3 - 2022 Statement of Work (SOW).pdf

COMMUNITY TREATMENT

SERVICES (CTS)

2022 STATEMENT OF WORK (SOW)

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TABLE OF CONTENTS

CHAPTER ONE: INTRODUCTION

1.1 Purpose

CHAPTER TWO: BUREAU INFORMATION

2.1 The Bureau’s Commitment

2.2 Cognitive Behavioral Therapy (CBT)

2.3 Institution Substance Use Disorder (SUD) Services

2.4 Institution Mental Health (MH) Services

2.5 Institution Sex Offender Treatment (SOT) Services

2.6 Institution Medication-Assisted Treatment (MAT)

2.7 Public Safety Concerns

CHAPTER THREE: GUIDING PRINCIPLES OF TREATMENT

3.1 Methods and Standards

3.2 Clinical Treatment Standards and Practices

3.3 Treatment Documentation

3.4 Caseloads

3.5 Treatment of Co-Occurring Disorders

3.6 Medication-Assisted Treatment (MAT)

3.7 Sex Offender Treatment (SOT)

3.8 Bureau Formulary for Mental Health Services

3.9 Monitoring Medications

3.10 Telehealth

CHAPTER FOUR: SCOPE OF WORK

4.1 Treatment Referral and Authorization

4.2 Initial Intake Appointment

4.3 Clinical Assessments, Evaluations, and Reports

4.4 Medication Services

4.5 Counseling Services

4.6 Complementary Services

4.7 Clinical Treatment Plan

4.8 Monthly Progress Reports (MPRs)

4.9 Termination Report

4.10 Clinical Interventions

4.11 Billing

4.12 Transportation

4.13 Summary of Contract Line Item (CLIN) Pricing

4.14 Deductions

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CHAPTER FIVE: STAFFING

5.1 Staffing

5.2 Key Personnel

5.3 Clinical Experience

5.4 Contractor Licensure

5.5 Background Information

5.6 Critical Vacancies

5.7 Subcontracting

5.8 Language Services

CHAPTER SIX: STAFF TRAINING REQUIREMENTS

6.1 Staff Training Requirements

6.2 Standards of Conduct

6.3 Drug Free Workplace

6.4 Sexual Abuse Information

CHAPTER SEVEN: ADMINISTRATION

7.1 Facility Requirements

7.2 Accountability

7.3 Communication

7.4 Facility Licensure/Certification

7.5 File Maintenance

7.6 HIPAA

7.7 Records Retention

CHAPTER EIGHT: CONTRACT AND CONTRACT MONITORING

8.1 Modifications

8.2 Monitoring Activities

LIST OF ATTACHMENTS

Monitoring Inspection Worksheets ............................................................................................ A CTS Training Record ................................................................................................................. B

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CHAPTER ONE: INTRODUCTION

1 Intro

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

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

1.1.1 Scope. The scope includes community SUD, MAT, MH, psychiatric, and SOT services for Bureau offenders in the United States and territories.

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

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

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

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

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

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

CHAPTER TWO: BUREAU INFORMATION

2 Treatment Programs

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

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• reduction of misconduct;

• reduction of mental illness symptoms and behavioral disorders;

• reduction of substance use, relapse, and recidivism;

• reduction of future sexual offending;

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

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

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

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

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

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

• core beliefs;

• intermediate beliefs;

• current situation;

• automatic thoughts; and

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

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

2.2.2 Self-Help Programs. Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Rational Recovery (RR) are often powerful and important interventions in an offender’s recovery, but they are not substitutes for CTS. Self-help programs cannot be conducted during treatment. The Contractor shall not require attendance at self-help groups, and shall not utilize as a treatment concept, mandate as treatment goal activities, or include as part of the treatment plan.

2.3 INSTITUTION SUBSTANCE USE DISORDER (SUD) SERVICES. The Bureau operates a structured, multi-component SUD treatment protocol to identify individuals in

2022 Statement of Work | Community Treatment Services 3 need of treatment upon entry and throughout their incarceration. The primary substance use disorder programs are the residential and non-residential drug abuse programs.

