rest of state adult behavioral health request for qualification (rfq) august 2015 applicant’s...
TRANSCRIPT
Rest of State Adult Behavioral Health Request for Qualification (RFQ)
August 2015
Applicant’s Conference-Updated
August 28, 2015
August 2015
2
Agenda
• Purpose of Behavioral Health Managed Care Transition
• Behavioral Health (BH) Managed Care Program Design and Timeline
• State Plan and Behavioral Health Home and Community Based Services (BH HCBS)
• BH HCBS Designation Status
• Health and Recovery Plan (HARP) Enrollment and Assessment
• Rest of State RFQ Questions Received to Date
August 2015
Medicaid Redesign Team: Objectives
• Fundamental restructuring of the Medicaid program to achieve:• Person-centered recovery oriented care
• Measurable improvement in health outcomes
• Sustainable cost control
• More efficient administrative structure
• Better integration of care
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August 2015
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Why we need to transform care:
• The 30-day readmission rate for NYC is 25% and 20% for Rest of state.
• Outpatient Mental Health (MH) or Substance Use Disorder (SUD) treatment within 7 days of discharge is 35% for NYC and 42% for Rest of State.
• Two or more Mental Health (MH) outpatient visits within 30 days of discharge in NYC is 32% and 40% for Rest of State.
August 2015
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Why we need to transform care:BHO Phase 1 post-discharge outcomes for Substance Use Disorder (SUD) discharges, CY 2012
• 45-Day readmission rate for NYC is about 45% and about 18% for Rest of state.
• Lower level of SUD service or MH outpatient care within 14 days of discharge is about 31% for NYC and 48% for Rest of State.
• Three or more SUD lower level services within 30 days of discharge in NYC is 20 % and 35% for Rest of State.
August 2015
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Integrated Care: In BHO Phase I, how often did behavioral health inpatient providers identify general medical conditions requiring follow-up, and did they arrange aftercare
appointments?
Based upon 56,167 statewide behavioral health community discharges (all service types) January 2012—June 2013
No physicalhealth condition identified: 64%
Physical health condition identified: 36%
No physical health appointment made: 82%
Physical health appointment made: 18%
Figure 4. Integrated care: How often did behavioral health inpatient providers identify general medical conditions requiring follow-up,
and did they arrange aftercare appointments?
Data submitted by BHO
Based upon 56,167 behavioral health community discharges (all service types), January 2012—June 2013
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August 2015
July 2015 – NYS received CMS approval for the 1115 Waiver Amendment expanding behavioral health services in Medicaid Managed Care.
Federal Approval of Behavioral Health Managed Care Design
August 2015
Principles of BH Benefit DesignPerson-centered care managementIntegration of physical and behavioral health servicesRecovery oriented servicesPatient/Consumer Choice
Ensure adequate and comprehensive networks
Tie payment to outcomes
Track physical and behavioral health spending separately
Reinvest savings to improve services for BH populations
Address the unique needs of children, families & older adults
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August 2015
Behavioral Health Managed Care Design
• Behavioral Health will be managed by:• Managed Care Organizations (MCO) meeting rigorous standards (perhaps in
partnership with a Behavioral Health Organization (BHO))• All Plans MUST qualify to manage newly carved inbehavioral health services and
populations
• Plans can meet State standards internally or contract with a BHO to meet State standards
• HARPs for adults with significant behavioral health needs • MCOs may choose to apply to operate a HARP product with expanded benefits
• HIV SNPs will include HARP benefits for eligible members
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August 2015
MMC Plan vs. HARP
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Medicaid Managed Care Plan
Health and Recovery Plan
• Medicaid Eligible
• Benefit includes Medicaid State Plan covered services
• Organized as Benefit within Managed Care Organization (MCO)
• Management coordinated with physical health benefit management
• Performance metrics specific to BH
• BH annual expenditure minimum
• Medicaid eligible adults
• Specialized integrated product line for people with significant behavioral health needs
• Eligible based on utilization or functional impairment
• Enhanced benefit package - All MMC covered benefits PLUS access to HCBS to help individuals meet their goals (employment, independent living, education, etc.)
