RFP TEXT

Transcription

RFP TEXT

Request for Proposal 16-X-23964
For: Fiscal Intermediary and Financial
Cash and Counseling Services: DHS
Event
Date
Bidder’s Electronic Question Due Date
August 18, 2015
(Refer to RFP Section 1.3.1 for more information.)
Proposal Submission Date
September 9, 2015
(Refer to RFP Section 1.3.2 for more information.)
Time
5:00 PM
2:00 PM
Dates are subject to change. All changes will be reflected in Addenda to the RFP posted on the
Division of Purchase and Property website.
Status
Category
Not Applicable
Small Business
Set-Aside
Entire Contract
I
Partial Contract
II
Subcontracting Only
III
RFP Issued By
State of New Jersey
Department of the Treasury
Division of Purchase and Property
Trenton, New Jersey 08625-0230
Date: August 4, 2015
Using Agencies
State of New Jersey
Department of Human Services
Table of Contents
1.0 INFORMATION FOR BIDDERS ..................................................................................................................................................... 6
1.1 PURPOSE AND INTENT .......................................................................................................................................................... 6
1.2 BACKGROUND ......................................................................................................................................................................... 7
1.2.1 DIVISION OF AGING SERVICES (DOAS) PROGRAMS ...................................................................................................... 8
1.2.1.1 JERSEY ASSISTANCE FOR COMMUNITY CAREGIVING (JACC) ............................................................................. 8
1.2.1.2 VETERANS-DIRECTED HOME AND COMMUNITY-BASED SERVICES (VD-HCBS) ................................................. 8
1.2.2 DIVISION OF DISABILITY SERVICES (DDS) PROGRAMS ................................................................................................. 9
1.2.2.1 MANAGED LONG-TERM SERVICES AND SUPPORTS (MLTSS) ............................................................................... 9
1.2.2.2 PERSONAL PREFERENCE PROGRAM (PPP) ............................................................................................................ 9
1.2.2.3 UPCOMING DDS PROGRAM(S) ................................................................................................................................. 10
1.2.3 DIVISION OF DEVELOPMENTAL DISABILITIES (DDD) PROGRAMS .............................................................................. 10
1.2.3.1 COMMUNITY CARE WAIVER (CCW) ......................................................................................................................... 10
1.2.3.2 SUPPORTS PROGRAM .............................................................................................................................................. 11
1.2.4 UTILIZATION SUMMARY – ALL PROGRAMS .................................................................................................................... 11
1.3 KEY EVENTS .......................................................................................................................................................................... 12
1.3.1 ELECTRONIC QUESTION AND ANSWER PERIOD ..................................................................................................... 12
1.3.2 SUBMISSION OF PROPOSAL ....................................................................................................................................... 12
1.3.3 ELECTRONIC BIDDING (EBID) ..................................................................................................................................... 13
1.3.4 ELECTRONIC SIGNATURES ......................................................................................................................................... 13
1.3.5 MANDATORY/OPTIONAL SITE VISIT ........................................................................................................................... 13
1.3.6 MANDATORY/OPTIONAL PRE-PROPOSAL CONFERENCE ....................................................................................... 13
1.3.7 PRE-PROPOSAL DOCUMENT REVIEW ....................................................................................................................... 14
1.4 ADDITIONAL INFORMATION ................................................................................................................................................. 14
1.4.1 ADDENDA: REVISIONS TO THIS RFP ......................................................................................................................... 14
1.4.2 BIDDER RESPONSIBILITY ............................................................................................................................................ 14
1.4.3 COST LIABILITY ............................................................................................................................................................. 14
1.4.4 CONTENTS OF PROPOSAL .......................................................................................................................................... 14
1.4.5 PROPOSAL SUBMISSION ............................................................................................................................................. 15
1.4.6 PRICE ALTERATION IN HARD COPY PROPOSALS .................................................................................................... 15
1.4.7 PROPOSAL ERRORS .................................................................................................................................................... 15
1.4.8 JOINT VENTURE ............................................................................................................................................................ 16
1.4.9 RECIPROCITY FOR JURISDICTIONAL BIDDER PREFERENCE ................................................................................ 16
1.4.10 PROPOSAL ACCEPTANCES AND REJECTIONS ...................................................................................................... 17
2.0 DEFINITIONS ............................................................................................................................................................................... 18
2.1 GENERAL DEFINITIONS ........................................................................................................................................................ 18
2.2 CONTRACT-SPECIFIC DEFINITIONS ................................................................................................................................... 20
3.0 SCOPE OF WORK ....................................................................................................................................................................... 27
3.1 APPROACH TO SERVICES ................................................................................................................................................... 27
3.1.1 CONTRACT IMPLEMENTATION PERIOD ..................................................................................................................... 27
3.1.2 PROJECT LAUNCH/ ORIENTATION ............................................................................................................................. 27
3.1.3 PRELIMINARY READINESS REVIEW ........................................................................................................................... 28
3.1.4 ASSUMPTION OF PROGRAM ....................................................................................................................................... 28
3.1.5 CONTINUITY OF OPERATIONS .................................................................................................................................... 29
3.2 PROJECT MANAGEMENT REQUIREMENTS ....................................................................................................................... 29
3.3 ADMINISTRATIVE REQUIREMENTS FOR THE CONTRACT’S OPERATIONS ................................................................... 29
3.3.1 PROTECTIONS FOR PARTICIPANT INFORMATION ................................................................................................... 30
3.3.2 TESTIMONY AND LITIGATION SUPPORT ................................................................................................................... 31
3.3.3 AUDIT SUPPORT ........................................................................................................................................................... 31
3.3.4 INVOICING...................................................................................................................................................................... 31
3.4 CUSTOMER SERVICE REQUIREMENTS ............................................................................................................................. 31
3.4.1 ALTERNATIVE LANGUAGES AND FORMATS ............................................................................................................. 31
3.4.2 TOLL-FREE TELEPHONE NUMBER AND TOLL-FREE FAX NUMBER ....................................................................... 32
3.4.3 CALL CENTER UTILIZATION STATISTICS ................................................................................................................... 33
3.4.4 VOICE MESSAGING ...................................................................................................................................................... 33
3.4.5 WEB SITE ....................................................................................................................................................................... 33
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3.4.6 COORDINATION OF SUPPORT SERVICES ................................................................................................................. 33
3.4.7 ADDITIONAL SUPPORT SERVICES ............................................................................................................................. 34
3.4.8 PROJECT MATERIALS .................................................................................................................................................. 34
3.4.8.1 POLICIES AND PROCEDURE MANUAL .................................................................................................................... 34
3.4.8.2 HANDBOOK FOR PARTICIPANTS ............................................................................................................................. 35
3.5 QUALITY MANAGEMENT REQUIREMENTS ........................................................................................................................ 36
3.5.1 MEDICAID STATE PLAN COMPLIANCE ....................................................................................................................... 37
3.5.2 QUALITY POLICIES COMPLIANCE............................................................................................................................... 37
3.5.3 CORRECTIVE ACTION PLAN (CAP) ............................................................................................................................. 38
3.5.4 GRIEVANCES AND APPEALS ....................................................................................................................................... 39
3.6 PROJECT OPERATIONS ....................................................................................................................................................... 39
3.6.1 CONTRACTOR’S OFFICE LOCATIONS ........................................................................................................................ 39
3.6.2 PROJECT STAFFING ..................................................................................................................................................... 39
3.6.3 OBTAIN AUTHORIZATIONS/ REGISTRATIONS ........................................................................................................... 47
3.6.4 CONTRACTOR’S RECORDS ......................................................................................................................................... 48
3.6.5 ENROLL AS A MEDICAID PROVIDER .......................................................................................................................... 49
3.6.6 THIRD-PARTY AGREEMENTS WITH THE STATE’S MANAGED CARE ORGANIZATIONS (MCOS) ......................... 49
3.7 MEET-AND-GREET THE PROGRAM PARTICIPANTS ......................................................................................................... 49
3.7.1 PARTICIPANT ORIENTATION AND SKILLS TRAINING ............................................................................................... 50
3.8 ESTABLISH INDIVIDUALS AS PARTICIPANTS .................................................................................................................... 52
3.9 BUDGET PLANS ..................................................................................................................................................................... 53
3.10 PARTICIPANTS’ AND CONTRACTOR’S ACCOUNTS FOR DDS AND DOAS ................................................................... 54
3.11 CONTRACTOR’S CASH FLOW ............................................................................................................................................ 56
3.12 ESTABLISH PAYROLL AND WITHHOLDING RECORDS ................................................................................................... 57
3.13 ACCOUNT FOR SERVICES RENDERED AND ONGOING ADMINISTRATIVE EXPENSES ............................................. 60
3.14 ACCOUNT FOR NON-MEDICAID PROVIDERS .................................................................................................................. 61
3.15 ELECTRONIC CLAIMING ..................................................................................................................................................... 62
3.16 BILL THE PARTICIPANTS’ GRANTS ................................................................................................................................... 62
3.17 BROKER WORKERS’ COMPENSATION INSURANCE FOR PARTICIPANT/ REPRESENTATIVE–EMPLOYERS ........... 63
3.18 ENROLL WORKERS, INDIVIDUAL-DIRECTED GOODS AND SERVICES PROVIDERS, AND VENDORS ...................... 63
3.19 PROJECT REPORTS ........................................................................................................................................................... 66
3.19.1 REPORT DELIVERY..................................................................................................................................................... 66
3.20 DOAS’ OPERATIONAL REQUIREMENTS ........................................................................................................................... 69
3.21 DDS’ OPERATIONAL REQUIREMENTS .............................................................................................................................. 80
3.22 DDD’S OPERATIONAL REQUIREMENTS ........................................................................................................................... 82
3.23 CONCLUSION OF READINESS REVIEW ............................................................................................................................ 84
3.24 ESTABLISH AND MAINTAIN FILES AND DOCUMENTATION ............................................................................................ 86
3.25 TURNOVER PERIOD ............................................................................................................................................................ 90
3.26 SECURITY AND CONFIDENTIALITY ................................................................................................................................... 91
4.0 PROPOSAL PREPARATION AND SUBMISSION ...................................................................................................................... 95
4.1 GENERAL ............................................................................................................................................................................... 95
4.2 PROPOSAL DELIVERY AND IDENTIFICATION .................................................................................................................... 95
4.3 EBID VS. NON-EBID SUBMISSION INSTRUCTION .............................................................................................................. 96
4.3.1 EBID SUBMISSION OF PROPOSAL .............................................................................................................................. 96
4.3.2 NON-EBID SUBMISSION ............................................................................................................................................... 96
4.4 PROPOSAL CONTENT .......................................................................................................................................................... 96
4.4.1 FORMS, REGISTRATIONS AND CERTIFICATIONS REQUIRED WITH PROPOSAL ................................................. 97
4.4.2 FORMS REQUIRED BEFORE CONTRACT AWARD AND THAT SHOULD BE SUBMITTED WITH THE PROPOSAL
............................................................................................................................................................................................... 101
4.4.3 TECHNICAL PROPOSAL ............................................................................................................................................. 102
4.4.4 ORGANIZATIONAL SUPPORT AND EXPERIENCE ................................................................................................... 104
4.4.5 PRICE SCHEDULE/SHEET .......................................................................................................................................... 106
4.4.6 COOPERATIVE PURCHASING ................................................................................................................................... 107
5.0 SPECIAL CONTRACTUAL TERMS AND CONDITIONS .......................................................................................................... 108
5.1 PRECEDENCE OF SPECIAL CONTRACTUAL TERMS AND CONDITIONS ...................................................................... 108
5.2 CONTRACT TERM AND EXTENSION OPTION .................................................................................................................. 108
5.3 CONTRACT TRANSITION .................................................................................................................................................... 108
5.4 CONTRACT AMENDMENT .................................................................................................................................................. 108
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5.5 CONTRACTOR RESPONSIBILITIES ................................................................................................................................... 108
5.6 SUBSTITUTION OF STAFF .................................................................................................................................................. 109
5.7 SUBSTITUTION OR ADDITION OF SUBCONTRACTOR(S) ............................................................................................... 109
5.8 OWNERSHIP OF MATERIAL ............................................................................................................................................... 109
5.9 SECURITY AND CONFIDENTIALITY ................................................................................................................................... 110
5.9.1 DATA CONFIDENTIALITY ............................................................................................................................................ 110
5.9.2 DATA SECURITY STANDARDS .................................................................................................................................. 112
5.9.3 TAX RETURN DATA SECURITY.................................................................................................................................. 113
5.9.4 SECURITY PLAN ............................................................................................................................................................... 115
5.10 NEWS RELEASES .............................................................................................................................................................. 117
5.11 ADVERTISING .................................................................................................................................................................... 117
5.12 LICENSES AND PERMITS ................................................................................................................................................. 117
5.13 CLAIMS AND REMEDIES ................................................................................................................................................... 117
5.13.1 CLAIMS ....................................................................................................................................................................... 117
5.13.2 REMEDIES.................................................................................................................................................................. 117
5.13.3 REMEDIES FOR FAILURE TO COMPLY WITH MATERIAL CONTRACT REQUIREMENTS................................... 117
5.14 LATE DELIVERY ................................................................................................................................................................. 118
5.15 RETAINAGE ........................................................................................................................................................................ 118
5.16 ADDITIONAL WORK AND/ OR SPECIAL PROJECTS ...................................................................................................... 118
5.17 MODIFICATIONS AND CHANGES TO THE STATE OF NJ STANDARD TERMS AND CONDITIONS ............................ 119
5.17.1 INDEMNIFICATION .................................................................................................................................................... 119
5.17.2 INSURANCE – AUTOMOBILE LIABILITY INSURANCE ............................................................................................ 119
5.17.3 INSURANCE – WORKER’S COMPENSATION INSURANCE ................................................................................... 119
5.17.4 INSURANCE - PROFESSIONAL LIABILITY INSURANCE ........................................................................................ 120
5.18 ACCESSIBILITY COMPLIANCE ......................................................................................................................................... 120
5.19 CONTRACT ACTIVITY REPORT ....................................................................................................................................... 120
5.20 ELECTRONIC PAYMENTS ................................................................................................................................................. 121
5.21 PROGRAM EFFICIENCY ASSESSMENT .......................................................................................................................... 121
6.0 PROPOSAL EVALUATION ....................................................................................................................................................... 122
6.1 RIGHT TO WAIVE ................................................................................................................................................................. 122
6.2 DIRECTOR’S RIGHT OF FINAL PROPOSAL ACCEPTANCE ............................................................................................. 122
6.3 STATE'S RIGHT TO INSPECT BIDDER'S FACILITIES ...................................................................................................... 122
6.4 STATE'S RIGHT TO REQUEST FURTHER INFORMATION ............................................................................................... 122
6.5 PROPOSAL EVALUATION COMMITTEE ............................................................................................................................ 122
6.6 ORAL PRESENTATION AND/OR CLARIFICATION OF PROPOSAL .................................................................................. 123
6.7 EVALUATION CRITERIA ...................................................................................................................................................... 123
6.7.1 TECHNICAL EVALUATION CRITERIA ........................................................................................................................ 123
6.7.2 BIDDER’S PRICE SCHEDULE/ SHEET ....................................................................................................................... 123
6.7.3 PROPOSAL DISCREPANCIES .................................................................................................................................... 123
6.7.4 EVALUATION OF THE PROPOSALS .......................................................................................................................... 124
6.8 NEGOTIATION AND BEST AND FINAL OFFER (BAFO) ..................................................................................................... 124
6.9 COMPLAINTS ....................................................................................................................................................................... 125
7.0 CONTRACT AWARD ................................................................................................................................................................. 126
7.1 DOCUMENTS REQUIRED BEFORE CONTRACT AWARD ................................................................................................ 126
7.1.1 REQUIREMENTS OF PUBLIC LAW 2005, CHAPTER 51, N.J.S.A. 19:44A-20.13 - N.J.S.A. 19:44A-20.25
(FORMERLY EXECUTIVE ORDER NO. 134) AND EXECUTIVE ORDER NO. 117 (2008) ................................................. 126
7.1.2 SOURCE DISCLOSURE REQUIREMENTS ................................................................................................................. 126
7.1.3 AFFIRMATIVE ACTION ................................................................................................................................................ 127
7.1.4 BUSINESS REGISTRATION ........................................................................................................................................ 127
7.2 FINAL CONTRACT AWARD ................................................................................................................................................. 127
7.3 INSURANCE CERTIFICATES .............................................................................................................................................. 127
7.4 PERFORMANCE SECURITY ............................................................................................................................................... 127
8.0 CONTRACT ADMINISTRATION................................................................................................................................................ 128
8.1 CONTRACT MANAGER ....................................................................................................................................................... 128
8.1.1 STATE CONTRACT MANAGER RESPONSIBILITIES ................................................................................................. 128
8.1.2 COORDINATION WITH THE STATE CONTRACT MANAGER ................................................................................... 128
9.0 PRICE SCHEDULE/ SHEET ................................................................................................................................................. 129
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EXHIBIT NUMBER 1 – DDD CONTRACT .................................................................................................................................. 132
EXHIBIT NUMBER 2 – DOAS COUNTY OFFICES .................................................................................................................... 138
EXHIBIT NUMBER 3 – DDD COMMUNITY SERVICES OFFICES ............................................................................................ 141
EXHIBIT NUMBER 4 – MANAGED CARE WORKFLOW ........................................................................................................... 143
EXHIBIT NUMBER 4 (CONTINUED) - MANAGED CARE WORKFLOW ................................................................................... 144
EXHIBIT NUMBER 5 – ENROLLMENT PACKET ....................................................................................................................... 147
EXHIBIT NUMBER 6 – SAMPLE CO-PAYMENT STATEMENT ................................................................................................. 148
EXHIBIT NUMBER 7 – DATA FIELDS ........................................................................................................................................ 149
EXHIBIT NUMBER 8 – PROCEDURE CODE LIST .................................................................................................................... 150
EXHIBIT NUMBER 9 – SAMPLE REPORT ................................................................................................................................ 151
EXHIBIT NUMBER 10 – SAMPLE REPORT .............................................................................................................................. 152
EXHIBIT NUMBER 11 – VD-HCBS FLOWCHART ..................................................................................................................... 153
EXHIBIT NUMBER 12 – VD-HCBS PROGRAM SAMPLE CASH MANAGEMENT PLAN.......................................................... 154
EXHIBIT NUMBER 13 – LISTING OF MEDICAID MANAGED CARE ORGANIZATIONS.......................................................... 155
EXHIBIT NUMBER 13 – LISTING OF MEDICAID MANAGED CARE ORGANIZATIONS.......................................................... 156
EXHIBIT NUMBER 14 – SAMPLE BUSINESS ASSOCIATE AGREEMENT (BAA) ................................................................... 157
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1.0 INFORMATION FOR BIDDERS
1.1 PURPOSE AND INTENT
This Request for Proposal (RFP) is issued by the Procurement Bureau, Division of Purchase and
Property, Department of the Treasury on behalf of the Department of Human Services (DHS) for
use by its Divisions of Disability Services (DDS), Aging Services (DOAS), Developmental
Disabilities (DDD), and Medical Assistance and Health Services (DMAHS). The purpose of this
RFP is to solicit proposals to engage one contractor to provide statewide fiscal management
services (FMS), administrative services, and financial counseling services (FCS) for individuals
(i.e., participants) who are enrolled in DHS programs that allow these participants to self-direct
and manage the services and budget in their plan of care, based on the participant’s personal
choices.
This RFP seeks a qualified contractor with the knowledge, experience, resources, and
infrastructure necessary to effectively execute the following FMS and FCS services:
A. Provide the Vendor Fiscal/ Employer Agent (VF/ EA) model of FMS services in
accordance with Agent Employment Tax Liability, as issued in the Federal Register under
Section 3504 of the Internal Revenue Code, and perform acts required of employers (i.e.,
the DHS participants), who are home care service recipients, and as their designated
agent pay the wages for the home care services of these DHS participants, which are
subject to taxes under the Federal Unemployment Tax Act; and follow Internal Revenue
Service (I.R.S.) procedures regarding Home-Care Service Procedures, such as 70-6,
Notice 2013-39; and I.R.S. Bulletin 137036-08;
Proposals offering the “Agency with Choice” model of FMS services will not be accepted;
and, as such, the State considers the following to be key components of the FMS VF/ EA
model, including, but not limited to:
1. The participants have Budget authority; and
2. The participants have Employer authority to act as the common law employer of
record; and
B. Provide administrative services to the participants enrolled in DDS, DOAS, and DDD
Programs; and provide fiscal conduit functions and financial counseling services to the
participants enrolled in DDS and DOAS programs, to include, at a minimum, orientation,
explanation, and training about the Program to participants—the DDD-enrolled
individuals only require the fiscal conduit function as these individuals receive their
financial counseling services separate and apart from the contract resulting from this
RFP; and
C. Have the financial capability to advance funds (i.e., using a Just-in-Time payment
processing approach and methodology, or similar approach) to pay participants’ workers
and vendors. In order to accomplish this, the contractor shall establish and maintain a $3
million line of credit, to be submitted with the bidder’s proposal, and maintained
throughout the term of the contract.
The intent of this RFP is to award a contract to that responsible bidder whose proposal,
conforming to this RFP is most advantageous to the State, price and other factors considered.
The State, however, reserves the right to separately procure individual requirements that are the
subject of the contract during the contract term, when deemed by the Director to be in the State’s
best interest.
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The State of NJ Standard Terms and Conditions will apply to all contracts or purchase
agreements made with the State of New Jersey. These terms are in addition to the terms and
conditions set forth in this RFP and should be read in conjunction with them unless the RFP
specifically indicates otherwise.
1.2 BACKGROUND
This is a re-procurement of three (3) State contracts—DDS term contract #T-2240 Third-Party
Services: Fiscal and Support Services, Cash and Counseling Program, presently due to
expire on 9/30/15; Department of Health and Senior Services DHSS term contract #T-1876 ThirdParty Services: DHSS Senior Initiatives, presently due to expire on 9/30/15; and DDD contract
for Fiscal Intermediary Services, presently due to expire on 6/30/15. The re-procurement will
consolidate these three (3) contracts into a single contract. The DDD contract is available as
Exhibit Number 1 to this RFP. A bidder interested in the current contract specifications and
pricing information for the DDS and DHS contracts may review the information for #T-2240 and
#T-1876 located at
http://www.state.nj.us/treasury/purchase/pricelists.shtml.
Prior to the release of this RFP, another RFP, #2015-x-23219 for Fiscal Intermediary and
Counseling Services: DHS, was issued on behalf of the Department of Human Services, and
then cancelled shortly thereafter, on September 5, 2014 before the receipt of any proposal.
The DHS administers a number of programs that promote and provide participant-directed care to
the elderly, individuals with disabilities, the medically needy, and veterans. These programs are
based upon the concept of participant direction, which allows participants to have choice and
control over the selection of their home and community-based services (HCBS); as well as,
purchase goods, and pay the individuals and entities that provide these services.
Participants, or their authorized representatives, function as the employing authority, and in that
capacity hire, discharge, train, and supervise their own directly hired workers; and have budget
authority to manage their budgets, determine the types of goods and services to be purchased,
and establish their worker’s wage rates.
The basis on which the participant may obtain goods and/ or individualized services is the
participant’s Budget, known as a Cash Management Plan (CMP) in DDS and a Plan of Care
(PoC) in DOAS and DDD. The contractor interacts with a number of systems within DHS to
obtain information about the participants: the Medicaid Fiscal Agent’s payment processing
system, the managed care organizations’ payment processing system(s), the DOAS’ HCBS/
ADRC database, and the DDD’s i-Record system.
In 2010, the State began a comprehensive overhaul of its Medicaid program; as well as,
redesigned its delivery of long-term services and support. Relevant initiatives, which have
bearing on the services being procured in this RFP, are listed below with a hyperlink to
information on each initiative.
A. The New Jersey Comprehensive Waiver, a new Medicaid §1115(a) demonstration, was
approved by the Centers for Medicare and Medicaid Services (CMS) in 2012, and includes
a new support component for individuals, who are receiving services from the Division of
Developmental Disabilities (DDD). Additional information is available at:
http://www.state.nj.us/humanservices/dmahs/home/waiver.html; and
B. The Medicaid Managed Long-Term Services and Supports (MLTSS) program was
implemented as of July 1, 2014, which requires NJ FamilyCare Managed Care
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Organizations (MCOs), also known as health plans, to manage certain home and
community-based services (HCBS) for eligible enrollees. Additional information is
available at:
http://www.state.nj.us/humanservices/dmahs/home/mltss.html.
1.2.1 DIVISION OF AGING SERVICES (DOAS) PROGRAMS
The DOAS is the DHS Agency that was created when the services and supports for seniors
programs were transferred from the Department of Health and Senior Services (DHSS) to the
Department of Human Services. The DOAS offers a single point of access for seniors and people
with disabilities and their caregivers, and provides community-based long-term services and
supports.
For those individuals who would otherwise require delivery of their services in a nursing facility,
DOAS currently manages two HCBS programs: Jersey Assistance for Community Caregiving
(JACC) and Veterans Home and Community-Based Services (VD-HCBS).
Please refer to Exhibit Number 2 for a listing of DOAS County Office locations.
1.2.1.1 JERSEY ASSISTANCE FOR COMMUNITY CAREGIVING (JACC)
The JACC program offers a Participant-Employed Provider (PEP) option, by which participants
may self-direct their caregivers. JACC is a 100% State-funded DOAS Program; and, as such, its
PEP participants are required to contribute a co-payment in order to participate in the program.
The contractor bills JACC participants for the co-payments that are due, and the participants remit
their co-payments to the contractor. The contractor executes payments to the participant’s
caregiver or authorized service provider, and submits a claim or invoice directly to DOAS for
reimbursement.
The JACC population currently includes approximately 1,500 individuals, of which about 115 are
selecting the PEP option at this time.
JACC utilization is summarized in Chart No. 1 below in RFP Section 1.2.4.
Additional information on the JACC Program is available at:
http://www.state.nj.us/health/senior/jacc.shtml.
1.2.1.2 VETERANS-DIRECTED HOME AND COMMUNITY-BASED SERVICES (VD-HCBS)
The VD-HCBS program serves veterans of any age who are at risk of nursing home placement
and their family caregivers. The VD-HCBS program provides veterans the opportunity to receive
home and community-based services that enable them to avoid institutionalization and continue to
live in their homes and communities.
Starting in 2008, the Administration for Community Living (ACL), on behalf of the U.S. Department
of Health and Human Services (HHS), began a partnership with the Veteran’s Health
Administration in the U.S. Department of Veterans Affairs (DVA) to help veterans in need of longterm care services avoid institutionalization. DOAS received a grant from the U.S. Administration
on Aging (AoA) in 2008 to design and implement the VD-HCBS program. The program began in
Somerset and Morris counties, and recently expanded to Warren and Bergen counties, with the
anticipation of expanding to other northern and central counties during the contract term resulting
from this RFP.
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Currently four (4) Area Agencies on Aging (AAAs) provide the enrollment, care management
services, and administrative oversight to VD-HCBS participants, and are reimbursed by DOAS’ FI
contractor. Individualized budgets are determined by the VD-HCBS program, and are based on
an individual’s assessed needs, and can vary from individual to individual. The DOAS submits biweekly expenditure reports to the DVA for the veterans’ budgeted program support services and
expenses. The DVA forwards reimbursement to DOAS’ current Fiscal Intermediary (FI)
contractor.
The VD-HCBS Program currently includes approximately 50 enrolled individuals.
VD-HCBS utilization is summarized in Chart No. 1 below in RFP Section 1.2.4.
Additional information on the VD-HCBS Program is available at:
http://www.acl.gov/Programs/CDAP/OIP/VDHCBS/index.aspx.
1.2.2 DIVISION OF DISABILITY SERVICES (DDS) PROGRAMS
The DDS is the DHS Agency providing information and referral services to people who have
become disabled as adults, whether through illness or injury. The DDS Personal Preference
Program (PPP) was initiated in 1999 under the National Cash and Counseling Demonstration and
Evaluation Program as a Medicaid §1115 research and demonstration waiver project, which
allowed the State to create a self-directed alternative to its existing Medicaid Personal Care
Assistance (PCA) benefits.
1.2.2.1 MANAGED LONG-TERM SERVICES AND SUPPORTS (MLTSS)
The MLTSS program offers self-directed home-based care to MLTSS-enrolled individuals; and as
such, participants can select the PEP option, and self-direct their caregivers utilizing the
contractor’s financial counseling services. MLTSS individuals may also choose to self-direct nonmedical transportation and chore services.
The MLTSS population currently includes
approximately 11,500 participants, of which, about 210 are selecting the PEP option at this time.
MLTSS utilization is summarized in Chart No. 1 below in RFP Section 1.2.4.
Additional information on the MLTSS Program is available at:
http://www.state.nj.us/humanservices/doas/services/go.
1.2.2.2 PERSONAL PREFERENCE PROGRAM (PPP)
Instead of receiving PCA benefits in the traditional manner, from a Medicaid-certified home care
agency, individuals enrolled in the PPP program can select self-directed PCA services. A
Medicaid §1915(j) State Plan Amendment (SPA), approved by CMS in 2008, included participantdirected PCA benefits, provided under PPP, as a permanent Statewide State Plan option. The
PPP program offers these individuals self-directed PCA services, using the concept of cash and
counseling.
In 2014, the §1915(j) authority was subsumed into the State’s Comprehensive §1115 Waiver, and
most of the clinical duties of the PPP became the responsibility of the MCOs. The DDS retains
control of PPP’s program operations and the clinical duties for those individuals who are eligible
for fee-for-service services.
On a monthly basis, the MCOs identify MCO members who desire to become self-directed
participants, and submit the participants’ referral packets to DDS. The referral packet includes an
initial authorization of hours for PCA services, which DDS subsequently converts into a monthly
9
cash grant [i.e., budgeted Cash Management Plan (CMP)] for the participant. The referral packet
also includes re-assessment authorizations.
Through their monthly cash grant, the participants can hire domestic household employees and
purchase special equipment, such as home modification items, etc. For reimbursement, the
contractor executes payments on the participants’ behalf, submits a claim to the MCOs for the
services provided to the participants who are enrolled in managed care and submits a claim to the
Medicaid fiscal agent for participants who are eligible for fee-for-service services. The contractor
also counsels (i.e., orients, trains, and explains) each participant for approximately 20 hours per
year. The total number of MCO enrollees to date who select the self-direct option, instead of
selecting traditional MCO service delivery, is approximately 5,000. The average grant is $1,390
and each participant employs approximately 1.2 directly hired workers. The current contractor
receives approximately 400 calls per day regarding the PPP Program.
PPP utilization is summarized in Chart No. 1 below.
Additional information on the PPP Program is available at
http://www.state.nj.us/humanservices/dds/projects/ppp.
1.2.2.3 UPCOMING DDS PROGRAM(S)
In addition to MLTSS and PPP, DDS is in the process of evaluating the implementation of
additional programs that will provide basic levels of supports and services to individuals who live
with family members, or who live in their own homes. The goal of the program(s) will be to
support each individual in the least restrictive setting in the community, while ensuring the
participant’s health and safety and respecting the rights of the individual.
1.2.3 DIVISION OF DEVELOPMENTAL DISABILITIES (DDD) PROGRAMS
The DDD is the DHS Agency that serves individuals with developmental disabilities, who are
Medicaid eligible and meet certain functional criteria for disability-related services. Presently, the
Division provides services and supports for approximately 25,000 adults in total, who reside in the
community independently, with family members, or in group home settings. Those individuals
who have self-directed employees (i.e., self-hires) require the use of a Fiscal Intermediary (FI) for
administration of these workers. This represents approximately 20 percent (20%) of those served
in total. In addition, use of the FI to act as a fiscal conduit for payment of approved goods and
services for individuals in the Division who are not Medicaid providers is required. All DDD’s
disability-related services are funded through one of two Medicaid waiver programs: the
Community Care Waiver (CCW) and the Supports Program.
Please refer to Exhibit Number 3 for a listing of DDD Community Services Offices locations.
1.2.3.1 COMMUNITY CARE WAIVER (CCW)
The CCW is a §1915(c) waiver program administered by DDD for individuals with developmental
disabilities, providing the services and support needed by these individuals to live in the
community. CCW services are provided based on each enrollee’s self-directed individualized
service plan.
With the waiver, federal matching funds are available for these community-based waiver services
as a way to help individuals with specific needs avoid institutionalization, and return to, or remain
in, the community. The CCW is a critical component of DDD’s ability to provide these communitybased services to individuals with developmental disabilities. Without the waiver, New Jersey
10
could only use Medicaid funding for services given to these individuals if they resided in an
institution.
The number of individuals served on the CCW is limited, and is based on projections of how much
State funding will be available to fund DDD’s portion of the cost of providing services to CCW
enrollees. Approximately 11,000 individuals are currently enrolled in the CCW.
CCW utilization is summarized in Chart No. 1 below.
Additional information on the CCW Program is available at:
http://www.state.nj.us/humanservices/ddd/services/ccw/
1.2.3.2 SUPPORTS PROGRAM
As part of the New Jersey Comprehensive Waiver, DDD will soon implement a new DDD waiver
program to be known as the Supports Program, which will provide support services to individuals
living with family members, their personal homes, or unlicensed settings due to family members or
natural supports providing assistance to the individual and/ or not meeting an institutional level of
care as required by the CCW eligibility requirements. Each enrollee will receive a narrower
benefit package to that available under the CCW Program, either because the individual has a
family member, or natural supports that provides unpaid services to the individual.
The goal of the Supports Program will be to service each participant in the least restrictive setting
in the community, while ensuring the participant’s health and safety and respecting their rights.
The Supports Program will provide both provider-managed and self-directed service models on a
Statewide basis. The waiver will have a limited, individualized budget cap (which will be based on
each individual’s assessment of needed services) capable of providing the participant with a
menu of participant-directed services.
The Supports Program utilization is summarized in Chart No. 1 below.
Additional information on the Supports Program is available at:
http://nj.gov/humanservices/ddd/programs/supportsprgm.html
1.2.4 UTILIZATION SUMMARY – ALL PROGRAMS
PoC
PoC
PoC
CMP
CMP
Current
Volume
210
1,500
50
5,000
N/A
Projected
Volume
213
1,500
50
13,000
N/A
PoC
PoC
10,796
N/A
16,000
10,710
Division
Program
Budget
DOAS
DOAS
DOAS
DDS
DDS
PEP
JACC
VD-HCBS
PPP
NEW
PROGRAMS
(TBD)
CCW
SUPPORTS
DDD
DDD
Chart No. 1
It is anticipated the DDS’ PPP Program will grow by 150 participants per month over the course of
the contract resulting from this RFP. Taking into consideration the natural occurrence of
approximately 1,100 projected participant disenrollments during the same period, this yields an
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estimated total population of 13,000 participants during the contract term resulting from this RFP,
although there is no guarantee as to minimum or maximum numbers.
It is anticipated the DDD’s CCW Program will grow by approximately 1,000 individuals per year
over the course of the contract resulting from this RFP. There is an estimated total population of
16,000 participants during the contract term resulting from this RFP, although there is no
guarantee of minimum or maximum numbers.
As the DDD’s Supports Program is a new waiver program, the population of participants is
estimated to grow during the term of the contract resulting from this RFP. The State anticipates
an estimated 10,710 program participants will be enrolled, although there is no guarantee of
minimum or maximum numbers.
1.3 KEY EVENTS
1.3.1 ELECTRONIC QUESTION AND ANSWER PERIOD
The Division will electronically accept questions and inquiries from all potential Bidders via the
web at http://ebid.nj.gov/QA.aspx.

Questions should be directly tied to the RFP and asked in consecutive order, from
beginning to end, following the organization of the RFP.

Each question should begin by referencing the RFP page number and section number to
which it relates.
Note: Questions regarding the State of NJ Standard Terms and Conditions and
exceptions to mandatory requirements must be posed during this Electronic Question
and Answer period and should contain the Bidder’s suggested changes.
A Bidder must not contact the Using Agency directly, in person, by telephone or by e-mail,
concerning this RFP.
The cut-off date for electronic questions and inquiries relating to this RFP is indicated on the
cover sheet. Addenda to this RFP, if any, will be posted on the Division’s website after the cutoff date. (See RFP Section 1.4.1 for further information.)
1.3.2 SUBMISSION OF PROPOSAL
In order to be considered for award, the proposal must be received by the Procurement Bureau
of the Division of Purchase and Property at the appropriate location by the required time. ANY
PROPOSAL NOT RECEIVED ON TIME AT THE LOCATION INDICATED BELOW WILL BE
REJECTED. THE DATE AND TIME ARE INDICATED ON THE COVER SHEET. THE
LOCATION IS AS FOLLOWS:
PROPOSAL RECEIVING ROOM – 9TH FLOOR
PROCUREMENT BUREAU
DIVISION OF PURCHASE AND PROPERTY
DEPARTMENT OF THE TREASURY
33 WEST STATE STREET, P.O. BOX 230
TRENTON, NJ 08625-0230
Directions
to
the
Division
are
available
http://www.state.nj.us/treasury/purchase/directions.shtml.
12
on
the
web
at
Note: Bidders using U.S. Postal Service regular or express mail services should allow additional
time since the U.S. Postal Service does not deliver directly to the Procurement Bureau.
Procedural inquiries concerning this RFP may be directed to [email protected].
This e-mail address also may be used to submit requests to review proposal documents. The
State will not respond to substantive questions related to the RFP or any other contract via this
e-mail address.
To submit an RFP or contract related question, go to the Current Bidding Opportunities webpage
or to http://eBid.nj.gov/QA.aspx.
1.3.3 ELECTRONIC BIDDING (EBID)
This RFP provides to the Bidder the opportunity to electronically submit its proposal. An
electronic bidding – “eBid” – application is available to bidders to promote an easier, more efficient
method to submit proposals.
On-line Electronic Proposal Training Sessions:
Online electronic proposal training for the eBid process is available on the web at
https://wwwnet1.state.nj.us/treasury/dpp/ebid/. The bidder is strongly encouraged to utilize the
on-line training session before attempting to submit an eBid. It will be the bidder’s responsibility to
ensure that the eBid has been properly submitted.
1.3.4 ELECTRONIC SIGNATURES
Bidders submitting proposals through the eBid system may sign the following forms electronically
by typing the name of the authorized signatory in the “Signature” block as an alternative to
downloading, physically signing the form, scanning the form and uploading the form to the eBid
system:



