RFI_ Medicaid Application Assistance Services.docx

This is a Request for Information Only; it is not a request for quotations or offers.

Network Contracting Office (NCO) 7 on the behalf of the Ralph H. Johnson VA Medical Center has developed this Request for Information (RFI)/Sources Sought Notice to solicit market research information from industry to assist the Government with analysis of a Government requirement and provide commercial insight on performance-based solutions, best practices, possible contractual arrangements, and potential issues. This RFI is to determine the availability of businesses (preferably Service-Disabled and/or Veteran-Owned Owned) entities within the local and surrounding areas.

THIS IS A REQUEST FOR INFORMATION ONLY. It is not a Request for Proposal, a Request for Quotation, an Invitation for Bids, a Solicitation, or an indication that NCO 7 will contract for the items contained in the RFI/Sources Sought Notice. This RFI/Sources Sought Notice is part of a Government market research effort to determine the scope of industry capabilities and interest, in accordance with Federal Acquisition Regulation (FAR) Part 15.201(e), response to this RFI / Sources Sought Notice are not offers and cannot be accepted by the Government to form a binding contract. Responses to this RFI / Sources Sought Notice are strictly voluntary and are considered as information only. The Government will not pay respondents for information provided in response to this RFI / Sources Sought Notice. Responses to this RFI / Sources Sought Notice will not be returned and respondents will not be notified of the result of the review. If a solicitation is issued, it will be announced a later date, and all interested parties must respond to that solicitation announcement separately from any response to this announcement. This RFI / Sources Sought Notice does not restrict the Government’s acquisition on a future solicitation.

NCO-7, Charleston SC is conducting market research for Medicaid Application Assistance Non-Personal Services. The Charleston VA Medical Center is seeking to provide personal assistance and resources to RHJVAMC staff, patients and caregivers, who have been identified as needing to complete this application in order to access additional community-based resources that Medicaid can provide. Individuals are identified through a screening process completed by RHJVAMC staff. The contractor will make a dedicated effort to continue to follow-up on pending Medicaid applications, which will help to ensure applications are processed in a timely and efficient manner.

The contractor will be proactive with contacting the Medicaid office to receive timely updates on the status of applications. The contractor will continue to follow-up with RHJVAMC staff, patients, caregivers, and the Medicaid office until an eligibility decision is made by Medicaid.

The Contractor shall furnish all personnel, materials, tools and equipment necessary to perform the task in accordance with the schedule and to comply with all guidelines established by Federal, State, County and local laws and ordinances.

Please review the draft Performance Work Statement (PWS) provided before responding to the market research questions as the Government desires that respondents offer their experience and recommendations on the following questions and issues related to this requirement. When addressing these items, respondents should consider the size and scope of the requirement described herein. Also note the compliance and transmission requirements detailed in the attached PWS.

*NOTE: Please complete the included “Source Information Sheet”

Source Information Sheet

THIS IS A REQUEST FOR INFORMATION/SOURCE SOUGHT NOTICE ONLY.

Company Name:

UEI Number or CAGE Code:

Address:

Contact Name:

Phone No:

Email:

Business size information

Select all that applies:

· Small Business

· Emerging Small Business

· Small Disadvantaged Business

· Certified under Section 8(a) of the Small Business Act

· HubZone

· Woman Owned

· Certified Service-Disabled Veteran Owned Small Business (registered in VetBiz.gov)

· Veteran Owned Small Business (registered in VetBiz.gov)

· Large Business

· Other ________________________

FSS/ GSA Contract Number

Effective Date / Expiration Date

Answer the following questions:

1. Have you performed Medicaid Application Assistance Services before?

2. Are you capable of fully meeting the requirements in the draft Performance Work Statement (PWS)?

3. Will you be submitting an offer for Medicaid Application Assistance Services?

The results of this market research will assist in the determination if a set-aside is in the best interest.

DRAFT PERFORMANCE WORK STATEMENT (PWS)

Medicaid Application Assistance Services

General Information

1. GENERAL: This is a non-personnel services contract to provide Medicaid Application Assistance Services. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform Medicaid Application Assistance Services as defined in this Performance Work Statement except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

1.2 Background: :

The Ralph H. Johnson VA Medical Center (RHJVAMC) is an integrated healthcare system comprised of the primary medical hospital located in the downtown area of Charleston, South Carolina and seven additional community outpatient clinics (CBOC) including Trident, Goose Creek, Myrtle Beach, Beaufort, Hinesville, Savannah and Conway. The RHJVAMC provides health services for veterans in South Carolina and Georgia. The main health care service offerings are outpatient, inpatient, extended care and telehealth care.

