Single Source Procurement: End of AIDS - Managed Care Organization - Pilot Project

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.

AIDS Institute Office of Medicaid Policy and Programs has been charged with implementing several recommendations of Ending the Epidemic (ETE) Blueprint. One goal of ETE is to reduce the detectable viral load of New York State Medicaid beneficiaries and reduce rates of transmission. Through a computer match program, 5 currently contracted Managed Care Organizations (MCO) (managing 6 plans) have been identified with the majority of enrolled HIV+ Medicaid beneficiaries with detectable viral loads (more than 75%). This pilot program would grant funds to these MCOs to implement options that have been identified as most likely to improve engagement in HIV care and viral load suppression (VLS) of HIV positive plan members. Based on a needs assessment, each plan will develop and implement interventions focused on provider network, antiretroviral prophylaxis medication and treatment adherence, and care management to address psychosocial needs. The AIDS Institute has provided a menu of linkage, retention, and treatment adherence interventions the plans may adapt to their member needs and plan infrastructure. Plans will be required to demonstrate progress in achieving VLS and submit aggregate data about the target population, interventions in place, and improvement in aggregate VLS.

MCOs are the most appropriate channels for this project. AIDS Institute has identified a subset of 5 MCOs that are uniquely suitable. The providers in this subset each have a caseload composed 75% or greater of Medicaid beneficiaries with detectable viral load (each plan services between 737 and 1,626 individuals with detectable viral load). Funding these 5 plans to implement this pilot offers the AIDS Institute the most efficient and effective opportunity for developing best practices and ideas for infrastructure changes within all MCOs that will give the plans the ability to integrate new strategies and improve the health of HIV-positive Medicaid beneficiaries. Implementation of this pilot is concurrent with expansion of and integration of behavioral health (BH) services. HIV-positive Medicaid beneficiaries with poorly addressed BH needs face significant barriers to achieving VLS. Without utilizing these specific MCOs, it is unlikely the pilot project will succeed. The AIDS Institute anticipates releasing a competitive procurement to continue this project if the pilot proves to be successful, contingent on future priorities and funding availability.

Procurement / Program Name End of AIDS - Managed Care Organization - Pilot Project
Contractor Name(s) Multiple – Please See Attached.
Contract Period 1/1/2016 – 12/31/2018
Contract Number(s) C030811 – C030815