DOH Seeks Applications for HIV "Special Needs Plans"
HIV/SNPs to be National Model for Comprehensive Medicaid Managed Care
Albany, May 4, 1999 – Acting State Health Commissioner Dennis P. Whalen today announced that the State Health Department has released a Request for Applications (RFA) for health plans that wish to participate in New York's Medicaid Managed Care program and provide comprehensive health care to Medicaid–eligible individuals who are living with HIV/AIDS.
"New York State is proud to be the leader in developing Special Needs Plans for individuals with HIV/AIDS," Acting Commissioner Whalen said. "We expect this initiative to be a national model of how to provide high quality comprehensive and coordinated care to HIV–infected New Yorkers to address their unique health and medical needs."
As many as 12 HIV Special Needs Plans (SNPs) may be qualified through the procurement to provide a medical home for HIV–positive Medicaid recipients and their children under age 19. The SNPs will be a key component of New York State's continuing efforts to improve health care for Medicaid–eligible citizens through managed care. Enrollment in the plans—which is expected to begin in about a year—initially will be voluntary.
"No other state in the nation provides the level of care and services that New York does for persons with HIV/AIDS," the Acting Commissioner said. "This innovative approach will provide a medical home for many New Yorkers with AIDS helping them live longer, healthier lives through primary care and preventive measures."
The SNPs are designed as an alternative to mainstream managed care plans and Medicaid fee–for–service coverage. Staff from the Health Department's AIDS Institute and Office of Managed Care worked cooperatively to develop criteria for the plans, with guidance from two public workgroups representing persons with HIV/AIDS and the HIV/AIDS service provider community.
The State Health Department expects to qualify HIV/SNPs by early next year and issue contracts by May 2000. Certified organizations must have comprehensive networks of prevention and care comprised of experienced HIV–service providers; inclusion of Community Based Organizations is strongly encouraged. Among other requirements, plans must demonstrate how they will guarantee access to care, how they will reach multi–cultural and non–English speaking communities and what procedures they will use to monitor quality. Care provided by SNPs must meet prevailing standards of professional medical practice, as well as clinical standards established by the State Health Department's AIDS Institute.
Qualified HIV/SNPs will be fully–capitated, that is, will receive a single monthly reimbursement rate for most covered services. Certain benefits, such as pharmaceutical coverage, will be "carved out" of the rate (reimbursed separately).
The RFA document will be posted on the State Health Department's public web site (www.health.state.ny.us) on the "Information for Providers" page. Letters of intent to submit applications are due by May 28, 1999. Bidders' conferences have been scheduled for July 8 and 9, 1999.