Request for Proposal Questions and Answers - Patient Review Instrument (PRI) Audit and Hotline, PRI,
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STATE OF NEW YORK__DEPARTMENT OF HEALTH. Rockefeller Empire State Plaza Albany, New York 12237Corning Tower The Governor Nelson ADennis P. WhalenAntonia C. Novello, M .D., M.P.H., Dr.P.H .Executive Deputy CommissionerCommissionerNovember 3, 2006Via facsimileDear Potential Bidder :: Request for Proposal (RFP)RePatient Review Instrument (PR!) Audit and Hotline FunctionPR!, H/C PR! and Screen TrainingThe enclosed document provides a summary of the questions asked at the PRI bidder's. It should be noted thatconference held on October 10, 2006, and the Department's responses.no written questions were received prior to the bidder's conferenceAs discussed in previous mailings, all proposals in response to the RFP must be received.m. on December 1, 2006 .in our office by 2 :00 p. We look forward to a potentialThank you for your expressed interest in the PRI RFPreceipt of your proposal .EnclosureRequest for Proposal PRI Audit and Hotline Training Program for PRI, H/C PRI and Screen Bidder’s Conference Summary October 10, 2006 1. Is it acceptable to submit different prices for each year of the contract or, is the price the same in each of the three years? Prices for the audit/hotline contract as well as the prices (registration fees) for the training contract will be firm and not subject to any increase during the three-year period of the contracts. For the audit/hotline contract it is expected that there be separate per diem rates for Downstate ...
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Request for Proposal
PRI Audit and Hotline
Training Program for PRI, H/C PRI and Screen
Bidder’s Conference Summary
October 10, 2006
1.
Is it acceptable to submit different prices for each year of the contract or, is the
price the same in each of the three years?
Prices for the audit/hotline contract as well as the prices (registration fees) for the training
contract will be firm and not subject to any increase during the three-year period of the
contracts.
For the audit/hotline contract it is expected that there be separate per diem
rates for Downstate (New York City and Long Island) and Upstate (rest of New York
State).
These per diem amounts however, must remain the same during the three-year
period of the audit/hotline contract.
For the training contract, it is expected that there be
one fee for the PRI-H/C PRI training and a separate fee for the SCREEN training. While
these two fees may vary, both fees will be firm and not subject to increase during the
three-year period of the training contract.
2.
Can you provide a brief history on these program activities and identify who were
the previous contractors?
Prior History:
On January 1, 1986 a new case mix reimbursement system for Residential Health Care
Facilities (RHCFs) was implemented in New York State.
This reimbursement
methodology is based on a resident classification system determined by responses to PRIs
submitted by each facility.
Due to their reimbursement implications, submitted PRIs are
subject to periodic on-site reviews (audits).
The PRI audit ensures that the form has been
accurately completed and is in full compliance with the assessment instrument’s
instructions.
To help interpret these instructions, as well as those applicable to the H/C
PRI and the Screen, a hotline must also be maintained.
The H/C PRI is used for
preadmission review of persons in a hospital or, living in community-based residences,
that apply for admission to a nursing facility.
The Screen is used for the Pre-Admission
Screening and Resident Review (PASSAR) which, assesses individuals with possible
mental illness (MI) and/or mental retardation (MR) and other related conditions.
The
Screen is also used to determine a person’s potential for care outside of a nursing facility
setting.
To foster uniformity in completing the forms, training to obtain either an
assessor or screener number is required.
Recent PRI Developments:
Although there are no changes for PRI filing requirements in 2006, recently enacted
statutory provisions contained in Chapter 109 of the Laws of 2006 repeals the
requirement that nursing homes submit PRIs in 2007 and 2008.
Nursing homes are
however, permitted to voluntarily submit full house PRIs if they believe they will result
in a case-mix increase greater than .05.
Upon doing so, they are then required to submit
full house PRIs for the remainder of 2007 and 2008.
Effective 2009, no new PRI
submissions will be permitted since the State will transition to a new reimbursement
classification system using the Minimum Data Set (MDS).
An existing backlog of
unprocessed PRIs and, PRIs which will be filed through 2008, will be subject to the audit
requirements specified in this RFP.
Consequently, the extent to which the above
referenced statutory changes will impact PRI audit volume over the course of this
contract remains unclear.
This uncertainty also exists on the need for PRI training in
2007 and 2008 however, it is important to note that required training in the HC/PRI and
the Screen are not impacted by such changes.
