FOR THIRD-PARTY MEDICAID BILLING PROVIDER RFP#20-1065 · 2 SAN ELIZARIO INDEPENDENT SCHOOL DISTRICT...

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SAN ELIZARIO INDEPENDENT SCHOOL DISTRICT

REQUEST FOR PROPOSALS

FOR THIRD-PARTY MEDICAID BILLING PROVIDER

RFP#20-1065

The San Elizario Independent School District is accepting requests for proposals for a Third-

Party Medicaid Billing Provider. Proposals will be accepted until Tuesday, August 13, 2019 at

2:00 p.m. They must be mailed or hand delivered to the District at the following address:

San Elizario Independent School District

PO Box 920 (for mailing)

1050 Chicken Ranch Road (for hand delivery)

San Elizario, Texas 79849

Attn: Nancy Tinoco, Purchasing Specialist

The request for proposals may be obtained starting Sunday, July 28, 2019, online at

www.seisd.net under the ‘Departments’ link, then the ‘Finance’ link, then the ‘Contract

Opportunities’ link then the ‘RFP# 20-1065’ link.

http://www.seisd.net/

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SAN ELIZARIO INDEPENDENT SCHOOL DISTRICT

REQUEST FOR PROPOSALS

FOR THIRD-PARTY MEDICAID BILLING PROVIDER

RFP#20-1065

1. General. The District accepts no obligation for the costs incurred in responding to this RFP

in anticipation of being awarded a contract. The District reserves the right to select proposals in

this RFP without discussion of the responses with the proposers. The District reserves the right to

reject any and all submitted proposals and also reserves the right to waive or dispense any

formalities contained herein. Facsimile, emailed, or late proposals will not be accepted. Proposers

are invited to submit their proposals in accordance with the requirements outlined in this document.

2. Scope & Description. San Elizario ISD is seeking a Third-Party Medicaid Provider to

provide Medicaid SHARS services to the Special Education Department. Proposal prices must

prevail for a period of two (2) years from the date of contract which is October 1, 2019 or otherwise

specified. The contract shall be for a period of one (1) year with the option to extend two (2) one

(1) year terms.

A. Must have proven experience and expertise in developing and implementing a direct

service SHARS program with a working knowledge of Medicaid rate structures, timelines,

regulations, etc. in a school district of a comparable size to the SEISD within the state of

Texas

B. Must be fully versed in legal requirements of Health Care Financing Administration,

Texas Education Agency, Texas Health and Human Services Commission, Centers for

Medicare and Medicaid services and/or any other state or federal agencies governing

SHARS program and services

C. Must be able to comply at all times with all requirements (and any revisions of such)

set forth by the HHSC, CMS and any other state, local or federal agency governing the

SHARS program and services (including documentation requirements)

D. Must have the capacity to fully implement all aspects of the SHARS reimbursement

services within the time frame established by SEISD

E. Must do all data entry for SHARS claims

F. Must have an internal systemic capacity of validating all SHARS requirements for

billing to include—but not limited to:

a) Parental consent to bill

b) Existence of a current Individualized Educational Plan (IEP) that authorizes the

frequency and duration of school health and related services

c) Verification of licensure and certifications for all service providers

d) Verification of prescription for services provided to students

e) Medicaid eligibility at different times of the year

f) Proper documentation on SHARS

G. Must provide relevant training to District personnel as needed to ensure legal

compliance and efficient claim processing

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H. Must provide, and agree to furnish all SEISD billing and related data as requested by

SEISD.

I. Must provide a software demonstration that illustrated the use of your Medicaid Billing

systems to include personal care services, transportation, speech therapy, and a sample of

the reports generated. You can submit a CD or provide a link to your software demo.

J. Must provide a copy of the services or reports to complete the annual SHARS cost

report.

K. Must explain if software interface is compatible with Frontline IEP Management

System.

