Q_A Step I.docx

Question & Answers

DBHDD-043

New Behavioral Health Hospital at Georgia Regional Hospital – Atlanta Campus Atlanta, Georgia

1. Forensic + Clinical Operations

• Can the Owner provide additional clarity on the intended operational model for the forensic population, including patient classification, security levels, and anticipated length of stay for competency restoration versus NGRI populations?

Response: Patient Classification and Treatment Purpose The forensic population is composed of individuals found Incompetent to Stand Trial (IST), those adjudicated Not Guilty by Reason of Insanity (NGRI), and a subset of individuals under forensic civil commitment. At present, approximately 60% of the population is civilly committed, while the remaining 40% consists of individuals receiving competency restoration services.

The competency restoration cohort (IST) represents the shorter length-of-stay population—typically less than one year—and is centered on psychiatric stabilization combined with structured educational interventions designed to restore trial competency. This group accounts for the majority of admissions and discharges and drives overall patient flow within the system.

The civilly committed population, which constitutes the majority, includes both NGRI individuals and IST patients who are determined to be non-restorable. These individuals generally require longer-term inpatient care, with a treatment model focused on recovery, risk management, behavioral stabilization, and gradual progression toward increased independence or conditional release. Operationally, this group functions as a long-term population within a secure forensic setting, requiring sustained clinical and security resources over extended periods.

Security Levels and Unit Organization - The system operates across multiple levels of security, which should be reflected in the physical organization of the facility.

Most patients are managed within secure, structured inpatient units that allow for active participation in treatment while maintaining appropriate supervision. Within that framework, higher-acuity units are needed for individuals with elevated behavioral risks or who require closer observation. These units typically operate with more restrictive movement and higher staffing intensity.

At the other end of the spectrum, lower-acuity or step-down environments support individuals who are progressing in treatment and preparing for transition. These settings allow for increased independence, greater access to programming, and a more normalized environment while still maintaining necessary security controls.

Length of Stay Considerations - Length of stay varies significantly by population and is heavily influenced by court processes.

For IST patients, inpatient stays are generally shorter and tied to statutory restoration timeframes, often measured in months rather than years. This creates a need for efficient patient flow, with an emphasis on rapid assessment, treatment engagement, and timely discharge back to the court system.

NGRI and other long-term forensic patients typically remain in the hospital for extended periods, often multiple years. Their progression is gradual and based on clinical stability, risk assessment, and court approval. As a result, these units require a more durable, recovery-oriented environment that supports longer-term occupancy.

Operational Flow and System Integration - Admissions are largely driven by court referrals, with placement decisions based on clinical acuity, legal status, and security needs. Once admitted, patients move through a structured treatment process that includes psychiatric care, competency-related services (for IST), and ongoing risk evaluation.

Discharge pathways vary. IST patients are typically returned to the court system upon restoration. Longer-term patients may transition through step-down levels within the hospital or to less restrictive settings as appropriate. Increasingly, the system is working to align hospital capacity with community-based and alternative programs to reduce bottlenecks and improve overall flow.

2. Safety + Behavioral Health Design Standards

• Are there specific operational or safety policies that should inform environmental design decisions, particularly related to observation, patient movement, and staff support spaces? Response: DBHDD Policies are publicly available here DBHDD Policy Stat. They are searchable and can be informative in multiple ways. Germane policies include but are not limited to The STEP System - Forensic STepwise Environmental Progression, 06-103, Safety Plan to Manage Severe, Persistent Aggression to Self or Others, 03-511, Safety Plan to Manage Severe, Persistent Aggression to Self or Others, 03-511, Risk Management, 03-601, Safety Program and Safety Management Plans in DBHDD Hospitals, 03-299, Key Control for Forensic Units at Regional Hospitals, 06-114

3. Campus Integration + Infrastructure

• What level of integration is anticipated between the new facility and existing GRHA campus infrastructure, including central utilities, security systems, and support services? Response: With the exception of security, the “New Hospital” will be substantially independent of the existing campus with the exception of the security infrastructure. Malmanagement of support services will be determined later but operationally, the New Hospital should be essentially “stand-alone”.

