claims when manufacturers retroactively change the 340B acquisition cost (prevent inappropriate payment).
c.  Review the manufacturer notices on the HRSA website.
d.  Determine whether there is a strategy to request a portion of the refund to the covered entity to be returned to the Agency and provide recommendations.
e. Determine how to quantify the refund to the Agency and provide recommendations.
6.  The Contractor shall maintain current Iowa Medicaid policies for 340B and perform ongoing review to offer recommendations for modifications or clarifications. The Contractor shall submit recommendations annually and/or as needed or when requested by the Agency.
7.   On a semi-annual basis, the Contractor shall collect 340B invoices and review them against
submitted charges for covered entities to include the following activities:
a.  Collect a sample of 340B invoices from a selection of 340B-participating covered entities (CE). The Contractor’s sample selection shall be based on industry sampling standards and agreed upon by the Agency.
b.  Select a sample of claims from covered entities to audit that coincide with the drug invoice
reporting period.
c.  Compare 340B invoice costs to submitted charges on an agreed upon number of 340B claims to determine if the covered entity is billing Medicaid at 340B Actual Acquisition Cost, as required by the Agency’s 340B program policy.
d.  Review claims for compliance with required use of claim modifiers or indicators. 
e.   Give consideration to include both claims that were submitted with the required
modifier/indicator, as well as those where the modifier/indicator may have been omitted
(as identified via risk assessment).
f.  Provide a report of findings of compliance with 340B policy and billing practices within 30 days of completion of the review.

