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Medical & Health Care - Consulting & Other Services

 
Issue Date: 10/20/2017 Contract Number: TBD

SOLICITATION OF INTEREST # 17532: HIV Innovator Accountable Care Organization (IACO)


Description:

The New York State Department of Health (NYSDOH) AIDS Institute (AI) announces the opportunity for HIV Special Needs Plans (SNPs) to develop and form an HIV Innovator Accountable Care Organization (IACO) in the five boroughs of New York City. The NYSDOH Office of Health Insurance Programs (OHIP), issued an IACO application in June 2017 to encourage accelerated transition to Value Based Payments (VBP) as part of the States Delivery System Reform Incentive Payment (DSRIP) Program initiative. An IACO for clinically integrated health care providers will work together to provide, manage and coordinate healthcare including primary care for the HIV/AIDS population, with a mechanism for shared governance; the ability to negotiate, receive and distribute payments; and accountability for the quality, cost and delivery of health care to its clients.

HIV SNPs authorized by the Managed Care Act of 1996 are comprehensive managed care delivery networks for Medicaid recipients with HIV. Designed to meet the needs of the HIV community, SNPs are an alternative to regular Medicaid Managed Care Plans operating since 2003.

 The SNP infrastructure is a proven and highly effective model for accessing HIV care, medications and support services. The development of an HIV IACO is a critical milestone in the States Medicaid Reform efforts. It will reduce health care costs, promote effective allocation of health care resources and enhance the quality and accessibility of health care.

 Expected Activities/Work Performed

 Funded organizations will support the development and incorporation of an HIV focused, provider-led IACO in 2018. The funded organization will draft a summary of their findings before the end of the contract term.

 Funded organizations will be expected to perform the following:

  •  Secure legal and VBP contracting assistance to advance a completed IACO Application.
  • Design and develop VBP level 2 and 3 contracting strategies for HIV primary care providers.
  • Design mechanisms to address IACO full risk.
  • Perform utilization review (UR), utilization case management (UCM), disease management (DM), and drug utilization review activities under one model of care for its members.
  • Report findings to the AIDS Institute on a quarterly basis.

Qualifications of eligible organizations:

  • Certification as an HIV Special Needs Plan by the New York State Department of Health (NYSDOH)*;
  • Demonstrated experience with areas of work in the HIV field, preferably with promoting increases in the rate of viral load suppression among its members;
  • Demonstrated experience working and collaborating with the Delivery System Reform Incentive Payment (DSRIP) Program Performing Provider Systems (PPSs);
  • Capacity to improve health outcomes and reduce costs; and
  • Current network must include the five New York City boroughs.

*Current listing available at: https://www.health.ny.gov/diseases/aids/general/resources/snps/plans.htm

 Funding for this project is contingent on the availability of State funds and the number of eligible organizations that respond to the advertisement. In making awards, the Department will need to ensure geographic coverage of the services proposed. The anticipated contract term is May 1, 2018 – April 30, 2019. The resulting contract will be a cost reimbursable contract. Progress reports will be required.

 Written questions will be accepted until 3:00 pm, on November 2, 2017.  All questions should be submitted electronically to the email address: AIGPU@health.ny.gov.  All questions should be submitted with the subject line “IACO SOI”.  In the event that any updates and/or clarification of information are warranted, information will be posted in the Contract Reporter under the tab “Documents” for this announcement.  Responses to questions received by November 2, 2017, will be posted on or about November 16, 2017.

 How to Apply

 Interested eligible organizations should submit a completed checklist and cover sheet (available under the “Documents” tab) and no more than a 2-page document describing the organization’s background, affiliates and experience that demonstrates their capacity to develop an HIV IACO per the qualifications above. Information submitted using the checklist may be subject to verification with the New York State Department of Health’s Office of Quality and Patient Safety. Please submit these documents via email to AIGPU@health.ny.gov no later than 4:00 pm EST on December 5, 2017.

 An internal review will determine eligibility. All eligible organizations will be included in the funding formula. This advertisement is not a guarantee or promise of funding. Available funding to support this initiative will be limited to the amount(s) appropriated in the enacted State budget for this purpose and will be distributed equally among those providers who are deemed eligible by the Department. The Department reserves the right to withdraw this solicitation and issue a competitive procurement for this project if the number of interested and eligible parties exceeds that which can be reasonably accommodated by available funds.

 

Due Date: 12/05/2017 4:00 PM

Contract Term: May 1, 2018 – April 30, 2019

Location:

Ad Type: Grant or notice of funds availability


Primary Contact:     Health, NYS Dept. of
AIDS Institute
Medicaid and Health Care Reform Policy and Analysis
Ann Maxwell, RN, MS
Consultant Nurse
Corning Tower, Room 465
Empire State Plaza
Albany, NY 12237
United States
Ph: 518-474-1099
Fax:
AIGPU@health.ny.gov

Secondary contact:     Health, NYS Dept. of
AIDS Institute
Medicaid and Health Care Reform Policy and Analysis
Ann Maxwell, RN, MS
Consultant Nurse
Corning Tower, Room 465
Empire State Plaza
Albany, NY 12237
United States
Ph: 518-474-1099
Fax:
AIGPU@health.ny.gov