Attachment A2a.docx

ATTACHMENT A2a

CATEGORY 2: SUB-ACUTE TREATMENT FACILITIES

CATEGORY 2 - SUB-ACUTE TREATMENT FACILITIES:

MENTAL HEALTH REHABILITATION CENTER

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 providing a supportive environment in a Mental Health Rehabilitation Center (MHRC) through specialized treatment services with a goal of rehabilitation that focuses on maximizing client levels of functioning.

The program shall provide a continuum of psychiatric and medical services that empowers and prepares clients to succeed in the least restrictive setting upon discharge from the program.

The program shall provide a homelike and therapeutic environment for clients who are experiencing behavioral health challenges. The goal is for client to move towards their potential in their physical, mental, and spiritual health.

I. Background Information A. The Realignment legislation in July 1992 gave the BHSD the responsibility of contracting for the provision of MHRC services. The BHSD manages all admissions to the MHRC facilities and discharges to lower level of care placements. The actions have enhanced social equity and safety by providing less restrictive and less costly psychiatric services to adults with Severe Mental Illness (SMI) in Santa Clara County. These services reduce the need for State hospitalization and hospitalization in acute care settings.

Target Population A. The program shall serve adult (18 years of age and older) residents of Santa Clara County that meet the following criteria:

1. Diagnosed with a SMI;

2. Diagnosed with substance use disorders; and/or

3. Have severe functional impairments meeting requirements for a MHRC level of care and who may also need nursing interventions.

B. Additional criteria may include:

1. Clients who are chronically ill with behaviors that may require 1:1 supervision and high levels of behavioral interventions, support, and/or a high level of nursing interventions.

2. Clients who have been rejected for admission by all lower levels of care (less restrictive environment) in the community or deemed not appropriate for lower levels of care.

3. Clients with significant behavior challenges that preclude them from living in the community independently.

4. Clients who have significant social skills deficits, substance use disorders, impaired self-regulation skills, thought disorders, or nursing complexity.

5. High risk clients or clients that continue to show that they are unable to function at the lower levels of care that are available in the community.

6. Clients at inpatient or acute hospitals with behaviors or conditions that have shown effectiveness to treatment with enhanced 1:1 staffing.

7. Clients with the following conditions: self-harm, brittle diabetics, scavenger behavior, intrusive behavior, aggressive/assaultive behavior, and food intake supervision.

8. Clients who have significant behavioral challenges, limited social skills, dual diagnoses, impaired or unable to attend to independent living skills, poor self- regulation skills, thought disorders, and/or nursing complexities that prevent them from living in the least restrictive settings.

9. Clients who are deemed gravely disabled by the treatment team and unable to care for their psychiatric needs, which prevents them from residing independently in the community.

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 the following:

Provide a continuum of psychiatric and medical services that empowers and prepares clients to succeed in the least restrictive setting upon discharge from the MHRC.

Provide a homelike and therapeutic environment for clients who are experiencing behavioral health challenges. The goal is for clients to move towards their potential in their physical, mental, and spiritual health.

Assist the County in efficiently and effectively managing limited resources by providing an alternative to utilization of state hospital days and acute hospital administrative days.

Increase the client’s motivation and skills toward self-restoration.

Reduce or decrease the rate of decompensation, thus reducing placements at higher, more costly levels of care.

Provide the intensive staffing required to supervise and treat clients with behavioral and medical conditions.

Reduce the need for re-hospitalization in acute psychiatric or medical facilities.

Assist clients to maintain or improve functioning and decrease symptoms.

Empower clients by involving them in directing their own treatment programs.

Ensure the maximum usage of the most effective and newest psychiatric and medical pharmacological treatments and methods.

Work collaboratively with the public behavioral health system to enable efficient utilization of this program’s specialized resources.

Assist clients in developing socially responsible behaviors, independent living skills, and coping skills to address their mental health conditions.

