Attachment B.pdf

ATTACHMENT B

CHILDREN, YOUTH, AND FAMILY SYSTEM OF CARE PROGRAMS

STANDARDIZED SCOPE OF WORK LANGUAGE

This attachment outlines the standardized scope of work language that applies to the majority of programs under the Children, Youth, and Family System of Care, with exceptions noted as applicable below1.

I. Purpose

A. The County of Santa Clara (County) Behavioral Health Services Department (BHSD) is seeking statements of qualifications from qualified Offerors interested in designing and operating Children, Youth, and Family System of Care Programs (hereafter referred to as “the program”).

B. Offeror shall provide comprehensive, appropriate, and trauma-informed behavioral health services for youth (ages birth through 25), their families, and significant supports that combine components of recovery-oriented, evidence-based practices (EBPs), promising practices (PPs), and trauma-informed practices.

C. Services shall be designed to improve the social, emotional, behavioral functioning of children, youth, and young adults (hereafter referred to as “clients”) and enhance their ability to participate in meaningful activities such as recreational activities, school, employment, and independent living. The program should build and nurture natural supports that help clients maintain a typical developmental trajectory.

D. Offeror shall work collaboratively with community navigators, community providers, and other mental health agencies, substance use treatment service providers, physical health providers, educational systems, child welfare systems, juvenile justice systems, and other groups that provide supportive services.

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.

B. Offeror shall strategically operate a Medi-Cal certified service delivery site within the identified County catchment areas. The site shall be considered the 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 be strategically situated within the identified County catchment areas.

1 This standardized Scope of Work applies to most of the Children, Youth, and Family System of Care programs in this solicitation, except for the following three (3) programs, which have unique scope requirements. Detailed requirements for these exceptions are provided in their respective program-specific Scope of Work sections:

1. A13: Community Youth Wellness Center - Peer Support and Engagement Program

2. A14: Therapeutic Behavioral Services

3. A15: Therapeutic Behavioral Services for Youth with Intellectual Disabilities or Developmental Delay

ATTACHMENT F

The four (4) primary regions of focus for program services are North, Central, East, and South County regions:

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 clients that are Medi-Cal beneficiaries and residents of Santa Clara County, from birth through age twenty-one (21), and, where applicable, through age twenty-five (25), who at minimum meet the medically necessary criteria for Specialty Mental Health Services (SMHS) or the Drug Medi-Cal Organized Delivery System (DMC-ODS) due to behavioral health or substance use treatment needs.

B. Clients whose level of functional impairment, symptoms, and psychiatric history necessitate service intervention in order to:

1. Maintain their engagement in school and/or community settings;

2. Achieve agreed-upon desired outcomes;

3. Develop a sense of mastery;

4. Positively influence their own lives; and/or

5. Retain therapeutic gains to continue leading productive lives.

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 subjective suffering from mental health symptoms and improving clinical/functional outcomes to prevent the need for more intensive services, such as emergency psychiatric services, crisis stabilization units, and hospitalization for clients;

b. Increasing engagement in appropriate programs that match each client’s level of clinical need, with consideration of culturally informed and efficient services;

c. Improving school functioning or job performance and increasing participation in community activities;

d. Creating opportunities to engage the client’s natural support systems and nurture supportive relationships, thereby increasing self-help and client/family involvement;

e. Reducing the psychosocial impact of trauma, victimization, homelessness, crisis, hospitalization, child welfare involvement, juvenile justice involvement, violence, and substance use;

f. Reducing multiple foster care placements, timelines to permanency, and length of stay in the child welfare system;

g. Reducing incarceration and/or juvenile justice involvement;

h. Reducing stigma and discrimination;

i. Reducing and preventing suicide risks; and/or

j. Reducing disparities in access to behavioral health services.

