Integrated Physical and Behavioral Health Care for the Elderly
Questions and Answers
- Can a NYS Office of Mental Health (OMH) licensed Article 31 provider partnering with a NYS Department of Health (DOH) licensed physical health care provider be the primary applicant for a Model 2 contract?
Assuming the not-for-profit OMH-licensed Article 31 provider operates an outpatient behavioral or physical health program for adults, it is an eligible applicant and yes, can partner with a DOH-licensed physical health care provider for a Model 2 proposal. The eligible applicant must submit the application and - if awarded a contract - will be the recipient of grant funding and assume responsibilities for the contract and fiscal and program operations.
- We are the Department of Hospitals operated by the County of Rockland. We operate a 57 bed long term acute care hospital (one of only 4 such hospitals in NYS), a 341 bed skilled nursing facility, and a Medical Model Adult Day Health Program for individuals who are not in need of skilled nursing care but who do need a social/recreational program during the day with medical oversight. The County of Rockland also operates the Department of Mental Health, and we have been in discussions regarding assimilating the geriatric mental health population into our Adult Day Health Program - as this population is beginning to experience medical problems associated with ageing, etc. Based on the above, would we be eligible to submit a proposal under this grant?
Because counties are local government units (which are eligible applicants) and your hospital is operated by a county, the Department of Hospitals of Rockland County is eligible.
- Is a hospital eligible to apply for this grant if they received OMH funding in 2007 for a Model 2 geriatric health integration program? The hospital would like to develop another program in a mental health clinic setting (Model 1).
Agencies with health integration programs funded by previous OMH geriatric service demonstration project grants may not submit proposals in response to this RFP that would expand or enhance those programs. They could, however, submit a proposal for a clearly separate and distinct project related to this RFP. If the proposal appears to expand or enhance the initial grant project in any way, it will not be considered.
- Could you tell me if federal agencies (e.g. Department of Veterans Affairs) can apply for this grant?
No, only OMH funded or licensed agencies or local government units in New York State are eligible to apply, though a federal agency could partner with an eligible applicant.
- I am not clear on who is eligible to apply for the Behavioral Health Grant. When you state "Local Government Units In New York State," would a Long Term Home Health Care Program or a Geriatric Medical practice be eligible units to provide screening and behavioral health services to the elderly populations that they serve?
A local government unit in NYS is defined by OMH as a municipality or county government (including boroughs), so a hospital, medical practice, or long term home health care program that is not funded or licensed by OMH or operated by a local government unit is not eligible.
- The Integrated Physical and Behavioral Health Care for the Elderly Request for Proposals requires submission of a Letter of Intent by May 13th. The RFP doesn't mention what format should be used or what information should be included. Can you please clarify?
The Letter of Intent should simply state that your organization or agency intends to submit a proposal. Ideally, it would be on agency letterhead and contain contact information relevant to the staff who is submitting the proposal. It may be sent by e-mail or regular U.S. Mail.
- Could you help me understand if there is a limit of one application per institution? In other words, could two different investigators from the same medical college submit separate proposals?
There is a limit of one proposal per eligible applicant organization or entity.
- The RFP states: "Agencies with health integration programs funded by OMH may not submit proposals." Ohel received a City Council Geriatric Initiative Grant through the NYC Department of Health and Mental Hygiene (DOHMH). This grant provides counseling and screening for the elderly in physician offices. In the proposed OMH RFP we will propose to integrate health services into our current Article 31 mental health clinics. Will we be disqualified?
As your project is funded through DOHMH and you have never been awarded an OMH geriatric service demonstration project grant, your eligible applicant status is not changed in any way.
- We would like to propose Model I and Model II, as we have extensive experience in these areas. Are there any budget guidelines, such a percentage of admin, etc.?
The RFP invites eligible applicants to submit proposals for either Model 1 or Model 2, so you must choose one or the other, not both. Budget requirements that have been identified are included in the body of the RFP and include the use of required budget formats.
