ATTACHMENT A9

CATEGORY 2: OUTPATIENT SERVICES

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ADULT AND OLDER ADULT CULTURALLY APPROPRIATE OUTPATIENT CONTINUUM 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 to designing and operating an Adult and Older Adult Culturally Appropriate Outpatient Continuum Services (hereafter referred to as “the program”), which includes the Deaf and Hard of Hearing population.

B. Offeror shall provide a range of services for adult (ages 18 through 59) and older adult clients (ages 60 years and up) diagnosed with severe mental illness (SMI) and/or co-occurring1 substance use disorders.

C. Services shall be designed to improve the emotional/behavioral functioning and enhance the abilities for clients to participate in meaningful activities such as recreational, school, employment, and independent living activities. The program shall build and nurture natural supports, which help clients remain in the communities as emotionally healthy and productive members.

D. Services shall include:

1. Culturally appropriate and trauma-informed outpatient services that combine components of recovery-oriented, evidence-based practices (EBPs), promising practices (PPs), and trauma-informed practices; and

2. Comprehensive behavioral health services (therapy, medication support, case management and crisis intervention) for clients, using a recovery and wellness model of care.

II. Operational and Logistical Requirements

A. Offeror shall have current Medi-Cal certification or become certified to provide Medi-Cal reimbursable services on or before the contract start date. In addition, Offeror shall also have Medicare certification or become certified to provide Medicare reimbursable services on or before the contract start date.

B. Offeror shall strategically operate a Medi-Cal and Medicare certified service delivery site within the identified County catchment areas. The site shall be considered home base for Offeror’s staff. Even with established sites, services can be offered in the community or wherever the clients are (e.g., work, school, home, homeless shelter, etc.), if appropriate.

C. Services shall strategically be situated within the identified County catchment areas. The

1 Clients require both mental health and substance use treatment services.

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1. North County: Palo Alto, Los Altos and Los Altos Hills, Mountain View, and Sunnyvale;

2. Central County: San Jose, Cupertino, Santa Clara, Los Gatos, Monte Sereno, Saratoga, and Campbell;

3. East County: San Jose (Foothills, Berryessa) and Northeast San Jose/Milpitas areas;

and

4. South County: Gilroy, Morgan Hill, and the unincorporated area of San Martin.

III. Target Population

A. The program shall target previously unserved and underserved adults (age 18-59 years) and older adults (ages 60 and over). Clients served may include adult and older adults that experience at least one (1) of the following:

1. Diagnosed with mental health problems associated with community-bound syndromes2 that may be limited to specific societies or cultural areas that are localized or folk-based;

2. At imminent risk of decompensation without treatment;

3. Require culturally informed services that embrace cultural differences that may impact the diagnosis of a condition;

4. Reduced access to behavioral health services due to significant situational, cultural, and linguistic needs that have isolated them; and/or

5. Require public assistance services or benefits due to mental functioning impairments and circumstances3.

B. Clients served are residents of County that have full-scope Medi-Cal, Medicare, or both Medi-Cal and Medicare (Medi-Medi). Clients with Medi-Cal shall meet Medi-Cal necessity criteria in accordance with all laws and regulations governing Medi-Cal and Medicare programs as mandated by federal, state, and local statues. This includes California Code of Regulations (CCR) Title 9, Social Security Act Title XXII Regulations, and California Welfare and Institutions Code (WIC) § 14705.5.

C. Adult and Older Adult Culturally Appropriate Outpatient

1. Clients served may include adult and older adults who would benefit from a culturally appropriate program. These include individuals who:

2 This includes symptoms from diagnostic categories framing coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations 3 E.g., community violence, interpersonal family violence, general neglect and exposure to trauma, social and emotional isolation, and physical decline, and/or from underserved cultural populations.

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a. Have been diagnosed with mental health problems associated with community-bound syndromes that may be limited to specific societies or cultural areas that are localized or folk-based. This includes symptoms from diagnostic categories framing coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations.

b. Require culturally informed services that embrace cultural differences that may impact the diagnosis of a condition and who would benefit from a culturally appropriate program.

2. The program shall provide services tailored to underserved communities.

IV. 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. Reducing suffering from mental illness;

b. Reducing functional impairment due to psychiatric symptoms and any co-occurring substance use;

c. Reducing experiences of homelessness, incarceration, crisis, hospitalization, substance use, violence, trauma, and victimization;

d. Strengthening recovery, self-sufficiency, and other psychosocial outcomes4;

e. Encouraging clients to actively participate in their recovery and self-monitor milestones and goals towards self-determination, family and vocational education, and recreational services.