2. Objectives shall be achieved by:

a. Providing culturally appropriate, non-stigmatizing access to behavioral healthcare services to clients, including underserved and unserved ethnic and cultural populations, and those involved in child welfare and juvenile justice systems;

b. Providing comprehensive age-specific behavioral health and co-occurring substance use services for clients by utilizing EBPs, PPs, Community-Defined Evidence Practices (CDEPs), and trauma-informed practices in the least restrictive and intrusive manner that maximizes the physical, emotional, and psychological safety of the client and family being served;

c. Addressing client substance/alcohol use and related risky behaviors as applicable;

d. Supporting clients in obtaining safe and stable housing;

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

f. Linking clients to relevant services (e.g., education, medical) as needed;

and/or

g. Effectively promoting social-emotional wellness and supporting clients by transitioning them to appropriate levels of care as necessary.

V. Reporting and Data Collection Requirements

A. Offeror shall comply with the reporting requirements reflected in Division 5 of the California Welfare Institutions Code (WIC) and Division 1 of Title 9 of the California Code of Regulations (CCR) when applicable.

B. Offeror shall collect and report required data, including, but not limited to:

1. Client demographic information, direct and outreach services information, and other appropriate data into the BHSD's data information system;

2. Client and service information (CSI) data;

3. Treatment and service data for outcomes or data reporting;

4. Client outcomes to assist in determining baseline and areas of improvement;

5. Functional assessment tool(s) outcomes, as part of the program requirements;

6. 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. Updates of these manuals shall be incorporated into the service delivery process as they become available.

7. When applicable, tracking and reporting fidelity and client outcomes of any EBPs, PPs, and other methodologies utilized in service provision. Offeror shall implement suitable mechanisms to gather relevant data and furnish regular reports on fidelity adherence and client outcomes.

C. Data Submission

1. Offeror shall complete and submit program-specific reports as requested.

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

a. Child Adolescent Needs Strengths (CANS) data;

b. Pediatric Symptom Checklist (PSC-35) data;

c. Client satisfaction data;

d. CSI data;

e. EBP assessment tool(s);

f. Client readmission(s) to the program, as applicable;

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

h. Data reporting requirements as requested by the Mental Health Services Act (MHSA); and

i. Any County data or assessment tools as required by BHSD.

D. Offeror shall detail the organization’s ability to use their current electronic health record (EHR) system (including the capability to exchange data with County systems) and/or the ability to implement a new EHR system as listed in Appendix H, Offeror’s Electronic Health Record (EHR) Status. Offeror shall indicate current and future County EHR system needs in Appendix H, using one (1) of the following myAvatar implementation types:

1. Provider Connect Enterprise (PCE) with 837 billing;

2. Provider 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.

VI. Outcomes and Measurements

A. Offeror shall achieve the following outcomes:

1. Timely access to services;

2. Ensuring clients are engaged in services;

3. Decreasing suffering from traumatic events;

4. Decreasing mental health symptomology and increasing social-emotional well-being;

5. Supporting a positive client experience;

6. Achieving a successful discharge; and

7. Providing referrals to appropriate levels of care.

B. Offeror shall use the following measurements:

1. Clinician-completed intake and follow-up assessments to capture basic intake and demographic information.

a. Client and/or caregiver-completed assessments, including the administration of the State Client Satisfaction Survey, or, where appropriate, an alternative assessment tool mutually agreed upon by BHSD and Offeror.

2. 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:

a. CANS

i. For programs with an average length of stay longer than three (3) months, the CANS assessment shall be administered to clients. This supports decision-making, treatment planning, quality improvement, and service outcome monitoring. Offeror shall abide by the CANS Operational Guideline developed by BHSD.

ii. Offeror is responsible for training, certifying, and annually re-certifying their staff on the appropriate CANS tool(s).

iii. Offeror shall maintain a minimum of two (2) staff members who are Offeror’s CANS trainers to ensure sustainability and that CANS principles and philosophy are integrated into clinical practice.

iv. Offeror shall establish and/or maintain an online account with Praed Foundation to access online CANS trainings and certification.

v. Offeror shall make CANS data available for the Child and Family Team (CFT) in conformity with all applicable regulations. County child welfare agencies and BHSD are jointly responsible for completion of the CANS and are expected to share completed CANS assessment information to avoid unnecessary duplication and over-assessment.

b. PSC-35

i. The PSC-35 is a tool required by the Department of Health Care Services (DHCS). This tool shall be administered for youth ages three (3) to eighteen (18) to support decision-making on the appropriate level of care and treatment planning. Offeror shall abide by the Operational Standards developed by BHSD and follow the state mandate, which includes additional details related to outcomes and reporting requirements.

c. Client Status Report (CSR) for Juvenile Justice System

i. If Offeror provides services to youth and young adults in the Juvenile Justice System, they shall provide a CSR monthly, upon request, to the Probation Department. The CSR shall contain relevant information regarding the client’s progress, compliance with program requirements, and any significant developments pertinent to the client’s case.