- I am reviewing your RFP for Integrated Physical and Behavioral Health Care for the Elderly and wanted to understand better what constituted a Behavioral Health Care Setting. Our organization operates a 100-bed shelter for women who are 45 and older with mental illness and other issues. Many of them are 55 and older. Would that setting qualify? We also operate a 54-unit supportive housing facility for individuals with mental illness. Many of them are also older. Lastly, I am wondering if our senior center might qualify. I believe the RFP requires that the facility in mind has to also already be receiving OMH funding. Is that correct?
The setting of a shelter or senior center is not considered a health care setting. For purposes of this RFP, a health care setting is where a patient/client goes to receive care or treatment, like a doctor's office or a health clinic, e.g., for physical health care. Behavioral health is a term that includes mental health and substance use. So a behavioral health care setting is one in which a patient/client goes to receive mental health or substance use care or treatment. Typical examples would be an OMH-licensed outpatient clinic for mental health or a NYS Office of Alcohol and Substance Abuse (OASAS) certified outpatient clinic for substance use. Regarding your second question, the RFP requires eligible applicants to be either (1) not-for-profit agencies funded or licensed by OMH that operate outpatient physical or behavioral health programs for adults or (2) local government units in New York State.
- Is a current OMH grantee (for Gatekeeper Geriatric Mental Health Demonstration Project) an eligible applicant for this Integrated Physical and Behavioral Health Care for the Elderly initiative?
Because your Gatekeeper program is not a health integration program and provides a different service to the geriatric population, your agency is an eligible applicant for this RFP, as long as what is proposed would not "expand or enhance" the current Gatekeeper program you are operating.
- The New York College of Osteopathic Medicine of New York Institute of Technology supports a Parkinson's disease treatment center in its on-campus health center. We would like to apply for funds to incorporate mental health services into our program of physical services for the center's patients and, possibly, their caregivers. However, we are not funded by OMH. Would we be able to partner with a group that is funded or supported by OMH?
Yes, your agency could partner with an eligible applicant who would apply for the Integrated Behavioral Health RFP. The eligible applicant must submit the application and - if awarded a contract - will be the recipient of grant funding and assume responsibilities for the contract and fiscal and program operations.
- Are ½ inch margins acceptable for the proposal?
- Would an Article 28 center that does not have an Article 31 license but that has been approved by OMH to provide behavioral health services be eligible to apply for this funding? Under what circumstances would an Article 28 center be eligible to apply for funding?
The RFP requires eligible applicants to be either (1) not-for-profit agencies funded or licensed by OMH that operate outpatient physical or behavioral health programs for adults or (2) local government units in New York State. Agencies that do not meet this criteria may partner with an eligible applicant, but they themselves would not be able to respond to the RFP because they do not meet the eligible applicant criteria. The eligible applicant must submit the application and - if awarded a contract - will be the recipient of grant funding and assume responsibilities for the contract and fiscal and program operations.
- While completing Appendix C in the Direct Contract Forms and Instructions, there is no room in the form for the address. Can this be fixed?
The Direct Contract Forms and Instructions are included for informational purposes only; it is not required that applicant include this information. It is posted to allow applicants the opportunity to review the necessary steps and requirements when contracting with the Office of Mental Health.
- Please explain what you mean in the following sentence in Section 5.2 A, Provide Treatment Services, "In both settings, behavioral and psychological issues are addressed when they have an impact on health care." In a behavioral health setting, providers typically address behavioral and psychosocial issues in a much broader context. Even in an Article 28 clinic setting, mental health disorders should be addressed regardless of their impact on health issues.
We have found that identifying and addressing behavioral issues and psychosocial issues affecting health care are important but often overlooked services in many health care settings, so it is emphasized in the RFP. Cited as a footnote in Section 1, 1.1 of the RFP, "The Medical Care and Psychosocial Needs of Older Adults" article is a good reference: http://www.mhnews.org/back_issues/MHN-Spring2011.pdf#zoom=100
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- Is the organizational chart required in Section 5.3 (3) counted toward the 7 page narrative limit, or is it an attachment not included in the page limit?
