190527 RFR Co-Occurring Enhanced Residential rolling~1.docx

THE COMMONWEALTH OF MASSACHUSETTS

DEPARTMENT OF PUBLIC HEALTH

BUREAU OF SUBSTANCE ADDICTION SERVICES

Address: 250 Washington Street, 3rd floor, Boston MA 02108

Contact Name: Olivia Laramie

Email : Olivia.T.Laramie@mass.gov

Request for Response (RFR)

Document Title: RESIDENTIAL REHABILITATION SERVICES /CO-OCCURRING ENHANCED 3.1

COMMBUYS BID Number: BD-19-1031-BSAS0-BSA01-32429

DPH RFR Document Number: 190527

September 13, 2024

COMMBUYS REGISTRATION

It is the responsibility of the prospective Bidder and awarded Contractor to maintain an active registration in COMMBUYS and to keep current the email address of the Bidder’s contact person and prospective contract manager, if awarded a contract, and to monitor that email inbox for communications from the Purchasing Department, including requests for clarification. The Purchasing Department and the Commonwealth assume no responsibility if a prospective Bidder’s/awarded Contractor’s designated email address is not current, or if technical problems, including those with the prospective Bidder’s/awarded Contractor’s computer, network or internet service provider (ISP) cause email communications sent to/from the prospective Bidder/Awarded contractor and the Purchasing Department to be lost or rejected by any means including email or spam filtering. To register review the COMMBUYS Job Aide COMMBUYS Vendor Registration and/or go to www.COMMBUYS.com.

QUOTE SUBMISSION

This BID requires the submission of electronic quotes. All Bidders are advised to allow adequate time for submission of their quotes by considering potential online impediments like Internet traffic, Internet connection speed, file size, and file volume. DPH is not responsible for delays encountered by Bidders or their agents, or for a Bidder’s local hardware failures, such as computers or related networks, associated with bid compilation or submission. Bids submitted via COMMBUYS are time stamped by the COMMBUYS system clock which is considered the official time of record.

If you plan to submit a quote to this RFR “No Bid” should not be checked anywhere in your quote in COMMBUYS. This includes on the General Screen and the Items tab. Checking No Bid sends your quote to a different location in COMMBUYS than the rest of the quotes for that Bid and you run the risk of the Department not receiving your response. The department will not guarantee that a bid received with a “No Bid” checked will be reviewed.

1.0 Procurement Scope and Description:

The current Request for Response (RFR) is transitioning to a rolling application format, providing an opportunity for new providers to apply while ensuring that existing providers can maintain their status without the need for reapplication.

Background:

The Commonwealth is in the midst of opioid epidemic. The number of confirmed and estimated opioid-related overdose deaths for 2016 was 2,154, this represents a 28% increase over confirmed cases in 2015 (n=1,685). The number of confirmed and estimated cases of opioid‐related overdose deaths for all intents in 2017 is 2,071. This represents a 4% decrease from 2016’s total confirmed and estimated cases (n=2,154). While the reduction in deaths in 2017 is positive news, we continue to see concerning rates of overdose as a result of fentanyl. Among the 477 individuals whose deaths were opioid‐related in 2018 where a toxicology screen was also available, 423 of them (89%) had a positive screen result for fentanyl. In February 2015, Governor Baker charged an 18-member working group with developing specific, actionable recommendations to address and respond to the opioid epidemic crisis. The workgroup established a set of 65 recommendations to address the crisis across various sectors on touch points. Specifics of the Governor’s Opioid Working Group’s plan can be found at www.mass.gov/stopaddiction.

The availability of treatment resources is a critical part of any effective response to the epidemic of opioid addiction in Massachusetts. The Department of Public Health/Bureau of Substance Addiction Services (DPH/BSAS), in response to recommendations developed by the Governor’s Opioid Working Group, is seeking to provide a range of comprehensive prevention, intervention, treatment and recovery support services, including Residential Rehabilitation Services/Co-Occurring Enhanced (RRS/COE) programs across the state.

The DPH/BSAS seeks to purchase RRS/COE services through this procurement. RRS/COE services are licensed as a 3.1 level of care (LOC), with programming, staffing, and space requirements that are appropriate for the treatment of individuals with a moderate to severe substance use and mental health disorder. All programs are expected to meet licensing requirements for the 3.1 level of care as well as requirements for treatment of individuals who have both a moderate to severe substance use and mental health disorder as further specified in this RRS/COE procurement.

The Bureau will consider applications that can demonstrate adaptations to the COE requirements in number of clients served, space, programming, models, and staffing specified in this RFR as long as the applicant can demonstrate that the adaptations have a foundation in research and/or best practice and can meet the safety and quality necessary to treat and support the population being served.