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

RDAP encourages participants to examine their personal behavior to help them become more pro-social and to engage in a lifestyle based on honesty, responsibility, hard work, and willingness to learn. As participants progress through the phases of the program, they assume greater personal and social responsibilities in the community. It is expected that program participants take on leadership and mentoring roles within the MTC. Progress in treatment is based on the offender’s ability to demonstrate comprehension and internalization of treatment concepts by behaviorally observable actions to change his or her maladaptive and unhealthy behaviors.

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

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

• completed the NR-DAP;

• completed a Psychology Treatment Program (PTP);

• volunteered for treatment; or

• self-reported or tested positive for using drugs/alcohol while in the RRC and/or HC, or

FLM.

2.4 INSTITUTION MENTAL HEALTH (MH) SERVICES. Mental health recovery refers to the process by which people are able to live, work, learn, and participate fully in their communities. For some individuals, recovery is the ability to live a fulfilling and productive life despite a disability, while for others, recovery implies the reduction or complete remission of symptoms.

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

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

• The Resolve Program. The Resolve Program is a non-residential trauma treatment program for male and female offenders. Originally developed for the large number of female offenders who had experienced traumatic life events, it is now offered to male offenders as well.

• The Skills Program. The Skills Program is a unit-based residential treatment program designed for male offenders who have intellectual and social impairments which create adaptive problems in prison and in the community.

• The STAGES Program. The Steps Toward Awareness, Growth, and Emotional Strength (STAGES) Program is a unit-based residential program which provides treatment to male offenders who require enhanced care for their mental illness and have a diagnosis of borderline personality disorder

• Transitional Care Unit. The Transitional Care Unit addresses the needs of mentally ill male offenders who have spent extended periods of time in secure treatment programs or restrictive housing settings. Mental health treatment is provided along with participation in work and leisure activities.

• Step Down Programs. Step Down Programs offer an intermediate level of care for male offenders with serious mental illness who do not require inpatient treatment, but lack the skills to function in a general population prison. Evidence based treatment is offered to maximize their ability to function and to minimize relapse and the need for inpatient hospitalization.

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

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

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

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

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

2022 Statement of Work | Community Treatment Services 5 health care on an ongoing basis (monthly); and/or brief, crisis-oriented mental health care of significant intensity (e.g., placement on suicide watch or behavioral observation status).

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

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

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

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

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

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

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

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

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

2.5.4 CTS Sex Offender Referrals. SOTP offenders will ordinarily be referred to community treatment providers with clinical documentation related to their criminal histories. This may include a summary of their in-prison treatment programming, including a Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis, and recommendations from Bureau clinicians.

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

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

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

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

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

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

2.6.2 CTS MAT Referrals. Offenders who initiated MAT while incarcerated or are evaluated in the community and recommended for MAT will be referred by CTS for MAT services.

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

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

2022 Statement of Work | Community Treatment Services 7 security precautions. “High” is the Bureau’s highest security level as assigned by a point system for various criteria and indicators.

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

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

• Greatest Severity Offense: This public safety factor is assigned to offenders whose current offense is considered by the Bureau to be among the most grievous. This includes, but is not limited to convictions of arson, assault, carjacking, escape, homicide/manslaughter, kidnapping, robbery, sexual crimes, and weapons charges.”

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

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

CHAPTER THREE: GUIDING PRINCIPLES OF TREATMENT

3 Guiding Principles

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

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

• diagnose each offender through an established diagnostic assessment process;

• develop individualized treatment plans together with each offender;

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

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

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

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

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

3.2.1 Treatment Services. The Contractor shall deliver all services in-person, or by audio-visual, real time, two-way interactive communication, or, in limited circumstances, by audio-only with FAC COR pre-approval. The method of service delivery is contingent on the requirements of the contract (e.g., telehealth only), Contractor capabilities, offender accessibility and technical availability, and the type of service being rendered. All services require clinical interactions between the offender and an appropriately licensed and Bureau-approved Contractor.

