REQUEST FOR PROPOSALS

Transcription

1 SOUTHEAST MICHIGAN COMMUNITY ALLIANCE REQUEST FOR PROPOSALS Electronic Medical Record System Issued July 14,

2 Southeast Michigan Community Alliance REQUEST FOR PROPOSAL TABLE OF CONTENTS SECTION I INTRODUCTION... 3 SECTION II GENERAL CONDITIONS.. 7 SECTION III COMPANY PROFILE... 8 SECTION IV SEMCA EMR PROJECT.. 10 SECTION V CRITERIA FOR EVALUATION OF RESPONSES SECTION VI VENDOR PROFILE SECTION VII TECHNICAL ENVIRONMENT. 14 SECTION VIII SYSTEM IMPLEMENTATION AND TECHNICAL SUPPORT...16 SECTION IX SYSTEM PROPOSAL SECTION X FUNCTIONAL REQUIREMENTS 19 2

3 SECTION I INTRODUCTION I-A PURPOSE This Request for Proposal (RFP) is intended to provide vendors with sufficient information to prepare and submit proposals for an Electronic Medical Record System for Southeast Michigan Community Alliance (SEMCA) and its approved substance use disorder provider agencies. The intent of the RFP is to identify a vendor with a product(s) that best meets the clinical and management needs of SEMCA and its provider agencies as described in this RFP and represents prudent expenditure of SEMCA resources. I-B ISSUING AGENCY This request is issued by Southeast Michigan Community Alliance, abbreviated as SEMCA. The Chief Information Officer of SEMCA is the only agent authorized to change, modify, amend, alter, or clarify the terms and conditions of the Request for Proposal and any contracts awarded as a result of the Request. SEMCA will remain the sole point of contact throughout the procurement process. All communications concerning this procurement must be addressed in writing via to: Bill Hellar Chief Information Officer Southeast Michigan Community Alliance Eureka Taylor MI Bill.hellar@semca.org Subject: EMRS RFP Question I-C CONTRACT ADMINISTRATOR Upon receipt of a properly executed contract agreement, the Chief Executive Officer of SEMCA, or his or her designee, will be authorized to administer the contract on a dayto-day basis during the term of the contract. I-D INCURRING COSTS SEMCA is not liable for any costs incurred by the proposing organization prior to the signing of a contract. The activities in the proposed contract cover the period from the beginning of implementation to such time when all system requirements have been met and training has been completed. 3

4 I-E PROPOSALS To be considered, a vendor must submit a complete response to information requested in Sections VI through IX. Incomplete or inaccurate proposals may be rejected and disqualified from further review and consideration. The response to the RFP must include a letter signed by an official of the proposing vendor authorized to bind the proposing vendor to the provisions stated in the vendor s proposal. The proposal must include a statement as to the period during which the proposal remains valid. This period must be at least ninety (90) days after the due date for responses to this RFP. Rates quoted in the proposal and the services proposed shall remain valid for the duration of the prospective contract, unless changed by SEMCA. The signed proposal must be received electronically by Southeast Michigan Community Alliance no later than 5:00 p.m. on August The electronic file must be submitted via to Bill Hellar, Chief Information Officer at bill.hellar@semca.org * Large files (over 15 MB) should be submitted via the following URL with the subject: EMRS RFP Response I-F ACCEPTANCE OF PROPOSAL CONTENT The contents of the RFP and the proposal will become contractual obligations if a contract ensues. Failure of the successful proposing vendor to accept these obligations may result in cancellation of the award. I-G INDEPENDENT PRICE DETERMINATION By submission of a proposal, the proposing vendor certifies that in connection with this proposal: A. The prices in the proposal have been arrived at independently, without consultation, communication, or agreement, for the purpose of restricting competition as to any matter relating to such prices with any other proposing vendor or with any competition; and B. Unless otherwise required by law, the prices which have been quoted in the proposal have not been knowingly disclosed by the proposing vendor and will not knowingly be disclosed by the proposing vendor prior to award directly or indirectly to any other proposing vendor or to any competitor; and C. No attempt has been made or will be made by the proposing vendor to induce any other person or firm to submit or not submit a proposal for the purpose of restricting competition. 4

