Attachment A22 rev 11142025.pdf

ATTACHMENT A22

CATEGORY #: 6 SUTS OUTPATIENT SERVICES

RFSQ-BHS-FY23-0210 Adult and Older Adult System of Care Services ATTACHMENT A22: ADULT AND OLDER ADULT SUBSTANCE USE TREATMENT SERVICES - OUTPATIENT CONTINUUM

SERVICES SCOPE OF WORK

CATEGORY 6: SUTS OUTPATIENT SERVICES

Last Revised 10/24/25

ADULT AND OLDER ADULT SUBSTANCE USE TREATMENT OUTPATIENT CONTINUUM

SERVICES

Scope of Work

I. Purpose

A. The County of Santa Clara (County) Behavioral Health Services Department (BHSD) is seeking statements of qualifications from qualified Offerors interested in providing outpatient substance use treatment services for adults and older adults throughout Santa Clara County. Offerors may submit an offer to provide services in one or multiple regions.

B. Offerors shall be consistent with American Society of Addiction Medicine (ASAM) Criteria, federal Substance Abuse and Mental Health Services Administration (SAMHSA) best practices; and longstanding BHSD program practices. Offerors shall provide Dual Diagnosis Enhanced (DDE) or Dual Diagnosis Capable (DDC), meaning that they can address the relationship between the substance-related disorders and mental health disorders and their effect on the client's readiness to change, as well as relapse and recovery environment issues, through individual and group program content. Readiness to change will be assessed for both substance related disorders and mental health disorders.

C. Offerors responding to this RFSQ shall immediately begin the process to get the facility licensed by DHCS as an outpatient treatment facility and certified as a Drug Medi-Cal program.

II. Operational and Logistical Requirements

A. Offeror shall have current Medi-Cal certification or become certified to provide Medi-Cal reimbursable services on or before the contract start date.

B. Offeror shall strategically operate a Medi-Cal 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.

C. Offeror shall implement at least two (2) of the following Evidence Based Practices (EBPs). The two (2) EBPs are per provider, per service modality. Offeror shall implement EBPs and deliver the practices to fidelity. The State shall monitor the implementation of EBPs during reviews. The EBPs include:

1. Motivational Interviewing: A client-centered, empathic, but directive counseling strategy designed to explore and reduce an individual's ambivalence toward treatment. This approach frequently includes other problem solving or solution-focused strategies that build on clients’ past successes.

2. Cognitive Behavioral Therapy: Based on the theory that most emotional and

RFSQ-BHS-FY23-0210 Adult and Older Adult System of Care Services ATTACHMENT A22: ADULT AND OLDER ADULT SUBSTANCE USE TREATMENT SERVICES - OUTPATIENT CONTINUUM

SERVICES SCOPE OF WORK

CATEGORY 6: SUTS OUTPATIENT SERVICES

Last Revised 10/24/25 behavioral reactions are learned and that new ways of reacting and behaving can be learned.

3. Relapse Prevention: A behavioral self-control program that teaches individuals with substance addiction on how to anticipate and cope with the potential for relapse.

Relapse prevention can be used as a stand-alone substance use treatment program or as an aftercare program to sustain gains achieved during initial substance use disorder treatment.

4. Trauma-Informed Practices: Services shall take into account an understanding of trauma, and place priority on trauma survivors' safety, choice, and control.

5. Psycho-Education: Psycho-educational groups are designed to educate clients about substance use, and related behaviors and consequences. Psycho-educational groups provide information designed to have a direct application to clients' lives, to instill self- awareness, suggest options for growth and change, identify community resources that can assist clients in recovery, develop an understanding of the process of recovery, and prompt individuals using substances to take action on their own behalf.

D. 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:

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 Serano, Saratoga, and Campbell;

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

and

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

III. Target Population

A. The program shall target previously unserved and underserved adults (age 18-59 years) and older adults (ages 60 and over). Clients served are suffering from substance use disorder and/or co-occurring conditions which may result in functional impairments or symptoms, and without treatment shall be at imminent risk of decompensation.

