2023HCA15 - 988 RFI.pdf

Washington State Health Care Authority and Department of Health

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Behavioral Health Integrated Referral Systems

Request For Information

The Washington State 988 NSPL Crisis Call Center and Behavioral Health Integrated Referral Systems Engrossed Second Substitute House Bill 1477; Laws of 2021, Chapter 302

March 23, 2023

Department of Health

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Acknowledgements

This work was supported by and in collaboration with the Military Department.

Cherry Street Plaza 626 8th Avenue SE Olympia, WA 98501 www.hca.wa.gov

Town Center 2 111 Israel Road SE Tumwater, WA 98501 www.doh.wa.gov http://www.hca.wa.gov/ http://www.doh.wa.gov/

Department of Health

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Contents

1. Introduction

Purpose

RFI Goals and Objectives:

Background

2. Project Overview

High Level Overview of the Crisis Call and Response System

Figure 1: High Level Process of the complex crisis call center platform and response system in Washington State

Summary of the Technical and Operational Plan

3. Engagement and Methodology

Planning

4. Technology Requirements

Instructions for Technology Requirements Responses

Section I. Cloud-based solutions

RFI Questions Section I:

Section II. SaaS/COTS solutions

RFI Questions Section II:

Section III. Natural System Boundaries

RFI Questions Section III:

Section IV. Data Governance

RFI Questions Section IV:

Section V. Data Security and System Management

RFI Questions Section V:

Section VI. Privacy and Protocols

RFI Questions Section VI:

Section VII. Tribal Data Sovereignty

RFI Questions Section VII:

5. Functional Requirements

Instructions for the Functional Requirements Responses

Section VIII. Call Center Platform: Create, Assign, & Track (follow-up)

RFI Questions Section VIII:

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Section IX. Responder Dispatching: Identify, Dispatch, & Track

RFI Questions Section IX:

Section X. Resource Directory: Access, Use, Query, & Share

RFI Questions Section X:

Section XI. Provider Portal: Search, Create, Request, Exchange (Ingest & Share), and Manage Account

RFI Questions Section XI:

Section XII. Referrals and Appointments: Search, Create, Assign, & Track

RFI Questions Section XII:

Section XIII. Manage Consent: Capture, Share, & Retrieve

RFI Questions Section XIII:

Section XIV. Electronic Documents: Create, Display, Modify, & Exchange

RFI Questions Section XIV:

Section XV: Bed Registry: Display, Search, Refer, Update, Collect, Capture, Report

RFI Questions Section XV:

Section XVI: Reporting: Create, Customize & Share

RFI Questions Section XVI:

6. Technology Assumption, Constraints, Risks

Assumptions

Constraints

Risks

Quality Assurance and/or Independent Verification and Validation services

7. Administrative Terms and Conditions

1 RFI Coordinator

2 RFI Schedule

3 Response Format

4 Revisions to the RFI

5 No Obligation to Buy or Issue Solicitation

Glossary

Appendix

Appendix N of the Technical and Operational Plan (Functional Requirements)

Summary Table

Call Center Platform Requirements: Details

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Bed Registry Requirements: Details

Responder Dispatching Requirements: Details

Referrals and Appointments Requirements: Details

Reporting Requirements: Details

Appendix O of the Technical and Operational Plan (Crosswalk of Functional Requirements and House Bill 1477)

Call Center Platform Requirements Crosswalk

Bed Registry Requirements Crosswalk

Responder Dispatching Requirements Crosswalk

Referrals and Appointments Crosswalk

Reporting Requirements Crosswalk

Department of Health

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1. Introduction Purpose

This Request for Information (RFI) is seeking information that will assist the Washington State Health Care Authority (HCA) and the Washington State Department of Health (DOH) in the prospective procurement and implementation of a system that meets the needs of Laws of 2021, Chapter 302, Engrossed Second Substitute House Bill 1477 (2021 E2SHB 1477). No contract will be awarded from this RFI. 2021 E2SHB 1477 requires enhancements to the crisis call and response platform and the behavioral health integrated client referral system. In October 2022, HCA, in collaboration with DOH, produced a Technical and Operational Plan that identifies the technology tools, platforms, processes, systems, and standards necessary to manage and operate the behavioral health crisis response and suicide prevention system in Washington State. Respondents to this RFI may find the Technical and Operational Plan a helpful resource in preparing responses.

