Attachment A2b.docx

ATTACHMENT A2b

CATEGORY 2: SUB-ACUTE TREATMENT FACILITIES

CATEGORY 2 - SUB-ACUTE TREATMENT FACILITIES:

SKILLED NURSING FACILITY

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 serving adult and older adult residents of Santa Clara County who are dual diagnosed with a Severe Mental Illness (SMI) in combination with medical conditions that preclude them from being admitted into a basic Skilled Nursing Facility (SNF).

This level of service is also designed to reduce the utilization of acute psychiatric or medical beds by stabilizing both behavioral and medical symptoms. Clients are expected to progress from intensive psychiatric behavior interventions to functioning independently in the least restrictive setting.

This program encompasses the following six (6) Special Treatment Programs:

1. Level 1: Medical and Geriatric Psychiatric Care.

2. Level 2: Complex Medical and Geriatric Psychiatric Care.

3. Level 3: Complex Medical and Geriatric Psychiatric Care (Specialized Individual Treatment Rate)

4. Level 4: Severe Mental Health and Medical Issues.

5. Level 5: Severely Impaired Psychiatric and Medical Conditions (Neuro-behavioral Specialty).

6. Level 6: Individualized Treatment Program for Severely Impaired Mental Health and Medical Conditions.

I. Background Information A. This level of care is for difficult to place clients who may have been declined for placement at a basic Skilled Nursing Facility due to their extensive psychiatric conditions and low functioning abilities.

Target Population A. The program shall serve adult County residents (ages 18 and older) that meet the following criteria:

1. Diagnosed with a SMI; and

2. Have severe functional impairments meeting requirements for a SNF level of care.

B. Clients who may have a history of or without adequate treatment, are at risk of displaying behavioral symptoms, such as combativeness, elopement risk, suicide risk, and excessive verbal abusiveness, which preclude them from being admitted into a regular SNF.

C. 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.

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

E. 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 due to their medical and psychiatric conditions.

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

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

H. Clients whose mental illness requires a residential treatment level of care, as well as clients suffering exclusively from developmental disability, mental retardation or physical illnesses alone (without a psychiatric component) shall not be considered for admission.

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

Goals shall include, but are not limited to:

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

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

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

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

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

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

Assisting clients to maintain or improve functioning and decrease psychiatric symptoms.

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

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

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

Assisting clients in developing socially responsible behaviors, independent living skills, and coping skills to address their mental illness and medical conditions.

Objectives shall be achieved by:

a. A reduction in inpatient psychiatric admissions

b. An increase placement of clients in the least restrictive settings in the community II. Reporting and Data Collection Requirements A. County and Offeror shall implement an appropriate reporting system to evaluate and monitor contract activities. County requires an accurate record of each client placed for contracted services for each day of service. All client data and services shall be maintained by County in County BHSD Billing Application (“APPLICATION”). Offeror is responsible for making sure that County receives accurate information of all clients served within twenty-four (24) hours of each transaction.

B. Offeror shall allow the BHSD Director or designee to 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 under this AGREEMENT.

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

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

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

F. Offeror is required to send in the monthly census report to the County with BHSD 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 County’s 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 County 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 County policies, procedures, and requirements concerning the reporting of unusual occurrences and incidents.

J. Upon receiving violations 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. County reserves the right to conduct an annual review of the program to ensure that 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 70%.

3. Offeror shall engage in continuous quality improvement process to minimize incidences of aggression towards others and self-harm by 70%.

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.

5. The above measurements shall be monitored and tracked through a designated tracking process/system provided by the County.

B. Offeror shall achieve the following data submission:

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

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. Overview of Offeror Service Requirements

1. Offeror shall communicate directly with the County 24-Hour Care Unit (24-Hour Care Unit) directly for concerns relating to finance, contracts, and questions on the appropriateness of certain referrals.

2. Offeror shall provide a specific treatment protocol for clients who may have a history of aggressive or difficult to manage behaviors, may be resistant to care, non-ambulatory, and poor impulse control.

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

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 Current Procedural Terminology (CPT) coding transition; and

f. Payment reform.

C. Overview of Services

1. Offeror shall admit clients in need of 24-hour skilled nursing services and psychiatric services. These clients may have a history of or who, without adequate treatment, are at risk of displaying behavioral symptoms (e.g., combativeness, elopement risk, suicide risk, disrobing, substance or alcohol use, and/or excessive verbal abusiveness), which preclude them from being accepted and admitted into a lower-level care facility.

2. Offeror shall provide professional nursing care with licensed nursing staff, bed and board, physical therapy, occupational therapy, speech therapy, social services, medications, supplies, equipment, and other services necessary to the health of the client.

3. Offeror shall provide a structured training regimen which includes life skills training that helps foster independent living, such as activities of daily living, safety awareness, stress management, impulse control, medication management, and awareness to community resources.