Ownership Disclosure Form;
Disclosure of Investigations and Other Actions Involving Bidder Form; and
Disclosure of Investment Activities in Iran Form
This practice applies only to proposals submitted through the eBid system and the forms listed
above. Both electronic signatures and scanned physical signatures will be accepted, provided that
the forms are otherwise properly completed.
1.3.5 MANDATORY/OPTIONAL SITE VISIT
During the evaluation of proposals, the Division may elect to exercise an option to schedule a
site visit with one bidder or multiple bidders. Notice of a site visit will be structured by the
Division to safeguard information and ensure that bidders are treated fairly.
1.3.6 MANDATORY/OPTIONAL PRE-PROPOSAL CONFERENCE
Not applicable to this procurement.
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1.3.7 PRE-PROPOSAL DOCUMENT REVIEW
In addition to the exhibits and attachments listed in this RFP, the following are publicly available
documents that bidders need to review in order to prepare and submit accurate and
comprehensive proposals:
These documents are located at:
http://www.state.nj.us/humanservices/dds/home/fireprocurement.html.
1.4 ADDITIONAL INFORMATION
1.4.1 ADDENDA: REVISIONS TO THIS RFP
In the event that it becomes necessary to clarify or revise this RFP, such clarification or revision
will be by addendum. Any addendum to this RFP will become part of this RFP and part of any
contract awarded as a result of this RFP.
ALL RFP ADDENDA WILL BE ISSUED ON THE DIVISION OF PURCHASE AND PROPERTY
WEB SITE. TO ACCESS ADDENDA, THE BIDDER MUST SELECT THE PROPOSAL
NUMBER ON THE WEB PAGE AT
http://www.state.nj.us/treasury/purchase/bid/summary/bid.shtml.
There are no designated dates for release of addenda. Therefore interested bidders should
check the Division’s "Bidding Opportunities" website on a daily basis from time of RFP issuance
through the proposal submission opening.
It is the sole responsibility of the bidder to be knowledgeable of all addenda related to this
procurement.
1.4.2 BIDDER RESPONSIBILITY
The bidder assumes sole responsibility for the complete effort required in submitting a proposal
in response to this RFP. No special consideration will be given after proposals are opened
because of a bidder's failure to be knowledgeable as to all of the requirements of this RFP.
1.4.3 COST LIABILITY
The State assumes no responsibility and bears no liability for costs incurred by a bidder in the
preparation and submittal of a proposal in response to this RFP.
1.4.4 CONTENTS OF PROPOSAL
Your proposal can be released to the public during the protest period established pursuant to
N.J.A.C. 17:12-3.3, or under the New Jersey Open Public Records Act, N.J.S.A. 47:1A-1 et seq.,
(OPRA) or the common law right to know. As provided in N.J.A.C. 17:12-1.2(b):
Subsequent to the proposal submission opening, all information submitted by bidders in
response to a solicitation is considered public information, notwithstanding any disclaimers to the
contrary submitted by a bidder, except as may be exempted from public disclosure by OPRA and
the common law.
14
Any proprietary and/or confidential information in your proposal will be redacted by the State. A
bidder may designate specific information as not subject to disclosure pursuant to the exceptions
to OPRA found at N.J.S.A. 47:1A-1.1, when the bidder has a good faith legal and or factual basis
for such assertion. The State reserves the right to make the determination as to what is
proprietary or confidential, and will advise the bidder accordingly. The location in the proposal of
any such designation should be clearly stated in a cover letter. The State will not honor any
attempt by a bidder to designate its entire proposal as proprietary, confidential and/or to
claim copyright protection for its entire proposal. In the event of any challenge to the
bidder’s assertion of confidentiality with which the State does not concur, the bidder shall be
solely responsible for defending its designation.
By signing the cover sheet of this RFP, the bidder waives any claims of copyright protection set
forth within the manufacturer's price list and/or catalogs. The price lists and/or catalogs must be
accessible to State using agencies and cooperative purchasing partners and thus have to be
made public to allow all eligible purchasing entities access to the pricing information.
1.4.5 PROPOSAL SUBMISSION
On the date and time proposals are due under the RFP, all information concerning the proposals
submitted may be publicly announced and those proposals, except for information appropriately
designated as proprietary and/or confidential, shall be available for inspection and copying. In
those cases where negotiation is contemplated, only the names and addresses of the bidders
submitting proposals will be announced and the contents of the proposals shall remain
proprietary and/or confidential until the Notice of Intent to Award is issued by the Director.
1.4.6 PRICE ALTERATION IN HARD COPY PROPOSALS
Proposal prices must be typed or written in ink. Any price change (including "white-outs") must
be initialed. Failure to initial price changes shall preclude a contract award from being made to
the bidder.
1.4.7 PROPOSAL ERRORS
In accordance with N.J.A.C. 17:12-2.11, “Proposal errors,” a bidder may withdraw its proposal as
described below.
A bidder may request that its proposal be withdrawn prior to the proposal submission opening.
Such request must be made, in writing, to the Supervisor of the Proposal Review Unit. If the
request is granted, the bidder may submit a revised proposal as long as the proposal is received
prior to the announced date and time for proposal submission and at the place specified.
If, after the proposal submission opening but before contract award, a bidder discovers an error
in its proposal, the bidder may make a written request to the Supervisor of the Proposal Review
Unit for authorization to withdraw its proposal from consideration for award. Evidence of the
bidder’s good faith in making this request shall be used in making the determination. The factors
that will be considered are that the mistake is so significant that to enforce the contract resulting
from the proposal would be unconscionable; that the mistake relates to a material feature of the
contract; that the mistake occurred notwithstanding the bidder’s exercise of reasonable care; and
that the State will not be significantly prejudiced by granting the withdrawal of the proposal. After
the proposal submission opening, while pursuant to the provisions of this section, you may
request to withdraw your proposal and the Director may, in her discretion allow you to withdraw
it, the Division also may take notice of repeated or unusual requests to withdraw by a bidder and
take those prior requests to withdraw into consideration when evaluating the bidder’s future bids
or proposals.
15
All proposal withdrawal requests must include the proposal identification number and the final
proposal submission date and be sent to the following address:
Department of the Treasury
Procurement Bureau
PO Box 230
33 West State Street – 9th Floor
Attention: Supervisor, Proposal Review Unit
If during a proposal evaluation process, an obvious pricing error made by a potential contract
awardee is found, the Director shall issue written notice to the bidder. The bidder will have five
(5) days after receipt of the notice to confirm its pricing. If the vendor fails to respond, its
proposal shall be considered withdrawn, and no further consideration shall be given it.
If it is discovered that there is an arithmetic disparity between the unit price and the total
extended price, the unit price shall prevail. If there is any other ambiguity in the pricing other
than a disparity between the unit price and extended price and the bidder’s intention is not
readily discernible from other parts of the proposal, the Director may seek clarification from the
bidder to ascertain the true intent of the proposal.
1.4.8 JOINT VENTURE
If a joint venture is submitting a proposal, the agreement between the parties relating to such
joint venture should be submitted with the joint venture’s proposal. Authorized signatories from
each party comprising the joint venture must sign the proposal. A separate Ownership
Disclosure Form, Disclosure of Investigations and Actions Involving Bidder form, Disclosure of
Investment Activities in Iran form, and Affirmative Action Employee Information Report must be
supplied for each party to a joint venture. NOTE: Each party comprising the joint venture must
also possess a valid Business Registration Certificate (“BRC”) issued by the Department of the
Treasury, Division of Revenue and Enterprise Services prior to the award of a contract. Refer to
Section 4.4.2.1 of this RFP.
1.4.9 RECIPROCITY FOR JURISDICTIONAL BIDDER PREFERENCE
In accordance with N.J.S.A. 52:32-1.4 and N.J.A.C. 17:12-2.13, the State of New Jersey will
invoke reciprocal action against an out-of-State bidder whose state or locality maintains a
preference practice for its bidders. For states having preference laws, regulations, or practices,
New Jersey will use the annual surveys compiled by the Council of State Governments, National
Association of State Purchasing Officials, or the National Institute of Governmental Purchasing to
invoke reciprocal actions. The State may obtain additional information as it deems appropriate to
supplement the stated survey information.
The bidder may submit information related to preference practices enacted for a local entity
outside the State of New Jersey. This information may be submitted in writing as part of the
proposal response, including name of the locality having the preference practice, as well as
identification of the county and state, and should include a copy of the appropriate documentation,
i.e., resolution, regulation, law, notice to bidder, etc. It is the responsibility of the bidder to provide
documentation with the proposal or submit it to the Director, Division of Purchase and Property
within five (5) working days of the public proposal submission date. Written evidence for a specific
procurement that is not provided to the Director within five (5) working days of the public proposal
submission date will not be considered in the evaluation of that procurement, but will be retained
and considered in the evaluation of subsequent procurements.
16
1.4.10 PROPOSAL ACCEPTANCES AND REJECTIONS
N.J.A.C. 17:12-2.7(d), the Director’s right to waive minor irregularities or omissions in a proposal
and N.J.A.C. 17:12-2.2 which defines causes for proposal rejection, apply to all proposals. In
addition, pursuant to N.J.S.A. 52:34-12, the Director retains the right to reject all proposals if it is
in the public interest.
17
2.0 DEFINITIONS
2.1 GENERAL DEFINITIONS
The following definitions will be part of any contract awarded or order placed as result of this RFP.
Addendum – Written clarification or revision to this RFP issued by the Division of Purchase and
Property.
All-Inclusive Hourly Rate – An hourly rate comprised of all direct and indirect costs including, but
not limited to: overhead, fee or profit, clerical support, travel expenses, per diem, safety
equipment, materials, supplies, managerial support and all documents, forms, and reproductions
thereof. This rate also includes portal-to-portal expenses as well as per diem expenses such as
food.
Amendment – An alteration or modification of the terms of a contract between the State and the
Contractor(s). An amendment is not effective until approved in writing by the Director or Deputy
Director, Division of Purchase and Property.
Bidder – An individual or business entity submitting a proposal in response to this RFP.
Contract – This RFP, any addendum to this RFP, and the bidder’s proposal submitted in
response to this RFP, as accepted by the State.
Contractor – The bidder awarded a contract resulting from this RFP.
Director – Director, Division of Purchase and Property, Department of the Treasury. By statutory
authority, the Director is the chief contracting officer for the State of New Jersey.
Division – The Division of Purchase and Property.
Evaluation Committee – A committee established or Division staff member assigned by the
Director to review and evaluate proposals submitted in response to this RFP and to recommend a
contract award to the Director.
Firm Fixed Price – A price that is all-inclusive of direct cost and indirect costs, including, but not
limited to, direct labor costs, overhead, fee or profit, clerical support, equipment, materials,
supplies, managerial (administrative) support, all documents, reports, forms, travel, reproduction
and any other costs. No additional fees or costs shall be paid by the State unless there is a
change in the scope of work.
Joint Venture – A business undertaking by two or more entities to share risk and responsibility
for a specific project.
May – Denotes that which is permissible, not mandatory.
Project – The undertaking or services that are the subject of this RFP.
Request for Proposal (RFP) – This document which establishes the bidding and contract
requirements and solicits proposals to meet the purchase needs of the using Agencies as
identified herein.
18
Shall or Must – Denotes that which is a mandatory requirement. Failure to meet a mandatory
material requirement will result in the rejection of a proposal as non-responsive.
Should – Denotes that which is recommended, not mandatory.
Small business – Pursuant to N.J.A.C. 17:13-1.2, “small business” means a business that meets
the requirements and definitions of “small business” and has applied for and been approved by
the New Jersey Division of Revenue and Enterprise Services, Small Business Registration and
M/WBE Certification Services Unit as (i) independently owned and operated, (ii) incorporated or
registered in and has its principal place of business in the State of New Jersey; (iii) has 100 or
fewer full-time employees; and has gross revenues falling in one of the three following categories:
(A) 0 to $500,000 (Category I); (B) $500,001 to $5,000,000 (Category II); and (C) $5,000,001 to
$12,000,000, or the applicable federal revenue standards established at 13 CFR §121.201,
whichever is higher (Category III).
State – State of New Jersey.
State Contract Manager – The individual responsible for the approval of all deliverables, i.e.,
tasks, sub-tasks or other work elements in the Scope of Work, as set forth in Sections 8.1, 8.1.1
and 8.1.2.
Subtasks – Detailed activities that comprise the actual performance of a task.
Subcontractor – An entity having an arrangement with a State contractor, where by the State
contractor uses the products and/or services of that entity to fulfill some of its obligations under its
State contract, while retaining full responsibility for the performance of all of its [the contractor's]
obligations under the contract, including payment to the subcontractor. The subcontractor has no
legal relationship with the State, only with the contractor.
Task – A discrete unit of work to be performed.
Transaction - The payment or remuneration to the contractor for services rendered or products
provided to the State pursuant to the terms of the contract, including but not limited to the
following: purchase orders, invoices, hourly rates, firm fixed price, commission payments,
progress payments and contingency payments.
Using Agency[ies] – A State department or agency, a quasi-State governmental entity, or a
Cooperative Purchasing Program participant, authorized to purchase products and/or services
under a contract procured by the Division.
19
2.2 CONTRACT-SPECIFIC DEFINITIONS
Note: In some cases, terminology is program-specific or agency-specific and unique to
that entity. In those circumstances, a reference to the agency immediately after the term is
used to provide additional clarification.
Administration on Aging (AoA) – The principal agency of the U.S. Department of Health and
Human Services designated to carry out the provisions of the Older Americans Act of 1965
(OAA).
Administration for Community Living (ACL) – The organization within the U.S. Department of
Health and Human Services designated to help people with disabilities and older adults to live at
home with the supports they need.
Agency with Choice Model – A business model whereby an agency acts as the employer of
record with consumers having marginal choice in how services are administered.
Americans with Disabilities Act (ADA) – Prohibits discrimination against people with disabilities
in employment, transportation, public accommodation, communications, and governmental
activities.
Area Agency on Aging (AAA) – An Agency designated in each of New Jersey’s 21 counties to
serve as the primary entity responsible for developing comprehensive, coordinated systems of
community-based services for older adults. AAAs also serve as Aging and Disability Resource
Connection (ADRC) lead agencies in their county, ensuring seniors and adults with disabilities
and their caregivers have easy access to information and long-term services and supports.
Assistive Technology – An item, piece of equipment, or product system, whether acquired
commercially, modified, or customized, used to increase, maintain or improve functional
capabilities of participants enrolled in the Division of Developmental Disabilities’ (DDD) Programs.
Authorized Representative – The participant's legal guardian, family member, or any other
identified individual who willingly accepts responsibility for performing employer and budget
management tasks that a participant is unable to perform him- or herself.
Automated Clearing House (ACH) – Nationwide batch-oriented electronic funds transfer system
operated by the Federal Reserve and Electronics Payments Network and governed by National
ACH Association (NACHA) operating rules, which provide for the interbank clearing of electronic
payments for participating depository financial institutions.
Bi-Weekly – Every other week.
Budget – A DDS Cash Management Plan (CMP), or a DDD Plan of Care (PoC), or a DOAS Plan
of Care (PoC).
Career Planning – For participants enrolled in DDD programs, a person-centered,
comprehensive employment planning and support service that provides assistance for program
participants to obtain, maintain or advance in competitive employment or self-employment.
Care Coordinator – For the JACC Program, an individual employed by the Area Agency on
Aging (AAA) assisting the Division of Disability Services’ (DDS) program requirements.
20
Care Manager (CM) – An individual employed by a Managed Care Organization (MCO), or by a
State contracted care management agency, who provides enrollee-centered, goal-oriented,
culturally relevant assistance to assure that an enrollee receives needed services in a supportive,
effective, efficient, timely, and cost-effective manner.
Cash and Counseling – For participants enrolled in DDS programs, a personal care services
delivery model using the concept of participant direction for DDS participants. A participant is
given a monthly cash allowance in place of traditional Personal Care Assistance (PCA) services,
and with the guidance of a consultant, purchases goods and services to meet personal care
needs.
Cash Management Plan (CMP) – The budget for a DDS participant.
Central Registry of Offenders Against Individuals with Developmental Disabilities –
Information on the Registry is available at:
http://www.state.nj.us/humanservices/staff/opia/central_registry.html.
Centers for Medicare and Medicaid Services (CMS) – A federal agency within the U.S.
Department of Health and Human Services.
Chore Services – A self-directed service option under MLTSS, administered by the Division of
Disability Services.
Community-Based Supports – For participants enrolled in DDD programs, services that provide
direct support and assistance.
Community Care Waiver – A §1915(c) Home and Community Based Services (HCBS) Medicaid
waiver program administered by DDD.
Community Choice Counselors/ Money Follows the Person Liaisons – Staff from the Division
of Aging Services (DOAS).
Community Inclusion Services – Services that are provided outside of a DDD-participant’s
home.
Community Transitional Services (CTS) – Services designed to aid in the transitioning of
individuals from institutional settings to their own home in the community.
Contract Effective Date – Date of award of the contract resulting from this RFP to a successful
bidder.
Contract Operational Date – A date when the contractor, who is awarded a contract resulting
from this RFP, completes a Readiness Review to become operational and fully assume all of the
tasks in the entire Scope of Work (SOW) in this RFP.
Co-Payment (or co-pay) – For participants enrolled in the DDS JACC program, the amount an
individual enrolled in the DDS JACC Program is obligated to contribute to the JACC Program.
Consultant – An individual who provides financial counseling services to participants of DDS and
DOAS Programs.
Counseling Entity – The contractor, a subcontractor to the contractor, or an entity in the employ
of the contractor that provides financial counseling services to participants enrolled in DDS and
DOAS Programs.
21
DOAS – Division of Aging Services within the Department of Human Services. The Managed
Long-Term Supports and Services, Jersey Assistance for Community Caregiving, and Veterans’
Self-Directed Home Care Services programs are administered by DOAS.
DDD – Division of Developmental Disabilities within the Department of Human Services. The
Community Care Waiver (CCW) and the Supports Program are administered by DDD.
Division Circular #14 (DDD) – Document created and maintained by the Division of
Developmental Disabilities defining “Reporting Unusual Incidents” and the mechanism for
reporting such incidents. The circular is located at:
http://www.state.nj.us/humanservices/ddd/news/publications/divisioncirculars.html.
DDS – Division of Disability Services within the Department of Human Services. The Personal
Preference Program (PPP) is administered by DDS.
DHS – New Jersey Department of Human Services in New Jersey.
DMAHS –Division of Medical Assistance and Health Services within the Department of Human
Services, which administers the managed long-term services and supports (MLTSS) Program on
behalf of the Department. DMAHS is the single state Medicaid agency for the State of New
Jersey.
Domestic Household Employee – A person who is an employee of the participant and provides
personal care services and supports to a participant, who is enrolled in a participant-directed
Program.
Federal Insurance Contribution Act (FICA) – Includes both Medicare and Social Security
Taxes.
Federal Unemployment Tax Act (FUTA) – A payroll or employment tax used to help fund the
federal share paid to state workforce agencies, including providing for some extended
unemployment benefits.
Financial Counseling Services – Services which include: (1) Orienting and training program
participants/ representatives on using financial management and counseling services, and
understanding their role and responsibilities as the common law employer of their workers and
effectively using the program participant’s budget (Cash Management Plan); (2) Assisting
program participants in preparing their initial budget and subsequent budget updates; (3)
Conducting quarterly home visits with program participants; and (4) Maintaining contact with
program participants/ representatives and providing guidance, support, and answers to questions
while participants are enrolled in the Personal Preference Program.
Grievance and Appeals Quality Assurance (QA) Committee – A group of participants and
representatives, the contractor, and the Using Agencies that meet to review Grievances from
participants, and to review and comment on the performance of the contractor.
Home and Community Based Services/ Aging and Disability Resource Center (HCBS/
ADRC) Database – A web-based care/ case management system to be used by the JACC
program to authorize service delivery for and payment to providers for program participants.
Home and Community-Based Services (HCBS) – Health and related tasks performed by
qualified individuals for participants who reside in the community home, including Assisted Living
Residences (ALRs).
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Health Insurance Portability and Accountability Act of 1996 (HIPAA) – A statute enacted by
the U.S. Congress on August 21, 1996. Pub.L 104-191 Stat. 1936.
Independent Contractor – People such as doctors, dentists, veterinarians, lawyers, accountants,
contractors, subcontractors, public stenographers, or auctioneers who are in an independent
trade, business, or profession through which they offer their services to the general public.
Whether these professionals are independent contractors or employees is a legal determination
dependent on the facts in each case.
Jersey Assistance for Community Caregivers (JACC) – A DOAS Program.
Just-in-Time Payments – Contractor assures itself of payment approvals from the MMIS and/ or
the appropriate MCO before paying provider claims; and similarly pends (i.e., suspends)
payments for those claims that are pended or denied thereby allowing itself time to resolve the
pended or denied claim.
Managed Long-Term Services and Supports (MLTSS) – A program that encompasses the NJ
FamilyCare A benefit package and the NJ FamilyCare Alternative Benefit Plan (ABP), and
excludes certain services as specified in Article 4 Provisions of Health Care Services in the HMO
contract.
Medicaid Fiscal Agent – Contracted vendor with responsibility for the processing and payment of
associated claims.
Medicaid Management Information System (MMIS) – Information technology platform and
system primarily responsible for the electronic processing and payment of Medicaid and other
benefits program claims, and currently operated by the Medicaid Fiscal Agent.
Medicaid Personal Care Assistant Services (PCA) – Health-related tasks performed by a
qualified personal care assistant in the Medicaid recipient's home or workplace.
Medicaid §1115 Research and Demonstration Waiver –Experimental, pilot, or demonstration
projects that promote the objectives of the Medicaid and Children's Health Insurance Program
(CHIP).
Medicaid §1915(c) HCBS Waiver – One of many options available to states to allow the
provision of long-term care services in home and community-based settings under the Medicaid
Program.
Medicaid §1915(j) Self-Directed Personal Care State Plan Amendment – Enables states to
offer a self-directed service delivery model for personal assistance services (i.e., cash and
counseling programs) as a State plan option, including payment to legally liable relatives (parent,
spouse, and others). Deficit Reduction Act (DRA) of 2005, Pub.L. 109-171, 120 Stat.4.
National Cash and Counseling Demonstration and Evaluation Program – A program
developed through CMS where participants are provided with cash grants to obtain their personal
care services with the assistance of a counselor.
Natural Supports Training – Training and counseling services for individuals who provide unpaid
support, training, companionship or supervision to participants, who are enrolled in DDD
programs.
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New Jersey Compensation Rating and Inspection Bureau (NJCRIB) – The Agency
responsible for managing the New Jersey Workers’ Compensation Insurance Plan.
New Jersey Department of Labor and Workforce Development – The Agency responsible for
administering State unemployment, disability and family leave insurance programs in the State of
New Jersey.
New Jersey Divisions of Revenue and Enterprise Services and Taxation – Divisions within
the New Jersey Department of the Treasury responsible for registering employers for state
income tax withholding, unemployment, disability and family leave insurance purposes among
other functions.
Non-Medical Transportation – A self-directed service option under MLTSS, administered by
DDS.
Nursing Facility – Residential facility for persons with chronic illness or disability, particularly
older people who have difficulty performing activities of daily living.
Office of Community Choice Options (OCCO) – The organizational unit within DOAS that
administers the Pre-Admission Screening (PAS) and the Pre-Admission Screening and Resident
Review (PASRR) programs. OCCO is responsible for the approval of clinical eligibility for
MLTSS.
Older Americans Acts of 1965 – The first federal-level initiate aimed at providing comprehensive
services for older adults. Pub.L. 89-73, 79 Stat 218.
Omnibus Budget Reconciliation Act of 1981 – Created many of the Medicaid Home and
Community-Based Waiver Programs. Pub.L. 97-35, 95 Stat. 357.
Participant Directed Goods and Services – Services, equipment or supplies not otherwise
provided through Medicaid or the Medicaid State Plan.
Participant-Directed – An approach to service delivery that affords participants choice and
control over the services they receive and the individuals who provide them.
Participant-Employed Provider (PEP) – An employee hired by a participant, in collaboration
with their Care Manager, to provide select care services.
Participant – An individual enrolled in one of the Programs specified in this RFP.
Per Member/ Per Month – An all-inclusive unit rate for routine Vendor Fiscal/ Employer Agent
Financial Management Services (VF/ EA FMS) provided to all participants in a specific program
on a monthly basis.
Personal Emergency Response System (PERS) – Electronic device that enables individuals at
high risk of institutionalization to obtain help in an emergency situation.
Personal Assistance Services – A New Jersey Medicaid State Plan Amendment (SPA) that
provides up to 40 hours of hands-on assistance with activities of daily living to individuals who are
Medicaid-eligible consumers and qualify clinically for the services. This service is governed by
N.J.A.C. 10:60-3, known as The Home Care Services Manual.
Personal Preference Program (PPP) – A DDS Program.
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Plan of Care (PoC) – For participants enrolled in DDS and DOAS programs, a tool describing, at
a minimum, the types of services to be furnished, amount, frequency, duration, and provider type.
For the MLTSS benefit, the PoC is based on the functional assessment, a written plan for
services, that addresses all identified formal and informal service needs of an MLTSS member.
Pre-Admission Screening (PAS) – A care needs assessment process mandated for persons
applying for Medicaid-reimbursed long-term care in nursing facilities and home and communitybased waiver programs to determine if they meet the clinical criteria to be eligible to receive these
services.
Provider – Individual or entity qualified as a provider of services pursuant to the approved
Medicaid waiver criteria and providing authorized services to a participant.
Prevocational Services – DDD services that assist participants in the development of
employment-related skills, as stated in their Service Plan, which contribute to participant’s
employability.
Respite – DDD Services provided to participants unable to care for themselves that are furnished
on a short-term basis because of the absence of, or need for relief for, those persons who
normally provide care for the participant.
Section 508 of the Rehabilitation Act –Federal law (codified at 29 U.S.C. §794d) requiring
access to and use of information and data that is comparable to that provided to the public who
are not individuals with disabilities, unless an undue burden would be imposed on the agency.
Section 3504 of the I.R.S. Code, Revenue Procedure 70-6, I.R.S. Bulletin REG-137036-08,
and Notice 2013-70, as applicable. The Internal Revenue Service code citation and subsequent
notifications that govern the work of a VF/ EA FMS vendor.
Special Medical Equipment/ Supplies – Devices, controls or appliances, specified in the Plan of
Care, that enable individuals to increase their ability to perform activities of daily living.
Support Coordination – A mandated service provided to DDD’s participants by a Medicaidapproved agency with DDD to assist a participant to develop their Plan of Care, and to monitor
the successful implementation/ operation of the Plan on an ongoing basis.
Supported Employment – Activities needed to help DDD’s participants, or group of participants,
develop the specific job skills necessary to successfully sustain paid employment.
Supports Program – A DDD Program established through the New Jersey Comprehensive
Waiver; a new Medicaid §1115(a) demonstration.
State Unemployment Tax Act (SUTA) – New Jersey’s Unemployment Compensation Law N.J.
Stat. §43:21-1 et seq.
Surrogate Representative – A representative designated by a court-appointed, legal guardian.
Technology Assistive Resource Program (TARP) – A federally funded, Statewide program
that provides presentations, information and referral services, advocacy and legal representation
for people with disabilities in the area of assistive technology.
Transportation – For DDD participants, this service is provided to DDD’s participants, in addition
to the medical transportation required under 42 CFR §431.53 and transportation services under
the State Plan, defined at 42 CFR §440.170(a) (if applicable), and does not replace them.
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Unclaimed Property Statutes – New Jersey Statutes established to protect property owners
from businesses, banks, and other financial institutions taking ownership of stale property in the
owner’s name. Additional information is located at: http://www.unclaimedproperty.nj.gov/faqspublic.shtml.
Vehicular Modification – For DDS participants, an enhancement or modification, such as
electronic monitoring systems to a participant’s personal or family vehicle to enhance a
participant’s safety, as defined within the participant’s Plan of Care.
Vendor Fiscal/ Employer Agent Model – A business model whereby participants have budget
authority and hiring authority as the common law employer.
Voluntary Representative – A representative designated by the participant, who voluntarily
represents the participant on the participant's behalf. The participant, and his or her voluntary
representative, work together to select the authorized representative.
Weekly Billing Cycle – The five- (5) day period (excluding weekends, but including holidays or
other non-business days) during which the contractor enters billing information into the
appropriate State database for processing and subsequent payment the following week.
Worker – Domestic household employee hired by, and who performs work in and around the
home, for DDS’ PPP participant; a participant-employed provider who is hired by and provides
home-based supportive care for a MLTSS participant; or an individual provider hired by a DDD
participant.
Worker Employment and Participant-Directed Goods and Services Provider and Vendor
Engagement Packet – A packet of employment-related forms produced and distributed to
workers by the contractor.
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3.0 SCOPE OF WORK
3.1 APPROACH TO SERVICES
Since this contract provides services to multiple Divisions within the Department of Human
Services (DHS), as specified in the RFP’s Scope of Work (SOW), four (4) State Contract
Managers (SCMs) will be assigned to represent the various Programs: one to represent DOAS
Programs, another to represent DDS Programs, and a third to represent DDD Programs.
Additionally, one SCM will be assigned to represent MLTSS enrollees and be the liaison between
the contractor and the MCOs.
A. The contractor shall structure its solution to this RFP as separated organizational units,
managing and administering the Vendor Fiscal (VF) / Employer Agent (EA) Financial
Management Services (FMS) tasks and the Financial Counseling Services (FCS) tasks
independently of the actions and performance of the other, and the contractor’s contractspecific organization chart(s) shall depict the separated organizational units; and
B. The subcontracting of any of these tasks requires the prior approval of the SCMs before
the contractor implements a task performed by a subcontractor. For additional information
about subcontracting, please refer to the RFP’s Section 5.7 Substitution or Addition of
Subcontractors.
3.1.1 CONTRACT IMPLEMENTATION PERIOD
The contractor shall have a ninety (90) calendar day contract implementation period, commencing
on the contract’s effective date. During this time, the contractor shall perform, but not be limited
to, the tasks as set forth in the RFP Section 3.1.2 Project Launch/ Orientation, becoming
completely operational, and fully assuming all of the tasks in the entire SOW by January 1, 2016.
3.1.2 PROJECT LAUNCH/ ORIENTATION
A. Within ten (10) business days of the contract effective date, the contractor shall conduct a
Project Launch meeting, and make arrangements to conduct a number of subsequent
Orientation meetings (estimated to be, at a minimum, three in number), coordinating the
arrangements and agendas for the meetings with the four SCMs. The location of
meetings shall be planned by the contractor to be within a ten- (10) mile drive of the
SCMs’ offices in Mercerville, NJ and Trenton, NJ, and be convenient in time and place for
the four SCMs and their respective teams, which are estimated to comprise a maximum
total of forty (40) individuals;
B. At a minimum, the contractor shall be represented at the Project Launch meeting by its
Account Manager, Project Manager-FMS, Project Manager-FCS, the Lead Counseling
Manager, and preferably a systems lead should also be in attendance;
C. At the Project Launch meeting, the contractor shall be prepared to present all aspects of
its proposed program startup, up to and including through the conclusion of the Readiness
Review (for additional information about the Readiness Review, please refer to RFP
Section 3.23). The SCMs will provide the contractor with a list of names and contact
information for the current Programs’ participants, the participants’ authorized
representatives where applicable, and the participants’ workers (i.e., employees) where
applicable. The State’s records consist of both paper and electronic files (i.e., Microsoft
Excel or Word formats or, in DDD, the files will be in a web-based application); both
formats, when available, will be provided to the contractor. At this meeting, the SCMs will
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arrange, at a day and time to be determined by the SCMs, a mutually convenient method
for the transfer of all files from the incumbent contractor(s) to the new contractor; and
D. Based on discussions at the Project Launch meeting, and within five (5) business days of
the Project Launch meeting, the contractor shall prepare and submit a contract
implementation Work Plan for the approach to contract implementation that will commence
at the subsequent Orientation meeting and conclude with the SCMs’ written approval of
the final Readiness Review.
The Work Plan shall include, at a minimum, the following:
1. An organization chart for the contract implementation period that identifies the key
personnel assigned to the contract implementation period;
2. Resumes of the key personnel who will be involved in managing the contract’s
implementation;
3. An up-to-date contract-specific organization chart (for reference, please refer to RFP
Section 4.4.4 Organizational Support and Experience);
4. A description of the contractor’s approach and methodology for managing and
invoicing the project during the contract implementation period and the full period of
the contract term;
5. A sequencing of tasks to be performed, and resources allocated, including the
identification of concurrent tasks;
6. Anticipated time frame for completion of each task; and
7. A schedule for delivery of each task and deliverable, including an invoice schedule and
web-based solution implementation (if applicable).
E. The respective SCM will review their respective sections of the Work Plan and may return
it to the contractor if modification is necessary. The contractor shall submit a revised Work
Plan within five (5) business days of any disapproval or need for modification; and
F. After receiving the SCMs’ approval of the Work Plan, the contractor shall perform the work
of the implementation period in accordance with the approved Work Plan. Variations in
the Work Plan require prior, written approval from the respective SCM, and require the
contractor to submit a written request to the respective SCM to revise or modify the Work
Plan.
3.1.3 PRELIMINARY READINESS REVIEW
A. Thirty (30) calendar days prior to the end of the contract implementation period, the
contractor shall complete a preliminary Readiness Review conducted by the SCMs; and
B. The SCMs will provide the contractor with written approval for when the contractor
successfully completes the Readiness Review, and then the contractor shall fully assume
the contract. Please refer to RFP Section 3.23 for additional information on the
Conclusion of the Readiness Review.
3.1.4 ASSUMPTION OF PROGRAM
Once 100 percent (100%) of the Readiness Review requirements have been approved by the
SCMs (please refer to RFP Section 3.23 Conclusion of the Readiness Review), the contractor
shall assume and perform all tasks of the SOW, to be determined once the contractor
demonstrated to the SCMs its ability to assume all of the tasks detailed in the RFP’s SOW and the
pre-approved contract implementation Work Plan. Exact dates for the assumption of specific
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contract duties will be determined throughout the contract implementation period after the
contractor’s consultation with, and the receipt of written approval from, the SCMs.
3.1.5 CONTINUITY OF OPERATIONS
The contractor shall create a Continuity of Operations Plan (COOP) during the contract
implementation period and maintain continuity throughout the contract term outside of the
operation’s business locations in the event of a man-made or natural disaster emergency, or due
to an unforeseen displacement.
The COOP must include, but is not limited to:
A. Prior, written approval from the SCMs to activate the COOP;
B. Forwarding of phones;
C. Reassignment of staff;
D. Emergency payroll disbursements to participants’ employees;
E. Secure access to data, documents, and files (both electronic and hard copy); and
F. Provisions to maintain business operations.
3.2 PROJECT MANAGEMENT REQUIREMENTS
The contractor, in consultation with the SCMs, shall develop and maintain a regular schedule of
meetings and/ or teleconferences with the SCMs to discuss the contractor’s performance during
the contract term, and prepare minutes of these sessions for approval by the SCMs within five (5)
business days of the session. This may include meetings at the SCMs’ location(s) or at the
contractor’s location.
During the contract implementation period, the meetings and/ or
teleconferences may be daily, if requested by any one of the SCMs.
3.3 ADMINISTRATIVE REQUIREMENTS FOR THE CONTRACT’S OPERATIONS
The contractor shall, at a minimum, perform the administrative requirements for the contract
operations as follows:
A. Maintain a physical site for the managing staff, who have been identified in this RFP to
work in New Jersey;
B. Submit all deliverables to the respective SCM for review and approval on time, according
to the pre-determined, approved project schedule (Please see RFP Section 3.1.2.E.7);
C. Attend meetings at dates, times, and locations designated by the respective SCM;
D. Present meeting minutes to the respective SCM within five (5) business days of any
regularly scheduled status meeting, and that contain the date of the meeting, a listing of
attendees, a brief summary of the discussion, and the next steps and obligations of each
attendee;
E. Prepare and provide a presentation of information at group meetings, at the request of the
respective SCM; and
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F. Proactively assist the respective SCM in identifying and interpreting changes to federal
regulations or policies as necessary. Examples include frequent (e.g., quarterly) reporting
of any emerging federal law or regulation that potentially impacts the process, or instances
where another state’s processes produce efficiencies and improved effectiveness, or
communicate regional or national events that may be of interest to the State.
3.3.1 PROTECTIONS FOR PARTICIPANT INFORMATION
A. The contractor shall, at all times, in performance of this contract, provide and maintain
compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996,
the Health Information Technology for Economic and Clinical Health (HITECH) Act, and
the Balanced Budget Act (BBA) of 1997 governing the protection of patient information,
and federal regulations, 45 CFR §§ 160, 162, and 164. The Centers for Medicare and
Medicaid Services (CMS) website provides additional information at:
http://www.cms.hhs.gov/home/regsguidance.asp;
B. The contractor shall establish and maintain files for each participant, worker, and provider/
vendor according to the State, federal, and HIPAA regulations contained in this RFP;
C. The contractor shall have up-to-date procedures and trained staff, ensuring, at all times
that its staff communicate with the participant only, or, if there is an authorized
representative recorded in the participant’s file, with the participant’s authorized
representative of record;
D. The contractor shall establish and be capable on the contract effective date of complying
with HIPAA requirements, and for ensuring all staff are HIPAA trained. HIPAA standards
(referred to as "Implementation Guides") are available at http://www.wpc-edi.com.
E. In addition, the NJ Medicaid HIPAA Companion Guide, a New Jersey-specific supplement
to the national Implementation Guide, is available at www.njmmis.com. All electronic
claims must adhere to the HIPAA standards. The HIPAA 837P transaction set must be
used;
F. The contractor may be required to submit hardcopy claims on a rare occasion, at the
discretion of the SCM, using Claim Form #1500. Instructions for submitting this form may
be obtained by contacting the current Medicaid Fiscal Agent at (850) 893-6954;
G. Such regulatory compliance shall include the erasure and deletion of all personal and
confidential information that may be contained on all personal computers and their
locations and storage devices/ drives prior to disposal, or any other disposition that may
be required as per requirements set forth by the U.S. Department of Defense (DoD) in its
data sanitization method, DoD 5220.22-M. Additional information is available at:
http://www.dtic.mil/whs/directives/;
H. All staff should receive training on the detection and reporting of suspected fraudulent
activity; and
I.
The contractor(s) shall submit an original, signed copy of DHS-DMAHS’ HIPAA Business
Associate Agreement (BAA) to the respective SCM upon contract award. A sample
HIPAA BAA is provided as Exhibit Number 14 in this RFP.
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3.3.2 TESTIMONY AND LITIGATION SUPPORT
The contractor shall provide expert testimony regarding any litigation resulting from work
performed in fulfillment of the requirements of this RFP and the contract resulting from this RFP,
upon request by the SCM.
3.3.3 AUDIT SUPPORT
In the event of an audit, the contractor shall provide full support to the SCM and the respective
Using Agencies (i.e., SCMs) within seven (7) business days of a request for assistance; except
unannounced audits due to fraud detection shall be supported immediately. This includes, but is
not limited to, on-site meetings, provision of documents, data, files, and documentation reviews
and support, with written responses required from the contractor.
3.3.4 INVOICING
When invoicing a Using Agency (i.e., SCM), the contractor shall submit all contract invoices to the
respective SCM for review and approval on time, in accordance with an invoice schedule that is
determined and approved at the Project Launch meeting (please refer to Project Launch/
Orientation RFP Section 3.1.2.E.7).
3.4 CUSTOMER SERVICE REQUIREMENTS
A. The contractor shall, at all times, provide the following customer service:
1. Provide courteous, prompt attention to an inquirer’s needs within twenty-four (24)
hours, Monday through Friday, of inquiry;
2. Respect the customer’s privacy during all communication and telephone calls;
3. Maintain sensitivity to the diversity inherent in all cultures and disabilities;
4. Display and communicate a professional demeanor; and
5. Strive for total accuracy when disseminating information to customers; and
B. When an inquiry or concern overlaps the contractor’s separated organizational units
serving VF/ EA FMS and FCS, the contractor shall provide the customer with seamless
transition and resolution when transferring the inquiry or concern from one organizational
unit to the other;
C. When an inquiry or concern overlaps with an enrollee’s MLTSS benefit, the contractor
shall provide a process to transfer the enrollee to their respective MCO representative for
further assistance, by ensuring the MCO representative, or his/ her designee, is personally
available to accept the transfer before the transfer is initiated;
D. At least 95 percent (95%) of the calls, e-mails, faxes, and letters of inquiry shall receive a
resolution or escalation within two (2) business days of receipt; and
E. The contractor shall, at a minimum, also perform the customer services described in RFP
Sections 3.4.1 through 3.4.8 as follows:
3.4.1 ALTERNATIVE LANGUAGES AND FORMATS
A. The contractor shall respond to participants’ written inquiries and provide written
information in both English and Spanish at all times and show evidence of the process to
accommodate languages spoken in New Jersey as needed;
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B. For callers, the contractor shall provide a translation and interpreter service that
accommodates customers requiring communication in another language, as needed or
when requested by the caller;
C. The contractor shall provide all recipient-based, written material in alternative formats that
adequately address the individual’s needs, such as having materials available in the
language of the recipient or large-print type, and making available communication devices
for the sight-, hearing-, and speech-impaired; and
D. All communication methods must be compliant with the Americans with Disabilities Act, as
well as, Section 508 of the U.S. Rehabilitation Act.
3.4.2 TOLL-FREE TELEPHONE NUMBER AND TOLL-FREE FAX NUMBER
A. The contractor shall provide and maintain a toll-free telephone number for the purpose of
providing customer service for this project;
B. The contractor shall provide telephonic customer service, at a minimum, as follows:
1. Separate and track callers by Program;
2. Business hours shall be Monday through Friday from 8:00 a.m. to 6:00 p.m. Eastern
Time (ET);
3. Holidays will be determined by the SCMs at the Project Launch meeting;
4. Call pick-up shall be by live, qualified staff within four (4) rings, with a performance
rate of 95 percent (95%) of calls being answered by live staff before transfer to a
voice messaging system;
5. A busy-signal rate shall be less than five percent (5%) for all calls, measured on a
weekly basis;
6. Service shall be compatible with TDD (Telephone for the Deaf) or TTY
(Teletypewriter) telecommunications devices for the hearing and speech impaired;
7. Password-protected voice messaging shall be available during non-business hours
and as back-up during hours of operation, and responded to within one (1) business
day of receipt;
8. A secured facsimile (fax) machine, with a toll-free fax number, shall be available
twenty-four (24) hours each day of the seven (7) day week;
9. A log and tracking process shall be maintained for all calls and faxes, whether
answered by live staff or messaged, to include the inquirer’s name, the participant’s
name, reason for the contact, action taken by the contractor’s staff, note if any
mandatory reporting occurred, and final resolution;
10. Submit the log to the respective SCM quarterly; and
C. Trained, knowledgeable, courteous staff shall answer the telephone calls and respond to
voice-messaged inquiries during business hours and provide first- or second-call
resolution whenever possible. Unresolved inquiries shall be directed as follows:
1. Unresolved inquiries shall be logged, tracked and, if not resolved within forty-eight (48)
hours of receipt, referred to the respective SCM. Notify the respective SCM of all
referrals (i.e., unresolved inquiries) by e-mail within one (1) business day of the inquiry
being designated by the contractor as an unresolved inquiry referral.
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3.4.3 CALL CENTER UTILIZATION STATISTICS
It is estimated that a population of 18,000 program participants generates approximately 1,700
telephone calls per day, for an approximate monthly average of 21,000 telephone calls. The call
center may have increased volume on the pay day of household employees.
3.4.4 VOICE MESSAGING
The contractor shall provide and maintain password-protected voice messaging, available 24
hours per day, seven (7) days each week, for the purpose of recording inquiries that are not
directly handled by live staff. The voice messaging shall include, at a minimum, a one (1)
business-day response by live staff to all inquiries, with a goal of first- or second-call resolution
whenever possible.
3.4.5 WEB SITE
A. The contractor shall provide and maintain a website for the purpose of providing education
regarding the contract’s services and displaying contact information for the contractor.
Information on the website shall be pre-approved by the SCM, and organized to be easily
understood by participants/ authorized representatives, participant’s workers, providers/
vendors, and the general public. The website shall be developed in compliance with the
Americans with Disabilities Act and Section 508 of the U.S. Rehabilitation Act; and a
website with the ability for language translation is preferred;
1. The website shall provide for routing of e-mailed inquiries from participants,
participant’s workers, providers/ vendors, and other interested parties;
2. E-mailed inquiries shall be logged, tracked, and responded to within one (1) business
day, with a goal of first- or second-contact resolution whenever possible;
3. Information displayed on the website shall include, at a minimum, the following:
a. Toll-free telephone number and toll-free fax number;
b. Contractor’s contact information, including hours of operation, web, and e-mail
address, organized by the contractor’s separated organizational operations units—
with instructional information provided for each operational unit;
c. Program information, such as, but not limited to: eligibility and enrollment
requirements; Bill of Rights for participants, instructions for how to file a complaint/
grievance, how to manage a cash management plan, plan of care, or service plan;
how to report suspected fraud, waste, or abuse about the Program, etc.; and
d. A link to, and ability to download, pdf documents; and
B. The contractor shall obtain prior written approval from the respective SCM for all content
appearing on the website. Web content shall be written in an easily understood narrative
that conforms to a 5th grade literacy level, taking into consideration the need to incorporate
and explain certain technical or unfamiliar terms to participants. The text shall be printed
in at least a ten- (10) point font and must be easily read by varying degrees of visual
impairment or limited reading proficiency. Update the website, at a minimum, annually on
the anniversary date of the contract effective date, or as directed by an SCM.
3.4.6 COORDINATION OF SUPPORT SERVICES
The contractor shall coordinate the activities in an effective and timely manner, and proactively
take the lead in communicating the role and responsibilities of its VF/ EA FMS and FCS functions,
with the participant’s case managers and care coordinators, when necessary.
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3.4.7 ADDITIONAL SUPPORT SERVICES
The contractor shall provide employment-related services to participants and their directly hired
workers. These activities include, but may not be limited to, the following:
A. Produce and distribute letters confirming employment;
B. Assist with self-hire (i.e., directly hired workers’) disability, unemployment, and worker’s
compensation claims;
C. Assist with employment and mortgage application verifications;
D. Communicate on behalf of participants with the I.R.S. and the NJ Department of Labor and
Workforce Development and the NJ Department of theTreasury, Division of Taxation; and
E. The contractor may be required to perform additional services, similar to those described
in RFP Section 3.4.7 (A through D), at the request of the SCMs.
3.4.8 PROJECT MATERIALS
The contractor shall develop, print, compile, and deliver all materials related to manuals,
handbooks, training materials, and other publications, as specified in this RFP, throughout the
term of this contract.
3.4.8.1 POLICIES AND PROCEDURE MANUAL
A. The contractor shall develop and maintain a Policies and Procedures Manual (the P&P
Manual) specific to New Jersey and its participant-directed service programs, describing
the contractor’s fulfillment of all VF/ EA FMS and FCS requirements covered under the
contract resulting from this RFP;
B. The contractor shall review a copy of the existing P&P Manual(s), which will be provided to
the contactor by the respective SCMs at the Project Launch meeting. Upon the
contractor’s completion of their review of the P&P Manual(s), the contractor must submit a
preliminary, revised, consolidated P&P Manual to the SCMs within thirty (30) calendar
days of the contract effective date;
C. The contractor shall provide a process for, and include in the P&P Manual, the procedures
for when a participant-directed goods and services provider is determined to be an
independent contractor (the contractor shall not be required to create a process for DOAS
participants’ independent contractors, which are handled directly by DOAS);
D. The contractor shall provide diagrams of each major P&P process, and update the
diagrams annually on the anniversary date of the contract effective date;
E. The contractor shall provide workflow visuals of each major P&P process and subtask,
and update the workflow visuals annually on the anniversary date of the contract effective
date;
F. The respective SCM will review their respective sections of the P&P Manual and may
return it to the contractor(s) if modification is necessary. The contractor(s) shall submit a
revised P&P Manual within five (5) business days of any disapproval or need for
modification; and
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G. The contractor must review and update the P&P Manual as designated by the SCMs when
needed, and at least annually within fifteen (15) days of the anniversary date of the
contract effective date, and any updates must be reviewed and approved by the SCMs
prior to publication and release. The contractor must publish and release updates to the
P&P Manual within ten (10) business days of receiving approval from the SCMs;
H. If it is the intention of the contractor to use subcontractors, the contractor shall include a
description of all tasks that will be performed by any subcontractor(s). The contractor
must have internal controls documented in the P&P Manual to monitor the performance of
all tasks to be performed by the subcontractor(s); and
I.
The contractor shall provide, and maintain real-time availability to the State, an up-to-date,
online electronic copy of the Manual.
3.4.8.2 HANDBOOK FOR PARTICIPANTS
A. The contractor shall collaborate with the SCMs to develop and maintain throughout the
contract term a Participant/ Authorized Representative-Employer Handbook (the
Handbook) for all participants;
B. The contractor shall update this Handbook as designated by an SCM when needed, and
at least annually within fifteen (15) days of the the anniversary date of the contract
effective date. The contractor must publish and release updates to the Handbook within
ten (10) business days of receiving approval from the SCMs;
C. The Handbook and all updates must be reviewed and approved by the SCMs before
implementation and distribution;
D. The contractor may be required, at the request of an SCM, to make the Handbook
available in languages other than English and Spanish;
J. The contractor shall review a copy of the existing Handbook, which will be provided to the
contractor by the SCMs at the Project Launch meeting. Upon completion of the
contractor’s review of the Handbook, the contractor must submit a preliminary, revised
Handbook to the SCMs within thirty (30) calendar days of the contract effective date;
K. The respective SCM will review their respective sections of the Handbook and may return
it to the contractor if modification is necessary. The contractor shall submit a revised
Handbook within five (5) business days of any disapproval or need for modification;
L. The Handbook shall contain the following information, at a minimum:
1. The contractor's operations and its roles and responsibilities;
2. The participant’s Enrollment Packet (e.g., NJ-Registration, I.R.S. SS-4 Form, I.R.S.
2678 Form; I.R.S. 8821 Form; Worker’s Compensation Insurance application;
Introductory Letter; and instructions and sample forms, with detail instructing the full
completion of each form, etc.);
3. How participants recruit workers and the hiring process;
4. How participants manage and discharge workers;
5. The process for engaging service providers and vendors that provide individualdirected goods and services;
6. The MCO’s role and responsibility under participant direction, if applicable;
7. Appeals and grievances policies and procedures; and
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8. Troubleshooting for common problems, which may potentially hinder the participant
from successfully utilizing the program; and
M. The contractor shall provide, and maintain real-time availability to the State and the public,
an up-to-date online electronic copy of the Handbook, and maintain readily available hard
copy(ies) for the contractor to mail postage-paid or hand-deliver to participants, following
the specific instructions given in a participant’s request, within five (5) business days of the
contractor’s receipt of each request. Currently, about 1,500 DOAS participants receive a
new hard copy Handbook each January; and DDD and DDS participants mostly download
an online, electronic copy.
3.5 QUALITY MANAGEMENT REQUIREMENTS
A. The contractor shall provide and maintain a quality assurance monitoring process, specific
to FMS services and FCS services, which monitors the contractor’s performance in
completing the required tasks and procedures as specified in this RFP, including, at a
minimum, the response times and accuracy for performing customer services, resolving
complaints, and processing payments;
B. The monitoring process shall be memorialized in a written Quality Management Plan (QM
Plan), subject to the SCMs’ approval prior to the contractor employing the monitoring
process;
C. Within fifteen (15) calendar days of the contract effective date, the contractor shall deliver
to the SCMs a written QM Plan detailing the contractor’s quality assurance monitoring
process, and the contractor’s QM Plan shall describe the contractor’s method of operation
for, at a minimum, the following tasks:
1. Quality measures to be used by the contractor to assure quality in its operations;
2. Quality-related requirements, as outlined in the Medicaid State Plan (described further
in RFP Section 3.5.1);
3. Compliance with quality policies, as instructed by the SCM (described further in RFP
Section 3.5.2);
4. Policies and procedures for Grievances and Appeals (described further in RFP Section
3.5.4); and
D. The SCMs must approve the QM Plan prior to its initial use, and annually thereafter on the
anniversary date of the contract effective date;
E. The contractor shall prepare reports that summarize the quality assurance monitoring
activities, and the statuses of performance monitoring metrics, prepared and delivered to
the SCMs at least every six (6) months of the contract term;
F. The contractor shall conduct, at a minimum, quarterly quality assurance monitoring/ quality
improvement teleconference calls, as scheduled by the SCMs. Teleconference calls may
be needed more frequently than quarterly, at the discretion of an SCM. Attendees
required from the contractor must include the managing staff for both FMS and FCS. The
State’s attendees may include SCMs, operational staff, participants/ authorized
representatives, MCO staff, and other interested stakeholders, as designated by the
SCMs; and
G. The contractor shall respond to corrective action plans (described further in RFP Section
3.5.3); and
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H. The contractor shall disseminate an annual Participant/ Authorized RepresentativeEmployer Satisfaction Survey (described further in RFP Section 3.5.2.2); and
I.
The contractor shall develop a process for evaluating the effectiveness of the participant
Orientation and skills training sessions (please refer to RFP Section 3.7.1), and include the
use of an evaluation form.
3.5.1 MEDICAID STATE PLAN COMPLIANCE
New Jersey’s Medicaid State Plan contains many quality-related requirements. The contractor
shall work with the respective SCM to develop a compliance plan for these requirements that
meets with the SCM’s prior approval before implementation.
3.5.1.1 MEDICAID MLTSS CONTRACT REQUIREMENTS
The contractor should refer to Article IX of the Medicaid Managed Care Contract for more
information on MLTSS quality monitoring requirements.
3.5.2 QUALITY POLICIES COMPLIANCE
The contractor shall comply with policies on Medicaid Fraud, Waste, and Abuse, including, but not
limited to, Section 6032 policies. Further information on these policies is available at:
http://www.cms.gov/Regulations-and-Guidance/Legislation/DeficitReductionAct/index.html.
3.5.2.1 PROCESSING, PAYING, AND TRACKING PAYMENTS
The contractor shall, at a minimum:
A. Pay 100 percent (100%) of invoices for participant-directed expenses within thirty (30)
calendar days of receipt of the invoice statement. Report to the participant any delay in
processing an invoice. In the event invoice payment does not occur as stated, the
contractor may be subject to a Corrective Action Plan as set forth in Section 3.5.3 of the
RFP;
B. Verify and process all invoices in accordance with the participant’s budget, and monitor
expenditures against the participant’s budget;
C. Maintain the appropriate payment-related documentation in the contractor's provider/
vendor file;
D. Process payments returned to the contractor as undeliverable in accordance with the NJ
Department of the Treasury’s Unclaimed Property requirements;
E. Form SS-8. Distribute I.R.S. Form SS-8, Determination of Worker Status for Purpose of
Federal Employment Taxes and Income Tax Withholding, when there is a question of
whether a provider or vendor should be categorized as an independent contractor;
F. Form W-9. Distribute, collect, and process I.R.S. Form W-9, Request for Taxpayer
Identification and Certification, when an individual-directed goods and services provider or
vendor is determined to be an independent contractor;
G. When a participant-directed goods and services provider or vendor is determined to be an
independent contractor, the contractor shall ensure the following:
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1. That each applicable provider or vendor is bonded and possesses a New Jersey
Business Registration Certificate;
2. Form 1099-Misc. Process, file, and distribute an I.R.S. Form 1099-Misc, Miscellaneous
Income, to each applicable provider or vendor that is paid $600 or more in a calendar
tax year, and maintain a copy of the I.R.S. Form 1099-Misc in the applicable provider’s
or vendor’s file;
3. Form 1096. File an I.R.S. Form 1096, Annual Summary and Transmittal of U.S.
Information Returns, as applicable. Maintain a copy of the IRS Form 1096 in the
Participant/ Authorized Representative-Employer’s file. An I.R.S. Form 1096 does not
have to be filed, when an I.R.S. Form 1099-Misc is filed electronically.
3.5.2.2 ANNUAL SATISFACTION SURVEY
The contractor shall, at a minimum:
A. Disseminate via U.S. postal mailing or by providing survey participants web-based access
to the survey, an annual Participant/ Authorized Representative-Employer Satisfaction
Survey, to be provided by the respective SCM, using a randomized statistical sampling
methodology, to at least twenty (20) percent of participants in each respective Program (a
sample survey will be provided to the contractor by the respective SCM at the Project
Launch meeting); and
B. The contractor shall collect, analyze, and summarize the data in accordance with the
SCMs’ requirements. The survey shall be distributed in formats that accommodate the
needs of all participants, such as individuals who are non-verbal or may not be able to
respond to a mailed survey. Based on the results of the annual Participant/ Authorized
Representative-Employer Satisfaction Survey, the contractor may be notified by an SCM
to prepare a corrective action plan to address issues that don’t meet a 95 percent (95%)
satisfaction rate. The corrective action plan process is described further in RFP Section
3.5.3.
3.5.3 CORRECTIVE ACTION PLAN (CAP)
A. In the event an SCM identifies a violation of the contract, or other noncompliance with the
contract, the SCM will notify the contractor of the occurrence in writing. The SCM will
require the contractor to submit a corrective action plan (CAP), particular to the issue,
within a specified time frame, to be determined by the SCM. The CAP shall provide an
opportunity for the contractor to resolve the deficiency(ies) without the SCM invoking more
serious remedies, such as, but not limited to, contract cancellation;
B. The SCM will provide the contractor with a written time frame for corrections to be made.
The SCM may modify the CAP and require changes or a complete rewrite of the CAP and
will provide the contractor with a revised time frame for corrections;
C. The contractor shall respond as follows:
1. Within the specified time frame, provide a CAP to the SCM;
2. The CAP shall be a written plan with a specific time frame for the resolution of the
deficiencies; and
3. Implement the CAP only after it has been reviewed and approved by the SCM; and
D. If the contractor fails to meet the standards established in the CAP within the agreed-upon
time frame stated in the CAP, the contractor’s retainage shall not be released until the
38
condition has been remedied and communicated to the contractor in writing as satisfactory
by the SCM.
3.5.4 GRIEVANCES AND APPEALS
A. The contractor shall provide and maintain a Grievances and Appeals procedure for the
receipt, and prompt resolution, of all complaints that escalate to a grievance, with appeal
rights provided, for complaints about payments and employee functions (e.g., internal
settlement of wage and hour discrepancies, I.R.S. issues, etc.) in accordance with State
and federal laws.
B. The Grievances and Appeals procedure shall include, but is not limited to, the following:
1. One hundred percent (100%) of the Grievances and Appeals must be recorded;
2. Implementation of a Grievance and Appeals Quality Assurance (QA) committee to
include, at a minimum, a participant/ authorized representative. The committee shall
meet in person, or via teleconference, at a minimum quarterly, to discuss the provision
of FMS and FCS, and to evaluate any Grievances or Appeals filed, or to review
complaints and/ or feedback provided to the committee from participants/ authorized
representatives or other interested parties (i.e., MCO representatives, as applicable);
and
3. The tracking and response to Grievances and Appeals shall follow the same
performance procedures outlined in RFP Section 3.4 Customer Service.
3.6 PROJECT OPERATIONS
3.6.1 CONTRACTOR’S OFFICE LOCATIONS
A. The contractor shall provide, equip, maintain, staff, and manage three (3) physical offices,
dedicated to performing all tasks required of the contractor as set forth in this RFP.
The offices must be located in three (3) regions of the State of New Jersey:
1. Northern Region serving Bergen, Essex, Hudson, Morris, Passaic, Sussex and
Warren Counties;
2. Central Region serving Hunterdon, Middlesex, Monmouth, Ocean, Somerset, and
Union Counties; and
3. Southern Region serving Atlantic, Burlington, Camden, Cape May, Cumberland,
Gloucester, Mercer, and Salem Counties; and
B. The offices must be able to accommodate walk-in clients. The offices must be physically
accessible and in proximity [i.e., a five (5) minute walking distance] to public
transportation. Offices must be staffed and open to the public from 8:30 a.m. to 5:00 p.m.
Eastern Time (ET), Monday through Friday, excluding holidays to be determined by the
SCMs at the Project Launch meeting. Each office must have a password-protected
voicemail, available 24 hours per day seven (7) days each week, as specified in RFP
Section 3.4.4 Voice Messaging.
3.6.2 PROJECT STAFFING
A. The contractor shall provide personnel for the project, who are knowledgeable and
experienced in providing VF/ EA FMS and and/ or FCS, as applicable to the role; including
39
VF/ EA FMS and FCS services under a managed care delivery system. These individuals
should also be experienced in assisting older adults and individuals with disabilities and
chronic conditions. The key personnel shall include, at a minimum, an Account Manager
(AM), and the following individuals are highly preferred: a Project Manager for VF/ EA
FMS (PM-FMS), a Project Manager for financial counseling services (PM-FCS), an
Enrollment Services Manager (ESM), a Payroll and Invoice Manager (PIM), a Lead
Counseling Manager (LCM), and a Customer Service Manager/ Call Center Manager
(CSM), at a minimum, who shall be designated as key personnel for VF/ EA FMS and/ or
for FCS; and
B. The AM shall submit a written request to the SCMs for prior approval of proposed key
personnel at the Project Launch meeting, and throughout the contract term; the SCMs
require forty-five (45) days’ advance notice to approve any proposed change in key
personnel. The contractor shall provide the resume of the AM, whenever an AM is being
proposed for consideration throughout the contract term. Section 4.4.4.3 of the RFP
provides the requirements for the format of resumes. Changes in key personnel shall be
reported to the SCMs immediately. No key personnel change may be made without prior,
written approval from the SCMs.
3.6.2.1 ACCOUNT MANAGER (AM) POSITION
A. The position of the AM shall be filled as follows:
Key Personnel Title
Account Manager
(AM)
Requirements

