Attachment A13.docx

ATTACHMENT A13

CATEGORY 2: OUTPATIENT SERVICES

ADULT AND OLDER ADULT INTENSIVE OUTPATIENT CONTINUUM SERVICES - JUSTICE INVOLVED

Scope of Work Purpose The County of Santa Clara (County) Behavioral Health Services Department (BHSD) is seeking statements of qualifications from qualified Offerors interested in designing and operating the Adult and Older Adult Intensive Outpatient Continuum Services - Justice Involved Program (hereafter referred to as “the program”) for eligible County residents.

The program shall serve adults (ages 18 through 59) and older adults (ages 60 and over) who are justice-involved and are diagnosed with severe mental illness (SMI) and include co-occurring[footnoteRef:1] substance use disorders that require outpatient services and other related needs. [1: Clients require both mental health and substance use treatment services.

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 client quality of life, community connections, self-reliance, and shall decrease negative outcomes, such as hospitalization, isolation, abuse, incarceration, and homelessness.

Services shall be culturally appropriate and trauma-informed to promote the recovery, stability, and resilience of all clients. 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 supports, which help clients remain in the communities as emotionally healthy and productive members.

Offeror shall work collaboratively with community navigators, community providers, other mental health agencies, substance use treatment services providers, physical health providers, educational systems, other groups that provide supportive services, and justice partners such as, but not limited to, probation, the courts, the district attorneys, and public defenders.

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.

Offeror shall strategically operate and 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. Services shall be offered in the community or wherever the clients are (e.g., work, school, home, homeless shelter, jails, courts, etc.), as appropriate.

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 have Medicare certification on or become certified to provide Medicare reimbursable services on or before the contract start date.

Background Information A. Research studies have indicated that high percentages of individuals who are incarcerated suffer from mental health and co-occurring conditions. According to a report from the American Psychological Association, “64% of jail inmates, 54% of state prisoners, and 45% of federal prisoners reported mental health concerns. Substance abuse is also rampant and often co-occurring” (2014). These individuals often encounter an array of psychosocial problems, including increased risk of incarceration, hospitalization, homelessness, lack of gainful employment, lack of family and social supports, and lack of financial support. These psychosocial problems make it difficult for individuals to re-integrate into their communities.

B. The County is considered linguistically more diverse with proportionally more local County residents speaking a language other than English. The BHSD seeks to identify interested applicants with ethnically and linguistically diverse staff to provide outpatient mental health services within diverse communities to increase outreach and access to those families who may be unaware of available services and treatment options.

C. The BHSD recognizes the importance of partnering with community organizations to make behavioral health services accessible to County residents with SMI and co-occurring substance use issues in need of treatment by allocating part of the Community Services and Supports (CSS) funding component of the Mental Health Services Act (MHSA) to outpatient services.

Target Population A. The program shall serve justice involved adults (ages 18 through 59) and older adults (ages 60 and above) who experience the following:

1. Are released from custody or in the process of being released from a County correctional facility into a community setting;

2. Have been arrested, charged with, or convicted of a criminal offense and have a history of mental illness or substance use disorders;

3. Diagnosed with severe and persistent mental health and/or co-occurring conditions that result in functional impairments or symptoms, and without treatment shall be at imminent risk of decompensation, resulting in hospitalizations and/or incarceration;

4. Are from underserved cultural populations;

5. Are trauma-exposed and/or in distressed families;

6. Identify with Lesbian, Gay, Bisexual, Transgender, Queer, Questioning + (LGBTQ+) communities;

7. Are at risk for suicide, homelessness, incarceration, or hospitalization;

8. Adhere poorly to treatment with medication management;

9. Require public assistance services or benefits due to mental functioning impairments and circumstances;

10. Difficulties in participating in structured activities;

11. Have a history of assaultive behavior;

12. Have resided in long term care facilities for extended periods;

13. Have habitually relied almost exclusively on emergency and institutional care;

14. Utilizated various services without improved outcomes;

15. Have cognitive difficulties;

16. Have medical co-morbidities; and

17. Are medically fragile but will not require medical care 24 hours per day, 7 days per week.

B. Clients served are residents of County that may be uninsured, have full-scope Medi-Cal, Medicare, or both Medi-Cal and Medicare (Medi-Medi).

