1
NEW YORK STATE
OFFICE OF THE MEDICAID INSPECTOR GENERAL
DIVISION OF SYSTEM UTILIZATION & REVIEW
BUREAU OF THIRD PARTY AND PAYMENT OVERSIGHT
REQUEST FOR PROPOSAL (RFP)
For
New York State’s Medicaid Casualty and Estate
Recovery Services
RFP# OMIG 24-23
Designated Contacts
pursuant to State Finance Law Sections 139-j and 139-k:
Edwin Lake
Contract Management Specialist 2
Office of the Medicaid Inspector General
800 North Pearl Street
Albany, New York 12204
Procurements@omig.ny.gov
(518) 408-5996
Alicia Wilson
Senior Budgeting Analyst
Office of the Medicaid Inspector General
800 North Pearl Street
Albany, New York 12204
Procurements@omig.ny.gov
(518) 402-1625
PROPOSALS MUST BE SENT TO THE ABOVE EMAIL ADDRESS ONLY
2
INTENT TO OFFER OR NOT TO OFFER
Offeror’s Federal Tax Identification Number (FEIN):
(Do Not Use Social Security Number)
NYS Vendor Identification Number (SFS):
(See “New York State Vendor File Registration” clause)
Legal Business Name of Company offering Proposal:
D/B/A - Doing Business As (if applicable):
Street
City
State
Zip
County
If you are not offering a proposal, place an “x” in the box and return this page only.
WE ARE UNABLE TO OFFER A PROPOSAL AT THIS TIME BECAUSE:
______________________________________________________________________________________
Offeror’s Signature:
Title:
Printed or Typed Name:
Date
Phone: ( ) -
Ext. ( )
Toll
Free
Phone:
( ) - Ext. ( )
Fax: ( ) Ext. ( )
Toll
Free
Fax:
( ) - Ext. ( )
E-mail Address:
Company Web Site:
The offer must be fully and properly executed by an authorized person.
By signing you certify your explicit authority to sign on behalf of yourself, your company, or other entity
and full knowledge and acceptance of this RFP, Appendix A (Standard Clauses For New York State
Contracts), Appendix B (General Specifications), Appendix F (Procurement Lobbying Legislation), and
Appendix H (HIPAA), and that all information provided is complete, true, and accurate. By signing,
Offeror affirms that it understands and agrees to comply with the procedures relative to permissible
contacts as required by State Finance Law § 139-j(3) and § 139-j(6)(b).
3
- RFP Schedule of Events-
EVENT
DATE
TIME
Release of RFP 04/24/24
Written questions due from Offerors(s) 05/08/24 2:30 pm EST
Official response to Offeror’s questions due (estimated) 05/29/24
Closing date for receipt of Proposals (Proposals Due) 06/20/24 2:30 pm EST
Selection of Prospective Contractor(s) (estimated) 09/13/24
Contract approved by Office of Attorney General (estimated) 12/04/24
Contract approved by Office of State Comptroller (estimated) 03/05/25
Contract term begins 04/07/25
4
- Table of Contents -
I. GENERAL INFORMATION ........................................................................................................................................... 7
A. PARAGRAPH HEADINGS ................................................................................................................................................ 7
B. ISSUING AGENCY .......................................................................................................................................................... 7
C. INTRODUCTION ............................................................................................................................................................. 7
D. PROGRAM DESCRIPTION ............................................................................................................................................... 8
E. CASUALTY AND ESTATE PROGRAM BACKGROUND .......................................................................................................... 8
F. PURPOSE OF THIS RFP ................................................................................................................................................ 9
G. PERTINENT STATISTICS ................................................................................................................................................ 9
II. SCOPE OF WORK ....................................................................................................................................................... 10
A. GENERAL REQUIREMENTS .......................................................................................................................................... 10
A. PROGRAM DETAILS ..................................................................................................................................................... 10
B. CUSTOMER SERVICE MEASURES ................................................................................................................................. 11
C. OUTREACH & RESPONSE ............................................................................................................................................ 11
D. STAKEHOLDER EDUCATION AND OUTREACH PROGRAM ................................................................................................ 12
E. CASEWORK ................................................................................................................................................................ 12
F. ESTATE RECOVERY .................................................................................................................................................... 16
G. MANAGED CARE RECOVERY ....................................................................................................................................... 19
H. QUALITY ASSURANCE ................................................................................................................................................. 20
I. REQUIRED PROJECT REPORTING ................................................................................................................................ 20
J. RISK ASSESSMENT ..................................................................................................................................................... 24
K. RECEIPT OF RECOVERIES ........................................................................................................................................... 24
III. CASE MANAGEMENT SYSTEM ................................................................................................................................ 25
A. GENERAL REQUIREMENTS – ALL CASES ....................................................................................................................... 27
B. CASUALTY SPECIFIC REQUIREMENTS .......................................................................................................................... 28
C. ESTATE SPECIFIC REQUIREMENTS .............................................................................................................................. 28
IV. OFFICE AND STAFFING REQUIREMENTS .............................................................................................................. 29
A. KEY PERSONNEL ........................................................................................................................................................ 30
B. SUPPORT PERSONNEL ................................................................................................................................................ 30
V. OFFEROR EXPERIENCE ............................................................................................................................................ 31
A. CURRENT MEDICAID C&E CONTRACTS........................................................................................................................ 31
B. OFFEROR REFERENCES .............................................................................................................................................. 31
5
VI. ORGANIZATIONAL CAPABILITY AND EXPERIENCE ............................................................................................. 31
A. SUMMARY OF ORGANIZATIONAL CAPABILITY ................................................................................................................ 32
B. SUMMARY OF CORPORATE EXPERIENCE ...................................................................................................................... 32
C. PROPOSED ENHANCEMENTS & IMPROVEMENTS ........................................................................................................... 33
D. STAFFING PLAN .......................................................................................................................................................... 33
VII. CONTRACTOR ACCOUNTABILITY ........................................................................................................................... 33
A. GENERAL ACCOUNTABILITY PROCESS ......................................................................................................................... 33
B. FEE ADJUSTMENT SCHEDULE:..................................................................................................................................... 34
VIII. CONTRACTOR RESPONSIBILITIES ......................................................................................................................... 35
A. ARCHIVAL BACKUP AND DISASTER RECOVERY ............................................................................................................. 35
IX. PROPOSAL SUBMISSION GUIDELINES .................................................................................................................. 36
A. FORMAT ..................................................................................................................................................................... 37
B. PROPOSAL AMENDMENT / WITHDRAWAL ...................................................................................................................... 39
C. PROPOSAL RESULTS .................................................................................................................................................. 39
D. REJECTION OF PROPOSALS ........................................................................................................................................ 39
X. METHOD OF AWARD ................................................................................................................................................. 40
A. PROPOSAL EVALUATION ............................................................................................................................................. 40
B. PROPOSAL CLARIFICATION ......................................................................................................................................... 40
C. EVALUATION PROCESS OVERVIEW .............................................................................................................................. 40
D. PROPOSAL REVIEW .................................................................................................................................................... 41
E. NOTIFICATION OF AWARD ............................................................................................................................................ 42
F. CONTRACT APPROVAL ................................................................................................................................................ 42
XI. ADMINISTRATIVE REQUIREMENTS ......................................................................................................................... 42
A. INQUIRIES .................................................................................................................................................................. 42
B. OPTIONAL OFFEROR’S CONFERENCE .......................................................................................................................... 43
C. ERRORS AND OMISSIONS ............................................................................................................................................ 43
D. CONTRACT AWARD ..................................................................................................................................................... 43
E. PAYMENT ................................................................................................................................................................... 44
F. INVOICING .................................................................................................................................................................. 44
G. CONTRACT TRANSITION .............................................................................................................................................. 46
H. CONFIDENTIAL INFORMATION ...................................................................................................................................... 47
I. CONFIDENTIALITY CLAUSES ........................................................................................................................................ 48
J. REQUEST FOR DEBRIEFING ......................................................................................................................................... 48
6
K. PROTEST OF CONTRACT AWARD ................................................................................................................................. 49
L. TERM OF CONTRACT................................................................................................................................................... 50
M. MINORITY AND WOMEN-OWNED BUSINESSES (MWBE) & EEO .................................................................................... 50
N. CONTRACTOR’S FORFEIT OF RIGHTS ........................................................................................................................... 51
O. INSURANCE REQUIREMENTS ....................................................................................................................................... 51
P. VENDOR RESPONSIBILITY ........................................................................................................................................... 53
Q. PIGGYBACKING ........................................................................................................................................................... 54
R. PROPOSAL OWNERSHIP .............................................................................................................................................. 54
S. LEGAL ENTITLEMENT TO WORK ................................................................................................................................... 54
T. NOTICES .................................................................................................................................................................... 54
U. SUBCONTRACTING ...................................................................................................................................................... 54
V. OMIG’S RIGHTS RESERVED ....................................................................................................................................... 55
W. OFFEROR CERTIFICATION REQUIREMENTS .................................................................................................................. 56
X. INFORMATION SECURITY BREACH AND NOTIFICATION ACT ............................................................................................ 57
Y. INDEMNIFICATION ....................................................................................................................................................... 57
XII. STANDARD CONTRACT REQUIREMENTS .............................................................................................................. 57
A. APPENDICES (AVAILABLE ELECTRONICALLY) ................................................................................................................ 57
B. ATTACHMENTS ........................................................................................................................................................... 61
7
I. GENERAL INFORMATION
A. PARAGRAPH HEADINGS
Paragraph headings contained in this solicitation are for convenience only and will not be considered for
any purpose in governing, limiting, modifying, construing, or affecting the provisions of this solicitation
and must not otherwise be given any legal effect.
B. ISSUING AGENCY
This Request for Proposal (RFP) is a solicitation issued by the New York State Office of the Medicaid
Inspector General (OMIG). OMIG is responsible for the requirements specified herein and for the
evaluation of all proposals.
C. INTRODUCTION
For all references to “Contractor”, it is assumed and expected that the “Offeror”, defined as an entity that
provides commodities, services, or technology who makes a proposal to procure or enter a contract,
accepts the responsibilities as outlined within this RFP upon full execution of the contract; thereby
becoming the “Contractor”.
OMIG was established by State statute as a separate, independent entity within the New York State
Department of Health (DOH) to improve and preserve the integrity of the New York State Medicaid
Program by conducting and coordinating fraud, waste, and abuse control activities for all State agencies
responsible for services funded by Medicaid. The contractor shall not report any information regarding
medical debt to a consumer reporting agency.
OMIG achieves its goal of effectively carrying out its mission by, but is not limited to:
• Pursuing civil and administrative enforcement actions against those who engage in fraud,
waste, abuse or other illegal or inappropriate acts perpetrated within the New York State
Medicaid program;
• Keeping the Governor and the heads of agencies with responsibility for the administration of
the Medicaid Program apprised of efforts to prevent, detect, investigate, and prosecute fraud,
waste, and abuse within the Medicaid system;
• Providing information and evidence relating to potential criminal acts, which may be obtained
in carrying out our duties, available to appropriate law enforcement;
• Receiving and investigating complaints of alleged failures to prevent, detect, and prosecute
fraud, waste, and abuse; and
• Performing any other functions that are necessary or appropriate to fulfill the duties and
responsibilities of the office.
In carrying out its mission, OMIG conducts and supervises activities to prevent, detect, and investigate
medical assistance program fraud and abuse amongst the agencies specified in Public Health Law (PBH)
§32.2.
OMIG furthermore coordinates, to the greatest extent possible, activities to prevent, detect and
investigate medical assistance program fraud and abuse amongst the following:
• The Department of Health; specifically, the Office of Professional Medical Conduct (OPMC),
Office of Health Insurance Programs (OHIP), and Bureau of Narcotic Enforcement (BNE).
• The Office of Mental Health (OMH); Office of People with Developmental Disabilities
(OPWDD); Office of Addiction Services and Supports (OASAS); Office of Temporary Disability
Assistance (OTDA); Office of Children and Family Services (OCFS); Office of the State
8
Comptroller (OSC), and the Office of the Attorney General's (OAG) Medicaid Fraud Control
Unit (MFCU).
• Other New York State agencies: State Education Department (SED), and Office of the Welfare
Inspector General (OWIG).
• New York State Justice Center.
• The State's fiscal agent — currently General Dynamics Information Technology (GDIT) —
employed to operate the Medicaid Management Information System;
• Other Federal agencies: Department of Health and Human Services (HHS), Office of the
Inspector General (OIG), US Attorney General, and the Federal Bureau of Investigations
(FBI); and
• New York City Human Resource Administration (HRA) and Local Department of Social
Services (LDSS).
OMIG is headquartered in Albany with regional offices in New York City, White Plains, Hauppauge,
Syracuse, Rochester, and Buffalo.
More information about OMIG can be found on the website www.omig.ny.gov
.
D. PROGRAM DESCRIPTION
The Medicaid Program must take all reasonable measures to determine the legal liability of third parties
to pay for a Medicaid recipient's health care. Federal and state law require the Medicaid Program to be
the payor of last resort.
The Casualty and Estate (C&E) Recovery Unit within OMIG oversees activities to recover Medicaid funds
associated with these third-party payor sources.
E. CASUALTY AND ESTATE PROGRAM BACKGROUND
Chapter 58 of the Laws of the 2008 amended New York State (NYS) Social Services Law (SOS) §369
give the State authority to make recoveries from estates, personal injury actions, and other areas. It also
permits the NYS Department of Health (and thereby, OMIG) to contract with one or more entities to
undertake this function (SOS §369 (7)). Federal and state laws and regulations pertaining to Third-Party
Liability (TPL) and relevant to this RFP include, but are not limited to, the Code of Federal Regulations
42 CFR Part 433, the Social Security Act Title XIX Section 1902 (a) (25), Health Insurance Portability and
Accountability Act of 1996, the Deficit Reduction Act of 2005, SOS 367-a, SOS 104,State Insurance Law
Section 3212, NY Civil Practice Law and Rules §306-C, and Title 18 NYCRR Section 540.6.
1. Casualty
If a Medicaid recipient is injured and receives a settlement because of that injury, relevant funds are
subject to recovery by Medicaid for any amount Medicaid paid for the treatment of injuries sustained.
Federally, recovery of Medicaid payments made on behalf of injured individuals from persons liable
for those injuries is required by Section 1902(a) (25) of the Social Security Act, 42 USC 1396a(a)
(25), and under state law as per NYS SOS §104-b.
2. Estate
When a Medicaid recipient passes away, any assets owned by the recipient are subject to recovery
by NYS Medicaid. The amount owed will depend upon the claims Medicaid paid on behalf of the
recipient up to 10 years preceding their death. Regardless of how an estate is administered, estate
recovery from recipient estates is mandated by Section 1917(b) (1) (B) of the Social Security Act, 42
USC 1396p (b) (1) (B), and SOS §369, subject to certain conditions.
9
3. Tax Equity and Fiscal Responsibility Act
The Tax Equity and Fiscal Responsibility Act (TEFRA), Pub.L. 97–248, governs liens that prevent the
transfer of real property made prior to a Medicaid recipient’s death for the purpose of avoiding estate
recovery. Liens may be placed on a recipient’s home if the recipient is a resident of a nursing facility
for at least six consecutive months and there is no reasonable expectation that they will return home.
F. PURPOSE OF THIS RFP
Federal and State regulations require that Medicaid be the payor of last resort, with exceptions made for
medical care provided at a time when the source of payment may be in question, as in automobile
insurance settlements. Even including those circumstances, if it is determined after Medicaid benefits
have been paid that rendered medical services should have been covered by a third party, such as a
settlement or assets remaining in an estate, the State may exercise its right to recover the payment
through subrogation pursuant to Title 18 of the New York Codes, Rules, and Regulations §542. To comply
with these requirements, OMIG is seeking proposals from the Offeror to perform subrogation actions,
recovering Medicaid funds in casualty and estate cases on behalf of NYS. Offeror must perform these
activities in a manner sensitive to the circumstances recipients and their families experience related to
an individual’s injury or death.
To date, New York has partially implemented the centralization of the management and reporting of
casualty and estate recovery for all Medicaid eligibility districts inclusive of all LDSS, DOH as the
administrator of the New York State of Health Exchange marketplace (NYSoH Marketplace), OPWDD,
OMH, etc. to OMIG and its contractor. The Offeror must be capable of undertaking Casualty and Estate
recoveries for all LDSS and the NYSoH marketplace and must provide and maintain a case management
system to manage these efforts. These efforts will encompass all Medicaid recipients in fee-for-service
and/or managed care programs and the Offeror must illustrate that their proposed system will adhere to
all federal and State statutory requirements relating to Casualty and Estate recoveries. Preferred
offerings will include innovative solutions to identify and pursue recoveries more efficiently, while
prioritizing a customer-centric approach. Additionally, the Offeror must provide and manage staff that are
able to handle the volume of work required to successfully manage this project. Such staff must be
assigned solely to this contract. An insufficient number of dedicated staff, or excessive staff vacancies,
will result in customer service and processing delays which could negatively impact performance.
Once awarded the contract, the Offeror will be interacting with local government agencies and officials,
as well as the general public. Therefore, it is a requirement of this RFP that staff assigned to the resultant
contract focus on customer service and that the Contractor partake in customer-centric training and
outreach efforts.
To comply with these requirements, the Offeror must be capable of performing Casualty and Estate
recoveries for OMIG, at the discretion of OMIG. These activities must encompass all Medicaid recipients
in fee-for-service or managed care programs. The Offeror must be capable of undertaking Casualty and
Estate recoveries for all counties in NYS and the NYSoH marketplace. This includes the creation and/or
maintenance of a case management system and employment of staff, both dedicated to the NY project,
and large enough to handle the volume of work required. In addition, the Offeror must illustrate that their
proposed system will adhere to all federal and State statutory requirements relating to Casualty and
Estate recoveries.
G. PERTINENT STATISTICS
Below, is a breakdown of OMIG’s Medicaid Casualty and Estate Recoveries by Calendar Year from 2018
through 2022. Future recoveries may vary based upon adjustments or restrictions in public policy,
assignments of work from OMIG, and additional work identified and successfully completed by the
selected vendor.
10
II. SCOPE OF WORK
A. GENERAL REQUIREMENTS
OMIG reserves the right to limit or increase the reviews conducted by the Offeror under this contract by
region, claim type, time period, or by any other reason that OMIG believes is in the best interest of the
New York Medicaid Program. This notice will be in writing (paper or electronic) and will be effective in 30
days from the date of the notice.
All Offeror functions and procedures must be in full compliance with federal and state laws and
regulations. Any entities utilized by the Offeror in the performance of the contract must not perform such
work nor must they access any OMIG protected health information outside of the United States without
OMIG’s express prior written consent. In no event must any subcontractor or vendor access any OMIG
protected health information outside of the United States without OMIG’s express prior written consent.
OMIG is procuring services to ensure that all eligible recoveries under the Casualty and Estate program
are pursued and collected effectively, timely, and in a manner that is sensitive to the individuals affected
by the circumstances associated with each recovery type. The services sought include identifying
recipients that meet the Casualty and Estate recovery criteria, valuing and filing liens and claims, working
with OMIG, DOH, LDSS, recipients and their families, and other stakeholders to effectively and efficiently
resolve outstanding Medicaid recoveries, and the creation and/or maintenance of a case management
system to house, track and report recovery activities. The specifics of the nature of the program, and how
work is to be performed, are detailed below.
In all instances of work to be performed at OMIG discretion, OMIG will, whenever possible, provide the
Offeror with written notice of any required changes at least thirty (30) days in advance of expected
compliance with the change.
A. PROGRAM DETAILS
The Offeror must be prepared to perform Casualty and Estate recovery activities for OMIG, at the
discretion of OMIG. These activities must encompass all Medicaid recipients accessing services through
fee-for-service or a managed care organization. While actual recoveries will be driven by the volume of
casualty or estate case availability, the Offeror must be prepared to perform duties that could potentially
exceed an annual volume of 75,000 cases, resulting in over $100,000,000 in recoveries.