Full-time;

Dedicated
solely to this
project; and

Person shall
be located in
the
contractor’s
NJ office.
Qualifications
Role
Five (5) to seven (7)
years’ senior-level
accounting
experience preferred
in multi-level
accounts of similar
size and scope to this
RFP; with customer
service, financial
management, and
quality management
experience preferred;
experience in health
service delivery
system preferred;
and, including a
minimum of three (3)
years’ experience
managing public
funds. The individual
should have a
Bachelor’s degree in
a relevant and related
field; an individual
with a Master’s
degree is preferred.
Direct contact person
to the SCMs, and
MCOs as
appropriate.
Table 3.6.2.1
B. Responsibilities of the AM include, but are not limited to, the following:
40
1. Be the direct contact person to the SCMs and MCOs, as applicable;
2. Revise the contractor’s processes and procedures, and the assignment of additional
resources, as needed, to maximize the efficiency and effectiveness of services required
by this RFP;
3. Resolve problems;
4. Oversee all fiscal and system operations of the program;
5. Provide trained contract employees;
6. Maintain accountability for all contract employees; and
7. Provide and monitor the contractor’s quality procedures, including audit or financial
reporting requirements set forth by the SCM and/ or MCO, as applicable.
3.6.2.2 PROJECT MANAGER-FMS (PM-FMS) POSITION
A. The position of the PM-FMS should be filled as follows:
Key Personnel
Title
Project Manager-FMS
(PM-FMS)
Requirements

Full-time;

Dedicated
solely to this
project; and

Person
should be
located in the
contractor’s
NJ office.
Qualifications
Minimum three (3) to
five (5) years’
experience leading
and effectively
managing VF/ EA
FMS operations. The
individual should
have a Bachelor’s
degree in a relevant
and related field, and
should have two (2)
years’ experience
managing the
provision of VF/ EA
FMS participants’
budgets and VF/ EA
FMS staff.
Role
Reports to the AM
and participates in
Project Launch and
oversight activities,
as needed.
Table 3.6.2.2
B. Responsibilities of the PM-FMS include, but are not limited to, the following:
1. Manage the contractor’s day-to-day operations to implement and manage the VF/ EA
FMS tasks of the contract.
41
3.6.2.3 PROJECT MANAGER-FCS (PM-FCS) POSITION
A. The position of the PM-FCS should be filled as follows:
Key Personnel
Title
Project Manager-FCS
(PM-FCS)
Requirements

Full-time;

Dedicated
solely to this
project; and

Person
should be
located in the
contractor’s
NJ office.
Qualifications
Minimum three (3) to
five (5) years’
experience leading
and effectively
managing Financial
Counseling
operations. The
individual should
have a Bachelor’s
degree in a relevant
and related field, and
should have two (2)
years’ experience
managing the
provision of
counseling services
and counseling
services staff.
Role
Reports to the AM
and participates in
Project Launch and
as needed.
Table 3.6.2.3
B. Responsibilities of the PM-FCS include, but are not limited to, the following:
1. Manage the contractor’s day-to-day operations to implement and manage the overall
Financial Counseling tasks of the contract.
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3.6.2.4 ENROLLMENT SERVICES MANAGER (ESM) POSITION
A. The position of the ESM should be filled as follows:
Key Personnel
Title
Enrollment Services
Manager (ESM)
Requirements

Full-time;

Dedicated
solely to this
project; and

Person
should be
located in the
contractor’s
NJ office.
Qualifications
Minimum two (2)
years’ experience in
project(s) of similar
size and scope: (1)
leading and
managing the
enrollment and
disenrollment of
individuals and their
authorized
representatives; (2)
developing employer
enrollment and
worker employer/
service provider and
vendor engagement
packets; and (3)
implementing the
provision of common
law employer
orientation and skills
training for
participants and
representatives; an
individual with a
Bachelor’s degree is
preferred.
Role
Reports to the AM
and contributes to
Project Launch and
as needed.
Table 3.6.2.4
B. Responsibilities of the ESM include, but are not limited to, the following:
1. Managing the contractor’s day-to-day operations to implement and manage the
enrollment services tasks of the contract; and
2. Under MLTSS, the ESM is required to verify and monitor members MLTSS eligibility
and MCO enrollment status.
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3.6.2.5 PAYROLL AND INVOICE MANAGER (PIM) POSITION
A. The position of the PIM should be filled as follows:
Key Personnel
Title
Payroll and Invoice
Manager (PIM)
Requirements

Full-time;

Dedicated
solely to this
project; and

Person
should be
located in the
contractor’s
NJ office.
Qualifications
Minimum two (2)
project(s) of similar
size and scope: (1)
processing workers’
timesheets and
preparing and issuing
worker’s payroll; (2)
acting as a billing
agent, processing
and paying invoices
to service providers
and participantdirected goods and
services providers;
and (3) performing
related activities,
including developing
and maintaining a
separate bank
account, files and
records, and
preparing and issuing
reports to participants
and government
agencies; an
individual with a
preferred.
Role
Reports to the AM
and contributes to
Project Launch and
as needed.
Table 3.6.2.5
B. Responsibilities of the PIM include, but are not limited to, the following:
1. Managing the contractor’s day-to-day operations to implement and manage the Payroll
and Invoice Payment Services tasks of the contract;
2. Ensure proper procedures and correct billing codes are used to submit electronic
claims to MCOs for MLTSS members; and
3. Implement and monitor processes, ensuring timely submission and processing of
workers’ timesheets and payroll.
44
3.6.2.6 LEAD COUNSELING MANAGER (LCM) POSITION
A. The position of the LCM should be filled as follows:
Key Personnel
Title
Lead Counseling
Manager (LCM)
Requirements

Full-time;

Dedicated
solely to this
project; and

Person
should be
located in the
contractor’s
NJ office.
Qualifications
Minimum two (2)
counseling services,
with experience in the
administration of
public assistance
programs and
possessing functional
knowledge of
participant-directed
programs; an
individual with a
Bachelor’s degree in
a relevant or related
field is preferred.
Role
Reports to the AM
and participates in
Project Launch and
as needed.
Table 3.6.2.6
B. Responsibilities of the LCM include, but are not limited to, the following:
1. Supervise the contractor’s day-to-day operations to implement and manage the
financial counseling tasks of the contract.
3.6.2.7 CUSTOMER SERVICE MANAGER (CSM) POSITION
A. The position of the CSM should be filled as follows:
Key Personnel
Title
Customer Service
Manager (CSM)
Requirements

Full-time;

