17-Specifications.pdf

SPECIFICATIONS

SCOPE

Harris County is seeking qualified healthcare entities with experience, capabilities, credentials, and qualified available personnel necessary to provide telepsychiatry services at the residential facilities of the Harris County Community Supervision & Corrections Department (HCCSCD). Telepsychiatry services are to be provided for a period of one (1) year beginning approximately October 1, 2026, and ending twelve (12) months thereafter.

PRE-PROPOSAL CONFERENCE

A pre-proposal conference will be held Thursday, January 29, 2026, at 10:00 a.m. CST via Microsoft Teams Conference ID: 295 212 402 648 13, password By9hB78Q, or call in (audio only) +1 281-985-1862,, 162 533 823#. Attendance is not mandatory; however, all vendor(s) are encouraged to attend in order to have a better understanding of the requirements of this RFP.

Join the meeting now Meeting ID: 295 212 402 648 13 Passcode: By9hB78Q

Or call in (audio only) +1 281-985-1862,, 162533823# United States, Aldine Phone conference ID: 162 533 823#

It is the responsibility of each vendor to examine the entire Request for Proposal (RFP) package, seek clarification in writing, and review their offer for accuracy before submitting. Questions relating to this RFP must be submitted in writing through Bonfire. The deadline for submission of questions relating to this RFP is listed on the Event schedule within Bonfire of this project. All questions submitted in writing prior to the deadline will be compiled and answered in writing.

A copy of all questions and answers will be released as a Public Notice within Bonfire to all firms. The County will not be bound be any information conveyed verbally.

RENEWAL OPTIONS

Harris County may consider four (4) one-year renewal options, renewable one (1) year at a time, based upon the same terms, conditions and pricing as the original year. Renewal is subject to approval by the Director of the Harris County Community Supervision & Corrections Department. Once renewal options are exhausted, the contract must be rebid.

Harris County reserves the right to rebid at any time as is in its best interest and is not automatically bound to renew.

BACKGROUND

Harris County is an urban county located in Texas and is one (1) of the most populated counties in Texas and in the United States. Harris County’s seat is Houston, the largest city in Texas, which is among the largest cities in the United States.

HCCSCD is currently one (1) of the largest adult probation departments in the United States. HCCSCD offers a broad array of services including community supervision, outpatient counseling, cognitive - behavioral programming and residential treatment to increase the capabilities of clients so that they can be successful in moving forward.

HCCSCD Mission Statement HCCSCD is committed to using evidence-based strategies to help individuals on community supervision eliminate future criminal behavior and become productive citizens, which in turn, creates a safer community with fewer victims.

HCCSCD Vision Statement HCCSCD strives to accomplish its mission by:

• Using interventions that are designed to effectively reduce criminal behavior.

• Using assessment to accurately identify and target criminal risk and needs.

Telepsychiatry Services for Harris County Community Supervision & Corrections Department https://teams.microsoft.com/l/meetup-join/19%3ameeting_N2ZhMDRiYzAtZDE1Ni00ZGFmLWE2ZWMtMWQ1ZTViNThlMGZk%40thread.v2/0?context=%7b%22Tid%22%3a%220d9bc79c-581b-4477-acf7-8d70dd3e555a%22%2c%22Oid%22%3a%220c98879c-7650-452d-bf5a-3b4923dc826c%22%7d

• Recognizing the ability of individuals to change.

• Treating all individuals with respect and dignity.

• Creating an environment that encourages learning and professional growth.

HCCSCD Values Respect – HCCSCD believes all individuals deserve respect and dignity.

Knowledge – HCCSCD is dedicated to creating an environment that encourages learning and professional growth.

Ability to change – HCCSCD recognizes that all people can change regardless of their past.

Collaboration – HCCSCD acknowledges the importance in understanding our role and working with other community stakeholders to help address our clients’ holistic needs.

SCOPE OF WORK

Harris County is seeking qualified vendors to deliver comprehensive, high-quality psychiatric care through a fee-for-service model with cost justification.

Vendor shall provide a full roster of staff physicians in the specialty of psychiatry. Vendor’s staff physicians shall provide skilled and efficient telepsychiatry services required to virtually treat adult clients in HCCSCD’s Dual Diagnosis Residential Program facilities in accordance with HCCSCD’s existing policies and procedures for telepsychiatry services.

At no additional cost to HCCSCD, vendor shall also provide cloud-based, Health Insurance Portability and Accountability Act (HIPAA)-compliant teleconferencing software for its staff physicians to conduct one-one virtual psychiatric assessments, therapy, and medication management for HCCSCD’s Dual Diagnosis Residential Program clients.

The Vendor shall provide telepsychiatry services through a hybrid model that includes three (3) distinct components:

scheduled clinical services for clients, on-demand crisis evaluations for clients experiencing a mental health crisis and who are in need of immediate psychiatric care, and on-demand telephone calls for HCCSCD staff.

I. PROGRAM OVERVIEW

A. HCCSCD’s Dual Diagnosis Residential Program Overview

The Vendor shall be capable of providing virtual telepsychiatry services to clients at HCCSCD’s Dual Diagnosis Residential Program (DDRP), which is a program for male and female clients who have been identified as needing a residential level of care to assist with co-occurring substance use and mental health concerns. The program is a collaboration of HCCSCD, the Texas Correctional Office on Offenders with Medical or Mental Impairments (TCOOMMI), and the Harris Center for Mental Health and Intellectual and Developmental Disabilities (The Harris Center).

