Attachment A3d.pdf

ATTACHMENT A3d

CATEGORY 3: ADULT RESIDENTIAL TREATMENT FACILITIES

RFSQ-BHS-FY23-0225: Behavioral Health Treatment Facility Continuum of Care Page 1 of 12 ATTACHMENT A3d: Substance Use Residential Treatment Services Scope of Work

CATEGORY 3 - ADULT RESIDENTIAL TREATMENT FACILITIES:

SUBSTANCE USE RESIDENTIAL TREATMENT SERVICES

Scope of Work I. Purpose

A. The County of Santa Clara (County) Behavioral Health Services Department (BHSD) is seeking statements of qualifications from qualified Offerors interested in providing residential substance use treatment services for adults.

B. Consistent with American Society of Addiction Medicine (ASAM) Criteria and federal Substance Abuse and Mental Health Services Administration (SAMHSA) best practices, and longstanding County of Santa Clara Substance Use Treatment Services (SUTS) program practice, Offerors must be Dual Diagnosis Capable (DDC), meaning that they can address the relationship between the mental and substance-related disorders and their effect on the client’s readiness to change, as well as relapse and recovery environmental issues, through individual and group program content.

C. Offeror shall be required to meet the ASAM 3.1, 3.3, and 3.5 Residential Treatment Services per Drug Medi-Cal Organized Delivery System (DMC-ODS) requirements. If not DMC-ODS certified, Offeror must obtain certification within six (6) months upon addition in the qualifying pool (QP).

II. Background Information

A. The mission of the County is to plan for the needs of a dynamic community, provide quality services, and promote a healthy, safe, and prosperous community for all. BHSD is part of the County of Santa Clara Health System (Health System) whose vision is “Better Health for All”. The BHSD seeks to fulfill this mission by providing services that improve the quality of life for County residents.

B. The County contracts with County-contracted Providers (CCPs) who provide residential SUTS program services to Santa Clara County residents. CCPs provide culturally competent residential treatment services to treat clients and their families who are experiencing difficulty functioning personally, in their relationships and environments.

The purpose of services is to provide improved clinical and functional outcomes for adults with substance use diagnoses.

C. The BHSD adheres to the Health System principles of care included in the County strategic roadmap. All BHSD services must align with the core objectives of the strategic plan:

1. Increasing healthy lifespan;

2. Improving customer experience and services;

3. Reducing the burden of illness;

4. Providing seamless coordination of care;

5. Improving training, retention, and recruitment of staff; and

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6. Reducing redundancies, delays, and cost of care.

III. Target Population

A. Offeror shall provide levels of residential care to both male, female, transgender, gender-fluid and non-binary clients.

B. The population to be served is adult County residents (ages eighteen [18] and older) in need of substance use treatment and/or Dual Diagnosis Capable (DDC) residential services.

C. QP preference shall be given to Offerors with staff/language capability that includes Spanish, Vietnamese, Mandarin, and Tagalog.

D. Offeror shall demonstrate knowledge of specialized populations for which they are bidding. Target populations include the following:

1. Adults with substance use disorders;

2. Adults with co-occurring disorders; and

3. Adults that are justice-involved.

IV. 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. Offeror shall utilize the American Society of Addiction Medicine (ASAM) criteria for residential levels (3.1, 3.3 and 3.5) of care, have the capability to utilize credentialed staff with appropriate ASAM training, and provide treatment informed by DMC-ODS evidence-based program requirements. Offeror shall utilize the ASAM Criteria to determine placement into the appropriate level of care for all clients. The County of Santa Clara uses the Authorization for Level of Care (ALOC) form for determining the level of care needs. The ALOC is a brief assessment utilizing the ASAM guidelines.

The County shall use the ALOC to indicate information needed for placement, however, offerors can use their own forms if they contain the same information as the County ALOC form. Clients sent for placement shall have an initial authorization for up to three days for ASAM 3.1 level of care, clinically managed low-intensity residential. If the initial authorization period includes a holiday or weekend, it shall be authorized for additional days. Offeror shall send all information via a secure email to SUTSAUTHORIZATION@hhs.sccgov.org. If a secure email is needed, please send an email with no PHI and the SUTS UM shall return an email with SCCSECURE in the description, which shall allow for encrypted email communication.

