Attachment A3a.docx

ATTACHMENT A3a

CATEGORY 3: ADULT RESIDENTIAL TREATMENT FACILITIES

CATEGORY 3 - ADULT RESIDENTIAL TREATMENT FACILITIES:

ADULT RESIDENTIAL TREATMENT SERVICES

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 operating and providing behavioral health Adult Residential Treatment (ART) Services adults (ages 18 years and above) diagnosed with Severe Mental Illness (SMI).

ART Services shall be provided to SMI clients whose level of functioning, symptoms, and psychiatric history necessitate service interventions for maintenance in community settings. This may include clients who suffer from an “institutionalized” syndrome, including increased passivity, lack of confidence, and lack of knowledge about the community.

ART Services shall provide a homelike and therapeutic environment for clients who are experiencing behavioral health challenges. The emphasis of ART services shall be on rehabilitation, which include focusing on maximizing each client’s level of functioning in the community by building cognitive, emotional, and behavioral skills.

Offerors that would operate and provide ART Services shall be licensed, certified, and Medi-Cal billable treatment environments. Offeror must establish and maintain certification through the County to provide Medi-Cal reimbursable services (“Medi-Cal Certification”) before providing and billing for Medi-Cal services to clients. Offeror shall serve clients, within Offeror resources, in compliance with the BHSD policies, procedures, directives, and guidelines. All clients authorized for services shall be informed that the services provided in this setting is time limited and is based on service needs, as determined by the BHSD 24-Hour Care Unit.

I. Background Information A. ART services include housing, medication, behavioral health treatment, and social support for SMI clients who are ready to transition from treatment centers (e.g., Institutions for Mental Diseases [IMD], Mental Health Rehabilitation Centers [MHRC], other acute inpatient psychiatric hospitals, etc.) to a lower level of care. Upon discharge, the step-down placement shall support the client’s stabilization, facilitate the transition to community services, and provide rehabilitative treatment services in a non-institutional and therapeutic community setting for clients at risk of (re)hospitalization or (re)institutional placements.

B. ART services must be based on the values and principles of the Mental Health Services Act (MHSA) Recovery Model of Care and Social Rehabilitation Model for clients without occurring substance use disorders. Under these models, services shall focus on the following:

a. Empowering clients;

b. Reducing symptoms;

c. Reducing barriers to self-sufficiency in the community;

d. Maximizing client’s engagement in treatment;

e. Improving the quality of life;

f. Maximizing family/support persons’ participation in the recovery plan; and

g. Instilling hope for long-term recovery.

C. ART Services shall gear towards assisting clients in developing socially responsible behaviors, independent living, and coping skills to address their behavioral health and medical conditions.

Target Population A. ART Services shall serve adult (ages 18-59) and older adult (ages 60 and older) residents of Santa Clara County who are ambulatory and able to transfer independently, and have the following conditions:

1. Diagnosed as SMI: This diagnostic spectrum includes psychotic disorders (e.g., schizophrenia, bipolar disorder, major depression, post-traumatic stress disorder, etc.) and may include a secondary diagnosis of substance use or developmental disability;

2. Dually diagnosed with behavioral/social impairments, poor self-regulation skills, thought disorders, or medical complexities that prevent independent living, which may include:

a. Cognitive difficulties and medical co-morbidities who require close supervision;

b. A history of assaultive behavior, poor engagement in treatment services, and/or severe functional impairments that meet the requirement for an unlicensed or unsupervised level of care; and/or

c. Chronic illness with behaviors that may require short term 1:1 supervision due to a history of wandering or non-medication compliance.

3. Deemed safe to be diverted to a less restrictive level of care, but still require a 24-hour supervised setting;

4. Considered high-risk, with a high utilization rate of emergency or locked psychiatric settings with limited successes in the community;

5. Transitioning from locked psychiatric settings into a less intense supervision setting;

6. Require Assistance with Daily Living (ADL) care, hygiene/grooming, supportive behavioral interventions, medication management, and/or some level of nursing care;

7. Receive Supplemental Security Income (SSI) benefits that pay for basic board-and-care costs;

8. May have Medi-Cal, Medicare, or be unsponsored;

9. May benefit from structured activities that gear towards rehabilitation; and/or

10. History with the County’s inpatient acute psychiatric hospital or other acute hospitals that have effective recovery and rehabilitative options when supplemental services are available.

