Oklahoma Healthcare Authority (OHCA) Care/Case Management Modernization Planning and Procurement Request for Information (RFI)

Transcription

1 Oklahoma Healthcare Authority (OHCA) Modernization Planning and Procurement Version 1.0 Date: October 08, 2014

2 Contents 1.0 INTRODUCTION PURPOSE OF REQUEST FOR INFORMATION (RFI) OKLAHOMA MEDICAID ENTERPRISE (OME) POPULATION CARE/CASE MANAGEMENT CASE MANAGEMENT UNIT (CMU) HEALTH MANAGEMENT PROGRAM (HMP) CHRONIC CARE UNIT (CCU) LONG TERM CARE (LTC) WAIVER OPERATIONS BEHAVIORAL HEALTH OPERATIONS (BHO) MEDICAID MANAGEMENT INFORMATION SYSTEM (MMIS) CURRENT CARE/CASE MANAGEMENT ENVIRONMENT OHCA OBJECTIVES SCOPE OF WORK (SOW) RESPONSE FORMAT VENDOR IDENTIFICATION COVER PAGE SUMMARY OF VENDOR ORGANIZATION RESPONSES TO SCOPE OF WORK (SOW) TIMELINE COST ESTIMATE OTHER COMMENTS VENDOR DEMONSTRATIONS INFORMATION ABOUT RESPONDING TO THIS REQUEST FOR INFORMATION POINT OF CONTACT QUESTIONS REGARDING THIS REQUEST FOR INFORMATION CLOSING DATE ACCEPTANCE OF RESPONSES COST OF PREPARING RESPONSES RETENTION OF RESPONSES ALL RESPONSES SUBJECT TO PUBLIC DISCLOSURE APPENDIX A VENDOR RESPONSE COVER PAGE APPENDIX B ACRONYMS ii

3 Tables Table 1: RFI Response Outline Table 2: RFI Schedule of Events Figures Figure 1: Current Service Authorization Process... 7 iii

4 1.0 INTRODUCTION The Oklahoma Health Care Authority (OHCA) is the state agency that administers the Oklahoma Medicaid Program, known as SoonerCare. Medicaid is a federal and state entitlement program that provides funding for medical benefits to low-income individuals who have inadequate or no health insurance coverage. Medicaid guarantees coverage for basic health and long term care (LTC) services based upon income and/or resources. Created as Title XIX of the Social Security Act in 1965, Medicaid is administered at the federal level by the Centers for Medicare and Medicaid Services (CMS) within the United States Department of Health and Human Services (HHS). CMS establishes and monitors certain requirements concerning funding, eligibility standards, and quality and scope of medical services. States have the flexibility to determine some aspects of their own programs, such as setting provider reimbursement rates and the broadening of the eligibility requirements and benefits offered within certain federal parameters. 1.1 Purpose of The OHCA, which operates Oklahoma s Medicaid program and other health benefit programs, is issuing this RFI to request information and potential demonstrations of state-of-the-art care/case management systems. OHCA is looking to replace their current care/case management system with a centralized care/case management system that will not only coordinate activities between units within the agency, but also between other agencies who are stakeholders in the care/case management process. OHCA is asking vendors to provide information on solutions that address: 1. Implementing a single care/case management system that interfaces with the Medicaid Management Information System (MMIS). 2. Simultaneous accessibility to system/application/database. 3. Utilization of an electronic workflow. 4. Tracking capabilities. 5. Data and reporting capabilities. OHCA needs a common care/case management system that provides smooth communication across business units and state organizations, as well as creates a registry of care/case management outcomes across the agency. Additionally, OHCA is looking for a solution that allows for management of multiple programs in multiple work queues while also allowing cases to be handled and integrated seamlessly between business units and other systems. 2.0 OKLAHOMA MEDICAID ENTERPRISE (OME) Proposed solutions will need to support the information needs of the various programs and populations across the Oklahoma Medicaid Enterprise (OME). To provide an understanding of program size, a summary of SoonerCare statistics for State Fiscal Year (SFY) 2013 (June 2012 through June 2013) are provided below: 1 in 4 Oklahomans were enrolled in SoonerCare. There were 1,040,332 unduplicated members enrolled in the SoonerCare or Insure Oklahoma programs. A total of 1,015,939 SoonerCare members received services 49,470,567 claims were processed, 94% of which were filed electronically On average, 809,904 members were enrolled each month of the SFY. Females comprised 58 % of the unduplicated enrollees. Age of SoonerCare enrollees: o Children age 18 and younger 57% 1

