40DHHS-S4018 - Scope of Work.docx

Family to Family Support Services – Scope of Work

SCOPE OF WORK

Family to Family Support Services Division of Child and Family Services (DCFS) Southern and Northern Nevada Children's Mental Health Services Contract Period: January 1, 2027 – December 31, 2031

1. PROJECT OVERVIEW

This contract is to provide Family Peer Support Services and Youth Peer Support Services to clients of the Division of Child and Family Services (DCFS) Children's Mental Health Services programs in Southern Nevada Child and Adolescent Services (SNCAS) and Northern Nevada Child and Adolescent Services (NNCAS).

Family Peer Support Services is a Medicaid-reimbursable service provided by qualified Family Peer Support Specialists (FPSS) - a person with lived experience as a parent or primary caregiver of a child with a behavioral health or emotional condition who uses that experience to support other parents and caregivers navigating similar challenges. Services are strength-based, recovery-oriented, and person-centered, designed to:

1. Strengthen the caregiver's capacity to support their child's behavioral health and emotional needs;

1. Enhance connection to community resources, services, and supports;

1. Build effective advocacy skills within child-serving systems; and

1. Promote resiliency, wellness, and empowerment for both the caregiver and family.

Youth Peer Support Services is a Medicaid-reimbursable service provided by a qualified Youth Peer Support Specialist (YPSS) — a young person with personal lived experience receiving behavioral health, substance use, child welfare, and/or juvenile justice services as a youth — who uses that lived experience directly with youth and young people navigating similar systems and challenges. Unlike Family Peer Support Services, the recipient of Youth Peer Support Services is the youth, not the parent or caregiver. Services are strength-based, recovery-oriented, and person-centered, designed to:

1. Strengthen the youth's self-advocacy, self-determination, and coping skills;

1. Enhance the youth's connection to community resources, natural supports, and peer networks;

1. Build skills for navigating behavioral health, education, child welfare, and juvenile justice systems; and

1. Promote hope, resiliency, wellness, and recovery for the youth.

Both Family Peer Support Services and Youth Peer Support Services are grounded in the principles and values established by SAMHSA's Core Competencies for Peer Workers in Behavioral Health Services and aligned with SAMHSA's National Model Standards for Peer Support Certification. Services must also comply with Nevada Medicaid Peer Support Services billing and documentation requirements under Provider Type 97, Medicaid Services Manual (MSM) Chapter 4300, and Nevada Revised Statutes (NRS) 433.627.

This contract does not guarantee specific usage amounts. DCFS reserves the right to adjust service volume based on availability of eligible recipients and program need.

2. GOALS AND OBJECTIVES

2.1 Primary Goal

The primary goal of this contract is to connect (1) parents and primary caregivers of children with behavioral health or emotional needs to a trained Peer Support Specialist who has navigated a similar experience, and (2) youth with behavioral health, substance use, child welfare, or juvenile justice involvement to a trained Youth Peer Support Specialist who has navigated a similar experience. These connections are peer-based and distinct from clinical or licensed behavioral health services. The Family or Youth Peer Support Specialist serves as a guide, advocate, and supportive ally — not a therapist or case manager.

2.2 Program Objectives

1. Provide individualized, goal-directed Family Peer Support Services and Youth Peer Support Services to eligible caregivers and youth, aligned with a person-centered plan of care.

1. Increase caregiver and youth capacity to understand, navigate, and advocate within behavioral health, education, child welfare, juvenile justice, and other child-serving systems.

1. Strengthen families' and youths' natural and informal support networks to promote long-term resiliency.

1. Support caregiver and youth wellness, self-care, self-determination, and the development of personal leadership skills.

1. Reduce barriers to accessing and remaining engaged in behavioral health services for the child, youth, and family.

1. Ensure service delivery aligns with Medicaid Service Manual and Billing standards for Peer Support Services; System of Care principles; SAMHSA National Model Standards, and SAMHSA Core Competencies for Peer Workers in Behavioral Health Services, as well as all other relevant laws, rules and regulations.

3. ELIGIBLE POPULATION

3.1 Family Peer Support Population

The recipient of Family Peer Support Services under this contract is the parent or primary caregiver, not the child. Services are provided to support the caregiver's ability to effectively meet the behavioral health and emotional needs of their child.