• Specialized medical and social necessity/ utilization review for expanded recovery-oriented benefits
• Benefit management built around higher need HARP patients
• Enhanced care coordination - All may be in Health Homes
• Performance metrics specific to higher need population and BH HCBS
• Integrated medical loss ratio
August 2015
• September 18, 2015 – MCOs submit ROS Adult RFQ application (Full and Expedited Versions)
• November 2015 – Anticipated MCO conditional designation• Mid-November 2015 – Individual NYS/MCO RFQ follow-up discussion• December-March 2016 –Readiness Reviews (Desk Audit/On-site) • April-June 2016 – Final MCO Designation and HARP Certificate of Authority• July 2016 – Mainstream and HARP behavioral health management begins
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Adult Rest of State (counties outside NYC) Behavioral Health Managed Care Timeline
August 2015
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Implementation Schedule of the Key Elements of Children’s Medicaid Redesign Plan (the “How”)
Anticipated Schedule for Implementing Children’s Medicaid Redesign Plan
Health Homes for Children• Enrollment begins for Eligible Children, OMH TCM Program Transitions to Health Home• Opportunity: CAH I & II providers may provide care management for children not enrolled
in waivers
January 1, 2016
• Transition Care Coordination Service of CAH I & II, and other 1915c Waiver Programs to Health Home (OMH SED, OCFS B2H)
January 1, 2017
Expanded Array of State Plan Services for All Children Early in 2016
• Transition existing Behavioral Health Benefits to Managed Care• Transition Foster Care Children (those which are currently subject to Agency Based Medicaid
Per Diem) to Managed Care• Expand Array of Home and Community Based Services
January 1, 2017(NYC and Long Island)July 2017(Rest of State)
Maintain Access to Services for Children without Medicaid/Family of One-continues for LOC children with 2017 transition; begins for Level of Need children in 2018
August 2015
Expansion of Behavioral Health in Medicaid Managed Care
The expansion of BH in Medicaid managed care is two-pronged:
• Benefit Expansion• BH services expanded for MMC enrollees
• HARP implementation
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August 2015
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Substance Use Disorder (SUD) and Mental Health (MH) State Plan Services-Adults
MMC Covered BH Services for all enrollees:
• Inpatient – SUD and MH• Clinic – SUD and MH• Personalized Recovery Oriented Services (PROS)• Intensive Psychiatric Rehabilitation Treatment (IPRT)• Assertive Community Treatment (ACT)• Continuing Day Treatment (CDT)• Partial Hospitalization• Comprehensive Psychiatric Emergency Program (CPEP)• Opioid treatment• Outpatient chemical dependence rehabilitation• Rehabilitation Services for Residents of Community Residences
(Not initially in the benefit package)
August 2015
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Expansion of BH Services in Services Medicaid Managed Care Benefit Package
Expanded services are available to all Medicaid Managed Care enrollees
• Mental Health Services• Licensed Mental Health Practitioner Services (Off-site services that may only be provided by
OMH licensed clinics)
• Behavioral Health Crisis Intervention
• Substance Use Disorder Services• Residential Redesign - Three phases: OASAS Intensive Residential, Community Residential,
Supportive Living and Medically Monitored Detox
• Reassignment of SUD clinic to State Plan “Rehab Option” to permit off-site delivery of services
August 2015
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HARP, Health Home and BH HCBS• All HARP members will be offered Health Home care management services
• All HARP members will be annually assessed for eligibility for BH Home and Community Based
Services. • The Community Mental Health (CMH) suite of the interRAI has been customized for NYS and includes:
• Brief Assessment to determine HARP and BH HCBS eligibility
• Full Assessment to identify needs and assist in the development of a care plan
• Health Homes will conduct the NYS Community Mental Health Assessment
• Health Homes will develop person-centered care plans that integrate physical and behavioral
health service, include BH HCBS
• HARPs will need to approve Health Home plans of care to comply with HCBS conflict-free
requirements
August 2015
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Home and Community Based Services for HARP enrollees and HARP eligible HIV-SNP enrollees
• Rehabilitation
• Psychosocial Rehabilitation
• Community Psychiatric Support and Treatment (CPST)
• Habilitation
• Respite
• Short-Term Crisis Respite
• Intensive Crisis Respite
• Educational Support Services
• Individual Employment Support Services
• Prevocational
• Transitional Employment Support
• Intensive Supported Employment
• On-going Supported Employment
• Peer Supports
• Support Services
• Family Support and Training
• Non- Medical Transportation
• Self Directed Services Pilot (pending CMS approval)
August 2015
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Rest of State HCBS Designation Process• The BH HCBS application is available on the OMH website and application
are due 9/14/2015• Providers must complete an application to be identified as a “State
designated BH HCBS provider” for each service they plan to deliver • A provider attestation form is required, indicating that the provision of the
service is consistent with the standards included in the HCBS provider manual
• OMH/OASAS will compile a list of all providers that have completed an application and attested to meeting the service standards
• In order to retain their “BH HCBS designation” providers must demonstrate on-going staff development competency for certain services
August 2015
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HARP Enrollment• All HARP eligible individuals identified by NYS will be offered an opportunity to
enroll into a HARP
