Single Source Procurement: Single Source Procurement: Medicaid Managed Care Health IT Support (Statewide)

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), Office of Health Insurance Programs (OHIP), requests to contract with the New York e-Health Collaborative (NYeC) for: 1) comprehensive Home and Community Based Services (HCBS) provider scoping, evaluation, and assessment of all health information technology capabilities including electronic health records (EHR), electronic billing systems (EBS), and health information exchange (HIE) capabilities; 2) assessment of EHR vendor qualifications for existing software to be upgraded to HCBS capabilities along with the creation of single-source contracts to upgrade these existing licenses, and develop a pricing model that includes new licenses; 3) implementation support for the go-live of upgraded HCBS compliant EHRs including reimbursement to providers for the purchase of approved systems; and 4) technical assistance to providers for EBS and modules support to promote financial sustainability of the HCBS model. This grant will be known as the behavioral health information technology (BHIT) grant for HCBS providers who are transitioning into the Medicaid Managed Care (MMC) program. The geographic scope of this BHIT program is for the 57 counties of New York State (NYS) outside of New York City (NYC).

This initiative builds on the expertise NYS has developed through programs such as the Health Care Efficiency and Affordability Law Capital Grant Program (HEAL), and the NY Medicaid Electronic Health Records Incentive Program. This project is intended to support HCBS adult providers and, pending funding, will extend project support to non-HCBS providers who may not have implemented HCBS compliant EHR/EBS systems. All eligible providers are or will be contracting with Medicaid Managed Care plans as established under the new NYS behavioral health 1115 waiver.

NYS has been undergoing a transformation of its Medicaid program for the past several years as services are moved into a managed care environment. Since October 2015, behavioral health services have been provided either by approved Managed Care plans or specialty plans known as Health and Recovery Plans (HARP). The HARP plans are targeted to care for persons with a high level of need for mental health or substance use services across the state.

HCBS providers will be serving patients with high levels of medical co-morbidity and psychiatric disability. These providers are critical to realizing improved health outcomes for this population within a larger system of Health Home and Delivery System Reform Incentive Payment Program (DSRIP) coordinated care. However, since HCBS providers are generally lacking in health information technology (HIT), especially EHRs, the BHIT investment in their infrastructure is essential.

The integration of patients’ medical care, psychiatric care, and specialized HCBS services through health information technology will ensure that care can be managed in a real-time manner, leading to improved health outcomes, improved community functioning, and reduced costs.

Through this Medicaid BHIT program, NYeC will be responsible for meeting all grant milestones in partnership with the DOH, New York State Office of Mental Health (OMH), and the New York State Office of Alcohol and Substance Abuse Services (OASAS), as well as impacted providers, advocacy organizations and stakeholders.

The contractor will utilize a geographically based implementation agent model across the 57 counties mentioned above. These agents will provide critical interface between providers and vendors along with one-to-one personalized support to assess provider and vendor capabilities. The agents will also provide technical assistance, support implementation and go live goals, and assure the success of electronic billing to Medicaid Managed Care plans. This geographic agent based implementation system is a single most effective way to reach all geographic regions of the state to ensure standardization and coordination across the system of care.

Sixty two Regional Extension Centers (REC) were established throughout the United States, each in a designated area, under the Health Information Technology for Economic and Clinical Health (HITECH) Act authorized as part of the American Recovery and Reinvestment Act (ARRA) of 2009. The HITECH Act provided grant funding for a Health Information Technology Extension Program under the supervision of ONC. Under the program the RECs assist healthcare providers with adoption and implementation of EHRs at their practices in order for them to use their systems meaningfully and be eligible for program incentives.

In New York State, two RECs exist: the New York City Regional Electronic Adoption Center for Health (NYC-REACH), under the New York City Department of Health and Mental Hygiene (NYC DOHMH), which serves the five boroughs of NYC, and NYeC which serves the Rest of State (ROS). Only NYeC serves the 57 counties of New York State outside of the NYC area and has the staffing, sub-contracting, and geographic agent depth, experience, and expertise to achieve the high level success needed for the BHIT program.

Procurement / Program Name Single Source Procurement: Medicaid Managed Care Health IT Support (Statewide)
Contractor Name(s) New York E-Health Collaborative (NYeC)
Contract Period 6/1/2016 – 5/31/2018
Contract Number(s) C31380GG