Single Source Procurement: Home and Community Based Services

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.

Chapter 196 of the Laws of 1994, Article 27-CC, amended NYS Social Services Law to establish the NYS Traumatic Brain Injury (TBI) waiver program within NYSDOH. This legislation charged the Department, "to develop a comprehensive statewide program ... with primary emphasis on community based services and to develop outreach services and to utilize existing organizations with demonstrated interest and expertise in serving persons with traumatic brain injuries and, within funds available, enter into contracts with such organizations." Since NYS Fiscal Year 1995-96, the enacted budget has appropriated funding in support of this program.

Chapters 615 and 627 of the Laws of 2004 amended NYS Social Services Law to authorize the State's Nursing Home Transition and Diversion (NHTD) waiver program. The Medicaid (MA) waiver, approved by the federal Centers for Medicare and Medicaid Services (CMS) in 2007 and subsequently re-approved in 2010, provides New York's seniors and other individuals living with disabilities a wide array of health and supportive services in the least restrictive, most appropriate available setting.

Additionally both programs work to support housing subsidies to participants in the 1915c Medicaid Waiver Programs who meet established eligibility criteria, including demonstrated financial need. The waivers serve individuals who would otherwise be cared for in a nursing facility and who, when considered as an aggregate group, can be served in the community at a lesser cost than institutional care. These waiver programs aim to reduce or avoid institutionalization and in turn, improve participants' lives, reduce Medicaid expenses, and support the Supreme Court mandate in Olmstead v. L.C. to provide state services to people with disabilities in the most appropriate, integrated setting.

With issuance of Executive Order #5, Governor Andrew M. Cuomo established the Medicaid Redesign Team (MRT) in January 2011, bringing together a group of health care stakeholders, experts and advocates from throughout New York State. The goals of the MRT are to improve overall health system quality and efficiency, streamline and focus health care administrative and financial structures, and reduce Medicaid costs while emphasizing the delivery of well-managed, cost effective quality health services. Medicaid Redesign Team Proposal #90 (MRT 90) was developed and enacted in the 2011 New York State budget. It requires the mandatory transition and enrollment of certain community-based long-term care services recipients into Manage Care Plans.

The Division of Long Term Care (DLTC) is currently planning the transition of NHTD/TBI Waiver participants and services into the managed care model, with input from a public Waiver Transition Workgroup composed of representatives from managed care plans, waiver service providers, stakeholders, service recipients, and their advocates. A series of public meetings and subgroup meetings began on August 24, 2015 with an expected approval of a transition plan by the Centers for Medicare and Medicaid (CMS) sometime in December, 2016. However, due to language included in the 2016-2017 FY budget, the transition has now been delayed to January 2018. The delay in the transition to managed care was not planned by DLTC. NYSDOH now anticipates voluntary enrollment into managed care to begin in January 2018 with full enrollment implementation in place by July 1, 2018.

As such, the NHTD/TBI Waiver Programs are required by CMS to continue to provide current services during the transition to managed care. DOH contracts with the RRDC agencies to provide administration of these waivers to participants and needs current services to remain in place. The RRDCs will continue to be required to complete intakes and referrals, process provider enrollment, facilitate nursing home transitions, approve eligibility and services, and ensure program compliance. Additionally, the RRDCs provide oversight to the housing subsidy programs.

Contractors were awarded contract(s) as a result of the competitive procurement process. This is a 24 month extension of the contract(s) under the same terms, conditions, and pricing authorized under the existing contract(s). The single source extension period will allow for the continuation of critical services pending outcome of a new competitive procurement to obtain these services.

Procurement / Program Name Home and Community Based Services
Contractor Name(s) Multiple – Please See Attached.
Contract Period 7/1/2016 – 6/30/2018
Contract Number(s) Multiple – Please See Attached.