• HARP eligible members will be passively enrolled in a HARP if they are enrolled in a Plan whose MCO offers a HARP product
• These members will have the choice to opt out
• Individuals initially identified as HARP eligible who are enrolled in an MCO without a HARP will not be passively enrolled
• They will be notified of their HARP eligibility and referred to the NYS Enrollment Broker (New York Medicaid Choice) for education about enrollment options
August 2015
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HARP ChoiceAbility to opt-out of HARP or choose different Plan:
• Individuals identified for passive enrollment will be notified by the NYS
Enrollment Broker
• They will be given no less than 30 days to opt out or to select another HARP
• Once enrolled in a HARP, members are allowed 90 days to choose another
HARP or return to Medicaid Managed Care
• After 90 days, they are locked into the HARP for 9 additional months (after
which they are free to change Plans at any time)
August 2015
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Provider Technical Assistance• NYS is funding the Managed Care Technical Assistance Center (www.mctac.org
) to offer support and capacity building for providers. Subject areas include:• Contracting • Business & Clinical Operations Innovation• Home and Community Based Services• Evaluating, measuring, & communicating• Billing, Finance & Revenue Cycle• Utilization Management
• Additional BH HCBS provider trainings• BH HCBS (with Center for Practice Innovation)• Business Practices (targeted at small providers)
August 2015
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Provider Start-Up Assistance
• Funding available for up to two years• Priority given to BH HCBS providers and agencies with little or no
Medicaid or Medicaid Managed Care experience• Key areas for Start-Up assistance include:
• Health Information Technology (HIT) • NYS is developing a process to assist behavioral health providers who currently do not
have the technological infrastructure to efficiently transition to a managed care system
• HCBS provider Start-Up grants• Providers must demonstrate a contractual relationship (or letters of intent) with HARPs
August 2015
Draft Rest of State Rates PM/PM by Region
Central $1,907.10
Finger Lakes $1,690.93
Long Island $2,493.08
Mid-Hudson $2,355.14
Northeast $1,887.45
Northern Metro $2,515.26
Utica-Adirondacks $1,717.78
Western $1,899.84
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Draft Rest of State HARP Rates can be found on the OMH website: http://omh.ny.gov/omhweb/bho/harp-ros-draft-rates.pdf
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RFQ Questions and Answers
August 2015
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FAQ Review Process• NYS will review questions received to date and provide answers
• Complete RFQ questions first followed by expedited RFQ questions
• NYS verbal responses to additional questions received today must be considered preliminary answers
• Final answers will be posted as soon as possible on the DOH, OMH, and OASAS websites
August 2015
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Complete RFQ: General Question: Would the State please share the Q&A prepared for the downstate RFQ?
Response: FAQs from the NYC applicants conference can be found online at: http://www.omh.ny.gov/omhweb/bho/faq.pdf
Note: Answers to some of these questions have changed. NYS is in the process of reviewing these FAQs and will update as appropriate in the near future.
August 2015
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Complete RFQ: General
Question: Please confirm the State requires 4 complete hardcopies of the response. In addition, please clarify whether the electronic submission (PDF and Word) should include attachments or just the narrative response to Section A through K.
Response: RFQ responses requires 4 complete responses and the PDF/Word versions should include attachments where possible.
August 2015
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Complete RFQ Section 1.5.A.ii Program Design
Question: If the member refuses a Health Home, is the HARP allowed to provide case management? If so, how is that funded?
Response:
• The HARP is responsible for care coordination, either though a Health Home or other State-designated entities. This service is included in the PMPM capitated rate.
• If a person refuses Health Home enrollment, the HARP must contract with a Health Home (or other state designated entity) to complete the assessment and develop the HCBS plan of care (POC).
August 2015
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Complete RFQ Section 1.5.A.ii Program Design Cont’d• The Health Home must bill the HARP for delivery of these two
services at the rates established by the State. • Once the BH HCBS POC has been developed, the Health Home
care manager forwards it to the HARP which is responsible for monitoring and implementing the POC.
• The HARP will not be paid an additional fee for monitoring and implementing POCs for their members who choose not to enroll in Health Homes.
August 2015
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Complete RFQ Section 1.5.A.ii.b Program Design
Question: What are the metrics for BH HCBS and Health Home providers, or is it up to the HARPs and MCOs to determine the performance metrics per their contracts with those Health Homes and BH HCBS providers?
Response: For BH HCBS, the Federal assurance and sub assurance requirements are being finalized. Additional information will be forthcoming.
August 2015
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Complete RFQ Section 1.7.C System Goals, Operating Principles, Requirements and Outcomes
Question: Are there standard reporting requirements/monitoring mechanisms or processes Plans are expected to use? Also, are these general outcomes or specific to HARP members/MMC members who access BH services?
Response: Plans will continue to be responsible for reporting requirements in QARR. NYS will issue additional guidance regarding required transitional monitoring reports specific to BH service utilization.
