MES Certification Navigator
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Award Contract

Contract Management

Description

The Award Contract business process utilizes requirements, advanced planning documents, requests for information, request for proposal, and sole source documents to request and receive proposals, verify proposal content against Request for Proposal (RFP) or sole source requirements, apply evaluation criteria, designate contractor/vendor, post award information, entertain protests, resolve protests, negotiate contracts, and notify parties. In some States, this business process makes a recommendation of award instead of the actual award itself. NOTE: The State Medicaid Agency (SMA) requires billing agents, clearinghouses, or other alternate payee (as defined by the Secretary) to register.

Business Process Template

Trigger events
Environment-based
  • Receive respondent’s proposal or approval for sole source.
Interaction-based

None published

Results
  • Alert to send notification of award status to respondent.
  • The SMA negotiates contract with awarded contractor.
  • Tracking information as needed for measuring performance and business activity monitoring.
Business process steps
  • 1. START: Receive respondent’s proposal (e.g., email, mail, web, or Electronic Data Interchange (EDI).
  • 2. Conduct collection of contractor information.
  • 3. Validate information submitted is correct and as complete as possible. Information complies with syntax criteria and respondent has completed all required fields for the type of contractor.
  • 4. If applicable, request additional information.
  • 5. Validate information provided is authentic (e.g., corporate status).
  • 6. Validate contractor network, resources, and other requirements and obtain appropriate approvals (i.e., state, federal).
  • 7. Assign identification to the respondent.
  • 8. Verify proposal content against RFP or sole source requirements.
  • 9. Apply evaluation criteria to respondent’s proposal.
  • 10. Make determination of awarded contractor.
  • 11. Post award information.
  • 12. Send alert to notify respondent of award results (e.g., award/recommend, deny, or continue negotiations).
  • 13. If applicable, send alert to Manage Contractor Grievance and Appeal business process to receive protests and disposition protests.
  • 14. END: Negotiate contract with contractor, collect additional information required to complete a contract, negotiate, and assign rates or other form of payment.
Predecessor processes
Successor processes
Shared data
  • Contractor data store including provider network and contract information
Constraints

The Contractor application will accommodate the full range of contractor types.

Failures
  • Information does not comply with syntax criteria.
  • Not all required information provided.
  • Information provided not authenticated.
  • Parties are unable to negotiate contract (e.g., no agreement on rates).
  • The SMA loses funding.
  • Responder successfully protests an award.
Performance measures
  • Time to complete process = ___ months; ___ weeks
  • Accuracy of information = ___ %
  • Accessibility of information for creating solicitation = ___ months; ___ weeks
  • Consistency of decisions and disposition = ___ %
  • Error rate = __% or less

Source: CMS MITA 3.0 Business Process Template, Contractor Management BPT.pdf, pages 12-14.

Business Capability Model (12 questions)

Each capability question defines five maturity levels, from Level 1 through Level 5.

