Scope of Work for Consultation Service Agreement

Transcription

1 Scope of Work for Consultation Service Agreement 1. Engagement. During the term of this Agreement Consultant hereby agrees to provide only such assistance/ consultative services for Los Angeles County Sheriff s Department (LASD) as may be requested by LASD, and its Officers, including, but not limited to: A. Assessment of LASD and Cerner requirements for set up of a billing infrastructure. B. Present LASD with a Cost-benefit analysis to set up a billing infrastructure. C. Review census and utilization data to estimate revenue potential. D. Review requirements for obtaining reimbursement from Medi-Cal and commercial plans and outline steps LASD and its providers would need to take to become eligible billers for pharmacy, physical, dental and behavioral health care services. E. Assess current compliance with requirements through site visits and direct observation, and identify gaps F. Will audit a sample of clinical encounters at each facility to determine how closely the reported information aligns with the needed components for automated billing. This audit will include consideration of the planned multi-encounter strategy to ensure it is in line with future billing strategies. G. Will gather intelligence on the contracts between Los Angeles Department of Health Services (LA DHS) and the California Department of Corrections (CA DOC) to determine what practices LASD can adapt for its own purposes of recouping Medi-Cal dollars. H. Estimate the cost to develop and maintain a billing infrastructure and integrate it into the Cerner EMR. Infrastructure includes building and incorporating a Charge Description Master (CDM) to establish the rates for billable services into the EMR. I. Estimate cost to contract with billing service, through Cerner Corp. J. Develop list of gaps in compliance and review with LASD staff. K. Revise list of gaps and develop strategies to address gaps. L. Review materials and assemble costs M. Present findings summarizing cost/benefit, requirements, gaps, and steps to achieve readiness to bill 2. Etent of Services. Consultant agrees to devote such time as required by LASD to fulfill the duties hereunder, with a projected completion within 90 days. Consultant agrees to perform such services to the best of their ability and in a diligent and conscientious manner and to devote the required time and energies to those duties called for hereunder during the Term of this Agreement. Consultant will report to LASD Medical Services Bureau Management. 3. Term. This agreement shall be for a term commencing as soon as possible due to scheduled deliverables related to the Cerner upgrade project.

2 PROJECT TIMELINE Eecute Agreement Interview LASD and Cerner staff for initial cost assessment, obtain census Review materials and assess revenue opportunities Gather and document requirements from commercial plans and Medi-Cal Perform site visits to three health care delivery facilities to evaluate compliance Gather inputs to assess costs/requirements of billing infrastructure Gather inputs to assess costs/requirements of billing service Develop list of gaps in compliance and review with LASD staff Revise list of gaps and develop strategies to address gaps Review materials and assemble costs Complete cost-benefit analysis Present findings summarizing cost/benefit, requirements, gaps, and steps to achieve readiness to bill Submit final report Month 1 Month 2 Month 3

3 4. Task and deliverables. Tasks and Deliverables 1. Task: Review census and utilization data to estimate revenue potential Deliverable: Provide LASD with report estimating potential revenue LASD could draw through insurers for each category of services. 2. Task: Review requirements for obtaining reimbursement from Medi-Cal and commercial plans Deliverable: Provide LASD with outline of steps LASD and its providers would need to take to become eligible billers for pharmacy, physical, dental, and behavioral health care services. 3. Task: Assess current compliance with requirements and identify gaps Deliverable: Provide LASD with summary report of site visit assessments including: delivery of clinical services; review of administrative practices; quality assurance program; utilization management program; HIPAA privacy and security safeguards; clinic review practices; provider credentialing practices. Included in this report will be a gap analysis and recommendations for strategies to address identified challenges to compliance requirements. 4. Task: Estimate the cost to develop and maintain a billing infrastructure and integrate it into the Cerner EMR Deliverable: Provide a detail of the costs associated with eternal billing, including both infrastructure and staff time. Infrastructure includes building and incorporating a Charge Description Master (CDM) to establish the rates for billable services into the EMR. 5. Task: Estimate cost to contract with Cerner s billing service Deliverable: Provide LASD with a needs analysis and recommendations for level of billing service needs through Cerner Rev works 6. Task: Construct a cost-benefit analysis Deliverable: Provide LASD with a comparison of potential revenue with the costs and challenges of building a comprehensive billing infrastructure and using a billing service. The cost of compliance with billing requirements as identified in the gap analysis will be incorporated. 7. Task: Present findings Deliverable: Findings will be presented to LASD Medical Services Eecutives and clinical leadership. In that discussion, best courses of action will be determined and strategized. 8. Task: Build a CDM Deliverable: Development and creation of a CDM that is compatible with the Cerner system, for LASD to utilize as part of billing infrastructure.