Priority Population Parents or primary caregivers of children from birth through age 17 who are currently seeking access to, are on a waiting list for, or are currently receiving a DCFS Children's Mental Health Services program.

3.2 Youth Peer Support Population

The recipient of Youth Peer Support Services under this contract is the youth, not the parent or caregiver. Services are provided directly to the youth to support their own behavioral health, emotional, and developmental needs.

Priority Population Youth who are currently seeking access to, are on a waiting list for, or are currently receiving a DCFS Children's Mental Health Services program.

3.3 Medicaid Eligibility

For services billed to Nevada Medicaid under Provider Type 97, the recipient — the caregiver for Family Peer Support Services, or the youth for Youth Peer Support Services — must be a Nevada Medicaid-enrolled recipient. For Family Peer Support Services, the child must be enrolled, and services must be provided to the caregiver in support of the child's behavioral health needs. Prior authorization is required once a recipient exceeds 52 hours (208 units) of Peer Support Services annually, per Nevada Medicaid MSM Chapter 4300.

4. CONTRACTOR REQUIREMENTS

4.1 Organizational Eligibility

1. The applicant agency must be a family-led, family-driven, and/or youth-guided organization as defined under System of Care principles.

1. The organization must be enrolled as a Nevada Medicaid provider under Provider Type 97 (Peer Support Services), including the applicable Family Peer Support (Specialty 899) and/or Youth Peer Support (Specialty 720) specialty, in accordance with Nevada Medicaid Web Announcement 3663 and MSM Chapter 4300.

1. The organization must maintain policies and procedures ensuring compliance with all applicable federal and state laws, including but not limited to HIPAA, Medicaid billing regulations, NRS 433.627, and Senate Bill 69 (2021 Nevada Legislative Session).

4.2 Family Peer Support Specialist & Youth Peer Support Specialist Qualifications Each Family Peer Support Specialist (FPSS) and Youth Peer Support Specialist (YPSS) employed or contracted under this scope of work must meet all minimum qualifications, as outlined in Nevada Medicaid’s Medicaid Services Manual for Provider Type 97, Peer Support Services.

Each employee or contractor providing services must hold a Peer Support Specialist (FPSS) and/or Youth Peer Support Specialist (YPSS) certification issued by the Nevada Certification Board (NCB), consistent with Nevada Medicaid requirements (per NRS 433.627 and SB 69, 2021).

1. Certification must align with SAMHSA's National Model Standards for Peer Support Certification, including the Family Peer Support certification track.

1. Certification renewal must be maintained per NCB standards, including required continuing education hours.

The contractor's Peer Support Specialist workforce must reflect the demographic and cultural diversity of the communities served, including representation of racial, ethnic, linguistic, and other minority populations.

4.2.1 Background Screening

1. FBI fingerprint-based criminal background check required prior to employment.

1. Positive background check results are subject to review and approval by DCFS prior to authorization to provide services.

4.2.2 Health and Safety Clearances

Prior to delivering any services under this contract and prior to submission of a Nevada Medicaid enrollment application, each Peer Support Specialist must:

1. Hold a current Cardiopulmonary Resuscitation (CPR) certification issued by an approved provider. CPR certification must remain current throughout the period of employment under this contract. A copy of the current CPR certification card must be maintained in the provider's personnel record and submitted to DCFS upon request.

1. Complete tuberculosis (TB) screening or testing with documented negative results, or obtain documented medical clearance, prior to the initiation of service delivery, in accordance with NAC 441A.375 and Centers for Disease Control and Prevention (CDC) guidelines and Nevada Medicaid. TB screening and results must be documented in the provider's personnel record by the supervising agency and repeated thereafter as indicated by NAC 441A.375. The contractor is responsible for maintaining all TB documentation and making it available for review by DCFS or Nevada Medicaid upon request.

4.4 Supervision Requirements

1. Each FPSS and YPSS must receive supervision at least twice monthly, or more frequently as determined by the supervisor based on the needs of the specialist or the caregivers/youth being served.

