Attachment A10.docx

ATTACHMENT A10

CATEGORY 2: OUTPATIENT SERVICES

ADULT AND OLDER ADULT INTEGRATED OUTPATIENT CONTINUUM SERVICES -

DEVELOPMENTAL DISABILITIES AND AUTISM

Scope of Work

Purpose The County of Santa Clara (County) Behavioral Health Services Department (BHSD) is seeking statements of qualifications from qualified Offerors to provide specialized outpatient continuum services (hereafter referred to as “the program”) to adult and older adult clients diagnosed with Severe Mental Illness (SMI) as well as co-occurring[footnoteRef:1] developmental disabilities and autism. Offeror shall develop and implement an integrated and holistic continuum that must encompass two (2) levels of care: [1: Clients require both mental health and substance use treatment services.

1. Offeror shall submit one (1) written proposal that addresses their plan to provide services at both levels of care. The BHSD shall not accept proposals that only address one (1) level of care.

2. Level 1

a. Offeror shall provide treatment and services essential for creating positive outcomes for clients diagnosed with SMI and co-occurring developmental disabilities and autism. The program shall serve clients with developmental and intellectual disabilities and autism, with an emphasis on behavioral health and co-occurring substance use disorders. Services shall support and inspire growth for clients’ social behavior and emotional needs.

b. Treatment shall be evidence-based, culturally, and linguistically proficient. Services shall include, but are not limited to: assessment, evaluation, medication support (oral and injectable), plan development, therapy (individual and group), crisis intervention, case management/brokerage, rehabilitation, collateral services, and counseling (to include available family members and significant others when appropriate).

c. Services shall focus on developing community support systems to maximize the client's utilization of non-mental health community resources.

d. The goal of this treatment and services shall be to encourage socialization in the program and general community, and the refinement of community living and interpersonal skills.

3. Level 2

a. Offeror shall provide services that focus on activities that offer low-intensity, short-term (one year or less), preventative and maintenance intervention/treatment to maintain or prevent a mental health problem from exacerbating. Examples of such services may include but are not limited to: mental health consultation with interventions, anger management guidance, and other activities to further develop the skills necessary for independent living, community participation, and the ability to make autonomous life choices.

b. The services shall be reasonably available and accessible to clients and provide for continuity of care and staffing flexibility to meet the individual client's needs. Offeror shall be integrated through regular staff meetings and other joint planning and treatment evaluation conferences.

The program shall provide comprehensive behavioral health services for clients that combine components of recovery-oriented, evidence-based practices (EBPs), promising practices (PPs), and trauma-informed practices.

The program shall promote recovery and shall increase clients’ quality of life, community connections, self-reliance, and shall decrease negative outcomes, such as hospitalization, isolation, abuse, incarceration, and homelessness.

The program is designed to provide services where it is essential that culture and identity is a part of the dialogue of behavioral health services. It provides a safe place for clients to feel comfortable and understood by their behavioral health professional, building an effective therapeutic relationship.

Services shall be designed to improve the emotional/behavioral functioning and enhance the abilities for clients to participate in meaningful activities such as recreational, school, employment, and independent living activities. The program shall build and nurture natural supports, which help clients remain in the communities as emotionally healthy and productive members.

Offeror shall work cooperatively with community navigators, community providers, other mental health agencies, substance use disorder service providers, physical health providers, educational systems, and other groups that provide supportive services.

Operational and Logistical Requirements

1. Offeror shall have current Medi-Cal certification or become certified to provide Medi-Cal reimbursable services on or before the contract start date. In addition, Offeror shall also have Medicare certification or become certified to provide Medicare reimbursable services on or before the contract start date.

Offeror shall strategically operate a Medi-Cal and Medicare certified service delivery site within the identified County catchment areas. The site shall be considered home base for Offeror’s staff. Even with established sites, services can be offered in the community or wherever the clients are (e.g., work, school, home, homeless shelter, etc.), if appropriate.