RFI Goals and Objectives:

• Inform – HCA and DOH are currently gathering information for possible procurement of technology tools, platforms, and systems to meet the requirements of 2021 E2SHB 1477. With this RFI, HCA hopes to inform the vendor community about this prospective procurement, including:

1. The business context for these procurement(s);

2. The framework HCA and DOH will use when making decisions regarding the design and implementation of these systems to meet the requirements of 2021 E2SHB 1477;

3. The major business and technical requirements HCA and DOH anticipate for these solutions;

and

4. Where applicable, any non-technical solutions needed to support technical systems.

• Learn – HCA and DOH aim to use this RFI to learn from the vendor community:

1. The technology available that would meet these needs;

2. Cost estimates for budget planning; and

3. Approaches for the design and implementation of systems to meet the requirements of

2021 E2SHB 1477.

• Guide – HCA and DOH hope to use this RFI to accelerate our efforts to design, procure, and implement needed systems to meet the requirements of 2021 E2SHB 1477 in the following ways:

1. Determine the technology needed to implement the systems to meet the requirements of

2021 E2SHB 1477; and

2. Determine whether to issue one or multiple Request(s) for Proposals (RFPs).

Background

In recognition that suicide is a leading cause of death in the United States and that this public health crisis has been exacerbated by the COVID-19 pandemic:

• In July 2020, the Federal Communications Commission (FCC) designated 988 as the dialing code for individuals in crisis to connect with suicide prevention and mental health services.

• In October 2020, the National Suicide Hotline Designation Act of 2020 was signed into law requiring all telephone service providers to direct all 988 Suicide & Crisis Lifeline calls to the existing National https://www.hca.wa.gov/assets/program/final-technical-and-operational-plan-988.pdf

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Suicide Prevention Lifelines (NSPLs) crisis centers by July 16, 2022. There are three NSPLs in Washington.

• In 2021, Vibrant Emotional Health, the national administrator for the 988 Lifeline, made grant awards available to states to plan for the implementation of the 988 Lifeline.

• In 2022, SAMHSA awarded $282 million in grants to help states transition the NSPL crisis centers to the 988 Lifeline, support the telephone, call/chat infrastructure, and strengthen crisis center staffing.

• In 2021, Washington passed 2021 E2SHB 1477 which set out expectations to build and implement a complex system that would standardize a crisis call and response system and client referral system statewide.

Call centers currently have multiple platforms. This RFI is intended to guide development of a new system that can either replace or integrate with the various platforms currently used.

2. Project Overview High Level Overview of the Crisis Call and Response System

The Washington NSPL call centers (that support call, chat, text capabilities) and response systems involve many complex components and actors, each with their own complexities and workflows. Figure 1 below shows a high-level process of how these complex systems and actors may work together. Please note that this diagram is an overarching representation of a highly complex system that requires technology solutions to finalize; details of the relationship between various actors are not explicitly stated.

Once the individual in crisis makes a call, it is routed to an NSPL where information is logged into the crisis contact center system. There, the caller’s needs are triaged, and proper responders will be engaged. If a referral and follow-up is needed for that caller, the future integrated referral system will provide the information to support the individual for longer term and follow-up treatment. Information into the referral system will be received from a variety of existing and future systems which will use our interoperability platform and applicable standards.

In Figure 1 below, systems that are planned are color coded and labeled as such. Each of the components and actors in the system may need to change current processes to operate smoothly with other systems or components. Systems will need to consider the need for interoperability with existing platforms and systems and have features to support that interoperability built into the solution.

As new systems are developed, the state will:

• Evaluate each of the components connected to a particular system to ensure the data can flow at appropriate security and privacy levels;

• Consider how the system functionality supports the business goals; and

• Work with the business to ensure that the business processes for each component achieves intended goals.

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Health Integrated Referral Systems

Caller (Individual in crisis or others calling for individual)

NSPL Crisis Call Operator

988 Call Is Active Rescue needed?

Safety & Crisis Plan Needed?

No No

Determine next steps, plan of action and care needed

Referral Required?

Yes

911 Forward WA Indian BH Hub

Regional Crisis Hubs

Calls from other sources forwarded to NSPL or from NSPL

Resolve Emergent Crisis

Situation

Create or pull from EHR, document, verify safety plan

Treatment facilities, ED, community or social services

Warm hand -off

Follow upNo

Future BH Integrated Client Referral System

Yes

If treatment is complete

Bed Availibility

System

Provider Directory

LRA/

Mental Health

Systems

Other Ancillary systems

EHRaaS Systems

Other Call Sources

Future Interoperable Systems

Individual in crisis In treatment or crisis is resolved

Future Crisis Call and Response

System

Call information logged into system

Call to other sources

Yes

Document Safety Plan

If additional services needed

Document, notes, plans reports

Provider with Certified EHRs

Advanced Directives

Engage DCR

Engage MCRU

Engage Co-responder

Engage 911/Police

Engage EMS, Fire

Responder Types

Document, notes, plans reports

Community Services

(ie. 211)

HSDS/AIRS

DOH/HCA Provider Info

HSDS/AIRS

CIE

Emergent Crisis Resolved

Start

End

Dispatched by RCL

Figure 1: High Level Process of the complex crisis call center platform and response system in Washington State

Department of Health

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When people reach out to the 988 NSPL Lifeline by call, text or chat they will be connected 24/7/365 to trained counselors who will proceed with established protocols to respond to the specific needs of the person including, as needed, coordinating with regions and providers to send mobile crisis response (MCR) teams and/or other in-person responders, providing support and resources, and as necessary, referring the person to an appointment or other needed community or facility-based services. Referrals will need to be a bi-directional electronic exchange allowing the sending provider to create a referral and the receiving provider to send a report regarding the outcome(s) of the referral (see definition of “closed loop referral” in the Glossary). The statewide goal is to ensure that the system provides equitable services to underserved communities and adequate follow-up and support to all users of the system. This complex process requires implementation of several technology solutions by multiple actors across five crucial domains: call center, referrals and appointments to resources, bed referral/registry, responder dispatching, and reporting. Several of these domains will require the use of provider resource directories.

