Specifications include, but are not limited to: All rate study activities and reports, value-based payment (“VBP”) model including payfor-performance (“P4P”) activities, metrics and reports, and billing activities provided to the State of Hawaii, Department of Health Behavioral Health Services Administration (“DOH BHA”), Adult Mental Health Division (“AMHD”) shall be in accordance with this RFP, including its attachments and any addenda. The scope of work encompasses the following tasks and responsibilities: A. Rate Study Activities and Reports • Examine the AMHD levels of care and discuss them with AMHD and DOH-defined workgroup partners to ensure a general agreement regarding defined elements in each level of care and the associated payment rates for each level of care. • AMHD rate table with service descriptions, current and historical (as available), shall be provided to the vendor. AMHD’s Array of Services are attached to this RFP as Exhibit “A”. • Evaluate rates based on a vendor-proposed defined methodology for review and p r o j e c t e d rate-setting for the next three years. The methods should have been proven in similar rate study activities recently in a minimum of three (3) other states or regions of the country. • Identify at least three (3) up to five (5) states or regions with closely analogous levels of care, obtain agreement from a DOH-defined workgroup to use these comparisons, and develop levels of care crosswalk from other regions to Hawaii. • Determine any adjustments and augmentation to Medicaid and other insurer rates, including proposed rate and contracted provider model changes. • Make recommendations in the Rate Study report section on VBP model. In a VBP model, providers are incentivized to focus on the quality of care they provide rather than quantity of service deliver. This model is designed to encourage healthcare providers to work together to improve patient outcomes and reduce healthcare costs. VBP shall include comparisons of metrics used in other states or regions for P4P of services for mental health and substance use and providing a list with details on no less than ten (10) metrics for AMHD, including descriptions and citations as to the suggested rollout, monitoring, and use of these metrics for payment or payment incentives. This shall be sufficient to allow the DOH to revise or issue new contracts allowing VBP mechanisms to be further defined in the second phase of this scope of work.
