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SECTION I - OVERVIEW OF THE DEPARTMENT AND PROGRAMA.PURPOSE OF REQUEST FOR PROPOSALSThe State of Connecticut Department of Social ualifiedorganizations to implement and administer a Web-based PreAdmission Screening and Resident Review System (PASRR) forindividuals seeking admission to a Medicaid Certified Nursing Facilityand perform medical necessity determinations of nursing facility (NF)Level of Care (LOC) for residents of, or individuals seeking admissionto, a NF for whom Medicaid payment is being sought.The Department/DSS is seeking to contract with an organization thatdemonstrates the capability to perform the minimum requirementsidentified in the RFP and a willingness to extend beyond theseminimum requirements if necessary to maintain the integrity andconsistency of providing PASRR and LOC services. Organizations mustexhibit an understanding of the impact these service requirementshave on providers and recipients.B.OVERVIEW OF THE DEPARTMENT OF SOCIAL SERVICESThe Department of Social Services provides a broad range of servicesto older adults, persons with disabilities, families, and persons whoneed assistance in maintaining or achieving their full potential forself-direction, self-reliance, and independent living. It administersmore than ninety legislatively authorized programs and about onethird of the State budget. By statute, it is the State agency responsiblefor administering human service programs sponsored by Federallegislation including the Rehabilitation Act, the Food Stamp Act, theOlder Americans Act, and the Social Security Act. The Department ofSocial Services is also designated as a public housing agency foradministering the Section 8 Program under the Federal Housing Act.The Commissioner of Social Services heads the Department of SocialServices and there are Deputy Commissioners for Administration andPrograms. There is a Regional Administrator responsible for each ofthe three service regions. By statute, there is a Statewide AdvisoryCouncil to the Commissioner of Social Services and each region musthave a Regional Advisory Council.PASRR RFP 042009Page 4

The Department of Social Services administers most of its programs atoffices located throughout the State. Within the Department of SocialServices, the Bureau of Rehabilitation Services provides vocationalrehabilitation services for eligible persons with physical and mentaldisabilities throughout the State. For the other programs, services areavailable at offices located in the three geographic service regions,with central office support located in Hartford. In addition, manyservices funded by the Department of Social Services are availablethrough community-based agencies. The Department of Social Serviceshas out-stationed employees at participating hospitals and nursingfacilities to expedite Medicaid applications and funds Healthy Startsites, which can accept applications for Medicaid for pregnant womenand young children. Many of the services provided by the Departmentof Social Services are available via mail or telephone.There are three entities attached to the Department of Social Servicesfor administrative purposes only. They are the Commission on Deafand Hearing-impaired, the Board of Education and Services for theBlind, and the Child Day Care Council.C.OVERVIEW OF THE ALTERNATE CARE UNITThe Department’s Medical Care Administration Alternate Care Unit(ACU) administers the Connecticut Home Care Program for Elders(CHCPE), a comprehensive Medicaid Waiver program for elders whoqualify for home and community based services as an alternative toNursing Home placement. The CHCPE provides home and communitybases services to over 14,000 elders in Connecticut. The Unit alsomanages the PASRR process and completes medical necessitydeterminations for NF LOC.A number of factors in Connecticut throughout the years havecontributed to the need for increased monitoring of the psychiatricpopulations in NF. The Department’s current PASRR program ismaintained and operated within the ACU. The PASRR program isstaffed by a Medical Review Team of nurses responsible for processingLOC requests received from the Department’s regional offices. TheACU also staffs a Nursing Home Review team responsible for reviewingNF for compliance with PASRR, LOC requests, and NF reviews todetermine if the facility is at risk of becoming an Institution for MentalDisease (IMD).The ACU will retain authority for oversight and monitoring of theResultant Contractor’s PASSR and LOC tasks and operations.PASRR RFP 042009Page 5