VII. Program Description

A. Service Description

1. 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 requirements.

2. Offeror shall provide comprehensive, integrated behavioral health assessment for emotional, behavioral, functional, and social issues affecting health, including substance use assessment. Offeror shall utilize a variety of treatment approaches to resolve identified behavioral health problems in a manner that considers the individual needs of the client and family.

3. Offeror shall ensure that their organization’s service plan meets MediCal/CalAIM behavioral health requirements, including, but not limited to:

a. Medical necessity criteria;

b. Documentation redesigns;

c. Co-occurring treatment;

d. Standardized screening and transition tools;

e. Behavioral Health CPT coding transition; and

f. Payment reform.

4. Offeror shall design the program to provide a range of services to meet the level of care needs for clients diagnosed with behavioral health and/or co-occurring disorders.

5. Offeror shall ensure that services are provided in a variety of settings, including outpatient clinics, educational settings, a client’s place of residence, via telehealth, and in the community, as appropriate.

6. Offeror shall prioritize efforts to enhance access and engagement for clients from unserved and/or underserved communities. Offeror shall implement targeted strategies aimed at reducing barriers to access and fostering meaningful engagement with these specified populations.

7. Services may include the following:

a. Providing individual, parent-child, family, and group counseling;

b. Conducting evaluations and assessments of clients using the standard behavioral health tools, which may include elements of an 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 medication management;

c. Offering case management and brokerage services (e.g., client support plan development, accessing housing, transportation, and medical care);

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

e. Managing medications;

f. Providing individual rehabilitation services (e.g., vocational readiness, education, and skills for activities of daily living);

g. Offering rehabilitation and collateral services;

h. Conducting Intensive Care Coordination (ICC) screening;

i. Providing 24-hour a day, 7-days a week crisis intervention services to respond to and support crises, if needed; and

j. Coordinating and linking with other providers and institutions, fostering strong engagement and participation with community-based resources that serve children, youth, families, adults, and/or older adults within Santa Clara County. Offeror shall establish and maintain collaborative relationships aimed at enhancing service integration and continuity of care across diverse service settings.

8. CFT Meetings

a. CFT meetings are central to the California Integrated Core Practice Model (ICPM). It is strongly recommended that all Offerors receive training to support the integration of ICPM. Children involved in the child welfare or juvenile justice system will have CFTs facilitated by an identified provider and will typically include the client, the client’s support system, a social worker or probation officer, a behavioral health provider, and other supports identified by the client or family. When invited, Offeror shall attend and participate in CFT meetings and shall summarize the CANS data using a template provided by BHSD to share with the CFT to help guide the process. A CFT meeting is required within the first sixty (60) days of entering the child welfare or probation systems.

b. Offeror should obtain a Release of Information (ROI) from the client to share information with parties attending the CFT who are not covered by the DHCS Information Notice. Additional guidance can be found in All County Letter (ACL) 18-09 (http://www.cdss.ca.gov/Portals/9/ACL/2018/18- 09.pdf?ver=2018-01-26-162122-640) and ACL 18-85 (http://www.cdss.ca.gov/Portals/9/ACL/2018/18-85.pdf?ver=2018-07-09- 134620-230).

9. Transformation Care Planning (TCP)

a. Offeror shall implement TCP as the model for service delivery and care planning. All clinical staff shall be trained in TCP and shall adhere to TCP standards and philosophy in their practice. Staff shall develop a collaborative case formulation and TCP care plan, as outlined in the BHSD TCP curriculum.

A care plan is required for youth receiving ICC, Intensive Home-Based Services (IHBS), and Therapeutic Behavioral Services (TBS). Offeror shall be responsible for ensuring their staff is properly trained.