Summary of the Technical and Operational Plan

The Final Technical and Operational Plan described the need for a “System of Systems” approach to integrate and interoperate systems to support requirements in 2021 E2SHB 1477. Reading the Technical and Operational Plan, or viewing referenced sections, is highly recommended to understand the project as it is currently, and where it aims to be. As depicted in Figure 2, 2021 E2SHB 1477 requires technology systems and tools for the:

1. Call Center: NSPLs managed by DOH (i.e., the Crisis Call Center Platform/Customer Relationship Management (CRM) Tools);

2. BH Integrated Client Referral System: Tools used by crisis service providers (e.g., tools that support the creation, exchange and access to information needed for and by the behavioral health integrated client referral system including bed registry, electronic health records (EHRs);

and

3. Interoperability platform: Supports interoperable exchange of information between crisis call centers and crisis providers, and between crisis providers and other providers (i.e., ancillary systems).

Department of Health

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Call Center

(DOH)

Interoperability Platform

(HCA)

Crisis Services Providers

(HCA)

m

Enabling functionality for:

• Referrals

• Follow up appointments

• Provider communication

• 988 Call Line

• Leveraging 911

• Call Center System

• Customer Relationship

Management (CRM)

• Bed Registry

• Certified EHR (including EHRaaS)

• Real-time location

• Referrals

• Follow-up appointments

Enabling Interoperability Between:

• 988 Crisis Call Centers

• Regional Crisis Lines

• Crisis Providers

• Behavioral Health/Other Providers

Figure 2: Systems of Systems

To further elaborate on Figure 2:

1. The “Call Center” referenced in Figure 2 refers to the 988 NSPL Crisis Call Center Platform: The 988 Lifeline crisis call center system platform that will be used by NSPLs will need to support the functionalities listed below either via the platform and/or leveraging third party vendor applications:

• Receive calls, texts, and chats via the 988 number;

• Document the call information including the safety plan;

• Provide for early identification of tribal affiliation;

• Share relevant information with the Integrated Referral System; and

• Create and share reports (e.g., related to outcomes).

The 988 Suicide & Crisis Lifeline is a nationwide network of more than 200 NSPL crisis call centers that answer the 988 Lifeline. Trained counselors offer free, confidential support to people in suicidal crisis or emotional distress, as well as prevention and crisis resources for people or their loved ones. There are three 988 Lifeline-accredited NSPLs in Washington State that answer 988 Lifeline calls:

1. Crisis Connections serves King County as the 988 NSPL provider, as well as the 24/7 King County Regional Crisis Line provider, and the King County 211 provider. Crisis Connections also provides 24/7 regional crisis lines for 8 counties in North Central, Southwest, and Pierce ASO regions, as well as several other state-wide hotlines.

2. Frontier Behavioral Health is the NSPL that serves the Greater Spokane Region (six counties in Eastern Washington) and is also the 24/7 Regional Crisis Line.

3. Volunteers of America Western Washington (VOA) is the NSPL serving the remaining 32 counties and is the only crisis center that is currently accredited in Washington state to answer 988 chats and texts.

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VOA is also home of the Native and Strong Lifeline, which is the first program of its kind in the nation dedicated to serving American Indian and Alaska Native (AI/AN) people who call 988. AI/AN people dialing 988 will now be able to choose option 4 on the dial pad connect to the Native and Strong Lifeline.

2021 E2SHB 1477 requires DOH to create rules with standards that NSPL crisis centers must meet to become designated as crisis call centers and use the 988 NSPL Crisis Call Center System Platform to perform the services outlined above.

2. The “Behavioral Health Integrated Client Referral System” (Integrated Referral System) referenced in Figure 2 refers to an Integrated Referral System that is needed to:

• establish needed connections (e.g., between 988 NSPL Lifeline crisis centers and RCLs);

• support information sharing and coordination (e.g., between RCLs and crisis responders, and between crisis responders and other providers);

• support and follow protocols for Tribal members outlined in the Tribal Crisis Coordination Protocols;

• support referrals (e.g., between crisis providers and other providers); and

• produce needed reports (including outcomes).

The behavioral health crisis system in Washington is operated regionally by BH-ASOs. The Final Technical and Operational Plan references the ten (10) BH-ASOs that administer the regionally based crisis system in the State. It is recommended vendors refer to the Technical and Operational Plan for additional information regarding BH-ASOs and regional crisis services.

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Figure 3: BH-ASO Map

• All BH-ASOs contract to provide RCL services for their region. Eight out of ten BH-ASOs contract with an NSPLs to provide crisis line services for their regions.

