Attachment J-1 SOW.pdf

ATTACHMENT J-1

SECTION C – DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK (SOW)

C.1 Agency Background. The Court Services and Patient Supervision Agency (CSOSA) was established under Section 11232 of the National Capital Revitalization and Self-Government Improvement Act of 1997 to effectuate the reorganization and transition of functions relating to pretrial services, parole, adult probation and Patient supervision in the District of Columbia to a Federal Executive Branch agency. The mission of CSOSA is to increase public safety, prevent crime, reduce recidivism, and support the fair administration of justice in close collaboration with the community through the supervision of all probationers, parolees and supervised releases held under the authority of any United States or District of Columbia statute, or any other lawful authority entrusted to the District.

C.2 Objectives.

C.2.1 The primary objective for this purchase order is to obtain Medically Managed Intensive Inpatient Withdrawal Management (IIWM) Services within the District of Columbia, the Maryland counties of Montgomery and Prince Georges, or the Virginia counties of Arlington and Alexandria, to be performed by licensed medical staff who are able to care for Patients with acute withdrawal signs and symptoms. Some of these Patients may present with behavioral health disorders along with other co-occurring disorders. The secondary objective is to stabilize and prepare the Patient for his/her next recommended level of care.

C.2.2 The Contractor shall utilize Evidence Based therapeutic interventions that focus on treating acute withdrawal symptoms and teaching the Patient skills that help him/her recognize and reduce relapse risks, maintain abstinence, and enhance self-efficacy. An effective outcome is defined as 90% of Patients will successfully complete the program.

C.2.3 CSOSA anticipates referring up to 182.5 clients during each 12-month period of performance.

The quantities outlined in this solicitation for each 12-month period are not guaranteed. The Contractor's facility must be located within a 30-mile radius of 633 Indiana Ave NW, Washington, DC 20004-2902.

C.3 Referral Authorization.

C.3.1 CSOSA will make placements for WM services based upon a Patient’s assessed need as determined by CSOSA’s Treatment Management Team (TMT) or Re-Entry and Sanctions Center (RSC) clinicians. The Patients also may have been ordered to be placed in WM Services and treatment interventions by the courts, either as part of a sentence or pre-sentence, or as a condition of probation, parole or supervised release.

C.3.1.1 CSOSA shall apply the ASAM Criteria 4.0 WM for referring Patients to the appropriate modalities. The CSOSA Referral Placement Team (RPT) shall provide a referral package to the Contractor a minimum of twenty-four (24) hours prior to each admission. The referral package shall contain a billing authorization document (Attachment J-2), admission date, projected discharge date, Patient identification information, supervision contact information, and information relevant to the Patient’s transportation requirements (when applicable). Additionally, it will contain Attachments J-3, Release of Information: Substance Abuse Treatment; J-4, Release of Information: Health Records; J-5, Release of Information: Mental Health Information; and J-6, Release of Information: Privacy Act Waiver Form.

C.3.1.2 Duration. The length of stay to be provided is from three (3) to seven (7) days. The length of the placement may be extended based on justifiable recommendations from the Contractor, with input from the Patient’s assigned Community Supervision Officer (CSO) and Intervention Specialist (IS).

Attachment J-1 Section C – Statement of Work

C.3.1.3 Referral/Billing Authorization. The CSOSA Contracting Officer’s Representative (COR) shall provide the Contractor a billing authorization for each Patient referred. The billing authorization shall contain the following:

a. Patient name.

b. Admission date.

c. Projected discharge date.

d. Treatment duration.

e. The maximum dollar amount authorized for the treatment duration.

f. The invoicing code.

C.3.1.4 The billing authorization is the only document that makes CSOSA financially responsible for Patient services provided by the Contractor. No verbal or other authorizations are recognized or allowed. CSOSA is not responsible for Patient services provided without a billing authorization, or for any Patient services provided that exceed the treatment duration, or the maximum dollar amount authorized for the treatment duration.

C.4 Tasks – Medically Managed Intensive Inpatient Withdrawal Management Programming Services

C.4.1 Task 1 - Pre-Admission Referral Review. Upon receipt of a referral package from CSOSA staff, the Contractor shall review the referral documentation to determine the individual’s suitability to successfully participate in treatment.

C.4.1.1 When completing the review, the Contractor shall assess the following areas:

a. Complicating Medical Conditions – to ensure the absence of any complicating medical conditions which would impact the Patient from appropriately receiving inpatient withdrawal management services.

b. Medication Compliance – to ensure that any pre-existing medical and mental health conditions (i.e. acute medical or actively psychotic) are adequately stabilized by appropriate medications and treatment.

c. Ambulatory Abilities – to ensure the requisite ambulatory abilities and physical stamina required to participate in treatment.

d. Self-Care – to ensure the individual’s ability to provide basic self-care (i.e., hygiene, etc.) during treatment.

C.4.1.2 The Contractor shall complete the review and render a suitability decision, or request for additional relevant information, to CSOSA staff, in writing (via email or fax), within two (2) business days of receipt of each referral package. When necessary, CSOSA staff will coordinate with the referral source to obtain any additional relevant information requested by the Contractor.