Services shall strategically be situated within the identified County catchment areas. The four (4) primary regions of focus for program services are North, Central, East, and South County regions:

1. North County: Palo Alto, Los Altos and Los Altos Hills, Mountain View, and Sunnyvale;

2. Central County: San Jose, Cupertino, Santa Clara, Los Gatos, Monte Sereno, Saratoga, and Campbell;

3. East County: San Jose (Foothills, Berryessa) and Northeast San Jose/Milpitas areas; and

4. South County: Gilroy, Morgan Hill, and the unincorporated area of San Martin.

Target Population

1. Adults (aged 18 through 59) and older adult clients (aged 60 and above) diagnosed with SMI and co-occurring developmental disabilities or autism, as well as clients with substance use disorders that require outpatient services and other related needs.

1. Previously unserved and underserved adults (age 18-59 years) and older adults (age 60 years and above).

1. Unserved and underserved County clients. This may include adult and older adults that are:

1. Trauma-exposed;

2. From underserved cultural population in distressed families;

3. At-risk of homelessness; and

4. Those who identify with Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, and Plus (LGBTQ+) communities.

D. Clients diagnosed with intellectual and developmental disabilities (e.g. autism) that result in substantial functional impairments or symptoms, and without treatment would be at imminent risk of decompensation.

E. Clients who are likely to become disabled as to require public assistance services or benefits due to mental functioning impairments and circumstances.

F. Residents of County that may be uninsured, have full-scope Medi-Cal, Medicare, or both Medi-Cal and Medicare (Medi-Medi). Clients with Medi-Cal shall meet medical necessity criteria in accordance with all laws and regulations governing Medi-Cal and Medicare program as mandated by federal, state, and local statues. This includes California Code of Regulations (CCR) Title 9 and Social Security Act Title XXII Regulations.

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

Goals shall include, but not be limited to:

a. Reduce subjective suffering from mental illness;

b. Reduce functional impairment due to psychiatric symptoms and any co-occurring substance use;

c. Strengthen recovery, self-sufficiency, and other psychosocial outcomes;

d. Reduce experiences of homelessness, incarceration, crisis, and hospitalization, as well as substance use, violence, and victimization.

e. Facilitate the increase of meaningful use of the client's time and capabilities in school, work, and age-appropriate activities, to support the client's sense of connection and self-worth;

f. Increase self-help and client/family involvement;

g. Reduce the client's social and emotional isolation;

h. Increase the client's access to substance use treatment services (e.g., link clients to activities and services);

i. Collaborate with partners such as San Andres Regional Center (SARC), START, and others as needed to provide linkages to naturally existing resources in Santa Clara County;

j. Encourage clients to actively participate in their recovery and self-monitor their milestones and goals;

k. Accurately assess mental health disorders in SMI adults with co-occurring developmental disabilities who require specialized services due to complex risk factors (e.g., substance use, community violence, psychological trauma); and

l. Reduce disparities in service access for underserved client groups, including ethnic and cultural groups;

Objectives shall be achieved by:

1. Engage underserved clients/the target population who have not benefitted from traditional outpatient mental health services due to complex risk factors including substance use, community violence, interpersonal family violence, general neglect and exposure to trauma, social and emotional isolation, and physical decline and losses by providing culturally and linguistically proficient services;

1. Improve culturally and linguistically proficient client-centered services that integrate or directly provide the full range of treatment modalities and rehabilitation services and resources to meet the needs of clients and their families in their recovery process;

1. Provide behavioral health and co-occurring substance use services for clients through care coordination and utilization of EBPs, PPs, cultural and trauma informed practices;

1. Assist clients in addressing substance and/or alcohol use and related risky behaviors (e.g., unsafe sex, criminal behaviors);

1. Enhance clients’ understanding of medication adherence and its effectiveness, if appropriate;

1. Support clients in obtaining safe and stable housing;

1. Assist clients in learning life skills that allow them to successfully transition to independent living or other residential care facilities;

1. Promote meaningful use of time and functional capacity in school, work, and/or social activities;

1. Assist clients in developing, increasing, and strengthening natural networks of supportive relationships;

1. Improve access to community-based and eligible public benefits;

1. Effectively promote wellness and recovery by transitioning clients to appropriate levels of care as necessary;

1. Provide education about the effects of intellectual and developmental disabilities and autism on home, community, and occupational functioning;

1. Assist clients in maintaining and/or improving functional daily living skills;

1. Expand and maintain clients’ ability to self-advocate;

1. Develop clients’ areas of personal interest and enrichment;

1. Provide linkage to opportunities where client can contribute to the community through volunteer or employment opportunities, when appropriate;

1. Increase clients’ sense of belonging, self-knowledge and self-awareness on how intellectual developmental disabilities and autism affect personal development, behavior, relationships, and worldview.

