In a Request for Proposal released Friday, the California Department of Health Care Services seeks the help of technology companies to stand up and run the California Accounts Receivable Management (CalARM) solution, which it says shall be commercially sourced cloud software as a service for “the automated identification, calculation, recovery, and reconciliation of Medi-Cal expenses,” to achieve needed business outcomes, while replacing and consolidating legacy apps and manual processes. Among the takeaways:
- DHCS pursues more than 100,000 debts annually, most of which are traditional Medicaid recovery — but the limits of its current system and statistical trends indicate the department “should be collecting on nearly three times as many cases.” DHCS’ Automated Collection Management System (ACMS) no longer meets its business needs; staffers have to manually enter “recoverable expenses and payers … to open recovery cases using data gathered from hard copy correspondence,” as well as manually track down possible sources of recoverable expenses for those who are liable. “If liable third parties cannot be identified timely and efficiently, amounts that they owe cannot be recovered, resulting in lost revenue for the state,” according to the RFP. ACMS’ “tedious manual processes” and DHCS’ limited staff resources hinder personnel: “This problem is significant as the State forgoes millions of dollars in recovery of Medi-Cal expenses each year as a direct result of necessary workarounds for the ACMS system,” per the RFP. However, according to the Statement of Work: “While the CalARM solution will replace the functionality within ACMS, the decommissioning of ACMS itself is not in scope of this project.”
- The department seeks “a modernized recovery solution to replace the ACMS and its supplemental applications” and automating manual processes. The solution should also achieve business outcomes including increasing receivables collected by 15 percent; enhancing “identification of potential third-party liabilities” by 25 percent; automating communications that notify third parties of possible liabilities; and boosting use of electronic funds transfer to receive payments by 20 percent of the present volume. Business needs include implementing debt collection workflow automation to increase the number and accuracy of debts found and collected; implementing a self-service portal to decrease the need for manual data re-entry; and aggregating multiple accounts receivable accounts into a single system. DHCS requires the CalARM solution to be “configurable and business rules-based, providing self-service and real-time transactions” through a self-service, customer-facing portal. CalARM must also use open standards and APIs to “facilitate data exchanges, interfaces, and integration with internal and external systems/entities.” It must “enable compliance” with the federal Centers for Medicare and Medicaid Services; and “elevate DHCS’ Medicaid Information Technology Architecture (MITA) maturity to a Level 3.”
- Among the minimum qualifications for staff, the implementation manager must be a certified project management professional and have at least seven years’ “documented project management experience in large-scale … complex systems”; and at least five years’ experience in implementation management and as a senior project manager. The data conversion/interfaces lead must have at least five years’ experience leading data migration, conversion and validation efforts in support of an IT system implementation; and at least three years’ experience “implementing large-scale and complex system interfaces” needed between a software solution and other systems. The technical lead must have at least five years’ experience analyzing, designing and configuring “large-scale and complex” IT solutions as a technical lead; at least five years’ experience “applying security policies, standards, testing and implementation” in technology solutions; and at least three years’ experience developing and designing interfaces.
- The contract’s estimated value is not stated. The term will be five years after “approval by the California Department of Technology, Statewide Technology Procurement … .” The state may, at its discretion, approve up to two three-year extensions — bringing the maximum possible term to 11 years. A bidders’ conference is scheduled for April 5, and intents to bid and written questions are due April 19. State responses to questions are expected May 17. Proposals are due June 8 and will be evaluated June 9-July 7. Discussions with the top three bidders are slated for July 8-Aug. 5; and negotiations are scheduled for Sept. 6-27, with best and final offers due Sept. 28. A notification of award is expected Oct. 12, and contract execution is scheduled for Jan. 11.