Dedicated
solely to this
project; and

Person
should be
located in the
contractor’s
NJ office.
Qualifications
Minimum two years’
experience that is
similar in size and
scope to this RFP’s
operation in (1)
customer service/ call
center operations;
and (2) working with
individuals with
disabilities in a social
services environment;
an individual with a
preferred.
Table 3.6.2.7
45
Role
Reports to the AM
and participates in
Project Launch and
as needed.
B. Responsibilities of the CSM include, but are not limited to, the following:
1. Manage the contractor’s day-to-day operations to implement and manage the
Customer Service/ Call Center tasks of the contract.
3.6.2.8 PROJECT STAFF-GENERAL REQUIREMENTS FOR TRAINING
A. The contractor shall conduct Project Staff training within fifteen (15) days of a project staff
member’s hire. Each individual must sign acknowledgement of the training given to him/
her. The SCMs may review a random selection of training sign-off sheets to confirm the
contractor’s compliance with the training;
B. The contractor shall develop a written Training Plan within thirty (30) calendar days of the
contract effective date, and the Training Plan must include at a minimum:
1.
2.
3.
4.
5.
Intended curricula for the training of all personnel;
Duration of the training, including the number and frequency of training sessions;
Number and competency level of the instructor(s);
Testing materials and criteria for how personnel pass training; and
A developed process for assessing the performance of VF/ EA FMS and FCS
personnel, including steps for progressive discipline and discharge; and
C. Training for Project Staff shall include, but not be limited to, caring for the elderly and
disabled population, identifying and reporting abuse and neglect, reporting critical
incidents, and submitting required documentation and withholdings.
3.6.2.8.1 PROJECT STAFF-CASH AND COUNSELING SPECIFIC REQUIREMENTS
A. All personnel who are hired by the contractor to service participants in any financial cash
and counseling Program shall complete the following training, which is specific to providing
financial cash and counseling services:
1. Participate in an SCM-provided mandatory training program, which includes one full
day (eight hours) of classroom style training;
2. Participate in a series of SCM-approved training modules, which comprise, at a
minimum, shadowing and reverse shadowing of trained consultants, and which
requires a post-test after the initial training; and
3. Counselors will receive a program overview from the SCM, which includes the State’s
philosophy for self-directed services, and training related to the completion of all
program forms, including the participant’s budget plan; and
B. All staff, including subcontracted staff, who are hired by the contractor must possess the
knowledge, skills, and abilities (KSAs) to provide financial cash and counseling services to
participants. The KSAs must demonstrate the person’s experience providing the following
services:
1. Orienting and training financial cash and counseling participants and their
representatives, as appropriate, to use financial management and cash and
counseling support services, the roles and responsibilities of a common law employer,
and how to effectively use the participant’s budget;
2. Assisting participants in preparing their initial CMP;
3. Conducting quarterly home visits with financial cash and counseling participants; and
4. Maintaining contact with cash and counseling participants.
46
C. The contractor shall hire a staff of consultants (i.e., fiscal counselors) to be assigned to
work with participants. Each full-time consultant shall have a maximum caseload of 110
participants. Each part-time consultant shall have a maximum caseload of 60 participants.
Prior permission from the SCM is required to exceed the numbers as set forth in this
requirement. These requirements (RFP Section 3.6.2.8.1.C) shall also apply to the VDHCBS Program. The contractor shall also hire trained fiscal counselors for the VD-HCBS
Program. Please refer to RFP Section 3.20.19 for VD-HCBS specific tasks attributed to
the VD-HCBS counselors.
3.6.3 OBTAIN AUTHORIZATIONS/ REGISTRATIONS
The contractor shall comply with all State and federal tax and insurance requirements.
3.6.3.1 FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN) FOR THE CONTRACTOR
During the contract implementation period, the contractor shall establish a new FEIN for itself
during the contract implementation period for the sole purpose of using the new FEIN when acting
as fiscal agent for the program participants. The FEIN is necessary for reporting taxes.
3.6.3.2 CONTRACTOR’S AUTHORIZATIONS
A. The contractor shall have federal authority to act as a VF/ EA FMS entity for Participant/
Authorized Representative-Employers for the sole purpose of acting as fiscal agent for
program participants.1
To receive federal authority, the contractor must complete the following tasks before, or
during, the contract implementation period:
1. Form SS-4. Complete I.R.S. Form SS-4 and associated I.R.S. correspondence;
2. Form 2678. Complete an agent application (I.R.S. Form 2678);
3. Form 1997C. Obtain written agent authorization from the I.R.S. to be the agent for
each Participant/ Authorized Representative-Employer it represents through the
receipt of an I.R.S. LTR 1997C, Notice of Appointment, for each Participant/
Authorized Representative-Employer;
4. Form 8821. Execute and submit an I.R.S. Form 8821, Tax Information Authorization,
with each Participant/ Authorized Representative-Employer it represents as agent as
specified in the form’s instructions. One or more persons from the contractor shall be
named and reported as appointee(s) on the form. Renewal and revocation of the
I.R.S. Form 8821 shall include, but are not limited to, the contractor’s completion of the
following:
a. Maintain a copy of any executed I.R.S. Form 8821;
b. Renew each Participant/ Authorized Representative-Employer’s I.R.S. Form 8821
on a periodic basis, as specified in the form’s instructions; and at minimum,
annually on the anniversary of the contract effective date; and
1
The NJ Division of Revenue and Enterprise Services and the NJ Department of Labor and Workforce Development
do not require a contractor providing VF/ EA FMS to obtain a power of attorney from each Participant/ Authorized
Representative-Employer in order to file and pay State income tax withholding, unemployment, temporary disability
or family leave insurance taxes on the employer and employee’s behalf.
47
B. The contractor shall maintain records and file all forms and associated correspondence
gathered through the federal authorization process within each Participant/ Authorized
Representative-Employer’s file.
3.6.3.3 PARTICIPANTS’ AUTHORIZATIONS
During the contract implementation period, the contractor shall submit an I.R.S. Form 8821, Tax
Revenue Authorization, to the I.R.S., for each participant in order to obtain authorization from the
I.R.S. to receive the participant’s confidential tax information.
3.6.3.4 FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN) FOR THE PARTICIPANT
During the contract implementation period, the contractor shall confirm an existing or establish a
new FEIN for each participant during the contract implementation period for the sole purpose of
using the new FEIN for the program participants. The contractor shall apply for and obtain an
FEIN for new participant/ authorized representative-employer it will represent as an agent. The
FEIN shall be obtained per I.R.S. guidelines applying for and obtaining an FEIN for a home care
service recipient. The FEIN is necessary for reporting taxes.
3.6.3.5 CONFIRM NJ EMPLOYER REGISTRATION
During the contract implementation period, the contractor shall review all transferred files received
from the incumbent contractor(s) and the SCM to ensure there is a valid NJ Employer Registration
for each program participant who directly hires workers.
3.6.4 CONTRACTOR’S RECORDS
A. During the contract implementation period, the contractor shall meet with the incumbent
contractor(s) as designated by the SCMs, to organize the transfer of all records, paper and
electronic, for the Programs. These records will include, but are not limited to, all historical
records related to each participant, including the name of the participant’s medical
provider, if available. The State anticipates the majority of the records to be transferred
will be electronic; however the contractor shall be responsible for making arrangements
with the SCMs for copying the paper files;
B. Throughout the contract term, the contractor shall have the following in their files to ensure
compliance with State and federal tax and insurance recordkeeping:
Maintain electronic records for each program participant and their directly hired workers;
except in the case of DDD’s participants and directly hired workers, maintain electronic
records only within the DDD web application;
1. These records include, but are not limited to, the following paper files for each program
participant:
a.
b.
c.
d.
e.
f.
Tax and payroll records;
Reports;
Withholding data;
Program participant data;
Budget Plans (i.e., Cash Management Plans); and
Workers Compensation records; and
2. These records include, but are not limited to, the following electronic files for each
program participant:
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a. Financial record files stored as accounting data files;
b. Budget plans (i.e., Cash Management Plans), stored as Excel files; and
c. MMIS transmittal records stored as Excel files.
3.6.5 ENROLL AS A MEDICAID PROVIDER
A. During the contract implementation period, the contractor shall submit an application to the
Fiscal Agent for the Medicaid MMIS to apply to become an approved Medicaid provider for
the purpose of submitting claims for services through the Medicaid fiscal agent. The SCM
will arrange for the contractor to submit the application within seven (7) business days of
the contract effective date. The application’s processing is usually completed within
approximately four (4) weeks; and
B. At the Project Launch meeting, the SCM will provide the contractor with the proper
procedure codes needed to perform MMIS billing.
3.6.6 THIRD-PARTY AGREEMENTS WITH THE STATE’S MANAGED CARE ORGANIZATIONS (MCOS)
A. During the contract implementation period, the contractor shall establish a third-party
agreement with the State’s managed care organizations (MCOs) to facilitate support of
those MCO members, who wish to self-direct the PCA and/ or the MLTSS benefits. The
MCOs’ contracts require the MCOs’ participation in third-party agreements with the
contractor, and each MCO utilizes its own proprietary agreements for setting up the
arrangement. Please refer to Exhibit Number 13 for a listing of MCO contacts;
B. The contractor is required to use an electronic claim submission platform. With prior
approval from the respective SCM, in certain circumstances, claims may be submitted for
payment using the #1500 form;
C. The contractor shall meet with and engage each MCO independently to set up an
electronic billing and payment method, including a process to calculate and claim
Administrative expenses, for the services and fees being claimed for participants enrolled
in an MCO and who elect to self-direct (Please refer to Exhibit No. 4 for the listing of
MCOs and contact information for each);
D. The contractor must obtain the SCMs’ prior approval before utilizing the billing and
payment method;
E. The contractor shall attribute funds received from the MCO, after services are rendered,
into the program participants’ accounts and the contractor's administrative account as set
forth in RFP Section 3.10 Participants’ and Contractor’s Accounts for DDS and DOAS; and
F. The SCM will provide the contractor with the proper procedure codes needed to perform
this billing at the Project Launch meeting, and will provide the contractor with all clinical
and operational information provided from and to the MCO.
3.7 MEET-AND-GREET THE PROGRAM PARTICIPANTS
A. Within sixty (60) calendar days of the contract effective date, the contractor shall have
conducted in-person meet-and-greets, or otherwise contacted by telephone, or mailed
communication to, 100 percent (100%) of the participants, identifying itself as the new
contractor, providing the contractor’s contact information (i.e., telephone number, web
address, and e-mail address) and explaining its role as the FMS and FCS contractor. The
49
contractor shall ensure its personnel speak directly with the participant, or the authorized
representative of record;
B. Further, it shall be the contractor's responsibility to:
1. Assign and introduce a consultant to each program participant and provide contact
information for the consultant;
2. Distribute for signature to each program participant an Enrollment Packet (Please refer
to Exhibit No. 5 and Section 3.8 of this RFP), which designates the contractor as the
new FMS contractor for the participant;
3. File completed form(s) with the I.R.S. for each program participant; and
4. During the contract implementation period, have at least one (1) staff member
available (please refer to RFP Section 3.4 Customer Service for customer service
requirements) to receive phone calls should participants call the contractor before the
program is formally assumed by the contractor, and the contractor’s customer service
representative shall redirect the caller to the incumbent contractor for service-related
matters; and
C. The contractor shall invoice for payment for the counseling services performed during the
contract implementation period at the hourly rate specified in the price schedule (please
refer to Section 9.1 Price Schedule/ Sheet, Price Line No. 10) for financial counseling
services.
3.7.1 PARTICIPANT ORIENTATION AND SKILLS TRAINING
The contractor shall develop an Orientation process and provide skills training to participants and
their authorized representatives in a culturally-sensitive manner, and in accordance with the
philosophy of participant direction, which supports empowering participants and their authorized
representatives by expanding their degree of choice and control over the services and supports
needed to live at home, and vesting in them decision-making and managerial authority.
3.7.1.1 ORIENTATION
A. The contractor shall develop an Orientation process that uses a standardized curriculum
and materials, to be approved by the SCM prior to use;
B. The contractor shall provide scheduled Orientation skills training with participants to
provide and review the information in the Orientation curriculum, at a frequency of at least
one Orientation meeting per year per participant; and
C. Please note: the respective SCM will supply the contractor with the following DHSnumbered forms at the Project Launch meeting. The Orientation curriculum shall include,
but not be limited to, the following:
1.
2.
3.
4.
5.
6.
7.
A description of the available contractor-provided VF/ EA FMS and FCS;
Contractor’s hours of operation;
Key contact names and contact information for the contractor;
Toll-free numbers for telephone, TTY/ TDD, and fax;
Role and responsibilities of the contractor;
Time frame and process for returning participants' and representatives' calls;
How the Participant/ Authorized Representative-Employers may interact with the
contractor’s personnel;
8. Participant’s Bill of Rights;
9. Program Consent Form;
50
10. Participant problem solving and decision making;
11. Development of and use of risk management and emergency worker back-up plans;
12. Process for resolving issues and complaints, including preparing and implementing
corrective action plans;
13. Process to identify and report abuse and neglect;
14. Description of the procedure for addressing emergencies, list of emergency contacts,
and emergency telephone numbers;
15. DHS PDS 1001, Designation of Authorized Representative Form;
16. DHS PDS 1002, Authorized Representative Screening Form;
17. DHS PDS 1003, Authorized Representative Description;
18. DHS PDS 1004, Participant/ Authorized Representative Employer Agreement;
19. DHS PDS 1005, Documentation of Worker Qualifications Form;
20. DHS PDS 1006, Worker Agreement;
21. DHS PDS 1007, Authorization for Release of Health Information Form with
instructions;
22. DHS PDS 1008, Emergency Back-up Worker Plan and Designation Form;
23. DHS PDS 1009, Notice of Worker Termination Form;
24. DHS PDS 1010, Participant Voluntary Termination Form;
25. DHS PDS 1013, Individual-directed Goods and Services Provider/ Vendor
Agreement;
26. DHS PDS 1014, Fraud Statement;
27. Process for completing and submitting the DHS PDS 1009, Notice of Worker
Termination Form to the contractor within twenty-four (24) hours of when a worker
ceases working for the participant for any reason, so that the contractor can complete
the Reason for Separation Notice from the New Jersey Department of Labor and
Workforce Development for unemployment and temporary disability insurance within
the required reporting period;
28. Participant/ Authorized Representative-Employer Enrollment Packet; Worker
Employment and Individual Goods and Services Provider Packet; Vendor
Engagement Packet; and required forms and agreements, as needed;
29. Description of who can be an authorized representative, how to determine when a
participant should have an authorized representative, and the role and responsibilities
of an authorized representative, which will be specified by each SCM at the Project
Launch meeting;
30. Role, responsibilities, and tasks of the Participant/ Authorized RepresentativeEmployer, including how to determine the participant-directed services that are
included in the participant’s Budget to ensure the appropriate services are received;
31. How to complete the documents and forms that are included in the Participant/
Authorized Representative-Employer Enrollment Packet; the Worker Employment and
Individual-directed Goods and Services Provider Packet; and Vendor Engagement
Packet;
32. Worker’s criminal background check process, as required by the Programs, or when
requested by the participant. Background checks shall be conducted in accordance
with the National Child Protection Act of 1993 (42 U.S. CODE §5119A) and the
enabling legislation for the Central Registry of Offenders against Individuals with
Developmental Disabilities (P.L. 2010 c.5). The SCMs will provide the contractor with
the criminal background check forms, and the instructions for completing the criminal
background checks at the Project Launch meeting;
33. Process for receiving and processing workers’ timesheets, including a timesheet due
date schedule, with timesheet due dates and payday dates;
34. Process for distributing workers’ payroll checks;
35. Process for selecting, use of, and payment for approved goods and services,
including the process and due date schedules for submitting an invoice and receiving
payment;
51
36. Process for brokering of participants workers’ compensation insurance policies and
payment of workers’ compensation premiums;
37. Informing workers of their right to file unemployment and workers’ compensation
insurance claims, when appropriate;
38. Recognizing and reporting critical incidents and unusual incidents reporting process;
39. Process for reviewing workplace safety, and strategies for identifying and effective
reporting of and management of workplace issues and injuries, for workers’
compensation insurance purposes; and including in the process a Site and Home
Safety Check List; and
40. Process explaining the Participant/ Authorized Representative-Employer Satisfaction
Surveys.
3.8 ESTABLISH INDIVIDUALS AS PARTICIPANTS
The contractor shall:
A. Establish an individual as a participant and their authorized representative as an
authorized representative, as set forth in this RFP;
B. Register the participant as an employer with the New Jersey Division of Revenue and
Enterprise Services for the purpose of NJ State income tax withholding, NJ State
unemployment and temporary disability insurance tax, and NJ State Family Leave Act tax,
in an accurate, complete, and timely manner as specified below:
C. Further, the contractor shall, at the minimum:
1. Receive the participant/ authorized representative information from the SCMs, begin
processing the participant/ authorized representative as a common law employer, and
assign the participant/ authorized representative to a consultant within three (3)
business days of notification from the SCM;
2. Within two (2) additional business days of the initial notification from the SCM, prepare
and distribute a hard copy Enrollment Packet, which is to be distributed to each
participant at an Orientation and skills training meeting. The contractor shall provide
the participant with additional copies of the Enrollment Packet in either paper or
electronic form, as requested by the participant with the format to be determined by the
participant, at their request;
a. The Enrollment Packet must be well organized, user friendly for the audience being
presented to, and contain an Enrollment Packet check list of all of the information
below:
i.
ii.
iii.
iv.
v.
An introductory letter introducing the contractor;
All information contained in the Orientation curriculum (please refer to RFP
Section 3.7.1 Participant Orientation and Skills Training);
A list of fees that may be charged to the participant through their Budget Plan;
Form SS-4, Application for Employer Identification Number and instructions,
semi-completed with the contractor-designated information, where applicable
(a sample form is available on the web at:
http://www.state.nj.us/humanservices/dds/home/fireprocurement.html);
Form 2678, Employer/ Payer Appointment of Agent and instructions, semicompleted with the contractor-designated information, where applicable (a
sample form is available on the web at:
http://www.state.nj.us/humanservices/dds/home/fireprocurement.html);
52
vi.
Form 8821, Tax Information Authorization and Instructions, semi-completed
with contractor-designated information, where applicable (a sample form is
available on the web at:
i. http://www.state.nj.us/humanservices/dds/home/fireprocurement.html);
vii.
Form NJ REG, Business Registration Application and instructions (available
at: http://www.state.nj.us/treasury/purchase/doingbusiness.shtml);
viii.
Form ACORD 133, NJ CRIB, NJ Workers’ Compensation Insurance Plan
Application for Designation of Insurance Company, semi-completed with
contractor-designated information, where applicable (a sample form is
available on the web at:
http://www.state.nj.us/humanservices/dds/home/fireprocurement.html); and
ix.
Self-addressed, stamped envelope;
3. Keep adequate records and file all forms within each participant’s file;
4. For DDS and DoAS participants, orient and train participants in the operation of the
program at the participant’s residence. The contractor’s consultants shall explain all
aspects of the program including, but not limited to, cash grant management, the
provision of information relating to the role of the contractor, and training that includes
discussions on the management of the Budget Plan. Information about the contractor’s
required Budget Plan training, creation, and implementation will be provided by the
SCM as part of the Consultant Training Sessions;
5. Assist the participant with completing and submitting the required information, and all of
the forms that are included in the Enrollment Packet, as needed;
6. Collect and process documents and forms included in the Enrollment Packet, with the
appropriate federal and New Jersey agencies;
7. Notify participants of missing or incomplete information from the Enrollment Packet and
obtain that information in an accurate and timely manner; and
8. Note: Should the New Jersey Division of Revenue and Enterprise Services provide
alternative procedures on filing the NJ-REG to the contractor, the contractor must
implement accordingly within thirty (30) days of notice from the SCM.
3.9 BUDGET PLANS
A. The contractor shall establish the following for each program participant:
1. Obtain from the SCM, or MCO, and have in its file, the current budget plan (e.g., Cash
Management Plan and Plan of Care) that details how the participant's cash grant is to
be expended;
2. Review each participant's file, so that any installment payments for purchases are paid
by the contractor in conformance with the installment payment schedule in the file,
without incurring over- or under-payments;
3. Develop a method to provide cash to a participant, should the budget plan indicate that
the participant is to be given cash as part of the grant;
4. Identify which budget plans have been revised during the month prior to the contractor
assuming the program, so that the new plans are put into effect on the first day the
contractor assumes responsibility for the contract resulting from this RFP; and
5. For historical purposes, maintain a file of all the budget plans filed by each participant,
starting with each participant's initial budget plan and continuing through the record of
budget plan revisions since the participant entered the program. The contractor will
receive the incumbent contractor’s historical files from the SCM; and
Further, the contractor shall:
53
B. Receive from the appropriate SCM or MCO, if applicable, and maintain participants’ initial
and updated budgets; and
C. Allow participants/ authorized representatives to adjust budget limitations, with the SCM’s
approval.
3.9.1 INITIAL DEVELOPMENT OF BUDGET PLANS FOR DDS AND DOAS PROGRAMS
A. The contractor shall assist participants with completing their budget plans. The
contractor‘s consultants shall meet in person with the participant to develop the initial
budget plan or to revise the budget plan as needed. Consultants must be available to
answer the participant’s questions regarding the budget plan;
B. NOTE: In providing consultation services to participants, it is understood that neither the
contractor, nor the contractor-provided counselors it utilizes, will be accountable or
responsible for the decisions made by the participants when completing the budget plan,
or when spending the grant;
C. Following the development of the initial budget plan, the contractor shall allow a participant
to revise the budget plan as often as they wish. Revisions will be approved and made
effective by the Using Agency, via a process to be predetermined and approved by the
respective SCMs prior to use, on the first (1st) day of each month, based on the Using
Agency’s designated deadline for submission to ensure that the revision takes effect on
the first day of the month following the revision. Participants may need the assistance of a
contractor-provided consultant to revise the budget plan;
D. The expenditure for each succeeding month will be governed by the initial, or the most
recent, approved budget plan. The budget plan must be completed by the contractor
before funds may be expended;
E. The contractor's consultants, or contractor staff, must be available as needed, or when
requested by participants, to answer program participant questions regarding the budget
plan;
F. The contractor shall invoice for the initial orientation and skills training that are provided to
DDS and DOAS Program’s participants, and for assisting these participants with
completing the initial, or revised, budget plan as set forth in RFP Section 9.0 Price Line 09;
and
G. In the case of MCO enrollees, the third-party agreement between the MCOs and the
contractor shall dictate the reimbursement of the initial orientation, skills training and cash
management plan development.
3.10 PARTICIPANTS’ AND CONTRACTOR’S ACCOUNTS FOR DDS AND DOAS
A. For non-MCO enrollees, the contractor shall establish individual participant accounts for
each participant and an account for itself, for the purpose of receiving each participant's
cash grant electronically from the Medicaid fiscal agent, excluding MCO enrollees, as
applicable;
B. For MCO members, the contractor shall establish individual enrollee accounts, as well as,
devise a method for tracking and monitoring on an individual basis the cash grant amount
in comparison to the authorized Plan of Care on an individual basis;
54
C. The SCMs will provide the contractor with a separate statement that specifies the total
amount of all cash grants for all participants not enrolled in an MCO for the upcoming
month. The contractor shall portion the money so that ten percent (10%) of the grant
money is set aside for administrative expenses, which the contractor shall place in an
administrative account. The contractor shall disburse the remaining ninety percent (90%)
of each program participant's grant into each program participant's account;
D. The process for calculating and claiming monthly Administrative expenses for MCO
members shall be determined through consultation with DMAHS, DDS, and the MCOs and
detailed in the third party agreement(s), which is specified in Section 3.6.6 of this RFP;
E. The contractor shall ensure 100 percent (100%) of the funds withdrawn from the account
are restricted to approved purposes only;
F. A physical bank account is not required for each participant, but the contractor must
maintain a separate and distinct sub-account for each participant;
G. The contractor shall submit claims throughout the contract period, as applicable, to either
the Fiscal Agent or an MCO, for the amount of the grant(s), as approved by the SCM.
SCMs may request a review of the files; and, if a discrepancy is noted, the contractor shall
respond to the SCM’s inquiry within fifteen (15) business days of receiving a written
request from the SCM;
H. For MCO members, after services are rendered, the contractor shall submit electronic
claim (837P) to the MCO and will be paid by the MCO. The contractor shall submit claims
to the MCO in the same manner to cover administrative costs associated with operating
the program; and
I.
Throughout the contract term, the contractor shall implement a process for reimbursing the
State for any funds remaining in the separate bank account for managing participantdirected funds at the end of each State fiscal year, which ends June 30.
3.10.1 FUNDS MANAGEMENT AND ACCOUNTING
A. Receive, disburse, and track Medicaid and State funds in an accurate and timely manner
and in accordance with federal and State requirements. DHS may, at any time and at its
discretion, audit the contractor’s administration and use of public funds, including the
management of the separate administrative bank account;
B. Establish and maintain an accounting and information system for receiving and disbursing
Medicaid and other federal funds and for tracking all transactions and balances;
C. Establish a separate administrative bank account into which all payments received from
the Using Agencies must be immediately deposited, and submit to the SCMs written
evidence that the bank has established said account, as set forth below:
1. Complete all forms as specified by the Using Agencies and the bank to establish
electronic fund transfers from DHS or MCO, as applicable, to the bank account;
2. Provide DHS with written acknowledgement from the bank that the funds are being
held in an interest-bearing account. The State of New Jersey shall have the right and
title to any and all interest earned, net of bank charges, in said bank account; and
55
3. Maintain an account, to the extent legally permissible, in a manner that prevents
creditors of the contractor from, in any way, encumbering or acquiring funds in the
separate bank account;
D. Absorb all bank charges, including monthly fees and stop payment fees that were initiated
by the contractor, to not reduce the balance of the separate administrative bank account.
Should the participant or his/ her authorized representative request a stop payment, the
fee must be charged to the participant’s account;
E. Prevent the co-mingling of other funds into the separate administrative bank account;
F. Funds deposited into the separate administrative bank account shall not be used by the
contractor, or by any other agent or third-party, to satisfy, temporarily or otherwise, any
contractor liability, or for any other purpose, except as provided under the contract
resulting from this RFP with prior approval from the SCMs; and
G. Withdraw from the separate administrative bank account all payments made by the Using
Agencies for administrative fees within seven (7) business days of receipt.
3.10.2 TRANSFER REMAINING ACCOUNT BALANCES
During the contract implementation period, the contractor shall transfer the remaining account
balances of the participants, and of the administrative account, from the incumbent contractors’
accounts to the new contractor's accounts, coordinating the process with the incumbent
contractors, and, obtaining prior approval for the process from the SCMs.
3.10.3 CO-PAYMENT ACCOUNTING
A. During the contract implementation period, the contractor shall establish a separate
account for the collection of cost share co-payments for the JACC Program; and
B. The contractor must develop and implement a tracking system for billing and collecting
these cost share co-payments.
3.11 CONTRACTOR’S CASH FLOW
A. The contractor shall have funds available to pay participants’ workers and providers/
vendors. The contractor shall be required to make payment for participants’ goods and
services, and directly hired workers’ payroll. Depending on the payment schedule and the
timing of the debits and credits into and from the contractor’s and participants’ cash
accounts, the contractor must be fiscally prepared to accept responsibility for making the
payments, while awaiting receipt of the reimbursements; and
B. To ensure the contractor has the financial capability to meet the above-mentioned
requirements, the contractor shall establish a $3 million line of credit, for this contract, and
provide the SCM with an original document from the entity providing the line of credit to
the contractor, before the contract’s effective date, and annually thereafter on the
anniversary date of the contract effective date, or within five (5) business days, if
requested by an SCM. The contractor shall maintain the above-mentioned line of credit
throughout the contract term. The State reserves the right to periodically review and
adjust the line of credit requirements based on the enrollment and operating costs of the
program. The SCMs will provide the contractor with sixty (60) days advance notice if the
State requires a change to this requirement;
56
C. Further, the contractor shall establish a $3 million cash reserve for this contract, and
provide the SCM with an original document from the entity holding the cash reserve,
before the contract’s effective date, and annually thereafter on the anniversary date of the
contract effective date, or within five (5) business days, if requested by an SCM. The
contractor shall maintain the above-mentioned cash reserve throughout the contract term.
The State reserves the right to periodically review and adjust the cash reserve
requirements based on the enrollment and operating costs of the program. The SCMs will
provide the contractor with sixty (60) days advance notice if the State requires a change to
this requirement
3.12 ESTABLISH PAYROLL AND WITHHOLDING RECORDS
A. The contractor shall provide and maintain payroll and withholding records for all
participants' domestic household employees. This includes, but is not limited to, the
following:
1. During the contract implementation period, obtain from the SCM and the incumbent
contractor, and maintain in the file during the contract term, the household employees'
payroll and tax records and all other records for the domestic household employees
that are on file with the incumbent contractor, including, but not limited to, files of
timekeeping, monthly, quarterly, and annual reports.
3.12.1 RELATED FEDERAL AND NEW JERSEY TAXES
A. The contractor shall accurately process and distribute workers’ payroll and related federal
and New Jersey income tax withholding and employment-related taxes in compliance with
all federal and State requirements in a timely manner.
3.12.2 PROCESS WORKERS’ PAYROLL
A. The contractor, as the fiscal agent for the participant, shall perform all employer-related
financial, accounting, withholding, filing, and payroll duties for the participant that is
required of an employer to provide for employees. Those duties include, but are not
limited to:
1. Determine if the workers are a family member of the participant, who is exempt from
paying into FICA and/ or FUTA and SUTA (i.e., spouse or parent of a minor child who is
the Participant/ Authorized Representative-Employer). The contractor must also
maintain documentation on the relationship of the participant to worker in the workers’
and Participant/ Authorized Representative-Employer’s file;
2. Determine and maintain documentation if a worker is a non-resident of New Jersey and
determine the appropriate method to be used for state income tax withholding for nonresident workers (i.e., DE, NY, or PA);
3. Verify workers’ hourly wages in compliance with federal and NJ Department of Labor
and Workforce Development wage and hour rules for domestic service workers. Note:
The participant-directed programs covered under this RFP allow for the payment of
overtime, if documented and approved, in the participant’s budget;
4. Develop, produce, and distribute timesheets and instructions for workers to Participant/
Authorized Representative-Employers;
5. Collect, verify, and process workers’ timesheets per NJ Department of Labor and
Workforce Development and Using Agencies' requirements The contractor must also
maintain copies of timesheets in the worker’s file;
57
6. The contractor shall prepare domestic household employee biweekly payroll checks
and send them to the program participant for distribution, or to the worker directly,
within five (5) business days after receipt of the relevant timesheet;
7. Implement a system for addressing situations when a participant has his/ her staff work
hours in excess of the approved hours; by signing the timesheet reflecting an overage
and notifying the Using Agency. Note: The contractor is required to pay the worker for
every hour worked. The FCS function must address the issue by immediately informing
the participant of the overage, inform him/ her that his/ her allowable hours must be
reduced by the overage, and adjust the worker’s time accordingly on the next
timesheet;
8. Notify the Using Agency and the participant when a worker works in excess of
approved hours within one (1) business day of receipt of the involved timesheet;
9. Implement a system for recouping overages when a worker works in excess of
approved hours per the Using Agencies requirements;
10. Federal Income Tax Withholding. Compute, withhold, file, and track federal income tax
withholding for Participant/ Authorized Representative-Employers and their workers,
quarterly in the aggregate, using the contractor's VF/ EA FMS Counseling function's
separate FEIN and using the I.R.S. Form 941, Employer’s Quarterly Federal Tax
Report, and the I.R.S. Form 941 Schedule R. The contractor VF/ EA FMS function’s
federal income tax withholding and FICA (Medicare and Social Security tax) depositing
rules are based on the contractor’s VF/ EA FMS Counseling function’s aggregate
deposit liability, not that of each Participant/ Authorized Representative-Employer.
Therefore, an I.R.S. Form 941 Schedule B is required in most cases;
11. Medicare and Social Security Taxes. Compute, withhold, and file Medicare and Social
Security taxes (FICA) for Participant/ Authorized Representative-Employers and their
workers, quarterly in the aggregate, using the contractor’s separate FEIN and using the
I.R.S. Form 941, Employer’s Quarterly Federal Tax Report, and the I.R.S. Form 941
Schedule R. The contractor’s VF/ EA FMS provider Federal income tax withholding
and FICA (Medicare and Social Security tax) depositing rules are based on the VF/ EA
FMS providers’ aggregate deposit liability, not that of each Participant/Authorized
Representative-Employer. Therefore, an I.R.S. Form 941 Schedule B is required in
most cases;
12. Maintain copies of the filed I.R.S. Forms 941, I.R.S. Form 941 Schedule R and
Schedule B, as applicable, and related correspondence in the contractor's files;
13. Deposit federal income tax withholding in the aggregate using the contractor’s separate
FEIN (electronic filing) and per I.R.S. depositing rules;
14. Maintain copies of federal income tax withholding and FICA deposit documentation in
the VF/ EA FMS' files;
15. Compute, withhold, and file FUTA, annually in the aggregate, using the VF/ EA FMSCounseling entity’s separate FEIN and the I.R.S. Form 940, Employer’s Annual Federal
Unemployment (FUTA) Report, and the I.R.S. Form 940 Schedule R;
16. Maintain copies of the annually filed I.R.S. Form 940, and I.R.S. Form Schedule R and
related documentation in its files;
17. Electronically deposit FUTA, in the aggregate, using its separate FEIN in accordance
with I.R.S. depositing rules;
18. Maintain copies of FUTA deposit documentation in its files;
19. Enroll as an electronic filer and payer for State income tax withholding, unemployment
and temporary disability insurance tax, and family leave tax with the NJ Division of
Revenue and Enterprise Services;
20. Maintain copies of all documentation related to electronic New Jersey State tax filings
and payments in the contractor’s file;
21. Compute, withhold, file, and deposit New Jersey state income tax withholding using the
NJ Form 927-H, Domestic Employer’s Annual Return, electronically for each
Participant/ Authorized Representative-Employer’s worker;
58
22. Maintain copies of New Jersey state income tax withholding, filings, and payments, and
other relevant documentation and correspondence, in each Participant/ Authorized
Representative-Employer’s file;
23. Compute, withhold, and file state income tax withholding for each Participant/
Authorized Representative-Employer’s non-New Jersey resident workers per NJ
Division of Taxation and, as applicable, other states’ department of revenue
requirements;
24. Deposit state income tax withholding for each Participant/ Authorized RepresentativeEmployer’s non-New Jersey resident worker per NJ Division of Taxation and, as
applicable, other states’ department of revenue requirements;
25. Maintain copies of state income tax withholding for non-New Jersey resident workers in
each Participant/ Authorized Representative-Employer’s file;
26. Compute, withhold, and file New Jersey unemployment and temporary disability
insurance tax and family leave tax annually for each Participant/ Authorized
Representative-Employer (including even when zero wages are reported) by
electronically filing the NJ Form 927-H, Domestic Employer's Annual Return, annually
and per NJ Division of Taxation requirements;
27. Deposit electronically New Jersey unemployment and temporary disability insurance
tax and family leave tax, annually, for each Participant/ Authorized RepresentativeEmployer (including final deposit) annually using the NJ Form 927-H, Domestic
Employer's Annual Return, per NJ Division of Taxation requirements;
28. Maintain copies of the annual NJ Form 927-H, Domestic Employer's Annual Return,
and state unemployment insurance, temporary disability insurance and family leave tax
deposits and related correspondence in each Participant/ Authorized RepresentativeEmployer’s file;
29. File the NJ Form WR-30, Employer Report of Wages Paid, annually per NJ Division of
Taxation requirements;
30. Maintain copies of the NJ Form WR-30, Employer Report of Wages to be Paid and
related correspondence in each Participant/ Authorized Representative-Employer's file;
31. Maintain copies of New Jersey unemployment and temporary disability insurance tax,
family leave tax deposits and related correspondence in each Participant/ Authorized
Representative-Employer’s file;
32. Process all judgments, garnishments, tax levies or other related holds on workers’ pay,
as may be required by federal or New Jersey law;
33. Maintain copies of documents for all judgments, garnishments, tax levies or other
related holds on workers’ pay in the contractor's files;
34. Generate and distribute payroll checks to all workers within the semi-monthly time
period required by New Jersey statute;
35. Process direct deposit or issue debit cards containing workers’ payroll checks with a
remittance advice, showing gross wages, net wages withholdings and deductions per
DHS requirements, as requested by worker;
36. Maintain copies of direct deposit and debit card documentation in the contractor's files;
37. Develop a system for managing improperly cashed or issued payroll checks, stopping
payment on checks, and re-issuance of lost, stolen or improperly issued checks,
including:
a. Maintain a log of voided and re-issued checks, and include all pertinent information
in the log;
b. Obtain authorization of all stop-payments and re-issuances; and
c. Re-issue checks [i.e., within three (3) business days of notification of lost/ stolen
check] and issuance of stop-payment request;
38. Research, track, and resolve all tax notices received from the I.R.S., NJ Department of
Labor and Workforce Development, and NJ Division of Revenue and Enterprise
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Services regarding worker tax liabilities/ liens, and file all pertinent information,
including all the steps to resolution; and
39. Process NJ Department of Labor and Workforce Development Reason for Separation
Notice for workers, who no longer work for a Participant/ Authorized RepresentativeEmployer, within ten (10) calendar days of receipt of notice.
3.13 ACCOUNT FOR SERVICES RENDERED AND ONGOING ADMINISTRATIVE EXPENSES
3.13.1 BILL FOR SERVICES RENDERED AND ADMINISTRATIVE EXPENSES
A. MMIS Fiscal Agent Claiming:
1. The contractor shall perform an eligibility and enrollment exchange before delivering
service to determine the appropriate business rules to follow when submitting
weekly claims to and receiving reimbursement from the Medicaid fiscal agent’s
MMIS for (a) Medicaid services rendered; and (b) the contractor’s claiming for the
administrative per-member, per-month expenses. Submit weekly claims for the
actual expense of providing the service electronically to the MMIS within one
hundred and eighty (180) calendar days of the date of service for Medicaid services
rendered, and in accordance with the participant’s budget and established service
rate(s), billing and contract requirements, and using the proper procedure codes;
2. The respective SCM will provide the contractor with the eligibility and enrollment
exchange procedure at the Project Launch meeting (e.g., a file extract will be
provided);
3. For DDD participants, DDD’s web-based application determines the participant’s
eligibility and enrollment status automatically;
4. For all claims submitted by Friday, and approved as correct by the Fiscal Agent,
reimbursement will occur approximately on Wednesday of the next week;
5. Ensure that the contractor’s claims submitted to the MMIS for Medicaid services
rendered do not exceed the applicable, approved rates, and, if the claim exceeds
the MMIS’ applicable, approved business rule (e.g. for the rate edit or for another
reason), the MMIS will reject the claim, and the contractor shall re-submit the claim
correctly until the claim is approved; and
6. The contractor’s administrative services must only be delivered, or billed, during the
period of the authorization. All services must be pre-authorized on an annual basis,
or more frequently when participants’ needs change;
B. MCO Claiming:
a. The contractor shall perform an eligibility and enrollment exchange before
delivering service to determine the correct MCO to bill and the appropriate
business rules to follow when submitting a weekly claim for the actual expense of
providing the service to each MCO, for services rendered;
b. The respective SCM will provide the contractor with the eligibility and enrollment
exchange procedure at the Project Launch meeting (e.g., a file extract will be
provided);
c. For DDD participants, DDD’s web-based application determines the participant’s
eligibility and enrollment status automatically;
d. For all clean claims (i.e., a claim that follows approved business rules is a clean
claim) submitted, reimbursement will occur approximately within fifteen (15)
calendar days of the contractor’s clean claim submission; and
e. Ensure that the contractor’s claims submitted to an MCO, for services rendered, do
not exceed the applicable, approved business rules set by the MCO;
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C. Invoicing for financial counseling services:
a. Submit a monthly invoice to the respective SCM for the financial counseling
services rendered by the contractor to non-MCO participants;
D. Further, the contractor shall provide, at a minimum, the following requirements:
1. Establish and convey its rules and requirements for payroll and invoice payment to
stakeholders (i.e., SCMs, participants, workers, MCOs and providers/ vendors,
etc.), and develop a rules-based system [i.e., utilize a system-based rules engine to
determine whether individual-directed goods and services on an invoice are
allowable];
2. Implement a process for reconciling Medicaid services paid to units billed;
3. Implement a process for reconciling hours of services paid to hours billed;
4. Implement a process for determining and documenting when a participant is
admitted to a nursing facility or hospital, and the length of the stay;
5. Ensure billing stops during a participant’s stay in a nursing facility or hospital;
6. Implement a process for billing the participant, excluding MCO members, directly
when any established service limit is exceeded;
7. Implement a process for monitoring the filing and payment of FICA and/ or FUTA/
SUTA paid for each worker by the participant-employer when applicable
exemptions apply, (certain family members who are paid workers are exempt from
FICA and/or FUTA/ SUTA), related to the U.S. Department of Labor FUTA Credit
Reduction process, or when applicable FICA and/ or FUTA wage thresholds are not
met, possibly reducing the rate billed to the MMIS fiscal agent;
8. Develop a denial notice or a suspended notice form letter for the rejection of a
payment for a submitted employee’s timesheet (e.g., timesheet exceeds authorized
hours, thereby exceeding the individuals’ budget, denial of a benefit due to the loss
of Medicaid coverage, etc.); the notice shall be subject to prior approval by the
respective SCM before use. Once the form letter is approved by the SCM, the
contractor must implement a process to issue denial notices detailing the reason(s)
for denial, as applicable; and
a. Issue suspended or denied claims notices and resubmission of any suspended
or denied claims for Medicaid services, as appropriate, within 365 calendar days
from the date of service, in accordance with the SCM-provided DHS’ billing
requirements.
3.14 ACCOUNT FOR NON-MEDICAID PROVIDERS
3.14.1 PAYMENTS TO NON-MEDICAID PROVIDERS
A. The contractor shall execute payment for various participant-directed components
provided by non-Medicaid providers, including but not limited to the following services:
1.
2.
3.
4.
5.
6.
7.
8.
Individual supports;
Respite services;
Community transition services;
Assistive technology;
Environmental and vehicle modifications;
Use of a Personal Emergency Response System ( PERS);
Approved transportation; and
Approved additional goods and services.
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3.14.2 THE ADMINISTRATIVE COST FOR PAYING NON-MEDICAID PROVIDERS
The contractor shall establish an electronic method to bill the State for the administrative cost to
provide reimbursements for payments made to non-Medicaid providers in accordance with the
associated contract price line.
3.15 ELECTRONIC CLAIMING
The contractor shall develop and maintain electronic claiming ability for billing through the Fiscal
Agent’s and the MCOs’ systems.
A. The contractor must register with the current MMIS fiscal agent and obtain a NJ Medicaid
Submitter ID. This is done through the completion of an Electronic Data Interface (EDI)
Agreement. A copy of the form and instructions are located in Section 2 of the NJ
Medicaid HIPAA Companion Guide, which is available at www.njmmis.com; and
B. The contractor must register with each MCO through the credentialing and contracting
process specified by the respective MCO.
3.16 BILL THE PARTICIPANTS’ GRANTS
A. For DDD, expenses for processing payroll, criminal background checks, etc. shall be
included as part of the per person, per month administrative fee to be charged to DDD by
the contractor. For DDS and DoAS only, there are expenses that will not be eligible for
reimbursement from the administrative account. These expenses are specified in the
Price Schedule of this RFP (See RFP Section 9.0 Price Schedule/ Sheet, Price Lines 11,
12, and 13), and the contractor must bill each participant's cash grant for reimbursement,
as if the contractor was any other vendor, excluding MCO members. It is the State's intent
that the contractor charge the participant, and that the amounts charged be minimal;
B. The contractor must charge (i.e., bill) the participant's cash grant directly, with participant
approval, for the following items:
1. Charge for processing payroll and non-payroll checks: charge on a price per check
basis, as a modest charge for processing a check for both labor and non-labor products
or services, the charge for which must not exceed $2.00 per check;
2. Charge for stop payment on a check: charge on a price per check stopped, resulting
from the participant requesting the contractor place a stop-payment on a check issued
by the contractor, the charge for which must not exceed the contractor’s current
banking fee per check; and
3. Charge for Statewide criminal background check: charge on a price per background
check for performing a Statewide criminal background check of current, or potential,
household employees at the request of the participant not to exceed $30.00; and
C. In billing program participants, the contractor shall itemize each transaction and the related
transaction fee charged for services rendered in the statements provided to participants;
and
D. For MCO members, there is no cost share, as such, expenses for processing payroll and
non-payroll checks, stop-payments, criminal background checks and workers’
compensation insurance will be calculated and included in the monthly administrative rate
detailed in the third party agreement(s), which is specified in Section 3.6.6 of this RFP.
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3.17 BROKER WORKERS’ COMPENSATION INSURANCE FOR PARTICIPANT/ REPRESENTATIVE–
EMPLOYERS
A. The contractor shall effectively broker workers’ compensation insurance for Participant/
Authorized Representative-Employers in accordance with the New Jersey workers’
compensation insurance law. Each consumer must have choice in the selection of a
workers' compensation policy, and the contractor itself shall not engage a policy for a
participant. The contractor shall provide, but not be limited to:
1. Manage the initial application and receipt of workers’ compensation insurance policies
for Participant/ Authorized Representative-Employers. Historically, no insurance
company has voluntarily underwritten workers’ compensation insurance for domestic
household employees hired by participants. Thus, for every employee that needs
coverage, the contractor, on behalf of the participant, must apply to three (3) Workers
Compensation Insurance providers, and obtain a letter of denial from each provider.
Once the contractor has received the denial documentation, it must obtain, complete,
and submit a NJ Designation of an Insurance Company (ACORD 133NJ) application for
Workers’ Compensation to the New Jersey Compensation Rating & Inspection Bureau
(NJ CRIB) on behalf of the Participant/ Authorized Representative-Employers. NJ
CRIB will then assign the participant to a Worker’s Compensation Insurance provider;
2. Manage the renewal of workers’ compensation insurance policies for Participant
/Authorized Representative-Employers;
3. Manage the revocation of workers’ compensation insurance policies for Participant
/Authorized Representative-Employers, when appropriate;
4. Manage the payment of Participant/ Authorized Representative-Employers’ workers’
compensation insurance premiums;
5. Provide wage information to workers’ compensation insurer(s) to determine worker’s
benefits, as required;
6. Facilitate the annual audit process for the workers’ compensation insurer, including
hosting the insurer’s staff on site, responding to audits submitted by the insurer by mail,
and providing the necessary information and documentation; and
7. Maintain the following information related to workers’ compensation insurance in the
participant’s file:
Workers’ compensation insurance application and renewal documentation;
Workers’ compensation insurance policies;
Workers’ compensation premium and payment documentation;
Worker wage information for determining workers’ compensation insurance benefits;
and
e. Relevant workers’ compensation insurance audit-related documentation.
a.
b.
c.
d.
3.18 ENROLL WORKERS, INDIVIDUAL-DIRECTED GOODS AND SERVICES PROVIDERS, AND
VENDORS
A. The contractor shall process workers’ human resource documentation and goods and
services providers’ and vendors’ information and input it into the contractor’s payroll and
billing invoice payment system in an accurate and complete manner within two (2) weeks
of being referred. The processing shall include checking individuals and providers/
vendors against the Medicaid exclusion databases upon initial enrollment and monthly
thereafter. The contractor shall provide, but is not limited to providing, the following:
1. Please note: the respective SCM will supply the contractor with the following DHSnumbered forms at the Project Launch meeting. Prepare Worker Employment,
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Individual-directed Goods and Services Provider, and Vendor Engagement Packets,
that include, as applicable, but are not limited to:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
Introductory letter;
Worker Employment Application;
I.R.S. Form W-4, Withholding Allowance Certificate, and instructions;
U.S. BCIS Form I-9, Employment Eligibility Verification Form, and instructions;
DHS PDS 1006, Worker Agreement (considered the Medicaid agreement);
Permission form for pre-employment criminal background check;
Permission form for pre-employment Central Registry of Offenders Against
Individuals with Developmental Disabilities;
Worker timesheets and instructions;
Worker timesheet due dates and payday schedule;
Individual-directed goods and services provider and vendor engagement
information form;
DHS PDS 1008, Individual-directed Goods and Services Provider/ Vendor
Agreement (considered to be the Medicaid agreement);
Individual-directed goods and services invoice format for submission of provider
and vendor payment requests and instructions for submitting invoices for payment;
Individual-directed goods and services provider and vendor invoice due dates and
payment schedule;
Form to collect information for New Jersey New Hire Reporting requirement;
Form to collect required information to determine if the family employee meets one
of the criteria to be FICA and/or FUTA/ SUTA exempt per Section 3 of I.R.S.
Publication 15 and NJ Department of Labor and Workforce Development and NJ
Division of Revenue and Enterprise Services requirements;
Notice of direct deposit and debit card payment options and instructions for signing
up;
Worker Employment and Individual-directed Goods and Services Provider and
Vendor Engagement Packet Checklist; and
Self-addressed stamped envelope.
2. Distribute and collect completed I.R.S. Forms W-9, Request for Taxpayer ID and
Certification, when it is determined that an individual-directed goods and services provider
vendor is an independent contractor;
3. Distribute the Worker Employment and Individual-directed Goods and Services Provider
and Vendor Engagement Packets to Participant/ Authorized Representative-Employers
within one (1) business day of receipt of receiving a request from the respective SCM
informing the contractor that the participant wishes to use participant-directed services
through the contractor;
4. Assist the participants with completing and submitting the required information and forms
included in the Worker Employment and Individual-directed Goods and Services Provider
and Vendor Enrollment Packets, as applicable and as needed by the participant;
5. Collect and process information from the Worker Employment and Individual-directed
Goods and Services Provider and Vendor Engagement Packets and file completed forms
with the appropriate federal and State agencies within two (2) business days of information
receipt;
6. Notify the participant regarding missing or incorrect information submitted from the Worker
Employment and Individual-directed Goods and Services Provider and Vendor
Engagement Packets, and obtain it in an accurate and timely manner;
7. Process the worker’s I.R.S. Forms W-4, Withholding Allowance Certificate, and the NJ
Form W-4, Withholding Allowance Certificate, when applicable;
8. Collect and maintain copies of the U.S. BCIS Form I-9, Employment Eligibility Verification
Form, in each worker’s file;
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9. Execute a Medicaid provider agreement with workers and providers/ vendors of authorized
individual-directed goods and services, as required for CMS §1915(c) HCBS waiver and
§1915(j) SPA programs. This shall be accomplished by executing a Worker Agreement
and an Individual Directed Goods and Services Provider/Vendor Agreement. The
contractor must maintain copies of these documents in the worker and provider/ vendor
files;
10. Confirm each worker’s social security number and vendor's FEIN, as appropriate, through
the SSA’s Business Services Online website located at: http://www.ssa.gov/bso;
11. Report participant’s new worker hires to the New Jersey New Hires Directory within twenty
(20) calendar days of hire;
12. Establish and implement a delivery process of all necessary information and vendor
packets to the participant/ authorized representative and worker. If the contractor fails to
make contact with the client within two (2) weeks of the initial request, the contractor shall
report all failed attempts to the SCM;
13. Submit the required documentation for criminal background checks to the appropriate
State agency upon initial hire. The contractor must then receive and maintain criminal
background check results on worker candidates on file and provide results to participants;
and
14. Submit the required documentation for Central Registry of Offenders against Individuals
with Developmental Disabilities checks to the appropriate State agency. The contractor
shall check at least annually that none of the caregivers or volunteers appear on the
Central Registry of Offenders Against Individuals with Developmental Disabilities and
document evidence of due diligence. Failure to comply with this requirement may result in
a decrease or cessation of funding and/or a suspension or revocation of contracting; and
B. The contractor must maintain copies of all forms, supporting documentation, and
authorizations in each worker’s file, provider’s/ vendor’s file, and Participant/ Authorized
Representative-Employer’s file.
3.18.1 DISENROLL WORKERS, INDIVIDUAL-DIRECTED GOODS AND SERVICES PROVIDERS, AND
VENDORS
A. The contractor shall accurately process, in a timely manner, a change in a participant’s
enrollment status with a provider or vendor when the participant permanently ceases to
use that provider or vendor for any reason. The contractor shall provide, but not be limited
to providing, the following:
1. A system to receive participant disenrollment information from the SCMs;
2. Revoke the I.R.S. Form 2678, Employer/ Payer Appointment of Agent, with the
participant, when appropriate, per I.R.S. Form instructions;
3. Revoke the I.R.S. Form 8821 with the participant, when appropriate, and per I.R.S.
Form instructions;
