Request for Information-Nationwide Provider Network.docx

WTC HEALTH PROGRAM

RFI NUMBER

WORLD TRADE CENTER (WTC) HEALTH PROGRAM

RFI NUMBER: RFI_011900

RFI_011900

NATIONWIDE PROVIDER NETWORK

RFI NUMBER:

DATE: APRIL 28, 2020

QUESTIONS DUE: MAY 4, 2020 AT 11:00AM EDT

RESPONSES DUE: MAY 12, 2020 AT 11:00AM EDT

World Trade Center Health Program Request for Information

The World Trade Center Health Program is administered by the National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention I. Purpose The purpose of this request for information (RFI) is to identify an experienced federal healthcare program provider to manage comprehensive Nationwide Provider Network (NPN) solutions for the World Trade Center (WTC) Health Program, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control (CDC) in the following areas:

1. To administer healthcare benefits to both responder and survivor members of the WTC Health Program nationwide except in the New York Metropolitan Area (NYMA) unless otherwise approved by the WTC Health Program

2. To establish a nationwide network of health care providers to provide monitoring and treatment benefits and initial health evaluations near such individuals’ areas of residence or work

3. To provide a wide range of member services and medical benefits, including claims administration and coordination of benefits Note that this is an RFI. It is not a solicitation for proposals, proposal abstracts, or quotations. Release of this information should not be construed as a commitment to procure items discussed or to incur costs for which reimbursement would be required or sought.

II. Background On January 2, 2011, the President signed into law the James Zadroga 9/11 Health and Compensation Act of 2010 (Zadroga Act). The Act established with the Department of Health and Human Services a program to be known as the World Trade Center Health Program (WTC Health Program). The WTC Health Program provides medical monitoring, screening and treatment for responders and survivors of the 9/11 terrorist attacks. Responders include a worker or volunteer who provided services in the aftermath of the September 11, 2001, attacks on the World Trade Center. Survivors include persons that worked, lived, or attended school, childcare, or adult day care in the New York City disaster area, who were adversely affected by the September 11, 2001, terrorist attacks in New York City. As of December 31, 2019, there are a total of 77,752 responders and 24,297 survivors enrolled in the Program. In order to enroll in the Program, survivors and responders must meet certain criteria described in the Zadroga Act (https://www.cdc.gov/wtc/laws.html).

The WTC Health Program is a limited benefit program, meaning that treatment is only covered for health condition(s) for which exposure to airborne toxins, hazards, or any other adverse conditions resulting from the September 11, 2001, terrorist attacks. There is a list of applicable WTC-related health conditions that must be diagnosed by a WTCHP provider and certified by the Program in order for the member to receive treatment. In order to qualify for treatment, an enrolled member must meet certain exposure, latency, and symptom onset requirements for conditions. A range of conditions are covered including mental health, aero-digestive, and cancer. There are currently seven (7) Clinical Centers of Excellence (CCE) and one temporary Survivor Clinic in the NYC metro area, and one Nationwide Provider Network (NPN) that administer the benefits to Members.

III. Requested Information To help inform the WTC Health Program with a comprehensive NPN program, please respond to the following questions in order:

1. Respond to all requirements and functions listed in Attachment 1. Requirements and Core Functions

a. Respond to all requirements and functions listed in attachment 1, with each response not to exceed one page using 12-point Calibri or any san serif fonts.

2. Based on information and guidelines available through the WTC Health Program website, provide recommendations and solutions as to how you would administer WTC Health Program benefits to the following two members. Please provide a detailed step-by-step process to include the steps you will take to assess for and assign to the appropriate Member Services and Medical Benefits, particularly Case Management services. Provide a one-page response to each scenario.

SCENARIO #1 (Survivor) A new enrollee, who recently located to Anchorage, Alaska from New York City, New York, is assigned to the NPN. The member has multiple health conditions including possible lung cancer, respiratory diseases, known hypertension and diabetes.

How will you fully enrolle and certify for qualified health conditions as per Program guidelines in order to proceed with any pertinent treatment?

SCENARIO #2 (Responder) A responder currently residing in the metropolitan New York area is retiring and relocating to Tampa, Florida. He is currently certified for PTSD, prostate and lung cancer and has recently completed his last course of chemotherapy. He is receiving Case Management services from his current CCE and is requesting transfer from a NY CCE to the NPN. He is planning to move in 60 days. Unfortunately, the member needs to have a left lung transplant within the next 30 days. How will you follow through with his care and ensure there are no gaps in care as a result of the transfer and pre-and post- transplant care?

IV. Instructions for Submission

1. Responses to this RFI with a white paper are due by 11 AM EDT on May 12, 2020, to Eric Lyons at kpy2@cdc.gov.

2. Section 1 of the white paper shall provide administrative information, including:

a. Name, mailing address, phone number, and email of designated point of contact; and

b. Business type.

3. Section 2 of the white paper shall be responses to Attachment 1: Requirements and Core Functions

4. Section 3 of the white paper shall respond to the case scenarios.

V. Resources:

https://www.cdc.gov/wtc/materials.html https://www.cdc.gov/wtc/laws.html https://www.cdc.gov/wtc/ataglance.html

The World Trade Center Health Program is administered by the National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention

The World Trade Center Health Program is administered by the National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention image1.jpeg