Attachment A3c.docx

ATTACHMENT A3c

CATEGORY 3: ADULT RESIDENTIAL TREATMENT FACILITIES

CATEGORY 3 - ADULT RESIDENTIAL TREATMENT FACILITIES:

ADULT TRANSITIONAL RESIDENTIAL AND MEDICATION SUPPORT SERVICES

Scope of Work Purpose A. The County of Santa Clara (County) Behavioral Health Services Department (BHSD) is seeking statements of qualifications from qualified Offerors interested in providing Adult Transitional Residential Services and Medication Support (the program) in Santa Clara County as part of the Behavioral Health Treatment Facility Continuum Care level of care. The program shall provide short-term, voluntary, structured, less restrictive, and therapeutic residential services for clients experiencing a mental health crisis. These clients often require support beyond those resources available in the community.

B. The program shall serve adults (ages 18-59) and older adults (age 60 and older) throughout the county as an alternative to hospitalization for clients presenting sub-acute psychiatric symptoms and possible co-occurring disorders (mental health and substance use) in the least restrictive environment possible to reduce involuntary hospitalizations, incarcerations, and homelessness.

C. The program shall be a community-based and lower-cost treatment option in a home-like setting, that offers safe, trauma-informed alternatives to psychiatric inpatient hospitalization or other locked facilities. Services shall follow a social rehabilitation model that integrates aspects of emergency psychiatric care, psychosocial rehab, milieu therapy, case management, and practical social work.

D. Offeror shall provide evidence-based, culturally competent, and linguistically proficient treatment services including assessment, evaluation, medication support (oral and injectable), plan development, case management/brokerage, rehabilitation, consultation/collateral services, and crisis intervention.

E. Please refer to Section V, “Certification and Facility Licensure” related to licensure and certification of facilities used for services.

I. Background Information A. California Welfare and Institution Codes (WIC) 5670-5676.5 delineate the intent of the California Legislature to develop a system of residential treatment programs in every county to provide a range of alternatives to institutional care based on principles of residential and community-based treatment. These regulations further outline the criteria for community residential treatment programs and indicate that the primary focus is the de-escalation of the crisis; stabilization; diagnostic evaluations; assessment of clients’ existing support system; and providing support to clients to design and develop their discharge plan.

A. The BHSD recognizes the importance of partnering with County-Contracted Providers (CCPs) to make behavioral health services accessible to clients with severe mental illness and co-occurring substance use treatment needs.

Target Population A. The program shall serve adults (ages 18 to 59) and older adults (age 60 and older) who are residents of Santa Clara County. Clients shall have full-scope Medi-Cal benefits based in Santa Clara County (County 43) or uninsured.

B. Clients served shall meet medical necessity criteria in accordance with all laws and regulations governing Medi-Cal and Medicare programs mandated by Federal, State, and Local statues, including but not limited to:

1. California Code of Regulations (CCR) Title 9 and Social Security Act Title XXII Regulations;

2. State of California Department of Health Care Services (DHCS) Certification Standards - https://www.dhcs.ca.gov/provgovpart/Pages/MH-Licensing.aspx; and

3. State of California Department of Social Services (CDSS) Community Care Licensing (CCL) Standards - www.cdss.ca.gov.

C. Clients served through the program shall meet the following prerequisites:

1. Diagnosed with a serious mental illness and/or with a qualifying co-occurring substance use disorder;

2. Experienced an acute psychiatric episode; and

3. Received referral from BHSD 24-Hour Care team.

D. Clients served in the program must be at risk of being in at least one (1) of the following:

1. Locked psychiatric treatment facility;

2. Emergency Psychiatric Services (EPS);

3. Correction/detention facility; and/or

4. An Institute for Mental Disease (IMD).

E. Clients served may:

1. Qualify as an immediate risk for hospitalization but does not meet California WIC, Section 5150 (Lanterman-Petris-Short Act or [LPS]) criteria;

2. Possess a history of assaultive behavior;

3. Have established patterns of relying on emergency and institutional care;

4. Utilize various services without improved outcomes; and/or

5. Experience cognitive difficulties or medical co-morbidities.

F. Clients served shall not require nursing care services and must be ambulatory and free of communicable diseases.

G. Clients simultaneously receiving Full Service Partnership Services by CCPs, who are temporarily in need of crisis residential services to prevent inpatient hospitalization, may also be eligible for the program.