B. Further, when the participant ceases to be an employer of workers, the contractor shall
provide, but not be limited to providing, the following:
1. Request and document in each participant's file, the complete retirement of a
participant’s FEIN. Note: If the participant is deceased, the I.R.S. must be notified to
allow for the FEIN to be retired;
2. Withhold, file, and deposit final New Jersey income tax (even when the final filing is
zero wages) for each applicable participant;
3. Compute, withhold, file, and deposit final New Jersey Unemployment and Temporary
Disability Insurance Tax and Family Leave Taxes (even when the final filing is zero
wages) for each applicable participant;
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4. Retire with the NJ Division of Revenue and Enterprise Services the Participant/
Authorized Representative-Employer’s State Income Tax withholding, Unemployment
and Temporary Disability Insurance Tax and Family Leave Tax account and number by
filing the NJ Form REG-C, Change of Employer Information, online, when appropriate;
5. Terminate the participant’s Workers’ Compensation Insurance policy, when
appropriate, and submit any premium refund to the participant, as applicable; and
6. Notify the SCM of any employment terminations immediately, so that the worker is
removed from the NJ State Police fingerprint file; and
C. The contractor must maintain copies of all forms, supporting documentation, and
authorizations obtained throughout the disenrollment process in each Participant/
Authorized Representative-Employer file.
3.19 PROJECT REPORTS
A. The contractor shall be required to produce and distribute a variety of reports. These
reports are used to provide participants, counselors, the SCM’s Using Agency, and other
stakeholders with valuable and timely information about the Programs being managed by
the contractor;
B. The contractor shall prepare and submit required reports to the State and federal
government, as specified in this RFP; and
C. The contractor shall establish a process for responding to requests from State and federal
agencies for wage information of directly hired workers.
3.19.1 REPORT DELIVERY
Reports must be submitted, within three (3) business days of the period’s end date, to the SCM in
password-protected Microsoft Word or Excel format documents, as is most appropriate to the
report content.
3.19.2 ADMINISTRATIVE ACCOUNT ACTIVITY REPORT
The contractor must prepare a monthly Administrative Account report of the Using Agencies'
separate administrative bank account activity in accordance with the Using Agencies' reporting
requirements. The contractor shall provide the SCM with one (1) electronic report for review
within three (3) business days of the period covered.
The contractor’s monthly reporting of bank account activity shall include, but is not limited to:
A. A summary of the month’s bank activity;
B. Reconciliation of the bank balance to the General Ledger; and
C. Reconciliation of any amounts advanced from the Using Agencies.
3.19.3 UTILIZATION (PROGRAM STATISTICS) REPORT
The contractor must prepare a monthly utilization report and submit one (1) electronic copy to the
SCM, and MCOs as appropriate, for the SCM’s approval or comment, within three (3) business
days of the period covered.
The report shall include, but not be limited to:
66
A. Claim verification;
B. Comparison of monthly participant-directed service expenditures to the amounts allocated
in the participants budget;
C. Listings and descriptions of new contractor staff and/ or consultant personnel; and
D. Listing of significant issues and problems encountered, both resolved and unresolved,
together with solutions and recommendations for the resolution of outstanding issues and
problems.
3.19.4 PARTICIPANT DETAIL REPORT
A. The contractor must prepare and submit status reports, on a monthly and quarterly basis,
to the SCM for approval within three (3) business days of the end of the period of the
report, to be delivered, after SCM approval, by the contractor to the Program Participants/
Authorized Representatives. The reports shall compare monthly participant-directed
service expenditures to the amounts allocated in the participant’s budget (for the current
period and cumulatively for the calendar year to date);
The contractor’s reports shall contain, at a minimum:
1. Name and Medicaid identification number of the Program Participant;
2. Amount of the Program Participant's monthly cash grant allotment for the current month
and the date the grant was received by the contractor;
3. Names, complete social security numbers, job titles, hire date(s), wages, taxes, and
insurance paid for all domestic household employees of each program participant;
4. Number, type and amount of all non-labor-related payments made by the contractor;
5. Total amount of interest accumulated in the Program Participant's interest-bearing
account;
6. Total year to date amount of Program Participant's cash grant allotments transferred to
the Program Participant's account; and
7. Total amount of the grant remaining; and
B. The contractor and all consultants shall review the report with participants enrolled in
participant-directed service programs (such as the Personal Preference Program) and with
their authorized representative, as appropriate; and
C. The contractor shall schedule a quarterly visit with the SCMs to review this report in
person.
3.19.5 PARTICIPANT SUMMARY REPORT
The contractor must prepare and deliver a quarterly summary report and submit one (1) electronic
copy to the SCM within three (3) business days of the end of the quarter. The contractor’s report
shall contain, at a minimum, the number of Program participants serviced.
3.19.6 PARTICIPANTS’ CO-PAYMENTS REPORT
A. The contractor’s shall submit electronic, quarterly reports documenting the status of the
co-payment cost share account to the SCM for approval;
67
B. The report is due within ten (10) business days after the end of the most recent quarter,
which is the quarter to be reported;
C. Instructions and specifications for the format of the quarterly report will be mutually
developed between the contractor and the SCM during the Project Launch Meeting;
D. The co-payment report shall include, at a minimum, the following:
1.
2.
3.
4.
5.
Participant name;
Participant’s Medicaid number;
Assessed cost share amount;
Cost share co-payments; and
Outstanding cost share co-payments including the duration of the delinquency.
3.19.7 COMPLAINTS/ GRIEVANCES REPORT
A. Provide a cumulative report, on a monthly basis, delivered to the SCMs by the fifth (5th)
business day of each month, describing the complaints that were received by the
contractor the previous month, which may escalate to a Grievance if not resolved, and the
report shall describe the resolutions achieved to date against those complaints. At a
minimum, the report shall contain the date of receipt, complainant’s name, and nature of
the complaint. The contractor shall continue to list each complaint cumulatively on the
report, until such time when the contractor receives written confirmation from the SCM that
the complaint was resolved to the SCM’s satisfaction.
3.19.8 TAX NOTICE REPORT
A. The contractor shall provide a report, on a quarterly basis, delivered to the SCMs by the
fifth (5th) business day after the end of the quarter being reported, describing the tax
notices received, and the report shall describe the resolutions achieved to date against
those notices.
3.19.9 RESULTS FROM PARTICIPANT-SATISFACTION SURVEY
The contractor shall provide a report, to be delivered to the SCMs by the fifth (5 th) business day
after conclusion of the survey, detailing the results of the survey.
3.19.10 MONTHLY PROGRESS NOTES
A. The contractor must prepare and submit progress notes, on a monthly basis, to the SCMs
for DDS and DoAS for approval within three (3) business days of the end of the period of
the report, to be delivered, after SCM approval, by the contractor to Program Participants/
Authorized Representatives. The SCM for DDD does not require progress notes.
The progress notes shall include, but not be limited to:
1. Status measure of the participant’s experience on the program; and
2. Noted successes and failures of the participant and any corrective action to be
recommended by the contractor.
B. Monthly progress notes should also meet the standards of the National Association of
Social Workers Guide to Social Work Case Management. Information regarding the
guidelines may be reviewed at:
http://www.socialworkers.org/practice/naswstandards/CaseManagementStandards2013.pdf.
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3.19.11 FINANCIAL COUNSELING-RELATED REPORTS
A. Prepare and distribute a quarterly counseling report to the SCMs for DDS and DoAS that
provides statistics on the participants, including detail on the participant’s demographic
statistics, renewal of budgets, budget monitoring and problem resolution, requests for
changes to levels of care, and customer service information, including incident reporting
and report individual contacts. The SCM for DDD does not require these reports.
3.19.12 VF/ EA FMS-RELATED REPORTS
A. Prepare and distribute to the SCMs electronic, monthly utilization and budget tracking
reports that show the total amount for each participant’s budget, the amount used, and the
amount remaining, by budget category, and cumulatively for the year.
3.20 DOAS’ OPERATIONAL REQUIREMENTS
3.20.1 DUTIES AND OBLIGATIONS OF CONTRACTOR -OVERVIEW
The contractor shall provide the following major business activities related to participants enrolled
in the JACC program and to participants’ health care and social services providers:
A. Interface with the DOAS HCBS/ ADRC database server via internet;
B. Process claims for services and issue payments to health and social services providers
and JACC Care Managers (CMs); and
C. Adjust previously paid claims as necessary.
Please refer to Exhibits Numbered 6 through 10 for additional information and to review
examples of sample JACC reports.
3.20.2 JACC PARTICIPANT ELIGIBILITY
An individual’s qualification for enrollment into the DOAS programs is to be determined by
DOAS, and all participants’ eligibility will be determined by DOAS. DOAS will provide the
contractor with a written set of the eligibility requirements for JACC’s participants and the HCBS/
ADRC database, which will have a record for the individuals who are eligible for the JACC
program.
3.20.3 PROVIDER ELIGIBILITY
A provider’s qualification for participation in the JACC program is determined by DOAS, and all
provider eligibility will be determined by DOAS. DOAS will provide the contractor with a written
set of the eligibility requirements for JACC’s providers and the HCBS/ ADRC database will have
a record for providers who are eligible for participation in the JACC program.
DOAS will provide the contractor with a list of county agencies providing care management to
participants. The list will contain agency name, address, telephone and fax numbers, and a
contact name. The list will be provided to the contractor at the respective Project Launch
meeting.
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3.20.4 NOTIFICATION OF CHANGES
The contractor shall ascertain service limitations for participants and providers through an
interface with the HCBS/ ADRC database. DOAS will notify the contractor of changes to the
following service limitations for providers:
A.
B.
C.
D.
E.
F.
G.
Units of service;
Units per visit;
Frequency of service;
Total units per week;
Authorized cost per unit;
Authorized cost per week; and
Authorized cost per month.
3.20.5 HCBS/ ADRC INTERNET DATABASE ACCESS
A. All participant and provider information is available through internet access to the HCBS/
ADRC database server. DOAS will provide the contractor with electronic access to the
DOAS data processing platform and the technical information necessary to enable
efficient integration between the HCBS/ ADRC database and the system used by the
contractor. The contractor shall process a batch process that occurs at a minimum of
once a week and accept service authorizations for participant and provider data via the
batch process; and
B. DOAS will maintain the HCBS/ ADRC database and data tables, which lists authorized
providers, eligible participants and PEPs, and all approved services and related
limitations contained in participants’ PoCs.
3.20.6 DATA COLLECTION METHOD
A. The contractor must maintain a system to track and store service authorizations and
rates, copay payments and billing, PEP information, and provider invoicing and payment
history; and
B. The contractor shall have the option of gathering data used in the quality assurance
program through either a statistically random and reliable sample or fully enumerated
systemic performance reports. The contractor shall submit for approval the method of
gathering data to the DOAS SCM for approval, prior to the contractor’s implementation of
the quality assurance program.
3.20.7 DATA METRICS
The contractor shall develop and begin adopting within six (6) months of the contract effective
date, performance measures for the accuracy and timeliness of the contract’s tasks including,
but not limited to:
A. Submission of bills and invoices;
B. Payments to providers;
C. Payment of wages to PEPs;
D. Length of processing times;
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E. Record keeping;
F. Updating of manuals and instruction;
G. Training in response to requests and changes in regulations;
H. Resolution of claim discrepancies;
I.
Resolution of conflicts between participant/ employers and PEPs; and
J. Adherence to Co-pay standards.
3.20.8 PROCESSING CLAIMS
The contractor shall record and process claims received from approved JACC providers and
enter the claims into the HCBS/ ADRC database in the following manner:
A. Date-stamp provider invoices;
B. Include participants’ information, claim units, claim payment, services provided, and dates
of service;
C. Verify claims have been completed in accordance with HIPAA requirements;
D. Notify providers when claims are pended;
E. Review the pended claim file for follow-up on problem resolutions; and
F. Electronically transfer claims data into the DOAS’ financial repository that provides the
final disposition of all submitted claims: paid (including the amount), denied (including the
reason for denial), pended (including the reason for pending the claim), and claims inprocess.
3.20.8.1 TIMELY FILING OF PROVIDER CLAIMS
A. The contractor shall assist DOAS providers in meeting claims deadlines. For the first
thirty (30) calendar days after assuming the contract, the contractor shall maintain the
original record that establishes the date the contractor received the claim as verification
that timeframe requirements are being satisfied, and when claims are submitted in
hardcopy, the envelope must be retained. This period may be extended at the discretion
of DOAS SCM; and
B. When a provider does not appear on the authorized provider file, the contractor shall
notify the billing provider of the problem within two (2) business days of the date the
contractor received notification.
3.20.8.2 PENDED CLAIMS
A. The contractor shall resolve claim discrepancies with all responsible parties, correct
claims in the pended file, and resubmit claims for payment;
B. If the claim cannot be processed because of incomplete or incorrect information, the
contractor shall notify the provider by telephone with a written letter follow-up, within two
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(2) business days, that the claim has not been processed, the reason(s), and the steps
necessary to have the claim processed;
C. The contractor shall notify the provider and CM in cases where claims are classified as
pended due to missing participant information; and
B. The contractor shall review all claims that remain listed on the pended file at the end of
the fiscal year and resolve the remaining outstanding issues with the affected providers
by notifying them that their claim(s) is about to be denied due to the filing deadline. The
filing deadline is six (6) months from date of service.
3.20.8.3 DENIED CLAIMS
A. The contractor shall develop a pro forma denial notice, subject to approval by the DOAS
SCM; and
B. The contractor shall issue denial notices detailing the reason(s) for denial as applicable.
Participant eligibility for a particular service is the most common reason for denied claims.
3.20.9 PAYMENT OF CLAIMS
3.20.9.1 CONTRACTOR PAYMENTS TO PROVIDERS AND CARE MANAGERS
A. The contractor shall issue payments to providers and CMs as calculated by the DOAS
HCBS/ ADRC database. The contractor shall offer providers a choice between payment
by check and electronic direct deposit;
B. In cases where the amounts calculated by DOAS for payment differ from the original
billed claim amount, the contractor shall pay the provider for the amount billed. The
contractor shall not issue payments to providers for amounts billed in excess of amounts
authorized by DOAS in the HCBS/ ADRC database; and
C. The contractor shall reconcile records of bills received with the current status, or final
disposition of each related claim, and shall report any claims adjustments to the provider
as part of the payment record.
3.20.9.2 PAYMENT PROCESSING CYCLE
A. The contractor shall accept the file of HCBS/ ADRC claims disposition extracts and
process payments on a monthly payment cycle. For other providers, including CMs, the
contractor may select which day of the week will mark the end of each monthly payment
cycle. The contractor shall obtain prior approval from DOAS to commence this payment
cycle. Payments shall be processed once a month regardless of holidays or other nonbusiness days; and
B. The contractor shall have the capability to accept HCBS/ ADRC authorization data
available on demand so the contractor can process and pay claims for health and social
service providers and CMs more frequently than once a month.
3.20.10 RE-ISSUANCE OF PROVIDER CHECKS
Should rates change, the contractor shall re-issue checks as applicable to compensate for the
difference between the new rate and the rate previously utilized. Based on experience, DOAS
anticipates one such rate change per year, resulting in approximately 350 re-issued checks.
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3.20.11 PAYMENT RECORD RECONCILIATION
A. The contractor shall complete a monthly reconciliation between its records regarding the
claims activity undertaken with JACC providers;
B. The contractor shall develop a monthly report of the results of reconciliation between the
two files, and submit the report to the DOAS SCM on a monthly basis. This monthly
reconciliation report shall be submitted either as hardcopy, or in Microsoft Word or Excel,
and shall include, at a minimum, the following information:
1. Differences in payment amounts;
2. Errors in reporting the claim disposition;
3. Errors in reporting the reasons for payment modifications;
4. Errors in reporting the reasons for claim denials;
5. Errors in reporting the reasons for pended claims;
6. Explanations as to the cause of the errors; and
7. Specific corrective actions taken.
3.20.12 CO-PAYMENTS
The contractor shall collect the co-payments for participants eligible for care under JACC on a
monthly basis.
3.20.12.1 CO-PAYMENT BILLING INFORMATION
A. The contractor shall develop a pro forma co-payment billing statement subject to prior
approval by the DOAS SCM. The billing Statement shall contain the following
information:
1. A clear statement that the bill is assessed on behalf of DOAS and the amount is the
co-payment the participant is required to pay as a participant in the JACC program;
2. The participant’s name and program identification number;
3. A list of services the participant is authorized to receive and the authorized costs of
such services;
4. The amount of co-payment due through the billing month;
5. The total of any overdue amounts;
6. The total amount of co-payment due as of the date of the bill;
7. A year-to-date history of total co-payment billed and paid as of the billing date;
8. The name and number of the CM and/ or financial counselor; and
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9. A telephone number the participant may call with questions regarding the bill.
3.20.12.2 CO-PAYMENT COLLECTION PROCEDURES
A. The contractor shall develop a pro forma warning letter, subject to prior approval by the
DOAS SCM, that warns participants that their services MAY be terminated from the
program for non-payment of their co-payment;
1. If a participant’s overdue amount exceeds sixty (60) days past due, the contractor shall
issue the first overdue warning letter and send a copy of the first overdue warning
letter to the CM;
2. If the participant’s overdue amount exceeds ninety (90) days, the contractor shall:
a) Issue a second overdue warning letter to the participant stating that services WILL
be terminated from the program in thirty (30) days if the co-payment is not paid;
b) Send a copy of the second overdue warning letter to the CM and DoAS;
c) Send a final notice letter if co-payment has not been received within thirty (30) days;
d) Send copy of the final notice letter to the CM and DOAS; and
e) The contractor shall maintain records of participants with an overdue co-payment
for at least ninety (90) days beyond any termination.
3.20.12.3 RECONCILIATION OF CO-PAYMENTS
A. The contractor shall be held harmless for co-payments that are overdue for more than
ninety (90) days. Such overdue co-payments shall be deducted from the total costs billed
to DOAS on a monthly basis; and
B. In the event that the contractor receives payments for such overdue amounts, those
amounts shall be deducted from the total remunerated amount due for the month
subsequent to the month the collection is reported.
3.20.12.4 REPORTING CO-PAYMENT INFORMATION TO DOAS
The contractor shall maintain a complete account of all co-payment activities regarding billing
and collection for DOAS, and audit and pass select co-payment related data to the HCBS/ ADRC
database and/ or another location as designated by DOAS (for example, DOAS’ financial
repository).
3.20.13 DOAS PARTICIPANT TERMINATION
Participant enrollment can only be terminated by DOAS. The contractor shall not, under any
circumstances, terminate services or fail to issue payments to JACC providers for reasons
related to uncollected co-payments.
3.20.14 TIMEKEEPING FOR PEP EFFORTS
A. The contractor may utilize an automated time tracking system that records the clocking in
and out of the PEP through use of the participant/ employer’s home telephone (i.e., the
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actual site where the services are being provided) as the primary method of recording the
PEP’s work hours.
The time tracking system must be able to perform the following functions:
1. Identify the incoming call as originating from the phone of the participant/ employer;
2. Prompt for, recognize, and record the PEP’s identification number and password;
3. Prompt for, and record, the dates and times worked by a PEP for each
Participant/employer; and
4. Should the time tracking system be unable to verify that a phone being used to clock in
or out belongs to the participant/ employer, a prompt shall inform the caller that they
are not authorized to provide services at this time and that the participant/ employer
should contact their CM;
B. The contractor shall develop a manual, hardcopy timesheet process to address
circumstances where the automated phone system cannot be used;
C. The contractor shall maintain all timesheets and enter all required data into the HCBS/
ADRC database, as specified by the DOAS SCM, within the SCM-designated timeframe;
D. In order to allow the contractor to meet PEP claim processing deadlines, the contractor
may accept an oral report from the participant/ employer only. In such instances, the
contractor shall obtain the appropriate timesheets from the CM (who obtains it from the
participant/ employer) and verify that the hours on the timesheet match the hours from
the HCBS/ ADRC authorization; and
E. The contractor shall resolve any discrepancies as part of the claims adjustment
processing cycle; and
F. The contractor shall notify the CM within two (2) business days of discovery that
timesheets have not been received.
3.20.15 PROCESSING PEP WAGES
A. The contractor shall enter all PEP-related data into the HCBS/ ADRC database for
processing the amounts to be paid as PEP wages. The contractor’s shall verify that the
PEP has completed employment related documentation required to act as the employee of
the participant/ employer.
The contractor shall process PEP wages as follows:
1. The contractor shall resolve any discrepancies, correct pended claims and report claim
modifications to the PEP and his/ her participant/ employer;
2.
The contractor shall process all withholdings, statements, and other related
documentation;
3. The contractor shall provide PEPs the option of receiving their pay through either
direct deposit or a mailed check;
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4. The contractor shall send the PEP wage data after it is processed via DOAS’ financial
repository, complete the necessary withholdings, and issue the payroll checks for the
specified amount of total wages; and
5. The contractor shall mail the original withholding statements to the PEP and mail a
copy of the wage statement to their participant/ employers.
3.20.15.1 PENDED WAGE CLAIMS
A. Upon realizing that a claim has been pended, the contractor shall notify the CM of the
discrepancies within one (1) business day via phone or email. The contractor shall not
be required to do anything further regarding the resolution of such discrepancies. In
cases where the hours reported do not agree with the participant/ employer’s PoC, in the
HCBS/ ADRC database, the contractor authorizes payment according to the hours
reported in the PoC or the hours reported on the timesheet, whichever is less; and
B. The contractor shall maintain a record of all activity it conducts regarding each PEP
claim.
3.20.15.2 PEP WAGE CLAIMS PROCESSING CYCLES AND TIMEFRAMES
A. The contractor shall process PEP wage claims bi-weekly and shall pay regular PEP
wages on a bi-weekly basis. The pay periods shall be for two-week periods ending on
Fridays. The contractor shall process retroactive adjustments to wages during the
intervening weeks.
The timeframes for both the regular bi-weekly pay and the retroactive wage adjustment
cycles shall be concurrent and as follows:
1. The second Tuesday following the bi-weekly pay period will be for regular PEP wages
and the intervening week will be for wage adjustments;
2. The contractor shall resolve all outstanding verification issues by the second business
day of the intervening week or the claim will be pended;
3. The contractor shall receive the HCBS/ ADRC data file for PEPs on the next business
day, (i.e., the third business day following the previous Friday);
4. The contractor shall issue payroll checks by the following business day, (i.e., the fourth
business day following the previous Friday); and
5. The contractor shall include explanations for any payroll adjustments or include the
reasons for the denial when payment has been denied with each payroll check.
3.20.15.3 RE-ISSUANCE OF PEP CHECKS
Should rates change, the contractor shall re-issue checks as applicable to compensate for the
difference between the new rate and the rate previously utilized. Based on historical experience,
DOAS does not anticipate any changes to PEP rates.
3.20.16 EMPLOYMENT INFORMATION AND OUTREACH
A. The contractor shall ensure that PEPs are in compliance with all applicable federal,
DOAS and local laws and with regulations regarding income and employment taxes,
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statutory benefits regarding unemployment, disability and worker's compensation
insurance, and all labor laws related to the employment of their PEP(s). This information
is contained in the program documents available for review as listed in Section 1.3.7 of
this RFP.
B. A letter detailing the contractor’s availability of employment services, hours of operation,
address and telephone numbers, including at least one toll-free number, must be sent as
a supplement with the first check sent by the contractor to all PEPs and their participant/
employer. Or, if payment is ACH Direct Deposit then the supplement must be sent within
one week of deposit.
3.20.16.1 DISPUTE RESOLUTION
A. The contractor shall attempt to settle any labor/ employer dispute brought to the attention
of the contractor, by either the participant/ employer or PEP.
The contractor shall adhere to the following steps until a resolution is reached or it is
determined that the dispute must be referred to the CM:
1. The contractor shall first attempt to resolve the dispute with both parties by phone;
2. The contractor shall provide both parties with information that will enable a resolution
to be reached;
3. The contractor shall require both parties to document their positions in the dispute in
writing and send these documents either electronically or via postal service to the
contractor for evaluation and resolution;
4. The contractor shall invite both parties to meet at the contractor office for mediating a
resolution; and
5. If no resolution can be reached after the previous steps have been taken, the
contractor shall refer the dispute to the appropriate CM, and include all applicable
documentation and a written statement of the contractor’s opinion for a recommended
resolution.
B. Settlements shall not be finalized at the contractor level unless both parties agree to sign a
resolution of the recommended resolution.
3.20.17 CONTRACTOR REMUNERATION
A. The contractor shall be reimbursed for payments it makes to providers for JACC and shall
be compensated for the services it provides in fulfilling the responsibilities of this RFP;
B. The source for reimbursement is predicated upon whether the contractor is being
reimbursed for provider payments or being compensated for the work performed and
whether the participant who received the service(s) was participating under the VD-HCBS
program or participating under the other JACC program at the time the service was
provided; and
C. The contractor shall develop, implement, and manage a financial system that accounts for
all remunerated funds and shall develop the information systems needed to process
transactions in the manner prescribed by both MMIS and DOAS.
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3.20.17.1 REIMBURSEMENT FOR PROVIDER PAYMENTS
The reimbursement of the contractor for provider payments shall be accomplished by the
contractor billing DOAS. The contractor shall not add additional service fees when billing for
reimbursement of the provider payments it made to DOAS provider (i.e., JACC providers and
VD-HCBS providers) accounts. Reimbursements to the contractor will be made one (1) time per
month.
3.20.17.2 CONTRACTOR REIMBURSEMENT FOR JACC RELATED PROVIDER PAYMENTS THROUGH
DOAS
A. The contractor shall bill DOAS through DOAS for payments made by the contractor to
those authorized providers for those participants who received services eligible under
DOAS Programs (i.e., JACC and VD-HCBS). The contractor shall complete a payment
voucher, at month’s end, for provider payments issued during that month;
B. The contractor shall attach sufficient supporting documentation to the DOAS payment
voucher, as designated by the SCM at the respective Project Launch meeting;
C. DOAS payment vouchers must include the contract number (issued to the contractor
upon award of the contract), the contractor’s company name, address and vendor
identification number and the units of service for each service billed;
D. The supporting documentation shall contain detail including, but not be limited to, such
items as the participants, types of providers, and units per service; and
E. The specific requirements for completing DOAS Payment Voucher will be provided to the
contractor by DOAS Contract Manager at the Project Launch meeting.
3.20.18 JERSEY ASSISTANCE FOR COMMUNITY CAREGIVING (JACC) OPERATIONAL
REQUIREMENTS
A. Invoice the administrative expense for VF/ EA FMS under JACC as a per member/ per
month administrative fee;
B. Deduct counseling costs and check processing costs from the participant's budget;
C. If approved by the SCM in advance, the contractor shall reimburse itself for amounts owed
to the contractor from participants for certain minor activities performed by the contractor
on behalf of the participants (i.e., payroll check fees, brokering workers’ compensation
insurance policies, and prospective workers’ criminal background checks, etc.). The
contractor shall keep participant’s direct payments to a minimum, in quantity and dollar
amount, and the total amount shall not exceed ten percent (10%) of the participant’s grant
in any one-month period;
D. Invoice for special projects, after prior approval from the SCM for initiating the special
project, at an hourly rate [please refer to Section 9.1 Price Schedule/ Sheet, Price Line No.
08.
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3.20.19 VETERANS’ SELF-DIRECTED HOME CARE SERVICES (VD-HCBS) OPERATIONAL
REQUIREMENTS
Veterans enrolled in the Veterans’ Self-Directed Home Care Services (VD-HCBS) Program
choose and hire their own personal care worker, whether it is a family member, friend, or
neighbor; receive a monthly budget, which allows them to purchase items that will help maintain
their independence at home and maintain medical services they currently receive from the
veterans' hospital. These services are 100% federally funded.
A. Since this program is governed by a partnership between DOAS and the DVA, DOAS
must retain responsibility to satisfy all requirements issued by the Department of Veterans
Affairs. The SCM will provide the contractor with thirty (30) days’ written notice of any
change in policy or procedure that impacts the contractor on the scope of work for VDHCBS as set forth in this RFP;
B. The contractor shall work directly with one of three supervisors in the following four
counties’ Area Agency on Aging (AAA):
1.
2.
3.
4.
Bergen (Supervisor);
Somerset (One of two Lead Supervisors);
Warren (One of two Lead Supervisors); and
Morris; and
C. The DVA sends an initial referral for the veteran, who is interested in participant-directed
services, to the coordinating AAA, who subsequently approves the referral and forwards
the AAA’s approval back to the DVA. Then the DVA sets a budget amount and forwards
the amount of the budget to the AAA, who subsequently forwards the approved budget
amount to the contractor. The contractor’s counselor shall make an appointment with the
veteran and discuss the veteran’s options by arranging a Home Visit at the residence of
the veteran, as follows:
1. At the Home Visit, the contractor’s counselor shall assist the veteran with preparing the
Enrollment Letter Packet and Employee Packet paperwork. The completion of the
paperwork may require the contractor’s counselor to make two (2) Home Visits;
2. Subsequent to the Home Visit, the contractor shall assign the veteran a permanent
counselor and shall process the veteran’s Employee Packet;
3. The contractor shall confirm with the coordinating AAA the preliminary service plan
and budget;
4. After obtaining preliminary approval from the coordinating AAA supervisor, the
contractor shall prepare a formal list of services the veteran will need, showing the
hourly wage rate, and calculating the budget (i.e., cash management plan) impact;
5. The contractor shall obtain prior, written approval from the coordinating AAA
supervisor for the cash management plan before initiating the veteran’s participantdirected services;
6. Participants begin their services on the first day of a month; and
7. The contractor shall pay the veterans’ payroll within five (5) business days of receipt of
a timesheet that is received by the contractor from the veteran’s participant-directed
worker;
D. An individual’s qualification for enrollment into the DOAS programs is to be determined
by DOAS, and all VD-HCBS participants’ eligibility will be determined by DOAS. DOAS
will provide the contractor with a written set of the eligibility requirements for participants
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and the HCBS/ ADRC database, which will have a record for the individuals who are
eligible for the VD-HCBS program.
E. The contractor’s fiscal counselor shall be required to make the first contact via telephone
within 48 hours of receiving the referral;
F. The contractor shall assign fiscal counselors to the participants as the contractor deems
appropriate; however the participant shall have the right to request and receive a change
in counselors;
G. The contractor shall submit a report to the respective SCM on a biweekly basis of all
participant/ fiscal counselor matches;
H. The respective SCM will provide the contractor with the current Policy & Procedure
Manual at the respective Project Launch meeting. The procedures are similar to those
outlined in this RFP for cash and counseling participants;
I.
The VD-HCBS workflow and a sample VD-HCBS Cash Management Plan can be found in
Exhibit 11 and Exhibit 12, respectively;
J. The VD-HCBS program has specific readiness criteria, as follows. The contractor must
assist DOAS with Readiness Review of new VD-HCBS provider agencies as per federal
regulations. The contractor shall demonstrate capacity to implement the program and
begin facilitation of the services in a consumer-directed fashion so that enrolled veterans:
1. Receive an assessment and care planning assistance;
2. Decide for themselves, or with a participant representative, what mix of goods and
services will best meet their, and their family caregiver’s care needs;
3. Manage a flexible, individual budget;
4. Hire and supervise their own workers, including family or friends;
5. Purchase items or services needed to live independently in the community;
6. Have fiscal management and support services which facilitate service delivery; and
7. Utilize traditional service providers, if desired, to supplement consumer directed care.
K. The contractor shall:
1. Invoice the administrative expense for the VD-HCBS participant-directed services as a
per member/ per month administrative fee; and
2. Deduct counseling costs and check processing costs out of the participant’s budget.
3.21 DDS’ OPERATIONAL REQUIREMENTS
A. In July 2014 NJ Medicaid contracted with MCOs to administer Medicaid services, including
Medicaid Personal Care Assistant (PCA) benefits. The MCOs currently provide both initial
assessments of function and reassessments for all Medicaid PCA recipients, including
those enrolled in or wishing to enroll in PPP;
B. The SCM will communicate the monthly budget amount for each MCO member/
participant to the contractor, who in turn will submit claims to the MCO for services
provided to the member, not to exceed the authorized level;
C. The contractor shall develop and provide a mechanism that supplies a pre-paid swipe card
(i.e., pre-paid debit card) to be used by participants, excluding MCO enrollees, for
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purchase of a pre-authorized type of service (e.g., could be accessed for pre-authorized
transportation service types only);
D. Cash grants are revised by the Using Agency on average three (3) times per year;
E. Invoice PCA reimbursement rates at $15.00 per hour for new participants;
F. Deduct check processing costs, workers’ compensation fees, and background checks
from the participants’ individual budgets, excluding MCO enrollees;
G. Invoice administrative expenses for VF/ EA FMS services for DDS program participants,
excluding MCO enrollees, on a per-member/ per-month basis, and administrative
expenses for counseling services on a fee-for-service basis; and
H. Invoice for special projects for DDS program participants, excluding MCO enrollees, after
prior approval from the SCM for initiating the special project, at an hourly rate [please refer
to Section 9.1 Price Schedule/ Sheet: Price Line No. 07].
3.21.1 PROVIDING COUNSELING SERVICES TO PARTICIPANTS/ AUTHORIZED REPRESENTATIVES
A. The contractor’s FCS functions must coordinate with its VF/ EA FMS functions, as
necessary; and the contractor shall perform the following functions for DDS’ participants:
1. Assist participants in communicating and coordinating with the contractor's VF/ EA
FMS function;
2. Assist participants in developing budgets, including identifying needs and
preferences, defining desired outcomes, identifying the natural supports available to
the participant, identifying services and supports to be purchased by the participant
that are safe and abide by an appropriate risk management strategy, identifying
providers of services and goods, providing technical support during the
implementation of the budget, and identifying options for worker training;
3. Assist participants in monitoring the services included in their budget to ensure the
receipt of appropriate services;
4. Assist participants in monitoring and tracking their budget expenditures and in
requesting reapportionment of service funds and budget adjustments;
5. Ensure that the contractor's FCS staff notifies the contractor’s VF/ EA FMS staff
regarding budget adjustments to ensure changes are implemented within the overall
category or budget;
6. Provide information and guidance to participants in problem-solving, decision-making,
purchasing goods and services, and recognizing and reporting critical events;
7. Assist participants in identifying, analyzing, and prioritizing risks associated with the
participants’ conditions, and work with the participants to develop a written Risk Plan
to manage those risks. The Risk Plan must instruct the participant how to respond to
events that occur and which may impact the scope and delivery of their services. To
develop the Risk Plan, participants and the contractor’s FCS staff must work together
to review the information particular to each participant, such as:
a.
b.
c.
d.
e.
f.
g.
Age;
Diagnosis/ Disability;
Mobility;
Home Environment;
Social/ Leisure Activities;
Safety/ Personal Emergency Response System;
Security;
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h. Medications; and
i. Family/ and other in-home support;
8. Refer fee-for-service participants to the SCM and MCO participants to their respective
MCO for additional assessments or reassessments, as needed;
9. Refer participants for additional employer skills training, as needed;
10. Assist participants in preparing a plan of correction when employers demonstrate a
performance issue (e.g., submitted timesheets exceed authorized hours);
11. Serve as an independent advocate to the participant;
12. Ensure that consultants maintain regular contact with participants. The consultant
shall meet with the participants on a quarterly basis for a face-to-face Home Visit.
The consultant shall make telephone contact with the participants once per month for
the first six (6) months of the program, and then as requested by the participant. The
contractor's consultant may not spend more than twenty (20) hours with any one
particular participant in a twelve- (12) month cycle (from time of enrollment) without
prior approval from the SCM. Requests for additional contact time must be reviewed,
and approved or denied in writing by the SCM, on a case-by-case basis;
13. Provide guidance for workers to meet any minimum training requirements of the Using
Agency or the participant;
14. Ensure that participants are able to implement their services within their budget;
15. At the Using Agency’s request, the contractor must provide ancillary personnel, at a
location to be designated by the SCM, to assist with additional Program functions.
Such functions may consist of, but are not limited to:
a. Assisting with processing participants’ enrollments;
b. Preparing and recording reassessment correspondence for distribution to the field
counselors;
c. Acting as a liaison to the MCO;
d. Performing quality assurance functions, including conducting surveys; and
e. Assisting with initial training of FCS staff;
16. The contractor shall submit quarterly reports on the participants to the SCM; and
a. The contractor shall have reviewed the reports with all participants during quarterly,
face-to-face Home Visits, or more frequently, as needed or as requested by the
participant; and then submitted the participant-reviewed report to the SCM; and
17. The contractor shall teach participants how to use the contractor’s website as it
pertains to functions relevant for participants of self-directed services, including initial
log-on and retrieval and submission of timesheets.
3.22 DDD’S OPERATIONAL REQUIREMENTS
Each participant will be able to utilize their assigned budget to fund services as needed. Each
person is assigned a supports coordinator who facilitates the person-centered planning process.
The support coordination is paid by DDD as an administrative expense for all participants and
does not come out of participant budgets. All participants are enrolled in fee-for-service services.
A. Establish and maintain connection with the DDD’s i-Record system. The SCM will provide
the contractor with access to the i-Record system for a number of Users (who will be
provided with View/ Look-Up access to most of the i-Record information but not all of the i82
Record information, and shall have enough ability to manually post expenditures to the
participants’ accounts);
1. The Supervisor Role shall manage the contractor’s Users;
2. The Regular Users will include a subset of Regular Users with View-Only Roles,
who shall view demographic information; active Plans of Care; expenditures;
historical active records; and historical inactive records (e.g., ineligible participants
and recently deceased participants). and
3. The Regular Users shall post expenditures by manually keying in the information.
B. The participant is considered the managing employer, and as such, creates the position
description, sets the hours of employment for the directly hired worker, manages the
worker, and decides the continuation or termination of employment;
C. DDD will be responsible to provide oversight and assistance to the participants and the
authorized Medicaid providers;
Further, the contractor shall:
D. Execute payment for the individuals who are enrolled in the various participant-directed
services of the CCW; however, a majority of services under the CCW and Supports
Program will be provided by Medicaid-authorized providers; these providers will claim
directly through the fiscal agent’s MMIS for services rendered.
E. Execute payment for the goods and services rendered to participants by providers/
vendors who are ineligible to become authorized Medicaid providers;
F. Act as the Administrator for the required online training provided by the College of Direct
Supports by enrolling any new staff, which includes both staff hired by the individual or by
a non-contracted approved provider agency, into mandatory training as determined by
DDD;
G. Ensure that individual support staff hired by the participant has successfully completed all
mandatory training prior to beginning work;
H. Execute check payments or an Automated Clearing House (ACH) transaction on behalf of
participants as follows:
1. Distribute timesheets, and verify, calculate, and produce payroll for directly hired
workers, who submit their biweekly payroll time sheets directly to the contractor;
2. Produce payment to goods and equipment providers/ vendors, who submit bills/
invoices to the participant, who subsequently forwards the invoices to the
contractor for payment; and
3. The contractor shall develop and provide a mechanism that supplies a pre-paid
swipe card (i.e., pre-paid debit card) to be used by participants for purchases of a
pre-authorized type of service (e.g., could be accessed for pre-authorized
transportation service types only).
I.
If approved by the SCM in advance, the contractor shall reimburse itself for pass-through
amounts owed to the contractor from participants for processing certain administrative
services performed by the contractor on behalf of the participants (i.e., criminal
background checks, fingerprinting, brokering workers’ compensation insurance policies,
etc.);
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J. The contractor shall claim through the fiscal agent’s MMIS for the contractor’s
management of administrative services at a per-member, per-month rate, if the
administrative service was pre-approved by the SCM, as set forth in the Section 9.1 Price
Schedule/ Sheet Price Line No. 05; and the contractor shall claim through the fiscal
agent’s MMIS the payroll for all participants’ directly hired workers;
K. The goal of the Supports Program is to support each individual in the least restrictive
setting in the community, and ensure the participant's health and safety, while respecting
their rights. The Supports Program will support both provider-managed and self-directed
service models on a Statewide basis. This program will have a limited individual cost cap
per person (based on the particular participant’s assessment of need) offering the
participant the opportunity to select from a menu of participant-directed services, including,
at a minimum, the services outlined in DDD’s website, which is located at:
http://nj.gov/humanservices/ddd/documents/service_definitions_supports_program.pdf.
L. As this is a new program, the population of the program participants will grow over the
term of the contract resulting from this RFP. While exact estimates are not guaranteed,
the SCM will provide the contractor with a schedule for a phased implementation of this
program at the Project Launch meeting, and an update will be provided to the contractor
thirty (30) calendar days prior to the operational start date of the Supports Program; and
M. Invoice for special projects for DDD program participants, after prior approval from the
SCM for initiating the special project, at an hourly rate [please refer to Section 9.1 Price
Schedule/ Sheet: Price Line No. 06].
3.23 CONCLUSION OF READINESS REVIEW
The contractor shall complete a Readiness Review evaluation conducted by the SCMs. Approval
to assume the services of the contract resulting from this RFP will be determined by the
contractor’s ability to satisfactorily demonstrate its assumption of the requirements in the RFP’s
SOW.
A. The Readiness Review will include, but is not limited to, confirmation of the following:
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RFP Section
3.4.8.1 D
3.4.8.1 E
3.13
3.13.1.A
3.13.1.B
3.11
3.11
3.1.2
3.1.2
3.7.1
3.20.19; 3.21.1
3.21; 3.22
3.10; 3.10.1; 3.10.2
3.19
3.9
3.9
3.9
3.4.8.2
3.4.8.1
3.4.8.2
3.6.5
Section Description
Diagrams of P&P
Manual’s Processes
Workflow Visuals
Submitting and
Adjudicating Claims to
the Medicaid Fiscal
Agent and MLTSS
MCOs.
The ability to verify
eligibility and
enrollment
electronically.
The ability to verify
eligibility and MCO
enrollment
electronically.
Establish a Line of
Credit
Establish a Cash
Reserve
Submit applicable
resumes; receive
approval for personnel
Establish approved
Work Plan
Establish/Complete
Orientation Meetings
Establish/Complete
Initial Home Visits
Establish Pre-Paid
Swipe Card
Establish Bank
Accounts
Establish Project
Reporting
Establish/Confirm
DDS Cash
Management Plans
Establish/Confirm
DOAS Plans of Care
Establish/Confirm
DDS Plans of Care
Establish Enrollment
Packet
Establish Approved
Policy and Procedure
Manual
Establish Approved
Handbook
Establish Working
Connections to
Medicaid Fiscal Agent
SCM Approval
85
Date of Approval
3.6.6
3.20.1
3.22
3.10.3
3.7.1.1
3.10.1
Establish Working
Connections to All
Managed Care
Organizations named
in this RFP
Establish Working
Connections to DOAS
HCBS/ ADRCS
Establish Working
Connections to DDD iRecord System
Establish Approved
Contract-Related
Accounts Receivable
Methodology
Establish Approved
Contract-Related
Accounts Payable
Methodology
Establish Approved
Contract-Related
Tracking System(s)
B. The SCMs will notify the contractor when/ if the results of the review require a corrective
action plan. Should the contractor not meet the readiness requirements, the respective
SCM will notify the contractor when/ if, based on the results of the review, a corrective
action plan is required (please see RFP Section 3.5.3 Corrective Action Plan for additional
information).
3.24 ESTABLISH AND MAINTAIN FILES AND DOCUMENTATION
A. The contractor shall provide and maintain current and archived files and documentation for
participants, workers, participant-directed goods and services providers and vendors, and
the contractor, itself, in a confidential and secure manner for seven (7) years after
expiration/ termination of the contract resulting from this RFP. The contractor’s files shall
be maintained in an accurate, secure, and confidential manner, and meet all requirements
established under the HIPAA and any other applicable federal and State regulations;
B. The contractor shall cooperate and respond to federal and New Jersey tax questions for
the time period that it represent(s)(ed) the Participant/ Authorized RepresentativeEmployer as its employer agent within ten (10) business days of the time an inquiry is
received by the contractor from the State; and
C. The contractor shall develop and maintain a master checklist for each file described in
RFP Sections 3.24.1 through 3.24.5, as set forth below, to ensure that all required
documents are included in each of these files.
3.24.1 PARTICIPANT/ REPRESENTATIVE-EMPLOYERS’ FILES
A. The contractor shall establish and maintain current participant files in an accurate,
complete, secure, and confidential manner, as set forth below:
1. Participant/ representative-employer’s name;
2. Participant/ representative-employer’s address;
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Participant/ representative-employer’s phone number;
Participant’s Medicaid Identification (MCI) Number;
Participant’s emergency contact person;
Completed Assessments;
Budgets and updates;
DHS PDS Form 1004, Participant/ Representative-Employer Agreement;
DHS PDS Form 1001, Designation of Authorized Representative Form (including
relationship to the participant);
10. DHS PDS Form 1008, Emergency Back-up Worker Backup Plan and Designation
Form;
11. DHS PDS Form 1005, Documentation of Worker Qualification Form;
12. DHS PDS Form 1006, Worker Agreement;
13. DHS PDS Form 1009, Notice of Worker Termination Form;
14. Monthly Progress Notes;
15. Participant/ Representative-Employer Performance Notice and Plan of Correction;
16. DHS PDS Form 1010, Voluntary Termination of Participant-directed Services;
17. Involuntary Termination of Participant-directed Services;
18. Participant’s completed Risk Assessment Profile;
19. Copy of participant/ representative-employer’s Form SS-4, Application for Employer
Identification Number, and federal employer identification number (FEIN);
20. Copy of completed and signed Form 2678, Employer/ Payer Appointment of Agent, and
I.R.S. LTR 1997C, Notice of Appointment;
21. Copy of letter retiring participant/ representative-employer’s FEIN, when applicable;
22. Copy of revoked I.R.S. Form 2678, Employer/ Payer Appointment of Agent, I.R.S. LTR
4228C, Notice of Agency Revocation Letter, and any other related correspondence
from the I.R.S., as applicable;
23. Copy of completed and signed I.R.S. Form 8821, Tax Information Authorization;
24. Copy of I.R.S. Form 8821, Tax Information Authorization, renewal (as applicable) and
any related correspondence from the I.R.S., as applicable;
25. Copy of I.R.S. Form 8821, Tax Information Authorization, revocation (as applicable)
and any related correspondence with the I.R.S., as applicable;
26. Copy of completed Form NJ-REG, Business Registration Application, and State income
tax withholding, unemployment, disability and family leave insurance employer account
number;
27. Copy of the participant/representative-employer’s NJ REG-C, Change of Employer
Information, that indicates he/she no longer has employees;
28. Copy of the NJ Form 927-H, Domestic Employer’s Annual Return (even if its zero
reporting);
29. Copy of the NJ Form WR 30, Employer Report of Wages to be Paid (even if zero
reporting);
30. Copy of documentation of all payments of New Jersey State income tax withholding;
31. Copy of filing and payments of State income tax withholding for New Jersey nonresident employees, as required;
32. Copy of proof of payment of unemployment, and family leave insurance taxes paid for
participant/ representative-employees;
33. Copy of all participant/ representative-employer–specific New Jersey unemployment
insurance benefits payments;
34. Copy of documentation related to any FICA refunding (employer portion) processed
and returned to DHS;
35. Copy of workers’ compensation insurance policies, premium invoices and
documentation of payments, refunds and all notices and correspondence;
36. Copy of completed workers’ compensation audit reports, as applicable,
37. Copy of the I.R.S. Form W-3, if I.R.S. Forms W-2 is filed in paper rather than
electronically;
3.
4.
5.
6.
7.
8.
9.
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38. Documentation of any independent contractors used;
39. Documentation summarizing invoices received and payments made to participantdirected goods and services providers and vendors, including when independent
contractors are used, for authorized services to the participant in accordance with his/
her authorized budget CMP;
40. Documentation for transitioning the participant/ representative-employer from the
current contractor to a new contractor, if applicable, (e.g., retired I.R.S. Forms 2678 and
8821 with current contractor, and I.R.S. Forms 2679 and 8821, executed with the new
contractor, when appropriate);
41. DHS PDS 1014, Fraud Statement; and
42. Other documentation, as applicable.
3.24.2 WORKERS’ FILES
A. The contractor shall establish and maintain current workers’ files in an accurate, complete,
secure, and confidential manner, as set forth below:
1. Copies of current required certifications, licenses and qualifications must be
maintained, and be available for review upon request by the SCM;
2. Worker Employment Application;
3. Copy of DHS PDS Form 1005, Documentation of Worker Qualifications Form;
4. Copy of executed DHS PDS Form 1006, Worker Agreement (considered to be the
Medicaid Provider Agreement);
5. Worker’s name, address, social security number (and verification), FEIN (as
applicable) and occupation;
6. Documentation showing verification that the worker’s social security number matches
the name and date of birth information provided obtained through the Social Security
Administration’s Business Service Online;
7. Dates of employment for each worker;
8. Certification the worker has successfully completed the DHS minimum training
requirements and any other training requirements as documented in the participant’s
budget;
9. Copy of the worker's criminal background checks pursuant to the New Jersey criminal
background check and the FBI Criminal History Check;
10. Worker’s state of residence;
11. If worker is a non-New Jersey resident, how state income tax withholding is to be
withheld, filed, and paid for that worker;
12. Copies of filings and payments of out-of-New Jersey state income tax withholding,
when required;
13. Determination that the worker is a paid family member of the participant who is
exempt from paying into FICA and/ or FUTA per I.R.S. Publication 15 and SUTA, and
documentation that applicable taxes have not been withheld and deposited;
14. Copy of the completed U.S. BCIS Form I-9, Employment Eligibility Verification;
15. Copy of I.R.S. Form W-4, Employee’s Withholding Allowance;
16. New Jersey Form W-4, Employee’s Withholding Allowance, when applicable;
17. Copies of worker's timesheets;
18. Copy of completed New Jersey New Hire Reporting documentation;
19. Copy of documentation regarding all judgments, garnishments and tax levies, or any
related holds on the worker’s pay, as may be required by federal or State
government(s);
20. Copy of completed I.R.S. Forms W-2 and W-2(c), as applicable;
21. Copy of documentation regarding all FICA refunds processed (employee portion) and
a copy of cancelled refund checks;
88
22. Copy of documentation of requests for verification of worker's wages, requested by
federal and New Jersey agencies, as applicable;
23. Copy of documentation of all workers’ compensation insurance claims filed by a
worker, or documentation that the contractor made every attempt to obtain the
documentation;
24. Copy of documentation of submission of worker's returned/ not cancelled payroll
checks, FICA refund checks, or any other payments due to, and in accordance with,
the policies and procedures of the N.J. Department of the Treasury's Unclaimed
Property requirements;
25. Copy of documentation related to direct deposit or debit card payroll option, as
applicable;
26. Copy of DHS PDS Form 1009, Notice of Worker Termination Form;
27. Copy of completed Department of Labor and Workforce Development Reason for
Separation Form;
28. Notice for State unemployment, disability insurance and family leave insurance;
29. DHS PDS 1014 Fraud Statement; and
3.24.3 PARTICIPANT-DIRECTED GOODS AND SERVICES PROVIDERS AND VENDORS FILES
A. The contractor shall establish and maintain current files for participant-directed goods and
services providers and vendors in an accurate, complete, secure, and confidential manner,
as set forth below:
1. Copy of invoices from participant-directed goods and services providers and vendors
for authorized participant-directed goods and services rendered;
2. Copy of payment documentation for authorized participant-directed goods and services
rendered by providers and vendors;
3. DHS PDS 1013 Form, Participant-directed Goods and Services Provider/ Vendor
Agreement (considered to be a Medicaid Provider Agreement);
4. Copy of potential independent contractor’s completed I.R.S. Form SS-8, Determination
of Worker Status for Purposes of Federal Employment Taxes and Income Tax
Withholding, and I.R.S. worker employment status ruling letter, as applicable;
5. Copy of independent contractor’s I.R.S. Form W-9, Request for Taxpayer Identification
Number and Certification, as applicable;
6. Copy of the I.R.S. Form 1099-Misc, Miscellaneous Income, when an independent
contractor is paid $600 or more in a calendar year, as applicable;
7. Copy of I.R.S. Form 1096, Annual Summary and Transmittal of U.S. Information
Returns, as applicable;
8. DHS PDS 1014, Fraud Statement; and
3.24.4 VF/ EA FMS FILE
A. The contractor shall establish and maintain current files related to the activities of the VF/
EA FMS division. Such files must be kept in an accurate, complete, secure, and
confidential manner, and in accordance with HIPAA and other federal and New Jersey
recordkeeping requirements, as applicable, and as set forth below:
1. Copy of executed contract resulting from this RFP;
2. Copy of Medicaid Provider Agreement, providing evidence of the contractor’s Medicaid
Provider number and executed between the contractor and DHS;
3. Copy of Contracts/ Agreements with each MLTSS MCO;
89
4. Copy of documentation that the contractor is registered as a business entity in New
Jersey and related documentation, as required, for the contractor to conduct business
in the State;
5. Copy of documentation verifying financial viability;
6. Documentation regarding the I.R.S. Form SS-4 to obtain the contractor’s separate
FEIN, FEIN Notification from the I.R.S., and the retirement of the VF/ EA FMS entity’s
separate FEIN, when/ if applicable;
7. Aggregate quarterly filings of I.R.S. Forms 941, Schedule R, Schedule B, as
appropriate, and Form 941-X, as appropriate (federal income tax withholding and FICA
[Social Security and Medicare]), with individual-level income tax withholding and FICA
filing back-up for each participant/ representative-employer and worker;
8. Aggregate payments of FICA and federal income tax withholding per I.R.S. depositing
schedule and the individual-level tax payment back-up for each participant/
representative-employer and worker;
