Administrative_Services_Organization_for_Specialty_Behavioral_Health_and_Drug_Medi-Cal_Substance_Abuse_Disorder_Services_(Addendum_#2_Revision).pdf

COUNTY OF ORANGE

HEALTH CARE AGENCY

REQUEST FOR PROPOSAL (RFP)

FOR

ADMINISTRATIVE SERVICES ORGANIZATION FOR SPECIALTY

BEHAVIORAL HEALTH AND DRUG MEDI-CAL SUBSTANCE ABUSE

DISORDER SERVICES

RFP NO. 042-2948102-MC

RESPONSES MUST BE SUBMITTED ELECTRONICALLY TO:

https://secure.procurenow.com/portal/ocgov https://secure.procurenow.com/portal/%7bproject.government.code%7d

County of Orange RFP

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County of Orange

Health Care Agency

Procurement and Contract Services

405 W 5th St.

Santa Ana, CA

92701

SCHEDULE OF ACTIVITIES

Release of RFP Solicitation March 2, 2026

Question Submission Deadline April 6, 2026, 4:00pm

Proposal Submission Deadline April 13, 2026, 4:00pm

Interviews with the Top Ranked

Firm(s)

Anticipated to be conducted April 2026

405 W 5th Street, Santa Ana, CA 92701

Anticipated Board of Supervisors Date August 11, 2026

Anticipated Start of Contract January 1, 2027

PROPOSALS MUST BE RECEIVED ON

OR BEFORE

Monday, April 13, 2026

4:00 pm

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SECTIONS

SECTION 1. INTRODUCTION AND INSTRUCTIONS TO RESPONDENTS

SECTION 2. PROTEST PROCEDURES

SECTION 3. SCOPE OF WORK

SECTION 4. PROPOSAL SCORING CRITERIA

SECTION 5. OCLSB AND DVBE PREFERENCE POLICIES CERTIFICATION

REQUIREMENTS

SECTION 6. VENDOR RESPONSES

Attachments:

A - Attachment A - Model Contract

B - Attachment B - Budget Forms (6-month period)

C - Attachment C - Budget Forms (12-month period)

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SECTION 1. INTRODUCTION AND INSTRUCTIONS TO RESPONDENTS

1.1 INTRODUCTION

The County intends that the successful Respondent shall provide Administrative Services

Organization for Specialty Behavioral Health and Drug Medi-Cal Substance Abuse Disorder

Services proposed in accordance with contract requirements set forth in the solicitation and Model

Contract, including Attachments.

1.2 INSTRUCTIONS TO RESPONDENTS AND PROCEDURES FOR SUBMITTAL

A. Proposals are to be uploaded via the County's eProcurement Portal at https://procurement.opengov.com/portal/ocgov. For assistance on uploading proposals via County’s eProcurement Portal, please contact procurement-support@opengov.com or https://help.procurement.opengov.com/en/

B. Examine the Request for Proposals (RFP) Documents and the site of the proposed work carefully before submitting a Proposal for the work contemplated. Investigate the conditions to be encountered, as to the character, quality, and quantities of work to be performed and materials to be furnished and as to the requirements of all RFP Documents.

County has attempted to provide all information available. It is the responsibility of each

Respondent to review, evaluate, and, where necessary, request any clarification prior to submission of a Proposal. If any person contemplating submitting a response to this RFP is in doubt as to the true meaning of any part of the solicitation documents attached hereto or finds discrepancies in or omissions from the specifications, they may submit a written request for clarification/interpretation to the County Deputy Purchasing Agent (DPA) via the County’s eProcurement Portal under the bid page for this solicitation.

If clarification or interpretation of this solicitation is considered necessary by County, an addendum shall be issued, and the information will be posted via the County’s eProcurement Portal. Any interpretation of, or correction to, this solicitation shall be issued by the DPA. It is the responsibility of each Respondent to periodically check the County’s eProcurement Portal to ensure that they have received and reviewed any and all addenda to this solicitation.

County is not responsible for any other explanations, corrections to, or interpretations of the documents, including any oral information. If an addendum is issued, Respondents must acknowledge the addendum via the County’s eProcurement Portal.

All questions or requests for interpretations must be received by Monday, April 6, 2026, before 4:00 pm. The DPA will provide all official communication concerning this

RFP. Any County response relevant to this solicitation other than through or approved by the DPA is unauthorized and will be considered invalid.

https://procurement.opengov.com/portal/ocgov https://procurement.opengov.com/portal/ocgov mailto:procurement-support@opengov.com https://help.procurement.opengov.com/en/

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C. Proposals must be valid for a period of at least three hundred sixty-five (365) calendar days from the Proposal Submission Deadline. No Proposal may be withdrawn after the submission deadline.

