NY Answers: A Point of Entry System for Long Term Care in New York State
REQUEST FOR INFORMATION (RFI)
NY ANSWERS: A POINT OF ENTRY SYSTEM FOR LONG TERM CARE IN NYS
TABLE OF CONTENTS
- Purpose of the Request for Information (RFI)
- Minimum Point of Entry (POE) Functions
- Content of Response
- Information, Assistance and Assessments
- Community, Capacity, Coordination, Communication
- Systems Performance, Evaluation, Data Collection and Management
- Organization and Finance
- Submission of Responses to the RFI
I. PURPOSE OF RFI
The purpose of this RFI is to gather information about how best to design, implement and manage a point of entry (POE) to New York State's Long Term Care (LTC) system. To assure such a POE is developed with stakeholders input, this RFI seeks recommendations on design strategies. RFI respondents are asked to provide input that reflects a system that will serve all New Yorkers regardless of age, income and resources, disability or payer.
Using information gathered from responses to this RFI, the State may issue a Request for Proposals (RFP) to bidders interested in becoming a POE entity. ALL STAKEHOLDERS ARE ENCOURAGED TO SUBMIT RESPONSES TO ALL OR PARTS OF THE RFI EVEN IF THEY DO NOT HAVE ANY INTENTION OF RESPONDING TO A FUTURE RFP.
Nothing in this document shall be construed as obligating the State to issue such an RFP. NO CONTRACT WILL BE AWARDED BASED ON RESPONSES TO THIS RFI.
Governor Pataki's Health Care Reform Working Group recently issued an Interim Report ( http://www.health.state.ny.us/health_care/medicaid/related/health_ care_ reform/index.htm) recommending significant changes to New York's LTC system. Included in the Working Group's Report is a recommendation that the State create a point of entry (POE) into the LTC system. This RFI seeks input on the creation of such a system that would apply to all individuals, regardless of age, income, disability, or payer source. While it is anticipated that systemic reforms resulting from the Working Group's recommendations will involve substantial changes to the Medicaid system, for purposes of this RFI it is presumed that a POE system can be initiated independent of Medicaid reforms.
There is a need for consistent, comprehensive information and assistance in accessing LTC services. This is particularly true for individuals whose needs cross various systems and who require multiple, diverse services. Consumers and their families, as well as LTC professionals, need access to trained and knowledgeable persons who are available at first contact to assure informed consumer choice among services designed to achieve and maintain independence in the most integrated setting possible appropriate to their needs. To that end, and in response to the many calls for easier access to impartial screening, information and assistance, the Health Care Reform Working Group has proposed, as a POE, NY ANSWERS (Access New York Services With Effective Responsive Supports).
III. MINIMUM POE FUNCTIONS
NY ANSWERS will be a POE that will be the critical bridge between consumers and services for private pay consumers, and the link to public services for eligible consumers. Its approach will support self-determination, promote personal responsibility, provide services that meet consumer needs, provide quality care, and ensure efficiency. It will be expected to offer the following functions for individuals of all ages, regardless of disability:
- Public relations/community education: On-going outreach, education, and awareness campaigns about LTC sufficient to educate all state residents about the POE in their community and assist consumers to prepare financially for their long term care needs.
- Information and Assistance: Comprehensive and objective information and support (as necessary) for individuals and their caregivers/families about all medical, non-medical (e.g. housing) and other community services, institutional services, eligibility criteria, etc. to link them with the opportunities, services and resources available to help meet their particular needs.
- Initial screening: A preliminary evaluation with the consumer and, if appropriate, his/her caregivers/family, to ascertain the consumer's general social, medical and financial needs and to identify appropriate service options and choices.
- Pre-Admission Assessments for Nursing Home Placement: An assessment required for all consumers regardless of payer source, prior to, and as a condition of nursing home placement.
- Comprehensive needs assessments: A comprehensive assessment (and reassessments, as necessary) of a consumer's needs and functioning and that of his/her caregivers/family that allows identification of the person's specific needs in day-to-day living in the community. The assessment is designed to evaluate from a strength-based perspective so that an individual's ability to maintain maximum independence is assured.
- Service/care coordination: The appropriate and prudent coordination of services and benefits in a manner sensitive to consumer preference, enabling consumers to make informed choices about their long term care needs and balancing cost, access and quality by involving consumers in the planning, evaluation and decision making for such care.
NOTE: Until planned changes occur, Medicaid eligible consumers will have access to the POE for public relations/community education, information and assistance, and initial screenings but will continue to have Medicaid eligibility determinations and Medicaid funded LTC service determinations through existing mechanisms.
IV. CONTENTS OF THE RESPONSE
Respondents should address the following desired outcomes and questions and are invited to recommend additional desired outcomes. It is not necessary to respond to each item. It is recognized that respondents may have different areas of expertise and interest. Please identify by letter/number, each outcome/question you are addressing.
a) Information, Assistance and Assessments
Outcomes and Performance Standards
- Individuals and families will be able to readily obtain comprehensive and unbiased information concerning home and community based and institutional LTC services.
- Information and guidance will address medical and social supports as well as publicly and privately funded services.
- Comprehensive screening information will be gathered as necessary concerning each participant's needs and abilities, health status, financial status, available formal and informal supports, personal goals and preferences. This information will be used in developing a person centered, strength based service plan.
- Individuals and caregivers will have ongoing access to assistance in obtaining and coordinating needed services. Issues encountered in daily community living will be addressed promptly.
- Significant changes in consumer's needs or circumstances will trigger consideration of modifications in services.
- Intake and eligibility information will be understandable, user friendly and timely.
- All individuals with long term care needs will be served.
- Barriers to access will be eliminated by centralizing significant consumer activities that currently require multiple interviews and applications.