10. ASAM Criteria

a. Offeror shall integrate the ASAM criteria within the assessment and treatment planning for outpatient integrated behavioral treatment services, in accordance with the ASAM guidelines (http://www.asam.org/publications/the-asam-criteria).

b. The program shall provide integrated care for co-occurring mental health conditions and be trained as Co-Occurring Capable.

c. ASAM criteria provides a comprehensive set of guidelines for assessment, service planning, placement, continued stay, and transfer/discharge of clients with addiction and co-occurring conditions. This person-centered approach offers a holistic framework for determining individualized and outcome-driven treatment plans. Use of the ASAM 6-dimensional assessment provides the following:

i. Assists client from assessment through treatment;

ii. Assesses and rates client risks to determine the focus of treatment and services;

http://www.cdss.ca.gov/Portals/9/ACL/2018/18-09.pdf?ver=2018-01-26-162122-640 http://www.cdss.ca.gov/Portals/9/ACL/2018/18-09.pdf?ver=2018-01-26-162122-640 http://www.cdss.ca.gov/Portals/9/ACL/2018/18-85.pdf?ver=2018-07-09-134620-230 http://www.cdss.ca.gov/Portals/9/ACL/2018/18-85.pdf?ver=2018-07-09-134620-230 http://www.asam.org/publications/the-asam-criteria

iii. Determines intensity and frequency of services needed to assess levels of care; and

iv. Assesses how risks, strengths, skills, and resources in one (1) life area affect other life domains.

11. Offeror shall possess the capability to identify risk factors associated with vulnerable child and youth populations, including, but not limited to, the following: commercial sexual exploitation of children and adolescence, juvenile justice involvement, child abuse and neglect, and clients with developmental needs. Furthermore, Offeror shall be equipped to provide necessary resources and training to staff members to effectively address the needs of these populations.

12. Offeror shall prioritize cultural competence and the ability to create conditions that maximize the optimal development of the client and client systems. The service array shall reflect the BHSD’s values pertaining to client and family empowerment, best practices, health and wellness, and cultural responsiveness, including the following:

a. Offeror shall provide cultural, ethnic, and language-specific services to meet individual and family needs (e.g., culture, preferred language(s) and communication needs, lived experience, related trauma, and access to systems).

13. Staff shall utilize EBPs, PPs, cultural and trauma-informed practices whenever clinically indicated, based on client’s social-emotional and behavioral health needs. EBPs and PPs recommended for the program may include, but are not limited to, the following: Motivational Interviewing (MI), Stages of Change, Cognitive Behavioral Therapy (CBT), Solution-Focused Brief Therapy (SFBT), trauma-informed approaches, integrated co-occurring disorder practices, and peer supports.

14. Offeror shall utilize a family-focused EBP or PP when clinically indicated.

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

16. Offeror shall provide medication management services as necessary.

17. Offeror shall ensure the following for children in foster care who receive medication management services:

a. Follow-up within two (2) weeks of client beginning a new medication, and at least monthly until symptoms are improved and the client is stable on the medication. Once stable, visits can be less frequent and based on the needs of the client and determination of the psychiatrist.

b. As dosages of medications are increased, reduced, or otherwise adjusted, more frequent follow-up appointments may be necessary.

c. A JV-220 Application for Psychotropic Medication shall be promptly completed and provided to a social worker immediately upon identification and recommendation of psychotropic medication as part of a treatment plan.

B. Staffing Requirements

1. 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 clients on an ongoing basis.

2. Offeror shall maintain appropriate staffing for the program, including the following positions, as appropriate for the program:

a. Psychiatrist;

b. Direct service staff, such as:

i. Licensed Practitioner of the Healing Arts (LPHA), including waivered staff;

ii. Licensed or Associate Marriage and Family Therapist (LMFT/AMFT);

iii. Licensed or Associate Clinical Social Worker (LCSW/ASW);

iv. Licensed or Associate Professional Clinical Counselor (LPCC/APCC);

v. Alcohol and Drug Counselor, certified or registered with one (1) of the three (3) approved certifying bodies:

1) California Consortium of Addiction Programs and Professionals

(CCAPP);

2) California Association for Alcohol/Drug Educators (CAADE);

and/or

3) California Association of DUI Treatment Programs (CADTP).

vi. Peer Recovery Specialists;

vii. Mental Health Rehab Specialist (MHRS);

viii. Nursing staff, licensed with the California Board of Registered Nursing:

1) Licensed Vocational Nurse (LVN);

2) Nurse Practitioner; and/or

3) Registered Nurse.

c. Quality Assurance Staff.