August 2015
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Complete RFQ Section 1.8.E.vi Covered Populations and Eligibility Criteria
Question: Please clarify what entails a significant change in an individual’s circumstances or needs.
Response: Significant change is when an individual experiences an acute episode, is re-hospitalized or experiences an event where additional support is required to live safely in the community.
August 2015
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Complete RFQ Section 1.10.E Covered Populations and Eligibility Criteria
Question: What are the authorization requirements related to BH HCBS?
Response: NYS is working in collaboration with the Health Plan Association to develop a uniformed UM policy for BH HCBS and plan of care.
August 2015
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Complete RFQ Section 3.1.I Organizational Capacity
Question: Is the Plan required to comply with 8am-6pm hours of operation for core business operations if this varies from existing Plan hours?
Response: Yes, Plans must comply with all standards reflected in the RFQ.
August 2015
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Complete RFQ Section 3.2.A.iv.b Experience RequirementsQuestion: Please clarify the Plan’s responsibility to deliver cultural competency training directly to provider staff vs. establishing a monitoring mechanism
Response: This RFQ requires Plans to monitor compliance with these training requirements, including cultural competence. Whenever possible, training and education for providers should be provided in coordination with the Regional Planning Consortiums (RPCs).
August 2015
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Complete RFQ Section 3.3.L.vi Contract PersonnelQuestion: As a small HARP (under 4,000 members), an MCO would be allowed to share key staff across products (e.g., MMC and HARP). If an MCO with a small HARP delegates services to a BHO, can key BHO staff (e.g., CMO, Med Director) serve more than one Plan within the BHO’s book of business?
Response: Yes, this is correct.
August 2015
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Complete RFQ: Section 3.9.E.ii Utilization Management
Question: What are authorization requirements related to LOCADTR services?
Response: • LOCADTR is for initial and ongoing level of care determinations tool for all OASAS
certified program types. • LOCADTR is a patient placement criteria system designed to assure that a client in need
of substance use disorder services is placed in the least restrictive, but most clinically appropriate level of care available that is to be used in making all initial and ongoing level of care decisions in New York State.
• LOCADTR is developed and updated, as appropriate, by OASAS, and is the clinical level of care tool that assesses the intensity and need of services for an individual with a SUD.
August 2015
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Complete RFQ: Section 3.9.E.ii Utilization Management Cont’d• The Contractor shall ensure that its’ Participating Providers and/or
Contractor’s utilization management staff use the LOCADTR 3 assessment tool to make initial and ongoing level of care determinations for SUD services.
• Please note that while OASAS encourages Plans to identify individual or program service patterns that fall outside of expected clinical practice OASAS does not permit Plans to request / require from providers regular treatment plan updates for otherwise routine outpatient and opioid service utilization.
August 2015
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Complete RFQ Section 3.10.G.i Clinical ManagementQuestion: What is the State’s expectation as it relates to the Plan developing definitive strategies to promote BH/medical integration that include co-location of BH practitioners in primary care and primary care into BH locations?
Performing Provider Systems (PPS) will lead efforts in this area, bolstered by the commitment of DSRIP funding and the State’s support for regulatory relief. Short of lending guidance/input and support for the PPSs, it’s not clear what the State’s assumption is for a Plan role in this integration.
August 2015
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Complete RFQ Section 3.10.G.i Clinical ManagementResponse: Plans should describe new processes and procedures they can implement that promote BH/Medical integration given the multiple statewide initiatives and resources available in Health Homes, DRSIP, etc.
August 2015
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Complete RFQ Section 4.0.A.5 Organization, Experience, and Performance
Question: Does the page limit apply to each government/public sector customer that the Plan/delegate has (i.e., one page per customer), or will the Plan/delegate need to list all of its government/public sector customers on one page.
Response: Plans/delegate must submit 1 page per each government/public sector customer.
August 2015
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Complete RFQ Section 4.0.A.5 Organization, Experience and Performance
Question: Please clarify that this question is only for a BHO responding on behalf of a health plan. We otherwise assume that a Plan’s own experience in managing the BH population and benefits will be answered in A.4.
Response: If the Plan is contracting with a BHO to meet the experience requirements both the Plan and the relevant delegate must respond to questions A.4 and A.5.
August 2015
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Complete RFQ Section 4.0A.7 Organization, Experience and Performance
Question: Please clarify whether this question applies only to BHO applicants or whether Plans proposing to manage without BHO assistance should nonetheless provide details about their current key staff.
Response: The RFQ allows the Plan to meet experience requirements by either contracting with a BHO or using experience of key and managerial BH staff. This question pertains to Plans using experience of key and managerial staff.
