Attachment A.pdf

ATTACHMENT A

RFSQ-BHS-FY23-0108: Substance Use Residential Withdrawal Management Services ATTACHMENT A: Scope of Work

Substance Use Residential Withdrawal Management Services Scope of Work

I. Purpose

A. The County of Santa Clara (County) Behavioral Health Services Department (BHSD) is seeking statements of qualifications from Offeror interested in providing Substance Use Residential Withdrawal Management (WM) Services for adult (18 years and above) clients throughout Santa Clara County.

B. The BHSD shall partner with County Contracted Providers (CCPs) to deliver WM services to Santa Clara County residents. These services shall provide culturally responsive, skilled, residential substance use treatment services (SUTS) to treat individuals experiencing difficulties with executive functioning, interpersonal relationships, and social settings. The purpose of these services is to provide improved clinical and functional outcomes for adults with substance use disorders.

II. Background Information

A. The County’s mission is to plan for the needs of a dynamic community, provide quality services, and promote a healthy, safe, and prosperous community for all. The BHSD is part of the County of Santa Clara Health System (Health System), whose vision is “Better Health for All.” The BHSD seeks to fulfill this mission by providing services that improve the quality of life for County residents.

B. The BHSD also adheres to the Health System principles of care included in the strategic roadmap. The roadmap lays out the principal obligations of County-provided health services. All BHSD services must align with the core objectives of the CHS strategic plan:

1. Increasing healthy life span;

2. Improving customer experience and services;

3. Reducing the burden of illness;

4. Providing seamless coordination of care;

5. Improving training, retention, and recruitment of staff; and

6. Reducing redundancies, delays, and cost of care.

C. In accordance with California Health and Safety Code Section 11834.015, DHCS is required to adopt the American Society of Addiction Medicine (ASAM) treatment criteria, or an equivalent evidence-based standard, as the minimum standard of care for licensed adult alcoholism or drug recovery or treatment (Substance Use Treatment Program) facilities.

D. For WM, DHCS has adopted ASAM level 3.2 treatment criteria as the standard of care required of all licensed residential Substance Use Treatment Program facilities. When providing WM services, Offeror shall adhere to this ASAM level of care and treatment criteria as the minimum standard of care.

E. Offeror shall refer to the RFSQ for additional information on the contract negotiation tier system relating to their organization’s DHCS Facility Certification Status, should qualification occur.

III. Target Population

A. The program shall serve Santa Clara County residents 18 years and above, in need of substance use disorder and/or Dual Diagnosis Capable services.

B. Services shall be made available throughout Santa Clara County.

C. Offeror shall work with clients with special needs and disabilities. Clients may have chronic mental health conditions in addition to substance use treatment needs and may require additional services beyond the detoxification services.

D. Offeror shall demonstrate knowledge of specialized populations for which they are submitting proposals, including the following:

1. Santa Clara County residents with substance use disorders;

2. Santa Clara County residents with co-occurring disorders; and/or

3. Santa Clara County residents involved with the justice system.

IV. Program Goals and Objectives

A. The program shall be aligned to achieve the following goals and objectives:

1. Goals shall include, but not be limited to:

a. Ensuring timely access to clients requiring WM services if they meet the criteria for placement at the level of care;

b. Ensuring transfers of clients to other levels of care after they have been stabilized in WM; and

c. Ensuring that a capacity range1 of 26-46 WM beds is available for County residents:

WM Bed Category Amount Population

Existing Static Capacity (current contractors) 26 Beds Adult

Board Referral (#110459) funded beds 15 Beds Adult

2. Objectives shall be achieved by:

a. Maintaining clear protocols for admissions and discharges, and utilization management to facilitate timely discharges from WM; and

b. Working out protocols with other network providers to facilitate transfer of clients to other levels of care.

V. Reporting, Audits, and Data Collection Requirements

1 Capacity range is dependent upon a variety of factors, including client needs, funding availability, etc.

A. Offeror shall be subject to the following State and County audits:

1. BHSD annual administrative audits include but are not limited to the review of:

i. Facility information;

ii. Staff credentialing and personnel files; and

iii. Policies and procedures.

