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COOK COUNTY HEALTH (CCH)REQUEST FOR PROPOSAL RFP# H20-0038TITLE: CMS Interoperability and Patient Access Final RuleGENERAL DESCRIPTION: Health Plan Services is requesting proposals for an Application ProgrammingInterface (API) that is compliant with the CMS Interoperability and Patient Access Final Rule andprovides an integrated solution that will standardize the exchange of healthcare information that willenable healthcare providers and payers to easily share patient information.DATE ISSUED: November 2, 2020VENDOR QUESTIONS DUE DATE: November 10, 2020 by 2:00 p.m. CTRESPONSE/ PROPOSAL DUE DATE: December 4, 2020 by 2:00 p.m. CTResponses to this RFP shall be delivered after 8:00 AM (CT) but no later than 2:00 PM (CT) to:Cook County Health C/O John H. Stroger, Jr. Hospital1969 West Ogden Ave., Lower Level Room # 250AChicago, IL 60612Attention: Supply Chain Management DepartmentPlease note that it takes approximately 20 minutes to pass security and walk to room 250A.Pre-Proposal Conference /Field Inspection:Cook County Health, Health Plan Services600 W Jackson, 4th floorChicago, IL 60661Delivery of RFP must include the RFP Acknowledgement Form included at the end of this document.All questions regarding this RFP should be directed to purchasing@cookcountyhhs.orgThe RFP and related Addenda will be posted at the http://www.cookcountyhealth.org website under the“Doing Business with Cook County Health” tab.
Health Plan Services CMS Interoperability and Patient Access Final Rule RFPRFP Number H20-0038Table of Contents1. Background . 51.1 Cook County Health . 51.2 About Health Plan Services . 51.3 CMS Interoperability and Patient Access Requirements . 62. Purpose . 72.1 Term of Services . 82.2 Basis of Award . 83. Schedule . 84. Scope of Services. 84.1 Services Overview . 84.2 Qualifications: . 84.3 Service Requirements and Responsibilities Matrix. 94.4 Overview of Existing Infrastructure . 124.5 Core Business Applications and Systems . 145. Required Proposal Content . 145.1 Executive Summary/Cover Letter . 155.2 Response to Scope of Services . 155.3 Proposer’s Profile and Track Record . 155.4Vendor Solution Capabilities and Services – Narrative. 165.4.1Solution Overview and Experience . 165.4.2FHIR API Server . 175.4.3Data Transformation to FHIR . 175.4.4Consent Management. 185.4.5Identity Management . 185.4.6Third-Party Application Support . 185.4.7Security and Privacy . 185.4.8Implementation, Testing and Training . 195.4.9Ongoing API Management and Support . 195.4.10Add-on Services and Capabilities . 205.4.11Alternatives . 205.5 Vendor Solution Capabilities and Services Matrix . 21Final Posting11/02/20Page 2 of 34
Health Plan Services CMS Interoperability and Patient Access Final Rule RFPRFP Number H20-00385.5Key Personnel. 225.6 MBE/WBE Participation . 235.7 Cost Proposal . 235.8 Financial Status . 245.9 Conflict of Interest . 245.10 Contract . 245.11 Legal Actions . 255.12 Confidentiality of Information . 255.13 Economic Disclosure Statement . 255.14 Security Questionnaire . 255.15 Addenda . 256 Evaluation and Selection Process. 266.1 Proposal Assessment . 266.1.1 Proposal Evaluation . 266.1.2 Shortlist Proposer Presentation . 266.1.3 System Demonstrations . 266.1.4 Site Visits/Reference Calls . 266.2 Right to Inspect . 266.3 Consideration for Contract . 277 Evaluation Criteria. 277.1 Responsiveness of Proposal . 277.1.1Criteria Proposal. 278 Instructions to Proposers . 288.1 Questions and Inquiries . 288.2 Pre-RFP Conference (if Applicable) . 288.3 Number of Copies . 288.4 Format . 298.5 Time for submission . 298.6 Packaging and Labeling . 298.7 Timely delivery of RFP . 298.8 Availability of Documents . 29Final Posting11/02/20Page 3 of 34
Health Plan Services CMS Interoperability and Patient Access Final Rule RFPRFP Number H20-00388.9 Alteration/Modification of Original Documents . 298.10 Cost of Proposer Response . 298.11 Proposer’s Responsibility for Services Proposed . 308.12 RFP Interpretation. 308.13 Specifications and Special Conditions . 308.14 Errors and Omissions . 308.15 Proposal Material . 308.16 Confidentiality and Response Cost and Ownership . 308.17 Awards . 308.18 CCH Rights . 318.19 Cancellation of RFP; Requests for New or Updated Information . 319 Definitions . 3210 Appendix A – RFP Receipt Acknowledgement Form . 3311 Appendix B – Security Questionnaire . 34Final Posting11/02/20Page 4 of 34