August 2015
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Complete RFQ Section 4.0A.12: Organization, Experience and Performance
Question: Please clarify whether this question applies only to a BHO. If it applies to an MCO applying without BHO assistance, has DOH provided the current rate components that comprise the BH portions of a Plan’s rate? It’s not currently clear in a Plan’s rate sheets what proportion of its revenue is for the BH service continuum.
Response: This question applies to the MCOs and HARPs. This question only applies to the amount the Plan paid in calendar years 2013 and 2014.
August 2015
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Complete RFQ Section 4.0.B.4 PersonnelQuestion: Please clarify whether it is acceptable to include total FTE counts in some service areas of a Plan if all FTEs in the service area will be trained and otherwise be available for carve-in or HARP services.
Response: Any staff working on the product line must be trained and reflected in the HARP and MMC Personnel Requirements Table. This table must identify the percentage of time that the staff will work on the MMC and the HARP.
August 2015
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Complete RFQ Section 4.0.B.9 PersonnelQuestion: Are completed training materials required to be submitted with the RFQ response, or will the training plan be sufficient?
Some materials are still in process and will not be completed until DOH releases further guidance to upstate Plans.
Response: A training plan is sufficient as long as it addresses the criteria in Question B.9. Specific training materials will be reviewed during the Readiness Review process.
August 2015
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Complete RFQ Section 4.0.C.1 Member Services
Question: Is it acceptable to maintain two member services call functions – a Plan’s general member services line (with increased training on carve-in and HARP services) and a BH service line for assistance in accessing care, speaking to a care manager, seeking urgent assistance? The BH line would not be used to handle typical member issues, such as requesting a replacement ID card, a replacement copy of a handbook, etc. The process for hand-offs to the BH line would be described in order to show how the two centers work together.
August 2015
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Complete RFQ Section 4.0.C.1 Member Services
Response: It is acceptable to maintain two member services call functions, as long as the BH services call center staff are knowledgeable about:
i. Covered services; ii. NYS managed care rules; iii. Approved BH UM criteria; iv. Approved BH HCBS rules and requirements (for HARPs); and v. Provider networks.
The Plan must describe how the two lines work together and how physical and behavioral health data will be integrated and available to both behavioral health and general member services personnel.
August 2015
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Complete RFQ Section 4.0.D.1 Network ManagementDescribe the specific service area [county or counties] in the responder’s current Medicaid Managed Care contract with NYS including anticipated enrollment and utilization, and the cultural, linguistic and other demographic information that will influence network development.
Question: Can you please provide guidance on the best approach for responding to this question?
August 2015
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Complete RFQ Section 4.0.D.1 Network ManagementResponse: The State recommends outlining the response as follows:
Service Area Population Characteristics Percentage of Service Area PopulationGender Male Female Race/Ethnicity White non-Hispanic Black non-Hispanic Asian Other non-Hispanic Hispanic Limited English Proficiency Lesbian, Gay, Bisexual, Transgender (LGBT), Heterosexual, and Other/Non-conforming
August 2015
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Complete RFQ Section 4.0.D.2 Network Management
Question: Please clarify the page limit for Question 2.
Response: The page limit for this question is one (1)
August 2015
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Complete RFQ Section 4.0.D.10 Network Management“Describe at least one (1) goal, strategy, and measureable outcome, from a public sector client, where improvements occurred in the availability of and member engagement in culturally appropriate BH services (as defined in Section 2.0 of the RFQ). Identify the customer reference(s) that can verify this experience…”
Question: Please clarify if MCOs applying without a BHO are to respond to this question.
Response: Yes, this question applies to all Plans.
August 2015
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Complete RFQ Section 4.0.D.12.b Network Management
Question: This RFQ question implies Plans must make completion of cultural competency training required for successful credentialing. While an admirable goal, this would have a negative impact on network adequacy for Plans whose providers do not timely complete such training. Also, since this RFQ does not permit a Plan to credential individual providers in state clinics, by default this provision would only apply to non-clinic providers. It would then be inequitably applied to BH providers. At this time, please clarify whether completion of such training could be reworded in the RFQ as a goal, not a requirement.
August 2015
54
Complete RFQ Section 4.0.D.12.b Network Management
Response: NYS expects Plans to train all BH providers, including OMH/OASAS licensed and certified credentialed providers, but this is not a condition of the credentialing process. Plans should work together to develop a unified training curriculum.
August 2015
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Complete RFQ Section 4.0.D.16 Network ManagementQuestion: “Provide an example of how the responder has assisted another government/public sector managed BH or similar client to successfully move from fee-for-service to managed care/capitation or to implement payment reform with network providers. Include the challenges and strategies to overcome those challenges. Identify the customer reference(s) that can verify the experience described.” Please clarify if this question is only for BHOs applying on behalf of an MCO.
