RFI 2023HCA15 - Q&A Round 1.pdf

Washington State Health Care Authority

Page 1 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral

Health Integrated Referral Systems Amendment 1 – Q&A Round 1

DATE: April 27, 2023

TO: RFI 2023HCA15 Organizations 988 NSPL Crisis Call Center and Behavioral Health Integrated Referral Systems

FROM: Jack Kent, RFI Coordinator HCA Contracts

SUBJECT: HCA Answers to Responder’s Questions – Round 1

HCA amends RFI 2023HCA15 with HCA’s answers to the vendors’ questions. The received questions and HCA’s corresponding answers are included on the pages below. For reference purposes, the “Vendor’s Question” column is organized to provide the related RFI text where applicable prior to listing the actual question received.

Q&A on Following Page

Page 2 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

Integrated Referral Systems Amendment 3 – Q&A Round 1

No. RFI Section Vendor’s Question HCA/DOH Response

1. 1. Introduction

RFI Questions Section:

Background

p. 6-7

RFI Text: In recognition that suicide is a leading cause of death in the United States and that this public health crisis has been exacerbated by the COVID-19 pandemic:

• In July 2020, the Federal Communications

Commission (FCC) designated 988 as the dialing code for individuals in crisis to connect with suicide prevention and mental health services.

• In October 2020, the National Suicide Hotline Designation Act of 2020 was signed into law requiring all telephone service providers to direct all 988 Suicide & Crisis Lifeline calls to the existing National Suicide Prevention Lifelines (NSPLs) crisis centers by July 16, 2022. There are three NSPLs in Washington.

• In 2021, Vibrant Emotional Health, the national administrator for the 988 Lifeline, made grant awards available to states to plan for the implementation of the 988 Lifeline.

• In 2022, SAMHSA awarded $282 million in grants to help states transition the NSPL crisis centers to the 988 Lifeline, support the telephone, call/chat infrastructure, and strengthen crisis center staffing.

• In 2021, Washington passed 2021 E2SHB 1477 which set out expectations to build and implement a complex system that would

The state issued a press release and held a press event when 988 launched in July 2022 and when we launched the Washington-specific Native and Strong Lifeline (988 Dialpad option 4) in November 2022. Additional advertising of 988 has been via social media. We track usage via metrics from the 988 national administrator and from our crisis centers’ EHRs.

The state has statistics on current call volumes, but not call referrals.

Page 3 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health standardize a crisis call and response system and client referral system statewide.

Call centers currently have multiple platforms. This RFI is intended to guide development of a new system that can either replace or integrate with the various platforms currently used.

Vendor Question: How is the State currently advertising 988 and tracking usage?

Does the State have statistics on current volumes of calls and referrals today?

2. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and Response System

p. 7

RFI Text: Once the individual in crisis makes a call, it is routed to an NSPL where information is logged into the crisis contact center system. There, the caller’s needs are triaged, and proper responders will be engaged. If a referral and follow-up is needed for that caller, the future integrated referral system will provide the information to support the individual for longer term and follow-up treatment.

Information into the referral system will be received from a variety of existing and future systems which will use our interoperability platform and applicable standards.

Vendor Question: Does the State already have an interoperability platform? If so, please describe this system, including vendor, name, and specifications.

If not, will this be part of a future 988 procurement?

The state has purchased MuleSoft from Salesforce. It will be used for multiple projects and leveraged for 988. The full interoperability platform would include supporting interoperability and data sharing for providers without API capability.

Page 4 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

3. 2. Project Overview

RFI Questions Section: Figure 1: High Level Process of the complex crisis call center platform and response system in Washington State

p. 8

RFI Text: Figure 1: High Level Process of the complex crisis call center platform and response system in Washington State

Vendor Question: If the respondent can provide the EHRaaS solution, is that something the State is willing to entertain in their future plans?

The state currently has an EHRaaS project. We will be procuring Epic for our EHRaaS solution.

4. 2. Project Overview

RFI Questions Section:

Summary of Technical and Operational Plan

p. 12

RFI Text: The statewide goal is to provide follow-up services to a 988 call as needed for up to 14 days in the near-term and up to 8 weeks in the mid to long-term.

Vendor Question: Would the State be interested in being able to follow up with and help with care coordination to those who have used the 988 system longer than the stated 8-week timeframe?

Care coordination services will be up to the discretion of the provider based on medical necessity and HCA policy. The provision of the care coordination services is not within the scope of this RFI.

5. 2. Project Overview

RFI Questions Section: Figure 1: High Level Process of the complex crisis

RFI Text:

Figure 1: High Level Process of the complex crisis call center platform and response system in Washington State

There are a wide variety of providers that deploy a wide variety of electronic health records (EHRs) including certified electronic health records and non-certified electronic health records across those different organizations.

Page 5 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health call center platform and response system in Washington State

p. 8

Vendor Question: How many organizations and of what different EHRs are deployed by the "Treatment Facilities, ED, Community or social Services"

6. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call Center and Response System

p. 7

RFI Text: The Washington NSPL call centers (that support call, chat, text capabilities) and response systems involve many complex components and actors, each with their own complexities and workflows.