C.4.1.3 Upon receipt of the additional information, the Contractor shall complete a secondary review and render a decision to CSOSA staff, in writing (via email or fax), within one (1) business day of receipt of the additional information. In the event that the referral source is unable to supply the requested information, the Contractor shall render a decision (based on the original referral documentation) within one (1) business day of notification of the unavailability of additional information.

C.4.2 Task 2 – Intake Process

C.4.2.1 Admission/No Show Notification. The Contractor shall notify CSOSA of all admissions and no-shows, within 12 hours of each scheduled admission, utilizing the Admission Notification form that is provided with each referral/billing authorization. This notification must be provided in writing (via email or fax) to the COR, and the Patient’s assigned CSO and IS. Specific contact information and notification instructions are found in each referral package. Failure to adhere with this requirement absolves CSOSA of financial responsibility for the Patient. The Contractor’s admission criteria shall include exclusionary factors such as medical and mental health or any condition(s) that would deem the Patient unacceptable for admission at the time of referral determination.

C.4.2.2 The Contractor shall transport Patients from pick-up locations designated in the referral package and drop off locations as determined during the discharge planning process. All vehicles used to transport CSOSA Patients shall be in good working condition and conform to all standards/requirements defined by the Department of Motor Vehicles in the jurisdiction where the Contractor’s place of performance is located.

C.4.2.3 Intake Interview. The Contractor shall conduct an intake interview with each Patient within 12 hours of admission. During the intake interview the Contractor shall:

a. Conduct a History and Physical Examination by a Physician, Physician Assistant, or Nurse Practitioner (within 12 hours of admission).

b. Conduct a nursing assessment, which shall include a Clinical Institute Withdrawal

Assessment (CIWA) (within 12 hours of admission).

c. Conduct a Mini-Mental Status Exam (within 12 hours of admission).

d. Conduct an initial suicide assessment using an evidence-based assessment tool (i.e., Columbia Suicide Severity Rating Scale) within 12 hours of admission).

e. Order and complete all necessary labs, to include urinalysis/oral toxicology (within 12 hours of admission).

f. If not provided by the Government, administer a Purified Protein Derivative (PPD) tuberculin test, or chest x-ray, and document the results in the Patient’s treatment file (within 12 hours of admission).

g. Retrieve and secure any medications or prescriptions from the Patient (within hours of admission).

h. Obtain signed waivers of confidentiality upon the informed consent of the Patient.

The waiver of confidentiality shall extend to all therapists and treatment providers treating the Patient (within 12 hours of admission).

i. Identify the Patient’s primary case manager (within 12 hours of admission).

j. Review the program rules with the Patient, as well as the Patient’s rights and responsibilities (within 12 hours of admission).

k. Conduct a nutritional assessment (within 12 hours of admission).

C.4.2.4 Patient Treatment File. The intake interview shall result in the creation of an individual Patient treatment file, unless a Patient treatment file was received from a previous treatment provider, which shall initially contain the following:

a. Patient personal information sheet.

b. The entire referral package as provided by CSOSA.

c. A form confirming the Patient has received the Patient’s handbook, which includes the Patient’s rights and responsibilities, and bears the signatures of both the Patient and the Contractor’s staff.

d. Current medical clearance - CSOSA will ensure Patients have PPD/TB test results that are valid within one (1) year of the actual treatment placement.

CSOSA will provide evidence of a chest x-ray completed within the last five (5) years, and clearance from a pulmonologist or other qualified public health facility, or a physician specializing in pulmonary disease which documents that the Patient is currently asymptomatic. Patients who show signs of disease must adhere to the D.C. Department of Health requirements for medication management and the treatment of Tuberculosis.

e. Signed Treatment Consent Forms. (Attachments J-3, J-4, J-5, and J-6).

f. The Patient treatment file shall be maintained in accordance with Part 2 HIPPA

Privacy Act Rule 45 CFR 164.530(c). The files should be maintained at the Contractor’s location in a locked file cabinet or properly secured electronic medical record, with access limited to those individuals who provide direct service to the Patient. CSOSA Patient treatment files must be maintained separately from non-CSOSA Patient treatment files. At no time should CSOSA Patient treatment files be removed from the Contractor’s facility where services are performed.

C.4.2.5 History and Physical Examination. The Contractor shall ensure that the Patient receives a history and physical examination at the Contractor’s facility within 12 hours of admission, to determine the Patient’s suitability for withdrawal management treatment. The Contractor shall have the right to refuse to treat any Patient to the extent allowed by relevant laws and regulations who, after a medical or mental health screening, is considered to be medically/mentally unstable, or who has a significant medical/mental condition that will unduly interfere with treatment. The RPT shall be notified in writing (via email or facsimile (fax)) of any decision to refuse to treat a Patient and the rationale for the decision.

C.4.2.6 Treatment Needs Assessment. The Contractor shall conduct an individualized treatment needs assessment for each Patient within 12 hours of admission. The individualized needs assessment shall utilize a Comprehensive Bio- Psychosocial assessment and shall be conducted by a Case Manager or other licensed professional (proper interpretation must be within the assessor’s scope of practice).

C.4.2.7 Comprehensive Bio-Psychosocial Needs Assessment. The Comprehensive Bio- Psychosocial Assessment must include, at a minimum:

a. A detailed description of the Patient’s substance use history, mental health history, and any prior treatment experiences.

b. A complete personal history, including information related to the Patient’s educational/vocational achievements, and experiences.

c. Any other information that may be helpful in determining Patient treatment and individualized needs consistent with ASAM Criteria.