• The remaining two BH-ASOs contract with different provider(s) for their Regional Crisis Call Systems.

BH-ASOs are tasked to ensure there are behavioral health crisis services available to anyone in Washington regardless of payer. These crisis services include Regional Crisis Lines (RCLs), Mobile Crisis Responder (MCR), and Designated Crisis Responders (DCRs) to perform, if necessary, evaluations for involuntary treatment act (ITA) services. BH-ASOs contract with providers for MCR, RCL, and DCR services to ensure 24/7/365 coverage. In most regions, RCLs act as the primary pathway to receive MCR services. RCLs send referrals to MCR providers for them to dispatch teams. MCR teams can also receive referrals from other sources and triage based on acuity.

The statewide goal is to provide follow-up services to a 988 call as needed for up to 14 days in the near-term and up to 8 weeks in the mid to long-term. The State’s preference is to have MCRs respond first on behalf of crisis callers who require an in-person response followed by use of DCRs. However, current workforce limitations sometimes result in DCRs being the first responder in some regions of the state. Under these circumstances, DCRs may provide both mobile crisis and ITA investigations. Currently, there are about 50 providers with approximately 800 responders total for both MCR and DCR services statewide.

In each region there are facilities to serve people in acute crisis. These facilities vary in titles but can be separated by license into a few categories. For mental health crisis, services include Crisis Stabilization Units (CSU), Crisis Triage (CT), Evaluation and Treatment (E&T), and inpatient treatment. For SUD crisis, services include withdrawal management, secure withdrawal management, and residential/intensive inpatient services. All facilities contract with BH-ASOs, Medicaid managed care organizations (MCOs), and commercial carriers for funding. There are approximately 90 facilities in the state now with about 15 more of various types being built.

Work is still ongoing to better integrate 988 NSPL crisis call centers with regional crisis service lines to ensure better services to callers. In the interim, BH-ASOs will continue to dispatch regional crisis services in response to calls to the 988 NSPL Lifeline crisis centers and the RCLs.

The responsibility to dispatch crisis response services will be determined.

3. The “Interoperability Platform” referenced in Figure 2 refers to systems that are needed to support and facilitate interoperable information exchange to and amongst these two primary systems (i.e., the crisis call center platform and the behavioral health integrated client referral system). For example:

• Referrals are envisioned to be supported by and will leverage several future interoperable systems including:

Department of Health

Page 13 of 58 RFI 2023HCA15 988 NSPL Crisis Call Center and o Resources for bed availability: health and behavioral health providers will enter real-time information regarding bed availability and other information that will be used by RCLs to support referrals;

and o Provider resource directories: health, behavioral health, and social service resource information will be used by both 988 NSPLs and RCLs to identify needed resources.

• Information will be shared regarding:

o Least restrictive alternative (LRA) treatment orders or Assisted

Outpatient Treatment (AOT) o Mental health advance directives (MHADs) o Crisis/suicide assessments o Crisis plans

• Information from:

1. EHRs (including statewide EHR) and

2. Other systems (i.e., 911, 211)

Vendors can suggest innovative approaches that use both interoperability and integration as pathways to architecting a connected system. Many industry standards are available to support interoperability and integration.

• APIs (Application Programming Interfaces) are preferred for any exchange of data in between systems. HCA uses MuleSoft for API management.

• Health care standards are published by the U.S. Department of Health and Human Services Office of the National Coordinator for Health IT (ONC). Any systems added to this architecture will be required to support applicable ONC standards including United States Core Data Interoperability (USCDI) content standards (e.g., LOINC, SNOMED, CPT), data exchange standards (e.g., HL7 Clinical Document Architecture (CDA) and/or FHIR standards), and other architectural standards to enable secure and interoperable information exchange. In addition, other standards and implementation specifications are available that support certain functional requirements included in this RFI such as:

o AIRS (Alliance of Information and Referral Systems) Taxonomy;

o Open Referral Human Service Data Specification (HSDS); and o National Emergency Number Association (NENA) i3 Solution Architecture (also known as the standard for Next Generation 911) standards and requirements that enables geolocation, use of the Emergency Services IP Network (ESInet) and Public Safety Answering Points (PSAPs).

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3. Engagement and Methodology Should the state elect to procure a solution in the future, the successful product(s) will require the principles below.

Product Lifecycle Ownership and User group: The future technology solution will require deep involvement of the eventual end users, various vendors, implementation by the NSPLs, and ongoing technology enhancement and lifecycle support.

Stakeholder Engagement: Implementing the technology tools and platforms required for the enhanced crisis call and response systems is complex and will require the engagement of multiple stakeholders including state agency staff, NSPLs, BH-ASOs and RCLs, and a variety of provider types during and after go-live (e.g., planning for and delivering training, addressing technical issues during implementation, supporting stakeholder implementation).

Solution Delivery Standards: HCA and DOH both subscribe to standards for Solution Design including architecture, requirements, code development, testing, training, platform, and network. These formal processes will be detailed as part of project planning and employed throughout the project. The configuration methodology employed with vendors is typically negotiated, and in some cases prescribed by, the software vendor.