I.  Pharmacy: Average Actual Acquisition Cost (AAC) Reimbursement Program
1.   Pharmacy Reimbursement Methodology- General
a.  The Contractor shall maintain, update and improve the methodologies for pharmacy reimbursement, based on pharmacy invoicing data. This includes, but is not limited to:
i.  Review overall pharmacy reimbursement methodologies;
ii.  Develop an options analysis report for changes or enhancements to reimbursement methodologies. The report shall include at a minimum:
a)  Average AAC-based reimbursement, State-based average AAC, national average drug acquisition cost (NADAC), or combination of the two.
b)  Average AAC rates for drugs/products that categorically do not currently
have a State average AAC or NADAC. These drugs/products include, but are not limited to, specialty drugs, over the counter (OTC) products and other infusion products.
c)  Alternative reimbursement methodologies for drugs not required by
CMS to meet AAC definition, including specialty drugs not dispensed by a retail community pharmacy and dispensed primarily through the mail; drugs not dispensed by a retail community pharmacy (e.g., institutional or long term care pharmacy when not included as part of an inpatient stay) and clotting factor from Specialty Pharmacies, Hemophilia Treatment Centers (HTCs), or Centers of Excellence.
d)  For enhancements to reimbursement methodologies, provide a summary of fiscal impact, policy impacts, dispensing fee considerations, State Plan changes, State law changes, recommended provider outreach and other pertinent considerations.
b.  The Contractor shall ensure compliance with 42 CFR part 447 Subpart I, Payment of
Drugs, to include at a minimum:
i.  A validation process to ensure reimbursement at AAC, including 340B, FSS
and NP; and
ii.  A reporting process to meet mandatory findings and assurance requirements, including recordkeeping pursuant to 42 CFR § 447.518.
2. The Contractor shall maintain and update average AAC rates. Duties include, but are not
limited to, the following activities:
a.   Rebase Updates. The Contractor shall:
i.  Complete a semi-annual rebase - Select a random sample of approximately one-half of the active Iowa Medicaid enrolled pharmacies with Medicaid claims in the last six months to be included in acquisition cost study. The Contractor shall include out-of-state enrolled pharmacies as appropriate. Pharmacies that were selected in the current year sample cannot be selected in the next six-month sample.
ii.  Complete Weekly Interim Updates- Adjust average AAC rates to be reflective
of relative changes in published drug pricing and market changes (new generics, increased generic competition, generic manufacturer withdrawal from the market, etc.); review new drug cost data and update/add average AAC rates weekly; and adjust average AAC rates as needed based on provider inquiries to the help desk as validated by invoices or published pricing.
iii.   Provide the Agency with information on external factors affecting prescription
drug pricing, including but not limited to, federal legislation and program implementation, any legal issues or cases affecting drug pricing, trends in drug reimbursement, trends in professional dispensing fees, and/or pharmacy provider issues.
b.   Develop acquisition cost study materials, and with Agency approval, mail studies to
selected providers. The Contractor shall develop and implement an Agency-approved follow-up process for unresponsive providers.
c.  Collect invoices from appropriate pharmacy providers, allowing invoice submission via fax, mail, and electronic means from the pharmacy and/or wholesaler.
d.  Receive and enter applicable data from invoice.
e.  Maintain all pharmacies' cost or purchase information obtained for rate setting in a secure and confidential environment.
f.  Calculate State average AAC rates for drugs mentioned above based on actual invoice
acquisition cost.
g.  Review/analyze new average AAC rates.
h.  Finalize effective date and rate file, subject to Agency approval.
i.   Prepare notification letter for Agency approval. Once approved, the Contractor shall send to the list serve and post to the website.
j. Deliver rate file to Pharmacy Point of Sale (POS) Contractor and other Contractors, as indicated by the Agency.
k. Verify rates have been correctly input into POS system.
l. Maintain a rate file history with rate changes and corresponding effective dates.
3.  On a monthly basis, the Contractor shall compile and submit to the Agency a drug monitoring report by the 10th business day of each month, including, but not limited to:
a.  Drug Group Summary.
b.  Average AAC rate group changes Summary.
c.  Summary of quarterly estimated ingredient costs avoided.
d.  Help desk call Summary. 
e.  Drug member watch list.
f.  Average AAC additions watch list.
g.  Brand/generic revisions to average AAC details. 
h.  State fiscal year to date estimated ingredient costs avoided.
4.  The Contractor shall provide the Agency with all reports necessary to validate compliance
with 42 CFR § 447.518 findings and assurances, including but not limited to:
a.  Semi-annual federal upper limit (FUL) aggregate test.
b.  Aggregate test annually for expenditures for multiple source drugs and triennially for a1l other drugs.
5.  The Contractor shall provide the Agency with a monthly average AAC monitoring report. This report shall include at a minimum:
a.  Detailed analysis on program performance;
b.  Detail of savings, using the Agency-approved method for the estimated quarterly fiscal impact provided by the average AAC-based pharmacy reimbursement;
c.  Summary of pharmacy provider help desk calls; and
d.  Availability of newly available generic drugs.
6.  The Contractor shall calculate the FUL aggregate test at least semi­annually to verify that the average AAC-based pharmacy reimbursement satisfies the FUL aggregate requirement set forth by CMS.
7.  The Contractor shall receive monthly claims files from the Agency or designee to support
evaluation and analysis of the program.
8.  The Contractor shall maintain a help desk to support pharmacy providers with inquiries relating to average AAC reimbursement, including rates and invoice survey process. Duties include, but are not limited to:
a.  Answer and respond to pharmacy provider inquiries (by phone, fax or email) related to average AAC reimbursement during normal Business Hours. The Contractor shall provide a toll-free number. The Contractor shall provide an initial response to provider inquiries within two business days.
b.  Research pricing inquiries for possible changes to average AAC rates and effective
dates. The Contractor shall communicate any change with the regular weekly rate file update.
c.  Calculate a State average AAC rate for drugs/products without a wholesale
acquisition cost (WAC) or "no rate on file" through select provider invoice collection or published benchmarks.
9.  The Contractor shall assist the Agency in maintaining the Agency’s website to include
average AAC drug pricing, Informational Letters, contact information, rate request review process, FAQ materials and reports related to the average AAC reimbursement program.
10. The Contractor shall develop all draft Informational Letters, responses to providers, stakeholders, legislators, CMS and other entities as determined by the Agency regarding the average AAC reimbursement methodology and following Agency-approved communication standards.