Federal and State law require that the Medicaid Program be the payor of last resort. Recovery of Medicaid
payments made on behalf of injured individuals from persons liable for those injuries is required by
Section 1902(a)(25) of the Social Security Act, 42 USC 1396a(a)(25). Estate recovery from probate
estates is mandated by Section 1917(b) (1) (B) of the Social Security Act, 42 USC 1396p (b) (1) (B). The
Medicaid Program must take all reasonable measures to determine the legal liability of third parties to
pay for health care for individuals eligible for Medicaid.
Calendar Year (CY)
Total Recoveries
CY 2018
$105,139,585
CY 2019
$118,626,318
CY 2020
$115,128,038
CY 2021
$111,123,465
CY 2022
$119,849,598
11
Chapter 58 of the Laws of the 2008 amended NYS SOS §369 give the State authority to make recoveries
from estates, personal injury actions and other areas, as well as permitting NYSDOH (and thereby, OMIG)
to contract with one or more entities to undertake this function (SOS §369 (7)).
Casualty and Estate recovery is based on Recipient County of eligibility which encompasses
approximately 65 Medicaid eligibility districts, including New York City and NYSoH marketplace. OMIG
currently offers three (3) recovery options, listed below. Each county can choose the option best suited
to its needs. As of December 2023, 46 counties and other Medicaid eligibility districts are fully outsourced
to the contract vendor (Option 3).
B. CUSTOMER SERVICE MEASURES
The Offeror must provide customer-centric staff to courteously and timely respond to stakeholders and
the public through various methods including, but not limited to, telephone, email, mailings, on-site visits,
informational website postings, portal responses, etc. The Offeror is required to provide language
translation service availability for both verbal and written correspondence, with languages inclusive of,
but not limited to Arabic, Bengali, Chinese, French, Haitian-Creole, Italian, Korean, Polish, Russian,
Spanish, Urdu and Yiddish. Additionally, all correspondence must include the Offeror’s name as
associated with their Federal Employer Identification Number (FEIN). The Offeror may propose
innovative and alternative outreach and response methods for OMIG review.
C. OUTREACH & RESPONSE
Every call and email received must be responded to within one business day of receipt. Outreach to
various stakeholders to obtain information on case reviews must be conducted within two weeks from
the identification of the potential case, and regularly thereafter to obtain required information. All incoming
and outgoing correspondence must be documented within the case management system.
The volume of calls and emails received can vary drastically and are dependent upon many factors
including, but not limited to the effectiveness and timeliness of the Offeror’s responses and outreach. The
Offeror should be prepared to field a high volume of both calls and emails daily (estimates of up to 55,000
annually). This includes contact from the public, OMIG prompted escalation requests, LDSS requests
and referrals, court, and clerk office contacts, etc. Caseworker staff must be sensitive to the personal
nature of their interactions and need to have the ability to deescalate upset or emotional stakeholders if
needed while still providing required information on established processes. While the nature of the work
requires the recovery of funds, this should be pursued in a manner sensitive to the circumstances
recipients and their families undergo when experiencing injury or death. All staff tasked with handling
calls from the public will be required to take specialized training specified and/or approved by OMIG,
including grief sensitivity training, annually and at no cost to OMIG.
Dedicated toll-free customer service phone lines and email contact points are required to be established
and staffed to receive and respond to inquiries from the general public, recipients, and their
representatives, LDSS staff, and other stakeholders. The Offeror must have all dedicated staff available
during normal business hours, defined as 8:00 AM to 5:00 PM Eastern Standard Time (EST), Monday
through Friday, excluding State observed holidays. Callers must be given the option to speak to a live
staff person dedicated to this contract at any time during those core hours.
The Offeror must assign dedicated staff to each Medicaid eligibility district’s recoveries, so that district’s
staff and the assigned Offeror staff develop a good working relationship. Details regarding assigned
Medicaid eligibility district(s) are required to be reported to OMIG regularly as part of Organizational Chart
reporting. All voicemails and emails received from LDSS and/or Medicaid eligibility district representatives
need to be reviewed and acknowledged within 24 hours of receipt by the appropriate Offeror staff. Calls
and emails, and their outcomes, must be documented in the Offeror’s case management system.
OMIG expects the Offeror to provide expedient turnaround times to OMIG, stakeholders, and the public
on requested items or updated information. Every voicemail and email received must be returned within
12
24 hours of receipt. Unless otherwise specified by LDSS or other Medicaid eligibility district specific
protocol, requests for updated or final lien amounts must be satisfied within five (5) business days of
receipt, or by the date required by the court if applicable, whichever is sooner. Timely filing and release
of estate claims and casualty liens is also required and may include statewide travel and professional
interaction with various court and clerk officials, the frequency of which will be at OMIG’s discretion. Liens
and claims are required to be filed no matter the valued amount. Lien and claim releases are required to
be filed within two (2) weeks from the date full payment has been received. All outreach, correspondence,
and case updates must be documented within the case management system at the time of occurrence.
The Offeror must be prepared to work closely with OMIG, LDSS, and other Medicaid eligibility district
staff to assist in the recovery efforts of the State. This contact will include communication with the local
Social Services departments such as Medical Assistance, Temporary Assistance, and the County
Attorneys’ office. Additionally, the Offeror is expected to have and maintain staff whose primary
responsibility is to support OMIG staff and the various County Attorney’s offices with matters related to
litigation. The Offeror should advance stakeholder relationships by presenting OMIG with innovative ways
to maximize potential Casualty and Estate recoveries.
As part of customer service, the Offeror must provide an online portal/website option for attorneys and
the public to provide and request documentation on active cases as well as the ability to request and
obtain status updates on active case reviews.
D. STAKEHOLDER EDUCATION AND OUTREACH PROGRAM
In coordination with OMIG, the Offeror must develop an outreach program to educate stakeholders of
Casualty and Estate policies and protocols. Stakeholders include, but are not limited to, the LDSS,
recipients and their families, and the legal community.
OMIG’s evaluation team will be made up of subject matter experts (SME). The following is a listing of
some of the criteria that may be considered by OMIG’s evaluation team during their review of responses
to this component:
• The Offeror provides a thorough description of the proposed customer service, education and
outreach plans. This should include the use of a public facing website and/or portal;
• The number and quality of customer service staff dedicated to the public and Medicaid
eligibility districts;
• The level of training staff will receive, and appropriate oversight for escalations;
• The scope and quality of the approach outlined for outreach and education efforts including
an understanding of the potentially impacted stakeholders;
• The Offeror’s understanding of laws, regulations, and published policies in place for Casualty
and Estate recovery;
• Any applicable, creative, viable, innovative, or constructive solutions that the Offeror proposes
to meet or exceed the mandatory requirements of this section.
E. CASEWORK
The Offeror must be capable of providing casework services for Casualty and Estate recoveries as
detailed below.
The Offeror must illustrate the ability to establish processes for rigorous and innovative case identification
and management. This includes case identification using resources such as leads, referrals, and data
matches, and determination if the Casualty or Estate case is subject to recovery, and proactive pursuit of
that recovery. The Offeror may propose other areas of recovery, such as Special Needs Trusts, and
Spousal Refusal cases for OMIG’s consideration and approval.
13
For each identified case proactive outreach and research, such asphone calls, online research, and
mailer questionnaires, must be utilized to gather additional information. Claims must be reviewed for
inclusion or exclusion in the lien or claim valuation, and a notice of claim/lien must be filed with the
appropriate parties, including the appropriate court/clerk’s office in the relevant county. Responses to and
communication with individuals/attorneys is required on a timely and regular basis. In this course of work,
the Offeror will interact with Medicaid recipients and their families who have suffered from a traumatic
experience. While the purpose of this procurement is to pursue/collect all eligible recoveries under the
Casualty and Estate program, this should be pursued in a sensitive manner, demonstrating an
understanding and awareness of the circumstances associated with each case. Information regarding
each step the Offeror has taken in pursuit of recovery, all correspondence, and all documentation relevant
to each case must be noted in the case management system. In certain cases including, but not limited
to, cases with limited settlement funds or when special consideration is being requested, the Offeror will
also be negotiating Casualty or Estate recoveries, as deemed appropriate by OMIG.
OMIG currently offers three (3) options to the Medicaid eligibility districts for Casualty and Estate recovery
outsourcing. The State reserves the right to modify the processes and or the options available.
OPTIONS
Option 1 - Case Management System Only
The LDSS or NYC HRA would have access to all the intake and referral networks and use of the Offeror’s
case management system to manage all active Casualty and Estate cases. (Ten (10) counties as of
December 2023.)
Option 2 - Hybrid Option
This second option includes the use of the Offeror’s case management system and expands to also
include some assistance from the Offeror. The LDSS or NYC HRA would maintain some of the case
management functions, but the Offeror would assist with agreed upon tasks. This would be individual to
agreements with each LDSS or NYC HRA under this option choice. (NYC HRA utilizes this option as of
December 2023.)
Option 3 - Full Outsourcing Option
This option includes use of the Offeror’s case management system and a total utilization of and
outsourcing to the Offeror’s services. The Offeror would be responsible for all case management from
referral to case completion - excluding legal actions that only the county has the authority to take under
Federal and state law. (46 Medicaid eligibility districts including the NYSoH marketplace as of December
2023)
In all options, the Offeror’s services do not extend to appearing in court on behalf of OMIG or the counties,
but must include the following:
1. Casualty Recovery
Identification and Verification of Cases
The Offeror must use a variety of leads and sources to proactively identify and manage potential
casualty cases. These include, but are not limited to:
• Personal Injury Clearinghouse (PIC) reports;
• Attorney referrals;
• Recipient referrals;
• Workers’ Compensation referrals;
14
• Medical malpractice files (including Mass Torts);
• County/State court files or notices;
• State and county department referrals;
• Claim analysis/Trauma Questionnaires;
• Processed Claims;
• Managed Care Organizations referrals;
• Provider referrals;
• Insurance Company referrals.
Leads generated will be entered into the case management database. Basic key information must
be included as well:
• Recipient Name (including aliases), Medicaid CINs (all applicable), SSN and Date of Birth;
• NYS Medicaid eligibility, both current and historical eligibility segments;
• Accident type and injuries sustained;
• Attorney or representative information;
• Member demographics; and
• Date of incident.
If any of this information is unavailable to the Offeror, the parties of interest must be contacted
proactively via any means available including, but not limited to phone and questionnaire, to complete
the case record. All correspondence must be sent out on State-approved letterhead, in a form and
format approved by OMIG. Additionally, all correspondence must include the Offeror’s company name
as associated with their FEIN. Outreach is required to be made within two (2) weeks from the date a
potential case is identified, and regularly thereafter until the required information is obtained or it is
determined that the review isn’t a viable case. All attempted and successful contact, as well as any
documentation obtained, must be recorded in the case management system.
The Offeror will review the documentation and any other available information gained through
proactive research to determine if casualty recovery should proceed. Casualty recovery must be
exempt, only as per federal and State statutory requirements.
2. Active Cases: Valuation and Lien Filing
The Offeror must review all Medicaid claims potentially related to the injury sustained with dates of
service on or after the date of incident. Calculations will be subject to prevailing Federal and State
statutory and case law precedent. For each month where the Offeror identifies at least one encounter
claim related to the incident, the Offeror will include that month’s capitation payment claim in the total
case valuation. All injury related fee-for-service claims with dates of service on or after the incident
are also included. Claims must be revalued at minimum every thirty (30) days to keep the lien amount
updated. All valuation will be documented in the case management system for claims both related to
the incident (and therefore included in the lien amount) and claims that the Offeror determines are
not related to the incident. Claims not related to the incident must have an indicator to identify why
they were determined not to be related for future quality assurance reviews.
The Offeror is required to file a 104-b lien as soon as practicable once it is determined a potential
recovery exists. The Offeror must work in conjunction with the appropriate NYS County to file a 104-
b lien in the county where the incident occurred, or in the county where the recipient resides if the
15
county where the incident occurred cannot be determined. The Offeror is required to file the lien in
whatever manner is accepted by the county the lien is being filed in. The Offeror must also mail a
copy of the lien to the recipient and their representative if applicable. Liens must be updated or lifted
as per the processes and time frames required by each county. Additionally, recipients and their
representatives must be made aware of any increase to the lien amount every thirty (30) calendar
days as related claims accrue, and as requested. The Offeror must proactively identify and document
settlement information within the case management system, and provide a final lien amount within
five (5) days as requested by any interested party for settlement negotiation purposes unless
otherwise specified by a Medicaid eligibility district or the court. Filing, updating, and lifting of liens
must be documented in the case management system and must include copies of any associated
documentation and correspondence.
The Offeror must require a valid medical release from the member or their guardian to release any
protected health information. The Offeror must submit requested documentation to interested third
parties within five (5) business days from the date the valid medical release is received. For requests
of itemization of claims, the Offeror must highlight or indicate all related claims, diagnosis codes,
dates of services, and expenditures for the benefit of the interested third-party. Medical release forms,
and requests for information as well as the Offeror’s responses must be documented in the case
management system.
In all instances, the type of correspondence (electronic or hard copy) will be determined by the
recipient of the information (LDSS, court, recipient, or their attorney). The Offeror will be required to
mail documents as needed. All documentation associated with the case, including any mail receipts,
must be documented in the case management system as applicable.
3. Negotiation and Recovery
Payment in full of the lien amount satisfies the debt to the State. However, certain situations including,
but not limited to, limited settlement funds, Federal and State case law precedents, and court orders,
require NYS to consider compromise in casualty cases. The Offeror will collaborate with OMIG to
determine parameters by which cases will be negotiated or settled. The Offeror must utilize these
parameters as directed by OMIG to determine settlement offers. If a compromise cannot be reached
then the final determination must be made by OMIG, or by the appropriate Medicaid eligibility district
as determined by OMIG. All documentation and correspondence related to a compromise must be
documented in the case management system.
4. Closed Cases
Payments for casualty recoveries will be made via check to an established lockbox or via automated
clearing house (ACH) process. A casualty case is closed upon payment of the lien, in full, or upon
payment of the approved, compromised amount. Upon reconciliation of payment in full, or from the
date of determination that the case should be closed with no recovery, the Offeror will mail a “Release
of Lien” to the county where the lien was filed, as well as to the recipient and their representative (if
applicable). The case will be marked as closed within the case management system, but must remain
available for historical documentation and reporting. Acceptable additional reasons for closure with
no recovery can be proposed and will be determined by OMIG. In all instances of closure with no
recovery, a detailed reason for closure must be documented in the case management system for
reporting.
16
F. ESTATE RECOVERY
1. Case Identification and Referrals Management
Recovery of Medicaid funds, which were paid for now-deceased recipients, must be achieved through
rigorous case identification and case management. The Offeror must identify and value cases using
leads, referrals, and data matches from various sources, which include but are not limited to:
• Vital Statistics File/DOD Match/SSA Death Match Subscriptions;
• Surrogate Court referrals;
• Attorney Correspondence;
• Notices to Creditors;
• Casualty Referrals/Wrongful Death Cases;
• State Referrals;
• Funeral home referrals;
• Long-term care facility/Nursing Home referrals;
• Bank referrals;
• Insurance Company referrals;
• Other provider referrals;
• Escheatable property/Unclaimed funds;
• Referrals from other state or county departments; and
• Referrals from other states.
Leads generated will be entered into the Offeror’s case management system. Basic information must
be required as well, which includes but is not limited to:
• Recipient Name, Medicaid CIN, SSN, Date of Birth and Date of Death;
• NYS Medicaid eligibility, both current and historical eligibility segments;
• Attorney or representative information;
• Member demographics; and
• Date of death
The Offeror must log and track all leads and referrals in its case management system. A verification
process must be run on all leads within thirty (30) days of identification to determine if the estate of
the deceased enrollee is subject to estate recovery.
A notice must be generated, advising of the intent to file a claim against the estate, and all other
federal and state-required program notifications must be issued. A questionnaire and/or other
methods of outreach must be utilized to gather any missing or critical estate information, as described
below. All documents must also be forwarded to the member’s authorized representative or their
attorney, as applicable; all correspondence must be sent out on State-approved letterhead, in a form
and format approved by OMIG. The Offeror must review the returned questionnaires, and any other
available information gained through proactive research, to determine if estate recovery should
proceed.
17
Estate recovery may be deferred or exempt, per federal and state statutory requirements, if any of
the following situations exist:
• Deceased recipient is survived by a spouse;
• Deceased recipient is survived by a child under the age of 21;
• Deceased recipient is survived by a blind or disabled child of any age who meets SSI criteria;
or
• If the decedent was a Native American, Alaskan Native, or if they had retained government
reparation payments at the time of death.
Additionally, Estate recovery must take into consideration reported instances of hardship. No recovery
of Medicaid correctly paid will be pursued against any portion of an estate if it will result in undue
hardship. Examples of undue hardship include:
• The sole income-producing asset of the beneficiary (ies), such as the family farm or family
business and income produced by the asset is limited; or
• Real property of modest value (i.e., having a value no higher than 50% of the average selling
price in the county where the home is located, as of the decedent’s date of death) and the
home is the primary residence of the beneficiary (ies); or
• Other complying circumstances.
When any of these circumstances are identified, the Offeror must either close the file or defer recovery
until the exemption no longer exists, in accordance with federal and state law. In all instances of
closure or deferment with no recovery, the reason must be documented in the case management
system for reporting. In situations of deferment the Offeror and their case management system must
have processes and mechanisms in place to proactively identify, reopen and process the case once
the deferment is no longer valid.
In cases where recovery should proceed, the Offeror will seek documentation substantiating the
existence of any recoverable estate assets, subject to any exclusions or limitations under State
probate law. Such documentation may include, but is not limited to:
• Inventory of Assets;
• Final Accountings and/or other probate documents;
• Copy of Will;
• Property appraisal records and/or Deed copies; and
• Questionnaires returned from personal representatives.
If any information is unavailable to the Offeror, the parties of interest must be proactively contacted
to complete the case record. Regular follow up to obtain the missing information is required and must
be documented in the case management system.
If it is clear that a case does not meet the necessary requirements for recovery, or if there are no
assets found or reported, the Offeror must close the case with a detailed note in the case
management system. In all instances of closure with no recovery, the reason for closure must be
documented in the case management system for reporting.
All cases and case data must be retained in the case management system for historical review and
reporting.
18
2. Active Cases: Valuation and Claim Filing
The Offeror must determine the value of NYS’ claim against the estate by adding the total of all
Medicaid expenditures that were incurred by a recipient subject to estate recovery regulations. This
must include all paid claims, including both fee-for-service and capitation claim payments as
applicable. These claims are subject to a ten year look back period from date of death, surviving
spouse deferrals, hardship waivers, etc. The claim value must be documented in the case
management system.
If the deceased recipient owned property and the Offeror had not previously placed a pre–death Tax
Equity and Fiscal Responsibility Act (TEFRA) lien on the deceased recipient’s property, the Offeror
may place a Medical Assistance property lien to protect the State’s claim and prevent improper
transfer. Liens will be placed at the request and discretion of LDSS, OMIG and the Medicaid eligibility
districts.
Once the personal representative has opened probate, the Offeror must file a claim against the estate
in accordance with federal and state statutes. The Offeror is required to file the claim in whatever
manner is accepted by the county the claim is being filed in. The claim entitles the State to recover
the total amount of eligible expenditures. If the value of the estate is less than the ‘claim value’, the
Offeror must seek recovery of the total value of the estate (less prioritized expenses). Prioritized
expenses under Federal Law and NYS Law include, but are not limited to, funeral expenses,
administration expenses, and federal and state liens and taxes.
A copy of the Notice of Claim must be served on the proper parties via Certified Mail, and documented
in the case management system.
The Offeror must require a signed medical release from the executor, administrator, or power of
attorney to release any protected health information. The Offeror must submit requested
documentation to interested third parties within five (5) business days from the date a valid medical
release authorizing the disclosure has been received. For a request of itemization of claims, the
Offeror must highlight or indicate all related claims, diagnosis codes, dates of services, and
expenditures for the benefit of the interested third-party.
If requested, the following documents must also be provided:
• Application for claiming a statutory exemption, undue hardship waiver, or partial recovery;
• A chronology of the Medical Payment History; and
• An explanation of medical assistance payments
Medical release forms, and requests for information as well as the Offeror’s responses must be
documented in the case management system.
