RFI 001-16/17 State of Florida Agency for Persons with Disabilities Request for Information Intermediate Care Facilities for Individuals with Intellectual Disabilities Utilization & Continued Stay Review The Florida Agency for Persons with Disabilities (Agency or APD) works in partnership with local communities to support people with developmental disabilities in living, learning, and working in their communities. The Agency provides critical services and supports for customers with developmental disabilities so they can reach their full potential. The Agency serves people with Autism, Cerebral Palsy, Down Syndrome, Intellectual Disabilities, Prader-Willi Syndrome, Spina Bifida, and Phelan-McDermid Syndrome. Additional information about the Agency can be found on the Agency s website at: http://apdcares.org. A. Request for Information The Florida Agency for Persons with Disabilities (APD or Agency) is requesting information from vendors for a system to conduct federal and state mandated utilization and continued stay reviews for the Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). This is a Request for Information (RFI) only. This RFI is issued solely for information and planning purposes, and it does not constitute a solicitation (e.g., Invitation to Bid, Request for Proposal, or Invitation to Negotiate), or a promise to issue a solicitation in the future. This RFI does not commit the Agency to contract for any service or proposed solution whatsoever. The Agency is not required to utilize any information gathered from this RFI, nor is a vendor who responds to this RFI excluded from participating in any resulting solicitation. A response to this RFI is not an offer and the Agency will not use a vendor s submission to justify a contract with the vendor without complying with applicable laws, rules, and policies. B. Background & Purpose 1. Background APD RFI 001 16/17, Page 1 of 8
ICF/IIDs are an optional Medicaid benefit that enables states to provide comprehensive and individualized health care and rehabilitation services to individuals to promote their functional status and independence. ICF/IIDs are available only for individuals in need of, and receiving, active treatment (42 Code of Federal Regulations (C.F.R.) 440.150(a)(4)). Active Treatment refers to aggressive, consistent implementation of a program of specialized and generic training, treatment and health services (42 C.F.R. 483.440(a)). ICF/IID are for individuals with intellectual disabilities and provide 24-hour medical, habilitative, and health-related services in an ICF/IID that is licensed and certified by the Florida Agency for Health Care Administration to participate in the Medicaid program in accordance with Chapter 400, Part VIII, F.S. (Intermediate Care Facility for Individuals with Intellectual Disabilities Services Coverage Policy (July 2016) ( Policy ), page 2-3). Admission to an ICF/IID must be based on a preliminary evaluation and physician certification that ICF/IID services are needed. (42 CFR 456.360, 42 CFR 483.440). Services provided in an ICF/IID must be medically necessary and individuals must have a developmental disability as defined in Chapter 393, Florida Statutes (F.S.). Utilization Review (UR) & Continued Stay Review (CSR) are federal requirements for all residents of both private and public ICF/IIDs. Each ICF/IID must comply with state and federal utilization control requirements to safeguard against unnecessary or inappropriate utilization on institutional care services. 42 CFR 456.1. Federal UR and CSR requirements are contained in 42 C.F.R. Part 456, Subpart F. State requirements are found in Chapters 393, 400, and 409, F.S., Chapter 59G-4, Florida Administrative Code, and the Intermediate Care Facility for Individuals with Intellectual Disabilities Services Coverage Policy ( Policy ) available from the Florida Agency for Health Care Administration s website at: http://ahca.myflorida.com/medicaid/review/index.shtml. There are approximately 2866 private and public ICF/IID beds in the State of Florida. Pursuant to 42 C.F.R. 456.431 456.456, Continued Stay Reviews are done at least every six (6) months to determine whether placement in the ICF/IID continues to be appropriate. Additional tasks include initial admission Level of Reimbursement (see Section B.2.f. below) and thirty (30) day reviews, changes in the Level of Reimbursement, and annual Choice Counseling (see Section B.2.c. below) for individuals in the ICF/IID s and all associated paperwork. The general requirements for URs are identified in 42 C.F.R. 456.400, which states: Sections 456.401 through 456.438 of this subpart prescribe requirements for a written utilization review (UR) plan for each ICF APD RFI 001 16/17, Page 2 of 8
2. Purpose providing Medicaid services. Sections 456.405 through 456.407 prescribe administrative requirements; 456.411 through 456.413 prescribe informational requirements; and 456.431 through 456.438 prescribe requirements for continued stay review. The Agency is seeking information from vendors for strategies in the design, implementation, and operation of a model to carry out ICF/IID Utilization Reviews and Continued Stay Reviews. Respondents must provide information about the following service components: a. Utilization Review: Pursuant to 42 C.F.R. 456.406, URs must be conducted by a group of professionals, referred to as the utilization review committee or utilization control committee (UCC) that includes at least one physician and one individual knowledgeable in the treatment of intellectual disabilities. The UCC may not include: (i) any individual directly responsible for the