1. The supervisor must hold a current Nevada Certification Board Peer Support Specialist Supervisor certification applicable to the relevant specialty — Peer Support Specialist Supervisor (FPSS-S) for staff providing Family Peer Support Services, or Youth Peer Support Specialist Supervisor (YPSS-S) providing Youth Peer Support Services.

1. Peer-to-peer support services must be provided under the clinical and direct supervision of a qualified behavioral health professional as required by Nevada Medicaid MSM Chapter 4300.

1. Supervision records must be maintained and made available for review by DCFS upon request.

5. TRAINING AND COMPETENCY REQUIREMENTS

General Requirements: All documentation of training curriculum content, and documentation of completion, including the date, trainer or training provider, and topics covered, must be maintained by the contractor and made available to DCFS upon request.

Training must align with SAMHSA's Core Competencies for Peer Workers in Behavioral Health Services and SAMHSA's National Model Standards for Peer Support Certification. All required training related to providing and billing Peer Support Services must be completed as outlined by the Nevada Health Authority.

Training requirements apply to both Family Peer Support Specialists (FPSS) and Youth Peer Support Specialists (YPSS) unless otherwise noted, and must address the following competency domains:

5.1 Peer Support Foundations

1. Effective and ethical use of lived experience in a peer support role, including sharing personal recovery and resiliency stories purposefully and appropriately, whether as a caregiver (FPSS) or as a youth with direct lived experience (YPSS).

1. Recovery orientation, resiliency, wellness, and strengths-based approaches for families of children with behavioral health or emotional conditions, and for youth with behavioral health, substance use, child welfare, or juvenile justice involvement.

1. Boundaries, ethics, and the distinction between peer support and clinical or licensed behavioral health services.

5.2 Person-Centered and Trauma-Informed Practice

1. Person-centered planning principles and practices, including development and support of individualized, goal-oriented plans of care for caregivers and for youth.

1. Trauma-informed care frameworks and their application in peer support relationships, including developmentally appropriate applications when working with youth and adolescents.

1. Self-care and wellness practices to prevent burnout and compassion fatigue among peer support staff.

5.3 Advocacy and Systems Navigation

1. Advocacy skills, including knowledge of consumer rights, entitlements, and negotiation strategies across child-serving systems (behavioral health, education, child welfare, juvenile justice).

1. Supporting caregivers and youth in Individualized Education Program (IEP) meetings, Section 504 meetings, Child and Family Team (CFT) meetings, and other formal planning processes.

1. Identification and connection to community resources, including TANF, housing supports, education and employment resources, and other public benefit programs.

1. Proficiency in Nevada's Medicaid enrollment process through the Division of Welfare and Supportive Services (DWSS) and the Nevada ACCESS system, including the ability to conduct a basic eligibility screening, assist caregivers or youth in completing and submitting a Medicaid enrollment application, track application status, and document eligibility determinations in accordance with the requirements of this contract.

1. Knowledge of Medicaid recipient rights, including the right to receive person-centered care, to participate in treatment planning, to file grievances or appeals, and to provide or withhold informed consent, as applicable to the family peer support or youth peer support role.

5.4 Cultural Humility and Diversity

1. Cultural humility, diversity, equity, inclusion, and accessibility (DEIA) as applied to peer support practice and community engagement.

1. Demonstrated ability to respectfully and effectively communicate and collaborate with diverse populations across race, ethnicity, language, gender, sexual orientation, religion, and socioeconomic background.

5.5 System of Care and Collaborative Practice

1. System of Care values, principles, and practices, including the role of Family and Youth Peer Support Specialists as members of the care team.

1. Child and Family Team (CFT) composition, roles, responsibilities, and best practices.

1. An overview of each DCFS Children's Mental Health Services program, to include eligibility and understanding of the continuum of care offered with the service array.

1. Natural and informal support identification, development, and integration into family and youth planning.

5.6 Legal, Regulatory, and Compliance Training

1. Health Insurance Portability and Accountability Act (HIPAA): privacy, confidentiality, and permissible disclosures.

1. Child abuse and neglect mandatory reporting requirements: completion of the Nevada Training Partnership online mandated reporting training is required prior to service delivery.

1. Consumer rights and practices across child-serving systems.

1. Medicaid peer support documentation and billing requirements, including Nevada Medicaid MSM Chapter 4300 and Provider Type 97 billing guidelines applicable to the Family Peer Support and Youth Peer Support billing codes.