3. Probate
In instances where a recipient who qualifies for estate recovery has been deceased for at least
(twelve) 12 months and no probate has yet been opened, the Offeror has (thirty) 30 days to evaluate
whether it would be cost effective for the Offeror, on behalf of the State, to refer the case to the local
county Public Administrator or County Treasurer to open probate. Detailed notes must be included in
the case file to support the Offeror's determination. In all instances, the Offeror’s determination must
be documented in a way that can be extracted for reporting. All referrals to the Medicaid eligibility
district, including all documentation and correspondence, must be documented in the case
19
management system. The Medicaid eligibility district determination regarding probate must also be
documented in a way that can be extracted in reporting.
4. Closed Cases
An estate case is closed only if it meets the following criteria for closure:
• Upon payment in satisfaction of the claim;
• If there are no recoverable assets in the estate;
• If the case meets any of the exemption criteria that do not warrant deferral.
Within ten (10) business days from the reconciliation of payment in satisfaction of the claim, or from
the date it is determined that there are no recoverable assets, or the date that it is determined that
the case meets exemption criteria that do not warrant a referral, the Offeror must mail the Satisfaction
of Claim, Release the Lien (if necessary), and the file itself must be closed in the case management
system. In all instances of closure with no recovery, the reason for closure must be documented in
the case management system in a way that can be extracted for reporting.
G. MANAGED CARE RECOVERY
The Offeror must include capitation payments as part of the case valuation process for both Casualty
and Estate recovery activities. This ensures that all Medicaid expenditures are appropriately recovered.
According to the State’s Medicaid Managed Care Contract, the State has authority to pursue such
recovery for Medicaid Managed Care recipients.
1. Estate Recovery
The Offeror must include all applicable capitation payment claims in valuations of Medicaid Estate
Recovery cases. These claims are subject to the same restrictions as other fee –for-service claims,
including a ten year look back period, surviving spouse deferrals, hardship waivers, etc.
2. Casualty Recovery
The Offeror must review encounter claims with dates of service on and after the date of incident when
the injury was sustained. For each month where the Offeror identifies at least one encounter claim
related to the incident, the Offeror will include that month’s capitation payment claim in the total case
valuation.
3. Other Areas of Recovery
The Offeror may propose other areas of recovery such as Special Needs Trusts and Spousal Refusal
cases for OMIG’s consideration and approval.
The following is a listing of some of the criteria that may be considered by OMIG’s evaluation team during
their review of responses to this component:
• Present a thorough description of the sources that will be used to proactively identify possible
Casualty and Estate reviews for potential recovery;
• Provide a thorough description of proposed processes that will be used to identify claims
related to Casualty and Estate cases, to value and re-value liens and claims as appropriate,
and to file, update and lift liens and claims as appropriate;
• Present a thorough description of the processes that will be used to proactively obtain and
document all necessary information on identified Casualty and Estate recovery cases;
20
• Present a thorough description of the proposed processes for identification and resolution of
cases appropriate for closure, both where recovery has been made and for cases with no
recovery.
• Demonstrates understanding of Medicaid claim billing;
• Demonstrates an understanding of both Casualty and Estate litigation processes and the
various stakeholders potentially involved;
• The quantity and quality of potential case sources presented;
• The timeframes presented within each of the areas listed above;
• Any applicable, creative, viable, innovative, or constructive solutions that the Offeror proposes
to meet or exceed the mandatory requirements of this section.
H. QUALITY ASSURANCE
The Offeror must conduct regular and ad hoc quality assurance reviews of Casualty and Estate recovery
activities following the policies and procedures described within this RFP, as well as documented in the
case management system. The Offeror is required to perform daily review of phone calls, email
responses, and all other interaction with the public, OMIG, LDSS and other Medicaid eligibility districts,
as well as in-depth evaluation of casework, valuation, and lien/claim filing activities. The percentage or
number of transactions, interactions, documents, cases, etc. reviewed will be at OMIG discretion. The
Offeror must report to OMIG on the quality and quantity of these reviews monthly, specifically by the 15
th
of each month, at minimum, in a form and format to be determined by OMIG.
As applicable, the Offeror must also provide suggested improvements, edits and additions to written
policies and procedures of Casualty and Estate recovery processes, to be approved by OMIG prior to
implementation.
Meetings to discuss quality assurance reports, findings and initiatives will be held at OMIG discretion, but
at a minimum monthly.
OMIG’s evaluation team may take into consideration if the Offeror presents a thorough description of the
type and quantity of quality assurance reviews of activities that will be implemented to ensure appropriate,
accurate and timely identification and processing of cases including, but not limited to, case creation, lien
or claim valuation, recovery, and case closure. OMIG’s expert reviewers will also consider the quality of
reviews and activities, as well as any applicable, creative, viable, innovative, or constructive solutions
that the Offeror proposes to meet or exceed the mandatory requirements of this section.
I. REQUIRED PROJECT REPORTING
The Offeror must provide reports of the project deliverables including case progress, statuses,
accomplishments, and roadblocks, in a form and format to be determined by OMIG. Offeror will be
required to present this information during face-to-face meetings to be held at OMIG’s Albany office
whenever possible, or via videoconferencing technology, at a frequency to be determined by OMIG. The
successful Offeror must have Key Personnel staff available and able to discuss case issues, reporting
questions, quality assurance issues, case management system questions, and other contract
performance questions during normal business hours, defined as 8:00 AM to 5:00 PM Eastern Standard
Time (EST), Monday through Friday, excluding State observed holidays. Additionally, OMIG may request
ad-hoc reports, analysis, proposals, or files of data be provided and/presented to OMIG’s Albany office,
in a form, format and frequency to be determined by OMIG.
The Offeror is required to prepare and submit to OMIG the following status reports:
21
1. Annual Reporting
Work Plan Reports
Within thirty (30) Business Days of contract execution, and prior to actual work engagement, and
annually thereafter by December 1
st
, the Offeror must provide a comprehensive work plan that
identifies the staff assigned to the contract and their geographic locations including, but not limited
to, employees, agents, and sub-contractors. The work plan must also describe the scope and
detailed steps of the project, State, and local agency involvement, goals and initiatives for the
upcoming calendar year, planned training and education both for Offeror staff and outreach to
various program stakeholders, outline the Emergency Preparedness Plan (EPP) for the coming
year, and any and all other current and historical facets of the project that have ongoing impact.
A work plan may be disapproved or modified by OMIG for reasons including but not limited to
interfering with existing or planned State or other contractor revenue initiatives. The Offeror’s
scope of work must be limited to activities strictly stated and authorized in the approved plan. No
claim or invoice will be submitted or paid unless an approved current work plan is on file with
OMIG.
2. Monthly Reporting
The following reports must be provided, or be made available, to OMIG and any additional
stakeholders as determined by OMIG, monthly by the 15
th
of each month, detailing the work
performed in the previous month. Reports must not be in a format limited by capacity and must
include all applicable items. Detailed information of the Offeror’s findings must be provided at
OMIG’s request.
Status Reports
The Offeror must prepare and submit to OMIG monthly status reports of its high level
accomplishments and pending work to be completed.
Casework reports
The Offeror must prepare and submit reports detailing casework performed. Reports must include
the ability for drill down in each category to the unique case number detail. Reports must be able
to be sorted by county of eligibility.
Casualty (including Mass Torts)
• Leads received, broken down by lead type
• Correspondence received and processed
- Requests for interim and final lien amounts received and sent
- Requests for lien amount compromises received, granted, and denied including denial
reasons.
- Lien amount disputes received, granted, and denied, including denial reasons
• Cases opened
• Cases closed both with and without recovery. For cases closed without recovery, the reason
for closure must be included.
• 104b liens Filed
• 104b liens Released
Estates and TEFRA
• Leads received, broken down by lead type
22
• Correspondence received and processed
- Questionnaires sent and received
- Requests for compromise received, granted, and denied, including denial reasons
- Requests for Hardship Waiver received, granted, and denied, including denial reasons
- Other documents received and processed by type
• Cases opened
• Cases closed both with and without recovery. For cases closed without recovery the reason
for closure must be included.
- Releases sent
• Assets verified
- By type including unclaimed funds
• Probate identified
- Offeror Identified
- Referred to the local County Public Administrator or County Treasurer to open probate
• Claims filed
• TEFRA Liens filed
• Post Death Property Liens filed
3. Recovery Reports
Reports detailing high level recoveries received must include recovery amounts. Reports must be
separated by Casualty, Estates and TEFRA totals, and list all the recoveries, per Medicaid
eligibility district (including the NYSoH marketplace), for that month. This must also include totals
monthly, and cumulatively by calendar and fiscal year.
By the same date, the Offeror must also submit to the county, or make accessible to the county,
a monthly report of the county’s own specific case detail and recovery data.
Reports detailing payments received must be available to OMIG and other stakeholders as
determined by OMIG. Reports must include details such as, but not limited to:
• Deposit date
• Payment type (check or electronic payment)
• Sub-payment type (Nursing Home account, structured or settlement or annuity, Mass Tort
settlement, Bank account payment, etc.)
• Check number (if applicable)
• Payment amount
• Associated case type and unique identification number(s)
4. Quality Assurance Reports
Reports detailing the quality assurance reviews conducted by the Offeror must be submitted to
OMIG and must contain, but not be limited to, the following:
23
Correspondence & Customer Service:
The Offeror must conduct a daily review of information exchanged with the public, NYS agencies,
or LDSS via phone calls, email responses, and all other correspondence for accuracy and
timeliness. A minimum of 10% of all correspondence and customer service contacts must be
reviewed for both Casualty and Estate correspondence and documentation. A report of the high-
level findings of any errors or issues, and subsequent changes to procedure/training/etc. must be
provided to OMIG monthly. The minimum review percentage can be changed at OMIG’s
discretion.
Valuation:
The Offeror must conduct a daily review of valuation and claim review activities for accuracy and
timeliness. A minimum of 10% of all lien and claim valuations for both Casualty and Estate
processes must be reviewed. Additionally, and at minimum:
• All $0 lien and claim determinations must be reviewed.
• All lien or claim reductions not related to an approved negotiation or compromise must be
reviewed.
• All increased Casualty lien re-valuations, in instance, where the valuation increased because
of related claims previously determined to be unrelated to the injury, must be reviewed.
• All increased Estate claim re-valuations must be reviewed
A report of the high-level findings of any errors or issues identified, and subsequent changes to
procedure/training/etc., must be provided to OMIG monthly. The minimum review percentage and
specified review areas can be changed at OMIG’s discretion.
Lien and Claim filing:
The Offeror must conduct a daily review of all lien/claim filing, updating, and lifting activities for
accuracy and timeliness. A minimum of 10% of all lien and claim filing activities for both Casualty
and Estate processes is required. A report of the high-level findings of any errors or issues, and
subsequent changes to procedure/training/etc., must be provided to OMIG monthly. The minimum
review percentage can be changed at OMIG’s discretion.
5. Staffing Reports:
The Offeror must provide to OMIG an organizational chart that reflects all positions assigned to this
project. The Offeror must provide additional information including a job description for each title, staff
name, contact information and physical working location of staff, and any additional access
designation or position performance details as specified by OMIG. Title descriptions must include, but
are not limited to, designations such as manager (area specified), supervisor (area specified),
caseworker, intake, quality assurance, call center, subcontractor (duties specified), etc. If a position
is vacant that information must be reported. Changes to staffing, both onboarding and offboarding,
must be reported to OMIG along with an updated organizational chart, at least fourteen (14) calendar
days in advance, or as soon as any known onboarding or offboarding changes occur.
6. Ad Hoc Reports:
Ad hoc reports requested by OMIG must be submitted in the form and format prescribed by OMIG,
within reasonable timeframes as specified by OMIG.
OMIG’s evaluation team may take into consideration if the Offeror presents a thorough description of
all reporting which will be available within the case management system for ad hoc extraction and
any additional reporting which the Offeror could provide to illustrate activities performed, as well as
the quantity and quality of reporting, and that all required reporting is encompassed. OMIG’s
24
evaluation team may also take into consideration any applicable, creative, viable, innovative, or
constructive solutions that the Offeror proposes to meet or exceed the mandatory requirements of
this section. Additionally, OMIG will also consider if any additional areas of recovery are proposed.
J. RISK ASSESSMENT
A System and Organization Controls (SOC) for Service Organizations Reports (SOC1 and SOC2) are
reports issued by an independent public accountant in accordance with standards promulgated by the
American Institute of Certified Public Accountants (AICPA) on the internal controls of a servicing
organization. The SOC defines the professional standard used by a service organization’s auditor to
assess the internal controls at a service organization. Reviews must be conducted to meet this
requirement. OMIG requires that SOC reports are prepared and submitted annually, no later than January
15
th
of each calendar year.
K. RECEIPT OF RECOVERIES
The Offeror must establish a comprehensive process for receipt and tracking of Casualty and Estate
recoveries. that includes, but is not limited to, the following:
• New York State maintains a separate lockbox and ACH process, to serve as a repository for
New York State’s Medicaid Casualty and Estate recoveries. The Offeror must not remove
money from the lockbox or ACH; however, is required to monitor the lockbox and ACH activity
for accounting and reconciliation purposes. The State will arrange for the periodic sweeping
of funds from these accounts or other transfer arrangement(s);
• Accounting for all recoveries in the case management system and posting payments and
documentation received to each case as applicable. Updating the case management system
in real time and in accordance with requirements and timeframes set by OMIG;
• Reconciling reported Medicaid recoveries to invoiced and vouchered Medicaid recoveries.
Every recovery amount invoiced and vouchered for, must tie back to a recovery case
documented in the case management system. OMIG reconciles the bank statements and
ACH statements against the case management system and approves payments based on
verified recovery amounts;
• Preparing and submitting to OMIG, monthly fiscal reports of recoveries;
• Resolving discrepancies with OMIG, LDSS staff and other stakeholders to accurately
document recoveries;
• Reconciling payments that are sent to the wrong lockbox or ACH account and/or are made
out to unacceptable payees; and
• Depositing monies collected under this procurement in accordance with the rules and
regulations of the Office of the State Comptroller.
• NYCRR (Audit and Control) §143 provides: "Monies received by any State agency for
subsequent payment into any fund in the custody of the State Treasury, and monies received
by custodian of special funds in which the State has an interest, direct or indirect, or under the
control of the State, must be deposited, daily if possible, and not later than once a week, in a
bank or trust company of the State. When required by law (see State Finance Law §§105
and106), such deposits must be in a depository approved by the Comptroller and must be
secured by bonds. Monies include cash, checks, bond coupons, etc. All such receipts must
be deposited in a bank, and any payments therefrom, if authorized, must be only by check on
the bank of deposit."
25
OMIG’s evaluation team may take into consideration if the Offeror presents a thorough description of the
processes that will be used to identify and reconcile payments received to established recovery cases,
including how payments will be documented and reported to OMIG. This should be inclusive of processes
for proactive identification and resolution of payments received in error or any scenarios that may require
refund. OMIG may also take into consideration any applicable, creative, viable, innovative, or constructive
solutions that the Offeror proposes to meet or exceed the mandatory requirements of this section. OMIG’s
evaluation team may take into consideration if the Offeror presents a thorough description of the
processes that will be used to identify and reconcile payments received to established recovery cases,
including how payments will be documented and reported to OMIG. This should be inclusive of processes
for proactive identification and resolution of payments received in error or any scenarios that may require
refund. OMIG may also take into consideration any applicable, creative, viable, innovative, or constructive
solutions that the Offeror proposes to meet or exceed the mandatory requirements of this section.
III. CASE MANAGEMENT SYSTEM
A recipient driven, high capacity, intuitive, amendable, and user-friendly case management system is needed to
house, process, and document New York State’s Casualty and Estate recovery case inventory. To accommodate
the high level of required system customization, and to remain flexible with potential program changes, the
Offeror must also provide a testing environment which mirrors the case management system in form, function
and capacity.
The Offeror must provide and maintain a case management system dedicated to the New York project and have
the ability to prove data security. The case management system must also have the capacity and ability to
accommodate all the active and historical Casualty and Estate cases for all the counties of NYS and NYC HRA
Investigation, Revenue & Enforcement Administration (IREA) Division of Liens and Recovery Casualty Program
and the NYC HRA Office of Legal Affairs (OLA), who administers the real property program for the estate recovery
of Medicaid recipients. The Offeror’s case management system must also contain the cases generated from
NYSoH marketplace. Fifteen (15) years of claims history must be accessible to the user and/or caseworker for
both Casualty and Estate cases. The system must be online and available between 6:00AM to 9:00PM Eastern
Standard Time, Monday through Friday.
The Offeror’s case management system is required to be operational within (three) 3 months from contract
commencement. Access will be granted by the Offeror through provisioned credentials at various user access
levels and with customizable functionality, and training will be provided by the Offeror to LDSS, HRA, and NYS
staff as needed or as requested by OMIG at no extra cost.
The Case Management system must be capable of performing all functions listed below, must be HIPAA &
HITECH compliant. It must be able to ingest information from the NYS Medicaid Data Warehouse (MDW), at a
frequency to be determined by OMIG, and be able to identify and reflect fee-for-service claims, managed care
capitation payments and encounter claims related to the injury, or estate, enabling the caseworkers to review
and value the cases. Reports and system information generated from the case management system must be in
a form and format directed by OMIG, to be compatible with OMIG systems. At OMIG’s request, the Offeror will
work with NYS to modify the case management system and create integration between Offeror and state systems
to the greatest extent possible.
The case management system must have the capability to accumulate the expenses associated with the
accident or estate and monitor the progress of the ongoing cases. The case management system must include
workflows conducive to case assignment, maintenance and updating, including the requirement of caseworkers
to re-value each case, conduct outreach for additional information, and maintain an updated caseload.
Stakeholders must be made aware of updated and final lien or claim amounts and any pending settlements
promptly upon the Offeror identifying them, and as requested.
The system must contain reporting functionality that is customizable, including customized data fields, system
query functionality, and various other customizable reporting functions as requested by OMIG.
26
The Offeror’s case management system, at a minimum, must be able to house and perform basic and complex
functions including, but not limited to:
• Accepting all cases from the current case management system used by OMIG and its
contractor (approximately 400,000 cases);
• Accepting and maintaining all files and documentation provided by the public, the counties
and state agency stakeholders;
• Interface with the Offeror’s public facing portal or website to document submissions, inquiries
and responses as well as receive and accurately file documents with the correct case file;
• Storing a minimum of fifteen (15) years of claims history and documentation for active cases
accessible to users, and an annual case load of approximately 75,000 cases;
• Interfacing with various lead and end users, in addition to the ability to ingest information from
the MDW, inclusive of, but not limited to, Fee For Service and Encounter claim data, eligibility
data, and recipient demographics;
• Medicaid eligibility span addition and retention (as part of data received from the MDW);
• Properly reflecting and retaining for valuation all applicable Medicaid fee-for-service claims
(including capitation payments) and managed care encounters regularly on a schedule to be
determined by OMIG;
• Scanning and associating all incoming documents and correspondence to the appropriate
case file, inclusive of handwritten forms and language translation as applicable;
• Document generation, intake from external sources, attachment to and storage within
applicable cases;
• System generated documents and letters to be approved in form and function by OMIG;
• Ability to document related and unrelated claims for lien or claim valuation (accident and/or
estate);
• Allow for the valuation and calculation of claims specific to each case file, including claim level
valuation determination and cumulative related claim totals;
• Allow for the documentation and cumulative calculation of the lien or claim amount on each
case;
• Documenting written and verbal communications in each case;
• Documenting the status or stage of workflow for each case;
• Statuses or stages of workflow and their definitions must be provided to OMIG to be approved
in form and function by OMIG;
• Documenting and retaining the litigation related dates or estate settlement date, and any
amounts associated with litigation or estate settlements, including any associated
documentation;
• The addition and retention of case notes and comments;
• Recipient and case linking:
- Linking of multiple cases by recipient
- Linking of multiple recipient Medicaid Identification Numbers by recipient
- Linking of multiple recipient names by recipient
27
- Linking of multiple recipients by event
- Linking of multiple cases and/or recipients across different areas (casualty, estates,
counties, etc.)
