attachment-2-rfa-2027-dltss-03-mfptc-appendix-a-1.pdf
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- Solicitation number
- RFA-2027-DLTSS-03-MFPTC
- Issued by
- Belknap County, New Hampshire
About this file
This document is Appendix A-1 to Request for Proposals RFA-2027-DLTSS-03-MFPTC issued by the New Hampshire Department of Health and Human Services for the Money Follows the Person Transitional Case Management program. The appendix outlines Medicaid billable supplemental services that contractors must provide to support individuals transitioning from institutional settings to community-based living. Pre-transition services include funding transportation for housing viewings (up to $300 per person), housing application and related fees including background checks (up to $1,300 per person), home accessibility modifications (up to $20,000 per person), home cleaning and pest eradication (up to $2,000 per person), security deposits (up to $2,000 per person), utility deposits (up to $1,000 per person), and household establishment items (up to $5,000 per person). Contractors must also coordinate furniture and equipment delivery and set up, and submit all supporting documentation and claims through the New Hampshire Easy account and Medicaid Management Information System (MMIS) at least fifteen days prior to participant transition.
Post-transition services require contractors to arrange and fund pantry and kitchen stocking within the first thirty days of community transition (up to $400 per person) and bill Medicaid for case management services from month four through month twelve of community tenure using the current Contextual Family Intervention (CFI) Case Management reimbursement rate. All pre-transition expenses must be pre-authorized by the Department, and these supplemental services are billed separately to Medicaid and are not included in the overall price limitation of the agreement.
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New Hampshire Department of Health and Human Services Money Follows the Person Transitional Case Management
Appendix A-1 – Medicaid Billable Supplemental Services
RFA-2027-DLTSS-03-MFPTC Contractor Initials __________
v. 1.0 Page 1 of 2 Date __________
Medicaid Billable Supplemental Services
1. The Medicaid Billable Supplemental Services described in this Appendix A-1 shall be billed to Medicaid as described herein, and shall not be billed to the overall price limitation of the Agreement.
2. Pre-Transition Services
2.1. The Contractor must fund transportation that has been arranged by Housing
Navigators for home visits that allow participants to view available housing options in the community prior to transition and submit claims for reimbursement as outlined in 1.6 below. Funding for this activity shall not exceed $300 per person.
2.2. The Contractor must fund housing application and related fees including criminal background checks, credit checks and vital record request fees prior to transition and submit claims for reimbursement as outlined in 1.6 below.
Funding for this activity shall not exceed $1,300 per person.
2.3. The Contractor must submit estimates and other supporting documentation as needed to the Department for pre-authorization approval, for the following services prior to the commencement of providing:
2.3.1. Home accessibility modifications not to exceed $20,000 per person;
2.3.2. Home cleaning and/or pest eradication not to exceed $2,000 per person;
2.3.3. Security deposits not to exceed $2,000 per person; and
2.3.4. Utility deposits not to exceed $1,000 per person.
2.4. The Contractor must fund, coordinate and monitor completion of the following services and submit claims for reimbursement as outlined in section 1.6..
Funding for each service listed below shall not exceed funding caps as outlined in Section 1.3.
2.4.1. Home accessibility modifications, which must include:
2.4.1.1. Coordinating home modification assessment with approved provider;
2.4.1.2. Coordinating and scheduling home modification; and
2.4.1.3. Monitoring for completion.
2.4.2. Home cleaning and/or pest eradication which may include:
2.4.2.1. Scheduling home cleaning, including mold remediation, pest eradication, and other services to ensure home environment is healthy.
2.4.3. The Contractor must fund and submit claims for reimbursement as outlined in 1.6 below for securing items needed to establish a
New Hampshire Department of Health and Human Services Money Follows the Person Transitional Case Management
Appendix A-1 – Medicaid Billable Supplemental Services
RFA-2027-DLTSS-03-MFPTC Contractor Initials __________
v. 1.0 Page 2 of 2 Date __________ household. Funding for this service shall not exceed $5,000 per person. This activity includes:
2.4.3.1. Facilitating a meeting to identify participant’s preferences, and document within the person-centered plan.
2.4.3.2. Shopping for and securing all items necessary to establish a household, such as cleaning and cooking supplies, home furniture, and other items utilizing an approved purchase list provided by the Department. Any exceptions to the list must be approved by the Department prior to purchase.
2.5. The Contractor must coordinate all furniture and equipment delivery and set up.
2.6. The Contractor must submit corresponding receipts for all service authorizations listed in 1.7 and 2.1 through the Contractors New Hampshire Easy account.
2.7. The Contractor must submit claims through MMIS, to the Department for reimbursement a minimum of fifteen (15) days prior to the participant’s transition into the community, unless otherwise authorized by the MFP Program Administrator for the following pre-transition expenses:
2.7.1. Transportation to view community housing options;
2.7.2. Housing application and related fees including criminal background checks, credit checks and vital record request fees;
2.7.3. Home accessibility modifications;
2.7.4. Home cleaning and/or pest eradication;
2.7.5. Security deposits;
2.7.6. Utility deposits; and
2.7.7. Items needed to establish a household.
3. Post-Transition Services
3.1. The Contractor must arrange for, purchase and submit a claim for reimbursement to the Department for pantry and kitchen stocking items purchased within the first thirty (30) days of the participant’s community transition. Funding shall not exceed $400 per person.
3.2. The Contractor must bill Medicaid for case management services starting with month four (4) through month twelve (12) of community tenure, if applicable utilizing the currently available monthly CFI Case Management reimbursement rate.
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