Bidders conference QA_04112018.docx

Questions and Answers from Bidders Webinar

RFR 190727

Tuberculosis Outpatient Services

1. How many contracts will be awarded?

MDPH will qualify facilities with the capacity to provide the access, diagnosis, and management of persons with, or at risk for, tuberculosis. There is no maximum or minimum number of contracts to be awarded.

2. Will grantees be encouraged to send specimen to the MDPH State Lab if a process for our internal hospital lab is already in place?

We will encourage vendors to send specimens to the Massachusetts State Public Health Laboratory (see Section 2.7). These specimens will be processed for smear, nucleic acid amplification testing (NAAT), speciation and drug susceptibility testing as well as management of specimens for genetic sequencing. For persons who have positive cultures for M. tuberculosis from any site, the M. tuberculosis-positive isolate must be submitted to the MA SPHL for confirmation of identification and drug-susceptibility testing, no matter where the laboratory performing the culture is located. Specimens labeled as TB clinic patients and submitted by approved applicants to the MA SPHL’s TB Laboratory will be processed without charge to the submitter or patient’s insurance.

MDPH will not require vendors to routinely send specimens to the State Public Health Laboratory. Facilities may test specimens in-house or follow their workflow for outpatient laboratory submissions.

3. We are concerned about how the recent changes in MassHealth will impact this service. For example, if a TB patient comes to us (our site is a PCC) and is enrolled under an ACO, can we still provide services? Can/should we try to get their plan coverage changed (which may not make sense if the patient receives all other medical care through an ACO)? Would a referral from the patient’s primary care physician suffice? Or will MassHealth make any kind of exception for these services that will allow us to bill for TB services?

The MDPH Bureau of Infectious Disease and Laboratory Sciences (BIDLS) is working with MassHealth to address issue of ACO membership relative to coverage of TB services. In the interim/until we get an answer, MDPH will serve as payer of last resort for services that aren’t paid by insurance as a result of being out of network. We’re in a complex healthcare environment. As a payer of last resort, if attempts to bill insurer isn’t successful, charges can be submitted to DPH.

4. Should we submit the Agency Demographic Chart for the entire organization or just the area of our facility that will be working most closely with TB patients?

The Agency Demographic Chart is a required attachment. Applicants may complete the chart for either the entire facility or the area that responsible for TB outpatient services. While our preference is that the applicant’s chart reflects the TB outpatient services area, MDPH will accept either chart.

5. Will DPH provide administrative support?

The TB outpatient services contracts are unit rate contracts. The rates are based on the services billed by CPT code. To the extent that the rates incorporate associated administrative costs, it would be the expectation of MDPH that administrative services would be funded through the reimbursement revenue. There is not a separate line in the contracts for administrative support.

6. Where are the attachments?

All attachments are posted on COMMBUYS https://www.commbuys.com/bso/external/bidDetail.sdo?docId=BD-18-1031-BID00-BID02-25058&external=true&parentUrl=bid

On the webinar, we clicked on the REQ Documents Required with Application for Response; this opened a .zip folder. Open the .zip folder and there are four required files – two in Word and two in Excel. One of the Excel files is the Agency Demographic Table.

The “Read only” files are for your own reference and do not need to be returned to MDPH with your application. In this folder are standard MDPH guidance documents (for example, Community Health Workers) as well as documents that are specific to this RFR (for example, a sample charge master). This sample charge master includes CPTs for Evaluation and Management, Laboratory, Radiology, and Medicine.

7. There is information in the RFR that the state will "pay" or reimburse costs for interpreter services? Is that separate from the state payment as payer of last resort for "A" or "B" type visits?

In Section 4.3, there is reference interpreter services: One unit of interpreter service can be billed to MDPH by non-HRSA funded facilities following rejection by the primary insurer. This provision is included in recognition that the facility may provide a higher intensity of interpreter services for the population served for TB outpatient services than the general patient population. Again, MDPH is the payer of last resort. Most interpreter costs are billed into rate so not a separate billable line.

8. Do we request a state community outreach worker (CHW) or are we expected to have one in our program?

With regard to community health worker (CHW) outreach, there is not a separate funding line in this RFR for CHW resources. We strongly support and believe in the important role that CHWs play in engagement and retention of patients in TB services. Decisions around allocations of resources from public and private insurers and MDPH are made by the facility. Thus, a facility could support CHW services, but MDPH does not require them through this RFR.

