1 - SOW Oct 2020.pdf

COMMUNITY TREATMENT SERVICES

STATEMENT OF WORK

(SOW)

OCTOBER 2020

Statement of Work | Community Treatment Services | October 2020 ii

TABLE OF CONTENTS

CHAPTER ONE: INTRODUCTION

1.1 Purpose

CHAPTER TWO: BUREAU INFORMATION

2.1 The Bureau’s Commitment

2.2 Cognitive-Behavioral Therapy (CBT)

2.3 Institution Substance Use Services

2.4 Institution Mental Health Services

2.5 Institution Sex Offender Services

2.6 Institution Medication-Assisted Treatment (MAT)

2.7 Public Safety Concerns

CHAPTER THREE: GUIDING PRINCIPLES OF TREATMENT

3.1 Methods and Standards

3.2 Clinical Treatment Standards and Practices

3.3 Treatment Documentation

3.4 Caseloads

3.5 Treatment of Co-Occurring Disorders

3.6 Sex Offender Specific Treatment

3.7 Bureau Formulary for Mental Health Services

3.8 Monitoring Medications

3.9 Video Conferencing Guidelines for Telehealth

CHAPTER FOUR: SCOPE OF WORK

4.1 Treatment Referral and Authorization

4.2 Intake

4.3 Clinical Assessments, Evaluations, and Reports

4.4 Medication Services

4.5 Counseling Services

4.6 Clinical Treatment Plan

4.7 Monthly Progress Reports (MPRs)

4.8 Termination Reports

4.9 Clinical Interventions

4.10 Billing

4.11 Transportation

4.12 Summary of Contract Line Item Pricing

4.13 Deduction and Reimbursements

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CHAPTER FIVE: STAFFING

5.1 Staffing

5.2 Key Personnel

5.3 Clinical Experience

5.4 Contractor Licensure

5.5 Background Information

5.6 Critical Vacancies

5.7 Subcontracting

5.8 Language Services

CHAPTER SIX: STAFF TRAINING REQUIREMENTS

6.1 Staff Training Requirements

6.2 Standards of Conduct

6.3 Drug Free Workplace

6.4 Sexual Abuse Information

CHAPTER SEVEN: ADMINISTRATION

7.1 Facility Requirements

7.2 Accountability

7.3 E-Mail

7.4 Facility Licensure/Certification

7.5 File Maintenance

7.6 HIPAA

7.7 Records Retention

CHAPTER EIGHT: CONTRACT AND CONTRACT MONITORING

8.1 Modifications

8.2 Deviations

8.3 Monitoring Activities

LIST OF ATTACHMENTS

Stages of Change ................................................................................................................... A-1 Eight Criminal Thinking Patterns ........................................................................................... A-3 Eight Attitudes of Change ....................................................................................................... A-4 Five Rules of Rational Thinking ............................................................................................. A-5 Criminal Thinking Patterns ..................................................................................................... A-5 Rational Thinking Errors ........................................................................................................ A-6 Rational Self-Analysis ............................................................................................................ A-8 Rational Self-Analysis Example ............................................................................................. A-9

Monitoring Check Sheet ............................................................................................................ B

CTS Training Record ................................................................................................................. C

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CHAPTER ONE: INTRODUCTION

1 Intro

1.1 PURPOSE. The purpose of this Community Treatment Services (CTS) Statement of

Work (SOW) is to outline the government's technical requirements for Contractors who provide substance use disorder, to include medication-assisted treatment (MAT), mental health, and/or sex offender treatment services to inmates in the custody of the Bureau of Prisons (Bureau), residing in a Residential Reentry Center (RRC), on Home Confinement (HC), or on Federal Location Monitoring (FLM).

1.1.1 Scope. The scope includes community substance use disorder, MAT, mental health, psychiatric, and sex offender treatment services for Bureau inmates in the United States and territories.

1.1.2 All services and programs will comply with the SOW; the U.S. Constitution; all applicable federal, state and local laws and regulations; applicable Presidential Executive Orders (E.O.); all applicable case law; and court orders. Should a conflict exist between any of the aforementioned standards, the most stringent will apply. When a conflict exists, and a conclusion cannot be made as to which standard is more stringent, the Bureau will determine the appropriate standard. The Bureau reserves the right to issue interim guidance that supersedes policy and/or aforementioned standards. The Contractor will comply with and implement any applicable changes to Bureau policy, Department of Justice (DOJ) regulation, Congressional mandate, federal law or Presidential Executive Orders.

1.1.3 The Bureau reserves the right to enter into negotiations with the Contractor to change the conditions or procedures in this SOW and the contract.

1.1.4 The Bureau reserves the right to conduct announced and unannounced inspections by various staff of any part of the Contractor’s operation at any time and method deemed reasonable by the Bureau to assess contract performance and compliance. The Bureau, or other appropriate agency, may investigate any incident pertaining to the performance of this contract. The Contractor must comply and cooperate with the Bureau, or other appropriate agency, on all investigations, inspections, and inquiries.