3.2.2 Assessments. The Contractor must conduct an intake assessment, ordinarily conducted in-person, on all offenders prior to initiating treatment. The assessment must include a diagnosis as a basis for treatment.

3.2.3 Clinician Engagement. The Contractor must actively engage in all therapeutic sessions without distractions, to include phone calls, computer work, or paperwork.

3.2.4 Frequency of Sessions. The frequency of treatment shall be individualized based upon offender need. Generally, the Contractor will meet with offenders weekly and not require the offender to attend treatment more than twice per week to reduce the negative impact on employment, family integration, and other necessary requirements for reentry to the community. Deviations from weekly treatment must be pre-approved by the FAC COR and justified in the monthly progress report and/or treatment plan. The FAC COR reserves the right to adjust the frequency and quantity of treatment as deemed necessary by the Bureau.

3.2.5 Standard Session Length. Ordinarily, individual counseling sessions should be two (2) units in length. Group counseling sessions should ordinarily be three (3) units in length.

Deviations above or below these standard session lengths require prior authorization from the FAC COR or written explanation after the session has completed. Those written explanations for session length should not be standard practice, but due to significant issues presented during the session.

3.2.6 Session Breaks. Standardized session breaks for all participants are not authorized during treatment. Brief individual breaks for immediate concerns may be granted by the Contractor. Brief breaks do not require the offender to sign in and out of the session, as this is a nominal pause in treatment.

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

3.2.8 Individual Counseling. Sessions should utilize a cognitive-behavioral approach and focus on relevant treatment issues and expectations. The Contractor should verify progress is

2022 Statement of Work | Community Treatment Services 9 being made toward goals and reassess the relevance of current treatment goals. The Contractor should explore treatment issues that surface in group sessions and medication concerns for offenders receiving psychiatric services or MAT (as applicable).

3.2.9 Group Counseling. All group sessions shall be process-oriented in nature with a cognitive-behavioral approach to address underlying clinical issues. Sessions should focus on targeting irrational thoughts, criminal thinking patterns, and maladaptive behavior. The Contractor is encouraged to focus on the here-and-now and direct discussion toward individual treatment progress, treatment activities, interpersonal dynamics, and be solution-focused. If didactic counseling is used, it must be limited in length. The practice of completing worksheets during the session is discouraged; however, clinically relevant homework is encouraged and can be reviewed and discussed during group sessions as a way to increase participation among members. If initial group check-ins are used, they should be limited in length and utilized to begin clinically relevant discussion and encourage feedback from the group.

3.2.10 Group Size Limitations. Ordinarily, group sessions shall consist of a minimum of three

(3) offenders, not to exceed twelve (12) offenders for substance use disorder and sex offender groups and eight (8) offenders for mental health groups. All telehealth groups shall consist of a minimum of three (3) offenders and not to exceed five (5). The Contractor must obtain authorization from the FAC COR for a temporary change in group size.

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

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

3.2.13 Agency Rules. The Contractor shall establish written rules, regulations, and expectations for offenders. At the intake session, offenders must be informed about the rules for individual and group sessions, attendance, and expectations of participation, as well as any other additional information necessary for successful treatment outcomes.

The Contractor may choose to have offenders recite group rules at the beginning of group sessions as a reminder to all participants, but no more than two (2) minutes should be devoted to this.

3.2.14 Cell Phones. The Contractor shall have a policy in place to limit the disruption of cell phones by offenders while at the facility and during all treatment sessions. Neither the Contractor nor the participants should place or answer calls or text during group sessions.

It is encouraged that all cell phones be powered off during treatment to reduce distractions.

Cell phones are a primary means for RRC offender accountability. Be advised that some locations use automated and randomized systems to call offenders and the systems may continue to call if the call is not acknowledged by the offender. Therefore, it is especially important for the RRC to be informed of the treatment schedule of every offender.