II. Program Description A. Service Description

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

2. The program is an alternative to acute and sub-acute hospital and residential treatment for clients experiencing a psychiatric episode or mental health crisis. Program services shall follow a social rehabilitation model that integrates psychosocial rehabilitation, milieu therapy, and case management.

3. Services shall increase each client’s level of functioning by addressing any deficiencies that affects their ability to function at their optimal level and allow them to reside in the community with stability.

4. Program treatment and length of stay (LOS) are determined on a case-by-case basis depending upon clinical need and the guidelines set forth by the County for clients with co-occurring substance use and mental health issues.

5. BHSD requires services to be provided using a Person-Centered Care and Treatment Planning approach such as transformational care planning. Person-Centered Care refers to an understanding of each clients’ strengths, abilities, needs, and challenges, and incorporates these into a personal recovery vision.

6. Offeror shall provide services in accordance with the ordinances and resolutions of the County Board of Supervisors and applicable policies, procedures, directives, and guidelines of the County, BHSD, and County of Santa Clara Health System, including, but not limited to the BHSD Provider Manual.

7. Offeror shall ensure their organization’s service plan meets 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 Procedure Terminology (CPT) coding transition; and

f. Payment reform.

8. Offeror shall differentiate the program from institutions by creating program flexibility, individualizing treatment, and committing to the principle that no type of behavior should be excluded, while maintaining awareness of the facility’s therapeutic capacity to avoid overloading clients and staff.

B. Service Delivery

1. Offeror shall establish and maintain certification to provide Medi-Cal reimbursable services in Santa Clara County before providing and billing for Medi-Cal services to clients.

2. Services shall be provided within the average LOS of ninety (90) days as determined by Evidence-based Practices (EBPs) or Promising Practices (PPs) with the understanding additional time may be needed in special circumstances.

3. Service activities shall include assessments, evaluation, plan development, therapy, rehabilitation, collateral intervention, crisis intervention, consultation, discharge planning, and referral. Services shall be based on clients’ presenting issues, needs, and identified wellness and recovery goals. Offeror shall be responsible for arranging emergency services for clients as needed.

4. Offeror shall utilize approaches, such as the Wellness Management and Recovery Services, Copeland’s Wellness Recovery Action Plan, Adams and Grieder's Person-Centered Care and Planning, and other methods as appropriate for client needs.

5. Offeror shall create a residential community/setting that places an expectation on the client to participate in the day-to-day activities of running a household, practice basic living skills of budgeting, meal preparation, household chores, and social/interpersonal skills, even when distracted by personal or external crises.

6. Offeror shall involve clients in creating their own treatment plans, defining their immediate and long-term goals, and deciding how those goals shall be met. Program staff shall assist clients in defining tangible and realistic steps to build necessary client skills, overcome personal fears in meeting their goals within a specific timeframe, and begin to build increments of success over time.

C. Medication Support Services

1. Offeror shall assist clients in understanding the role of medication in their recovery plan, explain the range of medication choices, and provide education on possible side effects and how to manage them.

2. Offeror shall obtain clients’ informed consent to take medication, and address concerns and questions quickly and proactively to increase self-responsibility for medication management.

3. Offeror shall make sure medication requirements are in accordance with, but not limited to, those described in the State of California, Manual of Policies and Procedures, CCL Title 22, Division 6, Chapter 2.

4. The medical and psychiatric policies and practices of the program shall be in writing and shall include, but not be limited to:

a. Monitoring of medications;

b. Screening for medical complications;

c. Client education;

d. Entries in clients’ case record; and

e. Provision for central storage of medications.