Response: This question applies to all Plans.
August 2015
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Complete RFQ Section 4.0.D.19 Network ManagementQuestion: Please provide an anticipated release date for the crisis services guidance that the RFQ indicates is in development.
Response: NYS will provide information on network requirements for crisis services in the near future.
August 2015
57
Complete RFQ Section 4.0.D.26 Network ManagementQuestion: Please clarify if MCOs intending to manage the BH services without a BHO should also answer this question and provide information on their current network and any augmentation efforts.
Response: Yes, Plans claiming staff experience and Plans utilizing a BHO must respond to this question. Please include either specific staff that meet the experience requirement and their role in the MMC plan and HARP or describe the planned approach to achieve the systems goals in this RFQ and any anticipated challenges.
August 2015
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Complete RFQ Section 4.0.E.3 Utilization Management
Question: Would the State clarify that denials of services for HCBS would be administrative denials with grievance appeal rights.
Response: Appeals of the BH HCBS assessment are through the State’s fair hearing process. Appeals for denials of access to individual BH HCBS are through the grievance and appeals process. UM guidelines being developed by NYS and the Health Plan Association will address questions related to prior authorization, denials, and appeal processes.
August 2015
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Complete RFQ Section 4.0.E.3.a Utilization Management
Question: Please indicate the anticipated release date for the uniform criteria/guidance for PROS and BH HCBS referenced in this section.
Response: NYS issued guidance related to UM for PROS on August 6th, 2015. NYS continues to work with the Health Plan Association on the UM guidance for BH HCBS. This information will be posted on the State agency websites.
August 2015
60
Complete RFQ Section 4.0.F.2.j Clinical Management
Question: F.2.j- “Which providers (both inpatient and outpatient) will receive performance reports and how often?”
What are the expectations for such reporting. While billable screenings are identifiable in Plans’ claims records, referrals to other services would not be readily accessible without medical record review?
Response: NYS is not issuing specifications for such reports. Plans should propose a process for monitoring provider performance including how information will be relayed to the provider.
August 2015
61
Complete RFQ Section 4.0.F.2.g Clinical Management
Question: Please clarify that guidance for integrated treatment can be required by Plans via policy (and inclusion in the provider manual) rather than in contract. Plan contracts already contain provisions binding providers to Plan policies.
Response: In the response to the RFQ the Plan should describe what guidance they propose for their provider contracts versus policy conveyed in the provider manual.
August 2015
62
Complete RFQ Section 4.0.F.7 Clinical Management
Question: Please clarify that references to contract requirements can be met with the institution of new policies. Contracts currently contain provisions that bind providers to Plan policies, including the topics/areas included in this section.
Response: The Plans will need to amend their provider contracts to conform with the requirements in the Managed Care Contracts with the State.
August 2015
63
Complete RFQ Section 4.0.I.1.b Reporting and Data Management
I.1.b.-“Describe an experience with receiving and loading provider information to accommodate a State’s BH provider network. If staff experience is claimed, please note this and answer accordingly.”
Question: Please clarify if this question is applicable only to BHOs. Plans load and submit provider data regularly to the State currently. Is that what a health Plan applying on its own should describe?
Response: Yes, Plans claiming staff experience and Plans utilizing a BHO should respond to this question.
August 2015
64
Complete RFQ Section 4.0.J.1 Claims Administration J.1- “Describe the responder’s experience for processing Medicaid claims specific to those services being added under the RFQ, including prior and current clients, type of claims administration (ASO or at risk), and the number of covered lives.”
Question: Please clarify how a Plan applying without a BHO should respond to this question. While Plans process considerable BH claims now, the new services to be carved in may not have been part of its current claims experience. Should Plans report on their current claims processing capabilities?
August 2015
65
Complete RFQ Section 4.0.J.1 Claims Administration Response:
• Yes, Plans should report on their current claims processing capabilities and changes necessary for BH services claims to be processed.
• Plans not using a BHO should indicate how they will bring in the expertise to understand new behavioral health programs and their reimbursement.
August 2015
66
Complete RFQ Section 4.0.K Financial Management
Question: Please clarify whether risk mitigation for Upstate HARPs will include risk corridors in addition to stop loss.
Response: Yes, the same general provisions as for the NYC HARPs will apply. NYS will be issuing guidance in the near future.
August 2015
67
Complete RFQ Section 4.0.K.4 Financial Management
Question: Please clarify if this section applies only to HARP applicants.
Response: Yes, this question applies only to HARP.
August 2015
68
Complete RFQ Section 4.0.K.5 Financial Management
Question: Please clarify if this section applies only to HARP applicants.
Response: Yes, this question applies only to HARP.