D. Each Respondent must submit their proposal electronically via the County’s eProcurement

Portal.

E. All pages must be numbered and identified sequentially by section. Proposals must be tabbed and indexed in accordance with the information requested in the Vendor Responses

Section. It is imperative that all Respondents comply, exactly and completely, with the instructions set forth herein. All responses to this solicitation shall be type written or word-processed (except where otherwise provided or noted), concise, straightforward, and must fully address each requirement and question. Although not as a substitute for a complete written response, additional material, such as technical documents, may be referenced in any response if the material is included in the same section as additional information.

F. Proposals are not to be marked as confidential or proprietary. County may refuse to consider any Proposal so marked. All Proposals and supporting documents will be subject to the provisions of the California Public Records Act (California Code Government Code

7920.000 et seq.) (PRA) and will be disclosed or withheld in accordance therewith. The

County shall not be liable in any way for disclosure of any such records. Additionally, all

Proposals shall become the property of the County.

Respondents should not request that certain information be treated as exempt, and statements in the Proposals should not be marked as confidential or proprietary.

G. Each Respondent shall exercise reasonable care and diligence to avoid submitting a

Proposal that could result in a conflict of interest if Respondent were to be selected. This obligation shall apply to Respondent, Respondent’s employees, agents, and relatives, sub-contractors, and third parties associated with accomplishing work and services in Proposal.

In the event Respondent has done work for County on this Project in the past or has reason to believe that a conflict of interest may exist for Respondent in regard to this Project, Respondent should consult with its legal counsel prior to responding to this solicitation.

Any Respondent who is found to have an actual conflict of interest may have its Proposal rejected on that ground.

Respondent, its employees and/or consultants may be subject to the provisions of the

California Political Reform Act of 1974 (the “Act”), which (1) requires such persons to disclose any financial interest that may be materially affected by services provided under this Contract, (2) prohibits such persons from making, or participating in making, decisions that could reasonably affect such interest; and (3) may require the filing a Statement of

Economic Interest (Form 700).

If subject to the Act, Respondent shall conform to all requirements of the Act. Failure to

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Contract by County. Respondent shall indemnify and hold harmless County for any and all claims for damages resulting from Respondent’s violation of this Section.

H. By submitting a Proposal, Respondent represents that it thoroughly examined County’s requirements, is familiar with the services required under this solicitation and is qualified and capable of providing the services to achieve County’s objectives.

I. Each Respondent must submit its Proposal in strict accordance with all requirements of this RFP and compliance must be stated in the Proposal. Deviations, clarifications and/or exceptions must be clearly identified and listed separately as alternative items on additional information section for County’s consideration as specified in the Vendor

Responses Section, “Statement of Compliance.”

Note: Allow sufficient time to upload all required files. The County’s eProcurement Portal will not allow any uploads after the due date and time specified herein, e.g., if Part 1 and 2 uploaded successfully at 3:58:38 P.M. and Part 3 is in progress of being uploaded at 4:00:01

P.M., Part 3 will not upload successfully.

J. Pre-contractual expenses shall not be reimbursed by County. Pre-contractual expenses are defined as including, but not limited to, expenses incurred by the Respondent in: a) preparing its Proposal in response to this solicitation; b) submitting that Proposal to

County; c) negotiating with County any matter related to Respondent’s Proposal; and d) any other expenses incurred by Respondent prior to the date of award and execution, if any, of the Contract.

K. Any Proposal may be construed as non-responsive and ineligible for consideration if it does not comply with the requirements of the solicitation. Failure to comply with the technical features and acknowledgment of receipt of addenda are common causes for holding a Proposal nonresponsive.

L. Where two or more Respondents desire to submit a single Proposal in response to this solicitation, they must do so on a prime/subcontractor basis rather than as a joint venture.

County intends to contract with a single firm that may subcontract with multiple firms

(team) but not with multiple firms doing business as a joint venture.

M. County does not require and neither encourages nor discourages the use of lobbyists or other consultants for the purpose of securing business.

N. County requires a valid UEI number and full registration prior to Contract

Award. Respondent must obtain one at no cost at www.usfcr.com. If Respondent is unable to provide/obtain a UEI number, please indicate so in your proposal submission response.

http://www.usfcr.com/

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O. Effective from the issuance date of this solicitation until a Contract is awarded or the solicitation is withdrawn, all individuals or entities responding—including their employees, agents, representatives, proposed partners, subcontractors, members, lobbyists, or attorneys (collectively "Respondents")—are prohibited from engaging in any direct or indirect communication with County personnel involved in the selection process, except with the designated DPA. Respondents may continue conducting business with County on matters unrelated to this solicitation and may communicate with County staff, provided the solicitation is not discussed. Any attempt to engage in discussion regarding this solicitation with anyone other than the designated DPA will be presumed to create an unfair competitive advantage and may result in disqualification.