D. Staffing Requirements

1. 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).

2. Offeror shall recruit staff (including staff with lived experience or in recovery) that bring a wide range of experience and perspective, comfortable with clients in psychiatric distress, and can skillfully function in an open, rather than clinical, environment.

3. Psychiatrist(s) shall be onsite to provide medication support services to clients, including on-call availability to deal with emergencies 24/7.

4. Addiction Counselor(s) shall administer assessments addressing any substance abuse concerns for clients served through this program.

5. All staff working directly with clients shall be a Certified Advanced Alcohol and Drug Counselor (CAADC) II.

6. All staff shall abide by the following staffing requirements:

a. Have knowledge and skills in confidentiality and principles of psychosocial rehabilitation and recovery processes;

b. Understand psychopathology and physical health problems within the context of client age range, cultural influences, and language needs;

c. Serve specialized ethnic and cultural populations and regions based on County needs. Preference for qualification shall include Offerors indicating available program language capacity for County threshold language, especially in Spanish and Vietnamese, with treatment and recovery staff designated as bilingual in these two languages.

d. Demonstrate knowledge of local community resources available to the diverse population, including services available through self-help centers, ethnic community resources, social services, and housing services; and

e. Have the ability to collaborate and coordinate with local providers of health and human services.

7. Staffing shall be provided at the minimum licensing requirements as set forth in Title 9, Title 19, and Title 22 of Medi-Cal regulations.

8. Offeror shall notify the County of all staffing changes within fourteen (14) days of occurrence and provide a year-end staffing report.

E. Cultural Competency

1. Offeror shall submit a complete and updated list of staff’s cultural, gender, and language specific competencies, per Appendix G, Cultural Competence Form.

2. 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.

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

4. 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.

5. Offeror’s organization shall provide outreach activities focused on reaching underserved, underrepresented, and/or multicultural populations.

F. Referrals and Admissions

1. Offeror shall accept referrals generated through BHSD 24-Hour Care team, including, but not limited to:

a. Priority access shall be given to clients whose immediate admission will prevent inpatient hospitalization;

b. All clients authorized for the program shall be informed by their case manager the service is time-limited and based on service needs as determined by the treatment team and authorized by the 24-Hour Care team; and/or

c. Identification of potential candidates through other providers of services, such as the Mental Health Substance Use Treatment and/or any other organization.

2. Client referrals may result from any of the following:

a. Discharge from an acute inpatient care facility, IMD, or EPS;

b. Outpatient Services;

c. Any CCPs;

d. Screenings by the Integrated Urgent Care Center for Medi-Cal beneficiaries;

e. Referrals from other counties for clients whose benefits are associated with Santa Clara County (County 43); and/or

f. BHSD Call Center.

3. Offeror shall abide by Level of Care Policy and Procedure #412-330, which indicates the integrated 24-Hour Care team may refer clients regardless of language and cultural focus in instances where the need for this specific language or cultural focus is required.

4. All clients placed within the program shall be authorized by the 24-Hour Care team before placement occurs.

G. Care Coordination

1. Offeror shall work collaboratively with the conservators, family members, and other providers to help clients transition from the program as soon as feasible.

H. Program Hours of Operations

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

2. Offeror shall provide an updated agency plan for 24/7 coverage to the AOA Division Director and BHSD Program Monitor at the beginning of each new fiscal year and when any changes to this plan occur for approval prior to implementation.

I. Evaluations, Transitional Planning, and Discharge

1. Client Evaluations

a. Offeror shall complete a client assessment and plan development of all client referrals within twenty-four (24) hours of admission. Based on assessment results, clients shall be supported in building on the strengths of recovery in partnership with the treatment team, family, and/or other supports.

2. Discharge

a. Offeror shall discharge clients according to BHSD Utilization Management (UM) discharge criteria for this level of care.

b. Offeror shall discharge clients upon improvement of symptoms and level of functioning to enable them to progress to a less restrictive community-based outpatient service and/or other levels of care.