1. Nevada Medicaid Initial 16-Hour Competency Training: Prior to submitting an enrollment application to Nevada Medicaid, and within 365 days prior to the requested enrollment effective date, each FPSS and YPSS must successfully complete the initial 16-hour competency training program required under Nevada Medicaid MSM Chapter 400.

1. Nevada Medicaid Quarterly In-Service Training: Each FPSS and YPSS must complete a minimum of two (2) hours of in-service training per quarter as required for continued Nevada Medicaid enrollment under MSM Chapter 400.

1. Peer Support Ethics: Prior to delivering services under this contract, each FPSS and YPSS must complete a minimum of six (6) hours of peer support ethics training from an NCB-approved curriculum.

50. Ethics training must address, at a minimum: the ethical use of lived experience in a peer support role; professional boundaries and dual relationship avoidance; confidentiality and its limits in a peer support context (including, for YPSS, the limits of confidentiality with minors and the caregiver's role); ethical decision-making frameworks as applied to family or youth peer support practice; the distinction between peer support and clinical or licensed behavioral health services; and adherence to the applicable NCB Code of Ethics.

50. Ethics training must be repeated as part of each FPSS or YPSS certification renewal cycle in accordance with NCB requirements. Documentation of ethics training completion must be maintained in the provider's personnel record and made available to DCFS upon request.

1. Medicaid Fraud, Waste, and Abuse (FWA) Prevention: Prior to delivering any Medicaid-billable services under this contract, each FPSS, YPSS, and all contractor staff involved in Medicaid billing, documentation, or supervision must complete Medicaid Fraud, Waste, and Abuse prevention training consistent with the requirements of Nevada Medicaid MSM Chapter 3300 and applicable federal requirements.

5.7 Child and Youth Behavioral Health and Developmental Awareness Family and Youth Peer Support Specialists must have sufficient general awareness of common childhood and adolescent behavioral health and developmental conditions to understand the context in which caregivers and youth are seeking support and to engage with them in an informed, credible, and empathetic manner. This training is not clinical in nature and does not confer diagnostic or treatment authority. Required competency areas include general awareness of:

1. Common childhood and adolescent behavioral health diagnoses and their general presentation, including but not limited to: Attention Deficit Hyperactivity Disorder (ADHD), anxiety disorders, depressive disorders, Oppositional Defiant Disorder (ODD), conduct disorders, and substance use disorders.

1. Neurodevelopmental conditions, including Autism Spectrum Disorder (ASD) and intellectual and developmental disabilities, and their impact on family functioning and caregiver or youth experience.

1. Childhood and adolescent trauma and Adverse Childhood Experiences (ACEs), including the effects of trauma exposure on behavior, development, and family systems, and the principles of trauma-informed care as applied in peer support contexts.

1. Co-occurring behavioral health and developmental needs, and how multiple diagnoses or conditions may interact to affect the child's or youth's behavior and the caregiver's or youth's capacity to access appropriate supports.

1. The general continuum of behavioral health services and supports available to children and youth in Nevada, including DCFS Children's Mental Health Services programs, school-based services, crisis resources, and community-based supports, to enable effective resource connection and referral.

1. The distinction between the peer support role and clinical or diagnostic roles when discussing a child's or youth's behavioral health or developmental needs, including appropriate boundaries and referral practices when a caregiver or youth raises concerns that require clinical assessment or intervention.

5.8 Youth-Specific Competencies: Adolescent Development and Self-Determination In addition to the competency domains above, Youth Peer Support Specialists must receive training addressing the developmental and systemic issues unique to working directly with youth and young people, including:

1. Adolescent development, identity formation, and typical developmental milestones, and how these intersect with behavioral health, substance use, and trauma.

1. Self-determination and youth voice: engaging youth as active participants and decision-makers in their own care and planning process, rather than as passive recipients of services.

1. Youth rights within the special education system, including Individualized Education Program (IEP) and Section 504 processes, and supporting youth to participate in and advocate for themselves at school-based meetings.

1. Transition planning for older youth, including transition-age youth (16 and older) planning for adulthood, independent living skills, post-secondary education, and workforce readiness, in coordination with the Child and Family Team.