P. After the Proposal Submission Deadline, evaluations, and if requested by County, interviews will commence. Respondents who submit proposals most responsive to

County’s requirements may be asked to give a presentation of their proposal to County staff. County makes no guarantee as to the number of Respondents selected for interviews.

Selected Respondents should be prepared to make its presentation within five (5) business days after notification and be prepared to discuss all aspects of its proposal in detail, including technical questions regarding the proposal. Respondents shall not be allowed to alter or amend its proposal through the use of the presentation process.

1.3 MINIMUM QUALIFICATIONS/REQUIREMENTS

All timely submitted Proposals first will be evaluated by the DPA for the minimum RFP requirements set out below. The minimum submission requirements must be met for a Respondent to be considered as an eligible candidate to be evaluated for the requested services described in this RFP. Should any of this information be missing, Respondent may be deemed non-responsive.

Respondents only need to upload required documents once. These qualifications must be maintained during the term of any resultant contract.

Respondent's Proposal shall meet the following minimum RFP Requirements to proceed to the

Evaluation Process Stage:

A. Has the ability to do business in Orange County, California;

B. Completed all required Vendor Response questions of the solicitation;

C. Provided all required information, complete all required Exhibits, and pass all IT security requirements;

D. Has minimum five (5) consecutive years of experience in the last seven (7) years providing administrative services to support the operations of a public behavioral health plan in California;

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E. Provided administrative services to support the operations of a public behavioral health plan in California for at least one (1) public agency of a similar size to Orange Couty, California;

F. Provided all of the following documents. Include an index of all the documents included, and an explanation for any document requested but not provided.

1. If Incorporated

a. Articles of Incorporation executed by the Secretary of State, including all amendments

b. By-laws, including all amendments

c. Board of Directors resolution empowering a Corporate Officer either by title or individual name, to act on behalf of the organization by his/her signature alone.

(If applicable)

2. If not incorporated: Documentation empowering an Authorized Representative to act on behalf of the organization by his/her signature alone.

a. Fictitious Business Name statement filed with the County Clerk and proof of publication

b. Partnership papers and/or joint venture contracts

c. Evidence of federal/state tax status

d. Business License/Certifications/Conditional Use Permits (CUP)

e. Table of Contents from the organization's policies and procedures manual covering daily operations and emergency procedures (medical, fire, etc.). If a policies and procedures manual does not exist, provide a plan and time frame for development.

f. Corporate organizational chart that includes all programs, identifies the relationship of the proposed program to the overall organization, and identifies the reporting relationship of each staff position.

3. Recent financial statement prepared by an independent Certified Public Accounting

(CPA) firm.

4. Any audits, reviews, or inspection reports completed by a CPA firm, regulatory agency (e.g., Occupational Safety and Health Administration), or other government agency within the last 12 months. IF THERE ARE NONE, PLEASE STATE SUCH

IN THE PROPOSAL RESPONSE.

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5. A description of any active litigation and resolution, performance issues and/or audit or review of any contractual documents (e.g., invoices, units of service reports, etc.)

within the last five (5) years that resulted in a corrective action plan, reimbursement of money to funder, investigation, and/or termination of any agreements or contracts between your organization and the County of Orange, other government entity, and/or private organization. Provide a copy of a letter from your organization’s attorney and/or in-house legal counsel concerning the status of lawsuits and pending litigation for the most recent year. IF THERE ARE NONE, PLEASE STATE SUCH IN THE

PROPOSAL RESPONSE. For each litigation and or performance issue include:

a. The type of contracts, contract term (dates), funding amount and services provided.

b. The issues and circumstances.

c. How and when the issues were resolved.

d. Your organization’s plans to ensure that the issues will not re-occur in future contracts.

6. Detailed information regarding past, current, or threatened litigation, liens, or claims

(including claims filed or pending with Financial Industry Regulatory Authority and/or with the Security Exchange Commission) within the past five (5) years involving your company, or any company your company holds a controlling interest in, or any company that holds an interest in your company, or any of the principal officers of your company that has also involved the County of Orange or any of its officers or agencies. IF THERE ARE NONE, PLEASE STATE SUCH IN THE

PROPOSAL RESPONSE.

Proposals deemed to meet all minimum RFP requirements will move to the Evaluation Process

Stage.

1.4 EVALUATION PROCESS

Proposals deemed to meet all minimum qualifications/requirements will be evaluated by an

Evaluation Panel of job knowledge experts on the basis of the responses to the requirements in this

RFP. The Evaluation Panel will score Proposals based on the established evaluation criteria set forth in Section 4. Proposal Scoring Criteria, which includes County of Orange Procurement

Preference Policy, in accordance with Sections 1.8-103 and 4.3-112 of the 2024 County Contract

Policy Manual (CPM). A copy of the 2024 CPM can be found at https://cpo.ocgov.com/cpm.