Independent Verification & Validation: To support project management and solution delivery practices, the project will employ external quality assurance and Independent Verification & Validation (IV&V) as oversight and assistance in confirming the project is using best practices.

Planning

We request that responders to this RFI:

• Submit a strategy and timeline for implementing the tools/modules described in the vendor’s response (including tools/modules that will be provided with partnering vendors) to meet requirements in 2021 E2SHB 1477; and

• Submit cost information (i.e., licensing fees, implementation, and support including costs to integrate and interoperate, and maintenance costs) for their response and the estimated costs for acquiring, integrating, and interoperating with other vendors for any additional modules needed to support the 2021 E2SHB 1477 requirements. Responders are requested to submit cost information in a format that describes any potential phase-in of functionality and costs.

We encourage vendors to submit artifacts that would help the state understand the vendor’s proposed solution(s). Detailed architectural, content, and exchange standards will be required through any future applicable Request for Proposal (RFP) process.

The desired functionalities specified below may be available to the Regional Crisis Lines (RCLs) in the future in addition to the 988 NSPL Lifeline crisis centers in the future, to further allow interoperability and compliance with 2021 E2SHB 1477.

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The state seeks to partner with other states to create the most effective and efficient implementation of this project. This will need to be a highly collaborative endeavor with partners such as HCA, DOH, 988 NSPL Lifeline crisis centers, Behavioral Health-Administrative Service Organizations (BH-ASOs), Regional Crisis Lines (RCLs), local providers, community partners, vendors, the Federal Government, Tribal governments, and other agencies.

4. Technology Requirements Instructions for Technology Requirements Responses Responses may include any preprinted materials that would provide the information HCA and DOH requests. The breadth of products and services covered in this RFI will likely require goods and services from multiple vendors. Please feel free to coordinate with other vendors on a single response.

Alternatively, please feel free to respond with a limited scope based on the nature of your goods and services and document the scope of your solution within the introduction of your response.

• Use the Technical Response Form provided to address each requirement below;

o Identify whether the responding vendor’s system currently supports each of the requirements (identified below), or whether these would be developed and/or subcontracted out;

• We invite vendors to describe any gaps or capabilities needed for the crisis call and response system that are not otherwise described in the RFI;

The technology requirements are driven by a set of guiding principles for enterprise architecture that are designed to maximize value for the state and the clients, providers, and communities. These principles include the following:

Section I. Cloud-based solutions

The state would prefer cloud-based solutions that:

• Allow the state to dynamically expand and contract capacity quickly to respond to business needs, such as handling peak capacity periods.

• Support needed storage consistent with data retention policies.

• Reduce cost by not owning hardware and infrastructure.

• Enable robust security across applications.

RFI Questions Section I:

1. Describe how your system(s) leverage cloud-based technology and scaling based on needs.

2. Describe how your system supports needed storage consistent with data retention policies.

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3. Describe how you engage, support, manage and segregate roles, data, and implement security across the system.

4. Describe how your system will keep up with future trends in cloud technology.

5. Tell us anything else you would like us to know about cloud-based solutions.

Section II. SaaS/COTS solutions

SaaS/COTS solutions are preferred over custom-built and/or custom components to:

• Share and leverage best practices that have been developed across the industry and more quickly respond to industry changes.

• More effectively plan, track, and monitor development, administration, and operations costs.

• Limit code development as much as possible to configuration.

• Implement new features on shorter and predictable implementation cycles.

RFI Questions Section II:

1. Describe how your system(s) leverage SaaS technology and shared resources.

2. Describe how your system is configured and administered.

3. Describe any coding or configuration that would need to be done for implementation of the system.

4. Describe how your system supports new features.

5. Describe how your system supports implementations of external technology that would need to interoperate with your system.

6. Tell us anything else you would like us to know about SaaS/COTS solutions.

Section III. Natural System Boundaries

Maintain loose coupling between systems based on natural system boundaries to:

• Dramatically reduce integration costs using open Application Program Interfaces (APIs) allowing interoperability between systems.

• Minimize costs and disruptions in the event a major component of the system must be replaced.

• The state requires that systems meet or exceed Federal certification and performance standards by meeting the conditions defined in 42 C.F.R. 433.112(b) and those principles established under the Medicaid Information Technology Architecture (MITA) initiative and framework. This includes the goals and technical principles that promote rules engines, where possible, to extend the system’s configuration abilities to be managed by the business community. All conditions must be met for the state to remain eligible for Federal Financial Participation (FFP) funding. The state requires that the system(s) establish and maintain a performance record of high availability.

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• Minimize efforts and costs to allow for extensibility of systems as new technology emerges or needs change.

RFI Questions Section III:

1. Describe how your system(s) supports API or any technology that would allow your system to be interoperable with other systems.

2. Describe how your system(s) help the state reduce disruptions and maintain a high availability environment.

3. Describe how you keeps costs down for the state when there are major issues, downtime, and major disruptions.

4. Describe how your system meets or exceeds Federal certification and performance standards by meeting the conditions defined in 42 C.F.R. 433.112(b) and those principles established under the Medicaid Information Technology Architecture (MITA) initiative and framework.