J.  Pharmacy: Cost of Dispensing Survey
1.  The Contractor shall conduct a cost of dispensing survey every even year for the Agency pursuant to State legislation and Agency timeline. The Contractor shall use the survey to determine the actual cost of dispensing a pharmaceutical prescription in the various practices of pharmacy by:
a.  Determining sufficient provider reimbursement to encourage statewide access to
prescribed medications by Medicaid members.
b.   Ensuring pharmacy provider reimbursement is based upon reasonable and accurate prescription dispensing costs.
c.  Determining whether separate reimbursement methodologies are desirable for different types of pharmacy providers.
2.   The Contractor’s cost of dispensing survey results shall indicate the costs incurred by the program pharmacies, in the most recently completed fiscal year, for dispensing prescription medication. The Contractor shall, at a minimum:
a.  Survey all Iowa Medicaid enrolled pharmacies currently participating in the program.
b.  Apply cost-finding methods and procedures, approved by the Agency, that yield fair and reasonable allocations to pharmacy dispensing functions.
c.  Develop and mail a survey instrument with complete instructions to each pharmacy to obtain the necessary dispensing cost data.
d.  Include a postage-paid return envelope with the survey instrument.
e.  Provide assistance by the way of a toll-free telephone number, e-mail or other equivalent service, for pharmacies requiring assistance to complete the survey forms.
f.  Send reminder letters to those pharmacies that have not submitted survey forms. The
Contractor shall contact and assist those pharmacies that have submitted inaccurate or incomplete forms.
g.  Specify quality control measures (e.g., desk review procedures) used to audit survey forms for consistency and completeness and to ensure an accurate data base from which all analyses are derived.
h. Take adequate measures to guarantee confidentiality of the data.
i.   Develop findings and make appropriate recommendations to the Agency concerning the reasonableness of any change in prescription dispensing costs for pharmacy reimbursement.
j.  Perform analysis of cost of dispensing for select provider types, including but not limited to, specialty pharmacy, 340B, federal supply schedule, and nominal price.
3.   The Contractor shall include, at minimum, in the survey results the categories listed below per prescription. For each category, the survey shall indicate the appropriate statistical measures and tests:
a.  Total prescription volume and subgroups by prescription volume.
b.  Independent and Chains.
c.  Urban (Metropolitan Statistical Areas) and Rural (Non-Metropolitan Statistical Areas). 
d.  Retail.
e.  Medicaid prescription volume and subgroups by Medicaid prescription volume.
f.  Medicaid prescription volume as a percentage of total volume. 
g.   Provision of unit dose dispensing services.
h.  Select provider groups, including providers of 340B drugs, FSS drugs, NP drugs, Specialty drugs, institutional or LTC pharmacy drugs, clotting factors and compounded drugs.
4.   The Contractor shall submit the following reports:
a.  Weekly status reports;
b.  Cost of dispensing report and formal presentation of findings and recommendation in an Agency-approved format.  The report shall contain the following sections:
i.  An executive summary providing an overview of the survey and its findings
and conclusions;
ii. A cost of dispensing survey section containing a description of the survey participants, the survey instrument, the data collection and processing techniques, the cost-finding methods and procedures used to assign and allocate costs to prescription dispensing functions including any and all statistical and analytical techniques utilized, and the detailed findings and conclusions of the analysis of the costs of dispensing prescriptions. This section shall also include the Contractor’s analysis and recommendations concerning the reasonableness of the current professional dispensing fee vis-a­vis the costs incurred by surveyed pharmacies; and
iii.  A section of appendices containing detailed data pon which findings and conclusions for the survey were drawn.
5.  The Contractor shall assist the Agency in maintaining the Agency’s website to include Informational Letters, contact information, FAQ, materials and reports related to the cost of dispensing survey.
6.  The Contractor shall develop all draft Informational Letters, responses to providers,
stakeholders, legislators, CMS and other entities as determined by the Agency, regarding the cost of dispensing survey following Agency-approved communication standards.