It counts, but the chart does not have to take up a whole page.
- Must the site where services are provided be physically within the outpatient medical clinic, or can different programs within an agency or community collaborate to provide home services to those unable to reach a central community site?
The RFP calls for an eligible applicant to submit a proposal to integrate physical and behavioral health care for the elderly in either a Model 1 or Model 2 health care setting, where there is an existing base of services to integrate with (for more about health care settings, see the answer to Question 10 above), so that must be accomplished. If, in addition, an eligible applicant is able to add home-based services to what is expected to be a sustainable and fiscally viable program by the end of the grant period, they may do so.
- OMH is seeking projects that are sustainable once the grant period is over. Is it permissible to use the grant as seed funding for training and other one-time costs that help the applicant to leverage Medicaid reimbursement during the grant period for reimbursable aspects of the integrated health project?
- If primary care is embedded at an Article 31 clinic, will the health assessment, monitoring and complex case management visits for medical coordination be counted toward the 30 visit threshold for full payment?
- Currently, certain regulations (599) prohibit our agency from billing for primary care geriatric services. Should the grant be awarded to us, would we be able to bill persons with Medicaid, Medicare and managed care organizations for primary medical screening, physical exam, and treatment services provided to our consumers? Under the APG billing structure, what will the CPT codes be and what are the anticipated reimbursement rates?
- Sustainability is based on approval of 599 billing codes - how should we address this?
- The OMH Clinic CTP Procedure Weight and Rate Schedule gives reimbursement amounts for Health Physicals and Health Monitoring Services. Would these reimbursement rates also apply for services delivered under this RFP?
- Within an Article 31 outpatient mental health clinic, will health-related services be billable under Medicaid?
Although Part 599 clinic program regulations are in effect, Ambulatory Patient Group (APG) claiming for OMH-licensed clinics cannot begin until the Centers for Medicare & Medicaid Services (CMS) approves the State Plan Amendment. Once approved, claims for services delivered after October 1, 2010 – including claims for physical health-related services defined in Part 599.4 – will be processed under APGs. OMH anticipates that the Part 599 regulations will be approved during the contract period of this RFP. Proposals will be evaluated as if the APG claiming procedures were in effect currently. See the Clinic section of the OMH website for more details: http://www.omh.ny.gov/omhweb/clinic_restructuring/index.html
- Proposal Element 5.1 - Assessment, treatment and any associated care management services are to be integrated or very highly coordinated. If a consumer is referred out of the Community Mental Health Center (CMHC) to a medical specialist, do we have to have a coordinated plan of care with the specialist? Would we need to have agreements in place with the specialists to do this coordinated care plan electronically and have consent forms prepared on both sides to share the information?
Yes, there should be a co-coordinated plan of care with the specialist, the more integrated or co-coordinated the better, especially if the specialist will have ongoing participation in treating a condition that cannot be handled by the CMHC primary care staff. Electronic communication and HIPAA conformity with regard to consent forms would be preferable, though well defined telephone and paper communication might be adequate.
- Under the Person Centered Medical Home Model, coordinated care is essential. Would it be required or preferred to employ a care specialist to coordinate all the care of this population? If so, what is the expected ratio of care coordinators to consumers? And what codes can we bill under to get reimbursed for the services of the coordinated care?
This is but one of a number of possible approaches to care co-ordination, so it is not specifically required. That being said, a care coordinator who could actively monitor the scheduling and keeping of appointments and other factors would be very valuable, particularly for individuals diagnosed with serious mental illness. Such a person could even help to assure the integration of primary care and outside referral care. At present there is no established ratio of coordinators to consumers and few reimbursement options.
- Are there any required physical health staff other than what is stated as Specialty Staff?
No, not in the RFP.
- Proposal Element 1.1 - Based on the significant recruitment and system changes that may occur as part of the implementation, will OMH consider a modification to the start dates of either September 1, 2011 or July 1, 2012 for Model 1 Proposals?
