NPNConsultantRFI_Responses 4-18-24.xlsx
XLSX spreadsheet 13 KB Posted
- Attached to
- Request for Information (RFI) | NPN Strategy Consultant for the World Trade Center Health Program
- Solicitation number
- 75D301-24-RFI-NPNCons
About this file
This document is a Request for Information (RFI) issued by the Department of Health and Human Services Centers for Disease Control and Prevention (CDC) regarding the World Trade Center (WTC) Health Program's Nationwide Provider Network (NPN). The RFI aims to gather insights and capabilities from experts in long-term planning and strategy development for nationwide healthcare programs to support the NPN's future growth and effectiveness.
The RFI includes a question and answer template with 10 questions covering topics such as data availability, program requirements, billing and coordination of benefits, and proposal timeline. The RFI states that responding to this RFI will not prohibit competing on the future NPN contract. The government is unable to extend the proposal due date of April 24, 2024 at 5pm Eastern, despite vendor requests for additional time to incorporate the government's responses to the vendor questions due on April 16, 2024.
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| File | Type | Posted |
|---|---|---|
| 20240402_NPNConsultantRFI_BackgroundData.xlsx | XLSX spreadsheet | |
| NPNConsultantRFI_20240410.docx | DOCX document |
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Sheet1
| Question and Answer Template | ||||
| Request for Information (RFI): 75D301-24-RFI-NPNCons | ||||
| Question Number | RFI Reference | Question | Response | |
| 1 | Excel Document Addendum | Is there an excel document that shows the number of NPN enrollment by State, including NYMA, from 2019-2024? If possible, by provider specialty. | No. Currently this data is not available. | |
| 2 | Excel Document Addendum | Is there an excel document that shows the number of Program members by State, including NYMA, from 2019-2024? | No. Currently this data is not available. | |
| 3 | Page 3: The WTC Health Program also contracts with a Third-Party Administrator (TPA) that manages enrollment eligibility, provider network, and claims processing for the NYMA CCEs and contracts with a Pharmacy Benefits Manager (PBM) to administer pharmacy benefits to Program members, both of which the NPN interfaces with. | Does the PBM administers pharmacy benefits to Program members outside of NYMA or just within? | PBM administers benefits to all Program members. | |
| 4 | Page 3: 1. | Unique Monitoring Requirements: Members are entitled to an Initial Health Evaluation (IHE) and Annual Monitoring Exam (AME), the components of which are Program-specific and not an industry-standard physical. These exams include certain questionnaires, tests and diagnostics needed to diagnose WTC-related conditions. | How many members on average by year by each state complete an Initial Health Evaluation (IHE) and Annual Monitoring Exam (AME) | Currently this data is not available. |
| 5 | Page 4: 4. | Unique Billing Requirements: The Program is required to collect and maintain Other Health Insurance (OHI) for all members and facilitate COB for Survivors, as the Program is the payer of last resort for treatment claims. For effective COB, the provider needs to comply with the primary insurance’s billing requirements, as well as the Program’s. This can be challenging, particularly for providers unfamiliar with the COB process. | Can we get a list of Other Health Insurance Providers to navigate industry wide challenges that industry providers may be dealing with, that may impact Program's NPNs as well? | No. Current Program members have a mix of public and private insurance coverage including employer-based insurance and government programs like Medicare and Medicaid. |
| 6 | Page 4: 5. | The NPN Contractor coordinates benefits for both the Responder and Survivor populations, which have different requirements. For example, only Responders can be certified for musculoskeletal disorders and only Survivor claims require coordination of benefits. | Is there a list of diagnosis category certificates that is specific to responders vs. survivors? | Musculoskeletal disorders are the only category of conditions that are different for responders vs. survivors. For more information, please see the Program website: https://www.cdc.gov/wtc/conditions.html |
| 7 | Pg. 3 - Some unique requirements for the NPN are mandated by the Zadroga Act, impacting all Program contractors, including: | Are there any requirements (legislative of other) specific to WTCHP's NPN beyond those referenced in the RFI under the Zadroga Act? | For more information on NPN requirements, see the following references: |
- Members must have minimum essential coverage as part of the Affordable Care Act
- Zadroga Act - https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title42-chapter6A-subchapter31&edition=prelim
- 42 C.F.R. Part 88 - https://www.cdc.gov/wtc/regulations2.html
- WTC Health Program Administrative Manual - https://www.cdc.gov/wtc/ppm.html#npn
| 8 | Pg. 5, Section V.3: Responses (white paper) Due By: April 24, 2024 at 5pm Eastern. Send responses to Michael Baron at lpc0@cdc.gov. Please include “WTC Health Program | RFI 75D301-24-RFI-NPNCons” in the subject line. | The government will require time to provide responses to the vendor Q&A due on 4/16/2024; Would the government also consider extending the proposal due by a full (7) days from the date of delivery of Q&A responses from the government if the due date is less than that to give vendors adequate time to incorporate critical information into their proposal response? | The Program is unable to extend the due date at this time. |
| 9 | General Question | Will responding to this RFI pose any restrictions on a contractor bidding on the future NPN contract? | No, responding to this RFI will not prohibit competing on the NPN contract. |
| 10 | General Question | Would the government consider an extension to this timeline to allow adequate time for incorporating Q+A responses? | The Program is unable to extend the due date at this time. |
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