2. Objectives shall be achieved by:

a. Engaging underserved clients who have not yet benefitted from outpatient mental health services due to complex risk factors including substance use, community violence, interpersonal family violence, general neglect and exposure to trauma, social and emotional isolation, and physical decline;

b. Providing behavioral health and co-occurring substance use services for clients through care coordination and utilization of EBPs, PPs, and trauma informed practices;

c. Address client substance/alcohol use and related risky behaviors (e.g., unsafe sex, criminal behaviors) as applicable;

d. Supporting clients in obtaining safe and stable housing;

e. Improving culturally and linguistically proficient client-centered services that integrates or directly provide the full range of treatment modalities and

4 E.g., housing stability, income and access to entitlement benefits, family relationships, and participation in meaningful activities).

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f. Increasing each client’s understanding pertaining to the importance of their medication adherence and treatment compliance through psychoeducation sessions;

g. Assisting clients to develop, increase, and strengthen natural networks of supportive relationships;

h. Assisting clients in learning life skills that allow them to become more independent and self-sufficient;

i. Promoting meaningful use of time and capabilities in school, work, and social activities;

j. Developing, increasing, and strengthening natural networks of supportive relationships;

k. Improving access to healthcare and successfully linking clients to appropriate lower levels of care as necessary; and

l. Linking clients to medical/dental healthcare and other relevant services before discharge;

m. Improving access to community-based and eligible public benefits; and

n. Effectively promoting wellness and recovery by transitioning clients to appropriate levels of care as necessary.

3. Key Outcomes

a. Offeror’s key outcomes plan shall incorporate and achieve the following target benchmarks:

i. Improve access for and engagement of culturally and ethnically diverse adult and older adult clients into intensive supports and behavioral health treatment;

ii. Demonstrate the ability to successfully transition clients to lower levels of care while maintaining successful recovery process;

iii. Improve functioning as defined through Department of Health Care Services (DHCS) and/or County approved assessment tool(s);

iv. Identify gaps and improve functioning by introducing other cultural/ethnic specific assessments;

v. Increase the number of clients engaged in educational and vocational activities;

vi. Decrease the number of times Emergency Psychiatric Services (EPS), RFSQ-BHS-FY23-0210: Adult and Older Adult System of Care Services Page 5 of 15 ATTACHMENT A9: Adult and Older Adult Culturally Appropriate Outpatient Continuum Services Scope of Work CATEGORY 2: Outpatient Services Last Revised 10/24/25

Behavioral Health Urgent Care (BHUC), Emergency Department (ED) and/or other crisis services are invoked; and5

vii. Increase the number of clients reporting satisfaction with services.

V. Reporting and Data Collection Requirements

A. Offeror shall complete the following requirements:

1. Enter client demographic information, direct and outreach services information, and other appropriate data into the BHSD’s data information system.

2. Enter client data into the state Client and Service Information (CSI) System.

3. Collect treatment and service data for outcomes data reporting.

4. Collect, document, track and report on data related to community outreach, education, and training services using BHSD provided tools.

5. Measure client outcomes for adult and older adult clients served through the program to assist in determining areas of improvement.

6. When applicable, administer assessment tool(s) as part of the Program requirement(s) and collect and report on assessment tool data.

7. Utilize the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-

5) and/or the International Classification of Diseases, Tenth Edition (ICD-10) for diagnoses and coding purposes.

B. Offeror shall complete and submit the MHSA reporting template6 to the BHSD quarterly.

The MHSA reporting template shall summarize and describe the following data elements:

1. Number of unduplicated clients served;

2. Number of clients at risk;

3. Number of clients with early onset;

4. Number of client family members;

5. Number of clients with SMI referred to treatment;

6. Type of treatment referred to;

7. Number of clients who followed through on referral and engaged in treatment;

8. Average duration of untreated mental illness;

9. Average time between referral and participation in treatment;

10. Number of referrals to a prevention program;

5 BHSD will provide data as needed.

6 BHSD will provide MHSA reporting template upon contract award.

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11. Number of referrals to an early intervention program;

12. Number of referrals to treatment beyond early onset; and

13. Description of the ways the County encouraged access to services and follow-through on referrals.

C. Data Submission

1. Offeror shall collect and report data including the following as appropriate for the program:

a. CSI data;

b. Network Adequacy Certification Tool (NACT);

c. AOA EBP assessment tool(s);

d. Active Caseload/Length of Stay (LOS) Report;

e. Units of Service (UOS) Report;

f. Client list per staff ratio;

g. Post-discharge (e.g., placement/service(s) type, frequency, etc.);

h. Outreach and Engagement Process;

i. Data reporting requirements as requested by the MHSA; and

j. Any County data systems or assessment tools as required by the BHSD.