Eligibility Criteria for HCCSCD’s Dual Diagnosis Program

• Low-Moderate to High risk on the TRAS (Texas Risk Assessment System);

• Significant mental health issue (Major Depression, Psychotic Disorders, Bipolar Disorders);

• Substance abuse or dependency issues as identified on the TRAS or TRAS Trailers;

• Significant barriers to maintaining stability in the community.

Vendor shall see patients for an initial assessment and then most patients are seen every thirty (30) days thereafter. There are approximately 138 male and female dual diagnosis patients at HCCSCD’s DDRP facilities. The current patient split is ninety (90) men and forty-eight (48) women. The length of the program varies based on individual need but on average is four (4) – six (6) months. The DDRP team believes that an integrated system of care and recovery principles, as well as a collaboration with community agencies, will lead to a reduced recidivism rate for program participants.

During their stay, HCCSCD and its designees provide DDRP clients with counseling on an individual and group basis to address their co-occurring disorders. Clients that are not successful in the program will be removed from DDRP and recommended for alternative placement.

Upon completion of the residential portion of the program, DDRP clients transition to outpatient aftercare services provided through The Harris Center and HCCSCD Outpatient Counseling. Clients are also supported by HCCSCD’s Community Supervision Officers on specialized caseloads.

B. HCCSCD’s Current Telepsychiatry Services Program HCCSCD’s telepsychiatry program has been in operation at its DDRP facility since 2016.

HCCSCD’s current telepsychiatry program includes the following:

• Approximately twenty (20) – thirty (30) hours per week of scheduled telepsychiatry clinic hours;

• On-demand phone calls related to medication management and clinician questions;

• Emergency or crisis psychiatric evaluations on-demand twenty-four (24) hours per day/seven (7) days per week/three hundred sixty-five (365) days per year.

An Executive Summary of Department’s (HCCSCD’s) Operational Guidelines for Telepsychiatry is available in Bonfire for vendor review.

C. Program Guidelines Vendor shall attempt to honor requests from the program:

• Before challenging a patient's behavior or presentation-review patient's behavior and history with the staff. (Staff does want patients challenged, but all of the intervention team needs to use the same language and be on the same page before challenging behavior, to prevent staff splitting and to present a unified front.)

• The staff requests appropriate pharmaceutical intervention to reduce client crisis and hospitalizations.

• Please communicate changes in diagnosis and medications as an educational opportunity to include both the patient and DDRP staff. Any changes shall be documented clearly. Staff are available to discuss clients before and after interviews.

• Any changes to the daily operations, including the way clients are seen, documentation, or any other such modification to must be approved by HCCSCD prior to implementation.

• Patients can be put on one (1) -to-one (1) observation for up to twelve (12) hours – otherwise, transfer to a higher level of care. Other levels of observation are standard observation (-q thirty (30) min) or close observation (-q fifteen (15) min for patients that are suicidal without a plan or means).

D. Clinic Flow

For each scheduled clinic, the following steps shall occur:

• The vendor’s provider and The Harris Center’s nursing staff both log into their video conferencing devices.

• The Harris Center’s nurse reviews the schedule of patients for the day with the vendor’s provider and answers any questions from the provider.

• Clinic Begins – Patients will be brought in as scheduled, staffed with the team, and then the vendor’s provider will conduct the visit. Nursing staff will remain present with the provider and patient.

• If intake assessments are scheduled, they will be brought in first. The nursing staff will provide the provider with the patient specific information listed above. As there is typically nothing to staff, the vendor’s provider will likely not be present for this initial visit.

• After each patient, the vendor’s provider will document the visit, order any medications, and communicate any additional orders to the nursing staff. All documentation shall be completed before vendor’s provider moves to the next patient.

• Nursing staff will review the sick call note, verify that all orders have been entered correctly, and if so, note off the sick call note verifying that all information and orders are correct. (This can be completed as the vendor’s psychiatrist is seeing his/her next patient.)

II. VENDOR GENERAL REQUIREMENTS AND QUALIFICATIONS

Vendor will provide telepsychiatry services including medication management for HCCSCD’s DDRP clients. The Vendor selected to provide these critical services shall demonstrate corporate stability, a commitment to quality, and a roster of highly qualified clinical professionals. The successful Vendor shall further demonstrate that it has sufficient staff with the required knowledge, expertise, skills, and abilities to provide the requested telepsychiatry services in a timely manner, as required by contract.

These specifications are intended to convey HCCSCD’s minimum requirements and are established to ensure that the Vendor is capable of meeting the needs of HCCSCD and its clients. Vendor’s submission(s) shall explain how the services offered will meet or exceed the requirements of the Specifications and Special Requirements. Vendor shall also identify any components of its proposed services that do not meet the specific requirements herein and identify any exceptions that it may have to the requirements of this RFP.

Vendor shall comply with all applicable federal, state, and local laws, rules, regulations, including the terms and conditions of participation in federal state health care programs. By the submission of a response to this RFP, vendor warrants and represents that it has and shall maintain compliance with all applicable regulations and laws, including federal, state, and municipal.

