STATEMENT OF WORK

COMPULSIVE PROBLEM GAMBLING TREATMENT

AND INTERVENTION SERVICES

INVITATION TO QUALIFY (ITQ) CONTRACT

Rev. 5.14.26

OVERVIEW: The purpose of the Compulsive Problem Gambling Treatment and Intervention Services ITQ is to qualify responsible and responsive service providers to provide compulsive problem gambling treatment and intervention services to residents of the Commonwealth of Pennsylvania.

Staff augmentation is not permitted under this contract.

ISSUING OFFICE: The Department of Drug and Alcohol Programs (DDAP) manages and administers this ITQ. All inquiries should be referred to:

Jenny Badman Administrative Officer Department of Drug and Alcohol Programs One Penn Center, 5th Floor 2601 N. 3rd Street Harrisburg, Pennsylvania 17110 Phone: 717-736-7493 jbadman@pa.gov

TERM OF CONTRACT: Any contract issued as a result of this ITQ will commence on the Contract Effective Date and be in effect for five years, with a maximum of one five-year renewal, unless terminated sooner by either party or extended in accordance with the Terms and Conditions.

DEFINITIONS:

1. “Authorized Case Manager” means an individual who meets at least one type of credentials under (a) and the training requirements under (b):

a. Credentials:

i. Holds a master’s degree in psychology, addiction, behavioral services, or similar field and is employed by a Qualified Service Entity and works under the direct guidance and supervision of an individual holding a license to practice in Pennsylvania as a physician, psychologist, social worker, marriage and family therapist, behavior specialist, or professional counselor.

ii. An individual employed by an agency licensed by DHS to provide mental health services and who holds a bachelor's degree that includes or is supplemented by successful completion of 12 college credits in sociology, social welfare, psychology, criminal justice, or other related social sciences.

iii. An individual employed by an agency licensed by DDAP or an SCA and who holds a bachelor's degree that includes or is supplemented by successful completion of 12 college credits in sociology, social welfare, psychology, criminal justice, or other related social sciences.

mailto:jbadman@pa.gov

b. Training Requirements: Satisfies the training requirements under paragraph 4(b) of this

Definitions section.

2. “Authorized Counselor” means an individual who meets at least one type of credentials under (a) and the training requirements under (b):

a. Credentials:

i. Holds a master’s degree in psychology, addiction, behavioral services, or similar field and is employed by a Qualified Service Entity and works under the direct guidance and supervision of an individual holding a license to practice in Pennsylvania as a physician, psychologist, social worker, marriage and family therapist, behavior specialist, or professional counselor.

ii. A mental health treatment counselor, case worker, agency director, supervisor, clinical supervisor, case management trainee, case management specialist, case management supervisor, or case management administrator who is employed and practicing in an agency licensed by DHS to provide mental health.

iii. A drug and alcohol counselor, project director, agency director, clinical supervisor, drug and alcohol case management specialist, drug and alcohol case management specialist trainee, case management supervisor, case management administrator, drug and alcohol treatment specialist, or drug and alcohol treatment specialist trainee who is employed by and practicing in an agency licensed by DDAP or an

SCA.

b. Training Requirements: Satisfies at least one of the training requirements under paragraph 5(b) of this Definitions section.

3. “Qualified Service Entity” means an agency that meets at least one of the following:

a. A facility licensed by the Pennsylvania Department of Human Services (DHS) to provide mental health treatment services.

b. A facility licensed by DDAP to provide substance use disorder treatment services.

c. A Single County Authority (SCA) has entered a grant agreement with DDAP.

d. An agency that provides counseling for compulsive and problem gambling.

4. “Qualified Trained Case Manager” means an individual who meets the credentials under (a) and the training requirements under (b) as well as, for sole practitioners, the additional training requirements under (c):

a. Credentials: Licensure to practice in Pennsylvania as a physician, psychologist, social worker, marriage and family therapist, behavior specialist, or professional counselor.

b. Training Requirements: A minimum of 30 hours of gambling-specific training approved by the International Problem Gambling and Gaming Certification Organization (IPGGC).

c. Additional Training Requirements for Sole Practitioners:

i. Training course in problem gambling motivational interviewing, approved by

DDAP.

ii. Training course in problem gambling and finances, approved by DDAP.

iii. Training course in problem gambling case management, approved by DDAP.