Vendor Question: How many unique residents in the state of Washington leveraged the existing 988 workflow in the last year

Since 988 launched in July 2022, there have been 46,162 calls to 988 in Washington, 7891 texts, and 9171 chats. These numbers likely include repeat callers/texters/chatters.

7. 2. Project

RFI Questions Section:

Summary of Technical and Operational Plan

p. 9

RFI Text:

As depicted in Figure 2, 2021 E2SHB 1477 requires technology systems and tools for the:

1. Call Center: NSPLs managed by DOH (i.e., the Crisis Call Center Platform/Customer Relationship Management (CRM) Tools);

2. BH Integrated Client Referral System: Tools used by crisis service providers (e.g., tools that support the creation, exchange and access to information needed for and by the behavioral health integrated client referral system including bed registry, electronic health records (EHRs); and

There is currently no preference if the functionality meets the needs.

Multiple vendors will be needed, we encourage partnerships between primary vendor and vendor partners (subcontractors).

Page 6 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

3. Interoperability platform: Supports interoperable exchange of information between crisis call centers and crisis providers, and between crisis providers and other providers (i.e., ancillary systems).

Vendor Question: Are you considering three different vendors for the three systems? (Call Center, Interoperability platform, Referral System)

8. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and Response System

p. 7

RFI Text: The Washington NSPL call centers (that support call, chat, text capabilities) and response systems involve many complex components and actors, each with their own complexities and workflows.

Vendor Question: What is the number of 988 call taking positions that will be utilized in each of the three 988 Lifeline-accredited NSPLs in Washington State? How many 988 contacts do you anticipate per year? These would include calls, texts, and chats from individuals in crisis or others calling for individual.

How many users at Other Call Sources? These would include users forwarding calls from 911 Forward WA, Indian Regional, Crisis BH Hub Hubs, and any other RCL sources.

Currently, there are 30-35 staff taking calls at each of our 988 Suicide and Crisis Lifeline Centers.

Historically we have received about 75,000 calls, 15,000 texts, and 20,000 chats annually. We can assume growth for this data (both call center staffing and number of annual contacts) but do not have current projections.

9. 2. Project

RFI Questions Section: High Level Overview of the Crisis Call and

RFI Text: The Washington NSPL call centers (that support call, chat, text capabilities) and response systems involve many complex components and actors, each with their own complexities and workflows.

Vendor Question: How many internal Call Center users? These would include NSPL Crisis Call

There are currently about 100 call center users providing direct service across calls, texts, and chat.

Regional call centers have between 150-200 staff answering calls only.

Page 7 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

Response System

p. 7

Operators and users dispatching crisis responders receiving calls, text, and chats. These users would also have the access to creating safety & crisis plans, documenting notes, creating referrals, and providing follow-up.

10. 2. Project

RFI Questions Section: High Level Overview of the Crisis Call and

p. 7

RFI Text: The Washington NSPL call centers (that support call, chat, text capabilities) and response systems involve many complex components and actors, each with their own complexities and workflows.

Vendor Question: How many internal core users (non-call center)? These would include users creating safety & crisis plans, documenting notes, creating referrals, and providing follow-up. These users would not be receiving calls, texts, or chats.

We don’t have exact counts, or a comprehensive list of roles needed. Non-call center staff would include supervisors, administrative staff, and support staff.

11. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and

RFI Text: The Washington NSPL call centers (that support call, chat, text capabilities) and response systems involve many complex components and actors, each with their own complexities and workflows.

Vendor Question: How many users at external agencies? These would include users at Service Facilities (Treatment facilities, ED, community, or social services) and Referred agencies.

V

The state does not currently have information about other users that might need access to the call center platform. At this time, we cannot provide information about number of users from external agencies.

12. 2. Project Overview

RFI Text: The Washington NSPL call centers (that support call, chat, text capabilities) and response systems involve many complex components and

Functional - DOH

Page 8 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

RFI Questions Section: High Level Overview of the Crisis Call and actors, each with their own complexities and workflows.

Vendor Question: How many knowledge article content writers/creators? These would most likely be a small population of users that are designated to create and maintain the enterprise knowledge base (e.g., FAQ’s).

The current call centers utilize a coordinator position (one user per call center) that maintains documentation for utilizing their 988 system. 211 is a separate knowledge base content repository maintained by another organization, used by the NSPL call centers.

13. 2 - Project Overview

3. Engagement and Methodology - Submit cost information

p. 14

Appendix N of the Technical and Operational Plan (Functional Requirements)

Pg. 42

RFI Text:

• Bed Registry (p.42): Bed Registry: Search, Schedule & Report Bed Availability Bed Metrics/Data Provider Portal Provider Integration Interoperable With Existing Systems

• Cost (p.14): Submit cost information (i.e., licensing fees, implementation, and support including costs to integrate and interoperate, and maintenance costs) for their response and the estimated costs for acquiring, integrating, and interoperating with other vendors for any additional modules needed to support the 2021 E2SHB 1477 requirements. Responders are requested to submit cost information in a format that describes any potential phase-in of functionality and costs.