A. Practitioner Credentials, Licensure, and Experience Requirements All psychiatrists delivering services to HCCSCD’s DDRP clients shall meet the following requirements:

• Hold a current, unrestricted license to practice medicine from the Texas Medical Board.

• Be board-certified in Psychiatry by the American Board of Psychiatry and Neurology (ABPN). Board-eligible practitioners may be considered on a case-by-case basis, but the Vendor's staffing plan shall be primarily composed of board-certified psychiatrists.

• Hold a current, unrestricted Drug Enforcement Administration (DEA) registration, including authorization for prescribing in Texas.

• Successfully pass a comprehensive background check and complete the credentialing process, as required by HCCSCD.

• Have no history of license revocation, suspension, or other disciplinary action from any state licensing board or federal agency that would impede his/her ability to perform the duties required.

• Authorized to work in the United States and shall obtain any necessary visas or work authorization documents at vendor’s or physician’s expense. Physicians shall properly comply with all state and federal immigration laws, rules, and regulations with regard to performing services.

• Authorized to participate in the Medicare and Medicaid programs during the term(s) of the agreement that results from this RFP.

• Provide the services in conformity with generally accepted medical practices and standards of care in effect at the time such services are rendered.

In addition to these mandatory requirements, the Vendor's proposed practitioners shall possess the following qualifications:

• A minimum of two (2) years of clinical experience post-residency.

• Demonstrated, substantial experience and/or specialized training (e.g., fellowship in addiction or forensic psychiatry) in the treatment of individuals with co-occurring serious mental illness and substance use disorders.

• Verifiable experience providing psychiatric treatment services to criminal justice agencies and justice-involved populations with substance use and mental health considerations in settings such as jails, prisons, hospitals, or inpatient substance abuse treatment facilities. The Vendor shall describe how its practitioners are oriented to the unique aspects of mental health care services provided to justice-involved populations, including the potential impacts of the environment on clinical presentation and establishing therapeutic rapport.

Vendor shall ensure that its physicians perform all services in accordance with all healthcare standards and regulatory and licensing standards, including without limitation, those requirements imposed by the Medicare/Medicaid Conditions of Participation and any amendments thereto and applicable provisions of the Administrative Simplification section of HIPAA.

Vendor shall warrant that no healthcare entity in which any physician providing services through the agreement that results from this RFP has an ownership or controlling interest in, or is an officer or managing employee of, is, or has ever been: 1) sanctioned within the meaning of the Social Security Act Section 1128A or any amendments thereof;

2) convicted of violating the federal law known as the “Stark Law”, federal False Claims Act, federal Medicare and Medicaid Anti-kickback Statute, Emergency Medical Treatment and Active Labor Act (EMTALA), federal civil monetary penalties statute, or equivalent Texas laws; or 3) debarred, excluded or suspended from participation in any federal or state health care program. The foregoing warranty shall also apply during the term of the agreement that results from this RFP.

Vendor shall notify HCCSCD and its designees within three (3) days in the event that any information or documentation submitted regarding the physicians providing services to HCCSCD clients is no longer true, correct, or complete.

The Vendor's proposal shall include a detailed staffing plan that not only provides curricula vitae for all proposed psychiatrists, demonstrating compliance with the above standards, but also describes the Vendor's internal processes for the recruitment, credentialing, supervision, and ongoing professional development of its clinical staff. This plan shall specifically address how the Vendor will train and support its psychiatrists on the policies, procedures, and clinical nuances specific to the HCCSCD residential environment.

B. Background/Criminal History Checks for Vendor Staff and Vendor Physicians Vendor warrants and represents that it shall not assign any person: 1) who fails or refuses to provide information necessary to obtain a criminal background history; or 2) whose criminal record information reveals a conviction or deferred adjudication that renders the person unqualified under state or federal law to perform services or unsuitable for assignment to HCCSCD. Vendor shall not permit any employee or independent contractor, who is currently a fugitive or under deferred adjudication supervision, probation, parole, and/or supervision, to provide contract services, to access or provide services at HCCSCD’s facilities, or to prepare reports or to have access to clients’ files during the course of providing services. Furthermore, vendor shall notify HCCSCD within twenty-four (24) hours if any employee or independent contractor is arrested for, pleads guilty or no contest to, and/or is convicted of a misdemeanor (other than a Class C Misdemeanor traffic offense) or felony offense.

Vendor shall provide HCCSCD with an initial list of physicians whom vendor proposes to utilize for performing the telepsychiatry services with vendor’s proposal response. Vendor shall supplement or confirm the initial list of physicians at the time vendor signs an agreement with HCCSCD, and upon request thereafter. On at least a quarterly basis, vendor shall send HCCSCD’s designees an updated list of approved physicians for HCCSCD’s review and for the completion of HCCSCD’s background check and credentialing processes, as determined to be necessary by

HCCSCD.

Vendor’s staff physicians providing telepsychiatry services shall be required to provide digital fingerprints to IdentoGO at one (1) of its locations. Vendor shall be charged the discounted price charged to criminal justice agencies of ten dollars ($10) per set of fingerprints.