DPH/BSAS has included the MassHealth Specifications for contracting and payment for Co-Occurring Enhanced Residential Rehabilitation Services for Substance Use Disorders (Level 3.1), which is an attachment to this RFR. All applicants and subsequent awarded vendors are expected to meet the MassHealth specifications along with those detailed in this RFR.

The Bureau of Substance Addiction Services is seeking to fund a total of 25 RRS/COE programs across the state. Descriptions of this service and requirements were developed from The American Society of Addictions Medicine (ASAM) Criteria,[footnoteRef:2] Level 3.1: Clinically Managed Low-Intensity Residential Services, Co-Occurring Enhanced. Priority will be given to programs proposing new RRS/COE beds for expanded capacity versus conversion of existing RRS beds to RRS/COE beds. [2: The American Society of Addictions Medicine (ASAM) Criteria , Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, American Society of Addictions Medicine, Third Edition and Substance Abuse and Mental Health Services Administration, Dual Diagnosis Capability in Addiction Treatment Toolkit Version 4.0. HHS Publication No. SMA-XX-XXXX, Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011]

Although these programs are expected to meet the 3.1 level of care requirements, the co-occurring enhancement requires a smaller program size with more intensive programming and staffing that integrates both mental health and substance use disorder treatment in all aspects of the program. Programs must ensure that the principles of both trauma- and gender-informed care are followed at all times and that all staff in every shift are adequately trained to do so.

Co-Occurring Enhanced Residential Rehabilitation Services (RRS) are provided in a 24-hour, safe, structured environment, located in the community, which supports residents’ recovery from addiction and moderate to severe mental health conditions as they reintegrate into the community and return to social, vocation/employment, and/or educational roles. Scheduled, goal-oriented clinical services are provided in conjunction with psychiatry, medication management, and access to primary health care to support stabilization, development of skills necessary to achieve recovery, and improvement of overall health. A minimum of five hours a week of clinical services must be provided, and additional outpatient levels of care must be accessible concurrently as appropriate.

1.2 Applicable Procurement Law

Executive Branch Goods and Services

1.3 Whether Single or Multiple Contractors Are Required For Contract(s):

Check One (“X”):

1.4 Calendar Rule Type:

* Rolling RFR; applications will be accepted up to 12/20/27)

1.5 Acquisition Method: Fee for Service:

1.6 Use of a Procurement by a Single or Multiple Departments:

· Identify additional Eligible Entities by name or type.

The Purchasing Department reserves the right to add or remove additional authorized users during the contract term.

1.7 Expected Duration of Contract:

Anticipated Initial Duration up to: ___5_ year(s);

Anticipated Renewal Options: __2__ options to renew for __2___ year(s) each option

Final End Date of this Contract: __6/30/2028_____________________

1.8 Anticipated Expenditures, Funding Or Compensation For Expected Duration

Estimated Value of Procurement (Including Anticipated Renewal Options):

Amount $99,000,000

Check One (“X”):

Will Federal Funds be used to fund any part of Contract(s)?

*Providers receiving federal grant funds will be considered sub-recipients for federal grant purposes and will be required to comply with applicable federal requirements, including but not limited to sub-recipient audit requirements under OMB Circular A-133.

Capital, Trust and Federal Accounts Only: Any funds designated in the budget that are unspent in any fiscal year will not be available for expenditure in the subsequent fiscal year.

Notice concerning rates of payment – implementation of Chapter 257 of the Acts of 2008: An Act Relative to Rates for Human and Social Service programs provides that the Secretary of Health and Human Services has the sole responsibility for established rates of payment for social service programs purchased by governmental units of the Executive Office. Contractors will be reimbursed based on rates established by EOHHS regulation, 101 CMR 346, and other applicable rate regulations as may be amended from time to time during the duration of the Contract. As a result of Chapter 257, during the life of the Contract, rates of payment and reimbursement structures may change.

Commercial Earnings Fees: Revenues generated by for-profit organizations that are awarded contracts under this RFR may not exceed expenses incurred except in cases where a ‘for profit earnings fee’ has been negotiated between the Department and the contractor and incorporated into the approved contract. Should no earnings factor be recognized in the contract, the earnings fee shall be assumed to be zero.

Start Up and Capital Budget Any start-up costs deemed necessary will be negotiated between the purchasing Agency and the provider. Payment rates for start-up costs will be governed by 114.5 CMR 4.00 Rates for Certain Social, Rehabilitation, and Health Care Services or any successor regulation, and 808 CMR 1.00 Compliance, Reporting and Auditing for Human and Social Services. Any capital requests deemed necessary will be negotiated between the purchasing Agency and the provider and will be governed by 114.5 CMR 4.00 and any successor regulation, 808 CMR 1.00 and the Operational Services Division Purchase of Service (POS) Capital Items Procurement Policy.