5 The person signing the proposal certifies that he/she is: A. The person in the proposing vendor responsible for the decision as to the prices being offered in the proposal and has not participated (and will not participate) in any action contrary to I-G.A., B. and C. above; or B. Not the person in the proposing vendor responsible for the decision as to the prices being offered in the proposal but has been authorized, in writing, to act as agent for the person(s) responsible for such decision in certifying that such person(s) have not participated (and will not participate) in any action contrary to I-G.A., B. and C. above. I-H DISCLOSURE All information in a proposing organization s proposal is subject to disclosure under the provisions of Public Act 442 of 1976 known as the Freedom of Information Act. I-I GENERAL REQUIREMENTS FOR PROPOSING VENDORS All vendors submitting a proposal must meet the following criteria. Proposals from vendors that do not meet the following criteria will not be considered in the review process and will be eliminated from consideration. Proposing organizations must meet the following minimum qualification criteria: 1. Be in compliance with Federal Regulation 45 CFR Part 76. a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; b. Have not within a three year period preceding this agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state anti-trust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statement, or receiving stolen property; c. Are not presently indicted or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in section B, and; d. Have not within a three year period preceding this agreement had one or more public transactions (federal, state or local) terminated for cause or default. I-J PROPOSAL RECEIPT Proposals must be received at the SEMCA office on or before 4:00 p.m. on August

6 I-K INDEMNIFICATION The vendor entering into a contract with SEMCA shall indemnify and hold harmless SEMCA and its agents and employees from and against all claims, damages, losses, and expenses including attorney s fees arising out of, or resulting from the performance or the work, including all labor, materials, and equipment necessary to produce the services required by this contract. I-L CONTRACT S LIABILITY INSURANCE The vendor entering into a contract with SEMCA shall purchase and maintain such insurance as will protect the vendor from claims which may arise out of, or result from the contractor s operations under the contract. The insurance shall include contractual liability insurance as applicable to the contractor s obligation under the Indemnification clause of the RFP. Before starting work, the contractor must furnish a Certificate of Insurance verifying liability coverage to SEMCA. I-M CANCELLATION Cancellation of contract by SEMCA may be executed for default by the contractor. Default is defined as the failure of the contractor to fulfill the obligations of the proposal, the quotation, or the contract. In the case of default by the contractor, SEMCA may cancel the contract immediately and procure services from another source. I-N TIMELINE FOR SELECTION PROCESS Anticipated Time Frames for Selection Process Issue RFP to Vendors Monday July 14, 2014 Questions on RFP due Sunday July 21, 2014 Responses to RFP due Monday August 4 4:00PM Vendor Demonstration August 2014 Reference Checks August 2014 Vendor Award Announcement (Tentative) September 23, 2014 Please note that all responses to questions received regarding the RFP will be posted within 72 hours on the SEMCA website, 6

7 I-O INSTRUCTIONS Vendor Response Instructions 1. Written responses are required to Sections VI through IX. Please respond in a separate MS Word Document. 2. Vendors will respond to all statements contained in all worksheets of the RFP Requirements Checklist.xls document. There is a response key on page 2 of the document. 3. All response documentation should be ed to the above listed SEMCA contact. 4. Please provide a price estimate based on up to 300 users. If developmental software or enhanced versions of existing software is included in the overall package being proposed, the nature, status, and timing of development and delivery activities should be clearly stated 5. Please provide an implementation and training timeline that would begin on September and be complete by December Complete the Proposal Signature Page (page 25) SECTION II GENERAL CONDITIONS Please note the following General Conditions that apply to this Request for Proposal SEMCA reserves the right to discontinue the RFP process at any time. SEMCA reserves the right to reject any and all vendors in this RFP process. SEMCA reserves the right to amend or supplement this Request for Proposal and will post changes on its website, no later than July