C. All individuals served through this program must meet Medi-Cal medical necessity criteria pursuant to Title 9, California Code of Regulations (CCR), Chapter 11, Sections 1820.205, 1830.205, and 1830.210 in order to receive Medi-Cal specialty mental health services.

Program Goals and Objectives Program goals shall include, but not be limited to:

1. Reduce subjective suffering from mental illness and/or co-occurring conditions;

2. Reduce the number of people with mental illness and/or co-occurring conditions who are booked into correctional facilities;

3. Decrease incarceration rates among justice-involved adults and older adults;

4. Reduce experiences of homelessness, crisis, hospitalization, substance use, violence, and victimization;

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

6. Promote active participation in recovery and self-monitoring of milestones and goals towards self-determination, family, vocational, and recreational services.

7. Increase the number of clients of successfully discharged;

8. Decrease the number of clients readmitted to inpatient hospitals;

9. Incorporate the principles of “wellness and recovery,” in which all services are client-centered, strength-based, and promote recovery and resiliency;

10. Improve client’s self-sufficiency through the development of a recovery plan that secures housing, food, clothing, and a stable income;

11. Increase client’s understanding of their medication and its effectiveness; and Program objectives shall be achieved in the following manner:

1. Provide services that meet timelines set forth by the BHSD;

2. Engage clients and families who have not benefitted from traditional outpatient mental health services due to complex risk factors including substance abuse, community violence, interpersonal family violence, general neglect, and exposure to trauma;

3. Engage clients in treatment after being released from custody;

4. Assist justice-involved clients in developing life skills that would improve their ability to live and thrive in the community following release from custody;

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

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

7. Link clients to medical and dental healthcare, and to relevant services, as applicable;

8. Enhance client understanding of the importance of medication adherence and its effectiveness, if appropriate;

9. Link clients to substance use treatment, if appropriate;

10. Provide time-limited services for each client through the care coordinator as the single point of responsibility for services based on clinical care and treatment needs;

11. Provide culturally and linguistically proficient services that directly provide the full range of treatment modalities and rehabilitation services and resources to meet the needs of the clients and their families in the recovery process.

Reporting and Data Collection Requirements A. Offeror shall comply with the reporting requirements reflected in Division 5 of the California Welfare and Institutions Code (WIC), Division 1, and Title 9 of the CCR.

B. Offeror shall complete the following requirements:

1. Submit a weekly capacity report that includes recent referrals, current enrollment, and recent discharges;

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

3. Collect Sexual Orientation and Gender Identity and Expression (SOGIE) information;

4. Enter client data into the State Client and Service Information (CSI) system;

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

6. Collect treatment and service data for outcomes data reporting;

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

8. Measure client outcomes to for justice-involved clients served to assist in determining areas of improvement;

9. When applicable, administer assessment tool(s) as part of the program requirement(s) and report on assessment tool data; and

10. 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.

C. The BHSD may request status updates on particular clients to coordinate care and service linkages between County clinics, County-contracted providers, and other Health System resources. Offeror shall designate primary and alternate management positions to coordinate all referrals and discharges.

D. Data Submission

1. Offeror shall collect and report data including the following as appropriate for the program:

a. CSI Data;

b. Active Caseload/Length of Stay (LOS);

c. Network Adequacy Certification Tool (NACT);

d. Units of Services (UOS);

e. Client to staff ratio;

f. Reports on client readmission to the program;

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

h. MHSA reports;

i. Outreach and Engagement Process report; and

j. Other data reporting requirements as requested by the BHSD.

2. 90+ Days Without Service Report

a. The Offeror shall run a 90+ Days Without Service Report that shall consist of a status update for each client listed.

b. The shall run a 90+ Days Without Service Report that shall consist of a status update for each client listed.

c. The Offeror’s report shall include the disposition for each client listed, indicating the reason the client has not been closed.

