RFP No. 0802151214 Revised
Name of the
Unit
Statutes and/or
Regulations -General
Governance
Description
Type of Staff
Minimum
Qualifications
Preferred
Qualifications
Required
Certifications
Location(S) of
Work
Reference
Location to the
Standard for the
Unit
Additional
Requirements
Staff Training
Requirements
Unit is
Complete When
Historical
Information
Issue Date August 18, 2008
Unit # 51
Hospital Quality Activities
Targeted Surveillance Team Activities
Public Health Law Article 28
(http://public.leginfo.state.ny.us/menugetf.cgi
10 NYCRR Part 405
http://www.health.state.ny.us/nysdoh/phforum/nycrr10.htm
Contractor staff will be responsible for statewide focused onsite surveillance activities
including key program or policy issues such as Emergency Department overcrowding
Physician
Survey Nurse
Social worker
Life Safety Code
Bachelor’s degree
Currently licensed in Currently registered Currently
registered in NYS; and 3 years of related
in NYS; Bachelors
NYS; Clinical
experience; Excellent
Clinical
degree or
experience in
telephone and written
background in
graduation from an
Emergency
communication skills;
acute care
approved nurse
Department
Basic computer skills;
Excellent
training program;
medicine and/or
Experience with
telephone and
Medical record and
Hospital
handling sensitive
written
QA experience;
administration;
confidential
Excellent telephone Clinical background communication
information.
skills; Basic
in acute care;
and written
Excellent telephone computer skills;
communication
Experience with
and written
skills; Basic
handling sensitive
communication
computer skills.
confidential
skills; Basic
information.
computer skills;
Experience
handling sensitive
confidential
information.
Master’s Degree
Medical record
Experience in acute
preferred
and QA
care settings
experience
No additional.
The team will be based out of Central Office, but will have statewide surveillance
assignments.
State Survey Manual.
See Attachment 51 of this RFP.
No additional.
No additional.
The first of the following events occurs:
(1) The facility is found to be in substantial compliance at the time of the survey; OR
(2) An SOD not requiring a POC is issued to the facility; OR
(3) An acceptable POC is received by the Department; OR
(4) Thirty days have passed since an SOD requiring a POC was issued and the facility
has not responded, or has failed to produce an acceptable POC.
If a revisit survey is required, this Unit is complete when the revisit survey is scheduled.
This is a new function. The Department estimates that approximately 100 surveys will
be completed each year, each taking approximately 90 hours, and 3 team members.
Department staff will provide supervision/support to the survey team. Approximately
90% will be hospital reviews and 10% D&TC Reviews.
101 Revised
RFP No. 0802151214 Revised
Issue Date August 18, 2008
101 Revised
RFP No. 0802151214 Revised
Issue Date August 18, 2008
Attachment E
Data Chart with Additional Information for Bidders
On Components 1 and 2
Unit #
Survey Type
Average
Total
Hours
Per
Survey
FTEs
Per
Survey
Total
Annual
Surveys
96.75
104.50
41.00
1.00
34.50
134.50
4.00
5.00
2.00
1.00
1.00
5.00
451
89
233
1058
817
16
22.50
1.00
38
25.00
1.00
1012
81.00
1.00
43
10.00
75.00
1.00
1.00
168
60
18.75
1.25
1.00
1.00
12
12
30.00
70.00
47.50
37.00
2.00
1.00
1.00
2.00
200
30
50
40
1.00
1.00
300
6.00
1.00
150
12.00
1.00
150
37.50
37.50
2.00
3.00
51
100
ADULT CARE FACILITIES