2.0 Specifications

Specialized RRS/Co-Occurring Enhanced (COE) programs must provide treatment for individuals with both a substance use disorder AND moderate to severe mental health disorder who can benefit from a safe, structured, and developmentally appropriate environment and are stable enough upon admission to benefit from this level of care. Programs offer appropriate psychiatric, and substance use treatment services, with an emphasis on integrated pharmacotherapy for mental health and addiction, inclusive of medication evaluation, monitoring, and reconciliation as well as induction on medication assisted treatment (MAT) when appropriate. Programs must also offer comprehensive primary healthcare services to address the uniquely complex medical needs of individuals with co-occurring substance use disorder and mental health disorders. Services must be delivered onsite or at an affiliated clinic or outpatient prescriber that has shared infrastructure with the residential program. Providers of co-occurring enhanced RRS must meet all requirements related to the integration of pharmacological and non-pharmacological treatments of substance use disorder, mental health disorders, and primary health conditions as appropriate to meet the needs of each resident in the program. These requirements include formalized relationships with prescriber entities, which must be demonstrated in this application process and reflected in the program and staffing models. Eligible providers must demonstrate one of the following arrangements in the application process in order to be selected for contracting:

a. The provider organization that is contracted for the Co-Occurring Enhanced RRS program must ensure timely access for residents to psychiatry, addiction pharmacotherapy, and primary healthcare by also operating outpatient services, including but not limited to, an opioid treatment center, licensed mental health center, substance use disorder outpatient clinic, health center, primary care practice, bridge clinic, hospital or hospital satellite. Programs must be able to coordinate all activities related to the individual’s care, including psychiatric and clinical services; or

b. The provider organization that is contracted for the Co-Occurring Enhanced RRS program must ensure timely access for individuals to psychiatry, addiction pharmacotherapy, and primary healthcare by utilizing a partnership model, codified through a formalized agreement, such as a memorandum of understanding (MOU), between partner organizations operating outpatient services, including but not limited to, an opioid treatment center, licensed mental health center, substance use disorder outpatient clinic, health center, primary care practice, bridge clinic, hospital or hospital satellite. The organizations that partner to provide the Co-Occurring Enhanced RRS services must both possess the infrastructure and implement protocols to ensure individuals in the program receive timely access to psychiatric, mental health, and primary healthcare services, including a medication assessment and diagnostic visit within 48 hours of admission, and that all psychiatric and clinical services are coordinated with the program’s clinical staff. The Co-Occurring Enhanced RRS program will have the ultimate responsibility to coordinate an individual’s care and ensure that the individual’s behavioral health and medical treatment needs are being met, including facilitating transportation when necessary.

Co-Occurring Enhanced RRS programs will support residents in establishing and maintaining relationships with community-based prescribers. If a resident has an existing relationship with a community-based prescriber for mental health, addiction pharmacotherapy, or primary healthcare, the program shall coordinate with the individual’s outpatient treaters, including the facilitation of transportation to the community-based prescriber location.

Written protocols established between the residential program and affiliated outpatient prescribers must demonstrate capacity for integrated service delivery to residents. These protocols may include, but are not limited to, (1) scheduled team meetings between program staff and outpatient staff to discuss cases and develop strategies, (2) regularly scheduled windows of time where prescribing staff are available to see residents at designated office space within the program, (3) on-site induction of MAT, (4) medication management groups led by medical staff, and (5) joint assessments conducted between clinical and medical staff to evaluate medical and psychosocial progress.

Residential programs and affiliated outpatient programs must develop information sharing and consent management protocols to ensure coordinated treatment activities.

Programs approved to provide this specialized service will be authorized to bill at the RRS/COE rate.

For admission, exclusion, continued stay, and discharge criteria, refer to the current edition of ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, Level 3.1: Clinically Managed Low-Intensity Residential Services, Co-Occurring Enhanced.

This is a developing substance addiction service being offered. BSAS is continuing to look at ways to improve services. New program enhancements may be added to the scope of services over the lifetime of this procurement.

Licensing/EHS Siting Approval:

Providers of RRS/COE will be required to have a current Residential Rehabilitation Services license in good standing with the Bureau of Substance Addiction Services (BSAS). A license in good standing is considered such when a licensee is in compliance with all applicable DPH regulations as found in 105 CMR 164.000 – Licensure of Substance Abuse Treatment Programs. A licensee with outstanding deficiency correction orders (DCOs) may be considered in good standing if there is no history of repeat unresolved DCOs and/or the deficiencies are not a threat to the health and safety of residents.