1. Awareness of the juvenile justice system and child welfare/foster care system, including how youth in these systems may experience behavioral health needs, and appropriate boundaries and referral practices when working with youth who have justice or child welfare involvement.

1. Confidentiality and consent considerations specific to working with minors, including the role of the parent/guardian, applicable Nevada minor consent laws, and appropriate communication boundaries between the YPSS, the youth, and the caregiver.

1. Suicide risk awareness and safe messaging practices appropriate to a non-clinical peer role, including recognizing warning signs and following the contractor's protocol for referral to crisis resources.

6. PROGRAM AND SERVICE REQUIREMENTS

6.1 Service Definitions

Family Peer Support Services: Family Peer Support Services are Medicaid-reimbursable behavioral health services provided by a qualified Peer Support Specialist to a parent or primary caregiver of a child with a behavioral health or emotional condition. As defined by the Centers for Medicare and Medicaid Services (CMS) and Nevada Medicaid MSM Chapter 4300, these services use the peer specialist's own lived experience to assist, guide, and empower caregivers. Services are non-clinical and do not require, replicate, or substitute for any service or activity requiring mental health licensure.

Youth Peer Support Services: Youth Peer Support Services are Medicaid-reimbursable behavioral health services provided by a qualified Youth Peer Support Specialist directly to a youth with behavioral health, substance use, child welfare, or juvenile justice-related need. As defined by CMS and Nevada Medicaid MSM Chapter 4300, these services use the peer specialist's own lived experience as a young person to assist, guide, and empower the youth receiving services. Services are non-clinical and do not require, replicate, or substitute for any service or activity requiring mental health licensure.

6.2 Direct Service Provision

All family and youth peer support services provided under this program must be delivered in full compliance with all applicable federal, state, and local Medicaid requirements, including but not limited to supervision, documentation, billing, and coding standards. Providers must ensure that services are medically necessary, consistent with the state’s Medicaid plan, and aligned with the National Model Standards for Peer Support Certification. The Contractor shall perform all services within the defined service limitations and scope boundaries, ensuring compliance with applicable contractual and operational requirements.

The organization will maintain a diverse, specialized Peer Support Specialist workforce capable of addressing the full spectrum of youth and family needs, with expertise aligned to all covered services defined under provider type 97.

6.3 Medicaid Billing Requirements

The contractor must bill Nevada Medicaid under Provider Type 97 in strict accordance with the billing codes, modifiers, unit definitions, prior authorization thresholds, and claim submission requirements currently in effect under the Nevada Medicaid Provider Type 97 Billing Guide and MSM Chapter 4300. Because these requirements are subject to change by Nevada Medicaid, the contractor is responsible for monitoring and complying with the most current published version at the time services are rendered and billed, rather than any specific code, modifier, or threshold referenced elsewhere in this Scope of Work.

6.4 Documentation Requirements

The contractor must ensure that appropriate documentation is provided for all services in strict accordance with Nevada Medicaid requirements for Peer Support Services.

For the purposes of this project, the contractor will ensure that all documentation of services is standardized and meets Nevada Medicaid requirements, regardless of whether services are provided to Medicaid-eligible or non-Medicaid-eligible recipients.

All records must be maintained for a minimum of seven (7) years and be available for audit by DCFS, the Division of Health Care Financing and Policy (DHCFP), or their designees.

Additional Required Services

1. Outreach and coordination with DCFS Children's Mental Health Services clinicians, care coordinators, and intake staff to facilitate referrals and integrated service delivery.

1. Participation in inter-agency meetings, in-services and training as requested by DCFS.

6.4 Protocol Development

The contractor shall collaborate with DCFS to develop and maintain written protocols for conflict resolution, communication, and coordination of services between the contractor and DCFS program staff. Protocols will be developed by the contractor and submitted to DCFS for review and agreement.

6.5 Caregiver and Youth Experience Survey

The contractor must develop and administer standardized experience surveys — one for caregivers and one appropriate for youth — to all caregivers and youth receiving Family Peer Support Services or Youth Peer Support Services under this contract. The youth-facing survey must be developmentally and age-appropriate. Both survey instruments must be submitted to DCFS for review and written approval prior to use and must be re-submitted for approval if revised at any point during the contract period. Surveys must be available in English and Spanish at minimum, and in any other language spoken by a significant portion of the population served, consistent with the contractor's language access obligations under Title VI of the Civil Rights Act of 1964.