Vendor agrees that on at least an annual basis, HCCSCD shall conduct national and state criminal background checks in accordance with HCCSCD standards and Texas law, including but not limited to, the review of Texas Department of Public Safety (DPS) and National Crime Information Center (NCIC) criminal records, for all vendor personnel who provide contract services, services at HCCSCD’s facilities, who prepare progress reports, or who access client files, prior to allowing the personnel to provide any services, as well as annually thereafter, if the personnel continue to provide services. Copies of the NCIC and Texas DPS records shall not be provided to the vendor due to record access restrictions; HCCSCD notifies the vendor whether its candidates pass the background check, and if not, HCCSCD advises the vendor that the candidate’s criminal history prohibits the candidate from providing contract services to HCCSCD, including but not limited to, working inside a HCCSCD facility, or accessing clients’ files.

HCCSCD shall not disclose such criminal history record information except as provided by law. Vendor shall also notify HCCSCD at least once per year of vendor employees or independent contractors with a criminal background, and all vendor employees or independent contractors with a criminal background shall be approved in advance by HCCSCD if they provide services at HCCSCD facilities. In addition, at least quarterly, vendor is also responsible for supplying HCCSCD with a list of any changes to existing staff or independent contractors assigned in conjunction with the services provided at HCCSCD facilities, including but not limited to, new personnel and terminated personnel. HCCSCD reserves the right, in its sole discretion, to require vendor to prohibit any of its personnel from providing services.

C. Background/Credentialing of Vendor Physicians In addition to the background criminal history checks outlined above, HCCSCD also conducts a credentialing process for each of vendor’s physician staff. Vendor shall assist HCCSCD and its designees with ensuring that each of its physicians complete any such credentialing processes in a timely manner.

Below is a list of documents typically requested during HCCSCD’s credentialing process:

• Copy of State Issued Photo ID

• Curriculum Vitae (CV)

• Texas Medical Board License Verification

• Any Specialty Certification(s) Verifications

• U.S. Department of Justice Drug Enforcement Administration (DEA) License

• National Provider Identifier (NPI) Verification

• National Practitioner Data Bank (NPDB) Query Result

• Malpractice Insurance Verification

• American Medical Association (AMA) Physician Profile

• Joint Commission Accreditation documentation for vendor’s company(ies)

HCCSCD reserves the right to request additional documentation that it deems necessary or appropriate during its credentialing process, in order to meet its operational requirements and to comply with state and federal laws.

D. Training Requirements for Vendor Physicians In order to provide high quality and efficient services to clients under HCCSCD’s supervision, HCCSCD requires vendor staff be trained in HCCSCD policies and procedures. In addition, if vendor staff physicians are unfamiliar with HCCSCD’s electronic medical record (EMR) system (currently CorEMR), they shall be required to attend HCCSCD training that will assist them in utilizing HCCSCD’s EMR and in facilitating contract compliance.

E. HCCSCD Policies and Procedures for Training In the event that vendor’s physicians are required to attend virtual trainings or staffing meetings with HCCSCD personnel (including EMR, facility security orientation, facility required competencies, virtual on-boarding etc.), HCCSCD agrees to pay vendor the per hour rate for Scheduled Clinic Hours for up to two (2) hours per physician per contract term, for the time spent by vendor’s physicians virtually attending such trainings or staffing meetings (“Training and Staffing Fees”). In consideration of HCCSCD’s agreement to pay Training and Staffing Fees, vendor shall agree that the Training and Staffing Fees chargeable to HCCSCD shall be capped and shall not exceed two (2) hours per physician, for up to five (5) physicians per contract term (“Training and Staffing Cap”). Vendor shall further agree that any Training and Staffing Fees associated with training and staffing matters for vendor’s physicians in excess of the Training and Staffing Cap shall be borne by vendor.

F. TDCJ-CJAD Requirements If a formal written contract is negotiated and entered into between vendor and HCCSCD, it is anticipated that the format, terms and provisions, of such contract will be substantially as set forth in the Contract Management Manual for the Texas Department of Criminal Justice (TDCJ) – Community Justice Assistance Division (CJAD) Funding of Offender Services (September 1, 2015). Such contract format, terms and provisions therein, are incorporated into this RFP by reference; and for vendor’s convenience, a copy of the agreement that vendor shall be expected to enter into with HCCSCD is available for review in Bonfire. Prior to its furnishing of a formal contract, HCCSCD reserves the right to revise or modify such contract format, terms and conditions as may be deemed appropriate under the circumstances and to accommodate any changes or revisions that may be necessary to comply with applicable TDCJ- CJAD standards, rules, regulations, or other legal requirements.

Vendor shall share program data and statistics on clients referred to vendor with the research and planning divisions of HCCSCD. Vendor shall submit monthly progress reports via email for each client to appropriate HCCSCD staff.

The reporting shall include relevant outcome data, as directed by HCCSCD and TDCJ. Vendor shall allow representatives from HCCSCD and TDCJ to access client and program data for research purposes, as requested.