1.1.5 The Contractor will submit any request for contract modifications through the Federal

Acquisition Certification Contracting Officer’s Representative (FAC COR) for evaluation.

Only the Bureau’s Contract Officer (CO) may approve contract modifications. Contract modifications must be in the best interest of the Government.

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CHAPTER TWO: BUREAU INFORMATION

2 Treatment Programs

2.1 THE BUREAU’S COMMITMENT. The Bureau is committed to providing high-quality, evidence-based programs to all inmates in need of services. Bureau Psychology Treatment Programs (PTPs) are based on the most recent research and evidence-based practices, ensuring effective treatment programs. These evidence-based treatment practices lead to:

• reduction of misconduct;

• reduction of mental illness symptoms and behavioral disorders;

• reduction of substance use, relapse, and recidivism;

• reduction of future sexual offending;

• increase the level of the individual’s stake in societal norms; and

• increase the likelihood of treatment success and the public’s health and safety.

2.2 COGNITIVE-BEHAVIORAL THERAPY (CBT). The Bureau uses CBT as its theoretical model because of its proven effectiveness in the criminal justice setting.

Empirical support for CBT’s effectiveness is noted in the treatment of substance use disorder, mental illness, and criminal thinking patterns. CBT emphasizes the learning and practice of skills associated with improved mental health and adaptive, pro-social, behavior. Therefore, inmates who participate in CBT and related interventions are better able to achieve goals the Bureau has for inmates, including responsibility, self-awareness, and independence.

According to the CBT model, a person’s feelings and behaviors are influenced by their perceptions and core beliefs. By helping inmates perceive events objectively and challenging irrational beliefs, they may become more successful in achieving pro-social goals.

CBT combines different treatment targets and specific conforming behaviors, focusing on an inmate’s:

• core beliefs;

• intermediate beliefs;

• current situation; and

• automatic thoughts, and the effects these thoughts and beliefs have on one’s emotional, behavioral, and psychological wellbeing.

2.2.1 CBT Treatment Protocols. While CBT is the primary treatment modality, other treatment protocols may be used in addition to CBT. These program additions must be CBT-based or compatible with CBT, and meet the goals of the treatment program (e.g., Motivational Interviewing, Rational Emotive Behavior Therapy, Mindfulness Based Cognitive Therapy, and Dialectical Behavior Therapy).

2.2.2 Self-Help Programs. Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Rational Recovery (RR) are often powerful and important interventions in an individual’s recovery, but they are not substitutes for CTS. Self-help programs cannot be conducted

Community Treatment Services | Statement of Work | October 2020 3 during treatment. Clients should not be mandated by the provider to attend these programs, nor should this be noted as a treatment goal on the treatment plan.

2.3 INSTITUTION SUBSTANCE USE DISORDER SERVICES. The Bureau operates a structured, multi-component substance use disorder treatment protocol to identify individuals in need of treatment upon entry and throughout their incarceration. The primary substance use disorder programs are the residential and non-residential drug abuse programs.

2.3.1 Residential Drug Abuse Program (RDAP). RDAP operates as a Modified Therapeutic Community (MTC). The community is the catalyst for change and focuses on the inmate as a whole person with overall lifestyle change needs, not simply abstinence from drug use.

RDAP encourages participants to examine their personal behavior to help them become more pro-social and to engage in "right living"—considered to be based on honesty, responsibility, hard work, and willingness to learn. RDAP emphasizes social learning and mutual self-help. Aid to others, consistent with emotional support and peer feedback is seen as an integral part of self-change. As participants progress through the phases of the program, they assume greater personal and social responsibilities in the community. It is expected that program participants take on leadership and mentoring roles within the MTC.

Progress in treatment is based on the inmate’s ability to demonstrate comprehension and internalization of treatment concepts by behaviorally observable actions to change his or her maladaptive and unhealthy behaviors.

2.3.2 Non-Residential Drug Abuse Program (NR-DAP). The NR-DAP is a flexible non-unit based, general population, psychoeducational-therapeutic group designed for treatment of inmates with self-reported substance use disorders. NR-DAP is presented through scheduled and time limited therapeutic group sessions. The journalized program is designed to meet the specific individualized treatment needs of the inmates, generally challenging their core beliefs, their most fundamental (negative and unhelpful) ideas about themselves, others, and/or their world views within the backdrop of their individual substance use. The focus of NR-DAP treatment is to improve an inmate's current functioning as well as to alleviate symptoms that may significantly interfere with their post-release functioning.

2.3.3 CTS Substance Use Disorder Referrals: RDAP inmates are required to participate in CTS as their final phase of treatment. Inmates who have not completed RDAP may be referred for treatment if they meet one or more of the following criteria:

• completed the NRDAP;

• completed a PTP and have a verifiable substance use disorder;

• volunteered for treatment and have a verifiable substance use disorder; or

• found guilty of, or admitted to, using drugs/alcohol while in the RRC and/or HC, or

FLM.