Health Plan Services CMS Interoperability and Patient Access Final Rule RFPRFP Number H20-00381. Background1.1 Cook County HealthCook County Health (CCH) provides a wide range of health care services and operates the John H. Stroger, Jr.Hospital of Cook County, a tertiary, acute care hospital and Provident Hospital of Cook County, a communityacute care hospital. Cook County Health is also comprised of: 16 community health centers offering primary and specialty care and diagnostic servicesThe Cook County Department of Public Health (CCDPH), a certified local public health departmentserving most of suburban Cook CountyCermak Health Services of Cook County, which provides health care services to the detainee in theCook County Sheriff’s Department of Corrections and to the residents of Cook County’s JuvenileTemporary Detention CenterThe Ruth M. Rothstein CORE Center, a comprehensive care center for care of HIV and other infectiousdiseases, andCountyCare, the largest Medicaid managed care plan in Cook County and one of the largest in thenortheast region of the state.CCH history and mission to care for all, regardless of the ability to pay, dates back to 1835. In that time, CCHhas cared for millions of people, trained thousands of doctors, and conducted important research that hascontributed to modern day practices in hospitals. We have centers of excellence in trauma, burn andemergency care, oncology, endocrinology, infectious disease and other areas. We have long been the safetynet to the safety net when it comes to caring for the uninsured, a mission that remains today despite the newhealthcare environment in which we operate.CCH is one of the largest public health systems in the United States. As a provider of care, CCH seesapproximately 300,000 unique patients annually through more than 1 million outpatient visits and more than20,000 admissions, including 77,000 detainees at the Cook County Department of Corrections and residentsof the Juvenile Temporary Detention Center. We are the largest provider of HIV care in the Midwest and oneof the largest in the nation. On an average day, CCH fills nearly 20 times as many outpatient prescriptionsthan the average commercial pharmacy. The CCDPH is a state and nationally certified public health authorityserving the majority of suburban Cook County.CCH firmly believes that to obtain the true benefits provided by the Patient Protection and Affordable CareAct (ACA) health care transformation must go beyond simply increased access to health insurance and mustextend to health practice as well. The launch of CountyCare in fall 2012 under the ACA’s Early EnrollmentOption set the course for CCH’s transformation. In the two years since, CCH has seen a dramatic shift in itsPayer mix such that a majority of CCH Patients is now insured – the first time this has been the case in CCH’s180-year history of direct care.1.2 About Health Plan ServicesHealth Plan Services (HPS) is a Department within CCH that manages two lines of business: CountyCare, anIllinois Medicaid managed care plan, and MoreCare, a portfolio of Medicare Advantage plans including aMedicare Advantage Part D Plan, a Chronic Special Needs Plan (C-SNP) for members with HIV, an InstitutionalSpecial Needs Plan, and an Institutional Equivalent Special Needs Plan (IE-SNP).In 2013, CCH launched CountyCare, as a demonstration project through the Centers for Medicare andMedicaid Services (CMS) 1115 Waiver granted to the state of Illinois Medicaid agency to enroll eligible lowincome Cook County adults (ACA adults) into a Medicaid managed care program. In July 2014, CountyCareFinal Posting11/02/20Page 5 of 34
