Consultative Medical Examinations for Local Social Services Districts

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Consultative Medical Examinations for Local Social Services Districts

Issue Date:
3/14/16, updated 6/9/16
Description:

NYS OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE, CENTER FOR EMPLOYMENT AND ECONOMIC SUPPORTS, EMPLOYMENT AND ADVANCEMENT SERVICES BUREAU, CONSULTATIVE MEDICAL EXAMINATIONS FOR LOCAL SOCIAL SERVICES DISTRICTS

This is an open ended Request for Qualifications. Qualified applicants may receive a contract to provide services beginning October 1, 2016 or after. Any resulting contract will have a termination date of September 30, 2021 unless modified by the New York State Office of Temporary and Disability Assistance (OTDA).

OTDA is responsible for establishing and monitoring State policy and local operations regarding employment services for public assistance and Supplemental Nutrition Assistance Program (SNAP) applicants and recipients. These efforts include a requirement under federal Temporary Assistance for Needy Families (TANF) regulations and State Social Services Law to maintain participation rates for individuals in receipt of public assistance supported by federal TANF or State/local funds claimed as TANF Maintenance of Effort (MOE) funds. State Law requires social services districts (districts) to meet a State participation rate for adult individuals without dependent children who are receiving Safety Net Assistance. Many applicants and recipients of Family Assistance, Safety Net Assistance, and Medicaid present with medical and/or psychological issues which may affect their ability to participate in employment or work preparation activities.

OTDA is seeking contractors to provide Consultative Medical Examinations (CE) for individuals referred by participating districts to obtain independent medical and psychiatric/psychological examinations and intelligence evaluations. The information provided from these examinations and any ancillary testing will be used to assist district staff in making a determination of employability under State guidelines. In addition, districts are looking for evaluations to determine if any of these individuals have disabilities severe enough to qualify them for Supplemental Security Income, Social Security Disability benefits or in some cases eligibility for Aid to Disabled reimbursement under Medicaid. OTDA is seeking providers throughout the State and is particularly interested in providers who are able to serve multiple districts. All examinations will be reimbursed by OTDA at up to the New York State Office of Temporary and Disability Assistance Division of Disability Determinations (DDD) fee schedule rate, which is subject to periodic revision. See attached list of current DDD reimbursement rates.

CE providers examine an individual referred by the district and perform or arrange for ancillary testing when authorized by the district. The most frequent types of testing include: X-rays, Resting and Exercise Treadmill EKG’s, Pulmonary Function Tests and Laboratory Tests. CE providers must perform or arrange for the ancillary testing and refer the laboratory work. CE providers will be required to complete and submit an examination report to the district, using forms provided by OTDA, within 10 business days of the examination. Examination reports provided to districts after 10 business days may be subject to a 5% penalty. CE providers will also be required to submit vouchers for payment to OTDA on a monthly basis along with a verifiable accounting of the examinations and testing performed for each client. The reported results of the physical/mental/intellectual examination, ancillary test(s), pertinent laboratory findings, diagnosis and prognosis must conform to accepted professional standards and practices in the medical field to be considered a complete and competent examination.

ELIGIBILITY/QUALIFICATIONS REQUIREMENTS/PREFERENCES: Applicants must clearly demonstrate capacity through past experience to perform the types of services specified in the application. Past experience may include NYS Division of Disability Determinations exams, employment exams, independent medical exams and direct patient care. The number and types of examinations will vary by district. OTDA cannot make any assurances on the number or type of examination or participation of any district. Applicants without substantial experience in providing the above-referenced examinations, credibility and/or who lack adequate financial resources will be rejected. A qualified applicant must be a single, fully responsible prime contractor and must identify any intended subcontractors and describe in detail their specified roles. The use of subcontractor(s) must be approved by OTDA. Applicants and their staff must be in full compliance with federal, State and local operating requirements, as appropriate, for providing a facility and services as specified in their application. Contractors providing medical consultative examination services must comply with those articles, which regulate the admission to and practice of the professions, including medicine. All such entities must be in compliance with the requirements of Education Law 6527 and in compliance with Article 15 of the New York State Business Corporation Law, or other corporate organization for physicians as authorized by law. All directors and officers of a corporation providing medical examinations (except those entities delineated in Education Law 6527) must be physicians. OTDA reserves the right to disqualify from consideration any organization that it believes is not capable of performing the services as specified in its application.

SUBCONTRACTING PROVISIONS: The applicant must be a single, fully responsible prime contractor and must identify any intended subcontractors and describe their specified roles in detail.

Information on a “Restricted Period” during which certain types of communications may only be made to an OTDA “Designated Agency Contact” along with additional information on the procurement lobbying requirements is available at The OGS Advisory Council on Procurement Lobbying (ACPL) website located at http://www.ogs.ny.gov/aboutOgs/regulations/defaultAdvisoryCouncil.html.

All inquiries concerning this procurement must be addressed to Susanne Haag, or her designee(s) at OTDA, via email (preferred) to susanne.haag@otda.ny.gov or via hard copy mail to:

Susanne Haag
Consultative Examination Contract
NYS Office of Temporary and Disability Assistance
40 North Pearl Street Floor 11D
Albany, NY 12243-0001

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