Business Capability Descriptions

Is the process primarily manual or automatic?
  1. LEVEL 1The process consists primarily of manual activity to accomplish tasks. Respondent mails the paper proposal(s) to SMA. Manual validation, verification, and assessment of proposal information are required.
  2. LEVEL 2SMA uses a mix of manual and automatic processes to accomplish tasks. Submission of proposals is via electronic media (e.g., Web portal). SMA implements a centrally accessible electronic storage of proposal materials and internal electronic communication. Assessment of proposal information is manual.
  3. LEVEL 3SMA automates process to the full extent possible within the intrastate.
  4. LEVEL 4SMA automates process to the full extent possible across the interstate.
  5. LEVEL 5SMA automates process to the full extent possible across the nation.
What is the primary mechanism for receipt of proposals and communication with respondents?
  1. LEVEL 1Receipt of proposals and communication with respondents is via paper, telephone, in person, and facsimile.
  2. LEVEL 2Receipt of proposals and communication with respondents utilizes electronic means of communication (e.g., submission of proposals via a Web portal, e-mail, or Compact Disc (CD)). SMA uses paper, telephone, in person, and facsimile for communications.
  3. LEVEL 3SMA adopts MITA Framework, industry standards, and other nationally recognized standards within the intrastate. SMA automates receipt of proposals and communication with respondents. The process still requires some in person communication.
  4. LEVEL 4SMA adopts MITA Framework, industry standards, and other nationally recognized standards across the interstate.
  5. LEVEL 5SMA adopts MITA Framework, industry standards, and other nationally recognized standards across the nation.
Does the State Medicaid Agency use standards in the process?
  1. LEVEL 1SMA focuses on meeting compliance thresholds for state and federal regulations using state-specific standards.
  2. LEVEL 2SMA applies a mix of nationally recognized and state-specific standards.
  3. LEVEL 3SMA adopts MITA Framework, industry standards, and other nationally recognized standards for intrastate exchange of information.
  4. LEVEL 4SMA adopts MITA Framework, industry standards, and other nationally recognized standards for clinical and interstate information exchange.
  5. LEVEL 5SMA adopts MITA Framework, industry standards, and other nationally recognized standards for national exchange of information.
How does the State Medicaid Agency verify proposal information?
  1. LEVEL 1Staff contacts external and internal document verification sources via mail, telephone, or facsimile.
  2. LEVEL 2Some automatic verifications of Contractor information are available such as Employer Identification Number (EIN), status of tax payment.
  3. LEVEL 3MITA Framework, industry standards, and other nationally recognized standards enable more automatic information verification within the intrastate.
  4. LEVEL 4MITA Framework, industry standards, and other nationally recognized standards enable more automatic information verification across the interstate.
  5. LEVEL 5MITA Framework, industry standards, and other nationally recognized standards enable more automatic information verification across the nation.
How does the State Medicaid Agency collaborate with other agencies or entities in performing the process?
  1. LEVEL 1Very little collaboration occurs with other agencies to standardize information exchange or business tasks.
  2. LEVEL 2SMA collaborates with other agencies and entities to adopt nationally recognized standards and Electronic Data Interchange (EDI) transactions.
  3. LEVEL 3SMA collaborates with other intrastate agencies and entities to adopt national standards, and to develop and share reusable business services.
  4. LEVEL 4SMA collaborates with other interstate agencies and entities to adopt national standards, and to develop and share reusable processes including clinical information.
  5. LEVEL 5SMA collaborates with agencies and entities for national (and international) interoperability improvements that maximize automation of routine operations.

Business Capability Quality: Timeliness of Process

How timely is the end-to-end process?
  1. LEVEL 1Process meets threshold or mandated requirements for timeliness (i.e., the process achieves results within the time specified by law or regulation). The process may require three (3) to seven (7) months.
  2. LEVEL 2Process timeliness improves through use of automation. Timeliness exceeds legal requirements.
  3. LEVEL 3Timeliness improves via state and federal collaboration, use of information sharing, standards, and regional information exchange hubs. Timeliness exceeds Level 2.
  4. LEVEL 4Information is available in near real time. Processes that use clinical information result in immediate action, response, and results. SMA has interstate interoperability, which further improves timeliness over Level 3.
  5. LEVEL 5Information is available in real time. Processes improve further through connectivity with other States and with federal agencies. Most processes execute at the point of service. Results are almost immediate.

Business Capability Quality: Data Access and Accuracy

How accurate is the information available to the process?
  1. LEVEL 1Use of direct data entry for information collection is manually intensive and susceptible to inconsistent or incorrect information. Stakeholders are unable to rely on information for decision-making. Manual processes allow gaps in the accuracy and completeness of proposal content.
  2. LEVEL 2Nationally recognized and state-specific standards improve accuracy of information but the decision-making process may be erroneous or misleading. Use of standards set by the state procurement office, implementation of internal information standards, implementation of centrally accessible electronic storage of proposal materials, and electronic communication mechanisms all contribute to increasing accuracy of information. Accuracy is higher than at Level 1.
  3. LEVEL 3Automation of information collection increases the reliability of SMA’s internal information. External sources of information use MITA Framework and industry standards for information exchange. Decision-making is automatic using standardized business rules definitions. Accuracy rating is at 99% or higher.
  4. LEVEL 4Automation of information collection increases the reliability of SMA’s internal and external sources of information. SMA adopts MITA Framework and industry standards for information exchange with interstate agencies. Decision-making is automatic using regional standardized business rules definitions. Accuracy rating is at 99% or higher.
  5. LEVEL 5SMA adopts MITA Framework and industry standards for information exchange with national agencies. Decision-making is automatic using national standardized business rules definitions. Accuracy rating is at 99% or higher.
How accessible is the information in the process?
  1. LEVEL 1SMA stores information in disparate systems including paper storage. SMA manually obtains or validates information.
  2. LEVEL 2SMA stores information in disparate systems, but adopts automation and nationally recognized standards. State procurement office increases standardization and the use of electronic storage of proposal materials and electronic communication mechanisms that simplify information access. Accessibility increases over Level 1.
  3. LEVEL 3SMA obtains information easily and exchanges with intrastate agencies and entities based on MITA Framework and industry standards. Accessibility is greater than Level 2.
  4. LEVEL 4SMA obtains information easily and exchanges with interstate agencies and entities. Accessibility is greater than Level 3.
  5. LEVEL 5SMA obtains information easily and exchanges with national agencies and entities. Accessibility is greater than Level 4.