Ensuring veterans are provided with excellent health care is the main priority of the RHJVAMC and staff work tirelessly to ensure veterans have access to the highest quality medical care. When veterans require admission to address acute health care problems, staff work closely with the veteran and his/her family to provide a safe and appropriate discharge care plan. While most of our veterans are able to discharge within clinically appropriate timeframes, a few veterans are not. These veterans are our most vulnerable as they have limited financial resources, are not eligible for placement and may lack appropriate support systems. These veterans may also require long term care, which is extremely challenging and difficult to secure without a known payor source. The inability to secure early identification of a primary payor source extends acute inpatient hospitalizations and limits care to other veterans.

By improving access to Medicaid services at the time of admission to the acute setting and confirming the payor source, the RHJVAMC can reduce inpatient bed days, improve access, and cut hospital costs.

1.3 Objectives:

· Reduce inpatient length of stay for Veterans requiring long term care placement via Medicaid.

· Complete Medicaid applications and assist with long term care placement as needed.

1.4 Scope: The contractor shall provide personal assistance and resources to RHJVAMC staff, patients and caregivers, who have been identified as needing to complete this application in order to access additional community-based resources that Medicaid can provide. Individuals are identified through a screening process completed by RHJVAMC staff. The contractor will make a dedicated effort to continue to follow-up on pending Medicaid applications, which will help to ensure applications are processed in a timely and efficient manner.

The contractor will be proactive with contacting the Medicaid office to receive timely updates on the status of applications. The contractor will continue to follow-up with RHJVAMC staff, patients, caregivers, and the Medicaid office until an eligibility decision is made by Medicaid.

This may also include appealing Medicaid decisions. Completing these applications will permit successful transitions from acute and subacute care to community based long-term care. It will also reduce length of stay and decrease health care costs.

The contractor shall accomplish:

· Contractor will meet with identified patient and/or caregiver at bedside within the expected timeline from admission.

· Contractor will obtain a release of information (ROI) from the patient/caregiver as part of initial meeting.

· Contractor will collaborate with VA staff to ensure ROI is sent to the ROI office.

· Contractor to provide personal assistance and resources to patients and caregivers who may not understand the application process or need help beyond financial assistances offered.

· Contractor will file the application within 72 hours of admission

· Contractor to be proactive in following-up with the Medicaid office

· Contractor to provide a focused and dedicated effort to follow up on pending Medicaid applications to ensure timely processing of cases.

· Contractor to continue to follow-up with Medicaid office, patients, and caregivers until eligibility determination has been issued

· Contactor to be knowledgeable of documentation required for Medicaid application and be comfortable obtaining these documents

· Contractor to be comfortable working with vulnerable populations

· Contractor will be comfortable traveling to and from campuses, as required

· Contractor will be able to assist in managing and following through on any appeals necessary with Medicaid until application is approved.

· Contractor will be able to manage multiple cases concurrently.

In the event RHJVAMC requests additional services outside the original scope of this contract, a contract modification will be issued upon completion of negotiation of the change by the Contracting Officer (CO).

The contractor shall comply with the following regulations. Regulations stated should only be used as a guide and not considered all inclusive.

· HIPPA

· Release of Information Policy

· Privacy

· Computer Security

· Medicaid

· TMS

· Quality Assurance Plan

The following is a listing and description of Medicaid assistance would be identified to be included in the scope of this contract:

· Medicaid Long term care (or Nursing home applications)

RHJVAMC employees shall:

· Screen veterans within RHJVAMC for eligibility for Medicaid

· Provide the contact information for veterans who screen positive to the contractor for completion of the application

Contractor shall: (Order of events)

· Contractor will meet with identified patient and/or activated healthcare proxy (HCP) at bedside within the expected timeline from admission.

· Contractor to provide personal assistance and resources to patients and caregivers who may not understand the application process or need help beyond financial assistances offered.

· Contractor will file the application within 72 hours.

· Contractor to be proactive in following-up with the Medicaid office

· Contractor to provide a focused and dedicated effort to follow up on pending Medicaid applications to ensure timely processing of cases.

· Contractor to continue to follow-up with Medicaid office, patients, and caregivers until eligibility determination has been issued

· Contactor to be knowledgeable of documentation required for Medicaid application and be comfortable obtaining these documents

· Contractor to be comfortable working with vulnerable populations

· Contractor will be comfortable traveling to and from campuses, as required

· Contractor will be able to assist in managing and following through on any appeals necessary with Medicaid until application is approved.

· Contractor will be able to manage multiple cases concurrently.

1.5 Period of Performance:

One base year with the possibility of four one-year option periods

1.6 General Information

1.6.1 Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. After acceptance of the quality control plan the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to his QC system.

1.6.2 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s). The Government facilities may at any time inspect and verify that the accuracy of the work compares to that indicated on the invoice. Any deviation will be deducted from the invoice price in accordance with the Quality Assurance Surveillance Plan (QASP). Quality measures that are expected to be tracked include, but may not be limited to, turnaround time on filing an application, timeliness of accessing Medicaid payer source to assist in discharge planning, patient satisfaction, and submitting proper invoices with the correct elements.