5. “Qualified Trained Counselor” means an individual who meets the credentials under (a) and at least one of the training requirements under (b):

a. Credentials: Licensure to practice in Pennsylvania as a physician, psychologist, social worker, marriage and family therapist, behavior specialist, or professional counselor.

b. Training Requirements:

i. A Certificate of Competency in Problem Gambling from the Pennsylvania Certification Board.

ii. A certificate as an International Certified Gambling Counselor Level I or II from the IPGGC.

iii. Progress toward receiving a certificate as an International Certified Gambling Counselor Level I or II from the IPGGC with at least 30 hours of gambling-specific training approved by the IPGGC.

iv. Certification as an Addiction Specialist with a specialization in Gambling Addiction issued by the American Academy of Health Care Providers in the Addictive Disorders.

QUALIFICATIONS: A person or agency interested in becoming an ITQ Contractor must meet one of the following:

1. Qualified Trained Counselor.

2. Qualified Trained Case Manager.

3. Qualified Service Entity that employs at least one of the following:

a. A Qualified Trained Counselor.

b. A Qualified Trained Case Manager.

c. An Authorized Counselor.

https://ipggc.org/

d. An Authorized Case Manager.

SERVICES: Contractors must choose the appropriate commodity code(s) to qualify for this contract.

Contractors will select the appropriate code(s) under the Business Details section of the qualification process.

1. Delivery of Individualized Services. The Contractor shall provide screening, assessment, planning, and delivery of individualized services to residents of Pennsylvania for the treatment of problem and compulsive gambling and related emotional and behavioral problems through one or more Qualified Trained Counselors, Qualified Trained Case Managers, Authorized Counselors, or Authorized Case Managers.

a. The Contractor shall respond to each client referral within one business day of receiving the referral. If a Contractor is unable to accept new clients, they shall contact DDAP and request to be put on a temporary referral hold until they are available to accept new clients.

b. The Contractor shall deliver outpatient and case management services as separate and distinct services. The Contractor shall not deliver both outpatient and case management services during a treatment session.

2. Policy for Culturally Appropriate Services. The Contractor shall develop and follow a written policy for staff to provide services in a non-discriminatory and culturally sensitive manner designed to meet the unique needs of clients including language; race; nationality; gender identity, expression, and orientation; and age.

3. Facility Location. The Contractor shall maintain an office or facility located in the Commonwealth for providing in-person services.

4. Telehealth. The Contractor may provide telehealth services through media that is capable of two-way video conferencing and encryption, but Contractor will offer all clients the option of receiving in-person services.

a. A Contractor that uses telehealth under this paragraph 4 shall comply with all applicable statutes and regulations.

b. A Contractor that uses telehealth under this paragraph 4 shall execute a business associate agreement with their software provider that complies with the Health Insurance Privacy and Accountability Act Privacy Rule, including 45 CFR Subchapter C, Parts 160-164, and Subchapter D, Parts 170-171. The Contractor shall submit a copy of the business associate agreement to DDAP.

c. A Contractor that uses telehealth under this paragraph 4 shall develop and follow a written policy that includes the process and format to deliver counseling services, the name and a description of the software or system used, privacy and confidentiality, crisis procedures, and the process to obtain documentation and signatures by clients.

5. Behavioral Health Screening. The Contractor shall ensure that a Qualified Trained Counselor, Qualified Trained Case Manager, Authorized Counselor, or Authorized Case Manager completes a screening for all potential clients using a form provided by DDAP to determine whether the client needs other behavioral health treatment services. All clients screened shall be offered a referral to both outpatient treatment services and case management services. The Contractor shall develop and follow a policy to refer clients to treatment providers to meet their behavioral health needs, including crisis services.

6. Client Liability Assessment – Outpatient Treatment Only. The Contractor shall conduct a client liability assessment for all potential outpatient treatment clients using a form provided by DDAP to determine whether the client has access to insurance or other resources to pay for some or all treatment services.

The Contractor shall ensure that the person who conducts the client liability assessment completes a training course provided by DDAP within 90 calendar days of hire.