The start dates are unlikely to be modified. The RFP is largely intended for agencies that want to integrate physical and behavioral health care and are ready but need some seed money to begin implementation.
- Please clarify specifically what project performance data will be required for submission to OMH by awardees of the RFP, as stated under section 5.2.3.
The data set, not yet developed, is anticipated to be web-based data collection system that will consist of a minimal set of performance measures.
- Can we provide integrated physical and behavioral health care services to all patients but only utilize the grant funding for project aspects for patients 55 and older?
- Am I correct in understanding that OMH will permit grant recipients to generate revenue immediately and throughout the first and second years? Reconciliation of grant funds, expenses, and reimbursements will take place at the end of the second year (as stated in Section 4-D Operating Budgets and Budget Narratives) so that the program can use any revenues that are generated during the first and second years of the grant to pay for 50% of the second year and 100% of the third year salaries. Is this correct?
This is correct regarding the first and second years (the grant period). However, contracts will be reconciled based on 24 months of all revenues and expenses at the end of the grant period, so there will be no accrued revenue to apply to year three. Year three is the first year that programs are expected to be sustainable and fiscally viable without OMH support.
- Can all of the grant monies be used for personnel costs?
- What is "programmatic and fiscal technical assistance from a Geriatric Technical Assistance Center"?
OMH is working on establishing a Geriatric Technical Assistance Center to provide programmatic and fiscal technical assistance for geriatric service demonstration project grantees – starting with those who are awarded contracts as a result of this RFP – with an emphasis on services, integration of care, and sustainability.
- For a Model 1 design, and in addition to the staffing requirements for one or more physical health professionals, will the grant help to fund additional staff for the first two years, assuming it will become self sustaining?
For the two-year grant period, OMH will award successful applicants a grant of up to $100,000 for the first year and up to 50 percent of the first year's grant award for the second year.
- Specific to Suffolk County - are you seeking an annual specified number of individuals served and the services provided?
Each proposal is expected to include the estimated number of individuals to be served and the number of services to be provided for each of the two years of the grant period and for the year following grant funding.
- On Appendix A, Agency Transmittal Form, can you advise what "Number of Units" refers to?
Please recheck this form for this specific RFP on the OMH website, as we can find no reference to number of units on it.
In rechecking this form on 5/24/11, we found that it does, indeed, ask for the "Number of Units," but in error. Please ignore it, as it does not apply. The form will be revised to correct the error.
- What model programs or guides should we be looking at for program design? Will all sites where behavioral healthcare services are offered be required to be designated as satellites? What services will be eligible for reimbursement?
We are recommending no specific program model or guide for program design related to this RFP, though the Scope of Work section of the RFP is very specific about program requirements. If you operate an Article 31 clinic, you may or may not need to seek satellite designation depending on whether or not you plan to provide services at an off-site location (review the satellite designation criteria found in OMH clinic program regulations, Part 599.5). Identifying services eligible for reimbursement depends on your setting and what services you are authorized to provide and bill for with the license or operating certificate you have, and then matching that up with the billable services guidelines of your payors.
- We are a Health Care Network with an acute care hospital and a diagnostic and treatment center, each with its own Article 28. Can we submit 2 applications-one for each facility?
Having determined that each has at least one OMH-licensed program, either, but not both of these facilities in your Network, may submit a proposal in response to this RFP.
- Are Chemical Dependency services considered behavioral/mental health services?
Chemical dependency services are considered behavioral health services.
- Our organization is licensed by OMH to provide Inpatient Treatment Programs for Adults, and by DOH to operate outpatient clinics. Are we eligible to apply?
- Is OMH's intent for this project to better serve eligible individuals who are already part of the mental health system, who are lacking integrated physical healthcare? Or, is OMH's intent for this project to serve individuals who are 55 plus years of age with medical conditions who are new to the Behavioral Health system?
The purpose of the RFP is to assist older adults with mental health and/or substance use disorders with their overall health by promoting integrated physical and behavioral health care in either behavioral health care settings or in physical health care settings.