Each Proposal will be assigned points that measure the responsiveness to each evaluation criterion.

The total number of points earned will be tallied for each Proposal, based upon the Respondent(s) submitted written materials.

https://cpo.ocgov.com/cpm

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Proposals will be evaluated from the most advantageous to the least advantageous to County.

County may request clarifications, or otherwise verify the contents of the Proposal, including information about the Respondent and sub-contractors.

Evaluation Process Stage

The evaluation process stage may be conducted in two phases. Phase 1 will be an evaluation of the written proposal based on the evaluation criteria for all Respondents and Phase 2 will be an evaluation of the interview/presentation for only the highest-rated Respondents in Phase 1 that are invited to participate in Phase 2. The Evaluation Panel has the right to determine whether to conduct Phase 2 and the number of Respondents who will participate in Phase 2 if it is conducted.

Please note that contract award will be made to the responsible Respondent whose proposal is most advantageous to County, taking into consideration the evaluation criteria. Cost Proposal as an evaluation criterion does not require County to select Respondent with the lowest cost proposal.

Phase 1:

In Phase 1, written proposals will be scored by the Evaluation Panel using the established criteria set out in Section 4. Proposal Scoring Criteria, which have been assigned points before the submission of proposal that measure the responsiveness to each criterion.

The Evaluation Panel will evaluate the written materials solely on the quality of the responses to all questions and requirements of this RFP using the evaluation criteria. The total number of points earned for all criteria will be tallied for each proposal, and the proposals will be rank-ordered based upon the points earned.

Phase 2:

If the Evaluation Panel decides to conduct Phase 2, then the selected highest-ranked Respondent(s) from Phase 1 will be invited to participate in Phase 2. In Phase 2, Respondents must provide an interview/presentation on their proposed services. Respondents must be prepared to travel to

County at their own expense to make their interview/presentation within five (5) business days after notification by the DPA. Respondents must be prepared to discuss all aspects of their proposals in detail, including answering technical questions. Respondents are not allowed to alter or amend their proposal during the interview/presentation process.

Written Proposal Scoring: 900 points maximum

See "Proposal Scoring Criteria" section for categories and points.

Presentation/Interview Scoring: 100 points maximum

County reserves the right to conduct, or not to conduct, oral interviews/presentations with the highest-ranked Respondent(s). The decision whether to conduct oral interviews/presentations exists solely with County, and the decision of the Evaluation Panel is final.

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Please note that, if the Evaluation Panel does not conduct Phase 2, the total score for all

Respondents is the points awarded in Phase 1. If the Evaluation Panel does conduct Phase 2, Respondents that County elects not to invite to participate in Phase 2 will not have a total score.

1.5 SELECTION/AWARD PROCEDURES

Upon the completion of the evaluation process, the Evaluation Panel will make a recommendation for an award to the County’s DPA. Final award determination shall be subject to reference checks and past performance.

The Model Contract contained in this RFP is the contract proposed for execution. Successful

Respondents are expected to accept the terms and conditions of Attachment A - Model Contract, which contains the contracting requirements between County and Respondent regarding the provision of services solicited under this RFP. It may be modified to incorporate negotiated items and other pertinent terms and conditions set forth in this RFP, including special conditions and requirements and those added by addendum, necessary attachments and/or exhibits, and to reflect

Respondent’s Proposal and qualifications. Any additional exceptions to the terms and conditions made by any Respondent after submission of its Proposal may result in its elimination from further consideration.

Exceptions to the terms and conditions of the Model Contract or the statements regarding

Respondent’s inability to comply with any of the provisions thereof are to be declared in the response to the RFP in Section 6 VENDOR RESPONSES - Statement of Compliance.

The ranking of Respondent(s) will be brought to the County Board of Supervisors for selection and negotiations may or may not be conducted with the finalist(s); therefore, the Proposal submitted should contain Respondent(s) most favorable terms and conditions, since the selection and award may be made without further discussion or need for clarification.

County will enter into negotiations with the selected Respondent and award a contract upon completion of negotiation of fees and contract terms. The award may require additional approval by the County Board of Supervisors.

If a satisfactory contract cannot be negotiated in a timely manner, County, in its sole discretion, may terminate negotiations with the selected Respondent and begin negotiations with the next

Respondent.

1.6 RIGHTS RESERVED TO COUNTY

County reserves the right to:

A. Make use of any information or ideas in the Proposals submitted.

B. Request proposal revisions and hold discussions and negotiations with any Respondent as necessary to serve the best interests of County.

C. Seek publicly available information about Respondents.

D. Conduct, or not to conduct, interviews and/or presentations with the highest-ranked

Respondent(s).