8 SECTION III COMPANY PROFILE The Southeast Michigan Community Alliance (SEMCA) is a regional substance use disorder Coordinating Agency (CA) serving 2 counties in Michigan. It will be referred to in this document as CA or MCO. It is established as a private nonprofit corporation, recognized as a 501 (c) 3 organization and designated as a regional coordinating agency under Michigan Public Act 368, Article 6 of SEMCA is responsible for evaluating and assessing need(s) and planning and developing services in response to this need. In addition, it is responsible for the management of public funding for services, monitoring of funded services and reporting as required in prime contracts with the Michigan Department of Community Health and two Pre-Paid Inpatient Health Plans (PIHP). SEMCA contracts with 32 Michigan licensed substance use disorder treatment providers that operate 79 offices. There are over 300 users of our current billing, data collection and authorization system. The providers offer different levels of treatment services. Treatment services include screening and referral, sub-acute detoxification (not hospital-based), short and long term residential treatment, individual and group outpatient counseling, methadone maintenance services, family counseling and geriatric counseling, case management, relapse recovery, and support services. SEMCA is not involved in all services that providers offer but is interested in a system that would provide functionality for the above mentioned services. SEMCA receives funding for Medicaid, SAMHSA Federal Block Grant, Adult Benefit Waiver (ABW), MIChild and other state proprietary funds. Medicaid and ABW funds are received from two regional Prepaid Inpatient Health Plans (PIHPs) that cover SEMCA two county regions. Other funding sources, such as SAMHSA Federal Block Grant and MIChild, are received directly from the Michigan Department of Community Health (MDCH). SEMCA is undergoing massive system change due to recent legislation that has eliminated the CA designation effective October As part of this change we are bidding to be designated a Managers of Comprehensive Provider Network (MCPN) for The Detroit Wayne Mental Health Authority. This designation would expand our purview to include services for adults with serious mental illness (SMI), children with serious emotional disorder (SED) in addition to persons with substance use disorders. In order to accommodate this enhanced business model, SEMCA is seeking to implement an Electronic Medical Record system that is Meaningful Use certified to serve as the platform to support fiscal management, regulatory and contractual requirements, data analysis and other critical operational functions. System data will be generated by a hybrid of direct entry and import from foreign systems. 8

9 SECTION III COMPANY PROFILE (cont) Current Management Information System Environment SEMCA currently contracts with Netsmart for the use of the CareNet Managed Care software product and provides this to each of its providers. Many of the provider developed systems are paper-and-file systems that involve intensive practices. This allows for increased opportunity of duplicate entry error and requires an unnecessary expenditure of staff resources. In some cases providers are using data systems with the capability to transfer EDI X12 format data files. It is SEMCA s intent to procure a system that will take advantage of this opportunity where possible to minimize redundant data entry. The historical and current data will need to be imported into the new EMR system. 9

10 SECTION IV SEMCA EMR PROJECT 1. EMR Project Goals and Expectations Our main goal of this project is to identify, select and successfully implement an Electronic Medical Record software that integrates the MCO and Clinical package and assures that SEMCA and its provider network have the necessary technology to respond to the requirements of the Affordable Care Act and compete in the behavioral health market. We believe that by moving to a well designed EMR system it will create efficiencies for SEMCA and our provider network by saving time and money, while most importantly increasing the quality of care to our clients. Several areas were identified where a well designed EMR will improve the outcome for clients served and increase the efficiencies and thus save on administrative dollars. Time and administrative cost savings will be recognized in the areas of contract monitoring, billing, data collection and reporting, and client care will improve through care coordination and quality control. In addition, it is anticipated that a well designed electronic medical record system will help to minimize the risks associated with non-compliance due to documentation errors. 2. Phases of the EMR Project Phase I: System Analysis Phase II: Request for Proposal and Selection of Vendor Phase III: Implementation and Data Migration Phase IV: Training Phase V: Maintenance 10

11 SECTION V CRITERIA FOR EVALUATION OF RESPONSES SEMCA staff will evaluate the responses to this RFP based on the vendor s ability to: Demonstrate expertise and functionality as evidenced by client references and company profile. (Section VI) (10) Provide a superior level of customer service and technical support, both preinstallation and post-installation to clients as evidenced by references. (Section VI) (10) Provide technical environment sufficient to support desired system with adequate disaster recovery plan (Section VII) (10) Provide timely program modifications and upgrades in response to changing industry needs, regulatory requirements, and advancing technology. (Section VIII) (10) Provide viable plan for implementation of the software successfully across the SEMCA provider network in a reasonable time frame. (Section VIII) (10) Provide a cost-effective solution that meets the financial goals of SEMCA and its provider network. (Section IX) (10) Meet the functional and technical requirements described in this RFP as evidenced by the response in the RFP Checklist. (Section X) (40) Proposals will be scored using an adjectival rating system categorizing these sections as Excellent, Very Good, Good, Fair, Poor, or Unacceptable. Bidders who achieve a score of 75% or higher will be considered for vendor demonstration which could lead to contract award negotiation. 11

