WTCHP_MentalHealthProviderEvaluation_RFI_09302024.docx

WTC HEALTH PROGRAM

RFI 75D301-24-RFI-541990

World Trade Center Health Program Request for Information

CDC WORLD TRADE CENTER (WTC) HEALTH PROGRAM MENTAL HEALTH PROVIDER NETWORK CONTRACT

REQUEST FOR INFORMATION

75D301-25-RFI-541990

RESPONSE DUE DATE: 29 November 2024

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. 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. 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.

I. Purpose

The World Trade Center (WTC) Health Program is seeking information from qualified vendors to develop or acquire and manage a specialized mental health provider network. This network aims to address the unique mental health needs of the WTC Health Program members by providing timely outpatient services, integrating with existing care teams, and overcoming challenges such as provider shortages, coordination of care, coordination of benefits (COB) billing, and reimbursement issues.

The objectives of this RFI are to:

1. Identify vendors who can provide a robust mental health provider network and manage the operations of the network including recruitment, care coordination, provider education, and compliance with Program requirements.

2. Understand solutions available to ensure timely outpatient mental health services to WTC members.

3. Explore strategies for integrating mental health providers with the WTC Health Program system.

4. Address challenges related to provider shortages, COB billing, and reimbursement.

5. Gather information on vendor capabilities, experience, and approach to meeting the WTC Health Program's needs.

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 mean the Director of the National Institute for Occupational Safety and Health (NIOSH) within the Centers for Disease Control and Prevention (CDC), or his or her designee. Information on the WTC Health Program is available at http://www.cdc.gov/wtc. High-level Program statistics can be found at Program Statistics - World Trade Center Health Program (cdc.gov).

The WTC Health Program provides monitoring, screening, and treatment (medical and pharmacy) to 9/11 Responders and Survivors. Specifically, the WTC Health Program is a limited benefit health plan, meaning that treatment is covered for only specified health condition(s) resulting from exposure to airborne toxins, hazards, or other adverse conditions arising from the September 11, 2001, terrorist attacks. An internal provider enrolled with the WTC Health Program must diagnose a member with a WTC-related health condition and determine that it is related to the member’s 9/11 exposure. The determination must then be certified by the WTC Health Program for the member to receive treatment. An enrolled member must meet certain exposure, latency, and symptom-onset requirements for their health condition to be certified. A list of certifiable conditions can be found in 42 CFR § 88.15 (https://www.cdc.gov/wtc/regulations2.html)

Mental Health Services within WTC Health Program

Mental health conditions are widespread within the WTC Health Program member population, many of whom have been diagnosed with conditions such as PTSD, anxiety, depression, and substance use disorders (SUD). These conditions have been recognized as directly related to the events of 9/11 and the prolonged exposure to trauma experienced by responders and survivors.

Services provided by the Program are managed through eight Clinical Centers of Excellence (CCEs) that are located in the New York Metropolitan Area (NYMA) or the Nationwide Provider Network (NPN). The CCEs are brick and mortar facilities that provide healthcare services in house including initial health evaluations, annual monitoring exams, treatment for some certified conditions, leveraging their expertise in 9/11-related health issues. Some CCEs are able to provide some mental health treatment within their clinic, however many members are referred to external providers. The CCEs use the Program NYMA provider network to coordinate care with external healthcare providers and support services.

Members living outside of NYMA are assigned to the NPN which coordinates services with providers nationwide including all states and US territories. Unlike the CCEs, the NPN is not a brick a mortar facility, but a vendor that coordinates care through phone and electronic communications (i.e., email, patient portal) using multiple provider networks. The NPN does not provide any services directly to members. This network is vital for ensuring that all eligible members, regardless of their location, receive the mental health services they need.

Existing Challenges

Despite the program's comprehensive coverage, several challenges impede the effective delivery of mental health services to the program members:

1. Provider Shortages: There is a nationwide shortage of mental health providers, exacerbated by increased demand and insufficient training opportunities. This shortage impacts the ability to provide timely and adequate care.

2. COB Requirements: A subset of the Programs member population is required to have their claims coordinated with primary insurance. Many mental health providers do not take insurance and/or are unwilling to do COB.