7. Pennsylvania Residency. The Contractor shall provide services under this ITQ only to residents of

Pennsylvania. The Contractor shall require each client to provide one of the following documents that shows Pennsylvania residency:

a. A current driver’s license or identification card issued by the Pennsylvania Department of Transportation.

b. A current student identification card issued by an educational institution located within the Commonwealth.

c. An income tax return or W-2 form issued within the previous 12 months that shows residence within the Commonwealth.

d. A receipt for a utility bill, vehicle registration, or vehicle insurance with the Commonwealth within the previous six months.

e. A receipt for a mortgage payment or rent payment for a residence within the Commonwealth within the previous six months.

f. A current ACCESS card issued by DHS.

g. A paystub that contains a client’s address within the Commonwealth within the previous six months.

8. Client Admission Form. The Contractor shall ensure that a Qualified Trained Counselor, Qualified Trained Case Manager, Authorized Counselor, or Authorized Case Manager completes a client admission form using a form provided by DDAP at the first client appointment.

9. Gambling Screening – Outpatient Treatment Only. The Contractor shall ensure that a Qualified Trained

Counselor or Authorized Counselor completes a gambling screening at the first client appointment for all outpatient treatment clients.

a. When the client is a compulsive or problem gambler, the Contractor shall use a screening tool provided by DDAP. DDAP may replace, revise, or update the screening tool by giving written notice to the Contractor.

b. When the client is the family member or significant other of a compulsive or problem gambler, the Contractor shall use a screening tool provided by DDAP. DDAP may replace, revise, or update the screening tool by giving written notice to the Contractor.

10. Authorization for Services. The Contractor shall submit the following information without client-identifying information to DDAP for authorization before providing services:

a. A client authorization form provided by DDAP.

b. The client liability assessment form in accordance with paragraph 6

c. A client admission form in accordance with paragraph 8.

11. Client Assessment. The Contractor shall ensure that a Qualified Trained Counselor, Qualified Trained

Case Manager, Authorized Counselor, or Authorized Case Manager performs a client assessment using a form provided by DDAP by the second outpatient treatment or case management service appointment.

12. Individualized Treatment Plan – Outpatient Treatment Only. The Contractor shall ensure that a

Qualified Trained Counselor or Authorized Counselor develops a written individualized treatment plan for all outpatient treatment clients, in collaboration with the client and any involved family members, by the end of the third treatment session that includes:

a. A list of the client’s needs identified in the client assessment performed under paragraph 11.

b. A list of the client’s treatment goals and the targeted completion date for each goal.

c. The dated signatures of the client, the Qualified Trained Counselor or Authorized Counselor, and any supervisor of the Qualified Trained Counselor or Authorized Counselor.

13. Treatment Plan Updates – Outpatient Treatment Only. The Contractor shall ensure that a Qualified Trained Counselor or Authorized Counselor reviews and updates the individualized treatment plan developed under paragraph 12 every 60 calendar days in collaboration with the client and any involved family members. The update must be signed by the Qualified Trained Counselor or Authorized Counselor and by the client.

14. Case Management Service Plan – Case Management Only. The Contractor shall ensure that a Qualified

Trained Case Manager or Authorized Case Manager develops a written case management service plan for all case management clients, in collaboration with the client and any involved family members, by the third case management services appointment that includes:

a. A list of the client’s needs identified in the client assessment performed under paragraph 11.

b. A list of the client’s case management goals and the targeted completion date for each goal.

c. The dated signatures of the client, the Qualified Trained Case Manager or Authorized Case

Manager, and any supervisor of the Qualified Trained Case Manager or Authorized Case Manager.

If the client provides written consent, the Contractor shall provide a copy to the client’s Qualified Trained Counselor or Authorized Counselor.

15. Case Management Service Plan Updates – Case Management Only. The Contractor shall ensure that a

Qualified Trained Case Manager or Authorized Case Manager reviews and updates the case management service plan developed under paragraph 14 every 30 calendar days in collaboration with the client and any involved family members. The update must be signed by the Qualified Trained Case Manager or Authorized Case Manager and by the client.

If the client provides written consent, the Contractor shall provide a copy to the client’s Qualified Trained Counselor or Authorized Counselor.