4. Offeror shall provide health education and specialized treatment, such as dual diagnosed groups, individual counseling as applicable, coping skills, and other recovery interventions as needed for the recovery of the clients.

D. Description of Special Treatment Programs

1. Level 1: Medical and Geriatric Psychiatric Care. This level of care is designed to include all the basic program requirements mentioned above and include the treatment and interventions described below:

a. 24-hour skilled nursing care with registered nurses on site twenty-four (24) hours a day;

b. Pain management;

c. Tend to clients that are verbally aggressive that cause altercations and unsafe situations for self and other clients;

d. General wound care for wounds requiring daily management and transportation for hospital visits;

e. Oversight on medical self-care, including brittle diabetes, catheter care, ileostomy care, unsafe gait, and colostomy management;

f. Care for clients with advanced cardiac or lung conditions;

g. Assist with feeding due to issues with choking;

h. Psychiatric and psychological care, including support and psychotherapeutic groups;

i. Therapeutic services, such as physical, occupational, and speech therapies, including swallowing rehabilitation and complicated/traumatic orthopedic rehabilitation, psychiatric and psychological care, including support and psychotherapeutic groups;

j. Onsite or contracted dental and optometry care; and

k. Contracted pharmacy services, lab services, and radiology services.

2. Level 2: Complex Medical and Geriatric Psychiatric Care. This level of care is designed for clients who have failed placements and who need daily prompts and interventions. This level of care is designed to include all the basic program requirements and level 1 services (listed above). Clients in this level of care may have the following conditions and/or require the following additional interventions:

a. Clients with assaultive behavior;

b. Constant yelling, grunting, and shouting;

c. Clients exhibiting sexual inappropriateness and vulnerability (e.g., exposing and disrobing self);

d. Clients with extreme anxiety and depression that require constant monitoring;

e. Clients who provoke unwanted attention to themselves;

f. Impaired long term and short-term memory due to dementia or other cognitive conditions; and

g. Clients with on-going behavioral issues, who are internally preoccupied and require constant redirection and/or prompting.

3. Level 3: Complex Medical and Geriatric Psychiatric Care (Specialized Individual Treatment Rate). This level of care is designed for clients who have failed placements in lower levels of care and need daily prompts, and 1:1 supervision. This level of service must be approved by the 24-Hour Care Unit prior to admission. This level of care is designed to include all the basic program requirements and level 1-2 services (listed above). Clients in this level of care may have the following conditions and/or require the following additional interventions:

a. Provide intense 1:1 supervision for conditions, such as polydipsia, PICA, fall risk, unsafe gait, or putting other clients at risk; and

b. Clients requiring 1:1 supervision during meals due to choking hazards or disruptive behaviors.

4. Level 4: Severe Mental Health and Medical Issues. This service is designed for individuals with on-going medical issues along with psychiatric conditions that preclude them from being admitted into a basic SNF. This level of care is designed to include all the basic program requirements and level 1-3 services (listed above). Clients in this level of care may have the following conditions and/or require the following additional interventions:

a. Intensive physical, occupational and speech therapy;

b. Hospice Care; and

c. Management of psychiatric conditions by providing individualized treatment services.

5. Level 5: Severely Impaired Psychiatric and Medical Conditions (Neuro-behavioral Specialty). This level of care is specifically for clients in need of on-going 1:1 supervision. In most cases, these clients are dually diagnosed with mental health and neurological issues, developmental disabilities, or other severe medical impairments that prevent placement in a basic locked SNF. Clients in this level of care may have the following conditions and/or require the following interventions:

a. Constant yelling and screaming;

b. Clients with sexual inappropriateness and vulnerability (exposing and disrobing self);

c. Clients with PICA and polydipsia who requires 1:1 supervision;

d. Impaired long term and short-term memory (dementia);

e. On-going behavioral issues that require re-directing and constant prompting;

f. Care for clients with advanced stages of conditions such as HIV/AIDS, brittle diabetes (insulin dependent), and hepatitis;

g. Tube feeding requiring 1:1 supervision;

h. Stage I and II skin care ulcers;

i. Intensive physical, occupational, and speech therapy;

j. Neurological diagnosis (e.g., Parkinson’s disease, Huntington’s disease, muscular degenerative conditions, developmental disability, seizure disorder, HIV dementia, and medically compromised debilitated individuals that require a locked placement);

k. 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; and

l. This program shall be designed to address the unique needs of the hearing impaired who also suffer from a chronic mental illness.