Contract History:
The initial audit and training contracts were bid separately resulting in two different
contractors, NextWave Inc., was the first training contractor and the Foundation for
Quality Medical Care (FQMC) was the first audit contractor.
After a few years, the
training contract was subsequently awarded to the Professional Standards Review
Council of America, Inc., an affiliated organization of the FQMC.
With the issuance of
the last RFP for these functions, the DOH and Health Research Incorporated (HRI)
decided to seek a sole contractor to provide both the audit/hotline and training functions.
While the same sole contractor is expected to provide both functions, two contracts are
necessary for this purpose:
an audit/hotline contract administered by DOH; and, a
training contract administered by HRI.
The Island Peer Review Organization (IPRO)
holds the current contracts awarded from the issuance of the last RFP.
3.
Are these medically related reviews?
The on-site review is meant to ascertain the accuracy of PRIs prepared and submitted by
nurse assessors retained by facilities.
To do so, auditors are to complete audit forms
through a review of medical record documentation with assistance from facility staff, as
needed.
As such, these reviews require clinical expertise.
At a minimum, PRI auditors
must be registered nurses (RNs) certified as PRI assessors with experience in resident
chart reviews including, the completion of PRIs or a similar resident assessment form.
4.
Is there a page limit to the proposal?
Page 15, Part C speaks about ‘clarity and
conciseness’.
Would a proposal be turned down because it is too long?
There are no page limits.
The bidder should be as clear and concise as possible
regardless of the length of their proposal.
5
.
Is there an estimate as to the volume of the training?
Section C-1.3 of the RFP discusses the estimated volume of attendance at the training
sessions.
This section states that:
1) A one day training session will be scheduled every six months in each of the major
five regions in New York State, i.e., New York City, Long Island, Albany, Syracuse,
and Rochester/Buffalo, for
PRI training
.
It is estimated that there will be 50
participants at each session, for a total of 500 participants annually.
Additional
sessions may be scheduled as demand warrants.
2) A one day training session will be scheduled every six months in each of the major
five regions in New York State, i.e., New York City, Long Island, Albany, Syracuse,
and Rochester/Buffalo, for
Screen training
.
It is estimated that there will be 75
participants at each session, for a total of 750 participants annually.
Additional
sessions may be scheduled as demand warrants
.
6)
Is there a maximum dollar amount to the contract?
The audit and hotline contract is supported by a budgetary appropriation. Historically,
this appropriation has been approximately $500,000 annually.
A budget appropriation
for the audit/hotline contract that will result from this RFP has yet to be enacted.
There is no budget appropriation for the training contract since it is fully funded through
fees charged to attendees.
7)
In lieu of the $300,000 performance bond [stated in Section D-12.10 of the RFP]
would the State allow the contractor to deposit that amount in an account?
The deposit of $300,000 into an account(s) would not meet the requirements of Section
D-12.10 of the RFP which states that the “contractor will be required to post a
performance bond in the amount of $300,000 for the period of the audit and hotline
contract... and an additional $300,000 for the period of the training contract...
” The cost
of posting such bonds is considered an allowable expense in determining the prices for
the audit/hotline and training functions.
8)
Does the DOH advertise for the PRI and Screen training or, is this part of the
budget we submit?
The DOH does not advertise for the PRI-H/C PRI or Screen training sessions.
It is
expected that a bidder’s proposal will include any expense necessary for such advertising
as part of their administrative overhead costs.
9)
How is the success of the contractor measured?
The DOH evaluates the contractor’s performance by monitoring the contractor to ensure
contract compliance.
The Bureau of Financial Management and Information Support
(BFMIS), which is part of the Division of Health Care Financing (DHCF), is responsible
for monitoring and approving the services provided under the audit/hotline contract.
The
DHCF and the Division of Quality Assurance and Surveillance (DQAS) are responsible
for monitoring and approving the services provided under the training contract.
Sections
C-1.4 through 1.8 of the RFP addresses requirements for providing information to the
DOH for contract monitoring purposes.
Such requirements include appointment of an
overall project manager, providing mechanisms to assure quality control, supplying
utilization reports, meeting continuing education credits needs, and participation in dry
run training sessions.
In addition, staff from the BFMIS periodically conducts on-site
monitoring of PRI auditors and performs desk reviews of all audits completed by the
contractor.
DHCF and DQAS staff must also approve all training materials and will
periodically attend training programs for monitoring purposes.
10)
Can additional questions be submitted after the Bidder’s conference?
The Department is not permitted to accept any additional questions in regard to this RFP
after the bidder’s conference (October 10, 2006).