Objectives shall be achieved by:

a. A reduction in in client psychiatric admissions; and

b. An increased rate of client placements in the least restrictive settings in the community.

II. Reporting and Data Collection Requirements A. Offeror shall implement an appropriate reporting system to evaluate and monitor program activities. The BHSD shall keep an accurate record of each person placed in the program, for each day of service. All client data and services shall be maintained in the BHSD Billing Application System. Offeror is responsible for making sure that the BHSD receives accurate information of all clients served within twenty-four (24) hours of each transaction.

B. The BHSD Director or their designee shall make periodic reviews of program activity and client care. Offeror shall provide all necessary information and client records as needed to complete the review, and to evaluate fiscal and clinical effectiveness, appropriateness, and timeliness of services being provided.

C. The BHSD may develop reporting instruments to facilitate evaluation and monitoring. Previously established documents shall be used when applicable and appropriate, as determined by the BHSD. Upon implementation of these reporting instruments, the Offeror shall comply with the established requirements.

D. Monthly meetings shall be held to discuss care coordination, outcome, and client progress on each BHSD client. Additional meetings may be required based on the needs of the clients and the facility.

E. Quarterly meetings shall be held with the Offeror to discuss contractual and operational concerns or issues. Offeror may request additional meetings with the BHSD if needed.

F. Offeror shall send monthly census reports to the BHSD, including client information such as admission and discharge dates, demographics, and client progress.

G. Offeror shall submit and implement, if requested in writing, a Quality Assurance Plan as required by and subject to approval of the BHSD Office of Quality Assurance. The plan shall include at minimum a description of utilization review, medication monitoring, case documentation, peer review, and other issues pertaining to Quality Assurance mandates and policies.

H. Offeror shall notify the BHSD by telephone of the violation of any provision within twenty-four (24) hours of obtaining reasonable cause to believe that a violation has occurred. In addition, notice of such violation shall be confirmed by delivering a written notice “Incident Report Form” to the Director of the BHSD within seventy-two (72) hours of obtaining reasonable cause to believe that such violation has occurred. Such notice shall describe the violation in detail.

I. Offeror shall comply with all State Hospital and County policies, procedures, and requirements concerning the reporting of unusual occurrences and incidents.

J. Upon receiving violation notification from the 24-Hour Care Unit, Offeror has fourteen (14) days to submit a plan of correction.

K. Offeror shall detail the organization’s ability to use their current electronic health record (EHR) system (including the capability to exchange data with County systems) and/or the ability to implement a new EHR system as listed in Appendix H, Offeror’s Electronic Health Record (EHR) Status. Offeror shall indicate current and future County EHR system needs in Appendix H, using one (1) of the following myAvatar implementation types:

1. Provider Connect Enterprise (PCE) with 837 billing;

1. Provider Connect NX (PCNX) with 837 billing;

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

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

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

1. The BHSD reserves the right to conduct an annual review of the program to ensure that the Offeror is providing quality care to the clients.

2. Offeror shall engage in a continuous quality improvement process to reduce the rate of recidivism into the acute psychiatric and medical settings by 50%.

3. Offeror shall engage in continuous quality improvement process to minimize incidences of aggression towards others and self-harm by 50%.

4. Offeror shall work towards transitioning at least 10% of the total census of BHSD clients to the least restrictive settings in the community within one-hundred and twenty (120) days of admission to the facility.

B. Offeror shall achieve the following data submission:

1. Outcome Measurements shall be monitored and tracked through a designated tracking process/system provided by the BHSD.

IV. Program Description A. Purchase of dedicated beds (if applicable) shall be upon successful contract negotiations and mutual agreement between the BHSD and Offeror.

B. Service Description

1. Offeror shall admit clients in need of 24-hour behavioral health services.

2. Clients who require 1:1 service may have the following conditions:

a. Have a history experiencing inadequate treatment;

b. Clients with other exceptional needs above and beyond the level of basic medical, psychiatric, or custodial care (e.g., requiring six (6) hours or more of 1:1 supervision or extensive assistance); and/or

c. Experiences which preclude them from being accepted and admitted into a lower level of care facility and/or put clients at risk for placement at the state hospital level.

