Questions and Answers
Disability Determinations Case Development Services ALERT DEADLINE EXTENDED UNTIL 1/9//12
Document #: JFSR1213078015
Question: If the vendor will be responsible for paying providers, can the state provide annual expenditures and number of occurrences of the following services: a. Transportation b. Testing c. Evaluation d. Any other defined services contemplated by this contract
Answer: ODJFS does not track this information.
Question: Page 14 Section IV 4.1 Scope of Work Item J. Will the Department be seeking Federal Financial Participation for administrative expenses on this contract? If so, historically has the Department done so, and can the information be provided?
Answer: This project has never before been undertaken by Ohio.
Question: RFP Section 4.1.B, Scope of Work: Is it a conflict of interest for an Ohio Medicaid managed care plan to use its provider network to service this contract?
Answer: The contractor and/or its skilled professional staff shall not, under any circumstances, engage in medical or psychological treatment for a consumer referred under a contract resulting from this RFP. Vendors must describe in their proposal the checks and balances they will have established to prevent this from occurring while still ensuring access.
Question: Page 13. Section IV. 4.1 Scope of Work Subsection E. 4. Is it expected that the ODJFS will ask the vendor to expedite specific cases? If so, is there an established process for doing so? Page 13. Section IV. 4.1 Scope of Work Subsection E. 8. Is there a policy in place that allows/requires the Medicaid agency to reimburse client’s treating sources for sending records in response to requests and/or completion of forms related to a disability-related Medicaid application? If so what are the requirements and what rates apply? Page 13. Section IV. 4.1 Scope of Work Subsections E. 11., 12., 13. Is there a fee schedule, e.g.-Ohio’s Medicaid fee schedule, for consultative examinations, testing, transportation and/or interpreters? If so, is the Medicaid fee schedule available to potential vendors for this RFP? Are there standard ODJFS letters and formats when contacting applicants by mail, e.g.-CE appointment letters or is the vendor to develop letters? Is there a specified format for reporting of consultative examinations and/or including the use of state Medicaid forms? Are there already designated transportation providers or does the vendor need to develop a transportation network? Is there a state policy on rescheduling CE’s? Or should the vendor use SSA disability rescheduling guidelines? Are CE providers paid for missed or cancelled appointments? If yes, is there a standard rate for these payments? Is reimbursement for client travel expenses a satisfactory method of providing transportation assistance? What number or percentage of cases require transportation? Page 13. Section IV. 4.1 Scope of Work Subsection E. 14. Once the vendor scans collected case documentation into multi-page TIFF image files, is the vendor expected to shred the hard copies of documentation? Page 13. Section IV. 4.1 Scope of Work Subsection E. 17. Is telephonic testimony permitted if the vendor is needed to provide such at hearings? Page 13. Section IV. 4.1 Scope of Work Subsection G. Does meeting the required production standard of 65 days exclude cases that meet the criteria of “unusual circumstances” in 42 CFR 432.911(c) e.g.-client misses a CE appointment that is subsequently rescheduled or asks for a change in a previously scheduled appointment? Does meeting the production standard exclude cases that require a deferral of case development as per the SSA Medical Listings, e.g.-Listing 11.04 Central Nervous System Vascular Accident? For disability-based Medicaid applications in Ohio, what currently is the average overall processing time? What is the average time, if available, from completion of the initial application at the county office to receipt by the vendor? What is the average time currently from CE request to CE completion? Pages 11 and 13. Section IV. 4.1 Scope of Work Subsections A. 4. and G. Does meeting the production standard exclude cases that are deferred or those for which the vendor is requested to obtain additional medical evidence? Page 13. Section IV. 4.1 Scope of Work Subsection J. How often and in what format is the information maintained in the fiscal/billing process that identifies Medicaid expenditures for Medicaid cases expected to be transmitted to ODJFS?