2.4 INSTITUTION MENTAL HEALTH SERVICES. Mental health recovery refers to the process by which people are able to live, work, learn, and participate fully in their communities. For some individuals, recovery is the ability to live a fulfilling and

Community Treatment Services | Statement of Work | October 2020 4 productive life despite a disability, while for others, recovery implies the reduction or complete remission of symptoms.

The components of mental health recovery are: self-direction, individualized and person-centered care, empowerment, holistic treatment, non-linear progression, strengths-based focus, peer support, respect, responsibility, and hope.

2.4.1 Mental Health Treatment Programs. Mental Health Treatment Programs are a series of programs dedicated to management and treatment of the Bureau’s seriously mentally ill and behaviorally disordered inmates. Current Mental Health Treatment Programs include:

• The Habilitation Program. The Habilitation Program targets high security, low functioning inmates who cannot successfully adapt to a penitentiary environment, but who may have the ability to function well at medium security level institutions.

• The Skills Program. The Skills Program is designed for inmates with significant cognitive limitations and psychological difficulties that create adaptive problems in prison and in the community.

• The Axis II Program. The Axis II Program targets inmates with severe personality disorders, typically Borderline Personality Disorder, who have a history of behavioral problems in the institution and who are amenable to treatment.

• Mental Health Treatment Units. Mental Health Treatment Units, including Step- Down Units, provide an intermediate level of mental health care for seriously mentally ill inmates. Typically, Mental Health Treatment Units are located in Care Level 3 institutions. Step-Down Units provide intensive treatment for inmates releasing from psychiatric hospitalization and may also function as Step-Up Units to intervene before an inmate requires hospitalization.

2.4.2 Bureau of Prisons Special Programs. The Bureau utilizes Evidenced Based Practices and interventions for diverse populations to include: transgender inmate care, inmates with disabilities, female offenders, and veteran services.

2.4.3 Mental Health Care Levels. Mental health care is generally guided by the level of need assigned to the inmate following a clinical assessment.

• CARE1-MH: No Significant Mental Health Care. The inmate shows no significant level of functional impairment associated with a mental illness and demonstrates no need for regular mental health interventions by psychologists. No history of serious functional impairment due to mental illness or, if a history of mental illness is present, the inmate has consistently demonstrated appropriate help-seeking behaviors in response to any reemergence of symptoms.

• CARE2-MH: Routine Outpatient Mental Health Care or Crisis-Oriented Mental

Health Care. The inmate has a mental illness requiring routine outpatient mental

Community Treatment Services | Statement of Work | October 2020 5 health care on an ongoing basis (monthly); and/or brief, crisis-oriented mental health care of significant intensity (e.g., placement on suicide watch or behavioral observation status).

• CARE3-MH: Enhanced Outpatient Mental Health Care or Residential Mental

Health Care. The inmate has a mental illness requiring enhanced outpatient mental health care (i.e., weekly mental health interventions); or residential mental health care (i.e., placement in a residential Psychology Treatment Program).

• CARE4-MH: Inpatient Psychiatric Care. The inmate requires acute care in a psychiatric hospital due to significant disability. The inmate cannot function in the general population in a CARE3-MH environment.

2.4.4 CTS Mental Health Referrals. CTS staff review all inmates for mental health services prior to community placement. All inmates assessed to have psychiatric or psychological needs are referred for community assessment and treatment. If an inmate has not been referred for treatment, and concerns arise, the Residential Reentry Management Branch (RRMB) or the local Residential Reentry Center (RRC), can initiate a referral in writing to the local CTS office.

2.5 INSTITUTION SEX OFFENDER SERVICES. The Bureau offers treatment, management, and psycho-educational opportunities for inmates with a history of sexual offenses. This is done through a stratified treatment model where volunteers are referred to one of the following programs. Programs are designed to match the delivery of treatment services to the unique characteristics of the offender (learning style, intelligence level, etc.).

2.5.1 Sex Offender Management Program (SOMP). SOMP is a multi-component program that includes treatment (SOTP-R or SOTP-NR), risk assessment services, and specialized correctional management.

Inmates who engage in conduct relevant to their history of sexual offending while incarcerated (e.g., offenders who collect pictures of children), may be referred to a SOMP where a Correctional Management Plan (CMP) is implemented. Sex offender treatment through CTS is the final component of SOMP. This allows inmates to build on the treatment received in the institution and to incorporate those philosophies into daily living in the community.

2.5.2 Sex Offender Treatment Program-Residential (SOTP-R). SOTP-R is a high-intensity program designed for high-risk sexual offenders. It is a unit-based program with a cognitive-behavioral emphasis. The co-housing of SOTP-R participants permits the implementation of a modified therapeutic community. This model has been proven effective in reducing inmate recidivism. A modified therapeutic community in a prison setting emphasizes pro-social values and behaviors that are needed in the outside community.

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2.5.3 Sex Offender Treatment Program-Non-Residential (SOTP-NR). SOTP-NR is a moderate intensity program designed for low-to-moderate risk sexual offenders. It shares the SOTP-R’s treatment philosophy and program materials, but lacks the frequency of treatment groups and the program duration of the SOTP-R. In addition, because SOTP- NR participants reside in the general population, there is not a modified therapeutic community setting.