3. Client Transition Plan

a. Offeror shall ensure that appropriate follow-up or other service linkages and placements are made.

b. Offeror shall coordinate with new service provider to assure an understanding of clients’ strengths, needs, supports, and goals.

c. Offeror shall provide copies of the care plan, narrative summary, assessment information, psychiatric assessment, and medication orders to the new service provider.

d. Offeror shall arrange a visit to the new program location with the current service provider to meet, tour the facility, and provide a warm hand-off.

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

Goals shall include, but are not limited to:

Serve as an alternative to acute inpatient hospitalizations (e.g., EPS, Barbara Arons Pavilion, Emergency Department [ED], and community hospitals) and other locked facilities.

Accurately assess co-occurring mental health disorders in seriously mentally ill (SMI) adults and older adults who require specialized services due to complex risk factors (e.g., abuse/violence, homelessness, substance use, psychological trauma).

Improve psychological functioning of clients using a strength-based recovery model to stabilize symptoms and return to community-based services.

Facilitate wellness and recovery services and reduce clients’ subjective suffering from mental illness and complex life stressors unique to them.

Facilitate the increase of meaningful use of clients’ time and capabilities in school, work, and age-appropriate activities to support a sense of connection and self-worth.

Educate clients, families, and significant others about mental illness and how to manage/cope with their mental illness using the principles of recovery and wellness.

Facilitate transitions to a less intensive level of care and assist clients’ return to the community.

Offeror shall empower clients in assuming responsibility and accountability for their wellness and recovery to reduce unnecessary stays in psychiatric hospitals and emergency room visits while producing similar outcomes to those in institutional care.

Objectives shall be achieved by the following:

a. Create and maintain a therapeutic residential community/setting that places an expectation on clients to participate in the day-to-day activities, practice basic living skills of budgeting, meal preparation and housework, and social/interpersonal skills (even when distracted by personal or external crises).

b. Provide time-limited services (within ninety [90] days) for each client through age-appropriate care coordination as the single point of responsibility for services.

c. Address and participate in therapeutic activities, assessments, and/or linkage services to facilitate the reduction of each client’s psychiatric inpatient admissions, including EPS and ED encounters.

d. Provide and facilitate psycho-educational sessions to increase clients’ understanding of the importance of medication compliance and effectiveness.

e. Improve client access to medical and dental healthcare.

f. Encourage clients to actively participate in their recovery and self-monitor their milestones and goals toward self-determination, family and vocational education, and recreation services.

g. Successfully link clients to outpatient services before discharge.

III. Certification and Facility Licensure A. Offeror shall meet the following certification requirements:

1. State of California Department of Health Care Services (DHCS), meeting California WIC Code Division 4, Part 1 Chapter 3, Article 4, Division 5, Part 2, Chapter 2.5, Article 1, Sections 5670 through 5676.5;

2. California Code of Regulations (CCR) Title 9, Subchapter 3, Article 3.5, Section 531 through 535.

3. Licensed as a Social Rehabilitation Facility or Community Care Facility by the Department of Public Social Services, Community Licensing Division (CCR Title 22, Division 6, and Chapter 2, “Social Rehabilitation Facilities”).

B. Allow for immediate provision of services, the County shall prioritize qualification of Offerors who meet either of the following:

1. Offerors with an existing residential facility; or

2. Offerors with a rental agreement/lease letter of intent.

a. Letter shall demonstrate their organization is in the process of securing a facility.

b. Provide a specific timeframe for beginning services.

C. Due to the time sensitive nature of program services:

1. The site must qualify for all applicable and appropriate licensing requirements (e.g., California Community Care Licensing) required to provide services;

2. The proposed facility shall be appropriately zoned; and

3. Facility access must comply with the DHCS requirements related to the Americans with Disabilities Act.

IV. Reporting and Data Collection Requirements A. Offeror shall comply with all reporting requirements, including but not limited to:

1. California WIC, Divisions 1 and 5; and

2. CCR Title 9 (State Department of Mental Health Social Rehabilitation and Medi-Cal Rehabilitation Option), Title 19 (Public Safety), and Title 22 (Community Care Licensing).

