March 21, 2016 Spurwink Services 899 Riverside St Portland ME 04103 Joseph Dougher President and Chief Executive Officer 777 East Park Drive Harrisburg, Pa 17111 RE: Request for Proposal OHA-4140-16: Care Coordination, Integration & Evaluation Services Dear Mr. Dougher: The purpose of this letter is to provide a reference for APS Healthcare Quality Review, Inc. d/b/a KEPRO for its response to the above-referenced Request for Proposal. I am delighted to provide this reference, based on my knowledge of the organization’s performance here in Maine, where they have delivered utilization management services for Medicaid-reimbursed behavioral health services since 2007. My organization is a non-profit provider of behavioral health services, with 37 active homes serving children with behavioral health issues and another 18 providing community residences for adults. We also operate 6 special education schools, where we serve children ranging from 5 to 21 years of age. Our community to recovery and resilience for individuals is legendary over our 50 years of service, and our 1,000 employees encompass the spectrum of behavioral health professionals, including Qualified Mental Health Professionals. Our staff works with APS/KEPRO on a daily basis for prior authorization and concurrent review of behavioral health services. We appreciate the behavioral health expertise of APS/KEPRO’s staff and their professional commitment to a delivery system here in Maine that provides exemplary, person-centered care. Their contract performance has been exceptional, with timely reviews, a transparent process, and informative reports. The State of Oregon could not find an organization better prepared to assist with administration of the 1915(i) Waiver program. The program here in Maine was implemented on a timely basis and continues to provide value to the State through sound medical appropriateness decisions, informed consultation for care planning, and proactive communication and technical assistance. Spurwink applauds the State of Oregon’s initiative for independent, coordinated, and integrated administration of the 1915(i) waiver for home and community-based services, and recommends the selection of KEPRO as its Independent and Qualified Agent. If further information is needed, please do not hesitate to contact me. Sincerely, Eric Meyer, LCSW, MBA President & CEO HEALTH DMSIDN Protader Clinioal Support Kale Brown. Sweater EDD Summer St NE E44 Salem. OR, W301 FEW 15+ 3015 tic-ice: 1-300-52i-57i'2 FAX: 503-3i'3-5314 T11 Witwategongovl?HNhea?hplan To More It Delay Concern: My name is Trevor Douglass and 1 am writing this letter to provide a refere one for Keystone Peer Re?ew {hganiantion lne. The Dragon Health Authority's contract with APE l-ieaithcare, a subsidiary ul'liEFRUs includes the following scope ofworlt. The name of the project . Oregon Health Plan (UHF) Care Coordination Program The time period of the project 5: new contracts Contract work relevant to the OHP Care Coordination Program: Care services for tit-Hor?servioe Medicaid and t'ee-t'or-serviee dual-eligible clients {approximately 1 clients out of the total (ii-1P population of L: million}. Telephonic and program management staff in Tualatin. Oregon. Field?based sta?? throughout the state {in eastern Gorgon, the Dragon coast, the Willamette Valley, southern Oregon and the Portland metropolitan area}. Services include a 1+hour Nin'se Advice Triage Line, face-to-faee asstatements+ health education mailings, disease mintagement coaching for chronic conditions. case management