2.5.4 CTS Sex Offender Referrals. SOTP inmates will ordinarily be referred to community treatment providers with clinical documentation related to their criminal histories. This may include a summary of their in-prison treatment experiences, including a DSM diagnosis, and recommendations from Bureau clinicians.

An individual with a documented sex offense history or diagnosis who did not participate in SOTP may also volunteer to participate in CTS while residing at an RRC. All cases must meet the following eligibility criteria in order to participate:

• documentation to verify the specific sex offense, or history; and

• sex offender diagnosis or significant clinical record based on DSM criteria; or

• a moderate or higher static risk level based on an assessment of the offense history and other relevant factors.

2.6 INSTITUTION MEDICATION-ASSISTED TREATMENT (MAT). MAT is the use of medications, in combination with counseling and behavioral therapies, for the treatment of substance use disorders, including opioid addiction. MAT operates to stabilize brain chemistry, block the euphoric effects of opioids, relieve physiological cravings, and stabilize body functions without the negative effects of the short-acting drugs of abuse.

2.6.1 Institution MAT Participants. The Bureau offers MAT to inmates while incarcerated and during their community placement. Providing MAT during the high-risk re-entry period is particularly important as it enhances the ability to resist opioid-seeking behaviors while in the community. To address the increased risk of recidivism and relapse for inmates with a history of opioid use disorder, MAT is available on a voluntary basis and treatment may be declined at any time. Inmates are screened and evaluated by psychology and health services departments, and if they wish to participate, receive a medication regimen and participate in counseling.

2.6.2 CTS MAT Referrals. Inmates who are active in MAT while incarcerated are referred by CTS to continue while in the community. Additionally, any inmate who is evaluated by a qualified practitioner in the community and recommended for MAT will be authorized by CTS for all necessary treatment.

2.7 PUBLIC SAFETY CONCERNS. The Bureau will inform providers of any public safety concerns and prior criminal history during the referral process. The below categories will be indicated when applicable:

• High Security Level: Inmates who transfer to the community in a high security status will be identified to provide the Contractor the ability to exercise appropriate security

Community Treatment Services | Statement of Work | October 2020 7 precautions. “High” is the Bureau’s highest security level as assigned by a point system for various criteria and indicators.

• Mental Health Care Level 3 or 4: Inmates who transfer to the community with a mental health care level of 3 or 4 (defined in 2.4.3 above) will be identified so the provider may exercise appropriate precautions and allocate necessary resources.

• Disruptive Group: This public safety factor is assigned to an inmate if the Presentence Investigation Report (PSIR) or other official documentation identifies the inmate as a member of a disruptive group (gang or organization). Bureau investigators validate the information is true prior to assignment of the code.

• Greatest Severity Offense: This public safety factor is assigned to male inmates whose current offense is considered by the Bureau to be among the most grievous.

• Sex Offender: This public safety factor is assigned to inmates if the PSIR or other official documentation clearly indicates that sexual offenses, or attempted sexual offenses, occurred (current or historical) regardless of conviction.

• Violent Behavior: This public safety factor is assigned only to female inmates whose current offense or history involves two (2) convictions for serious incidents of violence in the last five (5) years. Incidents while confined are also considered.

CHAPTER THREE: GUIDING PRINCIPLES OF TREATMENT

3 Guiding Principles

3.1 METHODS AND STANDARDS. Guiding principles refer to methods and standards for providing clinical services to inmates. They are based on clinical consensus of the most effective evidence-based practices available.

3.1.1 Clinical Elements. The Bureau has found that treatment programs with the most successful outcomes apply the following clinical elements:

• diagnose each client through an established assessment diagnostic process;

• develop individualized treatment plans together with each client;

• target criminogenic needs, such as antisocial attitudes and beliefs, to reduce the likelihood of misconduct and recidivism;

• promote activities that have a therapeutic impact (examples include: promoting peer feedback, improving negative attitudes through activities such as attitude checks, encouraging peers to assist each other in meeting goals, etc.);

• maintain knowledge of treatment progress and commitment of clients, and discuss with supervisors, peers, and stakeholders; and

• provide clinical supervision to necessary clinicians (supervision should include direct observation of treatment).

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3.2 CLINICAL TREATMENT STANDARDS AND PRACTICES. Expectations for treatment services include elements of the following standards.

3.2.1 Treatment Services. All treatment services must be provided face-to-face, other than pre-approved telehealth or remote communication sessions. All services require in-person clinical interactions between the client and an appropriately licensed and Bureau-approved staff member.

3.2.2 Clinician Engagement. Clinicians are expected to be actively engaged in all therapeutic sessions without distractions, to include phone calls, computer work, or paperwork.

3.2.3 Frequency of Sessions. The frequency of treatment shall be individualized based upon client need. Generally, clinicians will meet with clients weekly, and not require the client to attend treatment more than twice per week to reduce the negative impact on employment, family integration, and other necessary requirements for reentry to the community.

Deviations from weekly treatment must be justified in the monthly progress report and/or treatment plan. The FAC COR reserves the right to adjust the frequency and quantity of treatment as deemed necessary by the Bureau.

