Specifications include, but are not limited to: A. The Contractor shall provide nursing and/or social work care coordination services to persons with inherited bleeding disorders and their families served at the pediatric comprehensive bleeding disorders program (Insert HTC Name here), in conjunction with the statewide Virginia Bleeding Disorders Program (VBDP). These services include, but are not limited to the following: 1. Coordination of care with community medical home 2. Support for home management of bleeding disorders, including training in home therapy 3. Planning for transition from child to adult oriented care a. A center nurse/social worker will be designated as the transition coordinator for patients’ ages 16 years or over. The center will collaborate with the adult Comprehensive Bleeding Disorders Program(s) to plan for and facilitate individual transition. 4. Outreach to women, minorities, and other underserved populations 5. Collaboration with community-based organizations for program planning and to facilitate family-to-family support 6. Provision of opportunities for families of persons with inherited bleeding disorders to be involved in program planning and management such as strategic planning, material development, program activities and performance measurement 7. Collaboration with local school districts to provide accommodations as necessary for school-aged children and their families 8. Assessment of health insurance coverage and collaboration with VBDP and the Department’s contractor for premium assistance to ensure continuity of coverage and participation in quarterly conference calls hosted by VBDP a. A center nurse/social worker with expertise in bleeding disorders will be identified to serve as the key contact for health insurance issues. The designated staff is responsible for working with the health insurance consultant staff at the VBDP as needed, to assure effective health insurance case management for patients at the center. This will include consultation on a case-by-case basis, as well as participating in conference calls and/or other forums initiated by the VBDP. b. The designated nurse/social worker will participate in training provided or recommended by the VBDP on current trends in health insurance, specifically related to the implementation of the Affordable Care Act and consumer choices for insurance coverage. 9. Provide access to language translation services 10. Promotion of quality assurance and policy development through key stakeholder input 11. Coordination of services with VBDP and other hemophilia treatment centers to ensure seamless system of care for clients and their families 12. Provide plan for access to care for uninsured or underinsured clients 13. Participate in community needs assessment activities as requested by VDH 14. Participate in VBDP committees as identified in the 2022 VBDP Needs Assessment Project. 15. Identify priority unmet HTC service need (as identified in the 2022 VBDP Needs Assessment Project) and provide or contract for the provision of services to the VBDP HTC patients and families B. The Contractor shall provide documents and client and performance data in the format required by VDH for state and federal reporting. The documents and data on the bleeding disorders program to be submitted to the Virginia Bleeding Disorders Program, and the schedule for submission are described below: 1. VBDP patient application and health insurance assessment, where indicated, using the forms provided by the VBDP, shall be provided at the time of request, and annually thereafter for premiums or pool of funds (POF). 2. Quarterly Report (Attachment D) shall be provided quarterly by the fifteenth of the month following the end of the quarter. 3. Region III Family Satisfaction Survey (Attachment E) shall be submitted every other year. 4. Clinical Manager Virginia State Report (Attachment F) shall be submitted quarterly and annually. C. The Contractor shall submit a program budget for the contract year with their proposal in response to this RFP, and thereafter no later than 90 days prior to the annual contract expiration date.