To receive and maintain an RRS license, programs must be in compliance with the following DPH Regulations found in 105 CMR 164.000 (Licensure of Substance Abuse Treatment Programs):

· Part 1 – 105 CMR 164.001 – 164.087 Applicable to All Licensees

· Part 2 – 105 CMR 164.400 – 164.424 Applicable to Residential Rehabilitation Licensees

· Special Populations – Providers intending to serve special populations as outlined in the DPH Regulations (pregnant women, persons with co-occurring disorders, elders, or persons with disabilities) must be in compliance with 105 CMR 164.082 Special Populations.

· Link to DPH/BSAS online: www.mass.gov/dph/bsas Link to a PDF file of Licensing information: http://www.mass.gov/Eeohhs2/docs/dph/regs/105cmr164.pdf Specialized RRS for Pregnant and Post-partum Women and Their Infants: Providers submitting proposals aimed at serving pregnant and post-partum women must be in compliance with 105 CMR 164.059 Child Safety, and 105 CMR 460.00 Lead Poisoning and Prevention Control Regulations.

As part of the intent to award process applicants will be required to submit EHS New Group Home Request Form as part of the application and receive approval for program siting.

RRS/COE Linkages to Continuum of Care:

All RRS/COE must be closely connected with a range of services in the continuum of care. This continuum must provide

· integrated day-to-day linkages with services that enhance resident access to other programs;

· required services to the resident to address primary health and mental health concerns;

· support to the resident in learning the skills needed to maintain recovery;

· movement toward an independent life style;

· resources for effective aftercare planning.

When effectively implemented and coordinated in conjunction with a client’s existing care management supports (i.e. Behavioral Health Community Partner), these integrated service linkages promote the ability of residents to transition from one stage of their recovery process to the next with minimal gaps and continuing support. Effective wait list management is essential for facilitating timely and appropriate admissions while also supporting access for under-served populations.

RRS/COE providers must collaborate in the admission, transfer, referral, and/or discharge planning process from or to another treatment setting, with client consent, to ensure continuity of care. RRS/COE staff members must be familiar with all of the following levels of care/services and must be able and willing to accept referrals from, and refer to, these levels of care/services when clinically indicated. RRS/COE providers must maintain written affiliation agreements, which may include Qualified Service Organization Agreements (QSOA), Memorandum of Understanding (MOU), Business Associate Agreements (BAA) or linkage agreements, with local providers of these levels of care that refer a high volume of clients to its program and/or to which the program refers a high volume of clients. Such agreements include the referral process, as well as transition, aftercare, and discharge processes and include referrals to services including but not limited to Inpatient psychiatric hospitals, General hospitals, Emergency Services Program (ESP), Emergency departments, Acute Treatment Services (ATS) (Level 3.7), Clinical Stabilization Services (CSS) (Level 3.5), Transitional Support Services (TSS) (Level 3.1), Co-Occurring Capable Residential Rehabilitation Services (RRS) (Level 3.l), Outpatient services including Structured Outpatient Addiction Program (SOAP)/Day Treatment, Partial Hospitalization Programs, Community Crisis Stabilization (CCS), Regional court clinics, Medication-Assisted Treatment, including Opiate Treatment Programs (OTP) and Office-Based Opioid Treatment (OBOT). In addition, agreements and linkages must be established with community-based services to support ongoing recovery such as housing, recovery and peer networks, employment and vocational services, and the range of behavioral and medical health services.

With client consent, the provider must collaborate with the resident’s primary care clinician, primary care physician, and or mental health professional. When necessary, the provider must arrange transportation for services required that are external to the program during the admission. The provider must make reasonable efforts to assist residents in identifying transportation options when needed, including public transportation, Prescription for Transportation (PT-1) forms, etc. The provider shall demonstrate a capacity to work collaboratively with multiple systems, including substance use disorder treatment providers, primary health care, community-based support services, housing search services, supportive housing service providers, mental health service providers, other relevant human services, and various aspects of the criminal justice system, as appropriate.

Additionally, defined linkages with a range of substance use as well as non-substance use specific services reinforces and supports residents while they are in residential recovery services in an integrated and mutual fashion. Increasing service capacity for under-served and priority populations may be broadened through specific, well-developed linkages. Strong internal programming and linkages with primary health services, mental health services, HIV testing and counseling, housing services, and educational and vocational services (including job search) are vital for successful outcomes. Assisting residents in developing skills and opportunities needed to transition from the residential program to the next stage in their move towards independence is essential in the development of an effective treatment plan.

Persons utilizing medication assisted treatment: To reduce barriers for individuals utilizing medication assisted treatment (MAT), Residential Rehabilitation Service providers must be able to serve clients on medication assisted treatment including buprenorphine, methadone, or extended release naltrexone. Serving clients on MAT includes the ability to effectively establish collaborative agreements with methadone dosing services and prescribers to provide different components of the service and to integrate care for clients. Programs must demonstrate the ability to actively facilitate induction and maintenance of MAT for residents with opioid use disorder (OUD) as a core component of the treatment model. This can be occur by leveraging affiliations with waivered buprenorphine prescribers and/or opioid treatment centers.