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3.2.15 Disruptive Behavior. The Contractor shall inform the FAC COR of offender behavior that becomes disruptive to the treatment process. Significant actions must be reported to the FAC COR on the Behavior Notification form in accordance with section “4.9 Clinical Interventions”. However, more routine nuisance actions that do not require immediate notification, but create an environment non-conducive to treatment, must be reported in the Monthly Progress Reports, or discussed with the FAC COR. The report should include how the behavior was addressed and how the offender responded.

3.2.16 Favors and Items of Value. The Contractor shall not offer, give, or receive any gift, favor, article, or item of value, to include unauthorized transportation or consumable goods, to offenders, former Bureau offenders, family members, or anyone associated with or related to the offender. Exchange of currency in any form is prohibited.

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

3.2.18 Continuing Contract Performance During a Government Shutdown, Pandemic, Influenza or Other National Emergency. Refer to the full clause, or similar updated clause, in the Standard Form 1449 contract.

3.3 TREATMENT DOCUMENTATION. All treatment documents are provided by the Bureau. Contractors must thoroughly complete and submit all documents to the Bureau’s electronic file management system (EFMS). Contractors must use the most recent version of documents provided by the Bureau. When documents are updated, the Contractor shall implement use within twenty (20) business days.

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

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

3.3.1 Electronic File Management System (EFMS). The Contractor shall utilize the Bureau approved electronic system for the primary receipt of referrals and transmission of all treatment documents and notes. This system is a FISMA moderate system that meets NIST 800-53 security controls.

3.3.2 Documentation Requirements. All treatment documentation must be submitted to the EFMS and must be completed and signed by the Contractor who provided the service. All

2022 Statement of Work | Community Treatment Services 11 treatment documentation must be detailed, individualized, and contain specific examples of an offender’s thoughts, behaviors, feelings, progress toward specific treatment goals, and plans for future treatment. Generic content, templates, and general clinical themes do not constitute acceptable documentation of progress in treatment. Documentation that does not meet these standards will be returned for correction which may result in delay of payment until acceptable documentation is received.

3.3.3 Electronic Signatures. The Contractor shall provide legally acceptable signatures on all documentation in accordance with state and federal law. Signatures that are authenticated by the user, such as digital signature certificates or signature images, are acceptable.

Typed signatures that are easily added by any staff, such as cursive script, are not acceptable as an electronic signature. Proof of signature authentication shall be provided to the FAC COR upon request.

3.4 CASELOADS. The Contractor shall establish limits on overall clinician caseload size, to include total work volume of Bureau and non-Bureau offenders, to ensure effective treatment delivery and quality documentation. The Contractor must establish caseload sizes based on the number of offenders to be served, program design, characteristics, and needs of the population served to include gender concerns and other factors. The volume or complexity of a clinician’s overall caseload shall not negatively impact the treatment delivery or timeliness or quality of documentation.

3.5 TREATMENT OF CO-OCCURRING SUBSTANCE USE AND MENTAL

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

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

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

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

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For offenders with co-occurring disorders assessed by a single Contractor, only one assessment that encompasses both diagnoses (CLIN 2012) should be completed and submitted for payment.

3.6 MEDICATION-ASSISTED TREATMENT (MAT). A critical element of MAT is participation in SUD treatment to modify attitudes and behaviors related to substance use and to increase healthy life skills. Offenders receiving medications for SUD are at increased risk for relapse to substance use, and interventions should target reducing relapse risk factors. The Contractor shall provide opioid-specific SUD treatment as a “whole-patient” approach in an offender’s MAT program (e.g., cognitive behavioral therapies, relapse prevention, and motivational interviewing).

