RFI_WTCHP_ICD 9 Transition Solutions RFI_27 Sep 24.pdf

World Trade Center Health Program Request for Information

CDC WORLD TRADE CENTER

(WTC) HEALTH PROGRAM

MENTAL HEALTH PROVIDER

NETWORK CONTRACT

REQUEST FOR

INFORMATION 75D301-

24-RFI-541512

RESPONSE DUE DATE: November 26, 2024

WTC HEALTH

PROGRAM

RFI 75D301-25-541512

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

Title: CDC World Trade Center (WTC) Outreach and Education Contract

This Request for Information (RFI) is issued solely for information and planning purposes and is not a solicitation for proposals, proposal abstracts, or quotations. Respondents should indicate which information in their response they consider to be proprietary. Responses will assist the Government in the development of its acquisition strategy, including the determination of small business capabilities and interest in any possible future acquisition.

Release of this RFI shall not be construed as a commitment to procure items or services. Responses are not offers and cannot be accepted by the Government to form a binding contract. The Government will not pay for any information or administrative cost incurred in response to this RFI; all associated costs with responding to this RFI is solely at the respondent’s expense.

I. Purpose The purpose of this RFI is to solicit insights and solutions from qualified organizations regarding the transition of the World Trade Center (WTC) Health Program's medical coding system from the International Classification of Diseases (ICD)-9 to ICD-10, ICD-10 to ICD-11, and any future versions. Specifically, the RFI seeks to identify effective methods for automating the update of member certification files to the most valid ICD codes, ensuring accurate and seamless alignment with current healthcare standards. This information will assist the Program in developing a strategy to modernize the coding system, maintaining the integrity of the certification process and ensuring continued access to necessary healthcare services for 9/11 Responders and Survivors.

II. Background

The WTC Health Program was established by Title I of the James Zadroga 9/11 Health and Compensation Act of 2010 (Public Law 111–347, January 2, 2011), as amended by Public Law 114–113 (December 18, 2015) and Public Law 116–59 (September 27, 2019), adding Title XXXIII to the Public Health Service (PHS) Act (codified at 42 U.S.C. 300mm to 300mm-61). All references to the Administrator in this document refer to the Director of the National Institute for Occupational Safety and Health (NIOSH) within the Centers for Disease Control and Prevention (CDC) or their designee. The WTC Health Program provides monitoring, screening, and treatment (medical and pharmacy) for 9/11 Responders and Survivors. As a limited benefit health plan, the Program covers treatment only for specified health conditions resulting from exposure to airborne toxins, hazards, or other adverse conditions from the September 11, 2001, attacks. For treatment, a WTC Health Program provider must diagnose a member with a WTC-related health condition and certify that it is linked to the member’s 9/11 exposure. Members must meet specific exposure, latency, and symptom-onset criteria for certification. Information on the WTC Health Program is available at http://www.cdc.gov/wtc. High-level Program statistics can be found at https://www.cdc.gov/wtc/ataglance. The list of the program’s benefit plans, and care suites can be accessed here https://www.cdc.gov/wtc/ppm.html#medical_benefitPlans.

III. Supplemental Information

A critical component of the WTC Health Program is the certification process, where members' http://www.cdc.gov/wtc https://www.cdc.gov/wtc/ataglance https://www.cdc.gov/wtc/ppm.html#medical_benefitPlans

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 health conditions are certified based on ICD codes that are valid at the time of certification. This process determines the healthcare services and treatment options available to members through the Program. The WTC Health Program Codebook, which is regularly updated, lists these ICD codes and is organized by benefit plans and Care Suites. Benefit plans are groupings that define the acceptable ranges of care for specific health conditions based on the member's status (e.g., Responder or Survivor) and certified condition(s). Care Suites are collections of medical codes that link healthcare claims adjudication to the member’s certified condition, grouping conditions and procedures to guide claims processing and ensure appropriate care. When a member is certified, their certification is linked to a specific ICD code within a particular benefit plan or Care Suite, which informs clinics and providers of the appropriate services and treatment options available to the member.

Each year, the WTC Health Program manually updates the Codebook to reflect changes in industry practices. However, outdated ICD codes are still maintained in the system for historical certification purposes. This poses a significant challenge: if an ICD code that a member was originally certified for is removed or updated, the system currently lacks the capability to automatically adjust the member's certification file to reflect the most current valid code. Without this automatic update, there is a risk that the system may not correctly identify the benefits the member is entitled to, potentially disrupting their access to necessary healthcare services.

The WTC Health Program is seeking a solution to automate the process of updating a member's certification file to the most valid ICD code during the transition from outdated codes to valid codes. This RFI aims to gather information from experienced organizations on how to effectively implement such a solution, ensuring that the Program's coding system remains accurate, up-to-date, and compliant with current medical billing and coding standards, thereby safeguarding uninterrupted access to healthcare services for its members.

IV. Information Requested

The World Trade Center Health Program invites healthcare information management organizations, active stakeholders, members of the 9/11 community, and those with industry experience to provide comments and relevant evidence-based information addressing each of the areas/questions listed below.

1. Please provide a brief overview of your company, including years in business, areas of expertise, and key services offered and previous partners.

2. What experience does your company have in the transitioning of ICD-9 to ICD-10?

3. Please provide a proposed approach for a high-level project plan, including key milestones, timelines, and deliverables for transitioning from ICD-9 to ICD-10.

4. How do you identify and mitigate risks associated with transitioning and what risks have you identified related to the ICD-9 to ICD-10 transition?

5. Can you provide examples of how you have successfully managed risks in similar projects?

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

6. What experience and capabilities do you have to set up processes for ongoing code updates?

7. What tools and technologies will you use to ensure the accuracy and consistency?

8. How will you ensure that your coding practices comply with WTC Health Program regulations and relevant healthcare standards?

9. What training and support will you provide to WTC Health Program staff during and after the transition and how would you ensure that the transition knowledge is effectively transferred to our team?

10. Please describe your internal process on how you stay updated with the latest developments and innovations in medical coding.

11. What North American Industry Classification System do you recommend for these services?

12. What Product Service Code do you recommend for these services?

13. Is there any other information or value-added services you can provide that would be relevant to this RFI?

V. Instructions for Submission

1. Page Limit: 25 single-spaced pages with a minimum 11-point Times New Roman font to address the questions listed in section IV. Information Requested. (Note: any pictorial examples or attachments provided in support of descriptive responses do not count towards this page limit.)

2. Interested parties should respond to this RFI with a white paper by 9:00 AM ET on November 26, 2024, to Laurie Presley at xnp0@cdc.gov. Please include “WTC Health Program | RFI 75D301-24-RFI-541512” in the subject line of the email.

3. Page 1 of the white paper shall include the chart below, completed by your organization:

Company Name Company Address Unique Entity ID (UEI) Primary Point of Contact Name Primary Point of Contact Email Primary Point of Contact Phone Number Business Type (large business, small business, nonprofit, minority- or woman-owned, etc.)

GSA or other Federal Schedule Awards mailto:xnp0@cdc.gov