3. Offeror shall provide the following deliverables as part 3.1, 3.3 and 3.5 ASAM levels of service:

a. These levels of care rely on the treatment community as a therapeutic agent.

mailto:SUTSAUTHORIZATION@hhs.sccgov.org

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Care is provided twenty-four (24) hours a day. The focus of treatment is to stabilize the client on any bio-psycho-social ASAM dimension that is assessed as medium to high severity. Due to use of alcohol and/or drugs, client may have impaired judgment that leave them vulnerable to continued use outside of a structured environment.

b. ASAM Level 3.1 (Clinically Managed Low Intensity) Requirements:

i. At this level, the client shall need time and structure in a supportive living environment to practice and integrate their recovery and coping skills. The client could be in the pre-contemplation stage of change. These adults could have symptoms and impairments that cause significant interference with treatment, but do not present an immediate threat to safety nor prevent independent functioning.

ii. The primary goal of this level of residential treatment shall be to engage and stabilize the client.

iii. The client’s length of time in treatment shall be based on individual clinical needs.

iv. This level of care provides a structured recovery environment, staffed twenty-four (24) hours a day, and offers at least twenty (20) hours per week of low intensity treatment focused on applying recovery skills, preventing relapse, improving emotional functioning, and promoting personal responsibility.

v. Services may include individual, group, and family therapy; medication management; and medication education.

vi. Interpersonal and group living skills are promoted through community or house meetings of residents and staff.

vii. Mutual self-help meetings are usually available on site or easily accessible in the community.

c. ASAM Level 3.3 (Clinically Managed Population-Specific High-Intensity Residential Programs)

i. This gradation of residential treatment is specifically designed for specific population of adult patients with significant cognitive impairments resulting from substance use or other co-occurring disorders.

ii. This level of care is appropriate when a client’s temporary or permanent cognitive limitations make it unlikely for them to benefit from other residential levels of care that offer group therapy and other cognitive-based relapse prevention strategies. These cognitive impairments may be seen in clients who suffer from an organic brain syndrome as a result of substance use, who suffer from chronic brain syndrome, who have experienced a traumatic brain injury, who have developmental disabilities, or are older

RFSQ-BHS-FY23-0225: Behavioral Health Treatment Facility Continuum of Care Page 4 of 12 adults with age and substance-related cognitive limitations.

iii. Clients with temporary limitations receive slower paced, repetitive treatment until the impairment subsides and they are able to progress onto another level of care appropriate for their SUD treatment needs.

iv. Services are often provided in a structured, therapeutic rehabilitation facility and traumatic brain injury programs located within a community setting, or in specialty units located within licensed healthcare facilities where high-intensity clinical services are provided in a manner that meets the functional limitations of patients. Such programs have direct affiliation with more or less intensive levels of care as well as supportive services related to employment, literacy training and adult education.

v. Physicians, physician extenders, and appropriate credentialed mental health professionals lead treatment. On-site twenty (24)-hour allied health professional staff supervise the residential component with access to clinicians competent in SUD treatment. Clinical staff knowledgeable about biological and psychosocial dimensions of SUD and psychiatric conditions who have specialized training in behavior management support care.

Patients have access to additional medical, laboratory, toxicology, psychiatric and psychological services through consultations and referrals.

vi. Specialized services are provided at a slower pace and in a repetitive manner to overcome comprehension and coping challenges. This level of care is appropriate until the cognitive impairment subsides, enabling the client to engage in motivational relapse prevention strategies delivered in other levels of care. Level 3.3 clinically managed population-specific high-intensity residential services shall be provided in a deliberately repetitive fashion to address the special needs of clients for whom a Level 3.3 program is considered medically necessary. Daily clinical services designed to improve the client’s ability to structure and organize the tasks of daily living and recovery, to stabilize and maintain the stability of the client’s substance use disorder symptoms, and to help them develop and apply recovery skills are provided. The skilled treatment services include a range of cognitive, behavioral and other therapies administered on an individual and group basis; medication management and medication education; counseling and clinical monitoring; educational groups; occupational and recreational therapies; art, music or movement therapies; physical therapy; clinical and didactic motivational interventions; and related services directed exclusively toward the benefit of the Medicaid-eligible individual.

d. ASAM Level 3.5 (Clinically Managed Medium Intensity Residential Services) Requirements:

i. This level of care assists clients whose substance use and functional limitations are such that they cannot safely be treated outside of a 24-hour