BSAS Standards of Care:

BSAS will require compliance with all BSAS Standards of Care and will pay particular attention to compliance with the following:

Committed to Engaging and Serving Persons with Co-Occurring Mental Health Disorders:[footnoteRef:3] All treatment programs are expected to be co-occurring capable (COC). [3: The BSAS Standards of Care are the minimum standards required for all programs. Requirements for specific programs may go beyond the criteria delineated in the Standards of Care. ]

Treatment vendors are required to assess their capacity to serve individuals with co-occurring disorders, (COD) and to ensure that:

· Organizational leadership analyzes existing systems and operations to identify and implement ways to ensure smooth care coordination; this analysis is included in vendor’s quality improvement plans;

· Collaborative agreements with mental health service providers are in place and provide for systems for referral and follow-up, care coordination, and periodic review of obstacles and success;

· Screening and assessments include mental health needs; plans specify goals for mental health care;

· Treatment plans specify referral and follow up for mental health services, process for care coordination, plan for care management, specifically for ensuring proper medication management; and

· Staffs are trained in mental health issues and disorders as well as side effects of medications.

Trauma-Informed Services: Trauma-informed care is an approach to delivery of behavioral health services. Given the prevalence of trauma among persons with substance related disorders, and the benefits of trauma-informed approaches, BSAS requires vendors to establish trauma-informed treatment environments and provide trauma informed care, as evidenced by:

· Stated commitment to trauma-informed care, with emphasis on individual choice and decision making;

· Collaborative systems which provide for access to trauma specific services;

· Inclusion of trauma screening in all assessments, and periodic reassessments;

· Prohibition of coercion or force in treatment;

· Recognition that children of individuals served have experienced trauma, and that they and their parents may require support and assistance in obtaining effective trauma treatment.

Committed to Opioid Overdose Prevention: Vendors are required to support Massachusetts’ efforts to prevent and reduce opioid overdose, as evidenced by:

· A stated commitment to prevent and reduce opioid overdose;

· Up-to-date knowledge of overdose prevention and response resources in their communities, including identification of pharmacies stocking naloxone and/or having standing orders for naloxone;

· Establishing an on-site overdose emergency response plan and ensuring all staff are trained in preventing, recognizing and responding to overdose;

· Including review of overdose history (including witnessing overdose) in treatment assessments;

· Educating individuals served about opioid overdose prevention, recognition and response;

· Allowing individuals served to retain possession of naloxone rescue kits while in the treatment program;

· Including opioid overdose risk reduction in treatment and discharge plans.

Medication Assisted Treatment: Research and experience provide an increasingly comprehensive understanding of the physiological changes that accompany or result from substance use. For example, we understand a great deal about substance-related changes in metabolism and brain activities such as increased or decreased neurotransmitter production. This expanding field of knowledge is accompanied by increased availability of effective treatments using medications which target those physiological effects, for example by disrupting metabolism of the substances, or modifying substance-related brain activity. The effectiveness of medication assisted treatment in stabilizing individuals and enabling them to build a recovery-based lifestyle is well documented. BSAS supports the use of proven and effective medication assisted treatment in a variety of settings.

Service Elements:

A. Application and Admission:

1. Information and Waitlist Management for Potential Applicants:

RRS/COE providers will be expected to keep current their program’s relevant descriptive and referral information on the Massachusetts Substance Use Helpline system (or other system as identified by BSAS). In addition, RRS/COE providers are required for waitlist management of residential beds via an identified secure system (currently maintained by the MA Substance Use Helpline). Providers are expected to maintain protocols and practices for maintenance of current lists of all individuals on their waitlist including daily updates to the waitlist.

2. Criteria for Admission to RSS/COE programs

Admission to RRS/COE programs for all residents will be based on absence of acute withdrawal symptoms, behavioral appropriateness for the program and in accordance with the American Society of Addiction Medicine (ASAM) criteria http://www.asam.org/publications/the-asam-criteria

Admission to RRS/COE programs Individuals eligible for a Co-Occurring Enhanced RRS level of care must meet each of the following criteria:

1. Following a clinical assessment based on the six dimensions of the American Society for Addiction Medicine (ASAM) Criteria, the individual is deemed appropriate for a Co-Occurring Enhanced RRS level of care. The individual is sufficiently stabilized to participate in the assessment process.

2. The individual is diagnosed as having both a substance use disorder and moderate to severe mental health condition, consistent with relevant DSM-5 diagnosis.