9. Documentation of the receipt of aggregate FICA refunds and documentation on the
individual-level related to FICA refunds (participant/ representative-employers and
workers);
10. Aggregate annual filings of I.R.S. Forms 940 (FUTA) and Schedules;
11. Aggregate payments of FUTA and the individual-level payment back-up for each
Participant/ Authorized Representative-Employer;
12. All communications with federal and State governmental agencies; and
3.24.5 FINANCIAL COUNSELING FILE
A. The contractor shall establish and maintain current files related to its counseling function
and related activities, in an accurate, complete, secure, and confidential manner and in
accordance with HIPAA and other federal and New Jersey recordkeeping requirements,
as applicable, and as set forth below:
1. Participant's Budget Plans (i.e., Cash Management Plans, Plans of Care, and Service
Plan Budget Vouchers) and Updates;
2. Consent Form to Participate in PPP;
3. Participant’s Rights and Responsibilities Form;
4. Participant Risk Assessment Profile;
5. Quarterly Report Forms Related Participant Activity;
6. Monthly Progress Notes based on Participant Activity; and
3.25 TURNOVER PERIOD
The objective of the turnover period is to ensure an orderly turnover of the VF/ EA financial
management and counseling services to the Using Agencies, or to a successor contractor, at the
expiration of, or upon termination of, the contract resulting from this RFP.
A. The turnover period shall begin one hundred and eighty (180) calendar days prior to the
contract’s expiration or termination date, and shall conclude upon expiration or termination
of the contract resulting from this RFP, as set forth in RFP Section 5.3;
B. The contractor shall cooperate with the SCMs, and the successor contractor(s), at the
direction of the SCMs, during the turnover period. All data and information provided by the
contractor, as required by the contract, shall be accompanied by letter, and signed by the
contractor’s authorized representative or his/ her designee, attesting that the supplied
material(s) is/ are current, accurate, and complete;
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C. The contractor shall perform all of its contract obligations through the contract’s expiration
or termination, including, but not limited to, continuing the production and delivery of all
year-end tax related activities, which will occur even after the contract’s expiration or
termination (e.g., processing end-of-year forms);
D. Given the uncertainties associated with contract-end activities, the contractor shall be
flexible to changing requirements. Therefore, the order, timeline or structure of the
turnover period may be adjusted, at the direction of the SCM, from those required in the
contract resulting from this RFP. If any adjustments result in workload not compensated in
the contract price for the turnover period and its activities, contractor reimbursement will
be adjusted through a mutually agreed upon contract change process; and
E. Maintain the toll-free telephone number for one hundred and eighty (180) days after the
contract’s expiration to include a message directing callers to the new telephone number,
if applicable.
3.26 SECURITY AND CONFIDENTIALITY
A. The contractor(s) shall provide a detailed system design document showing its plans for
security and disaster recovery. Logical and physical diagrams are required.
3.26.1 SECURITY PLAN
A. The contractor shall provide a Security Plan for the proposed solution. The contractor’s
Security Plan must, at a minimum, provide security measures for the following areas:
1.
2.
3.
4.
5.
Facilities physical security;
System Security;
Systems Data Security;
Network Security; and
Administrative and Personnel Security.
B. The Security Plan shall provide for the respective SCM’s review and prior approval of the
contractor’s operations and control systems for the proposed solution before
implementation. The contractor’s personnel must have the capability to detect and report
attempted unauthorized entries into the facility and system. All security requirements for
the contractor shall apply to development, testing, production, and backup systems.
C. In addition, in the Security Plan, the contractor shall identify, address and/ or define the
requirements described in Section 5.9.
3.26.2 DISASTER RECOVERY
A. The contractor(s) shall provide and maintain a disaster recovery process for restoring
software, master files, and hardware backup if information systems are disabled so that
services are not disrupted. The disaster recovery process shall be documented in a written
Disaster Recovery Plan submitted for approval to the respective SCM within ten (10)
business days, and tested within four (4) business weeks of the Project Launch Meeting.
The Plan must detail how the contractor will ensure that the primary location and/ or
systems destroyed in such a disaster would be made available within 24 hours, in the
event the primary location is rendered unusable. The Plan must be annually reviewed and
tested thereafter within thirty (30) calendar days of the contract’s effective date. The
contractor(s) shall deliver to the respective SCM results of the testing within five (5)
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business days of testing, to include the method of correction and timeframe for any failed
testing area.
3.26.3 STATE TECHNOLOGY REQUIREMENTS AND STANDARDS
A. The contractor shall conform to the security and infrastructure review processes that are
required by OIT and its partner Departments and Agencies. The contractor shall submit
documentation, as requested by the respective SCM, and participate in the System
Architecture Review (SAR) process. Additional information on this process is located at:
http://www.nj.gov/it/reviews/.
3.26.4 SYSTEM DESIGN
A. The contractor shall conform to the State’s architecture review (SAR) process, and shall
develop a system that follows the State of New Jersey’s Shared IT Architecture, which is
located at: http://www.nj.gov/it/ps/Shared_IT_Architecture.pdf;
B. The contractor shall replicate all State data on its system(s) to a State system, to be
designated by the respective SCM, in a format and frequency as defined by the respective
SCM, no less frequently than once a month;
C. The respective SCM and the contractor shall establish a collaborative governance
structure as part of the design and development of service delivery;
D. The contractor shall identify, and provide a listing to the respective SCM at the project
launch, all of its strategic business partners, who will be involved in any application
development and/ or operations;
E. The State has a mature enterprise data warehousing environment that is based upon a
hub-and-spokes model, with a fairly normalized data warehouse hub supplying data to
multiple physical and virtual data marts using conformed dimensions. The data warehouse
hub is the State’s interface mechanism for system-to-system batch data transfers;
1. Where batch data from other State systems is required by the contractor’s system for
operational functionality, that data shall be routed through the enterprise data
warehousing staging area. Independent feeds of operational data from individual
source systems are not permitted;
2. Where there is a need to combine data from the contractor’s system with data from
other systems purely for analytical purposes, the contractor shall supply data to the
enterprise data warehouse where that integration will occur; and
3. Independent data warehouse silos based upon a transactional system are not
permitted. The Contractor shall supply data from its system to the enterprise data
warehouse on a nightly basis to support other State analytical needs.
3.26.5 HOSTING AND BACKUP SERVICES
A. For “outsourced hosting services,” the contractor must secure the physical application
infrastructure utilizing the above mentioned security requirements, and also control and
secure physical access to the application hosting facilities, the racks supporting network
infrastructure, processing server equipment, web, application and database servers. The
backed-up data shall not be co-mingled with another’s customer data; and
B. If the contractor is not supplying dedicated hardware resources to host applications and
data for this contract, the contractor must maintain application and/ or stack isolation using
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commercially available security devices to maintain security zones, routing isolation, and
access control to infrastructure devices and access/ security logging, with authentication,
authorization, and accounting services (AAA), within its infrastructure.
3.26.6 EXTRANET PLAN
A. The communication links between the State of New Jersey and the contractor can be
through a Multiprotocol Label Switching (MPLS) cloud (preferred) or Internet Protocol
Security (IPsec) tunnel over the Internet based upon approval from the respective SCM.
Once the communication links are established, and the respective SCM confirms to the
contractor that testing is completed, the OIT Hub will be the primary link to the contractor;
B. The contractor shall provide and maintain two (2) extranet communication links into the
State of New Jersey. One of these links will be active and one will be a "hot" spare. These
links shall terminate as follows:
C. Link 1 – Ethernet speed or greater communication circuit shall be established from the
contractor's data or communication center to the State of New Jersey’s Primary Data
Center at OIT HUB, 1 Schwarzkopf Drive, West Trenton, NJ to operate as the primary
data path. This data circuit shall provide the primary path and should terminate on the
State of New Jersey side into the contractor-owned and maintained equipment, which in
turn would provide an Ethernet connection to the State’s Extranet Partner access point at
OIT Hub (firewall); and
D. Link 2 – Ethernet speed or greater communication circuit shall be established from the
contractor's data or telecommunication center to the State of New Jersey’s SAC Data
Center - River Road PO Box 7068 W. Trenton, NJ 08628 to operate as the secondary data
path. This data circuit will provide a secondary backup path and should terminate on the
State of New Jersey side into the contractor-owned and maintained equipment, which in
turn would provide an Ethernet connection to the State’s Extranet access point at SAC
(firewall); and
State of NJ
Primary
Contractor
Primary
State of NJ
Secondary
Contractor
Secondary
E. The contractor must work with the respective SCM and OIT to establish an extranet
partner relationship. Please refer to the State of New Jersey’s extranet policy 09-11-NJOIT
http://www.nj.gov/it/reviews/forms/0137_Information_Security_Certification_Accreditation_
Checkli st.pdf; and
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F. In addition, the contractor must work with OIT’s network group: to establish the appropriate
routing protocols based on the system requirements; and OIT’s security group: to establish
appropriate firewall rule sets for business data flow.
3.26.7 TRANSMISSION OF FILES
A. The State of New Jersey supports multiple methods for data transfers internally within the
Garden State Network or external to an extranet or business partner. The transmission of
all files between the contractor and the State system must be transferred securely using
the State file transfer methodology. The contractor shall coordinate with the respective
SCM in the implementation of the file transfer process;
B. The State of New Jersey provides both asynchronous and synchronous file transfer
methodologies.
Synchronous:
1. Connect:Direct Secure ++ is a supported option for file exchange with the State of New
Jersey’s IBM mainframe;
2. FTPS over SSL (Explicit – port 21) is a supported option for file exchange for
connections originating from the State of New Jersey’s IBM Mainframe. RFC2228; and
3. SFTP (FTP over SSHv2 or greater) is a supported option for file exchange with the
State of New Jersey’s distributed servers (non-IBM Mainframe); and
Asynchronous:
1. The State of New Jersey’s DataMotion is a supported option for non-automated or adhoc file exchange with the State of New Jersey. A client license is required for this
option; and
2. The State of New Jersey’s DataMotion-DataBridge is a supported option for automated
file exchange with the State of New Jersey; and.
C. All file transfers with the State system shall be tested prior to full implementation;
D. During the life of the contract, the State may revise or change the file transfer method and/
or format for the transmission of files to accommodate real time processing; use case
specific information and the contractor’s solution shall conform to all requirements;
E. The secure file transfer must meet the state and federal security guidelines and standard;
and
F. For additional information, please refer to the following publication: NIST Special
Publication 800-47 - Security Guide for Interconnecting Information Technology Systems
(http://csrc.nist.gov/publications/nistpubs/800-47/sp800-47.pdf).
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4.0 PROPOSAL PREPARATION AND SUBMISSION
4.1 GENERAL
Proposals including supplemental terms and conditions may be accepted, but supplemental terms
or conditions that conflict with those contained in this RFP or the State's NJ Standard Terms and
Conditions (“RFP/SSTC”), as may be amended by addenda, or that diminish the State’s rights
under any contract resulting from the RFP will be considered null and void. The State is not
responsible for identifying conflicting supplemental terms and conditions before issuing a contract
award. In the event that prior to notice of intent to award, the Division notifies the Bidder of any
such term or condition and the conflict it poses, the Division may require the Bidder to either
withdraw it or withdraw its proposal. After award of contract:
a) if conflict arises between a supplemental term or condition included in the proposal and a
term or condition of the RFP/SSTC, the term or condition of the RFP/SSTC will prevail;
and
b) if the result of the application of a supplemental term or condition included in the proposal
would diminish the State’s rights, the supplemental term or condition will be considered
null and void.
The Bidder is advised to thoroughly read and follow all instructions contained in this RFP,
including the instructions on the RFP’s signatory page, in preparing and submitting its proposal.
Use of URLs in a proposal should be kept to a minimum and may not be used to satisfy any
material term of an RFP. If a preprinted or other document included as part of the proposal
contains a URL, a printed (or if a proposal is submitted electronically, electronic) copy of the URL
page shall be provided and will be considered as part of the proposal. Additional URLs on the
copy of the URL page shall not be considered as part of the proposal unless a copy of those URL
pages are also provided.
The forms discussed herein and required for submission of a proposal in response to this
RFP are available on the web at
http://www.state.nj.us/treasury/purchase/bid/summary/16-x-23964.shtml
unless noted otherwise.
4.2 PROPOSAL DELIVERY AND IDENTIFICATION
In order to be considered, a proposal must arrive at the Division in accordance with the
instructions on the RFP signatory page accompanying this RFP. Bidders are cautioned to allow
adequate delivery time to ensure timely delivery of proposals. State regulation mandates that
late proposals are ineligible for consideration. THE EXTERIOR OF ALL PROPOSAL
PACKAGES ARE TO BE LABELED WITH THE PROPOSAL IDENTIFICATION NUMBER AND
THE FINAL PROPOSAL SUBMISSION DATE OR RISK NOT BEING RECEIVED IN TIME.
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4.3 EBID VS. NON-EBID SUBMISSION INSTRUCTION
4.3.1 EBID SUBMISSION OF PROPOSAL
If the bidder is submitting an eBid proposal, hard copy submission is still required, please see
Section 4.3.2 for the number of complete and exact copies. Instructions detailing how to enroll in
and submit an eBid are available on the web at https://wwwnet1.state.nj.us/treasury/dpp/ebid/. If
the bidder submits both an eBid and a hard copy of the bidder's proposal, the eBid proposal will
prevail in the event of a discrepancy between the electronic and paper versions.
When submitting an eBid, do not use any symbols (i.e., #, @, $, &, *) in the filename. In addition,
the bidder should name each converted PDF electronic file and folder as follows:
Volume 1 Section 1 Forms
Volume 1 Section 2 Technical Proposal
Volume 1 Section 3 Organizational Support and Experience
Volume 2 Section 4 Cost Proposal
If exhibits or attachments are submitted as part of your proposal, the exhibits/ attachments should
be clearly labeled to accurately describe the form being submitted.
If a table of contents is provided, hyperlinks to the specific sections are preferred.
4.3.2 NON-EBID SUBMISSION
The bidder must submit the following proposal copies:
One (1) complete ORIGINAL proposal, clearly marked as the “ORIGINAL” proposal.
Six (6) complete and exact copy(ies), clearly marked "COPY".
One (1) unbound, complete and exact copy of the original, clearly marked "COPY.
One (1) complete and exact ELECTRONIC copy of the original proposal in an editable and
"writable" PDF file format on disc (CD or DVD) for redaction. Note: the electronic copy must be
editable.
Copies are necessary in the evaluation of the proposal and for record retention purposes. A
bidder failing to provide the requested number of copies will be charged the cost incurred by the
State in producing the requested number of copies. The bidder should make and retain a copy of
its proposal.
4.4 PROPOSAL CONTENT
The proposal should be submitted in two volumes with the content of each volume as indicated
below.
Volume 1
Section 1 - Forms (Sections 4.4.1 and 4.4.2)
Section 2 - Technical Proposal (Section 4.4.3) – NOTE: This section of the bidder’s
submission is limited to 25 pages or fewer, with no smaller than a 12 point font.
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Section 3 - Organizational Support and Experience (Section 4.4.4)
Volume 2
Section 4 – Price Schedule (Section 4.4.5)
Exhibits and Attachments are not counted toward the 25-page page count.
4.4.1 FORMS, REGISTRATIONS AND CERTIFICATIONS REQUIRED WITH PROPOSAL
4.4.1.1 SIGNATORY PAGE
The bidder shall complete, including signature of an authorized representative of the bidder, and
submit the Signatory Page accompanying this RFP. If the bidder is a limited partnership, the
Signatory Page must be signed by a general partner.
If the bidder is a joint venture, the
Signatory Page must be signed by a principal of each party to the joint venture. Failure to comply
will result in rejection of the proposal.
Note: A bidder’s written signature on the Signatory Page, or entry of a Personal
Identification Number (PIN) if using the eBid system, shall not serve as a certifying
signature on the forms comprising the NJ STANDARD RFP FORMS document. (See
4.4.1.2)
4.4.1.1.1 MACBRIDE PRINCIPLES CERTIFICATION
The bidder must certify pursuant to N.J.S.A. 52:34-12.2 that it is in compliance with the MacBride
principles of nondiscrimination in employment as set forth in N.J.S.A. 52:18A-89.5 and in
conformance with the United Kingdom’s Fair Employment (Northern Ireland) Act of 1989, and
permit independent monitoring of their compliance with those principles. Please refer to Section
2.5 of the State of NJ Standard Terms and Conditions and N.J.S.A. 52:34-12.2 for additional
information about the MacBride principles.
By signing the RFP Signatory Page, or by entering its PIN if submitting an eBid proposal, the
bidder/offeror is automatically certifying that either:
a. The bidder has no operations in Northern Ireland; or
b. The bidder has business operations in Northern Ireland and is committed to
compliance with the MacBride principles.
A bidder/offeror electing not to certify to the MacBride Principles must nonetheless sign the RFP
Signatory Page AND must include, as part of its proposal, a statement indicating its refusal to
comply with the provisions of this Act.
4.4.1.1.2 NO SUBCONTRACTOR CERTIFICATION
For a proposal that does NOT include the use of any subcontractors, by signing the RFP
Signatory Page, or by entering a PIN if submitting an e-Bid proposal, the bidder is automatically
certifying that:
1. In the event the award is granted to bidder’s firm and the bidder later determines at
any time during the term of the Contract to engage subcontractors to provide certain
goods and/or services, pursuant to Section 5.8 of the State of NJ Standard Terms and
Conditions, the bidder will submit a Subcontractor Utilization Plan form for approval to
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the Division of Purchase and Property in advance of any such engagement of
subcontractors.
2. If the contract is a small business subcontracting set-aside, the bidder certifies that in
engaging subcontractors, it will make a good faith effort to achieve the subcontracting
set-aside goals, and will attach to the Subcontractor Utilization Plan documentation of
such efforts in accordance with N.J.A.C. 17:13-4 et seq.
4.4.1.1.3 NON-COLLUSION
By submitting a proposal, the bidder certifies as follows:
a. The price(s) and amount of its proposal have been arrived at independently and
without consultation, communication or agreement with any other contractor, bidder or
potential bidder.
b. Neither the price(s) nor the amount of its proposal, and neither the approximate
price(s) nor approximate amount of this proposal, have been disclosed to any other
firm or person who is a bidder or potential bidder, and they will not be disclosed before
the proposal submission.
c. No attempt has been made or will be made to induce any firm or person to refrain from
bidding on this contract, or to submit a proposal higher than this proposal, or to submit
any intentionally high or noncompetitive proposal or other form of complementary
proposal.
d. The proposal of the firm is made in good faith and not pursuant to any agreement or
discussion with, or inducement from, any firm or person to submit a complementary or
other noncompetitive proposal.
e. The bidder, its affiliates, subsidiaries, officers, directors, and employees are not
currently under investigation by any governmental agency and have not in the last four
(4) years been convicted or found liable for any act prohibited by state or federal law in
any jurisdiction, involving conspiracy or collusion with respect to bidding on any public
contract.
4.4.1.1.4 NEW JERSEY BUSINESS ETHICS GUIDE CERTIFICATION
The Treasurer has established a business ethics guide to be followed by State contractors in their
dealings with the State. The guide provides further information about compliance with Section 2.8
of the State of New Jersey Standard Terms and Conditions. The guide can be found at:
http://www.state.nj.us/treasury/purchase/ethics_guide.shtml.
By signing the RFP signatory page, or by entering a pin if submitting an e-bid proposal, the bidder
is automatically certifying that it has read the guide, understands its provisions and is in
compliance with its provisions.
4.4.1.2 NJ STANDARD RFP FORMS
One of the downloadable RFP documents is titled NJ STANDARD RFP FORMS. It is comprised
of three separate forms, two of which (Ownership Disclosure and Disclosure of Investment
Activities in Iran) discussed below, must be completed, signed and submitted with the bidder’s
proposal. The bidder is cautioned that failure to complete, sign and submit either of these
two forms will be cause to reject its proposal as non-responsive as noted below. If the
bidder submits a hard copy proposal, each of the two forms must be physically signed.
If the bidder is submitting an electronic proposal through the Division’s eBid system, there are
only two acceptable forms of signature for the two forms:
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1. The bidder may download the document, physically complete and sign each form, scan
the completed document and then upload it, or
2. The bidder may download the document, type the name of the signatory in the space
designated for certification signature in each of the forms and then upload the document.
Note: A bidder’s entry of a Personal Identification Number (PIN) shall not suffice as a
certifying signature on the forms comprising the NJ STANDARD RFP FORMS document.
4.4.1.2.1 OWNERSHIP DISCLOSURE FORM
Pursuant to N.J.S.A. 52:25-24.2, in the event the bidder is a corporation, partnership or sole
proprietorship, the bidder must complete and sign the attached Ownership Disclosure Form. A
current completed Ownership Disclosure Form must be received prior to or accompany the
submitted proposal. A bidder’s failure to submit the completed and signed form with its proposal
will result in the rejection of the proposal as non-responsive and preclude the award of a contract
to said bidder unless the Division has on file a signed and accurate Ownership Disclosure Form
dated and received no more than six months prior to the proposal submission deadline for this
procurement. If any ownership change has occurred within the last six months, a new Ownership
Disclosure Form must be completed, signed and submitted with the proposal.
4.4.1.2.2 DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN FORM
Pursuant to N.J.S.A. 52:32-58, the bidder must utilize this Disclosure of Investment Activities in
Iran form to certify that neither the bidder, nor one of its parents, subsidiaries, and/or affiliates (as
defined in N.J.S.A. 52:32-56(e)(3)), is listed on the Department of the Treasury’s List of Persons
or Entities Engaging in Prohibited Investment Activities in Iran and that neither the bidder, nor one
of its parents, subsidiaries, and/or affiliates, is involved in any of the investment activities set forth
in N.J.S.A. 52:32-56(f). If the bidder is unable to so certify, the bidder shall provide a detailed and
precise description of such activities as directed on the form. A bidder’s failure to submit the
completed and signed form with its proposal will result in the rejection of the proposal as nonresponsive and preclude the award of a contract to said bidder.
4.4.1.3 SUBCONTRACTOR UTILIZATION PLAN
All bidders intending to use a subcontractor must submit a completed Subcontractor Utilization
Plan. Please see the State of New Jersey, Division of Purchase and Property’s Subcontractor
Forms which includes the Subcontractor Utilization Plan form.
4.4.1.4 SMALL BUSINESS REGISTRATION FOR SET-ASIDE CONTRACTS
Pursuant to the provisions of N.J.S.A. 52:32-17 and N.J.A.C. 17:13, this contract, or a portion
thereof, has been designated as a set-aside contract for small business. As such, as indicated on
page one of this document, eligibility to bid is limited to bidders that meet statutory and regulatory
requirements and have had their eligibility determined by the New Jersey Division of Revenue and
Enterprise Services, Small Business Registration and M/WBE Certification Services Unit.
As defined at N.J.A.C. 17:13-1.2, "Small Business" means a business that is incorporated or
registered in and has its principal place of business in the State of New Jersey, is independently
owned and operated, and has no more than 100 full-time employees. The program places small
business into the following categories: (i) those with gross revenues not exceeding $500,000; (ii)
those with gross revenues not exceeding $5 million; and (iii) those with gross revenues that do not
exceed $12 million, or the applicable federal revenue standards established at 13 CFR §121.201,
whichever is higher. While companies registered as having revenues below $500,000 can bid on
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any contract, those earning more than the $500,000 and $5 million amounts will not be permitted
to bid on contracts designated for revenue classifications below their respective levels.
Inasmuch as this is a full or partial set-aside contract, the bidder should provide, as part of its
response to this solicitation, proof of its current registration as a qualifying small business with the
New Jersey Division of Revenue and Enterprise Services, Small Business Registration and
M/WBE Certification Services Unit. Application and registration requirements are presented on
the web at: http://www.nj.gov/njbusiness/contracting/ or by contacting that agency during
business hours as indicated below.
NEW JERSEY DEPARTMENT OF THE TREASURY
DIVISION OF REVENUE AND ENTERPRISE SERVICES
SMALL BUSINESS REGISTRATION AND M/WBE CERTIFICATION SERVICES UNIT
33 WEST STATE STREET – FIFTH FLOOR
PO BOX 026, TRENTON, NJ 08625-0026
TELEPHONE: 609-292-2146
FAX #: 609-292-8764
** IF THE BIDDER IS AN INCUMBENT CONTRACTOR AND/OR HAS PREVIOUSLY
REGISTERED OR BEEN CERTIFIED UNDER THE FORMER SBE/MBE/WBE PROGRAM, THE
BIDDER SHOULD ENSURE IT IS REGISTERED ON THE DAY OF PROPOSAL RECEIPT AND
OPENING WITH THE DIVISION OF REVENUE AND ENTERPRISE SERVICES, SMALL
BUSINESS REGISTRATION AND M/WBE CERTIFICATION SERVICES UNIT TO BE ELIGIBLE
FOR AWARD.
IN ORDER TO EXPEDITE THE SMALL BUSINESS REGISTRATION PROCESS FOR THIS
PROCUREMENT, THE BIDDER MAY FAX A COPY OF RFP PAGE ONE (1) REFLECTING
THE PROPOSAL SUBMISSION DATE ALONG WITH THE COMPLETED SMALL BUSINESS
REGISTRATION FORM TO THE NEW JERSEY DIVISION OF REVENUE AND ENTERPRISE
SERVICES, SMALL BUSINESS REGISTRATION AND M/WBE CERTIFICATION SERVICES
UNIT TO THE FAX NUMBER ABOVE.
4.4.1.4.1 SMALL BUSINESS SUBCONTRACTING SET-ASIDE CONTRACTS
This is a Partial Set-Aside Contract for Category I, II, or III for Small Businesses. The Bidder
must be registered as a qualifying small business with the Division of Revenue and Enterprise
Services, Small Business Registration and M/WBE Certification Services Unit by the date the
proposal is received and opened. Evidence that the Bidder has registered as a small business
should be submitted with the proposal.
4.4.1.4.2 SMALL BUSINESS SUBCONTRACTING SET-ASIDE CONTRACTS
This is a contract with set-aside subcontracting goals for New Jersey Small Business
Enterprises. If the bidder intends to subcontract, it must submit a Subcontractor Utilization Plan.
If the bidder intends to subcontract, the bidder should take the following actions to achieve the
set-aside subcontracting goal requirements:
1. Attempt to locate eligible small businesses in Categories I, II, and III appropriate to the
RFP;
2. Request a listing of small businesses by Category from the New Jersey Division of
Revenue and Enterprise Services, Small Business Registration and M/WBE Certification
Services Unit;
3. Record efforts to locate eligible businesses, including the names of businesses contacted
and the means and results of such contacts;
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4. Provide all potential subcontractors with detailed information regarding the specifications;
5. Attempt, whenever possible, to negotiate prices with potential subcontractors submitting
higher than acceptable price quotes;
6. Obtain, in writing, the consent of any proposed subcontractor to use its name in response
to the RFP; and,
7. Maintain adequate records documenting efforts to achieve the set-aside subcontracting
goals.
Proposals should also contain a copy of the New Jersey Division of Revenue and Enterprise
Services, Small Business Registration and M/WBE Certification Services Unit’s proof of
registration as a small business for any business proposed as a subcontractor; and
documentation of the bidder’s good faith effort to meet the targets of the set-aside subcontracting
requirement in sufficient detail to permit the Proposal Review Unit of the Division to effectively
assess the bidder’s efforts to comply if the bidder has failed to attain the statutory goals.
If the bidder chooses to use subcontractors and fails to meet the small business subcontracting
targets set forth above, the bidder must submit documentation demonstrating its good faith effort
to meet the targets with its proposal or within seven (7) business days upon request.
NOTE: A BIDDER’S FAILURE TO SATISFY THE SMALL BUSINESS SUBCONTRACTING
TARGETS OR PROVIDE SUFFICIENT DOCUMENTATION OF ITS GOOD FAITH EFFORTS TO
MEET THE TARGETS WITH THE PROPOSAL OR WITHIN SEVEN (7) DAYS UPON REQUEST
SHALL PRECLUDE AWARD OF A CONTRACT TO THE BIDDER.
If awarded the contract, the bidder shall notify each subcontractor listed in the Plan, in writing.
Each bidder awarded a contract for a procurement which contains the set-aside subcontracting
goal requirement shall fully cooperate in any studies or surveys which may be conducted by the
State to determine the extent of the bidder’s compliance with N.J.A.C. 17:13-1.1 et seq., and this
RFP.
4.4.1.5 BID SECURITY
4.4.1.6 PRICING
The bidder must submit its pricing on the State supplied Price Schedule/ Sheet and supply any
additional pricing information as directed in RFP Section 4.4.5.
4.4.2 FORMS REQUIRED BEFORE CONTRACT AWARD AND THAT SHOULD BE SUBMITTED WITH
THE PROPOSAL
4.4.2.1 BUSINESS REGISTRATION
In accordance with N.J.S.A. 52:32-44(b), a bidder and its named subcontractors must have a valid
Business Registration Certificate (“BRC”) issued by the Department of Treasury, Division of
Revenue and Enterprise Services prior to the award of a contract. To facilitate the proposal
evaluation and contract award process, the bidder should submit a copy of its valid BRC and
those of any named subcontractors with its proposal. Refer to Section 2.1 of the State of NJ
Standard Terms and Conditions.
Any bidder, inclusive of any named subcontractors, who does not have a valid business
registration at the time of the proposal submission opening or whose BRC was revoked prior to
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the submission of the proposal should proceed immediately to register its business or seek reinstatement of a revoked BRC. Bidders are cautioned that it may require a significant amount of
time to secure the re-instatement of a revoked BRC. The process can require actions by both the
Division of Revenue and Enterprise Services and the Division of Taxation. For this reason, a
bidder’s early attention to this requirement is highly recommended. The bidder and its named
subcontractors may register with the Division of Revenue and Enterprise Services, obtain a copy
of an existing BRC or obtain information necessary to seek re-instatement of a revoked BRC
online at http://www.state.nj.us/treasury/revenue/busregcert.shtml.
A bidder otherwise identified by the Division as a responsive and responsible bidder, inclusive of
any named subcontractors, but that was not business registered at the time of submission of its
proposal must be so registered and in possession of a valid BRC by a deadline to be specified in
writing by the Division. A bidder who fails to comply with this requirement by the deadline
specified by the Division will be deemed ineligible for contract award. Under any circumstance,
the Division will rely upon information available from computerized systems maintained by the
State as a basis to verify independently compliance with the requirement for business registration.
A bidder receiving a contract award as a result of this procurement and any subcontractors
named by that bidder will be required to maintain a valid business registration with the Division of
Revenue and Enterprise Services for the duration of the executed contract, inclusive of any
contract extensions.
4.4.2.2 DISCLOSURE OF INVESTIGATIONS AND ACTIONS INVOLVING BIDDER FORM
The bidder should submit the Disclosure of Investigations and Actions Involving Bidder Form, one
of the three forms in the downloadable RFP documents titled NJ STANDARD RFP FORMS with
its proposal, to provide a detailed description of any investigation, litigation, including
administrative complaints or other administrative proceedings, involving any public sector clients
during the past five (5) years, including the nature and status of the investigation, and, for any
litigation, the caption of the action, a brief description of the action, the date of inception, current
status, and, if applicable, disposition. If a bidder does not submit the form with the proposal, the
bidder must comply within seven (7) business days of the State’s request or the State may deem
the proposal non-responsive.
4.4.2.3 SERVICES SOURCE DISCLOSURE CERTIFICATION FORM
Pursuant to N.J.S.A. 52:34-13.2, prior to an award of contract, the bidder is required to submit a
completed source disclosure form. The bidder’s inclusion of the completed Services Source
Disclosure Form with the proposal is requested and advised. Refer to RFP Section 7.1.2 for
additional information concerning this requirement.
4.4.3 TECHNICAL PROPOSAL
In this section, the bidder shall describe its approach clearly and thoroughly and provide detailed
plans for accomplishing the work outlined in the Scope of Work section, i.e., Section 3.0 within
the time frames specified in the RFP. The bidder must set forth its understanding of the
requirements of this RFP and its ability to successfully mobilize its operation and complete the
contract. This section of the proposal should minimally contain the information identified below.
4.4.3.1 MANAGEMENT OVERVIEW
The bidder should set forth its overall technical approach and plans to meet the requirements of
the RFP in a narrative format. This narrative should demonstrate to the State that the bidder
understands the objectives that the contract is intended to meet, the nature of the required work
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and the level of effort necessary to successfully complete the contract. This narrative should
demonstrate to the State that the bidder’s general approach and plans to undertake and
complete the contract are appropriate to the tasks and subtasks involved.
Mere reiterations of RFP tasks and subtasks are strongly discouraged, as they do not provide
insight into the bidder's ability to complete the contract. The bidder’s response to this section
should be designed to demonstrate to the State that the bidder’s detailed plans and approach
proposed to complete the Scope of Work are realistic, attainable and appropriate and that the
bidder’s proposal will lead to successful contract completion.
4.4.3.2 CONTRACT MANAGEMENT
The bidder should describe its specific plans to manage, control and supervise the contract to
ensure satisfactory contract completion according to the required schedule. The plan should
include the bidder's approach to communicate with the State Contract Manager including, but not
limited to, status meetings, status reports, etc.
4.4.3.3 CONTRACT SCHEDULE
The bidder should include a contract schedule. If key dates are a part of this RFP, the bidder’s
schedule should incorporate such key dates and should identify the completion date for each
task and sub-task required by the Scope of Work. Such schedule should also identify the
associated deliverable item(s) to be submitted as evidence of completion of each task and/or
subtask.
The bidder should identify the contract scheduling and control methodology to be used and
should provide the rationale for choosing such methodology. The use of Gantt, PERT or other
charts is at the option of the bidder.
4.4.3.4 MOBILIZATION AND IMPLEMENTATION PLAN
It is essential that the State move forward quickly to have the contract in place. Therefore, the
bidder must include as part of its proposal a mobilization and implementation plan, beginning
with the date of notification from the SCM of contract award for a period of ninety (90) calendar
days and a mandatory start date of January 1, 2016.
Such mobilization and implementation plan should include the following elements:
a. A detailed timetable for the mobilization and implementation period concluding on the
mandatory start date of January 1, 2016. This timetable should be designed to
demonstrate how the bidder will have the contract up and operational from the date of
notification of award.
b. The bidder's plan for the deployment and use of management, supervisory or other key
personnel during the mobilization and implementation period. The plan should show all
management, supervisory and key personnel that will be assigned to manage, supervise
and monitor the bidder’s mobilization and implementation of the contract within the period
of ninety (90) calendar days.
NOTE: The bidder should clearly identify management, supervisory or other key staff
that will be assigned only during the mobilization and implementation period.
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c. The bidder's plan for recruitment of staff required to provide all services required by the
RFP on the contract start date at the end of the mobilization and implementation period
covering a mandatory start date of January 1, 2016.
d. The bidder’s plan for the purchase and distribution of equipment, inventory, supplies,
materials, etc. that will be required to fully implement the contract on the required start
date.
e. The bidder’s plan for the use of subcontractor(s), if any, on this contract. Emphasis
should be on how any subcontractor identified will be involved in the mobilization and
implementation plan.
4.4.3.5 POTENTIAL PROBLEMS
The bidder should set forth a summary of any and all problems or conflicts of interest that the
bidder anticipates during the term of the contract. For each problem identified, the bidder should
provide its proposed solution.
4.4.4 ORGANIZATIONAL SUPPORT AND EXPERIENCE
The bidder should include information relating to its organization, personnel, and experience,
including, but not limited to, references, together with contact names and telephone numbers,
evidencing the bidder's qualifications, and capabilities to perform the services required by this
RFP. This section of the proposal must minimally contain the information identified in the
Section 4.4.4 subsections listed below.
4.4.4.1 LOCATION
The bidder should include the address of the bidder's office where responsibility for managing
the contract will take place. The bidder should include the telephone number and name of the
individual to contact.
4.4.4.2 ORGANIZATION CHARTS
a.
Contract-Specific Chart. The bidder should include a contract organization chart, with
names showing management, supervisory and other key personnel (including subcontractor
management, supervisory or other key personnel) to be assigned to the contract. The chart
should include the labor category and title of each such individual.
b.
Chart for Entire Firm. The bidder should include an organization chart showing the
bidder’s entire organizational structure. This chart should show the relationship of the individuals
assigned to the contract to the bidder's overall organizational structure.
4.4.4.3 RESUMES
Detailed resumes should be submitted for all management, supervisory and key personnel to be
assigned to the contract. Resumes for key personnel as set forth in the RFP should emphasize
relevant qualifications and experience of these individuals in successfully completing contracts of
a similar size and scope to those required by this RFP. Resumes should include the following:
a. The individual's previous experience in completing each similar contract;
b. Beginning and ending dates for each similar contract;
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c. A description of the contract demonstrating how the individual's work on the completed
contract relates to the individual's ability to contribute to successfully providing the
services required by this RFP; and
d. With respect to each similar contract, the name and address of each reference together
with a person to contact for a reference check and a telephone number.
If resumes are not available, the bidder shall submit a detailed recruitment plan as set forth in
RFP Section 4.4.3.4 Mobilization and Implementation Plan.
Subcontracting:
The bidder should provide detailed resumes for each subcontractor’s
management, supervisory and other key personnel that demonstrate knowledge, ability and
experience relevant to that part of the work which the subcontractor is designated to perform.
When a bidder submits resumes pursuant to this paragraph, the bidder shall redact the social
security numbers, home addresses, personal telephone numbers and any other personally
identifying information other than the individual’s name from the resume.
4.4.4.4 BACKUP STAFF
The bidder should include a list of backup staff that may be called upon to assist or replace
primary individuals assigned. Backup staff must be clearly identified as backup staff.
In the event the bidder must hire management, supervisory and/ or key personnel if awarded the
contract, the bidder should include, as part of its recruitment plan, a plan to secure backup staff
in the event personnel initially recruited need assistance or need to be replaced during the
contract term.
4.4.4.5 EXPERIENCE WITH CONTRACTS OF SIMILAR SIZE AND SCOPE
a. The bidder should provide a comprehensive listing of contracts of similar size and scope
that it has successfully completed, including those contracts of similar size and scope
currently active, as evidence of the bidder’s ability to successfully complete the services
required by this RFP;
b. Emphasis should be placed on contracts that are similar in size and scope to the work
required by this RFP;
c. A description of all such contracts should be included and should show how such
contracts relate to the ability of the firm to complete the services required by this RFP;
d. For each such contract, the bidder should provide two names and telephone numbers of
individuals for the other contract party;
e. Beginning and ending dates should also be given for each contract;
f.
Subcontracting: The bidder should provide documented experience to demonstrate that
each subcontractor has successfully performed work on contracts of a similar size and
scope to the work that the subcontractor is designated to perform in the bidder’s
proposal; and
g. The bidder must provide a detailed description of services to be provided by each
subcontractor.
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4.4.4.6 FINANCIAL CAPABILITY OF THE BIDDER
In order to provide the State with the ability to judge the bidder’s financial capacity and
capabilities to undertake and successfully complete the contract, the bidder should submit
certified financial statements which include a balance sheet, income statement and statement of
cash flow, and all applicable notes for the most recent calendar year or the bidder’s most recent
fiscal year. If certified financial statements are not available, the bidder should provide either a
reviewed or compiled statement from an independent accountant setting forth the same
information required for the certified financial statements, together with a certification from the
Chief Executive Officer and the Chief Financial Officer, that the financial statements and other
information included in the statements fairly present in all material respects the financial
condition, results of operations and cash flows of the bidder as of, and for, the periods presented
in the statements. In addition, the bidder should submit a bank reference.
If the information is not supplied with the proposal, the State may still require the bidder to submit
it. If the bidder fails to comply with the request within seven (7) business days, the State may
deem the proposal non-responsive.
A bidder may designate specific financial information as not subject to disclosure when the
bidder has a good faith legal/factual basis for such assertion. A bidder may submit specific
financial documents in a separate, sealed package clearly marked “Confidential-Financial
Information” along with the proposal.
The State reserves the right to make the determination to accept the assertion and shall so
advise the bidder.
4.4.5 PRICE SCHEDULE/SHEET
The bidder must submit its pricing using the format set forth in the State-supplied price schedule/
sheet(s) accompanying this RFP. Failure to submit all information required will result in the
proposal being considered non-responsive. Each bidder is required to hold its prices firm
through issuance of contract.
4.4.5.1 DELIVERY COSTS
Unless otherwise noted elsewhere in the RFP, all prices for items in proposals shall be submitted
F.O.B. Destination. Proposals submitted other than F.O.B. Destination may not be considered.
Regardless of the method of quoting shipments, the contractor shall assume all costs, liability and
responsibility for the delivery of merchandise in good condition to the State's using agency or
designated purchaser.
F.O.B. Destination does not cover "spotting" but does include delivery on the receiving platform of
the ordering agency at any destination in the State of New Jersey unless otherwise specified. No
additional charges will be allowed for any additional transportation costs resulting from partial
shipments made at contractor's convenience when a single shipment is ordered. The weights
and measures of the State's using agency receiving the shipment shall govern.
4.4.5.2 C.O.D. TERMS
C.O.D. terms are not acceptable as part of a proposal and will be cause for rejection of a
proposal.
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4.4.5.3 CASH DISCOUNTS
Bidders are encouraged to offer cash discounts based on expedited payment by the State. The
State will make efforts to take advantage of discounts, but discounts will not be considered in
determining the lowest proposal.
a. Discount periods shall be calculated starting from the next business day after the using
agency has accepted the goods or services, received a properly signed and executed
invoice and, when required, a properly executed performance security, whichever is
latest.
b. The date on the check issued by the State in payment of that invoice shall be deemed
the date of the State's response to that invoice.
4.4.6 COOPERATIVE PURCHASING
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5.0 SPECIAL CONTRACTUAL TERMS AND CONDITIONS
5.1 PRECEDENCE OF SPECIAL CONTRACTUAL TERMS AND CONDITIONS
The contract awarded as a result of this RFP shall consist of this RFP, addenda to this RFP, the
contractor's proposal, any best and final offer and the Division's Notice of Award.
Unless specifically stated within this RFP, the Special Contractual Terms and Conditions of the
RFP take precedence over the State of NJ Standard Terms and Conditions accompanying this
RFP.
In the event of a conflict between the provisions of this RFP, including the Special Contractual
Terms and Conditions and the State of NJ Standard Terms and Conditions, and any addendum to
this RFP, the addendum shall govern.
In the event of a conflict between the provisions of this RFP, including any addendum to this RFP,
and the bidder's proposal, the RFP and/or the addendum shall govern.
5.2 CONTRACT TERM AND EXTENSION OPTION
The term of the contract shall be for a period of five (5) years. The anticipated "Contract
Effective Date" is provided on the signatory page accompanying this RFP. If delays in the
procurement process result in a change to the anticipated Contract Effective Date, the bidder
agrees to accept a contract for the full term of the contract.
The contract may be extended for up to two (2) years with no single extension exceeding one (1)
year, by the mutual written consent of the contractor and the Director at the same terms,
conditions, and pricing at the rates in effect in the last year of the contract or rates more favorable
to the State.
5.3 CONTRACT TRANSITION
In the event that a new contract has not been awarded prior to the contract expiration date, as
may be extended herein, it shall be incumbent upon the contractor to continue the contract under
the same terms and conditions until a new contract can be completely operational. At no time
shall this transition period extend more than 180 CALENDAR DAYS beyond the expiration date
of the contract.
5.4 CONTRACT AMENDMENT
Any changes or modifications to the terms of the contract shall be valid only when they have
been reduced to writing and signed by the contractor and the Director.
5.5 CONTRACTOR RESPONSIBILITIES
The contractor shall have sole responsibility for the complete effort specified in the contract.
Payment will be made only to the contractor. The contractor shall have sole responsibility for all
payments due any subcontractor.
The contractor is responsible for the professional quality, technical accuracy and timely
completion and submission of all deliverables, services or commodities required to be provided
under the contract. The contractor shall, without additional compensation, correct or revise any
errors, omissions, or other deficiencies in its deliverables and other services. The approval of
deliverables furnished under this contract shall not in any way relieve the contractor of
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responsibility for the technical adequacy of its work. The review, approval, acceptance or
payment for any of the services shall not be construed as a waiver of any rights that the State
may have arising out of the contractor’s performance of this contract.
5.6 SUBSTITUTION OF STAFF
The contractor shall forward a request to substitute staff to the State Contract Manager for
consideration and approval. No substitute personnel are authorized to begin work until the
contractor has received written approval to proceed from the State Contract Manager.
If it becomes necessary for the contractor to substitute any management, supervisory or key
personnel, the contractor shall identify the substitute personnel and the work to be performed.
The contractor must provide detailed justification documenting the necessity for the substitution.
Resumes must be submitted evidencing that the individual(s) proposed as substitute(s) have
qualifications and experience equal to or better than the individual(s) originally proposed or
currently assigned.
5.7 SUBSTITUTION OR ADDITION OF SUBCONTRACTOR(S)
This Subsection serves to supplement but not to supersede Sections 5.8 and 5.9 of the State of
NJ Standard Terms and Conditions accompanying this RFP.
The contractor shall forward a written request to substitute or add a subcontractor or to substitute
its own staff for a subcontractor to the State Contract Manager for consideration. If the State
Contract Manager approves the request, the State Contract Manager will forward the request to
the Director for final approval. No substituted or additional subcontractors are authorized to begin
work until the contractor has received written approval from the Director.
If it becomes necessary for the contractor to substitute a subcontractor, add a subcontractor or
substitute its own staff for a subcontractor, the contractor will identify the proposed new
subcontractor or staff member(s) and the work to be performed. The contractor must provide
detailed justification documenting the necessity for the substitution or addition.
The contractor must provide detailed resumes of its proposed replacement staff or of the
proposed subcontractor’s management, supervisory and other key personnel that demonstrate
knowledge, ability and experience relevant to that part of the work which the subcontractor is to
undertake.
The qualifications and experience of the replacement(s) must equal or exceed those of similar
personnel proposed by the contractor in its proposal.
5.8 OWNERSHIP OF MATERIAL
All data, technical information, materials gathered, originated, developed, prepared, used or
obtained in the performance of the contract, including, but not limited to, all reports, surveys,
plans, charts, literature, brochures, mailings, recordings (video and/or audio), pictures, drawings,
analyses, graphic representations, software computer programs and accompanying
documentation and print-outs, notes and memoranda, written procedures and documents,
regardless of the state of completion, which are prepared for or are a result of the services
required under this contract shall be and remain the property of the State of New Jersey and shall
be delivered to the State of New Jersey upon thirty (30) Days’ notice by the State. With respect to
software computer programs and/or source codes developed for the State, except those
modifications or adaptations made to Bidder or Contractor’s Background IP as defined below, the
work shall be considered “work for hire”, i.e., the State, not the Contractor or subcontractor, shall
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have full and complete ownership of all software computer programs and/or source codes
developed. To the extent that any of such materials may not, by operation of the law, be a work
made for hire in accordance with the terms of this Contract, Contractor or subcontractor hereby
assigns to the State all right, title and interest in and to any such material, and the State shall
have the right to obtain and hold in its own name and copyrights, registrations and any other
proprietary rights that may be available.
Should the Bidder anticipate bringing pre-existing intellectual property into the project, the
intellectual property must be identified in the proposal. Otherwise, the language in the first
paragraph of this section prevails. If the Bidder identifies such intellectual property ("Background
IP") in its proposal, then the Background IP owned by the Bidder on the date of the contract, as
well as any modifications or adaptations thereto, remain the property of the Bidder. Upon contract
award, the Bidder or Contractor shall grant the State a nonexclusive, perpetual royalty free license
to use any of the Bidder/Contractor's Background IP delivered to the State for the purposes
contemplated by the contract.
Auditing firm working papers remain the property of the auditing firm in accordance with standards
issued by the American Institute of Certified Public Accountants (AICPA). While considered
confidential information, the State recognizes that the firm may be requested to make certain
working papers available to regulatory agencies pursuant to authority given by law or regulation.
In such instances, access to the working papers may be provided to these agencies based upon
AICPA standards and under supervision of the firm.
5.9 SECURITY AND CONFIDENTIALITY
5.9.1 DATA CONFIDENTIALITY
All financial, statistical, personnel, customer and/or technical data supplied by the State to the
Contractor are confidential (State Confidential Information). The Contractor must secure all data
from manipulation, sabotage, theft or breach of confidentiality. The Contractor is prohibited from
releasing any financial, statistical, personnel, customer and/or technical data supplied by the State
that is deemed confidential. Any use, sale, or offering of this data in any form by the Contractor,
or any individual or entity in the Contractor’s charge or employ, will be considered a violation of
this Contract and may result in Contract termination and the Contractor’s suspension or
debarment from State contracting. In addition, such conduct may be reported to the State
Attorney General for possible criminal prosecution.
The Contractor shall assume total financial liability incurred by the Contractor associated with any
breach of confidentiality.
When requested, the Contractor and all project staff including its subcontractor(s) must complete
and sign confidentiality and non-disclosure agreements provided by the State. The Contractor
may be required to view yearly security awareness and confidentiality training modules provided
by the State. Where required, it shall be the Contractor’s responsibility to ensure that any new
staff sign the confidentiality agreement and complete the security awareness and confidentiality
training modules within one month of the employees’ start date.
The State reserves the right to obtain, or require the Contractor to obtain, criminal history
background checks from the New Jersey State Police for all Contractor and project staff (to
protect the State of New Jersey from losses resulting from contractor employee theft, fraud or
dishonesty). If the State exercises this right, the results of the background check(s) must be
made available to the State for consideration before the employee is assigned to work on the
State’s project. Prospective employees with positive criminal backgrounds for cyber-crimes will
not be approved to work on State Projects. Refer to the National Institute of Standards and
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Technology (NIST) Special Publication (SP) 800-12, An Introduction to Computer Security: The
NIST Handbook, Section 10.1.3, Filling the Position – Screening and Selecting.
5.9.1.1 CONTRACTOR’S CONFIDENTIAL INFORMATION
a. The obligations of the State under this provision are subject to the New Jersey Open
Public Records Act (“OPRA”), N.J.S.A. 47:1A-1 et seq., the New Jersey common law right
to know, and any other lawful document request or subpoena.
b. By virtue of this contract, the parties may have access to information that is confidential to
one another. The parties agree to disclose to each other only information that is required
for the performance of their obligations under this contract. Contractor’s Confidential
Information, to the extent not expressly prohibited by law, shall consist of all information
clearly identified as confidential at the time of disclosure and anything identified in
Contractor’s proposal as Background IP (“Contractor Confidential Information”).
Notwithstanding the previous sentence, the terms and pricing of this contract are subject
to disclosure under OPRA, the common law right to know, and any other lawful document
request or subpoena.
c. A party’s Confidential Information shall not include information that: (a) is or becomes a
part of the public domain through no act or omission of the other party; (b) was in the other
party’s lawful possession prior to the disclosure and had not been obtained by the other
party either directly or indirectly from the disclosing party; (c) is lawfully disclosed to the
other party by a third party without restriction on the disclosure; or (d) is independently
developed by the other party.
d. The State agrees to hold Contractor’s Confidential Information in confidence, using at least
the same degree of care used to protect its own Confidential Information.
e. In the event that the State receives a request for Contractor Confidential Information
related to this contract pursuant to a court order, subpoena, or other operation of law, the
State agrees, if permitted by law, to provide Contractor with as much notice, in writing, as
is reasonably practicable and the State’s intended response to such order of law.
Contractor shall take any action it deems appropriate to protect its documents and/or
information.
f.
In addition, in the event Contractor receives a request for State Confidential Information
pursuant to a court order, subpoena, or other operation of law, Contractor shall, if
permitted by law, provide the State with as much notice, in writing, as is reasonably
practicable and Contractor’s intended response to such order of law. The State shall take
any action it deems appropriate to protect its documents and/ or information.
g. Notwithstanding the requirements of nondisclosure described in these Sections 5.9.1 and
5.9.1.1, either party may release the other party’s Confidential Information (i) if directed to
do so by a court or arbitrator of competent jurisdiction, (ii) pursuant to a lawfully issued
subpoena or other lawful document request, (iii) in the case of the State, if the State
determines the documents or information are subject to disclosure and Contractor does
not exercise its rights as described in Section 5.9.1.1(e), or if Contractor is unsuccessful in
defending its rights as described in Section 5.9.1.1(e), or (iv) in the case of Contractor, if
Contractor determines the documents or information are subject to disclosure and the
State does not exercise its rights described in Section 5.9.1.1(f), or if the State is
unsuccessful in defending its rights as described in Section 5.9.1.1(f).
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5.9.2 DATA SECURITY STANDARDS
Data Security: The Contractor at a minimum must protect and maintain the security of data
traveling its network in accordance with generally accepted industry practices.