• Document and maintain all payments and payment documentation to ensure proper
Federal/State split of funds;
• Document all the actions taken and determinations made in each case;
• Generate appropriate letters, questionnaires, information requests, follow-up reminders, and
any other documentation specified by OMIG;
• System generated documents and letters to be approved in form and function by OMIG;
• Generate case specific release of claims forms, satisfaction of claim forms or withdrawal of
claim forms;
• System generated documents and letters to be approved in form and function by OMIG;
• Ability to transfer data for uploading of recovery information to OMIG’s system; and
• Reporting capability, including case status and case count tracking, both current and historical,
lien, claim and recovery information, and ad-hoc reporting inclusive of all areas of the Case
Management System, for OMIG staff and other users as deemed appropriate and at OMIG
discretion.
At a minimum, the system must contain the following data:
A. GENERAL REQUIREMENTS – ALL CASES
1. Recipient demographics
• Date of Birth
• Date of Death (if applicable)
• First and Last name(s) including any known aliases
• All Medicaid Recipient ID numbers (CINs) attributable to the recipient
• Social Security Number
• All known addresses of residence
2. Medicaid eligibility information
• All Medicaid eligibility spans as noted in the MDW
- County of eligibility, including the NYSoH marketplace
- Dates of eligibility
- Fee-for-service vs. Managed Care indicator
3. Casework information
• Notes to detail correspondence, phone calls, and steps taken in the case including the date
of any such actions
• Capability to attach documents such as emails (both internal and external), letters, etc.
• All documents must be available to view, download and print
28
• Identification of caseworker
• Current and historical case status
• Lead source
• All known contacts and their information, including their association to the case/recipient
• Linking of all cases attributed to recipient and/or Date of Incident
B. CASUALTY SPECIFIC REQUIREMENTS
1. Incident detail
• Date of incident
• Description of incident
• Description of injuries sustained
• The attachment of and access to associated documentation received relevant to the incident
(suit documentation, police reports, etc.)
• Linking of all recipient cases attributed to incident
2. Financials
• Summary and detail of associated claims
- Claims reviewed, related to case and unrelated to case
- Claims pending review
• Lien filing information
- Date filed
- Court information
- Amount of filed lien
• Settlement information and documentation
• Payment detail
C. ESTATE SPECIFIC REQUIREMENTS
1. Verified assets
1. Deferral or Exemption details (if applicable)
2. Financials
• Summary and detail of associated claims
- Claims reviewed (related and unrelated to case)
- Claims pending review
• Claim filing information
- Date filed
- Court information
29
- Amount of filed claim
• Settlement information and documentation
• Payment detail
Within (thirty) 30 calendar days of separation, the Contractor will provide OMIG a final data extract of
data, information and documentation stored within the case management system that encompasses
the entire contract term. If this data extract is not provided within this timeframe, final payment will be
withheld until the information is provided.
The following is a listing of some of the criteria that may be considered by OMIG’s evaluation team
during their review of responses to this component:
• Present a thorough description of processes including timely and accurate case identification
and documentation, recipient eligibility and demographic identification, claim or lien valuation
and filing, communication with stakeholders, documentation storage, document generation,
and reporting functionality.
• Present a thorough and detailed review of system processing points which illustrate the
workflow of the system and ensure timely and accurate case processing from source of case
identification to case closure inclusive of quality assurance activity.
• OMIG will consider the quality of proposed system processes and workflows and the Offeror’s
understanding of Casualty and Estate recovery.
• OMIG’s evaluation team may take into consideration any applicable, creative, viable,
innovative, or constructive solutions that the Offeror proposes to meet or exceed the
mandatory requirements of this section.
IV. OFFICE AND STAFFING REQUIREMENTS
It is mandatory that all Offerors provide a current organizational chart that lists all positions (including staff who
are sub-contractors and their sub-contracting company, if applicable), locations, and full-time equivalents (FTEs)
who would be assigned solely to New York State's C&E Contract. The vendor is responsible for notifying OMIG
of all onboarding and offboarding of all staff including subcontractors. Notification must be sent to OMIG at least
fourteen (14) calendar days in advance, or as soon as any known onboarding or offboarding changes occur. All
state equipment must be returned immediately to OMIG upon separation of service.
The Offeror must ensure that all personnel dedicated to this contract, including all Key Personnel and Support
Staff as outlined below, are fully trained and knowledgeable about New York Medicaid standards and protocols,
the Casualty and Estate Recovery program, and recovery processes.
The Offeror must have customer centric dedicated staff available during normal business hours, defined as 8:00
AM to 5:00 PM Eastern Standard Time (EST), Monday through Friday, excluding State observed holidays.
The Offeror's Key Personnel must include an IT Specialist, Project Director, Project Manager and Project
Attorney. Key Personnel assigned to OMIG's Casualty and Estate contract must be available to come onsite to
OMIG, at the request of the agency. Upon OMIG's request, Key Personnel, at minimum, must appear onsite
within three (3) business days at the vendor’s expense.
The Offeror must be responsible for assuring that all persons (including but not limited to employees, agents,
and sub-contractors) are legally authorized to render services described in the Contract under applicable State
laws or regulations. The Offeror must not have an employment, consulting, or any other agreement with a person
that has been debarred or suspended by any Federal of State agency, licensing agency or certification board for
the provision of items of services related to the entity’s contractual obligation to the State. In addition, staff,
working on this contract, may not have secondary employment with providers that are subject to monitoring as
outlined in this RFP.
30
At minimum, the following staff must be assigned to this Contract, and must possess a current, active, and
unrestricted license in one or more United States licensing jurisdictions (if applicable).
While the nature of the work requires the recovery of funds, this should be pursued in a sensitive manner. All
staff tasked with handling calls from the public will be required to take specialized training approved by OMIG,
including grief sensitivity training, annually and at no cost to OMIG.
At minimum, the following Key Personnel and Support Personnel staff must be assigned to this Contract. These
staff must be full time, and 100% dedicated to this contract.
A. KEY PERSONNEL
A single individual may not hold more than one key position unless otherwise approved by OMIG. The
Offeror must notify OMIG concerning any changes in Key Personnel as soon as the Offeror is aware of
a change. The Offeror must provide one (1) résumé, including any pertinent certifications/licenses, for
each of the Key Personnel positions outlined below. If the Offeror submits more than one (1) résumé, the
first in the order that it appears in the proposal will be treated as the résumé to be reviewed.
1. IT Specialist
The IT Specialist must have a minimum of five (5) years of experience in information technology.
2. Project Director
The Project Director must have, at a minimum, five (5) years of experience in Healthcare Program
Integrity/Compliance and/or casualty or estate law and/or subrogation.
3. Project Manager
The Project Manager must have, at a minimum, five (5) years of experience in Healthcare Program
Integrity/Compliance and/or casualty or estate law and/or subrogation.
4. Project Attorney
The Project Attorney must possess a current, active, and unrestricted license to practice law in NY.
They must have, at minimum, five (5) years of experience in Healthcare Program
Integrity/Compliance and/or casualty or estate law and/or subrogation.
B. SUPPORT PERSONNEL
The Offeror must assign the following support personnel, dedicated to the NY Casualty and Estate
contract, at volume large enough to timely and efficiently handle the workload:
1. Customer Service Representatives
1. Caseworkers
2. Clerical staff
OMIG’s evaluation team may take into consideration if the Offeror presents a detailed organizational chart and
any additional listing of positions, including the quantity and quality of FTE positions in conjunction with the
proposed processes for customer service, case identification, management, and reconciliation. Key Personnel
resumes need to clarify how the experience and education presented are relevant to the work to be performed
under this contract.
31
V. OFFEROR EXPERIENCE
A. CURRENT MEDICAID C&E CONTRACTS
List all Medicaid Casualty & Estate contracts for which the Offeror is currently engaged and for each,
include the Contact Name, Contact Phone, state for which the services are being performed, the contract
number, beginning and end dates, and indicate which scope of service(s)/module(s) are being performed
by your company within each particular contract. OMIG will evaluate and confirm that the information is
accurate.
B. OFFEROR REFERENCES
The Offeror must provide at least three (3) client programmatic references (Attachment 2: “References
Form”) for which they have performed recoveries similar in scope or function within the last five (5) years.
If more than three (3) references are submitted, they will be contacted in the order they appear in the
proposal until three (3) interviews are completed.
References must be persons able to comment on the Offeror’s ability to perform the services specified
in this RFP. The contact person must be an individual familiar with the organization and its day-to-day
performance.
Contact will be made during the hours of 8:00 a.m. EST to 5:00 p.m. EST, Monday through Friday.
OMIG will be confirming the work that had been performed and will seek details regarding the quality of
work performed.
If OMIG is unable to contact or obtain information from a supplied reference, the Offeror will be afforded
the opportunity, with a deadline, to assist in obtaining cooperation from said reference(s).
* A non-responsive or negative reference may disqualify the Contractor by establishing it as a non-
responsible Contractor.
If the Offeror has been a Contractor for the State of New York within the last five (5) years, the Offeror
must include a State of New York reference. Offerors are strongly encouraged to call or write their
references to ensure the accuracy of their contact information and their willingness and capability to be
references.
References must include the organization’s name, name of a specific contact person, mailing address,
telephone number, and e-mail address.
If the Offeror’s submission proposes the use of subcontractor(s) for service provision, the Offeror’s
proposal must also include three (3) programmatic references for each proposed subcontractor.
If the Offeror’s reference is unwilling to provide a written reference, OMIG may consider verbal references
as an alternative.
OMIG staff will not be permitted to provide a reference on behalf of an Offeror.
VI. ORGANIZATIONAL CAPABILITY AND EXPERIENCE
Responses to the requirements in this section must describe the Offeror’s and any proposed subcontractor’s
background and experience relevant to Casualty and Estate Recovery. The responses must also address the
details regarding the Offeror’s organization and resources of the organization. The proposal must clearly
describe the Offeror’s ability and competence to perform the requirements as described in this RFP and must
identify how many FTEs will be solely dedicated to the NYS Casualty & Estate Contract. Failure to respond to
the requirements of this section will automatically disqualify an Offeror from contention.
32
A. SUMMARY OF ORGANIZATIONAL CAPABILITY
OMIG is requesting proposals from qualified organizations and proposed subcontractor(s), if applicable,
to fulfill the Casualty and Estate functions as directed by OMIG.
Include the following specific details regarding the Offeror and subcontractor(s), if applicable:
• Organization establishment date, mission at time of establishment, the current mission
statement, and if the current mission is different from the original, a description of the changes
in focus that led to the current missions.
• Explanation as to why Offeror’s organization is well suited to implement the services required
by this RFP.
B. SUMMARY OF CORPORATE EXPERIENCE
Demonstrate that the Offeror and any proposed subcontractor(s), if applicable, have no less than five (5)
years of experience in performing functions like those described in the qualification requirements.
Describe relevant experience and success related to the Scope of Work for Casualty and Estate including
the following information concerning the Offeror’s, and any proposed subcontractor(s), experience with
other contracts or projects like the type of service and/or scope of work contemplated by this RFP,
whether ongoing or completed. Include the current range of services the organization provides, relevant
to the functions to be performed as required under the resultant contract.
• Identify all State agencies and commercial vendors for which the Offeror has engaged in
similar or related contract work or projects completed within the last three (3) years with
emphasis on activities relevant and related to the proposed program.
• Explain whether work was performed as a prime Contractor or subcontractor. If the work was
performed as a subcontractor, the Offeror must describe the scope of subcontracting activities.
• Provide a signed release allowing OMIG to access any evaluative information including, but
not limited to, site reviews conducted by any state agency or commercial vendor for which
Offeror has performed work in the past three (3) years.
NOTE: The signed release must be submitted as a separate sheet of paper.
• Identify contacts for those projects of similar scope, including name of customer’s project
officer, title, mailing address, telephone number, fax number, and e-mail address.
• Identify the term for the contracts including the contract signing date, the project initiation date,
the initial scheduled completion date, and the actual completion date.
• List all contracts awarded to the Offeror or its predecessor firm(s) by the State of New York
during the past three (3) years by State, Agency, Division, Contact Person (with mailing
address/telephone number/e-mail address), period of performance and contract amount.
• List all sanctions, fines, penalties, or letters of non-compliance issued against the Offeror by
any of the contracting entities listed above. The list must describe the circumstance eliciting
the sanction, fine, penalty, or letter of non-compliance and the corrective action or resolution
to the sanction, fine, penalty, or letter of non-compliance. If no sanctions, fines, penalties, or
letters of non-compliance were issued, a statement that attests that no sanction, fine, penalty,
or non-compliance action has been imposed on the Offeror within the last three (3) years
immediately preceding the RFP posting/release date must be submitted.
33
C. PROPOSED ENHANCEMENTS & IMPROVEMENTS
Describe how the Offeror’s proposed Casualty and Estate Model will enhance and improve OMIG's
current Program and how it will integrate its proposed Casualty and Estate processes into a seamless
Casualty and Estate Model.
D. STAFFING PLAN
Submit a staffing plan that includes current and proposed staff and if/when your organization will hire staff
and orient them to your organization, the Casualty and Estate Program, and their roles and
responsibilities.
VII. CONTRACTOR ACCOUNTABILITY
A. GENERAL ACCOUNTABILITY PROCESS
While it is expected that the contractor will remain in compliance throughout the term of the resulting
contract, there may be instances where this is not the case. For all situations not specifically listed above,
where Contractor fails to comply with the terms of the RFP, OMIG will generally offer five (5) business
days to cure the situation. If, after five (5) business days the Contractor continues to remain out of
compliance, the matter will be promoted to the next level for review and determination of additional
corrective action, up to and including withholding of payment. If, after thirty (30) calendar days, the
Contractor continues to remain out of compliance, the matter may be promoted to the next and final level
of review to determine if the failure to comply warrants legal action, up to and including breach of contract.
Below, is an outline of the general levels of review and corrective action:
1. First Level (OMIG Program Area – DSUR):
If Contractor fails to comply with the terms of the RFP, OMIG’s program area, with whom the
Contractor generally interacts in the standard course of business, will address any issues with the
Contractor. The Contractor is expected to correct the issue within five (5) business days, or the issue
may be elevated to the next level.
2. Second Level (OMIG Bureau of Fiscal Management (BFM)/Contract Unit):
If Contractor continues its failure to comply with the terms of the RFP after having received notice five
(5) business days prior, the issue may be elevated to OMIG’s Contract Unit for review. OMIG’s
Contract Unit will review the situation and may offer the Contractor thirty (30) calendar days to comply
with the terms of the RFP or may impose a withhold of monthly payment until the action is corrected.
In addition, if the Contractor remains out of compliance at the end of thirty (30) calendar days, the
issue may be elevated to the next level of review.
3. Third (Final) Level (OMIG Counsel):
If Contractor continues its failure to comply with the terms of the RFP after having received notice
thirty (30) calendar days prior, the issue may be elevated to the OMIG Counsel for review. The OMIG
Counsel will review the situation and will determine if the failure to comply warrants legal action, up
to and including breach of contract.
*While this is a general guideline of OMIG’s process for remediation, OMIG reserves the right to
escalate the issue to the highest level at any time for continued failure to correct.
34
B. FEE ADJUSTMENT SCHEDULE:
The Fee Adjustment Schedule, below, represents adjustments that are separate and apart from the
General Accountability Process further below, but consistent non-compliance may still lead to breach.
All contingency fee adjustments will be assessed at OMIG’s discretion and will be applicable to
contingency fee for the entire invoice submitted for the month in which the issue was identified. For
example, if the contingency fee bid by the Contractor is 7.5% and the fee reduction on the schedule is
0.5%, the amount paid for the month’s recoveries would be 7%. Fee reductions will be applied additively.
The total fee adjustments will not reduce the contingency fee paid for any given month below 5%. Despite
the assessment of a fee adjustment, the Contractor is still expected to remedy the issue.
The Offeror will be notified of OMIG’s determination to impose a fee adjustment to any given monthly
invoice and will be provided the opportunity to respond to the notification relevant to the circumstances
which led to the adjustment determination. OMIG, however, retains the authority to apply an adjustment
at it’s discretion. If a fee adjustment response is under OMIG review for a month, no invoice received will
be accepted or processed for that month until OMIG’s determination regarding the fee adjustment is
complete, and the invoice for that month contains those applied adjustments as determined by OMIG.
OMIG reserves the right to apply fee adjustments to the Contractor's contingency fee, per the schedule,
below:
• The Contractor is expected to know and adhere to Casualty and Estate processes as outlined
in Federal and State law and regulation. Additionally, the Contractor will be provided with, and
is expected to adhere to, written directives, , policies, procedures and guidance, from OMIG
and DOH regarding reviews and/or agency topic specific positions. If the Contractor is found
by OMIG to be in violation of these laws, regulations, policies, procedures and written
directives then OMIG will reduce the Contractor's fee by 1% for the applicable vouchering
month.
• All 'Key Personnel' positions must be filled upon initiation of the Contract by the Contractor. If
any 'Key Personnel' positions are not filled upon initiation of the Contract, the Contractor’s
contingency fee will be reduced by 0.25% for the applicable vouchering month.
• Vacant 'Key Personnel' positions must be filled within sixty (60) calendar days of vacancy or,
upon expiration of the sixty (60) calendar days, the contingency fee will be reduced by 0.25%
for the applicable vouchering month. The reduction will continue for all subsequent months
until filled.If at any point in time, the Offeror becomes aware that a 'Key Personnel' position
will become vacant, they must notify OMIG within fourteen (14) business days of that
knowledge. If within forty-five (45) days of the vacancy, the Contractor does not believe the
position will be filled to meet the sixty (60) day deadline, then the Contractor must request an
extension of the timeframe. The extension will not exceed an additional sixty (60) days.
Approval or denial will be at the discretion of OMIG.
• If the contractor fails to accurately value lien or claim amounts and/or file and/or produce
necessary documents by the time frame(s) specified in the case documentation or the time
frame specified by OMIG, resulting in a reduction or loss of recovery payment, OMIG will
reduce the Contractor’s fee by that amount for the applicable vouchering month.
• If the contractor fails to submit any reports to OMIG within the time frame specified by OMIG,
it will result in a reduction of 0.25% for the applicable vouchering month.
• OMIG will review all aspects of casework and customer service performed by the Offeror and
will make OMIG contact information available to the public and other stakeholders as part of
the management oversight functions for this contract. During the course of OMIG’s reviews, if
any casework or performance issues are identified they will be escalated to the Offeror for
review and remediation or education. If trending or egregious errors or issues are identified,
35
OMIG will notify the Contractor. A formal corrective action plan will be required to be submitted
to OMIG within ten (10) business days of notification. If the issue continues to occur, OMIG
reserves the right to act, including but not limited to, reducing the Contractor’s contingency
fee by 1% for the applicable vouchering month for any month in which OMIG identifies the
continuing occurrence of the issue.
• If the Contractor fails to respond to LDSS or other Medicaid eligibility district inquiries within
three (3) business days, it will result in a contingency fee reduction of 1% for the applicable
vouchering month.
• If the Contractor fails to conduct recoveries as outlined within the agreed upon annual
workplan it will result in a contingency fee reduction of 1% for the applicable vouchering
month.
• OMIG identified inaccuracies or discrepancies in the Contractor's submitted Casualty & Estate
recovery monthly fee invoicing documentation to OMIG, inclusive of inaccuracies or
discrepancies with recoveries made or the fees invoiced, will result in a fee reduction of 0.25%
for the applicable vouchering month.
• The Case Management System availability window must span from 6:00AM to 9:00PM
Eastern Standard Time, Monday through Friday. Case Management System availability
delays during the availability window need to be reported within an hour of the Contractor
becoming aware of the issue. If the issue cannot be resolved within twenty-four (24) hours
from the onset of the outage, OMIG reserves the right to impose a fee reduction of 0.25%,
which will be assessed for that month.
• The Offeror must have dedicated staff available through email and through dedicated phone
lines during normal business hours, defined as 8:00 AM to 5:00 PM Eastern Standard Time
(EST), Monday through Friday, excluding State observed holidays. Callers must be given the
option to speak to a live staff person dedicated to this contract at any time during those core
hours. Email and phone line availability delays during the availability window need to be
reported within an hour of the Contractor becoming aware of the issue. If the issue cannot be
resolved within twenty-four (24) hours from the onset of the outage, OMIG reserves the right
to impose a fee reduction of 0.25%, which will be assessed for that month.