5. Tell us how you reduce risks in your systems.

6. Tell us how you have loose coupling in your system.

7. Describe the ability of the primary vendor to add, change or decouple features and components, as needed, to integrate and interoperate with tools/modules offered by partnering vendors, including Electronic Health Records (EHRs).

8. Tell us anything else you would like us to know regarding natural system boundaries.

Section IV. Data Governance

Data segregation: Data segregation allows for the creation of separate access rules for sets of data or different groups of users (including Tribal governments, urban Indian health organizations, and tribal organizations), ensuring that only those who are authorized can view, access, remove, or alter the data.

Data and Service Level Agreements: Service Level Agreements (SLAs), Data Sharing Agreements (DSAs), Business Associate Agreements (BAAs), and Non-disclosure Agreements (NDAs) are examples of needed agreements to support appropriate identity and access management to this protected data.

RFI Questions Section IV:

1. Describe how your system supports data segregations and roles for the various listed groups and users (including Tribal governments, urban Indian health organizations, and tribal organizations)

2. Describe any agreements that are needed for your systems and list:

a) What type of agreement,

b) And who the parties are in these agreements.

3. Tell us anything else you would like us to know regarding data governance.

Department of Health

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Section V. Data Security and System Management

All vendor hosted solutions will be required to complete and pass an Office of the Chief Information Officer (OCIO) Office of Cyber Security (OCS) security design review before any production data can be stored, processed, or transmitted in accordance and adherence with the OCIO Policy 141.10. Vendor solutions must also comply with FedRAMP standards. All systems holding data about callers will need to have required security process, procedures, or system controls in place to protect the data and provide high availability services. Requirements include, at a minimum:

a) Data Disclosure

b) Business Impact Analysis (BIA)

c) Data Backup and Recovery

d) Disaster Recovery Plan (DRP)

e) Continuity of Operations Plan (COOP)

f) Technical Support

g) Maintenance

h) Data Archiving for Security

i) Disposal of Data

j) Location Security

k) Encryption (in transit and at rest)

l) Data Sources

m) Data Interoperability Requirements

n) Extensibility, Scalability, and Availability

RFI Questions Section V:

1. Describe how your system supports each of the items listed above (a-n).

2. Tell us anything else you would like us to know about data security and system management.

Section VI. Privacy and Protocols

Washington State and federal laws (such as HIPAA and 42 CFR Part 2) govern data access, confidentiality, security, and sharing. Generally, PHI cannot be disclosed by a covered entity or business associate without the consent of the individual unless there is an exception. The systems will be required to have features that can accommodate these needs, such as a consent process and adequate security management tools to ensure adequate access and data management.

Vendors should address accessibility and ADA compliance in your systems, including OCIO Policy 188 (https://www.ocio.wa.gov/sites/default/files/public/policies/188_Accessibility_Interim_TSB_Sub_20170 5_3.pdf).

https://www.ocio.wa.gov/sites/default/files/public/policies/188_Accessibility_Interim_TSB_Sub_201705_3.pdf https://www.ocio.wa.gov/sites/default/files/public/policies/188_Accessibility_Interim_TSB_Sub_201705_3.pdf

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As the Federal Government addresses the use of geolocation for crisis calls, additional privacy requirements will likely be established. State and federal privacy laws include:

a) Washington State law (Chapter 9.73 RCW: PRIVACY, VIOLATING RIGHT OF (wa.gov)): most importantly the Uniform Health Care Information Act (UHCIA Chapter 70.02 RCW), which contains federal privacy and security laws;

b) HIPAA; and

c) 42 CFR Part 2.

RFI Questions Section VI:

1. Describe how your system supports privacy for each of the items listed above (a-c).

2. Describe how your system addresses accessibility and ADA compliance.

3. Tell us anything else you would like us to know regarding privacy and protocols.

Section VII. Tribal Data Sovereignty

Tribal governments, urban Indian health organizations, and tribal organizations have worked towards educating the state on data sovereignty principles and the importance of implementing these principles in the state’s practices on information gathered for tribal members. These organizations have also shared the importance of careful data gathering and sharing methodologies for AI/AN individuals.

RFI Questions Section VII:

1. Tell us how your system supports tribal data sovereignty if it has not already been addressed in the section for data segregation. If it has, please put “Addressed in Data Segregation section”.

2. Tell us anything else you would like us to know regarding Tribal data sovereignty.

5. Functional Requirements HCA and DOH identified a baseline list of specific functional requirements based on a review of requirements in 2021 E2SHB 1477. The requirements were refined/validated through extensive information gathering and sharing with providers, 988 NSPL Lifeline crisis centers, RCLs, BH-ASOs, other states, vendor interviews, and discussions with the Crisis Response Improvement Strategy (CRIS) Technology Subcommittee. They are driven in part by the set of principles listed below. Detailed requirements are specified in Appendix N and Appendix O of the Technical and Operational Plan, and are included in the appendix of this RFI for reference.

https://app.leg.wa.gov/rcw/default.aspx?cite=9.73 https://app.leg.wa.gov/rcw/default.aspx?cite=70.02 https://www.hca.wa.gov/assets/program/final-technical-and-operational-plan-988.pdf

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Business Principles

Respondents should consider the following principles when preparing a response to this RFI:

• Utilizing new technologies to improve clinical outcomes by creating an interconnected system capable of streamlined information sharing and coordination amongst different partners.