K.  Federal Supply Schedule (FSS) and Nominal Price (NP) Reimbursement
1. The Contractor shall collaborate with IME Provider Services to develop a requirement, as part of the enrollment/re-enrollment process for providers, to identify participation in federal supply schedule (FSS), and nominal price (NP) programs and a process to relay that provider participation detail in the provider file. Duties include, but are not limited to the following:
a.  Develop an IME annual attestation form for submission (based on criteria outlined in
Iowa Medicaid Informational Letters).
b.  Administer the Iowa Medicaid annual FSS and NP attestation form for all Medicaid enrolled providers.
c.  Address issues of compliance with FSS and NP.
d.  Develop the process for maintaining/monitoring provider compliance. 
e.   Provide an annual report on FSS/NP compliance activities and include recommendations for improvement.
2.  The Contractor shall perform an annual FSS point-of-sale (POS) compliance audit, to include the following activities:
a.  Address issues with potential policy non-compliance regarding FSS and NP
reimbursement.
b.  Perform a compliance audit on a pharmacy claims sample annually, at a minimum, for any provider purchasing at FSS or NP. The Contractor shall utilize a sample selection based on industry sampling standards and agreed upon with the Agency.
c.  Evaluate whether claims are being submitted in compliance with Iowa Medicaid guidelines for billing FSS and NP claims.
d.  Review POS claims for reasonableness of submitted charges compared to proxy amounts. The Contractor shall evaluate whether providers accurately submitted FSS or NP Actual Acquisition Cost for drugs.
e.  Provide annual report of FSS and NP findings.

L.    MCO Oversight
1.  The Contractor shall support the Agency by providing technical assistance to the Managed Care Organizations (MCOs) regarding provider rates and reimbursement methodologies. Duties include, but are not limited to:
a.  Transmitting files;
b.  Answering questions;
c.  Maintaining a schedule of all provider rate changes, to be distributed each quarter to
MCOs for the rolling year;
d.  Log all communications with MCOs related to transmission of provider rate changes, including effective date of rate change; and
e.  Ensure MCOs are notified of rate changes based on the Agency-approved schedule.
2. The Contractor shall review current Iowa Medicaid contracts, policies and procedures for MCO operations alignment and offer recommendations for modifications or clarifications based on industry best practices and other available benchmarks.
3. The Contractor shall accumulate and analyze claim report submissions for each of the MCOs to assist with determination of appropriate claim adjudication and make recommendations for reporting and process improvements based on that analysis. Duties include, but are not limited to:
a.  Assist in preparing ad hoc reports, as requested by the Agency, related to the claims report analysis. These ad hoc reports could include, but are not limited to, legislative reports when requirements for such reports become known.
b.  Participate in the Agency claims benefits workgroup.
c.  Conduct claims analysis and report findings to the Agency on a monthly basis.
d.  Conduct monthly trend reporting based on claims report analysis. The Contractor shall include prior month and accumulation to date, with the due date being contingent on the submission of reports by the MCOs for the prior month.
4. On a monthly basis, the Contractor shall analyze and report on managed care and FFS system edits for claims adjudication, to include the following activities:
a.  Assess MCO and FFS system edits for claims adjudication for comparability and
abrasion.  The Contractor shall leverage the MCO and Agency's National Correct
Coding Initiative (NCCI) and customized edits for comparison.
b.  Provide formal recommendations of MCO and FFS system improvements to the Agency no less than annually, on areas that should be aligned for best practice or ease of system functionality.  The Contractor’s recommendations shall include overall impact to MCOs, the Agency, and provider community.