3. Mental health symptomology and presentation, inclusive of social, emotional, cognitive, and behavioral presentations, must be sufficiently acute that a small milieu and high staff-to-client ratios are necessary for the individual to be successful in the program. Behavioral health presentation must be such that 24-hour clinical supervision may be required, and frequent individualized attention is necessary for the individual to be successful in the milieu and with treatment goals. Based on symptom presentation, the individual can be appropriately and safely treated in a community environment but would not likely be successful in a Co-Occurring Enhanced RRS program.

4. The individual is in immediate need of medication evaluation and reconciliation and requires support from a structured program environment in accessing community prescribers and achieving stability on a medication regimen.

5. The individual has a recent history of service utilization that highlights the need for co-occurring enhanced services. Within the past three months, an individual must have experienced at least one of the following events:

a. An inpatient psychiatric hospitalization

b. At least two emergency department and/or ESP visits

c. Unsuccessful engagement and/or inability to succeed in other community-based services based on psychosocial or clinical complexity related to substance use and/or mental health disorders

Note: Individuals who meet the Admission Criteria and do not meet the Exclusion Criteria, are still eligible for 3.1 co-occurring enhanced services if they meet either of the following criteria:

1. The individual has been discharged from an inpatient psychiatric program and is able to participate in the treatment activities in a community-based setting. Individuals discharged to Co-Occurring Enhanced RRS programs from an acute psychiatric setting may benefit from additional services that offer psychiatric and clinical supports in conjunction with the Co-Occurring Enhanced RRS program. In such cases, treatment planning and service delivery must be coordinated and aligned.

2. Individuals who have gone through withdrawal management and/or are inducted on MAT are eligible for direct admission to Co-Occurring Enhanced RRS services provided that any symptoms of post-acute withdrawal are manageable in a community setting with access to low-intensity nurse monitoring and/or management with medication-assisted treatment. This includes individuals discharged from the emergency department after receiving withdrawal management services.

Individuals are not eligible for a Co-Occurring Enhanced RRS program if they meet any of the following criteria:

1. The individual does not have a mental health diagnosis or has a substance use disorder as a primary diagnoses and can be treated effectively in a Co-Occurring Capable RRS program.

2. The individual has substance use disorder and mental health diagnoses and can be effectively treated in a Co-Occurring Capable RRS program with access to outpatient mental health counseling.

3. The individual does not require overnight clinical supervision, does not require substantial individualized staff attention, and could be effectively treated in a Co-Occurring Capable RRS program.

4. The individual is experiencing symptoms of severe withdrawal that require the resources of a hospital, emergency department, and/or medically monitored withdrawal management facility, such as an Acute Treatment Services program.

5. The individual cannot be appropriately treated and/or is not safe in a community-based setting based on acute psychiatric symptoms.

B. Resident Services:

1. Assessment:

In order to accept an individual into RRS/COE, the individual must meet the ASAM level of care for admission into the RRS and must be assessed before admission into the program. http://www.asam.org/publications/the-asam-criteria. The vendors must utilize evidence-based assessment tools for assessing Substance Use Disorders (SUD) and for ASAM level of care, which must be approved by the BSAS.

Upon admission to RRS/COE, residents must receive a diagnostic and medication evaluation as well as an evidence-based biopsychosocial clinical assessment using ASAM dimensions. The combined results of these assessments, along with information received from prior treatment histories and/or discharge plans, will become the basis of an individual’s treatment plan which must be developed in conjunction with the resident.

1. Providers must ensure residents have access to psychiatrists and/or mid-level practitioners under the direction of a psychiatrist within 48 hours of admission to perform diagnostic and medication evaluations, provide refills if necessary, and to begin the process of medication reconciliation, adjustments.

· The Co-Occurring Enhanced RRS program shall ensure that the resident goes through a medication reconciliation process in order to avoid inadvertent inconsistencies in medication prescribing that may occur in the transition of a resident from one care setting to this level of care.

· Results of the medication evaluation and medication reconciliation plan must be available to the staff in the program.

2. Clinicians in the RRS program must complete an initial evidence-based biopsychosocial clinical assessment using ASAM dimensions for each resident that includes the following elements:

· A statement as to the status and nature of the resident’s substance use disorder

· In addition to the requirements for assessment of a primary substance use disorder, residents must have a diagnosed primary mental health disorder that is moderate to severe and is documented in the records by an appropriate licensed clinician.

· Substance use disorder assessments must include review of the full range of substances of abuse that a client may be using, including alcohol, opioids, and other drugs (i.e. cocaine, tobacco, etc.)

· Assessment for mental health disorders is formal, standardized and integrated with assessment for substance use symptoms. The program provides standardized or formal integrated assessment to all individuals following all positive mental health screens per formal policy.

· Evidence supports that the full range of mental health diagnoses are provided.