August 2015
69
Complete RFQ Attachment BQuestion: Reporting requirements including CMS assurances/subs for Health Home (HH) and BH HCBS:
• How will Homeless, TAY, FEP, AOT, Criminal Justice cases be defined and how will the Plan be notified?
• Can the State provide clarity on actual reporting requirements with definitions?
• What are the implications for reporting on the BH HCBS? Any additional detail the State can provide?
Response: Detail for reporting requirements is not yet available. The Federal assurance and sub assurance requirements are being finalized. Additional information will be forthcoming.
August 2015
70
Expedited RFQ Section 1.5.A.iv Program DesignQuestion:
While the RFQ clearly states that managed care excludes reimbursement for inpatient care for persons 21-61 in state operated psychiatric inpatient hospitals, it further goes on to state that OMH and DOH will work with the MCOs to make the Plans accountable financially and programmatically for continuing admissions/transfers of their members to the State facilities.
Can you please clarify the intent of this requirement?
August 2015
71
Expedited RFQ Section 1.5.A.iv Program DesignResponse:
• The objective of this provision is recognition that inpatient admissions to OMH are short term.
• Therefore despite the Plans not being financially responsible, the State wants the Plans and HH to understand the patient will be discharged back into the community and will generally be enrolled in the same MCO/HARPs and HH.
• NYS is developing strategies to link the Plans and HHs during OMH inpatient admission.
August 2015
72
Expedited RFQ Section 1.12 Historical Utilization and Cost
Question: The data book issued for the ROS and NYC is the same. Mercer and DOH have stated in the past that the data book includes costs for some BH services that are already part of existing services covered by the MCOs.
We requested a breakout of estimates for the costs currently covered by the MCOs from Mercer and DOH so we could isolate the marginal costs for the new benefit in the data book.
Is it possible for this information to be released so MCOs can assess the marginal cost of providing services for the BHO carve-in?
August 2015
73
Expedited RFQ Section 1.12 Historical Utilization and Cost
Response:
• Rest of State Behavioral Health Funding• $646M in BH funding is being moved into the Medicaid Managed
Care Plans.• Of that $646M, $404M in BH funding is being moved into the
HARPs.• Draft Rest of State HARP Rates can be found on the OMH
website: http://omh.ny.gov/omhweb/bho/harp-ros-draft-rates.pdf
• Please refer to the MMC and HARP Data books for more information. http://omh.ny.gov/omhweb/bho/data-book.pdf
August 2015
74
Expedited RFQ Section 1.11 and 1.12 Historical Utilization and Cost
Question: DOH has said the rates for the NYC BHO carve-in will be released to Plans in late July. Will Mercer and DOH use a similar approach to rate development for the ROS as they did for NYC?
If Mercer intends to use different key rating assumptions (i.e., such as administration and retention elements, managed care savings, etc.) for the ROS than what it publishes for NYC, can MCOs receive guidance during the rate setting process so an accurate assessment of the expectations underlying the rate can be made?
August 2015
75
Expedited RFQ Section 1.11 and 1.12 Historical Utilization and Cost
Response: Yes. A similar approach to NYC will be utilized for Rest of State rates. All rate assumptions and other information will be shared with Plans via a rate briefing with Mercer.
August 2015
76
Expedited RFQ Section 3.3.N.i Contract Personnel
Question: Please confirm that staffing positions dedicated solely to the performance of work "under the RFQ" means that the individuals need to be dedicated to the BH and HARP product lines in general rather than just to these product lines outside of NYC.
Plans must hire incremental staff to support the products in the ROS; however, if Plans can provide rationale showing that existing staff dedicated to BH/HARP in NYC can support the additional membership, it would not be necessary to hire duplicative staff.
August 2015
77
Expedited RFQ Section 3.3.N.i Contract PersonnelResponse:
• Plans can propose which lines would have responsibilities for both NYC and ROS.
• If such proposals indicate that an individual’s NYC time will be reduced from the level approved by NYS during the NYC readiness reviews, the Plan must propose a clear rationale for the change that explains how the Plan will ensure the individual can adequately meet responsibilities in both NYC and ROS.
August 2015
78
Expedited RFQ Section 3.5. Table 3 Network Service Requirements
Question: Please indicate how regions are defined for rural county access standards. Are these the OMH/OASAS regions?
Response: NYS public health law defines a rural county as any county having a population of less than 200,000. These regions are not coterminous with OMH/OASAS regions.
August 2015
79
Expedited RFQ Section 3.11 Cross Systems CollaborationQuestion: Can you please clarify the number of Regional Planning Consortiums (RPCs) and the counties that each of the RPCs will cover?
Response: There will be 10 RPCs covering the counties throughout NYS, plus an RPC for NYC.