for high-acuityI members. and cam coordination in collaboration with printer}r care physicians and other health and social service providers. Work with clients on medication reeoneilinrion. transition ol?eare, diets establishing primary care physicians, and making appointments. Collaboration with OHA and DHS programs to improve outcomes and reduce disparities within the fee- t'or-serviee populalinrt; and overcome outcome challenges for individual high-acuity members. Please feel free to contact me if you have an} additional questions. 1it?ou may reach me at 3703-9412315 or via email at tresordonclass?statconus . Sincerely. nw Trevor 3. Douglass, DIET, MPH Provider Clinical Support Manager Health Systems Division 500 Summer Si NE E44 Salem, DR 9? SDI LTH of VIRGINIA ?epn?m?u af.HeJr'mf Ajsilr?mce Service: SUI rL 1m in Her rum-n I'rmn MEN-ID February 2016 Tu Wham ll May Curr-tern: My name ls 5.6th Ba?uw. Prior Ammrizatian Supervisor and I am writins ?'lii DIEM-ride a reference [or Clhiu IEPRD, Inc? Ieysrune Peer Reulew Brzanlrarhn. Inc. Dur :un?ent mull?act wilh HEPHD indu?e-E the hlhwin: scape nfwk: Tl'rll name and Iddmofrhe elem aflrirairil Depenmenl ul' Madlcel Insurance Sena-lees mo Em Breed 5treet,5Lile 13m 51553299ng 23:19 The name um: pmietl Virginia Slate Medlcald Contract 11.: [?ne puma um: pmjecl lumen-mama? {mm 1 additional cumin-11pm} Briaf Desu'iplinl'l of the EDI-mart Wurlrf Elite Madl?id Contract IDMASI KEPllu Servlre amnmiminn cann-attnt nature: In? Medicaid, FAMIS Plus. Incl Fm? Fee-lerrsenrlte enrolls-es race-rue medium memw and ?premiere hullh we unalter- Ihruugh Ill! Service Prawn. purl-mm: and revamp-Eula: reviews, and delands. member and provider appeal [lads-Inns. Uiilzhg llill?l'liH'f uilerla ?nch as Milieu-an lrrlar?ual. along wl?r DMAS nilerla and trainees rules. HEPFHJ prawn-e: management for sew-ice: thar Include durable medial equipment IBMEL acute InpatlenL several hare-cl waivers. iElde?v and Disabled with Cemumr ?remen. Individual and Famlhr Developmental DH-nb-ililles, Ruined. Alm-inur's. Henn- Fella-Is the spulallmd Eire long Starr Hmpiul, Early Pe?odl: Sunni-lg and Trealment Program rehlhiitaliurr. home health, transplant, Incl surgical tern-Ices. Annually- ICEFHO almust 15m imlie reqmb. slanl'l'lunl anlhl'mmh Incl Millennium:- Saved mr 51m :l-ullarsln 2015 lime Has yielded 11:1 EDI long Term client held since mun Wm are ulilirln? 1119 mhsuhmls?u-n program . Implemented Ftules-d riuen clinical a utherlzatid n5 Ithe next ge neratin nf I Added new services within date: in gee r5. df flea-allele cc: ntra cting ad] ?ing with the {lemme nwea Ith's changing. prueaatn Understanding of Requirements Waremlhg?eqnlrements 1u?irginia Hequlremenn Management and lie-view r? Utiliza Management ?re-parting. an due [ltl?ze rai L'LLIiIding and Integration v" Large atakeitnlder green. te arn huilding and cempletecare record integratien HEELS Waiver Management t? HEELS. We iver Ma nagement F'rmlider anage-rnent and Cernrnunieatiun Prd't-ider Engagement and Communicatinn Integrated Technical-egg 5 Integrated Teams and Patient Eeurdinatien Integrate-cl Technuldgg Re pnrta?nnaletice v" pmtingf'hnaltrties HEPHD and DMAE merit were well as a tea rn. HEP pmvidea geed qua lite services, reperts are i'il'l'lEi'r' and accurate, staff rnemhe rs are camera the. knewledgea tile and helpful. KEPHCI i3 preactiee in appriaing DMAS uf a In; er isau ea that the',? feel weld inn part ith ntity. The-r are always willing tn attempt reselutlein e-f problems. indepe den rig er in can] uncticl 'n'i th DMAS- HEP ED is