E. Offeror shall describe the organization’s ability to use their current electronic health record (EHR) system (including the capability to exchange data with County systems) and/or the ability to implement a new EHR system as listed in Appendix H. Offeror shall provide details on how their organization shall use the County’s myAvatar system using one (1) of the following 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 need for the particular program/contract.

Outcomes and Measurements A. Offeror shall achieve the following outcomes:

1. Services that meet program requirements:

a. Key outcomes (timeliness access, engagement in services, successful discharge, acute care readmission, recidivism);

b. Services to the target population;

c. Services to the number of clients/caseloads agreed upon by the BHSD and Offeror;

d. Number of clients who have successfully graduated from the FDR;

e. Number of clients who have obtained benefits;

f. Number of clients who were linked to a primary care physician;

g. Number of clients who enrolled in educational/vocational programs;

h. Number of clients who became employed;

i. Number of clients who were not re-incarcerated; and

j. Other categories as deemed necessary by the BHSD FDR Division.

B. Offeror shall achieve the following outcome measurement methods:

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

a. CSI system;

b. County data system;

c. Network Adequacy Certification Tool (NACT); and

d. Any outcome tools as identified and communicated by the BHSD.

2. Offeror shall administer the client feedback tool (Client Satisfaction Survey) bi-annually.

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

4. Offeror shall have a current behavioral health electronic health record (EHR) system with capability that meets the County’s standards or shall have a behavioral health EHR system in place upon start of contract. Offeror shall utilize the County-operated EHR for billing/reimbursement purposes.

Program Description A. Service Description

1. Services shall include the following:

a. Individualized assessments using standardized tools[footnoteRef:2], including, but not limited to the Functional Assessment Scale (FAS[footnoteRef:3]) and American Society for Addiction Medicine (ASAM2) Six-Dimension Scale; [2: The BHSD shall offer training through the Learning Partnership Division, as needed.] [3: 2 Given CalAim DHCS integrated oversight, administration, and payment of specialty mental health and substance use disorder services into one contract between DHCS and counties. Through CalAIM, DHCS is going to make it possible for patients to receive multiple services in one coordinated location or during one visit. FAS & ASAM 6 Dimension scale have been added as a billable code.

b. Care plans;

c. Individual, family, and group therapy;

d. Rehabilitation services (vocational readiness, education, and skills or activities of daily living);

e. Collateral services;

f. Medication support services;

g. Crisis intervention services;

h. Outreach services; and

i. Other services that assist clients in establishing a stable community living environment.

2. Offeror shall visit potential clients in custody to screen and determine the appropriateness of the referral, engage the client in mental health treatment, and develop a therapeutic relationship.

3. Offeror shall serve individuals leaving custody, an inpatient setting, Emergency Psychiatric Services (EPS), or an Institute of Mental Disorder (IMD).

4. Offeror shall provide services that are evidence based, such as:

a. Cognitive Behavioral Therapy (CBT);

b. Trauma-Focused CBT (TF-CBT);

c. Solution-Focused Brief Therapy;

d. Dialectical Behavior Therapy; and

e. Motivational Interviewing.

5. Treatment shall include least one of the following justice-involved models:

a. Criminal Thinking;

b. Thinking for a Change;

c. Moral Reconation Therapy; and

d. Risk and Responsivity.

6. Offeror shall coordinate and secure safe housing for clients released from custody. Designated staff shall transport clients to safe community placements upon their release from custody.

7. Offeror shall assist clients in completing their Tuberculosis test and results for the purpose of timely access to housing placements.

8. Offeror shall be responsible for transporting clients to and from scheduled appointments, including, but not limited to, medical and social security appointments.

9. Offeror shall appropriately assist clients who require additional support during scheduled court hearings to provide treatment updates/recommendations and gather information from the court on the client’s justice status.

10. Offeror shall attend weekly Community Awaiting Placement Supervision (CAPS) Meetings in which clients are scheduled for release into the community from custody.

11. Offeror shall ensure that the clients have access to their medically necessary health medications immediately upon release from custody.