5 o Adults age 19 to 64 36% o Adults age 65 and older 7% OHCA is the chartered, statutory agency responsible for Medicaid services within Oklahoma, but other sister agencies are also responsible for some aspects of the Medicaid program: Oklahoma Department of Human Services (OKDHS) Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) Oklahoma State Department of Health (OSDH) OHCA administers Oklahoma s Medicaid program, SoonerCare, which, through the programs outlined below, cover a wide range of services including: Behavioral Health Services (BHS) Child Health Services (Early Periodic Screening, Diagnosis, and Treatment (EPSDT)) Dental Services Physician Services Hospital Services Nursing Home Services Pharmacy Services School-Based Services Family Planning Services Non-Emergency Transportation Services Additional information on SoonerCare, Oklahoma s Medicaid program, can be found at Population Care/Case management The SoonerCare Population Care Management Department is comprised of three distinct work units, the Case Management Unit (CMU), the Chronic Care Unit (CCU), and the Health Management Program (HMP). The following wide-range of services is offered to members and providers Case Management Unit (CMU) The CMU provides episodic or event- based case management and certain supportive eligibility determinations and utilization management functions to other areas of the agency such as LTC Waiver Operations division and the Tax Equity and Fiscal Responsibility Act (TEFRA) Eligibility unit. It provides case management for members specifically identified through programs, episodes, or events. Included in Case Management Programs are: Obstetrics (OB) o At-Risk Obstetrical Case Management o High-Risk Obstetrical Case Management o Fetal Infant Mortality Reduction (Mom) Case Management (targets specific high-risk counties) o Strong Start for Mothers Pediatric o At-Risk Newborn Case Management o Fetal Infant Mortality Reduction (Baby) Case Management (targets specific high-risk counties) o Synagis Case Management 2

6 o o Other o o o o o o Private Duty Nursing Case Management Strong Start for Newborns Oklahoma Cares Program - (Breast and Cervical Cancer Treatment Program) Out of State Care Coordination Complex Case Management Emergency Room (ER) Utilization Case Management LTC Waiver Clinical Reviews Social Service Coordination Health Management Program (HMP) The Health Management Program (HMP) is a contracted service providing practice-based, chronic disease focused supports to SoonerCare members and primary care providers. Nurses known as health coaches, work with members at selected primary care practice sites to improve health outcomes. Specially-trained practice facilitators also work with selected practices to improve processes related to caring for persons with chronic illness Chronic Care Unit (CCU) The OHCA Chronic Care Units (CCU) and HMP work in tandem to provide member and provider supports to members who are high risk or at risk for chronic conditions. Nurses in this unit provide telephonic case management to high-risk and at-risk members with chronic conditions who are not aligned with a primary care provider where a health coach is present. Such services include: Assessment (health status, health literacy, behavioral health, pharmacy) Care coordination Self-management principles Behavior modification principles Care for chronic conditions include, but are not limited to: diabetes, hypertension, cardiac disease, asthma, hemophilia, hepatitis C and sickle cell anemia. 2.2 Long Term Care (LTC) Waiver Operations The LTC Waiver Operations division is responsible for providing targeted populations appropriate opportunities and choices for LTC programs and services; e.g., transitioning individuals from institutional care toward services in individuals homes and communities. The LTC Operations staff ensures the efficiency and effectiveness of services offered by providing oversight of waiver, demonstration, and program processes. The division works with the Oklahoma Department of Rehabilitation Services (ODRS) for those individuals wanting to return to work. Currently the division utilizes the current OHCA care/case management system to assist with the automation of care/case management. 2.3 Behavioral Health Operations (BHO) The Behavioral Health Operations (BHO) unit is responsible for prior authorizations (PAs), assessments of inpatient mental health facility admits, care/case management of discharged consumers age 5-21, Living Choice/PASSAR Level of Care (LOC) determination for behavioral health needs and nursing facility assessment, therapeutic foster care, care/case management and HMP behavioral health referrals. The unit also conducts LOC determinations for behavioral health needs of members and acts as consultants for other units in assessing members needs. 3