6. Level 6: Individualized Treatment Program Designed for Severely Impaired Mental Health and Medical Conditions. This level of care of supplemental care is designed for patients who have failed community placements, who need daily prompts and intense supervision due to severe psychiatric and medical conditions. The following conditions are included in this level of service:

a. Patients with assaultive behavior;

b. Patients with PICA and polydipsia who requires 1:1 supervision;

c. Constant yelling and screaming;

d. Patients with sexual inappropriateness and vulnerable (exposing and disrobing self);

e. Impaired long term and short-term memory (dementia);

f. On-going behavioral issues that need re-directing and constant prompting;

g. Care for patients with advanced stages of conditions such as HIV/AIDS, brittle diabetes (insulin dependent), and hepatitis;

h. G-Tube feeding requiring 1:1 supervision;

i. Stage I and II skin care ulcers;

j. More intense Physical, Occupational, and Speech Therapy than Level 1;

k. Neurological diagnosis (e.g., Parkinson’s disease, Huntington’s Disease, muscular degenerative conditions, developmental disability, seizure disorder, HIV dementia and medically compromised debilitated individuals that require a locked placement);

l. Parkinson’s Disease and Huntington’s disease;

m. Patients 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 patient, other patients, or staff; and

n. For Offerors who specializes in services for patients who are deaf, hard of hearing, and/or blind: the program shall be designed to address the unique needs of the hearing impaired who also suffer from a chronic mental illness.

E. 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. Skilled nursing staff shall possess and maintain appropriate licenses and certificates in accordance with all statuses and regulations. Background checks, criminal records review, Department of Justice (DOJ) clearance, etc. shall be obtained and maintained in accordance with County rules and regulations.

3. Staffing 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. Offeror shall document staff recruitment and outreach strategies.

4. Staff schedules and staffing levels need to be appropriate to provide necessary residential and treatment needs. Employee schedules shall be made available for review by BHSD staff upon request.

5. Offeror shall provide professional development and training requirements that are in accordance with BHSD standards.

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

7. Upon request, Offeror shall submit to the County Contract Administration an organizational chart, which reflects the contracted facility’s/facilities’ current operating structure.

8. 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.

9. Offeror shall follow licensure and regulations governing the qualifications of staff. Offeror agrees to submit any material changes in such duties or minimum qualifications to the County.

10. 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.

11. Offeror shall engage in a continuous quality improvement process to minimize any incidences of client aggression directed towards other clients and staff.

12. 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).

F. 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.

G. Referrals and Admissions

1. Offeror shall work closely with County 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. At the time of admission, County designated staff shall specify discharge readiness criteria for each client’s service plan.

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

a. County’s prior authorization form must be completed 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 County.

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

d. 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).

e. Offeror shall assess the clients based on their current behavior and symptoms dating back to no more than thirty (30) days. Denial of referrals based on the client’s history exceeding thirty (30) days must be discussed with the 24-Hour Care Unit or the referring provider prior to excluding the referral indefinitely.

H. Care Coordination

1. Median 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.

2. Clients shall receive active psychiatric, medical, nursing care, and rehabilitative treatment services and be supported to develop independent living skills and progress to a non-institutionalized setting in a timely manner as each client’s length of stay in the program is time limited.

3. 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.

4. Monthly discharge planning meetings shall be held to discuss clients who have reached their length of stay in addition to clients who are ready for discharge to lower levels of care in the community. 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.

5. Offeror’s psychiatrist shall 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 24-Hour Care Unit.

6. Offeror’s psychiatrist shall document medically necessary criteria requiring a client to be kept in the locked facility.

7. Offeror’s psychiatrists 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.

8. If Offeror’s psychiatrist disagrees with the assessment of the 24-Hour Care Unit that a client is ready for discharge, the psychiatrist must document his/her clinical rationale in the chart.

9. Offeror’s psychiatrists shall follow the BHSD’s medication monitoring guidelines.

10. Offeror’s psychiatrists shall 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 this must be clearly documented.

11. Bed Holds are granted up to seven (7) 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 shall inform the 24-Hour Care Unit staff immediately if the bed hold period is beyond the seven (7) day time frame. The 24-Hour Care Unit shall not be responsible for payment beyond the seven (7) day bed hold period without prior authorization. Offeror shall accept the client back to the facility within the seven (7) day bed hold period if the client is deemed appropriate to return.

I. 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.

J. Evaluations, Transitional Planning, and Discharge

1. Offeror and County shall mutually agree on Client transfer and discharge arrangements among facilities within a contracted corporation. Offeror shall provide notification to, and appropriate input from, the following:

a. Client’s conservator and significant family members;

b. BHSD 24-Hour Care Unit staff; and

c. Additional specified individuals involved in the client’s treatment and support system.

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

3. Offeror must provide County 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.

4. Offeror shall specify whether the client is able to manage his or her medical conditions independently without the intensive supervision if transitioning to a lower level of care.

5. 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.

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

7. 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.

8. 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.

9. If a client’s conservatorship status becomes “voluntary” due to a lapse in a 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.

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

11. 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.

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

13. 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.

14. Offeror shall notify the 24-Hour Care Unit when a client is discharged from the facility and admitted to another 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, County, and specified individuals involved with 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 B2b, 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 A2b: Skilled Nursing Facility Scope of Work