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Medicaid Case Management Program RFQ Information Session

Medicaid Case Management Program RFQ Information Session. February 10, 2016. Catherine Lester, Director | Ed Murray, Mayor | Hyeok Kim, Deputy Mayor | Kate Joncas, Deputy Mayor. Summary. Review timeline Overview of Medicaid Case Management Program RFQ Investment area and funding source

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Medicaid Case Management Program RFQ Information Session

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  1. Medicaid Case Management Program RFQ Information Session February 10, 2016 Catherine Lester, Director|Ed Murray, Mayor |Hyeok Kim, Deputy Mayor | Kate Joncas, Deputy Mayor

  2. Summary • Review timeline • Overview of Medicaid Case Management Program RFQ • Investment area and funding source • Service Delivery Framework • Client Eligibility • Focus Population and Priority Community(ies) • Expected Service Components • Outcomes and Indicators • Key Staff • Agency Eligibility • Data & Program Reporting • Review and Rating Process • Submission Process • Appeal Process • Questions & Answers Coordinator: Andrea Yip, 206-386-0035, andrea.yip@seattle.gov

  3. Timeline • Funding Opportunity AnnouncementTuesday, January 26, 2016 • Seattle Daily Journal of Commerce • HSD Funding Opportunities Web Page http://www.seattle.gov/humanservices/information-for-grantees • Mayor’s Weekly/HSD Blog website/Life Lines newsletter • Information Sessions Wednesday, February 10 9 a.m. – 11 a.m. Bellevue City Hall, room 1E-113 • Question & Answer Deadline Friday, February 19, 2016 12 p.m. • Application Deadline Tuesday, March 1, 2016 4 p.m. • Review & Rating Process March 14 – 28, 2016 • Agency Notification Thursday, May 5, 2016 • Appeal Process May 9 – 19, 2016 • Public Announcement of Awards May 20 (if no appeal) • Contract Start Date Friday, July 1, 2016

  4. Investment Area and Funding Source • This Medicaid Case Management Program RFQ is an open and competitive funding process. • Funding for the RFQ will be based on client volume and a negotiated rate. The program is fee for service and can range from $102.75 to $115 per client per month. • Funding awards will be made for the period of July 1, 2016 – June 30, 2017. • Continued investment after the initial contract period will be contingent on successful performance and funding availability.

  5. Overview of RFQ: Service/Program Model • Medicaid Case Management is part of the Medicaid state plan and 1915(c) waivers that provide an array of long term services and supports (LTSS). • Primary goal of case management is to enable vulnerable adults to reside in the setting of their choice with long term services and supports that maximize independence, dignity, and quality of life. • Shared responsibilities with Department of Social and Health Services (DSHS) and the Area Agency on Aging. • Aging & Disability Services along with three sub-contract providers: Evergreen Care Network, Asian Counseling and Referral Services, and Chinese Information & Service Center provide case management in King County.

  6. Overview of RFQ: Criteria for Eligible Clients • Clients are 18 and older living in King County who are eligible to receive Medicaid LTSS in their own home. • DSHS caseworkers determine client eligibility by assessing functional unmet need using a state assessment tool (CARE) and conducting a Medicaid financial determination. • Functional eligibility is determined based on how much support is needed for performing activities of daily living (dressing, bathing, hygiene, mobility, etc..), cognitive impairment, and complex medical/psychosocial needs. • If eligible and a client chooses to receive LTSS in their own home, case management responsibilities are transferred to the Area Agency on Aging.

  7. Overview of RFQ: Focus Population and Priority Community • Refer to pages 7-10 of the Guidelines and Application document. • 10,500 LTSS clients served monthly in King County. • Growth rate is about 3.5% per year, or about 400 new clients each year. • Focus population are clients residing in East King County – approximately 1100 as of December 2015. • Secondary focus is on addressing growth specifically with refugee and immigrants from Russian, Ukraine, the Middle East and East Africa.