7 2.4 Medicaid Management Information System (MMIS) OHCA utilizes the services of a fiscal agent (FA), currently Hewlett Packard Enterprise Services (HPES), to operate and maintain the state s MMIS, known as the interchange Enhancement (ice). A one directional interface exists with the current care/case management system. Some of the fields synchronized between the MMIS and the current care/case management system include: Record ID Authorized Services Eligibility Status Start, effective date, and end dates of service Coverage Priority Personally Identifiable Information (PII) such as SSN and Medicaid number Dependent PII Demographic information Guardianship information Consent information Predicted outcomes for the care/case management program (e.g., ER visits, pharmacy costs, etc.) Attachments Further details of the environment are provided below. 2.5 Current Care/Case management Environment OHCA utilizes a Clinical Case Management System (CCMS), called Atlantes, to manage a member s plan of care including the recording of case information, tracking of the case process, and production of any associated reports. This commercial off-the-shelf (COTS) system enables OHCA nursing staff to plan, implement, evaluate, and document health care delivery. This system accepts data from the MMIS member, claims, financial, and provider subsystems but currently does not integrate data from clinical data sources. Member records in the current care/case management system detail the range of services delivered to each member through the SoonerCare program. The system integrates nonclinical data as well. The range of services delivered outside of the SoonerCare program can also be stored in the case record through external interfaces with stakeholders and other systems such as: Department of Health Department of Human Services Indian Health Services MedAI Predictive Modeling Software Health Management Program (HMP) Telligen - Oklahoma s Quality Improvement Organization (QIO) and Quality Review Organization (QRO) Oklahoma Department of Mental Health and Substance Abuse Oklahoma Public School systems Clinical data 4

8 Currently, the case management solution serves a number of purposes within the agency: 1. Integrates data from the MMIS on payers, groups, networks, associations, products, providers and practices. 2. Manages alerts and some communications such as letters. 3. Manages triggers and condition assessments based on activities, conditions, member status updates, and letters. 4. Provides staff scheduling and reminder capabilities. 5. Manages assessments and risk profiles. 6. Manages enrollee case notes and communications. 7. Maintains metrics such as benefit utilization and service rate maintenance. 8. Maintains case details such as care history, status, activities, LOC, assignments, problems, goals, interventions, diagnosis, procedures, discharge, case acuity and clinical documents from multiple sources. 9. Manages authorizations for treatment plans, services, approvals, cost savings and managing wait lists and exception conditions. Not all the modules of the current case management system are implemented. The system is not used universally across business units or other stakeholders such as providers and contractors. As a result, there are gaps in continuity of care and case coordination, as well as inconsistent or inaccurate data received from providers. Some coordination of care is three-way collaboration where one state agency provides the case management; services are paid through another state payer program or Medicaid, and OHCA is responsible for recording and measuring outcomes. The lack of a single case management system hampers the ability to coordinate continuity of care across multiple entities responsible for different parts of the care/case management puzzle. Care/Case management activities include targeting of members for assessments, treatment plans and outcome tracking, and disease management in multiple business units across OHCA, as well as by contractors and providers. Collaboration between business units is taking place but has not produced standardization of process, system, or data. Outside of Atlantes, there is no single, comprehensive care/case management system universally available across the Enterprise. This leads to barriers such as staff unable to access data from providers in a consistent format producing gaps in continuity of care and case coordination for those under care/case management: There is a mixture of ad hoc processes for identifying populations for care/case management with just basic levels of automation Clinical data is entered manually based from paper, scanned images or information gained via telephonic interviews. The Manage Case Information and Authorize Service Plan / Plan of Care MITA processes play a critical role in the "on the ground" visibility of all those who play a part in the care/case management process. These require some level of automation in order for staff to execute their jobs most efficiently. Some units have a role authorizing services for members receiving services under a Care/Case management program who are receiving Medicaid benefits. 5