The state anticipates that a Bed Registry System will be used by a variety of provider types and crisis call centers. A Bed Registry System will require that a myriad of provider types regularly update information regarding availability both through automated means such as APIs when capable and through manual means for those systems not capable.

The state has not yet made the policy and program decisions regarding which provider types and crisis call centers will at least initially use the Bed Registry System.

Vendors are encouraged to offer cost estimates based on assumptions concerning the types and number of users.

Vendors may find the following high level statistics helpful in determining costs associated with your licensing model:

• Facility users – 750-800 licenses, could be more if we want to give EDs access. (Assumes 110 current facilities with about 7 licenses per facility)

• Current MCR staff – 600-700

• Future MCR staff ~ 1200

Current call center staff ~300

Page 9 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

Vendor Question: How many users would need access to the Bed Registry System? Will the State of Washington accept a price range for the total solution? Is a separate cost estimate required for each of the sub systems referred to in "Summary of the Technical and Operational Plan" (Call Center, Interoperability Platform and Crisis Services Providers)

14. 2 - Project Overview

3. Engagement and Methodology - Submit cost information

VIII.18 --

Response Form for Functional Requirements

RFI Text: 7. Tell us anything else that you would like us to know regarding functionality needed for the Call Center Platform.

Vendor Question: What does "needed" refer to in this statement: "Tell us anything else that you would like us to know regarding functionality needed for the Call Center Platform."

Based on the vendors experience, are there any additional areas of functionality the state has not considered as requirements for a Call Center Platform?

15. 2. Project Overview RFI Questions Section: High Level Overview of the Crisis Call and Response System

p. 7 - 9

RFI Text:

2. Project Overview

High Level Overview of the Crisis Call and Response

Vendor Question: What is the State's expected timeline for implementation?

This is currently to be determined.

16. 2. Project

RFI Text: Counselors will be expected to answer 988 calls. In addition, we anticipate crisis call takers to be able to also receive

Page 10 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

Level Overview of the Crisis Call and Response System

p. 7 - 9

2. Project Overview

Vendor Question: Will the counselors who answer 988 calls be exclusively assigned to 988 services or will counselors also handle other types of calls?

“warm” transfer from other crisis lines. A warm transfer is a call transfer where the agent patches the connection onto another agent while keeping the caller on hold. When the call connects to the destination agent, they quickly walk through the call’s context before completing the transfer. The original employee will speak to the caller again to introduce the next person who will handle the call and assist the caller. The warm transfer ensures that the people involved in the conversation feel more informed and better prepared for the exchange they are about to have.

17. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and Response System

p. 7 - 9

RFI Text:

2. Project Overview

Vendor Question: How do you manage counselor schedules and availability and plan staffing to ensure you have enough counselors available to handle call volume?

Call centers use different staffing models based on historical call volume data to staff appropriately. Call centers may utilize “PRN” employees to ensure there are enough counselors available to handle call volume.

18. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and Response System

p. 7 - 9

RFI Text:

2. Project Overview

Vendor Question: Is the HCA looking to replace the current telephony and client management systems of the three 988 Call Centers with this RFI or create

In some cases, yes, however some of these systems are integrated with other operational systems and will not replace but need to work with existing systems.

The state is looking at RFI responses to inform the need to replace or maintain current systems, in addition, the state anticipates the need for all systems to integrate and interoperate.

Page 11 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

API integrations with those existing systems and additional technologies?

19. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and Response System

p. 7 - 9

RFI Text:

Vendor Question: Will the three 988 Call Centers have a roll in selecting the final vendor(s)?

Yes, it is required in recently passed House Bill 1134 (2023- 2024).

20. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and Response System

p. 7 - 9

RFI Text:

2. Project Overview

Vendor Question: How many 988 contacts do you anticipate per year? These would include calls, texts, and chats from individuals in crisis or others calling for the individual.

Since 988 launched in July 2022, there have been 46,162 calls to 988 in Washington, 7891 texts, and 9171 chats. We expect call/text/chat volume to increase as people become more aware of 988 and as we do statewide and national promotion of 988.

21. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and

RFI Text:

2. Project Overview

Vendor Question: Interaction Volumes

988 launched in July of 2022, and therefore we are unable to provide data that predicts busiest months. Most months continue to grow in calls/texts/chats from the previous months.

Our 988 Suicide and Crisis Lifeline call centers are staffed to adequately respond to the calls, texts, and chats, that arrive simultaneously.

Page 12 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

p. 7 - 9

1) What are your busiest months?

2) What hours during the day are your busiest?

3) How many calls, on average, do you get during your busiest hours?

4) How many chats, on average, do you get during your busies hours?

5) How many texts, on average, do you get during your busiest hours?

6) How do you prioritize calls, texts, and chats currently?

7) What is the average wait time (AWT) during normal and busy hours?

8) What is the average call handling time

(AHT)?

The average wait time is between 10-30 seconds.

22. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and Response System

p. 7 - 9

RFI Text:

2. Project Overview

Vendor Question: Languages

1) What Languages does your contact center operate in? (e.g., English, Spanish, Korean, Chinese, Other?)

2) Do you have the percentage of calls, texts and chats received by language?

3) How do you handle a language your staff does not support?

4) Of the languages that you are not supporting today, are there any that you would like to be able to support?

1. 988 Lifeline services are available in English and Spanish and use Language Line Solutions to provide translation services in over 250 additional languages.

Text and chat are currently only available in English.

2. No

3. Crisis center staff use Language Line Solutions when translation services are needed.

4. No. However, video services for callers who are deaf and hard of hearing would be a benefit.

Page 13 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

23. 2. Project

RFI Questions Section: High Level Overview of the Crisis Call and Response System

p. 7 - 9

RFI Text:

2. Project Overview

Vendor Question: Existing IVR

How many calls does the IVR handle per month?

What is the average handling time of an IVR call?

Vibrant Emotional Health, the national 988 administrator, receives 988 calls into its IVR and then, based on the caller’s area code, routes calls to the crisis centers. Washington does not get data on how many calls go to the IVR; just how many calls are routed to Washington.

24. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and Response System

p. 7 - 9

RFI Text:

2. Project Overview

Vendor Question: Agent information

1) Call Center Agents.

a. How many agents do you have in total?

b. How many of them work concurrently?

c. Are any of them part-time employees and if so, how many?

2) Can you provide average wage information for the Agents, Supervisors, etc.?

3) Do your Agents work at a call center, remote or some combination of both?

4) If a combination, what percentage are at the call center, versus working remote?

There are currently about 100 staff providing direct service across calls, chats, and texts in WA State. These staff are a combination of remote and in-person staffing models.

25. 2. Project

RFI Text: No, callers are not identified and authenticated today.

Page 14 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

Level Overview of the Crisis Call and Response System

p. 7 - 9

2. Project Overview

Vendor Question: Authentication requirements

Do you identify and authenticate callers today and if so, how? (e.g. PIN code, two factor authentication, etc.)

26. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and Response System

p. 7 - 9

RFI Text:

2. Project Overview

Vendor Question: Support

1) Is existing call center support onshore or offshore? What’s the onshore/offshore requirement for this RFP?

2) Any on-site support requirement for this

RFP?

1) 1) Per OCIO Securing Information Technology Assets Standards Policy 141.10, it requires data to be onshore. The existing call center support is onshore.

2) 2) There are no on-site support requirements for this

RFI.

27. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and Response System

RFI Text:

2. Project Overview

Vendor Question: Transcription System

Current systems in place today do not offer transcription.

Page 15 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

p. 7 - 9 1) Do you have a transcription system in place today and if so, what is the technology and who is providing it?

2) What languages do you require transcription for, if any? (e.g., English, Spanish, etc.)

How do you wish to store your transcriptions and for how long?

28. 2. Project Overview

RFI Questions Section: High Level Overview of the Crisis Call and Response System

p. 7 - 9

RFI Text:

2. Project Overview

Vendor Question: Knowledgebase (KB) and Frequently asked Questions (FAQ)

1) Do you have a knowledgebase system in place today and if so, what is the technology and who is providing it?

2) If so, approximately how many articles does it contain?

3) Do you have a separate FAQ Database and if so how many articles does it contain?

There is no knowledgebase system currently in place.

29. 3. Engagement and Methodology

RFI Questions Section:

Planning

p. 14

RFI Text:

We request that responders to this RFI:

• Submit a strategy and timeline for implementing the tools/modules described in the vendor’s response (including tools/modules that will be provided with partnering vendors) to meet requirements in 2021 E2SHB 1477; and

• Submit cost information (i.e., licensing fees, implementation, and support including costs to

Vendor is encouraged to suggest needed resources as well as the required cost estimates or if needed other procurements.

Page 16 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health integrate and interoperate, and maintenance costs) for their response and the estimated costs for acquiring, integrating, and interoperating with other vendors for any additional modules needed to support the 2021 E2SHB 1477 requirements. Responders are requested to submit cost information in a format that describes any potential phase-in of functionality and costs.

Vendor Question: What type of resources plan to commit to this engagement?

30. 4. Technology Requirements

RFI Questions Section: III.

Natural System Boundaries

p. 17

RFI Text: Describe how your system meets or exceeds Federal certification and performance standards by meeting the conditions defined in 42 C.F.R. 433.112(b) and those principles established under the Medicaid Information Technology Architecture (MITA) initiative and framework.

Vendor Question: Will the State please confirm in the template document provided, that no checkmarks were proactively filled out, aside from this requirement. Was this intentional and if so, can the State provide details on the customer work they are expecting?

All check boxes should be empty, and not checked intentionally. Please feel free to check/uncheck any check boxes if they apply/don’t apply.

Compliance with Federal and State Laws is required. If your organization does not meet these requirements currently, please indicate you don’t meet them but give us information on the timeline to meet and what you are doing to meet these requirements.