Answer: 1. There are reasons for a case to be expedited.The county will determine if a case is to be expedited and notify the vendor when they submit the initial disability forms to the vendor. 2. Ohio Revised Code section 3701.741 states: "On request, a health care provider or medical records company shall provide one copy of the patient's medical record and one copy of any records regarding treatment performed subsequent to the original request, not including copies of records already provided, without charge to the following:...The department of job and family services or a county department of job and family services, in accordance with Chapters 5101. and 5111. of the Revised Code and the rules adopted under those chapters; [and]...A patient, patient's personal representative, or authorized person if the medical record is necessary to support a claim under Title II or Title XVI of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C.A. 401 and 1381, as amended, and the request is accompanied by documentation that a claim has been filed." This statute can be useful for obtaining medical records from providers, medical records companies, and entities including the Bureau of Worker's Compensation and the Social Security Administration, to help you create your consumers' disability determination packages. 3. No. 4. No. 5. No. 6. For those that have Medicaid there may be network in the county but for non-Medicaid may need a network established. 7. Is there a state policy on rescheduling CE’s? NO Or should the vendor use SSA disability rescheduling guidelines? Yes Are CE providers paid for missed or cancelled appointments? If on Medicaid no won't pay for missed appointment. Vendor discretion on whether or not to pay missed appointments. If yes, is there a standard rate for these payments? Is reimbursement for client travel expenses a satisfactory method of providing transportation assistance? Vendor discretion for non Medicaid recipients. What number or percentage of cases require transportation? Unknown 8. Once the vendor scans collected case documentation into multi-page TIFF image files, is the vendor expected to shred the hard copies of documentation?The vendor must have a verification process that ensures the electronic copy is an exact duplicate of the original. When necessary, an employee who is responsible for the records will have to be able to swear under oath the copy is a true and accurate copy of the original. Shredding is not a requirement, but disposal of records must be done in a manner that maintains their confidentiality. 9. Yes.
Question: What is the annual expenditure per applicant by service type?
Answer: ODJFS is unable to provide an answer to this question.
Question: General: If a disability applicant has Medicaid or some other insurance, does that pay for evaluation services (e.g., physician, transportation)? If they don’t have any insurance, or Medicaid, then is the vendor expected to pay for those services?
Answer: General: If a disability applicant has Medicaid or some other insurance, does that pay for evaluation services (e.g., physician, transportation)? Yes, those who have Medicaid (Continuing Disability Review [CDR] individuals) should have access to transportation networks within some counties and they should have ongoing medical documentation supporting the continuance of their disability with their Medicaid providers. If they don’t have any insurance, or Medicaid, then is the vendor expected to pay for those services? Yes.
Question: Page 9 Section III. Vendor Experience and Qualifications 3.3 Staff Experience and Capabilities Subsections B.C.D. Do the clinical staff need to be licensed in Ohio, or in the state in which they are domiciled?
Answer: The clinical staff need to be licensed in Ohio.
Question: General: If an applicant is granted disability, are benefits and services paid with State or Federal funds? If disability is granted, are services related to the application process eligible for retroactive coverage? If so, what party would be responsible for submitting the claim for these services?
Answer: If retroactive disability coverage is granted Medicaid coverage, vendor may be required to submit claim payment detail for review by ODJFS.
Question: RFP Section 4.1.J, Scope of Work: Could the state clarify, if the applicant already has coverage by Medicaid or another third party carrier, is it expected that the vendor will send these applicants to Medicaid-participating providers and track the claim expenditure, which will be reimbursed through the Medicaid program?
Answer: Persons on Medicaid (CDRs) should have on-going medical documentation that would support or not support the disability. If vendor is wanting to use a non-Medicaid provider, vendor would be responsible to pay the non-Medicaid provider.