B. Clients served are County residents that have Medi-Cal or unsponsored.

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. Reducing suffering from substance use disorder(s);

b. Reducing functional impairment due to co-occurring substance use;

RFSQ-BHS-FY23-0210 Adult and Older Adult System of Care Services ATTACHMENT A22: ADULT AND OLDER ADULT SUBSTANCE USE TREATMENT SERVICES - OUTPATIENT CONTINUUM

SERVICES SCOPE OF WORK

CATEGORY 6: SUTS OUTPATIENT SERVICES

Last Revised 10/24/25

c. Reducing experiences of homelessness, incarceration, crisis, hospitalization, substance use, violence, trauma, and victimization;

d. Strengthening recovery, self-sufficiency, and other psychosocial outcomes; and

e. Encouraging adult and older adult clients to actively participate in their recovery, self-monitor milestones, goals towards self-determination, and community engagement.

2. Objectives shall be achieved by:

a. Engaging underserved clients who are at risk 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;

b. Providing co-occurring services;

c. Addressing client substance/alcohol use and related risky behaviors (e.g., unsafe sex, criminal behaviors, etc.) as applicable;

d. Supporting clients in obtaining safe and stable housing;

e. Improving 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;

f. Increasing each client’s understanding pertaining to the importance of their medication adherence and treatment compliance through psychoeducation sessions;

g. Assisting clients in learning life skills that allow them to become more independent and self-sufficient;

h. Promoting meaningful use of time and capabilities in school, work, and social activities;

i. Developing, increasing, and strengthening natural networks of supportive relationships;

j. Linking clients to medical and dental healthcare, and other relevant services before discharge;

k. Improving access to community-based and eligible public benefits; and

l. Effectively promoting wellness and recovery by transitioning clients to appropriate levels of care as necessary.

3. Key Outcomes

a. Offeror’s key outcomes plan shall incorporate and achieve the following target benchmarks:

i. Improve access for and engagement of clients into substance use treatment services;

ii. Demonstrate the ability to successfully transition each client to lower levels of care while maintaining successful client recovery processes;

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CATEGORY 6: SUTS OUTPATIENT SERVICES

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iii. Improve functioning as defined through DHCS and/or County approved assessment tool(s); and

iv. Increase the number of clients reporting satisfaction with services.

V. Reporting and Data Collection Requirements

A. Offeror shall collect and report data including but not limited to:

1. California Outcomes Measurement System (CALOMS);

2. Drug and Alcohol Treatment Report (DATAR);

3. Treatment perceptions survey (TPS); and

4. Any County data systems or assessment reports requested by County, and/or DHCS.

B. Offeror described 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 provided 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.

VI. Outcomes and Measurements

A. Offeror shall comply with the County’s ongoing comprehensive Quality Assessment and Performance Improvement (QAPI) Program (42 C.F.R. § 438.330(a)) and work with the County to improve established outcomes by following structural and operational processes and activities that are consistent with current practice standards.

B. Offeror shall participate in quality improvement (QI) activities, including clinical and nonclinical performance improvement projects (PIPs), as requested by the County in relation to state and federal requirements and responsibilities, to improve health outcomes and clients’ satisfaction over time. Other QI activities include:

1. Quality assurance;

2. Collection and submission of performance measures specified by the County, mechanisms to detect both underutilization and overutilization of services;

3. Client and system outcomes;

4. Utilization management;

5. Utilization review;

6. Provider appeals;

7. Provider credentialing and recredentialing; and

8. Client grievances.

C. Offeror shall measure, monitor, and annually report to the County its performance.

D. Offeror shall implement mechanisms to assess client/family satisfaction based on

County’s guidance. Offeror shall assess client/family satisfaction by:

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CATEGORY 6: SUTS OUTPATIENT SERVICES

Last Revised 10/24/25

1. Surveying client/family satisfaction with the Offeror’s services at least annually.

2. Evaluating client grievances, appeals and State Hearings at least annually.

3. Evaluating requests to change persons providing services at least annually.

4. Informing the County and clients of the results of client/family satisfaction activities.

E. Offeror shall implement mechanisms to monitor the safety and effectiveness of medication practices, if applicable. This mechanism shall be under the supervision of a person licensed to prescribe or dispense prescription drugs, at least annually.

