Single Source Procurement: Balancing Incentive Program Demo Extension

Pursuant to New York State Finance Law § 163.10(b), The New York State Department of Health is presenting the following summary of relevant circumstances, and material and substantial reasons why a competitive procurement was not feasible.

The New York State Department of Health (DOH), Division of Long Term Care (DLTC) has selected five exceptional projects of the original 54 Innovation Fund awardees for additional funding. These projects have demonstrated success in providing innovative solutions that improve and rebalance the long term care system in New York State (NYS). An additional demonstration period would allow these programs to collect and analyze more data to demonstrate their impact on the health care delivery system and costs to the Medicaid program.

The Balancing Incentive Program (BIP) is a provision of the Affordable Care Act (ACA) passed by Congress and authorized by Section 10202 of the ACA of 2010 (Pub. L. 111148). BIP provides federal financial incentives to states to stimulate greater access to non-institutionally based long term services and supports (LTSS). Through BIP, the Centers for Medicaid and Medicare (CMS) provides enhanced Federal Medical Assistance Percentages (FMAP) to qualifying states to offer community long-term care services as an alternative to institutional care.

The new demonstration, time and funds will provide an additional period in which to collect, strengthen and assert more detailed and conclusive findings which will be beneficial to DOH/DLTC in making LTSS plans and policy changes. These projects dovetail with NYS' Medicaid Redesign Team's (MRT) efforts to lower health care costs and the Delivery System Reform Incentive Payment (DSRIP) program which enables insurance plans to pay for innovative solutions to healthcare problems. DOH believes that the following selected projects reflect overarching BIP goals and should be included in a second demonstration phase.

The original statute required BIP activities to conclude by 9/30/15. However, the Centers for Medicaid and Medicare (CMS) recently extended the timeframe for investment of Balancing Incentive Program funding through September 30, 2017. Furthermore, CMS approved additional BIP-related expenditures and activities, among those, additional funds to include a second demonstration phase for Innovation Fund projects. DOH has selected projects for a second demonstration phase that are unique, address a gap in service, are replicable and have great potential to help NYS achieve rebalancing benchmarks required by the BIP program. A second phase will enable these programs to provide more comprehensive data illustrating their ability to lower costs and keep individuals in the community.

Federal BIP award dollars were granted to meet CMS requirements with the express goals of rebalancing Medicaid Long Term Care Services and Supports by increasing access and expanding community services as an alternative to institutional care. The selected projects specifically impact the State's rebalancing goals and therefore the ability to claim enhanced Federal Medical Assistance Percentages (FMAP) associated with the overall BIP initiative.

The original grant contracts were awarded through a competitive procurement. These contracts have met all deliverables to date and in doing so have developed a particular expertise. The additional funds reflect the original terms and conditions. Additionally, these programs have internal controls in place to ensure quality assurance standards are consistently met. Extensive project protocols have been developed to coordinate care within the community in unique ways.

Procurement / Program Name Balancing Incentive Program Demo Extension
Contractor Name(s) Multiple – Please See Attached.
Contract Period 10/1/2015 – 3/31/2017
Contract Number(s) Multiple – Please See Attached.