9 Some units utilize Atlantes for case reporting, but not for managing care/case management processes. These units must collaborate with other agency business units who use Atlantes to ensure coordination of care. Some care/case management processes, though chartered under the Medicaid agency, depend on multiple outside entities for case management. OHCA may be responsible for establishing the service plan and outcome measures, but the case management plans are administered through other entities. Member Services is the main point of contact for customer service within the agency. It has its own issue resolution system and plays a role in eligibility and enrollment of services into care/case management programs within the agencies, through referrals. Once eligibility is established, it has a very limited role in care/case management and has to refer care/case management issues to the unit responsible for them. Unfortunately, its issue resolution and customer tracking system has no integration into Atlantes. Waiver Service plan and PA authorizations are not processed in the care/case management system. This workflow is heavily manual in the current system and contains a flow of multiple review steps of various automated and manual processes between multiple OHCA and stakeholder units. 6

10 Start Prior Authorization Service not Authorized Revise request for authorization Request for authorization submitted by phone or fax by physician office No Yes Disagreement on rationale? No Initial information insufficient? Request is checked for completeness and manually reviewed. Yes Review or appeal of determination Physician and CM worker review initial information submitted and determination rationale. Denied Request Approved? Approved Denial faxed or mailed to physician office and mailed to patient. No Review/Appeal Successful Yes Revise plan of care to reflect determination Approval given to physician and member is notified of approval. Authorization Approved Figure 1: Current Service Authorization Process This process of authorization of services, though typical, is a time consuming and manual process. This process is further complicated when outside agencies and other business units within OHCA do not have access to the same information as the care/case management unit. This workflow could be well served by more automation to smooth communication with physicians and providers. 3.0 OHCA OBJECTIVES Results of the recently completed Medicaid Information Technology Architecture (MITA) Framework 3.0 State Self-Assessment (SS-A) indicate that OHCA is targeting Level 2 and Level 3 MITA maturity for the functions supported by care/case management. This means the state will focus on automation, standard data models, standard business rules, and collaboration with data trading partners. These will be key considerations as OHCA reviews RFI responses. 7

11 As described in Section 1.1 Purpose of RFI, OHCA is looking to modernize care/case management by replacing the current system with a more collaborative care/case management system or general purpose customer relationship management (CRM) solution that can be used across the OME. To achieve this goal, OHCA has identified the following four capabilities that are needed in the new case management solution: 1. Ability to assign cases effortlessly between business units and outside stakeholders while securing sensitive information appropriately. 2. Ability to quickly create new programs and administer them across different work queues. 3. Ability to securely integrate into a service-oriented infrastructure, supporting the tools OHCA already has in place, securely. 4. Ability to integrate into a new data warehouse and use the new Business Intelligence (BI)/Decision Support System (DSS) tools for reporting and needs identification in the population. OHCA goals for the care/case management include the following: 1. Acquire and implement an efficient care/case management system for use across the OME that includes well-defined methods for case assignments, case organization, case documentation, and real-time case reporting. a. Facilitate access to and retrieval of clinical information to provide safer, timelier, efficient, effective, and equitable patient-centered care. 2. Implement an adaptable care/case management system that can respond to program changes quickly and effectively with modular, flexible systems development, separation of business rules from core programming, and wide use of standard business rules across the OME. a. Enhance coordination among service delivery systems (e.g., Health Access Network - HAN), Comprehensive Primary Care Initiative (CPCI), and Patient Centered Medical Home (PCMH)). 3. Connect to Oklahoma Health Information Exchanges (HIEs) for the electronic movement of health-related information among organizations according to nationally recognized standards and as a tool to assist in the improvement of healthcare outcomes. OHCA envisions that the case management system will be able to interoperate with electronic health record (EHR) systems through partners enrolled in EHR incentive programs. 4. Eventually the system should be capable of integrating Medicare data when it becomes available to the state and meet any security requirements specified by CMS. 5. Enhance quality of care efforts for data collection, monitoring, analysis, and reporting for continuous improvements within the OME. a. Promote efficient and effective data exchange, through use of a universal data directory with clear, unambiguous definitions and formats for each data element. (e.g., names, addresses, dates, gender, diagnosis). b. Improve clinical BI to transform raw information into meaningful and useful information for business purposes. Develop predictive models and reports based on enterprise-wide baselines. c. Identify targeted improvements for health outcomes focusing on developing baselines so that outcomes measures are comparable over time and to other states, health plans, and additional criteria. 6. Wherever possible, leverage existing infrastructure, sourcing solutions, and vendors who can work with HPES to add functionality with targeted solutions within current budget constraints. 8

