Recommendation of Vendors in Response to Requests for Proposals Community Support Team (CST) Intensive In-Home (IIH) SA Intensive Outpatient Program (SAIOP) January 9, 2014 Serving Durham,, Cumberland and Johnston Counties
Background Federal and State requirements for Managed Care Organizations to manage quality, effectiveness and cost of services within a closed provider network Alliance management of closed network since 2/1/13 Alliance Selection and Retention Procedure enables nonrenewal of contracts based on multiple factors Concerns raised about consistency in meeting quality and practice standards of CST, IIH and SAIOP Selection of providers for contract renewal through Request for Proposal (RFP) process Alliance Request for Information/Request for Proposal Procedure establishes guidance for fair, uniform and consistent process
Objectives Comprehensive and quality-driven network Improved quality and consistency of CST, IIH and SAIOP Fidelity to evidence-based practices Local continuum of care including outpatient and psychiatric services Compliance with standards of care, service definitions, crisis response expectations, CABHA expectations (when applicable) Provider viability Consumer Choice Fair, consistent and transparent selection process
Current RFPs Community Support Team Intensive In-Home Services Substance Abuse Intensive Outpatient Program (SAIOP) MH/SA Supported Employment and Long-Term Vocational Supports (to be presented to Board in February)
Provider Expectations All providers of CST, IIH and SAIOP were required to respond to RFP to be considered for Medicaid contract renewal Respondents must have credentialed site in Alliance catchment area Current CST, IIH and SAIOP providers may request expansion to other counties in Alliance catchment area Contracts extended for three months for respondents meeting minimum criteria Contracts for non-responding providers and those not meeting minimum criteria ended 12/31/13 No set number of awards
Request for Proposal Process Development and posting of RFP Pre-proposal conferences Questions and Answers posted RFP responses due Minimum Compliance review Review of written responses ( desk review ) Provider interviews Final recommendations and Board approval Contract renewal and consumer transition
RFP Schedule RFPs posted September 30, 2013 Pre-Proposal Conferences October 7 & 8, 2013 Questions and Answers Posted October 18, 2013 RFPs Due November 1, 2013 Minimum Compliance Review November 4-8, 2013 Desk Review November 12-26 Provider Interviews Dec. 11, 2013 Jan. 6, 2014 Recommendations to Board January 9, 2014
Minimum Compliance Response submitted by 5:00pm 11/1/13 Response contains all required elements Credentialed site in Alliance catchment area Good standing status with: Alliance Other MCOs (required by DMA-MCO contract) Accrediting body Federal and State oversight agencies Currently providing service covered by the RFP
Desk Review Rating Process Training for reviewers Sections reviewed by content specialists Ratings used Likert scale ranging from 1 5 Score sheets included justification for ratings of 3 or less Interview selection based on compiled scores of multiple raters Non-selected responses subjected to additional review Non-selected providers were offered opportunity to meet with Alliance CEO
Desk Review Rating Scale 1 Unsatisfactory Unclear Incomplete Insufficient 2 Minimal Weak Confusing Lacks some info 3 Sufficient Satisfactory, but some questions /concerns remain 4 Good Strong Wellplanned Clear, Reasonable 5 Exceptional Model Program No questions remain
Interview Selection Process Desk review score of 65% required to be invited to interview Conducted second review of ratings for non-selected Purpose of interview is to confirm desk review ratings and clarify information about services Provider invited to bring CEO, Medical Director, Clinical Director, Program Directors and other key staff (max. 10 employees) Consistent set of interview questions for each RFP, with additional follow-up and clarification questions allowed Group consensus rating of interview responses
RFP Selection Committee Representatives from multiple departments, all Alliance counties, Alliance Board and CFAC. The following departments/functions were represented on interview panels: Network Development and Evaluation: 17 Legal and Compliance: 8 Financial: 3 Clinical Operations: 11 QM: 5 Community Relations: 2 Consumer Affairs: 1 Alliance Board: 2 Alliance CFAC: 1
RFP Responses CST IIH SAIOP Eligible to Respond to RFP 35 49 41 Responses Received 28 45 28 Did Not Meet Minimum Review Criteria 6 7 3 Met Minimum Review Criteria 22 38 25 Met Desk Review / Interviewed 16 29 16 Recommended to Board 10 23 12
RFP Recommendations Alliance RFI/RFP Procedure requires a score of 65% for contract consideration This procedure allows exceptions if there is a critical need for the service, there is a limited response, and if committee is convinced that the prospective provider has the capability to successfully execute RFP requirements Recommend 35 providers for full-year contract extensions (through 12/31/14) Recommend 11 providers for six-month contract extensions (through 6/30/14) Recommend 15 providers for non-selection for these services (current contract ends 3/31/14)
Six-Month Contract Extensions Scores of 55% - 65% on interview Scores above 65% on desk review Providers will be notified in award letter of specific expectations and areas for improvement Alliance will provide technical assistance on identified areas of concern Alliance will monitor provider performance through 6/30/14 and will make further recommendations for contract renewal/non-renewal in May.
Recommendations for CST (Full-Year Contract) Provider Carolina Outreach Family Legacy MH Services Counties Served Cumberland, Durham Family Preservation Services of NC Durham, NC Recovery Support Services Southlight Tonya Omar / The Aya Center Durham Turning Point Family Care
Recommendations for CST (Six-Month Contract) Provider Counties Served A United Community B and D Behavioral Health Services Durham Yelverton's Enrichment Services Cumberland, Durham
Recommendations for IIH (Full-Year Contract) Provider Counties Served Access Family Services Alexander Youth Network Carolina Outreach Carolina Support Services Diverse Family Services Easter Seals UCP Family Legacy Mental Health Services Family Preservation Services of NC HealthCore Resource, Inc. Cumberland, Durham, Cumberland Cumberland, Durham Johnston Durham Durham,
Recommendations for IIH (Full-Year Contract) Provider Counties Served Hope Services Melange Health Solutions, LLC NC Mentor (merging with IFCS) NC Recovery Support Services Tonya Omar / The Aya Center Turning Point Family Care Upward Change Health Services Youth Extensions Youth Villages Durham Cumberland, Durham Durham Durham Durham
Recommendations for IIH (Six-Month Contract) Provider Counties Served A United Community B and D Behavioral Health Services Healing Interventions Quality Care Solutions Yelverton's Enrichment Services Durham Durham, Cumberland, Durham,
Recommendations for SAIOP (Full-Year Contract) Provider Carolina Outreach Cumberland County CommuniCare Family Legacy Mental Health Services Fellowship Health Resources NC Recovery Support Services Restoration Family Services Southlight UNC Horizons VisionQuest Nonprofit Corporation Visions Counseling Studio, PLLC Counties Served Cumberland Cumberland Johnston Durham Durham
Recommendations for SAIOP (Six-Month Contract) Provider B and D Behavioral Health Services Sigma Health Services Counties Served Durham
CST Claims by Agency (past three months) 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
IIH Claims by Agency (past three months) 140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48
SAIOP Claims by Agency (past three months) 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
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