Statement of Work - Medicaid.docx

STATEMENT OF WORK

Medicaid Application Assistance Services

1. BACKGROUND: The VA Boston Healthcare System (VHABHS) is an integrated healthcare system comprised of three medical centers: Jamaica Plain Campus in Boston, MA, West Roxbury Campus in West Roxbury, MA, and Brockton Campus in Brockton, MA, and many community outpatient clinics (CBOC) and other facilities located in Massachusetts.

VABHS is the tertiary care facility for VISN 1 and provides services for Veterans in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut. The main health care service offerings are outpatient, inpatient, extended care, and telehealth care. Ensuring veterans access to care is a priority. For veterans that are admitted to the acute setting, we work to achieve this by ensuring veterans have access to the right care at the right time in the right setting. By improving our access to Medicaid services at the time of admission to the acute setting, we ensure that veterans will have a payer source to assist with discharge planning when they are medically ready to leave the hospital. This will help us provide an appropriate length of stay to veterans and timely transition to the next level of care.

2. MEDICAID APPLICATION ASSISTANCE SERVICES: The contractor shall provide assistance with the completion of Medicaid applications. Medicaid has various names, based on the state administering the program. For purposes of this agreement, the contractor will be able to navigate the Medicaid application process to completion for states served within the VISN as noted above. The contractor shall provide personal assistance and resources to VABHS staff, patients, and caregivers, who have been identified as needing to complete this application to access additional community-based resources that Medicaid can provide. Individuals are identified through a screening process completed by VABHS 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 time 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 VHABHS staff, patients, caregivers, and the Medicaid office until a decision is made by Medicaid regarding eligibility. This may also include appealing Medicaid decisions. Completing these applications will permit successful transitions from acute and subacute care for the many patients in need of long-term care. It will also enable a reduced length of stay and decreased healthcare costs.

Medicaid refers to assistance provided by the government to individuals, including eligible low-income adults, elders, and people with disabilities, who meet financial and clinical criteria. This assistance enables recipients to access a spectrum of services including community-based and long-term care. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.

3. SERVICE LOCATIONS:

1400 VFW Pkwy, West Roxbury, MA 02132

940 Belmont Street, Brockton, MA 02301

150 S. Huntington Ave, Boston, MA 02130

4. PERIOD OF PERFORMANCE:

5. GENERAL REQUIREMENTS: a. It is one of the missions of the VA Boston Healthcare System to serve the Veteran through the delivery of timely quality care by staff who demonstrate outstanding quality service. Our key business drivers are quality, financial integrity, patient satisfaction, and employee satisfaction. Implementing this contract will enable excellent customer service, decreased length of stay, and decreased healthcare costs, thus improving the ability to meet our mission and incorporate key business drivers. Prospective bidders must have significant knowledge and understanding of the Medicaid application process throughout New England, including Long-Term Care and Community-Based applications, and the ability to complete these applications in a time-efficient manner. It is imperative that perspective bidders can meet the patient or family at the bedside and/or virtually to obtain collateral information and signatures, as required. Prospective bidders should be expected to follow-up with this application process until eligibility is determined. Prospective bidders should be able to obtain documents required to complete this process, even when the patient is unable to assist. Prospective bidders should be comfortable working with multiple types of vulnerable populations. Prospective bidders shall demonstrate a history of successful completion of the Medicaid application for long-term care and community-based care on behalf of a multitude of clients. Submittals by agencies that are unable to meet the above specifications may not be considered.

i. Contractor will meet with identified patient and/or caregiver at bedside, as needed, or virtually within the expected timeline from referral.

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

iii. Contractor will collaborate with VA staff to ensure ROI is scanned into medical record.

iv. 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.

v. Contractor will make initial outreach for all inpatient referrals within 48 hours and will continue daily outreach until contact is made.

vi. Contractor will make initial outreach for all outpatient referrals within 7 days and will continue weekly outreach until contact is made.

vii. Contractor will submit/file application within 72 hours of receiving signed referral form.

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

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

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

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

xii. Contractor to be comfortable working with vulnerable populations.

xiii. Contractor will be comfortable traveling to and from campuses and in the community, as required.

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

xv. Contractor will be able to manage multiple cases concurrently.

xvi. Contractor will be able to track and report on data/analytics of the process.

b. In the event VHABHS 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).