12 SECTION VI VENDOR PROFILE 1. Identify the company name, address, city, state, zip code, telephone, and fax numbers. 2. Provide statement that submission is a true and accurate representation of the products and services available as evidenced by signature of corporate officer or designee. 3. Identify the name, title, address, phone and fax numbers, and address of the primary contact person for this project. 4. Provide a brief overview of your company including number of years in business, number of employees, nature of business, and description of clients. 5. Identify any parent corporation and/or subsidiaries, if appropriate. 6. Identify if vendor is Public or Privately Owned. 7. Give a brief description of the evolution of the electronic medical record system software. Include the date of the first installed site and major developments which have occurred (e.g. new versions, new modules, specific features). Describe any previous ownership, if appropriate. 8. Bankruptcy/Legal Issues (including under which name the bankruptcy was filed and when, or any pertinent lawsuits, closed or pending, filed against the company.) 9. Indicate the total number of installations in the last 3 years by the year of installation and the total number of current users for the proposed system. 10. Provide a summary of your company s short term and long term goals and strategic vision. 11. List any certifications the vendor holds. 12. The vendor should provide a statement describing what differentiates its products and services from those of its competitors. 13. User Groups - Vendor should provide a list of the user groups and state if SEMCA can attend a meeting or a call for review purposes. 14. The vendor should describe how customer feedback, such as requests for new requirements are handled. 15. Provide contact information (telephone and ) for three to five references currently using the proposed solution. 12

13 SECTION VII TECHNICAL ENVIRONMENT Hardware 1. Describe the hardware configuration including descriptions of central processing unit(s), networking hardware, back up devices, and Uninterrupted Power Supply. 2. Describe the ability of the proposed system to support fail-safe data storage (redundancy, mirrored, etc.). 3. Describe the requirements of system cabling for communication to the server and to the existing network. 4. Does the system employ 32-bit or 64 bit architecture? 5. What are the warranty periods provided for hardware? Software 1. Describe the operating systems under which the proposed system will operate. (UNIX, DOS, Windows, Windows NT, etc.) 2. Name and describe the database management program utilized by the system. 3. What programming language(s) was used to develop the system? 4. How many records can be stored in the proposed system? 5. Describe the file purging/archiving methodology used by the proposed system. 6. Describe the length of time a software version is supported. 7. Please describe your system s database reporting tools. 8. Describe the security system used by the proposed system. 9. Describe your proposed disaster recovery plan to safeguard source code and ensure that the proposed system is recoverable in the event of a disaster at the headquarters of your facility. 10. Describe your proposed disaster recovery plan for SEMCA to ensure that data is safe and secure in the event of a disaster. 11. Has the system undergone a risk audit from an independent third party? If yes what were the results. 13

14 Network and Interface Issues 1. Have you interfaced your EMR with other Clinical Information Systems? (Provide names of interfaced systems.) 2. Does the proposed system comply with Health Level 7 (HL7) interface standards for importing and exporting data to and from other systems specifically the Health Insurance Exchange and the Health Information Exchanges? 3. Have you interfaced your EMR with reference libraries? (Provide names of interface reference libraries.) Describe the interface functionality. 4. Does your EMR have the capability to provide a direct link to off-site locations for order entry and result retrieval? 5. Does the system have the ability to import custom data sets? 6. What communication protocols are supported? 7. What speed of network lines are required for proposed system to function on a Wide Area Network? 14

15 SECTION VIII SYSTEM IMPLEMENTATION AND TECHNICAL SUPPORT 1. Describe and attach an implementation plan specific to SEMCA and its provider network. This plan should begin September and be complete by December Describe the experience and qualifications of your installation team. 3. What kind of client communication and implementation planning is done prior to the installation? 4. Describe the training provided. Include a training outline. 5. Where is your technical support center located? 6. What are the methods for contacting technical support? 7. What are your hours of operation for technical support? 8. Describe the qualifications of your technical support staff. 9. Describe the organization and structure of your technical support services. 10. What percentage of your total employees is responsible for direct client support? 11. Describe the ongoing system support provided by the vendor. 12. Are software upgrades provided as part of the software support contract? 13. Describe your software upgrade process. 14. Are there hot fixes or updates between versions? 15. How often are new versions released? 16. How are customer requests for enhancements and customizations handled? 17. Describe the recent history of system enhancements. 18. Describe the qualifications of your product development department. 19. What percentage of your total employees is responsible for product development? 20. Do you have a formal users group? 21. Describe the company s policy regarding source code. 22. Describe the product documentation that is available and its formats. 15