16. Case Notes. The Contractor shall ensure that a Qualified Trained Counselor, Qualified Case Manager, Authorized Counselor, or Authorized Case Manager creates a case note for each outpatient treatment session or case management session that describes the nature and extent of the session and includes:

a. The dated signature of the Qualified Trained Counselor, Qualified Trained Case Manager, Authorized Counselor, or Authorized Case Manager.

b. The date and exact start and end times of each session.

c. For individual outpatient treatment sessions and case management sessions:

i. Information provided by and about the client.

ii. Analysis of information and statement of the client’s treatment, non-treatment, and case management needs.

iii. Recommended and planned actions to address the client’s needs.

d. For group outpatient treatment sessions:

i. Number of participants.

ii. The overall theme or topic of the session.

iii. The client’s current mental status and risk of deterioration.

iv. A description of the client’s participation in the group session.

v. The next scheduled group session.

17. Discharge Form. The Contractor shall submit a client discharge form, using a form provided by DDAP, within 30 calendar days of the conclusion of treatment for each client who does any of the following:

a. Accomplishes the goals identified in the treatment plan under paragraph 12 or the case management service plan under paragraph 14, as updated in accordance with paragraph 13 or paragraph 15.

b. Has made no contact with the Contractor for 60 calendar days.

c. Refuses further services by the Contractor.

d. Has been referred to other services that cannot be performed in conjunction with services by the Contractor.

e. Is disruptive or fails to comply with their treatment plan or case management service plan.

f. Moves to a residence outside the Commonwealth.

g. Develops health issues that prohibit services by the Contractor.

18. Discharge Plan and Summary. The Contractor shall ensure that a Qualified Trained Counselor, Qualified Trained Case Manager, Authorized Counselor, or Authorized Case Manager completes a discharge plan and summary, using a form provided by DDAP and in collaboration with each client, within 30 calendar days after discharge.

19. Individual Client Record. The Contractor shall maintain separate client records for outpatient treatment services and case management services. An individual record for each client must contain:

a. Verification that the client was given notice of their client rights, grievance procedures, and the Contractor’s rules.

b. Verification that the client was given notice of their HIPAA rights.

c. Any consent forms for services.

d. Verification of any insurance denial of coverage.

e. The behavioral health screening completed under paragraph 5.

f. The client liability assessment form completed under paragraph 6.

g. A copy of the documentation showing Pennsylvania residency under paragraph 7.

h. The client admission form completed under paragraph 8.

i. The client gambling screening completed under paragraph 9.

j. The final Department-approved authorization form under paragraph 10.

k. The client assessment completed under paragraph 11.

l. The treatment plan developed under paragraph 12.

m. All treatment plan updates completed under paragraph 13.

n. The case management service plan developed under paragraph 14.

o. The case management service plan updates completed under paragraph 15.

p. All case notes created under paragraph 16.

q. The discharge form created under paragraph 17.

r. The discharge plan and summary completed under paragraph 18.

20. Confidentiality. The Contractor shall maintain confidentiality of all client records in accordance with applicable statutes and regulations. The Contractor shall develop and follow a written confidentiality policy for all staff that includes:

a. Exchange of client-identifying information.

b. Storage and security of paper and electronic client records.

c. Staff access to records.

d. Discipline for staff violating the policy.

e. Client consent to disclosure of identifying information.

21. Grievance and Appeals. The Contractor shall develop and follow a written policy to address clients’ grievances regarding planning and delivery of services under this agreement that includes:

a. Documentation of the grievance using a form provided by DDAP.

b. A requirement for the Contractor to render a written decision within seven calendar days of the receipt of the grievance.

c. Advising the client that they may appeal the Contractor’s decision to DDAP within 15 calendar days of the Contractor’s decision.

d. The Contractor shall submit all grievances and written decisions to DDAP within one business day to RA-DA_GAMBLING@PA.GOV.

22. Case Management Staff Supervision – Case Management Only. A Contractor who is not a sole practitioner shall develop and follow a written policy for staff supervision of any Qualified Trained Case Managers and Authorized Case Managers under this agreement that includes:

a. Supervision standards for all Qualified Trained Case Managers and Authorized Case Managers.

b. Additional supervision standards for Qualified Trained Case Managers or Authorized Case

Managers who have not yet completed all training requirements, including a combination of job shadowing, direct observation of assessments, and biweekly case consultations.

c. Monthly case consultation meetings with Qualified Trained Case Managers or Authorized Case Managers.