31. 4. Technology Requirements

RFI Questions Section: III.

Natural System Boundaries

RFI Text: Describe how your system(s) supports API or any technology that would allow your system to be interoperable with other systems.

Vendor Question: The state refers to request to support API to be interoperable. Is there any additional detail on the capabilities of the existing

FHIR support will be needed, however there are also other standards (Nena i3, AIRS, etc.). Support for systems that do not support APIs is needed as well.

Page 17 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

p. 17 systems to support healthcare industry standard integration such as FHIR?

32. 4. Technology Requirements

RFI Questions Section: IV [VI].

Data Governance

p. 18

RFI Text: Vendors should address accessibility and ADA compliance in your systems, including OCIO Policy 188 (https://www.ocio.wa.gov/sites/default/files/public/ policies/188_Accessibility_Interim_TSB_Sub_201705 _3.pdf).

Vendor Question: The state refers to ADA requirements as identified by the below link however this link appears to reference responsibilities of the agencies participating and not vendor technologies. Can the state provide more clarity on the requirements of ADA compliance for the technology vendor https://www.ocio.wa.gov/sites/default/files/public/ policies/188_Accessibility_Interim_TSB_Sub_201705 _3.pdf

The vendor system must be ADA compliant. The state must choose technical solutions that meet ADA requirements. As a provider of the technology for the state, the vendor must also comply with those same requirements. Yes OCIO Policy 188 does reference agency responsibility, but any system an agency purchases will also need to comply with these.

33. 4. Technology Requirements

RFI Questions Section: I.

Cloud-based solutions

p. 15

RFI Text: Describe how your system supports needed storage consistent with data retention policies.

Vendor Question: Does this refer to the data retention policies of HCA and if so, are there specific data retention policies HCA must comply with that you can provide to help us answer this question?

The complete records management scheduled is located here:

https://www.sos.wa.gov/archives/recordsmanagement/Man aging-State-Agency-Records.aspx

In addition, there is also a HCA specific schedule:

health-care-authority-records-retention-schedule-v.1.7-(june- 2021).docx (live.com)

34. 4. Technology Requirements

RFI Text: Tell us anything else you would like us to know regarding natural system boundaries.

The natural system boundary is a conceptual line that divides the system components. One of the tests for system boundaries is that if the state wanted to buy one component and not another, are they separated enough that https://www.ocio.wa.gov/sites/default/files/public/policies/188_Accessibility_Interim_TSB_Sub_201705_3.pdf https://www.ocio.wa.gov/sites/default/files/public/policies/188_Accessibility_Interim_TSB_Sub_201705_3.pdf https://www.ocio.wa.gov/sites/default/files/public/policies/188_Accessibility_Interim_TSB_Sub_201705_3.pdf https://www.sos.wa.gov/archives/recordsmanagement/Managing-State-Agency-Records.aspx https://www.sos.wa.gov/archives/recordsmanagement/Managing-State-Agency-Records.aspx https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww2.sos.wa.gov%2F_assets%2Farchives%2Frecordsmanagement%2Fhealth-care-authority-records-retention-schedule-v.1.7-(june-2021).docx&wdOrigin=BROWSELINK https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww2.sos.wa.gov%2F_assets%2Farchives%2Frecordsmanagement%2Fhealth-care-authority-records-retention-schedule-v.1.7-(june-2021).docx&wdOrigin=BROWSELINK

Page 18 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

Section: III.

Natural System Boundaries

p. 17

Vendor Question: Please provide some definition or scope on what you mean by "natural system boundaries."

components could be separated. Is the system designed in a modular way.

MITA Framework: Promote reusable components through modularity.

See: CMS’s Modularity Standard

Which requires the use of a modular, flexible approach to systems development, including the use of open interfaces and exposed application programming interfaces (APIs), the separation of business rules from core programming, and the availability of business rules in both human and machine-readable formats. These features are critical for the Medicaid Enterprise System (MES) in that they allow for modules to be easily updated and for one vendor’s product to be exchanged with a different vendor’s product with minimal effort

35. 4. Technology Requirements

RFI Questions Section: III.

Natural System Boundaries

p. 17

RFI Text: Tell us how you have loose coupling in your system.

Vendor Question: Please define what you would consider loose coupling.

See question 29, if you have loose coupling and natural boundaries it will be easier to change out or change different components of a system.

36. 4. Technology Requirements

RFI Questions Section: V.

Data Security and System Management &

RFI Text: V - All vendor hosted solutions will be required to complete and pass an Office of the Chief Information Officer (OCIO) Office of Cyber Security (OCS) security design review before any production data can be stored, processed, or transmitted in accordance and adherence with the OCIO Policy

141.10. Vendor solutions must also comply with

FedRAMP standards. All systems holding data about callers will need to have required security process, While certification is not required, compliance with FedRamp assists the vendor in compliance with state and federal requirements.

All systems must go through a security design review and must pass the review.