L. Must provide education and training to school employees concerning the SHARS

program in order to help maximize efforts and fund available to the District at no additional

cost

M. Offeror will electronically bill NHIC and Medicaid of Texas for services provided to

all eligible Medicaid Students

N. Must provide hard copies sample of documentation forms to be used to seek

reimbursement

3. General Information. The district’s current SHARS/MAC billing vendor is Intlmed. The

current fee the vendor is charging for SHARS interim reimbursements and for cost settlement

reimbursements is five percent (5%) of the gross total reimbursement. The district’s current form

of billing is primarily electronic with the exception of transportation.

Cost settlement & interim payment reimbursements in the last five years is as follows:

o 2016-17 $166,036 (cost settlement) $286,108 (interim payment)





District student information is as follows:

o Total Students: 3554

o Special Education child count: 421

4. Timeline.

Legal advertisement for RFP July 28th and August 4th

Sealed proposals due Tuesday, August 13, 2019 at 2:00pm

Award of contract September 2019

Any addendums will be made available online at www.seisd.net under the ‘Departments’

link, then the ‘Finance’ link, then the ‘Contract Opportunities’ link then the ‘RFP#20-

1065’ link. It is the proposer’s responsibility to check the website for any issued

addendums prior to submitting their proposal.


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5. Proposal Format and Content. Please include the following minimum information in

your response to this RFP in the order and format prescribed below.

a. Transmittal Letter

i. Shall contain the following annotation


Request for Proposals

For Third-Party Medicaid Billing Provider

RFP#20-1065

ii. Shall state that this submittal is valid for 60 days

iii. Shall include the original signature of a person legally authorized to bind

the proposer to the representation in the response

iv. Shall include a statement of acceptance of the terms and conditions of this

RFP. If a proposer takes exception to any of the proposed terms and

conditions stated in this RFP, those exceptions must be noted in the

transmittal letter, but failure to accept the terms and conditions specified in

this RFP may result in disqualification of the proposal

b. Required Forms

i. 3 current reference letters with contact information

ii. Proposal

iii. Certification Regarding Debarment, Suspension, Ineligibility and Other

Responsibility Matters

iv. Felony Conviction Notice

v. Prohibition on Lobbying or Solicitation

vi. Criminal History Record Information Review of Certain Contract

Employees

vii. Conflict of Interest Questionnaire

viii. IRS Form W-9

ix. House Bill 89 Verification Form

x. Submission of a HUB certificate, if applicable

6. Evaluation Criteria. The District is not bound to select the lowest priced proposal and

will select the proposal that provides the best value as determined by the District based on the

following criteria:

Purchase price 30

The reputation of the vendor and the vendor’s goods or services 5

The quality of the vendor’s goods or services 20

The extent to which the goods or services meet the district’s needs 20

The vendor’s past relationship with the district 5

The impact on the ability of the district to comply with laws relating to HUB 5

The total long-term cost to the district to acquire the goods or services 15

Total 100

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7. Proposal Submittal and Opening. The proposer must submit their sealed proposal by

2:00 pm on Tuesday, August 13, 2019 to the following address with the following notation:

a. Address


PO Box 920 (for mailing)

1050 Chicken Ranch Road (for hand delivery)

San Elizario, Texas 79849

Attn: Nancy Tinoco, Purchasing Specialist

b. Notation


Request for Proposals

For Third-Party Medicaid Billing Provider

RFP#20-1065

Due: Tuesday, August 13, 2019 at 2:00 pm

Proposals will be opened at the location and time specified. Prices will not be read, nor

disclosed in any other manner until the project is awarded because the District reserves the

right to request a best and final offer and to enter into negotiations with proposers.

Proposals received after the specified time shall not be considered. The District may reject

any and all proposals. Facsimile and emailed proposals will not be accepted.

By submitting a proposal, the proposer agrees to waive any claim it has or may have against

the School District, its Board of Trustees, agents and employees, and any persons or entities

contacted as references, arising out of or in connection with the review, evaluation, or

recommendation of any proposals, acceptance or rejection of any proposal, the waiver of

any requirements in this RFP, or any complaints or concerns regarding the award of a

contract.