RFSQ-BHS-FY23-0225: Behavioral Health Treatment Facility Continuum of Care Page 5 of 12 stable living environment that promotes recovery skill development and deters relapse. Their multidimensional needs are of such severity that they cannot safely be treated in less intensive levels of care.

ii. This level of care is characterized by their reliance on the treatment community as a therapeutic agent.

iii. The goals of treatment at this level are to promote abstinence from substance use and to arrest other addictive and maladaptive behaviors.

iv. Generally, they can be characterized as having unhealthy, non-supportive, and often abusive interpersonal relationships; extensive treatment or juvenile justice histories; and limited educational experiences.

v. The focus of treatment is on stabilization of dangerous patterns of substance use, and preparation for ongoing recovery in the broad continuum of care.

vi. Services may include individual, group, and family therapy; medication management; and medication education.

vii. Interpersonal and group living skills are promoted through house meetings of residents and staff.

4. Offeror shall incorporate SAMHSA best practices, and state and national best practices for client treatment.

5. Offeror shall provide individual and group content and be DDC to address the relationship between mental and substance-related disorders and their effect on the client’s readiness to change, as well as relapse and recovery environmental issues.

6. Offeror shall provide thorough information about treatment, including comprehensive summaries and treatment goals to the client’s team of providers (e.g., including those outside the residential facility) which shall include the client’s psychiatrist, primary care physician, outpatient provider and system providers.

Regular ongoing communication and consultation shall allow for the smooth transition of services from residential treatment to outpatient services.

7. Offeror shall provide weekly updates to BHSD’s designated staff, regarding client’s estimated length of stay at the residential facility upon initial assessment, within one week of admission, and on an-ongoing basis upon progress in treatment.

8. Offeror shall immediately (within twenty-four [24] hours) report any changes in the client’s medical or mental health condition requiring higher level of care including medical or psychiatric hospitalization, behavioral incidents, and elopement from the facility to the BHSD's designated staff.

9. 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 Health System, including, but not limited to the BHSD Offeror Manual and/or the BHSD policies and

RFSQ-BHS-FY23-0225: Behavioral Health Treatment Facility Continuum of Care Page 6 of 12 procedures.

10. 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.

B. Performance Standards

Offeror shall provide services based on the following performance standards and provisions:

1. Drug Program Certification Provisions. Offeror shall comply with all applicable State and the County of Santa Clara (County) requirements regarding program licensure or certification, including but not limited to state licensure for residential facilities, state certification for non-residential Offerors, and/or County certification of residential facilities and Recovery Residences. Offeror shall comply with any program instituted by the Board of Supervisors for evaluation, inspection or certification of Offeror’s facilities, employees, or programs including, but not limited to, the County’s Certification Program.

2. Other Applicable Laws. Offeror shall provide services in accordance with all other applicable federal, state, and local laws, rules, regulations, policies, and codes, including BHSD Policies and Procedures, effective at the inception of this AGREEMENT and that become effective during the TERM of this AGREEMENT.

3. Access to Services. Offeror shall maintain continuous availability and accessibility of contracted services. Offeror shall require that treatment programs are accessible to people with disabilities in accordance with Title 45, C.F.R., Part 84 and the Americans with Disabilities Act. Offeror shall make oral interpretation services available for clients, as needed.

4. Certification of Health Care Offerors.

a. Offeror certifies that neither Offeror nor its employees, directors, board members, subcontractors, or agents have been convicted of a criminal offense related to health care, nor is Offeror or its employees, directors, board members, or agents listed by any federal or state agency as debarred, excluded, or otherwise ineligible for participation in federal or state funded health care programs.

b. Certification of "non-excluded Offeror" status. Offeror certifies that none of its staff including all employees and agents, applicants for hire, directors, board members, volunteers and owners of five percent interest or more, have been

RFSQ-BHS-FY23-0225: Behavioral Health Treatment Facility Continuum of Care Page 7 of 12 convicted of a criminal offense related to health care, nor have any staff been listed by any federal or state agency as debarred, excluded, or otherwise ineligible for participation in Medicare, Medi-Cal, or any other federal or state funded health care program.