C.4.2.8 Assessments. CSOSA shall provide an Addiction Severity Index (ASI), or other Government approved assessment tool(s), that was conducted within six (6) months of the admission date. The Contractor shall incorporate all prior assessment information received from CSOSA (Re-Entry and Sanctions Center (RSC) Discharge Summary, Assessment, Evaluation, and Placement Unit (AEPU) Assessment, or the Patient’s Performance Contract) into its initial individualized assessment/treatment plan and also shall include references to relevant factors in its discharge summary to support a seamless continuum of care. Results of this individualized assessment shall be documented and maintained in the Patient treatment file.

C.4.2.9 Treatment Plan - The Contractor shall develop an individualized treatment plan for each Patient within 24 hours of admission, based on the results of the treatment needs assessment and referral information provided by CSOSA.

C.4.2.9.1 The individualized treatment plan shall include problem formulation, short- term and long-term measurable treatment goals, with specific services and activities designed to achieve those goals. It also shall include a schedule for service delivery, identifying frequency and duration of services.

C.4.2.9.2 The individualized treatment plan shall also reflect case management activities conducted by on-site staff, and the coordination of additional treatment, health, dental and mental health interventions. Additionally, pro-social supports, vocational and housing services, along with any other services at this and other levels of care shall be noted in this plan.

C.4.2.9.3 The plan shall be developed in collaboration with the Patient and reflect the Patient’s personal goals. A signed and dated copy of the treatment plan (with signatures of both the Patient and Contractor staff) shall be maintained in the Patient’s treatment file and a copy provided to the Patient. A copy with a signed Release of Information form shall be sent to the assigned IS and CSO.

C.4.2.9.4 At a minimum, treatment plans must be reviewed and reassessed daily by an inter-disciplinary treatment team that, at a minimum, consists of the Physician, Nurse, and Case Manager. Treatment plans also must be reviewed, updated and modified when major clinical changes occur, or when major life, family, or social circumstances may complicate treatment. When treatment plans are revised and resigned by the Client and Contractor staff, a copy shall be provided to the Client and the IS and CSO with a signed

ROI.

C.4.2.9.5 The Contractor shall document the evidence of treatment plan reviews in the Patient treatment file. The Contractor shall document treatment plan review by completing a signed and dated entry in the progress notes or in the form of a signed and dated revised treatment plan.

C.4.3 Task 3 –Medically Managed Intensive Inpatient Withdrawal Management Programming Expectations

C.4.3.1 The Contractor shall ensure that withdrawal management services is an organized service delivered by medical and nursing professionals, who provide 24-hour, medically supervised evaluation and safe withdrawal management in an acute care or psychiatric hospital inpatient unit. Services are delivered under a defined set of physician-approved policies and physician-managed procedures for medical protocols. This level provides care to patients whose withdrawal signs and symptoms are sufficiently severe enough to require 24-hour medically managed care, where the focus is primarily medical and nursing care. Withdrawal Management services include substance abuse assessment, daily medication monitoring and counseling services.

C.4.3.2 This care approximates ASAM Criteria, Level 4.0 WM care to include the ability to treat the following:

a. Individuals with withdrawal management disorders

b. Pregnant women

c. Poly-addicted persons, including those addicted to benzodiazepines

d. Individuals who may or may not be on opiate replacement therapy

e. Patients with non–life-threatening medical condition(s) that do not require the services of an acute care hospital.

C.4.3.4 In order to accommodate this increased acuity in patients being treated in this service, the facility must have an affiliation agreement and procedures in place with an acute care hospital that ensures the seamless transfer of the patient to the acute care setting, if clinically necessary.

C.4.3.5 The expected outcome of WM Services treatment is to target the Patient’s level of functioning based on the assessed needs in dimensions one (1) through six

(6) and to prepare them for successful entry into the next phase of the treatment continuum.

CSOSA will assess the outcome of the withdrawal management treatment intervention by reviewing the Patient’s level of functioning one (1) day before the Patient’s discharge date from WM Services.

C.4.3.6 The Contractor shall provide a highly structured, safe, drug and crime-free treatment environment. The structured programming shall consist of three (3) to seven (7) days to include a range of Cognitive Behavioral, Medical, Mental Health, and other Therapies which are designed to enhance the Patient’s understanding of addiction, the completion of the withdrawal management process, and the need for referrals to appropriate level of care for continuing treatment. Program services shall also include daily clinical practices to educate and reinforce the information directed at improving the Patient’s development and practice of pro- social behaviors.

The Contractor’s programming activities schedule shall be visibly posted for the Patient and staff’s information.

C.4.3.7 The Contractor shall provide organized daily programming through the use of approved standards for medical withdrawal management treatment in accordance with ASAM Criteria Level

4.0 WM. The Contractor shall also use evidence-based Cognitive Behavioral Interventions (CBI), (i.e. Thinking for a Change) industry approved best-practiced curriculum targeting criminal thinking and attitudes, motivational enhancement, and expressive therapy to address anti- social attitudes and cognitive distortions in order to achieve a 90% Patient successful outcome.

Program services shall include daily clinical practices to educate, and reinforce the information directed at improving the Patient’s development and practice of pro-social behaviors. The programming activities schedule shall be posted in plain sight for the Patient and staff’s information.