8. Requirements for Award of Contract.

a. Length of Contract

i. The contract shall be for a period of one (1) year with the option to extend

two (2) one (1) year terms.

9. Texas Public Information Act. Proposer acknowledges that San Elizario ISD is subject

to the Texas Public Information Act (TPIA). As such, upon receipt of a request under the TPIA,

San Elizario ISD is required to comply with the requirements of the TPIA. For purposes of the

TPIA, ‘public information’ is defined as information that is written, produced, collected,

assembled, or maintained under a law or ordinance or in connection with the transaction of

official business:

a. By San Elizario ISD; or

b. For San Elizario ISD and San Elizario ISD

i. Owns the information; or

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ii. Has a right of access to the information; or

iii. Spends or contributes public money for the purpose of writing, producing,

collecting, assembling, or maintaining the information; or

c. By an individual officer or employee of San Elizario ISD in the officer’s or

employee’s official capacity and the information pertains to official business of

San Elizario ISD.

Proposer is expected to fully cooperate with the District in responding to public

information requests. This includes, but is not limited to, providing the District with

requested information. In the event that the request involves documentation that is

clearly marked as confidential and/or proprietary, San Elizario ISD will provide the

proposer with the required notices under the TPIA. The proposer acknowledges that is

has the responsibility to brief the Attorney General’s Office on why the documents

identified as confidential and/or proprietary fall within an expiation to public disclosure.

10. Questions and Additional Information. Any person wishing to obtain additional

information about the Request for Proposals needs to email Amanda Sanchez, Director of

Special Education with a carbon copy to Nancy Tinoco, Purchasing Specialist. The deadline for

submitting questions is by the end of the business day on Tuesday, August 6, 2019. All questions

submitted and responses provided will be made available online at www.seisd.net under the

‘Departments’ link, then the ‘Finance’ link, then the ‘Contract Opportunities’ link then the

‘RFP#20-1065’ link as an addendum to the RFP by Thursday, August 8, 2019. It is the

proposer’s responsibility to regularly check the website for any addendums released.

Amanda Sanchez

Director of Special Education

San Elizario ISD

Email: [email protected]

Nancy Tinoco

Purchasing Specialist

San Elizario ISD

Email: [email protected]

No other persons may be contacted for questions or information. No proposer shall lobby,

contact or solicit members of the Board of Trustees or District staff during the process.


mailto:[email protected]

mailto:[email protected]

F I N A N C E D I V I S I O N

P.O. Box 920 – San Elizario, Texas 79849-0920 – Phone: (915) 872-3900

Certification Regarding Debarment, Suspension and Other Responsibility Matters

1. The prospective primary participant certifies to the best of its knowledge and belief that it and its

principals:

a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or

voluntarily excluded from covered transactions from any Federal department or agency;

b. Have not within a three year period preceding this proposal been convicted of or had a

civil judgment rendered against them for commission of fraud or a criminal offense in

connection with obtaining, attempting to obtain, or performing a public (Federal, State or

Local) transaction or contract under a public transaction; violation of Federal or State

antitrust statutes or commission or embezzlement, theft, forgery, bribery, falsification or

destruction of records, making false statements, or receiving stolen property;

c. Are not presently indicted for or otherwise criminally or civilly charged by a

governmental (Federal, State or Local) entity with commission of any of the offenses

enumerated in paragraph (1) (b of this certification)

d. Have not within a three-year period preceding this application/proposal had one or more

public transactions (Federal, State or Local) terminated for cause or default

2. Where the prospective primary participant is unable to certify to any of the statements in this

certification, such prospective primary participant shall attach an explanation to this proposal

Sign the appropriate option: Option 1 Option 2

Felony Conviction Notice

Section 44.034 of the Texas Education Code, Notification of Criminal History,

Subsection (a) states “A person or business entity that enters into a contract with a school district must

give advance notice to the district if the person or an owner or operator of the business entity has been

convicted of a felony. The notice must include a general description of the conduct resulting in the

conviction of a felony.”

