LPRO RFP 2023-1 Questions and Responses Nov. 2023 v2.pdf

Memorandum

PREPARED FOR: RFP 3396

DATE: November 13, 2023 BY: Legislative Policy and Research Office RE: Responses to Prospective Vendors

The State of Oregon’s Legislative Policy and Research Office (LPRO) seeks experts to assist the Joint Task Force on Hospital Discharge Challenges (Task Force). The Task Force is directed to develop recommendations to address the challenges faced by Oregon hospitals in discharging patients to appropriate post-acute care settings, including but not limited to long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies.

To support the work of the Task Force in meeting the requirements in House Bill 3396 (2023), LPRO is engaging in a competitive procurement process for professional services. LPRO issued a request for proposal through OregonBuys on October 11, 2023. LPRO seeks organizations to provide data collection, analysis, and consultation services to the Task Force in support of its second phase of work from January 2024 through November 15, 2024. The goal is to offer a range of analytical capacities, analyses, and expertise that, upon request, can inform and guide the Task Force in developing policies for Oregon.

Prospective proposers were invited to submit questions, including requests for explanations of the meaning or interpretation of provisions of the RFP, in writing to LPRO no later than November 3, 2023. This memo lists questions submitted along with LPRO’s written responses.

The solicitation closes at 5pm on November 17. Proposals can be submitted as a PDF via email to Oliver.Droppers@oregonlegislature.gov, or online through OregonBuys (link).

If your organization would like more information about the RFP, please access the RFP at OregonBuys (link).

Question 1. 3.4 Proposal Submission: Can you clarify what will be included in the email submission? Will the packet only include the proposal and price proposal?

Agency Response to Question 1: To ensure a completed proposal submission, a proposer shall sign and submit the Proposal Cover Sheet (see Appendix A in the RFP). Each written submitted proposal must address the proposal technical requirements and submission requirements set forth in this RFP and must describe how the proposer will provide the Services. A proposal may not consist of more than 25 pages, including all supporting material, but excluding a separate price proposal and any samples of work that the proposer submits under Section 2.3.1. Each submission, regardless of how a proposal is submitted (e.g., email or hardcopy sent vis postal), must include the proposal, price proposal, several examples, and at a minimum, three references.

Question 2. 3.4 Proposal Submission: Can you clarify what will be included in the hard copy mailed submission? Will the packet include the proposal, price proposal, and sample documents?

https://olis.oregonlegislature.gov/liz/2023I1/Committees/JTFHDC/Overview https://olis.oregonlegislature.gov/liz/2023R1/Measures/Overview/HB3396 mailto:Oliver.Droppers@oregonlegislature.gov https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Foregonbuys.gov%2Fbso%2Fexternal%2FbidDetail.sdo%3FdocId%3DS-14300-00008346%26external%3Dtrue%26parentUrl%3Dclose&data=05%7C01%7COliver.Droppers%40oregonlegislature.gov%7C9d857056f814496cb51108dbca9a7087%7C489a9c84574a48c7b72a2450511334cc%7C1%7C0%7C638326536887009429%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=p%2FtASyTymOvUJBCtgmSia1UysdKLdidkhxnYBlNhTBo%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Foregonbuys.gov%2Fbso%2Fexternal%2FbidDetail.sdo%3FdocId%3DS-14300-00008346%26external%3Dtrue%26parentUrl%3Dclose&data=05%7C01%7COliver.Droppers%40oregonlegislature.gov%7C9d857056f814496cb51108dbca9a7087%7C489a9c84574a48c7b72a2450511334cc%7C1%7C0%7C638326536887009429%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=p%2FtASyTymOvUJBCtgmSia1UysdKLdidkhxnYBlNhTBo%3D&reserved=0

Agency Response to Question 2: To meet the minimum proposal requirements set forth in the RFP, each packet, whether emailed or submitted via postal service, must include the proposal, price proposal, sample documents, and at least three references.

Question 3. Appendix A - Proposal Cover Sheet: Does the cover sheet require wet signatures for hard copy submission?

Agency Response to Question 3: No, the cover sheet does not require wet signatures for hard copy submission.

Question 4. PART II – TASK SPECIFICATIONS: Will any original data collection be needed or will the state provide all data needed for the assessment?