2. When applicable, DMC-ODS audits include but are not limited to:

i. Review of patient medical records for regulatory compliance;

ii. Documentation standards;

iii. Clinical best practices; and

iv. Medical necessity.

B. All DMC funds shall be subject to DHCS Medi-Cal audits to 1) determine the amount of actual, allowable cost and 2) ensure compliance with all Medi-Cal practice standards and regulations.

1. Audit procedures2 shall include, but not limited to the following:

a. Clinical chart review;

b. Verification of any required share of the cost;

c. Medi-Cal eligibility;

d. Third-party collection for all persons receiving DMC services; and

e. Certification of services provided.

C. Offeror shall submit one (1) report monthly and two (2) reports quarterly.

1. The Monthly Report shall be submitted to the provider’s designated BHSD SUTS Quality Improvement Coordinator by the 12th of each month; and

2. The two quarterly reports shall be submitted to SUTS data staff twenty-one (21) days after the end of each quarter.

3. When applicable, copies of all DHCS correspondence to the BHSD Director regarding DMC certifications, DMC audits and CAPs, and changes to DMC status must be submitted within thirty (30) days of receipt.

D. Offeror shall enter client demographic information, service, and other appropriate data into the County’s electronic data interchange system. Offeror shall need to meet certification standards for electronic data exchange with the BHSD’s electronic health record.

E. Offeror shall detail the organization’s ability to use their current electronic health record (EHR) system (including the capability to exchange data with County systems) and/or

2 Deficiencies in the DHCS audit may result in a Corrective Action Plan (CAP). Upon DHCS request, CAP documentation must be submitted within thirty (30) days indicating remediation of the areas found deficient in the DMC audit.

the ability to implement a new EHR system as listed in Appendix H, Offeror’s Electronic Health Record (EHR) Status. Offeror shall indicate current and future County EHR system needs in Appendix H, using one (1) of the following myAvatar implementation types:

1. PCE with 837 billing;

2. PCNX with 837 billing;

3. PCNX non-837 billing with fast service entry claims submission, or

4. Solely client information without billing, if no EHR billing is needed for the particular program/contract.

F. Offeror shall achieve the following outcomes:

1. Provide clients with the Client Feedback Survey at discharge. The Client Feedback Survey gathers data on client perceptions of services rendered.

2. Complete performance measures based on collected client data and submit to the BHSD electronically. Data includes, but is not limited to, the following:

a. Access to treatment;

b. Client flows;

c. Services; and

d. Treatment completions.

G. Offeror shall achieve the following data submission:

1. Include BHSD client data in the County’s EHR system.

2. Provide data on monthly admissions to treatment.

3. Provide data on monthly discharges from treatment.

VI. Program Description

A. Offeror responding to this RFSQ shall maximize DMC-eligible services. The BHSD recognizes that Offeror responding to this RFSQ may propose to provide services at a site that has yet, but are in process to be Medi-Cal approved and certified before the contract start date; or may choose not to pursue DMC-eligible services. All proposals will be reviewed and assessed based on the department’s needs for Withdrawal Management services.

B. Service Description

1. If applicable, Offeror shall submit to the BHSD annual budgets that include a projected Medi-Cal reimbursement.

2. Offeror shall monitor all the beneficiaries receiving both residential and WM services during the detoxification process.

3. Offeror shall provide medically necessary rehabilitative services in accordance with an individualized treatment plan approved by a Licensed Practitioner of the Healing Arts.

4. Offeror shall provide program services in accordance with the ordinances and resolutions of the County Board of Supervisors and the applicable policies, procedures, directives, and guidelines of the County, the BHSD, and the Health System, including, but not limited to the BHSD Provider Manual and/or the BHSD policies and procedures.