Question: Page 12 Section IV. 4.1 Scope of Work Subsections B. 1-2 Is there an existing network of CE providers and of medical testing providers who have previously provided these services? What number and/or percentage of cases require CEs and/or medical lab testing? What is the number and/or percentage of cases that require more than one CE? What is the number and/or percentage of cases that require more than one CE specialty discipline, i.e.-medical and psychological? Is the vendor required to provide interpreters for non-English speaking clients to access CEs and/or testing? And, if yes, what number and/or percentage of cases require interpreters? Does ODJFS want CE providers to get available/pertinent clinical data prior to the scheduled examination? If so, what is the standard used for information, records or material provided to consultative examination physicians prior to the examination? What credentials are required of CE providers? Licensure? Board certification? What, if any, CE provider specialties/subspecialties are required? Page 12. Section IV. 4.1 Scope of Work Subsections B. 3-4 Section #3 requires the vendor’s statewide medical provider network to complete JFS 07302 basic medical form including Section G. 1-5 Physical Functional Capacity Assessment and JFS 07308 Mental Functional Capacity Assessment if applicants do not have a primary care physician or psychological provider. Is the ‘residual functional capacity evaluation’ in #4 meant to reference either of the following or something else (please specify): a. The physician/psychologist member’s role in the disability determination team as described at SSA Program Operations Manual DI 24501.001B.2. What is the role of the MC/PC? https://secure.ssa.gov/apps10/poms.nsf/lnx/0424501001. If yes, is the vendor expected to provide an independent RFC evaluation of all the physical and/or mental information in the file? If yes, is there a separate form for assessing the RFC independently of the examining physician’s evaluation on the JFS 07302 and JFS 07308? Is it permissible for an ‘acceptable medical source’ (SSA POMS DI. 22505.003 and DI 24501.001) employed by the vendor, with experience in SSA or Medicaid disability determination but who has not examined the applicant to construct an RFC as per the SSA reference cited in this paragraph? b. Or does the term “residual functional capacity evaluations” refer to actual testing of an individual’s physical ability to perform a work-related series of tasks (functional capacity evaluation or FCE by an occupational therapist or other appropriately trained and licensed professional.)
Answer: 1. No. 2. 73% of the 35,000 yearly caseload were deferred for additional information in 2010. There is no data to identify how many cases had pertinent medical documentation available and how many required additional testing to be ordered. 3. See previous answer. 4. Approximately 17% of cases allege both psychological and medical impairments. 5. Yes. 6. During the last year ODJFS disability determination unit has had two claims that required translation. No number available for counties that required interpreters for disability applicants. 7. Yes, CE providers need pertinent data prior to the examination. Vendor should determine pertinent medical documentation and provide it to the CE provider. Gathering of existing medical documentation should occur prior to CE as existing medical documentation may preclude the necessity of a CE. 8. Please see § 416.913 (a) 9. Please see § 416.919g 10. The FCE is part of the JFS 07302 and JFS 07308 Medicaid forms. They can be completed by the primary care physician or by a provider in the vendor's network. An FCE by an occupational therapist is acceptable as well.
Question: General: What percentage of the disability applicant population already has Medicaid or other third party coverage?
Answer: In 2010, approximately 6.5% of the 35,000 cases were continuing disability reviews (CDRs). CDR cases have Medicaid.
Question: RFP Section 4.1, Scope of Work: How does the county office currently obtain a HIPAA compliant disclosure so the vendor may coordinate activities with the applicant and/or the applicant’s person of authority?
Answer: County offices obtain necessary signatures on releases and HIPAA forms that allow Ohio Medicaid or other entity (5101:1-39-03) to gather medical documentation. The county will provide these signed forms to the vendor.
Question: RFP Section 3.4, Vendor Information Technology Compatibility and Functionality: What percent of disability determination applications and county-generated information is expected to be submitted to the vendor via eQuIL? If not via eQuIL, how is the remaining documentation submitted?
Answer: All disability cases begin at the county. County information/forms will be submitted to the vendor by a secure pathway determined by the vendor. Vendor will build the disability case by obtaining medical documentation and/or examinations/testing. Vendor will then upload the forms and medical documentation to eQuIL for the disability review by ODJFS.
Question: Page 14. Section IV. 4.2 Number of Participants: Project Data For Continuing Disability Reviews (CDRs), will the ODJFS provide copies of the prior approval (s) to the vendor upon referral for CDR documentation?