Securing Information Technology Assets | OCIO (wa.gov) https://ocio.wa.gov/policy/securing-information-technology-assets

Page 19 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

VI. Privacy and Protocols

p. 18 procedures, or system controls in place to protect the data and provide high availability services.

VI.a-c: Washington State law (Chapter 9.73 RCW:

PRIVACY, VIOLATING RIGHT OF (wa.gov)): most importantly the Uniform Health Care Information Act (UHCIA Chapter 70.02 RCW), which contains federal privacy and security laws; HIPAA; and 42 CFR Part 2.

Vendor Question: RFI references compliance with data security standards such as FedRamp, Washington State law (Chapter 9.73 RCW: PRIVACY, VIOLATING RIGHT OF (wa.gov)) and 42 CFR Part 2. At this time do you anticipate any eventual vendor of services must achieve FedRamp or state certifications, or is it sufficient to have any potential/eventual vendors comply with the guidelines set forth in these standards without necessarily obtaining certification?

37. 4. Technology Requirements

RFI Questions Section: IV.

Data Governance

p. 17

RFI Text:

Data segregation: Data segregation allows for the creation of separate access rules for sets of data or different groups of users (including Tribal governments, urban Indian health organizations, and tribal organizations), ensuring that only those who are authorized can view, access, remove, or alter the data.

Data and Service Level Agreements: Service Level Agreements (SLAs), Data Sharing Agreements (DSAs), Business Associate Agreements (BAAs), and

There may be various formats used to connect and store the data. Data lake may be one format.

https://app.leg.wa.gov/rcw/default.aspx?cite=9.73 https://app.leg.wa.gov/rcw/default.aspx?cite=9.73 https://app.leg.wa.gov/rcw/default.aspx?cite=70.02

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Non-disclosure Agreements (NDAs) are examples of needed agreements to support appropriate identity and access management to this protected data.

Vendor Question: Will there be a data lake for linked data such as homelessness?

38. 4. Technology Requirements

RFI Questions Section: IV.

Data Governance

p. 17

RFI Text:

Data segregation: Data segregation allows for the creation of separate access rules for sets of data or different groups of users (including Tribal governments, urban Indian health organizations, and tribal organizations), ensuring that only those who are authorized can view, access, remove, or alter the data.

Vendor Question: Sharing of data: will it be possible for other states to have access to trends, etc. to help make better decisions?

Most likely yes, however, this will be aggregated data and not contain confidential, personally identifiable, or protected health information. Also, it will not be available if the sample size is too small to identify people.

39. 4. Technology

RFI Question Section: IX.

Responder Dispatching:

Identify, Dispatch, & Track p.22

RFI Text: Dispatch Coordination: The platform must be able to dispatch MCUs & DCRs, and coordinate with outside agencies (such as Law Enforcement, Ambulance etc.) if needed.

Vendor Question: Information around getting the data? Source of data/existing systems?

We anticipate that the crisis call center platform must support the dispatch of MCUs, DCRs, and coordinate with other agencies.

We look to the vendors’ responses to indicate how technology tools/systems could be used to support identification, dispatching, and tracking of these responders.

40. 4. Functional Requirements

RFI Question Section: XII.

RFI Text: Provider-to-Provider Referrals: The platform must have the ability to:

We anticipate the platform will likely support multiple resource directories that will be used by multiple user types, including crisis call centers, providers, and potentially the public.

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Referrals and Appointments:

Search, Create, Assign, & Track p.24-25

• Search, assign, and track provider-to-provider referrals;

• Search multiple resource directories for appropriate resource(s) (prioritized by the agency); and

• Display available resource(s) from multiple directories.

Vendor Question: Will the providers be on the same platform? Or we are looking for integration between multiple systems?

We look to vendor responses regarding how such tools could be designed to make available content appropriate to the role(s) of users.

41. 5. Functional

RFI Questions Section: VIII.

Call Center Platform:

Create, Assign, & Track (follow-up)

p. 21

RFI Text: Describe the issues associated with sending, receiving, retrieving, and using electronic information from providers and how your system(s) does (or will) address or mitigate these concerns.

Vendor Question: Will the State please confirm that Question VIII.15 and VIII.16 are duplicates?

Yes, Section VIII 15 & 16 are duplicative, please ignore 16.

42. 5. Functional Requirements

RFI Questions Section: X.

Resource Directory:

Access, Use, Query, & Share

RFI Text: Describe how your system supports:

- For providers without integration capabilities, accessing and searching a portal, creating requests via a portal, downloading information from a portal, and managing access and use of the portal.

Vendor Question: Will the State please confirm that Question X1.1 and X1.2 are duplicative?

Question X1.1 & X1.2 are not duplicative. Question X1.1 -addresses providers without integration and Question X1.2 addresses providers with integration capabilities.

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p. 24

43. 5. Functional Requirements

RFI Questions Section: XV.

Bed Registry:

Display, Search, Refer, Update, Collect, Capture, Report

p. 28 - 29

RFI Text:

The system must support the ability to display, search, refer, update, collect, capture, and report bed registry information.

Vendor Question: How many users need access to the Bed Registry System?