Surveys must be conducted at the following intervals:

1. Initial survey: 30-45 days following service initiation

1. Ongoing survey: every 6 months, for individuals who continuously receive services

1. Discharge/service closure survey: within the 30-day window, prior to the last date of service.

Surveys must be offered in a manner that protects the respondent's ability to respond honestly, including the option to complete the survey independently rather than in the presence of the FPSS or YPSS assigned to their case. The contractor must document the number of surveys administered and the number returned in each reporting period, by service type. Aggregate, de-identified survey results must be included in the Quarterly Program Report described in Section 8.3. Individual survey responses must be maintained in the caregiver's or youth's case file and made available to DCFS upon request.

The contractor will use survey results as part of its continuous quality improvement activities and to share aggregate findings with FPSS and YPSS staff as a tool for reflective practice and service improvement.

7. REPORTING REQUIREMENTS

7.1 Monthly Referral Report

1. Total number of referrals received per month, reported separately for Family Peer Support Services and Youth Peer Support Services.

1. For each referral:

71. Referral source (specify DCFS program when applicable)

71. Referral disposition, and if services were not provided or declined, the reason should be noted.

1. Number of active cases at end of reporting period/last day of the month, by service type.

1. Number of cases closed during the reporting month with associated duration of services in months, by service type.

1. Number of referrals on a waitlist at end of reporting period, with length of wait in days for each, by service type.

1. Number of Medicaid eligibility screenings initiated on behalf of caregivers or youths who were uninsured or whose insurance status was unknown at intake.

1. Any critical incidents or critical complaints involving a caregiver or youth, with a brief description and the contractor's response (excluding identifying information).

1. Any staffing changes, including specifying all vacant FPSS and YPSS positions.

7.2 Monthly Peer Support Specialist Report

Each FPSS and YPSS must submit a monthly activity report including:

1. Current caseload.

1. For each caregiver or youth served:

79. DCFS program(s) they are associated with

79. Total direct service hours, broken down by service activity type: Emotional Support; Community Service Connection; Self-Care; Instructional Support; Advocacy/Self-Advocacy; Information & Referral; Child & Family Team Support; Educational Support; Transition Planning Support (YPSS only); Crisis De-escalation.

79. Medicaid billing codes and units billed per caregiver or youth per month.

1. Number of caregivers or youth screened for Medicaid eligibility during the month, with outcomes reported as: confirmed eligible and enrolled, confirmed eligible and enrollment in process, determined ineligible, determination pending, or caregiver/youth declined assistance. Any recipient determined ineligible for Medicaid must have a copy of the eligibility denial or determination on file.

1. Confirmation/attestation that each FPSS and YPSS meets the certification and training requirements, received the required supervision, and is up to date on all required training courses. If a specialist is out of compliance, a plan must be included specifying how and when compliance will be attained and any resulting impact on service provision.

7.3 Quarterly Program Report

Service Reach and Access:

1. Average caseload per FPSS and per YPSS during the quarter.

1. Average number of service contacts per caregiver or youth per month during the quarter (frequency of engagement), by service type.

1. Average length of time caregivers and youth remain enrolled in services (tenure), reported in months, by service type.

1. Number and percentage of caregivers and youth who were served in a language other than English, with language noted.

1. Geographic distribution of caregivers and youth served, by zip code or region (Northern vs. Southern Nevada), to identify service gaps or access disparities.

1. Number of caregivers or youth who were newly enrolled in Medicaid during the quarter because of FPSS or YPSS assistance.

Caregiver and Youth Engagement and Goal Progress:

1. Unduplicated count of caregivers served and unduplicated count of youth served, reported separately.

1. Number of caregivers and youth with an active, documented person-centered plan of care at end of quarter.

1. Number of caregivers and youth who achieved at least one self-identified goal during the quarter, as documented in the Plan of Care (POC).