Agency Response to Question 4: Yes, the Agency anticipates original data collection will be needed to complete some of the required activities. Specifically: Task 1 will require the collection of survey data from post-acute care agencies or parent company representatives, also see Question 5. The contractor will need to work with the Agency to develop a questionnaire, sampling strategy, and outreach plan. Facility lists and contact information can be obtained from LPRO. Task 2 will require collection and analysis of qualitative data such as key informant interviews with state agency and hospital staff. The contractor will need to work with the Agency to develop a list of questions and outreach plan. A preliminary list of contacts will be provided and snowball sampling or other means will be needed for further participant recruitment. Task 5 may require informal interviews with representatives from other states or federal agencies as needed to advise on strategies that have been successful in other states, to the extent that such information is not available through public records.

Question 5. Workforce, please clarify reference to workforce included in Task 1 an assessment of Oregon’s post-acute care delivery system capacity and workforce. Are you asking for an assessment of the current workforce in terms of capacity to meet demand? Is licensing and utilization part of this review? Is scope of license included? Finally, are you asking for an assessment of current state, or does this include recommendations for how you can address workforce challenges?

Agency Response to Question 5: This is a facility-level analysis to examine how well Oregon’s existing post-acute care settings can meet demand generally, as well as for two high-acuity populations: 1) people with complex care needs and 2) people who lack stable housing.

The focus is not primarily related to workforce licensing and scope of practice although these issues may be addressed in findings where appropriate. The analysis seeks to explore facility-reported capacity through multiple dimensions, including:

• total bed capacity and staffed bed capacity relative to demand;

• additional capacity that could be available with different or additional staffing;

• the alignment of existing staff capabilities with demand;

• factors affecting ability to accept higher acuity patients;

• factors affecting recruitment and retention of staff to care for higher acuity patients; and

• facility-reported recommendations that would improve their capability to accept and care for higher acuity patients.

The analysis seeks to understand how these issues vary by county or region, and across different facility types. This work will build on earlier survey work completed by the Oregon Department of Human Services (ODHS) in 2022. The Agency and other state agencies can provide guidance on development of data collection instruments and approaches based on these earlier efforts. Consultant recommendations to address workforce challenges should draw from and synthesize across RFP Taks 1-3 to the extent possible.

Question 6. Please clarify the description of the project related to how to scope/price. There is a defined set of tasks, but the description lays out a 1-year project with the ability to be renewed for up to 2 years. As it relates to pricing, are we pricing based on total scope, set hours per year, etc?

Agency Response to Question 6: The Agency anticipates a completed price proposal will provide estimated costs to complete tasks and corresponding deliverables for tasks 1-4. Task 5, consultative services, will be based on hourly rates agreed upon by the vendor and Agency and specified in the contract. The price proposal should be based on completing tasks 1-4 within the specified timeframe as described in table 1 of the RFP found on pg. 51, specifically January through November of 2024. The final timelines for completing individual tasks will be determined after consultation with the Agency and assessment of the overall timeline of the task force.

The Agency may award one or more public contracts for all or selected portions of the services.

Proposers are able to submit a response for one or more tasks, if necessary, per section of the RFP, which states on page 5 of the RFP Agency recommends that the proposer note in the Proposal any items in the Statement of Work that the proposer would want to negotiate.

Question 7. What relevant initiatives are already in place or progress in Oregon, e.g., workforce initiatives; Medicaid/Medicaid-waiver reimbursement initiatives?

Agency Response to Question 7: The Agency would need more information about the intended scope (state agency initiatives, legislative workgroups or task forces, private sector efforts, etc.) to be able to provide a comprehensive response to this question. Some resources that may be relevant to this question include:

• The Oregon Department of Human Services, in a presentation to the Task Force in September, provided a list of agency-led initiatives during the COVID-19 public health emergency (PHE) to address hospital decompression and discharge delays. See slides beginning with slide 28.

https://olis.oregonlegislature.gov/liz/2023I1/Downloads/CommitteeMeetingDocument/27

• The state (and all states) received federal emergency authorities during the PHE that modified Medicaid eligibility rules, eligibility determination processes, and covered services. https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/COVID-19.aspx

• Oregon’s Section 1115 Medicaid Demonstration Waivers for 2017 to 2022 encouraged the state’s Coordinated Care Organizations to invest in Health-Related Services such as nutrition or transportation supports for members’ social needs. Oregon’s 2022-2027 waiver added new Health Related Social Needs services for certain populations. See https://olis.oregonlegislature.gov/liz/2023I1/Downloads/CommitteeMeetingDocument/276867 https://olis.oregonlegislature.gov/liz/2023I1/Downloads/CommitteeMeetingDocument/276867 https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/COVID-19.aspx https://www.oregon.gov/oha/HSD/Medicaid-Policy/Documents/2017-Renewal- Overview.pdf and https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/Waiver- Renewal.aspx