Unknown currently.

We anticipate a variety of provider types who will need access to the bed registry system.

44.

5. Functional

RFI Questions Section: XIV.

Electronic Documents:

Create, Display, Modify, & Exchange

p. 27

RFI Text: Describe how your system(s) supports needed functionality for:

a.) LRAs b.) MHADs c.) Crisis plans d.) Assessments, including risk assessments and level of care assessments

e) Safety plans

Vendor Question: Section 5. Functional Requirement (Section XIV. Electronic Documents:

Create, Display, Modify, & Exchange) - Req #XIV.1 - This has multiple definitions - can you please clarify what this means?

Further Vendor Clarification: XIV.1 - "LRAs" has multiple definitions. Please define LRA.

Definition: Least Restrictive Alternatives (LRAs) /Assisted Outpatient Treatment (AOT) court orders/Conditional Release (CR) orders: LRAs/AOTs/CRs are legal documents requiring out-patient services, subject to conditions set by the court, for individuals who otherwise meets criteria for commitment.

Page 23 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

45. 5. Functional

RFI Questions Section: XIV.

Electronic Documents:

Create, Display, Modify, &

p. 27

RFI Text: Describe how your system supports/will support the use of a cloud-based repository to maintain and access documents (as needed).

Vendor Question: Section 5. Functional Requirement (Section XIV. Electronic Documents:

Create, Display, Modify, & Exchange) - Req #XIV.2 - This has multiple definitions - can you please clarify what this means?

Further Vendor Clarification: XIV.2: "MHADs" has multiple definitions. Please define MHADs

Definition: Mental Health Advance Directives (MHAD):

MHADs are a legal tool that allows a person with mental illness or substance use disorder to state their preferences for treatment in advance of a crisis. MHADs may be developed by the individual or by the individual in collaboration with a clinician.

46. 5. Functional

RFI Questions Section: XII.

Referrals and Appointment:

Search, Create, Assign, & Track

1. Describe how your system(s) supports:

a) Next Day Appointments;

b) Closed loop referrals; and

c) Provider to Provider referrals.

2. Name the specific standards that are applicable and used in each of your systems/tools to support the interoperable creation and exchange of next day appointments and referrals (described in Section XII.1.).

3. Describe how your system supports efficient and timely access to needed appointments and referrals from the perspectives of the client, provider, and system.

a. Describe how your system supports referrals and appointments for specific populations including but not limited to those with opioid use disorder or substance use disorder.

The state welcomes vendor’s suggestions and solutions that work in this area. The primary intent is that referrals be closed loop, easy to be done in terms of sending data to the receiving provider, and the receiving provider being able to easily send the results back to the sending provider.

Provider-to-Provider referrals we would like to have it closed loop. Meaning that the sending provider would get a response back that the referral was accepted, and the results of the treatment once treatment has occurred.

For Provider to Individual would primarily be information given, however, if the vendor has ideas on how to make this closed loop, we welcome it.

Page 24 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

b. Describe how your system supports referrals and appointments generated from a diversity of settings (including emergency departments, correctional facilities, clinics, community-based settings) to the appropriate outpatient clinical settings (whether they be behavioral health providers, primary care or other).

4. Describe any issues and challenges associated with your systems/tools in supporting next day appointments, referrals, and closed loop referrals, and how these issues have been/will be resolved.

5. Describe how you engage, support, and manage stakeholder implementation of systems/tools in Section XII.1.

6. Tell us anything else that you would like us to know regarding functionality needed for Referrals and Appointments.

Vendor Question: How do you envision provider-to-provider referrals differing from Provider-to-individual referrals?

Could the State please provide further details about its intent for both?

47. 5. Functional Requirements

RFI Questions Section: XII.

Referrals and Appointment:

RFI Text:

See #12

Vendor Question: How do you envision provider-to-provider referrals differing from Provider-to-

DUPLICATE QUESTION to #12

Page 25 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

Search, Create, individual referrals? Could the State please provide further details about its intent for both?

48. 5. Functional Requirements

RFI Questions Section: XII.

Referrals and Appointments:

Search, Create,

p. 24-25

1. Describe how your system(s) supports:

a) Next Day Appointments;

b) Closed loop referrals; and

c) Provider to Provider referrals.

2. Name the specific standards that are applicable and used in each of your systems/tools to support the interoperable creation and exchange of next day appointments and referrals (described in Section XII.1.).

3. Describe how your system supports efficient and timely access to needed appointments and referrals from the perspectives of the client, provider, and system.

a) Describe how your system supports referrals and appointments for specific populations including but not limited to those with opioid use disorder or substance use disorder.

b) Describe how your system supports referrals and appointments generated from a diversity of settings (including emergency departments, correctional facilities, clinics, community-based settings) to the appropriate outpatient clinical settings (whether they be behavioral health providers, primary care or other).

We appreciate the policy suggestion offered by the vendor.

HCA and DOH will consider the policy and program options that will enable effective implementation of referral tools.