M.   Technical Assistance and Compliance Support
1.    The Contractor shall assist in development of the Agency's policies and procedures. The Contractor shall provide recommendations for improvement and continued compliance with State and federal regulations.
2. The Contractor shall analyze new Current Dental Terminology (CDT), Current Procedural Terminology (CPT), International Classification of Disease (ICD) 10, Healthcare Common Procedure Coding System (HCPCS) and other nationally recognized codes in the fourth quarter of each calendar year. The Contractor shall make recommendations to the Agency and include the pricing amount or logic if incorporated into an existing reimbursement system.
3.  The Contractor shall assist providers in understanding Medicaid regulations and make
recommendations on filing of cost reports.
4.  The Contractor shall maintain sufficient knowledge about federal requirements for funding of services for which costs are being reported so that the Contractor shall:
a.  Know what costs are allowable.
b.  Be familiar with any reporting that may be required for receipt of those funds in order to assist the Agency in complying with federal requirements.
5.  The Contractor shall provide draft policy changes to meet the timeframes for the filing processes required by:
a.  CMS for Medicaid State Plan Amendments
b.  The Agency for State administrative rules and provider or employee manuals.
6.  Upon request of the Agency, the Contractor shall provide assistance with policy-related items such as changes to the State Plan, Iowa Administrative Rules, Iowa Code, and provider manual updates.
7.  The Contractor shall provide support and technical assistance to the Agency for the development, implementation and monitoring of new programs directed by the Legislature or at the request of the Agency.
8.  The Contractor shall provide the following ongoing technical assistance and support to the Agency related to reimbursement methodologies:
a.  Conduct proactive analysis of national benchmarks and best practices and assist the Agency in the development of new reimbursement methodologies for institutional or other providers. This includes but is not limited to innovation in payment structures and rate methodologies to assist with payment reform that aligns with national healthcare reform (i.e., value-based purchasing).
b. Participate in or make presentations at trainings, meetings, or conferences for federal or State staff or providers in the development of reimbursement methodologies, as requested by the Agency. 
c. Participates in workgroups or task forces as subject matter experts, as requested by the Agency. 
9. The Contractor shall provide support to the Agency during the payment error rate measurement (PERM) Project, as requested. Duties include, but are not limited to: 
a. Follow up on all requests for pricing claims or explaining reimbursement methodologies for findings related to the PERM Project.
b. Provide assistance with repricing claims in cases of potential findings of overpayments or underpayments and consultation related to reimbursement methodologies and pricing of claims.
10. The Contractor shall notify the Agency of suggestions for improving provider accounting procedures and unusual cost discrepancies, including failure of provider records to substantiate costs reported to the Agency.
11. The Contractor shall maintain a monitoring and reporting system for nursing facilities.
12. The Contractor shall provide technical assistance to the Agency for:
a. Modified price-based case-mix reimbursement system for nursing facilities.
b. Method of reimbursing hospitals and nursing facilities for coinsurance and deductible amounts for dually eligible recipients. 
c. Medicaid payment policies designed to maximize available federal financial participation (FFP) (such as implementation of provider assessment and supplemental payment arrangements).
d. Development, implementation and monitoring of provider assessments, as required by the Agency.
e. Development and monitoring of the medical assistance budget.
13.The Contractor shall provide the Agency with findings related to State Plan amendments and assist with other special projects.
14. In collaboration with the Agency and the Agency’s actuary, the Contractor shall reconcile the total amount of direct and indirect graduate medical education (GME) payments made through FFS and managed care capitation rates to ensure the annual GME limit is not exceeded.
15. The Contractor shall develop an approach or methodology that can be used to perform upper payment limit (UPL) tests for all affected provider types that complies with federal regulations.
16. Based on the approved UPL approach or methodology, the Contractor shall accurately perform UPL tests each year or as requested by the Agency.  The Contractor shall provide the information and supporting documentation to the Agency for all affected provider types.
17. The Contractor shall update or make changes to the approved UPL approach or methodology to comply with any change in federal or State law. The Contractor shall upon request release the rates established for Iowa providers to other states' Medicaid programs. 
18. The Contractor shall assist in publication of rates to the Agency’s Medicaid website, as requested by the Agency.

N.	Change Pool
1.The Contractor shall provide an allowance of 300 person-hours of time in each Contract year to perform services not otherwise specified in this Contract.  The services will be included in the general administration and other fixed rate; the Agency will not have to pay the Contractor an additional fee for these services. The conditions of the change pool are as follows: 
a. No back-loading – the Agency must use the 300 hours within each year of the Contract, with no carryover of hours. 
b. Prior approval –All change pool hours must be approved in writing by the Agency in advance.  
1.3.1.4 Turnover Phase
Within this formal phase of the Contract, the Contractor turns over operations to a new Contractor near the end of the Contract term. This phase is activated when the Agency enters into a contract with a new entity (such as a newly awarded Contractor) and begins the process of transferring responsibility for operations to that entity. Once the turnover phase begins, the Contractor shall:
1.   Fully cooperate with the Agency and new entity.
2.   Develop and comply with a turnover plan detailing the activities necessary to transfer responsibility for operations to the new entity.

1.3.2 Performance Measures.  
A.   Planning
1.   The Contractor shall submit project work plans to the Agency for approval within 15bbusiness days after execution of this Contract, unless specified otherwise. 
2.   The Contractor shall submit the reporting, communications, and pharmacy reimbursement
plans to the Agency for approval within 20 business days after execution of this Contract. 
3.   The Contractor shall submit SOPs to the Agency for approval within 25 business days after
the execution of this Contract. 
 
