Single Source Procurement: Ombudsman Program

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, Office of Health Insurance Programs, has made a determination to issue funding to the Community Service Society of New York, in the amount of $4,012,500, to continue providing ombudsman services to enrollees in managed long-term care programs and individuals enrolled in the Health and Recovery Plan program (HARP). This funding will also allow for the continuation of services for individuals enrolled in mainstream Medicaid managed care plans and individuals enrolled in the Fully Integrated Duals Advantage program, designed for people with intellectual and development disabilities.

These programs serve vulnerable, mostly elderly individuals, with various complex medical, social, cognitive, and behavioral conditions. The program provides a full range of services, which are to help enrollees navigate program rules related to their health care coverage and understand and exercise their rights.

The program provides one-on-one consumer assistance to: 1) answers questions related to enrollee rights; Medicare, Medicaid, and long term care benefits; differences between various types of managed care plans; any issues relating to health insurance or services; 2) helps resolve issues relating to health insurance or services through mediation and informal negotiation with plans and/or providers; 3) provides advice and assistance; and 4) offers informational training about various aspects of managed care programs and outreach to consumers, providers, and advocates.

This nine month extension (August 1, 2019 – April 30, 2019) is necessary to avoid a disruption in services while the new competitive Request for Applications is issued to the public and new contracts are developed.

The new Ombudsman Program contracts will begin on May 1, 2020.

Procurement / Program Name Ombudsman Program
Contractor Name(s) Community Service Society of New York
Contract Period 08/01/2019 – 04/30/2020
Contract Number(s) C029863