16 23. Describe typical plans for current data migration into new system. 24. If the system is not currently ICD-10-CM/PCS compliant, describe plans for becoming compliant by regulatory required dates. 25. Describe your current status and any future plans for your system to comply with meaningful use stages I, II and lll. 26. Describe plans for configuring and implementing real time Medicaid and Medicare 270/271 into your software product. See links and 16

17 SECTION IX SYSTEM PROPOSAL Provide a system proposal that includes: 1. Detailed listing of software provided. 2. Description of training provided, including location and time commitment. 3. Description and cost of ongoing support. 4. Description of pricing system and/or structure to include estimates for data migration, development, implementation, etc. System pricing should be that of a web-based product hosted by the vendor with up to 300 users. 5. Complete the following cost matrixes Item One Time Fee One Time Price Implementation (System Setup and Configuration) Training (MCO Staff) Training (Provider Staff) Hardware (Hosting Server) Grand Total Annual Subscription Price (include all fees, licenses, use, access etc.) Base MCO / 32 providers / 300 users Each additional User Each additional Provider Annual Price Three Year Total Additional Price Structure comments: 17

18 SECTION X FUNCTIONAL REQUIREMENTS Refer to the document titled RFP Requirements checklist. A response to each checklist item is required. Brief comments may be entered in the table. Elaborate on any items that differentiate you from other vendor. Assign one of the Availability Codes to each item: VENDOR RESPONSE KEY FS = Fully Supported M = Supported via Modification C = Supported via Customization (Vendor charge) F = Included in Future Release (indicate anticipated date of availability) NS = Not Supported USER TYPE KEY PA = Provider Agency MCO = Managed Care Organization / Coordinating Agency Supporting documentation The following pages outline the necessary items SEMCA and our providers would need in an integrated MCO/Provider electronic medical record. Throughout this document and attachments our provider agencies may be referred to as provider, providers, agency or provider agency. The described MCO Functions and Provider Agency Functions are provided to assist the Vendor in understanding our current processes in order to complete the RFP Requirements Checklist. 18

19 MCO Functions 1. SEMCA needs access to all client records where it provides funding. Providers need access to all their clients regardless of funding source. We must develop a means to allow clients to release their records to other providers that meets the requirements of 42 CFR, Part 2. See a description of our current electronic claims process Attachment A Claims System Documentation-SEMCA.doc 2. Credentialing see narrative for SUD Treatment Attachment B Credentialing Needs for SEMCA.doc and for Prevention Attachment C PreventionCredentialing.pdf. 3. Program Monitoring see Attachment D ProgramMonitoring Policy.pdf 4. Billing see Attachment E BillingTaskOutline.docx a. Adjudicate by funding source and/or PIHP b. Verify Eligibility through 271 interface and /or DEG(835) auto-check c. Make available remittance advice to Provider d. Report on paid and unpaid treatment by provider and funding source 1. Revert units/dollars and switch funding between funding sources State Required Reporting a. 837 encounter data monthly submissions per HIPAA 5010 See Attachment F1 MDCH_Final_5010A1_CG_837P_Enc_SA_CA_11V202_370977_7.pdf Attachment F2 MDCH_Final_5010A1_CG_837I_Enc_SA_CA_11V202_370972_7.pdf 1. Slightly different loops and format for each PIHP (Medicaid / ABW) and DCH (Block Grant / MI Child) 2. Some PIHPs require an additional demographics batch file 3. We will also need a method for handling error files and correcting encounter data voids and resubmissions b. Performance Indicator data (Medicaid Only) Quarterly submissions See Attachment G FY14_PIHP_PI_CODEBOOK_rvs_443598_7.pdf 1. We must report on indicators 2,3,4 and Some PIHPs require different formatting in batch files 3. These reports are structured to determine if providers are meeting the Medicaid timeliness requirements and include date information on client initial contact date, first appointment offered date, appointment date, no shows, appointment rescheduled date and prescribed exception codes as described in the above mention guide. 4. Reporting may be expanded to include all measures. 19