The MDPH TB response team includes CHWs. Assignments to MDPH CHWs are typically for high-priority individuals.

9. How will we ensure that contract is tailored to need of the center?

MDPH encourages applicants to tailor their applications to their center or facility, based on capacity, resources, and organization of services. MDPH is not defining a single model for TB services, but is defining the key elements and standards essential to any model.

10. Must the provider bill insurance for services?

Yes, the provider must bill insurance first if the patient is insured. MDPH is a payer of last resort. If insurance rejects claims, then these can be submitted to MDPH for payment. MDPH only covers services that not paid by insurance. If patients have more than one insurer, claims must be submitted to each insurer before submitting rejected claims to MDPH.

11. How will reimbursement work with B1/B2 immigrants?

To answer this question, it may be helpful to begin with a brief overview of “B1/B2 immigrants”. All persons applying to enter the United States (US) on a permanent visa (immigrant or refugee) are required to complete a medical examination prior to the visa being issued. The medical examination includes an algorithm for TB evaluation. If, based on findings of the medical examination, there is a need for TB follow-up in US, that immigrant is then classified as Class B1 TB, Class B2 TB, or Class B3 TB.

Immigrants (but not refugees) are barred from using public benefits in their first five years in the US. Thus, for these priority cases, the bill for TB outpatient services will, in most cases, come directly to MDPH because the newly arrived immigrant will likely not have insurance.

12. Will DPH continue to pay for nursing visits for uninsured patients?

Yes. MDPH supports nursing visits, particularly for follow-up adherence and monitoring visits. MDPH will be the payer for uninsured individuals for physician, mid-level, or nurse visits based on CPT codes. In the case of uninsured patients, billing be directly to MDPH because there is no other payer. For insured patients, MDPH will be payer of last resort. Under some circumstances, nursing visits may not be billable or paid by insurers. These claims will be rejected and forwarded to MDPH for payment.

13. In terms of a new model to allow lower risk persons with TB infection to remain in their home health care setting, will you reimburse when a telemedicine or phone consultations is needed for a TB expert to talk with a provider who is doing the subsequent care for the last 8 months of INH (for example)? Since this is not reimbursed by insurance could we bill you an MD visit for example?

At the initiation of this contract cycle, MDPH is not including payment for telemedicine or phone consultation encounters. Over the course of the procurement, we anticipate a regular review of demand and capacity for telemedicine and telephone consults.

14. On this webinar, do the majority of participants already have an actual TB clinic in their agency?

I think that on today’s webinar, there is a mix of people representing a mix of facilities. Some of these facilities do have a current TB clinic contact that will end in June. Some do not. Again, through this RFR, MDPH will qualify facilities for TB Outpatient Services. MDPH is open to qualifying additional facilities.

15. Is there a cap for reimbursement for each specific center?

MDPH receives an annual budget allocation for TB Outpatient Services contracts. We project funding for each contract on an annual basis, but do not apply a funding cap at the contract level. Over the last five years, billing has come in below allocations and MDPH has not had to cap reimbursement.

16. Is there funding for capital purchases (i.e., UV lights, negative pressure rooms, etc)?

No, MDPH is not providing funding for capital purchases. Again, this is a unit rate contract and payment is for outpatient services.

17. Is there any payment for consult services for chart review or recommendations?

No, at this time, consult services are not billable to MDPH. We expect to review the need and options for coverage over the course of the procurement.

18. In the case of patients with active tuberculosis and high-deductible insurance plans, must the facility collection insurance information?

MDPH is the payer of last resort. The practice that happens at your hospital has to meet the requirements of your facility in terms of collection of insurance information. If MDPH is billed as the payer of last resort for an eligible service, then we will pay for that service.

19. Could patients with high deductibles be considered "under-insured"? This way, perhaps MDPH could cover those costs?

MDPH does not have resources to cover patient deductibles. We can cover visit copays, and medical costs as payer of last resort. MDPH recognizes that high deductible plans present challenges for patients who are in need of services.

20. Will MDPH provide epidemiology support – e.g., report of effectiveness of the program number of patients evaluated and treated?

Yes. Section 2.7 included this statement: MDPH is committed to working with designated TB outpatient sites to maximize electronic data transfer to report care and patient management. With routine reporting in place, facility-specific report on the TB care cascade will be prepared by MDPH on a regular basis for review with sites. Completion of treatment is our goal.