5. Offeror shall ensure that their organization’s service plan shall meet Medi- Cal/CalAIM behavioral health requirements, including, but not limited to:

a. Medical necessity criteria;

b. Documentation redesigns;

c. Co-occurring treatment;

d. Standardized screening and transition tools;

e. Behavioral health CPT coding transition; and

f. Payment reform.

C. Staffing Requirements

1. Offeror’s organization shall document and ensure all treatment staff is trained in accordance with the following DHCS staff certification requirements (DHCS Title 9, Division 4, Chapter 8):

a. Clinical supervision: Offeror’s organization shall ensure the clinical supervisor is licensed by one (1) of the DHCS-authorized licensing bodies and have two (2) years post-license experience.

b. Licensing requirements: All staff providing counseling services in substance use treatment programs must be considered Licensed, Certified, or Registered as required by the DHCS. Per BHSD requirements, a minimum of forty (40) percent of staff must be Licensed or Certified.

c. Registered staff: Non-licensed or non-certified staff that provide counseling in a substance use treatment program licensed and/or certified by DHCS shall be registered to obtain certification as substance use treatment counselor with one of the DHCS authorized certifying bodies. Registrants shall complete certification as a substance use treatment counselor within five (5) years of the date of registration. New hires who are not licensed or credentialed must register prior to first day of work. An individual who has not completed certification within the five (5) years may not be a substance use treatment counselor at any substance use treatment program licensed and/or DHCS certified.

d. For more information, please refer to the DHCS AOD Certification Standards (https://www.dhcs.ca.gov/Documents/DHCS-AOD-Certification-Standards- 2.7.2020.pdf) and Facility Staffing Data (https://www.dhcs.ca.gov/provgovpart/Documents/DCSS5050.pdf).

2. Credentialing Requirements for Staff:

a. All staff providing client care shall comply with the County credentialing policies.

https://www.dhcs.ca.gov/Documents/DHCS-AOD-Certification-Standards-2.7.2020.pdf https://www.dhcs.ca.gov/Documents/DHCS-AOD-Certification-Standards-2.7.2020.pdf https://www.dhcs.ca.gov/provgovpart/Documents/DCSS5050.pdf

3. Criminal Background Checks for Staff:

a. The BHSD may hold Offeror’s organization to applicable policies and procedures related to facility certification, as appropriate.

4. Staff must meet all BHSD and DHCS training requirements, including but not limited to:

a. Orientation to the County system, annual/clinical trainings;

b. DHCS ASAM modules; and

c. Continuing Education Unit (CEU) training requirements.

5. Offeror’s organization shall ensure appropriate levels of staffing are maintained throughout the entirety of the contract term, specifically in the areas of staff retention and staff training to develop the knowledge and skills necessary to work with the target population.

a. Offeror’s organization shall maintain staffing capacity to provide services 24/7.

b. Offeror shall ensure that all shifts include staff who have the experience and background in managing the symptoms and behaviors of the severely mentally ill (SMI) clients referred from the acute psychiatric settings.

6. Offeror’s organization shall maintain practices related to recruiting, hiring, and promoting multi-lingual staff and/or a culturally or ethnically diverse workforce.

Offeror’s organization shall have training requirements related to diversity, equity, and/or inclusion (e.g., Lesbian, Gay, Bisexual, Transgender, Queer, Questioning + [LGBTQ+], cultural and linguistic capacity, racial equity).

D. Cultural Competency

1. Offeror’s organization shall be inclusive of promoting behaviors and practices towards a more equitable, diverse, and inclusive organizational mindset. Offeror shall have a leadership model inclusivity and tools and support to improve their organization’s ability to identify and mitigate bias, respect differences, build empathetic relationships, and manage conflict.

2. Offeror shall monitor and evaluate client satisfaction and culturally responsive services/practices to continually improve service quality. Data shall be used to improve program satisfaction.

3. Offeror’s organization shall have a plan to address barriers when they do not have staff available to meet the seven (7) County threshold languages (e.g., Spanish, Vietnamese, Mandarin, Cantonese, Tagalog, Farsi, and Russian) and a plan for actions and changes to ensure diversity and inclusion in service delivery.

