Recommendation of Vendors inResponse to Requests for Proposals

Community Support Team (CST)Intensive In-Home (IIH)

SA Intensive Outpatient Program (SAIOP)

January 9, 2014

Serving Durham, Wake, Cumberland and Johnston Counties

Background

Federal and State requirements for Managed Care Organizations to manage quality, effectiveness and cost of services within a closed provider network

Alliance management of closed network since 2/1/13 Alliance Selection and Retention Procedure enables non-

renewal of contracts based on multiple factors Concerns raised about consistency in meeting quality and

practice standards of CST, IIH and SAIOP Selection of providers for contract renewal through Request

for Proposal (RFP) process Alliance Request for Information/Request for Proposal

Procedure establishes guidance for fair, uniform and consistent process

Objectives

Comprehensive and quality-driven network

Improved quality and consistency of CST, IIH and SAIOP

Fidelity to evidence-based practices

Local continuum of care including outpatient and psychiatric services

Compliance with standards of care, service definitions, crisis response expectations, CABHA expectations (when applicable)

Provider viability

Consumer Choice

Fair, consistent and transparent selection process

Current RFPs

Community Support Team

Intensive In-Home Services

Substance Abuse Intensive Outpatient Program (SAIOP)

MH/SA Supported Employment and Long-Term Vocational Supports (to be presented to Board in February)

Provider Expectations

All providers of CST, IIH and SAIOP were required to respond to RFP to be considered for Medicaid contract renewal

Respondents must have credentialed site in Alliance catchment area

Current CST, IIH and SAIOP providers may request expansion to other counties in Alliance catchment area

Contracts extended for three months for respondents meeting minimum criteria

Contracts for non-responding providers and those not meeting minimum criteria ended 12/31/13

No set number of awards

Request for Proposal Process

Development and posting of RFP

Pre-proposal conferences

Questions and Answers posted

RFP responses due

Minimum Compliance review

Review of written responses (“desk review”)

Provider interviews

Final recommendations and Board approval

Contract renewal and consumer transition

RFP Schedule

RFPs posted September 30, 2013

Pre-Proposal Conferences October 7 & 8, 2013

Questions and Answers Posted October 18, 2013

RFPs Due November 1, 2013

Minimum Compliance Review November 4-8, 2013

Desk Review November 12-26

Provider Interviews Dec. 11, 2013 – Jan. 6, 2014

Recommendations to Board January 9, 2014

Minimum Compliance

Response submitted by 5:00pm 11/1/13

Response contains all required elements

Credentialed site in Alliance catchment area

Good standing status with:

Alliance

Other MCOs (required by DMA-MCO contract)

Accrediting body

Federal and State oversight agencies

Currently providing service covered by the RFP

Desk Review Rating Process

Training for reviewers

Sections reviewed by content specialists

Ratings used Likert scale ranging from 1 – 5

Score sheets included justification for ratings of 3 or less

Interview selection based on compiled scores of multiple raters

Non-selected responses subjected to additional review

Non-selected providers were offered opportunity to meet with Alliance CEO

Desk Review Rating Scale

1Unsatisfactory

UnclearIncompleteInsufficient

2Minimal

WeakConfusing

Lacks some info

3Sufficient

Satisfactory, but some questions /concerns

remain

4Good

StrongWell-

plannedClear,

Reasonable

5Exceptional

Model Program

No questions

remain

Interview Selection Process

Desk review score of 65% required to be invited to interview

Conducted second review of ratings for non-selected

Purpose of interview is to confirm desk review ratings and clarify information about services

Provider invited to bring CEO, Medical Director, Clinical Director, Program Directors and other key staff (max. 10 employees)

Consistent set of interview questions for each RFP, with additional follow-up and clarification questions allowed

Group consensus rating of interview responses

RFP Selection Committee

Representatives from multiple departments, all Alliance counties, Alliance Board and CFAC.

The following departments/functions were represented on interview panels: Network Development and Evaluation: 17 Legal and Compliance: 8 Financial: 3 Clinical Operations: 11 QM: 5 Community Relations: 2 Consumer Affairs: 1 Alliance Board: 2 Alliance CFAC: 1

RFP Responses

CST IIH SAIOP

Eligible to Respond to RFP 35 49 41

Responses Received 28 45 28

Did Not Meet Minimum Review Criteria 6 7 3

Met Minimum Review Criteria 22 38 25

Met Desk Review / Interviewed 16 29 16

Recommended to Board 10 23 12

RFP Recommendations

Alliance RFI/RFP Procedure requires a score of 65% for contract consideration

This procedure allows exceptions if there is a critical need for the service, there is a limited response, and if committee is convinced that the prospective provider has the capability to successfully execute RFP requirements

Recommend 35 providers for full-year contract extensions (through 12/31/14)

Recommend 11 providers for six-month contract extensions (through 6/30/14)

Recommend 15 providers for non-selection for these services (current contract ends 3/31/14)

Six-Month Contract Extensions

Scores of 55% - 65% on interview

Scores above 65% on desk review

Providers will be notified in award letter of specific expectations and areas for improvement

Alliance will provide technical assistance on identified areas of concern

Alliance will monitor provider performance through 6/30/14 and will make further recommendations for contract renewal/non-renewal in May.

Recommendations for CST (Full-Year Contract)

Provider Counties Served

Carolina Outreach Cumberland, Durham

Family Legacy MH Services Wake

Family Preservation Services of NC Durham, Wake

NC Recovery Support Services Wake

Southlight Wake

Tonya Omar / The Aya Center Durham

Turning Point Family Care Wake

Recommendations for CST (Six-Month Contract)

Provider Counties Served

A United Community Wake

B and D Behavioral Health Services Durham

Yelverton's Enrichment Services Cumberland, Durham

Recommendations for IIH (Full-Year Contract)

Provider Counties Served

Access Family Services Cumberland, Durham, Wake

Alexander Youth Network Cumberland

Carolina Outreach Cumberland, Durham

Carolina Support Services Johnston

Diverse Family Services Durham

Easter Seals UCP Wake

Family Legacy Mental Health Services Wake

Family Preservation Services of NC Durham, Wake

HealthCore Resource, Inc. Wake

Recommendations for IIH (Full-Year Contract)

Provider Counties Served

Hope Services Wake

Melange Health Solutions, LLC Durham

NC Mentor (merging with IFCS) Cumberland, Wake

NC Recovery Support Services Wake

Tonya Omar / The Aya Center Durham

Turning Point Family Care Wake

Upward Change Health Services Durham

Youth Extensions Durham

Youth Villages Durham

Recommendations for IIH (Six-Month Contract)

Provider Counties Served

A United Community Wake

B and D Behavioral Health Services Durham

Healing Interventions Wake

Quality Care Solutions Durham, Wake

Yelverton's Enrichment Services Cumberland, Durham, Wake

Recommendations for SAIOP (Full-Year Contract)

Provider Counties Served

Carolina Outreach Cumberland

Cumberland County CommuniCare Cumberland

Family Legacy Mental Health Services Wake

Fellowship Health Resources Wake

NC Recovery Support Services Wake

Restoration Family Services Johnston

Southlight Wake

UNC Horizons Wake

VisionQuest Nonprofit Corporation Durham

Visions Counseling Studio, PLLC Durham

Recommendations for SAIOP (Six-Month Contract)

Provider Counties Served

B and D Behavioral Health Services Durham

Sigma Health Services Wake

CST Claims by Agency (past three months)

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

IIH Claims by Agency (past three months)

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48

SAIOP Claims by Agency (past three months)

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

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