3. Clients may experience at least one (1) of the following:

a. Have a history of or are at risk of displaying behavioral symptoms deemed not appropriate if released to the community. Symptoms include but are not limited to:

i. Violence or aggressive behaviors requiring constant redirection (e.g., combativeness, excessive verbal abusiveness, intrusive behavior, scavenger behavior, property destruction, challenging personality disorders);

ii. Areas relating to client health issues requiring staff monitoring (e.g., bowl and bladder clean-up and shower assistance, poor gate/mobility hypertension, brittle diabetes, seizure disorder conditions, at risk for choking during mealtimes meal refusal not related to eating disorders, medication refusal, substance or alcohol use, Polydipsia)

iii. Areas relating to client and community physical safety (e.g., History of property damage or arson, poor impulse control, rummaging/theft, aggressive/assaultive/sexual behavior that require redirection, elopement risk, absent without official leave [AWOL] risk, self-harm or suicidality risk, disrobing,

4. Offeror shall provide the following services to clients:

a. Twenty-four (24) hour client supervision.

b. Tailor client plans to specific needs of each client as identified through direct client assessments and from the client’s treatment team.

c. Conduct behavioral interventions specific to the client’s clinical and medical needs.

d. Structured training regimen with individualized therapy and other behavioral health treatment services to assist them in developing new skills and modifying behaviors.

e. Monitor medication compliance, provide support and structure needed to minimize behavioral and psychiatric symptoms.

f. Provide linkage and education to community resources.

g. Provide nutritionally healthy meals to all clients according to the County Nutritional Guidelines and Standards and provide individualized meal plans for clients with special medical needs.

h. Provide verbal prompts or physical assistance with personal care, such as bathing, hair care, dental care, hand washing, dressing, or other grooming tasks to maintain good physical hygiene and appearance.

i. Offeror shall provide reasonable transportation to designated psychiatric or medical appointments, or other activities that are necessary for the well-being of clients.

5. Offeror shall work collaboratively with clients to develop individualized treatment plans to prepare clients for independent living in the community.

6. Offeror shall communicate with conservators, the BHSD 24-Hour Care Unit, and the treatment team if there are changes to the client’s condition.

7. Offeror or designated employees shall possess a California driver’s license prior to transporting clients. Offeror shall provide supervision in a community setting twenty-four (24) hours, seven (7) days a week as set forth by Federal and State regulations.

8. Individualized intensive treatment services shall address special needs of clients requiring additional care above and beyond the basic services as described above. Such needs may include, but are not limited to, the following:

a. Medical care (e.g., diabetic diet, blood sugar monitoring, insulin dependent diabetic care, frequent lab work for medical conditions or physical medication, care for other conditions that require a special diet or monitoring). Medical care may also include other conditions, including, but not limited to, catheter care, and enemas.

b. Clients who are significantly impaired and more chronic than the general population in the facility that require intensive programming, supervision, and support.

c. Clients with severe behavioral issues that require supervision or intervention beyond usual redirections, prompting, or attention for psychiatric symptoms. This may include behavioral issues that interfere with psychiatric treatment, medical care, custodial care, or that present a danger or safety concern for the client, other clients, or staff.

d. Ensure Activities of Daily Living (ADLs) compliance.

e. Offeror shall provide intensive supervision for clients who have a history of wandering or are currently at risk of wandering offsite without supervision. The physical layout of the building shall always be secured.

f. Additional custodial care that requires assistance by the Offeror (e.g., incontinence of bladder or bowel). Assistance with eating, or ADLs due to a medical condition or severe psychiatric symptoms.