23. Case Management Reporting Requirements – Case Management Only. If providing case management services under this agreement, the Contractor shall report problem gambling case management services information quarterly on a form provided by DDAP.

24. Case Management Trainings – Case Management Only. The Contractor shall require all Qualified

Trained Case Managers and Authorized Case Managers to complete required DDAP-approved training mailto:RA-DA_GAMBLING@PA.GOV courses within 365 calendar days of becoming a Qualified Trained Case Manager or Authorized Case Manager as follows:

a. Training course in problem gambling motivational interviewing, approved by DDAP.

b. Training course in problem gambling and finances, approved by DDAP.

c. Training course in problem gambling case management, approved by DDAP.

25. Monitoring. The Contractor shall:

a. Participate in a monitoring inspection when requested by DDAP.

b. Provide DDAP with access to any requested client records, staff records, and fiscal records.

c. Submit to DDAP a corrective action plan within ten business days after receiving a monitoring summary with areas of non-compliance identified.

The Commonwealth may add additional commodity codes as the need arises. The table below lists the appropriate commodity code and description of each category.

COMMODITY CODE DESCRIPTION OF CATEGORY

85121700-ITQ-569

Gambling Outpatient Treatment

Provision of compulsive problem gambling outpatient treatment services to individuals identified in need across the Commonwealth.

82110000-ITQ-570

Translation Reimbursement

Reimbursement of costs to provide translation services for clients receiving compulsive problem gambling outpatient treatment and intervention services.

85101700-ITQ-571

Certification Reimbursement

Reimbursement of costs for qualified treatment providers and trained counselors to complete and maintain needed gambling treatment certifications

85120000-ITQ-613

Gambling Case Management

Provision of compulsive problem gambling case management services to individuals identified in need across the Commonwealth.

GENERAL INFORMATION/REQUIREMENTS:

A. Type of Contract. Upon determination that the Contractor meets the ITQ requirements, the Commonwealth will issue a contract to the Contractor. Upon receipt of a Purchase Order (PO) issued under this Contract, the Contractor agrees to furnish the requested services to the Commonwealth agency issuing the PO.

B. Service Rates. DDAP shall pay approved expenses at the following rates:

Service Category Unit Rate Individual Outpatient Treatment Session

Per 50+ Minute Session $100

Individual Outpatient Treatment Session- Delivered in-person at a prison or jail

Per 50+ Minute Session $130

Group Outpatient Treatment Session

Per 60 Minute Session $50

Group Outpatient Treatment Session

Per 90 Minute Session $75

Group Outpatient Treatment Session delivered in-person at a prison or jail

Per 60 Minute Session $75

Group Outpatient Treatment Session delivered in-person at a prison or jail

Per 90 Minute Session $100

Case Management Services

Per 15 Minutes not to exceed 120 minutes per day and not to exceed 240 minutes per week

$25

Translation Services Actual Costs Actual Costs Certification Expenses Actual Costs Actual Costs

C. Invoice. The Contractor shall submit invoices using a form provided by DDAP within 30 calendar days of the end of the calendar month when sessions or translation services took place or when certification expenses were incurred, except for a final invoice after this agreement terminates. The Contractor shall submit a final invoice within 45 calendar days after the termination of this agreement. The invoice must not contain client-identifying information. The Contractor shall not invoice for more than one individual outpatient treatment session per calendar day, except that the Contractor may conduct the first and second outpatient treatment sessions consecutively on the same calendar day.

D. Payment. DDAP shall provide payment to the Contractor upon receipt, review, and approval of invoices for eligible costs and services provided to Pennsylvania residents for which DDAP has approved an authorization request. DDAP shall pay the Contractor for:

a. The initial session in which the Contractor completes the client screening and client authorization form.

b. Authorized outpatient treatment services and case management services.

c. Actual costs of translation services.

d. Actual costs for certification as an International Certified Gambling Counselor Level I or II or as a Board Approved Clinical Consultant by the IPGGC, including application fees, examination, and renewal fees.