· Appropriateness of bidder’s level of care in relation to a resident’s treatment needs;

· A history of the use of alcohol, tobacco, and other drugs, including age of onset, duration, patterns and consequences of use; use of alcohol, tobacco, and other drugs by family members; types of and responses to previous treatment and risk for overdose;

· Assessment of the resident’s psychological, social, health, economic, educational/vocational status; criminal history; current legal problems; co-occurring disorders (COD); disability status and accommodations needed, if any; trauma history; and history of compulsive behaviors, such as gambling. This assessment must be completed before a comprehensive service plan is developed.

· Assessment of resident’s infectious disease risk including HIV/AIDS, viral hepatitis, STD, and TB ; Identification of key relationships (e.g. significant others) supportive to individual’s treatment and recovery

· A list of the resident’s current medication, based on pharmacy label, which shows the date of filling, the name and contact information of the prescribing practitioner, the name of the prescribed medication, condition for which the medication is prescribed;

The assessment must be reviewed and approved by the Clinical Supervisor and made available to medical staff at an affiliated clinic involved in the treatment of the resident.

2. Individual Recovery Treatment and Service Plan

Providers of RRS/COE must complete an individual recovery treatment and service plan, tailored to the need of each resident, in collaboration with the resident. The recovery treatment and service plan must be developed collaboratively and shared with medical, prescribing, clinical, and recovery staff involved in treating the resident and all subsequent updates must include documentation of, at a minimum, the following information:

· The treatment and service plans for individuals with COD must indicate that both the mental health disorder as well as the substance use disorder will be addressed.

· The interventions used by the program include both psychosocial and pharmacological treatments

· Within the program, the treatment plans of individuals with COD consistently and equivalently address both substance use and mental health disorders with clear, specific, measurable objectives and individualized interventions that systematically target symptoms of the specific disorders;

· A statement of the resident’s strengths, needs, abilities, and preferences in relation to his/her substance addiction treatment, described in behavioral terms;

· Evidence of the resident’s involvement in the formulation of the treatment plan, in the form of the resident’s signature attesting agreement to the plan;

· The service to be provided, and whether directly or through referral;

· The service goals, described in behavioral terms, with time lines;

· Clearly defined staff and resident responsibilities and assignments for implementing the plan;

· A description of discharge plans and aftercare service needs;

· Aftercare goals; and

· The date(s) the plan was developed and revised.

3. Aftercare Plan

Providers must ensure that residents and staff work together to identify action to be taken and resources needed in relation to the resident’s aftercare goals. The aftercare plan must be developed in conjunction with Treatment and service Recovery Plans and must set forth the expectation that treatment continues indefinitely with a goal of illness management. This individualized, appropriate resident aftercare plan must include

· referrals to: individual, group and/or family outpatient aftercare as appropriate;

· connection with ongoing primary healthcare;

· alcohol and drug free living environments;

· vocational and educational opportunities;

· resources to support access to social benefit programs designed to meet specific resident needs; etc.

· specify strategies to be used to follow-up with the resident after the resident leaves.

· capacity to assist individuals with psychotropic medication planning, prescription, medication reconciliation, and medication access and monitoring, and prescribing sufficient supplies of medications at discharge and ensuring a successful referral to professionals that will be able to continue to provide medication management for both substance use and mental health disorders, as appropriate.

· Discharge plans that are developed with an equivalent focus on needed follow-up services and for both mental health and substance use disorders including support for a client’s ongoing access to Medication Assisted Treatment in all environments.

· Referrals that are confirmed and documented in the discharge plan. The program must have specific protocols that guide the discharge process.

· Formal mechanism for providing ongoing needed mental health follow-up. Mental health concerns must be followed-up and monitored in a manner that is integrated with substance use follow-up.

· Assertive linkages and interventions routinely made should target specific co-occurring needs to facilitate use of addiction peer support groups or groups specific to both disorders upon discharge.

· Support for the resident in accessing peer recovery support groups by routinely facilitating the process of assertively matching individuals to these groups at discharge. This may be a component of the program’s continuity of care policy, and it may include facilitating connections to the recovery community by accompanying residents to meetings in the community, or enabling residents to attend in-house mutual aid meetings on site indefinitely

Residents and staff will work together to ensure that recovery maintenance strategies are in place and working effectively and that referrals to services have met intended goals. The provision of aftercare services by the RRS/COE vendor is not a component of this procurement.

4. Case Management Services

RRS/COE programs must provide case management referrals that address both substance use and mental health disorders in an integrated manner. Where possible, referrals must be made to programs that can address CODs and support individuals in the community.

Case management is a set of social service functions that include planning, linkage, monitoring, and advocacy.

Providers must demonstrate a capacity to work collaboratively with multiple systems, including substance addiction treatment providers, primary health care, community-based support services, housing search services, supportive housing service providers, mental health service providers, other relevant human services and various aspects of the criminal justice system, as appropriate. Staff will have well-developed up-to-date resources and linkages in the areas of: supportive housing, permanent housing, ambulatory services, self-help, vocational/educational opportunities in the community, including Mass Rehab services, mainstream services and benefits, and access to insurance.