D.OVERVIEW OF THE PROGRAMIntroduction - Pre-admission Screening and Resident Review (PASRR)described in 42 CFR 483 is a Federal requirement mandatingprocesses to identify evidence of Mental Illness (MI) or MentalRetardation (MR) or conditions related to mental retardation inindividuals seeking admission to or residing in Medicaid-CertifiedNursing Facilities (Level I). This Federal mandate was implemented forthe purpose of eliminating the practice of inappropriately placingindividuals with MI, MR and related conditions in Medicaid CertifiedNF. The PASRR process assists with determining whether theindividual being evaluated demonstrates evidence of MI, MR or relatedcondition, and if so, further evaluation is required (Level II). Ifevidence of MI/MR or related condition exists, further evaluationsmust be performed to determine whether the individual requires theLOC in a NF setting and whether the individual has a need for activetreatment or specialized services.NF are prohibited from admitting individuals with MI, MR or relatedconditions before the appropriate LOC is determined.CURRENT PASRR PROCESSCurrently the PASRR process is handled in-house by Department staffnurses.Level I Pre-Admission Screen – The Level I Pre-Admission Screen (PAS)is a brief Screening Tool to identify evidence of serious MI/ MR or arelated condition. Annually, the average number of Level I screensprocessed is 43,000. The Department reviews all Level I PAS forindividuals seeking admission to the NF to identify evidence of MI/ MRor a related condition.Individuals who appear to have MI/ MR orrelated condition must undergo a Level II Evaluation to determine theneed for NF LOC and/or other specialized services. A Level I PAS isconducted for all individuals who apply to a Medicaid-Certified NFregardless of payment source.Level II Evaluation – A Level II Evaluation is conducted when MI/MR orrelated condition is evidenced in an individual who has undergone aLevel I PAS, or a significant change of condition occurs to anindividual already identified as having MI and residing in a NF. ALevel II Evaluation may also be conducted when a diagnosis of MI is anew diagnosis on an individual residing in a NF.PASRR RFP 042009Page 6

All Level II Evaluations require a face-to-face evaluation to determine ifthe individual has MI or MR or related condition.MIThe Department currently allows acute care hospitals to completeLevel II Evaluations as well as the preliminary health Screening formedical necessity for NF placement on persons identified as havingserious MI.Department/DSS nurses are then responsible forreviewing the Level II Evaluations for completeness, accuracy, and anydisparities. Department nurses then validate the need for NF LOC forthe individual identified with MI and forward the information to acontractor of the State of Connecticut Department of Mental Healthand Addiction Services (DMHAS) for determination of risk (to self orothers) and the need for specialized services.The Department’s current PASRR process has resulted in a very rapidturnaround of positive screens. The Department anticipates that thetime needed to process Level II Evaluations will change significantlywhen hospital staff can no longer complete this service. The numberof Level II screens for mental illness annually averages 900-1000.Additionally, the Department/DSS ACU processes an average of 1700short-term placements for individuals with serious mental illness. Ofthose, approximately thirty five to forty percent stay beyond theallowable thirty days. The Bidder should calculate this into theirbudget projections as many individuals may require a full Level IIscreen. Approximately 200 changes in condition requiring a face-toface evaluation are completed annually. Approximately another 400Level II Evaluations are processed with dementia identified as theprimary diagnosis.The Department/DSS anticipates that someindividuals, perhaps as many as twenty-five percent might benefitfrom a more in depth clinical review to determine if dementia is trulythe primary diagnosis.MRIn Connecticut, persons identified as having MR and/or other relatedconditions requiring a Level II Evaluation have the Level II Evaluationcompleted by the State of Connecticut Department of DevelopmentalServices (DDS) (formerly the Department of Mental Retardation). Thatprocess will continue. The Resultant Contractor will need to develop acoordinated process with DDS to continue conducting Level IIEvaluations and determinations for persons identified with MR in theScreening process. The number of screens for persons with MR orother related conditions is approximately 400 annually. A LOCdetermination is made for those individuals identified as having MR orPASRR RFP 042009Page 7

related conditions. The State processes an average of 200 Level IIEvaluations per year for persons identified as having both MI and MR.LOCA health screen is conducted to determine if NF LOC is needed .Face-to-face assessment data and copies of the individual’s relevantmedical records data collected during the PASRR process must bereviewed and evaluated by a Physician. The Physician must make thefinal determination for NF LOC and must participate in theDepartment/DSS fair hearing process in cases of appeal, if requestedby the Department/DSS. Any potential denial of a LOC for a NFapplicant or resident requires face-to-face evaluation. All LOCdeterminations are based on criteria established by theDepartment/DSS.The Public Health Code in Connecticut states that patients shall beadmitted to a NF only after a Physician certifies that “the patientadmitted to a chronic and convalescent nursing home hasuncontrolled and/or unstable and/or chronic conditions requiringcontinuous skilled nursing services and/or nursing supervision or haschronic conditions requiring substantial assistance with personal care,on a daily basis; that a patient admitted to a rest home with nursingsupervision has controlled and/or stable chronic conditions whichrequire minimal skilled nursing services, nursing supervision, orassistance with personal care on a daily basis”.The Department is seeking to have the Resultant Contractor completeall LOC determinations for the Department, not only those linked tothe PASRR process, currently performed by the Department.The total number of LOC determinations required on an annual basisis anticipated to be approximately 7,000.PASRR RFP 042009Page 8

