Addendum One RFR 2027-003 Medication Assisted Treatment Questions and Answers.pdf
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- Solicitation number
- BD-27-1095-SDMPD-SDMPD-133626
- Issued by
- Middlesex County, Massachusetts
About this file
This addendum document contains questions and answers regarding RFR 2027-003 Medication Assisted Treatment Program Services issued by the Middlesex Sheriff's Office in Woburn, Massachusetts. The Addendum One clarifies operational procedures and responsibilities for the medication-assisted treatment program to be conducted at the Middlesex Jail and House of Correction in Billerica, Massachusetts. Key clarifications include that vendor nursing staff will conduct electrocardiograms (EKGs) using equipment provided and maintained by the Middlesex Sheriff's Office, while the vendor will be responsible for updating electronic medical records. The contract requires an MD Physician Addiction Specialist, though coverage may be split between multiple providers for different treatment modalities. Current patient census includes 58 patients on sublingual Suboxone, 54 on methadone, 13 on Brixadi, 6 on Sublocade, 19 on naltrexone/Vivitrol, and 2 on Campral. All nursing, clinical, and navigator services must be completed in-person, while Licensed Physician Addiction Specialist appointments for opioid treatment programs and quick abstinence syndromes may be conducted virtually with pre-approval from the MAT Program Director.
Vendor nursing responsibilities detailed in the addendum include conducting EKGs, scheduling and following up on laboratory results, performing urine analysis drug screens, documenting all activities in the CorEMR system, administering and documenting medication doses, conducting dose evaluations using the Clinical Opiate Withdrawal Scale, and maintaining communication with the Middlesex Sheriff's Office MAT Nurse Manager. The Middlesex Sheriff's Office will retain responsibility for procuring and paying for laboratory services, maintaining all equipment and supplies, and paying any auditing fees, while the vendor is responsible for all licensing fees. The office does not currently intend to obtain its own opioid treatment program license and will maintain separate DEA registrations for buprenorphine dispensing to distinguish between the vendor's and the agency's practices. Mock audit results must be submitted to the MAT Program Director and Health Services Administrator with any required corrective action plans included.
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The Commonwealth of Massachusetts Middlesex Sheriff’s Office
Peter J. Koutoujian Sheriff
12 Gill St. Suite 4700 Woburn, Massachusetts 01801 Phone (781) 960-2800 Fax (781) 960-2902
Addendum One:
RFR 2027-003 Medication Assisted Treatment Questions and Answers
1. Question: Who will conduct the EKGs?
Answer: The contract awarded vendors nursing staff
2. Question: If the OTP provider conducts them, will the provider have access to MSO’s EKG machine?
Answer: yes
3. Question: Will MSO be responsible for maintaining the EKG machine?
Answer: Yes, but vendor Nurses will be responsible for performing the EKG’s and updating our EMR.
4. Question: How much direct patient care does the current MAT physician provide?
Answer: Suboxone/Naltrexone-Vivitrol/Acamprosate and Disulfiram (QAS) Provider-16 hours a week, plus on-call services.
Methadone Provider-8 hours per month, the first and third Tuesday.
5. Question: What proportion of that care is delivered in person versus virtually?
Answer: All nursing, clinical and navigator services are completed in-person. Only the OTP Licensed Physician Addiction Specialists appointments are facilitated, virtually. The QAS’s virtual schedule is determined by MSO Staff. The Methadone Providers schedule is facilitated by the vendor Nurse.
6. Question: Can a mid-level practitioner provide physician coverage?
Answer: This bid requires an MD. In the event the vendor is requesting a mid-level practitioner cover the physician, prior approval must be received by the MSO MAT
Director, and an NP rate will be negotiated prior to coverage.
7. Question: Can physician coverage be split across multiple providers and can the split between both the OTP and the remainder of MAT services.
Answer: Yes, in our current model we have one Physician Addiction Specialist for Methadone and another Physician Addiction Specialist for all other treatment options.
8. Question: How is buprenorphine dispensing documented in the medical record?
Answer: We use CorEMR and all documentation is noted in this medical records system. This includes daily dosing, Provider Notes, Nursing Notes and Orders as well as Medication Ordering.
9. Question: Will MSO relinquish the DEA registration associated with its current buprenorphine practice? Or will separate registrations continue?
Answer: No, it is recommended for sperate registrations to continue.
10. Question: What percentage of patients receiving medication-assisted treatment are requesting buprenorphine? And, of those how many are receiving injectable medications?
Answer: See below the current census by medication. These numbers change, daily. We have multiple pathways for someone to be enrolled on Buprenorphine Treatment. LAI’s are determined by the QAS and patient using a shared decision-making model. It should also be noted that LAI’s are a treatment option for diversions.
SL Suboxone-58
Methadone-54
Brixadi-13
Sublocade-6
Naltrexone/Vivitrol-19
Campral-2
11. Question: Is the (1) MAT clinician expected to be a position filled by the vendor at all times, or is this dependent on the number of patients?
Answer: This position is dependent on the number of patients and programmatic needs.
12. Question: Can any of the Physician Addiction Specialist hours be done virtually? If so, is there a limit on how many virtual hours?
Answer: Yes, clinic can be conducted virtually. This must be pre-approved with the MAT
Program Director for scheduling purposes. There is no limit on the number of virtual hours.
13. Question: Are there visions from the Sheriff’s office of obtaining their own OTP license or program expansion in any way? (injectables, increasing inductions)
Answer: The Middlesex Sheriff’s Office is not looking to obtain our own OTP license at this time.
14. Question: At the site visit, it was mentioned that there would be a few duties that vendor nurses would now be tasked with, that were previously the responsibility of MSO nursing staff. Can you outline these responsibilities?
Answer:
a. Conducting their own EKGs;
b. Scheduling labs and following up with results;
c. Following up with anyone who did not disclose they were prescribed Methadone upon admission;
d. UA Drug Screens;
e. Documenting everything in our EMR and then completing the tasks at the end of each business day;
f. Signing off in our EMR the medication given and correct dose, daily;
g. Dose Evaluations/COWS;
h. Maintaining close communication with the MSO MAT Nurse Manager for dose changes or pertinent information related to patient care.
15. Question: What, if any, should be the process for reporting mock audit results to MSO?
Answer: The results of the mock audit should be sent to the MAT Program Director and the Health Services Administrator. Should any corrective action be identified during this process, a plan of corrective action should be outlined and submitted as well.
16. Question: Are the additional 4 hours of the Physician Addiction Specialist expected to be in person and would (2) 10 hour days be acceptable for these hours?
Answer: The Physician Addiction Specialist can facilitate their clinic in-person or virtually. Scheduling will be managed and determined by the Program Director/Nurse
Manager.
17. Question: If there are any licensing or auditing fees is the county or the vendor responsible for the payment?
Answer: The MSO is not responsible for any licensing fees. The MSO is responsible for any auditing fees.
18. Question: If the vendor is required to perform necessary services such as EKGs or labs will the county provide and maintain the equipment and supplies for the vendor's use?
Answer: Yes. The MSO would schedule, but the Contractor staff would be responsible for facilitating the task. The equipment will be provided by the MSO.
19. Question: Will the county or the vendor be responsible for procuring and paying a lab company to process and return results for MAT-specific labs?
Answer: The MSO will remain responsible for procuring and paying the labs for MAT services.
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