Vendor(s) awarded a contract may be required to allow CJAD/TDCJ, or their designee, to conduct an Evidence-based Correctional Program Checklist (CPC) during the term of the awarded contract. Information on the CPC is available on the National Institute of Corrections website: www.nicic.org

At all times, HCCSCD retains control over the clients that may be referred by vendor to government agencies or third parties to provide other or additional services. If a client is determined by vendor to be in need of additional or different treatment services, such client is to be referred back to HCCSCD for a determination as to what, if any, further action or treatment should occur. The policies and procedures that pertain to the circumstances for these additional and other referrals, if any, that may occur shall be addressed by vendor in its written proposal submitted in response to this RFP. If vendor has a preferred policy or practice of handling such situations, vendor shall describe its policies and/or practices in its proposal.

Any proposed agreement shall be subject to the availability of State and/or County funds as appropriated by the proper authorities. If such funds become reduced or unavailable, any agreement resulting from this RFP shall be subject to immediate modification, reduction or termination.

Before the award of any contract related to this RFP, vendor shall be required to furnish HCCSCD with satisfactory evidence as to the pecuniary and financial resources and insurance coverages that are available to fulfill the terms and conditions of the contract. Vendor shall include a copy(ies) of applicable certificates of coverage along with vendor’s response to Sections II and IV of this RFP. HCCSCD may further require that all financial reports or statements furnished reflect the vendor’s current financial status and are certified as to accuracy by a certified public accountant.

G. Vendor Operational Plan and Budget Under any contract that may be awarded related to this RFP, vendor shall provide all necessary personnel, equipment, materials, supplies, facilities, and services (except as may be furnished by the HCCSCD as specified in writing), and do all things necessary for, or incidental to, the provision of services requested in this RFP.

HCCSCD does not guarantee a minimum utilization rate of the proposed services and reserves the right to utilize the proposed services to a greater or lesser degree than estimated at the vendor’s proposed price.

If a contract is offered and furnished by HCCSCD to vendor, it is anticipated that the RFP Specifications, Sections I- IV of the RFP Special Requirements, vendor’s proposal as finally negotiated, vendor’s Best and Final Offer (BAFO), and the related operations and budget information as submitted in response to this RFP, shall become part of the Vendor Operational Plan, which shall be attached and incorporated by reference into such contract, as entered into and executed by the parties. The Vendor Operational Plan shall also include the performance measures outlined in the attachments titled Sample Services Operations Agreement and Executive Summary of Department’s Operational Guidelines for Telepsychiatry, under Supporting Documentation inside Bonfire. Under these circumstances, the http://www.nicic.org/

Vendor Operational Plan and Justification for Fee for Service Budget (“Budget”), as included in the vendor’s proposal and/or vendor’s BAFO, shall become legally binding upon the execution of an agreement by vendor and HCCSCD. The Vendor Operational Plan and Budget shall be included among the processes, circumstances, and terms under which the proposer’s treatment services shall be provided. The Vendor Operational Plan shall also be used in annual contract monitoring by HCCSCD.

Vendors with multiple contracts with state or local governments or other agencies are required to develop budgets, accounting processes and records that allow for the verification of rates by HCCSCD, TDCJ-CJAD, and any government auditors. This obligation for verification of vendor rates shall include information as to vendor’s indirect cost rates, overhead, and cost pooling practices.

Vendor Budgets included in proposals prepared in response to this RFP shall follow all applicable TDCJ-CJAD requirements. The prices quoted by vendors in response to this RFP shall be the full cost of the subject treatment.

Vendors shall ensure that only reasonable and allowable costs are used in the cost justification set forth in Vendor’s Budget and other provisions of vendor’s proposal submitted in response to this RFP (for examples of unallowable costs, see attachment titled Sample Services Operations Agreement, under Supporting Documentation inside Bonfire).

Time spent by vendor’s administrative, managerial, or non-physician healthcare staff on matters related to the services provided by vendor’s physicians, including but not limited to, phone calls and meetings with HCCSCD personnel, travel, trainings, staffing reviews, policies and procedures, and quality improvement/assurance reviews shall not be reimbursable to vendor or billable to HCCSCD. HCCSCD will not pay or reimburse vendor for any expense(s) not expressly allowed by, or for which specific rate(s), is/are not set forth in its contract with vendor. In addition, payment or reimbursement for the following items is specifically disallowed: indirect and overhead expenses, as well as administrative, copying, postage, travel, parking fees, long-distance telephone calls, mileage, hotel accommodations, meals, or other costs or expenses, unless approved in writing in advance by HCCSCD.

If, during the term of any contract that may be offered and furnished to the proposer, unallowable or unreasonable costs or monies are expended by the proposer in contravention of the requirements and specifications contained in this RFP, the proposer may be subject to contractual liabilities and damages, in addition to criminal sanctions, under certain circumstances.

H. Court Testimony Vendor shall agree to provide testimony in court, if required by HCCSCD. Historically, court testimony has not needed to be provided for HCCSCD’s telepsychiatry services.

In the event that court testimony is required in the future for HCCSCD’s telepsychiatry services, vendor agrees to provide video/remote testimony in court, if required and approved in advance by HCCSCD, at the per hour rate for Scheduled Clinic Hours. The foregoing shall apply to any required court testimony, written court reports, review of court documents, etc., that cannot be completed during the normal course of the Scheduled Clinic Hours.