c. Office of the Inspector General (OIG) List of Excluded Individuals/Entities and the Medi-Cal Suspended and Ineligible (S&I) Offeror List. Offeror shall conduct monthly credentialing using the OIG and S&I List to prevent employment of, or payments to, any individuals or entities on the exclusion lists. OIG and S&I verification of staff shall be satisfied prior to Medi-Cal certification. If Offeror is listed on these lists, the County shall not certify or pay Offeror with Medi-Cal funds, and any such inappropriate payments or overpayments shall be subject to recovery and/or be the basis for other sanctions by the appropriate authority.

d. Offeror shall screen all staff prior to making this certification, and shall screen all applicants for employment with Offeror on the OIG website at https://oig.hhs.gov/exclusions/exclusions_list.asp/ and the S&I website at https://files.medi-cal.ca.gov/pubsdoco/SandILanding.aspx.

e. Offeror shall establish a system to monitor the status of all staff on a monthly basis. Offeror shall draft a policy regarding the monitoring system Offeror establishes to monitor all staff and shall make such Policy available to County for review at County's request. Offeror shall maintain documentation verifying that Offeror has screened all staff. Offeror shall make such documentation available to County at County's request. Offeror shall notify County immediately by sending a written notice to the Department Director upon Offeror's learning that any staff person has been debarred, excluded, or otherwise listed as ineligible to participate in Medicare, Medi-Cal, or any other federal or state funded Program.

f. Offeror shall notify County immediately if any staff person is investigated, charged, or convicted of a criminal offense related to health care.

g. Federal Database Checks. Consistent with the requirements in 42 C.F.R.

455.436, Offeror shall check federal databases. This includes the Social Security Administration’s Death Master File, the National Plan and Offeror Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE), and the System for Award Management (SAM). These databases shall be checked monthly to prevent employment of, or payments to, any individuals or entities on the list, this must be satisfied prior to Medi-Cal certification of any individual or organizational Offeror. If Offeror is listed on these lists, the County shall not certify or pay Offeror with Medi-Cal or SABG funds, and any such inappropriate payments or overpayments shall be subject to recovery and/or be the basis for other sanctions by the appropriate authority. Offeror shall screen all staff prior to making this certification and shall screen all applicants for employment with Offeror on the federal databases. Offeror shall establish a system to monitor the status of all staff on a monthly basis. Offeror shall draft a policy regarding the https://oig.hhs.gov/exclusions/exclusions_list.asp https://files.medi-cal.ca.gov/pubsdoco/SandILanding.aspx

RFSQ-BHS-FY23-0225: Behavioral Health Treatment Facility Continuum of Care Page 8 of 12 monitoring system Offeror establishes to monitor all staff and shall make such Policy available to County for review at County's request. Offeror shall maintain documentation verifying that Offeror has screened all staff. Offeror shall make such documentation available to County at County's request. Offeror shall notify County immediately by sending a written notice to the BHSD Director upon Offeror's learning that any staff person has been debarred, excluded, or otherwise listed as ineligible to participate in Medicare, Medi-Cal, or any other federal or state funded program.

C. Staffing Requirements

1. Professional staff must be licensed, registered, certified, or recognized under California scope of practice statutes. Professional staff shall provide services within their individual scope of practice and receive supervision required under their scope of practice laws. The following positions qualify as Licensed Practitioner of the Healing Arts (LPHA):

a. Physician

b. Nurse Practitioners

c. Physician Assistants

d. Registered Nurses

e. Registered Pharmacists

f. Licensed Clinical Psychologists

g. Licensed Clinical Social Worker

h. Licensed Professional Clinical Counselor

i. Licensed Marriage and Family Therapists

j. License Eligible Practitioners working under the supervision of Licensed Clinicians:

i. Associate Clinical Social Worker;

ii. Associate Marriage and Family Therapist;

iii. Associate Professional Clinical Counselor; and/or

iv. Registered Psychologist.

2. Offeror shall have a system in place for monitoring the license or certification status of each staff person providing services.

3. Offeror shall make available all documentation verifying that Offeror is in compliance at County's request.

4. LPHAs shall receive a minimum of five (5) hours of continuing education related to addiction medicine each year.

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5. Offeror certifies that it has performed an appropriate screening of all its employees, directors, board members, subcontractors, and agents prior to making the aforementioned certification.

6. Offeror shall screen on a regular basis all Offeror employees, directors, board members, and agents to determine whether they are excluded or otherwise ineligible for participation in federal or state-funded health care programs.

