G007--Medicaid Application Services

PERFORMANCE WORK STATEMENT (PWS) Medicaid Application Assistance Services General Information 1. GENERAL: This is a non-personnel services contract to provide Medicaid Application Assistance Services. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government. 1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform Medicaid Application Assistance Services as defined in this Performance Work Statement except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract. 1.2 Background: The Ralph H. Johnson VA Medical Center (RHJVAMC) is an integrated healthcare system comprised of the primary medical hospital located in the downtown area of Charleston, South Carolina and seven additional community outpatient clinics (CBOC) including Trident, Goose Creek, Myrtle Beach, Beaufort, Hinesville, Savannah and Conway. The RHJVAMC provides health services for veterans in South Carolina and Georgia. The main health care service offerings are outpatient, inpatient, extended care and telehealth care. Ensuring veterans are provided with excellent health care is the main priority of the RHJVAMC and staff work tirelessly to ensure veterans have access to the highest quality medical care. When veterans require admission to address acute health care problems, staff work closely with the veteran and his/her family to provide a safe and appropriate discharge care plan. While most of our veterans are able to discharge within clinically appropriate timeframes, a few veterans are not. These veterans are our most vulnerable as they have limited financial resources, are not eligible for placement and may lack appropriate support systems. These veterans may also require long term care, which is extremely challenging and difficult to secure without a known payor source. The inability to secure early identification of a primary payor source extends acute inpatient hospitalizations and limits care to other veterans. By improving access to Medicaid services at the time of admission to the acute setting and confirming the payor source, the RHJVAMC can reduce inpatient bed days, improve access, and cut hospital costs. 1.3 Objectives: Reduce inpatient length of stay for Veterans requiring long term care placement via Medicaid. Complete Medicaid applications and assist with long term care placement as needed. 1.4 Scope: The contractor shall provide personal assistance and resources to RHJVAMC staff, patients and caregivers, who have been identified as needing to complete this application in order to access additional community-based resources that Medicaid can provide. Individuals are identified through a screening process completed by RHJVAMC 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 timely and 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 RHJVAMC staff, patients, caregivers, and the Medicaid office until an eligibility decision is made by Medicaid. This may also include appealing Medicaid decisions. Completing these applications will permit successful transitions from acute and subacute care to community based long-term care. It will also reduce length of stay and decrease health care costs. The contractor shall accomplish: Contractor will meet with identified patient and/or caregiver at bedside within the expected timeline from admission. Contractor will obtain a release of information (ROI) from the patient/caregiver as part of initial meeting. Contractor will collaborate with VA staff to ensure ROI is sent to the ROI office. 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. Contractor will file the application within 72 hours of admission Contractor to be proactive in following-up with the Medicaid office Contractor to provide a focused and dedicated effort to follow up on pending Medicaid applications to ensure timely processing of cases. Contractor to continue to follow-up with Medicaid office, patients, and caregivers until eligibility determination has been issued Contactor to be knowledgeable of documentation required for Medicaid application and be comfortable obtaining these documents Contractor to be comfortable working with vulnerable populations Contractor will be comfortable traveling to and from campuses, as required Contractor will be able to assist in managing and following through on any appeals necessary with Medicaid until application is approved. Contractor will be able to manage multiple cases concurrently. In the event RHJVAMC 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). The contractor shall comply with the following regulations. Regulations stated should only be used as a guide and not considered all inclusive. HIPPA Release of Information Policy Privacy Computer Security Medicaid TMS Quality Assurance Plan The following is a listing and description of Medicaid assistance would be identified to be included in the scope of this contract: Medicaid Long term care (or Nursing home applications) RHJVAMC employees shall: Screen veterans within RHJVAMC for eligibility for Medicaid Provide the contact information for veterans who screen positive to the contractor for completion of the application Contractor shall: (Order of events) Contractor will meet with identified patient and/or activated healthcare proxy (HCP) at bedside within the expected timeline from admission. 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. Contractor will file the application within 72 hours. Contractor to be proactive in following-up with the Medicaid office Contractor to provide a focused and dedicated effort to follow up on pending Medicaid applications to ensure timely processing of cases. Contractor to continue to follow-up with Medicaid office, patients, and caregivers until eligibility determination has been issued Contactor to be knowledgeable of documentation required for Medicaid application and be comfortable obtaining these documents Contractor to be comfortable working with vulnerable populations Contractor will be comfortable traveling to and from campuses, as required Contractor will be able to assist in managing and following through on any appeals necessary with Medicaid until application is approved. Contractor will be able to manage multiple cases concurrently. Period of Performance: One base year with the possibility of four one-year option periods Base Year: 1 Apr 2021-31Mar 2022 1st Option Period 1 Apr 2022-31Mar-2023 2nd Option Period 1 Apr 2023-31Mar-2024 3rd Option Period 1 Apr 2024-31Mar-2025 4th Option Period 1 Apr 2025-31Mar-2026