9. 1:1 Treatment Services:

a. Offeror shall provide designated staff to monitor each client 1:1 for up to sixteen (16) hours a day or during client waking hours.

b. Offeror shall provide client-centered plan with a specific goal within forty-eight (48) hours of being transitioned to this level of service.

c. Offeror shall review clients receiving 1:1 treatment services on a bi-weekly basis, or earlier as needed with the BHSD Program Monitor.

d. If a resident is no longer in need of their current 1:1 monitoring plan, the 1:1 service may be reduced to an appropriate level of care as determined by the Offeror and County assessment.

10. 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.

11. 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.

12. Length of Stay: The initial authorized length of stay shall be one-hundred and twenty days (120) days. If additional time is required, thirty (30) day additional increments shall be authorized based on the submission of an updated discharge plan by the Offeror. Extensions must be submitted in writing and sent to the 24-Hour Care Unit.

C. Staffing Requirements

1. Offeror shall ensure that the services provided to a specific client at a given time are cost-effective, clinically, and culturally appropriate and least restrictive.

2. MHRC staff shall possess and maintain appropriate licenses and certificates in accordance with all statuses and regulations. Background checks, criminal records review, DOJ clearance, etc. shall be obtained and maintained in accordance with County rules and regulations.

3. Offeror’s staffing patterns shall reflect, to the extent feasible, at all levels, the cultural, linguistic, ethnic, sexual, and other social characteristics of the client base served in the program.

4. Offeror shall make every effort to hire staff reflective of the County’s diversity with attention the County’s identified seven (7) Santa Clara County threshold languages (Spanish, Vietnamese, Mandarin, Cantonese, Tagalog, Farsi, and Russian). Offeror must be able to document recruitment and outreach strategies.

5. Staffing levels need to be appropriate to provide necessary residential and treatment needs. Employee schedules must be available for review by BHSD staff.

6. Offeror shall provide Professional Development and Training requirements that are in accordance with BHSD standards.

7. Offeror shall provide appropriate staff that possess the education and training to address the behaviors needs of the severely mentally ill population.

8. Offeror shall provide 1:1 staff monitoring to each client.

9. Upon request, Offeror shall submit to the BHSD Contracts Administration an organizational chart, which reflects the Offeror’s current operating structure per facility.

10. Offeror shall provide at least eight (8) hours of cultural competence training to staff per fiscal year. Trainings may be obtained internally within the facility or through external sources.

11. Offeror shall follow licensure and all laws governing the qualifications of staff reimbursed in whole or in part. Offeror agrees to submit any material changes in such duties or minimum qualifications to the County.

12. Offeror shall provide a continuing education to all staff to proactively address client’s problematic behaviors and to minimize transfers to emergency psychiatric services and inpatient hospitalization.

13. Offeror shall engage in a continuous quality improvement process to minimize incidences of aggression directed towards the clients and others.

14. Offeror’s organization shall maintain practices related to recruiting, hiring, and promoting multi-lingual staff and/or a culturally or ethnically diverse workforce. Offeror’s organization shall have training requirements related to diversity, equity, and/or inclusion (e.g., Lesbian, Gay, Bisexual, Transgender, Queer, Questioning + [LGBTQ+], cultural and linguistic capacity, racial equity).

D. Cultural Competency

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

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

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

E. Referrals and Admissions

1. Offeror shall work closely with BHSD staff to facilitate the admission, transfer, and discharge of clients. Offeror shall admit clients in accordance with the following: ability, scope of practice, and adequate staffing requirements.

2. Frequency, scope, and severity of the client’s behaviors shall be a determining factor to be negotiated on an individual client basis between County and Offeror.