If in-person testimony in court is required and is approved in advance by HCCSCD, vendor agrees to provide in-person testimony at the per hour rate for Scheduled Clinic Hours for any required court testimony, written court reports, review of court documents, etc., that cannot be completed during the normal course of the Scheduled Clinic Hours. Time that may be compensated by HCCSCD for such in-person testimony, includes the time spent by vendor’s physicians in court, starting from the required appearance time, and concluding with the end of the physician’s testimony, plus up to one (1) hour of travel time to and from the required court appearance.

In addition, travel expenses for in-person court appearances eligible for reimbursement, include, and are limited to the following: mileage for use of personal vehicle at IRS rate or flight; parking or the cost of transportation to and from the airport; baggage fees and car rental; daily subsistence at the rate of eighty dollars ($80) per day for on-site days; and costs of consumables and supplies directly attributable to the services, such as copies and facsimiles.

In order to be considered eligible for reimbursement, costs associated with court testimony shall fulfill the following general conditions:

• Costs must have been necessary for the performance of the services.

• Costs must have been actually incurred during the performance period of the contract.

• Costs must be identifiable, and supported by legible, itemized evidence (itemized invoices, receipts, or other payment documents).

III. SCHEDULED TELEPSYCHIATRY CLINICAL SERVICES

This component constitutes the core of the telepsychiatric services that vendor is expected to provide to HCCSCD’s DDRP clients. At this time, HCCSCD utilizes approximately twenty (20) – thirty (30) hours per week of telepsychiatry services during the Scheduled Clinic Hours; however, in the future, the utilization of the services may increase or decrease depending upon the needs of the clients present at HCCSCD’s DDRP facility, and there is no guarantee that the awarded vendor shall receive a specific number or volume of patients or a set number of hours per week during which services are to be provided.

A. Service Delivery Hours and Location

Modality: All scheduled clinical services shall be delivered via a real-time, interactive, audio-visual telehealth platform that meets the specifications outlined in this document and the requirements of Harris County’s information technology (IT) personnel.

Hours of Operation: Telepsychiatry consultations shall be conducted by vendor’s staff physicians for HCCSCD’s DDRP clients at times scheduled in advance by HCCSCD and vendor during the "Scheduled Clinic Hours," which are defined to include the hours of 8:00 a.m. to 6:00 p.m. Central Standard Time (CST), Monday through Friday. The Scheduled Clinic Hours shall be on dates and at times that best fit the needs of HCCSCD’s DDRP clients.

Service Locations: Services will be provided virtually to clients residing at HCCSCD’s DDRP facilities.

HCCSCD will provide rooms and the necessary computer hardware and internet connectivity for clients to participate in telepsychiatry sessions. Vendor shall provide the necessary software for vendor’s physicians to provide telepsychiatry services to HCCSCD’s DDRP clients.

Psychiatric Assessments: The Vendor shall conduct an initial psychiatric assessment for all clients. The assessments shall be consistent with the prevailing standard of care and shall include, at a minimum: a detailed psychiatric history (including substance use, trauma, and forensic history), a thorough mental status examination, a diagnostic formulation based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), a comprehensive risk assessment for suicide and violence, and an initial treatment plan.

After the initial assessment, most patients are seen every thirty (30) days thereafter.

Physicians shall use as a scheduling and productivity standard a forty-five (45) – sixty (60)-minute initial assessment.

Follow-up visits and medication management shall be conducted at clinically appropriate intervals to monitor the client's progress, assess treatment efficacy, and update the treatment plan. Follow-up visits and medication management shall be approximately fifteen (15) - twenty (20) minutes in length, depending upon acuity.

It is expected that documentation for all scheduled client encounters (evaluations and follow-ups) shall be entered into each client’s electronic health record (EHR) within HCCSCD’s EMR, prior to the conclusion of each client’s scheduled session with vendor’s physicians. Physicians shall close out patient-encounters in HCCSCD’s EMR within forty-eight (48) hours of patient encounters.

A medical doctor writes all the admission orders/medical care orders when client presents to HCCSCD’s DDRP or program. Medical providers address all of the patient’s medical concerns-vendor’s providers are to refer a client back to his/her medical provider if they identify any medical problems or complaints that need to be addressed. Some patients are being seen at Harris Health Clinics for health concerns, and patients with human immunodeficiency virus (HIV) typically are managed at the Thomas Street Clinic at Quentin Mease Health Center.

One (1) critical note: All patients at DDRP must have at least one (1) qualifying mental illness and at least one substance abuse/dependent diagnosis along with criminal risk factors/history. All patients admitted to DDRP have extensive substance use histories. Please include diagnoses, including International Classification of Diseases, Tenth Revision (ICD-10 codes) for both mental illness and substance use/dependency diagnoses.

B. Medication Management and Pharmacotherapy The Vendor shall provide continuous and expert medication management services for clients. This includes the prescription of psychotropic medications, ongoing monitoring for therapeutic efficacy and adverse side effects, and timely adjustments to the medication regimen as clinically indicated.

Practitioners shall demonstrate expertise in managing complex psychopharmacology for the dual-diagnosis population. Knowledge of Medication-Assisted Treatment (MAT) for substance use disorders and potential drug interactions is preferred.

All medication orders shall be entered in HCCSCD’s EMR for each client’s EHR. They can be entered through a sick call. No orders shall be entered without a sick call note being generated explaining the reason for the med change and listing the diagnosis.