12. Offeror shall provide a weekly status report to the BHSD FDR Division on CAPS clients who have been released into the community to the BHSD FDR Division, as well as immediately following the occurrence of an incident and when additional client information is needed.

13. Offeror shall conduct outreach to clients within twenty-four (24) hours of being remanded into custody to re-engage the client in treatment.

14. Offeror shall provide a Client Status Report (CSR) to the BHSD FDR Division for clients that are justice involved who have been released into the community as requested by the BHSD FDR Division.

15. Offeror shall immediately submit an incident report to the BHSD and the BHSD FDR Division when an event that causes or has the capacity to cause physical or psychological injury, or has the potential for a claim or litigation to occur.

16. Offeror shall have access to flex funds that shall be spent on clients’ personal needs including housing subsidies and other needs that assist the client in achieving successful outcomes of their care plan.

17. Upon client intake, Offeror shall conduct an assessment to determine the extent to which the client requires program services.

18. Offeror shall develop an individualized treatment plan for clients consistent with the principles of wellness and recovery. The treatment plan shall focus on using community resources rather than correctional settings, EPS, IMD, and inpatient settings.

19. Offeror shall maintain continuity of client medication evaluations and direct linkage to physical healthcare provider, as necessary.

20. Offeror shall work with the client to arrange for delivery and reminders that will support adherence to the client’s medication schedules.

21. Offeror shall determine whether clients qualify for low-income housing and shall link clients to housing as it becomes available.

22. Offeror shall link clients to psychiatric inpatient care, residential treatment, supplemental board and care, day treatment, or day rehabilitation utilizing current BHSD processes and guidelines, as appropriate.

B. Service Expectations

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 maintain fidelity to the requirements for MHSA CSS as set forth in the CCR CSS Title 9, Chapter 14, Article 6, Sections 3610-3620.10 and 3640.

3. Offeror shall ensure that Network Adequacy standards are met by ensuring that each of the outpatient services under the program shall 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 restrictions upon providing the BHSD with written authorization.

4. 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 shall maintain adequate staffing and maintain the ratio to client, including the following as appropriate for the program:

a. Psychiatrist;

b. 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.

b. Nursing staff and/or psychiatric nurse[footnoteRef:4]; and [4: Capable of providing injections and linking to other levels of care.

c. Quality assurance staff.

2. Offeror shall ensure that the psychiatric 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 have staff who are appropriate trained and meet the qualifications of Licensed Practitioner of the Healing Arts (LPHA) as well as meet specific discipline requirements.

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

5. Staff shall be specialized and experienced in working with justice involved clients.

6. Offeror’s staff shall meet the BHSD Co-Occurring Standards. The BHSD Co-Occurring Standards require all paraprofessional and professional practitioners to have the minimal core skills and be trained according to the following three-core skill levels:

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 are assessment, diagnosis, and integrated treatment.

7. Offeror’s staff shall participate in trainings related to the MHSA CSS required data collection and reporting.

8. Offeror’s staff shall participate in SOGIE 101 Training.

9. Offeror shall ensure that appropriate staff attend all systemwide BHSD trainings and shall participate in all required trainings specific to the needs of the program.

10. Staff shall be trained and proficient in the following:

a. Knowledge and skills in the principles of psychosocial rehabilitation and recovery process;

b. Confidentiality;

c. Crisis intervention;

d. Knowledge of community resources, including self-help centers and ethnic community resources;

e. Sensitivity and awareness of language and cultural influences on the individual;

f. Understanding of the behavioral health system of care;

g. Understanding of the justice system;

h. Understanding of psychopathology and physical health problems within the context of client’s age and culture.

11. Staff shall be required to obtain jail clearance to outreach to clients who are in custody.

12. Offeror shall provide quarterly staffing report to notify the FDR Contract Monitor and FDR Division Director of staffing changes.

13. 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).

D. Cultural Competency

1. 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.

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

3. 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.

4. Offeror shall provide outreach activities focused on reaching underserved, underrepresented, and/or multicultural populations. Furthermore, the outreach process may take place in custody settings, psychiatric hospitals, or in the community, as appropriate.