D. Offeror shall describe their 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 shall provide details on how their organization shall use the County’s myAvatar system using one (1) of the following implementation types:

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.

VI. Outcomes and Measurements

A. Offeror shall achieve the following outcome measurement methods by collecting the following MHSA CSS required assessment measures:

1. Clinician-completed assessments

a. Process client intake assessments to capture basic intake and demographic information; and

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b. Administer a clinician assessment at follow-up and discharge events. The assessment shall include the following components:

i. Key outcomes (timeliness access, engagement in services, successful discharge, acute care readmission);

ii. Illness Management and Recovery Scale (IMR);

iii. Relevant assessment tools; and

iv. Client treatment/recovery goals.

2. Client-completed assessments

a. Offeror may administer one (1) or both of the following self-assessments:

i. Patient Reported Outcomes Measurement Information System – Global Health Short Form (PROMIS Global Health); and/or

ii. Creating Healthy Outcomes Integrated Self-Assessment (CHOIS).

b. Offeror shall administer the Mental Health Statistics Improvement Program (MHSIP) Consumer Survey to obtain input from clients on care provided.

c. Offeror shall administer the client feedback tool (Client Satisfaction Survey) bi-annually.

d. Offeror shall administer client cultural competence assessments.

3. Additional assessments

a. Offeror shall administer the Illness Management and Recovery Scale – Family or Friend Version (IMR-FF) to obtain information from client’s family and/or supports to assist in client’s recovery.

B. Offeror shall develop a process to systematically monitor and analyze the performance of each targeted outcomes to be achieved, including, but not limited to the following outcome measurement methods:

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

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

3. Improved emotional and behavioral functioning and ability to participate in meaningful activities.

C. Offeror shall initiate any other monthly, quarterly, and annual measurement tools and documents, which may include Microsoft Excel and other formats as requested by the BHSD. Offeror shall supplement reviews using data sources listed in Section D.

VII. Program Description

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A. Offeror shall provide program services in accordance with the ordinances and resolutions of the County Board of Supervisors and the applicable policies, procedures, directives, and guidelines of the County, BHSD, and the County of Santa Clara Health System (“Health System”), including, but not limited to the BHSD Provider Manual, BHSD policies and procedures, and MHSA requirements7.

1. Offeror shall ensure that their organization’s service plan shall meet Medi- Cal/CalAIM behavioral health requirements, including but not limited to:

a. Medi-Cal 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.

B. The program is designed to provide culturally-relevant intensive behavioral health services and counseling to clients diagnosed with behavioral health and/or co-occurring disorders. The program shall assist clients in overcoming stigma by tailoring interventions to cultural beliefs and practices.

C. Services shall be provided in a variety of settings, including outpatient clinics, a client’s place of residence, via telehealth, and in the community, as appropriate. The clients’ cultural views, traditions, and spirituality shall be considered as necessary to contribute to enhanced engagement with treatment.

D. Services may include the following:

1. Provide individual, family, and group counseling;

2. Evaluation and assessments of clients using the standard behavioral health tools, which may include BHSD Integrated Assessment (IA), American Society for Addiction Medicine (ASAM) assessment, and other tools as needed to identify issues including, but not limited to, dual diagnosis, substance use physical disabilities, and medications;8

3. Case management and brokerage (e.g., client support plan development; accessing housing, transportation, and medical care);

4. Connect each client with a Primary Care Physician (PCP) to facilitate treatment of concurrent primary health care and ongoing behavioral health needs;

7 For more information, reference fidelity requirements for MHSA CSS as set forth in the CCR CSS Title 9, Chapter 14, Article 6, Sections 3610-3620.10 and 3640.