Policy Decisions - The Department/DSS retains final authority formaking policy decisions affecting implementation of Web-basedPASRR and LOC Determination. In addition, the Department/DSS shall:E. Monitor the Resultant Contractor’s performance and requestupdates, as appropriate, Respond to written requests for policy interpretations, Provide technical assistance to the Resultant Contractor, asneeded, Allow access to Department/DSS automated databases, asavailable and permitted, Allow access to management reports and case files, asappropriate, Provide a Program Manager, Hold regularly scheduled program meetings with the ResultantContractor, Provide a process for and facilitate open discussions with mendations for improvement, and Provide data as required by the Resultant Contractor to performthe functions of Web-based PASRR and LOC Determination.BIDDER QUALIFICATIONSQualified organizations must have a minimum of three (3) years ofexperience performing activities relating to PASRR and NF LOCdeterminations. Qualified organizations must also have a minimum ofthree (3) years experience with the development, application andmaintenance of a Web-based Computer System to accommodate therequirements as described in the RFP.The Resultant Contractor shall be available to conduct RFP definedactivities five (5) days per week Monday through Friday, with theexception of State-defined holidays, between the hours of 8:00 a.m.5:00 p.m. Clinical reviewers, as defined in the definition section of theRFP, who will be completing the face-to-face Level II Evaluations shallPASRR RFP 042009Page 9

also be available to complete the evaluations on a half day onSaturdays. The Department/DSS will not provide workspace for theResultant Contractor. The Resultant Contractor is not required to havean office in Connecticut.NOTE WELL: The bidder cannot be a NF or an entity that has adirect or indirect affiliation or relationship with a NF.In addition to the above noted minimum qualifications, TheDepartment is seeking to contract with an organization that exhibitsthe following:Flexibility to adapt to changes occurring due to Federal and Staterequirements;An understanding and awareness of Federal and State requirements toassure that the Department/DSS is in compliance with existing rulesand regulations; andProficiency in establishing a positive working relationship withConnecticut’s health care providers and governmental entities, and aresource for provider questions, technical assistance, training, andeducational needs.PASRR RFP 042009Page 10

SECTION II - OVERVIEW OF THE PROCUREMENT PROCESSA.ISSUING OFFICE AND CONTRACT ADMINISTRATIONThe Department/DSS is issuing the RFP through its Office of ContractAdministration - Procurement Unit. The Contract Administration Procurement Unit is the Issuing Office for the procurement and is theonly contact in the State of Connecticut for the procurement. Theintegrity of the procurement process is based in part on ensuring thatall potential and intended bidders be afforded the same informationand opportunities regarding the terms of the procurement. Therefore,it is incumbent on the Issuing Office to monitor, control, and releaseinformation pertaining to this procurement. Potential and intendedbidders are advised that they must refrain from contacting any otheroffice within the State of Connecticut or any other State employee withquestions or comments related to this procurement. Potential andintended bidders who contact others within the State of Connecticutwith questions or issues pertaining to this procurement may riskdisqualification from consideration. Decisions regarding suchdisqualification will be made by the Department of Social Services’Contract Administrator within the Issuing Office, after consultationwith the Office of the Commissioner. The contact information for theIssuing Office is:Marcia McDonoughState of Connecticut Department of Social ServicesContract Administration25 Sigourney StreetHartford, CT 06106Telephone: 860-424-5214 Fax: 860-424-4953E-mail: Marcia.McDonough@ct.govAll questions, comments, proposals, and other communications withthe Issuing Office regarding this RFP must be submitted in writingdirected to the Issuing Office and must be clearly identified aspertaining to theWeb-based Pre-Admission Screening & Resident Review System & Levelof Care Determination RFP:PASRR & LOC RFPAny material received that does not so state its RFP-related contentswill be opened as general mail.PASRR RFP 042009Page 11

B.PROCUREMENT SCHEDULEThe schedule for this procurement is as follows. The Department/DSSreserves the right to adjust this schedule, as needed.MilestonesRFP posting/releaseDeadline for mandatory Letter of Intent (nolater than 3:00 p.m. Eastern Standard Time)Deadline for the submission of writtenquestions (no later than 3:00 p.m. EasternStandard Time)Posting/release of the Department/DSS officialresponses to questions (Questions/AnswersAddenda)Proposals due (no later than 3:00 p.m. EasternStandard Time)Recommendations to CommissionersAnnouncement of awards for contractnegotiationContract negotiations end/contract executionPASRR & LOC commencesExpected End DateApril 20, 2009May 5, 2009May 5, 2009May 14, 2009June 18, 2009To be determinedTo be determinedTo be determinedOctober 1, 2009The dates for review of proposals and recommendation

1. ACU - Alternate Care Unit 2. Ad hoc reports - An unplanned report of concern or dealing with a . Masters prepared clinician that holds a current license to practice social work in the state of CT. . Programs. There is a Regional Administrator responsible for each of the three service regions. By statute, there is a Statewide Advisory .