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

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

b. Training and supervision to ensure staff competency, knowledge, skills and sensitivity to effectively engage and treat the population they are serving.

This includes understanding and addressing diverse needs, including by not limited to age-specific, cultural, developmental, and system-involved considerations;

c. Compliance with County policy (staff must meet specific discipline requirements and be appropriately trained as LPHA); and

d. Adherence to state and federal policy (Title 9, Title 19, and Title 22 of Medi- Cal Regulations).

4. Offeror’s staff shall meet the BHSD Co-Occurring Standards. These standards expect all paraprofessional and professional practitioners to possess the core skills and be trained according to the following three (3) 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, 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.

5. Offeror shall maintain practices related to recruiting, hiring, and promoting multilingual staff and/or a culturally or ethnically diverse workforce. Offeror shall implement training requirements related to diversity, equity, and/or inclusion (e.g., Lesbian, Gay, Bisexual, Transgender, Queer, Questioning + [LGBTQ+], cultural and linguistic capacity, and racial equity). Offeror’s staff shall also participate in the Sexual Orientation and Gender Identity and Expression (SOGIE) 101 training.

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

C. Cultural Competency

1. Offeror’s organization shall promote behaviors and practices that foster a more equitable, diverse, and inclusive organizational mindset. Offeror shall have leadership that models inclusivity and provides tools and support to enhance the organization’s ability to identify and mitigate bias, respect differences, build empathetic relationships, and manage conflict.

2. The program shall reflect the ethnic, cultural, and linguistically diverse populations of the County and the preferences of each client. Offeror shall monitor and evaluate client and family satisfaction as well as culturally responsive services and practices to continually improve service quality. Data shall be used to improve overall program satisfaction.

3. The program shall be staffed by individuals proficient in the seven (7) Santa Clara County threshold languages: Spanish, Vietnamese, Mandarin, Cantonese, Tagalog, Farsi, and Russian. Offeror’s organization shall have a plan to address barriers when staff are not available to meet the County threshold languages and implement a plan for action to ensure diversity and inclusion in service delivery.

4. Cultural diversity and inclusion services must be provided in a culturally responsible manner to the entire target population, demonstrating fair and equitable practices for participants of diverse identities, including gender, age, religion, race, ethnicity, sexual orientation, gender identity, and disability.

5. Offeror must maintain and promote an organization that provides the highest quality of services to clients regardless of actual or perceived sexual orientation, gender identity, or gender expression. Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+) clients shall receive fair and equitable treatment, without fear of negative bias or discrimination, and in a professional and confidential manner based sound professional practice.

D. Referrals and Admissions

1. Offeror shall accept referrals from the BHSD Call Center. Offeror shall also accept inter-agency transfers, direct referrals from identified system partners, and walk-ins from the community.

2. Offeror shall ensure that referrals that do not meet the criteria for specialty mental health or DMC-ODS services, specific eligibility criteria, or that need a different level of care, are directed and linked by the program to appropriate alternative resources or another provider.

3. Offeror shall accept urgent referrals, including discharges from in-patient hospitals, emergency psychiatric services, or crisis stabilization units, and similar facilities. Offeror shall ensure that all referrals are triaged and are seen within forty-eight (48) hours, as delineated in BHIN 23-041.

4. Offeror shall be aware that, based on the level of care per BHSD Policy and Procedure (P&P) 412-330, the BHSD Call Center shall refer non-English-speaking urgent care clients to clinics with availability, regardless of language and cultural specialization. Upon the client’s request, the Offeror shall initiate a transfer to a program of the client’s choice as soon as there is availability at that program, as outlined in P&P 412-330.