20 1. TEDS Admission and discharge information Monthly submissions See MDCH Document Attachment H Coding_Instructions_TEDS_398729_7.pdf 2. Will need an interface or means to determine those records which have been accepted into the SATWEB (MDCH) system and also to read and handle record data errors. 3. Future plans include the implementation of Behavioral Health, which will alter the specs. d. Financial Reports 1. Attachment I1 ABW and Medicaid template.xls 2. Attachment I2 Quarterly report template.xlsx 3. Attachment I3 Final RER template.xls.xlsx 4. Attachment I4 Legislative Report template.xls 5. Attachment I5 Primary Prev Exp by Strategy Rpt template.xlsx 6. Attachment I6 Status Report Template.xlsx 7. Attachment I7 ProcessedFSR-Results_FY2013.xlsx 8. Attachment I8 SA Schedule A-Sept 2012.xlsx e. Additional Required Reporting Attachment I1Reports for EMR process.xlsx 6. Access Center (Call in referrals for placement and Case Management. Access Managed Services (AMS) referred to in CareNet as (Access and Referral-AAR)) a. The Access Center performs Care Coordination see Attachment J1 AMS Training Manual FY2011.docx b. Client screening by phone to help determine treatment placement 1. See Attachment J2 SEMCA-Screening Process.docx 2. More details to be added after completing full analysis of our current screening application and data set c. Case Management see Attachment J3 09 Case Management Policy.pdf d. Treatment Units Authorization Four different types of authorizing treatment 1. Automatic Authorization for some designated treatments like Assessments Rules to be determined 2. Formal Authorization for treatments not covered in Auto-Auths 3. Post Treatment Authorization for clients leaving Detox Centers 4. Authorization Exchange for clients transferring to another provider 5. See Attachment J4 Authorization types.pdf 7. Utilities a. Provider System Setup 20

21 1. Info and Users see Attachment K1 Provider Setup.PDF 2. Clinicians see Attachment K2 Clinician Setup.PDF 3. Contracts Contract forms to be populated from Provider Setup fields b. Need utility to setup CPT Codes with modifiers. See Attachment K4 Treatment Code Configuration.doc And Attachment K5 DWMHA Coding Manual (F)_ pdf c. Need to be able to assign providers to each HCPC code Attachment K6 Treatment Codes.xlsx d. Need to be able to assign permissions Attachment K7 UserPermissions.xlsx e. Funding Source Setup see Attachment K8 Funding Source Configuration.doc f. Other utilities see Attachment K9 Miscellaneous Utility Functions.doc Provider Agency Functions I. How a provider treats a client can be broken down into different stages: initial contact, intake or registration, admission, authorization, treatment and discharge. Certain services may not complete all items in every section and may have certain items that are specific to those services only. The following provides a basic overview of what occurs in each stage for the provider. See Attachment L1 Clinical Workflow.doc, Attachment A2 SystemFlowChart_2.pdf, Attachment A3 Clinical\ReleaseOfInfo.doc. 1. Initial Contact The initial contact is the first time a client contacts a provider for this treatment episode whether a repeat client or a transfer from another level of care. The provider collects the basic information from the client so that an intake or registration appointment may be scheduled. Basic information includes basic demographics (name, address, phone), what type of services the person is looking for (drivers license assessment, mental health, substance use, etc.), who they were referred by and if they are pregnant or not. The client is then scheduled for an intake or registration appointment. a. Need to be able to update the demographics or add demographics if a new client. b. Some sort of scheduling system would be ideal so that the client can be scheduled for an intake appointment or registration. 21