B.  Reporting
1.   The Contractor shall deliver accurate and timely reports to the Agency. All submitted reports shall be concise, free from typographical and grammatical errors, and come to logical conclusions.
2.   Unless otherwise specified, the Contractor shall provide all identified reports in an Agency
approved format and in accordance with timeframes established in the Agency-approved reporting plan.
3.   The Contractor shall submit reports within the timeframes established in the Agency approved reporting plan and according to the following schedule, unless otherwise specified within the Agency-approved reporting plan:
a.   Weekly reports: within two business days of end of reporting period;
b.   Monthly reports: within 10 business days of end of reporting period;
c.   Semi-annual reports: within 10 business days of end of reporting period;
d.   Annual reports: within 20 business days of end of reporting period; and
e.   Ad hoc reports: within two business days of request, unless otherwise specified.
4.   For those reports that will be released to external stakeholders, and other special reports as identified within the reporting plan, the Contractor shall:
a.   Submit a draft to the Agency for review 30 calendar days prior to the release date.
 
C.   Cost Audits, Cost Settlements and Rate Settings
1.   Cost Settlements.  The Contractor shall perform final cost settlements for 100% of cost reports for specified providers within timeframes established in the Agency-approved performance reporting plan.
The following exceptions apply for this performance measure:
a.   If additional information is required of the provider to support expenses reported on the cost report, the Contractor is allowed to "stop the clock" when a request for additional information is sent to the provider. The clock starts again the date the additional information is received from the provider.
b.   If the provider submits significant changes to the cost report within 30 days or less of the due date for cost settlement, the Contractor is allowed an additional 30 days for final cost settlement.
2.   Desk Review Program. The Contractor shall perform annual desk reviews and send rate sheets for 100% of cost reports for specified providers within timeframes established in the Agency-approved performance reporting plan. The following exception applies for this performance measure:
a. If additional information is required of the provider to support expense reported on the cost report, the Contractor is allowed to "stop the clock" when a request for additional information is sent to the provider. The clock starts again the date the additional information is received from the provider.
3.   The Contractor shall update rates within five business days of Agency request for those rates that are updated on a routine basis.
4.   The Contractor shall send the quarterly rate sheets based on Case Mix adjustments to nursing facilities within 30 days of the end of each quarter.
 
D.   GEMT Cost Report Reviews
1.  The Contractor shall complete GEMT Cost Report Reviews within 90 business days from the date a GEMT cost report is received from a qualified provider.
 
E. Provider Overpayments (Credit Balance)
The Contractor shall complete a monthly review of Provider overpayments using the following timeframes:
i.	Initial notification occurred within five days  
ii.	Second notification occurred within 30 days
iii.	Refer the provider overpayment account to Program Integrity after 90 days from the initial notification, when a Provider with an overpayment fails to pay in full, sign a payment agreement, and/or has exhausted appeal rights.
 
F.  Rebasing and Diagnosis Related Group and Ambulatory Payment Classification Recalibration
1. The Contractor shall complete with 100% accuracy calculations to apportion costs to Medicaid for each hospital submitting Form CMS 2552, Hospital and Healthcare Complex Cost Report, for use in calculating the base, capital cost, direct and indirect medical education, and disproportionate share rates.
2.   The Contractor shall complete with 100% accuracy calculations of hospital case-mix indices, inpatient base, capital cost, direct and indirect medical education, and disproportionate share rates and outpatient base and direct medical education rates.
3.   The Contractor shall complete with 100% accuracy calculations of DRG and APC weights when determined using Medicaid paid claims data or when determined based on other negotiated or manually calculated means.

G. MCO Oversight
1. The Contractor shall complete quality assurance on 100% of files to be transmitted prior to sending.
2.  The transmitted files must achieve a 98% accuracy level with errors resolved within 2 business days. 