• Are there known constraints or expectations related to maintaining ongoing operations on the campus during construction that should inform site planning and phasing strategies? Response: Minimal constraints due to the project being new construction. Consideration of safety while construction crews, equipment and supplies come on to campus headed for the jobsite and safely segregating the job site during construction will be a priority.

4. Regulatory + Licensing Pathway

• Can the Owner clarify the anticipated licensing and regulatory approval process, including coordination with DBHDD, Department of Public Health, CMS, and any other governing agencies? Response: The New Hospital will be folded in under the current licensing arrangements for Georgia Regional Hospital Atlanta. CMS deemed status is maintained by virtue of TJC certification.

5. Delivery + Collaboration

• Can the Owner clarify the anticipated project delivery method and the timing of contractor engagement, including how collaboration between the Design Professional and builder will be structured during early design phases to support cost validation, constructability, and schedule alignment? Response: The project delivery method is construction manager at-risk (CM/GC). The Owner intends to finalize the selection of the CM/GC by the end of May.

• Could you clarify whether the project will be managed directly by the State, or if there are plans to engage a third-party program manager? Response: The project will be managed by the Georgia State Financing and Investment Commission. There are no plans to bring on a third-party program manager at this point however, the state reserves the right to enlist services as appropriate for the project.

6. Contract + Commercial Terms • Could the Owner please provide a draft agreement or standard contract template for review as part of the RFQ process? Response: The RFQ includes a link to the GSFIC standard contract including the (CM/GC DP) GSFIC Design Professional Contract for CM/GC Delivery. This can be found in the General Project Information section of the RFQ under the Contract Information paragraph.

7. Submission Requirements + Format • Could the Owner confirm whether tabs, dividers, and cover sheets are included in the overall page count for the SOQ submission? Response: Yes, everything being submitted should be included in the maximum overall page count.

8. Site + Planning Considerations

• Can you confirm whether any existing buildings on the site are anticipated to remain and, if so, whether they will remain operational during construction? Response: This will remain an active campus during the construction of the new facility. Depending upon the location on the campus, there will likely some number of buildings that will require demolition to create space for the new facility.

• Are there any findings or recommendations from the Livable Centers Initiative (LCI) 2024 that should be considered as part of the project planning and development approach? No

• Can you confirm the anticipated jurisdictional and permitting pathway for the project, including coordination with DeKalb County? Response: Given this is a State project, Dekalb County may be limited to issuing the Land Disturbance Permit (LDP). It is my understanding the County would become involved later in the project if the facility includes a kitchen with grease traps.

9. The RFQ does not specially indicate if the submission is for the architectural team only or consultants as well. Please confirm if the submission should include all consultants. Response: Typically, respondents will list design team members including key project team consultants on the organization chart but will not include the same detailed information being requested for the primary design professional firm responding to the solicitation.

10. Is the predesign study team precluded from submitting for the full design? Response: No, the predesign is not precluded from pursuing the project.

11. Will there be a separate solicitation for commissioning services or should those be submitted now? And should those qualifications be submitted as part of a design team or standalone commissioning submission? Response: The Owner will conduct a separate solicitation for commissioning.

12. In our experience with GSFIC projects, local AHJ is typically not involved. Only the State Fire Marshall provides review. In lieu of Department of Community Health approvals what agency will review? Response: We don’t know, but we don’t think so.

13. Is this project taking place outside the Certificate of Need (CON) requirement for typical hospitals? Yes

14. We understand that the project delivery method will be construction manager at risk (CM/GC); when in the design process is CM/GC participation expected to begin? Response: The Owner intends to finalize the selection of the CM/GC by the end of May and have the CM on board providing preconstruction services for the project no later than July 2026.

15. Are the existing buildings on site expected to remain, and if so, remain active during site construction? Yes and Yes.

16. Does the anticipated construction schedule of 30 months include site prep and demolition? Response: This is still to be determined.