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4. Describe any issues and challenges associated with your systems/tools in supporting next day appointments, referrals, and closed loop referrals, and how these issues have been/will be resolved.

5. Describe how you engage, support, and manage stakeholder implementation of systems/tools in Section XII.1.

6. Tell us anything else that you would like us to know regarding functionality needed for Referrals and Appointments.

Vendor Question: Regarding Provider-to-Provider referrals, this initiative seems like it will only be effective if the state requires providers to use the portal as their sole/primary method of making and receiving referrals. Otherwise, multiple pathways may dilute the intention of a central clearinghouse designed to assess needs and capacity. Is the state willing to enforce this, even with primary care providers?

49. 5. Functional Requirements

RFI Questions Section: XIV.

Electronic Documents:

Create, Display, Modify, &

p. 26

RFI Text: Electronic Documents: The system must support creation, display, exchange, modification, and revocation of interoperable document types including:

• Least Restrictive Alternatives (LRAs) /Assisted

Outpatient Treatment (AOT) court orders/Conditional Release (CR) orders:

LRAs/AOTs/CRs are legal documents authorizing out-patient services, subject to conditions set by the court, for individuals who otherwise meets criteria for commitment.

The RFI identifies several different document types for which the system must support the creation, display, exchange, modification, and revocation.

The system must support role-based access for different entities to create, modify, and/or revoke various document types.

In addition, the system must support displaying and exchanging various document types based on role-based permissions.

The system may leverage the ECM solution being implemented by the state as appropriate.

Page 27 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

• Mental Health Advance Directives (MHAD):

MHADs are a legal tool that allows a person with mental illness or substance use disorder to state their preferences for treatment in advance of a crisis. MHADs may be developed by the individual or by the individual in collaboration with a clinician.

• Conditional Release (CR) orders: are court orders that authorize a person who was committed to a state hospital or long-term hospitalization for a long-term civil commitment or Not Guilty by Reason of Insanity (NGRI) to live in the community while following certain requirements in the legal order.

• Crisis Plan: A crisis plan is a plan developed by an individual or by the individual in collaboration with their treating provider that documents how to assist the individual during a time when additional support or action is needed.

• Crisis Assessment: Crisis Assessments include suicide assessments (e.g., Columbia Suicide Risk Assessment) completed by a clinician.

• Level of Care Assessments: A Level of Care (LOC) Assessment is used to assess the individual’s physical, emotional, behavioral, and cognitive health to identify the most appropriate level of care based on the individual’s condition. For SUD related care, level of care is determined

There are multiple roles that will need to be identified and supported across the crisis call and response systems. Crisis counselors (call takers) are one role that the crisis call system and tools will need to support.

Crisis counselors (call takers) are anticipated to have the authority to create documents (e.g., crisis assessments, safety plans).

In other instances, crisis counselors (call takers) and others in the crisis response system are anticipated to have the authority to view certain documents (e.g., LRAs, AOT orders, CR orders).

If signatures are needed the vendor technology should suggest technology compatible with their systems

Page 28 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health using ASAM criteria. LOC assessments are completed by clinicians.

• Safety Plan: A safety plan is a brief intervention to help those experiencing self-harm and suicidal thoughts with a concrete way to mitigate risk and increase safety. Safety plans may be developed by the individual or the individual in collaboration with a clinician.

Vendor Question: The State refers to documents needing to be created or modifiable. Is the desire to provide crisis counselors with the ability to create/modify existing documents, as listed in the RFI? If so, how does the State anticipate handling documents which require signatures from the caller or from others. For instance, do the legal documents referenced come with, or require signatures? If so, exactly what elements would the system allow to be modified after they are uploaded?

50. 5. Functional Requirements

RFI Questions Section: XV.

Bed Registry:

Display, Search, Refer, Update, Collect, Capture, Report

p. 28

RFI Text: DOH and HCA would prefer bed registries be available on a public facing website to encourage accessibility. Describe how your solution(s) may support this.

Vendor Question: DOH and HCA prefer the bed registry to be on a public facing website. Is there an expectation or desire that log-in credentials would be required to gain access for viewing or interacting with this site?

As indicated in the Technical & Operational Plan, the state anticipates that there may be Public Facing Website, i.e., for

(i) provider resource directory, (ii) social service resource directory, and (iii) bed registry. Access to the public facing website is expected to be made available to entities with appropriate credentials. In addition, there may be components of the website that will be available to the public.

Page 29 of 44 RFP 2023HCA15 988 NSPL Crisis Call Center and Behavioral Health

51. 5. Functional

RFI Questions Section: XVI.

Reporting:

Create, Customize, & Share

p. 29

RFI Text: Name the specific standards that are applicable and used in each of your systems/tools to support interoperable creation, display, and exchange (send and received) of standard and custom reports (as summarized in Section XVI and the functions described in Section XVI.1.).

Vendor Question: Does data collection and reporting need to comply with NSPL guidelines and requirements?

At a minimum, the data collection and reporting should comply with existing NSPL guidelines and requirements but not all data collection and reporting must adhere to this.

52. 5. Functional Requirements

RF…