7. Offeror shall screen all new employees. The screening procedure shall meet the screening requirements set forth in the BHSD Policies and Procedures relating to excluded Offeror’s status. At a minimum, Offeror shall screen each person against

(1) the CMS OIG List of Excluded Individuals/Entities, and (2) the State Medi-Cal S&I Offeror List (Excluded Offeror Lists).

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 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 ensure residential placements are made twenty-four (24) hours a day, seven (7) days a week.

F. Care Coordination

1. Offeror’s treatment team shall coordinate and monitor treatment for each client and shall consult with other Offerors as needed.

G. Program Hours of Operations

1. Offeror shall have an emergency and after-hours plan.

2. Care shall be provided twenty-four (24) hours a day.

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H. Evaluations, Transitional Planning, and Discharge

1. To ensure that clients have a smooth transition post discharge, Offeror shall provide notice at least one week prior to discharge for collaboration regarding discharge planning. At this time a completed discharge plan shall be sent, and coordination for services shall be put in place prior to the beneficiary’s discharge.

2. Offeror shall work with the BHSD 24-Hour Care team to facilitate discharge and transition to outpatient CCPs, social workers, and probation officers as indicated.

3. Offeror shall inform the BHSD and client’s outpatient CCPs of planned discharge date.

V. Program Goals and Objectives

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

1. Goals shall include, but not be limited to:

a. All Offerors shall use the outcomes and performance tools defined by the BHSD.

Proposals must clearly demonstrate capacity to perform accurate outcomes evaluation.

b. The BHSD shall gather client and services data to monitor services and measure service performance. Services provided, clients served, capacity and productivity shall be monitored monthly and performance measures annually. Performance measures for Offerors shall be based on national standards for treatment of the target population. These performance measures shall be modified periodically to reflect changes in national standards and to comply with standards related to behavioral health services in the future. All Offerors shall be provided training to measure performance standards.

c. Performance measures shall be based on client data collected by Offeror and submitted to the BHSD electronically and through other sources.

d. Offerors shall be required to implement client experience surveys with outcome of 95% satisfaction as directed by the Department. The BHSD shall provide the survey items that shall be administered to all clients at exit from treatment, irrespective of the conditions of discharge.

e. Annual performance monitoring: Performance shall be assessed on a quarterly and yearly basis, using monthly data averaged over a twelve (12) month period.

Data required for performance measures shall be transmitted to the BHSD each month. Annual performance shall be measured against a baseline, which shall be calculated using data from prior fiscal year. Separate performance measures shall be required for residential, outpatient, detoxification, and transitional housing services. The purpose of the performance measures is to produce a system view of how the Continuum of Care is operating at any given time. The performance measures shall be piloted before they are finalized.

VI. Reporting and Data Collection Requirements

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A. All client demographic information, service and other appropriate data shall be entered into the County’s electronic data interchange (EDI) system. In addition, all Offerors shall have a current electronic health record system or plans to implement one, including the capability of EDI with other systems. Offerors shall be expected to already have electronic health record system/capabilities that meet the County’s standards or to work with the County to meet those requirements.

B. 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. Offeror Connect Enterprise (PCE) with 837 billing;

2. Offeror Connect NX (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 needed for the particular program/contract.

VII. Outcomes and Measurements

A. Offeror shall achieve the following outcomes:

1. Complete an initial assessment and develop an individualized Treatment Plan within five (5) days of the client admission to the residential facility. This treatment plan shall be tailored to fit the client’s diagnosis and treatment needs. It shall include measurable and time bound goals, objectives, and intervention plan.

2. Shall follow weekly treatment schedules which include individual and family therapy sessions, psychiatry, medical consultations (which may include access to labs, monitoring of vitals and medication administration/ compliance), and activities to support recovery, including, but not limited to, recreational and experiential therapies, sober recreational activities, substance use education, and development of a Recovery Support Network.

3. Provide effective evidence-based substance use treatment that results in cessation of or the reduction in the use of substances, including Medication Assisted Treatment (MAT) where applicable. Evidence-based treatment shall include at minimum two (2) of the five (5) practices specifically identified in the Drug Medi-Cal Organized Delivery System (DMC-ODS) state contract, (Cognitive-Behavioral Treatment, Motivational Interviewing, Trauma-Informed Treatment, Relapse Prevention, Psychoeducation).

VIII. 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

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B3d, 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