1.5 Contract Payment Clause.

1.5.1 Payment Methodology.
A. The Contractor will be paid a fixed amount for services rendered, in accordance with the pricing set forth in Attachment F (i.e., the Cost Proposal).
B. Withhold of First Payment. The Agency will withhold the first monthly payment until such time as the final work plans and SOPs are accepted by the Agency.
C. Deliverables and Performance Measure Withholding Payment. The Contractor may Invoice 92% of the fixed amount each month. The Agency will withhold 8% of the monthly amount to assure the Contractor meets required Deliverables and Performance Measures as follows: 
1. Section 1.3.2.B Reporting - four percent of the monthly amount
2. Section 1.3.2.C Cost Audits, Cost Settlements, and Rate Settings - four percent of the monthly amount 
In order to claim the withhold amount, the Contractor must show in the monthly performance report that each performance measure has been met. Determination of whether performance measures have been met is strictly and solely at the discretion of the Agency.
3. Withholding of Final Payment.  The Agency may withhold the last full monthly payment due at the end of the Contract until such time as the Contractor has fully completed all Turnover activities and completely closed out the Contract.

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:

Lisa Burk
Iowa Medicaid 
1305 East Walnut Street
Des Moines, IA  50319-0114
Phone:  515-371-4703
RFPMED-24-001@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. 
Materials available electronically include:

IME website https://dhs.iowa.gov/ime/about

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).

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. This list is maintained by the Iowa Public Employees’ Retirement System. The list is currently found here: https://ipers.org/investments/restrictions. 

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 and other background investigations of the Bidder, its officers, directors, shareholders, or partners and managerial and supervisory personnel retained by the Bidder for the performance of the resulting contract.  The Agency reserves the right to conduct criminal history and other background investigations of the Bidder’s staff and subcontractors  providing services under the resulting contract.    

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 either a notice of disqualification or notice of intent to award 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.  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 IAC 7.41 et seq.  
IAC 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 1 flash drive, 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, 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.
The Agency is requesting the following information in addition to the contents immediately above.  

3.2.4.1.1 Draft project work plans detailing all activities and timelines, to include:
• Transition Plan
• Operations Plan

3.2.4.1.2 Proof of licensure for the following key staff:
• Audit Manager –Certified Public Accountant 
• Drug Pricing and Pharmacy Reimbursement Specialist –Doctor of Pharmacy 

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. 
For each similar service, provide a matrix detailing:    
A.	Project title; 
B.	Project role (primary Contractor or subcontractor); 
C.	Name of client Agency or business; 
D.	General description of the scope of work;
E.	Start and end dates of contract for services as originally entered into between the parties;  
F.	If the contract was terminated for any reason before completion of all obligations under the contract provisions, detail the reason(s) for the termination;
G.	Contract value;
H.	Whether the services were provided timely and within budget;
I.	Any damages, penalties, disincentives assessed, or payments withheld, or anything of value traded or given up by the Bidder that were valued at or above $500,000.  Include the estimated cost assessed against the Bidder for the incident with the details of the occurrence;
J.	List administrative or regulatory proceedings or adjudicated matters related to this service to which the Bidder has been a party; 
K.	Whether the Bidder has been debarred or suspended from federally-funded healthcare programs by any state or the federal government; and
L.	Contact information for the client’s project manager including address, telephone number, and email address. 

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 Reserved.  (Financial Statements)

3.3 Cost Proposal. 

Content and Format.
The Bidder shall provide the following information in the Cost Proposal: 

The Bidder’s Cost Proposal shall be submitted using the pricing worksheet set forth in Attachment F of this RFP. 

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.

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	
1.3.1.1 General Obligations	30
	-------	120	
1.3.1.3.A. Cost Audits	50
	-------	200	
1.3.1.3.B. Cost Settlements	50
	-------	200	
1.3.1.3.C. Provider Rate Setting	50
	-------	200	
1.3.1.3.D. Nursing Facility and LTC Rate Setting	50
	-------	200	
1.3.1.3.E. GEMT Cost Report Review	50
	-------	200	
1.3.1.3.F. Provider Overpayments (Credit Balance) 	50
	-------	200	
1.3.1.3.G. Rebasing, Diagnosis Related Group and Ambulatory Payment Classification Recalibration	25
	-------	100	
1.3.1.3.H. 340B Drug Pricing Program	50
	-------	200	
1.3.1.3.I. Pharmacy: Average Actual Acquisition Cost Reimbursement Program	50
	-------	200	
1.3.1.3.J. Pharmacy: Cost of Dispensing Survey	25
	-------	100	
1.3.1.3.K. Federal Supply Schedule (FSS) and Nominal Price Reimbursement	25
	-------	100	
1.3.1.3.L. MCO Oversight	50
	-------	200	
1.3.1.3.M. Technical Assistance and Compliance Support, and Change Pool	20
	-------	80	
1.3.1.4 Turnover Phase	10
	-------	40	
3.2.4.1.1 Draft project work plans detailing all activities and timelines, to include:
• Transition Plan
• Operations Plan	10	-------	40	
3.2.4.1.2 Proof of licensure for the following key staff:
• Audit Manager –Certified Public Accountant 
• Drug Pricing and Pharmacy Reimbursement Specialist –Doctor of Pharmacy	10	-------	40	
3.2.4.2 Experience	50
	-------	200	
3.2.5.2 Names and Credentials of Key Corporate Personnel	50	-------	200	
3.2.5.3 Information About Project Manager and Key Project Personnel.	50
	-------	200	