3.7 SEX OFFENDER SPECIFIC TREATMENT (SOT). The Bureau does not compel offenders in sex offender treatment to reveal the identity of past victims. The Contractor shall not act in any manner which coerces them to reveal the names or identities of past victims. The Contractor shall encourage disclosure of past thoughts, feelings, and behaviors to foster the development of treatment initiatives consistent with the Good Lives Model (GLM) and CBT. Treatment is designed and offered to promote personal development, resulting in public safety, and should not be conceptualized as an investigative function.

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

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

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

• the likelihood of adequate compliance with the medication regimen;

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

• offender preference.

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

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

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

3.9 MONITORING MEDICATIONS. The following recommendations are not intended to interfere with or replace clinical judgment of the Contractor when evaluating an offender on psychotropic medications. Rather, it is intended to provide guidelines and assist the

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Contractor with decisions in providing high quality care, ensuring that offenders receive the intended benefit of the medications, and to minimize unwanted side effects from the medications.

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

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

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

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

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

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

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

3.9.2.1 OTP. An OTP is required to be licensed by the state and certified by SAMHSA in conformance with 42 Code of Federal Regulations (C.F.R.), Part 8, to provide supervised assessment and medication-assisted treatment for offenders with an opioid use disorder.

3.9.3 Buprenorphine. Buprenorphine is a Schedule III drug, indicating its lower potential for abuse or misuse than Schedule II substances. Pursuant to the Drug Addiction Treatment Act of 2000 (DATA 2000), qualified physicians can prescribe buprenorphine to patients for the treatment of opioid use disorder after completing a required training and submitting to SAMHSA a notification of intent to prescribe. This permits the physician to treat up to thirty (30) patients at a time in the first year and, if requested, one hundred (100) patients

2022 Statement of Work | Community Treatment Services 14 at a time after that. Some physicians, with added qualification, or in specific practice settings, are allowed to treat up to two hundred seventy-five (275) patients at a time.

3.10 TELEHEALTH. The Contractor shall provide services over real-time, audio and visual interactive telecommunications for telehealth sessions. The Contractor must be aware of federal and state telehealth regulations and be familiar with the laws in the state where offenders are located, if delivering services across state lines.

3.10.1 Security. The Contractor must adhere to the Health Insurance Portability and Accountability Act (HIPAA) regulations and federal confidentiality rules when providing telehealth services. The Contractor shall verify audio and video transmission is encrypted.

The Federal Information Processing Standard (FIPS) 140-2 is used by the U.S. government to accredit encryption standards. If partnering with 3rd party telehealth vendors, the Contractor must verify if their encryption meets the FIPS 140-2 certified 256-bit standard;

that any peer-to-peer videoconferencing (streamed endpoint-to-endpoint) is not stored or intercepted by the company in any way; and that any recorded videoconferences or—if available—text-based chat sessions near the chat window are stored locally, on their own HIPAA-compliant device or electronic record keeping system, in order to safeguard any electronic protected health information or PHI.

3.10.2 Clinical Suitability. The Contractor must determine which offenders are suitable for telehealth sessions based on clinical decision, available resources, and technology. The Contractor must also determine if a telehealth session is the most appropriate method of delivery for the type of service being rendered. Clinical judgment must guide the use of telehealth for the delivery of services, and not simply for the sake of convenience for the Contractor or offender.

3.10.3 Familiarization. The Contractor must be familiar with and comfortable operating and controlling their telehealth platform. Additionally, before conducting a telehealth session, the Contractor must provide information to the offender on telehealth delivery of care and using the selected technology. The Contractor shall also provide information to the offender on how to access any digital platform that may be used in the delivery of telehealth services.

3.10.4 Informed Consent. The Contractor shall obtain from the offender a telehealth specific informed consent that explains:

• what telehealth is,

• the potential benefits,

• the possible risks,

• confidentiality, including no recording of telehealth sessions,

• and alternatives to telehealth sessions, such as in-person treatment sessions.

The Contractor must document in the EFMS whether verbal or written consent was obtained from the offender. Written consent is preferred.