12 4.0 SCOPE OF WORK (SOW) OHCA is looking for vendors to provide information on available replacement solutions for their current care/case management system. Vendors are asked to provide answers to the general questions below. OHCA is interested in RFI responses being applied to actual past implementations by the vendor. OHCA wants to hear about examples where a combination of products and services in other implementations addressed similar gaps and objectives for other Health and Human Service organizations. For this reason, OHCA is asking vendors to please frame your response around a recent implementation of your solution. Design/Architecture 1. Describe the technical architecture and infrastructure requirements (i.e., database, hardware, software, security, web browser, data model, etc.). 2. Describe the basic process and functional features of the system or solution. Would other business areas benefit from the product? Interoperability/Integration 3. Discuss how the system can interoperate with other systems in regards to data exchange, application integration via application programming interfaces (APIs) or Web Services? 4. How will the solution integrate with existing network solutions including the eligibility system or member table in the MMIS? 5. Does the solution provide the ability to upload EHR data or consume clinical data associating or linking the information with a particular member or case? System Access 6. Describe the technology used for remote access to the system. 7. Describe the technology used to integrate with Microsoft Active Directory Federation Services (ADFS). 8. Does the solution provide external ability for providers to enter data directly into the system? 9. Does the solution support the use of handheld devices, such as tablets, mobile phones, laptops, and medical devices, for entry of patient information? 10. How does the solution manage levels of care (sub-categories within the same case) including maintenance of historical information in addition to the most current set of information for all the members cases? 11. Describe the solution s ability to add and maintain dated and user identifiable notes and comments made within a case. Does the solution offer free-text entry in addition to structured data capture? Does the solution have the ability to spell check data entered? 12. Describe how the solution manages scheduling of events and calendaring through the use of ticklers, alerts, prompts, notifications for both the care manager and communications. Are standard services available for text, phone and member communication interoperability? 13. Describe the solution s search and tracking capabilities. 14. Does the solution include the functionality to scan or upload documents and assign them to a member or case? 15. Describe the solution s ability to improve the following MITA business processes, including increased automation. 9

13 User Interface a. Establish Case. b. Manage Case Information. c. Manage Population Health Outreach. d. Manage Registry. e. Perform Screening and Assessment. f. Manage Service Plan/Plan of Care and Outcomes. g. Authorize Referral. h. Authorize Service. i. Authorize Service Plan/Plan of Care. j. Identify Utilization Anomalies. 16. Describe how your solution will provide user friendly graphical screens and intuitive navigation. 17. Does the solution provide a summary page for cases with features such as the status of the case and related documentation, upcoming due dates, actions past due, staff assigned, etc.? Technical Support 18. Describe the solution s scalability and evolution potential. 19. Describe your methodology for providing ongoing technical support. Reporting 20. Describe the reporting features provided by your solution including the systems capability to run and access the reports via the web. 21. Does your system offer data mining capabilities for utilization management and ordering pattern analysis? 22. Describe the solution s ability to track time spent on a case by user and unit for purpose of measuring employee performance and workload. 23. Value Adds a. Recommend any additional modules, such as integrated predictive analytics or other products that provide enhanced functionality and value. 5.0 RESPONSE FORMAT The following subsection provides instruction on response format. To facilitate evaluation and review, OHCA requests that vendors prepare their responses according to the outline below, which provides section numbering that should be used in responses, as well as page limits. Respondents are encouraged to provide all requested information to ensure that their response is most useful to OHCA. Table 1: RFI Response Outline Section # Section Page Limit 1.0 Vendor Identification Cover Page Summary of Vendor Organization Responses to SOW Design/Architecture 3.2 Interoperability/Integration 3.3 System Access