1. Number of caregivers and youth who disengaged from services during the quarter (prior to planned closure), with reason noted when known (e.g., lost contact, declined services, child/youth no longer in DCFS program, family relocated, youth aged out, other).

1. Number of cases closed during the quarter, with reason for closure (goal achieved, transfer to natural supports, caregiver or youth request, child/youth aged out, lost contact, other).

Workforce and Compliance:

1. Number of FPSS and YPSS staff with current NCB certification.

1. Number of supervisory contacts completed per FPSS and per YPSS during the quarter, compared to the required minimum.

1. Number of Medicaid claims submitted, number denied, number appealed, and number of denials resulting in DCFS invoice submission, reported separately for Family and Youth Peer Support Services.

1. Any critical incidents involving a caregiver or youth during the quarter, with a brief description and the contractor's response (excluding identifying information).

Program Quality:

1. Number of caregivers and youth who completed a satisfaction or experience survey during the quarter, and a summary of results, reported separately.

1. Summary of any grievances or complaints filed by caregivers or youth during the quarter, and their resolution status.

1. Summary of training completed by FPSS and YPSS staff during the quarter, including in-service hours completed and topics covered, to demonstrate compliance with the quarterly Medicaid in-service training requirement and ongoing support to enhance provider capacity.

1. Summary of outreach activities conducted.

1. Summary of collaborative efforts with DCFS programs.

1. Summary of successes, challenges, and continuous quality improvement activities.

8. BILLING OBLIGATIONS AND PAYOR OF LAST RESORT

8.1 Medicaid as Primary Payor

The contractor is required to bill Nevada Medicaid as the primary payor for all Family Peer Support Services and Youth Peer Support Services delivered to Medicaid-eligible recipients. The contractor must maintain active enrollment as a Nevada Medicaid provider under Provider Type 97, in the applicable specialty or specialties, and must bill all covered services prior to submitting any invoice to DCFS.

The contractor must make all reasonable and timely efforts to obtain Medicaid reimbursement for covered services before seeking payment from DCFS. Failure to bill Medicaid for a Medicaid-eligible recipient, without documented justification, may result in disallowance of the corresponding DCFS invoice line item.

8.2 DCFS as Payor of Last Resort

DCFS shall serve as the payor of last resort for Family Peer Support Services and Youth Peer Support Services provided under this contract. In cases where the denial is attributable to the provider’s actions, omissions, or compliance issues, the provider will be responsible for any associated costs. Claims that result in partial Medicaid payment must also clearly identify the unpaid balance being invoiced to DCFS.

DCFS payment to the contractor does not constitute a waiver of the contractor's obligation to seek Medicaid reimbursement, and DCFS reserves the right to recover any amounts paid by DCFS for services for which Medicaid reimbursement is subsequently obtained.

8.3 Required Documentation for DCFS Invoice Submission

All invoices submitted to DCFS must include the following documentation for each service line item being billed to DCFS:

For Medicaid-eligible recipients: A copy of the Nevada Medicaid Remittance Advice (RA) or Explanation of Benefits (EOB) showing the claim was submitted and either denied, paid at a rate less than the contracted DCFS rate, or adjudicated as non-covered, provided that the denial was not the result of negligence, error, or failure on the part of the provider.

For non-Medicaid-eligible recipients:

· Written documentation confirming the recipient's lack of Medicaid eligibility at the time of service (e.g., a Medicaid eligibility verification result, a DCFS-accepted eligibility determination, or other official documentation).

· Documentation of the Medicaid eligibility screening completed by the contractor on or before the first service contact, including the date of the screening, the screening outcome, and — if the recipient appeared potentially eligible — documentation of enrollment assistance provided and the status of the Medicaid application or eligibility determination.

For services subject to Medicaid prior authorization denial:

· A copy of the Notice of Decision (NOD) or other formal denial communication from Nevada Medicaid, along with documentation that the contractor submitted or is actively pursuing any available appeal or reconsideration under Nevada Medicaid billing procedures.

· Supporting clinical or programmatic justification for why the services are necessary, despite Medicaid denial.

Invoices submitted without the required documentation will be returned to the contractor and will not be processed for payment until all required documentation is received. DCFS reserves the right to audit the contractor's Medicaid billing records at any time to verify compliance with this section.