new FEE-pensive to the needs. of DMAE. They-- are flexible in meeting DMAE requests even when it ran uirea an irn me iate reapn nae. The-,r are we n; knewledgeable dl the centraet requirements and we rk lU adhere tc1 triage requirements. DMAS input when werlting With implementations and changes. has very staff. They are were res-pensive til the needs df the Medicaid members and provide ra as well as the gene ral public. Please- feel free to {entam me if gen have additienal que?l?ns. mint reach me at SIM-125- JETD er tria email at aenthiahariew @dlna ivirgirii?g?'a. Since rely, mew 5e nthla Earl-aw Pridr riaatidn Su pen-ism WEI HEALTH AND hum 1mm. ?3:331:wa J-uru awn. Gnu-d" I'm. m mm In: Eli-1m cm? 13. EDIE: Angeli Marin-n. Mum: wvum??emnmm and Infurmulun Eudjnm TECIW. {harem-E. Swill-WED Burr-1:. Mariam I ?l?l'l ?If: Etata lilr WEE Vi?lli. Hla?h and 5-:th Duh-a hem In ICED. Filth tn Harassment ?urhuhl'mrll hul'th sci-?u: Emu- Than. Thu tanlricl hr. Hui-d1 ?panda! Waugh Frail-Hunt 1-: migrant a brain of wmlniswllue SENHZH lulledhcul Minna-neat I- ?led and Dll?bl?l 'I'I'lh-Ier Traumrtk El?n Imunr 1mm: FAEHF: Blur-Hum Hulk: and Scull-f Sen-it: Hiallih Harm-I: Fragran- I thn?l [are ill ASCII {Humans Include but are nut knilld bu: UM, omit: pmidn' mule-m. l1l2 pru-ulder and qulh'llr ?argument acli'?lles. and anall'rlliand tama- II I: 111: preference-u! Dm?mutWEn-ul pe?nrma-nm in writing: ha Skill in ill'l'll?l'? 111m Etltn H'I'rumlng tn share an: an and with "1-55 ?f?iMit-i?n Fmiili' contartme-ai HUI-3554M Em Burem far Marital Elan-Inn State at Cailcrnie?l-leetm and Human Sereoee Agency BHCS Department of Health Care Services [nature H. DIRECTOR mm February 1e. acre To Whom tt Inlay Concern: My name 15 Flile Me?ebe. Fre?tdmleelon Screening and Heeldere Herlew Section Ghlet'. and I am writing the letter to ore-ride 3 reference for Keystone Peer He'r'lew Urgenlzalim, tnc. Healhcere. Brlel' Duerlp'?en of the Content Work Under the APS Heat-earn Gml?'y' Hen-leer HEPFID euheldlery. the CA PASRR pro-urem worlre the Stole ot Department of Health Care Seer-Iced. to provlde tederaly- mandaled FASHH Level II evaluallone I'er admlned to elrlled nurelr?rg taciltiee who have. or are to here, a eerloue meme! ereiuel'rore are pedenned by icEneed lece?to-tece the hdi'utdual. in thelr teem-g. women-henna Ind Program began Irene. wltl'r conoac?hJalIy-raqulred etel'l. Doubled cinlcal lleld ete? ln tlrat a months. Inherited 1,000+ referrals held during the traneilon from the prev-Ilene 1.nencler. These were cleared by May ol' 2015. while simultaneously resounding to reel- tine referrals. - Processed 29,433 re-l'errale in E?te. . Reduced etate'e Mmerormd time for these evaluatlone from no deyafeealmtlon. mder the prevloue vendor. tn 3.1 deyerevaherlm?enceedlng tederal mandate tor turnaround time. Eneured ooneietendy high quell-y wort-r product erllh moral clinical score or are In 2015. . 17M evaluations completed It remote end rurel GA arena in 2015. reel tree1e contact rne if you have anyr queetlone. ?r'ou may read: me e1 [9161 or via ?ll-all at erm? Sincerely. (5.5M Ftila McGabe. Section Chief melon lulu-m Haul: Sent-lee! [hell-en 1eoo Emlurl Am. HE em. El. Bo: Elf-Ha Beam. Gil [ere-r Fler.? tote] ?remen Ireemeernm: merreeceaw ME IE Defence Health Agency Buuleem'rl, Suit: SIDI Falls Church, Wt. 11El42 l2. EDIE 'l'c 'Whurn ll May C'unccm; I am w?tiae this tartar La pnwitlc a rc?a'cace t'cr Acquiairiana, lnc. My namc is. Dr. Frank lit: the Pleaae helnw scape 'l Quality ["mttr'ur't Ij I?l'rll'fl Centract A entry and Numhcr Defense Health 11ng Add real: lhcpartmcut ct?Uet?enac Ucfcnac Health Agency 1mm Fart Parkway Elli?J- Hl'l?l PUG Dr. Frank Deputy Clinical Quality ll] ??2495 Time Perla-cl April 1. 