The overall goal of Residential Rehabilitation Services Case Management is to facilitate comprehensive support and linkages for individuals by providing referrals, information, advocacy and follow-up for public assistance, substance addiction counseling, primary health care, insurance, self-help and mental health services, vocational/ educational opportunities, housing as appropriate; and residents who will be assisted in communicating with the criminal justice system as appropriate. In providing case management, providers will assist residents in developing their own skills in locating and obtaining needed services and resources. Providers will ensure that case management needs of residents are assessed on an individualized basis.

· Case Management will function as a resource to residents, beginning with development of residents’ treatment and service recovery plans;

· The extensive resources of Case Management will aid in discharge planning through well-developed resources and linkages;

· Case Management will contribute to the development of an Aftercare Plan, linked to residents’ Treatment and Service Recovery Plans;

· In discharge and Aftercare planning, residents and staff will work together to insure that recovery maintenance strategies are in place and working effectively, and that referrals to services have met intended goals.

· Case Management activities will begin at the onset of treatment, in accordance with the needs identified in the Treatment and Service Recovery Plan.

· Case Management activities will emphasis search for housing to facilitate discharge once residents have achieved clinical goals in the program.

5. Daily Programming:

Providers will establish a program of daily activities which are designed to facilitate stabilization of substance use and mental health symptoms, establishment maintenance of medication regimens, resident participation in community interaction, and promotion of resident recovery. Providers will develop daily and weekly schedules that ensure opportunities for residents receive services in accordance with their individualized treatment plans, including periodic reassessments to identify progress, accessing medical services, support in making and keeping appointments, receiving clinical services, including participating in groups which include accommodating residents’ with disabilities while also scheduling groups to accommodate residents who work. Providers will ensure that staff is able to prepare for groups, including preparation of curricula and follow up as needed after group sessions. Providers will also ensure that staff are available and will regularly communicate with residents outside of scheduled sessions to monitor status and progress.

The daily program shall include:

· Multi-dimensional treatment delivered by an integrated team involving staff trained in substance use disorders, mental health, and psychiatry/medication management. Resident’s mental health and addiction pharmacotherapy needs must be addressed along with clinical and psychosocial needs.

· Onsite delivery of coordinated psychiatry by providing the infrastructure and protocols to ensure psychiatrists and/or mid-level practitioners spend time with program staff, attend team meetings, review treatment plans, and interact with the residents in the program. This may include, but is not limited to, (1) scheduled team meeting between program staff and outpatient staff to discuss cases and develop strategies, (2) regularly scheduled hours where prescribing staff are available to see residents at designated office space within program, on-site induction of MAT, (3) medication management groups led by staff from the affiliated clinic or prescriber organization, (4) assessments and periodic reassessments conducted with residents jointly by residential staff and outpatient staff members to strengthen relationships and support coordinated, comprehensive treatment.

· Space on site and shared staff with an outpatient clinic as part of the daily schedule; procedures and protocols to ensure coordinated care.

· Treatment monitoring and documentation routinely reflect a systematic and in-depth focus on changes in the symptoms of both mental health and substance use disorders.

· Routine capability or a process to ascertain risk with ongoing use of substances and/or severity of mental health symptoms with focus on maintaining client in in program unless commitment is warranted. The program has explicit and thoroughly written guidelines for comprehensive mental health and substance use crisis/emergency management that outline explicit in-house procedures, including the completion of advance directives pertaining to mental health crisis and substance use relapse with every patient, use of a formal risk assessment tool, and expected intervention strategies matched to assessed risk, including opiate reversal medication. These guidelines are designed to maintain individuals within the program, unless the severity of the circumstance warrants alternative placement. This means that the program is capable of ongoing risk assessment and management of persons with interacting and exacerbating symptoms. Staff expects crisis/emergency situations, and is thoroughly familiar with and adheres to the guidelines.

· Stage of motivation routinely incorporated into individualized plan, and formally prescribed and delivered stage-wise treatments for both substance use and mental health issues. The program regularly assesses and documents stage of change or motivation for both substance use and mental health disorders throughout the course of treatment, and specific stage-wise treatments for both disorders are routinely provided to individuals based on these re-assessments.

· Planned and structured opportunities for residents to meet with prescribers and other medical staff to discuss symptoms and evaluate medication regimens, with an emphasis on regular visits during the initial period following admission to support activities such as induction to MAT, medications evaluation, reconciliation, and dosing adjustments.

· Nursing staff and other medical professionals must be available and present in the milieu as needed to monitor residents and address and mitigate any adverse physiological or psychiatric effects from changes in medication administered while in the program.