VIII. CONTRACTOR RESPONSIBILITIES
In addition to the specific requirements for this proposal, this RFP also lists expected duties of the Offeror once
the resulting contract is finalized; upon which, the Offeror will become the Contractor. For all references to
“Contractor”, it is assumed and expected that the Offeror, upon full execution of the contract, accepts the
responsibilities, as outlined within this RFP.
A. ARCHIVAL BACKUP AND DISASTER RECOVERY
The Offeror will maintain an archival backup and disaster recovery procedures in the event of destruction
or corruption of the Case Management System, or disasters or emergencies which require Offeror to
restore backup. The Offeror must provide back-up facilities to the primary operations and data centers
that can provide the services outlined in this Contract if an incident to the primary facilities significantly
interrupts the delivery of a significant service. Following the declaration of a disaster, once the primary
facilities have recovered, they must again be used to provide the services herein with no loss of time and
at no additional cost to OMIG.
The Offeror must develop and adhere to an Emergency Preparedness Plan (EPP) to protect and maintain
ongoing services as outlined in this Contract. Such plans must include, but are not limited to, the following
elements:
• Identification of staff roles and responsibilities during implementation of the EPP;
36
• Procedure for communicating during an emergency with all stakeholders during the required
hours of operation including, but not limited to:
- OMIG
- Subcontractors
- LDSS and other Medicaid eligibility district contacts
- The Contractor’s employees
- The public
• Description of alternate communication procedures to be used in case of telecommunication
and/or internet systems outages; and
• Procedure to initiate plan for the continuance of Case Management System availability,
including contact names, titles, and locations of staff responsible for initiating the plan and
locations of backup storage sites/equipment.
The Contractor must also:
• Provide its emergency contact information (staff names, telephone numbers and email
addresses) to OMIG and must notify OMIG immediately upon any subsequent updates of that
information.
• Notify OMIG when the EPP is initiated, and at what location(s), and provide periodic updates
to OMIG until the emergency is resolved.
• Review and update the details of the EPP with key staff annually.
• Ensure that all subcontractors have adequate emergency preparedness protocols in place
annually.
• Provide an update on the EPP in the annual Work Plan.
IX. PROPOSAL SUBMISSION GUIDELINES
The Offeror must submit a proposal that provides a complete and sufficient response to all the requirements of
this RFP. OMIG will review the proposal and determine whether the Offeror is responsible. A failure to provide
all the requested information will automatically disqualify an Offeror for being non-responsive. An Offeror must
meet the mandatory requirements of this RFP to have its Financial Proposal considered for final Contract Award.
No oral statements of any person will modify or otherwise affect the terms, conditions or specifications noted
herein or in the contract for the service. Any amendments or addendums to this RFP that may be necessary will
be issued in writing.
To expedite the review of the proposals, all documents and technical information should be submitted in the
order and format specified within this RFP. The Technical Proposal and the Financial Proposal, including
Financial Statements, should be sent separately with the subject “RFP# OMIG 24-23 Technical Proposal” or
“RFP# OMIG 24-23 Financial Proposal”. No information beyond that which has been specifically requested is
required.
Proposals and other forms must have original/wet signatures. The Offeror must respond to every specification
stated in this RFP. Moreover, the Offeror must list, cross-reference, and clearly explain all exceptions and/or
alternatives and/or caveats to any item contained in this RFP in the Comments and Limitations section of their
Technical Proposal.
A proposal that does not comply with the requirements and does not include all the information requested may
be negatively affected in the overall evaluation and could be subject to rejection.
37
One (1) electronic copy of the proposal with three (3) sets of original signature pages that have been signed with
a wet signature and scanned (and originals mailed), including everything in the original (forms, the Financial
Proposal, text and narrative sections and all attachments) are to be submitted.
The proposal must be submitted to [email protected].gov
with hard copies of the signature pages
submitted to the address listed in the Designated Contacts listed on the cover page of this RFP.
To be considered, electronic proposals must be received by the date and time indicated in the RFP Schedule
of Events. The Offeror is responsible for ensuring that proposals are submitted and delivered on time.
Consideration will be given only to complete and timely proposals. Proposals received after the deadline may
not be opened.
A. FORMAT
1. Transmittal Letter
The Transmittal Letter, which will be considered an integral part of the proposal, must be signed by
the individual or individuals authorized to bind the Offeror contractually. This transmittal letter must:
• Be submitted on the Offeror's official business letterhead and must be signed in blue ink by
an authorized representative of the Offeror.
• Indicate the signer is so authorized to sign the proposal and the contract, and the title or
position of the signer. An unsigned proposal will be rejected.
• Include a statement to the effect that the price quoted in the Financial Proposal constitutes a
firm and irrevocable offer for 120 days.
• Include a statement that the Offeror complies with or meets all Administrative Requirements,
as outlined in this RFP.
• Include a statement as to the willingness of the Offeror to enter into a contractual agreement
containing, at a minimum, those terms and provisions identified in this RFP. Any exceptions
to these terms and conditions must be explicitly stated in accordance with the terms of the
Comments and Limitations section of this RFP.
2. A Statement of Understanding
The Offeror in the Transmittal Letter or in a separate document, properly labeled “Statement of
Understanding,” must state in concise terms its understanding of the activities to be performed by the
vendor and the role the vendor is expected to perform, as well as the Offeror’s commitment to
performing the work as expeditiously as possible.
3. Title Page and Table of Contents
The Title Page must identify the following:
• The RFP, Solicitation Number: OMIG 24-23, Medicaid Casualty and Estate Recovery
Services;
• the Due Date, June 20, 2024, at 2:30 pm EST, for which the proposal is being submitted;
• the Offeror’s name; and
• the name, address, email address, and telephone number of the Offeror’s contact person(s).
The Table of Contents must identify each major section of the proposal and should follow this proposal
format.
38
4. Technical Proposal
• The Technical Proposal must contain the Offeror’s response to each of the required portions
of this RFP. An Offeror’s Checklist has been included as Attachment 1 and may be used to
ensure that all mandatory requirements are met.
• All aspects of the Technical Proposal must be sent as a separate document labeled “RFP#
OMIG 24-23 Technical Proposal.”
5. Financial Proposal
• All aspects of the Financial Proposal must be sent as a separate document labeled “RFP#
OMIG 24-23 Financial Proposal.” Complete the Cost Proposal Form and submit it only with
your Financial Proposal.
• Financial Statements must be included with the Financial Proposal and will be used to
determine the Offeror’s financial stability but will not be scored as part of the Financial
Proposal.
• Audited financial statements for the last three (3) years including income/operating
statements, balance sheets, statements of cash flow, and footnotes to financial statements.
• If audited statements are not available, please provide copies of the internally generated
financial statements used to prepare tax returns and / or management financial reports, for
the last three (3) years.
• Provide Dun and Bradstreet DUNS number and comprehensive reports for the last three (3)
years, if available.
• The Offeror must provide documentation attesting to any significant line(s) of credit that are
available to the Offeror. This documentation must include information identifying the source of
such lines and detailing the maximum credit amount(s) available to the Offeror, outstanding
balance(s), and current amount(s) available.
• The Offeror must provide the name and phone number of a contact at its primary bank for a
bank reference to be obtained as part of the financial stability evaluation.
All costs associated with the fulfillment of the requirements of the resultant contract must be
considered by the Offeror when developing its Financial Proposal. This may include improvements to
applications and processes developed exclusively for OMIG to meet those requirements more
appropriately. This is in reference only to those processes that are developed to fulfill the terms of the
RFP and any improvements that might be required to continue to fulfill the terms as the Contract Term
advances. Additional processes that would require separate compensation do not fall within the scope
of this RFP.
6. Statement of Competing Commitments
Each Offeror must provide a Statement of Competing Commitments; a list of any contractual
obligations it has entered which requires effort on its part during the period that the Offeror will be
working on the contract resulting from this RFP.
7. Comments and Limitations
Any exceptions, caveats, or additional information to the Offeror’s responses to specifications in this
RFP must be listed and cross-referenced to the response to which it applies and be clearly explained.
39
8. Proposal Information and Pricing
On the included Cost Proposal form, the Offeror must provide a contingency fee percentage of
Medicaid recoveries resulting from the Offeror’s recovery activities. The proposal price will be net,
excluding any pre- or post-collection interest, and will include all costs and expenses, incident to
completing the Offeror’s obligations under the Contract including, but not limited to, personnel costs,
fringe benefits, indirect costs (overhead, administrative, mark-up, etc.), travel and training. All
proposals must be submitted exclusive of Federal, State, and local taxes.
All employees of the Winning Offeror who are assigned to work on this project must, at the discretion
of OMIG, complete HIPAA and other mandatory training, made available by OMIG.
The Contractor will not bill OMIG for any hours that the employee devotes to said training.
B. PROPOSAL AMENDMENT / WITHDRAWAL
A proposal may be amended or withdrawn prior to the proposal due date and time. An Offeror who wishes
to amend or withdraw its proposal, must submit the amended proposal or proposal withdrawal in an
envelope which is clearly marked on the outside, “Amended proposal for RFP# OMIG 24-23,” or
“Proposal Withdrawal for RFP# OMIG 24-23,” as appropriate. Any such amendment or withdrawal
must be signed by a company representative who is duly authorized to amend or withdraw such proposal
on behalf of the Offeror (preferably the individual who signed the original proposal).
Amended proposals and proposal withdrawals may be sent via email, by regular mail, or via overnight
delivery, or delivered in person to the attention of Edwin Lake in the Bureau of Fiscal Management (BFM),
at the address indicated in the Designated Contact section of this RFP.
Amendments received after the proposal due date and time will be considered late and will be subject to
the conditions outlined in “Rejection of Proposals,” below. Proposal withdrawals received after the
proposal due date and time will be considered late and therefore invalid, null and void, and of no effect.
Unless properly withdrawn as specified herein, all proposals submitted in response to this RFP will remain
binding upon the Offerors for a period of one hundred twenty (120) days after the proposal due date.
C. PROPOSAL RESULTS
Copies of the proposal packages opened by the State may be requested after the final award and full
execution of the contract by writing to:
Records Access Officer
New York State Office of the Medicaid Inspector General
800 North Pearl Street
Albany, New York 12204
Or electronically by email address: [email protected].gov
D. REJECTION OF PROPOSALS
OMIG reserves the right to reject any or all proposals, in whole or in part, and to waive technicalities,
irregularities, and omissions if, in its sole judgment, such action will be in the best interest of the State. If
there are no satisfactory proposals, which fully comply with the proposal specifications, OMIG reserves
the right to consider late or non-conforming proposals. OMIG will only award a contract to a “responsible”
and “responsive” Offeror (as defined by State Finance Law Section 163(9)(f)), that OMIG determines to
be qualified to satisfy the terms and conditions of this solicitation. OMIG reserves the right and sole
discretion to qualify an Offeror as responsible and responsive. Neither OMIG nor the State of New York
will be liable for any costs incurred by the Offerors in preparation for, or prior to approval of, an executed
contract.
40
X. METHOD OF AWARD
A. PROPOSAL EVALUATION
As required by the New York State Finance Law, §163, award will be made based on “best value” (the
proposal which optimizes quality, cost, and efficiency) to a responsive and responsible Offeror, as
determined in the evaluation process. The contract will not be awarded based solely on lowest bid.
However, the Offeror with the lowest bid may be awarded the contract if it provides the best value, as
defined above.
B. PROPOSAL CLARIFICATION
OMIG reserves the right to require an Offeror to provide clarification and validation of its proposal through
any means OMIG deems necessary. Other than to provide such information as may be requested by
OMIG, no vendor will be allowed to alter its proposal or add new information after the final filing date and
time. Failure of an Offeror to cooperate with these efforts to clarify or validate proposal information may
result in the proposal being labeled as non-responsive and given no further consideration.
C. EVALUATION PROCESS OVERVIEW
1. Vendor Selection
This is a competitive procurement that will result in a contract to implement the RFP #OMIG 24-23
Casualty and Estate Project. At the sole discretion of the State, any and all proposals may be rejected.
2. Initial Compliance Evaluation
All responses to the RFP will be subject to an Initial Compliance Evaluation. In completing the Initial
Compliance Evaluation, OMIG has the right to request additional information. Proposals not in
compliance with the items below will be determined non–responsive; their proposal will have failed
the Initial Compliance Evaluation and will be removed from further evaluation.
The responses will be screened for the following items:
• Responsiveness to RFP – meets delivery due date, transmittal letter signed by an official,
format and content requirements, as specified herein;
• Inclusion and completion of all forms and proposal components in their entirety, required by
the RFP;
• The Technical Proposal includes all components, as itemized in the Proposal Submission
Guidelines section of this RFP;
• The Financial Proposal includes all components, as itemized in the Financial Proposal section
of this RFP; and
• The Contractor complies with all insurance requirements.
All responses that pass the Initial Compliance Evaluation will be submitted to both the Technical
Evaluation Committee and the Financial Evaluation Committee.
3. Evaluation Committees
The proposals will be evaluated by a Technical Evaluation Committee and a Financial Evaluation
Committee. Both committees will be comprised of State government staff that are experienced in the
Program area as well as contract management. Both Committees will independently recommend the
proposal that best meets the State’s requirements to the Selection Committee.
41
D. PROPOSAL REVIEW
The Technical Proposal is worth seventy-five percent (75%) of the Offeror’s final score. OMIG will
evaluate the capability of the Offeror to perform the required services at the time of the proposal, and the
Offeror’s experience in providing services of a similar or greater scope. References will be verified as
part of the Technical Evaluation. The qualifications, experience, and overall work narrative will be
evaluated. If a mandatory component is not met, the entire proposal will be deemed non-responsive, and
the review will end.
The following chart represents the maximum points available per section of the Technical Proposal:
Section
Points Available
Scope of Work
35
Case Management System
20
Office and Staffing Requirements
20
Total
75
All Desirable (D) items in the Technical Proposal are measurable and will be reviewed and scored by a
team of evaluators. All evaluators’ scores will be totaled together, per section. Once the section is
calculated, all sections will be added together to obtain the composite technical score for each Offeror.
The maximum points available for Technical Score are 75.
• The Offeror’s responses to the measurable portions of the Scope of Work section are worth
thirty-five (35) total points out of the seventy-five (75) available for technical score. The
responses will be scored on a scale of 0-5 (0 = Mandatory met but nothing more, 1 =
Unsatisfactory, 2 = Fair, 3 = Good, 4 = Excellent, and 5 = Superb). Decimals may be used
(e.g., 2.5) to reflect the rating more accurately, if necessary, with the maximum rating of 5.0.
• The Offeror’s responses to the measurable portions of the Case Management System section
are worth twenty (20) total points out of the seventy-five (75) available for technical score. The
responses will be scored on a scale of 0 - 5 (0 = Mandatory met but nothing more, 1 =
Unsatisfactory, 2 = Fair, 3 = Good, 4 = Excellent, and 5 = Superb). Decimals may be used
(e.g., 2.5) to reflect the rating more accurately, if necessary, with the maximum rating of 5.0.
• The Offeror’s responses to the measurable portions of the Office and Staffing Requirements
section are worth twenty (20) total points out of the seventy-five (75) available for technical
score. OMIG will review the Offeror’s Organizational Chart and consider the quantity and
quality of FTE positions in conjunction with the proposed processes.
The Financial Proposal is worth twenty-five percent (25%) of the Offeror’s final score.
The lowest total financial proposal will receive the full twenty-five (25) points allotted to the Final Financial
score.
The Financial proposals will be normalized as follows:
F = (A÷B) * 25 where:
F is the normalized score
A is Total Price of lowest Proposal
B is Total Price of Proposal being scored
42
OMIG, at its own discretion, may require the top Offeror(s) to give a Presentation/Interview or arrange for
a Site Visit to further document their ability to provide the required services. The Offeror will be notified
in writing of the date, time, and place of this event. The Offeror, as well as any Key Personnel, should be
present and participate in the Presentation/Interview/Site Visit.
OMIG will provide a list of subjects to be covered during the Presentation/Interview/Site Visit to ensure
that the Offeror is given the opportunity to address all subject areas of concern.
Sufficient time to present/visit should be reserved for a Site Visit. Questions may be asked by OMIG
representatives based on material covered in the Presentation/Interview/Site Visit and/or in the proposal.
The Presentation/Interview would take place at:
Office of the Medicaid Inspector General
800 North Pearl Street
Albany, New York 12204
The Offeror will be responsible for all costs associated with the Presentation/Interview/Site Visit.
OMIG would consider the Presentation/Interview/Site Visit as a non-graded addendum to the Technical
Evaluation and OMIG evaluators may use the information they gather during this process to revise their
evaluation scores, based on the merits and clarification provided during the Presentation/Interview/Site
Visit.
OMIG reserves the right to disqualify an Offeror if, in OMIG's sole opinion, the proposal does not pass
the evaluation for any or all the evaluation criteria.
E. NOTIFICATION OF AWARD
After evaluation and selection of the vendor, all Offerors will be notified in writing of the acceptance or
rejection of their proposals. The name of the successful Offeror may be disclosed. Press releases
pertaining to this project will not be made without prior written approval by the State and then only in
conjunction with the issuing office.
F. CONTRACT APPROVAL
The contract(s) between OMIG and the successful Offeror(s) will not be binding until approved by the
NYS Office of the State Comptroller, in accordance with the New York State contract approval process.
XI. ADMINISTRATIVE REQUIREMENTS
A. INQUIRIES
Any questions concerning this solicitation must be received by May 08, 2024, at 2:30 PM EST via email
at [email protected].gov or directed to:
New York State Office of the Medicaid Inspector General
Edwin Lake, Contract Management Specialist 2
Bureau of Fiscal Management
800 North Pearl Street, 2nd Floor
Albany, New York 12204
Questions and Answers, as well as any RFP updates and/or modifications, will be e-mailed to prospective
Offerors by May 29, 2024, (estimated).
43
B. OPTIONAL OFFEROR’S CONFERENCE
At OMIG’s discretion, an Offeror’s Conference may be held after questions are received by the Offerors
but prior to the proposal due date. If OMIG determines that an Offeror’s Conference is necessary to offer
clarification on a specific issue or issues, attendance at the Offeror’s Conference would be required by
anyone who intends to Offer a proposal. Each Offeror would be allowed to send no more than three (3)
representatives to the conference. Pre-Registration would be required (instructions would be sent upon
notice of said Offeror’s Conference) and a picture identification would be required for admittance to the
Offeror’s Conference.
The conference would be held at OMIG’s headquarters, located at 800 North Pearl Street, Albany, New
York 12204.
The intent of an Offeror’s Conference is to offer an interactive exchange of information, and appropriate
OMIG staff would attend to clarify RFP content. Offerors should clearly understand that the only official
answers or positions of OMIG are those stated in writing. Verbal responses provided during the Offeror’s
Conference (or at any other time) do not represent the official answer or position of OMIG and OMIG will
not be bound in any way by any such verbal answer(s).
C. ERRORS AND OMISSIONS
If an Offeror discovers any ambiguity, conflict, discrepancy, omission, or other error in this RFP,
immediately contact the person listed in Designated Contacts of such error and request the clarification
or modification thereof. Notice to OMIG of any problems described above must be made in writing and
received at OMIG on or before the date shown as the final filing date. Any modifications deemed
necessary by OMIG must be given by written notice to all parties who receive the RFP from OMIG.
If an Offeror fails prior to the final filing date for submission to notify OMIG of a known error or an error
that reasonably should have been known, the Offeror will assume the risk. If awarded the contract, the
Offeror will not be entitled to additional compensation or time by reason of the error or its late correction.
D. CONTRACT AWARD
OMIG will award one contract resulting from this RFP. The Offeror who has been found to be both
responsive and responsible and has offered the Proposal that is selected as the Best Value to the State,
will be selected as the winning Offeror. To be considered responsive, the Offeror must have submitted its
proposal on time and in accordance with the terms of this RFP. To be responsible, the Offeror will have
met all mandatory criteria listed within this RFP and will have successfully passed the vendor
responsibility review.
The contract will be awarded to the Offeror that provides the best value, has complied with all proposal
submission requirements, and is considered qualified by OMIG to perform its contractual obligations as
specified herein.