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

Goals shall include, but may not be limited to:

Provide a supportive environment (i.e., board and care facilities with specialized behavioral and social treatment programs). ART Services’ rehabilitation shall focus on maximizing a client’s level of functioning with the following goals:

1) Provide a homelike and therapeutic environment for clients who are experiencing medical and behavioral health challenges;

2) Motivate clients to move towards self-restoration in their physical, mental, and spiritual health;

3) Empower clients by involving them in taking part in their own treatment programs;

4) Improve and build upon each client’s social and family relationships;

5) Improve each client’s socially responsible behaviors, independent living skills, and coping skills to address their mental illness and medical conditions;

6) Improve each client’s self-sufficiency through the development of a recovery plan that secures housing, food, clothing, and stable funding; and

7) Increase the client’s understanding of the importance of medication adherence.

Clients are expected to progress from intensive psychiatric behavior interventions to functioning independently in the least restrictive setting. This level of service is also designed to divert clients from higher levels of care into the least restrictive setting with the following ART program goals:

8) Provide an alternative to utilization of state hospital days and acute hospital administrative days, effectively managing limited County resources;

9) Prevent or decrease the rate of decompensation, thus reducing placements at higher, more costly levels of care;

10) Prevent the need for client re-hospitalization into acute psychiatric or medical facilities and criminal incarceration;

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

12) Improve access to medical and dental healthcare, and successfully link clients to outpatient services before discharge; and

13) Prevent and/or reduce the homelessness rate of clients suffering from mental health and substance use challenges.

Objectives shall be achieved by the following:

a. Offeror shall promote behavioral health services that have a recovery and wellness model within a supervised and supportive residential program. Services shall implement a wellness program with the goal to reduce incidences of co-morbid diseases (e.g., obesity, diabetes, high blood pressure, etc.). Services provided in this residential setting shall include, but are not limited to, assessment, evaluation, plan development, rehabilitation services, and collateral treatment with the client’s support system.

b. Offeror shall utilize Evidence Based Practices (EBPs), Promising Practices (PPs), and Trauma Informed Practices whenever clinically indicated and based on each client’s diagnoses. EBPs and PPs recommended for the ART program may include the following: Motivational Interviewing (MI), Stages of Change, Cognitive Behavioral Therapy (CBT), Trauma Focused CBT (TF-CBT), Solution-Focused Brief Therapy (SFBT), Trauma Informed approaches, and integrated co-occurring disorder practices such as Integrated Dual Disorder Treatment (IDDT), and peer supports such as Wellness Recovery Action Planning as deemed appropriate for the client’s individualized treatment plan.

c. Offeror must provide a safe and structured environment that provides adequate supervision to clients who need intensive supervision. Some clients may require short term 1:1 supervision due to a history of unapproved absence from the facility.

d. Offeror must inform their clients that services are time-limited and based on clinical justification as determined by the BHSD 24-Hour Care Unit. If clients are reauthorized for services by the BHSD, Offeror must request for three (3) extensions in one (1) month increment if the client shall need to stay longer than the nine (9) month length of stay (LOS).

II. Reporting and Data Collection Requirements A. The BHSD requires an appropriate reporting system to be in place in order to evaluate and monitor contract activities (e.g., keep an accurate record of each person placed for contracted services for each day of service). All client data and services shall be maintained by the BHSD. Offeror is responsible for ensuring that the BHSD receives accurate information of all clients served within twenty-four (24) hours of each transaction.

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

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

D. Monthly meetings shall be conducted 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 the Offeror to discuss contractual and operational concerns or issues and performance outcomes. Offeror may request additional meetings with the BHSD if needed.

F. The BHSD shall conduct unannounced yearly supplemental site visits or facility reviews to ensure expectations for client care are met, or to address any complaints received.

G. Offeror shall be required to submit a Plan of Correction to the BHSD 24-Hour Care Unit within fourteen (14) business days of receiving the notice for citations or issues relating to the facility.

H. Offeror shall follow the BHSD data reporting requirements. Offeror shall become familiar with the Community Services and Supports (CSS) Evaluation Toolkit to determine the assessment measures to track, monitor and evaluate client outcomes. These reporting requirements and methods may include the following data reporting collection of:

1. Data Collection and Reporting (DCR)/Client Service Information (CSI) data; and

2. MyAvatar data.

I. Offeror shall communicate with the County of Santa Clara Health System’s Technological Solutions and Services (TSS) staff and the BHSD when data reporting issues arise.