1. Serve the target population by providing outreach, engagement, assessment, referral, treatment, and supportive services.

1. Provide treatment services according to Medi-Cal/Medicare guidelines including, but are not limited to:

18. Medication support services;

18. Teaching appropriate social skills in the community;

18. Hosting focus groups for personal, physical, and sexual safety;

18. Exercise;

18. Behavior modification; and

18. Other therapeutic approaches.

1. Provide on-going case management, activities, problem lists, and linkage services to reduce the client's psychiatric hospital admissions and justice involvement.

1. Collaborate with partners such as SARC as needed to provide linkages to naturally existing resources in Santa Clara County.

I. Key Outcomes A. Offeror’s key outcomes plan shall incorporate and achieve the following target benchmarks:

1. Improve access for culturally and ethnically diverse adult and older adult clients from unserved or underserved communities into behavioral health treatment;

Demonstrate the ability to successfully transition clients to lower levels of care while maintaining a successful recovery process;

a. Identify gaps in care and improve functioning by introducing cultural/ethnic specific treatment methods, as appropriate;

b. Increase the number of clients engaged in educational and vocational activities;

c. Promote positive client service experience;

d. Decrease the number of hospital and institution days;

e. Increase the number of clients reporting satisfaction with services; and

f. Successful engagement within five (5) days of Level 1 referral and within ten (10) days of Level 2 referral.

II. Reporting and Data Collection Requirements A. Offeror shall complete the following requirements:

a. Enter client demographic information, direct and outreach services information, and other appropriate data into the BHSD’s data information system.

b. Enter client data into the State Client and Service Information (CSI) System.

c. Collect treatment and service data for outcomes data reporting.

d. Collect, document, track, and report on data related to community outreach, education, and training services.

e. Complete and submit the MHSA reporting template to the BHSD on a quarterly basis.

f. Measure client outcomes to assist in determining areas of improvement.

g. When applicable, administer assessment tool(s) as part of the program requirements and collect and report on assessment tool data.

h. Utilize the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and/or the International Classification of Diseases, Tenth Edition (ICD-10) for diagnoses and coding purposes.

Data Submission A. Offeror shall collect and report data including the following as appropriate for the program:

1. CSI data;

2. Active Caseload/Length of Stay (LOS) Report;

3. Network Adequacy Certification Tool (NACT) data;

4. Units of Service (UOS) Report;

5. Client to staff ratio;

6. Report on client readmission to the program;

7. Post-discharge report placement/service(s) type, frequency, etc.;

8. MHSA reports; and

9. Other data as requested by the BHSD.

B. Offeror shall achieve the following data submission:

1. Offeror shall administer the client feedback tool semi-annually (Client Satisfaction Survey).

2. Offeror shall initiate any other monthly, quarterly, and annual measurement tools and documents, which may include, but shall not be limited to Microsoft Excel and other formats as requested by the BHSD.

3. Offeror shall have a behavioral health Electronic Health Record (EHR) system data collection and organization in place upon start of contract. Offeror shall utilize County operated EHR for billing/reimbursement purposes.

III. Outcomes and Measurements A. Offeror shall achieve the following outcomes by collecting the following MHSA CSS required assessment measures:

1. Clinician-completed assessments:

a. Offeror shall process an intake to capture basic client and demographic information;

b. Offeror shall administer a clinician evaluation and problem list upon intake, follow-up, and discharge. The assessment shall include, at minimum, the following components: timeliness access, engagement in services, successful discharge, and acute care readmission;

c. Offeror shall develop a process to systematically monitor and analyze the performance of each targeted outcomes to be achieved; and

d. Improved emotional and behavioral functioning and ability to participate in meaningful activities.

B. Offeror shall achieve the following outcome measurement methods:

1. Offeror shall provide monthly, quarterly, and annual reviews from the following data sources:

a. Client and Service Information (CSI) system;

b. County data system;

c. Network Adequacy Certification Tool (NACT).