• Oregon’s Substance Use Disorder (SUD) 1115 Demonstration Waiver effective April 2021 expanded access to community-based treatment, housing, and employment supports for people experiencing SUD. See https://www.oregon.gov/oha/HSD/Medicaid- Policy/Pages/SUD-Waiver.aspx

Question 8. The RFP does not include mental health or behavioral health. Are these included in the request? Is the assessment limited to the post-acute settings listed in the first paragraph of page 3/in the RFP, or will additional settings be added?

Agency Response to Question 8: HB 3396 defines “post-acute care” to include the following (hereafter called “list of post-acute settings”):

• A setting in which a patient receives in-home care services, as defined in ORS 443.305;

• A setting in which a patient receives home health services, as defined in ORS 443.014;

• Skilled nursing facilities, as defined in ORS 442.015;

• Residential care facilities, as defined in ORS 443.400, including assisted living facilities;

• Adult foster homes, as defined in ORS 443.705; and

• Community hemodialysis providers.

Consultant analyses will focus primarily on the care settings listed above but may consider behavioral health to the extent that these services are provided or could be provided in the listed settings.

More specifically, the agency anticipates the following settings will need to be included:

• Task 1: survey of post-acute care facilities includes the list of post-acute settings. The Taks Force may request inclusion of additional setting types at its January 2024 meeting; these may be incorporated to the extent that they do not require meaningful changes to the sampling strategy, questionnaire design, or recruitment of participants.

• Task 2: this task relates to processes occurring within the hospital setting during discharge planning.

• Task 3: This analysis will include rates and payment methods for services provided by the list of post-acute settings (see Question 10 for more information).

• Task 5: Task Force discussions will consider innovative models to provide post-acute care to people who need complex care or lack stable housing. These innovative models will include alternative settings such as recuperative care, shelter care, or other “step down” models. Consultation will be needed that addresses these alternative settings.

https://www.oregon.gov/oha/HSD/Medicaid-Policy/Documents/2017-Renewal-Overview.pdf https://www.oregon.gov/oha/HSD/Medicaid-Policy/Documents/2017-Renewal-Overview.pdf https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/Waiver-Renewal.aspx https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/Waiver-Renewal.aspx https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/SUD-Waiver.aspx https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/SUD-Waiver.aspx

Question 9. Is it the intent of the scope of work to include all post-acute care, all ages, or adults 18 or older, and or seniors only? Which populations are included in the request?

Agency Response to Question 9: Children are not specifically excluded from the Task Force’s charge but Agency anticipates the core focus of this work will be adults ages 18 or older with specific consideration of people with complex care needs and people who lack stable housing.

Analyses should be scoped for adults including seniors.

Question 10. The proposed scope of work and data assessment methodologies will depend on datasets made available by the state/departments of the state or other publicly available data.

What datasets will be available for the licensed and unlicensed in-home care agencies, residential care facilities, adult foster homes, nursing homes, and other post-acute care settings of concern?

Agency Response to Question 10: This response addresses several questions regarding data sources and measurement periods. Consultant will have access to state-hosted data sets (described below) to support the analyses. Available date ranges are approximate and will depend on the dates when data are requested. The Agency will provide support to engage the appropriate agency contacts, execute data sharing agreements, obtain data, and access subject matter experts as needed.

Task 1 Data Sources and Measurement Periods:

This task will require original data collection as described in Question 4 and 5.

Task 2 Data Sources and Measurement Periods:

This task will rely on a combination of original and secondary data. Primary data collection is described in Question 4. Secondary data for this analysis include:

• Wage and other personnel data for state and county employees who conduct eligibility screening and assist in post-acute placements. These data are available from Oregon Department of Human Services.

• Hospital stay, discharge, and delay data from the Oregon Capacity System. These data will be available from Oregon Health Authority for approximately December 2023 through March 2024 (earlier periods may be available for certain fields).