F. Offeror shall implement mechanisms to monitor appropriate and timely intervention of occurrences that raise quality of care concerns. Offeror shall take appropriate follow-up action when such an occurrence is identified. The results of the intervention shall be evaluated by the Offeror at least annually and shared with the County.

G. Offeror shall collaborate with County to create a QI Work Plan with documented annual evaluations and documented revisions as needed. The QI Work Plan shall evaluate the impact and effectiveness of its quality assessment and performance improvement program.

H. Offeror shall attend and participate in the County’s Quality Improvement Committee (QIC) to recommend policy decisions, review and evaluate results of QI activities, including PIPs, institute needed QI actions, and ensure follow-up of QI processes.

Offeror shall ensure that there is active participation by the Offeror’s practitioners and providers in the QIC.

I. Offeror shall assist County with the development and implementation of Corrective Action Plans as needed.

J. Offeror shall participate in annual, independent external quality reviews (EQR) of the quality, timeliness, and access to the services provided which are conducted pursuant to Subpart E of Part 438 of the Code of Federal Regulations. (42 C.F.R. §§ 438.350(a) and 438.320).

K. Offeror shall initiate any other monthly, quarterly, and/or annual measurement tools and documents, which may include Microsoft Excel and other formats as requested by the BHSD.

VII. Program Description

A. Offeror shall provide substance use disorder outpatient and recovery services. All outpatient services must be Integrated DDE.

1. Provide outpatient ASAM Level 1 services at low and medium intensity. It is expected that clients will move between these levels of intensity during treatment.

a. Low intensity services may include psycho-education services, group counseling and individual or family counseling sessions, and case management services as needed. Services may be provided less than once a week except during the first month after admission. A minimum of four (4) services must be provided during the first thirty (30) days of admission to treatment. Clients at this level of

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Last Revised 10/24/25 service may be in the “Discovery” stages of change and be treated most appropriately with Motivational Enhancement strategies rather than more intensive “action” oriented treatment approaches that focus on immediate change and consequences. These clients tend to respond to efforts to engage them “where they are” and to efforts that match the intensity and frequency of treatment to their understanding of the “problem.”

b. Medium intensity services include psychoeducation, group counseling, individual or family counseling sessions as needed. Services may be provided weekly or more frequently (but less than nine [9] hours per week).

2. Provide outpatient ASAM Level 2.1, group-based, nonresidential, intensive structured interventions. It is expected that clients will move between these levels of intensity during treatment.

a. Intensive Outpatient Treatment Services are provided to members when medically necessary in a structured programming environment. These services may be offered for a minimum of nine (9) hours with a maximum of nineteen

(19) hours a week for adults, and a minimum of six (6) hours with a maximum of nineteen (19) hours a week for members under the age of twenty-one (21).

Services may exceed the maximum based on individual medical necessity.

B. Offeror shall provide Recovery Services to clients after completing their course of outpatient treatment and includes the following:

1. Counseling services in the form of individual or group counseling to focus on relapse prevention areas and then reassess if the client needs further care;

2. Recovery monitoring: Recovery coaching, monitoring via telephone and internet;

3. Substance Use Assistance: Peer-to-peer services and relapse prevention;

4. Education and Job skills: Linkages to life skills, employment services, job training, and education services;

5. Family Support: Linkages to childcare, parent education, child development support services, family/marriage education;

6. Support Groups: Linkages to self-help and support, spiritual and faith-based support; and

7. Ancillary services: Linkages to housing assistance, transportation, case management, individual services coordination.