3.2.4 Standard Session Length. Ordinarily, individual and family counseling sessions should be two (2) units in length. Group counseling sessions should ordinarily be three (3) units in length. Deviations above or below these standard session lengths require prior authorization from the FAC COR or written explanation after the session has completed.

Those written explanations for session length should not be standard practice, but due to significant issues presented during the session.

3.2.5 Session Breaks. Standardized session breaks for all participants are not authorized during treatment. Brief individual breaks for medical issues or immediate concerns may be granted by the clinician. The individual break does not require the person to sign in and out of the session, as this is a nominal pause in treatment.

3.2.6 Schedules. The Contractor must accommodate various client work schedules. The Contractor shall offer flexible and accessible treatment schedules. Ordinarily, this would include morning, evening, and weekend appointments, when practicable.

3.2.7 Assessments. Ordinarily, clinicians must conduct an assessment on all clients prior to initiating treatment. The assessment will include a diagnosis as a basis for treatment. The documents provided by the Bureau are to assist with the assessment process, but do not negate the need for an assessment to be conducted prior to initiating treatment.

3.2.8 Individual Counseling. Sessions should focus on relevant treatment issues and expectations. The clinician should verify that progress is being made toward goals, and reassess the relevance of current treatment goals. When applicable, the clinician should explore topics discussed in the group sessions or psychiatric services.

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3.2.9 Group Counseling. All group sessions shall be process-oriented in nature with a cognitive-behavioral approach to address underlying clinical issues. Sessions should focus on changing learned behavior by targeting thinking patterns, beliefs, and perceptions.

Clinicians are encouraged to focus on the here-and-now and direct discussion toward individual treatment progress, treatment activities, interpersonal dynamics, and be solution-focused. If didactic counseling is used, it must be limited in length. The practice of completing worksheets during the session is discouraged. However, clinically relevant homework is encouraged and can be reviewed and discussed during group sessions as a way to increase participation among members. If initial group check-ins are used, they should be limited in length and utilized to begin appropriate discussion and encourage feedback from the group.

3.2.10 Group Size Limitations. Ordinarily, group sessions shall not exceed twelve (12) clients for substance use disorder and sex offender groups and eight (8) clients for mental health groups. The Contractor must obtain authorization from the FAC COR for a temporary increase in group size.

3.2.11 Group Composition. Ordinarily, all group sessions must be comprised of Bureau referred clients. If the Contractor wishes to mix non-Bureau referred clients in a group forum, it must be based upon sound clinical judgement, and preauthorized by the FAC COR.

3.2.12 AV Media. The Contractor shall not use videos or other types of audiovisual media during the course of treatment, as this is strictly prohibited.

3.2.13 Agency Rules. The Contractor will establish written rules, regulations, and expectations for clients. Each client must be informed about the rules for individual and group sessions, attendance, and expectations of participation. Contractors may choose to have group members recite these rules at the beginning of group sessions as a reminder to all participants, but no more than five (5) minutes should be devoted to this.

3.2.14 Cell Phones. The Contractor shall have a policy in place to limit the disruption of cell phones by clients while at the facility and during all treatment sessions. Neither the contractor, nor the participants should answer, receive, or text during group sessions. It is encouraged that all cell phones be powered off during treatment to reduce distractions. Cell phones are a primary means for RRC inmate accountability. Be advised that some locations use automated and randomized systems to call inmates and the systems may continue to call if the call is not acknowledged by the inmate. Therefore, it is especially important for the RRC to be informed of the treatment schedule of every client.

3.2.15 Disruptive Behavior. Contractors are required to inform the FAC COR of client behavior that becomes disruptive to the treatment process. Significant actions must be reported to the FAC COR on the Behavior Notification form in accordance with section “4.9 Clinical Interventions”. However, more routine nuisance actions that do not require immediate notification, but create an environment non-conducive to treatment, must be reported in the Monthly Progress Reports, at a minimum, or discussed with the FAC COR.

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3.2.16 Food, Beverage, and Items of Value. The Contractor will not offer, give, or receive any gift, favor, article, or item of value, to include consumable goods, to clients, former Bureau clients, family members, or anyone associated with or related to the client. Money may not be collected for any reason.

3.2.17 Immediate Crisis Intervention Plan. The Contractor will maintain an emergency crisis intervention plan. It will include specific local information to include an emergency psychiatric care facility, a local hospital with a crisis unit, or other emergency crisis intervention resources. When necessary, the Contractor will take appropriate action (e.g., ensure the individual is transported to an emergency room), and immediately (no later than the next business day) inform the FAC COR.

3.2.18 52.218-000 Continuing Contract Performance During a Pandemic, Influenza or Other National Emergency. During a pandemic or other emergency, the Contractor may experience the same high levels of absenteeism as the federal workforce. Although the Excusable Delays and Termination for Default clauses list epidemics and quarantine restrictions among the reasons to excuse delays in contract performance, Contractors are expected to make a reasonable effort to keep performance at an acceptable level during emergency periods. Contractors are also expected to have reasonable policies in place for continuing work performance during a pandemic, influenza or other emergency situation.