5. Offeror shall provide a weekly report of the number of intake slots (Capacity Report) to the BHSD Call Center or the BHSD Program Monitor for the appropriate programs.

6. Offeror shall have a centralized intake procedure for receiving referrals.

7. Offeror agrees to implement and maintain a feedback loop process that ensures timely notification to referral sources regarding the status of each referral. This process includes providing relevant sections of the assessment and informing referral sources of outcomes and/or next steps. Specifically, feedback must be provided to the client's Primary Care Physician (PCP) or any third-party referral source to ensure effective care coordination.

E. Care Coordination

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

a. To facilitate care coordination, Offeror shall request client authorization that is compliant with the Health Insurance Portability and Accountability Act (HIPAA) and California law, to share client information with all other providers involved in the client’s care, in compliance with state and federal privacy laws and regulations.

b. Offeror shall engage in care coordination activities beginning at client intake and continuing throughout the treatment and discharge planning processes.

c. Clients who are open to receiving traditional mental health services shall, as part of their acceptance into this program, sign the appropriate Authorization for Release of Information, allowing program staff to share client information with their primary mental health providers.

d. Offeror shall demonstrate the willingness, experience, and ability to collaborate with multiple County systems and services.

e. Offeror shall integrate co-occurring disorder practices that are inclusive of both the client and family.

f. Offeror shall review each client’s status and progress toward planned goals at regular intervals and at a minimum of every six (6) months to determine possible discharge planning and/or step down to a less intensive type of service. Offeror shall revise client goals as necessary to match the required level of care.

g. Offeror shall link clients to community-based resources, educational services, developmental services, and primary care services, based on client and family needs.

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

i. Co-occurring substance use treatment shall be based on harm reduction principles. If the Offeror is unable to provide this treatment specialty within its scope, a referral to appropriate services shall be facilitated, and collaboration between the two (2) providers shall address any co-occurring treatment needs.

F. Program Hours of Operations

1. Offeror shall provide services on a year-round basis. Every effort should be made to meet with clients and their families at times that are convenient for them.

Offeror shall accommodate clients requiring evening and/or weekend appointments.

2. 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 fiscal year and whenever changes to this plan occur.

3. Holidays and Afterhours: Offeror shall ensure the processing of referrals from the BHSD Call Center, including urgent referrals, particularly discharge referrals from in-patient hospital, crisis stabilization units, emergency psychiatric services, and similar facilities.

G. Evaluations, Transitional Planning, and Discharge

1. Offeror shall comply with all audits performed by the County, including regularly scheduled audits and evaluations for compliance and quality assurance. These include monitoring and review activities such as chart audits, administrative reviews of Offeror’s organization, policies, personnel, and fiscal reviews. The annual audit performed by the County may lead to a Corrective Action Plan.

Offeror shall adhere to timelines and follow-up as procedures as outlined in the Provider Manual and in any Notice of Correction issued by the County.

2. Offeror shall facilitate transitions and warm handoffs to other programs, such as managed care plans and Primary Care, for lower level of care or more specialized support for clients requiring higher levels of care, based on the client's need as determined by relevant screening tool.

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

a. Upon mutual agreement between the client and therapist that the client has successfully completed the program;

b. Upon a good faith determination by the 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 another level of care or another mental health provider;

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

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

g. When the client no longer needs medically necessary specialty mental health services; and/or

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

4. Offeror shall establish written discharge policies and procedures, either independently or by adopting the County's policies. These procedures shall cover:

a. Written criteria for discharge types, including successful completion, administrative discharge, involuntary discharge, transfers, and referrals.

b. A discharge summary that includes reason for discharge, a description of treatment episodes, a description of services completed, current alcohol and/or drug use; and other relevant information.

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 B, Evaluation Criteria and Qualifications and submit the following supplemental information:

1. Emergency and disaster plan to deliver services during a Public Health

Emergency or other emergency disaster that includes, at a minimum, evacuation procedures, training for workforce members, and quarterly emergency drills; and

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

B. Offeror shall comply with all County requirements in effect relating to COVID-19 for persons who routinely perform services for County onsite and share airspace with or proximity to other people at a County facility as part of their services for County as set forth in a County Health Order (or similar directives).