14 3.5 User Interface 3.6 Technical Support 3.7 Reporting 4.0 Timeline Cost Estimate Other Comments 1 Total: Vendor Identification Cover Page A cover page has been provided in Appendix A for vendors to include with their response submittal. 5.2 Summary of Vendor Organization Vendors should provide a brief description of their organization, including the following: A general description of the primary business of the organization and its client base The organization s areas of specialization Any current or recent experience working with state Medicaid agencies Size of the organization, including structure Vendor support staff qualifications including experience working with care/case management, clinical data, and Medicaid systems Length of time the organization has been in business, as well as how long the organization has been providing care/case management solutions 5.3 Responses to Scope of Work (SOW) To provide maximum benefit to OHCA, vendors are encouraged to answer all questions outlined in Section 4.0 Scope of Work. Responses should also contain information outlined in the following subsections Timeline Vendors should provide an estimated timeline for the implementation and rollout of the proposed solution Cost Estimate Vendors should provide a general estimate of how they would calculate costs for each of the products and services associated with their proposed solution. Vendors and OHCA acknowledge that providing a cost range does not bind nor obligate either party in any way. The cost range is simply a tool to be utilized by OHCA to determine the cost effectiveness of issuing a bid in the future. 5.4 Other Comments Vendors may provide additional comments or issues regarding any aspect of the care/case management project that OHCA should consider. 6.0 VENDOR DEMONSTRATIONS Based on review of RFI responses, OHCA may invite some vendors to make oral presentations and demonstrations about their proposed solutions, capabilities, and approaches to OHCA staff. OHCA may also request telephone interviews with key personnel at the vendor organization prior to or for follow-up after the demonstrations. 11

15 Only vendors who demonstrate experience and requirement functionality in their responses will be considered for demonstrations. OHCA appreciates all responses and may review incomplete responses or those received after the deadline at their discretion. Members of the OHCA steering committee will select demonstration vendors based on the quality of the RFI responses. 7.0 INFORMATION ABOUT RESPONDING TO THIS REQUEST FOR INFORMATION 7.1 Point of Contact The point of contact for this RFI is: Kimberely Helton Oklahoma Health Care Authority Phone: (405) (Preferred method of contact) 7.2 Questions Regarding this Request for Information Questions regarding this RFI should be submitted to the address listed above. Answers to questions will be addressed in writing and posted on the OHCA website, for all vendors to review. The following table provides the RFI schedule of events. Table 2: RFI Schedule of Events Calendar Event RFI Schedule Date RFI Posting and Release Friday, October 10, 2014 Vendor Questions Due by 5:00 p.m. CST Friday, October 31, 2014 Answers to Vendor Questions Posted Friday, November 7, 2014 RFI Responses Due Wednesday, November 26, 2014 Invitations to Vendor Demonstrations Week of December 29, 2014 Demonstrations Scheduled between January 12, 2015 February 20, Closing Date Responses, submitted electronically to the Contract Coordinator s address listed above, must be received by OHCA no later than 5:00 PM CDT on Monday, November 24, OHCA may consider responses received after this deadline at their discretion. 7.4 Acceptance of Responses OHCA will accept all responses submitted according to the requirements and deadlines outlined in this RFI. Responses must be complete when submitted and should clearly describe the vendor s ability to meet the requirements of the RFI and the needs of the State. 12