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E. Waive, at its discretion, any procedural, non-material defects, irregularity, or informality, which County deems correctable or otherwise not warranting rejection of the proposal that do not result in any unfair competitive advantage. Any waiver will not excuse a

Respondent from full compliance.

F. Verify and validate any information prior to contract Award and during the entire term of the contract.

G. Negotiate the final contract with any Respondent(s), including pricing/fee schedule, as necessary to serve the best interests of County;

H. Withdraw or cancel in part or in its entirety this solicitation at any time without prior notice and furthermore makes no representations that any contract will be awarded to any

Respondent responding to this solicitation;

I. Award its total requirements to one Respondent or to apportion those requirements among two or more Respondents as County may deem to be in its best interests;

J. Reject any Proposal if it is conditional, incomplete or deviates significantly from the services requested in this solicitation; and/or

K. Request Best and Final Offer from any Respondent determined to be within the competitive range. Unless requested by County, late Best and Final Offers will not be accepted by County for any reason. In addition, negotiations may or may not be conducted with Respondents.

L. Make multiple awards to Respondent(s) for services requested in this RFP, at its sole discretion, to serve the best interests of the County.

M. Defer award of this contract for a period of 180 days after the solicitation opening.

During this period of time, Respondent shall guarantee the prices quoted in their

Proposals. County and the lowest responsive, responsible Respondent may mutually agree in writing to a longer deferral period.

Therefore, Proposals submitted shall contain Respondent’s most favorable terms and conditions, since the selection and award may be made without discussion with any Respondent.

1.7 CONTRACT TERM AND FUNDING AVAILABILITY

County plans to contract with qualified organizations to provide the services described in this RFP and reserves the right to make multiple awards to Respondents for services requested in the RFP.

At the discretion of County, the initial term of the contracts resulting from this RFP may be renewed for an additional term or terms. Any renewal is contingent upon available funding, contractor performance, need for services, and County policies.

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Successful Respondents are expected to accept the terms and conditions of Attachment A - Model

Contract, which contains the contracting requirements between County and Respondent regarding the provision of services solicited under this RFP.

Contracts resulting from this RFP shall be a cooperative contract and may be utilized by all County of Orange departments.

The provisions and pricing of any contract resulting from this RFP will be extended to other governmental entities. Governmental entities wishing to use the contract are responsible for issuing their own purchase documents, providing for their own acceptance, and making any subsequent payments. Respondent shall be required to include in any subordinate contract entered into with another governmental entities pursuant to the contract, a contract clause that will hold harmless the County of Orange from all claims, demands, actions or cause of actions of every kind resulting directly or indirectly, arising out of, or in any way connected with, the use of the contract. Failure to do so will be considered a material breach of the contract and grounds for immediate contract termination. Respondent is responsible for providing each governmental entity a copy of the contract upon request. County makes no guarantee of usage by other users of the contract.

Respondent shall be required to maintain a list of County of Orange departments and governmental entities using the contract. The list shall report dollar volumes spent annually and shall be provided on an annual basis to County, at County’s request.

Subordinate contracts must be executed prior to the expiration or earlier termination of the contract and may survive the expiration of the contract up to a maximum of one year; however, in no case shall a subordinate contract exceed five (5) years in duration.

The contracts awarded through this RFP will be based on successful negotiations and County of

Orange. The funding source for these services consists of Substance Abuse Prevention and

Treatment Block Grant, Mental Health Realignment and 2011 Realignment and Medi-Cal Full

Financial Participation. Any contracts resulting from this RFP are contingent upon sufficient funds being made available by federal, state, and/or county governments for the term of the contracts.

County reserves the right to revise the contract terms stated in this RFP. Start-up funds are not available for these services.

1.8 TITLE VI SOLICITATION NOTICE

The County of Orange, in accordance with the provisions of the Title VI of the Civil Rights Act of 1964 (78 Stat. 252, 42 USC §§ 2000d to 2000d-4) and the Regulations, hereby notifies all

Respondents that it will affirmatively ensure that any contract entered into pursuant to this advertisement, will be afforded full and fair opportunity to submit proposals in response to this solicitation and will not be discriminated against on the grounds of race, color, or national origin in consideration for an award.

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1.9 DEPARTMENT OF THE TREASURY, INTERNAL REVENUE SERVICE FORM

W-9/W-8 REQUIREMENTS

Effective June 3, 2006, all contractors, entering into a contract with County, who are not already established in Countywide ERP System as an Auditor-Controller vendor, must submit to County a federal Form W-9, or form W-8 for foreign vendors. County will inform Respondent, at the time of award, if the Form W-9 or W-8 will be required.

In order to comply with this County requirement, within ten (10) days of notification of selection of award of contract but prior to official award of contract, the selected Respondent agrees to furnish to contract administrator, DPA, or the agency/department deputy purchasing agent the required W-9 or W-8.

