NYC IPA Solicitation Process
The NYC IPA is currently soliciting expressions of interest from organizations that would like to provide care management and social services to members of the NYC IPA in accordance with the NYC IPA care management model. Organizations that contract with the IPA will provide non-clinical services and may be healthcare organizations, care management agencies, community-based organizations, or other eligible organizations.
Organizations interested in contracting under the NYC IPA network must provide documentation validating that they meet the NYC IPA’s minimum organizational qualifications to provide services, the service area(s) that the organization would like to fulfill, and contact information for key stakeholders at the organization. The template for submitting this information can be found [here]. All organizations who meet the minimum qualifications for the program will follow the standardized review process for participation in the NYC IPA network.
Organizations that are under consideration for contracting with the NYC IPA will be required to attend a pre-proposal conference or review a recording of pre-proposal conference [link] with NYC IPA leadership to learn about the structure of the NYC IPA and requirements for providing services to its members and ask additional questions regarding program details. To move forward with the selection process, organizations will be required to submit a scope of work detailing how they will meet the administrative and service requirements of the NYC IPA overall, as well as the specific type of care management and, if applicable, social services they intend to provide.
The NYC IPA will assess all submissions to select participants and care management partners that may provide care management and social services. The assessment will take into consideration the scope of work submitted to the NYC IPA as well as presentations from and interviews with key organizational stakeholders and/or a site visit. For more information, please review the IPA Healthcare Participant Procurement Manual (for healthcare providers and FHQCs) or the IPA Care Management Partner Procurement Manual (for CMAs and CBOs).
Financing structure and administration (Medicaid)
The care management program is funded by a directed payment and 1115 waiver approved by the New York State Department of Health (NYS DOH) and Centers for Medicare and Medicaid Services (CMS). NYS DOH and CMS require New York City region Medicaid Managed Care Organizations (MCOs) to participate in the population-based payment model, whereby the IPA is responsible for the total cost of care and provision of care management services for single adults experiencing homelessness who have had at least 7 days in shelter in the past 12 months, who are enrolled in Medicaid Managed Care (MMC) or Health and Recovery Plan (HARP), and are NOT enrolled in Health Home.
MCOs in the NYC region will pay the IPA the enhanced care management funds for IPA Program Members in accordance with the directed payment and IPA-MCO contract terms. The IPA will select Network Partners and enter into an IPA Healthcare Participant contract that will detail the care management payment process and rates.
All interested Network Partners shall submit a detailed budget along with their Scope of Work in the Budget Template. The Budget Template requires interested Network Partners to provide, for all selected services, a service staffing model, anticipated patient volume and caseload assumptions (if applicable), and any other expenses related to program operations and administration. This budget will be considered as part of the proposal evaluation criteria. If the interested Network Partner is selected to join the network, the IPA will pay network participants on a monthly basis for services rendered.
Engagement & Navigation
The Engagement and Navigation (E&N) function requires a workforce that can physically meet patients where they are to engage them in care. Effective Engagement and Navigation activities connect individuals who have unpredictable, sporadic, low-yield health care interactions to teams who are better positioned to support their fundamental and long-term health and social service needs. Those preliminary interactions that take place as part of Engagement and Navigation often occur in a setting familiar to the patient, and such encounters are central to building trust and elucidating the member’s health and social care goals. This function of the care management model is intended to meet members where they are, address their basic needs, and work to build relationships and connections to a longitudinal care primary care and/or behavioral health provider. Engagement and Navigation services can be provided in the emergency department, on the inpatient wards, on the street, in shelter, and/or in another community setting. For more information, please review the IPA Healthcare Participant Procurement Manual (for healthcare providers and FHQCs) or the IPA Care Management Partner Procurement Manual (for CMAs and CBOs).
Core Care Management
The Core Care Management (CCM) function of the special populations care management program provides longitudinal, relationship-based care management supports and activities in a manner that is integrated with the member’s primary care and/or behavioral health care team and, ideally, is physically embedded at the point of care delivery to optimize communication and coordination across the entire care team. Members who are engaged in primary care or longitudinal behavioral health care will receive this function of the Special Populations Care Management model. NYC IPA Program Members will be moved into CCM from Engagement and Navigation after the IPA determines, through a combination of claims data and data from Care Management Participants or Providers, to be appropriately connected to primary care or longitudinal behavioral health care. Effective Core Care Management enables primary care and behavioral health providers to operate at the top of their license and provides the members with a comprehensive set of personalized wrap-around supports including health promotion and care coordination as defined and maintained in the member’s care plan. IPA Healthcare Participants must provide CCM and have the right of first refusal to provide CCM to their Managed Care attributed patients. For more information, please review the IPA Healthcare Participant Procurement Manual (for healthcare providers and FHQCs) or the IPA Care Management Partner Procurement Manual (for CMAs and CBOs).
Social Services
Rigorous evidence shows that factors beyond access to and quality of healthcare affect health outcomes and equity. Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Providing social services support is optional for all organizations under contract with the IPA. Social services eligible for funding under the IPA include: Housing Navigation, Medical Respite, Food and Nutrition, and Benefits Navigation. For more information, please review the IPA Healthcare Participant Procurement Manual (for healthcare providers and FHQCs) or the IPA Care Management Partner Procurement Manual (for CMAs and CBOs).