5-DHHS91286 Att B SOW UHPP 25CR162.docx

ATTACHMENT B: SCOPE OF WORK

Outreach and Healthcare Access for Substance Use Disorders

Article 1

PURPOSE AND DEFINITION

1.1 Purpose. The purpose of this contract is to identify individuals with opioid and/or stimulant use disorders, and their families, who qualify for public health plans, engage with them through public outreach and education activities, provide available market information on health plans and the availability of federal subsidies to the consumer, and assist them through the enrollment process.

1.2 Definition. In this contract, the following definition applies:

“SUD” means substance use disorder.

Article 2

POPULATION SERVED

2.1 Eligible Clients. The population to be served consists of:

(1) adults aged 18 and older, at risk of developing, or who currently have, an opioid or stimulant use disorder and who do not currently have Medicaid or other insurance coverage; and

(2) youth aged 12 to 17, at risk of developing, or who currently have, an opioid or stimulant use disorder and their legal guardian(s) and who do not currently have Medicaid or other insurance coverage.

Article 3

QUALIFICATIONS

3.1 Contractor Requirements. The Contractor shall:

(1) have and maintain registration with the State of Utah, Department of Commerce, Division of Corporations and Commercial Code;

(2) have at least three years of experience assisting consumers with Medicaid enrollment; and

(3) have at least two years of experience working with substance use treatment agencies, substance use community organizations, and carceral facilities to provide outreach and enrollment assistance to individuals with, or who are at risk of developing, opioid or stimulant use disorders.

3.2 Training Requirements. The Contractor shall:

(1) maintain policies and procedures that address staff training standards, safety, ethical practices, and competencies, which must be available to the DHHS monitoring team or to the Utah Department of Workforce Services; and

(2) ensure that all staff providing services have completed necessary and appropriate trainings, criminal background checks, and registration prior to assisting consumers.

Article 4

SERVICE REQUIREMENTS

4.1 General Service Requirements. The Contractor shall:

(1) perform public education and outreach activities designed to engage individuals with opioid and stimulant use disorders and their families;

(2) work closely with DHHS, local authority treatment providers, the Utah Support Advocates for Recovery Awareness, and other community treatment programs, including criminal justice agencies, and to develop educational materials and to schedule outreach events;

(3) ensure that information is appropriate for, and that outreach is provided to, homeless individuals and those involved in the criminal justice system;

(4) distribute all enrollment information available on the market on health plans and the availability of federal subsidies;

(5) facilitate enrollment in qualified health plans;

(6) conduct enrollments in rural areas within a 60-mile radius of the Contractor’s office;

(7) employ a health access assistant to conduct outreach activities and to assist clients in enrollment services for Box Elder, Cache, and Weber Counties;

(8) connect individuals who do not qualify for care to clinics that provide services at a reduced cost;

(9) follow up with all individuals within three weeks of enrollment to verify the individual paid their first premium, set an appointment with a primary care physician, and received their insurance card;

(10) provide referrals for grievances or complaints to appropriate agencies;

(11) at the Contractor’s discretion, attend or present at any local or national opioid or stimulant conference to spread knowledge of the Contractor's work and to learn about ways to improve its program and methods; and

(12) conduct train-the-trainer trainings for SUD service providers and related organizations on enrollment in accordance with the current Medicaid enrollment policy. These trainings must occur monthly as requested by the SUD service providers, and may be conducted at the contractor site or at the requested provider’s location.

Article 5

OUTCOMES

5.1 Outcomes. Public education, outreach activities, and enrollment assistance provided by the Contractor must lead to increased engagement of individuals with opioid and/or stimulant use disorders and their families. These services must lead to an increase in the number of eligible clients who are identified as eligible to enroll in public health insurance programs, an increase in the number of eligible clients who receive assistance enrolling in public health plans, and contribute to an increase in the percent of the total population of individuals who have health insurance coverage.

5.2 Outcome Measurements. The Contractor shall measure outcomes using the following metrics:

(A) 5% increase in outreach activities per federal fiscal year;

(B) 5% increase in people who attend outreach activities per federal fiscal year;

(C) 5% increase in people receiving assistance enrolling in qualified health plans per federal fiscal year;

(D) 5% increase in individuals identified as eligible for public insurance programs;

(E) the number referrals for grievances or complaints to appropriate agencies;

(F) 5% increase in individuals who set an appointment with a primary care physician per federal fiscal year;

(G) 5% increase in train-the-trainer trainings conducted per federal fiscal year; and

(H) 5% increase in total attendees of train-the-trainer trainings per federal fiscal year.

5.3 Outcome Reporting. The Contractor shall:

(a) meet with the DHHS program specialist once per quarter for the first year, then every six months the following years to report project progress;

(b) submit an annual report at the end of each fiscal year of the length of the contract, reporting general service requirements that address gaps, barriers, and successes to the service provision; and

(c) collect and record outcome measurements using the evaluation tool developed by DHHS. Reporting quarterly is due on or before the last day of April, July, October, and January for events and outcomes in the preceding quarter.

Article 6

BILLING REQUIREMENTS

6.1 Invoicing.

1. The Contractor shall submit monthly invoices for services through the electronic billing system made available for that purpose. The Contractor shall only submit allowable costs, as described in Attachment C: Funding Allocation, Rate Table, and Budget. The Contractor shall include the following on each invoice:

(1) a detailed description of the services rendered;

(2) dates services rendered;

(3) contract number;

(4) uniquely identifiable invoice number;

(5) Contractor name;

(6) Contractor’s address for payment;

(7) Contractor’s phone number;

(8) Contractor’s signature; and

(9) expenses incurred as indicated by the line items in the attached budget.

1. Invoices submitted without the required information will not be paid and will be returned to the Contractor for revision.

1. Payments will be made through the State of Utah, Department of Administrative Services, Division of Finance Electronic Funds Transfer (“EFT”) system.

1. Prior to the submission of invoices, the Contractor shall ensure it is enrolled in the EFT system. DHHS will provide the Contractor with instructions to enroll in the EFT system. The Contractor shall ensure that their EFT approval is maintained and shall notify DHHS of any change to the EFT status.

1. Failure to enroll in the EFT system will result in a delay of all payments until EFT is established.

1. All payments made will be made in the name of the Contractor as it appears on the cover page. Any change must be submitted in writing to the DHHS Administrative Services Director.

1. State Fiscal Year-End Billings. The state fiscal year is from July 1st through June 30th. The Contractor shall submit all billings for services performed on or before June 30th of a given fiscal year by July 14th of the following fiscal year, regardless of the Contractor’s billing period or the expiration or termination date of this contract. DHHS may delay or deny payment for services performed in a given fiscal year if it receives the Contractor’s bill for those services after July 14th of the following fiscal year.

1. Funding Allocation, Budget, and Rate Table Attachment. If the Contractor is a Utah governmental entity, a funding allocation, budget, and rate table attachment issued by DHHS subsequent to this contract constitutes an amendment to this agreement. DHHS may issue a funding allocation, budget, and rate table attachment on its own initiative without need for the Contractor’s signature and it may likewise issue a funding, budget, and rate table attachment in response to a request from the Contractor. Funding allocation, budget, and rate table attachments may increase or decrease the funding available to the Contractor and will be issued by DHHS and sent to the Contractor. Funding allocation, budget, and rate table attachments may reference and contain federal terms that apply to specific federal funding provided pursuant to this agreement. If the Contractor is not a Utah governmental entity, this paragraph does not apply.

1. Lapsing Funds: Any funds not expended by the end of the funding period for which they were allocated will lapse and the Contractor shall have no further claim to the funds.