  8. Overview of RFQ: Expected Service Components • Required Functions of Case Management • Assessment and care plan development • Implementing and monitoring care plan • Authorizing Medicaid in-home services • Working with Individual Providers (IP) and homecare agencies to meet the client’s personal care needs • Mandatory reporting – both abuse/neglect/exploitation and suicide ideation • Planning for service closure and transition to other services • Nurse Consulting • Educate clients, providers and case managers about health-related assessment topics • Act on triggered referrals from CARE tool • Supportive Functions • Client advocacy • Referrals to healthcare providers, behavioral health, other social supports • Family support • Crisis intervention • Access resources (e.g. assistive technology)

  9. Overview of RFQ: Expected Outcomes and Indicators • Vulnerable adults remain independent in their homes for as long as possible. Indicated by: • Timely annual comprehensive assessment and service plan • Appropriate authorizations and referrals • Number of contacts with clients • Payment is a unit rate and based on a client having an open in-home service authorization per month. • The unit rate will be determined during contract negotiations and based on proposed budget and agreed upon number of clients. • Agencies should propose to serve a minimum of 500 client per month.

  10. Overview of RFQ: Key Staffing and Staffing Level • Refer to Page 12 of the Guidelines and Application document. • Required roles: program management, clinical supervision, case management, nursing staff. • Supportive/Specialized roles: staff training, case aides • Staffing guidelines: • Case manager to client ratio 1:92 • Nurse to client ratio 1:800 • Case handling staff to client ratio 1:71 (case managers, nurses, case aides only) • Supervisor to case handling staff ratio 1:10 • Case Manager Qualifications • Bachelor’s degree in social services, psychology, or related field • Three years of social service experience

  11. Agency Eligibility • Applicant must meet all licensing requirements that apply to its organization.  Companies must license, report and pay revenue taxes for the Washington State Business License (UBI#) and Seattle Business License, if they are required by the laws of those jurisdictions. • Applicant must have a Federal Tax ID number/employer identification number (EIN) to facilitate payments from the City of Seattle to the provider. • Applicant must be incorporated as a private non-profit corporation in the State of Washington and must have been granted 501(C) (3) tax exempt status by the United States Internal Revenue Service, the applicant’s 501(C) (3) status must be in good standing and must not have been revoked in the previous calendar year.  OR • If the applicant is a public corporation, commission, other legal entity or authority established pursuant to RCW 35.21.660 or RCW 35.21.730, the applicant’s status as a legal entity must be in good standing and must not have been revoked in the previous calendar year. • Applicants cannot also be a provider of Medicaid LTSS services such as homecare. There is a conflict of interest if the agency both authorizes and delivers service. If an applicant has a conflict, then clearly outline how the agency will mitigate the conflict.

  12. Client Data and Program Reporting • Agencies must be able to collect and report client-level demographic and service data.  • Agencies must implement policies and procedures to ensure privacy and confidentiality of client records for both paper files and electronic databases. • Agencies must have the ability to submit reports electronically to ADS.  Current data specifications are available on the ADS website (www.agingkingcounty.org; click “Service Providers” then “Reporting Requirements”). • Agencies will be required to enter client-level data in the statewide Comprehensive Assessment and Reporting Evaluation (CARE) System to evaluate client functioning and authorize in-home hours and supports. • A VPN account for each case manager will be provided. 

  13. Review and Rating Process • Review for minimum eligibility and application completeness. Applications that are late, incomplete, or did not follow the required format will be deemed ineligible and will not be rated. Applications must include: • A completed Application Cover Sheet with a physical signature • A completed Narrative Response • A completed Proposed Program Budget • A completed Proposed Personnel Detail Budget form • Proof of IRS nonprofit status, or evidence of incorporation or status as a legal entity • Current Board of Directors roster • Minutes from last 3 Board of Directors meetings • Start-up timeline • On-time, complete applications meeting all eligibility requirements are forwarded to the Rating Committee for their review and rating according to the rating guidelines. The Rating Committee will make funding recommendations to the HSD Director.

  14. Review and Rating Process • Agency Financials and Insurance information will be requested only of agencies whose applications meet minimum eligibility and move to the rating committee. • Agencies for which we have current financial and insurance documents will not be required to resubmit. • Agencies for which we have incomplete or no financial and/or insurance documents will be notified by the Coordinator and required to submit ALL requested documents within 4 business days from the date of written request. • Financial and Insurance documentation that may be requested are listed in Section IV. of the Application (pg. 23). Be sure you are prepared to provide these to the Coordinator upon request.