Any Personally Identifiable Information must be protected. All data must be classified in
accordance with the State's Asset Classification and Control policy, 08-04-NJOIT
(www.nj.gov/it/ps). Additionally, data must be disposed of in accordance with the State's
Information Disposal and Media Sanitation policy, 09-10-NJOIT (www.nj.gov/it/ps).

Data usage, storage, and protection is subject to all applicable federal and state statutory
and regulatory requirements, as amended from time to time, including, without limitation,
those for Health Insurance Portability and Accountability Act of 1996 (HIPAA), Personally
Identifiable Information (PII), Tax Information Security Guidelines for Federal, State, and
Local Agencies (IRS Publication 1075), New Jersey State tax confidentiality statute,
N.J.S.A. 54:50-8, New Jersey Identity Theft Prevention Act, N.J.S.A. 56:11-44 et. seq., the
federal Drivers' Privacy Protection Act of 1994, Pub.L.103-322, and the confidentiality
requirements of N.J.S.A. 39:2-3.4. Contractor must also conform to Payment Card
Industry (PCI) Data Security Standard.
Data Transmission: The Contractor must only transmit or exchange State of New Jersey data
with other parties when expressly requested in writing and permitted by and in accordance with
requirements of the State of New Jersey. The Contractor must only transmit or exchange data
with the State of New Jersey or other parties through secure means supported by current
technologies. The Contractor must encrypt all data defined as personally identifiable or
confidential by the State of New Jersey or applicable law, regulation or standard during any
transmission or exchange of that data.
Data Storage: All data provided by the State of New Jersey or State data obtained by the
Contractor in the performance of the Contract must be stored, processed, and maintained solely
in accordance with a project plan and system topology approved by the State Contract Manager.
No State data shall be processed on or transferred to any device or storage medium including
portable media, smart devices and/or USB devices, unless that device or storage medium has
been approved in advance in writing by the State Project Manager. The Contractor must encrypt
all data at rest defined as personally identifiable information by the State of New Jersey or
applicable law, regulation or standard. The Contractor must not store or transfer State of New
Jersey data outside of the United States.
Data Scope: All provisions applicable to State data include data in any form of transmission or
storage, including but not limited to: database files, text files, backup files, log files, XML files, and
printed copies of the data.
Data Re-Use: All State data must be used expressly and solely for the purposes enumerated in
the Contract. Data must not be distributed, repurposed or shared across other applications,
environments, or business units of the Contractor. No State data of any kind must be transmitted,
exchanged or otherwise passed to other Contractors or interested parties except on a case-bycase basis as specifically agreed to in writing by the State Contract Manager.
Data Breach: Unauthorized Release Notification: The Contractor must comply with all applicable
State and Federal laws that require the notification of individuals in the event of unauthorized
release of personally identifiable information or other event requiring notification. In the event of a
breach of any of the Contractor's security obligations or other event requiring notification under
applicable law ("Notification Event"), the Contractor must assume responsibility for informing the
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State Contract Manager within 24 hours and all such individuals in accordance with applicable law
and to indemnify, hold harmless and defend the State of New Jersey, its officials, and employees
from and against any claims, damages, or other harm related to such Notification Event. All
communications must be coordinated with the State of New Jersey.
End of Contract Data Handling: Upon termination/expiration of this Contract the Contractor must
first return all State data to the State in a usable format as defined in the Contract, or in an open
standards machine-readable format if not. The Contractor must then erase, destroy, and render
unreadable all Contractor copies of State data according to the standards enumerated in
accordance with the State's most recent Information Disposal and Media Sanitation policy,
currently 09-10-NJOIT (www.nj.gov/it/ps) and certify in writing that these actions have been
completed within thirty (30) days after the termination/expiration of the Contract or within seven
(7) days of the request of an agent of the State whichever shall come first.
5.9.3 TAX RETURN DATA SECURITY
A. PERFORMANCE:
1. In performance of this contract, the contractor agrees to comply with and assume
responsibility for compliance by his or her employees with the following requirements:
a. All work will be done under the supervision of the contractor or the contractor's
employees;
b. Any return or return information made available in any format shall be used only for
the purpose of carrying out the provisions of this contract. Information contained in
such material will be treated as confidential and will not be divulged or made known
in any manner to any person except as may be necessary in the performance of
this contract. Disclosure to anyone other than an officer or employee of the
contractor will be prohibited;
c. All returns and return information will be accounted for upon receipt and properly
stored before, during, and after processing. In addition, all related output will be
given the same level of protection as required for the source material;
d. The contractor certifies that the data processed during the performance of this
contract will be completely purged from all data storage components of his or her
computer facility, and the contractor will retain no output at the time the work is
completed. If immediate purging of all data storage components is not possible, the
contractor certifies that any I.R.S. data remaining in any storage component will be
safeguarded to prevent unauthorized disclosures;
e. Any spoilage or any intermediate hard copy printout that may result during the
processing of Internal Revenue Service (I.R.S.) data will be given to the agency or
his or her designee. When this is not possible, the contractor will be responsible for
the destruction of the spoilage or any intermediate hard copy printouts, and will
provide the agency or his or her designee with a statement containing the date of
destruction, description of material destroyed, and the method used;
f. All computer systems receiving, processing, storing, or transmitting federal tax
information must meet the requirements defined in I.R.S. Publication 1075. To
meet functional and assurance requirements, the security features of the
environment must provide for the managerial, operational, and technical controls.
All security features must be available and activated to protect against unauthorized
use of and access to federal tax information;
g. No work involving federal tax information furnished under this contract will be
subcontracted without prior written approval of the I.R.S.;
h. The contractor will maintain a list of employees authorized access. Such list will be
provided to the agency and, upon request, to the I.R.S. reviewing office; and
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i.
The agency will have the right to void the contract if the contractor fails to provide
the safeguards described above;
B. CRIMINAL/ CIVIL SANCTIONS:
1. Each officer or employee of any person to whom returns or return information is or
may be disclosed will be notified in writing by such person that returns or return
information disclosed to such officer or employee can be used only for a purpose and
to the extent authorized herein, and that further disclosure of any such returns or
return information for a purpose or to an extent unauthorized herein constitutes a
felony punishable upon conviction by a fine of as much as $5,000 or imprisonment for
as long as 5 years’, or both, together with the costs of prosecution. Such person shall
also notify each such officer and employee that any such unauthorized further
disclosure of returns or return information may also result in an award of civil damages
against the officer or employee in an amount not less than $1,000 with respect to each
instance of unauthorized disclosure. These penalties are prescribed by Internal
Revenue Code (IRC) I.R.C. § 7213 and § 7431 and set forth at 26 CFR §301.6103(n)1;
2. Each officer or employee of any person to whom returns or return information is or
may be disclosed shall be notified in writing by such person that any return or return
information made available in any format shall be used only for the purpose of carrying
out the provisions of this contract. Information contained in such material shall be
treated as confidential and shall not be divulged or made known in any manner to any
person except as may be necessary in the performance of the contract. Inspection by
or disclosure to anyone without an official need to know constitutes a criminal
misdemeanor punishable upon conviction by a fine of as much as $1,000 or
imprisonment for as long as 1 year, or both, together with the costs of prosecution.
Such person shall also notify each such officer and employee that any such
unauthorized inspection or disclosure of returns or return information may also result in
an award of civil damages against the officer or employee [United States for federal
employees] in an amount equal to the sum of the greater of $1,000 for each act of
unauthorized inspection or disclosure with respect to which such defendant is found
liable or the sum of the actual damages sustained by the plaintiff as a result of such
unauthorized inspection or disclosure plus in the case of a willful inspection or
disclosure which is the result of gross negligence, punitive damages, plus the costs of
the action. These penalties are prescribed by I.R.C. § 7213A and § 7431;
3. Additionally, it is incumbent upon the contractor to inform its officers and employees of
the penalties for improper disclosure imposed by the Privacy Act of 1974, 5 U.S.C. §
552a. Specifically, 5 U.S.C. § 552a(i)(1), which is made applicable to contractors by 5
U.S.C. § 552a(m)(1), provides that any officer or employee of a contractor, who by
virtue of his/ her employment or official position, has possession of or access to
agency records which contain individually identifiable information, the disclosure of
which is prohibited by the Privacy Act or regulations established thereunder, and who
knowing that disclosure of the specific material is prohibited, willfully discloses the
material in any manner to any person or agency not entitled to receive it, shall be guilty
of a misdemeanor and fined not more than $5,000; and
4. Granting a contractor access to FTI must be preceded by certifying that each individual
understands the agency’s security policy and procedures for safeguarding I.R.S.
information. Contractors must maintain their authorization to access FTI through
annual recertification. The initial certification and recertification must be documented
and placed in the agency's files for review. As part of the certification and at least
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annually afterwards, contractors should be advised of the provisions of I.R.C. § 7431,
§ 7213, and § 7213A (see Exhibit 6, I.R.C. § 7431 Civil Damages for Unauthorized
Disclosure of Returns and Return Information and Exhibit 5, I.R.C. § 7213
Unauthorized Disclosure of Information). The training provided before the initial
certification and annually thereafter must also cover the incident response policy and
procedure for reporting unauthorized disclosures and data breaches. (See Section 10)
For both the initial certification and the annual certification, the contractor should sign,
either with ink or electronic signature, a confidentiality statement certifying their
understanding of the security requirements.
C. INSPECTION:
The I.R.S. and the Agency shall have the right to send its officers and employees into the
offices and plants of the contractor for inspection of the facilities and operations provided
for the performance of any work under this contract. On the basis of such inspection,
specific measures may be required in cases where the contractor is found to be
noncompliant with contract safeguards.
5.9.4 SECURITY PLAN
The contractor must provide a security plan. The contractor's security plan must, at a minimum,
provide security measures as described in Section 3.26.1.
The contractor shall provide a summary overview of the security document and describe how it
has been incorporated into a larger security program for automated data processing. In the plan,
the contractor shall highlight security features of the system.
In addition, the security plan shall identify and define:









Regulations and security requirements – how the contractor will address security
requirements such as PCI, HIPAA, FISMA and etc.
System, Administrative and Personnel Security - the security responsibilities of and
supervision required for information owned and / or operated by the contractor.
Security responsibilities include responsibilities for administration of the
infrastructure, implementing or maintaining security and the protection of the
confidentiality, integrity, and availability of information systems or processes.
Workforce Security - the control process for hiring and terminating of contractor’s
employees, and method used for granting and denying access to the contractor’s
network, systems and applications. Identify and define audit controls when
employment of the employee terminates.
Role based security access – the products and methods for role based security
and access to the contractor’s infrastructure and access to the State’s
infrastructure.
Account Management – the products and methods for identifying and controlling
the account types to meet defined regulation and security requirements.
Password Management – the appropriate password management controls to meet
defined regulation or security requirements.
Logging / Auditing controls – the contractor’s audit control methods and
requirements.
Incident Management – the methods for detecting, reporting and responding to an
incident, vulnerabilities and threats.
Vulnerability / Security Assessment – the products and methods used for scanning
contractor’s infrastructure for vulnerabilities and remediation of the vulnerabilities.
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Identify and define methods used for initiating and completing security
assessments.
Application Security – where the contractor is providing application hosting or
development services, the contractor, at a minimum, shall run application
vulnerability assessment scans during development and system testing.
Vulnerabilities shall be remediated prior to production release.
Application Partitioning and Single Tenant – where the contractor is providing
application hosting or development services, the contractor shall have a separate
and unique (single tenant) partition, infrastructure and media.
Anti-virus / malware controls – the products and methods for anti-virus and
malware controls that meet industry standards. It shall include policy statements
that require periodic anti-viral software checks of the system to preclude infections
and set forth its commitment to periodically upgrade its capability to maintain
maximum effectiveness against new strains of software viruses.
Network Security – where the contractor has access to the State’s confidential
data, and that data will traverse the contractor’s network, the contractor shall
maintain the contractor’s network security to include, but not be limited to: network
firewall provisioning, intrusion detection and prevention, denial of service
protection, annual independent and accredited third-party penetration testing, and
maintain a hardware inventory including name and network address. The
contractor shall maintain network security that conforms to current standards set
forth and maintained by the National Institute of Standards and Technology (NIST),
including those at: http://web.nvd.nist.gov/view/ncp/repository.
Firewall – the products and methods for firewall control process and intrusion
detection methodology.
Database – the products and methods for safeguarding the database(s).
Server and infrastructure – the products and methods for "hardening" of the
hardware’ operating systems.
Wireless, Remote and Mobile Access – where the contractor has access to the
State’s confidential data, and that data traverses the contractor’s network, the
contractor shall have security controls for provisioning accounts, authorization,
account/ credential verification, audit/ logging, VPN, and TCP/ UDP ports
restrictions.
Transmission - the products and methods on how its system addresses security
measures regarding communication transmission, access and message validation.
Continuous Monitoring – where the contractor has access to the State’s
confidential data, and that data will traverse the contractor’s network, the contractor
shall have products and methods for monitoring malicious activity, malware,
intrusions and audit records within the contractor’s network.
Security Audit – the contractor must allow State-assigned staff full access to all
operations for security inspections and audits which may include reviews of all
issues addressed in description of the security approach and willingness to enter
into good faith discussions to implement any changes.
Change/ Configuration Management and Security Authorization – the contractor
has established a change/ configuration methodology, established a baseline
configuration, and tracks changes to the configuration. The contractor shall identify
and maintain a list of software programs authorized to execute on its system(s).
When the contractor has a major change to the system or application, the
respective SCM is notified and a security reauthorization must be approved by the
respective SCM.
Risk Management – the contractor has established a risk management plan,
approved by the respective SCM at project launch; technical and security risks
must be identified, reported, and mitigated according to the plan.
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Confidentiality and Non-Disclosure Agreements – where required, it shall be the
contractor’s responsibility to have new staff sign the confidentiality agreement and
complete the security awareness and confidentiality training modules within one
month of the employee’s start date.
Data Integrity – the products and methods on the integrity of all stored data and the
electronic images, and the security of all files from unauthorized access. The
contractor must be able to provide reports on an as-needed basis on the access or
change for any file within the system.
5.10 NEWS RELEASES
The contractor is not permitted to issue news releases pertaining to any aspect of the services
being provided under this contract without the prior written consent of the Director.
5.11 ADVERTISING
The contractor shall not use the State’s name, logos, images, or any data or results arising from
this contract as a part of any commercial advertising without first obtaining the prior written
consent of the Director.
5.12 LICENSES AND PERMITS
The contractor shall obtain and maintain in full force and effect all required licenses, permits, and
authorizations necessary to perform this contract. The contractor shall supply the State Contract
Manager with evidence of all such licenses, permits and authorizations. This evidence shall be
submitted subsequent to the contract award. All costs associated with any such licenses, permits
and authorizations must be considered by the bidder in its proposal.
5.13 CLAIMS AND REMEDIES
5.13.1 CLAIMS
All claims asserted against the State by the contractor shall be subject to the New Jersey Tort
Claims Act, N.J.S.A. 59:1-1, et seq., and/or the New Jersey Contractual Liability Act, N.J.S.A.
59:13-1, et seq.
5.13.2 REMEDIES
Nothing in the contract shall be construed to be a waiver by the State of any warranty, expressed
or implied, of any remedy at law or equity, except as specifically and expressly stated in a writing
executed by the Director.
5.13.3 REMEDIES FOR FAILURE TO COMPLY WITH MATERIAL CONTRACT REQUIREMENTS
In the event that the contractor fails to comply with any material contract requirements, the
Director may take steps to terminate the contract in accordance with the State of NJ Standard
Terms and Conditions, authorize the delivery of contract items by any available means, with the
difference between the price paid and the defaulting contractor's price either being deducted from
any monies due the defaulting contractor or being an obligation owed the State by the defaulting
contractor as provided for in the State administrative code, or take any other action or seek any
other remedies available at law or in equity.
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5.14 LATE DELIVERY
The contractor must immediately advise the State Contract Manager of any circumstance or event
that could result in late completion of any task or subtask called for to be completed on a date
certain.
5.15 RETAINAGE
The amount of retainage is noted on the RFP signatory page accompanying this RFP. The using
agency shall retain the stated percentage of each invoice submitted. At the end of each three (3)
month period, the using agency shall review the contractor's performance. If performance has
been satisfactory, the Using Agency shall release ninety percent (90%) of the retainage for the
preceding three (3) month period. Following certification by the State Contract Manager that all
services have been satisfactorily performed the balance of the retainage shall be released to the
contractor.
5.16 ADDITIONAL WORK AND/ OR SPECIAL PROJECTS
The contractor shall not begin performing any additional work or special projects without first
obtaining written approval from both the State Contract Manager and the Director.
In the event of additional work and/or special projects, the contractor must present a written
proposal to perform the additional work to the State Contract Manager. The proposal should
provide justification for the necessity of the additional work. The relationship between the
additional work and the base contract work must be clearly established by the contractor in its
proposal.
The contractor’s written proposal must provide a detailed description of the work to be performed
broken down by task and subtask. The proposal should also contain details on the level of effort,
including hours, labor categories, etc., necessary to complete the additional work.
The written proposal must detail the cost necessary to complete the additional work in a manner
consistent with the contract. The written price schedule must be based upon the hourly rates, unit
costs or other cost elements submitted by the contractor in the contractor’s original proposal
submitted in response to this RFP. Whenever possible, the price schedule should be a firm, fixed
price to perform the required work. The firm fixed price should specifically reference and be tied
directly to costs submitted by the contractor in its original proposal. A payment schedule, tied to
successful completion of tasks and subtasks, must be included.
Upon receipt and approval of the contractor’s written proposal, the State Contract Manager shall
forward same to the Director for the Director’s written approval. Complete documentation from
the Using Agency, confirming the need for the additional work, must be submitted.
Documentation forwarded by the State Contract Manager to the Director must include all other
required State approvals, such as those that may be required from the State of New Jersey’s
Office of Management and Budget and NJOIT.
No additional work and/or special project may commence without the Director’s written approval.
In the event the contractor proceeds with additional work and/or special projects without the
Director’s written approval, it shall be at the contractor’s sole risk. The State shall be under no
obligation to pay for work performed without the Director’s written approval.
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5.17 MODIFICATIONS AND CHANGES TO THE STATE OF NJ STANDARD TERMS AND CONDITIONS
5.17.1 INDEMNIFICATION
Section 4.1 of the State of NJ Standard Terms and Conditions is supplemented with the following:
4.1 Indemnification
The contractor's liability to the State for actual, direct damages resulting
from the contractor's performance or non-performance, or in any manner
related to the contract, for any and all claims, shall be limited in the
aggregate to five-hundred percent (500%) of the value of the contract,
except that such limitation of liability shall not apply to the following:
1. The contractor's obligation to indemnify the State of New Jersey and its
employees from and against any claim, demand, loss, damage or
expense relating to bodily injury or the death of any person or damage to
real property or tangible personal property, incurred from the work or
materials supplied by the contractor under the contract caused by
negligence or willful misconduct of the contractor;
2. The contractor's breach of its obligations of confidentiality; and,
3. Contractor's liability with respect to copyright indemnification.
The contractor's indemnification obligation is not limited by but is in
addition to the insurance obligations contained in Section 4.2 of the State
of NJ Standard Terms and Conditions.
The contractor shall not be liable for special, consequential, or incidental
damages.
5.17.2 INSURANCE – AUTOMOBILE LIABILITY INSURANCE
Section 4.2 of the State of NJ Standard Terms and Conditions regarding insurance is modified
with the following section regarding Automobile Liability Insurance:
b. Automobile Liability Insurance which shall be written to cover any
automobile used by the insured. Limits of liability for bodily injury and
property damage shall not be less than $2 million per occurrence as a
combined single limit. The State must be named as an “Additional
Insured” and a blanket additional insured endorsement or its equivalent
must be provided when the services being procured involve vehicle use on
the State’s behalf or on State controlled property.
5.17.3 INSURANCE – WORKER’S COMPENSATION INSURANCE
with the following section regarding Worker’s Compensation Insurance.
c. Worker’s Compensation Insurance applicable to the laws of the State
of New Jersey and Employers Liability Insurance with limits not less than:
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$2,000,000 Bodily Injury, Each Occurrence
$2,000,000 Disease Each Employee
$2,000,000 Disease Aggregate Limit
5.17.4 INSURANCE - PROFESSIONAL LIABILITY INSURANCE
with the addition of the following section regarding Professional Liability Insurance.
d. Professional Liability Insurance: The contractor shall carry Errors and
Omissions, Professional Liability Insurance and/ or Professional Liability
Malpractice Insurance sufficient to protect the contractor from any liability
arising out the professional obligations performed pursuant to the
requirements of the contract. The insurance shall be in the amount of not
less than $5,000,000 and in such policy forms as shall be approved by
the State. If the Contractor has claims-made coverage and subsequently
changes carriers during the term of the contract, it shall obtain from its
new Errors and Omissions, Professional Liability Insurance and/ or
Professional Malpractice Insurance carrier an endorsement for retroactive
coverage.
5.18 ACCESSIBILITY COMPLIANCE
The Contractor shall abide by the State's website standards and guidelines which include the
mandatory accessibility information for Section 508 and Chapter 191 compliance for any web
based systems. The standards can be located at the following links:
 http://nj.gov/it/ps/07-12-NJOIT_web_accessibility_policy.pdf; and
 http://www.state.nj.us/it/ps/Web_Site_Standards_Guidelines.pdf.
5.19 CONTRACT ACTIVITY REPORT
Contractor(s) must provide, on a calendar quarter basis, to the assigned Division representative, a
record of all purchases made under the contract resulting from this RFP. This reporting
requirement includes sales to State using agencies, political sub-divisions thereof and, if permitted
under the terms of the contract, sales to counties, municipalities, school districts, volunteer fire
departments, first aid squads and rescue squads, independent institutions of higher education,
state and county colleges and quasi-State agencies. Quasi-State agencies include any agency,
commission, board, authority or other such governmental entity which is established and is
allocated to a State department or any bi-state governmental entity of which the State of New
Jersey is a member.
This information must be provided in a tabular format such that an analysis can be made to
determine the following:
a. Contractor’s total sales volume to each purchaser under the contract, subtotaled by
product, including, if applicable, catalog number and description, price list with appropriate
page reference and/or contract discount applied; and
b. Total dollars paid to Subcontractors.
Submission of purchase orders, confirmations, and/or invoices do not fulfill this contract
requirement for information. Failure to report this mandated information may be a factor in future
award decisions.
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Contractors must submit the required information in Microsoft Excel format.
5.20 ELECTRONIC PAYMENTS
With the award of this contract, the successful vendor(s) will be required to receive their
payment(s) electronically. In order to receive your payments via automatic deposit from the State
of New Jersey, complete and return the “Credit Authorization Agreement for Automatic Deposits
(ACH Credits)” Form with an original voided check or bank letter. The form must include ABA
number (routing or transit number), bank account number and if the bank account is a checking or
savings account. The form and instructions are located on the Office of Management & Budget’s
website at: http://www.state.nj.us/treasury/omb/forms/index.shtml. The completed form along
with the required voided check or bank letter should be mailed or faxed to: Department of the
Treasury, Office of Management and Budget, PO Box 221, 6TH Floor – Room 674, Trenton, N.J.
08625-0221; fax: (609)-984-5210. To assist in identifying payments, the State offers vendors
access to the Vendor Payment Inquiry web application (VPI) which offers check stub information
online. Contact the State of New Jersey at [email protected] to request access to this
application.
5.21 PROGRAM EFFICIENCY ASSESSMENT
The State Using Agencies shall be charged an assessment equal to one-quarter of one percent
(0.25%) of the value of all transactions under this contract. This assessment is authorized by
N.J.S.A. 52:27B-56 and N.J.A.C. 17:12-1.5, to maintain the State’s procurement system at a level
to meet industry standards of efficiency.
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6.0 PROPOSAL EVALUATION
6.1 RIGHT TO WAIVE
The Director reserves the right to waive minor irregularities. The Director also reserves the right
to waive a requirement provided that:
(1) the requirement is not mandated by law;
(2) all of the otherwise responsive proposals failed to meet the requirement; and
(3) in the sole discretion of the Director, the failure to comply with the requirement does not
materially affect the procurement or the State's interests associated with the procurement.
6.2 DIRECTOR’S RIGHT OF FINAL PROPOSAL ACCEPTANCE
The Director reserves the right to reject any or all proposals, or to award in whole or in part if
deemed to be in the best interest of the State to do so. The Director shall have authority to award
orders or contracts to the vendor or vendors best meeting all specifications and conditions in
accordance with N.J.S.A. 52:34-12. Tie proposals will be awarded by the Director in accordance
with N.J.A.C.17:12-2.10.
6.3 STATE'S RIGHT TO INSPECT BIDDER'S FACILITIES
The State reserves the right to inspect the bidder's establishment before making an award, for the
purposes of ascertaining whether the bidder has the necessary facilities for performing the
contract.
The State may also consult with clients of the bidder during the evaluation of bids. Such
consultation is intended to assist the State in making a contract award which is most
advantageous to the State.
6.4 STATE'S RIGHT TO REQUEST FURTHER INFORMATION
The Director reserves the right to request all information which may assist him or her in making a
contract award, including factors necessary to evaluate the bidder’s financial capabilities to
perform the contract. Further, the Director reserves the right to request a bidder to explain, in
detail, how the proposal price was determined.
6.5 PROPOSAL EVALUATION COMMITTEE
Proposals may be evaluated by an Evaluation Committee composed of members of affected
departments and agencies together with representative(s) from the Division. Representatives
from other governmental agencies may also serve on the Evaluation Committee. On occasion,
the Evaluation Committee may choose to make use of the expertise of outside consultant(s) in
an advisory role.
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6.6 ORAL PRESENTATION AND/OR CLARIFICATION OF PROPOSAL
After the submission of proposals, unless requested by the State as noted below, vendor contact
with the State is still not permitted.
After the proposals are reviewed, one, some or all of the bidders may be asked to clarify certain
aspects of their proposals. A request for clarification may be made in order to resolve minor
ambiguities, irregularities, informalities or clerical errors. Clarifications cannot correct any
deficiencies or material omissions or revise or modify a proposal, except to the extent that
correction of apparent clerical mistakes results in a modification.
The bidder may be required to give an oral presentation to the State concerning its proposal.
Bidders may not attend the oral presentations of their competitors.
It is within the State’s discretion whether to require the bidder to give an oral presentation or
require the bidder to submit written responses to questions regarding its proposal. Action by the
State in this regard should not be construed to imply acceptance or rejection of a proposal. The
Division will be the sole point of contact regarding any request for an oral presentation or
clarification.
6.7 EVALUATION CRITERIA
The following evaluation criteria categories, not necessarily listed in order of significance, will be
used to evaluate proposals received in response to this RFP. The evaluation criteria categories
may be used to develop more detailed evaluation criteria to be used in the evaluation process:
6.7.1 TECHNICAL EVALUATION CRITERIA
a. Personnel: The qualifications and experience of the bidder’s management, supervisory,
and key personnel assigned to the contract, including the candidates recommended for
each of the positions/roles required.
b. Experience of firm: The bidder’s documented experience in successfully completing
contracts of a similar size and scope in relation to the work required by this RFP.
c. Ability of firm to complete the Scope of Work based on its Technical Proposal: The
bidder’s demonstration in the proposal that the bidder understands the requirements of the
Scope of Work and presents an approach that would permit successful performance of the
technical requirements of the contract.
6.7.2 BIDDER’S PRICE SCHEDULE/ SHEET
For evaluation purposes, bidders will be ranked from lowest to highest according to the total
proposal price located on the Price Schedule/ Sheet accompanying this RFP.
6.7.3 PROPOSAL DISCREPANCIES
In evaluating proposals, discrepancies between words and figures will be resolved in favor of
words. Discrepancies between unit prices and totals of unit prices will be resolved in favor of
unit prices. Discrepancies in the multiplication of units of work and unit prices will be resolved in
favor of the unit prices. Discrepancies between the indicated total of multiplied unit prices and
units of work and the actual total will be resolved in favor of the actual total. Discrepancies
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between the indicated sum of any column of figures and the correct sum thereof will be resolved
in favor of the correct sum of the column of figures.
6.7.4 EVALUATION OF THE PROPOSALS
After the Evaluation Committee completes its evaluation, it recommends to the Director for
award the responsible bidder(s) whose proposal, conforming to this RFP, is most advantageous
to the State, price and other factors considered. The Evaluation Committee considers and
assesses price, technical criteria, and other factors during the evaluation process and makes a
recommendation to the Director. The Director may accept, reject or modify the recommendation
of the Evaluation Committee. Whether or not there has been a negotiation process as outlined in
Section 6.8 below, the Director reserves the right to negotiate price reductions with the selected
bidder.
6.8 NEGOTIATION AND BEST AND FINAL OFFER (BAFO)
After evaluating proposals, the Division may establish a competitive range. The Division may
also enter into negotiations with one bidder or multiple bidders. The primary purpose of
negotiations is to maximize the State’s ability to obtain the best value based on the mandatory
requirements, evaluation criteria, and cost. Multiple rounds of negotiations may be conducted
with one bidder or multiple bidders. Negotiations will be structured by the Division to safeguard
information and ensure that all bidders are treated fairly.
Similarly, the Division may invite one bidder or multiple bidders to submit a best and final offer
(BAFO). Said invitation will establish the time and place for submission of the BAFO. Any BAFO
that is not equal to or lower in price than the pricing offered in the bidder’s original proposal will
be rejected as non-responsive and the State will revert to consideration and evaluation of the
bidder's original pricing.
If required, after review of the BAFO(s), clarification may be sought from the bidder(s). The
Division may conduct more than one round of negotiation and/or BAFO in order to attain the best
value for the State.
After evaluation of proposals and as applicable, negotiation(s) and/or BAFO(s), the Division will
recommend, to the Director, the responsible bidder(s) whose proposal(s), conforming to the
RFP, is/are most advantageous to the State, price and other factors considered. The Director
may accept, reject or modify the recommendation of the Division. The Director may initiate
additional negotiation or BAFO procedures with the selected bidder(s).
Negotiations will be conducted only in those circumstances where they are deemed by
the Division or Director to be in the State’s best interests and to maximize the State’s
ability to get the best value. Therefore, the bidder is advised to submit its best technical
and price proposal in response to this RFP since the State may, after evaluation, make a
contract award based on the content of the initial submission, without further negotiation
and/or BAFO with any bidder.
All contacts, records of initial evaluations, any correspondence with bidders related to any
request for clarification, negotiation or BAFO, any revised technical and/or price proposals, the
Evaluation Committee Report and the Award Recommendation, will remain confidential until a
Notice of Intent to Award a contract is issued.
NOTE: If the Division contemplates negotiation, proposal prices will not be publicly read
at the proposal submission opening. Only the name and address of each bidder will be
publicly announced at the proposal submission opening.
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6.9 COMPLAINTS
A bidder with a history of performance problems as demonstrated by formal complaints and/or
contract cancellations for cause pursuant to Section 5.7.b of the State of NJ Standard Terms and
Conditions accompanying this RFP may be bypassed for an award issued as a result of this RFP.
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7.0 CONTRACT AWARD
7.1 DOCUMENTS REQUIRED BEFORE CONTRACT AWARD
7.1.1 REQUIREMENTS OF PUBLIC LAW 2005, CHAPTER 51, N.J.S.A. 19:44A-20.13 - N.J.S.A. 19:44A20.25 (FORMERLY EXECUTIVE ORDER NO. 134) AND EXECUTIVE ORDER NO. 117 (2008)
a) The State shall not enter into a contract to procure from any Business Entity services or any
material, supplies or equipment, or to acquire, sell or lease any land or building, where the value
of the transaction exceeds $17,500, if that Business Entity has solicited or made any contribution
of money, or pledge of contribution, including in-kind contributions, to a candidate committee
and/or election fund of any candidate for or holder of the public office of Governor or Lieutenant
Governor, to any State, county, municipal political party committee, or to any legislative
leadership committee during certain specified time periods
b) Prior to awarding any contract or agreement to any Business Entity, the Business Entity
proposed as the intended awardee of the contract shall submit the Certification and Disclosure
form, certifying that no contributions prohibited by either Chapter 51 or Executive Order No. 117
have been made by the Business Entity and reporting all contributions the Business Entity made
during the preceding four years to any political organization organized under 26 U.S.C.527 of the
Internal Revenue Code that also meets the definition of a “continuing political committee” within
the means of N.J.S.A. 19:44A-3(n) and N.J.A.C. 19:25-1.7. The required form and instructions,
available
for
review
on
the
Division’s
website
at
http://www.state.nj.us/treasury/purchase/forms.shtml#eo134, shall be provided to the intended
awardee for completion and submission to the Division with the Notice of Intent to Award. Upon
receipt of a Notice of Intent to Award a Contract, the intended awardee shall submit to the
Division, in care of the Division Procurement Specialist, the Certification and Disclosure(s) within
five (5) business days of the State’s request. Failure to submit the required forms will preclude
award of a contract under this RFP, as well as future contract opportunities.
c) Further, the Contractor is required, on a continuing basis, to report any contributions it makes
during the term of the contract, and any extension(s) thereof, at the time any such contribution is
made. The required form and instructions, available for review on the Division’s website at
http://www.state.nj.us/treasury/purchase/forms.shtml#eo134, shall be provided to the intended
awardee with the Notice of Intent to Award.
7.1.2 SOURCE DISCLOSURE REQUIREMENTS
Pursuant to N.J.S.A. 52:34-13.2, all contracts primarily for services awarded by the Director shall
be performed within the United States, except when the Director certifies in writing a finding that a
required service cannot be provided by a contractor or subcontractor within the United States and
the certification is approved by the State Treasurer. Also refer to Section 3.6 Service
Performance Within U.S. of the State of NJ Standard Terms and Conditions.
Pursuant to the statutory requirements, the intended awardee of a contract primarily for services
with the State of New Jersey must disclose the location by country where services under the
contract, including subcontracted services, will be performed. The Source Disclosure Certification
form accompanies the subject RFP. FAILURE TO SUBMIT SOURCING INFORMATION WHEN
REQUESTED BY THE STATE SHALL PRECLUDE AWARD OF A CONTRACT TO THE
BIDDER.
If any of the services cannot be performed within the United States, the bidder shall state with
specificity the reasons why the services cannot be so performed. The Director shall determine
whether sufficient justification has been provided by the bidder to form the basis of his or her
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certification that the services cannot be performed in the United States and whether to seek the
approval of the Treasurer.
7.1.2.1 BREACH OF CONTRACT
A SHIFT TO PROVISION OF SERVICES OUTSIDE THE UNITED STATES DURING THE TERM
OF THE CONTRACT SHALL BE DEEMED A BREACH OF CONTRACT. If, during the term of
the contract, the contractor or subcontractor, who had on contract award declared that services
would be performed in the United States, proceeds to shift the performance of any of the services
outside the United States, the contractor shall be deemed to be in breach of its contract. Such
contract shall be subject to termination for cause pursuant to Section 5.7b.1 of the State of NJ
Standard Terms and Conditions, unless such shift in performance was previously approved by the
Director and the Treasurer.
7.1.3 AFFIRMATIVE ACTION
The intended awardee must submit a copy of a New Jersey Certificate of Employee Information
Report, or a copy of Federal Letter of Approval verifying it is operating under a federally approved
or sanctioned Affirmative Action program. Intended awardee(s) not in possession of either a New
Jersey Certificate of Employee Information Report or a Federal Letter of Approval must complete
the Affirmative Action Employee Information Report (AA-302) located on the web at
http://www.nj.gov/treasury/purchase/forms/AA_%20Supplement.pdf.
7.1.4 BUSINESS REGISTRATION
In accordance with N.J.S.A. 52:32-44(b), a bidder and its named subcontractors must have a valid
Business Registration Certificate (“BRC”) issued by the Department of Treasury, Division of
Revenue and Enterprise Services prior to the award of a contract. (Refer to Section 4.4.2.1 of this
RFP for further information.)
7.2 FINAL CONTRACT AWARD
Contract award[s] shall be made with reasonable promptness by written notice to that responsible
bidder(s), whose proposal(s), conforming to this RFP, is(are) most advantageous to the State,
price, and other factors considered. Any or all proposals may be rejected when the State
Treasurer or the Director determines that it is in the public interest to do so.
7.3 INSURANCE CERTIFICATES
The contractor shall provide the State with current certificates of insurance for all coverages
required by the terms of this contract, naming the State as an Additional Insured. Refer to
Section 4.2 of the State of NJ Standard Terms and Conditions accompanying this RFP.
7.4 PERFORMANCE SECURITY
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8.0 CONTRACT ADMINISTRATION
8.1 CONTRACT MANAGER
The State Contract Manager is the State employee responsible for the overall management and
administration of the contract.
The State Contract Manager for this project will be identified at the time of execution of contract.
At that time, the contractor will be provided with the State Contract Manager’s name,
department, division, agency, address, telephone number, fax phone number, and e-mail
address.
8.1.1 STATE CONTRACT MANAGER RESPONSIBILITIES
For an agency contract where only one State office uses the contract, the State Contract
Manager will be responsible for engaging the contractor, assuring that Purchase Orders are
issued to the contractor, directing the contractor to perform the work of the contract, approving
the deliverables and approving payment vouchers. The State Contract Manager is the person
that the contractor will contact after the contract is executed for answers to any questions and
concerns about any aspect of the contract. The State Contract Manager is responsible for
coordinating the use of the Contract and resolving minor disputes between the contractor and
any component part of the State Contract Manager's Department.
If the contract has multiple users, then the State Contract Manager shall be the central
coordinator of the use of the contract for all Using Agencies, while other State employees
engage and pay the contractor. All persons and agencies that use the contract must notify and
coordinate the use of the contract with the State Contract Manager.
8.1.2 COORDINATION WITH THE STATE CONTRACT MANAGER
Any contract user that is unable to resolve disputes with a contractor shall refer those disputes to
the State Contract Manager for resolution. Any questions related to performance of the work of
the contract by contract users shall be directed to the State Contract Manager. The contractor
may contact the State Contract Manager if the contractor cannot resolve a dispute with contract
users.
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9.0 PRICE SCHEDULE/ SHEET
Instruction: Bidders for RFP 16-x-23964 shall use these Price Schedule/ Sheets (Sheets #1, #2, #3, #4, and #5) to
provide an estimated Firm Fixed Price for all price lines for each year of the contract. Bidders must submit a price for
each item. The bidder’s price schedule/ sheet must be submitted as specified in Section 4.4 (Proposal Content) and
Section 4.4.5 (Price Schedule/ Sheet).
Section 9.1 Price Schedule/ Sheet 1
Price
Line
No.
01
02
03
04
05
Description
Unit
DDS-PPP
FirmFixed
PerMember,
PerMonth
DOAS-VDHCBS
FirmFixed
PerMember,
PerMonth
DOASJACC
FirmFixed
PerMember,
PerMonth
DOAS-PEP
FirmFixed
PerMember,
PerMonth
DDD-CCW
FirmFixed
PerMember,
PerMonth
Monthly
Unit
Price
Contract
Year
One (1)
Monthly
Unit
Price
Contract
Year
Two (2)
Monthly
Unit
Price
Contract
Year
Three (3)
Monthly
Unit
Price
Contract
Year
Four (4)
Monthly
Unit
Price
Contract
Year
Five (5)
Total
Extend
ed
Estimat
ed Qty.
(for
bidding
purpose
s only)
Bidders
Total
Extended
Costs for all
Five (5) Years*
5,000
Membe
rs
x 12
Months
Per
Year x
5 Years
=
50
Membe
rs
x 12
Months
Per
Year x
5 Years
=
1,500
Membe
rs
x 12
Months
Per
Year x
5 Years
=
210
Membe
rs
x12
Months
Per
Year x
5 Years
=
10,900
Membe
rs x 12
Months
x5
Years
=
$
129
Bidders for RFP 16-x-23964 must submit a firm-fixed hourly fee as follows:
Price Line 06
Per Hour
DDD Special Projects
Price Line 07
Per Hour
DDS Special Projects
Price Line 08
Per Hour
DOAS Special Projects
Firm-Fixed
Hourly
Fee
Firm-Fixed
Hourly
Fee
Firm-Fixed
Hourly
Fee
Year 1
Year 2
Year 3
Year 4
Year 5
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
For DDS and DoAS Only - Reimbursable Items from the Administrative Account
Item
Unit
Unit Price X
2
Estimated
3
Quantity *
Total
Price Line 09
Orientation and
Development of the
Initial Cash
Management Plan
Per Orientation/ Cash
Management Plan
1,800
$0.00
Per Counseling Hour
72,000
$0.00
Price Line 10
Financial Counseling
Services
2
Estimated quantities are for bidding and bid evaluation purposes only. Contractor will be paid based on actual
quantities. See Section 3.9 for more information. Bidders are requested to submit minimal charges for these price lines
that are paid directly by the participant out of the cash management plan.
3
The reimbursable items (please refer to this table) are excluded from activities included in the per-member/ per-month
charge
130
For DDS and DoAS Only - Costs to be Billed to the Participants’ Budgets
Item
Unit
Estimated
4
Quantity *
Unit Price X
Total
Price Line 11
Processing Payroll
and Non-Payroll
Checks
5
Per Check
104,400
$0.00
Per Stop Payment
150
$0.00
Per Background
Check
50
$0.00
Price Line 12
Stop Payment on a
Check
Price Line 13
Statewide Criminal
Background Check
Section 9.0 Price Schedule/ Sheet 5.
For the purpose of evaluating cost proposals, bidders should provide the following staffing
resource information for all KEY staff named in the bidder’s proposal.
Position
Number
Position
Description
01
Account Manager
02
Bidder to Fill In
03
Bidder to Fill In
Etc.
Bidder to Fill In
Bidder’s
Hourly
Rate for
this
Position
(Year One)
Bidder’s
Hourly Rate
for this
Position
(Year Two)
4
Bidder’s
Hourly
Rate for
this
Position
(Year
Three)
Bidder’s
Hourly
Rate for
this
Position
(Year
Four)
Bidder’s
Hourly
Rate for
this
Position
(Year
Five)
Estimated quantities are for bidding and bid evaluation purposes only. Contractor will be paid based on actual
quantities. See Section 3.9 for more information. Bidders are requested to submit minimal charges for these price lines
that are paid directly by the participant out of the cash management plan.
5
The per check charge may not exceed $2.00 per check.
131
EXHIBIT NUMBER 1 – DDD CONTRACT
DDD Contract – Fiscal Intermediary Services
DDD FI Contract 2015– Program Description
PROGRAM DESCRIPTION
Years program has been funded by DDD:
Days and hours of operation:
Site location:
Phone number:
17
Monday through Friday 8:30 - 4:30
25 Kennedy Blvd., Suite 600, East Brunswick, NJ
(732) 257-6662
Since Fiscal Year 1997, Easter Seals New Jersey has been acting in the role of Fiscal Intermediary for
adults with developmental disabilities. State funds are available to support individuals living in the
community.
Individualized budgets are created with a Support Coordinator, approved by the Division of Developmental
Disabilities (DDD) and sent to Easter Seals New Jersey (Easter Seals) who manages the budget, pays
vendors and providers of service, and also acts as the employer of record for Direct Support Professionals
hired and supervised by the consumer. Easter Seals also performs audits on DDD non-contracted qualified
providers to ensure their compliance with DDD’s Central Registry of Offenders Against Persons with
Developmental Disabilities.
Self-directing respite was recently added as a new service to the Fiscal Intermediary Service. This service
replaced the Family Supports Respite and Hotel Respite where providers would be paid by the Fiscal
Intermediary for these services. Easter Seals requested and was approved for one accounting staff person.
The service was suspended after the transfer of children from DDD to Division of Children and Family.
Easter Seals is requesting the transfer of the Family Supports Respite and Hotel Respite to Self-Directing
Respite and change the funding of the accounting staff person budgeted to the team that is responsible for
the application process.
During the last Fiscal year and currently in FY15, the Fiscal Intermediary Service (FIS) has been
collaborating with a Lean manufacturing consultant in reviewing the workflow processes of the service to
improve the capacity of the service staff. As a result of the Lean process, staff have been grouped together
in teams to concentrate on specific service deliverables. Below is a description of the service deliverables
that are performed on a daily basis.
RECEIPT OF PLANS OF CARE
Easter Seals New Jersey receives electronic alerts from the Division of Developmental Disabilities
informing them when an individual’s first year, renewal or revised budget is approved. A team of 5 is
currently responsible for the printing of the plans, reviewing for accuracy of services with the selected
waiver/procedure code, and rates. This team is also responsible for creating the letters that are sent to the
individual informing them of the initial and renewal plans. Letters to the consumers contain a Signature
Authorization Form, Registration for a Consumer Portal and a Release of Information Form, which allows
Easter Seals to email correspondences to the provider instead of regular mail. Letters to all provider
agencies include the Service Details Reports, Provider Payment Voucher (PPV) and directions on how to
complete the PPV for payment. All Plans of Care (POC), Signature Authorization Forms, Release of
Information Form, Consumer Portal Registration Form and correspondence is scanned and saved to a
secured drive for later review by Fiscal Intermediary Services staff if necessary.
132
Individuals are entered into the Easter Seals New Jersey’s Electronic Health Record System.
The established timeframe from date of alert to correspondence to individuals and providers is 5 business
days.
BILL PAYMENTS
Consumers receive services from providers who have been qualified by the Division of Developmental
Disabilities. These Qualified Providers complete the Provider Payment Voucher (PPV) upon completion of
services and submits to the consumer or designated representative for payment approval. The PPV along
with back up documentation is then sent to Easter Seals for payment processing.
The following process pertains to the payment to Qualified Providers:

One accounting team receives the mail, and sets each Provider Payment Voucher up for the next
step in the payment process.

Currently there are three teams that are responsible for the entry of the PPV into the accounting
software for payment. Teams are set up by state regions.