Contract award is subject to availability of funds. OMIG is not liable for any costs for work performed by
the Offeror in preparation of its proposal or for any travel and/or other expenses incurred in the
preparation and/or submission of its proposal or interviews. Further, OMIG is not liable for any costs
incurred by the successful Offeror for services performed or costs incurred until the contracting process
has been completed and all required approvals are obtained.
Upon full execution of the contract, such Offeror will thereafter be referred to as the “Contractor.” The
contract will be deemed to be fully executed and binding upon the State, upon execution by OSC. OMIG
will provide the Contractor with a copy of the fully executed contract upon execution by OSC.
OMIG will send written notice to all Offerors notifying them that a contract has been awarded. If an Offeror
has been deemed “non-responsive” and/or “not responsible” in the process of determining an award,
such Offeror will receive, as part of the written notice, the reason(s) why its proposal was so deemed.
44
E. PAYMENT
If awarded a contract, the Contractor must submit monthly invoices to:
New York State Office of the Medicaid Inspector General
c/o NYS OGS Business Services Center
P.O. Box 2117
Albany, New York 12220-0117
Simultaneously, please email a copy of the invoice to [email protected].gov to expedite the
process, and a copy of the invoice must also be sent to OMIG’s Casualty and Estate Contract Manager
at the following address:
OMIG will make periodic payments for services rendered, as follows: (1) payment must be made after
OMIG verifies that all work has been performed in satisfactory manner, (2) subject to receipt of an
appropriate invoice and all supporting documentation as requested by OMIG, and (3) subject to the
regular processing of such payments by the State, in accordance with the NYS Finance Law. Payment
of such invoices by the State (OMIG) must be made in accordance with Article XI-A of the NYS Finance
Law. Payment for invoices submitted by the Contractor must only be rendered electronically and such
electronic payments must be made in accordance with ordinary State procedures and practices. The
Contractor must comply with the State Comptroller’s procedures to authorize electronic payments.
Offerors should refer to the OSC website (http://www.osc.state.ny.us/epay/index.htm
) for information
related to the electronic payments policies and procedures. All payments are based upon contingency
fee in the Offeror’s Cost Proposal, incorporated into Appendix D of the resulting contract, subject to
satisfactory submission of specified deliverables and mandatory requirements as detailed within this RFP.
Where Contractor generally offers more advantageous special price promotions or special discount
pricing to other customers during the Contract term for a similar quantity, and the maximum price or
discount associated with such offer or promotion is better than the discount or net pricing otherwise
available under this Contract, such better price or discount must apply for similar quantity transactions
under this Contract for the life of such general offer or promotion.
If the Contractor offers an early payment discount, at any point in time, that is more advantageous to the
State than the terms that are contractually obligated, the Contractor will include the payment terms of the
discount on the applicable invoice(s).
• The Contractor will be paid monthly on a fixed contingency fee basis.
• The contingency fee is a percentage rate to be paid from monies recovered by OMIG as a
direct result of the Contractor’s Casualty and Estate recovery efforts.
• The proposed contingency percentage rate(s) for recoveries must represent the entire cost
for the full and successful completion of all deliverables. No separate travel expenses or any
other type of expenses will be paid for under the Contract, resulting from this RFP.
• The contingency fee calculation will be based on the amount of actual recoveries received by
OMIG for the previous calendar month multiplied by the agreed upon contingency fee rate,
less any applied fee adjustments.
*Consistent with New York State Finance Law §§ 109(1) and 179-e(5), vendors should only invoice an
agency once the goods, property, or services have been delivered or rendered.
F. INVOICING
The Offeror will adhere to the following process for invoicing of Fees. OMIG reserves the right to amend
the process, however the Offeror will be given (thirty) 30 days written notice of any changes.
45
In a format determined by OMIG, the Offeror will submit an Invoice/Voucher reflecting the Offeror’s fee
calculation, with all relevant back-up documents. This may include but is not limited to a check log or
listing of ACH payments for reconciliation purposes.
All invoices for services must be signed by the Contractor and submitted to the NYS OGS Business
Services Center (BSC) and OMIG Casualty and Estate Contract Management Team no later than end of
the month following the month in which service was provided. The invoice must be itemized by type of
recovery and total. As needed, but prior to submission of an invoice, the Contractor and OMIG’s Casualty
and Estate Contract Management Team will discuss monthly billing and adjustments. The Contractor
must not submit any invoices that do not reflect all adjustments, as instructed by OMIG. All invoices must
include the following information:
• Contractor name;
• Remittance address;
• Federal taxpayer identification number (or if sole proprietorship, the individual’s social security
number);
• New York State’s Statewide Financial System (SFS) Vendor Identification Number;
• Invoice period;
• Invoice date;
• Invoice number;
• State assigned Contract number;
• State assigned (Blanket) Purchase Order number(s);
• Amount due, including details of recoveries identified for the period and the applicable
contingency fee rate; and
• Supporting documentation
• Additional details relevant to recoveries received such as recoveries totaled by Medicaid
eligibility district, monies received in error that could not be attributed to a casualty or estate
recovery case, and any necessary refunds are required to be submitted in addition to the
invoice. They may be sent in a separate file and must contain the following details as
applicable, in a form and format to be determined by OMIG. OMIG may in its discretion require
additional information.
• Deposit amount
• Deposit date
• Check or ACH Transaction Date
• Check or ACH Transaction number
• Entity/individual that issued the check
• Any additional details that identify the purpose of the payment or the reason it wasn’t able to
be reconciled to a casualty or estate recovery case.
The Offeror must provide access and ability for OMIG, LDSS and other Medicaid eligibility district staff to
extract reporting within the case management system detailing recoveries received and reconciled to
recovery cases inclusive of case identification detail, payment detail, and payment vs lien or claim
amount. OMIG may in its discretion require additional information as determined to be necessary to
reconcile the recoveries reported in any given invoicing period.
46
The invoice should clearly outline the calculation performed to arrive at the invoiced amount due to the
Contractor.
Invoices submitted without the required information cannot be processed for payment and will be returned
to the Contractor.
*Consistent with New York State Finance Law §§ 109(1) and 179-e (5), vendors should only invoice an
agency once the goods, property, or services have been delivered or rendered.
G. CONTRACT TRANSITION
1. Contract Implementation & Transition Requirements
(This section may be waived if OMIG deems it to be unnecessary)
The tentative awardee will work cooperatively with OMIG and the outgoing vendor to ensure an
efficient and timely commencement of contract responsibilities.
Upon contract commencement, the new Contractor must submit to OMIG an Implementation Plan
and Schedule of Activities to facilitate the assumption of responsibilities, information, computer
databases, software and documentation, materials, etc.
The Transition Plan must include, at a minimum:
• The Contractor’s proposed approach to implementation
• The Contractor’s tasks, subtasks, and schedule for all implementation activities
• An updated organizational chart and list of the Contractor’s staff (titles, phone, fax, email)
responsible for transition activities.
OMIG must approve the Implementation Plan before it can be initiated.
OMIG and the new Contractor will work together to define the initial data file required to be transferred
during this transition period. OMIG will have the final authority for determining the information
transmitted.
The new Contractor must work closely and cooperatively with OMIG to acquire appropriate software,
hardware, records, equipment, and other materials that are necessary to fulfill the Offeror’s
obligations.
The new Contractor will not begin working on reviews/adits without prior OMIG approval and direction.
If OMIG determines the new Contractor is ready to commence work prior to the end of the transition
period, OMIG may give the new Contractor approval via a Notice-To-Proceed to begin performing the
duties and tasks outlined within this RFP.
2. Contract Conclusion & Transition Requirements
If a new Contractor is selected, the current Contractor must work cooperatively with OMIG and the
successor Contractor at the end of this contract to ensure an efficient and timely transition of contract
responsibilities with minimal disruption of services.
The Contractor must prepare and submit an Exit Transition Plan and Schedule of Activities to facilitate
the transfer of responsibilities, information, software and documentation, materials, etc., to a
successor Offeror and/or OMIG. The Exit Transition Plan must be submitted by the Contractor within
thirty (30) days of the date of notification of termination by OMIG. The Exit Transition Plan must
include, at a minimum:
47
• Proposed approach to transition operations to another vendor;
• Working with OMIG to determine the appropriate state-owned documents to be released;
• The current Contractor will provide to OMIG, all lead review files in their entirety and any other
state-owned data;
• The Contractor would need to send over one final data feed of lead reviews recovered;
• If requested by OMIG, electronic records or files to be turned over to another entity, in an
acceptable format to OMIG (the cost of converting to the appropriate format will be the
responsibility of the Offeror);
• Collaborate with OMIG to reconcile receipts and payments from the lockbox, or received by
the contractor through other OMIG-approved processes, to ensure OMIG is up to date in
transitioning repayments;
• Any additional payments received by the contractor past the transition period must still be sent
to the lockbox;
• Access to the lockbox;
• Any transactions fully received and processed by the State will be paid according with the
terms of the contract. Transactions received after this time may not be subject to payment;
• Maintenance and transition of telephone services, including current toll-free numbers;
• Designation of a knowledgeable person who will be available daily to assist OMIG during the
transition process and for one month following the transition date; and
• Proposed timeline for the transfer process.
OMIG must approve the Exit Transition Plan before it can be implemented.
OMIG and the successor Contractor will define all data files related to the contract for transfer during
this transition period and deadlines for submission. OMIG will have the final authority for determining
the information required.
The current Contractor must work closely and cooperatively with OMIG and the successor Contractor
to transfer appropriate non-proprietary software, records, and other items deemed necessary by
OMIG, and to ensure uninterrupted services during the transition period.
At its sole discretion, OMIG may elect to withhold payment until all elements of the Exit Transition
Plan are completed to OMIG’s satisfaction.
H. CONFIDENTIAL INFORMATION
OMIG Confidential Information includes but is not limited to: (i) the meaning ascribed to “Nonpublic
Personal Information” in Title V of the Gramm-Leach-Bliley Act of 1999 (“GLBA”) or any successor
Federal statute, and the rules and regulations thereunder, all as may be amended or supplemented from
time to time, as it relates to OMIG’s consumers; (ii) “Protected Health Information (PHI)” as such term is
defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), or any successor
Federal statute, and the rules and regulations thereunder, all as may be amended or supplemented from
time to time; and (iii) any personally identifiable or other information protected under any other applicable
State or Federal statute, rule or regulation. All material made available to the Contractor or its staff will
remain the property of OMIG. In addition, the Contractor, subcontractor, and staff must maintain the
confidentiality of all material, including the identity of any parties and content of any material to which
they are exposed or have access. All improvements to applications and processes developed at OMIG’s
expense and within the scope of the services provided to OMIG must be the sole and exclusive property
48
of OMIG. The Contractor will not divulge, disclose, or furnish to any other party the information or
processes utilized at OMIG, disclosed to the Contractor, or developed by the Contractor or another during
the project unless such information is in the public domain. Any request for information from third parties
must be reported to OMIG in writing within twenty-four (24) hours. News releases pertaining to this
Agreement will not be made without prior State approval and then only in conjunction with OMIG.
I. CONFIDENTIALITY CLAUSES
All proposals, documents and materials submitted with a proposal must become the property of OMIG.
OMIG will notify all Offerors that the contract has been awarded to the winning vendor. Prior to issuing
notification of contract award, OMIG will not disclose the content of any proposals, correspondence,
working papers, or any other medium submitted to OMIG in response to this solicitation (excepting the
dissemination of Offerors’ questions to all Offerors as described in this solicitation).
After OMIG issues notification of the contract award, all proposals, and contracts in OMIG’s possession
are considered agency records pursuant to the NYS Freedom of Information Law (FOIL) (see Public
Officers Law, Article 6).
Agency records are generally available to the public upon request; however, pursuant to Public Officers
Law Section 87(2)(d), OMIG may “…deny access to records or portions thereof that: are trade secrets or
are submitted to an agency by a commercial enterprise or derived from information obtained from a
commercial enterprise and which if disclosed would cause substantial injury to the competitive position
of the subject enterprise;”. For the Offeror to claim the exemption from disclosure provided by this
provision of law, the Offeror must mark as “CONFIDENTIAL” any proprietary information contained in
their proposal(s) that they wish to protect from further disclosure or dissemination.
BY THE ACT OF SUBMITTING A PROPOSAL IN RESPONSE TO THIS SOLICITATION, OFFERORS
ACKNOWLEDGE THAT (1) THE SUBMISSION OF THE OFFEROR’S PROPOSAL MUST BE THE
OFFEROR’S SOLE OPPORTUNITY TO CLAIM SUCH EXEMPTION FROM DISCLOSURE OR
DISSEMINATION OF INFORMATION CONTAINED IN ITS PROPOSAL, AND (2) FAILURE TO MARK
SUCH INFORMATION AS “CONFIDENTIAL” WILL CONSTITUTE A WAIVER OF CONFIDENTIALITY
AND WILL RELEASE OMIG AND THE STATE FROM ANY LIABILITY FOR DISCLOSURE OR
DISSEMINATION THEREOF.
OMIG is charged with making the final determination concerning any exemption from disclosure claimed
by the Offeror. Simply stating a claim for exemption from disclosure or dissemination must not be binding
upon OMIG or the State. In addition to so marking the information, the Offeror must provide OMIG with
a detailed written justification for classifying the information as “CONFIDENTIAL.” A conclusory
declaration that disclosure would be injurious will not suffice. Offerors must assert, in a written justification
for exemption, that disclosure of claimed proprietary information or any portion thereof would be injurious
and must provide sufficient detail to support their claim for exemption from disclosure or dissemination
under FOIL.
The parties acknowledge that OMIG may be required to release any such information if ordered by a
court of competent jurisdiction. In such event, the Offeror will be notified of the commencement of legal
action to compel disclosure, and the Offeror must either participate in the defense of such action or waive
its claim of confidentiality. Failure to participate in the defense of such action must be deemed a waiver
of any claim of confidentiality.
J. REQUEST FOR DEBRIEFING
Notice of contract award will be provided to all Offerors who submit a proposal in response to this
solicitation. Such notice will be provided to Offerors by email and by regular mail.
49
In accordance with State Finance Law Section 163(9)(c), OMIG will, upon request, provide a debriefing
to any Offeror that submitted a proposal in response to this solicitation and was not selected for an award
of contract.
Debriefings are not provided as a forum for unsuccessful Offerors to elicit evidence of wrongdoing by
OMIG. Debriefings are provided to assist the unsuccessful Offeror in becoming a more viable competitor
for the provision of goods and services to the State of New York. To fulfill that objective, the scope of
debriefings will be limited to the following:
• the strengths and weaknesses of the Offeror’s proposal; and
• Identification of any areas in the proposal which OMIG found to be deficient.
OMIG will not discuss information concerning competitors’ proposals. Such information may be obtained
by submitting a FOIL request.
If any entity provides an unsatisfactory reference for the Offeror, OMIG will disclose the nature of the
unsatisfactory reference but will not identify the entity.
Offerors must submit a written request for a debriefing to OMIG’s BFM within ten (10) days from notice
of contract award. The debriefing must be scheduled within thirty (30) business days of receipt of written
request by OMIG or as soon as practicable under the circumstances.
K. PROTEST OF CONTRACT AWARD
After OMIG has awarded the contract to a successful Offeror, an interested party, meaning a participant
in the procurement process, and those whose participation in the procurement process has been ended
by the actions of OMIG, may file an initial protest of contract award with the New York State Office of
State Comptroller (OSC) in conformance with OSC’s “Contract Award Protest Procedure for Contract
Awards Subject to The Comptroller’s Approval.” A copy of such procedure may be obtained directly from
OSC’s website at:
https://web.osc.state.ny.us/agencies/guide/MyWebHelp/Content/XI/17.htm
Such protest must be made in writing, within ten (10) days from notice of the contract award; and an initial
protest may be made where the facts that give rise to the protest are not known to, and could not have
been reasonably known to, an interested party.
If the interested party is not provided with notice of the contract award, the interested party may file a
protest with OSC at any time after the contract award and prior to OSC’s approval of the Contract.
The protest to the OSC Bureau of Contracts must contain specific factual and/or legal allegations setting
forth the basis upon which the protesting party challenges the contract award by OMIG. The protest must
be filed with OSC at the following address:
Bureau Director
Bureau of Contracts
New York State Office of the State Comptroller
110 State Street, 11th Floor
Albany, NY 12236
bidprotests@osc.state.ny.us
The protesting party must simultaneously deliver a copy of the protest to OMIG and the successful Offeror
if the protesting party does know the identity of the successful Offeror and must attach to its protest an
affirmation in writing as to such delivery. If the protesting party does not know the identity of the successful
Offeror, the protesting party must state so in its affirmation and the OSC Bureau of Contracts must provide
the successful Offeror with a copy of the protest. Any filing deadlines may be waived by the OSC Bureau
of Contracts in its sole discretion.
50
L. TERM OF CONTRACT
The contract resulting from this RFP will be effective April 7, 2025, or upon approval of OSC, whichever
is later, and will run for three (3) years with two optional 1-year renewals. The contract may be terminated
by OMIG in accordance with Appendix B, attached hereto, without incurring any liability for breach of
contract, or liability for payment of any charges beyond payment for conforming goods and/or services
accepted by OMIG up to and including the date of termination. Contractor must use due diligence and
must provide any outstanding deliverables up to the date in which such termination must be effective.
M. MINORITY AND WOMEN-OWNED BUSINESSES (MWBE) & EEO
1. General Provisions
OMIG is required to implement the provisions of New York State Executive Law Article 15-A and 5
NYCRR Parts 142-144 ("MWBE Regulations") for all State contracts as defined therein, with a value
(1) in excess of $25,000 for labor, services, equipment, materials, or any combination of the foregoing
or (2) in excess of $100,000 for real property renovations and construction.
The Contractor to the subject contract (the "Contractor" and the "Contract," respectively) agrees, in
addition to any other nondiscrimination provision of the Contract and at no additional cost to OMIG,
to fully comply and cooperate with OMIG in the implementation of New York State Executive Law
Article 15-A. These requirements include equal employment opportunities (EEO) for minority group
members and women and contracting opportunities for certified minority and women-owned business
enterprises (MWBEs). Contractor's demonstration of "good faith efforts" pursuant to 5 NYCRR
Part142.8 will be a part of these requirements. These provisions will be deemed supplementary to,
and not in lieu of, the nondiscrimination provisions required by New York State Executive Law Article
15 (the "Human Rights Law") or other applicable federal, state, or local laws.
Failure to comply with all the requirements herein may result in a finding of non- responsiveness, non-
responsibility and/or a breach of contract, leading to the withholding of funds or such other actions,
liquidated damages, or enforcement proceedings as allowed by the Contract.
OMIG values the MWBE program and although it has not identified a NYS MWBE vendor capable of
performing these services, MWBEs who believe they meet the eligibility requirements of a particular
RFP are encouraged to submit a proposal as a prime or reach out to existing primes to offer their
services as a subcontractor.
2. Contract Goals
Per DMWBD direction, based upon the highly specialized nature of the work required, as well as the
size and the general lack of interest/expertise available via the Directory for NYS Certified MWBE
vendors available to provide these services, it was determined that a 0% goal is appropriate for
Minority and Women-Owned Business Enterprises (MWBE) participation, 0% for Minority-Owned
Business Enterprises (MBE) participation and 0% for Women-Owned Business Enterprises (WBE)
participation.
3. Equal Employment Opportunity (EEO)
By submission of a proposal in response to this solicitation, the Offeror agrees with all the terms and
conditions of Appendix A including Clause 12 – Equal Employment Opportunities for Minorities and
Women. The Contractor is required to ensure that the provisions of Appendix A, Clause 12 are
included in every subcontract, where applicable, in such a manner that the requirements of these
provisions will be binding upon each subcontractor as to work in connection with the State contract.
51
The following forms are required to ensure Offeror’s compliance with the Equal Employment
Opportunity requirements:
• Staffing Plan (Form EEO 100
)
To ensure compliance with the foregoing section, the Offeror will submit a staffing plan to
document the composition of the proposed workforce to be utilized in the performance of this
Contract broken down by the specified categories listed, including ethnic background, gender,
and Federal occupational categories. Offerors will complete the Staffing Plan form and submit
it as part of their proposal or within a reasonable time thereafter, but no later than the time of
award of the Contract.