Subsection (b) states “A school district may terminate a contract with a person or business entity if the

district determines that the person or business entity failed to give notice as required by Subsection (a)

or misrepresented the conduct resulting in the conviction. The district must compensate the person or

business entity for services performed before the termination of the contract.”

Sign the appropriate option:

1. My firm is a publicly-held corporation, therefore, this requirement is not applicable:

2. My firm is not owned nor operated by anyone who has been convicted of a felony:

3. My firm is owned or operated by the following individual(s) who has/have been convicted of a

felony (Name of Felon(s) & Conviction):

F I N A N C E D I V I S I O N


Prohibition on Lobbying or Solicitation

The San Elizario Independent School District prohibits lobbying, contacting or soliciting School

District staff members or members of the Board of Trustees during the selection process. This

does not include any attendance at any meeting scheduled by the School District such as a pre-

bid conference, or any contact with the Chief Financial Officer for the purpose of obtaining

clarification regarding any of the procedures or requirements. The School District reserves the right

to disqualify any firm that violates this policy. The undersigned acknowledges the district policy and

certifies that all employees, agents, consultants, or representatives of the representing firm have not or

will not contact, solicit, or lobby School District staff members, members of the Board of Trustees

regarding the above mention solicitation from the date of Board of Trustees authorization

to solicit proposals through final action of this solicitation by the Board of Trustees.

Signature of Acknowledgement:

Criminal History Record Information Review of Certain Contract Employees

Section 22.0834 of Texas Education Code requires an independent contractor who provides services

to a school district to submit to a criminal history review if the independent contractor will have

continuing duties related to the contracted services and direct student contact. Each independent

contractor must certify with the District that the contractor has complied with the law that requires

each contractor to obtain the criminal histories of its covered employees.

By signing below you indicate that you will comply with the Section 22.0834 of the TEC by

conducting background searches and having employees fingerprinted with the DPS-Fingerprint-

based Applicant Clearinghouse of Texas-(FACT) and will not allow any employees not meeting the

minimum standard to perform any services in reference to this contract on SEISD premises.

The District reserves the right to review any criminal history record information and to terminate any

services at any time if the criminal history of a contractor is not acceptable.

Signature of Acknowledgement:

Department of Finance


House Bill 89 Verification Form Prohibition on Contracts with Companies Boycotting Israel

The 85th Texas Legislature approved new legislation, effective Sept. 1, 2017, which amends Texas Local

Government Code Section 1. Subtitle F, Title 10, Government Code by adding Chapter 2270 which states

that a governmental entity may not enter into a contract with a company for goods or services unless the

contract contains a written verification from the company that it:

1) does not boycott Israel; and

2) will not boycott Israel during the term of the contract

Pursuant to Section 2270.001, Texas Government Code:

1. “Boycott Israel” means refusing to deal with, terminating business activities with, or otherwise

taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations

specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled

territory, but does not include an action made for ordinary business purposes; and

2. “Company” means a for-profit sole proprietorship, organization, association, corporation,

partnership, joint venture, limited partnership, limited liability partnership, or any limited liability

company, including a wholly owned subsidiary, majority-owned subsidiary, parent company or

affiliate of those entities or business associations that exist to make a profit.

I, (authorized official) _, do hereby depose and verify the

truthfulness and accuracy of the contents of the statements submitted on this certification under the

provisions of Subtitle F, Title 10, Government Code Chapter 2270 and that the company named below:

1) does not boycott Israel currently; and

2) will not boycott Israel during the term of the contract; and

3) is not currently listed on the State of Texas Comptroller’s Companies that Boycott Israel List

located at https://comptroller.texas.gov/purchasing/publications/divestment.php

Company Name

Signature of Authorized Official

Title of Authorized Official Date

https://comptroller.texas.gov/purchasing/publications/divestment.php

Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor doing business with local governmental entity

A complete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/

Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.