Facility Inspection
5
6
7
8
9
10
Complete Inspection of ACF, ALR, SNALR
Complete Inspection EALR
Partial Inspection
ACF Complaint Intake
Complaint Investigation
Pre-opening survey
Questionable Operations
11
Complaint Investigation
Death Investigations
12
Review or investigation
Facility Closure
13
Review and Monitor
ADULT DAY HEALTH CARE PROGRAMS
Survey
1
2
Desk Audit
Survey
Complaints
3
4
Complaint Investigation
Complaint Intake
HOME CARE SERVICES AGENCIES
Survey
14
16
16
15
LHCSA Routine Operational Survey
Policy & Procedure Manual Review Initial
Policy & Procedure Manual Review Follow-up
Pre-opening Survey
Complaints
17
18
18
Home Care and Hospice Complaint Intake
Home Care and Hospice Complaint Investigation Offsite
Home Care and Hospice Complaint Investigation Onsite
HOSPITALS
Survey
45
51
D&TC Survey
Targeted Surveillance Team
155 Revised
RFP No. 0802151214 Revised
Issue Date August 18, 2008
Average
Total
Hours
Per
Survey
FTEs
Per
Survey
Total
Annual
Surveys
2.50
30.00
8.00
1.00
1.00
1.00
3500
200
1500
5.00
6.00
1.00
1.00
2552
1164
240.50
35.50
121.75
4.75
1.00
3.00
15
15
2
22
24
Complaints
On-site Complaint Surveys
Complaint Intake and Investigation
Follow-up
36.00
18.00
1.00
1.00
10
25
23
Fed Revisit-Health
37.50
2.00
20
1.25
1.00
650
1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.00
200
6750
1250
750
220.25
121.75
14.25
4.50
4.50
4.50
642
31
63
18.75
107.25
1.25
2.00
2.00
1.00
3624
23
8800
Unit #
Survey Type
Complaints
46
47
48
Hospital & DTC Complaint Intake Program
Hospital & DTC Complaint Investigation / Survey
Hospital Complaint Resolution
Other
49
50
NYPORTS Reviews -- Central Office
NYPORTS Reviews -- Regional Offices
ICF/MRs
Re-Survey
19
20
21
Fed Standard
Life Safety Code Review
Extended Surveys (Additional Hrs)
OMR/DD Reviews
25
Off-site Survey Reviews
MEDICAID WAIVER PROGRAMS
Complaint Intake
26
Care At Home Waiver
27
Long Term Home Health Care Program
28
Nursing Home Transition & Diversion Waiver
29
Traumatic Brain Injury Waiver
NURSING HOMES
Re-Survey
30
Fed Standard
31
Extended Surveys (Additional Hrs)
32
33
34
41
Staggered Surveys (Premium Hrs)
Complaints
On-site Complaint Surveys
Partial Extended Surveys (Additional Hrs)
Complaint Intake
Off-site Investigations
35
Off-site Complaints
4.00
1.00
3000
36
Initial
Fed Initial Survey
Follow-up
85.25
2.00
2
13.25
11.25
4.50
2.00
680
355
37
38
Fed Revisit-Health
Fed Revisit Complaint
156 Revised
RFP No. 0802151214 Revised
Unit #
39
40
Issue Date August 18, 2008
Survey Type
State Monitoring Visits
Fed Revisit-Life Safety Code
Average
Total
Hours
Per
Survey
FTEs
Per
Survey
Total
Annual
Surveys
32.25
5.50
1.00
2.00
43
476
7.50
3.50
5.50
6.00
1.00
1.00
1.00
1.00
75
100
180
100
Other
42
42
43
44
Informal Dispute Resolution - Regional Offices
Informal Dispute Resolution - Central Office
Random Quality Assurance Audits
Enforcements
157 Revised
RFP No. 0802151214 Revised
Issue Date August 18, 2008
FORM TP-1-1
COMPONENT 1
DIRECT STAFFING SUMMARY
For each activity, list all position titles that will be utilized for that activity
including the percent of full time equivalent of each title and responsibilities and
duties of each title. You may use this Word document as a form or use additional
pages containing the information requested in a similar format, so long as
complete information is provided and that staff titles, FTEs and responsibilities
are associated with each of the individual Units listed.