August 2015
80
Expedited RFQ Section 4.0Question: The RFQ requests that "Proposal materials shall be organized into 4 3‐ring binders with tab dividers corresponding to headings in Section 4.0."
Is the Respondent expected to provide one complete response in no more than four 3‐ring binders or four copies of a complete response, using only 3‐ ring binders?
Response: Complete Expedited RFQ responses should be in 1 3-ring binder and there should be 4 sets of complete responses.
August 2015
81
Expedited RFQ Section 4.0Question: The RFQ released on 7/10 states that “Plans must complete all HARP questions in the Behavioral Health Managed Care RFQ released on 7/03.” The 7/10 RFQ also contains HARP questions (some of which are duplicates of the 7/3 version).
Should Plans respond to the HARP questions from both RFQs or only the HARP questions from the 7/3 RFQ?
Response: Plans that submitted a HARP application during the NYC designation process should only respond to the HARP questions in the Expedited RFQ. These instructions pertain to Plans that applied for the HARP benefit in NYC.
August 2015
82
Expedited RFQ Section 4.0Question: Does the 12 pt font requirement apply to tables as well? We have found that tables and graphics are often much clearer when using 10 pt font.
Response: 10 point font is acceptable for the tables.
August 2015
83
Expedited RFQ Section 4.0
Question: For Plans that have already qualified for HARP in NYC, are they required to answer the HARP only questions in the Behavioral Health Managed Care Request for Qualification Application released on 7/3/2015 or just Section 4.0 in the Expedited RFQ?
Response: Yes, NYC HARPs must complete the HARP questions in the Expedited RFQ Application.
August 2015
84
Expedited RFQ Section 4.0
Question: Please confirm that the option to submit "No change since NYC designation" indicates no change since materials were approved as part of the most recent readiness review to serve Adult Behavioral Health and as a HARP in NYC.
Response: If response has been addressed through submissions from the NYC readiness review process Plans may respond “no changes since NYC readiness review process”
August 2015
85
Expedited RFQ Section 4.0.A.3 Organization, Performance and Experience
Question: Section A.3 directs respondents to “Identify any change of entity, including a parent, subsidiary, or other related organization, with which the responder intends to delegate, through a partnership or subcontract, any administrative or management services required under the RFQ.” If there is no change, Section A.3 gives respondents the opportunity to indicate “no change since NYC designation.”
Please confirm that the opportunity for “no change since NYC designation” applies to each subcontractor individually and not section A.3 in total.
Response: This is correct. Please provide information requested in A.3 for each new subcontractor.
August 2015
86
Expedited RFQ Section 4.0.A.3 Organization, Performance and ExperienceQuestion: For response to section A.3, page 84, if there has been no “change of entity” but certain information about a partner/subcontractor has changed, i.e. its legal name, is the respondent required to provide a new response for partner/subcontractor, or should they only identify the new name (or other information that may have changed), but otherwise indicate “no change since NYC designation?”
Response: Please provide information if there have been any changes to an existing subcontractor. For example if the name of the subcontractor changed since the NYC RFQ, please include the original name and the new name.
August 2015
87
Expedited RFQ Section 4.0.A.3 Organization, Performance and Experience
Question: If there has been no change in a subcontractor/partner, should respondents submit updated Business Continuity, Disaster Recovery, and Emergency Response Plans from the subcontractor/partner?
Response: If there has been no change in the Business Continuity, disaster recovery, and emergency response plans no additional information is necessary and the Plan can indicate “no change.”
August 2015
88
Expedited RFQ Section 4.0.C Network Management
Question: In the identification of the specific counties to be served, if Plans have applied to DOH to expand their service area should this be indicated?
Response: Yes, Plans should indicate which counties are pending DOH approval.
August 2015
89
Expedited RFQ Section 4.0.C.6 Network Management
Question: Does the State have a list of existing crisis providers for each of the counties?
Response:
A list of OMH crisis providers can be found at the following link:
http://bi.omh.ny.gov/bridges/directory?region=&prog_selection=03
A full searchable list of all OASAS programs types, including crisis services, by county may be found at the following link:
https://www.oasas.ny.gov/providerDirectory/index.cfm?search_type=2
August 2015
90
Expedited RFQ Section 4.0.C.6 Network Management cont’d.
Response:
• The CMS 1115 waiver approval authorizes the State to require all MCOs to include Crisis Intervention services in their networks.
• These network requirements are expected to develop as a comprehensive local crisis intervention system is established throughout the State.
• To meet current standards for Crisis Intervention adequacy, the network should be comprised of existing providers of the following crisis services: OMH Clinics, Comprehensive Psychiatric Emergency Programs (CPEPs), and designated BH HCBS Mobile Crisis providers.