Refer to the full clause, or similar updated clause, in the Standard Form 1449 contract.

3.3 TREATMENT DOCUMENTATION. All treatment documents are provided by the Bureau. Contractors must thoroughly complete and submit Bureau-provided documents to the FAC COR within the required timeframes specified herein. Contractors must use the most recent version of documents provided by the Bureau. When documents are updated, the Contractor shall implement use within twenty (20) business days.

Contractors may request to use compatible internal documents if they satisfy all requirements of those provided by the Bureau. Contractors may not use internal documents until they receive written authorization from the FAC COR. This authorization may be rescinded at any time with a twenty (20) business day notice.

If a document for a specific service is not provided by the Bureau, the Contractor may, by default, use a compatible internal document that satisfies all requirements specified herein.

3.3.1 Documentation Requirements. All treatment documentation must be completed and signed by the clinician who provided the service. All treatment documentation must be typed, detailed, individualized and contain specific examples of an inmate’s thoughts, behaviors, feelings, and progress toward specific treatment goals. Generic content, templates, and general clinical themes do not constitute acceptable documentation of progress in treatment. Documentation that does not meet these standards will be returned for correction which may result in delay of payment until acceptable documentation is received.

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3.4 CASELOADS. The Contractor shall establish limits on overall clinician caseload size, to include total work volume of Bureau and non-Bureau clients, to ensure effective treatment delivery and quality documentation. The Contractor must establish caseload sizes based on the number of clients to be served, program design, characteristics, and needs of the population served to include gender concerns and other factors.

3.5 TREATMENT OF CO-OCCURRING SUBSTANCE USE AND MENTAL

HEALTH DISORDERS. Inmates with co-occurring substance use disorder and mental health issues are prevalent in the criminal justice system and present with challenging and complex needs. An integrated treatment approach of co-occurring substance use disorder and mental health diagnosis is recognized as an evidenced based-practice. Therefore, the Contractor shall follow a treatment and recovery philosophy that promotes the integrated treatment of substance use disorder issues and mental health.

Clients who are referred for mental health treatment, who also have a secondary diagnosis of substance use disorder, shall receive treatment focused on the mental health diagnosis and the impact of the substance use disorder issue. Upon intake for mental health services, the presence of substance use disorder should be assessed. During treatment, substance use disorder should be reassessed on an ongoing basis and discussed with the client in terms of its impact on and relationship to the primary mental health disorder.

Clients who are referred for substance use disorder services should also be assessed for mental health issues at intake. Throughout treatment, mental health issues should be continually reassessed as they may manifest during the transition to the community.

Clients with mental health disorders should be identified and receive treatment to assist in their progress toward recovery and to increase prosocial skills and the likelihood of successful reentry to the community.

If the client is seen by the same therapist for both mental health and substance use disorder treatment, only one assessment that encompasses both diagnoses (CLIN 2012) should be completed and submitted for payment.

3.6 SEX OFFENDER SPECIFIC TREATMENT. The Bureau does not compel inmates in sex offender treatment to reveal the identity of past victims. The Contractor shall not act in any manner which coerces them to reveal the names or identities of past victims. The Contractor shall encourage disclosure of past thoughts, feelings and behaviors to foster the development of treatment initiatives consistent with the Good Lives Model and CBT.

Treatment is designed and offered to promote personal development, resulting in public safety, and should not be conceptualized as an investigative function.

3.7 BUREAU FORMULARY FOR MENTAL HEALTH SERVICES. Practitioners must refer to the Bureau formulary when prescribing medications to clients. Non-formulary medications may be denied by the Bureau; prior authorization from the FAC COR is encouraged prior to prescribing a non-formulary medication. The guidelines below allow for clinical and cost effectiveness.

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The criteria for choosing a specific medication to prescribe shall be:

• the likelihood of efficacy, based on clinical experience and evidence-based practice;

• the likelihood of adequate compliance with the medication regime;

• minimal risks from medication side-effects and drug interactions; and

• client preference.

If two (2) or more medications equally satisfy the above criteria, choose the medication available to the client at the lowest cost.

For all initial prescriptions, consideration should be given to prescribing generic medication rather than brand name medication, unless there is superior efficacy for the brand name medication or the side-effect profile favors the brand name medication.

The FAC COR will ensure that all Contractors receive a copy of the latest Bureau formulary.

3.8 MONITORING MEDICATIONS. The following recommendations are not intended to interfere with or replace clinical judgment of the practitioner when evaluating an inmate on psychotropic medications. Rather, it is intended to provide guidelines and assist practitioners with decisions in providing high quality care, ensuring that inmates receive the intended benefit of the medications, and to minimize unwanted side effects from the medications.

• At the initial psychiatric evaluation, a change in medications should not be prescribed unless there is a significant documented need to alter the medication regimen;

• positive and negative effects and all changes in medications to include dosage increase or decrease should be documented; and

• medications should not be prescribed for off-label uses or used in a manner not specified by the Federal Drug Administration (FDA) for clients receiving psychiatric services or MAT.