- What kinds of tools are necessary to perform strength-based social and medical screenings?
- Are there existing tools available or will new tools need to be developed?
- How would those tools be developed and identified?
- What other tools would be necessary in order to create service plans and/or referrals?
- What is the best way to organize staff at NY ANSWERS to insure that the functions of information, assistance, screening, assessment, service/care coordination and public education are accomplished, and all functions are seamlessly coordinated?
- How can duplication with existing information, assistance and case management services be avoided?
- How should NY ANSWERS relate to existing services for infants and children?
- How can NY ANSWERS effectively integrate informal/family supports into consumers' care plans?
- Are there additional functions NY ANSWERS should provide?
- Are there particular functions NY ANSWERS should not provide?
b) Community, Capacity, Coordination, Communication
Outcomes and Performance Standards
- NY ANSWERS will be knowledgeable about and up to date on all community resources and supports, the availability of those services and all other necessary information that enables the consumer to acquire needed services in a timely manner.
- NY ANSWERS will coordinate its services, and have effective working relationships with all stakeholders including consumers, Local Departments of Social Services (LDSSs), Area Offices of the Aging, Independent Living Centers and consumer advocacy organizations, providers and provider associations.
- NY ANSWERS will actively promote consumer education and improve public awareness about LTC issues.
- NY ANSWERS will have the capacity to undertake local systems change to strengthen the local service configuration.
- How can NY ANSWERS staff be made fully aware of the populations to be served and of all available community resources and programs including social and personal supports, medical and social model services, ancillary supports such as housing, residential options, transportation, respite care, meal services etc.?
- How can NY ANSWERS work and collaborate with local stakeholders?
- How can NY ANSWERS monitor community service gaps and work with appropriate partners to address them?
- How would NY ANSWERS coordinate its services with other parts of the system used by participants e.g., hospitals, home and community based providers, Independent Living Centers, nursing homes, and State agency programs?
- How would NY ANSWERS obtain community feedback about its services?
c) Systems Performance, Evaluation, Data Collection and Management
Outcomes and Performance Standards
- NY ANSWERS will promote effective and efficient community services through systematic data collection and analysis that can be shared, as appropriate, to minimize the burden of duplicative data gathering for consumers and to facilitate service provision.
- NY ANSWERS will effectively serve participants of diverse cultural and ethnic backgrounds with responsive service plans.
- What data should be collected about consumers and about services to promote effective systems?
- For purposes of evaluation and planning, how would that data be shared with appropriate stakeholders (e.g. local communities, state agencies etc.)?
- What skills should staff have? What qualifications are necessary for which functions? Which functions require licensed staff (e.g. RNs, MSWs)?
- What system support and technology would be required (information systems, billing systems, tracking systems etc.)?
d) Organization and Finance
Outcomes and Performance Standards
- NY ANSWERS will be user friendly for consumers and their informal supports in terms of access and timeliness of service.
- NY ANSWERS must be a collaborative effort among government, the provider community and community-based organizations.
- Adherence to policy guidelines governing NY ANSWERS will be consistent statewide to effectively serve all consumers and their families.
- NY ANSWERS will be flexible and recognize that counties are different in terms of size, available services, local supports and individual needs.
- Reimbursement for entities administering NY ANSWERS will be reasonable and cost effective to meet desired outcomes.
- NY ANSWERS will serve all consumers and families who seek their service.
- What are the advantages/disadvantages of a single contract for NY ANSWERS with one statewide entity (with provision for local flexibility and adaptations)?
- What are the advantages/disadvantages of multiple contracts with several NY ANSWERS providers?
- Should NY ANSWERS services (regardless of the number of contract holders) be organized around single counties, consortia of counties (regions), or both?
- How would the number and location of NY ANSWERS sites be determined for each county/region?
- Should a NY ANSWERS system be phased in by:
- Geography (e.g. pilot programs offering all services in model counties followed by a statewide rollout)?
- Function (e.g. offering Information and Assistance in all counties initially and adding other functions gradually)?
- How can statewide performance standards and the need for local flexibility and variation (based on provider capacity, demographics, geographic factors, etc.) be accommodated and reconciled?
- Should the NY ANSWERS entity be required to provide all required services itself or should it be able to subcontract?
- What should be the relationship of NY ANSWERS to Medicaid, Medicare and other health insurance programs?
- What kinds of technology to support the POE functions are necessary, available and cost efficient?
- What reimbursement system for NY ANSWERS would best insure a comprehensive, quality, cost efficient, unbiased entity: grant or program dollars based on cost or cost plus incentives; fee for service; regional/local capitation; other?
- If incentives are part of the reimbursement to a NY ANSWERS entity, what are some examples of outcomes to be rewarded?
- Recognizing that there are many unknown factors, please give an estimate or range of the probable POE cost? If helpful, you may provide these estimates separately for upstate/downstate and for rural, suburban, urban.
- How could the transition from the current system (with considerable local variations) to the NY ANSWERS system be accomplished?
- How should NYS (the contractor) oversee and evaluate the service?
SUBMISSION OF RESPONSES TO THE RFI
Diverse insights are critical for the development of a comprehensive RFP. All stakeholders are encouraged to respond whether or not you intend to respond to an RFP. We appreciate your efforts on this important initiative.
This RFI has been mailed to potential respondents known to the Department of Health and the Office for the Aging. We may follow-up the receipt of written responses with a meeting(s) to solicit additional information. Please feel free to share the RFI with anyone you believe may be interested.
Please submit all responses in writing by June 1, 2004 to:Kathryn Kuhmerker
NYS Department of Health
Office of Medicaid Management
Corning Tower, Rm. 1466
Albany, New York 12237
Please include a name and phone number of whom to contact in the event there are questions regarding your submission.