J. The BHSD reserves the right to conduct an annual review of the program to ensure that Offeror is providing quality care to the clients. Offeror shall allow the BHSD at any given time to conduct annual reviews of the facility, review of services provided to CSI data, DCR data, and MyAvatar data submitted once contract is established.

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. Offeror shall engage in a continuous quality improvement process to reduce the rate of recidivism into the acute psychiatric and medical settings by 70%.

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

3. Offeror shall work towards transitioning at least 10% of the total census of BHSD clients to the least restrictive settings in the community within six (6) months of residing in the facility.

B. Offeror shall achieve the following outcome measurement methods:

1. Offeror shall measure the following priority program performance indicators for MHSA Programs funded by CSS to the extent possible:

Table 1: Applicable System Performance Indicators

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 provide services in a licensed board and care setting. ART Services shall also meet the facility requirements of Section 5405(a) of the Welfare and Institutions code, section 532.5 of Title 9 California Code of Regulations. Services include, but are not limited to, the following:

a. Lodging: Offeror shall provide lodging in a licensed board and care facility and use the client’s SSI or other financial benefits to cover the monthly board and care rate. The BHSD shall supplement the room and board fee for clients who are unsponsored or have no financial means to do so;

b. Food Services: Offeror shall provide clients with menus and three (3) meals a day in consultation with a dietitian when necessary. Menus shall be posted once a month in visible areas for clients to see;

c. Laundry Facilities: Offeror shall ensure access to laundry facilities and supplies for clients;

d. Phone Access: Offeror shall ensure access to phone service for the client’s use;

e. Healthcare Services: Offeror shall provide client access to meet medical and dental needs;

f. Client Activities: Offeror shall develop and provide social rehabilitation activities that are meaningful to the client’s treatment;

g. Emergency Evacuation Plan: Offeror shall develop an emergency evacuation plan in an event of an emergency;

h. Offeror shall have an orientation that includes:

1) Introduction to the facility, staff, and other residents;

2) House rules;

3) Information on client rights and responsibilities;

4) Description of scheduled activities and programs;

5) Public transportation schedules; and

6) Description of services and expected LOS.

2. Offeror shall provide groups and individual treatment that are geared towards the wellness and recovery model for the clients. The types of groups include, but are not limited to:

a. Adjunctive Therapy;

b. Process Groups;

c. Community Integration;

d. Psychoeducation;

e. Anger Management;

f. Healthy Living;

g. Mindfulness;

h. Social Skills Building;

i. Wellness Recovery Action Plan (WRAP);

j. Dialect Behavioral Therapy (DBT);

k. Therapeutic Recreation;

l. Dual Diagnosis;

m. Alcoholics Anonymous (AA)/Narcotics Anonymous (NA) Meetings;

n. Financial Management; and

o. Medication Management.

3. Offeror must provide treatment options that include, intensive outpatient (IOP), group treatment, family group treatment, or individual treatment to meet the needs of the client’s level of functioning.

4. Offeror shall collaborate with clients in developing their own treatment plans by defining their immediate and long-term goals. Offeror shall assist clients to define tangible and realistic steps based on their clinical presentation in order to build increments of success over time.

5. Offeror shall empower clients in assuming responsibility and accountability for their wellness and recovery, which in turn reduces the rate of recidivism into psychiatric hospitals and emergency room visits while producing similar outcomes to those in institutional settings.

6. Offeror shall provide individual, family, and group treatment at the site in order to increase family and social connectedness.

7. Offeror shall assist residents with medication management, provide transportation to medical appointments and/or to other activities that would benefit the client’s treatment.

8. Offeror shall obtain necessary psychiatric and medical information to monitor client’s psychiatric and medical conditions, including diabetes and hypertension.

9. Offeror shall utilize a variety of tools to assist clients with daily living skills, such as hygiene, grooming, bathing, dressing, and medication assistance.

10. Offeror shall provide health education and exercises, weekly residential council meetings, house meetings, staff meetings, and other community meetings shall be posted and visible in common areas.

11. Offeror shall provide linkages to community resources that increase integration into the community.

12. While group treatment is not required, Offeror shall encourage clients to attend at least two (2) or more groups per day with the goal of attending at least seven (7) groups per week or in accordance with each client’s treatment plan to help increase recovery awareness.