17. Are geotechnical and commissioning services provided by the owner or by the design professional’s team? Response: While the design professional will hold the contract for geotechnical services with a firm pre-qualified to provide services on GSFIC managed projects, GSFIC would pay the invoices directly to the Geotech firm as a pass thru expense. The Owner will contract with an independent third-party commissioning services provider.

18. Can you please clarify if a Georgia Peach certification level has been defined for this project? Response: The level of certification has not been determined at this point. Assume nothing less than the minimum certification.

19. Is the existing program and selected design option of the DBHDD study to be the starting point for continued design development, or is validation and confirmation of the program and design concept required? If validation is required, shall that be included as basic services or as an additional service?

Response: At a minimum, program validation will be part of the design professional’s basic services.

20. Is a functional program included in the study? If not, shall this project include development of a functional program? If yes, shall it be considered a basic service or an additional service? Response: The study does include a preliminary space program summary. However, this was done to assist DBHDD initial project planning and development. While the space program summary included in the study may be valid, the successful firm will likely need to go through a functional programming effort with DBHDD. We will work with the successful firm on the fee structure.

21. Will the hospital be designed in accordance with the 2022 edition of the Facility Guidelines Institute guidelines, or a more current version of the FGI code? Response: Yes, particularly the Behavioral Health / Forensic Design section – use 2022 and incorporate 2026 concepts as appropriate.

22. The RFQ indicates that "the total page count of the submittal must not exceed 50 pages (with licenses and forms excluded)". Can you please confirm/clarify that all content in sections A4–A7 (Insurance documentation, licensure, and Exhibits) will not contribute to page count? Response: See the response to question No. 7 above. Everything being submitted should be included in the 50 page count.

23. Do you want the entire design team in the proposal (MEP, IT, Structural, Site/Civil, Dietary, Landscape, Security)? Response: Yes, typically respondents will reflect design team members including key project team consultants on the organization chart but will not include the same detailed information being requested for the primary design professional firm responding to the solicitation.

24. Is the study team allowed to participate in this selection? Response: Yes.

25. When will the CM at Risk be brought on board? Response: See the response to question#14 above.

26. Will the 2024 study be treated as a fixed basis of design, or is the selected Design Professional expected to validate and potentially modify the program, bed mix, and overall square footage? Response: See the response to question #19 and question #20 above.

27. Will the Design Professional be responsible for programming services, or will the Owner provide a finalized program following selection? Response: See the response to question #19 and question #20 above.

28. Please clarify whether site planning, campus circulation, utilities, and off-site infrastructure are included within the Design Professional’s scope of services. Response: Consistent with answer 3 above, all mentioned physical plant items are within the scope of services to the extent required to assure that where needed existing infrastructure can support the New Hospital or be upgraded if necessary.

29. Is the Design Professional expected to validate the Stated Cost Limitation (SCL) during early design phases and recommend adjustments based on program or market conditions? Response: The GSFIC Design Professional Contract does contemplate the DP shall design this Project such that the CM/GC’s initial Guaranteed Maximum Price will not exceed the GMP Cost Limitation. In order to ensure the design is consistent with the GMP Cost Limitation, the Design Professional shall prepare and submit a Statement of Probable Construction Costs for Schematic Design and Design Development Phases in CSI Format Level 3. For Construction Documents, Statements of Probable Construction Cost shall be at CSI Format Level 3 or greater.

30. Is there a target milestone schedule (SD, DD, CD, permitting) that the Owner expects the Design Professional to follow? Response: While no target milestones have been established, DBHDD is interested in moving the project design along as expeditiously as possible. The design teams should provide a proposed design schedule with milestone for the various design phases.

31. The RFQ references an accelerated design schedule; are there statutory, funding, or operational drivers requiring an accelerated timeline? Response: The reference to an accelerated schedule in deliverable C-2 is language that was mistakenly carried over from previous solicitation. However, DBHDD is interested in advancing the design phase of the project as expeditiously as possible with the design team issuing early component packages allowing site work and other components of construction to begin prior to the completion of the 100% construction documents.

32. Are there any additional studies available for review? Response: None that I am aware of.

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