3. The BHSD may grant individual exceptions to the above admission criteria. All admissions are subject to the prior authorization process as follows:

a. The BHSD’s prior authorization form (Supplemental Services Authorization Form) must be completed and approved prior to admission of any client to the facility. Failure to obtain prior authorization shall result in nonpayment for services provided by the Offeror.

b. Offeror must notify the 24-Hour Care Unit of all admits and discharges within twenty-four (24) hours by using the Admit/Discharge Notification Form provided by the BHSD.

c. Offeror reserves the right to conduct a pre-admission interview and refuse clients who are not within their scope of practice.

d. Offeror must respond to referrals from referring providers within forty-eight (48) hours of receiving the referrals packets.

e. Offeror shall designate specific staff responsible for admission authorization and admission arrangements. Offeror shall provide specific clinical justifications for denials of admission within two (2) working days of request for admission. Upon denial of the referrals, the Offeror shall inform the referring providers if there are specific expectations that must be met prior to acceptance. All denials must be based on medical necessity, scope of practice, and the ability of the facility to manage the client’s current condition(s).

f. The BHSD must also provide a signed statement from a treating psychiatrist that states the client is appropriate for a transfer to an MHRC. Requirement of a signed statement shall apply to all levels of care.

1. Statements do not apply for clients who exhibit any exclusionary conditions/behaviors. Any clients who exhibit exclusionary conditions/behaviors must be evaluated for appropriateness and safety prior to admission.

4. Additional requirements for Individualized Intensive Treatment Services:

a. Clients in need of psychiatric treatment above and beyond the basic level of care for MHRC clients may be considered acceptable for individualized intensive treatment services. All admissions are subject to the prior authorization process described above and, in addition, must meet the BHSD’s criteria for individualized intensive treatment services.

b. Daily rate of individualized intensive treatment services shall be titrated down in accordance with services needed for the clients.

c. Offeror to review the enhanced services on a weekly basis with the BHSD to determine the appropriateness of continued individualized intensive treatment services. Reviews and justifications must be documented on a tracking tool and be sent to the 24-Hour Care Unit for review.

d. Individualized intensive treatment services shall be determined based on the needs of the client. The determination shall be made in collaboration with the Offeror and the 24-Hour Care Unit.

e. The initial authorization for individualized intensive treatment services shall be approved for fourteen (14) days. The 24-Hour Care Unit shall review the client’s progress under this level of service after fourteen (14) days. Additional approval beyond fourteen (14) days must be obtained from the BHSD 24-Hour Care Unit.

F. Care Coordination

1. A client’s length of stay in the MHRC is time-limited. Clients shall receive active psychiatric, medical, nursing care, and rehabilitative treatment services. Offeror shall support clients to develop independent living skills and progress to a non-institutionalized setting within the allotted time approved by the BHSD.

2. All clients approved under the 24-Hour Care Unit for supplemental services shall be reviewed after one-hundred and twenty (120) days regardless of their legal or conservatorship status.

3. Clients may enter the facility on a fast-track basis up to thirty (30) days for further stabilization. This process must be approved by the 24-Hour Care Unit prior to admitting the client into the facility.

4. Offeror’s psychiatrist(s) and the Offeror’s treatment team shall pro-actively identify clients for discharge. Offeror’s staff shall notify the 24-Hour Care Unit staff of clients that clinically can be moved to a lower level of care who refuse to leave the Offeror’s facility.

5. Offeror’s psychiatrist(s) shall provide the following actions for each client:

a. Provide active treatment of clients on a weekly basis. If a client does not need to be seen on a weekly basis, the psychiatrist shall help to identify any barriers to discharge and communicate with the BHSD 24-Hour Care Unit.

b. Document medically necessary criteria requiring a client to be kept in the locked facility.

c. Document any clinical rationale in the chart, shall there be disagreement with BHSD assessment that a client is ready for discharge.

d. Follow the BHSD’s medication monitoring guidelines in client care.

e. Limit the use of poly-pharmacy, which is defined as the use of two (2) or more anti-psychotics or the use of five (5) or more psychotropic medications, excluding dyskinetic agents. Clinical exceptions to poly-pharmacy must be clearly documented in client charts.

6. Offeror shall work closely with clients, County staff, conservators, and family members, if appropriate, to ensure that clients continue to receive services at the appropriate level of care and in the least restrictive setting.