13. Offeror shall ensure that their organization’s service plan shall meet Medi-Cal/ California Advancing and Innovating 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 ensure that staff possess and maintain appropriate licenses and certificates in accordance with all statuses and regulations. Background checks, criminal records review, Department of Justice clearance, and any additional County requirements shall be obtained and maintained.

2. Offeror shall provide appropriate staff that possess the education and training to address the behaviors needs of the SMI population.

a. Staff who possess substance use treatment qualifications shall provide services to clients who are currently experiencing or have a history with substance use.

3. Offeror shall maintain appropriate staffing levels to provide necessary residential and treatment needs. Offeror staff schedules must be available for review by the BHSD.

4. Offeror shall provide staff professional development and maintain training requirements that are in accordance with the BHSD requirements, including, but not limited to SOGIE (Sexual Orientation and Gender Identity and Expression) 101 Training.

5. Offeror shall comply with licensure and all laws governing the qualifications of personnel. Offeror agrees to submit any material changes in such duties or minimum qualifications to the BHSD.

6. Offeror shall provide continuing education to all staff to proactively address client’s problematic behaviors and to minimize transfers to Emergency Psychiatric Services (EPS) and other inpatient settings.

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

8. 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 the BHSD 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. Offeror shall meet with the client within seventy-two (72) hours of admission to the facility to develop a tangible treatment plan for the client. Offeror must inform the BHSD 24-Hour Care Unit if treatment plans change throughout the course of treatment at the facility.

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

4. The BHSD may grant individual exceptions to the above admission criteria. All admissions are subject to the prior authorization process. A County Supplemental Services 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.

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

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

7. Offeror shall designate specific individuals responsible for admission authorization and admission arrangements. Offeror shall provide 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).

8. 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.

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

10. Offeror shall only receive referrals from the inpatient psychiatric settings or long-term care facilities. Any other source of referrals shall be discussed in advance with the BHSD 24-Hour Care Unit.

F. Care Coordination

1. A client’s LOS in the ART Services facility is time limited. Clients shall receive active psychiatric, medical, nursing care, and rehabilitative treatment services. Clients shall develop independent living skills and progress to a non-institutionalized setting in a timely manner.

2. Services shall meet the LOS average of twelve (12) months, with one (1) possible extension for up to twelve (12) months and must not exceed twenty-four (24) months. Additional time may be needed in special circumstances, and if so, Offeror must complete and submit the appropriate extension request form to the BHSD for review and service authorization. Offeror must provide justifications for extensions to determine service areas in need of improvement.

G. Program Hours of Operations

1. ART Services must operate twenty-four (24) hours a day, seven (7) days a week, three-hundred and sixty-five (365) days a year.

H. Evaluations, Transitional Planning, and Discharge

1. 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.

2. Offeror shall arrange meetings with the client’s family members, conservators, outpatient case managers, and the BHSD 24-Hour Care Unit as needed to discuss any concerns prior to discharge.

3. Offeror shall initiate a care coordination conference with the outpatient case manager, the BHSD 24-Hour Care Unit, family members (and if applicable, conservators) should the discharge plan be modified.

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

5. 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.

6. Assistance with discharges may be obtained from public agencies, including the BHSD, Public Conservator’s Office, and California Department of Social Services.

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

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

9. Any entrusted funds held in an account for the client shall be disbursed to the client not conserved or to the conservator (if conserved) within three (3) banking days; and/or 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 to the conservator (if conserved) in compliance with existing laws and regulations.

10. Offeror shall notify the BHSD 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 BHSD 24-Hour Care Unit and arranged by mutual consent, with family members, and specified individuals involved with client’s treatment and support.

11. If the client is unmanageable or in a crisis, the Offeror shall explore alternative treatment options to maintain the client in the facility prior to discharging the client back to the BHSD’s Acute Psychiatric or Medical Services. Such discharge shall be coordinated with the BHSD 24-Hour Care Unit in advance.

12. If a client is expected to be away from the facility for more than five (5) calendar days, Offeror shall admit the next client on the waiting list. An exception to this rule may be made with advanced notice to the BHSD’s 24-Hour Care Unit as soon as Offeror receives confirmation on the client’s condition.

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 B3a, 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 A3a: Adult Residential Treatment Services Scope of Work