3.8.1 MAT State and Federal Regulations. Federal and state laws and other policies may affect the prescribing and dispensing of medications for opioid use disorders. Medications for the treatment of opioid use disorders must be prescribed or dispensed by individuals who are licensed to perform these activities in their respective states; however, additional rules and regulations apply to methadone and buprenorphine because of their status as controlled substances under the Comprehensive Drug Abuse Prevention and Control Act (Controlled Substances Act, 1970).

The Comprehensive Addiction and Recovery Act of 2016 (CARA) amended the Controlled Substances Act to allow qualifying nurse practitioners and physician assistants to receive a DATA 2000 waiver and prescribe buprenorphine at the original thirty (30) and one hundred (100) patient limits. However, several states have scope of practice laws that limit the effect of this federal law.

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In October 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act was signed into law, which contained provisions intended to increase access to and use of MAT.

3.8.2 Methadone. Methadone is a Schedule II drug that is used for the treatment of opioid addiction. For treating opioid addiction, methadone is dispensed only through an opioid treatment program (OTP) that has been certified by SAMHSA and registered as a narcotic treatment program by the U.S. Drug Enforcement Agency (DEA).

3.8.3 Buprenorphine. Buprenorphine is a Schedule III drug, indicating its lower potential for abuse or misuse than Schedule II substances. Pursuant to the Drug Addiction Treatment Act of 2000 (DATA 2000), qualified physicians can prescribe buprenorphine to patients for the treatment of opioid use disorder after completing a required training and submitting to SAMHSA a notification of intent to prescribe. This permits the physician to treat up to thirty (30) patients at a time in the first year and, if requested, one hundred (100) patients at a time after that. Some physicians, with added qualification, or in specific practice settings, are allowed to treat up to two hundred seventy-five (275) patients at a time.

3.9 VIDEO CONFERENCING GUIDELINES FOR TELEHEALTH. Contractors must follow the guidelines below in order to deliver secure telehealth services:

• Use a secure, trusted platform for videoconferencing.

• Verify devices and software use the latest security patches and updates. Install the latest antivirus, anti-malware, and firewall software to your devices. The underlying network must provide security.

• Verify device uses security features such as passphrases and two-factor authentication.

Preferably, your device will not store any client data locally, but if it must, it should be encrypted.

• Verify your audio and video transmission is encrypted. The Federal Information Processing Standard (FIPS) 140-2 is used by the U.S. government to accredit encryption standards. Encryption strengths and types can change.

• When partnering with 3rd party telehealth vendors, verify if their encryption meets the FIPS 140-2 certified 256-bit standard; that any peer-to-peer videoconferencing (streamed endpoint-to-endpoint) is not stored or intercepted by the company in any way; and that any recorded videoconferences or—if available—text-based chat sessions near the chat window are stored locally, on your own HIPAA-compliant device or electronic record keeping system, in order to safeguard any electronic protected health information or PHI.

• Choose a software solution that is HIPAA-compliant, as many popular, free products are not. Compliance with HIPAA (Health Insurance Portability and Accountability Act of 1996) is essential. HIPAA sets a minimum federal standard for the security of health information. States may also set privacy laws that can be even stricter; check any relevant statute for the state in which you practice. Just because software says its HIPAA-compliant isn’t enough. HIPAA compliance may also be dependent on the interface of your videoconferencing software with other aspects of your practice, such as EHRs.

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• It is recommended to use a broadband internet connection that, at minimum, has a transmission speed of at least five (5) MB upload/download to avoid pixilation, frequent buffering, and other video and audio difficulties associated with slow and insufficient transmission. Higher speeds might be required for newer technologies that use HD capabilities.

• When reviewing software options, you will notice that many vendors require a “business associate agreement,” (BAA) to ensure HIPAA compliance. Contact the vendor and confirm what such an agreement entails.

3.9.1 Telehealth. Telehealth services (e.g. psychiatry and counseling) may be approved for use in remote locations, locations deemed as acceptable by the Bureau, or during a national public health emergency. Telehealth services will only be reimbursed when delivered via live video. The client’s location at the time services are received via telehealth is known as the “originating site.” Clients shall only receive telehealth sessions at approved originating sites. The performance site or other suitable locations, as deemed necessary, e.g., RRC, residence for those on home confinement or FLM, may be authorized by the FAC COR as originating sites.

3.9.1.1 CTS must approve the use of telehealth prior to the provision of services. It is solely the Contractor’s responsibility to clearly provide the necessary information for approval.

The Contractor must submit evidence that the communication system and software application that will be used meet the Bureau’s electronic security requirements:

HIPAA-compliant, FIPS 140-2 certified, 256-bit encryption, and housed in Continental United States.

3.9.1.2 The Contractor must provide a plan that specifically addresses the telehealth policies and regulations for the state where services will be rendered. At the performance site (originating site), the Contractor must identify the location where clients will receive telehealth to ensure sessions are conducted in a secure and confidential setting. If the originating site is at a location other than the performance site, the Contractor is expected to make reasonable efforts to ensure telehealth sessions are conducted in a secure and confidential setting.