Answer: Previously approved case will be in eQuIL and vendor will have access to view it.
Question: Page 11. Section IV. Scope of Work Subsections A. 1-4 Is there a deferral process in the event a case sent to the vendor from the county is missing a form or the forms sent are not filled out completely? If there is a deferral process will sending the case back to the county as a deferral freeze the 65 day production standard? Are applications screened at the county offices for SSA approval and/or time remaining on a prior determination of disability (for CDRs), or does the vendor do this after receipt of the initial application?
Answer: Page 11. Section IV. Scope of Work Subsections A. 1-4 Is there a deferral process in the event a case sent to the vendor from the county is missing a form or the forms sent are not filled out completely? If a form from the county is not properly completed, the vendor will need to collaborate with the county to resolve the issue. The deferral process is a process in which the DDA unit in Columbus requests additional medical information from the vendor. If there is a deferral process will sending the case back to the county as a deferral freeze the 65 day production standard? No. Are applications screened at the county offices for SSA approval and/or time remaining on a prior determination of disability (for CDRs), or does the vendor do this after receipt of the initial application? For an individual to apply for Medicaid disability, the individual must have proof that they applied for SSA. The counties check this upon application for Medicaid disability by the individual and prior to requesting a CDR. Vendors will not be held responsible for individuals applying for SS.
Question: Page 4. Section II. Anticipated Procurement Timetable 2.1 Concerning the procurement timetable for Potential Contract Renewals, assuming satisfactory contractor performance, what is the likelihood of renewal dates of 7/01/13 and 7/01/15? What date is a realistic expectation for the renewal period to begin at the beginning of a Biennium?
Answer: It is anticipated that satisfactory contractor performance will result in renewal for 7-1-13 and 7-1-15.
Question: On pg. 10, Section 3.4, the RFP states: "The selected vendor will be required to use Ohios existing electronic disability system (eQuil) to receive and transmit medical case documentation as a regular part of the case-building work." But Supplement 1, eQuil Web Service Interface, Section 1.2, mentions only PutDocument.WSDL. It does not mention GetDocument.WSDL. Will the client provide a web method to get documents from eQuil to our system or should we assume that the demographic information will be keyed in by our staff? Please clarify.
Answer: That's correct, eQuil does not send documents OUT.
Question: 2.1, Anticipated Procurement Timetable. The timetable indicates that the proposal is due on Thursday January 5, 2012, but page 17 indicates that the proposal is due "Thursday January 6, 2012." Can you please clarify?
Answer: This has already been corrected in the RFP. The deadline for submissions is Thursday January 5, 2012.
Question: If an applicant is granted disability, can an examining provider bill retroactively for services provided during the determination process?
Question: Are disability applicants granted provisional Medicaid coverage?
Answer: No, disability applicants are not granted provisional Medicaid coverage.
Question: With regard to Mandatory Vendor Qualifications the RFP states each proposer must meet all outlined requirements. There are two different wordings listed below “b” allows for a broader scope of experience: a. “Experience with the Medicaid program and/or Public Assistance” b. “Vendor proposals must demonstrate experience with Medicaid and/or private or commercial health care programs Please clairify
Answer: A vendor must have had experience working with a Medicaid program. i.e. processing claims, working with eligibility as well as experience working with a commercial insurance carrier i.e. provider contracting or paying claims or benefit administration.
Question: Will the award go to a single vendor?
Answer: Yes, a single vendor will be selected for award of the contract.
Question: Will you provide the name of the current vendor?
Answer: There is no current vendor.
Question: What are the current program rates?
Answer: ODJFS is unsure what you are referring to with this question.
Question: How long has the current vendor had this contract?
Answer: No vendor has had this contract.
Question: Please define "Implentation" date of 4/1/12. Is this the date which program development begins? or, is it the go live date?
Answer: This is the date we plan on having vendor up and running to start doing the work.
Question: Will the vendor receive electronic images, paper documents, or a combination of both from the County offices?
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