1.10 LEVINE ACT REQUIREMENT

Effective January 1, 2023, all contractors entering into a contract with the County, must submit the Campaign Contribution Disclosure Form for any contributions made on or after January 1, 2023. In order to comply with this requirement, Respondent agrees to furnish the required

Campaign Contribution Disclosure Information form as a required submittal with its Proposal.

Failure to include the form as required will render the Proposal nonresponsive.

SECTION 2. PROTEST PROCEDURES

Any actual or prospective bidder or respondent who alleges an error or impropriety in the solicitation or award of a contract may submit a grievance or protest to Monica Cabral at mocabral@ochca.com, as set forth herein.

PROTEST PROCEDURES

All protests shall be typed under the protestor’s letterhead and submitted in accordance with the provisions stated herein. All protests shall include at a minimum the following information:

A. The name, address, and telephone number of the protestor;

B. The signature of the protestor or the protestor’s representative;

C. The solicitation or contract number;

D. A detailed statement of the legal and/or factual grounds for the protest; and, E. The form of relief requested.

Protest of Solicitation Specifications:

A. All protests related to solicitation specifications must be submitted to the Deputy

Procurement Agent (DPA), Monica Cabral at mocabral@ochca.com, no later than five

(5) business days prior to the Closing Date of the solicitation. Protests received after the five (5) business-day deadline will not be considered by the County.

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B. In the event the protest of specifications is denied, and the protestor wishes to continue in the solicitation process, the protestor must still submit a bid/response prior to the close of the solicitation in accordance with the solicitation submittal procedures provided in this solicitation.

Protest of Award of Contract:

A. Protests related to the award of a contract must be submitted to the Deputy Procurement

Agent, Monica Cabral at mocabral@ochca.com, no later than five (5) business days after the Notice of Solicitation Ranking Results is provided by the DPA.

B. Protests relating to a proposed contract award received after the five (5) business day deadline will not be considered by the County.

C. If the five (5) business day period expires without the receipt of a protest, the department may move forward with the contract award or if necessary, file the item for approval by the Board of Supervisors.

Protest Process

A. In the event of a timely protest, the County shall not proceed with the solicitation or award of the contract until the DPA issues a decision on the protest.

B. Upon receipt of a timely protest, the DPA will, within ten (10) business days of receipt of the protest, issue a decision in writing which shall state the reasons for the actions taken.

C. The County may, after providing written justification, make the determination that an immediate award of the contract is necessary to protect the substantial interests of the

County. The award of a contract shall in no way compromise the protester’s right to the protest procedures outlined herein.

D. If the protestor disagrees with the decision of the DPA, the protestor may submit a written appeal to the County Procurement Officer requesting an appeal to the

Procurement Appeals Board, in accordance with the process stated below.

APPEALS PROCESS

A. If the protestor wishes to appeal the protest decision of the Deputy Procurement Agent, the protestor must submit, within three (3) business days from receipt of the Deputy

Procurement Agent’s decision, a written appeal to the Office of the County Procurement

Officer.

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Written appeals must be sent by mail to the address below with a courtesy copy by email;

County of Orange/County Executive Office

County Procurement Office

400 W. Civic Center Drive, 5th Floor

Santa Ana, CA 92701

Attn: County Procurement Officer

CPOAppeals@ceo.oc.gov

B. Within fifteen (15) business days, the County Procurement Officer will review all materials in connection with the appeal, assess the merits of the protest and provide a written determination that shall contain his or her decision on whether the appeal shall be forwarded to the Procurement Appeals Board.

C. The decision of the County Procurement Officer on whether to allow the appeal to go forward will be final and there shall be no right to any administrative appeals of this decision.

SECTION 3. SCOPE OF WORK

3.1 GENERAL INFORMATION:

The County of Orange (County) Health Care Agency (HCA) is seeking proposals from qualified organizations to provide select services as an Administrative Services Organization (ASO) for

County Behavioral Health Plan (BHP), Specialty Mental Health Services (SMSH) and Drug Medi-

Cal Organized Delivery System (DMC-ODS). The primary goal of this program is to manage and deliver health plan administrative functions that support the provision of services to adults, older adults, and minors who are Orange County Medi-Cal members.

The successful Respondent must clearly demonstrate in their proposal an understanding of the role and responsibilities of an ASO and an ability to provide and manage timely and satisfactory service to support the needs of BHP Medi-Cal members of Orange County. Services include, but not limited to, operating a twenty-four (24) hour, seven (7) days a week (24/7) member Access Line and conducting screening for information and linkage to behavioral health treatment services within the BHP; developing and managing an adequate network of providers to render professional services on behalf of the BHP in external settings; providing timely utilization management and claims processing and adjudication; establishing and managing a concurrent review process of psychiatric inpatient hospital stays for BHP members; maintaining a complaint resolution process;

conducting quality improvement activities, including, data collection and analysis and reporting, and conducting fiscal planning and reporting.