C.4.3.8 Progress Notes

C.4.3.8.1 The Contractor shall maintain daily progress notes for each Patient that clearly reflect implementation of the treatment plan and the Patient’s response to treatment and all other therapeutic interventions. A progress note shall be entered for each service of intervention provided within one (1) business day. The individualized progress notes shall be maintained in the Patient’s treatment file.

C.4.3.8.2 The notes shall be maintained in the DAP (Data, Assessment, and Plan), SOAP (Subjective, Objective, Assessment and Plan) SIRP (Situation Intervention Response Plan, or other industry approved format.

C.4.3.8.3 Each daily progress note must be signed and dated by the Contractor’s staff providing direct care services. All progress notes shall be placed in reverse chronological order, maintained in the Patient treatment file with the most recent note on top.

C.4.3.9 The Contractor shall be able to access services to assist Patients to address mental health issues, sexual trauma and or substance use disorders.

C.4.3.10 The Contractor shall demonstrate evidence of a working relationship with CSOSA staff by submitting the discharge plan and utilizing a team approach for treatment interventions, case monitoring, and individualized discharge and planning for the next continuum of care.

C.4.3.11 The Contractor shall ensure necessary therapeutic interventions are consistent with the Patient’s progress through withdrawal management and assessed needs to include a range of cognitive, behavioral, medical, mental health and other therapies. These interventions are designed to enhance the Patient’s understanding of addictions, the completion of the withdrawal management process, and referral to an appropriate level of care for continued treatment.

C.4.3.12 The Contractor shall ensure that assessment and programming services incorporate other individuals or programs, as clinically indicated, who are likely to support the individual's recovery process as indicated. These might include family psychoeducation or multi-family peer support groups or family therapy and incorporate a focus on the issues of homelessness.

C.4.3.13 The Contractor shall provide case management services designed to address specific Patient needs that contribute to substance use disorders.

C.4.3.14 The Contractor shall establish a system of positive reinforcement to increase Patient engagement and adherence to program requirements. The Contractor shall also survey the Patient prior to discharge in order to gauge Patient’s satisfaction with the program and to improve outcomes. Contractor shall ensure that a copy of the survey is placed in the Patient’s treatment file.

C.4.3.15 Treatment Expectations for Medically Managed Intensive Inpatient Withdrawal Management Services:

C.4.3.15.1 The Contractor shall ensure that the withdrawal management treatment includes no less than two (2) hours per day of counseling services on at least two (2) separate occasions. The counseling, therapy, and case management services shall include at a minimum:

a. Individual: One (1) hour/daily.

b. Group: One (1) hour/daily.

c. Case Management sessions – One (1) hour minimum per Patient’s length of stay

C.4.3.15.2 The Contractor shall provide a minimum of three (3) hours of structured programming daily. The structured programming shall include at a minimum:

a. Structured Activities: Two (2) hours per day of the following are required:

1. Counseling Services (individual or group)

2. Psychoeducation

3. Family Education and Information sessions as clinically indicated.

C.4.3.15.3 Medication Monitoring – 24 hours daily as clinically indicated

C.4.3.16 The Contractor shall provide or arrange for Patient services in the following need/problem areas:

a. Mental health

b. Medical

c. Laboratory and toxicology services, as appropriate to the severity and urgency of the

Patient’s condition

d. Comprehensive needs assessment

e. Treatment planning

f. Individual counseling,

g. Group counseling/education

h. Substance abuse education

i. Discharge/aftercare planning

j. Other essential services as required to stabilize the Patient and to refer them to the next level of recommended care.

C.4.3.17 The Contractor shall hold daily clinical staffings. During these staffings, the Contractor shall review the Patient’s treatment planning progress, skills development, and positive accomplishments; address behavioral/compliance issues; and conduct ongoing individualized discharge planning, as well as other meetings and interventions as deemed necessary by

CSOSA.

C.4.3.18 Personnel. All Contractor personnel who handle Personally Identifiable Information (PII) must adhere to Part 2 HIPPA Privacy Act Rule 45 CFR 164.530 c and CSOSA’s security requirements outlined in Section H.9.

C.4.3.19 The Contractor shall assign a co-facilitator for any group that exceeds eight (8) Patients.

C.4.3.20 Urinalysis/Oral Toxicology. The Contractor shall conduct an initial intake urinalysis or oral toxicology test on all Patients. Random drug screening should be incorporated to address suspicious drug use while in treatment. The Contractor shall observe the following screening levels for all CSOSA Patients:

a. Amphetamines/Methamphetamine 500 ng/ml

b. Cocaine Metabolite 150 ng/ml

c. Marijuana 50 ng/ml

d. Methadone 300 ng/ml

e. Opiates 300 ng/ml

f. Heroin 10 ng/ml

g. PCP 25 ng/ml

h. Alcohol 20 mg/dl

i. Creatinine 20 mg/dl

j. Synthetic Cannabinoids 10 ng/ml

C.4.3.20.1 The Contractor shall comply with the specimen chain of custody protocols of the appropriate state or local regulatory accreditation body.

C.4.3.20.2 Results of all urinalysis/oral toxicology tests shall be maintained in the Patient treatment file.