Task 3 Data Sources and Measurement Periods:

This work will be completed through two parallel efforts to account for different data availabilities and to avoid duplication of other legislatively directed, in-progress work:

1) Medical Care: This analysis will include payments for skilled nursing, home health, and community dialysis care. Data sources include:

a. All Payer All Claims database of encounters, claims, and payment arrangements for approximately 2017-2021 (provided by Oregon Health Authority)

b. Medicaid Management Information System through Q4 2023 (provided by Oregon Health Authority)

c. Commercial insurer long-term care and short-term disability encounters and claims for 2017-2022 (provided by Oregon Department of Consumer and Business Services)

2) Home and Community-Based Care: This analysis will include payments for home and community-based services. Data sources include:

a. Payments made by private long term care and short-term disability insurers for home and community-based care for the period 2017-2022. The Oregon Department of Consumer and Business Services will provide data.

b. Payments made by Medicaid Coordinated Care Organizations to home- and community-based care providers under Health-Related Social Needs and Health Related Services spending arrangements for the period 2018 to 2022. Oregon Health Authority will provide data.

c. A study commissioned by Oregon Department of Human Services of Medicaid and private-pay rates for home and community-based services (including residential care, memory care, assisted living and home care) for the period July 2021 to June 2022. This study does not include adult foster homes. In 2024 ODHS will complete a rate study including adult foster homes.

Question 11. Will datasets be available for the period 2017 to 2022 or year to date?

Agency Response to Question 11: See question 10.

Question 12. The RFP includes a timetable to complete each Task. Is there flexibility of deadlines and is it possible to extend the deadlines?

Agency Response to Question 12: The Agency can extend the deadline for the written report.

The latest possible date would be July 19th for draft report submission and August 16th for final report submission.

The deadlines for Tasks 1-3 are tied to tentative meeting dates in the Task Force workplan (see https://olis.oregonlegislature.gov/liz/2023I1/Downloads/CommitteeMeetingDocument/277461).

The due dates for analysis plans and slides with preliminary results will be difficult to change though it may be possible to alter the sequence of some tasks. For example, consultant may propose to deliver preliminary results and slides for Task 2 first before Task 1.

The Agency intends to provide support for analytic planning during contractor onboarding in late December or early January to support meeting the timeline.

Question 13. Will there be a single point of contact assigned by The Legislative Policy and Research Office for consistency of managing the project?

Agency LPRO Response to Question 13: Yes, the Agency has a dedicated project team leading the work including interagency coordination among the Oregon Health Authority (OHA), Department of Consumer and Business Services (DCBS) and Department of Human Services (DHS). The LPRO project team consists of a legislative analyst and a research analyst co-staffing the day-to-day work of the task force. The research analyst serves as the primary contact for the technical aspects of the project including data and related analyses specified by

HB 3396.

https://olis.oregonlegislature.gov/liz/2023I1/Downloads/CommitteeMeetingDocument/277461

Question 14. Our clients’ work product is confidential, and written reports cannot be released. If samples of work completed are not submitted, will this cause our proposal to be declined?

Agency Response to Question 14: Contractor should explore options to share work samples including redacting work samples or removal of data tables or client identifying information. The agency encourages proposers to share any publicly reported presentations or written materials that summarize completed work considered confidential. To meet the minimum proposal requirements, proposers are required to submit work samples. Proposers that do not submit work samples will fail to meet minimum proposal requirements as specified in Appendix A on

pg. 2 and will be deemed nonresponsive.

Question 15. Will the following count against the 25-page limit? Title pages and table of contents

Agency Response to Question 15: No, the table of contents and title pages do not count towards the 25-page limit.

Question 16. Are there any meetings with and presentations to the Task Force that require in-person consultant attendance?

Agency Response to Question 16: The Joint Task Force on Hospital Discharge Challenges is meeting virtually on the Microsoft Teams platform. The agency does not anticipate any meetings or presentations requiring in-person consultant attendance.

Question 17. For Task 1 (Assessment of post-acute care capacity and workforce), is the OR Dept of Human Services planning to conduct another post-acute capacity and workforce survey and when will this survey occur?

Agency Response to Question 17: While ODHS is surveying post-acute providers on other topics, consultant will need to complete the data collection activities described in questions 4 and 5.

Question 18. Will the consultant receive access to the Oregon All Payer All Claims Administrative Claims Reporting Program (APAC) for this engagement in order to analyze administrative data? Will the consultant receive access to the Oregon Inpatient Hospital Discharge database? This will provide critical insight into trends related to patients awaiting discharge to post-acute care settings.

Agency Response to Question 18: See question 10.