21. We have a contract through which we provide HIV/HCV, chlamydia, gonorrhea, and syphilis testing but we do not have a formal TB clinic. Will MDPH provide TA?

After July 1, 2018, MDPH will provide technical assistance to organizations that have interest, but not the current capacity to operate a TB clinic, to submit a proposal under this RFR. Because this is a rolling procurement, sites have the opportunity to develop and submit a proposal in the future. At the time of posting, however, MDPH seeks to identify sites that have the current capacity and technical expertise to deliver this service on July 1, 2018.

22. What will be the role of local public health offices in this new contract?

The role of local public health departments in TB response and direct case management is independent of the TB Outpatient Services RFR and will not change from current practice. Local public health nurses are responsible for direct case management of persons with suspected or diagnosed active TB disease in the community where the individual resides. To ensure continuity of care, communication with the treating clinician is vitally important for local public health nurses to be successful in that role. Local public health nurses will continue to be involved in contact investigations, and they may refer individuals identified through contact investigations, including young children or people at high risk for immediate TB services. Local public health nurses may make other referrals for TB evaluation and management.

23. Will TB clinic sites be requested to handle or transfer funds from the state to local public health departments or VNAs for directly observed therapy (DOT) services?

No. MDPH will not request facilities to function as an intermediary for billing from local public health departments or local Visiting Nurse Associations (VNAs) for DOT services.

24. Can you clarify which form is not required if you were already qualified?

All forms that are in the REQ Documents Required with Application for Response folder of the RFR will need to be submitted by all applicants.

The forms in the COMPREQ folder are for new vendors. If your agency does business with MDPH or any other state agency, these forms do not need to be submitted.

25. Do we have to fill out a contract form?

No, the contract form is posted for your reference only and you do not submit it with your application.

26. Who should we contact if we have technical problems?

If you have technical problems, contact the COMMBUYS Help Desk. On the COMMBUYS screen, there is a number for you to call. They’re friendly and will help you upload and download your application. The number is 617-720-3197.

With this procurement, program staff will also reach out to you if any information is missing.

27. When all paper work is completed, we upload to COMMBUYS afterwards?

Correct. To ensure a successful submission it is recommended that you complete the upload and submission at one-time. Please follow the naming conventions established in the RFR Application document. POS recommends that a staff person be assigned to conduct a quality assurance check prior to document submission.

28. Where do we submit the signature pages?

Please mail the signature pages within ten days of your response to the address listed in the RFR (Page 20). For July 1, 2018 contracts, MDPH needs to receive the signature pages by June 5, 2018.

Because this is a rolling procurement, applications will continue to be accepted after May 25, 2018. Signature pages should be mailed within ten days of the application.

29. Will a copy of slides be provided?

Yes. The slides are now available as an attachment in COMMBUYS: the file name is BiddersConference_RFR190727 TB_final.

30. For patients who live in extreme poverty, will transportation or food vouchers to support adherence to TB treatment and medical services be covered?

Funding for patient supports such as transportation or food vouchers is outside the scope of this procurement. We note, though, that MDPH has some capacity to provide transportation support for high-priority individuals. These requests are reviewed on a case-by-case basis. Over the course of the contract period, MDPH will advise vendors of updates and procedures to access patient enablers.

31. Does the awardee receive any reimbursement for insured patients?

Yes. The facility must have the capacity to bill third party insurers. The awardee/facility retains reimbursements made by insurers for services delivered. Facilities may bill MDPH for visit co-payments up to a maximum amount set by MDPH (i.e., the facility does not collect the co-payment from the patient for the visit). MDPH payments for services are for uninsured patients or for eligible services rejected by the insurer.

32. Are there any unit rate resources available, including an explanation of how these work?

A Unit Rate contract means that billing and payment is based on the number of units of service delivered. For this contract, when MDPH is the payer, payments are made at the Massachusetts Medicaid (MassHealth) rates. See https://www.mass.gov/lists/provider-payment-rates-community-health-care-providers-ambulatory-care. The website posts the rate regulations, including updates. The facility bills MDPH based on the number of units of service delivered.

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Microsoft_PowerPoint_Presentation1.pptx Finding the RFR and application in COMMBUYS

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