3. Enrolling Providers: Difficulties in enrolling providers in insurance networks.

4. Federal Employee Compensation Program (FECA) Rates: The Program is statutorily required to reimburse at or below FECA rates. Providers tend to be unfamiliar with these rates and reluctant to agree to them.

5. Cultural and Linguistic Barriers: Some members require services in languages other than English, and there is a lack of culturally competent providers to meet these needs.

6. SUD Treatment Gaps: There is an increasing demand for substance use disorder treatment services, but availability of providers remains limited.

7. Quality of Care Concerns: Inconsistencies in the quality of care provided by external providers which can lead to suboptimal outcomes for members and/or dissatisfied members with the services.

8. Telehealth Regulations: Variations in telehealth regulations across states impact the ability of out-of-state providers to deliver services, limiting access to care for members in remote or underserved areas.

Need for a Specialized Mental Health Provider Network

Given the identified challenges and the growing demand for mental health services, there is a critical need to increase access to mental health providers through a specialized mental health provider network. This vendor would focus on recruiting and retaining providers with expertise in trauma-related mental health conditions, educating providers on the Programs unique requirements, ensuring timely access to outpatient services, and coordinating care in partnership with the CCEs and NPN. Additionally, addressing COB billing and reimbursement issues, enhancing provider training, and leveraging telehealth solutions are essential components of this initiative.

The development of this network aims to improve the quality of care, reduce reliance on inpatient and emergency services, and enhance the overall well-being of the WTC Health Program members. The information gathered through this RFI will inform the strategies and actions needed to achieve these goals.

III. Information Requested

The World Trade Center Health Program requests information from mental health networks, provider groups, active stakeholders, members of the 9/11 community, and those with industry experience to provide insight for the following questions. These questions aim to gather comprehensive information about the vendor's capabilities, solutions, and approach to developing a specialized mental health provider network for the WTC Health Program.

1. Company Overview and Experience Vendors should provide detailed company information, including name, address, and contact details, along with a brief overview of the company’s experience in developing and managing mental health provider networks. Vendors should describe any past projects or contracts similar to the WTC Health Program's requirements, including examples of successful implementations and how the company stays current with the latest developments and best practices in mental health care.

2. Proposed Solutions to Meet the WTC Health Program Mental Health Provider Needs Vendors are requested to outline the mental health provider network they will develop and manage, including a description of the services offered, network’s key features, and benefits to members and providers. The response should include strategies for ensuring timely outpatient mental health services, integrating the network with WTC Health Program’s existing care teams and infrastructure, and addressing challenges such as provider shortages, COB billing, reimbursement issues, and linguistic barriers. Vendors should also explain how they will ensure providers accept WTC reimbursement rates (Federal Employees’ Compensation Act (FECA)) and prevent members from being improperly billed.

3. Implementation, Support, and Cost Management Vendors should provide a proposed timeline for implementing the mental health provider network, along with the support and training they will offer to ensure successful integration and operation. The response should also include quality assurance measures and performance metrics to maintain high standards of care. Preliminary cost estimates for developing and managing the network, potential cost-saving measures, and efficiencies should be provided to give a clear understanding of the financial implications.

4. Provider Enrollment Additionally, vendors should outline their process for enrolling mental health providers, verifying credentials, and encouraging participation through incentives or support.

5. Coordination of Care Vendors should describe how they intend to work with the CCEs/NPN to identify providers for members, coordinate care with providers, educate providers on program requirements, and ensure compliance with program requirements.

6. Geographical Coverage and Telehealth Services Vendors are asked to explain how they will ensure adequate geographical coverage across various regions, particularly in underserved areas, and how they will monitor the equitable distribution of services. Telehealth solutions should be described in terms of how they will enhance access to mental health care and integrate with in-person care. Finally, vendors should describe how they intend to maintain compliance with telehealth regulations across different states.

IV. Instructions for Submission

1. Page Limit: 100 single-spaced pages with a minimum 10-point Times New Roman font. (Note: any pictorial examples or attachments provided in support of descriptive responses do not count towards this page limit.)

2. Questions Due By: 30 October 2024

3. Responses Due By: 29 November 2024

4. 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

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.png