8 BHSD will offer training through the Learning Partnership Division, as needed.

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5. Medication management;

6. Individual rehabilitation services (e.g., vocational readiness, education, and skills for activities of daily living);

7. 24-hour crisis intervention, if needed; and

8. Coordination and linkage with other providers and institutions including community-based resources that serve adults and/or older adults in Santa Clara County, recognizing that older adults may be less experienced in seeking resources.

E. Offeror shall prioritize cultural competence and the ability to engage in action or create conditions that maximize the optimal development of the client and client systems.

Service array shall reflects the BHSD’s values pertaining to client and family empowerment, best practices, health and wellness, and cultural responsiveness, including the following:

1. Offeror shall provide cultural, ethnic and language specific services, including culturally informed EBPs, to meet the individual recovery needs of the client (e.g., culture, preferred language(s) and communication needs, lived experience, related trauma, and access to systems).

2. Staff shall utilize EBPs, PPs, cultural and trauma-informed practices whenever clinically indicated and based on clients’ diagnoses. EBPs and PPs recommended for the program may include the following: Motivational Interviewing (MI), Stages of Change, Cognitive Behavioral Therapy (CBT), Solution-Focused Brief Therapy (SFBT), trauma-informed approaches, and integrated co-occurring disorder practices and peer supports such as Wellness Recovery Action Planning.

3. Offeror shall provide services based on the client’s problem list.

4. Offeror shall administer client injection(s) and related medication management services as necessary in outpatient clinics.

5. Special emphasis shall also be made to include mental health problems associated with culture-bound syndromes that may be limited to specific societies or cultural areas that are localized or folk. Offeror shall provide services in the clients’ preferred languages. If Offeror is unable to provide services in the clients’ specific language, Offeror shall provide interpreters or technology that provide real-time translations.

6. Offeror shall review the clients’ statuses and progress towards planned goals annually to determine possible discharge planning and/or step down to a less intensive type of service. Offeror shall rewrite clients’ goals as necessary to match the level of care needed.

7. Offeror shall link clients to community-based resources as well as primary care services.

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8. Co-occurring substance use treatment shall be based on harm reduction principles.

If Offeror is unable to provide this treatment specialty within their scope, a referral to appropriate services shall be facilitated and collaboration between the two (2) providers shall address any co-occurring treatment needs.

F. Staffing Requirements

1. The Program Team (Team) shall operate as an interdisciplinary team that work together to ensure that clients are able to access and benefit from services and supports included in their TCP. Staff on the Team shall provide the following client needs/services:

a. Provide co-occurring services for clients who have substance use disorder based on harm reduction principles. Services shall be integrated and address both substance use and mental health issues concurrently.

b. Provide a medication room to provide clients with psychiatric injectables, if needed in the outpatient clinic.

c. Participate in collaborative meetings when appropriate to address clients at risk in the community, address communication barriers, develop collaborative structures and/or appropriates to make treatment more accessible and homelessness, or incarcerations less likely.

d. Secure an array of community-based supports that shall meet the diverse and individualized needs of the clients being served.

e. Develop and maintain a plan for collaborative relationships with other community agencies, private and public, to create easy access to linkage and transfers to other services in the community.

f. Review the clients’ status and progress towards planned goals annually to determine possible discharge planning/step down to less intensive services or possibly rewrite of clients’ goals to address immediate needs.

g. Respond to calls from Emergency Psychiatric Services (EPS), Emergency Department (ED), Crisis Stabilization Unit (CSU), and Mobile Crisis Response Team as necessary regarding clients enrolled in the Program.

2. Offeror shall ensure that the psychiatrist and clinical staff required by the program are in place prior to the start of the program and shall remain available to provide services to the clients on an ongoing basis.

3. Offeror shall maintain adequate staffing for the program and maintain the ratio to client, including the following as appropriate for the program:

a. Psychiatrist;

b. Direct service staff, such as:

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i. Licensed or associate social workers;

ii. Licensed Professional Clinical Counselors;

iii. Marriage and family therapists and interns;

iv. Social workers;

v. California Association of Alcoholism and Drug Abuse Counselor (CAADAC)

vi. Peer mentors;

vii. Rehabilitation counselors; and

viii. Other direct service staff, as appropriate.

b. License Professional Clinical Counselors;

c. Nursing staff and/or psychiatric nurse; and

d. Quality assurance staff.