IV. Program Description A. Service Description

1. Individual, family, and group counseling, evaluation/assessment, medication management, plan development, case management/brokerage, rehabilitation and collateral services, referral support, and 24-hour crisis intervention, if needed. Services shall be provided in a variety of settings, including outpatient clinics, the clients’ places of residence, telehealth, and in the community, as appropriate.

2. 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, BHSD, and the County of Santa Clara Health System (“Health System”), including, but not limited to the BHSD Provider Manual and/or the BHSD policies and procedures.

3. The program shall demonstrate cultural competency and the ability to engage in action or create conditions that maximize the optimal mental development of the client. Multicultural counseling competence shall achieved by the counselor’s acquisitions of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society (i.e. the ability to communicate, interact, negotiate, and intervene on behalf of clients from diverse backgrounds) and on an organizational/societal level, advocating effectively to develop new theories, practices, policies, and organizational structures that are responsive to clients’ needs.

4. The program shall provide cultural, ethnic and language specific services to meet the individual recovery needs of the client. Services shall address culture, language, and communication, lived experience, trauma-informed practices, and access to systems.

5. The program shall utilize EBPs, PPs, and culturally- and trauma-informed practices whenever clinically indicated and based on clients’ diagnoses. EBPs and PPs recommended for the program may include the following:

a. Motivational Interviewing (MI);

b. Stages of Change;

c. Cognitive Behavioral Therapy (CBT);

d. Trauma-Focused CBT (TF-CBT)

e. Solution-Focused Brief Therapy (SFBT); and

f. Integrated co-occurring spectrum[footnoteRef:2] disorder practices and peer supports such as Wellness Recovery Action Planning. [2: Developmental disabilities and autism.]

6. Clients shall be assessed using the standard behavioral health tools, which may include BHSD Integrated Assessment (IA), and an American Society of Addiction Medicine (ASAM) assessment[footnoteRef:3], as needed to evaluate substance use treatment needs. [3: BHSD shall offer training through the Learning Partnership Division, as needed. ]

7. Offeror shall demonstrate that staff have appropriate knowledge, skills, and training to provide services to clients with co-occurring spectrum disorders.

8. Offeror shall discuss how they shall address the clients’ mental health, substance use, and other factors.

9. Offeror shall assist clients in develop life skills, thereby improving their quality of life.

10. Offeror shall provide a comprehensive treatment approach to outpatient services that focuses on integrated behavioral health treatment.

B. Service Expectations

1. Offeror shall provide an effective service delivery approach by offering a service array that reflects the BHSD’s values pertaining to client and family empowerment, best practices, health and wellness, and cultural responsiveness.

2. Offeror shall maintain fidelity to the requirements for MHSA CSS as set forth in the CCR CSS Title 9, Chapter 14, Article 6, Sections 3610.

3. Offeror shall provide a full range of recovery-oriented services, evidenced-based and culturally and linguistically proficient behavioral health and co-occurring spectrum disorder services that shall include, but is not limited to, the following:

a. Clinical services such as behavioral health assessment, and plan development;

b. Medication management;

c. Case management, such as accessing housing, transportation, and medical care;

d. Individual, family, and group therapy;

e. Individual rehabilitation services (vocational readiness, education, and skills for activities of daily living);

f. Client engagement;

g. 24-hour crisis intervention services; and

h. Other community services, as appropriate.

4. Offeror shall describe their ability to provide clients’ injection(s) and related medication management services as necessary in outpatient clinics.

5. Offeror shall provide services in the clients’ preferred language(s) with staff or with third party interpreter services that provide real-time translations.

6. Offeror shall describe their review process of clients’ status and progression towards planned goals throughout treatment.

7. Offeror shall describe plans for determining possible step-downs or step-ups within the continuum of care.

8. Offeror shall describe how they shall ensure that Network Adequacy standards are met by ensuring that each of the outpatient services under the Program are be available within fifteen (15) miles or thirty (30) minutes from the clients’ established residency. Clients may opt to receive services from another provider outside the specified distance and time restriction upon providing the BHSD with written authorization.

9. Offeror shall provide care coordination for clients and their families to ensure comprehensive and consistent care, good communication with system partners and other serving agencies, and/or institutions involved in clients’ service delivery.

