Single Source Procurement: HIV Health Home Care Management Programs

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.

Implementation of Health Homes for Medicaid enrollees with serious mental illness, HIV and other chronic conditions was recommended by the Medicaid Redesign Team. As a result, this initiative was included in the Governor's 2011-2012 Budget and was adopted into law effective April 1, 2011. Social Services Law (SSL) Section 365-L authorizes the Commissioner of Health, in collaboration with the Commissioners of the Office of Mental Health, Office of Alcohol and Substance Abuse Services, and the Office of People with Developmental Disabilities, to establish Health Homes for NYS Medicaid enrollees with chronic conditions.

A Health Home is a care management service model whereby all of an individual's medical, mental health, and social service providers communicate with one another so that all of a patient's needs are addressed in a comprehensive manner. This is done through a Care Manager or Coordinator who oversees and provides access to all the services an individual needs to ensure they are managing their chronic illness(s), have access to all the primary and specialty services they require, and have support to stay out of the emergency room or inpatient care. Health records are shared among a Health Home enrollee's providers to ensure that services are not duplicated or neglected. The Health Home services are provided through a network of organizations—medical providers, Managed Care Plans, and community-based organizations and consist of medical, mental health, substance use services, housing programs, home care, and other psycho-social community based providers which become a person's Health Home.

A comprehensive, integrated, individualized patient-centered care plan is required for all health home enrollees. The care plan must include and integrate the individual's medical and behavioral health services, rehabilitative, long term care, and social service needs, as applicable. A single care management record is agreed to and shared by all team professionals. The care manager will be responsible for overall management and coordination of the enrollee's care plan. The Lead Health Home is required to develop and utilize a system to track and share patient information and care plans across providers, monitor patient outcomes, and initiate changes in care as necessary to address patient need.

The AIDS Institute is requesting to award one time funding to eligible HIV Health Home Care Management Providers to support the Health Information Technology (HIT) requirements of the HIV/AIDS COBRA Targeted Case Management programs which have transitioned to Health Home Care Management. These programs previously provided Medicaid reimbursed targeted intensive case management to Persons Living with HIV/AIDS (PLWHA), and are now providing comprehensive Care Management to Medicaid eligible patients with HIV, serious mental illness, and people with two or more chronic illnesses including substance use. For HIV Health Home Care Management programs to be successful in meeting the standards for HIT connectivity and to provide quality care coordination services to clients, these programs need access to financial support. They need funds to develop or purchase care management systems to collect data, document care management services, produce integrated care plans, and access health information for their patients - all of which contribute to quality outcomes.

This award will be $51,282 per contractor. This small amount will assist them in covering HIT costs required for effective delivery of Health Home Care Management services, considering that most providers need connectivity to 2-4 different electronic systems. Each contractor will utilize this funding to help address the software and hardware needs of the agency in their development of HIT connectivity to Lead Health Home networks. The combined number of patients whose care will be affected by this HIT development is over 16,000 individuals statewide. Each contractor requires a much greater sum of money to cover all the HIT costs to bring them to 100% compliance with the HIT standards of the Health Home. Unfortunately additional funding beyond the $51,282 per contractor is not available. The remainder of the necessary funds to achieve HIT standards compliance must be obtained by the providers from other sources.

Procurement / Program Name HIV Health Home Care Management Programs
Contractor Name(s) Multiple – please see attached
Contract Period 4/1/2014 – 3/31/2015
Contract Number(s) C029760 – C029798, C030148