201 March 3:1, a l-?uneliana Pct-farmer] and Appwl?, SIandar-rl cf Cara, :?ipp-cala and Hearings, 'l'ranaiticln i'i?aialunL Program Bcac?ta Exteaalcn: Quality cl'lZLare Reviews: and SI udics Brief Deccripticn cl' Ihe Wurk Relevancy ta The purl-mac Mil-Ila contract is ta acciat Health Affairs: Defense Hcalth the MUCH-.1117, Regianal {lt'?cca the Designated l?l'avidcr Fragrant Cll'ficc the Eurasia-Africa, Paci?c and Latin Uf?cce, Dual Eligible Fiscal Contact Der-1m, and the Pharm acp and Ucnlal Fragrant Uf?cea, by pracidinp, with an independent impartial evalualiim cf car-c provided tc Military Health clcra {lull-IS?) L'Icne?clan'ec. reviews care prm-ided by Dccignatcrl Providers under the S-cn'icca l-arallgr' Health Plan ll-?J: Managcd Cal'c [Mil??aj aral TDEPIC ccrm'actcr. ln additlca, the will m'icw Pram 'l'ltllij?i?? canlraclcra {raga TRICHRE pharmacy and dental canLraelcr'i] lc satisfy Icauircmentc tc the quality cl'carc dclivcry umlcr the heaetiL. TQHC it; part cf' 'a Quality and llti-liearian Realm? Rceicw F'r?grdm, in accunlancc with {'c-dc cf 1"edc1'al llegulaticna 31 CPR In: Part Elm-c. lane-arm. TRIBARE FM MKEPRO Di ME n. II Her Cuntract Standards. me Apsjl I. EUll In March 3 Ell] I IS, KEPRU's performance L?s-seeded anrucl standards; table hem-w- - Standard ["th ?lau?ldilr'lls in Hcs'icw- sir-curacy ?ml Standard achieved {average user perm-LI] and Appeals: wi??n hunts ll'nc lac}: cufe nmehm?sm: Lu menltc-r limel inms. 0F mgr: review with a frequency 1? allnw Fur timely prugTeuunetlc change and ntmlity l?slanlain quality with llmeased vulumes. Maud I'cr accurate data [mu] I'cr quality metrics nl' fueusecl studies. 3-H days ExpediLe-d Reviews completed within 24 ll: 73 . Accuracy of Stud}- revicws at 11;: 95% level Hcllabllitjs el'res-iews must schicvc reliabilily level separate reviEwers Teeth Crested tracking Icpc? that limelinesa [31'an review access 11111ltipl-e review types: can a daily.r basis; extensive dashlJ??J'cl created In [Irmiclc rep-en cf multiple critics] anti-wines 14.1 include: res-ism prn'r'idcr cmcemcs. 2015 1 WW Tntme'ed 11'mell11ess crease review pnsceesing: idcnli?ccl Ilulu Entry Ilmely analysis Dl'prugmm activities In effect E'?lltl'a? requirements?llenli?' fnl' pm?r'ldm' ?Jchl processes are scalable and can adiusl 1n lulu: cm the addilinnal vulumc. munagemcn?r by scammed Bunch-ism}: Eta?'a?d daily meetings with review staff. Creulism teel ID ems ?scuscd stud}- date in cunjunc?eu with quality review of medical ream]. Eanl: F'ark Elriun PA HE Utililcuu'nn cf H11 internal? {reel-ring system that creeks the case ltlruLLgl-I cuch critical We 5: cf the process- Imprm-ml duh-1 dccumcnm?cn and I??Ji'elEL?mm'lL resulting in mere Gl'ga?ixull and precise dun-1 analysis :11" measures rel-Huiing. Page 2 [all WEPRD ?a IHIH hi [It Khl?l?l hes net. enh' met. but all I'ler?mnenee All deliverablee have heen either tirn ely er early. werln: pmdum hue been in all respects. Flees: feel free le eepteet me if you have any uddilitmul questions. ?I'eu may reaeh :nr: ul 3f] 319-2495 111' via email at F: ENHWIF1 T. Legal Medielne?iiek h-Ianegeunenl Clinieel Support Ulvieien. Waller Ema Mariel-rial Military Mmlieul Cenlm' Clinieal Support Divislnn, EH TA. 1iWelter Heed h'atlenel Meelieal Center BLDG IT, Suite 113 852101 Wit-3113161}! Amen?: MD Main: 31}! -Il I 9?1495 Enter. Farr: Drive. Her?abure. PA 1??-11a2?5ui TRIGAHE HGTIJNE: Page 3 ef 3