7. Monthly discharge planning meetings shall be held to discuss 1) clients who have reached their length of stay and 2) clients who are ready for discharge to lower levels of care in the community.

8. Bed Holds are granted up to three (3) days if the client is required to leave the facility for acute medical or psychiatric services. All bed holds require prior authorization from the 24-Hour Care Unit. The Offeror is expected to inform the 24-Hour Care Unit staff immediately if the bed hold period is beyond the three (3) day timeframe. The 24-Hour Care Unit shall not be responsible for payment beyond the three (3) day bed hold period without prior authorization. Offeror is expected to accept the client back to the facility within the three (3) day bed hold period if the client is deemed appropriate to return.

G. Program Hours of Operations

1. Offeror shall be available twenty-four (24) hours, seven (7) days a week, 365 days a year to address any client emergency needs.

H. Evaluations, Transitional Planning, and Discharge

1. At the time of a client’s admission into the program, the BHSD designated staff shall specify discharge readiness criteria as part of each client’s service plan.

2. Offeror shall specify whether the client is able to manage their medical conditions independently without the intensive supervision, if transitioning to a lower level of care.

3. Offeror shall arrange case conferences with the client’s family members, conservators, outpatient case managers, and the 24-Hour Care Unit’s liaison as needed to discuss any concerns or disagreements prior to discharge.

4. Transfers of clients among facilities within a contracted corporation shall be arranged by mutual consent between Offeror and the BHSD, and with notification to, and appropriate input from, the client’s conservator, significant family members, the 24-Hour Care Unit, and specified individuals involved in the client’s treatment and support system.

5. Offeror must provide the BHSD with nursing notes, client’s records, and other the documentation supporting the rationale for discharge and details of the disposition. A completed transfer form shall accompany the client to the receiving facility.

6. Offeror shall assist the 24-Hour Care Unit, and any other BHSD designee, to ensure an orderly transfer of the client.

7. In the event of unanticipated discharge, Offeror shall, whenever possible give twenty-four (24) hours’ notice, prior to the discharge of a client to the BHSD’s designated staff, the conservator, and any other individuals applicable in the client’s treatment.

8. Clients who are discharging or transitioning to lower levels of care in the community must be linked with an outpatient service team for continued care coordination.

9. Clients who are ready for discharge to a lower level of care must be consulted with the attending physician of the facility. Any potential delay in discharges due to medication changes or client’s change of functioning level must be addressed with the treatment team within fifteen (15) days of the discharge planning process.

10. If a client’s conservatorship status becomes “voluntary” due to a lapse in an Lanterman-Petris-Short conservatorship and wishes to leave the facility without a physician’s order, the client must sign a statement acknowledging departure from the facility without a written physician order.

11. Assistance with discharges may be obtained from partner agencies, including the designated BHSD staff, Public Conservator’s Office, State Department of Mental Health, and the State Department of Welfare.

12. Upon a client’s AWOL from the facility, the Offeror must discharge the client within twenty-four (24) hours. A discharge notification must be sent to the 24-Hour Care Unit within the next two (2) working days.

13. Upon discharge or death of the client, Offeror shall refund any unused funds received by the Offeror for the client’s bill to the payor source within thirty (30) days.

14. Any money or valuable entrusted by the client to the care of the facility shall be stored in the facility and returned to the client not conserved or conservator in compliance with existing laws and regulations.

15. Offeror shall notify the 24-Hour Care Unit when a client is discharged from the facility and admitted to another Offeror’s facility within twenty-four (24) hours. All such discharges and admissions shall be authorized by the 24-Hour Care Unit and arranged by mutual consent, with family members, the BHSD, and specified individuals involved with the client’s treatment and supports.

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 B2a, Evaluation Criteria and Qualifications and submit the following supplemental information:

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

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

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

RFSQ-BHS-FY23-0225: Behavioral Health Treatment Facility Continuum of Care Page 1 of 3 ATTACHMENT A2a: Mental Health Rehabilitation Center Scope of Work