10. Co-occurring substance use treatment shall be based on harm reduction principles. If Offeror is unable to provide this treatment specialty within their scope, a referral to appropriate services shall be facilitated and collaboration between the Offeror and the referral recipient to address any co-occurring substance use treatment needs.

11. Offeror shall have access to flex funding that can be used for the clients’ personal needs which assist clients in achieving their treatment goals and outcomes. These may include, but are not limited to: bus passes, hotel vouchers, etc.

C. Person-Centered Approach

1. 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, BHSD, and the County of Santa Clara Health System (“Health System”), including, but not limited to the BHSD Provider Manual and/or the BHSD policies and procedures.

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

a. Medical necessity criteria;

b. Documentation redesigns;

c. Co-occurring substance use treatment;

d. Standardized screening and transition tools;

e. Behavioral health CPT coding transition; and

f. Payment reform.

D. Staffing Requirements

1. Offeror shall maintain adequate staffing as clinically appropriate for the program, which may include the following:

a. Psychiatrist;

b. Nursing staff and/or psychiatric nurse(s);

c. Direct service staff, such as:

i. Licensed or associate social workers;

ii. Licensed Professional Clinical Counselors;

iii. Marriage and family therapists and interns;

iv. Social workers;

v. California Association of Alcoholism and Drug Abuse Counselor (CAADAC)

vi. Peer mentors;

vii. Rehabilitation counselors; and

viii. Other direct service staff, as appropriate.

d. Licensed Professional Clinical Counselors; and/or

e. Quality assurance staff.

2. Offeror shall ensure that the psychiatrist and clinical staff required by the program are in place prior to the start of the program and shall remain available to provide services to the clients on an ongoing basis.

3. Offeror shall provide an updated agency plan for administrative coverage or program-related changes to the BHSD Division Director at the beginning of each new fiscal year and when any changes to this plan occur for approval, prior to implementation.

4. Offeror shall describe the existing staff who shall be providing the services and program components described in this RFSQ. Offeror shall include a staffing table and credentials for those who shall be providing and supporting these services and indicate position title, linguistic and cultural skills, education, experience, licensure, and certifications, including administrative, supervisory, and direct service staff.

5. Offeror shall describe their plan to recruit and maintain appropriate staffing to meet the diverse population of Santa Clara County. Offeror shall provide a personnel retention plan for the program, which includes a current list of staff at the organization, their credentials, bilingual language capacity, and the length of time the employee has been with the organization.

6. Offeror shall provide the approximate percentage turnover of the direct service staff over the past three years. Offeror shall also describe how the organization shall provide continuity of care for clients and their families during staff turnover.

7. Offeror shall have staff who are appropriately trained and meet the qualifications of Licensed Practitioner of the Healing Arts (LPHA) as well as meet specific discipline requirements.

8. Offeror’s staff shall meet the licensing requirements as set forth in Title 9, Title 19, and Title 22 of Medi-Cal Regulations.

9. Offeror’s staff shall meet the BHSD Co-Occurring Standards[footnoteRef:4]. The BHSD Co-Occurring Standards expect all paraprofessional and professional practitioners to have the minimal core skills and be trained according to the following three-core skill levels: [4: Clients require both mental health and substance use treatment services.]

a. Co-Occurring Informed: This level of practice identifies the core skills needed to support treatment. The identified domains for this level are screening, engagement, readiness and retention, education, advocacy, and collaboration.

b. Co-Occurring Capable: This level of practice identifies the core skills needed to provide an integrated assessment and provide treatment to clients and families facing mild to moderate co-occurring disorders. The identified domains for this level are screening, assessment, diagnosis, and co-occurring capable treatment.

c. Co-Occurring Enhanced: This level of practice identifies the expertise needed to provide fully integrated treatment to clients and families challenged with moderate to severe co-occurring disorders. The identified domains for this level are assessment, diagnosis, and integrated treatment.

10. Offeror’s staff shall participate in trainings related to the MHSA CSS required data collection and reporting. Offeror’s staff shall also participate in the Sexual Orientation and Gender Identity and Expression (SOGIE) 101 Training.

11. Offeror shall ensure that appropriate staff shall attend all system-wide BHSD trainings and shall participate in all required trainings specific to the needs of the program.