E. Clinical Supervision

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

a. Submit a clinical supervision plan based around appropriate EBPs and/or PPs;

b. Provide a consistent schedule and structured weekly reflective supervision to serve their staff regardless of licensure.

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

d. Provide of clinical supervision activities for review during monthly or bi-monthly staff meetings.

F. Referrals and Admissions

1. Offeror shall accept referrals that are generated through the BHSD Collaborative Court Staff, BHSD Reentry Resource Center staff, and other FDR providers. These may include, but are not limited to, referrals that are a result of:

a. Step downs from higher level of care, such as crisis residential facilities;

b. Screenings completed by the BHSD Collaborative Court and BHSD Reentry Resource Center staff of clients that require an assessment based on Title 9 medical necessity criteria;

c. Referrals from other Counties for clients who receive benefits from Santa Clara County; and/or

d. Referrals from Adult Custody Health, the Probation Department, the Parole Department, the Pretrial Department, and other justice departments as determined appropriate by the BHS FDR Division.

2. Offeror shall accept referrals five (5) days per week, during regular scheduled business hours.

3. Offeror shall ensure that referrals which fail to 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, at the request of the client, shall initiate a transfer to a clinic of the client’s choosing as soon as there is availability at that program per P&P 412-330.

5. If a client has or is suspected to have Autism Spectrum Disorder/Intellectual Developmental Disability but is not connected to San Andrea Regional Center (SARC), the Offeror’s staff shall request collateral information from school, attorney, and/or doctor upon obtaining a signed Release of Information (ROI) to provide linkage to SARC and/or additional community resources.

G. Care Coordination

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

a. Utilize EBPs, PPs, and/or trauma informed practices whenever clinical indicated and based on each client’s diagnosis. EBPs and PPs recommended for FDR programs may include the following:

i. Cognitive Behavioral Therapy (CBT);

ii. Trauma-Focused (TF-CBT);

iii. Solution-Focused Brief Therapy;

iv. Dialectical Behavior Therapy;

v. Motivational Interviewing; and

vi. Integrated co-occurring disorder practices and peer supports such as Wellness Recovery Action Planning.

b. Review each client’s status and progress towards planned goals annually to determine possible discharge planning and/or step down to a non-justice focused program.

c. Provide client injection(s) and related medication management services as necessary in the outpatient clinics.

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

e. Communicate with clients and their families to ensure comprehensive and consistent care, good communication with system partners and other serving agencies, and/or institutions involved in service delivery.

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

H. 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, with 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 under the program.

2. Offeror shall ensure that the 24-hour coverage plan shall be on file with the BSHD Division Director.

3. During holidays, Offeror shall maintain an minimum a skeleton crew that shall facilitate the processing of referrals coming from the BHSD Reentry Center or the Collaborative Courts, provide crisis coverage, and initiate Lanterman-Petris-Short (LPS) protocols.

I. Evaluations, Transitional Planning, and Discharge

1. Clients shall be discharged by Offeror when the client meets at least one (1) of the following criteria:

a. Upon graduation from the program, which shall include linkage to other levels of care when a referral to ongoing mental health services as needed;

b. Upon mutual agreement between the client and their treatment team that the goals of treatment have been met;

c. Upon a good faith determination by Offeror that the client cannot be effectively served by the program and will be linked to other appropriate services that meet the needs of the individual;

d. Upon transfer out of the County to another mental health program or region, and appropriate follow-up or other service linkage have been made;

e. Upon the client’s long-term incarceration;

f. Upon client unilateral decision to terminate treatment against medical advice;

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

h. Upon transfer to another County 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;

i. Upon notification of client admission into an institutionalized setting (e.g., 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;

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

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

2. Offeror shall take all reasonable steps to avoid unnecessary discharges.

3. All discharges shall be accompanied with a discharge summary.

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 B13 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 A13: Adult and Older Adult Intensive Outpatient Continuum Services - Justice Involved Scope of Work CATEGORY 2: Outpatient Services