ACTIVITY
UNIT #
TITLES
ADULT DAY
HEALTH CARE
PROGRAM
QUALITY
ACTIVITIES
Desk Audit
1
Survey
2
Complaint
Investigation
3
Complaint Intake
4
ADULT CARE
FACILITY
QUALITY
ACTIVITIES
Complete
Inspection – ACF,
ALR, SNALR
5
Complete
Inspection EALR
6
159 Revised
FTEs RESPONSIBILITIES/DUTIES
RFP No. 0802151214 Revised
ACTIVITY
UNIT #
Partial
Inspection,
including ALR,
EALR, SNALR
7
Complaint Intake,
including ALR,
EALR, SNALR,
ALP
8
Complaint
Investigation
Survey, including
ALR, EALR,
SNALR, ALP
9
Pre-opening
Survey, including
ALR and ALP
Questionable
Operations
(Q-Op)
Investigation
Issue Date August 18, 2008
TITLES
10
11
ACF Death
Investigations
12
Monitoring
Facility Closure
13
HOME CARE
SERVICES
AGENCY
QUALITY
ACTIVITIES
LHCSA Routine
Operational
Survey
14
LHCSA Preopening Survey
15
160 Revised
FTEs RESPONSIBILITIES/DUTIES
RFP No. 0802151214 Revised
ACTIVITY
UNIT #
LHCSA Policy
and Procedure
Manual Review
16
Home Care and
Hospice
Complaint Intake
17
Home Care
Complaint
Investigation
18
Issue Date August 18, 2008
TITLES
ICF/MR QUALITY
ACTIVITIES
ICF/MR Federal
Standard Survey
19
ICF/MR Life
Safety Code
Review
20
ICF/MR Extended
Survey
21
On-Site
Complaint
Survey
22
Federal Revisit –
Health
23
ICF/MR
Complaint Intake
and Investigation
24
ICF/DD
Certification
Review
25
161 Revised
FTEs RESPONSIBILITIES/DUTIES
RFP No. 0802151214 Revised
ACTIVITY
UNIT #
Issue Date August 18, 2008
TITLES
MEDICAID
WAIVER
RELATED
QUALITY
ACTIVITIES
Complaint Intake
Related to Care
At Home Waivers
26
Complaint Intake
Related to Long
Term Home
Health Care
Waiver Program
27
Complaint Intake
Related to
Nursing Home
Transition and
Diversion Waiver
28
Complaint Intake
Related to
Traumatic Brain
Injury Waiver
29
NURSING HOME
QUALITY
ACTIVITIES
Federal Standard
Survey
30
Extended Survey
31
Staggered
Survey
32
On-site
Complaint
Survey
33
162 Revised
FTEs RESPONSIBILITIES/DUTIES
RFP No. 0802151214 Revised
ACTIVITY
UNIT #
Partial Extended
Survey
34
Off-site
Complaint
Investigation
35
Federal Initial
Survey
36
Federal Revisit -Health
37
Federal Revisit Complaint
38
State Monitoring
Visit
39
Federal Revisit -Life Safety Code
40
Complaint Intake
41
Informal Dispute
Resolution
42
Random Quality
Assurance
Audits
43
Enforcements
44
Issue Date August 18, 2008
TITLES
163 Revised
FTEs RESPONSIBILITIES/DUTIES
SPECIAL
PRICING UNITS
Adult Day Health
Care Information
and Referral
Adult Care
Facility
Information and
Referral
Home Care
Information
Hotline
Medicaid Waiver
Information and
Referral
Nursing Home
Information and
Referral
1-Ea
1-Eb
1-Ec
1-Ed
1-Ee
163a Revised
RFP No. 0802151214 Revised
Issue Date August 18, 2008
REVISED BIDDERS’ CHECKLIST
;
Technical Proposal
Transmittal Letter
Subcontractor Letters of Intent, if any
Table of Contents
Executive Summary
Bidder’s Assurances
HIPAA and Medicaid Confidentiality Assurances
Statement of Understanding of Department’s Goals
and Objectives
Statement of Understanding Scope of Work
Bidder’s Technical Processes, Policies and
Procedures
Bidder’s Personnel Organization
Bidder’s Organization, Experience and Capability
Statement of Data Security Measures
Work Plan and Deliverable Schedule
Units Proposal
Quality Assurance Plan
Part of RFP
D.2.a
E.1.c
D.2.b
D.2.c
Attachment D
D.2.k; Attachments O and P
D.2.d
D.2.e
D.2.f
D.2.g; Attachment F, Forms
TP-1 and TP-2
D.2.f
D.2.i
D.2.f
D.2.f, D.2.h, C.3 or C.4,
Attachment 7, Form TP-4
D.2.j; Attachment 7, Form TP3
General Documentation & Vendor Responsibility
Curricula Vitae, Licenses and Certifications for Staff
Managing the Contract and Assigned to Contract
Functions
Audited Financial Statements 2005, 2006 and 2007
Vendor Responsibility Questionnaire, if applicable
