Request for Information - WTC Health Program Survivor-Member Clinical Center of Excellence (CCE) Activities

**UPDATE (4/13/2023): A copy of the questions submitted by interested participating parties and all CDC responses have been posted to Attachments/Links section of this posting. Please see the two (2) Excel Sheets titled "RFI 72636 - Questions and Responses" and "RFI 72636 - Questions and Resposnes _ Attachment A " below. The deadline for response submission remains April 28, 2023, at 3:00pm EDT. **UPDATE (4/11/2023): The deadline to submit responses to this Request for Information (RFI) has been extended by two (2) weeks to Friday, April 28, 2023, at 3:00pm EDT. An amended version of the RFI has been attached that conveys this new due date; no other changes were made to the document. *NOTE: CDC is still working on addressing vendors' previous questions to this RFI and will provide another update to this posting including its answers in the coming days. This is a Request for Information (RFI). It is NOT a solicitation for proposals, proposal abstracts, or quotations. Release of this information should not be construed as a commitment to procure items discussed or to incur costs for which reimbursement would be required or sought. As permitted by Federal Acquisition Regulation (FAR) Part 10, this is a market research tool being utilized for informational and planning purposes only. Your responses will assist the Government in the definition of any furture requirements and overall development of its acquisition strategy. I. PURPOSE The purpose of this RFI is to identify potential contractors who would provide medical monitoring and treatment, as well as other Clinical Center of Excellence (CCE)-related activities to World Trade Center (WTC) Health Program Survivor members. Additionally, this RFI seeks to understand opportunities and enhance future solicitations to improve access to care for Survivor members. II. BACKGROUND The WTC Health Program provides medical monitoring, screening, and treatment to Responders and Survivors of the 9/11 terrorist attacks. Specifically, the WTC Health Program is a limited benefit health program, 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. Clinical Centers of Excellence (CCEs) are the New York metropolitan area-based medical facilities that operate under individual contractual relationships with the WTC Health Program to provide medical monitoring examinations, diagnosis, and treatment services for eligible persons in the New York metropolitan area. The WTC Health Program currently contracts with eight (8) CCEs to perform the critical tasks mandated by the Zadroga Act (42 USC 300mm-4) and listed in the attached RFI. Historically, the WTC Health Program has awarded multiple CCE contracts through the same solicitation, with each vendor proposing a specific geographic area and cohort (i.e., FDNY Responder, General Responder, Survivor) to serve. Currently, there is one (1) CCE that serves FDNY Responders, five (5) that serve General Responders, and two (2) that serve Survivors. The WTC Health Program is seeking to understand the feasibility/necessity of a more tailored survivor-only CCE Performance Work Statement, recognizing that survivor requirements are substantively different than responder requirements, which could impact required tasks and performance thresholds. A table of key differences between responder and survivor populations can be found in the attached RFI for reference. III. REQUESTED INFORMATION Building a Survivor Cohort Question 1: What are some barriers to care specific to the Survivor population? About what percentage of the population does this barrier affect? What are the implications of this? For example, the Program understands that there is a higher rate (~20%) of Survivors that are ineligible for health insurance compared to Responders because of the broader eligibility criteria. This affects the CCE's ability to coordinate benefits, because in these cases, there may not be a primary payer. Question 1.a: Describe tactics that you leverage to overcome/mitigate the impacts of these barriers to entry for Survivor members. Question 2: What are some barriers to entry to serving the Survivor population? What are ways to overcome that? For example, the Program understands that requirement for coordination of benefits is a challenge, as COB is difficult industry wide. Question 3: What are some ways to - divide the Survivor population to facilitate provision of services and increase access to care? Currently, the Program assigns Survivor CCEs based on number (i.e., first X # go to CCE 1, the rest go to CCE 2) and assigns Responders based on applicant preference. Question 3.a: What are some ways to - divide the Survivor contract requirements to facilitate provision of services and increase access to care? Currently, the Program has two Survivor CCEs that have identical performance work statements. Coordination of Benefits and Related Activities Question 4: What are effective ways of collecting and maintaining real-time Other Health Insurance (OHI) information that you have experienced in other Programs that you previously or currently administer? Are there additional ways that you have not had experience in that you think would be beneficial? Currently, the Program requests that OHI information be collected and updated at each interaction with the member but would be interested in more real-time updates; additionally, please note that the Program is not able to utilize Social Security numbers for this purpose. Question 4.a: What data elements are required to be collected to successfully facilitate coordination of benefits? Question 5: How does/should a Survivor CCE facilitate effective coordination of benefits (for members with OHI on file) where providers are in both the primary and WTCHP networks and all prior authorizations are met (describe process for both internal Survivor CCE providers and external providers)? Current CCEs have noted that it is challenging to find the overlap between Program and primary insurance requirements, resulting in multiple instances where the primary insurance denies the claim and pays $0. Question 5.a: What services do you provide to facilitate coordination of benefits in terms of member education to assist them in utilizing their primary insurance? Question 5.b: What services do you provide to ensure that all requirements of the Primary Payer are met (prior authorizations, step therapy, referrals, etc.)? Question 6: What are the barriers to referring members to external providers? The Survivor CCEs often need to provide referrals to members who need specialized care or care that cannot be provided by the CCE themselves. Question 6.a: What are some strategies to ensure provider referrals are with a WTC-related provider and within the member's OHI primary network? Question 7: What are some reasonable metrics to use to gauge the effectiveness of a Survivor CCE's OHI Collection and Coordination of Benefits Programs? The Program recognizes that these efforts require cooperation and compliance from members and are not exclusively in the CCEs control. Question 8: How does your organization track compliance with minimum essential coverage (MEC) in accordance with the Patient Protection and Affordable Care Act? Question 8.a: Describe tactics that you leverage to address non-compliance with MEC. (e.g., member refusal to explore options or divulge financial information for potential Medicaid eligibility) Access to Clinical Services Question 9: What are some strategies for managing a diverse population and ensuring that equitable services are provided? For example, compared to the Responder population, the Survivor population has a higher percentage of non-English-speaking, underinsured, and/or uninsured members. Question 9.a: Describe services that you provide to educate members and/or providers on their rights and responsibilities and on Program requirements and benefits. Question 10: How does your organization provide patient-centered care and ensure timely access to care? This would include promoting adherence to treatment protocols, facilitating provider choice, minimizing wait times, and ensuring appointment availability. Question 10.a: Describe how you address the above based on patient acuity and how patient acuity is determined. Contract Transition Risk Management Question 11: How long would it take to set up a new vendor from scratch (i.e., become an additional Survivor CCE)? What are the risks affiliated with this type of transition? Question 11.a: How long would it take to transition services from an existing CCE vendor to a new CCE vendor? (i.e., replace a current Survivor CCE)? What are the risks affiliated with this type of transition? IV. SUBMISSION INSTRUCTIONS Questions Due Questions about this RFI must be sent in the Questions & Answer Template provided below (see attached excel spreadsheet) via email to Liz Cole-Greenblatt at QST7@cdc.gov by Friday, March 31, 2023 by 12:00PM EST. Responses Due Interested parties are requested to respond to this RFI by submitting a white paper answering the eleven (11) questions and sub-questions above. White papers should follow the flow of Section III, - Requested Information, of the attached RFI and should be limited to twenty (20) single-spaced pages in length with a minimum 10-point Times Roman font. Responses must be sent via email to Liz Cole-Greenblatt at QST7@cdc.gov by Friday, April 14, 2023 at 12:00PM EST. Only emailed responses will be accepted. Late responses will not be accepted.