A Contractor’s failure to submit the Staffing Plan prior to the time required will result in the
rejection of the proposal.
• Workforce Employment Utilization/Compliance Report (Form EEO 101
)
Once a contract has been awarded, the Contractor is responsible for updating OMIG on any
changes to the Staffing Plan submitted.
This information is to be submitted on a quarterly
basis during the life of the Contract to report the actual workforce utilized in the performance
of the Contract broken down by the specified categories listed, including ethnic background,
gender, and Federal occupational categories. The Workforce Employment
Utilization/Compliance Report (Utilization/Compliance Report) must be submitted to report
this information. Separate forms are to be complete for the Contractor and any subcontractor
performing work on this Contract.
The Utilization/Compliance Report is to be completed for the quarters ending on March 31
st
,
June 30
th
, September 30
th
, and December 31
st
and submitted to OMIG’s BFM within fifteen
(15) calendar days of the end of each quarter. If there are no changes to the workforce utilized
on the Contract during the reporting period, the Contractor can submit a copy of the previously
submitted report with the date and reporting period updated, indicating no change.
N. CONTRACTOR’S FORFEIT OF RIGHTS
If the contract is terminated for breach, the Contractor forfeits the right to collect all contingency fees for
claims that remain unrecovered.
O. INSURANCE REQUIREMENTS
Prior to the commencement of the contract, the Offeror must file with OMIG certificates of Insurance, as
evidence of compliance with all requirements contained in the contract. Such certificates must be of a
form and substance acceptable to OMIG.
Acceptance and/or approval of the Certificates by OMIG do not and must not be construed as relief of
the Offeror’s obligations, responsibilities, or liabilities under the contract.
All required insurances must be:
• Obtained at the sole cost and expense of the Offeror;
• Maintained with an insurance carrier licensed to do business in the State of New York;
Payment of all deductibles and self-insured retentions subject to the policies must be
approved by OMIG and are the sole responsibility of the Offeror;
• Insured with a carrier that is rated at least and “A” Class VII in the most recently published
Best Insurance Report; and
• Must include OMIG as additional insured.
52
The Offeror must cause all insurance to be in full force and effect as of the commencement date of this
contract and to remain in full force and effect throughout the term of this contract and as further required
by this contract.
The Offeror must provide:
1. Commercial General Liability Insurance:
• Must have a limit of not less than $5,000,000 for each occurrence;
• Must be written on the ISO Occurrence form CG 00 01, or a substitute form providing
equivalent coverage;
• If such insurance contains an aggregate limit, it must apply separately per assignment per
investigator (project) basis; and
• Coverage for the use of reasonable force to protect persons and property must be included.
2. Employee dishonesty coverage:
• Must have a coverage limit of not less than $1,000,000;
• Must include money, securities, or property other than money and securities, including
property in your care, custody, or control;
• Must include all employees including contract and temporary, whether identified or not, acting
alone or in collusion with others; and
• A joint loss payable endorsement must be attached naming OMIG as loss payee due to any
loss arising out of this contract.
3. Commercial Business Automobile Liability Insurance:
• Must have coverage limit not less than $1,000,000 per accident; and
• Must cover liability arising out of any automobile including owned, leased, hired and non-
owned automobiles.
4. Errors and Omissions Liability Insurance:
• Must have a limit of not less than $5,000,000 per loss;
• Must apply to professional errors, acts, or omissions arising out of the scope of services
covered by this contract;
• if the coverage is written on a claims-made policy, any applicable retroactive date precedes
the effective date of this contract; and
• Continuous coverage will be maintained or an extended discovery period exercised, for a
period of not less than two years from the time work under this contract is completed.
The Offeror must require that any subcontractors that are hired to provide service(s) for this contract must
carry insurance with the same limits and provisions provided. This additional insurance requirement does
not replace or apply those required for Workers Compensation or Disability Benefits Coverage.
5. Workers’ Compensation coverage,
for which one of the following is incorporated into this contract as Appendix E-1:
53
• CE-200, Affidavit For New York Entities and Any Out-of-State Entities with No Employees, that
NYS Workers’ Compensation and/or Disability Benefits Insurance Coverage is NOT Required;
OR
• C-105.2 – Certificate of Workers’ Compensation Insurance. PLEASE NOTE: The State
Insurance Fund provides its own version of this form, the U-26.3; OR
• SI-12 – Certificate of Workers’ Compensation Self-Insurance, OR GSI-105.2 – Certificate of
Participation in Workers’ Compensation Group Self-Insurance.
6. Disability Benefits coverage,
for which one of the following is incorporated into this contract as Appendix E-2:
• CE-200, Affidavit for New York Entities and Any Out-Of-State Entities with No Employees, that
NYS Workers’ Compensation and/or Disability Benefits Insurance Coverage is NOT Required;
OR
• DB-120.1 – Certificate of Disability Benefits Insurance; OR
• DB-155 – Certificate of Disability Benefits Self-Insurance.
P. VENDOR RESPONSIBILITY
NYS Finance Law Article XI requires that contracts be awarded to responsible Offerors. Agencies must
conduct an affirmative review of the responsibility of any Offeror to whom they propose to make a contract
award and determine that such Offeror is responsible. Offerors are invited to file the required Vendor
Responsibility Questionnaire online, via the NYS VendRep System. Offerors may elect to submit with
their proposal a completed, written questionnaire, in lieu of using this electronic format.
To enroll in and use the NYS VendRep System, Offerors should refer to the VendRep System Instructions
available at www.osc.state.ny.us/vendrep
. For assistance using the VendRep System, Offerors may
Offerors electing to file a hard-copy questionnaire can obtain the questionnaire form at the VendRep
website, or they may contact OMIG or OSC to obtain a copy. Offerors must also complete and submit the
Vendor Responsibility Attestation.
OMIG reserves the right to verify all information provided by the Offeror to whom an award of contract is
made. OMIG reserves the right to disqualify an Offeror as “not responsible,” if the Offeror has intentionally
provided false or incomplete information or has intentionally failed to disclose pertinent information. OMIG
reserves the right to make continuing responsibility determinations at any time during the term of the
contract.
The Offeror must always during the contract term remain responsible. The Offeror agrees, if requested
by the Medicaid Inspector General (MIG) or his or her designee, to present evidence of its continuing
legal authority to do business in NYS, integrity, experience, ability, prior performance, and organizational
and financial capacity.
Suspension of Work (for Non-Responsibility): The Medicaid Inspector General (MIG) or his or her
designee, in his or her sole discretion, reserves the right to suspend any or all activities under this
contract, at any time, when he or she discovers information that calls into question the responsibility of
the Offeror. In the event of such suspension, the Offeror will be given written notice outlining the
particulars of such suspension. Upon issuance of such notice, the Offeror must comply with the terms of
the suspension order. Contract activity may resume at such time as the MIG or his or her designee issues
a written notice authorizing the resumption of performance under the contract.
Termination (for Non-Responsibility): Upon written notice to the Offeror, and a reasonable opportunity
to be heard with appropriate OMIG officials or staff, the contract may be terminated by the MIG or his or
54
her designee at the Offeror’s expense where the Offeror is determined by the MIG or his or her designee
to be non-responsible. In such event, the MIG or his or her designee may complete the contractual
requirements in any manner he or she may deem advisable and pursue available legal or equitable
remedies for breach.
Q. PIGGYBACKING
STF Section 163(10)(e) (https://ogs.ny.gov/procurement/piggybacking-using-other-existing-contracts-0)
allows the Commissioner of the NYS Office of General Services to consent to the use of this contract by
other NYS Agencies, and other authorized purchasers, subject to conditions and the Offeror’s consent.
R. PROPOSAL OWNERSHIP
All proposals and accompanying documentation become the property of the State of New York and will
not be returned. OMIG reserves the right to use any portions of the Offeror’s proposal not specifically
noted as proprietary. This includes, but is not limited to, the right to royalty-free, non-exclusive, and
irrevocable license to reproduce, publish or otherwise use, and authorize others to do so. This includes
all products and documentation.
S. LEGAL ENTITLEMENT TO WORK
Employers are required by Federal law to verify that all employees are legally entitled to work in the
United States. Accordingly, OMIG reserves the right to request legally mandated employer-held
documentation attesting to the same for each consultant assigned work under any project awarded
because of this solicitation. In accordance with such laws, OMIG does not discriminate against individuals
based on national origin or citizenship.
T. NOTICES
All notices permitted or required hereunder must be in writing and must be transmitted either: certified or
registered United State mail, return receipt requested; personal delivery; expedited delivery services; or
by email. Such notices must be addressed to the Designated Contacts listed or to such different
addresses as the parties may from time-to-time designate.
Any such notice must be deemed to have been given either at the time of personal delivery or, in the
case of expedited delivery service or certified or registered United States mail, as of the date of first
attempted delivery at the address and in the manner provided herein.
OMIG and Contractor (the parties) may, from time to time, specify any new or different address in the
United States as their address for purpose of receiving notice under this Agreement by giving fifteen (15)
days written notice to the other party sent in accordance herewith. The parties agree to mutually
designate individuals as their respective representatives for the purposes of receiving notices under this
Agreement. Additional individuals may be designated in writing by the parties for purposes of
implementation and administration/billing, resolving issues and problems and/or for dispute resolution.
U. SUBCONTRACTING
If the Offeror is proposing the use of any subcontractors to provide any of the services required by this
RFP, each subcontractor must be identified and the proposed services must be outlined in its proposal.
All subcontractors are subject to OMIG’s prior approval.
Include the following information about each proposed subcontractor:
• Legal Name, Address, Federal Employer Identification Number (FEIN);
• Contact Person Name, Title, Telephone Number, Fax Number, Email Address;
• Services to be provided;
55
• Subcontract Agreement Term;
• A sample subcontract must be included in an appropriately tabbed “Appendices” section of
the proposal; and
• A Letter of Intent, a written statement expressing the intention of the undersigned to enter into
a formal agreement, especially a business arrangement or transaction, from each
subcontractor indicating intent to perform the services to be provided throughout the entire
contract period.
All subcontracts must contain provisions specifying:
• That the work performed by the subcontractor must be in accordance with the terms of this
AGREEMENT, and
• That the subcontractor specifically agrees to be bound by the confidentiality provisions set
forth in the AGREEMENT between the STATE and the CONTRACTOR.
V. OMIG’S RIGHTS RESERVED
OMIG may:
• Withdraw the solicitation at any time, at the agency’s sole discretion.
• Choose to make no award.
• Make an award under the solicitation in whole or in part.
• Disqualify any Offeror whose conduct and/or proposal fails to conform to the requirements of
the solicitation.
• Seek clarifications and revisions of proposals.
• Award to several Offerors.
• Waive any requirements that are not material.
• Eliminate any mandatory, non-material specification that cannot be complied with by all the
prospective Offerors.
• Accept and consider for contract award bids with non-material bid deviations or non-material
bid defects such as errors, technicalities, irregularities, or omissions.
• Require clarification at any time during the procurement process and/or require correction of
arithmetic or other apparent errors for the purpose of assuring a full and complete
understanding of an Offeror’s proposal and/or to determine an Offeror’s compliance with the
requirements of the solicitation.
• Change any scheduled dates.
• At any time prior to contract award, amend and modify specifications to correct errors or
oversights, or to supply additional information, as it becomes available. Prospective Offerors
will be notified of all amendments and modifications to the solicitation.
• At any time prior to contract award, direct Offerors to submit proposal modifications
addressing subsequent solicitation amendments.
• Adopt as OMIG property all information obtained through the submitted proposal, site visits,
management interviews and the State’s investigation of a Offeror’s qualifications, experience,
ability or financial standing, and any material or information submitted by the Offeror in
response to the agency’s request for clarifying information in the course of evaluation and/or
selection under the solicitation.
56
• Utilize any and all ideas submitted in the proposals received.
• Find Offeror in breach if Offeror no longer meets requirements set forth in this solicitation,
including, but not limited to, staffing requirements.
• Negotiate with Offerors, within the scope of solicitation requirements, to serve the best
interests of OMIG.
• In the event of unsuccessful negotiations with the selected Offeror, conduct contract
negotiations with and/or award the contract to the next responsive and responsible Offeror.
• Require the Offeror to demonstrate, to the satisfaction of OMIG, any feature(s) presented as
a part of its proposal.
• Evaluate, accept, and/or reject any and all proposals received in response to the solicitation.
• In the event compliant proposals are not received, OMIG reserves the right to consider late or
non-conforming proposals offered.
• In any case where a question of non-performance of a contract arises, payment may be
withheld, in whole or in part, at the discretion of OMIG. Should the amount withheld be finally
paid, a cash discount originally offered may be taken by OMIG as if no delay in payment had
occurred.
• If OMIG must terminate the contract for non-performance or if the Offeror is unable to maintain
the support required, OMIG reserves the right, with the approval of the OSC, to award a
contract to the next highest Offeror of the original proposal submission within the first twelve
(12) months of the award.
• Submission of an invoice and payment, or electronic transmission, thereof by OMIG will not
preclude OMIG from reimbursement or demanding a price adjustment in any case where the
service delivered is found to deviate from the terms and conditions of the proposal and award
documents. Any delivery made which does not meet such terms and conditions may be
rejected or accepted on an adjusted price basis as may be determined by OMIG.
W. OFFEROR CERTIFICATION REQUIREMENTS
Any Offeror submitting a proposal in response to this RFP must certify in writing acceptance of the
following contract conditions that relate to consideration of the proposal:
• OMIG reserves the sole right of judgment and acceptance of an Offeror’s written proposal
and/or interview.
• The Offeror’s proposal must remain in effect for 120 days from the proposal due date.
However, a non-successful Offeror may withdraw its proposal upon notice any time after the
selection of the successful Offeror, upon written notice to OMIG. Offerors whose proposals
have been rejected by OMIG must be notified of such rejection.
• The Offeror certifies that, if selected, all services described within this RFP can and will be
provided.
• The Offeror warrants that, if selected, it will not delegate or subcontract its responsibilities
under the contract without prior written approval from OMIG.
• Written subcontracting agreements must be submitted for review and approval by OMIG
before any subcontracting arrangement may take place.
• The Offeror warrants that all information provided in connection with this proposal is true and
accurate.
57
• The Offeror agrees not to make any claims for or have any right to damages because of any
misinterpretation or misunderstanding of the specifications or because of any lack of
information.
• NYS law requires that a proposal must not be considered for award if the price in the proposal
was not arrived at independently without collusion, consultation, communication, or
agreement as to any matter relating to such prices with any other Offeror or with any
competitor.
• The successful Offeror agrees that no NYS or local sales tax, transportation tax or Federal
Excise tax will be charged on any part of this project, since OMIG is an agency of the State of
New York and tax exempt by statute.
• The successful Offeror will save and hold harmless OMIG and its personnel from all claims,
suits, litigation and legal liability from any acts or omissions committed by the Offeror during
the contract term. OMIG reserves the right to retain counsel of OMIG’s choice, at the expense
of the Offeror, to advise and represent OMIG in connection with any such suits or actions
including, without limitation, the initiation or defense of any litigation or other legal action.
X. INFORMATION SECURITY BREACH AND NOTIFICATION ACT
Section 208 of the State Technology Law (STT) and Section 899-aa of the General Business Law (GBS)
require that businesses conducting business in New York must disclose any breaches of computerized
data which include private information by notifying the offices of the New York Attorney General; the NYS
Division of State Police; and the Department of State's Division of Consumer Protection.
Note: State entities subject to Section 208 of the State Technology Law that experience breaches of
computerized data which include private information must file notices with the New York Attorney General;
Department of State's Division of Consumer Protection; and the Office of Information Technology
Services' Enterprise Information Security Office (EISO). Information relative to the law and the notification
process is available at: https://its.ny.gov/breach-notification
.
Y. INDEMNIFICATION
The Contractor must fully indemnify, defend and hold harmless OMIG, and the employees, agents and
officers of OMIG, from and against any and all losses, costs, liabilities, damages or deficiencies, including
interest, penalties, and reasonable attorney’s fees, in connection with any action, suit, proceeding or
other claim of any nature whatsoever, to the extent that such losses, costs, liabilities, damages or
deficiencies arise out of, are based upon, or result from a material breach of any of the express terms of
an Agreement, as a result of this solicitation, by the Contractor, or which are based upon or result from
acts or omissions constituting bad faith, willful misfeasance, negligence or reckless disregard of duties in
connection with the performance by the Contractor or any or its agents, officers, directors or employees
of any of the Contractor’s duties, responsibilities or obligations under an Agreement as a result of this
solicitation. The indemnification contained in this section is in addition to and not in lieu of any other rights
or remedies which OMIG or the employees, agents, or officers of OMIG may have against the Contractor
and must not be construed to limit in any way the duties and obligations of the Contractor contained in
an Agreement resulting from this solicitation. Nothing contained herein must inure to the benefit of any
insurer or other third party.
XII. STANDARD CONTRACT REQUIREMENTS
A. APPENDICES (AVAILABLE ELECTRONICALLY)
The following will be incorporated as appendices into any contract resulting from this RFP. This RFP will,
itself, be referenced as an appendix of the contract. All Offerors are required to agree with the terms
58
and/or complete the forms, as required, of the following appendices and attachments (All forms may be
accessed on OMIG website) at:
(https://omig.ny.gov/forms-and-appendices
) or by clicking the links within the following descriptions:
1. APPENDIX A - Standard Clauses for New York State Contracts
Appendix A includes several Federal and NYS laws, rules, and regulations which impact State
procurements. This document is always the controlling document.
2. APPENDIX B – General Specifications
These are specific terms and conditions applicable to procurements entered in to by OMIG.
3. APPENDIX C – Request for Proposals
This solicitation document, including all addendums or questions and answers issued by OMIG.
4. APPENDIX D – Proposal
The Offeror’s proposal (if selected for award), including any required forms.
5. APPENDIX E – Contractual Insurances
This appendix contains documentation that the Contractor complies with all the insurance
requirements of the Contract. In addition to the required insurances listed in the “Insurance
Requirements” section of this RFP, the Contractor must supply a copy of Worker’s Compensation and
Disability Benefits certificates prior to contract approval. The following are the only forms considered
acceptable proof of coverage:
• Workers’ Compensation, for which one of the following is incorporated into this Contract as
Appendix E-1:
- CE-200, Affidavit For New York Entities and Any Out-of-State Entities with No
Employees, that NYS Workers’ Compensation and/or Disability Benefits Insurance
Coverage is NOT Required; OR
- C-105.
2 – Certificate of Workers’ Compensation Insurance. PLEASE NOTE: The State
Insurance Fund provides its own version of this form, the U-26.3; OR
- SI-12
– Certificate of Workers’ Compensation Self-Insurance, OR GSI-105.2 –
Certificate of Participation in Workers’ Compensation Group Self-Insurance.
• Dis
ability Benefits coverage, for which one of the following is incorporated into this contract
as Appendix E-2:
- CE-200
, Affidavit for New York Entities and Any Out-Of-State Entities with No
Employees, that NYS Workers’ Compensation and/or Disability Benefits Insurance
Coverage is NOT Required; OR
- DB-120.
1 – Certificate of Disability Benefits Insurance; OR
- DB-155 – Certificate of Disability Benefits Self-Insurance.
6. APPENDIX F - Procurement Lobbying Legislation
Chapter 1 of the Laws of 2005, as amended by Chapter 596 of the Laws of 2005 (collectively referred
to as the “Lobbying Law”), makes major changes to the Legislative Law and State Finance Law (STF)
relative to lobbying on government procurements. More specifically, the Lobbying Law creates two
59
new sections in the STF: Section 139-j addresses the restrictions on “contacts” during the
procurement process; and Section 139-k addresses the disclosure of contacts and the responsibility
of Offerors during the procurement process. The Lobbying Law applies to all procurements initiated
on or after January 1, 2006, and with an annual expenditure greater than $15,000 for a commodity,
service, technology, public work, or construction; purchase, sale, or lease of real property; or revenue
contract. In conformity with the Lobbying Law – during the procurement’s restricted period [the period
of time commencing with the earliest written notice, advertisement, or solicitation of an Invitation for
Bid (IFB), Request for Proposal (RFP), or any other method for soliciting responses from Offerors
intending to result in a procurement contract by OMIG]; and ending with the final contract award and
approval by OMIG and OSC (if required) – the only OMIG employee(s) that the Offeror may contact
is/are OMIG’s designated contact person(s) for that procurement. In this regard, “contact” means any
oral, written, or electronic communication under circumstances where a reasonable person would
infer that the communication was intended to influence the procurement. An Offeror must not, under
any circumstances, attempt to influence an OMIG procurement in a way that violates or attempts to
violate: Public Officers Law Section 73(5), relating to gifts intended to influence; or Public Officers
Law Section 74, relating to the code of ethics for employees of State agencies.