4 5. Bidder s Minimum Requirements. Each interested and qualified Bidder that can demonstrate its ability to successfully provide the required services outlined above, is invited to submit a bid, provided the Bidder meets the following requirements. A. Bidder must be available and able to immediately initiate work upon awarding of bid and complete scope of work within 3 months. B. Bidder must have a minimum of five (5) years of eperience advising prisons, jails, policy makers, and correctional health vendors in correctional health care operations, best practices, and emerging trends. At least one (1) of these must be within Los Angeles County, California. Bidder shall submit references to verify this eperience. C. Bidder must have five (5) years of eperience participating in practice redesign projects, developing models for tracking inmate health care costs, written and monitored contracts for inmate health services, auditing inmate health care from intake through release. Bidder shall submit references to verify this eperience. D. Bidder must have five (5) years of eperience working with Department of Corrections (DOCs) in California and Medicaid agencies to assist in collecting federal matching funds of inpatient hospital admissions. Bidder shall submit references to verify this eperience. E. Bidder must have five (5) years of eperience working with more than two (2) prisons and jails preparing them for health care reform. Bidder shall submit references to verify this eperience. F. Bidder must have a Project Manager with at least ten (10) years of eperience (a)working with a wide variety of public and private sector health care clients, (b)advising prisons, jails, policy makers, and correctional health vendors in correctional health care operations, best practices, and emerging trends, (c) leading analyses of all aspects of inmate health care, (d) participating in practice redesign projects, (e) developing models for tracking inmate health care costs, (f) writing and monitoring contracts for inmate health services, and (g) auditing inmate health care from intake through release. Bidder shall submit a resume to verify eperience of the proposed Project Manager if personnel are already identified for the position. If personnel are not yet identified for the position, then Bidder shall submit the corporate job description for such Project Manager. In such case, Bidder shall provide a resume of the proposed Project Manager prior to commencement of Work under the agreement, if so awarded. Proposed Project Manager s eperience must meet LASD approval. G. Bidder must have at least one qualified subject matter epert on staff, who has at least five (5) years of eperience in (a) healthcare cost containment, (b)medicare payment policy, (c) Medi-Cal managed care, health insurance echanges and health information technology, (d)health based policy development for the State of California, and (e) performing health information technology evaluations for large health systems. Bidder shall submit a resume to verify eperience of the proposed subject matter epert if personnel are already identified for the position. If personnel are not yet identified for the position, then Bidder shall submit the corporate job description for such subject matter

5 epert. In such case, Bidder shall provide a resume of the proposed subject matter epert prior to commencement of Work under the agreement, if so awarded. Proposed subject matter epert s eperience must meet LASD approval. H. Bidder must have at least one qualified subject matter epert on staff, who is a Board Certified, clinically active Physician with five (5) years of eperience in (a)senior-level management epertise in strategic planning, clinical operations, health information technology, quality systems community benefit programs, and regulatory compliance and client relations, (b) working with federally qualified health centers and accountable care organizations, (c) integration of medical, behavioral and social services using health information technology to deliver high quality, cost efficient care, (d)leading implementation projects including ambulatory electronic health records, (e) developing and implementing a health information echange strategy, (f) developing and implementing provider training and engagement programs, (g) working with a Sheriff s Department health care entity developing a fully functional EMR, (h) and is able and willing to serve as the project s clinical lead, advising on clinical requirements, opportunities to meet clinical objectives, and provider use of EMR s. Bidder shall submit a resume to verify eperience of the proposed Physician subject matter epert if personnel are already identified for the position. If personnel are not yet identified for the position, then Bidder shall submit the corporate job description for such Physician subject matter epert. In such case, Bidder shall provide a resume of the proposed Physician subject matter epert prior to commencement of Work under the agreement, if so awarded. Proposed clinical subject matter epert s eperience must meet LASD approval.