care of the recipient whose care is being reviewed; (ii) any employee of the ICF/IID; or (iii) any individual who has a financial interest in any ICF/IID. Each ICF/IID must have an approved, written UR Plan. The UR Plan provides for the review of each Medicaid recipient s need for ICF/IID services (42 C.F.R. 456) and is available on the AHCA website at http://ahca.myflorida.com/medicaid/review/index.shtml A vendor shall perform the URs in accordance with the UR Plan and documented accordingly. Agency provided UR forms may be used for such documentation, and the Agency is willing to discuss the potential use of a vendor s electronic format of documenting the UR. b. Continued Stay Reviews: CSRs must be conducted within six (6) months of admission (42 C.F.R. 456.433) and at least every six (6) months thereafter (42 C.F.R. 456.434) to evaluate and determine the need for continued placement and the specific Level of Reimbursement required. More frequent reviews will be performed if the need is indicated at the time of assessment of medical necessity for continued stay. A vendor shall perform the CSRs in accordance with the UR Plan and documented accordingly. Agency provided CSR forms may be used for such documentation, and the Agency is willing to discuss the potential use of a vendor s electronic format of documenting the CSRs. APD RFI 001 16/17, Page 3 of 8
c. Choice Counseling: Individuals or their legal representative who are APD clients and currently receiving ICF/IID services will be counseled on community residential options and services. Choice Counseling will be provided, which will include information about the variety of services and supports available from the Medicaid Waivers, State Plan Medicaid, natural supports, or a combination thereof. A discussion with the individual or legal representative will include descriptions of residential options, work or meaningful day activity, transportation, medical and dental care, supplies, equipment, and therapies that are considered to be medically necessary. The individual or legal representative should have opportunities to visit a variety of living settings as part of the decision making process. (i) If the individual is not interested in moving to community-based services at the time of the Choice Counseling, a Documentation of Choice form will be completed, signed, and dated. (ii) If the individual chooses to move to community services at the time of the Choice Counseling, a Documentation of Choice form will be completed, signed, and dated to so indicate. Regional staff will assist the individual in choosing a Waiver Support Coordinator to help the individual or legal representative with transition planning. d. Certification and Recertification: (i) Pursuant to 42 U.S.C. 360(a), a physician at the ICF/IDD must certify for each applicant or beneficiary that ICF/DD services are or were needed. The certification must be made at the time of admission or, if an individual applies for assistance while in an ICF/DD, before the Medicaid agency authorizes payment. (ii) Pursuant to 42 U.S.C. 360(b), a physician, physician s assistant, or nurse practitioner s written recertification is required that the individual continues to require ICF/IID level of need and active treatment services. Recertification must be made at least every twelve (12) months after certification in an institution for individuals with intellectual disabilities. A recertification is completed by the ICF/IID. e. Level of Need: A determination by APD that an individual who has an intellectual disability as defined in Chapter 393, F.S. requires treatment in an ICF/IID (Policy, 2.) An individual requiring medically necessary ICF/IDD services must have a level of need determination, as well as a level of reimbursement determination (Policy, 3). f. Level of Reimbursement: A determination made for an individual requiring medically necessary ICF/IID services. The current levels are One and Two, as referenced in the Policy, Page 3. APD RFI 001 16/17, Page 4 of 8
(i) Admission Level of Reimbursement: The original Level of Reimbursement designation given by the UCC or its designee at the time of an individual s admission to an ICF/IID. (ii) Change in Level of Reimbursement: Any change made to the Level of Reimbursement based on medically necessity and related needs. f. Provision for Notification of Adverse Determinations: If a final determination is made that a recipient no longer meets an ICF/IID Level of Reimbursement or that further stay is no longer medically necessary, and the attending physician has had an opportunity to present additional documentation to the UCC, written notification of the findings shall be given to the facility, the attending physician, the qualified intellectual disabilities professional, Medicaid, and the individual or legal representative. The individual or legal representative is notified in writing of their right to a fair hearing to appeal any adverse determination. C. RFI Response Instructions Respondents to this RFI must respond to all components requested. The RFI response must be thorough, concise, and include the following: 1. The respondent s name, place of business address(es), contact information, including representative name and an alternate, if available, telephone number(s), and e-mail address(es); 2. A description of the respondent s business and its experience as it relates to the service components outlined in this RFI for which they are providing information. This description should include a narrative explaining past experience in which the respondent has engaged with other health care agencies, health care providers, or government agencies to deliver services pertaining to the service components outlined; 3. A statement of interest in or knowledge of the service requirements outlined in this RFI, and an overall description/model of how the Utilization Plan would be implemented on a statewide basis; 4. A description of: a. UCC composition, organization, authority, and function; b. Frequency of UCC meetings; c. Maintenance and use of records; d. Implementation of UCC findings and recommendations; APD RFI 001 16/17, Page 5 of 8