Formulary: Unfortunately, HCCSCD’s EMR does not have the functionality to allow HCCSCD to upload the formulary for The Harris Center, which is what the providers will be required to adhere to for prescribing purposes. A copy of the formulary will be provided to the psychiatrists as a resource to use when prescribing.

Medication Delivery: The cut-off time for next day delivery of meds is 1:00 p.m. CST. This means that if a doctor is seeing a patient and the orders are written after 1:00 p.m. CST, or the nurse does not process/transcribe the order by 1:00 p.m. CST then the medication(s) will NOT be delivered the next business day. This would result in the patient staying on their current medication profile until the new meds arrived to implement the new orders.

Emergency Orders: In the event a patient requires an urgent dose of medication, or the medication cannot wait until the next scheduled delivery, the nursing staff can submit an "emergency order" and have the order filled at a local "back up" pharmacy. The turnaround time on this process is typically around two (2) hours.

Medication Restrictions: HCCSCD asks that the vendor’s providers avoid prescribing Seroquel, Wellbutrin, Buspar, Ambien and any controlled substances. These medications are not typically prescribed medications due to abuse potential with our population. If you absolutely think one (1) of these medications are best for the patient, please be specific in your note why you ordered the medication. Regarding injectable antipsychotics, we ask that providers document failed attempts at oral antipsychotics and provide a justification for requiring the injectables, due to their expense.

Controlled Substances: In the RARE event that a client requires a controlled substance, the prescriber will need to overnight mail the hard copy prescription to the DDRP program to have it filled. Please mail the prescription to the facility as addressed below:

Dual Diagnosis Residential Program - Nursing Staff 2310 ½ Atascocita Rd Humble, TX 77396

C. Treatment Planning and Coordination of Care The telepsychiatrist is a member of the client's multidisciplinary treatment team. As such, the vendor's practitioners shall actively participate in the development, review, and modification of each client's individualized treatment plan. This requires collaboration with HCCSCD clinical staff, which includes, but is not limited to, therapists, nurses, and administrative personnel.

The vendor shall communicate collaboratively with HCCSCD’s clinical personnel during the Scheduled Clinic Hours regarding critical clinical information for each DDRP client seen by vendor’s psychiatrists. This includes, but is not limited to, timely discussion of medication changes, significant changes in mental status, newly identified risk factors, and treatment recommendations. Medication clarifications shall be handled by vendor’s physicians during Scheduled Clinic Hours immediately after each client’s visit as HCCSCD’s nurse performs a chart check. This communication is vital for the on-site staff who manage the client's day-to-day care and supervision.

D. Client Scheduling and Engagement Protocols HCCSCD’s clinical staff shall be responsible for the primary functions of identifying clients in need of psychiatric services during the Scheduled Clinic Hours that are staffed by vendor’s physicians.

The DDRP administrative team schedules appointments and plugs in urgent patients as needed. The vendor’s psychiatrist will be provided with a summary of the client's behavior, motivation, engagement, and progress prior to the visit with the patient. Staff will also provide the psychiatrist with the following:

• Multidisciplinary Treatment Team Staffing.

• Demographic information, especially birth date.

• Current vital signs.

• Medications patient currently takes.

• Hospitalization history/discharge summary from recent hospitalization.

• Lab work related to psychotropic medications:

o Vendor’s psychiatrist shall check with the staff to ensure labs have not been completed recently.

o IMPORTANT: Vendor’s psychiatrist shall identify when he/she wants the labs drawn on the order (as soon as possible, this week, next week, etc.).

o Order labs related to psychotropic interventions only.

o Document the rationale behind ordering unusual labs.

o Ordering levels for Depakote, Lithium and Tegretol as needed.

o Labs will be scanned and uploaded into HCCSCD’s EMR for review of each client’s EHR.

The Vendor shall collaborate with HCCSCD’s clinical staff during the Scheduled Clinic Hours to maintain an efficient workflow, minimizing client wait times and maximizing the number of clients seen during the Scheduled Clinic Hours.

A designated HCCSCD staff member shall function as a "telepresenter" at HCCSCD’s DDRP residential facilities. This staff member's responsibilities include, but are not limited to, bringing the client to the telehealth room, initiating the video call, assisting with any technical issues, and remaining available to provide in-person support or respond to emergencies as directed by the remote psychiatrist.

Additional details may be found in the Executive Summary of Department’s (HCCSCD’s) Operational Guidelines for Telepsychiatry, which is available in Bonfire for vendor review.

E. Documentation All clinical services provided to HCCSCD’s DDRP clients shall be documented in the client's EHR in HCCSCD’s EMR in a timely, concise, and clear manner, with sufficient information to support clinical findings, justify the interventions, and meet billing requirements.

All telepsychiatry visit documentation shall be completed within the sick call section of the patient chart.

Psychiatrists are asked to document in the Subjective, Objective, Assessment, and Plan (SOAP) format as that is the way the "sick call" note is set up in HCCSCD’s EMR.