C.4.3.20.3 The Contractor shall collaborate with the IS or CSO to coordinate a response to any Patient positive test result(s), refusal to provide a sample (behavioral positive), adulterates a sample, or submits a water loaded sample, while in treatment. This information may be transmitted via secured email or facsimile method that protects PII.

The Contractor shall be prohibited from discharging any Patient from treatment without coordinating a case conference with the IS or CSO.

C.4.3.21 Medication Storage and Administration

C.4.3.21.1 The Contractor shall meet all Federal, State, or District of Columbia requirements and develop policies to support compliance for any drugs administered to include methadone schedule and buprenorphine, including regulations established by the Food and Drug Administration, or the U.S. Drug Enforcement Agency.

C.4.3.21.2 The Contractor shall ensure that all medications are administered in accordance with the prescribing physician’s orders. The Contractor shall ensure that “watch-take” procedures are implemented when each Patient takes his/her medications and document any refusal to take their prescribed medication.

C.4.3.21.3 All medication (prescription and non-prescription) must be kept in a locked storage area maintained by the Contractor. Any prescription medication brought into the facility by a Patient shall not be administered or self-administered until the medication can be identified and the attending practitioner’s written order or approval is documented in the Patient record. All medications, both prescription and over the counter, brought into the facility must be packaged and labeled in accordance with state or District of Columbia, and Federal laws and regulations. All medication dispensation must be performed by a duly trained staff member and shall be recorded on a daily log that indicates the name, dosage, date and time of dispensation. Any changes to the medication type, dosage, or administration frequency shall be approved by a licensed Physician or Psychiatrist.

C.4.3.21.4 Medications requiring refrigeration shall be maintained in a separate and secure refrigerator, labeled “For Medication Only” and shall be maintained at a temperature between thirty-six degrees Fahrenheit (36 F) and forty-six degrees Fahrenheit (46 F). All refrigerators shall have thermometers, which are easily readable, in proper working condition, and accurate within a range of plus or minus two (2) degrees Fahrenheit.

C.4.3.21.5 The Contractor shall track and monitor the Patient’s on hand supply of medication(s) to ensure that the Patient secures his/her supply of medication no later than one (1) day prior to the Patient’s planned discharge date. In the event that the medication cannot be obtained before the Patient discharges, the Contractor shall ensure that the Patient has a valid written prescription.

C.4.3.21.6 The Contractor shall ensure that the results for Patients who require monitoring of daily blood sugar levels and high blood pressure levels are documented and stored in the Patient’s treatment file.

C.4.3.22 Medical Insurance. The Contractor shall connect Patients with publicly funded resources for medical care, medication services or use private insurance, as appropriate. To accomplish this goal the Contractor shall ensure that all eligible, uninsured Patients complete the necessary paperwork for enrollment in the District of Columbia’s Health Care System (DC Medicaid Expansion Program or the Affordable Health Care Act) within 24 hours of admission. The Contractor shall track the application status to ensure that the client receives the necessary insurance identification number and card issuance prior to being discharged or provided with the current status of their application.

C.4.4 Task 4 - Discharge Process

C.4.4.1 Discharge Staffing. The Contractor shall coordinate the discharge planning staffing with the CSO (or his/her designee), the IS, and the Patient, upon admission. This discharge staffing must include a review of the Patient’s course of treatment, treatment plan progress, aftercare planning, and recommendations for the next phase of treatment. No later than two (2) calendar days prior to the Patient’s completion of the program, the Contractor shall prepare a written, comprehensive, and individualized aftercare/relapse prevention plan that summarizes the results of the discharge planning staffing and outlines recommendations for further treatment or other needed services. The Contractor shall address substance use and co-occurring disorders in the discharge planning process.

C.4.4.2 Discharge Plan. The Contractor shall begin the discharge process at the time of admission and prepare a written discharge plan no later than one (1) calendar day prior to the Patient’s completion of the program. The discharge plan must contain:

a. The Patient’s name.

b. The admission date.

c. The date of the discharge staffing.

d. The individuals in attendance for the discharge staffing.

e. The discharge date.

f. The length of the Patient’s stay in the program.

g. Any DSM-5 diagnoses.

h. A summary of the overall treatment experience.

i. An aftercare/relapse prevention plan.

j. The discharge prognosis.

K. A list of the specific programs the Patient is required to attend for aftercare services such as community mental health care or community-based support meeting times, to include the locations with verified addresses, and the points of contact.

l. The name and telephone number of an individual who can be contacted should CSOSA require additional information.

m. The signature of the preparer and Clinical Supervisor, or Program Director.

n. Once signed, the Contractor shall email a copy of the completed plan to the CSO and IS within two (2) calendar days of the Patient’s discharge.

o. The Contractor shall file the original signed discharge plan in the Patient’s treatment file.

C.4.4.3 For those Patients who will be entering another treatment modality upon discharge, CSOSA will provide the necessary contact information and forwarding instructions prior to the Patient’s discharge date. The Contractor is required to provide a copy of the Patient treatment file to the subsequent provider at the time of transfer, or within 24 hours of a request from CSOSA.

C.4.4.4 Discharge for Compliance or Behavioral Management Issues. Keeping Patients involved in treatment activities and receiving required services is an expected goal. However, there are three (3) types of discharges or removals from treatment that CSOSA considers to be an intervention of the highest sanction in response to non- compliant behavior(s). They are non-threatening behavior, high-risk or threatening behavior, and abscondences. The intervention results in the termination of a Patient's active involvement with a program for any of the identified discharge types. If any of these occur, it is CSOSA’s expectation that the Patient be returned to community supervision to include a Continuity of Care Plan and required discharge report type.