e. A description of the methodology for performing URs and CSRs; f. A description of the methodology for performing annual Choice Counseling; and g. Provision for Notification of Adverse Findings & Notices of Appeal. 5. Additional elements to be included in the response if available are: a. An implementation schedule for the development of ICF/IID URs; b. A timeline for developing and implementing the program specific to ICF/IID URs; c. A description of the professional staffing requirements and qualifications to conduct URs and CSRs; and d. An estimate regarding the implementation and operational costs for conducting URs and CSRs. D. Proprietary Information Any portion of the submitted response which is asserted to be exempt from disclosure under Chapter 119, F.S. shall be clearly marked exempt, confidential, or trade secret (as applicable), and shall also contain the statutory basis for such claim on every page. Pages containing trade secrets shall be marked trade secret as defined in Section 812.081, F.S. Failure to segregate and identify such portions shall constitute a waiver of any claimed exemption, and the Agency will provide such records in response to public records requests without notifying the respondent. Designating material simply as proprietary will not necessarily protect it from disclosure under Chapter 119, F.S. An entire response should not be considered trade secret. E. Response Submission Respondents to this RFI shall submit an electronic copy of its response using Microsoft Word 97 and/or Excel 97 or newer, not to exceed fifty (50) singled sided pages in length, and sent via email. The software used to produce the electronic files must be logically named. Those respondents lacking internet access may submit a response in paper form. APD RFI 001 16/17, Page 6 of 8
If the response contains any portion that has been identified as exempt pursuant to the instructions in Section D above, the respondent shall also submit one (1) electronic or paper redacted copy of the response suitable for release to the public. Any confidential or trade secret information covered under Section 812.081, F.S., should be either redacted or completely removed. The redacted response shall be marked as the redacted copy and contain a transmittal letter authorizing release of the redacted version of the response in the event the Agency receives a public records request. Responses to the RFI must be received by APD no later than 5:00 PM, Eastern Standard Time, on September 14, 2016, 2016. Responses shall be submitted to: Agency for Persons with Disabilities Attn: Vickie Woodward, Procurement Manager 4030 Esplanade Way Suite 215 850-414-8879 Tallahassee, Florida 32399-0950 vickie.woodward@apdcares.org F. Process APD reserves the right to seek additional or clarifying information from respondents. Any such request shall be in writing. Questions and answers shall be published on the vendor bid system. APD will review and analyze information received from this RFI to determine the best option(s) to address the APD s objectives and requirements. Cost information may be, but is not required to be, submitted with the response; however, submission of cost information will assist APD in gaining perspective of the potential budgetary magnitude. Responses to this RFI will be reviewed for informational purposes only and will not result in the award of a contract. Vendors submitting a response to the RFI are not prohibited from responding to any related subsequent solicitation. Not responding to this RFI does not preclude participation in any future procurement, if any is issued. G. Vendor Costs APD RFI 001 16/17, Page 7 of 8
Vendors are responsible for all costs associated with preparation and submission of their response. APD will not be responsible for any vendor costs associated with responding to this RFI. H. Register With The State Of Florida In order to do business with the State of Florida, all vendors must be registered in MyFloridaMarketPlace. Information about registration with the State of Florida is available, and registration may be completed at the MyFloridaMarketPlace website link under the heading, Business, on the State portal at www.myflorida.com. Those lacking internet access may request assistance from the MyFloridaMarketPlace customer service at 866-352-3776. Prior registration is not required to respond to this RFI. I. Public Records Respondents shall allow public access to all documents, papers, letters, or other public records as defined in Section 119.011(12), F.S. and as prescribed by Section 119.07, F.S., made or received by the respondent in conjunction with this RFI, except that public records which are made confidential or exempt by law must be protected from disclosure. NOTICE TO PERSONS WITH DISABILITIES IN NEED OF A REASONABLE ACCOMMODATION: Please contact Vickie Woodward to make your request at Vickie.woodward@apdcares.org as soon as possible, prior to the deadline for submittal. Those who do not have access to the internet should call or write Vickie Woodward at the address set forth in Section E. above. APD RFI 001 16/17, Page 8 of 8