3.2 TARGET POPULATION

Orange County Medi-Cal members and individuals without health plan coverage (i.e., unfunded individuals).

mailto:CPOAppeals@ocgov.com

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The selected Respondent shall support the operations of the Orange County BHP in the delivery of services and care for Orange County Medi-Cal members seeking behavioral health services.

The Respondent may also serve the general public when seeking information about how to obtain

Medi-Cal covered behavioral health services.

3.3 SERVICES TO BE PROVIDED

Proposals shall address and the selected Respondent shall provide each of the following services, which may be awarded based on HCA’s needs.

A. Concurrent Review: Respondent shall provide Concurrent review of psychiatric inpatient services which entails ongoing review of the medical necessity of a patient’s care while still inpatient receiving treatment, as outlined on Department of Health Care Services

(DHCS) Behavioral Health Information Notice (BHIN) 22-017, for Medi-Cal members and unfunded members authorized by HCA to receive inpatient psychiatric treatment.

Members may be certified for involuntary, intensive treatment pursuant to California

Welfare and Institutions Code (WIC) Sections 5150, 5250 or 5270 or voluntary.

1. Respondent shall provide the facility with a written concurrent authorization for one to five calendar days of service at a time and continue to provide additional authorization as necessary through the duration of the patient’s psychiatric hospitalization and ultimate discharge.

2. Respondent shall review the facility’s documentation and review the case with the facility by phone or other agreed upon synchronous communication means to complete the psychiatric inpatient concurrent authorization.

3. Respondent shall verify insurance/Medi-Cal eligibility status, ensuring that appropriate pathways of billing are being followed, and the patient is an Orange

County Medi-Cal member.

4. Respondent will ensure confirmation of completion of required services per BHIN

22-017 by gathering the documentation and that all required documents are present (i.e. psychiatric evaluation, legal holds, daily psychiatric progress notes, proof of contact to long term care and skilled nursing facilities during administrative days, etc.); and develop a checklist to track documentation and timeframes ensuring compliance with requirements for reimbursement for acute inpatient services.

5. Respondent shall record submissions for concurrent review and will indicate authorization confirmation or denial through a county-provided web-based provider portal.

https://www.dhcs.ca.gov/Documents/BHIN-22-017-Concurrent-Review-Standards-and-Updated-Criteria-for-Psychiatric-Inpatient-Hospital.pdf

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6. Prior to the end of any authorization period (no more than 5 days), the submitting facility must submit clinical documentation/information sufficient for the Respondent to establish the medical necessity of any additionally required services.

A. The selected Respondent shall provide Utilization Management (UM) for Electro

Convulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS) services rendered through the Responder’s provider network. See Subparagraph F.

1. Pre-Authorization: Respondent shall ensure medical necessity and coordination of benefits (COB) before the ECT or TMS procedure is performed. The process shall include linking the member to a provider to be evaluated for medical necessity, verifying coverage, and conducting a clinical review.

2. Ongoing Review: Respondent shall conduct regular evaluations of the patient's progress and the continued appropriateness of the ECT or TMS treatment.

3. Additional eligible treatment modalities that can be appropriately delivered through the Responder’s external provider network may be included in this process.

Respondent shall have the capability to meet these future demands.

B. The selected Respondent shall provide UM for Eating Disorder Services for Day

Treatment Intensive services, also referred to as Partial Hospitalization Program (PHP), and higher Levels of Care (LOC) such as Residential treatment.

1. Respondent shall be responsible for medical necessity review, for determination of appropriate LOC as determined by utilizing a clinically acceptable diagnostic scale, per DHCS guidelines, to establish LOC, and for “in network” provider reimbursement for eating disorder Medi-Cal covered services rendered at residential and /or intensive day treatment programs.

2. Respondent shall provide UM services, including utilization reviews with providers to assess ongoing medical necessity and continued appropriateness of services for members placed within the responder’s Orange County BHP extended network. See

Subparagraph F.

3. Respondent shall complete a discharge review and coordinate follow-up services with both the BHP and Managed Care Plan (MCP) providers, as appropriate.

C. The selected Respondent shall provide Prior Authorization for Day Treatment

Intensive (DTI) Services.

1. The selected Respondent shall be responsible for medical necessity review of all DTI referrals, determination of appropriate LOC, and authorization of services for up to 90 days.

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2. The selected Respondent shall develop a tracking system of requests for prior authorization that monitors incoming requests, and a log of authorized and denied requests including the reason. The tracking system shall include a closed loop back to the referring provider.