• Establishing KPIs and benchmarks to track system improvements to track business process for improvement.

• Developing new ways for consumers to interact with the system by providing new technological tools to access and change information related to their choices in care.

Section VIII below describes needed functionality for the 988 NSPL crisis call center platform, with subsequent sections describing functionality needed/desired for ancillary systems. The Technical and Operational Plan contains additional information regarding the functional requirements and is recommended material for vendors. Please include what measurable outcomes your response would have.

HCA and DOH may invite vendors to sign up for meetings to demonstrate the functionality described in their responses to the questions and topics in this RFI.

Instructions for the Functional Requirements Responses

Responses may include any preprinted materials that would provide the information HCA and DOH requests. For the questions posed in that section, respondents should address only those questions that pertain to the functionality of the systems and tools that will be offered by the vendor (and its partners as applicable). The breadth of products and services covered in this RFI will likely require goods and services from multiple vendors. Please feel free to coordinate with other vendors on a single response.

Alternatively, please feel free to respond with a limited scope based on the nature of your goods and services and document the scope of your solution within the introduction of your response.

All respondents are requested to describe the approach to ensuring the architecture principles and technical requirements are accommodated in your system and encouraged to address these principles and technical requirements in the context of the functional requirements that will be supported by the vendor and its partners.

We request that vendors, in responding to questions about specific functionality, answer all questions.

However, an acceptable response could be “the vendor does not support this functionality.” In addition, we request that vendors address the following:

• Use the Functional Response Form provided to address each requirement below.

o Identify whether the responding vendor’s system currently supports each of the requirements (identified below), or whether the functionality would be developed and/or subcontracted out;

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• We invite vendors to describe any gaps or capabilities needed for the crisis call and response system that are not otherwise described in the RFI;

Section VIII. Call Center Platform: Create, Assign, & Track (follow-up) The system must support:

• Encounter Intake (Call/SMS/Chat): Ability to create, assign, receive, track, and record information in real time from crisis callers who contact the call center via call/SMS/chat. In addition, transcripts of calls/SMS/chats are required.

• Telephony/IVR/CTI Integration: Ability to receive and place (dial out) calls while logged into the platform without having to have a separate window or tab open. Can import data to platform such as Caller ID/phone number, Dialed Number Identification Service (DNIS), and Automatic Number identification (ANI). Associate Caller ID with past calls to help identify and respond to frequent callers.

• In-State Call Routing: Use the 911 technical infrastructure (e.g., Public Safety Answering Points (PSAPs), Emergency Services IP Network (ESInet), Computer Aided Dispatch (CAD) systems) to support real-time in-state call routing while aligning with national call center efforts.

• Global Positioning System (GPS) or Geolocation location of caller: Receive caller location information in the future (upon FCC approval).

• Caller Account History: Create, maintain, and use caller history and link Person Accounts (unless anonymous) to multiple encounters, referrals, and alerts.

• Crisis Alerts: The platform must have the capacity to create and share crisis alerts.

• Crisis Referrals: The platform must support referral management (i.e., the capacity to search, create, track, and close the loop on referrals to crisis responders, behavioral health providers, and social service organizations/services when needed).

• Follow-up Queue: The platform and system must have the capacity to support follow-up management (i.e., create, assign, and track follow-ups as needed).

• Provider Integration: The platform and system must support the ability to:

• Send and receive electronic information from providers (e.g., via the State Health Information

Exchange, provider EHRs/EMRs, provider portals).

• Retrieve and use electronic information sent by providers.

• Provider Portal: See Section XI for more details.

• Workforce Management: The platform and system must support the ability of the call center to manage staff in real-time and following the conclusion of crisis calls.

RFI Questions Section VIII:

1. Describe how your system supports each of the following:

a) Encounter Intake (Call/SMS/Chat);

b) Telephony/IVR/CTI Integration;

c) In-state Call Routing;

d) GPS location of caller;

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e) Caller history information;

f) Crisis alerts;

g) Referrals;

h) Follow-up;

i) System outages;

j) Provider Integration; and

k) Workforce Management, including call taker availability.

2. Name the specific standards that are applicable and used in each of your systems/tools for each of the functions listed above (Section VIII.1.) to support interoperable exchange, re-use, and access, including the standards identified in the Technical Requirements.

3. Describe how your system will support in-state call routing while aligning with national call center efforts.

4. Describe the issues associated with using geolocation of crisis callers and how your system(s) does (or will) address or mitigate these concerns (upon FCC approval).