- Could Medicaid services under this project be provided in an OMH licensed Personalized Recovery Oriented Services (PROS) Program which took in referrals from the general community?
Additional information is needed to answer this question.
- Can we split the budget differently between year 1 and year 2?
- Is there any other guidance on the year 3 budget? Is it required as part of the initial submission? If so, is there a minimum or maximum we should consider?
It is required as part of the original submission. Because OMH expects these programs to be sustainable and fiscally viable without OMH support after year 1 and year 2 (the grant period), the year 3 budget is expected to show how fiscally viable your program will be after the grant.
- Do we need to budget time and travel to work with the Technical Support Center?
You should budget for at least 4 trips to Albany per year.
- Is there an approved indirect cost rate? If so, is the $ for indirect cost part of the $100,000 in year 1?
- Are there any other budget limitations/requirements?
No, all requirements are included in the RFP.
- Can we submit a proposal that combines elements of Model 1 and Model 2? Or, should our proposal focus on either the behavioral health facility or the physical health facility, but not both?
The RFP calls for an eligible applicant to submit a proposal to integrate physical and behavioral health care for the elderly in either a Model 1 or Model 2 health care setting, not both.
- Suppose two proposed programs are equally good in terms of quality, but one expects to assess and treat twice as many patients as the other one. This might be because of a larger patient population or perhaps because of an outreach program (not included in the funding request). According to the scoring rules (Section 4.2.2), the first program will get the maximum score of 20 on cost, and the second one, say, 11. Can the second program expect that the fact that it treats twice as many patients will give it additional points in the scoring on other sections? Will it likely be enough to make up the 9-point cost gap or not?
The number of patients/clients to be served is not a factor in calculating cost. The formula described in Section 4, 4.2.2 of the RFP is based on State Finance Law requirements that all budgets be evaluated for bottom-line costs to the State, i.e., the total two-year funding request cost of your RFP proposal. While the Financial Assessment (Cost) component of the evaluation represents a total of 20 possible points, the non-cost components (the Summary and the four-part Program Narrative) represent a total of 80 possible points.
- We would like, if possible, to be one of the 5 projects starting on September 1, 2011. Should we indicate this in our proposal? If so, should we also demonstrate our capability of starting on that date?
Model 1 proposals are the only proposals that will be selected for a 9/1/11 starting date, but because awards will be made on a competitive basis, there is no way to tell whether or not your proposal will be selected as one of the top five proposals until all of them have been evaluated and scored.
- We currently have a community outreach program that targets elderly in our area. This program helps us to reach this target population more effectively and to address some of the behavioral and psychosocial issues addressed in the RFP. Are we correct in believing that an account of how this existing program supports our integrative healthcare efforts can strengthen our application?
If you feel it would strengthen your application, include it in a relevant part of your proposal.
- Are enhancements to our existing program admissible as part of the Integrated Behavioral program, as long as they are directly related to our goals of integrating mental and physical healthcare?
Yes, consistent with RFP requirements.
- Will partnering with a PROS agency in our area to provide rehabilitation services that complement inpatient and outpatient treatment of mental illness support our integrative healthcare efforts and strengthen our application?
You may partner with any program you feel would strengthen your application.
- In a behavioral setting, where a Nurse Practitioner is utilized for primary care treatment, what kind of supervision is required in terms of credentials?
Please check with the Office of Professions at the NYS Education Department for an authoritative answer. You may want to start with their website.
- May we employ a doctor on an hourly basis as a contractor, with the agency billing for and receiving reimbursement for medical services?
It depends on your setting and what services you are authorized to provide and bill for with the license or operating certificate you have. In an Article 31 clinic, for example, you would not be able to bill for medical specialty services.
- Does Model 1 require that applicants have Article 28 licensing?
- Can grant funding be used for facility renovation costs related to accommodating physical health care services on site at a licensed Behavioral Health Care Setting?
Yes, for costs within reason.
- For Model A. is the expectation that this integration process will replace an individual's primary health care physician (PCP)?
No, not at all.