16 Responses must be submitted by to with Attachment A in Adobe PDF. The subject line of the shall include the name for this RFI. Marketing material, illustrations, extra pages will not be reviewed as part of the RFI process. Information gathered in this process could potentially be incorporated in a Request for Proposal (RFP). Any resulting RFP will be openly competitive and should therefore not be exclusive or restrict competition. This RFI does not obligate OHCA to issue an RFP nor to include information submitted by vendors. 7.5 Cost of Preparing Responses All costs incurred by the vendor for response preparation and demonstration are the sole responsibility of the vendor. OHCA will not reimburse for any such costs. OHCA reserves the right to withdraw the RFI at any time during the RFI process. Issuance of this RFI in no way obligates the State to award or issue a contract or to pay any costs incurred by any vendor as a result of such withdrawal. 7.6 Retention of Responses All responses submitted in response to this RFI become the property of OHCA and will not be returned. 7.7 All Responses Subject to Public Disclosure a. Responses submitted are subject to Oklahoma Open Records Act, 51 Okla. Stat. 24A.1 et seq. No responses will be released under this Act until OHCA awards a contract for these services pursuant to Oklahoma Administrative Code (OAC) or determines that no contract will be awarded. b. Respondents may mark portions of their responses proprietary and indicate that they should not be released under the Act. If a respondent considers part of its response proprietary, it should an additional copy of its response with the proprietary information removed or blacked out. c. If the respondent provides a copy of its response with proprietary information redacted and OHCA appropriately supplies the redacted response to another party under the Oklahoma Open Records Act or other statutory or regulatory requirements, the respondent agrees to indemnify OHCA and step in to defend its interest in protecting the referenced redacted material. 13

17 APPENDIX A VENDOR RESPONSE COVER PAGE Respondent s Name Respondent s Physical Address City State Zip Code (include 4 digit add on) Respondent s Contact Person Phone Number & Area Code Fax Number & Area Code Address Website Address Authorized Signature of Respondent Data Signed Typed Name of Authorized Signatory Title of Authorized Signatory 14

18 APPENDIX B ACRONYMS The following acronyms are used within this document. Acronym ADFS API BHO BHS BI CCD CCMS CCU CDT CMS COTS CPCI CRM DSS EHR EMR EPSDT ER ESI FA HCBS HHS HIE HMO HMP HPES ice IOC Definition Active Directory Federation Services Application Programming Interface Behavioral Health Operations Behavioral Health Services Business Intelligence Continuing Care Document Clinical Case Management System Chronic Care Unit Central Daylight Time Centers for Medicare and Medicaid Services Commercial Off-the-Shelf Comprehensive Primary Care Initiative Customer Relationship Management Decision Support System Electronic Health Record Electronic Medical Record Early Periodic Screening, Diagnosis, and Treatment Emergency Room Employer-Sponsored Insurance Fiscal Agent Home and Community-Based Services United States Department of Health and Human Services Health Information Exchange Health Maintenance Organization Health Management Program Hewlett Packard Enterprise Services interchange Enhancement Inspection of Care 15

19 Acronym IP LOC LOS LTC MITA MMIS OAC OB ODMHSAS ODRS OHCA OKDHS OK-HAN OME OSDH OU PA PCMH PI PII QIO RFI RFP RTC SFY SOW SS-A TEFRA TFC Definition Individual Plan Level of Care Level of Service Long Term Care Medicaid Information Technology Architecture Medicaid Management Information System Oklahoma Administrative Code Obstetrics Oklahoma Department of Mental Health and Substance Abuse Services Oklahoma Department of Rehabilitation Services Oklahoma Health Care Authority Oklahoma Department of Human Services Oklahoma Health Access Network Oklahoma Medicaid Enterprise Oklahoma State Department of Health University of Oklahoma Prior Authorization Patient Centered Medical Home Program Integrity Personally Identifiable Information Quality Improvement Organization Request for Information Request for Proposal Residential Treatment Center State Fiscal Year Scope of Work State Self-Assessment Tax Equity and Fiscal Responsibility Act Therapeutic Foster Care 16