22 c. There are some specific questions which are required which dictate the length of time a client can wait to get into treatment. Attachment L2 Admission Priority Requirements.docx. 2. Intake/Registration The intake, or registration, is where most of the initial required paperwork gets completed along with the complete demographics (household size, dependents, etc.). The payor is also formulated at this stage. a. SEMCA should not be able to view any records unless there was a signed release of information b. The payor is determined by running a 270/271 which checks Medicaid eligibility. If the client is not eligible then the client s income is reviewed to determine eligibility for Block Grant funding. See Attachment L3 SEMCA_ _Sliding Fee Scale.xls for the guidelines. c. See Intake Column for each level of care for a list of the required paperwork Attachment L4 clinical field summary update With TEDS and Billing.xlsx 3. Admission When a client is admitted, a full clinical assessment is completed and any other assessments needed. The primary diagnosis is formulated as well as determination of level of care using the American Society of Addiction Medicine (ASAM) Patient Placement Criteria.. At admission, an initial treatment plan is begun as well as the recovery plan (for substance use clients). This is the stage that the billing cycle begins in that providers are paid for the completed assessment. Currently the Addiction Severity Index-Multimedia Version (ASI-MV) is the assessment tool for outpatient, residential and methadone clients. The ASI-MV is an interactive program that collects data directly from the clients and this data is utilized in the clinical interview and in the assessment. Results from the ASI-MV are required in the client record (at a minimum the severity scores for each area, composite scores for each area, clinical impression for each area and clinical summary). a. Need a record of the diagnosis, AXIS I-V. 4. Authorization for Treatment and Billing Authorizations are where the provider requests the right to provide and get paid for future services. The authorization request is basically a reiteration of information collected at the time of intake/registration and admission which details the need for services. Re-authorizations should contain updated information. Authorizations are either approved as is, pended for more information or denied. Currently, an auto authorization feature is in place which may be used for SEMCA clients. If a request for authorization is submitted that meets certain criteria it is approved automatically, without any review required. Rules need to be determined. 22

23 Need assessments to be allowable without an authorization in place. a. Detox services are completed prior to authorization and billing. b. The authorization would include the type of service, units (requested and authorized), AXIS I-V from the admission and the ASAM Patient Placement decision determined at admission. 5. Treatment During treatment a client is treated for the diagnosed problems. Updates to the treatment plan and recovery plan are made as needed, progress reports are sent to various agencies (courts, DHS, etc.) and a continuing care plan is created. Ancillary service documentation occurs throughout this stage in the form of phone calls, letters, etc. The billing cycle continues throughout treatment with invoices that have available authorized units and include a completed progress note being funded. a. Also need treatment plan reviews, supervisory reviews, medical reviews, reauthorizations and ancillary notes. 6. Discharge The client is either discharged (leaving treatment) or transferred to another level of care. The discharge summary is completed along with an update to the treatment plan, recovery plan and any other after care plans. The client has a date of last treatment and the date the chart was closed out. For SEMCA clients, for detoxification services, this is also where the authorization for the stay occurs. Residential and Detoxification services call the SEMCA Access Center prior to the discharge date to coordinate the next step. a. Transfer to other treatment center or level of care If a client is transferred to another treatment center or another level of care the discharge happens as noted above with a few additions: release of information obtained for the new provider, old provider and payor), the old provider transfers a copy of the assessments, treatment plan, recovery plan and/or continuing care plan to the new provider, the old provider should also transfer any other pertinent information. Ideally, the new provider would be contacted with the client to obtain an admission date. 7. Case Management Case management services may be provided in conjunction with other services or as a standalone service. Case management services are those activities that are designed to help support an individual in developing, implementing and maintaining his/her recovery plan. Services can be face-to-face or via telephone or other electronic forms of communication. Case management services include coordinating services, assisting in accessing needed resources, troubleshooting and/or providing support to the individual and/or his support network. 23

24 a. See Attachment J3 09 Case Management Policy.pdf for Case Management procedures 8. Program Monitoring Programs are monitored based upon contract and regulations. See Attachment D ProgramMonitoring Policy.pdf for expectations and procedures. II. The Attachment L4 clinical field summary update With TEDS and Billing.xlsx outlines the required fields for each stage for each level of care. 9. System Capabilities Additional items to be incorporated. See Attachment M System Integration Wish List2.pdf 24

25 SEMCA Request for Proposals for Electronic Medical Record System Proposal Signature Sheet (Legal Name of Bidding Organization) Address: (Street) (City) (Zip Code) Telephone: ( ) FAX: ( ) Type of Organization (Check all that apply) Date Established: Private Non-Profit School District Public Non-Profit Private for Profit Corporation Sole Proprietorship Government Partnership Other (Specify) Signed Statement of Authority I,, the (Type Name of Official) (Type Title of Official) of (Type Name of Agency or Organization), am authorized to make the following proposal on behalf of. (Legal Name of Bidding Organization) I hereby certify: The bidding organization understands and will comply with the specific assurances and certifications contained in this proposal. All responses to this Request for Proposals concerning the respondent organization, its operation, and proposed program are true and accurate. If selected for funding, the bidding organization will be bound by the information contained herein as well as by the terms and conditions of the resultant contract. Signed: Typed Name: Contact Person: Date: Title: Phone: Fax: 25

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