Vendor Responsibility Attestation
Proof of Incorporation, Copy of Partnership
Agreement, DBA, or Authority to Do Business in
New York
NYS DTF Contractor Certification Forms
Any Other Relevant Financial Information
References
F.16; Attachments J and K
D.3
D.2.n
Cost Proposal
Bid Form
Price Schedule – Unit Bids
Additional Work Units and Hourly Fees
Consultant Services Form A
Attachment B
Attachment G, Form CP-1
Attachment G, Form CP-2
F.12; Attachment I
170 Revised
D.2.l
D.2.m
E.1.i, F.11
E.1.i, F.11, Attachment H
D.3
RFP No. 0802151214 Revised
Issue Date August 18, 2008
FORM CP-1-1
COMPONENT 1
ANNUAL PRICE SCHEDULE
PROJECTED
# OF
ANNUAL
SURVEYS
UNIT #
SURVEY TYPE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
16
17
Adult Day Health Care Program
Quality Activities
Desk Audit
Survey
Complaint Investigation
Complaint Intake
Adult Care Facility Quality
Activities
Complete Inspection – ACF,
ALR, SNALR
Complete Inspection EALR
Partial Inspection, including ALR,
EALR, SNALR
Complaint Intake, including ALR,
EALR, SNALR, ALP
Complaint Investigation Survey,
including ALR, EALR, SNALR,
ALP
Pre-opening Survey, including
ALR and ALP
Questionable Operations (Q-Op)
Investigation
ACF Death Investigations
Monitoring Facility Closure
Home Care Services Agency
Quality Activities
LHCSA Routine Operational
Survey
LHCSA Pre-opening Survey
LHCSA Policy and Procedure
Manual Review Initial
LHCSA Policy and Procedure
Manual Review Follow-up
Home Care and Hospice
Complaint Intake
172 Revised
168
60
12
12
451
89
233
1058
817
16
38
1012
43
200
40
30
50
300
UNIT
PRICE
COLUMN
“C”
RFP No. 0802151214 Revised
Issue Date August 18, 2008
PROJECTED
# OF
ANNUAL
SURVEYS
UNIT #
SURVEY TYPE
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
Home Care Complaint
Investigation
ICF/MR Quality Activities
ICF/MR Federal Standard Survey
ICF/MR Life Safety Code Review
ICF/MR Extended Survey
On-Site Complaint Survey
Federal Revisit – Health
ICF/MR Complaint Intake and
Investigation
ICF/DD Certification Review
Medicaid Waiver Related Quality
Activities
Complaint Intake Related to Care
At Home Waivers
Complaint Intake Related to Long
Term Home Health Care Waiver
Program
Complaint Intake Related to
Nursing Home Transition and
Diversion Waiver
Complaint Intake Related to
Traumatic Brain Injury Waiver
Nursing Home Quality Activities
Federal Standard Survey
Extended Survey
Staggered Survey
On-site Complaint Survey
Nursing Home Quality Activities
(con’t.)
Partial Extended Survey
Off-site Complaint Investigation
Federal Initial Survey
Federal Revisit -- Health
Federal Revisit - Complaint
State Monitoring Visit
Federal Revisit -- Life Safety
Code
Complaint Intake
Informal Dispute Resolution
173 Revised
300
15
15
2
10
20
25
650
200
6750
1250
750
642
31
63
3624
23
3000
2
680
355
43
476
8800
175
UNIT
PRICE
COLUMN
“C”
RFP No. 0802151214 Revised
Issue Date August 18, 2008
PROJECTED
# OF
ANNUAL
SURVEYS
UNIT #
SURVEY TYPE
43
44
Random Quality Assurance
Audits
Enforcements
TOTAL COLUMN C
174 Revised
180
100
UNIT
PRICE
COLUMN
“C”
RFP No. 0802151214 Revised
Issue Date August 18, 2008
FORM CP-1-2
COMPONENT 2
ANNUAL PRICE SCHEDULE
PROJECTED
# OF
ANNUAL
SURVEYS
UNIT #
SURVEY TYPE
45
46
47
48
49
50
51
Diagnostic and Treatment Center
Quality Activities
D&TC Survey
Hospital Quality Activities
Hospital and D&TC Complaint
Intake
Hospital and D&TC Complaint
Investigation / Survey
Hospital Complaint Resolution
NYPORTS Reviews – Central Office
NYPORTS Reviews – Regional
Offices
Targeted Surveillance Team
TOTAL COLUMN C
174 Revised
51
3500
200
1500
2552
1164
100
UNIT
PRICE
COLUMN
“C”
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