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: 700

Total Points Possible for Technical and Cost Proposals:  3,520 

4.4 Recommendation of the Evaluation Committee.  
The evaluation committee shall present a final ranking and recommendation(s) to the Medicaid Director 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 Medicaid Director 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:	

Attachments Specific to This RFP

Attachment F: Cost Proposal
Attachment G: Vendor Security Questionnaire 

Attachment: 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-24-001	{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:  24-001	
Contract Include Sharing SSA Data?  No
	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.
{To be completed when contract is drafted.}
1.2 Contract Purpose. 
{To be completed when contract is drafted.}

1.3 Scope of Work. 
1.3.1 Deliverables.
The Contractor shall provide the following:  
{To be completed when contract is drafted.}

1.3.2 Performance Measures.  
{To be completed when contract is drafted.}

1.3.3 Monitoring, Review, and Problem Reporting.   

1.3.3.1 Agency Monitoring 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:
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.

1.3.3.2 Agency Review Clause.  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.  

1.3.3.3 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.  

1.3.3.4 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.

1.3.4 Contract Payment Clause.
1.3.4.1 Pricing.  In accordance with the payment terms outlined in this section and the Contractor’s completion of the Scope of Work as set forth in this Contract, the Contractor will be compensated as follows:  
{To be determined.}

1.3.4.2 Payment Methodology.
{To be completed when contract is drafted.}

1.3.4.3 Timeframes for Regular Submission of Initial and Adjusted Invoices.  The Contractor shall submit an Invoice for services rendered in accordance with this Contract.  Invoice(s) shall be submitted monthly.  Unless a longer timeframe is provided by federal law, and in the absence of the express written consent of the Agency, all Invoices shall be submitted within six months from the last day of the month in which the services were rendered.  All adjustments made to Invoices shall be submitted to the Agency within ninety (90) days from the date of the Invoice being adjusted.  Invoices shall comply with all applicable rules concerning payment of such claims.  

1.3.4.4 Submission of Invoices at the End of State Fiscal Year.  Notwithstanding the timeframes above, and absent (1) longer timeframes established in federal law or (2) the express written consent of the Agency, the Contractor shall submit all Invoices to the Agency for payment by August 1st for all services performed in the preceding state fiscal year (the State fiscal year ends June 30).  

1.3.4.5 Payment of Invoices.  The Agency shall verify the Contractor’s performance of the Deliverables and timeliness of Invoices before making payment.  The Agency will not pay Invoices that are not considered timely as defined in this Contract.  If the Contractor wishes for untimely Invoice(s) to be considered for payment, the Contractor may submit the Invoice(s) in accordance with instructions for the Long Appeal Board Process to the State Appeal Board for consideration.  Instructions for this process may be found at:  http://www.dom.state.ia.us/appeals/general_claims.html.  

The Agency shall pay all approved Invoices in arrears and in conformance with Iowa Code 8A.514.  The Agency may pay in less than sixty (60) days, but an election to pay in less than sixty (60) days shall not act as an implied waiver of Iowa law.

1.3.4.6 Reimbursable Expenses.  Unless otherwise agreed to by the parties in an amendment or change order 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, COBIT 5, CSA STAR Level 2 or greater, or ISO 27001 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).

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: 
NIST SP 800-53, HITRUST version 9, COBIT 5, CSA STAR Level 2 or greater, or ISO 27001 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  Reserved.  (Labor Standards Provisions.)  

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)? Yes