4. Offeror’s organization shall provide outreach activities focused on reaching underserved, underrepresented, and/or multicultural populations.

E. Referrals and Admissions

1. Offeror shall comply with the DHCS Managed Care Plan access standards.

2. Offeror shall provide intake and admission services seven (7) days per week and include evening hours.

a. Upon contract negotiations, County EHR ramp-up shall commence.

b. Intake performed after-hours and on weekends shall be communicated to the County the following Monday morning using the County EHR system.

3. Offeror shall accept referrals from medical and emergency psychiatric services regardless of history and after they are deemed psychiatrically appropriate by the treating provider. Referrals from these settings shall be made a priority with a response time of no longer than two (2) hours.

4. Offeror shall grant direct access to intakes and admissions to referring providers or clients without having to contact the County Behavioral Health Call Center in advance.

5. Offeror shall address customer satisfaction in conjunction with the BHSD.

6. Offeror shall maintain a placement list and collect data on requests for placement and those placed.

7. Offeror shall work closely with the BHSD to provide substance use residential withdrawal management services, which includes:

a. Making referrals to selected County-contracted Providers when clients require additional non-withdrawal management care;

b. Monitoring quality and frequency of services, client grievances, client satisfaction, and other performance indicators; and

c. Ensuring timely placement and engagement of clients.

F. Care Coordination

1. Offeror shall provide services 24/7 with structured monitoring of withdrawal symptoms and medical referral, if necessary.

2. Offeror shall provide stabilization, which involves creation of an individualized treatment plan to assist a client through a safe withdrawal experience.

3. Clients shall have access to an orientation to ongoing County adult system of care services, community reintegration services, counseling, psychoeducation in substance use, and referral and entitlement information.

4. Offeror shall collaborate with community groups and County agencies (e.g., court systems, Probation Department, Social Services Agency, primary medical care physicians and/or clinics, and psychiatric/mental health services).

5. Offeror shall monitor symptoms using a tool approved by the DHCS, such as the Clinical Institute Withdrawal Assessment (CIWA-A). The average stay for detoxification clients is 5-7 days (depending on withdrawal complications).

6. Offeror shall utilize motivational interviewing to encourage clients to remain in WM services as medically necessary.

7. Offeror shall provide trauma informed services.

G. Program Hours of Operations

1. Services shall be provided seven (7) days a week, year-round.

2. Per Section VII.B.5 of this Attachment, staffing shall be provided 24/7.

3. Offeror shall provide a short-stay voluntary program for care during detoxification and linkage to ongoing care for individuals with substance use needs and mental health services, if needed.

H. Evaluations, Transitional Planning, and Discharge

1. A Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis is required for a client to receive WM services.

2. Offeror shall provide evaluation of the client’s physical and psychological condition and history. Initial evaluations may assess a person’s acute intoxication and withdrawal potential, biomedical conditions, social relationships, and more.

3. Offeror shall provide an assessment using the ASAM placement criteria.

4. Offeror shall foster a client’s entry into a longer-term substance abuse treatment program by coordinating care with the next substance abuse treatment provider following the detoxification services.

VII. Public Health Emergency or Other Emergency Disaster Plan

A. Offeror shall have policies and procedures to address disaster preparedness during a Public Health Emergency or other emergency disaster. Offeror shall complete Appendix B, Evaluation Criteria and Qualifications and submit the following supplemental information:

1. Emergency and disaster plan to deliver services during a Public Health Emergency or other emergency disaster that includes, at a minimum, evacuation procedures, training for workforce members, and quarterly emergency drills;

and

2. Emergency and disaster plan to deliver services during a pandemic such as the COVID-19 pandemic.

B. Offeror shall comply with all County requirements in effect relating to COVID-19 for persons who routinely perform services for County onsite and share airspace with or proximity to other people at a County facility as part of their services for County as set forth in a County Health Order (or similar directives).