B. Offeror shall track extension requests on spreadsheets and provide justifications for those extensions in order to assist in determining areas of service improvements.

C. When applicable, Offeror shall administer assessment tools as part of the County’s program requirements.

D. The following data shall be entered into the County’s electronic health record (HER) system for outcomes data reporting:

1. Treatment and service data;

2. Client demographic information;

3. Direct and outreach services; and

4. Other appropriate data as requested by the BHSD.

E. When applicable, Offeror shall initiate other data collection methods, which may include, but shall not be limited to, entering data into a database as specified by the County and electronic submission of data to the County using other formats such as Microsoft Excel.

F. Offeror shall detail the organization’s ability to use their current 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 EHR Status. Offeror shall describe how their organization shall use the County’s myAvatar system for the following tasks:

1. PCE with 837 billing;

2. PCNX with 837 billing;

3. PCNX non-837 billing with fast service entry claims submission; or

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

G. All client demographic information, service, and other appropriate data shall be entered into the County’s EHR system.

H. Offeror shall follow the County’s data reporting requirements. Methods may include the following data reporting collection:

1. Offeror shall provide monthly data that shows the number of clients referred for crisis services, the number of referred clients that received crisis services, the type of services provided, the number and type of linkage referrals, and other resources provided to the clients.

2. Offeror shall follow the County’s data reporting requirements. Methods may include the following data reporting collection:

a. Track the number of referrals where clients received crisis services and interventions, monthly;

b. Track the number of crisis diversions from County partners or alternative resources, quarterly;

c. Track the number and type of clients served by region, quarterly;

d. Track Milestones of Recovery Scale (MORS) for target population;

e. Track number of extensions using spreadsheets.

f. Track the number of readmissions to program within thirty (30) days of discharge from program using spreadsheets; and

g. Track the rate of readmission and cost-saving from non-emergency settings and non-psychiatric hospitalization for clients served.

3. Offeror shall describe available data reporting methods and experience with providing monthly and annual reviews from the following data sources:

a. Individual and Service Information (CSI) system;

b. Data Collection and Reporting (DCR) data; and

c. County EHR data.

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

1. Use evidence-based assessment/tracking tools that monitor clients’ goals and recovery;

2. Demonstrate ability to successfully discharge clients back to community outpatient services or other lower levels of care;

3. Improve functioning as defined through MORS score;

4. Track positive clients service experience as evidenced by a decrease in EPS, ED, and acute psychiatric inpatient contacts;

5. Eighty percent (80%) of clients shall successfully complete the program and be discharged to a lower level of care within the average LOS;

6. Fifty percent (50%) of clients shall attain a sixty percent (60%) decrease in re-hospitalizations in the ninety (90) day period after participating in the program; and

7. Reduce clients’ LOS in locked facilities (psychiatric inpatient, IMDs, correctional settings, and other related facilities) which shall decrease cost and result in better long-term community stability.

B. Offeror shall achieve the following outcome measurement methods:

1. In collaboration with the BHSD, develop a well-defined referral and coordination procedure and decide which data shall be shared for evaluation purposes;

2. Offeror shall submit for review and approval an annual Quality Improvement Plan (QIP) as set forth by the BHSD;

3. Offeror shall assess performance targets, metrics, and improvement objectives, and address needed improvements in the QIP; and

4. Offeror shall submit a report demonstrating program performance. The report shall include run charts demonstrating monthly performance and discussion of improvement activities related to the targeted performance category.

VI. 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 B3c, 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 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: Residential Treatment Facility Continuum of Care Page 1 of 13 ATTACHMENT A3c: Adult Transitional Residential Services and Medication Support Scope of Work