Health Plan Services CMS Interoperability and Patient Access Final Rule RFPRFP Number H20-0038transitioned from the federal waiver authority and subsequently became a Medicaid managed care planunder the State’s County Managed Care Community Network (2018 County MCCN) rules. This transitionallowed CountyCare to expand beyond the newly eligible ACA adult population to include traditionalMedicaid populations in Family Health Plans (FHP), Managed Long Term Services and Supports (MLTSS),Special Needs Children (SNC), and Integrated Care Program (ICP).CountyCare receives a capitated per member (enrollee) per month rate for every enrollee in its health plan.Many of the enrollees we enrolled have long been our patients whose costs were previously part of ouruncompensated care expenses. The ACA, through CountyCare, has significantly reduced CCH’s reliance onlocal taxpayers. CountyCare currently has over 370,000 Enrollees and over 450 Medicare beneficiaries inCook County.The CountyCare provider network includes all CCH facilities, every Federally Qualified Health Center (FQHC)in Cook County, and more than 60 hospitals. For CountyCare, innovation remains a theme in its developmentand growth. With a consistent focus on establishing itself as a pioneering provider-led and governed healthplan, CountyCare has: Provided a real-time, online notification system to its care coordinators and medical homes consistingof real-time information regarding enrollee discharge at over 25 hospitals in Cook CountyLaunched high-risk care coordination for special needs childrenIntegrated care coordination into provider practicesProvided application assistance and linkage services for justice-involved enrolleesRecently, CCH also developed a strategy to provide the system’s long-standing patients with continuity ofcare as they age into Medicare. In January 2020, CCH launched its Medicare Advantage Program, MoreCare, apartnership between CCH and Medical Home Network. At present, MoreCare has 455 members and offersthe following products to Medicare-eligible residents of Cook County: MoreCare for You: A Medicare Advantage plan with prescription drug coverage (MAPD) MoreCare : A chronic conditions special needs plan for residents diagnosed with HIV (C-SNP/HIVSNP) MoreCare Home: An institutional special needs plan for residents living in long-term carefacilities/nursing homes (I-SNP) MoreCare at Home: An institutional equivalent special needs plan for residents who are receivingor will need nursing facility or skill nursing facility level of care but reside at home or in thecommunity (IE-SNP)The accomplishment of these and future innovations requires an infrastructure that is nimble and supportiveof creative approaches, while also ensuring compliance with its managed care contracts, and state andfederal regulations and guidelines. CountyCare will demonstrate its commitment to provider-led health careby: Providing clinical support and care coordination at the sharpest point of care, by frontline clinicalteams wherever feasible;Supporting and empowering its Enrollees by offering consumer-friendly interfaces and selfmanagement support for Medicaid and Medicare products.1.3 CMS Interoperability and Patient Access RequirementsOn March 9, 2020, the Center for Medicare and Medicaid Services (CMS) released final regulations –CMSInteroperability and Patient Access Final Rule or the CMS Final Rule (CMS-9115-F), to implement extensiveFinal Posting11/02/20Page 6 of 34
Health Plan Services CMS Interoperability and Patient Access Final Rule RFPRFP Number H20-0038requirements of health plans serving Medicaid, Medicare Advantage and the Federally Facilitated Exchanges.Beginning July 1, 2021, health plans will be required to share health information – at the direction andapproval of enrolled members, with third-party applications in a more accessible and timely manner. Theprimary goals of the CMS Final Rule are to ensure patients have seamless access to their health information,and that information follows them on their healthcare journey.CCH HPS is seeking an integrated solution that can implement and support the health plan requirementsdescribed in the CMS Final Rule for all Medicaid and Medicare lines of business.CMS is mandating that health plans must have the following: An API that:o Allows members to access their own administrative and clinical data. At a minimum, thedata classes and elements in the US Core Data for Interoperability document Claims: 1 day after the encounter is received Adjudicated claims: 1 day after adjudication Clinical data: 1 day after receivedo Health Plan Provider directory Contracted providers Any changes must be posted within 30 dayso Drug benefit data Within 1 day of effective date for covered drug list Formulary dataRoutine testing and monitoringAccessible API documentationPrivacy/Securityo Compliance with HL7 SMART App Launch Framework standardsThe ability to share data with third-party app