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3.10.5 Offender Verification. The Contractor shall verify the identity of the offender prior to each telehealth session by confirming the offender’s legal name, date of birth, and Bureau register number listed on the treatment referral form. The Contractor shall document the verification on clinical documents and notes added to the EFMS.

3.10.6 Originating Site Location. The Contractor shall be aware of the offender’s originating site, to include the exact physical location and address, at the time of the telehealth session (e.g., the RRC, the offender’s residence, or place of work), and document it in the EFMS and on the Treatment Services and Accountability Log. To maintain privacy, all individuals at the originating site location must be identified and the offender must consent to discussing confidential information with those individuals present or they should be asked to leave.

3.10.7 Contractor Originating Site. The Contractor shall make available their performance location as an originating site for telehealth sessions for offenders who do not have the availability of real-time audio and visual interactive telecommunication equipment.

3.10.8 RRC Originating Site. If the local RRC has available equipment, and a secure and private location for telehealth appointments as the originating site, the Contractor shall coordinate appointment times to mitigate scheduling conflicts with available equipment and space.

3.10.9 Distant Site. When conducting telehealth sessions at the distant site, the Contractor shall use a private location, with a neutral background, adequate lighting, and wear appropriate professional attire.

3.10.10 Alternative Sessions. The Contractor must conduct in-person sessions with the offender, if the offender does not have the technical capacity or ability, or if the offender does not consent to the use of real-time video technology. In some instances, audio-only communication for telehealth sessions may be utilized when pre-approved by the FAC

COR.

3.10.11 Standards. The Contractor shall exercise the same standards of care for telehealth treatment, such as providing standard session lengths and documentation as in person services. If the standard of care would require information or treatment that is only obtainable in person, the Contractor must see the offender for an in-person session.

3.10.12 Group Rules. The Contractor shall require offenders to follow the same in-person group rules regarding participation and confidentiality. The Contractor shall maintain order in the group sessions using facilitator controls and have a plan for offenders who become disruptive during telehealth group sessions. Minimum group size is three (3) offenders and shall not exceed five (5).

3.10.13 Crisis Intervention. The Contractor must be aware of local crisis resources and have a plan for crisis intervention if a telehealth session with an offender requires such services.

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CHAPTER FOUR: SCOPE OF SERVICES

4 Scope of Services

4.1 TREATMENT REFERRAL AND AUTHORIZATION. The Contractor will receive a treatment referral via the EFMS. The referral will specify the authorized treatment services and service authorization period for each offender. Services are only authorized from the start date to the end date as indicated on the referral. Amendments will be made as necessary.

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

4.1.2 Authorized Services. The Contractor shall only provide services authorized on the Treatment Referral and Authorization. The Bureau will not pay the Contractor for services that were not preauthorized. The Contractor may request clinically indicated changes to the offender’s authorized services by contacting the FAC COR. Changes to the treatment regimen, including discontinuing treatment, must be preauthorized by the FAC COR.

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

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

4.2 INITIAL INTAKE APPOINTMENT. Within ten (10) business days from the treatment authorization start date, the Contractor must meet in person with the referred offender for an intake and clinical assessment, unless preauthorization is granted by the FAC COR on a case-by-case basis for the session to be conducted via telehealth. The intake session will consist of an admission and orientation to the program and completion of Bureau intake forms as well as any documentation required by state regulatory boards. Additionally, the intake session shall include providing introductory information to the offender regarding assigned counselors, appointments, and offender responsibilities. A diagnostic interview and assessment (found in 4.3) is conducted at this time and ordinarily completed in a single visit. The intake session will be billed as an Intake Assessment & Report.

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4.2.1 Intake Screening. If an offender declines treatment, this session will be billed as an Intake Screening. Only one Intake Screening can be submitted for payment when an offender declines more than one service on the same day.

4.2.1.1 Substance Use Disorder Intake Screening (CLIN 2005): Upon arrival to the initial appointment, the offender declined participation in substance use disorder treatment.

4.2.1.2…