Clients who exhibit non-compliant behavior/behavioral management issues may be discharged or removed from treatment after an emergency staffing (by telephone or in person) is held.

C.4.4.4.1 In the event the CSO or IS are unable to be reached, the Contractor must notify the Supervisory Community Supervision Officer (SCSO). The notification shall be in writing (by email or fax) and must include:

b. Date and time of the non-compliant behavior.

c. A description of the behavior observed.

d. The name(s) of the CSOSA staff to whom the incident was reported.

e. The action taken by the Contractor in response to the non-compliance.

f. The name and telephone number of the reporting person, or an alternate person, who can be contacted should CSOSA require additional information from the Contractor.

g. The preparer shall sign and date the Non-Compliant Behavior report and the Contractor shall email the completed report to the CSO and IS within 48- hours of the occurrence.

h. The Contractor shall maintain copies of all non-compliance reports in the Patient’s treatment file.

C.4.4.5 Discharge for Non-Threatening Behavior

C.4.4.5.1 The Contractor shall notify the CSO, IS, and OCSIS RET (ocsisrapidengagement@csosa.gov) via telephone or email prior to discharging any Patient for non-threatening behavior. In the event that the CSO is unable to be reached, the Contractor must contact the SCSO.

C.4.4.5.2 Upon receiving CSO, SCSO, or IS concurrence, the Contractor shall discharge the Patient with instructions to report to his or her CSO immediately. The Contractor shall document the type of contact made with CSOSA on the CSOSA Contact Form.

C.4.4.5.3 The Contractor shall prepare and forward a written discharge report to the CSO and IS, not to exceed eight (8) hours of the Patient’s discharge. The discharge report must contain:

a. The Patient’s name.

b. Admission date.

c. Discharge date.

d. Any DSM-5 diagnoses.

e. Length of stay in the program.

f. A clear and detailed description of the circumstances under which the

Patient was discharged, to include a copy of the unusual incident, will at a minimum address the following: report.

g. The name of the CSOSA staff whom the incident was reported.

h. The name and telephone number of the reporting person or an alternate person that can be contacted should CSOSA require additional information from the Contractor.

i. After signing and dating the discharge report, the preparer shall forward it to the Contractor’s Clinical Supervisor or Program Director for review and signature before submitting it to CSOSA. Once signed, the Contractor shall email the completed report to the CSO and IS.

j. The discharge report must be filed in the Patient’s treatment file.

C.4.4.6 Discharge for High Risk or Threatening Behavior. If a Patient engages in aggressive behavior(s) or poses an imminent threat of harm to self, others or the Contractor’s property, the Contractor may discharge the Patient, with instructions to immediately report to their CSO, prior to contacting the CSO. If the behavior constitutes criminal activity, the Contractor must contact the appropriate legal authority (i.e., local police department). If the Patient poses a high risk to self or others (medically or psychiatrically), the Contractor shall develop a Continuity of Care Plan which provides for the referral and appropriate transfer of the Patient along with treatment information, medications, and other relevant information.

C.4.4.6.1 The Contractor shall contact the CSO, IS, and OCSIS RET (ocsisrapidengagement@csosa.gov) via telephone and email within one (1) hour of any discharge under these circumstances. In the event that the CSO is unable to be reached, the Contractor shall contact the SCSO. If such an incident occurs during non-business hours, the Contractor must contact the emergency point of contact identified in the referral package in order to provide notification of the discharge.

C.4.4.6.2 If a Patient demonstrates new substance use, an extensive pattern of relapse or a repeated inability to control his/her impulses to use alcohol or other drugs, or repeated behavioral problems, the Contractor shall immediately contact the CSO and IS for an intervention staffing resulting in a behavior contract. If the Patient fails to comply with the signed behavior contract, the Contractor shall discharge the Patient with instructions to report to his/her CSO immediately.

C.4.4.6.3 The Contractor shall prepare and forward a written discharge report to the CSO and IS, not to exceed eight (8) hours of the Patient’s discharge. The discharge report must contain:

c. Discharge date.

d. Length of stay in the program.

e. Any DSM-5 diagnoses.

f. A clear and detailed description of the circumstances under which the

Patient was discharged, to include a copy of the unusual incident report.

g. The name of the CSOSA staff whom the incident was reported.

h. The name and telephone number of the reporting person or an alternate person that can be contacted should CSOSA require additional information from the Contractor.

i. After signing and dating the discharge report, the preparer shall forward it to the Clinical Supervisor or Program Director for review and signature before submitting it to the Government. Once signed, the Contractor shall email the completed report to the CSO and IS.

j. The discharge report must be filed in the Patient’s treatment file.

C.4.4.7 Abscondences.

C.4.4.7.1. The Contractor shall notify the IS, CSO, OCSIS RET (ocsisrapidengagement@csosa.gov), via email, within one (1) hour for any Patient who absconds from the program. In the event that the CSO is unable to be reached, the Contractor must contact the SCSO.