vendors upon member consent2. PurposeHealth Plan Services is seeking a cost-effective solution that integrates with internal systems and datasources to enable compliance with the interoperability requirements described in the CMS Interoperabilityand Patient Access Final Rule (CMS-9115-F) for both Medicaid and Medicare lines of business. The solutionmust also be flexible enough to support future business requirements and regulatory changes. The goal is tobegin implementation of the new software vendor by January 15, 2021 for a successful launch of the newsoftware by July 1, 2021. HPS will work closely with the vendor to ensure successful planning andimplementation of the new system.The business need for this procurement is primarily driven by: The need to be compliant with the CMS Interoperability and Patient Access Final Rule The need for an integrated system to serve CCH’s growing membership and its strategic plan The need for a system that is dynamic and responsive to changing population, program, andMedicaid and Medicare requirements The need for a system that can be customized to reflect our unique situation as provider-drivenhealth plan with two hospitals, 16 community health centers, the County’s department of publichealth, and a correctional health program, among other services Expected future growth into additional lines of businessFinal Posting11/02/20Page 7 of 34
Health Plan Services CMS Interoperability and Patient Access Final Rule RFPRFP Number H20-00382.1 Term of ServicesThe term of services shall be for thirty-six (36) months with two optional two (2) year extensions. The awardagreement may be terminated by CCH for convenience following sixty (60) calendar days’ prior written noticeof termination.2.2 Basis of AwardThe basis of award shall be to a single proposer based on the highest rated proposal offering the best valueto CCH that meets the specifications, terms, and conditions as assessed using the evaluation criteria set forthin section 7 of this RFP.3. ScheduleCCH anticipates the following schedule:ActivityEstimated DateRFP posted to the websiteProposer Inquiry DeadlineCCH response to Vendor Questions-TentativeProposal Due DateEvaluation of RFP (Tentative)System Demonstrations (Tentative)System References (Tentative)Notification of Decision (Tentative)11/2/202011/10/2020 by 2:00 p.m. CT11/20/202012/4/2020 by 2:00 p.m. 0-12/18/202012/30/20204. Scope of Services4.1 Services OverviewHPS plans to select one vendor that offers a solution that integrates internal systems and data sources incompliance with interoperability requirements set forth in the CMS Interoperability and Patient Access FinalRule (CMS-9115-F). The Plan will select a vendor that has the capacity to provide all major systemcomponents, installation, customization, integration, reporting, migration of clinical data, training, technicalassistance, enhancements, and maintenance.Health Plan Services is requesting proposals for interoperability that meet the following criteria.4.2 Qualifications:Applicants must meet the following minimum qualifications:1234Minimum QualificationsSolution is compliant with the Patient Access API described in CMSInteroperability and Patient Access Final Rule (CMS-9115-F)Demonstrated track record of implementing a fully operational API in five (5)months or lessAbility to provide ongoing system support and maintenance over three-yearcontract periodKnowledge of and experience with Medicaid managed careFinal Posting11/02/20Response (Y/N)Page 8 of 34
Health Plan Services CMS Interoperability and Patient Access Final Rule RFPRFP Number H20-0038567891011Minimum QualificationsKnowledge of and experience of Medicare Part DAdvanced data integration capabilities, including integration of real-time datafeedsAdvanced data analytics and reporting capabilities, including real-time and selfservice reporting optionsFlexibility to adapt to new and changing industry and regulatory standardsStrong references that attest to the quality, reliability, and integrity of theapplicant – both in terms of its team and its products/servicesDemonstrated IT security following recognized industry framework(s)Demonstrated experience with FHIR APIResponse (Y/N)In addition, successful applicants will likely meet some of the following preferred qualifications:123456Preferred QualificationsDemonstrated