5. Describe the issues associated with sending, receiving, retrieving, and using electronic information from providers and how your system(s) does (or will) address or mitigate these concerns.

6. Describe how you engage, support, and manage stakeholder implementation of systems/tools in Section VIII.1.

7. Tell us anything else that you would like us to know regarding functionality needed for the Call Center Platform.

Section IX. Responder Dispatching: Identify, Dispatch, & Track The system must support:

• GPS (i.e., Geolocation) Responder Tracking (e.g., DCR and MCR): Ability to identify and track, in real-time using GPS technology, MCRs, DCRs, and fire department mobile integrated health teams, and be able to search for the closest unit, track and display location, including ETA on a map.

• Dispatch Coordination: Dispatching of MCRs, DCRs, and fire department mobile integrated health teams and to coordinate with outside agencies (e.g., law enforcement, ambulances) if needed via an electronic process.

• Resource Map: Having a resource map that can be used by the MCRs, DCRs, fire department mobile integrated health teams, and dispatch/call centers to display a map of responders, provide directions, provide an ETA for routing responders to nearest service location (e.g., hospital, care center), and other purposes.

RFI Questions Section IX:

1. Describe how your system supports each of the following:

a) GPS (i.e., Geolocation) Responder Tracking;

b) Dispatch Coordination; and

c) Resource Map (including updates).

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2. Name the specific standards that are applicable and used in each of your systems/tools to support interoperable exchange, re-use, and access regarding each of the functions listed above (Section IX.1) including the standards identified in the Technical Requirements in Section 4 above.

3. Describe how your system will support efficient and timely response for in-state calls routing while aligning with national 988 NSPL crisis call center efforts.

4. Describe the issues associated with using geolocation for crisis responders and how your system(s) does (or will) address or mitigate these concerns, including supporting responder tracking and dispatch in areas that are unserved/underserved by broadband.

5. Describe how you engage, support, and manage stakeholder implementation of systems/tools in Section IX.1.

6. Tell us anything else that you would like us to know regarding functionality needed for Responder Dispatching.

Section X. Resource Directory: Access, Use, Query, & Share Resource Directory: The platform must be able to access and use multiple external resource directories (e.g., behavioral health provider and social service resource directories, other community and health directories) including ingesting external resource information, querying resource availability, displaying results, and sharing resource information with callers and providers.

The system may support the means to create a public facing resource directory for different resources.

RFI Questions Section X:

1. Describe how your system supports:

a) Access to and use of multiple external resource directories;

b) Querying resource availability;

c) Displaying results; and

d) Sharing resource information with callers and providers.

2. Name the specific standards that are applicable and used in each of your systems/tools to support interoperable exchange and re-use for accessing and using external resource directories (described in Section X.1.).

3. Describe how your system supports efficient and timely access and use of external resource directories.

4. Describe any issues associated with your systems/tools in accessing and using external resource directories and how these issues have been/will be resolved.

5. Describe whether and why your system would support its own public facing resource directory, what issues such a directory would resolve and what issues remain.

6. Describe how you engage, support, and manage stakeholder implementation of systems/tools in Section X.1.

7. Tell us anything else that you would like us to know regarding functionality needed for Resource Directories.

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Section XI. Provider Portal: Search, Create, Request, Exchange (Ingest & Share), and Manage Account Provider Portal: The platform must support a search portal for required provider types, create requests, exchange (ingest & share) information, and manage accounts.

RFI Questions Section XI:

1. Describe how your system supports:

a) For providers without integration capabilities, accessing and searching a portal, creating requests via a portal, downloading information from a portal, and managing access and use of the portal.

b) For providers with integration capabilities, accessing and searching a portal, creating requests via a portal, downloading information from a portal, and managing access and use of the portal.

2. Name the specific standards that are applicable and used in each of your systems/tools to support interoperable access and use of the provider portal.

3. Describe how your system supports efficient and timely access to and use of the provider portal.

4. Describe any issues associated with your systems/tools in supporting provider portals (e.g., including electronic use) and how these issues have been/will be resolved.

5. Describe how you engage, support, and manage stakeholder implementation of systems/tools in Section XI.1.

Provider Portal.

Section XII. Referrals and Appointments: Search, Create, Assign, & Track The system must support an Integrated Referral System for the following:

• Next-Day Appointments: The platform must have the ability to:

o Search for appropriate referral resource for next day appointments;

o Create the referral for the appointment;

o Assign referral for the appointment; and o Track progress/status of appointment.

• Closed Loop Referrals: The platform must have the ability to:

o Create, assign, and track referrals;

o Search for appropriate resource(s) (prioritized by the agency);

o Create, assign, and track referrals;

o Close the loop on referrals and track outcomes; and o Receive encounter reports/results.

• Provider-to-Provider Referrals: The platform must have the ability to:

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o Search multiple resource directories for appropriate resource(s) (prioritized by the agency); and o Display available resource(s) from multiple directories.

RFI Questions Section XII:

1. Describe how your system(s) supports:

a) Next Day Appointments;

b) Closed loop…