C.4.4.7.2 A written discharge report must be prepared and forwarded to the CSO, not to exceed eight (8) hours. The discharge report must contain:

c. Discharge date.

d. Length of stay in the program.

e. Any DSM-5 diagnoses.

mailto:ocsisrapidengagement@csosa.gov

f. A clear and detailed description of the circumstances under which the Patient was discharged, to include a copy of the unusual incident report.

g. The name of the CSOSA staff to which the incident was reported.

h. The name and telephone number of the reporting person, or an alternate person, who can be contacted should CSOSA require additional information from the Contractor.

i. After signing and dating the discharge report, the preparer shall forward it to the Clinical Supervisor or Program Director for review and signature before submitting it to the Government. Once signed, the Contractor shall send via secured email the completed report to the SCSO, CSO and IS.

j. The discharge report must be filed in the Patient’s treatment file.

C.4.5 Task 5 – Administration

C.4.5.1 Patient Treatment File Management

C.4.5.1.1 File Entries. The Contractor is required to document all Patient encounters in the Patient’s Treatment file in accordance with the requirements identified in the contract.

File material shall be organized chronologically and should be consistently organized in accordance with standard case management practices. The Contractor shall ensure that Contractor staff maintains complete confidentiality of all Patient treatment files. The Patient treatment file shall, at a minimum, include:

a. Treatment Authorization Package.

b. All referral information provided by CSOSA.

c. CSOSA Consent for the Release of Sensitive Information Form, signed and dated.

d. Assessment Reports, to include, but not be limited to:

1. ASI.

2. Comprehensive Bio-Psychosocial Assessment.

3. Other Government approved assessment tool(s).

e. Treatment Plan signed by the Patient, the CSO, the SCSO, and the Contractor.

f. Daily Progress Notes.

g. Clinical Material (if provided).

h. Termination Report.

i. Chronological Contact Sheet.

C.4.5.1.2 File Storage and Removal. The Contractor shall ensure that all Patient records are stored in a secured manner and location within the Contractor’s facility. To ensure proper tracking of Patient treatment files, the Contractor shall establish a file tracking protocol to ensure that all Patient treatment files are organized in a manner to ensure accountability of the records and proper disposition upon the Patient’s discharge.

C.4.5.1.3 Active Treatment File Transition. CSOSA may direct that a copy of a Patient’s treatment file be securely transported to the physical custody of another CSOSA contractor who will be providing a continuum of care treatment services to the Patient.

C.4.5.1.4 Closed Patient Treatment Files. When a Patient is no longer receiving services from the Contractor, the Patient treatment file is considered closed. The Contractor shall close the Patient’s treatment file and return an electronic version to the Contracting Officer’s Representative (COR) within three (3) business days of the Patient’s completion of, or departure from, the treatment program. In returning closed treatment files to CSOSA, each file shall be clearly marked with the Patient’s last name, first name, PDID# and the date of close-out.

C.4.5.2 Additional Reporting Requirements

C.4.5.2.1 Unusual Incident Report. The Contractor shall report unusual incidents to CSOSA via telephone and email within eight (8) hours, and in writing no later than five (5) calendar days of each occurrence. Incidents involving a particular Patient must be reported to the CSO, IS, and COR. All other incidents must be reported to the COR only.

This information may be transmitted via facsimile or email. An unusual incident is an event that affects staff (CSOSA or Contractor) or Patients, which significantly differs from the regular routine or established procedures. Examples include, but are not limited to:

a. Death, serious illness, injury or incapacitation.

b. Physical, sexual or verbal abuse of a Patient by Contractor staff or other residents.

c. Contractor staff negligence or malpractice.

d. Fire.

e. Theft.

f. Destruction or loss of property, or sudden, serious problems in the facility.

g. Complaints from the Patient or the Patient’s family.

h. Requests for information from the media/press, attorneys, law enforcement, or Government officials outside of CSOSA.

i. Criminal charges, arrest, or incarceration of a Patient.

j. Patient behavior requiring attention of Contractor staff not usually involved in their care, such as hospitalization or emergency room visits etc.

k. Infestations or outbreak of communicable disease.

l. Inappropriate relationships and fraternization between a Patient and one or more members of the Contractor’s staff.

C.4.5.2.2 Monthly Program Activity Report. The Contractor shall furnish a Monthly Program Activity Report (Attachment J-7) via secured email to the COR.

C.4.5.2.2.1 The Monthly Program Activity Report must be submitted to the COR separate from the CSOSA Treatment Monthly Invoice (Attachment J-8) submission. The Monthly Program Activity Report provides a summary of program activity and is designed to inform CSOSA of performance data, significant events, problems, and changes associated with the progress of work.

This report shall include the following:

a. The total number of referrals received.

b. The total number of Patients admitted, total number of successful discharges.

c. The total number of unsuccessful discharges.

d. Reasons for discharge.

e. The number of Patients who remain in the program at the end of the month.

f. Any Unusual Incident Reports generated during the month.

g. A summary of program activity which includes, at a minimum, the following:

1. Program identification information (purchase order name, purchase order number, date of submission, period covered by the report).

2. Performance data.

3. A brief statement of any job injuries or medical emergencies.

4. A brief narrative summarizing any major accomplishments, problems encountered, or future plans.

5. Notification of all staff changes.

6. Significant facility changes.

C.4.5.2.2.2 All of the above-required topics shall be included as separate sections, however, the comment “none” may be noted, as appropriate, for any given section. Failure to submit this information with the invoice will result in invoice rejection.