system scalabilityExperience partnering with public sector organizationsExperience in the Illinois Medicaid Managed Care marketCustomization at the state and client levelIndustry-recognized accreditation and/or certifications (please list)Demonstrated experience with EHR integrationResponse (Y/N)Applicants should explicitly address the above qualifications in their response to this RFP. If the response is“No” to any of the above qualifications, please provide comment and additional detail in less than 3 pagessingle spaced.4.3 Service Requirements and Responsibilities MatrixApplicants should include and explicitly address the below System Requirements and Responsibilities Matrixin their response to this RFP. Please use the corresponding response codes listed below in your RFP response.If the response is “D/M/T/N” to any of the below qualifications, please provide comment and additionaldetail in less than 10 pages single spaced.ResponsecodeYDMCategoryYes (operational today). This response indicates that the line item on the checklist is anoperational feature that exists in a production environment. This functionality can bedemoed at HPS’ request.Under Development. This response indicates that the line item on the checklist is currentlyunder development and will be included as part of the next software release scheduled tooccur within the next six months. Responses in this category should include the releasenumber and release date.Modify. This response means that the vendor is willing to develop the feature as part of anew system component or as a modification to an existing system component. The cost ofthis enhancement should be itemized and included in the vendor’s projected cost of thesystem implementation.Final Posting11/02/20Page 9 of 34
Health Plan Services CMS Interoperability and Patient Access Final Rule RFPRFP Number H20-0038ResponsecodeTNCategoryThird Party. This response means that the functionality is available from a third party partnerof the vendor and an integrated solution exists in a production environment. If third partyproducts are proposed, please include an itemized list in the projected costs.No. Place an N in the box if none of the above descriptions are true.Functional RequirementsResponse code(Y/D/M/T/N)1FHIR API System RequirementsSolution is compliant with the Patient Access API described in CMS Interoperability and Patient Access FinalRule (CMS-9115-F)1.1Cloud-hosted FHIR API server supporting FHIR version 4.0.1 and subsequentversions1.2FHIR API server supporting FHIR version 4.0.1 – we will evaluate proposalscloud-hosted solutions1.3Facade or Repository data model1.4Makes available source data for claims, encounter, clinical data (based onUSCDI) and formulary data using publicly available implementation guides1.5Data for claims, encounters and clinical data are updated within one (1)business day1.6Data for the formulary are updated monthly1.724/7 availability1.8Ongoing maintenance and testing2Consent and Identity ManagementSolution is compliant with the Patient Access API described in CMS Interoperability and Patient Access FinalRule (CMS-9115-F)2.1Obtain HPS member consent of 3rd-party applications and ability for each HPSmember to view, track and modify their consent2.22.3Ability to integrate with existing HPS member portalAble to support identity verification and authentication via member matchingon discreet member identifiers in eligibility data2.4Support SMART on FHIR authorization process (Application Launch FrameworkImplementation Guide Release 1.0.0 and subsequent releases) for secureauthorization of 3rd-party application access to the Patient Access API2.5Customer service support for member questions and trouble-shooting3Third-Party Application SupportSolution is compliant with the Patient Access API described in CMS Interoperability and Patient Access FinalRule (CMS-9115-F)3.1Registration and onboarding process for 3rd-party applications to connect tothe Patient Access API3.2API documentation is publicly available3.33rd-party attestation process that obtains information about a 3rd-partyapplication’s privacy policy and shares that information with HPS members3.4Securit
Health Plan Services CMS Interoperability and Patient Access Final Rule RFP RFP Number H20-0038 Final Posting11/02/20 Page 5 of 34 1. Background 1.1 Cook County Health
