Attachment E.pdf

ATTACHMENT E

Rates for Supplemental Residential Care Facility Services

The Behavioral Health Services Department (BHSD) is prepared to offer the following supplemental rates for Offeror(s) to provide individualized services for clients who are diagnosed with Serious Mental Illness (SMI) and have a level of functioning, symptoms, and psychiatric history that necessitates supplemental service interventions. Clients are to be transitioned from a higher level of care to the safest and most appropriate residential type of setting based on their ability to function independently.

A. Specialized Individual Treatment Rates

1. For clients who are diagnosed with SMI and need supplemental services, BHSD will negotiate a mental health individualized treatment rate for placement depending on the individual client’s needs. The majority of these clients have Social Security Insurance (SSI) that pays for basic board and care costs. BHSD only pays for the individualized treatment rate which ranges from $55.00 to $150.00 per day depending on the severity of the medical and mental illness. If a client is unsponsored, then BHSD will also pay for the basic board and care costs.

2. The population to be served will be as indicated in Attachments A4a, A4b, and A4c.

B. Unsponsored patch - $43.56 per day (SSI rate is set by the State and is subject to change)

1. Offeror shall provide residential care facility (RCF) services to clients with SMI whose level of functioning, symptoms, and psychiatric history necessitates service intervention to maintain clients in community settings, and who are not SSI eligible and do not receive benefits. Standard of services will meet Community Care Licensing (CCL) requirements. This includes clients who may suffer from an institutionalized syndrome including increased passivity, lack of confidence, and lack of knowledge about the community.

2. If SSI is approved retroactively, then Offeror shall reimburse County only for the daily unsponsored facility rate, back to the date when the client was granted retro SSI eligibility.

C. Level 1: Basic Supplemental Residential Care Services - $55.00 per day

1. BHSD shall pay for basic supplemental services for individuals with on-going mental health issues that require assistance with daily living and are difficult to place.

2. Services shall include, but may not be limited to the following:

a. Assistance with grooming and hygiene;

b. Assistance with incontinence;

c. Monitoring and/or assistance with eating difficulties;

d. Providing support and assistance for clients with difficult sleeping patterns;

e. Providing meaningful day activities and interaction with others;

f. Monitoring clients smoking behavior;

g. Providing transportation to medical/psychiatric appointments;

h. Monitoring medication compliance; and

i. Assistance with walker and/or wheelchair.

3. Clients may have a history of:

a. Vulnerability;

b. Yelling and screaming;

c. Destruction of property;

d. Substance and/or alcohol use;

e. Suicidal and/or homicidal behavior; and/or

f. Assaultive behavior to staff and peers.

D. Level 2: Basic Supplemental Residential Care Services for clients who are mono-lingual, blind, deaf, or with dual-diagnosis - $68.00 per day

1. This level of service is designed for clients with on-going mental health condition, as well as the following conditions indicated below, that preclude them from being admitted into a regular RCF:

a. Hearing loss or deaf;

b. Vision loss or legally blind;

c. Developmentally disabled or mental retardation; and/or

d. Monolingual in Spanish, Cantonese, Mandarin, Tagalog, Vietnamese, or Farsi.

2. Client’s level of functioning, symptoms, and psychiatric conditions at this level are more severe and will require more intensive services than those listed in Level 1.

E. Level 3: Basic Supplemental Residential Care Services for clients with SMI or other minor medical conditions - $80.00 per day

1. This supplemental service is designed for clients who have exhibited difficult behaviors which interfere with standard RCF placement.

2. This level of care is for clients with the following:

a. May have secondary medical and/or substance use issues and/or are intellectually disabled in addition to psychiatric conditions;

b. Diagnosed with an intellectual disability on a continuum based on level of severity that includes the following categories: mild, moderate, severe, and profound. Depending on where clients fall on this continuum, they are oftentimes nonverbal and exhibit aggressive and/or self-injurious behaviors;

c. Have been refused for admission at a standard RCF due to aggressive behaviors or history of aggression towards staff and peers; and/or

d. Have a history of recidivism (in and out of psychiatric or medical hospitals) due to aggression or substance use issues.

3. Client’s level of functioning, symptoms, and psychiatric conditions at this level are more severe and will require more intensive services than those listed in Level 1.

F. Level 3: Basic Supplemental Residential Care Services for clients who are medically frail or require assistance with insulin - $80.00 per day

1. This supplemental service is designed for clients with significant co-morbid conditions of psychiatric and medical complications.

2. This level of care is for clients with the following:

a. Medically Frail: these are clients with significant co-morbid conditions such as psychiatric, medical, and health related issues such as Chronic Obstructive Pulmonary Disease (COPD), obesity, renal disease, clients needing daily assistance with hygiene and grooming due to medical conditions;

b. Diabetic/Insulin Dependent: these are clients with a history of diabetes who require finger stick and are unable to manage their disease and/or perform the basic self-care required to stabilize their blood sugar levels (this does not apply to clients who are solely on oral medication for a diabetic condition);

c. High blood pressure or other medical conditions who require assistance with medication management; and/or

d. Limited mobility who have assisted devices such as wheelchairs and canes.

3. Client’s level of functioning, symptoms, and psychiatric conditions at this level are more severe and will require more intensive services than those listed in Level 1.

G. Level 4: Intermediate Supplemental Residential Care Services - $140.60 per day

1. This level of service is designed to serve clients with significant difficult mental health and medical conditions that interfere with standard RCF placement and require specialized nursing care.

2. This level of care is for clients with the following:

a. Psychiatric issues and significant co-morbid medical conditions such as COPD, obesity, and renal disease;

b. History of Absence Without Official Leave (AWOL) and require intense supervision or with a Wander Guard provided by the facility;

c. Require daily assistance with hygiene and grooming due to medical conditions;

d. Specialized equipment (e.g., sleep apnea machine, electric wheel chair, colostomy bag, oxygen tank, etc.) that need one-on assistance and/or one-on-one supervision with the equipment;

e. Require temporary medical assistance with transition from release from a medical facility.

f. Require assistance with how to check and monitor their blood sugar levels and administer insulin to treat their diabetic condition;

g. Chronically ill with medical issues that may require one-to-one supervision who require high level of behavioral interventions, support, and/or a high level of nursing interventions;

h. Require hospice of end-of-life care; and/or

i. Significant behavioral challenges, limited social skills, dual diagnoses, impaired or unable to attend to independent living skills, poor self-regulation skills, thought disorders, and/or nursing complexities that prevent them from living in the least restrictive setting.

3. Client’s level of functioning, symptoms, and psychiatric conditions at this level are more severe and will require more intensive services than those listed in Level 1.

H. Level 5: Supplemental Services for Clients with SMI and Traumatic Brain Injury (TBI) - $150.00 per day

1. This level of service is designed to serve clients who are dually diagnosed with SMI with TBI, anoxia (absence of oxygen in the brain), stroke or seizure disorders, as well as other clients who are vulnerable or at risk of victimization in a community setting.

2. This level of care is for clients with the following:

a. Symptoms including cognitive and judgmental impairments, and a disability that causes significant interference with treatment, but do not present an immediate threat to safety nor prevent independent functioning;

b. Limited cognitive functioning level who require one-on-one assistance with hygiene and grooming due to low cognitive functioning level;

c. Difficulty with their thought process, functioning level, unable to perform basic tasks, which affects concentration, communication, speech, swallowing, vision, and mobility; and/or

d. Severe cognitive and psychiatric impairments who have been denied for admission at a regular RCF.

3. Client’s level of functioning, symptoms, and psychiatric conditions at this level are more severe and will require more intensive services than those listed in Level 1.