C.4.5.2.3 CSOSA Contact Form. The Contractor shall document contact with all CSOSA staff or other Government representatives on the CSOSA Contact Form (Attachment J-9). All contact forms shall be maintained in the Client treatment file.

C.4.6 Task 6 – Patient Facility Requirements. The Patient facility shall meet all local, state and federal requirements for zoning, fire prevention, safety, security, and the American with Disabilities Act (ADA). The Contractor shall have on hand at all times current documentation that demonstrates the routine testing of detectors for smoke, fire, and, if applicable, carbon monoxide, and other gases have been undertaken. Fire drills shall be conducted in accordance with the local jurisdiction requirements. The Contractor facility shall be air conditioned appropriate for the season and current outside/inside temperatures. The Contractor must observe all residential space regulations (i.e.

sleeping quarters, restrooms) appropriate for the jurisdiction in which the program operates.

C.4.6.1 Linens, Toiletries, and Laundry Facilities. The Contractor shall provide linens and toiletries (i.e. soap, lotion, deodorant, mouthwash, lotion, etc.) to all Patients upon admission, and as necessary during treatment as appropriate to maintain Patient comfort and hygiene. The Contractor shall provide Patients with access to laundry equipment and detergent, as necessary, at no cost to the Patient.

C.4.6.2 Safety and Security. The Contractor shall be responsible for the overall safety and security of the Patient while at the facility, and the Patients housed therein. The Contractor shall provide sufficient personnel to ensure that the entire facility is Managed and secured 24 hours every day. The Contractor shall properly secure and store any video and other security-related equipment. The Contractor shall have a metal detector or hand wand available for screening Patients entering the Contractor’s facility. The Contractor shall ensure proper monitoring of coed facilities.

C.4.6.2.1 The Contractor shall conduct random room inspections in order to minimize hoarding or eliminate all forms of contraband based on clear posting of facility rules and an identifying list of contraband items.

C.4.6.2.2 The Contractor shall ensure that the Patient, while in the facility, has the appropriate security measures in place to prevent Patients from having access to any parts of the Contractor’s facility that are restricted to Patient access.

C.4.6.2.3 The Contractor shall ensure that vacant rooms are kept in a state of readiness at all times to accept Patients upon referral by CSOSA.

C.4.6.2.4 The Contractor shall conduct a proper search of the personal belongings of Patient’s and their visitors upon entering the facility.

C.4.6.2.5 The Contractor shall maintain security protocols to reduce the introduction of contrabands into the facility (interior and exterior). These may include but are not limited to the following: search of the person /belongings, search, urine drug testing upon return from the outside, room search/inspections, and all other residential area searches.

C.4.6.3 Patient Performance of Daily Living Tasks. The Contractor may require Patients to perform certain daily living task, which shall be posted at all times within the Contractor’s facility.

The Contractor shall provide a listing of the required daily living tasks to CSOSA following award, and any time changes are made to the daily living tasks.

C.4.7 Task 7 – Patient Meals

C.4.7.1 Food and Nutrition Requirement. The Contractor shall prepare three (3) nutritionally balanced meals and one (1) evening snack for each Patient on a daily basis. The meals and evening snacks shall meet the Recommended Daily Allowances (RDA) for all adults. The evening snack shall include a beverage and may consist of, but not be limited to, a meat sandwich (beef, pork, non-pork), a non-meat sandwich, the appropriate condiments (e.g., mayonnaise, mustard, jelly, etc.), and fruit, etc. Whenever pork is offered as part of the evening snack, a non- pork alternative shall also be offered. The evening snacks shall be delivered to the Patient at a time separate from the dinner meal.

C.4.7.2 The Contractor shall post on a weekly basis, a nutritionally balanced menu in a visible location within the meal preparation/kitchen area in each facility where food preparation occurs.

All menu substitutions shall be equivalent in nutritional value and from the same food group of the menu item.

C.4.7.3 Special Diets. Special Diets are regular diets modified to comply with special food preferences due to religious or other practices. This may include vegan, semi-lacto, pepsco, or other varieties of vegetarianism. Special Diets may also include special content requirements or restrictions to address food allergies. These diets do not require a physician’s prescription or order. The Contractor shall ensure that all Special diet meals and types of special diets are nutritionally appropriate and labeled for the appropriate Patient(s).

C.4.7.4 Therapeutic Diets. Therapeutic diets are modifications of the Heart Healthy Regular Diet that are prescribed by a physician, physician’s assistant, or nurse practitioner. Typical therapeutic diet menus may include specific descriptions of liquid, soft, bland, diabetic, reduced fat, reduced cholesterol, reduced sodium, mechanical soft (dental soft), etc. or combinations of these. The Contractor shall ensure that all Therapeutic Diets are nutritionally appropriate and labeled for the appropriate Patient(s) and type of prescribed diet.

C.4.7.5 The Contractor shall provide nutrition services in accordance with Federal, State and local food services and food sanitation regulations and codes.

C.4.7.6 The contractor shall have a minimum of one (1) Certified Food Protection Manager on staff to oversee meal preparation in each facility where food preparation occurs. This certification must be posted in the meal preparation/kitchen area and must be available for review by the Government upon request.

C.4.7.7…