4. Offeror’s staff shall at least meet all BHSD training and licensing requirements, including but not limited to:

a. BHSD reflective supervision, reflective practice, and clinical supervision requirements;

b. County policy (staff which meet specific discipline requirements; appropriately trained Licensed Practitioner of the Healing Arts [LPHA]);

c. Staff that are fluent in American Sign Language (ASL) and have an understanding of/immersion in the deaf and hard of hearing culture; and

d. State and Federal (Title 9, Title 19, and Title 22 of Medi-Cal Regulations) policy.

5. Offeror shall complete Appendix B9 and include the following supplemental information:

a. Staffing table and credentials for those who shall be providing and supporting these services and indicate position title, linguistic and cultural skills, education, experience, licensure, and certifications, including administrative, supervisory, and direct service staff;

b. Detailed plan to recruit and maintain appropriate staffing to meet the diverse population of Santa Clara County;

c. Personnel retention plan for the program, which includes a current list of staff at the organization, their credentials, bilingual language capacity, and the length of time the employee has been with the organization;

d. Approximate percentage turnover of the direct service staff over the past three

(3) years; and

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e. Plan to provide continuity of care for clients and their families during staff turnover.

6. Offeror’s staff shall meet the BHSD Co-Occurring Standards. The BHSD Co-Occurring Standards expect all paraprofessional and professional practitioners to have the minimal core skills and be trained according to the following three-core skill levels:

a. Co-Occurring Informed: This level of practice identifies the core skills needed to support treatment. The identified domains for this level are screening, engagement, readiness and retention, education, advocacy, and collaboration.

b. Co-Occurring Capable: This level of practice identifies the core skills needed to provide an integrated assessment and provide treatment to clients and families facing mild to moderate co-occurring disorders. The identified domains for this level are screening, assessment and diagnosis, and co-occurring capable treatment.

c. Co-Occurring Enhanced: This level of practice identifies the expertise needed to provide fully integrated treatment to clients and families challenged with moderate to severe co-occurring disorders. The identified domains are assessment, diagnosis, and integrated treatment.

7. Offeror shall maintain practices related to recruiting, hiring, and promoting multi-lingual staff and/or a culturally or ethnically diverse workforce. Offeror 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).

8. Offeror’s staff shall participate in trainings related to the MHSA CSS required data collection and reporting. Offeror’s staff shall also participate in the Sexual Orientation and Gender Identity and Expression (SOGIE) 101 Training.

9. Offeror shall ensure that appropriate staff attend all system-wide BHSD trainings and shall participate in all required trainings specific to the needs of the program.

G. Cultural Competency

1. Offeror 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 satisfaction and culturally responsive services/practices to continually improve service quality. Data shall be used to improve program satisfaction.

3. Offeror shall have a plan to address barriers when they do not have staff available to meet the seven (7) Santa Clara County threshold languages (e.g., Spanish, RFSQ-BHS-FY23-0210: Adult and Older Adult System of Care Services Page 13 of 15 ATTACHMENT A9: Adult and Older Adult Culturally Appropriate Outpatient Continuum Services Scope of Work CATEGORY 2: Outpatient Services Last Revised 10/24/25

Vietnamese, Mandarin, Cantonese, Tagalog, Farsi and Russian) and a plan for actions and changes to ensure diversity and inclusion in service delivery. Staffing shall reflect the percentage of ethnic and cultural make-up of the target population. If unable to provide services in the clients’ primary language, Offeror shall provide the clients with access to interpreters or real-time technology. Offeror shall have a plan to address barriers when they do not have staff available to meet the six (6) Santa Clara County threshold languages and a plan for actions and changes to ensure diversity and inclusion in service delivery.

4. Offeror shall provide outreach activities focused on reaching underserved, underrepresented, and/or multicultural populations. Offeror shall provide culturally and linguistically proficient services to the clients. Services shall be delivered in accordance with Offeror’s Cultural Competency Plan (Plan). The Plan shall be submitted to the BHSD Director and shall be in accordance with the BHSD guidelines.

H. Referrals and Admissions

1. Offeror shall accept all referrals from the BHSD Call Center. Offeror shall also accept inter-agency transfers and walk-ins from the community, which shall be processed as post-authorizations through the BHSD Call Center.

2. Offeror shall ensure that referrals that do not meet the criteria for behavioral health services or that need a different level of care, shall be directed and linked by the program to appropriate alternative resources or another provider.