3. The Respondent shall complete a discharge review and coordinate follow- up services with both the BHP and Managed Care Plan (MCP) providers, as appropriate.

D. The selected Respondent shall establish and maintain a 24/7 Member Access Line and

Log: Access and quality customer service is a priority and is closely monitored by the

BHP. The BHP is responsible for ensuring that its members have timely and responsive access to Specialty Mental Health Services (SMHS) and to Substance Use Disorder

(SUD) services through the Drug Medi-Cal Organized Delivery System (DMC-ODS).

The Member Access Line shall operate 24/7 and offer a toll-free number, serving as the primary access point for SMHS and DMC-ODS within Orange County. The Access Line shall offer information and access to care to all callers regardless of insurance status. The

Access Line shall include services for hearing impaired (TDD) and multiple language capabilities, inclusive of all Orange County threshold languages. Respondent shall provide administrative coverage Monday through Friday 8:00 a.m. through 6:00 p.m.

Pacific Time. Additionally, the Access Line shall have after-hours staff available 6:00 pm to 8:00 am daily and 24/7 coverage for holidays and weekends. This line must have live operators at all times.

1. The BHP is required to develop and maintain a written Access Log of all requests for services received via telephone, in writing, or in person, which includes, but is not limited to, screenings and initial requests for SMHS and DMC-ODS by BHP members. The Respondent shall maintain the written Access Log in compliance with all current DHCS regulations and requirements, as interpreted by the County, and for maintaining records of all services requested, 24/7, including interventions provided during each call. The Access Log shall contain multiple fields including but not limited to; the name of the individual requesting services, the date of the request, the nature of the request, the type of call, and the disposition of the request including the date and time of an accepted BHP appointment. The Respondent must be able to produce the log for a time-period specified by County within twenty-four (24) hours of receiving the request from County.

2. Respondent shall be capable of providing a brief screening, determination of Medi-

Cal eligibility, linkage to services and community referrals and information requested by the caller, as established by County. The Respondent shall offer information including, but not limited to, the grievance process and how to access services for those not ready to accept services at the time the call is received. It is expected that

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E. Development and Management of an Extended Network of Providers. The

Respondent shall be responsible for developing and maintaining an extended BHP provider network through the ASO to meet member needs for services not readily available through the internal BHP provider network. Management of this network shall include the claims adjudication process. These services include, but are not limited to, the following listed below, as well as C and D above.

1. Medication Support Services: Services include prescribing, administering, dispensing and monitoring of psychiatric medications or biologicals that are necessary to alleviate the symptoms of mental illness and/or substance use disorders.

Service activities may include, but are not limited to, evaluation of the need for medication; evaluation of clinical effectiveness and side effects; the obtaining of informed consent; instruction in the use, risks and benefits of and alternatives for medication; and collateral and plan development related to the delivery of the service and/or assessment of the member. (CCR, Title 9, Section 1810.225)

2. Claims

a. The Respondent shall be responsible for providing claims processing services, including:

i. Generation and distribution of remittance information,

ii. Paying providers timely and accurately,

iii. Processing redeterminations timely and accurately,

iv. Processing adjustments and reconciliations appropriately,

v. Transmitting adjudicated claims information to providers and the County,

vi. Maintaining responsibility for any denied claims to ensure corrections needed are done to facilitate payment; and

vii. Bearing the risk for unpaid claims or for any recoveries by external payors that are the result of the Respondent’s performance under this scope of work.

b. The Respondent must develop system logic to ensure claims are adjudicated in compliance with all applicable county, state and federal regulations, including relevant service and payment limitations, authorization requirements, and appropriate Division of Financial Responsibility (DOFR). Respondent shall make all efforts to minimize and remediate “stale-dating” of claims, which are those

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c. The Respondent shall manage and process two different types of provider claims:

1) extended network outpatient claims for professional clinical services delivered to BHP members by providers within the Respondent extended network, and 2) claims for professional services completed within psychiatric inpatient settings during the course of a psychiatric inpatient hospitalization.

F. Grievances and Appeals: Respondent shall be responsible for 1st level provider appeals and ensuring that provider disputes, member grievances and 2nd level provider appeals are routed to the County, who will manage member grievances and 2nd level provider appeals for Medi-Cal. The Respondent shall be responsible for documenting and reporting 1st level provider appeals and may be requested to itemize member complaints that are routed to the County for formal grievances.

G. Data Collection and Reporting: The Respondent shall be accountable for dynamic data collection, analysis of outcomes, and reporting on services to determine effectiveness.

The Respondent shall report data to the County regarding a variety of areas to include but not be limited to: network provider adequacy, performance, utilization, relevant client data, service level cost data, National Committee for Quality Assurance (NCQA) standards, call statistics, claims submission and payment performance, and member satisfaction.