C. Recovery services can be utilized when the client is triggered, has relapsed, or as a preventive measure to prevent relapse. As part of the assessment and treatment needs of Dimension 6, Recovery Environment of the ASAM Criteria and during the transfer/transition planning process, Offeror shall provide clients with recovery services.

D. Offeror shall provide recovery services to clients as medically necessary.

E. Recovery services shall be provided either face-to-face, by telephone, or by telehealth with the client.

F. Treatment Standards:

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1. Treatment shall be provided in conformance with DHCS guidelines.

2. Each client shall receive individualized treatment with no fixed length of stay.

3. Develop an individualized treatment plan based on ASAM assessment with short-and long-term goals that are clinically appropriate and behaviorally measurable based on the comprehensive assessment.

4. Treat and address the co-occurring symptoms of the target population.

5. Work with dual diagnosis clients and provide a plan for providing DDE or DDC services.

6. Provide Trauma-Informed Practices.

7. Provide services for clients with who have served time in prison and/or County jail.

8. Work with clients with special needs and disabilities.

9. Utilize EBPs such as motivational interviewing to engage clients in treatment.

Confrontational approaches are not acceptable.

10. Families shall be involved in treatment when appropriate.

G. Staffing Requirements

1. Offeror shall document and ensure that all staff is trained in accordance with DHCS licensing requirements. All staff providing counseling services in all substance use treatment programs shall be licensed and/or certified by DHCS. In addition to licensing requirements all staff shall meet training requirements set by the BHSD.

Offeror shall ensure that the clinical supervisor be licensed by one (1) of the DHCS authorized licensing bodies and have two (2) years post license experience.

2. Offeror shall ensure stability in staffing specifically in the areas of staff retention and staff training to develop the knowledge and skills necessary to work with the target population.

3. Offeror shall ensure appropriate level of qualified clinical staff and administrative staff such as quality improvement staff.

4. Offeror’s organization shall maintain practices related to recruiting, hiring, and promoting bi/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, etc.).

H. 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. The program shall be reflective of the ethnic, cultural, and linguistically diverse populations of the County and preferences of each client. Offeror shall monitor and evaluate client/family satisfaction and culturally responsive services/practices to

RFSQ-BHS-FY23-0210 Adult and Older Adult System of Care Services ATTACHMENT A22: ADULT AND OLDER ADULT SUBSTANCE USE TREATMENT SERVICES - OUTPATIENT CONTINUUM

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Last Revised 10/24/25 continually improve service quality. Data shall be used to improve program satisfaction.

3. The program shall be composed of staff who are proficient in the seven (7) Santa Clara County threshold languages (e.g., Spanish, Vietnamese, Mandarin, Cantonese, Tagalog, Farsi and Russian). Offeror’s organization shall have a plan to address barriers when they do not have staff available to meet the County threshold languages 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.

I. Referrals and Admissions

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

2. Offeror shall ensure that referrals that do not meet the criteria for Substance Use Treatment Services (SUTS) or that need a different level of care, shall be directed, and linked by the program to appropriate alternative resources or another provider.

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

e. Offeror shall provide integrated co-occurring disorder practices and peer supports.

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

g. Offeror shall link clients to community-based resources as well as primary care services.

h. Offer shall communicate with clients and their families to ensure comprehensive and consistent care, good communication with system partners

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Last Revised 10/24/25 and other serving agencies, and/or institutions involved in service delivery.

i. Offeror shall utilize co-occurring substance use treatment that are 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 (2) providers shall address any co-occurring treatment needs.

K. Program Hours of Operations

1. Offeror shall provide services Mondays to Fridays during business hours.

2. Offeror shall be available twenty-four (24) hours daily, seven (7) days a week to address the emergency needs of clients.

L. Evaluations, Transitional Planning, and Discharge

Offeror shall provide a discharge planning process. Discharge planning will begin at the beginning of treatment and will be documented in clinical record. Discharge planning should be on-going and in compliance with BHSD policies and procedures.

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 B22 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.