Transforming Maternal Health: Third-Party Administrator to Manage Disbursement and Oversight of Provider Infrastructure Payments

The selected vendor will be responsible for payment distribution, monitoring, and oversight of the Provider Infrastructure Payments as required by the Wisconsin TMaH Notice of Award (NoA), which is attached to this Request for Application (RFA). The TPA must facilitate payments to a diverse "Maternal Health Care Team" to support infrastructure, technical system changes, and care delivery models.

“Provider Infrastructure Payments” (PIPs) are defined as a payment made by the vendor to Partner Providers and Partner Provider Care Delivery Locations to support care delivery transformation. Provider Infrastructure Payment recipients will also receive upside-only payments based on their performance.

Vendors will be responsible for regularly dispersing Provider Infrastructure Payments to Partner Providers and Partner Care Delivery Locations to support the activities through subrecipient agreements as detailed in the following sections. The value of the PIPs will be based on guidance from CMS outlined in the NoA as well as additional, forthcoming CMS guidance. PIPs must not duplicate or supplant existing federal, state or local funds available for the same activities.

The Provider Infrastructure Payments may only be used by providers for the following activities:

Patient Safety Initiatives and Maternal Care Assessment

• Implementation of the Perinatal Quality Collaborative (PQC)-led AIM patient safety bundles; such payments may not duplicate or supplant funds provided by Health Resources and Services Administration (HRSA), Centers for Disease Control and Prevention (CDC), or any other federal or state source for the same purpose.
• Achievement of the “Birthing-Friendly” hospital designation (for hospitals only).
• Planning, patient-flow revision, acquisition of electronic health record (EHR) systems or coding changes or other activities required to effectively use medical and non-medical risk assessments to drive risk-appropriate care.

Quality Measure Reporting

• Data reporting on mandatory quality measures (see Section A.4.3.2 Quality and Cost Performance Incentive for additional details), subject to federal and state privacy laws.
  • Low-risk cesarean delivery
  • Screening for maternal depression and follow-up
  • Severe obstetric complications
  • Timeliness of prenatal and postpartum care
• Data reporting on additional quality assurance measures (see Section A.4.6 Measures and Reporting)
• Provider surveys

Data integration and other activities to support data-driven maternity care

• Electronic health record (EHR) upgrades and data infrastructure improvement, as needed, to meet model data collection and reporting requirements.
• Connections to enable providers’ EHRs to exchange data with regional or national networks facilitating health information exchange.
• Creation of dashboards to support quality improvement activities.
• Integration with community-based organizations (CBOs) to share screening and referral information (and for CBOs to share notifications back to the referring provider) to meet member’s upstream drivers of health and behavioral health needs in compliance with state and federal data privacy laws.

Team-Based Care

• Support regular and ongoing interprofessional care team meetings and planned quality assurance and improvement activities. In addition to obstetricians and other physicians and registered nurses, the maternal care team may include doulas, perinatal community health workers, other community health workers, midwives, physician assistants and behavioral health providers, as appropriate.

Enhanced Access to Care

• Offer one or more alternatives to traditional office visits to increase access to care in ways that best meet the needs of the population. This may include home monitoring for diabetes and hypertension or other telehealth initiatives, group perinatal visits, home visits, alternate location visits, or expanded early morning, evening, and/or weekend hours.

Connections to CBOs to address upstream drivers of health and behavioral health needs

• Identification of local entities that can help address non-medical and/or mental health (for example, depression and anxiety) or substance use disorder-related needs of beneficiaries and integrate them into screening, referral and follow-up activities, where legally permissible and appropriate to do so.

In addition to the “Payment Model Requirements” beginning on page 17 of the attached NoA, the vendor will also be required to follow any forthcoming guidance provided by CMS and will work in collaboration with the Department to operationalize said guidance.

The vendor must be able to execute a legal agreement (subaward) with entities receiving PIPs to support payment disbursement and monitoring. The vendor must be able to manage large-scale fund distributions to administer PIPs. The vendor will be expected to monitor entities receiving PIPs and report to DHS and CMS, including records, data, and necessary information. The vendor is expected to support entities receiving PIPs in adhering to reporting requirements and adhere to timelines themselves. Vendor experience with multi-entity monitoring or reporting is required.

The vendor is expected to adhere to DHS and CMS requirements regarding data storage and management, including the security of protected health information (PHI) and personally identifiable information (PII). The vendor must comply with all applicable federal and state privacy and security laws, including but not limited to HIPAA, HITECH, CMS data security requirements, and applicable Wisconsin privacy statutes. The vendor must execute a Business Associate Agreement (BAA) with DHS prior to receiving any PHI or PII. Any subcontractors handling PHI or PII must also execute appropriate data protection agreements. The vendor must notify DHS within 48 hours of discovery of any suspected or confirmed data breach or security incident involving DHS data. The vendor must cooperate fully with DHS in any investigation, mitigation, or required reporting.

All data collected, created, maintained, or transmitted by the vendor for this project are property of the Wisconsin Department of Health Services. The vendor must provide full data extracts in a DHS-specified format upon request, termination, or expiration of the contract. Data extracts must be provided in structured, non-proprietary formats (CSV, XML, or other DHS-approved standard formats) to ensure portability and continuity of operations. DHS may request data from the vendor and entities who received PIPs to support the project.

• Financial Audits: Adhere to Wis. Stat. § 46.036, providing audits for any cumulative funding exceeding $100,000.
• Data Reporting: The vendor shall follow DHS and CMS required TMaH reporting guidelines for the distribution and use of the PIPs.
• Contract Termination: Per CMS guidelines, the final contract shall include a clause allowing for termination by either party with 60 days' notice.

Vendors must design their proposal to minimize the requirement/involvement of Department staff and resources. The Vendor must develop an approach, which (a) provides routine updates and reports to Department management, and (b) enables the Department to effectively monitor the direction, scope and performance of work.
The Department will review, modify, and approve all Vendor-proposed correspondence. The Department reserves the right to alter correspondence documents at any time. The Vendor must implement alterations to correspondence immediately upon receiving feedback.