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

i. HIPPA

ii. Release of Information Policy

iii. Privacy

iv. Computer Security

v. Medicaid

vi. TMS

vii. Quality Assurance Plan

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

i. Medicaid Long term care (or Nursing home applications)

ii. Medicaid community-based services including but not limited to PACE program, Frail Elder Services, Adult Day Healthcare, and Group Foster Homes.

iii. Consultation with Veterans/ caregivers

f. VHABHS employees shall:

i. Screen veterans within VHABHS or receiving care from VHABHS for eligibility for Medicaid.

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

g. Contractor shall: (Order of events)

i. Contractor will meet with identified patient and/or caregiver in person or virtually, as needed, within the expected timeline from admission and based on patient/caregiver preference and need.

ii. 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.

iii. Contractor will file the application within 72 hours of a signed referral form (see iv. thru vii. Above)

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

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

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

vii. Contactor to be knowledgeable of documentation required for Medicaid application throughout New England and be comfortable obtaining these documents.

viii. Contractor to be comfortable working with vulnerable populations.

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

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

xi. Contractor will be able to manage multiple cases concurrently.

xii. Contractor will attend monthly meetings with social work leaders for planning and problem solving, provide data and participate in annual reviews and presentations for effectiveness of the program to staff and leadership, and provide guidance to various social work programs, as needed.

h. Hours of Operations: The contractor will be available on an as needed basis from 7am to 8pm, 7 days/week, excluding federal holidays.

k. Federal Holidays

0. New Year’s Day

0. Birthday of Martin Luther King Jr.

0. Washington’s Birthday

0. Memorial Day

0. Juneteenth

0. Independence Day

0. Labor Day

0. Columbus Day

0. Veterans Day

0. Thanksgiving Day

0. Christmas Day

6. SPECIAL REQUIREMENTS:

a. QUALIFICATION OF OFFERORS: Quotes shall be considered only from companies who are regularly established in the business called for, and who in the judgment of the Contracting Officer are financially responsible and able to show evidence of their reliability, ability, experience, equipment, facilities, and personnel directly employed or supervised by them to render prompt and satisfactory service. Contractor shall be able to successfully assist patients and families with completing Medicaid applications immediately upon start of the contract period.

b. VEHICLES/TRANSPORTATION: Contractor is responsible for traveling to VHABHS sites, Medicaid offices, and community locations as needed. The contractor will have access to shuttles between campuses (veterans receive priority).

c. CONTINUATION OF SERVICES: Offeror shall submit written contingency plans outlining how they will continue to provide services in the event there is a disruption in any segment of services provided such as transportation, destruction, etc.

d. TERMS OF CONTRACT: This contract shall be effective from date of award through January 2025 with 4 option years.

e. CONTRACTING OFFICER’S REPRESENTATIVE (COR): A Contracting Officer’s Representative (COR) shall be appointed to this contract. The COR is not authorized to change the scope of the work. Changes can only be made by the Contracting Officer.

f. FUEL SURCHARGE: The Government will not make additional payments for fuel surcharges under this contract.

g. INVOICES: The Contractor is to submit monthly invoice in arrears, indicating the dates and type of service provided, supporting documents for all approvals, name and last 4 of Veteran, along with the contract number and purchase order number for which payment is due. Contractor shall receive payment for services rendered in accordance with the Prompt Payment Act.

h. QUALITY ASSURANCE: 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.

i. CORRESPONDENCE: All correspondence relative to this contract shall bear the VA Contract number, correct Fiscal Year Purchase Order number, Title and name of facility being billed against.

j. PAYMENTS: Will be paid monthly, in arrears, upon receipt of a proper invoice for services performed during the previous month in accordance with the terms of this contract. All invoices shall be submitted by the 15th day of the month following the month in which services were provided.

Payment will be made upon receipt of a properly prepared, itemized invoice, validated by the COR, and submitted to VA Electronic Payment System http://www.fsc.va.gov/einvoice.asp.

(1) A properly prepared invoice will contain:

· Invoice Number and Date

· Contractor’s Name and Address

· Accurate Purchase Order Number

· Total Applications completed

· Unit Price Charged

· Extended Price

· Price Broken Down by Location

· Dates service performed

· Location of service performed

(2) A single, consolidated invoice will be prepared for all facilities and submitted monthly in arrears