New York STF Section 139-k(4) obligates OMIG to make a written record of any contacts made during
a procurement’s restricted period, and the written record(s) of contact become part of the applicable
procurement record. OMIG employees who are designated as contacts must advise Offerors or those
designated, employed, or retained by the Offeror, of OMIG’s intent to record the contact. Information
that will be recorded includes the person’s name, address, telephone number, place of principle
employment, and occupation; a summary of the form and topic of each communication will be
included. Designated contacts will also inquire and record whether the person or organization that
made the contact was the Offeror or was retained, employed, or designated on behalf of the Offeror
to appear before or contact OMIG. It should be noted, however, that communications received from
members of the State Legislature, or their staff, when acting in their official capacity, are not
considered to be a contact, and must not be recorded. A separate form must be completed for each
permissible and impermissible contact received, including each of multiple contacts by a single
person or Offeror.
A Bidder or Offeror that submits a bid, proposal, or other response to an OMIG RFP, IFB, or other
solicitation method must: (a) affirm that it understands and agrees to comply with these guidelines
regarding permissible contacts during a procurement and the prohibition of inappropriate lobbying
influence; (b) certify that all information provided to OMIG with respect to the STF Section139-k is
complete, true, and accurate; and (c) disclose whether any governmental entity has, within the prior
four years, found the Bidder/Offeror non-responsible due to a violation of the STF Section 139-j, or
the intentional provision of false or incomplete information. To satisfy the requirement regarding
Bidder/Offeror’s disclosure, the governmental entity must specifically request information regarding
prior findings of non-responsibility for violations of STF Sections 139-j or 139-k. A general request for
prior findings of non-responsibility is not sufficient. Further, all OMIG procurement contracts will
contain a provision authorizing OMIG to terminate the contract in the event such certification is found
to be intentionally false or incomplete. General contract termination provisions, such as the authority
to terminate for convenience, will not satisfy this requirement. The contract provision must specifically
authorize termination if the certification is subsequently found to be intentionally false or intentionally
incomplete.
The completion of OMIG “Procurement Lobbying Act – Offeror Affirmation and Certification Form”
provides the Offeror’s affirmation of understanding and agreement to comply with OMIG’s guidelines
on permissible contacts during a procurement, and the prohibition of inappropriate lobbying influence;
certification that all information provided is complete, true, and accurate; disclosure of prior non-
responsibility determinations; and acknowledgement of the understanding of the contract termination
60
provision subsequent to OMIG’s finding that the information provided was intentionally false or
intentionally incomplete.
7. APPENDIX G – Affidavit of Non-Collusion
In accordance with Section 139-d of the State Finance Law, if this contract is awarded based upon
the submission of bids, the Bidder/Offeror affirms, under penalty of perjury, that its bid was arrived at
independently and without collusion aimed at restricting competition. The Bidder/Offeror further
affirms that, at the time the Bidder/Offeror submitted its bid, an authorized and responsible person
executed and delivered to the State a non-collusive bidding certification on the Bidder’s/Offeror's
behalf.
8. APPENDIX H - Health Insurance Portability and Accountability Act (HIPAA)
This agreement contains information about the Federal Health Insurance Portability and
Accountability Act of 1996 (HIPAA). DOH has summarized the criteria for compliance as a Business
Associate, and OMIG attaches Appendix H – “Federal Health Insurance Portability and Accountability
Act (HIPAA) Business Associate Agreement Governing Privacy and Security” to each applicable
procurement. Offerors should understand the criteria for remaining in compliance with HIPAA
regulations and should read and retain a copy for their files.
9. APPENDIX I - Confidentiality Agreement
Each Offeror must certify that, if awarded the contract, its employees and/or subcontractors are
restricted from divulging any knowledge or information, data, documents, and/or other matter of a
confidential nature obtained during their assignment. This agreement applies to any form of
disclosure: Verbal, Electronic or Paper.
10. APPENDIX J - Certification of Compliance with State Finance Law § 139-k(5)
Section 5-a of the Tax Law, as amended effective April 26, 2006, requires certain Contractors awarded
certain State contracts valued at more than $100,000 to certify to the Department of Taxation and
Finance (Tax)that they, and to the best of their knowledge, their affiliates and subcontractors, are
registered to collect NYS and local sales and compensating use taxes, if they made sales delivered
by any means to locations within NYS of tangible personal property or taxable services having a
cumulative value in excess of $300,000 during the immediately preceding four consecutive sales tax
quarters. The Contractor must also certify to the procuring agency, under penalty of perjury, in writing
(via ST-220-CA) that the requisite certification (ST-220-TD) has been made to Tax, or that the
certification is not required to be filed, and that the certification is correct and complete. Where the
Contractor is obligated to make certification to the procuring agency, in accordance with the Tax Law
Section 5-a, procuring agencies must include a copy of ST-220-CA in all contract packages submitted
to OSC for approval. The certification to the procuring agency must be included in the procurement
record. Tax Law Section 5-a applies to all contracts exceeding $100,000 for the purchase by a
covered agency of commodities or services, awarded pursuant to Article XI of the State Finance Law.
The Law does not apply to grants, intergovernmental agreements, or purchases of commodities or
services from a preferred source.
Information on Tax Law Section 5-a is available at:
http://www.tax.ny.gov/pdf/publications/sales/pub223.pdf
.
Fill-in versions of the required contract forms are available online from the NYS Department of Tax
and Finance (Tax) website:
• Contractor Certification (ST-220-TD)
61
http://www.tax.ny.gov/pdf/current_forms/st/st220td_fill_in.pdf
• Contractor Certification to Covered Agency (ST-220-CA)
http://www.tax.ny.gov/pdf/current_forms/st/st220ca_fill_in.pdf
11. APPENDIX K - Affidavit of Sexual Harassment Prevention Certification
State Finance Law Section 139-l requires Bidders/Offerors on state procurements to certify that they
have a written policy addressing sexual harassment prevention in the workplace and provide annual
sexual harassment training (that meets the Department of Labor’s model policy and training
standards) to all its employees.
Proposals that do not contain the certification will not be considered for award; provided however,
that if the Bidder/Offeror cannot make the certification, the Bidder/Offeror may provide a signed
statement with its proposal detailing the reasons why the certification cannot be made.
12. APPENDIX L – Information Security & Privacy Provisions
This appendix encompasses a suite of clauses that pertain to OMIG’s boilerplate Information Security
and Privacy Provisions.
13. APPENDIX X – Modification Agreement Form
This appendix is to accompany any modifications to the above referenced appendices. This includes
modification to change the term or consideration on an existing period or for renewal periods.
B. ATTACHMENTS
1. Attachment 1 - Offeror’s Checklist
A summary of all mandatory and desirable components that must be submitted with the proposal.
2. Attachment 2 – References Form
3. Attachment 3 - Subcontractor Forms; if applicable
4. Attachment 4 - Conflict of Interest
Each Offeror must include a statement in its proposal describing all actual or potential relationships
which may be considered a "conflict of interest." The "conflict of interest" will be taken under
consideration by OMIG Proposal Evaluation Committee. The Committee's determination of a
disqualifying "conflict of interest" is final. The statement will be included in the contract as Attachment
4 to the RFP.
5. Attachment 5 – Statement of Competing Commitments
Each Offeror must provide a Statement of Competing Commitments, a list of any contractual
obligations it has entered which requires effort on its part during the period that the Offeror will be
working on the contract resulting from this RFP. The statement will be included in the contract as
Attachment 5 to the RFP.
62
COST PROPOSAL FORM
New York State Office of the Medicaid Inspector General Cost Proposal Form
For New York State’s Medicaid Casualty and Estate Recovery Services
To Whom It May Concern:
The Offeror indicated below agrees to perform all New York State’s Medicaid Casualty and Estate
Recovery Services, as specified herein, for the following bid price:
____________%
Contingency Fee Percentage
__________________________________________________________________
Name and title of person authorized to submit Cost Proposal
_________________________________________
Signature Date
FEDERAL ID NUMBER COMPANY/OFFEROR
*NOTE* This Cost Proposal Form must be submitted as a separate electronic attachment, and
included as part of the financial proposal, marked as “RFP# OMIG 24-23 Financial Proposal”.
The bid price is inclusive of all processes and requirements outlined within the scope of work
as further defined by OMIG based on needs as they emerge.
( )
/ /
63
ATTACHMENT 1 - OFFEROR’S CHECKLIST
(To be completed and included with Proposal)
M = Mandatory (pass/fail), D = Desirable (gradable)
1.
Scope of Work
M, D
Response on
Proposal Page(s) #
1a.
Customer Service Measures: Provide a thorough description of the
proposed customer service, education, and outreach plans. This
should include the use of a public facing website and/or portal.
M
1b.
The following is a listing of some of the criteria that will be
considered by OMIG’s expert reviewers during their review of
responses to this component:
The number and quality of customer service staff dedicated to the
public and LDSS/other Medicaid eligibility districts;
The level of training staff will receive, and appropriate oversight
for escalations;
The scope, and quality, and examples of the innovative approach
outlined for outreach and education efforts including an
understanding of the potentially impacted stakeholders;
The Offeror’s understanding of laws, regulations, and published
policies in place for Casualty and Estate recovery
Any applicable, creative, viable, innovative, or constructive
solutions that the Offeror proposes to meet or exceed the
mandatory requirements of this section.
D
1c.
Casework: The Offeror must illustrate the ability to establish
processes for rigorous and innovative case identification and
management.
M
1d.
The following is a listing of some of the criteria that will be
considered by OMIG’s expert reviewers during their review of
responses to this component:
(1) Present a thorough description of the sources that will be used
to proactively identify possible Casualty and Estate reviews for
potential recovery;
(2) Provide a thorough description of proposed processes that will
be used to identify claims related to Casualty and Estate cases, to
value and re-value liens and claims as appropriate, and to file,
update and lift liens and claims as appropriate;
(3) Present a thorough description of the processes that will be
used to proactively obtain and document all necessary information
on identified Casualty and Estate recovery cases;
(4) Present a thorough description of the proposed processes for
identification and resolution of cases appropriate for closure, both
where recovery has been made and for cases with no recovery.
D
64
(5) Demonstrates understanding of Medicaid claim billing;
(6) Demonstrates an understanding of both Casualty and Estate
litigation processes and the various stakeholders potentially
involved;
(7) The quantity and quality of potential case sources presented;
(8) The timeframes presented within each of the areas listed above;
(9) Any applicable, creative, viable,
innovative, or constructive
solutions that the Offeror proposes to meet or exceed the
mandatory requirements of this section.
1e.
Quality Assurance: The Offeror must conduct regular and ad hoc
quality assurance reviews of Casualty and Estate recovery
activities.
M
1f.
OMIG’s evaluation team may take into consideration if the Offeror
presents a thorough description of the type and quantity of quality
assurance reviews of activities that will be implemented to ensure
appropriate, accurate and timely identification and processing of
cases including, but not limited to, case creation, lien or claim
valuation, recovery, and case closure. OMIG’s expert reviewers will
also consider the quality of reviews and activities, as well as any
applicable, creative, viable, innovative, or constructive solutions
that the Offeror proposes to meet or exceed the mandatory
requirements of this section.
D
1g.
Provide a description of processes and protections that will ensure
the proper release of HIPAA protected information.
M
1h.
Project Reporting: The Offeror must provide reports of the project
deliverables including case progress, statuses, accomplishments,
and roadblocks, in a form and format to be determined by OMIG.
M
1i.
OMIG’s evaluation team may take into consideration if the Offeror
presents a thorough description of all reporting which will be
available within the case management system for ad hoc extraction
and any additional reporting which the offeror could provide to
illustrate activities performed, as well as the quantity and quality of
reporting, and that all required reporting is encompassed. OMIG’s
evaluation team may also take into consideration any applicable,
creative, viable, innovative, or constructive solutions that the offeror
proposes to meet or exceed the mandatory requirements of this
section. Additionally, OMIG will also consider if any additional areas
of recovery are proposed.
D
1j.
Recoveries and Invoicing: The Offeror must establish a
comprehensive process for receipt and tracking of Casualty and
Estate recoveries. Illustrate processes.
M
1k.
OMIG’s evaluation team may take into consideration if the Offeror
presents a thorough description of the processes for monitoring
lockbox and ACH activity, and reconciliation of payments received
to established recovery cases, including how payments will be
documented and reported to OMIG. This should be inclusive of
processes for proactive identification and resolution of payments
received in error or any scenarios that may require refund. OMIG
may also take into consideration any applicable, creative, viable,
innovative, or constructive solutions that the Offeror proposes to
meet or exceed the mandatory requirements of this section.
D
65
M = Mandatory (pass/fail), D = Desirable (gradable)
2.
Case Management System
M, D
Response on
Proposal Page(s) #
2a.
It is mandatory that the Offeror’s case management system be able
to accommodate in capacity and functionality the historical, current,
and future recovery cases and related information as described in
the Case Management System section of this RFP.
M
2b.
The following is a listing of some of the criteria that may be
considered by OMIG’s evaluation team during their review of
responses to this component:
Present a thorough description of processes including timely and
accurate case identification and documentation, recipient eligibility
and demographic identification, claim or lien valuation and filing,
communication with stakeholders, documentation storage,
document generation, and reporting functionality.
Present a thorough and detailed review of system processing points
which illustrate the workflow of the system and ensure timely and
accurate case processing from source of case identification to case
closure inclusive of quality assurance activity.
OMIG will consider the quality of proposed system processes and
workflows, and the Offeror’s understanding of Casualty and Estate
recovery.
OMIG’s evaluation team may take into consideration any applicable,
creative, viable, innovative, or constructive solutions that the Offeror
proposes to meet or exceed the mandatory requirements of this
section.
D
M = Mandatory (pass/fail), D = Desirable (gradable)
3.
Office and Staffing Requirements
M, D
Response on
Proposal Page(s) #
3a.
The Offeror must provide to OMIG an organizational chart that reflects
all positions assigned to this project. The Offeror must provide
additional information including a job description for each title, staff
name, contact information and physical working location of staff, and
any additional access designation or position performance details as
specified by OMIG. Title descriptions must include, but are not limited
to, designations such as manager (area specified), supervisor (area
specified), caseworker, intake, quality assurance, call center,
subcontractor (duties specified), etc.
M
3b.
OMIG will consider the quantity and quality of FTE positions in
conjunction with the proposed processes for customer service, case
identification, management, and reconciliation.
D
66
3c.
The Offeror must provide one (1) résumé, including any pertinent
certifications/licenses, for each of the Key Personnel positions.
M
3d.
Résumés will be scored based upon experience and education
relevant to the work to be performed for this contract. Resumes need
to clarify how the experience and education presented are relevant to
the work to be performed under this contract.
D
M = Mandatory (pass/fail), D = Desirable (gradable)
4.
Contractor Experience
M, D
Response on
Proposal Page(s) #
4a.
It is mandatory that all Offerors provide at least three (3) client
references for which they have performed recoveries similar in scope
or function within the last five (5) years. If more than three (3)
references are submitted, they will be contacted in the order they
appear in the proposal until three (3) interviews are completed.
M
M = Mandatory (pass/fail), D = Desirable (gradable)
5.
Disaster Recovery
M, D
Response on
Proposal Page(s) #
5a.
The Offeror must develop and adhere to an Emergency Preparedness
Plan (EPP) to protect and maintain ongoing services as outlined in this
Contract .
M
67
ATTACHMENT 2 – REFERENCES FORM
Provide three (3) specific programmatic references for the Offeror. References must be persons able
to comment on the Offeror’s capability to perform the services specified in this RFP. The contact person
must be an individual familiar with the organization and its day-to-day performance. If the Offeror has
been a Contractor for the State of New York within the last five (5) years, the Offeror must include a
State of New York reference. Offerors are strongly encouraged to call or write their references to ensure
the accuracy of their contact information and their willingness and capability to be references.
References must include the organization’s name, name of a specific contact person, mailing address,
telephone number, and e-mail address. OMIG will use these references in its evaluation of an Offeror’s
responsibility. A non-responsive or negative reference may disqualify the Offeror by establishing it as
a non-responsible Offeror.
1.
Company Name:
_______________________________________________________
Company Address:
_______________________________________________________
Contract Number:
_______________________________________________________
Contact Phone:
_______________________________________________________
Contact Email:
_______________________________________________________
Contact Person:
_______________________________________________________
2.
Company Name:
_______________________________________________________
Company Address:
_______________________________________________________
Contract Number:
_______________________________________________________
Contact Phone:
_______________________________________________________
Contact Email:
_______________________________________________________
Contact Person:
_______________________________________________________
3.
Company Name:
_______________________________________________________
Company Address:
_______________________________________________________
Contract Number:
_______________________________________________________
Contact Phone:
_______________________________________________________
Contact Email:
_______________________________________________________
Contact Person:
_______________________________________________________
68
ATTACHMENT 3 - SUBCONTRACTOR FORMS (IF APPLICABLE)
ORGANIZATION SUBCONTRACTORS
Offeror:
__________________________________________________________________
Address:
__________________________________________________________________
City:
_____________________
State:
_______
Zip Code:
_____________
Signature:
_______________________________________
Phone #:
_____________
The Offeror must indicate with an “X” whether they intend to use subcontractors:
YES _____ No _____
If “YES” is indicated, the Offeror must provide the following information.
1.
Provide the following information for any organizations with which the Offeror will subcontract:
Subcontractor Legal Name:
_______________________
Subcontractor Address:
_______________________
Federal Employer Identification Number (FEIN):
_______________________
Services to be provided:
_______________________
Mechanism for Assuring Effective and Efficient Operations:
_______________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
2.
Provide the Contact Person Name, Title, Telephone Number, Fax Number, E-mail Address:
Contact Person Name:
_________________________________________________
Title:
_________________________________________________
Telephone Number:
_________________________________________________
Fax Number:
_________________________________________________
Email Address:
_________________________________________________
3.
Provide the Subcontract Agreement Term:
_____________________________________
4.
Provide a Letter of Intent (a written statement expressing the intention of the undersigned to
enter into a formal agreement, especially a business arrangement or transaction from each
subcontractor, indicating intent to perform the services to be provided throughout the entire
contract period.)
5.
List any financial interests the Offeror has in the proposed subcontractors:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
If necessary, Offerors may use additional pages to complete this form.
69
ATTACHMENT 4 - CONFLICT OF INTEREST
70
ATTACHMENT 5 - STATEMENT OF COMPETING COMMITMENTS
71
SUMMARY OF REQUIRED DOCUMENTS
APPENDICES
OMIG requires that all the appendices with a check box, listed below, be completed, and submitted with your
proposal. OMIG maintains fillable versions of all its appendices on its website at the following location:
(https://omig.ny.gov/forms-and-appendices
):
APPENDIX A
(Reserved) Standard Clauses for New York State Contracts
APPENDIX B
(Reserved) General Specifications
APPENDIX C
(Reserved) RFP# OMIG 24-23
APPENDIX D
(Reserved) Winning Offeror’s Response to RFP# OMIG 24-23
APPENDIX E
Contractual Insurances
APPENDIX F
Procurement Lobbying Legislation
APPENDIX G
Affidavit of Non-Collusion
APPENDIX H
Health Insurance Portability and Accountability Act (HIPAA)
APPENDIX I
Confidentiality Agreement
APPENDIX J
Certification of Compliance with State Finance Law 139 k (5)
APPENDIX K
Affidavit of Sexual Harassment Prevention Certification
APPENDIX L
Information Security & Privacy Provisions
APPENDIX X
Reserved
ATTACHMENTS
Attachment 1
Offeror’s Checklist
Attachment 2
References Form
Attachment 3
Subcontractor Forms; if applicable
Attachment 4
Conflict of Interest
Attachment 5
Statement of Competing Commitments