A team of four staff is involved within the coding of the Provider Payment Voucher for payment.
This team reviews the PPV and refers back to the individual’s scanned Signature Authorization
Form to ensure the signature on the PPV matches the signature on file. The Plan of Care (POC) is
also reviewed to ensure the services on the PPV match the services and rate identified in the Plan of
Care. After this review is complete, the information is input into the accounting software, ensuring
correct plan year and provider to be paid. If there are any issues that are not accepted into the
accounting software, the Provider Payment Voucher is then flagged for review of issue and
correction. A team member is responsible for any discrepancies between the POC and the PPV and
work to resolve the issues so that the PPV can be paid. This person then posts the batch of PPVs to
be paid and then that transmits to the team that cuts the checks and mails.
Checks are processed every morning and are mailed on the same day.
APPLICATION PROCESS
On a daily basis, Direct Support Professionals (DSP) provide direct care to the consumers with selfdirecting budgets. The DSP who is hired independent of an agency is hired through Easter Seals and is the
employee of record. The consumer is considered the managing employer and as such, creates the position
description, sets the hours of employment, manages the DSP and ultimately decides if employment should
continue.
All consumers who choose to hire a DSP on their own request an application packet from Easter Seals. A
portion of the application needs to be completed by the consumer or authorized representative and some
portions need to be completed by the applicant. The potential applicant needs to complete and pass preemployment screenings which include: electronic fingerprinting, alcohol/drug screening and completion
and passing of the Danielle’s Law on line training with a passing grade of 80 on the quiz at the end of the
training session. When the application is returned to Easter Seals, it is reviewed against a checklist to
ensure that all of the forms are returned and completed. Notification is sent to the consumer/authorized
representative when forms are not returned or are incomplete. Once all forms are completed and returned to
Easter Seals along with the pre-employment screenings complete, Easter Seals informs the Support
Coordinator to add the DSP to the consumer’s plan. Upon receipt of the plan of care revision, timesheets,
directions on how to complete and a schedule of dates when timesheets are due to Easter Seals is mailed to
133
the consumer. For consumers who have opted for the consumer portal, the timesheet is added to their portal
for easy access.
TIMESHEETS/PAYROLL PROCEDURES
Consumers/authorized representative are responsible for submitting consumer approved time sheets to
Easter Seals New Jersey on a biweekly basis. Appropriate wage calculations, taxes and other deductions are
handled. The bullets below outline the steps for the processing of time sheets:




Consumer approved time sheets are mailed or faxed to Easter Seals Customer Service
Representatives and are expected to be received the Friday before each pay date.
Customer Service Representatives log in the receipt of each timesheet along with the number of
hours. A report is produced from this information gathered to indicate the consumers who have
approved timesheets that exceed the number of hours they have budgeted for. This report is
sent to DDD for review.
Each time sheet is processed into the payroll system to produce paychecks.
Paychecks are either directly deposited or mailed to the DSP’s home, depending upon their
requested preference.
DATA ENTRY
All Provider Payment Vouchers, DSP timesheets and travel/expense vouchers that have been processed and
paid for need to be entered into the Division’s electronic record system(s). This job function is completed
by the Customer Service Representatives. The Customer Service Representatives enter either the E-record
or I-record system and enter the charges under the following criteria:
 Per consumer
 Per plan year
 Per Outcome
 Per Service
 Per date of service
 Per service description if necessary
The information processed by the Customer Service Representatives is then used by the Division for
Medicaid billing purposes.
STATEMENT OF NEED
Adults with developmental disabilities determine who will provide support and training in functional skills
to them. This training is provided in the home by families and in day activity programs through supported
employment and community services. Easter Seals’ Fiscal Intermediary Services provides these individuals
the opportunity to purchase the necessary services or supports. The individuals using these services have
been determined eligible in accordance with DDD guidelines.
As persons requiring significant supports continue to move from the developmental centers into community
homes and as increased numbers of persons labeled as having severe disabilities continue to reside with
their natural families, the provision of supports through programs such as fiscal intermediary services must
continue.
The target population is throughout the entire State.
134
POPULATION TO BE SERVED AND ELIGIBILITY DETERMINATIONS
The target population for this program is the individuals with developmental disabilities who have a selfdirecting budget. As the state continues its move into a fee for service environment, the level of service
will continue to grow.
PROGRAM GOALS
The primary goals of Easter Seals New Jersey as Fiscal Intermediary will continue into the following year
with an emphasis on improving the quality of the existing goals.
Goal:
To perform as Fiscal Intermediary for consumers with self-directing budgets.
Objectives:












Will manage consumer’s budgets.
Will pay vendors and invoices in accordance with proper accounting procedures and guidelines within
10 business days.
Will continue to process payments, currently being done daily.
Will produce monthly expense reports to consumer, Support Coordinator and to Division staff upon
request.
Will mail all recurring payments by the 1st of the month.
Will contact the Regional Monitor if an expense is sent to Easter Seals and Accounting Department is
not clear if this is an approved cost.
Will notify consumer, Support Coordinator and Division staff via the monthly expense report when the
consumer either has reached the annual amount per line item prior to year end, or when the consumer
has 20% of the budgeted amount remaining.
Will send memo to consumer if bill sent to Easter Seals is not an approved DDD expense.
Will notify consumer if a bill cannot be paid in full.
Will issue and send 1099s to applicable persons.
Will send correspondence to Qualified Providers when they are identified in a Plan of Care within five
(5) business days.
Will send correspondence to affected Qualified Providers when a revision is made that changes the
Qualified Provider’s service detail within five (5) business days.
Goal:
To perform as employer of record for Direct Support Professionals (DSPs) supporting
consumers with self-directing budgets.
Objectives:

Will manage/control the payment of wages to DSPs.

Will garnish wages, if applicable.

Will review time sheets and written documentation from DSPs.

Will assist in terminations when appropriate.

Will support DSP as an employee.

Will provide medical, dental and vision benefits to full time employees.

Will send W2s to staff.
Goal:
85% or greater of consumers, families, and provider will indicate they are satisfied with the
services provided by Easter Seals as Fiscal Intermediary.
135
Objectives:


Will assure that Easter Seals has adequate staff to provide Fiscal Intermediary Services.
Will return phone calls within 24 business hours. The Fiscal Intermediary Service receives about
4,200 phone calls a month ( 28% pertain to the receipt of timesheets, 11% pertain to general questions from
families and providers on the service, 37% pertain to the payments and questions on the budget and 24%
pertain to the application process).
EVALUATION
A top priority of quality assessment is to continually monitor the satisfaction of all Easter Seals New Jersey
constituencies. Consumers and families are polled annually via a satisfaction survey and the results are
analyzed to address the findings. Each year a sample size is determined to ensure a 95% confidence
interval. The 95% confidence interval ensures a 95% accurate result that is statistically representative of the
whole population. Once this sample size is determined a random sample is selected that matches the
appropriate sample size. The sample size and random sample are generated using software to ensure an
independent calculation is performed. Overall satisfaction for FY’14 was 89%. A copy of the survey is
attached.
LEVEL OF SERVICE
The service functions with an open-ended level of service, as consumers are added as budgets are approved.
STAFFING NEEDS
Service Area
Receipt of Plans of Care
Bill Payments
Description
Additional staff needed
Currently a team of 5 can process 5
approximately 84 E-record plans
a day resulting in an average of
210 letters. As a result of the Irecord process, the length of time
to enter a plan through the
process had increased from 18
minutes (E-record) to 48 minutes
resulting in approximately 21
plans processed on a daily basis.
From September 2014 – January 6
2015 the team has processed 340
vouchers daily. This has
increased from last fiscal year’s
daily average of 320. The process
starts from the receipt of the
mail, to the distribution to the
teams, to the coding, entering and
posting, cutting the check and
finally the collating the check
and remittance to be mailed.
136
Application Process
Data Entry
Support Staff
The team receives the
applications, reviews and ensures
all the pre-employment
screenings are conducted. This
team also creates and distributes
all timesheets. On average, an
application can take up to 3
attempts from start to finish.
All Provider Payment Vouchers,
travel and expense vouchers and
timesheets that are paid are
entered into the E-record and Irecord systems. This team also
enters the timesheets into the
payroll software.
To provide administrative
support to the additional staff
requested.
Total
4
5
1
21
137
EXHIBIT NUMBER 2 – DOAS COUNTY OFFICES
Department of Human Services, Division of Aging Services, County Offices
http://www.state.nj.us/humanservices/doas/home/index.html
Atlantic
(1-888-426-9243 or 609-645-5965)
Atlantic County Division of Intergenerational Services
Shoreview Building, Office 222
101 South Shore Road
Northfield, NJ 08225
Bergen
(201-336-7400)
Bergen County Division of Senior Services
One Bergen County Plaza, 2nd Floor
Hackensack, NJ 07601-7076
Burlington
(609-265-5069)
Burlington County Office on Aging
49 Rancocas Road
PO Box 6000
Mount Holly, NJ 08060
Camden
(856-858-3220)
Camden County Division of Senior & Disabled Services
512 Lakeland Avenue, 4th Floor
Blackwood, NJ 08012
Cape May
(609-886-2784/2785)
Cape May County Department of Aging and Disability Services
Social Services Building
4005 Route 9, South
Rio Grande, NJ 08242
Cumberland
(856-453-2220/ 2221)
Cumberland County Office on Aging and Disabled
Administration Building
800 East Commerce Street
Bridgeton, NJ 08302
Essex
(973-395-8375)
Essex County Division of Senior Services
900 Bloomfield Avenue
Verona, NJ 07044
Gloucester
(856-384-6900)
Gloucester County Division of Senior Services
138
115 Budd Blvd.
West Deptford, NJ 08096
Hudson
(201-369-4313)
Hudson County Office on Aging
595 County Avenue, Building 2
Secaucus, NJ 07094
Hunterdon
(908-788-1361/1362/1363)
Hunterdon County Division of Senior, Disabilities and Veterans' Services
4 Gauntt Place, Building 1
PO Box 2900
Flemington, NJ 08822-2900
Mercer
(609-989-6661/6662)
Mercer County Office on Aging
640 S. Broad Street
PO Box 8068
Trenton, NJ 08650
Middlesex
(732-745-3295)
Middlesex County Office of Aging and Disabled Services
75 Bayard Street, 5th Floor
New Brunswick, NJ 08901
Monmouth
(732-431-7450)
Monmouth County Division of Aging, Disabilities and Veterans Services
3000 Kozloski Road
Freehold, NJ 07728
Morris
(973-285-6848)
Morris County Division on Aging, Disabilities and Veterans
340 West Hanover Avenue
PO Box 900
Morristown, NJ 07963-0900
Ocean
(732-929-2091)
Ocean County Office of Senior Services
1027 Hooper Avenue, Building #2
PO Box 2191
Toms River, NJ 08754-2191
Passaic
(973-569-4060)
Passaic County Department of Senior Services, Disabilities and Veterans' Affairs
930 Riverview Drive, Suite 200
Totowa, NJ 07512
139
Salem
(856-339-8622)
Salem County Office on Aging
98 Market Street
Salem, NJ 08079
Somerset
(908-704-6346)
Somerset County Office on Aging and Disability Services
27 Warren Street, 1st Floor
PO Box 3000
Somerville, NJ 08876
Sussex
(973-579-0555)
Sussex County Division of Senior Services
Sussex County Administration Building
1 Spring Street, 2nd Floor
Newton, NJ 07860
Union
(908-527-4870 or toll-free 888-280-8226)
Union County Division on Aging
Administration Building
Elizabeth, NJ 07207
Warren
(908-475-6591)
Warren County Division of Aging & Disability Services
Wayne Dumont Jr. Admin. Bldg.
165 County Road, Suite 245
Route 519 South
Belvidere, NJ 07823-1949
140
EXHIBIT NUMBER 3 – DDD COMMUNITY SERVICES OFFICES
Department of Human Services, Division of Development Disabilities, Community Services
Offices
Flanders Office
Counties Served: Morris - Sussex - Warren
1-B Laurel Drive
Flanders, NJ 07836
Phone: (973) 927-2600
Paterson Office
Counties Served: Bergen - Hudson - Passaic
100 Hamilton Plaza, 7th Floor
Paterson, NJ 07505
Phone: (973) 977-4004
Newark Office
County Served: Essex
153 Halsey St., 2nd Flr
P.O. Box 47013
Newark, NJ 07101
Phone: (973) 693-5080
Plainfield Office
Counties Served: Union - Somerset
110 East 5th Street
Plainfield, New Jersey 07060
Phone: (908) 226-7800
Somerset Office
County Served: Somerset
275 Greenbrook Road, 2nd Floor
Green Brook, NJ 08812
Phone: (732) 424-3301
Freehold Office
Counties Served: Ocean - Monmouth
Juniper Plaza, Suite 1 - 11
3499 Route 9 North
Freehold, NJ 07728
Phone: (732) 863-4500
141
Trenton Office
Counties Served: Hunterdon - Mercer - Middlesex
120 South Stockton Street, Trenton, NJ 08611
Phone: (609) 292-1922
Mailing Address: P.O. Box 706, Trenton, NJ 08625-0706
Mays Landing Office
Counties Served: Atlantic - Cape May - Cumberland - Salem
5218 Atlantic Avenue
Suite 205
Mays Landing, NJ 08330
Phone: (609) 476-5200
Voorhees Office
Counties Served: Burlington - Camden - Gloucester
2 Echelon Plaza
221 Laurel Rd, Suite 210
Voorhees, NJ 08043
Phone: (856) 770-5900
142
EXHIBIT NUMBER 4 – MANAGED CARE WORKFLOW
143
EXHIBIT NUMBER 4 (CONTINUED) - MANAGED CARE WORKFLOW
144
145
AETNA Better Health
Melinda Tobin, Compliance Officer
3 Independence Way, Suite 400
Princeton, NJ 08540-6626
Office: (609) 282-8160
Cell: (401) 368-5420
[email protected]
AMERIGROUP
Jennifer Langer Jacobs, VP, LTSS Operations
101 Wood Avenue South, 8th Floor
Iselin, NJ 08830
Office: (732) 452-6029
Cell: (609) 468-2630
[email protected]
HORIZON NJ HEALTH
Joseph Manger, Director, Regulatory Affairs – Government Programs
370 Scotch Road
Ewing, NJ 08628
Office: (609) 718-9377
Cell: (609) 968-8555
[email protected]
UNITED HEALTHCARE
Michael Simone,
333 Thornall Street, 9th Floor
Edison, NJ 08837
Office: (848) 200-3563
Cell: (609) 672-5669
[email protected]
WELLCARE
Marjorie Forgang, Senior Director, Clinical Operations and MLTSS
550 Broad St., 12th Floor
Newark, NJ 07102
Office: (973) 274- 2123
Cell: (973) 494-1107
[email protected]
146
EXHIBIT NUMBER 5 – ENROLLMENT PACKET
ENROLLMENT PACKET
NJ-REG (N.J. Business Registration)
I.R.S. FORM SS-4
I.R.S. FORM 2678
I.R.S. FORM 8821
WORKER COMPENSATION INSURANCE APPLICATION
INTRODUCTORY LETTER
INSTRUCTIONS AND SAMPLES
For additional information, please refer to Section 3.8 of this RFP.
147
EXHIBIT NUMBER 6 – SAMPLE CO-PAYMENT STATEMENT
JACC
148
EXHIBIT NUMBER 7 – DATA FIELDS
JACC Field List for Data Extract
149
EXHIBIT NUMBER 8 – PROCEDURE CODE LIST
JACC Sample Procedure Code List
150
EXHIBIT NUMBER 9 – SAMPLE REPORT
JACC Sample Report
151
EXHIBIT NUMBER 10 – SAMPLE REPORT
JACC Sample Report
152
EXHIBIT NUMBER 11 – VD-HCBS FLOWCHART
153
EXHIBIT NUMBER 12 – VD-HCBS PROGRAM SAMPLE CASH MANAGEMENT PLAN
VETERANS DIRECTED HOME AND COMMUNITY BASED SERVICES PROGRAM
Cash Management Plan
**SAMPLE PLAN**
Consumer Name:
Sally J. Consumer
Type of Plan: (check one)
Initial
X
County:
Hunterdon
Cost Share % Assessed:
Revision
Reassessment
Hours Aw arded:
0%
Weekday:
Weekend:
12.5
0.0
Monthly
I.
Determination of Cash Benefit
Calculation Formula
Amount
Total Cost to State Program
=Sum (Weekday Hrs x $11 + Weekend Hrs x $14) x 4.33 Weeks
$
FI Administration Deduction (5%)
=Total Cost to State Program x 5%
$
Consumer Cost Share Payment Assessed
=Cost Share % Assessed x Total Cost to State Program
$
TOTAL CASHED OUT BENEFIT
II.
Direct Employment
Total Taxes
Service Type/Description
Worker
Assistance with errands; exercises
Hourly Wage
$
Hazel Home-Helper
Per Hour
8.75
$
2.00
$
595.38
(29.77)
565.61
Sum of Hourly
# of Hours
Total
Wages & Taxes
Per Month
Monthly Cost
$
10.75
17.3
$
186.19
$
186.19
mail; weekly meal preparation;
bedmaking/linen change; sewing;
check writing; trash disposal
Total Monthly Cost of Employment
III.
Purchase of Agency Services
Number of
Service Type/Description
Agency Name
Frequency
Unit Cost
Total
Units Per Month
Monthly Cost
Bath Service
ABC Home Health Agency
3 Times Per Week
$17 per visit
13
$
Cleaning Service-Housekeeping
Happy Hands Inc.
Twice a Month
$25 per visit
2
$
50.00
$
271.00
Total Monthly Cost of Agency Services
Consumer Name:
IV.
County:
Sally J. Consumer
Hunterdon
Miscellaneous Expenses
Total
Expense Type/Description
Provider Description
Frequency
Homeow ners Insurance Liberty Mutual
V.
Unit Cost
Monthly Cost
$
10.00
Cash Laundry-Pick Up & Delivery/XYZ Laundry Service
Once Per Week
$1.00 lb / 8 lbs.
$
34.64
Cash Gas Money for Grocery Trips/Once Per Week
Once Per Week
$10.00 Per Trip
$
40.00
Total Monthly Cost of Miscellaneous Expenses
$
84.64
Annual
Special Purchases/Modifications
Description of Work/Purchase
Microwave Oven
Proposed
Contractor/Provider Name
American Appliance
Estimated
Purchase Date
Within 9 Months
Total
Cost
$
Monthly Cost
180.00
Total Monthly Special Purchase/Modification Expenses
VI.
221.00
Fiscal Intermediary Services & Fees
Description of Services and Fees
Unit Cost
$
23.78
Monthly Cost
County:
Sally J. Consumer
Monthly
Amount
CALCULAT ION OF MONT HLY CASH BENEFIT
A. Total Cashed Out Benefit
$
565.61
B. LESS Direct Employment Expenses (Section I)
$
186.19
C. LESS Agency Service Expenses
(Section II)
$
271.00
D. LESS Miscellaneous Expenses
(Section III)
$
84.64
$
23.78
$
-
E. LESS Special Purchase / Modification
(Section
Expenses
IV)
F. LESS Fiscal Intermediary Expenses (Section VI)
G. MONTHLY BALANCE
23.78
Total
# of Units
Total Monthly Fiscal Intermediary Expenses
Consumer Name:
$
(A minus the sum of B through F)
Consumer Signature:
Date:
Coordinator Signature:
Date:
State Agency Signature:
Approval Date:
154
Hunterdon
EXHIBIT NUMBER 13 – LISTING OF MEDICAID MANAGED CARE ORGANIZATIONS
Listing of MCOs currently under contract, their addresses, and contact information
ADDRESS
AETNA BETTER HEALTH
AMERIGROUP
HORIZON NJ HEALTH
Aetna Better Health® of New
Amerigroup New Jersey, Inc. Horizon NJ Health
Jersey
101 Wood Avenue South, 8th
370 Scotch Road
Floor
Iselin, NJ 08830
Ewing, NJ 08628
UNITEDHEALTHCARE
WELLCARE
HEALTHFIRST (DSNP Only)
UnitedHealthcare Community
Healthfirst Health Plan of NJ,
WellCare Health Plans of NJ, Inc.
Plan
Inc.
333 Thornall Street, 9th Floor 550 Broad St., 12th Floor
821 Alexander Road, Suite 140
Edison, NJ 08837
Princeton, NJ 08540
MAIN TOLL FREE
1-855-232-3596
1.800.600.4441
1.877.765.4325
1.800.941.4647
TELEPHONE #
711
1.800.855.2880
1.800.654.5505
1-855-232-3596
1.800.454.3730
1.800.682.9091
TTY
MAIN PROVIDER RELATIONS
TELEPHONE #
888.702.2168 (MLTSS)
PROGRAM
Compliance Officer
LIAISION
Office: 609-282-8160
Cell: 401-368-5420
Cell: 732.713.0934
[email protected]
Michele Jaker
1.888.362.3368
Joseph Manger
Director, Regulatory Affairs Government Relations Director
Gov. Programs
Direct: 732.623.5838
Office: 609.718.9377
GOV
Melinda Tobin
711
Mobile: 609.968.8555
Newark, NJ 07102
WellCare NJ Office:
973.274.2100
Customer Service:
1.888.453.2534
Customer Service:
1.877.247.6272
1.888.588.9769
[email protected]
Main number: 609.325.4110
1.888.464.4365
1.800.852.7897
1.888.801.1660
1.866.889.2523
Vincent C. Ceglia
Lisa Knowles
Andrea Cotton
Compliance Officer
Compliance Liaison
Manager, Regulatory Manager
Office: 848.200.3576
Office: 973.274.2182
Office: 973.572.3574
Fax: 877.321.6558
Cell: 973.494.6127
Fax: 212.801.6197
michele.jaker@amerigroup.
[email protected]
Fax: 973.274.4371
Cell: 908.310.2163
[email protected]
com
m
joseph_manger@horizonnj
Joshua Timari (see mailing address
[email protected]
below)
health.com
Director, Regulatory Affairs
Office: 212.801.3249
Fax: 212.801.6197
[email protected]
155
EXHIBIT NUMBER 13 – LISTING OF MEDICAID MANAGED CARE ORGANIZATIONS
AETNA Better Health
Melinda Tobin, Compliance Officer
Office: 609-282-8160
Cell: 401-368-5420
[email protected]
AMERIGROUP
Michele Jaker, Government Relations Director
101 Wood Avenue South, 8th Floor
Iselin, NJ 08830
Office: 732-623-5838
Cell: 732-713-0934
[email protected]
HORIZON NJ HEALTH
Joseph Manger, Director, Regulatory Affairs – Government Programs
370 Scotch Road
Ewing, NJ 08628
Office: 609-718-9377
Cell: 609-968-8555
[email protected]
UNITED HEALTHCARE
Vincent C. Ceglia, Compliance Officer
333 Thornall Street, 9th Floor
Edison, NJ 08837
Office: 848-200-3576
Cell: 908-310-2163
[email protected]
WELLCARE
Lisa Knowles, Compliance Liaison
550 Broad St., 12th Floor
Newark, NJ 07102
Office: 973-274-2182
Cell: 973-494-6127
[email protected]
156
EXHIBIT NUMBER 14 – SAMPLE BUSINESS ASSOCIATE AGREEMENT (BAA)
State of New Jersey
DEPARTMENT OF HUMAN SERVICES
BUSINESS ASSOCIATE AGREEMENT
between
the New Jersey Department Human Services,
Division of Medical Assistance and Health Services,
And
_______________________for
Contract #________
This Business Associate Agreement sets forth the responsibilities of ________
(Business Associate), with an address of ______________, and the New Jersey
Department of Human Services, Division of Medical Assistance and Health Services, as a
Covered Entity, in relationship to Protected Health Information (PHI), as those terms are
defined and regulated by the Health Insurance Portability and Accountability Act of 1996
(HIPAA), and the regulations adopted there under by the Secretary of the United States
Department of Health and Human Services, with the intent that the Covered Entity and
Business Associate shall at all times be in compliance with HIPAA and the underlying
regulations. Business Associate and Covered Entity may be referred to herein collectively
as the “Parties”.
This Business Associate Agreement is entered into for the purpose of Business Associate
providing services on behalf of Covered Entity pursuant to Contract #______ between
Business Associate and the New Jersey Department of Treasury (Underlying Contract).
This Business Associate Agreement is an amendment to the Underlying Contract and
sets forth additional terms that may modify the Underlying Contract.
In consideration for the respective benefits, rights and obligations described above, and
for access to the PHI held by Covered Entity, the Parties agree to be bound by the terms
of this Agreement.
A. Definitions:
1. The terms specified below shall be defined as follows:
a.
“Business associate” shall mean a person or entity, other than a member of
the workforce of a covered entity, who performs functions or activities on
behalf of, or provides certain services to, a covered entity that involve
157
creating, receiving, maintaining, or transmitting protected health information.
A business associate’s Subcontractor that creates, receives, maintains, or
transmits protected health information on behalf of the business associate is
also a business associate (see 45 CFR §§ 160.103 and 164.502(e)(1)(ii)).
The Business Associate to this agreement is the entity named as Business
Associate above.
b.
“Covered Entity” shall generally have the same meaning as the term
“covered entity” at 45 CFR §160.103, and in reference to the Party to this
Agreement, shall be the New Jersey Department of Human Services,
Division of Medical Assistance and Health Services.
c.
"Agreement" shall mean this Business Associate Agreement.
d.
"Breach" shall have the same meaning as the term “Breach” at 45 CFR
§164.402 and includes the unauthorized acquisition, access, use or
disclosure of Protected Health Information in a manner not permitted by this
Agreement, the Privacy Rule or the Security Rule, which compromises the
security of such Protected Health Information.
e.
"Designated Record Set" shall have the meaning set forth at 45 CFR
§164.501: A group of records maintained by or for a covered entity that is:
(i) The medical records and billing records about individuals maintained by
or for a covered health care provider; (ii) The enrollment, payment, claims
adjudication, and case or medical management record systems maintained
by or for a health plan; or (iii) Used, in whole or in part, by or for the covered
entity to make decisions about individuals. For purposes of this paragraph,
the term record means any item, collection, or grouping of information that
includes protected health information and is maintained, collected, used, or
disseminated by or for a covered entity.
f.
"HIPAA" shall mean the Health Insurance Portability and Accountability Act.
g.
"HIPAA Regulations" shall mean the regulations promulgated under HIPAA
by the U.S. Department of Health and Human Services, including but not
limited to, the Privacy Rule and the Security Rule, and shall include the
regulations codified at 45 CFR §§ 160, 162 and 164.
h.
"HITECH" shall mean the Health Information Technology for Economic and
Clinical Health Act, Title XIII of Division A of the American Recovery and
Reinvestment Act of 2009, P.L. 111-005.
i.
"Individual" shall mean the person who is the subject of the Protected
Health Information and includes a person who qualifies as a personal
representative in accordance with 45 CFR §164.502(g).
j.
"Notice of Privacy Practices" shall mean the Notice of Privacy Practices
required by 45 CFR §164.520, provided by Covered Entity to Individuals.
158
k.
"Privacy Rule" shall mean the Standards for Privacy of Individually
Identifiable Health Information at 45 CFR §§ 160 and 164, Subparts A and
E.
l.
“Protected Health Information (PHI)” shall mean individually identifiable
health information that is transmitted or maintained by electronic media or
transmitted or maintained in any other form or medium as defined at 45
CFR §160.103.
m.
"Record" shall mean any item, collection, or grouping of information that
includes Protected Health Information and is maintained, collected, used, or
disseminated by or for a Covered Entity.
n.
"Required by Law" shall have the same meaning as in 45 CFR §164.103.
o.
"Secretary" shall mean the Secretary of the United States Department of
Health & Human Services or his designee.
p.
“Security Incident” shall mean the attempted or successful unauthorized
access, use, disclosure, modification, or destruction of information or
interference with system operations in an information system.
q.
"Security Rule" shall mean the Standards for Security for the Protection of
Electronic Protected Health Information, codified at 45 CFR §§ 160, 162 and
164.
r.
“Subcontractor” means a person to whom a business associate delegates a
function, activity, or service, other than in the capacity of a member of the
workforce of such business associate.
2. All other terms used herein shall have the meaning specified in the Privacy Rule or
if no meaning is specified, shall have their plain meaning.
B. Obligations and Activities of Business Associate
1. Business Associate acknowledges the requirements of 42 U.S.C. 17931 et seq.,
and that Sections 164.308, 164.310, 164.312, and 164.316 of title 45, Code of
Federal Regulations, shall apply to a Business Associate in the same manner that
such sections apply to the Covered Entity. The additional requirements of 42
U.S.C. 17931 that relate to security and that are made applicable with respect to
covered entities shall also be applicable to Business Associate. Business
Associate further acknowledges that if Business Associate violates any security
provision specified in the previous sentence, 42 U.S.C. 1320d-5 and 1320d-6 shall
apply to the Business Associate with respect to such violation in the same manner
such sections apply to a covered entity that violates such security provision.
2. Business Associate may use PHI for functions, activities, or services performed
pursuant to the Underlying Contract provided that such use would not violate this
Agreement, the HIPAA regulations, the Privacy Rule, or Notice of Privacy Practices
if done by Covered Entity. In the event that this Agreement conflicts with any other
159
written agreement related to the Underlying Contract, this Agreement shall control.
Business Associate's access to and use of the PHI is limited to the provision of
services by the Business Associate as set forth in the Underlying Contract.
3. Business Associate may further disclose PHI to a Subcontractor for the proper
management and administration of Business Associate and in compliance with the
requirements of 45 CFR §164.502(e) and 45 CFR §164.504(e), provided that such
disclosure is Required by Law, or would not violate this Agreement, the Privacy
Rule, or Notice of Privacy Practices if done by Covered Entity, and Business
Associate executes an additional business associate agreement as Required by
Law and for the purpose for which PHI is to be disclosed to the Subcontractor, and
the Subcontractor notifies Business Associate of any instances of which it is aware
that PHI has been disclosed. Business Associate is not in compliance with the
standards in § 164.502(e) if the Business Associate knows of a pattern of activity
or practice of a Subcontractor that constitutes a Breach or violation by the
Subcontractor, unless Business Associate takes reasonable steps to cure the
Breach or end the violation, as applicable, and, if such steps are unsuccessful,
terminate the contract. In the event that this Agreement conflicts with any other
agreement relating to the access or use of PHI, this Agreement shall control.
4. Business Associate agrees to comply with the requirements of HIPAA, HITECH,
and regulations at 45 CFR §§ 160, 162 and 164, including implementing
appropriate safeguards and compliance with 45 CFR §164.302 et seq., as
amended, and agrees to implement and use appropriate administrative, physical
and technical safeguards to protect the confidentiality, integrity, and availability of
PHI and to prevent use or disclosure of PHI other than as provided for by this
Agreement. Business Associate shall maintain a comprehensive written
information privacy and security program that includes administrative, technical
and physical safeguards appropriate to the size and complexity of the Business
Associate's operations and the nature and scope of its activities. Business
Associate agrees to require the same of any Subcontractor business associate
handling PHI.
5. Business Associate agrees to take prompt corrective action to mitigate any harmful
effect that is known to Business Associate of a use or disclosure of PHI by
Business Associate or by its Subcontractor in violation of the requirements of this
Agreement.
6. Business Associate agrees to notify Covered Entity of any use or disclosure of PHI
not provided for by this Agreement, or the Privacy Rule, or of any suspected or
actual Breach within twenty-four hours of Business Associate becoming aware of
such use, disclosure or suspected or actual Breach, consistent with 45 CFR
§164.410. Business Associate further agrees to take prompt corrective action to
cure or mitigate harmful effects of any such use, disclosure, or actual or suspected
breach of security or intrusion.
7. Business Associate agrees to ensure that any officer, employee, or Subcontractor
to whom it provides PHI received from or maintained, created or received by
Business Associate on behalf of Covered Entity agrees to the same restrictions
and conditions that apply through this Agreement to Business Associate with
160
respect to such PHI. Business Associate acknowledges that the requirements of
45 CFR §164.504(e)(2) through (e)(4) apply to the contract required by 45 CFR
§164.502(e)(1)(ii) between Business Associate and a Subcontractor business
associate in the same manner as such requirements apply between Covered Entity
and Business Associate.
8. Business Associate agrees to provide access to PHI in a Designated Record Set to
Covered Entity or to an Individual as directed by Covered Entity in order to meet
the requirements of 45 CFR §164.524, within 30 days of the date of any such
request, unless the request is denied by Covered Entity pursuant to 45 CFR
§164.524(a)(1), (a)(2) or (a)(3).
9. Business Associate agrees to make any amendment(s) to PHI in a Designated
Record Set as Covered Entity directs in order to meet the requirements of 45 CFR
§164.526, within 30 days of such a request, unless the request has been denied
pursuant to 45 CFR §164.526(d). Business Associate shall provide written
confirmation of the amendment(s) to the Covered Entity.
10. Business Associate agrees to make its comprehensive written information privacy
and security program, as well as its internal practices, books and records, including
policies and procedures relating to the use and disclosure of PHI received from, or
created, maintained, or received by Business Associate on behalf of Covered
Entity available to Covered Entity within 30 days of the date of such request, or to
the Secretary in a time and manner designated by the Secretary.
11. Business Associate agrees to document all disclosures of PHI which would be
required for Covered Entity to respond to a request by an Individual for an
accounting of disclosures of PHI in accordance with 45 CFR §164.528. Business
Associate agrees to provide to Covered Entity, within 30 days of the date of such
request, all disclosures of PHI.
12. Business Associate agrees that from time to time, upon reasonable notice, it shall
allow Covered Entity or its authorized agents or contractors, to inspect the
facilities, systems, books, records and procedures of Business Associate to
monitor compliance with this Agreement. In the event the Covered Entity, in its
sole discretion, determines that the Business Associate has violated any term of
this Agreement or the Privacy Rule, it shall so notify the Business Associate in
writing. Business Associate shall promptly remedy the violation of any term of this
Agreement and shall certify same in writing to the Covered Entity. The fact that
Covered Entity or its authorized agents or contractors inspect, fail to inspect or
have the right to inspect Business Associate's facilities, systems, books, records,
and procedures does not relieve Business Associate of its responsibility to comply
with this Agreement. Covered Entity's (1) failure to detect, or (2) detection but
failure to notify Business Associate, or (3) failure to require Business Associate to
remediate any unsatisfactory practices, shall not constitute acceptance of such
practice or a waiver of Covered Entity's enforcement rights under this Agreement.
Nothing in this paragraph is deemed to waive Section E of this Agreement or the
New Jersey Tort Claims Act, NJSA 59:1-1 et seq., as they apply to Covered Entity.
161
13. Business Associate shall report all Security Incidents within twenty-four hours of
becoming aware of such.
14. In the event of an actual or suspected Breach, Business Associate shall provide
Covered Entity with a written report, as soon as possible but not later than five (“5”)
days after the Breach/suspected Breach became known. The report shall include,
to the extent available: a) the identification of each individual whose unsecured
PHI has been, or is reasonably believed by the Business Associate to have been,
accessed, acquired, used or disclosed during the Breach; b) a brief description of
what happened, including the date of the Breach and the date of the discovery, if
known; c) a description of the types of unsecured PHI involved in the Breach; d)
any steps individuals affected by the Breach should take to protect themselves
from potential harm resulting from the Breach; and e) a description of what
Business Associate is doing to investigate the Breach, mitigate harm to the
individual(s), and protect against future breaches. In addition, the Business
Associate shall, at the request of the Covered Entity, provide Breach notification
required by HITECH.
15. In the event of a Breach, Business Associate agrees to provide the notifications
required by HIPAA at 45 CFR §164.400 et seq. Business Associate will obtain
Covered Entity’s approval of all notifications prior to the notifications being issued.
C. Obligations of Covered Entity.
1. Covered Entity shall be responsible for using appropriate safeguards to maintain
and ensure the confidentiality, privacy and security of PHI transmitted to Business
Associate pursuant to this Agreement, in accordance with the requirements and
standards in the Privacy Rule, until such PHI is received by Business Associate.
2. In accordance with 45 CFR §164.520, Covered Entity shall notify Business
Associate of any limitations in Covered Entity's Notice of Privacy Practices to the
extent that such limitation may affect Business Associate's use or disclosure of
PHI.
3. Covered Entity shall notify Business Associate of any changes in or revocation of
permission by an Individual to use or disclose PHI, to the extent that such changes
may affect Business Associate's use or disclosure of PHI.
4. Covered Entity shall notify Business Associate of any restriction to the use or
disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR
§164.522, to the extent that such restriction may affect Business Associate's use
or disclosure of PHI.
5. Covered Entity shall not request Business Associate to use or disclose PHI in any
manner that would not be permissible under the Privacy Rule if done by Covered
Entity or under Covered Entity's Notice of Privacy Practices or other policies
adopted by Covered Entity pursuant to the Privacy Rule.
D. Term of Business Associate Agreement and effect of breach
162
1. This Agreement shall be effective as of the date the Agreement is fully executed,
and it shall terminate when all of the PHI provided by Covered Entity to Business
Associate, or created, maintained or received by Business Associate on behalf of
Covered Entity, is destroyed or returned to Covered Entity, or, if it is infeasible to
return or destroy PHI, protections are extended to such information in accordance
with subsection 3, below.
2. Upon Covered Entity's knowledge of a material breach or violation(s) of any of the
obligations under this Agreement by Business Associate, Covered Entity shall, at
its discretion, either:
a.
Provide an opportunity for the Business Associate to cure the breach or end
the violation upon such terms and conditions as Covered Entity shall specify,
and if Business Associate does not cure the breach or end the violation, upon
such terms and conditions as Covered Entity has specified, Covered Entity
may terminate this Agreement and require that Business Associate fully
comply with the procedures specified in subsection 3, below.
b.
Require that Business Associate fully comply with the procedures specified in
subsection 3., below, if Business Associate has breached a material term of
this Agreement and Covered Entity has determined, in its sole discretion, that
cure is not possible.
3. Return or Destruction of PHI.
a.
Except as provided in paragraph c. of this section, upon termination of the
Underlying Contract for any reason, Business Associate shall return or
destroy all PHI received from Covered Entity or created or received by
Business Associate on behalf of Covered Entity. This provision shall also
apply to PHI that is in the possession of Subcontractors or agents of Business
Associate. Business Associate and its Subcontractors shall retain no copies
of PHI.
b.
Business Associate shall provide Covered Entity with a certification, within 30
days, that neither it nor its Subcontractors or agents maintains any PHI in any
form, whether paper, electronic, film or other, received from Covered Entity or
created or received by Business Associate on behalf of Covered Entity.
Covered Entity shall acknowledge receipt of such certification and, as of the
date of such acknowledgement, this Agreement shall terminate.
c.
In the event that Business Associate determines that returning or destroying
the PHI is infeasible, Business Associate shall provide to Covered Entity
notification of the conditions that make return or destruction infeasible.
Covered Entity shall have the discretion to determine whether it is feasible for
the Business Associate to return or destroy the PHI. If Covered Entity
determines it is feasible, Covered Entity shall specify the terms and conditions
for the return or destruction of PHI at the expense of Business Associate.
Upon Covered Entity determining that Business Associate cannot return or
destroy PHI, Business Associate shall extend the protections of this
163
Agreement to such PHI and limit further uses and disclosures of such PHI to
those purposes that make the return or destruction infeasible, for so long as
Business Associate maintains such PHI.
E. Indemnification and Release
1. Business Associate shall assume all risk and responsibility for, and agrees to
indemnify, defend and save harmless Covered Entity, its officers, agents and
employees and each and every one of them, from and against any and all claims,
demands, suits, actions, recoveries, judgments, and costs (including attorneys’
fees and costs and court costs), and expenses in connection therewith, on account
of loss of life, property or injury or damages to the person, body or property of any
person or persons, whatsoever, which shall arise from or result directly or indirectly
from Business Associate's use or misuse of PHI or from any action or inaction of
Business Associate or its officers, employees, agents or Subcontractors with
regard to PHI or the requirements of this Agreement or the Privacy Rule. The
provisions of this indemnification clause shall in no way limit the obligations
assumed by Business Associate under this Agreement, nor shall they be construed
to relieve Business Associate from any liability nor preclude Covered Entity from
taking any other actions available to it under any other provisions of this
Agreement, the Privacy Rule or at law.
2. Notwithstanding the above, the obligations assumed by the Business Associate
herein shall not extend to or encompass suits, costs, claims, expenses, liabilities
and judgments incurred solely as a result of actions or inactions of Covered Entity.
3. Business Associate acknowledges the possibility of criminal sanctions and
penalties for breach or violation of this Agreement or the Privacy Rule pursuant to
42 U.S.C. 1320d-6.
4. Business Associate acknowledges that Social Security number and Social Security
Administration (SSA) records, information or data regarding individuals (records)
are confidential and require safeguarding. Failure to safeguard Social Security
numbers and other SSA records can subject the Business Associate and its
employees to civil and criminal sanctions under Federal and State laws including
the Federal Privacy Act at 5 U.S.C. 552a; Social Security Act sections 205 and
1106 (see 42 U.S.C. 405(c)(2)(C)(viii) and 42 U.S.C. 1306, respectively); and
N.J.S.A. 56:8-164. The Business Associate shall ensure that all persons who will
handle or have access under this Agreement to any Social Security Number or
other SSA record will be advised of the confidentiality of the records; the
safeguarding requirements to protect the records and prevent unauthorized
access, handling, duplication and re-disclosure of the SSA records; and the civil
and criminal sanctions for failure to safeguard the SSA records. The Business
Associate shall enact and/or maintain safeguards necessary to protect these
records and prevent the unauthorized or inadvertent access to, duplication of or
disclosure of a Social Security number or other SSA record.
5. Business Associate acknowledges that all Medicaid applicant and beneficiary
information is confidential, and 42 CFR § 431.300 to 307 restricts the use or
disclosure of information concerning applicants and beneficiaries to purposes
164
directly connected with the administration of the plan. Purposes directly related to
plan administration include: (a) Establishing eligibility; (b) Determining the amount
of medical assistance; (c) Providing services for beneficiaries; and (d) Conducting
or assisting an investigation, prosecution, or civil or criminal proceeding related to
the administration of the plan. The types of information about applicants and
beneficiaries that are safeguarded include but are not limited to: (1) Names and
addresses; (2) Medical services provided; (3) Social and economic conditions or
circumstances; (4) Agency evaluation of personal information; (5) Medical data,
including diagnosis and past history of disease or disability; and (6) Any
information received for verifying income eligibility and amount of medical
assistance payments (see 42 U.S.C. 435.940 through § 435.965). Income
information received from SSA or the Internal Revenue Service must be
safeguarded according to the requirements of the agency that furnished the data,
including section 6103 of the Internal Revenue Code, as applicable; (7) Any
information received in connection with the identification of legally liable third party
resources; and (8) Social Security numbers.
6. Business Associate shall be responsible for, and shall at its own expense, defend
itself against any and all suits, claims, losses, demands or damages of whatever
kind or nature, arising out of or in connection with an act or omission of Business
Associate, its employees, agents, or contractors, in the performance of the
obligations assumed by Business Associate pursuant to this Agreement. Business
Associate hereby releases Covered Entity from any and all liabilities, claims,
losses, costs, expenses and demands of any kind or nature whatsoever, arising
under state or federal laws, out of or in connection with Business Associate's
performance of the obligations assumed by Business Associate pursuant to this
Agreement.
7. The obligations of the Business Associate under this Section shall survive the
expiration of this Agreement.
F. Miscellaneous
1. A reference in this Agreement to HIPAA or HITECH or a section of the Privacy
Rule or Security Rule means the law or section in effect at the time the Agreement
is executed or as it may be amended or interpreted by a court of competent
jurisdiction during the term of the Agreement.
2. Business Associate and Covered Entity agree to take such action as is necessary
to amend this Agreement from time to time in order that Covered Entity can
continue to comply with the requirements of the Privacy Rule, the Security Rule
and HIPAA, and case law that interprets the Privacy Rule, Security Rule or HIPAA.
All such amendments shall be in writing and signed by both Parties. Business
Associate and Covered Entity agree that this Agreement may be superseded by a
revised Business Associate Agreement executed between the Parties after the
effective date of this Agreement.
3. The respective rights and obligations of Business Associate and Covered Entity
under Section D, "Term of Business Associate Agreement and effect of breach",
above, shall survive the termination of the Contract. The respective rights and
165
obligations of Business Associate and Covered Entity under Section E,
"Indemnification and Release", and Section B.10 above, regarding internal
practices, shall survive the termination of this Agreement.
4. Any ambiguity in this Agreement shall be resolved to permit Covered Entity to
comply with the Privacy Rule, the Security Rule, and HIPAA, as it may be
amended or interpreted by a court of competent jurisdiction.
5. Nothing expressed or implied in the Agreement is intended to confer, nor shall
anything herein confer, upon any person other than the Business Associate and
Covered Entity, and any successor state agency to Covered Entity, any rights,
remedies, obligations or liabilities whatsoever.
6.
This Agreement constitutes the entire Agreement and supersedes all prior
agreements and understandings, both written and oral, among the Parties with
respect to the subject matter of this Agreement.
7. Neither this Agreement nor any of the rights, interests, or obligations under this
Agreement shall be transferred or assigned by Business Associate without the
prior written consent of Covered Entity.
8. With respect to any provision of this Agreement finally determined by a court of
competent jurisdiction to be unenforceable, such court shall have jurisdiction to
reform such provision so that it is enforceable to the maximum extent permitted by
applicable law, and the Parties shall abide by such court’s determination. In the
event that any provision of this Agreement cannot be reformed, such provision
shall be deemed to be severed from this Agreement, but every other provision of
this Agreement shall remain in full force and defect. This Agreement shall be
governed by and construed in accordance with the laws of the State of New
Jersey.
9. Any notices to be given hereunder shall be made via Regular and Certified US
Mail, Return Receipt Requested, and if possible, by facsimile to the addresses and
facsimile numbers listed below:
Business Associate:
______________________________
______________________________
______________________________
Facsimile #
Covered Entity:
______________________________
1.
Privacy Officer:
2.
Director
10. As the Covered Entity is a body corporate and politic of the State of New Jersey,
the signature of its authorized representative is affixed below. The undersigned
166
representative of Covered Entity certifies that he or she is fully authorized to enter
into the terms and conditions of this Agreement and to execute and legally bind
such Covered Entity to this document.
11. The undersigned representative of Business Associate certifies that he or she is
fully authorized to enter into the terms and conditions of this Agreement and to
execute and legally bind such Business Associate to this document.
Signatures To Be Determined
167

RFP TEXT

Transcription

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