Business Capability Quality: Cost Effectiveness

What is the cost of the process compared to the benefits of its results?
  1. LEVEL 1High relative cost due to low number of automatic, standardized tasks.
  2. LEVEL 2Automation improves process and allows focus on exception resolution, improving cost effectiveness ratio over Level 1.
  3. LEVEL 3SMA adopts MITA Framework, industry standards, and other nationally recognized standards further improving cost effectiveness ratio over Level 2.
  4. LEVEL 4SMA adopts MITA Framework, industry standards, and other nationally recognized standards for interstate information exchange. SMA increases cost effectiveness ratio over Level 3.
  5. LEVEL 5SMA adopts MITA Framework, industry standards, and other nationally recognized standards for national (and international) information exchange. SMA increases cost effectiveness ratio over level 4.

Business Capability Quality: Effort to Perform; Efficiency

How efficient is the process?
  1. LEVEL 1Process is labor intensive. There is wasted effort or expense to accomplish tasks. Process meets minimum state process guidelines and SMA performance standards. Efficiency is low.
  2. LEVEL 2Automation and state standards increase productivity. Efficiency is higher than Level 1.
  3. LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate agencies and entities improving efficiency to 95% or higher.
  4. LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with interstate agencies and entities improving efficiency to 98% or higher.
  5. LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national agencies and entities improving efficiency to 98% or higher.

Business Capability Quality: Accuracy of Process Results

How accurate are the results of the process?
  1. LEVEL 1Manual processes result in greater opportunity for human error and the process requires additional oversight to ensure compliance with state and federal procurement business rules. Accuracy is low.
  2. LEVEL 2Automation and standardized business rules definitions reduce error, level of oversight required, and improve accuracy above Level 1.
  3. LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate agencies and entities improving accuracy to 90% or higher.
  4. LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with interstate agencies and entities improving accuracy to 98% or higher.
  5. LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national agencies and entities improving accuracy to 98% or higher.

Business Capability Quality: Utility or Value to Stakeholders

Does the business process satisfy stakeholders?
  1. LEVEL 1Stakeholders lack confidence in information negatively affecting stakeholder satisfaction with the process. Staff is dissatisfied with the level of manual effort to validate, verify, and assess the proposal data, duplication of efforts across SMA, and the frequency that stakeholders appeal decisions. Respondents are dissatisfied with the burden of the process and the length of time.
  2. LEVEL 2Automation and standardization provides clear and useful information. Adoptions of state standards improve staff ability to validate, verify, and assess the proposal data, thus increasing staff satisfaction with the process. Respondent satisfaction improves with the ability to submit electronic proposals, increasing consistency in decisions and the reduction in turnaround time. Stakeholder satisfaction is greater than Level 1.
  3. LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate agencies and entities improving stakeholder satisfaction to 90% or higher. SMA uses survey or questionnaire for information collection.
  4. LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with interstate agencies and entities improving stakeholder satisfaction to 95% or higher.
  5. LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national agencies and entities improving stakeholder satisfaction to 98% or higher.

Source: CMS MITA 3.0 Business Capability Model, Contractor Management BCM.pdf, pages 45-54.

Other Contractor Management processes

Close Out ContractInquire Contractor InformationManage ContractManage Contractor CommunicationManage Contractor Grievance and AppealManage Contractor InformationPerform Contractor OutreachProduce Solicitation