12. Offeror shall maintain practices related to recruiting, hiring, and promoting bi/multi-lingual staff and/or a culturally or ethnically diverse workforce. Offeror 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).

B. Cultural Competency

a. Offeror 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.

1. At minimum, services shall be made available in the six (6) threshold languages: Spanish, Vietnamese, Tagalog, Mandarin, Cantonese, and Farsi. Staffing shall reflect the percentage of ethnic and cultural make-up of the target population. If unable to provide services in the clients’ primary language, Offeror shall provide the clients with access to interpreters or real-time technology.

2. Offeror shall provide culturally and linguistically proficient services to the clients. Services shall be delivered in accordance with Offeror’s Cultural Competency Plan (Plan). The Plan shall be submitted to the BHSD Director and shall be in accordance with BHSD guidelines.

3. 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.

4. Offeror shall have a plan to address barriers when they do not have staff available to meet the six (6) Santa Clara County threshold languages (Spanish, Vietnamese, Mandarin, Cantonese, Tagalog, and Farsi) and a plan for actions and changes to ensure diversity and inclusion in service delivery.

5. Offeror shall provide outreach activities focused on reaching underserved, underrepresented, and/or multicultural populations.

6. Offeror shall utilize EBPs or PPs that are standardized for use with adult and older adult clients and consider clients’ cultural background and primary language. Offeror shall modify practices as necessary to meet the needs of clients.

C. Clinical Supervision

1. Offeror shall meet reflective supervision, reflective practice, and clinical supervision requirements as follows:

a. Submit of a clinical supervision plan that includes fidelity to the chosen EBPs or PPs;

b. Provide a consistent schedule and structured weekly reflective supervision to serve their staff regardless of licensure. Reflective supervision shall be provided by a licensed clinician who has met the requirements for clinical supervision and who has completed the one-day training on Reflective Practice Part I provided by the BHSD. This requirement also applies to paraprofessional or other practitioners who are not on a licensure or certification track;

c. Participate in weekly reflective supervision and shall have completed the one-day training on Reflective Practice Part II provided by the BHSD;

d. Maintain a workflow that is manageable for supervisors and attending to the ratio of no more than a one-to-eight (1:8) ratio of supervisors to supervisees;

e. Ensure the number of supervisees assigned to a supervisor shall follow relevant licensure regulations and is appropriate in terms of level of expertise and experience, years of professional practice, comfort level, complexity and intensity of services, qualifications, etc.; and

f. Provide clinical supervision activities for review during monthly or bi-monthly providers’ meetings.

D. Referrals and Admissions

1. Offeror shall accept all referrals from the BHSD Call Center. Offeror shall also accept inter-agency transfers and walk-ins from the community.

2. Offeror shall be prepared to provide a set number of intake slots weekly, to the BHSD Call Center. Any referral slots that are not used by the end of the week shall roll over into the following week’s total number of set intake slots, resulting in an increase in the total number of intakes available for the following week. Additional concerns about utilization and capacity shall be reviewed by the BHSD.

3. Offeror shall ensure that referrals that do not meet the criteria for behavioral health services or that need a different level of care, shall be directed and linked by the program to appropriate alternative resources or another provider.

4. Offeror shall accept urgent and emergent referrals received from the BHSD Call Center, ensure that urgent referrals are triaged within twenty-four (24) hours of receipt and are to be seen within five (5) business days.

5. Offeror shall be aware that based on Urgent Care policy and procedure #412-330, the BHSD Call Center shall refer non-English-speaking urgent and emergent clients to clinics having availability regardless of language and cultural specialization.

6. Offeror, at the request of the client, shall initiate a transfer to a program of the client’s choice as soon as there is availability at that program, per P&P 412-330.