3.9.2 Remote Communication Technology. CTS may reimburse for certain services furnished remotely using communications technology that is not considered telehealth services, such as via telephone. The limitations and requirements applicable to telehealth would not apply. All services conducted by telephone require preapproval from the FAC COR.

CHAPTER FOUR: SCOPE OF SERVICES

4 Scope of Services

4.1 TREATMENT REFERRAL AND AUTHORIZATION. The Contractor will receive a

Treatment Referral and Authorization form from the FAC COR for each referred inmate.

It will specify the authorized treatment services and service authorization period for each inmate. Services are only authorized from the start date to the end date as indicated on the form. Amendments will be sent as necessary.

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4.1.1 Contract Line Item Numbers (CLINs). The Contractor must be capable of providing all treatment services, or CLINs, awarded with the contract at all times. The contractor must immediately inform the FAC COR of anticipated temporary or permanent inability to provide any CLIN whether due to staffing, change of law, performance site, public health emergency, natural disasters, or any other reason.

4.1.2 Authorized Services. The Contractor shall only provide services authorized on the Treatment Referral and Authorization. The Contractor may request clinically indicated changes to the client’s authorized services by contacting the FAC COR. The FAC COR must preauthorize changes to the treatment regimen, including discontinuing treatment.

4.1.3 Obligation to Treat. The Contractor must accept all referrals from the Bureau for treatment services. If the Contractor determines they cannot provide treatment to a particular inmate or condition, they must submit documentation that explains the issue to the FAC COR within five (5) business days from receipt of the referral. Examples would include a violation of local or state laws or ordinances or if the inmate’s condition is outside the Contractor’s scope of practice or competency. The Bureau reserves the right to pursue contractual remedies in the event the Contractor cannot provide contracted services.

4.1.4 Initial Contact. The initial contact to schedule an intake appointment must be made with the RRC (or other contact provided by the FAC COR) upon receipt of the referral. Prompt initial contact is necessary to ensure an intake session will take place within ten (10) business days from the treatment authorization start date.

4.2 INTAKE. Within ten (10) business days from the treatment authorization start date (indicated on the Treatment Referral and Authorization), the Contractor must meet individually with the referred client for an intake session. The intake session will consist of an admission and orientation to the program, completion of Bureau forms, and any documentation required by state regulatory boards, introductory information to the client regarding assigned counselor, appointments, session times, and other pertinent information related to client responsibilities and a diagnostic interview and assessment.

The intake session will be billed as an Intake Assessment & Report.

4.2.1 Intake Screening. If an inmate refuses treatment, this session will be billed as an Intake

Screening. Only one Intake Screening can be submitted for payment when an inmate refuses more than one service on the same day.

4.2.1.1 Substance Use Intake Screening (CLIN 2005): Upon arrival to initial appointment, the inmate refused participation in substance use treatment.

4.2.1.2 Mental Health Intake Screening (CLIN 5005): Upon arrival to initial appointment, the inmate refused participation in mental health treatment.

4.2.1.3 Sex Offender Intake Screening (CLIN 6005): Upon arrival to initial appointment, the inmate refused participation in sex offender treatment.

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4.2.1.4 Treatment Refusal. The client must understand their option not to participate in treatment, and they must also understand the consequences of their failure to participate if they choose not to volunteer for treatment while in the community. If the client refuses to sign the intake forms, or refuses to participate in treatment, the Contractor must terminate the initial intake immediately and notify RRC and CTS staff. Upon terminating the intake, the provider must also immediately alert RRC staff of the inmate’s departure to the RRC to ensure accountability is maintained. The appropriate Intake Screening line item may be billed by having the inmate sign the refusal, or staff certifying “inmate refused to sign,” on the Informed Consent form. This must be submitted to the FAC COR within one (1) business day of the intake session.

4.2.2 Intake Forms. The Contractor must obtain the client’s signature on the following documents during the intake. These forms must be completed and signed prior to beginning treatment, and must be submitted to the FAC COR within one (1) business day of the intake session. This notification is considered urgent, as it informs the Bureau of the timely start of treatment services.

• Authorization for Release of Information Form: Authorizes the Contractor to release information to the Bureau of Prisons, U. S. Probation, and Court Services and Offender Supervision Agency (CSOSA). All sections of the Authorization for Release of Information Form must be completed. Ordinarily, the expiration date should be a year from the client’s release date (treatment end date).

• Agreement to Participate in Community Transition Program (Informed Consent): Informed consent is a process for getting permission before conducting a healthcare intervention on a person. When completing the Informed Consent with the inmate, the clinician must first determine the inmate’s competency to provide consent.

Competence to give informed consent means the client has a basic understanding of his or her diagnosis or condition and that the treatment being offered is for that condition.

It also means the client has a basic understanding of the potential benefits, risks and side effects, and that they understand what to do in the event of any side effects.

4.2.2.1 Intake Contact Explanation of Delay: The Contractor will provide an explanation of delay for…