3. The contracting agency shall comply with a Feedback Loop process to ensure referral sources and contract manager are notified of the referral status and recommendations for the next step.

4. Offeror shall accept urgent and emergent outpatient referrals received from the BHSD call center, ensure referrals are triaged within twenty-four (24) hours of receipt and are to be seen within five (5) business days.

5. Offeror shall be aware that based on the level of care policy and procedure (P&P) 412-330, the BHSD call center shall refer non-English-speaking urgent care clients to clinics having availability regardless of language and cultural specialization. Offeror, at the request of the client, shall initiate a transfer to a program of the client’s choice as soon as there is availability at that program per P&P 412-330.

6. Offeror, at the request of the client, shall initiate a transfer to a program of the client’s choice as soon as there is availability at that program per P&P 412-330.

I. Care Coordination

1. Offeror shall adhere to the following care coordination guidelines:

a. Offeror’s treatment team shall work together with multiple systems as appropriate for adult and older adult clients, due to clients’ involvement in multiple systems, including participating in multi-disciplinary meetings to address the needs of the clients who are at risk in the community, address

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b. Offeror shall provide crisis intervention to enhance the safety and wellness of clients and to limit/prevent hospitalizations or institutionalized care. Availability by phone and or any other technological means is deemed clinically appropriate and a significant part of treatment and support to clients and their families.

Offeror shall provide the infrastructure and supports necessary to provide crisis intervention, including 24/7 crisis needs, such as medication support to mediate the crisis in a timely manner and indicate plans to respond in person when clinically appropriate.

c. Offeror shall provide care coordination for clients and their families to ensure comprehensive and consistent care, good communication with system partners and other serving agencies, and/or institutions involved in clients’ service delivery.

J. Program Hours of Operations

1. Offeror shall develop a plan to include after-hours crisis needs, and medication support to the crisis in a timely manner and indicate plans to respond in person when clinically appropriate. Offeror shall be open for services during regular office hours Monday through Friday, and for forty (40) hours per week, with after-hours services available to accommodate clients requiring evening and weekend appointments as well as crisis outpatient services available twenty-four (24) hours a day, seven (7) days a week to address the emergency needs of clients under the program. Offeror shall be required to maintain coverage that shall include Welfare and Institutions Code (WIC) 5150/5585.50/5751.7 evaluations for clients as needed.

2. Offeror shall ensure that the 24-hour coverage plan shall be on file with the BHSD Division Director. Offeror shall provide an updated agency plan for 24-hour coverage to the BHSD Division Director and the BHSD Program Monitor for approval prior to implementation at the beginning of each new fiscal year and when any changes to this plan occur.

3. Holidays: Offeror shall maintain at minimum a skeleton crew that shall facilitate the processing of referrals coming from the BHSD Call Center, 24-Hour Care unit, crisis coverage, and the ability to initiate Lanterman-Petris-Short (LPS) protocols.

K. Evaluations, Transitional Planning, and Discharge

1. Offeror shall transfer clients who have graduated from the Program to lower levels of care based on the client's level of care need.

2. Offeror shall facilitate transitions to other agencies for additional or more specialized support for clients requiring higher levels of care, such as Full Partnership Service (FSP) Maintenance.

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3. Offeror shall discharge clients when they meet at least one (1) of the following criteria:

a. Upon mutual agreement by the client and the client’s treatment team that the client completed the program successfully;

b. Upon a good faith determination by Offeror that the program cannot effectively serve the client;

c. Upon client or guardian's unilateral decision to terminate treatment against medical advice;

d. Upon transfer to a lower level of care or another mental health provider;

e. Upon transfer to another County mental health program, in which Offeror shall comply with a Feedback Loop Process to ensure that referral sources are notified of the status of the referral, provided the appropriate sections of the assessment, and informed of outcomes and/or next steps;

f. Upon notification of client admission into an institutionalized setting (e.g., Institute of Mental Disorder [IMD], Mental Health Rehabilitation Center [MHRC] or locked Skilled Nursing Facility [SNF]), with the BHSD 24-hour Care Team re-assigning the client to outpatient services as appropriate;

g. When the client is incarcerated for over thirty (30) days;

h. When the client no longer meets Medi-Cal medical necessity criteria; and

i. When the client is not engaged and responsive after thirty (30) days of persistent efforts to locate them and following all County policies and procedures.

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 B9 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;

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