E. Care Coordination

1. Offeror shall adhere to the following care coordination guidelines:

a. To facilitate care coordination, Offeror shall request Health Insurance Portability and Accountability Act (HIPPA) and California law-compliant client authorization to share client information with all other providers involved in the client’s care, in satisfaction of state, and federal privacy laws and regulations.

b. Offeror shall engage in care coordination activities beginning at client intake and throughout the treatment and discharge planning processes.

c. Offeror shall discuss in their proposal evaluation criteria for clients needing additional mental health services and other resources, including how they would assist in transitioning the client.

d. Clients who are open to receiving traditional mental health services shall, as part of their acceptance into this program, sign appropriate Consents for Release of Information so that program staff have authorization to share client information with their primary mental health providers.

e. Offeror shall describe their organization’s willingness, experience, and ability to collaborate with multiple County systems and services.

f. Review each client’s status and progress towards planned goals annually to determine possible discharge planning and/or step down to a less intensive type of service. Offeror shall rewrite clients’ goals as necessary to match the level of care needed.

g. Link clients to community-based resources as well as primary care services.

h. Co-occurring substance use treatment shall be based on harm reduction principles. If Offeror is unable to provide this treatment specialty within their scope, a referral to appropriate services shall be facilitated and collaboration between Offeror and the new provider(s) shall address any co-occurring substance use treatment needs.

F. Program Hours of Operations

1. Offeror shall be open for services during regular office hours Monday through Friday, and for forty (40) hours per week.

2. Offeror shall develop a plan to include after-hours crisis needs, and medication support to the crisis in a timely manner and indicate plans to respond in person when clinically appropriate.

3. Offeror shall provide after-hours services available to accommodate clients requiring evening and weekend appointments as well as crisis outpatient services available twenty-four (24) hours a day, seven (7) days a week to address the emergency needs of clients.

4. Offeror shall be required to maintain coverage that shall include Welfare and Institutions Code (WIC) 5150 evaluations for clients as needed.

5. Offeror shall ensure that the 24-hour coverage plan shall be on file with the BHSD Division Director. Offeror shall provide an updated agency plan for 24-hour coverage to the BHSD Division Director and the BHSD Program Monitor for approval prior to implementation at the beginning of each new fiscal year and when any changes to this plan occur.

6. During holidays, Offeror shall maintain staff that shall facilitate the processing of referrals coming from the BHSD Call Center, and operate the 24-Hour Care unit, provide crisis coverage, and the maintain ability to initiate Lanterman-Petris-Short (LPS) protocols.

G. Evaluations, Transitional Planning, and Discharge

1. Offeror shall transfer clients who have graduated from the program to lower levels of care, such as primary care, based on the client's level of care need as determined by the relevant screening tool(s).

2. Offeror shall facilitate transitions to other agencies for additional or more specialized support for clients requiring higher levels of care, such as Full Partnership Service (FSP) Maintenance.

3. Offeror shall discharge clients when they meet at least one (1) of the following criteria:

a. Upon mutual agreement by the client and their treatment team that the client completed the program successfully;

b. Upon a good faith determination by Offeror that the program cannot effectively serve the client;

c. Upon client or guardian's unilateral decision to terminate treatment against medical advice;

d. Upon transfer to a lower level of care or another mental health provider;

e. Upon transfer to another County mental health program, in which Offeror shall comply with a Feedback Loop Process to ensure that referral sources are notified of the status of the referral, provided the appropriate sections of the assessment, and informed of outcomes and/or next steps;

f. Upon notification of client admission into an institutionalized setting (e.g., Institute of Mental Disorder [IMD], Mental Health Rehabilitation Center [MHRC] or locked Skilled Nursing Facility [SNF]), with the BHSD 24-hour Care Team re-assigning the client to outpatient services as appropriate;

g. When the client is incarcerated for over thirty (30) days;

h. When the client no longer meets Medi-Cal medical necessity criteria; and

i. When the client is not engaged and responsive after thirty (30) days of persistent efforts to locate them and following all County policies and procedures.

V. 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 B10 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;

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 relating to COVID-19.

1. If applicable, Offeror shall complete the Attachment E, Contractor Certification of Compliance with COVID-19 Vaccine Requirements (“Certification”) upon successful contract negotiations. For staff who routinely perform services for the County onsite and share airspace with or proximity to other people at a County facility as part of their services for the County, including but not limited to vaccination, as applicable and periodically updated, and available at https://procurement.sccgov.org/doing-business-county/contractor-vaccinations and incorporated herein by this reference.

RFSQ-BHS-FY23-0210: Adult and Older Adult System of Care Services Page 1 of 3 ATTACHMENT A10: Adult and Older Adult Integrated Outpatient Continuum Services - Developmental Disabilities and Autism Scope of Work CATEGORY 2: Outpatient Services