  15. Review and Rating Process: Minimum Eligibility Screening • HSD will notify applicants, as soon as possible and in writing, if the application was incomplete or did not meet the minimum eligibility requirements and will therefore NOT be rated by the rating committee. • Applicants who believe that this determination was made in error may submit a written appeal within 5 business days from the date of written notification by HSD. • Such an appeal will only be determined to have merit if the applicant proves that the application did meet the minimum requirements, qualifications, formatting standards, and was complete. • No additional information or details not included in the original application will be considered. • A successful appeal will result in the inclusion of the application in the review and rating process (and does not guarantee an award).

  16. Rating Guidelines Program Design 30% Capacity and Experience 45% Cultural Competency 15% Budget and Leveraging 10%

  17. Submission Deadline • Submission deadline is 4:00 p.m. on Tuesday, March 1, 2016. • All applications must be received in person, by mail, or electronic submission by deadline. • No faxed or e-mailed applications will be accepted.

  18. Methods of submission • Applications can be mailed or hand delivered to: Seattle Human Services Department RFQ Response – Medicaid Case Management ATTN: Andrea Yip 700 Fifth Ave, Suite 5800 P.O. Box 34215 Seattle, WA 98124-4215 • Applications can be submitted online at: http://web6.seattle.gov/hsd/rfi/index.aspx.

  19. HSD Online Submission System • The HSD Online Submission System is a web-based program that allows applicants to upload their application for HSD Funding Opportunities (e.g. RFI, RFP, RFQ). • The system is NOT an online Application (e.g. it does not include assigned logins, ability to insert narrative responses within the system, manage your applications, etc.) • You may upload files up to a maximum of 100 MB. • Acceptable file types include: .pdf .doc .docx .rtf .xls .xlsx • There are required fields to be completed as well, depending on how many files you are uploading. Ensure you allow sufficient time to complete the steps in order to submit your application by the deadline. • The system automatically sends out an e-mail confirmation to all the e-mail addresses you entered.

  20. HSD Online Submission System • Review the Online Submission Assistance Page for helpful information: http://web6.seattle.gov/hsd/rfi/help.aspx. • All applicants are expected to make arrangements to ensure that applications are received by HSD by the funding opportunity application deadline. You are encouraged to submit your application early when possible. It is advisable to upload your documents several hours prior to the deadline in case you encounter an issue with your internet connectivity which impacts your ability to upload documents. If you encounter internet connectivity issues, attempting to submit your application early will allow time for you to submit a hard copy by the deadline instead. • HSD is not responsible for ensuring that applications are received by the deadline. • If you experience any issues and/or have questions about the online submission system, please contact Susan McCallister, HSD Funding Process Advisor, by phone at (206) 233-0014 or e-mail at susan.mccallister@seattle.gov.

  21. Before you respond… • Understand the focus and outcomes of the funding opportunity. • Do they match your agency’s mission and goals? • Evaluate your agency’s service capacity. • Ask questions!

  22. More tips… • Follow the required format defined in the Guidelines • Be specific, detailed, and concise • Answer all questions and in the context of your proposed program(s) • Submit an accurate budget; double check your numbers • Propose plans for addressing services that are not in place • Have someone else read your application before submitting • Use the application submission checklist to ensure that you have addressed all questions and requirements • Ensure enough time for application to get to HSD on time • Questions? E-mail Andrea Yip andrea.yip@seattle.govby12 p.m. Friday, February 19, 2016

  23. Post-Notice of Award Appeal Process Applicants have the right to protest or appeal certain decisions in the award process made by HSD. Grounds for Appeals: Only an appeal alleging an issue concerning the following subjects shall be considered: • A matter of bias, discrimination or conflict of interest. • Violation of policies or failure to adhere to guidelines or published criteria and/or procedures established in the funding opportunity. Appeals Deadlines: • Appeals must be received within ten (10) business days from the date of written application status (award/denial). • The HSD Director will review the written appeal and may request additional oral or written information from the appellant organization. A written decision by the HSD Director will be made within ten (10) business days of the receipt of the appeal. The HSD Director’s decision is final. No contracts resulting from the solicitation will be executed until the appeal process has closed. An appeal may not prevent HSD from issuing an interim contract for services to meet important client needs.

  24. Questions and Answers (V.2.0 - 2016)

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