Local Government Code § 176.001(1-a): "Business relationship" means a connection between two or more parties

based on commercial activity of one of the parties. The term does not include a connection based on:

(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an

agency of a federal, state, or local governmental entity;

(B) a transaction conducted at a price and subject to terms available to the public; or

(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and

that is subject to regular examination by, and reporting to, that agency.

Local Government Code § 176.003(a)(2)(A) and (B):

(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:

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(2) the vendor:

(A) has an employment or other business relationship with the local government officer or a

family member of the officer that results in the officer or family member receiving taxable

income, other than investment income, that exceeds $2,500 during the 12-month period

preceding the date that the officer becomes aware that

(i) a contract between the local governmental entity and vendor has been executed;

or

(ii) the local governmental entity is considering entering into a contract with the

vendor;

(B) has given to the local government officer or a family member of the officer one or more gifts

that have an aggregate value of more than $100 in the 12-month period preceding the date the

officer becomes aware that:

(i) a contract between the local governmental entity and vendor has been executed; or

(ii) the local governmental entity is considering entering into a contract with the vendor.

Local Government Code § 176.006(a) and (a-1)

(a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship

with a local governmental entity and:

(1) has an employment or other business relationship with a local government officer of that local

governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A);

(2) has given a local government officer of that local governmental entity, or a family member of the

officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any

gift described by Section 176.003(a-1); or

(3) has a family relationship with a local government officer of that local governmental entity.

(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator

not later than the seventh business day after the later of:

(1) the date that the vendor:

(A) begins discussions or negotiations to enter into a contract with the local governmental

entity; or

(B) submits to the local governmental entity an application, response to a request for proposals

or bids, correspondence, or another writing related to a potential contract with the local

governmental entity; or

(2) the date the vendor becomes aware:

(A) of an employment or other business relationship with a local government officer, or a

family member of the officer, described by Subsection (a);

(B) that the vendor has given one or more gifts described by Subsection (a); or

(C) of a family relationship with a local government officer.

http://www.ethics.state.tx.us/

http://www.statutes.legis.state.tx.us/

http://www.statutes.legis.state.tx.us/

Revised 11/30/2015Form provided by Texas Ethics Commission www.ethics.state.tx.us

FORM CIQ

OFFICE USE ONLYThis questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.

This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor whohas a business relationship as defined by Section 176.001(1-a) with a local governmental entity and thevendor meets requirements under Section 176.006(a).

By law this questionnaire must be filed with the records administrator of the local governmental entity not laterthan the 7th business day after the date the vendor becomes aware of facts that require the statement to befiled. See Section 176.006(a-1), Local Government Code.

A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. Anoffense under this section is a misdemeanor.

CONFLICT OF INTEREST QUESTIONNAIREFor vendor doing business with local governmental entity

Date Received

A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income,other than investment income, from the vendor?

Yes No

B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the directionof the local government officer or a family member of the officer AND the taxable income is not received from thelocal governmental entity?

Yes No

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Check this box if the vendor has given the local government officer or a family member of the officer one or more giftsas described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).

Signature of vendor doing business with the governmental entity Date

Name of vendor who has a business relationship with local governmental entity.1

Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated

completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which

you became aware that the originally filed questionnaire was incomplete or inaccurate.)

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3 Name of local government officer about whom the information is being disclosed.

Name of Officer

Describe each employment or other business relationship with the local government officer, or a family member of theofficer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer.Complete subparts A and B for each employment or business relationship described. Attach additional pages to this FormCIQ as necessary.

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5Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation orother business entity with respect to which the local government officer serves as an officer or director, or holds an

ownership interest of one percent or more.

FOR THIRD-PARTY MEDICAID BILLING PROVIDER RFP#20-1065 · 2 SAN ELIZARIO INDEPENDENT SCHOOL DISTRICT...

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