There are a few items that need to be listed in each note. First, every diagnosis shall be listed with the specific International Classification of Diseases (ICD) 10 code included. Next, in the plan section, when listing medications, a rationale shall be provided regarding why that medication is being prescribed. All prescription orders shall be completed within the sick call note. Providers shall change the billing type when ordering a medication and close the medication-ordering window once they are finished prescribing medications.

IV. ON-DEMAND TELEPSYCHIATRY CRISIS EVALUATIONS

This component addresses the need for rapid intervention for clients experiencing an acute mental health crisis or psychiatric emergency.

A. Service Availability and Access: The Vendor shall provide access to on-demand, real-time audio-visual telepsychiatry evaluations for clients experiencing a mental health crisis and who are in need of immediate psychiatric care (“On-Demand Telepsychiatry Crisis Evaluation”). This service shall be available twenty-four

(24) hours per day, seven (7) days per week, three hundred sixty-five (365) days per year, without exception.

B. Response Time: A qualified vendor psychiatrist shall be available to initiate a crisis evaluation via the vendor’s telehealth platform within one (1) hour of a request being made by authorized HCCSCD staff.

C. Scope of Clinical Evaluation: The On-Demand Telepsychiatry Crisis Evaluation is an urgent clinical intervention, not a routine psychiatric appointment. The scope of the evaluation shall include, at a minimum:

• A rapid assessment of the client's presenting problem and acute psychiatric symptoms.

• A thorough risk assessment for imminent harm to self or others.

• Evaluation for the need for a higher level of care, such as hospitalization, including clinical justification for transfer and completion of necessary transfer steps in coordination with on-site staff.

• Development of an immediate management plan, including any necessary de-escalation techniques, medication adjustments, and safety protocols.

It is expected that each On-Demand Telepsychiatry Crisis Evaluation shall last approximately fifteen (15) – thirty

(30) minutes.

D. Documentation: All On-Demand Telepsychiatry Crisis Evaluations shall be documented in the client's EHR within HCCSCD’s EMR in accordance with the requirements set forth in Section III, Subsection E above.

The Vendor shall also maintain a comprehensive and detailed log of every On-Demand Telepsychiatry Crisis Evaluation. This log is a critical component for both quality assurance and billing verification. The log shall include: the patient’s first and last name, the patient’s date of birth, the patient’s medical record number, the consult requested date and time, patient wait time in minutes, provider/ordering physician name, consult start date and time, encounter duration in minutes, clinical recommendations, and any other clinical information deemed necessary/important by the vendor’s physicians. This log shall be submitted as a supporting document with each monthly invoice.

Billing for this service will be on a per-evaluation, fee-for-service basis.

V. ON-DEMAND PHONE CALLS

This component provides HCCSCD staff with immediate access to psychiatric expertise for clinical support. This service is designed to be a rapid response resource for HCCSCD staff.

A. Service Availability and Access: The Vendor shall provide HCCSCD with a toll-free telephone number for on-demand phone consultations with vendor’s psychiatric staff physicians.

This service shall be continuously available, twenty-four (24) hours per day, seven (7) days per week, three hundred sixty-five (365) days per year, with no exceptions.

B. Authorized Callers and Topics Access to this consultation line shall be limited to designated HCCSCD clinical staff. HCCSCD shall provide the vendor with a list of authorized personnel to prevent misuse.

The scope of the on-demand phone calls is narrowly defined and limited to the following topics:

Medication Management Questions: Urgent questions regarding medication side effects, protocols for missed doses, or potential interactions.

Clinician Questions: Discussion regarding a client's acute change in presentation, challenging behaviors, or questions about differential diagnoses to inform the on-site team's immediate management plan.

For clarity, this service shall not be used for routine scheduling, non-urgent clinical questions, direct communication with clients, or for initiating emergency psychiatric consultations, and it is HCCSCD’s expectation that most medication management and clinician questions shall be discussed with HCCSCD’s DDRP clients and/or HCCSCD’s designated clinical personnel within the Scheduled Clinic Hours.

C. Call Duration and Structure Each on-demand phone call shall be limited to a maximum duration of twenty (20) minutes.

The service provides for a real-time discussion between the authorized HCCSCD staff member and a qualified vendor psychiatrist. By the conclusion of the call, the vendor’s psychiatrist shall provide clinical guidance and actionable recommendations based on the information provided by the caller.

D. Documentation and Billing If the call is client-specific, the call shall be documented in the client's EHR within HCCSCD’s EMR in accordance with the requirements set forth in Section III, Subsection E above.

The Vendor shall also maintain a comprehensive and detailed log of every on-demand consultation call. This log is a critical component for both quality assurance and billing verification. The log shall include: the date of the call, the exact start and end time, the calculated duration in minutes, the full name and title of the HCCSCD caller, the client's name and medical record number (if the call is client-specific), a concise summary of the clinical questions or issues, and a summary of the recommendation or advice provided. This log shall be submitted as a supporting document with each monthly invoice.

Billing for this service will be on a per-call, fee-for-service basis.

VI. CLINICAL PROTOCOLS AND STANDARDS OF CARE

The Vendor shall adhere to the highest clinical and ethical standards in the delivery of all telepsychiatry services, which shall be adapted to the needs of HCCSCD’s DDRP clients.

A. Adherence to Professional Guidelines

Vendor's psychiatrists shall provide services in a manner consistent with established guidelines.